Reasons For Use Research Articles

Antimicrobial use in laboratory rodent facilities in Australia and New Zealand- a cross-sectional survey of veterinarians and facility managers.

This cross-sectional study surveyed veterinarians and facility managers to characterise the use of antimicrobials in laboratory rodent facilities within Australia and New Zealand. Most facilities (71%) reported routine administration of antimicrobials. The indications for antibiotic use reflected those described in publications and differed significantly to reasons for use in non-laboratory animals. Antimicrobials used include those of critical importance to human health, and access to these drugs is unregulated, as prescription-only classes are ordered through research catalogues, without human or veterinary physician prescriptions. The ways in which antimicrobials are used in Australian and New Zealand rodent facilities are likely contributing to antimicrobial resistance within rodent populations, particularly as they are largely administered in drinking water, risking subtherapeutic dosing. Much antimicrobial use reported is unnecessary and could be replaced with changes to husbandry and handling. The generation of resistance in both pathogenic and commensal microbes may also represent a work health and safety issue for humans working with these animals. Reported disposal of antimicrobials included discharge into wastewater, without inactivation, and some respondents reported disposal of substrate, or soiled bedding, nesting material, and disposable enrichment items, from treated animals and medicated feed into landfill, without prior inactivation. Environmental contamination with resistant microbes and antimicrobials is a significant driver of antimicrobial resistance. As such, significant opportunities exist to implement judicious and responsible use of antimicrobials within research rodent facilities in Australia and New Zealand, with a particular focus on instituting aseptic surgery, optimising dosing regimens, and inactivation of medicated water and substrate before disposal.

Integrative and complementary health practices among university students: reasons for use or non-use

Resumo O objetivo deste estudo é compreender os motivos de uso e não uso das práticas integrativas e complementares entres estudantes universitários da área da saúde. Trata-se de uma pesquisa quanti-qualitativa, com dados coletados por meio de questionários (667) e entrevistas (34) e submetidos à análise de conteúdo. Os efeitos terapêuticos, a influência familiar e a oferta de alternativa à biomedicina foram as principais razões elencadas para o uso das práticas integrativas e complementares, ao tempo que a ausência de demanda, o desinteresse e a falta de oportunidade foram as motivações mais frequentes para o não uso. Nesse sentido, as motivações de uso enfatizam as vantagens obtidas através da interlocução com essas práticas e alguns contextos que determinam sua adoção. Em relação às motivações de não uso, destaca-se um cenário de baixa oferta e dominância da biomedicina na cultura ocidental contemporânea. Portanto, esses resultados corroboram a demanda de enfrentamento da monocultura da biomedicina, bem como a abordagem das práticas integrativas na educação superior. Desse modo, a universidade pode se construir a partir da tessitura entre diferentes culturas em saúde, com a facilitação do emprego das práticas não hegemônicas e a ampliação das bases epistêmicas de cuidado na formação e vida da comunidade acadêmica.

Uses of psychotropic drugs by university students in Switzerland.

The use of psychotropic drugs among students is well known, but very few studies have been carried out outside North America, and data on Switzerland are particularly scarce. This study investigates the factors that determine the use of drugs and psychotropic substances among students at the University of Lausanne. Our hypotheses were that study pressure could lead to psychotropic drug use; that use could be either regular or experimental; and that users and non-users would have different opinions about the reasons for use and the consequences. Based on a convenience sample (n = 1199) collected by Master's students from other university students as part of a course given in 2019, our three hypotheses were confirmed. The use of psychotropic drugs is well associated with poorer academic performance. Regarding frequency of use, certain types of psychotropic drugs are used regularly (e.g. antidepressants), while others are used on occasionally (e.g. tranquilizers). Psychotropic substances such as cannabis and cocaine, on the other hand, are mainly used irregularly. Finally, the majority of psychotropic drug users report that they use them as part of their medical treatment, while the majority of non-users suggest that they use them mainly to reduce anxiety and stress in everyday life and at school. Our results show that Switzerland, like other countries, is affected by the phenomenon of psychotropic drug use by students, even outside medical supervision. Accordingly, better information on the negative effects of these substances should then be provided to all university students.

Prevalence, reasons for use, perceived benefits, and awareness of health risks of cannabis use among cancer survivors - implications for policy and interventions.

There is increasing discourse on the use of cannabis as a palliative for cancer/cancer-treatment-related symptoms. We described the prevalent reasons for use, perceived benefits, and awareness of health risks from cannabis use for cancer management among cancer survivors. Cross-sectional survey of adult (≥ 18years) cancer survivors from 41 US states receiving treatment at a comprehensive cancer center. Of 1,886 cancer survivors included, 17.4% were current users, 30.5% were former users, and 52.2% were never users of cannabis. Among survivors who currently or formerly used cannabis after their cancer diagnosis (n = 510), the reasons for cannabis use in cancer management were; sleep disturbance (60%), pain (51%), stress (44%), nausea (34%), and mood disorder/depression (32%). Also, about a fifth (91/510) of survivors used cannabis to treat their cancer. Across the different symptoms assessed, over half of the survivors who reported a reason for using cannabis currently or after their cancer diagnosis perceived that cannabis was helpful to a great extent in improving their symptoms. However, of the 167 survivors who reported awareness of potential health risks from cannabis use, the awareness of adverse health risks associated with cannabis use was low: suicidal thoughts (5%), intense nausea and vomiting (6%), depression (11%), anxiety (14%), breathing problems (31%), and interaction with cancer drugs (35%). Prevalence of cannabis use among survivors was notable, with most reporting a great degree of symptomatic improvement for the specified reason for use. However, only a few were aware of the health risks of cannabis use during cancer management. With more cancer survivors using cannabis as a palliative in managing their cancer-related symptoms, future guidelines and policies on cannabis use in cancer management should incorporate cannabis-based interventions to minimize the inadvertent harm from cannabis use during cancer treatment among survivors.

CANNABIS USE AMONG OLDER ADULT CANCER PATIENTS: PATTERNS OF USE AND PERCEIVED SYMPTOM MANAGEMENT

Abstract Prevalence of cannabis use among U.S. older adults (>65 years) is increasing and is common among cancer survivors of all ages. This National Cancer Institute-funded supplement supported administration of a cross-sectional survey in a state with illegal access to cannabis. This study descriptively examined weighted estimates of cannabis rates (lifetime, post-diagnosis, current) among older patients (>65 years) (N=524; 51% of full sample) with a cancer diagnosis (< two years). Of those endorsing post-diagnosis use, weighted estimates examined patterns of use (timing relative to cancer treatment, reasons for use, primary mode of use) and self-reported impact of cannabis on symptoms (since diagnosis; 5-point Likert scale for 9 symptoms). Almost half (46.0%) of older patients used cannabis in their lifetime, with 18.2% using post diagnosis and 9.8% currently using. Of patients who used cannabis following diagnosis (N=107), approximately half used during cancer treatment (7.0% had not yet started) and most common mode of use was smoking (e.g., joint) followed by edible use. Most common reasons were for pain (44.3%), sleep (43.4%) and recreationally (38.1%). Most common symptoms patients endorsed improved quite a bit, included pain (27.7%), difficulty sleeping (27.3%), and stress, anxiety, depression (23.5%). Overall, few believed cannabis worsened symptoms, with most indicating either improvement or no change. Findings indicate older oncology patients commonly use cannabis to alleviate medical or health symptoms. Oncology care teams require evidence-based recommendations and guidance to inform conversations and shared decision making about cannabis with their older patients, even within a state without a legal cannabis marketplace.

PATTERNS OF MARIJUANA USE IN THE US OLDER ADULT POPULATION

Abstract Marijuana use is increasing in the U.S. population, including among adults 50 and older, but research on population characteristics of marijuana use in middle aged and older adults is limited. We use data from the 2018-2021 Behavioral Risk Factor Surveillance System (BRFSS) surveys, which are representative of U.S. state populations, to estimate prevalence and frequency of marijuana use by age. The data are from 39 states that included the module on marijuana use in the past 30 days (n=466,469). We also examine age patterns in use by legalization status and reasons for use of marijuana. Reported marijuana use is much lower among those ages 50 and older (6.49%) than 18-49 (16.3%). Multivariable regression analyses show that marijuana use declines with age (p<.001) and is lower among women (p<.001). Marijuana use among older adults is slightly lower in states where it is illegal compared to states that have legalized (4.6% vs. 7.1%, p<.001). Use of marijuana for medical reasons increases with age; nearly two-thirds of adults 80+ who use marijuana report doing so for medical reasons. Adults 80+ also report the highest frequency of use, likely reflecting greater medical need. The most common conditions reported among adults 50+ who use marijuana for medical reasons are arthritis (61%), depression (36%), asthma (20%), and COPD (18%). Our prevalence estimates of use at older ages match those from other national surveys, but our findings suggest older adults are using marijuana largely for medical reasons.

PATTERNS OF USE, RISK FACTORS, AND ATTITUDES OF OLDER ADULT CANNABIS USERS

Abstract While cannabis use continues to increase among older adults (OA), research within this population is limited. This study aimed to describe OA patterns of use, risk factors, and subjective effects of cannabis use. OA cannabis users ages 60-79 (N=17, Mage=68.29, SD=5.61) were 94% White and 59% women, with an average education of 15.94 years (SD=2.38). Participants completed online questionnaires and semi-structured interviews regarding medical and mental health, subjective cognitive functioning, and cannabis use patterns and attitudes. Participants reported M=33.41 years of cannabis use (SD=20.15) with an average age of first use of 20.11 years (SD=10.40). Current use was reported as 4.29 days/week (SD=3.14). Current reasons for use were recreational (n=6), medical (n=2), or both (n=8). The most common medical conditions for which participants reported using cannabis were arthritis/joint pain (n=4) and disordered sleep (n=4). The most commonly reported benefits of cannabis use were relaxation (n=8), improved sleep (n=6), improved mood/anxiety (n=6), cognitive enhancement (n=5), and pain management (n=4). Common drawbacks included subjective cognitive decline (n=7), social hindrance (n=6), and health complications (n=5), whereas 5 participants reported no drawbacks. Most participants (76%) reported discussing cannabis use with their physician, although only 38% of those reported that discussion was helpful. Disconnect between OA cannabis users and their physicians could result in cannabis use that is contraindicated by preexisting medical conditions or medications. Emphasis should be placed on individualized psychoeducation regarding the potential risks/benefits of cannabis use as well as continuing education for physicians regarding cannabis use in OA.

Tanning bed use in Germany between 2015 and 2022: Representative data of 28,000 individuals on indoor tanning, risk awareness and reasons for use.

Tanning beds were classified as first-group carcinogens in 2009. Nonetheless, research shows that people in industrialized Western countries use tanning beds. Based on the National Cancer Aid Monitoring (NCAM) including representative data on 28,000 individuals from Germany, we quantified the prevalence as a trend from 2015 to 2022, identified determinants of tanning bed use and analysed risk awareness and reasons for use. We used NCAM data from 2015 to 2022 to analyse the trends in the prevalence of tanning bed use (n = 28,000). To determine the characteristics of tanning bed users, risk awareness and reasons, we combined data from the waves 2019 to 2022 (n = 16,000, 49.2% female, 16-65 years) in a pooled dataset to have sufficient power to detect even smaller associations. Tanning bed use decreased to 5.1% in 2022. The use of tanning beds in spas, fitness and beauty facilities increased, except during the COVID-19 pandemic, while the use in tanning salons decreased. Typical tanning bed users were female, middle-aged, occupied, higher educated, had an immigrant background and were former or current smokers. Risk awareness was the lowest among the current users. The most frequently mentioned reasons were relaxation, enhancement of attractiveness and pre-tanning. Our nationwide representative data showed that the prevalence of indoor tanning has decreased. Of concern are the lower risk awareness among current users and the shift in place of use towards facilities associated with health and wellness. To further reduce the use of tanning beds, targeted information, educational campaigns and extended legislation are considered helpful.

Attitudes Toward Marijuana Use Among Public University Students in Tehran

Background: Substance use is a global mental health issue and a significant challenge in many countries. As reported by the United Nations, marijuana had the highest production, trafficking, and consumption rates in 2022. Attitudes play a crucial role in influencing substance use, including marijuana. Objectives: This study aimed to investigate the prevalence of lifetime marijuana use and attitudes regarding perceived harms, benefits, addictiveness, and reasons for use among students of Tehran universities. Additionally, it seeks to explore gender differences in these attitudes. Methods: This cross-sectional survey was conducted between June 2021 and January 2022 among 538 students from Tehran universities, comprising 44% men and 55.6% women. The sample size of 538 individuals was selected using convenience sampling. Lifetime marijuana use was self-reported, and attitudes were assessed using a validated marijuana attitude questionnaire rated on a 4-point Likert scale. Gender differences were analyzed using descriptive statistics and chi-square tests. Results: Overall, 17.5% of participants reported lifetime marijuana use, with a significantly higher prevalence among males (25%) compared to females (10.37%; P < 0.05). Most students (86%) considered marijuana to be addictive, especially females (92%) compared to males (78%) (χ2 = 17.6; P < 0.05). A larger proportion of females (74%) than males (58%) believed that marijuana was difficult to control (χ2 = 10.08; P < 0.05). While 93.5% acknowledged the existence of side effects, more males (39%) perceived benefits from marijuana use compared to females (28%; P < 0.05). The reported benefits included feelings of happiness (53%), stress and anxiety reduction (50%), and improved concentration (38%). Conclusions: The study revealed that both female and male students perceived marijuana use as equally harmful. However, female students exhibited a more negative attitude toward marijuana use compared to their male counterparts. Specifically, female students considered marijuana to be more addictive and harder to control than male students. This more negative attitude among female students regarding marijuana’s addictiveness, side effects, and controllability corresponded to lower actual usage rates.

Herbal Supplement Use Among Adolescent and Young Adult Women in a Family Planning Clinic

Study ObjectiveWe aimed to evaluate herbal medicine and supplement use patterns among adolescent and young adult women at a family planning focused clinic. MethodsWe conducted a cross-sectional survey of patients (ages 14-25) at an adolescent Title X clinic. Participants completed an electronic survey that assessed herbal medicine and supplement use, baseline demographics, and current contraceptive method. We evaluated supplement-drug interactions using the Natural Medicine's database interaction checker. Quantitative analyses were performed using chi-squared and independent medians tests. ResultsWe enrolled 99 participants with a median age of 20 (15-24) years. Overall, 42.4% of patients reported ever having used supplements or herbal medicines with 29.9% of patients reporting current supplement or herbal medicine use. Patients with higher education and private insurance were more likely to report a history of and current supplement use (p<0.05). The most common herbal supplements reported were green tea (n=26), cannabidiol (n=17), and cranberry (n=16) with 29.6% of participants reporting use to their general healthcare provider. The most common reasons for use were general health and wellness (29.1%), immune support (23.2%), stress (16.8%), and menstrual irregularities (6.0%). We found 62 moderate risk supplement-drug interactions with 50 interactions attributed to hormonal contraceptive therapies. The most common interactions were via cytochrome P450 enzyme (CYP3A4 or CYP1A2) inhibition, decreased caffeine clearance, and potential hepatotoxicity. ConclusionAdolescent and young adult women frequently reported past and current herbal medicine and supplement use, with high rates of moderate risk supplement-drug interactions. Further research is needed to better elucidate these clinically-relevant supplement-contraception interactions.

A Prospective Real-World Study of Bacillus clausii Evaluating Use, Treatment Habits and Patient Satisfaction in Italian Community Pharmacies: The PEGASO Study.

Ailments such as diarrhoea and antibiotic-associated gut symptoms are generally self-managed using probiotics. Real-world data on reasons behind self-medication with over-the-counter (OTC) products and patient-reported outcomes can be investigated strategically by the pharmacists. This study evaluates the use of Bacillus clausii (Enterogermina®) at the Italian community pharmacies among self-medicating patients, their treatment habits and perceived benefits. This is a multicentre, prospective, non-interventional study which included two visits [at screening (T0) and end of the study (T1) when symptoms had subsided, ≤ 30days from T0]. Patients who were already inclined to buy B. clausii were enrolled and instructed to complete a questionnaire at T0 and T1. The primary objective was to evaluate the reasons for taking B. clausii. Secondary objectives assessed treatment duration, perceived effectiveness, quality of life (QoL), treatment satisfaction and safety outcomes. Overall, 268 patients were enrolled; 99.6% of them were evaluated at T0 and 97.4% at T1, and safety was evaluated in 97.8% who had ≥ 1 dose of B. clausii. At T0, mean age was 50.7 years and majority were females (62.2%). In the interview, main reason stated for using B. clausii at T0 was diarrhoea (56.93%), followed by other gastrointestinal symptoms. Treatment duration was shorter in those with diarrhoea or abdominal pain versus those with constipation or abdominal tension. More than 90% perceived their symptoms to have improved or improved very much. Overall QoL improved in all the aspects measured. Treatment satisfaction was reported by nearly 90% of patients as satisfied, very satisfied or extremely satisfied. No adverse events were reported. This is the first pharmacy-based study in Italy that evaluated the real-world usage of an OTC probiotic containing B. clausii among self-medicating adults. Diarrhoea was the most common reason for use, with high-level of perceived effectiveness and patient satisfaction with B. clausii.

Why young adults use tobacco-free nicotine E-cigarettes: An analysis of qualitative data

BackgroundTobacco-free nicotine (TFN) is often marketed as being better tasting and healthier than tobacco-derived nicotine (TDN). Studies have yet to systematically characterize subjective experiences using TFN e-cigarettes. This qualitative study explored young adults’ reasons for using TFN e-cigarettes and perceptions of differences between using TFN and TDN e-cigarettes. MethodWe conducted a national online Qualtrics survey of U.S. young adults aged 18–25 years in October 2021. Respondents who reported lifetime TFN e-cigarette use (n = 317, mean age: 20.8 (SD:2.2), 53.9 % female) provided write-in responses to open-ended questions assessing reasons for using TFN e-cigarettes and perceptions of differences between TFN and TDN e-cigarettes. Responses from participants were thematically analyzed by independent raters. ResultsReasons for using TFN e-cigarettes included product taste/flavor, health reasons (e.g. believing TFN was healthy), and product accessibility. Perceptions of differences between TFN and TDN e-cigarettes included differences in taste/ flavor and acute psychoactive and physical effects (e.g., nicotine buzz, throat hit), with TFN e-cigarettes being described as generally stronger and superior relative to TDN e-cigarettes. ConclusionThese qualitative data suggest that taste and perceived health benefits are primary reasons that young adults try TFN e-cigarettes. Compared to TDN, young adults perceive TFN as better tasting with different psychoactive and less aversive effects. Determining if these perceived reasons for use and differences occur in blinded human experimental studies is a necessary next step to understanding TFN e-cigarette use. Additionally, understanding why young adults use TFN e-cigarettes is important in the development of prevention communication about these products.

Usage and health perception of cannabidiol-containing products among the population in Germany: a descriptive study conducted in 2020 and 2021

BackgroundCannabidiol (CBD), a non-intoxicating substance of Cannabis sativa L., is gaining consumer attention. Yet, legal regulations in the EU are complex and questions of potential health risks remain partly unanswered. In Germany, little is known about people who use CBD products. The aim of this cross-sectional study was to gain insight into the user group of CBD, reasons for consumption and risk perception towards CBD-containing products.MethodsThe study consisted of two parts: In the first part of the study, the prevalence of CBD awareness and usage in Germany was estimated using a telephone survey and a population-representative sample of n = 1,011 respondents. Based on these results, n = 2,000 participants being aware of CBD were surveyed with an online questionnaire in the second part of the study to examine usage and perception of CBD in users and non-users.ResultsWhen the study was conducted at the end of 2020 and beginning of 2021, 40.2% of the German participants had already heard of products containing CBD, and 11.4% had actually used them. 42.1% of the users consumed such products regularly, at least once a week, primarily orally via oils or tinctures, and purchased them mainly online. Besides curiosity – addressed especially in young adults – anticipated health benefits including pain and stress relief were main reasons for use. More than half of the study participants perceived the health benefits of CBD use as high or very high. In contrast, the health risks were rated as low or very low by most respondents. Assumptions about official testing for safety as well as physical effects of CBD-containing products varied between users and non-users.ConclusionAbout one in nine people in Germany uses CBD-containing products. Given reasons for consumption and perception of potential health risks and benefits suggest that people are insufficiently informed about CBD-containing products. The results of the study indicate that risk communication is needed to raise awareness for the topic and to inform (potential) users.

Artificial Intelligence in studies—use of ChatGPT and AI-based tools among students in Germany

AI-based tools such as ChatGPT and GPT-4 are currently changing the university landscape and in many places, the consequences for future forms of teaching and examination are already being discussed. In order to create an empirical basis for this, a nationwide survey of students was carried out in order to analyse the use and possible characteristics of AI-based tools that are important to students. The aim of the quantitative study is to be able to draw conclusions about how students use such AI tools. A total of more than 6300 students across Germany took part in the anonymous survey. The results of this quantitative analysis make it clear that almost two-thirds of the students surveyed use or have used AI-based tools as part of their studies. In this context, almost half of the students explicitly mention ChatGPT or GPT-4 as a tool they use. Students of engineering sciences, mathematics and natural sciences use AI-based tools most frequently. A differentiated examination of the usage behaviour makes it clear that students use AI-based tools in a variety of ways. Clarifying questions of understanding and explaining subject-specific concepts are the most relevant reasons for use in this context.

PSVIII-11 Antinutritional Factors Are Largely Mitigated By Extrusion and Did Not Negatively Impact Digestibility of Canine Grain-Free and Grain-Inclusive Foods

Abstract Ingredients commonly used in companion animal foods, such as whole grains and legumes, naturally contain antinutritional factors (ANF). Some ANF are known contributors to reduced nutrient digestibility and bioavailability, potentially resulting in defective protein synthesis, which is one hypothesis of potential root cause(s) for dilated cardiomyopathy. Yet some ANF, such as trypsin inhibitor (TI) and isoflavones, may act as beneficial bioactives at lower inclusion levels. While various processing methods can impact the presence or activity of ANF, the purpose of this investigation was to assess the presence of ANF in ingredients commonly used in canine foods, the effect of extrusion on ANF, and the subsequent digestibility of foods formulated using different ingredient strategies. Four test foods were formulated to meet requirements for adult dogs at maintenance: 1) grain-inclusive without peas or potatoes, 2) grain-inclusive with peas and pea fiber, 3) grain-free with peas and potatoes, and 4) grain-free with potatoes (Table 1). Grains, legumes, plant proteins, and finished test foods were analyzed for 41 ANF. Percent destruction of ANF was calculated from the inclusion levels of ingredients in the formulations and the tested levels in finished foods. Digestibility studies were then conducted to assess macronutrient digestibility of the test foods. Cereal grains and soybean meal were the primary sources of ANF in raw ingredients. Phytic acid, TI, and isoflavones (daidzin and genistin) were the most common ANF measured in ingredients. Lectin was not detectable in any ingredients or test foods; tannins were detected only in soybean meal. Except for phytic acid and TI, ANF were effectively (&amp;gt;99%) destroyed by this extrusion process. Trypsin inhibitor was detectable at levels slightly above the detection limit (1000 TIU/g) in all finished test foods (Table 2; 1,200 to 1,700 TIU/g). Phytic acid was detectable (0.49 to 0.76%) in all finished test foods except for the grain-free with potatoes formulation. This was unsurprising as both are known to be resistant to inactivation by heat, pressure and steam. Despite their presence in finished test foods, apparent DM, carbohydrate (NFE), and energy digestibility were high (&amp;gt;80%) for all foods; apparent fat and true protein digestibility were &amp;gt;90% (Figure 1). These data demonstrate the effectiveness of this specific extrusion process to minimize or mitigate the majority of ANF in canine foods when formulated with a variety of common ingredients. Despite the presence of these ANF, test foods remained highly digestible, demonstrating the importance and effectiveness of balanced nutritional formulation in mitigating their effects. We assert that the presence or absence of ANF in ingredients should not, by itself, be the reason for use or avoidance of an ingredient. Additional factors such as the quality of the raw ingredient, processing methods, and overall nutritional design must be considered.

Alternative Lymphodepletion Strategies Lead to Similar Response Rates and Toxicities in Standard-of-Care BCMA-Directed CAR-T Therapy in Relapsed Refractory Multiple Myeloma

Introduction: Lymphodepletion (LD) chemotherapy is critical for the efficacy of CAR-T therapy by eradicating immunosuppressive cells, inducing costimulatory molecules, and promoting expansion and persistence of CAR-T cells. It also can contribute to an increased risk of infections, cytopenia, and other toxicities. We evaluated the utilization of varying LD regimens used in standard-of-care (SOC) autologous B-cell maturation antigen-directed (BCMA) CAR-T therapy with ide-cel or cilta-cel for relapsed/refractory multiple myeloma (RRMM) and the effect on outcomes and toxicity. Methods: Data were retrospectively collected from patients with RRMM who underwent LD and CAR-T cell infusion by December 31, 2022, from 13 US academic institutions with SOC ide-cel or cilta-cel. Response rates and other categorical variables, specifically LD regimen, were tested for association using Wilcoxon rank-sum (or Kruskal-Wallis for three or more groups) or Fisher's exact tests, respectively. Results: A total of 523 patients were infused at the time of data cut-off with 489 patients evaluable for safety and survival analyses; 368 (75%) were infused with ide-cel and 121 (25%) with cilta-cel. The median age was 65 years old (range 30-90) with 206 females (42%) and 283 males (58%), and 13% with ECOG performance status ≥ 2 at time of LD. Fludarabine and cyclophosphamide (Flu/Cy) LD was used in 422 patients while 67 patients received other LD regimens including bendamustine-based (n = 35, 52%), cladribine-based (n = 25, 37%) or cyclophosphamide alone (n = 7, 10%). The primary reason for use of Flu/Cy LD was institutional guidance or SOC in 378 patients (90%), while the primary reason for use of other LD regimens was due to the fludarabine shortage in 65 patients (97%) with 3% citing physician's choice or institutional guidance. No significant difference was identified among response outcomes, with those receiving Flu/Cy LD achieving an ORR of 84% compared to 81% with other LD regimens (p = 0.59) and no difference observed in rates of ≥ VGPR (66% Flu/Cy LD vs 60% other LD; p = 0.48). Of those evaluable for MRD at 1 and 3 months, the MRD negative rate at 10 -6 for those with Flu/Cy LD was 77% (n= 137) and 77% (n=113) and with other LD regimens was 66% (n=35) and 79% (n=28), respectively. At a median follow-up of 9.7 months, no statistically significant difference was noted in median progression free survival (mPFS) with Flu/Cy vs other LD regimens (9.3 mos vs NR) or overall survival (OS) (19.4 mos vs NR). When stratified by type of CAR-T therapy, treatment with bendamustine-based LD was associated with an inferior mPFS compared to those receiving Flu/Cy LD in patients treated with ide-cel (3.8 vs 8.5 mos; p=0.0056), though not by multivariate analysis. Univariate analysis of patients treated with ide-cel between Flu/Cy and bendamustine LD did not reveal any significant differences in age, gender, ECOG, R-ISS stage, extramedullary disease, high-risk cytogenetics or renal dysfunction (Cr &amp;lt; 45 ml/min). LD regimen was not a predictor for PFS on multivariable analyses amongst patients treated with ide-cel, while ECOG ≥ 3 (hazard ratio [HR]= 4.44, 95% confidence interval [CI]= 1.40, 14.08) and t(4,14) (HR= 2.02, 95% CI=1.14, 3.59) were associated with worse PFS. No difference in mPFS by LD regimen was observed in patients receiving cilta-cel, which was a smaller cohort (mPFS: Flu/Cy 11.7 mos, bendamustine-based NR, cladribine-based NR, cyclophosphamide NR). Rates of all grade CRS (81% vs 70%), Grade ≥ 3 CRS (3% vs 3%), all grade ICANS (19% vs 12%, and Grade ≥ 3 ICANS (4% vs 2%) were similar among those receiving Flu/Cy or other LD regimens, respectively. Patients receiving Flu/Cy LD were less likely to have any grade cytopenia at 1 month (33% vs 55%, p &amp;lt; 0.001) and 3 months (52% vs 69%, p &amp;lt; 0.001), with no observed difference in infection rate. Conclusions: The fludarabine shortage experienced in the US in late 2022 necessitated the use of alternative LD regimens with BCMA-directed CAR-T therapy with most centers relying on bendamustine- or cladribine-based regimens. Use of bendamustine-based LD was associated with inferior PFS in patients receiving ide-cel on univariate analysis, but not on multivariate analysis after adjusting for other prognostic factors. In summary, there is no clear difference in efficacy or safety between Flu/Cy and non-Flu/Cy LD in patients receiving BCMA-directed CAR-T therapy. *Authors contributed equally

Peranan Sekuent Cartigram Pada Pemeriksaan MRI Knee Joint Dengan Kasus Anterior Cruciate Ligament DI Instalasi Radiologi RSUD Sidoarjo

Background: The MRI knee joint examination procedure for clinical ACL rupture in the Radiology Installation of Sidoarjo Regional Hospital often adds a T2 Mapping MR Cartigram sequence. T2 mapping MR Cartigram is a special sequence for detecting damage to the collagen component of the cartilage matrix using a quantitative approach method by producing a color map. The aim of this research is to determine the procedure, reasons for use, and diagnostic information resulting from the T2 mapping MR Cartigram sequence. Method: This type of research is qualitative research with a case study approach. The research was conducted in March-June 2022 at the Radiology Installation of Sidoarjo Regional Hospital. Research subjects included three patients, three radiographers, one radiologist, and one sending doctor. Data was collected by means of observation, interviews and documentation and then analyzed using an interactive model system method which would be processed in the form of transcripts, then identified, reduced and categorized the data and made open coding so that conclusions could be drawn. Results: The results of the study show that the clinical MRI knee joint examination procedure for ACL rupture at Sidoarjo District Hospital includes patient preparation, equipment preparation, examination techniques and routine sequences used such as PD Fatsat, T2, T1, STIR, T2*GRE, PD 3D Cube, and additional T2 Mapping MR Cartiram sequence. The use of the T2 mapping MR Cartigram sequence aims to determine the effect of ACL rupture on cartilage damage quantitatively and objectively by placing an ROI in the cartilage area so that it can provide diagnostic information including early detection of cartilage damage, increased water content, and cartilage degenerative processes. The results of the interpretation of the analysis carried out by the Sidoarjo Regional Hospital Radiologist were only subjective, namely looking at the resulting color map to see whether it looked even and homogeneous. Conclusion: Basically, existing saturation measurements are not always the same, they will depend on the patient's diagnosis for which the action will be taken. This saturation measurement uses the AVOXimeter 1000E. no less important in the continuity of actions in the cath lab room.

Challenges and achievements in the utilization of the health system among adolescents in a region of Burkina Faso particularly affected by poverty

ObjectiveHealthcare for adolescents receives little attention in low-income countries globally despite their large population share in these settings, the importance of disease prevention at these ages for later life outcomes and adolescent health needs differing from those of other ages. We therefore examined healthcare need and use among adolescents in rural Burkina Faso to identify reasons for use and gaps in provision and uptake.MethodsWe interviewed 1,644 adolescents aged 12-20 living in rural northwestern Burkina Faso in 2017. Topics included healthcare need and satisfaction with care provided. We calculated response-weighted prevalence of perceived healthcare need and utilization, then conducted multivariable regression to look at predictors of need, realized access and successful utilization based on the Andersen and Aday model.Results43.7 [41.2 - 46.0] % of participants perceived need for healthcare at least once in the preceding 12 months - 52.0 [48.1 - 56.0] % of females and 35.6 [32.5 - 39.0] % of males. Of those with perceived need, 92.6 [90.0 - 94.3] % were able to access care and 79.0 [75.6 - 82.0] % obtained successful utilization. Need was most strongly predicted by gender, education and urbanicity, while predictors of successful use included household wealth and female guardian’s educational attainment.ConclusionHealthcare utilization among adolescents is low in rural Burkina Faso, but mostly thought of as sufficient with very few individuals reporting need that was not linked to care. Future objective assessment of healthcare need could help identify whether our results reflect a well-functioning system for these adolescents, or one where barriers lead to low awareness of needs or low expectations for service provision.

Prevalence of antibiotic misuse in cases of pneumonia and diarrhea in Saudi Arabia.

Antibiotic misuse is a major public health issue with long-term repercussions. The purpose of this investigation was to evaluate the effects of pneumonia and diarrhea, with an emphasis on antibiotic misuse. This study included 410 participants (217 fathers and 193 mothers), of whom 239 purchased antibiotics for their children without a prescription, whereas 171 had a prescription or were unsure if one was required. Antibiotics were used incorrectly by 58.1% of respondents. About 51.2% of participants said they were taking two antibiotics at the same time. Around 30% of people admitted to using antibiotics inefficiently. The most prevalent reason for use was "viral and bacterial," followed by "viral," and then "bacterial," with 35%, 21%, and 20%, respectively. In addition, 22.4% of patients have used antibiotics for an unknown reason. Saudi parents of children with pneumonia and diarrhea abuse antibiotics. Saudi legislation banning medications without a prescription has helped reduce antibiotic abuse, but more community-based education and awareness are needed.

Covid-19 Pandemic, Communicable Diseases and Consumption of Dietary and Herbal Supplements in Sub-Sahara African Setting – Nigeria

Introduction: The Covid-19 pandemic brought about changes in the livelihood of most people around the globe, including variations in intake of dietary and herbal supplements (DHS) during the pandemic. Objectives: To evaluate the dynamics of dietary and herbal supplements intake by persons already diagnosed with Tuberculosis (TB), Human Immuno-deficient Virus (HIV) and Hepatitis (Hep) during the pandemic in Nigeria. Design: Cross-sectional questionnaire survey. Setting: Within the geographical location and boundary of the country only. Participants: Adolescents, and adults residing in Nigeria. Respondents with TB, HIV and Hepatitis (n = 243) from a larger study (n=645) were recruited from different geo-political zones and various ethnic groups. Primary and Secondary Outcomes: Prevalence and determinants for the use of different DHS during Covid-19 pandemic in Nigeria, sources of information and reasons for use of these DHS. Results: HIV was the most prevalent communicable disease (95%) in the study. Most of the respondents increased their intake of supplements during the pandemic. Female respondents with HIV were slightly more likely to increase their consumption of supplements more than their male counterparts (χ²=0.09, P-value=0.77, OR=1.12, 95% CI=0.52, 2.45). Vitamin C was the most-consumed supplement by respondents with HIV (64.5%) and TB (60%) but the least by respondents with Hep (14.3%). Calcium (30, 13%) and zinc (16, 7%) were taken only by respondents with HIV. Maintenance of good health was the main reason for increased consumption of DHS and health-care providers were the major source of information on the use of DHS during the pandemic. Conclusions: HIV was most prevalent among the respondents. There was increased consumption of DHS and Vitamin C was the most consumed supplement during Covid-19 pandemic in Nigeria, The use of DHS by Nigerians with communicable diseases should be explored further to ascertain their usefulness or otherwise during illness or a future pandemic.