Nevin Manimala

Rev Med Chil. 2023 Apr;151(4):453-460. doi: 10.4067/s0034-98872023000400453.

ABSTRACT

INTRODUCTION: Poisonings are a worldwide preventable public health problem that affects the general population.

OBJECTIVE: To epidemiologically characterize BZ and AD poisonings registered in Chile between 2002 and 2019.

METHODS: An observational retrospective study of poisonings registered in the medical outcome report system of the Chilean Ministry of Health was conducted. The World Health Organization International Classification of Disease codes T42.2, T43.0 and T43.2 were included.

RESULTS: 22,807 poisonings associated with BZ or AD were identified, representing 0.08% of all hospitalizations. Poisoning rates distribution were established at regional and national level. There were 9.8% of accidental events, 63.7% of intentional events, and 26.5% of undetermined cases. The highest accidental and intentional poisoning rates were estimated at the ages of 0 to 4 and 15 to 19 years old respectively. Poisoned patients remained hospitalized on average for 3.4 days. 0.3% of cases were related to death of patients.

CONCLUSIONS: Poisoning events were characterized according to the studied variables. National poisoning rates decreased over the years with prevalence of those intentional events linked to women. Efforts should be made in creating poisoning prevention campaigns focused on age-based groups in the general population.

PMID:38687520 | DOI:10.4067/s0034-98872023000400453

Rev Med Chil. 2023 Apr;151(4):435-445. doi: 10.4067/s0034-98872023000400435.

ABSTRACT

BACKGROUND: The increasing use of Mindfulness-based interventions requires standardized construct-based measurement instruments for clinical and research purposes. The Five Facet Mindfulness Questionnaire scale with five factors was developed in the United States and validated in Spain. There are versions of 39, 24 and 15 items (FFMQ-39, FFMQ-24 and FFMQ-15).

OBJECTIVE: To validate the FFMQ-24 and FFMQ-15 scale in Chile.

METHODOLOGY: Six experts performed a linguistic adaptation of the Spanish version of the FFMQ-24. The adapted instrument was applied to a sample of 795 physicians. Internal validity was analyzed by calculating Cronbach’s alpha (α) and confirmatory factor analysis (CFA). Finally, 15 items were retained, and the 5-factor solution was maintained. The FFMQ-15 scale was applied to a sample of 365 medical students and analyzed by calculating (α) and CFA. The external validity of FFMQ-15 was evaluated with the Mental Health Continiuum-14 (MHC-14) scale.

RESULTS: Linguistic changes were made. The CFA of FFMQ-24 obtained a lower-than-expected fit for a 5-factor solution. The (α) value varied between .68 and .86 in all dimensions. The FFMQ-15 had an adequate fit for five factors for physicians (c2 = 216.17, df = 80, p < .01; CFI = .96; TLI = .94; RMSEA = .05 [.04, .06]; SRMR = .04) and students (c2 = 163.61, df = 80, p < .01; CF = .96; TLI = .94; RMSEA = .05 [.04, .07]; SRMR = .05). External validity with MHC-14 was adequate.

CONCLUSION: The FFMQ-15 scale has acceptable internal consistency and adequate internal and external validity in Chile.

PMID:38687518 | DOI:10.4067/s0034-98872023000400435

Rev Med Chil. 2023 Apr;151(4):428-434. doi: 10.4067/s0034-98872023000400428.

ABSTRACT

BACKGROUND: HIV infection has sustained increased in the Chilean young population. In order to focus on sexual education in adolescents, it is first necessary to establish the degree of knowledge and risk behaviors in this group. Therefore, this study aimed to compare the degree of knowledge and HIV/AIDS risk behaviors in adolescents from rural and urban schools.

MATERIAL AND METHODS: The study included 385 adolescents between 14 and 18 years old. Through an anonymous survey, sociodemographic data, knowledge about HIV/ AIDS, risk behaviors, and ways of accessing information were collected.

RESULTS: A third of the adolescents surveyed (33.6%) reported having initiated sexual activity, primarily men. Rural students showed lower knowledge of HIV/AIDS. 32.2% of individuals who initiated sexual activity reported nonuse or rarely use of condoms, and only 4.4% of students have had an HIV detection/diagnostic test. Although the students had received information mainly from their teachers, they reported that if they needed help, they would go to health centers, youth programs, and, to a lesser extent, to teachers. They also preferred access to information in workshops, on the Internet, and social networks.

CONCLUSIONS: We observed regular knowledge of HIV/AIDS among adolescents. Rural students showed less knowledge and several risk behaviors. These findings emphasize the need to establish sexual education strategies in adolescents, considering the territory and the use of new technologies.

PMID:38687517 | DOI:10.4067/s0034-98872023000400428

Rev Med Chil. 2023 Apr;151(4):412-419. doi: 10.4067/s0034-98872023000400412.

ABSTRACT

INTRODUCTION: The distribution of causes of hyperferritinemia in international series is heterogeneous. Also, the association between ferritin and prognosis is controversial. This study aims to describe the diagnosis associated with hyperferritinemia in a retrospective cohort at an academic healthcare network in Chile.

METHODS: A retrospective review of adult patients admitted to our academic medical center from June 2014 to February 2017 with ferritin ≥3,000 ng/mL. All patients were classified into nine diagnostic categories. Then, the association between ferritin level and disease category, as well as mortality, was evaluated.

RESULTS: Ninety-nine patients were identified. The mean age was 50.8 ± 19.9 years, 54.5% were men. The most frequent categories were “inflammatory and autoimmune diseases” (21.2%) and “hematological malignancies” (19.2%). The average ferritin was 10,539 ± 13,016.9 ng/mL, while the higher mean was 16,707 ng/mL in the “inflammatory and autoimmune diseases” category. There was a statistically significant association between the ferritin value and age but not between ferritin and diagnostic categories. In the group over 50, hematologic neoplasms (19%) and infections (19%) were more frequent. In those under 50, inflammatory and autoimmune diseases were more frequent (26.8%). There was no association between the ferritin level and mortality at 1, 3, and 12 months.

CONCLUSIONS: The most frequent categories were “inflammatory and autoimmune diseases” and “hematological malignancies”, but ferritin level was similar in both. Further research could validate a prognostic role.

PMID:38687515 | DOI:10.4067/s0034-98872023000400412

Rev Med Chil. 2023 Apr;151(4):403-411. doi: 10.4067/s0034-98872023000400403.

ABSTRACT

BACKGROUND: The high prevalence of obesity, smoking, and physical inactivity in Chile despite government-sponsored measures and campaigns, along with others in the last 30 years, suggests additional reinforcement of these efforts at the primary care level.

OBJECTIVES: To determine if lifestyles and modifiable health risk factors in first-year students from the University of Chile Faculties of Medicine and Dentistry, potential future promoters of healthy lifestyles, show changes throughout their first academic year.

METHODS: In a randomized stratified sample of 388 students according to sex and chosen career weight, height, waist circumference, waist circumference-weight ratio, food consumption, smoking prevalence and dependence, alcohol use, perceived stress level, and physical activity were measured at the first week, 3 and 6 months after their admission. The Cochrane test assessed dichotomic variables, and the Friedman test was used for nonparametric values.

RESULTS: 253 students (186 women) completed the follow-up. A significant worsening of obesity (general and abdominal) and physical inactivity, persistent moderate and high-stress perception, and smoking prevalence were documented throughout the study period.

CONCLUSIONS: The progressive obesity and physical inactivity, high-stress perception, and persistent smoking prevalence in the first year of academic life suggest considering measures in the curricular academic structure that facilitate adjustments in the student’s lifestyles. Future follow-up of this cohort, increasing participants, and assessing students’ mental health are planned.

PMID:38687514 | DOI:10.4067/s0034-98872023000400403

Aging (Albany NY). 2024 Apr 29;16. doi: 10.18632/aging.205759. Online ahead of print.

ABSTRACT

Cholangiocarcinoma, a prevalent hepatic malignancy, exhibits a progressively rising incidence. While Eukaryotic translation initiation factor 3 subunit B (EIF3B) has been implicated in the occurrence and development of various cancers, its specific roles in cholangiocarcinoma remain unexplored. Immunohistochemical (IHC) analysis was employed to detect EIF3B/PCNA expression in cholangiocarcinoma. Cells were manipulated using short hairpin RNA (shRNA)-mediated lentiviruses or overexpression plasmids. Statistical significance was assessed using the Student’s t-test and one-way ANOVA, with P < 0.05 considered statistically significant. EIF3B exhibited robust expression in cholangiocarcinoma, demonstrating a significant correlation with the pathological grade of cholangiocarcinoma patients. Furthermore, modulation of EIF3B expression, either depletion or elevation, demonstrated the ability to inhibit or enhance cholangiocarcinoma cell survival and migration in vitro. Mechanistically, we identified Proliferating Cell Nuclear Antigen (PCNA) as a downstream gene of EIF3B, driving cholangiocarcinoma. EIF3B stabilized PCNA by inhibiting PCNA ubiquitination, a process mediated by E3 ligase SYVN1. Similar to EIF3B, PCNA levels were also abundant in cholangiocarcinoma, and knocking down PCNA impeded cholangiocarcinoma development. Intriguingly, silencing PCNA attenuated the promotion induced by EIF3B overexpression. Furthermore, the elevated P21 protein level in shEIF3B RBE cells was partially attenuated after UC2288 (P21 signaling pathway inhibitor) treatment. Our findings underscored the potential of EIF3B as a therapeutic target for cholangiocarcinoma. Unraveling its functions holds promise for the development of more specific and effective targeted therapy strategies.

PMID:38687509 | DOI:10.18632/aging.205759

JAMA. 2024 Apr 30. doi: 10.1001/jama.2023.25844. Online ahead of print.

ABSTRACT

IMPORTANCE: Breast cancer is a leading cause of cancer mortality for US women. Trials have established that screening mammography can reduce mortality risk, but optimal screening ages, intervals, and modalities for population screening guidelines remain unclear.

OBJECTIVE: To review studies comparing different breast cancer screening strategies for the US Preventive Services Task Force.

DATA SOURCES: MEDLINE, Cochrane Library through August 22, 2022; literature surveillance through March 2024.

STUDY SELECTION: English-language publications; randomized clinical trials and nonrandomized studies comparing screening strategies; expanded criteria for screening harms.

DATA EXTRACTION AND SYNTHESIS: Two reviewers independently assessed study eligibility and quality; data extracted from fair- and good-quality studies.

MAIN OUTCOMES AND MEASURES: Mortality, morbidity, progression to advanced cancer, interval cancers, screening harms.

RESULTS: Seven randomized clinical trials and 13 nonrandomized studies were included; 2 nonrandomized studies reported mortality outcomes. A nonrandomized trial emulation study estimated no mortality difference for screening beyond age 74 years (adjusted hazard ratio, 1.00 [95% CI, 0.83 to 1.19]). Advanced cancer detection did not differ following annual or biennial screening intervals in a nonrandomized study. Three trials compared digital breast tomosynthesis (DBT) mammography screening with digital mammography alone. With DBT, more invasive cancers were detected at the first screening round than with digital mammography, but there were no statistically significant differences in interval cancers (pooled relative risk, 0.87 [95% CI, 0.64-1.17]; 3 studies [n = 130 196]; I2 = 0%). Risk of advanced cancer (stage II or higher) at the subsequent screening round was not statistically significant for DBT vs digital mammography in the individual trials. Limited evidence from trials and nonrandomized studies suggested lower recall rates with DBT. An RCT randomizing individuals with dense breasts to invitations for supplemental screening with magnetic resonance imaging reported reduced interval cancer risk (relative risk, 0.47 [95% CI, 0.29-0.77]) and additional false-positive recalls and biopsy results with the intervention; no longer-term advanced breast cancer incidence or morbidity and mortality outcomes were available. One RCT and 1 nonrandomized study of supplemental ultrasound screening reported additional false-positives and no differences in interval cancers.

CONCLUSIONS AND RELEVANCE: Evidence comparing the effectiveness of different breast cancer screening strategies is inconclusive because key studies have not yet been completed and few studies have reported the stage shift or mortality outcomes necessary to assess relative benefits.

PMID:38687490 | DOI:10.1001/jama.2023.25844

JAMA Netw Open. 2024 Apr 1;7(4):e2411638. doi: 10.1001/jamanetworkopen.2024.11638.

NO ABSTRACT

PMID:38687485 | DOI:10.1001/jamanetworkopen.2024.11638

JAMA Netw Open. 2024 Apr 1;7(4):e248732. doi: 10.1001/jamanetworkopen.2024.8732.

ABSTRACT

IMPORTANCE: Individuals with dialysis-dependent kidney failure have numerous risk factors for medication-related adverse events, including receipt of care by multiple clinicians and initiation of some QT-prolonging medications with known risk of torsades de pointes (TdP), which is associated with higher risk of sudden cardiac death. Little is known about the prescription and dispensation patterns of QT-prolonging medications among people receiving dialysis, hindering efforts to reduce drug-related harm from these and other medications in this high-risk population.

OBJECTIVE: To examine prescription and dispensation patterns of QT-prolonging medications with known TdP risk and selected interacting medications prescribed to individuals receiving hemodialysis.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included patients 60 years or older who were enrolled in Medicare Parts A, B, and D receiving in-center hemodialysis from January 1 to December 31, 2019. Analyses were conducted from October 20, 2022, to June 16, 2023.

EXPOSURES: New-user prescriptions for the 7 most frequently filled QT-prolonging medications characterized by the timing of the new prescription relative to acute care encounters, the type of prescribing clinician and pharmacy that dispensed the medication, and concomitant use of selected medications known to interact with the 7 most frequently filled QT-prolonging medications with known TdP risk.

MAIN OUTCOMES AND MEASURES: The main outcomes were the frequencies of the most commonly filled and new-use episodes of QT-prolonging medications; the timing of medication fills relative to acute care events; prescribers and dispensing pharmacy characteristics for new use of medications; and the frequency and types of new-use episodes with concurrent use of potentially interacting medications.

RESULTS: Of 20 761 individuals receiving hemodialysis in 2019 (mean [SD] age, 74 [7] years; 51.1% male), 10 992 (52.9%) filled a study drug prescription. Approximately 80% (from 78.6% for odansetron to 93.9% for escitalopram) of study drug new-use prescriptions occurred outside of an acute care event. Between 36.8% and 61.0% of individual prescriptions originated from general medicine clinicians. Between 16.4% and 26.2% of these prescriptions occurred with the use of another QT-prolonging medication. Most potentially interacting drugs were prescribed by different clinicians (46.3%-65.5%).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, QT-prolonging medications for individuals with dialysis-dependent kidney failure were commonly prescribed by nonnephrology clinicians and from nonacute settings. Prescriptions for potentially interacting medications often originated from different prescribers. Strategies aimed at minimizing high-risk medication-prescribing practices in the population undergoing dialysis are needed.

PMID:38687480 | DOI:10.1001/jamanetworkopen.2024.8732

JAMA Netw Open. 2024 Apr 1;7(4):e248747. doi: 10.1001/jamanetworkopen.2024.8747.

ABSTRACT

IMPORTANCE: Area-level measures of sociodemographic disadvantage may be associated with racial and ethnic disparities with respect to receipt of treatment for metastatic renal cell carcinoma (mRCC) but have not been investigated previously, to our knowledge.

OBJECTIVE: To assess the association between area-level measures of social vulnerability and racial and ethnic disparities in the treatment of US Medicare beneficiaries with mRCC from 2015 through 2019.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included Medicare beneficiaries older than 65 years who were diagnosed with mRCC from January 2015 through December 2019 and were enrolled in fee-for-service Medicare Parts A, B, and D from 1 year before through 1 year after presumed diagnosis or until death. Data were analyzed from November 22, 2022, through January 26, 2024.

EXPOSURES: Five different county-level measures of disadvantage and 4 zip code-level measures of vulnerability or deprivation and segregation were used to dichotomize whether an individual resided in the most vulnerable quartile according to each metric. Patient-level factors included age, race and ethnicity, sex, diagnosis year, comorbidities, frailty, Medicare and Medicaid dual enrollment eligibility, and Medicare Part D low-income subsidy (LIS).

MAIN OUTCOMES AND MEASURES: The main outcomes were receipt and type of systemic therapy (oral anticancer agent or immunotherapy from 2 months before to 1 year after diagnosis of mRCC) as a function of patient and area-level characteristics. Multivariable regression analyses were used to adjust for patient factors, and odds ratios (ORs) from logistic regression and relative risk ratios (RRRs) from multinomial logistic regression are reported.

RESULTS: The sample included 15 407 patients (mean [SD] age, 75.6 [6.8] years), of whom 9360 (60.8%) were men; 6931 (45.0%), older than 75 years; 93 (0.6%), American Indian or Alaska Native; 257 (1.7%), Asian or Pacific Islander; 757 (4.9%), Hispanic; 1017 (6.6%), non-Hispanic Black; 12 966 (84.2%), non-Hispanic White; 121 (0.8%), other; and 196 (1.3%), unknown. Overall, 8317 patients (54.0%) received some type of systemic therapy. After adjusting for individual factors, no county or zip code-level measures of social vulnerability, deprivation, or segregation were associated with disparities in treatment. In contrast, patient-level factors, including female sex (OR, 0.78; 95% CI, 0.73-0.84) and LIS (OR, 0.48; 95% CI, 0.36-0.65), were associated with lack of treatment, with particularly limited access to immunotherapy for patients with LIS (RRR, 0.25; 95% CI, 0.14-0.43). Associations between individual-level factors and treatment in multivariable analysis were not mediated by the addition of area-level metrics. Disparities by race and ethnicity were consistently and only observed within the most vulnerable areas, as indicated by the top quartile of each vulnerability deprivation index.

CONCLUSIONS AND RELEVANCE: In this cohort study of older Medicare patients diagnosed with mRCC, individual-level demographics, including race and ethnicity, sex, and income, were associated with receipt of systemic therapy, whereas area-level measures were not. However, individual-level racial and ethnic disparities were largely limited to socially vulnerable areas, suggesting that efforts to improve racial and ethnic disparities may be most effective when targeted to socially vulnerable areas.

PMID:38687479 | DOI:10.1001/jamanetworkopen.2024.8747