Terms Of Health Outcomes Research Articles

School Age Developmental Outcomes of Children Conceived by IVF Compared with Controls: A Population Linkage Study

Background: There has been increasing interest in assessing longer term developmental and health outcomes in IVF-conceived offspring compared with those born after natural conception. So far, the findings have been conflicting. The Australian Early Developmental Consensus (AEDC) assesses children in their first year of primary school across five domains; physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. Aim: To compare school entry (5-7 years of age) outcomes in IVF-conceived children in Victoria with naturally conceived controls. Method: We undertook a statewide data linkage study, with perinatal data (births 2005-2014) linked to data from major IVF providers in Victoria and the AEDC. Our approach to analysis included: complete case analysis, multiple imputation of missing data, consideration of clustering (siblings) and inverse probability weighted modeling to adjust for covariates. Our primary outcome was an AEDC score indicative of developmental vulnerability in two or more domains. We adjusted for the child’s age at assessment, sex, highest level of maternal education, maternal age, parity, SEIFA (Socio-Economic Indexes for Areas) quintile, language background other than English, and Aboriginal and Torres Strait Islander (ATSI) status. Results: The linked dataset comprised 163,418 children, including 4,441 IVF-conceived children. The IVF conceived population had older, more highly educated mothers who lived in more affluent areas and were less likely to be from non-English speaking backgrounds or identify as ATSI. IVF-conceived children were less likely to be developmentally vulnerable, in both unadjusted (RR 0.59, 95%CI: 0.52-0.67, p<0.001) and adjusted analyses (aRR 0.72, 95%CI: 0.58-0.88, p<0.001). Conclusion: Children conceived by IVF were less likely to be developmentally vulnerable in their first year of schooling, compared with peers conceived naturally. Further research should aim to understand if similar patterns are seen in other education and health domains and the potential mechanisms for these differences.

Economic Evaluations of Mindfulness-Based Interventions: a Systematic Review.

ObjectivesThis study includes a systematic review of cost-effectiveness analyses (CEAs) and cost–benefit analyses (CBAs) of mindfulness-based interventions (MBIs).MethodsA literature search was conducted using PubMed, Web of Science, JSTOR, and CINAHL for studies published between January 1985 and September 2021, including an original cost-related evaluation of an MBI. A qualitative assessment of bias was performed using the Drummond checklist.ResultsTwenty-eight mindfulness-based intervention studies (18 CEAs and 10 CBAs) were included in this review. Mindfulness-based stress reduction (MBSR) was less costly and more effective when compared with the usual care of cognitive behavioral therapy among patients with chronic lower back pain, fibromyalgia, and breast cancer. MBSR among patients with various physical/mental conditions was associated with reductions in healthcare costs. Mindfulness-based cognitive therapy (MBCT) was also less costly and more effective than the comparison group among patients with depression, medically unexplained symptoms, and multiple sclerosis. MBCT’s cost-effectiveness advantage was also identified among breast cancer patients with persistent pain, non-depressed adults with a history of major depressive disorder episodes, adults diagnosed with ADHD, and all cancer patients. From a societal perspective, the cost-saving property of mindfulness training was evident when used as the treatment of aggressive behaviors among persons with intellectual/developmental disabilities in mental health facilities.ConclusionsBased on this review, more standardized MBI protocols such as MBSR and MBCT compare favorably with usual care in terms of health outcomes and cost-effectiveness. Other MBIs may result in cost savings from both healthcare and societal perspectives among high-risk patient populations.

Assessing the cost-effectiveness of COVID-19 vaccines in a low incidence and low mortality setting: the case of Thailand at start of the pandemic

ObjectiveThis study aimed to assess the cost-effectiveness of COVID-19 vaccines, preferred COVID-19 vaccine profiles, and the preferred vaccination strategies in Thailand.MethodsAn age-structured transmission dynamic model was developed based on key local data to evaluate economic consequences, including cost and health outcome in terms of life-years (LYs) saved. We considered COVID-19 vaccines with different profiles and different vaccination strategies such as vaccinating elderly age groups (over 65s) or high-incidence groups, i.e. adults between 20 and 39 years old who have contributed to more than 60% of total COVID-19 cases in the country thus far. Analyses employed a societal perspective in a 1-year time horizon using a cost-effectiveness threshold of 160,000 THB per LY saved. Deterministic and probabilistic sensitivity analyses were performed to identify and characterize uncertainty in the model.ResultsCOVID-19 vaccines that block infection combined with social distancing were cost-saving regardless of the target population compared to social distancing alone (with no vaccination). For vaccines that block infection, the preferred (cost-effective) strategy was to vaccinate the high incidence group. Meanwhile, COVID-19 vaccines that reduces severity (including hospitalization and mortality) were cost-effective when the elderly were vaccinated, while vaccinating the high-incidence group was not cost-effective with this vaccine type. Regardless of vaccine type, higher vaccination coverage, higher efficacy, and longer protection duration were always preferred. More so, vaccination with social distancing measures was always preferred to strategies without social distancing. Quarantine-related costs were a major cost component affecting the cost-effectiveness of COVID-19 vaccines.ConclusionCOVID-19 vaccines are good value for money even in a relatively low-incidence and low-mortality setting such as Thailand, if the appropriate groups are vaccinated. The preferred vaccination strategies depend on the type of vaccine efficacy. Social distancing measures should accompany a vaccination strategy.

The Arizona Prevention Research Center partnerships in Arizona to promote COVID-19 vaccine health equity.

BackgroundVaccine hesitancy in the face of the COVID-19 pandemic is a complex issue that undermines our national ability to reduce the burden of the disease and control the pandemic. The COVID-19 pandemic revealed widening health disparities and disproportionate adverse health outcomes in terms of transmission, hospitalizations, morbidity and mortality among Arizona's Latinx rural, underserved, farmworker, disabled and elderly populations. In March 2021, ~8.1% of those vaccinated were Latinx, though Latinxs make up 32% of Arizona's population. The Arizona Vaccine Confidence Network (AzVCN) proposed to leverage the expertise of the Arizona Prevention Research Center (AzPRC) and the resources of the Mel and Enid Zuckerman College of Public Health (MEZCOPH) Mobile Health Unit (MHU) to identify, implement and evaluate a MHU intervention to increase uptake of COVID-19 vaccines.MethodsThe AzVCN focused efforts on Latinx, rural, un/underinsured and farmworker communities in the four Arizona border counties that are at greater risk of COVID-19 morbidity and mortality and may have limited access to vaccination and other essential health services. The AzVCN used listening sessions to create a feedback loop with key stakeholders and critical health care workers to validate barriers/enablers and identify solutions to increase vaccination uptake emerging from the network. The AzVCN also implemented a community-based intervention using community health workers (CHWs) based in a MHU to increase knowledge of the COVID-19 vaccines, reduce vaccination hesitancy and increase vaccination uptake among Latinx rural, un/underinsured and farmworker populations in Southern Arizona.ResultsAzVCN outcomes include: identification of enablers and barriers of COVID-19 vaccination in the priority populations; identification of strategies and solutions to address vaccine hesitancy and increase vaccine uptake among priority population; and evidence that the proposed solutions being tested through the AzVCN contribute to increased vaccine uptake among the priority populations.ConclusionThrough these efforts the AzPRC contributed to the CDC's Vaccinate with Confidence Strategy by collaborating with CHWs and other key stakeholders to engage directly with communities in identifying and addressing structural and misinformation barriers to vaccine uptake.

Assessing knowledge, acts of discrimination, stigmatizing attitudes and its associated factors towards people living with HIV (PLHIV) among Family Medicine trainees in Malaysia.

Human immunodeficiency virus (HlV)-related stigmatisation and discrimination adversely affect health outcomes in terms of timely diagnosis, treatment and care. Despite global efforts, they remain common among healthcare workers worldwide. In Malaysia, family medicine specialists are entrusted with the care of HIV patients at the primary care level. This study aimed to assess HIV-related knowledge, acts of discrimination, stigmatising attitudes and their associated factors among family medicine trainees in Malaysia. This cross-sectional study was conducted among 397 family medicine trainees in Malaysia using a validated, self-administered questionnaire that assessed the participants' sociodemographic information, HIV/AIDS knowledge, stigmatising attitudes (attitudes of blame, attitudes towards imposed measures, comfort in dealing with HIV patients) and acts of discrimination. The most common stigmatisation was "attitudes of blame" (mean [SD] score: 3.0 (0.74); range score:1-5), and the most frequent discriminatory act was breaching patient confidentiality (54.9%). Around 82.1% had good knowledge of HIV/AIDS. Married participants and participants who had 7 years or less in service were more stigmatising in "attitudes of imposed measures" towards people living with HIV (p=0.006). Family medicine trainees exhibited stigmatisation and discrimination towards HIV patients despite having good HIV knowledge. Hence, appropriate and concerted health education should be given to all family medicine trainees to eliminate stigmatisation and discrimination.

Triage and dysphagia: Are hospitals in the South African public health sector ready?

Dysphagia screening is unequivocally beneficial for individuals who may be at risk of swallowing impairment. Benefits range from capitalising on early intervention, facilitating hydration and nutrition, reduced financial costs for the patient and prevention of dysphagia-related complications. Why then is there a need for triage? Inefficiencies and often non-existence of screening and referral processes require one to consider if triage may be a more viable option in the public healthcare context. Dysphagia triage could potentially prioritise emergency swallowing care and identify patients who need immediate swallowing attention because of the nature or severity of dysphagia. The use of a dysphagia triage checklist could have implications for patient health outcomes in terms of the safety of oral diets, development of aspiration pneumonia, malnutrition, administration of oral medication and overall patient prognosis.

Clinical Characteristics and Prognostic Relevance of Different Types of Caregivers for Elderly Patients with Acute Heart Failure-Analysis from the RICA Registry.

Background: Patients with heart failure encompass a heterogeneous group, but they are mostly elderly patients with a large burden of comorbid conditions. Objective: The aim of this study was to compare the clinical characteristics and the prognostic impact on hospital admissions and mortality in a population of patients with HF with different types of caregivers (family members, professionals, and the patient himself). Methods: We conducted an observational study from a prospective registry. Patients from the National Registry of Heart Failure (RICA), which belongs to the Working Group on Heart Failure and Atrial Fibrillation of the Spanish Society of Internal Medicine (SEMI), were included. Patients with heart failure were classified, according to the type of main caregiver, into four groups: the patient himself/herself, a partner, children, or a professional caregiver. A bivariable analysis was performed between the clinical, analytical, therapeutic, and prognostic characteristics of the different groups. The endpoints of the study were all-cause mortality at 1 year; mortality at 120 days; and the readmission rate for HF at 30 days, 120 days, and 1 year of follow-up. In all cases, the level of statistical significance was set at p < 0.05. Results: A total of 2147 patients were enrolled in this study; women represented 52.4%, and the mean age was 81 years. The partner was the caregiver for 703 patients, children were caregivers for 1097 patients, 199 patients had a professional caregiver, and only 148 patients were their own caregivers. Women were more frequently cared for by their children (65.8%) or a professional caregiver (61.8%); men were more frequently cared for by their spouses (68.7%) and more frequently served as their own caregivers (59.5%) (p < 0.001). No statistically significant differences were observed in relation to readmissions or mortality at one year of follow-up between the different groups. A lower probability of readmission and death was observed for patients who received care from a partner or children/relative, with log-rank scores of 11.2 with p= 0.010 and 10.8 with p = 0.013. Conclusions: Our study showed that the presence of a family caregiver for elderly patients with heart failure was associated with a lower readmission rate and a lower mortality rate at 120 days of follow-up. Our study also demonstrated that elderly patients with good cognitive and functional status can be their own caregivers, as they obtained good health outcomes in terms of readmission and mortality. More prospective studies and clinical trials are needed to evaluate the impact of different types of caregivers on the outcomes of patients with heart failure.

Qualification, socialization, and subjectification: a discussion of the purpose of daily physically active learning through the lens of secondary school teachers

ABSTRACT Based on the fact that many youth do not meet global health recommendations for physical activity (PA), and that schools constitute an arena in which all children may be reached, PA integrated into school settings is critical. Inspired by the theoretical framework of Gert Biesta and his three domains of education, i.e. qualification, socialization and subjectification, this study examines secondary school teachers’ overall perceptions of the purpose of physically active learning (PAL) in secondary school. This is accomplished by using a longitudinal design, and interviewing 12 teachers three times – before, during, and after a PA school intervention that they organized. The analysis of the teachers statements revealed two main purposes that are related to the domain of qualification, two to the domain of socialization, and none to the domain of subjectification. However, the analysis showed that some perceptions are implicitly related to the domain of subjectification. Our findings correspond with the leading discourse, which highlights the importance of public health and academic outcomes in terms of PAL. We suggest, however, that the aim of implementing PA in schools should comprise all three domains of education, and that teachers must achieve a successful balance between different aims, and make decisions based upon desired results in upcoming pedagogical situations.

Social and Regional Disparities in Utilization of Maternal and Child Healthcare Services in India: A Study of the Post-National Health Mission Period.

BackgroundIndia has enjoyed enhanced economic growth, but has fared poorly in human development indicators and health outcomes, over the last two decades. Significant health inequities and access to healthcare continue to exist and have widened within communities across states. This study examine the changes and disparities in maternal and child healthcare (MCH) among disadvantaged and advanced social groups in three states of India.Data and MethodsFour rounds of National Family Health Survey data were used to measure infant mortality rate (IMR) and under-five mortality rate (U5MR) according to the social groups for the selected states. This study investigates the socio-economic inequities manifested into caste and class differentials and inequities in availability, utilization, and affordability of maternal and healthcare services. Descriptive statistics and the logistic regression model were used. Individual- and household-level covariates were employed to understand the differentials in healthcare utilization.ResultsThe probability of not receiving full antenatal care (ANC) or full immunization for the children was highest among the Scheduled Caste/Scheduled Tribe (SC/ST) families, followed by economic class, mother's education and residence. Tamil Nadu showed the highest utilization of public health facilities, while Bihar was the poorest in terms of health outcomes and utilization of MCH care services even after the pre-National Health Mission (NHM) period. Bihar and West Bengal also showed private healthcare dependence.ConclusionThis study detected the presence of significant caste/tribe differentials in the utilization of MCH care services in the selected states of India. Limited accessibility and unavailability of complete healthcare were the foremost reasons for the under-utilization of these services, especially for people from disadvantaged social groups. The result also suggested that it is perilous to confirm “Health for All” immediately. It will be the efficiency with which India addresses inequities in providing healthcare services and guarantees quality care of health services.

Clinical trials and outcome reporting in congenital diaphragmatic hernia overlook long-term health and functional outcomes-A plea for core outcomes.

AimTo review the selection, measurement and reporting of outcomes in studies of interventions in Congenital Diaphragmatic Hernia (CDH).MethodsWe searched the Cochrane Central Register of Controlled Trials from 2000–2020 for randomised trials and observational studies. Outcomes reported were classified into seven key domains modelled on the patient journey.ResultsOur search yielded 118 papers; 27 were eligible. The most frequent domains measured were ‘short‐term markers of disease activity’ (17/27), whereas long‐term outcomes (3/27) and outcomes relating to functional health status (8/27) were reported infrequently. There was heterogeneity in the methods and timing of outcome reporting. Primary outcomes were varied and not always clearly stated.ConclusionLong‐term health and functional outcomes involving interventional studies in CDH are infrequently reported, which hinders the process of shared decision‐making and evidence‐based healthcare. A CDH core outcome set is needed to standardise outcome reporting that is relevant to both families and healthcare teams.

Rates of emergency room visits and hospitalizations among refugee and resident children in a tertiary hospital in Turkey.

Refugee children, as compared to resident children, are more likely to present to the ED with high acuity conditions and at a younger age resulting in higher rates of inpatient admissions. Strategies to increase access to preventive health care services for young refugee children should be explored to decrease ED and hospital services and improve health outcomes. • Children are the most affected victims of armed conflicts in terms of health outcomes. • Refugees prefer to access healthcare through the emergency department. • Refugee children were more likely to present as urgent when compared to resident children. • Admission to neonatal and intensive care units was more frequent among refugee than resident children.

Leaving no one behind: targeting mobile and migrant populations with health interventions for disease elimination—a descriptive systematic review

BackgroundMobile and migrant populations (MMPs) pose a unique challenge to disease elimination campaigns as they are often hard to survey and reach with treatment. While some elimination efforts have had success reaching MMPs, other campaigns are struggling to do so, which may be affecting progress towards disease control and elimination. Therefore, this paper reviews the literature on elimination campaigns targeting MMPs across a selection of elimination diseases—neglected tropical diseases, malaria, trypanosomiasis, polio, smallpox, and rinderpest.MethodsThrough a systematic review process following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a three-person review team identified papers from databases, conference records, and citation searches using inclusion/exclusion criteria. Papers were divided into three key outcome domains during the synthetization process: (1) MMP movement patterns in East Africa including reasons for movement and consequences in terms of health outcomes and healthcare access; (2) MMP contribution to the transmission of disease across all geographies; (3) surveillance methods and treatment interventions used to implement programming in MMPs across all geographies. Experts in the field also provided supplemental information and gray literature to support this review.ResultsThe review identified 103 records which were descriptively analyzed using the outcome domains. The results indicate that in East Africa, there are various motivations for migration from economic opportunity to political unrest to natural disasters. Regardless of motivation, mobile lifestyles affect health service access such that MMPs in East Africa report barriers in accessing healthcare and have limited health knowledge. Often lower service delivery to these populations has resulted in higher disease prevalence. A minority of articles suggest MMPs do not pose challenges to reaching disease control and elimination thresholds. Finally, the literature highlighted surveillance methods (e.g., using satellite imagery or mobile phone data to track movement, participatory mapping, snowball sampling) and intervention strategies (e.g., integration with animal health campaigns, cross-border coordination, alternative mass drug administration [MDA] methods) to implement health interventions in MMPs.ConclusionsUltimately, the literature reviewed here can inform programmatic decisions as the community attempts to reach these never treated populations.Systematic review registrationThe protocol for this manuscript was registered with the International Prospective Registry of Systematic Reviews (PROSPERO) (No. CRD42021214743),

Reciprocal associations between housing instability and youth criminal legal involvement: a scoping review

BackgroundYouth experiencing homelessness have disproportionate contact with the criminal legal system. This system contact represents a critical inflection point for enhancing risk or opportunities for stabilization; however, the policy and scholarly traditions examining the criminal legal system have not traditionally incorporated housing or other social determinants as a central focus of intervention.MethodsWe conducted a scoping review using PRISMA-ScR guidelines to examine how the research literature is currently addressing housing within the context of youth involvement in the legal system. Databases searched included PubMed, Web of Science, and Academic Search Complete. Google Scholar was used to identify papers not indexed in the academic databases of interest. Database searches were conducted between September and December 2019 and articles were restricted to those published in English between the year 2000 and 2019. Key study components extracted included demographic information regarding each sample, type of article, study methodology, direction of effects of interest, outcome measures and primary findings, as well as theoretical frameworks engaged by the authors.ResultsThe search results returned 2154 titles for review. After screening all 2154 titles, 75 met eligibility for inclusion. reviews were conducted for all 75 papers. 36 abstracts met eligibility criteria and underwent full-text review. Ultimately, 29 articles satisfied eligibility criteria and were included in this scoping review.ConclusionsPublications are primarily focused on the social epidemiology of risk factors and behaviors determining youth justice contact, but relatively less so on studies of interventions targeting youth delinquency, crime reduction, or recidivism that included housing support. The lack of continuity in theorizing from epidemiology to applied science in this area represents a gap in the literature that is likely reducing the effectiveness of interventions to interrupt patterns of legal system contact for youth. Integrating a public health framework that emphasizes the upstream social determinants leading to contact with the youth justice system would represent a paradigm shift for the field that would have beneficial effects on long term health outcomes for youth.

Corporate Capital and (De)Monopolization of Public Health in the USA: An Institutionalist Perspective

From the original institutional economics perspective, this article discusses the patent-driven R&D models and public support to the pharmaceutical industry that is linked to a rising monopoly power of corporate capital over public health in the USA. Using the U.S. historical health data, we analyze the effects of institutional changes, shaped by large corporate capital, on public health outcomes in terms of accessibility and affordability of the medical advances arising from R&D. The analysis reveals that private returns from publicly funded R&D is higher than its social returns, despite a growing public interest in providing more comprehensive medical coverage.

Long-Term Renal Outcome in Patients Bridged on ICU for Lung Transplantation

<h3>Purpose</h3> Survival in lung transplantation (LTx) patients continues to improve. The focus of post LTx care is shifting from short term survival to long term health outcome, including LTx related comorbidities like chronic kidney disease (CKD). LTx from the intensive care unit (ICU) remains controversial. However recent data showed similar long-term overall survival and allograft function in comparison with elective LTx. Long-term renal outcome for ICU bridged LTx patients is unknown. <h3>Methods</h3> Pre- and post-LTx data from all from all LTx patients bridged on ICU bridged LTx between April 2004 and 31th of December 2018 in the University Medical Center Groningen (UMCG) were used to calculate the absolute post-LTx decline of the estimated glomerular filtration rate calculated with the CKD-EPI equation (eGFR), incidence of CKD and end-stage renal disease (ESRD). <h3>Results</h3> A total of 357 patients received a LTx, of which 41 patients were bridged on ICU. Mean follow up time was 73 months. Mean age of ICU bridged LTx patients was 47 years (18-64), and 63,4% were male. 17,1% received renal replacement therapy directly post-transplantation. Of the ICU bridged patients the mean pre-LTx eGFR was 118 ml/min per 1.73 m². Mean eGFR decline at 1 and 5 years post-LTx was 61 and 69 ml/min per 1.73 m² respectively. The cumulative incidence of CKD 3a-5 for survivors post-LTx at 1 and 5 years was 54% and 69%. The cumulative incidence of CKD 4/5 at 1 and 5 years was 7.3% and 19%. In the largest international registry for LTx (International Thoracic Organ Transplant Registry, N=>10,000) the cumulative incidence of CKD 4/5 at 1 and 5 years was 5.7% and 16.3% respectively. 5 patients developed ESRD of which 3 were treated with hemodialysis an 2 received a renal transplant. <h3>Conclusion</h3> In this single center cohort, patients bridged from ICU to LTx have impaired long-term renal outcome, comparable to ISHLT registry data from patients receiving an elective LTx. However, questions remain unanswered. To complete this analysis, data from the 316 elective transplanted patients will be collected for comparison.

Combined quality of life and survival for estimation of long-term health outcome of patients with stroke

BackgroundAdvanced medical technologies can prolong life of stroke survivors. Dynamic change of health outcomes provides essential information to manage stroke. Mathematical models, to extrapolate health status over a lifetime from cross-sectional data, can be used to investigate long term health outcomes among stroke survivors. This study aimed to estimate the health outcomes of ischemic stroke (IS) and intracerebral hemorrhage (ICH) at each survival time point.MethodsThe cohort of 5391 patients with IS and ICH stroke, registered at Ramathibodi Hospital from 2005 to 2013, were followed up regarding survival status until 2016 with the National Mortality Registry. Survival functions were extrapolated over 50 years to age- and sex-matched referents simulated from the national data of the Thailand National Health Statistic Office. From July to December 2016, the EuroQoL 5-dimension questionnaire was used to measure quality of life (QoL) among 300 consecutive, cross-sectional subsamples. The survival functions were then adjusted by the utility values of QoL for the stroke cohort to estimate quality adjusted life expectancy (QALE).ResultsThe average health utility values were lower in the initial months, then slowly increased to stable levels. However, male stroke survivors presented higher health utility than females. Throughout lifetime estimation, patients with IS stroke exhibit better health outcomes than those with ICH [10.27 vs. 7.74 quality-adjusted life years (QALYs)]. Patients with ICH presented a significantly decreased QoL than patients with IS (16.15 and 8.41 QALYs).ConclusionPreventing stroke can save people from reduced years and QoL, which can be quantified by loss-of-QALE in QALY units to compare health benefits from prevention, clinical diagnosis and direct treatment.

Modelling the potential health and economic benefits of reducing population sitting time in Australia

BackgroundStrong evidence indicates that excessive time spent sitting (sedentary behaviour) is detrimentally associated with multiple chronic diseases. Sedentary behaviour is prevalent among adults in Australia and has increased during the COVID-19 pandemic. Estimating the potential health benefits and healthcare cost saving associated with reductions in population sitting time could be useful for the development of public health initiatives.MethodsA sedentary behaviour model was developed and incorporated into an existing proportional, multi-state, life table Markov model (ACE-Obesity Policy model). This model simulates the 2019 Australian population (age 18 years and above) and estimates the incidence, prevalence and mortality of five diseases associated with sedentary behaviour (type 2 diabetes, stroke, endometrial, breast and colorectal cancer). Key model inputs included population sitting time estimates from the Australian National Health Survey 2014–2015, healthcare cost data from the Australian Institute of Health and Welfare (2015) and relative risk estimates assessed by conducting literature reviews and meta-analyses. Scenario analyses estimated the potential change in disease incidence as a result of changes in population sitting time. This, in turn, resulted in estimated improvements in long term health outcomes (Health-adjusted life years (HALYs)) and healthcare cost-savings.ResultsAccording to the model, if all Australian adults sat no more than 4 h per day, the total HALYs gained would be approximately 17,211 with health care cost savings of approximately A$185 million over one year. Under a more feasible scenario, where sitting time was reduced in adults who sit 4 or more hours per day by approximately 36 min per person per day (based on the results of the Stand Up Victoria randomised controlled trial), potential HALYs gained were estimated to be 3,670 and healthcare cost saving could reach A$39 million over one year.ConclusionsExcessive sedentary time results in considerable population health burden in Australia. This paper describes the development of the first Australian sedentary behaviour model that can be used to predict the long term consequences of interventions targeted at reducing sedentary behaviour through reductions in sitting time. These estimates may be used by decision makers when prioritising healthcare resources and investing in preventative public health initiatives.

Access to Virtual Care: A New Social Determinant of Health

IntroductionThe novel COVID-19 illness has changed the world as we know it. The public health measures to contain the highly contagious virus mostly included social distancing, wearing a mask and hand hygiene. Our conventional daily routines adapted to accommodate for the need of the hour including the health care sector, hospital systems transformed their approach to provide timely and easy access to care for patients. However, challenges to provide standard of care were anticipated as neither the hospitals nor the patients were prepared initially for this sudden transition. Virtual care has seen tremendous growth in the United States since the pandemic started in 2020, and unprecedented progress has been made in the last year to provide patients virtual care that is well incorporated with their goals, accessibility and at the same time provide quality of care.We hypothesize that geographical areas which are limited in social resources or have higher income equalities will have higher telephone virtual visit or in person visits as compared to video visits, suggesting either lack of infrastructure or digital literacy in those areas. Lack of video visits can be a barrier to standard of care particularly in behavioral health.MethodsWe propose a de-identified retrospective study to analyze the visit type at all behavioral health outpatient clinics from January 2020 to most recent data available. Temporal trend of visit types based on demographics, geographical location, diagnoses and sub classification of virtual visit into telephone or video visit will be analyzed. Study has been approved by institutional IRB and currently is in data analysis phase.Aim 1: To study the impact of pandemic on temporal trend of outpatient visit subtypes (in person vs virtual) in behavioral health department.Aim 2: To study the impact of pandemic on temporal trend of outpatient video visits vs telephone visits in behavioral health department.Aim 3: Analyze demographics, location and diagnoses that may be affecting the virtual visits during the pandemic.ResultsCurrently the study is in data analysis phase and results will be availble in January 2022ConclusionsThis pandemic has highlighted the vulnerability of our communities and health care systems. Tan et al in their recent study showed that the income inequality within US counties was associated with more cases and deaths due to COVID-19 in the summer months of 2020.3 Relationship between race, income inequality and social resources are complex and implicated in predicting negative outcomes regarding COVID-19. Nearly 20% of U.S. counties are disproportionately black, and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally in 2020.4 With most healthcare system planning to incorporate virtual care as a standard of care, it is imperative that social determinants of health will impact access to virtual care in the imminent future and affect long term health outcomes. Additionally, access to virtual care have a complex relationship model with existing determinants but can also provide an opportunity to improve overall health by identifying limitations, populations and geographical areas which need higher level of awareness such as digital literacy or even perhaps infrastructure support to improve access to care.This research was funded byNone

Type 1 diabetes, cognitive ability and incidence of cardiovascular disease and death over 60years of follow-up time in men.

AimsThere are few cohorts of type 1 diabetes that follow individuals over more than half a century in terms of health outcomes. The aim of this study was to examine associations between type 1 diabetes, diagnosed before age 18, and long‐term morbidity and mortality, and to investigate whether cognitive ability plays a role in long‐term morbidity and mortality risk.MethodsIn a Swedish cohort, 120 men with type 1 diabetes and 469 without type 1 diabetes were followed between 18 and 77 years of age as regards morbidity and mortality outcomes, and impact of cognitive ability at military conscription for the outcomes. In Cox regression analyses and Kaplan‐Meier analyses with log‐rank tests, associations between diabetes and cognitive ability respectively, and outcomes (mortality, cardiovascular morbidity and diabetes complications) were investigated.ResultsMen with type 1 diabetes suffered from dramatically higher mortality (HR 4.62, 95% CI: 3.56–5.60), cardiovascular mortality (HR 5.60, 95% CI: 3.27–9.57), and cardiovascular events (HR 3.97, 95% CI: 2.79–5.64) compared to men without diabetes. Higher cognitive ability at military conscription was associated with lower mortality in men without diabetes, but was not associated with any outcome in men with diabetes.ConclusionsIn this historical cohort study with 60 years of follow‐up time and a less effective treatment of diabetes than today, mortality rates and cardiovascular outcomes were high for men with type 1 diabetes. Morbidity or mortality did not differ between those that had low to normal or high cognitive ability among men with type 1 diabetes.

Age and indication for pediatric septoplasty in the NSQIP-P database

IntroductionPediatric septoplasty has been a historically controversial topic in the field of otolaryngology. Past recommendations avoided reconstruction during development because of the potential for growth changes after intervention that may require later revision surgery. Recent studies have considered early operation to avoid further growth complications, pointing at changing trends in the field. MethodsA retrospective study was conducted using the ACS NSQIP-P database to identify patients under 18 years of age who underwent a septoplasty between 2012 and 2019. Cases were identified using CPT code 30520 for ‘septoplasty’ and grouped by primary procedure as follows: cleft lip repair, sinus surgery, rhinoplasty/reconstruction/other, and septoplasty as primary procedure. Variables of interest included patient demographics, comorbidities, perioperative risk factors and complications. Results2290 patients were included with a mean age of 14.2 years at time of surgery. Patients undergoing cleft lip repair were significantly younger than patients in the other procedure groups (mean age 9.3 years, p < .001), with 28% of the patients under 1 year of age. The most common comorbidity was congenital malformation (20.0%) followed by asthma (10.2%). Significantly longer total length of hospital stay was associated with younger age (p < .001), female gender (p = .007), and perioperative comorbidities (p < .001). 8 (0.3%) patients were readmitted within 30 days for reasons related to the primary septoplasty surgery and 15 patients (0.7%) had related reoperations within 30 days. ConclusionSeptoplasty is currently being performed on children of all ages. Children undergoing cleft lip repair account for the youngest demographic of pediatric septoplasty patients. General complications such as readmission and length of stay are more common in younger children undergoing septoplasty, however the number of readmissions and reoperations is relatively low. Further study is needed to describe the association between pediatric septoplasty and long term health outcomes.