Health Status Research Articles

UK Medical Cannabis Registry: a cohort study of patients prescribed cannabis-based oils and dried flower for generalised anxiety disorder

ABSTRACT Background Generalized anxiety disorder (GAD) is a common mental health condition. The endocannabinoid system has become a focus for new therapies, increasing interest in cannabis-based medicinal products (CBMPs). This study uses data from the UK Medical Cannabis Registry (UKMCR) to investigate real-world outcomes and safety of different CBMP formulations in GAD patients. Methods This study analyzed patient-reported outcomes from 302 GAD patients prescribed CBMPs (oil-based, dried flower, or a combination). Anxiety (GAD-7), sleep quality (SQS), and quality of life (EQ-5D-5 L) were assessed at 1, 3, 6, and 12 months. Adverse events were recorded. Results All CBMP formulations were associated with improvements in anxiety, sleep, and quality of life over 12 months (p < 0.050). At 12 months, there were no significant differences in outcomes between formulations (p > 0.050). The majority of reported adverse events (n = 707) were mild (n = 343) or moderate (n = 285) in severity, with no life-threatening events observed. Conclusion This study provides real-world evidence supporting the potential of CBMPs for improving GAD symptoms. Patients prescribed both oil-based and dried flower formulations have similar outcomes over 12 months. Further research is needed to determine the optimal CBMP formulation and long-term effects.

Healthcare costs and resource utilization of patients with chronic post-traumatic stress disorder: a retrospective US claims analysis of commercially insured patients.

Aim: Exploring the healthcare costs and resource use among privately insured US patients with post-traumatic stress disorder (PTSD). Methods: This study used Merative MarketScan data. The index date was defined as the first PTSD claim. Study period included a 1-year pre-index and 2-year post-index follow-up. Cases with only acute PTSD, cancer, or insurance gap during the study period were excluded. The PTSD with (PwC) and PTSD without comorbidities (PwoC) cohorts were defined by the presence/absence of comorbid mental health conditions (schizophrenia, bipolar and major depressive disorder). Baseline PTSD (BP) cohort included PwoC cases with only index PTSD event and without FDA-approved PTSD medications or psychotherapy. Sub-analysis is conducted among patients with PTSD and substance/alcohol use disorder. Study cohorts were matched in a 1:1:1 ratio. Results: The matched sample included 5076 patients (1681 PwC, 1681 PwoC, 1714 BP). PwC patients had higher 2-year PTSD-related costs than PwoC and BP patients ($3762 vs $1750 and $841; all p<0.001). The same trend was noted among all-cause and anxiety-related costs. PwC patients had higher 2-year PTSD-related inpatient and emergency department (ED) rates than PwoC (10.2% vs 1.7% and 6.8% vs 2.6%, all p<0.001) and inpatient and outpatient rates than BP (10.2% vs 2.1% and 98.0% vs 93.1%; all p≤0.004). The sub-analysis had 3776 patients (3154 PwC, 537 PwoC, 85 BP). PwC had higher 2-year PTSD-related costs than PwoC and BP ($7668 vs $2919 and $1,483; all p<0.001). The same trend was noted in all-cause and anxiety-related costs. PwC also had higher 2-year PTSD-related inpatient and ED rates than PwoC (25.6% vs 10.4% and 12.7% vs 5.2%; all p<0.001) and inpatient and outpatient rates than BP (25.6% vs 8.2% and 95.5% vs 84.7%; all p<0.001). Conclusion: PTSD is associated with high healthcare costs and resource use. The highest economic burden was observed in patients with PTSD and mental health comorbidities.

Stacked ensemble machine learning approach for electroencephalography based major depressive disorder classification using temporal statistics

Major depressive disorder (MDD) is a serious and widespread mental health condition that remains challenging to diagnose accurately. Traditional psychological assessments, which can be subjective and sometimes unreliable, emphasize the need for more objective diagnostic tools. In this study, we present a machine learning (ML) model designed to diagnose depression by analysing statistical time-domain features extracted from Electroencephalography (EEG) data. The model is built using a stacked ensemble ML approach, incorporating nine-base estimators with various meta-classifiers. Through multiple trials, the model achieved an accuracy of 98.01%, with precision and recall rates of 97.78% and 96.61%, respectively with Adaptive Boosting (AdaBoost) as the meta-classifer. We also investigated the effects of data sampling and the number of base classifiers on the model’s performance. The findings demonstrate that the stacked ensemble approach significantly enhances the accuracy of diagnosing MDD and that the proposed model outperforms the methods used in previous studies. This model offers a promising tool for psychologists and medical professionals to diagnose depression more reliably, potentially leading to better treatment outcomes for those affected by the disorder.

Nutrition Training in Medical Education Among Family Medicine Residents in North Carolina

Background This study surveyed family medicine residents in North Carolina regarding the state of nutrition education in their residency training. In addition, the survey explored comfort levels with, and attitudes about, discussing nutrition with patients. Methods We administered an online questionnaire to family medicine residents in North Carolina (n = 384) asking about their history of nutrition training and their current attitudes about nutrition. The 24-item survey included both Yes and No and Likert-scale responses. Results All but one resident had received formal or informal nutrition training during their medical education. Residents overwhelmingly considered nutrition to be an important component of health care, although a majority felt physicians are inadequately trained in nutrition. Feeling comfortable discussing nutrition with patients regarding specific health conditions varied from 45% (gastrointestinal concerns) to 94% (cardiovascular disease) or 95% (diabetes) among residents. Limitations The volunteer sampling method used in the study may limit generalizability of the study findings to a broader population of family medicine residents. In addition, precisely defining “formal” and “informal” nutrition training on the survey questionnaire would help to clarify the role of nutrition education in shaping resident attitudes and practices. Conclusion This study shows that family medicine residents recognize the importance of nutrition education but do not feel adequately trained to provide it to patients. Given the abundance of evidence linking nutrition and health as well as an apparent interest among family medicine residents in nutrition education, this study supports the integration of nutrition training in medical education. Suggestions for how to accomplish this objective are provided.

Abstract 4143258: Sex Differences in Health Status Outcomes: Analysis of the ISCHEMIA Randomized Clinical Trial

Background: Despite a lesser extent and severity of coronary artery disease (CAD), women had a higher burden of angina than men in the ISCHEMIA trial, suggesting that other factors may explain symptom severity in women. We aim to describe demographic and clinical characteristics, as well as differences in care patterns, associated with health status differences in women, as compared with men, in the conservative and invasive treatment groups of the ISCHEMIA trial. Methods: The ISCHEMIA trial randomized participants with moderate or severe ischemia to a routine invasive strategy of cardiac catheterization with complete revascularization plus guideline-directed medical therapy (GDMT), or an initial conservative strategy of GDMT alone with catheterization reserved for GDMT failure. Health status was a key secondary outcome. Using linear regression models we compared raw and adjusted Seattle Angina Questionnaire (SAQ) scores in women and men at baseline and at 1 year, stratified by randomized treatment strategy. Within the invasive strategy, sex differences were adjusted for completeness of revascularization among those with ≥1 coronary stenosis ≥70%. Results: Of 4,617 ISCHEMIA participants with valid SAQ data, women had lower (worse) baseline SAQ summary scores (SS) throughout follow up (Figure) after adjustment for demographics and clinical characteristics, including severity of CAD (difference 5.4 points, 95% CI 4.0-6.7). Women had lower SAQ SS after adjustment for post-randomization treatment (i.e., medical therapy, achievement of risk factor goals and, in the invasive strategy, complete revascularization), 2.4 points lower (95% CI 0.7-4.1) in the conservative group (Figure), and 1.9 points lower than in men (95% CI 0.1-3.7) in the invasive group. Findings were similar for all SAQ subscales. Conclusions: Women with chronic coronary disease in ISCHEMIA had worse health status than men at baseline and 1 year later, which was not explained by demographic or clinical characteristics, intensity of medical therapy, or completeness of revascularization.

Health profiling of conscripts from the Orenburg region drafted to serve in the Armed Forces of Russia

Relevance. Amid international unrest, Russia’s top priority is to augment its defense capacities. The President of Russia decided to increase the army and navy corps by 30 %. To fulfill this task, physically strong and healthy conscripts are required to man the military units.The objective is to analyze medical examination data of drafted young men aged 17 to assess the health profile of conscripts from the Orenburg region.Methods. The study relied on Rosstat statistics for the Orenburg region, as well as reports and records of the Military Medical Expertise Center at the Federal Budgetary Institution “Military Commissariat of the Orenburg Region” collected over a decade’s timespan from 2014 to 2023. Conscripts were split into the following categories labelled by letters of the Russian alphabet: ‘A’ for fit for military service, ‘B’ for fit for military service with minor restrictions, ‘V’ for fit for military service with limitations, ‘G’ for temporarily unfit for military service, ‘D’ for unfit for military service. In addition, conjoined analysis of A &amp; B categories of conscripts fit for military service vs V &amp; D ‘unfit or fit for military service with limitations’ was performed for peace-time settings. The incidence of diseases in conscripts was correlated with relevant chapters of the International Classification of Diseases and Behavioral Disorders (ICD-10); calculations per 1000 conscripts (‰) were carried out. The obtained dynamics across different indicators was studied using dynamic series analysis and second-order polynomial trend; the determination coefficient was calculated as well.Results and discussion. Within the last decade, the number of conscripts in the Orenburg region has not shown any sig nificant dynamics and is likely to remain unchanged in the coming years. The results showed that every 1,000 of examined conscripts included 761 those who were fit for military service, 98 needed treatment or rehabilitation, and 141 were unfit or fit with limitations. The annual disease incidence rate among B &amp; D category conscripts was (141.6 ± 2.6) ‰, standing for 14.1% of all the examined conscripts. In terms of significance, rank 1 was assigned to musculoskeletal and connective tissue (ICD-10, Chapter XIII), rank 2 to mental and behavioral disorders (Chapter V), rank 3 to circulatory diseases (Chapter IX), rank 4 to diseases of the eye and adnexa (Chapter VII), rank 5 to nervous system disorders (Chapter VI). Among all military service exemption causes in conscripts, cumulative specific contribution of these diseases was 61.9%. In 2014-2023, the average of 8.3% of conscripts needed conservative treatment, with treatment provided to 87.1% of those in need of treatment; 1.5% needed surgical treatment (treatment received by 79.4%) and 48.3% needed oral cavity sanitation (79.4% treated accordingly). Conscripts with eye-sight disorders underwent vision correction.Conclusion. Follow-up observation, medical and healthcare initiatives, and extensive promotion of healthy lifestyles allowed to improve the conscripts’ health status. The undertaken measures increased in the overall fitness for military service, allowing to sustainably deliver on Russia’s conscription demands.

Abstract 4122763: Health Status Outcomes of Antianginal Therapies in Patients After Coronary Revascularization: Insights From the GREAT Disease Registry Study

Background: The impact of antianginal therapies on the health status of coronary artery disease (CAD) patients who have undergone coronary revascularization has not been extensively researched. This study aimed to investigate the effect of nicorandil on the health status in patients after coronary revascularization, measured by the Seattle Angina Questionnaire (SAQ). Methods: We analyzed data from 1,556 patients enrolled in the GREAT Disease Registry Study (Clinicaltrial No. NCT05050773) between September 2021 and May 2022. Changes in SAQ summary score (SAQ-SS) from baseline to 3, 6, 9, and 12 months were assessed. Statistical methods included a linear mixed-effects model and propensity score matching (PSM) for comparative analysis. Results: Among the 1,038 patients receiving revascularization analyzed (22.7% female; mean age [SD], 59.9 [10.2] years), 648 (62.4%) received nicorandil, while 390 (37.6%) did not. In the linear mixed-effects model analysis, statistically significant improvements were observed with nicorandil in SAQ-SS across all time points ( Table 1 ), indicating beneficial effects of nicorandil on health status outcomes after revascularization. Sensitive analysis was conducted using the PSM method. After PSM adjustment, both groups comprised 321 patients each. The change in SAQ-SS from baseline to 12 months was significantly greater in the nicorandil group (19.2 ± 14.06 points) compared to the non-nicorandil group (14.91 ± 12.9 points, p &lt; 0.001). Conclusions: These findings indicated that nicorandil is associated with improved health status outcomes in CAD patients who have undergone coronary revascularization.

Associations between community social capital and posttraumatic growth among older survivors 11 years after a natural disaster.

We prospectively examined whether community-level social capital plays a significant role in developing Posttraumatic Growth (PTG) among older survivors of the 2011 Japan Earthquake and Tsunami. The baseline survey was conducted 7 months before the disaster among residents of a city located 80km west of the earthquake epicenter. The survey inquired about participants' health status and social capital (informal socializing and social participation, and social cohesion). Approximately 2.5 years after the disaster, we surveyed older survivors to assess their disaster experiences. A follow-up survey in 2022 inquired about PTG in the 11 years following experiences of the disaster (n = 1,819). Multilevel linear regression analysis showed that pre-disaster community-level informal socializing and social participation was associated with higher PTG scores (coefficient = 0.25, 95% CI: 0.02, 0.47). In cross-classified multilevel regression, maintenance of higher community-level informal socializing and social participation during the post-disaster period was associated with higher scores of PTG (coefficient = 0.22, 95% CI: 0.07, 0.37). Pre-disaster community-level informal socializing and social participation was associated with higher PTG scores among older survivors. Interventions encouraging social interactions among neighbors may be effective in promoting PTG of survivors after natural disasters.

Clinical effectiveness of picture exchange communication system (PECS) on 5- to 7-year-old children's oral health.

To assess the impact of the picture exchange communication system (PECS) on oral hygiene motivation and practices in healthy children aged five to sevenyears. A total of 160 healthy children aged five to seven years were included in this study. At the first visit, the participants' guardians were asked to answer a questionnaire focussing on the sociodemographic, and the oral hygiene habits of the participants. All participants received a clinical examination to assess their dental caries experience using the ICDAS score, gingival condition using the gingival index (GI), and the amount of accumulated dental plaque using the Turesky Modification of the Quigley-Hein Plaque Index (TQHI), followed by comprehensive explanation of the proper oral hygiene protocol. The participants were randomly divided into two equal groups; the PECS group and the control group. The participants were re-assessed after 6months. The collected data were statistically analysed using the Statistical Package for Social Sciences (SPSS) software version 23 at a p-value ≤ 0.05. By the end of the follow-up period, the PECS group reported significantly greater adherence to regular tooth brushing (p = 0.006) with a frequency higher than twice per day (p < 0.000) and no need for parental motivation (p < 0.001), and had significantly lower mean GI and TQHI scores (p < 0.000). Most of the participants' guardians reported that the PECS cards were useful for use and that they would continue to use them 66/76 (86%). The PECS was found to be effective in motivating children to adhere to proper tooth-brushing practices, as reflected by improvements in their oral health status and gingival condition.

Abstract 4128962: Medicaid Work Requirements and Changes in Insurance Coverage, Employment, Access to Care, and Health Status Overall and Among People with Cardiovascular Disease

Introduction: Medicaid work requirements have been at the forefront of health policy debate. Proponents argue that these policies increase employment, reduce poverty, and improve health. Critics have raised concerns that work requirements lead to loss of coverage and impede access to care. Hypothesis: We hypothesized that Medicaid work requirement implementation would be associated with decreased insurance coverage and healthcare access without impacting employment. Methods: We used the Behavioral Risk Factor Surveillance System (a nationally representative survey administered by the CDC) to estimate the impact of Medicaid work requirements on insurance coverage, employment, access to care, and self-reported health. We used a difference-in-differences (DID) approach to compare changes in outcomes in Arkansas (where work requirements were implemented) versus control states. Outcomes were self-reported and included: 1) insurance coverage, 2) employment, 3) presence of a personal healthcare provider, 4) inability to see a doctor due to cost, and 5) self-reported health. The analysis was conducted among all respondents and among respondents with cardiovascular disease, who were hypothesized to be particularly vulnerable to negative sequelae of insurance loss. Results: The implementation of Medicaid work requirements in Arkansas was associated with decreased insurance coverage compared with control states (adjusted DID estimate -4.3%, CI -8.4%, -0.1%), but no increase in employment rates (-2.2% CI -7.0%, 2.6%). There was a trend toward decreased likelihood of having a personal healthcare provider (-4.7% CI -9.9%, 0.5%). There was no change in inability to see a doctor due to cost or self-reported good health. When this analysis was repeated among participants with cardiovascular disease, work requirement implementation was not associated with changes in any of the outcome variables. Conclusions: The implementation of Medicaid work requirements in Arkansas was associated with decreased insurance coverage and no change in employment. Our findings are particularly relevant given national policy debate about work requirement expansion and the recent implementation of Medicaid work requirements in Georgia. Despite the null findings among respondents with cardiovascular disease (likely the result of a small sample size), this study has important implications for cardiovascular health given the close association between insurance coverage and cardiovascular outcomes.

Effect of nutrition on the nutritional status in preterm infants with very low birth weight

Introduction. Postnatal growth retardation in premature infants with very low birth weight (VLBW) remains an unresolved problem. There are different approaches regarding the duration of use of breast milk fortifiers during breastfeeding and specialized formulas during formula feeding, as well as the timing of the appointment of complementary feeding. Objective: to evaluate the physical development and component body composition in VLBW infants, depending on nutritional support over the first year of life. Materials and methods. The study included ninety three VLBW premature infants of 2 to 11 months postnatal age (PNA). The main (1st) group included infants (n = 74) who received dietary correction depending on the nutritional status, while no such intervention was performed in the (2nd) comparison group (n = 19). Up to 64 weeks of postconceptional age (PCA), weight, body length, and head circumference were assessed using INTERGROWTH-21st international growth standards, then in the software “WHO Anthro (2009)”. Fat and fat-free (lean) mass were determined using the air plethysmography method (PEA POD, LMi, USA). Results. The analysis of the nutritional status revealed a moderate deviation, not exceeding 1 sigma, decrease in indices (Z-scores) of anthropometric indices in infants of the 1st and 2nd groups by PNA of 2–3 months. Further in infants of the 1st group on the background of prolonged use of fortified nutrition (breast milk fortifier or specialized formulas for preterm infants) and timely introduction of complementary foods, nutritional deficiencies throughout the first year of life in general were not revealed. In the 2nd group of infants without additional correction of nutrition by 4–5 months of age, the development of mild nutritional deficiency was noted by 6–7 months of age. By 6–7 months of age, it turned into moderate nutritional deficiency, which persisted until 8–9 months of age and then turned into mild nutritional deficiency. Analysis of the component body composition showed that during the observation period, the fat-free body mass (FFM) gain in infants in the 1st group was 3.40 kg, in Group 2 infants — 2.2 kg. At the same time, % body fat mass (FM) in infants in groups 1 and 2 had no significant differences (%FM 1 = 19.3 [15.3–22.5], %FM 2 = 19.9 [16.7–24.6], p = 0.769) and did not exceed the values characteristic of preterm infants. Conclusion. A comprehensive assessment of the nutritional status of VLBW infants during the first year of life allowed us to eva­luate the positive impact of long-term use of fortified diets and timely introduction of certain complementary foods. Optimization of nutrition made it possible to prevent the development of nutritional deficiency, which can have a significant positive impact on their further growth, development, and health status.

ICF based comparison of musculoskeletal health in regions of Poland and Spain.

The International Classification of Functioning, Disability and Health (ICF) is the framework for describing disability. The aim of the study was to compare differences in health status between the populations of the Podkarpackie region of Poland and the Castilla y León region of Spain, using the ICF core set for post-acute musculoskeletal conditions. A total of 840 people were included in the study. The brief version of ICF core set for post-acute musculoskeletal conditions was used in the study. Information obtained from semi-structured interviews and a physiotherapy assessment was recoded into ICF qualifiers to obtain comparable data. Significant differences in functioning were found between the two samples, with a higher prevalence in all the ICF entities for the Spanish sample. Similarities were found in the ICF components 'Body Functions' and 'Environmental Factors', with the most prevalent ICF entities being 'b280 Sensation of pain' and 'e225 Climate' respectively. For 'Activities and Participation', differences were observed, with 'd430 Lifting and carrying objects' being the most common for the Spanish sample and 'd450 Walking' for the Polish sample. Significant differences were found between the two samples, indicating better musculoskeletal health in the Polish sample. Future research using the ICF Core Sets in practice should be expanded and carried out in other countries to improve the ability to make comparisons between populations and to develop policies for territorial equity in health.Trial registration: NCT06283407.

Association Between Daily Internet Use and Intrinsic Capacity Among Middle-Aged and Older Adults in China: Large Prospective Cohort Study.

Intrinsic capacity (IC), as a comprehensive measure of an individual's functional ability, has gained prominence in the framework for healthy aging introduced by the World Health Organization (WHO). As internet usage continues to integrate into daily life, it is imperative to scrutinize the association between internet use and IC to effectively promote healthy aging among the middle-aged and older population. This study aimed to investigate whether daily internet use in middle-aged and older adults delays or accelerates the decline in IC. Participants included in the China Health and Retirement Longitudinal Study (CHARLS) comprised individuals aged ≥45 years residing in China. We analyzed 4 years of CHARLS data from the first wave (May 2011-March 2012) to the third wave (July 2015-January 2016). Data from the first and third waves were used for longitudinal studies. Self-reported data encompassed internet use, frequency of use, and demographic baseline characteristics. In addition, the IC evaluation involved physical examination and blood test data. Initially, linear regression was used to assess the relationship between daily internet use and IC, followed by regression splines to explore potential nonlinear associations. Subgroup and sensitivity analyses were used to investigate the heterogeneity of IC in specific conditions and the robustness of our results. Mediation effect analysis was conducted to identify the factors that mediate the relationship between daily internet use and IC, focusing on social participation, physical activity, and health status. Among the 12,826 participants included in the longitudinal analyses, 12,305 (95.9%) did not use the internet, while 521 (4.1%) reported daily internet use with a mean age of 52.62 (SD 7.67) years. After adjusting for demographic variables, socioeconomic factors, lifestyle behaviors, and health conditions and examining the impact of daily internet use and frequency on changes in IC, our findings indicated important associations. Specifically, daily internet use is significantly linked to a slower decline in IC over time (marginal effect 1.58, 95% CI 1.03-2.12; P<.001). Individuals with moderate and regular internet use frequency exhibit higher levels of maintenance in IC (marginal effect 0.74, 95% CI 0.45-1.03, P<.001). In addition, the relationship between IC changes and internet use frequency demonstrated a nonlinear inverted U-shaped curve (nonlinear P=.003). Subgroup analysis further revealed that improvements in IC vary based on age and gender. Furthermore, mediation analysis denoted that more than 28.78% (95% CI 21.24-40.33) of the observed association is mediated by social participation (P<.001). The findings of our research underscore the potential benefits of consistent and moderate internet use in promoting and preserving IC, particularly in cognitive capacity, sensory, vitality, and locomotion. The observed effects may be related to social participation. These insights offer valuable guidance for crafting strategies aimed at fostering healthy aging within the middle-aged and older adult demographics.

Evaluation of a driving clinical decision pathway for generalist occupational therapists: Pilot test of practice change

Background Few evidence-based resources exist to support generalist occupational therapists address driving in practice. This pilot study aimed to evaluate whether a driving clinical decision pathway can assist generalist occupational therapists to address driving with clients. Methods Using a before (Timepoint-1) and after (Timepoint-2) design, data were collected at a multi-site outpatient community rehabilitation service. Medical record audits documenting how driving was addressed in practice and descriptive surveys of therapist’s perceptions of pathway use were collected at Timepoints 1 and 2. A driving clinical decision pathway was implemented over 6 months. Descriptive statistics and content analysis were used to analyse and compare data over time. Results Timepoint-1 data from 102 client medical records, and 13 clinician surveys were compared against Timepoint-2 data from 144 records and 8 surveys. Following implementation of the pathway, the number of assessments used by generalist occupational therapists increased three-fold, to inform driving process recommendations which increased two-fold. Clinicians’ self-reported knowledge, skills and confidence also increased two-fold. Conclusion A comprehensive driving clinical decision pathway provided clinicians with increased structure and support to guide practice change and promote role fulfilment in addressing return to driving with adults following a change in health status.

Abstract 4138593: Sex-, Age-and Racial- specific disparities, echocardiographic myocardial mechanics and biomarkers, and 1-year survival among patients with heart failure.

Background: Heart failure with reduced ejection fraction (HFrEF) is a global health burden affecting millions worldwide, particularly among resource constrained communities. Information is limited regarding addative prognostic relations of sex -, age- and racial- differences, myocardial mechanics and biomarkers, in HFrEF. Aim: Assess prognostic implications of sex-, age- and racial- related disparity in HFrEF; and additive prognostic implications of these parameters to other markers including echocardiography (myocardial mechanics). Methodology: The HFrEF patients’ data were prospectively evaluated during the initial assessment and those hospitalized, and subseguently followed for at least 12months. Patients' KCCQ and EQ-5D-5L Questionnaires were assessed during the initial evaluation and follow-up. Sex, age and racial/ethnic disparities, in-hospital management, follow-ups, health status and 1year mortality were assessed. These parameters were further assessed in addition to biomakers and echocardiographic parameters including LV and RV systolic and distolic strain. Multivariable Cox regression models were fitted to investigate additive prognostic differences. Results: The study population consisted mainly of blacks and major factors were hypertension, diabetes, mitral valve disease, and older age (p&lt;0.0001). Of the initial 2642 screened, only 1883 completed the 1year follow-up visit (mean LVEF 38%). Women were likely to have hypertension, atrial fibrillation and diabetes (p&lt;.001). Rheumatic or valvular heart diseases were more commonly identified among younger, black ethnicity, and males patients. No demonstrated sex differences in functional class and biomarkers including NT-proBNP levels. Men demonstrated significant risk for one-year mortality than women, as was black ethnicity and older age. Impaired strain parameters (RV&gt;LV systolic) were independent risk factors for poor survival, more so when added to sex, racial ethnicity, age and biomarkers i.e. the NT-proBNP levels. Conclusion: The prevalence of HFrEF was higher than anticipated. Men, black ethnicity and older age were associated with a high one-year mortality. Impaired strain (RV&gt;LV systolic) parameters were independent risk factors for poor survival, with additive prognostic implications to sex, racial ethnicity, age and traditional biomarkers. These parameters should be assessed routunely to risk stratify HFrEF patients earlier during their disease course.

Inequalities and Differences in Health Status of Pre- and Perinatal Periods in Hungarian Long-Term Series Analysis (1997–2019)

Objectives: The main goal of this study is to publish findings on the lifestyle factors of pregnant women in Hungary and their impact on early childhood health status by examining changes over time and regional/geographical disparities. Methods: The source of the data is the raw indicators reported by health visitors as per mandatory annual report data for the period of 1997–2019. To examine the association, we used indicators of pregnant women’s states as explanatory variables (for example, pregnant women in very late care, prenatal smoking habits, and pregnant women without care), and the outcome indicators were prematurity, intrauterine malnutrition, and newborn babies with developmental disorders. A univariate Poisson regression was used to examine the correlations. Results: Our results show a decreasing trend in the proportion of pregnant women who smoke and of pregnant women who apply late for care (after 28 weeks of pregnancy), with an increasing indicator of regional differences. The research results of the prenatal and perinatal indicators show that the counties Borsod-Abaúj-Zemplén and Szabolcs-Szatmár-Bereg are the most critical areas in terms of health status in Hungary. The number of pregnancies attended very late (after 28 weeks) and the number of women who gave birth without health visitor care are associated with the number of preterm births (R2 = 0.7313; p &lt; 0.001; R2 = 0.5519; p &lt; 0.001) and intrauterine growth restrictions (R2 = 0.3306; p &lt; 0.001; R2 = 0.2632; p &lt; 0.001). Conclusion: Interventions to improve early childhood health in some counties of Hungary are urgently needed to reduce regional disparities. Such counties include Borsod-Abaúj-Zemplén, Szabolcs-Szatmár-Bereg, Heves, Somogy, Bács-Kiskun, and Nógrád. Health education for pregnant women and activities to strengthen the compliance of pregnant women are key to improving early childhood health outcomes.

Abstract 4129729: Relationship Between Inflammatory Biomarkers and Quality of Life in Black Adults Living with Heart Failure: A Pilot Study

Introduction: Heart failure (HF) impacts quality of life considerably, with inflammatory biomarkers potentially playing a significant role in this relationship. The purpose of this study is to examine the relationship between NYHA Class, inflammatory biomarkers, and quality of life in Black adults living with HF. Methods: Black adults living with HF (N=41) were enrolled in this study. NYHA Class was extracted from the medical record. Health-related quality of life was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ), a 23-item questionnaire that quantifies physical function, symptoms, social function, and health-related quality of life in HF. Scores are transformed to a range of 0-100, with higher scores reflecting better health status. One-way ANOVA and correlation analyses were used to assess associations between NYHA class, inflammatory biomarkers (XO activity, IL-1β, IL-15, and CCL-19), and KCCQ scores. Results: Participants were 57±11 years of age and 66% female, with mean LVEF 33±14%. NYHA Class ranged from I (20%) to IV (12%), with the majority of participants in Class II (34%) and III (22%). Mean KCCQ Clinical Summary Score was 85± 21. NYHA Class I had significantly lower scores on the KCCQ Clinical Summary Score compared to Class III and IV (p &lt; .001, η 2 = 0.54), KCCQ Physical Limitation compared to Class II, III, and IV (p &lt; .001, η 2 = 0.53), and KCCQ Symptom Frequency compared to Class IV (p = .001, η 2 = 0.39). The KCCQ Clinical Summary Score was negatively associated with XO activity (r = -0.440, p = .046), IL-1β (r = -0.407, p = .043), IL-15 (r = -0.427, p = .033), and CCL-19 (r = -0.559, p = .004). Similar negative associations were observed for the KCCQ subscales. Conclusion: The negative association between XO activity and health-related quality of life (KCCQ) in individuals with HF highlights the potential impact of oxidative stress on these patients' subjective well-being and functional status. Understanding this relationship could underscore the importance of mitigating oxidative stress pathways to improve the overall quality of life and symptom burden experienced by individuals with HF. The KCCQ and subscales were also negatively associated with markers of inflammation, highlighting the potential impact of systemic inflammatory processes on subjective well-being and functional status in persons with HF. Targeting inflammatory pathways may improve quality of life and mitigate the burden of symptoms in HF.

Impact of Consumer Wearables Data on Pediatric Surgery Clinicians' Management: Multi-Institutional Scenario-Based Usability Study.

At present, parents lack objective methods to evaluate their child's postoperative recovery following discharge from the hospital. As a result, clinicians are dependent upon a parent's subjective assessment of the child's health status and the child's ability to communicate their symptoms. This subjective nature of home monitoring contributes to unnecessary emergency department (ED) use as well as delays in treatment. However, the integration of data remotely collected using a consumer wearable device has the potential to provide clinicians with objective metrics for postoperative patients to facilitate informed longitudinal, remote assessment. This multi-institutional study aimed to evaluate the impact of adding actual and simulated objective recovery data that were collected remotely using a consumer wearable device to simulated postoperative telephone encounters on clinicians' management. In total, 3 simulated telephone scenarios of patients after an appendectomy were presented to clinicians at 5 children's hospitals. Each scenario was then supplemented with wearable data concerning or reassuring against a postoperative complication. Clinicians rated their likelihood of ED referral before and after the addition of wearable data to evaluate if it changed their recommendation. Clinicians reported confidence in their decision-making. In total, 34 clinicians participated. Compared with the scenario alone, the addition of reassuring wearable data resulted in a decreased likelihood of ED referral for all 3 scenarios (P<.01). When presented with concerning wearable data, there was an increased likelihood of ED referral for 1 of 3 scenarios (P=.72, P=.17, and P<.001). At the institutional level, there was no difference between the 5 institutions in how the wearable data changed the likelihood of ED referral for all 3 scenarios. With the addition of wearable data, 76% (19/25) to 88% (21/24 and 22/25) of clinicians reported increased confidence in their recommendations. The addition of wearable data to simulated telephone scenarios for postdischarge patients who underwent pediatric surgery impacted clinicians' remote patient management at 5 pediatric institutions and increased clinician confidence. Wearable devices are capable of providing real-time measures of recovery, which can be used as a postoperative monitoring tool to reduce delays in care and avoidable health care use.

Can China’s national comprehensive medical reform increase medical resources and reduce healthcare burden: evidence from Chinese provinces

ObjectivesChina’s national comprehensive medical reform (NCMR) is an important attempt in the reform of healthcare system, and quantitative evaluation of its effect is of great significance for continuously deepening medical reform, grasping the reform direction, and building a healthy China. Therefore, focusing on medical resources and medical burden, this study aims to systematically explore the policy effectiveness and the provincial heterogeneity of NCMR, as well as the potential influencing factors.MethodsUtilizing the collected multi-period panel data of 31 provinces in mainland China in 2006–2021, we regarded the release of the two batches of pilot provinces in NCMR as a quasi-natural experiment and comprehensively adopted a Staggered difference-in-differences (DID) model and Synthetic Control Method (SCM), combined with word frequency statistics and grouping regression analysis.ResultsNCMR can effectively increase the number of licensed physicians by 12.6% and reduce the per capita medical expense for in-patients by 7.2% in the pilot provinces. Furthermore, the NCMR policy effect in different pilot provinces shows various characteristics, and only Jiangsu, Zhejiang, and Chongqing achieve both the growth of medical resources and the reduction of medical expenditure. Meanwhile, word frequency statistics are conducted based on related policy descriptions and news reports on the official websites, so as to summarize the specific policy means in the three provinces, and provide a reference for other provinces to practice the healthcare reforms. Besides, extensibility analysis shows that the effect of NCMR is affected by the population aging and health status. Groups with low degree of population aging (low-AG)/high population health status (high-HE) performed a more obvious reform effect.ConclusionThis study provides beneficial policy implications for increasing medical resources, reducing medical burden, and promoting medical reform process.

Abstract 4137927: Physicians’ Misrecognition of Stroke Risk in Patients with Atrial Fibrillation

Background: Current clinical practice guidelines for atrial fibrillation (AF) recommend stroke risk stratification and the use of oral anticoagulants (OACs) for patients at risk. However, physicians’ recognition of patients’ stroke risk may differ from the calculated risk, and the effect of this discrepancy on subsequent care remains unknown. Aims: We aimed to document treating physicians’ estimations of individual patients' stroke risk and assess its association with OAC utilization. Methods: A multicenter, prospective cohort study was conducted in two outpatient practices in Tokyo, Japan, between 2018 to 2020. Participants included patients with newly diagnosed AF or those referred for initial treatment for AF. Treating physicians were asked to document the patient's estimated risk of stroke in numbers. The estimations were categorized as low risk (&lt;1.0%/year), intermediate risk (1.0%≤ to &lt;2.0%/ year), and high risk (2.0%≤/year). We then calculated patients’ baseline CHA 2 DS 2 -VASc scores and divided them into three risk groups: 0 or 1 point as low risk, 2 points as intermediate risk, and 3 or more points as high risk. Higher risk categorization by physicians was defined as "overestimation," while lower risk categorization was defined as "underestimation." The independent association of physician-patient risk concordance with OAC use was explored by multivariable Logistic regression models. Results: Among the 285 patients enrolled in this study (mean age 68±12 years, male 72.6%), the mean CHA 2 DS 2 -VASc score was 2.3±1.6. Physicians correctly estimated stroke risk in 147 patients (51.6%), underestimated it in 25 patients (8.8%) and overestimated it in 113 patients (39.6%). OACs were used in 89.8% of patients whose stroke risk was correctly estimated, 72.0% of those whose stroke risk was underestimated, and 84.1% of patients whose health status was overestimated. After multivariable adjustment, the underestimation of stroke risk was independently associated with less use of OACs (adjusted odds ratio 0.23, 95% CI 0.061-0.85, P=0.028). Conclusions: In this cohort study, physician underestimation of stroke risk was not rare and associated with less use of OACs.