Outcomes For Individuals Research Articles

Racial and ethnic disparities in prior authorizations for patients with cancer.

Prior authorization is used to ensure providers treat patients with medically accepted treatments. Our objective was to evaluate prior authorization decisions in cancer care by race/ethnicity for commercially insuredpatients. Retrospective study of 18,041 patients diagnosed with cancer between January 1, 2017, andApril1,2020. Using commercial longitudinal data from a large national insurer, we described the racial and ethnic composition in terms of prior authorization process outcomes for individuals diagnosed with cancer. We then used linear regression models to evaluate whether disparities by race or ethnicity emerged in prior authorization process outcomes. The self-identified composition of the sample was 85% White, 3% Asian, 10% Black, and 1% Hispanic; 64% were female, and the mean age was 53 years. The average prior authorization denial rate was 10%, and the denial rate specifically due to no medical necessity was 5%. Hispanic patients had the highest prior authorization denial rate (12%), and Black patients had the lowest prior authorization denial rate (8%). Regressions results did not identify racial or ethnic disparities in prior authorization outcomes for Black and Hispanic patients compared with White patients. We observed that Asian patients had lower rates of prior authorization denials compared with White patients. We observed no differences in the prior authorization process for Black and Hispanic patients with cancer and higher rates of prior authorization approvals for Asian patients compared with White patients.

Assessment of Pain and Functional Outcomes in Individuals with Patellofemoral Pain Syndrome

Patellofemoral pain syndrome is a pathological condition of the patellofemoral joint characterized by knee pain in the peripatellar, anterior, and even retro patellar regions. Between 15% and 45% of persons in their 20s to 40s experience patellofemoral pain. Objective: To assess pain and functional outcomes in individuals with patellofemoral pain syndrome. Methods: At Mayo Hospital and the University of Lahore Teaching Hospital, 87 people enrolled in this cross-sectional study using a non-probability convenience sampling technique during the period of 20th January 2024 to 20th July 2024. Both male and female patients between ages of 20 to 40 years with a positive patellar grind test were included. The numeric pain rating scale and Kujala score were used for data collection to assess pain and functional outcomes respectively. Data were analyzed using IBM SPSS Statistics 25.0. All qualitative variables were shown as frequency and percentages; all quantitative data were provided as Mean ± S.D. Results: Mean age of participants was 30.68 ± 5.62 years. Out of 87 participants, there were 41 (47.1%) females and 46 (52.9%) males. The mean score of the Numeric Pain Rating Scale was 6.31 ± 1.56 and the Kujala score was 46.37 ± 10.36. Out of 87 participants, 6 (6.9%) had mild pain, 62 (71.3%) had moderate pain and 19 (21.8%) had severe pain. The NPRS and Kujala Score have a very weak correlation of 0.049 with a p-value of 0.655. Conclusion: It was concluded that this study had a significant impact of patellofemoral pain syndrome on pain and functional outcomes in affected individuals.

Histone Deacetylase Inhibitors for Peripheral T-Cell Lymphomas

Histone deacetylase inhibitors (HDACis) are being recognized as a potentially effective treatment approach for peripheral T-cell lymphomas (PTCLs), a heterogeneous group of aggressive malignancies with an unfavorable prognosis. Recent evidence has shown that HDACis are effective in treating PTCL, especially in cases where the disease has relapsed or is resistant to conventional treatments. Several clinical trials have demonstrated that HDACis, such as romidepsin and belinostat, can elicit long-lasting positive outcomes in individuals with PTCLs, either when used alone or in conjunction with conventional chemotherapy. They exert their anti-tumor effects by regulating gene expression through the inhibition of histone deacetylases, which leads to cell cycle arrest, induction of programmed cell death, and,the transformation of cancerous T cells, as demonstrated by gene expression profile studies. Importantly, besides clinical trials, real-world evidence indicated that the utilization of HDACis presents a significant and beneficial treatment choice for PTCLs. However, although HDACis showed potential effectiveness, they could not cure most patients. Therefore, new combinations with conventional drugs as well as new targeted agents are under investigation.

Intersectionality matters for hispanic health: A replication study using the All of Us Research Program

BackgroundDespite research dedicated to understanding the health profiles and health-related outcomes of Hispanic individuals, the prevailing body of literature frequently homogenizes the Hispanic population, failing to address the role of race in Hispanic health discourse. Thus, the current study applies an intersectional lens to identify health differences and similarities among Hispanic subgroups.MethodsSociodemographic characteristics and health domain variables (i.e., health status, health services, and health behaviors) from participants (N = 11,192) were included in the analyses. Bivariate Chi-squared tests examined the relationship between sociodemographic and health domain variables Black Hispanic individuals, white Hispanic individuals, and non-Hispanic Black individuals.ResultsFindings suggest that Non-Hispanic Black American individuals reported the highest rates of hypertension (49.09%) and diabetes (19.62%) compared to Black-Hispanic individuals (22.45% and 12.98%) and white Hispanic individuals (22.22% and 8.02%). Black Hispanic individuals reported the greatest proportion of asthma diagnoses (35.10%) and those who saw a doctor in the previous year (95.52%) compared to white Hispanic individuals (26.84%, and 91.10%, respectively) and non-Hispanic Black individuals ( 21.74%, and 94.69%, respectively).ConclusionSpecifically, we found that several health behaviors and health-related outcomes significantly varied across different racial/ethnic groups, demonstrating the advantage of an intersectional approach to identify health disparities among racially diverse ethnic groups.Public Health significanceWe encourage the development of health care services with an awareness of the complexities resulting from racial differences within the Hispanic diaspora.

Unraveling Neurodevelopmental Disorders: Signalling Pathways as Potential Targets for Therapeutic Intervention in Autism Spectrum Disorder

Introduction: Autism Spectrum Disorder (ASD) presents a multifaceted challenge with limited therapeutic options and a need for early biomarkers. Understanding disrupted signalling pathways offers promise for intervention and assessment. Methods: Literature review spanning genetic, pre-clinical, and patient studies elucidating pathways implicated in ASD pathogenesis, including melatonin, mTOR, Retinoic acid, Hedgehog, Notch and Wnt signalling. Results: Core components of key signalling pathways, such as melatonin, mTOR, Retinoic acid, Hedgehog, Notch and Wnt, are dysregulated in ASD. These pathways regulate crucial aspects of the nervous system, including immune function, neuronal growth, neurotransmission, and metabolism. Discussion: Manipulating these pathways could potentially modify ASD traits by influencing brain development and immune homeostasis. Targeting specific nodes within these pathways may offer novel therapeutic approaches for ASD management. Additionally, identifying biomarkers associated with pathway dysregulation could enable earlier diagnosis and monitoring of disease progression. Conclusion: Understanding the intricate interplay of signalling pathways in ASD pathogenesis provides insights into potential therapeutic targets and biomarkers. Further research into the manipulation of these pathways and their impact on ASD traits is warranted to advance personalized treatment strategies and improve outcomes for individuals with ASD.

Variation of All-Cause Mortality with Fat-Free Mass Index (FFMI) and Fat Mass Index (FMI) in Individuals with Asthma: Results from the NHANES Database Retrospective Cohort Study.

The relationship between fat-free mass index (FFMI), fat mass index (FMI), and mortality in patients with asthma remains unknown. This study aimed to examine the associations between FFMI and FMI and all-cause mortality in a cohort of American adults diagnosed with asthma. This study included 15,200 adults from NHANES. To assess mortality, we linked participant records to the National Death Index. FMI and FFMI were measured and evaluated using dual-energy X-ray absorptiometry (DXA). Survival differences across quintiles of FFMI and FMI were explored using Kaplan-Meier plots and log-rank tests, with the proportional hazards assumption assessed using Schoenfeld residuals. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) for mortality associated with FFMI and FMI, adjusting for potential confounders including age, sex, smoking status, physical activity, and other relevant factors. Additionally, stratified analyses based on theoretical considerations were conducted to identify subgroups of individuals exhibiting an elevated risk of mortality. This study also examined the nonlinear relationships between FFMI, FMI, and mortality using restricted cubic splines (RCS). After a median follow-up of 184 months, 12.11% of individuals had died. Kaplan-Meier plots revealed significant differences in all-cause mortality among patients with asthma across the FFMI and FMI quintiles. Specifically, individuals in the lowest FFMI quintile (Q1, 10.4-16.0, representing the range of FFMI values) exhibited a significantly increased risk of all-cause mortality (HR: 4.63; 95% CI: 1.59, 13.5; p < 0.01). Similarly, elevated risks of all-cause mortality were observed in the upper three quintiles of FMI, with Q3 (4.8-6.1) having an HR of 2.9 (95% CI: 1.20, 7.00; p < 0.05), Q4 (6.2-8.3) having an HR of 3.37 (95% CI: 1.41, 8.03; p < 0.01), and Q5 (8.4-22.8) having an HR of 4.6 (95% CI: 1.31, 16.2; p < 0.05). Moreover, the risk of all-cause mortality increased with increasing FMI and decreasing FFMI (p for non-linearity < 0.001 in both cases). Subgroup analyses further elucidated these associations across different categories. In examining the association between FMI and all-cause mortality among asthma patients across various subgroups, a heightened mortality risk found among males, individuals with medium education levels, medium income levels, and those who consume alcohol. The study shows that both high FMI and low FFMI are associated with increased mortality in patients with asthma. These findings underscore the critical role of FMI and FFMI in the health management of asthma patients. Therefore, it is recommended that clinicians proactively monitor and adjust these indices to improve patient prognosis and enhance health outcomes for individuals with asthma..

Metabolic and Hormonal Parameters in Polycystic Ovary Syndrome: A Cross-sectional, Multicenter Study in Bangladesh

ABSTRACT Introduction: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder affecting women globally, characterized by metabolic, hormonal, and reproductive disturbances. This study aims to elucidate the specific metabolic and hormonal intricacies of PCOS within the Bangladeshi demographic, addressing a noticeable dearth of comprehensive investigations in this population. Methodology: A cross-sectional study was conducted at the Endocrine Department of Ibn Sina Medical College Hospital and the National Healthcare Network Uttara Executive Center from January 2022 to March 2023. The study included 237 participants diagnosed with PCOS based on the modified Rotterdam criteria. Data collection encompassed demographic details, clinical parameters, and laboratory investigations recorded systematically through history taking, physical examinations, and laboratory analyses. Statistical analyses were performed using the Statistical Analysis Software Studio Version. Results: The study revealed a mean age of 25.1 years among 237 participants, with 70.5% married and 33.5% having children. Hormonal assessments uncovered intriguing patterns, including elevated luteinizing hormone (LH) levels and an increased LH:follicle-stimulating hormone (FSH) ratio. Weight distribution highlighted a significant association between obesity and fatty liver. Despite an elevation in thyroid-stimulating hormone levels among obese PCOS individuals, FSH, LH, and testosterone levels showed no significant differences between obese and nonobese groups. Conclusion: In-depth analysis of metabolic and hormonal parameters in Bangladeshi PCOS patients contributes to the global understanding of PCOS, while offering insights specific to this demographic. The study has implications for tailored therapeutic interventions and refined diagnostic criteria, potentially improving clinical outcomes for individuals affected by PCOS in Bangladesh and beyond.

State Policies Targeting Patient Brokering and Deceptive Marketing of Substance Use Disorder Treatment.

To characterize state laws targeting patient brokering and deceptive marketing of substance use disorder (SUD) treatment. Patient brokering and deceptive marketing of SUD treatment leads to poor outcomes for individuals with SUD, including relapse- or overdose-related hospitalizations, ED visits, or death. In response, several states within the United States have passed laws targeting unethical practices of SUD treatment in recent years. The context in which these laws were passed has not been previously described. The extent to which states engaged in recovery residence regulation that also pass patient brokering and deceptive marketing laws is unknown. We conducted a descriptive study and identified state laws relating to patient brokering and deceptive marketing that were enacted and effective as of December 31, 2022. Using a model state law for addressing unethical SUD treatment practices as a guide, we developed a taxonomy to describe the laws' elements, including covered entities, prohibited activities, and penalties. We used descriptive statistics to characterize variation across current laws. All patient brokering laws explicitly mention referrals to SUD treatment facilities, and most specify that both individuals and facilities are prohibited from paying, receiving, or soliciting referrals in exchange for fees or commissions. All deceptive marketing laws prohibit making false or misleading statements about the nature of services provided. Beyond these common features, there is wide variability in the degree to which states specifically prohibit other patient brokering and deceptive marketing activities (e.g., indirect offerings, lead generation, or kickback schemes involving laboratories). State policies targeting patient brokering and deceptive marketing may be useful for preventing instances of unethical SUD treatment practices. We constructed a taxonomy to characterize elements of patient brokering and deceptive marketing laws and facilitate future evaluations of their effectiveness.

Glucose-lowering drugs and liver-related outcomes among individuals with type 2 diabetes: A systematic review of longitudinal population-based studies.

While randomized controlled trials data on the long-term effect of glucose-lowering drugs (GLDs) on liver-related outcomes are lacking, population-based studies have evaluated the associations of GLDs with liver-related outcomes in individuals with type 2 diabetes (T2D). we aimed to conduct a systematic review of population-based studies evaluating the effects of GLDs on liver-related outcomes in people with T2D. PubMed, Web of Science, and Embase databases were systematically searched for population-based studies testing the associations of GLDs with liver-related outcomes in individuals with T2D and no liver disease other than non-alcoholic fatty liver disease (NAFLD) from inception to 23 February 2024. GLDs included SGLT2is, TZDs, insulin, GLP-1 RAs and dipeptidyl peptidase-4 inhibitors (DPP4Is). Ten cohort studies, comprising 1,274,641 participants, met the inclusion criteria. The median follow-up period ranged from 8.9 to 76 months. Of all the GLDs under investigation, SGLT2is were associated with the strongest reduction in NAFLD incidence, cirrhosis, and composite liver-related events compared to other medications. TZDs were associated with a reduced risk of developing NAFLD and cirrhosis but were not significantly associated with a lower incidence of hepatocellular carcinoma. GLP-1 RAs demonstrated a significant association with reduced liver-related mortality. Observational data from population-based studies suggest that GLDs such as SGLT2is are associated with beneficial long-term liver-related outcomes in T2D patients with NAFLD. Additional studies, including randomized controlled trials with long-term follow-up, are needed to confirm these findings. PROSPERO CRD442024536872.

Optical Coherence Tomography in Myocardial Infarction Management: Enhancing Precision in Percutaneous Coronary Intervention

In acute myocardial infarction (AMI), the urgency of coronary revascularization through percutaneous coronary intervention (PCI) is paramount, offering notable advantages over pharmacologic treatment. However, the persistent risk of adverse events, including recurrent AMI and heart failure post-revascularization, underscores the necessity for enhanced strategies in managing coronary artery disease. Traditional angiography, while widely employed, presents significant limitations by providing only two-dimensional representations of complex three-dimensional vascular structures, hampering the accurate assessment of plaque characteristics and stenosis severity. Intravascular imaging, specifically optical coherence tomography (OCT), significantly addresses these limitations with superior spatial resolution compared to intravascular ultrasound (IVUS). Within the context of AMI, OCT serves dual purposes: as a diagnostic tool to accurately identify culprit lesions in ambiguous cases and as a guide for optimizing PCI procedures. Its capacity to differentiate between various mechanisms of acute coronary syndrome, such as plaque rupture and spontaneous coronary dissection, enhances its diagnostic potential. Furthermore, OCT facilitates precise lesion preparation, optimal stent sizing, and confirms stent deployment efficacy. Recent meta-analyses indicate that OCT-guided PCI markedly improves safety and efficacy in revascularization, subsequently decreasing the risks of mortality and complications. This review emphasizes the critical role of OCT in refining patient-specific therapeutic approaches, aligning with the principles of precision medicine to enhance clinical outcomes for individuals experiencing AMI.

COVID-19 risk factors and outcomes in individuals with stiff person syndrome spectrum disorders before and after omicron

BackgroundStiff person syndrome spectrum disorders (SPSD) are rare, disabling disorders of the nervous system that are associated with risk factors for Coronavirus disease 2019 (COVID-19). However, limited data exist on the overall impact of COVID-19 on SPSD.MethodsPatients with SPSD and COVID-19 who are followed at Johns Hopkins SPS Center were included. Demographics and SPSD characteristics along with COVID-19-specific data were recorded.ResultsThirty-five cases of SPSD with COVID-19 cases were reported during the study time period. Mean age of the cohort was 56 (SD ± 10) and most were female (66.7%). Eighty percent of the COVID-19 cases were confirmed with testing, and the rest were highly suggestive of COVID-19. COVID-19 comorbidities among patients were hypertension (n = 6), diabetes (n = 6), obesity (n = 5), and cardiovascular disease (n = 4). The majority of participants were on immune therapies and/or benzodiazepines. Out of the cases reported, only 2 required hospitalization, both of whom had diabetes, and one was on immunosuppressive therapy. The majority of cases were post-full-vaccination cases. Fever was the most common COVID-19-associated symptom. Transient neurological symptoms were also reported.ConclusionRisk factors for developing severe COVID-19 in SPSD appear to be the same as historical data in the general population. Importantly, COVID-19 did not appear to be associated with worsening SPSD post-COVID-19. Vaccination may have played a role in preventing severe cases of COVID-19.

Trajectories of social outcomes in individuals born very preterm from childhood to adolescence.

To compare trajectories of social functioning in peer problems and prosocial behavior from 5 to 13 years between individuals born very preterm (VPT) and full-term (FT). Participants were from the Victorian Infant Brain Study (VIBeS) longitudinal cohort, consisting of 224 individuals born VPT and 77 born FT recruited at birth. Social functioning was measured using the parent-rated Strengths and Difficulties Questionnaire (SDQ) peer problems and prosocial behavior subscales at 5, 7, and 13 years' corrected age. Multilevel mixed effects models were fitted. Peer problems increased with age (adjusted mean difference per year = 0.04, 95% confidence interval [CI] = 0.01, 0.07, p = 0.02), with higher peer problems in the VPT compared with the FT group (adjusted mean difference between groups = 0.46, 95% CI = 0.06, 0.86, p = 0.02). Prosocial behavior increased from early to middle childhood and decreased approaching adolescence, but was similar between VPT and FT groups (adjusted mean difference between groups = -0.05, 95% CI = -0.50, 0.40, p = 0.82). Children born VPT are at greater risk for peer problems than FT peers and may benefit from receiving greater early social support.

Comparative Analysis of Independent Reviewer-Rated and Self-Rated Fidelity Scores in Individual Placement and Support Programs: Repeated Cross-Sectional Surveys.

Fidelity assessments can contribute to maintaining the adherence to the individual placement and support (IPS) model, which enhances vocational outcomes for individuals with mental illness worldwide. While independent reviews are standard, self-assessments could broaden the implementation of IPS. This study aimed to evaluate reviewer-rated and self-rated fidelity assessments using the Japanese version of the Individualized Supported Employment Fidelity Scale (JiSEF), and to compare the two assessment methods in terms of their correlations with employment outcomes in Japan. Over the 3-year research period, fidelity assessments were conducted by independent reviewers and trained program staff members across 26 programs, totaling 58 assessments. Analyses involved kappa statistics for item-level comparison, the intra-class correlation coefficient (ICC) and paired t-testfor the overall fidelity scores, and Pearson's correlations to examine the relationship between the fidelity scores and program-level employment outcomes. Most individual JiSEF items demonstrated fair to good reliability between reviewer-rated and self-rated assessments. The ICC for the overall JiSEF scores between the two assessment methods was 0.756, yet the distribution of self-rated scores was more scattered compared with that of reviewer-rated scores. The mean total scores from self-assessments were significantly lower than those from reviewer assessments (t = 2.072, P = 0.043). While both sets of scores correlated significantly with employment rates (r = 0.640, P < 0.001 for reviewer assessments; r = 0.325, P = 0.013 for self-assessments), the correlation was stronger for reviewer ratings (z = 2.207,P = 0.027). Self-rated fidelity assessments offer several benefits. However, since independent reviews had a more normal distribution and higher correlation with employment outcome, they should remain the priority in fidelity assessments within the Japanese IPS framework.

The Impact of Gamified Smartphone App Interventions on Behaviour and Metabolic Outcomes in Individuals at Risk of Cardiovascular Disease.

This study examines gamified smartphone app interventions for improving lifestyle choices and cardiometabolic health in adults at risk for cardiovascular disease. A systematic review of six databases compared gamified interventions with conventional methods. Despite a functionality rating of 4.07, user engagement was lacking. Findings suggest that incorporating game elements into health apps can promote lifestyle changes and improve cardiometabolic health, guiding future digital health strategies to reduce cardiovascular disease risk.

Predictors of liver disease outcomes in individuals with hemophilia and HCV infection

AbstractHemophilia is an X-linked congenital bleeding disorder for which factor replacement is life-saving but complicated by the sequelae of chronic hepatitis C virus (HCV) infection acquired decades ago. Although antiviral therapy clears HCV and reduces end-stage liver disease (ESLD), it may not reverse cirrhosis or prevent hepatocellular cancer (HCC). This was a retrospective cohort study of 121 men with hemophilia and HCV infection cared for at the Hemophilia Center of Western Pennsylvania to determine the incidence and predictors of ESLD and HCC. ESLD and HCC predictors were analyzed using Fisher exact test, and HCV-associated outcomes by Kaplan-Meier time-to-event and Cox proportional hazards regression analyses. At a mean 54 years (36-80) duration of HCV, ESLD occurred in 24 (19.8%), 0.365 per 100 person-years (py); and HCC in 7 (5.8%), 0.106 per 100 py. All 46 (38.0%) alive when HCV antiviral therapy became available, received it. Overall, 31 (25.6%) were HIV+. The leading causes of death were ESLD in 11 (32.3%), bleeding in 9 (26.5%), and HCC in 6 (17.6%). Major risk factors for ESLD included platelets <100 × 103/μL (odds ratio [OR], 6.009; P = .012) and HIV infection (OR, 3.883; P = .001). The major predictors of HCC were ESLD (OR, 11.476; P = .003) and platelets <100 000/μL (OR, 6.159; P = .014). No antiviral-treated subject developed ESLD, P = .001. For men with hemophilia, the sequelae of chronic HCV infection were significant. The major risk factors for ESLD were platelets <100 000/μL and HIV infection. Despite antiviral therapy, ESLD is the most significant predictor of HCC, and ESLD is the leading cause of death.

Daylight duration and time allocation of children and adolescents

This study explores the allocation of time, particularly to sleep, among children and adolescents in response to daily daylight variation. Utilising a dataset of over 50,000 time-use diaries from two Australian cohorts spanning 16 years and employing an individual fixed effects estimator, we uncover a substantial causal impact of daily daylight duration on sleep patterns. Our findings reveal that days with longer daylight hours are associated with a decrease in total sleep duration, primarily driven by a later sleep onset time. Additionally, longer daylight hours correspond to reduced time spent on personal care and media activities, with increased dedication to school and physical activities. Furthermore, we identify socio-demographic factors moderating these effects, such as older age and weekend days exerting a stronger influence on sleep duration, while females and children of unemployed mothers exhibit a subtle impact. These insights contribute to our understanding of how environmental factors shape daily routines and offer implications for designing schedules that promote positive developmental outcomes in young individuals.

Scheduling of methylphenidate: Preventing misuse or impeding ADHD treatment adherence?

Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, with a chronic, and potentially debilitating course if untreated. Medication adherence is poor - negatively affecting emotional, social, educational and employment outcomes. The current Schedule 6 status of methylphenidate (MPH) drives healthcare resource utilisation and costs - a potential barrier to care. This study explored stakeholders' understanding and perceptions of the potential impact of a regulatory shift in the scheduling of MPH on treatment accessibility and adherence for ADHD. Participants from multiple stakeholder groups, involved in ADHD management in South Africa, were recruited via professional networks. A qualitative analysis of semi-structured interviews with 23 stakeholders was conducted to explore their views on the utility, benefits and risks associated with rescheduling MPH. Six key themes emerged from the interviews: 'adherence', 'accessibility', 'affordability', 'stigma', 'rescheduling of MPH' and 'risk mitigation'. Core to these themes is the role of the scheduling of MPH - which can have a protective societal role, but also acts as a barrier to care for individuals with ADHD. The current Schedule 6 status of MPH is not an effective strategy to prevent misuse and diversion but negatively impacts on treatment adherence. The positive outlook from stakeholders on rescheduling MPH holds significant implications for the ADHD landscape in South Africa. It is crucial to address stigma, facilitate fundamental change in service delivery and remove structural and practical barriers to care to improve outcomes for individuals with ADHD. A framework for ADHD treatment adherence is provided.

Impact of the radiotherapy rhythm on prognosis in nasopharyngeal carcinoma

Objective The role of chronoradiobiology in nasopharyngeal carcinoma (NPC) has not been fully elucidated. We sought to investigate the impact of radiotherapy rhythm on the survival outcomes of individuals to explore a chronomodulated radiation strategy to improve prognosis of NPC. Methods A cohort comprising non-metastatic NPC patients subjected to intensity-modulated radiotherapy at Fujian Cancer Hospital between Jan. 2016 and Dec. 2019 was assembled. Rhythmic fluctuation of radiotherapy (RFRT) was quantified based on the temporal distribution of radiation delivery. Cox proportional hazard model was performed to explore the impact of radiotherapy rhythm on all-cause mortality. The maximally selected rank statistics method was employed to discern an optimal cutoff. Sensitivity analyses were conducted to ensure the robustness of observed associations. Results Our analysis encompassed 2245 patients, with a median follow-up duration of 55 months, during which 315 individuals succumbed. Multivariate Cox regression analysis unveiled a significant correlation between prolonged RFRT and heightened mortality risk in NPC patients (HR, 1.17, 95% CI, 1.07-1.27, p < .001), a relationship robust to comprehensive adjustment for confounding variables. A cutoff value of 3 h was selected for potential clinical application, beyond which patients exhibited markedly poorer survival outcomes. Subgroup analyses consistently underscored the directional consistency of observed effects. Conclusion Our study sheds light on the potential advantages of scheduling radiotherapy sessions at consistent times. These findings have implications for optimizing radiotherapy schedules and warrant further investigation into personalized chronotherapy approaches in NPC management.

Clinical Outcomes and Cost Implications of a Community Psychosocial Rehabilitation Service for Severe and Persistent Mental Illness in Nova Scotia, Canada.

Introduction: Individuals with severe and persistent mental illness (SPMI) present distinct challenges in mental healthcare due to the chronic and complex nature of their conditions. This study was conducted to assess the clinical efficacy and potential cost-effectiveness of a multidisciplinary community-based psychosocial rehabilitation team serving individuals with SPMI in Nova Scotia, Canada. Method: This study was conducted to evaluate the effects of a community-based psychosocial rehabilitation program on individuals with severe and persistent mental illness (SPMI) in Nova Scotia, Canada. This research focused on clinical outcomes and potential cost savings following a one-year intervention, offering critical insights into the benefits of community-based care for this population. A cohort of 137 clients accepted into the community rehabilitation service (Connections Dartmouth) between September 2016 and September 2020 was analyzed. Each participant received one year of community rehabilitation intervention. Using data from the Canadian Medical Service Insurance (MSI) billing system, this research compared the use of inpatient services and Emergency Department visits in the year prior to and the year following the intervention. The findings provide valuable evidence on the role of community rehabilitation in reducing healthcare utilization for individuals with SPMI. Results: The results demonstrated a statistically significant reduction in mean admission rates and length of inpatient admissions in the year following rehabilitation compared to the pre-rehabilitation year. A substantial percentage of patients experienced no inpatient admissions (88% vs. 60%) or Emergency Department visits (82% vs. 67%) in the post-rehabilitation year, compared to the pre-rehabilitation year. There was a significant reduction in inpatient days by 90%, translating into substantial cost savings. The findings highlight the potential economic benefits of community rehabilitation for people with SPMI. Conclusions: This uncontrolled study suggests that community rehabilitation is associated with positive clinical outcomes for individuals with SPMI in terms of reduced inpatient service use and associated costs. Further research, including controlled studies and cost-effectiveness studies, into the community psychosocial rehabilitation services in the Canadian setting is needed.

The Realities of Caring for a Person with a Mental Disorder in Rural and Remote Capricorn District of South Africa: A Qualitative Study.

In rural African communities, family caregivers shoulder the responsibility of caring for loved ones with mental disorders, often without professional support. This qualitative explorative study, conducted in Limpopo Province, South Africa, aimed to explore the realities of caring for a family member with a mental disorder in rural and remote Capricorn District, in order to uncover insights that can inform support systems, the academic community, interventions, and policies. Non-probability purposive sampling was used to ensure the reproducibility and validity of the results by focusing on participants who are actively involved in caregiving, living in the rural and remote of Capricorn District, in order to provide a comprehensive understanding of their experiences, and this resulted in 15 participants (13 females, 2 males). Data saturation determined the sample size, with data collected through in-depth interviews and analyzed using Tesch's open-coding method. The findings revealed that cultural and spiritual beliefs strengthen caregivers, who exhibit resilience and resourcefulness, yet face financial strain, career setbacks, social isolation, and health declines. The study underscores the critical role of healthcare professionals in recognizing and addressing the challenges faced by family caregivers, while also advocating for the academic community to prioritize the development and dissemination of educational programs focused on safe and ethical coping strategies for caregivers and for policymakers to develop comprehensive mental health services that are accessible and culturally sensitive to rural and remote communities. This is essential because the well-being of caregivers directly influences the rehabilitation and community integration outcomes for individuals with mental disorders.