scholarly journals More Screening or More Disease? Gonorrhea Testing and Positivity Patterns Among Men in 3 Large Clinical Practices in Massachusetts, 2010–2017

2020 ◽  
Author(s):  
Sarah J Willis ◽  
Heather Elder ◽  
Noelle Cocoros ◽  
Jessica Young ◽  
Julia L Marcus ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Positive Result ◽  
Risk Ratio ◽  
The United States ◽  
Clinical Practices ◽  
Clinical Encounters ◽  
Binomial Regression ◽  
Testing Patterns ◽  
Test Result ◽  
Annual Risk

Abstract Background Gonorrhea diagnosis rates in the United States increased by 75% during 2009–2017, predominantly in men. It is unclear whether the increase among men is being driven by more screening, an increase in the prevalence of disease, or both. We sought to evaluate changes in gonorrhea testing patterns and positivity among men in Massachusetts. Methods The analysis included men (aged ≥15 years) who received care during 2010–2017 in 3 clinical practice groups. We calculated annual percentages of men with ≥1 gonorrhea test and men with ≥1 positive result, among men tested. Log-binomial regression models were used to examine trends in these outcomes. We adjusted for clinical and demographic characteristics that may influence the predilection to test and probability of gonorrhea disease. Results On average, 306 348 men had clinical encounters each year. There was a significant increase in men with ≥1 gonorrhea test from 2010 (3.1%) to 2017 (6.4%; adjusted annual risk ratio, 1.12; 95% confidence interval, 1.12–1.13). There was a significant, albeit lesser, increase in the percentage of tested men with ≥1 positive result (1.0% in 2010 to 1.5% in 2017; adjusted annual risk ratio, 1.07; 95% confidence interval, 1.04–1.09). Conclusions We estimated significant increases in the annual percentages of men with ≥1 gonorrhea test and men with ≥1 positive gonorrhea test result between 2010 and 2017. These results suggest that observed increases in gonorrhea rates could be explained by both increases in screening and the prevalence of gonorrhea.

scholarly journals Association of subcutaneous or intravenous route of administration of casirivimab and imdevimab monoclonal antibodies with clinical outcomes in COVID-19.

2021 ◽  
Author(s):  
Erin K. McCreary ◽  
J. Ryan Bariola ◽  
Richard J. Wadas ◽  
Judith A. Shovel ◽  
Mary K. Wisniewski ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Risk Ratio ◽  
Intravenous Administration ◽  
Randomized Clinical Trials ◽  
Subcutaneous Administration ◽  
The United States ◽  
Risk Difference ◽  
Control Group ◽  
Intravenous Route ◽  
Adjusted Risk

Importance: Monoclonal antibody (mAb) treatment decreases hospitalization and death in outpatients with mild to moderate COVID 19; however, only intravenous administration has been evaluated in randomized clinical trials of treatment. Subcutaneous administration may expand outpatient treatment capacity and qualified staff available to administer treatment, but association with patient outcomes is understudied. Objective: To evaluate whether or not, i.) subcutaneous casirivimab and imdevimab treatment is associated with reduced 28 days hospitalization/death than non-treatment among mAb-eligible patients, and ii.) subcutaneous casirivimab and imdevimab treatment is clinically and statistically similar to intravenous casirivimab and imdevimab treatment. Design, Setting, and Participants: Prospective cohort study of outpatients in a learning health system in the United States with mild to moderate COVID 19 symptoms from July 14 to October 26, 2021 who were eligible for mAb treatment under emergency use authorization. A nontreated control group of eligible patients was also selected. Intervention: Subcutaneous injection or intravenous administration of the combined single dose of casirivimab 600mg and imdevimab 600mg. Main Outcomes and Measures: The primary outcome was the 28 day adjusted risk ratio or adjusted risk difference for hospitalization or death. Secondary outcomes included 28 day adjusted risk ratios/differences of hospitalization, death, composite endpoint of ED admission and hospitalization, and rates of adverse events. Results: Among 1,956 matched adults with mild to moderate COVID 19, patients who received casirivimab and imdevimab subcutaneously had a 28-day rate of hospitalization/death of 3.4% (n=652) compared to 7.8% (n=1,304) in nontreated controls [risk ratio 0.44 (95% confidence interval: 0.28 to 0.68, p < .001)]. Among 2,185 patients treated with subcutaneous (n=969) or intravenous (n=1,216) casirivimab and imdevimab, the 28 day rate of hospitalization/death was 2.8% vs. 1.7%, respectively which resulted in an adjusted risk difference of 1.5% (95% confidence interval: -0.5% to 3.5%, p=.14). The 28 day adjusted risk differences (subcutaneous and intravenous) for death, ICU admission, and mechanical ventilation were 0.3% or less, although the 95% confidence intervals were wide. Conclusions and Relevance: Subcutaneously administered casirivimab and imdevimab is associated with reduced risk adjusted hospitalization or death amongst outpatients with mild to moderate COVID 19 compared to no treatment and indicates low adjusted risk difference compared to patients treated intravenously.

scholarly journals The Southern California Extracorporeal Membrane Oxygenation Consortium during the Coronavirus Disease 2019 Pandemic

2021 ◽  
pp. 1-21
Author(s):  
Mazen Odish ◽  
Cassia Yi ◽  
Juliann Eigner ◽  
Amelia Kenner Brininger ◽  
Kristi L. Koenig ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
San Diego ◽  
Southern California ◽  
Limited Resource ◽  
The United States ◽  
San Diego County ◽  
Clinical Practices ◽  
Membrane Oxygenation ◽  
Effective Manner ◽  
Share Data

Abstract In March 2020, at the onset of the coronavirus disease 2019 (COVID-19) pandemic in the United States, the Southern California Extracorporeal Membrane Oxygenation (ECMO) Consortium was formed. The consortium included physicians and coordinators from the four ECMO centers in San Diego County. Guidelines were created to ensure that ECMO was delivered equitably and in a resource effective manner across the county during the pandemic. A biomedical ethicist reviewed the guidelines to ensure ECMO utilization would provide maximal community benefit of this limited resource. The San Diego County Health and Human Services Agency further incorporated the guidelines into its plans for the allocation of scarce resources. The consortium held weekly video conferences to review countywide ECMO capacity (including census and staffing), share data, and discuss clinical practices and difficult cases. Equipment exchanges between ECMO centers maximized regional capacity. From March 1 to November 30, 2020, consortium participants placed 97 patients on ECMO. No eligible patients were denied ECMO due to lack of resources or capacity. The Southern California ECMO Consortium may serve as a model for other communities seeking to optimize ECMO resources during the current COVID-19 or future pandemics.

scholarly journals Hispanic/Latino Ethnic Identity and Diabetes: An Examination of Underlying Acculturation Processes and the Hispanic/Latino Health Advantage

2021 ◽  
Vol 48 (3) ◽  
pp. 285-294
Author(s):  
Jeannie B. Concha ◽  
Kristen Kelly ◽  
Briana Mezuk
Keyword(s):  
Ethnic Identity ◽  
Confidence Interval ◽  
Health Outcomes ◽  
Physical Health ◽  
Odds Ratio ◽  
Well Being ◽  
The United States ◽  
Diabetes Prevalence ◽  
Physical Health Outcomes ◽  
The Relationship

Background. Hispanics/Latinos in the United States experience both a health advantage and disadvantage in developing diabetes. Ethnic identity, a predictor of psychological well-being, has not been widely applied to physical health outcomes. The objective of this study is to apply what is known regarding ethnic identity and psychological health to physical health outcomes (diabetes) and to explore the moderating effect of education as a possible underlying mechanism of the Hispanic Health Advantage/Disadvantage. Specifically, this study examines (a) the association between ethnic identity and diabetes prevalence among adult Hispanics/Latinos and (b) determines whether education modifies this relationship. Method. Data come from the nationally representative adult U.S. household study, National Latino and Asian American Study (NLAAS), collected in 2001 to 2003 ( N = 1,746). Multiple logistic regression was conducted to examine the relationship between ethnic identity, education, and their interaction with likelihood of diabetes. Results. Hispanics/Latinos with high ethnic identity have a higher odds of reporting diabetes among those with 13 to 15 years of education (odds ratio: 1.84; 95% confidence interval: 1.16–2.92) and a lower odds among those with 16+ years of education (odds ratio: 0.53; 95% confidence interval: 0.34–0.84). Ethnic identity is associated with diabetes prevalence and the relationship is moderated by educational attainment. Conclusion. Given the growth, diversity, and diabetes disparities among Hispanics/Latinos, our buffering and exacerbating findings exemplify the complexity and fluidity of theory in understanding psychological/behavioral processes. The findings highlight the importance of designing targeted health interventions that take into account the diverse psychosocial and educational experiences of Hispanics/Latinos.

scholarly journals Using multiple imputation to classify potential outcomes subgroups

2021 ◽  
pp. 096228022110028
Author(s):  
Yun Li ◽  
Irina Bondarenko ◽  
Michael R Elliott ◽  
Timothy P Hofer ◽  
Jeremy MG Taylor
Keyword(s):  
Multiple Imputation ◽  
Statistical Methods ◽  
The United States ◽  
Treatment Selection ◽  
Potential Outcomes ◽  
Model Framework ◽  
Medical Tests ◽  
Gene Assay ◽  
The Impact ◽  
Test Result

With medical tests becoming increasingly available, concerns about over-testing, over-treatment and health care cost dramatically increase. Hence, it is important to understand the influence of testing on treatment selection in general practice. Most statistical methods focus on average effects of testing on treatment decisions. However, this may be ill-advised, particularly for patient subgroups that tend not to benefit from such tests. Furthermore, missing data are common, representing large and often unaddressed threats to the validity of most statistical methods. Finally, it is often desirable to conduct analyses that can be interpreted causally. Using the Rubin Causal Model framework, we propose to classify patients into four potential outcomes subgroups, defined by whether or not a patient’s treatment selection is changed by the test result and by the direction of how the test result changes treatment selection. This subgroup classification naturally captures the differential influence of medical testing on treatment selections for different patients, which can suggest targets to improve the utilization of medical tests. We can then examine patient characteristics associated with patient potential outcomes subgroup memberships. We used multiple imputation methods to simultaneously impute the missing potential outcomes as well as regular missing values. This approach can also provide estimates of many traditional causal quantities of interest. We find that explicitly incorporating causal inference assumptions into the multiple imputation process can improve the precision for some causal estimates of interest. We also find that bias can occur when the potential outcomes conditional independence assumption is violated; sensitivity analyses are proposed to assess the impact of this violation. We applied the proposed methods to examine the influence of 21-gene assay, the most commonly used genomic test in the United States, on chemotherapy selection among breast cancer patients.

scholarly journals Longer Residence in the United States is Associated With More Physical Function Limitations in African Immigrant Older Adults

2020 ◽  
pp. 073346482097760
Author(s):  
Manka Nkimbeng ◽  
Yvonne Commodore-Mensah ◽  
Jacqueline L. Angel ◽  
Karen Bandeen-Roche ◽  
Roland J. Thorpe ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
Confidence Interval ◽  
Physical Function ◽  
Racial Discrimination ◽  
African Immigrants ◽  
The United States ◽  
African Immigrant ◽  
High Discrimination ◽  
The Mean

Acculturation and racial discrimination have been independently associated with physical function limitations in immigrant and United States (U.S.)-born populations. This study examined the relationships among acculturation, racial discrimination, and physical function limitations in N = 165 African immigrant older adults using multiple linear regression. The mean age was 62 years ( SD = 8 years), and 61% were female. Older adults who resided in the United States for 10 years or more had more physical function limitations compared with those who resided here for less than 10 years ( b = −2.62, 95% confidence interval [CI] = [–5.01, –0.23]). Compared to lower discrimination, those with high discrimination had more physical function limitations ( b = −2.51, 95% CI = [–4.91, –0.17]), but this was no longer significant after controlling for length of residence and acculturation strategy. Residing in the United States for more than 10 years is associated with poorer physical function. Longitudinal studies with large, diverse samples of African immigrants are needed to confirm these associations.

scholarly journals Economic Impact from Unrestricted Spread of Potato Cyst Nematodes in Australia

2009 ◽  
Vol 99 (12) ◽  
pp. 1387-1393 ◽  
Author(s):  
M. Hodda ◽  
D. C. Cook
Keyword(s):  
United States ◽  
Confidence Interval ◽  
Economic Impact ◽  
Annual Cost ◽  
The United States ◽  
Economic Consequences ◽  
Potato Cyst Nematodes ◽  
Cyst Nematodes ◽  
Model Predictions ◽  
Alternative Responses

Potato cyst nematodes (PCN) (Globodera spp.) are quarantine pests with serious potential economic consequences. Recent new detections in Australia, Canada, and the United States have focussed attention on the consequences of spread and economic justifications for alternative responses. Here, a full assessment of the economic impact of PCN spread from a small initial incursion is presented. Models linking spread, population growth, and economic impact are combined to estimate costs of spread without restriction in Australia. Because the characteristics of the Australian PCN populations are currently unknown, the known ranges of parameters were used to obtain cost scenarios, an approach which makes the model predictions applicable generally. Our analysis indicates that mean annual costs associated with spread of PCN would increase rapidly initially, associated with increased testing. Costs would then increase more slowly to peak at over AUD$20 million per year ≈10 years into the future. Afterward, this annual cost would decrease slightly due to discounting factors. Mean annual costs over 20 years were $18.7 million, with a 90% confidence interval between AUD$11.9 million and AUD$27.0 million. Thus, cumulative losses to Australian agriculture over 20 years may exceed $370 million without action to prevent spread of PCN and entry to new areas.

The Epidemiology of US High School Basketball Injuries, 2005–2007

2008 ◽  
Vol 36 (12) ◽  
pp. 2328-2335 ◽  
Author(s):  
Laurel A. Borowski ◽  
Ellen E. Yard ◽  
Sarah K. Fields ◽  
R. Dawn Comstock
Keyword(s):  
High School ◽  
Confidence Interval ◽  
Rate Ratio ◽  
Knee Injuries ◽  
Injury Rate ◽  
The United States ◽  
Basketball Players ◽  
Knee Ligament ◽  
Prevention Interventions ◽  
Nationally Representative

Background With more than a million high school athletes playing during the 2006–2007 academic year, basketball is one of the most popular sports in the United States. Hypothesis Basketball injury rates and patterns differ by gender and type of exposure. Study Design Descriptive epidemiology study. Methods Basketball-related injury data were collected during the 2005–2006 and 2006–2007 academic years from 100 nationally representative US high schools via Reporting Information Online. Results High school basketball players sustained 1518 injuries during 780 651 athlete exposures for an injury rate of 1.94 per 1000 athlete exposures. The injury rate per 1000 athlete exposures was greater during competition (3.27) than during practice (1.40; rate ratio, 2.33; 95% confidence interval, 2.10–2.57) and was greater among girls (2.08) than among boys (1.83; rate ratio, 1.14; 95% confidence interval, 1.03–1.26). The ankle/foot (39.7%), knee (14.7%), head/face/neck (13.6%), arm/hand (9.6%), and hip/thigh/upper leg (8.4%) were most commonly injured. The most frequent injury diagnoses were ligament sprains (44.0%), muscle/tendon strains (17.7%), contusions (8.6%), fractures (8.5%), and concussions (7.0%). Female basketball players sustained a greater proportion of concussions (injury proportion ratio, 2.41; 95% confidence interval, 1.49–3.91) and knee injuries (injury proportion ratio, 1.71; 95% confidence interval, 1.27–2.30), whereas boys more frequently sustained fractures (injury proportion ratio, 1.87; 95% confidence interval, 1.27–2.77) and contusions (injury proportion ratio, 1.52; 95% confidence interval, 1.00–2.31). The most common girls’ injury requiring surgery was knee ligament sprains (47.9%). Conclusion High school basketball injury patterns vary by gender and type of exposure. This study suggests several areas of emphasis for targeted injury prevention interventions.

Biomarker testing patterns and actionability in advanced non-small cell lung cancer (aNSCLC) at OneOncology (OneOnc).

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 287-287
Author(s):  
Ari M. Vanderwalde ◽  
Esprit Ma ◽  
Elaine Yu ◽  
Tania Szado ◽  
Richard Price ◽  
...  
Keyword(s):  
Performance Status ◽  
Ecog Performance Status ◽  
Personalized Care ◽  
Specimen Collection ◽  
Targeted Treatments ◽  
Biomarker Testing ◽  
Next Generation Sequencing Ngs ◽  
To Receive ◽  
Testing Patterns ◽  
Test Result

287 Background: Recent approvals of targeted treatments (tx) have improved personalized care in aNSCLC. Biomarker testing is crucial for patients (pts) to receive optimal tx expeditiously. This study examined aNSCLC biomarker testing and tx patterns at OneOnc. Methods: Pts diagnosed with aNSCLC (stage ≥ IIIb) from 1/1/2015 to 5/31/2020, aged ≥ 18 years, and with ≥ 1 visit ≤ 90 days of advanced (Adv) diagnosis (Dx) were retrospectively evaluated using the nationwide Flatiron Health electronic health record derived de-identified database from selected OneOnc sites. Descriptive analyses were conducted to evaluate testing patterns for ALK, BRAF, EGFR, KRAS, PD-L1, and ROS-1 biomarkers and actionable mutation tx pattern. Results: Overall 3,860 aNSCLC pts were included, median age was 69 years, 47% females, 66% non-squamous, 29% squamous, 4% histology NOS, and 23% with ECOG performance status 0-1. Of the 3,152 (82%) pts tested for any biomarker, 64% received next-generation sequencing (NGS) vs. 36% received other biomarker tests only. Testing rates varied by biomarker: EGFR (74%), ALK (72%), ROS-1 (66%), PD-L1 (57%), BRAF (56%), KRAS (54%). Pts who received all 6 biomarker tests increased from 12% (2015), 23% (2016), 40% (2017), 41% (2018), 48% (2019) to 56% (2020). Among the tested pts, the median time from Adv Dx to the first test result was 20 days (d) and from specimen collection after Adv Dx to the first test result was 12 d. Pts tested and treated before test result available declined from 28% (2015) to 16% (2020). Of 1,207 pts with actionable mutations, 390 (32%) received tx before the test result: 35% chemotherapy (chemo) only, 28% chemo + cancer immunotherapy (CIT), and 15% CIT only. After the test result, 26% to 81% of pts received no or other tx not specific to actionable mutations [Table]. Conclusions: Findings from this study demonstrated an increase in aNSCLC biomarker testing at OneOnc over time, while 44% pts in 2020 did not receive testing on all 6 biomarkers. Some pts had tx prior to the test result, but this trend appeared to decline. Further studies are warranted to better understand the reasons for pts receiving tx that were not specific to their actionable mutations.[Table: see text]

Utilization and patient characteristics for the trastuzumab originator, biosimilars, and other HER2 inhibitors in the United States.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 308-308
Author(s):  
Young Hee Nam ◽  
Aaron Mendelsohn ◽  
James Marshall ◽  
Nancy Lin ◽  
Jeffrey Brown ◽  
...  
Keyword(s):  
Endocrine Therapy ◽  
Metastatic Breast ◽  
Patient Characteristics ◽  
The United States ◽  
Baseline Period ◽  
Research Network ◽  
Health Plans ◽  
Clinical Practices ◽  
Full Data ◽  
The Us

308 Background: Biosimilars for trastuzumab, a HER2 inhibitor (HER2I), have been available for use in the US since in 2019, yet information on their utilization and patient characteristics is limited. We assessed utilization and patient characteristics for the trastuzumab originator, biosimilars, and other HER2Is in the US. Methods: We analyzed healthcare claims for 10/1/2016-up to 2/29/2020 (end date varied across health plans) from the Biologics and Biosimilars Collective Intelligence Consortium’s Distributed Research Network ( > 95 million persons) using the FDA’s Sentinel distributed analysis tools. We conducted descriptive analyses on the number of incident users and patients’ characteristics for each HER2I. Adults continuously enrolled in their health plan with medical and drug coverage ≥365 days (baseline period) prior to their incident HER2I use were eligible for analysis. Results: Of the incident users (incident to any HER2Is), we identified 6,631 originator trastuzumab users, 122 trastuzumab-anns, 116 ado-trastuzumab emtansine, 54 neratinib, and 54 lapatinib users. Trastuzumab-dkst and trastuzumab/hyaluronidase-oysk had < 11 users each. Mean age was the highest for trastuzumab/hyaluronidase-oysk (73.7 years; SD, 18.6) and similar between the trastuzumab originator and biosimilars (52.5-59.0). The number of incident users/100,000 person-years decreased for the trastuzumab originator from 13.5 in 2016 to 9.4 in 2020 and increased for trastuzumab-anns from 0.4 in 2019 to 4.9 in 2020. Of the baseline clinical characteristics examined, Charlson/Elixhauser comorbidity score was the highest for lapatinib (2.0), lowest for trastuzumab-dkst and neratinib (0.5), and similar between the trastuzumab originator (1.1) and trastuzumab-anns (1.3). The proportion of patients who received any chemotherapy during the baseline period was 38.9% for lapatinib, 18.5% for the trastuzumab originator, and 14.8% for trastuzumab-anns. The proportion of endocrine therapy users was the highest for neratinib (63.0%) and similar between the trastuzumab originator (11.1%) and trastuzumab-anns (10.7%). Among incident users with metastatic breast cancer, endocrine therapy receivers during the baseline period accounted for 19.3% for the trastuzumab originator and 69.6% for lapatinib. Conclusions: Though full data were not available for 2019-2020 for all health plans, these preliminary findings suggest that utilization of biosimilar trastuzumab-anns increased whereas the trastuzumab originator use decreased over time and that there is a variation in patient characteristics between HER2Is and by metastatic status while the characteristics were generally similar between the trastuzumab originator and trastuzumab-anns. We plan to conduct ongoing assessment of HER2I utilization as more data become available to help inform clinical practices and health policies.

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