Involuntary And Patient-Initiated Delays In Medical Care During The COVID-19 Pandemic

This paper uses data from a new, nationally representative survey to study delays in non–COVID-related medical care among US adults during the COVID-19 pandemic. We expand on prior research by taking a comprehensive look at the many reasons patients may have experienced delays in medical care and by studying the longer-run implications of these delays for patients’ self-reported health, use of telemedicine, feelings of regret, and likelihood of delaying care again in the future. Classifying delays in care broadly as involuntary (those due to availability or “supply-side” constraints) or patient-initiated (those due to patient concerns or “demand-side” constraints), we document important differences across demographic groups in the propensity to delay care for these reasons. In contrast to most prior work on this topic, our analyses can disentangle differences in the likelihood of delaying care from differences in pre-pandemic care-seeking behavior. We also demonstrate that the types of medical care that were delayed during the pandemic differed based on whether the delay was involuntary or patient-initiated, as did the duration of the delays and their associations with self-reported health, telemedicine use, and feelings of regret

A gestatiós diabetes mellitus súlyossága befolyásolja a három évvel a szülést követoen mért microvascularis diszfunkció mértékét, amely kapcsolatban állhat az emelkedett szisztémás oxidatív stresszel

INTRODUCTION: Oxidative-nitrative stress and poly(ADP-ribose) polymerase activation observed in gestational diabetes may play role in the increased cardiovascular risk in later life. AIM: The present study aimed to examine the influence of the severity of previous gestational diabetes (insulin need) on vascular function three years after delivery. Furthermore, the authors investigated the relation of vascular function with oxidative-nitrative stress and poly(ADP-ribose) polymerase activation. METHOD: Macrovascular function was measured by applanation tonometry; microvascular reactivity was assessed by provocation tests during Laser-Doppler flowmetry in 40 women who had gestational diabetes 3 years before the study. Oxidative-nitrative stress and poly(ADP-ribose) polymerase activity in blood components were determined by colorimetry and immunohistochemistry. RESULTS: Three years after insulin treated gestational diabetes impaired microvascular function and increased oxidative stress was observed compared to mild cases. CONCLUSIONS: The severity of previous gestational diabetes affects microvascular dysfunction that is accompanied by elevated oxidative stress. Nitrative stress and poly(ADP-ribose) polymerase activity correlates with certain vascular factors not related to the severity of the disease. Orv. Hetil., 2015, 156(47), 1932-1936

Guidelines for the Li–Fraumeni and heritable TP53 -related cancer syndromes

Abstract: Fifty years after the recognition of the Li–Fraumeni syndrome (LFS), our perception of cancers related to germline alterations of TP53 has drastically changed: (i) germline TP53 alterations are often identified among children with cancers, in particular soft-tissue sarcomas, adrenocortical carcinomas, central nervous system tumours, or among adult females with early breast cancers, without familial history. This justifies the expansion of the LFS concept to a wider cancer predisposition syndrome designated heritable TP53-related cancer (hTP53rc) syndrome; (ii) the interpretation of germline TP53 variants remains challenging and should integrate epidemiological, phenotypical, bioinformatics prediction, and functional data; (iii) the penetrance of germline disease-causing TP53 variants is variable, depending both on the type of variant (dominant-negative variants being associated with a higher cancer risk) and on modifying factors; (iv) whole-body MRI (WBMRI) allows early detection of tumours in variant carriers and (v) in cancer patients with germline disease-causing TP53 variants, radiotherapy, and conventional genotoxic chemotherapy contribute to the development of subsequent primary tumours. It is critical to perform TP53 testing before the initiation of treatment in order to avoid in carriers, if possible, radiotherapy and genotoxic chemotherapies. In children, the recommendations are to perform clinical examination and abdominal ultrasound every 6 months, annual WBMRI and brain MRI from the first year of life, if the TP53 variant is known to be associated with childhood cancers. In adults, the surveillance should include every year clinical examination, WBMRI, breast MRI in females from 20 until 65 years and brain MRI until 50 years

Guidelines for the Li–Fraumeni and heritable TP53 -related cancer syndromes

Abstract: Fifty years after the recognition of the Li–Fraumeni syndrome (LFS), our perception of cancers related to germline alterations of TP53 has drastically changed: (i) germline TP53 alterations are often identified among children with cancers, in particular soft-tissue sarcomas, adrenocortical carcinomas, central nervous system tumours, or among adult females with early breast cancers, without familial history. This justifies the expansion of the LFS concept to a wider cancer predisposition syndrome designated heritable TP53-related cancer (hTP53rc) syndrome; (ii) the interpretation of germline TP53 variants remains challenging and should integrate epidemiological, phenotypical, bioinformatics prediction, and functional data; (iii) the penetrance of germline disease-causing TP53 variants is variable, depending both on the type of variant (dominant-negative variants being associated with a higher cancer risk) and on modifying factors; (iv) whole-body MRI (WBMRI) allows early detection of tumours in variant carriers and (v) in cancer patients with germline disease-causing TP53 variants, radiotherapy, and conventional genotoxic chemotherapy contribute to the development of subsequent primary tumours. It is critical to perform TP53 testing before the initiation of treatment in order to avoid in carriers, if possible, radiotherapy and genotoxic chemotherapies. In children, the recommendations are to perform clinical examination and abdominal ultrasound every 6 months, annual WBMRI and brain MRI from the first year of life, if the TP53 variant is known to be associated with childhood cancers. In adults, the surveillance should include every year clinical examination, WBMRI, breast MRI in females from 20 until 65 years and brain MRI until 50 years

Welfare Families\u27 Use Of Early Childhood Care And Education Programs, And Implications For Their Children\u27s Development

With recent legislation placing a strong emphasis on the transition of welfare mothers into the workforce, it becomes increasingly important to understand whether and how participation in early childhood care and education programs has implications for the development of children from welfare families. This study focused on a sample of 182 African-American families, all of whom had applied for or were receiving Aid to Families With Dependent Children, and each with a child of between 3 and 5 years of age. We first examined which of a wide range of background characteristics predicted participation in early childhood care and education programs. We then examined whether measures of the children\u27s school readiness and social maturity were predicted by current participation in an early childhood program, above and beyond the background characteristics associated with the use of such a program. Our results indicate that participation in an early childhood program is associated with significantly higher scores on the measure of school readiness