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Stevenson JC, Ren M, Kahler E, Custodio MG, Nappi RE, Tatarchuk T, Simoncini T, Karpova V, Yu Q. Ultra-low dose estradiol and dydrogesterone for the treatment of menopausal symptoms in a pooled, multi-ethnic population. Maturitas 2024; 190:108117. [PMID: 39317030 DOI: 10.1016/j.maturitas.2024.108117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 08/29/2024] [Accepted: 09/16/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVES Evidence suggests ethnicity-specific differences in postmenopausal symptoms, highlighting the need for therapies that are efficacious across different ethnicities. We evaluated the efficacy of an ultra-low dose combination of 0.5 mg estradiol and 0.25 mg dydrogesterone (E 0.5 mg/D 2.5 mg) in alleviating vasomotor symptoms across a multi-ethnic population. STUDY DESIGN Data from two controlled trials were pooled to form a dataset of 583 postmenopausal women from across Europe and China. Participants were randomized to receive treatment with E 0.5 mg/D 2.5 mg or placebo for 12 weeks. MAIN OUTCOME MEASURES The main efficacy variable was absolute change in the number of hot flushes from baseline to end of treatment. Health-related quality of life and safety were also assessed. RESULTS Change in the number of hot flushes per day was greater with E 0.5 mg/D 2.5 mg versus placebo (mean difference - 1.5, 95 % confidence interval - 2.1, -1.0; p < 0.001). Participants treated with E 0.5 mg/D 2.5 mg reported improvement in health-related quality of life (including psychological symptoms, vaginal dryness), and high amenorrhea rates. Combined E 0.5 mg/D 2.5 mg was well tolerated: there were no differences between groups in the percentage of participants with at least one serious adverse event or treatment-emergent serious adverse events. Analysis of change in body weight indicated no differences between groups. CONCLUSIONS This pooled analysis demonstrates the consistent efficacy of E 0.5 mg/D 2.5 mg in the treatment of menopause-related symptoms across a multi-ethnic population of postmenopausal women.
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Affiliation(s)
- John C Stevenson
- Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London SW3 6NP, UK
| | - Mulan Ren
- Department of Obstetrics and Gynecology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Elke Kahler
- Global Biometrics, Established Pharmaceuticals Division, Abbott Laboratories GmbH, Hannover 30173, Germany
| | - Marcelo Graziano Custodio
- Global Innovation and Development, Established Pharmaceuticals Division, Abbott Products Operations AG, Basel 4123, Switzerland.
| | - Rossella Elena Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Research Center for Reproductive Medicine and Gynecological Endocrinology - Menopause Unit, IRCCS S Matteo Foundation, Pavia 27100, Italy
| | - Tetiana Tatarchuk
- Department of Endocrine Gynecology, National Institute of Pediatrics, Obstetrics and Gynecology of National Academy of Medical Science of Ukraine, Kyiv 04050, Ukraine
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - Viktoriya Karpova
- Established Pharmaceuticals Division, Abbott Ukraine LLC, Kyiv 01010, Ukraine
| | - Qi Yu
- Gynecological Endocrinology and Reproduction Center, Peking Union Medical College Hospital, Beijing 100032, China
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Dubbelman MA, Vromen EM, Tijms BM, Berkhof J, Ottenhoff L, Vijverberg EGB, Prins ND, van der Flier WM, Sikkes SAM. Pooling Alzheimer's disease clinical trial data to develop personalized medicine approaches is easier said than done: A proof-of-principle study and call to action. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12485. [PMID: 39114370 PMCID: PMC11303826 DOI: 10.1002/trc2.12485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/13/2024] [Accepted: 04/16/2024] [Indexed: 08/10/2024]
Abstract
With the advent of the first generation of disease-modifying treatments for Alzheimer's disease, it is clearer now more than ever that the field needs to move toward personalized medicine. Pooling data from past trials may help identify subgroups most likely to benefit from specific treatments and thus inform future trial design. In this perspective, we report on our effort to pool data from past Alzheimer's disease trials to identify patients most likely to respond to different treatments. We delineate challenges and hurdles, from our proof-of-principle study, for which we requested access to trial datasets from various pharmaceutical companies and encountered obstacles in the process of arranging data-sharing agreements through legal departments. Six phase I-III trials from three sponsors provided access to their data (total n = 3170), which included demographic information, vital signs, primary and secondary endpoints, and in a small subset, cerebrospinal fluid amyloid (n = 165, 5.2%) and tau (n = 212, 6.7%). Data could be analyzed only within specific data access platforms, limiting potential harmonization with data provided through other platforms. Limited overlap in terms of outcome measures, clinical and biological information hindered analyses. Thus, while it is a commendable advancement that (some) trials now allow researchers to study their data, we conclude that gaining access to past trial datasets is complicated, frustrating the field's communal effort to find the best treatments for the right individuals. We provide a plea to promote harmonization and open access to data, by urging trial sponsors and the academic research community alike to remove barriers to data access and improve collaboration through practicing open science and harmonizing outcome measures, to allow investigators to learn all there is to learn from past failures and successes. HIGHLIGHTS Pooling data from past Alzheimer's disease clinical trials may help identify subgroups most likely to benefit from specific treatments and may help inform future trial design.Accessing past trial datasets is complicated, frustrating the field's communal effort to find the best treatments for the right individuals.We urge trial sponsors and the academic research community to remove data access barriers and improve collaboration through practicing open science and harmonizing outcome measures.
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Affiliation(s)
- Mark A. Dubbelman
- Alzheimer Center AmsterdamDepartment of Neurology, Vrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
- Center for Alzheimer Research and TreatmentDepartment of NeurologyBrigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Eleonora M. Vromen
- Alzheimer Center AmsterdamDepartment of Neurology, Vrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Betty M. Tijms
- Alzheimer Center AmsterdamDepartment of Neurology, Vrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Johannes Berkhof
- Department of Epidemiology & Data ScienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Lois Ottenhoff
- Alzheimer Center AmsterdamDepartment of Neurology, Vrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
- Brain Research CenterAmsterdamThe Netherlands
| | - Everard G. B. Vijverberg
- Alzheimer Center AmsterdamDepartment of Neurology, Vrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | | | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamDepartment of Neurology, Vrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
- Department of Epidemiology & Data ScienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Sietske A. M. Sikkes
- Alzheimer Center AmsterdamDepartment of Neurology, Vrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
- Department of ClinicalNeuro and Developmental PsychologyFaculty of Behavioral and Movement SciencesVU UniversityAmsterdamThe Netherlands
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Bullard BM, Brown CL, Scheffer JA, Toledo AB, Levenson RW. Emotion Regulation Strategies and Mental Health in Dementia Caregivers: The Moderating Role of Gender. Dement Geriatr Cogn Disord 2024; 53:128-134. [PMID: 38537622 PMCID: PMC11187655 DOI: 10.1159/000538398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/13/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Providing care for a loved one with dementia can engender intense emotions that contribute to symptoms of anxiety and depression. Caregivers often attempt to regulate their emotions using strategies like cognitive reappraisal (CR; changing how they think about the situation) or expressive suppression (ES; hiding their emotions). However, men and women caregivers may differ in their use of these strategies. The current study examines gender differences in reported CR and ES usage and their associations with depression and anxiety in dementia caregivers. METHODS We combined data from three independent studies of informal dementia caregivers (total N = 460) who reported on their use of CR, ES, and symptoms of anxiety and depression. RESULTS Women caregivers reported greater use of CR and less use of ES compared to men. Gender moderated the association between CR and depression, such that greater use of CR in women was associated with fewer depressive symptoms, but not for men. Gender did not significantly moderate the association between ES and depression, or between either emotion regulation strategy and anxiety. CONCLUSION Findings of a unique relationship between greater CR use and less depression among women CGs, although correlational, suggest that utilizing CR may be particularly helpful for reducing depression in women caregivers. These results underscore the need for further research to determine how best to support the mental well-being of dementia caregivers.
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Affiliation(s)
- Breanna M. Bullard
- Department of Psychology and the Institute of Personality and Social Research, University of California, Berkeley, CA, USA
| | - Casey L. Brown
- Department of Psychology and the Interdisciplinary Program in Neuroscience, Georgetown University, Washington, D.C., USA
| | - Julian A. Scheffer
- Department of Psychology and the Institute of Personality and Social Research, University of California, Berkeley, CA, USA
| | - Anna B. Toledo
- Department of Psychology and the Interdisciplinary Program in Neuroscience, Georgetown University, Washington, D.C., USA
| | - Robert W. Levenson
- Department of Psychology and the Institute of Personality and Social Research, University of California, Berkeley, CA, USA
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Malik J, Kumar L. Comment on "Revisiting beta-blocker therapy in heart failure with preserved ejection fraction". Curr Probl Cardiol 2024; 49:102203. [PMID: 37967802 DOI: 10.1016/j.cpcardiol.2023.102203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/11/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Javeria Malik
- Dow Medical College, Dow University of Health Sciences, Mission Rd, Nanak Wara Nanakwara, Karachi, Pakistan
| | - Laksh Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Karachi, Karachi 75010, Pakistan.
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Agarwal CD, Palka JM, Gajewski AJ, Khan DA, Brown ES. The efficacy of citalopram or escitalopram in patients with asthma and major depressive disorder. Ann Allergy Asthma Immunol 2024; 132:374-382. [PMID: 37952772 DOI: 10.1016/j.anai.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Major depressive disorder is common in people with asthma. Yet, few studies have evaluated depression treatment in those with asthma. OBJECTIVE To explore the relationship between antidepressant use, depressive symptoms, and asthma control, pooled data from 3 randomized trials of either citalopram or escitalopram were assessed. METHODS Linear fixed effects and binary logistic regression analyses were conducted with between-subject covariates including treatment group, (original) study, and demographics. The within-subject effect of visit, and a treatment group-visit (between-within) interaction effect, were also evaluated. Analyses were repeated in a high asthma exacerbation subgroup having at least 3 oral corticosteroid bursts in the previous 12 months. Outcomes included the Hamilton rating scale for depression (HAM-D17), the 7-item asthma control questionnaire (ACQ), and oral corticosteroid use (yes or no). RESULTS In the pooled sample (n = 255), the antidepressant treatment group exhibited lower HAM-D17 overall (P ≤ .001) and a lower likelihood for oral corticosteroid use (P ≤ .001) relative to the placebo group. In the high-exacerbation subgroup (n = 96), treatment group participants had lower overall asthma control questionnaire (P = .004) and HAM-D17 scores (P ≤ .001), and a lower likelihood of oral corticosteroid use (P = .003), relative to placebo participants. All treatment group interaction effects were not significant. CONCLUSION Citalopram or escitalopram exhibited efficacy in reducing depressive symptoms and the need for rescue oral corticosteroids in patients with asthma and major depressive disorder. Future work should determine whether selective serotonin reuptake inhibitors are effective at improving asthma outcomes in those with asthma who are not depressed. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT00621946 and NCT01324700 (one study was conducted before ClinicalTrials.gov requirements).
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Affiliation(s)
- Catherine D Agarwal
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jayme M Palka
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alexander J Gajewski
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas; The Altshuler Center for Education and Research, Metrocare Services, Dallas, Texas.
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Anderson MR, Shashaty MGS. Metabolic Syndrome and Acute Respiratory Distress Syndrome Outcomes: A Most Ingenious Paradox or a Devil in the Details? Crit Care Med 2024; 52:502-505. [PMID: 38381011 PMCID: PMC11213551 DOI: 10.1097/ccm.0000000000006168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Michaela R Anderson
- Both authors: Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Frankot MA, Young ME, Vonder Haar C. Understanding Individual Subject Differences through Large Behavioral Datasets: Analytical and Statistical Considerations. Perspect Behav Sci 2024; 47:225-250. [PMID: 38660505 PMCID: PMC11035513 DOI: 10.1007/s40614-023-00388-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 04/26/2024] Open
Abstract
A core feature of behavior analysis is the single-subject design, in which each subject serves as its own control. This approach is powerful for identifying manipulations that are causal to behavioral changes but often fails to account for individual differences, particularly when coupled with a small sample size. It is more common for other subfields of psychology to use larger-N approaches; however, these designs also often fail to account for the individual by focusing on aggregate-level data only. Moving forward, it is important to study individual differences to identify subgroups of the population that may respond differently to interventions and to improve the generalizability and reproducibility of behavioral science. We propose that large-N datasets should be used in behavior analysis to better understand individual subject variability. First, we describe how individual differences have been historically treated and then outline practical reasons to study individual subject variability. Then, we describe various methods for analyzing large-N datasets while accounting for the individual, including correlational analyses, machine learning, mixed-effects models, clustering, and simulation. We provide relevant examples of these techniques from published behavioral literature and from a publicly available dataset compiled from five different rat experiments, which illustrates both group-level effects and heterogeneity across individual subjects. We encourage other behavior analysts to make use of the substantial advancements in online data sharing to compile large-N datasets and use statistical approaches to explore individual differences.
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Affiliation(s)
- Michelle A. Frankot
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV USA
- Injury and Recovery Laboratory, Department of Neuroscience, Ohio State University, 460 West 12th Avenue, Columbus, OH 43210 USA
| | - Michael E. Young
- Department of Psychological Sciences, Kansas State University, Manhattan, KS USA
| | - Cole Vonder Haar
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV USA
- Injury and Recovery Laboratory, Department of Neuroscience, Ohio State University, 460 West 12th Avenue, Columbus, OH 43210 USA
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Backenroth D, Royce T, Pinheiro J, Samant M, Humblet O. Considerations for pooling real-world data as a comparator cohort to a single arm trial: a simulation study on assessment of heterogeneity. BMC Med Res Methodol 2023; 23:193. [PMID: 37620758 PMCID: PMC10464044 DOI: 10.1186/s12874-023-02002-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Novel precision medicine therapeutics target increasingly granular, genomically-defined populations. Rare sub-groups make it challenging to study within a clinical trial or single real-world data (RWD) source; therefore, pooling from disparate sources of RWD may be required for feasibility. Heterogeneity assessment for pooled data is particularly complex when contrasting a pooled real-world comparator cohort (rwCC) with a single-arm clinical trial (SAT), because the individual comparisons are not independent as all compare a rwCC to the same SAT. Our objective was to develop a methodological framework for pooling RWD focused on the rwCC use case, and simulate novel approaches of heterogeneity assessment, especially for small datasets. METHODS We present a framework with the following steps: pre-specification, assessment of dataset eligibility, and outcome analyses (including assessment of outcome heterogeneity). We then simulated heterogeneity assessments for a binary response outcome in a SAT compared to two rwCCs, using standard methods for meta-analysis, and an Adjusted Cochran's Q test, and directly comparing the individual participant data (IPD) from the rwCCs. RESULTS We found identical power to detect a true difference for the adjusted Cochran's Q test and the IPD method, with both approaches superior to a standard Cochran's Q test. When assessing the impact of heterogeneity in the null scenario of no difference between the SAT and rwCCs, a lack of statistical power led to Type 1 error inflation. Similarly, in the alternative scenario of a true difference between SAT and rwCCs, we found substantial Type 2 error, with underpowered heterogeneity testing leading to underestimation of the treatment effect. CONCLUSIONS We developed a methodological framework for pooling RWD sources in the context of designing a rwCC for a SAT. When testing for heterogeneity during this process, the adjusted Cochran's Q test matches the statistical power of IPD heterogeneity testing. Limitations of quantitative heterogeneity testing in protecting against Type 1 or Type 2 error indicate these tests are best used descriptively, and after careful selection of datasets based on clinical/data considerations. We hope these findings will facilitate the rigorous pooling of RWD to unlock insights to benefit oncology patients.
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Affiliation(s)
| | - Trevor Royce
- Flatiron Health, Inc, 233 Spring Street, New York, NY, 10013, USA
| | | | - Meghna Samant
- Flatiron Health, Inc, 233 Spring Street, New York, NY, 10013, USA
| | - Olivier Humblet
- Flatiron Health, Inc, 233 Spring Street, New York, NY, 10013, USA.
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Leonardi A, Doan S, Aragona P, Amrane M, Ismail D, Montero J, Németh J, Bremond-Gignac D. Topical cyclosporine A cationic ophthalmic emulsion in paediatric vernal keratoconjunctivitis: pooled analysis of randomised NOVATIVE and VEKTIS trials. Eye (Lond) 2023; 37:2320-2326. [PMID: 36564576 PMCID: PMC10366270 DOI: 10.1038/s41433-022-02342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/28/2022] [Accepted: 11/30/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/OBJECTIVES Cyclosporine A cationic ophthalmic emulsion (CsA CE) was evaluated in paediatric and adolescent patients with vernal keratoconjunctivitis (VKC) in the NOVATIVE (NCT00328653) and VEKTIS (NCT01751126) trials. The similarity of these studies permitted pooled assessment of the effect of CsA CE on corneal damage as well as safety and tolerability. SUBJECTS/METHODS Pooled outcomes were assessed for the first 28 days of treatment. In NOVATIVE, 118 patients were randomised to 4 times daily (QID) CsA CE 0.05%, 0.1%, or vehicle eye drops. In VEKTIS, 169 patients were randomised to CsA CE 0.1% QID or twice daily (BID) or vehicle. For these analyses, treatment groups comprised: (1) pooled CsA CE 0.1% QID arms (high-dose; n = 96); (2) pooled CsA CE 0.05% QID arm from NOVATIVE and CsA CE 0.1% BID data from VEKTIS (low-dose; n = 93); and (3) pooled vehicle QID arms (vehicle; n = 98). RESULTS Changes from baseline to day 28 (mean ± standard deviation) in corneal fluorescein staining (CFS) scores for CsA CE high-dose, low-dose, and vehicle groups were -1.6 ± 1.47 (95% CI: -0.9, -0.1; p = 0.0124 vs vehicle), -1.7 ± 1.39 (95% CI: -1.1, -0.3; p = 0.0015 vs vehicle), and -1.0 ± 1.55, respectively. Adverse events (AEs) of any type were reported in 37.5%, 34.4%, and 37.8% of the high-dose, low-dose, and vehicle groups, respectively. Most were mild or moderate in severity. CONCLUSIONS CsA CE significantly decreased corneal damage and was safe and well tolerated in patients with VKC. These data support CSA CE as a treatment option for the management of VKC.
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Affiliation(s)
- Andrea Leonardi
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy.
| | - Serge Doan
- Bichat Hospital and Foundation A. de Rothschild, Paris, France
| | - Pasquale Aragona
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | | | | | | | - János Németh
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Dominique Bremond-Gignac
- Department of Ophthalmology, University Hospital Necker Enfants Malades, APHP, Paris, France
- INSERM Unit 1138, T17 Paris Cité University, Paris, France
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Ogdie A, Gladman DD, Coates LC, Pournara E, Parikh B, Mease PJ. Inhibition of Interleukin-17 in Patients with Oligoarticular Psoriatic Arthritis. Rheumatol Ther 2023; 10:849-860. [PMID: 37148474 PMCID: PMC10326182 DOI: 10.1007/s40744-023-00548-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/28/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION This study evaluated the efficacy of the interleukin-17A inhibitor secukinumab in patients with oligoarticular psoriatic arthritis (PsA). METHODS A total of 84 patients with oligoarticular PsA, defined as 1-4 tender joints and 1-4 swollen joints, were pooled from the FUTURE 2-5 and MAXIMISE trials (NCT01752634, NCT01989468, NCT02294227, NCT02404350, and NCT02721966). Patients were grouped by treatment received at week 12 (secukinumab 300 mg, secukinumab 150 mg, or placebo) and week 52 (any secukinumab 300 mg or any secukinumab 150 mg). Efficacy was assessed by the proportion of patients achieving selected clinical outcomes. The predictors of Disease Activity index for Psoriatic Arthritis (DAPSA) responses at weeks 12 and 52 were identified by logistic regression analysis. RESULTS Secukinumab treatment resulted in greater achievement of DAPSA-based low disease activity (LDA), DAPSA-based remission (REM), DAPSA50, and DAPSA75 than placebo at week 12, with improvements sustained or further increased through week 52. LDA or REM was achieved at week 52 by more than 90% of patients who received either secukinumab dose, although secukinumab 300 mg resulted in the highest achievement of the stringent DAPSA75 and DAPSA REM outcomes. At week 12, younger age was associated with DAPSA LDA or REM and DAPSA50, while lower baseline swollen joint count was associated with DAPSA REM. No predictors were identified at week 52. The safety profile was consistent with the full study populations. CONCLUSION Secukinumab demonstrated efficacy vs placebo across several outcome measures in patients with oligoarticular PsA at week 12, with sustained or improved responses through week 52.
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Affiliation(s)
- Alexis Ogdie
- Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 White Building, Philadelphia, PA, 19104, USA.
| | - Dafna D Gladman
- Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Bhumik Parikh
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, USA
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Harris HR, Peres LC, Johnson CE, Guertin KA, Beeghly A, Bandera EV, Bethea TN, Joslin CE, Wu AH, Moorman PG, Ochs-Balcom HM, Petrick JL, Setiawan VW, Rosenberg L, Schildkraut JM, Myers E. Racial Differences in the Association of Endometriosis and Uterine Leiomyomas With the Risk of Ovarian Cancer. Obstet Gynecol 2023; 141:1124-1138. [PMID: 37159277 PMCID: PMC10440275 DOI: 10.1097/aog.0000000000005191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/02/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To evaluate associations between endometriosis and uterine leiomyomas with ovarian cancer risk by race and the effect of hysterectomy on these associations. METHODS We used data from four case-control studies and two case-control studies nested within prospective cohorts in the OCWAA (Ovarian Cancer in Women of African Ancestry) consortium. The study population included 3,124 Black participants and 5,458 White participants, of whom 1,008 Black participants and 2,237 White participants had ovarian cancer. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs for the associations of endometriosis and leiomyomas with ovarian cancer risk, by race, stratified by histotype and hysterectomy. RESULTS The prevalences of endometriosis and leiomyomas were 6.4% and 43.2% among Black participants and 7.0% and 21.5% among White participants, respectively. Endometriosis was associated with an increased risk of endometrioid and clear-cell ovarian cancer in both racial groups (eg, OR for endometrioid tumors for Black and White participants 7.06 [95% CI 3.86-12.91] and 2.17 [95% CI 1.36-3.45], respectively, Phetereogeneity =.003). The association between endometriosis and ovarian cancer risk in White participants was stronger in those without hysterectomy, but no difference was observed in Black participants (all Pinteraction ≥.05). Leiomyomas were associated with an elevated risk of ovarian cancer only in those without hysterectomy in both Black (OR 1.34, 95% CI 1.11-1.62) and White (OR 1.22, 95% CI 1.05-1.41) participants (all Pinteraction ≥.05). CONCLUSIONS Black and White participants with endometriosis had a higher risk of ovarian cancer, and hysterectomy modified this association among White participants. Leiomyomas were associated with an increased risk of ovarian cancer in both racial groups, with hysterectomy modifying the risk in both groups. Understanding how racial differences in access to care and treatment options (eg, hysterectomy) may help guide future risk reduction strategies.
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Affiliation(s)
- Holly R. Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Lauren C. Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Courtney E. Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristin A. Guertin
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Alicia Beeghly
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Traci N. Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Campus, Washington, DC, USA
| | - Charlotte E. Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago School of Medicine, Chicago, IL, USA
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Anna H. Wu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Patricia G. Moorman
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Heather M. Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | | | - Veronica W. Setiawan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Joellen M. Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Evan Myers
- Department of Family Medicine and Community Health, Durham, NC, USA
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12
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Belohlavek J, Yannopoulos D, Smalcova J, Rob D, Bartos J, Huptych M, Kavalkova P, Kalra R, Grunau B, Taccone FS, Aufderheide TP. Intraarrest transport, extracorporeal cardiopulmonary resuscitation, and early invasive management in refractory out-of-hospital cardiac arrest: an individual patient data pooled analysis of two randomised trials. EClinicalMedicine 2023; 59:101988. [PMID: 37197707 PMCID: PMC10184044 DOI: 10.1016/j.eclinm.2023.101988] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023] Open
Abstract
Background Refractory out-of-hospital cardiac arrest (OHCA) treated with standard advanced cardiac life support (ACLS) has poor outcomes. Transport to hospital followed by in-hospital extracorporeal cardiopulmonary resuscitation (ECPR) initiation may improve outcomes. We performed a pooled individual patient data analysis of two randomised controlled trials evaluating ECPR based approach in OHCA. Methods The individual patient data from two published randomised controlled trials (RCTs) were pooled: ARREST (enrolled Aug 2019-June 2020; NCT03880565) and PRAGUE-OHCA (enrolled March 1, 2013-Oct 25, 2020; NCT01511666). Both trials enrolled patients with refractory OHCA and compared: intra-arrest transport with in-hospital ECPR initiation (invasive approach) versus continued standard ACLS. The primary outcome was 180-day survival with favourable neurological outcome (defined as Cerebral Performance Category 1-2). Secondary outcomes included: cumulative survival at 180 days, 30-day favourable neurological survival, and 30-day cardiac recovery. Risk of bias in each trial was assessed by two independent reviewers using the Cochrane risk-of-bias tool. Heterogeneity was assessed via Forest plots. Findings The two RCTs included 286 patients. Of those randomised to the invasive (n = 147) and standard (n = 139) groups, respectively: the median age was 57 (IQR 47-65) and 58 years (IQR 48-66), and the median duration of resuscitation was 58 (IQR 43-69) and 49 (IQR 33-71) minutes (p = 0.17). In a modified intention to treat analysis, 45 (32.4%) in the invasive and 29 (19.7%) patients in the standard arm survived to 180 days with a favourable neurological outcome [absolute difference (AD), 95% CI: 12.7%, 2.6-22.7%, p = 0.015]. Forty-seven (33.8%) and 33 (22.4%) patients survived to 180 days [HR 0.59 (0.43-0.81); log rank test p = 0.0009]. At 30 days, 44 (31.7%) and 24 (16.3%) patients had favourable neurological outcome (AD 15.4%, 5.6-25.1%, p = 0.003), 60 (43.2%), and 46 (31.3%) patients had cardiac recovery (AD: 11.9%, 0.7-23%, p = 0.05), in the invasive and standard arms, respectively. The effect was larger in patients presenting with shockable rhythms (AD 18.8%, 7.6-29.4; p = 0.01; HR 2.26 [1.23-4.15]; p = 0.009) and prolonged CPR (>45 min; HR 3.99 (1.54-10.35); p = 0.005). Interpretation In patients with refractory OHCA, the invasive approach significantly improved 30- and 180-day neurologically favourable survival. Funding None.
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Affiliation(s)
- Jan Belohlavek
- 2 Department of Medicine – Department of Cardiovascular Medicine, General University Hospital and 1 Faculty of Medicine, Charles University in Prague, Czech Republic
- Corresponding author. 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, U Nemocnice 2, Prague 2, 128 00, Czech Republic.
| | - Demetris Yannopoulos
- Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jana Smalcova
- 2 Department of Medicine – Department of Cardiovascular Medicine, General University Hospital and 1 Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Daniel Rob
- 2 Department of Medicine – Department of Cardiovascular Medicine, General University Hospital and 1 Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Jason Bartos
- Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michal Huptych
- Czech Institute of Informatics, Robotics and Cybernetics (CIIRC), Czech Technical University in Prague, Czech Republic
| | - Petra Kavalkova
- 2 Department of Medicine – Department of Cardiovascular Medicine, General University Hospital and 1 Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Rajat Kalra
- Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Brian Grunau
- Department of Emergency Medicine, St Paul’s Hospital, and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels 1070, Belgium
| | - Tom P. Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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13
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Tsai Z, Shah N, Tahir U, Mortaji N, Owais S, Perreault M, Van Lieshout RJ. Dietary interventions for perinatal depression and anxiety: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2023:S0002-9165(23)46315-0. [PMID: 37019362 DOI: 10.1016/j.ajcnut.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Dietary interventions are a widely available intervention for depression and anxiety among pregnant and/or postpartum (i.e., perinatal) persons but their effectiveness is not well known. OBJECTIVE We performed a systematic review and meta-analysis to assess the effectiveness of dietary interventions for the treatment of perinatal depression and/or anxiety. DESIGN We searched Medline, EMBASE, PsycINFO, CINAHL, and Web of Science from their inception to November 2, 2022. Studies were included if they were available in English and examined the effectiveness of a dietary intervention for perinatal depression and/or anxiety in a randomized controlled trial. RESULTS Our search identified 4,246 articles, 36 of which were included and 28 were eligible for meta-analysis. Random effects meta-analyses were performed. Polyunsaturated fatty acids (PUFAs) were not found to improve symptoms of perinatal depression compared to control conditions (SMD -0.11; 95% CI -0.26 to 0.04). These results did not change when examined during pregnancy or the postpartum period separately, nor did they vary according to fatty acid ratio. Elemental metals (iron, zinc, and magnesium) were also not found to be superior to placebo (SMD, -0.42; 95% CI, -1.05 to 0.21), though, vitamin D yielded a small to medium effect size improvements (SMD, -0.52; 95% CI, -0.84 to -0.20) in postpartum depression. Iron may help in those with confirmed iron deficiency. Narrative synthesis was performed for studies ineligible for meta-analyses. CONCLUSIONS Despite their widespread popularity, PUFAs and elemental metals do not appear to effectively reduce perinatal depression. Vitamin D taken in doses of 1800 to 3500 International Units (IU) per day may have some promise. Additional high-quality, large-scale randomized controlled trials (RCTs) are needed to determine the true effectiveness of dietary interventions on perinatal depression and/or anxiety. PROSPERO REGISTRATION DATE AND NUMBER July 5th 2020, CRD42020208830.
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Affiliation(s)
- Zoe Tsai
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Nirmay Shah
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Umair Tahir
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Neda Mortaji
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sawayra Owais
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maude Perreault
- Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Coghlan JG, Gaine S, Channick R, Chin KM, du Roure C, Gibbs JSR, Hoeper MM, Lang IM, Mathai SC, McLaughlin VV, Mitchell L, Simonneau G, Sitbon O, Tapson VF, Galiè N. Early selexipag initiation and long-term outcomes: insights from randomised controlled trials in pulmonary arterial hypertension. ERJ Open Res 2023; 9:00456-2022. [PMID: 36687361 PMCID: PMC9841313 DOI: 10.1183/23120541.00456-2022] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/03/2022] [Indexed: 11/12/2022] Open
Abstract
Further understanding of when to initiate therapies in pulmonary arterial hypertension (PAH) is important to improve long-term outcomes. Post hoc analyses of GRIPHON (NCT01106014) and exploratory analyses of TRITON (NCT02558231) suggested benefit of early selexipag initiation on long-term outcomes, despite no additional benefit versus initial double combination on haemodynamic and functional parameters in TRITON. Post hoc analyses investigated the effect of early selexipag initiation on disease progression and survival in a large, pooled PAH cohort. Data from newly diagnosed (≤6 months) PAH patients from GRIPHON and TRITON were pooled. Patients on active therapy with selexipag (pooled selexipag group) were compared with those on control therapy with placebo (pooled control group). Disease progression end-points were defined as per the individual studies. Hazard ratios (HR) and 95% CI for time to first disease progression event up to end of double-blind treatment (selexipag/placebo) +7 days and time to all-cause death up to end of study were estimated using Cox regression models. The pooled dataset comprised 649 patients, with 44% on double background therapy. Selexipag reduced the risk of disease progression by 52% versus control (HR: 0.48; 95% CI: 0.35-0.66). HR for risk of all-cause death was 0.70 (95% CI: 0.46-1.10) for the pooled selexipag versus control group. Sensitivity analyses accounting for the impact of PAH background therapy showed consistent results, confirming the appropriateness of data pooling. These post hoc, pooled analyses build on previous insights, further supporting selexipag use within 6 months of diagnosis, including as part of triple therapy, to delay disease progression.
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Affiliation(s)
- J. Gerry Coghlan
- Royal Free Hospital, London, UK,Corresponding author: J. Gerry Coghlan ()
| | - Sean Gaine
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Richard Channick
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Camille du Roure
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Global Medical Affairs, Allschwil, Switzerland
| | - J. Simon R. Gibbs
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School and German Center for Lung Research, Hannover, Germany
| | - Irene M. Lang
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | | | - Lada Mitchell
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Statistics & Decision Sciences - Medical Affairs and Established Products, Allschwil, Switzerland
| | - Gérald Simonneau
- Hôpital Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Olivier Sitbon
- Hôpital Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France
| | | | - Nazzareno Galiè
- Alma Mater Studiorum, University of Bologna and IRCCS-S.Orsola University Hospital, Bologna, Italy
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15
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Zou C, Harvard A, Qian J, Fox BI. A systematic review of digital health technologies for the care of older adults during COVID-19 pandemic. Digit Health 2023; 9:20552076231191050. [PMID: 37529545 PMCID: PMC10388634 DOI: 10.1177/20552076231191050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023] Open
Abstract
Objective During the Coronavirus Disease 2019 (COVID-19) pandemic, digital health technologies (DHTs) became increasingly important, especially for older adults. The objective of this systematic review was to synthesize evidence on the rapid implementation and use of DHTs among older adults during the COVID-19 pandemic. Methods A structured, electronic search was conducted on 9 November 2021, and updated on 5 January 2023, among five databases to select DHT interventional studies conducted among older adults during the pandemic. The bias of studies was assessed using Version 2 of the Cochrane Risk-of-Bias Tool for randomized trials (RoB 2) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I). Results Among 20 articles included in the review, 14 (70%) focused on older adults with chronic diseases or symptoms, such as dementia or cognitive impairment, type 2 diabetes, and obesity. DHTs included traditional telehealth interventions via telephone, video, and social media, as well as emerging technologies such as Humanoid Robot and Laser acupuncture teletherapy. Using RoB 2 and ROBINS-I, four studies (20%) were evaluated as high or serious overall risk of bias. DHTs have shown to be effective, feasible, acceptable, and satisfactory for older adults during the COVID-19 pandemic compared to usual care. In addition, some studies also highlighted challenges with technology, hearing difficulties, and communication barriers within the vulnerable population. Conclusions During the COVID-19 pandemic, DHTs had the potential to improve various health outcomes and showed benefits for older adults' access to health care services.
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Affiliation(s)
- Chenyu Zou
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Abbey Harvard
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Brent I Fox
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
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16
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Botsford C, Brellenthin AG, Cisler JM, Hillard CJ, Koltyn KF, Crombie KM. Circulating endocannabinoids and psychological outcomes in women with PTSD. J Anxiety Disord 2023; 93:102656. [PMID: 36469982 PMCID: PMC9839585 DOI: 10.1016/j.janxdis.2022.102656] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/10/2022] [Accepted: 11/22/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent research has attempted to elucidate the relationship between blood-based biomarkers (e.g., endocannabinoids; eCBs: including N-arachidonoylethanolamine [AEA] and 2-arachidonoylglycerol [2-AG]) and mental health outcomes in psychiatric populations such as posttraumatic stress disorder (PTSD). Prior research suggests that adults with PTSD may have altered circulating eCB tone and a blunted mobilization of eCBs (particularly 2-AG) in response to stress (e.g., aerobic exercise), although our understanding has been limited in part due to heterogenous samples and small sample sizes. METHODS A subset of data was pooled from five studies in which women with and without PTSD (N = 98) completed questionnaires related to mood states and a blood draw prior to and following a bout of moderate-intensity aerobic exercise in order to determine: 1) whether circulating eCBs differ between groups and whether depressive and PTSD symptom severity are associated with baseline eCBs, 2) whether a bout of aerobic exercise increases circulating eCBs in adult women with PTSD, and 3) whether circulating eCBs are associated with overall mood states and exercise-induced improvements in mood states in women with and without PTSD. RESULTS PTSD diagnoses were not associated with baseline concentrations of eCBs. Greater depressive symptom severity and PTSD symptom severity within the negative alteration in cognition and mood cluster were associated with lower circulating AEA. Circulating AEA significantly increased following aerobic exercise for both groups, whereas circulating 2-AG only increased in women without PTSD. Greater circulating AEA within the PTSD group was associated with lower depressive mood, confusion, and total mood disturbance. CONCLUSIONS These findings suggest that greater circulating AEA is associated with better overall mood and lower depressive and PTSD symptom severity, and that an acute bout of moderate-intensity aerobic exercise increases circulating AEA (but not 2-AG) in adult women with PTSD. These findings are consistent with the idea that greater eCB tone (particularly AEA) following pharmacological and/or non-pharmacological manipulations may be beneficial for improving psychological outcomes (e.g., mood, cognition) among PTSD, and possibly other psychiatric populations.
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Affiliation(s)
- Chloe Botsford
- University of Wisconsin - Madison, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI 53719, United States.
| | - Angelique G Brellenthin
- Iowa State University, Department of Kinesiology, Forker Building, 534 Wallace Road, Ames, IA 50011, United States.
| | - Josh M Cisler
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States; Institute for Early Life Adversity Research, The University of Texas at Austin Dell Medical School & Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States.
| | - Cecilia J Hillard
- Medical College of Wisconsin, Neuroscience Research Center, Department of Pharmacology and Toxicology, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Kelli F Koltyn
- University of Wisconsin - Madison, Department of Kinesiology, 1300 University Avenue, Madison, WI 53706, United States.
| | - Kevin M Crombie
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States.
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17
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Ochs-Balcom HM, Johnson C, Guertin KA, Qin B, Beeghly-Fadiel A, Camacho F, Bethea TN, Dempsey LF, Rosenow W, Joslin CE, Myers E, Moorman PG, Harris HR, Peres LC, Wendy Setiawan V, Wu AH, Rosenberg L, Schildkraut JM, Bandera EV. Racial differences in the association of body mass index and ovarian cancer risk in the OCWAA Consortium. Br J Cancer 2022; 127:1983-1990. [PMID: 36138071 PMCID: PMC9681872 DOI: 10.1038/s41416-022-01981-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Obesity disproportionately affects African American (AA) women and has been shown to increase ovarian cancer risk, with some suggestions that the association may differ by race. METHODS We evaluated body mass index (BMI) and invasive epithelial ovarian cancer (EOC) risk in a pooled study of case-control and nested case-control studies including AA and White women. We evaluated both young adult and recent BMI (within the last 5 years). Associations were estimated using multi-level and multinomial logistic regression models. RESULTS The sample included 1078 AA cases, 2582 AA controls, 3240 White cases and 9851 White controls. We observed a higher risk for the non-high-grade serous (NHGS) histotypes for AA women with obesity (ORBMI 30+= 1.62, 95% CI: 1.16, 2.26) and White women with obesity (ORBMI 30+= 1.20, 95% CI: 1.02, 2.42) compared to non-obese. Obesity was associated with higher NHGS risk in White women who never used HT (ORBMI 30+= 1.40, 95% CI: 1.08, 1.82). Higher NHGS ovarian cancer risk was observed for AA women who ever used HT (ORBMI 30+= 2.66, 95% CI: 1.15, 6.13), while in White women, there was an inverse association between recent BMI and risk of EOC and HGS in ever-HT users (EOC ORBMI 30+= 0.81, 95% CI: 0.69, 0.95, HGS ORBMI 30+= 0.73, 95% CI: 0.61, 0.88). CONCLUSION Obesity contributes to NHGS EOC risk in AA and White women, but risk across racial groups studied differs by HT use and histotype.
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Affiliation(s)
- Heather M Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA.
| | - Courtney Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristin A Guertin
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Alicia Beeghly-Fadiel
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fabian Camacho
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Campus, Washington DC, USA
| | - Lauren F Dempsey
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Will Rosenow
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago School of Medicine and Division of Epidemiology and Biostatistics, School of Public Health, Chicago, IL, USA
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Patricia G Moorman
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC, USA
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - V Wendy Setiawan
- University of Southern California Norris Comprehensive Cancer Center, and Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Anna H Wu
- University of Southern California Norris Comprehensive Cancer Center, and Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Joellen M Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Limaye RJ, Balgobin K, Michel A, Schulz G, Erchick DJ. What message appeal and messenger are most persuasive for COVID-19 vaccine uptake: Results from a 5-country survey in India, Indonesia, Kenya, Nigeria, and Ukraine. PLoS One 2022; 17:e0274966. [PMID: 36129894 PMCID: PMC9491563 DOI: 10.1371/journal.pone.0274966] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/07/2022] [Indexed: 11/29/2022] Open
Abstract
Effective strategies to encourage COVID-19 vaccination should consider how health communication can be tailored to specific contexts. Our study aimed to evaluate the influence of three specific messaging appeals from two kinds of messengers on COVID-19 vaccine acceptance in diverse countries. We surveyed 953 online participants in five countries (India, Indonesia, Kenya, Nigeria, and Ukraine). We assessed participants’ perceptions of three messaging appeals of vaccination—COVID-19 disease health outcomes, social norms related to COVID-19 vaccination, and economic impact of COVID-19—from two messengers, healthcare providers (HCP), and peers. We examined participants’ ad preference and vaccine hesitancy using multivariable multinomial logistic regression. Participants expressed a high level of approval for all the ads. The healthcare outcome–healthcare provider ad was most preferred among participants from India, Indonesia, Nigeria, and Ukraine. Participants in Kenya reported a preference for the health outcome–peer ad. The majority of participants in each country expressed high levels of vaccine hesitancy. However, in a final logistic regression model participant characteristics were not significantly related to vaccine hesitancy. These findings suggest that appeals related to health outcomes, economic benefit, and social norms are all acceptable to diverse general populations, while specific audience segments (i.e., mothers, younger adults, etc.) may have preferences for specific appeals over others. Tailored approaches, or approaches that are developed with the target audience’s concerns and preferences in mind, will be more effective than broad-based or mass appeals.
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Affiliation(s)
- Rupali J. Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Kristian Balgobin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Alexandra Michel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gretchen Schulz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Daniel J. Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Lipton RB, Singh RBH, Revicki DA, Zhao S, Shewale AR, Lateiner JE, Dodick DW. Functionality, satisfaction, and global impression of change with ubrogepant for the acute treatment of migraine in triptan insufficient responders: a post hoc analysis of the ACHIEVE I and ACHIEVE II randomized trials. J Headache Pain 2022; 23:50. [PMID: 35468729 PMCID: PMC9036751 DOI: 10.1186/s10194-022-01419-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/04/2022] [Indexed: 12/14/2022] Open
Abstract
Background Triptans are the first-line option for the acute treatment of migraine attacks; however, triptans are contraindicated in people with certain underlying cardiovascular risk factors and are associated with inadequate efficacy or poor tolerability in some individuals. Ubrogepant is an oral calcitonin gene–related peptide receptor antagonist approved for the acute treatment of migraine. Methods This post hoc analysis of the phase 3 ACHIEVE trials examined the impact of ubrogepant on the Functional Disability Scale (FDS), satisfaction with medication, and Patient Global Impression of Change (PGIC) in participants who were self-reported triptan insufficient responders (TIRs), defined as those who are unable to take triptans due to contraindications, tolerability issues, or insufficient efficacy. Responder definitions for the FDS, satisfaction measures, and PGIC were based on qualitative interpretation of the respective response options for the pooled ubrogepant 50 mg and placebo groups. Results In the pooled analysis population (n = 1799), 451 (25%) participants were TIRs, with most (80%) reporting insufficient efficacy with triptan use. A significantly higher proportion of TIRs treated with ubrogepant vs placebo reported being able to function normally from 2 to 8 h post dose (P < 0.05). Notably, significance was demonstrated at the time of the primary outcome assessments (2 h post dose), where rates of normal function were 38% for ubrogepant vs 29% for placebo (P = 0.048). A greater proportion of TIRs in the ubrogepant arm vs the placebo arm were satisfied with treatment at 2 (33% vs 21%, P = 0.006) and 24 h (58% vs 28%, P < 0.001) and indicated that their migraine improved at 2 h vs placebo (30% vs 18%, P = 0.006). Results were generally similar in the insufficient efficacy subpopulation of TIRs as in the overall TIRs group. Ubrogepant was safe and well tolerated in TIRs, with no new safety signals identified. Conclusions In people with migraine who are TIRs, individuals treated with ubrogepant had favorable 2-h outcomes, as measured by the FDS, satisfaction with medication, and PGIC, compared with placebo. Trial registration ClinicalTrials.gov: NCT02828020 (ACHIEVE I), registered July 11, 2016; NCT02867709 (ACHIEVE II), registered August 16, 2016.
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Chang CH, Chang YC, Yang L, Tzang RF. The Comparative Efficacy of Treatments for Children and Young Adults with Internet Addiction/Internet Gaming Disorder: An Updated Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052612. [PMID: 35270305 PMCID: PMC8909504 DOI: 10.3390/ijerph19052612] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/11/2022] [Accepted: 02/22/2022] [Indexed: 02/06/2023]
Abstract
Internet gaming disorder (IGD) is a formal mental disorder leading to bad outcomes for children and adolescents. This study comprehensively compared the estimated effect of various pharmacotherapy and psychosocial interventions for IGD from randomized controlled trials (RCT) through updated meta-analysis, using meta-regression. A search of PubMed/MEDLINE, Cochrane Library, and Airiti Library between 2000 and 2017 was conducted for various IA/IGD intervention modalities. A total of 124 studies from 29 selected papers involving 5601 children and young adults with IA/IGD were found. Meta-analyzing the pooled standardized mean difference (SMD) revealed a preliminary random effect of 1.399 with a 95% confidence interval of 1.272–1.527, suggesting highly effective treatment of IA/IGD. After adjusting for the confounding risks of age, publication year, type of subjects, and type of study, this study revealed that combining pharmacotherapy with cognitive behavioral therapy (CBT) or multi-level counseling (MLC) was the most effective treatment option. Using a scale of time spent online or a severity of IA symptoms scale was a more effective measurement, with p-values = 0.006 and 0.002, respectively. IA/IGD patients with comorbid depression showed worse outcomes than youth with another comorbidity. The corresponding model goodness-of-fit indices were τ2 = 1.188; I2-Residual = 89.74%; and Adjusted-R2 = 16.10%. This systematic review indicates that pharmacotherapy combined with CBT or MLC might be an effective therapeutic strategy for youth with gaming disorder.
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Affiliation(s)
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei City 251301, Taiwan;
| | - Luke Yang
- Department of Social Welfare, Hsuan Chuang University, Hsinchu 30092, Taiwan;
| | - Ruu-Fen Tzang
- Department of Psychiatry, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Department of Childhood Care and Education, Mackay Junior College of Medicine, Nursing, and Management, Taipei 25245, Taiwan
- Department of Audiology and Speech-Language Pathology, Mackay Medical College, New Taipei City 251301, Taiwan
- Correspondence: ; Tel.: +886-2-25433535
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21
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Thompson RE, Tuchman AJ, Alkon DL. Bryostatin Placebo-Controlled Trials Indicate Cognitive Restoration Above Baseline for Advanced Alzheimer’s Disease in the Absence of Memantine1. J Alzheimers Dis 2022; 86:1221-1229. [PMID: 35124654 PMCID: PMC9108553 DOI: 10.3233/jad-215545] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: In pre-clinical studies of Alzheimer’s disease (AD) transgenic mice, bryostatin restored synaptic connections, prevented neuronal death, reduced amyloid plaques, and reduced neurofibrillary tangles. Objective: Within pre-specified cohorts of advanced AD patients in two double-blind placebo-controlled bryostatin Phase II trials, to conduct exploratory statistical analyses of patients with identical conditions of enrollment and treatment. Methods: Severe Impairment Battery (SIB) scores above baseline at 5, 9, and 13 weeks were analyzed initially in the complete cases, with multiple imputation methods based on an iterative Markov chain Monte Carlo algorithm used for missing SIB scores. To mitigate confounding by a chance imbalance of 4.9 SIB baseline scores (Study #203), each patient was used as their own control with differences in 13-week SIB from baseline in single trial and pooled analyses to measure benefit at 13 weeks using general estimating equations (GEE) modeling. Results: Patients treated with bryostatin pre-specified at Mini-Mental State Examination scores 10–14, without memantine, showed baseline balance, complete safety, and SIB improvements at 13 weeks with multiple imputation analysis: Study #203 = 4.1 SIB points above baseline (p = 0.005), and Study #202 = 4.2 SIB points above baseline (p = 0.016). An increased power (N = 95) “pooled analysis” showed an increased SIB over time and a higher mean SIB at 13 weeks in the bryostatin treatment group (p < 0.001) but not significant (NS) for the placebo patients. Conclusion: Pre-specified exploratory analyses for the individual trials and the pooled trials confirmed significant bryostatin-induced improvement over baseline (treatment p < 0.001, placebo NS).
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Affiliation(s)
| | - Alan J. Tuchman
- New York Medical College, Valhalla, NY, USA
- Synaptogenix, Inc., New York, NY, USA
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22
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Huda MH, Chipojola R, Lin YM, Lee GT, Shyu ML, Kuo SY. The Influence of Breastfeeding Educational Interventions on Breast Engorgement and Exclusive Breastfeeding: A Systematic Review and Meta-Analysis. J Hum Lact 2022; 38:156-170. [PMID: 34229526 DOI: 10.1177/08903344211029279] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Breast engorgement and breast pain are the most common reasons for the early cessation of exclusive breastfeeding by mothers. RESEARCH AIMS (1) To examine the influence of breastfeeding educational interventions on breast engorgement, breast pain, and exclusive breastfeeding; and (2) to identify effective components for implementing breastfeeding programs. METHODS Randomized controlled trials of breastfeeding educational interventions were searched using five English and five Chinese databases. Eligible studies were independently evaluated for methodological quality, and data were extracted by two investigators. In total, 22 trials were identified, and 3,681 participants were included. A random-effects model was used to pool the results, and a subgroup analysis and meta-regression analysis were conducted. RESULTS Breastfeeding education had a significant influence on reducing breast engorgement at postpartum 3 days (odds ratio [OR]: 0.27, 95% CI [0.15, 0.48] p < .001), 4 days (OR: 0.16, 95% CI [0.11, 0.22], p < .001), and 5-7 days (OR: 0.24, 95% CI [0.08, 0.74], p = .013) and breast pain (standardized mean difference: -1.33, 95% CI [-2.26, -0.40]) at postpartum 4-14 days. Participants who received interventions had higher odds of exclusive breastfeeding. Breastfeeding educational interventions provided through lecture combined with skills practical effectively reduced breast engorgement (OR: 0.21; 95% CI [0.15, 0.28]; p = .001) and improved exclusive breastfeeding at postpartum 1-6 weeks (OR: 2.16; 95% CI [1.65, 2.83]; p = .001). CONCLUSIONS Breastfeeding educational interventions have been effective in reducing breast engorgement, breast pain, and improved exclusive breastfeeding. A combination of knowledge and skill-based education has been beneficial for sustaining exclusive breastfeeding by mothers.
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Affiliation(s)
- Mega Hasanul Huda
- 38032 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Roselyn Chipojola
- 38032 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yen Miao Lin
- 38032 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Gabrielle T Lee
- 6221 Applied Psychology, Faculty of Education, Western University, London, ON, Canada
| | - Meei-Ling Shyu
- 38032 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shu-Yu Kuo
- 38032 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Whittington MD, Campbell JD, Rind D, Fluetsch N, Lin GA, Pearson SD. Cost-Effectiveness and Value-Based Pricing of Aducanumab for Patients With Early Alzheimer Disease. Neurology 2022; 98:e968-e977. [PMID: 35022306 DOI: 10.1212/wnl.0000000000013314] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/29/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Aducanumab was granted accelerated approval with a conflicting evidence base, near-unanimous FDA Advisory Committee vote to reject approval, and a widely criticized launch price of $56,000 per year. The objective of this analysis was to estimate its cost-effectiveness. METHODS We developed a Markov model to compare aducanumab in addition to supportive care to supportive care alone over a lifetime horizon. Results were presented from both the health system and modified societal perspective. The model tracked the severity of disease and the care setting. Incremental cost-effectiveness ratios were calculated, and a threshold analysis was conducted to estimate at what price aducanumab would meet commonly used cost-effectiveness thresholds. RESULTS Using estimates of effectiveness based on pooling of data from both pivotal trials, patients treated with aducanumab spent four more months in earlier stages of AD. Over the lifetime time horizon, treating a patient with aducanumab results in 0.154 more QALYs gained per patient and 0.201 evLYGs per patient from the health care system perspective, with additional costs of approximately $204,000 per patient. The incremental outcomes were similar for the modified societal perspective. At the list price of $56,000 per year, the cost-effectiveness ranged from $1.02 million per evLYG to $1.33 million per QALY gained from the health care system perspective; and from $938,000 per evLYG to $1.27 million per QALY gained in the modified societal perspective. The annual price to meet commonly used cost-effectiveness thresholds ranged from $2,950 to $8,360, which represents a discount of 85-95% off from the annual launch price set by the manufacturer. Using estimates of effectiveness based only on the trial that suggested a benefit, the mean incremental cost was greater than $400,000 per QALY gained. DISCUSSION Patients treated with aducanumab received minimal improvements in health outcomes at considerable cost. This resulted in incremental cost-effectiveness ratios that far exceeded commonly used value thresholds, even under optimistic treatment effectiveness assumptions. These findings are subject to the substantial uncertainty regarding whether aducanumab provides any true net health benefit, but evidence available currently suggests that an annual price of aducanumab of $56,000 is not in reasonable alignment with its clinical benefits.
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Affiliation(s)
| | | | - David Rind
- Institute For Clinical and Economic Review, Boston, MA
| | | | - Grace A Lin
- Institute For Clinical and Economic Review, Boston, MA.,Department of Medicine, University of California San Francisco, San Francisco, CA
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Foldager J, Peppard PE, Hagen EW, Stone KL, Evans DS, Tranah GJ, Sørensen H, Jennum P, Mignot E, Schneider LD. Genetic risk for subjective reports of insomnia associates only weakly with polygraphic measures of insomnia in 2,770 adults. J Clin Sleep Med 2022; 18:21-29. [PMID: 34170227 PMCID: PMC8807892 DOI: 10.5664/jcsm.9468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES Subjective insomnia complaints and objective sleep changes are mostly studied outside of clinical trial studies. In this study, we tested whether 240 genetic variants associated with subjectively reported insomnia were also associated with objective insomnia parameters extracted from polysomnographic recordings in three studies. METHODS The study sample (total n = 2,770) was composed of the Wisconsin Sleep Cohort (n = 1,091) and the Osteoporotic Fractures in Men (n = 1,026) study, two population-based studies, and the Stanford Sleep Cohort, a sleep center patient-based sample (n = 653). Seven objective polysomnographic features related to insomnia defined outcome variables, with each variant allele serving as predictor. Meta-regression was performed, accounting for common confounders as well as variance differences between studies. Additionally, a normalized genetic risk score was generated for each subject to serve as a predictor variable in separate linear mixed models assessing objective insomnia features. RESULTS After correction for multiple testing, single-nucleotide polymorphisms associated with subjective insomnia were not significantly associated with 6 of 7 objective sleep measures. Only periodic limb movement index was significantly associated with rs113851554 (MEIS1), as found in previous studies. The normalized genetic risk score was only weakly associated with arousal index and duration of wake after sleep onset. CONCLUSIONS Our findings suggest that subjective insomnia does not have a strong genetic signature mapping onto objective (polysomnographic) sleep variables. CITATION Foldager J, Peppard PE, Hagen EW, et al. Genetic risk for subjective reports of insomnia associates only weakly with polygraphic measures of insomnia in 2,770 adults. J Clin Sleep Med. 2022;18(1):21-29.
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Affiliation(s)
- Jonathan Foldager
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark,Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark,Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, California
| | - Paul E. Peppard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
| | - Erika W. Hagen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
| | - Katie L. Stone
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - Daniel S. Evans
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - Gregory J. Tranah
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - Helge Sørensen
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, California
| | - Logan D. Schneider
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, California,Stanford/VA Alzheimer’s Research Center, Palo Alto, California,Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, California,Address correspondence to: Logan Schneider, MD, Stanford/VA Alzheimer’s Research Center, 3801 Miranda Ave, Building 4, 1st Floor, C-141, Palo Alto, CA 94304;
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25
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Blanco-Rojo R, Maldonado J, Schaubeck M, Özen M, López-Huertas E, Olivares M. Beneficial Effects of Limosilactobacillus fermentum CECT 5716 Administration to Infants Delivered by Cesarean Section. Front Pediatr 2022; 10:906924. [PMID: 35874592 PMCID: PMC9301023 DOI: 10.3389/fped.2022.906924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Cesarean section (CS) disrupts the natural microbiota colonization process in infants, which might compromise immune system maturation, leading to a higher risk of infections. We evaluated the effect of the probiotic Limosilactobacillus (L.) fermentum CECT 5716 on the incidence of gastrointestinal and respiratory infections in the CS infant subgroups (n = 173) of three randomized clinical trials in which this probiotic strain was demonstrated to be safe and effective for preventing infections. Therefore, the data for the CS infants were extracted to obtain the incidence rate ratio (IRR) and 95% CI for gastrointestinal and respiratory infections for each study and were then combined to obtain a pooled IRR and 95% CI using the generic inverse variance method. There was a significant reduction of 73% in the incidence of gastrointestinal infections in CS infants receiving L. fermentum CECT 5716 compared with those receiving the control formula [n = 173, IRR: 0.27 (0.13, 0.53), p = 0.0002]. Regarding respiratory infections, although pooled results showed a reduction of 14% in the probiotic group, the difference was not statistically significant [n = 173, IRR (95% CI): 0.86 (0.67, 1.11), p = 0.25]. In conclusion, the administration of L. fermentum CECT 5716 to CS-born infants protects them from gastrointestinal infections by reducing the risk by up to 73% in this population.
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Affiliation(s)
- Ruth Blanco-Rojo
- Research and Development Department, Biosearch Life, a Kerry Company, Granada, Spain
| | - José Maldonado
- Pediatric Unit, University Hospital Virgen de las Nieves, Granada, Spain.,Department of Pediatric, University of Granada, Granada, Spain.,Biosanitary Research Institute (IBS), Granada, Spain
| | | | - Metehan Özen
- Department of Pediatrics, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Eduardo López-Huertas
- Estación Experimental Zaidín, Consejo Superior Investigaciones Científicas, Granada, Spain
| | - Mónica Olivares
- Research and Development Department, Biosearch Life, a Kerry Company, Granada, Spain
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Kengneson CC, Blanchet R, Sanou D, Batal M, Phillips KP, Giroux I. Maternal perceptions and concerns about children's weight status and diet quality: a study among Black immigrant families. Public Health Nutr 2021; 25:1-14. [PMID: 34865677 PMCID: PMC9991773 DOI: 10.1017/s1368980021004729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify factors influencing Black immigrant mothers' perceptions and concerns about child weight and to compare children's diet quality according to these perceptions and concerns. DESIGN Mothers' perceptions and concerns about child weight were assessed with sex-specific figure rating scales and the Child Feeding Questionnaire, respectively. Participants' weights and heights were measured and characterised using WHO references. Children's dietary intakes were estimated using a 24-h dietary recall. Children's diet quality was evaluated using the relative proportion of their energy intake provided by ultra-processed products, which were identified with the NOVA classification. χ2 tests, multivariate logistic regressions and t tests were performed. SETTING Ottawa, Ontario, Canada. PARTICIPANTS Black immigrant mothers of Sub-Saharan African and Caribbean origin (n 186) and their 6-12-year-old children. RESULTS Among mothers, 32·4 % perceived their child as having overweight while 48·4 % expressed concerns about child weight. Girls and children with overweight or obesity were significantly more likely to be perceived as having overweight by their mothers than boys and normal-weight children, respectively. Mothers of children living with obesity, but not overweight, were significantly more likely to be concerned about their child's weight than mothers of normal-weight children. Children's diet quality did not differ according to mothers' perceptions and concerns. CONCLUSIONS Children's gender and weight status were major determinants of perceptions and concerns about child weight among Black immigrant mothers. Including knowledge about mothers' perceptions and concerns about child weight will help nutrition professionals develop interventions tailored to specific family needs within the context of their cultural backgrounds.
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Affiliation(s)
- Cris-Carelle Kengneson
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Rosanne Blanchet
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Québec, Canada
| | - Dia Sanou
- FAO Sub-Regional Office for Eastern Africa, Food and Agricultural Organizations of the United Nations, Addis Ababa, Ethiopia
| | - Malek Batal
- Nutrition Department, Faculty of Medicine, Université de Montréal, Centre de recherche en santé publique (CReSP), Québec, Canada
| | - Karen P Phillips
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Isabelle Giroux
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ONK1N 6N5, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
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Chen D, Jutkowitz E, Iosepovici SL, Lin JC, Gross AL. Pre-statistical harmonization of behavrioal instruments across eight surveys and trials. BMC Med Res Methodol 2021; 21:227. [PMID: 34689753 PMCID: PMC8543796 DOI: 10.1186/s12874-021-01431-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Data harmonization is a powerful method to equilibrate items in measures that evaluate the same underlying construct. There are multiple measures to evaluate dementia related behavioral symptoms. Pre-statistical harmonization of behavioral instruments in dementia research is the first step to develop a statistical crosswalk between measures. Studies that conduct pre-statistical harmonization of behavioral instruments rarely document their methods in a structured, reproducible manner. This is a crucial step which entails careful review, documentation and scrutiny of source data to ensure sufficient comparability between items prior to data pooling. Here, we document the pre-statistical harmonization of items measuring behavioral and psychological symptoms among people with dementia. We provide a box of recommended procedure for future studies. METHODS We identified behavioral instruments that are used in clinical practice, a national survey, and randomized trials of dementia care interventions. We rigorously reviewed question content and scoring procedures to establish sufficient comparability across items as well as item quality prior to data pooling. Additionally, we standardized coding to Stata-readable format, which allowed us to automate approaches to identify potential cross-study differences in items and low-quality items. To ensure reasonable model fit for statistical co-calibration, we estimated two-parameter logistic Item Response Theory models within each of the eight studies. RESULTS We identified 59 items from 11 behavioral instruments across the eight datasets. We found considerable cross-study heterogeneity in administration and coding procedures for items that measure the same attribute. Discrepancies existed in terms of directionality and quantification of behavioral symptoms for even seemingly comparable items. We resolved item response heterogeneity, missingness and skewness, conditional dependency prior to estimation of item response theory models for statistical co-calibration. We used several rigorous data transformation procedures to address these issues, including re-coding and truncation. CONCLUSIONS This study highlights the importance of each aspect involved in the pre-statistical harmonization process of behavioral instruments. We provide guidelines and recommendations for how future research may detect and account for similar issues in pooling behavioral and related instruments.
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Affiliation(s)
- Diefei Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States, 2024 E. Monument Street, Baltimore, MD 21205 USA
| | - Eric Jutkowitz
- Health Services, Policy & Practice, Brown School of Public Health, Providence, RI USA
- Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, RI USA
| | - Skylar L. Iosepovici
- Health Services, Policy & Practice, Brown School of Public Health, Providence, RI USA
| | - John C. Lin
- Health Services, Policy & Practice, Brown School of Public Health, Providence, RI USA
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States, 2024 E. Monument Street, Baltimore, MD 21205 USA
- Johns Hopkins University Center on Aging and Health, Baltimore, MD USA
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van der Kamp MR, Nieuwdorp BW, Thio BJ, Tabak M, Kamps AWA, Hermens HJ, Driessen JMM. Can the Childhood Physical Activity Questionnaire Be Used to Identify Physical Activity Levels in Children With Asthma? Front Pediatr 2021; 9:726695. [PMID: 34692606 PMCID: PMC8528107 DOI: 10.3389/fped.2021.726695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Children with asthma who are physically active have a better quality of life, emphasizing the importance of activity monitoring and promotion in daily life. The validity of self-reported activity measurements has been questioned in pediatric populations. In this study, we aim to compare the Physical Activity Questionnaire for Children (PAQ-C) with objectively measured PA using accelerometry. Design: In this comparison study, the pooled dataset of two cross-sectional studies was used, which prospectively home-monitored PA using the alternative self-report PAQ-C questionnaire as well as with the criterion standard accelerometry (Actigraph wGT3X-BT and GT1M). Participants:Ninety children with pediatrician-diagnosed asthma participated in the study. Main Outcome Measures:Correlation coefficients were calculated to determine the relation between the PAQ-C and accelerometer data. The predictive value of the PAQ-C in differentiating between achieving and failing the recommended daily level of moderate-to-vigorous activity (MVPA) was evaluated with receiver operator characteristic (ROC) analysis. Results: The results showed weak to moderate correlations of the PAQ-C with the accelerometer data (r = 0.29-0.47). A PAQ-C cutoff of 3.09 showed the best performance on predicting whether the recommended level of MVPA was achieved. With this cutoff, 21 of the 39 children that did achieve their daily MVPA level (53.8% sensitivity) and 33 of the 46 children that did fail their daily MVPA level (71.7% specificity) were correctly classified. A PAQ-C score of 3.5 revealed a negative predictive value of 100% for assessing physical inactivity. Conclusion: This study revealed a weak relation between the PAQ-C and PA assessed with accelerometry. However, a PAQ-C score of 3.5 or higher might be used as a low-cost and easy-to-use PA screening tool for ruling out physical inactivity in a portion of the pediatric asthma population. Clinical Trial Registration: Netherlands Trial Register: Trial NL6087.
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Affiliation(s)
- Mattienne R. van der Kamp
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands
- Roessingh Research and Development, Enschede, Netherlands
| | - Bram W. Nieuwdorp
- Department of Pediatrics, Martini Ziekenhuis, Groningen, Netherlands
| | - Boony J. Thio
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - Monique Tabak
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Roessingh Research and Development, Enschede, Netherlands
| | - Arvid W. A. Kamps
- Department of Pediatrics, Martini Ziekenhuis, Groningen, Netherlands
| | - Hermie J. Hermens
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Roessingh Research and Development, Enschede, Netherlands
| | - Jean M. M. Driessen
- Independent Researcher, Groningen, Netherlands
- Department of Sports Medicine, Ziekenhuis Tjongerschans, Heerenveen, Netherlands
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Ming Y, Zecevic AA, Hunter SW, Miao W, Tirona RG. Medication Review in Preventing Older Adults' Fall-Related Injury: a Systematic Review & Meta-Analysis. Can Geriatr J 2021; 24:237-250. [PMID: 34484506 PMCID: PMC8390322 DOI: 10.5770/cgj.24.478] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Medication review is essential in managing adverse drug reactions and improving drug safety in older adults. This systematic review evaluated medication review's role as a single intervention or combined with other interventions in preventing fall-related injuries in older adults. METHODS Electronic databases search was conducted in PubMed, EMBASE, Scopus, and CINAHL. Two reviewers screened titles and abstracts, reviewed full texts, and performed data extraction and risk of bias assessment. Meta-analyses were conducted on studies with similar participants, interventions, outcomes or settings. RESULTS Fourteen randomized, controlled studies were included. The pooled results indicated that medication review as a stand-alone intervention was effective in preventing fall-related injuries in community-dwelling older adults (Risk Difference [RD] = -0.06, 95% CI: [-0.11, -0.00], I2 = 61%, p = .04). Medication review also had a positive impact on decreasing the risk of fall-related fractures (RD = -0.02, 95% CI: [-0.04, -0.01], I2 = 0%, p = .01). DISCUSSION This systematic review and meta-analysis has demonstrated that medication review is effective in preventing fall-related injuries in general, and fractures specifically, in community-dwelling older adults. Future investigations focusing on the process of performing medication review will further inform fall-related injury prevention for older adults.
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Affiliation(s)
- Yu Ming
- Health and Rehabilitation Sciences, School of Health Studies, Western University, London, ON
| | | | | | - Wenxin Miao
- School of Information and Media Studies, Western University, London, ON
| | - Rommel G. Tirona
- School of Physiology and Pharmacology, Western University, London, ON
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Davis CP, Bandera EV, Bethea TN, Camacho F, Joslin CE, Wu AH, Beeghly-Fadiel A, Moorman PG, Myers ER, Ochs-Balcom HM, Peres LC, Rosenow WT, Setiawan VW, Rosenberg L, Schildkraut JM, Harris HR. Genital Powder Use and Risk of Epithelial Ovarian Cancer in the Ovarian Cancer in Women of African Ancestry Consortium. Cancer Epidemiol Biomarkers Prev 2021; 30:1660-1668. [PMID: 34155063 PMCID: PMC8419086 DOI: 10.1158/1055-9965.epi-21-0162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/01/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Genital powder use is more common among African-American women; however, studies of genital powder use and ovarian cancer risk have been conducted predominantly in White populations, and histotype-specific analyses among African-American populations are limited. METHODS We used data from five studies in the Ovarian Cancer in Women of African Ancestry consortium. Participants included 620 African-American cases, 1,146 African-American controls, 2,800 White cases, and 6,735 White controls who answered questions on genital powder use prior to 2014. The association between genital powder use and ovarian cancer risk by race was estimated using logistic regression. RESULTS The prevalence of ever genital powder use for cases was 35.8% among African-American women and 29.5% among White women. Ever use of genital powder was associated with higher odds of ovarian cancer among African-American women [OR = 1.22; 95% confidence interval (CI) = 0.97-1.53] and White women (OR = 1.36; 95% CI = 1.19-1.57). In African-American women, the positive association with risk was more pronounced among high-grade serous tumors (OR = 1.31; 95% CI = 1.01-1.71) than with all other histotypes (OR = 1.05; 95% CI = 0.75-1.47). In White women, a significant association was observed irrespective of histotype (OR = 1.33; 95% CI = 1.12-1.56 and OR = 1.38; 95% CI = 1.15-1.66, respectively). CONCLUSIONS While genital powder use was more prevalent among African-American women, the associations between genital powder use and ovarian cancer risk were similar across race and did not materially vary by histotype. IMPACT This is one of the largest studies to date to compare the associations between genital powder use and ovarian cancer risk, overall and by histotype, between African-American and White women.
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Affiliation(s)
- Colette P Davis
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Campus, Washington, District of Columbia
| | - Fabian Camacho
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago School of Medicine and Division of Epidemiology and Biostatistics, School of Public Health, Chicago, Illinois
| | - Anna H Wu
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, Los Angeles, California
| | - Alicia Beeghly-Fadiel
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patricia G Moorman
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, North Carolina
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Heather M Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York
| | - Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Will T Rosenow
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Veronica W Setiawan
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, Los Angeles, California
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Joellen M Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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Hu W, DeMarcus LS, Sjoberg PA, Robbins AS. Inactivated influenza vaccine effectiveness among department of defense beneficiaries aged 6 months-17 years, 2016-2017 through 2019-2020 influenza seasons. PLoS One 2021; 16:e0256165. [PMID: 34450617 PMCID: PMC8397503 DOI: 10.1371/journal.pone.0256165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
A test-negative case-control study was conducted to assess inactivated influenza vaccine effectiveness (VE) in children aged 6 months-17 years. The database was developed from the US Department of Defense Global Respiratory Pathogen Surveillance Program over four consecutive influenza seasons from 2016 to 2020. A total of 9,385 children including 4,063 medically attended, laboratory-confirmed influenza-positive cases were identified for VE analysis. A generalized linear mixed model with logit link and binomial distribution was used to estimate the VE. The adjusted VE for children was 42% [95% confidence interval (CI): 37-47%] overall, including 55% (95% CI: 47-61%) for influenza A(H1N1)pdm09, 37% (95% CI: 28-45%) for influenza A(H3N2), and 49% (95% CI: 41-55%) for influenza B. The analysis by age groups indicated that the adjusted VE in children aged 6 months-4 years was higher against influenza A(H1N1)pdm09 and influenza B, and comparable against influenza A(H3N2), compared to those in children aged 5-17 years. Further age-stratified analysis showed that the VE against any types of influenza was low and non-significant for children aged 6-11 months (33%; 95% CI:-2-56%), but it was high (54%; 95% CI: 34-67%) in children aged 12-23 months, and then declined linearly with increasing age. In conclusion, the inactivated influenza vaccination was moderately effective against influenza infection, based on the analysis from a large number of children aged 6 months-17 years over multiple influenza seasons.
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MESH Headings
- Adolescent
- Child
- Child, Preschool
- Female
- Humans
- Infant
- Influenza A Virus, H1N1 Subtype/drug effects
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H1N1 Subtype/pathogenicity
- Influenza A Virus, H3N2 Subtype/drug effects
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/pathogenicity
- Influenza Vaccines/immunology
- Influenza Vaccines/therapeutic use
- Influenza, Human/epidemiology
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Male
- Seasons
- Vaccination
- Vaccine Efficacy
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Affiliation(s)
- Wenping Hu
- The Department of Defense Global Emerging Infections Surveillance Branch, Armed Forces Health Surveillance Division, WPAFB, OH, United States of America
- JYG Innovations, LLC, Dayton, OH, United States of America
- * E-mail:
| | - Laurie S. DeMarcus
- The Department of Defense Global Emerging Infections Surveillance Branch, Armed Forces Health Surveillance Division, WPAFB, OH, United States of America
- JYG Innovations, LLC, Dayton, OH, United States of America
| | - Paul A. Sjoberg
- The Department of Defense Global Emerging Infections Surveillance Branch, Armed Forces Health Surveillance Division, WPAFB, OH, United States of America
- JYG Innovations, LLC, Dayton, OH, United States of America
| | - Anthony S. Robbins
- The Department of Defense Global Emerging Infections Surveillance Branch, Armed Forces Health Surveillance Division, WPAFB, OH, United States of America
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Factors associated with feeding practices of black immigrant mothers of African and Caribbean origin living in Ottawa, Canada. Appetite 2021; 167:105641. [PMID: 34384808 DOI: 10.1016/j.appet.2021.105641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 07/30/2021] [Accepted: 08/06/2021] [Indexed: 11/24/2022]
Abstract
In Canada, Black immigrant women and their children are at higher risk of developing obesity. Factors that could influence children's weight status include parental feeding practices. Feeding practices such as monitoring, restriction and pressure to eat, are well studied among non-Hispanic White and Latinos groups, however, little is known about the feeding practices of Black immigrant parents of African and Caribbean origin. The aim of this study was to identify factors associated with feeding practices of Black immigrant mothers in Ottawa, Canada. The sample includes 188 Black mothers of African and Caribbean origin and their 6-12-year-old children. The Child Feeding Questionnaire was used to assess mothers' feeding practices. Demographic and socioeconomic data were collected using questionnaires. All participants' weight status was determined from measured weight and height. Pearson Chi-square tests and multivariate logistic regressions were performed. Results showed that mothers who felt responsible for feeding their children were more likely to monitor their children's food intake (p < 0.05). While mothers of children with underweight or normal weight were more like to use pressure to eat (p < 0.01), mothers of children with overweight or obesity were more like to use restriction (P < 0.05). Recent immigrant mothers were also more likely to use pressure to eat (P < 0.05). This study also provides evidence for associations between maternal feeding practices and mothers' weight status, household income and food security status. Findings build on previous research suggesting that parental feeding practices vary based on parents' and children's characteristics. Longitudinal studies are needed to assess the directionality of the association between mothers' feeding practices, and children's weight, diet quality and health in this population.
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Love thy (partisan) neighbor: Brief befriending meditation reduces affective polarization. GROUP PROCESSES & INTERGROUP RELATIONS 2021. [DOI: 10.1177/13684302211020108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The rising partisan animus between Democrats and Republicans has significant consequences for American society, both political and nonpolitical. The present study used two preregistered randomized controlled designs to investigate whether scalable meditation interventions could reduce affective polarization, relative to baseline scores measured 1 week earlier, in American adults (Study 1: N = 353; Study 2: N = 246) who affiliated with either the Democratic Party or the Republican Party. The results suggest that a brief befriending meditation can reduce affective polarization between Democrats and Republicans by increasing positive feelings relatively more for the political outgroup than the political ingroup.
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Bethea TN, Ochs-Balcom HM, Bandera EV, Beeghly-Fadiel A, Camancho F, Chyn D, Cloyd EK, Harris HR, Joslin CE, Myers E, Moorman PG, Peres LC, Rosenow W, Setiawan VW, Wu AH, Rosenberg L, Schildkraut JM. First- and second-degree family history of ovarian and breast cancer in relation to risk of invasive ovarian cancer in African American and white women. Int J Cancer 2021; 148:2964-2973. [PMID: 33521947 PMCID: PMC8353974 DOI: 10.1002/ijc.33493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/05/2021] [Accepted: 01/20/2021] [Indexed: 11/07/2022]
Abstract
Family history (FH) of ovarian cancer and breast cancer are well-established risk factors for ovarian cancer, but few studies have examined this association in African American (AA) and white women by histotype. We assessed first- and second-degree FH of ovarian and breast cancer and risk of epithelial ovarian cancer in the Ovarian Cancer in Women of African Ancestry Consortium. Analyses included 1052 AA cases, 2328 AA controls, 2380 white cases and 3982 white controls. Race-specific odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multilevel logistic regression with adjustment for covariates. Analyses were stratified by histotype (high-grade serous vs others). First-degree FH of ovarian cancer was associated with high-grade serous carcinoma in AA (OR = 2.32, 95% CI: 1.50, 3.59) and white women (OR = 2.48, 95% CI: 1.82, 3.38). First-degree FH of breast cancer increased risk irrespective of histotype in AAs, but with high-grade serous carcinoma only in white women. Associations with second-degree FH of ovarian cancer were observed for overall ovarian cancer in white women and with high-grade serous carcinoma in both groups. First-degree FH of ovarian cancer and of breast cancer, and second-degree FH of ovarian cancer is strongly associated with high-grade serous ovarian carcinoma in AA and white women. The association of FH of breast cancer with high-grade serous ovarian carcinoma is similar in white women and AA women, but may differ for other histotypes.
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Affiliation(s)
- Traci N. Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Campus, Washington, D.C., USA
| | - Heather M. Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Alicia Beeghly-Fadiel
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fabian Camancho
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Deanna Chyn
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Emily K. Cloyd
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Holly R. Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Charlotte E. Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago School of Medicine and Division of Epidemiology and Biostatistics, School of Public Health, Chicago, Illinois, USA
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - Patricia G. Moorman
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren C. Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Will Rosenow
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Veronica W. Setiawan
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Anna H. Wu
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts, USA
| | - Joellen M. Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Yang KH, Lane HY, Chang YC, Tzang RF. Exploring the Effects of Pharmacological, Psychosocial, and Alternative/Complementary Interventions in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Meta-Regression Approach. Int J Neuropsychopharmacol 2021; 24:776-786. [PMID: 34086891 PMCID: PMC8538900 DOI: 10.1093/ijnp/pyab034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/23/2021] [Accepted: 06/03/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There have been various therapies for attention-deficit/hyperactivity disorder (ADHD), but the previous meta-analysis of ADHD efficacy remains unclear. This study aims to systemically meta-regress the effect sizes (ES) of psychostimulant pharmacotherapy (methylphenidate and lisdexamfetamine), non-stimulant pharmacotherapy (atomoxetine and alpha-2 agonists), psychosocial therapy (parental behavioral therapy [PBT]), combination therapy (psychostimulant plus PBT), and alternative/complementary interventions to determine the right treatment for ADHD. METHODS We searched various ADHD interventions from the MEDLINE and PubMed databases (National Center for Biotechnology Information) between January 1, 1980, and July 30, 2018. Following the meta-analysis of random effects, the meta-regression analyses were used to explore factors potentially influencing treatment efficacy. The confounding variables included type of treatment, type of study, age, type of symptom scale used, and year of publication. RESULTS A total of 107 trials (n = 9883 participants) were included. After adjustment, compared with the psychostimulant therapy (28 trial, 2134 participants), non-stimulant pharmacotherapy (28 trials, 4991 participants) and alternative/complement intervention (25 trials, 1195 participants) were less effective by the ES of -0.384 (P = .004) and -0.419 (P = .028), respectively. However, compared with psychostimulant, PBT (19 trials, 1122 participants; ES = -0.308, P = .095) and the combination of psychostimulant and PBT (7 trials, 441participants; ES = -0.196, P = .209) did not differ significantly. CONCLUSIONS Psychostimulant therapy surpassed non-stimulant pharmacotherapy and alternative/complement intervention. Psychostimulant therapy, PBT, and the combination of psychostimulant therapy and PBT appear to be similar in efficacy according to this meta-regression.
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Affiliation(s)
- Kung-Han Yang
- Department of Applied Mathematics, Chinese Culture University, Taipei, Taiwan
| | - Hsien-Yuan Lane
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan,Graduate Institute of Biomedical Sciences, China Medical University Medical College, Taichung, Taiwan,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, Taipei, Taiwan
| | - Ruu-Fen Tzang
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan,Correspondence: Ruu-Fen Tzang, MD, Department of Psychiatry, Mackay Memorial Hospital, Number 92, Sec. 2, Zhong Shan N Road, Taipei 104, Taiwan ()
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36
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Saa JP, Tse T, Baum CM, Cumming T, Josman N, Rose M, O'Keefe S, Sewell K, Nguyen V, Carey LM. Cognitive Recovery After Stroke: A Meta-analysis and Metaregression of Intervention and Cohort Studies. Neurorehabil Neural Repair 2021; 35:585-600. [PMID: 34027728 DOI: 10.1177/15459683211017501] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cognition affects poststroke recovery, but meta-analyses of cognition have not yet provided a comparison of observational and intervention evidence. OBJECTIVE To describe the trajectory of poststroke cognition and the factors that moderate it across intervention and observational cohorts. METHODS Six databases were searched up to January 2020. Studies describing quantitative changes in cognition in adults poststroke were included. Interventions were classified into pharmacological, therapist-led, nonroutine/alternative, and usual care. Summary estimates were compared via hierarchical mixed-effects models. Age, recovery stage, stroke etiology, cognitive domain targeted in studies, and intervention types were investigated as moderators of cognition. Recovery stage and intervention were further analyzed in a multiplicative metaregression model. RESULTS A total of 43 intervention trials and 79 observation cohorts involving 28 222 stroke participants were included. Heterogeneity was significant (τ2 = 0.09; CI = 0.01-0.21, P < .001) with no evidence of publication bias. Cognitive recovery was greater in intervention trials (g = 0.47; CI = 0.37-0.58) than observational cohorts (g = 0.28; CI = 0.20-0.36) across all moderators analyzed. Nonroutine/alternative and pharmacological trials achieved the best overall results (g = 0.57, CI = 0.42-0.73, and g = 0.52, CI = 0.30-0.74, respectively), followed by therapist-led (g = 0.46; CI = 0.17-0.74), and usual care (g = 0.28; CI = 0.11-0.45) interventions. Medium recovery effects (ie, g ≥ 0.5) were observed in examining first-ever stroke, executive function, visuo-perceptual, consciousness, and psychomotor skills, 61 to 180 days poststroke, in participants aged 65 to 70 years. CONCLUSION Cognitive recovery is possible using different controlled interventions in all recovery stages, with smaller benefits ≥2 years poststroke. Longer-term studies are needed to determine the role of nonroutine/alternative therapies and the association between cognitive recovery and performance in everyday activities.
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Affiliation(s)
- Juan Pablo Saa
- La Trobe University, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, Australia
| | - Tamara Tse
- La Trobe University, Melbourne, VIC, Australia
| | - Carolyn M Baum
- Washington University in Saint Louis, MO, USA.,Washington University School of Medicine, St Louis, MO, USA
| | | | | | | | | | - Katherine Sewell
- La Trobe University, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, Australia
| | - Vinh Nguyen
- La Trobe University, Melbourne, VIC, Australia
| | - Leeanne M Carey
- La Trobe University, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, Australia
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Ross JJ, Wasserfall CH, Bacher R, Perry DJ, McGrail K, Posgai AL, Dong X, Muir A, Li X, Campbell-Thompson M, Brusko TM, Schatz DA, Haller MJ, Atkinson MA. Exocrine Pancreatic Enzymes Are a Serological Biomarker for Type 1 Diabetes Staging and Pancreas Size. Diabetes 2021; 70:944-954. [PMID: 33441381 PMCID: PMC7980193 DOI: 10.2337/db20-0995] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/01/2021] [Indexed: 01/04/2023]
Abstract
Exocrine pancreas abnormalities are increasingly recognized as features of type 1 diabetes. We previously reported reduced serum trypsinogen levels and in a separate study, smaller pancreata at and before disease onset. We hypothesized that three pancreas enzymes (amylase, lipase, and trypsinogen) might serve as serological biomarkers of pancreas volume and risk for type 1 diabetes. Amylase, lipase, and trypsinogen were measured from two independent cohorts, together comprising 800 serum samples from single-autoantibody-positive (1AAb+) and multiple-AAb+ (≥2AAb+) subjects, individuals with recent-onset or established type 1 diabetes, their AAb-negative (AAb-) first-degree relatives, and AAb- control subjects. Lipase and trypsinogen were significantly reduced in ≥2AAb+, recent-onset, and established type 1 diabetes subjects versus control subjects and 1AAb+, while amylase was reduced only in established type 1 diabetes. Logistic regression models demonstrated trypsinogen plus lipase (area under the receiver operating characteristic curve [AUROC] = 81.4%) performed equivalently to all three enzymes (AUROC = 81.4%) in categorizing ≥2AAb+ versus 1AAb+ subjects. For cohort 2 (n = 246), linear regression demonstrated lipase and trypsinogen levels could individually and collectively serve as indicators of BMI-normalized relative pancreas volume (RPVBMI, P < 0.001), previously measured by MRI. Serum lipase and trypsinogen levels together provide the most sensitive serological biomarker of RPVBMI and may improve disease staging in pretype 1 diabetes.
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Affiliation(s)
- James J Ross
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
| | - Clive H Wasserfall
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
| | - Rhonda Bacher
- Department of Biostatistics, College of Medicine, University of Florida, Gainesville, FL
| | - Daniel J Perry
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
| | - Kieran McGrail
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
| | - Amanda L Posgai
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
| | - Xiaoru Dong
- Department of Biostatistics, College of Medicine, University of Florida, Gainesville, FL
| | - Andrew Muir
- Department of Pediatrics, Emory University, Atlanta, GA
| | - Xia Li
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Martha Campbell-Thompson
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
- Department of Biomedical Engineering, College of Engineering, University of Florida, Gainesville, FL
| | - Todd M Brusko
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
- Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL
| | - Desmond A Schatz
- Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL
| | - Michael J Haller
- Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL
| | - Mark A Atkinson
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
- Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL
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Wu Y, Johnson BT, Chen S, Chen Y, Livingston J, Pescatello LS. Tai Ji Quan as antihypertensive lifestyle therapy: A systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:211-221. [PMID: 32360952 PMCID: PMC7987647 DOI: 10.1016/j.jshs.2020.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND Professional health organizations are not currently recommending Tai Ji Quan alongside aerobic exercise to treat hypertension. We aimed to examine the efficacy of Tai Ji Quan as antihypertensive lifestyle therapy. METHODS Tai Ji Quan interventions published in English and Chinese were included when they involved healthy adults, reported pre- and post-intervention blood pressure (BP), and had a non-exercise/non-diet control group. We systematically searched 11 electronic databases for studies published through July 31, 2018, yielding 31 qualifying controlled trials. We (1) evaluated the risk of bias and methodological study quality, (2) performed meta-regression analyses following random-effects assumptions, and (3) generated additive models representing the largest possible clinically relevant BP reductions. RESULTS Participants (n = 3223) were middle-aged (56.6 ± 15.1 years of age, mean ± SD) adults with prehypertension (systolic BP (SBP) = 136.9 ± 15.2 mmHg, diastolic BP (DBP) = 83.4 ± 8.7 mmHg). Tai Ji Quan was practiced 4.0 ± 1.4 sessions/week for 54.0 ± 10.6 min/session for 22.3 ± 20.2 weeks. Overall, Tai Ji Quan elicited significant reductions in SBP (-11.3 mmHg, 95%CI: -14.6 to -8.0; d+ = -0.75) and DBP (-4.8 mmHg, 95%CI: -6.4 to -3.1; d+ = -0.53) vs. control (p < 0.001). Controlling for publication bias among samples with hypertension, Tai Ji Quan trials published in English elicited SBP reductions of 10.4 mmHg and DBP reductions of 4.0 mmHg, which was half the magnitude of trials published in Chinese (SBP reductions of 18.6 mmHg and DBP reductions of 8.8 mmHg). CONCLUSION Our results indicate that Tai Ji Quan is a viable antihypertensive lifestyle therapy that produces clinically meaningful BP reductions (i.e., 10.4 mmHg and 4.0 mmHg of SBP and DBP reductions, respectively) among individuals with hypertension. Such magnitude of BP reductions can lower the incidence of cardiovascular disease by up to 40%.
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Affiliation(s)
- Yin Wu
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA; Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT 06269, USA.
| | - Blair T Johnson
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT 06269, USA; Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Shiqi Chen
- Department of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yiyang Chen
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Jill Livingston
- Homer Babbidge Library, University of Connecticut, Storrs, CT 06269, USA
| | - Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA; Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT 06269, USA
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Hodgson SH, Mansatta K, Mallett G, Harris V, Emary KRW, Pollard AJ. What defines an efficacious COVID-19 vaccine? A review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2. THE LANCET. INFECTIOUS DISEASES 2021; 21:e26-e35. [PMID: 33125914 PMCID: PMC7837315 DOI: 10.1016/s1473-3099(20)30773-8] [Citation(s) in RCA: 402] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022]
Abstract
The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused more than 1 million deaths in the first 6 months of the pandemic and huge economic and social upheaval internationally. An efficacious vaccine is essential to prevent further morbidity and mortality. Although some countries might deploy COVID-19 vaccines on the strength of safety and immunogenicity data alone, the goal of vaccine development is to gain direct evidence of vaccine efficacy in protecting humans against SARS-CoV-2 infection and COVID-19 so that manufacture of efficacious vaccines can be selectively upscaled. A candidate vaccine against SARS-CoV-2 might act against infection, disease, or transmission, and a vaccine capable of reducing any of these elements could contribute to disease control. However, the most important efficacy endpoint, protection against severe disease and death, is difficult to assess in phase 3 clinical trials. In this Review, we explore the challenges in assessing the efficacy of candidate SARS-CoV-2 vaccines, discuss the caveats needed to interpret reported efficacy endpoints, and provide insight into answering the seemingly simple question, "Does this COVID-19 vaccine work?"
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Affiliation(s)
| | - Kushal Mansatta
- University of Oxford Clinical Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Garry Mallett
- University of Oxford Clinical Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Victoria Harris
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, UK
| | - Katherine R W Emary
- Oxford Vaccine Group, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
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Abstract
BACKGROUND Digital technologies provide a platform for accelerating science and broadening impact in behavioral medicine. PURPOSE The objective of this invited keynote presentation or paper is to offer a blueprint for navigating the rapidly changing waters of digital health. METHODS A strategic literature review on digital health technologies in behavioral medicine was combined with a review of relevant policy initiatives to yield insights on: (a) knowledge building, (b) collaboration, and (c) public health stewardship. RESULTS Digital platforms offer unprecedented leverage for accelerating science, facilitating collaboration, and advancing public health. Early successes in behavioral medicine demonstrated how digital platforms could extend the reach of theory-based behavioral therapeutics through increases in efficiency and scale. As medical investments in health information technology increased, the field of behavioral informatics emerged as the collaborative glue binding behavioral theory into a new generation of patient-facing applications, clinical decision support tools, evidence-based communication programs, and population health management strategies. As a leader within the interstitial space between medicine, psychology, and engineering, the Society of Behavioral Medicine is in a distinct position to exert influence on the ways in which our science is utilized to eliminate health disparities; improve support for patients, caregivers, and communities; to promote general health and well-being; and to offer relief when confronted with psychological pain or addiction. CONCLUSION Riding the wave of digital transformation has less to do with mastering the complexities of the latest technologies and more to do with adhering closely to established principles for navigating a rapidly changing information environment.
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Peres LC, Bethea TN, Camacho TF, Bandera EV, Beeghly-Fadiel A, Chyn DL, Harris HR, Joslin CE, Moorman PG, Myers E, Ochs-Balcom HM, Rosenow W, Setiawan VW, Wu AH, Rosenberg L, Schildkraut JM. Racial Differences in Population Attributable Risk for Epithelial Ovarian Cancer in the OCWAA Consortium. J Natl Cancer Inst 2020; 113:710-718. [PMID: 33252629 DOI: 10.1093/jnci/djaa188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/31/2020] [Accepted: 10/14/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The causes of racial disparities in epithelial ovarian cancer (EOC) incidence remain unclear. Differences in the prevalence of ovarian cancer risk factors may explain disparities in EOC incidence among African American (AA) and White women. METHODS We used data from 4 case-control studies and 3 case-control studies nested within prospective cohorts in the Ovarian Cancer in Women of African Ancestry Consortium to estimate race-specific associations of 10 known or suspected EOC risk factors using logistic regression. Using the Bruzzi method, race-specific population attributable risks (PAR) were estimated for each risk factor individually and collectively, including groupings of exposures (reproductive factors and modifiable factors). All statistical tests were 2-sided. RESULTS Among 3244 White EOC cases and 9638 controls and 1052 AA EOC cases and 2410 controls, AA women had a statistically significantly higher PAR (false discovery rate [FDR] P < .001) for first-degree family history of breast cancer (PAR = 10.1%, 95% confidence interval [CI] = 6.5% to 13.7%) compared with White women (PAR = 2.6%, 95% CI = 0.8% to 4.4%). After multiple test correction, AA women had a higher PAR than White women when evaluating all risk factors collectively (PAR = 61.6%, 95% CI = 48.6% to 71.3% vs PAR = 43.0%, 95% CI = 32.8% to 51.4%, respectively; FDR P = .06) and for modifiable exposures, including body mass index, oral contraceptives, aspirin, and body powder (PAR = 36.0%, 95% CI = 21.0% to 48.8% vs PAR = 13.8%, 95% CI = 4.5% to 21.8%, respectively; FDR P = .04). CONCLUSIONS Collectively, the selected risk factors accounted for slightly more of the risk among AA than White women, and interventions to reduce EOC incidence that are focused on multiple modifiable risk factors may be slightly more beneficial to AA women than White women at risk for EOC.
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Affiliation(s)
- Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Campus, Washington, DC, USA
| | - Tareq F Camacho
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Alicia Beeghly-Fadiel
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Deanna L Chyn
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago School of Medicine and Division of Epidemiology and Biostatistics, School of Public Health, Chicago, IL, USA
| | - Patricia G Moorman
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Evan Myers
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC, USA
| | - Heather M Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Will Rosenow
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - V Wendy Setiawan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Joellen M Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Moore SM, Musil CM, Alder ML, Pignatiello G, Higgins P, Webel A, Wright KD. Building a Research Data Repository for Chronic Condition Self-Management Using Harmonized Data. Nurs Res 2020; 69:254-263. [PMID: 32205788 DOI: 10.1097/nnr.0000000000000435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Building nursing research data repositories with the goal of comparing and synthesizing results across numerous studies and public sharing of data is still in early stages of development. OBJECTIVES We describe the process of using common data elements (CDEs) to build a data repository for research addressing self-management of chronic conditions. Issues in the development of CDEs, lessons learned in the creation of a combined data set across seven studies of different chronic condition populations, and recommendations for creating and sharing harmonized nursing research data sets are provided. METHODS In 2014, at initiation of a National Institutes of Health-funded Centers of Excellence in Self-Management Research, our center investigators defined a set of CDEs for use in future center-funded pilot studies consisting of populations having different chronic conditions with the intent to combine the study data sets. Over the next 4 years, center investigators were provided with standardized codebooks and data collection protocols for applying the CDEs and data storage. Data from seven pilot studies were subsequently combined. RESULTS Although each pilot study was small-with sample sizes ranging from 18 to 31 participants-our combined data set of 179 participants provides us with a sample size sufficient to conduct analyses that could not be done with the individual small samples alone. The research data repository addressing self-management of chronic conditions will soon be available for public sharing. DISCUSSION Our experience demonstrates that, with careful, upfront planning and ongoing vigilant oversight, CDEs can be applied across studies consisting of different chronic condition populations to combine data sets to create research data repositories for public sharing.
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Affiliation(s)
- Shirley M Moore
- Shirley M. Moore, PhD, RN, is Professor Emerita, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Carol M. Musil, PhD, RN, is Dean and Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Megan L. Alder, BSN, RN, is PhD student, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Grant Pignatiello, PhD, RN, is Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Patricia Higgins, PhD, RN, is Associate Professor Emerita, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Allison Webel, PhD, RN, is Associate Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Kathy D. Wright, PhD, RN, CNS, is Assistant Professor and Chief Diversity Officer, College of Nursing, The Ohio State University, Columbus
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Jalali A, Ryan DA, Jeng PJ, McCollister KE, Leff JA, Lee JD, Nunes EV, Novo P, Rotrosen J, Schackman BR, Murphy SM. Health-related quality of life and opioid use disorder pharmacotherapy: A secondary analysis of a clinical trial. Drug Alcohol Depend 2020; 215:108221. [PMID: 32777692 PMCID: PMC7502461 DOI: 10.1016/j.drugalcdep.2020.108221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the health-related quality-of-life (HRQoL) of persons with opioid use disorder (OUD) seeking treatment in an inpatient detoxification or short-term residential setting; continuing treatment as outpatients. METHODS We conducted a secondary analysis of data from a clinical trial (N = 508) where participants were randomized to extended-release naltrexone or buprenorphine-naloxone for the prevention of opioid relapse. We used a generalized structural equation regression mixture model to identify associations of HRQoL (EQ-5D) trajectories, including latent characteristics, over the 24-week trial and 36-week follow-up period, among participants who reported HRQoL beyond baseline. This novel framework accounted for baseline and time-varying characteristics, while simultaneously identifying latent classes. RESULTS We identified two subpopulations: HRQoL "pharmacotherapy responsive" (82.3 %) and HRQoL "characteristic sensitive" (17.7 %). The pharmacotherapy responsive subpopulation was characterized by a shortterm HRQoL improvement and then stable HRQoL over time, and by a positive association between HRQoL and receiving pharmacotherapy in the past 30 days. The characteristic sensitive subpopulation was characterized by an initial improvement in HRQoL with a gradual decline over time, and no significant HRQoL response to pharmacotherapy. HRQoL changes over time in this subpopulation were more influenced by baseline demographic, socioeconomic, and psychosocial characteristics. CONCLUSION Our findings suggest that while HRQoL may be improved and sustained through targeted efforts to promote use of pharmacotherapy for many persons with OUD, an identifiable subpopulation may require additional services that address socioeconomic and psychosocial issues to achieve HRQoL benefits. Our analysis provides insight for improving individualized care for persons with opioid use disorder seeking treatment.
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Affiliation(s)
- Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA.
| | - Danielle A Ryan
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Philip J Jeng
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jared A Leff
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Joshua D Lee
- New York University Grossman School of Medicine, New York, NY, USA
| | - Edward V Nunes
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY USA
| | - Patricia Novo
- New York University Grossman School of Medicine, New York, NY, USA
| | - John Rotrosen
- New York University Grossman School of Medicine, New York, NY, USA
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
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Jones CW, Woodford AL, Platts-Mills TF. Characteristics of COVID-19 clinical trials registered with ClinicalTrials.gov: cross-sectional analysis. BMJ Open 2020; 10:e041276. [PMID: 32948577 PMCID: PMC7500290 DOI: 10.1136/bmjopen-2020-041276] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To characterise current COVID-19-related research activities. DESIGN Cross-sectional analysis. SETTING Clinical trials registered with ClinicalTrials.gov testing interventions relevant to COVID-19. DATA SOURCES ClinicalTrials.gov was searched for COVID-19 and related terms to identify trials registered between 1 December 2019 and 1 May 2020 that test interventions related to the COVID-19 pandemic. MAIN OUTCOME MEASURES We classified trials according to intervention type, and report key trial characteristics including recruitment status, location, funder type, target enrolment number, intervention model (single group, randomised or sequential assignment) and projected completion date. RESULTS Of the 630 identified clinical trials related to COVID-19, 509 (81%) involved the study of drugs or biological agents. Of these trials of drugs and biologics, 305 (60%) use an open-label design, 43 (8%) are single blinded (participant only) and 161 (32%) are double blinded (participant and investigator). 94 (18%) of the drug/biological trials are non-randomised. Either hydroxychloroquine or chloroquine is administered as part of the study protocol in 152 (30%) of the drug/biological trials. The total planned enrolment for these hydroxychloroquine/chloroquine trials is over 200 000 participants, which represents 65% of the total planned enrolment for all registered trials of drugs or biologics. There are also at least 25 registered trials of azithromycin (n=53), convalescent plasma (n=38), lopinavir/ritonavir (n=30), stem cell treatments (n=29) and tocilizumab (n=25). 142 trials were registered in the first 3 months of 2020, and 488 trials were registered between 1 April and 1 May 2020. CONCLUSIONS These findings demonstrate a robust research response to the COVID-19 pandemic, though many of the currently planned and ongoing trials focus on a small number of potential therapies, and many also lack essential design features and power necessary to provide accurate treatment effect estimates.
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Affiliation(s)
- Christopher W Jones
- Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Ashley L Woodford
- Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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Joyeux L, De Bie F, Danzer E, Russo FM, Javaux A, Peralta CFA, De Salles AAF, Pastuszka A, Olejek A, Van Mieghem T, De Coppi P, Moldenhauer J, Whitehead WE, Belfort MA, Lapa DA, Acacio GL, Devlieger R, Hirose S, Farmer DL, Van Calenbergh F, Adzick NS, Johnson MP, Deprest J. Learning curves of open and endoscopic fetal spina bifida closure: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:730-739. [PMID: 31273862 DOI: 10.1002/uog.20389] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/18/2019] [Accepted: 06/24/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The Management of Myelomeningocele Study (MOMS) trial demonstrated the safety and efficacy of open fetal surgery for spina bifida aperta (SBA). Recently developed alternative techniques may reduce maternal risks without compromising the fetal neuroprotective effects. The aim of this systematic review was to assess the learning curve (LC) of different fetal SBA closure techniques. METHODS MEDLINE, Web of Science, EMBASE, Scopus and Cochrane databases and the gray literature were searched to identify relevant articles on fetal surgery for SBA, without language restriction, published between January 1980 and October 2018. Identified studies were reviewed systematically and those reporting all consecutive procedures and with postnatal follow-up ≥ 12 months were selected. Studies were included only if they reported outcome variables necessary to measure the LC, as defined by fetal safety and efficacy. Two authors independently retrieved data, assessed the quality of the studies and categorized observations into blocks of 30 patients. For meta-analysis, data were pooled using a random-effects model when heterogeneous. To measure the LC, we used two complementary methods. In the group-splitting method, competency was defined when the procedure provided results comparable to those in the MOMS trial for 12 outcome variables representing the immediate surgical outcome, short-term neonatal neuroprotection and long-term neuroprotection at ≥ 12 months of age. Then, when raw patient data were available, we performed cumulative sum analysis based on a composite binary outcome defining successful surgery. The composite outcome combined four clinically relevant variables for safety (absence of extreme preterm delivery < 30 weeks, absence of fetal death ≤ 7 days after surgery) and efficacy (reversal of hindbrain herniation and absence of any neonatal treatment of dehiscence or cerebrospinal fluid leakage at the closure site). RESULTS Of 6024 search results, 17 (0.3%) studies were included, all of which had low, moderate or unclear risk of bias. Fetal SBA closure was performed using standard hysterotomy (11 studies), mini-hysterotomy (one study) or fetoscopy by either exteriorized-uterus single-layer closure (one study), percutaneous single-layer closure (three studies) or percutaneous two-layer closure (one study). Only outcomes for standard hysterotomy could be meta-analyzed. Overall, outcomes improved significantly with experience. Competency was reached after 35 consecutive cases for standard hysterotomy and was predicted to be achieved after ≥ 57 cases for mini-hysterotomy and ≥ 56 for percutaneous two-layer fetoscopy. For percutaneous and exteriorized-uterus single-layer fetoscopy, competency was not reached in the 81 and 28 cases available for analysis, respectively, and LC prediction analysis could not be performed. CONCLUSIONS The number of cases operated is correlated with the outcome of fetal SBA closure, and the number of operated cases required to reach competency ranges from 35 for standard hysterotomy to ≥ 56-57 for minimally invasive modifications. Our observations provide important information for institutions looking to establish a new fetal center, develop a new fetal surgery technique or train their team, and inform referring clinicians, potential patients and third parties. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L Joyeux
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - F De Bie
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E Danzer
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - F M Russo
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - A Javaux
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - C F A Peralta
- Department of Fetal Medicine, The Heart Hospital, University of São Paulo, São Paulo, Brazil
- Department of Fetal Medicine, Pro Matre Hospital, São Paulo, Brazil
| | - A A F De Salles
- Neuroscience Institute, The Heart Hospital, University of São Paulo, São Paulo, Brazil
| | - A Pastuszka
- Department of Descriptive and Topografic Anatomy, Medical University of Silesia, Katowice, Poland
- Division of Dentistry, School of Medicine, Zabrze, Poland
| | - A Olejek
- Department of Gynecology, Obstetrics and Gynecologic Oncology, Medical University of Silesia, Bytom, Poland
| | - T Van Mieghem
- Department of Obstetrics and Gynecology, Sinai Health System, Mount Sinai Hospital, Toronto, ON, Canada
| | - P De Coppi
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Specialist Neonatal and Paediatric Surgery Unit, Great Ormond Street Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Moldenhauer
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - W E Whitehead
- Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Fetal Center, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Texas Children's Fetal Center, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - D A Lapa
- Fetal Therapy Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - G L Acacio
- Department of Obstetrics and Gynecology, Taubate University, São Paulo, Brazil
| | - R Devlieger
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
| | - S Hirose
- Fetal Care and Treatment Center, UC Davis Children's Hospital, Sacramento, CA, USA
| | - D L Farmer
- Fetal Care and Treatment Center, UC Davis Children's Hospital, Sacramento, CA, USA
| | - F Van Calenbergh
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - N S Adzick
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M P Johnson
- Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J Deprest
- MyFetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Division Women and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium
- Institute of Women's Health, University College London Hospitals, London, UK
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Meunier A, Marignol L. The radiotherapy cancer patient: female inclusive, but male dominated. Int J Radiat Biol 2020; 96:851-856. [PMID: 32162989 DOI: 10.1080/09553002.2020.1741720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: The sex-neutral language used in preclinical and clinical research intends to be inclusive of both the female and the male population, but the practice of data pooling prevents the detection of the impact of sex on cancer biology and response to medications and treatment. This study aimed to examine the consideration of sex as biological variable in the evaluation of radiation therapy in preclinical and clinical studies.Methods: Preclinical and clinical studies published over a 12-month period were reviewed for the reporting of cells, animal or patient sex and the inclusion of sex as a biological variable in both study design and data analysis.Results: A total of 321 articles met the inclusion criteria: 41 (13%) preclinical and 280 (87%) clinical studies. Two articles reported separate outcome data for males and females. Where the sex of participants was stated (230/280 (82%), 81% reported a larger number of male participants, compared to females. Less than half (45%) of studies used sex as a variable in data analysis. Sex disparity was not dependent on study location but may be more prominent in certain cancer sites. In preclinical studies, sex was at best stated in those reporting on animals (48% of studies).Conclusion: Referring to a radiotherapy cancer patient, the literature is female inclusive, but a gap does exist when it comes to consideration of sex in data analysis. The pooled analysis of female and male data could introduce statistical biases and prevent the identification of key sex-specific biological subtilities that do affect radiation responses.
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Affiliation(s)
- Armelle Meunier
- Translational Radiation Biology and Molecular Oncology, Applied Radiation Therapy Trinity, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Laure Marignol
- Translational Radiation Biology and Molecular Oncology, Applied Radiation Therapy Trinity, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
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Feustel AC, MacPherson A, Fergusson DA, Kieburtz K, Kimmelman J. Risks and benefits of unapproved disease-modifying treatments for neurodegenerative disease. Neurology 2020; 94:e1-e14. [PMID: 31792092 PMCID: PMC7011691 DOI: 10.1212/wnl.0000000000008699] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/22/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To determine whether patients randomized to unapproved, disease-modifying interventions in neurodegenerative disease trials have better outcomes than patients randomized to placebo by performing a systematic review and meta-analysis of risk and benefit experienced by patients in randomized placebo-controlled trials testing investigational treatments for Alzheimer disease, Parkinson disease, Huntington disease, or amyotrophic lateral sclerosis (ALS). METHODS We searched MEDLINE, Embase, and ClinicalTrials.gov for results of randomized trials testing non-Food and Drug Administration-approved, putatively disease-modifying interventions from January 2005 to May 2018. Trial characteristics were double-extracted. Coprimary endpoints were the treatment advantage over placebo on efficacy (standardized mean difference in outcomes) and safety (risk ratios of serious adverse events and withdrawals due to adverse events), calculated with random effects meta-analyses. The study was registered on PROSPERO (CRD42018103798). RESULTS We included 113 trials (n = 39,875 patients). There was no significant efficacy advantage associated with assignment to putatively disease-modifying interventions compared to placebo for Alzheimer disease (standardized mean difference [SMD] -0.03, 95% confidence interval [CI] -0.07 to 0.01), Parkinson disease (SMD -0.09, 95% CI -0.32 to 0.15), ALS (SMD 0.02, 95% CI -0.25 to 0.30), or Huntington disease (0.02, 95% CI -0.27 to 0.31). Patients with Alzheimer disease assigned to active treatment were at higher risk of experiencing serious adverse events (risk ratio [RR] 1.15, 95% CI 1.04-1.27) and withdrawals due to adverse events (RR 1.44, 95% CI 1.21-1.70). CONCLUSIONS Assignment to active treatment was not beneficial for any of the indications examined and may have been slightly disadvantageous for patients with Alzheimer disease. Our findings suggest that patients with neurodegenerative diseases are not, on the whole, harmed by assignment to placebo when participating in trials.
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Affiliation(s)
- Aden C Feustel
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY
| | - Amanda MacPherson
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY
| | - Dean A Fergusson
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY
| | - Karl Kieburtz
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY
| | - Jonathan Kimmelman
- From the Biomedical Ethics Unit (A.C.F., A.M., J.K.), McGill University, Montreal, Quebec; Ottawa Hospital Research Institute (D.A.F.), ON, Canada; and Department of Neurology (K.K.), University of Rochester, NY.
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Brody C, Sok S, Tuot S, Pantelic M, Restoy E, Yi S. Do combination HIV prevention programmes result in increased empowerment, inclusion and agency to demand equal rights for marginalised populations in low-income and middle-income countries? A systematic review. BMJ Glob Health 2019; 4:e001560. [PMID: 31673432 PMCID: PMC6797339 DOI: 10.1136/bmjgh-2019-001560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/30/2019] [Accepted: 09/11/2019] [Indexed: 12/23/2022] Open
Abstract
Introduction This systematic review aims to determine if combination HIV prevention programmes include outcome measures for empowerment, inclusion and agency to demand equal rights and measure the relationship between empowerment and HIV prevention outcomes. Methods An electronic literature search of PubMed, POPLINE, Index Medicus and Google Scholar was conducted between August and October 2018. We included studies that evaluated combination prevention programmes that had all three types of intervention components and that specifically serve members of populations disproportionately affected by HIV published from 2008 to 2018. The selected studies were screened for inclusion, and relevant data abstracted, assessed for bias and synthesised. Results This review included a total of 15 studies. Findings indicate that combination HIV prevention programmes for marginalised populations have delivered a variety of theory-based behavioural and structural interventions that support improvements in empowerment, inclusion and agency. However, empowerment, inclusion and least of all agency are not measured consistently or in a standardised way. In addition, analysis of their relationships with HIV prevention outcomes is rare. Out of our 15 included studies, only two measured a relationship between an empowerment, inclusion or agency outcome and an HIV prevention outcome. Conclusion These findings suggest that policy-makers, programme planners and researchers might need to consider the intermediate steps on the pathway to increased condom use and HIV testing so as to explain the ‘how’ of their achievements and inform future investments in HIV prevention. This will support replication and expansion of programmes and ensure sustainability of the programmes. PROSPERO registration number CRD42018106909
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Affiliation(s)
- Carinne Brody
- Center for Global Health Research, Touro University California, Vallejo, California, USA
| | - Say Sok
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Marija Pantelic
- Department of Social Policy and Intervention, Oxford University, Oxford, UK.,Frontline AIDS, Brighton, UK.,Department of Medical Education, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Enrique Restoy
- Frontline AIDS, Brighton, UK.,School of Global Studies, Sussex University, Brighton, United Kingdom
| | - Siyan Yi
- Center for Global Health Research, Touro University California, Vallejo, California, USA.,KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Singh DKA, Shahar S, Vanoh D, Kamaruzzaman SB, Tan MP. Diabetes, arthritis, urinary incontinence, poor self‐rated health, higher body mass index and lower handgrip strength are associated with falls among community‐dwelling middle‐aged and older adults: Pooled analyses from two cross‐sectional Malaysian datasets. Geriatr Gerontol Int 2019; 19:798-803. [DOI: 10.1111/ggi.13717] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Devinder Kaur Ajit Singh
- Center for Healthy Aging and Wellness, Faculty of Health SciencesUniversiti Kebangsaan Malaysia Kuala Lumpur Malaysia
| | - Suzana Shahar
- Center for Healthy Aging and Wellness, Faculty of Health SciencesUniversiti Kebangsaan Malaysia Kuala Lumpur Malaysia
| | - Divya Vanoh
- Center for Healthy Aging and Wellness, Faculty of Health SciencesUniversiti Kebangsaan Malaysia Kuala Lumpur Malaysia
- Program of Nutrition and Dietetics, School of Health Sciences, Health CampusUniversiti Sains Malaysia Kubang Kerian Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Department of Medicine, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
- Aging and Age‐Associated Disorders Research Group, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
- Aging and Age‐Associated Disorders Research Group, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
- Center for Innovation in Medical EngineeringUniversity of Malaya Kuala Lumpur Malaysia
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50
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Dickinson SL, Golzarri-Arroyo L, Brown AW, McComb B, Kahathuduwa CN, Allison DB. Change in study randomization allocation needs to be included in statistical analysis: comment on 'Randomized controlled trial of weight loss versus usual care on telomere length in women with breast cancer: the lifestyle, exercise, and nutrition (LEAN) study'. Breast Cancer Res Treat 2019; 175:263-264. [PMID: 30721442 PMCID: PMC6494688 DOI: 10.1007/s10549-019-05155-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Stephanie L Dickinson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, 1025 E. 7th St, Bloomington, IN, 47408, USA.
| | - Lilian Golzarri-Arroyo
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, 1025 E. 7th St, Bloomington, IN, 47408, USA
| | - Andrew W Brown
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Bryan McComb
- Division of Biostatistics, Department of Population Health, New York University Langone Health, New York, NY, USA
| | - Chanaka N Kahathuduwa
- Department of Human Development and Family Studies, Texas Tech University, Lubbock, TX, USA
| | - David B Allison
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, 1025 E. 7th St, Bloomington, IN, 47408, USA
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