Tag: pubmed

BMJ Mil Health. 2024 May 2:e002677. doi: 10.1136/military-2024-002677. Online ahead of print.

ABSTRACT

INTRODUCTION: There have been few epidemiological studies on the impact of the SARS-CoV-2 (COVID-19) pandemic on the veteran population, other than on specific aspects such as mental health, and none in the UK. We used data from the Trends in Scottish Veterans Health cohort to explore the risk of hospitalisation and death associated with COVID-19 in veterans resident in Scotland in comparison with matched non-veterans.

METHODS: Retrospective cohort study of 71 000 veterans and a comparison group of 230 000 non-veterans matched for age, sex and geography, using Cox proportional hazard analysis to explore the risk of hospitalisation with COVID-19 and COVID-19-associated death overall and by birth cohort, sex and length of military service.

RESULTS: Between 1 January 2020 and 31 December 2021, 564 (0.79%) veterans had been hospitalised with COVID-19 compared with 1728 (0.75%) non-veterans. The Cox model showed no significant difference overall, HR 0.99, 95% CIs 0.90 to 1.11, p=0.800. Subgroup analysis showed increased risk in older, short-serving (<20 weeks) Early Service Leavers (ESL). There was no overall difference in COVID-19-associated deaths, HR 0.99, 95% CI 0.79 to 1.23, p=0.993, but subgroup analysis showed a non-significant reduced risk of death in veterans aged 61-70 years, and a 38% higher risk in veterans aged over 70 years which almost reached statistical significance, p=0.054. This was only partially explained by socioeconomic factors and common comorbidities, although we had no data on domestic circumstances or care home residence.

CONCLUSIONS: Overall, military service was not a risk factor for either hospitalisation or death associated with COVID-19. Older ESLs were at increased risk compared with non-veterans, but military service is unlikely to have been causal. The risk of death was increased in the oldest veterans and further studies are needed to explain this once census data become available for linkage.

PMID:38697753 | DOI:10.1136/military-2024-002677

Lancet Respir Med. 2024 May;12(5):e31-e32. doi: 10.1016/S2213-2600(24)00084-5.

NO ABSTRACT

PMID:38697725 | DOI:10.1016/S2213-2600(24)00084-5

J Pediatr Health Care. 2024 May-Jun;38(3):438-449. doi: 10.1016/j.pedhc.2023.09.008.

NO ABSTRACT

PMID:38697699 | DOI:10.1016/j.pedhc.2023.09.008

Nefrologia (Engl Ed). 2024 Mar-Apr;44(2):194-203. doi: 10.1016/j.nefroe.2024.04.004.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Diabetes, dyslipidemia, older age, gender, urinary tract infections, and recent antibiotic intake have been associated with a decrease in the urobiome richness and other fluctuations in this microbiome. Gut and blood microbiome have been reported to be altered in patients with chronic kidney disease (CKD), and specifically in peritoneal dialysis (PD) patients. Still, there are currently no studies describing the urogenital microbiome in CKD-PD patients. In this study we characterized the urobiome profile in 46 PD patients and analyzed its clinical and inflammatory parameters.

MATERIALS AND METHODS: Mid-stream urine, fecal and blood samples were collected from 46 patients undergoing PD at Centro Hospitalar Universitário de São João (CHUSJ) in Porto, Portugal. Exclusion criteria were age under 18 years old, inability to give informed consent, history of infection in the last three months, and antibiotic intake in the last three months. The microbiome communities were analyzed by amplification and sequencing of the V3-V4 region of the bacterial 16S rRNA gene. Correlations with the patients’ clinical data and inflammatory profile were performed.

RESULTS: CKD-PD patients presented a unique urobiome profile dominated by Bacillota, Actinomycetota and Pseudomonadota and characterized by a lower Shannon diversity than fecal and blood microbiome. The taxonomic profiles of urogenital samples were organized in multiple subtypes dominated by populations of Lactobacillus, Staphylococcus, Streptococcus, Gardnerella, Prevotella, Escherichia-Shigella, being similar to other non-PD-CKD patients. Gender, sCD14, residual diuresis and history of peritonitis were significantly associated to variations in the urobiome. Although not reaching statistical significance, diabetes and the time on PD also showed association with particular taxonomic groups. Depletion of Gardnerella, Staphylococcus, Corynebacterium, Lactobacillus or Dermabacter populations correlated with CKD-PD patients with history of diabetes, history of peritonitis and altered levels of sCD14.

CONCLUSIONS: Our results highlight urogenital microbiome as a potential partner and/or marker in the overall health state of CKD-PD patients.

PMID:38697697 | DOI:10.1016/j.nefroe.2024.04.004

BMJ Open Respir Res. 2024 May 2;11(1):e001999. doi: 10.1136/bmjresp-2023-001999.

ABSTRACT

BACKGROUND: Multidrug-resistant tuberculosis is a type of tuberculosis that is resistant to at least the first-line antituberculosis drugs namely, rifampicin and isoniazid. However, most of these studies were limited only to a single hospital. Therefore, this study aimed to identify the determinants of multidrug-resistant tuberculosis among adults undergoing treatment for tuberculosis in the Tigray region of Ethiopia.

METHODS: Hospital-based unmatched case-control study was conducted from 1 April 2019 to 30 June 2019. A simple random sampling method was used to select the required sample size. Variables at a p value less than 0.25 in bivariate analysis were entered into a multivariable analysis to identify the determinant factors of multidrug-resistant tuberculosis. Finally, the level of significance was declared at p<0.05.

RESULTS: Rural residence (adjusted OR (AOR) 2.54; 95% CI 1.34 to 4.83), HIV (AOR 4.5; 95% CI 1.4 to 14.2), relapse (AOR 3.86; 95% CI 1.98 to 7.5), return after lost follow-up (AOR 6.29; 95% CI 1.64 to 24.2), treatment failure (AOR 5.87; 95% CI 1.39 to 24.8) were among the determinants of multidrug-resistant tuberculosis.

CONCLUSION: Rural residence, HIV, relapses, return after lost follow-up and treatment failure were the identified determinant factors of multidrug-resistance tuberculosis.

PMID:38697676 | DOI:10.1136/bmjresp-2023-001999

J Nucl Med. 2024 May 2:jnumed.123.267321. doi: 10.2967/jnumed.123.267321. Online ahead of print.

ABSTRACT

Prospective results have demonstrated favorable safety and efficacy of [¹⁷⁷Lu]Lu-PSMA radiopharmaceutical therapy for up to 6 cycles in men with metastatic castration-resistant prostate cancer. However, no systematic data are available outlining the feasibility of extended therapy beyond 6 cycles. We aim to evaluate the safety and efficacy of extended [¹⁷⁷Lu]Lu-PSMA radiopharmaceutical therapy in patients who have received more than 6 cycles. Methods: In total, 111 patients were included in this multicenter retrospective analysis. Based on individual decisions, patients underwent uninterrupted continuation of therapy (continuous treatment) or reexposure after a therapy break (rechallenge treatment) between 2014 and 2023. Overall survival, 50% prostate-specific antigen (PSA) decline (measured 8-12 wk after treatment initiation or rechallenge), PSMA PET response, and grades per Common Terminology Criteria for Adverse Events were assessed. χ² tests, multivariable Cox regression analysis, and log-rank tests were applied for statistical analyses. Results: Patients received extended treatment with [¹⁷⁷Lu]Lu-PSMA, either as a continuous treatment (43/111, 38.7%) or as a rechallenge (68/111, 61.3%) treatment, with median cumulative doses of 57.4 or 60.8 GBq, respectively. Overall survival from the initiation of [¹⁷⁷Lu]Lu-PSMA was 31.3, 23.2, and 40.2 mo for the entire cohort, the continuous treatment group, and the rechallenge treatment group, respectively. The initial 50% PSA decline was significantly higher in the retreated group than in the continuous group (57/63 [90.4%] vs. 26/42 [61.9%]; P = 0.006). A 50% PSA decline was observed in 23 of 62 patients (37.1%) after the first rechallenge. The rate of grades 3-4 toxicity was comparable between continuous and rechallenge treatments (anemia, 7/43 [16.3%] vs. 13/68 [19.1%)], P = 0.6; leukocytopenia, 1/43 [2.3%] vs. 2/67 [3.0%], P = 0.3; thrombocytopenia, 3/43 [7.0%] vs. 3/68 [4.4%], P = 0.3; renal, 2/43 [4.7%] vs. 5/68 [7.4%], P = 0.2). Conclusion: Extended therapy with [¹⁷⁷Lu]Lu-PSMA is safe and has not been associated with increased grades 3-4 toxicity. Patient candidates for extended treatment experienced a favorable median survival of 31.3 mo from the first administration. Response under [¹⁷⁷Lu]Lu-PSMA rechallenge demonstrated preserved efficacy of [¹⁷⁷Lu]Lu-PSMA after a treatment break.

PMID:38697669 | DOI:10.2967/jnumed.123.267321

BJGP Open. 2024 May 2:BJGPO.2024.0007. doi: 10.3399/BJGPO.2024.0007. Online ahead of print.

ABSTRACT

BACKGROUND: Research suggests that in both France and the UK, between 5 to 10% of appointments with General Practitioners (GPs) are unattended. A comprehensive Irish study linked missed appointments with an increased short-term risk of mortality, prompting further investigation into the reasons behind absenteeism.

AIM: This study seeks to delve into the underlying causes of missed appointments, within the context of an urban health center.

DESIGN & SETTING: Using a mixed-method approach, this study combines qualitative telephone interviews with quantitative analysis of medical records. The research focuses on patients who failed to attend appointments at an urban health center over a 15-day period.

METHOD: The interview guide collected data on circumstances leading to missed appointments and explored patients’ social determinants of health. Additionally, patients’ socio-economic backgrounds was undertaken of medical records.

RESULTS: Among 53 missed appointments (4.9% of all scheduled), 22 patients were interviewed. SHC beneficiaries (68% of the sample) cited socio-economic instability, including precarious work hours, social isolation, and multiple commitments, as reasons for non-attendance. For non-SHC beneficiaries, forgetfulness was the main cause. Remarkably, 36% disclosed a history of domestic violence. Retrospective analysis by physicians deemed over a quarter of these missed appointments as significant.

CONCLUSION: The findings indicate that missed appointments can highlight social inequality, emphasising the need to align healthcare with patients’ temporal realities. The identification of patients who have experienced violence and the use of missed appointments as triggers for follow-up calls seems to be promising strategies to enhance care and mitigate health inequalities.

PMID:38697664 | DOI:10.3399/BJGPO.2024.0007

N Z Med J. 2024 May 3;137(1594):43-53. doi: 10.26635/6965.6442.

ABSTRACT

AIM: Bariatric surgery is an effective tool for weight loss and for improving weight related co-morbidities. Changes in medication usage after a silastic ring laparoscopic Roux-en-Y gastric bypass (SR-LRYGB) compared with laparoscopic sleeve gastrectomy (LSG) are unknown.

METHODS: This was a single-centre, double-blind, randomised controlled trial. Patients were randomised to either SR-LRYGB or LSG. A medication history was obtained at regular follow-up intervals, and mean numbers of prescribed medications were analysed over 5 years. Poisson regression and generalised estimating equations were used to test for statistically significant changes in usage.

RESULTS: After eight patients were lost to follow-up, data from 52 patients in each group were available for analysis. There was no difference between the SR-LRYGB or LSG groups in the number of medications prescribed, with the exception of oral glucose-lowering medications, where there was a greater decrease after SR-LRYGB compared to LSG (79% vs 55% respectively) from baseline to 5 years. At 5 years, total medication prescribed was down 10% from pre-operative levels. Prescribed insulin decreased by 72%, and cardiovascular medication decreased by 56% compared to baseline. Prescriptions for analgesia increased by 50%, psychiatric medications by 133% and proton-pump inhibitors by 81%.

CONCLUSION: Both SR-LRYGB and LSG reduced requirement for diabetic and cardiovascular medications, but increased requirement for nutritional supplementation, analgesia and psychiatric medications. There was a greater reduction in oral anti-diabetic medication prescriptions following SR-LRYGB compared to LSG, but no other difference in medication usage between surgical groups was found.

PMID:38696831 | DOI:10.26635/6965.6442

N Z Med J. 2024 May 3;137(1594):23-30. doi: 10.26635/6965.6392.

ABSTRACT

AIM: To report dispensing trends for attention-deficit hyperactivity disorder (ADHD) in Aotearoa New Zealand, focussing on adults in order to highlight increasing demand for ADHD treatment by adults and to prompt discussion.

METHOD: Demographic and dispensing data for ADHD were obtained from the Pharmaceutical Collection between the years 2006 and 2022. This was stratified according to child (<18 years) and adult (≥18 years) populations. Population dispensing rates for methylphenidate and atomoxetine were calculated. Key findings are reported to reveal demographic and dispensing trends for medication treated ADHD in Aotearoa New Zealand.

RESULTS: More males are dispensed ADHD medication than females, although this is less evident for adults (54.8% male). Māori adults are dispensed ADHD medication at a lower rate (10.1%) than Māori children (22.9%). There was a 10-fold increase in dispensing of ADHD medication for adults compared to a three-fold increase for children over the study period. New dispensing for adults doubled between 2011 and 2022.

CONCLUSION: Medication treatment for adult ADHD is increasing in Aotearoa New Zealand and includes treatment for persisting childhood ADHD and new diagnoses made in adulthood. Despite increases, dispensing rates for ADHD remain lower than prevalence estimates, suggesting a significant treatment gap. Addressing the treatment gap for ADHD may reduce negative effects of ADHD, but wider social influences should also be considered.

PMID:38696829 | DOI:10.26635/6965.6392

N Z Med J. 2024 May 3;137(1594):13-22. doi: 10.26635/6965.6387.

ABSTRACT

AIM: To better understand the reasons for reduced hospital admissions to a hospital general medicine service during COVID-19 lockdowns.

METHODS: A statistical model for admission rates to the General Medicine Service at Wellington Hospital, Aotearoa New Zealand, since 2015 was constructed. This model was used to estimate changes in admission rates for transmissible and non-transmissible diagnoses during and following COVID-19 lockdowns for total admissions and various sub-groups.

RESULTS: For the 2020 lockdown (n=734 admissions), the overall rate ratio of admissions was 0.71 compared to the pre-lockdown rate. Non-transmissible diagnoses, which constitute 87% of admissions, had an admission rate ratio of 0.77. Transmissible diagnoses, constituting 13% of admissions, had an admission rate ratio of 0.44. Reductions in admissions did not exacerbate existing ethnic disparities in access to health services. The lag in recovery of admission rates was more pronounced for transmissible than non-transmissible diagnoses. The 2021 lockdown (n=105 admissions) followed this pattern, but was of shorter duration with small numbers, and therefore measures were frequently not statistically significant.

CONCLUSIONS: The biggest relative reduction in hospital admission was due to a reduction in transmissible illness admissions, likely due to COVID-related public health measures. However, the biggest reduction in absolute terms was in non-transmissible illnesses, where hospital avoidance may be associated with increased morbidity or mortality.

PMID:38696828 | DOI:10.26635/6965.6387