Tag: pubmed

BJU Int. 2024 Nov 30. doi: 10.1111/bju.16598. Online ahead of print.

ABSTRACT

OBJECTIVE: To define the natural history, patterns of recurrence and treatment modalities for local prostate cancer (PCa) recurrence following radical prostatectomy (RP) and radiation therapy (RT), and to investigate factors that could predict metastasis-free survival (MFS) in this unique patient population.

METHODS: We queried a prospectively maintained PCa registry to identify men developing in-field recurrence (IFR) following RP and RT from 2008 to 2021 at a single institution. IFR was defined as biopsy-proven recurrent PCa or the presence of persistent positron emission tomography-avid lesions in the prior radiation field without evidence of metastasis. Cox regression was conducted to determine predictors of MFS. Kaplan-Meier methods were used to calculate MFS, cancer-specific survival (CSS) and overall survival (OS) for patients in three primary therapy categories: cryoablation, androgen deprivation therapy (ADT) alone, and surveillance.

RESULTS: Of 4575 patients from our registry, 108 (2.3%) with IFR were identified. The median (interquartile range [IQR]) time to IFR from salvage treatment was 78 (50-126) months. A total of 29 patients (26%) were managed with cryoablation, 23 (21%) with ADT, and 28 (25%) with surveillance. The median (IQR) follow-up was 76 (48-100) months. There were no statistically significant differences in MFS (P = 0.67) or OS (P = 0.07) among the three primary treatment cohorts. Patients treated with ADT or cryoablation had longer CSS compared to patients managed with surveillance (P = 0.047).

CONCLUSIONS: We found that IFR may present years after completion of primary treatment for PCa. While curative management strategies may be attempted, local and distant metastatic recurrence is common and often requires systemic therapy.

PMID:39614716 | DOI:10.1111/bju.16598

Inquiry. 2024 Jan-Dec;61:469580241304244. doi: 10.1177/00469580241304244.

ABSTRACT

This study analyzes hospital bed capacity and resource allocation using inflow and outflow indices to identify disparities in bed utilization. The COVID-19 pandemic highlighted the need for effective healthcare management, particularly in the allocation of specialized beds such as those in intensive care units (ICU). Despite a high bed-to-population ratio, South Korea faces regional disparities in bed distribution, especially in Seoul, which accounts for 12.4% of the nation’s hospital beds. Hospital beds were categorized based on the Medical Service Act, and the Relevance Index (RI) and Commitment Index (CI) were used to assess patient flow in 2019 across different bed types and functions. Data from the “Statistical Yearbook on the Usage of Medical Service by Region” provided insights into utilization patterns in tertiary referral hospitals, general hospitals, hospitals, and long-term care facilities. The analysis revealed high RIs for tertiary referral hospitals, indicating strong patient retention and minimal outflow, whereas lower RIs for long-term care hospitals suggested underutilization. Regional analysis within Seoul found a concentration of tertiary referral hospitals in the Southeast and a shortage of ICU beds in the Northwest and Southwest regions. The Inflow and Outflow Index confirmed significant patient inflow into tertiary referral hospitals, with some areas experiencing higher outflows, particularly for long-term care beds. These findings underscore the need for strategic hospital bed capacity management, prioritizing essential beds in underserved regions. Future research should incorporate more recent data and employ direct patient flow analysis to optimize resource allocation, addressing evolving healthcare demands, such as an aging population and new infectious diseases. This study offers valuable insights for regional health policy, aiming to enhance functional hospital bed management and improve overall healthcare resource utilization.

PMID:39614715 | DOI:10.1177/00469580241304244

Inquiry. 2024 Jan-Dec;61:469580241301528. doi: 10.1177/00469580241301528.

ABSTRACT

Scientific research has shown that the sustainability of public health insurance is crucial for governments to effectively manage the risks associated with populations aging. In response, the Chinese government has initiated efforts to ensure the long-term viability of its medical insurance funds. This study utilizes data from 24 484 respondents in the 2013, 2015, 2018, and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS), treating the digital supervision of medical insurance funds as a quasi-natural experiment. The study employs a difference-in-differences (DID) model to evaluate the policy effects and uses heterogeneity analysis to explore variations in impact. The objective is to assess the effectiveness of digital supervision and understand how it achieves its policy goals. The findings indicate that digital supervision of medical insurance funds has a significant positive impact on residents’ out-of-pocket medical expenditure. Heterogeneity analysis reveals that the policy’s effect is particularly strong in urban samples, especially among younger and elderly urban residents, while showing no significant impact on rural populations. This suggests that the policy has a greater influence on groups with higher moral hazard. By implementing digital supervision of medical insurance funds, the Chinese government has ensured the sustainability of these funds, laying a foundation for mitigating the risks associated with population aging. Additionally, the policy has contributed to promoting healthcare equity and reducing the waste of medical resources.

PMID:39614714 | DOI:10.1177/00469580241301528

J Foot Ankle Res. 2024 Dec;17(4):e70015. doi: 10.1002/jfa2.70015.

ABSTRACT

BACKGROUND: Health inequalities are a well-known and widespread phenomenon throughout health care settings. In particular, people of color experience higher rates of delayed and/or misdiagnosis contributing to poorer outcomes and an increased mortality risk. Research suggests that health care professionals find it more difficult to correctly diagnose dermatological conditions in the non-White patient demographic. Although podiatrists routinely examine and assess skin lesions, there is a paucity of research exploring their accuracy or confidence in recognizing skin pathologies. This study aims to investigate podiatry student’s ability, confidence, approaches, and perceptions in diagnosing dermatology pathologies in different skin tones. A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data.

METHODS: A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data.

PMID:39614694 | DOI:10.1002/jfa2.70015

Int J Gynaecol Obstet. 2024 Nov 30. doi: 10.1002/ijgo.16057. Online ahead of print.

ABSTRACT

OBJECTIVE: In the present study, a bidirectional two-sample Mendelian randomization approach was utilized to explore potential causal relationships between mitochondrial DNA copy number (mtDNA-CN) and ovary-related reproductive disorders (ORRDs), including ovarian dysfunction, ovarian cyst, polycystic ovary syndrome (PCOS), premature ovarian failure (POF) and ovarian endometriosis.

METHODS: Genetic associations with mtDNA-CN were obtained from three genome-wide association study (GWAS) summary statistics from the UK Biobank, and ORRD data were investigated using summary statistics from the FinnGen cohort. Single nucleotide polymorphisms (SNPs) correlated with mtDNA-CN were selected as genetic instrumental variables (IVs) to estimate the causal effect of mtDNA-CN on ORRDs using the inverse-variance weighted (IVW) method with heterogeneity and pleiotropy analysis, and we repeated this in the opposite direction using instruments for ORRDs.

RESULTS: We found that the genetically predicted mtDNA was indicative of increased levels of PCOS (OR = 1.16; P < 0.001) and ovarian endometriosis (OR = 1.25; P = 0.007) in the IVW analysis and was not associated with the risk of other ORRDs. In the reverse direction, genetically predicted ORRDs were not associated with mtDNA-CN levels in the IVW analysis. Sensitivity and replication analyses showed the results to be stable.

CONCLUSION: We found that mtDNA-CN may increase the risk of PCOS and ovarian endometriosis. This may have implications for mtDNA-CN as a biomarker for these conditions in clinical practice.

PMID:39614691 | DOI:10.1002/ijgo.16057

J Hum Lact. 2024 Nov 30:8903344241296043. doi: 10.1177/08903344241296043. Online ahead of print.

ABSTRACT

BACKGROUND: Medical students should have adequate knowledge and positive attitudes toward breastfeeding to support breastfeeding dyads. No studies in Croatia have explored breastfeeding knowledge, attitudes or intentions among medical students.

RESEARCH AIM: To investigate breastfeeding knowledge, attitudes and intentions among medical students at the University of Split School of Medicine.

METHODS: A cross-sectional study was conducted from March to April 2023, using online and written questionnaires. All medical students without children were eligible to participate. The validated Breastfeeding Intentions, Attitudes, and Knowledge Questionnaire (BIAKQ) was used. Sociodemographic data were collected. Analysis was conducted using descriptive statistics, t tests, and Mann-Whitney U test.

RESULTS: A total of 357 medical students participated (response rate 64.1%). There was no significant difference between preclinical and clinical students. Students who attended the elective “Breastfeeding Medicine” demonstrated significantly more positive attitudes toward breastfeeding (Mean Rank = 215.62) than those who did not attend (Mean Rank = 173.58; U= 5468.50, p = 0.010); however, no significant difference was found in knowledge or intentions. Female students had significantly more positive attitudes compared to male students (Mean Rank = 189.47 vs. Mean Rank = 150.55, U = 9796.50, p = 0.001), whereas male students expressed significantly more positive intentions (M = 36.97, SD = 5.26 vs. M = 34.44, SD = 5.86, t = -3.69, p = 0.002). The mean knowledge score was 11.92 (SD = 1.43) out of 13 points. Negative attitudes towards breastfeeding beyond 1 year and breastfeeding in public were found.

CONCLUSION: Despite adequate breastfeeding knowledge, some medical students demonstrated negative attitudes and intentions toward breastfeeding. Including breastfeeding education into core medical subjects focusing on the importance of breastfeeding for maternal and infant health and the risks of formula feeding could help improve attitudes, especially during the clinical years. It would also be important to address prevailing prejudices.

PMID:39614671 | DOI:10.1177/08903344241296043

Int J Cancer. 2024 Nov 29. doi: 10.1002/ijc.35267. Online ahead of print.

ABSTRACT

Pancreatic adenocarcinoma (PAC) is notorious for its poor survival. The provision of survival scenarios-that is, best-case, typical and worst-case scenarios-could prove valuable to patients and clinicians. This study investigated survival scenarios and how these have changed over a period of 16 years for patients with PAC. Data from the Netherlands Cancer Registry were used to identify patients with localized and metastatic PAC (2005-2021). Survival scenarios, including best-case, upper-typical, typical (median), lower-typical, and worst-case, were estimated based on survival curve percentiles (p10, p25, p50, p75, and p90). Annual differences were assessed for significance using weighted linear regression analyses. Factors associated with these scenarios were identified through univariable tests. Overall, 14,622 patients with localized and 20,199 with metastatic PAC were included. For patients with localized PAC, the best, upper-typical and typical survival scenarios improved statistically significant with average annual improvement of 1.54 (95%CI: 1.2-1.88), 0.67 (0.56-0.78), and 0.24 (0.19-0.29) months, respectively. For patients with metastatic PAC the best and upper-typical survival scenarios increased statically significantly with annual improvement of 0.28 (0.21-0.34) and 0.06 (0.02-0.09) months, respectively. The best-case and upper-typical scenarios were associated with younger patients, more aggressive disease-focused treatments, fewer comorbidities, and better overall performance status. Over the past 16 years, survival improvements in patients with PAC have been most notable in these scenarios. Although the absolute gains were modest, these results offer encouraging potential for advancements in life-prolonging care for this type of cancer.

PMID:39614657 | DOI:10.1002/ijc.35267

Womens Health (Lond). 2024 Jan-Dec;20:17455057241299213. doi: 10.1177/17455057241299213.

ABSTRACT

BACKGROUND: Researchers and participants who are members of minoritized populations experience negative psychosocial and wellness outcomes like burnout. Burnout may manifest uniquely for Black women in academia conducting research with Black women participants navigating similar sociocultural contexts.

OBJECTIVES: This article qualitatively interprets our experiences as 15 Black women scholar-practitioners at a midwestern university conducting community-engaged research. We discuss our experiences of care and burnout while working to reduce opioid use disparities among Black women community members as we simultaneously navigate multilevel challenges in academia.

DESIGN: We employ collaborative autoethnography, an autobiographical writing method, using a Black feminist framework and intersectionality methodology.

METHODS: We are 15 Black women researcher-subjects on the REFOCUS study-a mixed-methods National Institute on Health-funded project examining nonmedical prescription opioid misuse among Black Kentuckians. We examined a series of multigenerational sista circles and individual journal entries we completed to understand the multilevel power dynamics impacting our individual and collective work, burnout, and care.

RESULTS: Themes were: (1) “I see me in you”: Research with Black Women, (2) “Pervasive, cellular, and epigenetic”: Burnout Experiences; (3) “Taxing but rewarding”: The Price We Pay to See an Outcome, and (4) “Thank God for the collective”: Complexities of Caring Through the Process.

CONCLUSION: We highlight the importance of continued efforts to address workload inequities among Black women in academia, particularly for those working to combat health disparities among Black women or within Black communities. We make recommendations for structural, institutional, and interpersonal steps to improve the support of Black women across career stages.

PMID:39614651 | DOI:10.1177/17455057241299213

Aging Cell. 2024 Nov 29:e14436. doi: 10.1111/acel.14436. Online ahead of print.

ABSTRACT

Recent studies indicated that the dysregulation of mitochondria-associated endoplasmic reticulum membrane (MAM) could be a significant hub in the pathogenesis of Parkinson’s disease (PD). However, little has been known about how MAM altered in PD. This study was aimed to observe morphological changes and analyze proteomic profiles of MAM in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced PD mouse models. In MPTP-treated mice, transmission electron microscopy was applied for MAM ultrastructural visualization. Nano ultra-high performance liquid chromatography-tandem mass spectrum and bioinformatic analysis were adopted to obtain underlying molecular data of MAM fractions. The loosened, shortened and reduced MAM tethering was found in substantia nigral neurons from MPTP-treated mice. In midbrain MAM proteomics, 158 differentially expressed proteins (DEPs) were identified between two groups. Specific DEPs were validated by western blot and exhibited significantly statistical changes, aligning with proteomic results. Bioinformatic analysis indicated that membrane, cytoplasm and cell projection were three major localizations for DEPs. Biological processes including metabolism, lipid transport, and immunological and apoptotic signaling pathways were greatly affected. For consensus MAM proteins, the enriched pathway analysis revealed the potential relationship between neurodegenerative diseases and MAM. Several biological processes such as peroxisome function and clathrin-mediated endocytosis, were clustered, which provided additional insights into the fundamental molecular pathways associated with MAM. In our study, we demonstrated disrupted ER-mitochondria contacts in an MPTP-induced PD mouse model. The underlying signatures of MAM were revealed by proteomics and bioinformatic analysis, providing valuable insights into its potential role in PD pathogenesis.

PMID:39614648 | DOI:10.1111/acel.14436

Acupunct Med. 2024 Nov 29:9645284241298011. doi: 10.1177/09645284241298011. Online ahead of print.

ABSTRACT

BACKGROUND: Considering the importance of cardiac rehabilitation after coronary artery bypass grafting (CABG) and the development of acupuncture over the past few decades, the aim of this study was to evaluate the effects of acupuncture on patients’ exercise tolerance, heart rate and blood pressure after CABG.

METHODS: Thirty-four patients with a history of recent CABG were recruited between 2019 and 2020 for this clinical trial and randomly divided into two groups receiving acupuncture plus cardiac rehabilitation (group A) and cardiac rehabilitation alone (group B). In both groups, exercise-based rehabilitation exercise was performed. Group A additionally received acupuncture at PC6, PC4, HT7 and GB20 bilaterally. Changes in blood pressure, heart rate and Borg scale score were evaluated before, during and after the course of the treatment.

RESULTS: Heart rate was significantly lower in group A compared to group B after completion of the course of the treatment (P = 0.022). However, there were no statistically significant differences between the two groups in systolic or diastolic blood pressure or Borg scale scores (P > 0.05). Nevertheless, the Borg scale scores showed a significant decrease within each group over time (P < 0.001), reflecting an improvement in the patients’ ability to tolerate activity after cardiac rehabilitation with or without acupuncture.

CONCLUSION: Acupuncture in combination with exercise-based cardiac rehabilitation was more effective at decreasing heart rate than cardiac rehabilitation alone after CABG. Both approaches appeared to be similarly effective at improving exercise tolerance. In this study, the addition of acupuncture at the aforementioned traditional acupuncture point locations to exercise-based cardiac rehabilitation did not affect blood pressure.

TRIAL REGISTRATION NUMBER: IRCT20171208037793N1 (Iranian Registry of Clinical Trials).

PMID:39614639 | DOI:10.1177/09645284241298011