Characterizing idiopathic pulmonary fibrosis patients using US Medicare-advantage health plan claims data.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a rare life-threating interstitial lung disease (ILD). This study characterizes demographics, health care utilization, and comorbidities among elderly IPF patients and estimates prevalence and incidence rates for selected outcomes. METHODS: Cohort study using a large US health insurance database (Optum's Medicare Advantage plan). INCLUSION CRITERIA: ≥ 1 diagnosis code for IPF (2008 - 2014), age ≥65 years, no diagnosis of IPF or other ILD in prior 12 months. Demographics, health care utilization, comorbidities and incidence rates for various outcomes were estimated. Follow-up continued until the earliest of: health plan disenrollment, death, a claim for another known cause of ILD, or end of the study period. RESULTS: 4,716 patients were eligible; 53.4% had IPF diagnostic testing. Median age was 77.5 years, 50.3% were male, median follow-up time was 0.8 years. Incidence rates ranged from 1.0/1,000 person-years (lung transplantation) to 374.3/1,000 person-years (arterial hypertension). Baseline characteristics and incidence rates were similar for cohorts of patients with and without IPF diagnostic testing. CONCLUSIONS: Elderly IPF patients experience a variety of comorbidities before and after IPF diagnosis. Therapies for IPF and for the associated comorbidities may reduce morbidity and associated health care utilization of these patients.

Forced degradation studies: current trends and future perspectives for protein-based therapeutics.

INTRODUCTION: Forced degradation (FD) studies (stress testing) are an integral part of pharmaceutical product development. AREAS COVERED: The design and execution of these studies require thorough planning and coordination through the various stages of development as well as post-approval commercial operations. This is particularly crucial in the case for protein-based therapeutics due to complexity of the molecular structure as well as the potential influence of the manufacturing process on product attributes. Often, FD study applications are linked to specific product development in a phase-specific and case-by-case manner with differing purposes and focus. Expert commentary: This paper summarizes some key FD approaches commonly employed in the industry and provides considerations on study design strategies and database management through the course of the product lifecycle.

Assessment of MRI image quality for various setup positions used in breast radiotherapy planning.

This study investigates breast magnetic resonance imaging (MRI) image quality for 3 different breast radiotherapy positions (prone, supine flat and supine inclined) and associated choice of breast coils. Supine breast MRI has comparable image quality to prone breast MRI for the purposes of radiotherapy delineation for T2-weighted sequences.

Factors Associated With Hepatitis C Infection Among HIV-Infected Men Who Have Sex With Men With No Reported Injection Drug Use in New York City, 2000-2010.

BACKGROUND: Hepatitis C (HCV) infection is a major source of morbidity and mortality among HIV-infected patients. Despite decreasing HCV incidence in the United States, the proportion of cases among men who have sex with men (MSM) without history of injection drug use (IDU) in New York City has more than tripled between 2000 and 2010. METHODS: Using matched surveillance data, we identified non-IDU HIV-infected MSM with and without diagnosed HCV. Differences in continuous variables were assessed with Mann-Whitney U tests, and Pearson χ tests were used for categorical variables. Poisson regression was used to compare HCV diagnosis rates by race/ethnicity and sexual transmitted disease history. RESULTS: There were 41,303 non-IDU MSM diagnosed as having HIV before 2010 alive as of 2000, of whom 2016 (4.9%) were diagnosed as having HCV after HIV diagnosis. The HCV diagnosis rate was 605/100,000 person-years. Adjusting for birth year and age at HIV diagnosis, Hispanics (rate ratio [RR], 1.4; 95% confidence interval [CI], 1.2-1.5) and non-Hispanic blacks (RR, 1.6; 95% CI, 1.4-1.8) had higher HCV diagnosis rates than did non-Hispanic whites. Adjusting for race/ethnicity, birth year, and age at HIV diagnosis, MSM diagnosed as having syphilis (RR, 2.5; 95% CI, 2.3-2.8) had higher HCV diagnosis rates than did those without syphilis. CONCLUSIONS: We found a racial/ethnic disparity in HCV diagnosis rates and an association between HCV and syphilis, which is consistent with sexual transmission of HCV. With curative HCV treatment available, emphasis should be placed on adherence to guidelines recommending annual HCV screening for HIV-infected MSM, and education and outreach to MSM to prevent sexually transmitted HCV infections.

Importance of Women's Relative Socioeconomic Status within Sexual Relationships in Communication about Safer Sex and HIV/STI Prevention.

The socioeconomic status (SES) of women is increasingly considered an important factor for HIV/STI risk. The HIV/STI literature has largely focused on women's absolute levels of SES, and therefore, the importance of their SES relative to their male sexual partners remains understudied. This paper examines the association between women's relative SES and frequency of safer sex communication among heterosexual couples. A convenience sample of 342 couples (N = 684) recruited in New York City was asked about frequency of discussions with their partner about the need to use male condoms, about HIV prevention, and about STI prevention in the previous 90 days. Differences between partners in education, income, employment, housing, and incarceration history were combined using principal component analysis to form an index of women's relative SES. Negative binomial regression models assessed associations between woman's relative SES and communication frequency controlling for age, sex, race, ethnicity, education, and relationship type using a generalized estimating equation framework. On average, participants had 2.5, 4.2, and 4.8 discussions regarding the need to use male condoms, about HIV prevention, and about STI prevention, respectively. A one standard deviation increase in a woman's relative SES score was associated with increased frequency of discussions about male condom use (adjusted rate ratio [aRR], 1.15; 95% confidence interval [CI], 1.03-1.29), about HIV prevention (aRR, 1.25; CI, 1.14-1.37), and about STI prevention (aRR, 1.29; CI, 1.18-1.41). Women's relative SES may be an important factor for sexual communication, and further research on its role in HIV/STI risk may uncover avenues for intervention.

Health-related quality of life of preschool caregivers in Hong Kong.

The aim of this study was to explore the health-related quality of life (HRQOL) of preschool caregivers in Hong Kong with a view to informing policy-makers about health promotion within this population. The following research questions were addressed: (i) What was the HRQOL of young children's caregivers in Hong Kong? (ii) Were there differences between these caregivers' health and the general Hong Kong population's health? (iii) What demographic factors were related to these caregivers' quality of life? Mixed methods research, including quantitative and qualitative tools, was utilized. Data from a study consisted of a survey of 834 preschool caregivers along with 3 in-depth interviews with employees of kindergarten-cum-childcare centres from different socio-economic groups within the city of Hong Kong. An HRQOL questionnaire (the SF-36 v. 1), together with demographic characteristics and illness/disease incidence data, were collected. The results suggested that the Hong Kong preschool caregivers had a substantially poorer HRQOL than Hong Kong's general population. The analysis found that young caregivers and caregivers with young families had a significantly lower HRQOL than more senior caregivers. They tended to feel tired, lacked energy and failed to perform vigorous activities. Significant differences were also found according to the caregivers' socio-economic status. Health and education policy-makers should note that young children's caregivers are in a serious state of ill health. Further health education and promotion efforts should target this population.

Use of glycosylated hemoglobin increases diabetes screening for at-risk adolescents in primary care settings.

OBJECTIVE: To examine rates of diabetes screening in obese adolescents in an ethnically diverse primary care health care system before and after an internal recommendation to use HbA1c-based screening. RESEARCH DESIGN AND METHODS: Adolescents 12-18-years old with BMI > 95% were identified through electronic medical record review during two 18-month periods in 8 community health clinics and 13 school-based health centers: period 1 (P1, 19 April 2008 to 19 October 2009) and period 2 (P2, 3 May 2010 to 3 November 2011). Testing for diabetes in the 2 yr preceding the most recently elevated BMI was reviewed. RESULTS: A total of 2870 obese adolescents were identified in P1 and 3940 in P2. Ethnicity was primarily Hispanic, with smaller populations of Black and White youth. The percent of obese teens screened for diabetes increased from 40% in P1 to 47% in P2. Use of HbA1c increased 493% during P2. Older teens (>15 yr), those seen during P2, and those with BMI ≥ 30 kg/m2 were more likely to be screened. Record review confirmed equal rates of type 2 diabetes in the two periods: 8 incident (0.7%) cases in P1 and 13 (0.7%) in P2. CONCLUSIONS: The use of HbA1c, a non-fasting and logistically simpler test, was associated with increased diabetes screening in primary care. The percentage of screened patients with confirmed type 2 diabetes remained unchanged. Thus, despite potential pitfalls, the use of HbA1c for screening appears to be as successful as previous approaches in identifying adolescents with diabetes.

Obesity in Hong Kong Chinese preschool children: where are all the nurses?

We report an ethnographic study of 10 preschool children aged 2-6 years recruited from kindergartens in Hong Kong, 6 of whom were overweight or obese. Each was followed for 12-18 months. We confirmed previously described risk factors and showed how these interacted to produce obesity in some but not all at-risk children. Despite much rhetoric in the literature about holistic care of the preschool child, we were struck by the lack of coordinated professional input to the needs of children at risk of obesity and by the absence of nursing input in particular. We argue that a "whole-systems" nursing role, based in the community and with remit that includes clinical care, education, and policy, is urgently needed, as well as review examples of such roles from other countries.

Exploratory factor analysis: health perceptions of Chinese early childhood educators in Hong Kong.

The aim of this study was to explore health perceptions of preschool teachers, with a view to inform early childhood practices and teacher education. Pre-service student-teachers and in-service teachers (n = 200) who were voluntarily recruited completed a 24-item health attitude questionnaire. Factor analysis identified four dimensions of health attitudes, reflecting physical, psychosocial, mental and emotional domains. Inter-correlations among the factors suggested that early childhood educators in Hong Kong embrace a holistic view of health, although they consider physical and emotional health as more salient than the psychosocial and mental health dimensions. In comparisons of the perceptions of in-service teachers and student-teachers, students placed less emphasis on psychosocial health, but teachers placed more emphasis on physical health. The findings are discussed in terms of their implications for designing health education programmes for preschool teacher education.

Recombinant rat and mouse growth hormones: risk assessment of carcinogenic potential in 2-year bioassays in rats and mice.

Recombinant rat growth hormone (rrGH) and recombinant mouse growth hormone (rmGH) were developed to evaluate the potential carcinogenicity of each biologically active growth hormone (GH) as assessed in the respective species. Biological activities of rrGH and rmGH were demonstrated by showing an increase in body weight gain and serum levels of insulin-like growth factor-1 (IGF-1) in hypophysectomized rats receiving daily sc injections for 6 days. With the exception of pharmacologically mediated weight gain, rrGH and rmGH had no adverse effects in 5-week oral toxicity studies and no production of anti-recombinant GH antibodies. The high doses selected for the carcinogenicity studies provided systemic exposures of GH up to approximately 10-fold over basal levels. In the 105-week mouse carcinogenicity study, daily sc injections of rmGH at 0.1, 0.2, or 0.5 mg/kg/day were well tolerated and had no effects on survival or incidence of tumors. In the 106-week rat carcinogenicity study, daily sc injections of rrGH at 0.2, 0.4, or 0.8 mg/kg/day had a favorable effect on longevity in female rats administered 0.4 or 0.8 mg/kg/day, an increased weight gain in females and males, and no increase in the incidence of tumors. The absence of carcinogenic effects of recombinant GH administered daily for 2 years to rodents was consistent with publications of clinical experience, indicating a lack of convincing evidence for an increased risk of cancer in children receiving human recombinant GH replacement therapy.

Using multiple criteria decision analysis for supporting decisions of solid waste management.

Design of solid-waste management systems requires consideration of multiple alternative solutions and evaluation criteria because the systems can have complex and conflicting impacts on different stakeholders. Multiple criteria decision analysis (MCDA) has been found to be a fruitful approach to solve this design problem. In this paper, the MCDA approach is applied to solve the landfill selection problem in Regina of Saskatchewan Canada. The systematic approach of MCDA helps decision makers select the most preferable decision and provides the basis of a decision support system. The techniques that are used in this study include: 1) Simple Weighted Addition method, 2) Weighted Product method, 3) TOPSIS, 4) cooperative game theory, and 5) ELECTRE. The results generated with these methods are compared and ranked so that the most preferable solution is identified.