Category: Nevin Manimala

JAMA Netw Open. 2023 Feb 1;6(2):e2255050. doi: 10.1001/jamanetworkopen.2022.55050.

ABSTRACT

IMPORTANCE: Use of tyrosine kinase inhibitors (TKIs) is the standard therapy for epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) with brain metastases. Several studies have shown that adding chemotherapy to EGFR-TKIs could improve progression-free survival (PFS) in patients with EGFR-mutant advanced NSCLC; however, the efficacy of these agents in patients with brain metastases remains unclear.

OBJECTIVE: To investigate the efficacy and safety of gefitinib plus chemotherapy (pemetrexed with platinum) compared with gefitinib alone in patients with untreated EGFR-mutant NSCLC brain metastases.

DESIGN, SETTING, AND PARTICIPANTS: This open-label prospective, multicenter, phase 3 randomized clinical trial was conducted in 6 centers in China from January 13, 2016, to August 27, 2021. The median follow-up time was 21.1 months (IQR, 13.5-31.8 months). Patients with untreated confirmed brain metastases and EGFR-sensitive mutated NSCLC were enrolled.

INTERVENTIONS: The eligible patients were randomly assigned (1:1) to receive gefitinib plus chemotherapy or gefitinib alone.

MAIN OUTCOMES AND MEASURES: The primary end point was intracranial PFS; secondary end points included PFS, overall survival (OS), intracranial objective response rate, overall objective response rate, and safety. Intention-to-treat analysis was performed.

RESULTS: A total of 161 patients (87 [54.0%] women; mean [SD] age, 55 [9.8] years; range, 26-80 years) were enrolled and randomized to receive gefitinib (n = 81) or gefitinib plus chemotherapy (n = 80). The median intracranial PFS was 15.6 months (95% CI, 14.3-16.9 months) in the gefitinib plus chemotherapy group vs 9.1 months (95% CI, 8.0-10.2 months) in the gefitinib group (hazard ratio, 0.36; 95% CI, 0.25-0.53; P < .001). Similarly, the median PFS was significantly longer with gefitinib plus chemotherapy than gefitinib alone (16.3; 95% CI, 14.4-18.2 months vs 9.5; 95% CI, 8.3-10.8 months; P < .001). Gefitinib plus chemotherapy had a better intracranial objective response rate (85.0%; 95% CI, 77.0%-93.0% vs 63.0%; 95% CI, 52.2%-73.7%; P = .002) and overall objective response rate (80.0%; 95% CI, 71.0%-89.0% vs 64.2%; 95% CI, 53.5%-74.9%; P = .03) than gefitinib alone. At data cutoff, the median OS was also significantly longer in the gefitinib plus chemotherapy group vs the gefitinib group (35.0 vs 28.9 months; hazard ratio, 0.65; 95% CI, 0.43-0.99; P = .04). Grade 3 or worse adverse events were more common with gefitinib plus chemotherapy, most of which were manageable.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, gefitinib plus chemotherapy significantly improved intracranial PFS, PFS, and OS compared with gefitinib alone in patients with untreated EGFR-mutant NSCLC brain metastases and could be an optional first-line treatment for these patients.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01951469.

PMID:36753281 | DOI:10.1001/jamanetworkopen.2022.55050

JAMA Netw Open. 2023 Feb 1;6(2):e2255107. doi: 10.1001/jamanetworkopen.2022.55107.

ABSTRACT

IMPORTANCE: Rights and access for transgender individuals, including the participation of transgender athletes in sports, have long been debated. These discussions often center around fairness and mental health impacts on youths associated with identity-based inclusion in sports.

OBJECTIVE: To assess the experiences and perspectives of adolescents and young adults on the inclusion of transgender individuals in competitive sports.

DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, 5 open-ended survey questions were sent to the MyVoice cohort from December 10 to 17, 2021. MyVoice is a nationwide text-message polling platform of US youths aged 14 to 24 years. All coding and subsequent analysis was completed between January 10 and December 11, 2022.

MAIN OUTCOMES AND MEASURES: Qualitative perspectives of youths regarding transgender athlete participation in sports as measured by survey responses. Responses were reviewed using an inductive approach to qualitative thematic analysis to develop a codebook. The codes were independently applied to all responses by 2 investigators; discrepancies were resolved with discussion. Summary statistics were calculated for demographic characteristics and code frequencies, and χ2 tests (α = .05, 2-tailed) were used to evaluate differences in opinion based on gender identity and participation in competitive sports.

RESULTS: A total of 905 of 1199 youths (75%) responded to the survey. Respondents had a mean (SD) age of 20 (2) years; 482 (53%) identified as male, 29 (3%) identified as transgender, and 306 (34%) reported having participated in high school and/or collegiate athletics. Three themes emerged: (1) youths differed regarding the inclusion of transgender athletes based on gender identity vs sex assigned at birth, (2) many youths did not have personal experience related to the inclusion of transgender athletes, and (3) youths were uncertain about the impacts of gender identity-based participation on cisgender individuals but perceived positive impacts for transgender individuals. Nearly half of respondents (327 of 691 [47%]) thought that transgender athletes should participate based on their gender identity or personal preference, whereas 240 (35%) favored participation based on sex assigned at birth or in a transgender-only category. Respondents mentioned concern about the fairness of identity-based participation, specifically for cisgender women, but many (410 of 697 [59%]) also reported that it would be affirming for transgender athletes to participate based on gender identity.

CONCLUSIONS AND RELEVANCE: The youths in our study differed in their opinions regarding sports participation of transgender youths, but many felt that inclusive policies would affirm and support the mental health of transgender individuals. Negative impacts on fairness were noted by some respondents. These findings suggest that nuanced policies are needed to address the participation of transgender athletes in competitive sports and should consider the impacts on and perspectives of youths most affected.

PMID:36753280 | DOI:10.1001/jamanetworkopen.2022.55107

Rev Salud Publica (Bogota). 2023 Feb 3;21(4):430-438. doi: 10.15446/rsap.V21n4.67831.

ABSTRACT

OBJETIVE: To describe and to compare the previous and the current tobacco use profile between psychiatric population of secondary and tertiary levels of care and general population of basic health care.

METHODS: Descriptive epidemiological/analytical cross sectional study with 378 participants from three Brazilian health services: a) Basic Unity of Health (BUH); b) Mental Health Ambulatory (MHA); c) Psychiatric Hospital (PH). The answers provided during individual interviews were registred in mobile device. Data were submitted to descriptive statistics, Fischer’s exact test, analysis of variance and Kruskal-Wallis test.

RESULTS: In the PH all were daily smokers, noticing lower prevalence in MHA (94.1%) and in BUH (91.7%). Among the products utilized has highlighted manufactured cigarettes (98%), followed by roll-your-own cigarettes (39%). The average of cigarettes smoked per day (MHA=19,3, PH=25,3, BUH=17,2) and the percentage of multiple tobacco products users (MHA=28.1%, PH=55.3%, BUH=9.1%) were higher in PH. 73% of smokers exceed ≥ 4% of familiar income with tobacco. In PH were identified higher commitment. Smokers of PH were less advised to stop smoking (MHA=50%, PH=39.5%, BUH=50%).

CONCLUSION: The current tobacco use profile by psychiatric hospital smokers differs from the others. Besides higher tobacco dependency, they smoked a higher amount of cigarettes per day, compromised higher perceptual of personal income to buy tobacco and used multiples tobacco products as well as received less support to stop smoking.

PMID:36753266 | DOI:10.15446/rsap.V21n4.67831

Rev Salud Publica (Bogota). 2023 Feb 3;21(4):398-403. doi: 10.15446/rsap.V21n4.75787.

ABSTRACT

OBJECTIVE: To identify the capacity to provide appropriate access to facilities and equipment that encourage drinking water consumption at the Universidad de Panamá, as part of its commitment to promote behaviors that benefit the health of this community.

MATERIALS AND METHODS: A descriptive statistical study and a multivariate analysis were carried out using the correspondence analysis technique to explore relationships among the variables “University Group” (students, teachers and administrative staff) vs. “Access to water sources” and “Access to water sources” vs. “Inputs to facilitate water consumption”.

RESULTS: 66.3% of the population surveyed recognized drinking water as the most accessible drink for consumption, mainly from water sources, followed by bottled water.

CONCLUSIONS: This work highlights the importance of promoting water consumption in the university population, suggesting that the Universidad de Panamá has infrastructure conditions that allow water intake, thus promoting healthy habits and fulfilling its commitment to the health of the population.

PMID:36753261 | DOI:10.15446/rsap.V21n4.75787

Rev Bras Enferm. 2023 Feb 6;76(2):e20220182. doi: 10.1590/0034-7167-2022-0182. eCollection 2023.

ABSTRACT

OBJECTIVE: To analyze the spatiotemporal distribution of homicide mortality and association with social determinants of health in the Northeast Region of Brazil.

METHODS: Ecological study with spatiotemporal modeling of homicide deaths between 2000 and 2019. Temporal trends were analyzed by segmented linear regression. Crude mortality was calculated and adjusted by smoothing the local empirical Bayesian method and analyzed by the Global/Local Moran Index and spatiotemporal scan statistics. The association between social determinants of health and homicide mortality was performed using multiple linear regression and autoregressive spatial models.

RESULTS: 353,089 deaths were recorded. Mortality increased from 2000 to 2019, with an annual increase of 4.37 in males and 3.57 in females. High risk spatial and spatiotemporal clusters were identified in the coastal region of the states. The spatial regression model showed an association with socioeconomic inequalities.

CONCLUSIONS: High risk areas for homicides associated with socioeconomic inequality, which should be considered as a priority for designing and investing in public health policies were investigated.

PMID:36753255 | DOI:10.1590/0034-7167-2022-0182

Rev Bras Enferm. 2023 Feb 6;76(2):e20210244. doi: 10.1590/0034-7167-2021-0244. eCollection 2023.

ABSTRACT

OBJECTIVE: To evaluate a proposal for teaching entrepreneurship in an undergraduate Nursing course that uses active methodologies and activities based on the theory of meaningful learning.

METHODS: Interventional, prospective study, with a quantitative perspective, with a total of 102 participating students, carried out from July 2017 to December 2019 at a public university in the state of Sao Paulo. Statistical analysis were performed by non-parametric Chi-square or Fisher’s exact tests, with differences considered statistically significant if p < 0.05.

RESULTS: Improvements were observed in almost all items evaluated, revealing that meaningful learning became more effective with the use of active teaching methodologies. Most students need adaptation and effort to be put into these methods.

CONCLUSIONS: The proposal offers pedagogical content adaptation, specifically for nursing students. New research should expand teaching-learning techniques for the development of future nurses, preparing them adequately for the job market.

PMID:36753251 | DOI:10.1590/0034-7167-2021-0244

Rev Salud Publica (Bogota). 2023 Feb 3;22(4):421-427. doi: 10.15446/rsap.V22n4.87535.

ABSTRACT

OBJETIVE: To determine the temporal and spatial behavior of leptospirosis in Mexico during the period 2013-2019.

MATERIALS AND METHODS: It was used the information deposited in the epidemiological bulletins of National System of Epidemiological Surveillance of Mexico. To determine spatial behavior, endemic channels and time series analyzes were constructed. The spatial statistical model Scan was used to determine the spatial behavior.

RESULTS: It was determined that leptospirosis cases in Mexico occur throughout the year, however endemic peaks were observed during the months of August, September and October. Regarding to spatial behavior, it was not statistically determined any aggrupation, nevertheless the States with the highest prevalence were Sinaloa with 146.7 cases per million of habitants and Tabasco with 142 cases per million of habitants.

DISCUSSION: Leptospirosis is a disease which is affected by habits and customs of the populations, as well as by climatological events, favoring the contact with the etiological agent, which coincides with that reported in other studies, in which it was determined that leptospirosis incidence increases during the rainy season, likewise, it was reported that this disease is related to recreational activities in tropical areas.

CONCLUSIONS: To date leptospirosis is an important emerging zoonotic disease in Mexico, the disease occurs more frequently during rainy season, being Sinaloa and Tabasco the most affected States by this disease.

PMID:36753241 | DOI:10.15446/rsap.V22n4.87535

Rev Salud Publica (Bogota). 2023 Feb 3;22(4):407-413. doi: 10.15446/rsap.V22n4.86460.

ABSTRACT

OBJECTIVE: Estimate the integrity, in terms of completeness, of the mortality records in the vital statistics information system of the Orinoquia and its departments.

METHODOLOGY: A descriptive study was carried out, with a secondary source of information, from the records of non-fetal deaths reported in the vital statistics systems of each department, using methods of distribution of the mortality of Brass, Preston-Coale, Hill and Bennet-Hourichi to estimate the integrity of the records.

RESULTS: Completeness was found in the mortality records of women and men (≥95%) in Meta, and in the men of Orinoquia and Arauca (≥95%), in contrast to the records of the rest of the territorial units, where under-registration is presented.

CONCLUSIONS: Both demographic dynamics and migration influenced the results obtained from the integrity of the mortality records, therefore, also in the selection of the most appropriate method to estimate integrity; when the population is neither stable nor closed, methods based on two censuses with specific growth rates and migration adjustment should be applied; if there is no information on migration, the Hill method is recommended.

PMID:36753239 | DOI:10.15446/rsap.V22n4.86460

Rev Salud Publica (Bogota). 2023 Feb 3;22(5):544-551. doi: 10.15446/rsap.V22n5.75923.

ABSTRACT

OBJECTIVE: To analyze the predictive factors associated with the teachers’ perception of their Quality of Life at Work at the public university.

METHOD: Descriptive-analytical, cross-sectional, quantitative study, conducted with 91 professors from different areas of a public university in southwest Goiás, Brazil. To estimate the predictive factors, Total Quality of Work Life -42 and a socio-demographic and labor characterization questionnaire were used. For statistical analysis, the STATA program was used.

RESULTS: The dimensions assessed in the Quality of Life at Work were considered satisfactory, with a better score in the psychological behavioral dimension. In the bivariate analysis of the potential factors associated with the General Quality of Life at Work, significance was found with the academic title (p=0,005), the work-related health problem (p<0,001), the leisure time reserve (p<0,001), satisfaction with physical, psychological and social condition (p<0,001) and age (p=0,024). In the regression analysis, length of service at the institution (p=-0.15; p=0.039), work-related health problems (p=-0.44; p<0.001) were decreasing predictors of good General Quality of Life, while satisfaction with their physical, mental and social condition (p=0.30; p<0.001) and having a PhD degree is shown as an increasing predictor (p=0.20; p=0.046).

CONCLUSION: Teachers have a satisfactory assessment of their Quality of Life at Work, however some predictive factors punctuate elements that interfere with QWL and health perception in their work environment.

PMID:36753224 | DOI:10.15446/rsap.V22n5.75923

Rev Salud Publica (Bogota). 2023 Feb 3;22(5):486-490. doi: 10.15446/rsap.V22n5.78180.

ABSTRACT

OBJECTIVE: To determine if there are differences in factors favoring dysphonia in a group of preschool children with healthy voice and another with dysphonia.

METHOD: In this research a total of 96 children between 2 and 5 years old were evaluated, of which 17 had dysphonia and 79 had a healthy voice. The presence of factors favoring dysphonia was compared between both groups, by means of a questionnaire addressed to their parents or caregivers created and validated especially for this research. Statistical analysis was performed by independent samples analysis to extract the p value.

RESULTS: The results show a significant difference in the values of the questionnaire (p=0.000) between the two groups. The 91.6% of the questions behaved differently between the groups with and without dysphonia.

CONCLUSION: In this research, differences were found between the presence of factors favoring dysphonia in preschool children with and without dysphonia. The factors that have more differences are related to physical, environmental and psychological causes.

PMID:36753215 | DOI:10.15446/rsap.V22n5.78180