Nevin Manimala

Cancer. 2022 Oct 30. doi: 10.1002/cncr.34503. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer remains a leading cause of morbidity and mortality among women in the United States. Previous analyses show that breast cancer incidence increased from 1999 to 2018. The purpose of this article is to examine trends in breast cancer mortality.

METHODS: Analysis of 1999 to 2020 mortality data from the Centers for Disease Control and Prevention, National Center for Health Statistics, among women by race/ethnicity, age, and US Census region.

RESULTS: It was found that overall breast cancer mortality is decreasing but varies by race/ethnicity, age group, and US Census region. The largest decrease in mortality was observed among non-Hispanic White women, women aged 45 to 64 years of age, and women living in the Northeast; whereas the smallest decrease in mortality was observed among non-Hispanic Asian or Pacific Islander women, women aged 65 years or older, and women living in the South.

CONCLUSION: This report provides national estimates of breast cancer mortality from 1999 to 2020 by race/ethnicity, age group, and US Census region. The decline in breast cancer mortality varies by demographic group. Disparities in breast cancer mortality have remained consistent over the past two decades. Using high-quality cancer surveillance data to estimate trends in breast cancer mortality may help health care professionals and public health prevention programs tailor screening and diagnostic interventions to address these disparities.

PMID:36309838 | DOI:10.1002/cncr.34503

Diabetes Metab Res Rev. 2022 Oct 30:e3588. doi: 10.1002/dmrr.3588. Online ahead of print.

ABSTRACT

BACKGROUND: It remained unknown about the status of and trends in racial/ethnic subgroup reporting in the diabetes trials over the past two decades.

OBJECTIVES: In this survey, we aimed to evaluate the current state of and temporal trends in subgroup reporting by race/ethnicity regarding the effects of interventions in diabetes randomized controlled trials (RCTs) from year 2000 to 2020, and to explore the potential trial factors in relation to racial/ethnic subgroup reporting.

METHODS: We searched electronic databases for eligible diabetes RCTs. The outcome was whether the trials had the event of racial/ethnic subgroup reporting regarding the intervention effects on trial primary outcomes. Poisson regression was used to assess the temporal trends in racial/ethnic subgroup reporting, and univariable logistic regression models were employed for evaluating trial factors related to racial/ethnic subgroup reporting.

RESULTS: A total of 405 diabetes RCTs were eligible for inclusion. There were 26 (6.42%) trials with racial/ethnic subgroup reporting. A chronological trend towards increased rates of racial/ethnic subgroup reporting was observed; however the trend was not statistically significant (p = 0.07). Advanced patients’ age (Odds ratio [OR] = 2.92, 95% confidence interval [CI]: 1.24 – 6.88), follow-up duration (OR = 3.53, 95% CI:1.13 – 11.00) and BIPOC (Black, Indigenous, and People of Color) enrollment (OR = 2.39, 95% CI: 1.01 – 5.62) were found to positively relate with racial/ethnic subgroup reporting, while the industrial funding was associated with decreased reporting (OR = 0.43, 95% CI: 0.19 – 0.97). Less than one fourth of the trials with racial/ethnic subgroup reporting predefined the subgroup analysis.

CONCLUSIONS: The majority of diabetes RCTs did not report intervention effects by racial/ethnic subgroup, which was not temporally improved over the past two decades. More efforts and strategies are needed to improve the racial/ethnic subgroup consideration and reporting in diabetes trials. This article is protected by copyright. All rights reserved.

PMID:36309818 | DOI:10.1002/dmrr.3588

Occup Ther Health Care. 2022 Oct 29:1-18. doi: 10.1080/07380577.2022.2138675. Online ahead of print.

ABSTRACT

The purpose of this quasi-experimental pretest-posttest control group study was to examine the effect of group synchronous action observation/mental practice intervention compared to usual rehabilitation care on upper extremity motor recovery after stroke. The intervention group (n = 25) received usual care, consisting of a minimum of 3 hours of rehabilitation services per day, 5 days a week, plus group synchronous action observation/mental practice sessions 3 times per week and the control group (n = 26) received usual care. Outcome measures included the Kinesthetic and Visual Imagery Questionnaire Short Version (KVIQ-10), the Fugl-Meyer Assessment (FMA-UE) of affected upper extremity motor function only and The Box and Block Test (BBT). Although there were no statistically significant differences in upper extremity motor function between the two groups, a subgroup analysis of the intervention group identified statistically significant (FMA-UE: p < .001; BBT: p = .04) and Minimally Important Clinical Differences on upper extremity motor recovery between patients with behaviors demonstrating more versus less commitment to the intervention. Group synchronous action observation/mental practice is a promising intervention for patients demonstrating commitment to actively participating in the intervention to improve outcomes on upper extremity motor recovery after stroke.

PMID:36309807 | DOI:10.1080/07380577.2022.2138675

Pediatr Dent. 2022 Sep 15;44(5):363-367.

ABSTRACT

Purpose: The purpose of this study was to evaluate the surface roughness of three different brands of prefabricated pediatric zirconia crowns (ZRCs) following simulated toothbrushing with a variety of dentifrices. Methods: Ninety-six total maxillary right central incisor prefabricated pediatric ZRCs (n equals 32 ZRCs/brand) were obtained from the manufacturers: Kinder Krowns^®, NuSmile^®, and Sprig^®. ZRCs were equally assigned to dentifrices (n equals eight/dentifrice) with a variety of Relative Dentin Abrasion (RDA) values: Tom’s of Maine Children’s; Crest Kid’s; Prevident 5000; and Crest^® Pro-Health. ZRCs were brushed 10,000 strokes with a V-8 Toothbrushing Machine using the assigned dentifrices. Pre- and post-intervention data for the surface roughness of ZRCs, represented in Ra (average roughness) and Rz (mean roughness depth), were obtained using a stylus profilometer. Data were analyzed independently using two-way repeated measures analysis of variance with the Holm- Sidak method (α equals 0.05). Results: Baseline versus brushed Ra Kinder Krowns^® with Prevident and Sprig^® with Crest Kid’s indicated statistically significant differences. Sprig^® versus NuSmile^® utilizing Crest Kid’s were different in change in roughness. Both baseline and brushed NuSmile^® dentifrice options were different versus all Sprig^® and Kinder^® ZRCs. Conclusions: Despite statistical significance, changes in surface roughness were small in scale. Although this study did not address toothbrushing and different dentifrices may affect the mechanical properties, durability, and/or retention properties of ZRCs, the study’s results provide confidence to clinicians when using prefabricated pediatric ZRCs as a sustainable treatment option along with other restorative options, such as strip crowns and stainless steel crowns.

PMID:36309785

Pediatr Dent. 2022 Sep 15;44(5):340-344.

ABSTRACT

Purpose: The purpose of this retrospective cross-sectional study was to examine protective stabilization (PS) patterns before and after the availability of weighted blankets (WBs) as a behavioral guidance approach during in-office dental moderate sedation. Methods: A retrospective chart review evaluated pediatric patient sedation records after six-pound lead-free WBs were introduced into the dental clinic and compared clinical outcomes to a time before WBs were available. Multivariable logistic regression analyses assessed variables associated with the occurrence of PS use during a sedation visit. Results: PS (PS) usage decreased from 78.7 percent before to 32.8 percent after the availability of WBs during sedation visits (chi-square, P<0.001). Increase in age (adjusted odds ratio [OR] equals 0.69, 95 percent confidence interval [95% CI] equals 0.53 to 0.90, P=0.006) and WB use reduced PS management (adjusted OR equals 0.067, 95% CI equals 0.020 to 0.22, P<0.001). Body mass index, gender, treatment amount, and sedation regimen did not predict the occurrence of PS. The number of completed teeth treated was not found to be statistically different between cases managed with PS versus those managed without restraint. Children managed with PS but without WBs had statistically higher heart rate changes (20.26±23.17) during treatment than children managed without restraint (8.12±15.15). Conclusions: An increase in age and weighted blanket use was associated with a reduction in the occurrence of protective stabilization during moderate sedation dental visits at the university pediatric dental clinic. Clinical practice sedation protocols should consider weighted blanket use as an alternative to PS.

PMID:36309778

Rev Diabet Stud. 2022 Sep 28;18(3):140-145. doi: 10.1900/RDS.2022.18.140.

ABSTRACT

OBJECTIVE: Non-alcoholic fatty liver disease (NAFLD) is recognized as a common cause of chronic liver disease worldwide. Its association with type 2 diabetes mellitus (T2DM) is known to increase the risk of degenerative complications of diabetes and the likelihood of developing severe hepatic injuries. The objective of this study was to assess the prevalence of NAFLD and to describe the characteristics of its association with T2DM. METHODS: This was a descriptive analytical study, involving patients with T2DM with no history of alcohol consumption, viral hepatitis, hepatotoxic medications, or other chronic liver diseases. The patients underwent an investigation of NAFLD including abdominal ultrasound, non-invasive biomarkers of liver fibrosis, elastography and ultrasound-guided liver biopsy. RESULTS: We collected data from 180 patients with a mean age of 59.3 ± 10.9 years with strong female predominance. The mean duration of diabetes progression was 9.2 ± 7.3 years. Hepatic sonography showed signs of NAFLD in 45.6% of cases. Non-invasive hepatic biomarkers indicated significant fibrosis in 18.3% of cases. Overall, 21% of patients underwent an elastography evaluation, revealing severe fibrosis or cirrhosis in 15.4% of patients. The diagnosis of NASH (Non-alcoholic steatohepatitis) was confirmed histologically in 3 patients. The overall prevalence of NAFLD was 45.6%. Patients with NAFLD had a statistically significant incidence of obesity, metabolic syndrome, hypertension, dyslipidemia, macrovascular complications, and hypertriglyceridemia (p < 0.05). CONCLUSIONS: The combination of NAFLD and T2DM is often found in patients with obesity or metabolic syndrome. The presence of NAFLD can be responsible for increased morbidity and important cardiovascular risks in patients with T2DM.

PMID:36309775 | DOI:10.1900/RDS.2022.18.140

Rev Diabet Stud. 2022 Sep 28;18(3):152-156. doi: 10.1900/RDS.2022.18.152.

ABSTRACT

OBJECTIVE: We evaluated glycemic control among T1DM pediatric patients attending the endocrinology pediatrics clinics at King Fahd Hospital of the University (KFHU) prior to and during COVID-19 restraining regulations. In addition, we assessed the trends and variations in the incidence of T1DM during 2017-2021, including the COVID-19 years by identifying newly diagnosed patients presenting to pediatrics emergency department (ED) in KFHU. METHODS: To estimate the effect of COVID-19 on the incidence of T1DM, we identified newly diagnosed cases of T1DM among pediatric patients attending the ED during the years 2017- 2021. The participants’ data were collected through electronic medical records. Information collected included patient age, sex, and HbA1c readings. Three HbA1c readings of interest that were defined and collected are pre-COVID reading, in-COVID reading, and post-COVID reading. RESULTS: The difference of female participants’ readings was statistically non-significant (Z= -0.416, p = 0.678), with a pre- and post-COVID median of 10.70 (Q1= 9.00, Q3= 12.15), and 10.50 (Q1= 8.80, Q3= 12.35), respectively. In contrast, the difference was statistically significant among male participants (Z= -2.334, p = 0.02), with a pre- and post-COVID median of 10.20 (Q1= 8.70, Q3= 11.80), and 10.65 (Q1= 9.00, Q3= 12.70), respectively. There was a statistically significant increase in HbA1c of persons > 11 years old (Z= -2.471, p= 0.013), with a pre- and post-COVID median of 10.40 (Q1= 9.00, Q3= 12.10), and 10.90 (Q1= 9.00, Q3= 12.60), respectively. Conversely, persons ≤ 11 years old showed no statistically significant change in HbA1c (Z= -.457, p= 0.648), with a pre- and post-COVID median of 10.45 (Q1= 8.70, Q3= 11.85), and 10.20 (Q1= 8.40, Q3= 12.075), respectively. Disregarding any influence of time, the effect of sex showed no statistically significant difference in HbA1c between males and females [F (1,125) = 0.008, p = 0.930]. Meanwhile, the age effect on HbA1c, regardless of time influence, was statistically significant [F (1,125) = 4.993, p = 0.027]. There was no statistically significant interaction between time and sex on HbA1c levels [F (1.74, 217) = 0.096, p = 0.883] and between age and time [F (3.92,289.57) = 1.693, p = 0.190]. CONCLUSIONS: The number of visits to healthcare facilities dropped significantly during the COVID-19 pandemic, but the rate of newly diagnosed T1DM increased. There was a variable effect on HbA1c levels of those patients, which suggests that each demographic group in the population might have been affected differently by the pandemic. Future research should determine factors associated with better glycemic control and measures to sustain these changes the pandemic might have created.

PMID:36309774 | DOI:10.1900/RDS.2022.18.152

Sr Care Pharm. 2022 Nov 1;37(11):565-570. doi: 10.4140/TCP.n.2022.565.

ABSTRACT

Objective To describe the impact of consultant pharmacist recommendations on the frequency of pneumococcal vaccines administered to older people admitted to a long-term care facility (LTCF). Design: Retrospective observational study. Setting: LTCF with skilled and intermediate level care. Participants: Adult patients newly admitted to a LTCF in Southwestern Pennsylvania between December 1, 2016, and November 30, 2017, and between January 1, 2018, and December 31, 2019, were included. Interventions The intervention in the study was a consultant pharmacist-driven immunization screening service that was implemented as part of the admission medication review process in January 2018. To assess the impact of the service, the pneumococcal immunization rates of patients who were candidates for pneumococcal vaccination were compared between two patient cohorts who were defined by exposure to the immunization needs assessment and subsequent recommendations by a consultant pharmacist. Results A total of 468 patient admissions were included, with 68 in Cohort 1 and 400 in Cohort 2. Pneumococcal immunization rate, calculated as number of pneumococcal vaccinations administered over the number of admissions eligible for pneumococcal vaccination, had a statistically significant increase (1.9%-20.2%; P < 0.05). Conclusion The recommendations from a consultant pharmacist as a result of an immunization needs assessment upon admission to a LTCF significantly contributed to an increased rate of pneumococcal immunizations. Further investigation is warranted to evaluate future strategies to reduce vaccination refusals.

PMID:36309764 | DOI:10.4140/TCP.n.2022.565

J Cannabis Res. 2022 Oct 29;4(1):56. doi: 10.1186/s42238-022-00165-6.

ABSTRACT

BACKGROUND: In the UK, legislation and regulations governing medical cannabis and over the counter cannabidiol (CBD) wellness products have rapidly evolved since 2018. This study aimed to assess the public awareness of the availability, regulations, and barriers to access medical cannabis and over the counter CBD wellness products.

METHODS: A cross-sectional survey study was performed through YouGov® using quota sampling methodology between March 22nd and March 31st 2021. Responses were matched and statistically weighted to UK adult population demographics, including those without internet access, and analysed according to percentage of respondents. Statistical significance was defined by p-value < 0.050.

RESULTS: Ten thousand six hundred eighty-four participants completed the survey. 5,494 (51.4%) respondents believed that medical cannabis is legal in the UK. 684 (6.4%) participants consumed CBD for wellness reasons, 286 (2.7%) were prescribed CBD for a medical reason and 222 (2.1%) consumed CBD for another reason. 10,076 (94.3%) respondents were unaware of April 2021 regulations meaning that all over the counter CBD wellness products in the UK must conform to European Novel Foods Regulations. The most frequently reported main barriers to accessing medical cannabis were its association with recreational cannabis (n = 2,686; 25.1%), being unsure if it was legal (n = 2,276; 21.3%) and being unsure what medical conditions its can be used for (n = 1,863; 17.4%).

CONCLUSION: A large proportion of respondents are unaware of the legislation and regulations surrounding medical cannabis and over the counter CBD wellness products. Lack of knowledge may present a barrier to safe access to either product.

PMID:36309761 | DOI:10.1186/s42238-022-00165-6

J Pharm Policy Pract. 2022 Oct 29;15(1):74. doi: 10.1186/s40545-022-00465-5.

ABSTRACT

BACKGROUND: Reforms to models of health and care regulation internationally have adapted to address the challenges associated with regulating healthcare professionals. Pharmacists in Ireland entered a new era of regulation with the enactment of the Pharmacy Act in 2007 which significantly updated the law regulating pharmacy in Ireland and expanded the regulatory scope considerably. An earlier study in 2017 examined the experiences of 20 community pharmacists of the Act. This follow-up study aimed to expand the scope of the original study to all community pharmacists in Ireland, to report their “lived experience” of the regulatory model introduced by the Act, assessing its impact on their professional practice using the principles of “better regulation”.

METHODS: Survey methodology was used to assess the perception of all community pharmacists registered with the Pharmaceutical Society of Ireland of the Act, as implemented, on their practice using an experimental design based on the seven principles of “Better Regulation”. Descriptive statistics analyzed quantitative responses while answers from open-ended questions were analyzed using a combination of a modified framework analysis and a qualitative content analysis.

RESULTS: Respondents agreed that the Act was necessary, although its implementation by the regulator was largely not viewed as fulfilling the remaining “Better Regulation” principles of being effective, proportional, consistent, agile, accountable and transparent. In particular, its proportionality was questioned. This resulted in pharmacists perceiving that their professional competency to act in the best interests of their patients was not appropriately acknowledged by the regulator, which in turn compromised their ability to provide optimal care for their patients.

CONCLUSION: While healthcare professional regulation must primarily be concerned with public protection, it must also have regard to its impact on those delivering healthcare services. The findings highlight the challenge internationally of balancing rigidity and flexibility in professional health and care regulation, and the importance of a regulatory conversation occurring between those regulating and those regulated. This would serve to promote mutual learning and understanding to create a responsive approach to regulation, underpinned by mutual trust, effective risk assessment and adherence to the principles of “Better Regulation”.

PMID:36309758 | DOI:10.1186/s40545-022-00465-5