Anonymous Data Research Articles

Anonymity‐Aware Framework for Designing Recommender Systems

Due to increasing secondary use of data, recommender systems using anonymized data are in demand. However, implementing a recommender system requires complicated data processing and programming, and the relationship between anonymization level and recommendation quality has not been investigated. Therefore, this study proposes a framework that facilitates the development of recommender systems. Additionally, a method is proposed for quantitatively evaluating recommendation quality when the anonymization level is varied. The proposed method promotes data utilization by recommender systems and determination of compensation for providing data based on anonymization level. © 2024 Institute of Electrical Engineer of Japan and Wiley Periodicals LLC.

Abstract PO2-16-06: Treatment Patterns of Neoadjuvant Therapy in Chinese Patients with HR-Positive/HER2-Positive Early or Locally Advanced Breast Cancer: A Real-World Study Using NCID Data in 2019-2022

Abstract Background: With the approval of pertuzumab (P) in China in 2019, P plus trastuzumab (T) and chemotherapy has become a standard of care in the neoadjuvant setting for patients with HER2-positive (HER2+) early or locally advanced breast cancer (BC). As a unique subtype, HR-positive (HR+)/HER2+ BC is less responsive to neoadjuvant chemotherapy plus HER2 targeted therapy with lower pathologic complete response (pCR) rates compared with the HR−/HER2+ subgroup. In China, the treatment pattern of HR+/HER2+ BC patients is unclear. In this real-world study, we summarized the current treatment patterns of Chinese patients diagnosed with HR+/HER2+ BC at an early or locally advanced stage based on national-level data to drive clinical decision support. Methods: A representative sample of 51 hospitals (31 cancer centers and 20 general hospitals) covering 29 provinces from NCID (National Cancer Information Database) were generated. Anonymous individual patient data from electronic medical records (EMR) were retrieved to extract information on therapy modalities. Early or locally advanced HR+/HER2+ BC patients who were initially diagnosed between January 1, 2019 and May 31, 2022 were included. Data were analyzed both by year and in the aggregate to ensure accuracy and stability. Results: The types of hospitals and study period reflected the current treatment landscape of HR+/HER2+ early or locally advanced BC in Chinese clinical practice. From 2019 to 2022, the results were consistent by year. In the aggregate, a total of 290,626 patients were initially diagnosed with BC during the study period. 84% (243,528/290,626) were at an early or locally advanced stage, of which 50% (121,548/243,528) had a pathologic diagnosis, 24% (29,390/121,548) were identified as HER2+, 69% (20,370/29,390) were both HR+ and HER2+, and 87% (17,630/20,370) underwent surgery. After excluding those without post-operative pathologic reports or with other primary cancers, 15,368 patients were analyzed regarding treatment patterns. 30% (4,598/15,368) received neoadjuvant therapy but 69% (10,677/15,368) had no neoadjuvant therapy. Among 4,598 patients, 31% (1,434/4,598) received T as single anti-HER2 targeted therapy, 36% (1,649/4,598) received dual HER2 blockade (1,522 T plus P, 127 T plus a TKI [tyrosine kinase inhibitor]), and the rest (1,515) received treatment that not contain a targeted agent. For patients treated with T plus P, 1,465 received concurrent chemotherapy (410 anthracyclines-based, 828 platinum-based); for patients treated with T plus TKI, 123 received concurrent chemotherapy (15 anthracyclines-based, 79 platinum-based). The most frequently prescribed chemotherapies were platinum-based regimens (57% for T plus P plus chemotherapy and 64% for T plus TKI plus chemotherapy). Conclusions: Based on the largest nationwide database, strong representativeness and stability of our data sources, our findings are of great significance to clinical decision-making. The proportion of patients who underwent neoadjuvant therapy of HR+HER2+ BC is much lower than in many other countries, with T plus P in combination with chemotherapy appearing to be the most commonly used targeted regimen. We also found some distinctions between neoadjuvant patterns of early-stage BC in the real world of China and guidelines, which would be further explored in subsequent research. Citation Format: Zhenzhen Liu, Jiujun Zhu, Chengzheng Wang, Zhenduo Lu, Xiuchun Chen, Lianfang Li, Xianfu Sun, Chongjian Zhang, Jianghua Qiao, Min Yan. Treatment Patterns of Neoadjuvant Therapy in Chinese Patients with HR-Positive/HER2-Positive Early or Locally Advanced Breast Cancer: A Real-World Study Using NCID Data in 2019-2022 [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-16-06.

Abstract PO1-05-12: Pooled clinical trial data analyses comparing the biology of HER2-low vs HER2-0 breast cancer in patients with metastatic breast cancer following treatment with standard single agent chemotherapy

Abstract Background: Prior analyses of observational data suggest that for patients with metastatic breast cancer (MBC), tumor biology does not vary by HER2-low vs. HER2-0 expression given similar overall survival (OS) times after accounting for patients’ clinicopathologic features including hormone receptor (HR) status. We sought to evaluate potential differential biology by HER2-low status by (1) studying data pertaining to patients treated in historic clinical trials (i.e., data collected to measure associations between protocol defined treatments and outcomes) and (2) evaluating the endpoint of progression-free survival (PFS) in addition to OS following treatment with standard single agent chemotherapy for MBC. Methods: Pooling anonymized clinical trial data from studies within the Medidata Enterprise Data Store, we identified 142 women with HER2-negative MBC who received treatment with an NCCN recommended single agent chemotherapy in the context of a clinical trial. Using patient-level immunohistochemistry (IHC) results, we categorized patients as either HER2-low (IHC 1+/2+ and not amplified by in situ hybridization) or HER2-0 (IHC 0). We compared patients’ baseline demographic and clinicopathologic features according to HER2-low vs HER2-0 status. We used Cox proportional-hazard models stratified by HR status to estimate OS and PFS according to HER2-low vs HER2-0 classification while adjusting for patients' baseline demographic and clinicopathologic attributes. Results: Patients with HER2-low disease represented 20% (28/142) of the HER2-negative cohort. Twenty-five percent (7/28) of HER2-low patients had tumors that expressed hormone receptors compared with 17% (19/114) of HER2-0 patients (p=0.31). In this cohort, the maximum follow up time was 38.4 months. For HER2-low patients vs HER2-0 patients, the median OS was 10.7 vs. 12.7 months (p=0.37), and the median PFS was 3.5 vs. 2.9 months (log rank test, p=0.53) respectively. In Cox proportional-hazard models that adjusted for patient demographic and clinicopathologic features and were stratified by HR status, patients with HER2-low tumors had an 16% elevated (non-significant) hazard of death compared with patients with HER2-0 tumors (HR 1.16, 95% CI: 0.69-1.95) and a 22% reduced (non-significant) hazard of progression or death (HR 0.78, 95% CI: 0.45-1.35). Conclusions: Analyses of pooled historic clinical trial data pertaining to women with HER2-negative MBC who were treated with single agent chemotherapy revealed no meaningful clinical differences in either OS or PFS endpoints according to HER2-negative subtypes (i.e., HER2-low vs. HER2-0) after accounting for patient demographic and clinicopathologic features. These results support prior findings from observational research suggesting that there are no biological differences associated with HER2-negative subtypes. Table. Multivariable Cox Proportional Hazards Models for OS and PFS Stratified by Hormone Receptor Status, (N=134) Variable OS PFS HR* 95% CI HR* 95% CI Age (decade) 0.84 0.70-1.01 0.86 0.72-1.01 Race White 1.00 (referent) 1.00 (referent) Black 1.75 0.84-3.63 1.57 0.66-3.73 Asian 0.93 0.47-1.80 1.33 0.71-2.51 Other 1.69 0.45-6.38 2.10 0.62-7.15 Ethnicity Non-Hispanic or Latino 1.00 (referent) 1.00 (referent) Hispanic or Latino 2.10 0.95-4.64 1.02 0.44-2.35 HER2 Characterization HER2-0 1.00 (referent) 1.00 (referent) HER2-1+/2+ 1.16 0.69-1.95 0.78 0.45-1.35 Prior Lines of Chemotherapy for Metastatic Disease 0 1.00 (referent) 1.00 (referent) 1 0.82 0.46-1.46 1.13 0.65-1.95 2 0.69 0.35-1.36 1.00 0.52-1.93 3 0.59 0.10-3.42 2.18 0.45-10.50 ECOG Performance Status 0 1.00 (referent) 1.00 (referent) 1 1.65 1.07-2.54 1.57 1.02-2.43 Legend: OS=overall survival; PFS=progression-free survival; HR=hazard ratio; HER2=human epidermal group factor receptor 2; ECOG=Eastern Cooperative Oncology Group. *Analyses adjusted for clinical trial membership (coefficients not reported) Citation Format: Elizabeth Lamont, Emily Stein, Paolo Tarantino, Sara Tolaney, Corinne Ahlberg, Krishna Chinnathambu, Jiezhi Qi, Kala Tummagunta, Jackie Bilan, Ruthanna Davi, Lisa Ensign. Pooled clinical trial data analyses comparing the biology of HER2-low vs HER2-0 breast cancer in patients with metastatic breast cancer following treatment with standard single agent chemotherapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-05-12.

Comparing conventional and modified Seldinger techniques using a micro-insertion kit for PICC placement in neonates: a retrospective cohort study

ObjectiveThis study aims to assess the comparative effectiveness of a conventional splitting needle or a peelable cannula vs. the modified Seldinger technique (MST) by utilizing a dedicated micro-insertion kit across various clinically significant metrics, including insertion success, complications, and catheter-related infections.MethodsWe conducted a retrospective observational cohort study using an anonymized data set spanning 3 years (2017–2019) in a large tertiary-level neonatal intensive care unit in Qatar.ResultsA total of 1,445 peripherally inserted central catheter (PICC) insertion procedures were included in the analysis, of which 1,285 (89%) were successful. The primary indication for insertion was mainly determined by the planned therapy duration, with the saphenous vein being the most frequently selected blood vessel. The patients exposed to MST were generally younger (7 ± 15 days vs. 11 ± 26 days), but exhibited similar mean weights and gestational ages. Although not statistically significant, the MST demonstrated slightly higher overall and first-attempt insertion success rates compared to conventional methods (91 vs. 88%). However, patients undergoing conventional insertion techniques experienced a greater incidence of catheter-related complications (p < 0.001). There were 39 cases of catheter-related bloodstream infections (CLABSI) in the conventional group (3.45/1,000 catheter days) and eight cases in the MST group (1.06/1,000 catheter days), indicating a statistically significant difference (p < 0.001). Throughout the study period, there was a noticeable shift toward the utilization of the MST kit for PICC insertions.ConclusionThe study underscores the viability of MST facilitated by an all-in-one micro kit for neonatal PICC insertion. Utilized by adept and trained inserters, this approach is associated with improved first-attempt success rates, decreased catheter-related complications, and fewer incidences of CLABSI. However, while these findings are promising, it is imperative to recognize potential confounding factors. Therefore, additional prospective multicenter studies are recommended to substantiate these results and ascertain the comprehensive benefits of employing the all-in-one kit.

Analysis of the effectiveness of hygiene measures and COVID-19 vaccination at a tertiary-care university hospital during the first two years of the SARS-CoV-2 pandemic

ObjectiveAssessment of the effectiveness of protective measures at a tertiary-care hospital during the SARS-CoV-2 infection waves to provide advice for future pandemics. DesignRetrospective cohort study among hospital staff using in-house surveillance data. SettingUniversity Hospital Erlangen (UKER), a tertiary-care provider in Bavaria, Germany. MethodsWe outline the preventive measures introduced at UKER and retrospectively assess their effectiveness using anonymized monitoring data that were collected during the SARS-CoV-2 pandemic from February 2020 to the end of January 2022. Analysed data includes the incidence of SARS-CoV-2 infections among employees, the frequency of high-risk contacts with infected patients or staff members and breakthrough infections considering the context of exposure. ResultsThe cumulative incidence of SARS-CoV-2 infections among UKER employees was higher before, but lower after the vaccination campaign when compared to the general population. Healthcare workers (HCW), notably physicians and nurses, were especially at risk of infection compared to other UKER employees with less direct patient contact (OR 1.36 [95% CI 1.18-1.57 p<0.001]). Breakthrough infections mostly occurred after exposure during private life, i.e. in situations without protective equipment. The frequency of high-risk contacts during direct patient care remained stable after SARS-CoV-2 vaccination. Prior to vaccination, 5.2% of HCW with direct patient care tested positive for SARS-CoV-2 within 14 days. After vaccination until the onset of the Omicron wave, conversion rate dropped to 0%. ConclusionsThis study provides real-world data on the effectiveness of vaccination, contact tracing, personal protective equipment and general hygiene measures during the SARS-CoV-2 pandemic. Based on our findings, we recommend a protective approach combining all these preventive measures.

Does 2D and 3D built environment matter for the spreading of COVID-19 at early stages in Wuhan, China: A spatial and multi-scale analysis

Evidence for the impacts of urban physical attributes on the spread of COVID-19 remains weak due to few investigations into the modifiable areal unit problem (MAUP) and spatial autocorrelation, as well as the lack of fine-grained COVID-19 case data. This study presents a spatial and multi-scale approach to examine the relationships between two-dimensional (2D) and three-dimensional (3D) urban parameters and accumulative confirmed infection cases. The spatial distributions of COVID-19 infections are mapped using anonymized neighborhood-level report data with nearly 50,000 confirmed cases at the early stages of the epidemic in Wuhan, China, and the 2D and 3D built environment factors at multiple spatial scales are characterized. Next, geographical detector model is used to examine the MAUP in the spread of COVID-19 and effects of urban parameters, and spatial regression models are then used to address spatial autocorrelation in the results at the identified appropriate spatial scales. Results reveal that the influences of most urban parameters are sensitive to the scale and areal unit used, and 3D urban parameters, such as building height, have a greater influence than 2D parameters. The estimates from both spatial and non-spatial models suggest the presence of spatial dependence and unobserved autocorrelated factors, and the overestimation of the effects of most urban parameters.

Factors Correlating to Decisions for Prescribing Pharmacological Treatment and Referrals in Suspected Peripheral Neuropathy Cases in Chat Consultation-Based Application

IntroductionSince the COVID-19 pandemic, there has been increasing use ofchat-based telemedicine, including for patients with neuropathy complaints. It is imperative to learn how to effectively use telemedicine. This study describes the characteristics of patients with neuropathy complaints in chat-based telemedicine services in Indonesia and their influence on treatment decisions and referrals. MethodsThis is a retrospective cross-sectional study during the COVID-19 pandemic era (March 2020 to December 2021) using anonymous secondary data from patient chat databases on Indonesian application-based telemedicine services (Halodoc, Alodokter, Good Doctor, and Milvik). We applied bivariate and multivariate analysis. ResultsWe obtained 1,051 patients with suspected peripheral nerve complaints (4 per 10,000) from a total of 2,199,527 user consultations, with the majority being 40-64 years old females and diabetes mellitus was the leading comorbid (90.7%). Most patients received treatment (90.7%) and only 11.4% patients were referred. Multivariate analysis showed that treatment was more likely to be given by a neurologist (p<0.01). Chronic symptoms (p<0.01) and previous laboratory/other tests (p = 0.01) decreased the likelihood of medication prescription. Referrals were more likely to be given to chronic onset (p=0.02), hypertension and heart disease (p<0.01), and previous laboratory/other tests (p=0.02). The opposite was true for age≥65 years, female (p=0.04), and neurologists or other specialists as responders (p<0.01). ConclusionWe identified several factors that influence the treatment decision such as female patients and onset. Meanwhile, age, sex, chronic symptoms, history of hypertension and heart disease, and previous laboratory/other tests may influence the referral decisions. General practitioners were more likely to refer the patients whereas neurologists or other specialists were more likely to give treatment. Chat-based telemedicine services can still be developed in the future to be better.

Changes in analgesic prescribing among older adults hospitalised for osteoarthritis or joint replacements

Abstract Introduction Osteoarthritis is a chronic, progressive joint disease, associated with frequent pain, and functional decline. The primary risk factor for developing osteoarthritis is advanced age. Older patients are more susceptible to the adverse effects of commonly prescribed analgesics such as opioids and non-steroidal anti-inflammatory drugs (NSAIDs), owing to a greater prevalence of comorbidities and age-related changes in this cohort. The analgesic burden and prescribing trends in this cohort are largely unknown in the Irish context despite their increased susceptibility to adverse effects. Aim This study aims to evaluate analgesic prescribing patterns before and after an osteoarthritis or joint arthroplasty related hospital admission in patients aged ≥65 years and to identify factors associated with long-term prescribing of opioids and oral NSAIDs post-discharge. Methods This was an observational study of older adults with an osteoarthritis or joint arthroplasty hospitalisation. Data were collected for a larger study from 44 general practices in Ireland from 2012-2018 and included general practice records (12 months pre/post-index hospitalisation) and hospital discharge summaries, which was extracted as anonymous data from the practice software system. The analysis described prevalence of use of analgesics in the 12 months pre and post their hospitalisation. To assess long-term prescribing, multivariable analysis assessed discharge prescription and patient characteristics associated with opioid and oral NSAID use 3-12 months post-discharge. Results Overall, 738 individuals were included (52.9% female, mean age 78.1 years). Compared to 12 months pre-hospitalisation, patients were less likely to be prescribed a weak opioid or oral NSAID from discharge to 3 months post-discharge, or in the 3-12 months post-discharge. For strong opioids, prescribing was significantly less likely in the 3-12 months post-discharge compared to pre-discharge (odds ratio (OR) 0.54, 95%CI 0.40-0.74). Female sex (OR 1.61, 95%CI 1.10-2.36), strong opioid prescribing at discharge (OR 2.47, 95%CI 1.56-3.90) and pregabalin discharge prescribing (OR 2.21, 95%CI 1.12-4.33) were significantly associated with long-term strong opioid prescribing 3-12 months post-discharge. For oral NSAID prescribing, lower age (OR 0.97, 95%CI 0.95-1.00), female sex (OR 1.56, 95%CI 1.08-2.25), and discharge prescribing of strong opioids (OR 1.94, 95%CI 1.23-3.04) were significantly associated. Conclusion The use of opioids and oral NSAIDs is typically reduced for patients post-discharge from an osteoarthritis or joint arthroplasty hospitalisation. Female sex and strong opioids at discharge are associated with the prescribing of strong opioids and oral NSAIDs. Although our study was limited by use of prescription records which may not accurately represent what was dispensed or utilised by patients, it is the first to examine changing patterns of analgesic prescribing among osteoarthritis/joint arthroplasty patients. This contributes knowledge on modifiable characteristics which could reduce long-term use of these medications where appropriate.

When Would Owners Decide to Block Their Properties? Deciphering the Airbnb Business Decisions with Transactional Data

The sharing economy create a new model for the society to provide the properties with different status which is not be full-utilized by the host. Airbnb is a typical example, which allows the host to provide their rooms to the customers. Our work focus on the micro level to show the relation. Using the anonymous data of properties in New York City from Airbnb, we estimate the effects of properties status on market performance and supply behaviors. Our result shows that the higher daily rates would lead to higher booking numbers. However, the extra fee such as clean fee and Security Deposit will do negative effects on number of booking. Further more, Convince and information availability cause better performance. Supply behaviors will not be changed easily. However, we found that the weekend, higher price and lower annual revenues will lead to higher probability of block.

The Costs of Anonymization: Case Study Using Clinical Data.

Sharing data from clinical studies can accelerate scientific progress, improve transparency, and increase the potential for innovation and collaboration. However, privacy concerns remain a barrier to data sharing. Certain concerns, such as reidentification risk, can be addressed through the application of anonymization algorithms, whereby data are altered so that it is no longer reasonably related to a person. Yet, such alterations have the potential to influence the data set's statistical properties, such that the privacy-utility trade-off must be considered. This has been studied in theory, but evidence based on real-world individual-level clinical data is rare, and anonymization has not broadly been adopted in clinical practice. The goal of this study is to contribute to a better understanding of anonymization in the real world by comprehensively evaluating the privacy-utility trade-off of differently anonymized data using data and scientific results from the German Chronic Kidney Disease (GCKD) study. The GCKD data set extracted for this study consists of 5217 records and 70 variables. A 2-step procedure was followed to determine which variables constituted reidentification risks. To capture a large portion of the risk-utility space, we decided on risk thresholds ranging from 0.02 to 1. The data were then transformed via generalization and suppression, and the anonymization process was varied using a generic and a use case-specific configuration. To assess the utility of the anonymized GCKD data, general-purpose metrics (ie, data granularity and entropy), as well as use case-specific metrics (ie, reproducibility), were applied. Reproducibility was assessed by measuring the overlap of the 95% CI lengths between anonymized and original results. Reproducibility measured by 95% CI overlap was higher than utility obtained from general-purpose metrics. For example, granularity varied between 68.2% and 87.6%, and entropy varied between 25.5% and 46.2%, whereas the average 95% CI overlap was above 90% for all risk thresholds applied. A nonoverlapping 95% CI was detected in 6 estimates across all analyses, but the overwhelming majority of estimates exhibited an overlap over 50%. The use case-specific configuration outperformed the generic one in terms of actual utility (ie, reproducibility) at the same level of privacy. Our results illustrate the challenges that anonymization faces when aiming to support multiple likely and possibly competing uses, while use case-specific anonymization can provide greater utility. This aspect should be taken into account when evaluating the associated costs of anonymized data and attempting to maintain sufficiently high levels of privacy for anonymized data. German Clinical Trials Register DRKS00003971; https://drks.de/search/en/trial/DRKS00003971. RR2-10.1093/ndt/gfr456.

OA12 Patient reported pregnancy outcomes and experiences in women with axial spondyloarthritis: preliminary results from a UK patient survey

Abstract Background/Aims Axial spondyloarthritis (axSpA) affects women of childbearing age and is associated with increased prevalence of pregnancy complications. There are limited UK data published on women with axSpA and pregnancy. We aimed to analyse the pregnancy outcomes and perspectives from women in the UK with axSpA who have been pregnant, with a particular focus on their access to support, flares, medication, and pregnancy complications. Methods An online patient survey was launched using RedCAP for women in the UK with axSpA who are or have been pregnant. The survey including 5 parts for details on: 1) general information and axSpA; 2) maternal; 3) pre-pregnancy; 4) pregnancy; 5) postpartum. The project was approved by UCL Research and Ethics Committee and endorsed by NASS and BRITSpA. Patients were recruited through the NASS and BRITSpA websites, social media platforms and e-mail. The survey collected anonymous data from February to June 2023. Descriptive statistical analysis was performed using Stata17. Results Among the 172 respondents, 89% were white, mean age was 44 years, 74% were HLA-B27 positive and 35%, 22% and 17% self-reported a history of uveitis, skin psoriasis and inflammatory bowel disease, respectively. This abstract focuses on data from the first pregnancy after axSpA diagnosis (n = 60, 35% of respondents). Not all questions were answered by participants and data are reported as a percentage of questions answered. Overall, 42% (20/40) reported a flare during their first pregnancy, of which 30% (6/20) contacted their obstetrician, 45% (9/20) contacted rheumatology and 40% (8/20) self-managed. 92% (52/60) of respondents say they planned pregnancy but only 32 (57%) had discussed pregnancy plans with rheumatology and only 26% were seen in a combined obstetric-rheumatology clinic. Regarding medications, 48% (24/50) felt comfortable with their medication regime during pregnancy, 55% stopped their biologic during pregnancy, and 3% started on a biologic. Regarding pregnancy outcomes, 45% had a natural delivery and 54% had caesarean section. 80% (48/60) of first pregnancies resulted in live birth and 16% (7/44) of respondents reported birth defects. Pregnancy complications were reported in 23% (11/48), of which 45% had pre-eclampsia (5/11), 27% had diabetes, 9% had eclampsia and, overall, 19% (9/47) had a self-reported infection. Regarding postpartum, 54% (25/46) had a flare after first delivery; average time to flare post-delivery was 5.4 weeks. Conclusion Preliminary results from UK-based patient survey provides essential insights into self-reported issues of women with axSpA and pregnancy. The study highlights the need for improvement in pre-pregnancy counselling and access, the increased risk of flares during pregnancy, and complications such as pre-eclampsia. Limitations include recall bias as it was a retrospective survey, being unable to clarify respondents' understanding, self-reported outcomes, and incomplete data capturing. Full analyses of the further pregnancies is planned. Disclosure A. Mootoo: None. M. Mouyis: Other; Speaking and advisory fees from UCB and Galapagos. B. Farisogullari: None. P.M. Machado: Consultancies; Consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB. D. Webb: None. J. Hamilton: None. Z. Clark: None. H. Marzo-Ortega: Honoraria; AbbVie, Biogen, Eli-Lilly, Janssen, Moonlake, Novartis, Pfizer, Takeda and UCB. Grants/research support; Janssen, Novartis and UCB.

Protocol for a systematic review and meta-analysis on Janus kinase inhibitors in the management of vitiligo

BackgroundVitiligo is a disease that affects people of all skin shades and can impact their quality of life. Reliable evidence on the effectiveness and adverse events associated with the recent use of Janus kinase (JAK) inhibitors to treat vitiligo is needed. This protocol for a systematic review and meta-analysis seeks to collect evidence from both randomized controlled trials (RCTs) and observational studies to determine the effectiveness and patient-centered outcomes concerning treatment with JAK inhibitors.MethodsWe will conduct a systematic review of the literature for RCTs and observational studies that used upadacitinib, ritlecitinib, brepocitinib, ifidancitinib, cerdulatinib, deglocitinib, baricitinib, tofacitinib, and ruxolitinib JAK inhibitors as treatments for vitiligo compared to placebo, no treatment, or combination therapies. We will systematically search from inception in Epistemonikos, MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, EMBASE, ClinicalTrials.gov, PsycINFO, Allied and Complementary Medicine Database, Latin American and Caribbean Health Sciences Literature, Web of Science Core Collection, relevant preprint servers, and the gray literature. Ethics approval was not sought as the protocol and systematic review will not involve human participants, but rather summarized and anonymous data from studies. Primary outcomes include quality of life, percentage repigmentation, decreased vitiligo within 1 year or more, lasting repigmentation after a 2-year follow-up, cosmetic acceptability of repigmentation and tolerability or burden of treatment, and adverse events. Secondary outcomes are patient and study characteristics. We will include full-text articles, preprints, and clinical trial data in any language and all geographic regions. For data sources unavailable in English, we will obtain translations from global collaborators via the Cochrane Engage network. We will exclude articles for which sufficient information cannot be obtained from the authors of articles and systematic reviews. At least two investigators will independently assess articles for inclusion and extract data; reliability will be assessed before subsequent selection and data extraction of remaining studies. The risk of bias and certainty of evidence with Grading of Recommendations Assessment, Development, and Evaluation guidelines will be assessed independently by at least two investigators. We will estimate treatment effects by random-effects meta-analyses and assess heterogeneity using I2. Data that cannot be included in the meta-analysis will be reported narratively using themes.DiscussionThe proposed systematic review and meta-analysis describe the methods for summarizing and synthesizing the evidence on the effectiveness and patient-centered outcomes concerning the treatment of vitiligo with JAK inhibitors that were recently approved for this indication. To disseminate further the results of our systematic review, we plan to present them at international conferences and meetings. Our findings will provide robust evidence to facilitate decision-making at the policy or practitioner level.Systematic review registrationPROSPERO CRD42023383920.

Aspects of occupational safety: a survey among European cancer nurses

PurposeNurses are particularly at risk for occupational exposure to hazardous cancer drugs, risking both acute and chronic health effects. Knowledge on the implemented safety precautions into minimizing these risks is limited. MethodsThe European Cancer Nursing Index (ECNI) was developed by the European Oncology Nursing Society (EONS) to illustrate the development and status of this profession. In this study, anonymous online survey data on occupational safety reported by European cancer nurses as part of the ECNI 2022, was analysed. ResultsA total of 630 cancer nurses from 29 countries responded to the survey. A majority reported that written guidelines (n = 553, 88%) on safe handling and administration of hazardous drugs, personal protection equipment (PPE) and cytotoxic spillage kits (n = 514, 82%) were available at their workplaces. 130 (21%) nurses reported that wipe testing to assess any residual hazardous drugs on workplace surfaces were conducted systematically at their workplaces. 185 (29%) nurses reported that nurses sometimes or always continued with their regular tasks (including handling hazardous cancer drugs) during pregnancy and breast feeding. 185 (29%) also responded that nurses at their workplaces did not receive an introductory education program before handling hazardous drugs. In total, 346 (55%) of the nurses reported that their workplace had a freedom to speak-up guardian or whistle blower policy for members of staff. ConclusionsEven if most nurses report that there are safety routines in place at their workplaces, the results reveal several serious occupational risks for European nurses handling hazardous cancer drugs. Actions are needed to improve and optimize occupational safety for nursing staff.

All-cause, cardiovascular disease and cancer mortality in the population of a large Italian area contaminated by perfluoroalkyl and polyfluoroalkyl substances (1980–2018)

BackgroundPer- and polyfluoroalkyl substances (PFAS) are associated with many adverse health conditions. Among the main effects is carcinogenicity in humans, which deserves to be further clarified. An evident association has been reported for kidney cancer and testicular cancer. In 2013, a large episode of surface, ground and drinking water contamination with PFAS was uncovered in three provinces of the Veneto Region (northern Italy) involving 30 municipalities and a population of about 150,000. We report on the temporal evolution of all-cause mortality and selected cause-specific mortality by calendar period and birth cohort in the local population between 1980 and 2018.MethodsThe Italian National Institute of Health pre-processed and made available anonymous data from the Italian National Institute of Statistics death certificate archives for residents of the provinces of Vicenza, Padua and Verona (males, n = 29,629; females, n = 29,518) who died between 1980 and 2018. Calendar period analysis was done by calculating standardised mortality ratios using the total population of the three provinces in the same calendar period as reference. The birth cohort analysis was performed using 20–84 years cumulative standardised mortality ratios. Exposure was defined as being resident in one of the 30 municipalities of the Red area, where the aqueduct supplying drinking water was fed by the contaminated groundwater.ResultsDuring the 34 years between 1985 (assumed as beginning date of water contamination) and 2018 (last year of availability of cause-specific mortality data), in the resident population of the Red area we observed 51,621 deaths vs. 47,731 expected (age- and sex-SMR: 108; 90% CI: 107–109). We found evidence of raised mortality from cardiovascular disease (in particular, heart diseases and ischemic heart disease) and malignant neoplastic diseases, including kidney cancer and testicular cancer.ConclusionsFor the first time, an association of PFAS exposure with mortality from cardiovascular disease was formally demonstrated. The evidence regarding kidney cancer and testicular cancer is consistent with previously reported data.

Generative adversarial networks for anonymous acneic face dataset generation.

It is well known that the performance of any classification model is effective if the dataset used for the training process and the test process satisfy some specific requirements. In other words, the more the dataset size is large, balanced, and representative, the more one can trust the proposed model's effectiveness and, consequently, the obtained results. Unfortunately, large-size anonymous datasets are generally not publicly available in biomedical applications, especially those dealing with pathological human face images. This concern makes using deep-learning-based approaches challenging to deploy and difficult to reproduce or verify some published results. In this paper, we propose an efficient method to generate a realistic anonymous synthetic dataset of human faces, focusing on attributes related to acne disorders at three distinct levels of severity (Mild, Moderate, and Severe). Notably, our approach initiates from a small dataset of facial acne images, leveraging generative techniques to augment and diversify the dataset, ensuring comprehensive coverage of acne severity levels while maintaining anonymity and realism in the synthetic data. Therefore, a specific hierarchy StyleGAN-based algorithm trained at distinct levels is considered. Moreover, the utilization of generative adversarial networks for augmentation offers a means to circumvent potential privacy or legal concerns associated with acquiring medical datasets. This is attributed to the synthetic nature of the generated data, where no actual subjects are present, thereby ensuring compliance with privacy regulations and legal considerations. To evaluate the performance of the proposed scheme, we consider a CNN-based classification system, trained using the generated synthetic acneic face images and tested using authentic face images. Consequently, we show that an accuracy of 97.6% is achieved using InceptionResNetv2. As a result, this work allows the scientific community to employ the generated synthetic dataset for any data processing application without restrictions on legal or ethical concerns. Moreover, this approach can also be extended to other applications requiring the generation of synthetic medical images.

Climate Change Curricula in Family Medicine Residency Programs: Program Directors' Perspectives From a CERA Survey.

Climate change is a major threat to the health of people worldwide. The health care system deals with the immediate health-related effects of climate change and, at the same time, is a major emitter of greenhouse gas. This study aimed to investigate (a) the awareness and perception of climate change among family medicine residency program directors, and (b) the state of climate change education in family medicine residency programs. The Council of Academic Family Medicine Educational Research Alliance (CERA) conducted a cross-sectional survey of family medicine program directors in the United States in April 2023. We analyzed anonymous data using descriptive and bivariate statistics. We analyzed responses from 284 family medicine residency program directors (response rate 41.1%). Of these, 56.8% indicated not having any lectures/seminars dedicated to climate change and no plans to introduce such curricula, with considerably higher rates in East South Central United States (92.8%). A majority considered principles of climate change, carbon emissions emitted by the health care system, and discussion of climate change with patients of lesser importance for residency program education. While climate change is an emerging topic affecting health and the provision of health care worldwide, our study suggests that many family medicine residency programs do not teach about it. Family medicine trainees may not always receive sufficient education about the risks posed to their patients by climate change, which could lead to them having limited knowledge and skills when discussing this topic with their patients in the future.

Changes in long-term care insurance revenue among service providers during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has impacted peoples’ health-related behaviors, especially those of older adults, who have restricted their activities in order to avoid contact with others. Moreover, the pandemic has caused concerns in long-term care insurance (LTCI) providers regarding management and financial issues. This study aimed to examine the changes in revenues among LTCI service providers in Japan during the pandemic and analyze its impact on different types of services.MethodsIn this study, we used anonymized data from “Kaipoke,” a management support platform for older adult care operators provided by SMS Co., Ltd. Kaipoke provides management support services to more than 27,400 care service offices nationwide and has been introduced in many home-care support offices. The data used in this study were extracted from care plans created by care managers on the Kaipoke platform. To examine the impact of the pandemic, an interrupted time-series analysis was conducted in which the date of the beginning of the pandemic was set as the prior independent variable.ResultsThe participating providers were care management providers (n = 5,767), home-visit care providers (n = 3,506), home-visit nursing providers (n = 971), and adult day care providers (n = 4,650). The results revealed that LTCI revenues decreased significantly for care management providers, home-visit nursing providers, and adult day care providers after the COVID-19 pandemic began. The largest decrease was an average base of USD − 1668.8 in adult day care.ConclusionThe decrease in revenue among adult day care providers was particularly concerning in terms of the sustainability of their business. This decrease in revenue may have made it difficult to retain personnel, and staff may have needed to be laid off as a result. Although this study has limitations, it may provide useful suggestions for countermeasures in such scenarios, in addition to support conducted measures.

Home care models dedicated to COVID-19 patients: the experience of a Local Health District of Veneto Region (Italy).

During COVID-19 pandemic, health professionals have been working in an extreme uncertainty context. Affected patients needed to be cared at home as long as possible to avoid virus spreading and hospital resources saturation. The Veneto Regional Administration (North-east of Italy) released Regional guidelines about it. The Western Healthcare District of the Local Health Authority of the city of Vicenza (180,000 inhabitants) implemented a healthcare pathway following them. Aim of the study is to describe the results and outcomes of such implementation. In the implemented health care pathway, a new service called "Special Unit of continuity of care" (USCA) with physicians and nurses has been dedicated to the prise en charge at home of patients suffering from Sars-CoV-2. They were referred to the USCA by general practitioners or by hospital specialists, and managed through a daily clinical monitoring by regular home visits and phone calls, specialist consultations and therapy management. In order to prevent hospital admission, an oxygen concentrator when possible has been employed and managed at home by the members of the USCA when the oxygen saturation was below 93%. An observational retrospective study has been conducted using anonymized data from different databases: the USCA activity database (from 12/01/20 to 21/31/21), the hospital and Emergency Department discharge databases, and the "healthcare co-payments exemptions database". The latter database refers to the people excluded - because of their chronicity - from the co-payment of a list of medical exams and services. Descriptive and multivariate logistic regression analyses have been implemented. 1,419 patients suffering from Sars-CoV-2 have been cared and managed by the USCA in the considered period of time (mean 11.4 days), of whom 787 (55.5%) with at least one chronic condition (described in the above quoted "healthcare co-payments exemption database") and 261 provided with oxygen concentrator. 275 (19.4%) needed a hospital admission, 39 (2.8%) in intensive unit; 53 died during hospitalization (3.8%). Out of the 261 patients utilizing oxygen concentrator, 103 have been admitted to hospital (39.5%), 7.3% in intensive unit and 8.0% died. In implemented multivariate analyses, the use of oxygen concentrator, proxy measure of the severity of the condition, is the major determinant for the risk of hospital admission (adj OR: 3.2, CI 2.3-4.3) and of dying within 30 days (adj OR: 2.8 CI 1.5-5.1). Among the 261 patients provided with oxygen concentrator, 158 (60,5%) have been managed at home without any admission to emergency department and/or hospitalization. In an uncertain context such as COVID-19 pandemic, the already-implemented home care model has been modified by integrating the USCA physicians and nurses and specialist care networks to prevent hospitalization and the sense of isolation and abandonment of people as much as possible. Almost 1,500 patients suffering from COVID-19 have been cared for at home over 13 months by such new service with complex and multidisciplinary activities. The risk of hospitalization and death appears determined by the severity of the pathology with high and significant OR 60% of patients with oxygen concentrators who, despite an initial high hyposaturation were not hospitalized, represent, partly, the group of patients who would have been requiring hospital care in the absence of a home care pathway in a standard situation.

Birthweight trends and their explanatory factors in Hungary between 1999 and 2018: an analysis of the Hungarian Tauffer registry

BackgroundThe increasing birthweight trend stopped and even reversed in several high income countries in the last 20 years, however the reason for these changes is not well characterized. We aimed to describe birthweight trends of term deliveries in Hungary between 1999 and 2018 and to investigate potential maternal and foetal variables that could drive these changes.MethodsWe analysed data from the Hungarian Tauffer registry, a compulsory anonymized data collection of each delivery. We included all singleton term deliveries in 1999–2018 (n = 1,591,932). We modelled birthweight trends separately in 1999–2008 and 2008–2018 in hierarchical multiple linear regression models adjusted for calendar year, newborn sex, maternal age, gestational age at delivery, and other important determinants.ResultsMedian birthweights increased from 3250/3400 g (girl/boy) to 3300/3440 g from 1999 to 2008 and decreased to 3260/3400 g in 2018. When we adjusted for gestational age at delivery the increase in the first period became more pronounced (5.4 g/year). During the second period, similar adjustment substantially decreased the rate of decline from 2.5 to 1.4 g/year. Further adjustment for maternal age halved the rate of increase to 2.4 g/year in the first period. During the second period, adjustment for maternal age had little effect on the estimate.ConclusionsOur findings of an increasing birthweight trend (mostly related to the aging of the mothers) in 1999–2008 may forecast an increased risk of cardiometabolic diseases in offsprings born in this period. In contrast, the decreasing birthweight trends after 2008 may reflect some beneficial effects on perinatal morbidity. However, the long-term effect cannot be predicted, as the trend is mostly explained by the shorter pregnancies.

Supportive periodontal care in dental practice: Part 2 - perceptions of locally referring UK general dental practitioners.

Background Supportive periodontal care (SPC) is important in maintaining periodontal treatment outcomes. Hospital services provide specialist periodontal care at high costs. On completion of treatment, patients are discharged back to the general dental practitioner (GDP) to provide SPC. This project aimed to evaluate the change in GDPs' understanding of SPC over more than 20 years.Method A validated questionnaire about SPC was sent to GDPs during 1996 (397) and 2020 (300), with a response rate of 74% and 52%, respectively. The anonymous data were entered on a Microsoft Excel spreadsheet for analysis.Results In total, 98.5% of the GDPs in 1996 and 97% in 2020 perceived SPC to be highly important. Additionally, 49% in 2020 had a better understanding of SPC when compared to 1996 (42%). Finally, 70-74% (1996, 2020) of the GDPs indicated that they were responsible for SPC; however, 13-16% said that they were not.Conclusion and clinical relevance Notwithstanding the lower response rate in 2020, there has been an improvement in understanding and awareness of responsibility of SPC among GDPs. Reported challenges of provision were related to education and funding. If GDPs are to effectively deliver SPC, education and current funding should be addressed to prevent compromised treatment outcomes for patients.