RESUMO
OBJECTIVES: To assess initial and long-term outcome of children with persistent/chronic idiopathic thrombocytopenic purpura (ITP) treated with 4 infusions of rituximab and three 4-day cycles of dexamethasone (4R+3Dex) including cohorts with most benefit and/or treatment associated toxicity. STUDY DESIGN: All pediatric patients with ITP at Weill-Cornell who received 4R+3Dex were included in this retrospective study. Duration was median time from first rituximab infusion to treatment failure. Patient cohort included 33 children ages 1-18 years with persistent/chronic ITP; 19 were female, 10 of whom were adolescents. Every patient had failed more than 1 and usually several ITP treatments. RESULTS: Children were treated with rituximab, 375 mg/m2 weekly for 4 weeks and three 4-day courses of dexamethasone 28 mg/m2 (40 mg max). Average age of nonresponders was 7.75 years, and initial responders averaged 12.7 years (P = .0073); 30% maintained continuing response at 60 months or last check-up. Eight of the 10 patients who underwent remission were female with ITP <24 months prior to initiating 4R+3Dex. All responding male patients except 2 relapsed. CONCLUSIONS: Durable unmaintained ITP remission after 4R+3Dex was seen almost exclusively in female adolescents with <24 months duration of ITP. This provides a new therapeutic paradigm for a subpopulation with hard-to-treat chronic ITP. The pathophysiology of ITP underlying this distinction requires further elucidation.
Assuntos
Anti-Inflamatórios/administração & dosagem , Dexametasona/administração & dosagem , Fatores Imunológicos/administração & dosagem , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Rituximab/administração & dosagem , Adolescente , Anti-Inflamatórios/uso terapêutico , Criança , Pré-Escolar , Doença Crônica , Dexametasona/uso terapêutico , Esquema de Medicação , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Fatores Imunológicos/uso terapêutico , Lactente , Infusões Intravenosas , Masculino , Estudos Retrospectivos , Rituximab/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVE: There is little research on factors associated with alcohol consumption among Puerto Ricans living in the USA; thus the aim of the present study was to examine alcohol intake patterns, and factors associated with drinking categories, in a cohort of Puerto Rican adults in Massachusetts. DESIGN: Cross-sectional study. Descriptive and polytomous logistic regression analyses were used to identify factors associated with drinking patterns, stratified by gender. SETTING: Greater Boston area, MA, USA. SUBJECTS: Puerto Rican adults (n 1292), aged 45-75 years. RESULTS: Eight per cent of men and 39% of women were lifetime abstainers; 40% of men and 25% of women were former drinkers; 31 % of men and 27% of women were moderate drinkers; and 21% of men and 8% of women were heavy drinkers. Thirty-five per cent of participants reported drinking alcohol while taking medications with alcohol contraindications. After multivariable adjustment, young men were less likely than older men to be moderate drinkers. Among women, higher BMI, age, lower income and lower psychological acculturation were associated with abstention; age and lower perceived emotional support were associated with increased likelihood of former drinking; and women without v. with diabetes were more likely to be heavy drinkers. CONCLUSIONS: High prevalence of chronic disease, heavy drinking and alcohol use while taking medications with alcohol contraindications suggest an urgent need for better screening and interventions tailored to this rapidly growing Hispanic national subgroup. As heavy drinking appears to increase with acculturation for women, public health initiatives are needed to support appropriate alcohol use.
Assuntos
Envelhecimento , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Saúde da População Urbana , Aculturação , Idoso , Consumo de Bebidas Alcoólicas/etnologia , Consumo de Bebidas Alcoólicas/psicologia , Bebidas Alcoólicas/efeitos adversos , Alcoolismo/etnologia , Alcoolismo/psicologia , Boston/epidemiologia , Estudos de Coortes , Contraindicações , Estudos Transversais , Etanol , Feminino , Interações Alimento-Droga , Inquéritos Epidemiológicos , Hispânico ou Latino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Prevalência , Porto Rico/etnologia , Risco , Fatores Sexuais , Saúde da População Urbana/etnologiaRESUMO
PURPOSE: No studies have examined the differences in smoking attitudes and behavior between Dominicans (DRs) and Puerto Ricans (PRs). Identification of pretreatment differences is important for cultural adaptation of evidenced-based smoking cessation treatments. DESIGN: Secondary analysis. SETTING/INTERVENTION: Three home visits for asthma education and smoking cessation. SUBJECTS: Caregivers who smoke and have a child with asthma: DRs (n = 30), PRs (n = 67), and non-Latino whites (n = 128; NLWs). MEASURES: Baseline assessment of psychosocial variables. ANALYSES: Controlled for age, education, and acculturation. RESULTS: Compared with DRs, PRs were more acculturated, more nicotine dependent, less motivated and confident to quit, and identified more pros of smoking (all p < .05). Compared with NLWs, PRs were less likely to be employed, smoked fewer cigarettes per day, and had lower education, greater depressed mood, greater pros and cons of smoking, less social support, and higher child asthma morbidity (all p < .05). Compared with NLWs, DRs were less nicotine dependent, more confident to quit, and less likely to live with a smoker; reported greater cons of smoking and greater stress; and were more likely to have a household smoking ban (DRs 60% vs. NLWs 33.6%). Only 3.3% of DRs were precontemplators vs. 16.4% (PRs) and 10.9% (NLWs). CONCLUSIONS: PRs appear to have more factors associated with risk of smoking treatment failure; DRs appear to have more protective factors. Examination of the role of these smoking attitudes as potential moderators and mediators of smoking behavior are needed to guide the cultural adaptation of evidenced-based treatments.