Skin cancer diagnosis over the lifetime in persons with different disabilities

Persons with disabilities globally experience barriers to medical care, preventative screening, and experience disparate health outcomes compared to those without disabilities. The prevalence of skin cancer in persons with different disabilities is not known. The Behavioral Risk Factor Surveillance System (BRFSS) data from 2017 to 2021 was analyzed to study skin cancer across the lifetime in patients with disabilities related to hearing, vision, ambulation, cognition, independent living, and self-care. Of the 10% of BRFSS respondents with a history of skin cancer, the unadjusted prevalence in those with any disability (9.2%) was higher than those without (5.1%). Patients with hearing (adjusted odds ratio (aOR) 1.29, 95% CI 1.26-1.33) and cognitive disabilities (aOR 1.27, 95% CI 1.24-1.31) had higher odds of skin cancer than those with visual, ambulatory, selfcare, and independent living disabilities. Every disability subgroup had an elevated odds of skin cancer and this was maintained in age-stratified analysis. The elevated odds of a skin cancer diagnosis in Americans with different disabilities may be explained by differences in healthcare utilization but further research is needed to understand this association and propose proactive interventions.

Prevalence of self-skin exams and full body skin exams among patients with disabilities

Full body skin exams and self-skin exams are screening methods associated with reduced skin cancer incidence due to earlier detection and treatment of lesions. We performed a retrospective analysis on skin cancer screening and risk factors from the Health Information National Trends Survey (HINTS). The study cohort comprised a weighted population of 478,008,736 respondents, of whom 26,727,370 were patients with disabilities. Respondents with disabilities reported a lower frequency of full body skin exams (OR 0.74; CI 95% 0.69-0.79; P < 0.001) and self-skin exams (OR 0.85; CI 95% 0.78-0.91; P < 0.001), compared to respondents without disabilities. Lower rates of self-guided and clinician-guided screening may adversely affect skin cancer-related morbidity and mortality in persons with disabilities. Future research is needed to identify barriers to self-skin exams and full body skin exams in this population.

Patient Perspectives on Clinic Note Transparency Within Dermatology

This survey study assesses dermatology patient experiences with viewing online medical records and seeks to identify areas for improvement.

P–227 Fatty acid regulation of Nrf2/Keap1 pathway during mouse preimplantation embryo development

Study question

Our objective is determining whether supplementing embryo culture media with palmitic acid and/or oleic acid impacts Nrf2/Keap1 antioxidant response pathways during preimplantation mouse embryo development.

Summary answer

Supplementation of embryo culture media with palmitic acid increases cellular Nrf2 levels per embryo after 48-hour culture, while oleic acid reverses this effect.

What is known already

Obese women experience higher incidence of infertility than women with healthy BMIs. The obese reproductive tract environment supporting preimplantation embryo development is likely to include enhanced free fatty acid (FFA) levels and increased accumulation of reactive oxygen species. Exposure to palmitic acid (PA) in vitro significantly impairs mouse embryo development while increasing ER stress mRNAs. Oleic acid (OA) reverses these effects. To further define effects of FFA exposure, we are characterizing the influence of FFAs on the Nrf2–Keap1 pathway and its downstream antioxidant defense systems. We hypothesize that PA treatment induces Nrf2-Keap1 activity, while OA treatment alleviates pathway activity.

Study design, size, duration

Female CD–1 mice (4–6 weeks) were super-ovulated via intraperitoneal injections of PMSG, followed 48 hours later by hCG. Female mice were mated with male CD–1 mice (6–8 months) overnight. Females were euthanized using CO2 and two-cell embryos were collected by flushing oviducts. Two-cell embryos were placed into KSOMaa-based treatment groups: 1) BSA (control); 2) 100µM PA; 3) 100µM OA; 4) 100µM PA+OA, and cultured for 48 hours (37 °C; 5% O2, 5% CO2, 90% N2).

Participants/materials, setting, methods

After 48-hour embryo culture, developmental stages of all mouse embryos were recorded. Immunofluorescence analysis of Nrf2 and Keap1 localization was performed for embryo treatments (BSA, 100µM PA, 100µM OA & 100µM PA+OA) using rabbit polyclonal anti-Nrf2 antibody, with Rhodamine-Phalloidin and DAPI staining. Embryos were imaged using confocal microscopy and Nrf2-positive cells were counted using ImageJ. Nrf2 and Keap1 mRNA abundances were assessed after culture in each treatment condition using RT-qPCR and the delta-delta Ct method.

Main results and the role of chance

Inclusion of 100µM PA in embryo culture significantly decreased blastocyst development frequency from 70.06±16.38% in the BSA (control) group to 11.61±8.19% in the PA-treated group (p &lt; 0.0001). Embryo culture with 100µM OA and 100µM PA+OA co-treatment did not significantly impair blastocyst development (OA: 61.59±8.07%, p = 0.4053; PA+OA: 63.53±7.63%, p = 0.6204).

Embryo culture with PA treatment significantly increased the mean percentage of Nrf2-positive cells to 56.83±30.49% compared with 21.22±15.63% in the control group (p &lt; 0.0001). Conversely, 100µM OA and 100µM PA+OA treatments did not significantly affect Nrf2-positive cell frequencies compared with the control group (OA: 33.28±21.83%, p = 0.1825; PA+OA: 34.84±12.66%, p = 0.0691). Immunofluorescence results show that treating embryos with 100µM PA for 48 hours results in increased levels of cellular Nrf2, while combining 100µM PA with 100µM OA reversed these effects.

Preliminary qPCR analysis showed no significant differences in Nrf2 or Keap1 relative transcript abundance between any embryo treatment groups. Nrf2 and Keap1 mRNA levels were both higher after embryo culture with 100µM OA than all other culture groups (p = 0.6268; p = 0.3201). Notably, Keap1 relative transcript levels dropped to undetectable levels after culture with 100µM PA, which suggests an increase in Nrf2 activation.Limitations, reasons for caution: While immunofluorescence localization of Nrf2/Keap1 provides insight into how the proteins behave during preimplantation embryo development, confocal images cannot determine protein-protein interactions or activity levels. Similarly, transcript information from RT-qPCR analysis only provides information about Nrf2 and Keap1 at the transcript level. Nrf2 activity will be assessed via downstream targets.

Wider implications of the findings: The Nrf2–Keap1 pathway coordinates numerous cellular defence mechanisms, and is implicated in various diseases, including cancer. Establishing an impact of free fatty acid exposure on Nrf2–Keap1 during preimplantation embryo development will provide valuable information regarding the effects of maternal obesity on outcomes for embryos produced from these patients.

Trial registration number

Not applicable

Immediate resolution of severe bullous chronic regional pain syndrome with onset of spinal paralysis

Complex regional pain syndrome (CRPS) is an incompletely understood disorder characterized by progressive regional pain and sensory changes, with fluctuating cutaneous edema and erythema. We describe a patient with a rarely reported severe bullous CRPS variant on the left lower extremity, which resolved immediately upon developing spinal paralysis.

Maternal and neonatal outcomes for pregnancies before and after gastric bypass surgery

BACKGROUND

Interaction between maternal obesity, intrauterine environment and adverse clinical outcomes of newborns has been described.

METHODS

Using statewide birth certificate data, this retrospective, matched-control cohort study compared paired birth weights and complications of infants born to women before and after Roux-en-Y gastric bypass surgery (RYGB) and to matched obese non-operated women in several different groups. Women who had given birth to a child before and after RYGB (group 1; n=295 matches) and women with pregnancies after RYGB (group 2; n=764 matches) were matched to non-operated women based on age, body mass index (BMI) prior to both pregnancy and RYGB, mother's race, year of mother/s birth, date of infant births and birth order. In addition, birth weights of 13 143 live births before and/or after RYGB of their mothers (n=5819) were compared (group 3).

RESULTS

Odds ratios (ORs) for having a large-for-gestational-age (LGA) neonate were significantly less after RYGB than for non-surgical mothers: ORs for groups 1 and 2 were 0.19 (0.08-0.38) and 0.33 (0.21-0.51), respectively. In contrast, ORs in all three groups for risk of having a small for gestational age (SGA) neonate were greater for RYGB mothers compared to non-surgical mothers (ORs were 2.16 (1.00-5.04); 2.16 (1.43-3.32); and 2.25 (1.89-2.69), respectively). Neonatal complications were not different for group 1 RYGB and non-surgical women for the first pregnancy following RYGB. Pregnancy-induced hypertension and gestational diabetes were significantly lower for the first pregnancy of mothers following RYGB compared to matched pregnancies of non-surgical mothers.

CONCLUSION

Women who had undergone RYGB not only had lower risk for having an LGA neonate compared to BMI-matched mothers, but also had significantly higher risk for delivering an SGA neonate following RYGB. RYGB women were less likely than non-operated women to have pregnancy-related hypertension and diabetes.

Effects of low-dose metformin and rosiglitazone on biochemical, clinical, metabolic and biophysical outcomes in polycystic ovary syndrome

The aim of this study was to compare the effect of low-dose metformin and rosiglitazone on clinical, biochemical, ultrasound features and endothelial function in patients with polycystic ovary syndrome (PCOS). After randomisation, a group of 17 women received metformin 500 mg b.d. (MG) and a group of 18 received rosiglitazone 4 mg o.d. (RG) for 3 months. Serum FSH, LH, testosterone, fasting glucose, insulin, IGF-1, IGFBP-3, CRP were measured at baseline and follow-up. Ovarian scan and microcirculation studies were also performed. It was found that there was a reduction in hyperandrogenaemia, insulin resistance, lipidaemia, CRP levels, ovarian volume and number of follicles in both groups. No improvement in endothelial- dependent function was noted but a significant improvement in endothelial-independent function in rosiglitazone group. It was concluded that low-dose therapeutic regimen with rosiglitazone and metformin, has comparable beneficial impacts on metabolic, hormonal and morphological features of PCOS but no obvious effect on vascular parameters in a population of predominantly mild PCOS.

Enhanced preservation of pig cardiac allografts by combining erythropoietin with glyceryl trinitrate and zoniporide

Erythropoietin has a tissue-protective effect independent of its erythropoietic effect that may be enhanced by combining it with the nitric oxide donor glyceryl trinitrate (GTN) and the sodium-hydrogen exchange inhibitor zoniporide in rat hearts stored with an extracellular-based preservation solution (EBPS). We thus sought to test this combination of agents in a porcine model of orthotopic heart transplantation incorporating donor brain death and total ischaemic time of approximately 260 min. Pig hearts were stored in one of four storage solutions: unmodified EBPS (CON), EBPS supplemented with GTN and zoniporide (GZ), EBPS supplemented with erythropoietin and zoniporide (EZ), or EBPS supplemented with all three agents (EGZ). A total of 4/5 EGZ hearts were successfully weaned from cardiopulmonary bypass compared with only 2/5 GZ hearts, 0/5 CON hearts and 0/5 EG hearts (p = 0.017). Following weaning from bypass EGZ hearts demonstrated superior contractility and haemodynamics than GZ hearts. All weaned hearts displayed impaired diastolic function. Release of troponin I from EGZ hearts was lower than all other groups. In conclusion, supplementation of EBPS with erythropoietin, glyceryl trinitrate and zoniporide provided superior donor heart preservation than all other strategies tested.

Evaluating a web-based self-management program for employees with hypertension and prehypertension: a randomized clinical trial

BACKGROUND

Web-based self-management programs offer a novel approach for self-insured employers seeking to improve and maintain employee health.

METHODS

We conducted a 6-month prospective, cluster-randomized controlled trial designed to evaluate whether worksite access to an automated, web-based, self-management program resulted in better blood pressure control. The trial was conducted at 6 EMC Corporation worksites in Massachusetts, each of which had at least 600 employees; 404 EMC employees with pre-hypertension or hypertension participated. Participants at 3 worksites received a home blood pressure cuff that uploaded readings to a Web site where they could view trends and read automated rules-based messages. Participants at 3 worksites received access to an onsite blood pressure cuff. Primary outcome measure was change in systolic blood pressure. Secondary outcome measures were change in diastolic blood pressure, proportion of participants achieving significant changes in systolic and diastolic blood pressure, and subject satisfaction.

RESULTS

Although the mean change in systolic blood pressure was not significantly different between intervention and control groups (-1.69 vs. -0.86 mm HG, respectively, P = .49) the change in diastolic blood pressure between groups was significant. (-1.08 vs. = 1.47 mm HG, respectively, P < .001). Significantly more intervention participants experienced a >10-mm Hg decrease in systolic blood pressure or >5-mm Hg decrease in diastolic blood pressure compared to controls (22% vs 17%, P = .02 and 29% vs 16%, P = .03, respectively). Intervention participants were twice as likely to report starting a new medication (P = .02) and more likely to report improved communication with their doctor (P = .02).

CONCLUSIONS

Participation in an automated online self-management program resulted in improved blood pressure among employees with prehypertension or hypertension.

Linking electronic health record-extracted psychosocial data in real-time to risk of readmission for heart failure

BACKGROUND

Knowledge of psychosocial characteristics that helps to identify patients at increased risk for readmission for heart failure (HF) may facilitate timely and targeted care.

OBJECTIVE

We hypothesized that certain psychosocial characteristics extracted from the electronic health record (EHR) would be associated with an increased risk for hospital readmission within the next 30 days.

METHODS

We identified 15 psychosocial predictors of readmission. Eleven of these were extracted from the EHR (six from structured data sources and five from unstructured clinical notes). We then analyzed their association with the likelihood of hospital readmission within the next 30 days among 729 patients admitted for HF. Finally, we developed a multivariable predictive model to recognize individuals at high risk for readmission.

RESULTS

We found five characteristics-dementia, depression, adherence, declining/refusal of services, and missed clinical appointments-that were associated with an increased risk for hospital readmission: the first four features were captured from unstructured clinical notes, while the last item was captured from a structured data source.

CONCLUSIONS

Unstructured clinical notes contain important knowledge on the relationship between psychosocial risk factors and an increased risk of readmission for HF that would otherwise have been missed if only structured data were considered. Gathering this EHR-based knowledge can be automated, thus enabling timely and targeted care.

Abstract P99: Improving Blood Pressure Control in a Workplace Setting: Evaluation of a Web-Based Self-Monitoring Program for Hypertensive and Prehypertensive Employees

INTRODUCTION: Many self-insured companies are exploring innovative programs to improve their workforce health. Hypertension and prehypertension are prevalent and lead to costly consequences for both employer and employee. New technologies allow individuals to play a greater role in self-management of their condition.

METHODS: We conducted a cluster randomized clinical trial to explore the effect of a web-based self-monitoring program on blood pressure (BP) control of employees with hypertension and prehypertension. A total of 404 subjects across 6 EMC worksites in Massachusetts were randomized at the site level to intervention or control group. Intervention subjects received a BP monitor linked to a communication device that uploaded BP readings to a secure website. The website enabled intervention subjects to track BP readings over time, access tailored feedback and educational material, and prompted them to see a doctor if readings became, or remained, out of control. Control subjects had access to a BP monitor at the worksite. All subjects were monitored for 6 months.

RESULTS: Overall, 56.9% (107/188) and 55.3% (104/188) of intervention subjects showed an improvement in systolic (SBP) and diastolic blood pressure (DBP) respectively, compared to 49.51% (101/204) and 35.78% (73/204) of controls (p=0.002 and p=0.002 respectively). A decline of >=5 mm Hg in DBP was seen in 28.7% (54/188) of intervention subjects compared to 16.2% (33/204) controls (p=0.03). Similarly, 22.3% (42/188) of intervention subjects achieved a >= 10 mm Hg decline in SBP compared to 16.7% (34/204) of controls (p=0.02). In addition, 63.4% (111/175) of intervention subjects reported improved communication with their doctor as a result of participation, compared to 51.1% (97/190) of controls (p=0.02); and 22.2% (26/117) of intervention subjects started a new BP medication as a result of participation, compared to 10.9% (12/110) of control subjects (p=0.03). Findings remained significant after adjusting for demographics, lifestyle factors etc.

CONCLUSION: This study demonstrates the efficacy of a web-based BP self-monitoring program at improving employee BP control. Use of the program appears to promote discussions about BP management between patients and their physicians.

Characterization of a new trabectedin-resistant myxoid liposarcoma cell line that shows collateral sensitivity to methylating agents

Myxoid Liposarcomas (MLS), characterized by the expression of FUS-CHOP fusion gene are clinically very sensitive to the DNA binding antitumor agent, trabectedin. However, resistance eventually occurs, preventing disease eradication. To investigate the mechanisms of resistance, a trabectedin resistant cell line, 402-91/ET, was developed. The resistance to trabectedin was not related to the expression of MDR related proteins, uptake/efflux of trabectedin or GSH levels that were similar in parental and resistant cells. The 402-91/ET cells were hypersensitive to UV light because of a nucleotide excision repair defect: XPG complementation decreased sensitivity to UV rays, but only partially to trabectedin. 402-91/ET cells showed collateral sensitivity to temozolomide due to the lack of O(6) -methylguanine-DNA-methyltransferase (MGMT) activity, related to the hypermethylation of MGMT promoter. In 402-91 cells chromatin immunoprecipitation (ChIP) assays showed that FUS-CHOP was bound to the PTX3 and FN1 gene promoters, as previously described, and trabectedin caused FUS-CHOP detachment from DNA. Here we report that, in contrast, in 402-91/ET cells, FUS-CHOP was not bound to these promoters. Differences in the modulation of transcription of genes involved in different pathways including signal transduction, apoptosis and stress response between the two cell lines were found. Trabectedin activates the transcription of genes involved in the adipogenic-program such as c/EBPα and β, in 402-91 but not in 402-91/ET cell lines. The collateral sensitivity of 402-91/ET to temozolomide provides the rationale to investigate the potential use of methylating agents in MLS patients resistant to trabectedin.

A survey of nematode control measures used by sheep farmers and of anthelmintic resistance on their farms Part 2: South Island excluding the Nelson region

Forty-three randomly selected farms located throughout South Island, excluding the Nelson region, were surveyed for anthelmintic usage and for sheep nematodes resistant to anthelmintics. Most farmers had used both benzimidazole and non-benzimidazole broad-spectrum drenches on their properties in previous years. Sheep were being drenched, on average, 5.6 times within their first year of life but much less frequently thereafter. Commercial interests played the dominant role in helping farmers formulate their drenching policies. On each farm 24 numbered ewe replacement lambs, born during the spring of 1980, were sampled for faeces at the beginning of the trial to provide material for egg counts and larval cultures. The lambs were weighed and divided into three groups of eight. One group received thiabendazole (TBZ) at 66 mg/kg, the second levamisole (LEV) at 8 mg/kg while the third remained untreated as controls. All were resampled 4 to 10 days later. On 32 (88%) of the 40 farms where drenching trials were successfully carried out during autumn 1981, the faecal egg count depression (FECD) following treatment with either drench was 100%. On one farm TBZ was less than 100% effective as gauged by FECD. LEV proved to be less than 100% effective on 7 farms. On one farm the FECD was less than 80%, on 2 between 90% and 95% and on 4 between 95% and 99%.

A phase I study of the safety and tolerability of olaparib (AZD2281, KU0059436) and dacarbazine in patients with advanced solid tumours

Background:

Poly adenosine diphosphate (ADP)-ribose polymerase (PARP) is essential in cellular processing of DNA damage via the base excision repair pathway (BER). The PARP inhibition can be directly cytotoxic to tumour cells and augments the anti-tumour effects of DNA-damaging agents. This study evaluated the optimally tolerated dose of olaparib (4-(3--4-fluorophenyl) methyl-1(2H)-one; AZD2281, KU0059436), a potent PARP inhibitor, with dacarbazine and assessed safety, toxicity, clinical pharmacokinetics and efficacy of combination treatment.

Patients and methods:

Patients with advanced cancer received olaparib (20–200 mg PO) on days 1–7 with dacarbazine (600–800 mg m⁻² IV) on day 1 (cycle 2, day 2) of a 21-day cycle. An expansion cohort of chemonaive melanoma patients was treated at an optimally tolerated dose. The BER enzyme, methylpurine-DNA glycosylase and its substrate 7-methylguanine were quantified in peripheral blood mononuclear cells.

Results:

The optimal combination to proceed to phase II was defined as 100 mg bd olaparib with 600 mg m⁻² dacarbazine. Dose-limiting toxicities were neutropaenia and thrombocytopaenia. There were two partial responses, both in patients with melanoma.

Conclusion:

This study defined a tolerable dose of olaparib in combination with dacarbazine, but there were no responses in chemonaive melanoma patients, demonstrating no clinical advantage over single-agent dacarbazine at these doses.

Text messages as a reminder aid and educational tool in adults and adolescents with atopic dermatitis: a pilot study

Optimal management of atopic dermatitis (AD) requires patients to adhere to self-care behaviors. Technologies, such as cell phones, have been widely adopted in the USA and have potential to reinforce positive health behaviors. We conducted a pilot study with 25 adolescents and adults age 14 years and older [mean 30.5 yrs, SD 13.4] with AD. Daily text messages (TMs) that provided medication reminders and AD education were sent for six weeks to participants. Our goals were to (1) measure changes in pre- and posttest scores in treatment adherence, self-care behaviors, disease severity, and quality of life and (2) assess the usability and satisfaction of the TM system. Significant improvements in treatment adherence, self-care behaviors, skin severity, and quality of life (P ≤ .001, .002, <.001, and .014, resp.) were noted postintervention. User feedback on the TM system was positive with 88% and 92% of participants reporting that the reminder TMs and educational TMs were helpful, respectively. In conclusion, study participants were receptive to using TMs as a reminder aid and educational tool. The positive trends observed are promising and lay the ground work for further studies needed to elucidate the full potential of this simple and cost-effective intervention.

Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases

We carried out a retrospective review of 47 intra-articular fractures of the calcaneum treated by open reduction and internal fixation in 45 patients by a single surgeon between 1993 and 2001. The fractures were evaluated before operation by plain radiographs and a CT scan using Sanders' classification. Osteosynthesis involved a lateral approach and the use of the AO calcaneal plate. The mean follow-up was for ten years (7 to 15). Clinical assessment included the American Orthopaedic Foot and Ankle Society Score (AOFAS), the Creighton-Nebraska Score, the Kerr, Prothero, Atkins Score and the SF-36 Health Questionnaire. The radiological evaluation consisted of lateral and axial views of the os calcis. Arthritic changes in the subtalar joint were assessed with an internal oblique view and were graded using the Morrey and Wiedeman scale. There were 18 excellent (38.3%), 17 good (36.2%), three fair (6.3%) and nine poor (19.2%) results. Five patients had a superficial wound infection and five others eventually had a subtalar arthrodesis because of continuing pain. Restoration of Böhler's angle was associated with a better outcome. The degree of arthritic change in the subtalar joint did not correlate with the outcome scores or Sanders' classification. Prompt osteosynthesis should be considered for intra-articular fractures of the calcaneum in order to restore the shape of the hindfoot and Böhler's angle.

Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases

We carried out a retrospective review of 47 intra-articular fractures of the calcaneum treated by open reduction and internal fixation in 45 patients by a single surgeon between 1993 and 2001. The fractures were evaluated before operation by plain radiographs and a CT scan using Sanders' classification. Osteosynthesis involved a lateral approach and the use of the AO calcaneal plate. The mean follow-up was for ten years (7 to 15). Clinical assessment included the American Orthopaedic Foot and Ankle Society Score (AOFAS), the Creighton-Nebraska Score, the Kerr, Prothero, Atkins Score and the SF-36 Health Questionnaire. The radiological evaluation consisted of lateral and axial views of the os calcis. Arthritic changes in the subtalar joint were assessed with an internal oblique view and were graded using the Morrey and Wiedeman scale. There were 18 excellent (38.3%), 17 good (36.2%), three fair (6.3%) and nine poor (19.2%) results. Five patients had a superficial wound infection and five others eventually had a subtalar arthrodesis because of continuing pain. Restoration of Böhler's angle was associated with a better outcome. The degree of arthritic change in the subtalar joint did not correlate with the outcome scores or Sanders' classification. Prompt osteosynthesis should be considered for intra-articular fractures of the calcaneum in order to restore the shape of the hindfoot and Böhler's angle.

Text-message reminders to improve sunscreen use: a randomized, controlled trial using electronic monitoring

OBJECTIVE

To evaluate the effectiveness of cellular telephone text messaging as a reminder tool for improving adherence to sunscreen application.

DESIGN

We conducted a randomized, controlled trial of the effect of an electronic text-message reminder system on adherence to sunscreen application. Adherence to daily sunscreen use was evaluated using a novel electronic monitoring device.

SETTING

Participants were recruited from the general community.

PARTICIPANTS

Seventy participants constituted a volunteer sample from the general community. The inclusion criteria required participants to be 18 years or older, to own a cellular telephone with text-message features, and to know how to retrieve text messages. Intervention Half of the participants received daily text-message reminders via cellular telephone for 6 weeks, and the other half did not receive reminders. The text-message reminders consisted of 2 components: a "hook" text detailing daily local weather information and a "prompt" text reminding users to apply sunscreen. Main Outcome Measure The primary end point of the study was adherence to sunscreen application measured by the number of days participants applied sunscreen during the 6-week study period.

RESULTS

All 70 participants completed the 6-week study. There were no statistically significant differences in baseline characteristics between the 2 study groups. At the end of the study period, the 35 participants who did not receive reminders had a mean daily adherence rate of 30.0% (95% confidence interval, 23.1%-36.9%). In comparison, the 35 participants who received daily text-message reminders had a mean daily adherence rate of 56.1% (95% confidence interval, 48.1%-64.1%) (P < .001). Among the participants in the reminder group, 24 (69%) reported that they would keep using the text-message reminders after the study, and 31 (89%) reported that they would recommend the text-message reminder system to others. Subgroup analysis did not reveal any significant demographic factors that predicted adherence.

CONCLUSIONS

Despite awareness of the benefits of sunscreen, adherence is low, even in this population, for whom adherence was knowingly monitored. Short-term data demonstrate that using existing cellular telephone text-message technology offers an innovative, low-cost, and effective method of improving adherence to sunscreen application. The use of ubiquitous communications technology, such as text messaging, may have implications for large-scale public health initiatives. Trial Registration clinicaltrials.gov Identifier: NCT00535769.

Text-message reminders to improve sunscreen use: a randomized, controlled trial using electronic monitoring

OBJECTIVE

To evaluate the effectiveness of cellular telephone text messaging as a reminder tool for improving adherence to sunscreen application.

DESIGN

We conducted a randomized, controlled trial of the effect of an electronic text-message reminder system on adherence to sunscreen application. Adherence to daily sunscreen use was evaluated using a novel electronic monitoring device.

SETTING

Participants were recruited from the general community.

PARTICIPANTS

Seventy participants constituted a volunteer sample from the general community. The inclusion criteria required participants to be 18 years or older, to own a cellular telephone with text-message features, and to know how to retrieve text messages. Intervention Half of the participants received daily text-message reminders via cellular telephone for 6 weeks, and the other half did not receive reminders. The text-message reminders consisted of 2 components: a "hook" text detailing daily local weather information and a "prompt" text reminding users to apply sunscreen. Main Outcome Measure The primary end point of the study was adherence to sunscreen application measured by the number of days participants applied sunscreen during the 6-week study period.

RESULTS

All 70 participants completed the 6-week study. There were no statistically significant differences in baseline characteristics between the 2 study groups. At the end of the study period, the 35 participants who did not receive reminders had a mean daily adherence rate of 30.0% (95% confidence interval, 23.1%-36.9%). In comparison, the 35 participants who received daily text-message reminders had a mean daily adherence rate of 56.1% (95% confidence interval, 48.1%-64.1%) (P < .001). Among the participants in the reminder group, 24 (69%) reported that they would keep using the text-message reminders after the study, and 31 (89%) reported that they would recommend the text-message reminder system to others. Subgroup analysis did not reveal any significant demographic factors that predicted adherence.

CONCLUSIONS

Despite awareness of the benefits of sunscreen, adherence is low, even in this population, for whom adherence was knowingly monitored. Short-term data demonstrate that using existing cellular telephone text-message technology offers an innovative, low-cost, and effective method of improving adherence to sunscreen application. The use of ubiquitous communications technology, such as text messaging, may have implications for large-scale public health initiatives. Trial Registration clinicaltrials.gov Identifier: NCT00535769.

Mobile phone technology for children with type 1 and type 2 diabetes: a parent survey

PURPOSE

The novel application of information technology has the potential to improve care for children with diabetes. We surveyed parents of children with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) to (1) identify their concerns related to their children's diabetes and (2) assess the relationship between these concerns and parental attitudes toward a glucometer integrated into a mobile phone that could provide parents and health care providers with a child's real-time glucose readings via text message and a secure Web site.

METHODS

We conducted a cross-sectional Web-based survey of parents with children ages 10-19 years (125 with T1DM and 77 with T2DM). Parental concerns were grouped by (1) access to their child's provider, (2) parenting challenges, and (3) knowledge about managing their child's diabetes.

RESULTS

Parental concerns focused mostly on access to their child's health care provider. Over half of respondents expressed interest in subscribing to a mobile-phone-based service. In multivariate logistic regression models, the odds of being willing to use the service increased if parents had concerns about provider access, a child with T2DM, a college education, or currently subscribed to text messaging. Enthusiasm decreased with increasing annual service cost.

CONCLUSIONS

Study participants-particularly parents with provider access concerns or a child with T2DM-were receptive to adopting novel health technology to help manage their children's diabetes. Adoption of such tools is most likely driven by the unmet needs of parents.

Cutaneous fungal infections in the United States: Analysis of the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS), 1995-2004

BACKGROUND

Dermatophyte infections lead to high costs and differentially affect certain groups. Previous population studies have been limited in size, duration, and representativeness.

METHODS

Using the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (1995-2004), a cross-sectional analysis of ambulatory visits in the USA was performed. Outpatients presenting with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-coded diagnoses of tinea unguium, tinea corporis/manuum, tinea pedis, tinea capitis, and tinea cruris were identified. Trends, descriptive epidemiology, and point prevalence estimates for these conditions were determined using stratification and standardization.

RESULTS

There was an estimated average of 4,124,038 +/- 202,977 annual visits for dermatophytoses during the study period. Tinea unguium, tinea corporis, tinea pedis, tinea capitis, and tinea cruris represented 23.2%, 20.4%, 18.8%, 15.0%, and 8.4%, respectively, of such infections; 71.6% of tinea unguium visits occurred among those older than 45 years. Tinea capitis was significantly more common among the black than the white population (prevalence odds ratio = 12.4; 95% confidence interval, 9.9-15.7). Ineffective treatment of tinea pedis, tinea corporis, and tinea cruris with polyenes, such as nystatin, commonly occurred.

CONCLUSIONS

Improved healthcare provider education is needed to ensure judicious antidermatophyte drug management. Further studies, including proven diagnoses via fungal microscopy and culture, are needed to explain the prevalence discrepancy of tinea capitis among black children and tinea unguium in older adults, focusing on preventable risk factors.

A phase I study of extended dosing with lomeguatrib with temozolomide in patients with advanced melanoma

Lomeguatrib, an O⁶-methylguanine-DNA methyltransferase inactivator, was evaluated in an extended dosing regimen with temozolomide, designed according to pharmacodynamic data from previous studies. Patients with unresectable stage 3 or 4 cutaneous or unknown primary melanoma metastases were treated with lomeguatrib 40 mg, b.i.d. for 10 or 14 days and temozolomide 75–100 mg m⁻² on days 1–5. Drugs were administered orally with cycles repeated every 28 days, for up to six cycles. A total of 32 patients were recruited to the study. Lomeguatrib for 10 days with temozolomide 75 mg m⁻² was established as the optimal extended lomeguatrib dosing schedule, with haematological toxicity being dose limiting. There were two partial responses to treatment giving an overall response rate of 6.25%. Extending lomeguatrib administration beyond that of temozolomide requires a reduced dose of the latter agent. Only limited clinical activity was seen, suggesting no advantage for this regimen over conventional temozolomide administration in the treatment of melanoma.

Diabetes connected health: a pilot study of a patient- and provider-shared glucose monitoring web application

BACKGROUND

Real-time sharing of blood glucose results with providers could improve communication and lead to more timely medication titration. New technology platforms are available to support the delivery of innovative models of care delivery.

METHODS

In the Diabetes Connected Health (DCH) pilot study, patients with diabetes received access to an online application that stored and graphed glucose readings uploaded from a standard glucometer. Both patients and providers had access to this Web site, where data could be viewed, analyzed, and discussed. To examine the impact of the DCH program, we assessed adoption of the program, patient and provider satisfaction, frequency of use, and changes in glucose levels over a period of 3 months.

RESULTS

The mean age of the 7 pilot participants was 51 (range 35-65). Participants sent in an average of 50 readings in Month 1 and 38 readings in Month 3 and made, on average, 6 comments in Months 1 and 12 comments in Month 3. The mean blood glucose range decreased in Month 3 versus Month 1 (141.1 and 146.5, respectively). Self-reported HbA1c fell from 6.8% at the start of the study to 5.8% at the end. Five/seven participants described the site as excellent or good. Qualitative data analysis highlighted key benefits of the program as well as areas for improvement.

CONCLUSIONS

This pilot study of a shared glucose monitoring Web application was well received by patients. Programs like this may lead to improvements in the quality of clinical care delivered to people with type 2 diabetes.

Brave new worlds: how virtual environments can augment traditional care in the management of diabetes

New technologies, such as online networking tools, offer innovative ways to engage patients in their diabetes care. Second Life (SL) is one such virtual world that allows patients to interact in a 3D environment with peers and healthcare providers. This article presents a framework that demonstrates how applications within SL can be constructed to meet the needs of patients with diabetes, allowing them to attend group visits, learn more about lifestyle changes, and foster a sense of support and emotional well-being. This experiential approach to education may prove more engaging, and therefore successful, than existing strategies. Addressing concerns relating to privacy and liability is a necessary first step to engage providers in this new approach to patient care.

A phase II trial of lomeguatrib and temozolomide in metastatic colorectal cancer

To evaluate the tumour response to lomeguatrib and temozolomide (TMZ) administered for 5 consecutive days every 4 weeks in patients with metastatic colorectal carcinoma. Patients with stage IV metastatic colorectal carcinoma received lomeguatrib (40 mg) and TMZ (50–200 mg m⁻²) orally for 5 consecutive days every 4 weeks. Response was determined every two cycles. Pharmacokinetics of lomeguatrib and TMZ as well as their pharmacodynamic effects in peripheral blood mononuclear cells (PBMC) were determined. Nineteen patients received 49 cycles of treatments. Despite consistent depletion of O⁶-methylguanine-DNA methyltransferase in PBMC, none of the patients responded to treatment. Three patients had stable disease, one for the duration of the study, and no fall in carcinoembryonic antigen was observed in any patient. Median time to progression was 50 days. The commonest adverse effects were gastrointestinal and haematological and these were comparable to those of TMZ when given alone. This combination of lomeguatrib and TMZ is not efficacious in metastatic colorectal cancer. If further studies are to be performed, emerging data suggest that higher daily doses of lomeguatrib and a dosing period beyond that of TMZ should be evaluated.

Connected health: a new framework for evaluation of communication technology use in care improvement strategies for type 2 diabetes

Current methods of analyzing the use of communication technologies in diabetes care improvement programs are limited by a poor understanding of the impact of technology on the delivery of care. We applied a standardized methodology using a functional framework to analyze 14 diabetes care improvement programs that used communications technology. Controlled trials and observational studies were selected after searching 5 electronic databases to identify care improvement programs for type 2 diabetes that used communications technology in the past 10 years with greater than 10 subjects. A 3-stage framework was used to analyze intervention elements: 1) functional components, 2) structural components, and 3) level of automation in program design. Using this methodology we found marked variability in operational design of programs and poor rationalization of choice of outcome metrics with program components. Although 11 of 14 studies showed significant declines in HbA1c, our analysis indicated that the causal pathways remain unclear. Recent systematic reviews have highlighted the difficulties in evaluating communication technology use in diabetes. The functional framework presented in this review provides a systems approach to the problem and represents a standardized methodology for analyzing communications technology use in diabetes care.

Oocyte cytoplasmic maturation: a key mediator of oocyte and embryo developmental competence

Efforts have intensified to successfully mature and inseminate oocytes in vitro and then culture ensuing embryos to transferable stages from a large number of mammalian species. Success varies, but generally even for the most successful species it is only possible to obtain a maximum of a 40 to 50% development of zygotes to the blastocyst stage. Reduced oocyte developmental competence is suggested as a primary reason for the reduced potential of in vitro-produced embryos. The vast majority of in vitro-matured oocytes are meiotically competent; however, many do not attain an optimal oocyte diameter before insemination. Variations in oocyte in vitro maturation media can influence embryo development, blastocyst cell number, and apoptosis. In addition, studies have indicated that cytoplasmic donation from so-called competent to incompetent oocytes can improve developmental outcomes. Oocyte cytoplasmic maturation includes those events that instill upon the oocyte a capacity to complete nuclear maturation, insemination, early embryogenesis and thus provide a foundation for implantation, initiation of pregnancy, and normal fetal development. Although we can define oocyte cytoplasmic maturation, we are only now beginning to understand the molecular steps that underlie this process. In general terms, oocyte cytoplasmic maturation involves the accumulation of mRNA, proteins, substrates, and nutrients that are required to achieve the oocyte developmental competence that fosters embryonic developmental competence. Collectively we are beginning to specify oocyte cytoplasmic maturation, and eventually a coherent understanding of this critical event in oocyte biology will emerge.