Discontinuation and nonpublication of clinical trials for the pharmacologic treatment of posttraumatic stress disorder among military veterans.

Failures by researchers and clinicians to overcome barriers in veteran health-related research may result in clinical trial (CT) discontinuation and nonpublication. Such outcomes are a waste of limited academic resources. To determine rates of discontinuation and nonpublication among CTs for posttraumatic stress disorder (PTSD) with pharmaceutical interventions specific to the veteran population, we performed a systematic search of registered trials in ClinicalTrials.gov for pharmaceutical interventions for the treatment of PTSD. Extracted study characteristics included sample size, study design, trial status, phase, and funding source. Studies were classified as completed or discontinued based on the status listed in ClinicalTrials.gov. Descriptive statistics of trials were reported, and associations of trial termination and nonpublication were assessed using logistic regression. The final sample included 54 CTs, 15 of which (27.8%) had not been published within the FDA's required timeframe, and 11 (20.4%) were discontinued. The total number of trial participants was 3,463, with a median of 37 (interquartile range: 15-92). Of the 54 trials, 12 (22.2%) were nonrandomized, and 42 (77.8%) were randomized. There were 25 (46.3%) trials that were in either Phase 3 or Phase 4, and 39 (72.2%) were government-funded. We found high rates of CT discontinuation and nonpublication among PTSD pharmaceutical intervention studies in veterans, as has been shown in other fields of research.

Prevalence and associations among metabolically unhealthy obesity, asthma exacerbations, and emergency department use.

BACKGROUND: Helper type 1 T cell polarization and monocyte cell activation influence forced expiratory volume in 1 second/forced vital capacity and are affected by body mass index (BMI), insulin resistance, and serum lipoproteins. No study has assessed the impact of metabolic syndrome components on asthma symptom control. OBJECTIVE: To determine the prevalence of patients with metabolically unhealthy obesity (MUO) and asthma. Our secondary objective was to compare the strength of associations among asthma outcomes in patients with obesity measured by BMI, waist circumference, and MUO. METHODS: A cross-sectional analysis of the combined 2011 to 2016 cycles of the National Health and Nutrition Examination Survey was performed among persons with asthma. Metabolically unhealthy obesity was defined as a BMI of at least 30 kg/m2 and one of the following: increased waist circumference, insulin resistance, low physical activity, hyperlipidemia, or hypertension. Multiple logistic regression models were computed to assess asthma exacerbations and emergency department use for asthma in patients with MUO compared with unhealthy obesity. RESULTS: Among respondents with MUO, 50.09% (n = 543; N = 17,011,880) had asthma compared with 7.91% in those with metabolically healthy obesity (n = 77; N = 2,685,858). Persons with MUO were significantly more likely to report the use of an emergency department for their asthma symptoms within the past 12 months (odds ratio, 3.53; 95% confidence interval, 1.54-8.09; P < .05). Persons with elevated waist circumference were more likely to report asthma exacerbations (odds ratio, 1.58; 95% confidence interval, 1.09-2.26). No significant difference existed in reported asthma exacerbations or emergency department use in patients measured by BMI. CONCLUSION: MUO is associated with increased emergency department use for asthma and is better at predicting exacerbations and emergency department use than BMI alone.

The Mean Single Molecule Rate (mSMR) in the Analysis of Fluorescence Fluctuations: Measurements on DNA Mixtures of Defined Composition.

We present a method for the evaluation of fluorescence fluctuations on the basis of Mandel's Q parameter, using sampling time-dependent factorial cumulants. By relating the Q parameter to the sampling time, we obtain the mean single molecule rate (mSMR), an easy to interpret expression that provides both brightness and diffusion information. The model is suitable for the widely used confocal setups with single photon excitation and a single detection channel. We present a way to correct the mSMR for afterpulsing, dead time and background noise. To account for photokinetic effects at short sampling times, we expand the model by a simple on/off isomerization term, which is similar to the well-known triplet model. The functionality of the mSMR is shown using Monte Carlo simulations. The correction mechanisms and the experimental applicability of the model are then demonstrated by DNA measurements of defined composition. By systematically analyzing DNA mixtures, we can show that at large sampling times, the mSMR correctly describes the single molecule brightness rates and the diffusive properties of DNA molecules. At short sampling times, the photokinetic effects of isomerization are accurately described by the mSMR model. Since additionally the mSMR can easily be corrected for measurement artefacts such as detector dead time, afterpulsing and background noise, this is a valuable advantage over the standard method of fluorescence correlation spectroscopy.

Increased serum cotinine and obesity negatively impact asthma exacerbations and hospitalizations: A cross-sectional analysis of NHANES.

Background: Asthma is the most common non-communicable chronic airway disease worldwide. Obesity and cigarette use independently increase asthma morbidity and mortality. Current literature suggests that obesity and smoking synergistically increase asthma-related wheezing. Objective: To assess whether increased serum cotinine and obesity act synergistically to increase the likelihood of having an asthma exacerbation, emergency department (ED) visit, or hospitalization. Methods: A cross-sectional analysis of the 2011-2015 iterations of NHANES database was performed. Patients aged 18 years or greater with asthma were included. Serum cotinine was utilized as an accurate measurement of cigarette use. Logistic regression models were constructed to determine whether elevated serum cotinine and obesity were associated with self-reported asthma exacerbations, asthma-specific ED usage, and hospitalizations for any reason in the past year. Odds ratios were adjusted for age, gender, race, and ethnicity. Interactions were assessed by multiplying the adjusted effect sizes for elevated cotinine and obesity. Results: We identified 2179 (N = 32,839,290) patients with asthma, of which 32.2% were active smokers and 42.7% were obese. Patients with an elevated cotinine and asthma were significantly more likely to have had an asthma-related ED visit in the past year (adjusted odds ratio [AOR] 1.82; 95% CI 1.19-2.79), have a physician-prescribed asthma medication (AOR 2.04; 95% CI 1.11-3.74), and have a hospitalization for any reason (AOR 3.65; 95% CI 1.88-7.07) compared to those with low cotinine. Patients with asthma and obesity were more likely to have an asthma-related ED visit (AOR 1.67; 95% CI 1.06-2.62) or hospitalization for any reason in the past year compared to non-obese patients (AOR 2.76; 95% CI 1.69-4.5). However, a statistically significant interaction between obesity and cotinine was only identified in patients who currently have asthma compared to a previous asthma diagnosis (AOR 1.76; 95% CI 1.10-2.82). There were no synergistic interactions among ED usage or asthma exacerbations. Conclusion: Nearly one-third of patients with asthma were current smokers, and almost half were obese. This study identified elevated serum cotinine, a metabolite of cigarette use, and obesity as key risk factors for asthma exacerbations, asthma-related ED visits, and hospitalizations for any reason. Elevated serum cotinine and obesity were not found to act synergistically in increasing asthma exacerbations or ED visits. However, the presence of both risk factors increased the risk of currently having asthma (compared to a previous diagnosis) by 76%. Serum cotinine may be useful in predicting asthma outcomes.

Trends of colorectal cancer screening methods: an analysis of Behavioral Risk Factor Surveillance System data from 2018-2020.

CONTEXT: Colorectal cancer (CRC) has a high mortality rate and a large financial burden. Therefore, it is imperative to screen appropriately for this disease. By evaluating trends in different CRC screening methods and evaluating screening methods based on sex and race, improvements in screening can be made. OBJECTIVES: By analyzing data from the Behavioral Risk Factor Surveillance System (BRFSS), our primary objective was to evaluate trends in CRC screening methods from 2018 through 2020. Our secondary objectives were to investigate deviations in screening rates by sex and race/ethnicity. METHODS: A cross-sectional design was utilized to analyze trends in CRC screening methods utilizing data from the BRFSS for the years 2018 through 2020. Sex and race were also analyzed to evaluate for deviations in screening rates. RESULTS: All race/ethnicity groups most often completed colonoscopies, with all but individuals identifying as Hispanic having higher than 56% completion rates. Individuals reporting as Hispanic received more blood stool tests than other races at 23.4%. Average CRC screening among all methods showed that 89.7% of individuals who reported as being White completed screening, with 91.3% of individuals reporting as Black, and 81.9% with race not listed, completed screening. Individuals identifying as Asian (74.4%), American Indian/Alaska Native (AI/AN [79.2%]) and Hispanic (78.1%) had lower rates of screening overall. CONCLUSIONS: Our study found that trends in CRC screening were similar across years for individuals who reported as being White or Black. We also found that those identifying as Asian, AI/AN, Hispanic, and those whose identifying race was not listed deviated across years. These latter groups were also less likely to have received colonoscopies, the gold standard of screening. Because CRC is oftentimes a preventable disease, the importance of appropriate screening cannot be emphasized enough.

Disparities in seasonal influenza vaccine uptake and language preference among Hispanic US adults: an analysis of the 2017-2020 BRFSS.

CONTEXT: Influenza-related hospitalization and mortality disproportionately affects the Hispanic population in the United States. Among other medical conditions in addition to influenza, Spanish-preferring Hispanics may be more affected than those who speak English. OBJECTIVES: The purpose of this study was to compare seasonal influenza vaccine uptake rates between Spanish-and English-preferring Hispanic US adults from 2017 to 2020. METHODS: For this cross-sectional study, we extracted data from the Behavioral Risk Factor Surveillance System (BRFSS) from the 2017 through 2020 cycles. We calculated the population prevalence of individuals getting influenza vaccines per year, and among subpopulations based on language spoken, age, and sex. We then utilized chi-squared tests of independence to discover possible associations between these subpopulations per year. An alpha level of 0.05 was utilized in this study. Respondents were included if they identified as Hispanic, responded to questions regarding influenza vaccine uptake, and were grouped by the language of the survey returned, age, and sex. RESULTS: Our results show that self-identified Hispanic individuals who were English-preferring had greater seasonal influenza vaccine uptake rates in the latter 2 years of our study for both sexes in the younger age group. Hispanic individuals over the age of 65 years (n=11,328) were much more likely to have received an influenza vaccine compared to younger individuals (n=34,109). In 2018, Spanish-preferring women over age 65 years (n=677) were more likely to have received a vaccine over English-preferring women (n=772). CONCLUSIONS: Our findings showed that disparities exist between English- and Spanish-preferring Hispanic individuals and age groups. Language barriers may play a role in receiving influenza vaccines. The incorporation of medical translators may assist in reducing these disparities in influenza-related healthcare expenses, overall morbidity, and mortality.

Public Interest in Myocarditis during the SARS-CoV-2 Pandemic.

OBJECTIVE: Public interest in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines has been rising with regard to associated myocarditis. Thus, the objective of our study was to assess trends in public interest in myocarditis during the course of the pandemic and the SARS-CoV-2 vaccine rollout in the United States. METHODS: We conducted a longitudinal assessment of public interest in myocarditis, and its association with actual coronavirus disease 2019 (COVID-19) -related myocarditis during the first wave of the pandemic and SARS-CoV-2 vaccine-related myocarditis following vaccine rollout. To complete this objective, we used data from 3 sources: a report from the Morbidity and Mortality Weekly Report, the Vaccine Adverse Event Reporting database, and from Google Trends. RESULTS: Results show that Relative Search Interest (RSI) was low before and during the initial phase of the pandemic and peaked in April 2021, during the initial vaccine push. The ratio of myocarditis related to the SARS-CoV-2 vaccines was considerably lower than the ratio of myocarditis from natural infection. CONCLUSIONS: Search interest in myocarditis was low until SARS-CoV-2 vaccines were rolled out, in which media coverage intensely focused on a relatively small number of cases. This study highlights both the benefits of COVID-19 vaccine uptake and the impact of the media on public interest.

Associations of Combustible Cigarette, Electronic Cigarette, and Dual Use With COVID Infection and Severity in the U.S.: A Cross-sectional Analysis of the 2021 National Health Information Survey.

Given the potential respiratory health risks, the association of COVID infection and the use of combustible cigarettes, electronic nicotine delivery systems (ENDS), and concurrent dual use is a priority for public health. Many published reports have not accounted for known covarying factors. This study sought to calculate adjusted odds ratios for self-reported COVID infection and disease severity as a function of smoking and ENDS use, while accounting for factors known to influence COVID infection and disease severity (i.e., age, sex, race and ethnicity, socioeconomic status and educational attainment, rural or urban environment, self-reported diabetes, COPD, coronary heart disease, and obesity status). Data from the 2021 U.S. National Health Interview Survey, a cross-sectional questionnaire design, were used to calculate both unadjusted and adjusted odds ratios for self-reported COVID infection and severity of symptoms. Results indicate that combustible cigarette use is associated with a lower likelihood of self-reported COVID infection relative to non-use of tobacco products (AOR = .64; 95% CI [.55, .74]), whereas ENDS use is associated with a higher likelihood of self-reported COVID infection (AOR = 1.30; 95% CI [1.04, 1.63]). There was no significant difference in COVID infection among dual users (ENDS and combustible use) when compared with non-users. Adjusting for covarying factors did not substantially change the results. There were no significant differences in COVID disease severity between those of varying smoking status. Future research should examine the relationship between smoking status and COVID infection and disease severity utilizing longitudinal study designs and non-self-report measures of smoking status (e.g., the biomarker cotinine), COVID infection (e.g., positive tests), and disease severity (e.g., hospitalizations, ventilator assistance, mortality, and ongoing symptoms of long COVID).

Associations of intimate partner violence and maternal comorbidities: a cross-sectional analysis of the Pregnancy Risk Assessment Monitoring System.

CONTEXT: Intimate partner violence (IPV) occurs when an intimate partner inflicts physical, sexual, and/or emotional assault with coercive control and is a traumatic experience with repercussions that can be exacerbated when a woman is pregnant. While screening for IPV during pregnancy is recommended to occur regardless of risk, less than 50% of pregnant women are screened. OBJECTIVES: Identifying clinical factors commonly associated with IPV during pregnancy may improve screening rates, thus our primary objective was to examine associations between IPV and maternal comorbidities. METHODS: We conducted a cross-sectional analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 spanning 2016 through 2019. Bivariate and multivariable logistic regression was utilized to calculate adjusted odds ratios (AORs) to determine associations between IPV and diabetes, anxiety, hypertension, depression, asthma, polycystic ovary syndrome (PCOS), and thyroid disease. RESULTS: More than 40% of women experiencing IPV reported a history of depression or anxiety. The occurrence of IPV was higher among women with depression (AOR 3.48, CI 3.14-3.85), anxiety (AOR 2.98, CI 2.64-3.37), hypertension (AOR 1.21, CI 1.02-1.44), and asthma (AOR 1.37; CI 1.17-1.59) than women without those respective conditions, but not among diagnoses of diabetes, PCOS, or thyroid disorders. CONCLUSIONS: Our findings show that pregnant individuals reporting having experienced IPV were more likely to report having certain comorbidities compared to those who did not report experiencing IPV. Given the low rates of screening, knowing clinically relevant associations may increase screening sensitivity among clinicians and, in turn, increase the likelihood that individuals experiencing IPV receive supportive care.

Examination of Homologies between COVID-19 Vaccines and Common Allergens: The Potential for T Cell-mediated Responses for Allergic Rhinitis and Asthma.

As the SARS-CoV-2 virus shares relatively large protein sequences homologous to grass pollens, dust mites, and molds, our objective was to assess the potential overlap between the COVID-19 mRNA vaccines from Pfizer-BioNtech and Moderna and known allergens. We found 7 common allergens with potential for cross-reactivity with the Pfizer vaccine and 19 with the Moderna vaccine, including common grasses, molds, and dust mites. T-cell mediated antigen cross-reactivity between viruses and allergens is a relatively new area of study in clinical immunology; a discipline that may be particularly useful regarding the SARS-CoV-2 virus and the allergic response in humans. These results suggest that vaccination with the Pfizer-BioNtech and Moderna COVID-19 vaccines may contribute to T-cell cross-reactivity with allergens that impact allergic asthma and allergic rhinitis. Further research should assess the clinical implications of COVID-19 vaccination on the severity and symptomatology of the allergic disease, in addition to natural viral infection.

Association of Public Interest in Preventive Measures and Increased COVID-19 Cases After the Expiration of Stay-at-Home Orders: A Cross-Sectional Study.

OBJECTIVE: Following stay-at-home (SAH) orders issued for coronavirus disease (COVID-19), state-level economic concerns increased and many let these orders expire. As a method to measure public preparedness, we sought to explore the association between public interest in preventive measures and the easing of SAH orders - specifically the increases in COVID-19 cases and fatalities after the orders expired. METHODS: Search volume was collected from Google Trends for "hand sanitizer," "social distancing," "COVID testing," and "contact tracing" for each state. Bivariate correlations were computed to analyze associations between public interest in preventive measures, changes in confirmed COVID-19 cases after SAH expirations, COVID-19 case-fatality rates, and by-state presidential voting percentages. RESULTS: A higher interest in preventive measures was associated with lower rates of confirmed cases after SAH orders had expired (r = -0.33), higher state-wide deaths per capita (r = 0.42), and case-fatality rates (r = 0.60). Moderate to strong negative correlations were found between states' percentage of voters supporting the Republican nominee in 2016 and proportion of queries for average preventive measures (r = -0.77). CONCLUSION: Our investigation shows that increased public interest in COVID-19 prevention was associated with longer SAH orders and less COVID-19 cases after the SAH orders' expiration; however, it was also associated with higher case-fatality rates.

Cancer screenings during the COVID-19 pandemic: An analysis of public interest trends.

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic has impacted breast, colon, prostate, and lung cancer screenings in the U.S. by decreasing screening numbers.​We believe multiple types of cancer screenings may have been impacted during the pandemic as a result of cancellations of elective procedures and patient fear of seeking cancer screenings during a pandemic and that Google Trends may be a marker to estimate screening usage. METHODS: Google Trends (trends.google.com) was utilized to assess public interest in multiple cancer types. We then constructed a forecasting model to determine the expected search interest had the pandemic not occurred. We then compared our models to actual screening usage during the pandemic. RESULTS: Public interest in cancer screenings decreased precipitously at the onset of the COVID-19 pandemic. We found that the Google Trends estimated the decrease in mammogram usage 25.8% below the actual value. Similarly, Google Trends estimated the decrease in colon cancer screening usage 9.7% below the true value. DISCUSSION: We found the decrease in public interest in breast and colon cancer screenings slightly underestimated the actual screening usage numbers, suggesting Google Trends may be utilized as an indicator for human behavior regarding cancer screening, particularly with colon and breast cancer screenings. If the negative trend in cancer screening continues and missed screenings are not appropriately corrected for, socioeconomic and racial disparities in cancer diagnoses, morbidity, and mortality will widen.

Pathophysiology, Diagnosis, and Management of Chronic Spontaneous Urticaria: A Literature Review.

Chronic spontaneous urticaria (CSU) is characterized by recurring wheals that last 6 weeks or longer without an identifiable cause. The estimated point prevalence of CSU worldwide is 1%. Furthermore, it has a significant impact on quality of life in both adults and pediatric patients and their families. Although it is most often a self-limited disease, some patients have urticaria refractory to first-line treatment: second-generation H1 antihistamines. In these patients, the use of targeted monoclonal antibodies is necessary. While omalizumab is the only Food and Drug Administration-approved monoclonal antibody for CSU, others, including ligelizumab, dupilumab, benralizumab, and several orally administered Bruton's tyrosine kinase inhibitors, are also promising therapeutics for reducing the morbidity of CSU. Novel therapies, among others discussed here, are rapidly being developed with new trials and therapeutics being released nearly monthly. Thus, we performed a scoping literature review of randomized controlled trials studying targeted therapies for CSU. We also discuss the pathophysiology, diagnosis, prognosis, and future research directions in CSU.

Cervical cancer screening among women with comorbidities: a cross-sectional examination of disparities from the Behavioral Risk Factor Surveillance System.

CONTEXT: Implementation of guideline-based Papanicolaou (Pap) smear screening, human papillomavirus (HPV) testing, and HPV vaccination has reduced cervical cancer (CC) rates up to 80%, yet prevention disparities continue to exist. OBJECTIVES: This study aims to analyze whether CC screening rates differ among women with comorbidities-body mass index (BMI) ≥30 kg/m2, diabetes mellitus, hypertension, cardiovascular disease, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, depression, or skin cancer-compared to women without these comorbidities. METHODS: Combined 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) datasets were evaluated utilizing multivariate logistic regression models to determine the adjusted odds ratios (AORs) of persons having completed CC screening without comorbidities compared to those with individual diagnoses, as well as in those with multiple comorbidities (1, 2-4, 5+). Confidence intervals (CIs) were reported at 95%. RESULTS: Among the 127,057 individuals meeting inclusion criteria, 78.3% (n = 83,242; n = 27,875,328) met CC screening guidelines. Multivariable regression showed that women who had a BMI ≥30 kg/m2 were significantly less likely to have completed a CC screening (AOR: 0.90; CI: 0.83-0.97) as were those with COPD (AOR: 0.77; CI: 0.67-0.87) and kidney disease (AOR: 0.81; CI: 0.67-0.99). Conversely, women with skin cancer were significantly more likely to report CC screening (AOR: 1.22; CI: 1.05-1.43). We found no significant differences in CC screening completion rates by diagnosis of diabetes, hypertension, cardiovascular disease, arthritis, or depression nor between women lacking comorbidities compared to women with multiple comorbidities. CONCLUSIONS: Women with BMI ≥30 kg/m2, COPD, and kidney disease were less likely to complete CC screening, whereas women with skin cancer were more likely to complete CC screening. Additionally, diabetes mellitus, hypertension, cardiovascular disease, arthritis, and depression diagnoses did not significantly impact rates of CC screening. Physicians should be aware of the deviations in CC screening completion among patients with diagnoses to know when there may be an increased need for Pap tests and pelvic examinations. CC screening is critical to reduce mortality through early detection and prevention measures.

Health disparities, COVID-19, and maternal and childbirth outcomes: a meta-epidemiological study of equity reporting in systematic reviews.

BACKGROUND: Pregnant women with COVID-19 are at increased risk for adverse maternal and pregnancy outcomes, and birth complications. Given the health outcome disparities among pregnant women of racial and ethnic minorities and the reliance of medical practice on systematic reviews and meta-analyses (SRMAs)-as they are the apical component in the hierarchy of evidence in medical research-the primary objective of the study is to examine the inclusion of the equity reporting in SRMAs focused on pregnancy outcomes and COVID-19 using PROGRESS-Plus equity framework. PROGRESS represents equity measures of Place, Race, Occupation, Gender, Religion, Education, Social capital, and Socio-economic status. METHODS: We conducted a systematic search of three databases to identify SRMAs related to maternal and pregnancy outcomes related to COVID-19. We extracted whether SRMAs reported or analyzed PROGRESS-Plus components among other study characteristics. RESULTS: Nearly 85% of SRMAs did not include any equity items to account for racial or geographic disparities. Reporting of race was absent from 95% of the studies. Place was the most common PROGRESS item and maternal age was the most common PROGRESS-Plus item reported overall. CONCLUSION: When research is performed and reported in a way that fails to address disparities, the downstream repercussions may include medical care in the form of new protocol-driven hospital management, pharmacologic interventions, and other treatment options that mirror this absence in reporting. The absence of adequate reporting widens gaps in health outcomes among at-risk groups, such as pregnant women of racial and ethnic minorities.

Spin within systematic review abstracts on antiplatelet therapies after acute coronary syndrome: a cross-sectional study.

OBJECTIVES: Spin is a reporting practice in which study results are misrepresented by overestimating efficacy or underestimating harm. Prevalence of spin varies between clinical specialties, and estimates are based almost entirely on clinical trials. Little is known about spin in systematic reviews. DESIGN: We performed a cross-sectional analysis searching MEDLINE and Embase for systematic reviews and meta-analyses pertaining to antiplatelet therapies following acute coronary syndrome on 2 June 2020. Data were extracted evaluating the presence of spin and study characteristics, including methodological quality as rated by A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). All data extraction was conducted in a masked, duplicate manner from 2 June 2020 to 26 June 2020. PARTICIPANTS AND SETTING: Not applicable. PRIMARY AND SECONDARY OUTCOME MEASURES: We assessed abstracts of systematic reviews on antiplatelet therapy following acute coronary syndrome and evaluated the prevalence of the nine most severe types of spin. We additionally explored associations between spin and certain study characteristics, including quality. RESULTS: Our searches returned 15 263 articles, and 185 systematic reviews met inclusion criteria. Of these 185 reviews, 31.9% (59/185) contained some form of spin in the abstract. Seven forms of spin (1, 2, 3, 4, 5, 7 and 9) among the nine most severe were identified. No instances of types 6 or 8 were found. There were no statistically significant relationships between spin and the evaluated study characteristics or AMSTAR-2 appraisals. CONCLUSIONS: Spin was present in abstracts for systematic reviews and meta-analyses; subsequent studies are needed to identify correlations between spin and specific study characteristics. There were no statistically significant associations between spin and study characteristics or AMSTAR-2 ratings; however, implementing changes will ensure that spin is reduced in the field of cardiology as well as other fields of medicine.

The presence of spin in systematic reviews focused on diabetic neuropathy: A cross-sectional analysis.

BACKGROUND: Spin-the misrepresentation of a study's actual results-has the potential to alter a clinician's interpretation of the study's findings and therefore could affect patient care. Studies have shown spin frequently occurs in abstracts of systematic reviews from a variety of other medical disorders and specialties. AIMS: Our primary aim was to evaluate whether the nine most severe types of spin occurred in systematic review abstracts' concerning diabetic neuropathy treatments. Secondly, we aimed to determine whether spin presence was associated with the methodological quality of a systematic review. METHODS: A search of MEDLINE and Embase collected 1297 articles focused on diabetic neuropathy treatments, of which we included 114 systematic reviews for spin assessment. Each included study was evaluated for the nine most severe types of spin as defined by Yachitz et al. The methodological quality of a systematic review was determined by using the AMSTAR-2 instrument. All screening and data extraction were conducted in a masked, duplicate fashion. Since the final sample size of 114 was not sufficiently powered to do multivariable logistic regression, we calculated unadjusted odds ratios which evaluated relationships between spin presence within abstracts and study characteristics. RESULTS: From the 114 articles reviewed, spin was present in 7.9% of the studies (9/114), with spin type 5: "conclusion claims the beneficial effect of the experimental treatment despite the high risk of bias in the included primary studies" as the most frequent in our study. Spin types 1, 2, 6, and 8 were not identified. No association was observed between the study characteristics and spin presence, including the methodological quality of a systematic review. CONCLUSIONS: Overall, spin is infrequently observed in abstracts of systematic reviews covering diabetic neuropathy treatments. When comparing our results to other fields of medicine, the field of diabetic neuropathy research publishes systematic reviews whose abstracts mostly portray the findings of the review's full-text to reflect the results adequately.

The pink elephant in the room: Declining public interest in breast cancer and the impact of marketing efforts.

BACKGROUND: Public interest in breast cancer is associated with breast cancer awareness month. However, no study has analyzed the temporal trends in breast cancer interest or assessed how funding for breast cancer research is influenced by public interest. METHODS: We performed a cross-sectional analysis of Google Trends using the search query "Breast Cancer" between January 2004 - July 2020. We then computed bivariate correlations to assess the association between relative search interest (RSI) and the financial records of the Susan G. Komen Foundation. RESULTS: Average search interest has declined since 2004. We identified increasing breast cancer RSI beginning in October 2009, corresponding with breast cancer awareness month, with an overall peak in 2012 followed by a downtrend through 2017. These fluctuations in peak RSI corresponded with the U.S. National Football League's initiation of "Pink October" during which the players wore pink jerseys which started in 2009 and ceased in 2017. We also found a strong correlation between peak RSI and Susan G. Komen Foundation net assets as well as funding of public health screening services and public health education. CONCLUSIONS: Average interest in breast cancer has been declining since 2004 and peak interest, as well as breast cancer funding, has been declining since 2012. This suggests new marketing efforts are needed to improve breast cancer awareness and to increase fundraising. POLICY SUMMARY: Considering the decline in breast cancer interest and funding, we recommend implementing local, regional, and national policies that improve marketing campaigns and improve breast cancer awareness.