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Liu C, Jiao Y, Su L, Liu W, Zhang H, Nie S, Gong M. Effective Privacy Protection Strategies for Pregnancy and Gestation Information From Electronic Medical Records: Retrospective Study in a National Health Care Data Network in China. J Med Internet Res 2024; 26:e46455. [PMID: 39163593 PMCID: PMC11372317 DOI: 10.2196/46455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 01/02/2024] [Accepted: 06/22/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Pregnancy and gestation information is routinely recorded in electronic medical record (EMR) systems across China in various data sets. The combination of data on the number of pregnancies and gestations can imply occurrences of abortions and other pregnancy-related issues, which is important for clinical decision-making and personal privacy protection. However, the distribution of this information inside EMR is variable due to inconsistent IT structures across different EMR systems. A large-scale quantitative evaluation of the potential exposure of this sensitive information has not been previously performed, ensuring the protection of personal information is a priority, as emphasized in Chinese laws and regulations. OBJECTIVE This study aims to perform the first nationwide quantitative analysis of the identification sites and exposure frequency of sensitive pregnancy and gestation information. The goal is to propose strategies for effective information extraction and privacy protection related to women's health. METHODS This study was conducted in a national health care data network. Rule-based protocols for extracting pregnancy and gestation information were developed by a committee of experts. A total of 6 different sub-data sets of EMRs were used as schemas for data analysis and strategy proposal. The identification sites and frequencies of identification in different sub-data sets were calculated. Manual quality inspections of the extraction process were performed by 2 independent groups of reviewers on 1000 randomly selected records. Based on these statistics, strategies for effective information extraction and privacy protection were proposed. RESULTS The data network covered hospitalized patients from 19 hospitals in 10 provinces of China, encompassing 15,245,055 patients over an 11-year period (January 1, 2010-December 12, 2020). Among women aged 14-50 years, 70% were randomly selected from each hospital, resulting in a total of 1,110,053 patients. Of these, 688,268 female patients with sensitive reproductive information were identified. The frequencies of identification were variable, with the marriage history in admission medical records being the most frequent at 63.24%. Notably, more than 50% of female patients were identified with pregnancy and gestation history in nursing records, which is not generally considered a sub-data set rich in reproductive information. During the manual curation and review process, 1000 cases were randomly selected, and the precision and recall rates of the information extraction method both exceeded 99.5%. The privacy-protection strategies were designed with clear technical directions. CONCLUSIONS Significant amounts of critical information related to women's health are recorded in Chinese routine EMR systems and are distributed in various parts of the records with different frequencies. This requires a comprehensive protocol for extracting and protecting the information, which has been demonstrated to be technically feasible. Implementing a data-based strategy will enhance the protection of women's privacy and improve the accessibility of health care services.
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Affiliation(s)
- Chao Liu
- Digital Health China Technologies Co, Ltd, Beijing, China
| | - Yuanshi Jiao
- Digital Health China Technologies Co, Ltd, Beijing, China
| | - Licong Su
- Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenna Liu
- Digital Health China Technologies Co, Ltd, Beijing, China
| | - Haiping Zhang
- Digital Health China Technologies Co, Ltd, Beijing, China
| | - Sheng Nie
- Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mengchun Gong
- School of Biomedical Engineering, Guangdong Medical University, Zhanjiang, China
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Bao WKJ, Feng Q, Liu KS, Ho YC. Effectiveness and safety profile of introducing less invasive surfactant administration in management of respiratory distress syndrome: A retrospective cohort study in a tertiary neonatal unit in Hong Kong. Pediatr Neonatol 2024:S1875-9572(24)00116-5. [PMID: 38991861 DOI: 10.1016/j.pedneo.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND The objective was to evaluate the efficacy of introducing less invasive surfactant administration (LISA) for management of preterm neonates with respiratory distress syndrome (RDS). METHODS This was a retrospective cohort study identifying preterm neonates with RDS born between 2017 and 2022 in a tertiary neonatal unit, where LISA was introduced in January 2020. Time trend analysis comparing cohort of neonates born before (2017-2020) and after LISA introduction (2020-2022) was performed. The primary outcomes were incidence and severity of bronchopulmonary dysplasia (BPD). Multivariable regression models were used to estimate the association between introducing LISA to RDS management and health and safety outcomes. RESULTS In total, 261 neonates with RDS were included (114 born after LISA was introduced). Neonates receiving invasive surfactant administration had lower gestational age, birth weight, lower Apgar scores, and higher oxygen requirement, compared to those receiving LISA. In the time trend analysis, introduction of LISA was associated with lower incidence of BPD (odds ratio (95% confidence interval) 0.34 (0.16, 0.72)), and lower severity of BPD (0.31 (0.16, 0.59)). Pre- and post-LISA period showed similar treatment safety profiles. CONCLUSION Introduction of LISA was associated with improved prognosis in neonates with RDS in Hong Kong.
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Affiliation(s)
- Wing Kan Julianna Bao
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong.
| | - Qi Feng
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - King Shun Liu
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong
| | - Yok Chiu Ho
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong
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Wang Y, Shi X, Yin Y, Yang F, Zhang Y, He X, Wen D, Li BX, Ma K. Association Between Neuroinflammation and Parkinson's Disease: A Comprehensive Mendelian Randomization Study. Mol Neurobiol 2024:10.1007/s12035-024-04197-2. [PMID: 38709392 DOI: 10.1007/s12035-024-04197-2] [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: 02/13/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
The objective of the study is to determine the causal relationship and potential mechanisms between Parkinson's disease (PD) and neuroinflammatory and neurotoxic mediators. We conducted two-sample Mendelian randomization (2SMR) study and multivariable Mendelian randomization (MVMR) analysis to investigate the causality between PD and neuroinflammatory and neurotoxic mediators. The mediation analysis with MR was also conducted to determine the potential mediating effect of neuroinflammatory and neurotoxic mediators between asthma and PD. Genetically predicted levels of nine neuroinflammation were associated with changes in PD risk. The associations of PD with CCL24, galectin-3 levels, haptoglobin, and Holo-Transcobalamin-2 remained significant in multivariable analyses. The mediation analysis with MR revealed that asthma affects PD through CCL24 and galectin-3. The results showed neuroinflammation could affect the pathogenesis of PD. In the combined analysis of these nine variables, CCL24, galectin-3 levels, HP, and Holo-Transcobalamin-2 alone were found to be significant. Asthma plays an intermediary role through CCL24 and galectin-3 levels.
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Affiliation(s)
- YiNi Wang
- Department of Hygienic Toxicology, School of Public Health, Harbin Medical University, 157 Baojian Road, NanGang District, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - XinYu Shi
- Department of Hygienic Toxicology, School of Public Health, Harbin Medical University, 157 Baojian Road, NanGang District, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - YaPing Yin
- Department of Hygienic Toxicology, School of Public Health, Harbin Medical University, 157 Baojian Road, NanGang District, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Fei Yang
- Department of Hygienic Toxicology, School of Public Health, Harbin Medical University, 157 Baojian Road, NanGang District, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - YiNan Zhang
- Department of Hygienic Toxicology, School of Public Health, Harbin Medical University, 157 Baojian Road, NanGang District, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Xin He
- Department of Hygienic Toxicology, School of Public Health, Harbin Medical University, 157 Baojian Road, NanGang District, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Da Wen
- Department of Hygienic Toxicology, School of Public Health, Harbin Medical University, 157 Baojian Road, NanGang District, Harbin, 150081, Heilongjiang Province, People's Republic of China
| | - Bai-Xiang Li
- Department of Hygienic Toxicology, School of Public Health, Harbin Medical University, 157 Baojian Road, NanGang District, Harbin, 150081, Heilongjiang Province, People's Republic of China.
| | - Kun Ma
- Department of Hygienic Toxicology, School of Public Health, Harbin Medical University, 157 Baojian Road, NanGang District, Harbin, 150081, Heilongjiang Province, People's Republic of China.
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Tassorelli C, Barbanti P, Finocchi C, Geppetti P, Kokturk P, Russo A, Sacco S, Cepparulo M. The first interim analysis of Italian patients enrolled in the real-world, Pan-European, prospective, observational, phase 4 PEARL study of fremanezumab effectiveness. Neurol Sci 2024; 45:2353-2363. [PMID: 38424386 PMCID: PMC11021338 DOI: 10.1007/s10072-024-07357-3] [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: 10/26/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION In 2020, the Italian Medicines Agency (AIFA) approved the reimbursement of calcitonin gene-related peptide (CGRP) pathway monoclonal antibodies (mAbs), including fremanezumab, in patients with a Migraine Disability Assessment Scale (MIDAS) score ≥ 11, with prescription renewals for up to 12 months in patients with ≥ 50% reduction in MIDAS score at Months 3 and 6. In this sub-analysis of the Pan-European Real Life (PEARL) study, we provide real-world data on fremanezumab use in Italian routine clinical practice (EUPAS35111). METHODS This first interim analysis for Italy was conducted when 300 enrolled adult patients with episodic or chronic migraine (EM, CM) completed 6 months of treatment with fremanezumab. The primary endpoint is the proportion of patients achieving ≥ 50% reduction in monthly migraine days (MMD) across the 6 months post-fremanezumab initiation. Secondary endpoints include: proportion of patients achieving ≥ 50% reduction in MIDAS score at Months 3 and 6, and mean change from baseline across Months 1-6 in MMD and headache-related disability. Safety was assessed through adverse events (AEs) reported. RESULTS Of 354 patients enrolled at Italian centers, 318 (EM, 35.5%, CM, 64.5%) were included in the effectiveness analysis. Of patients with available data, 109 (61.2%) achieved the primary endpoint. 61.0% and 65.1% achieved ≥ 50% reduction in MMDs at Months 3 and 6, respectively; 79.9% and 81.0% experienced ≥ 50% reduction in MIDAS at the same timepoints. CONCLUSION Fremanezumab was effective and well-tolerated over the first 6 months of treatment, with approximately 80% of patients meeting Italian criteria for treatment continuation at Months 3 and 6.
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Affiliation(s)
- Cristina Tassorelli
- Department of Brain & Behavioral Sciences, Headache Science and Neurorehabilitation Centre, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy.
- IRCCS C. Mondino Foundation, Pavia, Italy.
| | - Piero Barbanti
- Headache and Pain Unit, IRCCS San Raffaele, Rome, Italy
- San Raffaele University, Rome, Italy
| | | | - Pierangelo Geppetti
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | | | - Antonio Russo
- Headache Center, Department of Advanced Medical and Surgical Sciences, School of Medicine and Surgery, University of Campania Studies "Luigi Vanvitelli", Naples, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Al-Sahab B, Leviton A, Loddenkemper T, Paneth N, Zhang B. Biases in Electronic Health Records Data for Generating Real-World Evidence: An Overview. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2024; 8:121-139. [PMID: 38273982 PMCID: PMC10805748 DOI: 10.1007/s41666-023-00153-2] [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: 06/30/2023] [Revised: 09/05/2023] [Accepted: 11/07/2023] [Indexed: 01/27/2024]
Abstract
Electronic Health Records (EHR) are increasingly being perceived as a unique source of data for clinical research as they provide unprecedentedly large volumes of real-time data from real-world settings. In this review of the secondary uses of EHR, we identify the anticipated breadth of opportunities, pointing out the data deficiencies and potential biases that are likely to limit the search for true causal relationships. This paper provides a comprehensive overview of the types of biases that arise along the pathways that generate real-world evidence and the sources of these biases. We distinguish between two levels in the production of EHR data where biases are likely to arise: (i) at the healthcare system level, where the principal source of bias resides in access to, and provision of, medical care, and in the acquisition and documentation of medical and administrative data; and (ii) at the research level, where biases arise from the processes of extracting, analyzing, and interpreting these data. Due to the plethora of biases, mainly in the form of selection and information bias, we conclude with advising extreme caution about making causal inferences based on secondary uses of EHRs.
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Affiliation(s)
- Ban Al-Sahab
- Department of Family Medicine, College of Human Medicine, Michigan State University, B100 Clinical Center, 788 Service Road, East Lansing, MI USA
| | - Alan Leviton
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Department of Neurology, Boston Children’s Hospital, Boston, MA USA
| | - Tobias Loddenkemper
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Department of Neurology, Boston Children’s Hospital, Boston, MA USA
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI USA
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI USA
| | - Bo Zhang
- Department of Neurology, Boston Children’s Hospital, Boston, MA USA
- Biostatistics and Research Design, Institutional Centers of Clinical and Translational Research, Boston Children’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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Ashina M, Mitsikostas DD, Amin FM, Kokturk P, Schankin CJ, Sahin G, Pozo-Rosich P, Dorman PJ, Nežádal T, Poole AC, Martins IP, Sumelahti ML, Ramirez Campos V, Ahn AH, Lyras L, Tassorelli C. Real-world effectiveness of fremanezumab for the preventive treatment of migraine: Interim analysis of the pan-European, prospective, observational, phase 4 PEARL study. Cephalalgia 2023; 43:3331024231214987. [PMID: 37987641 DOI: 10.1177/03331024231214987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND The ongoing Pan-European Real Life (PEARL) phase 4 study is evaluating fremanezumab effectiveness and safety for the prevention of episodic and chronic migraine. This interim analysis reports primary, secondary and exploratory endpoints from when 500 participants completed at least six months of treatment. METHODS Adults with episodic migraine or chronic migraine maintaining daily headache diaries were enrolled upon initiation of fremanezumab. Primary endpoint: proportion of participants with ≥50% reduction in monthly migraine days during the six-month period after fremanezumab initiation. Secondary endpoints: mean change from baseline across months 1-12 in monthly migraine days, acute migraine medication use, and headache-related disability. Exploratory endpoint: mean change in headache severity from baseline across months 1-12. Safety was assessed through adverse events reported. RESULTS Overall, 897 participants were enrolled and 574 included in the effectiveness analyses (episodic migraine, 25.8%; chronic migraine, 74.2%). Of participants with data available, 175/313 (55.9%) achieved ≥50% monthly migraine days reduction during the six-month period post-initiation. Across months 1-12, there were sustained reductions in mean monthly migraine days, acute medication use, disability scores, and headache severity. Few adverse events were reported. CONCLUSION PEARL interim results support the effectiveness and safety of fremanezumab for migraine prevention in a real-world population across several European countries.Trial registration: encepp.eu: EUPAS35111.
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Affiliation(s)
- Messoud Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dimos D Mitsikostas
- First Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Faisal Mohammad Amin
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Neurorehabilitation/Traumatic Brain Injury, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Christoph J Schankin
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Gurdal Sahin
- Department of Clinical Sciences of Lund, Lund University, Skåneuro Neurology Clinic, Lund, Sweden
| | - Patricia Pozo-Rosich
- Headache Unit & Research Group, Vall d'Hebron Hospital & Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Paul J Dorman
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tomáš Nežádal
- Institute of Neuropsychiatric Care, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Isabel Pavão Martins
- Centro de Estudos Egas Moniz, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | | | - Andrew H Ahn
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | | | - Cristina Tassorelli
- Department of Brain & Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
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Simião VDM, Gonzalez EF, Probst LF, Pinto RDS, De-Carli AD. Factors affecting the performance of periodontal specialty in secondary oral health care in Brazil. PLoS One 2023; 18:e0287361. [PMID: 37824446 PMCID: PMC10569536 DOI: 10.1371/journal.pone.0287361] [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: 06/04/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate, at a national level, which individual factors of the work process/infrastructure are associated with the achievement of goals in the periodontics specialty in Brazilian Dental Specialty Centers (BDSC). METHODS This was a quantitative, analytical, cross-sectional study. Secondary data from DATASUS and the external evaluation of the second cycle of the BDSC Access and Quality Improvement Program were used. Variable description was carried out in the first stage, and then the bivariate Poisson regression was performed to verify possible associations between the variables and the outcome (achievement of goals in Periodontics in the BDSC). In this analysis, the covariates that were associated with the outcome at the p <0.20 significance level were included in the next step of the analysis. Multivariate Poisson regression with a robust estimator was then performed with those that met the above criterion. The variables that showed a p value < 0.05 were considered in the final model. RESULTS The outcome was achieved in more than seven months of the year (mean 7.03 months, SD 4.20). Most BDSC monitored the established goals (93.2%), had referral as the only way of access (61.7%), had only municipal coverage (68.4%), carried out planning and periodic evaluation of actions (89.2%). A minority has quotas of procedures by Oral Health teams (OHTs) in Primary Health Care (PHC) (18.8%). The presence of a specialist in periodontics was (on average) 1.16 per BDSC and the sum of the workload of dentists working in this specialty was 31.1 hours (SD = 23.9). CONCLUSION It was concluded that the individual factors of the work process/infrastructure associated with the achievement of goals in periodontics in Brazilian BDSC are: monitoring of established goals, BDSC scope and number of professionals working in the specialty.
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Affiliation(s)
- Vinícius de Moraes Simião
- Postgraduate Program in Family Health, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Livia Fernandes Probst
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, São Paulo, São Paulo, Brazil
| | - Rafaela da Silveira Pinto
- Department of Social and Preventive Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alessandro Diogo De-Carli
- Faculty of Dentistry, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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De-Carli AD, da Cunha AR, do Amaral-Silva GK, Vasconcelos J, Dos Santos MLDM, Probst LF. Factors related to the waiting time for scheduling an oral biopsy in Brazil: a multilevel analysis. BMC Health Serv Res 2023; 23:461. [PMID: 37161464 PMCID: PMC10170778 DOI: 10.1186/s12913-023-09437-0] [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: 12/18/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Timely diagnosis of oral cancers is critical, and performing biopsies of oral lesions with suspected malignancy is a crucial step in achieving this goal. The waiting time for the diagnosis may be related to the progression and prognosis of malignant neoplasms. OBJECTIVE The aim of this observational, cross-sectional, national-level study was to identify the factors associated with the waiting time for scheduling an oral biopsy, based on the identification of its need. METHODS We used secondary data from the Brazilian public health system, obtained from the 2nd cycle of the National Program to Improve Access and Quality of Dental Specialty Centers (PMAQ-CEO). The study outcome was the waiting time for scheduling an oral biopsy, starting from the identification of the need for the exam. We analyzed individual and contextual variables using multilevel statistical analysis. RESULTS In 51.8% of DSC the waiting time for scheduling a biopsy was non-immediate; in 58.1% of CEOs, the sum of the weekly workload of dentists working in the Stomatology specialty is up to 20 h per week; in terms of coverage, 67.1% of the CEOs have only municipal coverage and 34.0% are references for up to 12 oral health teams in primary health care; only the coverage variable remained significant in the multivariate model (p < 0.05). Of the contextual variables, none of the variables remained significant (p > 0.05). When these were analyzed together, only the coverage remained significant (p < 0.05); CONCLUSION: Our analysis indicates that the waiting time for scheduling an oral biopsy is longer in CEOs that cover only one municipality and is not related to contextual factors.
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Sathe C, Accordino MK, DeStephano D, Shah M, Wright JD, Hershman DL. Social determinants of health and CDK4/6 inhibitor use and outcomes among patients with metastatic breast cancer. Breast Cancer Res Treat 2023; 200:85-92. [PMID: 37157005 DOI: 10.1007/s10549-023-06957-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/23/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Survival outcomes in metastatic breast cancer (MBC) have improved due to novel agents such as CDK4/6 inhibitors (CDK4/6i). Nevertheless, Black patients and patients with lower socioeconomic status (SES) continue to bear a disproportionate mortality burden. METHODS We conducted a retrospective analysis of EHR-derived data from the Flatiron Health Database (FHD). A dataset was constructed to include Black/African-American (Black/AA) and White patients with hormone receptor (HR)-positive, HER2-negative MBC. Outcomes included CDK4/6i use (overall and first-line), and rates of leukopenia, dose reduction, and time on treatment for first-line CDK4/6i. Multivariable logistic regression was used to evaluate factors associated with use and outcomes. RESULTS A total of 6802 patients with MBC were included, of which 5187 (76.3%) received CDK4/6i. Of those, 3186 (61.4%) received CDK4/6i first-line. Overall, 86.7% of patients were categorized as White and 13.3% as Black/AA; 22.4% were > 75 years old; 12.6% were treated at an academic site; 3.3% had Medicaid insurance. In addition to advanced age and poorer performance status, lower use of CDK4/6i was associated with Black/AA vs White race (72.9% vs 76.8%; OR 0.83, 95% CI 0.70-0.99, p = 0.04) and Medicaid vs commercial insurance (69.6% vs 77.4%; OR: 0.68, 95% CI 0.49-0.95, p = 0.02). Odds of CDK4/6i use were twofold higher for patients treated at an academic center (p < 0.001). Rates of CDK4/6i-induced leukopenia and dose reductions did not differ significantly by race, insurance type, or treatment site. Time on CDK4/6i was significantly lower among Medicaid patients (395 days) than patients with commercial insurance (558 days) or Medicare (643 days) (p = 0.03). CONCLUSION This analysis of real-world data suggests that Black race and lower SES are associated with decreased CDK4/6i use. However, among patients treated with CDK4/6i, subsequent toxicity outcomes are similar. Efforts to ensure access to these life-prolonging medications are warranted.
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Affiliation(s)
- Claire Sathe
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
| | - Melissa K Accordino
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - David DeStephano
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Mansi Shah
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jason D Wright
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
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Baron R, Mick G, Serpell M. The relevance of real-world data for the evaluation of neuropathic pain treatments. Pain Manag 2022; 12:845-857. [DOI: 10.2217/pmt-2022-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Treatment of neuropathic pain (NP) is challenging. Interest in real-world evidence (RWE) for benefit-risk assessments of NP treatments increases given the paucity of drugs showing efficacy in randomized controlled trials and restricted labels of available medicines. To provide further context, a literature review regarding regulatory use of RWE and a clinical trial registry search for randomized controlled trials over the last 10 years was carried out. Taken together, and especially for available NP treatments, there is increasing support to consider RWE when evaluating their benefit-risk profile. Examples are provided in which RWE could be used effectively for updating the product label and informing treatment recommendations. Collected and analyzed according to state-of-the-art standards, RWE can inform treatment recommendations and product label decisions.
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Affiliation(s)
- Ralf Baron
- Division of Neurological Pain Research & Therapy, Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - Gérard Mick
- Pain Center, Voiron Hospital, CHU Grenoble Alpes, Grenoble, France
- Health, System, Process (P2S) Research Unit 4129, University of Lyon, Claude Bernard Lyon I, Lyon, France
| | - Mick Serpell
- Department of Anaesthesia, University of Glasgow, Glasgow, Scotland
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Elias C, Feteira-Santos R, Camarinha C, de Araújo Nobre M, Costa AS, Bacelar-Nicolau L, Furtado C, Nogueira PJ. COVID-19 in Portugal: a retrospective review of paediatric cases, hospital and PICU admissions in the first pandemic year. BMJ Paediatr Open 2022; 6:e001499. [PMID: 36053592 PMCID: PMC9438012 DOI: 10.1136/bmjpo-2022-001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND COVID-19 is considered by WHO a pandemic with public health emergency repercussions. Children often develop a mild disease with good prognosis and the recognition of children at risk is essential to successfully manage paediatric COVID-19. Quality epidemiological surveillance data are required to characterise and assess the pandemic. METHODS Data on all reported paediatric COVID-19 cases, in Portugal, were retrospectively assessed from a fully anonymised dataset provided by the Directorate General for Health (DGS). Paediatric hospital admission results were obtained from the DGS vaccine recommendations and paediatric intensive care unit (PICU) admission results from the EPICENTRE.PT group. Reported cases and PICU admissions from March 2020 to February 2021 and hospital admissions between March and December 2020 were analysed. RESULTS 92 051 COVID-19 cases were studied, 50.5% males, average age of 10.1 years, corresponding to 5.4% of children in Portugal. The most common symptoms were cough and fever, whereas gastrointestinal symptoms were infrequent. The most common comorbidity was asthma. A high rate of missing surveillance data was noticed, on presentation of disease and comorbidity variables, which warrants a cautious interpretation of results. Hospital admission was required in 0.93% of cases and PICU on 3.48 per 10 000 cases. PICU admission for Multisystem Inflammatory Syndrome in Children (MIS-C) was more frequent in children with no comorbidities and males, severe COVID-19 was rarer and occurred mainly in females and infants. Case fatality rate and mortality rates were low, 1.8 per 100 000 cases and 1.2 per 1 000 000 cases, respectively. CONCLUSIONS The overall reported case incidence was 5.4 per 100 children and adolescents and <1% of cases required hospital admission. MIS-C was more frequent in patients with no comorbidities and males. Mortality and case fatality rates were low. Geographic adapted strategies, and information systems to facilitate surveillance are required to improve surveillance data quality.
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Affiliation(s)
- Cecilia Elias
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Unidade de Saúde Pública Francisco George, Lisboa, Portugal
| | - Rodrigo Feteira-Santos
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Laboratório Associaodo TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Camarinha
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel de Araújo Nobre
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Clinica Universitaria Estomatologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Andreia Silva Costa
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Laboratório Associaodo TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- CIDNUR - Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisboa, Potugal
- CRC-W-Católica Research Centre for Psychological, Family and Social Wellbeing, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Leonor Bacelar-Nicolau
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Cristina Furtado
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Laboratório Associaodo TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Paulo Jorge Nogueira
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Laboratório Associaodo TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- CIDNUR - Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisboa, Potugal
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa; Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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Paneth N, Joyner MJ, Casadevall A. Finding evidence for treatment decisions in a pandemic. Trends Mol Med 2022; 28:536-541. [DOI: 10.1016/j.molmed.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/15/2022]
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Wiffen P. Real-world evidence: what is it and can it be trusted? Eur J Hosp Pharm 2022; 29:1. [PMID: 34857641 PMCID: PMC8717788 DOI: 10.1136/ejhpharm-2021-003163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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