First Year Of Enrollment Research Articles

Enablers of and Barriers to Self-Regulated and Self-Directed Aptitudes of Learning (SELF-ReDiAL) in Health Professional Education: A Systematic Review and Meta-analysis.

Recently, accrediting organizations have focused on developing lifelong learners who possess self-regulated and self-directed aptitudes of learning (hereinafter SELF-ReDiAL or in short, SR). This meta-analysis aimed to identify factors which promote or deter SR in health professionals. Original studies which, by using self-reports, evaluated enablers of and barriers to SR in health professionals (dentistry, medicine, nursing, and pharmacology), and were indexed in Scopus® and PubMed® databases from 1 January 2000 to 31 August 2022, were retrieved. Major themes suggested to affect SR were determined, and enablers or barriers related to those themes, were considered eligible for inclusion. Studies were excluded if they were not in English, and if the full text could not be retrieved. From 149 identified papers, 43 studies were subsequently included in the meta-analysis. The strongest effect was generated by wellbeing (d = 0.806; 95% confidence of interval [CI]: 0.296, 1.316). In respect of teaching method, problem-based learning (d = 0.590; 95%CI: 0.375, 0.806), team-based learning (d = 0.382; 95%CI: 0.232, 0.531), and flipped classroom (d = 0.095; 95%CI: -0.088, 0.279) showed positive effects on SR, whereas lectures were negatively associated with SR (d = -0.079; 95%CI: - 0.389, 0.230). Further, the analysis showed that SR generally decreases during the first year of enrolment (d = -0.144; 95%CI: - 0.284, -0.004), while no major change in SR is observed in the second year (d = 0.027; 95%CI: -0.044, 0.099). Considering that student wellbeing had the strongest observed effect on SR, policy-setting and governing bodies should incorporate methods which improve wellbeing to develop health professionals with high levels of SR. The online version contains supplementary material available at 10.1007/s40670-024-02068-y.

Healthcare costs and utilization in medically fragile pediatric patients during the first year of care coordination

ABSTRACT The current study explored the impact of pediatric outpatient care coordination across the first year of enrollment to better understand how services can be stratified for medically fragile children to ensure their needs are met. A retrospective chart review was conducted on pediatric patients with at least one care coordination encounter in a large health system from 2018 to 2020. Utilization, costs, and care coordination encounters were extracted. Data analysis included descriptive statistics and general linear modeling techniques. Children with more severe medical complexity had higher overall utilization and costs than children with moderate medical complexity across the first year. Both moderately and severely medically complex patients saw a reduction healthcare utilization and costs and decreased frequency of care coordination encounters over the first year. Effective and targeted care coordination can reduce healthcare costs and utilization and may equip the family to better navigate the health system.

Social Activities and Risk of Dementia in Community-Dwelling Older People: Gender-Specific Findings From a Prospective Cohort Study.

This study examines thegender-specific associations between a wide range of social activities and dementia risk. A prospective cohort study was conducted involving community-dwelling older Australians (≥70 years) without significant cognitive impairment at enrolment. During the first year of enrolment, we assessed 25 self-reported social activities covering various aspects, including support from relatives and friends, community participation, social interactions with surroundings, and loneliness. Dementia diagnosis followed DSM-IV criteria, adjudicated by an international expert panel. To estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations between social activities and dementia, we performed Cox proportional hazards models, adjusting for age, educational attainment, baseline global cognition, and depressive symptoms. Among 9,936 participants who completed all social activity questionnaires (median [IQR] age: 73.4 [71.6-77.1] years; 47.4% men), dementia was diagnosed in 3.8% of men (n = 181/4,705) and 2.6% of women (n = 138/5,231) over a median 6.4 years (IQR: 5.3-7.6, range: 0.2-10.1) follow-up. Gender-specific relationships emerged: caregiving for a person with illness/disability in women (HR: 0.65, 95% CI: 0.42-0.99), and having ≥9 relatives feeling close to call for help in men (HR: 0.56, 95% CI: 0.33-0.96; reference <9 relatives) were associated with reduced dementia risk. Unexpectedly, in women, having ≥5 friends with whom they felt comfortable discussing private matters were associated with a greater dementia risk (HR: 1.69, 95% CI: 1.10-2.59; reference ≤2 friends). Imputed models further identified that babysitting/childminding was associated with lower dementia risk in men (HR: 0.75, 95% CI: 0.56-0.99). No other social activities showed significant associations with dementia. This study provides evidence of social activities influencing dementia risk. Further investigations are required to uncover the mechanisms driving these observed relationships.

Long-term retention on antiretroviral treatment after enrolment in prevention of vertical HIV transmission services: a prospective cohort study in Dar es Salaam, Tanzania.

To prevent vertical HIV transmission and ensure healthy mothers and children, pregnant women with HIV must remain on antiretroviral treatment (ART) for life. However, motivation to remain on ART may decline beyond the standard 2-year breastfeeding/postpartum period. We assessed attrition and retention in ART care among women with HIV up to 6 years since enrolment in vertical transmission prevention services in Dar es Salaam, Tanzania. A prospective cohort of 22,631 pregnant women with HIV were enrolled in vertical transmission prevention services between January 2015 and December 2017 in routine healthcare settings and followed-up to July 2021. Kaplan-Meier was used to estimate time to ART attrition (died, stopped ART or was lost to follow-up [no show ≥90 days since scheduled appointment]) and the proportion retained in care. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) of ART attrition in relation to predictors. Participants were followed-up to 6 years for a median of 3 years (IQR: 0.1-4). The overall ART attrition rate was 13.8 per 100 person-years (95% CI: 13.5-14.1), highest in the first year of enrolment at 27.1 (26.3-27.9), thereafter declined to 9.5 (8.9-10.1) in year 3 and 2.7 (2.1-3.5) in year 6. The proportion of women retained in care were 78%, 69%, 63%, 60%, 57% and 56% at 1, 2, 3, 4, 5 and 6 years, respectively. ART attrition was higher in young women aged <20 years (aHR 1.63, 95% CI: 1.38-1.92) as compared to 30-39 year-olds and women enrolled late in the third versus first trimester (aHR 1.29, 95% CI: 1.16-1.44). In contrast, attrition was lower in older women ≥40 years, women who initiated ART before versus during the index pregnancy and women attending higher-level health facilities. ART attrition among women with HIV remains highest in the first year of enrolment in vertical transmission prevention services and declines markedly following a transition to chronic HIV care. Targeted interventions to improve ART continuity among women with HIV during and beyond prevention of vertical transmission are vital to ending paediatric HIV and keeping women and children alive and healthy.

Findings from the KNOW-CKD Study indicate that higher systolic blood pressure time in target range is associated with a lower risk of chronic kidney disease progression

Time-in-target range (TTR) of systolic blood pressure (SBP) is determined by the proportion of time during which SBP remains within a defined optimal range. TTR has emerged as a useful metric for assessing SBP control over time. However, it is uncertain if SBP-TTR can predict the progression of chronic kidney disease (CKD). Here, we investigated the association between SBP-TTR during the first year of enrollment and CKD progression among 1758 participants from the KNOW-CKD (KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease). Baseline median estimated glomerular filtration rate (eGFR) was 51.7 ml/min per 1.73 m2. Participants were categorized into four SBP-TTR groups (0%, 1–50%, 51–99%, and 100%). The primary outcome was CKD progression defined as 50% or more decline in eGFR from baseline measurement or the initiation of kidney replacement therapy. During the follow-up period (9212 person-years over a median 5.4 years), the composite outcome occurred in 710 participants. In the multivariate cause-specific hazard model, a one-standard deviation increase in SBP-TTR was associated with an 11% lower risk of the composite outcome with hazard ratio, 0.89 (95% confidence interval, 0.82–0.97). Additionally, compared to patients with SBP-TTR 0%, the respective hazard ratios for those with SBP-TTR 1–50%, 51–99%, and 100% were 0.85 (0.68–1.07), 0.76 (0.60–0.96), and 0.72 (0.55–0.94), and the respective corresponding slopes of eGFR decline were –3.17 (–3.66 to –2.69), –3.02 (–3.35 to –2.68), –2.62 (–2.89 to – 2.36), and –2.33 (–2.62 to –2.04) ml/min/1.73 m2 . Thus, higher SBP-TTR was associated with a decreased risk of CKD progression in patients with CKD.

Total Therapy (TT)-4: A Phase 3 Trial Comparing L-TT4 and S-TT4 and Tandem Auto Transplants in Standard Risk Multiple Myeloma

BACKGROUND: In the context of the TT4 study, a phase 3 trial was conducted to investigate whether a modified fixed duration treatment approach, known as L-TT4, could reduce toxicity while maintaining efficacy in tandem transplants for low-risk multiple myeloma (MM) defined by gene expression profiling. Here we report final analysis of TT4 study with long-term follow up of 11.7 years. METHODS: Treatment modification involved reducing the number of induction and consolidation cycles from 2 cycles each in the standard S-TT4 regimen to 1 cycle in L-TT4. The transplant regimen in L-TT4 was further adjusted by administering melphalan in a fractionated schedule of 50mg/m2 per day for 4 days (MEL50x4), instead of a single high-dose (MEL200) to reduce toxicity. To compensate for the potential decrease in effectiveness, bortezomib, thalidomide and dexamethasone (VTD) added for synergy between MEL50x4 and VTD. Maintenance was with 3 years of bortezomib, lenalidomide and dexamethasone The goal of this trial was to evaluate the impact of these modifications on toxicity levels and treatment outcomes in patients undergoing tandem transplants for multiple myeloma. Patients were enrolled in the period of August 2008 until March 2016. Data cut-off was July,2023. Results: Our study consisted of 380 patients after excluding 2 patients who were identified as high-risk gene expression profile (S-TT4:238, L-TT4:142). Median age was 58.7 years (range: 30-76 years) with 11.6% of enrolled patients identified as African Americans. 91.4% of enrolled patients completed at least one auto transplant and 78.3% of patient completed tandem transplants. The median follow-up duration for all patients of 11.66 years (interquartile range: 10.11-13.27 years). Median progression free survival (PFS) was 6.54 years (95% confidence interval (CI): 5.75-7.72 years)) with 10-year PFS of 39% (95% CI: 34.3-44.4%). Median overall survival (OS) was 12.6 years (95% CI: 11.6 years-not reached (NR)) with 10-year OS of 58.4% (95% CI:53.5%-63.7%). No statistically significant difference between S-TT4 vs. L-TT4 (median PFS: 7.33 years (95% CI: 6.01-9.44 years), median OS: 13.1 years (95% CI:12.30 years-NR) vs. (median PFS: 5.74 years (95% CI: 4.63-7.41 years),median OS:11.8 years (95% CI:9.21 years-NR) with OS hazard ratio of L-TT4 vs. S-TT4 of 1.17 (95% CI: 0.86-1.58, p=0322). [Figure] PFS HR of L-TT4 vs. S-TT4 of 1.21 (95% CI: 0.94-1.56, P=0.132). Early mortality (defined as death in the first year of enrollment) occurred in 6.1% of enrolled patients. No difference in treatment related mortality was found between L-TT4 and S-TT4. Grade III-V toxicities and maximum grade for system organ classes with at least 5% of the population experiencing an event showed no difference between L-TT4 vs. S-TT4 in all adverse events except grade III/IV infections which was higher in L-TT4 (60% vs. 44%, p=0.002). Secondary acute myeloid leukemia (AML) and/or myelodysplastic syndrome (MDS) occurred in 21 (5.5%) patients with the median time from diagnosis to diagnosis of AML and/or MDS of 4.5 years. AML and/or MDS was more frequently seen in patients assigned to L-TT4 when compared to S-TT4 though this difference was not statistically significant (7% vs. 4.6, P=0.317 ) Conclusion: Fixed duration therapy including multi-agent chemotherapy and tandem autologous stem cell transplantation and 3 years of extended therapy resulted in excellent patients' outcomes with median OS of 12.6 years and at least one in three patients being progression free for at least 10 years. Conditioning with single high-dose (MEL200) as used in S-TT4 resulted in similar outcomes compared to fractionated MEL50x4 combined with VTD with better safety profile and thus should be the preferred approach.

An evaluation of an employment assistance program focused on people living with HIV in Toronto, Canada

ABSTRACT Unemployment is more common among people living with HIV (PLWH) compared to the general population. PLWH who are employed have better physical and mental health outcomes compared to unemployed PLWH. The main objective of this mixed-methods study was to conduct a program evaluation of Employment Action (EACT), a community-based program that assists PLWH in Toronto, Ontario, Canada to maintain meaningful employment. We extracted quantitative data from two HIV services databases used by EACT, and collected qualitative data from 12 individuals who had been placed into paid employment through EACT. From 131 clients included in the analysis, 38.1% (n = 50) maintained their job for at least 6 weeks within the first year of enrollment in the EACT program. Gender, ethnicity, age, and first language did not predict employment maintenance. Our interviews highlighted the barriers and facilitators to effective service delivery. Key recommendations include implementing skills training, embedding PLWH as EACT staff, and following up with clients once they gain employment. Investment in social programs such as EACT are essential for strengthening their data collection capacity, active outreach to service users, and sufficient planning for the evaluation phase prior to program implementation.

Why do students leave? Persistence in selective universities

ABSTRACT In Chile many university students do not persist to graduation. Some students dropped out in the first year, others later. The objective of this study, based on students admitted to but not graduating from selective universities, was to identify factors associated with their academic success and length of persistence before withdrawal. The 707 subjects for the study were a non-probabilistic sample of two cohorts of students who had withdrawn from 11 selective universities before graduation. One cohort of students had been admitted in 2010. The second cohort for this study was composed of students entering in 2016 and 2017. Data was collected in 2021 from university records and a questionnaire survey of the students. Pre-university measures included family education and income, secondary level academic performance, and cognitive knowledge. In-university measures included academic performance, and scales representing academic resources, family stability, non-student work, and engagement in social and academic activities. Data were analysed using correlations, means tests and linear regression. Pre-university (family and secondary school) factors influenced academic success in the first year of enrolment but not in later years. Academic success in the first year of university had the highest overall association with persistence. After Year 1 other factors contributed.

Reproductive health syndemics impact retention in care among women living with HIV in Rio de Janeiro, Brazil.

Syndemic psychosocial and reproductive factors affecting women's retention in HIV care remain understudied. We analyzed correlates of non-retention in a cohort of women with HIV in Brazil from2000‒2015. Participants self-reported exposure to physical/sexual violence, illicit drug use, adolescent pregnancy, or induced abortion. Lifetime history of these psychosocial stressors were used to create a syndemic score based on the presence or absence of these conditions. All dichotomous variables were summed (range0to4), with greater scores indicating more syndemic factors experienced. Logistic regression models identified predictors of non-retention, defined as< 2HIV viral load or CD4 results within the first year of enrollment. Of915women, non-retention was observed for18%. Prevalence of syndemic factors was adolescent pregnancy(53.2%), physical/sexual violence(38.3%), induced abortion(27.3%), and illicit drug use(17.2%); 41.2%experienced ≥ 2syndemic conditions. Syndemic scores of2and3were associated with non-retention, as well as low education, years with HIV and seroprevalent syphilis. Psychosocial and reproductive syndemics can limit women's retention in HIV care. Syphilis infection predicted non-retention and could be explored as a syndemic factor in future studies.

Plasma Interleukin-6 Level Predicts the Risk of Arteriovenous Fistula Dysfunction in Patients Undergoing Maintenance Hemodialysis.

Systemic inflammation has been proposed as a relevant factor of vascular remodeling and dysfunction. We aimed to identify circulating inflammatory biomarkers that could predict future arteriovenous fistula (AVF) dysfunction in patients undergoing hemodialysis. A total of 282 hemodialysis patients were enrolled in this prospective multicenter cohort study. Plasma cytokine levels were measured at the time of data collection. The primary outcome was the occurrence of AVF stenosis and/or thrombosis requiring percutaneous transluminal angioplasty or surgery within the first year of enrollment. AVF dysfunction occurred in 38 (13.5%) patients during the study period. Plasma interleukin-6 (IL-6) levels were significantly higher in patients with AVF dysfunction than those without. Diabetes mellitus, low systolic blood pressure, and statin use were also associated with AVF dysfunction. The cumulative event rate of AVF dysfunction was the highest in IL-6 tertile 3 (p = 0.05), and patients in tertile 3 were independently associated with an increased risk of AVF dysfunction after multivariable adjustments (adjusted hazard ratio = 3.06, p = 0.015). In conclusion, circulating IL-6 levels are positively associated with the occurrence of incident AVF dysfunction in hemodialysis patients. Our data suggest that IL-6 may help clinicians identify those at high risk of impending AVF failure.

Economic evaluation of integrated services for non-communicable diseases and HIV: costs and client outcomes in rural Malawi

ObjectiveTo evaluate the costs and client outcomes associated with integrating screening and treatment for non-communicable diseases (NCDs) into HIV services in a rural and remote part in southeastern Africa.DesignProspective cohort...

Intracoronary Imaging in left main stent percutaneous coronary intervention has a clear survival benefit particularly in more complex patients

Abstract Background Left Main Stem Disease (LMS) is prognostically important coronary artery disease that is managed either with coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI). Use of intracoronary imaging (ICI) modalities such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been shown to improve outcomes with PCI revascularization. The primary objective of this study was to evaluate the impact of ICI on outcomes following LMS PCI. Methods Retrospective observation study of 498 (5.1% of all PCI cases) patients who had undergone LMS PCI at our tertiary primary PCI centre hospital over a 11-year period between July 2010-July 2021. Data was collected from electronic medical records. Follow-up was also obtained through linkage with the Office of National Statistics. Results The mean age at the time of enrolment was 70.7±11.5 years. Majority of the patients were male 351 (70.5%). 353 (70.9%) of cases had acute coronary syndrome (ACS) presentation while the remainder were elective procedures. Mean follow-up duration was 3.75±3.06 years. Survival calculated by Kaplan-Meier was 70%. 87 patients (17.5%) deceased during first year of enrolment. 344 (69.1%) patients had ICI, with IVUS in 316 (63.5%) and OCT in 28 (5.6%) patients. IVUS comprised 91.9% of ICI procedures. Protected LMS (OR 0.175, 95% CI: 0.037–0.833, P-value=0.029) and the use of left ventricular mechanical support device (OR 0.324, 95% CI: 0.122–0.859, P-value=0.024) were associated with decreased odds of undergoing an ICI. Patients undergoing ICI had significantly better survival compared to those without ICI (HR: 0.54, P&amp;lt;0.001). Moreover, OCT showed significantly better survival compared with IVUS (HR: 0.181, P=0.017). Use of ICI was associated with better survival in patients who had Rotablation (HR: 0.455, 95% CI: 0.232–0.892, P=0.022), ACS (HR: 0.523, 95% CI: 0.383–0.714, P&amp;lt;0.001) or comorbidities of diabetes and stroke (HR: 0.551, 95% CI: 0.337–0.807, P=0.002). Conclusion ICI in LMS PCI has a significant survival benefit in our dataset. This is especially the case in patients presenting with ACS, those with comorbidities of Diabetes mellitus and stroke and those undergoing rotablation. Funding Acknowledgement Type of funding sources: None.

Association Between Systolic Blood Pressure Variability and Major Adverse Cardiovascular Events in Korean Patients With Chronic Kidney Disease: Findings From KNOW-CKD.

BackgroundWhether visit‐to‐visit systolic blood pressure (SBP) variability can predict major adverse cardiovascular events (MACE) in patients with chronic kidney disease is unclear.Methods and ResultsWe investigated the relationship between SDs of visit‐to‐visit SBP variability during the first year of enrollment and MACE among 1575 participants from KNOW‐CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease). Participants were categorized into 3 groups according to tertiles of visit‐to‐visit SBP variability (SD). The study end point was MACE, defined as a composite of nonfatal myocardial infarction, unstable angina, revascularization, nonfatal stroke, hospitalization for heart failure, or cardiac death. During 6748 patient‐years of follow‐up (median, 4.2 years), MACE occurred in 64 participants (4.1%). Compared with the lowest tertile of visit‐to‐visit SBP variability (SD), the hazard ratios (HRs) for the middle and the highest tertile were 1.64 (95% CI, 0.80–3.36) and 2.23 (95% CI, 1.12–4.44), respectively, in a multivariable cause‐specific hazard model. In addition, the HR associated with each 5‐mm Hg increase in visit‐to‐visit SBP variability (SD) was 1.21 (95% CI, 1.01–1.45). This association was consistent in sensitivity analyses with 2 additional definitions of SBP variability determined by the coefficient of variation and variation independent of the mean. The corresponding HRs for the middle and highest tertiles were 2.11 (95% CI, 1.03–4.35) and 2.28 (95% CI, 1.12–4.63), respectively, in the analysis with the coefficient of variation and 1.76 (95% CI, 0.87–3.57) and 2.04 (95% CI, 1.03–4.03), respectively, with the variation independent of the mean.ConclusionsHigher visit‐to‐visit SBP variability is associated with an increased risk of MACE in patients with chronic kidney disease.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT01630486.

Trends in Permanent Work Disability Associated With Rheumatoid Arthritis in the United States, 1999-2015.

Advances in treatment over the past 20 years have resulted in improved control of rheumatoid arthritis (RA). The objective of our study was to investigate whether there has been a decrease in permanent work disability associated with RA in the US. Medicare data from 1999 to 2015 were used to identify beneficiaries age 20-59 years with RA who became eligible for Medicare coverage under Social Security Disability Insurance. Diagnosis of RA was based on physician claims in the first year of enrollment. Annual rates of enrollment were sex- and age-standardized to the 2000 US population. The study included 97,787 beneficiaries with RA and Social Security Disability Insurance across all years. Medicare enrollment was 26.0 per million in 1999 and 26.0 per million in 2015. Rates increased following the Great Recession of 2008-2009 before returning to prerecession levels. There was no linear trend over time after adjusting for the annual national unemployment rate (relative risk 0.99 per year [95% confidence interval 0.99-1.00]; P = 0.69). Risks of work disability were much higher among workers over age 50 years. Based on Medicare enrollment by recipients of Social Security Disability Insurance, there was no decrease in permanent work disability among young and middle-age workers with RA in the US between 1999 and 2015.

Rhythm Control Better Prevents Dementia than Rate Control Strategies in Patients with Atrial Fibrillation-A Nationwide Cohort Study.

Background: Atrial fibrillation (AF) increases the risk of dementia. Whether the pharmacological rhythm control of AF can reduce the risk of dementia compared to the rate control strategy remains unclear. We hypothesize that the rhythm control strategy is better than the rate control strategy in preventing dementia. Methods: AF patients aged ≥65 years were identified from the Taiwan National Health Insurance Database. Patients receiving anti-arrhythmic drugs at a cumulative defined daily dose (cDDD) of >30 within the first year of enrollment constituted the rhythm control group. Patients who used rate control medications for a cDDD of >30 constituted the rate control group. A multivariate Cox hazards regression model was used to determine the hazard ratio (HR) for dementia. Results: A total of 3382 AF patients (698 in the rhythm control group; 2684 in the rate control group) were analyzed. During a 4.86 ± 3.38 year follow-up period, 414 dementia events occurred. The rhythm control group had a lower rate of dementia than the rate control group (adjust HR: 0.75, p = 0.031). The rhythm control strategy reduced the risk of dementia particularly in those receiving aspirin (p = 0.03). Conclusions: In patients with AF, pharmacological rhythm control was associated with a lower risk of dementia than rate control over a long-term follow-up period, particularly in patients receiving aspirin treatment.

First Year Comparison of Sickle Cell Pediatric Cohorts from Haiti and Miami (CSHSCD Multicenter Study): Baseline Data

Background: The NIH-sponsored observational study “Comparative Study of Haiti and Miami Cohorts of Sickle Cell Disease CSHSCD” (R01HL149121) coordinates the follow up of children with sickle cell disease (SCD) in Haiti and compares it to a Miami cohort of children of either Haitian or African American ethnicity for the purpose of assessing barriers through questionnaires and examining differences in the care received in their respective environments.Methods: Children less than 6 years of age with SCD are eligible for enrollment in five participating sites: University of Miami (UM, Miami, Florida), Hôpital Saint Damien (HSD, Tabarre, Haiti), Hôpital de l' Université d'Etat d'Haïti (HUEH, Port-au-Prince, Haiti), Hôpital Universitaire Justinien (HUJ, Cap Haitien, Haiti), and Hôpital Sacré Coeur (HSC, Milot, Haiti).Medians and interquartile ranges or percentages were compared at baseline regarding demographics, clinical and growth parameters, laboratory tests, and the children's hydroxyurea (HU) utilization during the first year of enrollment (May 25, 2020-May 24,2021). A Likert-scale barrier questionnaire was distributed at baseline to assess differences in healthcare access. A P value <0.05 was considered statistically significant to establish differences.Results: 130 children were enrolled during the reported period. Significant differences were observed in age, weight percentiles, hemoglobin levels, pain rates, HU treatment, and pneumococcal vaccination.Penicillin prophylaxis was always given by oral route in Miami, but only 39.8% times in Haiti, with 58% of children receiving prophylaxis by intramuscular injection every month and 2.2% (N=2 children) with either unknown or not receiving prophylaxis. Previous medication outsourcing accounted for the oral tablet form in Haiti. Parents in Haiti had more barriers regarding not able to afford treatment (21.5% compared to 8.1% in Miami) and had similar responses regarding not able to afford coming to clinic (21.5% vs. 18.9%). Parents in Miami expressed living far away from clinic (70.2% compared to 25.8% in Haiti), but had more help from other family members (78.4% vs. 33.3%). Interestingly, parents in Miami did not know sometimes what to do when the child was sick (40% respondents vs. 11% in Haiti). There were no major differences between the responses from the African Americans and Haitians living in Miami, except for not knowing sometimes what to do when child is sick (African-Americans having less doubts than Haitians; 25% vs. 52.6%). In short-term follow up, no enrolled children died, although two eligible children in Haiti died before enrollment. One child developed COVID-19 in Miami with only mild symptoms, which resolved.Conclusion: At entry children in Haiti are older, weigh less, are more anemic, have more pain episodes, and fewer receive hydroxyurea treatment. Under-vaccination with pneumococcal 13-valent conjugate (Prevnar-13) is notable in Haiti. There were significant differences detected on the barrier questionnaire among respondents in both countries.Acknowledgment: We acknowledge NHLBI for supporting this work. [Display omitted] DisclosuresAlvarez: GBT: Membership on an entity's Board of Directors or advisory committees; Forma Therapeutics: Membership on an entity's Board of Directors or advisory committees.

Predictors of Persistent Symptoms in People in Coordinated Specialty Care Services for Early Psychosis in New York State.

This study aimed to determine the prevalence and predictors of persistent transdiagnostic symptoms in the first year of enrollment in OnTrackNY, a coordinated specialty care (CSC) program for individuals with recent-onset nonaffective psychosis. Three groups were defined by using the Mental Illness Research, Education, and Clinical Centers Global Assessment of Functioning symptom subscale: persistently symptomatic, intermittent, and improving to moderate. The authors compared groups on baseline demographic characteristics, family and living situation, clinical measures, and pathways to care. Of 1,129 eligible participants, 12% were persistently symptomatic through follow-up. Being medication nonadherent, being homeless, having a diagnosis of schizophrenia, and having a longer duration between symptom onset and program enrollment were predictive of persistent symptoms during the first year of CSC. Findings suggest that despite intensive treatment, severe symptoms in young people with psychosis may persist because of economic barriers, treatment delays, and lack of stability.

870-P: Patient Factors and Engagement of Care in Type 2 Diabetes in Phnom Penh, Cambodia

Cambodia is developing its response to non-communicable diseases including the increasing prevalence of diabetes. Third party payment for care is limited therefore much of the financial burden is left to the patient. The Community Medical Center (CMC) is an NGO-sponsored outpatient clinic in Phnom Penh which started a diabetes specialty clinic in 2013 in the absence of endocrinologists by relying on a corps of internists. This corps plays a critical role in monitoring and treating patients over time given the chronic nature of the disease. Multiple visits annually are considered standard of care in the developed world. The CMC team launched a database tracking all patients in 2015 and had enrolled 3634 patients with T2DM as of January, 2019. Complete data sets were available for 3570. We performed a fixed effects regression analysis to identify patient characteristics at the initial visit that might impact engagement in care (ENC), defined as fully engaged if patient had at least 2 follow-up visits within the first year of enrollment (FENC), or partially engaged (one f/u visit) PENC. Of the patients enrolled, 2,019 met criteria for FENC, 420 met criteria for PENC, and 1,131 were not engaged. In a fully adjusted model, receiving financial assistance for health expenses had the greatest impact (β = 0.382, p&amp;lt;.001) on ENC. Taking antihypertensive medication was also associated with ENC (β = 0.141, p&amp;lt;.001). BMI &amp;gt; 35 was negatively associated with ENC (β = -0.280, x p&amp;lt;.05). Proximity of residence to CMC, presence of complications, A1C level, and use of insulin were not significantly associated with ENC. This is the first large longitudinal study of its type in Cambodia. Assistance with cost of care to the patient had the strongest positive correlation with ENC. Further research is needed to better understand the factors that lead to ENC in resource challenged environments such as Cambodia as well as guide what modifications can be made to programs. Disclosure J. M. Vicencio: None. S. Peng: None. P. Menh: None. P. G. Curran: None. M. Hudson: None. Funding Peco Foundation

Association of 1-Year Blood Pressure Variability With Long-term Mortality Among Adults With Coronary Artery Disease

Accumulating evidence indicates that higher blood pressure (BP) variability from one physician office visit to the next (hereafter referred to as visit-to-visit BP variability) is associated with poor outcomes. Short-term measurement (throughout 1 year) of visit-to-visit BP variability in high-risk older patients may help identify patients at increased risk of death. To evaluate whether short-term visit-to-visit BP variability is associated with increased long-term mortality risk. The US cohort of the International Verapamil SR-Trandolapril Study (INVEST), a randomized clinical trial of 16 688 patients aged 50 years or older with hypertension and coronary artery disease, was conducted between September 2, 1997, and December 15, 2000, with in-trial follow-up through February 14, 2003. The study evaluated a calcium antagonist (sustained-release verapamil plus trandolapril) vs β-blocker (atenolol plus hydrochlorothiazide) treatment strategy. Blood pressure measurement visits were scheduled every 6 weeks for the first 6 months and biannually thereafter. Statistical analysis was performed from September 2, 1997, to May 1, 2014. Visit-to-visit systolic BP (SBP) and diastolic BP variability during the first year of enrollment using 4 different BP variability measures: standard deviation, coefficient of variation, average real variability, and variability independent of the mean. All-cause death, assessed via the US National Death Index, beginning after the exposure assessment period through May 1, 2014. For the present post hoc analysis, long-term mortality data were available on 16 688 patients (9001 women [54%]; mean [SD] age, 66.5 [9.9] years; 45% White patients, 16% Black patients, and 37% Hispanic patients). During a mean (SD) follow-up of 10.9 (4.2) years, 5058 patients (30%) died. All 4 variability measures for SBP were significantly associated with long-term mortality after adjustment for baseline demographic characteristics and comorbidities. After comparison of lowest vs highest variability measure quintiles, the magnitude of the association with death remained statistically significant even after adjustment for baseline demographic characteristics and comorbidities (average real variability: adjusted hazard ratio [aHR], 1.18; 95% CI, 1.08-1.30; standard deviation: aHR, 1.14; 95% CI, 1.04-1.24; coefficient of variation: aHR, 1.15; 95% CI, 1.06-1.26; variability independent of the mean: aHR, 1.15; 95% CI, 1.05-1.25). The signal was stronger in women compared with men. Associations of diastolic BP variability measures with death were weaker than for SBP and were not significant after adjustment. This study suggests that, in a large population of older patients with hypertension and coronary artery disease, short-term visit-to-visit SBP variability was associated with excess long-term mortality, especially for women. Efforts to identify and minimize visit-to-visit SBP variability may be important in reducing excess mortality later in life. ClinicalTrials.gov Identifier: NCT00133692.

POS-526 UNDERSTANDING THE PATIENT EXPERIENCE AND CLINICAL COURSE DURING THE INCIDENT DIALYSIS PERIOD: DESIGN AND IMPLEMENTATION OF A DOPPS CHINA STUDY

Initiation of chronic dialysis for patients with kidney failure broadly affects all aspects of health-related quality of life (HRQoL). The transition to chronic dialysis is particularly challenging, with marked life disruption and exceptionally high mortality rates. Longitudinal trajectories of patient-reported outcomes (PROs) in incident dialysis populations are scarce and poorly understood, especially in China. The Dialysis Outcomes and Practice Patterns Study in China (DOPPS China, launched in 2011) provides a platform to gain in-depth real-world understanding of the complexities of care and outcomes for in-center hemodialysis (ICHD) patients. Leveraging the recently launched DOPPS China 7 (1488 prevalent ICHD patients enrolled to date), we aim to collect longitudinal clinical and PRO data from newly enrolled incident ICHD patients to: (1) characterize trajectory of laboratory variables; (2) assess change in PROs and (3) describe outcomes such as hospitalization and mortality rates during the transition period and first year of ICHD. We enrolled 43 sites in Beijing, Guangzhou, and Shanghai metropolitan areas (14, 15, and 14 sites respectively) in DOPPS China 7, using stratified random sampling by clinic characteristics. We plan to include >650 incident ICHD patients (median accrual/facility/year is 16) at these sites with longitudinal follow-up to characterize clinical course and optimally capture the complete patient experience. Eligible patients, ≥18 years old, will be approached sequentially for enrolment within one month of starting ICHD. Where available, clinical data will be collected retrospectively for up to 6 months prior to and during ICHD initiation. Clinical data will be submitted monthly via secure, web-based software. In parallel, we will deploy an electronic patient questionnaire (ePQ) into which patients report information directly via mobile device over the first year of enrollment. The ePQ encompasses a short version administered monthly and a longer version quarterly. Instruments were chosen based on previous validation in dialysis patients to minimize patient burden and content overlap (Table). To date, the DOPPS 7 China study has enrolled 184 incident patients. With approximately 1 year of follow-up, less than 10% have died or left ICHD. Twenty-eight have been hospitalized, mostly for HD access-related reasons. Initial results from the enriched selection of incident ICHD patients with clinical and PRO data are anticipated in 2021. We expect this innovative study to contribute meaningful new insights on the interplay among complications of kidney failure, treatment, clinical conditions, and the patient experience during the incident dialysis period in China.