Testing of a Tool for Prostate Cancer Screening Discussions in Primary Care

BackgroundAs prostate cancer (PCa) screening decisions often occur in outpatient primary care, a brief tool to help the PCa screening conversation in busy clinic settings is needed.MethodsA previously created 9-item tool to aid PCa screening discussions was tested in five diverse primary care clinics. Fifteen providers were recruited to use the tool for 4 weeks, and the tool was revised based upon feedback. The providers then used the tool with a convenience sample of patients during routine clinic visits. Pre- and post-visit surveys were administered to assess patients’ knowledge of the option to be screened for PCa and of specific factors to consider in the decision. McNemar’s and Stuart–Maxwell tests were used to compare pre-and post-survey responses.Results14 of 15 providers completed feedback surveys and had positive responses to the tool. All 15 providers then tested the tool on 95 men aged 40–69 at the five clinics with 2–10 patients each. The proportion of patients who strongly agreed that they had the option to choose to screen for PCa increased from 57 to 72% (p = 0.018) from the pre- to post-survey, that there are factors in the personal or family history that may affect PCa risk from 34 to 47% (p = 0.012), and that their opinions about possible side effects of treatment for PCa should be considered in the decision from 47 to 61% (p = 0.009).ConclusionA brief conversation tool for the PCa screening discussion was well received in busy primary-care settings and improved patients’ knowledge about the screening decision

Toxic effect of emerging aquatic micropollutants on marine microalgae through the analysis of cytotoxicity biomarkers

Programa Oficial de Doutoramento DO*MAR Marine Science, Technology and Management . 564V01[Resumen] Debido a la creciente presencia de microcontaminantes emergentes en el medio marino, ha surgido la necesidad de estudiar la potencial toxicidad de estos compuestos sobre organismos acuáticos como las microalgas, utilizadas como indicadores de la contaminación debido a su papel fundamental como productores primarios. En este trabajo se propone una aproximación metodológica basada en el análisis citómico, para caracterizar las alteraciones producidas por distintos compuestos pertenecientes a las principales clases de fármacos y productos de cuidado e higiene personal, en la microalga marina Tetraselmis suecica, y establecer marcadores específicos de contaminación que sean sensibles y de respuesta rápida. Esta microalga verde es de crecimiento rápido, fácil de cultivar en laboratorio y muy utilizada en acuicultura como cultivo auxiliar. Todos los contaminantes emergentes ensayados, los antibióticos cloranfenicol, florfenicol y oxitetraciclina, el fármaco omeprazol, el filtro solar benzofenona‐3, el conservante triclosán y la fragancia tonalide, provocaron alteraciones fisiológicas en T. suecica. La autoflurescencia celular, la actividad esterasa y el potencial de membrana citoplasmático, han sido los parámetros más sensibles, mostrando alteraciones significativas en las células transcurridas sólo 24 h de exposición a los contaminantes, antes de poder detectar cambios en el crecimiento o viabilidad celular de los cultivos.[Resumo] Debido á crecente presenza de microcontaminantes emerxentes no medio mariño, xurdiu a necesidade de estudar a potencial toxicidade destes compostos sobre organismos acuáticos como as microalgas, utilizadas como indicadores da contaminación debido ao seu papel fundamental como produtores primarios. Neste traballo proponse unha aproximación metodolóxica baseada na análise citómica, para caracterizar as alteracións producidas por distintos compostos pertencentes ás principais clases de fármacos e produtos de coidado e hixiene persoal, na microalga mariña Tetraselmis suecica, e establecer marcadores específicos de contaminación que sexan sensibles e de resposta rápida. Esta microalga verde é de crecemento rápido, fácil de cultivar en laboratorio e moi utilizada en acuicultura como cultivo auxiliar. Todos os contaminantes emerxentes ensaiados, os antibióticos cloranfenicol, florfenicol e oxitetraciclina, o fármaco omeprazol, o filtro solar benzofenona‐3, o conservante triclosán e a fragrancia tonalide, provocaron alteracións fisiolóxicas en T. suecica. A autoflurescencia celular, a actividade esterasa e o potencial de membrana citoplasmático, foron os parámetros máis sensibles, mostrando alteracións significativas nas células transcorridas só 24 h de exposición aos contaminantes, antes de poder detectar cambios no crecemento ou viabilidade celular dos cultivos.[Abstract] Due to the growing presence of emerging micropollutants in the marine environment, the need to study the potential toxicity of these compounds on aquatic organisms such as microalgae has arisen. These microorganisms are used as indicators of pollution due to their fundamental role as primary producers. This study suggest a methodological approach based on the cytometric analysis, to characterize the alterations produced by different compounds belonging to the main classes of pharmaceuticals and personal care products, on the marine microalga Tetraselmis suecica, and to establish sensitive and fast specific markers of pollution. This green microalga is fast‐growing, easy to culture in the laboratory and widely used in aquaculture as auxiliary culture. All the assayed emerging pollutants, the antibiotics chloramphenicol, florphenicol and oxytetracycline, the pharmaceutical omeprazole, the ultraviolet filter benzophenone‐3, the disinfectant triclosan and the fragrance tonalide, caused physiological alterations in T. suecica. Cell autofluorescence, esterase activity and cytoplasmic membrane potential were the most sensitive parameters, showing significant alterations in the cells after only 24 h of exposure to the pollutants, before being able to detect changes in cell growth or viability of the cultures

Changes in Characteristics and Treatment Patterns of Patients with Newly Diagnosed Type 2 Diabetes in a Large United States Integrated Health System between 2008 and 2013

To assess changes in the clinical characteristics and treatment patterns of patients with newly diagnosed type 2 diabetes (T2D), the electronic health record system at Cleveland Clinic was used to create cross-sectional summaries of all patients with new-onset T2D in 2008 and 2013. Differences between the 2008 and 2013 data sets were assessed after adjusting for age, gender, race, and income. Approximately one-third of patients with newly diagnosed T2D in 2008 and 2013 had an A1C ≤8%, suggesting the continued presence of a delayed recognition of the disease. Patients with newly diagnosed T2D in 2008 were older than those in 2013. Hypertension, cardiovascular disease, and neuropathy were highly prevalent among patients diagnosed with T2D. The prevalence of neuropathy, cerebrovascular disease, and peripheral vascular disease increased from 2008 to 2013. Metformin was the most commonly prescribed antidiabetic medication. Sulfonylurea usage remained unchanged, while use of thiazolidinediones decreased considerably

Antidiabetic treatment patterns and specialty care utilization among patients with type 2 diabetes and cardiovascular disease

Abstract Background To evaluate real-world patient characteristics, medication use, and health care utilization patterns in patients with type 2 diabetes with established cardiovascular disease (CVD). Methods Cross-sectional analysis of patients with type 2 diabetes seen at Cleveland Clinic from 2005 to 2016, divided into two cohorts: with-CVD and without-CVD. Patient demographics and antidiabetic medications were recorded in December 2016; department encounters included all visits from 1/1/2016 to 12/31/2016. Comorbidity burden was assessed by the diabetes complications severity index (DCSI) score. Results Of 95,569 patients with type 2 diabetes, 40,910 (42.8%) were identified as having established CVD. Patients with CVD vs. those without were older (median age 69.1 vs. 58.2 years), predominantly male (53.8% vs. 42.6%), and more likely to have Medicare insurance (69.4% vs. 35.3%). The with-CVD cohort had a higher proportion of patients with a DCSI score ≥ 3 than the without-CVD cohort (65.0% vs. 10.3%). Utilization rates of glucagon-like peptide-1 receptor agonists and sodium–glucose co-transporter-2 inhibitors were low in both with-CVD (4.1 and 2.5%) and without-CVD cohorts (5.4 and 4.1%), respectively. The majority of patient visits (75%) were seen by a primary care provider. During the 1-year observation period, 81.9 and 62.0% of patients with type 2 diabetes and CVD were not seen by endocrinology or cardiology, respectively. Conclusions These data indicated underutilization of specialists and antidiabetic medications reported to confer CV benefit in patients with type 2 diabetes and CVD. The impact of recently updated guidelines and cardiovascular outcome trial results on management patterns in such patients remains to be seen

Multi-omic brain and behavioral correlates of cell-free fetal DNA methylation in macaque maternal obesity models.

Maternal obesity during pregnancy is associated with neurodevelopmental disorder (NDD) risk. We utilized integrative multi-omics to examine maternal obesity effects on offspring neurodevelopment in rhesus macaques by comparison to lean controls and two interventions. Differentially methylated regions (DMRs) from longitudinal maternal blood-derived cell-free fetal DNA (cffDNA) significantly overlapped with DMRs from infant brain. The DMRs were enriched for neurodevelopmental functions, methylation-sensitive developmental transcription factor motifs, and human NDD DMRs identified from brain and placenta. Brain and cffDNA methylation levels from a large region overlapping mir-663 correlated with maternal obesity, metabolic and immune markers, and infant behavior. A DUX4 hippocampal co-methylation network correlated with maternal obesity, infant behavior, infant hippocampal lipidomic and metabolomic profiles, and maternal blood measurements of DUX4 cffDNA methylation, cytokines, and metabolites. We conclude that in this model, maternal obesity was associated with changes in the infant brain and behavior, and these differences were detectable in pregnancy through integrative analyses of cffDNA methylation with immune and metabolic factors