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

‘Registrato un incremento dalle 4 alle 10 volte’

Introduction
Cardiac inotrope medications administered to cardiac surgical patients carry steep risk–benefit trade-offs, yet wide inter-institutional variation exists in inotrope practices. Despite known wide variation in use of any inotrope for cardiac surgery, limited multicentre data exist regarding determinants of inotrope selection and time course for use. Additionally, the reasons that underpin how clinicians decide on inotrope usage and the factors that influence inotrope practice change are not well understood.

Methods and analysis
This is an investigator-initiated, multicentre mixed methods study. Quantitative data will include electronic health records from an observational cohort of adult cardiac procedures within the Multicenter Perioperative Outcomes Group (MPOG) database, comprising cardiac surgical procedures from over 30 US academic and community hospitals. Additional quantitative data will be collected via surveys of clinicians involved in inotrope decision-making, contacted through an existing multicentre research and quality improvement infrastructure with engaged clinician representatives participating across MPOG hospitals. Qualitative data will be collected from open-ended questions within surveys, as well as semi-structured interviews with surveyed clinicians, sampled across approximately six institutions selected for diversity of settings and inotrope practices. An explanatory sequential mixed methods design will merge quantitative and qualitative data to develop meta-inferences explaining inotrope practices, as guided by an existing framework for characterising clinical practice variation and levers for practice change.

Ethics and dissemination
The study is approved by the institutional review board at the University of Michigan Medical School (HUM00245353). Findings will be disseminated through peer-reviewed journals, conference proceedings and quality improvement forums. The study began in February 2025 and will continue until 2028.

Introduction
Cardiac inotrope medications administered to cardiac surgical patients carry steep risk–benefit trade-offs, yet wide inter-institutional variation exists in inotrope practices. Despite known wide variation in use of any inotrope for cardiac surgery, limited multicentre data exist regarding determinants of inotrope selection and time course for use. Additionally, the reasons that underpin how clinicians decide on inotrope usage and the factors that influence inotrope practice change are not well understood.

Methods and analysis
This is an investigator-initiated, multicentre mixed methods study. Quantitative data will include electronic health records from an observational cohort of adult cardiac procedures within the Multicenter Perioperative Outcomes Group (MPOG) database, comprising cardiac surgical procedures from over 30 US academic and community hospitals. Additional quantitative data will be collected via surveys of clinicians involved in inotrope decision-making, contacted through an existing multicentre research and quality improvement infrastructure with engaged clinician representatives participating across MPOG hospitals. Qualitative data will be collected from open-ended questions within surveys, as well as semi-structured interviews with surveyed clinicians, sampled across approximately six institutions selected for diversity of settings and inotrope practices. An explanatory sequential mixed methods design will merge quantitative and qualitative data to develop meta-inferences explaining inotrope practices, as guided by an existing framework for characterising clinical practice variation and levers for practice change.

Ethics and dissemination
The study is approved by the institutional review board at the University of Michigan Medical School (HUM00245353). Findings will be disseminated through peer-reviewed journals, conference proceedings and quality improvement forums. The study began in February 2025 and will continue until 2028.

Objectives
To investigate long-acting injectable (LAI) antipsychotic prescribing patterns and their associations with transition and continuation of care and healthcare resource utilisation (HCRU) for patients with schizophrenia in the USA.

Design
A retrospective cohort study.

Setting
Electronic health record data from adults in the USA with schizophrenia were extracted from the NeuroBlu Database V.21R2.

Participants
Adults (aged ≥18 years) with a schizophrenia diagnosis who initiated LAI antipsychotic treatment during psychiatric inpatient admission. The index date was the date of LAI initiation. Patients who had ≥1 primary, secondary or tertiary ICD-9/10 (International Classification of Diseases) diagnosis of schizophrenia at clinical sites that had both inpatient and outpatient facilities were included.

Primary outcome measures
Transition-of-care (eg, risk of rehospitalisation, number of hospital readmissions, number of outpatient visits post discharge), continuation-of-care (eg, first treatment path after discharge, time to index LAI discontinuation and number of patients who restarted LAIs after discontinuation) and HCRU endpoints (eg, length of stay of index hospitalisation and estimated cost for psychiatric outpatient visits pre-index and post-index) were the primary outcome measures.

Results
A total of 1197 patients were included who initiated an LAI in an inpatient setting. Of 339 patients with ≥3 months pre-index and post-index data, median time to rehospitalisation was 135 days. Patients discharged taking an LAI alone had lower frequency of rehospitalisation (incidence rate ratio (IRR)=0.62 (95% CI, 0.46 to 0.84)), lower risk of longer hospital stays (IRR=0.60 (95% CI, 0.43 to 0.84)), lower risk of becoming rehospitalised (HR=0.49 (95% CI, 0.35 to 0.69)) and lower risk of outpatient visits (IRR=0.50 (95% CI, 0.36 to 0.70)) versus patients co-prescribed an oral antipsychotic (LAI+OA). Patients discharged taking an LAI dosed once every 1–2 months or once every 2 weeks had lower frequency of rehospitalisation (IRR=0.85 (95% CI, 0.64 to 1.14)), lower risk of longer hospital stays (IRR=0.90 (95% CI, 0.70 to 1.15)) and lower risk of becoming rehospitalised versus an LAI dosed once every 2 weeks; risk of becoming rehospitalised was no different (HR=1.00 (95% CI, 0.76 to 1.32)) and risk of outpatient visits was greater (IRR=1.25 (95% CI, 0.96 to 1.63)). During hospitalisation, 73.4% of patients were co-prescribed an OA, most frequently risperidone, with their index LAI. From pre-admission to post-discharge, psychiatric clinic costs significantly increased (US$14 231, p

Nel 2019 il marito tentò di ucciderla dandole fuoco

Objectives
This study explores the drug use behaviour in the US general population in the early days of the COVID-19 pandemic with a focus on the relationship between sociopsychological factors, mobility restrictions from March to June 2020 and mental health conditions.

Design
A retrospective anonymous online survey representing a cross-section of the US population in 2020.

Setting
A qualified panel of 500 000 Qualtrics participants stratified by gender, race, age and geographical region to represent the US population.

Participants
3340 participants voluntarily consented to respond.

Measures
Outcome measure for illicit and non-medical use of prescription drugs based on the National Institute on Drug Abuse-Modified Alcohol, Smoking and Substance Involvement Screening Test Level-2 Substance Use for Adult Questionnaire and predictor measures include self-reports of mobility behaviours, demographics and mental states using psychometrically validated scales.

Results
2 tests showed that those who stayed home reported higher odds (p

Objective
This study investigated how workplace culture may affect the development of lifestyle medicine (LM) programming in health systems to inform the successful growth of LM programs. No study has examined how the impact of workplace culture (shared knowledge, values and behaviours within an organisation) affects practitioners’ abilities to engage in LM.

Design
A cross-sectional, multiple case study investigation of the implementation of LM in five health systems was conducted by administering semi-structured in-depth interviews (n=45) from May 2022 to January 2023. Following the transcription of interviews verbatim, narrative reports depicting each health system’s experience with LM were drafted and collectively reviewed by the research team who discussed emerging themes.

Setting
Five health systems across the USA that have implemented LM were selected based on diversity in size, location, payer model, and patient population.

Participants
Administrative leaders, physicians and other personnel involved in the LM programming from selected health systems were invited to participate.

Results
The implementation of LM is facilitated when practices such as forming social groups, visually advertising LM and offering plant-based cafeteria items are present to support core values, such as trust, gratitude, collaboration and optimism.

Conclusions
LM implementation can be supported by health system clinicians and administrators striving to make their workplaces more supportive and synergetic so that they can take advantage of all available resources. Future research should further explore this relationship between cultural factors and resource availability.

Introduction
Preterm birth is a significant contributor to pregnancy-related morbidity and mortality, particularly affecting black women. Racism is a key driver of perinatal inequities, but mechanisms remain unclear. Epigenomics research offers promise in understanding how environmental exposures, including racism, influence gene expression and adverse pregnancy outcomes. We present our study protocol describing how we will investigate the interactive effects of individual- and structural-level racism on preterm birth within and across black and white women, characterise the blood-based methylome of black pregnant women and identify whether DNA methylation mediates the association between multilevel racism and preterm birth in black women.

Methods and analysis
We will conduct a secondary analysis of data from 6843 participants in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b), a longitudinal, prospective cohort study (2010–2014). Individual-level racism was collected using the Experiences of Discrimination scale. Structural racism measures include racial residential segregation, income and racial polarisation, political participation, judicial treatment, homeownership and employment. These measures will be calculated using geocoded participant addresses and publicly available census data for black and white populations. Epigenome-wide methylation analyses will be conducted on stored DNA for all enrolled black women using the EPIC 2.0 BeadChip. Preterm birth was determined by abstraction from participant electronic health records. We will determine the joint effects of individual and structural racism on preterm birth, characterise DNA methylation profiles associated with preterm birth among black women and explore the mediating role of DNA methylation in the association between multilevel racism and preterm birth.

Ethics and dissemination
Study procedures were approved by the Columbia University Institutional Review Board (#AAAU0215). This study aims to fill critical knowledge gaps regarding the role of racism and epigenomics in preterm birth among black women.

Objectives
Despite widespread vaccination programmes and consensus recommendations, the understanding of the durability of COVID-19 vaccination against ensuing infection and transmission at the individual level is incomplete. The objective of this study was to estimate the effects of time-varying covariates including time since vaccination and symptoms on subsequent positive SARS-CoV-2 test results and assess the stability of these effects between March 2020 and April 2022.

Design
Prospective cohort study.

Setting
Urban university in the USA.

Participants
Drexel University students, faculty, and staff (n=15 527) undergoing mandatory COVID-19 symptom tracking, testing and vaccinations.

Intervention
Systematic symptom tracking and SARS-COV-2 testing starting in September 2020 and mandatory COVID-19 vaccination starting in September 2021.

Main outcomes and measures
COVID-19 vaccine effectiveness modified by time since vaccination and symptoms.

Results
Using fit-for-purpose digitally based symptom and vaccine tracking and mandatory comprehensive testing for SARS-CoV-2 infection, we estimate the time-dependent effects of vaccination, symptoms and covariates on the risk of infection with a Cox proportional hazards model based on calendar time scale. We found a strong protective effect of vaccination against symptomatic infection. However, there was strong evidence of a protective effect against infection only in the first 90 days after completed vaccination, and only against symptomatic versus asymptomatic infection. The overall estimated effect of vaccination within 30 days, including asymptomatic infections, was 37.3% (95% CI 26%, 47%). Vaccine effect modification by reported symptoms and time period was estimated, revealing the protective effect of vaccination within 90 days against symptomatic infection that varied from 90% (95% CI 84%, 94%) to 49%(95% CI –77%, 85%) across time periods.

Conclusions
This study is among the first to prospectively capture complete COVID-19 symptom, testing and vaccination data over a multiyear period. Overall effectiveness of the COVID-19 vaccine against subsequent infection, including transmissible asymptomatic infections, is modest and wanes after 90 days. Vaccination policies may need to take these issues into account.

This Special Communication from the International Antiviral Society–USA provides updated 2024 recommendations for HIV treatment and clinical management and HIV prevention.

Objective
The aim of this study was to estimate the total national direct cost of breast cancer screening from 2019 to 2022 and project the total national cost and average lifetime cost of screening per woman for three current guidelines.

Design
We estimated the national cost of screening from 2019 to 2022, and per cancer detected in 2022, using real-world data on the number of mammograms performed per year. We also projected the national cost of screening using life table modelling for three guidelines: 2021/2023 American College of Radiology (ACR), 2023 American Cancer Society (ACS) and 2024 United States Preventative Services Task Force (USPSTF). The average lifetime cost to screen one woman until age 74 years with each guideline was also estimated. The Optum Labs Data Warehouse was used to estimate commercial and Medicare costs and recall rates. Sensitivity analyses were used to estimate uncertainty and determine which inputs had the largest impact on total national costs.

Setting
This study was conducted for the USA.

Participants
Women eligible for breast cancer screening.

Interventions
Digital mammograms (2D) or digital breast tomosynthesis (3D) and/or MRI.

Primary outcome measure
Total national cost of screening calculated as the sum of screening and recall costs. Average lifetime cost of screening per woman until 74 years.

Results
Nationally, screening cost approximately US$11 billion (B) per year from 2019 to 2022 with approximately 37% of eligible women screened each year. In 2022, screening cost US$55 471 per 3D-detected and US$44 000 per 2D-detected invasive or ductal carcinoma in situ case. Using target yearly participation rates of 54%–78% by age of women, the projected cost of screening was US$30B for ACR, US$18B for ACS and US$8B for USPSTF guidelines. The average lifetime cost to screen an average-risk woman was: US$13 416 for ACR, US$7946 for ACS and US$6931 for USPSTF. Participation rates, the proportion of women with a lifetime risk >20% and commercial MRI and 3D costs had the largest impact on total costs.

Conclusion
The cost of screening varies significantly by guideline (US$8B–US$30B) and was most influenced by participation rates, high-risk population proportions and technology costs. Future work can investigate whether risk-based screening strategies being tested in ongoing clinical trials can reduce national screening costs while improving outcomes.Cite Now

Objective
Incidence and mortality are fundamental epidemiologic measures of cancer burden, yet few studies have examined individual cancers to determine how these measures correlate across place. We assessed the relationship between incidence and mortality for commonly diagnosed cancers in the USA.

Design
Population-based observational study of US counties.

Setting and participants
The Surveillance, Epidemiology and End Results (SEER) database was used to obtain incidence (2000–2016) and mortality (2002–2018) data for the 12 most commonly diagnosed non-haematologic cancers.

Outcome measures
County-level correlation between cancer incidence and mortality. Cancers were grouped into terciles based on the population-weighted correlation coefficient (r). We also examined the 10 year risk of death, both from the diagnosed cancer and other causes.

Results
County-level incidence and mortality were strongly correlated in some cancers, yet uncorrelated in others. Cancers in the high-correlation tercile (r range: 0.96 to 0.78) included lung, stomach, liver and pancreas. For patients with these cancers, the risk of death from the diagnosed cancer was >4-times the risk of death from other causes. The moderate-correlation tercile (r: 0.75 to 0.58) included cancers of the colon, bladder, kidney and uterus. There was little or no relationship between incidence and mortality for cancers in the low-correlation tercile (r: 0.33 to –0.10): melanoma, prostate, breast and thyroid. The risk of death from the diagnosed cancer for these patients was either lower or no different than their risk of death from other causes.

Conclusions
For some cancers in the USA, the fundamental epidemiologic measure of disease frequency—incidence—now has little relationship with cancer death (mortality). Low correlations are most likely explained by differences in diagnostic practice leading to variable amounts of cancer overdiagnosis between different US counties.

Objective
This study investigated the association of poor oral health with appetite loss and deterioration in appetite longitudinally in older adults.

Design
Cross-sectional and longitudinal observational study.

Setting
Data came from two population-based cohorts of older adults from the UK and USA.

Participants
The British Regional Heart Study (BRHS) included men (n=1348, age=79–87 years in 2016–2017 at baseline and 81–89 years in 2018–2019 at follow-up). The US Health, Aging and Body Composition (HABC) Study included men and women (n=2998, age=71–77 years in 1998–1999 at baseline and 73–79 years in 2000–2001 at follow-up). Objective and self-reported oral health measures were collected.

Outcome measures
Loss of appetite, at baseline and 2-year follow-up, was based on the Simplified Nutrition Assessment Questionnaire in the BRHS and self-reported appetite loss in the HABC Study. In the BRHS, changes in oral health over time were also assessed. Logistic regression models were adjusted for sociodemographic, behavioural and health-related factors.

Results
Cross-sectionally, poor self-rated oral health, dry mouth, eating or chewing difficulty, food avoidance and cumulative oral health problems were associated with appetite loss in both studies. Longitudinally, in the BRHS, dry mouth (OR=2.12 (95% CI=1.40 to 3.20)), eating or chewing difficulty (OR=1.59 (95% CI=1.02 to 2.48)), food avoidance (OR=1.75 (95% CI=1.16 to 2.65)) and cumulative oral health problems (OR=2.84 (95% CI=1.80 to 4.50)) at baseline were associated with sustained poor/deterioration in appetite over the follow-up, after full adjustment. In the HABC Study, self-rated oral health ((OR=1.13 (95% CI=1.01 to 1.27)), tooth loss (OR=1.78 (95% CI=1.15 to 2.76)), dry mouth (OR=1.76 (95% CI=1.02 to 3.03)), eating or chewing difficulty (OR=1.88 (95% CI=1.41 to 2.50)) and cumulative oral health problems (OR=1.89 (95% CI=1.33 to 2.70)) at baseline were associated with sustained poor/deterioration in appetite during follow-up. In the BRHS, sustained poor/deterioration in oral health markers (self-rated oral health, dry mouth, eating or chewing difficulty, food avoidance, loose denture/s) over the follow-up were associated with sustained poor/deterioration of appetite.

Conclusion
Oral health is a potentially important contributor to maintaining good appetite in older age.

Introduction
To improve surgical quality and safety, health systems must prioritise equitable care for surgical patients. Racialised patients experience worse postoperative outcomes when compared with non-racialised surgical patients in settler colonial nation-states. Identifying preventable adverse outcomes for equity-deserving patient populations is an important starting point to begin to address these gaps in care. To derive literature-based estimates of the outcome gap for racialised surgical patients, we will systematically review and meta-analyse rates of adverse postoperative events associated with common and/or high-risk operations performed in Canada and the USA.

Methods and analysis
An electronic search of Medline, Embase, Web of Science, Cochrane Central, CINAHL and Scopus will be conducted to identify studies reviewing complication rates of racialised compared with non-racialised patients from inception to December 2023. We will include publications from the USA and Canada comparing surgical outcomes of racialised and non-racialised patients. The procedures of interest will be the four most common (hip arthroplasty, knee arthroplasty, appendectomy and cholecystectomy), and the five highest risk (oesophagectomy, abdominal aortic aneurysm, aortic valve replacement, coronary artery bypass graft and pancreatectomy) surgical procedures performed in these countries. The outcomes will be mortality, length of stay in hospital, readmission, reoperation, wound dehiscence, surgical site infection, pulmonary embolism, sepsis or septic shock, pneumonia, blood transfusion, stroke, myocardial infarction and bile duct injury. Summary estimates of cumulative incidence, prevalence, incidence rate and occurrence rate of complications using DerSimonian and Laird random effects models will be calculated for the systematic review and meta-analysis. Heterogeneity in these estimates will be examined using subgroup analyses and meta-regression.

Ethics and dissemination
This study uses secondary data and, therefore, does not require ethics approval. This study will be communicated through presentations at international conferences and published in peer-reviewed literature. The results from this study will inform the development of future surgical equity tools and quality improvement programmes and provide benchmarks on the impact of racism on surgical outcomes.

PROSPERO registration number
CRD42024491439.

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