Differences In Sociodemographic Characteristics Research Articles

The Role of Pre-Treatment Traumatic Stress Symptoms in Adolescent Substance Use Treatment Outcomes

Background: Prominent theories suggest that individuals with co-occurring traumatic stress symptoms (TSS) and substance use (SU) may be less responsive to SU treatment compared to those with SU only. However, empirical findings in adult samples are mixed, and there has been limited work among adolescents. This study assesses the association between TSS and SU treatment outcomes among trauma-exposed adolescents, using statistical methods to reduce potential confounding from important factors such as baseline SU severity. Method: 2,963 adolescents with lifetime history of victimization received evidence-based SU treatment in outpatient community settings. At baseline, 3- and 6-months, youth were assessed using the Global Appraisal of Individual Needs Traumatic Stress Scale and the Substance Frequency Scale. Propensity score weighting was used to mitigate potential confounding due to baseline differences in sociodemographic characteristics and SU across youth with varying levels of TSS. Results: Propensity score weighting successfully balanced baseline differences in sociodemographic factors and baseline SU across youth. Among all youth, mean SU was lower at both 3- and 6- month follow-up relative to baseline, indicating declining use. After adjusting for potential confounders, we observed no statistically significant relationship between TSS and SU at either 3- or 6-month follow-up. Conclusions: Based on this investigation, conducted among a large sample of trauma-exposed youth receiving evidence-based outpatient SU treatment, baseline TSS do not appear to be negatively associated with SU treatment outcomes. However, future research should examine whether youth with TSS achieve better outcomes through integrative treatment for both SU and TSS.

Weight Management Behaviors are Associated with Elevated Glycemic Outcomes in Adolescents and Young Adults with Type 1 Diabetes.

Many adolescents and young adults (AYAs) with type 1 diabetes (T1D) engage in weight management behaviors (i.e., trying to lose weight), and efforts to manage weight may impact glycemic control. We assessed objective/subjective weight status and weight management behaviors in a diverse sample of 76 AYAs with T1D, and examined differences in sociodemographic characteristics and A1c levels by the following categories: (1) Overweight BMI/weight management (n = 21), (2) overweight BMI/no weight management (n = 6), (3) in/below-range BMI/weight management (n = 25), (4) in/below-range BMI/no weight management (n = 24). Subjective overweight status was more common among late adolescents and females; female gender was associated with weight management behaviors. AYAs endorsing weight management behaviors evidenced higher A1c values than those who did not. Clinicians working with AYAs should be aware of associations among weight management and glycemic indicators and routinely screen for weight management behaviors. Future research should explore interventions to promote healthy lifestyle behaviors among AYAs.

Exploring Care Service Use Among Latino LGBTQ+ Caregivers of Persons Living with Alzheimer’s Disease and Related Dementias

AbstractBackgroundLatino and lesbian, gay, bisexual, transgender or queer (LGBTQ+) adults are both growing populations at increased risk of Alzheimer’s disease and related dementias (ADRD). The increased prevalence in ADRD among these populations requires caregiving that is often met by informal caregivers. Yet, very little is known about the experiences of informal ADRD caregivers who identify as both Latino and LGBTQ+.MethodWe examined differences in sociodemographic characteristics, caregiving characteristics, and use of caregiver support services between English‐proficient Latino and non‐Latino LGBTQ+ ADRD caregivers recruited via social media (n = 286; Latino n = 103).ResultLatino caregivers identified as gay (45%), lesbian (24%), bisexual (20%), and queer/other (11%). Sixty‐one percent identified as cisgender (not transgender) women, 39% cisgender men, and 19% identified as transgender. On average, Latino caregivers were younger (36 vs. 38 years old), reported a lower percentage of individuals who completed a college degree (36% vs. 51%), a higher income (64% vs. 50%), and a lower percentage of being married or partnered (44% vs 63%). Latino caregivers were in their caregiving roles for seven months less than non‐Latino caregivers, and reported a greater (8% vs. 6%) presence and severity of behavioral symptoms of distress (e.g., agitation, disrupted sleep) among their care recipients living with ADRD. Latino caregivers indicated their care recipients had less dependence in activities of daily living (1.3 vs. 1.8) and more independence in instrumental activities of daily living (5.1 vs. 4.2). Latino caregivers also reported lower use of respite services (38% vs. 51%), transportation services (37% vs. 53%), and making home modifications (34% vs. 71%) for their care recipients living with ADRD.ConclusionFindings indicate Latino and non‐Latino LGBTQ+ ADRD informal caregivers differed in sociodemographic characteristics, length of time caregiving, and the presence and severity of behaviors and functioning levels of their care recipients living with ADRD. Latino caregivers utilized caregiver support services to a lesser degree than non‐Latino caregivers. More research is needed to understand ways to address the needs and better serve this growing population.

Who are the 10%? Characteristics of the populations and communities receiving fluoridated water in England.

In England, around 10% of the population receive optimally fluoridated water. This coverage has evolved through a combination of historical local decision-making and natural geography, rather than being strategically targeted at the national level. It is important to understand if the current distribution is equitable according to indicators of oral health need and to identify any population-level differences in socio-demographic characteristics that could introduce bias to studies evaluating the effectiveness of water fluoridation. Descriptive analysis comparing the census characteristics of populations that received optimally fluoridated (=/⟩ 0.7 mg F/L) and non-fluoridated water (⟨0.7 mg F/L) between 2009 and 2020. Populations receiving fluoridated water between 2009-2020 were on average slightly younger, more urban, more deprived, with lower education levels, higher unemployment and lower car and home ownership than the populations who received non-fluoridated water. They are more ethnically diverse, with a higher proportion of Asian ethnicity and a lower proportion of White ethnicity, compared to the non-fluoridated population. This descriptive analysis provides evidence that water fluoridation coverage within England is targeted reasonably equitably in relation to population-level indicators of need. It also confirms the need to consider the impact of underlying differences in age, deprivation, rurality, and ethnicity when evaluating the impact of water fluoridation on health outcomes in England.

Disparities in Mortality Among Myelodysplastic Syndrome-Related Hospitalizations

Introduction: Myelodysplastic syndromes (MDS) are a diverse group of disorders characterized by clonal proliferation of hematopoietic stem cells, ineffective hematopoiesis, and cytopenia. These disorders can be difficult to diagnose and carry a high risk of evolution to acute myeloid leukemia (AML). Prognostic risk is determined by cytogenetic and molecular features. Outcomes are dependent on pathologic, molecular, and clinical features. However, it is becoming increasingly apparent that socioeconomic and racial/ethnic differences also contribute to disparate outcomes in hematologic malignancies and MDS. Here, we analyzed in-hospital death among MDS-related hospitalizations and evaluated differences in sociodemographic characteristics, focusing on the effect of primary payer on MDS mortality. Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS), the largest all-payer database of hospital admissions in the United States, from January 1st, 2010 through December 31st, 2019. The study sample consisted of adult (18 years and above) hospitalizations with MDS diagnosis captured using ICD-9 and 10 codes indicative of MDS. We performed adjusted survey logistic regression analyses to assess associations between sociodemographic characteristics (exposure) and in-hospital mortality among MDS hospitalization (outcomes). Results: Our data captured 304,050,043 hospital encounters of adult patients from 2010 to 2019, and 787,105 of those had a MDS diagnosis. Overall, patients who self-paid were more likely to have in-hospital mortality compared to those with private insurance [odds ratio (OR), 95% confidence interval: 1.85 (1.61-2.12)]. In contrast, patients with Medicare or Medicaid had less in-hospital mortality compared to those with private insurance [OR: 0.80 (0.75-0.85) and 0.65 (0.55-0.76) respectively). This trend was observed in NH-White, NH-Black, and NH-other patients and was most pronounced and significant in the NH-White population. Among NH-White patients, in-hospital mortality in self-paid was nearly double to their privately insured counterparts [OR 1.99 (1.70-2.33)]. Additional findings noted were relatively higher in-hospital mortality among overall males compared to female [OR 1.22 (1.16-1.27)] and higher among NH-white compared to NH-black or Hispanic (Table 1). Interestingly, the Midwest region had better outcomes than the other regions, and Medicaid patients had better outcomes than other payer groups (Table 1). Conclusion: In-hospital mortality was higher in self-paid patients, both overall as well as in multiple racial/ethnic groups. Patients with Medicaid were relatively younger which might have resulted in better mortality outcome noted in our study. It is possible that those who are self-paid are too young to qualify for Medicare, are low-income but not enough to qualify for Medicaid, or do not qualify for public assistance due to other unmeasured variables, such as undocumented residency status. Self-paid patients may delay seeking care and have fewer interactions with the healthcare system prior to hospitalization due to associated cost and thus are sicker at time of hospitalization. Further research is needed to explore if this disparity in mortality in self-paid patients is related to access to care, treatment received including transplant status, or the disease severity and its complications. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 11156: Over Time, Heart Failure Symptoms Worsen Depression

Introduction: Heart failure (HF) is a global health problem, contributing to increases in hospital readmission rates, high health care costs, and increased morbidity and mortality. HF symptoms can be difficult to manage and lead to depression. Purpose: To examine the impact of a nurse-led, telephone, coping intervention and HF symptoms on depression in patients with HF. Methods: A 3-group randomized controlled pilot study was conducted with 107 HF patients to test the effectiveness of a 12-week telephone-based coping intervention for HF symptoms. The intervention group (n = 34) received 1 home visit, weekly (1st month), and biweekly (months 2-3) telephone calls. The attention group (n = 38) received sham calls on a similar pattern as the intervention group. All groups received usual care, with the control group (n = 35) receiving usual care only. HF patients were 61 years old, on average; 54.2% male; 54.2% African American; and 43.9% NYHA II. Data were collected at baseline, 5, 9, and 13 weeks on social support (Interpersonal Support Evaluation List), problem-solving (Social Problem-Solving Inventory Revised-Short), HF symptoms (Heart Failure Symptom Survey), and depression (Center for Epidemiological Studies-Depression scale). Linear mixed modeling was implemented to examine the effect of the intervention and HF symptoms on depression over time, controlling for social support and problem-solving. Results: Sixty-four patients completed the study (18 intervention; 24 attention; 22 control). No significant between-group differences in sociodemographic characteristics, HF symptoms, or depression was noted at baseline. There was no significant intervention effect over time on depression. However, experiencing HF symptoms over time contributed to worse depression across all groups. Conclusions: Experiencing HF symptoms can lead to worsened depression over time. Interventions that improve self-management of HF symptoms can potentially be effective in reducing depression in HF patients.

Multiple chronic conditions among older adults in China: differences in socio-demographic characteristics

ObjectiveThere are relatively few studies on multiple chronic conditions (MCC) among older adults in China. This study sought to assess the potential differences in the risk of MCC among different elderly populations, and thus to identify the most vulnerable populations at higher risk of developing the MCC. MethodsA sample of 5320 adults aged 60 years or above from the China's Health-Related Quality of Life Survey for Older Adults 2018 (CHRQLS-OA 2018) were included in this study. Descriptive statistics frequencies and proportions were used to summarize the sample characteristics, and logistic regression models were conducted to identify the differences in the risk of having MCC among different populations. ResultsOverall, 52.6% of respondents had been clearly diagnosed with at least one chronic disease with 25.3% having MCC. The males ((adjusted odds ratio [AOR] = 0.84; 95% confidence interval [CI] = 0.73–0.98) were less likely to have MCC. This was also true among female elderly with a non-agricultural hukou (AOR = 0.75; 95% CI = 0.57–0.99). The elderly with a non-agricultural hukou aged 60–64 (AOR = 0.55; 95% CI = 0.34–0.88) had a lower risk of having MCC. Those whose average annual household income per capita were 15,000–30,000 RMB (AOR = 1.42; 95% CI = 1.03–1.96) were more likely to suffer from MCC. The odds ratios of having MCC were smaller as the personal savings increases in total samples (all P < 0.05). ConclusionsThe findings suggest that different policies or approaches should target these specific populations who are most in need and are most likely to suffer from MCC.

Bridging differences across cohorts in the relationship between prenatal secondhand smoke exposure and birth weight: Transportability of effect estimates in the ECHO consortium

Background and Aim: Transportability of effect estimates in epidemiology can potentially help investigators explain the differences in effect estimates for the same exposure-outcome relationships observed across different cohorts. In this study we aim to explain potential differences in the relationship between prenatal secondhand smoke exposure (SHS) and birth weight across different cohorts of the Environmental influences on Child Health Outcomes (ECHO) consortium that may be due to population differences in sociodemographic characteristics. Methods: We assessed transportability of effect estimates across 5 different cohorts in the ECHO consortium consisting of 6582 mother-offspring dyads. We first estimated individual cohort effects using Targeted Maximum Likelihood Estimation adjusting for several sociodemographic covariates. We then proceeded to estimate transported effects from one cohort to each of the remaining cohorts using a robust non-parametric estimation approach. We compared the transported effect estimates to the original effect estimates for these cohorts with any decrease in differences between cohort-specific estimates potentially attributable to different sociodemographic variable distributions. Results: Individual cohort effects associated with SHS exposure varied across the 5 cohorts with a range of strongly suggestive results for harmful effects of exposure (149.0 gram decrease in birthweight (95% confidence interval (CI): -254.4, -43.5), to results on the protective side of the null albeit with very wide confidence intervals. Transported effect estimates partially explained differences in 3 out of the 4 cohort pairs, explaining 7% to 97% of the differences in the effect point estimates. Conclusion: Differences in sociodemographic characteristics across different populations may partially explain differences observed in the relationship between prenatal SHS exposure and birth weight across cohorts in the ECHO consortium. This framework could have broader implications in in multi-cohort consortiums by aiding in the comparability of cross-cohort results. Keywords: transportability, causal inference, machine learning, secondhand smoke, birth outcomes

Investigating the effect of couple-centered counseling by Gottman method on the intimacy of infertile couples referring to the infertility Ward of Fatemieh hospital, Hamadan, Iran in 2020: a quasi-experimental study

BackgroundInfertility is among the most unpleasant experiences for couples struggling with it. Therefore, coping with its associated psychological burden has become a concern in many societies due to its negative impacts on couples’ lives and intimacy levels.Lack of marital intimacy leads to unfortunate consequences such as dissatisfaction with marital relationships between spouses. Therefore, these people should be encouraged to find an effective solution to cope with infertility.Regarding the importance of the emotional relationship between infertile couples and the success rate of infertility treatment, this study aims to determine the effect of couple-centered counseling by the Gottman method on marital intimacy of infertile couples referred to the infertility ward of Fatemieh Hospital in Hamadan.MethodThe sample of this quasi-experimental study included 60 infertile couples in the evaluation phase of treatment with primary infertility. We collected data in a referral infertility center in Hamadan (Iran) between December 2020 and May 2021. Marital intimacy was measured using Thompson & Walker’s Marital Intimacy Questionnaire. At the beginning of the study, the intervention and control groups completed this questionnaire. The intervention group received Gottman couple-centered counseling based on GATHER principles in 8 sessions. The groups completed the questionnaires 4 weeks after the last intervention session again. If the distribution was normal, the ANCOVA test was used to evaluate the differences between the two groups. Intra-group comparisons were performed using paired t-test, and intergroup comparisons were performed using an independent t-test.ResultsThe mean score of female intimacy increased significantly after the intervention (P = 0.009). There was no significant difference in socio-demographic characteristics between groups (P < 0.05), both of which were adjusted in ANCOVA. After the intervention, the mean marital intimacy scores were significantly higher in women participating in the intervention group (from 75.6 (±10.63) to 78.86 (±7.87)). In addition, after the ANCOVA test, the difference was statistically significant (P = 0.009; MD: 3.74, CI: 0.95 and 6.52). The mean score of male marital intimacy increased after the intervention (from 78.93 (±10.21) to 78.9 (±9.79)), although the difference was not statistically significant (P = 0.54; MD: -0.58, CI: − 2.51 and 1.34).ConclusionThe findings support the effective role of Gottman’s couple-centered counseling in increasing marital intimacy by raising couples’ awareness about the principles of proper relationships between them. This outcome suggests that counseling with couples, especially in critical life situations, can improve their relationship in the infertility treatment process and prevent emotional divorce and other negative impacts on their lives.Trial registrationIRCT Registration Number IR.UMSHA.REC.1399.535, registered on 21/09/2020.

Barriers to the cervical cancer screening attendance among Czech women.

The main aim of this study was to find specific barriers to cervical cancer screening attendance that Czech women declare. Furthermore, the objective was to find out whether there are differences between women who do and do not attend screening according to sociodemographic characteristics. Finally, we investigated whether women who do not attend the screening differ by sociodemographic characteristics in declaring particular barriers to attendance. Data were collected using a representative questionnaire survey. The women were asked about their previous participation in the cervical cancer screening program. Those who did not attend screening in the past 2 years or those who do not (intend to) attend screening regularly were considered non-attendees. The non-attendees were then asked about their reasons for non-attendance in the screening. First, descriptive statistical methods were used to analyze the data. Second, the differences between the different groups of women were analyzed by Pearsons chi-squared independence test. In the studied sample population (N = 902), 36.7% were considered non-attendees. Statistically significant differences in sociodemographic characteristics (age, education, marital status, household type) were observed between attendees and non-attendees. The three most common reasons for non-attendance were: "I do not experience any symptoms", "fear of cancer diagnosis", and "fear of the examination procedure". Almost no differences in sociodemographic characteristics in the declaration of particular barriers to attendance were found. We observed differences between women who attended and those who did not attend the screening. However, sociodemographic characteristics do not play an important role once a woman decides not to attend the screening. Therefore, it is essential to communicate cancer prevention throughout the spectrum of Czech women.

Associations Between the Physical Availability of Alcohol and Alcohol Use: Regional Variation Across 15 Major Cities in Ontario, Canada.

Rates of alcohol use and alcohol-related harms increase with greater alcohol availability. However, regional differences in sociodemographic characteristics and built environment may affect this association. This study evaluated the association between off-premise alcohol availability and alcohol use in Ontario, Canada, and the degree to which this association varies between cities. This was a cross-sectional spatial analysis of urban neighborhoods in Ontario, Canada (n = 11,742). The primary exposure was off-premise alcohol availability, based on the drive time from a neighborhood to the closest off-premise outlets. The primary outcome was the neighborhood-level prevalence of high-volume alcohol use (>2 drinks/day [males], >1 drink/ day [females]) based on survey data from 2000 to 2014. The association between availability and use was assessed using Bayesian hierarchical spatial models to account for spatial autocorrelation. There was an overall positive association between alcohol availability and high-volume alcohol use (male coefficient estimate (β) = 0.19, 95% credible interval [CI] [0.16, 0.22]; female β = 0.17, 95% CI [0.13, 0.21]). However, the association was eliminated in models that allowed for this association to vary between cities via an interaction term (male β = -0.04, 95% CI [-0.26, 0.19]; female β = -0.04, 95% CI [-0.34, 0.26]). This was explained by variability in the association between cities, where some cities demonstrated a positive association between availability and use and others demonstrated a negative association. Although there is a province-wide positive association between off-premise alcohol availability and high-volume alcohol use, there is substantial regional variation in this association that may affect the local effectiveness of alcohol regulation policies.

Early versus late onset depression: sociodemographic and clinical characteristics

BackgroundLate-onset depression is different from early-onset depression in its sociodemographic and clinical characteristics and risk factors. This study aimed to demonstrate the differences in sociodemographic characteristics as well as clinical presentation between late-onset depression (after the age of 60 years) and early-onset depression (before the age of 45 years) and to determine the sociodemographic risk factors for late onset depression. Fifty-five patients between 18 and 45 years of age (group 1) and 55 patients aged 60 years and above (group 2) diagnosed for the first time with major depressive disorder were compared regarding sociodemographic and clinical characteristics. They were recruited from the psychiatric clinic at Sohag University Hospital. All participants were subjected to a Structured Clinical Interview for DSM-IV (SCID-IV), sociodemographic data form, Beck Depression Inventory-Second Edition (BDI-II), and Apathy Evaluation Scale (AES).ResultsThe patients in group 2 were more commonly single (29%), employed (74.54%), living in rural areas (56.36%), and had high school education (41.81%). While the patients in group 2 were more commonly widows (18.18%), unemployed (61.81%), had less than high school education (47.27%), and had chronic diseases (78.81%). Significant risk factors for late onset depression are being widow, unemployed, having low socioeconomic status, and having a chronic medical disease. Patients with late-onset depression were more commonly presented with apathy, cognitive impairment, and somatic symptoms, as well as sleep disturbance (mean±SD 57±6, 70.9%, 61.81%, and 81.81%, respectively) than early-onset depression (mean±SD 49± 4, 47.27%, 36.36%, and 70.9%, respectively).ConclusionsCases with late onset depression are featured by being unemployed, widow, having low socioeconomic status and low educational level, suffering from a chronic medical condition and living in an urban area. In late onset depression, somatic symptoms, apathy, sleep disturbances, as well as cognitive impairment are prevalent presenting symptoms.

Differences in the incidence and clinical outcomes of SARS-CoV-2 infection between Italian and non-Italian nationals using routine data

ObjectivesThis study was to compare the incidence and clinical outcomes of SARS-CoV-2 infection between Italian and non-Italian nationals. Study designWe retrospectively analysed data from the COVID-19 Italian integrated surveillance system (14 September 2020 to 17 October 2021). MethodsWe used multivariable Cox proportional hazards models to estimate the hazard ratio (HR) of infection and, among cases, the HRs of death, hospitalisation and subsequent admission to intensive care unit in non-Italian nationals relative to Italian nationals. Estimates were adjusted for differences in sociodemographic characteristics and in the week and region of diagnosis. ResultsOf 4,111,067 notified cases, 336,265 (8.2%) were non-Italian nationals. Compared with Italian nationals, non-Italians showed a lower incidence of SARS-CoV-2 infection (HR = 0.81, 95% confidence interval [CI]: 0.80–0.81). However, once diagnosed, they were more likely to be hospitalised (HR = 1.90, 95% CI: 1.87–1.92) and then admitted to intensive care unit (HR = 1.08, 95% CI: 1.04–1.13), with differences larger in those coming from countries with a lower human development index. Compared with Italian cases, an increased rate of death was observed in non-Italian cases from low–human development index countries (HR = 1.41, 95% CI: 1.23–1.62). The HRs of SARS-CoV-2 infection and severe outcomes slightly increased after the start of the vaccination campaign. ConclusionsUnderdiagnosis and delayed diagnosis in non-Italian nationals could explain their lower incidence compared with Italians and, among cases, their higher probability to present clinical conditions leading to worse outcomes. Facilitating early access to vaccination, diagnosis and treatment would improve the control of SARS-CoV-2 transmission and health outcomes in this vulnerable group.

Cervical cancer screening and predictors of screening by diabetes status.

PurposeWomen with diabetes have lower survival rates after a cervical cancer diagnosis compared to women without diabetes. Pap smears and human papilloma virus (HPV) testing are highly effective screening tests for cervical cancer, therefore, it is important to know the prevalence of guideline-concordant screening among women with diabetes and understand if their predictors of screening differ. The purpose of this analysis was to assess guideline-concordant cervical cancer screening and predictors by diabetes status.MethodsWe used the 2019 National Health Interview Survey data, limited to women aged 21–65 years without a previous diagnosis of cancer, a hysterectomy, or diagnosed with diabetes in the year prior to the survey. We considered the Pap and HPV tests together and concordance as being tested within the past 3 years as part of a routine exam. We calculated weighted, adjusted prevalence, and prevalence ratios (PRs) of screening concordance comparing women with diabetes to those without.ResultsThe unadjusted prevalence of concordant screening was 66.5% for women with diabetes compared to 73.3% for women without diabetes (PR = 0.91 95% CI 0.84–0.98). In the fully adjusted model adjusting for factors known to be associated with diabetes and access to healthcare, the association was attenuated and no longer statistically significant (PR = 0.96 95% CI 0.89–1.04).ConclusionCervical cancer screening concordance was lower in women with diabetes compared to those without overall but the deficit appears to be due primarily to underlying differences in sociodemographic characteristics and access to healthcare and not diabetes independently.

From pandemic to endemic: A comparison of first, second, and third waves of COVID-19 for applicability in communicable disease management

Background: The COVID-19 pandemic created pressure on healthcare systems worldwide. Hospitals have developed strategies to efficiently address the demand for inpatient beds.Objective: This paper examines changes in length of stay at a southern academic medical center and documents the intervention efforts aimed at providing high quality care and reduced lengths of stay.Methods: Data include 3,279 patients receiving inpatient treatment for COVID-19 between March 29, 2020, and October 31, 2021. The study data mirrors the three major waves of COVID-19 pandemic in Alabama as reported in Johns Hopkins’ coronavirus resource center. To account for the chronological change in care processes, we interviewed Hospitalists and categorized the interventions by month, June 2020-February 2021. We examined changes in average length of stay and differences in sociodemographic characteristics among the three waves using ANOVA and chi-square tests. Socio demographic factors analyzed include age, gender, race/ethnicity, marital status, and insurance.Results: The average length of stay, ICU admissions, and 30-day readmissions each decreased in the second and third waves compared to the first wave. Statistically significant differences were found for ICU admission, age, and insurance for hospitalized patients among waves.Conclusions: This study contributes to the COVID-19 literature by providing the chronological evolution of ALOS and interventions during the pandemic by highlighting the case of a southern academic medical center.

Utilization Patterns and Outcomes of People With Diabetes and COVID-19: Evidence From United States Medicare Beneficiaries in 2020.

Determine differences in utilization patterns, disease severity, and outcomes between patients with and without diabetes mellitus diagnosed with COVID-19 in 2020. We used an observational cohort comprised of Medicare fee-for-service beneficiaries with a medical claim indicating a COVID-19 diagnosis. We performed inverse probability weighting between beneficiaries with and without diabetes to account for differences in socio-demographic characteristics and comorbidities. In the unweighted comparison of beneficiaries, all characteristics were significantly different (P<0.001). Beneficiaries with diabetes were younger, more likely to be black, had more comorbidities, higher rates of Medicare-Medicaid dual-eligibility, and were less likely to be female. In the weighted sample, hospitalization rates for COVID-19 among beneficiaries with diabetes was higher (20.5% vs 17.1%; p < 0.001). Outcomes of hospitalizations were similarly worse among beneficiaries with diabetes: admissions to ICU during hospitalizations (7.78% vs. 6.11%; p < 0.001); in-hospital mortality (3.85% vs 2.93%; p < 0.001); and ICU mortality (2.41% vs 1.77%). Beneficiaries with diabetes had more ambulatory care visits (8.9 vs. 7.8, p < 0.001) and higher overall mortality (17.3% vs. 14.9%, p < 0.001) following COVID-19 diagnosis. Beneficiaries with diabetes and COVID-19 had higher rates of hospitalization, ICU use and overall mortality. While the mechanism of how diabetes impacts the severity of COVID-19 may not be fully understood, there are important clinical implications for persons with diabetes. A diagnosis of COVID-19 leads to greater financial and clinical burden than for their counterparts, persons without diabetes, including perhaps most significantly, higher death rates.

P-370 The vaginal microbiome in the first trimester of pregnancy is different in spontaneous versus IVF gestation

Abstract Study question Are there differences in the vaginal microbiome of pregnant women who had a spontaneous pregnancy compared to those who required IVF? Summary answer The composition of the vaginal microbiome at 12 week's gestation is different in women who achieve the pregnancy spontaneously or by IVF. What is known already The vaginal microbiome plays an important role in women's reproductive health, finding associations between different microbiome patterns and the presence of infertility and embryo implantation failure in IVF. Additionally, recent studies show a correlation between obstetrics and perinatal outcomes and the composition of vaginal microbiota in pregnant women, as well as an increased risk of obstetrics complications in pregnant women after IVF. Study design, size, duration Observational, prospective and multicentre study. A total of 64 women were enrolled between January 2020 and June 2021. Spontaneous pregnancies n = 30; and IVF pregnancies n = 34. Participants/materials, setting, methods Vaginal swabs were obtained by speculum exam at 12 weeks of gestation in two public hospitals and a fertility private clinic in Spain, to evaluate the differences in vaginal microbiome between both cohorts. The microbiome composition was analyzed by sequencing the V3-V4 region of the 16S rRNA on the Illumina MiSeq platform. Main results and the role of chance There were no significant differences in socio-demographic characteristics between groups, except for an expected higher maternal age in the IVF cohort. Lactobacillus was the most prevalent genus in both groups. When we compared the beta diversity of vaginal microbial by cohort a significant difference was obtained (p = 0.001). Gardenella, Neisseria, Prevotella and Staphyloccocus were significantly enriched in the IVF group (p = 0.01). A further evaluation of the four most abundant Lactobacillus species showed that Lactobacillus iners was dominant in IVF pregnancies (15.2%) compared to spontaneous (9.8%) (p = 0.002). On the other hand, Lactobacillus gasseri showed a lower abundance in vaginal microbiome from women belonged to IVF (9.2%) vs spontaneous pregnant group (13.8%) (p = 0.005). These findings allowed us to create a model to identify a microbial signature. This model is able to discriminate between IVF and spontaneous pregnancies. Limitations, reasons for caution The main limitation of our study is the small sample size. Larger studies are needed to corroborate our findings and their relationship with important aspects such as obstetric and perinatal complications. Wider implications of the findings The microbiome composition is different between both cohorts. The microbiome found in our IVF cohort has been also associated with obstetric complications as preterm delivery in previous studies. This suggest that the microbiome composition could be a plausible etiology for a higher risk of adverse pregnancy outcomes in IVF patients. Trial registration number Not applicable

A paradigm of difficult-to-treat rheumatoid arthritis: subtypes and early identification.

Multiple failures to biologic or targeted specific disease-modifying anti-rheumatic drugs (b/tsDMARDs) that lead to difficult-to-treat rheumatoid arthritis (D2TRA) may be the result of multi-drug inefficacy or reflect treatment problems related to adverse events, comorbidities, and/or poor adherence. We aimed to characterise a cohort of D2TRA patients in clinical practice, to analyse the differences between D2TRA due to inefficacy versus D2TRA from other causes, and to compare them with non-D2TRA. The D2TRA group included patients who were receiving ≥2b/tsDMARDs due to inefficacy (D2TRA-inef cacy) or because of adverse events, poor adherence, contraindications, comorbidities, drug-intolerance, etc. (D2TRA-other). Patients who achieved low disease activity or remission with the rst bDMARD were classified as non-D2TRA patients. For all patients, demographic, clinical characteristics and laboratory parameters were assessed prior to starting the rst b/tsDMARD. Descriptive analysis was performed and bivariate logistic regression models were assembled. In total, 253 patients were included: 131 non-D2TRA and 122 D2TRA [86 (70.5%) D2TRA-inefficacy and 36 (29.5%) D2TRA-other]. Comparison of the two groups of D2TRA patients: no differences in gender, age at start of b/tsDMARD or age at RA diagnosis were found; this was also true of socioeconomic status, frequency of anxiety-depression and other comorbidities. Patients categorised as D2TRA-other had less extra-articular manifestations than D2TRA-inef cacy, as well as lower values of DAS28 at the start of the rst b/tsDMARD. Comparisons of Non-D2TRA patients versus D2TRA-other resulted in the following observations: no differences in sociodemographic characteristics were evident nor were there any differences in terms of disease activity. Patients with D2TRA-other are indistinguishable from non-D2TRA patients at baseline, indicating the former cohort does not appear to have any predictive value during the early stages of b/tsDMARD treatment, unlike what occurs in patients with D2TRA-inefficacy.

Sociodemographics of Formal and Informal Sector Women Workers of Pakistan and a Comparison of their Perceived and Practiced Autonomy

The majority of Pakistani women are employed in the informal sector of the economy, devoid of protection, safety, and employment benefits, which prevents them from having autonomy. In this study, we aimed to identify (i) the differences in socio-demographic characteristics of formal versus informal sector women workers and (ii) compare the perceived and practised autonomy between the two groups. We used a convenience sample of 150 women, half each from the informal and formal sectors of the economy, specifically the teaching sector. We were able to find through mean analysis that women from the informal sector have higher autonomy. We also found that informal sector women workers in the country are impoverished, illiterate, non-Muslims, living in underdeveloped areas, and have no property ownership. There is a critical need to support policy for transfer to formal sector employment and to develop interventions to improve autonomy in working women.

Demographic characteristics, torture experiences, and posttraumatic stress disorder symptoms among asylum seekers and refugees persecuted for same-sex behaviors.

Increasingly, lesbian, gay, and bisexual (LGB) individuals are fleeing the 67 countries that criminalize consensual same-sex intimate relationships, seeking asylum in countries such as the United States. Minority stress theory posits that compared with non-LGB refugees and asylum seekers (RAS), LGB RAS are likely to face persecution, rejection, and discrimination and have a higher risk of experiencing posttraumatic stress disorder (PTSD) symptoms. This study assessed differences in sociodemographic characteristics, persecution experiences, and mental health outcomes among 959 RAS persecuted for same-sex behavior (pLGB RAS) who presented for care and social services at the Boston Center for Refugee Health and Human Rights. Data were derived from intake interviews with RAS clients that elicited torture experiences and assessed PTSD symptoms using the Short Screening Scale for PTSD. Over 11% of the total sample were pLGB RAS. Compared with non-pLGB RAS, pLGB RAS reported higher PTSD symptom levels, β = .08, p = .031; more difficulty loving others, d = 0.13, p < .001; and feeling more isolated, d = 0.10, p = .005. pLGB RAS reported more persecution, d = 0.31, p = .002; physical assaults, d = 0.22, p = .029; and psychological assaults, d = 0.20, p = .047; and were more likely to be asylum seekers, d = 0.11, p = .001, and have experienced persecution in Uganda, d = 0.39, p < .001, and other countries that criminalize same-sex acts, d = 0.26, p < .001. More research is needed to understand clinical outcomes and implications of treatment for this population.