Category: Nevin Manimala

JAMA Netw Open. 2021 May 3;4(5):e2111813. doi: 10.1001/jamanetworkopen.2021.11813.

ABSTRACT

IMPORTANCE: Married patients with cancer have better cancer-specific survival than unmarried patients. Increasing the early diagnosis and definitive treatment of cancer among unmarried patients may reduce the survival gap.

OBJECTIVES: To evaluate the extent to which marriage is associated with cancer-specific survival, stage at diagnosis, and treatment among patients with 9 common solid cancers and to recommend methods for reducing the survival gap.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based cohort study included patients older than 18 years who were diagnosed with 1 of 9 common cancers between January 1, 2007, and December 31, 2016. Patient data were retrieved from the Surveillance, Epidemiology, and End Results Program. Statistical analyses were performed from August 1 to October 1, 2020.

EXPOSURES: Marital status, classified as married and unmarried (including single, separated, divorced, widowed, and unmarried patients or domestic partners).

MAIN OUTCOMES AND MEASURES: The primary outcome was the time ratio (TR) of cancer-specific survival (married vs unmarried). Mediation analyses were conducted to determine the extent to which the association of marriage with cancer-specific survival was mediated by stage at diagnosis and treatment.

RESULTS: This study included 1 733 906 patients (894 379 [51.6%] women; 1 067 726 [61.6%] married; mean [SD] age, 63.76 [12.60] years). Multivariate analyses found that those who were married were associated with better cancer-specific survival than unmarried patients (TR, 1.36; 95% CI, 1.35-1.37). Early diagnosis in breast cancer, colorectal cancer, endometrial cancer, and melanoma mediated the association between marital status and cancer-specific survival (breast cancer: proportion mediated [PM], 11.4%; 95% CI, 11.2%-11.6%; colorectal cancer: PM, 10.9%; 95% CI, 10.7%-11.2%; endometrial cancer: PM, 12.9%; 95% CI, 12.5%-13.3%; melanoma: PM, 12.0%; 95% CI, 11.7-12.4%). Surgery mediated the association between marital status and cancer-specific survival in lung (PM, 52.2%; 95% CI, 51.9%-52.4%), pancreatic (PM, 28.9%; 95% CI, 28.6%-29.3%), and prostate (PM, 39.3%; 95% CI, 39.0%-39.6%) cancers. Chemotherapy mediated the association of marital status with cancer-specific survival in lung (PM, 37.7%; 95% CI, 37.6%-37.9%) and pancreatic (PM, 28.6%; 95% CI, 28.4%-28.9%) cancers. Improved cancer-specific survival associated with marriage was greater among men than women (men: TR, 1.27; 95% CI, 1.25-1.28; women: TR, 1.20; 95% CI, 1.19-1.21). The contribution of receiving an early diagnosis and treatment with surgery or chemotherapy to the association between marital status and cancer-specific survival was greater among men than women (early diagnosis: PM, 21.7% [95% CI, 21.5%-21.9%] vs PM, 20.3% [95% CI, 20.2%-20.4%]; surgery: PM, 26.6% [95% CI, 26.4%-26.7%] vs PM, 11.1% [95% CI, 11.0%-11.2%]; chemotherapy: PM, 6.8% [95% CI, 6.7%-6.8%] vs PM, 5.1% [95% CI, 5.0%-5.2%]).

CONCLUSIONS AND RELEVANCE: In this study, survival disparities associated with marital status were attributable to early diagnosis in breast, colorectal, and endometrial cancers as well as melanoma and to treatment-related variables in lung, pancreatic, and prostate cancers. The findings also suggest that marriage may play a greater protective role in the cancer-specific survival of men than of women.

PMID:34047792 | DOI:10.1001/jamanetworkopen.2021.11813

Arch Dermatol Res. 2021 May 28. doi: 10.1007/s00403-021-02242-x. Online ahead of print.

ABSTRACT

BACKGROUND: Stromal vascular fraction (SVF), derived enzymatically or mechanically from adipose tissue, contains a heterogenous population of cells and stroma, including multipotent stem cells. The regenerative capacity of SVF may potentially be adapted for a broad range of clinical applications, including the healing of acute cutaneous wounds.

OBJECTIVE: To evaluate the available literature on the efficacy and safety of autologous adipose-derived stromal vascular fraction (SVF) for the treatment of acute cutaneous wounds in humans.

METHODS: A systematic review of the literature utilizing MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was performed to identify published clinical trials of autologous adipose-derived SVF or similar ADSC-containing derivatives for patients with acute cutaneous wounds. This was supplemented by searches for ongoing clinical trials through ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform.

RESULTS: 872 records were initially retrieved. Application of inclusion and exclusion criteria yielded 10 relevant studies: two completed non-randomized controlled trials and eight ongoing clinical trials. Both completed studies reported a statistically significant benefit in percentage re-epithelialization and time to healing for the SVF treatment arms. Safety information for SVF was not provided. Ongoing clinical trials were assessing outcomes such as safety, patient and observer reported scar appearance, wound healing rate, and wound epithelization.

CONCLUSION: In the context of substantial limitations in the quantity and quality of available evidence, the existing literature suggests that SVF may be a useful treatment for acute cutaneous wounds in humans. More clinical trials with improved outcome measures and safety assessment are needed.

PMID:34047823 | DOI:10.1007/s00403-021-02242-x

Eur Arch Otorhinolaryngol. 2021 May 28. doi: 10.1007/s00405-021-06901-7. Online ahead of print.

ABSTRACT

PURPOSE: The skin tumors can occur on any part of the body, these anatomical subunits are considered prognostic factors for localized carcinomas. Tumor size is a prognostic criterion that also varies according to the anatomical location of these tumors. Head and neck region is the most common location. This study aimed to investigate the distribution of BCC, SCC, and MM in the anatomical subunits of the head and neck region and their relationships with these anatomical subunits.

MATERIALS AND METHODS: Patients who underwent surgery for BCC, SCC, BSCC and/or MM in the head and neck region. The head and neck region was divided topographically into the following subunits: scalp, forehead, orbital region, ear and periauricular region, cheeks, nose, perioral region, and neck. Patients were analyzed according to age, sex, and tumor location, type, and size.

RESULTS: The SCC group was found to have significantly larger mean tumor size than the BCC group (p = 0.003). SCC was more frequently located in the perioral region (p = 0.001), BCC was more frequently located on the nose (p = 0.001), and MM was more frequently located on the forehead and scalp (p = 0.034, p = 0.49) when compared with the other types. BCC was more frequently located in the orbital region than SCC (p = 0.018) CONCLUSIONS: In this study, we observed statistically significant differences in the distribution of BCC, SCC, and MM, the most common types of skin cancer, among the topographical subunits of the head and neck region.

PMID:34047838 | DOI:10.1007/s00405-021-06901-7

Demography. 2021 May 28:9335177. doi: 10.1215/00703370-9335177. Online ahead of print.

ABSTRACT

Previous research has shown that childbearing is associated with short-term improvements in women’s subjective well-being but that these effects depend on the timing and quantum of the birth as well as on the parents’ education and socioeconomic status. These studies did not address whether and, if so, how this effect varies according to the mode of conception. This represents an important knowledge gap, given that conceptions through medically assisted reproduction (MAR) have been increasing rapidly in recent decades, exceeding 5% of live births in some European countries. Drawing on nine waves (2009/2010-2017/2018) of the UK Household Longitudinal Study, we use distributed fixed-effects linear regression models to examine changes in women’s mental health before, during, and after natural and MAR conceptions. The results show that the mental health of women who conceived naturally improved around the time of conception and then gradually returned to baseline levels; comparatively, the mental health of women who conceived through MAR declined in the year before pregnancy and then gradually recovered. The findings also indicate that women’s happiness decreased both two years and one year before an MAR conception and then increased above the baseline in the year of pregnancy. We further show that the deterioration in mental health and subjective well-being before an MAR conception affects both partners, which could be part of a longer process in which the partners potentially suffer from stress related not solely to the MAR treatments themselves but also to the experience of subfertility.

PMID:34047787 | DOI:10.1215/00703370-9335177

JAMA Netw Open. 2021 May 3;4(5):e2111858. doi: 10.1001/jamanetworkopen.2021.11858.

ABSTRACT

IMPORTANCE: The Comprehensive Care for Joint Replacement (CJR) model is Medicare’s mandatory bundled payment reform to improve quality and spending for beneficiaries who need total hip replacement (THR) or total knee replacement (TKR), yet it does not account for sociodemographic risk factors such as race/ethnicity and income. Results of this study could be the basis for a Medicare payment reform that addresses inequities in joint replacement care.

OBJECTIVE: To examine the association of the CJR model with racial/ethnic and socioeconomic disparities in the use of elective THR and TKR among older Medicare beneficiaries after accounting for the population of patients who were at risk or eligible for these surgical procedures.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used the 2013 to 2017 national Medicare data and multivariable logistic regressions with triple-differences estimation. Medicare beneficiaries who were aged 65 to 99 years, entitled to Medicare, alive at the end of the calendar year, and residing either in the 67 metropolitan statistical areas (MSAs) mandated to participate in the CJR model or in the 104 control MSAs were identified. A subset of Medicare beneficiaries with a diagnosis of arthritis underwent THR or TKR. Data were analyzed from March to December 2020.

EXPOSURES: Implementation of the CJR model in 2016.

MAIN OUTCOMES AND MEASURES: Outcomes were separate binary indicators for whether a beneficiary underwent THR or TKR. Key independent variables were MSA treatment status, pre- or post-CJR model implementation phase, combination of race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic beneficiaries) and dual eligibility, and their interactions. Logistic regression models were used to control for patient characteristics, MSA fixed effects, and time trends.

RESULTS: The 2013 cohort included 4 447 205 Medicare beneficiaries, of which 2 025 357 (45.5%) resided in MSAs with the CJR model. The cohort’s mean (SD) age was 77.18 (7.95) years, and it was composed of 2 951 140 female (66.4%), 3 928 432 non-Hispanic White (88.3%), and 657 073 dually eligible (14.8%) beneficiaries. Before the CJR model implementation, rates were highest among non-Hispanic White non-dual-eligible beneficiaries at 1.25% (95% CI, 1.24%-1.26%) for THR use and 2.28% (95% CI, 2.26%-2.29%) for TKR use in MSAs with CJR model. Compared with MSAs without the CJR model and the analogous race/ethnicity and dual-eligibility group, the CJR model was associated with a 0.10 (95% CI, 0.05-0.15; P < .001) percentage-point increase in TKR use for non-Hispanic White non-dual-eligible beneficiaries, a 0.11 (95% CI, 0.004-0.21; P = .04) percentage-point increase for non-Hispanic White dual-eligible beneficiaries, a 0.15 (95% CI, -0.29 to -0.01; P = .04) percentage-point decrease for non-Hispanic Black non-dual-eligible beneficiaries, and a 0.18 (95% CI, -0.34 to -0.01; P = .03) percentage-point decrease for non-Hispanic Black dual-eligible beneficiaries. These CJR model-associated changes in TKR use were 0.25 (95% CI, -0.40 to -0.10; P = .001) percentage points lower for non-Hispanic Black non-dual-eligible beneficiaries and 0.27 (95% CI, -0.45 to -0.10; P = .002) percentage points lower for non-Hispanic Black dual-eligible beneficiaries compared with the model-associated changes for non-Hispanic White non-dual-eligible beneficiaries. No association was found between the CJR model and a widening of the THR use gap among race/ethnicity and dual eligibility groups.

CONCLUSIONS AND RELEVANCE: Results of this study indicate that the CJR model was associated with a modest increase in the already substantial difference in TKR use among non-Hispanic Black vs non-Hispanic White beneficiaries; no difference was found for THR. These findings support the widespread concern that payment reform has the potential to exacerbate disparities in access to joint replacement care.

PMID:34047790 | DOI:10.1001/jamanetworkopen.2021.11858

JAMA Intern Med. 2021 May 28. doi: 10.1001/jamainternmed.2021.1974. Online ahead of print.

ABSTRACT

IMPORTANCE: Patient reviews of health care experiences are increasingly used for public reporting and alternative payment models. Critics have argued that this incentivizes physicians to provide more care, including low-value care, undermining efforts to reduce wasteful practices.

OBJECTIVE: To assess associations between rates of low-value service provision to a primary care professional (PCP) patient panel and patients’ ratings of their health care experiences.

DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study used Medicare fee-for-service claims from January 1, 2007, to December 31, 2014, for a random 20% sample of beneficiaries to identify beneficiaries for whom each of 8 low-value services could be ordered but would be considered unnecessary. The study also used health care experience reports from independently sampled beneficiaries who responded to the 2010-2015 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare fee-for-service survey. Statistical analysis was performed from January 1, 2019, to December 9, 2020.

MAIN OUTCOMES AND MEASURES: The main outcomes were health care experience ratings from Medicare beneficiaries who responded to the CAHPS survey from 2 domains, namely “Your Health Care in the Last 6 Months” (overall health care, office wait time, timely access to nonurgent care, and timely access to urgent care) and “Your Personal Doctor” (overall personal physician and a composite score for interactions with personal physician). Beneficiaries in both samples were attributed to the PCP with whom they had the most spending. For each PCP, a composite score of low-value service exposure was constructed using the 20% sample; this score represented the adjusted relative propensity of the PCP patient panel to receive low-value care. The association between low-value service exposure and health care experience ratings reported by the CAHPS respondents in the PCP patient panel was estimated using regression analysis.

RESULTS: The final sample had 100 743 PCPs, with a mean of approximately 258 patients per PCP. Only 1 notable association was found; more low-value care exposure was associated with more frequent reports of having to wait more than 15 minutes after the scheduled time of an appointment (a mean of 0.448 points lower CAHPS score on a 10-point scale for PCP patient panels who received the most low-value care vs the least low-value care). Although some other associations were statistically significant, their magnitudes were substantially smaller than those typically considered meaningful in other CAHPS literature and were inconsistent in direction across levels of low-value service exposure.

CONCLUSIONS AND RELEVANCE: This quality improvement study found that more low-value care exposure for a PCP patient panel was not associated with more favorable patient ratings of their health care experiences.

PMID:34047761 | DOI:10.1001/jamainternmed.2021.1974

Indian Pediatr. 2021 May 28:S097475591600333. Online ahead of print.

ABSTRACT

AIM: To compare effectiveness, safety and tolerance of two colon cleansing regimens using polyethylene glycol 4000 (PEG) in children.

METHODS: Prospective, randomized, open clinical trial carried out in 129 children, 3 to 18 years old undergoing colonoscopy. Patients were randomized into two groups, 64 children received PEG with electrolyte (50 mL/kg) and oral bisacodyl (PEG+B) group or 65 other children received PEG with electrolyte (70 mL/kg) and glycerol enema (PEG+G) group.

RESULTS: Both regimens showed a good colon cleansing effectiveness with the percentage of successful cleansing being 93.8% for PEG+B regimen and 89.1% for PEG+G regimen (P=0.510). There was no statistically significant difference between the pre-regimen and post-regimen laboratory values. The rates of nausea (65.6% vs 31.3%; P<0.001) and bloating (50% vs 17.2%; P<0.001) of PEG+G group were significantly higher than that of PEG+B group.

CONCLUSION: Both regimens had good efficacy and safety for clon cleansing in children. The tolerance of PEG+B regimen was better.

PMID:34047716

Indian Pediatr. 2021 May 28:S097475591600337. Online ahead of print.

ABSTRACT

Durations of any event, such as duration of hospitalization, has an annoying feature of highly skewed distribution and incomplete values due to dropouts and limited follow-up. The usual methods of statistical analysis are, therefore, not applicable. The method of survival analysis is a nonparametric method and is designed to overcome these problems. Survival is a generic term and is used for any time-to-event data. The entire survival pattern at different points in time is studied by the Kaplan-Meier method under certain conditions. Log-rank method is used to compare survival pattern in two or more groups. Hazard is the rate of occurrence of an event per unit of time and studied by Cox method. The concept of survival and all these methods of survival analysis are briefly discussed in this short note in a nonmathematical format for medical audience.

PMID:34047720

Arch Environ Occup Health. 2021 May 28:1-13. doi: 10.1080/19338244.2021.1931796. Online ahead of print.

ABSTRACT

Among health care professionals, dentists are more prone to infection due to their direct contact with blood and saliva. This study highlights the level of compliance with infection control measures among dental students; and linked this to their knowledge and attitudes regarding infection control measures and proper vaccinations. The study is a multi-centre analytical cross-sectional survey. The sample size was 969 clinical years’ students from governmental and private dental colleges in Sudan and Saudi Arabia. A pre-coded, pre-tested, and anonymous questionnaire consisted of seven categories of knowledge, attitude, awareness, and practices, including 40 questions, was answered. The study has linked knowledge, attitude, and practice in dental clinics with possible COVID-19 transmission in dental clinics. The results showed that the use of some Personal Protective Equipment was low in Sudan and moderate in Saudi Arabia (statistically significant, p < 0.001). Moderate percentage of Hepatitis B vaccination status, with low percentage of Post HBV serology, was reported (p < 0.001). The percentages of major causes of percutaneous and/or eye exposure/injury, for examples, were as follows: anesthesia (33.3-62.7%, p 0.006) and suture needle (17.5-39.4%, p 0.037). In conclusion, dental students in the present study had good knowledge and positive attitudes regarding infection control in general, but showed moderate compliance with the recommended infection control guidelines.

PMID:34047677 | DOI:10.1080/19338244.2021.1931796

Parasite. 2021;28:46. doi: 10.1051/parasite/2021042. Epub 2021 May 27.

ABSTRACT

Dicrocoelium dendriticum is a trematode that infects ruminant livestock and requires two different intermediate hosts to complete its lifecycle. Modelling the spatial distribution of this parasite can help to improve its management in higher risk regions. The aim of this research was to assess the constraints of using historical data sets when modelling the spatial distribution of helminth parasites in ruminants. A parasitological data set provided by CREMOPAR (Napoli, Italy) and covering most of Italy was used in this paper. A baseline model (Random Forest, VECMAP^®) using the entire data set was first used to determine the minimal number of data points needed to build a stable model. Then, annual distribution models were computed and compared with the baseline model. The best prediction rate and statistical output were obtained for 2012 and the worst for 2016, even though the sample size of the former was significantly smaller than the latter. We discuss how this may be explained by the fact that in 2012, the samples were more evenly geographically distributed, whilst in 2016 most of the data were strongly clustered. It is concluded that the spatial distribution of the input data appears to be more important than the actual sample size when computing species distribution models. This is often a major issue when using historical data to develop spatial models. Such data sets often include sampling biases and large geographical gaps. If this bias is not corrected, the spatial distribution model outputs may display the sampling effort rather than the real species distribution.

PMID:34047693 | DOI:10.1051/parasite/2021042