Risk of chemotherapy-induced febrile neutropenia in patients with metastatic cancer not receiving granulocyte colony-stimulating factor prophylaxis in US clinical practice.

OBJECTIVES: To evaluate the use of granulocyte colony-stimulating factor (G-CSF) prophylaxis in US patients with selected metastatic cancers and chemotherapy-induced febrile neutropenia (FN) incidence and associated outcomes among the subgroup who did not receive prophylaxis. METHODS: This retrospective cohort study was conducted at four US health systems and included adults with metastatic cancer (breast, colorectal, lung, non-Hodgkin lymphoma [NHL]) who received myelosuppressive chemotherapy (2009-2017). Patients were stratified by FN risk level based on risk factors and chemotherapy (low/unclassified risk, intermediate risk without any risk factors, intermediate risk with ≥ 1 risk factor [IR + 1], high risk [HR]). G-CSF use was evaluated among all patients stratified by FN risk, and FN/FN-related outcomes were evaluated among patients who did not receive first-cycle G-CSF prophylaxis. RESULTS: Among 1457 metastatic cancer patients, 20.5% and 28.1% were classified as HR and IR + 1, respectively. First-cycle G-CSF prophylaxis use was 48.5% among HR patients and 13.9% among IR + 1 patients. In the subgroup not receiving first-cycle G-CSF prophylaxis, FN incidence in cycle 1 was 7.8% for HR patients and 4.8% for IR + 1 patients; during the course, corresponding values were 16.9% and 15.9%. Most (> 90%) FN episodes required hospitalization, and mortality risk ranged from 7.1 to 26.9% across subgroups. CONCLUSION: In this retrospective study, the majority of metastatic cancer chemotherapy patients for whom G-CSF prophylaxis is recommended did not receive it; FN incidence in this subgroup was notably high. Patients with elevated FN risk should be carefully identified and managed to ensure appropriate use of supportive care.

Attributable Cost of Adult Hospitalized Pneumonia Beyond the Acute Phase.

BACKGROUND: While much is known about the cost of community-acquired pneumonia (CAP) during the acute phase of illness, little is known about the potential attributable cost of CAP thereafter. OBJECTIVE: The aim of this study was to assess long-term attributable costs associated with CAP among adults in US clinical practice. METHODS: A retrospective matched cohort design and data from a US private healthcare claims repository were employed. In each month during the study period (2011-2016), adults who were hospitalized for CAP in that month ('CAP patients') were matched (1:1, without replacement) on demographic, clinical, and healthcare profiles to adults who did not develop CAP in that month ('comparison patients'). All-cause healthcare expenditures were tallied for the qualifying CAP hospitalization and during the 30-day period post-discharge (collectively, 'acute phase'), as well as from the end of the acute phase to the end of the 3-year follow-up period ('long-term phase'). RESULTS: The study population included 43,975 matched pairs of CAP patients and comparison patients. Expenditures averaged $33,380 (95% confidence interval [CI] $32,665-$34,161) for the CAP hospitalization and $4568 (95% CI $4385-$4749) during the 30-day period thereafter (vs. $2075 [95% CI $1989-$2167] in total for the comparison patients). During the long-term phase, all-cause expenditures averaged $83,463 (95% CI $81,318-$85,784) for CAP patients versus $51,017 (95% CI $49,553-$52,491) for comparison patients, and thus attributable expenditures during this phase totaled $32,446 (95% CI $29,847-$35,075). The majority of attributable CAP expenditures (53% of $68,319) occurred during the acute phase, while 21%, 14%, and 12% occurred during the first, second, and third years, respectively, after the acute phase. CONCLUSIONS: Our findings provide additional evidence that the cost of CAP requiring hospitalization is high, and that the impact of CAP extends well beyond the expected time for resolution of acute inflammatory signs.

Predictors of imminent non-vertebral fracture in elderly women with osteoporosis, low bone mass, or a history of fracture, based on data from the population-based Canadian Multicentre Osteoporosis Study (CaMos).

Using data from the Canadian Multicentre Osteoporosis Study, several risk factors predictive of imminent (2-year) risk of low-trauma non-vertebral fracture among high-risk women were identified, including history of falls, history of low-trauma fracture, poorer physical function, and lower T score. Careful consideration should be given to targeting this population for therapy. PURPOSE: Fracture risk assessment has focused on a long-term horizon and populations with a broad risk range. For elderly women with osteoporosis or low bone mass, or a history of fragility fractures ("high-risk women"), risk prediction over a shorter horizon may have greater clinical relevance. METHODS: A repeated-observations design and data from the Canadian Multicentre Osteoporosis Study were employed. Study population comprised women aged ≥ 65 years with T score (total hip, femoral neck, spine) ≤ - 1.0 or prior fracture. Hazard ratios (HR) for predictors of low-trauma non-vertebral fracture during 2-year follow-up were estimated using multivariable shared frailty model. RESULTS: The study population included 3228 women who contributed 5004 observations; 4.8% experienced low-trauma non-vertebral fracture during the 2-year follow-up. In bivariate analyses, important risk factors included age, back pain, history of falls, history of low-trauma fracture, physical function, health status, and total hip T score. In multivariable analyses, only four independent predictors were identified: falls in past 12 months (≥ 2 falls: HR = 1.9; 1 fall: HR = 1.5), low-trauma fracture in past 12 months (≥ 1 fracture: HR = 1.7), SF-36 physical component summary score (≤ 42.0: HR = 1.6), and total hip T score (≤ - 3.5: HR = 3.7; > - 3.5 to ≤ - 2.5: HR = 2.5; > - 2.5 to ≤ - 1: HR = 1.3). CONCLUSIONS: Imminent risk of low-trauma non-vertebral fracture is elevated among high-risk women with a history of falls or low-trauma fracture, poorer physical function, and lower T score. Careful consideration should be given to identifying and targeting this population for therapy.

La trasnversalidad del discurso eugenésico en los saberes educativos y en el discurso político durante la década del treinta / The transversality of the eugenic discourse in the educative knowledge and in the political discourse during the 30s´

Sitúa la problemática de la salud en la provincia de Buenos Aires durante la década del treinta y se propone extender el análisis sobre dos ejes. Por un lado, analiza las discusiones en cuanto a la responsabilidad de los teóricos de la educación en la formación de hábitos higié nicos y cuidados de la salud, como multiplicadores de la política estatal. Por otro, intenta demostrar cómo el discurso político remite a las concepciones de higiene del momento para moldear al cuidadano, en particular a los sectores populares, usuarios de la escuela pública.

La trasnversalidad del discurso eugenésico en los saberes educativos y en el discurso político durante la década del treinta / The transversality of the eugenic discourse in the educative knowledge and in the political discourse during the 30s´

Sitúa la problemática de la salud en la provincia de Buenos Aires durante la década del treinta y se propone extender el análisis sobre dos ejes. Por un lado, analiza las discusiones en cuanto a la responsabilidad de los teóricos de la educación en la formación de hábitos higié nicos y cuidados de la salud, como multiplicadores de la política estatal. Por otro, intenta demostrar cómo el discurso político remite a las concepciones de higiene del momento para moldear al cuidadano, en particular a los sectores populares, usuarios de la escuela pública.(AU)

La trasnversalidad del discurso eugenésico en los saberes educativos y en el discurso político durante la década del treinta / The transversality of the eugenic discourse in the educative knowledge and in the political discourse during the 30s

Sitúa la problemática de la salud en la provincia de Buenos Aires durante la década del treinta y se propone extender el análisis sobre dos ejes. Por un lado, analiza las discusiones en cuanto a la responsabilidad de los teóricos de la educación en la formación de hábitos higié nicos y cuidados de la salud, como multiplicadores de la política estatal. Por otro, intenta demostrar cómo el discurso político remite a las concepciones de higiene del momento para moldear al cuidadano, en particular a los sectores populares, usuarios de la escuela pública.(AU)

Entrenamiento en habilidades sociales en pacientes esquizofrénicos crónicos: estudio piloto / Social skill training in chronic schizophrenic patients: pilot study

Con el propósito de corroborar la efectividad y aplicabilidad del "Entrenamiento grupal en habilidades Sociales" con pacientes psiquiátricos desarrollado por R.P. Liberman et al, en nuestro medio, fueron seleccionados cinco pacientes esquizofrénicos crónicos de Consulta Externa del Servicio de Adultos y Geriatría del Instituto Nacional de Salud Mental "H. Delgado - H. Noguchi" en base a ciertos criterios de inclusión tales como: repertorio de conductas básicas (atención, discriminación, seguimiento de instrucciones), repertorio verbal mínimo, y ausencia de síntomas positivos prominentes de la enfermedad. Los resultados, en base a 20 conductas evaluadas, antes y después del entrenamiento, revelan un incremento en el número de habilidades sociales en los cinco sujetos. En general, los datos analizados de los cambios observados en el grupo son estadísticamente significativos ( p <. 05).

The purpose of this study is to confirm the efficacy and applicability of R.P. Liberman's "Group Training in Social Skills" for psychiatric patients in our milieu. Five outpatients with DSM-III-R diagnoses of chronic schizophrenia were selected from the Adult and Geriatrics Outpatient Service of the National Institute of Mental Health "H. Delgado - H. Noguchi". Inclusion criteria such as: a list of basic behaviors (attention, discrimination, following instructions), minimal speech reportoire and no positive symptoms of the disorder where considered. The results over 20 behaviors assessed, before and after the training, reveal an increase in the number of social skills in all the subjects at the end of the trial. In general, the analysed data showed that the observed changes in the group were statistically significant (P < .05).