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BACKGROUND: Children with congenital heart defects (CHDs) are at higher risk of developing an intellectual disability. However, severity of intellectual disabilities among this group of children are largely unknown. Our objective was to determine the risk of intellectual disability (ID), ID severity, and autism among children with CHDs. METHODS: We conducted a retrospective cohort study of singleton live births in Western Australia (n = 20,592) between 1983 and 2010. Children with CHDs were identified from the Western Australian Register for Developmental Anomalies (n = 6563) and infants without CHDs were randomly selected from state birth records (n = 14,029). Children diagnosed with ID before 18 years were identified by linkage to statewide Intellectual Disability Exploring Answers database. Odds ratios (OR) and 95% confidence intervals (CI) were calculated from logistic regression models for all CHDs combined and by CHD severity adjusting for potential confounders. RESULTS: Of 20,592 children, 466 (7.1%) with CHDs and 187 (1.3%) without CHDs had an ID. Compared to children without CHDs, children with any CHD had 5.26 times (95% CI 4.42, 6.26) the odds of having an ID and 4.76 times (95% CI 3.98, 5.70) the odds of having mild/moderate ID. Children with any CHD had 1.76 times the odds of having autism (95% CI 1.07, 2.88), and 3.27 times the odds of having an unknown cause of ID (95% CI 2.65, 4.05) compared to children without CHD. The risk of having autism (aOR 3.23, 95% CI 1.11, 9.38), and unknown cause of ID (aOR 3.45, 95% CI 2.09, 5.70) was greatest for children with mild CHD. CONCLUSIONS: Children with CHDs were more likely to have an ID or autism. Future research should elucidate underlying etiology of ID in children with CHDs.
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Trastorno Autístico , Cardiopatías Congénitas , Discapacidad Intelectual , Lactante , Humanos , Niño , Australia Occidental , Australia , Estudios RetrospectivosRESUMEN
PURPOSE: Lung stiffness alters with many diseases; therefore, several MR elastography (MRE) studies were performed earlier to investigate the stiffness of the right lung during breathhold at residual volume and total lung capacity. The aims of this study were 1) to estimate shear stiffness of the lungs using MRE under free breathing and demonstrate the measurements' repeatability and reproducibility, and 2) to compare lung stiffness under free breathing to breathhold and as a function of age and gender. METHODS: Twenty-five healthy volunteers were scanned on a 1.5 Tesla MRI scanner. Spin-echo dual-density spiral and a spin-echo EPI MRE sequences were used to measure shear stiffness of the lungs during free breathing and breathhold at midpoint of tidal volume, respectively. Concordance correlation coefficient and Bland-Altman analyses were performed to determine the repeatability and reproducibility of the spin-echo dual-density spiral-derived shear stiffness. Repeated measures analyses of variances were used to investigate differences in shear stiffness between spin-echo dual-density spiral and spin-echo EPI, right and left lungs, males and females, and different age groups. RESULTS: Free-breathing MRE sequence was highly repeatable and reproducible (concordance correlation coefficient > 0.86 for both lungs). Lung stiffness was significantly lower in breathhold than in free breathing (P < .001), which can be attributed to potential stress relaxation of lung parenchyma or breathhold inconsistencies. However, there was no significant difference between different age groups (P = .08). The left lung showed slightly higher stiffness values than the right lung (P = .14). There is no significant difference in lung stiffness between genders. CONCLUSION: This study demonstrated the feasibility of free-breathing lung MRE with excellent repeatability and reproducibility. Stiffness changes with age and during the respiratory cycle. However, gender does not influence lungs stiffness.
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Diagnóstico por Imagen de Elasticidad , Imagen Eco-Planar , Femenino , Humanos , Pulmón/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVES: To assess associations between maternal smoking and congenital heart defects (CHDs) in offspring. STUDY DESIGN: We performed a retrospective case-control study using data for cases of CHD (n = 8339) and nonmalformed controls (n = 11 020) from all years (1997-2011) of the National Birth Defects Prevention Study. Maternal self-reported smoking 1 month before through 3 months after conception was evaluated as a binary (none, any) and categorical (light, medium, heavy) exposure. Multivariable logistic regression was used to estimate aOR and 95% CIs. Stratified analyses were performed for septal defects according to maternal age, prepregnancy body mass index, and maternal race/ethnicity. RESULTS: Multiple CHDs displayed modest associations with any level of maternal periconceptional smoking independent of potential confounders; the strongest associations were for aggregated septal defects (OR, 1.5; 95% CI, 1.3-1.7), tricuspid atresia (OR, 1.7; 95% CI, 1.0-2.7), and double outlet right ventricle (DORV) (OR, 1.5; 95% CI, 1.1-2.1). Tricuspid atresia and DORV also displayed dose-response relationships. Among heavy smokers, the highest odds were again observed for tricuspid atresia (aOR 3.0; 95% CI, 1.5-6.1) and DORV (aOR 1.5; 95% CI, 1.1-2.2). Heavy smokers ≥35 years old more frequently had a child with a septal defect when compared with similarly aged nonsmokers (aOR 2.3; 95% CI, 1.4-3.9). CONCLUSIONS: Maternal periconceptional smoking is most strongly associated with septal defects, tricuspid atresia, and DORV; the risk for septal defects is modified by maternal age.
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Cannabis , Cardiopatías Congénitas , Efectos Tardíos de la Exposición Prenatal , Adulto , Anciano , Estudios de Casos y Controles , Niño , Femenino , Cardiopatías Congénitas/epidemiología , Cardiopatías Congénitas/etiología , Humanos , Lactante , Embarazo , Efectos Tardíos de la Exposición Prenatal/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Fumar/efectos adversosRESUMEN
OBJECTIVE: The purpose of this study was to explore the utilization of the Y Balance Test (YBT) alongside the Balance Error Scoring System (BESS) during examination of healthy adolescent athletes (14-18 year old) as well as those with acute and chronic concussion. DESIGN: A repeated-measures study of balance in a cross-sectional convenience sample of adolescents participating in high-school athletics. SETTING: Data were collected on healthy athletes in their school setting for comparison purposes and on concussed athletes in the physical therapy rehabilitation center at the hospital. PARTICIPANTS: Participants were a convenience sample of male and female athletes between the ages of 14 to 18 year old [180 healthy (111 male, 69 female) and 44 (28 male, 16 female) with concussion]. ASSESSMENT OF RISK FACTORS: All participants were cleared for participation by preparticipation examination or by the treating sport medicine physician. MAIN OUTCOME MEASURES: Healthy athletes performed the YBT, a dynamic assessment of balance. Athletes with concussion also performed the BESS, a static assessment of balance. RESULTS: Means for each YBT reach direction were statistically different for both healthy males and females ( P < 0.05). Within both the acute and chronic subsets of the concussed sample, some participants performed over the median value for the BESS but not the YBT. CONCLUSIONS: These data may suggest that dynamic balance testing in conjunction with static balance testing could be valuable in both the acute and chronic phases of concussion to ensure a comprehensive assessment of the necessary balance skills for athletic play.
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Traumatismos en Atletas , Conmoción Encefálica , Adolescente , Atletas , Traumatismos en Atletas/diagnóstico , Conmoción Encefálica/diagnóstico , Estudios Transversales , Femenino , Humanos , Masculino , Modalidades de Fisioterapia , Equilibrio PosturalRESUMEN
INTRODUCTION: Acute pancreatitis (AP) occurs among patients with pancreas-sufficient cystic fibrosis (PS-CF) but is reportedly less common among patients with pancreas-insufficient cystic fibrosis (PI-CF). The incidence of AP may be influenced by cystic fibrosis transmembrane conductance regulator (CFTR) modulator use. We hypothesized that CFTR modulators would reduce AP hospitalizations, with the greatest benefit in PS-CF. METHODS: MarketScan (2012-2018) was queried for AP hospitalizations and CFTR modulator use among patients with CF. Multivariable Poisson models that enabled crossover between CFTR modulator treatment groups were used to analyze the rate of AP hospitalizations on and off therapy. Pancreas insufficiency was defined by the use of pancreas enzyme replacement therapy. RESULTS: A total of 10,417 patients with CF were identified, including 1,795 who received a CFTR modulator. AP was more common in PS-CF than PI-CF (2.9% vs 0.9%, P = 0.007). Overall, the observed rate ratio of AP during CFTR modulator use was 0.33 (95% confidence interval [CI] 0.10, 1.11, P = 0.07) for PS-CF and 0.38 (95% CI 0.16, 0.89, P = 0.03) for PI-CF, indicating a 67% and 62% relative reduction in AP hospitalizations, respectively. In a subset analysis of 1,795 patients who all had some CFTR modulator use, the rate ratio of AP during CFTR modulator use was 0.36 (95% CI 0.13, 1.01, P = 0.05) for PS-CF and 0.53 (95% CI 0.18, 1.58, P = 0.26) for PI-CF. DISCUSSION: CFTR modulator use is associated with a reduction in AP hospitalizations among patients with CF. These observational data support the prospective study of CFTR modulators to reduce AP hospitalizations among patients with CF.
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Regulador de Conductancia de Transmembrana de Fibrosis Quística/farmacología , Fibrosis Quística/tratamiento farmacológico , Hospitalización/tendencias , Pancreatitis/terapia , Adolescente , Adulto , Niño , Preescolar , Estudios Cruzados , Fibrosis Quística/complicaciones , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Pancreatitis/epidemiología , Pancreatitis/etiología , Estudios Prospectivos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Despite potential benefits of tobacco-free campus policies, compliance remains a challenge. Observational measures hold the most promise in determining compliance with these policies. There is need for further study to determine validity of observational measures of compliance with tobacco-free campus policies. The purpose of this study was to determine the validity of two observational measures of compliance with a tobacco-free campus policy: direct observation of violators and cigarette butts. Data collection took place over a 1-year time period. Direct observation was operationally defined as the number of observed violators in hot spots. A cigarette butt protocol previously found to be reliable was used to count the number of butts in campus hot spots. Results indicated a positive relationship between number of violators observed per visit and number of cigarette butts collected. Although most of the hot spots exhibited two or fewer violators per visit and 100 butts or fewer per collection, the data points outside this range supported a positive association between observed violators per visit and cigarette butts. The findings support that direct observation of violators is a valid measure of compliance compared to cigarette butts. Given available resources, using one or the other as evaluation measures is warranted.
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Recolección de Datos/métodos , Estudios Observacionales como Asunto/métodos , Política para Fumadores , Fumar/epidemiología , Universidades/estadística & datos numéricos , Promoción de la Salud , Humanos , Reproducibilidad de los Resultados , Productos de TabacoRESUMEN
Promoting tobacco control policies in rural tobacco-growing communities presents unique challenges. The purpose of this study was to assess smoke-free coalition cohesiveness in rural communities and identify coalition members' perceived barriers or divisive issues that impede the development of smoke-free policies. A secondary aim was to evaluate differences in coalition cohesiveness between advocates in communities receiving stage-based, tailored policy advocacy assistance versus those without assistance. Tobacco control advocates from 40 rural Kentucky communities were interviewed by telephone during the final wave of a 5-year longitudinal study of community readiness for smoke-free policy. On average, five health advocates per county participated in the 45-min interview. Participants rated coalition cohesiveness as not at all cohesive, somewhat cohesive, or very cohesive, and answered one open-ended question about potentially divisive issues within their coalitions. The mean age of the 186 participants was 48.1 years (SD = 13.3). The sample was predominantly female (83.6%) and Caucasian (99.5%). Divisive concerns ranged from rights issues, member characteristics, type of law, and whether or not to allow certain exemptions. Three of the divisive concerns were significantly associated with their rankings of coalition cohesiveness: raising tobacco in the community, the belief that smoke-free would adversely affect the economy, and government control. Educating coalition members on the economics of smoke-free laws and the actual economic impact on tobacco-growing may promote smoke-free coalition cohesiveness. More resources are needed to support policy advocacy in rural tobacco-growing communities as well as efforts to reduce the divisive concerns reported in this study.
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Conducta Cooperativa , Formulación de Políticas , Población Rural , Política para Fumadores , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Kentucky , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Adulto JovenRESUMEN
OBJECTIVES: To evaluate the perceptions of independent community pharmacists within a regional independent community pharmacy cooperative on implementing personalized medicine services at their pharmacies and to gauge the pharmacists' self-reported knowledge of pharmacogenomic principles. DESIGN: Descriptive, exploratory, nonexperimental study. SETTING: American Pharmacy Services Corporation (APSC), 2011-12. PARTICIPANTS: Pharmacists (n = 101) affiliated with the independent pharmacies of APSC. INTERVENTION: Single-mode survey. MAIN OUTCOME MEASURES: Independent community pharmacists' interest in implementing personalized medicine services, perceived readiness to provide such services, and perceived barriers to implementation. RESULTS: 101 completed surveys were returned for data analysis. The majority of pharmacists surveyed (75%) expressed interest in offering personalized medicine services. When asked to describe their knowledge of pharmacogenomics and readiness to implement such services, more than 50% said they were not knowledgeable on the subject and would not currently be comfortable making drug therapy recommendations to physicians or confident counseling patients based on results of genetic screenings without further training and education. Respondents identified cost of providing the service, reimbursement issues, current knowledge of pharmacogenomics, and time to devote to the program as the greatest barriers to implementing personalized medicine services. CONCLUSION: The majority of independent community pharmacists are interested in incorporating personalized medicine services into their practices, but they require further education before this is possible. Future initiatives should focus on the development of comprehensive education programs to further train pharmacists for provision of these services.
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Servicios Comunitarios de Farmacia/organización & administración , Farmacéuticos/organización & administración , Farmacogenética/métodos , Medicina de Precisión/métodos , Adulto , Actitud del Personal de Salud , Femenino , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Rol Profesional , Estados Unidos , Adulto JovenRESUMEN
INTRODUCTION: Grocery vouchers that specifically target foods associated with reduced cardiovascular disease (CVD) risk result in increased consumption of those foods. In regions with disproportionately high CVD rates, there is little research concerning the impact of vouchers on purchases of risk-reducing foods when there are no restrictions placed on grocery voucher redemption. Since many food assistance programs place few restrictions on type of foods that can be purchased, identifying demographic factors associated with purchasing habits is a prerequisite to promoting healthy eating. The purpose of this study was to determine the associations of age, gender, education and income level with purchasing of healthful foods through the use of a grocery voucher in a rural food desert (poverty rate of ≥20% and ≥33% of residents living >16 km from a large grocery store) with high rates of chronic disease. METHODS: The effectiveness of an intervention that included a media campaign, a $5 grocery voucher, local heart healthy food branding and a grocery store event was tested. Brief nutritional articles were published in both local newspapers during four consecutive weeks. These articles explained the physiological actions of healthy foods and listed a health-promoting recipe. During the fourth week of the media campaign, a voucher for a $5 grocery gift card redeemable at one of either community grocery stores was also printed in both local newspapers. In each store, foods that are known to be associated with a reduced risk of CVD were marked with a blue logo. Participants (N=311) completed a questionnaire that assessed demographics and usual servings of fruits, vegetables and grains. Participants received a $5 grocery card and a list of labelled foods. Returned grocery receipts were stapled to the questionnaires to analyse the relationship between demographics and food choices. RESULTS: Participants who bought at least one labelled food item were older (M=48.5, SD=14.7) than those who did not buy any of these items (M=42.3, SD=16.4; p=0.0008). There was a significant association between labelled food purchases and gender, with 47% of male participants purchasing at least one labelled food item compared with 63% of females in the study (p = 0.008). There were no significant associations between purchase of labelled food items and either education or income. The significant predictors were age (p=0.003) and gender (p=0.01). For every 10 year increase in age, there was a 29% increase in the likelihood that at least one labelled food item would be purchased. Male participants were 48% less likely to purchase at least one designated food item than female participants were. CONCLUSIONS: Younger adults and men may be less responsive to media-based educational strategies, heart-healthy food labelling and grocery vouchers to defray the cost of healthy eating than older adults and women. Previous studies show that concerns about cost and availability of foods are greater factors in the decision to purchase these foods than demographic characteristics. However, age and gender are associated with the likelihood of using grocery vouchers for the purchase of healthful foods. Additional research is needed to determine whether different educational strategies paired with food labelling and grocery vouchers may be successful strategies to promote purchase of healthful foods, particularly for men and younger adults.
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Dieta , Preferencias Alimentarias , Promoción de la Salud/métodos , Población Rural , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/prevención & control , Conducta de Elección , Enfermedad Crónica , Femenino , Abastecimiento de Alimentos , Frutas , Humanos , Kentucky , Masculino , Persona de Mediana Edad , Proyectos Piloto , Factores Sexuales , Factores Socioeconómicos , Verduras , Adulto JovenRESUMEN
BACKGROUND: Death after resuscitation from cardiac arrest is common. Although associated factors have been identified, knowledge about their relationship with specific modes of death is limited. OBJECTIVE: To identify clinical factors associated with specific modes of death following cardiac arrest. METHODS: This study involved a retrospective medical record review of patients admitted to a single health care center from January 2015 to March 2020 after resuscitation from cardiac arrest who died during their index hospitalization. Mode of death was categorized as either brain death, withdrawal of life-sustaining therapies due to neurologic causes, death due to medical causes, or withdrawal of life-sustaining therapies due to patient preference. Clinical characteristics across modes of death were compared. RESULTS: The analysis included 731 patients. Death due to medical causes was the most common mode of death. Compared with the other groups of patients, those with brain death were younger, had fewer comorbidities, were more likely to have experienced unwitnessed and longer cardiac arrest, and had more severe acidosis and hyperglycemia on presentation. Patients who died owing to medical causes or withdrawal of life-sustaining therapies due to patient preference were older and had more comorbidities, fewer unfavorable cardiac arrest characteristics, and fewer days between cardiac arrest and death. CONCLUSIONS: Significant associations were found between several clinical characteristics and specific mode of death following cardiac arrest. Decision-making regarding withdrawal of care after resuscitation from cardiac arrest should be based on a multimodal approach that takes account of a variety of personal and clinical factors.
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Paro Cardíaco , Humanos , Masculino , Femenino , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Paro Cardíaco/mortalidad , Causas de Muerte , Privación de Tratamiento/estadística & datos numéricos , Reanimación Cardiopulmonar/estadística & datos numéricos , Muerte Encefálica , Anciano de 80 o más Años , Factores de Edad , Comorbilidad , Prioridad del Paciente/estadística & datos numéricosRESUMEN
Objective: The Return of Answer ALS Results (RoAR) Study was designed to provide a mechanism for participants in Answer ALS, a large, prospectively designed natural history and biorepository study to receive select clinical genetic testing results and study participants' experience with the results disclosure. Methods: Participants consented to receive results of five ALS genes (C9orf72, SOD1, FUS, TARDP, TBK1) and/or 59 medically actionable genes as designated by the American College of Medical Genetics. Patient-reported genetic testing outcomes were measured via a post-disclosure survey. Results: Of 645 eligible Answer ALS enrollees, 143 (22%) enrolled and completed participation in RoAR. Pathogenic variants were identified in 22/143 (15.4%) participants, including 13/143 (9.0%) in ALS genes and 9/143 (6.3%) in ACMG genes. Participant-reported measures of result utility indicated the research result disclosure was as or more successful than published patient-reported outcomes of result disclosure the clinical setting. Conclusions: This study serves as a model of a "disclosure study" to share results from genomic research with participants who were not initially offered the option to receive results, and our findings can inform the design of future, large scale genomic projects to empower research participants to access their genetic information.
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BACKGROUND: Hepatocellular carcinoma (HCC) disproportionately impacts racial and ethnic minorities and patients with lower socioeconomic status. These social determinants of health (SDH) lead to disparities in access to care and outcomes. We aim to understand the relationship between SDH and survival and locoregional treatment options in HCC. METHODS: Using the National Cancer Database, we evaluated survival and access locoregional treatments including non-transplant surgery, liver transplant (LT), and liver-directed radiation therapy (LDRT) in patients with HCC diagnosed between 2004 and 2017. Variables including clinical stage, age, sex, race, income, rurality, year of diagnosis, facility type (FT), Charlson-Deyo score (CD), and insurance were evaluated. Cox proportional hazards multivariable regression and dominance analyses were used for analyses. RESULTS: In total, 140â340 patients were included. Worse survival was seen with advanced stage, older age, Black race, rurality, public insurance, treatment at a nonacademic center, and lower income. The top predictors for survival included stage, age, and income. Completion of non-transplant surgery was best predicted by stage, FT, and insurance type, whereas LT was predicted by age, year of diagnosis, and CD score. LDRT utilization was most associated with year of diagnosis, FT, and CD score. CONCLUSION: For patients with HCC, survival was predicted primarily by stage, age, and income. The primary sociodemographic factors associated with access to surgical treatments, in addition to FT, were insurance and income, highlighting the financial burdens of health care. Work is needed to address disparities in access to care, including improved insurance access, addressing financial inequities and financial toxicities of treatments, and equalizing care opportunities in community centers.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Estados Unidos/epidemiología , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/patología , Neoplasias Hepáticas/patología , Seguro de Salud , Renta , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: Stair negotiation is crucial for functional independence and is a leading cause of fall-related injuries in older adults. The Step Test Evaluation of Performance on Stairs (STEPS) is a quick and easily administered outcome measure for assessing stair negotiation. This study investigated the reliability and concurrent content validity of the STEPS test to determine its usefulness in older adults. METHODS: Eighty-two community-dwelling older adults (mean age 81.2 years, 51 females) were assessed on the STEPS test, Timed Up and Go (TUG), 5-times sit to stand (5XSTS), stair self-efficacy (SSE) questionnaire, and time to ascend and descend stairs. Participants repeated the STEPS test 7 to 14 days later for intrarater reliability by the same rater. Spearman rank and intraclass correlations were used to determine the association of measures and intrarater reliability. RESULTS AND DISCUSSION: The mean STEPS score was 15.6 (SD = 3.7) out of 20. The STEPS total score demonstrated excellent intra- and interrater reliability. It had moderate to good and significant correlations with TUG, 5XSTS, SSE, and time to ascend and descend measures. Faster performance on the 5XSTS, TUG, and time to ascend and descend correlated with better performance on the STEPS test, indicating validity for assessing balance and mobility during stair negotiation in older adults. Lower SSE correlated with lower observer ratings of performance on stairs (STEPS scores), indicating agreement between participant reports of self-efficacy and observer ratings of performance. Step Test Evaluation of Performance on Stairs items that demonstrated the most frequent loss of points were balance (use of handrail), step continuity, foot placement, and self-propulsion (ascent only). CONCLUSIONS: Assessment of older adults' safety and performance on stairs is vital given the increased difficulty of stair navigation and the high risk for injurious falls in this population. This study demonstrates that the STEPS test is a reliable and valid outcome measure for assessing stair performance in older adults.
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OBJECTIVES: For many malignancies, hypofractionated radiotherapy (HFRT) is an accepted standard associated with decreased treatment time and costs. United States provider beliefs regarding HFRT likely impact its adoption but are poorly studied. We surveyed US-based radiation oncologists (ROs) to gauge HFRT utilization rates for prostate (PC), breast (BC), and rectal cancer (RC) and to characterize the beliefs governing these decisions. METHODS: From July to October 2021, an anonymized, online survey was electronically distributed to ROs actively practicing in the United States. Demographic and practice characteristic information was collected. Questions assessing rates of offering HFRT for PC, BC, and RC and perceived limitations towards using HFRT were administered. RESULTS: A total of 203 eligible respondents (72% male, 72% White, 53% nonacademic practice, 69% with 11+ years in practice) were identified. Approximately 50% offered stereotactic body radiation therapy (SBRT) for early/favorable intermediate risk PC. Although >90% of ROs offered whole-breast HFRT for early-stage BC, only 33% offered accelerated partial-breast irradiation (APBI). Overall, 41% of ROs offered short-course neoadjuvant RT for RC. The primary reported barriers to HFRT utilization were lack of data, inexperience, and referring provider concerns. CONCLUSIONS: HFRT is safe, effective, and beneficial, yet underutilized-particularly prostate SBRT, APBI, and short-course RT for RC. Skills retraining and education of ROs and referring providers may increase utilization rates.
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Pautas de la Práctica en Medicina , Neoplasias de la Próstata , Hipofraccionamiento de la Dosis de Radiación , Oncólogos de Radiación , Humanos , Oncólogos de Radiación/estadística & datos numéricos , Masculino , Estudios Transversales , Femenino , Estados Unidos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Neoplasias de la Próstata/radioterapia , Neoplasias de la Mama/radioterapia , Encuestas y Cuestionarios , Neoplasias del Recto/radioterapia , Oncología por Radiación , Persona de Mediana EdadRESUMEN
BACKGROUND/OBJECTIVES: Germline genetic testing is recommended for younger patients with idiopathic pancreatitis but there has been a lack of consensus in recommendations for those over age 35. We aimed to analyze the results of genetic testing among subjects of varying ages. METHODS: Individuals who underwent germline multigene testing for pancreatitis susceptibility genes (CASR, CFTR, CPA1, CTRC, PRSS1, SPINK1) through a large commercial laboratory between 2017 and 2022 were included. Test results and information collected from test requisition forms were evaluated. Multivariable logistic regression models were performed to identify factors associated with a positive pancreatitis panel (pathogenic, likely pathogenic, and/or increased risk variants) in pancreatitis-related genes. RESULTS: Overall, 2,468 subjects with primary indication of acute pancreatitis (AP) (n = 401), chronic pancreatitis (CP) (n = 631), pancreatic cancer (n = 128), or other indications (n = 1,308) completed germline testing. Among patients with AP or CP, the prevalence of any positive result for those <35 versus ≥35 years of age was 32.1% and 24.5% (p = 0.007), and the prevalence of a clinically meaningful result was 10.8% and 5.4%, respectively (p = 0.001). Positive family history of pancreatitis was associated with increased odds ratio (OR) of 8.59 (95% confidence interval (CI) 2.92-25.25) for a clinically significant panel result while each 5-year increase in age at test completion had lower odds (OR 0.89, 95% CI 0.83-0.95). CONCLUSIONS: The highest prevalence of pathogenic variants is seen in younger individuals with a positive family history of pancreatitis. However, clinically meaningful results are identified in older subjects, suggesting that genetic counseling and testing should be considered for all age groups.
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Predisposición Genética a la Enfermedad , Pruebas Genéticas , Mutación de Línea Germinal , Pancreatitis Crónica , Humanos , Adulto , Femenino , Masculino , Pruebas Genéticas/métodos , Persona de Mediana Edad , Pancreatitis Crónica/genética , Pancreatitis Crónica/diagnóstico , Anciano , Pancreatitis/genética , Pancreatitis/diagnóstico , Adulto Joven , Adolescente , Enfermedad Aguda , NiñoRESUMEN
PURPOSE: The current standard for meningioma treatment planning involves magnetic resonance imaging-based guidance. Somatostatin receptor ligands such as 68Ga-DOTATATE are being explored for meningioma treatment planning due to near-universal expression of somatostatin receptors 1 and 2 in meningioma tissue. We hypothesized that 68Ga-DOTATATE positron emission tomography (PET)-guided treatment management for patients with meningiomas is safe and effective and can identify which patients benefit most from adjuvant radiation therapy. METHODS AND MATERIALS: A single-institution prospective registry study was created for inclusion of patients with intracranial meningiomas who received a 68Ga-DOTATATE PET/CT to assist with radiation oncologist decision making. Patients who received a PET scan from January 1, 2018, to February 25, 2022, were eligible for inclusion. RESULTS: Of the 60 patients included, 40%, 47%, and 5% had World Health Organization grades 1, 2, and 3 meningiomas, respectively, and 8% (5 patients) had no grade assigned. According to Radiation Therapy Oncology Group 0539 criteria, 22%, 72%, and 7% were categorized as high, intermediate, and low risk, respectively. After completing their PET scans, 48 patients, 11 patients, and 1 patient proceeded with radiation therapy, observation, and redo craniotomy, respectively. The median follow-up for the entire cohort was 19.5 months. Of the 3 patients (5%) who experienced local failure between 9.2 and 28.5 months after diagnosis, 2 had PET-avid disease in their postoperative cavity and elected for observation before recurrence, and 1 high-risk patient with multifocal disease experienced local failure 2 years after a second radiation course and multiple previous recurrences. Notably, 5 patients did not have any local PET uptake and were observed; none of these patients experienced recurrence. Only 1 grade 3 toxicity was attributed to PET-guided radiation. CONCLUSIONS: This study examined one of the largest known populations of patients with intracranial meningiomas followed by physicians who used 68Ga-DOTATATE PET-guided therapy. Incorporating 68Ga-DOTATATE PET into future trials may assist with clinician decision making and improve patient outcomes.
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Neoplasias Meníngeas , Meningioma , Compuestos Organometálicos , Cintigrafía , Humanos , Meningioma/diagnóstico por imagen , Meningioma/radioterapia , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radioisótopos de Galio , Tomografía de Emisión de Positrones/métodos , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/radioterapiaRESUMEN
BACKGROUND: Pharmacologic prophylaxis for venous thromboembolism (VTE) in patients with chronic liver disease (CLD) presents a unique challenge because of coagulopathies associated with the disease. When evaluating whether these patients require VTE prophylaxis upon hospitalization, it would be advantageous if risk factors for the development of VTE in this population were known. OBJECTIVE: To evaluate risk factors associated with the development of VTE in patients with CLD. METHODS: A retrospective case-control study was conducted. Patients admitted to the University of Kentucky Chandler Hospital from October 2006 to July 2010 with a diagnosis of CLD and VTE were matched in a 1:3 fashion with CLD patients without VTE. The primary objective was to determine whether there were significant differences in laboratory values between the 2 groups. RESULTS: During this time, 27 patients with CLD (1.0%) were diagnosed with VTE. These patients had significantly lower median aspartate aminotransferase (AST) (47 vs 70 U/L, p = 0.04), alanine transaminase (ALT) (24.5 vs 36 U/L, p = 0.02), albumin (2.1 vs 2.4 g/dL, p = 0.02) and hematocrit (Hct) (28.3% vs 32%, p = 0.03) values compared to the control patients. Patients with albumin lower than 1.9 g/dL had a 5.1 times greater risk of VTE compared to patients with albumin of 2.8 g/dL and higher (OR 5.14, 95% CI 1.05-25.2). CONCLUSIONS: Patients with CLD who developed VTE had significantly lower AST, ALT, albumin, and Hct compared to those of control patients. Studies are necessary to further examine the significance of this finding.
Asunto(s)
Hepatopatías/epidemiología , Tromboembolia Venosa/epidemiología , Alanina Transaminasa/sangre , Albúminas/análisis , Aspartato Aminotransferasas/sangre , Hematócrito , Humanos , Hepatopatías/sangre , Estudios Retrospectivos , Factores de Riesgo , Tromboembolia Venosa/sangreRESUMEN
The use of generic antiepileptic drugs (AEDs) in patients with epilepsy is controversial. The purpose of this study is to identify patient characteristics associated with increased odds of receiving a generic AED product. A large commercial database was used to identify patients with a primary diagnosis of epilepsy who were prescribed an AED during a three-month window. Data analysis found that those ≥65 years old had 15.7% greater odds of receiving a generic AED (OR = 1.157; 95% CI = 1.056-1.268). Patients with Medicaid were found to have 2.44 times the odds of having had a generic AED prescription (OR = 2.44; CI = 2.168-2.754). Patients residing in the Northeast had 12.6% decreased odds of receiving a generic AED (OR = 0.874; C I= 0.821-0.931). These patient characteristics could signify certain health care disparities and may represent potential confounders to future observational studies.
Asunto(s)
Anticonvulsivantes/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Medicamentos Genéricos/uso terapéutico , Epilepsia/tratamiento farmacológico , Epilepsia/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Seguro , Cobertura del Seguro/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Suboptimal lifestyle factors in combination with genetic susceptibility contribute to cardiovascular disease and type 2 diabetes risk among Latinos. We describe a community-academic collaboration that developed and explored the feasibility of implementing a socioculturally tailored, healthy lifestyle intervention integrating genomics and family history education to reduce risk of cardiovascular disease and type 2 diabetes among Latinos. COMMUNITY CONTEXT: The community-based participatory research was conducted with communities in Kentucky, which has a rapidly growing Latino population. This growth underscores the need for socioculturally appropriate health resources. METHODS: Su Corazon, Su Vida (Your Heart, Your Life) is a Spanish-language, healthy lifestyle educational program to reduce cardiovascular disease and type 2 diabetes risk among Latinos. Twenty natural leaders from an urban Latino community in Kentucky participated in sociocultural tailoring of the program and development of a genomics and family history module. The tailored program was presented to 22 participants to explore implementation feasibility and assess appropriateness for community use. Preintervention and postintervention assessments of genomic knowledge and lifestyle behaviors and qualitative postintervention evaluations were conducted. OUTCOMES: Postintervention improvements in health-promoting lifestyle choices and genomic knowledge specific to cardiovascular disease and type 2 diabetes suggested that the program may be effective in reducing risk. Feedback indicated the program was socioculturally acceptable and responsive to community needs. INTERPRETATION: These findings indicated that a tailored healthy lifestyle program integrating genomics and family history education was socioculturally appropriate and may feasibly be implemented to reduce cardiovascular disease and type 2 diabetes risk in a Latino community with limited health care resources. The project highlights contributions of community-based processes in tailoring interventions that are appropriate for community contexts.