Unmarried Patients Research Articles

Demographic Pattern, Tumor Size and Stage of Breast Cancer in Africa: A Meta-analysis

Purpose: Understanding the epidemiology of breast cancer (BC) in Africa, as well as regional variation is essential for planning future intervention. Our objective was to describe summary estimates of socio-demographic and clinical characteristics of BC in Africa, thus providing researchers and policymakers baseline data for planning diagnostic and treatment programs to improve BC outcomes in the future.Method: We screened African publications on BC between 2010 and 2019 in PubMed, AJOL, Google, ScienceDirect, and ResearchGate to estimate the distribution of socio-demographic and clinical tumor characteristics. The meta-analysis used the random effect model. Result: Eighty articles were eligible, including 33,199 total patients. Overall, 58% of patients were <50 years old. In East Africa, 38% (95% CI 31-45) were diagnosed before 40 years. Conversely, in Southern Africa, 37% were diagnosed after 60 years, with Caucasian-like age distribution. The overall prevalence of male BC was high (3%), with East Africa having the highest prevalence (5% (95% CI 5.0-6.0)). Only 2% (95% CI 1-2) of patients were diagnosed with carcinoma-in-situ. Invasive tumors were 7% stage I, 26% stage II, 50% stage III, and 17% stage IV. Seventy per-cent (95% CI 60-80) had clinical nodal involvement. The smallest tumors were in North Africa. The largest and most advanced tumors were in West Africa. Trend analysis showed decreasing age, an increasing population of unmarried BC patients, a relatively high proportion of uneducated BC patients, and a stable proportion of late-stage disease in the last decade. Conclusion: Regional variation in the presentation of BC throughout Africa necessitates region/country-specific targets for improving BC control.

Effects of marital status on survival of medullary thyroid cancer stratified by age.

PurposeMarital status has emerged as an important influence on several cancer outcomes, but its role in medullary thyroid cancer (MTC) remains unclear. This study was to explore the effects of marital status on the prognosis of MTC patients and to determine whether its effects vary by age.Patients and methodsWe retrospectively extracted 1344 eligible patients diagnosed with MTC between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Based on the marital status, we divided those patients into married and unmarried groups. We compared the difference in overall survival (OS) and cancer‐specific survival (CSS) between married and unmarried via the Kaplan–Meier analysis. Univariate and multivariate Cox proportional models were performed to identify the prognostic factors of OS and CSS.ResultsThere were 1344 MTC eligible patients in a total of which 883 (65.7%) were married and 461 (34.3%) were unmarried. The comparison observed between married and unmarried patients was as follows: male (45.2% vs. 28.0%), age (≥52 years) (55.9% vs. 44.6%), White (86.7% vs. 78.7%), and undergo surgery (97.7% vs. 93.3%). Multivariate analysis revealed unmarried status as a risk factor independently associated with worse OS (HR: 2.15, 95% CI: 1.59–2.92) rate and CSS (HR: 1.70, 95% CI: 1.17–2.47) rate. In a further analysis stratified by age, there was no significant difference in OS and CSS between married and unmarried patients younger than 52 years. For the remaining group with 52 years old and higher, unmarried patients showed significantly higher risk of OS and CSS than married patients at all stages of the pathology except M1 stage.ConclusionMarried patients with MTC have a better prognosis than unmarried ones. Age can affect the association between marital status and the survival of MTC, and married elders may benefit more than youngers.

Diversité des prises en charge hospitalières de l’anorexie mentale en psychiatrie en France

BackgroundHospitalization is rare in anorexia nervosa (AN) and local application of indications is heterogeneous. However, no study has evaluated the effect of these different treatment modalities on the mean length of stay. Our objective was to describe the context and modalities of a wide range of hospital care programs offered to patients with anorexia nervosa in eleven specialized French psychiatric centers for patients from childhood to adulthood. This work was carried out within the framework of the EVHAN (Evaluation of Hospitalization for AN, Eudract number: 2007-A01110-53, registered in Clinical trials) research program. The EVHAN program comprises five main lines: weight objectives at discharge, the practice or not of a separation period, the use of clear nutritional dietary objectives (cognitive/behavioral), the intensity of family involvement in treatment, and the existence or absence of a stabilization phase before ending inpatient treatment. These main lines will make it possible to study the impact of treatment modalities on the future of patients in the short and medium term (at discharge and at 1-year follow-up). MethodsThe eleven centers are located in France (Bordeaux, Nantes, Paris and Ile-de-France, Rouen and Saint-Étienne). Various staff members (psychiatrists, somatic doctors, nurses, dieticians, psychologists) from each center were interviewed using a semi-structured questionnaire. Data on operating modalities and context of care were collected and analyzed. ResultsFour of the eleven centers were exclusively child/adolescent centers, and seven of 11 were adolescent (from 11, 13 or 16 years) and young adult centers. All centers offered a graduated approach from outpatient to full hospitalization. The majority had a number of beds allocated for patients with eating disorders. The criteria for hospitalization were homogeneous with respect to somatic and/or psychic severity prefiguring the consensus criteria defined by the French Health Authority (HAS) in 2010. Child/adolescent units used the weight curve to set weight objectives at discharge (between the 10th and 50th percentiles). Most adult units used weight objectives at discharge corresponding to a body mass index between 17 and 20kg/m2. Nine centers used a written or oral care contract. One unit did not separate the patient from her/his usual environment, the others had a practice gradient of partial separation and total separation times. These were either short, lasting a maximum of 3 weeks, or long, lasting more than 3 weeks. Conversely, patients were not isolated within the unit, and benefited from a rich social life, depending on her/his physical condition. The patient's family was in contact with the team and fully supported. The longest periods of separation involved adolescents and adults. Nutritional support varied from a group approach (meals in the dining room, standardized meals of the care center) to very individualized approaches within a specific framework. All the units reported meeting with families at least once during the hospitalization; with the patient's parents for child/adolescent patients and/or unmarried patients and with the husband/wife for married patients. The majority of the centers requested a phase of weight stabilization, whatever the age before hospital discharge. ConclusionThere is international and national consensus regarding the indications for hospitalization, and the main lines of multidisciplinary care to be developed within this framework. However, local application of these indications was heterogeneous resulting in diverse modalities of hospital care for anorexia nervosa in France. Specialized teams have developed management strategies arising from their “team culture”. The complexity of the anorexic pathology, due to the psyche-soma intrication and the diversity of age groups, highlights the complexity of care available. The impact of this diversity of hospital care on patient outcomes will be studied as a result of this work.

Patient Factors Associated With Loss to Radiation Oncology Specialty Follow-Up Among Head and Neck Cancer Survivors

Patients who receive radiotherapy (RT) for head and neck cancer (HNC) are at risk for late radiation toxicity, recurrence, and subsequent neoplasms. Ongoing monitoring by a radiation oncologist during the survivorship period is important for detection of adverse outcomes and to guide early intervention. The purpose of this study was to identify patient level factors associated with HNC survivors becoming lost to radiation oncology follow-up care.This cross-sectional study included all surviving patients who received RT for HNC at a single comprehensive cancer center in Alabama between 2001-2018. Death records were identified using a combination of medical records and LexisNexis Accurint. Patients who had not been evaluated in the radiation oncology clinic for > 2 years were considered as lost to follow-up care. Patient level factors considered for association with becoming lost to follow-up included age (older vs. young than 65 years), distance from the clinic (more vs. less than 100 miles), median income of the zip code of residence (above vs. below median), sex, race (white vs. non-white) and time since completion of RT (more vs. fewer than 5 years). Between group differences in frequencies were assessed using the chi-square test. A classification tree was created to classify participants according to the risk of becoming lost to follow-up, with terminal nodes required to contain at least 50 patients.Of the 737 patients who met the inclusion criteria, 391 (53.1%) had not been evaluated by a radiation oncologist for > 2 years. When considered individually, becoming lost to follow-up was statistically more common among patients who were > 5 years from RT (61.4% vs. 39.1%, P < 0.001), below the median income for the state of Alabama (55.8% vs. 47%, P = 0.025), and were unmarried (61.7% vs. 46.4%, P < 0.001). The first level split of the decision tree was by time from completion of RT. For patients within 5 years of completing RT, unmarried patients were more likely to be lost to follow-up (67.9% vs. 32.1%). For patients more than 5 years from completion of RT, the group consisting of both unmarried patients and married patients living > 100 miles from the clinic were more likely to be lost to follow-up (69% vs. 31%).This study identified time from RT, marital status, income level, and travel distance as factors associated with becoming lost to radiation oncology follow-up at an academic center in the Deep South. The decision tree supports the hypothesis that distance to the clinic may become more meaningful later in the survivorship period. Identifying factors associated with becoming lost to specialty care after cancer treatment is important for developing and targeting social support interventions for cancer survivors, particularly those with HNC who are disproportionately affected by socioeconomic disparities.

Depressive disorders and quality of life in patients with acute coronary syndrome in real clinical practice

Abstract Background The prevalence of depressive disorders has become more significant in recent years. Objective To study the prevalence of depressive disorders using Zung Anxiety Rating Scale (ZARS) in patients with acute coronary syndrome (ACS) in the daily work of the Regional Vascular Center (RVC) in various gender and social subgroups and to compare their severity with the life quality level. Materials and methods The survey included 116 (57 female and 59 male) patients, admitted to RVC with ACS from March to November 2020 (Group I), and 49 patients without ACS, comparable with demographic parameters (Group II). Patients were interviewed with the use of ZARS and the life quality assessment questionnaire (SF-36). Statistical data processing was carried out using Statistica v.13.3, Mann–Whitney U-test, Pearson's chi-squared test, Spearman's rank correlation coefficient. P values &amp;lt;0.05 were considered statistically significant. Results In Group I the score on ZARS was higher or equal to 50 (depression) in 18% of cases: 15% female and 3% male patients (p&amp;lt;0.05). The average score on ZARS was notably higher in women than in men (p&amp;lt;0.05). In Group II depression was detected in 27% of cases, without gender differences. A negative correlation was established for the indicators of ZARS and SF-36: in Group I r=−0.62, p&amp;lt;0.05, in Group II r=−0.76, p&amp;lt;0.05. In Group I indicators of health physical component (SF-36) among women were: physical functioning 50, role functioning 34, general health 51, in men: 80, 58 and 63 respectively (p&amp;lt;0.05). In Group II these indicators significantly differed only in physical functioning: 60 female and 72 male. In Group I depression was observed in 2% of working and in 30% of non-working patients (p&amp;lt;0.05); in Group II: 0% and 34% respectively. In Groups I and II depression was found in 10% and 5% among married, in 31% and 43% among unmarried patients (p&amp;lt;0.05). In Group I depression was detected in 31% among patients with diabetes, in 12% - without diabetes (p&amp;lt;0.05). The other analyzed diseases did not have a significant effect on the depression score. Conclusions The presence of ACS did not effect on the severity of depressive disorders in comparison with patients with other cardiac pathology, but among women with ACS their severity and prevalence was significantly higher. The severity of depressive disorders was inversely associated with life quality. Among patients with ACS, the health physical component according to SF-36 was significantly lower in women than in men; without ACS - no gender differences. Lack of work and marriage negatively affected on the prevalence of depression among all examined patients. Patients with ACS and diabetes had more elevated level of depression; the presence of depressive disorders was in close relationship with the health physical component among women (according to SF-36). It is necessary to develop and implement specialized rehabilitation programs for this subgroup of patients. Funding Acknowledgement Type of funding sources: None.

Psychological profile of COVID-19 pneumonia survivors three month after hospitalization

BackgroundCOVID-19 is the highly contagious infectious disease, which affects different organs and systems. Anxiety and depression symptoms, that are common results of severe diseases, used to make recovery more difficult.PurposeTo study the prevalence of cardiovascular diseases, signs of anxiety, depression, stress, and their relationship in patients with proven COVID-19 pneumonia 3 months after discharge depending of gender.MethodsThe study was carried out within “One-year Cardiac Follow-up of COVID-19 Pneumonia”. 103 patients (mean age 46.6±15.8 years) were divided into 2 groups: 52 men (50.9%) and 51 women. Anxiety and depression symptoms were measured by GAD-7 and PHQ-9, respectively. PSS-10 was used to measure stress symptoms. The minimum value of anxiety and depression was a total value of 5 points.Results48.5% of patients had cardiovascular diseases, out of which arterial hypertension (AH) was the most common (44.7%). Less common was coronary artery disease (CAD) (16.5%), which in 14.6% of patients was accompanied by AH. Chronic heart failure (CHF) NYHA class I-II was found in 19.4% of patients, and severe CHF (NYHA class III–IV) - in 4.9%. Arrhythmia was detected in 11.7% of patients. According to the clinical characteristics, no significant differences were found between the groups of men and women. AH affected 21.4% of men and 23.3% of women, CAD −10.7% and 5.8%, respectively. NYHA class I-II CHF were found in 8.7% of men and 10.7% of women, and severe CHF (NYHA class III–IV) - in 2 men and 3 women. Arrhythmia had a prevalence of less than 6% among both men and women. Anxiety or depression symptoms were reported in 29.1% and 27.2%, respectively. Combination of anxiety and depression symptoms was determined in 18.4%, symptoms of stress in 8.7% of patients. Symptoms of depression were found in women more often (p=0.023). The value of the median scores of the PHQ-9 questionnaire in the group of women was significantly higher than in the group of men (3.00 [1.00; 8.00] and 1.00 [0; 3.75], p=0.006). Depression symptoms were associated with female gender (OR 2.83; CI 95% 1.35–7.08). Despite the absence of gender differences in the prevalence of anxiety (18.4% and 10.7%, p=0.072), when comparing the values of the median scores of the GAD-7 questionnaire in the groups of men and women, the difference was statistically significant (1.00 [0; 4.00] and 3.00 [2.00; 7.00], p=0.001, respectively). Signs of stress among married people were less common in comparison with unmarried (2.9% vs 5.8%, p=0.037).ConclusionThree months after discharge, no significant differences in clinical characteristics between men and women were found. Signs of anxiety or depression were detected in more than a quarter of patients with proven COVID-19-associated pneumonia. Women experienced symptoms of depression 3 times more often than men. Unmarried patients tended to experience stress more often.FUNDunding AcknowledgementType of funding sources: None.

Utilization of Intravenous Ribavirin Among Reproductive Age Adults in 2010-2017: A Population-Based Study in the Yinzhou District, Ningbo City of China.

Background: Intravenous (IV) ribavirin is not approved in US and European Union, but it is authorized in China. Significant teratogenic and embryocidal effects of ribavirin have been found in almost all animal studies, it is critical to investigate the prevalence and trends of the utilization of IV ribavirin among reproductive age population.Objective: To evaluate the prevalence and trends of IV ribavirin use among reproductive-age population in 2010–2017.Methods: The study design of our study is retrospective cross-sectional study based on healthcare database. We identified and extracted the data of residents aged 18–44 years by using Yinzhou healthcare information database at 21 January, 2018. A cohort of IV ribavirin users were identified through outpatient prescription records in 3 general hospitals and 24 community health centers from 2010 to 2017. We reported the number, proportion, and prevalence of the exposure to IV ribavirin stratified by sex, age, marital status, education level, occupation, hospital level, calendar year, diagnosis, and dosage. The overall trends of IV ribavirin use, and the trends in different levels of hospital and common diagnoses were further analyzed and described.Result: During the study period, the prevalence of IV ribavirin use among reproductive-age adults was 6.02% (48,287/801,667). Relatively higher prevalence were found in adults aged 40–44 (8.04%, 95% CI: 7.90–8.17), unmarried patients (8.91%, 95% CI: 8.74–9.08), and who had more than 9 years of education (6.82%, 95% CI: 6.74–6.90). Compared to secondary and tertiary hospitals, IV ribavirin was more likely to be dispensed in primary hospitals (19.44%, 95% CI: 19.28–19.61). The most common diagnoses were acute upper respiratory infections (AURIs), accounting for 80% of the patients exposed to IV ribavirin. For patients with AURIs, the prevalence of IV ribavirin was nearly 30%. Overall, the prevalence of IV ribavirin use decreased from 1.72% in 2010 to 0.24% in 2017.Conclusion: We found IV ribavirin was mainly used for AURIs which suggested that a large amount of IV ribavirin use was probably inappropriate. The prevalence was decreasing by 87% over the past 8 years, and we encourage clinicians and pharmacists to continually avoid inappropriate use of IV ribavirin.

Real-World Utilization of Oral Anticancer Agents and Related Costs in Older Adults with Metastatic Renal Cell Carcinoma in the United States.

BACKGROUND:Substantial racial and socioeconomic disparities in metastatic RCC (mRCC) have persisted following the introduction of targeted oral anticancer agents (OAAs). The relationship between patient characteristics and OAA access and costs that may underlie persistent disparities in mRCC outcomes have not been examined in a nationally representative patient population.METHODS:Retrospective SEER-Medicare analysis of patients diagnosed with mRCC between 2007–2015 over age 65 with Medicare part D prescription drug coverage. Associations between patient characteristics, OAA receipt, and associated costs were analyzed in the 12 months following mRCC diagnosis and adjusted to 2015 dollars.RESULTS:2,792 patients met inclusion criteria, of which 32.4%received an OAA. Most patients received sunitinib (57%) or pazopanib (28%) as their first oral therapy. Receipt of OAA did not differ by race/ethnicity or socioeconomic indicators. Patients of advanced age (> 80 years), unmarried patients, and patients residing in the Southern US were less likely to receive OAAs. The mean inflation-adjusted 30-day cost to Medicare of a patient’s first OAA prescription nearly doubled from $3864 in 2007 to $7482 in 2015, while patient out-of-pocket cost decreased from $2409 to $1477.CONCLUSION:Race, ethnicity, and socioeconomic status were not associated with decreased OAA receipt in patients with mRCC; however, residing in the Southern United States was, as was marital status. Surprisingly, the cost to Medicare of an initial OAA prescription nearly doubled from 2007 to 2015, while patient out-of-pocket costs decreased substantially. Shifts in OAA costs may have significant economic implications in the era of personalized medicine.

255. A clinical calculator to predict survival in elderly spine trauma patients

<h3>BACKGROUND CONTEXT</h3> Spine trauma in the elderly is increasing in prevalence. Given their often extensive medical comorbidities and higher propensity to short-term mortality after spine trauma, surgical decision-making presents unique challenges when compared to younger patients with similar injury characteristics. The marked decrease in physiologic reserve, bone density and sometimes cognitive function in these patients contribute to a weakened response to injury—making traditional severity scores less reliable. <h3>PURPOSE</h3> Predictive calculators have proven useful in other areas of spine surgery; however, there have yet to be any meaningful clinical tools to predict mortality in elderly patients considered for surgical treatment of spine fractures. The goal of this study was to develop a predictive clinical calculator to predict mortality and better guide patient care and surgical decision-making in this complicated and rapidly growing population. <h3>STUDY DESIGN/SETTING</h3> Using data extracted from our clinical trauma registry, we conducted a single center retrospective cohort study. The outcome of interest was time to death within 3 years after trauma presentation. We prespecified and collected 12 baseline variables that are readily accessible and presumably relevant to mortality, including age, gender, marital status, hypotension on admission, max AIS, MFI-5, presence of high energy traumatic mechanism, injury level, spinal cord injury, closed head injury, WBC and HCT. A model-based predictive calculator was developed for patient's mortality at different time points after trauma presentation given his baseline characteristics. <h3>PATIENT SAMPLE</h3> A total of 1,746 elderly patients (65+) with spine trauma who presented to a single, level I trauma center from 2010-2019 were included. <h3>OUTCOME MEASURES</h3> Outcomes were identified and recorded including in-hospital mortality, mortality after discharge, medical and surgical complications. <h3>METHODS</h3> Retrospective chart review was completed to record comorbidities, presenting injury information, frailty scores, imaging evidence of sarcopenia and osteopenia, presence of spinal cord injury, as well as long-term outcomes for all patients who underwent operative treatment. Operative specifics including site, approach, number of levels, estimated blood loss were recorded as well as trends in lactate at the time of admission and time of surgery. Results from multivariate logistic regression analyses served as the basis for development of the model. Model calibration and discrimination were assessed graphically and by calculation of a concordance index, respectively. LASSO method was used to identify 12 variables which accounted for the majority of the variance in mortality. A subsequent model was developed with those 12 variables—including age, gender, marital status, hypotension on admission, max AIS, MFI-5, presence of high energy traumatic mechanism, injury level, spinal cord injury, closed head injury, WBC and HCT. A multivariable Cox proportional hazards model was fitted for time to death within 3 years after trauma presentation; the prespecified 12 predictors, surgical treatment as well as interactions between surgical treatment and other predictors are included in the model as independent variables. Internal validation was performed using bootstrap approach to evaluate its performance (discrimination and calibration) in future patients. <h3>RESULTS</h3> A total of 1,746 patients met inclusion criteria over the 9-year period. Patients were primarily male (n=927, 53%) with an average age of 76. All the predictors were significantly associated with mortality except presence of high energy traumatic mechanism. The most important predictors were age, MFI-5, closed head injury, HCT and hypotension. Older patients, males or unmarried patients suffered a significantly higher risk of death. Mortality hazard was also significantly higher in patients with higher MFI-5, presence of closed head injury, presence of hypotension, higher Max AIS, presence of spinal injury, higher level of WBC or injury site being cervical. A higher level of HCT decreased the risk. The effect of max AIS on mortality tended to be more noticeable in patients with surgical treatment, but injury site (cervical vs others) did not make a significant difference when patients had surgery. The model had an optimism-corrected C-index of 0.72. By visual inspection of calibration plot, the model predicted mortality risk well at a wide range of time points with a calibration slope around 0.88. The calculator was created to predict 30d, 90d, 180d and 365d mortality after injury for both operative and nonoperative management given the patient's baseline characteristics. Prospective patient information may be inputted to our online calculator to produce a personalized mortality risk. <h3>CONCLUSIONS</h3> This predictive calculator is the first comprehensive tool to be created to predict mortality in elderly victims of spine trauma. Prospective internal and external validation is needed to refine predictive power, but this tool offers valuable insight into surgical decision-making in this complex population. A better prediction of each patient's mortality risk will aid surgeons in patient and family counseling around these difficult clinical decisions. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Health-related quality of life after pulmonary tuberculosis in South Korea: analysis from the Korea National Health and Nutrition Examination Survey between 2010 and 2018

BackgroundAlthough several studies have reported an association between tuberculosis and health-related quality of life, the change in health-related quality of life after pulmonary tuberculosis has been rarely studied. The purpose of this study was to investigate the effect of past history of pulmonary tuberculosis on health-related quality of life using a nationwide, cross-sectional, observational study in Korea.MethodsAmong 72,751 people selected using a stratified multi-stage sampling method, 7260 Korean participants were included using propensity score matching. Past history of pulmonary tuberculosis was defined as a previous diagnosis of pulmonary tuberculosis excluding patients with active pulmonary tuberculosis. The primary outcome, health-related quality of life, was assessed by EQ-5D disutility.ResultsBefore matching, the mean EQ-5D of individuals with pulmonary tuberculosis history was lower (0.066 vs. 0.056, p: 0.009). However, the difference was nullified after matching (0.066 vs. 0.062, p = 0.354). In multivariable Poisson regression analysis, EQ-5D disutility score was not associated with past pulmonary tuberculosis history. In subgroup analysis, past pulmonary tuberculosis history increased odds of low health-related quality of life in young (odds ratio [OR] 1.57, 95% confidence interval [CI] 1.17–2.11, p = 0.003), unmarried (OR 1.98, 95% CI 1.05–3.73, p = 0.036), or separated patients (OR 1.30, 95% CI 1.02–1.66, p = 0.032). Age and marital status were modulating factors on the effect of past pulmonary tuberculosis history on health-related quality of life.ConclusionsThere was no difference in health-related quality of life between individuals with and without past pulmonary tuberculosis history. Young and unmarried groups had increased odds for low health-related quality of life after pulmonary tuberculosis due to modulating effects of age and marital status.

Impact of Low Frequency Electro-acupuncture on Glucose and Lipid Metabolism in Unmarried PCOS Women: A Randomized Controlled Trial.

To explore the effect of electro-acupuncture (EA) on glucose and lipid metabolism in unmarried patients with polycystic ovary syndrome (PCOS). Fifty-four PCOS patients were equally randomized into true acupuncture group and sham acupuncture group (control) for totally 16 weeks of treatment by random method with a computerized randomization program. Patients in true acupuncture group accepted traditional acupuncture methods with EA and two sets of acupoint groups were used alternatively. The first set consisted of Zhongji (CV 3), Qihai (CV 6), Guilai (ST 29), Sanyinjiao (SP 6), Yinlingquan (SP 9), Hegu (LI4) and Baihui (GV 20), and the second set consisted of Tianshu (ST 25), ST 29, CV 3, CV 6, SP 6, Taichong (LR 3), Neiguan (PC) 6 and GV 20. Patients in the sham acupuncture group accepted shallow acupuncture methods through EA without electricity at 4 non-meridian points in each shoulder and upper arm. Outcome measures included body mass index (BMI), waist-hip-ratio (WHR), oral glucose tolerance test (OGTT), insulin release test, glucose and lipid metabolism indicators such as total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, adiponectin, leptin, visfatin, resistin, and interleukin (IL-6). Twenty-six subjects in the true acupuncture group and 20 subjects in the sham group completed the clinical trial. After 16 weeks of treatment, no significant difference in the outcome measures were observed between the two groups (P>0.05). However, as compared with baseline data, a reduction in weight, BMI, hipline, WHR, fasting glucose, homeostatic model assessment of insulin sensitivity, visfatin and HDL-C, and an increase in resistin and IL-6 were observed in the true acupuncture group (P<0.05). In addition, a reduction in visfatin and an increase in TC were also observed in the sham group (P<0.05). Acupuncture may have a beneficial effect in the treatment of PCOS by improving glucose and lipid metabolism. Moreover, the sham acupuncture may be not completely ineffective. Sham acupuncture may improve some of the aspects of the glucose and lipid metabolism of PCOS patients through a placebo effect. (Registration Nos. ChiCTR-TRC-12002529 and NCT01812161).

Long-term survival on LVAD support: Device complications and end-organ dysfunction limit long-term success

Preoperative variables can predict short term left ventricular assist device (LVAD) survival, but predictors of extended survival remain insufficiently characterized. Patients undergoing LVAD implant (2012-2018) in the Intermacs registry were grouped according to time on support: short-term (<1 year, n=7,483), mid-term (MT, 1-3 years, n=5,976) and long-term (LT, ≥3 years, n=3,015). Landmarked hazard analyses (adjusted hazard ratio, HR) were performed to identify correlates of survival after 1 and 3 years of support. After surviving 1 year of support, additional LVAD survival was less likely in older (HR 1.15 per decade), Caucasian (HR 1.22) and unmarried (HR 1.16) patients (p < 0.05). After 3 years of support, only 3 preoperative characteristics (age, race, and history of bypass surgery, p < 0.05) correlated with extended survival. Postoperative events most negatively influenced achieving LT survival. In those alive at 1 year or 3 years, the occurrence of postoperative renal (creatinine HR MT=1.09; LT HR=1.10 per mg/dl) and hepatic dysfunction (AST HR MT=1.29; LT HR=1.34 per 100 IU), stroke (MT HR=1.24; LT HR=1.42), infection (MT HR=1.13; LT HR=1.10), and/or device malfunction (MT HR=1.22; LT HR=1.46) reduced extended survival (all p ≤ 0.03). Success with LVAD therapy hinges on achieving long term survival in more recipients. After 1 year, extended survival is heavily constrained by the occurrence of adverse events and postoperative end-organ dysfunction. The growth of destination therapy intent mandates that future LVAD studies be designed with follow up sufficient for capturing outcomes beyond 24 months.

Validity and reliability of the Japanese version of the Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE) questionnaire.

The purpose of this study was to investigate the validity and reliability of the Japanese version of the Peace, Equanimity, and Acceptance in the Cancer Experience questionnaire (PEACE-J) and to evaluate the association between the PEACE subscales and Japanese patient characteristics. A cross-sectional web-based survey was conducted among 412 patients with cancer. This survey assessed medical and demographic factors, such as the PEACE, the Coping Inventory for Stressful Situations (CISS), and the Functional Assessment of Chronic Illness Therapy - Spiritual well-being (FACIT-Sp). The forward-backward translation method was used to develop the PEACE-J. The validity of PEACE-J was evaluated by exploratory and confirmatory factor analysis, and correlation analysis between each subscale of PEACE and FACIT-Sp and CISS. The Cronbach's α and the item-total correlation of each subscale of the PEACE questionnaire were calculated to assess internal consistency reliability. The factor analysis yielded two subscales corresponding to the original version: Cronbach's α coefficients were 0.84 and 0.86 for the Peaceful Acceptance of Illness subscale and the Struggle with Illness subscale, respectively. The PEACE subscales and the FACIT-Sp subscales and the CISS subscales were moderately associated with each other, including the Peaceful Acceptance to each subscale of FACIT (r = 0.22-0.55, p < 0.01); and the Peaceful Acceptance and the Struggle with Illness to CISS emotion-oriented coping (r = -0.36 and r = 0.45, p < 0.01, respectively). Married patients showed higher levels of peaceful acceptance than unmarried patients (p < 0.001). Poorer performance status, chemotherapy use, and recurrence or metastasis were significantly associated with higher levels of struggle with illness (p < 0.001). This study indicated that the PEACE-J is a valid and reliable measure of the patient's sense of acceptance, calmness or equanimity, and peace, as well as their sense of struggle or desperation concerning their illness.

ASSESSMENT OF DENTAL TREATMENT RELATED ANXIETY AND ITS ASSOCIATION WITH THE SOCIODEMOGRAPHIC FACTORS

Objective:&#x0D; To assess the association of gender, level of education and marital status on the dental anxiety levels of patients.&#x0D; Materials and Methods:&#x0D; This was a descriptive cross-sectional study conducted on 400 patients visiting the dental OPD of Sharif Medical and Dental College, Lahore from June 2019 to June 2020. A questionnaire regarding level of dental anxiety was given to the patients. Data were collected using a pre-validated scale with a Cronbach alpha value of 0.89; Modified Dental Anxiety Scale (MDAS). Chi square test was applied to see the association of socio-demographic factors on dental anxiety. P value ≤0.05 was taken as significant.&#x0D; Results:&#x0D; Our data showed that the association between gender and level of dental anxiety was statistically significant (p-value 0.04). It was found to be no significant association of age, education level and marital status with level of anxiety (p=0.934, p=0.484, p=0.422) respectively.&#x0D; Conclusion:&#x0D; Majority of males and females experienced moderate to low anxiety. It was seen that the greatest percentage of patients with moderate/low anxiety as well as high anxiety had tertiary education. A similar trend was seen in unmarried patients The age group 18 to 29 years was the group that reported experiencing highest percentage of low/moderate anxiety as well as high anxiety.

Psychological Problems among Patients Suffer in HIV/AIDS in Pakistan

This study examines the treatment motivation, stigma, and disclosure in 287 HIV-infected patients in Pakistan. Four validation scales were applied to assess treatment motivation, stigma and disclosure of patients. The results showed that female patients had significantly higher levels of stigma and disclosure than male patients. Unmarried patients had significantly higher levels of stigma and disclosure than married patients. Moreover, the treatment motivation significantly positively correlated with self-disclosure. Stigma significantly positively correlated with disclosure. Stigma and self-disclose could predicate the treatment motivation. The study concluded that female and unmarried patients with HIV positive had more stigma and disclosure. Stigma, and disclosure affect the treatment motivation of patients with HIV positive.

Effects of Surgery on Prognosis of Young Women With Operable Breast Cancer in Different Marital Statuses: A Population-Based Cohort Study.

BackgroundThe influence of surgical approaches [including mastectomy, breast-conserving therapy (BCT) and post-mastectomy breast reconstruction (PMBR) on prognosis of young women (<40 years old) with operable breast cancer has not been determined yet, and this might vary in patients with different marital statuses. Therefore, we aimed to investigate the effect of surgery on survival outcomes for young women with operable breast cancer in different marital statuses.MethodsWe used the Surveillance, Epidemiology, and End Results (SEER) database to identify young women with operable breast cancer between 2004 and 2016, who underwent mastectomy, BCT or PMBR. We assessed overall survival (OS) and breast cancer-specific survival (BCSS) using the Kaplan–Meier method and hazard ratios using multivariate Cox proportional hazard regression.ResultsCompared to mastectomy, both of BCT and PMBR conferred better OS (BCT: HR = 0.79, 95%CI: 0.69–0.90, p <0.001; PMBR: HR = 0.70, 95%CI: 0.63–0.78, p <0.001) and BCSS (BCT: HR = 0.79, 95%CI: 0.69–0.91, p = 0.001; PMBR: HR = 0.73, 95%CI: 0.65–0.81, p <0.001), but there was no significant difference of survival between BCT and PMBR group. The survival benefit of BCT compared to mastectomy remained significant in unmarried young women (OS: HR = 0.68, 95%CI: 0.55–0.83, p <0.001; BCSS: HR = 0.69, 95%CI: 0.56–0.86, p = 0.001) but not in the married (OS: HR = 0.89, 95%CI: 0.75–1.05, p = 0.177; BCSS: HR = 0.89, 95%CI: 0.75–1.05, p = 0.161), while no matter married or not, PMBR group had better OS and BCSS than mastectomy group but not BCT group.ConclusionBoth of BCT and PMBR had improved survival compared to mastectomy for young women with operable breast cancer. The survival benefit of BCT compared to mastectomy remained significant in unmarried patients but not in married patients.

Contemporary analysis of the effect of marital status on survival in upper tract urothelial carcinoma patients treated with radical nephroureterectomy: A population-based study

PurposeUnmarried status is an established risk factor for worse cancer control outcomes in various malignancies. Moreover, several investigators observed worse outcomes in unmarried males, but not in females. This concept has not been tested in upper tract urothelial carcinoma and represents the topic of the study. MethodsWithin Surveillance, Epidemiology and End Results database (2004–2016), we identified 8833 non-metastatic upper tract urothelial carcinoma patients treated with radical nephroureterectomy (5208 males vs. 3625 females). Kaplan Meier plots and multivariable Cox regression models predicting overall mortality, other-cause mortality and cancer-specific mortality were used. ResultsOverall, 1323 males (25.4%) and 1986 females (54.8%) were unmarried. Except for lower rates of chemotherapy in unmarried males (15.6 vs. 19.6%, P = 0.001) and unmarried females (13.8 vs. 23.6%, P < 0.001), no clinically meaningful differences were recorded between males and females. In multivariable Cox regression models, unmarried status was an independent predictor of higher overall mortality in both males (Hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 1.19–1.48, P < 0.001) and females (HR: 1.13, 95%CI: 1.00–1.27, P = 0.04), as well as of higher other-cause mortality in both males (HR: 1.53, 95%CI: 1.26–1.84,P < 0.001) and females (HR: 1.43, 95%CI: 1.15–1.78,P < 0.01). However, higher cancer-specific mortality was only recorded in unmarried males (HR: 1.24, 95%CI: 1.08–1.42, P < 0.01), but not in females (HR: 1.02, 95%CI: 0.89–1.17, P = 0.7). ConclusionUnmarried status is a marker of worse survival in both males and females and should be flagged as an important risk factor at diagnosis, in both sexes. In consequence, unmarried patients represent candidate for interventions aimed at decreasing the survival gap relative to married counterparts.

Assessment of Modifiable Factors for the Association of Marital Status With Cancer-Specific Survival

Married patients with cancer have better cancer-specific survival than unmarried patients. Increasing the early diagnosis and definitive treatment of cancer among unmarried patients may reduce the survival gap. To evaluate the extent to which marriage is associated with cancer-specific survival, stage at diagnosis, and treatment among patients with 9 common solid cancers and to recommend methods for reducing the survival gap. This retrospective, population-based cohort study included patients older than 18 years who were diagnosed with 1 of 9 common cancers between January 1, 2007, and December 31, 2016. Patient data were retrieved from the Surveillance, Epidemiology, and End Results Program. Statistical analyses were performed from August 1 to October 1, 2020. Marital status, classified as married and unmarried (including single, separated, divorced, widowed, and unmarried patients or domestic partners). The primary outcome was the time ratio (TR) of cancer-specific survival (married vs unmarried). Mediation analyses were conducted to determine the extent to which the association of marriage with cancer-specific survival was mediated by stage at diagnosis and treatment. This study included 1 733 906 patients (894 379 [51.6%] women; 1 067 726 [61.6%] married; mean [SD] age, 63.76 [12.60] years). Multivariate analyses found that those who were married were associated with better cancer-specific survival than unmarried patients (TR, 1.36; 95% CI, 1.35-1.37). Early diagnosis in breast cancer, colorectal cancer, endometrial cancer, and melanoma mediated the association between marital status and cancer-specific survival (breast cancer: proportion mediated [PM], 11.4%; 95% CI, 11.2%-11.6%; colorectal cancer: PM, 10.9%; 95% CI, 10.7%-11.2%; endometrial cancer: PM, 12.9%; 95% CI, 12.5%-13.3%; melanoma: PM, 12.0%; 95% CI, 11.7-12.4%). Surgery mediated the association between marital status and cancer-specific survival in lung (PM, 52.2%; 95% CI, 51.9%-52.4%), pancreatic (PM, 28.9%; 95% CI, 28.6%-29.3%), and prostate (PM, 39.3%; 95% CI, 39.0%-39.6%) cancers. Chemotherapy mediated the association of marital status with cancer-specific survival in lung (PM, 37.7%; 95% CI, 37.6%-37.9%) and pancreatic (PM, 28.6%; 95% CI, 28.4%-28.9%) cancers. Improved cancer-specific survival associated with marriage was greater among men than women (men: TR, 1.27; 95% CI, 1.25-1.28; women: TR, 1.20; 95% CI, 1.19-1.21). The contribution of receiving an early diagnosis and treatment with surgery or chemotherapy to the association between marital status and cancer-specific survival was greater among men than women (early diagnosis: PM, 21.7% [95% CI, 21.5%-21.9%] vs PM, 20.3% [95% CI, 20.2%-20.4%]; surgery: PM, 26.6% [95% CI, 26.4%-26.7%] vs PM, 11.1% [95% CI, 11.0%-11.2%]; chemotherapy: PM, 6.8% [95% CI, 6.7%-6.8%] vs PM, 5.1% [95% CI, 5.0%-5.2%]). In this study, survival disparities associated with marital status were attributable to early diagnosis in breast, colorectal, and endometrial cancers as well as melanoma and to treatment-related variables in lung, pancreatic, and prostate cancers. The findings also suggest that marriage may play a greater protective role in the cancer-specific survival of men than of women.

P434 Factors associated with medical and psycosocioeconomic changes in IBD during the COVID-19 pandemic and post-pandemic period

BackgroundThe pandemic of COVID-19 had posed challenges in every aspect of the people’s life. COVID-19 had affected all age groups in both previously healthy individuals and those with chronic disease including IBD. This study aimed to investigate the occurrence and factors associated with psychosocioeconomical and medical changes in patients with IBD during the COVID-19 pandemic and post-pandemicperiod in China.MethodsThe survey questionnaires were sent to the patients with IBD in China including epicentres and outside. Bivariate analyses and logistic regression models were used to analysis associations between IBD and various demographic, disease factors, and patient-reported outcomes including working conditions, income, anxiety, stress, and sadness. ResultsOf the 2277 respondents, 144 (6.3%) respondents were from Hubei province which was the epicenter of COVID-19 in China. Multivariable regression demonstrated that patients had part-time work (odds ratio [OR]: 4.28; 95% confidence interval [CI]: 2.48-7.36; P<0.001) or those had middle education level (high school graduate and bachelor’s degree) (OR:7.28; 95%CI: 3.58-14.81; P<0.001) were more likely to have reduced income compared with those had full-time work or less than high school education level. In addition, female (OR: 1.41; 95%CI: 1.16-1.71; P= 0.01) patients were at higher risk of having an anxiety, stress and sadness disorder. While un-married patients (OR: 0.76; 95% CI: 0.63-0.91; P=0.003) patients were less likely to have mood changes. Moreover, IBD patients with active disease (OR: 4.79; 95% CI: 3.87-5.91; P<0.001) were at higher risk of IBD medication changes. ConclusionThe results from this large survey demonstrated that the COVID-19 pandemic affected the patients with IBD financially, psychosocially, and medically. Our findings highlighted the importance of screening for psychosocioeconomic and medical changes in patients with IBD, with particular attention to those of female sex, have part-time work, and active disease. Our IBD community needs to develop effective and feasible strategies to deal with current and future challenges such as a viral pandemic.

Sociodemographics, lifestyle determinants, and viral infections in patients with head and neck cancer undergoing radiotherapy in Taiwan: A prospective cohort study.

10553 Background: Human papillomavirus (HPV) screening has been implemented to monitor both cervical cancer and head and neck cancer. In this prospective cohort study, we determined sociodemographic, behavioral, and infectious etiology for head and neck squamous cell carcinoma (HNSCC) in Taiwan using data collected from an anonymous sexually transmitted infections screening program. Methods: An anonymous sexually transmitted infections screening program was conducted at a medical center during 2016, in which sociodemographic characteristics including gender, age, marital status, education level, and occupation; medical history regarding underlying comorbidities and history of receiving HPV and other vaccines; lifestyle determinants including betel quid chewing, drug using, and sexual behaviors, were inquired. Blood, anal swab, and penile swab samples were collected to determine viral infections using polymerase chain reaction (PCR). With PCR, 37 HPV genotypes were detected. Regular follow-ups were made for patients enrolled in the screening program until end of 2020, during which all suspected malignancies were recorded upon referrals to oncologists. From this prospective cohort, odds ratios (ORs) of HNSCC for sociodemographic, lifestyle, and infectious variables were derived with logistic regression (R version 4.0.1). P &lt; 0.05 was considered statistically significant. Results: A total of 376 patients were enrolled. Most patients were men (n = 372), with a median age of 27 years. There were 124 (32.98%) HPV-positive patients and 78 (20.74%) HIV-positive patients. Among HPV-positive patients, 20 (25.64%) were of high-risk genotypes. During the follow-up, 44 patients developed HNSCC and all received radiotherapy. Multivariate analysis revealed that patients who were single (OR = 1.43, 95% CI = 1.12-1.83, P = 0.01) or widowed (OR = 2.47, 95% CI = 1.88-3.25, P &lt; 0.001) had higher risk of HNSCC than patients who were married. Patients aged 51-60 (OR = 2.93, 95% CI = 2.10-4.09, P &lt; 0.001) and over 60 (OR = 1.89, 95% CI = 1.45-2.47, P &lt; 0.001) presented higher risks of HNSCC, compared with those aged below 20. Patients addicted to betel quid chewing had high HNSCC risk (OR = 1.29, 95% CI = 1.11 – 1.50, P &lt; 0.001). However, patients with HPV infections did not present with higher HNSCC risks (OR = 0.925, 95% CI = 0.852 – 1.003, P = 0.058). Conclusions: In this prospective cohort study, the elderly, unmarried patients, and patients addicted to betel quid chewing, presented with high HNSCC incidence. On the contrary, the association between HPV infection and HNSCC was insignificant. As both betel nut-chewing and HPV infection could be prevented, we advocate for comprehensive screening and patient education for HNSCC prevention.