Longer Study Period Research Articles

Deciphering consumer behaviours in the innovative hospitality settings

Purpose This study aims to analyse the antecedents and consequences of consumer participation behaviour in the hotel industry. It investigates how citizenship behaviour influences the link between participation and switching intention. It also investigates hotel innovativeness, brand identification and consumer value co-creation using the frameworks of innovation diffusion theory, social identity theory and social exchange theory. By combining different academic perspectives, the study provides a thorough grasp of the elements that influence consumer behaviour and loyalty to hospitality brands. Design/methodology/approach This study used a descriptive-analytical approach to survey 526 guests who stayed at five-star hotels affiliated with chains in Egypt. The hotels were chosen using stratified random sampling, which ensured representation across multiple segments. For practical reasons, convenience sampling techniques were used to pick research participants. To test the study hypotheses, structural equation modelling was used, which provided a strong statistical analysis to assess the correlations between variables and validate the suggested theoretical framework. Findings The research indicates that hotel innovativeness has a substantial impact on consumers’ brand identification and involvement behaviour, but not their propensity to move brands. The relationship between participation behaviours and intention to switch is mediated by consumer citizenship behaviour. Research limitations/implications The cross-sectional study methodology may not address causal linkages or developmental difficulties because it only collected data at one point in time. A longer study period is required, and the sample group’s breadth is restricted to five-star hotel guests from Egypt’s chain-affiliated hotels. Originality/value This study offers a thorough methodology for assessing how hotel innovation influences consumer brand identification. It also looks at how consumer brand identification affects involvement and switching intentions. The study also investigates the moderating influence of consumer citizenship behaviour in the link between involvement and switching intentions.

A CROSS-SECTIONAL STUDY TO FIND THE ASSOCIATION OF MIGRATION ON DEPRESSIVE AND ANXIETY DISORDERS AMONG NURSING STUDENTS IN A TERTIARY CARE HOSPITAL IN BANGALORE

Objectives:To determine the prevalence of depression and anxiety disorders among Nursing students and their association with migration. Methodology: A cross-sectional study was conducted at Sapthagiri Institute of Medical Sciences from December 2023 to January 2024. The study included 60 BSc nursing students, using Generalised Anxiety Disorder-7 Item Score and Zung Self Rating Scales to assess anxiety and depression. Migrant students were compared with local students to explore the impact of migration. Results: Out of 75 students, 60 participated, with 62% female and 48% male. The majority (73%) were from Kerala, with 87% being migrants. The prevalence of depressive disorders was 11.7%, with a higher proportion (87.5%) among migrants. Anxiety disorders affected 57.5% of the participants, with 78% being migrants. Migrants had a significantly higher prevalence of mild to moderate anxiety symptoms compared to non-migrants. Statistical analysis showed a positive correlation between migration and Generalised Anxiety Disorder-7 Item Score, and it was indicated that migrants had a 3.63 times higher likelihood of developing depressive or anxiety disorders. Conclusion: Migration significantly impacts the mental health of nursing students, with a notable increase in anxiety disorders among migrants. Depression rates were lower than expected. Further research with larger sample sizes and longer study periods is needed to validate these findings.

HbA1c Point-of-Care Testing and its Role in the Management of Diabetes

The San Joaquin Central Valley, known for its thriving agricultural industry, faces challenges related to low socioeconomic status, limited access to healthy food, and healthcare disparities. To enhance compliance among patients with diabetes, United Health Centers (UHC) implemented in-clinic HbA1c Point-of-Care Testing (POCT) to provide instant data for managing diabetes. The total number of patients with diabetes screened was 2,020 across three sites, with the total number of those in poor control totaling 825. Despite theorizing that these HbA1c machines would improve patient management, statistical analysis revealed no significant impact on diabetes control within the population. However, a closer examination of percentage data demonstrated clinical relevance across UHC sites. Initially, only one out of three UHC sites met the organization’s goal of keeping uncontrolled diabetic patient populations below 30%. After one year of POCT utilization, two out of three sites nearly achieved this goal, resulting in a 27% reduction in poorly managed diabetic patients. While the study’s duration may have limited statistical significance, further analysis and a longer study period could confirm the positive impact of HbA1c POCT on patient compliance.

Effects of Cashew Nuts (Anacardium occidentale L.) and Cashew Nut Oil on Intestinal Permeability and Inflammatory Markers during an Energy-Restricted 8-Week Intervention: A Randomized Controlled Trial (Brazilian Nuts Study).

Cashew nuts can contribute to improving intestinal permeability and inflammation as they contain essential nutrients and bioactive compounds, but no clinical trials have evaluated these potential effects. This randomized trial aimed to assess the effects of cashew nuts and their oil on intestinal permeability and inflammatory markers. Sixty-four adults with overweight or obesity were allocated into three groups receiving energy restriction (-500 kcal/day): control (CT, free nuts), cashew nuts (CN, 30 g/day), or cashew nut oil (OL, 30 mL/day). Urine lactulose and mannitol, plasma zonulin and the lipopolysaccharide-binding protein (LBP), plasma interleukins (IL-6, TNF-α, IL-10, IL-1β, IL-8, and IL-12p70), and C-reactive proteins were analyzed. Energy restriction reduced body fat and other indicators of adiposity without differences between the groups. Only the control group increased LBPs after an 8-week intervention. There were no statistically significant differences found between the groups in terms of intestinal permeability and inflammatory markers. In conclusion, incorporating cashew nuts or cashew nut oil into an energy-restricted 8-week dietary intervention did not change intestinal permeability and inflammatory markers. As studies evaluating cashew nuts on these markers remain scarce, further research is needed, perhaps with a longer study period and a higher concentration of cashew nuts and oil.

Effects of Chemotherapy on Aneuploidy Rates in Sperm from Male Patients with Testicular Cancer or Hodgkin's Lymphoma-A Systematic Review.

Testicular cancer and Hodgkin's lymphoma are prevalent malignancies among young males aged 20 to 39. The incidence of testicular cancer and lymphoma has risen in recent years, with orchiectomy often followed by adjuvant chemotherapy as the primary treatment for testicular cancer and chemotherapy for lymphoma. Chemotherapy has been associated with an increased risk of aneuploidy and reduced fertility. This systematic review included seven studies, both case-control and longitudinal prospective designs, from the PubMed, Embase, and Cochrane Library databases. The screening process was conducted using the online tool covidence.org. The study outcomes indicate varied impacts of chemotherapy on aneuploidy rates. An increase in the aneuploidy rates, notably for the sex chromosomes, immediately post-treatment was a common trend, followed by a decline in pretreatment values. This systematic review presents the effects of chemotherapy on the aneuploidy rates of testicular cancer and Hodgkin's lymphoma patients, with a decrease post-treatment. The findings underscore the need for larger, well-designed studies with a longer study period.

Effectiveness of COVID-19 vaccines administered in the 2023 autumnal campaigns in Europe: Results from the VEBIS primary care test-negative design study, September 2023–January 2024

In autumn 2023, European vaccination campaigns predominantly administered XBB.1.5 vaccine. In a European multicentre study, we estimated 2023 COVID-19 vaccine effectiveness (VE) against laboratory-confirmed symptomatic infection at primary care level between September 2023 and January 2024. Using a test-negative case–control design, we estimated VE in the target group for COVID-19 vaccination overall and by time since vaccination. We included 1057 cases and 4397 controls. Vaccine effectiveness was 40 % (95 % CI: 26–53 %) overall, 48 % (95 % CI: 31–61 %) among those vaccinated < 6 weeks of onset and 29 % (95 % CI: 3–49 %) at 6–14 weeks. Our results suggest that COVID-19 vaccines administered to target groups during the autumn 2023 campaigns showed clinically significant effectiveness against laboratory-confirmed, medically attended symptomatic SARS-CoV-2 infection in the 3 months following vaccination. A longer study period will allow for further variant-specific COVID-19 VE estimates, better understanding decline in VE and informing booster administration policies.

Black carbon and PM0.49 characterization in manila north harbour port, Metro Manila, Philippines

Globalization and industrialization have increased the shipping activities in Metro Manila. This increase in economic activity has contributed to the exacerbation of atmospheric particle pollution, particularly black carbon (BC) and particulate matter (PM). In this study, PM0.49 and BC were characterized in North Harbour in Metro Manila, Philippines. Using a multiple-split high-volume cascade impactor, PM0.49 and PM2.5 were collected from December 2019 to January 2020. Equivalent BC (eBC) mass concentrations were measured using an aethalometer (AE33, Magee Scientific) while chemical analysis was also performed using ion chromatography. The PM0.49 was tested for its morphological and mineralogical characteristics. Daily analysis showed no significant difference between the weekday and weekend pollution concentration in the port, although mean concentration (70 ± 21 μg/m3) exceeds that of the 24-hr Philippine air quality guideline value of 50 μg/m3 for PM2.5 concentrations. The particle compositions of PM0.49 are mostly from Si-rich particles and Pb-rich particles. High variability was observed for Mg, Si, Ca, Fe, Cd, Zn, Mn, S, Cl, V, and Cr heavy metals. The carbonaceous species with the highest concentration was organic carbon (OC) (33 ± 9 μg/m3) followed by BC (16 ± 3 μg/m3) and eBC (12 ± 3 μg/m3). An analysis of the ionic species showed SOX and NOX emissions as the primary ions, which are mostly related to ship emissions while the mineralogical analysis showed that soot particles are the main composition of the particles. Overall, the pollution assessment showed that North Harbour is polluted with heavy metals but within the Philippine air quality pollutant standard. In brief, the results of this study suggest that atmospheric pollution in the study site was mostly caused by local anthropogenic sources, particularly vessel emissions. The researchers suggest that a longer study period be conducted to further assess the seasonal variation of atmospheric particle pollution in North Harbour, Metro Manila.

CORPORATE GOVERNANCE AND FINANCIAL PERFORMANCE: A CASE STUDY IN THE PHARMACEUTICAL SECTOR IN MALAYSIA

The introduction of the Malaysian Code of Corporate Governance has been progressively updated since its inception in the year 2000 and the latest update in the year 2021, proves that the government of Malaysia has been serious in regulating to ensure that the companies in Malaysia have been compliant with good corporate governance practices. Observing that it is an evergreen issue and to have more updated research, this study evaluates factors that could influence the effectiveness of corporate governance of five pharmaceutical companies listed in Malaysia and its relationship with the financial performance for the period of 2017 - 2021. The methodologies that have been employed for this study are descriptive statistics, non-parametric correlations, scatter plots and regression linear. The findings reveal that variables of board size, board independence, and disclosure of sustainability reports have correlations with the financial performance measured by the return on assets. However, the disclosure of sustainability reports is the only variable that has a significant correlation with ROA whereas board size and board independence do not possess similar relationships. For a better representation of the results’ precision and robust findings, it is recommended to have a longer study period than five years and a larger sample size by extending it to other sectors.

Testing the feasibility of mobile ecological momentary assessment for symptom burden and management among metastatic cancer patients.

Individuals who have metastatic cancer experience substantial physical and psychological distress (e.g., pain, depression, anxiety) from their disease and its treatment compared to patients with less advanced disease. As the burden of symptoms varies over time, ecological momentary assessment (EMA) may be used to better understand patients' symptom trajectories, complimenting traditional longitudinal data collection methods. However, few have used EMA in patients with metastatic disease. The current study adds to the existing literature by exploring interrelated, common cancer-related symptoms of pain, anxiety, and depression and use of cannabis-based products, opioid medications, other (nonopioid) pain medications, and medications for anxiety or depression. An eight-day prospective observational feasibility study was conducted among 50 patients with metastatic cancer recruited from seven solid cancer clinics at The Ohio State University Comprehensive Cancer Center. Participants completed a week of interval-contingent mobile EMA, administered daily at 9 a.m., 3 p.m., and 8 p.m., and a comprehensive interviewer-administered questionnaire on Day 8. Participants were queried on their symptom burden and management strategies (i.e., use of medications and cannabis). We considered EMA to be feasible if a priori retention (80%) and adherence goals (75%) were met. Seventy-nine percent of eligible patients contacted enrolled in the study (n = 50 of 63). Among those enrolled, 92% were retained through Day 8 and 80% completed >90% of EMAs, exceeding a priori objectives. Participants' average pain, anxiety, and depressive symptoms across the week of EMA ranged from 1.7 to 1.8 (1 to 5 scale). Symptoms varied little by day or time of administration. On Day 8, significant proportions of participants reported past-week use of medications and cannabis for symptom management. Participants exceeded a priori adherence and retention objectives, indicating that mobile EMA is feasible among metastatic cancer patients, addressing a gap in the existing literature and informing future research. Restricting eligibility to participants with a minimum cutoff of symptom burden may be warranted to increase observations of symptom variability and provide opportunities for future health interventions. Future research is needed to test the acceptability and quality of data over a longer study period in this patient population.

Effectiveness of Different Online Intervention Modalities for Middle-Aged Adults with Overweight and Obesity: A 20-Year Systematic Review and Meta-analysis.

The main objectives of this systematic review and meta-analysis study include evaluating the methodological quality of existing randomized controlled trials (RCTs) for weight loss and features of online intervention [OI]s in each trial, examining the associations between the methodological quality, intervention features and the effectiveness of OIs, and comparing the effectiveness of OIs and other intervention modalities through systematic review and meta-analysis. Systematic searches were conducted using PubMed, Cochrane Library, CINAHL, and PsycINFO in the past two decades (2000 through 2019). Inclusion criteria includes Online intervention (intervention modality), middle-aged adults with overweight or obesity, at least six months or longer study period, an RCT, and 70% plus retention rate. Risk of Bias was assessed using Miller et al. in (Hester, Miller (eds) Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed.). Allyn & Bacon, Boston, 2003)'s Methodological Quality Rating Scale (MQRS) and GRADE. MOOSE guidelines was referred for data synthesis. In total, 29 OIs were evaluated using 10 criteria for methodological quality and eight criteria for intervention features. Results revealed that the mean methodological quality score of the RCTs was 12.1 (out of 16), and the mean intervention features score was 6.6 (out of 8). RCTs with higher scores were more effective in weight loss than those with lower scores. Results of meta-regression showed that methodological quality was more important than intervention features to increase the effectiveness. Results of meta-analysis showed that OIs were significantly more effective than controls. Compared to OIs only, OIs with interactions with others and professionals were more effective. The study limitation includes assessing 'effectiveness' based on weight only due to lack of other indicators to compare between studies; some results are self-reported; and feedback from intervention participants were hard to review. Nevertheless, this study may contribute to improving the effectiveness of existing OIs for weight loss considering methodological quality and better intervention features.

Goat hair as a bioindicator of environmental contaminants and adrenal activation during vertical transhumance.

Autochthonous breeds of livestock are considered a pivotal genetic resource for agriculture, rural development, and food and nutrition security. In the Italian Alps, local livestock breeds are maintained using the traditional alpine farming system based on vertical transhumance, with the use of alpine pastures from late spring to autumn and indoor housing with a hay-based diet for the remaining part of the year. Because of their tight link with the territory of origin, local breeds could be used to biomonitor environmental contaminations. Moreover, animal welfare should also be monitored during transhumance in animals, which are exposed to a sudden farming system change and different types of stressors. For these reasons, this investigation hypothesized that the content of trace elements, heavy metals, and cortisol in the hair of goats changes during vertical transhumance, possibly reflecting different dietary contents and activity of the hypothalamic-pituitary-adrenal (HPA) axis. This study aimed to assess the response of an Italian local goat breed to the change from indoor housing to alpine pasture in summer in terms of hair concentrations of (i) trace elements and heavy metals and (ii) cortisol. The regrown hair of Frisa goats was monthly collected for 2 consecutive years (n = 10 for heavy metals and trace elements and n = 6 for cortisol in 2021, n = 17 for both analyses in 2022), once before vertical transhumance and twice after that event. Hair was then analyzed for trace elements, heavy metals, and cortisol by inductively coupled plasma-optical emission spectrophotometer (ICP-OES) and enzyme immunoassay (EIA), respectively. Data were analyzed by multilevel models. The results showed an increase in As content during alpine pasture (p < 0.01), probably reflecting the soil and water As contents of the grazing area, while Mg, Zn, and Al (p < 0.01) followed the opposite trend, decreasing in the second month after vertical transhumance. Hair cortisol concentrations increased during 2 months of alpine pasture (p < 0.001), indicating an increase in the activation of the HPA axis, in agreement with previous studies. Future investigations can consider a longer study period and the development of ad hoc animal welfare indicators.

Are exceptions justified in the current heart allocation system?

BackgroundIn the current six-tiered heart allocation system, waitlisted candidates frequently receive an exception to any of the top four allocation statuses. Studies have shown varying results regarding the mortality risk of exceptions compared to standard criteria listings in the top two statuses. It remains unclear whether exception statuses in the current allocation system are justified. MethodsWe performed a retrospective cohort study on all adults waitlisted for heart transplant between November 1st 2018 and December 31st 2022, contained in the United Network for Organ Sharing database. The waitlist mortality and transplantation rate of all exception status and standard criteria listings were compared and ranked, using status 6 as the reference status, in univariable and multivariable Cox models including status as a time-dependent variable. ResultsA total of 17116 heart waitlist candidates were included in the study. The waitlist mortality rates of exceptions in status 1 and 2 were lower than, but close to, the mortality rates of their standard criteria counterparts: status 1 standard HR 43.47 (p<0.001), status 1 exception HR 31.48 (p<0.001), status 2 standard HR 10.21 (p<0.001), status 2 exception HR 7.76 (p<0.001). The mortality rate of exceptions in status 3 and 4 was higher than, but also close to, the mortality rate of their standard criteria counterparts: status 3 standard HR 2.61 (p<0.001), status 3 exception HR 4.18 (p<0.001), status 4 standard HR 1.31 (p=0.104) and status 4 exception HR 2.13 (p<0.001). ConclusionBased on waitlist mortality over a longer study period than previous analyses, high-priority exceptions are appropriately placed in the current heart allocation system. The current allocation system requires a large fraction of candidates to seek exceptions, suggesting that we should focus on objective data to risk stratify all heart waitlist candidates, and thereby reduce the need for exceptions.

Changes of health-related quality of life after initiating basal insulin treatment among people with type 2 diabetes.

To assess the association between insulin regimens and health-related quality of life (HRQoL) after the introduction of basal insulin (BI) among people with type 2 diabetes in real-world clinical settings. 16,339 registered people with diabetes who had inadequate glycaemic control by oral agents initiated BI (either single BI or Basal-bolus) and completed a 6-month follow-up from 209 hospitals were included in the analyses. At the end of the follow-up, the switches of insulin regimens, change of HRQoL (EQ-5D-3L) and their associations were assessed. Initial insulin regimens of single BI and of basal-bolus (BI included Glargine, Detemir, and Neutral Protamine Hagedorn) accounted for 75.6% and 24.4%, respectively. At 6 months, regimens used were BI alone (65.2%), basal-bolus (10.4%), and premixed (6.4%), whereas 17.9% stopped all insulin therapy. The visual analogue scale score increased by 5.46 (P < .001), and the index value increased slightly by 0.02 (P < .001). Univariate analysis showed that people with diabetes taking basal-bolus regimen had the greatest improvement on HRQoL in all dimensions, especially in the reduction of the percentage of Pain/Discomfort (by 10.03%) and Anxiety/Depression (by 11.21%). In multivariable analysis, single BI or premixed insulin at 6 months was associated with more improvement of visual analogue scale score compared with stopping all insulin. Improved HRQoL was observed after initiating BI in people with type 2 diabetes . If the same achievement on HbA1c control can be guaranteed, single BI is preferred to other regimens from the viewpoint of HRQoL. Basal-bolus has the most significant potential to increase HRQoL, however, the people with diabetes characteristics differ from those initiating BI alone. Further longitudinal cohort study with a longer study period might be necessary to evaluate the certain effect.

Efficacy and safety of celecoxib monotherapy for treatment of moderate depressive symptoms following COVID-19 infection: A randomized, double-blind, placebo-controlled trial

ObjectiveCelecoxib, a nonsteroidal anti-inflammatory agent, was found to be an effective add-on treatment for unipolar and bipolar depression. We investigated the potential beneficial effect of celecoxib monotherapy on depressive symptoms after Coronavirus disease (COVID-19). MethodsThis was a randomized, double-blind, placebo-controlled clinical trial investigating the therapeutic effects of celecoxib monotherapy in patients with moderate depressive symptoms following COVID-19 infection. Patients were randomized to receive either a celecoxib capsule (100 mg) twice daily or a placebo capsule twice daily for 6 weeks. Participants were assessed with the Hamilton Depression Rating Scale (HDRS) and the side effect checklist at baseline and weeks 3 and 6. ResultsA total of 62 patients were included. GLM repeated-measures showed a significant effect of time × treatment (F = 12.95, df = 1.98, p < 0.001) for celecoxib, suggesting superior improvement of depressive symptoms in celecoxib compared to placebo from baseline to the study endpoint. HDRS scores in the celecoxib group showed a greater decline from baseline to both week 3 (t = 4.12, p < 0.001, Cohen's d = 1.10) and week 6 (t = 4.76, p < 0.001, Cohen's d = 1.27), compared to the placebo group. Rate of response to treatment (70% vs 9%, p < 0.001) and remission (67% vs 0%, p < 0.001) was significantly higher in celecoxib compared to the placebo group at week 6. Adverse event frequencies were not significantly different between the two groups. ConclusionWe demonstrated that treatment with celecoxib significantly improved depression scores of patients with depressive symptoms following COVID-19 infection. Further trials with larger sample sizes and longer study periods should assess our findings before any suggestion for clinical use.The trial was prospectively registered at the Iranian registry of clinical trials (www.irct.ir; registration number: IRCT20090117001556N142).

FTP6.13 Do prophylactic antibiotics on general anaesthetic induction improve surgical site and intra-abdominal infection post emergency laparoscopic cholecystectomy?

Abstract Background The role of prophylactic antibiotics in reducing surgical site infection (SSI) and intra-abdominal infection rates in emergency laparoscopic cholecystectomy remains controversial. New antimicrobial Trust guidelines at our unit introduced in May 2022 stated that all emergency “hot” laparoscopic cholecystectomies should receive single dose of IV antibiotics on general anaesthetic induction. We aim to assess whether SSI and intra-abdominal infection rates have improved since introducing these new guidelines. Methods Retrospective study comparing SSI and intra-abdominal infection rates within 30 days of all emergency laparoscopic cholecystectomy cases between February and April 2022 (before new guidelines), to those between August to October 2022 (post new guidelines). Results Total of 56 emergency “hot” laparoscopic cholecystectomy cases prior to, and 44 cases after introduction of new guidelines. 91% cases received IV antibiotics on induction post new guidelines, compared to 35% prior to new guidelines (P=0.038). Proportion of patients who continued with antibiotics post-surgery between 2 cohorts was not statistically significant (P=0.69). There was no statistically significant improvement in overall SSI rates post introduction of new guidelines (P=0.61). Skin closure method (P=0.044) and operating time (P=0.031) were statistically significant in contributing to SSI. There was further no statistically significant difference in rate of intra-abdominal infection post introduction of new guidelines (P=0.83). Conclusion Prophylactic antibiotics at induction do not appear to improve either SSI or intra-abdominal infection rates post emergency lap cholecystectomy cases. Further evaluation is needed over a longer study period, however, in order to ascertain whether these guidelines should be altered for future practise.

Global or Local Spatial Spillovers? Industrial Diversity and Economic Resilience in the Middle Reaches of the Yangtze River Urban Agglomeration, China

A growing body of literature has studied the empirical relationship between industrial diversity and economic resilience since the 2008 Great Recession. However, many existing studies are based on a nonspatial perspective, and little is known about the local or global spatial spillover effect of industrial diversity on economic resilience. This paper employs Bayesian spatial econometric methods to investigate the roles of related variety and unrelated variety on economic resilience in the middle reaches of the Yangtze River urban agglomeration, China and explores the possible local or global spatial spillover effect in the diversity–resilience relationship. The empirical results from the spatial Durbin error model estimation show that: (1) regions with high levels of related variety are economically resilient to the external shock in the postcrisis era, whereas unrelated variety has no significant direct effect on recovery resilience; (2) both related and unrelated variety have local spatial spillovers with respect to the one-year resilience of 2008–2009, but these spillovers are negligible in longer study periods. These results confirm the role of industrial relatedness and immediate neighbors in promoting regions’ short-run capabilities of recovery from external economic shocks.

Comparison of long-term effects of metformin on longevity between people with type 2 diabetes and matched non-diabetic controls

BackgroundMetformin, a medication for type 2 diabetes, has been linked to many non-diabetes health benefits including increasing healthy lifespan. Previous work has only examined the benefits of metformin over periods of less than ten years, which may not be long enough to capture the true effect of this medication on longevity.MethodsWe searched medical records for Wales, UK, using the Secure Anonymised Information Linkage dataset for type 2 diabetes patients treated with metformin (N = 129,140) and sulphonylurea (N = 68,563). Non-diabetic controls were matched on sex, age, smoking, and history of cancer and cardiovascular disease. Survival analysis was performed to examine survival time after first treatment, using a range of simulated study periods.FindingsUsing the full twenty-year period, we found that type 2 diabetes patients treated with metformin had shorter survival time than matched controls, as did sulphonylurea patients. Metformin patients had better survival than sulphonylurea patients, controlling for age. Within the first three years, metformin therapy showed a benefit over matched controls, but this reversed after five years of treatment.InterpretationWhile metformin does appear to confer benefits to longevity in the short term, these initial benefits are outweighed by the effects of type 2 diabetes when patients are observed over a period of up to twenty years. Longer study periods are therefore recommended for studying longevity and healthy lifespan.Evidence before this studyWork examining the non-diabetes outcomes of metformin therapy has suggested that there metformin has a beneficial effect on longevity and healthy lifespan. Both clinical trials and observational studies broadly support this hypothesis, but tend to be limited in the length of time over which they can study patients or participants.Added value of this studyBy using medical records we are able to study individuals with Type 2 diabetes over a period of two decades. We are also able to account for the effects of cancer, cardiovascular disease, hypertension, deprivation, and smoking on longevity and survival time following treatment.Implications of all the available evidenceWe confirm that there is an initial benefit to longevity of metformin therapy, but this benefit does not outweigh the negative effect on longevity of diabetes. Therefore, we suggest that longer study periods are required for inference to be made about longevity in future research.

Lipid lowering effects and safety of evolocumab in Chinese patients at very high cardiovascular risk: a single-center study.

Lipid lowering effects and safety of evolocumab in Chinese patients at very high cardiovascular risk: a single-center study.

The Impact of Social Determinants of Health on the Time Between Diagnostic Breast Imaging and Biopsy at a Safety Net Hospital.

Although social determinants of health (SDH) are thought to be associated with health outcomes, there is limited literature on the direct impact of SDH on delays in breast cancer diagnosis via breast imaging. Identifying SDH associated with longer lapses (defined in this study as a time interval between two events) between imaging and biopsy is essential to early-stage detection of breast cancer, which has a significant impact on survival. Previous work demonstrated associations between both housing and food insecurity with longer lapses between diagnostic imaging and biopsy. We aim to expand upon this retrospective analysis with a longer study period, more participants, and improved data cleaning techniques to better understand how SDH may affect the lapse between imaging and biopsy. This retrospective study was institutional review board approved and HIPAA compliant. Informed consent was waived. Patients who underwent screening mammography between January 1, 2015, and January 1, 2020, were assessed for timing of recommended biopsy due to a BI-RADS category 4 or 5. SDH were assessed with the unique Tool for Health & Resilience in Vulnerable Environments screening questionnaire developed at Boston Medical Center. Associations between imaging and biopsy timing and eight explanatory SDH variables (food insecurity, housing insecurity, ability to pay for medications, transportation access, ability to pay for utilities, caretaking needs, employment, and desire for more education) were assessed with multivariate Cox proportional hazard modeling, as well as demographic data. There were 2,885 unique patients who underwent 3,142 unique diagnostic imaging studies and were included in the multivariate analysis. Of those 3,142 imaging studies, 196 (6.2%) had not yet been followed by the recommended biopsy by the end of the study period; 2,271 patients (78.7%) had SDH data in at least one domain; and the individual domains ranged from 962 patients (32.1%) with complete data for education to 2,175 patients (75.4%) with complete data for food insecurity. A positive screen for at least one SDH was associated with a longer lapse between diagnostic imaging and biopsy (P= .048). Furthermore, housing insecurity alone was nearly associated with longer lapses between diagnostic imaging and biopsy (P= .059). Those who desired more education were found to have shorter lapses between diagnostic imaging and biopsy (P= .037). Only a positive screen of the aggregate of all SDH (using a novel tool developed at our safety net hospital) was associated with a statistically significant lengthening of this lapse. Of the eight SDH screened, housing insecurity was the closest to association with longer lapses between diagnostic imaging and biopsy, whereas patients who desired more education were found to have statistically significant shorter lapses; however, this survey domain had the lowest completion rate. Identification of which SDH might affect the time from imaging to biopsy can potentially inform targeted programs to intervene. Government and health system interventions addressing SDH, notably housing insecurity, could allow for shorter time to breast cancer diagnosis and treatment.

Feasibility and safety of robotic surgery for low rectal cancer combined with transanal total mesorectal excision

PurposeLaparoscopic surgery for low rectal cancer is often challenging. Transanal total mesorectal excision (TaTME) and robotic surgery have been introduced to overcome the technical difficulties in laparoscopic surgery and achieve more favorable outcomes. Hybrid robotic surgery, which combines TaTME with the abdominal robotic approach, incorporates the advantages of each of these surgical techniques and might achieve less invasive and safer surgery. This study evaluated the safety and feasibility of hybrid robotic surgery with TaTME (hybrid TaTME).MethodsWe retrospectively reviewed 162 TaTME cases performed at our department from September 2016 to May 2022. Among them, 92 cases of conventional TaTME and 30 of hybrid TaTME were eligible. We used propensity score matching analysis (PSM) to adjust for patients’ characteristics and compared the short-term outcomes of the two treatment groups.ResultsTwenty-seven cases in each group were extracted using PSM. The operation time in hybrid TaTME was comparable to that in conventional TaTME. There was no significant difference in the postoperative hospital stay between the two groups. Other intra- and post-operative outcomes were also comparable between the two groups. Furthermore, no significant differences were observed between the two groups in the curative resection and recurrence rates.ConclusionHybrid TaTME for low rectal cancer was as favorable as conventional TaTME in producing satisfactory short-term outcomes. However, furthermore, larger-scale studies conducted over longer study periods are needed to evaluate the validity of the findings.