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Context Colorectal cancer (CRC) has a high mortality rate and a large financial burden. Therefore, it is imperative to screen appropriately for this disease. By evaluating trends in different CRC screening methods and evaluating screening methods based on sex and race, improvements in screening can be made. Objectives By analyzing data from the Behavioral Risk Factor Surveillance System (BRFSS), our primary objective was to evaluate trends in CRC screening methods from 2018 through 2020. Our secondary objectives were to investigate deviations in screening rates by sex and race/ethnicity. Methods A cross-sectional design was utilized to analyze trends in CRC screening methods utilizing data from the BRFSS for the years 2018 through 2020. Sex and race were also analyzed to evaluate for deviations in screening rates. Results All race/ethnicity groups most often completed colonoscopies, with all but individuals identifying as Hispanic having higher than 56% completion rates. Individuals reporting as Hispanic received more blood stool tests than other races at 23.4%. Average CRC screening among all methods showed that 89.7% of individuals who reported as being White completed screening, with 91.3% of individuals reporting as Black, and 81.9% with race not listed, completed screening. Individuals identifying as Asian (74.4%), American Indian/Alaska Native (AI/AN [79.2%]) and Hispanic (78.1%) had lower rates of screening overall. Conclusions Our study found that trends in CRC screening were similar across years for individuals who reported as being White or Black. We also found that those identifying as Asian, AI/AN, Hispanic, and those whose identifying race was not listed deviated across years. These latter groups were also less likely to have received colonoscopies, the gold standard of screening. Because CRC is oftentimes a preventable disease, the importance of appropriate screening cannot be emphasized enough.

Objectives Cesarean delivery (CD) is a common obstetrical procedure aimed at reducing maternal and infant morbidity and mortality in complicated pregnancies and medical emergencies yet carries potential complications. CD rates in the USA have increased over the years—likely associated with increased comorbidities. Thus, to expand the literature, our objective was to identify the likelihood of a woman having a CD when comorbidities—diabetes, high blood pressure (HBP), or depression—are present. Methods We conducted a cross-sectional analysis of the 2019 Pregnancy Risk Assessment Monitoring System. Binary and multivariable logistic regression were used to calculate adjusted odds ratios (AORs) to determine associations between pre-existing and gestational comorbidities and CD among pregnant women. Results Compared to those without a diagnosis, women with pre-existing diabetes (AOR: 1.69; CI: 1.54–1.86), pre-existing HBP (AOR: 1.58; CI: 1.46–1.69), and pre-existing depression (AOR: 1.14; CI 1.08–1.20; Table 2) were more likely to have a CD. Additionally, participants with gestational diabetes (AOR 1.43; CI 1.34–1.52), HBP (AOR 1.86; CI 1.76–1.95) and depression (AOR 1.13; CI 1.07–1.19) were also more likely to have a CD than those without comorbidities. Conclusions Higher rates of CD were found among individuals with a pre-existing or gestational diagnosis of diabetes, HBP, or depression than those without these diagnoses. With increasing rates of these conditions, it is likely that CD rates will continue their trajectory in the USA. Thus, professional organizations can have more impact by popularizing and making effective evidence-based guidelines for management.

INTRODUCTION: Children, adolescents, and young adults (AYAs) with cancer are a special population who are subjected to a number of unique challenges, stressors, and barriers to high-quality psychological care. In a recent systematic review of measurement properties, we found that 5 of 18 identified patient-reported outcome measures (PROMs) had sufficient psychometric properties to justify their use. A next step is to analyze the reliability of these scale scores in a reliability-generalization meta-analysis. METHODS: We conducted a systematic review of three databases for all studies reporting reliability data for previously identified PROMs. Included studies were further required to include patients with cancer, or survivors of cancer, ages 2–39. We next synthesized alpha and test-retest coefficients using best statistical practices, according to prespecified subgroups, where possible. We considered a threshold of 0.7 to represent sufficient evidence of reliability. RESULTS: Seventy-one studies were included. Overall, reliability coefficients for scale and subscale scores exceeded 0.7. Subgroup analyses were limited by incomplete reporting and a lack of sufficient studies for each subgroup; however, where conducted, these subgroup analyses showed significant differences in the reliability of self-reports versus proxy reports and original versus adapted versions of PROMs. DISCUSSION: We recommend better reporting of reliability data in future studies of children and AYAs with cancer. We discourage relying on historical reliability data in different samples and the reporting of only ranges of reliability coefficients for subscales. Our study suggests that significant differences in the reliability of PROMs may be associated with the PROM respondent and the version of the PROM, thus highlighting the need for further investigation.

Introduction: Children, adolescents, and young adults with cancer are a vulnerable population in whom improvements in psycho-oncology care would be valuable. We previously published a scoping review exploring what is known about positive psychological constructs in this population. A key finding was that evidence-based patient-reported outcome measures (PROMs) were needed to standardize psycho-oncology research. Methods: We undertook a systematic review of measurement properties focused on PROMs in the pediatric and adolescent/young adults (AYAs) with cancer populations. We searched for PROMs that measured at least 1 of 15 previously identified, key positive constructs. This systematic review followed COSMIN guidelines, considered the gold standard manual for systematic reviews of measurement properties. Results: We identified 20 (22 if proxy reports are counted separately) unique PROMs that met inclusion criteria. Of those, only five were recommended for use given the current evidence. The remainder may be used if no alternative exists. Only eight PROMs had any evidence of content validity, considered the most important psychometric property by COSMIN. Many studies were at risk of bias owing to incomplete or suboptimal methods. Discussion: Five PROMs are considered reliable for the pediatric and AYA with cancer populations. A number of PROMs require additional research to ensure their items and instructions are comprehensive, relevant, and comprehensible to children and AYAs. Given the overall lack of research, this review may be considered a starting point for the future refinement of a core set of PROMs to measure positive psychological constructs.

To assess the quality of harms reporting in systematic reviews (SRs) regarding minimally invasive hysterectomies (MIHs).We performed a cross sectional analysis on SRs addressing MIHs to assess completeness of harms reporting. Hysterectomies are common gynecological procedures and are associated with complications. Such adverse events can directly affect physician decision making and patient outcomes. Thus, it is important that SRs equally weigh the harms and benefits surrounding MIHs.On May 15th, 2022, we searched MEDLINE (Pubmed and Ovid), Embase, Epistemonikos, and the Cochrane Database of Systematic Reviews for SRs with or without a meta-analysis on MIH for any indication. Eligible studies underwent full text screening, data extraction, harms reporting assessment, and AMSTAR-2 quality assessment in a masked, duplicate fashion. The corrected covered area (CCA) was calculated to indicate any overlap between SR dyads.A total of 52 SRs met the inclusion criteria for data extraction. We found that over 44 (of 52; 84.6%) of included SRs reported more than 50% of the harms items. Completeness of harms reporting was significantly associated with harms specification as a primary outcome (P0.05). The corrected covered area was 0.60%.The harms reporting was more complete than hypothesized, but still had deficiencies throughout, such as inconsistent use of severity scales to classify harms. Even though MIH harms reporting in sample SRs was more complete than other fields of medicine, it was still suboptimal overall and requires refinement.

Owing to the frequent perioperative use of ketorolac tromethamine and its ability to minimise postoperative opioid requirements, it is important to continually reassess harms associated with its use. Our primary objective was to investigate the extent of harms reporting in systematic reviews (SRs) on ketorolac for perioperative pain.In May 2022, we conducted a search of major databases, MEDLINE (PubMed and Ovid), Embase, Epistemonikos, and the Cochrane Database of Systematic Reviews to identify eligible SRs on ketorolac for perioperative pain. Screening and data extraction were performed in masked, duplicate fashion. A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to appraise the methodological quality of included SRs. Corrected covered area (CCA) was calculated to determine overlap of primary studies between SR dyads.A total of 28 SRs evaluating 630 primary studies met the inclusion criteria. Seven SRs (7/28, 25%) reported no harms and 17 SRs (17/28, 60.7%) reported ≤50% of harms items. A significant association was found between completeness of harms reporting and whether harms were specified as a primary outcome (P0.001). No other associations were statistically significant. Regarding methodological quality, 22 SRs were appraised as 'critically low' (22/28, 78.6%), 5 as 'low' (5/28, 17.9%), and 1 as 'high' (1/28, 3.6%). One SR dyad had a CCA50% but neither reported harms.The extent of harms reporting in systematic reviews was inadequate. Given the importance that systematic reviews have on guiding perioperative decision-making, it is essential to improve the completeness of harms reporting.

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 Smoking cessation treatments and available evidence continue to evolve. To stay current with the latest research, physicians often refer to abstracts of systematic reviews. Because abstracts of systematic reviews may have direct effects on patient care, the information within them should be free of 'spin'. Spin is a specific way of reporting, intentional or not, to highlight that the beneficial effect of the experimental treatment in terms of efficacy or safety is greater than that shown by the results (i.e. overstate efficacy and/or understate harm). Methods We searched systematic reviews and meta-analyses focused on interventions and treatments for smoking cessation. Full-text screening, data extraction, evaluation of spin, and quality assessment were conducted in masked, duplicate fashion. Study and journal characteristics were also recorded to determine whether they were associated with the presence of spin. Results A total of 200 systematic reviews that met inclusion criteria were included in the final analyses. Spin occurred in 3.5% (7/200) of the systematic review abstracts included in our sample. No study characteristics were significantly associated with spin. Conclusions Of the reviewed abstracts in systematic reviews and meta-analyses, 96.5% of those that focused on smoking cessation were free of spin. However, the existence of spin warrants further steps to improve the scientific accuracy of abstracts on smoking cessation treatments. By identifying and acknowledging the presence of spin in systematic reviews, we hope to increase awareness about reporting practices in an ultimate effort to improve the integrity of scientific research as a whole.

Garrett Morgan1–31Department of Physiology, University of Utah School of Medicine, University of Utah, 2George E. Wahlen Department of Veterans Affairs Medical Center, 3Geriatric Research, Education and Clinical Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USAAbstract: Advancing age in humans is associated with a decline in function of physiological systems, as well as the onset and progression of many chronic diseases. An ongoing focus of basic aging research is to identify biomarkers that could be used to assess the severity of age-related diseases or that could also be modulated to treat them. Telomerase is an enzyme with mechanistic links to telomere length homeostasis and cell viability. Human telomerase is a ribonucleoprotein complex that consists of its catalytic subunit (hTERT) and ribonucleic acid template (hTERC). Telomerase adds de novo TTAGGG repeats to the ends of telomeres, which may prevent telomere shortening and subsequent dysfunction in certain cell compartments. Telomerase function within the cell represents a growing area of interest among biologists who study human aging, due to its potential use as a biomarker and therapeutic target for chronic disease. Here I review the basic biology of telomerase and the consequences of telomerase overexpression and deficiency in human cells and animal models. I discuss the putative role of telomerase in telomere-length homeostasis with advancing age in humans. Finally, I describe novel nontelomeric activities of telomerase related to cell viability and mitochondrial function.Keywords: chronic disease, inflammation, oxidative stress, hTERT, hTERC, mitochondria