The use of haematopoietic stem cell transplantation in Fanconi anaemia patients: a survey of decision making among families in the US and Canada

Background

Fanconi anaemia (FA) is a rare genetic disorder associated with bone marrow failure (BMF), congenital anomalies and cancer susceptibility. Stem cell transplantation (SCT) offers a potential cure for BMF or leukaemia, but incurs substantial risks. Little is known about factors influencing SCT decision making.

Objective

The study objective was to explore factors influencing patients' with FA and family members' decision making about SCT.

Design

Using a mixed‐methods exploratory design, we surveyed US and Canadian patients with FA and family members who were offered SCT.

Main variables studied

Closed‐ended survey items measured respondents' beliefs about the necessity, risks and concerns regarding SCT; multivariable logistic regression was used to examine the association between these factors and the decision to undergo SCT. Open‐ended survey items measured respondents' perceptions of factors important to the SCT decision; qualitative analysis was used to identify emergent themes.

Results

The decision to undergo SCT was significantly associated with greater perceived necessity (OR = 2.81, P = 0.004) and lower concern about harms of SCT (OR = 0.31, P = 0.03). Qualitative analysis revealed a perceived lack of choice among respondents regarding the use of SCT, which was related to physician influence and respondent concerns about patients' quality of life.

Conclusions

Overall, study results emphasize the importance of the delicate interplay between provider recommendation of a medical procedure and patient/parental perceptions and decision making. Findings can help providers understand the need to acknowledge family members' perceptions of SCT decision making and offer a comprehensive discussion of the necessity, risks, benefits and potential outcomes.     

Time to delivery: Transfers for threatened preterm labour and prelabour rupture of membranes in Western Australia

Objective

To describe the outcomes of patients transferred to King Edward Memorial Hospital (KEMH) with signs of labour at preterm gestations.

Design

A retrospective observational study of the 69 cases transferred to KEMH during 2015.

Setting

Patient transfers from all locations across Western Australia (WA) to the sole tertiary perinatal centre in Perth.

Participants

Pregnant women within WA with threatened or actual preterm labour (PTL) or preterm prelabour rupture of membranes (PPROM) between 23 and 32 weeks gestation.

Main outcome measures

The occurrence of delivery during the admission and time‐to‐delivery as well as length of admission and association between clinical factors and time‐to‐delivery.

Results

The percentage of the study population delivered during the admission following transfer was 72.5%. Eighty‐six per cent of those who delivered did so within 72 hours of transfer. The median time from transfer to delivery was 1 day. Sixty‐three per cent of those who did not deliver during the admission progressed to 36 weeks gestation. Patients transferred with PPROM were less likely to deliver during the admission compared to those with uterine activity (50% versus 19.6%, P = 0.007) and nulliparas were more likely to deliver (93.5% versus 55.3%, P < 0.001).

Conclusion

The majority of women transferred with signs of PTL progress to delivery during the same admission with the highest risk of delivery being the first 72 hours following transfer. If the pregnancy is ongoing at 72 hours, there is a reasonable chance of progression to late preterm gestation supporting the return of woman to their place of origin for antenatal care following discharge.     

Validation of the EQ-5D in a general population sample in urban China

Purpose  

To evaluate the reliability and validity of the EQ-5D in a general population sample in urban China.     

Ten-year trends in vitamin intake in free-living healthy elderly people: The risk of subclinical malnutrition

Objective  

To explore the trends of vitamin intake over a 10-year follow-up in a group of successfully aging elderly people.     

Patient and public perspectives of community pharmacies in the United Kingdom: A systematic review

Background

The United Kingdom has been at the forefront of enhancing pharmacist roles and community pharmacy services, particularly over the past decade. However, patient and public awareness of community pharmacy services has been limited.

Objective

To identify and synthesize the research literature pertaining to patient and public perspectives on: existing community pharmacy services, extended pharmacist roles and strategies to raise awareness of community pharmacy services.

Search strategy

Systematic search of 8 electronic databases; hand searching of relevant journals, reference lists and conference proceedings.

Inclusion criteria

UK studies investigating patient or public views on community pharmacy services or pharmacist roles from 2005 to 2016.

Data extraction and synthesis

Data were extracted into a grid and subjected to narrative synthesis following thematic analysis.

Main results

From the 3260 unique papers identified, 30 studies were included. Manual searching identified 4 additional studies. Designs using questionnaires (n = 14, 41%), semi‐structured interviews (n = 8, 24%) and focus groups (n = 6, 18%) made up the greatest proportion of studies. Most of the studies (n = 28, 82%) were published from 2010 onwards and covered perceptions of specific community pharmacy services (n = 31). Using a critical appraisal checklist, the overall quality of studies was deemed acceptable. Findings were grouped into 2 main themes “public cognizance” and “attitudes towards services” each with 4 subthemes.

Discussion and conclusions

Patients and the public appeared to view services as beneficial. Successful integration of extended pharmacy services requires pharmacists’ clinical skills to be recognized by patients and physicians. Future research should explore different approaches to increase awareness.     

Ten-year trends in dietary intake,health status and mortality rates in free-living elderly people

Objective  

To explore the trends of food preferences and nutrient intake over a 10-year follow-up in a group of successfully aging elderly.     

The association between symptoms and exposure is stronger in dropouts than in non-dropouts among employees in Norwegian smelters: a five-year follow-up study

Purpose  

We have investigated the association between respiratory symptoms and dust exposure among employees in 18 Norwegian smelters using a longitudinal design.     

Depression,nutritional risk and eating behaviour in older caregivers

Objective  

This study investigated the relationship between depression, nutritional risk and dietary intake in a population of older caregivers.     

Effect of time interval between food intake and exercise on substrate oxidation during exercise in obese and lean children

Background & aims

Exercise induces adaptations in fat metabolism favourable to the treatment of obesity. However, time interval between meal and exercise alters substrate bioavailability and oxidation during exercise. The aim of this study was therefore to investigate the effect of time interval between food intake and exercise on substrate oxidation rates in obese and lean children.

Methods

The metabolic responses to exercise of nine obese children (10.3 ± 1.8 years; %body fat: 36.1 ± 6.1) and seven lean children (9.2 ± 1.6 years; %body fat: 22.2 ± 4.1) were compared 1 h (time interval 1, TI1) and 3 h (TI3) after a standardized breakfast.

Results

Despite significantly lower plasma glucose and insulin concentrations and large effect size suggesting a higher plasma FFA availability (lean, 1.43, obese 0.98), fat oxidation was not significantly increased in TI3 compared to TI1 in both lean and obese children. Fat oxidation contributed marginally to energy expenditure during exercise (<20%) in both conditions and groups but was moderately increased during TI3 compared to TI1 in lean children (effect size: 0.54).

Conclusions

The low contribution of fat oxidation to energy expenditure during exercise in obese and lean children fed 3 h before exercise questions the efficacy of moderate intensity exercise to favourably affect fat balance.     

Errors and misquotations in the study of shisha, blood pressure and heart rate in Jordan

Aim  

This comment is based on a critical review of a study on blood pressure and heart rate in shisha (narghile, hookah) smokers in Jordan.     

The geography of Medicare's hospital value-based purchasing in relation to market demographics

Objective

To illustrate the association between the sociodemographic characteristics of hospital markets and the geographic patterns of Medicare hospital value-based purchasing (HVBP) scores.

Data Sources and Study Setting

This is a secondary analysis of United States hospitals with a HVBP Total Performance Score (TPS) for 2019 in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare database (4/2021 release) and American Community Survey (ACS) data for 2015–2019.

Study Design

This is a cross-sectional study using spatial multivariable autoregressive models with HVBP TPS and component domain scores as dependent variables and hospital market demographics as the independent variables.

Data Collection/Extraction Methods

We calculated hospital market demographics using ZIP code level data from the ACS, weighted the 2019 CMS inpatient Hospital Service Area file.

Principal Findings

Spatial autoregressive models using eight nearest neighbors with diversity index, race and ethnicity distribution, families in poverty, unemployment, and lack of health insurance among residents ages 19–64 years provided the best model fit. Diversity index had the highest statistically significant contribution to lower TPS (ß = −12.79, p < 0.0001), followed by the percent of the population coded to “non-Hispanic, some other race” (ß = −2.59, p < 0.0023), and the percent of families in poverty (ß = −0.26, p < 0.0001). Percent of the population was non-Hispanic American Indian/Alaskan Native (ß = 0.35, p < 0.0001) and percent non-Hispanic Asian (ß = 0.12, p < 0.02071) were associated with higher TPS. Lower predicted TPS was observed in large urban cities throughout the US as well as in states throughout the Southeastern US. Similar geographic patterns were observed for the predicted Patient Safety, Person and Community Engagement, and Efficiency and Cost Reduction domain scores but are not for predicted Clinical Outcomes scores.

Conclusions

The lower predicted scores seen in cities and in the Southeastern region potentially reflect an inherent—that is, structural—association between market sociodemographics and HVBP scores.     

Low-level environmental lead exposure in childhood and adult intellectual function: a follow-up study

Background  

Early life lead exposure might be a risk factor for neurocognitive impairment in adulthood.     

The beneficial effect of fiber supplementation in high- or low-fat diets on fetal development and antioxidant defense capacity in the rat

Background  

There is mounting evidence that an imbalance in oxidant/antioxidant activities plays a pivotal role in fetal development.     

Determinants of within-country variation in traffic accident mortality in Italy: a geographical analysis

Objective  

To identify determinants of regional differences in traffic accident mortality in Italy.     

Physical disease in schizophrenia: a population-based analysis in Spain

Background  

Physical disease remains a challenge in patients with schizophrenia. Our objective was to determine the epidemiological characteristics and burden of physical disease in hospitalized patients with schizophrenia.     

Health utility scores of colorectal cancer based on societal preference in Japan

Purpose  

We measured health utility scores of colorectal cancer (CRC) patients from a societal perspective in Japan.     

Age-related differences in muscular capacity among workers

Purpose  

To quantify the age-related changes in muscular capacity in a working population, and to investigate whether these changes are dependent on sports participation.     

Maintaining nutrition in aged care residents with a train-the-trainer intervention and nutrition coordinator

Objective  

To investigate the impact of a train-the-trainer program on the nutritional status of older people in residential care.     

The presence of ochratoxin A in cord serum and in human milk and its correspondence with maternal dietary habits

Background  

Ochratoxin A (OTA) is a mycotoxin present in food that can be found in human blood and milk.