Helminth infections, including hookworms and Schistosomes, can cause severe disability and death. Infection management and control would benefit from identification of biomarkers for early detection ...and prognosis. While animal models suggest that Trefoil Factor Family proteins (TFF2 and TFF3) and interleukin-33 (IL-33) -driven type 2 immune responses are critical mediators of tissue repair and worm clearance in the context of hookworm infection, very little is known about how they are modulated in the context of human helminth infection. We measured TFF2, TFF3, and IL-33 levels in serum from patients in Brazil infected with Hookworm and/or Schistosomes, and compared them to endemic and non-endemic controls. TFF2 was specifically elevated by Hookworm infection in females, not Schistosoma or co-infection. This elevation was correlated with age, but not worm burden. TFF3 was elevated by Schistosoma infection and found to be generally higher in females. IL-33 was not significantly altered by infection. To determine if this might apply more broadly to other species or regions, we measured TFFs and cytokine levels (IFNγ, TNFα, IL-33, IL-13, IL-1β, IL-17A, IL-22, and IL-10) in both the serum and urine of Nigerian school children infected with S. haematobium. We found that serum levels of TFF2 and 3 were reduced by infection, likely in an age dependent manner. In the serum, only IL-10 and IL-13 were significantly increased, while in urine IFN-γ, TNF-α, IL-13, IL-1β, IL-22, and IL-10 were significantly increased in by infection. Taken together, these data support a role for TFF proteins in human helminth infection.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Cancer-related financial hardship (i.e., financial toxicity) has been associated with anxiety and depression, greater pain and symptom burden, treatment nonadherence, and mortality. Out-of-pocket ...healthcare costs and lost income are primary drivers of financial toxicity, however, income loss is a pronounced risk factor for cancer patients with low incomes. There has been little progress in developing an income intervention to alleviate financial toxicity cancer patients with low incomes. Unconditional cash transfers (UCT), or guaranteed income, have produced positive health effects in experiments with general low-income populations, but have not yet been evaluated in people with cancer. The Guaranteed Income and Financial Treatment (GIFT) Trial will use a two-arm randomized controlled trial to compare the efficacy of a 12-month UCT intervention providing $1000/month to treatment as usual on financial toxicity, health-related quality of life and treatment adherence in people with cancer who have low-incomes. The study will recruit 250 Medicaid beneficiaries with advanced cancer from two comprehensive cancer centers in Philadelphia, obtain informed consent, and randomize patients to one of two conditions: (1) $1,000/month UCT or (2) treatment as usual. Both arms will receive information on financial toxicity and the contact information for their hospital social worker or financial advocate upon enrollment. Participants will complete online surveys at baseline, 3, 6, 9, and 12 months from enrollment to collect patient-reported data on primary (i.e., financial toxicity, health-related quality of life, and treatment adherence) and secondary outcomes (i.e., anxiety, depression, food insecurity, housing stability). Social security records will be used to explore the effect on mortality at 2, 3, and 5 years post-enrollment. Linear mixed-models will be used to analyze all primary and secondary continuous outcomes over time and general estimating equations with a logit link and binary distribution for all binary outcomes over time. Differences between treatment and control groups and treatment effects will be determined using models that control for age, gender, race, baseline food security, baseline housing stability, and baseline ECOG. Findings from this study will have significant implications for the development and implementation of programs and policies that address the financial burden of cancer and other serious illnesses.
Exposure and response prevention (ERP) therapy, a form of cognitive-behavioral therapy, is a first-line, evidence-based treatment for obsessive-compulsive disorder (OCD) for adults and children. It ...is effective for the majority of those who engage in it, but treatment adherence can be challenging for some due to the stress involved in the treatment as well as different life circumstances that arise. To help improve treatment adherence, NOCD, a provider of video teletherapy ERP, identifies those at risk of non-adherence using a prediction algorithm trained on a data set of
N
= 13,809 and provides targeted peer support interventions by individuals (“Member Advocates”) who successfully completed ERP treatment for OCD. Member Advocates, using lived OCD experience as well as experience with ERP, engage at-risk patients through digital messaging to engage, educate, and encourage patients in the early stages of treatment. From June 2022 to August 2022,
N
= 815 patients deemed at risk were reached out to and
n
= 251 responded and engaged with the Member Advocates. In the at-risk patients who engaged, the intervention resulted in a significant mean 30.4% more therapy hours completed compared to those who did not engage. Additionally, engaged patients had greater reductions in OCD severity. These results have implications for how data science, digital interventions, and strategic peer-to-peer communication and support can be combined to enhance the effectiveness of treatment.
Significant disparities exist in clinical trial participation in non-gynecologic cancers, but little is known about disparities in ovarian cancer trial participation. Our objective was to examine ...patient, sociodemographic (race/ethnicity, insurance), cancer, and health system factors associated with clinical trial participation in ovarian cancer.
We conducted a retrospective cohort study of patients with epithelial ovarian cancer diagnosed from 2011 to 2021, using a real-world electronic health record derived database, representing around 800 sites of care in US academic and community practices. We used multivariable Poisson regression modeling to analyze the association of ever participating in an ovarian cancer clinical drug trial with patient, sociodemographic, health system, and cancer factors.
Of the 7540 patients with ovarian cancer, 5.0% (95% CI 4.5–5.5) ever participated in a clinical drug trial. Patients of Hispanic or Latino ethnicity were 71% less likely to participate in clinical trials (RR 0.29, 95% CI 0.13–0.61) than non-Hispanic patients, and patients whose race was unknown or other than Black or White were 40% less likely to participate in clinical trials (RR 0.68, 95% CI 0.52–0.89). Patients who had Medicaid insurance were 51% less likely (RR 0.49, 95% CI 0.28–0.87) and those with Medicare were 32% (RR 0.48–0.97) less likely to participate in clinical trials than privately-insured patients.
In this national cohort study, only 5% of patients with ovarian cancer participated in clinical drug trials. Interventions are needed to decrease race, ethnicity, and insurance disparities in clinical trial participation.
•In a national cohort of 7540 patients with ovarian cancer, only 5.0% ever participated in a clinical drug trial.•Hispanic or Latino patients were 71% less likely to participate in ovarian cancer clinical trials.•Patients with Medicaid were 51% less likely and patients with Medicare 32% less likely to participate in clinical trials than privately-insured patients.
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Background: Clinical trial participation may be a way to mitigate disparities in endometrial cancer. Our objective was to examine the association of clinical trial participation with patient, ...health system, and cancer factors in endometrial cancer. Methods: We conducted a retrospective cohort study of patients with endometrial cancer diagnosed from 2013-2021 using the nationwide de-identified electronic health record-derived Flatiron Health database. We used multi-level Poisson regression modeling to analyze the association of clinical trial participation (receipt of clinical trial drug) with patient, sociodemographic, health system, and cancer factors. Results: Of 4,662 patients with endometrial cancer, 3.9% (95% CI 3.3-4.5) were ever enrolled in a clinical drug trial. While Black patients accounted for 12% of endometrial cancers and 59% of high-risk histologies (MMT, serous, clear cell), only 3% were enrolled in clinical trials. Black patients were 57% less likely to enroll in a clinical trial (95%CI 0.26-0.72), and this disparity persisted in academic and community settings. Having a more aggressive cancer histology and living in the Southeast were associated with higher rates of clinical trial enrollment. Conclusions: Despite higher rates of aggressive cancer histologies, Black patients were disproportionately under-enrolled in endometrial cancer drug trials. Efforts to increase clinical trial diversity are needed.Table: see text
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Background: Telemedicine rapidly increased with the COVID-19 pandemic and may be a way to reduce care disparities. Our aim was to evaluate sociodemographic (race, insurance), patient, health ...system, and cancer factors associated with use of telemedicine in gynecologic cancers. Methods: We conducted a retrospective cohort study of patients with documented endometrial or ovarian cancer using the nationwide de-identified electronic health record-derived Flatiron Health data. We used multi-level regression models to analyze the association of telemedicine usage during COVID-19 pandemic (2020-2021) with sociodemographic, patient, health system, and cancer factors overall. Results: Of 13,450 patients with endometrial or ovarian cancer, 14.4 % (95%CI 14.0-16.1) used telemedicine during COVID-19 for their cancer care within the Flatiron Health network. Insurance was not associated with likelihood of telemedicine in any model. Region was significantly associated with telemedicine usage across models with patients living in the Northeast more likely to use telemedicine. Conclusions: In this large cohort study, we found regional disparities across cancer types and oncology settings. Expanding access to telemedicine may improve racial and geographic disparities in gynecologic cancer. Table: see text
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