Search

Persons living in long-term care facilities (LTCFs) have experienced disproportionate illnesses and deaths from the COVID-19 pandemic. By June 2020, >50,000 COVID-19 deaths had occurred in LTCF residents in the [...]

BackgroundThe cumulative socioeconomic status (SES) model posits that childhood and adult experiences accumulate to influence disease risk. While individual SES indicators such as education and income are independently associated with incident type 2 diabetes (T2D), the association of cumulative SES and incident T2D is unclear, especially in African American adults.MethodsWe utilized cohort data of African American participants (n = 3681, mean age 52.6 years) enrolled in the Jackson Heart Study from 2000 to 2013 free of T2D or cardiovascular disease at baseline (2000-2004). Cumulative SES scores at baseline were derived using six SES indicators (education, wealth, income, occupation, employment status, and mother's education) categorized as low, middle, and high. Incident T2D was defined at exam 2 (2005-2008) or exam 3 (2009-2013) based on fasting glucose ≥126 mg/dL, HbA1c ≥ 6.5, reported diabetic medication use, or self-reported physician diagnosis. Proportional hazards regression, allowing for interval censoring, was used to estimate the association between cumulative SES and incident T2D (hazard ratio(HR), 95% confidence interval (CI)) after adjustment for covariates. Sex and age differences were tested using interaction terms.ResultsThere were 544 incident T2D cases. The association between low (versus high) cumulative SES and incident T2D was not significant (HR 1.04 [95% CI 0.85, 1.28]) and did not differ by sex (p value for interaction>0.05). However, there were differences by (age p value for interaction = 0.0052 for middle-aged adults and 0.0186 for older adults). Low (versus high) cumulative SES was associated a greater hazard of incident T2D among those 20-46 years (HR 1.12 [95% CI 1.03, 1.21]), 47-59 years (HR 1.25 [95% CI 1.06, 1.47]) and those 60-93 years (HR 1.39 [95% CI 1.09, 1.78]) after adjustment for sex and family history of diabetes. Associations attenuated after adding behavioral and lifestyle risk factors.ConclusionThe association of low cumulative SES and incident T2D differed by age, which may suggest interventionist should consider impacts of SES on T2D by age.

Purpose: This study determined the time course of the emergence of prevocalic stop consonants in young children with cleft palate following surgical repair. Method: A total of 120 children in four cohorts from three institutions were followed from 12 to 24 months of age: (a) 24 with repaired cleft lip and palate (CLP), (b) 36 with repaired cleft palate only (CP), (c) 33 without clefts but with histories of frequent otitis media and ventilation tubes (OM), and (d) 27 typically developing (TD) children without clefts or OM. Emergence of prevocalic stops and symbolic language skills were determined during administration of the Communication and Symbolic Behavioral Scales Developmental Profile. Parametric survival models were fitted with and without covariates--recruitment site, gender, maternal education level, middle ear status, language ability, and age at surgery for children with clefts--to describe the time course of the emergence of prevocalic stops. Results: The estimated age at which 80% of children demonstrated prevocalic stop emergence was 15.0, 15.3, 18.9, and 21.8 months for TD, OM, CP, and CLP groups, respectively (p < 0.001, unadjusted model). Both CP and CLP cohorts had a significantly longer time to stop emergence than either the TD or OM cohorts, even after adjusting for covariates. Abnormal middle ear status, lower symbolic language ability, and older age at palatal surgery were significantly associated with delayed stop emergence. Conclusions: Survival model estimates show that four out of five children with repaired cleft palate will achieve emergence of prevocalic stop consonants by 19-22 months of age, corresponding to 9-12 months following palate repair. Clinical implications are discussed.

Purpose: This study investigated vocabulary growth from 18 to 24 months of age in young children with repaired cleft palate (CP), children with otitis media, and typically developing (TD) children. In addition, the contributions of factors such as hearing level, middle ear status, size of consonant inventory, maternal education level, and gender to the development of expressive vocabulary were explored. Method: Vocabulary size of 40 children with repaired CP, 29 children with otitis media, and 25 TD children was measured using the parent report on MacArthur-Bates Communicative Development Inventories: Words and Sentences (Fenson et al., 2007) at 18 and 24 months of age. All participants underwent sound field audiometry at 12 months of age and tympanometry at 18 months of age. A multiple linear regression with and without covariates was used to model vocabulary growth from 18 to 24 months of age across the 3 groups. Results: Children with CP produced a significantly smaller number of words at 24 months of age and showed significantly slower rate of vocabulary growth from 18 to 24 months of age when compared to TD children (p < 0.05). Although middle ear status was found to predict vocabulary growth from 18 to 24 months of age across the 3 groups (p < 0.05), the confidence interval was large, suggesting the effect should be interpreted with caution. Conclusions: Children with CP showed slower expressive vocabulary growth relative to their age-matched TD peers. Middle ear status may be associated with development of vocabulary skills for some children.

Aim: This study aimed to compare microbial and inflammatory profiles in periodontally/systemically healthy African American (AA) and Caucasian (C) individuals. Materials and Methods: Thirty‐seven C and 46 AA aged from 5 to 25 years were evaluated regarding periodontal disease, caries, microbial subgingival profile via 16‐s sequencing, as well as salivary and gingival crevicular fluid (GCF) inflammatory profile via multiplex assay. Results: Greater probing depth percentage was detected in AA (p =.0075), while a higher percentage of caries index (p =.0069) and decayed, missing, filled teeth (DMFT) index (p =.0089) was observed in C, after adjusting for number of teeth, sex and age. Salivary levels of IL‐6, IL‐8 and TNFα were higher for C, whereas GCF levels of eotaxin, IL‐12p40, IL‐12p70, IL‐2 and MIP‐1α were higher in AA (p <.05). Different microbial profiles were observed between the races (p =.02). AA presented higher abundance of periodontopathogens (such as Tanerella forsythia, Treponema denticola, Filifactor alocis, among others), and C presented more caries‐associated bacteria (such as Streptococcus mutans and Prevotella species). Bacillaceae and Lactobacillus species were associated with higher DMFT index, whereas Fusobacterium and Tanerella species with periodontal disease parameters. Conclusions: A different inflammatory and bacterial profile was observed between healthy AA and C, which may predispose these races to higher susceptibility to specific oral diseases. [ABSTRACT FROM AUTHOR]

Purpose: For the same reasons that rural telehealth has shown promise for enhancing the provision of care in underserved environments, social media recruitment may facilitate more inclusive research engagement in rural areas. However, little research has examined social media recruitment in the rural context, and few studies have evaluated the feasibility of using a free social media page to build a network of rural community members who may be interested in a research study. Here, we describe the rationale, process, and protocols of developing and implementing a social media approach to recruit rural residents to participate in an mHealth intervention. Methods: Informed by extensive formative research, we created a study Facebook page emphasizing community engagement in an mHealth behavioral intervention. We distributed the page to local networks and regularly posted recruitment and community messages. We collected data on the reach of the Facebook page, interaction with our messages, and initiations of our study intake survey. Findings: Over 21 weeks, our Facebook page gained 429 followers, and Facebook users interacted with our social media messages 3,080 times. Compared to messages that described desirable study features, messages that described community involvement resulted in higher levels of online interaction. Social media and other recruitment approaches resulted in 225 people initiating our in‐take survey, 9 enrolling in our pilot study, and 26 placing their names on a waiting list. Conclusions: A standalone social media page highlighting community involvement shows promise for recruiting in rural areas. [ABSTRACT FROM AUTHOR]

Purpose: This study determined the time course of the emergence of prevocalic stop consonants in young children with cleft palate following surgical repair. Method: A total of 120 children in four cohorts from three institutions were followed from 12 to 24 months of age: (a) 24 with repaired cleft lip and palate (CLP), (b) 36 with repaired cleft palate only (CP), (c) 33 without clefts but with histories of frequent otitis media and ventilation tubes (OM), and (d) 27 typically developing (TD) children without clefts or OM. Emergence of prevocalic stops and symbolic language skills were determined during administration of the Communication and Symbolic Behavioral Scales Developmental Profile. Parametric survival models were fitted with and without covariates--recruitment site, gender, maternal education level, middle ear status, language ability, and age at surgery for children with clefts--to describe the time course of the emergence of prevocalic stops. Results: The estimated age at which 80% of children demonstrated prevocalic stop emergence was 15.0, 15.3, 18.9, and 21.8 months for tD, OM, CP, and CLP groups, respectively (p < .001, unadjusted model). Both CP and CLP cohorts had a significantly longer time to stop emergence than either the TD or OM cohorts, even after adjusting for covariates. Abnormal middle ear status, lower symbolic language ability, and older age at palatal surgery were significantly associated with delayed stop emergence. Conclusions: Survival model estimates show that four out of five children with repaired cleft palate will achieve emergence of prevocalic stop consonants by 19-22 months of age, corresponding to 9-12 months following palate repair. Clinical implications are discussed., Children born with cleft palate are at a significant risk for delays in development of early speech sounds, especially stop consonants. Prior to repair of palatal clefts, infants typically show [...]

Purpose: This study investigated vocabulary growth from 18 to 24 months of age in young children with repaired cleft palate (CP), children with otitis media, and typically developing (TD) children. In addition, the contributions of factors such as hearing level, middle ear status, size of consonant inventory, maternal education level, and gender to the development of expressive vocabulary were explored. Method: Vocabulary size of 40 children with repaired CP, 29 children with otitis media, and 25 TD children was measured using the parent report on MacArthur-Bates Communicative Development Inventories: Words and Sentences (Fenson et al., 2007) at 18 and 24 months of age. All participants underwent sound field audiometry at 12 months of age and tympanometry at 18 months of age. A multiple linear regression with and without covariates was used to model vocabulary growth from 18 to 24 months of age across the 3 groups. Results: Children with CP produced a significantly smaller number of words at 24 months of age and showed significantly slower rate of vocabulary growth from 18 to 24 months of age when compared to TD children (p < .05). Although middle ear status was found to predict vocabulary growth from 18 to 24 months of age across the 3 groups (p < .05), the confidence interval was large, suggesting the effect should be interpreted with caution. Conclusions: Children with CP showed slower expressive vocabulary growth relative to their age-matched TD peers. Middle ear status may be associated with development of vocabulary skills for some children., Early expressive vocabulary development has been characterized by two idiosyncratic features. First, there is high individual variability in the onset, size, and rate of vocabulary development (Bates, Bretherton, & Snyder, [...]

Simple Summary: The bodily response to cancer treatment is difficult to track in real time. This study aimed to demonstrate the possible application of magnetic resonance imaging (MRI) as a non-invasive and non-radiative modality to evaluate cancer response to therapy. We injected a fluorinated contrast agent in mouse models of breast and colon cancer to tag and track macrophages in real time. Longitudinal tracking of macrophages in tumors following radiation therapy via MRI provided a means of analyzing the tumor microenvironment without the need for a biopsy. It was shown that tumor-associated macrophage recruitment can be quantified through magnetic resonance imaging. Moreover, the findings suggest that macrophage response to radiation therapy is dependent on several factors including tumor origin. Since tumor recurrence following therapy is a major barrier following treatment, this imaging technique will be extremely beneficial in the future analysis of inflammation's role in that process. Background: Magnetic resonance imaging (MRI) is a non-invasive imaging modality which, in conjunction with biopsies, provide a qualitative assessment of tumor response to treatment. Intravenous injection of contrast agents such as fluorine (19F) nanoemulsions labels systemic macrophages, which can, then, be tracked in real time with MRI. This method can provide quantifiable insights into the behavior of tumor-associated macrophages (TAMs) in the tumor microenvironment and macrophage recruitment during therapy. Methods: Female mice received mammary fat pad injections of murine breast or colon cancer cell lines. The mice then received an intravenous 19F nanoemulsion injection, followed by a baseline 19F MRI. For each cancer model, half of the mice then received 8 Gy of localized radiation therapy (RT), while others remained untreated. The mice were monitored for two weeks for tumor growth and 9F signal using MRI. Results: Across both cohorts, the RT-treated groups presented significant tumor growth reduction or arrest, contrary to the untreated groups. Similarly, the fluorine signal in treated groups increased significantly as early as four days post therapy. The fluorine signal change correlated to tumor volumes irrespective of time. Conclusion: These results demonstrate the potential of 19F MRI to non-invasively track macrophages during radiation therapy and its prognostic value with regard to tumor growth. [ABSTRACT FROM AUTHOR]

The purpose of the current research was to compare the lexical–grammatical skills of two-year-old children with and without repaired cleft palate (CP), accounting for the effect of variables such as vocabulary size at 18 months of age, maternal education level, and gender. Participants included 52 children with CP and 25 typically developing (TD) children. The CDI-WS was employed to measure vocabulary and grammatical skills. Significant differences were observed between the CP and TD groups with respect to the number of words, word forms (irregular nouns and verbs), word endings (overuse of plural (-s) and past tense (-ed) markers), the mean number of morphemes in their three longest utterances (M3L), and sentence complexity. In addition, compared to TD children, significantly smaller proportions of children with CP were observed to use words to talk about past and future events or use words to talk about an absent object. The difference between the CP and TD groups in terms of the size of vocabulary at 24 months of age remained statistically significant in the multivariable model. Among all predictors, the size of vocabulary at 18 months of age was identified as the most robust precursor of lexical and grammatical skills at 24 months of age. Gender was identified as a predictor of the M3L measure as an index for syntactic ability. [ABSTRACT FROM AUTHOR]

Context COVID-19 may cause respiratory distress syndrome and death. Treatment of COVID-19 to prevent complications remains a priority. Objective Our investigation sought to determine whether combination of spironolactone and sitagliptin could reduce mortality for inpatients with SARS-CoV-2 infection. Methods This single-blind, 4-arm, prospective randomized clinical trial was conducted at Shiraz and Bushehr University of Medical Sciences hospitals between December 2020 and April 2021. We randomized hospitalized adult patients with COVID-19 pneumonia into 4 groups: control, combination therapy, sitagliptin add-on, or spironolactone add-on. The primary outcome was the clinical improvement of the patients in the hospital as measured on an 8-point numerical scale. The secondary outcomes included intubation, ICU admission, end organ damages, CT findings, and paraclinical information. Results A total of 263 admitted patients were randomly assigned to control group (87 patients), combination group (60 patients), sitagliptin group (66 patients), and spironolactone group (50 patients). There were no significant differences in baseline characteristics, except for higher age in control group. The intervention groups, especially combination therapy, had better clinical outcomes (clinical score on fifth day of admission: 3.11 ± 2.45 for controls, 1.33 ± 0.50 for combination, 1.68 ± 1.02 for sitagliptin, and 1.64 ± 0.81 for spironolactone; P = 0.004). However, the mortality rate was lower in patients who received spironolactone (21.84% control, 13.33% combination, 13.64% sitagliptin, 10.00% spironolactone; P = 0.275). Our intervention reduced lung infiltration but not the area of involvement in lungs. Conclusion Sitagliptin and spironolactone can potentially improve clinical outcomes of hospitalized COVID-19 patients. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) is a chronic illness that is comprised of two major disorders: Crohn's disease and ulcerative colitis. Adults with IBD have adopted telehealth and mobile health (mHealth) interventions to improve their self‐management skills and symptom‐monitoring. This systematic review aimed to evaluate the efficacy of telehealth and mHealth interventions and explore the benefits and challenges of these interventions in patients with IBD. This review used a convergent segregated approach to synthesize and integrate research findings, a methodology recommended by the Joanna Briggs Institute for mixed‐methods systematic reviews. Databases searched included PubMed, CINAHL, Embase, Cochrane Controlled Trials Registry, and ClinicalTrials.gov. The search followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses, which yielded sixteen quantitative and two qualitative articles. A narrative synthesis was performed to present the findings of quantitative and qualitative studies. Evidence from quantitative and qualitative studies was then integrated for a combined presentation. The results of quantitative analysis supported the efficacy of telehealth and mHealth interventions to improve patients' quality of life, medication adherence, disease activity, medication monitoring, disease‐related knowledge and cost savings. While some participants in qualitative studies reported certain challenges of telehealth and mHealth interventions, most of the participants conferred the benefits of the interventions, including improved disease‐related knowledge, communication between patients and providers, sense of reassurance, and appointment options. The evidence from quantitative and qualitative synthesis partially supported each other. [ABSTRACT FROM AUTHOR]