Tag: pubmed

Public Health Nurs. 2021 Mar 22. doi: 10.1111/phn.12887. Online ahead of print.

ABSTRACT

PURPOSE: Pre-exposure prophylaxis (PrEP) prevents HIV yet uptake remains suboptimal across the United States. This paper evaluates the impact of outreach activities led by nurse supervised community healthcare workers (CHWs) on the PrEP care cascade.

METHODS: This is an observational programmatic evaluation of LGBTQ + community outreach between March 1, 2016, to March 31, 2020, as part of a public health initiative. Descriptive statistics are used to characterize the data by outreach type.

RESULTS: 2,465 participants were reached. Overall, a PrEP appointment was scheduled for 94 (3.8%) with 70 (2.8%) confirmed to have completed a PrEP visit. Success for each type of community outreach activity was evaluated with virtual models outperforming face-to-face. Face-to-face outreach identified nine persons among 2,188 contacts (0.41%) completing an initial PrEP visit. The website prepmaryland.org identified 4 among 24 contacts (16.7%) and the PrEP telephone/text warm-line identified 18 among 60 contacts (30%). The PrEPme smartphone application identified 39 among 168 contacts (23.2%).

CONCLUSIONS: Face-to-face community outreach efforts reached a large number of participants, yet had a lower yield in follow-up and confirmed PrEP visits. All virtual platforms reached lower total numbers, but had greater success in attendance at PrEP visits, suggesting enhanced linkage to care.

PMID:33749022 | DOI:10.1111/phn.12887

Exp Physiol. 2021 Mar 21. doi: 10.1113/EP089365. Online ahead of print.

ABSTRACT

NEW FINDINGS: Cardio-ventilatory coupling refers to the onset of inspiration occurring at a preferential latency following the last heartbeat in expiration. According to the cardiac-trigger hypothesis, the pulse pressure initiates an inspiration via baroreceptor activation. However, the central neural substrate mediating this coupling remains undefined. Using a combination of animal data, human data and mathematical modeling, this study tests the hypothesis that the heartbeat, by way of pulsatile baroreflex activation, controls the initiation of inspiration which occurs through a rapid neural activation loop from the carotid baroreceptors to Bötzinger Complex expiratory neurons.

ABSTRACT: Cardio-ventilatory coupling refers to a heartbeat (HB) occurring at a preferred latency prior to the next breath. We hypothesized that the pressure pulse generated by a HB activates baroreceptors that modulates brainstem expiratory neuronal activity and delays the initiation of inspiration. In supine male subjects, we recorded ventilation, electrocardiogram, and blood pressure during 20-min epochs of baseline, slow-deep breathing, and recovery. In in situ rodent preparations, we recorded brainstem activity in response to pulses of perfusion pressure. We applied a well-established respiratory network model to interpret these data. In humans, the latency between a HB and onset of inspiration was consistent across different breathing patterns. In in situ preparations, a transient pressure pulse during expiration activated a subpopulation of expiratory neurons normally active during post-inspiration; thus, delaying the next inspiration. In the model, baroreceptor input to post-inspiratory neurons accounted for the effect. These studies are consistent with baroreflex activation modulating respiration through a pauci-synaptic circuit from baroreceptors to onset of inspiration. This article is protected by copyright. All rights reserved.

PMID:33749038 | DOI:10.1113/EP089365

Public Health Nurs. 2021 Mar 22. doi: 10.1111/phn.12897. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the degree to which nurses in a national public health home visiting program collaborate with interprofessional providers to serve families experiencing adversity.

DESIGN: A descriptive, cross-sectional survey measured collaborative practices between nurse home visitors, health care, and social service providers. A census of 263 nursing supervisors completed a web-based survey.

MEASUREMENTS: The survey included the validated 7-item Relational Coordination Scale, adapted items from the Interagency Collaboration Activities Scale on shared resources, and items related to collaboration attitudes and beliefs. Data were analyzed with descriptive statistics.

RESULTS: Relational coordination scores, which are relative measures, ranged from 1 to 5; highest with supplemental nutrition for Women, Infants & Children (M = 3.77) and early intervention (M = 3.44); and lowest with housing (M = 2.55). The greatest sharing of resources was with supplemental nutrition (sum = 12.95) and mental health providers (sum = 11.81), and least with housing (sum = 7.26); with a range of 1-30 where higher scores indicated greater resource-sharing.

CONCLUSION: Home visiting nurses collaborate with interprofessional providers with variation in the degree of collaboration between agencies and by provider type within an agency. Collaboration was a function of two interrelated domains: interpersonal relationships supported by organizational and contextual factors at the systems-level.

PMID:33749013 | DOI:10.1111/phn.12897

J Orthop Res. 2021 Mar 21. doi: 10.1002/jor.25040. Online ahead of print.

ABSTRACT

BACKGROUND: Numerous studies have examined the histology of metal-on-metal hip tissues for evidence of a dose response to metal wear but have often reported inconclusive or contradictory findings. The aim of the present study was to address these discrepancies using multiple histological scoring methods to characterize the tissue features of one large group of revised metal-on-metal total hips.

METHODS: Periprosthetic tissues from 165 metal-on-metal hip revisions were examined for features of aseptic lymphocytic associated lesions (ALVAL) as rated using two scoring systems as well as rankings for macrophage and lymphocyte numbers, intracellular wear debris and necrosis. Correlations between histological features and clinical variables including gender and time to revision and implant variables including articular surface wear volume or visual taper corrosion scores were examined.

RESULTS: Both ALVAL scores reflected the macrophage dominated histology with average scores of 5.9/10 and 1.5/3. There was a statistically significant correlation between the original ALVAL score and wear rate per year (correlation coefficient= 0.17, p= 0.05) and a moderate correlation between the number of macrophages and wear particles and wear volume. There was no statistically significant correlation between wear and any other feature including lymphocytic inflammation or necrosis.

CONCLUSIONS: Strong correlations between combined cup and ball wear volume and histological characteristics were not observed, although the number of macrophages was more closely correlated with wear than lymphocytes or necrosis. This article is protected by copyright. All rights reserved.

PMID:33749015 | DOI:10.1002/jor.25040

Clin Pharmacokinet. 2021 Mar 22. doi: 10.1007/s40262-021-00989-0. Online ahead of print.

ABSTRACT

BACKGROUND: Two pharmacokinetic/pharmacodynamic studies were conducted to evaluate the potential drug-drug interaction between elagolix, an oral gonadotropin-releasing hormone receptor antagonist, and an oral contraceptive (ethinylestradiol [EE] 0.035 mg and norgestimate 0.18/0.215/0.25 mg) or progestin-only contraceptive (norethindrone 0.35 mg) in healthy premenopausal women.

METHODS: These phase I studies used a two-period, sequential design, where period 1 included treatment with oral contraceptives, followed by period 2 with contraceptives coadministered with elagolix 150 mg once daily.

RESULTS: In study 1, pharmacokinetic exposures for EE in period 2 increased by 30% and the norgestimate metabolites decreased by approximately 15% when coadministered with elagolix. Mean hormone exposure appeared lower for follicle-stimulating hormone (FSH; 31%), luteinizing hormone (LH; 38%), and estradiol (E2; 16%). The percentage of women with consecutive progesterone (P) concentrations above 5 nmol/L was similar in both periods. Norethindrone pharmacokinetic exposures were comparable in both periods. The hormone exposure for LH and FSH was similar, and mean E2 exposure was 32% lower in period 2. The percentage of subjects with consecutive ovulatory P concentrations was also similar in both periods (study 2). Safety and tolerability profiles were unremarkable in both studies.

CONCLUSIONS: Coadministration of elagolix 150 mg once daily with oral contraceptives containing EE and norgestimate, or norethindrone, resulted in small pharmacokinetic changes in the oral contraceptive components. Similar or lower FSH, LH, and E2 exposures were observed during coadministration, with ovulatory P concentrations also comparable in both periods. The pharmacodynamic profiles of the oral contraceptives were maintained when coadministered with elagolix.

PMID:33748934 | DOI:10.1007/s40262-021-00989-0

Br J Haematol. 2021 Mar 21. doi: 10.1111/bjh.17388. Online ahead of print.

ABSTRACT

Glucocorticoid treatment increases venous thromboembolism (VTE) risk. Whether this is due to the medication or the underlying disease, or affects the risk of VTE recurrence, has been difficult to determine. The aim of our present study was to quantify the risk for first and recurrent VTE associated with oral glucocorticoids use, considering the underlying disease. A total of 2547 patients with VTE from the Multiple Environmental and Genetic Assessment of Risk Factors for Venous Thrombosis (MEGA) study were linked to the Dutch Pharmaceutical Statistics register. The risk of first VTE during periods of exposure with oral glucocorticoids was estimated by the self-controlled case series method and that of recurrent VTE was examined in a cohort design. The incidence rate ratio (IRR) of first VTE in the period of glucocorticoid treatment was 3·51 [95% confidence interval (CI) 2·55-4·80]. This IRR was 2·53 (95% CI 1·10-5·72) in the week before treatment started, 5·28 (95% CI 2·89-9·53) in the first 7 days of treatment, remained elevated afterwards and decreased to 1·55 (95% CI 0·85-3·12) after 6 months, as compared to unexposed periods. The hazard ratio for recurrence was 2·72 (95% CI 1·64-4·78) in treatment periods as compared with no treatment. The increased risk of VTE associated with oral glucocorticoid treatment is due to a combined effect of the treatment and the underlying disease, remaining high during the first months of prescription.

PMID:33748963 | DOI:10.1111/bjh.17388

Community Dent Oral Epidemiol. 2021 Mar 21. doi: 10.1111/cdoe.12633. Online ahead of print.

ABSTRACT

OBJECTIVES: Evidence on serum arsenic and oral cancer risk was limited. We aimed to evaluate the association between serum arsenic and the risk of oral cancer in a southeast China population.

METHODS: Serum arsenic was determined for 325 oral cancer patients and 648 controls using inductively coupled plasma-mass spectrometry (ICP-MS). Logistic regression and restricted cubic spline were analysed the association between serum arsenic level and oral cancer risk, and crude and adjusted odds ratios (aOR) with 95% confidence interval (95% CI) were calculated. Factors adjusted for included age, gender, BMI, smoking, drinking, education, residence, marital status and dietary factors. Stratification analysis was further performed according to drinking, smoking and dietary characteristics.

RESULTS: Serum arsenic level was lower in the case group (P₅₀ = 19.2μg/L, IQR = 11.6 ~ 26.4μg/L) than in the control group (P₅₀ = 30.2 μg/L, IQR = 25.0 ~ 36.4 μg/L). An inverse but nonlinear association was observed between arsenic level and oral cancer risk by restricted cubic spline. These with moderate serum arsenic levels had a lower risk of oral cancer than those with low levels (OR = 0.11; 95%CI: 0.07-0.18), after adjusting for demographic and dietary intake factors. We also kept serum arsenic as a continuous variable in a regression model, where a similar inverse association between arsenic and oral cancer was observed, with OR = 0.86 (95%CI: 0.84-0.88). Stratification analysis revealed no significant multiplicative interactions between serum arsenic and smoking, drinking or dietary intake.

CONCLUSION: Serum arsenic is inversely related to oral cancer risk. Relative to those with low levels of arsenic, people with moderate serum arsenic levels had a lower risk of oral cancer. If confirmed, serum arsenic level may be a useful predictive marker for oral cancer risk.

PMID:33748987 | DOI:10.1111/cdoe.12633

Environ Res. 2021 Mar 18:111023. doi: 10.1016/j.envres.2021.111023. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence is limited regarding the association between temperatures and health costs.

OBJECTIVES: We tried to investigate the association between temperatures and emergency department visits (EDVs) costs in China.

METHODS: Daily data on EDVs costs, weather, air pollution were collected from 17 sites in China during 2014-2018. A quasi-Poisson generalized additive regression with distributed lag nonlinear model was applied to assess the temperature-EDVs cost association. Random-effect meta-analysis was used to pool the estimates from each site. Attributable fractions and national attributable EDVs costs due to heat and cold were calculated.

RESULTS: Relative risk (RR) due to extreme heat over 0-7 lag days was 1.14 [95% confidence intervals (CI): 1.08-1.19] and 1.11 (95% CI: 1.07-1.16) for EDVs examination (including treatment) and medicine cost, respectively. People aged 18-44 and those with genitourinary diseases were at higher risk from heat. 0.72% of examination cost and 0.57% of medicine cost were attributed to extreme heat, costing 274 million Chinese Yuan annually. Moderate heat had lower RR but higher attributable fraction of EDVs costs. Exposure to extreme cold over 0-21 lag days increased the risk of medicine cost for people aged 18-44 [RR: 1.30 (95% CI: 1.10-1.55)] and those with respiratory diseases [RR: 1.56 (95% CI: 1.14-2.14)], but had non-statistically significant attributable fraction of the total EDVs cost.

CONCLUSIONS: Exposure to heat and cold resulted in remarkable health costs. More resources and preparedness are needed to tackle such a challenge as our climate is rapidly changing.

PMID:33745933 | DOI:10.1016/j.envres.2021.111023

Arthroscopy. 2021 Mar 18:S0749-8063(21)00227-9. doi: 10.1016/j.arthro.2021.03.005. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the accuracy of the Trampoline and Hook tests, used in the arthroscopic assessment of triangular fibrocartilage complex (TFCC) tears compared to arthroscopic direct visualization of the radiocarpal joint (RCJ) and of the distal radial ulnar joint (DRUJ).

METHODS: 135 patients (97 males, 38 females, mean age 43.5 years) were divided into 2 groups: A) 80 patients with chronic ulnar sided wrist pain and positive fovea sign and B) 55 patients with other complaints. TFCC was assessed by RCJ and DRUJ arthroscopy, by Trampoline and Hook tests to detect rupture of distal and proximal components of the TFCC. Accuracy, specificity, sensitivity and likelihood ratio of the two diagnostic methods were measured and compared, using RCJ and DRUJ arthroscopy as reference.

RESULTS: The Trampoline and the Hook test showed an overall accuracy of 70.37% and 86.67%, respectively. The accuracy of the Trampoline test was similar for distal (69%), proximal (66%) and complete (73%) TFCC tears. The Hook test was more accurate when evaluating proximal (97%) and complete (98%) tears, rather than distal lesions (75%). Sensitivity for Trampoline and Hook tests was 75.00% and 0.00% (p<0.001) for distal tears, and 78.85% and 100.00% (p<0.001), and 58.33% and 100.00% (p<0.001), for complete or isolated proximal tears, respectively. Specificity for Trampoline and Hook tests was 67.27% and 96.36% (p<0.001) respectively.

CONCLUSIONS: Trampoline and Hook tests can assure accurate diagnosis of peripheral TFCC tear. The Hook test shows higher specificity and sensitivity to recognize foveal TFCC tears. Values of positive likelihood ratio suggest a higher probability to detect foveal laceration of peripheral TFCC for the Hook test than for the Trampoline test. These findings suggest that DRUJ arthroscopy is not necessary to confirm foveal detachment of the TFCC, if the Hook test is positive.

PMID:33745938 | DOI:10.1016/j.arthro.2021.03.005

Clin Lung Cancer. 2021 Feb 19:S1525-7304(21)00032-2. doi: 10.1016/j.cllc.2021.02.009. Online ahead of print.

ABSTRACT

BACKGROUND: We conducted a 2-part study to evaluate the incorporation of veliparib, a PARP inhibitor, into chemoradiotherapy (CRT) for stage III non-small-cell lung cancer.

PATIENTS AND METHODS: In the phase I part, patients were treated successively at 3 dose levels of veliparib (40, 80, and 120 mg) twice daily during CRT. In the phase II part, patients were randomized to receive veliparib or placebo during thoracic radiotherapy with concurrent weekly carboplatin and paclitaxel, followed by 2 cycles of consolidation carboplatin and paclitaxel with veliparib or placebo. The study was prematurely discontinued owing to the emergence of adjuvant immunotherapy as standard of care.

RESULTS: Of 21 patients enrolled in phase I, 2 patients developed dose-limiting toxicities (DLTs): 1 grade 3 esophagitis with dysphagia (at 40 mg) and 1 grade 3 esophagitis with dehydration (at 80 mg). No DLTs were seen at veliparib dose of 120 mg twice daily, which was selected for the phase II part that enrolled 31 eligible patients. Progression-free survival (PFS) was not different between the 2 arms (P = .20). For the veliparib and placebo arms, response rates were 56% and 69%, PFS at 1 year 47% and 46%, and overall survival at 1 year 89% and 54%, respectively.

CONCLUSION: Veliparib with CRT was feasible and well tolerated. Efficacy could not accurately be determined because of early study closure. Nonetheless, there is enthusiasm for the evaluation of PARP inhibitors in lung cancer as predictive biomarkers are being developed and combinations with immunotherapy are attractive.

PMID:33745865 | DOI:10.1016/j.cllc.2021.02.009