High Rates Of Disease Research Articles

Developing an integrated clinical decision support system for the early identification and management of kidney disease—building cross-sectoral partnerships

BackgroundThe burden of chronic conditions is growing in Australia with people in remote areas experiencing high rates of disease, especially kidney disease. Health care in remote areas of the Northern Territory (NT) is complicated by a mobile population, high staff turnover, poor communication between health services and complex comorbid health conditions requiring multidisciplinary care.AimThis paper aims to describe the collaborative process between research, government and non-government health services to develop an integrated clinical decision support system to improve patient care.MethodsBuilding on established partnerships in the government and Aboriginal Community-Controlled Health Service (ACCHS) sectors, we developed a novel digital clinical decision support system for people at risk of developing kidney disease (due to hypertension, diabetes, cardiovascular disease) or with kidney disease. A cross-organisational and multidisciplinary Steering Committee has overseen the design, development and implementation stages. Further, the system’s design and functionality were strongly informed by experts (Clinical Reference Group and Technical Working Group), health service providers, and end-user feedback through a formative evaluation.ResultsWe established data sharing agreements with 11 ACCHS to link patient level data with 56 government primary health services and six hospitals. Electronic Health Record (EHR) data, based on agreed criteria, is automatically and securely transferred from 15 existing EHR platforms. Through clinician-determined algorithms, the system assists clinicians to diagnose, monitor and provide guideline-based care for individuals, as well as service-level risk stratification and alerts for clinically significant events.ConclusionDisconnected health services and separate EHRs result in information gaps and a health and safety risk, particularly for patients who access multiple health services. However, barriers to clinical data sharing between health services still exist. In this first phase, we report how robust partnerships and effective governance processes can overcome these barriers to support clinical decision making and contribute to holistic care.

Lipoprotein(a) as a risk factor for atherosclerotic cardiovascular disease in patients in non-metropolitan areas of Brandenburg, Germany.

In the non-metropolitan region of Brandenburg (Germany), which is characterized by high rates of cardiovascular diseases and underserved medical care, there is a lack of awareness regarding lipoprotein(a) [Lp(a)] as a risk factor. In addition, data from patients with atherosclerotic cardiovascular disease (ASCVD) in diverse regional backgrounds, including the understudied Brandenburg cohort, and various healthcare statuses remain insufficient. In this WalkByLab study, Lp(a) levels were monitored in a non-metropolitan cohort (n = 850) in Brandenburg, Germany, comprising 533 patients at high cardiovascular risk and 317 healthy controls. Patients underwent a comprehensive angiological screening, which included blood serum analysis, assessment of medical and family history, cardiovascular risk, and disease status, and evaluation of lifestyle and quality of life. All parameters were evaluated with regard to two groups based on Lp(a) levels: low (<50 mg/dl) and high (≥50 mg/dl). Brandenburg patients with cardiovascular diseases showed higher Lp(a) levels than healthy controls (24.2% vs. 14.8%, p = 0.001). Logistic regression analysis with different characteristics revealed that Lp(a) was an independent risk factor significantly associated with ASCVD (OR 2.26, 95% CI 1.32-3.95, p = 0.003). The high-Lp(a) group showed a higher proportion of patients with coronary artery disease, peripheral artery disease, or cerebrovascular disease compared to the low-Lp(a) group (50% vs. 36.8%; 57.7% vs. 45.8%; 17.6% vs. 9.2%; p = 0.004); also, a higher percentage of patients in the high-Lp(a) group had heart failure (72.8% vs. 53.2%, p = 0.014) and myocardial infarction (24.7% vs. 13.9%, p = 0.001). The high-Lp(a) group exhibited higher rates of statins (63.1% vs. 50.4%, p = 0.003), ezetimibe (14.8% vs. 5.5.%, p = 0.001), and beta-blockers (55.7% vs. 40.7%, p = 0.001) use. Lp(a) levels were found to be independent of physical activity or smoking behavior and did not change over time (12 months). Our study highlights the significance of elevated Lp(a) levels in Brandenburg cardiovascular patients and identifies them as an independent risk factor for ASCVD, which has implications for addressing cardiovascular health of non-metropolitan populations.

Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass at 5 years (YOMEGA): a prospective, open-label, non-inferiority, randomised extension study

The multicentre randomised trial YOMEGA (NCT02139813) comparing the one anastomosis gastric bypass (OAGB) with the Roux-en-Y gastric bypass (RYGB) confirmed the non-inferiority of OAGB on weight loss outcomes at 24 months. We aimed to report weight loss, metabolic, and safety outcomes at 5 years. YOMEGA is a prospective, open-label, non-inferiority, randomised trial conducted at nine centres in France. Inclusion criteria were BMI of 40 kg/m2 or more, or 35 kg/m2 or more with comorbidities. Key exclusion criteria were severe gastro-oesophageal reflux disease or Barrett's oesophagus and previous bariatric surgery. Patients were randomly assigned (1 :1) to OAGB (one gastrojejunal anastomosis with a 200 cm biliopancreatic limb) or RYGB (with a 150 cm alimentary limb and a 50 cm biliary limb), stratified by centre, with blocks of variable size. The primary endpoint of this extension study was percentage excess BMI loss and was analysed in the per-protocol population, including patients with data who were operated on with the technique randomly assigned to them and excluding patients with major deviations from the protocol during the follow-up (change of surgical technique, death, or withdrawal of consent). Non-inferiority was concluded for the primary endpoint if the upper bound of the CI was less than the non-inferiority limit (7 percentage points). YOMEGA is registered with ClinicalTrials.gov, NCT02139813, and the 5-year follow-up of YOMEGA is registered with ClinicalTrials.gov, NCT05549271. Between May 13, 2014, and March 2, 2016, 253 patients were randomly assigned to OAGB (n=129) or RYGB (n=124), and from these patients 114 in the OAGB group and 118 in the RYGB group were included in the per-protocol analysis. In the per-protocol population, at baseline, mean age was 43·0 years (SD 10·8), mean BMI was 44·0 kg/m2 (5·6), 54 (23%) patients were male and 178 (77%) were female; 55 (27%) of 207 patients had type 2 diabetes. After 5 years, mean percentage excess BMI loss was -75·6% (SD 28·1) in the OAGB group versus -71·4% (SD 29·8) in the RYGB group, confirming non-inferiority (mean difference -4·1% [90% CI -12·0 to 3·7], p=0·0099). Remission of type 2 diabetes was similar in both groups. Nutritional status did not differ; the most common adverse event was clinical gastro-oesophageal reflux disease, occurring in 27 (41%) of 66 patients in the OAGB group versus 14 (18%) of 76 patients in the RYGB group (p=0·0030). Among serious adverse events, ten (8%) of 127 patients converted from OAGB to RYGB. 171 (68%) of 253 patients were followed up. OAGB was not inferior to RYGB regarding percentage excess BMI loss at 5 years with similar metabolic outcomes. The high rate of clinical gastro-oesophageal reflux disease after OAGB raises questions about its long-term consequences, which need to be further investigated. Medtronic.

Abstract A022: Detecting cardiovascular disease risk in early-stage endometrial cancer survivors: preliminary evidence of pulse wave velocity and social vulnerability index

Abstract BACKGROUND: Endometrial cancer survivors (ECS) experience high rates of cardiovascular disease (CVD) likely due to lifestyle and social-environmental factors, including high obesity rates up to 60%. Early detection of CVD is crucial in order to intervene; however, strategies to identify ECS most at risk for CVD are currently lacking. The gold-standard methodology to non-invasively measure CVD is pulse wave velocity (PWV), and one way to identify social-environmental susceptibility is the Centers for Disease Control social vulnerability index (SVI). PURPOSE: Therefore, the purpose of this study is to investigate (1) CVD risk in stage 1 ECS using PWV and (2) the social-environmental influence on CVD risk using SVI. METHODS: Stage 1 ECS who were 1-12 months post-treatment, with a BMI ≥ 25.0 kg/m2, age 50-80 years, and English speaking were recruited in the gynecology-oncology clinic. Oscillometric PWV was measured in a supine position via Mobil-O-Graph. Body composition [body fat percentage (%)] was measured via Bioelectrical Impedance Analysis. Participant zip code was used to determine SVI of their county of residence. SVI is defined as low-medium (0.00-0.49), medium-high (0.50-0.69), and high (0.70-1.00). Linear regression was used to compare PWV and SVI. RESULTS: Seventeen ECS (65% White, 25% Black, 5% Asian, 5% American Indian, 64 ± 7 years old, 6 ± 4 months post-treatment, 44 ± 6% body fat) participated in the study. Participants resided in counties with low-medium (18%), medium-high (24%), and high (58%) SVI and PWV was measured as 8.2 ± 0.8 m/s, 9.1 ± 0.8 m/s, and 9.7 ± 1.0 m/s respectively. The overall regression was not statistically significant (R=0.38, R2=0.14, F=1.15, p=0.34). DISCUSSION: Overall, PWV was elevated in ECS residing in counties with medium-high and high SVI categories compared to normative data. PWV can be used to non-invasively measure CVD risk in clinic in early-stage ECS. Despite failing to reach statistical significance, a 1.0 m/s change is considered to be a clinically meaningful difference in PWV. Therefore, ECS residing in counties with high SVI may be at greater CVD risk compared to those living in less vulnerable communities. Further research is needed, including a larger sample size, to identify successful interventions to reduce CVD in ECS most at risk. Citation Format: Lauren C. Bates-Fraser, Victoria Bae-Jump, Lee Stoner, Erik D. Hanson. Detecting cardiovascular disease risk in early-stage endometrial cancer survivors: preliminary evidence of pulse wave velocity and social vulnerability index [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr A022.

Meeting the Health and Social Needs of America's Unhoused and Housing-Unstable Populations: A Position Paper From the American College of Physicians.

Access to safe and stable housing has both a direct and indirect effect on health. Experiencing homelessness and housing instability can induce stress and trauma, worsening behavioral health and substance use. The absence of safe and stable living conditions can make it challenging to rest, recuperate, and recover from health ailments and can pose barriers to treatment adherence. Homelessness and housing instability is associated with high rates of numerous diseases and chronic conditions. Its cyclical relationship with other social drivers of health can exacerbate health disparities. As a result, unhoused persons experience unique health challenges and require a health care system and professionals designed to meet their distinct needs. Physicians and other health professionals have a role in educating themselves about the needs of unhoused patients as well as making themselves aware of community and government resources available to these populations. Policymakers must support health professionals in these efforts by supporting the data infrastructure needed to facilitate these referrals to resources, supporting research into best practices for caring for these populations, and investing in community-based organization capacity. Policy action is needed to address the underlying drivers of homelessness, including a dearth of affordable housing, while also addressing the short-term need for safe shelter now. In this position paper, the American College of Physicians (ACP) recognizes the need to address universal access to housing to fulfill one's right to health. ACP offers several recommendations to prevent homelessness and promote the necessary health care and social needs of unhoused populations.

Does thyroid diseases contribute to the natural history of idiopathic adult-onset dystonia? Data from the Italian Dystonia Registry.

A few earlier observations and recent controlled studies pointed to the possible contribution of thyroid diseases in idiopathic adult-onset dystonia (IAOD). The aim of this study was to investigate the association between thyroid status and clinical characteristics of IAOD, focusing on dystonia localization, spread, and associated features such as tremors and sensory tricks. Patients were identified from those included in the Italian Dystonia Registry, a multicentre dataset of patients with adult-onset dystonia. The study population included 1518 IAOD patients. Patients with hypothyroidism and hyperthyroidism were compared with those without any thyroid disease. In the 1518 IAOD patients, 167 patients (11%; 95% CI 9.5-12.6%) were diagnosed with hypothyroidism and 42 (2.8%; 95% CI 1.99-3.74) with hyperthyroidism. The three groups were comparable in age at dystonia onset, but there were more women than men in the groups with thyroid disease. Analysing the anatomical distribution of dystonia, more patients with blepharospasm were present in the hyperthyroidism group, but the difference did not reach statistical significance after the Bonferroni correction. The remaining dystonia-affected body sites were similarly distributed in the three groups, as did dystonia-associated features and spread. Our findings provided novel information indicating that the high rate of thyroid diseases is not specific for any specific dystonia subpopulation and does not appear to influence the natural history of the disease.

MORTALITY RATE FOR ACUTE MYOCARDIAL INFARCTION (AMI) IN BRAZIL IN YOUNG ADULTS WITH DIABETES MELLITUS IN THE LAST 5 YEARS (2016-2021)

Introduction: Acute Myocardial Infarction (MI) is characterized by a process of ischemic necrosis. This ischemia results from a pathophysiological basis and/or from predisposing factors, such as Diabetes Mellitus (DM). In this context, it is evident that patients with type 2 DM have two to four times greater risk of mortality from Cardiovascular Diseases (CVD) than patients who do not have this condition. Objective: To identify the variation of mortality rate due to Acute Myocardial Infarction in young adults with DM according to the Brazilian region, gender and ethnicity. Method: This is a descriptive cross-sectional study of deaths due to acute myocardial infarction in young patients, with diagnosis of DM in Brazil, between January 2016 and April 2021. Results: 6 articles were chosen to compose the final sample. Prevalence of death and mortality rate due to AMI were observed in male, older age, and dark-skinned (mainly black and brown) patients. Independent of DM, mortality after MI remained low in young adults. Conclusion: DM in young adults was associated with high rates of circulatory diseases. Complications in specific groups caused serious clinical cases, as verified in the AMI. The populations with prevalence of mortality were male, older, black and brown.

Risk of cardiovascular disease after hospital-diagnosed overweight or obesity.

The aim was to examine the association between hospital-diagnosed overweight/obesity and incident CVD according to the time period of the overweight/obesity diagnosis. This is a cohort study. From Danish national health registries, we identified all residents with a first-time hospital-based overweight/obesity diagnosis code, 1977-2018 (n = 195,221), and an age and sex-matched general population comparison cohort (n = 1,952,210). We computed adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) using Cox regression. We adjusted for comorbidities and educational level and applied 10 years of follow-up. The overall incidence rate was 10.1 (95% CI 10.0-10.1) per 1000 person-years for the comparison cohort and 25.1 (95% CI 24.8-25.4) per 1000 person-years for the overweight/obesity cohort, corresponding to an aHR of 2.5 (95% CI 2.4-2.5). The aHR was elevated for all subtypes of CVD: heart failure: 3.9 (95% CI 3.7-4.1), bradyarrhythmia: 2.9 (95% CI 2.7-3.1), angina pectoris: 2.7 (95% CI 2.7-2.8), atrial fibrillation or flutter: 2.6 (95% CI 2.5-2.6), acute myocardial infarction: 2.4 (95% CI 2.3-2.4), revascularization procedure: 2.4 (95% CI 2.2-2.5), valvular heart disease: 1.7 (95% CI 1.6-1.8), ischemic stroke: 1.6 (95% CI 1.4-1.7), transient ischemic attack: 1.6 (95% CI 1.5-1.7), and cardiovascular death: 1.6 (95% CI 1.5-1.6). The 1-10-year aHR of any CVD associated with an overweight/obesity diagnosis decreased from 2.8 (95% CI 2.7-2.9) in 1977-1987 to 1.8 (95% CI 1.8-1.9) in 2008-2018. Patients with hospital-diagnosed overweight/obesity had high rates of ischemic heart disease, heart failure, structural heart disease, arrhythmia, stroke, and death, although the strength of the association decreased in recent years. Obesity is linked to metabolic abnormalities that predispose individuals to an increased risk of subtypes of CVD. In this population-based nationwide 40-year cohort study, we found that of 195,221 patients with an overweight/obesity diagnosis, more than 31,000 (15.9%) were admitted to hospital within 10 years because of CVD; corresponding to a 2.5-fold greater relative risk of any CVD associated with overweight/obesity than in the general population. We observed an increased risk for most CVD subtypes, including ischemic heart disease, heart failure, structural heart disease, arrhythmia, stroke, and cardiovascular death, although the strength of the association decreased in recent years. Our study emphasizes the importance of improved clinical handling of obesity and underscores the need to prevent associated complications to alleviate the burden of obesity.

Social determinants of chronic diseases reporting among slum dwellers in Egypt.

The high prevalence of chronic diseases in urban slums poses increasing challenges to future social and economic development for these disadvantaged areas. Assessing the health status of slum residents offers guidance for formulating appropriate policies and interventions to improve slum residents' health outcomes. This research aimed to identify the social determinants of chronic diseases reporting among slum dwellers in Egypt. A cross-sectional survey was conducted from March to December 2021 in three slum areas in Giza governorate, Egypt, including 3,500 individuals. We constructed an asset index and a welfare index to measure the economic status and living conditions of slum residents, respectively. We used these indices, along with demographic and socio-economic factors, as independent variables in the analysis. We modeled factors associated with health status using a two-level mixed logistic model to control the effects of slum areas and the potential correlation between household members. The study contributed significantly to a better understanding of the context in which slum dwellers live and the interlinkages among poor living conditions, low economic status, and health outcomes. The results showed a high rate of self-reported chronic diseases among adults aged 18 and older, reaching more than 22%, while it did not exceed 2.0% among children in the slum areas. Therefore, measuring the determinants of chronic diseases was limited to adults. The sample size was 2530 adults after excluding 970 children. The prevalence of chronic diseases among adults ranged between 16.3% in Zenin and 22.6% in Bein El Sarayat. Our findings indicated that low socio-economic status was significantly associated with reporting chronic diseases. Future policies should be dedicated to improving living conditions and providing necessary healthcare services for these vulnerable areas.

Exploring gender disparities in the disease and economic tobacco-attributable burden in Latin America.

Tobacco use has significant health consequences in Latin America, and while studies have examined the overall impact, the gender-specific effects have not been thoroughly researched. Understanding these differences is crucial for effective tobacco control policies. The objective of this study was to explore the differences in tobacco-attributable disease and economic burden between men and women in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, and Peru. We used a previously validated economic model to quantify the impact of tobacco-related illnesses, including morbidity, mortality, healthcare costs, productivity losses, informal care expenses, and DALYs, by gender and age. We utilized data from national surveys, records, studies, and expert opinions to populate the model. In 2020, there were 351,000 smoking-attributable deaths. Men accounted for 69% and women 31%. Ecuador and Mexico had the highest male-to-female death ratio, while Peru and Chile had the smallest disparities. 2.3 million tobacco-related disease events occurred, with 65% in men and 35% in women. Ecuador and Mexico had higher disease rates among men, while Peru had a more balanced ratio. Regarding DALYs, men lost 6.3 million due to tobacco, while women lost 3.3 million, primarily from COPD, cardiovascular disease, and cancer. Brazil and Mexico had the highest DALY losses for both genders. Costa Rica had a lower male-to-female tobacco use prevalence ratio but ranked second in deaths, disease events, and DALYs attributed to tobacco. Colombia had a unique pattern with a male-to-female death ratio of 2.08 but a higher ratio for disease events. The health systems spent $22.8 billion to treat tobacco-attributable diseases, with a male-to-female cost ratio 2.15. Ecuador showed the greatest gender cost difference, while Peru had the lowest. Productivity loss due to tobacco was $16.2 billion, with Ecuador and Mexico exhibiting the highest gender disparities and Peru the lowest. Informal care costs amounted to $10.8 billion, with men incurring higher costs in Ecuador, Costa Rica, and Mexico. Tobacco causes significant health and economic burdens in Latin America, with gender-based differences. There is a need for gender-disaggregated data to improve tobacco control policies.

Availability and Quality of Dialysis Care in Rural versus Urban US Counties

Introduction: Rural areas face significant disparities in dialysis care compared to urban areas due to limited access to dialysis facilities, longer travel distances, and a shortage of healthcare professionals. The objective of this study was to conduct a national examination of rural-urban differences in quality of dialysis care offered across counties in the USA. Methods: Data were gathered from Medicare-certified dialysis facilities in 2020 from the Centers for Medicare and Medicaid Services website. To identify high-need counties, county-level estimated crude prevalence of diabetes in adults was obtained from the 2022 CDC PLACES data portal. Our analysis reviewed 3,141 counties in the USA. The primary outcome measured was whether the county had a dialysis facility. Among those counties that had a dialysis facility, additional outcomes were the average star rating, whether peritoneal dialysis was offered, and whether home dialysis was offered. Results: The type of services offered by dialysis facilities varied significantly, with peritoneal dialysis being the most commonly offered service (50.8%), followed by home hemodialysis (28.5%) and late-shift services (16.0%). These service availabilities are more prevalent in urban facilities than in rural facilities. The Centers for Medicare and Medicaid Services Five Star Quality ratings were quite different between urban and rural facilities, with 40.4% of rural facilities having a ranking of five, compared to 27.1% in urban. Conclusion: The majority of rural counties lack a single dialysis facility. Counties with high rates of chronic kidney disease, diabetes, and blood pressure, deemed high need, were less likely to have a highly rated dialysis facility. The findings can be used to further inform targeted efforts to increase diabetes educational programming and design appropriate interventions to those residing in rural communities and high-need counties who may need it the most.

An Update on Current Therapeutic Options in IgA Nephropathy.

Immunoglobulin A nephropathy (IgAN) remains the leading cause of primary glomerular disease worldwide. Outcomes are poor with high rates of progressive chronic kidney disease and kidney failure, which contributes to global healthcare costs. Although this disease entity has been described, there were no disease-specific treatments until recently, with the current standard of care focusing on optimal supportive measures including lifestyle modifications and optimization of the renin-angiotensin-aldosterone blockade. However, with significant advances in the understanding of the pathogenesis of IgAN in the past decade, and the acceptance of surrogate outcomes for accelerated drug approval, there have been many new investigational agents tested to target this disease. As these agents become available, we envision a multi-pronged treatment strategy that simultaneously targets the consequences of ongoing nephron loss, stopping any glomerular inflammation, inhibiting pro-fibrotic signals in the glomerulus and tubulo-interstitium, and inhibiting the production of pathogenic IgA molecules. This review is an update on a previous review published in 2021, and we aim to summarize the developments and updates in therapeutic strategies in IgAN and highlight the promising discoveries that are likely to add to our armamentarium.

Diagnostic value of serum amyloid A in differentiating the inflammatory disorders in wild birds.

Rescued wild birds have very high rates of inflammatory diseases; however, there have been limitations in assessing them sensitively. Few studies have examined acute-phase proteins in wild birds. In this study, serum amyloid A (SAA) was evaluated as an inflammatory indicator along with traditional indices such as white blood cell count, albumin, and albumin/globulin ratio. In total, 291 samples from 139 birds of six avian species were analyzed. All samples were divided into four groups (severe, moderate, mild injuries, and clinically healthy) based on clinical examinations and evaluated by group. SAA levels were measured using an anti-chicken SAA ELISA kit and compared with leukocyte counts, albumin concentrations, and albumin/globulin ratios. Differences among groups were evaluated using the Kruskal-Wallis test, followed by a post hoc test using Dunn's multiple comparisons with SPSS V27. Statistical significance was set at a value of p of <0.05. The median concentration and interquartile range (ng/mL) of SAA in each group were 78.10 ng/mL (50.71-109.30), 31.15 ng/mL (19.85-49.24), 9.68 ng/mL (4.71-22.06), and 3.10 ng/mL (1.50-6.00). We observed a significant difference in the mean levels between the groups (p < 0.001), with the same results observed across species. All four indices showed significant differences in mean values between the groups (p < 0.001). In addition, SAA showed rapid changes in periodically collected samples, reflecting either a positive treatment response or the onset of subclinical diseases. SAA can be used to detect inflammatory conditions and asymptomatic disease in wild birds and is helpful in accurately identifying current health status, which is essential for successful treatment and release.

Exposome and Metabolome Analysis of Sugarcane Workers Reveals Predictors of Kidney Injury

IntroductionSugarcane workers are exposed to potentially hazardous agrochemicals including pesticides, heavy metals, and silica. Such occupational exposures present health risks and have been implicated in a high rate of kidney disease seen in these workers. MethodsTo investigate potential biomarkers and mechanisms that could explain chronic kidney disease (CKD) among this worker population, paired urine samples were collected from sugarcane cutters at the beginning and end of a harvest season in Guatemala. Workers were then separated into two groups: those with or without kidney function decline (KFD) across the harvest season. Urine samples from these two groups underwent elemental analysis and untargeted metabolomics. ResultsUrine profiles demonstrated increases in silicon, certain pesticides, and phosphorus levels in all workers while heavy metals remained low. While the KFD group had a reduction in eGFR across the harvest season, kidney injury marker 1 (KIM-1) did not significantly change. Cross-harvest metabolomic analysis found trends of fatty acid accumulation, perturbed amino acid metabolism, presence of pesticides and other known signs of impaired kidney function. ConclusionSilica and certain pesticides were significantly elevated in the urine of sugarcane workers with or without KFD. Future work should determine whether long-term occupational exposure to silica and pesticides across multiple seasons contributes CKD in these workers. Overall, these results confirmed multiple exposures are occurring in sugarcane workers and may provide insight into early warning signs of kidney injury and may help explain the increased incidence of CKD among agricultural workers.

Vaccine Attitudes and Uptake Among Latino Residents of a Former COVID-19 Hotspot

Abstract: Early in the COVID-19 pandemic, the Centers for Disease Control and Prevention identified Prince William County (PWC), Va. as a hotspot with a high disease rate among Latinos. This study uses spatial, survey, and qualitative data to understand attitudes towards vaccine uptake among PWC Latinos. A quantitative analysis (n=266) estimates the association for vaccine acceptance among Latinos. Next, qualitative interviews with Latinos (n=37) examine vaccine attitudes. Finally, a spatial analysis identifies clusters of social vulnerability and low vaccine uptake in PWC and adjacent counties. Our findings show that a substantial proportion of PWC Latinos had low vaccination rates as of December 2022, two years after the vaccine's release. Side effects and safety and approval concerns were cited in both the quantitative and qualitative studies. Persistent vaccine disparities are concerning given the high hospitalization and mortality rates that prevailed among Latinos early in the pandemic.

Abstract TP236: Racial Disparities in Young Patients With Ischemic Stroke in Central Connecticut

Introduction: A rising prevalence of stroke in young patients was noticed in recent years. Studies have reported racial disparities in young stroke patients and less desired outcomes of minorities. The healthcare system located in central Connecticut provides stroke care for diverse populations allowing investigations of racial disparities in young stroke population. This study aimed to identify potentially modifiable factors for better stroke treatment and prevention in minority populations. Methods: We retrospectively identified young patients (aged 18-55 years) who were admitted with ischemic stroke from 01/2014 to 12/2022. Race groups were characterized as non-Hispanic White (White), non-Hispanic Black (Black), and Hispanic. Socioeconomic status, risk factors, stroke etiology, acute interventions and short-term outcomes were accessed. Comparisons among racial groups were tested with Chi-square and Wilcoxon rank sum tests as appropriate. Results: A total of 915 patients were identified, the median age was 49, 58.8% were male, and 60.4% White, 21.6% Black, 17.9% Hispanic. White lived in households with a higher median income than Hispanic and Black (p&lt;0.001). Compared to White, black and Hispanic had higher rate of Diabetes, Hypertension and prior stroke (p&lt;0.001). The rates of other risk factors (hyperlipidemia, smoking, illicit drug use, chronic heart failure, coronary artery disease, and atrial fibrillation) did not vary by race. The rates of stroke etiologies (large vessel disease, cardioembolic stroke, cryptogenic stroke and other determined etiology) were similar among racial groups, yet the trend showed a higher rate of dissection stroke in White (White 7.9 % vs. Black 3.9% and Hispanic 3.8%) and a higher rate of small vessel disease stroke in Black and Hispanic (White 7.9 % vs. Black 17.3% vs. Hispanic 12.4%). Acute intervention (IV tPA, thrombectomy) and short-term outcomes (mRS and disposition at discharge) were similar among groups. Conclusions: This study highlighted a higher prevalence of hypertension and diabetes may correlate with a high rate of small vessel disease in Black and Hispanic young stroke patients. A tailored interventions of hypertension and diabetes for stroke prevention are urged in minorities.

Racial and ethnic determinants of psoriatic arthritis phenotypes and disease activity.

Individuals of racially and ethnically diverse backgrounds are underrepresented in psoriatic arthritis (PsA) research/clinical trials, despite evidence that their disease presentation, severity and course may be distinct. Here we aim to describe how race, ethnicity and other socioeconomic factors inform disease characteristics in PsA. 817 consecutive patients with PsA from a large, diverse metropolitan area, were enrolled in an observational, longitudinal registry. Demographics, medical history, medication use, and psoriatic disease phenotype and activity were all recorded and analyzed. The population was 77.4% non-Hispanic White, 2.2% Black, 7.1% Asian, and 9.9% identified as other races or multiracial, and 11.8% identified as Hispanic. Hispanic and non-White individuals had higher tender joint counts (p= 0.033) with similar swollen joint counts (p= 0.308) and medication use (p= 0.171). They also had high rates of radiographic axial disease. Hispanic individuals were significantly more likely to have higher tender joint counts (p= 0.029), higher RAPID3 scores (p= 0.004), and moderate-severe psoriasis (p= 0.010) compared with non-Hispanic White individuals. In this diverse cohort, 22.6% of patients identified as underrepresented racial and/or ethnic groups, mostly Asian or Hispanic. Despite similar swollen joint counts and medication use, non-white individuals have higher tender joint counts compared with white individuals. Phenotypically, they also were more likely to have radiographic axial involvement. These findings may reflect differences in PsA presentation, experience and outcomes in individuals of various racial and ethnic groups, which need to be taken into consideration in clinical care and research design.

Building Statewide Quality Improvement Capacity to Improve Cardiovascular Care and Health Equity: Lessons from the Tennessee Heart Health Network

Many states with high rates of cardiovascular disease (CVD) lack statewide quality improvement (QI) infrastructure (for example, resources, leadership, community) to address relevant health needs of the population. Academic health centers are well positioned to play a central role in addressing this deficiency. This article describes early experience and lessons learned in building statewide QI infrastructure through the Tennessee Heart Health Network (Network). A statewide, multistakeholder network composed of primary care practices (PCPs), health systems, health plans, QI organizations, patients, and academic institutions was led by the University of Tennessee Health Science Center (UTHSC), an academic health center, to improve cardiovascular health by supporting dissemination and implementation of patient-centered outcomes research (PCOR) evidence-based interventions in primary care. PCPs were required to select and implement at least one of three interventions (health coaching, tailored health-related text messaging, and pharmacist-physician collaboration). Thirty statewide organizational partners joined the Network in year one, including 18 health systems representing 77 PCPs (30.0% of 257 potentially eligible PCPs identified) with approximately 300,000 patients. The organizational partners share EHRs for the ongoing tracking and reporting of key health metrics, including hypertension control and delivery of tobacco cessation counseling. Of the 77 PCPs, 62 continue participation after year two (80.5% retention). Main barriers to participation and reasons for discontinuing participation included reluctance to share data and changes in leadership at the health system level. These 62 PCPs selected the following interventions to implement: health coaching (41.9%), tailored health-related text messages (48.4%), and pharmacist-physician collaboration (40.3%). Academic health centers have broad reach and high acceptability by diverse stakeholders. Tennessee's experience illustrates how academic health centers can serve as platforms for building a statewide infrastructure for disseminating, implementing, and sustaining QI interventions at the practice level. Assessment of Network impact is ongoing.

Prevalence, knowledge and practices on prevention and management of overweight and obesity among adults in Dodoma City, Tanzania.

Overweight/obesity is increasing leading to high rates of non-communicable diseases. The study aimed to assess the prevalence, knowledge and practices on prevention and management of overweight/obesity among adults in Dodoma region. A cross- sectional research was conducted among 313 randomly selected adults aged 25-65 years. Face to face interviews were conducted to obtain demographic information, knowledge on preventing and managing overweight/obesity using a pre-tested questionnaire. Weight and height were measured following standard procedures and nutrition status was categorized using WHO criteria. Dietary intake was assessed using qualitative 24 hours recall to obtain dietary diversity score. Data was analyzed using the SPSS™ Version 20 to obtain descriptive and inferential statistics. About 62.6% (n = 196) of the participants were females. The overall prevalence of overweight/obesity was 59.7% (n = 186) of which 28% (n = 88) were overweight and 31.3% (n = 98) obese. Obesity was three times higher among females (41.8% vs 13.7%) than males. Overweight/obesity was positively associated with female sex (Adjusted OR 2.34; 95%CI: 1.235-4.68; p = 0.001), low knowledge (Adjusted OR 2.15; 95%CI: 1.22-3.81; p = 0.008) and negatively associated with dietary diversity score (Adjusted OR 0. 452; 95%CI: 0.199-1.87; p = 0.03). About 76% of respondents reported that overweight/obesity is a result of consuming high energy (38.8%; n = 92) and high fat foods (27%; n = 63). More than half of the respondents reported to be insensitive with kind of foods they consume and for those who were sensitive, 64% do so to avoid diseases. Furthermore, 60% control their weight by doing physical exercises while 18% by both physical exercises and diet management. However, about 43% did not know foods exposing individuals to health problems. High prevalence of overweight/obesity was observed and significantly associated with female sex, low dietary diversity and knowledge on overweight/obesity prevention. This creates a need to improve knowledge on prevention of overweight/obesity.

COVID-19 vaccination and transmission patterns among pregnant and postnatal women during the fifth wave of COVID-19 in a tertiary hospital in Hong Kong.

Vaccination is a key strategy to control the coronavirus disease 2019 (COVID-19) pandemic. Safety concerns strongly influence vaccine hesitancy. Disease transmission during pregnancy could exacerbate risks of preterm birth and perinatal mortality. This study examined patterns of vaccination and transmission among pregnant and postnatal women during the fifth wave of COVID-19 in Hong Kong. The Antenatal Record System and Clinical Management System of the Hospital Authority was used to retrieve information concerning the demographic characteristics, vaccination history, COVID-19 status, and obstetric outcomes of women who were booked for delivery at Queen Mary Hospital in Hong Kong and had attended the booking antenatal visit from 1 July 2021 to 30 June 2022. Among 2396 women in the cohort, 2006 (83.7%), 1843 (76.9%), and 831 (34.7%) had received the first, second, and third doses of COVID-19 vaccine, respectively. Among 1012 women who had received the second dose, 684 (67.6%) women were overdue for their third dose. There were 265 (11.1%) reported COVID-19 cases. Women aged 20 to 29 years had a low vaccination rate but the highest disease rate (19.1%). The disease rate was more than tenfold higher in women who had no (20.3%) or incomplete (18.8%) vaccination, compared with women who had complete vaccination (2.1%; P<0.001). Acceptance of COVID-19 vaccination was low in pregnant women. Urgent measures are needed to promote vaccination among pregnant women before the next wave of COVID-19.