Gender disparities in utilization and outcome of comprehensive substance abuse treatment among racial/ethnic groups

This study examined gender differences within Black, Latino, and White subgroups in the utilization of comprehensive services and their relation to posttreatment substance use. Survey data were collected during the National Treatment Improvement Evaluation Study (NTIES), a prospective, longitudinal, multisite study of substance abuse treatment programs and their clients in the United States. The analytic sample consisted of 1,812 Blacks (734 women and 1,078 men), 486 Latinos (147 women and 339 men), and 844 Whites (147 women and 339 men) from 59 service delivery organizations. Results related to service utilization indicated that compared to men, women in all racial and ethnic groups needed and received more services targeted to their needs and reported more positive relations with service providers. Gender was a significant moderator of the relationship between service receipt and treatment outcomes for all racial and ethnic groups, but especially for the Latino subsample. Findings point to the need to consider race-specific gender differences in the development of culturally competent, comprehensive substance abuse treatment.     

Efficacy and safety of ertugliflozin across racial groups in patients with type 2 diabetes mellitus

Abstract

Objective: To assess the efficacy and safety of the sodium–glucose cotransporter 2 inhibitor ertugliflozin across racial groups in patients with type 2 diabetes mellitus (T2DM).

Methods: Pooled analysis of data from randomized, double-blind studies in the ertugliflozin phase III development program. Seven placebo- and comparator-controlled studies were used to assess safety (N?=?4859) and three placebo-controlled studies were used to assess efficacy (N?=?1544). Least-squares (LS) mean change from baseline was calculated for glycated hemoglobin (HbA1c), body weight and systolic blood pressure (SBP). Safety evaluation included overall and prespecified adverse events (AEs).

Results: At Week 26, ertugliflozin provided a greater reduction in HbA1c, body weight and SBP versus placebo in all racial subgroups. The placebo-adjusted LS mean change (95% confidence interval) from baseline in HbA1c was ?0.8% (?1.0, ?0.7) and ?1.0% (?1.1, ?0.8) with ertugliflozin 5?mg and 15?mg, respectively, in the White subgroup, ?0.7% (?1.2, ?0.2) and ?0.8% (?1.3, ?0.3) in the Black subgroup, and ?0.8% (?1.1, ?0.5) and ?1.0% (?1.3, ?0.8) in the Asian subgroup. The incidences of overall AEs, serious AEs and AEs leading to discontinuation from study medication were similar between the ertugliflozin 5?mg, 15?mg and non-ertugliflozin groups within each racial subgroup. The incidence of female genital mycotic infection (GMI) was higher with ertugliflozin than non-ertugliflozin across all racial subgroups. The incidence of male GMI was higher with ertugliflozin than non-ertugliflozin in the White sub-group; however, there were few male GMI events in the non-White subgroups.

Conclusions: In patients with T2DM, treatment with ertugliflozin improved HbA1c, body weight and SBP across all racial subgroups. Ertugliflozin had a generally similar safety profile across racial subgroups and was generally well tolerated.

Clinicaltrials.gov identifiers: NCT01986855, NCT01999218, NCT01958671, NCT02099110, NCT02036515, NCT02033889, and NCT02226003.     

Evaluation of the association between health insurance status and healthcare utilization and expenditures among adult cancer survivors in the United States

BackgroundHealth care expenditures for cancer care has increased significantly over the past decade and is further projected to rise. This study examined the associations between health insurance status and total direct health care expenditures and health care utilization among cancer survivors living in the United States.MethodsA cross-sectional study of cancer survivors aged ≥18 years, identified from the Medical Expenditures Panel Survey (MEPS) during 2017 using International Classification of Diseases, Tenth Revision codes specific for cancer. Health insurance was categorized into Private, Medicare, Medicaid, and uninsured. Multivariable ordinary least squares regression was used to examine the association between log expenditures and health insurance. Negative binomial regression with log link was used to obtain adjusted incident rate ratios (AIRR) for health care utilization. Survey weights were used to produce nationally representative estimates of the US population.ResultsA total of 1140 (weighted = 13.9 million) cancer survivors were identified. Compared to the adjusted mean annual health care expenditures for the private group ($14,265; 95% confidence interval (CI): $12,645 to $16,092), the adjusted mean annual health care expenditures for the Medicare group were higher ($15,112; 95%CI: $13,361 to $17,092). As compared to the private group, the average annual expenditures for uninsured cancer survivors ($2315; 95%CI:1038 to $3501) was significantly lower and so was their health care utilization. Adjusted rates of ER visits for Medicaid were twice (AIRR:2.04; SE:0.28; p = 0.001) as compared to privately insured.ConclusionsA difference in the average total direct expenditures between uninsured and privately insured patients was found. Uninsured had the lowest health care utilization while Medicaid reported significantly higher number of ER visits. Despite differences in program structures, health care expenditures across insurance types were similar. Lower utilization of health care services among uninsured suggests cost maybe a barrier to accessing care.     

两种桡动脉穿刺置管手法用于小儿的临床比较

目的 比较两种桡动脉穿刺置管手法用于小儿的首次穿刺置管成功率。方法 120例行左桡动脉穿刺置管小儿随机分为A组（n=60）、13组（n=60），A组选择小角度穿刺置管手法，B组选择大角度穿刺置管手法．比较两组首次穿刺置管成功率。结果 A组首次穿刺置管成功率高于B组（91．7％vs78．3％．P〈0．05）。结论 与大角度穿刺置管手法相比，小角度穿刺置管手法更适用于小儿。     

不同年龄阶段小儿肺炎支原体感染引起肺外损害临床分析

目的 探讨不同年龄阶段小儿肺炎支原体感染引起肺外损害特点及其治疗方案的选择,为以后该方面的病症提供更为有效的临床治疗依据.方法 我院2008年1月至2011年12月收治的共399例小儿肺炎支原体感染,其中206例合并肺外损害,回顾性分析患儿肺外损害年龄分布及不同年龄阶段出现的肺外损害情况.结果 1～6岁是小儿出现肺炎支原体感染引起肺外损害的高发年龄阶段.引起肺外损害的206病例中,发生消化系统损害最多见,为98例(47.57％),血液系统损害为82例(39.81％),泌尿系统损害为20例(9.71％),另外有4例为过敏性紫癜,2例为心血管系统损害.消化系统损害多发于3岁以上患儿,血液系统损害多发于1～3岁,泌尿系统损害多发于1岁以下.结论 不同年龄段的小儿肺炎支原体感染引起的肺外损害情况有一定的规律性,临床应提高认识,早期诊断并早期应用阿奇霉素规范治疗,根据肺外损害具体情况制定具体应对治疗方案.     

Phenotyping and genotyping study of thiopurine S-methyltransferase in healthy Chinese children: a comparison of Han and Yao ethnic groups

AIMS: Ethnicity is an important variable influencing drug response. Thiopurine S-methyltransferase (TPMT) plays an important role in the metabolism of thiopurine drugs. Previous population studies have identified ethnic variations in both phenotype and genotype of TPMT, but limited information is available within Chinese population that comprises at least 56 ethnic groups. The current study was conducted to compare both phenotype and genotype of TPMT in healthy Han and Yao Chinese children. METHODS: TPMT activity was measured in healthy Chinese children by a HPLC assay (n = 213, 87 Han Chinese and 126 Yao Chinese). Allele-specific polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (RFLP) were used to determine the frequency of TPMT mutant alleles (TPMT*2, TPMT*3 A, TPMT*3B and TPMT*3C) in these children. RESULTS: There was no significant difference in the mean TPMT activity between Han and Yao Chinese children. A unimodal distribution of TPMT activity in Chinese children was found and the mean TPMT activity was 13.32 +/- 3.49 U ml(-1) RBC. TPMT activity was not found to differ with gender, but tended to increase with age in Yao Chinese children. TPMT*2, TPMT*3B and TPMT*3A were not detected, and only one TPMT*3C heterozygote (Han child) was identified in 213 Chinese children. Erythrocyte TPMT activity of this TPMT*3C heterozygote was 12.36 U ml(-1) RBC. The frequency of the known mutant TPMT alleles was 0.2%[1/426] in Chinese children. CONCLUSION: The frequency distribution of RBC TPMT activity was unimodal. The frequency of the known mutant TPMT alleles in Chinese Children is low and TPMT*3C appears to be the most prevalent among the tested mutant TPMT alleles in this population.     

炉甘石薄荷脑洗剂治疗儿童局部红色粟疹临床研究

目的研究炉甘石薄荷脑洗剂治疗儿童局部红色粟疹的效果。方法根据统计学方法进行95%可信区间的双侧检验,计算样本64例含量;将实验样本随机平均分配到试验组和对照组,根据红色粟疹体积缩小和数量减少的程度评定两组的临床疗效;采用Ridit分析比较两组的数据,计算u值和P值,判断两组之间差异是否有显著性。结果炉甘石薄荷脑洗剂治疗儿童局部红色粟疹的总有效率为84.4%,u=4.003,P<0.05,与对照组比较差异有显著性。结论炉甘石薄荷脑洗剂是治疗儿童局部红色粟疹的有效药品,可以推广使用。     

四川省某县城乡居民慢性病情况、就医现状与经济负担调查

目的：了解四川省某县城乡居民慢性病情况、就医现状及经济负担情况,为卫生预防及卫生服务体系发展提供政策依据。方法采用自行设计的调查问卷表,对2013年7月随机抽取的1000名威远县城乡居民进行问卷调查,并对结果进行统计学分析。结果95.2%的居民均患不同程度的慢性病,多数是农村高于城市;高血压患病率为48.1%,明显高于全国平均水平;慢性病患者对所患疾病的了解程度均很低。城市患者多在市级医院就医,相对更看重高诊疗水平,农村患者多在私人诊所就医,相对更看重低就诊费;明知患病却不就医的情况仍普遍,即使就医仍有超过80.0%患者没有完全按照医嘱执行。51.6%的城市患者和51.8%的农村患者家庭每月人均收入为＆gt;500~2000元;70.0%的城市患者和68.0%的农村患者均认为医疗总费用勉强可以接受,其中门诊挂号费排在易接受的首位,住院药品费排在难以接受的首位;64.3%的患者未参加医疗保险,且有19.9%的城市患者和9.1%的农村患者仍然认为医疗保险报销完全不能解决看病贵问题。结论城乡居民的基本健康状况不容乐观,慢性病患者的健康素养普遍较低,并面临很重的经济负担,农村情况较城市严重。提高居民健康素养,加强医疗机构建设与管理,稳步健康发展西部地区经济,改革和完善医疗保障制度,对改善现状可能是行之有效的方法。     

Genetic polymorphisms and linkage disequilibrium of sulfotransferase SULT1A1 and SULT1A2 in a Korean population: comparison of other ethnic groups

Aims: To determine the allele frequencies of sulfotransferases (SULTs) 1A1 and 1A2 and their linkage disequilibrium in a Korean population and compare them with those of other ethnic groups. Methods: Genotypes of the SULT1A1*1, *2, and *3 and SULT1A2*1, *2, and *3 allelic variants were determined in 234 Korean subjects using polymerase chain reaction (PCR)–restriction fragment length polymorphism (RFLP) methods. Results: Allele frequencies for SULT1A1*1 and *2 were 0.876 [95% confidence interval (CI), 0.843–0.905] and 0.124 (95% CI, 0.096–0.157), respectively. Similarly, those for SULT1A2*1 and *2 were 0.885 (95% CI, 0.852–0.912) and 0.115 (95% CI, 0.088–0.150), respectively. However, no subject with SULT1A1*3 or SULT1A2*3 was detected. These genotype distributions are similar to those of Asian populations including the Chinese and Japanese, but quite different from other ethnic groups such as African-Americans and Caucasians. The expected allelic frequencies of SULT1A1 and SULT1A2 at Hardy–Weinberg equilibrium are quite similar to the observed distributions in the population. SULT1A1*2 and SULT1A2*2, the most common variant alleles of these two genes, are strongly and positively linked in the Korean population (D′=0.8919, χ² =343.24, P=0.0034). Conclusions: SULT1A1*2 and SULT1A2*2 are the major allelic variants in the Korean population, whereas the SULT1A1*3 and SULT1A2*3 alleles were not found. SULT1A1*2 and SULT1A2*2 are strongly linked.     

Association of <Emphasis Type="Italic">hOGG1</Emphasis> genotype with life style and oxidative DNA damage among Chinese ethnic populations

To assess the natural variation of hOGG1 gene and the gene–environmental interactions, the hOGG1 codon 326 polymorphism and urinary 8-OHdG levels were investigated in large samples (n = 953) of healthy individuals from five Chinese ethnic populations by using PCR-RFLP and HPLC-ECD. Life-style parameters under study were obtained through a questionnaire. The allelic frequencies of the hOGG1 gene in the Chinese populations were found to be 0.16 (Ser/Ser), 0.49 (Ser/Cys) and 0.35 (Cys/Cys), respectively. The frequencies of Ser326Cys polymorphism were significantly different among the five Chinese ethnic populations (P = 0.002). No association was found between the hOGG1 gene polymorphism and other life-style parameters except for the association between Ser326Cys and smoking (P = 0.027). A significant increase of urinary 8-OHdG level was observed in Cys326Cys allelic healthy subjects (P = 0.033). These results suggest that there are natural variations of hOGG1 gene among Chinese ethnic populations. Smoking relates to Cys/Cys polymorphism frequencies, and oxidative DNA damage is repaired less in individuals with the hOGG1 Cys326Cys genotype.     

多西他赛与顺铂联合放疗治疗晚期肺癌疗效比较

目的 比较多西他赛联合放疗和顺铂联合放疗治疗局部晚期肺癌的疗效和不良反应.方法 将98例晚期非小细胞肺癌患者随机分为两组,所有患者均给予三维适形放疗,一组(多西他赛组)放疗联合静滴多西他赛20 mg/m2周剂量,共6次;另一组(顺铂组)放疗联合静滴顺铂,每周静滴顺铂30mg/m2,共6次.两组放疗剂量均为60 ～66 GY,每次2 GY,1周5次,共5～7周.观察两组患者疗效及毒副反应.结果 多西他赛组中位生存期为17.2个月,中位局部无进展生存时间13.5个月,1、2、3年生存率分别为78.6％、35.7％和19.5％.顺铂组中位生存期为16个月,中位局部无进展生存时间16.S个月,1、2、3年生存率分别为74％、34％和20％.两组生存时间差异无统计学意义(P＞0.05).但多西他赛组胃肠道反应、晚期放疗反应较顺铂组轻.结论 多西他赛联合放疗和顺铂联合放疗治疗局部晚期肺癌疗效相当,但多西他赛联合放疗毒副反应较轻,治疗耐受性较好.     

A pharmacokinetic comparison of anrukinzumab,an anti- IL-13 monoclonal antibody,among healthy volunteers,asthma and ulcerative colitis patients

AimsAnrukinzumab is an anti-IL13 monoclonal antibody. The goals of this study are to characterize the pharmacokinetics of anrukinzumab in healthy volunteers and different disease states and to identify covariates.MethodsA population pharmacokinetic (PK) model was developed in NONMEM, using data from five clinical studies including healthy volunteers, asthma and ulcerative colitis (UC) patients. Different dosing regimens including different routes of administration were also included in the data.ResultsThe PK of anrukinzumab were described by a two compartment model with first order absorption and elimination. The population estimates (relative standard error) of the volumes of distribution in the central (V_c) and peripheral (V_p) compartments were 3.8 (4.6%) and 2.2 l (8.7%), respectively. In non-UC patients, the population estimate of the systemic clearance (CL) and inter-compartmental CL was 0.00732 l h^–1 (4.9%) and 0.0224 l h^–1 (15.4%). For subcutaneous administration, the absorption rate constant was 0.012 h^–1 (6.6%) and bioavailability was nearly 100% in healthy and mild to moderate asthma patients. Both V and CL increased with body weight. CL (but not V) decreased with increasing baseline albumin concentrations. UC patients had an increased CL of 72.3% (10.5%), after correction for differences in body weight and albumin. Moderate to severe asthma patients had decreased bioavailability compared with other populations.ConclusionsAnrukinzumab''s PK behave like a typical antibody. UC patients were identified to have a faster CL of anrukinzumab than healthy volunteers and asthma patients. This finding suggests a higher dose level may be required for this population.     

儿科临床开放式和封闭式输液使用的对比实验

目的:对开放式和封闭式输液的微生物和微粒污染状态进行对照比较。方法:按中国药典不溶性微粒和微生物法进行测定。结果:两种输液中微生物污染无显著差异。但不溶性微粒污染有显著差异。结论:封闭式输液在微粒污染方面明显少于开放式输液。     

Effect of UGT1A1, UGT1A3, DIO1 and DIO2 polymorphisms on L-thyroxine doses required for TSH suppression in patients with differentiated thyroid cancer

AimTo evaluate the impact of genetic polymorphisms in uridine 5′-glucuronosylytansferases UGT1A1 and UGT1A3 and iodothyronine-deiodinases types 1 and 2 on levothyroxine (T₄; 3,5,3′,5′-triiodo-L-thyronine) dose requirement for suppression of thyrotropin (TSH) secretion in patients with differentiated thyroid cancer (DTC).MethodsPatients (n = 268) submitted to total thyroidectomy and ablation by ¹³¹I, under T₄ therapy for at least 6 months were recruited in three public institutions in Brazil. Multivariate regression modelling was applied to assess the association of T₄ dosing with polymorphisms in UGT1A1 (rs8175347), UGT1A3 (rs3806596 and rs1983023), DIO1 (rs11206244 and rs2235544) and DIO2 (rs225014 and rs12885300), demographic and clinical variables.ResultsA regression model including UGT1A haplotypes, age, gender, body weight and serum TSH concentration accounted for 39% of the inter-individual variation in the T₄ dosage. The association of T₄ dose with UGT1A haplotype is attributed to reduced UGT1A1 expression and T₄ glucuronidation in liver of carriers of low expression UGT1A1 rs8175347 alleles. The DIO1 and DIO2 genotypes had no influence of T₄ dosage.ConclusionUGT1A haplotypes associate with T₄ dosage in DTC patients, but the effect accounts for only 2% of the total variability and recommendation of pre-emptive UGT1A genotyping is not warranted.     

A new B‐chain mutant of insulin: comparison with the insulin crystal structure and role of sulfonate groups in the B‐chain structure

Abstract: The solution structure of a new B‐chain mutant of bovine insulin, in which the cysteines B7 and B19 are replaced by two serines, has been determined by circular dichroism, 2D‐NMR and molecular modeling. This structure is compared with that of the oxidized B‐chain of bovine insulin [Hawkins et al. (1995) Int. J. Peptide Protein Res. 46 , 424–433]. Circular dichroism spectroscopy showed in particular that a higher percentage of helical secondary structure for the B‐chain mutant is estimated in trifluoroethanol solution in comparison with the oxidized B‐chain. 2D‐NMR experiments confirmed, among multiple conformations, that the B‐chain mutant presents defined secondary structures such as a α‐helix between residues B9 and B19, and a β‐turn between amino acids B20 and B23 in aqueous trifluoroethanol. The 3D structures, which are consistent with NMR data and were obtained using a simulated annealing protocol, showed that the tertiary structure of the B‐chain mutant is better resolved and is more in agreement with the insulin crystal structure than the oxidized B‐chain structure described by Hawkins et al. An explanation could be the presence of two sulfonate groups in the oxidized insulin B‐chain. Either by their charges and/or their size, such chemical groups could play a destructuring effect and thus could favor peptide flexibility and conformational averaging. Thus, this study provides new insights on the folding of isolated B‐chains.     

A comparison of the bronchodilatory effect of 50 and 100 μg salbutamol via Turbuhaler® and 100 μg salbutamol via pressurized metered dose inhaler in children with stable asthma

Aim: The aim of the study was to compare the efficacy of single doses of salbutamol Turbuhaler® (50 and 100 μg), salbutamol pressurized metered dose inhaler (pMDI) (100 μg) and placebo in children with stable chronic reversible airway obstruction. Primary efficacy variable (FEV₁-av) was calculated as the area under the curve of forced expiratory volume in one second (FEV₁) (AUC, 0–4 h) and divided by the observed time. Design: The study was of a randomized, single-dose, crossover and double-blind design. Seven centres participated. FEV₁ was measured pre-dose and at 15 min, 0.5, 1, 1.5, 2, 3 and 4 h post study dose. Patients: Forty asthmatic children (9 girls) with a mean age of 9 years (range: 6–12), mean FEV₁ of 1.6 l (range: 0.9–2.4) and a mean FEV₁ in percentage of predicted normal value of 80% (range: 61–109) were randomized into the study. The mean reversibility 30 min after inhaling 2×100 μg salbutamol from pMDI was 20% (range: 9–45) or 15% (range: 8–27) in percentage of predicted normal value. Results: The mean FEV₁-av was 1.63 l for placebo, 1.71 l for 50 μg salbutamol Turbuhaler, 1.76 l for 100 μg salbutamol Turbuhaler and 1.76 for 100 μg salbutamol pMDI. Corresponding values for maximum FEV₁ were 1.76, 1.85, 1.87 and 1.87 l, respectively. There were no statistically significant differences between the active treatments in FEV₁-av or maximum FEV₁. All active treatments were significantly better than placebo. Conclusion: No significant differences in bronchodilating effect between 50, 100 μg salbutamol Turbuhaler and 100 μg salbutamol pMDI in children, aged 6–12 years, with stable asthma could be demonstrated. All active treatments were significantly better than placebo.