Healthcare Visits Research Articles

Abstract B101: Bridging the gap between cancer care service delivery and the sexual and gender minority communities: a scoping review of the literature

Abstract Purpose: While there has been an increase in health equity research, there is scarcely research focusing on health equity for cancer survivors who identify as LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, Pansexual and Two-Spirit). This is in part the result of a lack of routine collection of SOGI (Sexual Orientation and Gender Identity) data within the LGBTQIA+ community. Our research aims to analyze and discuss how labelling and terminology have both influenced medical practice and posed barriers and delays in care to the LGBT community over time. Further, examining whether the literature supports increasing LGBT experiences in interprofessional training. By identifying these gaps in the literature and in interprofessional training we hope to decrease barriers to timely and supportive cancer services. Methods: To examine the breadth of research on the LGBTQIA+ community and cancer, a scoping review methodology was utilized to identify knowledge and research gaps. This review examines literature published in the U.S, in academic journals between 1913 and 2021 to gain a greater understanding of how historical contexts, policy, and research have evolved alongside the growing visibility of the LGBTQIA+ community. The authors used a scoping review strategy outlined by Arksey and O’Malley (2005) to review the literature employing a comprehensive list of search terms for cancer and LGBTQIA+. Rayyan software was then utilized to organize the data as our team hand-searched the articles for inclusion (cancer, LGBTQIA) and exclusion (non-US, foreign language, prevention, screening) criteria. A total of 3,290 articles were included in the final analysis. Findings: In 2011, a review of all articles on PubMed demonstrated only 0.3% of all publications pertained to LGBT health-related subject matters, and in a study conducted about U.S and Canadian medical education, research showed that medical students spent < 5 hours, on average, learning about LGBT discrimination and healthcare disparities. 70% of LGBT persons reported discrimination, refusal of care, bias, erroneous assumptions, and derogatory statements during healthcare visits in the United States. Conclusions: There is an urgent need for culturally competent interprofessional care, and we must challenge our approach by not only listening to the needs of the communities we serve but also by being receptive to their feedback. There is an unmet need for education to inform healthcare professionals, health social workers and their community partners of the unique experiences and needs of the LGBTQIA+ community. It is imperative that we use the recommendations and guidelines provided by the LGBTQIA+ cancer patient population to transform their healthcare experiences, improve patient-provider communication, and provide precision-supportive care. Citation Format: Brittany M. Hernandez, Sanford E. Jeames, Lailea Noel. Bridging the gap between cancer care service delivery and the sexual and gender minority communities: a scoping review of the literature [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B101.

Insomnia symptoms and postoperative healthcare utilization in veterans undergoing decompressive laminectomy for lumbar spinal stenosis.

Lumbar spinal stenosis is an age-related spine condition that contributes to pain and disability. Decompressive laminectomy (DL) is regularly performed to alleviate symptoms. Insomnia symptoms are common among people living with chronic pain and may affect key DL outcomes, such as healthcare utilization. We examined associations of insomnia symptom severity with post-DL healthcare utilization in veterans with lumbar spinal stenosis. Veterans (N = 200) with lumbar spinal stenosis undergoing DL were recruited into a prospective cohort study and self-reported insomnia symptom severity on the Insomnia Severity Index prior to DL. Post-DL, veterans reported on pain and non-pain-related monthly healthcare office visits, emergency room visits, hospitalizations, and mental health visits for 1 year. Incident rate ratios (IRRs) obtained via negative binomial regression evaluated associations of insomnia symptom severity with healthcare utilization rates. Approximately 51% of participants endorsed insomnia symptoms of at least mild severity. Participants who reported at least mild insomnia symptoms had more healthcare office visits (IRR = 1.23, p = .04), general mental health visits (IRR = 3.98, p < .0001), and pain-related mental health visits (IRR = 9.55, p = .01) than those without insomnia symptoms. Adjusting for covariates, rates of mental health visits, overall (IRR = 3.13, p = .001) and pain-related (IRR = 6.93, p = .02), remained statistically significantly higher. Insomnia symptoms are associated with postoperative healthcare utilization lending support for future work to examine the value of assessing and intervening on insomnia symptoms prelaminectomy.

Turnaround Time of Consults in a Primary Care System in Rural Philippines: A Descriptive Retrospective Cohort Study.

Turnaround time is an integral component of primary healthcare and is a key performance indicator of healthcare delivery. It is defined as the time patients spend during a healthcare facility visit. In this study, turnaround time is defined as the time elapsed from registration to the end of consultation. This study aimed to determine the turnaround time of consults in the primary care system in a rural site in the Philippines, and compare turnaround time during the pre-pandemic and COVID-19 pandemic periods. This is a retrospective cohort study of patients seen at the primary care facility under the Philippine Primary Care Studies (PPCS) rural site from April 2019 to March 2021. Patients included in this study were chosen through random sampling. Electronic medical records (EMR) of these patients were reviewed. Turnaround time was computed electronically from time of registration to end of consultation. Descriptive statistics was used to summarize data and report turnaround time. The turnaround time before and during the pandemic was compared using an independent sample t-test (if normally distributed) or Mann Whitney U test (if not normally distributed). A p-value of <0.05 was considered statistically significant. A random sample of 342 patients out of the total 45,501 patient consults seen at the rural primary healthcare facility from April 2019 to March 2021 were included in this study. The median turnaround time was 29.0 minutes (interquartile range [IQR] 68.3), with range of 0.9 to 437.2 minutes. During the pre-pandemic period, the median turnaround time of consults is 29.3 minutes (IQR 70.4) which is 1.8 minutes longer than the pandemic period which showed median turnaround time of 27.5 minutes (IQR 72.7). The difference between the two time periods was not statistically significant (P = 0.39). The study showed that the median turnaround time of medical consults was 29.0 minutes, which was shorter by 80 minutes compared to other published Philippine studies. The turnaround time did not differ significantly in the pandemic and pre-pandemic period, despite new policies and systems that were implemented during the pandemic.

Healthcare usage and expenditure among people with type 2 diabetes and/or hypertension in Cambodia: results from a cross-sectional survey

ObjectiveTo assess usage of public and private healthcare, related healthcare expenditure, and associated factors for people with type 2 diabetes (T2D) and/or hypertension (HTN) and for people without those conditions...

The Impact of Recreational Cannabis Legalization on Cannabis Use and Associated Outcomes: A Systematic Review.

Recreational cannabis legalization has become more prevalent over the past decade, increasing the need to understand its impact on downstream health-related outcomes. Although prior reviews have broadly summarized research on cannabis liberalization policies (including decriminalization and medical legalization), directed efforts are needed to synthesize the more recent research that focuses on recreational cannabis legalization specifically. Thus, the current review summarizes existing studies using longitudinal designs to evaluate impacts of recreational cannabis legalization on cannabis use and related outcomes. A comprehensive bibliographic search strategy revealed 61 studies published from 2016 to 2022 that met criteria for inclusion. The studies were predominantly from the United States (66.2%) and primarily utilized self-report data (for cannabis use and attitudes) or administrative data (for health-related, driving, and crime outcomes). Five main categories of outcomes were identified through the review: cannabis and other substance use, attitudes toward cannabis, health-care utilization, driving-related outcomes, and crime-related outcomes. The extant literature revealed mixed findings, including some evidence of negative consequences of legalization (such as increased young adult use, cannabis-related healthcare visits, and impaired driving) and some evidence for minimal impacts (such as little change in adolescent cannabis use rates, substance use rates, and mixed evidence for changes in cannabis-related attitudes). Overall, the existing literature reveals a number of negative consequences of legalization, although the findings are mixed and generally do not suggest large magnitude short-term impacts. The review highlights the need for more systematic investigation, particularly across a greater diversity of geographic regions.

Intrapartum oral azithromycin to prevent maternal and newborn sepsis or death: a multinational rct

Sepsis is among the top causes of maternal and newborn death worldwide. Based on promising data from 2 small trials, we tested the hypothesis that a single oral dose of azithromycin (AZI) given during labor in women planning a vaginal delivery would reduce maternal death or perinatal death or sepsis. Women in labor at ≥28 weeks’ gestation with a live fetus and planned vaginal delivery were randomized to either a single oral dose of 2g AZI or identical placebo at 8 sites in 7 low- and middle-income countries (LMICs). There were 2 primary outcomes: 1) a composite of maternal death or sepsis and 2) a composite of stillbirth or neonatal death or sepsis. Secondary outcomes included specific maternal infections, hospital readmission and unscheduled healthcare visits. A sample size of N=34,000 would provide up to 90% power to detect 20% reduction in each primary composite outcome assuming 2-sided alpha = 0.05, loss to follow-up = 2-3% and baseline rates of 3% (maternal outcome) and 6% (newborn outcome). During an interim analysis ( >70%), the Data Monitoring Committee recommended to stop the trial for benefit. A total of 29,278 participants were randomized; 14590 to AZI and 14688 to placebo and 99.6% followed to 42 days postpartum. Baseline characteristics were remarkably well-balanced between groups including overall from Africa (40%), Asia (55%) and Latin America (5%), nulliparous (43%), labor induction (18%) and high-risk i.e. labor ≥24 hours or membrane rupture ≥8 hours prior to randomization (8.6%). The maternal primary outcome (1.6% vs. 2.4%) and sepsis (1.5% vs. 2.3%) risks were lower in the AZI group; p-values < 0.005 (Table). The risks of maternal endometritis, wound infections, other infections, readmissions and unscheduled visits were also lower with AZI (Table). The risk of the newborn primary outcome (10.5% vs. 10.3%) did not differ by group (p=0.54). A single intrapartum oral dose of AZI reduced the risk of maternal death or sepsis, but not newborn death or sepsis in women in labor planning to deliver vaginally.

Identifying problematic opioid use in electronic health record data: Are we looking in the right place?

To examine the value of data obtained outside of regular healthcare visits (clinical communications) to detect problematic opioid use in electronic health records (EHRs). A retrospective cohort study. Chronic pain patient records in a large academic medical center. We compared evidence for problematic opioid use in (1) clinic notes, (2) clinical communications, and (3) full EHR data. We analyzed keyword counts and calculated concordance and Cohen's κ between data sources. Evidence of problematic opioid use in EHR defined as none, some, or high. Twenty-six percent of records were discordant in determination of problematic opioid use between clinical communications and clinic notes. Of these, 54 percent detected more evidence in clinical communications, and 46 percent in clinic notes. Compared to full EHR review, clinic notes exhibited higher concordance (78 percent; κ = 0.619) than clinical communications (60 percent; κ = 0.290). Clinical communications are a valuable addition to opioid EHR research.

Critical Appraisal of the Concept Frailty: Rating of Frailty in Elderly People has Weak Scientific Basis and should not be Used for Managing Individual Patients.

The concept frail elderly has been used to highlight the biological, rather than chronological, age. International and national bodies recommend that individuals over age 70 who visit healthcare facilities should be screened for frailty. There are important objections to the concept. Diagnostics: 'Frailty' is used for several completely different types of health problems. There are no useful biomarkers, but more than 60 different published rating methods for frailty, where different methods provide very different prevalence of frailty and also do not identify the same groups of elderly people. There is significant overlap between Clinical Frailty Scale- scores and activity of daily living (ADL)-scores. There is no gold standard method against which published frailty rating scales can be validated. It is unclear when, where and how often screening for frailty should occur in healthcare. Treatment: The evidence for treatment of frailty is very weak. A recent systematic overview found that the 21 included randomised, controlled studies (RCTs) were very heterogeneous as regards inclusion/exclusion criteria, how the condition of frailty was defined, what treatment was given and what health outcomes were assessed. In addition, there are often problems with the quality of the studies. The lack of a clear definition and evidence-based treatment of frailty means that it is inappropriate to introduce assessments of frailty in individual elderly patients in health care.

Association between medication regimen complexity and glycemic control among patients with type 2 diabetes

IntroductionType 2 diabetes mellitus (T2DM) and comorbid conditions require patients to take complex medication regimens. Greater regimen complexity has been associated with poorer T2DM management; however, the relationship between overall regimen complexity and glycemic control is unclear. ObjectivesOur objectives were: (1) to examine associations between regimen complexity (with the Medication Regimen Complexity Index [MRCI]) and glycemic control (A1C), and (2) to compare overall MRCI with other measures of regimen complexity (overall and diabetes-specific medication count) and diabetes-specific MRCI. MethodsThis was a secondary data analysis of cross-sectional data from a parent trial. Participants were patients with T2DM taking at least 3 chronic medications followed in safety net clinics in the Chicago area. The MRCI measures complexity based on dosing frequency, route of administration, and special instructions for prescribed medications. MRCI scores were created for overall regimens and diabetes-specific medications. Sociodemographics and outpatient visit utilization were included in models as covariates. Linear regression was used to examine the associations between variables of interest and hemoglobin A1C. ResultsParticipants (N = 432) had a mean age of 56.9 years, most were female (66.0%), and Hispanic or Latino (73.3%). Regimen complexity was high based on overall medications (mean = 6.6 medications, SD: 3.09) and MRCI (mean = 21.4, SD: 11.3). Higher diabetes-specific MRCI was associated with higher A1C in bivariate and multivariable models. In multivariable models, overall MRCI greater than 14, fewer outpatient health care visits, male gender, and absence of health insurance were independently associated with higher A1C. The variance in A1C explained by MRCI was higher compared to medication count for overall and diabetes-specific regimen complexity. ConclusionsMore complex regimens are associated with worse A1C and measuring complexity with MRCI may have advantages. Deprescribing, increasing insurance coverage, and promoting engagement in health care may improve A1C among underserved populations with complex regimens.

노인의 예방적 건강관리를 위한 방문건강관리사업 필요 전문인력 추계

Purpose: In countries with a large elderly population, the integrated visiting health care program for the elderly in communities was effective in preventing frailty and reducing medical expenses. Customized preventive health service is essential in a super-aged society. The purpose of this study is to estimate the number of professionals who perform visiting health care for the elderly. Methods: The statistics for the elderly from Statistics Korea and the Visiting Healthcare Performance Report from Korea Health Promotion Institute were employed in the analysis. The elderly were divided into four groups: healthy, pre-frailty, frailty I, and frailty II, according to their health level. Through the focus group interview, the ratio of nurses, physical activity experts, and nutritionists was set at 8:1:1. Results: Three scenarios were classified into minimum, medium, and maximum according to the number of visits. In the case of Seoul, the number of essential professionals was calculated at least from 719 to a maximum of 1,837. Conclusion: Since this study has a limitation in calculating visiting health care experts only by the ratio of nurses, physical activity experts, and nutritionists, future studies should consider experts or professionals in the field of social welfare, oral health, and visiting treatment.

Epistaxis and thrombocytopenia as major presentations of louse borne relapsing fever: Hospital-based study.

Louse-borne relapsing fever (LBRF) remains a cause of sporadic illness and occasional outbreaks in Ethiopia and other east African countries in overcrowded and unhygienic settings. In this article, we present clinical profiles and treatment outcome of patients treated as confirmed or probable cases of LBRF at Jimma Medical Center (JMC) in southwest Ethiopia. Patients treated as confirmed or probable cases of LBRF at JMC during a period of May-July 2022 were prospectively followed during their course of hospital stay. All patients were evaluated with blood film for hemoparasites, complete blood count, and liver enzymes on hospital presentation. They were followed with daily clinical evaluation during their hospital stay. Thirty-six patients were treated as cases of LBRF. All patients except one were from Jimma Main Prison in Jimma Town, Ethiopia. All the patients were male with mean age of 28.7 years (SD = 12.7). The diagnosis of LBRF was confirmed by detection of B. recurrentis in blood film of 14 (38.9%) of the patients; the rest were treated as presumptive case of LBRF. Fever, reported by all patients, and an acute onset epistaxis, 30 (83.3%), were the major reasons for healthcare visits. Twenty-two (61.1%) patients were having thrombocytopenia with a platelet count < 150,000/μL; nine (25%) of which had severe forms (<50,000/μL). All patients were treated with oral doxycycline and discharged with improvement after a mean length of hospital stay of 4.25 days (SD = 0.77), range 2-6 days. Public health emergency was activated within two days of the first cases and helped in delousing all the cases and their contacts. LBRF remains a public health problem in Ethiopia in settings with poor personal hygiene. Patients with LBRF may present with severe thrombocytopenia and life-threatening bleeding. Early detection and treatment initiation prevents outbreak propagation and improves treatment outcome.

The Importance of Differentiating Oligoarticular Juvenile Idiopathic Arthritis From Lyme Arthritis in Pediatric Patients.

Objective This study aims to compare clinical and laboratory features between Lyme arthritis (LA) and oligoarticular juvenile idiopathic arthritis (oligoarticular JIA) by examining several potential predictors in pediatric patients. This study also aims to improve and increase awareness of ways to detectLA and oligoarticular JIA in pediatric patients who present with clinical features of joint pain. Methods A medical chart review was conducted among pediatric patients diagnosed with LA or oligoarticular JIA at John R. Oishei Children's Hospital of Buffalo between January 2014 and September 2018. Patients' diagnoses were identified using the International Classification of Disease10th Revision code for LA (ICD 10 code A69.23) and oligoarticular JIA (ICD 10 code M08.40). Patients with LA were only included in this study if they (1) exhibited arthritis, (2) tested positive for Lyme antibodies, (3) indicated a positive western blot (WB) of five or more out of 10 Borrelia burgdorferi proteins by IgG antibodies or at least two of three B. burgdorferi proteins by IgM antibodies, and (4) at the age of 16 or below at the time of diagnosis. Patients with oligoarticular JIA were included in this study if they (1) exhibited arthritis affecting one to four joints for at least six weeks in the first six months of diagnosis and (2) are at the age of 16 or below at the time of diagnosis after ruling out LA and reactive arthritis. In this study, clinical presentations, physical exam findings during initial healthcare visits, and demographics including age, sex, and race of patients were obtained. In addition, laboratory results including white blood cells (WBCs), hemoglobin (Hgb), platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, Lyme antibodies through enzyme-linked immunosorbent assay (ELISA) and WB, synovial fluid analysis for red blood cells (RBCs), nucleated cells, and polymerase chain reaction (PCR) for B. burgdorferi DNA were also collected and analyzed. Results In our data, ESR and CRP were significantly higher in LA compared to oligoarticular JIA (P=0.0053 and 0.0005, respectively). The mean WBC in the synovial joint fluid was significantly higher in LA compared to oligoarticular JIA (P=0.002). Conclusion LA shares features with oligoarticular JIA. This overlap prevents the creation of a clinically useful predictive model for LA. Therefore, Lyme testing should be performed on all patients presenting with monoarticular and oligoarticular arthritis. In addition, ESR, CRP, and WBC in the synovial joint fluid were significantly higher in LA compared to oligoarticular JIA in our findings. While this difference is not definitive by any means, it may help distinguish between the two in cases where the diagnosis is not clear-cut, and the values of ESR, CRP, and WBC in the joint aspirate may help guide clinical judgment in cases that lack a definitive diagnosis.

FACTORS RELATED TO COMPLETE BASIC IMMUNIZATION BEHAVIOR IN THE WORKING AREA OF THE TALANG ULU HEALTH CENTER

The immunization coverage program is a program to improve public health in order to achieve the vision of an independent community for healthy living, one of the targets is to reduce infant mortality. Data on the number of UCI villages in the Talang Ulu Health Center is 71.4% of the 7 villages. This research was to determine the relationship between knowledge and the role of health workers with complete basic immunization behaviors. This research used a cross-sectional approach. The research sample was mothers who had children aged 10-12 months as many as 71 people. Samples were selected using a simple random sampling technique. The data was collected through interviews using questionnaires. The data that had been collected were analyzed univariately and bivariately with statistical tests of the Chi square test. Univariate results showed that 71.8% of respondents had incomplete basic immunization behaviors, 62% had poor knowledge and 71.8% stated that the role of health workers was not good. Bivariate results showed that there was a relationship between knowledge (p=0.034) and the role of health workers (p=0.000) with complete basic immunization behavior in the working area of the Talang Ulu Health Center in 2021. Variables related to complete basic immunization behavior were the knowledge and role of health workers. We recommend increasing the role as an educator through counseling or counseling activities about immunizations given when mothers visit health care places, so as to increase maternal knowledge about the importance of immunization in infants.

Recovering from COVID lockdowns: Routine public sector PHC services in South Africa, 2019 - 2021

In a previous article on the impact of COVID-19, the authors compared access to routine health services between 2019 and 2020. While differential by province, a number of services provided, as reflected in the District Health Information System (DHIS), were significantly affected by the pandemic. In this article we explore the extent to which the third and fourth waves affected routine services. To assess the extent to which waves 3 and 4 of the COVID-19 pandemic affected routine health services in South Africa, and whether there was any recovery in 2021. Data routinely collected via the DHIS in 2019, 2020 and 2021 were analysed to assess the impact of the COVID-19 pandemic and extent of recovery. While there was recovery in some indicators, such as number of children immunised and HIV tests, in many other areas, including primary healthcare visits, the 2019 numbers have yet to be reached - suggesting a slow recovery and continuing impact of the pandemic. The COVID-19 pandemic continued to affect routine health services in 2021 in a number of areas. There are signs of recovery to 2019 levels in some of the health indicators. However, the impact indicators of maternal and neonatal mortality continued to worsen in 2021, and if interventions are not urgently implemented, the country is unlikely to meet the Sustainable Development Goals targets.

Regional differences in patient-reported outcomes as a proxy of healthcare practices for Americans living with vestibular symptoms.

Geographical location is known to affect health outcomes; however, evidence regarding whether location affects healthcare for persons suspected to have vestibular dysfunction is lacking. To investigate whether location affects healthcare seeking and outcomes for adults with symptoms of vestibular pathology. We assessed for regional disparities associated with demographics, diagnosis, chronological factors, and financial expenditures from Americans who participated in the Vestibular Disorders Association registry (N = 905, 57.4±12.5 years, 82.7% female, 94.8% White, and 8.1% Hispanic or Latino). Respondents were grouped per geographical regions defined by the United States Census Bureau. There were no significant between-region differences for age (p = 0.10), sex (p = 0.78), or ethnicity (p = 0.24). There were more Asian respondents in the West versus the Midwest (p = 0.05) and more Black respondents in the South versus the West (p = 0.05). The time to first seek care was shorter in the Northeast (17.3 [SD = 49.5] weeks) versus the South (42.4 [SD = 83.7] weeks), p = 0.015. The time from the first healthcare visit to receiving a final diagnosis was shorter in the Northeast (46.5 [SD = 75.4] weeks) versus the South (68.9 [SD = 89.7] weeks), p = 0.015. Compared to the Midwest, fewer respondents in the Northeast reported "no" out-of-pocket financial impact, p = 0.039. Geographical location affects healthcare seeking and outcomes for persons suspected to have vestibular dysfunction.

2215. Pre-pregnancy STI Counseling and HIV Testing Among Married Women: PRAMS 2016-2019

Abstract Background Chlamydia, gonorrhea, and syphilis are one of the most reported and curable sexually transmitted infections (STIs) in the US, but rates continue to rise. STI during pregnancy can lead to perinatal infections. The best time to address this is at pre-conception. This study aims to examine health care visit practices among women before pregnancy and compare pre-pregnancy STI counseling and HIV testing rates among married women. Methods We utilized the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-2019, a population-based survey of postpartum women. Mothers self-reported if any health care worker talked to them about STIs or tested for HIV during any health care visit in the 12 months before pregnancy. Marital status was obtained from birth certificate records. Multivariable logistic regression analysis was performed adjusting for age, race, Hispanic ethnicity, education, insurance, income, and previous live birth. Results Of the the162,558 surveyed women, only 66.1% had any health care visit within 12 months pre-pregnancy (Figure1). Among those with a health care visit and STI screening response (n=104,256), approximately 70% of women reported never receiving pre-pregnancy STI counseling or HIV testing. Puerto Rico and D.C. had the highest pre-pregnancy screening rates while Utah had the lowest (Figure 2). Married women were less likely to receive pre-pregnancy STI counseling (OR 0.6: 95% CI 0.56, 0.64) or HIV testing (OR 0.65: 95% CI 0.61, 0.69) compared to unmarried women (Figure 3). Other risk factors for missing pre-pregnancy STI screening were older age, having more education, private insurance, higher income, and previous live birth. Black and Hispanic women were 2-3 times more likely to receive STI screening compared to White women. Figure 1:Any health care visit and visit type within 12 months before pregnancy (n=162,558)Figure 2:Pre-pregnancy STI counseling and HIV testing across 43 states, DC, NYC, and PR (n=104,256)Figure 3:Adjusted odds of receiving pre-pregnancy STI counseling and HIV testing among recent mothers, PRAMS 2016-2019 (n=104,256) Conclusion Married women were less likely to receive pre-pregnancy STI counseling and HIV testing. Our study highlights the lack of preconception care among women who recently gave birth. Marital status, demographics, and socioeconomic factors continue to affect a woman’s likelihood of receiving STI screening. Risk-based, selective STI screening creates gaps and missed opportunities to address STIs before pregnancy. Universal screening should be adopted for all women regardless of their preconceived risk or assumptions. Disclosures All Authors: No reported disclosures.

Newborn behavioral observations system in rural Pakistan: A feasibility and acceptability study.

The Newborn Behavioral Observations (NBO) system is a relationship-based tool that helps parents recognize their infant's competencies and learn their behavioral cues, with the goals of enhancing parental responsiveness and satisfaction in the infant-parent relationship. In our study, a pediatrician integrated the NBO into 44 pediatric health care visits of infants in rural Pakistan villages, under the remote guidance of two U.S.-based child psychiatrists. A clinician then gave the mothers a survey about their experience of the NBO and found that the mothers were highly satisfied, reporting greater appreciation of their infant's strengths, greater understanding of their infant's behavioral cues, stronger attachment to their infant, and greater self-confidence as a mother. In their consideration of these results, the authors explore cultural reasons for the mothers' responses and generate hypotheses to inform an outcome study of a similar intervention. This was a feasibility and acceptability study and was not randomized, had no control group, and did not use objective measures of outcome.

Adolescent Knowledge of When to Use Inhaled Asthma Medications: Implications for Management

PurposeIt is unclear how often adolescents with persistent asthma know when to use different inhaled medications (as-needed rescue vs. daily controller; ‘accurate use’), or whether this knowledge is associated with clinical asthma outcomes. This study aimed to characterize adolescent knowledge of accurate use; examine whether accurate use is associated with controller medication adherence, asthma symptoms, or exacerbations requiring acute health care services; and determine whether knowledge of accurate use improves following regular exposure to controller medications with school-based directly observed therapy (DOT). MethodsWe analyzed baseline and 7-month data from the School-Based Asthma Care for Teens trial. Adolescents (12–16 years) identified inhaled medications on a chart and stated when each is used. We compared accurate use with adolescent-reported adherence, recent symptoms, and asthma-related acute health care visits; and exposure to DOT. Analyses were limited to subjects with controller medication. ResultsOf 430 participants, 252 had controller medication at baseline. Knowledge of accurate use was described by 62%, and associated with adherence (odds ratio [OR]: 2.06, 95% confidence interval [CI]: 1.12–3.83). By 7 months, 313 adolescents had controller medication; 75% described accurate use, which was associated with adherence (OR: 3.46, 95% CI: 1.83–6.54), health care (OR: 0.39, 95% CI: 0.20–0.79), and DOT exposure (OR: 1.83, 95% CI: 1.10–3.32). Associations with adherence and health care at 7 months persisted in adjusted analyses. DiscussionAdolescent knowledge of accurate medication use was linked with greater adherence (baseline, 7 months), less acute health care (7 months), and exposure to in-school DOT. Interventions to support adolescents with persistent asthma should consider school-based care strategies and facilitate adolescent understanding of when to use different medications.

1352. Exploring spatial and temporal trends in the incidence of Lyme borreliosis in Finland using surveillance data, 2015 - 2020

Abstract Background Lyme borreliosis (LB) is a tick-borne zoonotic disease endemic in many European countries, including Finland. We describe the incidence, time trends and geographical distribution of LB in Finland for the period 2015–2020. The data generated can help inform public health policy, including prevention strategies. Methods We retrieved online available LB cases and incidence from two Finnish national databases. Microbiologically confirmed disseminated LB cases were identified from The National Infectious Disease Register (NIDR) and clinically diagnosed LB cases, from the National Register of Primary Health Care Visits (Avohilmo), with the total LB cases equal to the sum from these two sources. Both registers contain data from the entire country and by hospital districts (HDs) and municipalities. Total LB incidence was calculated as the sum of microbiologically confirmed and clinically diagnosed LB cases divided by the population size. Results A total of 33,185 LB cases were reported over the 2015-2020 period, of which 12,590 (38%) were microbiologically confirmed and 20,595 (62%), clinically diagnosed. The average annual national incidence for total, microbiologically confirmed and clinically diagnosed LB were, respectively, 99.6, 38.1, and 61.4 per 100,000 population. The overall LB incidence was highest in the south to southwestern coastal areas by the Baltic Sea and in eastern areas, with average annual incidences of 109.0 to 207.3/100,000. The Ahvenanmaa Island was a hyperendemic region with an average annual incidence of 2,473.9/100,000 and the only HD to report more microbiologically confirmed cases (69%) as compared to clinically diagnosed cases. The highest incidence rates were among persons aged over 60 years, peaking at age 70–74 years. Below 40 years, the highest incidence rates were observed among 5-9-year-olds. Most cases were reported between May and October, with a peak in July and August. Average annual incidence (per 100,000 residents) by the Finnish hospital districts (HD) from 2015-2020. A) Clinically diagnosed LB; B) Microbiologically confirmed LB; C) Both combined, clinically diagnosed, and microbiologically confirmed LB. Conclusion The incidence of LB in Finland is among the highest in Europe but varied substantially by HD and many regions reported incidence much higher than the national average. These regions also corresponded to high population density areas, suggesting preventive measures such as vaccines may be an efficient use of resources. Disclosures Jozica Skufca, Epidemiologist, p95: Paid by Pfizer to perform the study Nick DeSmedt, Masters in Computer Engineering, P95: P95 was paid by Pfizer to perform the study Andreas Pilz, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds|Pfizer: Stocks/Bonds Andrew Vyse, Ph.D., Pfizer: Stocks/Bonds Elizabeth Begier, M.D., M.P.H., Pfizer: Employee|Pfizer: Stocks/Bonds Margarita Riera, MD, MPH, P95: Paid by Pfizer to perform the study Maxim Blum, Ph.D., P95: Paid by Pfizer to perform the study Bradford Gessner, MD, MPH, Pfizer: Stocks/Bonds James Stark, Ph.D., Pfizer: Stocks/Bonds.

1463. Association between Herpes Simplex Virus Type 1 and the Risk of Alzheimer’s Disease

Abstract Background There is significant unmet need of novel therapeutics for Alzheimer’s Disease (AD). A growing body of evidence suggests a role for herpesviruses in the development of AD and reduced risk of AD among patients receiving antivirals. We investigated the association between herpes simplex virus type 1 (HSV-1) diagnoses, antiviral use, and AD using real-world data. Methods In a matched case-control study, AD patients aged ≥ 50 years diagnosed between 2006 and 2021 were identified from IQVIA PharMetrics Plus® claims database using International Classification of Disease (ICD) codes (ICD 9 331.0; ICD 10 G30.x). Controls without any history of neurological disorders were matched in a 1:1 ratio with AD subjects on age, sex, region, database entry year, and healthcare visit numbers. HSV-1 diagnoses were identified using relevant ICD codes. Conditional logistic regression was used to evaluate the association between HSV-1 and AD. The association between antiviral use (e.g., acyclovir, famciclovir, valacyclovir) and AD was assessed by multivariate Cox proportional hazards model in patients with HSV-1 diagnosis. Results The study included 344,628 AD patient-control pairs. Most patients were female (65%) with a mean age of 73 (± 5) years. AD patients had more comorbidities (50% vs. 45% with ≥ 2 comorbidities) and shorter follow up time (median of 33 vs. 48 months) when compared to controls. History of HSV-1 diagnosis was present in 1507 (0.44%) AD patients vs. 823 (0.24%) controls. HSV-1 diagnosis was associated with AD (adjusted odds ratio [OR] 1.80; 95% confidence interval [CI] 1.65-1.96). In a stratified analysis, this association was more pronounced in the older age group (75+ years: OR 2.10, 95% CI 1.88-2.35; 71-74 years: OR 1.51, 95% CI 1.27-1.80; 50-70 years: OR 1.14, 95% CI 0.91-1.44). Patients with HSV-1 who used antivirals were less likely to have AD compared to those who did not use antivirals (adjusted hazard ratio 0.83, 95% CI 0.74-0.92). Similar results were observed when the analysis was extended to include all patients with AD-related dementia and matched controls. The association between herpes simplex virus type 1 (HSV-1) and Alzheimer’s Disease (AD)/AD-related Dementia(ADRD) Conclusion Findings from this large real-world data study is consistent with emerging literature on HSV-1 and risk of AD and the possible protective role of antiviral drugs. Disclosures Luke Liu, PhD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds Christine Johnston, MD, MPH, AbbVie: Advisor/Consultant|Gilead: Grant/Research Support|GSK: Advisor/Consultant Simon P. Fletcher, PhD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds Shahed Iqbal, PhD, MBBS, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds.