Association of Morbid Progression With Overall Survival Among Patients With Multiple Myeloma: Validation of the Progression-free Survival Endpoint.

INTRODUCTION: Multiple myeloma (MM) is an incurable malignancy, marked by end-organ damage that is frequently irreversible. Progressive disease (PD) can be defined as morbid PD, associated with new-onset hypercalcemia, renal insufficiency, anemia, or lytic bone lesions (CRAB symptoms), or as asymptomatic biochemical progression. The frequency of morbid versus asymptomatic PD and its effect on survival is unknown. Our aim was to determine the incidence of morbid PD, and to evaluate if this influences survival. PATIENTS AND METHODS: Data from 2 phase III trials of transplant-ineligible patients with newly diagnosed MM were included in a post hoc analysis. RESULTS: Of 2082 patients enrolled, 1243 (59.7%) experienced PD. At first progression, 543 (43.7%) patients had morbid PD; 12 (2.2%) had hypercalcemia, 271 (49.9%) had renal insufficiency, 370 (68.1%) developed anemia, and 79 (14.5%) developed new or enlarged bone lesions. A total of 700 (56.3%) patients had asymptomatic PD. Patients with morbid PD had worse second progression-free survival (PFS) versus patients with asymptomatic biochemical PD (median second PFS, 11.5 months vs. 20.0 months; hazard ratio, 1.63; 95% confidence interval, 1.43-1.85; P < .0001) and worse overall survival (OS) (median OS, 23.2 months vs 39.3 months; hazard ratio, 1.51; 95% confidence interval, 1.30, 1.74; P < .0001). CONCLUSIONS: Morbid PD occurs frequently and is associated with inferior second PFS and OS. As CRAB symptoms may not reverse with therapy, morbid PD is a meaningful event, and its association with a shortened PFS adds validity to PFS as a relevant endpoint in patients with MM.

Elevated Blood Lead Levels by Length of Time From Resettlement to Health Screening in Kentucky Refugee Children.

OBJECTIVES: To examine elevated blood lead levels (EBLLs) in refugee children by postrelocation duration with control for several covariates. METHODS: We assessed EBLLs (≥ 5µg/dL) between 2012 and 2016 of children younger than 15 years (n = 1950) by the duration of resettlement to health screening by using logistic regression, with control for potential confounders (gender, region of birth, age of housing, and intestinal infestation) in a cross-sectional study. RESULTS: Prevalence of EBLLs was 11.2%. Length of time from resettlement to health screening was inversely associated with EBLLs (tertile 2 unadjusted odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.56, 1.12; tertile 3 OR = 0.62; 95% CI = 0.42, 0.90; tertile 2 adjusted odds ratio [AOR] = 0.62; 95% CI = 0.39, 0.97; tertile 3 AOR = 0.57; 95% CI = 0.34, 0.93). There was a significant interaction between intestinal infestation and age of housing (P < .003), indicating significant risk in the joint exposure of intestinal infestation (a pica proxy) and age of house. CONCLUSIONS: Elevated blood lead levels were reduced with increasing length of time of resettlement in unadjusted and adjusted models. Improved housing, early education, and effective safe-house inspections may be necessary to address EBLLs in refugees.

Postsplenectomy vaccination guideline adherence: Opportunities for improvement.

BACKGROUND AND PURPOSE: Patients undergoing splenectomy for trauma are at life-long risk for rapidly progressive septicemia. The purpose of this study was to investigate long-term patient understanding and follow-up with recommendations regarding their asplenia. METHODS: Patients undergoing splenectomy for trauma January 2010-December 2014 were analyzed. Medical records were reviewed and telephone follow-up interviews were conducted in October-December 2015. Patients were asked a standard set of questions that included hospitalizations, awareness of infectious risks associated with asplenia, need for revaccination, and vaccines they had received since their index hospitalization. FINDINGS: Two hundred forty-four patients underwent splenectomy during the study period. A total of 95 patients (39%) were included in the study. Thirty (32%) had been hospitalized since their trauma admission. Only 46% were aware of the risks for sepsis and the need to revaccinate. Only 7% reported having rapid access to antibiotics. CONCLUSIONS: Despite uniform education prior to discharge, most patients undergoing splenectomy for trauma were unaware of the risks for sepsis and did not follow recommended guidelines for risk reduction. IMPLICATIONS FOR PRACTICE: Improvements that have direct implications for advanced practice included the need to refer for vaccination, educate regarding infection risks, and facilitate rapid access to antibiotic treatment.

Infection prevention and control and the refugee population: Experiences from the University of Louisville Global Health Center.

BACKGROUND: During 2016, approximately 140,000 individuals entered the United States as part of the federal government refugee resettlement program and established themselves in communities in virtually every state. No national database regarding refugee health currently exists; therefore, little is known about existing infectious diseases, conditions, and cultural practices that impact successful acculturation. The objective of this report is to identify what is currently known about refugees and circumstances important to infection prevention and control with respect to their roles as new community members, employees, and consumers of health care. METHODS: Using data from the University of Louisville Global Health Center's Newly Arriving Refugee Surveillance System, health issues affecting refugees from the perspective of a community member, an employee, and a patient were explored. RESULTS: Lack of immunity to vaccine-preventable diseases is the most widespread issue impacting almost every adult, adolescent, and child refugee resettled in Kentucky. Health issues of concern from an infection prevention and control perspective include latent tuberculosis infection, HIV, hepatitis B, hepatitis C, syphilis, and parasites. Other health conditions that may also be important include anemia, obesity, oral health, diabetes, and cardiovascular disease. CONCLUSIONS: Refugee resettlement provides motivation for collaborative work among those responsible for infection prevention and control in all settings, their public health partners, and those responsible for and interested in community workforce concerns.

Co-occurrence of autism and asthma in a nationally-representative sample of children in the United States.

Few large epidemiological studies have examined the co-occurrence of autism and asthma. We performed a cross-sectional study to examine this association using the 2007 National Survey of Children's Health dataset (n = 77,951). We controlled for confounders and tested for autism-secondhand smoke interaction. Prevalence of asthma and autism were 14.5 % (n = 11,335) and 1.81 % (n = 1,412) respectively. Unadjusted odds ratio (OR) for asthma among autistic children was 1.35 (95 % CI 1.18-1.55). Adjusting for covariates (age, gender, body mass index, race, brain injury, secondhand smoke and socio-economic status) attenuated the OR to 1.19 (95 % CI 1.03-1.36). Autism-secondhand smoke interaction was insignificant (p = 0.38). Asthma is approximately 35 % more common in autistic children; screening may be an efficient approach to reduce risk of morbidity due to asthma.