Registry Data Research Articles

Psychiatric disorder before and after exposure to violent injury: A nationwide Norwegian register-based cohort study

Interpersonal violent injury is associated with increased risk of subsequent psychological problems, but pre-existing psychopathology may complicate this association in ways that are poorly understood. Using nationwide longitudinal registry data from Norway, we tested how psychiatric history modified the association between violent injury exposure and subsequent psychiatric disorder, and examined disorder continuity before vs. after violent injury. We identified all individuals presenting to emergency services in 2010–2018 with a violent injury, along with sex- and age-matched comparison individuals from the general population. The primary outcome was subsequent psychiatric disorder, observed through December 31, 2018, with secondary analyses examining psychiatric diagnoses pre- vs. post-injury. Of the 28,276 violence-injured patients, 20% had a history of psychiatric disorder, vs. 6% of the 282,760 comparison individuals. In Cox regression models, violence-injured patients had substantially higher rates of any subsequent psychiatric disorder when compared to matched peers (HRadj: 2.36; 95% CI: 2.29, 2.42), but this association was confounded and modified by psychiatric history. Continuity of psychiatric diagnosis before and after injury was high among violence-injured patients, but they were also more likely than the comparison group to receive a new diagnosis, potentially indicating incident onset of new psychiatric disorder associated with violence exposure. Violence-injured patients face substantial burden of psychiatric disorder, especially for substance use and mood/anxiety disorders; clinical and public health strategies are needed to address this burden, which precedes violent injury in some cases but is likely provoked by it in others.

6550 National Statin Prescription Trends in Patients With Breast Cancer and Diabetes for Primary Cardiovascular Disease Prevention

Abstract Disclosure: A.B. Yang: None. G. Mhango: None. C. Kong: None. J.J. Lin: None. J.P. Wisnivesky: Consulting Fee; Self; Sanofi, Banook, PPD. Grant Recipient; Self; Sanofi, Regeneron Pharmaceuticals, Axella, Arnold Consultants. A. Leiter: None. Background: Cardiovascular disease (CVD) is the leading cause of death in older early-stage breast cancer (BC) survivors. Due to cardiotoxic BC treatments such as chemotherapy and radiation, patients with BC and diabetes (DM) are at increased risk of CVD. In patients with BC and DM, statins decrease CVD mortality. Since 2013, many clinical guidelines broadened statin indications for primary CVD prevention in patients with DM, making >85% of patients eligible. Little is known about statin prescription (Rx) patterns in older BC survivors with DM, a group at high risk of CVD. Hypothesis: We hypothesized that statin Rxs increased over time, but were less likely in BC survivors with more advanced locoregional BC and lower comorbidity burden. Methods: A population-based, retrospective cohort study was conducted using Surveillance, Epidemiology and End Results (SEER) cancer registry data linked to Medicare claims. We identified women with preexisting DM who were diagnosed with stage 0-III primary BC between 2008-17. We excluded patients with prior CVD who died <1 year after BC diagnosis. Statin Rx (atorvastatin, pravastatin, rosuvastatin, simvastatin, fluvastatin, lovastatin) was defined as ≥1 statin pharmacy claim <1 year after BC diagnosis. Comorbidity burden was assessed with a modified Charlson Comorbidity Index (CCI). We compared patient demographic and clinical characteristics by statin Rx status using the chi-square test. Using a multivariate logistic regression adjusting for age, race, CCI, BC stage, and diagnosis year, independent predictors of statin Rx were identified. Results: Of 8,423 BC patients with pre-existing DM, 5,698 (68%) had a statin Rx. Statin Rx increased over time (BC diagnosis year 2008-10: 66%, 2011-13: 66%, 2014-15: 69%, 2016-17: 70%; p=0.01) and differed by age (66-69: 66%, 70-74: 70%, 75-79: 69%, ≥80: 65%; p<0.01) and race (White: 68%, Black: 62%, Latinx: 66%, Other: 72%; p<0.01). Statin Rx did not differ by comorbidity burden (CCI 0: 68%, 1-2: 67%, ≥3: 67%; p=0.87) and declined with higher BC stage (0: 73%, I: 70%, II: 65%, III: 63%; p<0.01). In adjusted analyses, more recent BC diagnosis (2016-17 vs. 2008-10: odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.04-1.38), age group (70-74 vs. 66-69: OR: 1.24, 95% CI: 1.09-1.41), race (Black vs. White: OR 0.77, 95% CI: 0.66-0.89) and higher BC stages (II vs. 0: OR: 0.76, 95% CI: 0.58-1.00; III vs. 0: OR: 0.72, 95% CI: 0.54-0.97) remained predictors of statin Rx. Conclusions: In a nationally representative cohort analysis of older early-stage BC patients, statin Rx increased between 2008-17 and varied by age, race, and BC stage. Elucidating gaps in statin Rx can potentially improve guideline-concordant Rx in a group at high risk for CVD and reduce disparities. Presentation: 6/2/2024

6777 Exploring the comorbidity in males with 45,X/46,XY mosaicism unveils a pattern mirroring that of Turner syndrome

Abstract Disclosure: K. Stochholm: None. C.H. Gravholt: None. A. Berglund: None. Background: Males with 45,X/46,XY mosaicism are rare with an apparent prevalence of 6 per 100,000 newborn males. Knowledge about associated health outcomes are limited. Females with 45,X/46,XY fall under the Turner syndrome diagnosis but males do not. Aim: To investigate the comorbidity pattern in a national cohort of males with 45,X/46,XY. Methods: Morbidity were investigated using Cox regression analysis on administratively longitudinally collected registry data regarding hospital diagnoses, prescribed medication, and surgery codes. Data were retrieved for all males diagnosed with 45,X/46,XY from 1960 to 2018 (n=135) and for 13,500 age-matched males from the general population, who served as comparator. Results: 45,X/46,XY was associated an increased overall risk of receiving a hospital diagnosis (HR: 1.6, CI: 1.3-1.9), being prescribed medication (HR: 1.2, CI: 1.03-1.5), and undergoing a surgical procedure (HR: 1.8, CI: 1.4-2.1). Dividing hospital diagnoses into 18 chapters according to the International Classification of Diseases (ICD-10), 45,X/46,XY had a significantly increased risk of diagnoses in all but three chapters. Among diagnoses with a significantly increased risk were gonadal dysfunction (HR=63.7, CI: 34.8-116.9), short stature (HR=24.7, CI: 10.0-60.6), pubertal disorders (HR=25.8, CI:7.2-92.6), type 1 (HR=4.1, CI: 1.8-9.4) and type 2 diabetes mellitus (HR=3.4, CI: 1.7-6.6), thyroid disorders (HR=3.8, CI: 1.4-10.4), obesity (HR=4.4, CI: 2.3-8.2), osteoporosis and osteopenia (HR=5.4, CI: 2.4-12.3), hearing loss (HR=2.2, CI: 1.3-3.8), otitis media (HR=1.6, CI: 1.3-1.9), ischemic heart disease (HR=2.4, CI: 1.3-4.4), hypertension (HR=2.3, CI: 1.4-3.9), inflammatory bowel disease (HR=2.5, CI: 1.2-5.4), cryptorchidism (HR=11.9, CI: 7.8-17.8), hypospadias (25.9, CI: 14.0-47.8), testis cancer (HR=6.4, CI: 2.0-20.6), infertility (HR=23.5, CI: 16.0-34.4), gynecomastia (HR=4.6, CI: 1.7-12.5), horse shoe kidney (HR=177,8, CI: 16.1-1968.8), coarctation of the aortae (HR=66.0, CI: 11.0-394.9), and bicuspid aortic valve (HR=53.4, CI: 12.7-223.7). Conclusion: Males with 45,X/46,XY mosaicism exhibit heightened morbidity, evidenced by a notable surge in hospital diagnoses, prescribed medications, and surgical interventions. This increased morbidity is linked to a broad spectrum of diseases, showcasing a comorbidity pattern reminiscent of Turner syndrome. This study emphasizes the need for systematic follow-up in individuals with 45,X/46,XY mosaicism, highlighting the imperative for proactive healthcare management in this population. Presentation: 6/1/2024

6777 Exploring the comorbidity in males with 45,X/46,XY mosaicism unveils a pattern mirroring that of Turner syndrome

Abstract Disclosure: K. Stochholm: None. C.H. Gravholt: None. A. Berglund: None. Background: Males with 45,X/46,XY mosaicism are rare with an apparent prevalence of 6 per 100,000 newborn males. Knowledge about associated health outcomes are limited. Females with 45,X/46,XY fall under the Turner syndrome diagnosis but males do not. Aim: To investigate the comorbidity pattern in a national cohort of males with 45,X/46,XY. Methods: Morbidity were investigated using Cox regression analysis on administratively longitudinally collected registry data regarding hospital diagnoses, prescribed medication, and surgery codes. Data were retrieved for all males diagnosed with 45,X/46,XY from 1960 to 2018 (n=135) and for 13,500 age-matched males from the general population, who served as comparator. Results: 45,X/46,XY was associated an increased overall risk of receiving a hospital diagnosis (HR: 1.6, CI: 1.3-1.9), being prescribed medication (HR: 1.2, CI: 1.03-1.5), and undergoing a surgical procedure (HR: 1.8, CI: 1.4-2.1). Dividing hospital diagnoses into 18 chapters according to the International Classification of Diseases (ICD-10), 45,X/46,XY had a significantly increased risk of diagnoses in all but three chapters. Among diagnoses with a significantly increased risk were gonadal dysfunction (HR=63.7, CI: 34.8-116.9), short stature (HR=24.7, CI: 10.0-60.6), pubertal disorders (HR=25.8, CI:7.2-92.6), type 1 (HR=4.1, CI: 1.8-9.4) and type 2 diabetes mellitus (HR=3.4, CI: 1.7-6.6), thyroid disorders (HR=3.8, CI: 1.4-10.4), obesity (HR=4.4, CI: 2.3-8.2), osteoporosis and osteopenia (HR=5.4, CI: 2.4-12.3), hearing loss (HR=2.2, CI: 1.3-3.8), otitis media (HR=1.6, CI: 1.3-1.9), ischemic heart disease (HR=2.4, CI: 1.3-4.4), hypertension (HR=2.3, CI: 1.4-3.9), inflammatory bowel disease (HR=2.5, CI: 1.2-5.4), cryptorchidism (HR=11.9, CI: 7.8-17.8), hypospadias (25.9, CI: 14.0-47.8), testis cancer (HR=6.4, CI: 2.0-20.6), infertility (HR=23.5, CI: 16.0-34.4), gynecomastia (HR=4.6, CI: 1.7-12.5), horse shoe kidney (HR=177,8, CI: 16.1-1968.8), coarctation of the aortae (HR=66.0, CI: 11.0-394.9), and bicuspid aortic valve (HR=53.4, CI: 12.7-223.7). Conclusion: Males with 45,X/46,XY mosaicism exhibit heightened morbidity, evidenced by a notable surge in hospital diagnoses, prescribed medications, and surgical interventions. This increased morbidity is linked to a broad spectrum of diseases, showcasing a comorbidity pattern reminiscent of Turner syndrome. This study emphasizes the need for systematic follow-up in individuals with 45,X/46,XY mosaicism, highlighting the imperative for proactive healthcare management in this population. Presentation: 6/1/2024

Mapping refugee populations at high resolution by unlocking humanitarian administrative data

BackgroundInforming local decision-making, improving service delivery and designing household surveys require having access to high-spatial resolution mapping of the targeted population. However, this detailed spatial information remains unavailable for specific population subgroups, such as refugees, a vulnerable group that would significantly benefit from focused interventions. Given the continuous increase in the number of refugees, reaching an all-time high of 35.3 million people in 2022, it is imperative to develop models that can accurately inform about their spatial locations, enabling better and more tailored assistance.MethodsWe leverage routinely collected registration data on refugees and combine it with high-resolution population maps, satellite imagery derived settlement maps and other spatial covariates to disaggregate observed refugee totals into 100-m grid cells. We suggest a deterministic grid cell allocation inside monitored refugee sites based on building count and a random-forest-derived grid cell allocation outside refugee sites based on geolocating the textual geographic information in the refugee register and on high-resolution population mapping. We test the method in Cameroon using the registration database monitored by the United Nations High Commissioner for Refugees.ResultsUsing OpenStreetMap, 83% of the manually inputted information in the registration database could be geolocated. The building footprint layer derived from satellite imagery by Ecopia AI offers extensive coverage within monitored refugee sites, although manual digitization was still required in rapidly evolving settings. The high-resolution mapping of refugees on a 100-m grid basis provides an unparalleled level of spatial detail, enabling valuable geospatial insights for informed local decision-making.ConclusionsGathering information on forcibly displaced persons in sparse data-setting environment can quickly become very costly. Therefore, it is critical to gain the most knowledge from operational data that is frequently collected, such as registration databases. Integrating it with ancillary information derived from satellite imagery paves the way for obtaining more timely and spatially precise information to better deliver services and enhance sampling frame for target data collection exercises that further improves the quality of information on people in need.

Consequences of a welfare benefit reduction for refugee families on children’s school absence and crime

ABSTRACT I investigate the effect of lowering welfare benefits for refugees on children's outcomes in Denmark. For identification, I exploit a reform that gave refugees lower benefits if they were granted residency after September 2015. The exact date of residency is plausible random due to the nature of the asylum process. By using Danish register data, I compare children who were granted residency before and after the benefit reduction and show that reform reduced household income by 22%. Secondly, I find a 19% increase in absence from primary school, driven by an increase in residual absence.

EVs meet health: A complex-systems policy integration approach for electric vehicle adoption and its impact on respiratory and cardiovascular disease

The transition from gasoline-combustion to zero-emission vehicles represents one of the most ambitious public and private enterprises around the globe to mitigate air pollution and its subsequent effects on climate change. The present study uses the rapid transition in the state of California to analyze the connections between the increasing utilization of electric vehicles (EVs) and two critical health outcomes: Asthma and acute myocardial infarction (AMI) emergency department (ED) visits. We fit simultaneous quantile and interquartile-range regression models to health and sociodemographic data from the California Office of Health and Hazard Assessment and electric vehicles registration data, 2011–2017. Results show that changes in EV utilization, from 2011 to 2013 to 2015–2017, have larger and more favorable effects as asthma and AMI deteriorate across zip codes. Looking at zip codes located at the 75th and 25th percentiles of the change in the asthma- and AMI-related ED visits distribution, a 5-percentage points change in the EV-to-gasoline combustion utilization ratio is associated with a 25-percentage points (p<.01) and 12.5-percentage points (p<.01) decline in asthma- and AMI-related ED visits, respectively. Our findings also suggest that, should the U.S. meet the goals of Executive Order N-79-20 by 2035, we could observe about 37,000 fewer asthma-related ED visits (95% CI: 16,154–59,280) per year, with an overall possible annual savings of about $65.5 million dollars (95% CI: $29.1M – $106.7M), and a possible decline of about 19,292 AMI-related hospitalizations, with possible annual savings of about $425 million dollars (95% CI: $365M – $509M). Our findings are optimistic in that spillover effects from increasing EV utilization can reduce healthcare costs while improving population health. Research should point toward the development of public-private coalitional strategies to effectively bridge usually disparate sectors of the economy and policy-making like energy and health.

Safety and efficacy assessment of the Inno-Xmart venous stent system in managing symptomatic iliofemoral venous obstruction: a 12-month outcome analysis.

This study aims to evaluate the safety and efficacy of the dedicated Inno-Xmart braided venous stent system (Suzhou Innomed Medical Device Co., Ltd., Jiangsu, China) in treating symptomatic iliofemoral venous obstruction. This clinical study followed a prospective, multicentre, single-arm design with the application of an objective performance goal. Patients diagnosed with symptomatic iliofemoral venous obstruction who met the eligibility criteria of this study were enrolled and treated with the Inno-Xmart venous stent system. The safety endpoints included the assessment of stent fracture, satisfaction of delivery system and 12-month incidence rate of major adverse events (MAEs). The primary efficacy endpoint focused on evaluating the 12-month primary patency rate through venography as determined by core laboratory. Secondary efficacy endpoints included surgical success rate, 6-month primary patency rate and the changes in quality of life from baseline to 6- and 12-month follow-up intervals. Between September 18, 2019, and April 26, 2021, 193 patients were successfully enrolled across 18 research institutions. The surgical success rate was 95.3% (184/193), the 12-month MAE rate was 5.1% (9/178) with no stent fractures or migrations. The 12-month primary patency rate for the participants was 96.1%, significantly surpassing the literature-derived objective performance of 80% (95% confidence interval [CI], 92.1-98.4; P < 0.0001). In addition, the mean venous clinical severity score (VCSS) and Chronic Venous Disease Quality of Life Questionnaire (CIVIQ) scores at the 6- and 12-month follow-ups were significantly lower than the preoperative scores (P < 0.001). The innovative, dedicated braided venous stent designed to address symptomatic iliofemoral venous obstruction demonstrates a high technical success rate, low complication rates, and impressive mid-term (12-month) patency. It effectively enhanced the quality of life for patients and holds promising prospects for a wide range of applications. The clinical study was officially registered in the "Chinese Clinical Trial Registry" (Registration number: ChiCTR2000040216, date of registration: November 25th, 2020).

Maladaptive eating behaviors and health-related quality of life in Spanish children

In children, assessing health-related quality of life (HRQoL) and identifying the factors that can influence it are essential to understanding their overall health and well-being. Although eating disorders in children have been associated with reduced HRQoL, the impact of maladaptive eating behaviors, such as external eating, emotional eating and restrained eating, on children's HRQoL has not yet been prospectively explored. Therefore, the aim of this study was to determine whether external, emotional and restrained eating at baseline was associated with HRQoL in children after 14.65 months (95% CI: 14.57–14.73) of follow-up. The study involved 690 boys and 681 girls aged between 8 and 10 years, recruited from primary schools in Catalonia (Spain). To assess the relationship between external, emotional and restrained eating behaviors at baseline and HRQoL at follow-up, the Dutch Eating Behavior and KIDSCREEN-10 questionnaires were used, respectively. After adjusting for sex, age, intervention allocation group, school, maternal education, zBMI and physical activity, external and emotional eating behaviors at baseline were negatively associated with HRQoL at follow-up (p < 0.01). These associations were attenuated after final adjustment for HRQoL at baseline. Furthermore, a composite score of maladaptive eating behaviors at baseline was created by summing the individual scores for emotional, restrained and external eating behaviors. This composite score showed a significant inverse association with HRQoL at follow-up, even after adjusting for baseline HRQoL (p = 0.024). In conclusion, external and emotional eating behaviors seems to negatively affect HRQoL prospectively in Spanish children. The composite score of maladaptive eating behaviors showed a stronger inverse association with HRQoL than each eating behavior individually. Trial registration numberISRCTN registry: ISRCTN68403446; Date of registration, August 01, 2014 ′Retrospectively registered'.

Plasma EGFR mutation ctDNA dynamics in patients with advanced EGFR-mutated NSCLC treated with Icotinib: phase 2 multicenter trial result

Plasma epidermal growth factor receptor mutation (EGFRm) circulating tumor DNA (ctDNA) dynamics exhibit promise in predicting outcomes in patients with EGFRm-advanced non-small cell lung cancer (NSCLC). However, there remains limited trial-level data on integrating ctDNA monitoring into clinical practice. We performed a prospective, multicenter trial to investigate the relationship between EGFRm ctDNA dynamic changes and clinical outcomes in NSCLC patients with EGFRm. Ninety-eight treatment-naive EGFRm-advanced NSCLC patients were recruited and administered icotinib until disease progression. Plasma samples were collected at baseline and four weeks after icotinib administration. ctDNA was analyzed using a droplet-digital polymerase chain reaction. At baseline, 71.4% of patients had detectable EGFRm ctDNA. Among them, 45.9% of patients’ ctDNA became undetectable within four weeks of treatment. These patients demonstrated significantly longer progression-free survival (PFS) and overall survival (OS) than those with detectable ctDNA after treatment (P = 0.004 and < 0.001, respectively) and were comparable to those with undetectable ctDNA at both baseline and four weeks. ctDNA detectable at four weeks emerged as a poor independent risk factor for PFS and OS. Patients whose ctDNA became undetectable after treatment had outcomes similar to those with initially undetectable ctDNA, underscoring the predictive value of ctDNA dynamics in treatment efficacy.Registry and the Registration No. of the study/trial: ChiCTR-DDD-17013131. Date of registration: 2017-10-27.

Disparities Between Clinical Trial Recruitment and Real-World Demographics in Macular Edema Secondary to Retinal Vein Occlusion

PurposeClinical trial cohorts frequently differ demographically from the overall population receiving treatment for the condition under study. Our study describes the racial, ethnic, and gender composition of the cohorts of retinal vein occlusion (RVO) macular edema (ME) clinical trials and compares this to the racial, ethnic, and gender composition of patients undergoing treatment for ME secondary to RVO from the (Intelligent Research in Sight) IRIS® Registry. DesignRetrospective observational case series Subjects: Participants in RVO-ME clinical trials that met the following inclusion criteria: conducted in the United States of America, Phase III completed, data reported between Jan 1, 2000, and Jan 1, 2020, and demographic information reported with results. MethodsThis study identified clinical trials by searching PubMed with the following search terms; “retinal vein occlusion” and “clinical trial” and by searching ClinicalTrials.gov with the search term “retinal vein occlusion”. Main Outcome MeasuresThe primary outcome was the enrollment fraction defined as the number of trial enrollees divided by the reference sample size of RVO patients undergoing treatment for ME from published IRIS® Registry (Intelligent Research in Sight) data. Enrollment fraction was compared between different races, ethnicities, and genders. ResultsEight clinical trials met our inclusion criteria. Compared to the enrollment fraction of 7.69% among Whites, lower enrollment fractions were found in Black patients (4.32%, odds ratio [OR] 0.541, confidence interval [CI] 0.468-0.626, P< 0.001) and Hispanic patients (3.38%, OR 0.420, CI 0.351-0.503, P<0.001), and higher enrollment fraction in Asian patients (10.68%, OR 1.436, CI 1.207-1.708, P<0.001). Men were more likely to enroll in the clinical trials compared to women (enrollment fraction, 7.69% vs 5.77%, respectively, OR 1.364, CI 1.273-1.462, P < 0.001). ConclusionsRVO-ME clinical trials have a higher relative proportion of Asian, White and male subjects when compared to the population undergoing treatment for ME secondary to RVO. Further efforts should encourage clinical trial recruitment that is reflective of the RVO population undergoing treatment for ME to ensure generalizability of clinical trial results.

Unemployment as a risk factor for gambling disorder: A longitudinal study based on national registry data.

Unemployment rates are elevated among individuals with disordered gambling, yet the directionality of the relationship remains unclear. The present study investigated paid and unpaid unemployment as risk factors for future gambling disorder (GD). The study employed a case-control design, including all adult Norwegians receiving a GD diagnosis within specialist health services from January 2008 to December 2018 (n = 5,131). These individuals were compared with age- and sex-matched controls from the general population (n = 30,164), as well as controls with somatic and psychiatric diagnoses (n = 30,476). Logistic regressions showed that those in the highest quartile of unpaid unemployment days had more than double the odds (odds ratio [OR] 2.23 (95% CI [1.96, 2.52]) of developing GD compared to those with no unpaid unemployment days. Similarly, higher levels of paid unemployment were also found to increase the odds for GD, with those in the highest quartile having an OR of 1.86 (95% CI [1.50, 2.28]) compared to those with no paid unemployment days. Moreover, an interaction analysis indicated that the association between paid unemployment days and GD was significantly stronger among men compared to women. The present study suggests that both paid and unpaid unemployment constitute risk factors for GD. Programs aiming at obtaining and sustaining work have been found to improve health and future studies should examine ifthe risk for GD can be similarly mitigated.

Reliability of Variables of Consonant Production and Velopharyngeal Competence in 10-year-olds with Cleft Palate Using Multiple Raters.

To assess the reliability of speech data and speech-related quality indicators in the Swedish quality registry for cleft lip and palate (CLP) at 10 years of age. Retrospective study. University hospitals. One hundred twenty-one 10-year-olds with unilateral or bilateral CLP. Six independent raters reassessed audio recordings for comparison with registry data. For calculation of agreement, the single measures intraclass correlation coefficient (ICC) was used for percentage of consonants correct (PCC) and non-oral speech errors, quadratic weighted kappa for velopharyngeal competence (VPC), and percentage agreement and kappa for quality indicators. The results of the three to four raters with the highest intra-rater and inter-rater reliability were used for comparison with registry data. There was excellent agreement between registry data and reassessments for PCC (ICC, 0.93) and percentage of non-oral errors (ICC, 0.80). For VPC, one rater and registry data had good agreement (k, 0.704); the remaining cases had fair agreement (k, 0.476-0.554). The percentage agreement between registry data and reassessments for quality indicators ranged from fair to excellent. When calculated with kappa, agreement was good to excellent (mean of all k values, 0.67-0.70). The CLP registry variables PCC and percentage of non-oral errors and the quality indicators without non-oral speech errors and competent/marginally incompetent velopharyngeal function are reliable for use in clinical audits and research of 10-year-olds. The three-tier ratings of VPC have weaker reliability but can still be useful in more detailed analyses if interpreted with caution.

The Effect of a Physical Activity Program on Subjective Well-Being, Happiness and Problem-Solving Skills in Patients with Schizophrenia: A Randomized Controlled Trial.

The aim of this randomized controlled trial was to examine the effect of Physical Activity Program applied to patients with schizophrenia on subjective well-being, happiness and problem-solving skills levels. This study was conducted with a total of 86 individuals diagnosed with schizophrenia (43 intervention and 43 control) registered in a family health center. Subjective Well-Being Scale, the Short Form of the Oxford Happiness Questionnaire and Problem-Solving Inventory were used to collect the data at baseline and, post-intervention. Significant increases in subjective well-being, happiness, and problem-solving skills were found in the intervention group after the total of 12 weeks of the Physical Activity Program, which included walking and exercises, compared to the control group. Accordingly, it can be said that the Physical Activity Program is an effective method that increases subjective well-being, happiness and problem-solving skills. ClinicalTrials.gov Identifier number is NCT15976921 and date of registration is 21/11/2023, retrospectively registered.

Epidemiological Study of Adenoid Cystic Carcinoma and Its Outcomes: Insights from the Surveillance, Epidemiology, and End Results (SEER) Database

Objective: Adenoid cystic carcinoma (ACC) is a rare malignant tumor that mainly arises in the head and neck area. We aimed to compare the long-term survival of patients with ACC based on their geographic regions within the United States using the Surveillance, Epidemiology, and End Results (SEER) registry data. Methods: We queried the SEER database to evaluate the geographic distribution of ACC patients based on inpatient admissions. The states included in the study were divided into four geographical regions (Midwest, Northeast, South, and West) based on the U.S. Census Bureau-designated regions and divisions. Demographic and clinical variables were compared between the groups. Kaplan–Meier curves and Cox regression were used to assess late mortality. Results: A total of 5150 patients were included (4.2% from the Midwest, 17.2% from the Northeast, 22.5% from the South, and 56.1% from the West regions). The median follow-up was 12.3 (95% CI: 11.6–13.1 years). Median overall survival was 11.0 (95% CI: 9.2-NR years), 14.3 (95% CI: 12.4–16.4 years), 11.3 (95% CI: 9.7–14.8 years), and 12.0 (95% CI: 11.3–13.0 years) for Midwest, Northeast, South, and West regions, respectively. In multivariable analysis, older age, male sex, thoracic cancer, the presence of regional and distal disease, receiving chemotherapy, not undergoing surgical resection, and being treated in the West vs. Northeast region were found to be independent predictors of poor survival. We identified a significant survival difference between the different regions, with the West exhibiting the worst survival compared to the Northeast region. Conclusions: In addition to the well-known predictors of late mortality in ACC (tumor location, stage, and treatment modalities), our study identified a lack of social support (being unmarried) and geographic location (West region) as independent predictors of late mortality in multivariable analysis. Further research is needed to explore the causal relationships.

Likelihood adaptively incorporated external aggregate information with uncertainty for survival data.

Population-based cancer registry databases are critical resources to bridge the information gap that results from a lack of sufficient statistical power from primary cohort data with small to moderate sample size. Although comprehensive data associated with tumor biomarkers often remain either unavailable or inconsistently measured in these registry databases, aggregate survival information sourced from these repositories has been well documented and publicly accessible. An appealing option is to integrate the aggregate survival information from the registry data with the primary cohort to enhance the evaluation of treatment impacts or prediction of survival outcomes across distinct tumor subtypes. Nevertheless, for rare types of cancer, even the sample sizes of cancer registries remain modest. The variability linked to the aggregated statistics could be non-negligible compared with the sample variation of the primary cohort. In response, we propose an externally informed likelihood approach, which facilitates the linkage between the primary cohort and external aggregate data, with consideration of the variation from aggregate information. We establish the asymptotic properties of the estimators and evaluate the finite sample performance via simulation studies. Through the application of our proposed method, we integrate data from the cohort of inflammatory breast cancer (IBC) patients at the University of Texas MD Anderson Cancer Center with aggregate survival data from the National Cancer Data Base, enabling us to appraise the effect of tri-modality treatment on survival across various tumor subtypes of IBC.

Impact of the COVID-19 Pandemic and Lockdown on Cancer Diagnoses Using Swiss Cantonal Cancer Registry Data

Background/Objectives: This study aims to investigate differences in cancer diagnosis based on absolute case numbers and age-standardized incidence rate ratios (IRRs) in the pre-Coronavirus disease 2019 (COVID-19) years (2018/19) and the first two years of the COVID-19 pandemic (2020, 2021) in two Swiss cantons. Methods: Data of the Swiss cantonal cancer registry of the cantons of Zurich (ZH) and Zug (ZG) were used to descriptively investigate differences in annual and monthly absolute numbers regarding all-cancer and the five most common cancer types. Directly age-standardized monthly incidence rates (IRs) were calculated. Multivariate Quasipoisson regression models were fitted to determine the IRRs with 95% confidence intervals (95% CI). Results: Annual absolute numbers of all investigated cancers were similar in 2018/19, 2020, and 2021, except for prostate cancer (increase of 20.8% in 2021 compared to 2018/19). In 2020, there were generally more cancer diagnoses in January and February followed by a decrease in April and May. Compared to the pre-COVID-19 period, lower IRs were observed in 2020 for all-cancer (IRR = 0.96 [95% CI 0.96, 0.97]) and female breast cancer (0.92 [0.89, 0.96]), whereas higher IRs were observed in 2021 for all-cancer (1.02 [1.02, 1.02]) and prostate cancer (1.23 [1.18, 1.28]). Conclusions: Cancer detection and diagnoses decreased during the first year of the pandemic, especially during the most stringent lockdown phase in April. The findings of this study may inform the decisions of policymakers and public health system during future pandemics.

Defining sensitivity and specificity for quality control of organized cancer screening using Prefectural Cancer Registry data in Japan

Objective To decrease cancer mortality by implementing cancer screening programs, rigorous quality control measures that utilize standardized indicators are imperative. In Japan, although each municipality performing cancer screening programs implements quality control for their programs using the checklist authorized by the Ministry of Health, Labour and Welfare, compliance with all the items listed is not possible because calculating sensitivity and specificity using cancer registry data is difficult under these circumstances. This report elucidates the methodology for calculating indicators, including sensitivity and specificity, by delineating the parameters of false-negative cases within population-based cancer screening programs in Japan. Furthermore, the inherent challenges associated with ensuring the quality control of cancer screening procedures are expounded upon in this report.Method Data from the Prefectural Cancer Registry of Japan and cancer screening records compiled by municipalities were used to differentiate true-positive, true-negative, false-positive, and false-negative cases based on the combination of screening test outcomes and subsequent cancer incidence.Results A false-negative case was defined as an examinee who received a cancer diagnosis within one year after undergoing the screening test, notwithstanding the negative judgment of the cancer screening decision. The duration for judgment of true-positive, true-negative, and false-negative cases was also extended to one year. Cancer identification after cancer screening was ascertained using data from the Prefectural Cancer Registry, ensuring uniform categorization of the four cases. Subsequently, sensitivity and specificity values were calculated for municipalities conducting cancer screening programs.Conclusion Sensitivity and specificity are indispensable metrics for the inherent quality control of cancer screening because these parameters directly assess the efficacy of screening tests. The anticipated increase in the number of municipalities engaged in comprehensive quality control of cancer screening in Japan is poised to enhance the efficiency of cancer control policies. This augmentation will be accomplished through the meticulous utilization of the sensitivity and specificity values elucidated in the present report. The forthcoming challenges involve the proliferation of medical institutes reporting their adherence to the checklist stipulated by the National Cancer Center of Japan and the widespread dissemination of fundamental knowledge pertaining to cancer screening.

Identifying when racial and ethnic disparities arise along the continuum of transplant care: a national registry study

Fewer minoritized patients with end-stage kidney disease (ESKD) receive kidney transplantation (KT); efforts to mitigate disparities have thus far failed. Pinpointing the specific stage(s) within the transplant care continuum (being informed of KT options, joining the waiting list, to receiving KT) where disparities emerge among each minoritized population is pivotal for achieving equity. We therefore quantified racial and ethnic disparities across the KT care continuum. We conducted a retrospective cohort study (2015-2020), with follow-up through 12/10/2021. Patients with incident dialysis were identified using the US national registry data. The exposure was race and ethnicity (Asian, Black, Hispanic, and White). We used adjusted modified Poisson regression to quantify the adjusted prevalence ratio (aPR) of being informed of KT, and cause-specific hazards models to calculate adjusted hazard ratios (aHR) of listing, and transplantation after listing. Among 637,951 adults initiating dialysis, the mean age (SD) was 63.8 (14.6), 41.8% were female, 5.4% were Asian, 26.3% were Black, 16.6% were Hispanic, and 51.7% were White (median follow-up in years [IQR]:1.92 [0.97-3.39]). Black and Hispanic patients were modestly more likely to be informed of KT (Black: aPR=1.02, 95% confidence interval [CI]:1.01-1.02; Hispanic: aPR=1.03, 95% CI: 1.02-1.03) relative to White patients. Asian patients were more likely to be listed (aHR=1.18, 95% CI: 1.15-1.21) but less likely to receive KT (aHR=0.56, 95% CI: 0.54-0.58). Both Black and Hispanic patients were less likely to be listed (Black: aHR=0.87, 95% CI: 0.85-0.88; Hispanic: aHR=0.85, 95% CI: 0.85-0.88) and receive KT (Black: aHR=0.61, 95% CI: 0.60-0.63; Hispanic: aHR=0.64, 95% CI: 0.63-0.66). Improved characterization of the barriers in KT access specific to each racial and ethnic group, and the interventions to address these distinct challenges throughout the KT care continuum are needed; our findings identify specific stages most in need of mitigation. National Institutes of Health.

A randomized controlled trial of a self-guided mobile app targeting repetitive negative thought to prevent depression in university students: study protocol of the Nurture-U Reducing Worry prevention trial

BackgroundTackling poor mental health in university students has been identified as a priority in higher education. However, there are few evidence-based prevention initiatives designed for students. Repetitive Negative Thought (RNT, e.g. worry, rumination) is elevated in university students and is a well-established vulnerability factor for anxiety and depression. Furthermore, there are now evidence-based cognitive-behavioural interventions to tackle RNT. A mobile self-help cognitive-behavioural app targeting RNT, adapted for students may therefore be an effective, scalable, and acceptable way to improve prevention in students.MethodsAn online single blind, two-arm parallel-group Randomised Controlled Trial (RCT) to examine the incidence of major depression and symptoms of anxiety and depression across 12 months in university students aged over 16 who screen into the study with self-reported high levels of worry and/or rumination and no current diagnosis of major depression. Eligible participants will be randomised to the active intervention arm (usual practice plus using a self-guided mobile app targeting RNT) or to the control arm (usual practice). In total, 648 participants aged over 16, with no current major depression, bipolar disorder or psychosis will be recruited from UK universities. Assessments will take place at baseline (pre-randomisation), 3 months and 12 months post- randomisation. Primary endpoint and outcome is incidence of major depression as determined by self-reported diagnostic criteria at 12-month follow-up. Depressive symptoms, anxiety, well-being, health-related quality of life, functioning and academic outcomes are secondary outcomes. Compliance, adverse events, and potentially mediating variables will be carefully monitored.DiscussionThe trial aims to provide a better understanding of the causal role of tackling RNT (worry, rumination) using a self-help mobile app with respect to preventing depression in university students. This knowledge will be used to develop and disseminate innovative evidence-based, feasible, and effective mobile-health public health strategies for preventing common mental health problems.Trial registrationhttps://www.isrctn.com/ISRCTN86795807 Date of registration: 27 October 2022