Mayo Clinic partially owns and operates Mayo Clinic Health System. Founded in 1992, Mayo Clinic Health System is as a network of community-based medical services. In 2021, it consisted of more than 40 hospitals and clinics in Minnesota, Iowa, and Wisconsin. The President of Mayo Clinic Health System, Prathibha Varkey, M.B.B.S. (since 2021), is a board member of the Mayo Clinic Board of Directors.
Adverse social determinants are known contributors to poorer long-term allograft outcomes. Yet optimal measures of social determinants are lacking. We sought to evaluate the association between socioeconomic status (SES) and graft loss in children using several different metrics of social determinants of health (SDOH). Our study included 137 pediatric kidney transplant recipients (< 18 years at kidney failure onset) transplanted between 2010 and 2020. The association between SES measures (individual- and area-level) and graft survival was examined using Cox regression models. Measures were dichotomized: HOUSES Index [low SES(Q1) vs. high (Q2–Q4)], Area Deprivation Index (ADI) [high deprivation (76–100 percentile) vs. low (1–75 percentile)], and Childhood Opportunity Index (COI) [low opportunity (1s–25 percentile) vs. high (26–100)]. All models were adjusted for transplant age, sex, donor type, pretransplant dialysis, insurance, kidney failure cause, and body mass index z-score. After adjusting for covariates, we observed a significantly increased risk of graft loss in HOUSES Q1 vs. Q2–4 recipients (adjusted hazard ratio [aHR]: 3.25; 95
PURPOSE:NRG Oncology/Alliance LU005 (ClinicalTrials.gov identifier: NCT03811002) tested the addition of atezolizumab to concurrent chemoradiation (CRT) in this open-label, phase III international trial. METHODS:Patients with limited-stage small cell lung cancer (LS-SCLC), stage Tx-IV, N0-3, and M0 with Eastern Cooperative Group performance status (PS) 0-2 received one cycle of chemotherapy (platinum/etoposide) before study registration and were randomly assigned to CRT alone versus CRT plus concurrent and adjuvant atezolizumab, 1,200 mg once daily, every 3 weeks until investigator-assessed progression or intolerable side effects for a maximum of 17 cycles. Patients were stratified by choice of chemotherapy (cisplatin v carboplatin), radiation fractionation schedule (66 Gy once daily v 45 Gy twice daily), sex, and PS (0/1 v 2). The primary end point was overall survival (OS). Secondary end points included investigator-assessed progression-free survival (PFS), objective response rate, local control, and distant-metastasis-free survival (DMFS). RESULTS:patients were randomly assigned from May 2019 to December 2023. The median OS was 36.1 months (95% CI, 28.1 to 42.5) for the CRT-alone arm and 31.1 months (95% CI, 28.5 to 44.7) for the CRT + atezolizumab arm, respectively (hazard ratio [HR], 1.03 [95% CI, 0.80 to 1.32]). The median PFS was 11.4 months (95% CI, 10.3 to 13.2) for the CRT-alone arm and 12.1 months (95% CI, 10.9 to 15.2) for the CRT + atezolizumab arm, respectively (HR, 0.98 [95% CI, 0.79 to 1.22]). The median DMFS was 13.0 months (95% CI, 11.3 to 18.2) for the CRT-alone arm and 16.8 months (95% CI, 12.1 to 21.6) for the CRT + atezolizumab arm (HR, 0.96 [95% CI, 0.76 to 1.21]). No unexpected safety signals with concurrent atezolizumab were observed. CONCLUSION:Concurrent and adjuvant atezolizumab with chemoradiation did not improve survival in patients with LS-SCLC.
Background:Human granulocytic anaplasmosis (HGA) can cause severe illness requiring intensive care, but factors associated with critical illness among hospitalized patients are incompletely described. Method:We performed a retrospective multicenter cohort study of adults hospitalized with PCR-confirmed HGA at Mayo Clinic Rochester and affiliated Mayo Clinic Health System sites in Minnesota and Wisconsin from 2014 through 2024. Patients who required ICU-level care were compared with those managed on general medical wards using exploratory univariate analyses (Fisher exact and Kruskal-Wallis tests). Results:Among 101 hospitalized patients, 12 (12%) required ICU-level care. Symptoms documented at hospital presentation/admission were more frequent in ICU patients, including vomiting (64% vs 30%) and abdominal pain (55% vs 26%). On admission, ICU patients had lower sodium (mean 128.8 vs 132.3 mmol/L) and higher total bilirubin (mean 1.3 vs 0.8 mg/dL). Platelet nadir during hospitalization was lower in ICU patients (mean 54.8 × 109/L vs 84.1 × 109/L). Peak ferritin, measured in a subset, was markedly higher in ICU patients (median 21 666 vs 961 µg/L). The composite endpoint of HGA-related complications or serious treatment-related adverse events occurred more often in ICU patients (75% vs 17%); one death occurred in the ICU group. Conclusions:In hospitalized adults with HGA, ICU-level care was associated with gastrointestinal symptoms at presentation/admission, admission hyponatremia and hyperbilirubinemia, lower platelet nadir, and marked hyperferritinemia when measured. Because these findings were derived from univariate group-level comparisons with substantial overlap between groups, they should be viewed as hypothesis-generating rather than individually predictive or sufficient as stand-alone triage criteria.
Background and ObjectivesHigh adherence to the Mediterranean diet (MeDi) has been associated with slower age-dependent cognitive decline and better cardiovascular health (CVH). We examined the association between adherence to MeDi and white matter (WM) integrity in community-dwelling Hispanic or Latino adults. In secondary analysis, we assessed whether CVH and WM integrity were pathway variables between MeDi and global cognition (GC).MethodsData from Study of Latinos-Investigation of Neurocognitive Aging-MRI Ancillary Study were analyzed. Dietary intake was collected during the baseline visit (2008-2011) using 24-hour recalls, from which a MeDi score ([MeDiS], range 0-9) was derived. Brain MRI scans with diffusion tensor imaging were obtained between 2017 and 2022. WM integrity was assessed using total WM volume (tWM), WM hyperintensity (WMH) volume, fractional anisotropy (FA), and free water (FW). GC was ascertained between 2015 and 2018 using a composite score derived from 4 standardized cognitive tests. CVH was evaluated at baseline using the Life's Essential 7 score ([LE7], range 0-100), a modified version of the existing Life's Essential 8 score, in which diet was excluded to avoid collinearity with our exposure. We used linear regression models that controlled for age, sex, and socioeconomic factors to investigate the association of MeDiS with WM integrity. We performed mediation analysis to explore whether CVH and WM integrity were pathway variables between diet and GC.ResultsA total of 2,642 participants with a mean age of 64.3 years (95% CI 63.4-65.1, 44% male) were included. The average MeDiS was 5.0 (95% CI 4.9 to 5.1), and the LE7 score was 66.6 (95% CI 65.-67.6). Higher MeDiS was associated with lower WMH volume (beta = -0.08, 95% CI -0.11 to -0.04), higher tWM volume (beta = 0.05, 95% CI 0.005-0.09), lower FW (beta = -0.04, 95% CI -0.08 to -0.002), and higher fractional anisotropy (FA) (beta = 0.09, 95% CI 0.05-0.13). WMH, tWM, and FA mediated the association between MeDiS and GC. In addition, there was serial mediation from MeDiS on GC through LE7 score, WMH, tWM, and FA.DiscussionHigher adherence to MeDi is linked to better WM structural integrity, which, together with CVH, mediates the association between MeDi and GC.
OBJECTIVES:This retrospective cohort of patients undergoing surgery from 2019 to 2023 evaluated the association between individual-level social drivers of health (SDoH) and postoperative outcomes (length of stay, 30-day mortality, 30-day readmission). METHODS:Patients from a multi-site health system who completed a SDoH questionnaire were categorized as high-risk or not high-risk across five SDoH domains (e.g., financial resources) and were stratified into 3 surgical cohorts (elective outpatient, inpatient and emergency surgery). Regression models, adjusted for potential confounders, assessed the association between SDoH and postoperative outcomes. RESULTS:Among 297,723 patients, 74% completed the SDoH questionnaire. High-risk transportation need was associated with higher unplanned 30-day readmission for all cohorts; for elective surgeries, high-risk transportation was also associated with higher mortality. The other SDoH domains were inconsistently associated with postoperative outcomes. CONCLUSIONS:Individual-level SDoH, particularly transportation needs and financial strain, are linked to adverse postoperative surgical outcomes. Systematic SDoH interventions are crucial to addressing healthcare disparities.
