Medicine
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Chinese rural-to-urban migrant workers (MWs) who are employed in service industry are a rapidly growing population in urban China. Like other MWs, service industry MWs (SIMWs) are generally excluded from the mainstream of city societies, but unlike other MWs, they are more marginalized in cities. Social isolation increases the feelings of loneliness; however, there are little empirical data on the epidemiology of loneliness of SIMWs. ⋯ Being aged 60 years or older (odds ratio [OR] = 2.30), marital status of "others" (OR = 2.77), being physically ill in the last 2 weeks (OR = 1.46), migrating alone (OR = 1.97), working >8 hours/day (OR = 1.06), MSPSS inside family subscale score ≤18 (OR = 1.80), and MSPSS outside family subscale score ≤38 (OR = 1.50) were significantly associated with increased risk of loneliness in SIMWs. Loneliness is prevalent in Chinese SIMWs and should be seen as a major public health issue. The high prevalence and many negative health consequences of loneliness highlight the importance of routine screening, evaluation, and treatment of loneliness in this vulnerable population.
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The relationship between dilated blood vessels in the tumor periphery and the tumor invasion depth is unclear. Therefore, the present study aimed to clarify the relationship between dilated blood vessels and the invasion depth of small-sized (<30 mm) colorectal cancer (CRC), and its implications on endoscopic treatment. We performed a single-arm observational study of the diagnostic accuracy of the existence of dilated vessels in the tumor periphery of CRC lesions as an indicator of submucosal deep (SM-d, ≥1000 μm) carcinomas. ⋯ When the dilated vessels were used as an indicator of SM-d or deeper invasion in depressed lesions, the sensitivity was 95.6%, specificity was 66.7%, and accuracy was 90.2%. No correlation was observed between the existence of dilated vessels and the lesion site, lesion diameter, and lymphovascular invasion/poorly differentiated cluster. The existence of dilated blood vessels in the tumor periphery suggests SM-d or deeper invasion in depressed lesions.
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Breast cancer patients may present with patient delay or experience provider delay-2 factors which can lead to a late-stage diagnosis and poor prognosis. Mass disasters drastically change social structures, and have the potential to contribute to these delays. However, there is little information available on patient and provider delay related to cancer after disasters. ⋯ She did not seek further medical attention for the breast symptoms for another 1 year and 10 months, despite multiple clinic visits for unrelated reasons. The present disasters, particularly the nuclear disaster, seem to have led to the social isolation of local residents, reducing their opportunities to discuss health concerns with others and seek subsequent medical attention. This case highlights that social isolation may contribute to patient and provider delay in breast cancer patients, as accentuated in this disaster setting.
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From the year 1986 onwards, several studies have been published focusing on the comparison between fibrinolysis and primary percutaneous coronary intervention (PPCI) in patients with ST segment elevated myocardial infarction (STEMI). However, because antiplatelet and anticoagulating medications are used in approximation, before and during these procedures, bleeding events have been reported to be associated with both reperfusion therapies. This study aimed to compare the bleeding events associated with fibrinolytic therapy and primary angioplasty in patients with STEMI. ⋯ According to the results of this study, even if the rate of nonintracranial bleeding was not statistically significant between these 2 reperfusion therapies, fibrinolytic therapy was associated with a significantly higher rate of intracranial bleeding than PPCI. In addition, PPCI was associated with a significantly lower rate of death, reinfarction, and stroke. Therefore, PPCI should be recommended in patients with STEMI, especially in PCI-capable hospitals.
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Comparative Study
Comparative effectiveness of incretin-based therapies and the risk of death and cardiovascular events in 38,233 metformin monotherapy users.
There is limited comparative effectiveness evidence to guide approaches to managing diabetes in individuals failing metformin monotherapy. Our aim was to compare the incidence of all-cause mortality and major adverse cardiovascular events (MACEs) among new metformin monotherapy users initiating a dipeptidyl-peptidase-4 inhibitor (DPP4i), glucagon-like peptide-1 receptor agonist (GLP-1RA), sulfonylurea (SU), thiazolidinedione, or insulin. We conducted a cohort study using the UK-based Clinical Practice Research Datalink. ⋯ MACE rates were 19.1/1000 person-years for DPP4i initiators, 15.9/1000 person-years for GLP1-RA initiators versus 33.1/1000 person-years for SU initiators (aHR: DPP4i vs SU initiators = 0.64, 95%CI 0.52-0.80; GLP1RA vs SU initiators = 0.73, 95% CI 0.34-1.55). In this cohort of metformin monotherapy users, 2nd-line DPP4i use was associated with a 42% relative reduction in all-cause mortality and 36% reduction in MACE versus SUs, the most common 2nd-line therapy in our study. GLP-1RAs were not associated with adverse events in this cohort.