mortality benefit
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2022 ◽  
Vol 31 (163) ◽  
pp. 210100
Author(s):  
Meera Ragavan ◽  
Manali I. Patel

In stark contrast to a few decades ago when lung cancer was predominantly a disease of men who smoke, incidence rates of lung cancer in women are now comparable to or higher than those in men and are rising alarmingly in many parts of the world. Women face a unique set of risk factors for lung cancer compared to men. These include exogenous exposures including radon, prior radiation, and fumes from indoor cooking materials such as coal, in addition to endogenous exposures such as oestrogen and distinct genetic polymorphisms. Current screening guidelines only address tobacco use and likely underrepresent lung cancer risk in women. Women were also not well represented in some of the landmark prospective studies that led to the development of current screening guidelines. Women diagnosed with lung cancer have a clear mortality benefit compared to men even when other clinical and demographic characteristics are accounted for. However, there may be sex-based differences in outcomes and side effects of systemic therapy, particularly with chemotherapy and immunotherapy. Ongoing research is needed to better investigate these differences to address the rapidly changing demographics of lung cancer worldwide.


2022 ◽  
Vol 14 (1) ◽  
pp. 164-196
Author(s):  
Nicolas Gendron-Carrier ◽  
Marco Gonzalez-Navarro ◽  
Stefano Polloni ◽  
Matthew A. Turner

We investigate the effect of subway system openings on urban air pollution. On average, particulate concentrations are unchanged by subway openings. For cities with higher initial pollution levels, subway openings reduce particulates by 4 percent in the area surrounding a city center. The effect decays with distance to city center and persists over the longest time horizon that we can measure with our data, about four years. For highly polluted cities, we estimate that a new subway system provides an external mortality benefit of about $1 billion per year. For less polluted cities, the effect is indistinguishable from zero. Back of the envelope cost estimates suggest that reduced mortality due to lower air pollution offsets a substantial share of the construction costs of subways. (JEL I12, L92, O13, O18, Q51, Q53, R41)


Author(s):  
Venkatesh Ravi ◽  
Abhushan Poudyal ◽  
Li Lin ◽  
Timothy Larsen ◽  
Jeremiah Wasserlauf ◽  
...  

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052121
Author(s):  
Kaitlyn M Tsuruda ◽  
Marit B Veierød ◽  
Nehmat Houssami ◽  
Gunvor G Waade ◽  
Gunhild Mangerud ◽  
...  

ObjectiveTo investigate conceptual knowledge about mammographic screening among Norwegian women.DesignWe administered a cross-sectional, web-based survey. We used multiple-choice questions and a grading rubric published by a research group from Australia.SettingOur Norwegian-language survey was open from April to June 2020 and targeted women aged 45–74 years.Participants2033 women completed our questionnaire. We excluded 13 women outside the target age range and 128 women with incomplete data. Responses from 1892 women were included in the final study sample.Primary and secondary outcome measuresThe questionnaire focused on women’s knowledge about the breast cancer mortality reduction, false positive results and overdiagnosis associated with mammographic screening. The primary outcome was the mean number of marks assigned in each of the three themes and overall. There were three potential marks for questions about breast cancer mortality, one for false positives and six for overdiagnosis.ResultsMost women (91.7%) correctly reported that screened women are less likely to die of breast cancer than non-screened women. 39.7% of women reported having heard of a ‘false positive screening result’ and 86.2% identified the term’s definition; 51.3% of women had heard of ‘overdiagnosis’ and 14.8% identified the term’s definition. The mean score was 2.59 of 3 for questions about breast cancer mortality benefit and 0.93 of 1 for the question about false positive screening results. It was 2.23 of 6 for questions about overdiagnosis.ConclusionsMost participants correctly answered questions about the breast cancer mortality benefit and false positive results associated with screening. The proportion of correct responses to questions about overdiagnosis was modest, indicating that conceptual knowledge about overdiagnosis was lower. Qualitative studies that can obtain in-depth information about women’s understanding of overdiagnosis may help improve Norwegian-language information about this challenging topic.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4275-4275
Author(s):  
Alessandra Carrillo ◽  
Shil Punatar ◽  
Sushma Pavaluri ◽  
Madeline Jentink ◽  
Dixita Patel ◽  
...  

Abstract Background Hospitalized patients with coronavirus disease 2019 (COVID-19) infection have higher rates of venous thromboembolism (VTE).Higher mortality rates have been reported in severe cases of COVID-19 including those who have elevated D-dimer levels and have thromboembolic phenomena. Objective The objective of this retrospective and observational study was to ascertain which type and dosages of anticoagulation provide a mortality benefit and decrease the risk of developing VTE. Methods We evaluated the risk factors for VTEs in patients with a confirmed polymerase chain reaction test positive for COVID-19 who were admitted to our facility from April 1 to July 1, 2020. In addition, we performed a logistic regression to examine the relationship between mortality and intensive care unit (ICU) admission, specific risk factors outlined in the study, D-dimer, ferritin, prothrombin time (PT) and international normalized ratio (INR). Patients with a history of VTE, those already on anticoagulation (AC) prior to hospitalization, and patients on comfort care were excluded from study. Results There were originally 331 patients in the data set. Of those, 111 patients were excluded based on exclusion criteria and 4 additional patients were removed as they were the only individual patients in their specific AC covariant group. The analysis was performed on the remaining 216 patients. We divided the AC medications administered to the patients into five separate covariates: 1. enoxaparin 40 mg subcutaneous (sq) daily, 2. enoxaparin 40 mg sq every 12 hours (q12h), 3. heparin 5000 mg sq q12h, 4. heparin 5000 mg sq every 8 hours (q8h), 5. Patients taking multiple AC or deep venous thrombosis (DVT) prophylaxis medications. 6. No AC and examined them via logistic regression for mortality at 28 days and 60 days (Table 1). Patients in enoxaparin 40 mg daily group had statistically significant lower 28 day mortality. There was no statistically significant relationship between the use of enoxaparin 40 mg q12h and 28 day mortality rate. Patients in both heparin groups did not have significantly lower 28 day mortality rates. Patients in groups 5 & 6 had significantly higher 28 day mortality rates (Table 1). It is important to note that 33 patients underwent a pulmonary computed tomography angiography due to concern for pulmonary embolism and 38 patients underwent an ultrasound of their lower extremities to rule out the development of DVT. For patients with additional risk factors defined as chronic kidney disease, chronic obstructive pulmonary disease, organ transplant recipient, obesity (BMI > 30), cardiac disease (heart failure, coronary artery disease or cardiomyopathy), sickle cell disease, diabetes mellitus and smoking history, the odds of death at 28 days increased by a factor of 1.71, at 60 days by a factor of 1.63 and being admitted to the ICU by a factor of 1.41. Patients with 3-5 risk factors are 2.48 times more likely to be admitted to the ICU than patients with 0-2 risk factors. Patients with 4 or 5 risk factors are 3.56 times more likely to be admitted to the ICU than patients with 0-3 risk factors (Table 2). Predictably, patients that were admitted to the ICU had a significantly increased rate of mortality compared to those who were not (Table 3). Per our analysis, there was no relationship between PT or INR and mortality. At 28 days and 2 months, the D-dimer > 4000 was indicative of a higher odds of death versus patients with a D-dimer < 4000. An increased ferritin was also indicative of a higher mortality rate (Table 4). Conclusion Patients receiving enoxaparin 40 mg daily benefited more than any other AC regimen with respect to the development of VTE at both 28 days and 2 months. Increasing the dosing to twice daily did not decrease mortality. Additionally, patients receiving heparin did not have a decreased mortality. It is important to note that there was no standard protocol used to determine which patients received daily or twice daily dosing. The type and dose of AC was determined based on the clinical judgment of intensivists in each case. It is also possible that patients with severe COVID-19 infection were more likely to be given twice daily dosing which could account for the lack of mortality benefit with more frequent dosing. We did not report bleeding rates in AC groups in our study and this can be a possible reason for no mortality benefit among higher dose AC groups. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.


Author(s):  
Emily B Rubin ◽  
Jonathan A Boiarsky ◽  
Lauren A Canha ◽  
Anita Giobbie-Hurder ◽  
Mofei Liu ◽  
...  

Abstract Background Given the challenges associated with timely delivery of monoclonal antibody (mAb) therapy to outpatients with Covid-19 who are most likely to benefit, it is critical to understand the effectiveness of such therapy outside the context of clinical trials. Methods Case-control study of 1257 adult outpatients with Covid-19, ≥ 65 years of age or with BMI ≥ 35, who were entered into a lottery for mAb therapy. Results Patients who were called to be offered mAb therapy had a statistically significant, 44% reduction in the odds of hospitalization within 30 days of a positive SARS-CoV-2 test compared with those who were not called (OR 0.56, 95% CI [0.36, 0.89], P=.01). Patients who actually received bamlanivimab had a statistically significant, 68% reduction in the odds of hospitalization compared with those who did not receive bamlanivimab (OR 0.32, 95% CI [0.11, 0.93], P=0.04). There was no statistically significant difference in the odds of death between patients who were called and patients who were not called (OR 1.79, 95% CI [0.52, 6.17], P=0.35), but there was a statistically significant difference in the odds of death between patients who received bamlanivimab and those who did not (OR 0.03, 95% CI [0, 0.25), P<0.01). Conclusions This study supports the effectiveness of bamlanivimab in reducing Covid-19 related hospitalizations in patients ≥ 65 or with BMI ≥ 35 and suggests a mortality benefit.


2021 ◽  
pp. 1-8
Author(s):  
Bryon P. Jackson ◽  
Jason L. Sperry ◽  
Mark H. Yazer

<b><i>Background:</i></b> Early initiation of blood products transfusion after injury has been associated with improved patient outcomes following traumatic injury. The ability to transfuse patients’ plasma in the prehospital setting provides a prime opportunity to begin resuscitation with blood products earlier and with a more balanced plasma:RBC ratio than what has traditionally been done. Published studies on the use of prehospital plasma show a complex relationship between its use and improved survival. <b><i>Summary:</i></b> Examination of the literature shows that there may be a mortality benefit from the use of prehospital plasma, but that it may be limited to certain subgroups of trauma patients. The likelihood of realizing these survival benefits appears to be predicted by several factors including the type of injury, length of transport time, presence of traumatic brain injury, and total number of blood products transfused, whether the patient required only a few products or a massive transfusion. When taken as a whole the evidence appears to show that prehospital plasma may have a mortality benefit that is most clearly demonstrated in patients with blunt injuries, moderate transfusion requirements, traumatic brain injury, and/or transport time greater than 20 min, as well as those who demonstrate a certain cytokine expression profile. <b><i>Key Messages:</i></b> The evidence suggests that a targeted use of prehospital plasma will most likely maximize the benefits from the use of this limited resource. It is also possible that prehospital plasma may best be provided through whole blood as survival benefits were greatest in patients who received both prehospital plasma and RBCs.


2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
William Lim ◽  
Frederick Lim

Since the World Health Organization (WHO) announced coronavirus 2019 (COVID-19) as a pandemic in March 2020, it has been wreaking havoc across countries, affecting people’s lives. Corticosteroids have proven to provide a mortality benefit in patients with COVID-19. Although dexamethasone is the most commonly used glucocorticoid and have shown to have mortality benefit in COVID-19 patients, it cannot be used in patients with adrenal insufficiency due to its lack of mineralocorticoid activity. Herein, we discuss a case of challenging corticosteroid management in a patient with COVID-19 complicated by her medical history of bilateral adrenalectomy.


2021 ◽  
Vol 10 (19) ◽  
pp. 4610
Author(s):  
David Balaz ◽  
Philip Erick Wikman-Jorgensen ◽  
Vicente Giner Galvañ ◽  
Manuel Rubio-Rivas ◽  
Borja de Miguel Campo ◽  
...  

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID-19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7–160) vs. 49.3 (16–109) mg/dL; p < 0.001), ferritin (791 (393–1534) vs. 470 (236–996) µg/dL; p < 0.001), D dimer (750 (430–1400) vs. 617 (345–1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%.


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