Nevin Manimala

JCO Glob Oncol. 2025 Jun;11:e2400474. doi: 10.1200/GO-24-00474. Epub 2025 Jun 18.

ABSTRACT

PURPOSE: To evaluate baseline distress among patients with breast cancer in Botswana, and assess the impact of culturally tailored peer survivor video narratives on distress and its mediators.

METHODS: We enrolled patients with stage I-IV breast cancer at Princess Marina Hospital. A Setswana-translated National Comprehensive Cancer Network distress thermometer (DT) and problem list (PL) were used for distress screening. DT score of ≥4 was considered a positive screen for moderate to high (moderate-high) distress. We analyzed independent PL factors associated with moderate-high distress using logistic regression. Participants then watched one to two videos and completed a postintervention DT/PL assessment after each video at 4 and 8 weeks. We conducted descriptive statistics to explore the impact of the videos.

RESULTS: One hundred six participants were enrolled, of whom 103 completed baseline DT and 106 completed baseline PL. Sixty-seven percent (69/103) of participants screened positive for moderate-high distress at baseline. Fear (odds ratio [OR], 11.25 [95% CI, 1.66 to 76.49]; P = .01) and appearance (OR, 4.96 [95% CI, 1.03 to 23.80]; P = .046) were PL factors significantly associated with moderate-high distress in the multivariable model. Sixty-eight and 47 participants completed postvideo assessments at approximately 4 and approximately 8 weeks, respectively. The greatest impact was observed at 8 weeks after watching two videos-29.8% of participants with moderate-high distress had no or mild distress. Similarly, there was a 29% (44%-15%; P = .005) and 17% (32%-15%; P = .03) absolute decrease from baseline to 8 weeks, in the proportion of patients who identified fear and appearance as sources of distress, respectively.

CONCLUSION: Two thirds of patients with breast cancer screened positive for moderate-high distress. Fear and appearance were sources of distress significantly associated with a positive screen. Our results show promising potential of peer survivor videos to mitigate distress and its potential mediators among patients with breast cancer.

PMID:40532135 | DOI:10.1200/GO-24-00474

Health Rep. 2025 Jun 18;36(6):15-26. doi: 10.25318/82-003-x202500600002-eng.

ABSTRACT

BACKGROUND: Oral contraceptives (OCs) have been legally available in Canada since 1969. OCs remain the most common method of reversible contraception in Canada and are among the most commonly used medications by reproductive-aged women in Canada. The use of OCs offers protection against unplanned pregnancy, in addition to other non-contraceptive benefits. Detailed data about current and lifetime OC use in Canada are rarely available.

METHODS: Data from four cycles (from the 2007-to-2009 cycle to the 2018-to-2019 cycle) of Statistics Canada’s Canadian Health Measures Survey were combined to estimate current OC use (past 30 days) by sociodemographic characteristics and other factors and formulations by estrogen dose and progestin type. Logistic regression was used to examine the association between current OC use and sociodemographic characteristics and other factors. Combined data from 2016-to-2017 and 2018-to-2019 were used to estimate lifetime OC use and use duration.

RESULTS: According to combined data from the 2007-to-2009 period to the 2018-to-2019 period, an average of 15.9% of non-pregnant women aged 15 to 49 had used OCs in the previous 30 days. Most (98.6%) used OCs containing estrogen and progestin, and 48.7% of them took lower-dose formulations with 10 to 25 micrograms of ethinylestradiol. Younger women aged 15 to 39 were more likely to have used OCs in the previous 30 days than those aged 40 to 49. Additionally, the adjusted odds of being an OC user were higher for women who had not had children, were non-racialized and non-Indigenous, and were currently sexually active. Another 53.9% of women aged 15 to 49 reported former use. A majority of both current (67.5%) and former (52.8%) OC users reported having used them for at least four years.

INTERPRETATION: Substantial proportions of reproductive-aged women in Canada are current or former OC users.

PMID:40532082 | DOI:10.25318/82-003-x202500600002-eng

Health Rep. 2025 Jun 18;36(6):3-14. doi: 10.25318/82-003-x202500600001-eng.

ABSTRACT

BACKGROUND: The OncoSim-Breast model, developed by the Canadian Partnership Against Cancer and Statistics Canada, represents breast cancer-related events in the Canadian female population. This study aimed to compare OncoSim-Breast with recent results from the United States’ National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer models. The primary focus was on the impact of extending breast cancer screening to women aged 40 to 49.

DATA AND METHODS: The OncoSim-Breast model used Canadian demographics, competing mortality, and test performance, while the CISNET models used comparable United States data to analyze 10 different mammography screening scenarios. Lifetime outcomes were calculated for a cohort of 40-year-old women born in 1980, assuming perfect adherence to digital mammography screening. OncoSim-Breast’s estimates were compared with the median and range of estimates from the five CISNET models. The primary outcomes were breast cancer deaths averted and life years gained per 1,000 40-year-old women.

RESULTS: OncoSim-Breast projected that starting screening at age 40 would lead to 1.7 breast cancer deaths averted and 53 life years gained per 1,000 women, compared with starting screening at age 50. CISNET models projected a median of 1.3 breast cancer deaths averted (range 0.8 to 3.2) and 43 life years gained (range 31 to 103) per 1,000 women for the same scenario. Secondary outcomes estimated by OncoSim-Breast and CISNET models were similarly consistent and comparable.

INTERPRETATION: This study demonstrates that OncoSim-Breast’s estimates of the impact of starting breast cancer screening earlier align with those from CISNET models.

PMID:40532081 | DOI:10.25318/82-003-x202500600001-eng

P R Health Sci J. 2025 Jun;44(2):116-120.

ABSTRACT

OBJECTIVE: To determine the association between health literacy, adherence to treatment with quality of life in patients with chronic obstructive pulmonary disease (COPD).

METHODS: This cross-sectional study conducted among adults with COPD between February and March 2023. Sociodemographic characteristics, EuroQol Five-Dimension questionnaire (EQ-5D-5L), Health Literacy Scale, Morisky Medication Adherence Scale (MMAS-8), and COPD assessment test (CAT) were assessed.

RESULTS: A total of 425 patients with COPD were included. Better treatment adherence was positively correlated with better quality of life (p<0.001). There was a negative correlation between the quality of life and age (p<0.001; r=-0.174), COPD duration (p<0.001; r=-0.261), pack-years smoking history (p=0.002; r=- 0.162), and CAT score (p<0.001; r=-0.765). There was a positive correlation between quality of life and body mass index (p=0.049; r=0.096), and health literacy scores (p<0.001; r=0.473). Increased health literacy scores were also significantly related to better quality of life (p=0.004).

CONCLUSION: Treatment adherence and health literacy significantly influenced HRQoL, highlighting the need for interventions focused on enhancing health literacy and adherence in COPD management.

PMID:40532060

P R Health Sci J. 2025 Jun;44(2):111-115.

ABSTRACT

OBJECTIVE: Systemic Sclerosis (SSc) is an autoimmune disease with significant morbidity and mortality secondary to pulmonary manifestations. The six-minute walk test (6MWT) has been used in SSc studies to measure respiratory complications, particularly pulmonary hypertension. In this study, we evaluated whether the six-minute walk distance (6MWD), measured during the 6MWT, is associated with clinical SSc symptoms in Puerto Rican patients in a rheumatology clinic.

METHODS: We prospectively collected 6MWT data for 37 consecutive SSc patients at the University of Puerto Rico every three months for one year between 2013 and 2015. A linear mixed regression model was used to investigate the effects of the SSc clinical features and subtypes on average 6MWD over time.

RESULTS: The average baseline distance walked by SSc patients was 365.2 (± 8.1) meters, with no significant differences over time. No statistically significant differences (p>0.05) were found in the sixminute walk distance (6MWD) at different time intervals for SSc subtypes. Two clinical features, palpitations and lung crackles, were associated with a significantly shorter 6MWD(p<0.05).

CONCLUSION: Our study showed that the 6MWT can be used to evaluate SSc patients. No association was found between 6MWD and most clinical SSc symptoms in our population. Two clinical symptoms, lung crackles and palpitations, were associated with decreased 6MWD.

PMID:40532059

P R Health Sci J. 2025 Jun;44(2):95-98.

ABSTRACT

OBJECTIVE: This study compared the healthcare utilization of and costs for adults (18-64 years) with diabetes mellitus (DM) by plan type in Puerto Rico in 2013. This study is important because understanding disparities in healthcare access and expenditures can inform public health policy decisions aimed at improving diabetes care in Puerto Rico.

METHODS: Puerto Rico public and private medical insurance paid claims and enrollment data from 2013 were used to calculate the diabetes prevalence and medical care expenditures associated with this disease for total enrollers and by type of health insurance. This cross-sectional analytic study analyzed healthcare claims from 96% of the insured population in Puerto Rico, providing a comprehensive assessment of diabetes-related healthcare costs.

RESULTS: The total expenditure for patients with DM for 2013 was $388,536,735, with 58.0% attributed to the private sector. In the public sector, the largest expenditure was for hospital services (53.8%), while in the private sector, the highest spending occurred in outpatient services (54.6%). After adjusting for sex, age, Charlson comorbidity index, and percent of copayment, public insurance beneficiaries were more likely to use hospital services (PR=3.23, 95% CI: 3.13-3.33, p<0.001) and emergency services (PR=1.61, 95% CI: 1.56-1.64, p<0.001), while private insurance beneficiaries used more ambulatory services (PR=0.91, 95% CI: 0.89-0.93, p<0.001).

CONCLUSION: The findings of this study suggest disparities in access to primary health services for people with DM between public and private insureds, and that there is no continuity of care, leading to high costs for such services.

PMID:40532056

P R Health Sci J. 2025 Jun;44(2):89-94.

ABSTRACT

OBJECTIVE: This cross-sectional study aimed to estimate the prevalence of impacted maxillary canines in patients seeking treatment from 2016 2020 at the University of Puerto Rico School of Dental Medicine Orthodontic Graduate Program and compare it to the prevalence of published reports. Additionally, we sought to describe the clinical pattern of impaction using initial photographs and panoramic radiographs.

MATERIALS AND METHODS: Data were extracted from the dental records aged 14 years and older who had sought orthodontic treatment in 2016 2020. A calibrated examiner conducted all the dental measurements using 2D images from the initial records. Descriptive statistics included means (standard deviations), medians (interquartile range), and frequencies. A one-sample binomial test was used to compare the prevalence found to those of published reports. A chi-square, Fisher’s exact, and the Mann-Whitney tests were used to compare patients with and without impaction. We used logistic regression to evaluate the associations between tooth-level risk factors and impaction, accounting for clustering and adjusting for age and sex.

RESULTS: The study included 217 patients (mean age: 21.38 ± 9.16 years; 58.5% were female). The prevalence of maxillary canine impaction was 7.83%. The odds of impaction were higher if the deciduous canine was present (OR = 67.59; 95% CI: 18.61-245.40) or if the canine overlapped the lateral incisor root (OR = 155.92; 95% CI: 36.32-669.29).

CONCLUSION: The overall prevalence of maxillary canine impaction was high, although parallel to that reported in a Mexican population; site-level risk factors (deciduous canine presence, overlap) were identified.

PMID:40532055

P R Health Sci J. 2025 Jun;44(2):84-88.

ABSTRACT

OBJECTIVE: The objective of this study was to analyze and compare the distribution patterns of fentanyl, morphine, meperidine, and codeine in the continental US compared to Puerto Rico from 2018-2023. Attention was given to meperidine due to its extensive adverse effect profile and irreversible central nervous system toxicity.

METHODS: Data was collected from Automation of Reports and Consolidated Orders Systems (ARCOS). The dataset included annual distribution data for meperidine, fentanyl, morphine, and codeine in the US and Puerto Rico. Population data was collected from US Census data and the American Community Survey. Data analyses were conducted using Microsoft Excel Version 2410. For each opioid, the mean distribution and standard deviation (SD) were calculated for the continental US. The mean distribution in Puerto Rico was compared to the US mean distribution with a 95% confidence interval. ANOVA tests were performed to assess differences in distribution of each opioid across years (2018, 2020, and 2022) within the continental US. All descriptive statistics and ANOVA calculations were conducted with statistical significance determined at p < 0.05.

RESULTS: From 2018 to 2023, meperidine distribution declined in both regions but decreased more sharply in the continental US (82.6%) compared to Puerto Rico (43.5%). Distribution levels exceeded six standard deviations above the US mean in 2023. Fentanyl and morphine distributions were consistently lower in Puerto Rico than in the continental US.

CONCLUSION: There was a disproportionately high distribution of meperidine in Puerto Rico compared to the continental US across the years studied.

PMID:40532054

Biostatistics. 2024 Dec 31;26(1):kxaf016. doi: 10.1093/biostatistics/kxaf016.

ABSTRACT

In basket trials a single therapeutic treatment is tested on several patient populations simultaneously, each of which forming a basket, where patients across all baskets on the trial share a common genetic aberration. These trials allow testing of treatments on small groups of patients, however, limited basket sample sizes can result in inadequate precision and power of estimates. It is well known that Bayesian information borrowing models such as the exchangeability-nonexchangeability (EXNEX) model can be implemented to tackle such a problem, drawing on information from one basket when making inference in another. An alternative approach to improve power of estimates, is to incorporate any historical or external information available. This paper considers models that amalgamate both forms of information borrowing, allowing borrowing between baskets in the ongoing trial whilst also drawing on response data from historical sources, with the aim to further improve treatment effect estimates. We propose several Bayesian information borrowing approaches that incorporate historical information into the model. These methods are data-driven, updating the degree of borrowing based on the level of homogeneity between information sources. A thorough simulation study is presented to draw comparisons between the proposed approaches, whilst also comparing to the standard EXNEX model in which no historical information is utilized. The models are also applied to a real-life trial example to demonstrate their performance in practice. We show that the incorporation of historic data under the novel approaches can lead to a substantial improvement in precision and power of treatment effect estimates when such data is homogeneous to the responses in the ongoing trial. Under some approaches, this came alongside an inflation in type I error rate in cases of heterogeneity. However, the use of a power prior in the EXNEX model is shown to increase power and precision, whilst maintaining similar error rates to the standard EXNEX model.

PMID:40532037 | DOI:10.1093/biostatistics/kxaf016

J Am Heart Assoc. 2025 Jun 18:e039290. doi: 10.1161/JAHA.124.039290. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with acute coronary syndrome (ACS) are at high risk for recurrent cardiovascular events and bleeding complications, particularly in Asian populations. The long-term impact of multiple cardiovascular events and bleeding on outcomes remains unclear.

METHODS: Using Taiwan’s National Health Insurance Research Database, this retrospective cohort study included 28 086 patients with ACS categorized into single-event and multiple-event groups based on cardiovascular events occurring within 2 years of the index ACS event. After matching for age, sex, and event interval, 8756 patients were assigned to the multiple-event group and 17 446 to the single-event group.

RESULTS: The multiple-event group had higher comorbidity rates, including hypertension, prior coronary disease, heart failure, stroke, and chronic kidney disease. Over 5 years, the multiple-event group had significantly higher all-cause mortality (34.0% versus 24.0%) and cardiovascular mortality (11.2% versus 5.5%) compared with the single-event group (both P <0.0001). Major (8.4% versus 1.6%) and minor (35.5% versus 7.4%) bleeding rates were also higher (both P <0.0001). Notably, major bleeding persisted beyond 3 months in the multiple-event group, whereas the single-event group showed reduced bleeding after 1 month. In the multiple-event group, each additional major bleeding event was associated with earlier subsequent cardiovascular events (coefficient=-0.2875, P=0.0325).

CONCLUSIONS: Patients with ACS with multiple cardiovascular events have higher rates of all-cause mortality, cardiovascular mortality, and major bleeding than patients with ACS with a single cardiovascular event. Major bleeding may also be associated with the risk of subsequent cardiovascular events, highlighting the importance of implementing a tailored antiplatelet strategy in Asian populations.

PMID:40530479 | DOI:10.1161/JAHA.124.039290