Married Patients Research Articles

Social Support and Quality of Life in Hemodialysis Patients: A Comparative Study with Healthy Controls

Background and Objectives: Hemodialysis patients face significant physical and psychological challenges, including diminished quality of life and reduced social support. This study aimed to assess the levels of social support and quality of life in hemodialysis patients and identify the sociodemographic and dialysis-related factors influencing these outcomes. Materials and Methods: This study included 115 hemodialysis patients and 107 healthy controls. Social support was measured using the Modified Social Support Survey (MSSS) and its abbreviated version (MSSS-5). Quality of life was assessed using the WHOQOL-BREF questionnaire. Demographic variables (age, sex, education, marital status) and dialysis-related factors (session duration, Kt/V, vascular access type, and urea reduction ratio) were analyzed to determine their effects on social support and quality of life. Results: Hemodialysis patients reported significantly lower scores in the Physical Health and Psychological Health domains of the WHOQOL-BREF compared to healthy controls. Males on hemodialysis scored lower than the controls in the Physical Health, Psychological Health, and Environment domains of the WHOQOL-BREF and the Affectionate Support and Positive Social Interaction subscales of MSSS. Conversely, hemodialysis females reported higher scores for Tangible Support, Emotional/Informational Support, and Affectionate Support. Longer dialysis sessions negatively impacted the Social Relationships domain. Married hemodialysis patients had higher Emotional/Informational Support and Affectionate Support scores. Conclusions: Hemodialysis patients experience diminished physical and psychological quality of life, particularly males. Social support, especially emotional and informational support, is crucial for hemodialysis patients, with marital status playing a key role. Addressing these psychosocial factors may improve outcomes for hemodialysis patients.

Gender-specific correlates for suicide mortality in people with schizophrenia: a 9-year population-based study

BackgroundSchizophrenia is associated with a high mortality rate due to the high risk of suicide. However, there is still a lack of evidence on the gender-specific risk factors for suicide among people with schizophrenia. In this study, we aimed to measure the sociodemographic and clinical correlates of suicide deaths in different genders among people with schizophrenia.MethodsData on patients with schizophrenia from 2013 to 2021 in Guangzhou, China were obtained from the National Information System for Psychosis (NISP), involving a total of 33,080 patients. Cox regression and Fine-Gray models were used to explore the sociodemographic and clinical risk factors for suicide mortality in different genders.ResultsThe overall age-standardized mortality rates due to suicide were 133.89 (95% CI: 124.31-143.47) per 100,000 person-years for females and 163.25 (95% CI: 152.92-173.59) per 100,000 person-years for males. To be specific, lack of medical insurance, history of non-treatment, and history of suicidal behavior was associated with a higher risk for suicide mortality for females, while an age of 35–54, being hospitalized once, and the age of onset being > 28 years were linked to lower risk for suicide mortality for males. For both genders, a lower risk for suicide mortality was observed in patients at an older age (≥ 55 years) and with a history of hospitalization more than once, and a higher suicide mortality risk was found in married patients and those residing in rural areas.ConclusionThe present study found that gender differences should be taken into account in the development of suicide prevention programs for people with schizophrenia, and future research is still required to verify our preliminary results.

Disparities in patient-reported distress in head and neck cancer.

257 Background: Distress is common among cancer patients, and impacts morbidity and mortality. Head and neck cancer (HNC) is considered one of the most emotionally distressing of all cancers, and given the stark racial disparities in HNC outcomes, we sought to examine racial and sociodemographic factors associated with clinically meaningful distress in a cohort of patients with HNC. Methods: We built a retrospective cohort of patients at a semi-urban, academic, National Cancer Institute (NCI)-designated comprehensive cancer center in the Southeastern United States. Cohort included patients with a diagnosis of HNC who received care from the Radiation Oncology department 5 weeks or less of initial diagnosis, from 2017 to 2022. Outcome of interest was clinically meaningful distress, a binary variable defined as a score of ≥4 on the distress thermometer (DT), a validated tool measuring distress, with scores ranging from 0-10. Main independent variables were sociodemographic factors (race/ethnicity, age, sex, marital status, and health insurance status). We further adjusted for clinical variables (stage of presentation, anatomical subsites, smoking and alcohol history), and problem list domain items. Using chi-square tests and multinomial regression analysis, we estimated differences in distress and odds of meaningful distress by sociodemographic factors, adjusting for clinical factors and problem list domains. Results: From a primary sample of 1,167 patients, 507 patients met our inclusion criteria. Nearly half (45.8%) of our sample had clinically meaningful distress, with a median DT score of 3 (IQR, 0-6). Total number of problem list items and physical concerns showed significant racial differences ( p < 0.05); however, in our final models, race was not significantly associated with clinically meaningful distress. Compared to those unmarried, married patients were significantly less likely to report distress (aOR = 0.62; 95% CI: 0.40, 0.95). Also, patients with emotional problems had double the odds of reporting clinically meaningful distress (aOR = 2.03; 95% CI: 1.02, 4.08). Other factors associated with significant clinical distress included tobacco history, and reported practical problems. Conclusions: Marital status and reported emotional problems are significantly associated with clinically meaningful distress in patients with HNC. Our study underscores the need for social support in mitigating distress and optimizing mental healthcare in our patient population. Further studies will explore distress trajectories across the HNC continuum and impact on HNC outcomes.

“Tell me I’m okay”: A cross-sectional quality-of-life assessment of patients in a breast cancer survivorship program.

213 Background: The number of breast cancer survivors is increasing due to improvements in care and an aging population, leading to an increased need for care that addresses the physical and psychological needs of patients after completion of active treatment. The Sunnybrook Breast Cancer Survivorship Program was established to provide comprehensive evidence-based survivorship care and facilitate the transition to family doctors. Despite rising interest in dedicated survivorship care, there is little consensus regarding which individuals are likely to suffer the most long-term impacts of breast cancer treatment. Factors as varied as age, ethnicity, socioeconomic status, and treatment type can influence Quality-of-Life (QoL) outcomes. This cross-sectional assessment uses mixed methods to evaluate QoL trends in the patient cohort. Methods: Current patients of the Sunnybrook Breast Cancer Survivorship Program were asked to complete a baseline information form, as well as the EORTC QLQ-30 and BR-45, two validated measures of QoL for breast cancer patients and survivors. QoL, functional, and symptom domains were calculated from these responses accordingly and analyzed statistically. Patients reported their most bothersome QoL concerns through an open-ended questionnaire, which was analyzed and organized thematically. 99 patients have been recruited to date, of a planned 200. Results: We find that sexual health is of importance for this population, with 50 (50.5%) participants reporting sexual activity. Patients under 50 have poorer sexual functioning scores (p<0.01) as well as more issues with body image (p<0.05) than older survivors. Both married and under-50 patients are significantly more likely to have poorer outlooks on the future (p<0.05; p<0.01). Younger patients also tended to have worse role functioning, cognitive functioning, emotional functioning, and social functioning scores, though these differences were not statistically significant. Thematic analysis of qualitative data showed that patients’ chief concerns were the impact that ongoing side effects had on their daily functioning, impact of treatment on body image, disruptions to work and personal relationships, and strong anxiety about potential recurrence. Conclusions: While it is understood that younger BC survivors face unique challenges, our findings indicate that these obstacles persist into older age groups. In addition to physical side effects, such concerns as body image issues, social strain, and emotional functioning can drive QoL scores for these patients. Notably, many patients endorsed strong anxiety regarding potential recurrence that affected QoL, and identified dedicated survivorship follow-up as an ameliorating factor. Further research should be conducted into the unique needs of under-50 survivors, as well as the role of recurrence anxiety in impacting QoL.

Assessment of social stigma among multiple sclerosis patients in Saudi Arabia: A cross-sectional study.

To assess the social stigma towards multiple sclerosis in Saudi Arabia. A descriptive cross-sectional online survey study was done in Saudi Arabia. It targets social stigma among multiple sclerosis patients in Saudi Arabia. This questionnaire was filled out by patients using Google Forms, and the questionnaire was designed to measure the demographic data and social Stigma using a validated RSS-MS scale. After we applied the exclusion criteria, we received 381 MS patients who completed the study questionnaire. The results of the study showed that there are regions in the Kingdom of Saudi Arabia where the societal stigma towards multiple sclerosis is high compared to other regions in the Northern region (25.5±10.0) and the lowest among Eastern region patients (17.3±7.2). The study also, showed that unmarried people have a higher stigma compared to married patients (21.0±8.3 vs. 18.9±8.0, respectively; p=.011). Our study showed the extent of societal stigma towards patients with multiple sclerosis in the Kingdom of Saudi Arabia. We recommend more psychological and social support for patients with multiple sclerosis and more volunteer campaigns for the disease.

Predictive model of prognosis index for invasive micropapillary carcinoma of the breast based on machine learning: a SEER population-based study

BackgroundInvasive micropapillary carcinoma (IMPC) is a rare subtype of breast cancer. Its epidemiological features, treatment principles, and prognostic factors remain controversial.ObjectiveThis study aimed to develop an improved machine learning-based model to predict the prognosis of patients with invasive micropapillary carcinoma.MethodsA total of 1123 patients diagnosed with IMPC after surgery between 1998 and 2019 were identified from the Surveillance, Epidemiology, and End Results (SEER) database for survival analysis. Univariate and multivariate analyses were performed to explore independent prognostic factors for the overall and disease-specific survival of patients with IMPC. Five machine learning algorithms were developed to predict the 5-year survival of these patients.ResultsCox regression analysis indicated that patients aged > 65 years had a significantly worse prognosis than those younger in age, while unmarried patients had a better prognosis than married patients. Patients diagnosed between 2001 and 2005 had a significant risk reduction of mortality compared with other periods. The XGBoost model outperformed the other models with a precision of 0.818 and an area under the curve of 0.863.ConclusionsA machine learning model for IMPC in patients with breast cancer was developed to estimate the 5-year OS. The XGBoost model had a promising performance and can help clinicians determine the early prognosis of patients with IMPC; therefore, the model can improve clinical outcomes by influencing management strategies and patient health care decisions.

Comparative overall survival analysis of chordomas of the base of the skull from the Surveillance, Epidemiology, and End Results (SEER) program between 2000 and 2020

Chordomas of the skull base are rare, slow growing, locally invasive cancers with limited long-term survival analysis reported in the literature. We seek to provide comparative survival analysis of patients on a long-term (20-year) basis using population-level data. The Surveillance, Epidemiology, and End Results (SEER) program was queried for cases of chordoma relegated to the base of the skull, diagnosed between 2000 and 2020. Demographic, disease, and treatment information were analyzed using Cox proportional hazards and log-rank comparisons. 630 patients with chordoma of the skull base were identified. Age ≤ 49 years at diagnosis was associated with increased five-, 10-, and 20-year overall survival (hazard ratio (HR) = 0.39, 0.33, and 0.30, respectively; p < 0.001 for all). Treatment with surgery and adjuvant radiotherapy was associated with increased five-, 10-, and 20-year survival (HR = 0.71, 0.79, and 0.79, respectively; p < 0.001 for all). On univariate analysis, widowed patients had decreased survival (20-year overall survival = 34.8% [15.3%-34.8%] compared to married patients (74.4% [68.1%-80.8%]. Surgery remains the primary treatment associated with increased survival among patients with chordoma of the skull base, with adjuvant radiotherapy serving a complimentary role. Demographic factors such as marital status are also associated with changes in survival.

Assessment of Healthcare Service Quality and Patient Satisfaction Using the SERVQUAL Questionnaire in Khuzestan Province During 2022 - 2023

Background: Hospital service quality is the primary predictor of a hospital's success, and any decrease in patient satisfaction is a cause for concern for the organization. Objectives: This study aimed to evaluate the service quality of Golestan Hospital in Ahvaz, Iran, based on patient satisfaction measured using the SERVQUAL questionnaire. Methods: This cross-sectional study was conducted in 2022 - 2023. Patients over 18 years old who visited the emergency department at Golestan Hospital were evaluated, with the exception of those with mental or multiple chronic disorders. Data collection tools included demographic and SERVQUAL Questionnaires. The data were analyzed using SPSS software, with a significance level set at less than 0.05. Results: A total of 200 subjects participated in the study, comprising 124 females (62%) and 76 males (38%). The results of the SERVQUAL Questionnaire indicated that the highest score was in the tangibility dimension (4.35), while the lowest score was in the assurance dimension (1.38). Negative gaps between perception and expectation were observed in the responsiveness (-0.99) and empathy (-1.22) dimensions. The mean total scores for expectation and perception were 99.55 ± 5.06 and 92.85 ± 5.5, respectively, with the highest scores observed for reliability. No significant association was found between expectation and perception (P-value &gt; 0.05). However, the reliability of the gap and expectation in males was significantly higher (P-value &lt; 0.05). A direct correlation was found between age and tangibility, Assurance, and total score of gaps (P-value &lt; 0.05). Conversely, a reverse correlation was observed between age and tangibility and the total score in perception (P-value &lt; 0.05). Post-hoc analysis revealed that the Assurance and total score of gaps and expectations were significantly higher in married patients compared to single patients (P-value &lt; 0.05). Conclusions: This study revealed a negative gap between patients' expectations and perceptions, highlighting the need for adjustments and improvements in hospital service quality by addressing all five dimensions of service quality.

Evaluation of efficacy and safety of Botulinum toxin-A injection at three deferent sites in treatment of premature ejaculation.

Premature ejaculation (PE) is a common sexual problem, resulting in adverse effects on the quality of life, of both the patient and the partner. The idea of muscular contraction inhibition during the ejection phase of ejaculation by Botulinum toxin-A injection may delay ejaculation. This study was performed to assess the efficacy and safety of Botulinum toxin-A injection in PE treatment. This study included 45 married male patients diagnosed with primary PE. All included patients were injected with 75 units of Dysport equal efficacy of 25 units of Botulinum toxin-A (Botox) into three sites: the root of the penis (Group 1), glans penis (Group 2), and each side of the ischiocavernosus muscle (Group 3). All patients were subjected to an assessment of intravaginal ejaculation latency time (IELT) using a stopwatch and answering the Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire before and after treatment. There was a statistically significant improvement in IELT after treatment in all groups. The most significant improvement was shown in Group 3 (average 108% increase), followed by Group 1 (74%) and Group 2 (40%), respectively. There was a positive correlation between age and the improvement in improved IELT. There was a statistically significant improvement in PEDTq scores in Group 1 and Group 3. Botulinum toxin-A injection into the root of the penis and ischiocavernosus muscle could be recommended in the treatment of premature ejaculation.

Association of Sexual Dysfunctions and Sociodemographic Characteristics among Married Couples

Background: Sexual dysfunction is a prevalent issue that affects the quality of life and marital satisfaction among couples. This study aims to explore the association of sexual dysfunction with various sociodemographic characteristics among married couples in Bangladesh. Methods: This cross-sectional study was conducted in Shaheed Monsur Ali Medical College Hospital, Dhaka, Bangladesh during the period from January 2015 to 31st August 2015. A total of 49 married patients with substance use disorder were selected using purposive sampling. Data were collected using a structured questionnaire, DSM-5 criteria for substance use disorder, and the Bangla version of the Arizona Sexual Experience Scale (ASEX). Statistical analyses were performed using SPSS version 25. Results: The study found that sexual dysfunction was significantly associated with age, gender, education, and occupation. Specifically, 22.22% of participants under 25 years, 44.44% of those between 25 to 40 years, and 33.33% of those over 40 years reported sexual dysfunction (p=0.025). Males reported a higher incidence (83.33%) compared to females (0%) (p=0.04). Sexual dysfunction was more common among illiterate participants (16.67%) compared to those with higher education levels (p=0.04). Farmers reported higher rates of sexual dysfunction (33.33%) compared to other occupations, though this was not statistically significant (p=0.18). Income, habitat, and family history of psychiatric illness did not show significant associations with sexual dysfunction. Conclusion: The study underscores the significant impact of sociodemographic factors on sexual dysfunction among married couples in Bangladesh. Targeted interventions addressing these specific factors are essential for improving sexual health outcomes. Further research should aim to deepen the understanding of these associations and develop culturally appropriate strategies for prevention and management.

Pregnancy characteristics in Egyptian female patients with NMOSD.

Neuromyelitis optica spectrum disorder (NMOSD) primarily affects women of childbearing age. Studying the potential relationship between NMOSD and pregnancy characteristics and outcomes. This is a retrospective cohort study that was conducted on 66 married female patients diagnosed with NMOSD. All patients underwent a thorough review of their demographic and clinical history through their medical records and personal interviews. Additionally, a complete neurological examination was performed, along with the expanded disability status scale (EDSS) and a pregnancy registry questionnaire. After comparing married patients before and after disease onset, there was a significant increase in the number of abortions and the percentage of cesarean sections, as well as a decrease in the percentage of breastfeeding after disease onset. The p values were .02, <.001, and <.001, respectively, with odds ratios of 2.03, 5.13, and 6.17. Additionally, there was a rise in the occurrence of postpartum relapses, which accounted for 66% of all relapses after the disease onset. Most of these relapses (88.7%) occurred within the first 3 months postpartum. Presence of NMOSD increased the percentage of miscarriage, delivery by cesarean section, and decreased the chance of breastfeeding. In addition, pregnancy increases NMOSD relapse and subsequent disability.

Incidence rate and risk factors for suicide in patients with breast cancer in the USA: A surveillance, epidemiology, and end results analysis (SEER)

PurposeTo investigate suicide mortality and the related factors among female breast cancer patients in the United States. MethodsThe SEER database was used to identify 716,422 patients diagnosed with breast cancer between 2010 and 2018 to calculate a standardized mortality rate (SMR). An analysis of risk factors for suicide death was conducted using the univariate and multivariate Cox proportional risk model. An estimation of suicide probability was performed through a nomogram model. ResultsCompared with the expected suicide cases (n = 155) in the general population of the United States at the corresponding period (a suicide death rate of 5.71 per 100,000 person-years), the suicide rate among 716,422 breast cancer patients was followed during 2010–2018 and showed a relatively higher rate of 9.02 per 100,000 person-years. The SMR was 1.58 (95%CI: 1.39–1.79). White and other races were nine and seven times more likely to complete suicide than Black race, respectively (aHR = 9.013, 95%CI: 3.335–24.36, P < 0.001; aHR = 7.129, 95%CI: 2.317–21.931, P = 0.001); unmarried or single patients were at higher risk than married patients (aHR = 1.693, 95%CI: 1.206–2.377, P = 0.002). Patients receiving radiotherapy (aHR = 0.731, 95%CI: 0.545–0.980, P = 0.036) were less likely to complete suicide than those who did not. ConclusionFemale breast cancer patients in the United States have a higher suicide rate than the general public, and the risk factors consist of non-black ethnicity, being single or unmarried, and not being treated with radiotherapy. As a result of this study, clinicians may be able to identify female breast cancer patients who are at high risk of suicide, thus providing appropriate psychological support at the early stage.

Unprotected Risky Sex Among Men with Opioid Dependence: Is More Needed to Be Done?

Background and Objectives: Risky behaviors are common among patients with substance use disorders. Knowing the determinants of risky sexual behaviors can identify individuals who may benefit from targeted interventions. The primary aim of the study was to assess unprotected risky sexual behavior and its sociodemographic and clinical correlates in treatment-seeking opioid-dependent patients. Methods: A cross-sectional exploratory study was done on 112 married treatment-seeking opioid-dependent male patients. A semi-structured proforma consisting of sociodemographic and clinical details was used to assess sexual behavior, other risky behaviors like injecting drug use (IDU), and knowledge of and attitude toward risky sexual behavior. Results: The mean age of the sample was 34.1 years, and that at first sexual intercourse was 18.6 years. History of unprotected risky sex (unprotected sex with a casual partner or female sex worker or person having a sexually transmitted disease or with males or having sex for rewards) was present in 30 patients (26.8% of the sample). Unprotected risky sex was found to be significantly associated with younger age at first sexual encounter ( p = .010), more sexual partners ( p &lt; .001), greater frequency of masturbation ( p = .031), and watching pornography ( p = .028). However, it was not found to be related to other risky behaviors such as IDU ( p = .210) and sex under intoxication ( p = .149) and also did not vary between treatment-naïve and under-treatment populations ( p = .434). No significant relationship was found between knowledge and attitude about risky sexual behavior and unprotected risky sex in the present sample. Conclusion: Risky sexual behavior in opioid-dependent patients is a concern, as this may be an additional mode of transmission of blood-borne viruses apart from IDU. Safe sex practices need to be emphasized in this population, and efforts at behavioral changes are desirable.

Predicting completion of endocrine therapy for older patients with early-stage breast cancer.

535 Background: Clinical trials suggest that adjuvant radiotherapy (RT) may be omitted in women aged ≥65 with early-stage, hormone-receptor positive breast cancer provided completion of 5 years of endocrine therapy (ET). However, at the time of RT consult, it is often unknown whether the patient will start ET, or will start ET but not complete 5 years, either of which, if known in advance, would alter RT recommendations. We studied a cohort of patients who would have been eligible for these trials to examine which factors were related to declining or discontinuing ET. Methods: Using a prospectively maintained institutional database, we identified patients age ≥65 who underwent surgery between 2010 and 2017 with stage I breast cancer, hormone receptor positive. Missing data were replaced using multiple imputation. Recurrence statistics were calculated using Kaplan-Meier analysis. Multivariate (MVA) logistic regression was used to assess which factors were associated with not starting or discontinuing ET. Results: We identified 590 patients who met eligibility criteria. 453 (76.8%) patients started ET, of whom 315 (69.5%) completed at least 5 years, 84 (18.5%) stopped ET before 5 years, and 54 patients (11.9%) were lost to follow up. Median follow up was 67.2 months. Among the 137 patients who did not start ET, the most common reasons were osteopenia or osteoporosis (27.7%), arthritis (18.2%), and declined consultation with medical oncology (15.3%). On MVA, not starting ET was significantly associated with older age (OR 1.10, p &lt; 0.0001), osteopenia (OR 2.27, p = 0.005) or osteoporosis (OR 3.82, p = 0.009), or not undergoing radiation (OR 1.92, p = 0.006) or chemotherapy (OR 6.45, p = 0.02). The most common reason for stopping ET was joint pain (50.0%), with other reasons including hot flashes (10.7%) and fatigue (7.1%). Not completing 5 years of ET was significantly associated with older age (OR 1.09, p = 0.002) and prior/current smoking history (OR 1.75, p = 0.037), while patients whose marital status was single or never married were significantly more likely to complete 5 years of ET (OR 0.26, p = 0.019). Recurrence-free survival was lower among the group which never started ET (p &lt; 0.0001) or which stopped ET before 5 years (p &lt; 0.0001) as compared to those who completed 5 years, with 5-year recurrence-free survival of 97.5% (95% CI: 95.6-99.3) for patients who completed 5 years of ET, compared to 88.7% (95% CI: 82.5-95.4) for those who did not undergo ET and 87.6% (95% CI: 80.4-95.6) for those who started ET but did not complete 5 years. Conclusions: Patients who are older, have osteopenia/osteoporosis, or who have declined prior treatment such as chemotherapy or RT are more likely not to start ET, while patients who are older or prior/current smokers are more likely to discontinue ET after starting and single / never married patients are more likely to complete ET. These factors may be used to guide discussion of omission of adjuvant radiotherapy.

Time to treatment initiation of lung cancer and contributing factors from 2015-2020 utilizing Surveillance, Epidemiology and End Results program database.

1540 Background: Time from diagnosis of cancer to definitive therapy, or time to treatment initiation (TTI), has significant impact on prognosis. Kohorana et al performed an observational study in 2019 that found that TTI has increased in the United States with an absolute increased risk of mortality ranging from 1.2-3.2% per week in early-stage breast, lung, renal and pancreatic cancers. This study aims at identifying contributing factors and trends that can assist in shortening TTI of lung cancer. Methods: This is a retrospective cohort study conducted by review of Surveillance, Epidemiology and End Results Program database. Participants included 212,607 adults ages 18 and older diagnosed with lung cancer during 2015-2020. Variables contributing to TTI were studied like age, sex, race, marital status, geographic location, household income, stage and grade. TTI was measured as less than 30 days and greater than 30 days. ANOVA analysis was performed with SPSS and BlueSky Statistics, with p-value of &lt;0.05 as significant. Results: TTI was 1.30 months in males and 1.31 months in females (p=0.038). In patients less than 65 years, TTI was 1.14 months, while those greater than 65 had a delay of 1.38 months (p&lt;0.001). White patients had TTI of 1.26 months versus non-white patients, 1.44 months (p&lt;0.001). Married patients had TTI of 1.24 months versus 1.44 months in widowed patients (P&lt;0.001). Income less than $35,000 had less TTI (1.22 months) than income greater than $75,000 (1.33 months) (p&lt;0.001), but the population earning &lt;$35,000 was smaller (n=3,082) compared to &gt;$75,000 (n=209,525), therefore not representative of the total population. Metropolitan had longer TTI than nonmetropolitan at 1.34 months versus 1.24 months, p&lt;0.001. Grade IV had shorter TTI at 0.94 months with grades I and II having TTI of 1.42 and 1.46 months, respectively (p&lt;0.001). Localized cancers had the longest TTI at 1.71 months versus distant at 1.01 months (p&lt;0.001). More aggressive cancers had shorter TTI such as grade IV + distant at 0.76 months versus grade I + localized at 1.42 months. Association between grade and stage and impact on TTI was significant at p&lt;0.001. Conclusions: This study revealed significant factors influencing the duration from cancer diagnosis to treatment among adult patients greater than 18 years old diagnosed with lung cancers. Shorter TTI intervals were observed for females, younger individuals (&lt;65 years-old), white patients, married and those with higher tumor grades and distant cancer. Addressing these disparities requires targeted interventions that consider socioeconomic status, geographic location and cancer characteristics to ensure equitable access to timely and high-quality cancer care. Further investigation is warranted to fully understand the impact of factors such as household income and regional variations on treatment delays.

The Risk of Infection-Caused Mortality in Gastric Adenocarcinoma: A Population-Based Study.

Gastric adenocarcinoma (GAC) is a deadly tumor. Postoperative complications, including infections, worsen its prognosis and may affect overall survival. Little is known about perioperative complications as well as modifiable and non-modifiable risk factors. Early detection and treatment of these risk factors may affect overall survival and mortality. We extracted GAC patient's data from the Surveillance, Epidemiology, and End Results (SEER) database and analyzed using Pearson's Chi-square, Cox regression, Kaplan-Meier, and binary regression methods in SPSS. At the time of analysis, 59,580 GAC patients were identified, of which 854 died of infection. Overall, mean survival in months was better for younger patients, age < 50 years vs. ≥ 50 years (60.45 vs. 56.75), and in females vs. males (65.23 vs. 53.24). The multivariate analysis showed that the risk of infectious mortality was higher in patients with age ≥ 50 years (hazard ratio (HR): 3.137; 95% confidence interval (CI): 2.178 - 4.517), not treated with chemotherapy (HR: 1.669; 95% CI: 1.356 - 2.056), or surgery (HR: 1.412; 95% CI:1.132 - 1.761) and unstaged patients (HR: 1.699; 95% CI: 1.278 - 2.258). In contrast, the mortality risk was lower in females (HR: 0.658; 95% CI: 0.561 - 0.773) and married patients (HR: 0.627; 95% CI: 0.506 - 0.778). The probability of infection was higher in older patients (odds ratio (OR) of 2.094 in ≥ 50 years), other races in comparison to Whites and Blacks (OR: 1.226), lesser curvature, not other specified (NOS) as a primary site (OR: 1.325), and patients not receiving chemotherapy (OR: 1.258). Older, unmarried males with GAC who are not treated with chemotherapy or surgery are at a higher risk for infection-caused mortality and should be given special attention while receiving treatment.

Use of surgery for de novo metastatic breast cancer (mBC).

1590 Background: In the U.S., locoregional surgery for de novo mBC was common in the 1990s and 2000s, but subsequent prospective data did not show a survival advantage. Current guidelines recommend surgery only for symptom control. We investigated trends in the use of surgery (lumpectomy or mastectomy) for mBC from 2010 to 2019 using SEER and institutional data, aiming to identify factors that correlate with variability in surgery use. Methods: We included all de novo mBC diagnoses from SEER-17 from 2010-2019. The primary outcome was receipt of surgery, and we included year of diagnosis, demographic (race/ethnicity, age, marital status, median household income in the patient’s county, and urban/rural residence), and disease factors (estrogen receptor (ER) and HER2 status, tumor size, and presence of visceral metastases) in the multivariable logistic regression. We similarly identified all de novo mBC diagnoses from Oncoshare, which merges EMR and California Cancer Registry (CCR) data for patients treated in the Stanford Health Care Alliance. For Oncoshare inclusion a patient must have an encounter with Stanford and be in CCR; however, a patient does not have to receive all cancer care at Stanford. In this analysis, we included distance to the cancer center and insurance status. Results are presented as unadjusted percentages or odds ratios with 95% confidence intervals. Results: In SEER (n = 24,146), the use of surgery for mBC declined from 41% in 2010 to 22% in 2019, a trend also observed in the institutional data (n = 785). Surgery rates were highest in younger patients and declined with each decade of life (44% for those in their 30s vs 19% for those &gt; 80). Surgery was more common in tumors &gt; 2 cm, ER-negative disease, and in patients without visceral metastases. In SEER, patients from counties with median incomes &lt; $50,000 were more likely to have surgery than those from counties with incomes &gt; $75,000 (36% vs 27%; OR: 1.3 [1.2-1.5]). Rural patients were more likely to have surgery than urban patients (34% vs 30%; OR: 1.1 [1.0-1.3]). Unmarried persons had lower odds of surgery than married persons (OR: 0.8 [0.7-0.9]). The institutional data reproduced the findings of the SEER analysis, except that a relationship between surgery and marital status and income was not observed. In the institutional data, patients living farther from the Stanford Cancer Center ( &gt; 100 km) were more likely to have surgery (40% vs 32%; OR 2.1 [1.2-3.8]). Conclusions: The use of surgery for de novomBC decreased dramatically in the 2010s from 41% to 22%. All demographics saw a reduction; however, younger, and married patients underwent surgery at higher rates. Patients from lower-income and rural counties—areas typically with less access to care—were also more likely to have surgery. The institutional analysis showed that a greater distance from an urban hospital network correlated with increased odds of surgery. These patterns suggest differential care provision in rural areas for patients with mBC.

The Utility of SHBG Assay in Clinical Biochemistry for Iraqi Women

Polycystic ovarian syndrome, additionally called PCOS is the most widespread endocrine illness amongst women. The aetiology of PCOS is attributed to a multi-factorial interplay among environmental and genetic effects. The overarching goal evaluates the correlation among blood concentrations of total testosterone, sex-hormone-binding globulin (SHBG), estradiol (E2), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in ladies with PCOS and the impact of obesity, age, marital popularity on the obtained results. This study was conducted at the National Center for Educational Laborites /Medical City/ Baghdad. The study comprised of a sample of 83 women, elderly between 17 -45 years, who had been selected in a random manner from a Gynaecology Clinic. The statistics collection duration spanned from November 2022 to March 2023. Women with polycystic ovary syndrome (PCOS) were based on their body mass index (BMI), age and marital status. Investigations included serum-free testosterone measurements by enzyme-linked immune sorbent assay (ELISA), total testosterone, SHBG, E2, FSH and LH by Automated Immunoassay Analyzer (AIA-2000). The current findings showed non-significant distinctions in mean values of BMI between studied groups of patients and controls which reflect matches between them. This study revealed the effect of marital status compared to PCOS and healthy control subjects. Married PCOS patients were non significantly affected (83.9% vs. 85.2%, p&gt;0.05) as compared to married controls. Results of these studies showed a significantly higher mean rate of serum FSH level in PCOS-affected women when opposed to normal individuals.

Differential Anxiety Responses in Acute Myocardial Infarction vs. COVID-19 Pneumonia Patients.

Background and Objectives: Amidst the COVID-19 pandemic, concerns about the psychological impact of disease-related anxiety on public health have risen. This study aims to compare general and death anxiety levels between acute coronary artery syndrome and COVID-19 pneumonia patients. Materials and Methods: A cross-sectional study of 132 individuals, including acute myocardial infarction (MI), COVID-19 pneumonia patients, and healthy volunteers from Trakya University Hospital (Turkey), was analyzed. Validated scales like the Beck Anxiety Inventory (BAI), Coronavirus Anxiety Scale Short Form, and Thorson-Powell Death Anxiety Scale (TPDAS) were employed. Demographic data such as age, gender, income levels, employment status, presence of a close relative with COVID-19, and whether participants followed COVID-19-related news were collected and compared across groups with significance level of 0.05 set for all analyses. Results: Among 41 COVID-19, 41 MI, and 50 healthy subjects, the pneumonia group showed highest COVID-19 anxiety (p = 0.01) and BAI scores (p = 0.008). Both COVID-19 and MI patients had significantly higher BAI and TPDAS scores compared to healthy controls (p < 0.001). Factors like female gender (p = 0.004), low education (p = 0.003), current employment (p = 0.008), and low income (p = 0.002) correlated with higher BAI scores. Low income (p = 0.001) and COVID-19 news exposure (p = 0.002) correlated with higher TPDAS scores. Males and married patients had lower anxiety scores (p = 0.008). High income, education, and employment reduced anxiety levels (p = 0.008). TPDAS scores decreased with higher income (p = 0.001), but increased in the MI group (p = 0.002) with COVID-19 news exposure. The multivariate linear regression analysis found that MI and COVID-19 pneumonia were associated with TPDAS; female gender, university education, and COVID-19 pneumonia with the Beck scale; and COVID-19 pneumonia with anxiety scores on the COVID-19 Anxiety scale. Conclusions: This research showcases differing anxiety patterns between illnesses such as MI and COVID-19 pneumonia amidst the pandemic, emphasizing the amplifying influence of media coverage on death-related anxieties. It underscores the imperative of targeted interventions and socioeconomic considerations in managing psychological consequences and formulating responsive public health strategies.

Profile of gastroduodenal perforation patients admitted in a rural tertiary care hospital: An observational cross-sectional study.

Gastro-duodenal perforation is a common surgical emergency that remains a formidable health burden worldwide with significant morbidity and mortality. Ulcer disease remains the most common cause of gastro-duodenal perforation. Diagnosing the presence of H. pylori can help eradicate the infection from the community at large and thereby reduce the chances of gastro-duodenal perforation. To assess the clinical presentation of gastro-duodenal perforation patients and to evaluate the detection of Helicobacter pylori infection by available investigations. A descriptive observational study was conducted among 80 patients presenting with clinical features suggestive of gastro-duodenal perforation and confirmed by clinical, radiological basis and operative findings admitted at a rural tertiary care hospital during 2019-2020. Detailed history was taken from the patient/party, clinically examined, and blood/tissue samples were investigated. The patients were managed with standard treatment modality in the studied institute. Data were collected, compiled, and entered MS Excel and analyzed using appropriate software. Descriptive analysis was done in the form of proportion for categorical variables, mean or median for continuous variables. Cases of gastro-duodenal perforations were more among middle to later age of life, mostly affecting married male patients hailed from rural area and unskilled workers. History of intake of spicy food, prolonged starvation, history of NSAID use were common among them. Majority of the patients had history of pain abdomen in the past suggesting of PUD and history of taking variety group of acid reducing agents. Most of them presented with epigastric pain, vomiting, abdominal distension along with other signs of peritonitis. Obliteration of liver dullness and free gas under right dome of diaphragm was also noted in large proportion among them. Majority of cases were found positive for H. pylori on Histology (85%), followed by rapid urease test (RUT) (80%) and a positivity of 72.5% and 68.8% on serum IgG and IgA antibody respectively. Rapid Urease Test was more sensitive as well as specific in diagnosing of H. pylori than antibody detection test. Early detection of H. pylori infection and treatment with potent anti H. pylori therapy postoperatively has been found to be adequate.