Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19

Importance: Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality. // Objective: To evaluate whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality. // Design, Setting, and Participants: The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis. // Exposures: SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated. // Main Outcomes and Measures: The primary end point was all-cause mortality within the primary hospitalization. // Results: Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19–related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86). // Conclusions and Relevance: The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed

Diabetes Care and Serious Mental Illness: An Institutional Ethnography

People with serious mental illness are genetically predisposed to diabetes. Their risk is heightened with the use of atypical antipsychotic medications. Contextual conditions also influence diabetes care and outcomes. There is a lack of research on diabetes care for the mentally ill in residential care facilities. Therefore, there is little understanding of the social relations that contribute to this group’s health disparities. Institutional ethnography was chosen to explore this phenomenon in a group of 26 women in a rural for-profit group home in southern Ontario. Work activities of residents and providers were examined to map out the social organization of health inequities. Interviewees included residents with diabetes, care providers, field workers, and health professionals. Observations and analysis of coordinating texts were further methods used to reveal disjunctures between discourses embedded within diabetes care guidelines and the actualities of living within imposed constraints of group home care. The overarching State interest in cost containment creates rationing that limits the care afforded residents, resulting in poor dietary intake and lack of quality of life opportunities. Further, group home policies regulate systems of safety, reporting, and financial accountability, but do not promote health. The medical and psychiatric divide also contributes to health disparities. Diabetes care provision supports ‘self-care,’ which is challenging for this group, and health providers lack understanding of contextual constraints. Combined, these social circumstances perpetuate disease development and make illness management difficult. These findings warrant the need for State financial support and policy changes that give primacy to illness prevention, health promotion, and medical management so the mentally ill can realize health and wellbeing. A linkage between mental and physical health care is also crucial. Further, health providers are urged to be critical of social ideologies that sustain health inequalities, and to deliver services that are sensitive to unique particularities.Ph

Snap-happy? The promise and problems of photovoice

Although photovoice is often hailed as a method that includes and gives voice to those whose perspectives are left out of research, this chapter details limits of photovoice within the context of rapid ethnography and institutional research. Although photovoice proved its worth in offering a fun, interactive way to engage residents in research, and in generating rich data on their perspectives of care home life, we experienced challenges incorporating this method into the project. We were unable to obtain ethical approval for its use with our original target group of those living with dementia, a limitation that changed our use of the method considerably. We also faced time constraints: our ethnographies were not long enough to recruit, teach camera usage, take and develop pictures, and conduct a follow-up interview. Ethical restrictions were placed on publishing photographs, limiting the ability to connect visual representations to narratives, which impacted presentation of findings

Prevalence of human papillomavirus antibodies in males and females in England.

BACKGROUND: Most studies of human papillomavirus (HPV) epidemiology have employed DNA testing, which measures current infections. Serum antibodies offer a longer-term marker of infection in individuals who seroconvert and can therefore provide additional information about the exposure of populations to HPV. METHODS: Sera from a population-based sample of males and females aged 10 to 49 years, in England, were tested for type-specific HPV antibodies using a multiplexed competitive Luminex assay and previously defined cutoffs of 20, 16, 20, and 24 mMU mL for HPV 6, 11, 16, and 18, respectively. Seropositivity and geometric mean titers of seropositives were analyzed by HPV type, gender, and age. Catalytic models were developed to explore potential effects of antibody waning over time and changing risk of infection by age-cohort. RESULTS: Seroprevalence for HPV 6, 11, 16, and 18 was 16.4%, 5.7%, 14.7%, and 6.3%, respectively, among females and 7.6%, 2.2%, 5.0%, and 2.0%, respectively, among males. Seroprevalence in females was significantly higher than males (P < 0.001 for all types) and showed a decline in older ages that was not seen in males. There was no evidence of declining antibody titers with increasing age. Model results suggest that cohort effects mediated through changes in sexual behavior better explain the observed trend in seroprevalence than waning antibodies over time. CONCLUSIONS: Preimmunization HPV seroprevalence in England shows similar trends to reports from other developed countries. We find the lower seroprevalence in older females probably reflects changes in sexual behavior over the last few decades. This study provides baseline data to monitor the impact of the immunization programme