Outcome of African-American (AA) Multiple Myeloma (MM) Patients after Autologous Stem Cell Transplantation (ASCT): A Single-Center Experience.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3327-3327
Author(s):  
Yin Wu ◽  
Olga Goloubeva ◽  
Kathleen Ruehle ◽  
Saul Yanovich ◽  
Aaron P. Rapoport ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Access To Health Care ◽  
Cox Regression ◽  
The Past ◽  
Single Center Experience ◽  
Time Period ◽  
Younger Age ◽  
Access To Health ◽  
Significant Difference ◽  
Caucasian Patients

Abstract The incidence of MM in African-Americans is more than double that in Caucasians. Historically AAs have had a higher mortality rate than Caucasians; but over the past 10 yrs, the age-adjusted mortality rate has been on the decline for AAs while it has been stable for Caucasians as a result of ASCT and novel agents. Previous studies (n=74 AA patients) suggested that response to ASCT is similar, if not better, for AA patients (Verma et al 2008, Saraf et al 2006). We retrospectively analyzed the clinical presentation of a large cohort of AA patients (n=103) who underwent ASCT at our center between 1998 and 2008 and compared their outcome to that of Caucasians patients (n=183) transplanted in the same time period. AA patients were significantly younger than Caucasian patients at diagnosis with median age 53 (range: 32–75) vs 59 (range: 27–80), respectively (p<0.0001). The distribution of isotype and stage of MM at diagnosis were similar between the two groups. Approximately 20% patients in each group presented with renal insufficiency. Among the AA patients, 45% had albumin < 3.5 g/dL; 14% and 18% had beta2-microglobulin > 3.5 mg/L and > 5.5 mg/L, respectively. Initial cytogenetic data were not available for the majority of patients. Median time from diagnosis to ASCT was significantly longer for AA than for Caucasian patients at 0.8 yrs (range: 0.23–9.2) vs 0.5 yrs (range: 0.1– 7.0), respectively (p<0.0001). There was no difference in incidence of transplant-related complications, as reflected by similar lengths of hospital stay, with a median of 15 days for both groups. No significant difference in response to ASCT was found between the two groups. Median EFS was 1.7 yrs (range: 1.5–2.7) for AAs and 1.8 yrs (range: 1.5–2.4) for Caucasians (p=NS). At a median follow up of 5 yrs, 74% of AA and 70% of Caucasian patients were alive. Median OS was also not significantly different at 9 yrs (range: 6.7- not reached) for AAs and 8 yrs (range: 5.9-not reached) for Caucasians (p=NS). Cox regression model for prognostic markers: albumin, calcium, creatinine, hemoglobin, and platelet count were significant for OS in AA patients (p range 0.004–0.0001). The current study is the largest one of AA patients undergoing SCT at a single institution. AA patients with MM present at a younger age, but undergo ASCT at a significantly later time from diagnosis than Caucasian patients. This delay may reflect a disparity in referral pattern and access to health care. AA patients have similar EFS and OS after ASCT. It is likely that better responses to the newer anti-myeloma agents, as well as favorable impact of ASCT, even if delayed, may explain the improvement of AA patients with MM over the past decade. Further studies of responses of AA patients to novel myeloma agents are needed.

scholarly journals Health Care Access Among Essential Critical Infrastructure Workers, 31 States, 2017-2018

2021 ◽  
pp. 003335492199668
Author(s):  
Winifred L. Boal ◽  
Jia Li ◽  
Sharon R. Silver
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Access ◽  
Access To Health Care ◽  
Health Care Services ◽  
Personal Health ◽  
The Past ◽  
Care Access ◽  
Care Services ◽  
Access To Health

Objectives Essential workers in the United States need access to health care services for preventive care and for diagnosis and treatment of illnesses (coronavirus disease 2019 [COVID-19] or other infectious or chronic diseases) to remain healthy and continue working during a pandemic. This study evaluated access to health care services among selected essential workers. Methods We used the most recent data from the Behavioral Risk Factor Surveillance System, 2017-2018, to estimate the prevalence of 4 measures of health care access (having health insurance, being able to afford to see a doctor when needed, having a personal health care provider, and having a routine checkup in the past year) by broad and detailed occupation group among 189 208 adults aged 18-64. Results Of all occupations studied, workers in farming, fishing, and forestry occupations were most likely to have no health insurance (46.4%). Personal care aides were most likely to have been unable to see a doctor when needed because of cost (29.3%). Construction laborers were most likely to lack a personal health care provider (51.1%) and to have not had a routine physical checkup in the past year (50.6%). Compared with workers in general, workers in 3 broad occupation groups—food preparation and serving; building and grounds cleaning and maintenance; and construction trades—had significantly lower levels of health care access for all 4 measures. Conclusion Lack of health insurance and underinsurance were common among subsets of essential workers. Limited access to health care might decrease essential workers’ access to medical testing and needed care and hinder their ability to address underlying conditions, thereby increasing their risk of severe outcomes from some infectious diseases, such as COVID-19. Improving access to health care for all workers, including essential workers, is critical to ensure workers’ health and workforce stability.

scholarly journals Place-based Inequality in “Energetic” Pain: The Price of Residence in Rural America

2018 ◽  
Vol 4 ◽  
pp. 237802311880303 ◽  
Author(s):  
Lazarus Adua ◽  
Ashley Beaird
Keyword(s):  
Access To Health Care ◽  
Rural Households ◽  
Well Being ◽  
Rural America ◽  
Residential Energy ◽  
The Past ◽  
Rural And Urban ◽  
Access To Health ◽  
Urban Places ◽  
Lower Educational Attainment

Despite the tendency for some to view rural life or living close to nature with nostalgia, the unpalatable truth is that rural America is beset with many problems, including lower incomes, higher poverty rates, limited access to well-paying jobs, higher morbidity and mortality rates, inadequate access to health care, and lower educational attainment. In this study, we question whether this palpable rural disadvantage extends to residential energy costs, a subject with serious implications for the well-being of households. Analyses of data spanning two decades show that rural households consistently spend more on residential energy than urban households, although they generally use less. This finding, which indicates the existence of energy cost inequality between rural and urban places, represents a kind of rural tax. Any sustained spikes in costs, which has happened in the past and would likely happen in the future, could portend significant access risks to rural households.

scholarly journals Comparative Analysis of Acral Melanoma in Chinese and Caucasian Patients

2020 ◽  
Author(s):  
Kai Huang ◽  
Yu Xu ◽  
Emmanuel M. Gabriel ◽  
Subhasis Misra ◽  
Yong Chen ◽  
...  
Keyword(s):  
Survival Data ◽  
Cox Regression ◽  
Patient Characteristics ◽  
Chinese Patients ◽  
Cancer Center ◽  
Cox Regression Analysis ◽  
Acral Melanoma ◽  
Significant Difference ◽  
Positive Rate ◽  
Caucasian Patients

Abstract Background Acral melanoma is the most common subtype of melanoma in Chinese patients and one of the least common in Caucasian patients. It has been unclear if outcomes differ between Chinese and Caucasian patients diagnosed with Acral Melanoma. This study investigated patient characteristics and survival differences between Chinese and Caucasian Acral Melanoma patients. Methods Two large institutional melanoma databases from Fudan University Shanghai Cancer Center (FUSCC) and Mayo Clinic enterprise, were retrospectively reviewed from 2009 to 2015. Clinicopathologic and survival data were collected and analyzed between the two groups. The primary outcome was disease-specific survival (DSS) and was calculated using the Kaplan Meier (KM) method. Results The Chinese group presented with more advanced disease compared with Caucasians: thicker Breslow depth (median 3.0 mm vs. 1.2 mm, p=0.003), more ulcerated disease (66.1% vs 29%; p<0.001), and advanced stages (stage II/III 84.3% vs. 37.1%; p<0.001). No significant difference was identified in terms of age at diagnosis, location, histologic subtypes, or node positive rate. The 5-year DSS rate was 68.4% and 73% (p=0.56) for Chinese and Caucasians, respectively. Male gender, Breslow thickness, ulceration, and positive sentinel lymph nodes predicted worse DSS on multivariate Cox regression analysis. Conclusions There appears to be no difference in stage-stratified survival between Chinese and Caucasians, supporting the implementation of clinical trials of AM that could include both Chinese and Caucasian patients.

scholarly journals Impact of Ethnicity on COVID-19 Related Hospitalizations in Children During the First Pandemic Wave in Northern Italy

2021 ◽  
Vol 9 ◽  
Author(s):  
Roberto Baronio ◽  
Lucia Savaré ◽  
Jessica Ruggiero ◽  
Beatrice Crotti ◽  
Angelo Mazza ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Access To Health Care ◽  
Black People ◽  
Northern Italy ◽  
Pediatric Care ◽  
Information Barriers ◽  
Access To Health ◽  
Starting Point ◽  
Significant Difference ◽  
A Minor

There is increasing evidence that black people and other minorities have a higher incidence of severe COVID-19 disease, but little is known about the situation of children, especially in Europe. In general children are less infected and if so, frequently show mild or asymptomatic disease, making conclusions difficult. We collected data on SARS-CoV-2 associated hospitalizations in a well-defined population of 550,180 children up to 15 years in five hub-centers during the “first wave” at the heart of the pandemic in Northern Italy. Among the 451,053 Italian citizens 80 were hospitalized as compared to 31 out of 99,127 foreign citizens, giving a significantly higher risk (odds ratio 1.76; 95% CI: 1.16–2.66) for the foreign children. The risk was highest for children of African ethnicity as compared to Italians with an odds ratio of 2.76 (95% CI: 1.56–4.87). None of the patients deceased. There was no significant difference in age (thou infants regardless of ethnicity had a 10-fold higher risk), sex, length of hospitalization or comorbidities, namely overweight. As bureaucratic, cultural and information barriers mostly affect preventive and adult services and considering that in contrast to other countries, in Italy pediatric care is guaranteed free of (out-of-pocket) charge to all people &lt;16 years, and hospitals are densely spaced, access to health care seems to be a minor problem. Thus, other possible root causes are discussed. We believe that this is an unbiased starting point to understand and overcome the reasons for the higher risk those children experience.

scholarly journals P346 The changing epidemiology of infective endocarditis in a tertiary center

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Denes ◽  
A Bence ◽  
T Ferenci ◽  
S Borbas ◽  
G Prinz ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
Cox Regression ◽  
Temporal Trends ◽  
Tertiary Hospital ◽  
Incidence And Mortality ◽  
Tertiary Center ◽  
Significant Difference ◽  
Over Time

Abstract Background Despite the adequate antibiotic prophylaxis, the incidence and mortality rate of infective endocarditis (IE) is still high. In the past few decades, several studies have noted an increase in the proportion of IE caused by staphylococcal species. Aims The aim of our retrospective study was to assess the clinical and microbiological characteristics, trends, and the 1, 6 and 12-month cardiovascular (CV) mortality rate of patients administered for IE in our tertiary hospital between January 1, 2006 and December 31, 2016. Results We identified 465 cases (311 men, 154 women) of 448 patients, mean age was 56,1 ± 16,4 years (14-92). Native left-sided IE (NLIE) was assessed in 286 cases (61,5%, mitral in 117, aorta in 116, combined in 53 cases), prosthetic valve IE (PVIE) was in 111 cases (24%, early in 44, late in 67), right-sided IE (RIE) in 12 cases (2,5%), cardiac device related IE (CDRIE) in 50 cases (11%), other in 6 cases (1%). The underlying infection was caused by streptococci in 124 cases (27%), Staphylococcus aureus (SA) in 112 cases (24%, out of them 23 had MRSA), coagulase negative Staphylococcus (CoNS) in 39 cases (8%), enterococci in 75 cases (16%). Blood culture negative cases found in 61 patients (13%), in 38 cases (8%) other, diversified germs and in 16 cases (4%) there were no data on the pathogen agent. The mortality rates of the total population were one-month was 12.8%, six-month was 26.4%, one-year was 29.7%, and five-year was 40%. There was a significant difference in the mortality rate regarding both of the type of IE and in terms of the underlying microorganism (log-rank p = 0.03 and p = 0.04 resp). The worst survival rate was detected among patients with PVIE, and patients with staphylococcal infection, especially with MRSA. Cox regression found that age (HR: 1.4; CI:1.3-1.6; p &lt;0.001), ejection fraction (HR: 1.4; CI:1.2-1.5; p &lt;0.001), hemoglobin and creatinin levels (HR: 0.9; CI:0.8-0.97 p = 0.01; HR: 1.3; CI: 1.1-1.5; p = 0.001 resp.), MRSA compared to streptococcal infection (HR: 2.5; CI:1.4-4.5; p &lt;0.001), stroke as complication (HR: 1.98; CI:1.4-2.8; p &lt;0.001) were independent risk factors of mortality. In terms of temporal trends the rate of combined NLIE decreased over time (14.5% to 5.1%, p = 0.03), while the rate of other types of IE did not changed. Regarding the type of underlying microorganism the rate of SA infection increased (17% to 41%, p = 0.002) and the rate of CoNS decreased (16.1% - 1.3% p &lt; 0.001) over time. The 1-year mortality rate did not change through the years. Conclusions During the observed 11 years 465 cases were administered with IE to our tertiary hospital, out of which two-third were NLIE. One-quarter of the underlying microorganism were streptococci, and the rate of Staphylococcus aureus infection was increased over time, which was associated with a worse prognosis. In addition IE had a high mortality, which unfortunately did not improve through the years.

scholarly journals SINGLE CENTER EXPERIENCE IN MANAGEMENT OF ACUTE MESENTERIC ISCHEMIA AND THE IMMEDIATE OUTCOME FOLLOWING SURGICAL SALVAGE

2021 ◽  
Vol 31 (04) ◽  
pp. 201-203
Author(s):  
Shabbir Ahmad ◽  
Ahmad Naeem Akhtar ◽  
Nazia Farooq ◽  
Ajmal Farooq ◽  
Farman Ali ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Mesenteric Ischemia ◽  
Surgical Intervention ◽  
Acute Mesenteric Ischemia ◽  
Rare Condition ◽  
Abdominal Distension ◽  
Early Presentation ◽  
Late Presenters ◽  
Single Center Experience ◽  
Time Period

Acute Mesenteric Ischemia is a rare condition with an incidence of 5/100,000. Occlusive subtype has the better outcome if early presentation and urgent surgical intervention is made. The study was conducted at Lahore General Hospital, Lahore from Jan, 2016 to Jan, 2018. During this time period 12 patients were enrolled in the study fulfilling the inclusion and exclusion criteria. Mean age was 58 years and all were male (range 45 - 75 years). All 12 patients were symptomatic at presentation with severe abdominal pain (94.3%), abdominal distension (63.6%) and vomiting (40.4%) alone or in combination. 7 patients (58.3%) presented within 24 hours from the onset of symptoms whereas 5 patients (41.6%) presented late. All patients who presented within 24 hours of onset of symptoms survived whereas all patients who presented after 24 hours from the onset of symptoms could not survive. The mortality rate for early presenters was zero % while for late presenters it was 100 %. On whole the mortality rate for our 12 patients with Acute Mesenteric Ischemia was 41.7 %. Conclusion Acute mesenteric ischemia patient presentation within 24 hours from the onset of symptoms with early diagnosis and surgical intervention had much better outcome.

scholarly journals Afghan women and access to health care in the past 25 years

2022 ◽  
Vol 43 ◽  
pp. 101235
Author(s):  
Zainab Ezadi ◽  
Nesa Mohammadi ◽  
Roqia Sarwari ◽  
Shakardokht M Jafari
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Afghan Women ◽  
The Past ◽  
Access To Health

scholarly journals Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU

2020 ◽  
Vol 75 (11) ◽  
pp. 3359-3365 ◽  
Author(s):  
Zeno Pasquini ◽  
Roberto Montalti ◽  
Chiara Temperoni ◽  
Benedetta Canovari ◽  
Mauro Mancini ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cox Regression ◽  
Compassionate Use ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Time Period ◽  
Significant Difference ◽  
Comorbidity Index

Abstract Background Remdesivir is a prodrug with in vitro activity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Its clinical efficacy in patients with COVID-19 under mechanical ventilation remains to be evaluated. Methods This study includes patients under mechanical ventilation with confirmed SARS-CoV-2 infection admitted to the ICU of Pesaro hospital between 29 February and 20 March 2020. During this period, remdesivir was provided on a compassionate use basis. Clinical characteristics and outcome of patients treated with remdesivir were collected retrospectively and compared with those of patients hospitalized in the same time period. Results A total of 51 patients were considered, of which 25 were treated with remdesivir. The median (IQR) age was 67 (59–75.5) years, 92% were men and symptom onset was 10 (8–12) days before admission to ICU. At baseline, there was no significant difference in demographic characteristics, comorbidities and laboratory values between patients treated and not treated with remdesivir. Median follow-up was 52 (46–57) days. Kaplan–Meier curves showed significantly lower mortality among patients who had been treated with remdesivir (56% versus 92%, P &lt; 0.001). Cox regression analysis showed that the Charlson Comorbidity Index was the only factor that had a significant association with higher mortality (OR 1.184; 95% CI 1.027–1.365; P = 0.020), while the use of remdesivir was associated with better survival (OR 3.506; 95% CI 1.768–6.954; P &lt; 0.001). Conclusions In this study the mortality rate of patients with COVID-19 under mechanical ventilation is confirmed to be high. The use of remdesivir was associated with a significant beneficial effect on survival.

Using hepatitis A and B vaccination as a paradigm for effective HIV vaccine delivery

Sexual Health ◽  
2007 ◽  
Vol 4 (2) ◽  
pp. 121 ◽  
Author(s):  
Scott D. Rhodes ◽  
Leland J. Yee
Keyword(s):  
Access To Health Care ◽  
Vaccine Acceptance ◽  
Qualitative Systematic Review ◽  
Younger Age ◽  
Access To Health ◽  
The Usa ◽  
Health Promoting ◽  
Higher Educational Attainment ◽  
Sex With Men ◽  
Political Differences

Background: An understanding of vaccine acceptance and uptake is imperative for successful vaccination of populations that will be primary targets for vaccination after a vaccine against HIV is developed and ready for dissemination. Experiences with vaccination against vaccine-preventable hepatitis (VPH) among men who have sex with men (MSM) may offer key insights to inform future HIV vaccination strategies. The purpose of this analysis was to explore what is known currently about vaccination among MSM, using knowledge gained from vaccination against VPH, and to identify important considerations from these experiences that must be explored further as a vaccine against HIV is promoted among MSM. Because cultural and political differences make it difficult to extrapolate findings from studies in one country to another, we have focused our analyses on studies conducted in the USA. Methods: Through a qualitative systematic review of published reports, we identified eight studies that reported correlates of VPH among MSM in the USA. Results: Six major domains of variables associated with vaccination against VPH were identified, including: demographics (e.g. younger age, higher educational attainment); increased vaccine knowledge; increased access to health care; provider recommendation; behaviours (e.g. same-sex behaviour, health-promoting and disease-preventing behaviours); and psychosocial factors (e.g. openness about one’s sexual orientation, reduced barriers to being vaccinated, self-efficacy). Conclusions: Further research is needed to understand vaccination behaviour among MSM and to maximise acceptance and uptake after a vaccine exists. Experiences with VPH provide a real-world model on which to base preliminary assumptions about acceptance and uptake of a vaccine against HIV.

Correlation between blast percentage in myelofibrosis and outcomes: A single-center experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18562-e18562 ◽  
Author(s):  
Lucia Masarova ◽  
Prithviraj Bose ◽  
Kate Newberry ◽  
Abdallah Abou Zahr ◽  
Jorge E. Cortes ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Cox Regression ◽  
Chronic Phase ◽  
Cancer Center ◽  
Normal Range ◽  
Single Center Experience ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Systemic Symptoms ◽  
Md Anderson

e18562 Background: Patients with accelerated phase (AP) myelofibrosis (MF; >10% blasts [BL] in bone marrow [BM] or peripheral blood [PB]) have shorter overall survival (OS) than those in the chronic phase (<10% BM/PB BL). However, outcomes of patients with “lower” BM/PB BL (1-9%) are not well described. Methods: Clinical characteristics and OS of 1099 patients with MF who presented to MD Anderson Cancer Center between years 1984 – 2013 were retrospectively evaluated. Kaplan-Meier analysis and Cox regression models were used for calculations and comparisons. Results: PB and BM BL were available for 1038 (94%) patients at presentation. Five percent had AP, 10% had 5-9% BM or PB BL; 45% had < 5% BM BL and 1% (n=282), 2% (n=110), 3% (n=47) or 4% (n=27) PB BL; and 40% had < 5% BM BL and 0% PB BL (normal range). OS was similar among patients with 5-9% BM or 4-9% PB BL and those in AP (P>0.05). OS was also similar among patients with BL in the normal range and those with <5% BM and 1-3% PB BL (p>0.05). By grouping patients with similar OS, we have identified 2 groups with distinctive OS of 54 and 27 months, respectively (Table; p<0.001; HR = 1.81 [95%CI 1.5-2.2]). Five-year leukemia free survival was 65% for those in AP, 76% for ≥ 5-9% BM or ≥ 4-9% PB blasts, and 91% for < 4% BM or ≤ 3% PB BL (P<0.001). Clinical characteristics were similar for patients in the AP and with ≥ 5-9% BM or ≥ 4-9% PB blasts. Both groups had significantly higher leukocytes, lower hemoglobin and platelet levels, and were more likely to be transfusion dependent, have systemic symptoms, and unfavorable karyotype than patients with ≤ 4% BM or ≤ 3% PB blasts. There was no significant difference in age, splenomegaly, BM fibrosis grade, or distribution of JAK2, MPL and CALR mutations among these groups. Conclusions: Patients with ≥ 4% PB or ≥ 5% BM BL have OS that appears to be the same as those with >10% BL, suggesting that these patients may require a more aggressive treatment approach. [Table: see text]

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