-
JAMA Network Open Aug 2023In addition to technical barriers, public attitudes about the use of gene therapy have an important association with the clinical implementation of gene therapy.
IMPORTANCE
In addition to technical barriers, public attitudes about the use of gene therapy have an important association with the clinical implementation of gene therapy.
OBJECTIVE
To investigate the factors associated with public acceptance of gene therapy among individuals in China.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study used data from a survey conducted among 21 880 individuals in mainland China from June 20 to August 31, 2022.
MAIN OUTCOMES AND MEASURES
Stepwise linear regression was used to analyze factors associated with public acceptance of gene therapy in 5 key areas: basic personal information (gender, region, age, and educational level), family situation (marital status, children, and cousins), economic status (assets, debts, and insurance coverage), health knowledge (health literacy score and media use), and physical health status (chronic illness, cancer, European Quality of Life 5-Dimension 5-Level version [EQ-5D-5L] score, and Brief Illness Perception Questionnaire [BIPQ] score). Acceptance scores were calculated based on a visual analog scale (range, 0-100, with higher scores indicating higher acceptance of gene therapy). Further subgroup analysis was carried out in different age subgroups and populations with or without chronic diseases.
RESULTS
A total of 21 880 participants (mean [SD] age, 39.4 [18.9] years; 10 947 female participants [50.0%]; 10 933 male participants [50.0%]) were analyzed in this study. The mean (SD) acceptance score of gene therapy in the survey was 60.56 (27.60). Compared with people aged 60 years or older, those aged 12 to 18 years had higher acceptance of gene therapy (β = 1.48 [95% CI, 0.09-2.88]), while groups aged 19 to 30 years (β = -3.43 [95% CI, -4.80 to -2.07]), 31 to 44 years (β = -1.44 [95% CI, -2.76 to -0.12]), and 45 to 59 years (β = -2.05 [95% CI, -3.27 to -0.83]) had lower acceptance. Compared with people living in Eastern China, those in Central China had lower acceptance of gene therapy (β = -1.58 [95% CI, -2.54 to -0.62]), while those in Western China had higher acceptance (β = 0.92 [95% CI, 0.09-1.76]). Higher educational level (undergraduate or above vs junior high or below) was associated with higher acceptance of gene therapy (β = 1.56 [95% CI, 0.49-2.63]). Number of properties owned was also associated with higher acceptance of gene therapy (2 vs 0: β = 2.38 [95% CI, 1.04-3.72]; ≥3 vs 0: β = 4.66 [95% CI, 2.92-6.39]). Diagnosis of chronic disease was associated with lower acceptance of gene therapy (β = -17.86 [95% CI, -20.49 to -15.24]), while diagnosis of cancer was associated with higher acceptance (β = 6.99 [95% CI, 1.84-12.14]). Higher BIPQ score (β = 0.40 [95% CI, 0.34-0.45]), higher health literacy score (β = 0.70 [95% CI, 0.62-0.78]), and media use (β = 0.49 [95% CI, 0.41-0.57]) were all associated with high acceptance of gene therapy, while a higher EQ-5D-5L score was associated with lower acceptance (β = -0.29 [95% CI, -0.47 to -0.11]). For older people, being in debt, not having health insurance, and the EQ-5D-5L score were uniquely relevant factors. For people with chronic disease, having an undergraduate degree or higher, a diagnosis of cancer, and the BIPQ score were uniquely relevant factors.
CONCLUSIONS AND RELEVANCE
These results suggest that basic personal information, economic status, health knowledge, and physical health status were the main factors associated with the acceptance of gene therapy. Improving the health literacy of the population and promoting trust in gene therapy may be effective ways to increase the acceptance of gene therapy. Poorer economic levels and worse disease states may reduce the public's willingness to accept gene therapy.
Topics: Child; Humans; Male; Female; Aged; Adult; Quality of Life; Cross-Sectional Studies; China; Neoplasms; Chronic Disease; Attitude
PubMed: 37566417
DOI: 10.1001/jamanetworkopen.2023.28352 -
Fertility and Sterility Sep 2015Third-party reproduction has introduced a host of changing family constellations. Research has shown that children conceived through third-party reproduction are doing... (Review)
Review
Third-party reproduction has introduced a host of changing family constellations. Research has shown that children conceived through third-party reproduction are doing well psychologically and developmentally, but what about their parents? How have they coped with the transition to third-party reproduction? Has the experience impacted their marital stability or the quality of their parenting? This review will address parents of children conceived through oocyte donation, parents of children conceived through gestational surrogacy, and gay male parents of children conceived through oocyte donation and gestational surrogacy.
Topics: Adaptation, Psychological; Counseling; Donor Selection; Emotions; Female; Fertility; Humans; Infertility; Male; Mental Health; Oocyte Donation; Parent-Child Relations; Parents; Patient Care Team; Pregnancy; Reproductive Techniques, Assisted; Surrogate Mothers; Tissue Donors
PubMed: 26232745
DOI: 10.1016/j.fertnstert.2015.07.1128 -
BJU International Oct 2022To develop and validate an accurate, usable prediction model for other-cause mortality (OCM) in patients with prostate cancer diagnosed in the United States.
OBJECTIVE
To develop and validate an accurate, usable prediction model for other-cause mortality (OCM) in patients with prostate cancer diagnosed in the United States.
MATERIALS AND METHODS
Model training was performed using the National Health and Nutrition Examination Survey 1999-2010 including men aged >40 years with follow-up to the year 2014. The model was validated in the Prostate, Lung, Colon, and Ovarian Cancer Screening Trial prostate cancer cohort, which enrolled patients between 1993 and 2001 with follow-up to the year 2015. Time-dependent area under the curve (AUC) and calibration were assessed in the validation cohort. Analyses were performed to assess algorithmic bias.
RESULTS
The 2420 patient training cohort had 459 deaths over a median follow-up of 8.8 years among survivors. The final model included eight predictors: age; education; marital status; diabetes; hypertension; stroke; body mass index; and smoking. It had an AUC of 0.75 at 10 years for predicting OCM in the validation cohort of 8220 patients. The final model significantly outperformed the Social Security Administration life tables and showed adequate predictive performance across race, educational attainment, and marital status subgroups. There is evidence of major variability in life expectancy that is not captured by age, with life expectancy predictions differing by 10 or more years among patients of the same age.
CONCLUSION
Using two national cohorts, we have developed and validated a simple and useful prediction model for OCM for patients with prostate cancer treated in the United States, which will allow for more personalized treatment in accordance with guidelines.
Topics: Child; Humans; Life Expectancy; Male; Nutrition Surveys; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms; United States
PubMed: 35373440
DOI: 10.1111/bju.15740 -
BMC Public Health Nov 2020The importance of socioeconomic status for survival in cirrhosis patients is more or less pronounced within different populations, most likely due to cultural and...
BACKGROUND
The importance of socioeconomic status for survival in cirrhosis patients is more or less pronounced within different populations, most likely due to cultural and regional differences combined with dissimilarities in healthcare system organisation and accessibility. Our aim was to study the survival of patients with cirrhosis in a population-based Swedish cohort, using available data on marital status, employment status, and occupational skill level.
METHODS
We conducted a retrospective cohort study of 582 patients diagnosed with cirrhosis in the Region of Halland (total population 310,000) between 2011 and 2018. Medical and histopathologic data, obtained from registries, were reviewed. Cox regression models were used to estimate associations between survival and marital status (married, never married, previously married), employment status (employed, pensioner, disability retired, unemployed), and occupational skill level (low-skilled: level I; medium-skilled: level II; medium-high skilled: level III; professionals: level IV); adjusting for sex, age, aetiology, Model for End-stage Liver Disease (MELD) score, Child-Pugh class, and comorbidities.
RESULTS
Alcohol was the most common aetiology (51%). Most patients were male (63%) and the median age was 66 years. Occupational skill level was associated with the severity of cirrhosis at diagnosis and the prevalence of Child-Pugh C gradually increased from professionals through low-skilled. The mean survival for professionals (6.39 years, 95% CI 5.54-7.23) was higher than for low-skilled (3.00 years, 95% CI 2.33-3.67) and medium-skilled (4.04 years, 95% CI 3.64-4.45). The calculated hazard ratios in the multivariate analysis were higher for low-skilled (3.43, 95% CI 1.89-6.23) and medium-skilled (2.48, 95% CI 1.48-4.12), compared to professionals. When aggregated, low- and medium-skilled groups also had poorer mean survival (3.79 years, 95% CI 3.44-4.14; vs 5.64 years, 95% CI 5.00-6.28) and higher hazard ratios (1.85, 95% CI 1.32-2.61) compared to the aggregated medium-high skilled and professional groups. Marital and employment status were not statistically significant predictors of mortality in the multivariate analysis.
CONCLUSIONS
Occupational skill level was strongly associated with mean survival and mortality risk. Poorer prognosis among patients with low and medium occupational skill level could not be explained by differences in sex, age, marital status, employment status, MELD score, Child-Pugh class, or comorbidity.
Topics: Adult; Aged; Aged, 80 and over; Female; Health Status Disparities; Humans; Liver Cirrhosis; Male; Marital Status; Middle Aged; Retrospective Studies; Risk Assessment; Social Class; Sweden
PubMed: 33256682
DOI: 10.1186/s12889-020-09783-2 -
Advanced Biomedical Research 2023Sexual desire and sexual activity are natural needs of human beings, which can be problematic and lead to various sexual disorders, if not used in the right way,...
BACKGROUND
Sexual desire and sexual activity are natural needs of human beings, which can be problematic and lead to various sexual disorders, if not used in the right way, including hypersexuality. The present study aimed to compare the effect of dialectical behavior therapy (DBT) and aripiprazole drug on marital instability in patients with hypersexuality.
MATERIALS AND METHODS
This experimental case--control Pretest--Posttest Control Group Design with follow up was done on 27 male and female patients with hypersexuality having at least a higher education degree selected from four hospitals and psychiatric centers including Khorshid Hospital, Asgariyeh Specialized Hospital, Farhangian Clinic and Imam Reza Medical Center in Isfahan and were randomly assigned to two groups of treatment (nine patients in every group) and one group of control (nine patients) after adjusting the age and gender. Pretest phase was done for both three groups using Marital Instability Index (MII). The first treatment group underwent DBT intervention for eight sessions of 2 hours (once a week), and the second experimental group was prescribed aripiprazole for 2 months. Afterwards, the posttest and follow-up were performed for all the three groups. The data were analyzed using SPSS 24 and multivariate analysis of covariance (MANCOVA).
RESULTS
The findings showed that DBT and aripiprazole had little effect on the problem of marital instability in patients with hypersexuality ( > 0.05); also, there was no significant difference between the effect of DBT and aripiprazole ( > 0.05).
CONCLUSION
DBT and the drug aripiprazole cannot have a significant effect on the marital instability in patients.
PubMed: 37694240
DOI: 10.4103/abr.abr_161_22 -
Cancer Dec 2021Phase 1 trials are increasingly important in the molecularly driven era of oncology, but few studies have examined phase 1 participation disparities. The authors of this...
BACKGROUND
Phase 1 trials are increasingly important in the molecularly driven era of oncology, but few studies have examined phase 1 participation disparities. The authors of this study investigated factors associated with phase 1 versus phase 2/3 trial enrollment.
METHODS
They authors conducted a cross-sectional study using serial samples of patients age ≥18 years enrolling on cancer trials from October 2011 to November 2014 at an academic cancer center. They used univariable and multivariable logistic regression models to analyze sociodemographic and clinical associations with phase 1 versus phase 2/3 trial enrollment.
RESULTS
Among 3103 patients enrolled in cancer trials, 2657 unique patients participated in phase 1/2/3 trials. For patients enrolled in phase 1 (n = 1401) versus phase 2/3 (n = 1256) trials, we found no significant differences by age, insurance status, marital status, and income. Overall, 1216 (93%) White, 72 (6%) Asian, and 21 (2%) Black patients enrolled on phase 1 trials, whereas 1068 (93%) White, 40 (3%) Asian, and 43 (4%) Black patients enrolled on phase 2/3 trials. Adjusting for age, sex, race, ethnicity, insurance status, marital status, income, cancer type, disease status, travel distance, and trial year, compared with White patients, Black patients had lower phase 1 enrollment (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.25-0.82), as did Hispanic/Latino (OR, 0.25; 95% CI, 0.08-0.79) and male patients (OR, 0.77; 95% CI, 0.62-0.94). Asian patients had higher phase 1 enrollment (OR, 1.38; 95% CI, 0.88-2.16).
CONCLUSIONS
Disparities in phase 1 versus phase 2/3 cancer clinical trial enrollment underscore the urgent need for interventions addressing inequities in early-phase trial participation.
LAY SUMMARY
Phase 1 trials are of increasing importance in oncology. The authors of the study analyzed all patients enrolling on cancer clinical trials at a large academic cancer center from October 2011 to November 2014. Among the 2657 trial participants, when age, sex, race, ethnicity, insurance status, marital status, income, cancer type, disease status, travel distance, and trial year were taken into account, Black, Hispanic/Latino, and male patients were less likely to enroll on phase 1 trials versus phase 2/3 trials. These findings suggest a need for targeted interventions to improve access to and education about phase 1 trials for Black and Hispanic/Latino patients.
Topics: Adolescent; Black People; Cross-Sectional Studies; Ethnicity; Healthcare Disparities; Humans; Insurance Coverage; Male; Neoplasms
PubMed: 34379799
DOI: 10.1002/cncr.33853 -
Journal of Medical Internet Research Nov 2021Adherence to internet-delivered interventions targeting mental health such as online psychotherapeutic aftercare is important for the intervention's impact. High dropout...
BACKGROUND
Adherence to internet-delivered interventions targeting mental health such as online psychotherapeutic aftercare is important for the intervention's impact. High dropout rates limit the impact and generalizability of findings. Baseline differences may be putting patients at risk for dropping out, making comparisons between online with face-to-face (F2F) therapy and care as usual (CAU) necessary to examine.
OBJECTIVE
This study investigated adherence to online, F2F, and CAU interventions as well as study dropout among these groups and the subjective evaluation of the therapeutic relationship. Sociodemographic, social-cognitive, and health-related variables were considered.
METHODS
In a randomized controlled trial, 6023 patients were recruited, and 300 completed the baseline measures (T1), 144 completed T2 (retention 44%-52%), and 95 completed T3 (retention 24%-36%). Sociodemographic variables (eg, age, gender, marital status, educational level), social-cognitive determinants (eg, self-efficacy, social support), health-related variables (eg, depressiveness), and expectation towards the treatment for patients assigned to online or F2F were measured at T1.
RESULTS
There were no significant differences between the groups regarding dropout rates (χ=0.02-1.06, P≥.30). Regarding adherence to the treatment condition, the online group outperformed the F2F and CAU conditions (P≤.01), indicating that patients randomized into the F2F and CAU control groups were much more likely to show nonadherent behavior in comparison with the online therapy groups. Within study groups, gender differences were significant only in the CAU group at T2, with women being more likely to drop out. At T3, age and marital status were also only significant in the CAU group. Patients in the online therapy group were significantly more satisfied with their treatment than patients in the F2F group (P=.02; Eta²=.09). Relationship satisfaction and success satisfaction were equally high (P>.30; Eta²=.02). Combining all study groups, patients who reported lower depressiveness scores at T1 (T2: odds ratio [OR] 0.55, 95% CI 0.35-0.87; T3: OR 0.56, 95% CI 0.37-0.92) were more likely to be retained, and patients who had higher self-efficacy (T2: OR 0.57, 95% CI 0.37-0.89; T3: OR 0.52, 95% CI 0.32-0.85) were more likely to drop out at T2 and T3. Additionally, at T3, the lower social support that patients reported was related to a higher likelihood of remaining in the study (OR 0.68, 95% CI 0.48-0.96). Comparing the 3 intervention groups, positive expectation was significantly related with questionnaire completion at T2 and T3 after controlling for other variables (T2: OR 1.64, 95% CI 1.08-2.50; T3: OR 1.59, 95% CI 1.01-2.51).
CONCLUSIONS
While online interventions have many advantages over F2F variants such as saving time and effort to commute to F2F therapy, they also create difficulties for therapists and hinder their ability to adequately react to patients' challenges. Accordingly, patient characteristics that might put them at risk for dropping out or not adhering to the treatment plan should be considered in future research and practice. Online aftercare, as described in this research, should be provided more often to medical rehabilitation patients.
TRIAL REGISTRATION
ClinicalTrials.gov NCT04989842; https://clinicaltrials.gov/ct2/show/NCT04989842.
Topics: Aftercare; Female; Humans; Male; Patient Compliance; Randomized Controlled Trials as Topic; Surveys and Questionnaires
PubMed: 34730541
DOI: 10.2196/31274 -
International Journal of Environmental... Feb 2022Fibromyalgia syndrome (FMS) is characterized by generalized chronic musculoskeletal pain, fatigue, and sleep disturbance, as well as cognitive, somatic, and other...
Fibromyalgia syndrome (FMS) is characterized by generalized chronic musculoskeletal pain, fatigue, and sleep disturbance, as well as cognitive, somatic, and other symptoms. Most people affected by FMS are women, and studies analyzing this condition in men are scarce. In this study, we discuss the physical and psychological symptoms of FMS in men, analyze the possible side effects of pharmacological therapies, and explore the impact of the illness comparing these results between the different classification groups according to sociodemographic variables (marital status, level of education, employment situation and number of people living at home). We used a sequential exploratory mixed method (MM). Qualitative information was obtained from two focus groups (n = 10). Structured questionnaires were administered to 23 men affected by FMS. The mean age of the participants was 51.7 years (SD = 9.64). The most common drugs used were antidepressants and anxiolytics (86.9%), followed by non-steroidal anti-inflammatory drugs (82.6%) and opioids (60.9%). Current level of pain was high (8.2; SD = 1.1), while perceived health and satisfaction with pharmacological treatments were low (4.6; SD = 2.6 and 3.5; SD = 3.2, respectively). The impact of FMS measured using the Fibromyalgia Impact Questionnaire (FIQ) was very high at 88.7 (SD = 8.2). Six categories related with symptoms and side effects of the medication were observed in the qualitative data: (1) main physical symptoms, (2) mood disorders, (3) insomnia and non-restorative sleep, (4) cognitive disturbance, (5) hypersensitivity, and (6) symptoms secondary to opioids. Pain and fatigue were the symptoms most often mentioned by the participants (70% and 80%, respectively). Other important symptoms were anxiety, depression, and memory and sleep disorders. The consumption of opioids causes further unwanted symptoms such as drowsiness and dependence, which makes it difficult for patients to perform basic everyday activities. We believe it is vitally important to continue investigating this symptomatology in order to improve diagnosis and treatment for these patients.
Topics: Fatigue; Female; Fibromyalgia; Humans; Male; Middle Aged; Pilot Projects; Sleep; Sleep Wake Disorders
PubMed: 35162747
DOI: 10.3390/ijerph19031724 -
Journal of Cancer 2021Thyroid adenomas/adenocarcinomas are the most common type of thyroid cancer. The impact of socioeconomic factors on the prognosis of thyroid cancer is unclear....
Thyroid adenomas/adenocarcinomas are the most common type of thyroid cancer. The impact of socioeconomic factors on the prognosis of thyroid cancer is unclear. Clinical information and socioeconomic factors were obtained from the Surveillance, Epidemiology, and End Results Database (SEER) 18 Registries Custom Database. The association between thyroid adenomas/adenocarcinomas and socioeconomic factors including gender, race/ethnicity, insurance status, marital status, living area, and Yost index (including education, income, working, etc.) were fully evaluated. A total of 136,313 patients between 2010 and 2016 were finally included in the present study. Among them, 126,160 patients were diagnosed with the single malignancy. Median follow-up time was 64 months. In general, non-Hispanic Asian or Pacific Islander and Hispanic patients had significantly better survival than non-Hispanic White patients (All <0.05). Patients insured by Medicaid had significantly poorer cancer-specific survival (CSS, hazard ratio, HR=2.15, <0.001) and overall survival (OS, HR=2.42, P <0.001) than those insured by commercial insurance or Medicare. In addition, divorced or widowed status, rural living location and low Yost index were significantly associated with poor CSS and OS of thyroid adenomas/adenocarcinomas (All <0.05). Subgroup analyses showed similar results in patients who received surgical procedure, as well as in patients who received both surgical and radiation therapy. Multivariate analyses suggested that insurance status, marital status and Yost index remained significantly associated with CSS and OS (all <0.05). Socioeconomic factors, including insurance status, marital status, living area, and Yost index, were significant predictors for the survival of thyroid adenomas/adenocarcinomas.
PubMed: 33854612
DOI: 10.7150/jca.52329 -
Behavioral Sleep Medicine 2017For most adults, sleep is a dyadic behavior. Only recently have studies explored the dynamic association between sleep and relationship functioning among bed partners....
For most adults, sleep is a dyadic behavior. Only recently have studies explored the dynamic association between sleep and relationship functioning among bed partners. The current study is the first to examine bidirectional associations between changes in insomnia and changes in marital quality over time, in the context of a marital therapy trial. Among husbands, improvements in marital satisfaction were associated with a 36% decreased risk of insomnia at follow-up. Regarding the reverse direction, counter-intuitively, wife baseline insomnia was associated with improvements in husbands' marital satisfaction, but only among the non-treatment-seeking comparison group. Results are discussed in terms of implications for sleep and marital therapy, and suggest that improving sleep may be an added benefit of improving the marital relationship.
Topics: Adult; Female; Humans; Male; Marital Therapy; Marriage; Risk Factors; Sexual Partners; Sleep; Sleep Initiation and Maintenance Disorders; Spouses
PubMed: 27110636
DOI: 10.1080/15402002.2015.1133420