SAGE Open Medicine最新文献

Objective: The present study aims to determine the causal association between sodium-glucose cotransporter inhibitors and depression, as previous observational studies have concluded a potential link between sodium-glucose cotransporter 1/2 inhibition and depression.

Methods: A total of 16 instrumental variables mimicking sodium-glucose cotransporter-1 inhibition and 6 instrumental variables mimicking sodium-glucose cotransporter-2 inhibition were selected for the study. Depression data from the Psychiatric Genomics Consortium and the UK Biobank (n = 500,199) was used as the primary outcome. We employed the random inverse variance weighted method as the primary Mendelian randomization analysis. Supplemental analyses were also conducted to ensure the robustness of the evidence.

Results: Our results indicated that genetically predicted sodium-glucose cotransporter-1 inhibition was negatively related with depression risk (OR_IVW = 0.78; 95% CI: 0.67-0.91, p = 0.002) in the European population. However, we did not find a causal association between sodium-glucose cotransporter-2 inhibition and depression (OR_IVW = 0.98; 95% CI: 0.71-1.36, p = 0.919).

Conclusions: The findings of this Mendelian randomization study indicate that sodium-glucose cotransporter-1 inhibition may decrease the risk of depression in the European population. Future studies must be done to clarify the mechanisms that underlie the causal relationship. Our study provides clear evidence of the potential benefits of sodium-glucose cotransporter-1 inhibition in depression.

Objective: This study aimed to investigate the causal relationship between varicose veins and hydroceles.

Methods: Genetic data for varicose veins and hydroceles were extracted from a Genome-Wide Association Study (GWAS). A total of 22,037 cases of varicose veins and 2634 cases of hydroceles were included for Mendelian randomization analysis. Inverse variance-weighted (IVW) analysis was employed as the primary method, with weighted median and MR-Egger analyses were used for supplementary validation. Several sensitivity analyses were performed to further assess the results.

Results: The IVW analysis of varicose veins on hydroceles revealed an odds ratio (OR) of 1.117 (95% confidence interval (CI), 1.009-1.236; P = 0.014). Conversely, the IVW analysis of hydroceles on varicose veins showed an OR of 0.983 (95% CI, 0.944-1.025; P = 0.330). Heterogeneity and pleiotropy were negative in the bidirectional analysis.

Conclusions: This study suggests that varicose veins may be a risk factor for hydroceles. However, there is no evidence to support hydroceles as a causal risk factor for varicose veins. Our findings provide genetic evidence for the potential role of varicose veins as a risk factor for hydroceles, offering new insights for clinical practice. By establishing the causal relationship, high-risk patients can be identified, allowing for early surveillance of hydrocele presence to facilitate timely intervention and optimized treatment strategies. A statistically significant causal relationship between varicose veins and hydroceles was found, whereas hydroceles did not exert a causal impact on varicose veins.

Objectives: Ruxolitinib is used to treat myelofibrosis, polycythemia vera, and steroid-refractory graft-versus-host disease following allogeneic stem cell transplantation. This study aimed to determine the association between ruxolitinib and adverse events by evaluating case reports published between January 2014 and March 2024 in the Japanese Adverse Drug Event Report database.

Methods: The signals for the ruxolitinib-adverse event association were identified using propensity score-adjusted reporting odds ratio analysis. Data obtained from the drug-gene interaction, drug signature, search tool for chemical interactions, and interaction reference index databases were used to construct a drug-gene interaction network. Functional and pathway enrichment analyses were performed using the Disease Ontology Semantic and Enrichment and ReactomePA R packages.

Results: The propensity score-adjusted reporting odds ratio for ruxolitinib-associated adverse events was as follows: anemia, 18.49 (95% confidence interval (CI): 16.15-21.16); myelosuppression, 4.70 (95% CI: 3.54-6.24); pancytopenia, 1.97 (95% CI: 1.23-3.16); cardiac failure, 2.29 (95% CI: 1.60-3.28); hepatic function abnormal, 1.60 (95% CI: 1.15-2.23); herpes zoster, 6.40 (95% CI: 4.35-9.41); pneumonia, 2.96 (95% CI: 2.35-3.73); renal impairment, 1.34 (95% CI: 0.94-1.90); sepsis, 5.14 (95% CI: 3.75-7.05); interstitial lung disease, 0.33 (95% CI: 0.21-0.52); deep vein thrombosis, 0.32 (95% CI: 0.07-1.44); hemorrhage, 1.99 (95% CI: 1.05-3.75). We also assessed 3015 human genes that directly or indirectly interact with ruxolitinib. The molecular complex detection plug-in of Cytoscape was used to detect 24 clusters. Several genes were enriched in the biological processes of "anemia" and "bacterial infections," identified as significant ruxolitinib-related disease terms.

Conclusions: This retrospective analysis using the Japanese Adverse Drug Event Report database indicated potential associations between ruxolitinib and adverse events, including anemia and bacterial infections. Future research should explore the underlying pharmacological mechanisms using functional enrichment analysis of ruxolitinib-associated genes related to blood toxicity and bacterial infections.

Introduction: Recommender systems are technology-based systems that generate recommendations or guide users to relevant information. This study is a scoping review aiming to describe what is known about the recommender systems for obesity prevention according to systematic reviews on this topic.

Methods: This scoping review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) guideline. Out of 148 records labeled as reviews in the database and online searches until October 2023, 10 reviews fulfilled the inclusion criteria according to the Population, Concept, and Context framework: Population (human), Concept (recommender systems), and Context (obesity prevention). Bibliographic, population, concept, and context characteristics, and topics addressed in reviews were charted and synthesized using relative frequencies or described narratively. An overlap that occurs when the same primary studies are included in multiple reviews was assessed as the overall Corrected Covered Area (CCA: 0%-5% low overlap to ⩾15% very high overlap).

Results: The reviews were published between 2017 and 2023 and included 308 primary studies. The overlap in primary studies among the 10 reviews was low (CCA = 1.29%). The reviews described the recommender system properties (n = 8) or their implementation (n = 2) in any (n = 6) or specific populations (e.g., elderly; n = 4) and focused on nutrition (n = 9) and physical activity (n = 4) within obesity prevention context. The topics addressed in reviews were recommendation generation (i.e., technical system properties; n = 9), health content (e.g., nutritional advice; n = 7), and implementation (i.e., system evaluation and user application; n = 5). The evidence gaps included the need for new system development and evaluation (n = 8) and a focus on diverse health contexts (n = 4).

Conclusion: Evidence from past reviews suggests that despite the existence of several technical solutions, there is yet no consensus on how to generate the most accurate nutrition recommendations in the obesity prevention context. Future studies addressing system and user outcome evaluation are needed to identify the optimal parameters for any long-term behavior change in recommender system users.

Objectives: According to the World Health Organisation, nearly 50% of people aged 12-35 years worldwide are at risk of permanent hearing loss due to excessive and prolonged recreational and environmental noise exposure. There is no research literature on noise-induced hearing loss in the Pacific Islands. This study was conducted in order to support the development of public health policies and health promotion campaigns aimed at addressing preventable hearing loss among youth and young adults in Samoa.

Methods: The Youth Attitude to Noise Scale is a validated 19-item questionnaire requiring a response on the 5-point Likert scale. The Youth Attitude to Noise Scale was formally translated into Samoan, and a bilingual version (English/Samoan) was administered to university students in Samoa to assess their attitudes towards recreational and environmental noise. Participants (N = 129, 39.5% male, 38% female, 22.5% missing data) represented the School of Medicine (N = 24), the Center for Samoan Studies (N = 29), and the Faculty of Technical Education (N = 76). Age range was 15-30 years (mean = 19.54, median = 19.00, SD = 2.9).

Results: A total of 61.2% of participants agreed that there should be more rules/regulations for the sound levels in society, with more female students agreeing with this statement than male; 46.6% felt entertainment venues were too loud, with more medical students supporting this statement than either technical education or Samoan Studies students. A total of 72.9% agreed it should be quiet in classrooms; 60.5% were prepared to help make the educational environments quieter; 58.9% responded that listening to music helps them concentrate when doing homework; and 45.7% responded that it was difficult to concentrate when surrounded by many different sounds.

Conclusion: Results indicated that there was a readiness among young adults to participate in the co-design of noise health policies, including the development of noise health promotion campaigns.

Background: To evaluate the efficacy of adjunctive intratympanic dexamethasone therapy in improving outcomes of myringotomy with ventilation tube insertion for bilateral otitis media with effusion in children with cleft palate.

Methods: Children with cleft palate aged 2-12 years were recruited. Dexamethasone or placebo was administered intratympanically based on randomized allocation, with contralateral ear receiving the alternate treatment.

Results: Twenty-three children with cleft palate (mean age: 33.04 ± 27.80 months) were enrolled. Baseline demographics were comparable between groups (p > 0.05). Both dexamethasone and placebo groups demonstrated significant hearing level improvements at 1-month follow-up (p < 0.001). Patients with otitis media with effusion duration ⩽ 3 months exhibited superior outcomes in the dexamethasone group (mean difference: -3.18 dB HL, 95% CI: -4.88 to -1.49, p = 0.002). Patients with cleft palate without other anomalies demonstrated a significant improvement in the dexamethasone group (mean difference: -3.24 dB HL, 95% CI: -5.04 to -1.43, p = 0.002). No significant differences in adverse events were observed between groups (p > 0.05).

Conclusions: Early intratympanic dexamethasone injection adjunct to myringotomy with ventilation tube insertion is recommended for otitis media with effusion in children with cleft palate.

Objectives: Legionella pneumophila is a waterborne bacterium known to cause Legionnaires' disease, a severe form of pneumonia particularly affecting older and immune compromised individuals. This study evaluates the level of risk awareness, clinical practices, and barriers to optimal management of nosocomial Legionnaires' disease in Ethiopia's two largest hospitals.

Methods: We employed a cross-sectional survey design, utilizing a self-administered questionnaire to collect data from 374 practicing physicians at two specialized hospitals in Addis Ababa.

Results: A total of 324 questionnaires were returned, yielding a response rate of 86.6%. Eighty percent (n = 270) reported some level of awareness of Legionnaires' disease as a clinical condition. However, 43% of the physicians were unaware of the association between hospital water systems and the risk of nosocomial Legionnaires' disease. Fifty-seven percent of the respondents indicated the absence of technical guidelines to inform the diagnosis and management of nosocomial Legionnaires' disease. Most physicians relied on clinical assessment (57%, n = 51) for diagnosing the disease, citing diagnostic barriers (68%, n = 140) and perceived low reliability of existing laboratory tests as key challenges. Notably, physicians with limited knowledge about Legionnaires' disease were associated with a 79% reduction in accurate diagnosis of cases. Additionally, poor hospital water quality (43%) and inadequate infection prevention and control measures were identified as significant contributors to the persistence of waterborne hospital-acquired pneumonia.

Conclusions: This study highlights physicians' limited awareness of the risks posed by hospital water systems in the transmission of Legionnaires' disease. Additionally, the diagnosis of Legionnaires' disease is impeded by the lack of clinical guidelines and specific diagnostic testing capabilities. These findings underscore the urgent need to revise hospital-acquired pneumonia protocols, strengthen infection prevention and control guidelines, and enhance hospital water management practices.

The US opioid crisis has rapidly escalated over the past 4 decades, with a shifting profile of available substances contributing to rising fatalities. Leading this crisis is illicitly manufactured fentanyl, now increasingly adulterated with xylazine, a veterinary sedative not approved for human use. Despite a greater awareness in recent years regarding the vital role of naloxone in preventing fatal cases of overdose, xylazine has been associated with a sharp increase in overdose-related deaths due to its potent central nervous system effects. Recent data suggest a significant spread of xylazine, underscoring the importance of strategies to counteract fentanyl and implement aggressive supportive care for xylazine-fentanyl toxicity. This combination, often undetectable by standard drug tests, presents challenges in diagnosis and treatment of overdoses. These challenges have become relevant among young adults, a demographic particularly affected, underscoring the need for harm reduction measures and further research into the shifting patterns of fentanyl-related intoxication across the United States.

Background: Lung adenocarcinoma is a highly heterogeneous group of diseases with distinct molecular genetic features, pathological characteristics, metabolic profiles, and clinical behaviors. However, the clinical relevance of metabolic characteristics of lung adenocarcinoma remains unclear. This study aimed to describe the molecular characteristics of lung adenocarcinoma.

Methods: The gene expression profiles of 1037 lung adenocarcinoma samples were downloaded from The Cancer Genome Atlas and Gene Expression Omnibus databases. This study is based on sample data from 2006 to 2020. The long-time span and sufficient sample size ensure the robustness of the research findings. Using unsupervised transcriptome analysis, we identified three distinct subtypes (C1, C2, and C3). We then compared the prognostic traits, transcriptome characteristics, metabolic signatures, immune infiltration, clinical features, and drug sensitivity of the lung adenocarcinoma subclasses. A classifier was generated to determine lung adenocarcinoma classification, and we verified the clinical value of this classifier in other tumors.

Results: Our results indicated that C1 possessed the most abundant metabolic pathways. Compared with C2 and C3, C1 possessed 35 metabolic pathways that exhibited significant differences. The immune score, matrix score, and immune infiltration for subtype C1 were significantly lower than those for subtypes C2 and C3, suggesting that C1 is a metabolically active subtype. Five metabolic pathways were observed in C2. Subtype C2 was associated with the best prognosis and exhibited the lowest tumor mutation burden and copy number variation. Subtype C3 comprised five metabolic pathways. Immune checkpoint analysis revealed that C3 cells may potentially benefit from immunotherapy.

Conclusions: Our study deepens the understanding of the metabolic characteristics of lung adenocarcinoma and may provide valuable information for immunotherapy.

Objective: To develop and validate the Mental Health Literacy Assessment Scale for assessing mental health literacy among community health workers.

Method: A total of 24 items were initially generated and refined through cognitive interviews and expert evaluation. The final scale consisted of 20 items. Face validity was ensured through cognitive interviews conducted in two phases with community health workers and volunteers. Content validity was assured based on the ratings of six experts. Cross-sectional survey was performed among 233 community health workers. Exploratory factor analysis using Varimax rotation was performed to identify latent variables with factor loadings > 0.4. Confirmatory factor analysis was employed to validate the model, using root mean square error of approximation < 0.05, standardized root mean square residual < 0.08, comparative fit index ⩾ 0.90, and Tucker-Lewis index ⩾ 0.90. Reliability was assessed through Cronbach's alpha where alpha coefficient > 0.70 indicated internal consistency.

Results: Exploratory factor analysis identified four factors explaining 50.75% of variance explained by positive mental health behaviors (21.44%), misconceptions about mental health (14.24%), symptoms of mental distress (8.70%), and mental health stigma (6.37%). The confirmatory factor analysis demonstrated excellent model fit, with indices such as the normed Chi-square (1.31), comparative fit index (0.95), Tucker-Lewis index (0.94), and root mean square error of approximation (0.03). The scale displayed strong convergent and discriminant validity, with an average variance extracted > 0.43 and composite reliability > 0.70 for all factors. Internal consistency was confirmed, with a Cronbach's alpha value of 0.78 for the overall scale.

Conclusion: The Mental Health Literacy Assessment Scale has demonstrated robust psychometric properties and comprehensive coverage of mental health literacy components, making it a valuable tool for both research and practical applications among Community health workers in Nepal. While these findings support its utility in this context, further validation is needed to establish its applicability across other low- and middle-income countries to assess its effectiveness in diverse cultural and geographic settings.