Adult Outcomes Research Articles

Developing Self-Management in Type 1 Diabetes at Secondary Schools: Who Is Responsible? A Qualitative Study.

Occupational therapists have the proven capacity to improve outcomes for young adults who are self-managing Type 1 diabetes (T1D). There is insufficient understanding of adolescents' experiences of developing responsibility for diabetes self-management (DSM). To investigate adolescents' perceptions of sharing responsibility for T1D management at school. This study had a descriptive qualitative design and used semistructured interviews and thematic analysis. It is the second phase of a mixed-methods study with a sequential explanatory design that investigated mechanisms of responsibility-sharing at school. Secondary school in Australia. Purposive sample of adolescents (age 15-16 yr) with T1D (N = 11). Adolescents approached the complex occupation of school-based DSM primarily in partnership with their parents, with each adolescent having unique responsibilities while sharing others. Health care professionals and teachers reportedly had minimal involvement. Adolescents described owning most DSM tasks, with their perceptions of building independence limiting the sharing of this responsibility. A heightened sense of risk meant that adolescents were likely to communicate with others in cases of errant blood glucose readings. Current processes commonly resulted in reduced school participation. Adolescents valued working responsively and interdependently with their parents to manage T1D at school, which aligns with the occupational therapy model of co-occupation. Effective responsibility-sharing depends on clear, frequent, autonomy-supportive, team-based communications. Our results showed that patterns of communication for determining school-based DSM processes were fragmented and risk focused, with limited adolescent involvement, resulting in strategies that led to students at times being excluded from school activities. Plain-Language Summary: This is the first study to use an occupational lens to examine the way in which adolescents share their responsibility for diabetes care at school. Diabetes self-management in secondary schools occurs more often when adolescents work interdependently with their parents to manage their diabetes. Adolescent involvement in formal school processes and a clearer allocation of team roles and responsibilities would better support health-promoting habits and school participation.

Dwelling characteristics and mental well-being in older adults: A systematic review

The increasing prevalence of mental health challenges in older adults underscores the need for a comprehensive understanding of the interplay between dwelling characteristics and mental health outcomes. This systematic review aims to investigate house characteristics associated with mental well-being in older adults. The review meticulously explores existing literature from databases such as PubMed, Scopus, Web of Science, and the Google Scholar search engine. The Newcastle-Ottawa Scale (NOS) was utilized to assess the quality of the included articles. Out of an initial 1182 references, 21 pertinent articles published between 2002 and 2023 were included in the study. While the geographical scope was global, a notable concentration of studies was observed in China. The synthesis of studies reveals that specific attributes of dwelling characteristics, such as high-rise and multi-floor houses, larger house size, high house quality, bathing facilities, and the use of clean fuels for heating and cooking, positively impact mental health outcomes in older adults. However, inconsistent results were found regarding the impact of construction materials on mental health outcomes. Further research is warranted to deepen our understanding of the intricate relationship between construction materials and mental health outcomes. These findings underscore the importance of considering specific dwelling characteristics in designing interventions to enhance the mental well-being of older adults, necessitating targeted strategies for creating age-friendly living environments.

Examining the importance of neighborhood natural, and built environment factors in predicting older adults' mental well-being: An XGBoost-SHAP approach

BackgroundPrevious studies have shown that urban neighborhood environmental factors significantly influence the health outcomes of urban older adults. However, most cross-sectional studies exploring the health effects of these factors have failed to quantify the relative importance of each factor. MethodsWe use XGBoost machine learning techniques and SHAPley Additive Interpretation (SHAP) to rank the importance of urban neighborhood environmental factors in shaping the mental health of urban older adults. To address self-selection bias in housing choice, we distinguish older adults living in private housing from those living in public as residents in private housing have more freedom to choose where to live. ResultsThe results show that both natural and built environmental factors in urban neighborhoods are important predictors of mental well-being scores. Five natural environmental factors (blue space, perceived greenery quantity, NDVI, street view greenness, aesthetic quality) and three built environmental factors (physical activity facilities quality, physical activity facilities quantity, neighborhood disorder) had considerable predictive power for mental well-being scores in two groups. Among them, blue space, perceived greenery quantity and street view greenness quantity became less important after controlling for self-selection bias, possibly because of the unequal distribution of quantity and quality, and the performance of neighborhood disorder, aesthetic quality and physical activity facilities quality was more sensitive in public housing. ConclusionsThese results highlight the nuanced and differential effects of neighborhood environmental exposures on mental well-being outcomes, depending on housing preferences. The results of this study can provide support for decision makers in urban planning, landscape design and environmental management in order to improve the mental well-being status of urban older adults.

Physical Activity and Psychosocial Outcomes in Adults with Achondroplasia: An Exploratory Study.

Adults with achondroplasia face physical and psychosocial challenges that may impact their health-related quality of life and mental health. This exploratory cross-sectional study aimed to investigate relationships between health-related quality of life, mental health, and physical activity levels in adults with achondroplasia, focusing on potential gender differences. Sixteen adults with achondroplasia (10 women, 6 men; age 37.2 ± 13.5 years) completed the Short Form Health survey, the Brief Symptom Inventory, and the International Physical Activity questionnaire. Descriptive statistics, non-parametric group comparisons, correlational analyses, and linear regressions were conducted. Moderate physical activity showed strong positive correlations with general health (rs = 0.79, 95% CI [0.50, 0.92]), vitality (rs = 0.60, 95% CI [0.15, 0.85]), and physical functioning (rs = 0.62, 95% CI [0.18, 0.86]), on SF-36. Women reported lower quality of life scores than men across most SF-36 dimensions. Significant gender difference was observed in vitality (r = 0.61) and pain (r = 0.55). Physically active participants presented better outcomes in general health (r = 0.63) and vitality (r = 0.55) compared to inactive participants. This study provides preliminary evidence suggesting potential benefits of moderate-intensity physical activity on health-related quality of life and mental health among adults with achondroplasia, with notable gender differences. While limited by sample size and study design, the findings highlight the need for larger, longitudinal studies to further explore the role of physical activity in enhancing well-being in this population.

Efficacy and safety of compound porcine cerebroside and ganglioside injection (CPCGI) versus piracetam on cognition and functional outcomes for adults with traumatic brain injury: A study protocol for randomized controlled trial

BackgroundTraumatic brain injury (TBI) is a common neurosurgical disease in emergency rooms with poor prognosis, imposing severe burdens on patients and their families. Evidence indicates that piracetam and compound porcine cerebroside and ganglioside injection (CPCGI) can improve cognitive levels in TBI patients to enhance functional prognosis, but there is still a research gap regarding the efficacy of CPCGI. This study aims to determine the effectiveness and safety of CPCGI in improving cognitive and functional outcomes in TBI patients. MethodsThis study is a multicenter, randomized, parallel-group, double-blind trial aiming to recruit 900 adult patients with mild to moderate TBI. After providing informed consent, 600 patients will be randomly assigned to the CPCGI group (20 ml/d, for 14 days), and 300 patients will be randomized to the piracetam group as a control (20 ml/d, for 14 days), followed up for 3 months after treatment. The primary outcome is the change in the Montreal Cognitive Assessment (MoCA) score from baseline after 3 months. The main secondary outcome measures include Mini-Mental State Examination (MMSE) scores, Glasgow Outcome Scale-Extended (GOS-E), and the Barthel Index at 1 and 3 months. DiscussionThis multi-center clinical trial aims to provide high-quality evidence on the efficacy and safety of CPCGI in improving cognitive and functional outcomes in mild to moderate TBI patients. Trial registrationChiCTR2000040466, date of registration: November 28, 2020.

Do Non-Clinical Services Help to Improve Functional Outcomes Among Young Adults With Mental Disorders? A Systematic Review.

Mental disorders during young adulthood can significantly impair functioning in daily activities. Non-clinical support services aim to improve functioning by helping people to build social and life skills, participate in education and employment and improve physical health. This study aims to examine and synthesise the evidence for non-clinical services on improving functional outcomes for young adults with mental disorders. A systematic search was undertaken to identify quantitative and qualitative studies reporting on a non-clinical service component (vocational support, peer support, youth development, lifestyle interventions, family and network support) and examining functional outcomes (e.g., outcomes focussed on work and education, life skills, relationships and healthy behaviours). Seventeen studies met inclusion criteria. Identified studies focussed on vocational support services (n = 9), lifestyle interventions (n = 6) and family and network support services (n = 2). No studies on peer-support services or youth development services were found. More than half of the vocational support service studies reported increased employment rates among young adults (n = 6). Studies focussing on lifestyle interventions included a combination of physical activity, nutrition education, health coaching and motivation and behaviour change. However, the measures of functioning used across studies were too varied to determine whether lifestyle interventions may be useful in improving functional outcomes for young adults. Further research is needed to understand the impact of non-clinical services on functioning. This evidence will provide pragmatic guidance for service planners to invest in supports and interventions that make a meaningful difference to the lives of young adults living with mental disorders.

Effectiveness and Tolerability of Anti-Calcitonin Gene-Related Peptide Therapy for Migraine and Other Chronic Headaches in Adolescents and Young Adults: A Retrospective Study in the USA.

This retrospective study assesses the efficacy and tolerability of anti-calcitonin gene-related peptide (anti-CGRP) therapy in adolescents and young adults (ages 12-21) with migraine and chronic daily headaches unresponsive to standard treatments. Migraines in this demographic significantly impair school performance, self-esteem, psychological well-being, and cognitive health. These young patients are also particularly sensitive to the side effects of conventional medications, which are often prescribed off-label and come with high insurance denial rates. Medication overuse, including analgesics, triptans, and NSAIDs, is prevalent due to treatment failures. Elevated plasma CGRP levels observed during migraines suggest that anti-CGRP therapies, successful in adult populations, may also benefit this younger age group. Over a three-year period, patients at a specialized pediatric headache center were evaluated for the impact of anti-CGRP treatments, including monoclonal antibodies (erenumab, fremanezumab, and galcanezumab) and small-molecule CGRP receptor antagonists (ubrogepant, rimegepant, and atogepant), administered either alone or in combination with OnabotulinumtoxinA. Data were extracted from the hospital's electronic medical records, and patient progress was consistently documented using a structured template for each clinic visit. Additional patient satisfaction data were collected via telephone follow-ups and patient message reviews. The study included 23 patients, primarily treated for chronic migraine (CM) (78.3%), with a smaller subset addressing episodic migraine (EM), new daily persistent headaches (NDPHs), and post-traumatic headaches (PTHs). Comprehensive demographic and clinical data, including age, treatment duration, history of preventive treatment failures, and comorbidities like psychiatric conditions and sleep disorders, were collected. Anti-CGRP therapies, particularly when combined with traditional treatments or OnabotulinumtoxinA, resulted in significant improvements: 91.3% of patients experienced reduced migraine duration and intensity, 82.6% reported improvements in other bothersome symptoms, and 73.9% saw an improved response to rescue medications. Additionally, 78.3% of patients reported a reduction in their use of rescue medications per week by more than 50%, and emergency room visits were reduced for 56.5% of patients. Significant reductions in headache days were observed in 82.6% of patients after one month and 87% after three months, with nearly 40% experiencing more than a 50% reduction in both periods. The greatest benefits were observed in patients treated for more than six months. Adverse effects were minimal, with 95.7% of patients reporting no side effects, and patient satisfaction was high, with 69.6% opting to continue treatment. Overall, this study highlights the substantial potential of anti-CGRP therapy in improving outcomes for adolescents and young adults with CM and EM, offering a promising approach for a demographic that faces considerable challenges with conventional treatment options. However, further research is needed to confirm these findings and expand clinical applications in this age group.

The Impact of Positive and Adverse Experiences in Adolescence on Health and Wellbeing Outcomes in Early Adulthood.

This study evaluated the associations between positive and adverse experiences and environments in adolescence and health, education and employment outcomes in early adulthood. Data were extracted from the Longitudinal Studies of Australian Youth cohort that commenced in 2003. The items were conceptually mapped to Positive and Adverse Youth Experiences and environments (PYEs and AYEs) at 15, 16 and 17 years old and outcomes at 25 years old. The associations between PYEs, AYEs and general health, mental health, education and employment were examined, including testing whether PYEs mitigated the association between AYEs and outcomes. A higher number of AYEs was associated with poorer health, education, and employment outcomes. Conversely, a higher number of PYEs was correlated with positive outcomes. The participants with higher PYEs had significantly greater odds of better general and mental health outcomes, even after accounting for AYEs. This relationship was not observed for employment or education outcomes. Adolescence and the transition to adulthood are critical developmental stages. Reducing adverse experiences and environments and increasing positive ones during adolescence could enhance adult wellbeing.

Comparative Cardiovascular Effectiveness of Empagliflozin Versus Dapagliflozin in Adults With Treated Type 2 Diabetes: A Target Trial Emulation.

Empagliflozin and dapagliflozin have proven cardiovascular benefits in people with type 2 diabetes at high cardiovascular risk, but their comparative effectiveness is unknown. This study used nationwide, population-based Danish health registries to emulate a hypothetical target trial comparing empagliflozin versus dapagliflozin initiation, in addition to standard care, among people with treated type 2 diabetes from 2014 through 2020. The outcome was a composite of myocardial infarction, ischemic stroke, heart failure (HF), or cardiovascular death (major adverse cardiovascular event). Participants were followed until an outcome, emigration, or death occurred; 6 years after initiation; or December 31, 2021, whichever occurred first. Logistic regression was used to compute inverse probability of treatment and censoring weights, controlling for 57 potential confounders. In intention-to-treat analyses, 6-year adjusted risks, risk differences, and risk ratios considering noncardiovascular death competing risks were estimated. Analyses were stratified by coexisting atherosclerotic cardiovascular disease and HF. A per-protocol design was performed as a secondary analysis. There were 36 670 eligible empagliflozin and 20 606 eligible dapagliflozin initiators. In the intention-to-treat analysis, the adjusted 6-year absolute risk of major adverse cardiovascular event was not different between empagliflozin and dapagliflozin initiators (10.0% versus 10.0%; risk difference, 0.0% [95% CI, -0.9% to 1.0%]; risk ratio, 1.00 [95% CI, 0.91 to 1.11]). The findings were consistent in people with atherosclerotic cardiovascular disease (risk difference, -2.3% [95% CI, -8.2% to 3.5%]; risk ratio, 0.92 [95% CI, 0.74 to 1.14]) and without atherosclerotic cardiovascular disease (risk difference, 0.3% [95% CI, -0.6% to 1.2%]; risk ratio, 1.04 [95% CI, 0.93 to 1.16]) and in people with HF (risk difference, 1.1% [95% CI, -6.5% to 8.6%]; risk ratio, 1.04 [95% CI, 0.79 to 1.37]) and without HF (risk difference, -0.1% [95% CI, -1.0% to 0.8%]; risk ratio, 0.99 [95% CI, 0.90 to 1.09]). The 6-year risks of major adverse cardiovascular event were also not different in the per-protocol analysis (9.1% versus 8.8%; risk difference, 0.2% [95% CI, -2.1% to 2.5%]; risk ratio, 1.03 [95% CI, 0.80 to 1.32]). Empagliflozin and dapagliflozin initiators had no differences in 6-year cardiovascular outcomes in adults with treated type 2 diabetes with or without coexisting atherosclerotic cardiovascular disease or HF.

Relationship between morphologic remission with or without hematologic recovery and outcome after allogeneic hematopoietic cell transplantation in adult acute myeloid leukemia.

Outcomes of adults with AML after allografting vary widely. While numerous covariates have been associated with relapse, non-relapse mortality (NRM), and/or shorter survival, the impact of incomplete blood count recovery before transplantation has remained unclear. To address this uncertainty, we examined all adults with AML or MDS/AML who received an allograft in first or second remission between 2006 and 2023 at a single institution. Of 1264 patients, 891 (70%) met criteria for CR, whereas 291 (23%), 24 (2%), and 58 (5%) were classified as CRh, CRi, and morphologic leukemia-free state (MLFS), respectively. CR, CRh, CRi, and MLFS patients differed significantly regarding demographics, disease biology, pre-transplant measurable residual disease, and types of transplants. After multivariable adjustment, outcomes for CRh and CRi patients were not significantly different from each other or from those of CR patients. In contrast, outcomes of MLFS patients were substantially worse than those of CR and CRh patients, with significantly higher risk of NRM and relapse, and significantly shorter relapse-free and overall survival. Similar results were obtained in several distinct subsets. Together, our analysis provides empiric evidence for the importance of distinguishing MLFS from CR and CRh patients for optimized risk assessment and, possibly, individualized treatment decision making.

Effects of Defatted Rice Bran-Fortified Bread on the Gut Microbiota Composition of Healthy Adults With Low Dietary Fiber Intake: Protocol for a Crossover Randomized Controlled Trial.

Inadequate dietary fiber (DF) intake is associated with several human diseases. Bread is commonly consumed, and its DF content can be increased by incorporating defatted rice bran (DRB). This first human study on DRB-fortified bread primarily aims to assess the effect of DRB-fortified bread on the relative abundance of a composite of key microbial genera and species in fecal samples. Secondary outcomes include clinical (cardiovascular risk profile), patient-reported (daily bread consumption and bowel movement, gut comfort, general well-being, and total DF intake), biological (fecal microbiota gene abundances, and fecal and plasma metabolites), and physiome (whole-gut and regional transit time and gas fermentation profiles) outcomes in healthy adults with low DF intake. This is a 2-armed, placebo-controlled, double-blinded, crossover randomized controlled trial. The study duration is 14 weeks: 2 weeks of lead-in, 4 weeks of intervention per phase, 2 weeks of washout, and 2 weeks of follow-up. Overall, 60 healthy adults with low DF intake (<18 g [female individuals] or <22 g [male individuals] per day) were recruited in Christchurch, New Zealand, between June and December 2022. Randomly assigned participants consumed 3 (female individuals) or 4 (male individuals) slices of DRB-fortified bread per day and then placebo bread, and vice versa. The DRB-fortified bread provided 8 g (female individuals) or 10.6 g (male individuals) of total DF, whereas the placebo (a matched commercial white toast bread) provided 2.7 g (female individuals) or 3.6 g (male individuals) of total DF. Before and after each intervention phase, participants provided fecal and blood samples to assess biological responses; completed a 3-day food diary to assess usual intakes and web-based questionnaires to assess gut comfort, general and mental well-being, daily bread intake, and bowel movement via an app; underwent anthropometry and blood pressure measurements; and drank blue food dye to assess whole-gut transit time. Additionally, 25% (15/60) of the participants ingested Atmo gas-sensing capsules to assess colonic gas fermentation profile and whole-gut and regional transit time. Mean differences from baseline will be compared between the DRB and placebo groups, as well as within groups (after the intervention vs baseline). For metabolome analyses, comparisons will be made within and between groups using postintervention values. Preliminary analysis included 56 participants (n=33, 59% female; n=23, 41% male). Due to the large dataset, data analysis was planned to be fully completed by the last quarter of 2024, with full results expected to be published in peer-reviewed journals by the end of 2024. This first human study offers insights into the prospect of consuming DRB-fortified bread to effectively modulate health-promoting gut microbes, their metabolism, and DF intake in healthy adults with low DF intake. Australian New Zealand Clinical Trials Registry ACTRN12622000884707; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383814. DERR1-10.2196/59227.

The impact of a virtual wellness course for adults with intellectual and developmental disabilities in the third year of COVID-19.

The current study examines how a virtual wellness intervention may improve health outcomes in adults with intellectual and developmental disabilities. Thirty-six adults with intellectual and developmental disabilities participated in the wellness intervention. Outcome measures related to satisfaction, mental health, wellbeing, health behaviours and overall health were completed at three time points (pre, post and follow-up). Participants reported high levels of satisfaction and had significant improvements in outcomes related to mental health and wellbeing. Changes in sleep, sedentary behaviour and overall health were not reported, though qualitative evidence suggests that some changes were implemented. The study provides evidence to support the use of virtual interventions to address health concerns in individuals with intellectual and developmental disabilities.

Looking Back on Career, Looking Forward to Retirement: Antecedents of Subjective Career Evaluations and Their Impact on Retirement Adjustment.

An individual's past, and reflections on it, may influence current and future well-being. Recent qualitative studies suggest retirees' recollections about their careers relate to well-being in retirement. We investigated associations between life course events and subjective career evaluations, gender differences in these associations, and their subsequent association with retirement adjustment. We used data from three waves (2015, 2018, and 2023) of the (NIDI Pension Panel Study (NPPS), a longitudinal survey of Dutch older workers. Using a sample of 6,109 respondents, we used ordinary least squares (OLS) regression models to investigate associations between employment stability facilitators and inhibitors (e.g., promotion, demotion, unemployment) and personal shocks (e.g., divorce, widowhood) and subjective evaluations of satisfaction with the work and family domains of career between genders. Using a follow-up sample (N=4,106), we employed ordinal logistic regression models to investigate the impact of these baseline subjective evaluations on retirement adjustment at follow-up. Employment stability factors such as demotion and unemployment, and personal shocks such as poor psychological health were associated with subjective evaluations of the work and family career domains. Gender differences in these associations were found. Evaluations in both the work and family domains were associated with retirement adjustment at follow-up. Our results demonstrate the importance of life course events on older workers' evaluations of their careers and the long-term impact of subjective career evaluations. Further research is needed to evaluate the predictive utility of these evaluations for other outcomes in older adulthood.

Outcomes of Adults With Unrepaired Partial Anomalous Pulmonary Venous Return and Intact Atrial Septum.

The purpose of this study was to describe the correlates and outcomes in adults with unrepaired partial anomalous pulmonary venous return and intact atrial septum (PAPVR-IAS). We identified adults with PAPVR-IAS who received care at the Mayo Clinic, while those with unrepaired PAPVR-IAS comprised the reference group. Clinical indices (New York Heart Association class, peak oxygen consumption, and NT-proBNP [N-terminal pro-B-type natriuretic peptide]) and echo-derived right heart indices (right atrial [RA] volume, RA reservoir strain, right ventricular [RV] free wall strain, RV end-diastolic area, and RV systolic pressure) were assessed at baseline and 3-year and 5-year follow-up. There were 80 patients and 38 patients with unrepaired versus repaired PAPVR-IAS, respectively. The clinical predictors of surgical repair were the number of anomalous veins, RA volume, and RV end-diastolic area. The PAPVR-IAS risk score, derived from these clinical predictors, was associated with surgical repair (adjusted odds ratio, 1.37 [95% CI, 1.24-1.65] per unit increase in risk score; area under the curve, 0.742). Among patients with unrepaired PAPVR-IAS with 3-year (n=73) and 5-year follow-up (n=36), there was no temporal change in clinical indices (New York Heart Association class, predicted peak oxygen consumption, and NT-proBNP) and right heart indices (RA volume index, RA reservoir strain, RV end-diastolic area index, RV free wall strain, and RV systolic pressure). The PAPVR-IAS risk score can be used to assess the odds of requiring surgical repair. Furthermore, there was no temporal deterioration in clinical and right heart indices during follow-up in adults with unrepaired PAPVR-IAS.

Illness perceptions, symptom severity and psychosocial outcomes in adults with dysfunctional breathing

Background People with dysfunctional breathing (DB) experience symptoms such as air hunger and breathing pattern irregularities. The condition is often comorbid with other respiratory conditions, as well as anxiety and depression. Illness perceptions, the beliefs an individual has of an illness may explain health and wellbeing outcomes. Methods In this cross-sectional study we examined the illness perceptions of those diagnosed with DB, symptom severity, and psychosocial outcomes of depression, anxiety, and impact on daily living. Data were analyzed using tests of comparison and regression analysis. Results 82 people diagnosed with DB completed the brief illness perception questionnaire, the Nijmegen symptoms questionnaire, and questionnaires measuring mood and impact on daily living. The illness perceptions of those with DB were overall negative. There was a positive correlation between illness perceptions and mood, indicating that the stronger the beliefs that individuals had that DB is a serious condition, the more negative their mood. Illness perceptions significantly predicted psychosocial outcomes, even when controlling for demographic factors and symptom severity (depression: adj. R2=.352, F(10,51)=4.32, p<.001; anxiety: adj. R2=.40, F(11,47)=4.55, p<.001; impact on daily living: adj. R2= .33, F(8,53)=4.79, p<.001). Conclusions This is the first study to examine illness perceptions held by those diagnosed with DB. Our study found significant relationships between illness perceptions and psychosocial outcomes. It is possible that psychological interventions that target illness perceptions may also improve outcomes.

Sodium-Glucose Cotransporter-2 Inhibitor and Glucagon-Like Peptide-1 Receptor Agonist Discontinuation in Patients with CKD.

Little is known about the association of discontinuation of sodium-glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RA) with outcomes in patients with chronic kidney disease (CKD). We identified adults with CKD stages 3-4 from 2005-2022 in the Veterans Affairs healthcare system. Individuals with an incident prescription for SGLT2 inhibitors or GLP-1 RAs were included, with the first fill date considered the index date. Factors associated with time to first treatment discontinuation, defined as an interruption in SGLT2 inhibitor or GLP-1 RA prescription for ≥90 days, were studied using Cox proportional hazards regression models. Associations of discontinuation 90-179 days and ≥180 days with death, myocardial infarction, coronary revascularization, hospitalization for heart failure, and ischemic stroke were assessed using Cox proportional hazards regression. Of 96,345 individuals who received an SGLT2 inhibitor and 60,020 who received a GLP-1 RA, at least one discontinuation occurred in 35,953 (37%) of SGLT2 inhibitor users and 28,407 (47%) of GLP-1 RA users. SGLT2 inhibitor users were 24% Black, 71% White, 71% age ≥70, and 84% with CKD stage 3a. GLP-1 RA users were 20% Black, 75% White, 63% age ≥70, and 81% with CKD stage 3a. Black race, Hispanic ethnicity, cerebrovascular disease, peripheral vascular disease, and ischemic heart disease were associated with discontinuation of both drug classes. Female sex and more advanced CKD stage were also associated with SGLT2 inhibitor discontinuation. SGLT2 inhibitor discontinuation ≥180 days was associated with death, (adjusted hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.58-1.77) and heart failure hospitalization, (adjusted HR 1.26, 95% CI 1.13-1.40). GLP-1 RA discontinuation ≥180 days was associated with death, (adjusted HR 1.97, 95% CI 1.87-2.07), myocardial infarction (adjusted HR 1.23, 95% CI 1.11-1.36), heart failure hospitalization (adjusted HR 1.48, 95% CI 1.33-1.64), and ischemic stroke (adjusted HR 1.24, 95% CI 1.14-1.35). SGLT2 inhibitor and GLP-1 RA discontinuation was common and associated with harmful outcomes in adults with CKD.

Life outcomes in adults living with FASD in a rural South African community: A follow-up study.

Even though adults with foetal alcohol spectrum disorder (FASD) are at risk of negative life outcomes, there is no published evidence of this in South Africa, which has the highest estimated FASD prevalence rate globally. The purpose of the study was to describe and compare the life outcomes of adults with FASD and adults without FASD in a South African rural community, 16 years after diagnosis. Participants were examined and interviewed regarding their biographical information, knowledge of FASD, information on their family, relationships, home circumstances, education, work and medical history. Adults with FASD were less likely to be in a relationship and more likely to have poor educational outcomes and to be exposed to violence as victim or perpetrator than their peers who did not have FASD. None of the participants with FASD completed secondary school successfully. No differences were found for independent living, employment, health, substance use and legal outcomes, between the foetal alcohol syndrome (FAS) or partial foetal alcohol syndrome (PFAS) and control group. While significant differences existed in certain aspects, differences are not as stark as one would expect between individuals with FASD and controls. This study highlights the importance of considering the social context in which a FASD diagnosis is made. The comparative negative impact of an FASD diagnosis and the associated challenges on life outcomes may be less pronounced in rural communities where everyone has fewer opportunities and resources. This can also make the unique needs of persons with disabilities less visible.

Patient-Reported Outcomes in Adults With Newly Diagnosed Ph+ Acute Lymphoblastic Leukemia Treated With Ponatinib or Imatinib in Combination With Reduced-Intensity Chemotherapy: Results From the Phase III PhALLCON Study

Patient-Reported Outcomes in Adults With Newly Diagnosed Ph+ Acute Lymphoblastic Leukemia Treated With Ponatinib or Imatinib in Combination With Reduced-Intensity Chemotherapy: Results From the Phase III PhALLCON Study

ALL-442 Patient-reported Outcomes in Adults With Newly Diagnosed Ph+ Acute Lymphoblastic Leukemia Treated With Ponatinib or Imatinib in Combination With Reduced-Intensity Chemotherapy: Results From the Phase III PhALLCON Study

ALL-442 Patient-reported Outcomes in Adults With Newly Diagnosed Ph+ Acute Lymphoblastic Leukemia Treated With Ponatinib or Imatinib in Combination With Reduced-Intensity Chemotherapy: Results From the Phase III PhALLCON Study

Self-Reported Psychosocial Outcomes of Autistic Adults Living in China and The Netherlands

Self-Reported Psychosocial Outcomes of Autistic Adults Living in China and The Netherlands