Search Results (80)

At diagnosis, metastatic prostate cancer (PC) is sensitive to androgen deprivation therapy (ADT), and patients are usually referred to as having castration-sensitive prostate cancer (mCSPC). The combination of ADT and androgen receptor pathway inhibitors (ARPI) is the current standard of care for mCSPC. This study aimed to review the literature on economic evaluations and health economic models related to mCSPC. A literature search was performed covering Medline, Embase, and Scopus with additional grey literature sources. Studies with data on health economic evaluations focusing on Europe or North America were relevant. 18 peer-reviewed articles and 10 grey literature documents were included. The majority (n = 23) had a deterministic Markov structure and applied either Markov cohort or partitioned survival models. Evaluations investigated various types of ADT-based combinations, comparing the addition of ARPI, chemotherapy agents, or radiation therapy to ADT alone. We concluded that economic evaluations in the field of PC are widely published, and there are a large number of publications even in the specific subgroup of mCSPC. Regardless of the investigated interventions, most studies applied similar methodologies and simulated patients from the mCSPC state until the development of mCRPC or death. Full article

Competitive reactions between additives and probes towards peroxyl radicals (ROO^•) are usually employed to determine the antioxidant activity (AC) of bioactive peptides. In this work, we investigated the AC of free and peptide Trp and Tyr residues, employing pyranine (PYR) as the probe and AAPH (2,2′-azobis(2-methylpropionamidine) dihydrochloride) as the ROO^• source. Solutions containing PYR and 10 mM AAPH were incubated at 37 °C in the absence and presence of additives. The initial consumption rates (R₀) of PYR (5 µM) were affected by the type of peptide, with free Trp showing a higher effect than short peptides (R₀ = Gly-Trp > Gly-Trp-Gly > Trp-Gly > free Trp), while the order of R₀ of Tyr residues was as follows: free Tyr ~ Tyr-Tyr-Tyr > Gly-Tyr. Experiments carried out at 1 µM PYR, and employing larger peptides showed that the AC of Trp and Tyr cannot be explained by a simple mechanism. While the generation of lag times in the kinetics would not be necessarily associated with PYR repairing, their absence would not exclusively reflect competition for ROO^•. These results demonstrate that the AC of Trp and Tyr follows complex mechanisms, implying that particular care should be taken when amino acids and peptides are proposed as antioxidants. Full article

Background: The foreign-born population in the United States has reached a record high over the last three years. Significant disparities in cancer screening rates exist among this population, resulting in later-stage diagnoses and worse outcomes. This narrative review explores the sociodemographic factors, barriers, and interventions influencing cancer screening rates among foreign-born individuals in the U.S. Methods: A comprehensive review of studies was conducted to assess colorectal, cervical, and breast cancer screening disparities among immigrants. Factors examined include length of residence, race and ethnicity, income, education, citizenship, insurance, usual source of care, language, medical literacy, and cultural barriers. Furthermore, the effectiveness of educational interventions, patient navigators, and at-home testing in addressing these screening disparities was evaluated. Results: Immigrants have lower screening rates for colorectal, cervical, and breast cancer compared to U.S.-born individuals, with the largest disparities observed in colorectal cancer. Factors influencing these gaps include shorter duration of residence, Asian ethnicity, and lower income and education levels. Lack of health insurance and of a usual source of care are currently the most significant barriers to screening. Interventions such as education, patient navigation, and at-home testing have shown moderate success in improving screening rates, though data on their effectiveness remain limited. Conclusions: Addressing cancer screening disparities within the U.S. foreign-born population is essential, especially as the immigrant population continues to reach record numbers. Targeted interventions are needed to improve screening among immigrant groups with the lowest completion rates. Future research on these interventions should prioritize larger sample sizes, longitudinal studies, and the utility of new technologies such as artificial intelligence. Full article

Background: Human central nervous system infections due to free-living nematodes, although extremely rare, are usually fatal. Immunodeficiency has not been a feature of most of these cases, unlike the situation pertaining to disseminated Strongyloides stercoralis infection. Case report: An elderly immunocompetent man presented with a history of tinnitus and otalgia, progressing to central nervous system involvement with confusion, weakness, and other neurological signs. Examination revealed a unilateral external auditory canal soft tissue mass and radiological evidence of ipsilateral temporal bone destruction and brain parenchymal disease. A biopsy of the ear canal mass revealed the presence of an unidentified nematode species, and treatment with anthelminthics was started. The patient’s clinical condition deteriorated and he died shortly after admission to the intensive care unit. The immediate cause of death was bronchopneumonia. During the autopsy, an extensive involvement of the right middle cranial fossa was found, with destruction of the squamous and petrous parts of the temporal bone. Results: We identified adult, larval, and egg stages of a free-living nematode in the antemortem external auditory canal tissue mass and the post-mortem brain samples. Polymerase chain reaction assays, with Sanger and whole-genome sequencing, identified Cephalobus cubaensis. This is a free-living species not previously known to be pathogenic to humans, although nematodes of the same genus have caused mastitis in horses. Conclusions: Microscopic appearance and the invasive behaviour of the pathogen evoked a putative diagnosis of Halicephalobus gingivalis, the most frequently reported free-living nematode infecting humans. However, this nematode’s size and anatomical features, and the clinical presentation and duration of illness, prompted the consideration of an alternative species. We speculate that an initial bacterial otitis externa provided the opportunity for colonization by the nematode from an environmental source and subsequent invasion. Full article

Background: Pilates is one of the non-pharmacological interventions for fibromyalgia (FM). However, its impacts on pain and health-related quality of life (HRQOL) in fibromyalgia patients (FMPs) are inconclusive. This study aimed to assess the effects of Pilates on pain and HRQOL among FMPs. Methods: A systematic review and meta-analysis were conducted. Four databases—PubMed, ScienceDirect, Scopus, and Cochrane CENTRAL—along with one grey literature source, Google Scholar, were searched for randomized controlled trials comparing Pilates with other exercises or usual care in FMPs. The outcomes were pain and HRQOL. A meta-analysis was performed using a random-effects model. Results: Six studies were included (n = 265). We found that the effects of Pilates from each individual study on pain were inconsistent. Our pooled analysis of visual analog scale (VAS) scores demonstrated significant pain reduction (mean difference (MD), −0.71, 95%CI, −1.33 to −0.10, p = 0.023; (I² = 29.3%, p = 0.226)). However, neither the algometric score (AS) nor tender point count (TPC) showed an insignificant difference (AS: MD, −0.43, 95%CI, −2.60 to 1.74, p = 0.700; (I² = 0.0%, p = 0.654); TPC: MD, −0.16, 95%CI, −2.22 to 1.89, p = 0.520; (I² = 0.0%, p = 0.515)). Regarding HRQOL, Pilates showed statistically significant improvements on the Fibromyalgia Impact Questionnaire (FIQ) (MD, −7.28, 95%CI, (−12.06 to −2.49), p = 0.003; (I² = 95.7%, p < 0.001)). A sensitivity analysis of three RCTs (n = 176) based on the ACR 2010 supported this finding (MD, −7.68, 95% CI, −8.60 to −6.76, p < 0.001; (I² = 0.0%, p = 0.832)) with non-important heterogeneity. Conclusions: Pilates may benefit FMPs. It could reduce pain and improve HRQOL. Given the small number of studies and the presence of data heterogeneity, future high-quality RCTs would provide a clearer conclusion. Full article

Background: For patients undergoing abdominal surgery, postoperative pulmonary complications (PPCs) are a major source of morbidity and mortality. The use of point-of-care ultrasonography (POCUS), and specifically POCUS of the lungs, has seen many advancements in recent years. Objectives: We hypothesize that perioperative lung ultrasonography can be used as a predictor for PPCs. Methods: In a Single, 1000 beds, trauma level I medical center, patients presenting for elective intra-abdominal surgery with no severe pulmonary or cardiac diseases were evaluated preoperatively with a standardized 12-point lung ultrasound exam. A second identical exam was performed after surgery in the post-anesthesia care unit. PPCs were also documented. All lung ultrasound exams were presented to a blinded researcher and a lung ultrasound score (LUS) was calculated. Statistical analysis comparing pre- and postoperative LUS and PPC scores were performed. Results: A total of 61 patients were evaluated. The pre-surgery median LUS was 0 (in the range of 0–6) and the post-surgery median LUS was 3 (in the range of 0–14). The pre- to postsurgical LUS delta was 3.4 (standard deviation of 3.3). A postoperative LUS of 6 or more was defined as “high.” A High LUS did not correlate with prolonged post-anesthesia care unit or hospital stay, prolonged oxygen support, or number of desaturation events. Conclusion: For elective abdominal surgery in relatively healthy patients, preoperative LUS usually begins at a normal level and becomes worse after general anesthesia. However, this difference in LUS is not significantly associated with clinically relevant postoperative pulmonary complications such as prolonged oxygen therapy, pneumonia, and noninvasive or invasive mechanical ventilation. Trial registration: Clinicaltrials.gov identifier: NCT05502926. Summary: This paper explores the use of point-of-care ultrasonography as a predictor for postoperative pulmonary complications. The findings suggest that while the lung ultrasound score worsens with general anesthesia, the differences are not significantly associated with postoperative pulmonary complications. Full article

Background/Objectives: The COVID-19 pandemic reduced in-person pediatric visits in the United States by over 50%, while telehealth visits increased significantly. The national use of telehealth for children and the factors influencing their use have been rarely studied. This study aimed to investigate the prevalence of telehealth use during the COVID-19 pandemic and explore the potential factors linked to its use at the state level. Methods: A cross-sectional study of the National Survey of Children’s Health (2021–22) sponsored by the federal Maternal and Child Health Bureau was performed. We used the least absolute shrinkage and selection operator (LASSO) regression to predict telehealth use during the pandemic. A bar map showing the significant factors from the multivariable regression was created. Results: Of the 101,136 children, 15.25% reported using telehealth visits due to COVID-19, and 3.67% reported using telehealth visits due to other health reasons. The Northeast states showed the highest telehealth use due to COVID-19. In the Midwest and Southern states, children had a lower prevalence of telehealth visits due to other health reasons. The LASSO regressions demonstrated that telehealth visits were associated with age, insurance type, household income, usual source of pediatric preventive care, perceived child health, blood disorders, allergy, brain injury, seizure, ADHD, anxiety, depression, and special needs. Conclusions: This study demonstrated significant variability in the use of telehealth among states during the COVID-19 pandemic. Understanding who uses telehealth and why, as well as identifying access barriers, helps maximize telehealth potential and improve healthcare outcomes for all. Full article

Background: Antimicrobial consumption (AMC) data in Latin America are scarce and usually spread out across different sources used to make AMC calculations, making it difficult to both standardize and compare regions through similar time frames. The main objective was to analyze AMC trends in Social Security tertiary care hospitals in Costa Rica in the period spanning January 2017 to December 2021, using both the defined daily dose (DDD)/100 bed days and DDD/100 discharges. Methods: This is a retrospective observational study of antimicrobial consumption. Global consumption trends were calculated and expressed as DDD/100 bed days and DDD/100 discharges. Trends in antimicrobial consumption were analyzed using a simple linear regression model to determine potential differences in antimicrobial usage throughout the study’s duration. Results: A statistically significant increase in the consumption expressed in DDD/100 discharges was observed in the following groups: carbapenems, 7.6% (trend: 64.68, p < 0.0001), trimethoprim-sulfamethoxazole: 12.6% (trend: 16.45, p < 0.0001), quinolones 9.4% (trend: 36.80, p = 0.02), vancomycin 2.0% (trend: 16.30, p = 0.03), echinocandins: 6.0% (trend: 15.17, p = 0.01) and azole antifungals: 12.10% (trend: 102.05, p < 0.0001). Additionally, a statistically significant increase of 10.30% in the consumption of azole antifungals expressed in DDD/100 bed days was observed (p = 0.0008). In contrast, a statistically significant decrease in consumption, expressed in DDD/100 discharges, was identified for cephalosporins −6.0% (p < 0.0001) and macrolides −16.5% (p < 0.0001). Macrolides also showed a downward trend in consumption, as expressed in DDD/100 bed days (−14.3%, p < 0.0001). According to World Health Organization (WHO) access, watch and reserve (AWaRe) classification trend analysis, only the reserve group showed a statistically significant upward change of 9.2% (p = 0.016). Conclusions: This five-year analysis demonstrated trends over time in overall antimicrobial consumption measured in DDD/100 bed days and DDD/100 discharge rates that correlate. In general, for all antimicrobials, after the implementation of antimicrobial stewardship programs (ASP), a downward trend is reported; in contrast, during the COVID-19 pandemic the AMC shows a general upward trend. The comparison between DDD/100 bed days and DDD/100 discharges allows for complementary comparisons to be made regarding antimicrobial exposure in a clinical setting. Full article

The current research, guided by the intersectionality theory and the Institute of Medicine’s healthcare access model, explored the determinants of preventive care utilization within the Asian American community. Analyzing data from the Asian American Quality of Life Survey (with a sample size of 2535), logistic regression models were employed, incorporating various factors: demographic variables, immigration-related variables, health and access, and patient–provider relationship. Results revealed that longer stays in the U.S., having health insurance coverage, having a usual source of care, and higher satisfaction levels with prior healthcare services were associated with increased odds of utilizing preventive healthcare. These findings contribute to our comprehension of preventive care utilization among Asian Americans and offer practical insights for targeted interventions in social work and public health and strategic healthcare planning. Full article

Objective: The primary objectives of this study are to assess the cost-effectiveness of early postnatal screening and prenatal psychological interventions for the prevention and treatment of postpartum depression (PPD) among Chinese pregnant women. Additionally, we aim to explore the most cost-effective prevention and treatment strategies for PPD in China. Methods: We used TreeAge 2019 to construct a decision tree model, with the model assuming a simulated queue size of 10,000 people. The model employed Monte Carlo simulation to assess the cost-effectiveness of PPD prevention and treatment strategies. Transfer probabilities were derived from published studies and meta-analyses. Cost and effectiveness data were obtained from published sources and relevant studies. Incremental cost-effectiveness ratios (ICERs) were used to describe the results, with willingness-to-pay (WTP) thresholds set at China’s gross domestic product (GDP) per capita. Results: Compared to the usual care group, the cost per additional quality-adjusted life year (QALY) for the early postnatal screening group and the prenatal psychological interventions is USD 6840.28 and USD 3720.74, respectively. The cure rate of mixed treatments for PPD has the greatest impact on the model, while patient participation in treatment has a minor impact on the cost-effectiveness of prevention and treatment strategies. Conclusion: Both early postnatal screening and prenatal psychological interventions are found to be highly cost-effective strategies for preventing and treating PPD in China. Prenatal psychological interventions for pregnant women are the most cost-effective prevention and treatment strategy. As such, from the perspective of national payers, we recommend that maternal screening for PPD be implemented in China to identify high-risk groups early on and to facilitate effective intervention. Full article

Health checks have beneficial effects on health outcomes in adults with intellectual disability; however, little is known about their effect on people with Down syndrome. The aim of this study was to assess the effect of receiving a health check on the unmet health needs of people with Down syndrome. A pooled analysis of three randomized trials conducted by the same Australian research team was undertaken. The trials used the same tools but differed by participant source (adults in 24 h supported accommodation, adults in private dwellings, adolescents living with parents). The intervention was a one-off health check, and the comparator was usual care. Among 216 participants, health actions were more likely to occur for those allocated to receive health checks, including increased hearing (odds ratio = 4.4; 95% confidence interval: 1.2, 16.4), vision (2.7; 1.1, 6.7), and thyroid (2.3; 1.3, 4.2) testing, and weight recording (4.7; 2.5, 8.8). Health checks conducted at the primary-care level produced substantially increased attention to the health needs of people with Down syndrome. Full article

Quick and effective point-of-care (POC) devices have the chance to revolutionize healthcare in developed and developing countries since they can operate anywhere the patient is, with the possibility of obtaining and sending the results to the doctor without delay. In recent years, significant efforts have focused on developing new POC systems that can screen for biomarkers continuously and non-invasively in body fluids to prevent, diagnose, and manage diseases. However, one of the critical challenges left to address is how to power them effectively and sufficiently. In developing countries and rural and remote areas, where there are usually no well-established electricity grids or nearby medical facilities, and using batteries is unreliable or not cost-effective, alternative power sources are the most challenging issue for stand-alone and self-sustained POC devices. Here, we provide an overview of the techniques for used self-powering POC devices, where the sample is used to detect and simultaneously generate energy to power the system. Likewise, this paper introduced the state-of-the-art with a review of different research projects, patents, and commercial products for self-powered POCs from the mid-2010s until present day. Full article

Because subjective cognitive decline (SCD) manifests before the clinical and irreversible onset of dementia, efforts to address SCD are imperative for the early identification and prevention of dementia. For people who actually experience SCD, having a usual source of care may be an important catalyst for addressing memory issues. This study investigates the relationship between having a usual source of care and the discussion of SCD with healthcare providers, while taking into account racial and ethnic differences. The pooled 2019–2020 Behavioral Risk Factor Surveillance System (BRFSS) from 47 states in the U.S. was used. The sample included 7900 individuals aged 50 and older who reported significant cognitive decline. Using logistic regression with state-level clustering, we found that those with a usual source of healthcare were almost twice as more likely to discuss memory loss with a healthcare provider. In order to test for the multiplicative effects, we included an interaction term between each race category and having a primary care provider (PCP). There was a significant interaction effect between Hispanic ethnicity and having a PCP (OR = 0.25, p < 0.05). While non-Hispanic respondents who had a PCP had a higher probability of discussing memory issues with a healthcare provider (42% vs. 25%), Hispanic respondents with a PCP were less likely to discuss their memory loss with a healthcare provider (36% vs. 49%). The study adds to the growing literature on the vital role of the primary care service in provision of service to those with cognitive decline, while revealing ethnic disparity in memory-loss-related communication with healthcare providers in a primary care setting. Full article

The occurrence of micropollutants, including pharmaceuticals, personal care products, pesticides, and hormones in various aquatic ecosystems is a matter of grave concern due to their possible repercussions on human and wildlife endocrine systems. The wastewater containing pharmaceuticals from various sites is usually introduced to sewage treatment plants (STPs); therefore, monitoring of pharmaceuticals in STPs is crucial. In this study, we determined the occurrence of 58 pharmaceuticals in the influent and effluent of 13 STPs based on regional and linked wastewater differences and investigated their removal rates. Furthermore, we assessed the contribution rates of some STP effluents on pharmaceutical concentration in the upstream and downstream areas of the discharge source. Different kinds of pharmaceuticals were measured in the STPs. The top five pharmaceuticals with high concentrations in the influent of each STP were similar due to the dominance of domestic sewage in the influent. The average concentration of acetaminophen, caffeine, acetylsalicylic acid, naproxen, and ibuprofen in the influent of the STPs was higher than that of other pharmaceuticals, and their removal was 94–100%. In contrast, iopamidol, cimetidine, diphenhydramine, and carbamazepine showed a high average concentration in the effluent. The monitoring results of nine streams near STPs indicated that the effluent could contribute to the increase in the types of pharmaceuticals in the receiving streams. The detected pharmaceuticals’ types were 9–29 and 17–33 in the upstream and downstream areas, respectively, of STP discharge channels. Based on flowrate data, the contribution rate of the STP effluent on the stream was −69–326%. Full article

Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on patients and their behaviors. Objective: To investigate the socio-demographic, educational, and occupational characteristics and work-related attitudes that may serve as predictors of defensive medicine among Italian psychiatrists. This research extends the results of a previous analysis based on a national survey. Methods: A secondary analysis of the database of a national survey on attitudes and behaviors of Italian psychiatrists regarding defensive medicine and professional liability was performed for this study. Results: Among 254 surveyed psychiatrists, 153 admitted to practicing defensive medicine, while 101 had this attitude with less than half of their patients. The first group was predominantly comprised of women (p = 0.014), who were younger in age (43.34 y 9.89 vs. 48.81 y 11.66, p < 0.001) and had fewer years of professional experience (12.09 y ± 9.8 vs. 17.46 y ± 11.2, p < 0.001). There were no significant differences in prior involvement in complaints (p = 0.876) or the usual place of work (p = 0.818). The most prominent predictors for practicing defensive medicine were (1) considering guidelines and good clinical practices not only for their clinical efficacy but also or exclusively for reducing the risk of legal complaints for professional liability (OR = 3.62; 95%CI, 1.75–7.49), and (2) hospitalizing patients with violent intentions even if not warranted according to their mental state (OR = 2.28; 95%CI, 1.50–3.46, p < 0.001). Prioritizing protection from professional liability over patients’ actual needs in prescribing or adjusting drug dosages and in involuntary hospitalization, as well as prescribing lower dosages than recommended for pregnant patients, were identified as additional predictors. Finally, years of professional experience exhibited a protective function against defensive practices. Conclusions: Psychiatrists advocate the need to implement a ‘risk management culture’ and the provision of more balanced duties in order to ensure ethical and evidence-based care to their patients. A particular source of concern stems from their professional responsibility towards not only the health of patients but also their behavior. However, these aspects conflict with a limited potential for assessment and intervention based on effective clinical tools. A reform of professional liability that considers the specificities of patients cared for by mental health services could contribute to reducing the risk of defensive medicine. Full article