Outpatient sexually transmitted infection testing and treatment patterns in the United States: a real-world database study.

BACKGROUND: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most common notifiable sexually transmitted infections (STIs) in the United States. Because symptoms of these infections often overlap with other urogenital infections, misdiagnosis and incorrect treatment can occur unless appropriate STI diagnostic testing is performed in clinical settings. The objective of this study was to describe STI diagnostic testing and antimicrobial treatment patterns and trends among adolescent and adult men and women with lower genitourinary tract symptoms (LGUTS). METHODS: We analyzed insurance claims data from the IBM® MarketScan® Research Databases. Patients included were between 14 and 64 years old with LGUTS as determined by selected International Classification of Diseases codes between January 2010 and December 2019. Testing of STIs and relevant drug claims were captured, and distribution of testing patterns and drug claims were described. RESULTS: In total, 23,537,812 episodes with LGUTS (87.4% from women; 12.6% from men) were analyzed from 12,341,154 patients. CT/NG testing occurred in only 17.6% of all episodes. For episodes where patients received treatment within 2 weeks of the visit date, 89.3% received treatment within the first 3 days (likely indicating presumptive treatment), and 77.7% received it on the first day. For women with pelvic inflammatory disease and men with orchitis/epididymitis and acute prostatitis, ≤ 15% received CT/NG testing, and around one-half received antibiotic treatment within 3 days. CONCLUSIONS: Our study revealed low CT/NG testing rates, even in patients diagnosed with complications commonly associated with these STIs, along with high levels of potentially inappropriate presumptive treatment. This highlights the need for timely and accurate STI diagnosis in patients with LGUTS to inform appropriate treatment recommendations.

Adherence to National Comprehensive Cancer Network ALK Testing Guidelines for Patients with Advanced Non-Small Cell Lung Cancer in U.S. Community Medical Centers.

BACKGROUND: National Comprehensive Cancer Network (NCCN) guidelines recommend biomarker testing as the first step in the management of patients with advanced non-small cell lung cancer (aNSCLC). We assessed anaplastic lymphoma kinase (ALK) testing rates and factors related to underuse in community medical systems between 2012 and 2019 to understand guideline adoption. METHODS: A retrospective observational study using a nationwide electronic health record (EHR)-derived deidentified database was conducted. Patients with aNSCLC diagnosed in community medical centers from January 2012 to May 2019 were included to describe the ALK testing trend. This cohort was further restricted to patients diagnosed after 2015 to understand factors associated with testing underuse using mixed-effects multivariable logistic regression models. RESULTS: Trends for increased ALK testing rates by year were observed in both NCCN guideline-eligible patients (59.5% in 2012 to 84.1% in 2019) and -ineligible patients (15.6% to 50.8%) in a cohort of 41,728 patients. Histology type and smoking status had the greatest impact on test use. Compared with patients with nonsquamous histology and no smoking history, patients with squamous histology and no smoking history (adjusted odds ratio [aOR], 7.6; 95% confidence interval [CI], 5.6-10.4), NSCLC histology not otherwise specified (NOS) with smoking history (aOR, 3.4; 95% CI, 2.8-4.2); NSCLC NOS/nonsmoker (aOR, 1.8; 95% CI, 1.1-3.2), and nonsquamous/smoker (aOR, 1.5; 95% CI, 1.3-1.7) were less likely to be tested. Factors related to underuse also included Eastern Cooperative Oncology Group performance status, stage at initial diagnosis, and demographics. CONCLUSION: This analysis of real-world data shows increasing test use by year; however, one fifth of patients eligible for ALK testing still remain untested and potentially missing therapeutic options. IMPLICATIONS FOR PRACTICE: Advancement in treatment of lung cancer is accompanied by an increasing number of tests that should be run to determine potential therapy options for each patient. This study assessed adoption of testing recommendations for anaplastic lymphoma kinase rearrangements in a national database. Although test use increased over the time period studied (2012-2019), there is still room for improvement. Efforts are needed to increase test use in undertested groups, thus enabling eligible patients to benefit from novel lung cancer therapies.

Value of Precision Medicine in Advanced Non-Small Cell Lung Cancer: Real-World Outcomes Associated with the Use of Companion Diagnostics.

BACKGROUND: Companion diagnostic (CDx) testing for patients with advanced non-small cell lung cancer (aNSCLC) identifies patients more likely to benefit from biomarker-driven treatments. METHODS: Patients with nonsquamous cell (non-Sq) aNSCLC from the Flatiron Health database (diagnosed January 1, 2011-May 31, 2018) who had CDx testing were compared with those who had no reported evidence of testing. The association between CDx testing and overall survival was evaluated by unadjusted and adjusted Cox proportional hazards regression models. Logistic regression analysis identified characteristics associated with CDx testing. The revised modified Lung Cancer Prognostic Index and other factors identified a priori were included in the adjusted models. RESULTS: A total of 17,555 patients with non-Sq aNSCLC (CDx, n = 14,732; no CDx, n = 2,823) with mean ± SD age of 67.2 ± 10.0 years were included. Most were insured (91.7%) and white (67.1%). Asian patients and those who were never-smokers were more likely to undergo CDx testing. Those with CDx testing lived longer than those without (median [95% confidence interval (CI)] survival, 13.04 [12.62-13.40] vs. 6.01 [5.72-6.24] months) and had a decreased mortality risk (adjusted hazard ratio [95% CI], 0.72 [0.69-0.76]). A survival advantage was also seen for patients with CDx testing who received biomarker-driven first-line therapy. CONCLUSION: Patients with non-Sq aNSCLC who had CDx testing had a greater survival benefit than those without, supporting broader use of CDx testing in routine clinical practice to identify patients more likely to benefit from precision medicine. IMPLICATIONS FOR PRACTICE: Companion diagnostic (CDx) testing coupled with biomarker-driven treatment offers a greater survival benefit for patients with advanced non-small cell lung cancer (aNSCLC). In this study, patients with nonsquamous aNSCLC from Flatiron Health, a large, real-world oncology database, with CDx testing had a reduced mortality risk and lived longer than patients without reported evidence of CDx testing; those who received biomarker-driven therapy as their first line of treatment were likely to survive three times longer than those who did not. These results demonstrate the clinical utility of CDx testing as the first step in treating nonsquamous aNSCLC in real-world clinical practice.

"You Do Not Think of Me as a Human Being": Race and Gender Inequities Intersect to Discourage Police Reporting of Violence against Women.

Intimate partner violence (IPV) and sexual violence (SV) are drivers of women's morbidity and mortality in urban environments yet remain among the most underreported crimes in the USA. We conducted 26 in-depth interviews with women who experienced past-year IPV or SV, to explore structural and community influences on police contact in Baltimore, MD. Results indicate that gender-based and race-based inequities intersected at the structural and community levels to discourage women from police contact following IPV/SV. Structural influences on police reporting included police discriminatory police misconduct, perceived lack of concern for citizens, power disparities, fear of harm from police, and IPV/SV-related minimization and victim-blaming. Community social norms of police avoidance discouraged police contact, enforced by stringent sanctions. The intersectional lens contextualizes a unique paradox for Black women: the fear of unjust harm to their partners through an overzealous and racially motivated police response and the simultaneous sense of futility in a justice system that may not sufficiently prioritize IPV/SV. This study draws attention to structural race and gender inequities in the urban public safety environment that shape IPV/SV outcomes. Race-based inequity undermines women's safety and access to justice and pits women's safety against community priorities of averting police contact and disproportionate incarceration. A social determinants framework is valuable for understanding access to justice for IPV/SV. Enhancing access to justice for IPV/SV requires overcoming deeply entrenched racial discrimination in the justice sector, and historical minimization of violence against women.

Meat consumption and pancreatic cancer risk among men and women in the Cancer Prevention Study-II Nutrition Cohort.

PURPOSE: Prospective cohort studies suggest that red and processed meat consumption is associated with increased risk of pancreatic cancer among men, but not women. However, evidence is limited, and less evidence exists for other types of meat. METHODS: Cox proportional hazards regression was used to estimate multivariable-adjusted hazard ratios (HR) for the association of meat consumption, by type, with pancreatic cancer risk among 138,266 men and women in the Cancer Prevention Study-II Nutrition Cohort. Diet was assessed at baseline in 1992, and 10 years earlier, at enrollment into the parent CPS-II mortality cohort. 1,156 pancreatic cancers were verified through 2013. RESULTS: Red meat, processed meat, and fish intake at baseline were not associated with pancreatic cancer risk. However, for long-term red and processed meat consumption (highest quartiles in 1982 and 1992, vs. lowest quartiles), risk appeared different in men [hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.90, 1.95] and women (HR 0.72, 95% CI 0.47, 1.10, p heterogeneity by sex = 0.05). Poultry consumption in 1992 was associated with increased pancreatic cancer risk (HR 1.27, 95% CI 1.04, 1.55, p trend = 0.01, top vs. bottom quintile). CONCLUSIONS: The associations of meat consumption with pancreatic cancer risk remain unclear and further research, particularly of long-term intake, is warranted.

Police violence among women in four U.S. cities.

Police violence has been identified as a public health concern in the U.S., yet few studies have assessed the prevalence and nature of police violence among women. Furthermore, increasing evidence suggests that women reporting intimate partner violence (IPV) and sexual violence (SV) to police are often met with harmful or neglectful police responses and thus, women's exposures to police violence may be associated with experiences of IPV and SV; however, this has not yet been empirically tested. This study assesses lifetime prevalence and sociodemographic correlates of police violence among women and investigates potential associations between IPV, SV, and police violence. A cross-sectional survey was administered in four Eastern U.S. cities in March and April 2016 (N=932). Physical, sexual, and psychological police victimization and neglect by police were assessed. Logistic regression was used to examine the relationship between IPV, SV, and police violence, adjusting for sociodemographics. Lifetime prevalence of physical (4%), sexual (3.3%), and psychological (14.4%) police violence and neglect (17.2%), show that a notable proportion of women experience police victimization, with significantly higher rates among racial and ethnic minority women. Women with IPV and SV histories had increased odds of experiencing most forms of police violence compared to women without IPV and SV histories. Findings suggest the need for gender-inclusive community-centered policing initiatives and other preventive efforts aimed at eliminating police violence. Police violence and victimization among women should also be considered in IPV and SV intervention and treatment responses.

Pre- and postdiagnostic diet in relation to mortality among breast cancer survivors in the CPS-II Nutrition Cohort.

PURPOSE: Due to the limited evidence on the role of diet and cause-specific mortality among breast cancer survivors, current nutrition guidelines for this population are consistent with those for cancer prevention. We evaluated whether diets consistent with the American Cancer Society recommendations for cancer prevention were associated with risk of death in breast cancer survivors. METHODS: Participants reported information on diet and other factors at baseline in 1992-1993 and twice during follow-up. A nine-point score reflecting concordance with diet recommendations was calculated. Multivariable-adjusted relative risks (RR) and 95 % confidence intervals (CI) for diet score in relation to overall and cause-specific mortality were computed using Cox proportional hazards regression methods. RESULTS: Among 4,452 women diagnosed with locally and regionally staged breast cancer after baseline and until 2011, 1,204 died during follow-up through 2012 (398 from breast cancer). Prediagnostic diet score was not associated with mortality from any cause. Postdiagnostic diet score was associated with neither breast cancer-specific mortality (RR 1.44, 95 % CI 0.90-2.30 for scores 6-9 vs 0-2) nor cardiovascular disease mortality (RR 0.81, 95 % CI 0.47-1.39), but compared to a score of 0-2, a score of 6-9 was associated with a borderline lower risk of other causes of death (RR 0.78, 95 % CI 0.56-1.07, p trend = 0.03; per two-point increase in score RR 0.88, 95 % CI 0.79-0.99). Of diet score components, only limiting red and processed meat consumption was associated with statistically significantly lower risk of total, CVD, and other non-breast cancer mortality. CONCLUSIONS: Diets consistent with guidelines for cancer prevention were not associated with breast cancer-specific mortality. However, their association with other causes of mortality underscores the importance of consuming a healthy diet in this population.

Dietary Energy Density and Postmenopausal Breast Cancer Incidence in the Cancer Prevention Study II Nutrition Cohort.

BACKGROUND: Dietary energy density (ED) is a measure of diet quality that estimates the amount of energy per unit of food (kilocalories per gram) consumed. Low-ED diets are generally high in fiber and fruits and vegetables and low in fat. Dietary ED has been positively associated with body mass index (BMI) and other risk factors for postmenopausal breast cancer. OBJECTIVE: We evaluated the associations of total dietary ED and energy-dense (high-ED) foods with postmenopausal breast cancer incidence. METHODS: Analyses included 56,795 postmenopausal women from the Cancer Prevention Study II Nutrition Cohort with no previous history of breast or other cancers and who provided information on diet, lifestyle, and medical history in 1999. Multivariable-adjusted breast cancer incidence rate ratios (RRs and 95% CIs) were estimated for quintiles of total dietary ED and for the consumption of high-ED foods in Cox proportional hazards regression models. RESULTS: During a median follow-up of 11.7 y, 2509 invasive breast cancer cases were identified, including 1857 estrogen receptor-positive and 277 estrogen receptor-negative tumors. Median dietary ED was 1.5 kcal/g (IQR: 1.3-1.7 kcal/g). After adjusting for age, race, education, reproductive characteristics, and family history, high compared with low dietary ED was associated with a statistically significantly higher risk of breast cancer (RR for fifth quintile compared with first quintile: 1.20; 95% CI: 1.05, 1.36; P-trend = 0.03). The association between the amount of high-ED foods consumed and breast cancer risk was not statistically significant. We observed no differences by estrogen receptor status or effect modification by BMI, age, or physical activity. CONCLUSION: These results suggest a modest positive association between total dietary ED and risk of postmenopausal breast cancer.

Oxidative balance scores and risk of incident colorectal cancer in a US prospective cohort study.

Although oxidative stress is implicated in colorectal carcinogenesis, human studies on associations of individual prooxidants and antioxidants with colorectal cancer (CRC) have been inconclusive. We incorporated individual environmental factors known to affect oxidative stress into 4 oxidative balance scores (OBS) and investigated their associations with CRC in the Cancer Prevention Study II Nutrition Cohort. During 1999-2009, a total of 1,109 incident CRC cases were identified among 80,063 participants in the Nutrition Cohort who had completed detailed questionnaires. Four OBS with different weighting methods (equal weights, literature review-based, a posteriori data-based, and weights based on Bayesian analysis) were created by combining 16 dietary and nondietary lifestyle factors. Higher values for all 4 OBS, representing more antioxidant exposures than prooxidant exposures, were associated with 41%-53% lower risks of CRC; for example, the relative risk for the highest OBS quartile versus the lowest in the Bayesian analysis was 0.50 (95% confidence interval: 0.41, 0.61). The associations were more modest when OBS was restricted to either dietary or nondietary components. These results, obtained using comprehensive summary measures of oxidative balance-especially considering the similarity of the findings derived using the different weighting methods-support the hypothesis that a predominance of antioxidant lifestyle exposures (both dietary and nondietary) over prooxidant lifestyle exposures reduces risk of CRC.

Dietary flavonoid and proanthocyanidin intakes and prostate cancer risk in a prospective cohort of US men.

Higher dietary intakes of flavonoids and proanthocyanidins have been associated with a lower risk of several cancers. Few prospective epidemiologic studies have examined individual flavonoids and proanthocyanidins in relation to prostate cancer. We examined these associations in a prospective US cohort of 43,268 men with a mean age of 70 years who completed detailed self-administered questionnaires in 1999-2000. During a mean follow-up of 7.8 years, 3,974 total prostate cancers, including 567 high-grade cases and 362 advanced cases, were ascertained. Cox proportional hazards regression models were used to calculate multivariable-adjusted relative risks and 95% confidence intervals. Residual energy-adjusted total flavonoids (for fifth quintile vs. first quintile, relative risk = 1.11, 95% confidence interval: 1.01, 1.23; P for trend = 0.02) and several subclasses were positively associated with overall prostate cancer risk, mostly limited to the top quintile and the first 2 years of follow-up. The associations for total flavonoids, flavan-3-ols, and proanthocyanidins with high-grade prostate cancer risk varied by follow-up time. During follow-up from 2002 to 2009, we observed suggestive inverse trends with higher total flavonoids (P for trend = 0.05) and proanthocyanidins (P for trend = 0.04) with high-grade prostate cancer, but not with advanced prostate cancer. Although evidence is limited, a possible role of total flavonoids and proanthocyanidins in prostate cancer tumor progression deserves further study.

Artificially and sugar-sweetened carbonated beverage consumption is not associated with risk of lymphoid neoplasms in older men and women.

BACKGROUND: Concern about the carcinogenic potential of aspartame was raised after an increase in lymphomas and leukemia was reported in an animal study at doses similar to human exposure. Two prospective cohort studies published after the report found inconsistent results for estimated aspartame intake, artificially sweetened beverage consumption, and risk of lymphoid neoplasms. OBJECTIVE: The objective of this study was to examine associations of artificially and sugar-sweetened carbonated beverage consumption (for comparison) and aspartame intake with risk of non-Hodgkin lymphoma (NHL) overall and by major histologic subtype in the Cancer Prevention Study-II Nutrition Cohort. METHODS: Among 100,442 adult men and women who provided information on diet and lifestyle factors in 1999, 1196 NHL cases were verified during a 10-y follow-up period. Cox proportional hazards regression was used to estimate multivariable-adjusted RRs and 95% CIs. RESULTS: In women and men combined, there were no associations of consumption of ≥1 (355 mL) servings/d of artificially (RR: 0.92; 95% CI: 0.73, 1.17; P-trend: 0.14) or sugar- (RR: 1.10; 95% CI: 0.77, 1.58; P-trend: 0.62) sweetened carbonated beverages with NHL risk, compared to no consumption (P-heterogeneity by gender: 0.11-1.00). Similarly, aspartame intake was not associated with NHL risk (RR: 1.02; 95% CI: 0.84, 1.24; P-trend: 0.69, top vs. bottom quintile). Associations with NHL subtype (multiple myeloma, diffuse large B-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, and follicular and other B-cell lymphoma) were generally null. CONCLUSION: These findings do not support associations of daily consumption of artificially or sugar-sweetened carbonated beverages, or aspartame, with NHL risk.

Increasing knowledge and campus trust in reporting sexual and interpersonal violence: The role of the Title IX coordinator.

Objective: The present study explores the influence of Title IX awareness on systematic barriers to reporting sexual and interpersonal violence among college students. Participants: The study surveyed undergraduate and graduate students from a public Northeastern institution (n = 10,615). The study also used a sub-sample of those that did not report their experience of violence (n = 6,319). Methods: The relationship between Title IX awareness and non-reporting was examined using the total sample (n = 10,615) and the relationship between Title IX awareness and systematic barriers was examined using the sub-sample of non-reporting participants (n = 6,319). Analysis was conducted using chi-square tests and logistic regression modeling. Results: Students who could identify their Title IX Coordinator were more likely to report their experience of sexual and interpersonal violence and less likely to identify the systematic barriers. Conclusions: The Title IX Coordinator may play a crucial role in increasing reporting knowledge and improving the campus climate.

Potential delayed and/or missed STI diagnoses among outpatients presenting with lower genitourinary tract symptoms: a real-world database study.

OBJECTIVES: Sexually transmitted infection (STI) diagnosis is complicated as these infections can present with lower genitourinary tract symptoms (LGUTS) that overlap with other disorders, i.e. urinary tract infections (UTIs). The study's objective was to determine potential missed STI diagnoses from patients presenting with LGUTS in the US between January 2010 and December 2019. METHODS: The de-identified insurance claims data from the IBM® MarketScan® Research Databases were collected from patients (14-64 years old) who presented with LGUTS, which could be caused by an STI. A 'GAP' cohort was created, consisting of episodes with potentially delayed STI (Chlamydia trachomatis [CT]/Neisseria gonorrhoeae [NG]) treatment. The intention was to capture episodes where an STI was not initially suspected. Four subgroups were defined depending on the treatment received (fluoroquinolone; azithromycin and/or doxycycline; cephalosporins; gentamicin and azithromycin). RESULTS: The GAP cohort consisted of 833,574 LGUTS episodes from the original cohort (23,537,812 episodes). Post-index CT/NG testing was carried out for 4.6% and 5.4% of the episodes from men and women, respectively. There were ≥2 return visits for 16.1% and 15.8% of the episodes from men and women, respectively. A substantial percentage of episodes from men (52.1%) and women (68.3%) were diagnosed with a UTI and/or acute cystitis at the index prior to receiving post-index STI treatment. Other top conditions diagnosed at index for men were dysuria (25.8% of the episodes), orchitis/epididymitis (14.3% of the episodes), and acute prostatitis (10.1% of the episodes), and for women were dysuria (24.2% of the episodes), vaginitis/vulvitis/vulvovaginitis (11.7% of the episodes), and cervicitis (3.3% of the episodes). CONCLUSION: These findings highlight delayed STI antibiotic treatment and low rates of CT/NG testing, suggesting late STI consideration and suboptimal diagnosis. Additionally, our study illustrates the importance of accurately diagnosing and treating STIs in patients with LGUTS and associated conditions, to avoid antibiotic misuse and complications from delayed administration of appropriate treatment.

Intimate Partner Violence Training and Readiness to Respond among Students, Staff, and Faculty in Three Institutions in the United States.

Intimate partner violence (IPV) is a significant public health concern; however, limited studies have explored perceptions and experiences towards IPV among students, staff, administrators, and faculty across diverse disciplines at institutions of higher education. The purposes of this study were to (1) assess experiences of IPV among a sample of students, staff/administrators, and faculty and (2) examine the relationship among attitudes, actual and perceived knowledge, awareness, training, readiness, and personal experiences with IPV in this sample. Participants were recruited from an urban university and two university-affiliated medical institutions to participate in an online survey. Bivariate and multivariate associations were assessed. Structural Equation Modeling (SEM) was used to examine direct and indirect effects of perceived and actual knowledge and personal experiences with IPV. Of the 216 respondents, 42.6% reported personally experiencing IPV and 34.3% reported having witnessed IPV. Over 34% of participants never received training on IPV. The sub-sample with training received between one and more than 15 hours of training. Standardized total effect of training on attitudes and awareness was ß = 0.42 (95% confidence interval [CI] = 0.30-0.51), the combined indirect effects was ß = 0.18 (95% CI = 0.10-0.27) and the direct effects of ß=0.23 (95% CI = 0.12-0.34), indicating that hours of training was highly associated with the participants' perceived knowledge and actual knowledge, which improved their attitudes and awareness towards IPV survivors. Our findings suggest the need for campus-wide formal training on IPV to better prepare members in higher education to accurately identify, assess, and intervene to protect victims of abuse. Interprofessional approaches are needed that focus on the multiple and intersecting needs of victims of violence and should also enhance professional self-efficacy and increase readiness to respond to IPV survivors.

Garlic consumption and colorectal cancer risk in the CPS-II Nutrition Cohort.

PURPOSE: The World Cancer Research Fund/American Institute for Cancer Research identified a probable role for garlic in colorectal cancer prevention based on preclinical evidence and epidemiologic studies, but prospective data are limited. The purpose of this paper was to contribute additional evidence on this topic for men and women in a large prospective cohort study. METHODS: In 1999, 42,824 men and 56,876 women in the Cancer Prevention Study II Nutrition Cohort completed a questionnaire with information on dietary garlic consumption. Garlic supplement use was assessed in 2001. Cox proportional hazards regression was used to estimate multivariable-adjusted hazard rate ratios (HRs) and 95 % confidence intervals (CIs). RESULTS: During 7 years of follow-up, 579 men and 551 women were diagnosed with colorectal cancer. Among men, daily garlic consumption was associated with a non-significant higher colorectal cancer risk (HR = 1.04, 95 % CI 0.99-1.08 for each additional clove or "4 shakes" of garlic per week), whereas the association was borderline inverse in women (HR = 0.95, 95 % CI 0.91-1.00, p heterogeneity by sex = 0.03). Garlic supplement use was not related to a lower risk of colorectal cancer, and in men, former use was associated with a higher risk of colorectal cancer (HR = 1.85, 95 % CI 1.13-3.03). CONCLUSIONS: These results provide weak support for a role of dietary garlic consumption in colorectal cancer prevention in women, but a possible increased risk in men. Further research is needed to confirm different associations by sex.

Caffeine and risk of Parkinson's disease in a large cohort of men and women.

Caffeine consumption has been associated with a reduced risk of Parkinson's disease (PD). The association is strong and consistent in men, but uncertain in women, possibly because of an interaction with hormone replacement therapy (HRT). We sought to confirm these findings using data on PD incidence in the Cancer Prevention Study II Nutrition Cohort (CPS II-Nutrition), a large, prospective study of men and women. We conducted a prospective study of caffeine intake and risk of PD within the CPS II Nutrition Cohort. Intakes of coffee and other sources of caffeine were assessed at baseline. Incident cases of PD (n = 317; 197 men and 120 women) were confirmed by treating physicians and medical record review. Relative risks (RRs) were estimated using proportional hazards models, adjusting for age, smoking, and alcohol consumption. After adjustment for age, smoking, and alcohol intake, high caffeine consumption was associated with a reduced risk of PD. The RR comparing the 5th to the 1st quintile of caffeine intake was 0.43 (95% confidence interval [CI]: 0.26, 0.71; P trend = <0.002) in men, and 0.61 (95% CI: 0.34, 1.09; P trend = 0.05) in women. Among women, this association was stronger among never users of HRT (RR = 0.32) than among ever users (RR = 0.81; P interaction = 0.15). Consumption of decaffeinated coffee was not associated with PD risk. Findings from this large, prospective study of men and women are consistent with a protective effect of caffeine intake on PD incidence, with an attenuating influence of HRT in women. © 2012 Movement Disorder Society.

Defining Justice: Restorative and Retributive Justice Goals Among Intimate Partner Violence Survivors.

Intimate partner violence (IPV) and sexual violence (SV) are drivers of women's morbidity and mortality yet remain among the most underreported crimes in the United States. Understanding IPV/SV survivors' justice preferences and justice definitions can strengthen violence prevention and response systems. In-depth interviews were conducted with women who experienced past-year IPV (n = 26), to explore their justice preferences and recommendations. Primary themes included accountability, safety, and rehabilitation, with examples within and outside the current justice system, and across restorative and retributive justice frameworks. Women sought accountability through a variety of means. Retributive approaches like incarceration offered accountability as well as fleeting safety, but were critically limited in addressing the root causes of violence and, in some cases, were felt to exacerbate the problem. Women's expressed needs and preferences centered on restorative aspects of justice, including perpetrator's acknowledgment of harm, achieving physical safety and stability, and perpetrator rehabilitation through counseling. Paradoxically, women's safety-related justice goals both encouraged and discouraged their engagement in the formal justice system. The discordance between women's justice preferences and their perceptions and experiences within the current justice system illustrate complex and difficult trade-offs faced by survivors in achieving physical, social, and economic safety. Moreover, they likely contribute to the low levels of IPV/SV reporting to police. Women's goals were aligned with restorative justice principles, illustrating the value of this approach. In an era of unprecedented dialogue on justice reform, results provide direction for integrating restorative justice practices to strengthen the justice response to violence against women.

Understanding Factors Associated With Anaplastic Lymphoma Kinase Testing Delays in Patients With Non-Small Cell Lung Cancer in a Large Real-World Oncology Database.

CONTEXT.­: With multiple therapeutic options available for patients with advanced non-small cell lung cancer, the timely ordering and return of results to determine therapy are of critical importance. OBJECTIVE.­: To assess factors impacting anaplastic lymphoma kinase (ALK) test ordering and time to result delivery. DESIGN.­: A retrospective study using a de-identified electronic health record database was performed. Postdiagnosis ALK tests (n = 14 657) were analyzed from 14 197 patients with advanced non-small cell lung cancer diagnosed between January 2015 and May 2019. Time from non-small cell lung cancer diagnosis to ALK sample receipt in the laboratory was a surrogate for test order time. Test ordering was considered delayed if order time was more than 20 days. Turnaround time from sample received to test result was calculated and considered delayed if more than 10 days. Multivariable logistic regression was used to assess factors associated with order time and turnaround time delays. RESULTS.­: Median ALK test order time was 15 days, and 36.4% (5342) of all 14 657 orders were delayed. Factors associated with delays were non-fluorescence in situ hybridization testing, send-out laboratories, testing prior to 2018, nonadenocarcinoma histology, and smoking history. Median turnaround time was 9 days, and 40.3% (5906) of all 14 657 test results were delayed. Non-fluorescence in situ hybridization testing, tissue sample, and orders combining ALK with other biomarkers were associated with delayed ALK result reporting. CONCLUSIONS.­: This study provides a snapshot of real-world ALK test ordering and reporting time in US community practices. Multiple factors impacted both test ordering time and return of results, revealing opportunities for improvement. It is imperative that patients eligible for targeted therapy be identified in a timely fashion.

Clinical Impact of Adherence to NCCN Guidelines for Biomarker Testing and First-Line Treatment in Advanced Non-Small Cell Lung Cancer (aNSCLC) Using Real-World Electronic Health Record Data.

INTRODUCTION: Although clinical guidelines are broadly available, the relationship between adherence and outcomes is not well studied. This study aimed to assess the association between adherence to National Comprehensive Cancer Network (NCCN) guidelines and clinical outcomes for adult patients with advanced non-small-cell lung cancer (aNSCLC). METHODS: This was a retrospective cohort study of adult patients with aNSCLC (stages IIIB, IIIC, and IV) from a de-identified real-world database. The objective was accomplished in a two-step analysis process. We first assessed adherence to NCCN recommendations for biomarker testing and overall survival (OS). Next, we assessed adherence to NCCN-recommended first-line therapy and time to treatment discontinuation (TTD). Multivariable Cox regression analyses were conducted to evaluate the association between guideline adherence and patient outcomes. Kaplan-Meier analyses were used to assess median OS and TTD. RESULTS: A total of 28,784 patients with a diagnosis for aNSCLC between January 1, 2011 and July 31, 2019 met the inclusion criteria for the analysis of NCCN-recommended biomarker testing adherence. Two-thirds of these patients (n = 19,787) had evidence of biomarker testing (adherent). Multivariable Cox models found that testing-adherent patients had a significantly lower risk of mortality [hazard ratio (HR) = 0.89, 95% confidence interval (CI) 0.86, 0.92; p < 0.01]. Median OS was modestly longer in the testing-adherent group compared to the testing-non-adherent group (15.4 vs. 14.2 months; p < 0.01). For the first-line therapy analysis, 15,898 patients met the inclusion criteria, of which 69.9% had evidence of appropriate first-line therapy (first-line-adherent). The multivariable Cox model found that adherent patients had significantly lower risk of treatment discontinuation versus non-adherent patients (HR = 0.60, 95% CI 0.57, 0.62; p < 0.01). First-line-adherent patients had a modest, yet significantly longer median TTD compared to first-line-non-adherent patients (3.45 vs. 2.40 months; p < 0.01). CONCLUSIONS: Improved clinical outcomes were observed in patients who were adherent to NCCN-recommended biomarker testing and first-line therapy. This study demonstrated the value of following NCCN guideline recommendations and the need to prioritize timely access to biomarker testing and individualized treatment.

Moderating Effects of Resilience on Depression, Psychological Distress, and Suicidal Ideation Associated With Interpersonal Violence.

Resilience has been found to attenuate the effects of negative mental health symptomology associated with interpersonal victimization; however, existing research has largely focused on resilience traits, such as individual cognitive and environmental factors that promote resilience. In addition, empirical knowledge on the extent to which resilience mitigates suicidal symptomology associated with interpersonal violence victimization is particularly limited. This study assesses whether the relationship between interpersonal violence (i.e., IPV and nonpartner sexual violence) and mental health symptomology (i.e., depression, psychological distress, and suicidal ideation) is moderated by resilience using a general population sample of women (N = 932). A cross-sectional, observational survey was administered in four U.S. cities (Baltimore, New York City, Philadelphia, and Washington, D.C.). Bivariate results indicated that women exposed to interpersonal violence reported significantly higher rates of suicidal ideation, depression, and psychological distress compared with women without exposure to interpersonal violence. Regression models revealed significant positive associations between interpersonal violence and depression, distress, and suicidal ideation, adjusting for sociodemographics. Resilience did not significantly moderate the relationship between interpersonal violence victimization and any associated mental health outcomes. However, subgroup analyses reveal significant interaction effects between resilience and IPV within specific racial and ethnic minority subgroups, suggesting that attenuating effects of resilience on mental health symptoms (i.e., depression and psychological distress) associated with IPV likely vary across race and ethnicity. Implications for future research and clinical interventions focused on resilience among survivors of interpersonal violence are discussed.