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cal approach over another for rectal resection.
To assess tumour behaviour and the efficacy of active surveillance (AS) in patients with desmoid-type fibromatosis (DTF).
AS is recommended as initial management for DTF patients. Prospective data regarding the results of AS are lacking.
In this multicentre prospective cohort study (NTR4714), adult patients with non-intra-abdominal DTF were followed during an initial AS approach for 3 years. Tumour behaviour was evaluated according to RECIST. Cumulative incidence of the start of an active treatment and progression-free survival (PFS) were calculated using the Kaplan-Meier method. Factors predictive for start of active treatment were assessed by Cox regression analyses.
A total of 105 patients started with AS. Median tumour size at baseline was 4.1 cm (IQR 3.0-6.6). Fifty-seven patients had a T41A CTNNB1 mutation; 14 patients a S45F CTNNB1 mutation. At 3 years, cumulative incidence of the start of active treatment was 30% (95% CI 21-39) and PFS was 58% (95% CI 49-69). Median time to start active treatment and PFS were not reached at a median follow-up of 33.7 months. During AS, 32% of patients had stable disease, 28% regressed and 40% demonstrated initial progression. Larger tumour size (≥5 cm; hazard ratio (HR) = 2.38 [95% CI 1.15-4.90]) and S45F mutation (HR = 6.24 [95% CI 1.92-20.30]) were associated with the start of active treatment.
The majority DTF patients undergoing AS do not need an active treatment and experience stable or regressive disease, even after initial progression. Knowledge about the natural behaviour of DTF will help to tailor the follow-up schedule to the individual patient.
The majority DTF patients undergoing AS do not need an active treatment and experience stable or regressive disease, even after initial progression. Knowledge about the natural behaviour of DTF will help to tailor the follow-up schedule to the individual patient.
To study the association of perioperative administration of renin angiotensin system inhibitors (RASi) and clinical outcomes of patients with heart failure (HF) undergoing cardiac surgery.
It is controversial whether the perioperative RASi should be administered in HF patients undergoing cardiac surgery.
A total of 2,338 patients with HF and undergoing CABG and/or valve surgeries at multiple hospitals from 2001 to 2015 were identified from STS database. After adjustment using propensity score and instrumental variable, logistic regression was conducted to analyze the influence of preoperative continuation of RASi (PreRASi) on short-term in-hospital outcomes. Independent risk factors of 30-day mortality, major adverse cardiovascular events (MACE), and renal failure were analyzed by use of stepwise logistic regression. The effects of pre- and postoperative use of RASi (PostRASi) on long-term mortality were analyzed using survival analyses. Stepwise Cox regression was conducted to analyze the independent risk factors of 6-year mortality. The relationships of HF status and surgery type with perioperative RASi, as well as PreRASi-PostRASi, were also evaluated by subgroup analyses.
PreRASi was associated with lower incidences of 30-day mortality (p < 0.0001, OR 0.556, 95% CI 0.405-0.763), stroke (p = 0.035, OR 0.585, 95% CI 0.355-0.962), renal failure (p = 0.007, OR 0.663, 95% CI 0.493-0.894). Both PreRASi (p = 0.0137) and PostRASi (p = 0.007) reduced 6-year mortality compared with the No-RASi groups.
Pre- and postoperative use of RASi was associated with better outcomes for the patients who have HF and undergo CABG and/or valve surgeries. Preoperative continuation and postoperative restoration are warranted in these patients.
Pre- and postoperative use of RASi was associated with better outcomes for the patients who have HF and undergo CABG and/or valve surgeries. Preoperative continuation and postoperative restoration are warranted in these patients.
We conducted a multi-centre study to assess treatments and outcomes in a national cohort of infants with congenital ovarian cysts.
Wide variability exists in the treatment of congenital ovarian cysts. The effects of various treatment strategies on outcomes, specifically ovarian preservation, are not known.
Female infants diagnosed with congenital intra-abdominal cysts between 2013-2017 at 10 Canadian pediatric surgical centres were retrospectively evaluated. Sonographic characteristics, median time to cyst resolution, incidence of ovarian preservation, and predictors of surgery were evaluated. Subgroup analyses were performed in patients with complex cysts and cysts ≥40 mm in diameter.
The study population included 189 neonates. Median gestational age at diagnosis and median maximal prenatal cyst diameter were 33 weeks and 40 mm, respectively. Cysts resolved spontaneously in 117 patients (62%), 14 (7%) prenatally and the remainder at a median age of 124 days. Intervention occurred in 61 patients (32%), including prenatal aspiration (2, 3%), ovary-sparing resection (14, 23%) or oophorectomy (45, 74%). Surgery occurred at a median age of 7.4 weeks. Independent predictors of surgery included postnatal cyst diameter ≥ 40 mm (OR 6.19, 95% CI 1.66 - 35.9) and sonographic complex cyst character (OR 63.6, 95% CI 10.9 - 1232). There was no significant difference in the odds of ovarian preservation (OR 3.06, 95% CI 0.86 - 13.2) between patients who underwent early surgery (n = 22) and those initially observed for at least 3 months (n = 131).
Most congenital ovarian cysts are asymptomatic and spontaneously resolve. Early surgical intervention does not increase ovarian preservation.
Most congenital ovarian cysts are asymptomatic and spontaneously resolve. Early surgical intervention does not increase ovarian preservation.
The value effect of winning the health and productivity management (HPM) award on their stock prices is to be evaluated.
An event study and an evaluation of portfolio over the first-time HPM awardees were conducted.
The abnormal return (AR) of all the first-time HPM awardees was significantly positive (0.25%, P = 0.03), as well as cumulated AR ( P < 0.01 on day 0 and 3, P < 0.05 on day 1 and 2), with a booster effect on the market value by 1.7 × 10 9 JPY. The stock value appreciation of the portfolio of them was greater than that of the market portfolio (34.3% vs 21.8%).
The market participants support the view that HPM improves firms' performance. This positive and instantaneous value effect will encourage business managers to promote employee health.
The market participants support the view that HPM improves firms' performance. This positive and instantaneous value effect will encourage business managers to promote employee health.
We aimed to analyze the relationship between long working hours and depressive and anxiety symptoms according to gender and shift work.
After dividing shift and day workers according to sex, multiple logistic regression analysis was performed to investigate the relationship between weekly working hours and both depressive and anxiety symptoms.
Both depressive and anxiety symptoms were significantly higher in weekly working 40 to 52 and more than 52 hours compared with working fewer than 40 hours in female day workers. Male day workers and both male and female shift workers, showed the association between weekly working more than 52 hours and both depressive and anxiety symptoms, compared with working fewer than 40 hours.
Our study demonstrated a significant association between long working hours and depression and anxiety symptoms, regardless of gender and shift work schedule.
Our study demonstrated a significant association between long working hours and depression and anxiety symptoms, regardless of gender and shift work schedule.
To study healthcare avoidance behavior in pilots related to fear of aeromedical certificate loss.
Voluntary participation in an anonymous survey distributed to U.S. pilots.
A total of 3765 pilots were included in the analysis. There were 56.1% of pilots (n = 2111) who reported a history of healthcare avoidance behavior due fear for losing their aeromedical certificate. There were 45.7% who sought informal medical care (n = 1721) and 26.8% who misrepresented/withheld information on a written healthcare questionnaire for fear of aeromedical certificate loss (n = 994).
Aircraft pilots may participate in healthcare avoidance behavior related to fear of losing their aeromedical certificate. Further work is necessary to address pilot healthcare avoidance.
Aircraft pilots may participate in healthcare avoidance behavior related to fear of losing their aeromedical certificate. Further work is necessary to address pilot healthcare avoidance.
To examine the attributes associated with long duration COVID- 19 workers' compensation (WC) claims.
A study was conducted on 13,153 COVID-19 WC claims accepted by a workers' compensation insurance carrier between January 1, 2020 and November 30, 2021.
1) Ninety-five percent of accepted WC claims were closed within the study period; 2) five percent of claims had 30 days or longer of lost time accounting for 65% of total paid WC costs; 3) medical costs increased 8-fold once paid days lost crossed the threshold of 60 days or greater; 4) age was the strongest risk factor associated with increased WC costs and prolonged impairment.
Age at the time of infection was the major factor associated with prolonged impairment and high costs of COVID-19 related WC claims.
Age at the time of infection was the major factor associated with prolonged impairment and high costs of COVID-19 related WC claims.
Massive Open Online Courses (MOOCs) offer a flexible method of providing education to large numbers of people around the world. This study aimed to develop and pilot test a mini MOOC in order to teach knowledge and skills in occupational epidemiology.
Using instructional design principles, an open online course was developed.
Four modules have been designed and delivered in a pilot version requiring an 8-hour time commitment. Thirty postgraduate students evaluated different aspects of the MOOC. They appreciated the active learning approach, gave high rates of approval for learning effects and structure but would welcome more feedback and interaction.
Although students were satisfied, developing the MOOC entailed a considerable amount of time. A multi-institutional approach and international collaboration would be beneficial to improve the present MOOC and develop new ones.
Although students were satisfied, developing the MOOC entailed a considerable amount of time. H3B-120 molecular weight A multi-institutional approach and international collaboration would be beneficial to improve the present MOOC and develop new ones.
Our aim was to describe the effectiveness of employee temperature screening at a public hospital in San Francisco during the COVID-19 pandemic.
An estimated 6000 health care personnel (HCP) underwent daily screening before entry to campus. Logs of failed employee entrance temperature screenings from March 2020 through March 2021 were reviewed.
From March 2020 through March 2021, only one employee, who reported no symptom that could bar their entry to work, had an elevated temperature on screening. On re-check with an oral thermometer, that individual's temperature was normal.
While the rationale to continue temperature screening may be rooted in beliefs it will increase employee reporting of symptoms or exposures, our results indicates that such screening of HCP at large US hospitals has no utility in detecting COVID-19 or controlling its transmission.
While the rationale to continue temperature screening may be rooted in beliefs it will increase employee reporting of symptoms or exposures, our results indicates that such screening of HCP at large US hospitals has no utility in detecting COVID-19 or controlling its transmission.
