Nevin Manimala

JCO Glob Oncol. 2025 Feb;11:e2400313. doi: 10.1200/GO-24-00313. Epub 2025 Feb 20.

ABSTRACT

PURPOSE: Ovarian cancer remains among the most aggressive tumors with the lowest survival probability. Projections are that ovarian cancer will claim more than 8 million lives between 2022 and 2050 without better prevention or control measures.

METHODS: We built an Excel-based instrument that uses a prevalence-based cost-of-illness approach and a societal perspective to estimate the burden of ovarian cancer. The instrument leverages data from editions of the World Ovarian Cancer Coalition’s Every Woman Study, contains a micro-costing framework to assess the resources and costs of providing care, and uses data from novel systematic reviews and meta-analyses conducted to estimate the effect of ovarian cancer on patient labor productivity outcomes and the time caregivers devote to caring for people living with the disease.

RESULTS: Across 11 countries, we estimated US dollars 70 billion in socioeconomic losses attributable to ovarian cancer. Health expenditures to cover treatment in the first 2 years after diagnosis were 7, 41, and 118 times total health spending per capita in high-, upper-middle-, and low- and lower-middle countries, respectively. Patients spent 3,663 years traveling to or receiving treatment. Women lost labor productivity equivalent to 2.5 million workdays due to ill-health from ovarian cancer, and 9,403 women living with ovarian cancer or survivors were estimated to be missing from the workforce. Caregivers spent 17,112 person-years providing practical support to patients-an average of 33 days per woman living with ovarian cancer.

CONCLUSION: This study is the first to quantify the social and economic burden of ovarian cancer in 11 countries and highlights its significant cost and defines actions needed to improve ovarian cancer outcomes.

PMID:39977710 | DOI:10.1200/GO-24-00313

JCO Glob Oncol. 2025 Feb;11:e2400340. doi: 10.1200/GO-24-00340. Epub 2025 Feb 20.

ABSTRACT

PURPOSE: Triple-negative breast cancer (TNBC) presents notable treatment difficulties, especially in the public health care systems of low- and middle-income countries where access to advanced therapies is restricted. This study investigates TNBC’s clinical, epidemiologic, and economic effects on survival within Brazil’s public health care system.

METHODS: We conducted a retrospective cohort study of patients with TNBC treated between 2010 and 2019. Overall survival (OS) rates by stage were analyzed across various patient groups, including those receiving neoadjuvant or adjuvant treatment, patients with or without complete pathologic response, Black and non-Black patients, and those treated with or without carboplatin-based therapy. Cox proportional hazards models were applied to estimate hazard ratios (HRs) with 95% CIs, and annual treatment costs were calculated per stage.

RESULTS: Among 1,266 patients with TNBC, 710 met eligibility criteria. Kaplan-Meier analysis indicated stage II patients had a 47% lower mortality risk than stage III (HR, 0.53 [95% CI, 0.33 to 0.85]; P = .009). Patients in the adjuvant treatment group had a reduced risk (HR, 0.48 [95% CI, 0.34 to 0.69]) compared with the neoadjuvant group. Achieving complete pathologic response (pCR) greatly improved OS (HR, 0.21 [95% CI, 0.11 to 0.43]; P < .001). Black patients had better survival rates than non-Black (HR, 0.58 [95% CI, 0.40 to 0.86]; P = .006). Carboplatin use did not significantly affect OS (HR, 0.96 [95% CI, 0.65 to 1.43]; P = .857). The average monthly cost for systemic TNBC treatment increased with disease progression, from $101.87 in US dollars (USD) for stage I to $314.77 USD for stage IV second-line therapy.

CONCLUSION: This study provides insight into TNBC in Brazil’s public health system, showing that OS decreases with disease progression but is higher among Black patients. pCR and adjuvant therapy improve survival, although costs increase significantly at advanced stages, highlighting the economic burden of late-stage TNBC management.

PMID:39977709 | DOI:10.1200/GO-24-00340

Nurse Educ. 2025 Mar-Apr 01;50(2):84-89. doi: 10.1097/NNE.0000000000001772. Epub 2024 Nov 12.

ABSTRACT

BACKGROUND: Interprofessional team training (IPTT) prepares students from health care professions for team-based care. Evaluating different learning environments to inform decisions about delivery format is timely and important.

PURPOSE: To compare in-person and online IPTT learner outcomes.

METHOD: Undergraduate and graduate students (n = 866) from 11 professions participated. Using retrospective pre-/post-methodology, 20 item Interprofessional Collaboration Competency Attainment Survey (ICCAS) scores were compared, and qualitative responses analyzed.

RESULTS: Mean ICCAS scores improved for in-person and online delivery (P < .0001) with large effect sizes (Cohen’s D = 0.94-1.86). In-person delivery resulted in greatest improvement (P = .038), offset by online logistical benefits. Qualitative themes highlighted impact on learning, importance of facilitator competence, and setting expectations.

CONCLUSION: IPTT achieved learning consistent with competency development. Advantages from in-person delivery should be weighed against online logistical advantages.

PMID:39977695 | DOI:10.1097/NNE.0000000000001772

Nurse Educ. 2025 Mar-Apr 01;50(2):79-83. doi: 10.1097/NNE.0000000000001770. Epub 2024 Nov 12.

ABSTRACT

BACKGROUND: Seventeen percent of individuals in the United States live with substance use disorder (SUD). Nursing curricula may not adequately address SUD, and stigma can impact care.

PURPOSE: This project aimed to measure stigma toward people with SUD among nursing students.

METHODS: Surveys were administered to prelicensure nursing students. Stigma was measured using the Opening Minds Provider Attitudes Toward Opioid-Use Scale. Students were asked about personal experience with SUD and perceived adequacy of SUD-related curricula.

RESULTS: A total of 193 students participated. The mean stigma score was 31.35. Those with personal experience had lower stigma scores than those without ([95% CI 2.26-9.23]; P value = .0014). Most students (71.0%) desired to see content from individuals with lived experience incorporated into curriculum.

CONCLUSION: Addressing stigma in SUD education is critical for improving future patient care. Nursing schools should consider incorporating stigma-reducing content, including perspectives from individuals with lived experiences, into SUD curricula.

PMID:39977694 | DOI:10.1097/NNE.0000000000001770

Psychol Methods. 2025 Feb 20. doi: 10.1037/met0000730. Online ahead of print.

ABSTRACT

Confirmatory bifactor models have become very popular in psychological applications, but they are increasingly criticized for statistical pitfalls such as tendency to overfit, tendency to produce anomalous results, instability of solutions, and underidentification problems. In part to combat this state of affairs, many different reliability and dimensionality measures have been proposed to help researchers evaluate the quality of the obtained bifactor solution. However, in empirical practice, the evaluation of bifactor models is largely based on structural equation model fit indices. Other critical indicators of solution quality, such as patterns of general and group factor loadings, whether all estimates are interpretable, and values of reliability coefficients, are often not taken into account. In addition, in the methodological literature, some confusion exists about the appropriate interpretation and application of some bifactor reliability coefficients. In this article, we accomplish several goals. First, we review reliability coefficients for bifactor models and their correct interpretations, and we provide expectations for their values. Second, to help steer researchers away from structural equation model fit indices and to improve current practice, we provide a checklist for evaluating the statistical fit of bifactor models. Third, we evaluate the state of current practice by examining 96 empirical articles employing confirmatory bifactor models across different areas of psychology. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:39977687 | DOI:10.1037/met0000730

Salud Publica Mex. 2024 Apr 29;66(3, may-jun):256-266. doi: 10.21149/15253.

ABSTRACT

OBJECTIVE: To estimate usual intake and the prevalence of excessive intake (PE) and insufficient intake (PI) of trans fatty acids (FAs) and other dietary FAs in the Mexican adult population in 2012 and 2016, and to compare these time points.

MATERIALS AND METHODS: Data were collected through dietary recall using the five-step multiple-pass method of the 2012 and 2016 Mexican National Health and Nutrition Surveys. Prevalences were estimated using the Iowa State University method. Linear and logistic regressions were used for analytic comparisons.

RESULTS: Both in 2012 and 2016, we observed high PE in trans FA, saturated FA, and total fat. High PI was found for polyunsaturated FA, omega 6, omega 3, Eicosapentaenoic Acid (EPA) + Docosahexaenoic Acid (DHA). In 2016, PE was lower in trans FAs (29.1 vs. 38.4%), total fat (14.9 vs. 17.8%), saturated FAs (45.6 vs. 54.6%). PI was also lower in omega 3 FA (90.7 vs. 92.8%), omega 6 FA (39.8 vs. 62.2%), and EPA + DHA FA (96.3 vs. 99.6%; p<0.05) (p<0.05) vs 2012.

CONCLUSION: Mexican adults showed notably high PE in trans FA, saturated FA, and total fat, as well as high PI in polynsaturated FA, omega 6, omega 3, and EPA. Given the associated health risks, it is critical to implement nutrition policies that regulate trans and saturated FAs in Mexico and faciliate improved dietary quality towards more polyunsaturated and omega 3 FAs, and less trans and saturated FAs.

PMID:39977071 | DOI:10.21149/15253

Salud Publica Mex. 2024 Jan 26;66(2, mar-abr):119-129. doi: 10.21149/14856.

ABSTRACT

OBJECTIVE: To compare Covid-19 risk factors, self-reported Covid-19 testing and infection, and Covid-19 vaccination among H-2A workers and agricultural workers without H-2A visas.

MATERIALS AND METHODS: Farmworkers completed surveys at randomly selected sites in five U.S. states from March – August 2022. Descriptive statistics and bivariate analyses were conducted for key characteristics and outcomes.

RESULTS: A total of 532 H-2A workers and 748 non-H-2A workers participated in the surveys. H-2A workers had significantly higher Covid-19 primary vaccine series uptake than non-H-2A workers (94.7 vs. 65.9%). More than one in four H-2A workers (29.6%) continued working while ill or positive with Covid-19. Fewer H-2A than non-H-2A workers reported receiving a Covid-19 test (51.5 vs. 59.2%, respectively) and a positive test result for Covid-19 (24.5 vs. 44.9% among those tested).

CONCLUSIONS: Although H-2A workers had a lower self-reported prevalence of Covid-19 and higher Covid-19 primary vaccine series uptake than non-H-2A workers, findings such as reporting to work while ill or positive for Covid-19 indicate areas for improvement by binational public health leaders.

PMID:39977040 | DOI:10.21149/14856

Am J Hypertens. 2025 Feb 20:hpaf026. doi: 10.1093/ajh/hpaf026. Online ahead of print.

ABSTRACT

INTRODUCTION: Evidence on left ventricular (LV) mechanics, assessed by speckle tracking echocardiography (STE), in children and adolescents with elevated blood pressure (BP)/hypertension is scanty.

AIM: The aim of the present meta-analysis was to provide an updated information on LV systolic function phenotyped by global longitudinal strain (GLS) and LV ejection fraction (LVEF) in the setting of pediatric hypertension.

METHODS: Following the PRISMA guidelines, systematic searches were conducted across bibliographic databases (Pub-Med, OVID, EMBASE and Cochrane Library) to identify eligible studies from inception up to November 30th 2024. Clinical studies reporting data on LV mechanics in pediatric hypertension and controls were included. The statistical difference of the echocardiographic variables of interest between groups such as LVEF and GLS was calculated by standardized mean difference (SMD) with 95% confidence interval (CI) using random-effects models.

RESULTS: Eight studies including 719 individuals with elevated BP/hypertension and 1653 age-matched healthy controls were considered for the analysis. Pooled average LVEF values were 72.4±1.6% in the healthy control group and 72.5±1.8% in the elevated BP/hypertensive group (SMD: 0.08±0.15,CI: -0.21/0.36, p=0.60); the corresponding values of GLS were -19.6±1.1% and 18.5±0.9% (SMD:-0.96±0.25, CI: -1.46/-0.47, p< 0.0001). A parallel impairment of global circumferential strain (GCS) also emerged from pooled data of 3 studies (SMD: -0.96±0.25, CI: -1.46/-0.47, p< 0.0001).

CONCLUSIONS: Our data suggest that LVEF is unable to detect early alterations in systolic function in pediatric hypertension, and the implementation of STE may be highly useful in unmasking systolic dysfunction in this setting.

PMID:39977013 | DOI:10.1093/ajh/hpaf026

Am J Respir Crit Care Med. 2025 Feb 20. doi: 10.1164/rccm.202411-2169OC. Online ahead of print.

ABSTRACT

RATIONALE: Extended continuous positive airway pressure (eCPAP) in the neonatal intensive care unit (NICU) for stable preterm infants increases lung volumes. Its effect on lung growth after discharge is unknown.

OBJECTIVE: To assess whether 2-weeks of eCPAP in stable preterm infants is associated with increased alveolar volume (V_A) at 6-months corrected age.

METHODS: Randomized controlled trial conducted at Oregon Health & Science University. Outpatient assessors unaware of treatment assignment. 100 infants randomized to eCPAP versus CPAP discontinuation (dCPAP) to room air.

MEASUREMENTS: The primary outcome was V_A by the single breath hold technique at 6-months corrected age. Secondary outcomes included lung diffusion capacity to carbon monoxide (D_L) and forced expiratory flows (FEFs). Functional residual capacity (FRC) was measured in the NICU.

MAIN RESULTS: Infants randomized to eCPAP (n=54) versus dCPAP (n=46) had the following measurements shown as adjusted mean [SE] : V_A (500.2 [24.9 ] vs 418.1 [23.4] mL; adjusted mean difference, 82.1 [ 95% CI, 8.3-155.9]; p =0.033); D_L (3.4 [0.2] vs 2.8 [0.1] mL/min/mmHg; adjusted mean difference, 0.6 [95% CI, 0.1-1.1]; p = 0.018); FEF₅₀ (500.6 [18.2] vs 437.9 [17.9] mL/sec; adjusted mean difference, 62.7 [95% CI 4.5-121.0]; p = 0.039); FEF_25-75 (452.0 [17.4] vs 394.4 [17.4] mL/sec; adjusted mean difference, 57.5 [95% CI 1.3-113.8]; p=0.046).

CONCLUSIONS: Infants randomized to eCPAP vs dCPAP had significantly increased V_A at 6-months corrected age. D_L and FEFs were also increased. Extending CPAP in stable preterm infants in the NICU may be a non-pharmacologic and safe therapy to promote lung growth. Clinical trial registration available at www.

CLINICALTRIALS: gov, ID: NCT04295564.

PMID:39977011 | DOI:10.1164/rccm.202411-2169OC

Clin Exp Rheumatol. 2025 Feb 13. doi: 10.55563/clinexprheumatol/4g8g9q. Online ahead of print.

ABSTRACT

OBJECTIVES: Rheumatoid arthritis (RA) is a prevalent autoimmune disorder. This study examines the comparative efficacy of Janus kinase inhibitors (JAKi) and adalimumab (ADA) in managing RA.

METHODS: As of May 2024, four electronic databases were systematically reviewed: PubMed, Web of Science, Embase, and the Cochrane Library. Data were analysed using Review Manager (RevMan) software. The risk ratio (RR) and its 95% confidence interval (CI) represented dichotomous outcomes. Evaluated outcome measures included ACR20, ACR50, ACR70, Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), and Disease Activity Score 28-4 (C-reactive protein) (DAS28-4(CRP)).

RESULTS: The analysis encompassed 6 studies, totalling 4048 patients with RA. There was no statistically significant difference in efficacy between JAKi and ADA when assessing ACR20 (p=0.25) and DAS28-4(CRP) (p=0.57). However, JAKi demonstrated superior efficacy compared to ADA for ACR50 (RR=1.20; p=0.02), ACR70 (RR=1.24; p=0.03), CDAI (RR=1.17; p=0.01), and SDAI (RR=1.19; p=0.006) outcomes. Longitudinal analysis revealed that over a 52-week period, JAKi did not exhibit superior efficacy to ADA for ACR50 (RR=1.16; p=0.19) and ACR70 (RR=1.10; p=0.26). Specifically, the tofacitinib subgroup outperformed ADA (RR=1.49; p=0.003), while other JAKi treatments did not show a significant difference (RR=1.19; p=0.11) compared to ADA.

CONCLUSIONS: JAKi generally offers better efficacy than ADA in the treatment of RA, though this advantage appears to be influenced by the duration of treatment.

PMID:39977004 | DOI:10.55563/clinexprheumatol/4g8g9q