Tag: pubmed

J Womens Health (Larchmt). 2024 Aug 23. doi: 10.1089/jwh.2024.0248. Online ahead of print.

ABSTRACT

Background: Ovarian aging, often leads to increased use of a donor oocyte, which is associated with greater risk for age-related diseases. Objective: To evaluate the association between women conceiving through oocyte donation (OD) and future cancer-related morbidity, as compared with women conceiving through IVF (in vitro fertilization) with autologous oocytes (AO), spontaneous conceptions (SC), and nulliparas. Methods: This retrospective, cohort study was based on the electronic health records of a very large health maintenance organization. The cohort included mothers who delivered before age 45, during 2000-2019. The index date for surveillance was the delivery date of the relevant pregnancy. Each woman from the OD group was matched to a woman the same age at delivery and with the same number of children. Cancer diagnosis was the main outcome. Results: Matching: 664 OD cases to 664 AO, 700 OD cases to 700 SC, and 700 OD cases to 700 nulliparas. Mean follow-up times were 8.9 ± 3.8 OD, 10 ± 4.1 AO, and 6.4 ± 4.1 years SC. Cancer-related morbidity rates were comparable between OD and the other groups, but compared with nulliparas, a trend was noted (1.6% and 3.1%, respectively, p = 0.07). Survival analysis curves were not significantly different, although a trend was shown in the curve comparing to nulliparity (p = 0.07). In a Cox regression model corrected for BMI, smoking and hormone replacement therapy exposure, cancer in the OD group did not differ compared to the other groups. Conclusion: Women conceiving through OD do not have increased risk for cancer-related morbidity in the decade following delivery.

PMID:39177947 | DOI:10.1089/jwh.2024.0248

Clin Transl Oncol. 2024 Aug 23. doi: 10.1007/s12094-024-03620-3. Online ahead of print.

ABSTRACT

BACKGROUND: The predictive role of exosomal programmed cell death ligand l (exoPD-L1) in prognosis has been studied extensively; however, there is still no consensus.

METHODS: Three databases, including EMBASE, PubMed, and Web of Science, were searched through January 4, 2024. The pooled hazard ratios (HRs) with 95% confidence intervals (95%CIs) were used to identify the relationship between circulating exoPD-L1 and prognosis.

RESULTS: 15 studies with 1091 patients with cancer were included in this statistical analysis. High exoPD-L1 level was correlated with shorter progression-free survival (PFS) (HR = 2.58, 95% CI: 1.75-3.81) and overall survival (OS) (HR = 1.61, 95% CI: 1.32-1.98). Meanwhile, we found that dynamic upregulation of circulating exoPD-L1 in the early stages of immunotherapy was a favorable factor for prognosis (PFS: HR = 0.34, 95% CI: 0.23-0.51; OS: HR = 0.21, 95% CI: 0.13-0.26).

CONCLUSION: Circulating exoPD-L1 may be a valuable prognostic indicator for patients with cancer and monitoring its changes in the early stages of immunotherapy might be used to predict tumor response and clinical outcome. This conclusion may not apply to superficial tumors.

PMID:39177941 | DOI:10.1007/s12094-024-03620-3

Res Health Serv Reg. 2024 Mar 27;3(1):3. doi: 10.1007/s43999-024-00040-2.

ABSTRACT

INTRODUCTION: Hypertension is a widespread and life-threatening condition globally, with its prevalence increasing rapidly, particularly among adults. This study aims to examine the trend in adult hypertension prevalence and associated risk factors in both urban and rural areas of Bangladesh from 2011 to 2018.

METHODS: Nationally representative cross-sectional data from the Bangladesh Demographic and Health Survey was used at two time points, 2011 and 2018. In our study, we used a two-step approach for variable selection, combining traditional statistical methods ( ${\chi }^2$ test) with a machine learning algorithm (Boruta algorithm).. This study also employed two different multivariate binary logistic regression models to identify the risk factors that are most closely connected to the presence of hypertension (respectively for urban and rural locations).

RESULTS: According to the study, hypertension has been on the rise in Bangladesh. In 2011, over a third of adults (38.7%) in urban Bangladesh had hypertension, a number that rose by 22.6% in 2017-18. Though rural areas had a lower hypertension prevalence in 2011 (36%), it surged to 64% in 2017-18, surpassing the rate in urban areas. The results of the multivariate analysis showed that age, gender, education, wealth status, area, and survey year had a significant influence on the determinants of hypertension status in connection to place of residence. According to the odds ratio, the prevalence was significantly higher among older respondents, female respondents, wealthy families and higher-educated respondents.

CONCLUSION: A large proportion of Bangladesh’s adult population suffers from hypertension. A health education program is required to develop appropriate strategies, including appropriate weight control, appropriate physical activity, and healthier eating habits. Health authorities should take initiatives to spread awareness among people, particularly at an older age.

PMID:39177903 | DOI:10.1007/s43999-024-00040-2

Res Health Serv Reg. 2024 Apr 24;3(1):6. doi: 10.1007/s43999-024-00042-0.

ABSTRACT

INTRODUCTION: Most new-born babies are born at home in rural communities which is not new phenomenon due to lack of access to primary healthcare services and trained skilled health attendants, exposing mothers and children to a high risk of labour complications. The purpose of this study was to better understand factors influence rural women’s access to primary health care and skilled delivery services as well as their reasons for using or not using maternal health care and skilled delivery services.

METHODS: The study employed a social survey design with a quantitative approach to data analysis. Cluster Sampling was used, possibly based on rural communities, to efficiently collect data from different geographic locations. Simple random sampling individuals from each cluster ensures that all eligible individuals have an equal chance of being included in the study. This enhances the representativity of the sample. A total of 366 mothers were selected from four rural communities in the North East Region of Ghana. The choice of sample size considered factors like the study’s objectives, available resources, and the desired level of statistical power. Data was primarily gathered through the administration of a questionnaire to the respondents. Factors considered for achieving representativity include, geographic representation, accessibility, healthcare infrastructure and healthcare professionals’ attitudes.

FINDINGS: The study found that distance to health centres limits women’s access to skilled delivery services. Lack of primary health facilities in the rural communities hamper maternal and child care services delivery. The attitude of health care professionals determines a mother’s utilisation of maternal health care and skilled delivery services.

CONCLUSION: The study contributes to the limited research on maternal health services and their impact on mother and child health in the study area. This study is one of the first to investigate into maternal health care as a key predictor of mother and child health in the study area. The study’s theoretical lens was the Andersen and Newman Health Behavioural Model theory, which supports the explanation of distance, lack of primary health centres, attitudes and lack of skilled personnel to the non-utilisation of maternal and health services in rural communities. The study recommended that primary healthcare facilities and trained health professionals should be a priority of government in rural communities to promote maternal and child healthcare.

PMID:39177893 | DOI:10.1007/s43999-024-00042-0

Res Health Serv Reg. 2023 Aug 9;2(1):12. doi: 10.1007/s43999-023-00027-5.

ABSTRACT

AIM: Immediate care of newborns is essential to scale back the mortality rate. This study tries to search out several aspects of newborn care practices of newborn birth from BDHS 2017-18 data.

METHODS: Initially, bivariate analysis is employed to look at the differentials’ initial newborn care practices by several selected background variables. The study used a simple and multinomial logistic regression model to identify the important determinants of initial care practices. Besides determinates of the factor, the study also compares the results with the cross-sectional survey data of 2014 and 2011.

RESULTS: The percentage of employing a clean delivery kit during delivery and skin-to-skin contact are 22.8 and 13.7 respectively in Bangladesh in 2017 which is lower than the previous report in 2014. The odds of clean delivery kits and skin-to-skin are higher for educated mothers (OR = 3.30 and OR = 1.74) and in the case of delayed bathing the odds of the Rangpur division (OR = 1.90) are more likely higher compared to the reference category. Besides, the odds of a mother’s age above 25 and birth order 3+ are less likely to reference the category for newborn care practices.

CONCLUSION: Factors identified in early newborn care practices will not only help policy makers undertake a series of interventions for improved newborn health but also ensure good -quality health services.

PMID:39177886 | DOI:10.1007/s43999-023-00027-5

Infection. 2024 Aug 23. doi: 10.1007/s15010-024-02366-y. Online ahead of print.

ABSTRACT

PURPOSE: The consequent use of malaria rapid diagnostic tests (RDTs) preceding a treatment decision has improved the global management of malaria. A combination RDT, including an inflammation marker to potentially guide antibiotic prescription, could improve the management of acute febrile illness (AFI).

METHODS: We performed a prospective, cross-sectional study in Gabon evaluating the STANDARD Malaria/CRP DUO (S-DUO) RDT. Participants aged 2 to 17 years with fever at presentation and/or a history of fever < 7 days were enrolled. Expert microscopy, SD Bioline Malaria Ag P.f/Pan test for malaria detection, and NycoCard CRP device for CRP were used as comparators. AFI cases were classified on a spectrum encompassing bacterial vs. non-bacterial infection.

RESULTS: 415 participants with AFI were enrolled. S-DUO RDT sensitivity and specificity for malaria detection vs. microscopy were 99·1% (95·2-100%) and 72·7% (64·3-80·1%); and for CRP detection (20 mg/L and above) 86·9% (80-92%) and 87% (79·2-92·7%), respectively. The difference in CRP levels between bacterial infection (mean = 41·2 mg/L) and other causes of fever, measured from our study population using the Nycocard device, was statistically significant (p < 0·01); CRP precision-recall AUC to distinguish bacterial infection class vs. non-bacterial classifications was 0·79.

CONCLUSION: S-DUO RDT is suitable for malaria detection in moderate-to-high malaria transmission settings such as in Lambaréné; however, a CRP band detection limit > 40 mg/L is more adequate for indication of antibiotic prescription for AFI cases in Gabon.

PMID:39177882 | DOI:10.1007/s15010-024-02366-y

Pharmacoeconomics. 2024 Aug 23. doi: 10.1007/s40273-024-01423-6. Online ahead of print.

ABSTRACT

Treatment effect waning (TEW) refers to the attenuation of treatment effects over time. Assumptions of a sustained immuno-oncologic treatment effect have been a source of contention in health technology assessment (HTA). We review how TEW has been addressed in HTA and in the wider scientific literature. We analysed company submissions to English language HTA agencies and summarised methods and assumptions used. We subsequently reviewed TEW-related work in the ISPOR Scientific Presentations Database and conducted a targeted literature review (TLR) for evidence of the maintenance of immuno-oncology (IO) treatment effects post-treatment discontinuation. We found no standardised approach adopted by companies in submissions to HTA agencies, with immediate TEW most used in scenario analyses. Independently fitted survival models do however suggest TEW may often be implicitly modelled. Materials in the ISPOR scientific database suggest gradual TEW is more plausible than immediate TEW. The TLR uncovered evidence of durable survival in patients treated with IOs but no evidence that directly addresses the presence or absence of TEW. Our HTA review shows the need for a consistent and appropriate implementation of TEW in oncology appraisals. However, the TLR highlights the absence of direct evidence on TEW in literature, as TEW is defined in terms of relative treatment effects-not absolute survival. We propose a sequence of steps for analysts to use when assessing whether a TEW scenario is necessary and appropriate to present in appraisals of IOs.

PMID:39177877 | DOI:10.1007/s40273-024-01423-6

Res Health Serv Reg. 2023 Dec 5;2(1):18. doi: 10.1007/s43999-023-00032-8.

ABSTRACT

BACKGROUND: Child healthcare services such as diphtheria-tetanus-pertussis (DPT3) vaccination are known to reduce childhood mortality and morbidity. However, inequalities in access to these services in developing countries continue to constrain global efforts aimed at improving child health. This study examines the impact and equity effect of a community-based primary healthcare programme known as the Ghana Essential Health Intervention Programme (GEHIP) on improving the uptake of childhood DPT3 immunisation coverage in a remote rural region of Ghana.

METHODS: Using baseline and end-line household survey data collected from mothers, the effect of GEHIP’s community-based healthcare programme on DPT3 immunisation coverage is evaluated using difference-in-differences multivariate logistic regression models. Household wealth index and maternal educational attainment were used as equity measures.

RESULTS: At end-line, both intervention and comparison districts recorded increases in DPT3 immunisation coverage although intervention districts had a relatively higher coverage than comparison districts (90% versus 88%). While children resident in intervention areas had slightly higher rates than children resident in comparison areas, regression results show that this difference was not statistically significant (DiD = 0.038, p-value = 0.102). There were also no significant equity disparities in the coverage of DPT3 vaccination for both household wealth index and maternal educational attainment.

CONCLUSION: DPT3 vaccination coverage in both study arms met the global vaccine action plan targets. However, because estimated effects are not significantly higher among treatment area children than among comparison districts counterparts, no equity/inequity effects of the community-based healthcare programme on DPT 3 coverage is evident.

PMID:39177872 | DOI:10.1007/s43999-023-00032-8

Res Health Serv Reg. 2024 May 15;3(1):8. doi: 10.1007/s43999-024-00044-y.

ABSTRACT

PURPOSE: The aim of this study was to examine geographic and socioeconomic variation in curative treatment and choice of treatment modality among elderly prostate cancer (PCa) patients.

METHODS: This register-based cohort study included all Norwegian men ≥ 70 years when diagnosed with non-metastatic, high-risk PCa in 2011-2020 (n = 10 807). Individual data were obtained from the Cancer Registry of Norway, the Norwegian Prostate Cancer Registry, and Statistics Norway. Multilevel logistic regression analysis was used to model variation across hospital referral areas (HRAs), incorporating clinical, demographic and socioeconomic factors.

RESULTS: Overall, 5186 (48%) patients received curative treatment (radical prostatectomy (RP) (n = 1560) or radiotherapy (n = 3626)). Geographic variation was found for both curative treatment (odds ratio 0.39-2.19) and choice of treatment modality (odds ratio 0.10-2.45). Odds of curative treatment increased with increasing income and education, and decreased for patients living alone, and with increasing age and frailty. Patients with higher income had higher odds of receiving RP compared to radiotherapy.

CONCLUSIONS: This study showed geographic and socioeconomic variation in treatment of elderly patients with non-metastatic, high-risk PCa, both in relation to overall curative treatment and choice of treatment modality. Further research is needed to explore clinical practices, the shared decision process and how socioeconomic factors influence the treatment of elderly patients with high-risk PCa.

PMID:39177854 | DOI:10.1007/s43999-024-00044-y

Res Health Serv Reg. 2022 Nov 30;1(1):13. doi: 10.1007/s43999-022-00013-3.

ABSTRACT

Despite decades of atlas production and use within multiple healthcare systems, and consistent reporting of geographical differences in the utilisation of services, significant levels of clinical variation persist. Drawing on over forty years of combined experience using atlases of clinical variation, we reflect on why that might be the case and explore the role of atlases have played in efforts to reduce inappropriate overuse, underuse and misuse of healthcare services. We contend that atlases are useful but, on their own, are not enough to drive change in clinical practice and improvement in patient outcomes. Building on four conceptual models we have published since 2017, we argue that atlases, with their focus on measuring healthcare utilisation by residents in different geographies, generally fail to provide sufficient information and statistical analyses to truly assess the nature of the variation and support action for change. They seldom use structures such as hospitals or teams as the unit of analysis to understand variation; they rarely feature the key elements of healthcare performance which underlie variation; they are mostly silent about how to assess whether the variation measured is warranted or truly unwarranted; nor do they identify evidence-based levers for change. This means that a stark choice confronts producers of atlases – to either continue with the current model and more explicitly rely on other players to undertake work to complete the ‘data to action’ cycle that is necessary to secure improvement; or to refine their offering – including more sophisticated performance measurement approaches, nuanced guides for interpretation of any differences found, support for the selection and application of levers for change that align with local context, and provision of evidence-based options for implementation.

PMID:39177847 | DOI:10.1007/s43999-022-00013-3