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JAAD International Sep 2024Empirical decisions to select therapies for psoriasis (PSO) and atopic dermatitis (AD) can lead to delays in disease control and increased health care costs. However,...
BACKGROUND
Empirical decisions to select therapies for psoriasis (PSO) and atopic dermatitis (AD) can lead to delays in disease control and increased health care costs. However, routine molecular testing for AD and PSO are lacking.
OBJECTIVE
To examine (1) how clinicians choose systemic therapies for patients with PSO and AD without molecular testing and (2) to determine how often the current approach leads to patients switching medications.
METHODS
A 20-question survey designed to assess clinician strategies for systemic treatment of AD and PSO was made available to attendees of a national dermatology conference in 2022.
RESULTS
Clinicians participating in the survey (265/414, 64% response rate) ranked "reported efficacy" as the most important factor governing treatment choice ( < .001). However, 62% (165/265) of clinicians estimated that 2 or more systemic medications were typically required to achieve efficacy. Over 90% (239/265) of respondents would or would likely find a molecular test to guide therapeutic selection useful.
LIMITATIONS
To facilitate ease of recall, questions focused on systemic therapies as a whole and not individual therapies.
CONCLUSION
Clinicians want a molecular test to help determine the most efficacious drug for individual patients.
PubMed: 38774343
DOI: 10.1016/j.jdin.2024.03.019 -
Women's Health (London, England) 2024Adolescent girls face numerous challenges which hinder their ability to manage menstruation in a healthy and dignified manner.
BACKGROUND
Adolescent girls face numerous challenges which hinder their ability to manage menstruation in a healthy and dignified manner.
OBJECTIVES
To examine the menstrual hygiene practices of adolescent girls schooling in rural Anambra communities.
STUDY DESIGN
Cross-sectional descriptive study.
METHOD
Participants were selected using multistage stratified random sampling technique and interviewed using self-administered semi-structured questionnaire. Data were analysed using Statistical Package for Social Sciences version 22.0.
RESULTS
Mean age of all, pre-menarche and post-menarche girls were 14.7 ± 1.84, 12.8 ± 1.09 and 15.1 ± 1.73 years, respectively. About 46% of the pre-menarche girls had not received any information on menstruation. Common sources of initial menstruation information were mother (87.3%), school (52.2%) and peers (20.0%). Among the 1091 (85.0% (1091/1283)) post-menarche girls, last menstrual period, last menstrual period duration and cycle length could not be recalled by 53.9%, 34.4% and 39.3%, respectively. Majority (98.3%) who could recall last menstrual period had a cycle length of ⩽30 days and the mean duration of menses was 4.4 ± 0.84 days. Disposable sanitary pad was mostly (60%) cited as recommended product, but cloth/rags (40.6%) or tissue paper (32. 3%) were predominantly used. Majority (88.6%) took their bath ⩾twice/day, 50.9% changed sanitary product ⩽twice/day while 72.5% exhibited poor hand washing. Sanitary products were mostly discarded by burning (45.4%). Fifty-one percent could not change in school predominantly due to lack of functional toilets/changing rooms (84.2%) while 72.5% of those who changed did so in bushes or unused spaces. Challenges faced during menstruation include restriction from holy places (38.9%), waist pain (74.9%), blood stains (36.1%) and lack of money to buy pad (27.0%). Factors significantly associated with using commercial pads were age (p = 0.047), class (p = 0.006), mother's educational status (p < 0.001), social class (p < 0.001), ability to recall last menstrual period date (p = 0.029) or duration (p = 0.001).
CONCLUSION
Menstrual hygiene management was unsatisfactory among studied adolescents. Continuous education of adolescent girls on menstrual hygiene management and advocacy for adequate menstrual hygiene management support are imperative.
Topics: Female; Adolescent; Humans; Menstruation; Hygiene; Cross-Sectional Studies; Health Knowledge, Attitudes, Practice; Schools
PubMed: 38318680
DOI: 10.1177/17455057241228204 -
Journal of Family Medicine and Primary... Sep 2023Chronic gastritis is one of the most prevalent disorders affecting individuals, which affects hundreds of millions of people in different ways around the world. The...
INTRODUCTION
Chronic gastritis is one of the most prevalent disorders affecting individuals, which affects hundreds of millions of people in different ways around the world. The significant incidence of poor dietary quality and diet-related illnesses may be addressed by orienting customers toward healthier food options. The objective of the study was to estimate the knowledge of front-of-package labels (FoPLs) and food group-based dietary intake of nutrients among patients with chronic gastritis.
MATERIALS AND METHODS
The study design was a hospital-based cross-sectional study that was done in Guntur district of Andhra Pradesh. The study population included 208 chronic gastritis patients between 20 to 60 years of age selected by systematic sampling. Detailed information on sociodemographic and lifestyle factors was collected using a questionnaire and 24-h dietary recall was done. The objective assessment of Knowledge of FoPLs was assessed mock package images representing a fictional brand to prevent other factors from interfering with product evaluation.
RESULTS
A total of 208 patients were studied with a near-equal proportion of males and females. Among participants, more than half (57.2%) can interpret FoPL, more than three-fourths (77.4%) have a belief that they eat a healthy diet mostly and only half (52.4%) of participants are somewhat knowledgeable about nutrition, and finally almost half (46.6%) of participants are not seeing the FoP label during food purchase. The mean score of knowledge of FoP labeling was 0.92 ± 1.135. Knowledge of FOPL was positively associated with the age of study participants OR 0.178 (95% CI: 0.178 to 0.856) with P value = 0.02. Grains have the maximum intake among all the food groups with a mean intake of 123.21 g/day.
CONCLUSION
The majority of participants do not know the food labeling, thus methods of education that focus on dietary interventions are urgently needed to raise awareness among the people.
PubMed: 38024917
DOI: 10.4103/jfmpc.jfmpc_322_23 -
Sensors (Basel, Switzerland) Jul 2023Moving target detection (MTD) is a crucial task in computer vision applications. In this paper, we investigate the problem of detecting moving targets in infrared (IR)...
Moving target detection (MTD) is a crucial task in computer vision applications. In this paper, we investigate the problem of detecting moving targets in infrared (IR) surveillance video sequences captured using a steady camera in a maritime setting. For this purpose, we employ robust principal component analysis (RPCA), which is an improvement of principal component analysis (PCA) that separates an input matrix into the following two matrices: a low-rank matrix that is representative, in our case study, of the slowly changing background, and a sparse matrix that is representative of the foreground. RPCA is usually implemented in a non-causal batch form. To pursue a real-time application, we tested an online implementation, which, unfortunately, was affected by the presence of the target in the scene during the initialization phase. Therefore, we improved the robustness by implementing a saliency-based strategy. The advantages offered by the resulting technique, which we called "saliency-aided online moving window RPCA" (S-OMW-RPCA) are the following: RPCA is implemented online; along with the temporal features exploited by RPCA, the spatial features are also taken into consideration by using a saliency filter; the results are robust against the condition of the scene during the initialization. Finally, we compare the performance of the proposed technique in terms of precision, recall, and execution time with that of an online RPCA, thus, showing the effectiveness of the saliency-based approach.
PubMed: 37514626
DOI: 10.3390/s23146334 -
Heliyon Jun 2024The aim of this study was to investigate the effects of temporal instability and possible heterogeneity on pedestrian accident severity, 48786 accident data from 2018 to...
The aim of this study was to investigate the effects of temporal instability and possible heterogeneity on pedestrian accident severity, 48786 accident data from 2018 to 2021 in the UK STATS database were used as the study object, and accident severity was used as the dependent variable, and 49 accident characteristics were selected as independent variables from 6 characteristics of accident pedestrian, driver, vehicle, road, environment and time to construct the pedestrian accident mean heterogeneity random-parameter logit model and examined its temporal stability. The results of model estimation and likelihood ratio tests indicate that the variables affecting pedestrian injury severity are highly variable and not stable over the years. And further demonstrates the potential of models that address unobserved heterogeneity for significant relationships in pedestrian accident severity analyses.
PubMed: 38867994
DOI: 10.1016/j.heliyon.2024.e32013 -
Nucleic Acids Research Jan 2024One challenge in the development of novel drugs is their interaction with potential off-targets, which can cause unintended side-effects, that can lead to the subsequent...
One challenge in the development of novel drugs is their interaction with potential off-targets, which can cause unintended side-effects, that can lead to the subsequent withdrawal of approved drugs. At the same time, these off-targets may also present a chance for the repositioning of withdrawn drugs for new indications, which are potentially rare or more severe than the original indication and where certain adverse reactions may be avoidable or tolerable. To enable further insights into this topic, we updated our database Withdrawn by adding pharmacovigilance data from the FDA Adverse Event Reporting System (FAERS), as well as mechanism of action and human disease pathway prediction features for drugs that are or were temporarily withdrawn or discontinued in at least one country. As withdrawal data are still spread over dozens of national websites, we are continuously updating our lists of discontinued or withdrawn drugs and related (off-)targets. Furthermore, new systematic entry points for browsing the data, such as an ATC tree, were added, increasing the accessibility of the database in a user-friendly way. Withdrawn 2.0 is publicly available without the need for registration or login at https://bioinformatics.charite.de/withdrawn_3/index.php.
Topics: Humans; Drug-Related Side Effects and Adverse Reactions; Pharmacovigilance; Safety-Based Drug Withdrawals; Databases, Pharmaceutical
PubMed: 37971295
DOI: 10.1093/nar/gkad1017 -
JRSM Open May 2024Commentators and professional organisations note that an expanding market in human milk-based products (HMBPs) could reduce breastfeeding, compromising maternal and...
OBJECTIVES
Commentators and professional organisations note that an expanding market in human milk-based products (HMBPs) could reduce breastfeeding, compromising maternal and infant health, and undermine public milk bank donations. We investigate whether English NHS trusts purchased these products and whether HMBP companies have marketed to them.
DESIGN
Freedom of Information (FOI) requests asking: (1) whether trusts obtained human milk; (2) if so, how; and (3) whether HMBP companies had approached them. We analysed trusts' responses qualitatively. In 2023, an FOI request to the Food Standards Authority (FSA) following a product recall.
SETTING
England.
PARTICIPANTS
One hundred and ninety-four NHS trusts, the FSA.
MAIN OUTCOME MEASURES
Obtaining human milk, approaches by companies, and trust responses to approaches.
RESULTS
One hundred and seventy-six trusts responded, 102 reporting human milk from milk banks. No trusts reported purchasing from companies in 2022. In 2023, the FSA confirmed six English hospitals used HMBPs from one company; an FOI for trusts' names was refused on law enforcement grounds. Two trusts reported participating in clinical trials funded by companies. Twenty-one reported approaches, using several strategies, including uninvited ward visits. Trusts rejected marketing based on guidance from: (1) trust dieticians or physicians; (2) regional regulatory bodies; (3) professional bodies; and (4) perceived application of an International Code on breastfeeding.
CONCLUSIONS
Companies market to trusts, adopting methods previously used by the formula industry. Trusts express confusion over whether this infringes agreements designed to promote breastfeeding. We encourage clarification and guidance for professionals and trusts to ensure safety, infant and maternal health, and protect public provision.
PubMed: 38699203
DOI: 10.1177/20542704241237658 -
Frontiers in Medicine 2024Human Immunodeficiency Virus (HIV) remains a global health challenge, and novel approaches to improve HIV control are significantly important. The cell and gene therapy...
Human Immunodeficiency Virus (HIV) remains a global health challenge, and novel approaches to improve HIV control are significantly important. The cell and gene therapy product AGT103-T was previously evaluated (NCT04561258) for safety, immunogenicity, and persistence in seven patients for up to 180 days post infusion. In this study, we sought to investigate the impact of AGT103-T treatment upon analytical treatment interruptions (ATIs). Six patients previously infused with AGT103-T were enrolled into an ATI study (NCT05540964), wherein they suspended their antiretroviral therapy (ART) until their viral load reached 100,000 copies/mL in two successive visits, or their CD4 count was reduced to below 300 cells/μL. During the ATI, all patients experienced viral rebound followed by a notable expansion in HIV specific immune responses. The participants demonstrated up to a five-fold increase in total CD8 counts over baseline approximately 1-2 weeks followed by the peak viremia. This coincided with a rise in HIV-specific CD8 T cells, which was attributed to the increase in antigen availability and memory recall. Thus, the protocol was amended to include a second ATI with the first ATI serving as an "auto-vaccination." Four patients participated in a second ATI. During the second ATI, the Gag-specific CD8 T cells were either maintained or rose in response to viral rebound and the peak viremia was substantially decreased. The patients reached a viral set point ranging from 7,000 copies/mL to 25,000 copies/mL. Upon resuming ART, all participants achieved viral control more rapidly than during the first ATI, with CD4 counts remaining within 10% of baseline measurements and without any serious adverse events or evidence of drug resistance. In summary, the rise in CD8 counts and the viral suppression observed in 100% of the study participants are novel observations demonstrating that AGT103-T gene therapy when combined with multiple ATIs, is a safe and effective approach for achieving viral control, with viral setpoints consistently below 25,000 copies/mL and relatively stable CD4 T cell counts. We conclude that HIV cure-oriented cell and gene therapy trials should include ATI and may benefit from designs that include multiple ATIs when induction of CD8 T cells is required to establish viral control.
PubMed: 38808136
DOI: 10.3389/fmed.2024.1342476 -
Journal of Epidemiology and Global... May 2024Mammography (MG) has demonstrated its effectiveness in diminishing mortality and advanced-stage breast cancer incidences in breast screening initiatives. Notably,...
BACKGROUND
Mammography (MG) has demonstrated its effectiveness in diminishing mortality and advanced-stage breast cancer incidences in breast screening initiatives. Notably, research has accentuated the superior diagnostic efficacy and cost-effectiveness of digital breast tomosynthesis (DBT). However, the scope of evidence validating the cost-effectiveness of DBT remains limited, prompting a requisite for more comprehensive investigation. The present study aimed to rigorously evaluate the cost-effectiveness of DBT plus MG (DBT-MG) compared to MG alone within the framework of Taiwan's National Health Insurance program.
METHODS
All parameters for the Markov decision tree model, encompassing event probabilities, costs, and utilities (quality-adjusted life years, QALYs), were sourced from reputable literature, expert opinions, and official records. With 10,000 iterations, a 2-year cycle length, a 30-year time horizon, and a 2% annual discount rate, the analysis determined the incremental cost-effectiveness ratio (ICER) to compare the cost-effectiveness of the two screening methods. Probabilistic and one-way sensitivity analyses were also conducted to demonstrate the robustness of findings.
RESULTS
The ICER of DBT-MG compared to MG was US$5971.5764/QALYs. At a willingness-to-pay (WTP) threshold of US$33,004 (Gross Domestic Product of Taiwan in 2021) per QALY, more than 98% of the probabilistic simulations favored adopting DBT-MG versus MG. The one-way sensitivity analysis also shows that the ICER depended heavily on recall rates, biopsy rates, and positive predictive value (PPV2).
CONCLUSION
DBT-MG shows enhanced diagnostic efficacy, potentially diminishing recall costs. While exhibiting a higher biopsy rate, DBT-MG aids in the detection of early-stage breast cancers, reduces recall rates, and exhibits notably superior cost-effectiveness.
PubMed: 38748377
DOI: 10.1007/s44197-024-00239-z -
Pharmaceutical Medicine Mar 2024Cyproterone acetate (CPA) is a synthetic progesterone derivative introduced in the 1970s and prescribed as antiandrogenic therapy for inoperable prostate cancer, sexual...
BACKGROUND
Cyproterone acetate (CPA) is a synthetic progesterone derivative introduced in the 1970s and prescribed as antiandrogenic therapy for inoperable prostate cancer, sexual deviations in men, and signs of androgenization in women. In 2020, the CPA summary of product characteristics (SmPC) was revised to include an updated special warning and precaution about (1) the risk of meningioma with increasing cumulative dose and (2) contraindication in patients with meningioma or history of meningioma. A Direct Healthcare Professional Communication (DHPC) was distributed. The European Medicine Agency's Pharmacovigilance Risk Assessment Committee requested that marketing authorization holders in Europe conduct a survey to assess physicians' knowledge of the updated key safety information. The primary objective of this study was to measure physicians' awareness (i.e., did they receive and review the revised SmPC and DHPC) and level of knowledge and understanding of the key safety information pertaining to the restricted use of CPA monotherapy because of the risk of meningioma.
METHODS
This cross-sectional web-based survey was administered to dermatologists, endocrinologists, gynecologists, urologists, oncologists, psychiatrists, and general practitioners in France, Germany, Poland, Spain, and the Netherlands who had prescribed CPA monotherapy in the previous 12 months to assess awareness of the risk of meningioma associated with CPA monotherapy.
RESULTS
Of the 613 physicians who participated, 85% correctly indicated that CPA monotherapy should be prescribed with the lowest effective dose, 75% correctly indicated that the risk of meningioma increases with increasing cumulative CPA monotherapy doses, and 73% correctly indicated that treatment with CPA-containing products must be stopped permanently if a patient is diagnosed with meningioma. Overall, 40% of physicians reported having received the DHPC, and 42% reported having received the revised SmPC.
CONCLUSIONS
Despite low recall of receipt of the updated SmPC and DHPC, most physicians surveyed are aware of the meningioma risk and actions to mitigate the risk.
Topics: Male; Humans; Female; Cyproterone Acetate; Meningioma; Cross-Sectional Studies; Europe; Physicians; Meningeal Neoplasms; Phospholipid Ethers
PubMed: 38296916
DOI: 10.1007/s40290-023-00510-x