Equal Benefit Research Articles

A roadmap to increase diversity in genomic studies.

Two decades ago, the sequence of the first human genome was published. Since then, advances in genome technologies have resulted in whole-genome sequencing and microarray-based genotyping of millions of human genomes. However, genetic and genomic studies are predominantly based on populations of European ancestry. As a result, the potential benefits of genomic research-including better understanding of disease etiology, early detection and diagnosis, rational drug design and improved clinical care-may elude the many underrepresented populations. Here, we describe factors that have contributed to the imbalance in representation of different populations and, leveraging our experiences in setting up genomic studies in diverse global populations, we propose a roadmap to enhancing inclusion and ensuring equal health benefits of genomics advances. Our Perspective highlights the importance of sincere, concerted global efforts toward genomic equity to ensure the benefits of genomic medicine are accessible to all.

Mother Tongue Injustice: Reflections on the Kenyan Justice System

The inalienable right to one’s mother tongue has long been acknowledged universally. This was first captured by the UN’s ‘Universal Declaration of Human Rights’ as early as 1948 and recently reinforced through the ‘Declaration on the Rights of Indigenous People’ in 2006. The constitution of Kenya 2010, in The Bill of Rights (BR), reiterates this position by stating that the rights and fundamental freedoms belong to each individual and are not granted by the state. Mother tongue is one of the Human Rights. In essence, the constitution is expected to provide a basis upon which mother tongue can play a central role in the legal and judicial system of the country. However, mother tongue language remains on the periphery as the language of the law not to mention its subordinate role both as a legal language and the language of the administration of justice. This paper examines the current low status assumed by mother tongue in the Kenyan context within the Forensic Linguistics perspective. It is argued that there is an attempt at forced assimilation of mother tongue language to the dominant English language in our justice system. This process is at the heart of human rights violations as envisaged in the constitutional provisions on equality and freedom against discrimination as per article 27(4) of the Bill of Rights. The right to use of one’s mother tongue in the legal process is a fundamental pillar of equality and freedom against discrimination. It ensures that every person is equal before the law and has the right to equal protection and benefit of the law. The state players, therefore, have an obligation to protect the mother language through enforceable legislation as contemplated by the constitution of Kenya Article 7(3). The same constitution must be re-examined and amended to put mother tongue at the core of judicial administration and legal practice in the country. Keywords: Mother tongue, injustice, legal, constitution, forensic linguistics. DOI: 10.7176/JLPG/118-13 Publication date: February 28 th 2022

Research on the child healthcare system in China from the perspective of equal health benefits: Beijing as the case study

BackgroundWith government's proposal of the Healthy China Strategy, universal health has become the focus of increasing attention in China. As a special group, children's health is the basis and start of the national health. The construction of children's healthcare system should be given the priority. This study applied the concept of health equal benefits and conducted a systematic and in‐depth theoretical and empirical research on the children's healthcare system in Beijing, aiming at proposing relevant countermeasures and suggestions such as constructing the path of children's health care system in China.MethodsThis study adopted the way of questionnaire on children's basic information, health status, health service demand, insured situation and system satisfaction and then analysed the children's health, healthcare, satisfaction influence factors and their healthcare needs based on a survey in Beijing China. Methods such as descriptive statistics, analysis of variance and logistic regression are adopted to analyse the correlation between factors affecting children's health.ResultsThe findings show that overall health of the children in Beijing was better. However, there are still problems such as insufficient resource coverage and incorrect cognition in some groups. Their mental health and support need to be put emphasis on. The popularization of medical insurance policies for urban and rural residents in Beijing needs to be further improved. The burden of seeing a doctor is slightly lower than before, and the contribution to protecting children's health is not strong enough.ConclusionsThrough the survey of children in Beijing, it can be seen that there are still some problems existing in the healthcare system of children in China from the perspective of equal benefit. This study draws policy attention to the issues of financing, service contents, targets, service level and the degree of social recognition.

Education's economic return in multicultural Australia: Demographic analysis

This article focuses on the impact of education as the most important human capital endowment in the context of migration, religion, gender and ethnic identity from a demographic perspective. It presents research-based evidence to address such key research questions as whether and how significantly women's education provides equal benefit in the labour market for individuals, based on their migration status, religion, and ethnic identity. The field of this study is the multi-ethnic and multicultural context of Australia with a wide range of ethnic and religious groups of migrants from throughout the world. Preliminary results show that labour market achievement is positively and significantly associated with the educational attainment of individuals, irrespective of their migration status, religious affiliation and ethnicity. However, more comprehensive analysis from comparative perspectives reveals that the positive economic return of education is higher for natives (compared with migrants), for ethnic migrants from developed regions of origin (compared with those from less developed regions of origin) and for non-Muslims (compared with Muslims). The article provides two plausible explanations for these patterns. The first refers to the lack of recognition of overseas qualifications and to the devaluation of foreign education that particularly applies to ethnic migrants from less developed regions. The second relates to disadvantage through structural discrimination against migrants, particularly when their cultural and religious identity, such as Islamic names and dress codes, are distinctively displayed. In sum, this analysis presents further research-based evidence to go beyond the human capital theory in order to explain more appropriately the economic return of women's education in the context of religion and migration from a demographic perspective.

Knowledge transfer and technological upgrading of foreign affiliates in Indonesia: firm level analysis

Knowledge transfer is an essential process to generate the capacity of technological advancement for industrial development in developing countries. This paper aims to explore the role of knowledge transfer and learning process to support the improvement of technological capabilities of local suppliers. By using a sampling method of 26 multinational companies (foreign affiliates) in machinery and electrical components sector in Indonesia, several possible determinants pursuing knowledge transfer activities are analysed. The size of the sample is limited by the data collection. This study confirms findings that the possibility of knowledge transmission for local suppliers does exist, particularly for joint venture firms and those who have export activities. The foreign affiliates with research and development divisions are more likely to transfer knowledge to local firms. To explore in detail, two case studies were selected from the sample to describe how knowledge transfer activities managed among partners. It suggested that knowledge transfer as an effort of upgrading technology dependent on the learning experience between firm development and external source of knowledge. A process to formalise knowledge transfer relationships with equal benefits between sender and recipient is a key.

Post-Soviet States of Eurasia in International Economic Relations

The present article is devoted to the analysis of participation of new post-Soviet Eurasian states in international economic relations, of current goals and strategic targets of this policy in the economic development of these states. Many, in fact the majority of them appeared to be unable after achieving political sovereignty to solve complex economic problems of national development since they had neither organizational experience in carrying out an independent and effective economic policy nor the personnel, technological and financial provisions for these goals. Therefore new independent Eurasian states had to approach foreign countries searching for adequate forms and methods of cooperation with them on these issues. In this connection the article explores the nature of interrelations between post-Soviet states with their principal foreign partners on a bilateral basis as well as in multilateral international economic organizations, of the comparative role of political and economic factors in these relations. Some of the post-Soviet states have begun their participation in the Eurasian integration project headed by Russia, others aim at solving their external political and economic problems by strengthening relations with the USA and European Union on a priority basis, still others see the way out in promoting their orientation primarily on their closest regional partners (such as China, Turkey, Iran). However, neither of these directions of external economic activities has become a dominant one on the post-Soviet space. Moreover, some of their elements may get a priority significance, neighboring others or even replacing them at various stages of development of this or that post-Soviet state. Besides, three decades after their formation the new sovereign Eurasian states having endured complex processes of national state building began to differ substantially from each other by their political systems, by levels of economic development and above all – by their strategic goals, aspirations and orientations. And in its turn this has caused serious changes in their approaches to building relations with their external partners, both in bilateral and multilateral formats. Under these conditions the most important national priority of Russia is to implement such a foreign policy at the post-Soviet space that would react timely and most flexibly at social, political and economic processes going on there and emphasizing that most important goal of such a policy is neither a political expansion or an institution of a great power hegemony but development of partnership and friendly relations with the post-Soviet states on the basis of equality and mutual benefits.

Equal Benefits? An Examination of the Potential Consequences of Later School Start Times for Adolescents and Their Mental Health

Given the documented benefits of later school start times on adolescents' mental health, the aim of the current study was to examine if the association between school start times and depressive symptoms differed across adolescents from families of different socioeconomic status levels. Using a cross-sectional design, the current study incorporated an online survey for high school students and their parents across the United States, with average sleep duration measured through a 7-day sleep diary. A total of 193 adolescent (Meanage =15.7 years old, SD=.94; 54.4% female; 71% white) and parent (Meanage =47.6 years old, SD=5.4; 80% female; 79% white) dyads participated. Adolescents reported on depressive symptoms, sleep quality and duration, chronotype, and demographic covariates; parents reported on school start times and socioeconomic status. Results suggested that only in adolescents from higher socioeconomic status families (+1 SD) did the association between later start times and fewer depressive symptoms emerge as significant. Although more school start times research is needed to understand its impact across diverse groups of students, current findings suggest a disproportionate benefit of reduced depression for youth from families of higher socioeconomic status with having a later start time.

Increased survival disparities among children and adolescents & young adults with acute myeloid leukemia: A Dutch population-based study.

For many cancers, adolescents and young adults (AYAs) have a poorer prognosis than pediatric patients. Our study evaluates survival outcomes of children (0‐17 years) and AYAs (18‐39 years) diagnosed with acute myeloid leukemia (AML) in the Netherlands between 1990 and 2015 (N = 2058) utilizing the population‐based Netherlands Cancer Registry, which includes information on therapy and site of primary treatment. Five‐ and 10‐year relative (disease‐specific) survival were estimated for all patients, children and AYAs. Multivariable analyses were performed using generalized linear models (excess mortality) and logistic regression (early mortality). AYAs with AML had a substantially lower 5‐ and 10‐year relative survival than children (5‐year: 43% vs 58%; 10‐year: 37% vs 51%). The gap in 5‐year relative survival was largest (nearly 20 percent‐points) in 2010 to 2015, despite survival improvements over time across all ages. The multivariable‐adjusted excess risk of dying was 60% higher in AYAs (95% CI: 37%‐86%). Early mortality (death within 30 days of diagnosis) declined over time, and did not differ between children and AYAs. In conclusion, AYAs diagnosed with AML in the Netherlands had a worse prognosis than pediatric patients. The survival gap seemed most pronounced in recent years, suggesting that improvements in care resulting in better outcome for children have not led to equal benefits for AYAs.

Understanding Multiple Dimensions of Perceived Greenspace Accessibility and Their Effect on Subjective Well-Being During a Global Pandemic

The COVID-19 pandemic has demonstrated how the accessibility of greenspace can shift in response to social-ecological disturbance, and generated questions as to how changing dimensions of accessibility affect the ecosystem services of greenspace, such as improved subjective well-being. Amidst the growing consensus of the important role of greenspace in improving and maintaining well-being through times of duress, we examine how access to greenspace is affecting subjective well-being during the COVID-19 pandemic. Both the relationship of greenspace to subjective well-being and the barriers to greenspace access are well-established for normal conditions. Much remains to be known, however, about how barriers to access and the effect of greenspace on subjective well-being shift in response to periods of social duress, such as the current COVID-19 pandemic. Using data from surveys and interviews conducted with 1,200 university students in the United States during the spring of 2020, we assess the effect of going outdoors on subjective well-being, commonly experienced barriers to going outside, and how these barriers in turn affected subjective well-being. We find that time spent outside, particularly in greenspace, correlates with higher levels of subjective well-being, and that concern over COVID-19 risk and transmission negatively affects this relationship both in reducing time spent outdoors and the subjective well-being benefits. We also find that type of greenspace (public vs. private) does not have a significant effect on subjective well-being, that while those in areas with lower population density have significantly higher subjective well-being when outdoors, all participants experience a statistically equal benefit to subjective well-being by going outside. Our findings suggest how understanding the ways dimensions of accessibility shift in response to times of social duress can aid public health messaging, the design and management of greenspace, and environmental justice efforts to support the use of greenspace in improving and maintaining subjective well-being during future crisis events.

Abstract 12197: Rural Caregivers With Low Health Literacy Show Greater Improvements in Diet Quality From a Cardiovascular Disease Risk Reduction Intervention Designed to Address Low Health Literacy Than Those With High Health Literacy

Introduction: Rural caregivers of those with chronic illnesses have higher cardiovascular disease (CVD) risk than urban caregivers. Diet is a major lifestyle factor that contributes to CVD risk. We conducted a randomized controlled trial of a CVD risk reduction intervention called Rural Intervention for Caregivers’ Heart Health (RICHH), that was designed to promote CVD risk reduction, including healthy eating and that was designed to be accessible to those with low health literacy (HL). We tested the moderating effect of HL on the impact of the intervention on diet quality. Hypothesis: Rural caregivers with low HL would gain equal or greater benefits from the RICHH intervention on diet quality compared to those with high HL. Methods: The newest vital sign (NVS), rural-urban commuting area (RUCA) code ≥4 or living in Appalachian counties, and Healthy Eating Index-2015 (HEI-2015) were used to determine HL, rurality, and diet quality, respectively. The HEI-2015 was computed based on a food frequency questionnaire at baseline and post-intervention. The RICHH intervention was delivered using videoconference technology by nurse interventionists once a week for 12 weeks. A linear mixed effect model was used to evaluate the moderation effect of HL (NVS ≥ 4) on the impact of the intervention on diet quality. Results: A total of 296 rural caregivers (54.5 ± 13.7 years old, 76% female) completed the study. The improvement in HEI-2015 scores was greater in the low HL group than in the high HL group controlling for age and sex (beta estimate = 9.21, SE = 3.31, P = 0.0058). Conclusions: The RICHH intervention was effective in improving diet quality of rural caregivers compared to the control group. In particular, rural caregivers with low HL benefited more from the intervention aimed at increasing diet quality. Thus, addressing low HL could play an important role to improve diet quality and to reduce CVD risk among caregivers residing in rural environment.

Increased Survival Disparities Among Children and Adolescents & Young Adults with Acute Myeloid Leukemia: A Dutch Population-Based Study

Introduction: For many cancers, adolescent and young adult (AYA) patients have a poorer prognosis than pediatric patients. This study compares long-term survival outcomes of children and AYAs diagnosed with acute myeloid leukemia (AML) in the Netherlands. This has not been done before despite the availability of high-quality data collected by the nationwide, population-based Netherlands Cancer Registry (NCR).Methods: Data on all AML patients aged 0-39 years, diagnosed between 1990-2015, were obtained from the NCR (N=2058). Relative (disease-specific) survival was estimated for all patients, children (0-17 years), and AYAs (18-39 years) using the traditional cohort approach. Early mortality was defined as death within 30 days of diagnosis. Multivariable analyses were performed using generalized linear models (excess mortality) and logistic regression (early mortality).Results: The prognosis of Dutch AML patients below the age of 40 years has improved considerably during the past decades with 5-year relative survival rates increasing from 39% in 1990-1999 to 61% in 2010-2015 (p trend<0.01). AYAs had a substantially lower 5-year relative survival than children (43% vs. 57%, Figure). Although survival increased over time in both age groups, the improvement was more pronounced among children. Therefore, the survival gap was largest in the most recent period. In 2010-2015, 5-year relative survival was 74% for children compared to only 54% for AYAs. More detailed analyses showed that 1-9 year old children had the best prognosis with a 5-year relative survival of 84% in 2010-2015. With respect to the AML subtypes, core-binding factor (CBF) leukemia was more structurally tested and registered as from 2001. Within the group of patients diagnosed with CBF leukemia since 2001 (children: N=68, AYAs: N=68), children also had a better 5-year relative survival than AYAs (84% vs. 75%, not statistically significant).When compared to children, the excess risk of dying due to AML was 70% higher in AYAs [95% confidence interval (95% CI), 47%-97%] after adjustment for follow-up time, sex, period of diagnosis, and stem cell transplantation. The excess hazard ratios (HRs) of mortality were 2.0 (95% CI, 1.6-2.4) for 18-29 year olds and 2.1 (95% CI, 1.7-2.6) for 30-39 year olds, using 1-9 year olds as reference.Early mortality declined over time from 9% to 4% (p trend<0.01), and did not differ between children and AYAs. However, multivariable-adjusted odds ratios (ORs) of early death were doubled when comparing older age groups to 1-9 year olds.Conclusions: AYAs diagnosed with AML in the Netherlands between 1990 and 2015 had a worse prognosis than pediatric patients. The survival disparity seemed most evident in recent years, suggesting that improvements in care resulting in better outcome for children have not led to equal benefits for AYAs yet. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Effectiveness of reduced- versus standard-dose radiotherapy on survival and radiation-associated toxicity in patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma: a systematic review protocol.

The objective of this review is to investigate overall survival in patients with human papillomavirus positive oropharyngeal squamous cell carcinoma (HPV+ OPSCC) comparing standard- versus reduced-dose radiotherapy. The improved survival of patients with HPV+ compared to HPV-negative OPSCC has raised the question of reducing the total radiation treatment dose delivered to patients with HPV+ OPSCC. A de-escalated radiotherapy protocol may provide equal oncological benefit, with reduced adverse events/toxicity. We will include any adult patients aged 18years or older who have undergone curative intent treatment for HPV+ OPSCC. These patients can be at any stage at the time treatment is initiated. Exclusion criteria are as follows: pre-clinical or animal studies, patients with non-squamous cell carcinoma lesions of the oropharynx, patients with primary lesions in other head and neck sites, or patients receiving palliative treatment. A three-step search strategy will be used to identify relevant articles for inclusion through MEDLINE, CINAHL, Embase, Web of Science, Scopus, and gray literature sources. These articles will be assessed against our inclusion and exclusion criteria at the title and abstract level as well as at full-text level. Remaining studies will be critically appraised based on their trial design. Data extraction will occur for all studies and, where possible, will be pooled with statistical meta-analysis. PROSPERO CRD42021252161.

Gender gap and access to finance: A cross‐country analysis

AbstractUsing a rich firm‐level data set pertaining to 80 countries, this paper investigates the relationship between institutional gender equality and financial constraints on female‐led firms. We employ a broad index of gender inequality as well as alternate measures in terms of economic, educational, and political inequality. We observe that institutional gender equality benefits female entrepreneurs’ access to finance. In addition, in a gender‐equal environment, we observe that female‐owned and female‐managed firms are less likely to be discouraged from applying for formal finance. We find these effects are more pronounced in the case of small and medium enterprises (SMEs) and young firms. Further, our results suggest that economic, educational, and political gender equality is vital to improving women enterprises’ access to external finance.

Factors of Ukrainian men involving in men’s movements that support gender equality

In recent years, Ukraine has received more attention to the issues of masculinity, the position of men and their participation in activism in support of gender equality. In Ukraine, there are several men’s organizations and initiatives that support the ideas of gender equality: dad schools, men against violence, HeforShe Ukraine and HeforShe Congresses, profeminist schools for men, national networks of male leaders against violence, an international union of courageous dads, etc. Feminist public activists appear to talk about the benefits of gender equality. The men’s movement for gender equality in the world and in Ukraine is seen as focusing on either women’s rights or men’s rights. According to men’s movement researcher Michael Messner, institutional privileges and costs of masculinity are the aspects of the classification of male movements. As a result of the analysis of six in-depth interviews with Ukrainian activists of men’s movements, Michael Messner’s ideas were illustrated with examples from Ukrainian society. Factors involving men in men’s movements for gender equality differ depending on the type of the men’s movement. Women’s rights movements were characterized by awareness of cases of discrimination against women and a corresponding sense of solidarity and compassion. Movements for men’s rights – by awareness of cases of discrimination against men in their own experience, a sense of the need to respond to the movement for women’s rights, and the situation of men’s movements in Ukraine, i.e. factors that directly affect men. In addition, it has been found that there are common factors in involving men in women’s and men’s rights movements, such as the existence of a feminist movement, a sense of the need for change, and a desire to be involved in local or global change. Expert interviews have found that the use of personal experience is the most effective way to influence the level of men’s involvement in men’s movements for gender equality, including in Ukraine. Attention to real cases of gender discrimination against women will be perceived more sincerely and openly than statistics. Attention to real cases of gender discrimination against women will be perceived more sincerely and openly than statistics. In addition, it is important to demonstrate the experience of men who understand the benefits of gender equality for men as well. They, according to experts, will be able to serve as examples for other men to follow. Separately, experts noted the role of education in the desire to join the struggle of men for the idea of gender equality. Both non-formal education programs and formal education on equal rights and opportunities can be tools for introducing changes in men’s attitudes to discrimination.

Sex Differences in Objective Measures of Adult Patients Presenting for Pectus Excavatum Repair

BackgroundWomen have a reported incidence of pectus deformities four to five times less than men. Sex differences have not been well studied. MethodsA retrospective review was performed of adult patients (aged 18 years or more) who underwent a pectus excavatum repair at Mayo Clinic in Arizona (January 1, 2010, to December 31, 2019). ResultsIn total, 776 adults underwent pectus repair, with 30% being women. Women presented older (mean age 35 vs 32 years, P = .007) and more symptomatic. Despite this, women performed better on cardiopulmonary exercise testing (higher maximum oxygen consumption and oxygen pulse). Women had more severe deformities (Haller index 5.9 vs 4.3, P < .001). However, in 609 patients undergoing attempted primary minimally invasive pectus repair, intraoperative fractures/osteotomies occurred equally between men and women, with the majority occurring in patients 30 years of age or more (11.5% for age 30 or more, 1.7% for age less than 30; total 7%). Women were also less likely to require three bars for repair (12% vs 42%, P < .001). Hospital length of stay and postoperative complication rates were not significantly different. Postoperatively, women reported a greater daily intensity of pain, but only on the initial postoperative day did they use significantly more opioids than men. Cardiopulmonary exercise testing of 142 patients undergoing baseline and postoperative evaluation at bar removal showed equal and significant benefits in both sexes. ConclusionsWomen presented for pectus excavatum repair at an older age and with greater symptoms and more severe symptoms. Despite this, women required fewer bars, and there were no significant differences in length of stay or complications. Cardiopulmonary benefits of repair were significant and equal for both women and men.

Gender (in)equality in Australia: good intentions and unintended consequences

Gender inequality is a complex problem with multiple interrelated indicators (e.g. underrepresentation of women in leadership roles, gender pay gaps). Our academic community has been following a three‐step ‘script’ to motivate organisations to act on gender inequality: we document the inequality, we build a business case for equality, and we advocate solutions to correct inequality. But too often, our well‐meant messages have negative consequences. We may be inadvertently presenting gender inequality as an intractable problem and creating unrealistic expectations among stakeholders about gender equality benefits and gender inequality solutions. As stakeholders become impatient with Australia’s slow progress toward gender equality, we may need to reconsider this strategy. Academic researchers may be more successful change agents if we are more deliberate about highlighting the interconnections among gender inequality indicators, identifying the organisational value of gender equality beyond financial performance, and advocating small‐scale structural changes alongside large‐scale interventions.

Where You Live Matters: Local Bank Competition, Online Marketplace Lending, and Disparity in Borrower Benefits

In the past decade, the proliferation of online marketplace lending has been disrupting the consumer credit market, especially for personal loans for debt consolidation. These lenders, for example, Lending Club, transcend the geographic boundaries within which local banks operate and offer homogeneous access and terms to borrowers. However, the ultimate benefits borrowers derive from marketplace lending can differ significantly because local alternatives may replace marketplace loans when available and favorable. Correspondingly, if local bank competition drives the substitution of an existing marketplace loan with a traditional bank loan, the promise of equal benefits to all borrowers from marketplace lending is unlikely to fully materialize. This competitive dynamic has implications for policy making, particularly in judging the ramifications of bank mergers and acquisitions (M&amp;As). Our results indicate that a borrower who resides in a more competitive market is more likely to pay off a P2P loan early by making a large, one-time payment compared with a borrower from a less competitive market, indicating a substitution with a local bank loan. Thus, borrowers from different markets do not benefit equally from online marketplace lending, disrupting the consumer credit market. In particular, consumers in smaller markets continue to be disadvantaged because of the absence of competitive intensity. This is a consequence of traditional banks competing within their local markets and incentivized to attract marketplace borrowers to traditional loans primarily by their local market conditions. Therefore, unless geographic frictions in traditional lending markets are removed, digital disruptions cannot equalize the benefits to consumers.

Inclusive Science Policy and Economic Development in the 21st Century: The Case for Rural America

While many of the original recommendations of Vannevar Bush’s Science—The Endless Frontier report were implemented with great success in the twentieth century, the benefits of scientific innovation have not been fully realized in all corners of the United States. In particular, rural America persistently lags behind other locales in terms of scientific investment and economic development. In the coming decades, more place-conscious science policy will be needed to provide equal opportunities—and equal benefits—to all. This article highlights some of the current challenges relevant to science policy that are faced by rural America, with a specific emphasis on educational policy. The author offers recommendations for a more geographically inclusive science policy agenda and contends that rural equity should be a key priority for science policymakers in the United States.

Outcomes for Geriatric Urolithiasis Patients aged ≥80 Years Compared to Patients in Their Seventies

BackgroundDemographic changes are leading to an increase in geriatric urolithiasis patients aged ≥70 yr. Published data regarding their management remain sparse. In particular, for the subgroup of patients aged ≥80 yr there is a lack of evidence supporting the hypothesis that stone-removing treatment is effective, safe, and beneficial. ObjectiveTo examine the efficiency and safety of stone-removing treatment in geriatric urolithiasis patients aged ≥80 yr compared to their younger geriatric counterparts aged 70–79 yr against the background of their respective life expectancy. Design, setting, and participantsData for the study cohort were extracted from an institutional review board–approved retrospective database with 325 patients aged ≥70 yr (70–79 yr: n = 241; ≥80 yr: n = 84) consecutively admitted to hospital because of symptomatic urolithiasis from 2013 to 2018. Outcome measurements and statistical analysisBaseline characteristics, outcome and follow-up data, and survival were compared using Wilcoxon-Mann-Whitney U tests, χ2 tests, Kaplan-Meier estimation, log-rank tests, and Cox regression. Results and limitationsAt baseline, the incidence of infected hydronephrosis was greater among patients aged ≥80 yr (p < 0.05), whereas the median stone burden and Charlson comorbidity index did not differ between the groups. Outcome analysis revealed no significant differences in terms of complication, stone-free, and 6-mo readmission rates (p > 0.05). Survival analysis for the two groups demonstrated a 2-yr overall survival (OS) rate of 0.91 (95% confidence interval [CI] 0.75–1) for patients aged ≥80 yr and 0.97 (95% CI 0.88–1), for those aged 70–79 yr (p < 0.01). Multivariable Cox analysis revealed age ≥80 yr (hazard ratio [HR] 3.3, 95% CI 1.3–8.5) and infected hydronephrosis (HR 2.8, 95% CI 1.0–7.8) as predictors of all-cause mortality (p < 0.05). The study is limited by its retrospective design. ConclusionsStone-removing treatment for patients aged ≥80 yr proved to be as effective and safe as for patients in their seventies. Although characterized by shorter remaining life expectancy, excellent 2-yr OS for patients aged ≥80 yr supports the hypothesis of equal benefit from stone-removing treatment when compared to septuagenarians. Patient summaryThere is a lack of evidence supporting the benefit of urinary stone-removing treatment for patients older than 80 yr. Our study included geriatric patients older than 70 yr with symptomatic urinary stone disease for which urinary drainage or stone removal is indicated. We compared treatment outcomes and survival between two age groups: patients aged 70–79 yr and those aged 80 yr or older. We found equivalent outcomes for the two groups and excellent 2-yr overall survival of 91% for those older than 80 yr. The study strengthens the evidence that active stone-removing therapy is safe and beneficial for these patients.

Omega-3 Polyunsaturated Fatty Acid: A Pharmaco-Nutraceutical Approach to Improve the Responsiveness to Ursodeoxycholic Acid.

Ursodeoxycholic acid (UDCA) is the first line therapy for the treatment of cholestatic and autoimmune liver diseases. Its clinical use is currently limited by a significant proportion of non-responder patients. Polyunsaturated fatty acids (n-3 PUFAs) possess important anti-inflammatory properties and protect liver cells against bile acid (BA)-induced toxicity. The present study was designed to rapidly evaluate whether combining n-3 PUFAs (i.e., eicosapentaenoic [EPA] and docosahexaenoic [DHA] acids) to UDCA would provide additional benefits when compared to the drug alone. The parameters evaluated were (i) the expression of genes governing BA synthesis, transport, and metabolism; (ii) the prevention of BA-induced apoptosis and endoplasmic reticulum (ER)-stress; and (iii) the control of BA- and LPS-dependent inflammation. In the absence of n-3 PUFAs, most of the parameters investigated were unaffected by UDCA or were only altered by the higher dose (500 µM) of the drug. By contrast, in the presence of EPA/DHA (50/50 µM), all parameters showed a strongly improved response and the lowest UDCA dosage (50 µM) provided equal or better benefits than the highest dose used alone. For example, the combination EPA/DHA + UDCA 50 µM caused comparable down-regulation of the CYP7A1 gene expression and of the BA-induced caspase 3 activity as observed with UDCA 500 µM. In conclusion, these results suggest that the addition of n-3 PUFAs to UDCA may improve the response to the drug, and that such a pharmaco-nutraceutical approach could be used in clinic to open the narrow therapeutic dose of UDCA in cholestatic liver diseases.