Risultati per: Come il corpo usa il grasso per combattere le infezioni

Proveniente da un’azienda contaminata. Invito a non berlo crudo

Objective
Few epidemiological studies are reported in the published literature on the incidence or prevalence of antiphospholipid syndrome (APS), and available results are heterogeneous. This study aimed to estimate the incidence and prevalence of APS in the USA, overall and by APS subtype.

Design
A retrospective analysis of APS disease incidence and a cross-sectional analysis of disease prevalence.

Setting
Merative MarketScan Commercial Claims and Encounters Database, and the Medicare Supplemental and Coordination of Benefits Database.

Participants
All individuals with claims for at least two antiphospholipid antibody tests undertaken at least 12 weeks apart and a diagnosis claim for APS as a primary or secondary diagnosis on or after the second antibody test, during the period 1 January 2016 to 31 December 2019.

Main outcome measures
Annual incidence and prevalence of APS and APS subtypes.

Results
In total, 1708 cases of APS were identified during the study period (2016–2019), of which 83% were women. The overall annual standardised incidence rate of APS per 100 000 person-years increased slightly over the study period, from 2.31 in 2016 to 2.71 in 2019. In 2019, the estimated annual prevalence of APS per 100 000 persons was 10.42 per 100 000 persons (95% CI 9.96–10.90). Based on this and US census data, we have estimated that 34 000 persons in the USA were affected by APS in 2019.

Conclusions
These data add to the estimates of prevalence and incidence of APS in the literature, all of which have different strengths and limitations of the different data sources and case ascertainment methods.

Cnr, nuovo approccio potrebbe migliore sopravvivenza pazienti

Sono 377 sulle 2349 del 2023, nel 41% dei casi diagnosi tardiva

Introduction and objective
Maternal morbidity and mortality (MMM) is a public health concern in the USA, with Native American women experiencing higher rates than non-Hispanic White women. Research on risk factors for MMM among Native American women is limited. This systematic review comprehensively synthesizes and critically appraises the literature on risk factors for MMM experienced by Native American women.

Methods and analysis
A systematic search was conducted on 10 October 2022 in PubMed, Embase, CINAHL and Scopus for articles published since 2012. Selection criteria included observational studies set in the USA, involving Native American women in the perinatal period, and examining the relationship between risk factors and MMM outcomes. Three reviewers screened and extracted data from the included studies, with risk of bias assessed using the National Institutes of Health Quality Assessment Tools. Data were analysed descriptively.

Results
15 studies were included. All studies used administrative databases, with settings, including nationwide (seven studies), statewide (four studies) and Indian reservations (four studies). The majority of studies focused on hypertensive disorders of pregnancy (eight studies) and severe maternal morbidity (SMM) (four studies). 26 risk factors were identified. Key risk factors included Native American race (six studies), rural maternal residency (four studies), overweight/obese body mass index (two studies), maternal age (two studies), nulliparity (two studies) and pre-existing medical conditions (one study).

Conclusion
This review identified risk factors associated with MMM among Native American women, including rural residency, overweight or obesity and advanced maternal age. However, the findings also reveal a scarcity of research specific to this population, limiting the ability to fully understand these risk factors and develop effective interventions. These results emphasise the need for further research and culturally relevant studies to inform public health and address disparities for Native American women, particularly those in rural areas.

PROSPERO registration number
CRD42022363405.

Introduction
Many Americans fail to receive equitable access to or positive outcomes from rehabilitation services. These disparities result from broader societal inequities that disproportionately affect certain groups of people due to non-medical factors such as race, gender, education and living status. This scoping review aims to describe research papers that examine social determinants of health (SDOH) that underlie disparities in access to, use of, or outcomes related to rehabilitation (in occupational therapy, physical therapy, recreational therapy, rehabilitation medicine/physiatry and speech-language pathology) among adults in the USA. Identifying SDOH-related factors that drive inequities in rehabilitation will inform the development of potential solutions to improve access, professional education and patient outcomes.

Methods and analysis
The Joanna Briggs Institute methodological framework will be used to conduct this scoping review. To meet the inclusion criteria, articles will need to be published in English since 2013, be classified as full-length original research, include at least 100 sampled adults, be conducted in the USA or its territories, and investigate SDOH-related disparities in rehabilitation. Search terms will include SDOH, rehabilitation and disparities. Five databases (Embase, PubMed, Scopus, Sociological Abstracts and Web of Science: Core Collection) will be searched for articles published in English between 2013 and 2023. Records from these databases as well as reference lists of included papers and review papers will be screened for eligibility. Two people will independently review each record during title and abstract screening and full-text screening, and three people will independently extract data. Screening and data extraction processes will be piloted. The results will be presented in tables, graphs and narrative summaries.

Ethics and dissemination
Findings will be disseminated through scientific conferences, professional networks, stakeholder meetings, invited workshops and webinars, email listservs of professional associations, academic social media and in a peer-reviewed journal. Ethics approval is not required as the review will only include previously published data.

Iss, “necessità di misure che consentano la condivisione ruoli”

Marsh, ‘per aziende la gestione diventa sempre più complicata’

Objective
This study explores the cost-effectiveness of atezolizumab monotherapy compared with chemotherapy as first-line treatment for stage IIIB or IV non-small cell lung cancer (IIIB/IV-NSCLC) ineligible for platinum-based chemotherapy from a US payer perspective.

Design
This is based on the IPSOS clinical trial. We conducted a comprehensive assessment of the cost-effectiveness of atezolizumab monotherapy versus single-agent chemotherapy over a 15-year duration. Employing a robust Markov model incorporating data from 453 patients, we calculated total costs, life-years (LYs), quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER) at a willingness-to-pay (WTP) threshold of $150 000 per QALY. We performed one-way, two-way and probabilistic sensitivity analyses to validate our model.

Setting
The US payer perspective.

Participants
A cohort with NSCLC ineligible for treatment with a platinum-containing regimen from IPSOS clinical trial.

Interventions
Atezolizumab monotherapy versus chemotherapy.

Primary outcome measure
Cost, QALYs, LYs and ICER.

Result
Chemotherapy resulted in an average survival of 0.930 QALYs (1.528 LYs) per patient at an average cost of $67 579. Atezolizumab treatment provided an additional 0.309 QALYs but incurred an extra cost of $66 472, leading to an ICER of $215 069 per QALY compared with chemotherapy. The cost of atezolizumab had the most significant impact on the model outcomes. Probabilistic sensitivity analysis showed that atezolizumab had a 30.2% probability of being considered cost-effective at a WTP threshold of $150 000 per QALY in the USA. These results remained consistent across various scenarios and sensitivity analyses employing both deterministic and probabilistic approaches.

Conclusion
The current price of atezolizumab renders it an unlikely cost-effective treatment option for patients with IIIB/IV-NSCLC from the payer’s perspective in the USA. To achieve cost-effectiveness, substantial discounts are necessary.

Trial registration number
The IMpower-110, an open-label, randomised, phase 3 clinical trial (NCT02409342). The IPSOS clinical trial (NCT03191786).

Background
There are limited prospective data among overweight and obese individuals on the prevalence of advanced fibrosis, and cirrhosis using advanced MRI-based methods in the USA. The aim of this study was to fill that gap in knowledge by prospectively determining the MRI-based prevalence of steatotic liver disease (SLD) and its subcategories, advanced fibrosis and cirrhosis among overweight and obese individuals residing in the USA.

Methods
This is a cross-sectional analysis of prospectively enrolled overweight or obese adults aged 40–75 years from primary care and community-based settings in Southern California. Participants were classified as having SLD if MRI proton density fat fraction ≥5%, and subclassified as metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-associated liver disease (MetALD) and alcohol-related liver disease (ALD) consistently with the new nomenclature guidance per AASLD–EASL–ALEH. Advanced fibrosis and cirrhosis were defined as magnetic resonance elastography (MRE) ≥3.63 kPa and MRE ≥4.67 kPa, respectively.

Results
The cohort included 539 participants with mean (±SD) age of 51.5 (±13.1) years and body mass index of 32.6 (±6.2) kg/m2, respectively. The prevalence of SLD, advanced fibrosis and cirrhosis was 75%, 10.8% and 4.5%, respectively. The prevalence of MASLD, MetALD and ALD was 67.3%, 4.8% and 2.6%, respectively. There was no difference in prevalence of advanced fibrosis and cirrhosis among subcategories.

Conclusions
Using advanced MRI methods among community-dwelling overweight and obese adults, the prevalence of cirrhosis was 4.5%. Most common SLD subcategory was MASLD with 67% of individuals, whereas MetALD and ALD were less common. Systematic screening for advanced fibrosis among overweight/obese adults may be considered.

Circulation, Volume 150, Issue Suppl_1, Page A4145655-A4145655, November 12, 2024. Background:Heart failure (HF) is a primary cause of hospital readmissions with extremely high projected annual costs. Social Vulnerability Index (SVI) assesses a community’s ability to recover from external impacts on public health and provides valuable insights into community-level health outcomes. We aim to identify the association between SVI and HF.Methods:We used a national database (CDC WONDER) to identify the mortality of HF patients in the USA who were ≥25 years in 2020. HF was identified by specific ICD codes I11.0, 13.0, I13.2, and I50. We obtained the SVI per county from the CDC Database. We used the Pearson correlation coefficient (PCC) to examine the association between HF mortality and total SVI overall and within subgroups. Additionally, we employed ANOVA to evaluate the relationship between SVI quartiles and mortality.Results:In 2020, out of 215,907,184 individuals, 113,401 died of HF (40.7% were female and 37% male, 65.9% were of white race, and 8.8% Hispanic). Age-adjusted mortality rate (AAMR) was higher in males (65.3 vs 50.7 in females) and in Black race (75.8 vs 55.8 in White). However, the AAMR was lower in Hispanics (33.5 vs 58.6). Mortality rate increased from 0.044% in 2016 to 0.052% in 2020. The SVI ranged from 2.6045 to 12.7688. Texas, Mississippi, and Georgia were the states with the most counties in the 4th quartile of the SVI. In 2020, Mississippi, Alabama, and Louisiana had the highest AAMR (94.9, 88.6 and 76.4). A weak positive linear relationship was observed between HF mortality and total SVI, with a PCC of 0.2546, p

Circulation, Volume 150, Issue Suppl_1, Page ASa703-ASa703, November 12, 2024. Aims:The primary objective of this study was to investigate ethnic disparities in out-of-hospital cardiac arrest (OHCA) interventions, specifically the administration of epinephrine and ant arrythmias. The secondary objective was to explore the association with the provision of bystander CPR (CPR) and the application of Automated External Defibrillator (AED).Methods:This was a retrospective analysis of data from the Salt Lake City Fire Department from 2010 to 2023. The study included adults 18 years or older who experienced OHCA and were treated by EMS. Ethnicity was categorized as Whites, Blacks, Hispanics, Asians, and others. Multivariable regression analysis was used to examine the association between ethnicity and the specified outcomes.Results:Unadjusted analyses revealed no significant differences across ethnic groups in epinephrine and antiarrhythmic medication administration and bystander CPR. However, significant ethnic disparities were observed in AED use: the Asian population had the highest rate (21.8%), while the Black population had the lowest (6.5%). The multivariable analysis found no significant association between ethnicity and any OHCA interventions examined in this study.Conclusions:Our multivariable analysis did not reveal any statistically significant association between ethnicity and various OHCA interventions, including epinephrine administration, antiarrhythmic medication use, bystander CPR, and AED intervention in Salt Lake City. These findings suggest that regional differences in ethnic disparities in OHCA may vary across locations, emphasizing the need for further research into disparities in other regions and the impact of factors such as socioeconomic status and neighborhood conditions.

Gonorrea aumenta del 50%, sifilide del 20%; cala l’uso del preservativo