Tag: nevin manimala

Pharmacogenet Genomics. 2025 Mar 21. doi: 10.1097/FPC.0000000000000564. Online ahead of print.

ABSTRACT

OBJECTIVE: Optimizing antiplatelet therapy is crucial in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary interventions (PCIs). This study aimed to assess the prevalence of CYP2C19 loss-of-function (LOF) variants and evaluate the clinical outcome of ticagrelor, clopidogrel, and aspirin in patients with ACS-PCI.

METHODS: This study included patients from the southern part of India (predominantly Tamil Nadu) with coronary artery disease and PCI. They were categorized based on their CYP2C19 LOF variants. Patients were further divided into group 1 (continued ticagrelor) and group 2 (switched to clopidogrel) and followed up for 40 months. The primary and secondary outcomes were evaluated.

RESULTS: A total of 287 patients were genotyped, 36.2% were normal, 46.3% were intermediate, and 17.5% were poor metabolizers, the predominant allele being CYP2C19*2. After considering only patients who underwent PCI and received ticagrelor, 111 patients were recruited. Ticagrelor was switched to clopidogrel in 45.9% of patients. No statistically significant differences in major adverse cardiovascular events or individual outcomes were observed among different metabolizer groups and patients switched from ticagrelor to clopidogrel. Intermediate metabolizers (IMs) exhibited a trend favoring ticagrelor continuation. Notably, discontinuation of aspirin in IM was linked to increased target vessel reintervention (TVR) in the clopidogrel-only group.

CONCLUSION: Our study provides preliminary evidence on favoring ticagrelor continuation and increased TVR upon aspirin withdrawal in IM.

PMID:40112230 | DOI:10.1097/FPC.0000000000000564

Prim Care Companion CNS Disord. 2025 Mar 20;27(2):24m03833. doi: 10.4088/PCC.24m03833.

ABSTRACT

Objective: To assess the relationship of perceived social support and pregnancy related anxiety (PRA) among third trimester pregnant women.

Methods: This was a cross-sectional observational study. The data were collected from July 2021 to March 2022. Study participants included a total of 124 antenatal women who were in their third trimester. PRA was assessed with the Perinatal Anxiety Screening Scale and Pregnancy Anxiety Questionnaire Revised 2. Perceived social support was measured using the Multidimensional Scale for Perceived Social Support (MSPSS). Adequate statistical analysis was done.

Results: Frequency of PRA in the study population was 40.3%. The total MSPSS scores and all its domains were significantly lower in the anxious group (total: P = .002, significant other: P = .006, family: P = .031, and friends: P = .004). PRA was significantly associated with lower perceived social support (P= .002), higher education level (P= .028), and higher number of antenatal visits (P= .031).

Conclusion: Late-pregnancy anxiety is linked to perceived social support, and specific PRA themes (delivery, body shape, and child health) correlate with distinct perceived social support domains.

Prim Care Companion CNS Disord 2025;27(2):24m03833.

Author affiliations are listed at the end of this article.

PMID:40112212 | DOI:10.4088/PCC.24m03833

N Z Vet J. 2025 Mar 20:1-10. doi: 10.1080/00480169.2025.2473347. Online ahead of print.

ABSTRACT

AIMS: To describe the current capacity, resource limitations and challenges of cat and kitten rescue organisations (CKR) in New Zealand; to document the source and destination of the animals cared for; and to explore the role of foster programmes in cat rescue and rehoming in New Zealand.

METHODS: A national cross-sectional survey was administered to companion animal rescue organisations in New Zealand in May 2022. For those engaged in CKR, the survey included questions about types and numbers of cats cared for, facilities, locations, origins and outcomes of cats in care, reasons for owner surrender, whether the CKR had a foster programme, and foster programme capacity. Descriptive statistics were provided for all quantitative study variables and free-text comments were analysed for common themes.

RESULTS: Of the 64 organisations that indicated they cared for cats on the broader companion animal rescue survey, 50 (78%) completed the questions on CKR. At the time of the survey, these 50 organisations cared for an estimated total of 6,206 cats (median 39 (IQR 17-96) cats per CKR). The highest reported source of animals was strays (median of the CKR’s reported percentage: 72%; IQR 50-93%), followed by surrendered animals (median 14.5%; IQR 5-31%). The most common reasons for owners surrendering animals were unplanned litters, lack of pet-friendly accommodation, and inability to afford to care for the animal’s daily needs. An estimated median of 66% (IQR 60-80%) of cats under care in the previous year were subsequently rehomed. Most CKR were “usually” (26/50; 52%) or “always” (11/50; 22%) full to capacity. The majority of CKR that responded operated a fostering programme (40/50; 80%), with an estimated 59% (3,619/6,206) of all cats currently in the care of CKR located in foster homes. The availability of fosterers was identified by CKR as the most important factor affecting their ability to accept animals.

CONCLUSIONS AND CLINICAL RELEVANCE: These findings highlight that CKR in New Zealand currently handle a large volume of animals each year. Initiatives that focus on preventing unplanned litters, ensuring owned free-roaming cats have permanent identification through microchipping, and initiatives to prevent unnecessary owner relinquishment may help to reduce the number of animals entering care. With the majority of CKR relying on foster programmes, there is a need for further research to better understand how these operate and whether there may be opportunities to expand their capacity.

PMID:40111413 | DOI:10.1080/00480169.2025.2473347

Prim Health Care Res Dev. 2025 Mar 20;26:e29. doi: 10.1017/S1463423625000222.

ABSTRACT

AIM: This study aims to assess the effect of primary health care (PHC) service provision continuity on inpatient admissions for people with chronic diseases in Estonia.

BACKGROUND: Non-communicable diseases (NCDs) were collectively responsible for more than 7 out of 10 deaths worldwide in 2019. As the burden of NCDs increases, PHC has an increased role of coordinating care management. High-performing PHC can reduce unnecessary hospitalizations. Estonia has a strong PHC system focusing on multidisciplinary care. Yet it has not been evaluated for its effect on hospitalizations. Therefore, it is imperative to evaluate PHC continuity to improve care for NCD patients.

METHODS: This study used routinely collected electronic medical billing data of the Estonian population aged 15 years or older from 2005 to 2020 identifying patients with seven ambulatory care sensitive chronic (ACSC) conditions. We developed an indicator to describe the continuity of PHC. Charlson Comorbidity Index (CCI) was used to assess the impact of comorbidities and we controlled the patient’s age, gender, county of residency and socio-economic status. We estimated multilevel logistic regression models with family doctor patient list random effects to assess how the odds of hospitalization depend on continuity of care, allowing for confounders.

FINDINGS: We identified that 45% of the adult Estonian population had at least one of the target diagnoses. Among the target population, 96% had contact with their PHC providers. We found that there is a non-linear relationship between PHC continuity and patient outcomes. Any contact with PHC provider during the past 5 years decreases odds for hospitalization, but hospitalization risk is higher for people who are elderly and have higher CCI score. We found that after accounting for patient characteristics, differences among patient lists minimally impact outcomes. Further research should explore policies to better support family doctors in reducing hospitalizations for chronic patients.

PMID:40111407 | DOI:10.1017/S1463423625000222

J Prim Care Community Health. 2025 Jan-Dec;16:21501319251326750. doi: 10.1177/21501319251326750. Epub 2025 Mar 20.

ABSTRACT

OBJECTIVE: The Wrightington, Wigan, and Leigh NHS Teaching Hospitals Foundation Trust (WWL) developed a novel virtual ward (VW) service that integrated with community and primary care, supported healthcare throughout a patient’s journey, and had a clinical workflow that could step-up or step-down care as needed. We described their VW and evaluated clinical outcomes, adherence, safety, and patient satisfaction.

METHODS: Retrospective, single-center study of patients admitted to the WWL VW service from January 14, 2022 to January 31, 2024. Clinical data collected by WWL in their database for patients admitted to the VW, were matched to data captured automatically by the Current Health (CH) platform linked to the CH remote monitoring kits assigned to patients on the VW. The CH kits enabled the VW care at WWL and included a wearable device for continuous vital signs monitoring, a blood pressure cuff, and tablet. Evaluation metrics included clinical scope, clinical outcomes, adherence, safety, and patient satisfaction.

RESULTS: There were 1835 admissions and a 93% match rate between the clinical and CH databases. About 38% of referrals were step-up (31% ambulatory care and 7% primary care) and 62% of referrals were step-down (100% inpatients). Most specialty referrals were from thoracic and acute medicine (77%). The median length of stay on the VW was 8 days [IQR 5-13], 209 (12%) admissions were escalated to the hospital, 179 (11%) escalated to the emergency department out of hours, and 29 (2%) signposted to urgent medical services. Adherence to the wearable device was 92%. There were 38 minor safety incidents (typically hypersensitivity reactions or administrative errors) and 17 expected deaths. About 94% of admissions rated the VW experience as “excellent” or “good.” Results were similar between step-up and step-down referrals.

CONCLUSION: We have shown the VW service yielded acceptable clinical outcomes, was safe with no serious adverse events or negative impact on mortality rate. Patient adherence to the technology and satisfaction with the VW service were high. The VW service was innovative in its acceptance of a broad range of patients, expanding services beyond respiratory medicine, and in developing a step-up pathway, preventing some patients from ever taking up an acute bed in the hospital.

PMID:40111405 | DOI:10.1177/21501319251326750

J Prev Interv Community. 2025 Mar 20:1-24. doi: 10.1080/10852352.2025.2480455. Online ahead of print.

ABSTRACT

Hyperlipidemia, a major risk factor for cardiovascular disease, disproportionately affects racial and ethnic minority populations. This cross-sectional study examined the prevalence and risk factors for hyperlipidemia among middle-aged adults in the United States using data from the fifth wave of the Adolescent to Adult Health Study (Add Health). The study analyzed merged sociodemographic and biomarker data (N = 4,196) using descriptive statistics and binary logistic regression. The mean age was 37.14 years (SD = ±1.99), with a slightly higher proportion of males (50.38%). The overall prevalence of hyperlipidemia was 16.26%, with higher rates observed in males (20.1%) compared to females. Notably, Asian individuals had significantly higher odds of hyperlipidemia (OR = 2.70, 95% CI: 1.28-5.65), whereas Black/African Americans had a significantly lower risk (OR = 0.57, 95% CI: 0.34-0.94) compared to Whites. Chronic health conditions, including hypertension (OR = 2.46, 95% CI: 1.72-3.52) and diabetes (OR = 4.95, 95% CI: 3.08-7.97), were strong predictors of hyperlipidemia. Additionally, individuals with higher income levels had increased odds of hyperlipidemia (OR = 1.10, 95% CI: 1.01-1.19). Contrary to prior research, obesity was not significantly associated with hyperlipidemia risk. Physical activity was marginally protective, though the effect lost significance in the adjusted model. These findings highlight the importance of targeted cardiovascular health interventions, particularly for Asian populations and those with chronic conditions, to reduce disparities in hyperlipidemia and improve public health outcomes.

PMID:40111399 | DOI:10.1080/10852352.2025.2480455

JAMA Netw Open. 2025 Mar 3;8(3):e251186. doi: 10.1001/jamanetworkopen.2025.1186.

ABSTRACT

IMPORTANCE: Immune checkpoint inhibitors (ICIs) have been approved for treatment of microsatellite instable (MSI-H) metastatic colorectal cancer (mCRC), but factors associated with receipt and efficacy of ICIs in routine clinical practice remain largely unknown.

OBJECTIVE: To identify factors associated with receipt of ICIs and associated survival outcomes among patients with mCRC in routine clinical practice.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used deidentified data from a nationwide electronic health record-derived database to include 18 932 patients diagnosed with mCRC between January 2013 and June 2019. Population-based patients were diagnosed with de novo mCRC and had at least 2 documented clinical visits on or after the date of diagnosis. The study analyses were performed between September 2020 and April 2021.

EXPOSURE: Patients received ICI therapy and/or chemotherapy as part of a systemic treatment for mCRC.

MAIN OUTCOMES AND MEASURES: The outcomes were receipt of ICI therapy, overall survival (OS), and time to treatment discontinuation (TTD).

RESULTS: In this cohort study of 18 932 patients diagnosed with mCRC (10 537 [55.7%] male; 546 [2.9%] Asian, 2005 [10.6%] Black or African American, 1674 [8.8%] Hispanic, 12 338 [65.2%] White, 4043 [21.4%] unknown race or ethnicity; median [IQR] age at metastatic diagnosis, 64.6 [55.0-73.3] years), patients with MSI-H tumors had a significantly higher probability of receiving ICIs than those with microsatellite stable (MSS) tumors (odds ratio [OR], 22.66 [95% CI, 17.30-29.73]; P < .001), whereas patients initially diagnosed with synchronous mCRC had significantly lower odds of receiving ICIs than patients with metachronous mCRC (OR, 0.57 [95% CI, 0.45-0.73]; P < .001). Patients with MSI-H tumors who received ICIs as first line of therapy had significantly longer OS than those receiving chemotherapy only (HR, 0.37 [95% CI, 0.25-0.56]; P < .001). Among patients with MSS tumors, ICI-based therapy was associated with significantly longer OS for patients with high albumin level (vs low: HR, 0.28 [95% CI, 0.18-0.45]; P < .001) and antibiotic use (vs nonuse: HR, 0.43 [95% CI, 0.27-0.67]; P < .001), but a significantly shorter OS for patients with synchronous mCRC (vs metachronous: HR, 1.90 [95% CI, 1.24-2.89]; P = .003). In addition, 29 out of 235 patients with MSS tumors (12.3%) experienced durable responses on ICI-based therapy. Similar patterns of associations with TTD were observed.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with mCRC, clinical characteristics were associated with different survival outcomes in patients treated with ICI-based therapy, with important clinical implications for patients with MSS tumors who are generally unresponsive to immunotherapy.

PMID:40111368 | DOI:10.1001/jamanetworkopen.2025.1186

JAMA Netw Open. 2025 Mar 3;8(3):e251271. doi: 10.1001/jamanetworkopen.2025.1271.

ABSTRACT

IMPORTANCE: Evidence from diverse global populations suggests that household food insecurity (HFI) is associated with adult disability, but the association between household water insecurity (HWI) and disability remains understudied. Examinations of the joint association of dual HFI and HWI with disability are lacking.

OBJECTIVE: To explore independent and joint associations of HFI and HWI with functional disability in Ecuadorian adults.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the 2018 Ecuadorian National Health and Nutrition Survey, a nationally representative, population-based survey conducted in Ecuador. The study included adults (aged 18-99 years) with information on sociodemographic characteristics, household food and water security, and functional disability status. Data were collected in 2 waves of the survey, from November 2018 to January 2019 and June to July 2019. Statistical analysis was performed from May to December 2024.

EXPOSURES: HFI, WFI, or both.

MAIN OUTCOMES AND MEASURES: The primary outcome was self-reported functional disability, assessed using the Washington Group Short Set on Functioning, a tool that uses a set of 6 questions to measure activity limitations.

RESULTS: Among 42 071 participants (mean [SE] age, 48.0 [0.1] years; 31 683 male [75.3%]; 1840 African descendant [4.4%], 5184 Indigenous [12.3%], and 35 047 Mestizo ethnic majority group [83.3%]), most lived in urban areas (26 164 participants [62.2%]). Exposure to HFI only was associated with an increased risk for any functional disability (adjusted relative risk [aRR], 1.44; 95% CI, 1.37-1.52), as well as sensory (aRR, 1.43; 95% CI, 1.35-1.52), physical (aRR, 1.56, 95% CI, 1.42-1.72), and cognitive (aRR, 1.78; 95% CI, 1.61-1.98) disabilities. HWI exposure only was associated with increased risk for any functional disability (aRR, 1.12; 95% CI, 1.06-1.20), as well as sensory (aRR, 1.17; 95% CI, 1.09-1.25), physical (aRR, 1.15; 95% CI, 1.05-1.26), and cognitive (aRR, 1.17; 95% CI, 1.03-1.34) disabilities. Exposure to dual HFI and HWI was associated with a greater increase in risk than HFI or HWI alone of any functional disability (aRR, 1.61; 95% CI, 1.50-1.72), as well as sensory (aRR, 1.65; 95% CI, 1.52-1.79), physical (aRR, 1.72; 95% CI, 1.59-1.87), and cognitive (aRR, 2.01; 95% CI, 1.76-2.29) disabilities.

CONCLUSION AND RELEVANCE: In this study, dual exposure to HFI and HWI was associated with a greater increase in risk of any and specific functional disabilities compared with independent contributions of HFI and HWI alone. These findings highlight the importance of addressing HFI and HWI jointly rather than independently when conducting research on disability and other health outcomes and in designing policies and programs to protect at-risk adults and their households.

PMID:40111365 | DOI:10.1001/jamanetworkopen.2025.1271

JAMA Netw Open. 2025 Mar 3;8(3):e251281. doi: 10.1001/jamanetworkopen.2025.1281.

ABSTRACT

IMPORTANCE: Emergency medical services (EMS) clinicians commonly care for patients with behavioral health emergencies (BHEs), including acute agitation. There are known racial and ethnic disparities in the use of physical restraint and chemical sedation for BHEs in emergency department settings, but less is known about disparities in prehospital use of restraint or sedation.

OBJECTIVE: To investigate the association of patient race and ethnicity with the use of prehospital physical restraint and chemical sedation during EMS encounters for BHEs.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide retrospective cohort study used data from EMS agencies across the US that participated in the 2021 ESO Data Collaborative research dataset. Emergency medical services encounters among patients aged 16 to 90 years with a primary or secondary impression, sign or symptom, or protocol use associated with a BHE from January 1 to December 31, 2021, were included. Statistical analysis was conducted from July 2023 to March 2024.

EXPOSURES: Patient race and ethnicity, which was categorized as Hispanic, non-Hispanic Black, non-Hispanic White, non-Hispanic other (American Indian or Alaska Native, Asian, Hawaiian Native or Other Pacific Islander, other, or multiracial), and unknown.

MAIN OUTCOMES AND MEASURES: The primary outcome was administration of any physical restraint and/or chemical sedation (defined as any antipsychotic medication, benzodiazepine, or ketamine).

RESULTS: A total of 661 307 encounters (median age, 41 years [IQR, 30-56 years]; 56.9% male) were included. Race and ethnicity were documented as 9.9% Hispanic, 20.2% non-Hispanic Black, 59.5% non-Hispanic White, 1.9% non-Hispanic other, and 8.6% unknown race and ethnicity. Restraint and/or sedation was used in 46 042 (7.0%) of encounters, and use differed across racial and ethnic groups (Hispanic, 10.6%; non-Hispanic Black, 7.9%; non-Hispanic White, 6.1%; non-Hispanic other, 10.9%; unknown race and ethnicity, 5.9%; P < .001). In mixed-effects logistic regression models accounting for clustering by EMS agency and adjusted for age, gender, urbanicity, and community diversity, patients who were non-Hispanic Black had significantly greater odds of being restrained or sedated across all categories compared with non-Hispanic White patients (eg, any restraint and/or sedation: adjusted odds ratio [AOR], 1.17 [95% CI, 1.14-1.21]; physical restraint: AOR, 1.22 [95% CI, 1.18-1.26]). There was no significant difference in adjusted odds of any restraint and/or sedation use for the remaining racial and ethnic groups compared to non-Hispanic White patients. Clustering was associated with agency-level variation in restraint or sedation use (intraclass correlation coefficient, 0.16 [95% CI, 0.14-0.17]).

CONCLUSIONS AND RELEVANCE: This nationwide retrospective cohort study of EMS encounters for patients with BHEs found differences in the use of prehospital restraint and/or sedation by patient race and ethnicity and an agency-level association with variation in restraint and/or sedation use. These data may inform improvements to protocols and training aimed at equitable care for BHEs.

PMID:40111364 | DOI:10.1001/jamanetworkopen.2025.1281

JAMA Netw Open. 2025 Mar 3;8(3):e251292. doi: 10.1001/jamanetworkopen.2025.1292.

ABSTRACT

IMPORTANCE: International guidelines use cancer antigen (CA) 125 thresholds to recommend which patients with pelvic masses should undergo evaluation by gynecologic oncologists for ovarian cancer. However, CA-125 thresholds were developed from White populations. If CA-125 levels differ among patient populations, current guidelines may contribute to delayed ovarian cancer diagnoses among women of other races and ethnicities than White.

OBJECTIVE: To examine CA-125 levels at ovarian cancer diagnosis by patient race and ethnicity and associations of elevated CA-125 levels with timely treatment.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included all patients with ovarian cancer diagnosed between January 1, 2004, and December 31, 2020, using the US National Cancer Database. The data analysis was performed between November 1, 2023, and July 10, 2024.

EXPOSURE: Patient race and ethnicity as identified in the National Cancer Database.

MAIN OUTCOME AND MEASURES: Cancer antigen 125 level was defined as elevated or borderline and negative or normal. Multivariable logistic regression models were used to examine the association of patient race and ethnicity with CA-125 level overall and for epithelial and high-grade serous cancers. Generalized linear models were used to examine the association of CA-125 level with days from diagnosis to chemotherapy start for patients with stage II to IV ovarian cancer.

RESULTS: Of the 250 749 patients with ovarian cancer diagnosed between 2004 and 2020 (median [IQR] age, 62.0 [52.0-73.0] years; 0.4% American Indian, 3.7% Asian, 8.6% Black, 85.2% White, and 2.0% other or unknown race and 6.7% Hispanic, 88.8% non-Hispanic, and 4.6% of unknown ethnicity), 212 477 had measured CA-125 levels, and 88.2% had an elevated CA-125 level at diagnosis. Patients with American Indian, Asian, or Black race were less likely to have an elevated CA-125 level at ovarian cancer diagnosis than White patients. In multivariable analyses adjusted for stage, comorbidities, and menopausal status, Black patients had lower odds of elevated CA-125 levels (adjusted odds ratio [AOR], 0.77; 95% CI, 0.74-0.81) compared with White patients, as did American Indian patients (AOR, 0.77; 95% CI, 0.62-0.94). Among patients with high-grade serous ovarian cancer only, Black patients had a lower odds of having an elevated CA-125 level at diagnosis (AOR, 0.81; 95% CI, 0.73-0.91). Patients with stage II to IV ovarian cancer with false-negative CA-125 findings at diagnosis had 9.38 days longer (95% CI, 8.43-10.34 days) to chemotherapy start compared with patients with an elevated CA-125 level.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with ovarian cancer, American Indian and Black patients were 23% less likely to have an elevated CA-125 level at diagnosis. Current CA-125 thresholds may miss racially and ethnically diverse patients with ovarian cancer. Work is needed to develop inclusive CA-125 thresholds and diagnostic guidelines and not compound disparities in ovarian cancer diagnosis and treatment.

PMID:40111363 | DOI:10.1001/jamanetworkopen.2025.1292