OBJECTIVES: The phase 3 ProDERM study demonstrated intravenous immunoglobulin (IVIg) was safe and effective in patients with dermatomyositis (DM). This analysis assessed clinical and serological predictors of IVIg response in DM patients from ProDERM. METHODS: ProDERM was a prospective, randomized, placebo-controlled study of DM patients. For weeks 0-16, patients received 2.0 g/kg IVIg (Octagam, 10%) or placebo every 4 weeks. Eligible patients entered the open-label extension phase, where all received IVIg to week 40. Univariate and multivariate analyses examined associations between baseline variables and total improvement score (TIS), including myositis disease activity assessment tool (MDAAT; assessing different organ involvement), and myositis-specific and myositis-associated autoantibodies. RESULTS: Ninety-five patients were enrolled. Univariate analyses found no significant association between TIS at week 16 or 40 and age; sex; ethnicity; disease duration/activity; cutaneous, skeletal, gastrointestinal or muscle disease activity; or previous failed or concomitant medications. Multivariate analysis found patients with higher MDAAT cutaneous scores had a better chance of at least minimal TIS improvement. Higher MDAAT pulmonary scores were associated with a lower, but still considerable, chance of improvement. Patients with TIF1-γ antibodies had a better TIS response; however, after controlling for cutaneous disease activity, there was no significant association between antibody classification (including anti-TIF1-γ) and efficacy outcome. CONCLUSION: IVIg was effective in treating DM patients regardless of demographic features and autoantibody status (for most autoantibodies). Patients with higher cutaneous disease activity and/or anti-TIF1-γ responded best to IVIg, while pulmonary disease activity predicted a lower, but still effective, IVIg response, warranting further investigation. TRIAL REGISTRATION: ClinicalTrials.gov, http://clinicaltrials.gov, NCT02728752.

• MeSH
• autoprotilátky krev   imunologie   MeSH
• dermatomyozitida * farmakoterapie   imunologie   MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• imunologické faktory * terapeutické užití   MeSH
• intravenózní imunoglobuliny * terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

Introduction: The e-STROKE study is a prospective, multicenter observational study designed to assess the impact of various CT parameters (including e-ASPECT, CT perfusion (CTP), collateral flow status, and the size and location of the ischemic lesion) on the clinical outcomes of patients with ischemic stroke, as evaluated by the modified Rankins Scale (mRS) three months post-stroke. This study also aims to investigate whether the use of multimodal CT imaging increases the number of patients eligible for recanalization therapy. The analysis will integrate data from the RES-Q registry and radiological data from the e-STROKE system provided by Brainomix Ltd. Aims: The primary aim is to determine the predictive value of CT parameters (e-ASPECTS, CTP, collateral vessel status, and ischemic lesion volume and location) on three-month functional outcomes, as defined by the mRS, in patients with non-lacunar stroke following recanalization treatment (IVT and/or MT). The secondary aim is to evaluate whether multimodal CT examination leads to an increase in the number of patients eligible for recanalization therapy. Additionally, this study seeks to assess the specificity and sensitivity of multimodal CT in distinguishing stroke mimics from actual strokes. Methods: This multicenter observational study involves patients with suspected acute ischemic stroke and a premorbid mRS ≤ 4, who are treated with endovascular thrombectomy (EVT), intravenous thrombolysis (IVT), or managed conservatively in stroke centers within the Czech Stroke Research Network (STROCZECH), which is part of the Czech Clinical Research Infrastructure Network (CZECRIN). Data collection includes demographic, clinical, and imaging data variables such as age, sex, ethnicity, risk factors, treatment times (OTT, DNT, and OGT), TICI scores, post-treatment hemorrhage (ECAS II), mRS outcome, stroke etiology, e-ASPECTS, acute ischemic volume (AIV), thrombus length on NCCT, CTA collateral score and collateral vessel density, location of large vessel occlusion, ischemic core, hypoperfusion volume, mismatch ratio and volume, final infarct volume, hemorrhage volume, and MRI in case of negative follow-up NCCT. Conclusions: We anticipate collecting robust clinical and radiological data from approximately 2000 patients across 22 centers over a 12-month period. The results are expected to enhance the precision of diagnostic and prognostic radiological markers in managing acute stroke.

• Publikační typ
• časopisecké články MeSH

Celosvětově narůstající etnická diverzita pacientů přináší pro lékaře nové výzvy týkající se poskytování léčebné péče pacientům s odlišným etnickým pozadím. Východiskem je postulát, že to je především určitá kultura, která utváří prostředí, v němž probíhá setkání a komunikace pacientů se zdravotníky. To se pak promítá do vztahů lékařů s pacienty a ovlivňuje jejich vzájemnou komunikaci. Článek popisuje kulturní specifika romských pacientů a definuje nejdůležitější zásady poskytování kulturně senzitivní zdravotní péče této svébytné skupině, která se od většinové populace v mnoha ohledech liší. Popisované zásady a doporučení lze využít také v rámci zdravotní péče pro migranty a uprchlíky, jejichž zastoupení mezi našimi pacienty narůstá.

Globally increasing ethnic diversity of patients brings new challenges for physicians regarding the provision of medical care to patients with different ethnic backgrounds. The starting point is the postulate that it is above all a certain culture that shapes the environment in which the patient meets and communicates with medical professionals, and this is reflected in the relationship between doctors and patients and their mutual communication. The article describes the cultural specifics of Roma patients and defines the most important principles of providing culturally sensitive health care to this unique group, which differs from the major population in many respects. The described principles and recommendations can also be used within the framework of health care for migrants and refugees, whose representation among our patients is increasing.

• MeSH
• kulturně kompetentní péče MeSH
• lidé MeSH
• poskytování zdravotní péče * MeSH
• Romové * MeSH
• vztahy mezi lékařem a pacientem MeSH
• Check Tag
• lidé MeSH

Po stránce antropometrické si Romové zachovali výraznou svébytnost a liší se tak od většinové populace. Odlišují je také kulturní rozdíly, které se promítají do pojetí zdraví a spotřeby zdravotní péče. Dostupná data ukazují na sociálně a kulturně podmíněné zdravotní nerovnosti a znevýhodnění Romů ve srovnání s většinovou populací, které se dlouhodobě nemění. Kromě jiného hraje roli také nízká úroveň kulturní kompetence a citlivosti zdravotníků k potřebám menšin a specificky k romskému etniku. Článek popisuje zdravotně relevantní kulturní odlišnosti v kontextu romské kultury a způsobu života českých Romů a nastiňuje některé bariéry, kterým ve zdravotnictví čelí.

From anthropometrics point of view, the Roma have retained a distinct individuality and thus differ from the majority population. They are also distinguished by cultural differences, which are reflected in the concept of health and health care consumption. The available data show socially and culturally determined health inequalities and disadvantages of the Roma compared to the majority population, which do not change in the long term. Among others, the low level of cultural competence and sensitivity of health professionals to the needs of minorities and specifically to the Roma ethnicity also plays a role. The article describes health-relevant cultural differences in the context of Roma culture and way of life of the Czech Roma and outlines some of the barriers faced by Roma in healthcare.

• MeSH
• kulturní charakteristiky MeSH
• lidé MeSH
• poskytování zdravotní péče MeSH
• rizikové faktory MeSH
• Romové * MeSH
• zdraví menšin * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH
• Geografické názvy
• Česká republika MeSH

Roma represent one of the largest ethnic groups facing marginalization worldwide. However, significant knowledge gaps persist regarding: A) the social mechanisms supporting health-endangering practices among Roma; B) the social mechanisms adversely affecting their use of health services; and C) the social determinants underlying both above pathways. To fill these gaps, we conducted a series of four explorative ethnographic studies spanning over ten years. Beginning in 2004, the series involved 260 participants, including segregated Roma and health services staff in Slovakia. Of the four studies, two addressed gap A, two addressed gap B, and all addressed gap C. Regarding pathway A, we found that Roma in segregated Roma enclaves can be socialized into ethnically framed racialized ideologies that oppose the cultural standards of local non-Roma life, including certain healthy practices. This adherence to counter-cultural ideals of Roma identity increases specific health and care challenges. Regarding pathway B, we discovered that health service frontliners frequently lack any organizational support to better understand and accommodate the current living conditions and practices of segregated Roma, as well as their own and others' racism and professional expectations regarding equity. This lack of support leads many frontliners to become cynical about segregated Roma over their careers, resulting in health services being less effective and exacerbating health problems for both Roma and the frontliners themselves. Concerning pathway C, we found that the societal omnipresence of antigypsyism - racist and racialized anti-Roma ideas and sentiments - serves as a prominent driver of both the above pathways. We conclude that much of the unfavorable health status of Roma can be understood via a systems perspective that embraces structural racism.

• MeSH
• dospělí MeSH
• kulturní antropologie * metody   MeSH
• lidé MeSH
• rasismus psychologie   MeSH
• Romové * psychologie   statistika a číselné údaje   MeSH
• sociální determinanty zdraví etnologie   MeSH
• sociální marginalizace psychologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Slovenská republika MeSH

Preterm birth remains an important global problem, and an important contributor to under-5 mortality. Reducing spontaneous preterm birth rates at the global level will require the early identification of patients at risk of preterm delivery in order to allow the initiation of appropriate prophylactic management strategies. Ideally these strategies target the underlying pathophysiologic causes of preterm labor. Prevention, however, becomes problematic as the causes of preterm birth are multifactorial and vary by gestational age, ethnicity, and social context. Unfortunately, current screening and diagnostic tests are non-specific, with only moderate clinical risk prediction, relying on the detection of downstream markers of the common end-stage pathway rather than identifying upstream pathway-specific pathophysiology that would help the provider initiate targeted interventions. As a result, the available management options (including cervical cerclage and vaginal progesterone) are used empirically with, at best, ambiguous results in clinical trials. Furthermore, the available screening tests have only modest clinical risk prediction, and fail to identify most patients who will have a preterm birth. Clearly defining preterm birth phenotypes and the biologic pathways leading to preterm birth is key to providing targeted, biomolecular pathway-specific interventions, ideally initiated in early pregnancy Pathway specific biomarker discovery, together with management strategies based on early, mid-, and-late trimester specific markers is integral to this process, which must be addressed in a systematic way through rigorously planned biomarker trials.

• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Príspevok sa venuje rómskej komunite, demografii, podmienkam na bývanie, jej zdravotnému stavu a prístupe k zdravotným službám, prevencii a problémom, ktorým čelí táto skupina obyvateľstva a zároveň popisuje špecifiká prístupu sestier k tejto komunite.

The article focuses on the Romany community, its demographics, living conditions, its health status and access to health services, prevention and the problems faced by this population group, and also describes the specifics of nurses' approach to this community.

• MeSH
• komunitní ošetřovatelská péče MeSH
• kulturní charakteristiky MeSH
• rizikové faktory MeSH
• Romové MeSH
• transkulturní ošetřovatelství MeSH
• zdraví menšin MeSH
• zdravotní stav MeSH

PURPOSE: Cxbladder tests are urinary biomarker tests for detection of urothelial carcinoma. We developed enhanced Cxbladder tests that incorporate DNA analysis of 6 single nucleotide polymorphisms for the FGFR3 and TERT genes, in addition to the current 5 mRNA biomarkers and clinical risk factors. MATERIALS AND METHODS: Two multicenter, prospective studies were undertaken in: (1) U.S. patients with gross hematuria aged ≥18 years and (2) Singaporean patients with gross hematuria or microhematuria aged >21 years. All patients provided a midstream urine sample and underwent cystoscopy. Samples were retrospectively analyzed using enhanced Cxbladder-Triage (risk stratifies patients), enhanced Cxbladder-Detect (risk stratifies patients and detects positive patients), and the combination enhanced Cxbladder-Triage × Cxbladder-Detect. RESULTS: In the pooled cohort (N=804; gross hematuria: n=484, microhematuria: n=320), enhanced Cxbladder-Detect had a sensitivity of 97% (95% CI 89%-100%), specificity of 90% (95% CI 88%-92%), and negative predictive value of 99.7% (95% CI 99%-100%) for detection of urothelial carcinoma. Overall, 83% of patients were enhanced Cxbladder-Detect-negative (ie, needed no further work-up). Of 133 enhanced Cxbladder-Detect-positive patients, 59 had a confirmed tumor, of which 19 were low-grade noninvasive papillary carcinoma or papillary urothelial neoplasm of low malignant potential. In total, 40 tumors were high-grade Ta, T1-T4, Tis, including concomitant carcinoma in situ. Of the 74 patients with normal cystoscopy, 41 were positive by single nucleotide polymorphism analysis. Enhanced Cxbladder-Triage and enhanced Cxbladder-Detect had significantly better specificity than the first-generation Cxbladder tests (P < .001). CONCLUSIONS: This study in ethnically diverse patients with hematuria showed the analytical validity of the enhanced Cxbladder tests.

• MeSH
• cystoskopie MeSH
• dospělí MeSH
• hematurie etiologie   genetika   MeSH
• hodnocení rizik MeSH
• karcinom in situ * MeSH
• karcinom z přechodných buněk * diagnóza   genetika   moč   MeSH
• lidé MeSH
• mladiství MeSH
• mutace MeSH
• nádorové biomarkery genetika   moč   MeSH
• nádory močového měchýře * diagnóza   genetika   moč   MeSH
• prospektivní studie MeSH
• receptor fibroblastových růstových faktorů, typ 3 genetika   MeSH
• retrospektivní studie MeSH
• senzitivita a specificita MeSH
• telomerasa * genetika   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

OBJECTIVES: This study aims to analyse the way immigrants and their personality traits get affected by traumatic events in the post-migration process. METHODS: This descriptive study was conducted through Google Forms with the involvement of 2,509 immigrants. A descriptive questionnaire, the "IFOMA Post-Migration Post-Traumatic Effect Scale" and the "GADOT Personality Types Determination Scale" were used to collect the research data. Independent samples t-test, one-way ANOVA, and related sample Friedman's two-way analysis tests were used in data analysis. RESULTS: Immigrants were exposed to significant effects in all sub-dimensions of the Post-Migration Post-Traumatic Effect Scale. Experiencing post-traumatic stress was found to be significantly related to the research parameters, which, respectively, are gender, age, marital status, educational background, legal status, years of living in the current country, employment status, ethnicity, Turkish language proficiency, and post-migration psychological problems (p < 0.05); 42.8% of the immigrants had the Type 9 personality, and all personality types were affected by the Psychological Affection, Physical Affection, Anxiety, and Social Adaptation sub-dimensions, respectively (p < 0.05). CONCLUSION: By analysing the impact of migration-induced trauma on immigrants within their society, it can be recommended to implement initiatives specific to immigrants' personality traits and to carry out protective/preventive projects that will minimize immigrants' exposure to trauma and encourage their participation in social adaptation processes.

• MeSH
• emigranti a imigranti * MeSH
• etnicita MeSH
• lidé MeSH
• manželský stav MeSH
• osobnost MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: To assess differences in the distribution of type and number of D'Amico high-risk criteria (DHRCs) according to race/ethnicity (R/E) and their effect on cancer-specific mortality (CSM) in prostate cancer (PCa) patients treated with external beam radiotherapy (RT). METHODS: In the SEER database (2004-2016), we identified 31,002 PCa patients treated with RT with at least one DHRCs, namely PSA >20 ng/dL, biopsy Gleason Grade Group 4-5, and clinical T stage ≥T2c. Competing risks regression (CRR) model tested the association between DHRCs and 5-year CSM in all R/E subgroups. RESULTS: Of 31,002 patients, 20,894 (67%) were Caucasian, 5256 (17%) were African American, 2868 (9.3%) were Hispanic-Latino, and 1984 (6.4%) were Asian. The distributions of individual DHRCs and combinations of two DHRCs differed according to R/E, but not for the combination of three DHRCs. The effect related to the presence of a single DHRC, and combinations of two or three DHRCs on absolute CSM rates was lowest in Asians (1.2-6.8%), followed by in African Americans (2.3-12.2%) and Caucasians (2.3-12.1%), and highest in Hispanic/Latinos (1.7-13.8%). However, the opposite effect was observed in CRR, where hazard ratios were highest in Asians vs. other R/Es: Asians 1.00-2.59 vs. others 0.5-1.83 for one DHRC, Asians 3.4-4.75 vs. others 0.66-3.66 for two DHRCs, and Asians 7.22 vs. others 3.03-4.99 for all three DHRCs. CONCLUSIONS: R/E affects the proportions of DHRCs. Moreover, within the four examined R/E groups, the effect of DHRCs on absolute and relative CSM metrics also differed. Therefore, R/E-specific considerations may be warranted in high-risk PCa patients treated with RT.

• Publikační typ
• časopisecké články MeSH