Nevin Manimala

Pharmacoepidemiol Drug Saf. 2024 Nov;33(11):e70024. doi: 10.1002/pds.70024.

ABSTRACT

PURPOSE: Accurate identification of hepatic decompensation is essential for pharmacoepidemiologic research among patients with chronic liver disease.

METHODS: An algorithm using ≥ 1 inpatient or ≥ 2 outpatient International Classification of Diseases, 10th revision (ICD-10) codes for hepatic decompensation was developed in Veterans Health Administration data from October 2015 through July 2019. Medical records were reviewed by hepatologists to confirm cases. The positive predictive value (PPV) of the coding algorithm for confirmed hepatic decompensation was calculated.

RESULTS: Hepatic decompensation was confirmed in 149/185 records meeting the algorithm (PPV 81%; 95% CI, 70%, 90%). The most common hepatic decompensation diagnosis was ascites. Only 56% of confirmed cases had an accompanying diagnosis code for cirrhosis.

CONCLUSIONS: Our ICD-10-based coding algorithm identified hepatic decompensation with high PPV in Veterans Health Administration data.

PMID:39477692 | DOI:10.1002/pds.70024

Pharmacoepidemiol Drug Saf. 2024 Nov;33(11):e70025. doi: 10.1002/pds.70025.

ABSTRACT

PURPOSE: Uncontrolled hypertension causes significant morbidity and mortality worldwide. Several prescribing guidelines have been created to address this, however, prescriber adherence to guidelines is influenced by various sociodemographic patient factors. This study aims to determine the effects of these patient factors on prescriber adherence to antihypertensive prescription guidelines.

METHODS: A secondary analysis of data from the first wave of The Irish Longitudinal Study on Ageing (TILDA), was conducted. Participants were included if they reported previous hypertension diagnoses. Antihypertensive medication regimes were compared with the prescribing guidance in the 2011 NICE hypertension guidelines. The effects of patient sociodemographic factors on prescriber adherence to guidelines, and the effect of prescriber adherence on blood pressure control (≥ 140/90 mmHg), were determined using binomial logistic regression models.

RESULTS: A total of 2992 participants were included in this analysis; 54.9% female with mean age 65.7 years (±9.23). Male sex and older age, and lower socioeconomic status were associated with increased prescriber guideline adherence. Prescribers were less likely to adhere to guidelines in female patients ≥ 55 years (Relative Risk [RR] 0.75 [0.62, 0.91]), and female patients across all age groups (RR 0.80 [0.67, 0.95]). Better blood pressure control was seen with medication regimes adherent to prescription guidelines (140.38 (±18.98)/83.09 (±11.02) mmHg adherent vs. 141.66 (±19.86)/84.77 (±11.71) mmHg non-adherent).

CONCLUSIONS: This study highlights the effect of patient sex on prescriber adherence to antihypertensive prescription guidelines, emphasizing a larger issue of systemic undertreatment of females observed within healthcare. Further research is needed to determine the reasons for such differences in hypertensive care.

PMID:39477691 | DOI:10.1002/pds.70025

Pestic Biochem Physiol. 2024 Nov;205:106112. doi: 10.1016/j.pestbp.2024.106112. Epub 2024 Aug 31.

ABSTRACT

The carmine spider mite, Tetranychus cinnabarinus (Boisduval), is an important agricultural arthropod pest. This study investigated acaricide susceptibility differences between sexes to determine the biochemical mechanisms potentially involved in these differences. The susceptibility of females and males to seven acaricides (pyridaben, cyflumetofen, abamectin, chlorpyrifos, propargite, profenofos and fenpropathrin) was compared with laboratory bioassays. Males were more susceptible than females for each acaricide. Differences in the lethal concentration 50 % (LC₅₀) values between the sexes were observed to range from 2.04-fold to 6.05-fold. The surface area was markedly greater for females than males (by 1.87-fold) and the weight was significantly greater for females compared to males (by 4.67-fold). The specific surface area of male was 2.61-fold higher than that of female. There were no differences in the cuticle structure, whereas the thickness of females was 1.63-fold than that of males. The penetration rate of males was statistically significantly higher than that of females, both in pyridaben and cyflumetofen. Synergism experiments and biochemical assays suggested the involvement of the three detoxification enzyme systems in the sexual susceptibility of T. cinnabarinus. The activities of cytochrome P450 monooxygenases (P450s) (p < 0.01), glutathione-S-transferase (GSTs) (p < 0.05) and carboxylesterase (CarEs) (p < 0.05) in females were significantly higher than that in males. The results reveal that the individual size (specific surface area), cuticle thickness, and detoxification enzyme activity were involved in the sexual susceptibility to acaricides of T. cinnabarinus.

PMID:39477574 | DOI:10.1016/j.pestbp.2024.106112

Nurs Clin North Am. 2024 Dec;59(4):577-592. doi: 10.1016/j.cnur.2024.07.006. Epub 2024 Aug 30.

ABSTRACT

This scoping review delves into psychometric measures assessing the strong Black woman and superwoman constructs among African American women. It evaluates various scales, emphasizing their clinical relevance and implications for women’s health. By recognizing and addressing unique stressors faced by Black women, health care interventions can be tailored to promote holistic well-being and mitigate adverse health outcomes. The review underscores the necessity for culturally relevant stress measures in clinical practice to ensure equitable health care access and outcomes for this population.

PMID:39477565 | DOI:10.1016/j.cnur.2024.07.006

Lancet HIV. 2024 Nov;11(11):e746-e755. doi: 10.1016/S2352-3018(24)00240-6.

ABSTRACT

BACKGROUND: When used effectively, oral pre-exposure prophylaxis (PrEP; tenofovir disoproxil fumarate and emtricitabine) prevents maternal HIV acquisition and reduces the risk of vertical transmission. Our study aimed to better understand PrEP initiation, continued use, and adherence in pregnant and postpartum women.

METHODS: The PrEP in Pregnancy and Postpartum (PrEP-PP) study is a demonstration cohort study that enrolled pregnant women aged 16 years and older without HIV attending their first antenatal care visit in Cape Town, South Africa, between Aug 29, 2019, and Oct 10, 2021. Eligible, consenting women were followed up quarterly up to 12 months postpartum with regular HIV testing and offer of PrEP with ongoing adherence counselling. The primary outcome was distribution of women across the PrEP cascade (ie, initiation and continuation up to 12 months postpartum) with crude and adjusted hazard ratios (HRs). We also report on HIV incidence by pregnancy and postpartum status.

FINDINGS: Overall, 1195 pregnant women were recruited and followed up (median age 26 years, IQR 23-31; median gestational age 21 weeks, IQR 15-31); 1009 (84·4%) started PrEP at enrolment. Among women who initiated PrEP at enrolment, 668 (67·5%) of 990 continued PrEP at the 1-month follow-up, 485 (49·9%) of 972 continued at 3 months, 392 (39·4%) of 994 at 6 months, and 275 (27·4%) of 1005 at 12 months. Of 186 women who did not accept PrEP at enrolment, 70 (37·6%) of 186 subsequently initiated PrEP. Overall, 200 (18·6%) of 1076 women continued PrEP at 12 months postpartum. Of 186 women who did not initiate PrEP at baseline, 70 (37·6%) subsequently initiated PrEP during the study. Factors associated with PrEP discontinuation up to 12 months postpartum included being married or cohabiting (adjusted HR 1·32, 95% CI 1·16-1·50), condomless sex since last visit (1·43, 1·23-1·65), reporting intimate partner violence (2·03, 1·59-2·59), or depression in the past 12 months (1·53, 1·14-2·05). Overall, 16 women seroconverted over 1673·8 woman-years (HIV incidence rate 0·96 per 100 woman-years, 95% CI 0·49-1·42); 14 discontinued PrEP use and two never initiated PrEP. HIV incidence was 0·28 per 100 woman-years during pregnancy (95% CI 0·22-0·33), and the incidence rate ratio was 1·77 per 100 woman-years (0·53-5·90) 0-6 months postpartum and 2·19 per 100 woman-years (0·61-7·83) 6-12 months postpartum compared with pregnant women.

INTERPRETATION: There is an urgent need for the integration of PrEP into antenatal and postnatal care and interventions that address barriers to continued use, including targeted counselling during pregnancy and postpartum to reduce PrEP discontinuation.

FUNDING: National Institute of Mental Health and Fogarty International, US National Institutes of Health.

TRANSLATION: For the French translation of the abstract see Supplementary Materials section.

PMID:39477557 | DOI:10.1016/S2352-3018(24)00240-6

Nihon Eiseigaku Zasshi. 2024;79. doi: 10.1265/jjh.24004.

ABSTRACT

OBJECTIVES: The objectives of this study were to develop a Japanese version of the Pediatric Epilepsy Medication Self-Management Questionnaire Caregiver Version (PEMSQ-J) and to examine its reliability and validity.

METHODS: A quantitative cross-sectional study was conducted among primary caregivers (N=309) of children under the age of 18 taking epilepsy medication. The PEMSQ-J was the main instrument used to collect information such as basic demographics.Cronbach’s α was calculated to determine internal consistency, and the intraclass correlation coefficient was calculated to assess reproducibility. In addition, confirmatory factor analysis with covariance structure analysis was performed to confirm the goodness of fit of the model. Finally, criterion-related validity was confirmed.

RESULTS: Analysis of responses to items on the PEMSQ-J revealed no ceiling or floor effects, and there was no marked bias in distributions in terms of skewness or kurtosis. Internal consistency assessed with Cronbach’s α ranged from 0.847 to 0.935. A test of reproducibility revealed that the intraclass correlation for the total score was 0.730. Exploratory factor analysis identified two factors, which differed from the four factors in the original version. When their details and structure were examined, however, the two were interpreted as having a similar structure. Similarly to those of the original version, the goodness-of-fit indices for the four factors according to confirmatory factor analysis were close to the standard values.

CONCLUSION: The PEMSQ-J, which consists of 27 items with a four-factor structure, was statistically acceptable, and it was found to have a certain degree of reliability and validity.

PMID:39477524 | DOI:10.1265/jjh.24004

J Nucl Med. 2024 Oct 30:jnumed.124.268443. doi: 10.2967/jnumed.124.268443. Online ahead of print.

ABSTRACT

Multiparametric MRI (mpMRI) and prostate-specific membrane antigen (PSMA) PET/CT are complementary imaging modalities used in the presurgical evaluation of patients with prostate cancer (PCa). The purpose of this study was to characterize clinically significant PCa (csPCa) detected and not detected by PSMA PET/CT and mpMRI, focusing on tumors detected solely by PSMA PET/CT and overlooked by mpMRI. Methods: We conducted a single-center, retrospective analysis of patients who underwent both PSMA PET/CT and mpMRI within 3 mo of each other and before radical prostatectomy. Two nuclear medicine physicians and 2 radiologists, in a masked manner, independently contoured PCa lesions on PSMA PET/CT and mpMRI, respectively. A consensus read was done with a third reader for each modality, and a majority rule was applied (2:1). After centralized imaging, a pathologic review was done by a genitourinary pathologist. We assessed agreement between imaging modalities and correlation with pathology. Logistic regression models explored associations between clinicopathologic variables and tumor detection on imaging. Results: In total, 132 csPCa tumors from 100 patients were identified on surgical pathology. PSMA PET/CT showed higher lesion-level (87% vs. 80%) and patient-level (98% vs. 94%) sensitivity than mpMRI. Tumors detected on both imaging modalities were larger and had higher grade groups than those not detected by one or both imaging modalities. On multivariable analysis, csPCa tumors undetected by mpMRI but detected by PSMA PET/CT were smaller than those detected by both modalities. Most tumors showing aggressive pathologic features, such as the large cribriform pattern (94.7%) and the intraductal carcinoma (96%), were correctly detected by both imaging modalities. Limitations included selection bias in a surgical cohort. Conclusion: PSMA PET/CT tends to detect smaller csPCa not detected by mpMRI. Larger tumors on pathology with higher grade groups are more likely to be correctly detected by both imaging modalities. These findings provide insights for refining presurgical evaluation strategies in PCa.

PMID:39477501 | DOI:10.2967/jnumed.124.268443

J Nucl Med. 2024 Oct 30:jnumed.124.268277. doi: 10.2967/jnumed.124.268277. Online ahead of print.

ABSTRACT

It is well known that patients with liver metastasis from metastatic castration-resistant prostate cancer have poor or only transient responses to many forms of systemic therapy. Data on outcomes after treatment with [¹⁷⁷Lu]Lu-PSMA-617 (LuPSMA) are scarce. The VISION trial reports a hazard ratio for overall survival (OS) in the subgroup of patients with liver metastasis without disclosing the absolute duration of survival. Using real-world clinical data, we examined this important subgroup of patients, describing prostate-specific antigen (PSA) response and OS. Methods: A single-institution database was assembled to include all patients receiving LuPSMA at Mayo Clinic in Rochester, Minnesota, for whom treatment was initiated between March 2022 and March 2023. Baseline clinicopathologic and imaging characteristics were abstracted. Patients were then categorized by presence or absence of liver metastasis on pretreatment prostate-specific membrane antigen (PSMA) PET. PSA response and OS for the 2 groups (liver metastasis vs. no liver metastasis) were compared using χ² testing and the Kaplan-Meier method, respectively. A multivariate Cox regression analysis was performed, including established prognostic factors. Finally, those with pretreatment circulating tumor DNA as determined in an 83-gene panel were assessed for the presence of pathogenic and likely pathogenic alterations. These findings were summarized using descriptive statistics and compared between the 2 cohorts using the Fisher exact test. Results: The overall cohort consisted of 273 patients, including 43 (15.75%) with liver metastasis on pretreatment PSMA PET/CT. The median number of cycles received was 3 (range, 1-6) for patients with liver metastasis and 5 (range, 1-6) for those without hepatic involvement. The 50% or greater reduction in PSA from baseline response rate was lower for those with liver metastasis than for those without (30.23% [13/43] vs 49.77% [106/213], P = 0.019). At a median follow-up of 10 mo (interquartile range, 9-13 mo), there was a significant difference in median OS (8.35 mo vs. not reached, P < 0.001). On multivariate analysis, the presence of liver metastasis was independently associated with shorter survival (hazard ratio, 4.06; P < 0.001). Conclusion: Our data suggest that the presence of liver metastasis predicts poorer outcomes in patients receiving LuPSMA treatment. Alternative and combination approaches should be explored to maximize the antitumor activity of radiopharmaceutical therapy in the liver.

PMID:39477495 | DOI:10.2967/jnumed.124.268277

J Nutr Sci Vitaminol (Tokyo). 2024;70(5):422-429. doi: 10.3177/jnsv.70.422.

ABSTRACT

This study clarifies the association between disaster knowledge levels and beginning to stockpile food at home as a disaster preparedness. This survey was conducted between 18-20 December 2019 using a self-administered web-based questionnaire. The participants were recruited from panel members of an online survey company. A total of 1,200 adults living in the five Japanese prefectures with the highest predicted food shortages after the anticipated Nankai Trough earthquake, took part in the study. Multivariable logistic regression analyses revealed a significant positive relationship between disaster knowledge level and beginning food stockpiling (p for trend <0.001). Compared with those who had a low level of disaster knowledge, participants who had a medium level of knowledge were 2.11 times more likely to begin stockpiling food (adjusted odds ratio [OR]: 2.11, 95% confidence intervals [CI]: 1.49-2.97), whereas those with the highest knowledge level were 2.52 times more likely to begin stockpiling food (adjusted OR: 2.52, 95% CI: 1.79-3.56). Beginning food stockpiling can be the first step toward disaster preparedness. It is considered that people with low disaster knowledge levels are more likely to have no beginning food stockpiling and are at high risk for disasters. These findings suggest ways to approach prioritizing people facing high disaster risk.

PMID:39477479 | DOI:10.3177/jnsv.70.422

JMIR Pediatr Parent. 2024 Oct 30;7:e62878. doi: 10.2196/62878.

ABSTRACT

BACKGROUND: Autism spectrum disorder (ASD) can have traits that impact multiple domains of functioning and quality of life, which can persevere throughout life. To mitigate the impact of ASD on the long-term trajectory of an individual’s life, it is imperative to seek early and adequate treatment via scientifically validated approaches, of which applied behavior analysis (ABA) is the gold standard. ABA treatment must be delivered via a behavior technician with oversight from a board-certified behavior analyst. However, shortages in certified ABA therapists create treatment access barriers for individuals on the autism spectrum. Increased ASD prevalence demands innovations for treatment delivery. Parent-led treatment models for neurodevelopmental conditions are effective yet underutilized and may be used to fill this care gap.

OBJECTIVE: This study reports findings from a retrospective chart review of clinical outcomes for children that received parent-led ABA treatment and intends to examine the sustained impact that modifications to ABA delivery have had on a subset of patients of Montera, Inc. dba Forta (“Forta”), as measured by progress toward skill acquisition within multiple focus areas (FAs).

METHODS: Parents received ≥40 hours of training in ABA prior to initiating treatment, and patients were prescribed focused (<25 hours/week) or comprehensive (>25-40 hours/week) treatment plans. Retrospective data were evaluated over ≥90 days for 30 patients. The clinical outcomes of patients were additionally assessed by age (2-5 years, 6-12 years, 13-22 years) and utilization of prescribed treatment. Treatment encompassed skill acquisition goals; to facilitate data collection consistency, successful attempts were logged within a software application built in-house.

RESULTS: Improved goal achievement success between weeks 1-20 was observed for older age, all utilization, and both treatment plan type cohorts. Success rates increased over time for most FAs, with the exception of executive functioning in the youngest cohort and comprehensive plan cohort. Goal achievement experienced peaks and declines from week to week, as expected for ABA treatment; however, overall trends indicated increased skill acquisition success rates. Of 40 unique combinations of analysis cohorts and FAs, 20 showed statistically significant positive linear relationships (P<.05). Statistically significant positive linear relationships were observed in the high utilization cohort (communication with P=.04, social skills with P=.02); in the fair and full utilization cohorts (overall success with P=.03 for the fair utilization cohort and P=.001 for the full utilization cohort, and success in emotional regulation with P<.001 for the fair utilization cohort and P<.001 for the full utilization cohort); and in the comprehensive treatment cohort (communication with P=.001, emotional regulation with P=.045).

CONCLUSIONS: Parent-led ABA can lead to goal achievement and improved clinical outcomes and may be a viable solution to overcome treatment access barriers that delay initiation or continuation of care.

PMID:39476396 | DOI:10.2196/62878