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1.
JAMA Cardiol ; 2024 Jun 05.
Article in English | MEDLINE | ID: mdl-38837166

ABSTRACT

Importance: Survival for out-of-hospital cardiac arrest (OHCA) varies widely across emergency medical service (EMS) agencies in the US. However, little is known about which EMS practices are associated with higher agency-level survival. Objective: To identify resuscitation practices associated with favorable neurological survival for OHCA at EMS agencies. Design, Setting, and Participants: This cohort study surveyed EMS agencies participating in the Cardiac Arrest Registry to Enhance Survival (CARES) with 10 or more OHCAs annually during January 2015 to December 2019; data analyses were performed from April to October 2023. Exposure: Survey of resuscitation practices at EMS agencies. Main Outcomes and Measures: Risk-standardized rates of favorable neurological survival for OHCA at each EMS agency were estimated using hierarchical logistic regression. Multivariable linear regression then examined the association of EMS practices with rates of risk-standardized favorable neurological survival. Results: Of 577 eligible EMS agencies, 470 agencies (81.5%) completed the survey. The mean (SD) rate of risk-standardized favorable neurological survival was 8.1% (1.8%). A total of 7 EMS practices across 3 domains (training, cardiopulmonary resuscitation [CPR], and transport) were associated with higher rates of risk-standardized favorable neurological survival. EMS agencies with higher favorable neurological survival rates were more likely to use simulation to assess CPR competency (ß = 0.54; P = .05), perform frequent reassessment (at least once every 6 months) of CPR competency in new staff (ß = 0.51; P = .04), use full multiperson scenario simulation for ongoing skills training (ß = 0.48; P = .01), perform simulation training at least every 6 months (ß = 0.63; P < .001), and conduct training in the use of mechanical CPR devices at least once annually (ß = 0.43; P = .04). EMS agencies with higher risk-standardized favorable neurological survival were also more likely to use CPR feedback devices (ß = 0.58; P = .007) and to transport patients to a designated cardiac arrest or ST-segment elevation myocardial infarction receiving center (ß = 0.57; P = .003). Adoption of more than half (≥4) of the 7 practices was more common at EMS agencies in the highest quartile of favorable neurological survival rates (70 of 118 agencies [59.3%]) vs the lowest quartile (42 of 118 agencies [35.6%]) (P < .001). Conclusions and Relevance: In a national registry for OHCA, 7 practices associated with higher rates of favorable neurological survival were identified at EMS agencies. Given wide variability in neurological survival across EMS agencies, these findings provide initial insights into EMS practices associated with top-performing EMS agencies in OHCA survival. Future studies are needed to validate these findings and identify best practices for EMS agencies.

2.
Implement Sci Commun ; 5(1): 52, 2024 May 06.
Article in English | MEDLINE | ID: mdl-38711156

ABSTRACT

BACKGROUND: Alcohol screening and brief intervention (SBI) is an evidence-based intervention recommended by the World Health Organization. This study applied the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers of SBI implementation in primary care settings in Hong Kong, China. METHODS: This was a sequential mixed-method study. In-depth interviews of 21 physicians and 20 nurses working in the primary care settings from the public and private sectors were first conducted to identify CFIR constructs that were relevant to SBI implementation in the Chinese context and potential factors not covered by the CFIR. A questionnaire was then developed based on the qualitative findings to investigate factors associated with SBI implementation among 282 physicians and 295 nurses. RESULTS: The in-depth interviews identified 22 CFIR constructs that were facilitators or barriers of SBI implementation in Hong Kong. In addition, the stigmatization of alcohol dependence was a barrier and the belief that it was important for people to control the amount of alcohol intake in any situation was mentioned as a facilitator to implement SBI. In the survey, 22% of the participants implemented SBI in the past year. Factors associated with the SBI implementation echoed most of the qualitative findings. Among physicians and nurses in both sectors, they were more likely to implement SBI when perceiving stronger evidence supporting SBI, better knowledge and self-efficacy to implement SBI, more available resources, and clearer planning for SBI implementation in the clinics but less likely to do so when perceiving SBI implementation to be complicated and of higher cost, and drinking approved by the Chinese culture. Participants were more likely to implement SBI when perceiving SBI fit better with the existing practice and better leadership engagement in the public sector, but not in the private sector. Perceiving a stronger need and greater importance to implement SBI were associated with higher likelihood of SBI implementation among physicians, but not among nurses. Perceiving better organizational culture supporting SBI was positively associated with SBI implementation among nurses, but not among physicians. CONCLUSIONS: There was a significant gap between SBI evidence and its implementation. Some strategies to improve SBI implementation may be different between physicians and nurses and between those in the public and private sectors. The CFIR is a useful framework for understanding facilitators and barriers of SBI implementation in primary care settings.

3.
Curr Pediatr Rev ; 2024 May 20.
Article in English | MEDLINE | ID: mdl-38778597

ABSTRACT

BACKGROUND: The COVID-19 global pandemic was caused by a novel coronavirus (SARS-CoV-2), which then became an endemic infection. COVID refers to the World Health Organization's coined acronym for coronavirus disease. CASE PRESENTATION: We have, herein, reported three cases of coronavirus diseases that could have been misdiagnosed as COVID-19. All of these families reported previous COVID-19 infection based on self-administered Rapid Antigen Testing (RAT) and completed a period of home isolation. In the current presentation, one child had an RSV-associated asthma attack, one had norovirus gastritis, and another had an infection with Campylobacter and E. coli. NL63, OC43, and 229E, respectively, were found by PCR in these patients. DISCUSSION: Seven human coronaviruses cause infectious diseases, including in children. Confusion and issues associated with coronavirus disease diagnosis by Polymerase Chain Reaction (PCR) testing and Rapid Antigen Test (RAT) may arise. Some RATs are Antigen Fluorescent Immunoassays (FIA) that target monoclonal antibodies for the detection of viral nucleocapsid protein. Others target the non-nucleocapsid proteins. False positivity is possible. False negativity is also possible if the specimen's antigen level is below the test's detection limit. RAT results usually remain positive for 6 to 7 days, but they may stay positive as long as 2 weeks. Stigmatization with the COVID-19 diagnosis may occur. The PCR test is a highly sensitive 'gold standard' for the detection of COVID-19, but it can also detect non-infectious individuals' fragmented non-infectious viral nucleic acids, and could be positive for a long period. An individual may be tested positive for a few weeks to months after the individual becomes non-infectious. CONCLUSION: The cases presented here had coronavirus diseases other than COVID-19. Coronavirus diseases can be caused by coronavirus variants other than SARS-CoV-2. Co-infections with other pathogens are present in these diseases. PCR testing of non-COVID-19 diseases may help in the accurate diagnosis of these ailments and respiratory co-infections.

4.
Circ Heart Fail ; 17(5): e011164, 2024 May.
Article in English | MEDLINE | ID: mdl-38742418

ABSTRACT

BACKGROUND: Quantifying guideline-directed medical therapy (GDMT) intensity is foundational for improving heart failure (HF) care. Existing measures discount dose intensity or use inconsistent weighting. METHODS: The Kansas City Medical Optimization (KCMO) score is the average of total daily to target dose percentages for eligible GDMT, reflecting the percentage of optimal GDMT prescribed (range, 0-100). In Change the Management of Patients With HF, we computed KCMO, HF collaboratory (0-7), and modified HF Collaboratory (0-100) scores for each patient at baseline and for 1-year change in established GDMT at the time (mineralocorticoid receptor antagonist, ß-blocker, ACE [angiotensin-converting enzyme] inhibitor/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitor). We compared baseline and 1-year change distributions and the coefficient of variation (SD/mean) across scores. RESULTS: Among 4532 patients at baseline, mean KCMO, HF collaboratory, and modified HF Collaboratory scores were 38.8 (SD, 25.7), 3.4 (1.7), and 42.2 (22.2), respectively. The mean 1-year change (n=4061) for KCMO was -1.94 (17.8); HF collaborator, -0.11 (1.32); and modified HF Collaboratory, -1.35 (19.8). KCMO had the highest coefficient of variation (0.66), indicating greater variability around the mean than the HF collaboratory (0.49) and modified HF Collaboratory (0.53) scores, reflecting higher resolution of the variability in GDMT intensity across patients. CONCLUSIONS: KCMO measures GDMT intensity by incorporating dosing and treatment eligibility, provides more granularity than existing methods, is easily interpretable (percentage of ideal GDMT), and can be adapted as performance measures evolve. Further study of its association with outcomes and its usefulness for quality assessment and improvement is needed.


Subject(s)
Angiotensin-Converting Enzyme Inhibitors , Heart Failure , Practice Guidelines as Topic , Humans , Heart Failure/drug therapy , Practice Guidelines as Topic/standards , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Female , Male , Adrenergic beta-Antagonists/therapeutic use , Mineralocorticoid Receptor Antagonists/therapeutic use , Guideline Adherence/standards , Aged , Angiotensin Receptor Antagonists/therapeutic use , Middle Aged , Treatment Outcome
5.
J Am Heart Assoc ; 13(9): e033411, 2024 May 07.
Article in English | MEDLINE | ID: mdl-38686873

ABSTRACT

BACKGROUND: Cardiac arrest is 1 of the leading causes of morbidity and mortality, with an estimated 340 000 out-of-hospital and 292 000 in-hospital cardiac arrest events per year in the United States. Survival rates are lower in certain racial and socioeconomic groups. METHODS AND RESULTS: We performed a county-level cross-sectional longitudinal study using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research multiple causes of death data set between 2016 and 2020 among individuals of all ages whose death was attributed to cardiac arrest. The Social Vulnerability Index is a composite measure that includes socioeconomic vulnerability, household composition, disability, individuals from racial and ethnic minority groups status and language, and housing and transportation domains. We examined the impact of social determinants on cardiac arrest mortality stratified by age, race, ethnicity, and sex in the United States. All age-adjusted mortality rate (cardiac arrest AAMRs) are reported as per 100 000. Overall cardiac arrest AAMR during the study period was 95.6. The cardiac arrest AAMR was higher for men compared with women (119.6 versus 89.9) and for the Black population compared with the White population (150.4 versus 92.3). The cardiac arrest AAMR increased from 64.8 in counties in quintile 1 of Social Vulnerability Index to 141 in quintile 5, with an average increase of 13% (95% CI, 9.8%-16.9%) in AAMR per quintile increase. CONCLUSIONS: Mortality from cardiac arrest varies widely, with a >2-fold difference between the counties with the highest and lowest social vulnerability, highlighting the differential burden of cardiac arrest deaths throughout the United States based on social determinants of health.


Subject(s)
Heart Arrest , Social Vulnerability , Humans , United States/epidemiology , Male , Female , Middle Aged , Heart Arrest/mortality , Heart Arrest/ethnology , Aged , Cross-Sectional Studies , Adult , Young Adult , Adolescent , Social Determinants of Health , Risk Factors , Longitudinal Studies , Aged, 80 and over , Child, Preschool , Child , Infant , Health Status Disparities , Infant, Newborn
6.
Expert Opin Drug Metab Toxicol ; 20(4): 175-179, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38594810

ABSTRACT

INTRODUCTION: Over the last few years, there has been a substantial increase in the data available about the benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in improving cardiovascular and renal outcomes in patients with type 2 diabetes (T2D). Very little new information is available for the other groups of glucose-lowering drugs. AREAS COVERED: This brief report summarizes the recent information about the respective benefits of the two newer groups of glucose-lowering drugs and the effects on cardiovascular risk factors that may be involved in these benefits. The articles reviewed were identified by a Medline search. EXPERT OPINION: Recent guidelines recommend SGLT2 inhibitors or GLP-1 RAs with proven cardiovascular disease benefits as potential first line treatment for patients with T2D and established atherosclerotic cardiovascular disease (ASCVD) or those with high risk of ASCVD or with chronic kidney disease or heart failure. Both groups of drugs have been shown to reduce major adverse cardiovascular events, but the mechanisms vary between them. SGLT2 inhibitors are preferred for the treatment and prevention of heart failure and chronic kidney disease, whereas GLP-1 RAs are more effective in reducing body weight and improving glycemic control in patients with T2D.


Subject(s)
Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Glucagon-Like Peptide-1 Receptor , Hypoglycemic Agents , Sodium-Glucose Transporter 2 Inhibitors , Humans , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/physiopathology , Sodium-Glucose Transporter 2 Inhibitors/pharmacology , Sodium-Glucose Transporter 2 Inhibitors/administration & dosage , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/etiology , Hypoglycemic Agents/pharmacology , Hypoglycemic Agents/administration & dosage , Glucagon-Like Peptide-1 Receptor/agonists , Heart Disease Risk Factors , Blood Glucose/drug effects , Blood Glucose/metabolism , Practice Guidelines as Topic , Renal Insufficiency, Chronic/drug therapy , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/physiopathology
7.
NPJ Biofilms Microbiomes ; 10(1): 39, 2024 Apr 08.
Article in English | MEDLINE | ID: mdl-38589501

ABSTRACT

Dysbiosis of the human oral microbiota has been reported to be associated with oral cavity squamous cell carcinoma (OSCC) while the host-microbiota interactions with respect to the potential impact of pathogenic bacteria on host genomic and epigenomic abnormalities remain poorly studied. In this study, the mucosal bacterial community, host genome-wide transcriptome and DNA CpG methylation were simultaneously profiled in tumors and their adjacent normal tissues of OSCC patients. Significant enrichment in the relative abundance of seven bacteria species (Fusobacterium nucleatum, Treponema medium, Peptostreptococcus stomatis, Gemella morbillorum, Catonella morbi, Peptoanaerobacter yurli and Peptococcus simiae) were observed in OSCC tumor microenvironment. These tumor-enriched bacteria formed 254 positive correlations with 206 up-regulated host genes, mainly involving signaling pathways related to cell adhesion, migration and proliferation. Integrative analysis of bacteria-transcriptome and bacteria-methylation correlations identified at least 20 dysregulated host genes with inverted CpG methylation in their promoter regions associated with enrichment of bacterial pathogens, implying a potential of pathogenic bacteria to regulate gene expression, in part, through epigenetic alterations. An in vitro model further confirmed that Fusobacterium nucleatum might contribute to cellular invasion via crosstalk with E-cadherin/ß-catenin signaling, TNFα/NF-κB pathway and extracellular matrix remodeling by up-regulating SNAI2 gene, a key transcription factor of epithelial-mesenchymal transition (EMT). Our work using multi-omics approaches explored complex host-microbiota interactions and provided important insights into genetic and functional basis in OSCC tumorigenesis, which may serve as a precursor for hypothesis-driven study to better understand the causational relationship of pathogenic bacteria in this deadly cancer.


Subject(s)
Carcinoma, Squamous Cell , Head and Neck Neoplasms , Microbiota , Mouth Neoplasms , Humans , Squamous Cell Carcinoma of Head and Neck/genetics , Epigenomics , Dysbiosis , Mouth Neoplasms/genetics , Mouth Neoplasms/metabolism , Mouth Neoplasms/pathology , Carcinoma, Squamous Cell/genetics , Carcinoma, Squamous Cell/metabolism , Carcinoma, Squamous Cell/pathology , Bacteria , Fusobacterium nucleatum , Head and Neck Neoplasms/genetics , Epigenesis, Genetic , Tumor Microenvironment
8.
Crit Care Med ; 52(6): 878-886, 2024 06 01.
Article in English | MEDLINE | ID: mdl-38502800

ABSTRACT

OBJECTIVES: Contrary to advanced cardiac life support guidelines that recommend immediate defibrillation for shockable in-hospital cardiac arrest (IHCA), epinephrine administration before first defibrillation is common and associated with lower survival at a "patient-level." Whether this practice varies across hospitals and its association with "hospital-level" IHCA survival remains unknown. The purpose of this study was to determine hospital variation in rates of epinephrine administration before defibrillation for shockable IHCA and its association with IHCA survival. DESIGN: Observational cohort study. SETTING: Five hundred thirteen hospitals participating in the Get With The Guidelines Resuscitation Registry. PATIENTS: A total of 37,668 adult patients with IHCA due to an initial shockable rhythm from 2000 to 2019. INTERVENTIONS: Epinephrine before first defibrillation. MEASUREMENTS AND MAIN RESULTS: Using multivariable hierarchical regression, we examined hospital variation in epinephrine administration before first defibrillation and its association with hospital-level rates of risk-adjusted survival. The median hospital rate of epinephrine administration before defibrillation was 18.8%, with large variation across sites (range, 0-68.8%; median odds ratio: 1.54; 95% CI, 1.47-1.61). Major teaching status and annual IHCA volume were associated with hospital rate of epinephrine administration before defibrillation. Compared with hospitals with the lowest rate of epinephrine administration before defibrillation (Q1), there was a stepwise decline in risk-adjusted survival at hospitals with higher rates of epinephrine administration before defibrillation (Q1: 44.3%, Q2: 43.4%; Q3: 41.9%; Q4: 40.3%; p for trend < 0.001). CONCLUSIONS: Administration of epinephrine before defibrillation in shockable IHCA is common and varies markedly across U.S. hospitals. Hospital rates of epinephrine administration before defibrillation were associated with a significant stepwise decrease in hospital rates of risk-adjusted survival. Efforts to prioritize immediate defibrillation for patients with shockable IHCA and avoid early epinephrine administration are urgently needed.


Subject(s)
Electric Countershock , Epinephrine , Heart Arrest , Epinephrine/administration & dosage , Epinephrine/therapeutic use , Humans , Heart Arrest/therapy , Heart Arrest/mortality , Heart Arrest/drug therapy , Female , Male , Aged , Middle Aged , Electric Countershock/statistics & numerical data , Electric Countershock/methods , Hospitals/statistics & numerical data , Cohort Studies , Vasoconstrictor Agents/administration & dosage , Vasoconstrictor Agents/therapeutic use
11.
Nat Commun ; 15(1): 2546, 2024 Mar 21.
Article in English | MEDLINE | ID: mdl-38514647

ABSTRACT

Influenza virus continuously evolves to escape human adaptive immunity and generates seasonal epidemics. Therefore, influenza vaccine strains need to be updated annually for the upcoming flu season to ensure vaccine effectiveness. We develop a computational approach, beth-1, to forecast virus evolution and select representative virus for influenza vaccine. The method involves modelling site-wise mutation fitness. Informed by virus genome and population sero-positivity, we calibrate transition time of mutations and project the fitness landscape to future time, based on which beth-1 selects the optimal vaccine strain. In season-to-season prediction in historical data for the influenza A pH1N1 and H3N2 viruses, beth-1 demonstrates superior genetic matching compared to existing approaches. In prospective validations, the model shows superior or non-inferior genetic matching and neutralization against circulating virus in mice immunization experiments compared to the current vaccine. The method offers a promising and ready-to-use tool to facilitate vaccine strain selection for the influenza virus through capturing heterogeneous evolutionary dynamics over genome space-time and linking molecular variants to population immune response.


Subject(s)
Influenza Vaccines , Influenza, Human , Humans , Animals , Mice , Influenza Vaccines/genetics , Influenza A Virus, H3N2 Subtype/genetics , Hemagglutinin Glycoproteins, Influenza Virus , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Mutation , Seasons
12.
Resusc Plus ; 18: 100614, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38549691

ABSTRACT

Cardiac arrest is common and associated with significant mortality and morbidity among survivors. To better understand the epidemiology and outcomes of cardiac arrest, many countries and regions have developed cardiac arrest registries. In the United States, with the diversity of its population, these registries have illuminated differences and disparities in the care and outcomes of cardiac arrest patients based on their race, ethnicity, and sex. These findings raise concerns as traditionally vulnerable patient groups have lower survival rates for cardiac arrest-a condition for which overall survival is already low. Although leveraging registries to raise awareness of disparities in cardiac arrest outcomes is an important first step, further research is needed to understand the sources of these differences, narrow observed disparities and improve overall outcomes.

13.
Virol Sin ; 39(2): 218-227, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38316363

ABSTRACT

The SARS-CoV-2 Omicron variants are notorious for their transmissibility, but little is known about their subgenomic RNA (sgRNA) expression. This study applied RNA-seq to delineate the quantitative and qualitative profiles of canonical sgRNA of 118 respiratory samples collected from patients infected with Omicron BA.2 and compared with 338 patients infected with non-variant of concern (non-VOC)-D614G. A unique characteristic profile depicted by the relative abundance of 9 canonical sgRNAs was reproduced by both BA.2 and non-VOC-D614G regardless of host gender, age and presence of pneumonia. Remarkably, such profile was lost in samples with low viral load, suggesting a potential application of sgRNA pattern to indicate viral activity of individual patient at a specific time point. A characteristic qualitative profile of canonical sgRNAs was also reproduced by both BA.2 and non-VOC-D614G. The presence of a full set of canonical sgRNAs carried a coherent correlation with crude viral load (AUC â€‹= â€‹0.91, 95% CI 0.88-0.94), and sgRNA ORF7b was identified to be the best surrogate marker allowing feasible routine application in characterizing the infection status of individual patient. Further potentials in using sgRNA as a target for vaccine and antiviral development are worth pursuing.


Subject(s)
COVID-19 , RNA, Viral , SARS-CoV-2 , Viral Load , Humans , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , RNA, Viral/genetics , COVID-19/virology , COVID-19/diagnosis , Male , Female , Middle Aged , Adult , Aged , Genome, Viral/genetics , Young Adult , Subgenomic RNA
14.
J Med Virol ; 96(2): e29460, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38348874

ABSTRACT

A cross-sectional study in 2021-23 collected oral rinse gargle samples from an human papillomaviruses (HPV) vaccine-naïve general adult population in Hong Kong. HPV was detected by a PCR using SPF10 primers, and genotyped by a linear array covering 25 genotypes. Epidemiologic information including sociodemographics, medical history, oral health, and sexual behavior were collected by a self-administered questionnaire. Altogether, 2323 subjects aged 18-75 (median 47) years with 50.1% male were recruited. The prevalence for oral HPV infection with all genotypes combined, high-risk, and low-risk genotypes was 1.5%, 0.7%, and 0.7%, respectively; and with no statistically significant difference between participant gender. The prevalence increased with age and was highest in women at 45-54 years (2.7% for all genotypes combined), and highest in men aged >64 years (4.1% for all genotypes combined). HPV52 was the most common genotype among all participants. Univariate analysis suggested more lifetime sexual or oral sexual partners as risk factors, but they did not reach statistical significance upon multivariate analysis; whereas higher educational level had an independent protective effect. To conclude, oral HPV prevalence increased with age in Hong Kong. Strategies to prevent oral HPV infection and the associated cancers are urgently needed.


Subject(s)
Papillomavirus Infections , Adult , Humans , Male , Female , Hong Kong/epidemiology , Papillomavirus Infections/epidemiology , Prevalence , Cross-Sectional Studies , Sexual Behavior , Risk Factors , Papillomaviridae/genetics , Genotype
15.
Circ Cardiovasc Qual Outcomes ; 17(2): e009960, 2024 02.
Article in English | MEDLINE | ID: mdl-38318702

ABSTRACT

BACKGROUND: It is unclear how the type of an atherosclerotic cardiovascular disease (ASCVD) event potentially influences patients' likelihood of smoking cessation. METHODS: Using 2013 to 2018 data from the US based National Cardiovascular Data Registry Practice Innovation and Clinical Excellence outpatient cardiac registry, we identified patients who were current smokers at a clinic visit and followed them over time for a subsequent ASCVD event. Self-reported smoking status was assessed at each consecutive visit and used to determine smoking cessation after each interim ASCVD event (myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, stroke/transient ischemic attack, peripheral artery disease). We constructed separate multivariable Cox models with nonproportional hazards to examine the association of each interim ASCVD event with smoking cessation, compared with not having an interim ASCVD event. We estimated the relative association of ASCVD event type with smoking cessation using contrast tests. Analyses were stratified by presence versus absence of ASCVD at baseline. RESULTS: Across 530 cardiology practices, we identified 1 933 283 current smokers (mean age 62±15, male 54%, ASCVD at baseline 50%). Among the 322 743 patients who had an interim ASCVD event and were still smoking, 41 336 (12.8%) quit smoking by their first subsequent clinic visit, which was higher among those with baseline ASCVD (13.4%) as compared with those without baseline ASCVD (11.5%). Each type of ASCVD event was associated with an increased likelihood of smoking. Patients who had an myocardial infarction, underwent coronary artery bypass graft (hazard ratio, 1.60 [95% CI, 1.55-1.65]), or had a stroke or transient ischemic attack were more likely to quit smoking as compared with those who underwent elective percutaneous coronary intervention or had a new diagnosis of peripheral artery disease (hazard ratio, 1.20 [95% CI, 1.17-1.22]). CONCLUSIONS: Only 13% of patients reported smoking cessation after an ASCVD event, with the type of event being associated with the likelihood of smoking cessation, prompting the need for patient-centered interventions.


Subject(s)
Atherosclerosis , Cardiovascular Diseases , Ischemic Attack, Transient , Myocardial Infarction , Peripheral Arterial Disease , Smoking Cessation , Stroke , Humans , Male , Middle Aged , Aged , Outpatients , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/epidemiology , Ischemic Attack, Transient/therapy , Stroke/diagnosis , Stroke/epidemiology , Stroke/therapy , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/epidemiology , Peripheral Arterial Disease/therapy , Registries , Risk Factors
16.
JAMA Netw Open ; 7(2): e2356693, 2024 Feb 05.
Article in English | MEDLINE | ID: mdl-38393730

ABSTRACT

Importance: A primary objective in managing atrial fibrillation (AF) is to optimize patients' health status, which can be done only if physicians accurately quantify the outcomes associated with AF in patients' lives. Objective: To explore physicians' estimation of the health status of patients with AF and its association with subsequent care and outcomes. Design, Setting, and Participants: A multicenter, prospective cohort study was conducted in 2 outpatient practices in Tokyo, Japan. Participants included patients with newly diagnosed AF or those referred for initial treatment of AF at outpatient practices and treating physicians from November 8, 2018, to April 1, 2020. Data analysis was performed from December 22, 2022, to July 7, 2023. Exposures: Participating patients completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire, a 20-item tool covering 4 domains with a 7-point Likert scale; 3 domains (symptoms, daily activities, and treatment concerns) were used in this study. Blinded to patients' responses, treating physicians answered a 3-item questionnaire quantifying each patient's AFEQT domain with a single item. Patients' mean Likert scale responses within each AFEQT domain were subtracted from the physicians' assessments so that higher scores (≥0.5 points) indicate physician underestimation, while lower scores (≤0.5 points) indicate physician overestimation of the health status of patients with AF. Main Outcomes and Measures: The independent association of physician-patient concordance with treatment escalation (alteration or initiation of antiarrhythmic drugs, cardioversion, or catheter ablation) and 1-year adjusted changes in AFEQT scores. Results: Among 330 patients (238 [72.1%] men; mean [SD] age, 67.9 [11.9] years; 163 [49.4%] with paroxysmal AF), physicians correctly estimated health status in 112 patients (33.9%), underestimated it in 42 patients (12.7%), and overestimated it in 176 patients (53.3%). Treatment escalation occurred in 63.6% of patients whose health status was correctly estimated, 47.6% of those whose health status was underestimated, and 66.3% of patients whose health status was overestimated. After multivariable adjustment, underestimation of health status was independently associated with less treatment escalation (adjusted odds ratio, 0.43; 95% CI, 0.20-0.90) and less frequent AFEQT overall summary score improvement at 1 year (underestimated, 2.5 [95% CI, -1.6 to 6.7] vs correctly and overestimated health status, 8.4 [95% CI, 7.0-9.9] points; P = .01). Conclusions and Relevance: In this cohort study, physician underestimation of the health status of patients with AF was common and associated with less aggressive treatment and less health status improvement at 1 year.


Subject(s)
Atrial Fibrillation , Physicians , Aged , Female , Humans , Male , Atrial Fibrillation/drug therapy , Cohort Studies , Patient Reported Outcome Measures , Prospective Studies , Quality of Life , Middle Aged
17.
JAMA Intern Med ; 184(2): 218-220, 2024 Feb 01.
Article in English | MEDLINE | ID: mdl-38165699

ABSTRACT

This cohort study examines bystander automated external defibrillator (AED) application and survival outcomes for out-of-hospital cardiac arrest at recreational facilities in US states with and without AED legislation.


Subject(s)
Out-of-Hospital Cardiac Arrest , Humans , Out-of-Hospital Cardiac Arrest/therapy , Defibrillators , Electric Countershock
18.
Cancers (Basel) ; 16(1)2024 Jan 03.
Article in English | MEDLINE | ID: mdl-38201653

ABSTRACT

The incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is rising in the West, but little is known in Asia. This study elucidated changes in the incidence and HPV-positive portion of OPSCC in Hong Kong. Data from population-based cancer registry were used to analyze the incidence of OPSCC in association with other head and neck cancers. Archived tumor tissues were tested for HPV. From 1986 to 2020, there was a marked decrease in the incidence of nasopharyngeal and laryngeal cancers, but a persistent increase in OPSCC from 36 cases in 1986 to 116 cases in 2020. The average positive rate for high-risk HPV was 36.1% (112/310) among OPSCC diagnosed in 2010-2020. The HPV-positive rate in recent years was significantly higher than earlier cases (tonsil SCC: 64.7% (55/85) in 2016-2020 vs. 40.4% (19/47) in 2010-2015, p = 0.007). Patients with HPV-positive tonsil cancers were significantly younger than those negative (mean [SD]: 58.9 [9.9] vs. 64.3 [13.3] years, p = 0.006), but no significant difference was observed between genders. A persistent increase in the incidence of oropharyngeal cancer over the last few decades was observed in Hong Kong, which can be explained by the remarkable increase in HPV-positive tonsil cancers.

19.
Resuscitation ; 196: 110126, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38280509

ABSTRACT

BACKGROUND: Delays in bystander cardiopulmonary resuscitation (CPR) are associated with worse out-of-hospital cardiac arrest (OHCA) outcomes. Whether disparities exist in time to CPR between women and men is unknown. METHODS: We included witnessed OHCAs treated with bystander CPR from the Cardiac Arrest Registry Enhancing Survival between 2013-2021. The primary outcome was time to first bystander CPR, and secondary outcomes were survival to hospital discharge and favorable neurological survival. Hierarchical ordinal regression was used to model time to first CPR, which estimates the odds of having a 2-minute longer delay (from 0 to ≥10 minutes) in receiving bystander CPR. The model included sex, age, race, location of arrest, cardiac arrest etiology, day of week, and season as fixed effects and EMS agency as a random effect to account for clustering of patients within an agency. RESULTS: Of 78,043 patients with a witnessed OHCA that received bystander CPR, 25,197 (32.3%) were women. The median [IQR] time to first bystander CPR was 2 [1,5] minutes for both women and men. In adjusted analysis, time to bystander CPR was similar in men and women (p = 0.26). Moreover, there was a statistically significantly graded inverse association between time to bystander CPR and survival. CONCLUSION: For patients with witnessed OHCA that received bystander CPR, women and men had similar times to CPR, although 5-minute or greater delays in initiating CPR was not uncommon. Delays in bystander CPR in OHCA were associated with worse survival outcomes.


Subject(s)
Cardiopulmonary Resuscitation , Out-of-Hospital Cardiac Arrest , Male , Humans , Female , Out-of-Hospital Cardiac Arrest/therapy , Cluster Analysis , Patient Discharge , Registries
20.
JMIR Public Health Surveill ; 10: e45647, 2024 Jan 24.
Article in English | MEDLINE | ID: mdl-38265866

ABSTRACT

BACKGROUND: Counseling supporting HIV self-testing (HIVST) is helpful in facilitating linkage to care and promoting behavior changes among men who have sex with men (MSM). Different levels of counseling support for MSM HIVST users may lead to variance in the linkage to care. OBJECTIVE: This study aims to synthesize evidence on counseling supporting MSM HIVST users and to conduct a meta-analysis to quantify the proportion of MSM HIVST users who were linked to care. METHODS: A systematic search was conducted using predefined eligibility criteria and relevant keywords to retrieve studies from the MEDLINE, Global Health, Web of Science, Embase, APA PsycINFO, and Scopus databases. This search encompassed papers and preprints published between July 3, 2012, and June 30, 2022. Studies were eligible if they reported counseling supporting HIVST or quantitative outcomes for linkage to care among MSM and were published in English. The screening process and data extraction followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The quality of the included studies was assessed by the National Institutes of Health quality assessment tool. Data were extracted using random effects models to combine the proportion of HIVST users who were linked to care. Subgroup analyses and metaregression were conducted to assess whether linkage to care varied according to study characteristics. All analyses were performed with R (version 4.2.1; R Foundation for Statistical Computing) using the metafor package. RESULTS: A total of 55 studies published between 2014 and 2021, including 43 observational studies and 12 randomized controlled trials, were identified. Among these studies, 50 (91%) provided active counseling support and 5 (9%) provided passive counseling support. In studies providing active counseling support, most MSM HIVST users were linked to various forms of care, including reporting test results (97.2%, 95% CI 74.3%-99.8%), laboratory confirmation (92.6%, 95% CI 86.1%-96.2%), antiretroviral therapy initiation (90.8%, 95% CI 86.7%-93.7%), and referral to physicians (96.3%, 95% CI 85%-99.2%). In studies providing passive counseling support, fewer MSM HIVST users were linked to laboratory confirmation (78.7%, 95% CI 17.8%-98.4%), antiretroviral therapy initiation (79.1%, 95% CI 48.8%-93.7%), and referral to physicians (79.1%, 95% CI 0%-100%). Multivariate metaregression indicated that a higher number of essential counseling components, a smaller sample size (<300), and the use of mobile health technology to deliver counseling support were associated with better linkage to care. The quality of the studies varied from fair to good with a low to high risk of bias. CONCLUSIONS: Proactively providing counseling support for all users, involving a higher number of essential components in the counseling support, and using mobile health technology could increase the linkage to care among MSM HIVST users. TRIAL REGISTRATION: PROSPERO CRD42022346247; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346247.


Subject(s)
HIV Infections , Sexual and Gender Minorities , United States , Male , Humans , Homosexuality, Male , Self-Testing , Counseling
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