Higher Odds Of Use Research Articles

National Incidence of Nurse Suicide and Associated Features.

The aim of this study was to estimate the national incidence of nurse suicide. Nurses are at a higher risk of suicide than nonnurses; however, data have been limited since 2018. This study used a retrospective cohort design using 2017-2021 National Violent Death Reporting System suicides. Female nurses had higher suicide rates than female nonnurses in 2018 (incidence rate ratio, 1.21 [95% confidence interval (CI), 1.05-1.39]), 2019 (1.41 [95% CI, 1.23-1.60]), 2020 (1.26 [95% CI, 1.08-1.45]), and 2021 (1.35 [95% CI, 1.17-1.55]), whereas male nurses were comparable with male nonnurses. Nurses had higher odds of mental health problems (adjusted odds ratio, 1.28 [95% CI, 1.13-1.46], P < .001), job problems (1.60 [95% CI, 1.33-1.92], P < .001), and use of poisoning (1.54 [95% CI, 1.37-1.74], P < .001). Nurses had higher odds of using opioids, cardiovascular/diabetic agents, and drugs not prescribed for home use. Female nurses are at a higher risk of suicide than other females. Multimodal nurse suicide prevention strategies remain indicated.

Prevalence, demographic, socio-economic, and lifestyle factors associated with cigarette, e-cigarette, and dual use: evidence from the 2017-2021 Scottish Health Survey.

Understanding the correlation between demographic, socio-economic, and lifestyle factors with e-cigarette use, cigarette smoking, and dual use is essential for targeted public health interventions. This study examines the prevalence of these behaviors in Scotland and identifies the associated factors. We conducted a repeated cross-sectional analysis of the Scottish Health Survey data from 2017 to 2021, leveraging data from 12,644 participants aged 16 and older: 2271 cigarette smokers, 687 e-cigarette users, 428 dual users, and 9258 never users. Weighted prevalences were calculated by age group, sex, and survey year, followed by weighted multinomial logistic regression to explore associated factors. The overall prevalences were 72.0% (95% CI 70.9-73.1) for never users, 18.9% (95% CI 17.9-19.9) for cigarette smokers, 5.5% (95% CI 5.0-6.1) for e-cigarette users, and 3.6% (95% CI 3.2-4.0) for dual users. From 2017 to 2021, cigarette smoking declined from 21.7% (95% CI 19.6-23.9) to 13.1% (95% CI 11.5-15.0), e-cigarette use from 6.5% (95% CI 5.4-7.8) to 4.8% (95% CI 3.6-6.4), and dual use from 3.7% (95% CI 2.9-4.6) to 2.7% (95% CI 1.9-3.7). Age was a critical factor, with the 25-34 age group more likely to use e-cigarettes (p = 0.007) and the 35-44 age group more likely to engage in dual use (p = 0.006) compared to the 16-24 age group. Males had higher odds of e-cigarette use than females (p = 0.031). White individuals had higher odds of using e-cigarettes (p = 0.023) and being dual users (p = 0.017) compared to non-whites. Previously married individuals had higher odds of dual use than singles (p = 0.031). Larger household sizes were linked to reduced odds of all three behaviors (p = 0.001). Rural residents were less likely to use e-cigarettes compared to urban residents (p = 0.025). Higher education correlated with lower odds of all three behaviors (p = 0.001). Manual occupation increased the likelihood of dual use (p = 0.042). Lower income and higher deprivation significantly increased the odds of all three behaviors (p < 0.001). Excessive alcohol consumption was associated with increased odds of the three behaviors (p < 0.001). Poor sleep quality correlated with increased odds of dual use (p = 0.002) and cigarette smoking (p < 0.001). Adherence to physical activity guidelines was associated with reduced odds of all three behaviors (cigarette smoking p < 0.001, e-cigarette use p = 0.031, dual use p = 0.016). In conclusion, this study showed a decline in the prevalence of cigarette smoking, e-cigarette use, and dual usage from 2017 to 2021 in Scotland. Significant associations with demographic, socio-economic, and lifestyle factors highlight the need for targeted public health interventions.

Sex disparities in short-term outcomes among patients with diffuse large B cell lymphoma undergoing chimeric antigen receptor T-cell therapy in the United States.

e19062 Background: Chimeric Antigen Receptor (CAR) T-cell therapy, a promising immunotherapy used in various cancers, including Diffuse large B cell lymphoma (DLBCL), can involve multiple complications and the need for medical interventions. Our retrospective study strives to gain up-to-date insight into sex-based differences among DLBCL patients undergoing CAR T-cell therapy. Methods: We focussed on DLBCL patients undergoing CAR T-cell therapy via the 2017-2020 National Inpatient Sample(NIS). The events of complications between males and females were examined via multivariate regression models. Since the ICD-10 code for cytokine release syndrome (CRS) involved cases between October and December 2020, we used samples for that timeline while evaluating that particular complication. Results: Our study involved 3280 adult cases of DLBCL undergoing CAR T-cell therapy, with 1930 (58.8%) males and 1350(41.2%) females. Age differences were seen as females were older(mean age 61.93 vs. 60.40 years, p&lt;0.01). Females also had lower odds of atrial fibrillation (6.7% vs. 14.2%, aOR 0.440, p&lt;0.01) and acute kidney injury (AKI) (10.0% vs. 18.4%, aOR 0.458, p&lt;0.01), while having higher odds of use of invasive mechanical ventilation (5.6% vs. 5.2%, aOR 2.179, p&lt;0.01), events of sepsis (9.6% vs. 7.8%, aOR 1.575, p&lt;0.01), pancytopenia (69.6% vs. 64.0%, aOR 1.454, p&lt;0.01), and cryoprecipitate transfusion (2.2% vs. 1.8%, aOR 2.325, p=0.041) than males. We did not find any statistically significant differences for events of gastrointestinal bleeding (GIB)(aOR 0.866, p=0.636), tumor lysis syndrome(aOR 0.980, p=0.890), acute pulmonary embolism(aOR 1.133, p=0.719), toxic encephalopathy(aOR 1.009, p=0.935), platelet transfusion(aOR 0.994, p=0.976), RBC transfusion(aOR 0.828, p=0.192), or all-cause mortality(aOR 1.829, p=0.064). In addition, while 51.6% of males and 51.7% of females reported CRS, it was not statistically valid (aOR 0.923, p=0.850). Conclusions: The sex of DLBCL patients undergoing CAR T-cell therapy can influence multiple complications, as described in our study. Further research and endeavors aimed to deepen our understanding of our findings will help bring changes in protocols by physicians to improve the quality of care and outcomes of these patients.

Abstract 768: Awareness and use of genetic testing among cancer survivors in the United States: A HINTS-SEER study

Abstract Background: Germline genetic testing is a valuable tool for cancer treatment and family cancer risk assessment, but its uptake among cancer survivors remains low. Understanding the factors that influence awareness and use of genetic testing among survivors is crucial for improving access to this important tool. Methods: We analyzed HINTS-SEER data, a pilot project conducted by the National Cancer Institute (NCI) in 2021, that oversampled cancer survivors diagnosed prior to 2018 using three registries from the Surveillance, Epidemiology, and End Results (SEER) Program (Iowa, New Mexico, Greater Bay Area). We examined sociodemographic factors in relation to awareness and use of genetic testing using survey-weighted multivariable logistic regression models. We also examined associations among breast and prostate cancer survivors, separately, as these cancer types have guidelines for genetic testing and had sufficient observations (&amp;gt;100) for stratified analyses. Results: Of 1232 survivors included in the analysis, 277 (23%) had a history of breast cancer, 285 (23%) had prostate cancer, 82 (6.7%) had colorectal cancer, 25 (2%) had ovarian cancer, and 563 (45.7%) had other cancers. Overall, 76.5% of survivors were aware of genetic testing and 23.5% had used it. Among breast and prostate cancer survivors: 40.0% of breast and 20.6% of prostate cancer survivors were aware of genetic testing, and 21.0% and 2.4% had used it, respectively. In multivariable models, female gender (vs. male; OR=3.1, 95% CI: 2.3, 4.2), higher education (high school or less education vs. greater than high school; OR=2.4, 95% CI: 1.4, 3.9), higher income ($100,000 or more vs. &amp;lt;$20,000; OR=3.2, 95% CI: 1.8,5.7), and family history (OR=2.0, 95% CI: 1.4,3.0) were significantly associated with higher odds of awareness of genetic testing. Older age (≥65 vs. &amp;lt;40 years; OR=0.4, 95% CI: 0.2,0.6), Asian American race (vs. non-Hispanic white; OR= 0.3, 95% CI: 0.3-0.9), and Hispanic ethnicity (vs. non-Hispanic white; OR= 0.5, 95% CI: 0.3-0.9) were associated with lower odds of awareness of genetic testing. Female gender (vs. male; OR=5.3, 95% CI: 3.3,8.5) was significantly associated with higher odds of use of genetic testing. Older age (&amp;gt;65 years vs. &amp;lt;40 years; OR=0.4, 95% CI: 0.2,0.7) and unemployed status (OR=0.4, 95% CI: 0.3-0.6) were significantly associated with lower odds of use of genetic testing. In stratified analyses, only older age among breast cancer survivors (≥65 vs. &amp;lt;40 years; OR=0.2, 95% CI: 0.0,0.9) was associated with lower odds of use of genetic testing. Conclusion: Our study provides valuable insights into genetic testing awareness and utilization among a large sample of cancer survivors in the United States. The identified factors associated with awareness and utilization can be used by healthcare providers to target interventions aimed at improving genetic testing awareness and utilization among cancer survivors. Citation Format: Kirithiga Ramalingam, Aaron Scheffler, Erin Van Blarigan, Stephen Li, Robin C. Vanderpool, Sarah H. Nash, Salma Shariff-Marco, Scarlett Gomez, Mindy Hebert-DeRouen. Awareness and use of genetic testing among cancer survivors in the United States: A HINTS-SEER study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 768.

Stenting for Traumatic Pseudoaneurysms of the Cervical Internal Carotid Artery: Case Report and Systematic Review

The optimal stenting approach for traumatic pseudoaneurysms (PSA) of the extracranial internal carotid artery (ICA) remains underinvestigated. We present a case of a traumatic pseudoaneurysm of the extracranial ICA managed with stenting and review of prior published similar cases. The systematic review followed PRISMA-S guidelines and included studies that investigated traumatic pseudoaneurysms of the extracranial ICA managed by stent placement. Statistical analysis assessed the association between the type of injury and stent type, dual antiplatelet therapy (DAPT) duration, and clinical presentation, and the association between stent type and DAPT duration. Our search yielded 82 publications with 135 patients with extracranial ICA PSA treated with stenting. The odds of neck hematoma presentation was 12.2 times greater for patients with penetrating rather than blunt injuries (P= 0.000002). Covered stents had 2.02 times higher odds of use for penetrating rather than blunt injuries compared to bare metal stents. (P= 0.0029). Shorter duration DAPT was seen with bare metal stents having 1.25 higher odds of DAPT duration less than one month compared to covered (P= 0.001). In traumatic extracranial ICA pseudoaneurysms, covered stents are used more commonly for penetrating injuries compared to blunt injuries. Penetrating injuries are more strongly associated with the presentation of a hematoma compared to blunt injuries. Stent type may influence the recommended DAPT duration. Surgeons should consider these findings when selecting stent type and DAPT duration with patients presenting with traumatic extracranial ICA pseudoaneurysm.

Religiosity and alcohol use in adolescents with orofacial cleft: correlational study.

To evaluate the correlation between religiosity and alcohol use among adolescents with orofacial clefts. Cross-sectional study, developed in a Brazilian public and tertiary hospital, between December 2021 and March 2022. Data collection was hybrid, and three instruments were used: Sociodemographic Questionnaire, Durel Religiosity Scale, and the Alcohol Use Disorders Identification Test. For statistical analysis, the following tests were used: χ2, Fisher's Exact, Mann-Whitney and Spearman's Correlation Coefficient, in addition to analyses of linear correlation strength and bivariate logistic regression. The significance level adopted for all tests was 5% (p≤0.05). 370 adolescents participated, with a mean age of 15.2 years (±1.8). Among them, 23 (5.4%) used alcohol riskly or harmfully, being more frequent among male adolescents (p=0.001), those of mixed race (p=0.046), attending high school (p=0.011), with no religion (p<0.001), or who did not attend religious services (p<0.001). Levels of organizational, non-organizational and intrinsic religiosity were significantly lower among adolescents with risky or harmful alcohol use (p=0.005; p<0.001 and p=0.002, respectively). There was a moderate correlation between risky or harmful alcohol use and non-organizational (r=0.31; p=0.002) and intrinsic (r=0.36; p<0.001) religiosity. Male adolescents (p<0.001; OR=6.58), closest in age to 18 years (p<0.001; OR=1.37), and non-practitioners of religion (p<0.001; OR=6. 48) presented higher odds of risky or harmful alcohol use. Adolescents with higher levels of organizational and intrinsic religiosity used less alcohol, while males, closest in age to 18 years, and non-practitioners of religion presented higher odds of using alcohol riskly or harmfully.

EXPLORING THE ROLE OF SOCIAL FACTORS AND CHANGES IN RIDE-HAIL (UBER/LYFT) USE AMONG OLDER ADULTS

Abstract Previous research has observed low ride-hail (e.g., Uber) use among older adults and identified some factors related to use. However, uptake of technology changes quickly and pandemic-related factors (e.g., social distancing) may have affected ride-hail use. The Pew Research Center’s American Trends Panel (ATP) datasets include variables related to political and social views, behavior, religion, geography, internet use, and other factors that have not been previously assessed in relation to ride-hailing among older adults. ATP waves from 2015, 2018, and 2021 included questions about ride-hail use, and were assessed in this study. In 2015, 15.4% of all respondents and 4.5% of older adults reported having ever used ride-hailing. In 2018, the numbers had increased to 36.1% overall and 18.1% for older adults. In 2021, participants were only asked about ride-hail use during the past year, with 22.4% overall and 8.7% of older adults reporting ride-hail use. Separate logistic regression models were used to determine factors associated with reporting ever using ride-hail services (2018) and having used ride-hailing during the past year (2021), among older adults. Higher odds of reporting any use (2018) were related to living in a metropolitan area, living in the US’s West, attending religious service monthly vs. never, high income, more liberal ideology, female gender, and volunteering. Higher odds of use during the past year (2021) were related to metropolitan area, male gender, more education, Hispanic ethnicity, divorced and single vs. married, unaffiliated vs Catholic religion, less frequent religious attendance, high income, and frequent internet use.

Digitalization in China: who’s left behind?

ABSTRACT In an age of digitalization, who still refuses to use digital technology? Drawing on nationally-representative Chinese General Social Survey data, this article finds that about half of Chinese households do not actively use the Internet or e-payment systems, despite their ubiquity. This article estimates the effects of socioeconomic resources on these technologies’ (non-)use across urban, resident but previously urban, resident but previously rural, and rural hukou household registrations in China. Educational attainment is associated with higher odds of use among rural hukou, but the size of this effect is nearly double compared to urban hukou. Additionally, being female increases the odds of use among urban and resident but previously urban hukou, and lowers the odds of use in rural hukou, but which are attenuated by the mediating effects of education. The results give credence to education as a direct and indirect mechanism for digital skills development, especially for rural households. Individuals proximal to rural living conditions have fewer opportunities to learn about digital technology, resulting in greater dependency on education as a rare source of skills training. Simultaneously, education indirectly creates opportunities for women to learn digital skills by improving chances for higher-status job participation that require information management skills, especially in rural regions where traditional cultural norms constrain opportunities for upward mobility. Ultimately, digital technology non-use is traced not to lack of interest, but to lack of skills development opportunities among the socioeconomically disadvantaged.

Prevalence of Nicotine and Tobacco Product Use by Sexual Identity, Gender Identity, and Sex Assigned at Birth Among Emerging Adult Tobacco Users in California, United States.

Sexual and gender minority (SGM) nicotine and tobacco use disparities are well-documented among youth and young adults (YYA), and despite decades of prevention efforts, these disparities stubbornly persist. To better understand tobacco use disparities and craft tailored interventions, tobacco use patterns must be assessed in a contemporary sample of YYA across lines of sexual and gender identity, sex assigned at birth, and tobacco product types. Data were from an online survey of a diverse sample of emerging adult tobacco users (ages 18-29; N = 1491) in California, United States (2020-2021). Participants were recruited from various online and in-person locations. Bivariate and adjusted models assessed differences in four nicotine and tobacco use outcomes (past 30-day use of cigarettes, e-cigarettes, other tobacco products, and multiple tobacco product types) across six groups: Cisgender heterosexual males, cisgender heterosexual females, cisgender sexual minority (SM) males, cisgender SM females, transfeminine participants, and transmasculine participants. Compared to cisgender heterosexual males, both transfeminine (OR = 2.25, 95% confidence intervals (CI) = 1.29 to 4.05) and transmasculine (OR = 1.85, 95% CI = 1.32 to 2.80) participants had higher odds of using cigarettes. Few differences were noted between groups in use of e-cigarettes. Cisgender heterosexual males had higher odds of other tobacco product use, compared to most other groups (eg, cisgender SM males: OR = 0.57, 95% CI = 0.37 to 0.87). Transmasculine participants had higher odds of multiple product use, compared to cisgender heterosexual females. Among multiple product users, transfeminine participants had the highest prevalence of using all three individual product types (35.6%). Results highlight the need for different tobacco control approaches across sexual and gender identities, sex assigned at birth, and nicotine and tobacco products. SGM nicotine and tobacco use disparities remain entrenched, despite concerted efforts to reduce them. The SGM population is heterogeneous and different SGM subgroups may have different needs. This study assessed, among young adult nicotine and tobacco users in California, U.S. patterns of tobacco use across sexual and gender identities, sex assigned at birth, as well as specific tobacco products used-a necessity to craft tailored tobacco control measures. We found patterns of nicotine and tobacco product use across several of these characteristics, highlighting how different prevention and cessation interventions may be needed to meaningfully address SGM nicotine and tobacco use disparities.

Electronic cigarettes use in COVID-19 era among students of a tertiary institution in Nigeria.

Electronic cigarette (e-cigarette) use is becoming popular among undergraduate students in Nigeria with a tendency for escalation because of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to assess electronic cigarette use in COVID-19 era among undergraduate students of a tertiary institution in Lagos state, Southwestern Nigeria. A tertiary institution in Southwestern Nigeria. The study design was a descriptive cross-sectional study with a pretested, structured, close- and open-ended self-administered questionnaire used for collection of data on knowledge, attitude and use of e-cigarettes. Data from 183 respondents were analysed. The mean age of respondents was 24.8 ± 3.38 years, most (63%) of whom were males. The prevalence of ever-use of e-cigarettes was 15.3% of which 60.7% reported increased use of e-cigarettes since the COVID-19 pandemic. Age, education, tribe and religion (p 0.001) were significantly associated with higher odds of use of e-cigarettes. This study found an increase in the quantity of e-cigarettes used and online purchase of the same by respondents since the COVID-19 pandemic. Paying attention to the rate of use and having control measures in place for online purchase of e-cigarettes by youths in Nigeria may be necessary in the years to come.Contribution: This study addresses a gap in the availability of knowledge of use of e-cigarettes among a growing population of youths in Nigeria.

Electronic cigarettes use in COVID-19 era among students of a tertiary institution in Nigeria

Background: Electronic cigarette (e-cigarette) use is becoming popular among undergraduate students in Nigeria with a tendency for escalation because of the coronavirus disease 2019 (COVID-19) pandemic. Aim: The aim of this study was to assess electronic cigarette use in COVID-19 era among undergraduate students of a tertiary institution in Lagos state, Southwestern Nigeria. Setting: A tertiary institution in Southwestern Nigeria. Methods: The study design was a descriptive cross-sectional study with a pretested, structured, close- and open-ended self-administered questionnaire used for collection of data on knowledge, attitude and use of e-cigarettes. Results: Data from 183 respondents were analysed. The mean age of respondents was 24.8 ± 3.38 years, most (63%) of whom were males. The prevalence of ever-use of e-cigarettes was 15.3% of which 60.7% reported increased use of e-cigarettes since the COVID-19 pandemic. Age, education, tribe and religion ( p &lt; 0.001) were significantly associated with higher odds of use of e-cigarettes. Conclusion: This study found an increase in the quantity of e-cigarettes used and online purchase of the same by respondents since the COVID-19 pandemic. Paying attention to the rate of use and having control measures in place for online purchase of e-cigarettes by youths in Nigeria may be necessary in the years to come. Contribution: This study addresses a gap in the availability of knowledge of use of e-cigarettes among a growing population of youths in Nigeria.

Comparing Substance Use and School-Based Stressors Among Black and Latinx Transgender Youth and Peers With Shared Minoritized Identities

PurposeThe aim of this study is to compare substance use and school-based stressors among Black and Latinx transgender youth (trans BLY), White transgender youth (trans WY), and Black and Latinx cisgender youth (cis BLY) and identify associations between substance use and stressors among trans BLY. MethodsWe analyzed 2015–2017 Biennial California Healthy Kids Survey data with a weighted sample of the state’s secondary school population. The analytic sample included 9th and 11th grade trans BLY, trans WY, and cis BLY. Past 30-day and lifetime substance use (cigarettes, e-cigarettes/vaping, marijuana, and alcohol) and school-based stressors (victimization, race-, gender-, and sexuality-based harassment) were compared between cohorts via logistic regression. For trans BLY, associations between substance use and stressors were assessed via logistic regression. ResultsThe analytic sample (n = 19,780) included 252 trans BLY, 104 trans WY, and 19,424 cis BLY. Among trans BLY, estimated prevalence of 30-day (and lifetime) use of cigarettes, e-cigarette/vaping, marijuana, and alcohol were 13% (23%), 19% (39%), 27% (42%), and 29% (48%), respectively. Trans BLY had similar odds of 30-day and lifetime use of all substances compared to trans WY but higher odds of use compared to cis BLY. For trans BLY, race- and gender-based harassment and higher victimization levels were associated with higher odds of 30-day and lifetime use of all substances. Sexuality-based harassment was associated with higher odds of 30-day and lifetime marijuana and alcohol use. DiscussionTrans BLY have high prevalence of substance use, comparable with trans WY but higher than cis BLY. Substance use among trans BLY is associated with school-based stressors.

Trends in utilization of first-line palliative treatments for anal squamous cell carcinoma.

Anal squamous cell carcinoma patients often present with significant symptoms, including pain, bleeding, and obstructive symptoms. This requires palliation-directed therapy as a first-line treatment to alleviate symptoms. The proportion of patients receiving first-line palliative treatments is unknown. We aimed to study the factors associated with the use of first-line palliative treatments in stage II-IV anal squamous cell carcinoma patients. We used the National Cancer Database to identify adult patients diagnosed with stage II-IV anal squamous cell carcinoma between 2004 and 2016. We performed univariable and multivariable logistic regression analysis to determine the clinical and sociodemographic variables associated with the utilization of palliative treatment in the first-line setting, including palliative radiotherapy, chemotherapy, surgery, and pain management. Among 16,944 patients diagnosed with stage II-IV anal squamous cell carcinoma, only a small proportion of 492 (2.9%) required first-line palliative treatments to control symptoms. The majority of these patients received palliative radiotherapy (32%), followed by palliative surgery (25%), palliative chemotherapy (19%), combination therapies (14%), and pain management (10%). On multivariable analysis, higher stage disease, lower income, Medicare and Medicaid insurance, and life expectancy <6 months were associated with higher odds of use of first-line palliative therapy. First-line use of palliative treatments to control symptoms is needed in a small proportion of anal squamous cell cancer patients. It was utilized in all stages, but it was most frequently observed in patients with stage IV disease and patients with <6 months life expectancy. First-line palliative therapy was also more frequent in lower-income patients and patients with Medicare and Medicaid insurance which highlights the disparities in anal cancer management.

Immigration status and utilization of secondary preventive treatment after ischemic stroke.

The objective of the study was to assess use and persistence of secondary preventive treatment after ischemic stroke comparing immigrants and Danish-born residents. A cohort of patients discharged with ischemic stroke (IS) diagnosis (n = 106,224) by immigration status was identified from the Danish Stroke Registry between 2005 and 2018. We investigated use (claiming at least one prescription in 180 days post-discharge according to information from the Register of Medicinal Products Statistics) and persistence of treatment within 180 days thereafter using multivariable logistic regression and Fine and Gray models. Overall, 82,078 Danish-born residents (80.6%) and 3589 (80.7%) immigrants with IS used at least one of the recommended preventive medications post-discharge. Immigrants had lower odds of use of anticoagulants and angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB) (odds ratio (OR), 0.66; 95% confidence interval (CI), 0.53-0.82 and OR, 0.87; 95% CI, 0.75-0.98, respectively) but had higher odds of use of beta-blockers (OR, 1.25; 95% CI, 1.02-1.53) than Danish-born residents after adjustment for age at stroke, sex, sociodemographic factors, duration of residence, stroke severity, and comorbidities. The odds were most evident among immigrants originating from non-Western countries. Persistence of medication use did not differ between immigrants and Danish-born residents after adjustment for sociodemographic factors and comorbidities. Modest disparities in use of standard guideline recommended secondary preventive medications were observed when comparing immigrants and Danish-born residents with ischemic stroke. Furthermore, no differences in persistence of medication therapy were observed.

Association of corticosteroid use and attention deficit/hyperactivity disorder in asthmatic children varies by age

Objective We aim to examine the impact of corticosteroids use on ADHD among children with asthma by administration routes. Methods A population-based, cross-sectional analysis included pediatric patients ages 5–20 years old from the 2016 and 2019 Kids Inpatient Database (unweighted N = 111,702). ICD-10-CM codes were used to identify corticosteroids use, asthma, and ADHD cases. Survey logistic regression models with purposeful variable selection algorithms were built to examine the association between corticosteroids use, and ADHD by asthma severity and age. An inverse probability weighting (IPW) approach was used to help further control residual confounding, Results Among children aged 5–11 years old, the odds of ADHD were significantly higher in children with moderate to severe asthma who used inhaled corticosteroids than nonusers (moderate asthma: adjusted odds ratios [aOR] 1.46, 95% confidence interval [CI] 1.14–2.44; severe asthma: aOR 1.61, 95% CI 1.18–2.21). Although oral corticosteroid use was not independently associated with ADHD in young children, combined use of inhaled and oral corticosteroid had almost 5 times higher odds of use among ADHD in children with severe asthma vs. nonusers (aOR 4.85, 95% CI 2.07 − 11.35). No associations were found between any corticosteroid use and ADHD among asthmatic children aged 12–20 years. Conclusions In this retrospective analysis, we found inhaled corticosteroids were positively associated with ADHD in younger children with moderate to severe asthma, but not in older children.

Predictors of health facility childbirth among unmarried and married youth in Uganda.

Uganda has a high maternal mortality rate combined with poor use of health facilities at childbirth among youth. Improved use of maternal health services by the youth would help reduce maternal deaths in the country. Predictors of use of health facilities at childbirth among unmarried compared to married youth aged 15-24 years in Uganda between 2006 and 2016 are examined. Binary logistic regression was conducted on the pooled data of the 2006, 2011 and 2016 Uganda Demographic and Health Surveys among youth who had given birth within five years before each survey. This analysis was among a sample of 764 unmarried, compared to 5,176 married youth aged 15-24 years. Overall, unmarried youth were more likely to have a childbirth within the health facilities (79.3%) compared to married youth (67.6%). Higher odds of use of health facilities at childbirth were observed among youth with at least secondary education (OR = 2.915, 95%CI = 1.747-4.865 for unmarried vs OR = 1.633, 95%CI = 1.348-1.979 for married) and frequent antenatal care of at least four visits (OR = 1.758, 95%CI = 1.153-2.681 for unmarried vs OR = 1.792, 95%CI = 1.573-2.042 for married). Results further showed that youth with parity two or more, those that resided in rural areas and those who were engaged in agriculture had reduced odds of the use of health facilities at childbirth. In addition, among married youth, the odds of using health facilities at childbirth were higher among those with at least middle wealth index, and those with frequent access to the newspapers (OR = 1.699, 95%CI = 1.162-2.486), radio (OR = 1.290, 95%CI = 1.091-1.525) and television (OR = 1.568, 95%CI = 1.149-2.138) compared to those with no access to each of the media, yet these were not significant among unmarried youth. Frequent use of antenatal care and higher education attainment were associated with increased chances of use of health facilities while higher parity, rural residence and being employed in the agriculture sector were negatively associated with use of health facilities at childbirth among both unmarried and married youth. To enhance use of health facilities among youth, there is a need to encourage frequent antenatal care use, especially for higher parity births and for rural residents, and design policies that will improve access to mass media, youth's education level and their economic status.

Lessons Learned From the Historical Trends on Thrombolysis Use for Acute Ischemic Stroke Among Medicare Beneficiaries in the United States.

BackgroundThe most recent time trends on intravenous thrombolysis (IVT) utilization for acute ischemic stroke was reported in 2011 using the Get with the Guidelines. Our objectives are to assess and validate the change in IVT utilization through 2014 in a national sample of Medicare beneficiaries and to examine the effect of patient, stroke center designation, and geography on IVT utilization.MethodsWe built a comprehensive national stroke registry by combining patient-level, stroke center status, and geographical characteristics, using multiple data sources. Using multiple national administrative databases from 2007 to 2014, we generated a mixed-effect logistic regression model to characterize the independent associations of patient, hospital, and geographical characteristics with IVT in 2014.ResultsUse of IVT increased consistently from 2.8% in 2007 to 7.7% in 2014, P < 0.001. Between group differences persisted, with lower odds of use in patients who were ≥86 years (aOR 0.74, 95% CI 0.65–0.83), Black (aOR 0.73, 95% CI 0.61–0.87), or treated at a rural hospital (aOR 0.88, 95% CI 0.77–1.00). Higher odds of use were observed in patients who arrived by ambulance (aOR 2.67, 95% CI 2.38–3.00), were treated at a hospital certified as a stroke center (aOR 1.96, 95% CI 1.68–2.29), or were treated at hospitals located in the most socioeconomically advantaged areas (aOR 1.27, 95% CI 1.05–1.54).ConclusionsBetween 2007 and 2014, the frequency of IVT for patients with acute ischemic stroke increased substantially, though differences persisted in the form of less frequent treatment associated with certain characteristics. These findings can inform ongoing efforts to optimize the delivery of IVT to all AIS patients nationwide.

Associations between use of psychotropic medications and use of hormonal contraception among girls and women aged 15–49 years in Finland: a nationwide, register-based, matched case–control study

ObjectivesThe relationship between the use of contraception and of psychiatric medications is understudied. We examined whether the current and past use of psychotropic medications is associated with the use and...

Concerts, bars, parties, and raves: Differential risk for drug use among high school seniors according to venue attendance

Background: Nightlife attendance is an established risk factor for drug use, but studies have not focused on adolescent general population samples or compared risk according to type(s) of venues attended. We examined whether attendance of various types of venues was associated with drug use. Methods: Data were examined from an annual nationally representative survey of high school seniors in the US (2014–2019, N = 11,565). We determined whether past-year attendance of parties, concerts, bars or nightclubs, and raves or dance music events was associated with past-year drug use using mixed-effects logistic regression. Mall and movie attendance were examined as negative controls. Results: Compared to those who reported not attending specific venues, attending parties was associated with higher odds of using alcohol in particular (aOR = 5.03, 95% CI: 3.92–6.44). Attending concerts was associated with higher odds for use of alcohol, cannabis, ecstasy, and nonmedical use of prescription stimulants and opioids. All drugs examined were concentrated among those who attend bars, nightclubs, raves, and dance parties. Rave or dance party attendance was associated with higher odds for use of ecstasy (aOR = 3.71, 95% CI: 2.50–5.50) and methamphetamine (aOR = 4.92, 95% CI: 2.43–9.96) in particular, and bar or nightclub attendance was associated with higher odds of use of cocaine (aOR = 6.49, 95% CI: 4.37–9.63), ecstasy (aOR = 6.49, 95% CI: 4.54–9.27), and methamphetamine (aOR = 5.49, 95% CI: 2.57–11.72) in particular. Attending movies was associated with lower odds for use of cocaine and nonmedical prescription stimulant use. Conclusion: We determined differential risk of drug use depending on types of venues attended by adolescents.

Factors associated with drug use during pregnancy and breastfeeding among females who use drugs (FWUDs) in Malaysia

Females who use drugs (FWUDs) are at risk of continuing illicit substance use during pregnancy and breastfeeding. We investigated the prevalence rates and factors associated with these practices in a sample of 200 FWUDs recruited from a publicly-run drug rehabilitation center. A semi-structured questionnaire was used to collect the data. The majority (86%) was Malay (n = 171/200), currently single (71%, n = 141/200), and 51% had nine years of education. The mean age of respondents was 32.2 years (SD = 8.61). Thirty-eight percent (n = 75/200) reported ever using illicit substances during pregnancy, while 15% (n = 30/200) had used them during breastfeeding. Higher odds of using drugs during pregnancy were associated with having an intimate male drug-using partner and with persons who reported abandoning an infant in the past. Lower odds were linked with women who used heroin with ATS (relative to those who used only ATS), and shorter-term ATS (≤3 years) relative to long term ATS users. At a lower level of significance (p = 0.054), being married also lowered the odds. Higher odds of drug use during breastfeeding were associated with having an intimate male drug-using partner, and previous methadone use history, while lower odds were associated with short-term ATS use and being employed. The findings highlight the need for timely and targeted interventions to inform, engage and promote the participation of FWUDs in pre- and post-natal care services.