Roles and activities of nurses in cancer prevention and early detection in low- and middle-income countries: A scoping review.

Objective: Nurses play a crucial role in cancer control. Prior reviews presented the effectiveness of nursing interventions such as tobacco cessation counseling and cervical cancer screening but did not focus on low- and middle-income countries (LMICs). This scoping review addresses a gap in the literature by describing the roles and activities of nurses in cancer prevention and early detection in LMICs. Methods: Following Arksey and O'Malley's scoping review framework, we searched seven databases using subject headings and keywords from 1990 to January 2021 and updated in April 2022. The reference lists of relevant studies were also searched. Two reviewers independently screened the relevance of studies through Rayyan, assessed full text articles, and extracted data using a Google Form. Conflicts were resolved by a third reviewer. Results: A total of 180 studies were included, representing all six World Health Organization regions and 48 LMICs. The largest number of studies were from the African region (n â€‹= â€‹72), the Americas (n â€‹= â€‹49), and South-East Asia region (n â€‹= â€‹29). The main nursing roles featured were patient/community education (n â€‹= â€‹113), history taking and cancer risk assessment (n â€‹= â€‹63), performing screening exams (n â€‹= â€‹136), care coordination (n â€‹= â€‹57), and training other healthcare professionals (n â€‹= â€‹9). Conclusions: This scoping review provides a comprehensive picture of nurses' role in cancer prevention and early detection in LMICs, across all six World Health Organization regions. Additional cancer workforce data sources at the country level are needed to fully understand the activities of nurses in cancer prevention. Future research is also needed to measure the impact of nursing educational and other interventions in both primary and secondary cancer prevention.

Effects of portable air cleaners and A/C unit fans on classroom concentrations of particulate matter in a non-urban elementary school.

Given the increased use of air cleaners as a prevention measure in classrooms during the COVID-19 pandemic, this study aimed to investigate the effects of portable air cleaners with HEPA filters and window A/C fans on real-time (1 minute) concentrations of PM less than 2.5 microns (PM2.5) or less than 1 microns (PM1.0) in two classrooms in a non-urban elementary school in Rhode Island. For half of each school day, settings were randomized to "high" or "low" for the air cleaner and "on" or "off" for the fan. Descriptive statistics and linear mixed models were used to evaluate the impacts of each set of conditions on PM2.5 and PM1.0 concentrations. The mean half-day concentrations ranged from 3.4-4.1 µg/m3 for PM2.5 and 3.4-3.9 µg/m3 for PM1.0. On average, use of the fan when the air cleaner was on the low setting decreased PM2.5 by 0.53 µg/m3 [95% CI: -0.64, -0.42] and use of the filter on high (compared to low) when the fan was off decreased PM2.5 by 0.10 µg/m3 [95% CI: -0.20, 0.005]. For PM1.0, use of the fan when the air cleaner was on low decreased concentrations by 0.18 µg/m3 [95% CI: -0.36, -0.01] and use of the filter on high (compared to low) when the fan was off decreased concentrations by 0.38 µg/m3 [95% CI: -0.55, -0.21]. In general, simultaneous use of the fan and filter on high did not result in additional decreases in PM concentrations compared to the simple addition of each appliance's individual effect estimates. Our study suggests that concurrent or separate use of an A/C fan and air cleaner in non-urban classrooms with low background PM may reduce classroom PM concentrations.

Epidermolysis Bullosa Pruriginosa successfully treated with concomitant topical and systemic agents.

Epidermolysis bullosa pruriginosa, a genetic mechanobullous disease, manifests at birth or late in life and is characterised by intense pruritus, resulting in lichenified or nodular prurigo-like lesions and scarring most prominent on the shins. Treatment is unsatisfactory. We report a patient treated with success using a combination of topical and systemic agents.

Management of psoriasis in pregnancy - a review of the evidence to date.

The onset of psoriasis collides with women's reproductive timeframe, and pregnancy brings challenges to its treatment. Indeed, the health of both mother and foetus must be considered. When choosing to treat pregnant women affected by psoriasis with pharmacological therapy, it is important to be aware of all possible options and their repercussions. Although there are several pharmacological therapies available, pregnancy brings ethical concerns and any pharmacological approach must be well thought out. The data available in humans are limited, and further investigation on this matter is needed. Within biological therapies, certolizumab pegol has recently been identified as a promising approach during pregnancy because it has been shown to have no late active placental transfer and no clear signs of foetal harm. This article aims to review the impact of psoriasis during pregnancy, how the disease can be managed pharmacologically during this period according to the available armamentarium, and the possible effects of the therapeutic options for the mother and the foetus.

Maternal and paternal preconception exposure to phenols and preterm birth.

BACKGROUND: Phenol exposure during pregnancy has been associated with preterm birth, but the potential effect of preconception exposure in either parent is unknown. There is a growing body of evidence to suggest that the preconception period is a critical window of vulnerability for adverse pregnancy outcomes. OBJECTIVE: We examined whether maternal and paternal preconception urinary concentrations of select phenols were associated with the risk of preterm birth among couples attending fertility care. METHODS: The analysis included 417 female and 229 male participants of the Environment and Reproductive Health (EARTH) Study who gave birth to 418 singleton infants between 2005 and 2018 and for whom we had phenol biomarkers quantified in at least one urine sample collected before conception. Mothers and fathers provided an average of 4 and 3 urine samples during the preconception period, respectively. We calculated the geometric mean of bisphenol A (BPA), bisphenol S (BPS), benzophenone-3, triclosan, and the molar sum of parabens (ΣParabens) urinary concentrations to estimate each participant's preconception exposure. Risk ratios (RRs) of preterm birth (live birth before 37 completed weeks' gestation) were estimated using modified Poisson regression models adjusted for covariates. RESULTS: The mean (SD) gestational age among singletons was 39.3 (1.7) weeks with 8% born preterm. A natural log-unit increase in maternal preconception BPA (RR 1.94; 95% CI: 1.20, 3.14) and BPS (RR 2.42; 95% CI: 1.01, 5.77) concentration was associated with an increased risk of preterm birth. These associations remained after further adjustment for maternal prenatal and paternal preconception biomarker concentrations. Paternal preconception ΣParabens concentrations showed a possible elevated risk of preterm birth (RR 1.36; 95% CI: 0.94, 1.96). No consistent pattern of association was observed for benzophenone-3 or triclosan biomarkers in either parent. DISCUSSION: Maternal preconception urinary BPA and BPS concentrations, as well as paternal preconception urinary parabens concentrations were prospectively associated with a higher risk of preterm birth. Subfertile couples' exposure to select phenols during the preconception period may be an unrecognized risk factor for adverse pregnancy outcomes.

Urinary concentrations of bisphenol A, parabens and phthalate metabolite mixtures in relation to reproductive success among women undergoing in vitro fertilization.

BACKGROUND: We have previously investigated whether urinary concentrations of bisphenol A (BPA), parabens, and phthalate metabolites were individually associated with reproductive outcomes among women undergoing in vitro fertilization (IVF) treatment. However, humans are typically exposed to many man-made chemicals simultaneously. Thus, investigating one chemical at a time may not represent the effect of mixtures. OBJECTIVE: To investigate whether urinary concentrations of BPA, parabens, and phthalate metabolite mixtures are associated with reproductive outcomes among women undergoing IVF. METHODS: This prospective cohort study included 420 women contributing 648 IVF cycles who provided up to two urine samples per cycle prior to oocyte retrieval (N = 1145) between 2006 and 2017 at the Massachusetts General Hospital Fertility Center, and had available urine biomarker data. Urinary concentrations of BPA, parabens, and phthalate metabolites were quantified using isotope-dilution tandem mass spectrometry. Intermediate and clinical end-points of IVF treatments were abstracted from electronic medical records. Principal component analysis (PCA) and Bayesian kernel machine regression (BKMR) were used to identify main patterns of BPA, parabens, and phthalate metabolites concentrations. We used generalized linear mixed models to evaluate the association between PCA-derived factor scores, in quartiles, and IVF outcomes, using random intercepts to account for multiple IVF cycles and adjusting for known confounders. Because of temporal trends in exposure, we conducted a sensitivity analysis restricted to women who underwent IVF cycles in the earlier years of study (2006-2012). RESULTS: Urinary concentrations of BPA, parabens, and most phthalate metabolites were significantly lower during the second half of the study period (2013-2017) than during the first half (2006-2012). None of the three factors derived from the PCA [di(2-ethylhexyl) phthalate (DEHP), non-DEHP, and paraben] was associated with IVF outcomes in the main analyses. Similarly, BKRM analyses did not identify any associations of individual urinary concentrations of BPA, paraben and phthalate metabolites with IVF outcomes while accounting for correlation between exposures. However, in sensitivity analyses restricted to women who underwent IVF cycles from 2006 to 2012, where concentrations of most phthalates and phenols were higher, there were decreases in implantation, clinical pregnancy, and live birth across quartiles of the DEHP factor. Specifically, women in the highest quartile of the DEHP factor had, on average, lower probabilities of implantation (-22% p, trend = 0.08), clinical pregnancy (-24% p, trend = 0.14), and live birth (-38% p, trend = 0.06) compared to women in the lowest quartile. Among this group of women, BKMR results did not identify any single contributor driving the decreased probabilities of live birth within the DEHP factor. CONCLUSIONS: We confirmed that women undergoing IVF are concurrently exposed to multiple endocrine disrupting chemicals (EDCs). While we found no overall significant associations, we observed diminished pregnancy success with specific clusters of chemicals among women who underwent IVF cycles in earlier years of study, when urinary concentrations of these EDCs were higher.

Biosimilar Agents for Psoriasis Treatment: The Perspective of Portuguese Patients.

INTRODUCTION: Biosimilars are highly similar copies of previously approved original biologic medicines. Their introduction on the market may yield cost reduction. The aim of this study was to evaluate the perspectives of psoriasis patients on biosimilar medications. MATERIALS AND METHODS: We conducted a 14 questions survey of psoriasis patients receiving biological therapy and followed-up in a dermatology department of a Portuguese tertiary care hospital. RESULTS: From a total of 108 patients included, 70.4% of patients did not know the definition of biosimilar agent and 76.6% of patients showed partial or total interest in using a biosimilar drug. Nearly 80% of patients partially or totally agreed in using a biosimilar drug in order to reduce healthcare costs with psoriasis treatment. However, the lack of studies in the European population and in psoriatic patients led most of the patients (72.2% and 75.0%, respectively) to somewhat or completely oppose to the use of biosimilars. Demographic variables, household income and type of current biologic therapy did not affect patient preferences. DISCUSSION: Despite of the unfamiliarity of the respondents with biosimilars, most patients seem receptive to their use. Nevertheless, there are two issues of concern: i) the use of biosimilars that are not tested in a European population, and ii) its approval for psoriasis without trials in this disease. Thus, an immediate need exists for patient education about biosimilars. CONCLUSION: Biosimilars may increase patient access to biologic therapies. Improved communication and the involvement of patients in decision-making regarding biosimilars may increase their acceptance in future.

Introdução: Os agentes biossimilares são cópias muito semelhantes de agentes biológicos originais previamente aprovados. A sua introdução no mercado tem como objetivo reduzir custos. O objetivo deste estudo foi avaliar as perspetivas dos doentes com psoríase sobre os medicamentos biossimilares. Material e Métodos: Foi realizado um inquérito com 14 questões em doentes com psoríase medicados com agentes biológicos e seguidos num Serviço de Dermatologia de um hospital terciário português. Resultados: Dos 108 doentes incluídos, 70,4% desconheciam a definição de agente biossimilar e 76,6% mostraram interesse parcial ou total no uso de medicamentos biossimilares. Perto de 80% concordaram com o uso de agentes biossimilares de modo a reduzir os custos associados às terapêuticas biológicas. Contudo, a ausência de estudos na população europeia e em doentes com psoríase levaram a maioria dos doentes (72,2% e 75,0%, respetivamente) a oporem-se, parcial ou totalmente, ao uso dos medicamentos biossimilares. Dados demográficos, rendimento mensal e tipo de terapêutica biológica não influenciaram as preferências dos doentes. Discussão: Apesar do desconhecimento dos participantes sobre os medicamentos biossimilares, a maioria dos doentes parece recetiva à sua utilização. Todavia, existem dois motivos de preocupação: i) o uso de medicamentos biossimilares que não foram testados na população europeia, e ii) a sua aprovação para a psoríase sem estudos nesta doença. Assim, é necessário fornecer mais informação aos doentes sobre os medicamentos biossimilares. Conclusão: Os biossimilares podem aumentar o acesso dos doentes a terapêuticas biológicas. Melhor comunicação e o envolvimento dos doentes na tomada de decisões relativamente aos medicamentos biossimilares pode aumentar a adesão no futuro.

Predicting prognosis in patients with advanced cancer: A prospective study.

BACKGROUND: Prognosis is one of the most challenging questions with which physicians are confronted. Accuracy in the prediction of survival is necessary for clinical, ethical, and organizational reasons. AIM: Evaluate young doctors' clinical prediction of survival and the aids they could get: expert opinion, Palliative Prognostic score, and Palliative Prognostic Index. DESIGN: Prospective, observational study. SETTING/PARTICIPANTS: Advanced cancer patients under observation of an inhospital palliative care team, from April to July 2014. A total of 38 patients were included, mostly male (65.8%), average age 68.5 years. Average survival time was 24 days. Follow-up concluded with death or after 90 days. RESULTS: Young doctors' clinical prediction of survival was adequate at 10.5%, with 55.3% severe errors in an optimistic direction. Palliative care experts were more adequate (23.7%) and made less severe errors (42.1%). Palliative Prognostic score and Palliative Prognostic Index were even more adequate (47% and 55%, respectively) and made even less severe errors (0% and 11%, respectively). The best correlation with observed survival was achieved when palliative care experts used palliative prognostic score ( rs = -0.629; p < 0.01). CONCLUSION: Young doctors' clinical prediction of survival is often inadequate. Palliative Prognostic score, which includes clinical prediction of survival, calculated by palliative care experts had the best performance. Our results support the recommendation of using clinical prediction of survival together with prognostic scores.

Tofacitinib: A New Oral Therapy for Psoriasis.

Psoriasis is a common, chronic, immune-mediated disease associated with several comorbidities. Biologic therapy revolutionized the treatment of moderate-to-severe psoriasis, improving physical and emotional burden of the disease. Still, there are unmet needs in the treatment of psoriasis regarding long-term efficacy, tolerability, safety, route of administration, and cost. The increased knowledge of the pathogenesis of the intracellular metabolic pathways allowed the development of new compounds that inhibit certain intracellular proteins involved in the immune response. Tofacitinib is an oral small molecule that inhibits JAK/STAT pathway, which is then unable to upregulate the pro-inflammatory genes implicated in psoriasis. Data from phase II and III trials reveal that tofacitinib is a well-tolerated treatment for moderate-to-severe chronic plaque psoriasis with sustained efficacy for up to 2 years. With a convenient oral administration in the absence of organ toxicity associated with conventional oral treatments, tofacitinib may represent an important therapeutic to be included in the treatment algorithms of psoriasis.

The successful treatment with ixekizumab in a multi-failure psoriasis patient.

We report a patient with severe psoriasis who failed to respond to phototherapy, conventional systemic treatment and four biologic agents (etanercept, ustekinumab, adalimumab and secukinumab). Combination of a higher-dose secukinumab regimen with phototherapy had no success. Remarkably, ixekizumab, an IL-17A inhibitor, provided almost complete psoriasis clearance after 24 weeks of treatment. The reason for the success of ixekizumab after the failure to respond to a biologic with same mechanism of action is still unknown. Interestingly, failure of secukinumab does not preclude future therapeutic success with a second IL-17A-inhibitor.

Comparison of survival patterns of northern and southern genotypes of the North American tick Ixodes scapularis (Acari: Ixodidae) under northern and southern conditions.

BACKGROUND: Several investigators have reported genetic differences between northern and southern populations of Ixodes scapularis in North America, as well as differences in patterns of disease transmission. Ecological and behavioral correlates of these genetic differences, which might have implications for disease transmission, have not been reported. We compared survival of northern with that of southern genotypes under both northern and southern environmental conditions in laboratory trials. METHODS: Subadult I. scapularis from laboratory colonies that originated from adults collected from deer from several sites in the northeastern, north central, and southern U.S. were exposed to controlled conditions in environmental chambers. Northern and southern genotypes were exposed to light:dark and temperature conditions of northern and southern sites with controlled relative humidities, and mortality through time was recorded. RESULTS: Ticks from different geographical locations differed in survival patterns, with larvae from Wisconsin surviving longer than larvae from Massachusetts, South Carolina or Georgia, when held under the same conditions. In another experiment, larvae from Florida survived longer than larvae from Michigan. Therefore, survival patterns of regional genotypes did not follow a simple north-south gradient. The most consistent result was that larvae from all locations generally survived longer under northern conditions than under southern conditions. CONCLUSIONS: Our results suggest that conditions in southern North America are less hospitable than in the north to populations of I. scapularis. Southern conditions might have resulted in ecological or behavioral adaptations that contribute to the relative rarity of I. scapularis borne diseases, such as Lyme borreliosis, in the southern compared to the northern United States.