Geriatric assessment-derived deficit accumulation and patient-reported treatment burden in older adults with bladder cancer

BACKGROUND

When a person's workload of healthcare exceeds their resources, they experience treatment burden. At the intersection of cancer and aging, little is known about treatment burden. We evaluated the association between a geriatric assessment-derived Deficit Accumulation Index (DAI) and patient-reported treatment burden in older adults with early-stage, non-muscle-invasive bladder cancer (NMIBC).

METHODS

We conducted a cross-sectional survey of older adults with NMIBC (≥65 years). We calculated DAI using the Cancer and Aging Research Group's geriatric assessment and measured urinary symptoms using the Urogenital Distress Inventory-6 (UDI-6). The primary outcome was Treatment Burden Questionnaire (TBQ) score. A negative binomial regression with LASSO penalty was used to model TBQ. We further conducted qualitative thematic content analysis of responses to an open-ended survey question ("What has been your Greatest Challenge in managing medical care for your bladder cancer") and created a joint display with illustrative quotes by DAI category.

RESULTS

Among 119 patients, mean age was 78.9 years (SD 7) of whom 56.3% were robust, 30.3% pre-frail, and 13.4% frail. In the multivariable model, DAI and UDI-6 were significantly associated with TBQ. Individuals with DAI above the median (>0.18) had TBQ scores 1.94 times greater than those below (adjusted IRR 1.94, 95% CI 1.33-2.82). Individuals with UDI-6 greater than the median (25) had TBQ scores 1.7 times greater than those below (adjusted IRR 1.70, 95% CI 1.16-2.49). The top 5 themes in the Greatest Challenge question responses were cancer treatments (22.2%), cancer worry (19.2%), urination bother (18.2%), self-management (18.2%), and appointment time (11.1%).

CONCLUSIONS

DAI and worsening urinary symptoms were associated with higher treatment burden in older adults with NMIBC. These data highlight the need for a holistic approach that reconciles the burden from aging-related conditions with that resulting from cancer treatment.

Increasing adherence to the Mediterranean diet and lifestyle is associated with reduced fecal calprotectin and intra-individual changes in microbial composition of healthy subjects

The Mediterranean diet (MED) is associated with the modification of gut microbial composition. In this pilot study, we investigate the feasibility of a microbiota-targeted MED-based lifestyle intervention in healthy subjects. MED intervention integrating dietary counseling, a supporting mobile application, and daily physical activity measurement using step trackers was prospectively applied for 4 weeks. Blood and fecal samples were collected at baseline, after the 4-week intervention, and at 6 and 12 months. Blood counts, inflammatory markers, microbial and eukaryotic composition were analyzed. Dietary adherence was assessed using daily questionnaires. All 20 healthy participants (females 65%, median age 37), completed the 4-week intervention. Adherence to MED increased from 15.6 ± 4.1 (baseline) to 23.2 ± 3.6 points (4 weeks), p < .01, reflected by increased dietary fiber and decreased saturated fat intake (both p < .05). MED intervention modestly reduced fecal calprotectin, white blood cell, neutrophil, and lymphocyte counts, within the normal ranges (P < .05). Levels of butyrate producers including Faecalibacterium and Lachnospira were positively correlated with adherence to MED and the number of daily steps. Bacterial composition was associated with plant-based food intake, while fungal composition with animal-based food as well as olive oil and sweets. Increasing adherence to MED correlated with increased absolute abundances of multiple beneficial gut symbionts. Therefore, increasing adherence to MED is associated with reduction of fecal calprotectin and beneficial microbial alterations in healthy subjects. Microbiota targeted lifestyle interventions may be used to modify the intestinal ecosystem with potential implications for microbiome-mediated diseases.

Antibody response to group A streptococci in an epidemic of streptococcal pharyngitis

An epidemic of acute pharyngitis involving 280 cases occurred in a kibbutz in Israel during the fall and winter of 1972-1973. Group M and/or T type 12 streptococci was associated with the outbreak. No cases of rheumatic fever and no acute nephritis appeared in spite of the vigorous immune response to both cellular and extracellular antigens of group A streptococci documented in 50% to 80% of patients, suggesting that strain variation may be a feature of rheumatogenicity as well as nephritogenicity of group A streptococcal pharyngitis.

Evaluation of streptozyme and antistreptolysin O tests in streptococcal pyodermal nephritis

The evaluation of the streptozyme test in sera from 34 patients with streptococcal pyodermal nephritis was studied. Ninety-seven percent of the patients developed high titers of antistreptozyme antibodies on the first bleeding after hospitalization, in contrast to only 40% of patients who developed elevated antistreptolysin O titers. The high antistreptozyme titers declined during convalescence and reached normal levels in the sixth month after onset of the disease. The most significant fall in titers occurred between 1 and 2 months from the onset of disease. The streptozyme test may be particularly helpful as a rapid screening test for antibodies in streptococcal pyodermal nephritis.

Typing of Pseudomonas aeruginosa: comparison of the phage procedure with the pyocine technique

Two hundred and sixty strains of Pseudomonas aeruginosa were isolated from patients of the Asaf Harofe Government Hospital. The strains were typed by phage technique and 64 of them were also typed according to pyocine sensitivity. The two methods proved complementary, and reduced the number of untypable strains. Phage typing was performed with both routine test dilution (RTD) and more concentrated phage suspensions. The most reliable results were obtained at 100 RTD.