Patient Sociodemographic Characteristics Research Articles

Clinical expression of radiographic axial spondyloarthritis and its association with HLA-B27 in European and Ibero-American populations.

To compare the clinical and sociodemographic characteristics of Ibero-American patients with radiographic axial spondyloarthritis (r-axSpA) to those of European patients, with a particular focus on the influence of HLA-B27. This was an observational, cross-sectional, and multicentre study of patients who fulfilled the European Spondyloarthropathy Study Group (ESSG) criteria for SpA from the REGISPONSER and RESPONDIA registries. Univariate and multivariate analyses between European and Ibero-American populations stratified by HLA-B27 status were conducted. Race stratification (White, Black American, and Indian American) was also performed to evaluate clinical differences according to HLA-B27. A total of 2592 patients with a clinical diagnosis of r-axSpA were included in the analysis: 1083 (41.8%) Ibero-American patients and 1509 (58.2%) European patients. Among the HLA-B27-positive patients, Ibero-American status was independently associated with conventional synthetic disease-modifying antirheumatic drugs (csDMARD) intake (OR: 4.21), arthritis (OR: 2.36), enthesitis (OR: 6.01), dactylitis (OR: 6.10), severe structural damage (BASRI) (OR: 1.12) and poor functionality (BASFI) (OR: 1.40). Multivariate analysis of HLAB27-negative patients revealed that Ibero-American status was independently associated with enthesitis (OR: 11.67), csDMARDs (OR: 15.51) and total BASRI (OR: 1.34). Clinical manifestations also varied across racial groups, with differences noted in the prevalence of peripheral joint manifestations such as more arthritis and enthesitis in American Indian patients than in White and Black American patients. Ibero-American r-axSpA patients in our study exhibit more peripheral manifestations, more structural damage, and worse functionality than European patients, regardless of the presence of HLA-B27.

Post-Telemedicine Acute Care for Undifferentiated High-Acuity Conditions: Is a Picture Worth a Thousand Words?

Objectives: Telemedicine use increased substantially with the COVID-19 pandemic. Understanding of the impact of telemedicine modality (video vs. phone) on post-telemedicine acute care for higher risk conditions is limited. Methods: We conducted a retrospective study of telemedicine visits, comparing video with telephone, for selected diagnoses with potentially higher illness acuity, evaluating post-telemedicine emergency department (ED) and hospitalization rates. In a large, multicenter cohort of adult patient-initiated primary care telemedicine visits from March 1, 2020, to July 31, 2021, we evaluated 7-day ED and hospitalization rates for higher acuity diagnostic categories (cardiac, gastrointestinal, and respiratory) by telemedicine modality, provider familiarity, and patient sociodemographic and clinical characteristics. Results: Among 431,705 telemedicine encounters, 128,129 (29.7%) were video visits and 303,576 (70.3%) were telephone visits. Adjusting for patient and appointment factors, telephone encounters for cardiac conditions were associated with significantly higher 7-day ED visit rates than video encounters (5.5% vs. 4.9%, respectively) but similar hospitalization rates (0.7% vs. 0.8%, respectively); for gastrointestinal conditions, post-telemedicine adjusted ED and hospitalization rates were comparable between telemedicine modalities (4.0% for ED and 1.2% vs. 1.3% for hospitalization, respectively); among respiratory conditions, video encounters were associated with higher ED and hospitalization rates than telephone encounters (ED: 5.9% after video vs. 5.2% after phone; hospitalization: 1.9% after video vs. 1.5% after phone). Telemedicine encounters with patients' own primary care provider (PCP) were associated with lower adjusted rates of ED use across all conditions and modalities. Conclusions: Short-term ED and hospitalization rates following primary care video or telephone visits for selected acute, high-risk conditions varied by condition and PCP familiarity. Nuanced use of video visits may confer benefits triaging to downstream acute care.

Public hospital-based care for abortive events in Mexico: complication rates and socio-demographic factors, 2018-2022

BackgroundAbortion-related complications are difficult to measure due to lack of standardized definitions and limited available data. We describe the proportion of abortive events that result in a documented complication in Mexico’s public sector hospitals.MethodsWe used ICD-10 codes from Mexico’s hospital discharge system (2018-2022), Subsistema Automatizado de Egresos Hospitalarios (SAEH), to describe abortive events admitted to hospitals: complications for excessive bleeding, infection, embolism, and unspecified; patient socio-demographic and clinical characteristics; and municipality-level structural vulnerability. We estimate complications by pregnancy duration, describe types of complications, identify characteristics associated with the presence of a complication using multuvariable regression, and calculate complication rates (proportion of abortive event that result in a complication treated in a public sector hospital per 1,000 women of reproductive age) by state in 2022.FindingsThere were 399,405 abortive events that received hospital-based care in Secretaria de Salud (SS) hospitals between 2018-2022. Ninety-two percent had no complication reported. The adjusted predicted probability of a complication was higher among patients at > 13 weeks’ gestation (8.9%; 95% CI 8.1–9.7%) compared with ≤ 13 weeks (6.6%; 95% CI 6.0–7.2%). Higher parity, care at a tertiary hospital, and high marginalization at place of residence were positively associated with presence of a complication. States with higher complication rates are primarily in the central and southern regions.ConclusionsIn Mexico, 92% of patients who seek care for all abortive events (induced, spontaneous, post-abortion) in SS hospitals have no complications. Marginalized patients are more likely to have a complication and to seek care at later pregnancy durations. Routinely conflating care-seeking and complications leads to overestimates of the risk of abortion.

Analysis of the Temporal Trend and Factors Associated With Aids Mortality in Bahia, 2009-2019

Objective: To analyze the temporal trend of AIDS mortality rates in Bahia, from 2009 to 2019, taking into account the sociodemographic characteristics of patients. Theoretical framework: Increased access to testing and highly active antiretroviral therapy have favored the reduction of opportunistic diseases, enabling a better quality of life for people living with Acquired Immunodeficiency Syndrome (AIDS). In recent years, there has been an increase in the number of cases in the Northeast region. In the 1990s, Bahia was relevant in the occurrence of deaths from HIV, leading to the need to to analyze the epidemiological picture of this disease to direct control actions. Method: The spatial distribution of average HIV death rates in Bahia from 2009 to 2019 will be investigated using data from the Mortality Information System and trend analysis, using simple linear regression with residual correction, according to the Prais Winsten methodology. Results and discussion: The analysis of the temporal trend showed that the rates by sex and race were stationary, while the rates by race/color (mixed race and indigenous people) were increasing. This highlights the need to plan health policies and reorganize specialized services to serve people with AIDS, considering the epidemiological profile of each region and the most vulnerable populations. Research implications: The results can contribute to the management and planning of public health policies, highlighting the need for a deeper understanding of the aspects that interfere with AIDS mortality, considering local and regional specificities to combat the disease, especially in Bahia. Originality/Value: The epidemiological picture of AIDS mortality in Bahia has been little analyzed at the local level.

Home Medication Regimen Complexity in Newly Diagnosed Pediatric Oncology Patients.

Parents of children newly diagnosed with cancer require specialized education to provide care for their child at home, including the management of complex medication regimens. To assess the complexity of home medication regimens in a cohort of newly diagnosed pediatric oncology patients. We inventoried and categorized all discharge medications for each patient and used the Medication Regimen Complexity Index (MRCI) to quantify the complexity of the prescribed medication regimens. We used logistic regression to identify patient sociodemographic and clinical characteristics significantly (P < .05) associated with higher medication burden (ie, higher total MRCI scores). The cohort consisted of 105 newly diagnosed pediatric oncology patients initially hospitalized between December 2016 and February 2019 (61.9% male, 65.7% non-Hispanic White, 65.7% leukemia or lymphoma; median [range] age at diagnosis, 7.1 [0.4-17.7] years; median [range] number of discharge medications, 9 [1-14]). The proportion of patients prescribed ≥1 medication in each pharmacologic category was as follows: antiemetics, 94.3%; antimicrobials, 93.3%; pain management, 88.6%; oral care, 86.7%; stool softeners/laxatives, 81.0%; gastrointestinal protectants, 60.0%; cancer-directed therapy, 51.5%, other supportive therapies, 49.5%, other, 27.6%. Characteristics associated with ≥ median (≥33.0) MRCI score included a diagnosis of leukemia or lymphoma (odds ratio, 2.7; 95% confidence interval, 1.1-6.6; P = .027; comparison: solid tumor) and older age (odds ratio, 1.1 per year; 95% confidence interval, 1.0-1.2; P = .020). Most children newly diagnosed with cancer are discharged with complex medication regimens that parents/caregivers must manage at home. Nurses can use these findings to develop tailored medication education plans for parents/caregivers of newly diagnosed pediatric oncology patients.

Depression among people living in rural and urban areas of Thailand: A cross-sectional study.

Depression has a growing trend in the population worldwide. In this cross-sectional study, we investigated the prevalence and associated factors of depression among individuals residing in rural (Ban Luang district, Nan Province) and urban (Lak Si, Bangkok) areas of Thailand. Understanding the differences in depression between these two settings can provide insights for specific targeted interventions and mental health policies. The multistage stratified random sampling was applied to select the study participants. We recruited participants from rural and urban communities in Thailand using a structured survey questionnaire through either face-to-face interviews or in paper or electronic form. We collected data on depression using the Patient Health Questionnaire-9 (PHQ-9) tool and sociodemographic characteristics and conducted descriptive statistics and logistic regression analysis. Of 867 survey participants, 420 were from rural areas (Nan) and 447 were from urban areas (Bangkok). Participants' mean age was 55.9±9.5 years in rural areas and 56.0±12.0 years in urban areas. Most participants in urban areas were women, married, and had lower education levels (71.1%, 50.3%, 58.8%, respectively). The overall prevalence of depression across both settings was 18.6%. We found a higher prevalence of depression in the urban (31.8%) than the rural (4.5%) setting. In multiple logistic regression analysis, urban residence was significantly associated with higher rates of depression compared with rural residence (adjusted odds ratio [AOR] 9.43, 95% confidence interval [CI] 5.08-17.52). Nuclear family and using social media were associated with lower levels of depression in urban areas (AOR 0.50 and 0.43, 95% CI 0.27-0.93 and 0.22-0.84, respectively). Higher education level was significantly associated with higher levels of depression in rural areas (AOR 3.84, 95% CI 1.19-12.42). This study emphasized the difference in depression and related factors between rural and urban areas of Thailand, highlighting a greater prevalence in urban areas. To help prevent depression, it is important to address specific challenges in each setting, such as those faced by highly educated individuals living in rural areas with high depression rates, exploring social media use patterns in urban populations, and understanding dynamics of the nuclear family. Our findings can inform the development of public health policies aimed at effectively mitigating the burden of depression and improving overall mental well-being in specific settings.

MISSING DEMENTIA DIAGNOSIS INFORMATION DURING HOME HEALTH: PREVALENCE AND IMPACTS

Abstract Medicare-funded Home Health Care (HHC) delivers skilled health care services through visits to patients’ homes. Poor information transfer between HHC and other care settings is a perennial issue; HHC providers rarely have reliable and complete information regarding patients’ clinical history or needs. One-third of HHC patients have dementia, but lack of visibility into a patient’s dementia status could negatively impact HHC providers’ ability to appropriately tailor care to these individuals. We examined a national sample of 426,606 older adults (65+) who received Medicare HHC in 2018 and had diagnosed dementia, as reported in the Medicare Beneficiary Summary File. The majority (68.3%) did not have their dementia diagnosis captured in the HHC claims or assessment files. We fit multilevel logistic models clustering at the HH agency-level and adjusting for patient sociodemographic characteristics and clinical status and HHC agency characteristics. Patients whose dementia diagnosis was not captured during HHC were less likely to receive Speech-Language Pathology (aOR: 0.63; 95% CI: 0.61-0.64), social work (aOR: 0.70; 0.69-.72), or aide visits (aOR: 0.81, 95% CI: 0.80-0.82). Patients whose dementia diagnosis was not captured were also more likely to be hospitalized (aOR: 1.69; 1.65-1.73) or to visit the Emergency Department (aOR: 1.47; 95% CI: 1.44-1.50) during HHC, and less likely to have their Activities of Daily Living (ADL) limitations stabilize or improve by HHC discharge (aOR: 0.70; 95% CI: 0.68-0.72). Results suggest HHC providers often lack pertinent information regarding patients’ dementia status, contributing to reduced access to relevant services and increased risk for negative outcomes.

Sociodemographic and clinical characteristics of patients admitted to an addiction center with methamphetamine use

Sociodemographic and clinical characteristics of patients admitted to an addiction center with methamphetamine use

Exploring correlates of high psychiatric inpatient utilization in Switzerland: a descriptive and machine learning analysis

Abstract Background This study investigated socio-demographic, psychiatric, and psychological characteristics of patients with high versus low utilization of psychiatric inpatient services. Our objective was to better understand the utilization pattern and to contribute to improving psychiatric care. Methods One-hundred and twenty inpatients of the University Psychiatric Clinics (UPK) Basel, Switzerland, participated in this cross-sectional study. All patients were interviewed using different clinical scales. As target variables we investigated the number of days of psychiatric inpatient treatment within a 30-month period. Results Despite including multiple relevant patient variables and using elaborate statistical models (classic univariate und multiple regression, LASSO regression, and non-linear random forest models), the selected variables explained only a small percentage of variance in the number of days of psychiatric inpatient treatment with cross-validated R2 values ranging from 0.16 to 0.22. The number of unmet needs of patients turned out to be a meaningful and hence potentially clinically relevant correlate of the number of days of psychiatric inpatient treatment in each of the applied statistical models. Conclusions High utilization behavior remains a complex phenomenon, which can only partly be explained by psychiatric, psychological, or social/demographic characteristics. Self-reported unmet patient needs seems to be a promising variable which may be targeted by further research in order to potentially reduce unnecessary hospitalizations or develop better tailored psychiatric treatments.

Exploring the Socio-Demographic Profile of Non-Completion in Public Oral Healthcare Services: A Cross-Sectional Study in Melbourne, Victoria

(1) Background: Completion of the full oral health course of care (CoC) is essential to prevent further deterioration of oral and overall health. Understanding these patterns, particularly in public oral healthcare services, is crucial for improving access to and the delivery of care. This study aims to identify the socio-demographic and clinical characteristics of adult patients who did not complete required dental treatments within a 12-month period at Monash Health Dental Services (MHDS), Melbourne, Victoria. (2) Methods: Data were collected on patients’ course of care (CoC), socio-demographic characteristics, and clinical information from the MHDS Titanium electronic database. This study represents a secondary data analysis from adult patients who attended MHDS between November 2022 and October 2023, excluding emergency dental care visits. Logistic regression analyzed the socio-demographic and clinical variables affecting CoC. (3) Results: Our findings identified several significant predictors of incomplete CoC; being a non-priority group, mental health clients, refugees, and identifying as Aboriginal or Torres Strait Islanders (OR = 1.41; 95% CI: 1.08–1.84). Conversely, speaking a language other than English increased the odds of completing treatment (OR = 0.85; 95% CI: 0.74–0.98). By age, patients in the 36-to-55- or the 56-to-75-year-old age groups were more likely to be in the incomplete group (OR = 1.65; 95% CI: 1.37–1.98; and OR = 1.43; 95% CI: 1.22–1.66, respectively). (4) Conclusions: This study identified predictors of discontinued care, emphasizing accessibility and equitable outcomes for users of public oral healthcare. The findings indicate that the predictors of course of care (CoC) completion differ from barriers to accessing care. This highlights key objectives in public health dentistry, focusing on improving accessibility and promoting equitable oral health outcomes for vulnerable populations.

Patients Discharged "Against Medical Advice" More than Once: A Cross-Sectional Descriptive Analysis of a Vulnerable Population.

Patients who have been discharged "against medical advice" (AMA) are at increased risk of morbidity and mortality, but there is little research about patients who have had more than one AMA discharge. We aimed to describe the socio-demographic and clinical characteristics of patients with more than one AMA discharge. We conducted a cross-sectional, retrospective chart review of a sample of adult patients who were discharged AMA more than once between 2016 and 2021 and abstracted detailed characteristics of this sample. A total of 81 patients were discharged AMA more than once during the study period. We reviewed demographics, health insurance, substance use and mental health diagnoses, psychiatric consultations, documentation of prior AMA discharges, admitting medical service, length of stay, number of hospitalizations during the study period, and readmission within 30days of the first AMA discharge. We also noted the presence of relevant psychosocial stressors. Among 81 patients reviewed, the average age was 41years (range 19-76). Most were unmarried (n = 72, 89%) and most had public insurance or were uninsured (n = 74, 91%). More than half (n = 52, 64%) had a readmission within 30days. The average number of hospitalizations in the study period was 10 (range 2-47). These patients had a high burden of psychosocial stressors including financial stress (56, 69%), housing insecurity (n = 40, 49%), and grief or loss of social support (n = 20, 25%). Patients who have been discharged AMA more than once represent a vulnerable population with significant unmet needs.

Characteristics of Patients Hospitalized With Methamphetamine-Associated Heart Failure: A Comparative Study of Enrolled vs Nonenrolled Patients.

Methamphetamine-associated heart failure (MethHF) carries devastating individual and societal consequences; however, our understanding of this condition is limited. The objective of this study is to compare the sociodemographic and clinical characteristics of patients hospitalized with MethHF with patients hospitalized with heart failure (HF) not associated with methamphetamine (non-MethHF). This was an analysis of screening data from MethHF patients who screened out of the Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure study and a subset of non-MethHF patients enrolled in the study. Descriptive and comparative statistics were used. Patients hospitalized with MethHF (n = 99), compared with non-MethHF (n = 87), were significantly younger, more often male, more likely from urban areas, and had higher rates of prior emergency room usage. Patients with MethHF also had more nonischemic etiologies and reduced ejection fraction. Nearly a third of patients with MethHF also had a new diagnosis of HF. There are a few notable differences in sociodemographic and clinical characteristics between patients hospitalized with MethHF versus non-MethHF.

Evaluation of Knowledge and Attitude toward Diabetes among Adolescents with Diabetes Mellitus attending Diabetes and Endocrine Center in Babylon Governorate/ Iraq

Background: Diabetes is a lifelong chronic condition that is becoming more common in both industrialized and developing countries. People who have diabetes are more likely than those who do not to experience a wide range of illnesses. Aim: to measure the knowledge and attitude among diabetic adolescents and find their relationship with socio-demographic features of patients, their families, clinical history, family history, and lifestyle features. Patient and methods: a Cross -sectional study carried out at a diabetic and endocrine center included 300 Adolescents aged 13–19 years who were diagnosed with diabetes mellitus by clinicians and attended the center from October first, 2023, to February first, 2024. The questionnaire included: - Socio-demographic features of the participants and their families, Knowledge about Diseases, attitude of the patient toward disease, SPSS version 26 was used to analyze data and a P value≤ 0.05 considered statistically significant. Results: patients' mean knowledge and attitude scores were significantly higher for older age group patients, urban residence, higher level of education, older parents, family history of the disease, longer duration of disease and current smoking. (P&lt; 0.05), high mean score of knowledge was found among those with retired fathers and older mothers. higher mean attitude score was found among engaged patients. Conclusion: The result of the present study showed about two-third of the participants had good knowledge scores while only half had good attitude score. older age, higher education, living in urban areas, lived with disease for more than 5 years, had a family history of disease and smoking are significant determinants of knowledge and attitude.

Sociodemographic and Clinical Profiles of Patients With Substance Use Disorders Admitted to a Psychiatric Hospital in Erbil: A Retrospective Study.

Substance use is a growing concern, impacting the health, social stability, and economic well-being of individuals and communities. In Iraq, particularly in Erbil, limited data exists on the sociodemographic and clinical characteristics of patients with substance use disorders (SUDs). This study aims to identify these characteristics among inpatients at Hawler Psychiatric Hospital to better understand the profiles and associated factors influencing substance use in this region. A retrospective study was conducted at Hawler Psychiatric Hospital from January 2023 to September 2024. A total of 115 patient records with substance use disorder diagnoses were reviewed. Data on sociodemographic details, clinical characteristics, types of substances used, and comorbidities were collected and analyzed using Microsoft Excel 2016 (Microsoft Corp., Redmond, WA) and IBM SPSS Statistics version 26 (IBM Corp., Armonk, NY). Frequency, percentages, and mean values were calculated, while Chi-square and Fisher's exact tests were used to assess associations between categorical variables. A P-value of 0.05 or less was deemed statistically significant. The majority of the patients were male (112, 97.4%), with an age of 31.95 ± 9.46 years (mean ± standard deviation (SD)).Among them, 67 (58.3%) had only primary school education. Methamphetamine was the most commonly used substance (52, 45.2%), followed by alcohol (28, 24.3%), opioids (13, 11.3%), and heroin (13, 11.3%). High rates of psychiatric comorbidities were observed, with 97 (84.3%)patients diagnosed with additional mental health conditions, such as depression and psychosis. Furthermore, 73 (63.5%)patients exhibited aggressive behaviors, and 33 (28.7%) had a forensic history. Significant associations were identified between aggression and factors such as educational level, occupation, psychiatric comorbidity, and forensic history. The study highlights a pattern of poly-substance use among patients and the pressing need for comprehensive treatment strategies, including both pharmacotherapy and psychotherapy, to address the complex needs of individuals with substance use disorders in Erbil. These findings underscore the importance of targeted interventions and preventive measures to reduce substance misuse and improve patient outcomes.

Clinical and Sociodemographic Profile and Pattern of Echocardiographic Diagnosis of Patients Attending Outpatient Echo Department of NICVD

Background: Cardiovascular diseases (CVDs) represent a significant public health burden globally, including in Bangladesh. Echocardiography is a pivotal diagnostic tool in the assessment of cardiac function, structure, and abnormalities in patients with suspected cardiovascular conditions. Objective: This study aimed to evaluate the clinical and sociodemographic characteristics of patients attending the outpatient echocardiography department at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, and to analyze the pattern of echocardiographic findings. Methods: A cross-sectional study was conducted over six months, including [total number] patients referred for echocardiographic evaluation. Sociodemographic data, including age, gender, and clinical history, were collected. Echocardiographic assessments were performed following standard guidelines, with measurements including aortic root diameter (AO), left atrial size (LA), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and ejection fraction (EF). Descriptive statistics were used to analyze the data, and associations between demographic factors and echocardiographic findings were evaluated. Results: The mean age of the study population was 48.02 ± 14.49 years, with a majority (65.63%) aged between 31-60 years. Males constituted 86.22% of the patients, resulting in a male-to-female ratio of 6.21:1. The mean aortic root diameter was 27.81 ± 4.46 mm, and the mean left atrial diameter was 33.28 ± 4.82 mm. The mean LVEDD and LVESD were 45.28 ± 6.02 mm and 29.74 ± 5.13 mm, respectively. The average ejection fraction was 63%, indicating preserved systolic function in the majority of patients. Notably, 35.32% of patients exhibited regional wall motion abnormalities (RWMA), suggestive of ischemic heart disease. Conclusion: The study highlights that middle-aged and elderly adults, particularly males, constitute the majority of patients undergoing ...

Beneficial Impact of Follow-Up 24-Hour Urine Testing on Adherence to Pharmacological Therapy for Kidney Stone Prevention

Purpose: Preventive pharmacological therapy (PPT) is recommended for certain patients with urinary stone disease to reduce their recurrence risk, but they frequently do not adhere. With causal inference methods, we evaluated whether follow-up urine testing could be used to improve PPT adherence. Materials and Methods: Using claims data from Optum’s deidentified Clinformatics Data Mart database (2008-2019), we identified patients with urinary stone disease who were prescribed PPT (thiazide diuretic, alkali therapy, or allopurinol) after baseline 24-hour urine testing and assessed their adherence with the proportion of days covered method. After distinguishing between patients who did and did not receive follow-up urine testing, we examined the association between follow-up testing and PPT adherence with logistic regression. We then emulated a target trial using propensity score matching, stratification, and doubly robust estimators to estimate the equivalent causal effect. Results: Among 4166 patients, 496 (11.9%) completed both baseline and follow-up testing. Follow-up testing was associated with a 9.0% increase in adherence odds after adjusting for sociodemographic, behavioral, and disease-related and treatment-related patient characteristics. Furthermore, we estimated a 7.1% increase in proportion of days covered caused by follow-up testing using causal inference methods. Subgroup analyses indicated the most significant effects are among women, those with low baseline medication adherence, and those not at high risk of stone formation. Conclusions: These data suggest that follow-up urine testing after starting PPT may have a beneficial effect on long-term medication adherence.

Time to Surgery in Early-Stage Non-Small Cell Lung Cancer (NSCLC): Defining the Optimal Diagnosis-to-Resection Interval to Reduce Mortality.

Most patient variables that impact cancer case complexity and outcomes are not modifiable pre-operatively. However, the time from diagnosis to surgical resection is fluid. This retrospective study sought to identify the optimal time from NSCLC diagnosis to surgery to reduce mortality. We evaluated adult patients with early-stage NSCLC who underwent upfront surgical resection between 2009-2019 using institutional data. Diagnosis date was uniformly defined as the date of computed tomography (CT) that prompted diagnostic workup. We evaluated time to surgery in 2-week intervals. Using Cox regression analysis with adjustment for key patient sociodemographic, clinical and cancer characteristics, we examined time to surgery associations with recurrent/new lung cancer and overall mortality at 1 and 5-years post-surgery. Among 2567 early-stage patients, median time to surgery was 57.0 [IQR: 41.0-79.0] days. Five-year mortality was elevated for surgeries performed >8 (vs. <8) weeks (aHR [adjusted hazard ratio] 1.19 (95% CI: 1.06-1.33)) and >12 (vs. <12) weeks (aHR 1.31 (95% CI: 1.10-1.55)) post-diagnosis. One-year recurrence was also elevated for surgeries delayed >8 (vs. <8) (aHR: 1.25 (95% CI 0.98-1.60)) and >12 (vs. <12) weeks (aHR 1.62 (95% CI: 1.12-2.36)). Although NSCLC aggressiveness varies, quality metrics for time to surgery are needed to optimize outcomes. This will be increasingly important as more early-stage, resectable NSCLC is identified. Our results suggest that performing surgery within 8 weeks of CT-based clinical diagnosis may be an important heath system target for early-stage NSCLC patients.

Quality of life among patients with systemic lupus erythematosus in Karbala Governorate

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease with a variety of clinical symptoms that primarily affect women of childbearing age causing a significant patient burden. Objectives: To assess health-related quality of life (HRQOL) among patients with SLE and to evaluate its association with different sociodemographic and clinical characteristics of SLE patients. Patients and methods: Seventy five patients with SLE who attended the rheumatology outpatient clinics of Imam Al-Hassan Al-Mujtaba Teaching Hospital, were enrolled in a cross-sectional study. Lupus quality of life (LupusQoL) was used to assess disease-specific health related quality of life; and SLE disease activity index (SLEDAI) was applied to evaluate disease activity. Results: The mean age of the studied patients was 38.12±11.70 years and were 97.3% female. All LupusQoL domains were reduced. Intimate relationship accounted for the highest QoL score with a median of 50, and IQR of 25-100, whereas fatigue represented the lowest score with a median of 25, and IQR of 6.2-50. LupusQoL was positively correlated to address, education, disease duration, occupation, and impact on job especially in physical health domain with r equal (0.277, 0.342, 0.137, 0.240, 0.314respectively). LupusQol was negatively correlated with age (r= -0.461), and with disease activity (r= -0.292), with p- values of all were &gt;0.05. Renal and neuropsychiatric involvement of the disease did not statistically correlate with HRQOL. Conclusion: patients with SLE had low scores of all LupusQoL domains. There was significant positive correlation between LupusQoL domains and address, education, disease duration, occupation, and impact on job and significant negative correlation with age, and disease activity. Key words: SLE, health related quality of life, LupusQoL

Surgical and transcatheter aortic valve interventions for aortic stenosis in England: sociodemographic variations in treatment trends and outcome over 20 years

BackgroundHealth inequalities in cardiovascular care have been identified in the UK. The sociodemographic characteristics of patients undergoing intervention for aortic stenosis (AS) in England, and the impact of COVID-19, is...

Sexually dimorphic response to tobacco in the development of chronic kidney disease: a systematic review

IntroductionChronic kidney disease (CKD) demonstrates a complex interaction with tobacco exposure and sex differences, where females and males may experience varying risks and outcomes. This study aims to investigate how sex differences mediate the relationship between tobacco exposure and CKD development, with a secondary focus on regional variability and social determinants of health.Study selection and criteriaComprehensive searches on MEDLINE, EMBASE, clinicaltrials.gov, and MedRxiv until October 6, 2022, were conducted. Eligibility criteria involved any study that reported primary data on the prevalence of CKD, with information pertaining to both sex and tobacco exposure.Data extractionData retrieved include patient socio-demographic characteristics, general study information, diagnostic methods, social determinants of health, and the cause of CKD (e.g., tobacco-related or non-tobacco-related).ResultsStudies were selected through a comprehensive search using key terms such as "chronic kidney disease," "smoking," and "sex differences," which identified 3,025 articles, of which 28 were selected for full texts after screening titles, abstracts. Among the 28 included studies, smoking was consistently identified as a significant risk factor for CKD, with notable disparities related to sex, socioeconomic status, race, and urban versus rural settings. Significant geographical variability in CKD prevalence was observed, ranging from 2.5% to 68.1%, with the highest prevalence in Asia. However, due to high heterogeneity and methodological limitations, a meta-analysis of CKD prevalence stratified by sex and tobacco exposure was not feasible.ConclusionsThe findings emphasize the need for further research to comprehend the intricate relationship between, tobacco exposure, sex, and CKD management, as well as the consideration of cultural, geographical, socioeconomic, political, and structural factors when understanding the pathophysiology and management of CKD.