Cross-sectional Analysis Research Articles

Friedreich Ataxia Caregiver-Reported Health Index: Development of a Novel, Disease-Specific Caregiver-Reported Outcome Measure.

The Friedreich ataxia (FRDA) scientific community needs access to patient-centered outcome measures that satisfy regulatory guidelines and are capable of tracking clinically meaningful changes in FRDA disease burden. The objective of this research was to develop a novel, disease-specific caregiver-reported outcome measure for use in FRDA research and clinical care. In prior work, we conducted qualitative interviews and a cross-sectional study of FRDA caregivers and patients to determine the symptoms of greatest importance to individuals with FRDA. We designed the Friedreich Ataxia Caregiver-Reported Health Index (FACR-HI) to serially measure the symptoms of greatest importance to patients and utilized factor analysis, beta testing, reliability testing, and cross-sectional subgroup analysis to further evaluate and optimize this disease-specific outcome measure. The FACR-HI was designed to measure total disease burden and disease burden in 18 symptomatic domains. The FACR-HI total score demonstrated high internal consistency (Cronbach's α = 0.98) and test-retest reliability (intraclass correlation coefficient = 0.96). Beta interview participants found the FACR-HI to be highly relevant, comprehensive, and easy to use. FACR-HI total and subscale scores were associated with functional staging for ataxia scores and speech impairment. Initial evaluation of the FACR-HI supports its content validity, test-retest reliability, and construct validity as a caregiver-reported outcome measure for assessing how pediatric individuals with FRDA feel and function. The FACR-HI provides a potential mechanism to quantify changes in multifactorial FRDA disease burden during future clinical trials.

Comparison of Colistin Susceptibility via Two Different Methods in Gram-Negative Extensive Drug-Resistance Isolates from ICU Patients.

To compare the susceptibility of colistin by two methods in extensive drug-resistant (XDR) Gram-negative isolates from ICU patients. Cross-sectional comparative analysis. Place and Duration of the Study: Department of Microbiology, Combined Military Hospital Karachi, Pakistan, from August 2022 to February2023. A total of 100 clinical specimens received from the intensive care unit yielded growth of extensively drug-resistant gram-negative bacteria, which were evaluated for polymyxin E susceptibility. The agar dilution method was compared with the reference broth microdilution (BMD) method. Minimum inhibitory concentration (MIC) was noted for both methods. Comparison of the MIC method by agar dilution showed a 90% correlation with the reference method of broth microdilution. With MICs within the acceptable range of the clinical and laboratory standards institute (CLSI) recommendations, 89 isolates were susceptible to colistin, whereas only 11 remained resistant. Polymyxin E's MIC 50 and MIC 90 were determined to be 1 and 2 µg/ml, respectively, with 97% susceptibility. Agar dilution susceptibility method can be used for screening purposes for the susceptibility testing of polymyxin E. This method is reliable and can easily identify the heteroresistance. Extensively drug-resistant, Broth microdilution, Multidrug-resistant, Agar dilution, Minimum inhibitory concentration, Colony forming unit.

Aetiology of pleural effusions in children living in a high TB endemic setting.

<sec id="st1"><title>BACKGROUND</title>Confirming the aetiology of pleural effusion in children may be difficult in TB-endemic settings. We investigated the role of polymerase chain reaction (PCR) and routine biochemical tests in discriminating pleural effusion caused by bacteria from other aetiologies.</sec><sec id="st2"><title>METHODS</title>This is a cross-sectional post-hoc analysis among children with pleural effusion in a tertiary hospital in South Africa, incorporating new data from PCR testing of stored pleural fluid. Aetiological classification was defined by microbiological confirmation.</sec><sec id="st3"><title>RESULTS</title>Ninety-one children were enrolled; the median age 31 months (IQR 12-102). The aetiology of pleural effusion was 40% (36/91) bacteria, 11% (10/91) TB, 3% (3/91) viruses, 11% (10/91) polymicrobial and 35% (32/91) had no pathogen identified. The most common pathogen was Staphylococcus aureus (27/91, 30%) with similar yields on culture and PCR, followed by Streptococcus pneumoniae (12/91, 13%), detected more commonly by PCR. PCR reduced the number of children with unconfirmed aetiologies from 48 to 32. Characteristics of children with no pathogen most resembled those with TB. Pleural fluid lactate dehydrogenase ≥1,716 U/L best discriminated bacterial pleural effusion from other aetiologies (sensitivity of 86%; specificity 95%).</sec><sec id="st4"><title>CONCLUSION</title>PCR improved detection of pathogens and reduced number of children with unconfirmed aetiologies in presumed exudative pleural effusion.</sec>.

Social Determinants of Health and Psychological Capital Among Youth Experiencing Homelessness.

Social determinants of health affect health behaviors and outcomes. Youth experiencing homelessness suffer significant deprivation of resources such as inadequate housing, reduced education, poor health care, and decreased economic stability. Inner resources, such as psychological capital, may also be related to health behaviors and health outcomes. In this study, we sought to describe and explore associations among selected determinants of health and self-reported scores on indicators of psychological capital among youth experiencing homelessness. This cross-sectional secondary analysis was conducted with a randomized subsample of 148 youth. We calculated chi-square frequencies to describe the data, classical item analyses to evaluate responses, and correlation tests to examine significance of associations. Youth in this sample demonstrated that they possess inner resources associated with determinants of health. Education, health care, and social support were significantly associated with attributes of psychological capital (hope, efficacy, resilience, optimism). Sexual minority groups had high representation in this subsample (25.7%), indicating a need for more study and equitable services for this population. More research should be conducted to better understand the associations between determinants of health, psychological capital, and health behaviors among disadvantaged youth to advance health equity initiatives.

Evaluation of Aspirin Prescribing and Gastrointestinal Bleeding in Adults 60 Years of Age and Older in a Large, Academic Health System.

Background National guidelines no longer recommend adults 60 years of age and older to begin treatment with low-dose daily aspirin for primary prevention of atherosclerotic cardiovascular disease (CVD) due to a lack of proven net benefit and a higher risk of bleeding. Objective The objective of this cross-sectional retrospective analysis was to evaluate the appropriateness of low-dose aspirin prescribing and subsequent gastrointestinal bleeding in older persons receiving primary care in a large academic health system. Setting Large, academic health system within Colorado. Patients Patients with an active order for daily low-dose aspirin as of July 1, 2021, were assessed for appropriateness based on indication (primary vs secondary prevention) and use of a concomitant proton-pump inhibitor (PPI). Incident gastrointestinal bleeds (GIBs) in the subsequent 12 months and GIB risk factors were also evaluated. Results A total of 19,525 patients were included in the analysis. Eighty-nine percent of patients identified as White and 54% identified as male. Of the total cohort, 44% had CVD and 19% were co-prescribed a PPI. GIB occurred in 247 patients (1.27%) within the subsequent year. Risk factors significantly associated with a GIB within 1 year included: history of GIB, history of peptic ulcer disease, other esophageal issue (esophagitis, Barrett's esophagus, Mallory Weiss tears, etc.), 75 years of age or older, and history of gastroesophageal reflux disease. Conclusion This evaluation found that many older persons at this institution may be inappropriately prescribed aspirin, providing opportunities for pharmacists to improve medication safety by deprescribing aspirin among primary prevention patients or potentially co-prescribing a PPI in secondary prevention patients.

Experimental investigation on the high-temperature corrosion of 12Cr1MoVG boiler steel in waste-to-energy plants: Effects of superheater operating temperature and moisture

Waste-to-energy (WTE) technology via municipal solid waste incineration (MSWI) have developed very rapidly with the advantages of achievement on waste disposal and energy conversion. This technology is developing towards higher capacity and efficiency. Therefore, the operation parameters of WTE boilers must be improved. However, higher steam parameters means higher surface temperature of exchange tube in superheaters and reheaters in WTE boilers, resulting higher risk of engineering failure due to high-temperature corrosion. Additionally, the incineration of MSW releases flue gas with a high content of corrosive species and water vapor, which can cause severe high-temperature corrosion. This experimental investigation details the effect of surface temperature and water vapor concentration on the high-temperature corrosion behavior of 12Cr1MoVG boiler steel under an atmosphere mimicking MSWI. The corrosion test environment consists of high temperature, ash deposit and simulated flue gas of waste incineration according to a real WTE boiler. The experiment was conducted using a two-zone bench-scale tube furnace with a gas temperature of 600℃ and the sample temperatures of 380℃, 430℃, and 480℃. For the investigation of water vapor concentration effect, 18 % vol and 23 % vol were set up in this study. After 240 hours of exposure, the corrosion weight curves illustrated that the corrosion kinetics was highly dependent on the surface temperature of corrosion samples. Furthermore, an increase in water vapor concentration exacerbated the high-temperature corrosion. XRD analysis identified the corrosion products as metal chlorides and metal oxides. Cross-sectional SEM images and EDS analysis revealed that an increase in water vapor accelerated the corrosion rate of the steel samples due to chromium dilution behavior.

Cross-Sectional Analysis of Exome Sequencing Diagnosis in Patients With Neurologic Phenotypes Facing Barriers to Clinical Testing.

Exome sequencing (ES) demonstrates a 20-50 percent diagnostic yield for patients with a suspected monogenic neurologic disease. Despite the proven efficacy in achieving a diagnosis for such patients, multiple barriers for obtaining exome sequencing remain. This study set out to assess the efficacy of ES in patients with primary neurologic phenotypes who were appropriate candidates for testing but had been unable to pursue clinical testing. A total of 297 patients were identified from the UCLA Clinical Neurogenomics Research Center Biobank, and ES was performed, including bioinformatic assessment of copy number variation and repeat expansions. Information regarding demographics, clinical indication for ES, and reason for not pursuing ES clinically were recorded. To assess diagnostic efficacy, variants were interpreted by a multidisciplinary team of clinicians, bioinformaticians, and genetic counselors in accordance with the American College of Medical Genetics and Genomics variant classification guidelines. We next examined the specific barriers to testing for these patients, including how frequently insurance-related barriers such as coverage denials and inadequate coverage of cost were obstacles to pursuing exome sequencing. The cohort primarily consisted of patients with sporadic conditions (n = 126, 42.4%) of adult-onset (n = 239, 80.5%). Cerebellar ataxia (n = 225, 75.8%) was the most common presenting neurologic phenotype. Our study found that in this population of mostly adult patients with primary neurologic phenotypes that were unable to pursue exome sequencing clinically, 47 (15.8%) had diagnostic results while an additional 24 patients (8.1%) had uncertain results. Of the 297 patients, 206 were initially recommended for clinical exome but 88 (42.7%) could not pursue ES because of insurance barriers, of whom 14 (15.9%) had diagnostic findings, representing 29.8% of all patients with diagnostic findings. In addition, the incorporation of bioinformatic repeat expansion testing was valuable, identifying a total of 8 pathogenic repeat expansions (17.0% of all diagnostic findings) including 3 of the common spinocerebellar ataxias and 2 patients with Huntington disease. These findings underscore the importance and value of clinical ES as a diagnostic tool for neurogenetic disease and highlight key barriers that prevent patients from receiving important clinical information with potential treatment and psychosocial implications for patients and family members.

Assessing the Accuracy of Substance Use Disorder Treatment Search Tools: A Cross-sectional Analysis of National and State-Level Directories

BackgroundAddressing the critical public health crisis of substance use disorder (SUD), this study evaluates the accuracy of SUD treatment search tools, such as FindTreatment.gov, to connect patients with appropriate care. MethodsTo ensure geographic diversity, we randomly selected one state from four distinct US regions (Arizona, Florida, Massachusetts, Ohio) and then randomly selected counties of varying sizes (one large, two medium, three small) within each state using a random number generator. Contact information for practices was extracted from the tools and validated through phone calls. The primary outcome measures were exact accuracy rate (wherein all information was accurate) and functional accuracy rate (wherein enough information was provided to facilitate care establishment). ResultsA total of 697 practices from within ten SUD treatment search tools were assessed. Accuracy of the ten SUD treatment search tools varied considerably, with exact accuracy rates ranging from 9.1% to 76.0% (mean: 56.0%) and functional accuracy rates from 50.0% to 92.0% (mean: 82.8%). National tools exhibited higher accuracy for both exact accuracy rate (66.3% v. 49.0%; p = 0.2864) and functional accuracy rate (83.8% v. 82.2%; p = 0.9148) than state tools, while privately funded tools demonstrated higher accuracy for both exact accuracy rates (66.8% v. 48.9%; p = 0.2008) and functional accuracy rates (83.8% v. 82.2%; p = 0.9148), but none of these differences were statistically significant. ConclusionsThis study found that SUD treatment search tools commonly list inaccurate information, underscoring the need for systematic improvements in data management and validation practices.

Disparities in gynecologic oncology clinical trial availability in the United States: A state-level analysis.

e23128 Background: Disparities in minority participation in gynecologic cancer clinical trials is well documented. FDA guidance stipulates geographic informed analyses to reduce barriers to trial participation. We performed a geographical analyses of gynecologic cancer clinical trials in the United States relative to racial distribution and social vulnerability indices to identify areas of increased need. Methods: We performed a cross-sectional analysis of NIH ClinicalTrials.gov by retrieving all trials first posted 1/1/2013 through to 1/10/2024. We searched for ovarian, uterine, cervical, endometrial, vaginal/vulvar and gynecological cancer. We reviewed enrollment criteria to exclude non-gynecological cancers (1643 trials) or non-invasive gynecological conditions (224 trials). We aggregated census data, state-level total population size, percent Non-Hispanic White (NHW), and the FEMA Expected Annual Loss per state as a measure of social vulnerability. Using R statistical software (v 4.3.1), we measured the association between these variables and the number of gynecological trials per 100,000 persons using Pearson’s correlation. Results: We identified 3,428 trials, filtered down to 1,561 invasive cancer trials. The most common trials were ovarian (911, 58.3%) and cervical (438, 28.0%), followed by endometrial (385, 24.6%), uterine (158, 10.1%), vulva-vaginal (78, 4.99%), and 7.62% genetic-based. Texas had the highest number of trials (501) followed by California (454) and New York (427). The state with the highest population-adjusted number of trials was South Dakota (8.57 trials per 100,000 persons), followed by Rhode Island at 8.38 per 100,000 persons. California, Mississippi, and Puerto Rico had the lowest number of trials per 100,000 persons with 1.148, 0.979, 0.466 respectively. States/territories with greater than 4 trials per 100,000 were comprised of populations that were &gt; 50% NHW. The correlation between the state-level percentage of NHW in 2020 and the number of trials per 100,000 persons was p = 0.057 indicating that there was a correlation between Whiteness at the state-level and trial availability. We found that states with higher FEMA expected annual loss had lower numbers of gynecological trials per 100,000 persons (p &lt; 0.001). Conclusions: We found a disparity in the geographical distribution of trials available for gynecological cancers that was correlated with racial disparities and social vulnerability. Efforts to increase decentralization of trials and improve access and availability of gynecologic cancer clinical trials are necessary to increase equity for minority representation in clinical trials at the national level.

Frequency of HER2-Low in breast cancer biopsies in Chile.

e13163 Background: In breast cancer (BC), human epidermal growth factor receptor 2 (HER2) is a prognostic and predictive biomarker. Traditionally, the use of HER2-targeted therapies is reserved for BC that overexpress HER2, defined as immunohistochemical (IHC) expression of 3+ or 2+ with amplification of the gene encoding HER2, detected by in situ hybridization (ISH). Recently, the term HER2-Low, defined as the IHC expression of 1+ or 2+ with negative ISH, has gained relevance as a new predictive biomarker for the use of trastuzumab-deruxtecan. The frequency of HER2-Low BC in the Chilean population is unknown. The objective of this study is to show the frequency of HER2-Low BC in a Chilean center. Methods: Descriptive cross-sectional analysis of clinical records and biopsies of localized or metastatic invasive breast carcinoma performed at Clínica Santa María between January 2020 and December 2023. The IHC expression of the estrogen receptor (ER), progesterone receptor (PR), Ki-67, HER2, histological grade (G) and HER2 in situ hybridization (ISH) when appropriate. The frequency and characteristics of HER2-Low cases are described and compared with the surrogate clinicopathological subtypes luminal A, luminal B (HER2-Positive and Negative), HER2-Positive and Triple Negative (TN), according to the St Gallen Consensus Conference 2013. Results: Between January 2020 and December 2023, a total of 339 biopsies with invasive BC were identified, from which 104 (36.0%) met the definition of HER2-Low. The frequency of luminal B and luminal A that met the definition of HER2-Low was 54 (51.9%) and 40 (38.5%), respectively. Of the 253 biopsies classified as luminal, 94 (37.2%) met the definition of HER2-Low, while of the 36 biopsies classified as TN, 10 (27.8%) did. Luminal B HER2-Negative and TN surrogate subtypes that met the definition of HER2-Low had a higher frequency of G3 than their non-HER2-Low counterpart. Conclusions: In the population analyzed, a considerable percentage of cases meet the definition of HER2-Low. This has relevant therapeutic implications. Distribution of biopsies that meet HER2-Low criteria according to surrogate clinicopathological subtype of breast cancer. [Table: see text]

A Retrospective Analysis of Southeastern U.S. Police Recruit Health and Fitness From 4 Points in Time Within a 16-Year Period: Implications for Physical Fitness Training.

Gonzales, SM, Orr, RM, Coburn, JW, Hoffmann, MD, Kennedy, K, Dawes, JJ, and Lockie, RG. A retrospective analysis of southeastern U.S. police recruit health and fitness from 4 points in time within a 16-year period: Implications for physical fitness training. J Strength Cond Res 38(6): 1118-1126, 2024-Drawing from the general population for its recruiting needs, police departments often employ academy curricula to improve a recruit's fitness so they can perform occupational tasks. Recently, obesity and physical inactivity have increased in the general population, potentially influencing the health and fitness of incoming recruits. This study involved a retrospective, cross-sectional analysis of health and fitness data of police recruits. Data from 1 police department in southeastern United States were analyzed at 4 specific time points, splitting the recruits into natural immerging groups; 2003 (n = 93), 2006 (n = 137), 2009 (n = 74), and 2019 (n = 242). Health and fitness data for all recruits included age, height, body mass, and body mass index (BMI); systolic and diastolic blood pressure (BP); sit-and-reach; combined grip strength; push-ups and sit-ups completed in 60 seconds; physical ability test time; and 2.4-km run time. Several univariate analyses, with sex and age as covariates (analyses of covariance), and a Bonferroni's post hoc, determined whether there were significant between-group differences. Effect sizes (d) were also calculated. Key results demonstrated that 2019 recruits were heavier than the recruits in 2006 and 2009 (p ≤ 0.032; d = 0.14-0.38); had a greater BMI (p ≤ 0.028; d = 0.24-0.75) and systolic BP (p < 0.001; d = 0.47-0.65), and lesser sit-and-reach distance (p ≤ 0.020; d = 0.26-0.46), than all recruit groups; completed fewer sit-up repetitions than the recruits in 2006 and 2009 (p ≤ 0.025; d = 0.42-0.48); and were slower in the 2.4-km run than the recruits in 2006 (p = 0.009; d = 0.36). Police training staff may need to address lesser health (BMI, BP) and fitness (hamstring flexibility, abdominal endurance, aerobic fitness) in incoming recruits.

Utilization and potential disparities in access to physical therapy for spine pain in the long-term care population

ObjectiveTo determine the frequency of physical therapy (PT) services and potential disparities in receiving PT amongst Medicare fee-for-service beneficiaries with a history of spine pain who live in long-term care (LTC) settings. DesignSecondary cross-sectional analysis of Medicare administrative data on beneficiaries with a history of spine pain from 2017 – 2019. We identified LTC residents using a validated algorithm, then identified and described PT episodes that occurred after the LTC index date. To identify potential disparities in access to PT services, we performed multivariable logistic regression to determine resident demographic, clinical, and community factors associated with receiving PT. SettingN/A ParticipantsMedicare fee-for-service LTC residents ages ≥65. InterventionsN/A Main Outcome MeasureReceiving PT services. ResultsOf the 999,495 LTC residents with a history of spine pain, 49.6% received PT. Only 12.1% of PT episodes specifically treated spine pain. The odds of receiving PT were higher for residents with pain in multiple spine regions or neuropathic pain (OR 1.27, 95%CI 1.26-1.29) and for residents with inpatient admissions (OR 1.76, 95%CI 1.75-1.78). Odds of receiving PT were lower for residents from minoritized racial and ethnic groups, and for residents with dementia (OR 0.89, 95% CI 0.88-0.90), depression (OR 0.95, 95% 0.94, 0.96), or who lived in urban or more socioeconomically deprived areas. ConclusionsWhile nearly half of LTC residents with histories of spine pain received PT services, most PT was not for spine pain. There are potential disparities in access to PT for LTC residents from minoritized groups living in urban and more deprived areas. Further work should examine PT outcomes and remove barriers to PT for LTC residents with histories of spine pain.

Statistical and cross-sectional analysis of factors effecting the prevalence of pressure ulcer in hospital admitted stroke patients

Every year, millions of people around the world are disabled by stroke, it is well recognized that complications aftera stroke extend hospital stays and pressure ulcers, a stroke consequence, which can be prevented by educating the caregiver. The primary focus of this research is not only to investigate the prevalence of pressure ulcers (PU) among stroke patients, but this study also introduced a variety of factors which influence the formation of PU, such as restricted mobility, gender, duration of stroke, hypertension, diabetes, hygiene, type of mattress, malnutrition, awareness, etc. In addition, this research provides a comparative and statistical analysis, a cause of the catastrophic disabilities influenced by a variety of factors. Moreover, the proposed research also provides a room for the pertinent treatment of stroke patient to curtail the formation of pressure ulcer. In this research, a total of 120 stroke patients were initially included to monitor the frequency of pressure ulcers at incipient stage. Out of the total patients, the number of patients with ischemic stroke were 78.5 % while 8.3 % were of haemorrhagic type. In the results, the demographic characteristics and the factors which influence the formation of PU of the patients were examined with their cross-sectional impact on each other through comparative and statistical analysis. It was discovered that among all the stroke patients, 8.3 % were found with a PUs and the most frequent localization was sacrum and no new PU was observed for the participants under the observation.

Older adults with communication disabilities and their use of communication support at doctor’s visits: a nationally representative study

Purpose Older adults with communication disabilities (CDs) experience barriers to receiving care and face a paucity of accommodations for their disability. Utilizing someone that supports communication with healthcare providers (communication support persons) may be a way that this group self-supports their disability. We examined if this utilization was independently associated with CDs among older adults. We also sought to understand if socioeconomic factors were associated with utilization. Methods We used the 2015 National Health and Aging Trends Survey (NHATS) to conduct a cross-sectional analysis of Medicare beneficiaries (n = 5954) with functional hearing, expressive, or cognitive difficulties. We calculated a weighted, population prevalence and an adjusted prevalence ratio (APR) controlling for sociodemographic, health and other disability factors. Results Among community dwelling older adults, having CDs was associated with higher utilization of a communication support person at medical visits (APR: 1.41 [CI: 1.27 − 1.57]). Among adults with CDs, Black adults and women had lower levels of utilization as compared to White adults and men, respectively. Conclusion Communication support persons may be a way that older adults with CDs self-support their disability. However, not all older adults with CDs bring someone and variation by social factors could suggest that unmet support needs exist.

A Cross-Sectional Analysis of Bystander Cardiopulmonary Resuscitation (CPR): Behavioural Changes in the COVID-19 Era.

Objectives The coronavirus disease 2019 (COVID-19) pandemic has impacted public health systems and individuals' behaviour, with decreasing survival rates among out-of-hospital cardiac arrest (OHCA) patients. Bystander cardiopulmonary resuscitation (CPR) improves OHCA outcomes, which may have been affected by COVID-19. We sought to understand the impacts of COVID-19 on bystanders' willingness to administer CPR in three Canadian provinces. Methods Participants ≥ 18 years of age were surveyed online about their current and recalled pre-pandemic attitudes toward CPR and perceived transmission risk. We compared mean willingness to perform various CPR actions before and during the pandemic using paired t-tests. Differences in willingness across three provinces were assessed using analysis of variance (ANOVA) and Tukey's Honestly Significant Difference (HSD) test. We also conducted Chi-square tests to assess changes in willingness to perform CPR on children and older adults. Results Five hundred thirty-five participants were surveyed from October 1 to November 15, 2021. The mean age was 42.7 years (SD 14.5), and 60.2% were female. Participants reported less willingness to perform chest compressions on strangers during the pandemic compared to their recollections before the pandemic (mean willingness 86.2% vs. 94.3% prior, p<0.001). With personal protective equipment (PPE) available, particularly masks, willingness recovered to 91.3% (p<0.001). Willingness was higher in Nova Scotia (NS) than in British Columbia (BC) or Ontario (ON). Reluctance to assist older adults increased from 6.6% to 12.0% (p=0.020). Conclusions This study highlights changes in CPR willingness during the COVID-19 pandemic, underscoring the importance of PPE and offering insights into public health strategies pertaining to CPR during a pandemic.

Utility of colposcopy for the screening and management of cervical cancer in Africa: A cross-sectional analysis of providers’ training and practices.

10555 Background: Cervical cancer is a public health issue in Africa with devastating socioeconomic consequences due to the lack of organized screening programs. The success of screening programs depends on the appropriate investigation and management of women who test positive for screening. Colposcopic assessment following positive screening results is a critical issue in Africa. This study aimed to assess the utilization of colposcopy by providers in the region. Methods: A cross-sectional study was conducted in 2021-2022 among healthcare providers involved in cervical cancer prevention activities in Africa. They were invited to report prior colposcopy training, whether they performed colposcopy and the indications of colposcopy in their practice. Results: Of the 130 providers from 23 African countries who responded to the survey (mean age [SD]: 39.0 years [9.4]), half were female (65 [50.0%]), and 90.7% were working in urban areas. Overall, only 12.6% of respondents indicated having received prior training on colposcopy, and 11.7% reported that they were performing colposcopy in their current practice. Among the providers who reported performing colposcopy in their practice, colposcopy was indicated for routine visual screening in 21.2% of clinicians, to visualize the transformation zone in 15.2% of respondents, to assess vascularization of cervical mucosa in 33.3% of respondents, and to determine treatment modality in 12.1% of respondents. Conclusions: Providers’ training and utilization of colposcopy for cervical cancer screening remain suboptimal in Africa. To address this situation in the region, further training is needed to improve providers' knowledge and engagement. With the development of lower-cost and portable colposcopes, efforts to equip cervical cancer prevention programs and facilities with colposcopy should be enhanced to ensure that women can be screened and managed appropriately.

Therapeutic utilization in chronic lymphocytic leukemia: A cross-sectional analysis of the Lymphoma Coalition’s 2022 Global Patient Survey.

e19026 Background: Chronic Lymphocytic Leukemia (CLL) is a highly prevalent disease with heterogenous prognostic trajectories. With a multitude of treatment options, we sought to explore therapeutic utilization trends from a global perspective in order to gain a more in-depth understanding of how different treatment regimens are utilized in different health systems. Methods: In 2022, The Lymphoma Coalition designed and globally deployed a survey to patients with lymphoma and CLL in order to gather patient reported outcomes and patient reported experience measures. Data were collected and enumerated with relevant contingency analyses performed to determine associations with a particular treatment regimen in the context of CLL. Results: The entire cohort of patients with CLL was 1289. The median age of the cohort was 65 and ranged from 26 to 97 years old. Biological sex was equally distributed with 50.5% of respondent indicating that they were female. Respondents were derived from 29 countries. The top three contributors to each region were China (50%), Australia (25%) and New Zealand (18%) for Asia-Pacific (N = 227); France (50%), Italy (13%) and Sweden (7%) for Europe (N = 950); Canada (75%) and The United States (25%) for North America (N = 112). Of those, 636 indicated that they received at least one therapy. The use of chemo-immunotherapy was most common (42%) followed by targeted therapy (32%), immunotherapy alone (18%), and chemotherapy alone (16%). Neither age nor biological sex was a significant predictor of therapy. Europe had the highest rates of chemo-immunotherapy utilization (45%) with North America and Asia-Pacific indicating 32% respectively (p = 0.01). Targeted therapy was used at a higher rate in North America (45%) but failed to demonstrate a significant difference against Asia-Pacific and Europe (31%); (p=0.10). Both immunotherapy and chemotherapy alone failed to demonstrate significant differences across regions. Conclusions: The data support that the majority of patients with CLL who require treatment are most likely to receive combination chemo-immunotherapy utilizing rituximab. However, we acknowledge that the data presented here is two years old and that the use of targeted molecular therapy is likely increasing. We found it reassuring that we could not identify any biases in the administration of the therapeutic regimens across the demographics of age and biological sex. Our research in this space will continue as we have deployed the 2024 version of the Global Patient Survey and have focused on increasing respondent participation from North America. With this new data, we plan on producing a time-dependent model to investigate how emerging therapies enter and expand in the CLL therapeutic space.

Use of Acid-Suppression Therapy and Odds of Migraine and Severe Headache in the National Health and Nutrition Examination Survey.

Headache is an adverse event associated with the use of proton pump inhibitors (PPIs). Recently, migraine has emerged more specifically as a potential adverse event with PPI use. The objectives of this work were to capitalize on existing data to evaluate the association between migraine and severe headache prevalence and use of acid-suppression therapy, including PPIs, H2 receptor antagonists (H2RAs), and generic antacids; to compare risk from PPIs vs H2RAs; and to assess for potential mitigation by a dietary factor affected by acid-suppression therapy. Data from adults in the 1999-2004 National Health and Nutrition Examination Survey were used for this cross-sectional analysis. Acid-suppression therapy use was identified from self-report confirmed by product packaging review. Respondents who endorsed migraine or severe headache in the past 3 months were classified in the migraine or severe headache group. Dietary intake of magnesium was determined using one 24-hour recall interview. Multivariable logistic regression models were generated to analyze the relationship between acid-suppression therapy use and migraine or severe headache, and an interaction test was conducted to evaluate whether migraine or severe headache prevalence differed in relation to nutritional magnesium intake across acid-suppression therapy users and nonusers. In 11,818 US adults, the use of acid-suppression therapy was associated with higher odds of migraine or severe headache for all types of acid-suppression therapy and use of any type, as compared with those who did not use acid-suppression therapy: use of PPIs (70% higher), H2RAs (40% higher), and generic antacids (30% higher). Differences between acid-suppression therapy were not significant. An interaction was observed for H2RA use and magnesium intake (p = 0.024). These observations in US adults agree with previous findings that migraine or severe headache is a potential adverse event of PPIs, the most efficacious and most frequently used type of acid suppressing medication, and further suggest that other classes of acid suppressing medications (H2RAs and generic antacids) may also be implicated for migraine and severe headache. Future prospective analyses are needed to investigate migraine risk associated with acid suppressing medications while current evidence is sufficient to evaluate patients with migraine in light of recent deprescribing advice for PPIs.

Cross-sectional analysis of state and federal malpractice and medical liability claims for cutaneous energy-based device procedures, 1985 to 2023

Cross-sectional analysis of state and federal malpractice and medical liability claims for cutaneous energy-based device procedures, 1985 to 2023

Trends in thyroid function following radiofrequency ablation of benign, nonfunctioning thyroid nodules: A single institution review

BackgroundRadiofrequency ablation (RFA) effectively reduces volume and improves symptoms of benign, non-functioning thyroid nodules (NFTNs). Given RFA's unclear impact on thyroid function, we examined post-RFA trends in thyroid hormones and antibodies. MethodsA retrospective cross-sectional analysis was conducted of patients treated at Columbia University with RFA for benign NFTNs between August 2019 and July 2023. Thyroid function tests were recorded pre-RFA and repeated 3, 6, and 12 months post-RFA. ResultsWe analyzed 185 patients with 243 benign NFTNs who underwent RFA. Volume reduction ratio increased post-RFA. Mean TSH increased to 2.4 mlU/L (p ​= ​0.005) at 3 months post-RFA and decreased to 1.8 mlU/L (p ​= ​0.551) by 12 months post-RFA. Tg and TPO antibody levels peaked at 6 months post-RFA (103.1 IU/mL, p ​= ​0.868 and 66.6 IU/mL, p ​= ​0.523, respectively). ConclusionsWith expected volume reduction post-RFA, we observed transient relative hypothyroidism as well as transient increases in thyroid antibodies, with normalization of these changes within 12 months.