General Health Characteristics Research Articles

Why do patients with low back pain seek care at emergency department? A cross-sectional study

BackgroundIt is unclear why patients with low back pain seek care in emergency departments. ObjectivesWe aim to describe the demographic, physical, and psychological characteristics, and reasons for seeking care at emergency departments due to an episode of low back pain. MethodsThis is a cross-sectional study conducted in an emergency department of a public hospital in São Paulo, Brazil, from September 2018 to May 2019. All patients who presented with a new episode of low back pain as the main complaint for seeking care at the emergency department on regular weekdays were invited to participate. We collected data on sociodemographic characteristics, general health characteristics, psychosocial risk factors, and reasons for visiting the emergency department. ResultsA total of 200 patients participated. We observed that most patients (68%) were women, with a mean age of 55 years, and who had previous episodes of low back pain (86%). Most patients went to the emergency department because they were worried about their pain (78%) and because they could not control their pain (73%). Patients also choose the emergency department because it is always available, it is free, and provided them good care. ConclusionsMost patients with low back pain seek care at emergency departments because they were worried about their pain and because the department is always open and does not require appointment. Understanding these reasons is an important step for the implementation of future public policies to make health care more efficient, to reduce unnecessary expenses and to avoid low-value care.

Identification of spatio-temporal clusters of lung cancer cases in Pennsylvania, USA: 2010–2017

BackgroundIt is known that geographic location plays a role in developing lung cancer. The objectives of this study were to examine spatio-temporal patterns of lung cancer incidence in Pennsylvania, to identify geographic clusters of high incidence, and to compare demographic characteristics and general physical and mental health characteristics in those areas.MethodWe geocoded the residential addresses at the time of diagnosis for lung cancer cases in the Pennsylvania Cancer Registry diagnosed between 2010 and 2017. Relative risks over the expected case counts at the census tract level were estimated using a log-linear Poisson model that allowed for spatial and temporal effects. Spatio-temporal clusters with high incidence were identified using scan statistics. Demographics obtained from the 2011–2015 American Community Survey and health variables obtained from 2020 CDC PLACES database were compared between census tracts that were part of clusters versus those that were not.ResultsOverall, the age-adjusted incidence rates and the relative risk of lung cancer decreased from 2010 to 2017 with no statistically significant space and time interaction. The analyses detected 5 statistically significant clusters over the 8-year study period. Cluster 1, the most likely cluster, was in southeastern PA including Delaware, Montgomery, and Philadelphia Counties from 2010 to 2013 (log likelihood ratio = 136.6); Cluster 2, the cluster with the largest area was in southwestern PA in the same period including Allegheny, Fayette, Greene, Washington, and Westmoreland Counties (log likelihood ratio = 78.6). Cluster 3 was in Mifflin County from 2014 to 2016 (log likelihood ratio = 25.3), Cluster 4 was in Luzerne County from 2013 to 2016 (log likelihood ratio = 18.1), and Cluster 5 was in Dauphin, Cumberland, and York Counties limited to 2010 to 2012 (log likelihood ratio = 17.9). Census tracts that were part of the high incidence clusters tended to be densely populated, had higher percentages of African American and residents that live below poverty line, and had poorer mental health and physical health when compared to the non-clusters (all p < 0.001).ConclusionsThese high incidence areas for lung cancer warrant further monitoring for other individual and environmental risk factors and screening efforts so lung cancer cases can be identified early and more efficiently.

How are patient-related characteristics associated with shared decision-making about treatment? A scoping review of quantitative studies

ObjectivesTo identify what patient-related characteristics have been reported to be associated with the occurrence of shared decision-making (SDM) about treatment.DesignScoping review.Eligibility criteriaPeer-reviewed articles in English or Dutch reporting on associations...

P291 Long-term use of glucocorticoids for polymyalgia rheumatica: follow-up of the PMR cohort study

Abstract Background/Aims Polymyalgia rheumatica (PMR) is a common inflammatory rheumatological condition in older adults, characterised by pain and stiffness in the shoulder and hip girdles. The mainstay of treatment is oral glucocorticoids (GCs). Classically, treatment is tapered to a stop over two years, but there is growing evidence this does not happen in practice. International guidelines recommend early referral to specialist services for patients at risk of prolonged treatment. However, they do not specify who these patients are. This study considers the factors at, and shortly after, diagnosis that might be associated with prolonged glucocorticoid treatment, and therefore who may benefit from early specialist review. Methods 652 people with incident PMR were recruited from English general practice between 2012 and 2014. They completed up to seven questionnaires over two years and a further long-term follow-up questionnaire (LTFUQ) 4.5-6.5 years after diagnosis. The first seven questionnaires have previously been used to allocate people to pain-stiffness trajectory classes. In the LTFUQ, participants reported current symptoms and other general health and lifestyle characteristics, as well as whether they were still taking GCs and whether they self-managed their GC use. Characteristics of those having successfully stopped GCs were compared to those still taking them. Results A median 5.16 years after diagnosis, 179 people responded to the LTFUQ. Of these, 67 (40.1%) were still on GCs with a mean daily dose of 5mg (1.5, 9). Those still taking GCs were more likely to be older (72.5 vs 70.2 years, p = 0.035), to live alone (31.8% v 15.0%, p = 0.01), and to report having self-managed their GCs (39.1% versus 11.0%, p &amp;lt; 0.0001). They were also more likely to have reported sustained pain-stiffness symptoms in the first two years, as defined by their trajectory class in earlier work (trajectory class [n{%} still treated]; partial recovery, sustained moderate symptoms [23 {34.3%}]; recovery before worsening [17 {25.4%}]; rapid and sustained recovery [15 {22.4%}]; Slow and continuous recovery [11 {16.34%}]). Conclusion PMR is not always the typically-described, time-limited condition. There are few patient characteristics that are associated with prolonged treatment early in the disease course, but those who are older and have sustained or recurrent pain and stiffness over two years appear to be at greater risk of remaining on GCs. Whilst accurate prediction of long-term treatment need is not possible from our data, people with sustained symptoms may benefit from specialist review to ensure diagnostic accuracy and consider need for additional therapies to reduce their GC burden. Disclosure S. Muller: None. S.L. Hider: None. B. Singh Sokhal: None. S.A. Lawton: None. T. Helliwell: None. C.D. Mallen: None.

Health outcome priorities in older patients with head and neck cancer

ObjectivesOlder patients with head and neck cancer often have comorbidity, have reduced life-expectancy and await intensive treatment. For the decision-making process, knowledge of a patient's health outcome prioritization is of paramount importance. We aim to study the health outcome priorities of older patients with head and neck cancer, and to evaluate whether general health, markers of physical, cognitive, and social functioning, and quality of life are associated with health outcome prioritization. Materials and MethodsPatients aged ≥70 years with head and neck cancer received a Comprehensive Geriatric Assessment and their priorities were assessed using the Outcome Prioritization Tool (OPT). Distribution of first priority, and associations with general health, markers of physical, cognitive, and social functioning, and quality of life were evaluated using ANOVA or chi-square. ResultsOf the 201 included patients, the OPT was available in 170 patients. The majority prioritized maintaining independence (n = 91, 53.3%), followed by extending life (n = 58, 34.1%), reducing pain (n = 14, 8.2%), and reducing other symptoms (n = 7, 4.1%). Housing situation, Body Mass Index, presence of musculoskeletal diseases, and quality of life were significantly related to prioritization of health outcomes. Reducing pain or other symptoms was more often prioritized by patients who lived alone, had a history of musculoskeletal problems, or had poor perceived quality of life. Age, sex, comorbidity, and markers of physical and cognitive functioning were not associated with health prioritization. ConclusionMaintaining independence is most often prioritized by older patients with head and neck cancer. In addition, we found that health outcome priorities of older patients are only limited based on general and specific health characteristics. We suggest to systematically discuss patients' priorities in order to facilitate complex treatment decisions in older patients with cancer.

Feasibility, reliability and validity of the health-related quality of life instrument Child Health Utility 9D (CHU9D) among school-aged children and adolescents in Sweden

BackgroundThis study was conducted in a general population of schoolchildren in Sweden, with the aim to assess the psychometric properties of a generic preference-based health related quality of life (HRQoL) instrument, the Swedish Child Health Utility 9D (CHU9D), among schoolchildren aged 7–15 years, and in subgroups aged 7–9, 10–12 and 13–15 years.MethodsIn total, 486 school aged children, aged 7–15 years, completed a questionnaire including the CHU9D, the Pediatric quality of life inventory 4.0 (PedsQL), KIDSCREEN-10, questions on general health, long-term illness, and sociodemographic characteristics. Psychometric testing was undertaken of feasibility, internal consistency reliability, test–retest reliability, construct validity, factorial validity, concurrent validity, convergent validity and divergent validity.ResultsThe CHU9D evidenced very few missing values, minimal ceiling, and no floor effects. The instrument achieved satisfactory internal consistency (Cronbach’s Alfa > 0.7) and strong test–retest reliability (r > 0.6). Confirmatory factor analyses supported the proposed one-factor structure of the CHU9D. For child algorithm, RMSEA = 0.05, CFI = 0.95, TLI = 0.94, and SRMR = 0.04. For adult algorithm RMSEA = 0.04, CFI = 0.96, TLI = 0.95, and SRMR = 0.04. The CHU9D utility value correlated moderately or strongly with KIDSCREEN-10 and PedsQL total scores (r > 0.5–0.7). The CHU9D discriminated as anticipated on health and on three of five sociodemographic characteristics (sex, age, and custody arrangement, but not socioeconomic status and ethnic origin).ConclusionsThis study provides evidence that the Swedish CHU9D is a feasible, reliable and valid measure of preference-based HRQoL in children. The study furthermore suggests that the CHU9D is appropriate for use among children 7–15 years of age in the general population, as well as among subgroups aged 7– 9, 10–12 and 13–15 years.

Gynecological Cancer Awareness: Reproductive Age and Postmenopausal Women

Objective: An important factor in the protection of women from gynecological cancers is awareness. Increasing awareness of gynecological cancer is important in terms of early diagnosis of the disease, treatment and reduction of mortality. The research was conducted to determine the gynecological cancer awareness of women of reproductive age and postmenopausal period. Methods: The study, designed as a descriptive cross-sectional type, was conducted with women who were admitted to a state hospital in Çankırı between October 2019 and February 2020. The sample consisted of 339 women who met the inclusion criteria. At the data collection stage, the 'Participant Information Form' and 'Gynecological Cancers Awareness Scale', which includes socio-demographic obstetric and general health characteristics (age, marital status, education, number of pregnancy, genital cancer history, sexual disease history) '' used. SPSS 21.0 (Statistical packet for Social Sciences for Windows) package program was used for the analysis of the data obtained from the study. Results: In the study, it was determined that women in the age group of 36-50, working, with 1-3 pregnancies and children, using oral contraceptives and having ideas about whether gynecological cancers can be prevented, had higher Gynecological Cancers Awareness Scale mean scores. It was determined that the gynecological Cancer Awareness Scale total mean scores were higher in women of reproductive age (150.7±20.6) compared to women in the postmenopausal period (144.4±18.5), and the difference between them was statistically significant (p &amp;lt;0.05). Conclusion: According to the research results; In women, factors such as education, number of pregnancies, number of births, family planning used and being in reproductive age affect gynecological cancer awareness. Postmenopausal women need information about gynecological cancer awareness.

Safety and Effectiveness of Dapoxetine On Demand in Chinese Men With Premature Ejaculation: Results of a Multicenter, Prospective, Open-Label Phase IV Study.

IntroductionDapoxetine on demand has been approved for premature ejaculation (PE) management in China; however, studies on the efficacy and safety of this treatment in the Chinese population are scarce.AimThe aim of this study was to evaluate the safety and effectiveness of dapoxetine 30 mg and 60 mg on demand in Chinese men with PE.MethodsPhase IV real-world study on 1,252 patients with PE. If men reported no response to dapoxetine 30 mg after 4 weeks treatment, dapoxetine has been uptitrated at 60 mg for 4 weeks more.Main Outcome MeasureSelf-reported data were collected for demographics, general and sexual health characteristics, PE severity, and treatment safety and effectiveness, as measured by the PE profile questionnaire.ResultsAdverse events (AEs), such as nausea, thirst, headache, and dizziness, similarly to previous literature, were detected. The treatment-emergent AEs rate was higher in the patients treated with 30 and 60 mg (n = 192) compared with those treated with the dapoxetine 30 mg only (n = 1060) (34.4% vs 15.8%, respectively). No new safety concerns were observed. The overall effectiveness rates were 88.2% in subjects using 30 mg of dapoxetine, whereas a rescue from the previous failure was in 55.7% in the patients who received 60 mg after the initial 30 mg. Overall, 83.2% responded to dapoxetine at dosages equal to or lower than 60 mg.ConclusionThe results in this study demonstrated in a large Chinese population that on-demand dapoxetine is a safe and effective symptomatic treatment in patients with PE.J Peng, L Yang, L Liu, et al. Safety and Effectiveness of Dapoxetine On Demand in Chinese Men With Premature Ejaculation: Results of a Multicenter, Prospective, Open-Label Phase IV Study. Sex Med 2021;9:100296.

Sex differences in deterioration of sleep properties associated with aging: a 12-year longitudinal cohort study.

The sleep patterns of humans are greatly influenced by age and sex and have various effects on overall health as they change continuously during the lifespan. We investigated age-dependent changes in sleep properties and their relation to sex in middle-aged individuals. We analyzed data from 2,640 participants (mean age of 49.8 ± 6.8 years at baseline, 50.6% women) in the Korean Genome and Epidemiology Study, which assessed sleep habits using the Pittsburgh Sleep Quality Index and other clinical characteristics. We analyzed the sleep habit changes that occurred between baseline and a follow-up point (mean interval: 12.00 ± 0.16 years). Associations of age and sex with 9 sleep characteristics were evaluated. Age was associated with most of the sleep characteristics cross-sectionally and longitudinally (P < .05), except for the time in bed at baseline (P = .455) and change in sleep duration (P = .561). Compared with men, women had higher Pittsburgh Sleep Quality Index scores, shorter time in bed, shorter sleep duration, and longer latency at baseline (P ≤ .001). Longitudinal deterioration in Pittsburgh Sleep Quality Index score, habitual sleep efficiency, duration, and latency was more prominent in women (P < .001). The sex differences in these longitudinal sleep changes were mainly noticeable before age 60 years (P < .05). Worsening of Pittsburgh Sleep Quality Index scores, habitual sleep efficiency, and latency was most evident in perimenopausal women. Men presented with greater advancement of chronotype (P = .006), with the peak sex-related difference occurring when they were in their late 40s (P = .048). Aging is associated with substantial deterioration in sleep quantity and quality as well as chronotype advancement, with the degree and timing of these changes differing by sex.

Determinants of Workforce Preparedness during Pandemics Among Healthcare Workers at the U.S. Department of Veterans Affairs.

Objective:An infectious disease outbreak can place a significant burden on healthcare systems, however, our understanding of the broader healthcare workforce’s preparedness during a pandemic is limited. This study examines factors that influence perceived workforce preparedness at the U.S. Department of Veterans Affairs (VA) during a pandemic.Methods:The VA Preparedness Survey was a random, anonymous, web-based survey fielded nationwide October to December 2018. Multivariate statistical analyses examined the effects of study relevant factors (sociodemographic, work-related, general health, and household-related characteristics of VA employees) on perceptions of workforce preparedness, including institutional readiness and understanding of individual roles during a pandemic.Results:Four thousand and twenty-six VA employees responded. Overall, 55% were confident in their VA medical facility’s ability to respond; 49% understood their role; and 68% reported their role to be important during a pandemic. After controlling for study-relevant factors, household preparedness, having plans that address the health care needs of family members, and higher self-reported health status were associated with all 3 workforce preparedness variables. Clinical staff (compared to non-clinical staff) were less likely (OR:0.80, 95% CI:0.68-0.94, P < .01) to have confidence in their medical facility’s ability to respond but more likely (OR:1.77, 95% CI:1.49-2.10, P < .001) to believe their role was important. Employees who have been at the VA longer (OR:1.07, 95% CI:1.01-1.14, P < .05) or have experienced a disaster while working at the VA (OR:1.29, 95% CI:1.04-1.59, P < .05) were more likely to understand their role during a pandemic.Conclusion:The findings from this study suggest the need for identifying ways to increase VA employees’ confidence in their medical facility’s ability to respond to a pandemic; develop trainings to improve understanding of their different yet critical roles, for both clinical and non-clinical staff, during a pandemic; create different workforce trainings for newly hired employees; and identify ways to improve household preparedness for a pandemic outbreak.

Self-perception of oral health in the elderly associated with health literacy and related factors

Abstract The aim of this study was to evaluate the self-perception of oral health in the elderly and to verify its association with oral health literacy and sociodemographic factors, through a cross-sectional study. Data collection took place in a probabilistic sample consisting of 535 elderly people over 60 years of age, who did not have cognitive problems, and were residents of the areas covered by six Family Health Units of the public health service, as well as users of a Center for Dental Specialties and dental clinics at the Faculty of Dentistry of Piracicaba (FOP), all located in the city of Piracicaba, Sao Paulo. A questionnaire with sociodemographic and health issues was applied, as well as the Health Literacy in Dentistry (HeLD-14) instrument for the assessment of oral health literacy. Poisson regression was used to estimate the associations between self-perceived oral health and literacy in oral health, as well as sociodemographic and general health characteristics. The data were analyzed using the SAS statistical software. The final regression model demonstrated that the elderly who were more likely to report poor oral health self-perception were associated with a low level of oral health literacy, were of the “non-white” ethnic group, had chronic illnesses and had sought the dentist for curative reasons in the last year. It was concluded that the self-perception of oral health in the elderly is influenced by variables that go beyond the dental sector, a fact that demands multiprofessional and intersectoral actions for their care. This fact highlights the importance of integrating aspects of health literacy in health and sociodemographic factors into the process of assessing oral health in the elderly, expanding the perspective of public health assessment for actions focused only on normative needs. Key messages We show the importance of assessing the oral health of the elderly in association with health literacy, expanding the perspective of public health assessment to actions beyond the normative needs. Despite the importance of the topic, there is still a scarcity of studies on health literacy and its impact on oral health behaviors and outcomes, impacting public health.

Impact of Problematic Smartphone Use on Mental Health of Adolescent Students: Association with Mood, Symptoms of Depression, and Physical Activity.

Problematic smartphone use in adolescent students can impair their mental health and behavior, thereby affecting academic performance and interpersonal relationships as well as reducing time spent on physical activity. This study investigated the association between problematic smartphone use and mood, symptoms of depression, and level of physical activity in adolescent students. The sample consisted of 308 boys (46.1 percent, 16.04 ± 1.30 years) and 359 girls (53.9 percent, 15.54 ± 1.44 years), aged 13-18 years (15.77 ± 1.40 years). Four instruments were used: the Sociodemographic, School, and General Health Characteristics Questionnaire; Smartphone Addiction Scale (to measure problematic smartphone use); Brunel Mood Scale; and Beck Depression Inventory. The study found that physically inactive adolescent students were more likely to present with problematic smartphone use than those who were physically active, and girls were more likely to exhibit problematic smartphone use than boys. Adolescent students with problematic smartphone use presented with more mood disturbances and symptoms of depression than did adolescent students without problematic smartphone use. Overall, physical inactivity and problematic smartphone use can reduce vigor and increase symptoms of depression in adolescent students.

Laparoscopic Liver Resection for Intrahepatic Cholangiocarcinoma: A Single-Center Experience.

Background: Despite recent advances in the field of laparoscopic liver surgery, intrahepatic cholangiocarcinoma (iCC) as an entity has been nearly exempted from the new approaches because of proposed technical difficulties in achieving lymphadenectomy (LAD) and beneficial oncologic outcomes. Materials and Methods: Clinical courses of all consecutive patients (n = 159) undergoing liver resection for iCC at the Department of Surgery, Charité-Universitätsmedizin between January 2015 and October 2019 were studied. Ultimately, after applying selection criteria 27 laparoscopic liver resections were compared with 31 open liver resections. Results: Preoperative patient characteristics were similar with regard to general health and tumor characteristics. However, patients in the laparoscopic group tended to have more advanced liver fibrosis. When LAD was performed laparoscopically, a median of eight lymph nodes were resected, complying with current AJCC treatment guidelines. Patients undergoing laparoscopic resection showed lower overall morbidity contributing at least in part to a markedly decreased hospital stay. Conclusions: Herein, we report on one of the largest series of laparoscopically resected iCC, with a high proportion of major resections. Our data show laparoscopic resection to achieve noninferior outcomes to open resection despite impaired preoperative liver function.

Beyond biomedical and comorbidity approaches: Exploring associations between affinity group membership, health and health seeking behaviour among MSM/MSW in Nairobi, Kenya

ABSTRACT We explored general health and psychosocial characteristics among male sex workers and other men who have sex with men in Nairobi, Kenya. A total of 595 MSM/MSW were recruited into the study. We assessed group differences among those who self-reported HIV positive (SR-HIVP) and those who self-reported HIV negative (SR-HIVN) and by affinity group membership. Quality of life among SR-HIVP participants was significantly worse compared to SR-HIVN participants. Independent of HIV status and affinity group membership, participants reported high levels of hazardous alcohol use, harmful substance use, recent trauma and childhood abuse. The overall sample exhibited higher prevalence of moderate to severe depressive symptoms compared to the general population. Quality of life among participants who did not report affinity group membership (AGN) was significantly worse compared to participants who reported affinity group membership (AGP). AGN participants also reported significantly lower levels of social support. Membership in affinity groups was found to influence health seeking behaviour. Our findings suggest that we need to expand the mainstay biomedical and comorbidity focused research currently associated with MSM/MSW. Moreover, there are benefits to being part of MSM/MSW organisations and these organisations can potentially play a vital role in the health and well-being of MSM/MSW.

Burden of relapsing-remitting multiple sclerosis on workers in the US: a cross-sectional analysis of survey data

BackgroundMultiple sclerosis (MS) is prevalent among working age individuals (20–60 years), leading to high burden on work productivity. Few data are available about the absenteeism and presenteeism in employed individuals with MS in comparison to non-MS personnel. This study aimed to quantify the burden of illness of employed US adults with relapsing-remitting multiple sclerosis (RRMS) and examine burden by levels of work impairment.MethodsA retrospective cross-sectional analysis was conducted using patient-reported responses from the US National Health and Wellness Survey (NHWS). Data from NHWS 2015–2016 were analyzed from 196 employed RRMS respondents who were matched 1:4 to employed respondents without MS based on demographic and general health characteristics. Demographic and general health characteristics for employed RRMS individuals were analyzed by levels of work impairment (none, 1–30%; 31–68%; 69–100%). Work productivity (absenteeism, presenteeism, and work impairment), decrements in health-related quality of life (HRQoL) (short form-36, EQ-5D), and healthcare resource utilization (HCRU) were compared to determine the burden of RRMS.ResultsAfter propensity score matching, the levels of absenteeism and presenteeism were 2 and 1.8 times higher in the employed RRMS population than the employed non-MS population, respectively (P < 0.001 for both). HRQoL was significantly lower in employed respondents with RRMS than those without MS (P < 0.001 for all). Employed respondents with RRMS had significantly more HCRU over 6 months compared to those without MS (P < 0.001). Furthermore, among employed RRMS respondents, greater levels of impairment were associated with increasing disease severity, greater healthcare resource use, fatigue, and cognitive impairment and inversely associated with mental and physical HRQoL (P < 0.0001 for all).ConclusionsAmong employed individuals, respondents with RRMS had lower, work productivity, HRQoL, and higher HCRU as compared with those without MS. Given the large impact RRMS has on work impairment, a need exists to manage individuals on therapies that improve HRQoL, reduce symptoms, and improve their ability to perform in the workforce.

Health Characteristics of the Wayuu Indigenous People.

The identified number of isolated populations with unique medical characteristics is growing. These populations are difficult to study. Civil-military humanitarian operations are part of our medical force readiness training, and are also a venue through which unique populations can be simultaneously served and evaluated. Continuing Promise 2017 was a collaborative effort between the US Navy, non-governmental organizations, and the Colombian Ministry of Health, Navy and Army to provide primary medical care to the Wayuu indigenous people in the La Guajira Department of Colombia. In the course of providing primary care services, demographic and health data of the Wayuu people were collected. Descriptive statistics were used to generate averages, and t-tests were used to compare Wayuu means with age and gender matched US means for weight and age in children and blood pressure in adults. Observational data on skin afflictions and arthritis were also collected. This project was approved by Naval Medical Center Portsmouth Institutional Review Board. Although the Wayuu live in an arid desert with chronic sun exposure, they have no apparent affliction from squamous cell carcinoma or melanoma. They live almost exclusively through manual labor, yet rarely develop osteoarthritic joint disease. Their incidence of hypertension is 35% lower than their US age and gender matched cohort. Although their region is known for extreme poverty and malnutrition, their weight-for-age curve from 2 months through 17 years is similar to their US cohort. This study is the first to document the general health characteristics of the Wayuu people. It demonstrates that in addition to providing important readiness training to our own personnel, humanitarian missions can provide medical care and explore unique, isolated populations. Although retrospective and limited in size, it can be used to shape future medical missions to their region, and will hopefully stimulate formal research into their remarkable characteristics.

Abstract TP337: Predictors of the Patient Activation Measure (PAM) Among Acute Stroke Survivors: An Analysis of the Michigan Stroke Transitions Trial (MISTT) Data

Introduction: Stroke transitions-of-care are complex and effective self-management is required for success. Patient activation, measured by the Patient Activation Measure (PAM), is a self-management construct that measures knowledge, skill, and confidence to manage one’s own health. Scores from this 13-item instrument range from 0-100 with mean scores of 62 (SD=13). PAM has been validated among ill and healthy populations, however, little is known about what factors are associated with PAM among stroke survivors. Methods: This cross-sectional analysis of the Michigan Stroke Transitions Trial (MISTT) utilized interview data collected 7 days after stroke survivors returned home. Multivariable linear regression was used to identify independent associations between PAM scores and a range of patient factors including sociodemographic, perceived support, general health, and stroke-related characteristics. Age and education were forced into the model. Results: Of 265 participants, 180 (70%) completed the 7-day interview. Mean age was 66 years (range 27-90), 49% were female, 18% were non-white, 88% had ischemic stroke, and 53% were discharged to acute or sub-acute rehab. 64% also had a caregiver enrolled in the MISTT trial. The mean PAM score was 64.5 (SD=16). Perceived emotional support was positively associated with PAM score, while having a consented caregiver and higher self-reported post-stroke disability were negatively associated with PAM (Table). Conclusions: Perceived emotional support, caregiver involvement, and post-stroke disability were associated with patent activation. These may represent intervention targets for enhancing post-stroke transitions.

The Risk of Gout Among Patients With Sleep Apnea: A Matched Cohort Study.

Obstructive sleep apnea (OSA) is associated with a range of serious comorbidities. This study was undertaken to investigate whether people with OSA are more likely to develop gout, in the short and long term, compared to those without OSA. A matched retrospective cohort study was undertaken using the UK Clinical Practice Research Datalink. Individuals age ≥18 years who received a diagnosis of OSA between 1990 and 2010 were identified and matched on age, sex, and practice with up to 4 individuals without OSA; follow-up was until the end of 2015. Hazard ratios (HRs) were estimated using Cox regression adjusted for general health, lifestyle, and comorbidity characteristics. The risk of developing gout was assessed at different time points, and the body mass index (BMI) category-specific results were presented. The study sample included 15,879 patients with OSA and 63,296 without. The median follow-up was 5.8 years. We found that 4.9% of patients with OSA and 2.6% of patients without the disorder developed gout. The incidence rate per 1,000 person-years was 7.83 (95% confidence interval [95% CI] 7.29-8.40) and 4.03 (95% CI 3.84-4.23) among those with and without OSA, respectively. The adjusted HR was 1.42 (95% CI 1.29-1.56). The risk of developing gout among OSA patients compared to those without was highest 1-2 years after the index date (HR 1.64 [95% CI 1.30-2.06]). This finding persisted among those who were overweight and obese. For those with normal BMI, the highest significant HR (2.02 [95% CI 1.13-3.62]) was observed at 2-5 years after the index date. In this study, patients with OSA continued to be at higher risk of developing gout beyond the first year following the diagnosis. Our results further indicate that peak incidences of gout vary according to BMI.

Chewing function, general health and the dentition of older Australian men: The Concord Health and Ageing in Men Project.

To describe the associations between chewing function with oral health and certain general health characteristics, in a population of community-dwelling older Australian men. Analysis of data obtained from a cross-sectional analysis of the 4th wave of the Concord Health and Ageing in Men Project cohort of 614 participants, 524 whom were dentate, aged 78years and over. Their chewing capacity was assessed using three main indicators: capacity to chew eleven food items ranging from boiled eggs through to fresh carrots and nuts; discomfort when eating; and interruption of meals. Associations with chewing were tested for dentate vs edentate participants, numbers of teeth present, active dental disease and key general health conditions such as disabilities, comorbidities and cognitive status. Log binomial regression models adjusted for age, country of birth, income, education and marital status. Prevalence ratios and 95% confidence intervals were estimated. Twenty-one per cent of participants could not eat hard foods, while 23.1% reported discomfort when eating, and 8.8% reported interrupted meals when eating. There was a threefold difference in the capacity of dentate men to chew firm meat over that of edentulous men (95% CI, 2.0-4.9); a 2.5 times greater likelihood of edentate men reporting discomfort when eating (95% CI: 1.5-4.3); and 1.9 times greater likelihood of edentate participants reporting having meals interrupted (95% CI: 1.4-2.6). Chewing/eating difficulties were associated with both dental status (number of teeth, active dental caries) and self-rated dental health. Fewer than 20 teeth and the presence of active coronal or root decay were associated with more discomfort when eating. General health conditions associated with chewing function included disability, physical activity, comorbidities, cognitive status and depression. Older men's self-rated oral health and general health perceptions were also associated with aspects of chewing function. Poorer self-reported oral health was associated with inability to eat hard foods (95% CI: 1.3-2.7) and with discomfort when eating (95% CI: 2.6-5.1), while poorer self-reported general health was associated with discomfort when eating (95% CI: 1.2-2.2). Falling rates of edentulism may lead to improved chewing and eating function in older men. Maintaining 20 or more natural teeth, and preventing active coronal and root caries should enhance chewing function and promote self-reported health and oral health. Lower capacity to chew hard foods and a higher reporting of discomfort when eating is associated with co-morbidity in older Australian men.

Current General Health Characteristics of Young Adults Following Sport and Non-Sport Concussion

To investigate concussion history and current health characteristics of young adults.