Jacobs Institute of Women's Health
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Current advances 2024: A critical review of selected topics by the Association for the Advancement of Blood and Biotherapies (AABB) Clinical Transfusion Medicine Committee
No full textThe 2018 World Cancer Research Fund /American Institute for Cancer Research Score and Cancer Risk: Results from the Diabetes Prevention Program Outcomes Study
No full textBACKGROUND: Modifying lifestyle factors may reduce the incidence of obesity, diabetes, and cancer. OBJECTIVE: We examined how alignment with the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations using the 2018 WCRF/AICR Score was associated with incident lifestyle-related cancer in adults with prediabetes in the Diabetes Prevention Program (DPP, 1996-2001) and DPP Outcomes Study (DPPOS, 2002-2020), an observational follow-up of a randomized clinical trial. METHODS: Participants were randomized to lifestyle, metformin, or placebo interventions (mean 3y) and followed for an additional 19y. The 2018 WCRF/AICR Score (0-7 points; higher score, better alignment) was calculated from body weight, physical activity, diet, and alcohol components at 0, 1, 5, 6, 9, and 15y after randomization. Incident cancer was based on the 2018 WCRF/AICR 3rd Expert Report (18 cancers associated with lifestyle). Adjusted Cox proportional hazard models estimated associations between the Score (baseline [0], change from 0-1y, time-dependent) and lifestyle-related cancer. RESULTS: Participants\u27 (N=3000) mean baseline WCRF/AICR Score was 3.2 (SD=1.1). There were 403 incident lifestyle-related cancer cases. Scores improved after 1y and 15y (mean increase=0.43 and 0.27pts, respectively, both p\u3c0.001). The baseline Score was not associated with cancer risk. However, a 1-unit Score improvement from 0-1y and time-dependent Scores were significantly associated with a 14% (Hazard Ratio (HR)=0.86; 95% Confidence Interval (CI) 0.76, 0.97) and 9% (HR=0.91; 95% CI 0.83, 0.997) lower risk, respectively, with no effect modification by intervention group or diabetes status. In exploratory by-component analyses, no single component was associated with risk. CONCLUSIONS: Alignment with WCRF/AICR Recommendations may lower cancer risk in adults with prediabetes and type 2 diabetes, highlighting the importance of considering lifestyle factors for cancer prevention. TRIAL REGISTRATION NUMBER: Diabetes Prevention Program, NCT00004992; Diabetes Prevention Program Outcomes Study, NCT00038727 DPP STUDY REGISTRATION PAGE: https://clinicaltrials.gov/study/NCT00004992 DPPOS STUDY REGISTRATION PAGE: https://clinicaltrials.gov/study/NCT00038727
Culturally Adapting a Video-Based Self-acupressure Intervention to Manage Symptoms for Black and Latina Breast Cancer Survivors
No full textBlack and Latina breast cancer survivors (BCS) experience greater physical functioning decline and symptom burden than non-Hispanic White BCS, partially due to systemic racism and socioeconomic barriers. Self-administered acupressure has shown promising effects for reducing cancer-related symptoms and is a low-cost, integrative approach to managing symptoms. However, self-acupressure has not been tested in Black and Latina BCS. This study aimed to culturally adapt an existing self-acupressure video intervention and assess Black and Latina BCS\u27s feedback on the acceptability of the adapted video. Following learner verification and revision methods, we collaborated with community organizations and partners for cultural and linguistic adaptation of the existing video. We conducted semi-structured interviews with four community partners, two oncology providers, and six Black and Latina BCS to gather feedback on content comprehension, engagement, cultural acceptability, and satisfaction with the intervention. We made iterative revisions to the video and then conducted usability testing with the six BCS. We produced an 11-min self-acupressure video following participant feedback, including a need for clear differentiation between acupressure and acupuncture, simplified explanations of physiological effects of self-acupressure, increased culturally relevant presentation by including Black and Latina BCS performing acupressure demonstrations, testimonial segments, and lay language explanations. In usability testing, the six BCS rated the intervention highly. Black and Latina BCS were highly satisfied with the culturally adapted self-acupressure video and expressed strong interest in performing self-acupressure. Future studies will evaluate the intervention\u27s effects on symptom management and quality of life in these underrepresented populations
Bias in vital signs? Machine learning models can learn patients\u27 race or ethnicity from the values of vital signs alone
No full textOBJECTIVES: To investigate whether machine learning (ML) algorithms can learn racial or ethnic information from the vital signs alone. METHODS: A retrospective cohort study of critically ill patients between 2014 and 2015 from the multicentre eICU-CRD critical care database involving 335 intensive care units in 208 US hospitals, containing 200 859 admissions. We extracted 10 763 critical care admissions of patients aged 18 and over, alive during the first 24 hours after admission, with recorded race or ethnicity as well as at least two measurements of heart rate, oxygen saturation, respiratory rate and blood pressure. Pairs of subgroups were matched based on age, gender, admission diagnosis and disease severity. XGBoost, Random Forest and Logistic Regression algorithms were used to predict recorded race or ethnicity based on the values of vital signs. RESULTS: Models derived from only four vital signs can predict patients\u27 recorded race or ethnicity with an area under the curve (AUC) of 0.74 (±0.030) between White and Black patients, AUC of 0.74 (±0.030) between Hispanic and Black patients and AUC of 0.67 (±0.072) between Hispanic and White patients, even when controlling for known factors. There were very small, but statistically significant differences between heart rate, oxygen saturation and blood pressure, but not respiration rate and invasively measured oxygen saturation. DISCUSSION: ML algorithms can extract racial or ethnicity information from vital signs alone across diverse patient populations, even when controlling for known biases such as pulse oximetry variations and comorbidities. The model correctly classified the race or ethnicity in two out of three patients, indicating that this outcome is not random. CONCLUSION: Vital signs embed racial information that can be learnt by ML algorithms, posing a significant risk to equitable clinical decision-making. Mitigating measures might be challenging, considering the fundamental role of vital signs in clinical decision-making
Strengthening ethical oversight in genomics and biobanking: a retrospective analysis of research practices in Zimbabwe
No full textBACKGROUND: As genomics and biobanking expanded rapidly across Africa, ethical governance frameworks for genomic research and biobanking often failed to keep pace, particularly in countries like Zimbabwe, where research increasingly involved international collaboration, but regulatory oversight remained limited. This study analysed how Zimbabwean researchers addressed the ethical, legal, and sociocultural issues (ELSIs) central to human biospecimen and genomic research. METHODS: We conducted a comprehensive review of research protocols submitted to the Medical Research Council of Zimbabwe between 2009 and 2016, specifically those involving human biospecimen collection, biobanking, and genomic research. A structured abstraction form was employed to evaluate how these protocols addressed key ELSIs, including informed consent, biospecimen and data sharing, benefit sharing, and intellectual property considerations. RESULTS: Of the 200 eligible protocols, 92(46%) were submitted by independent research institutions and 67(33.5%) by universities. Consent practices varied: 99(49.5%) protocols utilized specific consent, 37(18.5%) employed broad consent, and 37(18.5%) used blanket consent. Notably, 2(1%) protocols did not use consent forms, opting instead for broad or specific notifications. Only 44(22%) protocols included plans for the destruction of collected samples. While 44(22%) protocols involved exporting biospecimens, nearly two-thirds of these lacked a material transfer agreement (MTA). Critically, benefit sharing was absent across all protocols, and only 26(13%) addressed intellectual property rights. CONCLUSIONS: This review exposes systemic gaps in the ethical planning of genomics and biobanking research in Zimbabwe. Although researchers are increasingly engaging in cutting-edge science, the regulatory and ethical frameworks require transformation. The limited attention to benefit sharing, consent for future use, and intellectual property reflects deeper governance and equity challenges. To protect research participants and ensure ethical integrity, Zimbabwe urgently needs updated national guidelines that define minimum standards for addressing a full range of ELSIs, moving beyond consent and privacy to embrace justice, accountability, and long-term stewardship. Strengthening these frameworks is crucial to ensuring ethical integrity in Zimbabwe\u27s growing biobanking and genomic research landscape
Coffee and cardiovascular disease
No full textWhile rigorous longitudinal study of a widely and enthusiastically consumed dietary substance has it challenges, recent exponential growth in the scientific evaluation of coffee consumption has resulted in a clearer appreciation of the link between this common drink and health outcomes. Coffee has complex effects that can vary between individuals depending on both inherited predispositions as well as consumption habits. Despite the common concern and conventional \u27wisdom\u27 that coffee can promote various cardiovascular diseases, the available data suggest that moderate coffee consumption is associated with a reduced risk of hypertension, type 2 diabetes, myocardial infarction, arrhythmias, heart failure, and even overall mortality. Some exceptions have emerged, including the potentially harmful effects of unfiltered coffee with respect to LDL cholesterol and randomized controlled data demonstrating an acute increase in frequency of premature ventricular contractions with coffee consumption. In many instances, the beneficial effects of coffee appear to be independent of caffeine. Given the ubiquity of coffee consumption and the growing prevalence of cardiovascular disease, translating the latest science into accessible knowledge has the capability to tremendously empower patients and impact global health
Complications Are Elevated in Patients Who Have Decubitus Ulcers Undergoing Hemiarthroplasty, But There are No Significant Difference in Two-Year Outcomes
No full textINTRODUCTION: Patients undergoing hemiarthroplasty for femoral neck fracture are generally frail and prone to complications. Decubitus ulcers, associated with poor mobility, may indicate worse outcomes, though this relationship remains understudied. We hypothesized that preoperative decubitus ulcers increase the risk of postoperative complications at 90 days and two years following hemiarthroplasty. METHODS: A national administrative claims database was queried for patients undergoing hemiarthroplasty for femoral neck fracture from 2010 to 2021. Patients were stratified by the presence of absence of a preoperative decubitus ulcer. Multivariable logistic regressions were used to evaluate the association between preoperative decubitus ulcers and postoperative complications occurring within 90 days and two years, including revision surgery, periprosthetic joint infection (PJI), and periprosthetic fracture (PPF). Odds ratios (OR) with 95% confidence intervals (CI) were reported, with statistical significance set at P \u3c 0.05. RESULTS: A total of 76,539 patients were included, of whom 1,288 (1.7%) had a diagnosed decubitus ulcer prior to surgery. The mean age was 72 years (range, 50 to 89). Within the first 90 days postoperatively, patients who had decubitus ulcers had an increased risk of 90-day readmission (OR 1.4, 95% CI: 1.2 to 1.6), surgical site infection (SSI) (OR 1.6, 95% CI: 1.2 to 2.2), pneumonia (PNA) (OR 2.2, 95% CI: 1.8 to 2.6), sepsis (OR 3.2, 95% CI: 2.5 to 4.0), and deep vein thrombosis (DVT) (OR 1.8, 95% CI: 1.4 to 2.3). There was no statistically significant difference in 90-day renal failure, arrhythmia, or mortality. The two-year risks of revision surgery (OR 1.4, 95% CI: 0.9-2.1), PJI (OR 1.5, 95% CI: 0.7-2.6), and PPF (OR 1.5, 95% CI: 0.8-2.8) were also not significantly different. CONCLUSION: Preoperative decubitus ulcers are associated with elevated risk of multiple 90-day postoperative complications but do not predict increased two-year surgical complication rates
Beyond Integration: Advancing Climate-Conscious Clinical Ethics Through Temporal, Resilience, and Responsibility Frameworks
No full textJuvenile Psoriatic Arthritis Inception Cohort in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry: Characteristics and Early Disease Outcomes
No full textOBJECTIVE: To characterize the demographics, disease characteristics and treatment patterns of an inception cohort of children with psoriatic arthritis (jPsA) within the CARRA Registry. METHODS: Patients diagnosed with jPsA within 6 months of CARRA Registry enrollment were included and observed for up to 24-months. Baseline disease characteristics, treatment history, disease activity measures, and patient reported outcomes were captured at 6-month intervals (+/- 3 months) at usual-care visits during the 24-month period. RESULTS: 306 patients were included. Patients were predominantly female (62.4%) with a median (IQR) age of onset of 11.0 years (6.0-14.0). At Registry enrollment, 52.3% had polyarticular course, median active joint count was 3.0 (1.0-6.0), 20.1% had enthesitis, 34.3% had dactylitis, 9.5% had active sacroiliitis, and 58.8% had psoriasis. Tumor necrosis factor inhibitors (TNFi) were used in 61.1% and other biologic DMARDs in 13.4% of patients. 20.5% of patients received treatment with ≥2 biologic DMARDs or traditional synthetic DMARDs. cJADAS-10 improved from a median of 10.0 (5.5-15.0) at baseline to 1.0 (0.0-5.0) at 24 months. Improvements were also seen in active enthesitis and active sacroiliitis. CONCLUSION: In this inception cohort of jPsA in the CARRA Registry, one-half of patients had polyarticular presentation, and the majority of patients required advanced therapy. Regardless of the treatment used, most patients had improvements in disease activity measures and patient reported outcomes, with most achieving clinically inactive disease. However, escalation of treatment was common, highlighting the unmet need for precision medicine in identifying the optimal initial drug for each individual patient
