Tag: pubmed

Clin Lymphoma Myeloma Leuk. 2024 Oct 2:S2152-2650(24)02356-5. doi: 10.1016/j.clml.2024.09.011. Online ahead of print.

ABSTRACT

BACKGROUND: Prognostic models in peripheral T cell lymphoma (PTCL) have identified biological factors including age, performance status, LDH, and BM involvement as prognostic for survival. The association of social determinants of health (SDH), on PTCL outcomes remains unexplored.

METHODS: To evaluate the impact of actionable SDH on PTCL mortality across race groups, we conducted a retrospective cohort study that included all White, Hispanic, Asian/Pacific Islander (PI) and Black adult patients with nodal PTCLs , diagnosed 2000-2020, in California. We utilized Chi² and Wilcoxon rank-sum tests for descriptive metrics and Kaplan-Meier statistics for mortality estimation. Regression models included patient- (age, sex, race, stage, Charlson Comorbidity Index, histology, treatment, academic center treatment, payer), and neighborhood-level factors (socioeconomic (SES) quintile, proportion without a high school diploma, and rural/urban). Risk factors significant in univariate regression of P < .10 were incorporated into the multivariable model.

FINDINGS: Our analysis included 6158 patients: 51.8% White, 25.8% Hispanic, 14.7% Asians/PI, and 7.6% Black. Hispanics exhibited the longest median survival (33 months) followed by Whites, Blacks, and Asian/PI (25, 20, and 14 months, respectively; P = .011). Risk factors independently associated with inferior lymphoma-specific survival (LSS) included Asian/PI compared with NH Whites (HR, 1.23; 95% CI, 1.10-1.34; P = .0002), AITL/ALCL compared with PTCL, NOS (AITL HR, 1.14; 95% CI, 1.02-1.25; P = .011; ALCL HR, 1.15; 95% CI, 1.04-1.26; P = .004), academic compared to nonacademic facility-type (HR 0.71; 95% CI, 0.64-0.77; P < .01), Medicare compared with uninsured (HR 1.48, 95% CI, 1.25-1.73; P < .01), and the lowest 3 compared to the highest education quartiles (Q2 HR 1.13; 95% CI, 1.01-1.25; P = .021; Q3 HR 1.14; 95% CI, 1.02-1.26; P = .018; Q4 HR 1.22; 95% CI, 1.08-1.36; P < .001). In the least resourced patients, histology, treatment, treatment facility-type, payer and education were independently prognostic for LSS. Academic center treatment was associated with a striking improvement in LSS (academic institution: yes = 101 months, no = 17 months; P < .01).

INTERPRETATION: Treatment facility-type, payer and education, areindependent actionable SDH for PTCL mortality. Treatment center-type had the strongest prognostic association with LSS, conferring a risk reduction of PTCL mortality by nearly 30%.

PMID:39477702 | DOI:10.1016/j.clml.2024.09.011

Clin Lymphoma Myeloma Leuk. 2024 Oct 9:S2152-2650(24)02358-9. doi: 10.1016/j.clml.2024.09.014. Online ahead of print.

ABSTRACT

INTRODUCTION: Obinutuzumab is hypothesized to improve progression-free survival (PFS) combined with bendamustine induction in mantle cell lymphoma (MCL). Measurable-residual disease (MRD) testing may predict benefit from maintenance therapy.

METHODS: Adults (≥ 18 years) with untreated MCL ineligible for intensive therapies received 4 to 6 cycles of bendamustine + obinutuzumab (BO) followed by consolidation obinutuzumab (CO). Restaging after CO included MRD assessment by next-generation sequencing of bone marrow aspirate (BMA) and peripheral blood (PB). Maintenance obinutuzumab (MO) was omitted for patients with imaging complete response (CR) and MRD-negativity in PB/BMA. All other patients received 8 cycles MO. Primary endpoint is PFS; secondary endpoints are response rates, overall survival, and estimation of MRD status.

RESULTS: Twenty-one patients enrolled, with median age 70 years and stage IV disease in 95%. Twenty patients completed BO; 10 patients received MO per protocol. Six patients did not complete MO due to progression (n = 4), infection (n = 1) and carcinoma (n = 1). Overall response is 95% (75% CR, 20% partial response). Concordance rate between post-consolidation MRD testing in PB and BMA was 70%. After a median follow-up of 43.9 months, median PFS is 46.5 months. The observed difference between 2-year PFS in groups receiving MO versus observation was not statistically significant (HR 0.45, 95% CI, 0.10-1.91). Most common grade 3/4 toxicities were neutropenia, leukopenia, and infections.

CONCLUSIONS: BO is a tolerable induction regimen with higher rates of CR compared with historical rates with bendamustine + rituximab. Omission of MO did not worsen outcomes in patients achieving MRD-negative status after nonintensive induction/consolidation therapy.

PMID:39477701 | DOI:10.1016/j.clml.2024.09.014

Pharmacoepidemiol Drug Saf. 2024 Nov;33(11):e70044. doi: 10.1002/pds.70044.

ABSTRACT

AIM: Benzodiazepine prescription is a growing phenomenon among the elderly population. However, information related to the frequency of these drugs among the elderly population attending in emergency departments (ED) and its impact over prognosis is scarce. The aim of this study is to assess the prevalence of benzodiazepine prescription and to analyze its association with short-term prognosis in elderly patients attended in ED.

METHODS: A retrospective analysis of the EDEN (Emergency Department Elderly in Need) cohort was conducted. This registry included all elderly patients attending in 52 Spanish EDs for any condition, between April 1st and 7th in 2019. Socio-demographic data, comorbidities, and medication were recorded by consulting the patient’s electronic health records. The assessed outcomes consisted on new ED visit, hospitalization, and mortality at 30 days after the first ED visit, associated with the use of benzodiazepines at baseline in comparison with no prescription of benzodiazepines. Crude and adjusted logistic regression analyses including patient’s comorbidities were performed. Two sensitivity analyses were performed considering concomitant prescription of other central nervous system depressants as well as direct discharge from the ED.

RESULTS: 25 557 patients were evaluated (mean age 78 [IQR: 71-84]). 7865 (30.8%) patients were taken benzodiazepines at admission. After adjustment for comorbidities and other central nervous system drugs, benzodiazepine prescription was associated with ED revisit [OR: 1.10 (95%CI: 1.03-1.18)]. Similar results were found in the sensitivity analysis, eliminating patients with central nervous depressors [OR: 1.11 (1.03-1.25)] and patients discharged to home [OR: 1.13 (1.04-1.23)]. No association was found between the use of these drugs and new hospitalizations [OR: 0.90 (0.77-1.05)] or mortality 30 days after discharge [OR: 1.01 (0.88-1.18)]. The results held for all three outcomes in the sensitivity analyses.

CONCLUSION: The use of benzodiazepines is a frequent phenomenon among the elderly population attended in the ED, being associated with an increased risk of new visits to the emergency room, but not with an increased risk of 30-day hospitalization or mortality.

PMID:39477694 | DOI:10.1002/pds.70044

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