National Sample Research Articles

Survivorship care plans and adherence to breast and cervical cancer screening guidelines among cancer survivors in a national sample

Abstract Purpose The impact of the components of survivorship care plans on adherence to cancer screening guidelines among cancer survivors is limited. We examined the association of receipt of treatment summaries, follow-up instructions, and type of doctor providing survivorship care with adherence to breast cancer screening (BCS) and cervical cancer screening (CCS) guidelines in female cancer survivors. Methods A cross-sectional analysis using Behavioral Risk Factor Surveillance System (BRFSS) data from 2014, 2016 and 2018 was conducted. BCS and CCS-eligible women were aged 40–74 and 30–64, respectively. BCS adherence was defined as a mammogram within 2 years and CCS adherence as a pap smear within 3 years or HPV test within 5 years. Univariate analysis with chi-square and multivariable logistic regression are reported. Results 5,001 BCS and 3,014 CCS-eligible survivors were identified. In the BCS group, recipients of treatment summaries and follow-up instructions were significantly more adherent with BCS (84.1% vs. 77.4%; 83.4% vs. 74%, respectively, p < 0.001). In the CCS group, recipients of follow-up instructions were significantly more adherent with CCS (78.1% vs. 67.7%, p < 0.001). In both groups, there was no significant difference in BCS or CCS based on type of physician providing care (p = 0.087). On multivariate analysis, receipt of follow-up instructions was the only factor significantly associated with BCS (OR:2.81; 95%CI:1.76–4.49) and CCS (OR:3.14; 95%CI:1.88–5.23). Conclusions Follow-up instructions, as part of survivorship care plans, have the strongest association with BCS and CCS among female cancer survivors. Additional research should focus on improving the distribution of survivorship care plans, particularly follow-up instructions, as a method to increase BCS and CCS among cancer survivors.

Lingering Effects of Loss? Widowhood and Substance Use in the LGB Population

Little is known about widowhood's effects on externalizing expressions of distress, like substance use, among sexual minorities. Our study is the first to address this issue using a large national sample of LGB individuals living in the United States. Using the 2010 Aging with Pride: National Health, Aging, and Sexuality/Gender Study ( n = 2,258), we ran logistic regression models predicting current smoking, past 30-day binge drinking, and past year drug use. Widowhood predicted higher odds of drug use. These results were found for currently partnered individuals, suggesting that widowhood's effects are not completely offset by current partnership. In contrast, widowhood did not predict smoking or binge drinking. All results held for women and men. Results suggest that LGB widowhood's effects on substance use vary by current partner status and substance type. These findings contrast with those of studies examining widowhood's effects on internalized expressions of distress, which consistently find detrimental effects.

Assessing Current Knowledge of Hearing Impairment With Diabetes by Surveying Providers With CBDCE Certification.

The purpose of this study was to assess current knowledge, attitudes, and practices regarding hearing impairment and screening referrals in patients with diabetes among providers who have a Certified Diabetes Care and Education Specialist (CBDCE) Certification. A cross-sectional survey created through Qualtrics was emailed to health care providers in the United States with CDCES certification. Providers responded regarding knowledge and importance of hearing impairment compared to other diabetes complications, when they would refer a patient to an audiologist, the percentage of patients referred, and awareness of over-the-counter hearing aids. Descriptive statistics were calculated for all questionnaire items. One thousand four hundred and ninety-five CDCES providers completed the survey. Participants selected the most common conditions associated with diabetes as kidney dysfunction (96.7%), retinopathy (96.5%), obesity (95.6%), and foot infection (94.5%); 44.5% chose hearing impairment. Over 60% of providers were not familiar with how to refer patients to an audiologist and acknowledged being unfamiliar with recommended screening frequency as the most common barrier. Most providers had referred fewer than 20% of patients to an audiologist. Over half of providers were not aware of over-the-counter hearing aids. Among a national sample of health care providers with comprehensive knowledge in diabetes care, many providers do not associate hearing impairment with diabetes and rate other microvascular complications of higher importance.

Instructor recommendations for student learning strategies and metacognition: An analysis of undergraduate biology syllabi

AbstractAn inequitable distribution of resources and opportunities for marginalized students (i.e., opportunity gaps) leads to challenges in identifying effective study behaviors, metacognition, and academic help‐seeking in higher education. While students benefit when these skills are taught explicitly through co‐curricular workshops and courses, these interventions often require significant time investment from faculty and students, underscoring a need for alternative interventions that provide students with access to resources related to these skills. Course syllabi are one potential resource that can address these needs, and we asked to what extent biology syllabi are used for this purpose. We collected a national sample of introductory biology syllabi and used content analysis to determine if syllabi are learner‐centered and whether they incorporate information on study behaviors, metacognition, and academic help‐seeking. We found that most syllabi are not learner‐centered, encourage ineffective study behaviors, did not include metacognition recommendations, and include incomplete academic help‐seeking recommendations. We make several recommendations on how to incorporate complete, accurate information regarding study behaviors, metacognition, and academic help‐seeking.

Between east and west, between past and future: The effects of exclusive historical victimhood on geopolitical attitudes in Hungary and Serbia.

In Eastern Europe, collective victim beliefs have become integral elements of national ideologies, especially amid rising geopolitical polarization. In this study, we investigated how exclusive victimhood was related to geopolitical attitudes in Hungary and Serbia. The study involved Serbian (N = 630) and Hungarian (N = 471) adult national samples stratified by gender, age, political orientation, and place of residence. As expected, exclusive victimhood predicted higher support for a geopolitical shift from the West (i.e., EU and US) to the East (i.e., Russia and China) via Euroscepticism in both samples. In Serbia, the strongest indirect effect was observed among participants with neutral attitudes towards the war in Ukraine. In Hungary, there was no expected moderated mediation while the direct effect of exclusive victimhood on the West-to-East geopolitical shift was largest for pro-Russian participants and non-significant for pro-Ukrainian participants. Different measures of ethnic identity showed no expected moderation effect, but an exploratory analysis revealed that exclusive victimhood partially mediated the relationship between identity measures (superiority and attachment) and support for a pro-Eastern (vs. pro-Western) geopolitical orientation. We discuss how the construals of the past based on exclusive victimhood shape future geopolitical preferences of the public in Hungary and Serbia.

Beyond Dichotomy: Understanding Violent Offending and Victimization Among Immigrant Youths

ABSTRACT Research has suggested a pattern of lower levels of crime and victimization among first-generation immigrants than subsequent generations. A distinct drawback of most previous research is its focus on the premise of immigrants as either aggressive offenders or submissive victims. Little is known about the co-occurrence of these roles among immigrant groups. Using a longitudinal, national representative sample of school-aged adolescents in the U.S. this study provides an empirical assessment of how generational differences in violent offending and victimization vary when the victim-offender is considered a group separate from victim only and offender only. The findings of this study shed light on our understanding of the often-understudied topic of the victim – offender overlap among immigrant adolescents and can help identify specific targets for anti-violence/victimization intervention and prevention programs.

Contemporary comparative surgical outcomes of type A aortic dissection in US and China: an analysis of the national inpatient sample database and a Chinese multi-institutional registry.

To investigate the contemporary comparative inpatient prognosis among US and Chinese patients with type A aortic dissection (TAAD). Data from Chinese multi-institutional TAAD registry and the US National Inpatient Sample databases were analyzed. We used multivariable logistic regression models to compare in-hospital mortality and perioperative complication rates between the US and China. Length of stay and overall costs were fitted with quantile regression models. Independent prognostic factors associated with post-operative survival were assessed via Cox proportional hazards models. Among 3,121 eligible TAAD patients, 1,073 were from China (25.0% female; mean ± SD age, 53.9 ± 12.4) and 2,048 were from the US (31.2% female; mean ± SE age, 59.8 ± 0.3). During the study period, the in-hospital mortality rates in China and the US were 15.5% and 13.3%, yet the difference was insignificant after adjustment (aOR, 1.16; 95% CI, 0.69-1.97). While there was no significant difference in overall perioperative complications (aOR, 1.07; 95% CI, 0.52-2.18), the patterns of complications differed between two cohorts. While Chinese TAAD patients experienced significantly longer duration of hospitalization (median difference, + 10.4 days; 95% CI, 9.2-11.5), the US TAAD cohort had significantly greater overall hospitalization costs (49.9; 95% CI, 55.4-44.5, in 1000 USD). Notwithstanding significant differences in demographic and clinical characteristics, TAAD patients from China and the US demonstrated comparable in-hospital mortality and overall perioperative complication rates. Future initiatives should focus on expanding surgical eligibility to the elderly Chinese TAAD patients and optimizing the duration of hospitalization without undermining meaningful clinical outcomes. KY20220425-05, April 5th 25 2022.

Warm glow feelings can promote green behavior

Abstract For climate mitigation to be successful, vast numbers of people must change how they go about daily life. Social scientists have tried to promote environmentally-sustainable (i.e., “green”) behavior with interventions involving cues, frames, and information, but the cumulative impact of those efforts has been modest. A growing number of studies—largely observational—suggests the promise of “warm glow” messaging that features the pleasure and satisfaction one experiences from acting sustainably. While past work has established the association between intrinsic motivations and green behavior, our study offers novel evidence regarding the causal effect of warm glow feelings in the climate domain. In three survey experiments administered on different national samples, we induce feelings of warm glow and examine the impact on green behavioral intentions. The treatment, an adaptation of a standard feeling induction, has a significant influence on a wide range of actions—an effect that is distinct from the influence of general positivity. Most importantly, we observe the largest treatment effects in surprising places: among Republicans, and within this subgroup, on more socially visible activities. Manipulated warm glow also increases intentions to engage in more difficult (e.g., costly, effortful) activities. Our findings are valuable for scholars and practitioners seeking to promote broad-based climate mitigation across the ideological spectrum.

Mindful eating and diet quality among U.S. adults with lower incomes.

Mindful eating, a practice that encourages attention to sensations and awareness during the eating experience, has shown effectiveness in inducing positive behavioral changes. Mindful eating practices have been examined in relation to energy intake (i.e., quantity of food) but to a lesser extent to the quality of that food, hence, it is crucial to comprehensively understand the association between mindful eating and diet quality. The objective of this study is to examine the association between mindful eating and diet quality among United States (U.S.) adults with lower incomes and to examine heterogeneity in the associations by gender identity. This study employs a cross-sectional study design. In December 2022, a national convenience sample of 1,798 U.S. adults with lower incomes, recruited through Prime Panels, completed a web-based survey. Diet quality was measured using the 30-day Prime Diet Quality Score screener (ranges from 0-126). A higher score reflects higher diet quality. Associations between the Mindful Eating Questionnaire (MEQ) (ranges from 1-4) and its four factors (Awareness, External Cues, Emotional Response, and Distraction) in relation to diet quality were examined using multivariable regression models, adjusting for sociodemographic covariates. The mean MEQ score was 2.30; the mean PDQS-30D score was 50.2. The associations between MEQ scores and PDQS-30D scores were significantly modified by gender identity. Among men, a higher MEQ score reflecting more mindful eating (β=3.81, 95% CI: 2.19, 5.43) was associated with higher PDQS-30D scores. In addition, a higher Awareness factor score (β=3.21, 95% CI: 2.48, 3.93), a higher External Cues factor score indicating less response to external cues (β=0.76, 95% CI: 0.01, 1.52), and a higher Distraction factor score indicating less distraction (β=1.09, 95% CI: 0.28, 1.90) were all associated with higher PDQS-30D scores. Among women, a higher Awareness factor score was associated with higher PDQS-30D scores (β=2.50, 95% CI: 1.78, 3.22); and a higher Emotional response factor score (i.e., eating less in response to emotional eating) was associated with lower PDQS-30D scores (β=-0.85, 95% CI: -1.58, -0.12). Mindful eating and its factors are associated with a higher diet quality among U.S. adults with lower incomes, particularly among men. Future longitudinal and intervention studies are warranted to better understand these associations among adults with lower incomes, as an understudied population in the mindful eating literature.

Protocol for the development and piloting of a cluster randomised controlled trial for stress prevention, management, and coping mechanism among police officers in Nigeria.

Policing is a stressful occupation. Police officers are exposed to stressors that are inherent in the organization and operations of law enforcement. Similar to their counterparts around the world, many Nigeria police officers are exposed to high levels of stress, making them vulnerable to stress-related mental health conditions and other noncommunicable diseases. Despite these risks and their consequences to the health and safety of police officers and the larger society, interventions are currently not available to address this challenge in Nigeria. This pilot study aims to assess the burden of stress from a national sample of police officers and test the feasibility of an intervention for stress prevention, management, and coping mechanisms among police officers in Nigeria. This is a three-phase study: (1) a needs assessment and situational analysis using a convergent parallel, mixed-methods approach to determine the prevalence of stress and mental health burden among 1200 police officers in four randomly selected states in four geopolitical zones of the country, (2) the development of a peer-led intervention for stress prevention, management, and coping mechanism which will be tested using a cluster randomized trial among 200 police officers, and (3) the preliminary evaluation of the intervention based on knowledge about stress management and mental disorders and psychological distress and reduction in stress levels. These measures will be obtained at baseline (T0), immediate (T1), and 6-month post-intervention (T2). Feasibility will be determined based on enrollment rate, attendance, and completion of the group sessions. Multivariable linear regression models taking into account clustering effects will be used to estimate between-group differences in outcome measures. Findings from the study will inform policy review and the development of a pragmatic intervention on stress prevention and management among police officers. This will enhance the policing role of officers, thus contributing to the safety of the communities they serve. PACTR Registry: PACTR202310474721238. Registered on 6 October, 2023. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25663 . Protocol version number 1.0 (date: 6 October, 2023).

Association of vaping with respiratory symptoms in U.S. young adults: Nicotine, cannabis, and dual vaping.

Although studies have found nicotine and cannabis vaping to be individually associated with respiratory symptoms, little is known about the harm of dual vaping. We aim to assess the association of nicotine-only, cannabis-only, and dual vaping with respiratory symptoms. Using a national sample of 8033 U.S. young adults (ages 18-24) interviewed in 2021, we employed multivariable logistic regressions to assess the association between vaping behaviors and past 12-month respiratory outcomes. Of all participants, 75.4 % did not vape, 15.0 % vaped nicotine only, 4.7 % vaped cannabis only, and 4.9 % vaped both. Compared with no vaping, nicotine-only vaping was associated with sounding wheezy (aPR = 1.75, 95 % CI, 1.28-2.39) and dry cough at night (aPR = 1.43, 95 % CI, 1.19-1.72). Cannabis-only vaping was also associated with these two symptoms, with aPRs at 1.82 (95 % CI, 1.15-2.88) and 1.61 (95 % CI, 1.18-2.21), respectively. In addition to these two symptoms (aPR = 2.24, 95 % CI, 1.42-3.54 for sounding wheezy, and aPR = 1.50, 95 % CI, 1.01-2.22 for dry cough at night), dual vaping was associated with wheezing or whistling (aPR = 1.93, 95 % CI, 1.23-3.04) and high level of respiratory symptoms (aPR = 2.02, 95 % CI, 1.24-3.32). Compared with non-frequent vaping, cannabis-only and dual frequent vaping were associated with higher risks of wheezing or whistling. Nicotine-only and cannabis-only vaping were associated with two respiratory symptoms while dual vaping with four. The elevated respiratory risk of dual vaping warrants future research on the underlying mechanisms of different vaping behaviors and respiratory outcomes.

Teaching social skills that enable learning and healthy relationships of high achieving students

Social skills are critical behaviors that enable students to effectively navigate their social lives. Further, social skills function as protective factors against emotional behavior concerns and enable strong academic growth. Social skills can be developed and improved via programs implemented in schools. Students identified as gifted have long faced stereotypes as “nerds” or “geeks” with strong academic but weak social skills. Yet, there are few studies investigating the social skills of these students. Thus, we explicated the definition of social skills, their importance, and instructional approaches supported by research. Further, we utilized a national sample of students who provided self-ratings ( N = 325) or were rated by teachers ( N = 322) to compare the social skills and emotional behavior concerns of students identified as gifted or not gifted. Results indicated few differences with notable exceptions for teacher rated cooperation and responsibility skills. Implications for further research and practice are discussed.

The impact of reminders on representativeness and survey estimates among web-mode invited in the Danish National Health Survey.

Declining response proportions in health surveys may lead to increased non-response bias. Multiple reminders are often used to increase response proportions, and, thus, we aimed to determine if the use of reminders decreased the magnitude of non-response bias among web-mode invited in the Danish National Health Survey 2023. In the Danish National Health Survey 2023, a national random sample of 23467 individuals (aged ≥16 years) with residence in Denmark were invited by a secure electronic mail service. Invited individuals received up to five inquiries: (i) web invitation, (ii) web reminder, (iii) paper invitation including a questionnaire and a prepaid return envelope, (iv) paper reminder, and (v) paper reminder including a questionnaire and a prepaid return envelope. The cumulative response proportions after first-, second-, third-, fourth-, and fifth inquiries were 19.1%, 28.9%, 37.2%, 39.3%, and 42.0%, respectively. In general, third, fourth, and fifth mailing respondents were more often men, at younger ages, with non-Western backgrounds, and unmarried compared to first mailing respondents. Furthermore, third, fourth, and fifth mailing respondents were in general found to have less favorable health behavior than first mailing respondents, but also a lower prevalence of fair or poor self-rated health and long-standing health problems. In conlusion, reminders are an effective way to increase the response proportion. Furthermore, the use of reminders was found to decrease the magnitude of non-response bias; however, the decrease was small due to the low number of individuals responding after fourth and fifth inquiries.

Abstract 4144567: Prevalence of Atrial Fibrillation in Amyloidosis and Their Association: A 5-Year Nationwide Analytical Cross-Sectional Study

Background: Atrial fibrillation (AF) is a common cardiac arrhythmia associated with significant morbidity and mortality. Amyloidosis (AM) is characterized by the accumulation of amyloid protein in various anatomical sites, including the heart, atria, and ventricles. This amyloid infiltration leads to adverse chamber remodeling, predisposing patients to tachyarrhythmias such as atrial fibrillation/flutter. This study aims to re-evaluate the association of AM with AF by using the large nationwide inpatient database over a total duration of 5 years. Methods: An analytical cross-sectional study was conducted utilizing the data from a survey-weighted national inpatient sample database covering admissions from Jan 2017 to Dec 2021. A total of 147,015,073 admissions of patients aged 18 years and above were included. Descriptive statistics and univariate logistic regression models were used to calculate prevalence rates and odds ratios (OR), respectively. The multivariate logistic regression model was then used to adjust various potential confounders, including age, gender, race, income, hypertension, diabetes, stage 3 or above chronic kidney disease (CKD), Charlson comorbidity index, and hospital-related factors. Results: The 5-year prevalence of AF was 36.73% and 15.42% in admissions with and without AM, respectively. Significant differences between the with AM and without AM groups were in mean ages (72.40 vs. 58.08), female (41.83% vs. 56.92%), race of Black (24.57% vs. 15.40%), and CKD stage 3+ (44.83% vs. 16.65%), respectively. The univariate logistic regression analysis showed an OR for AF of 3.18 (95%CI: 3.102 - 3.267, P<0.000) in admissions with AM compared to those without. After adjustment for the potential confounders, the OR for AF decreased to 1.64 (95%CI 1.597- 1.686; P<0.000) in patients with Amyloidosis compared to those without. Conclusion: This study confirms a significant association between amyloidosis and atrial fibrillation, demonstrating that patients with amyloidosis have a markedly higher prevalence of atrial fibrillation compared to those without. Univariate analysis showed an odds ratio of 3.18 for atrial fibrillation in amyloidosis patients, which remained significantly elevated at 1.64 after adjusting for confounders. These findings indicate the need for a comprehensive workup of suspected atrial fibrillation in amyloidosis patients. Further research should investigate the mechanisms behind this association and potential prevention.

Abstract 4144525: An Observation Of Racial Disparities In Patients Admitted With St Segment Elevated Myocardial Elevation

introduction: This sudy explores the multifaceted nature of racial disparities among patients admitted with STEMI, shedding light on the complex interplay of social, economic, and healthcare factors that contribute to differential outcomes among diverse populations. Methods: we examined the national inpatient sample 2017-2020 for adult admitted with st segment myocardial infarction,we compared the clincal outcome based on racial distribution.STATA 18th edition was used for analyses. Age, gender, race, hypertension, diabetes, obesity, dyslipidemia, and Elixhauser comorbidity index were identified as confounders by univariate analyses and tested further with multivariate logistic regression models. The primary outcome was mortality. Secondary outcomes were the need for intubation, cardiac arrest, length of stay (LOS), and total hospital charges. Results: There were 826315 hospitalizations with STEMI. Mean age was 64 yrs and 62% were male. Among the admitted patients, Caucasians were 593575 (72%), Blacks were 75025(9.1%),Hispanics were 69605(8.4%), Asians were 23734(2.9%). All-cause mortality in patients admitted with STEMI was 88125 where subgroup Analysis with Caucasians, Blacks ,Hispanics and Asians had 60074(10.1%) vs 9135 (12.1%) vs 7645(10.9%) and 2999(12.6%) respectively. Further subgroups analysis revealed that Blacks (13.9%, aOR 1.37 CI 1.28-1.47,P value<0.001) were more likely to require intubation,followed by Asians(13.5% aOR 1.59 CI 1.43--1.76, p value <0.001) ,then Hispanic (13% aOR 1.45,CI 1.35-1.56 P vale <0.001)and caucasians were least likely to require intubation(9.7% ) Finally, racial subgroup showed significant primary andsecondary outcomes that are presented in Table 1. Conclusion: All obtained results revealed statistical significance and we considered Caucasian population as baseline. Mortality waa highest amongst Asians,followed by Blacks then Hispanics and least in the caucasian subgroup. Understanding these disparities is essential for improving healthcare equity and ensuring that all patients receive appropriate and equitable care regardless of their racial or ethnic background.

Abstract 4136267: Racial and ethnic disparities in-hospital outcomes after out-of-hospital cardiac arrest: Insight from the United States national inpatient sample

Background: Out-of-hospital cardiac arrest (OHCA) continues to have a high mortality with an overall survivability to hospital discharge of less than 10%. Increased bystander cardiopulmonary resuscitation has resulted in better survival after OHCA. Some studies have tackled sociodemographic characteristics and rates of survival, but these are mostly localized studies with varied results. We investigated racial disparities in in-hospital mortality and mechanical circulatory support (MCS) use in OHCA. Methods: Retrospective cohort study based on the 2019-2020 National Inpatient Sample database of the Healthcare Utilization Project. Our population included patients 18 years or older with out-of-hospital cardiac arrest (OHCA) identified using ICD-10 codes. The primary risk factors examined were race/ethnicity categorized into White, Black, and Hispanic. The primary outcome was in-hospital mortality among patients with OHCA. The secondary outcome was mechanical circulatory support (MCS) use. Left ventricular assist device (LVAD), extracorporeal membrane oxygenation (ECMO), and intra-aortic balloon pump (IABP) were identified as MCS. Multivariate regression analysis was used to estimate the odds ratio. Results: During the study period, 26,640 hospitalizations with OHCA were identified, of whom 67,4% were White, 22,9% were Black, and 9,7% were Hispanic. The mean (SD) age of patients with OHCA was 65.2 (16) years old, and Black patients well as Hispanic patients had lower mean age compared to White patients (63.1 vs 63 vs 66.3 years old, p<0.001). A total of 19,425 died (72.9%) and 0.9% needed MCS. Notably, more Hispanics needed MCS, compared to White and Black patients (1.7% vs 0.9% vs 0.4%, p=0.049). In the multivariate analysis, we did not find statistical significance among racial/ethnic groups regarding in-hospital mortality. However, Hispanic patients had higher odds of MCS (OR=2.4; CI 95% 1.05-5.55, p=0.039) compared to White patients. No statistical significance was found regarding the use of IABP or LVAD. Conclusion: Overall, in-hospital mortality was elevated. Moreover, our findings highlight significant racial disparities after OHCA regarding MCS use. More research is needed to identify factors of racial disparities to improve outcomes.

Abstract 4129945: Risk of stroke for AMI treated with temporary mechanical circulatory support: ten-year data from National Inpatient Sample

Objectives: The aim of this study was to assess the risk of stroke for temporary mechanical circulatory support (tMCS) device treated acute myocardial infarction (AMI). Background: Data are limited regarding risk of stroke for temporary mechanical circulatory support (tMCS) device treated acute myocardial infarction (AMI). Methods: The national inpatient sample database was analyzed to identify adults who were hospitalized for AMI between 2012 and 2021, hospitalizations were grouped based on the temporary mechanical circulatory support device. Study design: In the final cohort, there are 8,272,163 (96.0%) weighted hospitalizations treated without tMCS, 265,870 (3.1%) with Intra-Aortic Balloon Pump (IABP) alone, 59,240 (0.7%) with Impella alone, and 16,225 (0.2%) with Extracorporeal Membrane Oxygenation (ECMO) used during the hospitalization. Results: The overall stroke rates for patients who treated without tMCS, IABP alone, Impella alone, and ECMO group were 3.41%, 3.46%, 4.51%, and 13.34% respectively. Specifically, the rates of ischemic stroke for these groups were 2.95%, 3.12%, 3.96% and 10.11% respectively. The rates for hemorrhagic stroke were 0.68%, 0.55%, 0.81%, and 4.90% for the same groups. In the stepwise forward Cox regression analysis, the adjusted OR (aOR) of ECMO use for overall stroke was 3.04 (95%CI [2.66-3.48]), followed by Impella only use with an aOR of 1.79 (95%CI [1.61-2.00]), and atrial fibrillation (aOR 1.34, 95%CI [1.31-1.38]). The subgroup analysis revealed that hospitalization with age younger than 50 years old, those without hypertension, and those presented with ST-elevation myocardial infarction are at particularly high risk of stroke for ECMO treated AMI. Conclusion: This ten years AMI hospitalizations analysis revealed that ECMO and Impella treatment associated with increased risk of both ischemic and hemorrhagic stroke. Particularly for those younger than 50, those without hypertension, and those presented with ST-elevation myocardial infarction. However, treatment with IABP alone does not increase the risk of stroke.

Characterizing Event-Driven PrEP Use and Investigating its Association with Experiences of PrEP-Related Barriers Among a US National Sample of PrEP Users.

After a decade of implementation in the US, PrEP uptake remains underutilized by communities that would greatly benefit from it. Event-Driven (ED) PrEP is a potential avenue to increase uptake, however very little is known about its use in the US. We analyzed data derived from Together 5000, an internet-based U.S. national cohort of Sexual and Gender Minority (SGM) individuals aged 16-49years and at risk for HIV. First, we looked at predictors of ED PrEP use using a framework based on current US-based PrEP implementation-related variables. Then, we explored whether experiencing certain types of barriers were associated with choice of ED PrEP over daily PrEP using logistic regression analysis. Our findings showed that variables related to education and sexual behaviors were associated with ED PrEP choice, while experiencing barriers to daily PrEP had no effect. We found a gradient effect with education, where individuals who reported having some college had 3 times the odds of taking ED PrEP, those reporting a bachelor's degree had 3.25 times the odds, and those with graduate school education had 7.56 times the odds of choosing ED PrEP compared to those with a high school diploma or less. Individuals who reported having 2 or more hours of lead time for sex had 3.35 times the odds of using ED PrEP (aOR = 3.35, 95% CI 2.23-5.47). Participants who reported having an STI within the last 6months had 60% lower odds of using ED PrEP (aOR = 0.4, 95% CI 0.2-0.72). The use of ED PrEP is a promising pathway for expanding PrEP due to its success and protection levels. Our studies indicated that educational background and behavior influence PrEP choice. Ensuring PrEP candidates and users have access to information about new PrEP types may increase uptake and support implementation efforts.

Life After EBPs: Characterizing Subsequent Engagement in Evidence-Based Psychotherapy After Completion of an Initial Trauma-Focused EBP in a National Sample of VA Patients.

Many Veterans who complete prolonged exposure (PE) or cognitive processing therapy (CPT) report residual symptoms, but it is unclear how to best address the mental health needs of these individuals. Examining patterns of mental health service utilization following completion of these two treatments may provide insight into how to best serve this group of individuals. In a large cohort of Veterans (N = 12,514) who sought treatment in the Veterans Health Administration during Fiscal Years 2015-2019, logistic regression models were used to assess the odds of initiating an additional course of trauma-focused (i.e., PE or CPT) or depression-focused psychotherapy in the year following completion of PE or CPT based on demographic, psychiatric, and treatment effectiveness-related variables. Approximately 9% of Veterans engaged in either trauma-(6%) or depression-(3%) related psychotherapy in the year following discharge from PE or CPT. Factors associated with increased odds of trauma-focused treatment initiation included having a sleep disorder diagnosis (OR = 1.23), a substance use disorder diagnosis (OR = 1.27), or experiencing military sexual trauma (OR = 1.64). Factors associated with increased odds of depression-focused treatment initiation included having a depression diagnosis (OR = 2.02). This study suggests that certain subgroups of Veterans who engage in PE or CPT (e.g., Veterans with comorbid sleep or substance use problems) are more likely to seek additional evidence-based treatment and may require augmentations to maximize clinical benefits, either during the initial course of treatment or subsequent to PTSD treatment.

Abstract 4138019: eQTL Analysis of the PAH Biomarker CCN2 Identifies a Novel SNP that Associates with Survival

Background: We recently determined that cellular communication network factor 2 (CCN2) (also known as IGFBP8) levels associate with metrics of severity, and survival, in pulmonary arterial hypertension (PAH). While genetic variants that modify CCN2 gene expression have been described, the variants across the genome that associate with CCN2 protein levels in human circulation remain unknown. Research Question: We sought to identify genetic variants associated with circulating levels of CCN2 and to determine those variants’ relationship with clinical severity and survival. Methods: Serum CCN2 was measured by ELISA in subjects from a national sample repository, the PAH Biobank. A genome wide association study (GWAS) for CCN2 (natural log transformed) was performed in White idiopathic PAH (IPAH) PAH Biobank participants (n = 768) using Illumina OMNI5 genotypes in plink after standard quality control. Subsequent exploration of the SNP of interest was conducted in a separate dataset of 687 White PAH participants (n=360 IPAH, n=313 APAH) linked to genetic and clinical data, including REVEAL 2.0 risk score assessment (divided into low, medium, and high-risk levels) and outcomes (the STRIDE (Sitaxsentan To Relieve Impaired Exercise) trials cohort). Results: In the PAH Biobank, using GWAS, we found CCN2 levels were significantly associated with rs9493157 (p = 2.8 x10 -12 ) ( Figure A ). rs9493157 is reported in the Genotype-Tissue Expression (GTEx) portal to be an eQTL for CCN2 expression in the left ventricle. In the STRIDE cohort, the hazard ratio (HR) for death was 1.33 (99% CI 1.03 to 1.72) for participants with one or more T alleles (p=0.027; ( Figure B )). On multivariate analysis, the HR for death was 1.28 (95% CI 0.99 to 1.66; p=0.060). Among subjects with the highest REVEAL2.0 risk, those with a T allele had worse survival than those no T allele, with best survival among those with low a REVEAL2.0 score and no T allele. Conclusions: In White PAH subjects, rs9493157 associates with human levels of serum CCN2, a known biomarker for PAH. While additional studies are warranted, the T allele associates with worse survival and may enhance the prognostic value of the REVEAL2.0 risk score.