The fear of needles: A systematic review and meta‐analysis

AimsThe aim of this study was to evaluate the prevalence of needle fear and summarize the characteristics of individuals who exhibit this fear.BackgroundInjections are among the most common medical procedures, yet fear of needles can result in avoidance of preventive measures and treatment.DesignSystematic review and meta‐analysis.Data SourcesMEDLINE (1966–2017), Embase (1947–2017), PsycINFO (1967–2017), and CINAHL (1961–2017) were searched, with no restrictions by age, gender, race, language, or country.Review MethodsThe prevalence of needle fear was calculated and restricted maximum likelihood random effects models were used for meta‐analysis and meta‐regression.ResultsThe search yielded 119 original research articles which are included in this review, of which 35 contained sufficient information for meta‐analysis. The majority of children exhibited needle fear, while prevalence estimates for needle fear ranged from 20‐50% in adolescents and 20–30% in young adults. In general, needle fear decreased with increasing age. Both needle fear and needle phobia were more prevalent in females than males. Avoidance of influenza vaccination because of needle fear occurred in 16% of adult patients, 27% of hospital employees, 18% of workers at long‐term care facilities, and 8% of healthcare workers at hospitals. Needle fear was common when undergoing venipuncture, blood donation, and in those with chronic conditions requiring injection.ConclusionsFear of needles is common in patients requiring preventive care and in those undergoing treatment. Greater attention should be directed to interventions which alleviate fear in high‐risk groups.目的本研究旨在评估针头恐惧的发生率,并总结出现这种恐惧的个体的特征。背景注射是最常见的医疗程序之一,但对针头的恐惧会导致患者拒绝预防处理和治疗。设计系统回顾与元分析。数据来源搜索MEDLINE(1966‐2017)、Embase(1947‐2017)、PsycINFO(1967‐2017)和护理学数据库(CINAHL)(1961‐2017),不限制年龄、性别、种族、语言或国家。评价方法计算针头恐惧的发生率,采用限制性最大似然随机效应模型进行元分析和元回归分析。结果此次审查中检索出119篇原创研究论文,其中35篇包含足够的元分析信息。大多数儿童表现出针头恐惧症,而针头恐惧症的患病率估计在青少年中为20‐50%,年轻人为20‐30%。一般而言,随着年龄的增长,针头恐惧感也降低。女性的针头恐惧感和打针恐惧症比男性更普遍。16%的成年患者、27%的医院工作人员、18%的长期护理机构工作人员和8%的医院医务人员因害怕针头而避免接种流感疫苗。在静脉穿刺、献血和需要注射治疗的慢性疾病患者中,针头恐惧是一种常见现象。结论对针的恐惧在需要预防护理的患者和正在接受治疗的患者中很常见。应更加注重采取干预措施,减轻高危人群的针头恐惧。Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147205/1/jan13818_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147205/2/jan13818.pd

Longitudinal study of short‐term corticosteroid use by working‐age adults with diabetes mellitus: Risks and mitigating factors

BackgroundThis study assessed the frequency of short‐term oral corticosteroid use in adults with diabetes, examined the incidence of fractures, venous thromboembolism (VTE), and hospitalization for sepsis after corticosteroid use, and evaluated whether preventative medications mitigated adverse events.MethodsA longitudinal study (2012–14) was conducted of 1 548 945 adults (aged 18–64 years) who received healthcare coverage through a large national health insurer. Incidence rate ratios (IRR) were calculated using conditional Poisson regression.ResultsShort‐term oral corticosteroids were used by 23.9%, 20.8%, and 20.9% of adults with type 2 diabetes, type 1 diabetes, and no diabetes, respectively, during the 3‐year period (P < 0.001). Baseline risks of fracture, VTE, and sepsis were greater for individuals with than without diabetes (P < 0.001). The combined effect of having diabetes and using corticosteroids was greater than the sum of the individual effects (synergy indices of 1.17, 1.23, 1.30 for fracture, VTE, and sepsis, respectively). The IRR for VTE in the 5–30 days after corticosteroid use was 3.62 (95% confidence interval [CI] 2.41–5.45). Fractures increased in the 5–30 days after corticosteroid use (IRR 2.06; 95% CI 1.52, 2.80), but concomitant use of ergocalciferol mitigated this risk (IRR 1.13; 95% CI 0.12, 11.07). The risk of hospitalization for sepsis was elevated with corticosteroid use (IRR 3.79; 95% CI 2.05, 7.01), but was mitigated by the concomitant use of statins.ConclusionsShort‐term oral corticosteroid use is common in adults with diabetes and is associated with an elevated, but low, risk of adverse events. The findings suggest that preventative medications may mitigate risk.摘要背景这项研究在成年糖尿病患者中评估了短期使用口服糖皮质激素的频率,  调查了使用糖皮质激素后骨折与静脉血栓栓塞(venous thromboembolism, VTE)的发生率以及脓毒症的住院率,  并且评估了预防性用药是否会减少不良事件。方法这是一项在1548945名具有大型国家健康保险公司医疗保险的成年(年龄为18‐64岁)患者中进行的纵向研究(2012‐14)。使用有条件的Poisson回归分析来计算发病率比(incidence rate ratios, IRR)。结果在这3年期间,  短期使用口服糖皮质激素治疗的2型糖尿病、1型糖尿病以及非糖尿病成年患者的比例分别为23.9%、20.8%与20.9%(P < 0.001)。与非糖尿病患者相比,  糖尿病患者基线时的骨折、VTE以及脓毒症的风险都更高(P < 0.001)。患糖尿病以及使用糖皮质激素的联合效应大于个体效应之和(骨折、VTE以及脓毒症的协同指数分别为1.17、1.23、1.30)。使用糖皮质激素后的5‐30日内发生VTE的IRR为3.62(95%置信区间[CI]为2.41‐5.45)。使用糖皮质激素后的5‐30日内发生骨折的风险增加(IRR为2.06;95% CI为1.52, 2.80),  但同时使用麦角骨化醇治疗可以减少这种风险(IRR为1.13;95% CI为0.12, 11.07)。使用糖皮质激素后脓毒症的住院风险也增加了(IRR为3.79;95% CI为2.05, 7.01),  但是同时使用他汀类药物治疗可以减少这种风险。结论成年糖尿病患者短期使用口服糖皮质激素治疗很常见并且与不良事件风险轻度升高有关。这项研究结果表明预防性用药可以减少这种风险。HighlightsAdults with diabetes mellitus have a greater risk of fracture, venous thromboembolism, and sepsis than those without diabetes; the use of corticosteroids, even for short durations, increases this risk.Vitamin D mitigated the risk of fracture in patients with diabetes who used corticosteroids, and statins decreased the likelihood of hospitalization for sepsis in corticosteroid users with diabetes.Corticosteroids should be used with caution in patients with diabetes and mitigating factors should be considered.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144644/1/jdb12631.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144644/2/jdb12631_am.pd

Associations of common breast cancer susceptibility alleles with risk of breast cancer subtypes in BRCA1 and BRCA2 mutation carriers

Introduction: More than 70 common alleles are known to be involved in breast cancer (BC) susceptibility, and several exhibit significant heterogeneity in their associations with different BC subtypes. Although there are differences in the association patterns between BRCA1 and BRCA2 mutation carriers and the general population for several loci, no study has comprehensively evaluated the associations of all known BC susceptibility alleles with risk of BC subtypes in BRCA1 and BRCA2 carriers. Methods: We used data from 15,252 BRCA1 and 8,211 BRCA2 carriers to analyze the associations between approximately 200,000 genetic variants on the iCOGS array and risk of BC subtypes defined by estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and triple-negative- (TN) status; morphologic subtypes; histological grade; and nodal involvement. Results: The estimated BC hazard ratios (HRs) for the 74 known BC alleles in BRCA1 carriers exhibited moderate correlations with the corresponding odds ratios from the general population. However, their associations with ER-positive BC in BRCA1 carriers were more consistent with the ER-positive as

Functional mechanisms underlying pleiotropic risk alleles at the 19p13.1 breast-ovarian cancer susceptibility locus

A locus at 19p13 is associated with breast cancer (BC) and ovarian cancer (OC) risk. Here we analyse 438 SNPs in this region in 46,451 BC and 15,438 OC cases, 15,252 BRCA1 mutation carriers and 73,444 controls and identify 13 candidate causal SNPs associated with serous OC (P=9.2 × 10-20), ER-negative BC (P=1.1 × 10-13), BRCA1-associated BC (P=7.7 × 10-16) and triple negative BC (P-diff=2 × 10-5). Genotype-gene expression associations are identified for candidate target genes ANKLE1 (P=2 × 10-3) and ABHD8 (P<2 × 10-3). Chromosome conformation capture identifies interactions between four candidate SNPs and ABHD8, and luciferase assays indicate six risk alleles increased transactivation of the ADHD8 promoter. Targeted deletion of a region containing risk SNP rs56069439 in a putative enhancer induces ANKLE1 downregulation; and mRNA stability assays indicate functional effects for an ANKLE1 3′-UTR SNP. Altogether, these data suggest that multiple SNPs at 19p13 regulate ABHD8 and perhaps ANKLE1 expression, and indicate common mechanisms underlying breast and ovarian cancer risk

Genome-Wide Association Study in BRCA1 Mutation Carriers Identifies Novel Loci Associated with Breast and Ovarian Cancer Risk

BRCA1-associated breast and ovarian cancer risks can be modified by common genetic variants. To identify further cancer risk-modifying loci, we performed a multi-stage GWAS of 11,705 BRCA1 carriers (of whom 5,920 were diagnosed with breast and 1,839 were diagnosed with ovarian cancer), with a further replication in an additional sample of 2,646 BRCA1 carriers. We identified a novel breast cancer risk modifier locus at 1q32 for BRCA1 carriers (rs2290854, P = 2.7×10-8, HR = 1.14, 95% CI: 1.09-1.20). In addition, we identified two novel ovarian cancer risk modifier loci: 17q21.31 (rs17631303, P = 1.4×10-8, HR = 1.27, 95% CI: 1.17-1.38) and 4q32.3 (rs4691139, P = 3.4×10-8, HR = 1.20, 95% CI: 1.17-1.38). The 4q32.3 locus was not associated with ovarian cancer risk in the general population or BRCA2 carriers, suggesting a BRCA1-specific associat

A case-only study to identify genetic modifiers of breast cancer risk for BRCA1/BRCA2 mutation carriers

Breast cancer (BC) risk for BRCA1 and BRCA2 mutation carriers varies by genetic and familial factors. About 50 common variants have been shown to modify BC risk for mutation carriers. All but three, were identified in general population studies. Other mutation carrier-specific susceptibility variants may exist but studies of mutation carriers have so far been underpowered. We conduct a novel case-only genome-wide association study comparing genotype frequencies between 60,212 general population BC cases and 13,007 cases with BRCA1 or BRCA2 mutations. We identify robust novel associations for 2 variants with BC for BRCA1 and 3 for BRCA2 mutation carriers, P < 10−8, at 5 loci, which are not associated with risk in the general population. They include rs60882887 at 11p11.2 where MADD, SP11 and EIF1, genes previously implicated in BC biology, are predicted as potential targets. These findings will contribute towards customising BC polygenic risk scores for BRCA1 and BRCA2 mutation carriers

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century