Search

Background and Objectives Neighborhood walkability can influence walking behaviors in older adults. However, its associations of walkability with walking may differ by demographic, socioeconomic, health, social, and residential characteristics due to factors such as increased vulnerability to environmental factors or increased resilience. Research Design and Methods In a sample of older adults (n  = 493, median age = 82 [range 78–89], 56% female, 31% Black), a walkability index was derived from audits of Google Street View images of participants' immediate neighborhoods. Walking was self-reported in the past week. Effect modifiers by demographic (age, race, gender, marital status), socioeconomic (education, income), health (gait speed, falls, knee pain, depressive symptoms, cognitive status, perceived energy), social (driving status, social engagement), and residential/neighborhood (residence type, neighborhood socioeconomic status [SES], population density) characteristics were assessed by interaction terms in logistic regression models, adjusted for gender, race, gait speed, prior falls, high depressive symptoms, currently driving, and cognitive status. When effect modification was suggested (p for interaction <.1), adjusted analyses of walkability with walking stratified on the effect modifier were conducted. Results In this sample, 59% walked in the past week and greater walkability was associated with greater odds of walking (odds ratio [OR] = 1.16, 95% confidence interval [CI]: 1.01–1.34). This association (p for interaction range 0.002–0.07) was present for those who were not currently married (OR = 1.35, 95% CI: 1.17–1.56), who reported knee pain (OR = 1.40, 95% CI: 1.14–1.72) or high depressive symptoms (OR = 1.30, 95% CI: 1.06–1.60), or who had declining cognitive function (OR = 1.30, 95% CI: 1.09–1.55). Discussion and Implications High walkability may influence physical activity, particularly for those with vulnerabilities related to social, pain, and brain health characteristics. These results should inform neighborhood planning and targeted interventions for vulnerable older adults. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) presents diverse symptoms and comorbidities, complicating its diagnosis and management. The primary objective of this cross-sectional, monocentric study was to assess digital gait sensor data's utility for monitoring and diagnosis of motor and gait impairment in PD. As a secondary objective, for the more challenging tasks of detecting comorbidities, non-motor outcomes, and disease progression subgroups, we evaluated for the first time the integration of digital markers with metabolomics and clinical data. Using shoe-attached digital sensors, we collected gait measurements from 162 patients and 129 controls in a single visit. Machine learning models showed significant diagnostic power, with AUC scores of 83–92% for PD vs. control and up to 75% for motor severity classification. Integrating gait data with metabolomics and clinical data improved predictions for challenging-to-detect comorbidities such as hallucinations. Overall, this approach using digital biomarkers and multimodal data integration can assist in objective disease monitoring, diagnosis, and comorbidity detection. [ABSTRACT FROM AUTHOR]

Introduction: While there is an interest in defining longitudinal change in people with chronic illness like Parkinson's disease (PD), statistical analysis of longitudinal data is not straightforward for clinical researchers. Here, we aim to demonstrate how the choice of statistical method may influence research outcomes, (e.g., progression in apathy), specifically the size of longitudinal effect estimates, in a cohort. Methods: In this retrospective longitudinal analysis of 802 people with typical Parkinson's disease in the Luxembourg Parkinson's study, we compared the mean apathy scores at visit 1 and visit 8 by means of the paired two-sided t-test. Additionally, we analysed the relationship between the visit numbers and the apathy score using linear regression and longitudinal two-level mixed effects models. Results: Mixed effects models were the only method able to detect progression of apathy over time. While the effects estimated for the group comparison and the linear regression were smaller with high p-values (+ 1.016/ 7 years, p = 0.107, -0.056/ 7 years, p = 0.897, respectively), effect estimates for the mixed effects models were positive with a very small p-value, indicating a significant increase in apathy symptoms by + 2.345/ 7 years (p < 0.001). Conclusion: The inappropriate use of paired t-tests and linear regression to analyse longitudinal data can lead to underpowered analyses and an underestimation of longitudinal change. While mixed effects models are not without limitations and need to be altered to model the time sequence between the exposure and the outcome, they are worth considering for longitudinal data analyses. In case this is not possible, limitations of the analytical approach need to be discussed and taken into account in the interpretation. [ABSTRACT FROM AUTHOR]

Introduction: In India, the National Medical Commission, introduced the concept of "Environmental health and wellness," in the medical curriculum in the year 2020, to equip the future doctors in addressing complex issues such as climate change and health. As a part of the "Family adoption Program," the students are required "to carry out and be a part of the environment protection and sustenance activities." The study was done to assess the knowledge and practices of "environmental wellness (EW)" of 1st-year medical students. Materials and Methods: Using a cross-sectional study design, the study was conducted using a semi-structured, self-administered, online questionnaire, with sections on demographics, climate change, environmental laws, and wellness, after institutional ethics committee approval. Responses on aspects of EW were rated and scored as "never," "rarely," "sometimes," "regularly," and "always" from lowest to highest. Results were presented as frequency, proportion, percentages, and mean scores; Chi-square, F -test, and t -test were used as tests of association; P < 0.05 considered statistically significant. Results: Of the 250 students, 212 were present during the preawareness generation session; 179 consented, with a response rate of 84.4%. Their mean age was 19.79 ± 1.76 years and 70.94% were females; 84.9% knew about appropriate state-level laws regarding environmental pollution. 77.65% had excellent, 16.20% good, and 6.15% had a fair level of EW scores. The females had a better attitude (P = 0.004) and practice (P = 0.037) in comparison to male students with regard to different aspects of EW. Conclusion: The students were well aware of EW, with the female students having better practices. Inculcating these good practices with regard to EW would help them to spread awareness regarding the same in the community, thereby helping them achieve the competency required in the field visits, which would help them with regard to percolating the importance of the environment in health and wellness, at the community level. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, Systems-based practice, and Professionalism. [ABSTRACT FROM AUTHOR]

In this community-partnered study we conducted focus groups with non-English speaking immigrant and refugee communities of color in 4 languages to understand their perspectives on COVID-19 vaccines, barriers to accessing vaccines, and recommendations for healthcare providers. We used a mixed deductive-inductive thematic analysis approach and human centered design to guide data analysis. 66 individuals participated; 85% were vaccinated. The vaccination experience was often positive; however, participants described language inaccessibility, often relying on family members for interpretation. Community-based organizations played a role in connecting participants to vaccines. Unvaccinated participants expressed fear of side effects and belief in natural immunity. Participants shared recommendations to providers around increasing vaccine access, improving language accessibility, and building trust. Results from our study show numerous barriers immigrant and refugee communities of color faced getting their COVID-19 vaccine, but also highlights opportunities to engage with community partners. Future implications for research, policy, and practice are described. [ABSTRACT FROM AUTHOR]

Title: The impact of systematic lymphadenectomy in the management of epithelial ovarian cancer: a single institution experience Kiran Abhijit Kulkarni1, Geeta Acharya1, Premalatha T. S1, Sumithra Selvam2, Vishakha C. Bidkar1, Sumangala G1, Julian Crasta3, Elizabeth Vallikad1 1 Department of Gynecologic Oncology, 2 Department of Biostatistics, 3 Department of Pathology, St. John's Medical College, Bengaluru Background: Ovarian cancer is the most fatal of gynecologic malignancies. The benefit of maximal surgical effort towards achieving complete cytoreduction, on the overall survival is well established. However, the extent of lymph node assessment is not well defined and practices are variable in different centers. This study attempts to assess the impact of systematic lymphadenectomyin the management of epithelial ovarian cancer. Methods: This was an observational study involving the record review of patients with a diagnosis of epithelial ovarian, fallopian tube or primary peritoneal cancer who underwent primary surgery or interval cytoreduction with effect from January 2012. All patients' follow up data was prospectively updated till 30 April 2017. Systematic lymphadenectomy was defined as a complete procedure when at least 30 lymph nodes are reported in the pathologic specimen. Statistics: Kaplan-Meier curve, log rank test was used to compare the survival curves between clinical variables. Univariate and multivariate Cox regression analysis was done to find the hazards for variables. Probability value < 0.05 was considered statistically significant. Statistical analysis was performed using an SPSS statistical package 23. Results: A total of 83 cases met the inclusion criteria for this study and a majority had a highgrade carcinoma (n = 70; 84.3 %) and a serous histology (n = 68; 81.9 %). Lymphadenectomy was performed in 74 (89.2%) patients. Lymphadenectomy was deemed systematic in 43 (51/8%) cases and the median number of removed lymph nodes was 44 (IQR 25- 75%: 38-52). Complete gross cytoreduction (defined as no macroscopic tumor) was achieved in 52 (62.7%). Univariate cox regression analysis revealed that performance status, N stage and residual disease were the significant predictors of mortality considering the overall survival. However, multivariate cox regression analysis revealed that none of the variables were significant predictors of mortality. Similarly, when disease free survival was considered, performance status, N stage and residual disease were significant predictors of mortality. However, none of the variables were significant in the multivariate analysis. Conclusion: Systematic lymphadenectomy does not have a significant impact on overall or progression free survival. However, a randomized clinical trial with a larger sample size is required to validate this finding. [ABSTRACT FROM AUTHOR]

INTRODUCTION- Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease accounting for 1-2% of trophoblastic tumors. Common presentation is irregular vaginal bleeding. PSTT originates from the intermediate trophoblasts in the placenta. Age >35 years, interval since antecedent pregnancy of over 2 years, deep myometrial invasion, stage III or IV, maximum hCG level >1, 000IU/L, extensive coagulative necrosis, high mitotic rate, and the presence of cells with clear cytoplasm were signi?cant prognostic factors. The standard treatment for PSTT is hysterectomy as it is fairly resistant to chemotherapy. Single agent chemotherapy is not effective for PSTT and a regimen of multiagent chemotherapy for choriocarcinoma (EMA/CO, MEA, EP/EMA) is recommended. CASE REPORT- A 35-year-old P3L3 woman presented with 2 months of heavy menstrual bleeding. Her last pregnancy was delivered by spontaneous vaginal delivery 11 years ago She was tubectomised. On examination she had mass protruding through cervical Os and 10 weeks uterus. Ultrasound and MRI showed 9x8 cms heterogenous mass protruding in the cervical canal. Inital beta hcg was 9498. HPR of the mass showed PSTT. She was treated with total abdominal hysterectomy and retroperitoneal lymphnode dissection. Immunohistochemistry showed a mixed intermediate trophoblastic tumour with components of epithelioid trophoblastic tumour and placental site trophoblastic tumour. She received 6 cycles of adjuvant chemotherapy with etoposide, methotrexate, actinomycin, and cisplatin (EMA-EP). On follow up patient is disease free for 9 months. [ABSTRACT FROM AUTHOR]

INTRODUCTION- Uterine sarcomas are uncommon aggressive mesenchymal tumours comprising of 3% of uterine malignancies. Most frequent is carcinosarcoma (CS), followed by leiomyosarcoma (LMS), endometrial stromal sarcomas (ESS), undifferentiated uterine sarcomas (UUS) and adenosarcoma. CS though considered as metaplastic form of endometrial carcinoma, most of the clinical trials and retrospective studies include CS under uterine sarcomas. ESS are very rare accounting for around 0.2% of all uterine malignancies and less than 10% of the uterine mesenchymal neoplasms. Mullerian adenosarcoma is a low grade biphasic tumor composed of malignant stromal and benign epithelial components with recurrences up to 30-40%. Primary LMS has prevalence of around 1% of malignancies of the cervix with its origin being from mesodermal tissue. Vulvar sarcomas represent only 1-2% of vulvar malignancies. This is a report of a series of these rare sarcomas of the genital tract. OBJECTIVETo study the clinical and histopathological characteristics, treatment outcome, pattern of relapse, and survival of patients diagnosed with rare sarcomas of the uterine corpus, cervix and vulva. MATERIALS AND METHODS- A retrospective data of rare sarcomas of the genital tract collection was done between march 2012 to Dec 2016. Their clinical profile, treatment delivered and survival were noted. RESULTS- Eight pathologically proven - one primary leiomyosarcoma of the uterine cervix, four sarcomas of uterine corpus (three high grade endometrial stromal sarcoma/undifferentiated uterine sarcoma and one adenosarcoma with sarcomatous overgrowth), one carcinosarcoma of the left fallopian tube, one angiosarcoma of the vulva and one case of mucinous cystadenoma of left ovary with sarcomatous change in mural nodule was seen. Post menopausal bleeding was the commonest complaint. They were treated with total abdominal hysterectomy with bilateral salpingo oophorectomy and retroperitoneal lymphnode dissection. Adjuvant chemotherapy was given in 7 cases. 2 patients had recurrence of which one was teeated with palliative chemotherapy and the other with cytoreduction. DFS ranged from 8 to 28 months and OS ranged from 8 to 33 months. CONCLUSION- As these rare sarcomas of the genital tracts are hardly encountered in clinical practice and management guidelines cannot be laid down, need for case series reporting and analysing becomes necessary. [ABSTRACT FROM AUTHOR]

Background: Globally, cervical cytology continues to serve as the cornerstone of cervical cancer screening programs, but WHO 2021 guidelines advocate HPV DNA testing as the primary screening modality due to its heightened sensitivity. This method necessitates additional triage with cytology or colposcopy to detect precancerous lesions. Hormonal shifts and anatomical alterations in postmenopausal women may impact diagnostic outcomes in either modality., Aim: To describe the spectrum of cytological lesions in HPV-positive postmenopausal women to detect precancerous lesions as part of cervical cancer screening., Methods: Conventional cytology smears of high-risk HPV-positive postmenopausal women were reported according to The Bethesda System 2014. Results of follow-up biopsies of the positive smears were recorded, and cyto-histological correlation was performed., Results: The retrospective study included conventional cytology smears of 124 postmenopausal women positive for high-risk HPV DNA with a mean age of 52 years. Of the 124 cases, 68 were positive for HPV 16 and/or 18, and 56 were positive for other high-risk HPV. On cytology, 78% were negative for intraepithelial lesions. HSIL+ lesions were noted in 12%, and low-grade lesions were noted in 10% of smears with HPV16/18 predominance. Follow-up biopsies of 17 smears revealed SCC in two cases, HSIL+ in 11 cases, LSIL in 2, and 2 were negative/benign lesions. Of the cyto-histological discordant cases, four were upgraded on review., Conclusion: Cytology is a useful triage tool in detecting preinvasive and early invasive tumors in HPV DNA-positive postmenopausal women., (© 2025 Wiley Periodicals LLC.)