Tag: pubmed

Radiol Oncol. 2025 Feb 27;59(1):43-53. doi: 10.2478/raon-2025-0014. eCollection 2025 Mar 1.

ABSTRACT

BACKGROUND: A considerable proportion of metastatic melanoma (mM) patients do not respond to immune checkpoint inhibitors (ICIs). There is a great need to develop noninvasive biomarkers to detect patients, who do not respond to ICIs early during the course of treatment. The aim of this study was to evaluate the role of early [¹⁸F]2fluoro-2-deoxy-D-glucose PET/CT (¹⁸F-FDG PET/CT) at week four (W4) and other possible prognostic biomarkers of survival in mM patients receiving ICIs.

PATIENTS AND METHODS: . In this prospective noninterventional clinical study, mM patients receiving ICIs regularly underwent ¹⁸F-FDG PET/CT: at baseline, at W4 after ICI initiation, at week sixteen and every 16 weeks thereafter. The tumor response to ICIs at W4 was assessed via modified European Organisation for Research and Treatment of Cancer (EORTC) criteria. Patients with progressive metabolic disease (PMD) were classified into the no clinical benefit group (no-CB), and those with other response types were classified into the clinical benefit group (CB). The primary end point was survival analysis on the basis of the W4 ¹⁸F-FDG PET/CT response. The secondary endpoints were survival analysis on the basis of LDH, the number of metastatic localizations, and immune-related adverse events (irAEs). Kaplan-Meier analysis and univariate Cox regression analysis were used to assess the impact on survival.

RESULTS: Overall, 71 patients were included. The median follow-up was 37.1 months (952% CI = 30.1-38.0). Three (4%) patients had only baseline scans due to rapid disease progression and death prior to W4 ¹⁸F-FDG-PET/CT. Fifty-one (72%) patients were classified into the CB group, and 17 (24%) were classified into the no-CB group. There was a statistically significant difference in median overall survival (OS) between the CB group (median OS not reached [NR]; 95% CI = 17.8 months – NR) and the no-CB group (median OS 6.2 months; 95% CI = 4.6 months – NR; p = 0.003). Univariate Cox analysis showed HR of 0.4 (95% CI = 0.18 – 0.72; p = 0.004). median OS was also significantly longer in the group with normal serum LDH levels and the group with irAEs and cutaneous irAEs.

CONCLUSIONS: Evaluation of mM patients with early ¹⁸F-FDG-PET/CT at W4, who were treated with ICIs, could serve as prognostic imaging biomarkers. Other recognized prognostic biomarkers were the serum LDH level and occurrence of cutaneous irAEs.

PMID:40014787 | DOI:10.2478/raon-2025-0014

Radiol Oncol. 2025 Feb 27;59(1):121-131. doi: 10.2478/raon-2025-0013. eCollection 2025 Mar 1.

ABSTRACT

BACKGROUND: Adrenocortical carcinoma (ACC) is a rare cancer that presents significant diagnostic and therapeutic challenges. We analyzed the management and estimated survival of ACC patients in Slovenia over a 17-year period.

PATIENTS AND METHODS: Patients registered in the National Cancer Registry and treated from 2000 to 2017 were included. The survival and prognostic factors were assessed using the Kaplan-Meier method and Cox regression, respectively.

RESULTS: Forty-eight patients were included in our analysis. At the time of diagnosis, 6%, 42%, 25% and 27% had stage according European Network for the Study of Adrenal Tumors (ENSAT) I, II, III and IV, respectively. Adjuvant treatment with mitotane was assigned to 18 of 34 potentially eligible patients. High-risk patients treated with adjuvant mitotane showed a reduced probability of death, although the difference was not statistically significant. Relapses had numerically higher rate of R1 resection and higher Ki67. Eleven patients underwent first-line therapy with etoposide, doxorubicin, cisplatin and mitotane (EDP-M). Their median progression-free survival was 4.4 months. The median overall survival of entire cohort was 28.9 and the median disease-specific survival (DSS) was 36.2 months. The 5-year DSS rate of ENSAT I, II, III and IV were 100%, 56%, 50% and 0%, respectively. The prognostic value of ENSAT stage and Helsinki score regarding overall survival was confirmed with the multivariate analysis.

CONCLUSIONS: The 5-year DSS of our ENSAT II patients was worse than reported in contemporary cohorts. Suboptimal surgery and inconsistent adjuvant therapy with mitotane might have contributed to this outcome. Better outcomes of this rare disease might be accomplished with dedicated teams including various specialties, working towards optimal staging, diagnostic and therapeutic measures.

PMID:40014786 | DOI:10.2478/raon-2025-0013

N Z Med J. 2025 Feb 28;138(1610):74-92. doi: 10.26635/6965.6714.

ABSTRACT

AIM: To explore the impact of COVID-19 protection measures on children’s respiratory health in Aotearoa New Zealand.

METHOD: Annual hospitalisation rates (2017/2018 to 2022/2023) for specific respiratory illnesses in children under age 15 years were calculated. Comparisons were made across time and age/sex/ethnicity groups.

RESULTS: Hospitalisation rates for respiratory illnesses were lower for all children in the years when COVID-19 protection measures were strictly enforced, followed by an increase in rates in subsequent years. There was an excess of hospitalisations for tamariki Māori and for Pacific children compared with non-Māori, non-Pacific children. Inequities in influenza that were present before the pandemic re-emerged rapidly following the relaxation of COVID-19 protection measures.

CONCLUSION: Reducing the burden of respiratory illness in children is a key challenge for health delivery in Aotearoa New Zealand. The re-appearance of inequities across outcomes and age groups following the relaxation or removal of COVID-19 protection measures indicates the need for an effective strategy that embeds learnings from our pandemic response.

PMID:40014773 | DOI:10.26635/6965.6714

N Z Med J. 2025 Feb 28;138(1610):52-59. doi: 10.26635/6965.6596.

ABSTRACT

AIM: To assess the hepatitis C virus (HCV) seroprevalence data for defined regions in New Zealand.

METHODS: Email or mobile phone text invitations were sent out to adults enrolled with three participating general practices in different parts of New Zealand. Patients who provided informed consent were instructed to self-present for HCV blood tests. Patients with positive HCV antibodies had reflex testing of HCV antigen and ribonucleic acid (RNA) viral load.

RESULTS: In total, 26,247 invitations were issued. Of these, 1,368 (5.2%) people gave informed consent and 1,021 patients (3.9%) had HCV blood tests. Ten out of 1,021 (0.98%; 95% confidence interval [CI] 0.51-1.82%) tested positive for HCV antibodies, of whom two (0.2%; 95% CI <0.01-0.76%) had positive antigen and elevated RNA viral load. The proportion of NZ Māori and Pacific people was low, at 3.8% and 0.4%, respectively. Volunteers with a high deprivation index were under-represented (3% from New Zealand Index of Deprivation deciles 9 and 10).

CONCLUSIONS: The HCV viraemia prevalence in this general practice-based screening programme is 0.2%, which is lower than previous estimates. This may have implications for appropriate resource allocations and the determination of the best strategies to find new HCV infections. Participation rates of people with high deprivation indexes or who were NZ Māori and Pacific people were low, suggesting that a tailored screening approach is needed.

PMID:40014771 | DOI:10.26635/6965.6596

N Z Med J. 2025 Feb 28;138(1610):39-51. doi: 10.26635/6965.6404.

ABSTRACT

AIM: To estimate the current prevalence of dysphagia in the Aotearoa New Zealand population and to project its prevalence to 2073.

METHODS: The current prevalence of dysphagia in Aotearoa New Zealand is computed from the prevalences of the aetiologies of dysphagia combined with the rates at which the aetiologies result in dysphagia. Projected dysphagia rates use autoregressive integrated moving average forecasting techniques combined with population projections from Statistics New Zealand and estimates of current and past prevalence rates of dysphagia.

RESULTS: The prevalence of dysphagia in Aotearoa New Zealand is estimated to have been approximately 1.78% in 2020, with the biggest aetiological contributors being stroke, Alzheimer’s disease and other dementias, and gastroesophageal reflux disease. These three causes made up 81.5% of all estimated dysphagia cases in 2019. The prevalence rate of dysphagia in Aotearoa New Zealand is projected to rise to 2.54%, reflecting the ageing population.

CONCLUSION: An increased prevalence of dysphagia will result in an increased healthcare burden, both from resources spent on treating dysphagia and complications stemming from undiagnosed and thus untreated dysphagia. Estimating the full extent of this increased burden is hampered by the absence of systematic, extensive and reliable records available relating to cases of dysphagia in Aotearoa New Zealand.

PMID:40014770 | DOI:10.26635/6965.6404

N Z Med J. 2025 Feb 28;138(1610):13-30. doi: 10.26635/6965.6801.

ABSTRACT

AIM: To characterise patient mortality risk following intensive care unit (ICU) admitted community-acquired sepsis (CAS) in Aotearoa New Zealand (Aotearoa), comparing in-hospital and post-discharge mortality and associated risk factors.

METHODS: We examined de-identified, linked ICU-admitted adult patient data from ICU sites in Aotearoa retrieved from the Australian and New Zealand Intensive Care Society’s CORE adult patient database (ANZICS-CORE-APD) between 2009 and 2019. Patients were followed from ICU admission to death or 365 days post-hospital discharge alive, using descriptive, survival and regression analyses. The outcomes of interest were in-hospital mortality and post-discharge mortality during the first 365 days.

RESULTS: In-hospital mortality was 16.3%. Post-discharge mortality was 3.6% by 30 days after discharge, 9.1% by 180 days and 12.9% by 365 days. There was no significant difference in in-hospital mortality risk by ethnicity or New Zealand Index of Deprivation quintile of usual residence. By contrast, significant differences in post-discharge survival were observed by ethnicity, area deprivation quintile and presence of severe comorbidities, particularly for Māori usually resident in high-deprivation areas.

CONCLUSIONS: There was no evidence of associations between in-hospital mortality and ethnicity or socio-economic deprivation; however, these associations become marked post-discharge. Interventions should be implemented to support early identification and management of CAS and address health inequities following hospital discharge.

PMID:40014768 | DOI:10.26635/6965.6801

J Prim Care Community Health. 2025 Jan-Dec;16:21501319251320181. doi: 10.1177/21501319251320181.

ABSTRACT

BACKGROUND: Readmission can be be related to the work of several stakeholders involved in the care of individuals throughout the community, including, for example, primary care and social care providers. A narrative review was performed to assess definitions and frequency of readmission for older adults found in previous research. In addition, a dataset for a cohort of older adults in Stockholm, Sweden, was used to quantify how different definitions of readmission affect frequency.

MATERIALS AND METHODS: The review was based on pre-specified search criteria within PubMed and Embase databases. All studies based on a cohort of older adults with a primary objective to assess readmission to inpatient care, were included for the assessment of readmission criteria. The dataset was based on a cohort of older adults treated at a geriatric department in Stockholm during 2016. Estimations of readmission were performed with the most common criteria found in the narrative review.

RESULTS: The narrative review showed that definitions of readmission included predominantly time-based criteria, either alone or combined with additional criteria such as medical condition or readmitting department. Frequency of readmission based on different definitions varied substantially; a 14-day time interval implied a rate of 8.0% whilst a 30-day interval-more commonly used-rendered a rate of 12.6%. The density of readmissions per day was higher during the first weeks after discharge, and then dropped continuously.

CONCLUSION: Transparency on definitions is imperative in studies that include rates of readmission. The levels of readmission rates are highly dependent on the study population and its context. Furthermore, the actual value of readmission monitoring is dependent on what purpose it is supposed to fulfill, and it is essential to put it into context of all relevant stakeholders including, for example, the primary care providers and different social care providers throughout the community.

PMID:40014763 | DOI:10.1177/21501319251320181

Scand J Pain. 2025 Feb 27;25(1). doi: 10.1515/sjpain-2024-0018. eCollection 2025 Jan 1.

ABSTRACT

OBJECTIVES: Chronic pain causes loss of workability, and pharmacological treatment is often not sufficient, whereas psychosocial treatments may relieve continual pain. This study aimed to investigate the effect of peer group management intervention among patients with chronic pain.

METHODS: The participants were 18-65-year-old employees of the Municipality of Helsinki (women 83%) who visited an occupational health care physician, nurse, psychologist, or physiotherapist for chronic pain lasting at least 3 months. An additional inclusion criterion was an elevated risk of work disability. Our study was a stepped wedge cluster, randomized controlled trial, and group interventions used mindfulness, relaxation, cognitive behavioral therapy, and acceptance and commitment therapy. We randomized sixty participants to either a pain management group intervention or to a waiting list with the same intervention 5 months later. After dropouts, 48 employees participated in 6 weekly group meetings. We followed up participants from groups A, B, and C for 12 months and groups D, E, and F for 6 months. As outcome measures, we used the pain Self-Efficacy Questionnaire, the number of areas of pain, the visual analog scale of pain, and the pain self-efficacy. We adjusted the results before and after the intervention for panel data, clustering effect, and time interval.

RESULTS: The peer group intervention decreased the number of areas of pain by 40%, from 5.96 (1-10) to 3.58 (p < 0.001), and increased the pain self-efficacy by 15%, from 30.4 to 37.5 (p < 0.001). Pain intensity decreased slightly, but not statistically significantly, from 7.1 to 6.8.

CONCLUSIONS: Peer group intervention for 6 weeks among municipal employees with chronic pain is partially effective. The number of areas of pain and pain self-efficacy were more sensitive indicators of change than the pain intensity. Any primary care unit with sufficient resources may implement the intervention.

PMID:40014757 | DOI:10.1515/sjpain-2024-0018

Womens Health (Lond). 2025 Jan-Dec;21:17455057251322815. doi: 10.1177/17455057251322815.

ABSTRACT

BACKGROUND: Women in couples experiencing infertility are at heightened risk for intimate partner violence (IPV) from husbands and domestic violence (DV) from family. Couples experiencing infertility in Jordan, a patriarchal culture with high rates of IPV and DV, are particularly vulnerable. This article explores the gendered similarities and differences in the experiences of mental health, social support, exclusion, and IPV.

OBJECTIVES: The objectives of this study are to understand both men and women’s perspectives on their experiences of infertility and to develop intervention strategies to reduce IPV among married couples experiencing infertility.

DESIGN: This study is a descriptive, observational study.

METHODS: Through quantitative surveys and in-depth qualitative interviews, we examined key themes including: challenges to mental health and well-being; reproductive health and fertility care-seeking; experiences of shame, isolation, and discrimination; coping skills; sources of support; and challenges within spousal and family relationships.

RESULTS: In this article, we analyze primary areas of gender discordance and discuss how gendered experiences can shape implementation of psychosocial support intervention programs to prevent IPV. Our findings provide important insight into facilitators and barriers to prevention of IPV in this vulnerable group.

CONCLUSION: We conclude that providing both women and men with culturally appropriate support during fertility treatment-seeking can improve psychosocial health and couple functioning and ultimately to reduce the occurrence of IPV in this vulnerable population.

PMID:40014755 | DOI:10.1177/17455057251322815

Telemed J E Health. 2025 Feb 27. doi: 10.1089/tmj.2025.0011. Online ahead of print.

ABSTRACT

Objective: The Health Resources and Services Administration (HRSA)-funded health centers provide critical behavioral health services to historically and medically underserved individuals with complex health and social needs. As health centers rapidly expanded telehealth in response to COVID-19, the objective of the study was to assess whether telehealth use was associated with utilization and continuity within mental health care received by patients of HRSA-funded health centers. Methods: Cross-sectional analyses, using a nationally representative sample of adult patients with mental health needs from the 2022 Health Center Patient Survey (n = 1,044), explored associations between telehealth use and utilization of mental health services from primary care providers (PCP) and continuity of counseling services. Multivariate logistic regression models accounted for predisposing, enabling, and need factors to assess the influence of telehealth use on utilization and continuity outcomes. Results: After adjusting for patient-level factors, telehealth users with mental health needs had statistically significant and higher odds of receiving mental health services from a PCP at a health center compared with nontelehealth users (adjusted odds ratios [aOR] = 2.60, p < 0.001; 95% confidence interval [CI] [1.50, 4.52]). Telehealth-using patients receiving counseling services had statistically significant and higher odds of receiving all counseling services at a health center compared with nontelehealth users (aOR = 3.65, p < 0.001, 95% CI [2.04, 6.53]). Conclusions: Telehealth facilitates mental health care utilization and continuity for historically and medically underserved patients at health centers and can be an important tool for care management and coordination for patients with mental health needs, particularly during and following public health emergencies.

PMID:40014364 | DOI:10.1089/tmj.2025.0011