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Background: Neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) are closely related to the prognosis of patients with non‐small cell lung cancer, but their effect on extensive‐stage small cell lung cancer (ES‐SCLC) remains uncertain. Methods: This retrospective study was conducted in ES‐SCLC patients treated with first‐line atezolizumab or durvalumab and platinum‐etoposide. Clinical data from three hospitals were analyzed. Significant risk factors for survival were identified using descriptive statistics and Cox regression. Homogeneity was assessed using t‐tests or nonparametric tests. Kaplan‐Meier analysis revealed an association between high NLR level and median PFS and OS. Results: A total of 300 ES‐SCLC patients were included in the study. Cox regression analysis revealed that an elevated NLR level after the second treatment cycle (defined as NLRT2) was an independent prognostic factor for survival. Stratifying patients based on median NLRT2 showed significant differences in both PFS (HR: 1.863, 95% CI: 1.62–2.12, p < 0.001) and OS (HR: 2.581, 95% CI: 2.19–3.04, p < 0.001) between NLR ≥ 1.75 and NLR < 1.75 groups. mPFS and mOS were 8.2 versus 6.1 months and 13.7 versus 9.5 months, respectively. NLR was also associated with treatment efficacy and occurrence of irAEs. Further stratification based on NLR and irAEs showed that in the NLR < 1.75 group, patients with irAEs had prolonged mPFS and mOS. In the NLR ≥ 1.75 group, only mPFS showed a significant difference between patients with and without irAEs. Conclusion: NLRT2 and irAEs can predict the prognosis of ES‐SCLC patients with first‐line ES‐SCLC receiving PD‐L1 inhibitors combined with chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) screening rates remain low in Latino communities. We sought to determine the screening awareness and attitudes in Omaha, Nebraska. Methods: We interviewed 150 Latinos at an urban Federally Qualified Health Center, June-October 2017. Chi-square or Fisher-exact tests and multiple logistic regression models were used for data analysis. Results: Participants reported low educational attainment, low income, and limited access to insurance or a primary provider. Less than one-third of participants aged 50 + had ever heard of FOBT (32.6%) or colonoscopy (30.4%). For individuals 50+, access to a primary care provider (p =.03) and knowing the screening initiation age (p =.03) were associated with ever having a colonoscopy. Higher knowledge score was a strong predictor of any CRC screening. Discussion: Knowledge predicted screening, suggesting interventions should aim to educate this population regarding CRC screening guidelines and options and work with stakeholders to make CRC screening more accessible. [ABSTRACT FROM AUTHOR]

Aims and objectives: To understand the factors that influence nurses empathy towards patients and to explore its influence on effort–reward imbalance involving empathy. Background: Empathy is highly valued in nurse–patient relationships. However, currently, little evidence currently exists on the impact of work‐related stress measured by effort–reward imbalance and empathy. Design: An anonymous, cross‐sectional online survey using a sample of convenient was conducted. Methods: Convenient online sampling was conducted with select nurses from seven cities in Shandong province, China. The nurses worked in clinical settings in 10 different hospitals. Two questionnaires, for example the Effort‐Reward Imbalance Questionnaire and the Jefferson Scale of Physician Empathy, were used. Medians, percentages, related analysis and regression analysis were used to measure the relationship between Effort‐Reward Imbalance and empathy levels among nurses in China. In addition, this study adhered to the EQUATOR checklist, STROBE (see Supplementary file 1). Results: Among 1,077 participants, 26.5% stated experiencing an Effort‐Reward Imbalance, with a mean empathy score among Chinese nurses, was 109.78 ± 13.98. Multiple regression analysis revealed that females and head nurses had higher levels of empathy, and that those who had no experience learning about empathy‐related courses and an Effort‐Reward Imbalance ratio were negatively associated with empathy. Conclusions: Gender, department, position, experience learning about empathy‐related courses and Effort‐Reward Imbalance ratio were significant elements related to nurses' empathy levels. Relevance to clinical practice: As we all know, empathy can affect the relationship between nurse and patient. If nurses are in an Effort‐Reward Imbalance, they may have less empathy. It is advised to improve the reward level of nurses, so that the level of empathy towards patients is enhanced. [ABSTRACT FROM AUTHOR]

Background: PH domain and leucine‐rich repeat protein phosphatase 2 (PHLPP2) has been reported to be a potent tumor suppressor in many human cancers. However, PHLPP2 has not been fully researched as a putative clinical prognostic biomarker of lung cancer. Methods: The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases including data on 1383 non‐small cell lung cancer (NSCLC) patients were used to determine PHLPP2 expression. PHLPP2 expression was then examined by immunohistochemistry, and its clinical significance analyzed in 134 NSCLC patients, including 73 patients with adenocarcinoma and 81 with squamous cell carcinoma. Results: We found PHLPP2 expression to be less pronounced in NSCLC tissue samples than that in nontumoral lung tissues according to data taken from TCGA and GEO datasets; this outcome was further validated by immunohistochemistry assay. The low PHLPP2 expression level was found to be associated with the presence of lymph node metastasis (P = 0.003). Importantly, PHLPP2 was found to be an independent indicator of prognosis for overall (hazard ratio [HR] = 0.520, 95% confidence interval [Cl] = 0.327–0.827; P = 0.006) and disease‐free survival (HR = 0.489, 95% Cl = 0.308–0.775; P = 0.002) in patients with surgically‐resected NSCLC by multivariate analysis. Conclusion: Taken together, our findings show that PHLPP2 is a robust clinical marker for NSCLC survival and could serve as a potential therapeutic target. [ABSTRACT FROM AUTHOR]

This study assessed the association between acculturation and unmet health needs among refugees. Based on data from the Refugee Health Needs Assessment Survey (n = 291) recently conducted in Omaha, Nebraska, Chi square tests and multivariate logistic regressions were estimated to examine how acculturation among refugees was related to their unmet health needs. Relative to refugees who had been in the U.S. for less than 3 years, refugees who had been in the U.S. for 3-5 years were more likely to report lack of health insurance coverage (AOR 2.87, 95% CI 1.19, 6.92) and delaying to see a health care provider due to cost during the 12 months prior to the survey (AOR 4.01, 95% CI 1.18, 13.67). Acculturation among refugees did not necessarily alleviate their unmet health needs. Addressing these needs calls for sustainable medical assistance to refugees that well go beyond the 8-month health insurance coverage currently provided to newly arrived refugees. [ABSTRACT FROM AUTHOR]

Abstract School-based health centers (SBHCs) have been suggested as potential medical homes, but may experience challenges implementing the patient-centered medical home (PCMH) model. It is currently unknown if there are PCMH variations among different types of SBHCs. The purpose of this study was to examine the associations between SBHC characteristics and PCMH capacity. Using 2013–2014 National Census of School-Based Health Centers data, SBHC PCMH Index scores were calculated and used as outcomes in linear regression models examining associations between PCMH capacity and SBHC characteristics. The mean PCMH capacity score for all SBHCs was 68.59%, with higher scores in the Comprehensive Care domain than in the Care Quality domain. Managed care arrangements, Medicaid PCMH initiatives, more funding sources, and higher patient billing activity were all positively associated with overall PCMH capacity. Having higher percentages of students who are members of racial/ethnic minority groups was negatively associated with overall PCMH capacity. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we examined the association between changes in leisure time physical activity (LTPA) preference (the extent to which participants liked or disliked certain types of physical activity) and the incidence of hypertension; we also assessed whether the association differed between urban and rural China. Methods: Based on longitudinal data from 2687 Chinese adults between 2004 and 2011, we performed multivariate logistic regressions were to assess the aforementioned association. We conducted stratified analyses to examine the urbanrural differences in this association. Results: The mean age was 40.0 (Standard Deviation = 12.5), and the mean BMI was 23.7 (Standard Deviation = 3.3). Adjusted estimates show that relative to respondents with no changes in LTPA preference, respondents who reduced preference were more likely to develop hypertension (OR = 1.92, 95% CI = 1.13-3.28). This association, however, was statistically significant among urban residents (OR = 2.19, 95% CI = 1.04-4.60), but not rural participants. Conclusions: Changes in LTPA preference and development of hypertension were significantly correlated, especially among urban Chinese. Hypertension prevention programs may identify the groups at elevated risk by examining levels and changes of LTPA preferences. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate changes in clinical outcomes for patients with type 2 diabetes (T2D) after a 3-month remote patient monitoring (RPM) program, and examine the relationship between hemoglobin A1c (HbA1c) outcomes and participant characteristics. The study sample included 955 patients with T2D who were admitted to an urban Midwestern medical center for any reason from 2014 to 2017, and used RPM for 3 months after discharge. Clinical outcomes included HbA1c, weight, body mass index (BMI), and patient activation scores. Logistic regression was used to estimate the likelihood of having a postintervention HbA1c <9% by patient characteristics, among those who had baseline HbA1c >9%. Most patients experienced decreases in HbA1c (67%) and BMI (58%), and increases in patient activation scores (67%) (P < 0.001 in all 3 cases) at the end of RPM. Logistic regression analyses revealed that among patients who had HbA1c >9% at baseline, men (odds ratio [OR] = 3.72; 95% confidence interval [CI], 1.43–9.64), those who had increased patient activation scores after intervention (OR = 1.05; 95% CI, 1.01–1.09), those who had higher baseline patient activation scores, and those who had a greater number of biometric data uploads during the intervention (OR = 1.02; 95% CI, 1.00–1.04) were more likely to have reduced their HbA1c to <9% at the end of RPM. RPM for postdischarge patients with T2D might be a promising approach for HbA1c control with increased patient engagement. Future studies with study designs that include a control group should provide more robust evidence. [ABSTRACT FROM AUTHOR]

This article investigates the reliability and validity of the Chinese version of the 7-item Fear of Cancer Recurrence Questionnaire (FCR-7). A total of 1,025 cancer patients were recruited and asked to complete the Chinese FCR-7, Fear of Progression Questionnaire—Short Form (FoP-Q–SF), 9-item Patient Health Questionnaire (PHQ-9), and 7-item General Anxiety Disorder Questionnaire (GAD-7). The internal consistency and test–retest reliabilities were examined. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted on random split-half samples. Overall relationships of FCR-7 with other psychological constructs were examined. The Chinese FCR-7 showed good internal consistency (Cronbach's alpha =.87), test–retest reliability (r =.90), and item–total correlations (range =.583–.872). The unitary factor structure was supported by the EFA and the CFA fit statistics (comparative fit index =.99, root-mean-square error of approximation =.039, 95% confidence interval [.01,.07]). The total score of FCR-7 was positively associated with FoP-Q–SF (r =.756, p <.01), PHQ-9 (r =.522, p <.01), and GAD-7 (r =.553, p <.01). Patients with low monthly income (p <.001) and family cancer history (p =.012) and those who had gone through chemotherapy (p =.001) tended to report higher fear of cancer recurrence (FCR). The FCR-7 has been translated and successfully culturally adapted into a Chinese version. It is a reliable and valid measurement for assessing FCR. The present study suggests that the Chinese version of the seven-item Fear of Cancer Recurrence Questionnaire is a reliable and valid measure for assessing patients' recurrence fears. Additionally, patients with low income and family cancer history and those who had gone through chemotherapy were more likely to report higher fears. Therefore, specific and flexible psychological interventions are needed for these high-risk populations. [ABSTRACT FROM AUTHOR]