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Differences in Pediatricians\u27 Income by Sex Over Time
No full textObjective: Previous Pediatrician Life and Career Experience Study (PLACES) 2016 data revealed that female pediatricians reported earning ∼94% of what male pediatricians reported, after adjusting for factors that might impact income. Has this disparity persisted?
Methods: Data from PLACES, a national longitudinal study, was used to examine pediatrician-reported income from 2017 to 2022. A regression analysis estimated the adjusted differences in female and male pediatricians\u27 annual income for each survey year. Models included sex and other key personal and practice characteristics for which female and male pediatricians\u27 careers might differ. A mixed effects regression for longitudinal analysis examined income across years for female and male pediatricians and if time-variant characteristics are associated with increased or decreased income.
Results: PLACES participation ranged from 83.6% in 2017% to 75.5% in 2022 (analytic n = 1251 in 2017 and 1077 in 2022). The unadjusted mean annual income in 2022 was 220 374 for female pediatricians and 11 000 annually. Income increased across years (coefficient = 0.03, P \u3c .001). The year-sex interaction was not significant, indicating that the female-male disparity did not change over time. Three time-variant characteristics associated with increased income over time included increased portion of continuous full-time work, work hours, and time in administrative work.
Conclusions: A national longitudinal study revealed that female pediatricians reported earning ∼93% of what their male colleagues reported, with a consistent gap from 2017 to 2022
Benefit of early oseltamivir therapy for adults hospitalized with influenza A: an observational study
No full textBackground: clinical guidelines recommend initiation of antiviral therapy as soon as possible for patients hospitalized with confirmed or suspected influenza.
Methods: A multicenter US observational sentinel surveillance network prospectively enrolled adults (aged ≥18 years) hospitalized with laboratory-confirmed influenza at 24 hospitals during October 1, 2022-July 21, 2023. A multivariable proportional odds model was used to compare peak pulmonary disease severity (no oxygen support, standard supplemental oxygen, high-flow oxygen/non-invasive ventilation, invasive mechanical ventilation, or death) after the day of hospital admission among patients starting oseltamivir treatment on the day of admission (early) versus those who did not (late or not treated), adjusting for baseline (admission day) severity, age, sex, site, and vaccination status. Multivariable logistic regression models were used to evaluate the odds of intensive care unit (ICU) admission, acute kidney replacement therapy or vasopressor use, and in-hospital death.
Results: A total of 840 influenza-positive patients were analyzed, including 415 (49%) who started oseltamivir treatment on the day of admission, and 425 (51%) who did not. Compared with late or not treated patients, those treated early had lower peak pulmonary disease severity (proportional aOR: 0.60, 95% CI: 0.49-0.72), and lower odds of intensive care unit admission (aOR: 0.24, 95% CI: 0.13-0.47), acute kidney replacement therapy or vasopressor use (aOR: 0.40, 95% CI: 0.22-0.67), and in-hospital death (aOR: 0.36, 95% CI: 0.18-0.72).
Conclusion: Among adults hospitalized with influenza, treatment with oseltamivir on day of hospital admission was associated reduced risk of disease progression, including pulmonary and extrapulmonary organ failure and death.
Keywords: antiviral therapy; influenza; oseltamivir; severity
Fostamatinib for Hospitalized Adults With COVID-19 and Hypoxemia: A Randomized Clinical Trial
No full textImportance: Fostamatinib, a spleen tyrosine kinase inhibitor, has been reported to improve outcomes of COVID-19.
Objective: To evaluate the efficacy and safety of fostamatinib in adults hospitalized with COVID-19 and hypoxemia.
Design, setting, and participants: This multicenter, phase 3, placebo-controlled, double-blinded randomized clinical trial was conducted at 41 US sites and 21 international sites between November 17, 2021, and September 27, 2023; the last follow-up visit was December 31, 2023. Participants were adults aged 18 years or older hospitalized with acute SARS-CoV-2 infection and hypoxemia. Data were analyzed between January 10 and March 8, 2024.
Interventions: Fostamatinib, 150 mg orally twice daily for 14 days, or placebo.
Main outcomes and measures: The primary outcome was oxygen-free days, an ordinal outcome classifying a participant\u27s status at day 28 based on mortality and duration of supplemental oxygen use. An adjusted odds ratio (AOR) greater than 1.0 was considered to indicate superiority of fostamatinib over placebo. A key secondary outcome was 28-day all-cause mortality. Safety outcomes included elevated transaminase values, neutropenia, and hypertension.
Results: Of the 400 participants randomized (median age, 67 years [IQR, 58-76 years]; 210 [52.5%] men), 199 received fostamatinib and 201 received placebo. The mean (SD) number of oxygen-free days was 13.4 (12.4) in the fostamatinib group and 14.2 (12.1) in the placebo group (unadjusted mean difference, -1.26 days [95% CI, -3.52 to 1.00 days]; AOR, 0.82 [95% credible interval (CrI), 0.58-1.17]). Mortality at 28 days occurred in 22 of 195 patients (11.3%) in the fostamatinib group and 16 of 197 (8.1%) in the placebo group (AOR, 1.44; 95% CrI, 0.72-2.90). Aspartate aminotransferase elevation occurred more commonly in the fostamatinib group (23 [11.6%]) than in the placebo group (11 [5.5%]; AOR, 2.28; 95% CrI, 1.07-4.84). Other safety outcomes were similar between groups.
Conclusions and relevance: In this randomized clinical trial of adults hospitalized with COVID-19 and hypoxemia, fostamatinib did not increase the number of oxygen-free days compared with placebo. These results do not support the hypothesis that fostamatinib improves outcomes among adults hospitalized with hypoxemia during the Omicron era
Fractional flow reserve-guided complete revascularization versus culprit-only percutaneous coronary intervention in patients with myocardial infarction: A meta-analysis of randomized controlled trials
No full textIntroduction: The optimal revascularization strategy for patients with myocardial infarction (MI) and multivessel coronary artery disease (CAD) remains an area of research and debate. Fractional flow reserve (FFR)-guided complete revascularization (CR) by percutaneous coronary intervention (PCI) has emerged as an alternative to traditional culprit-only PCI.
Objective: To investigate the outcomes of FFR-guided CR versus culprit-only PCI in patients with MI and multivessel CAD.
Methods: We systematically searched PubMed, Scopus and Cochrane Central databases for randomized controlled trials (RCTs) comparing FFR-guided CR versus culprit-only PCI in MI patients with multivessel CAD. Outcomes included a composite of all-cause death, MI, stroke and repeat revascularization, these individual outcomes, cardiac death, stent thrombosis (definite or probable), and contrast-induced acute kidney injury (CIAKI). Random effects models were used to generate risk ratios (RRs) with 95 % confidence intervals (CIs).
Result: The search identified 5 RCTs including 4618 patients with a median follow-up duration of 3 years. Compared with culprit-only PCI, FFR-guided CR was associated with less composite adverse events (RR 0.73; 95%CI 0.57-0.92; p = 0.009), cardiac death (RR 0.73; 95%CI 0.55-0.97; p = 0.03), and repeat revascularization (RR 0.61; 95%CI 0.44-0.84; p = 0.003). Both strategies were similar in terms of all-cause death, MI, stroke, stent thrombosis, and CIAKI.
Conclusion: FFR-guided complete revascularization appears to be superior to culprit-only PCI in reducing composite adverse events, cardiac death, and the need for repeat revascularization in patients with MI and multivessel CAD without a significant impact on recurrent myocardial infarction rates.
Social media abstract: 4618-patient meta-analysis: in MI w/ multivessel #CAD, #FFR-guided complete revascularization yields less composite adverse events, cardiac death & repeat revascularization than culprit-only #PCI.
Keywords: Acute Myocardial Infarction; Complete Revascularization; Culprit-Only PCI; Fractional flow reserve; Percutaneous coronary intervention
Rheumatoid arthritis associated recurrent pleural effusion
No full textPleural effusions and pulmonary nodules are known complications of rheumatoid arthritis (RA) though pleural extra-articular manifestations without clinical arthritis are rare. We present a 66-year-old male with dyspnea and weight loss, whose imaging revealed pleural effusions and lung nodules, multiple exudative pleural effusions, and a thoracoscopic biopsy showing chronic pleuritis and granulomatous inflammation. Subsequent joint stiffness and positive rheumatoid markers led to a RA diagnosis. Patient received prednisone and methotrexate, leading to symptomatic improvement but with recurrent pleural effusions, requiring regular thoracenteses. RA can cause pleural effusions and lung nodules without arthritis necessitating advanced treatments for persistent effusions
Developing personas to inform the design of digital interventions for perinatal mental health
No full textObjectives: Digital interventions are increasingly in demand to address mental health concerns, with significant potential to reach populations that disproportionately face barriers to accessing mental health care. Challenges with user engagement, however, persist. The goal of this study was to develop user personas to inform the development of a digital mental health intervention (DMHI) for a perinatal population.
Materials and methods: We used participatory User-Centered Design (UCD) methods to generate and validate personas (ie, representative profiles of potential users). We applied this methodology to a case example of an Anxiety Sensitivity Intervention. Phases included (1) Characteristic identification, (2) Persona generation, (3) Persona consolidation, (4) Persona validation, and (5) Persona refinement. Advisory Council members with lived expertise of perinatal mental health conditions generated 6 personas. We used cluster analysis and qualitative analysis to consolidate personas. We used participant interviews with perinatal individuals experiencing depression or anxiety and economic marginalization (n = 12) to qualitatively validate and refine these personas.
Results: We identified 4 user personas with potentially unique design needs that we characterized as being Resilient, Lonely, Overwhelmed, and Aware.
Discussion: Personas generated through this process had distinct characteristics and design implications including the need to prioritize (1) content personalization, (2) additional content describing support options and resources (eg, doulas, midwives), (3) careful consideration of the type of information provided by users, and (4) transparent options for information and data sharing.
Conclusion: DMHIs will need to be adapted for relevance for a perinatal population. The personas we developed are suggestive of the need for design considerations specific to distinct potential user groups within this population.
Keywords: digital health; perinatal anxiety; personas; prevention; user-centered design
Buprenorphine Injection Among Rural Persons Who Inject Drugs
No full textThis cross-sectional study investigates buprenorphine injection, including factors associated with this use, among rural individuals who inject drugs
Dementia Care Research and Psychosocial Factors
No full textBackground: Dementia care management programs, including the Care Ecosystem, have been shown to improve patient and caregiver outcomes, reduce unnecessary healthcare expenditures, and are the focus of Medicare\u27s new GUIDE payment model. Until now, prior research has focused on evaluating the effectiveness of participating for a short (eg, 12-month) time frame. The purpose of this study was to evaluate the effects of the Care Ecosystem when delivered for up to 5 years or end of life.
Methods: Of the 804 PLWD-caregiver dyads enrolled in the previously reported single-blind 12-month RCT of the Care Ecosystem (NCT02213458), 456 reported high baseline caregiver burden and were included in this extension trial (NCT04287738). Telephone-based dementia care management was delivered by a trained care team navigator, with a team of dementia specialists.
Primary outcome: PLWD quality of life (QoL-AD); Secondary: caregiver depression (PHQ-9), self-efficacy (Care Ecosystem Self-Efficacy scale), and burden (Zarit-12), and PLWD ED and hospital use. The cumulative treatment effect was the sum of the average treatment effect on each outcome at each timepoint, weighted by the number of active participants over time. Linear mixed effects models were used to estimate the treatment effect at the annual timepoints. Caregivers\u27 perspectives on the value of longer care were derived via semi-structured interviews after 5 years of participation.
Results: In this prespecified analysis including 297 dyads randomized to Care Ecosystem participation and 159 dyads to usual care, the cumulative 5-year treatment effect on quality of life, caregiver depression and self-efficacy were significant; there was a trend for caregiver burden. These treatment effects were most robust during the first 2-3 years of the study (Figure). The cumulative treatment effects on ED and hospital use were not significant. Most caregivers who participated for the 5 full years indicated that the emotional and practical support was helpful for the duration, but many derived the greatest benefit during the first few years when they were newer to being a caregiver.
Conclusion: The benefits of dementia care management on PLWD quality of life and caregiver well-being are sustained for five years, with the greatest effects in the first 2-3 years
Use of Practices to Reduce of Sudden Unexpected Infant Death among Caregivers of Opioid Exposed Newborns
No full textObjectives: Sudden unexpected infant death (SUID) occurs disproportionately among opioid exposed newborns (OENs) compared to those unexposed. The extent that primary caregivers of OENs adhere to SUID-reducing infant care practices is unknown. We examined rates of SUID-reducing practices (smoking cessation, breastfeeding, and safe sleep [supine sleep, room-sharing not bed-sharing, nonuse of soft bedding or objects]) in a pilot sample of caregivers of OENs.
Methods: We surveyed 50 English-speaking mothers and other primary caregivers of OENs 1-6 months old between 02/2022 and 10/2023. We examined prenatal and postnatal cigarette smoking exposure, breastfeeding initiation and duration, and sleep position (side, back, or stomach), sleep location (bed-sharing, room-sharing not bed-sharing, or separate room), and soft bedding or objects in the infant sleep space.
Results: Thirty-six (72%) of 50 respondents were birth mothers and 14/50 (28%) were other caregivers. Sixty-one percent of infants were exposed to cigarette smoking prenatally (mothers only) and 34% postnatally (41% mothers vs 14% other caregivers). Sixty percent of infants received breast milk ≤4 weeks. Among respondents, 32% placed infants in nonsupine sleep position (36% mothers vs 21% other caregivers), 38% shared a bed with their infant for sleep (47% mothers vs 14% other caregivers), and 30% used soft bedding in the infant sleep space (33% among mothers vs 21% among other caregivers).
Conclusions: Infant care practices associated with SUID were highly prevalent in our pilot sample of OENs and differed among mothers versus other caregivers. Further investigation and tailored approaches to this population are needed
