Early Enrollment Research Articles

Gold Coast Criteria in ALS Diagnosis: A Real-World Experience

Background: Revised El Escorial (rEEC) and Awaji criteria are currently used for diagnosing and categorizing amyotrophic lateral sclerosis (ALS). However, they are complex; their sensitivity is still not optimal for research purposes, and they present high inter-rater variability in clinical practice. To address these points, in 2019, a new set of diagnostic criteria was proposed, namely the Gold Coast criteria (GCC), characterized by a dichotomous diagnostic categorization, i.e., ALS or not ALS. Methods: In order to investigate the sensitivity, specificity, and clinical usefulness of GCC in a practical clinical setting, we retrospectively evaluated 131 patients diagnosed with ALS and 104 control subjects. ALSFRS-R score, electrophysiological tests, neuroradiological investigations, and CSF analysis were obtained. rEEC, Awaji, and GCC were applied at the first and last evaluations. Results: The sensitivity of GCC (93.1%; 96.1%) was greater than rEEC (71.8%; 87%) and Awaji criteria (77.8%; 89.3%) both at the first visit and last follow-up. The GCC’s specificity (28.8%) is lower than that of the other two criteria (rEEC 45.2%; Awaji 43.3%). Conclusions: Our study suggests that in a real-world setting, the GCC are more sensitive and have substantially lower risk of false negative diagnoses than rEEC and Awaji criteria. Although rEEC had the highest specificity, they may delay the diagnosis. Systematically using the GCC could help to achieve an earlier diagnosis and quickly refer patients to the correct management. The low specificity of GCC is likely to not significantly impact patient recruitment in clinical trials; therefore, its use might allow a faster and earlier enrollment.

Neuromotor and Neurosensory Impairment among High Risk Infants at One Year of Age – Risk Factor Analysis

Background: Improvement in the quality of perinatal care in the last few decades has led on to improve newborn survival. Sick neonates who have survived are exposed to high risk factors in the prenatal period and are termed as high risk infants (HRIn). This study aimed at determining the proportion of neuromotor and neurosensory impairments among HRIn. Methods: This prospective observational study was conducted in a tertiary care centre in South India between January 2020 and December 2021. Study population comprised of intramural high risk infants fulfilling the criteria. At discharge infants were stratified as mild, moderate or severe risk for developing neurodevelopmental disorders and follow up plan was given. The subjects were assessed at 4, 6, 8 and 12 month for impairments. Results: Total 138 infants were enrolled and 88 completed follow up. Lost for follow up was 36.2%. The impairments detected with respect to motor and vision were 12.5% and 1.1% respectively. Sepsis, seizures, birth asphyxia and preterm were robust prognostic factors for neuromotor impairment. Risk of tone abnormality was 13 times higher in infants who had sepsis. At risk for developmental delay was noticed in 11.4% of the study for which significant association was with prematurity, sepsis and birth asphyxia. Discussion: HRIn are susceptible for neurodevelopmental impairments. Hence early identification and enrolment in intervention programs will ensure favorable outcomes.

A non-parametric approach to predict the recruitment for randomized clinical trials: an example in elderly inpatient settings

BackgroundAccurate prediction of subject recruitment, which is critical to the success of a study, remains an ongoing challenge. Previous prediction models often rely on parametric assumptions which are not always met or may be difficult to implement. We aim to develop a novel method that is less sensitive to model assumptions and relatively easy to implement.MethodsWe create a weighted resampling-based approach to predict enrollment in year two based on recruitment data from year one of the completed GRIPS and PACE clinical trials. Different weight functions accounted for a range of potential enrollment trajectory patterns. Prediction accuracy was measured by Euclidean distance for enrollment sequence in year two, total enrollment over time, and total weeks to enroll a fixed number of subjects, against the actual year two enrollment data. We compare the performance of the proposed method with an existing Bayesian method.ResultsWeighted resampling using GRIPS data resulted in closer prediction evidenced by better coverage of observed enrollment with the prediction intervals and smaller Euclidean distance from actual enrollment in year 2, especially when enrollment gaps were filled prior to the weighted resampling. These scenarios also produced more accurate predictions for total enrollment and number of weeks to enroll 50 participants. These same scenarios outperformed an existing Bayesian method for all 3 accuracy measures. In PACE data, using a reduced year 1 enrollment resulted in closer prediction evidenced by better coverage of observed enrollment with the prediction intervals and smaller Euclidean distance from actual enrollment in year 2, with the weighted resampling scenarios better reflecting the seasonal variation seen in year (1) The reduced enrollment scenarios resulted in closer prediction for total enrollment over 6 and 12 months into year (2) These same scenarios also outperformed an existing Bayesian method for relevant accuracy measures.ConclusionThe results demonstrate the feasibility and flexibility for a resampling-based, non-parametric approach for prediction of clinical trial recruitment with limited early enrollment data. Application to a wider setting and long-term prediction accuracy require further investigation.

The Third Epidemic of Blindness: Early ROP Screening vs. KIDROP Conventional Screening of Retinopathy of Prematurity in Neonates- A Prospective Cohort Study

Aim: To assess the benefits of initiating early Retinopathy of Prematurity (ROP) screening compared to conventional KIDROP screening and study the incidence, severity, and risk factors of ROP. Methods: Preterm neonates born with weight < 2000 g and/or < 36 weeks of gestation admitted to the Level III-A neonatal intensive care unit (NICU), BLDE (Deemed to be University), Shri B. M. Patil Medical College, Hospital and Research Centre, were enrolled in the study. The in-house retina specialist performed Early ROP screening at 10-14 days of life, depending on the gestational age at birth. Subsequently, KIDROP conventional screening was done at 3 to 6 weeks of life by the Karnataka Internet Assisted Diagnosis for Retinopathy of Prematurity (KIDROP) team once weekly. ROP findings were recorded as per the standard ICROP norms. The data was analyzed for gestational age, birth weight, and systemic factors predisposing to ROP. Results: The incidence of Early ROP was 14% (7/50). Of the neonates diagnosed with ROP, 43% had a gestational age of < 30 weeks, and 86% had birth weight in the group 1000- 1500 g. The incidence of type 1 ROP is 28.5% (2/7). The significant predictors of the increased risk of ROP were birth weight, gestational age, prolonged oxygen therapy, synchronized intermittent mandatory ventilation (SIMV), sepsis, patent ductus arteriosus (PDA), and nutrition, including MOM & Parenteral Nutrition. Conclusion: Early enrolment of neonates for ROP screening in the NICU itself ensures early diagnosis and timely intervention and also ensures compliance and routine follow-up of these neonates. 14% had early ROP, which suggests the need to redefine the ROP screening criteria.

Determinants of Late HIV Diagnosis and Advanced HIV Disease Among People Living with HIV in Tanzania.

About half of people infected with Human Immunodeficiency Virus (HIV) often present late for care, resulting in higher healthcare costs, undesired treatment outcomes, and ongoing HIV transmission. This study aimed to assess the prevalence and determinants of late HIV diagnosis and advanced HIV disease (AHD) in Tanzania. Data were obtained from the 2016-17 Tanzania HIV impact survey. We included 677 newly diagnosed people living with HIV. Late HIV diagnosis and AHD were defined as having a CD4 cell count below 350 cells/µL or 200 cells/µL at diagnosis, respectively. Bivariate and multivariable logistic regression models were fitted to identify the determinants of late HIV diagnosis or AHD. The mean age of the participants was 37.8 years (SD, 12.4). About two-thirds were women (62.6%). The prevalence of late HIV diagnosis was 42.4%, whereas the prevalence of AHD was 17.7%. Factors associated with late HIV diagnosis included age 31-40 years (adjusted odds ratio [aOR] = 1.72, 95% confidence interval [CI]: 1.14-2.60), age ≥41 years (aOR = 1.79, 95% CI: 1.16-2.76), male sex (aOR = 1.88, 95% CI: 1.29-2.73), and active syphilis infection (aOR=2.63, 95% CI: 1.20-5.76). Factors associated with AHD were age 31-40 years (aOR = 2.12, 95% CI: 1.18-3.81), age ≥41 years (aOR = 2.42, 95% CI: 1.32-4.41), male sex (aOR = 1.77, 95% CI: 1.09-2.87), formal education (aOR = 0.49, 95% CI: 0.30-0.81) and active syphilis infection (aOR = 2.49, 95% CI: 1.07-5.77). Late HIV diagnosis and AHD are prevalent among newly diagnosed people living with HIV in Tanzania. Specific subgroups are more likely to present late for HIV care, including middle-aged and older adults, men, illiterate individuals, and those with active syphilis and HIV co-infection. Therefore, we recommend expanding HIV testing services and implementing targeted interventions to improve early access and enrollment in HIV care.

DIPG-80. IMAGING CHARACTERISTICS IN PEDIATRIC PATIENTS WITH DIFFUSE INTRINSIC PONTINE GLIOMA AND OUTCOME: THE MD ANDERSON CANCER CENTER EXPERIENCE

Abstract BACKGROUND Diffuse intrinsic pontine glioma (DIPG) occurs exclusively in children and, although rare, carries a poor prognosis with a median survival of approximately 10 months. Diagnosis is made on clinical and radiological appearance of the tumor. The treatment for DIPG is radiation therapy, but it is inadequate as most patients experience rapid progression and succumb to the disease. Our study sought to review radiological characteristics and survival outcomes in pediatric DIPG patients at MD Anderson Cancer Center to better understand imaging and improve current DIPG management. METHODS We performed a retrospective review of demographic and clinical data of patients with radiographic diagnosis of DIPG from 2006-2019, with IRB approval. The patients included in this study were treated at The University of Texas MD Anderson Cancer Center. Imaging findings upon diagnosis of DIPG, including the presence of hydrocephalus, intratumoral bleeding, contrast enhancement, and necrosis, were correlated with survival using Kaplan-Meier methods RESULTS This study included 25 patients diagnosed with DIPG via MRI imaging. The median OS was 13.7 months and median PFS was 10 months for this cohort. At diagnosis, if the patient had hydrocephalus or intratumoral bleeding, the median PFS were shorter compared with those who did not (8.5 and 5.4 months vs 12.2 and 10.8 months; Log-rank, P=0.019 and P=0.029, respectively). Other imaging findings, including contrast enhancement (CE) or presence of necrosis, are trending toward worse outcomes (CE vs no CE: PFS 7.9 vs 11.1 months, P=0.10; necrosis vs no necrosis: PFS 5.2 vs 10.5 months, P=0.78, respectively) CONCLUSION Imaging characteristics at diagnosis can be predictive of outcome. Hence, we propose to consider early interventions for these subgroups with worse outcomes to proceed with shunt placement and early enrollment for clinical trials as feasible. To further validate these findings, a large prospective study is required.

Improving esophageal cancer screening across the globe: Translating knowledge into action.

Esophageal cancer (EC) is a pressing global health concern, ranking as the eighth most common cancer and the sixth leading cause for cancer-related deaths worldwide. Esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC) are the two major histological types of esophageal cancer associated with distinct risk factors and geographical distributions. Unfortunately, the outcomes for both types of EC remain discouraging, with a five-year survival rate of less than 20% when diagnosed at advanced stages. Advanced endoscopic techniques have the potential to vastly enhance patient outcomes and impede the progression of pre-malignant lesions to cancer. However, low screening rates with endoscopy due to its invasive nature and high cost hinder its effectiveness. Despite extensive research on risk predictors, a significant number of cases still go undiagnosed, highlighting the need for improved screening techniques that can be implemented at the population level. To increase uptake, a shift towards minimally invasive, well-tolerated and cost-effective non-endoscopic technologies is crucial. The implementation of such devices in primary care settings, specifically targeting high-risk populations, can be a promising strategy. With early detection and enrollment in surveillance programs, there is hope for substantial improvement in morbidity and mortality rates through modern minimally invasive endoscopic and surgical techniques.

Impact of early phase study enrollment for pediatric oncology patients on symptom burden and quality of life (QOL): Early report of trial-in-progress results.

e23195 Background: Pediatric patients with relapsed or refractory malignancy have few options. The quality of life (QoL) impact for enrolling in a phase I or II trial compared to those not participating is unknown. This information is invaluable to the consenting process as well as to clinical trial design. The primary aim was to determine if those enrolled on a phase I or II trial had lower scores on the Symptom Screening in Pediatrics Tool (SSPedi) total score compared to those not enrolled on a trial. Methods: This Canadian multi-site study had nine sites open for accrual. SSPedi was calculated based on patient reports for 8-18 years and parent-proxy reports for all children. The total score is the sum of 15 items’ 4 Likert scale scores, score ranges from 0 to 60 (worst possible). Scores from baseline, 4 weeks and 8 weeks of those enrolled on an early phase trial were compared to those who did not enroll in such trials. Results: Of the 54 49 patients, 21 (43%) patients were enrolled on an early phase trial and 28 (57%) patients were not enrolled in a study. For those enrolled on the study at enrollment time, 4 weeks and 8 weeks time points, the total SSPedi score for the participant mean was 11.1 (SD 8.1), 9.2 (SD 6.3) and 10.1 (8.3) respectively compared to those not enrolled on a study with mean scores at the same time points of 13.8 (SD 8.6), 13.5 (SD 9.4), and 15.4 (SD 12.6). Conclusions: These results suggest that it is feasible to evaluate patients enrolled and not enrolled on early phase trials, and to compare their symptom experience. Further efforts will focus on more recruitment and using the PedsQL 3.0 Acute Cancer Module to further define differences in QoL. The results suggest that those enrolled in an early phase trial had an improved quality of life compared to those non-enrolled. This research is supported through granting from the C17 Council and Kindred Foundation. [Table: see text]

Financial Inclusion and Retirement Planning: A Scenario Analysis of the Feasibility of Atal Pension

Financial inclusion, crucial for economic development, has gained global attention, particularly in emerging economies like India where initiatives to improve access to financial services are vital. Objective: This study aims to assess the feasibility and potential impact of the Atal Pension Yojana (APY) on retirement planning within India's unorganised sector through scenario analysis. Methodology: Utilising secondary data, the study analyses the present and future values of contributions and pension benefits under various scenarios, focusing on different starting ages and pension amounts. Findings: The analysis suggests that, at higher interest rates, the present value of pension benefits from APY may fall short of contributions, indicating potential shortcomings in fulfilling retirement needs. However, younger subscribers could benefit under certain conditions, emphasising the importance of early enrolment. Implications: The research highlights concerns regarding the effectiveness of APY in addressing retirement needs, suggesting the need for additional government support to enhance the scheme's attractiveness and financial feasibility. Originality: This study offers a multidimensional exploration of financial inclusion and retirement planning within the framework of APY, contributing to the literature on this topic, especially in economies with informal labour markets and limited social security mechanisms. Keywords: Retirement Planning, Financial Inclusion, Social Security, Pension Scheme, Atal Pension Yojana.

Medical care services interplay between individual and Medicaid managed care markets in expansion versus non‐expansion states

AbstractWe study enrollment, medical service utilization, and incurred expenses of individual comprehensive and Medicaid managed care plans in states with or without Medicaid expansion adopted at the Affordable Care Act (ACA) early stage 2014–2016. To make healthcare services more accessible, 27 states expanded Medicaid eligibility to cover nearly‐poor non‐elderly adults who have had incomes between 100% and 138% of federal poverty level in 2014. In non‐expansion states, early enrollees in this income cohort had to choose individual market plans rather than Medicaid. Early enrollees' enrollment choices and their health status have had a great impact on the individual market premiums and Medicaid spending. We examined health insurers' annual regulatory filings with the National Association of Insurance Commissioners for 2013–2016 and found that: First, individual comprehensive insurance enrollment grew much faster in states not expanding Medicaid eligibility. Second, after incorporating early enrollees, per member per month (PMPM) medical service utilization and expenses of individual comprehensive insurance grew much faster in non‐expansion states. Third, among major types of medical utilization and expense measures, PMPM hospital inpatient days and PMPM prescription drug expenses increased substantially since 2014. Finally, Medicaid beneficiaries generated more PMPM medical utilization and expenses in expansion states.

A prospective study of sleep status, anxiety, and depression levels of college students at a university in Shandong Province, China.

To investigate the changes in sleep conditions, anxiety, and depression levels among college students before and after entering the university. Utilizing a random sampling method, 692 new students from a college in Shandong province were selected in September 2019, and relevant indices were statistically analyzed in September 2021 following a comprehensive follow-up. Sleep status, anxiety, and depression levels were assessed using the Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7), respectively. Gender, passive smoking, exercise, intake of fruits, and intake of seafood were identified as significant influencing factors on college students' sleep status, anxiety, and depression levels (p < 0.05). A substantial difference was observed in the sleep quality of college students between the early enrollment stage and the follow-up stage (p < 0.05). Moreover, a significant positive correlation was found between PSQI scores and the levels of anxiety and depression (p < 0.05), cumulatively explaining approximately 10% of the variance in anxiety and depression levels. The sleep quality of college students exhibited significant improvement after enrollment compared to the early enrollment period. Engaging in appropriate exercise and consuming fruits and seafood demonstrated a positive impact on sleep conditions, anxiety, and depression levels. These findings underscore the importance of fostering healthy lifestyle habits for promoting overall well-being among college students.

Trajectories of early childhood development in children experiencing homelessness

IntroductionThe experience of homelessness early in life can potentially disrupt childhood development. Enrollment in early education has been identified as a buffer to promote adequate development. Nevertheless, there has not yet been a quantitative assessment of the developmental trajectories of children experiencing homelessness receiving early education. MethodsWe compared the development of children from birth to 6 years old enrolled at a high-quality early education center, against a US representative sample and the acceptable ranges of developmental indicators. Further, we studied predictors of developmental trajectories in children exposed to homelessness. A total of 459 children enrolled at an early education center, Horizons for Homeless Children (HHC), between 2017 and 2022, between birth to 6 years old, were included in the analysis, with an average follow-up time of 22 months. We assessed the development in six domains, including Socio-emotional, Motor, Language, Literacy, Cognitive, and Mathematics, using the scaled scores from the Teaching Strategies GOLD system. The scores of children at HHC were compared with the norm scores from a US representative sample and the expected scores for different ages. We assessed developmental trajectories and included child and family covariates in a linear mixed model to examine developmental differences over time. ResultsThe scores of HHC students on Teaching Strategies GOLD assessments were lower than those of a US representative sample and frequently did not meet age group expectations. Within the HHC cohort, boys scored lower than girls. Socioeconomic characteristics remained a factor associated with development; specifically, having older primary caregivers and having parental education below High School were associated with worse developmental trajectories. Earlier enrollment into HHC was associated with higher scores for all domains and faster developmental progress for the Literacy domain over time. Discussion and conclusionEven in the context of a high-quality early education program, the developmental delays of children who experienced homelessness did not attenuate in the first six years of life compared with a normative sample. Furthermore, within a population experiencing homelessness, there are developmental differences associated with socioeconomic status, including parental education. Early enrollment in education centers may reduce the developmental delays of children experiencing homelessness. This actionable determinant of development supports enrollment into schooling as early as possible.

Days spent with healthcare contact by patients with metastatic castrate-resistant prostate cancer in the last year of life.

100 Background: Days spent with healthcare contact while pursuing cancer treatment (i.e., “time toxicity”) may be particularly relevant when life expectancy is most limited. Patients with metastatic castrate resistant prostate cancer (mCRPC) ultimately choose whether to pursue further cancer directed therapies or receive supportive care and reduce expected healthcare contact. We sought to define the evolution of time toxicity over the last year of life in patients with mCRPC. Methods: Contact days, defined as any day with healthcare contact outside the home, were retrospectively assessed and categorized (e.g., infusion, ER visit) in 96 patients at an academic cancer center. The primary objective was to compare contact days in the 90-day period between 12 and 9 months prior to date of death (“first quarter”) and the 90-day period prior to death (“last quarter”) using the Wilcoxon signed rank test. Additional exploratory analyses were performed evaluating the association between clinicodemographic variables and systemic treatments received. Results: There were higher median [IQR] total contact days in the last quarter (6 [2,17]) compared to the first quarter (4 [3,6], p &lt; 0.01), driven by ER visits and hospitalizations. Compared to patients off treatment/supportive care (4 [3,4]) in the first quarter, chemotherapy (5 [4,6], p = 0.02) and radiotherapeutics (5 [4,9], p = 0.03) were associated with greater contact days, but androgen signaling inhibitors were not (3 [2,5], p = 0.20). However, there were no significant differences in contact days between any treatment vs non-treatment in the last quarter. Non-White patients (n = 27) and those without higher education (n = 30) had more contact days in the last quarter (9 [2,19], p &lt; 0.01 for both). Patients who enrolled on hospice 7 days (n = 11) or 30 days (n = 39) before date of death had more contact days in the last quarter than those with earlier enrollment (23 [7,28], p &lt; 0.01; 13 [4,24], p &lt; 0.01 respectively). Conclusions: Healthcare contact was higher in the last 3 months of life due to increased number of days with inpatient level of care. Further studies to define healthcare exposure and time toxicity of mCRPC treatments are warranted to inform patient expectations towards the end-of-life. [Table: see text]

Fatores associados ao escore de ansiedade de mães surdas e ouvintes

ABSTRACT Purpose To associate maternal anxiety with sociodemographic factors, breastfeeding practices, oral habits, and the child’s entry into daycare among deaf and hearing (non-deaf) mothers. Methods This retrospective comparative cross-sectional study included 116 mothers (29 deaf and 87 hearing) of children aged between two and five years. Deaf mothers belonged to a reference center in the city, while hearing mothers were contacted in public daycares where their children were enrolled. Mothers underwent interviews covering socio-economic factors and child development-related aspects. Additionally, they completed the Brazilian Beck Anxiety Inventory, adapted for both deaf and hearing individuals, serving as instruments to assess anxiety. The Kolmogorov-Smirnov normality test, Kruskal Wallis test, Mann-Whitney test, and Poisson Regression were employed for statistical analyses (p&lt;0.05). Results Deaf mothers exhibited anxiety scores one and a half times higher than hearing mothers. Moreover, mothers of children with thumb-sucking habits showed higher anxiety scores, while mothers whose children started attending daycare as infants demonstrated lower anxiety scores compared to mothers of children without such habits and who did not attend daycare. Conclusion Deaf mothers displayed higher anxiety levels when compared to hearing mothers. Children’s behaviors, such as thumb-sucking habits, and early enrollment in daycare during the first year of life influenced maternal anxiety.

Factors associated with the anxiety score of deaf and hearing mothers.

To associate maternal anxiety with sociodemographic factors, breastfeeding practices, oral habits, and the child's entry into daycare among deaf and hearing (non-deaf) mothers. This retrospective comparative cross-sectional study included 116 mothers (29 deaf and 87 hearing) of children aged between two and five years. Deaf mothers belonged to a reference center in the city, while hearing mothers were contacted in public daycares where their children were enrolled. Mothers underwent interviews covering socio-economic factors and child development-related aspects. Additionally, they completed the Brazilian Beck Anxiety Inventory, adapted for both deaf and hearing individuals, serving as instruments to assess anxiety. The Kolmogorov-Smirnov normality test, Kruskal Wallis test, Mann-Whitney test, and Poisson Regression were employed for statistical analyses (p<0.05). Deaf mothers exhibited anxiety scores one and a half times higher than hearing mothers. Moreover, mothers of children with thumb-sucking habits showed higher anxiety scores, while mothers whose children started attending daycare as infants demonstrated lower anxiety scores compared to mothers of children without such habits and who did not attend daycare. Deaf mothers displayed higher anxiety levels when compared to hearing mothers. Children's behaviors, such as thumb-sucking habits, and early enrollment in daycare during the first year of life influenced maternal anxiety.

Prevalence, severity and associated risk factors of anemia among human immunodeficiency virus-infected adults in Sawla General Hospital, Southern Ethiopia: A facility-based cross-sectional study

Background Anemia is a significant public health problem in HIV/AIDS patients worldwide. This study is aimed to determine the prevalence of anemia and its risk factors among HIV-infected adults in Sawla General Hospital, southern Ethiopia. Methods A facility-based cross-sectional study involving HIV-infected adults was conducted in ART clinic of Sawla General Hospital from April 01 to May 31, 2019. A systematic random sampling technique was employed to recruit the study participants. Socio-demographic and clinical data were collected using a structured questionnaire and checklist. Hemoglobin concentration from venous blood was determined by HemoCue® 301 analyzer. Descriptive and inferential statistics, by Statistical Package for Social Science version 26.0, were applied; p-values ≤ 0.05 in the multivariable logistic regression analysis were considered statistically significant. Results A total of 220 HIV-infected adults participated in this study. The prevalence of anemia was 38.6%, from which 90.6, 7.1, and 2.3% are mild, moderate, and severe anemia, respectively. Anemia among HIV-infected adults was significantly associated with CD4 cell count below 200 cells/mm3 (AOR: 4.32; 95% CI: 2.10–8.86), clinical stage III or above (AOR: 4.20; 95% CI: 1.06–16.62), five or more years duration of HIV infection (AOR: 2.32; 95% CI: 1.08–4.94) and BMI below 18.5 kg/m2 (AOR: 3.82; 95% CI: 1.83–8.00). Conclusion Anemia is a moderate public health problem among the study population. Longer duration of HIV infection, advanced clinical stage, lower CD4 cell count, and BMI are risk factors for anemia. Therefore, early ART enrolment for HIV-infected adults with nutritional support and rigorous monitoring of CD4 cell count are essential to lower the prevalence.

Real-World Validation of the European Leukemia Network 2022 Risk Stratification in Acute Myelogenous Leukemia

Background: The 2017 European LeukemiaNet (ELN 2017) guidelines have become foundational for the risk stratification, prognostication, and treatment of acute myelogenous leukemia (AML). The updated 2022 European LeukemiaNet (ELN 2022) guidelines include additional cytogenetic abnormalities and genetic mutations for risk group assignment. It remains unknown how these updated guidelines compare for risk stratification and prognosis. Methods: We studied (N=287) adults with newly diagnosed AML from MedStar Georgetown University, MedStar Washington Hospital Center, and Baylor University Medical Center from 2012 to June 2023. Patients were stratified as favorable (fav), intermediate (int), or adverse (adv) risk according to ELN 2017 and ELN 2022 criteria. Overall survival (OS) was compared by age, race, and sex. Statistical analysis performed with SAS. Results: Median age was 65+16 years with a predominance of males (N=168, 59%). African-Americans (AA) composed 15% (N=44) of the cohort. Myelodysplastic-related mutations were present in 33 patients (15%), whereas the prevalence of epigenetic mutations was 25% (N=55). By ELN 2017 criteria, 19 (7%) patients were characterized as fav, 64 (23%) as int, and 198 (70%) as adv risk. Using ELN 2022 criteria, 18 (6%) patients were categorized as fav, 52 (19%) as int, and 211 (75%) as adv risk. Kaplan-Meier (KM) curves revealed a median overall survival of 200 days (d), 400 d, and 1532 d in the adv, int, and fav risk groups, respectively (log-rank p&amp;lt;0.001) by ELN 2017 criteria. Median OS was 379 d, 527 d, and 1552 d for the adv, int, and fav groups, respectively (log-rank p&amp;lt;0.001) in the ELN 2022 cohort. Stratifying by age &amp;lt;60 years, median OS was 390 d in the adv group and 832 d in the int group (log-rank p=.021)by ELN 2017 criteria,as compared to 350 d in the adv group and 757 d in the int group (log-rank p=.0012) by ELN 2022 criteria.Among those &amp;gt;60 years of age, median OS was 244 d and 349 d in the adv and int groups, respectively by ELN 2017 criteria (Anova p&amp;lt;0.25). In the ELN 2022 cohort, median OS among those &amp;gt;60 years of age was 284 d for the adv group and 209 days in the int group (Anova p&amp;lt;0.62). Among females, median OS in the adv group was 224 d and 342 d in the int group by ELN 2017 criteria (Anova p=0.4). In the ELN 2022 cohort, median OS among females was 214 d in the adv group and 421 d in the int group (Anova p=.13). Median OS among male patients in the ELN 2017 cohort was 324 d for those of adv risk and 623 d for those of int risk (Anova p&amp;lt;0.004). In the ELN 2022 cohort, median OS in males was 352 d and 563 d in the adv and int groups, respectively (Anova p&amp;lt;0.07) . In the ELN 2017 cohort, median OS was 259 d in AA patients as compared to 719 d in non-AA patients; this was not statistically significant (Anova p=0.16). Comparatively, in the ELN 2022 cohort, median OS for the AA patients was 153 d as compared to 212 d for the non-AA patient population (Anova p=0.86) .Conclusions: In this real-world dataset, the updated ELN 2022 guidelines reproduce differential survival for proposed favorable, intermediate, and adverse risk categories. When considering time to endpoint survival [Kaplan Meier curves] in our study, ELN 2022 seems to lack the ability to clearly discriminate among the adverse and intermediate risk subgroups. It is possible that patients seen in academic institutions not participating in FLT3 directed therapy trials retained inferior survival whereas similar patients fared better through early enrollment in trials using molecular targeted therapy. Finally, neither ELN 2017 nor ELN 2022 discriminate survival in AA populations for either adverse or intermediate subgroups. Efforts should be directed to develop novel risk stratification schemas to better encapsulate this vulnerable population.

A glass ceiling at the playhouse? Gender gaps in public and private preschool enrollment in India

India has reduced male-biased gender gaps in primary school enrollment and progression rates in recent years. However, patterns of early childhood education enrollment, selection of preschool, and related gender gaps remain inadequately studied. This study uses data from India’s National Family Health Survey (2019–2021), which collected preschool information for children aged 2–4 years, to examine female-male gaps in preschool enrollment. An estimated 40% of children were enrolled in preschools, and among them, 28% were enrolled in private preschools, with substantial variation across states. State, district, and household fixed-effects regressions, which accounted for a wide range of background characteristics of children, show that while preschool enrollment rates were 3.6–4.1% higher among girls than boys, girls were 9.3–16.7% less likely to be enrolled in higher quality private preschools. Using a mother fixed-effects regression, we found that while there was no gender gap in siblings’ preschool enrolment rates, girls were 18.6% less likely to be enrolled in private preschool than their brothers. The relative bias towards males in private preschool enrollment decreased with standard of living and maternal schooling levels. The findings indicate gender discrimination in enrollment in higher quality private preschool against young girls.

From Option B+ to Universal "Test and Treat" in Cameroon: Identification and Evaluation of District-level Factors Associated with Retention in Care.

Retaining women in Option B+ services is crucial for eliminating new pediatric HIV infections. However, there are few studies on factors influencing retention at the district level. This study evaluates the factors associated with retention in two health districts of Cameroon. From September 1, 2015, to February 29, 2016, we reviewed the records of pregnant and breastfeeding women initiating Option B+, a lifelong approach to preventing mother-to-child transmission (PMTCT) of HIV, between October 2013 and July 2014. We abstracted sociodemographic and clinical data from registers in 22 health facilities in the Bamenda urban and Kumba rural districts into spreadsheets. Cox regression age-adjusted survival curves were used to compare retention probabilities at 6 and 12 months post-antiretroviral therapy (ART) initiation. Multivariable modified Poisson regressions were run to estimate adjusted relative risk (aRR) of factors associated with retention in PMTCT care at 12 months post-ART initiation. STATA software was used for the analyses. Of the 560 files reviewed, majority, 62.7% (n=351), were above 24 years of age and married, 68.9% (n=386). From the multivariable analysis, enrolling early in antenatal care (ANC) (aRR: 1.50, 95% CIL: 1.17-1.93) and knowing the male partner's HIV-negative status (aRR: 1.16, 95% CI: 1.00-1.34) were significantly associated with higher retention in care, adjusting for maternal age, marital status, and distance from the health facility. By health district, knowing the male partner's HIV-negative status (aRR: 1.30, 95% CI: 1.13-1.50) in the Bamenda urban and enrolling early in ANC (aRR: 2.03, 95% CI" 1.21-3.41) in the Kumba rural district, had significantly higher retention rates after adjusting for the same covariates. Overall, factors influencing retention varied by urban or rural district. Therefore, tailored district-level interventions are needed to enhance early ANC enrollment in the rural and partner HIV status disclosure in the urban districts to improve retention in PMTCT care.

Current challenges and new approaches to implementing optimal management of sickle cell disease in sub-Saharan Africa

Sickle cell disease (SCD) is the most common life-threatening monogenic disorder in the world. The disease is highly prevalent in malaria endemic areas with over 75% of patients residing in Sub-Saharan Africa (SSA). It is estimated that, without proper care, up to 90% of children with SCD will not celebrate their fifth birthday. Early identification and enrolment into comprehensive care has been shown to reduce the morbidity and mortality related with SCD complications. However, due to resource constraints, the SSA is yet to implement universal newborn screening programs for SCD. Furthermore, care for patients with SCD in the region is hampered by the shortage of qualified healthcare workers, lack of guidelines for the clinical management of SCD, limited infrastructure for inpatient and outpatient care, and limited access to blood and disease modifying drugs such as Hydroxyurea which contribute to poor clinical outcomes. Curative options such as bone marrow transplant and gene therapy are expensive and not available in many SSA countries. In addressing these challenges, various initiatives are ongoing in SSA which aim to enhance awareness on SCD, improve patient identification and retention to care, harmonize the standards of care for SCD, improve the skills of healthcare workers and conduct research on pertinent areas in SCD in the SSA context. Fortifying these measures is paramount to improving the outcomes of SCD in SSA.