Tag: pubmed

Eur J Trauma Emerg Surg. 2023 Dec 8. doi: 10.1007/s00068-023-02399-2. Online ahead of print.

ABSTRACT

PURPOSE: The current study was undertaken to describe the independent contribution of chronic obstructive pulmonary disease (COPD) to the risk of postoperative morbidity and in-hospital mortality among patients undergoing surgery for an acute abdominal diagnosis.

METHODS: Patients who underwent emergency abdominal procedures were identified from the electronic database of the Department of Visceral, Transplantation, Thoracic and Vascular Surgery of our institution. To evaluate differences in surgical risk associated with COPD, patients with COPD were matched for age, sex, and type of surgery with an equal number of controls who did not have COPD. Logistic regression was performed to evaluate the univariate and multivariate associations between the independent variables, including COPD and outcome variables.

RESULTS: Between January 2012 and December 2022, 3519 patients undergoing abdominal emergency surgery were identified in our abdominal surgical department. After removing ineligible cases, 201 COPD cases with an equal number of matched controls remained for analysis. The prevalence of COPD after the exclusion of ineligible cases was 5.7%. There were statistically significant differences in the rate of postoperative pulmonary complications (PPCs [57.7% vs. 35.8%; P < 0.001]), ventilator dependence (VD [63.2% vs. 46.3%; P < 0.001]), thromboembolic events (TEEs [22.9% vs. 12.9%; P = 0.009]), and in-hospital mortality (41.3% vs. 30.8%; P = 029) for patients with and without COPD. Independent of other covariates, the presence of COPD was not associated with a significantly increased risk of in-hospital mortality (OR, 1.16; 95% CI 0.70-1.97; P = 0.591) but was associated with an increased risk of PPCs (OR, 2.49; 95% CI 1.41-4.14; P = 0.002) and VD (OR, 2.26; 95% CI 1.22-4.17; P = 0.009).

CONCLUSIONS: Preexisting COPD may alter a patient’s risk of PPCs and VD. However, it was not associated with an increased risk of in-hospital mortality.

PMID:38062271 | DOI:10.1007/s00068-023-02399-2

J Womens Health (Larchmt). 2023 Dec 8. doi: 10.1089/jwh.2023.0429. Online ahead of print.

ABSTRACT

Background: Physicians are less likely to discuss lung cancer screening (LCS) with women, and women have lower awareness of LCS availability. The objective of this qualitative study was to determine information needs, patient-provider communication barriers, and preferences for LCS education among women. Materials and Methods: Eight semistructured qualitative focus groups were conducted with 28 self-identified women meeting LCS eligibility criteria. Participants were recruited through a large health system, from a community-based LCS program, and through a national online database between October 2020 and March 2021. Focus groups were led by a trained moderator via Zoom. Audio recordings were transcribed and analyzed using thematic analysis by investigators. Results: LCS decision-making influences included: (1) Health care provider recommendation; (2) Self-advocacy; (3) Insurance coverage and cost; (4) Family; and (5) Interest in early detection. Participants preferred video and print materials, available at physician’s office or shared by physician, without scare tactics or shaming about smoking, use clear language, with diverse participants and images. Preferred content focused on: (1) Benefits of early detection; (2) Lung cancer definition, statistics, and risk factors; (3) Benefits of quitting smoking; (4) Demonstration or explanation of how LCS is done; and (5) Availability of other tests and potential harms of screening. Conclusion: Women in our study had limited awareness of LCS and their eligibility and wanted recommendation and support for LCS from their health care providers. We identified addressable information needs about lung cancer and the screening process that can be used to improve LCS uptake in women and shared decision-making processes.

PMID:38061051 | DOI:10.1089/jwh.2023.0429

J Womens Health (Larchmt). 2023 Dec 8. doi: 10.1089/jwh.2023.0326. Online ahead of print.

ABSTRACT

Objective: To compare gender compositions in the leadership of the top 25 medical schools in North America with the leadership of their affiliated university senior leadership and other faculties. Materials and Methods: This retrospective cross-sectional observational study used publicly available gender data from 2018 to 2019 of universities drawn from the U.S. News Best Global Universities for Clinical Medicine Ranking report. Gender compositions in eight leadership tiers from senior leadership to medical school department directors were analyzed. Data analysis included gender compositions by leadership tier and faculty. Results: Male representation is greater at higher leadership tiers, with the largest imbalance being at the level of medical school department heads. The faculty of medicine has more men in leadership positions than the average of the other faculties (p = 0.02), though similar to schools of engineering, business, dentistry, and pharmacy. Across the eight leadership tiers, a significant trend exists between tier and proportions, indicating that male representation was greater at higher tiers (p < 0.001). No correlation was found between a university’s leadership gender composition and its ranking. Conclusion: The under-representation of women is greater in medical school leadership than the leadership of their affiliated universities. The faculty of medicine has greater male over-representation than the average of the other faculties.

PMID:38061046 | DOI:10.1089/jwh.2023.0326

J Womens Health (Larchmt). 2023 Dec 8. doi: 10.1089/jwh.2023.0032. Online ahead of print.

ABSTRACT

Background: Cardiovascular risk is increased by a history of adverse pregnancy outcomes (APOs). Efforts to understand and prevent these adverse outcomes may improve both fetal and birthing persons’ outcomes in the peripartum period, and over the patient’s lifetime. This study aims to assess the association of clinical, sociodemographic, and economic neighbor-hood factors with preterm birth (PTB) and APOs (the composite of stillbirth, small for gestation age, and low birthweight). Materials and Methods: This is a cross-sectional study using the electronic medical records of deliveries from seven Northwell Health hospitals between January 1, 2018 and July 31, 2020. There were 62,787 deliveries reviewed in this study. Deliveries that were not the first for the patient during the study period and multiple gestational pregnancies were excluded. Patients with incomplete data on outcome were also excluded. Main outcomes were PTB and composite APOs. Measures included history of PTB, hypertension, diabetes, body mass index, race/ethnicity, age, preferred language, marital status, parity, health insurance, and median income, percent unemployment, and mean household size by zip code. Results: Of the 62,787 deliveries, 43.3% were from white, Non-Hispanic, and Non-Latino patients. There were 4,552 (7.2%) PTBs and 8,634 (13.8%) APOs. Patients enrolled in public insurance had higher odds of PTB (odds ratio [OR] 1.15, 95% CI 1.06-1.24) and APOs (OR 1.19, 95% CI 1.12-1.25). There was a statistically significant association of both PTB (p = 0.037) and APOs (p = 0.005) when comparing patients that live in a zip code with a median income over 100k to those with an income <100k. In addition, living in a zip code within the second quintile of unemployment was associated with lower odds of APOs (OR 0.92, 95% CI 0.84-0.99). Conclusions: Numerous sociodemographic and clinical factors are associated with both PTB and APOs. Tailored programs addressing these disparities may improve outcomes in pregnant persons.

PMID:38061042 | DOI:10.1089/jwh.2023.0032

AIDS. 2023 Dec 7. doi: 10.1097/QAD.0000000000003811. Online ahead of print.

ABSTRACT

OBJECTIVE: Bone loss in people with HIV (PWH) is poorly understood. Switching tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) has yielded bone mineral density (BMD) increases. PETRAM (NCT#:03405012) investigated whether BMD and bone turnover changes correlate.

DESIGN: Open-label, randomized controlled trial.

SETTING: Single-site, outpatient, secondary care.

PARTICIPANTS: Nonosteoporotic, virologically suppressed, cis-male PWH taking TDF/emtricitabine (FTC)/rilpivirine (RPV) for more than 24 weeks.

INTERVENTION: Continuing TDF/FTC/RPV versus switching to TAF/FTC/RPV (1 : 1 randomization).

MAIN OUTCOME MEASURES: :[18F]NaF-PET/CT for bone turnover (standardized uptake values, SUVmean) and dual-energy x-ray absorptiometry for lumbar spine and total hip BMD.

RESULTS: Thirty-two men, median age 51 years, 76% white, median duration TDF/FTC/RPV 49 months, were randomized between 31 August 2018 and 09 March 2020. Sixteen TAF:11 TDF were analyzed. Baseline-final scan range was 23-103 (median 55) weeks. LS-SUVmean decreased for both groups (TAF -7.9% [95% confidence interval -14.4, -1.5], TDF -5.3% [-12.1,1.5], P = 0.57). TH-SUVmean showed minimal changes (TAF +0.3% [-12.2,12.8], TDF +2.9% [-11.1,16.9], P = 0.77). LS-BMD changes were slightly more favorable with TAF but failed to reach significance (TAF +1.7% [0.3,3.1], TDF -0.3 [-1.8,1.2], P = 0.06). Bone turnover markers decreased more with TAF ([CTX -35.3% [-45.7, -24.9], P1NP -17.6% [-26.2, -8.5]) than TDF (-11.6% [-28.8, +5.6] and -6.9% [-19.2, +5.4] respectively); statistical significance was only observed for CTX (P = 0.02, P1NP, P = 0.17).

CONCLUSION: Contrary to our hypothesis, lumbar spine and total hip regional bone formation (SUVmean) and BMD did not differ postswitch to TAF. However, improved LS-BMD and CTX echo other TAF-switch studies. The lack of difference in SUVmean may be due to inadequate power.

PMID:38061030 | DOI:10.1097/QAD.0000000000003811

Annu Rev Public Health. 2023 Dec 7. doi: 10.1146/annurev-publhealth-101322-031206. Online ahead of print.

ABSTRACT

The industrial revolution and urbanization fundamentally restructured populations’ living circumstances, often with poor impacts on health. As an example, unhealthy food establishments may concentrate in some neighborhoods and, mediated by social and commercial drivers, increase local health risks. To understand the connections between neighborhood food environments and public health, researchers often use geographic information systems (GIS) and spatial statistics to analyze place-based evidence, but such tools require careful application and interpretation. In this article, we summarize the factors shaping neighborhood health in relation to local food environments and outline the use of GIS methodologies to assess associations between the two. We provide an overview of available data sources, analytical approaches, and their strengths and weaknesses. We postulate next steps in GIS integration with forecasting, prediction, and simulation measures to frame implications for local health policies. Expected final online publication date for the Annual Review of Public Health, Volume 45 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

PMID:38061019 | DOI:10.1146/annurev-publhealth-101322-031206

Br J Dermatol. 2023 Dec 7:ljad488. doi: 10.1093/bjd/ljad488. Online ahead of print.

ABSTRACT

BACKGROUND: Occupational exposure to metals such as nickel, chromium and cobalt can be associated with contact dermatitis which can adversely affect the individual’s health, finances and employment. Despite this, little is known about the incidence of metal-related occupational contact dermatitis over prolonged periods of time.

OBJECTIVES: This study aimed to investigate the medically reported trends in the incidence of work-related contact dermatitis attributed to nickel, chromium and cobalt in the UK.

METHODS: Incidence and trends in incidence of cases of occupational contact dermatitis caused by nickel, chromium, or cobalt between 1996 and 2019 (inclusive), reported to the EPIDERM surveillance scheme, was investigated and compared to trends in incidence of occupational contact dermatitis attributed to agents other than the aforesaid metals. A sensitivity analysis restricting the study cohort to cases attributed to only one type of metal was also conducted.

RESULTS: Of all cases reported to EPIDERM during the study period, 2374 cases (12%) were attributed to nickel, chromium, or cobalt. Cases were predominantly females (59%), with a mean (±SD) age (males plus females) of 38 ± 13 years. Cases were most frequently reported in manufacturing, construction and human health and social activities. The most frequently reported occupations were hairdressers, sales and retail assistants/cashiers/check-out operators. The highest annual incidence rate of contact dermatitis was observed in females (2.60 per 100,000 person employed per year), with the first and second peak seen in those aged 16-24 and ≥65 years old, respectively. A statistically significant decrease in the incidence of occupational contact dermatitis attributed to metals over the study period was observed for all occupations (annual average change -6.9% [95% CI -7.8, -5.9]), with much of the decrease occurring between 1996 and 2007. Similar findings were observed in the sensitivity analyses.

CONCLUSIONS: Over a period of 24 years, a statistically significant decline in the incidence of metal-related occupational contact dermatitis was observed in the UK. This could be attributed to improvements in working conditions which resulted in reduced metal exposure but could also be due to closure of industries in the UK that might have generated cases of contact dermatitis due to metal exposure.

PMID:38061005 | DOI:10.1093/bjd/ljad488

J Clin Endocrinol Metab. 2023 Dec 7:dgad700. doi: 10.1210/clinem/dgad700. Online ahead of print.

ABSTRACT

BACKGROUND: Barraquer-Simons syndrome (BSS) is a rare acquired form of lipodystrophy characterized by progressive loss of upper body subcutaneous fat, which affects face, upper limbs, and trunk. The pathogenesis of the disease is not entirely known and may involve autoimmune mechanisms.

AIM: This study aimed to provide a comprehensive picture of the clinical, immunological, and metabolic features of a large cohort of BSS patients. Our primary objectives included the validation of existing diagnostic tools, the evaluation of novel diagnostic approaches, and the exploration of potential disease triggers or genetic predispositions.

SUBJECTS AND METHODS: Twenty-six patients were diagnosed with BSS based on accepted criteria defined by international guidelines. Anthropometric parameters, biochemical tests, organ- and non-organ-specific autoantibodies, HLA status, and screening of the LMNB2 gene were performed.

RESULTS: Patients were predominantly females (73%); fat loss occurred mostly during childhood (77%) at a median age of 8 years. Among various anthropometric measures, the ratio between the proportion of fat mass in upper limbs/lower limbs showed the best predictive value for diagnosis. 11.5% of patients had diabetes, 34.6% dyslipidemia, and 26.9% hepatic steatosis. 75% of children and 50% of adults had C3 hypocomplementemia; 76% of patients were positive for one or more autoantibodies. HLA-DRB1 11:03 had higher allelic frequencies compared to the general population. A single variant in the LMNB2 gene was found in one patient.

CONCLUSIONS: BSS has a childhood onset and is often associated with autoimmune diseases. Skinfold thickness measurements and fat assessment by DEXA are useful tools to identify the disease. C3 hypocomplementemia and the presence of autoantibodies may be used as additional diagnostic supportive criteria but prevalence of C3 hypocomplementemia may be lower than previously reported.

PMID:38061004 | DOI:10.1210/clinem/dgad700

Br J Dermatol. 2023 Dec 7:ljad486. doi: 10.1093/bjd/ljad486. Online ahead of print.

ABSTRACT

BACKGROUND: Atopic dermatitis (AD) may affect cognitive function, but studies are limited and inconsistent. The effect of AD severity on cognition remains underexplored and few previous studies have examined clinically validated or repeated measures of cognition throughout childhood.

OBJECTIVE: To evaluate the relationship of AD activity and severity with validated measures of general cognition in a longitudinal birth cohort.

METHODS: We conducted cross-sectional analyses using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a U.K. cohort of 14,975 individuals followed prospectively since their birth in 1991-1992. AD was assessed 11 times between 6 and 166 months old. Mothers were asked if their child had an “itchy, dry skin rash in the joints and creases,” and AD status was accordingly time-updated as never, maybe, inactive, active/mild, or active/moderate-severe. General cognition (i.e., IQ) was measured at 18, 49, 103, and 186 months old using the Griffiths Mental Development Scales (GMDS), Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Wechsler Intelligence Scale for Children (WISC), and Wechsler Abbreviated Scale of Intelligence (WASI), respectively. Multivariable linear regression was used to compare IQ with respect to nearest time-updated AD status. Secondary analyses were stratified by the presence or absence of psychiatric or learning disorders. An exploratory longitudinal analysis of IQ across all four outcome assessments was conducted using generalized estimating equations.

RESULTS: No significant associations between AD status and full-scale IQ scores on the GMDS, WPPSI, WISC, and WASI were observed after adjustment for sociodemographic factors, atopic comorbidities, and sleep characteristics. However, at 8 years old, WISC Performance IQ was slightly though statistically significantly lower among children with active/moderate-severe AD (β-coefficient -2.16 [95% CI -4.12, -0.19]) and Verbal IQ was slightly but statistically significantly higher among those with inactive AD (β 1.31 [0.28, 2.34]) compared to those without AD. Analyses stratified by psychiatric or learning disorders, and exploratory longitudinal analyses of cognition revealed similar findings.

CONCLUSIONS: We did not find any clinically meaningful associations between AD activity and severity and general cognitive function during early childhood and adolescence. Future studies should incorporate objective measures of AD severity and investigate outcomes beyond IQ.

PMID:38060978 | DOI:10.1093/bjd/ljad486

JCO Glob Oncol. 2023 Sep;9:e2300182. doi: 10.1200/GO.23.00182.

ABSTRACT

PURPOSE: Multiple myeloma (MM) is a highly heterogeneous, incurable disease most frequently diagnosed in the elderly. Therefore, data on clinical characteristics and outcomes in the very young population are scarce.

PATIENTS AND METHODS: We analyzed clinical characteristics, response to treatment, and survival in 103 patients with newly diagnosed MM age 40 years or younger compared with 256 patients age 41-50 years and 957 patients age 51 years or older.

RESULTS: There were no statistical differences in sex, isotype, International Scoring System, renal involvement, hypercalcemia, anemia, dialysis, bony lesions, extramedullary disease, and lactate dehydrogenase (LDH). The most used regimen in young patients was cyclophosphamide, bortezomib, dexamethasone, followed by cyclophosphamide, thalidomide, dexamethasone and bortezomib, thalidomide, dexamethasone. Of the patients age 40 years or younger, only 53% received autologous stem-cell transplant (ASCT) and 71.1% received maintenance. There were no differences in overall survival (OS) in the three patient cohorts. In the multivariate analysis, only high LDH, high cytogenetic risk, and ASCT were statistically associated with survival.

CONCLUSION: In conclusion, younger patients with MM in Latin America have similar clinical characteristics, responses, and OS compared with the elderly.

PMID:38060975 | DOI:10.1200/GO.23.00182