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Abamectin (ABM) is a common agricultural pesticide and veterinary anthelmintic drug. It can discharge from the sites of application to aquatic systems via surface run-off or spray drift, causing harmful effects to aquatic organisms. The present study investigated the protective effect of dietary quercetin supplementation on hemato-biochemical parameters and hepato-renal oxidative stress biomarkers in Nile tilapia (Oreochromis niloticus) exposed to a sublethal dose of ABM. Fish were allocated into six equal groups. The first group was kept as a control group. The second and third groups (Q400, and Q800) were fed diets supplemented with two quercetin levels (400 and 800 mg/kg diet), respectively. The fourth group (ABM) was intoxicated with 20.73 µg/L of ABM. The fifth and sixth groups (ABM + Q400, and ABM + Q800) were fed diet supplemented with two quercetin levels (400 and 800 mg/kg diet) and simultaneously intoxicated with ABM for 60 days. The results showed that ABM significantly decreased RBCs, hemoglobin content, hematocrit, total protein, albumin levels, and acetylcholinesterase activity activities compared to the control. Meanwhile, ABM significantly increased white blood cells, glucose, total lipids, cholesterol, and alanine and aspartate aminotransferase activities. Liver and kidney levels of lipid peroxidation was significantly increased, while hepato-renal antioxidant biomarkers (reduced glutathione, super oxide dismutase, catalase, and total antioxidant capacity) were significantly decreased upon ABM exposure. On the other hand, quercetin dietary supplementation improved the hemato-biochemical alterations and alleviated oxidative stress induced by ABM exposure. Fish supplemented with quercetin at a level of 800 mg/kg diet showed better alleviating effects against ABM compared to 400 mg/kg diet. Based on these study findings, we suggest that quercetin dietary supplementation (800 mg/kg) offered direct protection against ABM-induced physiological disturbance and oxidative stress in Nile tilapia.

The current perspective is a pioneering trial to assess the efficacy of the dietary supplementation of Alchemilla vulgaris powder (AVP) in the diet of Nile tilapia (Oreochromis niloticus) on growth performance, blood picture, hepatic and renal biomarkers, immune status, and serum and tissue antioxidant capacity and to investigate the resistance against Flavobacterium columnare challenge. Fish (n = 360) were distributed into six groups (three replicates each) and received increasing AVP supplementation levels (0, 2, 4, 6, 8, and 10 g kg−1) for 60 days. Furthermore, fish were exposed to the bacterial challenge of a virulent F. columnare strain and maintained under observation for 12 days. During the observation period, clinical signs and the cumulative mortality percentage were recorded. The results demonstrated that the growth performance, feed conversion ratio, and hematological profile were noticeably enhanced in the AVP-supplemented groups compared to the control. The most promising results of weight gain and feed conversion ratio were recorded in the groups with 6, 8, and 10 g AVP kg−1 diets in a linear regression trend. The levels of hepatorenal function indicators were maintained in a healthy range in the different dietary AVP-supplemented groups. In a dose-dependent manner, fish fed AVP dietary supplements displayed significant augmented serum levels of innate immune indicators (lysozyme, nitric oxide, and complement 3) and antioxidant biomarkers (Catalase (CAT), superoxide dismutase (SOD), total antioxidant (TAC), and reduced glutathione (GSH) with a marked decrease in myeloperoxidase (MPO) and malondialdehyde (MDA) levels). Likewise, hepatic CAT and SOD activities were significantly improved, and the opposite trend was recorded with hepatic MDA. The highest AVP-supplemented dose (10 g/kg) recorded the highest immune-antioxidant status. Based on the study findings, we highlight the efficacy of AVP as a nutraceutical dietary supplementation for aquaculture to enhance growth, physiological performance, and immune-antioxidant status and as a natural economic antibacterial agent in O. niloticus for sustaining aquaculture. It could be concluded that the dietary supplementation of 10 g AVP/kg enhanced O. niloticus growth, physiological performance, immune-antioxidant status, and resistance against F. columnare.

Based on their functional groups, the use of various seaweed forms in phytoremediation has recently gained significant eco-friendly importance. The objective of this study was to determine whether a novel, sustainable, and ecologically acceptable adsorbent could be employed to remove toxic textile dye (Ismate Violet 2R (IV2R)) from an aqueous solution. The low-cost adsorbent was prepared from the nanoparticles form of the native red seaweed species, Pterocladia capillacea. Before and after the adsorption procedure, comprehensive characterization experiments on the bio-adsorbent were carried out, including BET, SEM, FTIR, UV, and dynamic light scattering (DLS) examination. The adsorption performance of the prepared nano-Pterocladia capillacea was optimized by adjusting operating parameters such as the initial dye concentration of 60 mg L−1, pH of 2, and contact time of 15 min, all of which were obtained by batch experiments in the lab. At the optimum conditions, the prepared adsorbent had maximum removal effectiveness of 87.2%. Most typical kinetics and isotherm models were used to test the experimental results. The equilibrium data fit well with the Langmuir isotherm model, with comparatively higher R2 values and fewer standard errors, while the pseudo-second-order kinetic model fits better with a decent correlation coefficient. Thermodynamic parameters revealed that the sorption process on nano-alga was exothermic and spontaneous.

Background: Disparities in invasive cardiovascular care and outcomes in rural and urban hospitals across the United States have been reported. However, studies investigating disparities regarding leadless pacemaker outcomes and complications based on hospital location are lacking., Objective: To evaluate differences in outcomes and complications related to leadless pacemaker implantations among rural and urban hospitals., Methods: The National Inpatient Sample was used to identify patients who underwent leadless pacemaker implantations in the United States from 2016 to 2020. Study endpoints assessed included procedural complications and inpatient outcomes of leadless pacemaker implantations among rural and urban hospitals., Results: From 2016 to 2020, there were a total of 28 340 and 665 leadless pacemaker implantations in urban and rural hospitals, respectively. Baseline characteristics were similar among both groups, with notable exceptions of higher rates of coagulopathies (13.2% vs. 6.8%, p < 0.001) and peripheral vascular disorders (10.4% vs. 4.5%, p < 0.001) among urban patients. After multivariable adjustment for confounding variables, leadless pacemaker placements occurring in rural hospitals had lower odds of major complications (aOR 0.59, 95% CI 0.41-0.86), but increased odds of inpatient mortality (aOR 1.70, 95% CI 1.21-2.40). Overall, rural leadless pacemaker recipients experienced lower rates of discharge to home, as well as lower costs and length of stay., Conclusions: A majority of leadless pacemaker implantations occurred in urban hospitals in the United States. Important differences in outcomes were described based on urban and rural hospital location. Further investigation and policy changes are encouraged to promote improved cardiovascular care and outcomes in rural residents., (© 2025 The Author(s). Clinical Cardiology published by Wiley Periodicals LLC.)

Background: Black/African American adults are underrepresented in oncology clinical trials in the United States, despite efforts at narrowing this disparity., Objective: This study aims to explore differences in how Black/African American oncology patients perceive clinical trials to improve support for the clinical trial participation decision-making process., Methods: As part of a larger randomized controlled trial, a total of 244 adult oncology patients receiving active treatment or follow-up care completed a cross-sectional baseline survey on sociodemographic characteristics, clinical trial knowledge, health literacy, perceptions of cancer clinical trials, patient activation, patient advocacy, health care self-efficacy, decisional conflict, and clinical trial intentions. Self-reported race was dichotomized into Black/African American and non-Black/African American. As appropriate, 2-tailed t tests and chi-square tests of independence were used to examine differences between groups., Results: Black/African American participants had lower clinical trial knowledge (P=.006), lower health literacy (P<.001), and more medical mistrust (all P values <.05) than non-Black/African American participants. While intentions to participate in a clinical trial, if offered, did not vary between Black/African American and non-Black/African American participants, Black/African American participants indicated lower awareness of clinical trials, fewer benefits of clinical trials, and more uncertainty around clinical trial decision-making (all P values <.05). There were no differences for other variables., Conclusions: Despite no significant differences in intent to participate in a clinical trial if offered and high overall trust in individual health care providers among both groups, beliefs persist about barriers to and benefits of clinical trial participation among Black/African American patients. Findings highlight specific ways that education and resources about clinical trials could be tailored to better suit the informational and decision-making needs and preferences of Black/African American oncology patients., (©Ariel Hoadley, Linda Fleisher, Cassidy Kenny, Patrick JA Kelly, Xinrui Ma, Jingwei Wu, Carmen Guerra, Amy E Leader, Mohammed Alhajji, Paul D’Avanzo, Zoe Landau, Sarah Bauerle Bass. Originally published in JMIR Cancer (https://cancer.jmir.org), 30.09.2024.)

Objectives: The study aimed to assess the national attitudes toward individuals with mental health illnesses in Saudi Arabia, exploring the relationship between these attitudes and various sociodemographic factors., Methods: A cross-sectional design with computer-assisted telephone interviews was employed, covering all 13 administrative regions in Saudi Arabia. A total of 4,533 adults agreed to participate, and their attitudes toward people with mental illnesses (PWMI) were measured using an 11-item scale. The translation of the original English version of the PWMI to Arabic was validated and published previously. The scale used level of agreement on a 5-point Likert scale. The score varies from 11 to 55, where a higher score signifies higher stigma. The associations between total PWMI scores and sociodemographic variables were analyzed using linear regression., Results: The mean age of participants was 35.92 ± 12.84, with equal distribution across regions. The linear regression model showed significant associations between total PWMI scores and gender, education level, marital status, living with, or being friends with someone diagnosed with a mental illness, and working in healthcare. No significant associations were found with age, income level, and previous mental health diagnosis. The study suggests that negative stereotypes about mental illness may be more prevalent in Saudi Arabia, while Saudi participants had a more optimistic view regarding the recovery and outcomes of mental illnesses., Conclusions: The study highlights the importance of assessing mental health stigma and its associations with sociodemographic factors in Saudi Arabia. The significant associations found point to the need for targeted interventions and public health campaigns to address misconceptions and stereotypes surrounding mental health, ultimately improving the societal acceptance and well-being of individuals with mental health illnesses., Competing Interests: Conflict of interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Objectives This study aimed to assess the impact of the COVID-19 pandemic on radiology department employees and trainees. It also compared the impact of COVID-19 to the pre-COVID-19 era in the Al-Qassim region. Methods This was a quantitative observational analytical cross-sectional study conducted in the largest government hospitals under the Ministry of Health (MOH) in Al-Qassim. A pre-determined questionnaire was distributed among radiology staff that included demographic characteristics, the impact of the COVID-19 pandemic among radiology staff, the behavior of staff related to COVID-19 infection, and the assessment of mental health using the patient health questionnaire (PHQ-9). Results Eighty-four radiology staff were recruited (64.3% males vs 35.7% females). Of these, 66.7% were trainees and the rest were employees (33.3%). Of the trainees, 32.1% and 42.9% thought that elective imaging, procedures, and outpatient/clinic exposures were reduced during the pandemic, and 37.5% indicated that their training had been affected negatively. The prevalence of depression among radiology staff was 36.9%. The prevalence of depression was substantially higher among radiology trainees (p=0.038), those who were not infected with COVID-16 (p=0.041), and those who indicated that their studying time increased at the time of the pandemic (p=0.047). However, after conducting multivariate regression analysis, these variables did not seem to have significantly affected depression (p>0.05). Conclusion Training and medical education have been affected negatively because of the outbreak. Studying time and research activities of employees and trainees slowed down, which could be critical to their careers. Trainees complained about the significant reduction in their exposure to clinics and imaging procedures. Therefore, a method to safeguard the well-being of employees and trainees in the radiology department is necessary to limit the impact of such pandemics., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Albweady et al.)

Introduction: Body dysmorphic disorder (BDD) causes distress due to one's negative appraisal of their body image. The development of BDD has been linked to the passive use of social media and photo-editing apps. People with BDD typically pursue cosmetic surgeries to remedy their perceived flaws. The dramatic increase in the use of photo-editing apps and their well-established effects on mental health is a public health concern., Purpose: To study the association between use of social media and the development of BDD and acceptance toward cosmetic surgeries (ACSS) among Saudis., Methods: An online, cross-sectional, validated survey conducted among Saudis 18 and older. Descriptive analyses were utilized for demographics and prevalence rates of main study variables. ANOVA was used to compare mean scores in BDD and ACSS among different demographic groups. Tukeys post-hoc test was done to identify the categories that were different when the ANOVA test showed a statistically significance. A p -value of <0.05 was considered statistically significant., Results: A total of 1,483 Saudi adults completed the questionnaire. Key results showed that BDD was found in 24.4 % of the sample. The percentage of participants with BDD who spent 4-7 h per day on Instagram and Snapchat (29%) was significantly higher than those who spent only less than an hour per day on these platforms (19%) ( p < 0.001). Individuals with BDD had a significantly higher risk of accepting cosmetic surgery compared to those without BDD ( p < 0.001)., Conclusion: A growing body of evidence suggests that social media may impact mental health in different ways. This study reveals that heavy use of these platforms is associated with negative appraisals about one's physical appearance, and it fosters one's tendency toward cosmetic surgery, especially among females., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ateq, Alhajji and Alhusseini.)

Background: Pericardial effusion requiring percutaneous or surgical-based intervention remains an important complication of a leadless pacemaker implantation., Objective: The study sought to determine real-world prevalence, risk factors, and associated outcomes of pericardial effusion requiring intervention in leadless pacemaker implantations., Methods: The National Inpatient Sample and International Classification of Diseases-Tenth Revision codes were used to identify patients who underwent leadless pacemaker implantations during the years 2016 to 2020. The outcomes assessed in our study included prevalence of pericardial effusion requiring intervention, other procedural complications, and in-hospital outcomes. Predictors of pericardial effusion were also analyzed., Results: Pericardial effusion requiring intervention occurred in a total of 325 (1.1%) leadless pacemaker implantations. Patient-level characteristics that predicted development of a serious pericardial effusion included >75 years of age (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08-1.75), female sex (OR 2.03, 95% CI 1.62-2.55), coagulopathy (OR 1.50, 95% CI 1.12-1.99), chronic pulmonary disease (OR 1.36, 95% CI 1.07-1.74), chronic kidney disease (OR 1.53, 95% CI 1.22-1.94), and connective tissue disorders (OR 2.98, 95% CI 2.02-4.39). Pericardial effusion requiring intervention was independently associated with mortality (OR 5.66, 95% CI 4.24-7.56), prolonged length of stay (OR 1.36, 95% CI 1.07-1.73), and increased cost of hospitalization (OR 2.49, 95% CI 1.92-3.21) after leadless pacemaker implantation., Conclusion: In a large, contemporary, real-world cohort of leadless pacemaker implantations in the United States, the prevalence of pericardial effusion requiring intervention was 1.1%. Certain important patient-level characteristics predicted development of a significant pericardial effusion, and such effusions were associated with adverse outcomes after leadless pacemaker implantations., (© 2024 Heart Rhythm Society. Published by Elsevier Inc.)

Objective: This research aimed to culturally adapt and validate the MIAS scale for Arabic-speaking individuals within the Saudi Arabian general population, with an emphasis on cultural, societal, and individual nuances., Methods: An initial pilot testing with a small group ensured the scale's clarity. Subsequently, two cross-sectional studies involving 189 participants to assess structural validity of the Arabic MIAS scale, and 38 participants to assess the test-retest reliability. Descriptive statistics, Cronbach's α, Intraclass Correlation Coefficient (ICC), and Confirmatory Factor Analysis (CFA) were employed for data analysis., Results: The Arabic MIAS scale demonstrated good internal consistency and acceptable test-retest reliability (ICC α = 0.631). A three-factor model emerged (CFI = 0.890, TLI = 0.845, RMSEA = 0.094), including "Outcomes," "Negative Stereotypes," and "Recovery," closely mirroring the original study's structure. one item was excluded from the model since it didn't align with any of the three factors., Conclusion: The study contributes a culturally adapted, validated, non-condition-specific tool to gauge public attitudes toward mental health stigma in an Arabic context. It highlights the need for culturally sensitive stigma research and interventions and underscores the importance of improving such tools for cross-cultural applicability and comparability., Competing Interests: AS was employed by the UZIK Consulting Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 BinDhim, Althumiri, Al-Luhaidan, Alhajji, Saad, Alyami, Svendrovski, Al-Duraihem and Alhabeeb.)

According to the Global Burden of Disease Project, the morbidity and mortality of myocarditis continue to be a significant worldwide burden. On October 1, 2015, hospital administrative data started using the International Classification of Diseases (ICD)-10 codes instead of the ICD-9. To our knowledge, nationwide trends of myocarditis have not been studied after this update. The NIS database from 2005-2019 was analyzed using ICD-9 and 10 codes. Our search yielded 141,369 hospitalizations due to myocarditis, with 40.9% females. There were 6627 (4.68%) patients who required mechanical circulatory support (MCS) using left ventricular assisted devices (LVAD), intra-aortic balloon pump (IABP), or extracorporeal membrane oxygenation (ECMO). The use of LVAD and ECMO increased significantly during the study period (p-trend 0.003 and <0.001, respectively), whereas the use of IABP decreased during the same period (p-trend 0.025). Our study demonstrated an overall increase in the use of MCS overall in myocarditis, with increasing utilization of more advanced MCS in the forms of LVAD and ECMO., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Appointment non-attendance - often referred to as "missed appointments", "patient no-show", or "did not attend (DNA)" - causes volatility in health systems around the world. Of the different approaches that can be adopted to reduce patient non-attendance, behavioural economics-oriented mechanisms (i.e., psychological, cognitive, emotional, and social factors that may impact individual decisions) are reasoned to be better suited in such contexts - where the need is to persuade, nudge, and/ or incentivize patients to honour their scheduled appointment. The aim of this systematic literature review is to identify and summarize the published evidence on the use and effectiveness of behavioural economic interventions to reduce no-shows for health care appointments., Methods: We systematically searched four databases (PubMed/Medline, Embase, Scopus, and Web of Science) for published and grey literature on behavioural economic strategies to reduce no-shows for health care appointments. Eligible studies met four criteria for inclusion; they were (1) available in English, Spanish, or French, (2) assessed behavioural economics interventions, (3) objectively measured a behavioural outcome (as opposed to attitudes or preferences), and (4) used a randomized and controlled or quasi-experimental study design., Results: Our initial search of the five databases identified 1,225 articles. After screening studies for inclusion criteria and assessing risk of bias, 61 studies were included in our final analysis. Data was extracted using a predefined 19-item extraction matrix. All studies assessed ambulatory or outpatient care services, although a variety of hospital departments or appointment types. The most common behaviour change intervention assessed was the use of reminders (n = 56). Results were mixed regarding the most effective methods of delivering reminders. There is significant evidence supporting the effectiveness of reminders (either by SMS, telephone, or mail) across various settings. However, there is a lack of evidence regarding alternative interventions and efforts to address other heuristics, leaving a majority of behavioural economic approaches unused and unassessed., Conclusion: The studies in our review reflect a lack of diversity in intervention approaches but point to the effectiveness of reminder systems in reducing no-show rates across a variety of medical departments. We recommend future studies to test alternative behavioural economic interventions that have not been used, tested, and/or published before., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: During the COVID-19 pandemic, Saudi Arabia witnessed hesitancy from a proportion of the population toward taking the vaccine; thus, it was necessary to nudge them to uptake it. This study was conducted to assess the impact of using different types of messages to nudge the public to increase the proportion of vaccinated individuals., Methods: This study is a multi-arm randomized controlled trial aiming to assess the efficacy of using differently framed messages that appear as pop-notifications in Sehatty application. Of those who preregistered to receive a COVID-19 vaccine but didn't take it according to the Saudi national vaccine registry (n = 1,291,686), 12,000 individuals were randomly recruited and randomly assigned to one of five intervention groups (commitment, loss aversion, salience, social norms, and ego) or a control group. To ensure the exposure occurred in the intervention groups, we included only those who received the notification, which was confirmed by checking the information technology system. We used the Chi-square test to compare each intervention group against the control group separately. Also, we used the same test to investigate whether sex and age influenced the percentage of booked appointments in the intervention groups., Results: Social norms, ego, salience and loss aversion groups had higher percentages of booked appointments when compared to the control group (21.0%, p  = 0.001; 19.1%, p  = 0.011; 19.0%, p  = 0.013; 18.4%, p  = 0.034, respectively). Moreover, when combining the intervention groups, the percentage was higher than the control group ( p  < 0.001). The percentages of booked appointments made by Young adults (18-35 years old) were higher than that of adults over 35 years old in the social norms (22.6%, p  = 0.016) and ego groups (21.0%, p  = 0.010). At the same time, sex didn't affect the percentages of booked appointments in any group., Conclusion: Using different framings of messages to nudge the public to take vaccines can help increase the percentage of immunized individuals in a community. Nudges can boost the public health of a population during an unusual spread of vaccine-preventable diseases. Findings might also inspire governmental responses to other public health situations., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Coronavirus disease 2019 (COVID-19)-associated mortality is predominantly due to respiratory failure. However, risk factors and predictive models for disease progression in patients with COVID-19 are not consistent across the globe. In this study, we aimed to assess the risk factors associated with intensive care (ICU) admission and mortality in patients with COVID-19 pneumonia., Methods: Information was retrieved from the database of all patients admitted with COVID-19 pneumonia between March 2020 and July 2020 at a tertiary care center in Saudi Arabia. The patients' demographic, clinical, laboratory and radiological characteristics were analyzed., Results: Of 1054 patients admitted with PCR proven COVID-19, 254 patients (24%) with radiological evidence of pneumonia were enrolled. The median age was 55, with 25.6% above 65 years and 55.1% males. The comorbidities included hypertension (45%), diabetes (43%), dyslipidemia (24%), solid organ and bone marrow transplantation (14.5%), malignancy (13.4%), ischemic heart disease (10.6%) and chronic kidney disease (9.4%). The mortality rate was 4.7%, and 22.8% were admitted to the ICU. The risk factors for ICU admission were> 65 years of age (RR: 1.74, CI 95%, 1.10-2.74, p = 0.017), diabetes melitus (RR: 1.66, CI 95% 1.06-2.62, p = 0.028), heart failure (RR: 2.51, CI 95%, 1.28-4.93, p = 0.007), respiratory rate> 25 (RR: 2.75, CI 95%, 1.66-4.55, p < 0.001), upper lobe involvement (RR: 1.68, CI 95%, 1.02-2.77, p = 0.043), and C-reactive protein (CRP)> 140 (RR: 1.89, CI 95%, 1.14-3.13, p = 0.013). The risk factors for mortality were> 65 years of age (RR: 5.82, CI 95%, 1.81-18.68, p = 0.003), upper lobe involvement on chest radiography (RR:4.40, CI 95%, 1.22-15.86, p = 0.016), diffuse chest computed tomography changes (RR: 7.36, CI 95%, 2.31-23.46, p < 0.011), ischemic heart disease (RR: 4.20, CI 95%, 1.36-13.04, p = 0.028), chronic kidney disease (RR: 6.85, CI 95%, 2.35-19.90, p < 0.003), cerebrovascular disease (RR:13.61, CI 95%, 5.01-36.96 p < 0.001), respiratory rate> 25 (RR: 3.94, CI 95%, 1.32-11.78 p = 0.023), oxygen saturation< 90% on admission (RR: 12.19, CI 95%, 3.71-40.01, p < 0.001), thrombocytopenia (RR:4.16, CI 95%, 1.37-12.64, p = 0.013), and elevated troponin (RR: 6.20, CI 95%, 1.73-22.24, p = 0.003)., Conclusions: In this study, nearly a quarter of the patients with COVID-19 pneumonia required intensive care. We identified several risk factors associated with ICU admission and mortality that may be useful for predicting, triaging, and managing COVID-19 pneumonia patients. However, these findings need to be validated prospectively., Competing Interests: Declaration of Competing Interest Authors declare that they have no interest to declare., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Inhaler combination formulations consisting of an inhaled corticosteroid (ICS) (fluticasone propionate) and a long-acting β2 agonist (salmeterol xinafoate) are indicated as maintenance treatments for patients with asthma and/or for selected patients with chronic obstructive pulmonary disease. The emergence of generic equivalents to branded inhalers is expected to offer economic edge/savings; however, some may argue that cost advantages offered by generic inhalers may be offset by worsening outcomes due to improper inhaler use, reduced adherence, and consequently worse disease control. To understand how unsupervised and unconsented switch of dry-powder inhalers and/or metered-dose inhalers affects clinical and humanistic outcomes in asthma, comprehensive searches of Embase and MEDLINE were conducted to identify research articles published in the English language since 2011. Patients with asthma of any age who underwent an unsupervised and unconsented switch from an ICS/long-acting β2 agonist to another (brand-to-generic or brand-to-brand) for non-medical reasons were the target of this research. Relevant outcomes included asthma control, medication adherence, and healthcare resource utilization. In total, 11 studies were identified for review (ten non-interventional and one post hoc ); cohorts ranged from 19 to 42,553 patients. Six studies indicated that unsupervised and unconsented inhaler switch had a negative impact on asthma control; six studies indicated reduced medication adherence post-switching; and five studies reporting healthcare resource utilization showed it was unchanged or increased post-switching. Findings from this targeted review support concerns that unsupervised and unconsented inhaler switch has a largely negative impact on asthma-associated outcomes. Additional studies are warranted to further explore unsupervised and unconsented switch in asthma., Competing Interests: AA declares he is a deputy Editor in Chief at the journal Annals of Thoracic Medicine. MA declares no conflicts of interest. WA declares no conflicts of interest. MHS declares he is a GSK employee and holds shares in GSK., (Copyright: © 2023 Annals of Thoracic Medicine.)

Abnormalities associated with phosphate metabolism can lead to thoracic deformities that result in respiratory failure, which is conventionally managed by means of supplemental oxygenation, positive airway pressure and physiotherapy. However, when these measures fail, the clinician faces a dilemma, since many patients cannot tolerate a major surgical procedure. A minimally invasive technique, insertion of an endobronchial stent, might offer a solution., (© Royal College of Physicians 2023. All rights reserved.)

Lurasidone is an antipsychotic medication that blocks dopamine D2 and serotonin 5-hydroxy-tryptamine (5-HT) 2A  receptors and affects other serotoninergic and noradrenergic receptors. It has rapid absorption and linear pharmacokinetics. The rates of metabolic syndrome for patients taking lurasidone are comparable to placebo groups. Lurasidone is a safe and effective treatment for patients with acute schizophrenia and bipolar depression. It has been found to improve the brief psychiatric rating scale and other secondary measures in schizophrenic patients and reduce depressive symptoms in bipolar I depression. The once-daily administration of lurasidone is generally well-tolerated and does not cause clinically significant differences in extrapyramidal symptoms, adverse effects, or weight gain compared to a placebo. However, lurasidone's effectiveness in combination with lithium or valproate has been mixed. Further research is needed to determine optimal dosing, treatment duration, and combination with other mood stabilizers. Long-term safety and effectiveness and its use in different subpopulations should also be evaluated., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Tarzian et al.)

Background: The coronavirus disease 2019 (COVID-19) pandemic places a high demand on frontline healthcare workers. Healthcare workers are at high-risk of contracting the virus and are subjected to its consequential emotional and psychological effects. This study aimed to measure the level of depression and anxiety among healthcare workers in Saudi Arabia during the early stages of the COVID-19 pandemic., Methods: This was a cross-sectional study; data were collected from healthcare workers in Saudi Arabia using a survey that included the Zung Self-Rating Depression Scale and the Generalized Anxiety Disorder Scale-7. A total of 326 participants took part in the study by completing and submitting the survey., Results: The vast majority of the participating healthcare workers were Saudi nationals (98.8%) working in a public healthcare facility (89.9%). The results indicated that most of the participants had mild levels of anxiety and depression. A total of 72.5% of the respondents had anxiety, ranging from mild (44.1%) to moderate (16.2%) and severe (12.2%). Moreover, 24.4% of the respondents had depression ranging from mild (21.7%) to moderate (2.1%) and severe (0.6%). The generalized linear models showed that the <30 age group (Beta = 0.556, p  = 0.037) and the 30-39-year age group (Beta = 0.623, p  = 0.019) were predicted to have anxiety. The analysis revealed that females were more anxious (Beta = 0.241, p  = 0.005) than males. Healthcare providers working in primary healthcare centers (Beta = -0.315, p  = 0.008) and labs (Beta = -0.845. p  = 0.0001 were predicted to be less anxious than those working in other healthcare facilities. The data analysis showed that participants with good economic status had more depression than the participants in the other economic status groups (Beta = 0.067, p  = 0.003)., Conclusion: This study found that the level of anxiety and depression in healthcare workers was mild. The factors that may contribute to anxiety in healthcare workers included being female, being younger than 30 or between the ages of 31 and 39, working in a specialized hospital facility, and the number of COVID-19 cases the workers dealt with. Economic status was associated with depression. A longitudinal study design is needed to understand the pattern of anxiety levels among healthcare workers over time during the COVID-19 pandemic., Competing Interests: Abbas Shamsan was employed by the Dr. Sulaiman Al Habib Medical Group. The authors declare there are no competing interests., (©2022 Shamsan et al.)

This case report describes a 40-year-old male who presented to the emergency department (ED) with chest pain. Initial diagnostic workup was concerning for a congenital cardiac anomaly, further imaging revealed complete congenital absence of the pericardium (CAP) which is a rare condition. Multimodality cardiac imaging including cardiac computed tomography angiogram (CCTA) was used to confirm the diagnosis of CAP. We briefly discuss various clinical presentations of CAP along with potential complications and other anomalies that could be associated with pericardial agenesis., (Published by Elsevier Inc. on behalf of University of Washington.)

The extent to which individual and structural factors influence cancer patients' reports of their experiences are not yet well understood. We sought to identify which groups of patients consistently report poorer experiences and whether structural care factors might also be associated with better or worse reports. We conducted a systematic review of literature in PubMed and Web of Science with the date of last search as 27th of February 2022 following PRISMA guidelines. We focused on studies from three established population-based surveys datasets and instruments. After screening 303 references, 54 studies met the inclusion criteria. Overall, being from an ethnic minority group, having a more deprived socioeconomic status, poorer general or mental health status, being diagnosed with poor prognosis cancers, presenting to care through an emergency route, and having delayed treatment were consistently associated with poorer cancer care experiences. Conversely being diagnosed with earlier stage disease, perceiving communication as effective, positive patient-provider relationships, and receiving treatment with respect were overall associated with better reports of cancer care experiences. Improvement efforts aimed at delivering better experiences of patient-centred care need to take account much more explicitly patients' differing characteristics, prognoses, and trajectories they take through their care journeys., Competing Interests: None., (© 2022 The Authors.)

Despite efforts to increase the diversity of cancer clinical trial participants, African Americans are still underrepresented. While perceptions of participation have been studied, the objective of this study was to compare perceptions and decisional conflict towards clinical trials among African American cancer patients who have and have not participated in clinical trials to identify key areas for intervention. Post hoc analysis also looked at whether they had been asked to participate and how that group differed from those who did. Forty-one African American cancer patients were surveyed at two urban cancer centers and asked to agree/disagree to statements related to clinical trials perceptions (facilitators, barriers, beliefs, values, support, and helpfulness), and complete the O'Connor Decisional Conflict Scale. Independent-samples t tests compared participants by clinical trials participation status; 41% had participated in a clinical trial. Results revealed significant perceptual differences among the groups in three main areas: helpfulness of clinical trials, facilitators to participate in clinical trials, and barriers to participating in clinical trials. Post hoc analysis indicated that those who were not asked about clinical trials and had not participated differed significantly in all areas compared with participants. Additionally, clinical trial participants reported significantly lower decisional conflict in most items compared with both those who had and had not be asked to participate. These differences can give practitioners clues as to how to bridge the gap from non-participator to participator. Messages could then be infused in the clinician-patient dyad when introducing and discussing clinical trials, potentially providing a more effective strategy for communicating with African American patients., (© 2020. American Association for Cancer Education.)

Interstitial lung disease (ILD) is a well-established common manifestation of idiopathic inflammatory myopathies. Yet, till now, the pathogenetic mechanisms are still poorly understood, classification is evolving and prognosis is variable. A refractory and rapidly progressive ILD (RPILD) that is associated with dermatomyositis (DM) with minimal muscle weakness and normal creatine kinase (termed clinically amyopathic DM) is increasingly being recognized, with more incidence in Asians. However, we are not aware of reports of the Arab region. Herein, we present a 38-year-old male with this condition that ended with a fatal outcome despite aggressive therapy, with a review of recent literature., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Annals of Thoracic Medicine.)

Purpose: This study aims to evaluate the overall emotional wellbeing and emotional predictors of the Saudi population during COVID-19., Patients and Methods: A cross-sectional design was employed; the data were collected by using the Arabic version of the Mental Health Inventory., Results: A total of 5041 participants were successfully recruited over 1 week. The participants scored moderately on Anxiety, Depression, Loss of Behavioral/Emotional Control, General Positive Affect, Emotional Ties, and Life Satisfaction. The results indicated that age, gender, marital status, socioeconomic status, and having chronic health conditions are major predictors of emotional wellbeing during the COVID-19 pandemic., Conclusion: A rehabilitation program should be initiated to restore the community function and the wellbeing of individuals who have been impacted by the COVID-19 pandemic., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Al Mutair et al.)

Women with early-stage unilateral breast cancer and no familial or genetic risk factors are increasingly electing contralateral prophylactic mastectomy (CPM), despite the lack of evidence demonstrating improved outcomes. To better understand and extend the literature focused on treatment decision-making, a survey was conducted among women with early-stage breast cancer and no associated risk factors, who were in the process of making a surgical decision. This prospective study sought to expand our understanding of the factors that influence patients' decision to have CPM, with the goal of providing healthcare providers with useful guidance in supporting breast cancer patients who are making treatment decisions. Data were collected for this prospective study through an internet survey. Results were analyzed using perceptual mapping, a technique that provides visual insight into the importance of specific variables to groups of women making different surgical decisions, not available through conventional analyses. Results suggest that women more likely to elect CPM demonstrate greater worry about breast cancer through experiences with others and feel the need to take control of their health through selection of the most aggressive treatment option. The information obtained offers guidance for the development of targeted intervention and counsel that will support patients' ability to make high quality, informed decisions., (© Society of Behavioral Medicine 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: We sought to assess the national trends in the utilization and outcomes of percutaneous coronary interventions (PCI) in patients with cirrhosis., Background: Contemporary data on PCI in patients with liver cirrhosis are limited., Methods: The National-Inpatient-Sample was used to identify patients who underwent PCI between 2003 and 2016. We examined the annual PCI rate, and compared the in-hospital morbidity, mortality, resource utilization, and cost following PCI in patients with and without cirrhosis., Results: A total of 8,860,178 PCI hospitalizations were identified, of those, 20,339 (0.2%) were performed in patients with cirrhosis. Annual PCI rates decreased overtime in patients without liver cirrhosis but increased in those with cirrhosis (P trend < .001). Patients with cirrhosis had a characteristic clinical, demographic, and socioeconomic profile compared with those without cirrhosis. The use of bare-metal stents decreased from 69.1 to 11.4% in the noncirrhosis group, and from 81.9 to 21.3% in the cirrhosis group. Compared with propensity-matched patients without cirrhosis, PCI in cirrhotic patients was associated with higher in-hospital mortality across all indications (STEMI 19.1 vs. 11.5%, p = .002; NSTEMI 8.7 vs. 5.6%, p = .002; and UA/SIHD 7.7 vs. 4.3%, p < .001). Cirrhotic patients also had significantly higher rates of acute kidney injury, but similar rates of vascular complications and stroke. Additionally, cirrhotic patients had longer hospitalizations, were less likely to be discharged home, and accrued higher cost across all PCI indications., Conclusions: Patients with cirrhosis who are deemed "suitable PCI candidates" in current practice remain at high-risk for worse short-term morbidity and mortality, and higher cost of care., (© 2019 Wiley Periodicals, Inc.)

HIV disproportionately impacts US racial and ethnic minorities but they participate in treatment and vaccine clinical trials at a lower rate than whites. To summarize barriers and facilitators to this participation we conducted a scoping review of the literature guided by the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Studies published from January 2007 and September 2019 were reviewed. Thirty-one articles were identified from an initial pool of 325 records using three coders. All records were then assessed for barriers and facilitators and summarized. Results indicate that while racial and ethnic minority participation in these trials has increased over the past 10 years, rates still do not proportionately reflect their burden of HIV infection. While many of the barriers mirror those found in other disease clinical trials (e.g., cancer), HIV stigma is a unique and important barrier to participating in HIV clinical trials. Recommendations to improve recruitment and retention of racial and ethnic minorities include training health care providers on the importance of recruiting diverse participants, creating interdisciplinary research teams that better represent who is being recruited, and providing culturally competent trial designs. Despite the knowledge of how to better recruit racial and ethnic minorities, few interventions have been documented using these strategies. Based on the findings of this review, we recommend that future clinical trials engage community stakeholders in all stages of the research process through community-based participatory research approaches and promote culturally and linguistically appropriate recruitment and retention strategies for marginalized populations overly impacted by HIV.

Background: Several studies have investigated early readmissions after percutaneous coronary interventions (PCIs). However, studies investigating 30-day readmission following PCI for chronic total occlusion (CTO) are lacking., Methods: The National-Readmission-Database (NRD) was queried to identify patients undergoing elective CTO PCI between January 1, 2016 and December 31, 2016. We assessed the incidence, predictors, and cost of 30-day readmissions., Results: A total of 30,579 CTO PCIs were identified in the NRD. After excluding patients who had acute myocardial infarction (n = 14,852), the final cohort included 15,907 patients. In this group of patients, 254 patients (1.5%) expired during their index admission and, 1600 patients (10%) had an unplanned readmission within 30 days. Cardiac causes constituted 54.2% of all causes of readmission. During the readmission, 15.8% of patients had coronary angiography, 8.4% underwent PCI, and 0.9% underwent bypass grafting. Independent predictors of 30-day readmission included baseline characteristics [age (OR 0.99, 95%CI 0.98-0.99), female (OR 1.14, 95%CI 1.01-1.28), lung disease (OR 1.36, 95%CI 1.20-1.55), heart failure (OR 1.42, 95%CI 1.24-1.62), anemia (OR 1.30, 95%CI 1.12-1.50), vascular disease (OR 1.18, 95%CI 1.03-1.35), history of stroke (OR 1.50, 95%CI 1.28-1.76) and the presence of a defibrillator (OR 1.68, 95%CI 1.39-2.03)], and procedural complications [acute kidney injury (OR 1.55, 95%CI 1.33-1.80) and gastrointestinal bleeding (OR 1.67, 95%CI 1.03-2.71)]., Conclusions: One-tenth of patients undergoing CTO PCI are readmitted within 30-days, mostly for cardiac causes. The majority undergo angiography but <10% receive revascularization. Certain patient and procedural characteristics independently predicted 30-day readmission., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The frequency, characteristics and outcomes of acute myocardial infarction (AMI) during exacerbation of chronic obstructive pulmonary disease (COPD) are unknown. Adult patients hospitalized with a principle diagnosis of acute COPD exacerbation were identified using retrospective analysis of the Nationwide Inpatient Sample (NIS) from 2003 to 2016. Patients were stratified into 2-groups with and without a secondary diagnosis of AMI. The study's endpoints were in-hospital morbidity, mortality, and resource utilization. We also assessed the impact of invasive management strategy on the same end-points. We included 6 894 712 hospitalizations, of which 56 515 (0.82%) were complicated with AMIs. Patients with AMI were older, and had higher prevalence of known coronary disease (48.9% vs. 27.4%), atrial fibrillation (23.3% vs. 15.2%), heart failure (47.8% vs. 26.2%), and anemia (20.7% vs. 14.8%) ( p  < 0.001). Rates of oxygen dependence were similar (16.3% vs. 16.1%, p  = 0.24). In 56 486 propensity-matched pairs of patients with and without AMI, mortality was higher in the AMI group (12.1% vs. 2.1%, p  < 0.001). Rates of major morbidities, non-home discharge, and cost were all higher in the AMI group. A minority (18.1%) of patients with AMI underwent invasive assessment, and those had lower in-hospital mortality before (4.9% vs. 13.8%) and after (5.0% vs. 10.0%) propensity-score matching ( p  < 0.001). This lower mortality persisted in a sensitivity analysis accounting for immortal time bias. AMI complicates ∼1% of patients admitted with acute COPD exacerbation, and those have worse outcomes than those without AMI. Invasive management for secondary AMI during acute COPD exacerbation may be associated with improved outcomes but is utilized in <20% of patients.

Data on the efficacy of left atrial appendage occlusion (LAAO) in clinical practice are limited. We performed a systematic review and meta-analysis of observational studies that reported observed versus expected rates of ischemic strokes and/or major bleeding following LAAO. Our primary end points were the pooled relative risk reduction (RRR) in ischemic stroke and major bleeding with corresponding 95% confidence intervals compared with what was expected by the CHA2DS2-VASc and HASBLED scores, respectively. Twenty-nine studies including 11,071 patients (age 74.0 ± 8.7 years, 60% males) met the inclusion criteria. The mean CHA2DS2-VASc score was 4.22 ± 1.48, and the mean HASBLED score was 3.04 ± 1.16. During 19,567 patient-year follow-up, 290 of 11,071 patients (2.62%) suffered an acute ischemic stroke. This represented a 73.6% (95% confidence interval 68.9-78.2%) RRR in ischemic strokes compared with what was expected based on the CHA2DS2-VASc score. A total of 26 studies reported observed versus expected major bleeding (10,056 patients; age 74.0 ± 8.7, 60% males). During 16,967 patient-year follow-up, 404 of 10,056 patients (4.0%) suffered a major bleeding event. This represented a 55% (95% confidence interval 44.2% to -65.9%) RRR in major bleeding compared with what was expected based on the HASBLED score. These estimates were consistent across subgroups stratified according to age, CHADS2VASc, HASBLED scores and type of LAAO device used. In conclusion, LAAO is associated with a favorable observed/expected ratio with regards to ischemic stroke and major bleeding in clinical practice. Future clinical trials remain essential to further assess the efficacy of LAAO via a direct comparison with oral anticoagulation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To assess contemporary trends in the incidence, characteristics, and outcomes of hospital admissions for infective endocarditis (IE) in the United States., Patients and Methods: Patients ≥18 years admitted with IE between January 1, 2003, and December 31, 2016, were identified in the National Inpatient Sample. We assessed the annual incidence, clinical characteristics, morbidity, mortality, and cost of IE-related hospitalizations., Results: The incidence of IE-related hospitalizations increased from 34,488 (15.9; 95% confidence interval [CI], 15.73, 16.06) per 100,000 adults) in 2003 to 54,405 (21.8; 95% CI, 21.60-21.97) per 100,000 adults) in 2016 (P<.001). The prevalence of patients below 30 years of age, and those who inject drugs, increased from 7.3% to 14.5% and from 4.8% to 15.1%, respectively (P<.001). The annual volume of valve surgery for IE increased from 4049 in 2003 to 6460 in 2016 (P<.001), but the ratio of valve surgery to IE-hospitalizations did not decrease (11.7% in 2003; 11.8% in 2016). There was also a temporal increase in risk-adjusted rates of stroke (8.0% to 13.2%), septic shock (5.4% to 16.3%), and mechanical ventilation (7.7% to 16.5%; P<.001). However, risk-adjusted mortality decreased from 14.4% to 9.8% (P<.001). Median length-of-stay and mean inflation-adjusted cost decreased from 11 to 10 days and from $45,810±$61,787 to $43,020±$55,244, respectively, (P<.001). Nonetheless, the expenditure on IE hospitalizations increased ($1.58 billion in 2003 to $2.34 billion in 2016; P<.001)., Conclusions: There is a substantial recent rise in endocarditis hospitalizations in the United States. Although the adjusted in-hospital mortality of endocarditis and the cost of admission decreased over time, the overall expenditure on in-hospital care for endocarditis increased., (Copyright © 2019. Published by Elsevier Inc.)

Half of U.S. states measure students' body mass index (BMI), with many communicating that information to parents through a "BMI report card" or notification letter. School nurses are usually responsible for implementing these programs and communicating results to parents. The purpose of this study was to understand parents' perceptions of BMI screening programs to help inform school nurses about messages that are most helpful to use in report cards to motivate parents to follow-up with a health-care provider or to make behavioral changes for their child. Using a cluster analysis and perceptual mapping methods, a commercial marketing technique that creates three-dimensional graphic maps, we identified four unique clusters of parents based on their core attitudes and beliefs related to BMI screenings and report cards. Based on vector modeling techniques, key message strategies were developed that can be used by school nurses to enhance parent response to a BMI report card.

Background: Acute pancreatitis is the leading gastrointestinal cause of hospital admissions. Our study aims to determine the trends and predictors of discharge against medical advice (AMA)., Methods: We utilized the Nationwide Inpatient Sample (2003 - 2016) to identify patients admitted with pancreatitis. We compared in-hospital complications and determined predictors of discharge AMA using a multivariate logistic regression., Results: A total of 7,158,894 patients were admitted with pancreatitis. Of those, 199,351 left AMA. Discharge AMA increased over time from 2.3% to 3.2%. Patients who left AMA were more likely to be younger, male, black, and a lower socioeconomic status (SES). They had a greater prevalence of depression, cirrhosis, smoking, drug abuse, and human immunodeficiency virus (HIV) infection. Alcohol use was the most likely etiology of pancreatitis among those leaving AMA. In a multivariate regression, patients more likely to leave AMA included: age 18 - 44, male, and black. Patients with a history of depression, drug abuse, and HIV infection were also more likely to be discharged AMA., Conclusions: Discharges AMA increased over time. Predictors of AMA include patients who are younger, male, black, lower socioeconomic status, and have a history of depression, HIV infection, alcohol and drug use. Future studies are necessary to examine the reasons for discharge AMA among this population., Competing Interests: None of the authors has any conflict of interest to disclose., (Copyright 2020, Chaudhary et al.)

Objective: To study the in-hospital outcomes and 30-day readmission data in homeless patients admitted with acute myocardial infarction (AMI)., Methods: Adult patients (>18 years of age) who were admitted with AMI between January 1, 2015, and December 31, 2016, were identified in the National Readmission Database. Patients were classified into homeless or non-homeless. Baseline characteristics, rates of invasive assessment and revascularization, mortality, 30-day readmission rates, and reasons for readmission were compared between the 2 cohorts., Results: A total of 3938 of 1,100,241 (0.4%) index hospitalizations for AMI involved homeless patients. Compared with non-homeless patients, homeless patients were younger (mean age, 57±10 years vs 68±14 years; P<.001) and had a lower prevalence of atherosclerotic risk factors (hypertension, hyperlipidemia, and diabetes) but a higher prevalence of anxiety, depression, and substance abuse. Homeless patients were less likely to undergo coronary angiography (38.1% vs 54%; P<.001), percutaneous coronary intervention (24.1% vs 38.7%; P<.001), or coronary artery bypass grafting (4.9% vs 6.7%; P<.001). Among patients who underwent percutaneous coronary intervention, bare-metal stent use was higher in homeless patients (34.6% vs 12.1%; P<.001). After propensity score matching, homeless patients had similar mortality but higher rates of acute kidney injury, discharge to an intermediate care facility or against medical advice, and longer hospitalizations. Thirty-day readmission rates were significantly higher in homeless patients (22.5% vs 10%; P<.001). Homeless patients had more readmissions for psychiatric causes (18.0% vs 2.0%; P<.001)., Conclusion: Considerable differences in cardiovascular risk profile, in-hospital care, and rehospitalization rates were observed in the homeless compared with non-homeless cohort with AMI. Measures to remove the health care barriers and disparities are needed., (Copyright © 2020 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Importance: Data on the contemporary changes in risk profile and outcomes of patients undergoing percutaneous coronary intervention (PCI) or coronary bypass grafting (CABG) are limited., Objective: To assess the contemporary trends in the characteristics and outcomes of patients undergoing PCI or CABG in the United States., Design, Setting, and Participants: This retrospective cohort study used a national inpatient claims-based database to identify patients undergoing PCI or CABG from January 1, 2003, to December 31, 2016. Data analysis was performed from July 15 to October 4, 2019., Main Outcomes and Measures: Demographic characteristics, prevalence of risk factors, and clinical presentation divided into 3 eras (2003-2007, 2008-2012, and 2013-2016) and in-hospital mortality of PCI and CABG stratified by clinical indication., Results: A total of 12 062 081 revascularization hospitalizations were identified: 8 687 338 PCIs (72.0%; mean [SD] patient age, 66.0 [10.8] years; 66.2% male) and 3 374 743 CABGs (28.0%; mean [SD] patient age, 64.5 [12.4] years; 72.1% male). The annual PCI volume decreased from 366 to 180 per 100 000 US adults and the annual CABG volume from 159 to 82 per 100 000 US adults. A temporal increase in the proportions of older, male, nonwhite, and lower-income patients and in the prevalence of atherosclerotic and nonatherosclerotic risk factors was found in both groups. The percentage of revascularization for myocardial infarction (MI) increased in the PCI group (22.8% to 53.1%) and in the CABG group (19.5% to 28.2%). Risk-adjusted mortality increased slightly after PCI for ST-segment elevation MI (4.9% to 5.3%; P < .001 for trend) and unstable angina or stable ischemic heart disease (0.8% to 1.0%; P < .001 for trend) but remained stable after PCI for non-ST-segment elevation MI (1.6% to 1.6%; P = .18 for trend). Risk-adjusted CABG morality markedly decreased in patients with MI (5.6% to 3.4% for all CABG and 4.8% to 3.0% for isolated CABG) and in those without MI (2.8% to 1.7% for all CABG and 2.1% to 1.2% for isolated CABG) (P < .001 for all)., Conclusions and Relevance: Significant changes were found in the characteristics of patients undergoing PCI and CABG in the United States between 2003 and 2016. Risk-adjusted mortality decreased significantly after CABG but not after PCI across all clinical indications.

Hepatitis C (HCV) is a highly prevalent infection in current and former IV drug users. Current estimates indicate that over 70% of those in methadone maintenance treatment programs (MMTs) have HCV, but only 11% have initiated treatments despite availability of new treatments that are easily tolerated and can cure infection in about 8 weeks. We conducted a pilot randomized trial at four Philadelphia, PA MMTs to test acceptability, feasibility and promise of efficacy of our "Take Charge, Get Cured" mobile health (mHealth) treatment decision tool, developed through extensive formative work that included methadone patients' input and targeted directly to concerns of methadone patients with Hepatitis C (HCV). We compared its impact on perceptions and knowledge about HCV and HCV treatment, decisional conflict, intention to and actual initiation of HCV care to a web-based Cochrane-reviewed, non-targeted HCV decision tool. Subjects (n = 122) were randomized, administered baseline questionnaires, interacted with the targeted or non-targeted decision tool on an electronic tablet, and answered post-test questions. After 3-months subjects (n = 93; 76%) were surveyed for follow up. "Take Charge, Get Cured" users were more likely to report the tool helped with decision making and demonstrated greater improvement in knowledge, decisional conflict, and intention to be treated for their HCV infections than users of the non-targeted decision tool. They were significantly more likely to say the targeted tool was helpful and that they would recommend it to others. At three month follow up, targeted group participants were more likely to say the tool helped them make a better decision about treatment and prepared them to talk to their doctor about what matters most to them about treatment. No differences were seen in actions to initiate HCV care, but more targeted group participants reported talking to their doctors about HCV treatment. Results indicate a highly targeted mHealth decision tool is an important strategy to affect perceptions and knowledge of HCV treatment that lowers decisional conflict about initiating treatment, key components in decision making. We believe this highly acceptable and feasible intervention could be utilized in clinical settings to address the important barriers to initiating HCV treatment in a vulnerable population., (Copyright © 2019. Published by Elsevier Inc.)

Objective: Designing salient digital health interventions requires theoretically-based formative research and user-center design with stakeholder input throughout impacting content and technology design. mychoice is a theory-based, stakeholder-guided digital health tool to improve clinical trial informed decision making, particularly among African American patients., Methods: mychoice was developed by (1) mixed-methods formative research, including in-depth interviews (n=16) and surveys (N=41) with African American cancer patients who had and had not participated in a clinical trial; (2) e-tool design process including perceptual mapping analysis to prioritize messages, multi-disciplinary team and stakeholder input; and (3) iterative production and user testing., Results: Interview findings showed that clinical trial participants expressed more positive attributes about and an openness to consider clinical trials, even though they expressed common concerns such as "fear of being a guinea pig". Survey results indicated that clinical trial participants expressed they had been given information to make the decision (P = .001), while those who had not more frequently reported (P > .001) that no one had talked to them about trials. Perceptual mapping indicated that values such as "helping find a cure" or "value to society" had little resonance to those who had not participated, providing message strategy for prototype development. User testing of the tool resulted in modifications; the most significant was the adaptation to a multi-cultural version., Conclusions: With the promise of digital health interventions, theory-guided, user-centered and best practice development is critical and mychoice serves as an example of the application of these principles., (© 2019 John Wiley & Sons, Ltd.)

Background . Cyberbullying is a serious issue among adolescents, but little is known about how demographics are associated with mental health conditions and violent behaviors. The present study examined the association of cyberbullying victimization with mental health conditions and violent behaviors among adolescents, specifically examining potential differences by sex and race. Methods . National data obtained from a representative sample of 9th to 12th grade students (N = 15 465) in the United States were examined using bivariate and logistic regression analysis. Results . More than 15% of students reported cyberbullying victimization. Females were twice as likely to report victimization than males, and non-white students were 50% less likely to report cyberbullying victimization. Cyberbullying victimization was significantly more likely in students who reported depressive symptoms, suicidal ideation, suicide planning, carrying a weapon, and engaging in a physical fight. These associations were more pronounced in males. Conclusions . Our findings show that female and white adolescents are at increased risk of being cyberbullied. However, negative mental health outcomes and violent behaviors are more pronounced in males, indicating potential negative effects of being a cyberbullying victim based on sex. We envisage the best way to combat cyberbullying is to develop programs that are sensitive to potential demographic differences to empower students based on individual risks., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.