Database Study Research Articles

Routine vaccine uptake in school-aged autistic and non-autistic youth: A linked database study.

This study was conducted to determine whether school-aged autistic youth received routine vaccines at a lower rate than their non-autistic peers. In Nova Scotia (NS), Canada, vaccines routinely delivered in early adolescence are administered to Grade 7 students through a school-based Public Health vaccination program. NS youth eligible to receive Grade 7 vaccinations between 2011 and 2017 were included in this study. Autism spectrum disorder (ASD) diagnoses were determined from administrative health data. Rates of receipt of any Grade 7 vaccine and of individual vaccines were compared between autistic and non-autistic youth. Subgroup analyses included comparing Grade 7 vaccine receipt between autistic youth and their non-autistic siblings and early childhood vaccine receipt between autistic and non-autistic cohorts. The rates of receipt of any vaccine were 73% among 916 autistic youth and 82% among 49,599 non-autistic youth (adjusted relative risk = 0.91; 95% confidence interval = 0.87-0.95). Similar results were found for individual vaccines. Subgroup analyses revealed lower rates of Grade 7 vaccine receipt among autistic youth compared to among their non-autistic siblings. Rates of early childhood vaccine receipt did not differ between autistic and non-autistic cohorts. Autistic youth were under-vaccinated compared to their non-autistic peers for Grade 7 vaccinations. Lower vaccination rates in autistic youth than in their non-autistic siblings suggest that setting-related factors may contribute more to the under-vaccination of autistic youth than parental vaccine hesitancy. Barriers to vaccine uptake for school-aged autistic youth, including those unique to school-based vaccination programs, must be explored and addressed.

ASO Visual Abstract: Survival Outcomes of Cytoreductive Surgery with HIPEC in Gastric Adenocarcinoma: A National Cancer Database Study.

ASO Visual Abstract: Survival Outcomes of Cytoreductive Surgery with HIPEC in Gastric Adenocarcinoma: A National Cancer Database Study.

Boosting efficiency in a clinical literature surveillance system with LightGBM.

Given the suboptimal performance of Boolean searching to identify methodologically sound and clinically relevant studies in large bibliographic databases, exploring machine learning (ML) to efficiently classify studies is warranted. To boost the efficiency of a literature surveillance program, we used a large internationally recognized dataset of articles tagged for methodological rigor and applied an automated ML approach to train and test binary classification models to predict the probability of clinical research articles being of high methodologic quality. We trained over 12,000 models on a dataset of titles and abstracts of 97,805 articles indexed in PubMed from 2012-2018 which were manually appraised for rigor by highly trained research associates and rated for clinical relevancy by practicing clinicians. As the dataset is unbalanced, with more articles that do not meet the criteria for rigor, we used the unbalanced dataset and over- and under-sampled datasets. Models that maintained sensitivity for high rigor at 99% and maximized specificity were selected and tested in a retrospective set of 30,424 articles from 2020 and validated prospectively in a blinded study of 5253 articles. The final selected algorithm, combining a LightGBM (gradient boosting machine) model trained in each dataset, maintained high sensitivity and achieved 57% specificity in the retrospective validation test and 53% in the prospective study. The number of articles needed to read to find one that met appraisal criteria was 3.68 (95% CI 3.52 to 3.85) in the prospective study, compared with 4.63 (95% CI 4.50 to 4.77) when relying only on Boolean searching. Gradient-boosting ML models reduced the work required to classify high quality clinical research studies by 45%, improving the efficiency of literature surveillance and subsequent dissemination to clinicians and other evidence users.

Adverse Obstetric Outcomes after Breast Cancer Diagnosis: An Observational Database Study in Germany.

Breast cancer may negatively affect later pregnancy and childbirth. We aimed to analyze the impact of previous breast cancer on obstetric outcomes in postdiagnosis pregnancies. Insurance claims data in Southern Germany were used to identify breast cancer (BC) survivors with at least one subsequent delivery after cancer diagnosis between 2010 and 2020. In total, 74 BC survivors were compared to 222 age-matched controls with frequency matching on their age at their postdiagnosis delivery. Endocrine therapy was associated with a significantly lower probability of birth compared to BC survivors without endocrine therapy (HR 0.36; 95% CI 0.18-0.53; p < 0.0001). The risks of preterm birth, low birth weight (LBW), gestational diabetes, hypertensive disorders, and cesarean section were not significantly increased among BC survivors compared to healthy controls. BC survivors were at an increased risk for a small-for-gestational-age (SGA) fetus (OR 3.24; 95% CI 1.17-8.97, p = 0.03). Delivery in less than 2 years after diagnosis increased the risk for SGA (OR 5.73; 95% CI 1.37-24.02, p = 0.03) and LBW (OR 4.57; 95% CI 1.32-15.87, p = 0.02). Our findings are encouraging regarding the risks of preterm delivery, gestational diabetes, hypertensive disorders, and cesarean section to women who consider pregnancy after BC. Delivery in less than 2 years after diagnosis was associated with an increased risk for SGA and LBW.

Abstract A072: Lung cancer survival disparities: A disaggregated AANHPI study of the SEER database

Abstract Cancer is the overall leading cause of death in Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations, with lung cancer specifically being the leading cause of cancer- related mortality. The AANHPI population has historically been treated as a "monolith" in scientific literature. However, an accurate understanding of AANHPI communities is needed to address disparities in cancer outcomes. Thus, it is necessary to analyze disaggregated data to identify unique factors and barriers for each unique subpopulation. Our study aims to explore lung cancer survival disparities between Asian American, Native Hawaiian, and Pacific Islander (AANHPI) subpopulations and non-Hispanic Whites (NHW) using SEER Research Data from 2000-2020. Cohorts were developed in order to disaggregate the AANHPI population. Due to the small sample size between nationalities, cohorts were grouped by geographical similarity. Cox regression analysis revealed a generally lower risk of death for AANHPI individuals compared to NHW. However, notable differences were observed within AANHPI subpopulations. South Asians demonstrate a 34.2% lower likelihood of lung cancer mortality compared to NHW, while East Asians show an 18.3% reduced risk. Native Hawaiian and Pacific Islanders saw similar survival, though it was not statistically significant. These disparities could indicate the influence of genetic, environmental, and lifestyle factors and differences in offered treatment on lung cancer prognosis. Our study highlights the importance of recognizing the diversity within AANHPI groups when assessing cancer risk and survival and the necessity for further investigation into the specific factors influencing survival differences. A more nuanced understanding will facilitate more targeted healthcare strategies to address the unique needs of each subpopulation. Citation Format: Christopher Huy Doan, James Chen, Peter Wang, David Wang, Brian Mai. Lung cancer survival disparities: A disaggregated AANHPI study of the SEER database [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A072.

Fight Retinal Blindness SPAIN. Report 3: clinical outcomes of vascular endothelial growth factor inhibitors in low vision eyes with neovascular age-related macular degeneration. A national database study

Fight Retinal Blindness SPAIN. Report 3: clinical outcomes of vascular endothelial growth factor inhibitors in low vision eyes with neovascular age-related macular degeneration. A national database study

Racial and ethnic differences in transfusion rates in adolescent scoliosis surgery: Preoperative anemia as a mediator of disparity

AbstractBackgroundPediatric patients from minoritized racial and ethnic groups receive red blood cell (RBC) transfusions more frequently while undergoing major surgical procedures. Our objective was to identify the contribution of preoperative anemia to racial and ethnic differences in RBC transfusion rates in adolescent spine surgery.Study Design and MethodsThis is a multicenter, retrospective cohort study of the National Surgical Quality Improvement Program Pediatric database, 2016 to 2021 for patients in the United States and Canada.ResultsAdolescents identifying as non‐Hispanic Black, Hispanic, and other race/ethnicity presented with higher rates of preoperative anemia than non‐Hispanic White adolescents (16.3%, 10.6%, and 9.9%, vs. 7.8%, respectively; p &lt; .0001) and were transfused at higher rates (14.4%, 11.9%, 16.5%, vs. 10.0%, respectively; p &lt; .0001). Minoritized groups demonstrated higher adjusted odds of RBC transfusion compared with non‐Hispanic Whites (non‐Hispanic Black: aOR 1.45 95% CI 1.26–1.65, Hispanic: aOR 1.17 95% CI 0.96–1.41, other race/ethnicity: aOR 1.63 95% CI 1.26–2.09). Of the total effect of minoritized race and/or ethnicity on RBC transfusion, 13.9% was attributed to the indirect effect through preoperative anemia.DiscussionIn this cohort study, patients from minoritized racial and ethnic groups received RBC transfusions at a higher rate than non‐Hispanic White patients, and the difference was partially mediated by preoperative anemia. Future efforts to minimize transfusions and improve health equity should target this modifiable risk factor alongside other sources of disparity and discrimination.

Semen sEV tRF-Based Models Increase Non-Invasive Prediction Accuracy of Clinically Significant Prostate Cancer among Patients with Moderately Altered PSA Levels.

PSA screening has led to an over-diagnosis of prostate cancer (PCa) and unnecessary biopsies of benign conditions due to its low cancer specificity. Consequently, more accurate, preferentially non-invasive, tests are needed. We aim to evaluate the potential of semen sEV (small extracellular vesicles) tsRNAs (tRNA-derived small RNAs) as PCa indicators. Initially, following a literature review in the OncotRF database and high-throughput small RNA-sequencing studies in PCa tissue together with the sncRNA profile in semen sEVs, we selected four candidate 5'tRF tsRNAs for validation as PCa biomarkers. RT-qPCR analysis in semen sEVs from men with moderately elevated serum PSA levels successfully shows that the differential expression of the four tRFs between PCa and healthy control groups can be detected in a non-invasive manner. The combined model incorporating PSA and specific tRFs (5'-tRNA-Glu-TTC-9-1_L30 and 5'-tRNA-Val-CAC-3-1_L30) achieved high predictive accuracy in identifying samples with a Gleason score ≥ 7 and staging disease beyond IIA, supporting that the 5'tRF fingerprint in semen sEV can improve the PSA predictive value to discriminate between malignant and indolent prostate conditions. The in silico study allowed us to map target genes for the four 5'tRFs possibly involved in PCa. Our findings highlight the synergistic use of multiple biomarkers as an efficient approach to improve PCa screening and prognosis.

The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: Report 17, a risk factor model for posterior capsule rupture.

To create a risk factor model for posterior capsule rupture (PCR) during cataract surgery. Eligible operations between 01/04/2016 and 31/03/2022 from centres supplying data to the UK national cataract audit with complete data including patients' gender and age at surgery, anterior chamber depth (ACD) measurement and preoperative visual acuity (VA) were included. A logistic regression model was fitted to identify risk factors and calculate their odds ratios (OR) and 95% confidence intervals (CI) for PCR. This analysis included 961,208 cataract operations performed on 682,381 patients from 136 participating centres by 3198 surgeons. 9730 (1.01%) of surgeries were complicated by PCR. The median age was 75.7 and 76.7 years for first and second eye surgery respectively, and 5154 (53.0%) were female. The highest risk factors for PCR were less experienced trainee surgeon (OR 3.75, 95% CI 3.33-4.24, p < 0.001), pseudoexfoliation/phacodonesis (OR 3.47, 95% CI 3.05-3.94, p < 0.001), younger males (OR 3.05, 95% CI 2.23-4.16, p < 0.001) and brunescent/white/mature cataract (OR 2.41, 95% CI 2.24-2.60, p < 0.001). Other risk factors identified were glaucoma, worse preoperative VA, previous intravitreal therapy, high myopia, previous vitrectomy, systemic diabetes, diabetic retinopathy, amblyopia, older age, shallower ACD and inability to lie flat and cooperate. Various surgical, patient and ocular factors increase the risk of PCR during cataract surgery. This risk factor model permits estimation of individualised risks for patients and allows risk-adjustment for surgeons to evaluate their PCR rates based on case complexity.

Prevalence of obesity and cardiovascular disease in adults with type 2 diabetes and use of diabetes medication in Germany: A claims data study.

To identify the prevalence of cardiovascular disease (CVD) and obesity in patients with type 2 diabetes (T2D) in Germany and to evaluate if antidiabetic treatment patterns varied by comorbidity status. Patients with T2D (aged ≥18 years) were identified during the study period (2014-2020) from medical claims of 4.5 million publicly insured German residents and divided into different cohorts based on CVD and/or obesity diagnosis. Annual prevalence and incidence were estimated for each study year, while characteristics and treatments were assessed in 2020. Data were extrapolated to the German population by age and sex. The prevalence of T2D in 2020 was 11.4%. Among patients with T2D, 53.0% had CVD, 39.3% had obesity, and 20.9% had CVD and obesity. Since 2014, CVD increased by 1.4%, obesity by 4.5%, and CVD with obesity by 2.7% in patients with T2D. The incidence of T2D in 2020 was 1.0% (42.9% had CVD, 37.9% had obesity, and 15.8% had CVD and obesity). Among the prevalent T2D population in 2020, 4.9% received glucagon-like peptide-1 receptor agonists (GLP-1RAs), 9.7% received sodium-glucose cotransporter-2 (SGLT2) inhibitors, and 13.0% received GLP-1 RAs and/or SGLT2 inhibitors. Of those with CVD, 12.9% received GLP-1 RAs and/or SGLT2 inhibitors (without CVD, 13.2%). Of those with obesity, 19.4% received GLP-1RAs and/or SGLT2 inhibitors (without obesity, 9.0%). In this retrospective claims database study, more than two thirds of patients with T2D also had CVD, obesity, or both CVD and obesity. GLP-1 RA and SGLT2 inhibitor use remained low.

Efficacy versus effectiveness: The HORIZON Pivotal Fracture Trial and its emulation in Claims Data.

To evaluate the concordance of results between the HORIZON-Pivotal Fracture Trial (PFT) and a non-randomized database study designed to emulate the trial. HORIZON-PFT evaluated the efficacy of zoledronic acid vs placebo in reducing the risk of hip fractures and found a 41% risk reduction over a 3-year treatment period (HR = 0.59; 95% CI 0.42 to 0.83). Using two U.S. claims databases from 08/2007 to 12/2020 or 06/2021 we applied eligibility criteria from HORIZON-PFT and identified women with osteoporosis who initiated zoledronic acid or raloxifene as a proxy for placebo. The study protocol was registered on ClinicalTrials.gov (NCT04736693) before inferential analyses. We compared HORIZON-PFT and database study results using prespecified metrics. Due to low adherence in clinical practice, on-treatment follow up was truncated at 18 months in the database study. The hip fracture risk after 18 months was 9.3/1000 in the trial and 8.3/1000 in the database analysis. In the database study, zoledronic acid was associated with a 28% reduction in hip fractures risk compared to raloxifene (HR = 0.72; 95% CI 0.51 to 0.92). The attenuated effect of zoledronic acid in the database study may be explained by its shorter follow-up, as the interpolated estimate of the effect in HORIZON-PFT at 18 months was HRRCT 0.74, nearly identical to the observational estimate HRdatabase 0.72. Real-world emulation of the HORIZON-PFT found that zoledronic acid reduced hip fractures risk over an 18-month follow-up period. Limited adherence in clinical practice diminished the magnitude of its preventive effect and precluded long-term estimation of effectiveness in this setting.

Burden of Herpes Zoster in Individuals With Chronic Conditions in the Republic of Korea: A Nationwide Population-Based Database Study

Abstract Background Chronic conditions (CCs) may increase the risk of herpes zoster (HZ) infection, leading to a greater healthcare burden in these individuals compared to those without CCs. It is therefore clinically important to quantify HZ disease burden in individuals with and without CCs, given the rapidly aging population in the Republic of Korea (ROK). Methods This retrospective cohort study examines the trends in incidence rates (IRs) and incidence rate ratios (IRRs) in individuals aged ≥18 years with CCs, using the National Health Insurance Service National Sample Cohort (NHIS-NSC) database from 2010 to 2019. These patients were stratified by age group, sex, HZ complications, and CCs. The annual average number of HZ patients, IRs, and IRRs were calculated for individuals with and without CCs. Results In total, 729 347 patients with HZ were eligible for the study. HZ IRs were highest in patients with diabetes, followed by chronic obstructive pulmonary disease, chronic kidney disease, asthma, and chronic liver disease, with HZ IRRs following a similar trend. Overall, HZ IRs generally increased with age, typically peaking at 60–64 or 65–69 years, and were similar for females and males. HZ IRs were highest among patients without complications, followed by HZ with other, cutaneous, ocular, and neurologic complications across all CCs. For each of the CCs, HZ IRs were consistently higher than those of the non-CC population regardless of sex. Conclusions The findings of this study reiterate the importance of HZ prevention for healthy aging, especially for CC populations at increased risk of HZ in the ROK.

ASO Visual Abstract: Rates of Pathologic Complete Response and Overall Survival in Patients with Inflammatory Breast Cancer-A National Cancer Database Study.

ASO Visual Abstract: Rates of Pathologic Complete Response and Overall Survival in Patients with Inflammatory Breast Cancer-A National Cancer Database Study.

Maternal, Fetal and Infant outcomes Associated with Bariatric Surgery

Objective: The purpose of this study was to determine the association between bariatric surgery and maternal, fetal and infant outcomes. Summary Background Data: Obesity during pregnancy is a risk factor for adverse pregnancy outcomes. Bariatric surgery is the most effective weight loss treatment but the impact of bariatric surgery on pregnancy outcomes remains poorly characterised. Methods: This was a population-based, matched cohort study of prospective databases in Ontario, Canada. Patients with obesity who received bariatric surgery from 2010 to 2016 and subsequently became pregnant matched on multiple factors to non-surgical pregnant patients with obesity. The primary outcomes of interest were the incidence included of gestational diabetes, preeclampsia/HELLP syndrome, small for gestational age (SGA), large for gestational age (LGA), and a composite of severe fetal/infant morbidity/mortality. Multivariable regression evaluated outcomes. Results: 680 patients who underwent bariatric surgery and later became pregnant were matched to 2002 pregnant patients with obesity. Gestational diabetes occurred in 8.7% of the surgery group and 18.8% of the non-surgical group (adjusted OR (aOR) 0.29, 95%CI 0.21-0.40, P&lt;0.001). A lower incidence of preeclampsia/HELLP was observed post-surgery (aOR 0.20, 95%CI 0.13-0.31, P&lt;0.001). Bariatric surgery impacted SGA (aOR 2.74, 95%CI 2.04–3.70, P&lt;0.001) and LGA (aOR 0.25, 95%CI 0.18-0.36, P&lt;0.001). There were no observed associations between bariatric surgery and any adverse fetal or infant outcomes. A lower composite severe fetal/infant morbidity/mortality was observed post-surgery (aOR 0.73, 95%CI 0.54-0.97, P&lt;0.05). Conclusions: Pregnancy after bariatric surgery appears safe and was associated with a reduced risk of several obesity related adverse pregnancy outcomes.

Causal association between hyperthyroidism and risk of gastroesophageal reflux or esophageal cancer: a bidirectional Mendelian randomization investigation.

Emerging observational studies indicated an association between hyperthyroidism and gastrointestinal disorders. However, it remains unclear whether this association is causal, particularly in the case of gastroesophageal reflux (GERD) and esophageal cancer. To assess the potential causal relationship between hyperthyroidism and GERD or esophageal cancer, we conducted a bidirectional 2-sample Mendelian randomization study. Independent genetic instruments for hyperthyroidism from the UK Biobank (N case=3,545 and N control=459,388) and public genome-wide association study (GWAS) dataset (N case=3,731 and N control=480,867) were used to investigate the association with esophageal cancer in the UK Biobank study (N case=740 and N control=372,016) and GERD in the public GWAS database (N case=20,381 and N control=464,217). Four different approaches (inverse variance weighted (IVW), weighted mode, MR-Egger, and weighted median regression) were used to ensure that our results more reliable. Additional sensitivity analyses were also performed to validate our results. When hyperthyroidism was considered as the exposure factor, it appeared to act as a protective factor for GERD (ORIVW = 0.88, 95% CI, 0.79-0.99, P = 0.039), while as a risk factor for esophageal cancer (ORIVW = 1.03, 95% CI, 1.01-1.06, P = 0.003). However, there is no evidence supporting a reverse causal relationship between genetic susceptibility to hyperthyroidism and GERD or esophageal cancer. Our findings provided genetic evidence supporting bidirectional causal relationships between hyperthyroidism and GERD or esophageal cancer. These results substantiate certain discoveries from previous observational studies on a causal level and provide insight into relevant genetic susceptibility factors.

Drug-Related Keratitis: A Real-World FDA Adverse Event Reporting System Database Study.

This study aimed to assess the drug risk of drug-related keratitis and track the epidemiological characteristics of drug-related keratitis. This study analyzed data from the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database from January 2004 to December 2023. A disproportionality analysis was conducted to assess drug-related keratitis with positive signals, and drugs were classified and assessed with regard to their drug-induced timing and risk of drug-related keratitis. A total of 1606 drugs were reported to pose a risk of drug-related keratitis in the FAERS database, and, after disproportionality analysis and screening, 17 drugs were found to significantly increase the risk of drug-related keratitis. Among them, seven were ophthalmic medications, including dorzolamide (reporting odds ratio [ROR] = 3695.82), travoprost (ROR = 2287.27), and brimonidine (ROR = 2118.52), and 10 were non-ophthalmic medications, including tralokinumab (ROR = 2609.12), trazodone (ROR = 2377.07), and belantamab mafodotin (ROR = 680.28). The top three drugs having the highest risk of drug-related keratitis were dorzolamide (Bayesian confidence propagation neural network [BCPNN] = 11.71), trazodone (BCPNN = 11.11), and tralokinumab (BCPNN = 11.08). The drug-induced times for non-ophthalmic medications were significantly shorter than those for ophthalmic medications (mean days, 141.02 vs. 321.96, respectively; P < 0.001). The incidence of drug-related keratitis reached its peak in 2023. Prevention of drug-related keratitis is more important than treatment. Identifying the specific risks and timing of drug-induced keratitis can support the development of preventive measures. Identifying the specific drugs related to medication-related keratitis is of significant importance for drug vigilance in the occurrence of drug-related keratitis.

Unveiling the Landscape of Acute Kidney Injury in Surgical Patients: A Systematic Review of Risk Factors and Clinical Biomarkers

Acute Kidney Injury (AKI) is a critical complication with significant implications for surgical patients, leading to increased morbidity, mortality, and healthcare costs. Identifying the risk factors and clinical biomarkers associated with AKI in the surgical context is essential for timely intervention and personalized management. To address this knowledge gap, we conducted a systematic review to comprehensively analyze existing literature on AKI in surgical patients. In this paper, we provided a systemically review analysis based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) technique for AKI risk factors and clinical biomarkers. The advanced searching into two powerful databases which is Scopus, Pubmed and Mendeley. Based on searching, find finally main data n=30 and will be analyzed using the synthesis approach. Through a meticulous search and appraisal of studies in reputable scientific databases, we identified a diverse range of research articles, clinical trials, and cohort studies that met our rigorous inclusion criteria. Synthesizing the findings from these studies, we explored the multifactorial nature of AKI, encompassing patient-related factors, surgical variables, and exposure to potential nephrotoxic agents. Our review revealed that AKI in surgical patients is influenced by a complex interplay of risk factors, including patient demographics, comorbidities, surgical procedures, anaesthetic management, and exposure to nephrotoxic drugs. The systematic analysis identified the most common drug classes associated with drug-induced AKI, such as diuretics, ACE inhibitors/angiotensin receptor blockers (ACEIs/ARBs), and antibiotics

Real world analysis of treatment change and response in adults with attention-deficit/hyperactivity disorder (ADHD) alone and with concomitant psychiatric comorbidities: results from an electronic health record database study is the United States

BackgroundThe objectives of this study were to examine the association of psychiatric comorbidities and patient characteristics with treatment change and response as well as to assess the association between treatment change and healthcare resource utilization (HCRU) among adult patients with attention-deficit/hyperactivity disorder (ADHD) and psychiatric comorbidities.MethodsDe-identified electronic health records from the NeuroBlu Database (2002–2021) were used to select patients ≥ 18 years with ADHD who were prescribed ADHD-specific medication. The index date was set as the first prescription of ADHD medication. The outcomes were treatment change (discontinuation, switch, add-on, or drop) and HCRU (inpatient, outpatient, composite) within 12 months of follow-up. Cox proportional-hazard model was used to assess the association between clinical and demographic patient characteristics and treatment change, while generalized linear model with negative binomial distribution and log link function was used to assess the association between key risk factors linked to treatment change and HCRU rates.ResultsA total of 3,387 patients with ADHD were included (ADHD only: 1,261; ADHD + major depressive disorder (MDD): 755; ADHD + anxiety disorder: 467; ADHD + mood disorder: 164). Nearly half (44.8%) of the study cohort experienced a treatment change within the 12-month follow-up period. Treatment switch and add-on were more common in patients with ADHD and comorbid MDD and anxiety disorder (switch: 18.9%; add-on: 20.5%) compared to other cohorts (range for switch: 8.5–13.6%; range for add-on: 8.9–12.1%) Survival analysis demonstrated that the probability of treatment change within 12 months from treatment initiation in the study cohort was estimated to be 42.4%. Outpatient visit rates statistically significantly increased from baseline (mean [SD] 1.03 [1.84] visits/month) to 3 months post-index (mean [SD] 1.62 [1.91] visits/month; p < 0.001), followed by a gradual decline up to 12 months post-index. Being prescribed both a stimulant and a non-stimulant at index date was statistically significantly associated with increased risk of treatment change (adjusted hazard ratio: 1.64; 95% CI: 1.13, 2.38; p = 0.01).ConclusionsThis real-world study found that treatment change was common among patients with ADHD and psychiatric comorbidities. These findings support the need for future studies to examine the unmet medical and treatment needs of this complex patient population.

Comparison of High-Dose versus Low-Dose Trimethoprim-Sulfamethoxazole for Treating Pneumocystis jirovecii Pneumonia among Hemodialysis Patients: A Nationwide Database Study in Japan.

Background: Hemodialysis patients are at high risk for developing Pneumocystis jirovecii pneumonia (PJP), and trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line agent for treating this disease. However, there is a lack of consensus on the required dosage of TMP-SMX for hemodialysis patients. Methods: This study used the nationwide Japanese Diagnosis Procedure Combination database to review hemodialysis patients hospitalized for PJP from April 2014 to March 2022. Eligible patients were divided into high-dose and low-dose groups based on the median daily dose per body weight of TMP. The 90-day mortality and adverse events after propensity score matching were compared between the groups. Results: A total of 126 hemodialysis patients with PJP were included, and the median daily dose per body weight of TMP was 5.74 mg/kg/day (interquartile range: 4.33-8.18 mg/kg/day). Thirty-two pairs were analyzed after the propensity score matching. No significant differences in the 90-day mortality and proportion of adverse events were observed between the high-dose and low-dose groups. Conclusions: A high dose of TMP-SMX is unlikely to decrease the in-hospital mortality and adverse events among hemodialysis patients with PJP. However, the results should be interpreted with caution, given the lack of power and lack of long-term follow-up. Additional prospective interventional studies are required to validate these results.

The Stories of Us: Queer Tamils and Their Experiences Reclaiming Culture and Heritage in Canada

“The Stories Of Us” considers the ways that culture, heritage, and rituals come together. This ethnographic study is guided by methodologies of narrative photovoice that speak to the lived experiences of how five 2nd Generation Queer Tamil Canadians living in Toronto/Scarborough reclaim their Tamil culture and heritage as Queer people living in the West. The intersectional marginalization Queer Tamil people face often ostracizes them from both their Tamil community as well as their Queer community. The participants of this study reflected on their identities growing up as well as how they’ve engaged with community at different stages of their Queer journey, speaking to their experiences reclaiming their cultural identity as Queer people. Based on the lived experiences of the participants, this data-based study looks at the creative ways that Queer Tamils take up space and reclaim their cultural heritage as a politically and historically silenced community.