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Chronic spontaneous urticaria (CSU) is characterized by recurring wheals that last 6 weeks or longer without an identifiable cause. The estimated point prevalence of CSU worldwide is 1%. Furthermore, it has a significant impact on quality of life in both adults and pediatric patients and their families. Although it is most often a self-limited disease, some patients have urticaria refractory to first-line treatment: second-generation H1 antihistamines. In these patients, the use of targeted monoclonal antibodies is necessary. While omalizumab is the only Food and Drug Administration-approved monoclonal antibody for CSU, others, including ligelizumab, dupilumab, benralizumab, and several orally administered Bruton's tyrosine kinase inhibitors, are also promising therapeutics for reducing the morbidity of CSU. Novel therapies, among others discussed here, are rapidly being developed with new trials and therapeutics being released nearly monthly. Thus, we performed a scoping literature review of randomized controlled trials studying targeted therapies for CSU. We also discuss the pathophysiology, diagnosis, prognosis, and future research directions in CSU.

Context Intimate partner violence (IPV) occurs when an intimate partner inflicts physical, sexual, and/or emotional assault with coercive control and is a traumatic experience with repercussions that can be exacerbated when a woman is pregnant. While screening for IPV during pregnancy is recommended to occur regardless of risk, less than 50% of pregnant women are screened. Objectives Identifying clinical factors commonly associated with IPV during pregnancy may improve screening rates, thus our primary objective was to examine associations between IPV and maternal comorbidities. Methods We conducted a cross-sectional analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 spanning 2016 through 2019. Bivariate and multivariable logistic regression was utilized to calculate adjusted odds ratios (AORs) to determine associations between IPV and diabetes, anxiety, hypertension, depression, asthma, polycystic ovary syndrome (PCOS), and thyroid disease. Results More than 40% of women experiencing IPV reported a history of depression or anxiety. The occurrence of IPV was higher among women with depression (AOR 3.48, CI 3.14–3.85), anxiety (AOR 2.98, CI 2.64–3.37), hypertension (AOR 1.21, CI 1.02–1.44), and asthma (AOR 1.37; CI 1.17–1.59) than women without those respective conditions, but not among diagnoses of diabetes, PCOS, or thyroid disorders. Conclusions Our findings show that pregnant individuals reporting having experienced IPV were more likely to report having certain comorbidities compared to those who did not report experiencing IPV. Given the low rates of screening, knowing clinically relevant associations may increase screening sensitivity among clinicians and, in turn, increase the likelihood that individuals experiencing IPV receive supportive care.

Acute autoimmune hemolytic anemia requires rapid stabilization, typically through the administration of high-dose corticosteroids. However, it is important to consider reactivation of latent infection and how immune suppression can interfere with molecular screening tools. In this case report, we present a patient with Rheumatoid Arthritis/Systemic Lupus Erythematosus experiencing severe autoimmune hemolytic anemia complicated by an unknown latent tuberculosis infection.

Objective: Public interest in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines has been rising with regard to associated myocarditis. Thus, the objective of our study was to assess trends in public interest in myocarditis during the course of the pandemic and the SARS-CoV-2 vaccine rollout in the United States. Methods: We conducted a longitudinal assessment of public interest in myocarditis, and its association with actual coronavirus disease 2019 (COVID-19) -related myocarditis during the first wave of the pandemic and SARS-CoV-2 vaccine-related myocarditis following vaccine rollout. To complete this objective, we used data from 3 sources: a report from the Morbidity and Mortality Weekly Report, the Vaccine Adverse Event Reporting database, and from Google Trends. Results: Results show that Relative Search Interest (RSI) was low before and during the initial phase of the pandemic and peaked in April 2021, during the initial vaccine push. The ratio of myocarditis related to the SARS-CoV-2 vaccines was considerably lower than the ratio of myocarditis from natural infection. Conclusions: Search interest in myocarditis was low until SARS-CoV-2 vaccines were rolled out, in which media coverage intensely focused on a relatively small number of cases. This study highlights both the benefits of COVID-19 vaccine uptake and the impact of the media on public interest

Background:Asthma is the most common non-communicable chronic airway disease worldwide. Obesity and cigarette use independently increase asthma morbidity and mortality. Current literature suggests that obesity and smoking synergistically increase asthma-related wheezing.Objective:To assess whether increased serum cotinine and obesity act synergistically to increase the likelihood of having an asthma exacerbation, emergency department (ED) visit, or hospitalization.Methods:A cross-sectional analysis of the 2011–2015 iterations of NHANES database was performed. Patients aged 18 years or greater with asthma were included. Serum cotinine was utilized as an accurate measurement of cigarette use. Logistic regression models were constructed to determine whether elevated serum cotinine and obesity were associated with self-reported asthma exacerbations, asthma-specific ED usage, and hospitalizations for any reason in the past year. Odds ratios were adjusted for age, gender, race, and ethnicity. Interactions were assessed by multiplying the adjusted effect sizes for elevated cotinine and obesity.Results:We identified 2179 (N= 32,839,290) patients with asthma, of which 32.2% were active smokers and 42.7% were obese. Patients with an elevated cotinine and asthma were significantly more likely to have had an asthma-related ED visit in the past year (adjusted odds ratio [AOR] 1.82; 95% CI 1.19–2.79), have a physician-prescribed asthma medication (AOR 2.04; 95% CI 1.11–3.74), and have a hospitalization for any reason (AOR 3.65; 95% CI 1.88–7.07) compared to those with low cotinine. Patients with asthma and obesity were more likely to have an asthma-related ED visit (AOR 1.67; 95% CI 1.06–2.62) or hospitalization for any reason in the past year compared to non-obese patients (AOR 2.76; 95% CI 1.69–4.5). However, a statistically significant interaction between obesity and cotinine was only identified in patients who currently have asthma compared to a previous asthma diagnosis (AOR 1.76; 95% CI 1.10–2.82). There were no synergistic interactions among ED usage or asthma exacerbations.Conclusion:Nearly one-third of patients with asthma were current smokers, and almost half were obese. This study identified elevated serum cotinine, a metabolite of cigarette use, and obesity as key risk factors for asthma exacerbations, asthma-related ED visits, and hospitalizations for any reason. Elevated serum cotinine and obesity were not found to act synergistically in increasing asthma exacerbations or ED visits. However, the presence of both risk factors increased the risk of currently having asthma (compared to a previous diagnosis) by 76%. Serum cotinine may be useful in predicting asthma outcomes.

Aim: News articles and their use of sensational language have the potential to influence health behaviors and decisions, thus the purpose of this study was to evaluate the use of sensational language (i.e., superlatives) describing stem cell therapies in public news articles. Materials & methods: In this study, we conducted a Google News search for news articles using superlatives to exaggerate the efficacy of stem cell therapies. Results: Our analysis included 262 news articles from 193 news outlets using 714 unique superlatives to describe stem cells. Health on the Net’s Code of Conduct certification was applied to determine credibility of each site. Conclusion: These results demonstrate the need for improving news reporting surrounding stem cell research and therapies.

Context “Spin” is a form of bias that involves highlighting study results in a way that presents the conclusions about benefit or efficacy beyond the scope of the data. Spin in the abstract of published studies has the potential to affect patient care, making investigations about its presence and prevalence important for readers. Objectives To evaluate the most severe types of spin in the abstracts of systematic reviews and metaanalyses focused on percutaneous coronary intervention. Methods Using a cross sectional study design, the authors searched MEDLINE and Embase with the terms “percutaneous coronary intervention,” “percutaneous coronary revascularization,” “PCI,” “systematic review,” “meta analysis,” and “meta-analysis.” To be considered for this study, the article must have (1) focused on PCI; (2) had either a systematic review or metaanalysis study design; (3) been conducted on human subjects; and (4) been available in English. Reviews were excluded if these criteria were not met. Each included article was assessed for the nine most severe types of spin as defined in a previously published article, as well as other study characteristics (type of intervention being compared, date the review was received, adherence of systematic review and/or meta-analysis to Preferred Reporting for Systematic Reviews or Metanalyses (PRISMA) guidelines, requirement of PRISMA guidelines by the publishing journal, the publishing journal’s five-year impact factor, and sources of funding). Results Our database search retrieved 7,038 records; 2,190 duplicates were removed. Initial title and abstract screening led to the exclusion of 4,367 records, and an additional 281 records were excluded during full text screening. An arbitrary limit of 200 articles was applied for this analysis; five additional articles were excluded for ineligible study design, so 195 were included in our final analysis. Spin was present in the abstracts of 43 studies from that pool (22.1%). Spin type 3—selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention—occurred most frequently (29; 14.8%). The presence of spin was not associated with any of the extracted study characteristics. Conclusions Our data showed that spin occurred in more than one in every five systematic reviews or metaanalyses of PCI. Spin has the potential to distort a reader’s ability to translate the true findings of a study; therefore, efforts are needed to prevent spin from appearing in article summaries.

Purpose Publication bias has a significant impact on the results of systematic reviews. Clinical trial registry searches, which include unpublished research, should be conducted when performing systematic reviews to reduce publication bias. We aimed to analyze the use of clinical trial registry searches in critical care systematic reviews. Methods Systematic reviews published between 01/01/2010–02/18/2020 from the top 5 critical care journals were extracted from PubMed and screened for trial registry use. Additionally, of the studies not performing registry searches, we assessed ClinicalTrials.gov for potentially relevant trials that were missed by not performing a registry search. Results Three hundred and twenty six systematic reviews were analyzed, of which 37 (11.3%) performed trial registry searches. Of the studies not performing clinical trial registry searches, 56% had at least 1 potentially relevant trial that was missed. Conclusions The omission of relevant, unpublished clinical trial results may be negatively impacting the accuracy of critical care systematic reviews. We recommend all systematic reviewers conduct clinical trial registry searches to reduce publication bias.

Context Influenza-related hospitalization and mortality disproportionately affects the Hispanic population in the United States. Among other medical conditions in addition to influenza, Spanish-preferring Hispanics may be more affected than those who speak English. Objectives The purpose of this study was to compare seasonal influenza vaccine uptake rates between Spanish-and English-preferring Hispanic US adults from 2017 to 2020. Methods For this cross-sectional study, we extracted data from the Behavioral Risk Factor Surveillance System (BRFSS) from the 2017 through 2020 cycles. We calculated the population prevalence of individuals getting influenza vaccines per year, and among subpopulations based on language spoken, age, and sex. We then utilized chi-squared tests of independence to discover possible associations between these subpopulations per year. An alpha level of 0.05 was utilized in this study. Respondents were included if they identified as Hispanic, responded to questions regarding influenza vaccine uptake, and were grouped by the language of the survey returned, age, and sex. Results Our results show that self-identified Hispanic individuals who were English-preferring had greater seasonal influenza vaccine uptake rates in the latter 2 years of our study for both sexes in the younger age group. Hispanic individuals over the age of 65 years (n=11,328) were much more likely to have received an influenza vaccine compared to younger individuals (n=34,109). In 2018, Spanish-preferring women over age 65 years (n=677) were more likely to have received a vaccine over English-preferring women (n=772). Conclusions Our findings showed that disparities exist between English- and Spanish-preferring Hispanic individuals and age groups. Language barriers may play a role in receiving influenza vaccines. The incorporation of medical translators may assist in reducing these disparities in influenza-related healthcare expenses, overall morbidity, and mortality.

In this report, we discuss how autoimmune conditions and associated immunocompromise may impact diagnostic utility of molecular screening tools for mycobacterial infection. Imaging, molecular screening, and clinical judgment are required to rule out disease in the immunocompromised, especially in an acute setting

Context As a result of new developments in medicine, the need for evidence-based clinical practice guidelines (CPG) is of utmost importance. However, studies have shown that many medical societies are using low quality research to develop CPGs. Objectives To evaluate the quality of research underlying the CPGs issued by the Infectious Diseases Society of America (IDSA). Methods We examined 29 CPGs issued between January 1, 2012 and December 31, 2019 and classified each by research quality according to levels reported by the CPG authors and previously specified by the IDSA: Levels I through III, corresponding to high, moderate, and low quality of evidence, respectively. Each ranking was cross-checked with a second researcher to improve inter-rater reliability. To analyze evolution of research quality over time, three updated CPGs were randomly selected and compared to their original versions. Chi-square analysis was then performed to determine statistical significance. Results We evaluated the quality of research for 2,920 recommendations within the 29 CPGs that met our criteria and found that 418 (14%) were developed using high-quality (Level I) research from randomized, controlled trials. Of the remaining recommendations, 928 (32%) were based on moderate quality research (observational studies) and 1574 (54%) on low quality research (expert opinion). A Pearson chi-squared analysis indicated no-statistically significant difference between original guidelines or their subsequent updates for Clostridium difficile (χ2=0.323; n=85; degrees of freedom [df]=2; p=0.851), candidiasis (χ2=4.133; n=195; df=2; p=0.127), or coccidiomycosis (χ2=0.531; n=95; df=1; p=0.466). Conclusions The proportion of high-quality research underlying guideline recommendations is remarkably low, indicating that moderate and low quality evidence is still influencing infectious disease guidelines despite IDSA standards. Moreover, the quality of research has not significantly changed over time. IDSA CPGs are a formidable source of information for clinicians, but an increased number of quality studies should be utilized to further guide CPG development.

Introduction The prevalence of chronic obstructive pulmonary disease (COPD) in U.S. military veterans is higher than that of non-veterans. Smoking and physical activity behaviors of veterans with COPD have not been studied. Therefore, our objective was to determine whether smoking and physical activity behaviors of veterans with COPD differ from non-veterans with COPD. Our secondary objective was to describe lifestyle behaviors of veterans after being diagnosed with COPD. Materials and Methods A cross-sectional analysis of lifestyle behaviors in veterans and non-veterans with COPD from the 2017 BRFSS was conducted. Logistic regression models were constructed to obtain adjusted risk ratios (ARRs). All confidence intervals (CIs) were reported at 95%. Results The prevalence of COPD among veterans was 14.2% (13.45–14.99) and 11.1% (10.82–11.41) among the non-veteran population (X2: F(1, 250,985) = 62.71, P Conclusions Veterans were significantly more likely to have COPD compared with non-veterans. Additionally, female veterans were significantly more likely to be current smokers following a diagnosis of COPD, which was not significant in male veterans, and both sexes were less likely to have a quit attempt compared with non-veterans. Finally, both male and female veterans were less likely to meet aerobic physical activity recommendations compared with non-veterans. Our findings suggest that further efforts should be made to increase the frequency of quit attempts and improve smoking rates and physical activity in veterans with COPD.

With the continued increase in skin cancer incidence rates, the population of skin cancer survivors continues to grow. Understanding skin cancer survivors’ lifestyle behaviors, including ultraviolet radiation exposure, is important in reducing skin cancer recurrences and improving health outcomes. The objective of this study is to compare the differences in lifestyle behaviors among skin cancer survivors or individuals who currently have skin cancer versus individuals who have never had a skin cancer diagnosis. To investigate these lifestyle behaviors, we performed a cross-sectional analysis comparing lifestyle behaviors in persons diagnosed with skin cancer and those without a history of skin cancer among US citizens using publicly available data from the 2018 Behavior Risk Factor Surveillance System (BRFSS). In total, there were 437,436 respondents. No significant difference existed between the two cohorts in sunburn frequency, use of sun protection, or indoor tanning; in fact, males were more likely to be afflicted with sunburns following diagnosis. Skin cancer survivors were less likely to be current smokers and sedentary. Female survivors were more likely to binge and heavily drink alcohol. Our findings highlight important areas for reducing risk factors, which could reduce the recurrence of skin malignancies in skin cancer survivors. Our study provides insight to lifestyle behaviors among skin cancer survivors. Being aware of these behaviors has the potential to reduce skin cancer recurrence.

Background: Physical activity is widely known to positively affect serum lipids. Yet, no study has utilized a path analysis methodology, which is more efficacious at analyzing complex relationships...

Introduction:One method of monitoring public preparedness is through measuring public interest in preventive measures. The objective of this study was to analyze public interest in the coronavirus disease 2019 (COVID-19) preventive measures and to identify variables associated with timely stay-at-home (SAH) orders issued by governors.Methods:State-level search volume was collected from Google Trends. Average preventive measure interest was calculated for the query terms “hand sanitizer,” “hand washing,” “social distancing,” and “COVID testing.” We then calculated the delay in statewide SAH orders from March 1, 2020, to the date of issuance and by-state presidential voting percentage. Bivariate correlations were computed to assess the relationship between interest in preventive measures and SAH order delay.Results:The correlation between average preventive measure interest and length of time before the SAH order was placed was −0.47. Average preventive measure interest was also inversely related to voting for a Republican presidential nominee in the 2016 election (R = −0.75), the latter of which was positively associated with longer delays in SAH orders (R = 0.48).Conclusions:States with greater public interest in COVID-19 preventive measures were inversely related to governor issuance of timely SAH orders. Increasing public interest in preventive measures may slow the spread of the virus that causes COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), by improving preparedness.

Pregnant women with COVID-19 are at increased risk for adverse maternal and pregnancy outcomes, and birth complications. Given the health outcome disparities among pregnant women of racial and ethnic minorities and the reliance of medical practice on systematic reviews and meta-analyses (SRMAs)-as they are the apical component in the hierarchy of evidence in medical research-the primary objective of the study is to examine the inclusion of the equity reporting in SRMAs focused on pregnancy outcomes and COVID-19 using PROGRESS-Plus equity framework. PROGRESS represents equity measures of Place, Race, Occupation, Gender, Religion, Education, Social capital, and Socio-economic status.We conducted a systematic search of three databases to identify SRMAs related to maternal and pregnancy outcomes related to COVID-19. We extracted whether SRMAs reported or analyzed PROGRESS-Plus components among other study characteristics.Nearly 85% of SRMAs did not include any equity items to account for racial or geographic disparities. Reporting of race was absent from 95% of the studies. Place was the most common PROGRESS item and maternal age was the most common PROGRESS-When research is performed and reported in a way that fails to address disparities, the downstream repercussions may include medical care in the form of new protocol-driven hospital management, pharmacologic interventions, and other treatment options that mirror this absence in reporting. The absence of adequate reporting widens gaps in health outcomes among at-risk groups, such as pregnant women of racial and ethnic minorities.

Introduction Approximately 3% of invasive U.S. cancer diagnoses are made among veterans in a Veterans Affairs (VA) clinic each year, while VA patients only comprise about 1.9% of the U.S. population. Although some research has shown that veterans have higher incidence rates of cancer compared to civilians, evidence is sparse regarding possible disparities in rates of cancer screening between these populations. Thus, the purpose of this study is to compare differences in rates of screening for colorectal, lung, breast, and cervical cancers between current and former U.S. Military service members and civilians. Methods Using the data extracted from the Behavioral Risk Factor Surveillance System, we assessed the rates of cancer screening among current and former U.S. Military service members compared to civilians from self-reported surveys assessing when individuals had been screened for colorectal or lung cancer among all participants and breast and cervical cancer among women participants. Persons greater than 25 years of age were included in the cervical cancer screening, 50 years of age for colon cancer screening, and 40 years of age for the breast cancer screening—the latter based on recommendations from the American Cancer Society. We used multivariate logistic regression models to determine the adjusted risk ratios (ARRs) of current and former U.S. Military service members receiving screening compared to civilians, adjusting for age, gender, race, education, and health care coverage. Results Current and former U.S. Military service members accounted for 2.6% of individuals included for the cervical cancer screening analysis, 2.2% for the breast cancer screening analyses, nearly 10% of the lung cancer screening, and 15% of the colorectal cancer (CRC) screening analyses. Prevalence of screening was higher for current and former U.S. Military service members among lung cancer and CRC. When controlling for age, race, education, and health care coverage, current and former U.S. Military service members were statistically more likely to be screened for CRC (ARR: 1.05; 95% confidence interval: 1.04–1.07) and lung cancer (ARR: 1.32; 95% confidence interval: 1.15–1.52). The odds of having completed a cervical or breast cancer screening were not significantly different between groups. Conclusion Our study showed that current and former U.S. Military service members were more likely to complete CRC and lung cancer screenings, while no significant difference existed between each population with regard to cervical and breast cancer screenings. This is one of the few studies that have directly compared cancer screening usage among civilians and current and former U.S. Military service members. Although current and former U.S. Military service members were more likely to receive several cancer screenings, improvements can still be made to remove barriers and increase screening usage due to the disproportionate rates of cancer mortality in this population. These solutions should be comprehensive—addressing personal, organizational, and societal barriers—to improve prognosis and survival rates among current and former U.S. Military service members.

Helper type 1 T cell polarization and monocyte cell activation influence forced expiratory volume in 1 second/forced vital capacity and are affected by body mass index (BMI), insulin resistance, and serum lipoproteins. No study has assessed the impact of metabolic syndrome components on asthma symptom control.To determine the prevalence of patients with metabolically unhealthy obesity (MUO) and asthma. Our secondary objective was to compare the strength of associations among asthma outcomes in patients with obesity measured by BMI, waist circumference, and MUO.A cross-sectional analysis of the combined 2011 to 2016 cycles of the National Health and Nutrition Examination Survey was performed among persons with asthma. Metabolically unhealthy obesity was defined as a BMI of at least 30 kg/msup2/supand one of the following: increased waist circumference, insulin resistance, low physical activity, hyperlipidemia, or hypertension. Multiple logistic regression models were computed to assess asthma exacerbations and emergency department use for asthma in patients with MUO compared with unhealthy obesity.Among respondents with MUO, 50.09% (n = 543; N = 17,011,880) had asthma compared with 7.91% in those with metabolically healthy obesity (n = 77; N = 2,685,858). Persons with MUO were significantly more likely to report the use of an emergency department for their asthma symptoms within the past 12 months (odds ratio, 3.53; 95% confidence interval, 1.54-8.09; Plt; .05). Persons with elevated waist circumference were more likely to report asthma exacerbations (odds ratio, 1.58; 95% confidence interval, 1.09-2.26). No significant difference existed in reported asthma exacerbations or emergency department use in patients measured by BMI.MUO is associated with increased emergency department use for asthma and is better at predicting exacerbations and emergency department use than BMI alone.

Purpose: To evaluate 2 published normal tissue complication probability models for radiation-induced hypothyroidism (RHT) on a large cohort of oropharyngeal carcinoma (OPC) patients who were treated with intensity-modulated radiation therapy (IMRT). Methods and Materials: OPC patients treated with retrievable IMRT Digital Imaging and Communications in Medicine (DICOMs) data and available baseline and follow-up thyroid function tests were included. Mean dose (Dmean) to the thyroid gland (TG) and its volume were calculated. The study outcome was clinical HT at least 6 months after radiation therapy, which was defined as grade ≥2 HT per Common Terminology Criteria for Adverse Events grading system (symptomatic hypothyroidism that required thyroid replacement therapy). Regression analyses and Wilcoxon rank-sum test were used. Receiver operating characteristic curves and area under the curve for the fitted model were calculated. Results: In the study, 360 OPC patients were included. The median age was 58 years. Most tumors (51%) originated from the base of tongue. IMRT-split field was used in 95%, and median radiation therapy dose was 69.96 Gy. In the study, 233 patients (65%) developed clinical RHT that required thyroid replacement therapy. On multivariate analysis higher Dmean and smaller TG volume maintained the statistically significant association with the risk of clinical RHT (P

Context Cardiovascular disease (CVD) is the leading cause of death in the United States, and cardiovascular events have been shown to be reduced and prevented when patients follow the Mediterranean diet. Objective To understand how familiarity with the Mediterranean diet affects dietary habits in cardiology patients by using social cognitive theory. Method This cross-sectional study included patients at a metropolitan outpatient cardiology clinic in Oklahoma. A survey was used to analyze patient knowledge of the Mediterranean diet. Patients were separated into low–, medium–, and high–diet adherence groups based on their daily consumption of fruits, vegetables, fish, whole grains, and nuts. Multinomial logistic regression was used to analyze patients’ knowledge of Mediterranean diet principles with dietary adherence. Results A total of 337 patients were included in the study. Patients with a college education, patients reporting familiarity with the diet, and women were 6.7, 4.0, and 3.2 times as likely, respectively, to have strong adherence to the Mediterranean diet. Conclusion The finding that familiarity with the Mediterranean diet was closely associated with adherence to its principles indicates that patient education on heart-healthy diets may improve the eating habits of patients, especially patients at risk for cardiac events.

ObjectivesSpin is a reporting practice in which study results are misrepresented by overestimating efficacy or underestimating harm. Prevalence of spin varies between clinical specialties, and estimates are based almost entirely on clinical trials. Little is known about spin in systematic reviews.DesignWe performed a cross-sectional analysis searching MEDLINE and Embase for systematic reviews and meta-analyses pertaining to antiplatelet therapies following acute coronary syndrome on 2 June 2020. Data were extracted evaluating the presence of spin and study characteristics, including methodological quality as rated by A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). All data extraction was conducted in a masked, duplicate manner from 2 June 2020 to 26 June 2020.Participants and settingNot applicable.Primary and secondary outcome measuresWe assessed abstracts of systematic reviews on antiplatelet therapy following acute coronary syndrome and evaluated the prevalence of the nine most severe types of spin. We additionally explored associations between spin and certain study characteristics, including quality.ResultsOur searches returned 15 263 articles, and 185 systematic reviews met inclusion criteria. Of these 185 reviews, 31.9% (59/185) contained some form of spin in the abstract. Seven forms of spin (1, 2, 3, 4, 5, 7 and 9) among the nine most severe were identified. No instances of types 6 or 8 were found. There were no statistically significant relationships between spin and the evaluated study characteristics or AMSTAR-2 appraisals.ConclusionsSpin was present in abstracts for systematic reviews and meta-analyses; subsequent studies are needed to identify correlations between spin and specific study characteristics. There were no statistically significant associations between spin and study characteristics or AMSTAR-2 ratings; however, implementing changes will ensure that spin is reduced in the field of cardiology as well as other fields of medicine.

Context Each year, approximately 53,200 people die in the U.S. from colorectal cancer (CRC), indicating a need to increase screening efforts. Some studies have suggested mammography use is higher in patients with comorbid conditions, a reflection of increased follow up. Another study found that patients with obesity were less likely to be screened for CRC than nonobese patients. However, no study has assessed the impact of multiple comorbidities on CRC screening. Objectives To analyze CRC screening rates in patients with comorbidities compared with healthy patients, and to assess whether the number of comorbid diagnoses impacted screening rates. Methods A cross sectional analysis of patients who received CRC screening was performed using the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS). Respondents were classified as having had CRC screening if they answered “yes” to either of the following: “Have you ever had a blood stool test?” or “Have you ever had a sigmoidoscopy/colonoscopy?” Respondents younger than age 50 were excluded. A weighted multivariate logistic regression model was constructed to determine adjusted risk ratios (ARR). Confidence intervals (CI) were reported at 95%. Results We identified 279,784 respondents who met inclusion criteria. Of those, 79.7% (sample n=222,879; population N=46,304,360) of respondents had received CRC screening. Patients with diabetes, hypertension, skin cancer, chronic obstructive pulmonary disease (COPD), arthritis, depression, and chronic kidney disease were significantly more likely to be screened than those without comorbidities. There was no statistically significant difference in screening rates between patients with and without cardiovascular disease. Compared with patients with zero comorbidities, those with one were significantly more likely to receive screening (ARR, 1.11; CI, 1.09–1.12) as were those with two to four (ARR, 1.2; CI, 1.18–1.22). Patients with five or more comorbidities were significantly less likely to be screened than those with two to four (ARR, 1.12; CI, 1.1–1.14). Conclusions Patients with one or more comorbidities were more likely to be screened than those without comorbidities, but those with five or more conditions were less likely to be screened than patients with two to four conditions. This indicates that physicians may be more fatigued and less likely to recommend CRC screening to patients with many comorbidities compared with patients diagnosed with only a few conditions. The results of this study add to the literature by identifying an interaction between the number of comorbidities and likelihood of being screened for CRC.

Context The combination of osteoarthritis and rheumatoid arthritis affects nearly one-fourth of Americans. Many of the risk factors for arthritis are lifestyle related, such as obesity, physical activity, dietary behaviors, and alcohol and tobacco use. Objective To analyze lifestyle behaviors of patients with vs. those without arthritis. Methods A cross-sectional analysis of 2017 Behavioral Risk Factor Surveillance System (BRFSS) data was conducted on patients with and without a history of arthritis. Physical activity, smoking status, alcohol use, and dietary behaviors were extracted. Logistic regression models were constructed to calculate adjusted risk ratios (ARRs). All confidence intervals (CIs) were reported at 95%. Results The median response rate for the 2017 BRFSS survey was 45.1% (sample n=292,808; population N=118,751,156). The overall prevalence of arthritis was 44% (n=128,850). Respondents with arthritis were significantly more likely to be physically inactive than nonarthritic respondents, with a significant gender interaction (male absolute risk reduction [ARR], 1.2 [CI, 1.15–1.25]; female ARR, 1.29 [CI, 1.24–1.33]). Those with arthritis were also more likely to be current smokers (ARR 1.1; CI, 1.05–1.15) and less likely to have attempted to quit smoking in the last 12 months (ARR, 0.91; CI, 0.87–0.96). Finally, men with arthritis were more likely to drink alcohol heavily (ARR, 1.14; CI, 1.02–1.27]). Conclusion Patients with arthritis were more likely to be women, White, current smokers, and physically inactive, and to have poor mental health, lower education levels, and difficulty paying for healthcare and medications than those without arthritis. Further efforts should be made to address these findings through resource allocation in the care of patients with arthritis. Practitioners should also seek increased understanding of the psychological, social, and economic impacts of physical activity and smoking in patients with arthritis.

Background Public interest in breast cancer is associated with breast cancer awareness month. However, no study has analyzed the temporal trends in breast cancer interest or assessed how funding for breast cancer research is influenced by public interest. Methods We performed a cross-sectional analysis of Google Trends using the search query “Breast Cancer” between January 2004 - July 2020. We then computed bivariate correlations to assess the association between relative search interest (RSI) and the financial records of the Susan G. Komen Foundation. Results Average search interest has declined since 2004. We identified increasing breast cancer RSI beginning in October 2009, corresponding with breast cancer awareness month, with an overall peak in 2012 followed by a downtrend through 2017. These fluctuations in peak RSI corresponded with the U.S. National Football League’s initiation of “Pink October” during which the players wore pink jerseys which started in 2009 and ceased in 2017. We also found a strong correlation between peak RSI and Susan G. Komen Foundation net assets as well as funding of public health screening services and public health education. Conclusions Average interest in breast cancer has been declining since 2004 and peak interest, as well as breast cancer funding, has been declining since 2012. This suggests new marketing efforts are needed to improve breast cancer awareness and to increase fundraising. Policy Summary Considering the decline in breast cancer interest and funding, we recommend implementing local, regional, and national policies that improve marketing campaigns and improve breast cancer awareness.

The Stratospheric Observatory for Infrared Astronomy (SOFIA) employs an airborne telescope with a 2.7m primary mirror. The telescope structure is composed of carbon fibre with major parts of steel for the suspension and balancing components. It is exposed to harsh environmental conditions and subject to vibration excitation due to aircraft motions and turbulence from the airflow coming into the telescope cavity. To meet pointing requirements and improve image stability there are ongoing efforts on various components of the telescope system, one of which is the implementation of an Active Mass Damping (AMD) control system: Based on accelerometer signals, reaction mass actuators impose forces onto the support structure to dampen the vibration of optical components. The system has been designed, implemented and preliminary tested in the early years of SOFIA’s scientific operation, but concerns about the structural integrity of the primary mirror and new requirements regarding software qualification have prevented the activation and further development for several years. These concerns being addressed, we are now in the process of reactivating the AMD system on the support structure of the primary mirror. Recent ground tests and in-flight jitter measurements indicate that the damping system is very efficient at eliminating the excitation of targeted structural modes of the telescope structure at 40 to 80 Hz and the first bending modes of the primary mirror at 175 Hz, resulting in a significantly improved image quality. This paper presents the analysis of those measurements and discusses options for future development.

Introduction The Coronavirus Disease 2019 (COVID-19) pandemic has impacted breast, colon, prostate, and lung cancer screenings in the U.S. by decreasing screening numbers.​We believe multiple types of cancer screenings may have been impacted during the pandemic as a result of cancellations of elective procedures and patient fear of seeking cancer screenings during a pandemic and that Google Trends may be a marker to estimate screening usage. Methods Google Trends (trends.google.com) was utilized to assess public interest in multiple cancer types. We then constructed a forecasting model to determine the expected search interest had the pandemic not occurred. We then compared our models to actual screening usage during the pandemic. Results Public interest in cancer screenings decreased precipitously at the onset of the COVID-19 pandemic. We found that the Google Trends estimated the decrease in mammogram usage 25.8% below the actual value. Similarly, Google Trends estimated the decrease in colon cancer screening usage 9.7% below the true value. Discussion We found the decrease in public interest in breast and colon cancer screenings slightly underestimated the actual screening usage numbers, suggesting Google Trends may be utilized as an indicator for human behavior regarding cancer screening, particularly with colon and breast cancer screenings. If the negative trend in cancer screening continues and missed screenings are not appropriately corrected for, socioeconomic and racial disparities in cancer diagnoses, morbidity, and mortality will widen.

Objective:Following stay-at-home (SAH) orders issued for coronavirus disease (COVID-19), state-level economic concerns increased and many let these orders expire. As a method to measure public preparedness, we sought to explore the association between public interest in preventive measures and the easing of SAH orders – specifically the increases in COVID-19 cases and fatalities after the orders expired.Methods:Search volume was collected from Google Trends for “hand sanitizer,” “social distancing,” “COVID testing,” and “contact tracing” for each state. Bivariate correlations were computed to analyze associations between public interest in preventive measures, changes in confirmed COVID-19 cases after SAH expirations, COVID-19 case-fatality rates, and by-state presidential voting percentages.Results:A higher interest in preventive measures was associated with lower rates of confirmed cases after SAH orders had expired (r = −0.33), higher state-wide deaths per capita (r = 0.42), and case-fatality rates (r = 0.60). Moderate to strong negative correlations were found between states’ percentage of voters supporting the Republican nominee in 2016 and proportion of queries for average preventive measures (r = −0.77).Conclusion:Our investigation shows that increased public interest in COVID-19 prevention was associated with longer SAH orders and less COVID-19 cases after the SAH orders’ expiration; however, it was also associated with higher case-fatality rates.

Diabetes is a leading cause of morbidity and mortality in the US. Current USPSTF guidelines recommend screening asymptomatic, overweight patients greater than 40 years. Our study showed that ¼ of patients with type 2 diabetes were diagnosed prior to 40 years. Therefore, we recommend lowering the screening age for diabetes.

Objective We analyzed the constructs of social cognitive theory that explain adherence to the Mediterranean diet in patients diagnosed with cardiovascular disease. Methods A cross-sectional study of 337 cardiac patients using a validated questionnaire was conducted and analyzed at an outpatient cardiology clinic, employing social cognitive theory (SCT) as the theoretical framework. Results Dietary adherence was associated with statistically significant improvements in the SCT constructs. Self-regulation to consume healthy diet groups, negative perceived outcomes, and self-efficacy had the most influence on patient ability to maintain the Mediterranean diet. Self-regulation to avoid unhealthy food options like processed, sugary foods and positive perceived outcomes had smaller associations with patient ability to maintain the Mediterranean diet. Conclusions SCT constructs should be utilized by physicians when educating patients on heart healthy dieting as they are highly associated with improved dietary behaviors. Self-efficacy, self-regulation in choosing healthy diet options, and negatively perceived expected outcomes predicted diet quality in cardiac patients. Improvements in these constructs might yield positive results in cardiac patients attempting diet modifications.

We present a 41-year-old woman with hypothyroidism who presented to the emergency department with acute onset of angioedema and profound hypothyroidism. She required complex airway management and medical treatment before being discharged home 10 days later. This may be the first case of hypothyroidism-induced angioedema that was not associated with chronic urticaria or hives.

Highlights • The majority of OPC patients are affected from late taste impairment after RT. • Taste markedly improved in the first years from end of RT, but plateaued after year 5. • Treatment site, CTV1 dose and age might have an influence on taste impairment., Background and purpose Taste impairment is a common radiation-induced toxicity in head and neck cancer (HNC) patients acutely. However, data on the potential for recovery and the time dependent course of late taste impairment are limited. Materials and methods As part of an IRB-approved observational prospective study, HNC patients underwent serial surveys including the MD Anderson Symptom Inventory - Head and Neck module (MDASI-HN). For our analysis, we extracted MDASI-HN taste item results from oropharyngeal cancer patients treated with intensity-modulated radiotherapy or volumetric modulated arc therapy and at least two taste assessments after ≥1 year from end of radiotherapy (RT). Results 1214 MDASI taste items from 326 patients between 1 and 13 years post-RT were included. Median prescribed dose to the high-dose clinical target volume (CTV1) was 66.0 Gy, with 180 patients (55%) receiving chemotherapy. Taste markedly improved in the first years from end of RT, but plateaued after year 5. In patients with taste assessment in subsequent years, a significant reduction in taste impairment was found from the second to the third year (p = 0.001) and tended towards significance from the third to the fourth year (p = 0.058). Multivariate analysis revealed treatment site as significant factor in the sixth year from RT and CTV1 dose and age in the seventh year. Conclusion Radiation-induced taste impairment may improve over an extended time interval, but becomes relatively stable from year 5 post-RT. Direct characterization of RT-induced taste impairment and the calculation of normal tissue complication probability should include consideration of the time-dependent course in taste recovery.

PLOS ONE 15(7), e0231918 (2020). doi:10.1371/journal.pone.0231918, Published by PLOS, San Francisco, California, US

BackgroundPersons with rare disorders, such as tetralogy of Fallot, often feel socially isolated due to poor public awareness of the disorder. On 1 May 2017, Jimmy Kimmel aired a segment on Jimmy Kimmel Live! highlighting the impact of tetralogy of Fallot on his son and how the public can learn more about the disorder.MethodsWe tracked public interest in tetralogy of Fallot using Google Trends and Twitter after the episode and constructed an autoregressive integrated moving average algorithm to calculate search volumes had Kimmel not aired the episode.ResultsGoogle searches and the number of Tweets for tetralogy of Fallot increased by 3063.27% and 4672.62%, respectively, above expected.ConclusionsOur findings indicate that television talk shows may represent strong outlets for increasing public awareness of rare disorders.

Background The COVID-19 pandemic has contributed to risk factors for child abuse and neglect and disrupted conventional abuse surveillance. Objective The goal of this study was to assess how counts of criminal charges have been affected by COVID-19 social distancing measures and related policy changes. Participants and Setting This study used publicly available court filings pertaining to child abuse and neglect from Jan 1, 2010 to June 30, 2020. Methods Autoregressive integrated moving average (ARIMA) algorithms were constructed with case data from January 2010 to January 2020 to forecast trends in criminal charges for February to June 2020. These forecasted values were then compared to actual charges filed for this time period. Results Criminal cases filed between February and June 2020, had an overall 25.7 percent lower average than forecasted. All individual months had progressively lower cases than forecasted with the exception of March. June had the largest deviation from forecasted with 60.1 percent fewer cases than predicted. Conclusions Although risk factors for child abuse have increased due to COVID-19, these findings demonstrate a declining trend in child abuse charges. Rather than a decreasing incidence of child abuse and neglect, it is more likely that less cases are being reported. The results warrant immediate action and further investigation in order to address the dangers this pandemic poses for children in abusive situations.