Related Outcomes Research Articles

Early Parent-Child Relationship in the Shadow of War-Related Trauma: A Systematic Review.

War-related trauma has detrimental effects on millions of individuals worldwide, including infants, toddlers, and their parents. Among various adverse outcomes, this trauma may significantly disrupt the essential sense of security crucial for fostering a healthy early parent-child relationship. Yet, research on the effects of war-related trauma on parent-child relationships remains limited. This study aimed to bridge this gap by synthesizing evidence from empirical studies focused on war-related trauma and early parent-child relationship outcomes from 0 to 3 years. Studies were identified by searching across multiple databases. The inclusion criteria encompassed studies examining the effects of exposure to war, armed conflict, or terrorism, focusing on the parent-young child relationship, published in English, peer-reviewed, and accessible. Eleven studies, published in 23 articles, met these criteria. The research findings revealed various impacts on the parent-child relationship due to exposure to war-related trauma. Notably, parents' emotional distress and post-traumatic stress disorder, rather than their direct trauma exposure, were associated with adverse parent-child relational outcomes within the parent-child relationship, such as parents' insensitive, inconsistent, hostile, and anxious behaviors toward their children, as well as children's vigilance and unresponsive behaviors toward their parents. This research indicates various ways that war-related trauma may impact early parent-child relationships, highlighting directions for future research and offering insights that could assist in developing trauma-informed interventions focused on parent-child dyads experiencing war-related adversity.

Validating the predicted impact of HPV vaccination on HPV prevalence, cervical lesions, and cervical cancer: A systematic review of population level data and modelling studies.

We compared model predictions with independently published primary data from population-based studies on the impact of HPV vaccination on HPV prevalence, cervical cancer and its precursors. We searched Cochrane Library, EMBASE, MEDLINE, Web of Science for studies concerning high-income countries published between 2005 to June 2, 2023. Relative risk (RR) for HPV-related outcomes comparing the pre-vaccination and post-vaccination periods were collected from observational and modelling studies. The relationship between vaccination coverage and observed relative reductions was determined using meta-regressions, and we compared model prediction to observations. We identified a total of 5649 potential articles, of which one systematic review, 14 observational studies and 32 modelling studies met our inclusion criteria. A clear relation was found between the RR of HPV diseases related outcomes in the pre- versus post-vaccination era and the vaccination coverage, with 23 out of 28 data points and 19 out of 20 data points showing significant reductions in HPV prevalence and CIN2+ prevalence respectively. Around 67% (n/N=12/18) of model predictions were more optimistic on HPV prevalence reductions compared to the 95% CI of the meta-regression derived from observational studies. For CIN2+ lesions, 48% (n/N=31/64) of model predictions for CIN2+ outcomes fell within the 95% CI. Model predictions and observational data agree that HPV vaccination can have a substantial impact on HPV related outcomes on a population level. Despite large heterogeneity in observational data and modelling studies, it is particularly encouraging that model predictions on the impact of HPV vaccination on CIN2+ model lesions align with observational studies. Ontario Health (formerly known as Cancer Care Ontario).

Perceived Usefulness of Sex and Relationship Education and Sexual Minority Men’s Relationship Outcomes

Perceived Usefulness of Sex and Relationship Education and Sexual Minority Men’s Relationship Outcomes

Gonadotropin Therapy for Mini-Puberty Induction in Male Infants With Hypogonadotropic Hypogonadism.

Congenital hypogonadotropic hypogonadism (CHH) is defined as an isolated deficiency of gonadotropin hormones. Mini-puberty, a transient postnatal activation of the hypothalamic-pituitary-gonadal axis in healthy infants, provides a window of opportunity to diagnose and treat CHH. Currently, in male infants with CHH, testosterone is used to increase phallus size. However, gonadotropin replacement could additionally promote testicular descent and development, particularly relating to Sertoli cells. We conducted a systematic review of the effectiveness of gonadotropin therapy in stimulating mini-puberty related outcomes in male infants with CHH. In line with PRISMA guidelines, a systematic review of 11 databases was carried out (August 2023). Evidence quality was assessed using the Cochrane Risk of Bias for Non-Randomised Studies of Interventions tool. Protocol registered on PROSPERO (CRD42023453080). After a double-consensus screen of 767 abstracts and 66 full texts, 11 studies were included from 7 countries. A total of 71 male infants were enrolled, 12 with Kallmann syndrome. Median age at treatment initiation was 4.2 months (range, 0.25-57 months) and follow-up ranged from 3 to 10 years. Gonadotropin therapy was administered using continuous subcutaneous infusion (n = 35) or subcutaneous injection (n = 36). Due to treatment variability, modalities were combined for data synthesis. Gonadotropins induced a statistically significant increase in penile length and inhibin B concentration (P = .0007) and led to partial or full testicular descent in 73% (n = 62) of patients. This systematic review provides unique evidence supporting the efficacy of gonadotropins for induction of mini-puberty. However, the reliability and generalizability are limited due to disparate data and treatment modality variation.

College Students’ Lived Experiences of Healthy Romantic Relationships and Violence Prevention Program

ABSTRACT The study investigated college students’ experiences of attending a healthy romantic relationship prevention program in Türkiye. Semi-structured interviews were conducted with 12 students who successfully completed the Healthy Romantic Relationships and Violence Prevention Program. Three major themes emerged from the interpretative phenomenological analysis: (a) acknowledging power dynamics; (b) challenging entrenched beliefs and behaviors; and (c) facilitating enduring behavioral transformations. The findings underscore the efficacy of psychoeducational group in fostering positive outcomes in romantic relationships. The success of psychoeducational group is attributed to factors such as students’ motivations, the mixed-gender composition of the groups, and the interactive nature of the group.

Pin-site related outcomes after temporary staging external fixator pin placement using the self-drilling pin insertion technique.

To report on pin-related complications in patients who underwent temporary staging external fixation using a self-drilling pin insertion technique. Retrospective cohort study. Single tertiary referral level one trauma center. Adult patients were included who underwent temporary spanning external fixation of the lower extremity (AO/OTA 32, 33, 41, 42, 43, 44, 81, 82, 83, 84, and 85 fractures) using self-drilling and self-tapping pins placed using the self-drilling technique (Stryker Hoffman External Fixation System, Kalamazoo, MI, USA) between August 1st, 2015, and December 31st, 2022, with minimum follow up of 90 days. The self-drilling technique included use of a soft tissue sleeve for pin protection in the femur and tibia, release of the tourniquet if inflated, and full speed insertion with the final turns completed by hand. Irrigation of the pin-bone interface was not typically used. Outcome measures included pin-site infection, pin loosening, loss of reduction in external fixator, and deep infection of the primary surgical site. 265 patients were included with a mean follow-up of 556 days. Mean age was 50 years (range 18-86 years). 155 patients (59%) were male. 1154 total pins were placed: 289 (25%) in the femur (one metaphyseal), 527 (46%) in the tibia (12 metaphyseal), 161 (14%) transfixion pins in the calcaneus, and 171 (15%) in the midfoot/forefoot. 7 patients (2.6%) developed a pin site infection. The infection rate for the total number of pins placed was 7/1154 (0.6%). 1 patient sustained a loss of reduction in the external fixator and 3 pins were noted to be loose at the time of definitive fixation (two in the tibial diaphysis and one in the 1st metatarsal shaft). 35/265 (13.2%) patients developed deep fracture related infection or septic nonunion in the post-operative period, none of which were associated with prior pin site infection. The self-drilling technique for temporary external fixator pin insertion in the present study demonstrated low rates of pin site infection, pin loosening, and loss of reduction. Level III Therapeutic Study.

Prognostic value of the Hospital Frailty Risk Score (HFRS) and outcomes in peripheral artery disease and end-stage kidney disease.

Peripheral artery disease (PAD) and end-stage kidney disease (ESKD) are independent risk factors affecting outcomes like in-hospital mortality. The role of a frailty index in prognosticating outcomes in patients with ESKD and PAD is unknown. We aim to assess the prognostic value of the Hospital Frailty Risk Score (HFRS) and its association with outcomes in these patients. We identified patients with PAD using data from the United States Renal Data System (USRDS) for the years 2015-2018. These patients were stratified into three categories of frailty risk based on their HFRS, a validated frailty assessment tool using ICD-10 codes: low (< 5), intermediate (5-10), and high risk (> 10) and based on revascularization or not. Primary outcomes included in-hospital mortality and composite of mortality or major amputation. Secondary outcomes encompassed postdischarge mortality and composite of mortality or major amputation at 1 year. Out of 122,649 patients with PAD and ESKD, 4118 underwent revascularization and 118,531 did not. In-hospital outcomes demonstrated a nonlinear relationship and postdischarge outcomes displayed a nearly linear relationship with HFRS, regardless of revascularization status. In both cohorts, the high-risk group was associated with a significantly higher risk of in-hospital mortality/amputation (revascularization: odds ratio [OR] 4.6, 95% CI 3.3-6.2, p < 0.001; no revascularization: OR 3.1, 95% CI 2.8-3.3, p < 0.001) and mortality (revascularization: OR 5.5, 95% CI 3.4-8.7, p < 0.001; no revascularization: OR 5.1, 95% CI 4.6-5.6, p < 0.001) compared with the low-risk group. In patients with ESKD and PAD, the HFRS serves as a valuable predictor of mortality and amputation irrespective of revascularization. This information can support informed decision-making.

Shorting of existing conditioning regimen for relapsed/refractory gastric diffuse large B-cell lymphoma transplant and studying its related outcomes: A first of its kind case report

Shorting of existing conditioning regimen for relapsed/refractory gastric diffuse large B-cell lymphoma transplant and studying its related outcomes: A first of its kind case report

Role of circulating tumor DNA in early-stage triple-negative breast cancer: a systematic review and meta-analysis

BackgroundTriple-negative breast cancer (TNBC) accounts for 15% of all breast cancers and carries a worse prognosis relative to other breast cancer subtypes. This systematic review and meta-analysis evaluated the prognostic value of circulating tumor DNA (ctDNA) in early-stage TNBC.MethodsA literature search was conducted using Ovid Medline, Elsevier EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science Databases for publications up to 11/16/2023. Results were uploaded to Covidence and assessed by two independent reviewers. Studies assessing the use of ctDNA to predict recurrence free survival and related outcomes as well as overall survival were included. All recurrence outcomes were combined during analysis. Statistical analysis was performed using Revman Web. Log-hazard ratios (HR) were pooled for studies reporting recurrence and death as a time-to-event outcomes. Odds ratios (OR) were calculated and pooled for studies reporting patient-level data on recurrence, death, and pathological complete response (pCR). Prospero ID: CRD42023492529.ResultsA total of 3,526 publications were identified through our literature search, and 20 publications (n = 1202 patients) were included in the meta-analysis. In studies that reported recurrence as a time-to-event outcome, post-neoadjuvant (before or after surgery) ctDNA + status was associated with a higher likelihood of disease recurrence (HR 4.12, 95% confidence interval [CI] 2.81–6.04). For studies that reported patient-level data, post-neoadjuvant ctDNA + status was associated with higher odds of disease recurrence (OR 6.72, 95% CI 3.61–12.54). Pooled log-HR also revealed that ctDNA + status in the post-neoadjuvant setting (before or after surgery) was associated with worse overall survival (HR 3.26, 95% CI 1.88–5.63).ConclusionsOur findings suggest that ctDNA could be used as a prognostic biomarker to anticipate the risk of relapse. However, it remains unclear if therapeutic intervention for patients who are ctDNA + can improve outcomes. While more studies are needed before incorporating ctDNA into clinical practice, the findings of this meta-analysis are reassuring and show the promise of ctDNA as a biomarker.

Preventing Falls in Older Adults with Educational Interventions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This systematic review and meta-analysis evaluates the effectiveness of educational interventions in preventing falls and related outcomes in older adults. A systematic review with meta-analysis, including the CINAHL, PubMed, Scopus, Web of Science, Cochrane, and PEDro databases was conducted. Randomized controlled clinical trials that presented interventions and educational strategies for preventing and reducing falls were included. The risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. Of the 3,066 identified articles, 17 were included. There was great heterogeneity among the educational strategies used, settings, sample sizes, follow-up, and quality of the studies. The meta-analyses revealed no significant differences between the control and intervention groups for total fallers (RR=1.08 [0.99-1.18]), falls with hospitalization (RR=1.05 [0.59-1.87]), falls with fractures (RR=0.64 [0.37-1.11]), falls with injuries (RR=1.13 [0.98-1.30]), number of falls (SMD = 0.07 [-0.06 to 0.20]), and fear of falling ((Self-Efficacy Scale) SMD=0.05 [-0.24 to 0.34]). Findings indicate educational interventions alone may not significantly reduce falls among older adults, emphasizing the need for integrated, multi-component strategies. Nevertheless, the heterogeneity of randomized controlled trials may have impacted the results obtained. CRD42023458558.

Impact of Condoliase on Health-Related Quality of Life in Participants with Radicular Leg Pain Associated with Lumbar Disc Herniation: Results From a United States Phase 3 Clinical Trial.

An exploratory analysis of a randomized, double-blind, sham-controlled, phase 3 study. To evaluate the impact of SI-6603 (condoliase) on health-related quality of life (HRQoL)-related outcomes in patients with lumbar disc herniation (LDH)-associated radicular leg pain from the Discovery 6603 study (NCT03607838). Condoliase is a novel chemonucleolytic agent that selectively degrades chondroitin sulfate in the nucleus pulposus. Condoliase is approved in Japan for the treatment of radicular leg pain associated with LDH. Recently, the Discovery 6603 study demonstrated the efficacy and tolerability of condoliase in the United States (US). Adults with LDH and unilateral radicular leg pain were randomized to receive a single intradiscal injection of condoliase (1.25 units) or sham followed by 52 weeks of observation. Exploratory HRQoL-related outcomes included change from baseline (CFB) in EuroQol Group 5-Dimension Quality of Life instrument, 5-Level version (EQ-5D-5L) and visual analogue scale (EQ-VAS), CFB in the 36-item Short Form Health Survey (SF-36), Patient Global Impression of Change (PGIC), Clinical Global Impression of Change (CGIC), and CFB in Work Productivity and Activity Impairment (WPAI) scores. EQ-5D-5L and SF-36 measures were assessed using a longitudinal analysis model. Of 352 randomized participants, 341 constituted the modified intention-to-treat population (condoliase: 169; sham: 172). Condoliase showed numerically greater improvements in EQ-5D-5L self-care and pain/discomfort dimensions at Week 13 and Week 52 compared with sham (P<0.05). The SF-36 physical component and WPAI scores numerically favored condoliase compared with sham. Patients and clinicians more frequently reported "very much improved" in overall status following condoliase treatment vs sham. Previous findings confirmed the efficacy and tolerability of condoliase for LDH management. Condoliase showed notable improvements in exploratory HRQoL-related outcomes, which were consistent across multiple patient-reported measures. Condoliase has the potential to enhance QoL and work productivity in individuals with LDH.

'Coping cat' - A CBT modality for Indian children with high anxiety.

AimThis study aimed to examine the efficacy of the Coping Cat program, a CBT intervention, for Indian children (11-13 years) with high anxiety.MethodologyA total of 240 children were screened, and 120 children with high anxiety were randomly assigned to either a treatment group (n = 60) or a control group (n = 60). The Spence Children's Anxiety Scale (SCAS), Strength and Difficulties Questionnaire (SDQ), and Child Anxiety Impact Scale (CAIS) were used to assess anxiety symptoms and related outcomes. Systematic random sampling was employed to select participants.InterventionThe therapeutic process consisted of a modified CBT protocol, comprising 16 sessions of 40-45 minutes each. The Coping Cat program was specifically designed to address anxiety symptoms in children.Data AnalysisA linear mixed-effects model was used to analyze the data, accounting for both fixed effects (e.g., time and intervention) and random effects (e.g., individual differences). This approach was particularly suited for the repeated-measures design. A follow-up study was conducted one year after the intervention to assess its long-term effects.ResultsSignificant differences were observed between the treatment and control groups, indicating the efficacy of the Coping Cat program in reducing anxiety symptoms. Notably, treatment gains were maintained at the one-year follow-up. Conclusion: The findings suggest that the Coping Cat program is an effective CBT-based intervention for reducing anxiety symptoms in highly anxious children.ConclusionThe results indicated the efficacy of Coping Cat CBT in highly anxious young children.

Sputum microbiology data and related clinical outcomes among adult Aboriginal Australians with bronchiectasis.

Sputum microbiology is an integral aspect of managing patients with bronchiectasis. Adult Aboriginal Australians have a high bronchiectasis disease burden; however, as yetthere is sparce literature detailing the sputum microbiology profile in this population. To assess the sputum microbiology profile among Aboriginal patients aged ≥18 years with chest computed tomography-confirmed bronchiectasis in the Top End Northern Territory of Australia. All available sputum samples processed in a single laboratory service with established protocols for examining and reporting sputum microbiology results between 2011 through 2020 were assessed in relation to demographics, lung function parameters, chest radiology, inhaled pharmacotherapy, hospital admissions restricted to respiratory conditions and all-cause mortality. Four hundred twenty-eight patients (median age 47 years, 56% female) had sputum cultures available to assess. Haemophilus spp. was the most common (64%), followed by yeast/Candida spp. (53%) and Pseudomonas spp. (36%). Polymicrobial cultures were noted in 92% of patients. There were significant geographic differences on a region-wise and community-wise basis. Patients with yeast/Candida spp. and Pseudomonas spp. recorded more hospitalisations (median 7 (interquartile range (IQR) 3-14) and 8 (IQR 4-16)). In multivariate models, both yeast/Candida spp. (odds ratio (OR) 2.63 (95% confidence interval (CI) 1.68-4.14)) and Pseudomonas spp. (OR 1.95 (95% CI 1.25-3.04)) were associated with increased odds for mortality. Other than higher Pseudomonas spp. isolated with the use of inhaled corticosteroids, no significant association was observed either with lung function or chest radiology. Adult Aboriginal Australians with bronchiectasis harbour a significant microorganism load that may play a role in overall morbidity and mortality.

Efficacy of Structured Exercise Protocol on Patient-Related Outcome Measures, Blood Pressure, And Waist-Hip Ratio in Post Myocardial Infarction Subjects with Hypertension

Hypertension, commonly known as high blood pressure, is a chronic condition where the force of blood against artery walls remains consistently high. Hypertension is a widespread global health concern, affecting over 1.2 billion people worldwide. Its prevalence is increasing due to factors like aging populations, unhealthy lifestyles, and rising obesity rates. It is a major risk factor for heart disease, stroke, and other serious health complications. The study was conducted to find the efficacy of structured exercise protocol training in post-angioplasty subjects with hypertension. A total of 168 subjects were selected, met the inclusion and exclusion criteria, and were randomly divided into two groups. Group A (n= 84) received conventional physiotherapy with lifestyle modifications and Group B (n= 84) received structured exercise training for 6 months. Subjects were evaluated based on pre and post assessment by patient related outcome measures, blood pressure and waist hip ratio. Both the groups showed significant improvement but Group B showed much substantial improvement as compared to Group A. Group B ( anxiety p &lt; 0.000, depression p &lt; 0.000, sleep disturbance p &lt; 0.000, QOL - physical functioning p &lt; 0.000, emotional p &lt; 0.001, social p &lt; 0.029and social function p &lt; 0.389 ), blood pressure - systolic p &lt; 0.000, diastolic p &lt; 0.485 and waist-hip ratio p &lt; 0.70, indicating the rejection of null hypothesis and acceptance of structured exercise protocol. Given the robust evidence supporting the benefits of cardiac rehabilitation, it should be incorporated into standard post-MI care protocols to improve long-term cardiovascular outcomes.

Examining the Association Between Engagement in Shared Relationship Activities, Couple Quality, and Negative Interactions

This study examined the association between shared relationship activity, couple quality, and negative interaction among 499 couples in the southeastern region of the United States. Using regression and the Actor-Partner Interdependence Model (APIM) analyses, findings revealed that increased engagement in conjoint activities was significantly associated with increased couple quality and decreased negative interaction. Engagement in shared relationship activities was also significantly linked with the perception of couple quality for both partners individually and as a couple. These results underscore the importance of shared engagement for relationship outcomes, with implications for relationship educators, researchers, and practitioners.

Rise in alcohol‐linked hepatitis has more adverse impact on women

A cohort study from Canada has found that although the overall prevalence of alcohol‐associated hepatitis is greater among young males than young females, women experience a considerably higher risk of related adverse outcomes. This includes a 47% higher risk of cirrhosis in young women.

Impact of resection margin width on local recurrence following breast-conserving surgery and whole breast radiotherapy for pure ductal carcinoma in situ: a systematic review and meta-analysis

ObjectiveThe aim of this study was to determine the impact of margin width and boost radiotherapy on the local recurrence risk of pure ductal carcinoma in situ (DCIS).Methods and analysisThis...

What are the symptom trajectories of self-regulatory fatigue among family caregivers of stroke survivors? A protocol of mixed-methods study in Chinese rehabilitation settings

IntroductionStroke presents a considerable burden not only to patients but also to their families and society at large. In many instances, stroke patients opt for home rehabilitation, relying on family...

Changes in pain and related health outcomes after cognitive processing therapy in an active duty military sample.

This study explored the association between changes in pain and related health outcomes and posttraumatic stress disorder (PTSD) symptoms following cognitive processing therapy (CPT) in an active duty military sample. Based on the mutual maintenance model, we hypothesized that PTSD symptom reductions would be associated with improvements in pain and health symptoms following CPT. This secondary, intent-to-treat analysis included data from a parent trial of 127 active duty U.S. Army soldiers diagnosed with PTSD who were receiving variable-length CPT. We used mixed-effect regression models with repeated measures to examine whether treatment responders (i.e., individuals with a reduction of 11 points or more on the PCL-5) demonstrated improvements in pain and health outcomes posttreatment. Models included fixed effects of visit (baseline and 1-month follow-up), clinically significant PTSD improvement classification (present or absent), and the respective interaction. There were significant interactions on pain interference, F(1, 75.92)=6.32, p =.014; perceived life control, F(1, 95.59)=5.17, p=.025; affective distress, F(1, 83.15)=9.77 p=.002; mental health, F(1, 96.27)=20.75, p<.001; physical health, F(1, 84.97)=3.98, p=.049; and somatic symptoms, F(1, 80.64)=6.08, p=.016. These interactions revealed that participants with clinically significant PTSD improvement following CPT also demonstrated certain better pain and health outcomes compared to nonresponders. Service members with pain and health issues in addition to PTSD who respond to CPT may also report improvements in these issues posttreatment, increasing the value of connecting them to treatment.

Does robotic assisted surgery mitigate obesity related systemic inflammatory response and clinical outcomes in left sided colorectal cancer resections?

Obesity (BMI > 30 kg/m2) is rapidly increasing worldwide with 26% of the UK population being obese and 38% being overweight. Obesity is intimately related to several life-limiting conditions including colorectal cancer (CRC). Obese patients have a higher degree of perioperative systemic inflammatory response (SIR) and an increased risk of perioperative complications. The aim of this current study was to investigate whether robotic-assisted surgery mitigates the effects of obesity in left sided CRC resections on the SIR and clinical outcomes. All patients undergoing left-sided colorectal cancer resections from May 2021 to May 2023 were, prospectively, entered into a database with patient characteristics and perioperative short-term outcomes recorded. CRP was considered a surrogate for SIR. The relationship between obesity and complications were examined using Chi Square for linear association, Kruskal–Wallis for continuous data and multivariate binary logistic regression model. 221 patients who underwent RAS for left-sided CRC were analysed. Obesity was associated with more comorbidity (ASA, p < 0.01) and SSI (p < 0.05) but not with age, sex, procedure or pathology. POD3 CRP < 150 mg/l was also associated with obesity (p < 0.01). In turn, greater comorbidity was associated with age (p < 0.001), site of resection (p < 0.05), SSI (p < 0.05), postoperative blood transfusion (p < 0.01) and LOS (p < 0.001). On multivariate analysis, only greater ASA (p < 0.05) and surgical procedure (p < 0.01) were associated with the development of an SSI independently. Greater comorbidity but not obesity was independently associated with postoperative SIR and clinical outcomes in patients undergoing RAS. These results support the use of RAS for left sided CRC resections, particularly in the obese.