Primary Hepatic Neuroendocrine Carcinoma: A Rare Entity.

Neuroendocrine tumors are typically low-malignancy growths arising from neuroectodermal cells of neural crest origin. Neuroendocrine carcinoma, on the other hand, represents a high-malignancy form of these tumors. While rare in the liver, they often indicate metastasis when present. We present a unique case of incidentally discovered primary hepatic neuroendocrine carcinoma. Initially, the patient's management was based on misleading radiological findings. However, histopathology confirmed the diagnosis, with subsequent imaging ruling out an extrahepatic source. Despite this, the patient opted against surgical intervention, resulting in a fatal outcome. This case underscores the critical importance of prompt diagnosis and intervention to avert adverse outcomes.

National Breast, Cervical, and Colorectal Cancer Screening Use in Federally Qualified Health Centers.

Importance: Federally qualified health centers (FQHCs) deliver health care to nearly 30 million underserved persons across the US, yet nationwide and state-level breast, cervical, and colorectal cancer screening use in FQHCs is not described. Furthermore, it is unknown how the underscreened FQHC population contributes to the total underscreened population at national and state levels. Objective: To describe national- and state-level breast, cervical, and colorectal cancer screening use among individuals served by FQHCs in the US and to estimate the percentage of underscreened individuals in the general population served by FQHCs. Design, Setting, and Participants: This cross-sectional analysis of cancer screening used data from January 1 through December 31, 2020, from the FQHC Uniform Data System, reported by 1364 FQHCs across the US, and self-reported estimates from the Behavioral Risk Factor Surveillance System. Participants were 16 696 692 US adults served by FQHCs who were eligible for breast (age, 50-74 years), cervical (age, 21-64 years), and colorectal (age, 50-75 years) cancer screening. Analyses were conducted between January 1 and June 30, 2023. Exposures: Breast, cervical, and colorectal cancer screening. Main Outcomes and Measures: Percentages of breast, cervical, and colorectal cancer screening-eligible individuals up to date on screening. Results: A total of 3 162 882 breast, 7 444 465 cervical, and 6 089 345 colorectal screening-eligible individuals were served by FQHCs in 2020. Nationally, screening use in FQHCs was 45.4% (95% CI, 45.4%-45.5%) for breast cancer, 51.0% (95% CI, 51.0%-51.1%) for cervical cancer, and 40.2% (95% CI, 40.1%-40.2%) for colorectal cancer. Screening use among the US general population was 78.2% (95% CI, 77.6%-78.9%) for breast cancer, 82.9% (95% CI, 82.3%-83.4%) for cervical cancer, and 72.3% (95% CI, 71.7%-72.8%) for colorectal cancer. The contribution of the underscreened population served by FQHCs to the national underscreened general population was 16.9% (95% uncertainty interval [UI], 16.4%-17.4%) for breast cancer, 29.7% (95% UI, 28.8%-30.7%) for cervical cancer, and 14.7% (95% UI, 14.4%-15.0%) for colorectal cancer. Conclusions and Relevance: Findings from this national cross-sectional study indicated major gaps in cancer screening use in FQHCs in the US. Improved prevention is urgently needed to address screening disparities.

Do conditional cash transfers reduce hypertension?

Progresa, an anti-poverty conditional cash transfer program, has been a model for similar programs in more than 60 countries. Numerous studies have found positive impacts on schooling, the nutritional and health status of children and adolescents, and household consumption. However, the effects on the health of older adult beneficiaries have been particularly understudied. In this paper we analyze the effects of Progresa on middle-aged and older adult health, focusing on a high prevalence chronic condition: hypertension. Our results show that Progresa had significant benefits in terms of improved hypertension diagnosis and use of treatment drugs. However, we did not find significant changes in uncontrolled hypertension as measured by systolic and diastolic blood pressure biomarkers in household survey data. Thus, while cash transfer programs may facilitate financial access to healthcare visits and the ability to buy prescribed medicines, by itself the program might not improve hypertension outcomes without complementary healthcare system follow-up to ensure dosage titration and medication adherence.

A Novel Home for Hemangiomas: Sclerosing Hemangioma in the Pancreas.

Pancreatic hemangiomas, predominantly in female patients, are rare benign vascular tumors. We report a unique case of an incidentally discovered pancreatic sclerosing hemangioma. The patient's clinical presentation and imaging were concerning for an abdominal mass. Endoscopic ultrasound and histopathology confirmed the pancreatic sclerosing hemangioma. Because there were no complications, surgery was not performed, and the patient was monitored. Biopsy confirmation is crucial to rule out malignancy and avoid unnecessary surgical resection.

Improving End-of-Life Care for Nursing Home Residents Using an Interprofessional Approach.

Interprofessional collaboration enhances quality end-of-life care leading to a dignified death. Hospice care uses an interdisciplinary approach to optimize quality of life and mitigate impacts of serious illness. Interventions to improve hospice care delivery have been proven to be effective, but little is known about nursing home staff preparedness, implementation of hospice education, and interprofessional communication. Research is limited on how hospice care can be implemented into the nursing home setting. The purpose of this study was to determine if education combined with a communication tool improved nursing home staff knowledge and improved communication with the hospice team. The descriptive study invited participants to take a preseminar and postseminar survey to assess end-of-life preparedness in terms of willingness, capability, and resilience. A communication tool was implemented to measure collaboration with the hospice team over 3 months. The results from this study suggest education combined with interprofessional communication improves end-of-life care.

Self-Sampling for Human Papillomavirus Testing: Acceptability in a U.S. Safety Net Health System.

INTRODUCTION: Self-sampling for human papillomavirus testing is increasingly recognized as a strategy to expand cervical cancer screening access and utilization. Acceptability is a key determinant of uptake. This study assesses the acceptability of and experiences with mailed self-sampling kits for human papillomavirus testing among underscreened patients in a safety net health system. METHODS: A nested telephone survey was administered between 2021 and 2023 to a sample (n=272) of the 2,268 participants enrolled in the Prospective Evaluation of Self-Testing to Increase Screening trial. Trial participants include patients of a safety net health system aged 30-65 years who were not up to date on screening. Participants were asked about barriers to provider-performed screening. Kit users and nonusers were asked about their experiences. RESULTS: Prevalent barriers to provider-performed screening included perceived discomfort of pelvic examination (69.4%), being uncomfortable with male providers (65.4%), and embarrassment (57.0%). Among participants who reported using the mailed kit (n=164), most reported good experiences (84.8%). Most reported self-sampling as more/equally convenient (89.0%), less/equally embarrassing (99.4%), and less/equally stressful (95.7%) than provider-performed screening. Among kit nonusers (n=43), reasons for not using the kit included forgetting about it (76.7%), preferring provider-performed screening (76.7%), and fearing cancer (67.4%). CONCLUSIONS: Prospective Evaluation of Self-Testing to Increase Screening trial participants generally had a positive experience with self-sampling for human papillomavirus testing. Increased comfort and reduced embarrassment/anxiety with self-sampling are relevant attributes because these were the most prevalent reported barriers to provider-performed screening. High acceptability suggests potentially high uptake when self-sampling for human papillomavirus testing receives regulatory approval and is available in safety net health systems.

Cervical cancer screening among English- and Spanish-speaking Hispanic women in an urban safety net health system, 2015-2020.

BACKGROUND: The Hispanic population is heterogeneous with differences in health behaviors across subgroups by nativity and preferred language. We evaluated cervical cancer screening adherence among English- and Spanish-speaking Hispanic patients receiving care at a safety net health system. METHODS: Electronic health records were used to identify 46,094 women aged 30-65. Up to date (UTD) screening was defined based on date of last Pap test, human papillomavirus (HPV) test, or Pap/HPV co-test. RESULTS: Overall, 81.5% of 31,297 Hispanic women were UTD. English-speaking Hispanic women had a lower prevalence of being UTD when compared to Spanish-speaking Hispanic women (aPR: 0.94, 95% CI: 0.93 - 0.96). Further, those with indigent healthcare plans had a higher prevalence of being UTD when compared to those with private insurance (aPR: 1.10, 95% CI: 1.09 - 1.12), while all other health insurance plans were associated with lower UTD screening when compared to private insurance. CONCLUSIONS: These findings suggest screening differences within the Hispanic population, highlighting the need for disaggregated research assessing heterogeneity within racial/ethnic groups, specifically among Hispanic populations.

Perceived barriers to cervical cancer screening and motivators for at-home human papillomavirus self-sampling during the COVID-19 pandemic: Results from a telephone survey.

Background: Home-based self-sampling for human papillomavirus (HPV) testing may be an alternative for women not attending clinic-based cervical cancer screening. Methods: We assessed barriers to care and motivators to use at-home HPV self-sampling kits during the COVID-19 pandemic as part of a randomized controlled trial evaluating kit effectiveness. Participants were women aged 30-65 and under-screened for cervical cancer in a safety-net healthcare system. We conducted telephone surveys in English/Spanish among a subgroup of trial participants, assessed differences between groups, and determined statistical significance at p<0.05. Results: Over half of 233 survey participants reported that clinic-based screening (Pap) is uncomfortable (67.8%), embarrassing (52.4%), and discomfort seeing male providers (63.1%). The last two factors were significantly more prevalent among Spanish vs English speakers (66.4% vs 30% (p=0.000) and 69.9 vs 52.2% (p=0.006), respectively). Most women who completed the kit found Pap more embarrassing (69.3%), stressful (55.6%), and less convenient (55.6%) than the kit. The first factor was more prevalent among Spanish vs English speakers (79.6% vs 53.38%, p=0.001) and among patients with elementary education or below. Conclusions: The COVID-19 pandemic influenced most (59.5%) to participate in the trial due to fear of COVID, difficulty making appointments, and ease of using kits. HPV self-sampling kits may reduce barriers among under-screened women in a safety-net system. Funding: This study is supported by a grant from the National Institute for Minority Health and Health Disparitie s (NIMHD, R01MD013715, PI: JR Montealegre). Clinical trial number: NCT03898167.

Perceived Barriers and Use of Evidence-Based Practices for Adolescent HPV Vaccination among East Texas Providers.

Adolescents living in rural areas are less likely to be up to date on the human papillomavirus (HPV) vaccine, which can prevent cervical cancer. We administered a telephone survey to 27 clinics in rural East Texas to assess perceived barriers to HPV vaccination and current use of evidence-based interventions to promote HPV vaccination. Perceived barriers were assessed using a 5-point Likert scale and clinical implementation of evidence-based practices was determined. Findings are reported using descriptive statistics. The most commonly reported barriers were missed vaccination opportunities due to the pandemic (66.7%), followed by vaccine hesitancy due to the pandemic (44.4%) and due to the HPV vaccine specifically (33.3%). Fewer than a third of clinics reported using the evidence-based strategies of use of a "refusal to vaccinate" form (29.6%), having an identified HPV vaccine champion (29.6%), and recommending the HPV vaccine at age 9 (22.2%). While many clinics surveyed currently implement evidence-based practices to promote HPV vaccination, there is a need and desire for additional HPV vaccination interventions in East Texas clinics.

The effect of tablet computer-based telemonitoring added to an established telephone disease management program on heart failure hospitalizations: The Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) III Randomized Controlled Trial.

BACKGROUND: Mobile health applications are becoming increasingly common. Prior work has demonstrated reduced heart failure (HF) hospitalizations with HF disease management programs; however, few of these programs have used tablet computer-based technology. METHODS: Participants with a diagnosis of HF and at least 1 high risk feature for hospitalization were randomized to either an established telephone-based disease management program or the same disease management program with the addition of remote monitoring of weight, blood pressure, heart rate and symptoms via a tablet computer for 90 days. The primary endpoint was the number of days hospitalized for HF assessed at 90 days. RESULTS: From August 2014 to April 2019, 212 participants from 3 hospitals in Massachusetts were randomized 3:1 to telemonitoring-based HF disease management (n = 159) or telephone-based HF disease management (n = 53) with 98% of individuals in both study groups completing the 90 days of follow-up. There was no significant difference in the number of days hospitalized for HF between the telemonitoring disease management group (0.88 ± 3.28 days per patient-90 days) and the telephone-based disease management group (1.00 ± 2.97 days per patient-90 days); incidence rate ratio 0.82 (95% confidence interval, 0.43-1.58; P = .442). CONCLUSIONS: The addition of tablet-based telemonitoring to an established HF telephone-based disease management program did not reduce HF hospitalizations; however, study power was limited.

Responding flexibly to the complex problem of chronic pelvic pain: Incorporating patient needs into program development.

BACKGROUND: Chronic pelvic pain (CPP) in women is both common and disabling, and access to interdisciplinary care is limited. Patient education programs may represent a pragmatic approach to delivering interdisciplinary care, but to date the specific educational needs of patients with CPP are unknown. METHOD: We surveyed 136 patients at a tertiary CPP treatment center to identify their educational needs and preferences; 71 (52%) completed surveys. Based on the results, we developed an interdisciplinary educational program, including expert presentations and an extensive participant handbook. We modified our program to a webinar format following the advent of COVID-19. Participants registered for the webinar only or for our study involving completion of three measures of pain-related functioning before and 2 months after the webinar. RESULTS: Our survey results indicated that CPP patients were most interested in learning about the diagnosis and treatment of CPP, coping with CPP, and diet and exercise in the context of CPP; patients also indicated a preference for brief, one-time programs. Of the 164 webinar participants, 64 (39%) enrolled in the study and completed baseline measures; 20 (31%) of those returned follow-up measures 2 months after the webinars. Participants who completed follow-up measures reported significant reduction in pain-related interference; no other significant differences were observed. Participants who completed feedback surveys were positive in their evaluation of the program. CONCLUSION: Patients with CPP desire more knowledge about their complex symptoms. Addressing their specific needs through educational supports may enhance their ability to manage their symptoms independently. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceived barriers to cervical cancer screening and motivators for at-home human papillomavirus self-sampling during the COVID-19 pandemic: Results from a telephone survey.

Home-based self-sample human papillomavirus (HPV) testing may be an alternative for women who do not attend clinic-based cervical cancer screening. We assessed barriers to care and motivators to use at-home HPV self-sampling kits during the COVID-19 pandemic as part of a randomized controlled trial evaluating kit effectiveness. Participants were women, aged 30-65 years and underscreened for cervical cancer in a safety-net healthcare system. We conducted telephone surveys in English/Spanish among a subgroup of trial participants, assessed differences between groups and determined statistical significance at p<0.05. Over half of 233 survey participants reported clinic-based screening (Pap) is uncomfortable (67.8%), embarrassing (52.4%), and discomfort seeing male providers (63.1%). The latter two factors were significantly more prevalent among Spanish versus English speakers (66.4% vs 30% and 69.9 vs 52.2%, respectively, p<0.01). Most women who completed the kit found Pap more embarrassing (69.3%), stressful (55.6%) and less convenient (55.6%) than the kit. The first factor was more prevalent among Spanish versus English speakers (79.6% vs 53.38%, p<0.05). The COVID-19 pandemic influenced most (59.5%) to participate in the trial due to fear of COVID, difficulty making appointments and ease of using kits. HPV self-sampling kits may reduce barriers among underscreened women in a safety-net system.

Health Shocks and Economic Well-being of the Aging Population: Evidence from Mexico.

We exploit the longitudinal Mexican Health and Aging Study to estimate the effects of health shocks in the short-run on the subsequent economic well-being of the aging population in Mexico. While there is substantial evidence indicating negative economic effects of such changes in industrialized countries, little is known about health impacts on the future economic position of older adults in low- and middle-income countries. This paper takes an important step towards filling this gap in knowledge. Our results are widely relevant, with a large percentage of the world's population residing in developing countries such as Mexico that are experiencing rapid aging. We find evidence of negative impacts of health shocks on subsequent economic well-being of older adults in Mexico, but the effect varies according to several dimensions. First, the impact is clearly on income, not wealth. Second, responses are heterogenous across sources of income, with evidence of an impact mainly on labor income. Third, we find clear differences by gender in the impact of a health shock, with a larger negative impact on men. Fourth, we conclude that the population groups most negatively affected are those with the greatest degree of vulnerability prior to the shock, as measured by education and access to health insurance. Even though Mexico has made important gains with anti-poverty programs such as the Programa 70+ pension and a move towards universal health insurance, additional interventions targeted at the most vulnerable subsets of the aging population might be warranted.

The emerging infrastructure of US firearms injury data.

For every fatal shooting in the United States, detailed information from reports of coroners or medical examiners, police departments, and other sources is recorded in the National Violent Death Reporting System. There is no such system in place for nonfatal shootings, which far outnumber fatalities. Hospital data systems are in place that could, with some improvements, provide access to reliable local, state and national estimates of firearm injuries. Such estimates are possible because most firearms injuries are treated in hospitals, and hospitals routinely assign "external cause of injury" codes to all injury encounters. Federal health agencies supervise a number of data systems that centralize hospital data. Challenges currently being addressed are public access, timeliness, and accuracy of coding of intent. (Hospitals misclassify many firearm assaults as accidents.) Law enforcement agencies provide detailed data on shootings in criminal circumstances, including shootings that are not treated in a hospital. The FBI's Uniform Crime Reports (UCR) system aggregates data from agencies. The FBI instituted a radical reform of this system beginning in 2021, resulting in a sharp agency participation drop that prevents valid national estimates. The reform requires agencies to report incident-level data instead of summary counts, which is all that was required for the previous 90 years. There are ongoing efforts to increase participation in the new system and restore its former status as the leading source of national crime estimates. In the meantime, data on nonfatal gunshot cases are available from a number of police departments. We discuss additional reforms needed to generate timely, accurate, publicly accessible data from hospitals and police.

Pulmonary Alveolar Proteinosis due to Familial Myelodysplastic Syndrome with resolution after stem cell transplant.

Pulmonary alveolar proteinosis (PAP) is a rare lung disease with an incidence of 0.2 cases per million. PAP has multiple causes, including autoimmune, hereditary, congenital, or secondary. The latter includes hematologic conditions and exposure to different kinds of dust. Most patients present fever, dyspnea, and cough. The chest computed tomography (CT) may reveal the crazy-paving polygonal shapes with superimposed ground glass opacities delimited by thickened interlobular septa; however, this finding is more prevalent in patients with autoimmune PAP. Bronchoalveolar lavage (BAL) shows a milky-opaque appearance with PAS-positive debris on cytology. Treatment is focused on the underlying disease; however, some patients may require whole lung lavage for symptomatic management. We report a case of a 30-year-old female with a history of familial myelodysplastic syndrome (MDS) with GATA 2 mutation who presented to the outpatient clinic with several months of progressive dyspnea and nonproductive cough. The chest CT revealed bilateral ground-glass opacities prominently in the upper lobes. She underwent a bronchoscopy with lavage and biopsy, which revealed fragments of lung parenchyma with intra-alveolar coarse granular eosinophilic material strongly positive for PAS and d-PAS. The overall clinical presentation and histologic findings were diagnostic of PAP. Her GM-CSF was negative, and due to her history of MDS, secondary PAP (S-PAP) was strongly suspected. She underwent a successful allogeneic bone marrow pluripotent stem cell transplant to treat the myelodysplastic syndrome, with a follow-up chest CT showing clear lung parenchyma. The patient had resolution of symptoms about four months after the bone marrow transplant, confirming the diagnosis of S-PAP.

Measuring gun violence in police data sources: transitioning to NIBRS.

BACKGROUND: The majority of gun violence in the United States does not result in physical injury and therefore cannot be completely measured using hospital data. To measure the full scope of gun violence, the nation's crime reporting systems that collect police reports of crimes committed with a firearm are vital. However, crime data reporting conventions may underestimate gun violence in the U.S. This paper compares crime data sources to assess underestimation of gun violence. FINDINGS: The Federal Bureau of Investigation's Summary Reporting System (SRS) and National Incident Based Reporting System (NIBRS) measures of gun violence were compared in 2019 for states comprehensively reporting data to both systems. Gun violence is underestimated in the SRS compared to NIBRS. Within the sample, 18.8% more aggravated assaults with a firearm are recorded and 2.1% more robberies with a firearm are recorded in NIBRS. The proportion of assaults and robberies committed with a firearm measured in both sources did not differ. If the additional gun violence events recorded in the NIBRS sample are consistent with national crime reporting, the number of additional gun violence events per year captured using NIBRS totals approximately 65,071 additional events, or an additional 178 gun violence events per day. Of the additional gun violence events, approximately 31% are due to omitted crime categories, with the remaining variation driven mostly by aggravated assaults with a firearm. CONCLUSIONS: Police data are important data sources for estimating the full scope of gun violence. Comparisons between police data sources suggest that the proportion of crimes committed with a firearm is unchanged. Due to crime reporting conventions, however, the number of gun violence events may be substantially understated. Despite advantages in measuring gun violence, agency participation in NIBRS is alarmingly low and jeopardizes accurate and reliable national crime data.

Safety and immunogenicity of monovalent H7N9 influenza vaccine with AS03 adjuvant given sequentially or simultaneously with a seasonal influenza vaccine: A randomized clinical trial.

BACKGROUND: Influenza A/H7N9 viruses have pandemic potential. METHODS: We conducted an open-label, randomized, controlled trial of AS03-adjuvanted 2017 inactivated influenza A/H7N9 vaccine (H7N9 IIV) in healthy adults. Group 1 received H7N9 IIV and seasonal quadrivalent influenza vaccine (IIV4) simultaneously, followed by H7N9 IIV three weeks later. Group 2 received IIV4 alone and then two doses of H7N9 IIV at three-week intervals. Group 3 received one dose of IIV4. We used hemagglutination inhibition (HAI) and microneutralization (MN) assays to measure geometric mean titers and seroprotection (≥1:40 titer) to vaccine strains and monitored for safety. RESULTS: Among 149 subjects, seroprotection by HAI three weeks after H7N9 IIV dose 2 was 51% (95 %CI 37%-65%) for Group 1 and 40% (95 %CI 25%-56%) for Group 2. Seroprotection by MN at the same timepoint was 84% (95 %CI 72%-93%) for Group 1 and 74% (95 %CI 60%-86%) for Group 2. By 180 days after H7N9 IIV dose 2, seroprotection by HAI or MN was low for Groups 1 and 2. Responses measured by HAI and MN against each IIV4 strain three weeks after IIV4 vaccination were similar in all groups. Solicited local and systemic reactions were similar after a single vaccination, while those receiving simultaneous H7N9 and IIV4 had slightly more reactogenicity. There were no serious adverse events or medically-attended adverse events related to study product receipt. CONCLUSIONS: Adjuvanted H7N9 IIV was modestly immunogenic whether administered simultaneously or sequentially with IIV4, though responses declined by 180 days. IIV4 was immunogenic regardless of schedule. CLINICAL TRIALS REGISTRATION: NCT03318315.

Open hardware microsecond dispersive transient absorption spectrometer for linear optical response.

An open hardware design and implementation for a transient absorption spectrometer are presented that has microsecond time resolution and measures full difference spectra in the visible spectral region from 380 to 750 nm. The instrument has been designed to allow transient absorption spectroscopy measurements of either low or high quantum yield processes by combining intense sub-microsecond excitation flashes using a xenon lamp together with stroboscopic non-actinic white light probing using LED sources driven under high pulsed current from a capacitor bank. The instrument is sensitive to resolve 0.15 mOD flash-induced differences within 1000 measurements at 20 Hz repetition rate using an inexpensive CCD sensor with 200 µm pixel dimension, 40 K electrons full well capacity and a dynamic range of 1800. The excitation flash has 230 ns pulse duration and the 2 mJ flash energy allows spectral filtering while retaining high power density with focussing to generate mOD signals in the 10-4-10-1 ΔOD range. We present the full electronics design and construction of the flash and probe sources, the optics as well as the timing electronics and CCD spectrometer operation and modification for internal signal referencing. The performance characterisation and example measurements are demonstrated using microsecond TAS of Congo red dye, as an example of a low quantum yield photoreaction at 2% with up to 78% of molecules excited. The instrument is fully open hardware and combines inexpensive selection of commercial components, optics and electronics and allows linear response measurements of photoinduced reactions for the purpose of accurate global analysis of chemical dynamics.