High Health Burden Research Articles

Prevalence and correlates of symptoms of depression, anxiety, and psychological distress among women of reproductive age with delayed conception in urban and peri-urban low to mid-socioeconomic neighborhoods of Delhi, India: A cross-sectional study.

One in six people of reproductive age experience infertility in their lifetime. Infertility can have significant impacts on mental health. Psychological distress is a broad term encompassing emotional suffering and mental health discomfort that can include symptoms of anxiety and depression but is not limited to these conditions. We investigated the prevalence of symptoms of depression, anxiety, and psychological distress and their associated risk factors among women of reproductive age with delayed conception. A total of 1530 women were recruited from community settings in Northern India. Quantitative data were collected using a 4-item Patient Health Questionnaire-4 (PHQ-4) which is an ultra-brief self-report questionnaire consisting of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (generalized anxiety depression-2). Data were collected between July 2020 and August 2021. Descriptive analysis was conducted to summarise the characteristics and prevalence of symptoms of depression, anxiety, and psychological distress. Logistic regression was used to identify risk factors for psychological distress. We obtained responses from all 1,530 women using these scales. Over half (54.31%) of participants had psychological distress, of whom 38.10% were experiencing mild distress, 10.59% moderate distress, and 5.62% severe distress. Additionally,16.07% of participants reported symptoms of anxiety and 20% reported symptoms of depression. Factors associated with psychological distress were: (i) a higher total number of children that women intended to have in their lifetime, (ii) longer duration of trying to get pregnant (> 18 months), (iii) continuous effort trying to achieve pregnancy, (iv) women's perception that conception is taking long, (v) social isolation, (vi) being emotionally or verbally abused by husband and family members, and (vii) having other co-morbidities such as hypertension, irregular menstrual cycles, irregular bleeding between regular cycles, abnormal vaginal discharge or pain during sex. This study demonstrates the high mental health burden faced by women with delayed conception in low- to mid-socioeconomic neighbourhoods of North India including high levels of anxiety and depression. To better support individuals and couples achieve their reproductive goals, we advocate for the integration of psychosocial interventions to improve mental health outcomes and promote the well-being of those facing delays in achieving pregnancy. Specifically, addressing social isolation, fostering supportive networks, combating violence towards women, and incorporating fertility counselling and group-based psychosocial interventions within community and healthcare settings are needed to alleviate mental health symptoms among women who have difficulties in conceiving. However, the successful implementation of these recommendations may be challenged by the availability of the state's healthcare resources, necessitating tailored strategies with contextual adaptations.

The Association of Fruits and Vegetables Consumption and COVID-19: Results from Yazd Health Study and TAMYZ Study

Background: COVID-19 has caused a high health burden worldwide and increased the need to identify factors affecting its risk. Fruits and vegetables are essential for a healthy diet and immune system function. This study investigated the associations between fruit and vegetable intake and COVID-19 incidence in a large sample of Iranian adults. Methods: In this cross-sectional study, we used data from 9189 participants of Yazd Health Study (YaHS) and Taghzieh Mardom-e-Yazd (TAMIZ) study aged 20 to 70 years. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ). Results: After adjusting for confounding variables, we found that higher intake of total fruit (OR: 0.42, CI: 0.20–0.83, P-trend =0.05), fresh fruit (OR: 0.46, CI: 0.23– 0.92, P-trend =0.04), green leafy vegetables (OR: 0.48, CI: 0.24–0.96, P-trend =0.08), and vitamin C (OR: 0.38, CI: 0.17– 0.81, P-trend =0.02) were associated with lower odds of COVID-19. No significant associations were observed for fruit juice, dried fruit, fruit compote, cruciferous vegetables, yellow vegetables, total vegetables and dietary fiber intake. Conclusion: Our study suggests that higher consumption of fresh fruit, total fruit, green leafy vegetables, and dietary vitamin C may reduce the risk of COVID-19. Further studies are needed to confirm these findings and provide evidence-based nutritional recommendations. Furthermore, the current study's findings could be important for similar pandemics.

State-level LGBTQ+ policies and health: the role of political determinants in shaping health equity.

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals in the United States experience higher rates of discrimination and stressors that negatively impact health compared with their straight, cisgender counterparts. Using 2022 Behavioral Risk Factor Surveillance Survey (BRFSS) data, estimating multilevel mixed-effects logistic regressions, we examined the relationship between state LGBTQ+ policies and health among LGBT people. Findings reveal a statistically significant inverse link between protective (high) state policy scores and poor self-rated health, poor mental health days, and poor physical health days. Specifically, with each 1-point increase in policy score, the odds of poor self-rated health are reduced by 0.03%, high mental health burden by 0.02%, and high physical health burden by 0.02%. Inequalities in self-rated health, high mental health burden, and high physical health burden are greater in policy environments with fewer state-level protections, with LGBT individuals reporting better health where there are more protections. These results indicate that discriminatory state policies are linked to poorer health for LGBT individuals and suggest that protective policies could improve health. Further research with comprehensive data is needed to deepen understanding.

The Arcana of Zinc.

This perspective discusses the essential micronutrient zinc, which functions in >3000 human proteins (the zinc proteome), and the implications of three aspects to ascertain an adequate zinc status for human health. First, the advent of highly sensitive fluorescent (bio)chemicals revealed cellular pools of zinc ions involved in signaling and secretion from cells for paracrine, autocrine, and possibly endocrine functions. Zinc signaling adds a yet unaccounted number of targeted proteins to the already impressive number of zinc proteins. Second, cellular zinc concentrations are remarkably high in the order of the concentrations of major metabolites and, therefore, at the cellular level zinc is not a trace element. Zinc is also not an antioxidant because zinc ions are redox-inactive in biology. However, zinc can express indirect pro-oxidant or proantioxidant effects depending on how cellular zinc is buffered. Zinc sites in proteins and other biomolecules can become redox-active when zinc is bound to the redox-active sulfur donor atom of cysteine. This interaction links zinc and redox metabolism, confers mobility on tightly bound zinc, and has implications for treating zinc deficiency. Third, the concept of zinc deficiency in blood as the only measure of an inadequate zinc status needs to be extended to zinc dyshomeostasis in cells because overwhelming the mechanisms controlling cellular zinc homeostasis can result in either not enough or too much available zinc. We need additional biomarkers of zinc status that determine cell-specific changes and perturbations of the system regulating cellular zinc, including functional deficits, and address the multiple genetic and environmental factors that can cause a conditioned zinc deficiency or overload. Considering the wider context of altered zinc availability in different organs, cells, and organelles impinges on whether zinc supplementation will be efficacious and adds another dimension to the already high health burden of zinc deficiency and its sequelae worldwide.

Exploring the pathways between depression, anxiety, stress, and quality of life on life satisfaction: a path analysis approach

BackgroundLife satisfaction, one promising health asset, is associated with reduced risk of several chronic diseases and mortality. Mental health conditions and quality of life (QoL) are important aspects of well-being in late life and are significantly associated with life satisfaction. Despite the complex interrelationships between mental health, QoL and life satisfaction, the current literature has evaluated the simple association between them and failed to consider the complex pathways among these variables, especially among the older population. Hence, this study explores the pathways between mental health conditions (depression, anxiety, and stress), QoL and life satisfaction among older adults in eastern Nepal.MethodsThis cross-sectional study was conducted in eastern Nepal via face-to-face interviews with 847 older adults selected by multi-stage cluster sampling. The 5-item Satisfaction with Life Scale and 13-item Older People’s QoL scale assessed life satisfaction and QoL, respectively. The 21-item Depression, Anxiety and Stress scale measured mental health conditions. The relationship between QoL, depression, anxiety, and stress with life satisfaction was first evaluated using linear regression, subsequently by path analysis.ResultsThe mean (± SD) life satisfaction and QoL score were 19.7 (± 5.3) and 42.9 (± 7.1), respectively. More than one-fifth of the participants had moderate to severe depression (30%), anxiety (34%), and stress (20%). In adjusted regression analysis, QoL was positively associated (β: 0.44; 95% CI: 0.40 to 0.48) with life satisfaction, whereas depression, anxiety, and stress were inversely associated. In the path analysis, the relationship between depression and stress with life satisfaction was mediated by QoL. Depression was indirectly related to life satisfaction (mediated by QoL, β = -0.25), whereas stress was both directly (β = -0.11) and indirectly (mediated by QoL, β = -0.08) related to life satisfaction.ConclusionsGiven the high mental health burden among the older Nepali population and its potential impact on life satisfaction and QoL, routine screening for mental health should be encouraged in clinical practice. Additionally, community-based interventions and mental health promotion programs should be launched at regional and local levels.

Promoting sexual health in schools: a systematic review of the European studies

Abstract Background Sexual ill-health causes a high health burden. There is, therefore, a need for more effective sexual health promotion interventions. Previous research has focused on preventive sexual health interventions and the limited evidence concerning school-based sexual health promotion interventions has not been synthesized. Hence, this study aimed to systematically review the current evidence on the effects of sexual health promotion interventions conducted in European schools. Methods A systematic review based on the JBI and PRISMA standards was performed, encompassing searches in seven databases to identify sexual health promotion interventions conducted in European schools between 2012 and 2022. Data coding was performed according to a predetermined protocol and a narrative synthesis of the included studies was performed, highlighting the collective results. Results The review included 17 records, reporting 16 individual studies conducted in 7 European countries. Of the 16 included studies, 13 had a quantitative research design, and three had a qualitative design. All qualitative studies described positive effects as experienced by the participants, and ten of the quantitative studies showed statistically significant positive effects on at least one of the outcomes of interest. Conclusions The findings indicate good evidence for the effectiveness of interventions with a health promotion approach, underscoring the importance of sexual health resources such as respect, communication skills, and attitudes. Most sexual health promotion intervention studies have focused on sexual health resource outcomes connected to attitudes and skills, whereas, e.g., sexual health literacy is less studied and can be recommended to be included in future research. Key messages • The synthesized evidence sheds light on the lack of evaluated interventions employing holistic and positive, resource-focused sexual health promotion interventions targeting European adolescents. • The included school-based sexual health promotion studies, although limited in number, show evidence of promising effects on sexual health outcomes among participants.

Patterns and correlates of traumatic stress, depression, anxiety, and moral injury in U.S. health care providers late in the COVID-19 pandemic.

Providing health care during the COVID-19 pandemic has been associated with a high mental health burden for health care providers. This study examined patterns of responses and correlates of class membership across commonly assessed mental health symptoms, psychosocial functioning, and moral injury for providers in the United States in Fall 2022. A convenience sample of 1,504 primary care physicians, pediatricians, nurse practitioners, and physician assistants who had been in practice for three or more years (Mage = 46.1 years, SDage = 11.3, 58% male) completed self-report measures in an online, opt-in panel survey from September to November 2022. Using latent class analysis, three classes were identified: No/Low Symptoms (64.8%), High Moral Injury (19.9%), and Elevated Symptoms (15.2%). Several factors were correlated with class membership including age, sex, social support, personal risk of COVID-19, pandemic-related work stressors, proportion of COVID-19 patients seen at the height of the pandemic, and death of a patient due to COVID-19. This study found high levels of mental health symptoms, and problems with psychosocial functioning and moral injury in health care providers well past the pandemic's peak. The results also demonstrated the importance of considering the unique contribution of moral injury to psychosocial functional difficulties experienced by health care providers during the pandemic given their defined role as essential workers. These findings have implications for preventing and managing mental health problems and burnout among providers postpandemic as well as for future pandemics at both the organizational and individual levels. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impact of Social Needs and Identity Experiences on the Burden of Illness in Patients with Multiple Myeloma: A Mixed-Methods Study.

Multiple myeloma (MM) is a common hematologic malignancy, but due to its incurable nature, patients experience many relapses in their lifetime and hence face unique challenges. This mixed-methods study consisting of an online survey and subsequent focus groups aimed to understand how social and identity experiences affected the diagnostic, treatment, and care journey for patients with MM. Twenty-three adult patients with MM participated in this study. The survey participants identified common determinants negatively impacting their health, including mental health concerns (experienced by 90.5% of respondents), worries about food shortage (42.9%), and transportation concerns (28.6%). Focus group participants described high physical and mental health burdens associated with MM. Frequent monitoring, fear of a relapse, and unpredictable side effects contributed to high anxiety. Participants indicated that MM differed from other types of cancer and chronic health conditions in many ways, particularly how and where the diagnosis was made, disease progression and relapse, treatments and side effects, and financial concerns. Most participants (65.0%) reported ≥1 social need that negatively impacted health outcomes including lack of knowledge about MM, financial instability, and lack of insurance, transportation, and social support. The findings reveal that patients with MM continually experience patient-specific mental and physical health burdens indicating high unmet needs throughout the disease journey.

Harnessing high-throughput OMICS in emerging zoonotic virus preparedness and response activities

Emerging and re-emerging viruses pose unpredictable and significant challenges to global health. Emerging zoonotic infectious diseases, which are transmitted between humans and non-human animals, have been estimated to be responsible for nearly two-thirds of emerging infectious disease events and emergence events attributed to these pathogens have been increasing in frequency with the potential for high global health and economic burdens. In this review we will focus on the application of highthroughput OMICS approaches to emerging zoonotic virus investigtations. We highlight the key contributions of transcriptome and proteome investigations to emerging zoonotic virus preparedness and response activities with a focus on SARS-CoV-2, avian influenza virus subtype H5N1, and Orthoebolavirus investigations.

Prevalence of mental health symptoms in Austrian veterinarians and examination of influencing factors

Although previous studies point to a high mental health burden in veterinarians, little is known about mental health in Austrian veterinarians as well as potential underlying factors of poor mental health. We assessed mental health in Austrian veterinarians, compared it to the mental health of the general population, and explored potential risk factors for poor mental health in veterinarians. A total of n = 440 veterinarians (72.0% women; mean age: 44.53 ± 11.25 years) took part in an online survey in 2022 in which validated screening tools for symptoms of depression (PHQ-9), anxiety (GAD-7), sleep disorders (ISI-2), perceived stress (PSS-4), and alcohol abuse (CAGE) were applied. Multivariable logistic regression revealed higher adjusted odds for exceeding cut-offs for clinically relevant depressive, anxiety, and insomnia symptoms in veterinarians (1.35–2.70) compared to the general population. Mental health symptoms in veterinarians were associated with female gender, physical inactivity, higher smartphone usage, higher working hours, less professional experience, and working with pets. In conclusion, it appears that veterinarians encounter mental health challenges that are more pronounced than those experienced in the general population. The teaching of strategies to improve mental hygiene as part of the curricula of veterinary education and targeted training and mentoring of employers and their team should be implemented to improve mental health in the veterinary profession.

Stress factors in veterinary medicine-a cross-sectional study among veterinary students and practicing vets in Austria.

Although the issue of high mental health burden among veterinarians is well-documented in previous studies, little is known about the specific occupational stress factors associated with mental health issues. Therefore, the aims of this study were twofold: (1) to assess occupational stress factors within the veterinary profession, with a particular emphasis on comparing the expectations of veterinary students with the experiences of practicing veterinarians and (2) to link the experienced stress with mental health indicators in veterinarians. All registered veterinarians and veterinary-medicine students in Austria were invited to participate in a cross-sectional online survey. The data collection took place during the winter of 2022/2023 and included standardized questionnaires on mental well-being (WHO-5), depression (PHQ-9), anxiety (GAD-7), stress (PSS-4), and insomnia (ISI-2). Additionally, participants were asked about various estimated (students) or experienced (vets) occupational stress factors, which were to be rated on a 5-point Likert scale ranging from "not at all" to "very strongly". An open question invited respondents to identify in free text further experienced/anticipated sources of work-related stressors in veterinary practice. A total of 430 students and 440 veterinarians participated in the study. The results of a repeated measures analysis of variance (ANOVA) indicate that the burden of bureaucracy is perceived as less stressful by students than experienced by veterinarians, all other areas are perceived as more stressful by students than by veterinarians. In veterinarians, bureaucracy is experienced as the most burdensome, followed by animal suffering, and communication with animal owners. Further analysis of possible associations between the extent of perceived stressors and indicators of mental health shows that while bureaucracy is the most burdensome, it has the smallest correlation with mental health indicators. On the other hand, financial concerns, which are not ranked among the main stressors, have the strongest correlation with impaired mental health. The results suggest that financial security for veterinarians is crucial to safeguard their mental health. The training of veterinary medicine students and practicing veterinarians in the areas of administration, time management, handling animal suffering, and communication with animal owners might be beneficial in reducing their job-related stressors.

A sono-responsive antibacterial nanosystem co-loaded with metformin and bone morphogenetic protein-2 for mitigation of inflammation and bone loss in experimental peri-implantitis

BackgroundDental implants have become an increasingly popular option for replacing missing teeth, and the prevalence of peri-implantitis has also increased, which is expected to become a public health problem worldwide and cause high economic and health burdens. This scenario highlights the need for new therapeutic options to treat peri-implantitis.MethodsIn this study, we proposed a novel sono-responsive antibacterial nanosystem co-loaded with metformin (Met) and bone morphogenetic protein-2 (BMP-2) to promote efficacy in treating peri-implantitis. We introduced the zeolitic imidazolate framework-8 (ZIF-8) as a carrier for hematoporphyrin monomethyl ether (HMME) to enhance the antibacterial effect of sonodynamic antibacterial therapy and tested its reactive oxygen species (ROS) production efficiency and bactericidal effect in vitro. Afterward, HMME-loaded ZIF-8, BMP-2-loaded polylactic acid-glycolic acid (PLGA), and Met were incorporated into gelatin methacryloyl (GelMA) hydrogels to form HMME@ZIF-8/Met/BMP-2@PLGA/GelMA composite hydrogels, and the biocompatibility of which was determined in vitro and in vivo. A bacterial-induced peri-implantitis model in the maxilla of rats was established to detect the effects of the composite hydrogels with adjunctive use of ultrasound on regulating inflammation and promoting bone tissue repair in vivo.ResultsThe results indicated that HMME@ZIF-8 with ultrasound stimulation demonstrated more better ROS production efficiency and antimicrobial efficacy. The composite hydrogels had good biocompatibility. Ultrasound-assisted application of the composite hydrogels reduced the release of the inflammatory factors IL-6 and TNF-α and reduced bone loss around the implant in rats with bacterial-induced peri-implantitis.ConclusionOur observations suggest that HMME@ZIF-8 may be a new good sonosensitizer material for sonodynamic antibacterial therapy. The use of HMME@ZIF-8/Met/BMP-2@PLGA/GelMA composite hydrogels in combination with ultrasound can provide a novel option for treating peri-implantitis in the future.

Implementing nasal povidone-iodine decolonization to reduce infections in hemodialysis units: a qualitative assessment.

A substantial proportion of patients undergoing hemodialysis carry Staphylococcus aureus in their noses, and carriers are at increased risk of S. aureus bloodstream infections. Our pragmatic clinical trial implemented nasal povidone-iodine (PVI) decolonization for the prevention of bloodstream infections in the novel setting of hemodialysis units. We aimed to identify pragmatic strategies for implementing PVI decolonization among patients in outpatient hemodialysis units. Qualitative descriptive study. Outpatient hemodialysis units affiliated with five US academic medical centers. Units varied in size, patient demographics, and geographic location. Sixty-six interviewees including nurses, hemodialysis technicians, research coordinators, and other personnel. We conducted interviews with personnel affiliated with all five academic medical centers and conducted thematic analysis of transcripts. Hemodialysis units had varied success with patient recruitment, but interviewees reported that patients and healthcare personnel (HCP) found PVI decolonization acceptable and feasible. Leadership support, HCP engagement, and tailored patient-focused tools or strategies facilitated patient engagement and PVI implementation. Interviewees reported both patients and HCP sometimes underestimated patients' infection risks and experienced infection-prevention fatigue. Other HCP barriers included limited staffing and poor staff engagement. Patient barriers included high health burdens, language barriers, memory issues, and lack of social support. Our qualitative study suggests that PVI decolonization would be acceptable to patients and clinical personnel, and implementation is feasible for outpatient hemodialysis units. Hemodialysis units could facilitate implementation by engaging unit leaders, patients and personnel, and developing education for patients about their infection risk.

The Vicious Worm education tool improves the knowledge of community health workers on Taenia solium cysticercosis in Rwanda.

The pork tapeworm Taenia solium causes human taeniasis and cysticercosis when ingested as viable cysts and eggs, respectively. Despite its high health burden in low-income countries, knowledge of the parasite in endemic areas such as Rwanda is often limited. Here, we assess whether The Vicious Worm education software can increase knowledge in endemic areas of Rwanda. A cross-sectional mixed-methods study was conducted to evaluate knowledge about T. solium among community health workers trained using the Vicious Worm education software. Knowledge was assessed before, immediately after, and four weeks after the training. The health workers perceptions of the software were analysed thematically. A total of 207 community health workers were recruited from Nyamagabe district in Southern Province, Rwanda. Participants were composed of males (33.5%) and females (66.5%), aged between 22 and 68 years, and most (71%) had only completed primary education. Knowledge of cysticercosis at baseline was low, particularly knowledge of human cysticercosis and neurocysticercosis. The overall knowledge score increased significantly after training and was maintained four weeks after the training. Overall, insufficient knowledge was associated with neurocysticercosis-related questions, which after the training, remained relatively lower compared to questions of other categories. Participants reported the software to be user-friendly and educational. Digital illiteracy and the lack of smartphones were among the critical challenges highlighted in responses. This study has shown gaps in knowledge regarding T. solium infections within rural Rwanda, particularly neurocysticercosis. Health education using the Vicious Worm education software should be considered in integrated control programs.

Exploring the link between vitamin D deficiency and obstructive sleep apnea: A comprehensive review.

Despite the high prevalence and significant health burden of obstructive sleep apnea (OSA), its underlying pathophysiology remains incompletely understood. This comprehensive review explores the emerging connection between vitamin D deficiency and OSA, discusses potential mechanisms underlying this association, and explores the therapeutic implications of these findings. Recent research has consistently highlighted the high incidence of vitamin D deficiency among patients with OSA, which often occurs independently of geographical location. This suggests that factors beyond lack of sunlight exposure may be involved. This review also discusses how reduced vitamin D may be associated with more severe manifestations of OSA. In addition, it explores the potentiality of using vitamin D supplements as a therapeutic strategy for OSA, noting that some studies have found improvements in sleep quality and a reduction in OSA severity. Potential mechanisms are proposed, including the role of vitamin D deficiency in promoting inflammation, oxidative stress, hypoxia, impairing immune function, muscle function, and gene polymorphism of vitamin D receptors, all of which could contribute to the pathogenesis of obstructive sleep apnea. The paper underscores the need for future research to validate these observations, to determine optimal vitamin D supplementation dosage and duration, to explore potential side effects and risks, and to investigate potential interactions with other treatments.

Diet Supplementation with Rosemary (Rosmarinus officinalis L.) Leaf Powder Exhibits an Antidiabetic Property in Streptozotocin-Induced Diabetic Male Wistar Rats

Diabetes mellitus is a metabolic disorder that has a high global health burden and causes high mortality and morbidity in humans. Medicinal herbs and plants offer a promising alternative to conventional therapies for the management of diabetes. Rosemary (Rosmarinus officinalis L.) is a traditional medicinal herb that has been used for the management of several diseases. Therefore, the present study investigates the antidiabetic properties of diets supplemented with R. officinalis leaf powder on streptozotocin-induced diabetic Wistar rats. First, the phytochemicals and 2,2-dephenyl-1-picrylhydrazyl (DPPH) free-radical scavenging activity of aqueous R. officinalis leaf extract were determined. Streptozotocin-induced diabetic male Wistar rats were fed a diet supplemented with R. officinalis leaf powder (ROP) at 3%, 6%, and 12%, respectively, for 6 weeks. Investigations of food intake, body weight, rat relative organ weights, blood glucose, lipid profiles, creatinine, bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were estimated according to standard procedures. The results show that ROP aqueous extract contains significant amounts of phenolics, flavonoids, and tannins, which exhibit in vitro DPPH free-radical scavenging activity. Based on an in vivo study, ROP reduced blood glucose levels in streptozotocin-induced diabetic animals (p < 0.05). Dietary supplementation with ROP in diabetic rats significantly (p < 0.05) lowered ALT, AST, bilirubin, creatinine, total triglyceride (TG), total cholesterol (TC), and low-density lipoprotein (LDL) levels while increasing high-density lipoproteins (HDLs) when compared with the diabetic control group. Our findings demonstrate that a diet supplemented with R. officinalis leaf powder exhibits an antidiabetic potential with improved health outcomes, as demonstrated by the improved lipid and liver profile enzymes in our animal model.

Patterns of health care interactions of individuals with alcohol use disorder: A latent class analysis

IntroductionGiven the high rates at which individuals with alcohol use disorder (AUD) utilize health care for co-existing conditions, health systems are promising venues for interventions that will facilitate access to AUD treatment. However, how individuals with AUD interact with such systems and, thus, how systems should intervene is unclear. In this study, we seek to identify patterns in how individuals diagnosed with AUD within an academic health system interacted with the system prior to diagnosis. MethodsWe use electronic health records from a single academic health system in a major US metropolitan area to create a deidentified retrospective cohort including all individuals age 18+ diagnosed with AUD 2010–2019 (n = 26,899). Latent class analysis (LCA) identified subgroups defined by aspects of previous system interaction and health status, including having an in-system primary care provider, previous utilization of primary and specialty care, diagnosis setting, payer, and presence of other chronic conditions. We then assessed subgroup differences in demographics and associations with in-system AUD treatment receipt in the year following diagnosis, adjusting for demographics. ResultsThe population was on average 38.6 years old (standard deviation = 15.4) and predominantly male (66.1 %), White (64.5 %), and not of Hispanic/Latino ethnicity (87.8 %). Only 4.7 % received in-system treatment following diagnosis. We deemed the four-class model the optimal LCA model. This model identified subgroups that can be described as 1) average utilization (20.7 % of population), 2) low utilization (54.5 %), 3) high health burden and low utilization (14.2 %), and 4) high health burden and high utilization (10.6 %). Predicted membership in the high health burden and high utilization subgroup and low utilization subgroup were associated with higher and lower odds of treatment receipt, respectively, compared with predicted membership in the average utilization subgroup (odds ratio (OR) for high/high subgroup = 1.21, 95 % confidence interval (CI) = 1.01, 1.27; OR for low subgroup = 0.29 95 % CI = 0.24, 0.34). ConclusionIndividuals diagnosed with AUD within a health system interact with that system in markedly different ways and are unlikely to benefit uniformly from system-based interventions to facilitate treatment. Group-tailored interventions are more likely to have impact and provide returns on investments for systems.

Injury and illness among Norwegian Olympic athletes during preparation for five consecutive Summer and Winter Games

ObjectiveTo describe the patterns of health problems among Norwegian Olympic candidates during their preparations for five consecutive Olympic Games (London 2012, Sochi 2014, Rio de Janeiro 2016, PyeongChang 2018 and...

Abstract 18359: Association of Depressive Symptoms and Risk of 30- and 90-day Hospital Admissions in Patients With a New or Worsening Diagnosis of Peripheral Artery Disease

Introduction: Patients diagnosed with Peripheral Artery Disease (PAD) often present with a complex profile of comorbidities, including a high mental health burden. Depressive symptoms are associated with worse long-term PAD outcomes, but it is unknown whether they translate into a higher short term hospital admission. Methods: Patients with a new or worsening PAD diagnosis (Rutherford 1-3) enrolled at US in the PORTRAIT registry from 2011-2015 were included. The 8-item Patient Health Questionnaire assessed depressive symptoms (scores 0 to 24, higher scores more depressive symptoms). The Youden Criterion based on time-dependent receiver operator curves was used to describe high vs. low-risk admission groups. Adjusted Cox regression models generated risk estimates associated with continuous PHQ-8 scores and all-cause, cumulative 30- and 90-day admissions based on patients’ medical records. Results: We included 669 patients in the analysis (mean age 68.6 ± 9.6 years, 57.6% male, 73.0% white). The mean PHQ-8 Score was 4.8 ± 5.2; 61.9% was classified as low- (PHQ-8 <5) vs. 38.1% high-risk (PHQ-8 ≥ 5) for admissions based on the Youden Criterion. Patients in the low-risk vs. high-risk group had admission rates of 7.7% [95% CI 5.5-10.7] vs. 12.9% [95% CI 9.5-17.5] at 30 days (p-value: 0.023) and 16.2 [95% CI 13.1-20.0] vs. 25.6% [95% CI 21.0-31.0] at 90 days (p=0.002). In the adjusted model, depressive symptoms (per 1-unit increase) were independently and proportionally associated with 30-day (HR=1.06, 95% CI 1.01-1.11; p=0.026) and 90-day (HR=1.04, 95% CI 1.01-1.08; p=0.021) admissions following PAD diagnosis (e.g. those with scores >20 had a >20% or >30% 30- and 90-day admission risk, respectively) (Figure 1). Conclusion: Thirty- and 90-day admission risk for patients with a new or worsening PAD diagnosis is high, especially for those with depressive symptoms. Value-based PAD care should include screening and integrated care pathways for depression to mitigate this risk.

Forgotten and without Protections: Older Adults in Prison Settings.

The number of older adults incarcerated in prisons is growing significantly, and there is a great need for legal authority, processes, and resources to mitigate individual and social burdens of elder neglect and abuse within these settings. Older adults in prison may be particularly vulnerable to abuse, neglect, or exploitation. They are dependent on the carceral system for basic resources, are at risk for retaliatory actions for reporting mistreatment, and bear disproportionately high health burdens. This essay first considers standards and resources for mitigating elder mistreatment in the community and residential-care settings in contrast to the available resources in prisons. Arguing that a conceptual model of elder abuse tailored to the prison population is needed, the essay proposes a research agenda through which such a model could be developed. The model could then be used in the creation of policy for detecting and mitigating elder mistreatment of incarcerated people. The essay concludes with a call to action to address the rift in legal protections and processes that leave older adults in prison at increased risk of abuse and neglect without a clear pathway for recourse.