Percentage Of Persons Research Articles

Impact of interferon-free regimens in patients with chronic HCV and successfully ablated HCC

BackgroundHepatocellular carcinoma (HCC) ranks sixth amongst all cancers and is the 2nd top cause of mortality attributable to cancer.Aim of the workThis study aimed to ascertain the sustained virological response (SVR) to interferon-free regimens in chronic people with HCV after the successful treatment of hepatocellular carcinoma, as well as the percentage of persons who would demonstrate any radiological or laboratory alterations indicating a local or de novo recurrence of HCC.Patients and methodsThis trial was carried out on 90 Egyptian persons with chronic HCV infection who were eligible for treatment with oral antiviral agents (DAAs) with hepatic focal lesion(s). Patients were referred to from both the outpatient clinic and hepatocellular carcinoma clinic at the National Hepatology and Tropical Medicine Research Institute (NHTMRI), and the trial was conducted in the period between October 2017 and May 2021.ResultsFour patients with distant metastasis, three dying from liver-related incidents, received surgical resection, TACE, and RFA treatment, while one patient survived with compensated chronic liver disease. By multivariate logistic regression, we found that AFP is an independent predictor of HCC recurrence, while baseline urea level and FIB4 before antiviral therapy protect against recurrence. PLT was the best predictor, with AFP having a sensitivity of 52% and specificity of 93.8% at a cutoff value of 135 and PCR having a sensitivity of 72%.ConclusionThe HCC recurrence rate was 27.8%, slightly higher than the estimated annual HCC recurrence rate following curative procedures (20%).

Lead Phytomolecules for Treating Parkinson's Disease.

One percent of persons over 65 years of age suffer from Parkinson's disease, a neurological ailment marked by dopaminergic neurons in the nigrostriatal pathway gradually dying and being depleted in the striatum. Parkin and PINK1 gene mutations, which are essential for mitophagy and impair mitochondrial function, are the cause of it. Parkinson's disease is linked to a number of motor and impairment disorders, including bradykinesia, rigid muscles, tremor at rest, and imbalance. Numerous signaling pathways, including α-synuclein aggregation, lead to age-related decline in proteolytic defense systems. Parkinson's disease etiology involves oxidative stress, ferroptosis, mitochondrial failure, and neuroinflammation. Parkinson's disease is significantly influenced by neuroinflammation, which is a result of both innate and adaptive immune responses. The purpose of studying mechanisms and phytomolecules is to assist researchers in creating therapies for Parkinson's disease. Phytomolecules, like curcumin, β- amyrin, berberine, capsaicin, and gentisic acid, exert neuroprotective properties by reducing ROS levels, lessening α-synuclein-induced toxicity, and shielding the cells from apoptosis. In conclusion, the studies presented here provide valuable insights into the potential of various medications for Parkinson's disease treatment. By understanding the mechanisms behind these treatments, researchers can develop more effective treatments for PD.

Breast cancer diagnosis and staging in Chile: A non-randomized survey-based study to assess frequency and delays.

Breast cancer progression involves physiological mechanisms such as metastasis. Delays in diagnosis and treatment increase the risk of mortality and are associated with barriers to healthcare access. In Chile, breast cancer is highly prevalent, and early diagnosis has improved, although disparities in the disease evolution persist. This study characterized diagnostic and staging tests, waiting times, and sociodemographic profiles to identify delays and inequities in care. Survey study. Using a non-probabilistic sample, a questionnaire was applied in an encrypted platform with prior informed consent. The instrument collected data on requested tests, associated times, staging, and sociodemographic characteristics. These variables were analyzed using descriptive statistics, tests of association, confidence intervals, and comparison tests using bootstrapping. A sample of 263 persons was obtained. The most requested tests were biopsy (99.62%) and blood tests (80.23%). The median number of tests requested was six (Q1:4, Q3:8), with a mean of 5.87 (standard deviation: 2.24). No significant differences were observed in the percentage of persons from whom the total number of examinations were requested according to the studied variables. The day-hour-result intervals ranged from 1 to 365 days. The median day-hour-result of the biopsy was 15 days (Q1:10, Q3:30). People between 40 and 49 years old, non-residents of the capital city, belonging to income quintile I, with high school education, from the public health system, with late-stage diagnosis had higher median day-hour-result in biopsy. There was no significant difference in the number of requested tests according to staging (I and II, or III and IV). Biopsy in Chile is the test of choice for diagnostic confirmation in breast cancer. Other tests are requested regardless of the diagnosis stage, contrary to the recommendations of clinical guidelines. Cancer prognosis is crucial, especially in countries with greater inequalities.

Status and Trend of General Education, Technical Education, and Vocational Education by Persons with Disabilities in India: Reflection of three NSS rounds

Abstract : The present study attempts to estimate the status and trend in educational achievement, particularly in technical and vocational education among persons with disabilities in India across gender and social groups. 47th, 58th, and 76th round unitlevel National Sample Survey data were analyzed using the gender parity index, compound annual growth rate, ordered logit model, and binary logit model. Result shows that though the literacy rate among persons with disabilities in India gradually increases over time, still half of the persons with disabilities were illiterate compared to one-fifth of non-disabled peers. A large section of children with disabilities drops out. The transition of education from school level to higher education, technical and vocational education by persons with disabilities was very slow. Only 4.31 percent, 3.08 percent, and 1.08 percent of persons with disabilities received higher education, vocational education, and technical training in 2018. There was a gradual decrease in gender disparity against women with disabilities and turns in favor of women at all levels of general education. However, gender disparity persisted against females with disabilities, in the attainment of technical and vocational training. The attainment of technical education by males with disabilities was three times higher compared to females with disabilities. Strong caste discrimination still exists in all levels of educational attainment against scheduled castes and scheduled tribes. Educational achievement is negatively related to the severity of the disability, household size, and rural-urban areas, but positively to households' economic status. The study draws important policy implications to improve the education of persons with disabilities. Keywords: Caste discrimination, Gender discrimination, General education, Persons with disabilities, Technical Education, Vocational Education

Abstract B150: Social determinants of health and comorbidities increasing inflammation cytokines related to breast cancer in African American and Latinx women

Abstract Introduction: Comorbidities such as obesity, Type-2 diabetes (T2D), and hypertension (HTN) are highly prevalent among under-resourced African Americans (AA) and Latinx, and they are associated with breast cancer (BC) risks and outcomes. Social determinants of health (SDOH) also have been found related to BC incidence, stage, and survival. In addition, elevated inflammatory cytokines may be an underlying factor in comorbidities that contribute to tumorigenesis and adverse cancer outcomes. Limited research has been conducted to explore the process and associations among SDOH, comorbidities, and inflammation cytokines related to BC. The purpose of this study was to fill this research gap using a sample recruited from AA and Latinx communities. Methods: This was a cross-sectional study conducted in South LA. A total of 570 AA and Latinx women with or without BC were recruited. A panel of 19 cytokines from serum samples were measured by Luminex assay. Demographic information, body mass index, comorbidities, and diagnosis/stage of BC were collected from patients’ medical records. SDOH factors were selected from the social vulnerability index (e.g., percentage of persons in poverty, unemployed, with no high school diploma) obtained through Geographic Information Systems. Chi-square tests, independent sample Mann-Whitney U tests, and Cox regression were employed to examine the associations between BC diagnosis/stages, comorbidities, and cytokines. Path analyses were adopted to further explore the associations between SDOH, comorbidities, and cytokines. Results: Among the 570 women, 45.79% had a diagnosis of BC. Over half (50.97%) had ER/PR+, HER2-, and 27.80% had triple negative BC. Results from Chi-square tests showed that a higher percentage of women with obesity (p=.001), HTN (p<.0001), and T2D (p=.024) had a BC diagnosis than those without the comorbidity. Women with obesity had significantly higher levels of Leptin, VEGFα, and MIP1b; women with HTN had significantly higher levels of VEGFα and MIP1b; and women with T2D had significantly higher levels of Leptin and TGFβ1/β2. Leptin was found significantly higher in ER/PR+ BC (p<.0001) and VEGFα was significantly higher in triple negative BC (p=.001). Increasing VEGFα and TGFβ1/β2 reduced BC disease-free survival significantly. The path model showed community poverty and education level did not affect TGFβ1/β2 directly but were indirectly associated with them through obesity and T2D status (p<.01). Community poverty level was indirectly associated with the level of MIP1b through HTN status (p<.01). Conclusions: To eliminate breast cancer disparities, effective interventions are needed that account for the social and community contexts in which women live and are treated. Interventions that target comorbidities of T2D, HTN, and obesity are important to reduce the disparities. Citation Format: Weizhou Tang, Yanyuan Wu, Jaydutt Vadgama. Social determinants of health and comorbidities increasing inflammation cytokines related to breast cancer in African American and Latinx women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B150.

Progress Toward Tuberculosis Elimination and Tuberculosis Program Performance - National Tuberculosis Indicators Project, 2016-2022.

Elimination of tuberculosis (TB) is defined as reducing TB disease incidence in the United States to less than 1 case per million persons per year. In 2022, TB incidence in the United States was 2.5 TB cases per 100,000 persons. CDC's TB program developed a set of national TB indicators to evaluate progress toward TB elimination through monitoring performance of state and city TB program activities. Examining TB indicator data enables state- and city-level TB programs to identify areas for program evaluation and improvement activities. These data also help CDC identify states and cities that might benefit from technical assistance. The 5-year period for which the most recent data were available for each of five indicators: 1) overall TB incidence (2018-2022), 2) TB incidence among non-U.S.-born persons (2018-2022), 3) percentage of persons with drug susceptibility results reported (2018-2022), 4) percentage of contacts to sputum acid-fast bacillus (AFB) smear-positive TB patients with newly diagnosed latent TB infection (LTBI) who completed treatment (2017-2021), and 5) percentage of patients with completion of TB therapy within 12 months (2016-2020). The National TB Indicators Project (NTIP) is a web-based performance monitoring tool that uses national TB surveillance data reported through the National TB Surveillance System and the Aggregate Reports for TB Program Evaluation. NTIP was developed to facilitate the use of existing data to help TB program staff members prioritize activities, monitor progress, and focus program improvement efforts. The following five indicators were selected for this report because of their importance in Federal TB funding allocation and in accelerating the decline in TB cases: 1) overall TB incidence in the United States, 2) TB incidence among non-U.S.-born persons, 3) percentage of persons with drug susceptibility results reported, 4) percentage of contacts to sputum AFB smear-positive TB cases who completed treatment for LTBI, and 5) percentage of patients with completion of TB therapy within 12 months. For this report, 52 TB programs (50 states, the District of Columbia, and New York City) were categorized into terciles based on the 5-year average number of TB cases reported to National TB Surveillance System. This grouping allows comparison of TB programs that have similar numbers of TB cases and allocates a similar number of TB programs to each category. The following formula was used to calculate the relative change by TB program for each indicator: [(% from year 5 - % from year 1 ÷ % from year 1) × 100]. During the 5-year period for which the most recent data were available, most TB programs had improvements in reducing overall TB incidence (71.2%) and increasing the percentage of contacts receiving a diagnosis of LTBI who completed LTBI treatment (55.8%); the majority of programs (51.0%) also had improvements in reducing incidence among non-U.S.-born persons. The average percentage of persons with drug susceptibility results reported in most jurisdictions (28 of 52, [53.9%]) met or exceeded the 5-year national average of 97% (2018-2022). The percentage of contacts to sputum acid-fast bacillus (AFB) smear-positive TB patients with newly diagnosed latent TB infection (LTBI) who completed treatment increased in 29 of 52 (55.8%) jurisdictions from 2017 to 2021, signifying that, for most jurisdictions, steps have been taken to enhance performance in this area. The average percentage of patients with completion of TB therapy within 12 months was at or above the national average of 89.7% in approximately two-thirds (32 of 52 [61.5%]) of jurisdictions. This report is the first to describe a 5-year relative change for TB program performance. These results suggest that TB programs are making improvements in activities that help identify persons with TB and LTBI and ensure patients complete treatment in a timely manner. Use of NTIP data from individual TB programs enables a more detailed examination of trends in program performance and identification of areas for program improvement. Assessing indicator trends by TB program provides an opportunity to gain a better understanding of program performance in comparison to other programs. It can also facilitate communication between programs regarding successes and challenges in program improvement. This information is valuable for TB programs to allocate resources effectively and provide additional context on TB control for public health policymakers.

Association between Asthma and Lower Levels of Physical Activity: Results of a Population-Based Case-Control Study in Spain.

(1) Background: Our aim was to determine changes in the prevalence of physical activity (PA) in adults with asthma between 2014 and 2020 in Spain, investigate sex differences and the effect of other variables on adherence to PA, and compare the prevalence of PA between individuals with and without asthma. (2) Methods: This study was a cross-sectional, population-based, matched, case-control study using European Health Interview Surveys for Spain (EHISS) for 2014 and 2020. (3) Results: We identified 1262 and 1103 patients with asthma in the 2014 and 2020 EHISS, respectively. The prevalence of PA remained stable (57.2% vs. 55.7%, respectively), while the percentage of persons who reported walking continuously for at least 2 days a week increased from 73.9% to 82.2% (p < 0.001). Male sex, younger age, better self-rated health, and lower body mass index (BMI) were significantly associated with greater PA. From 2014 to 2020, the number of walking days ≥2 increased by 64% (OR1.64 95%CI 1.34-2.00). Asthma was associated with less PA (OR0.87 95%CI 0.47-0.72) and a lower number of walking days ≥2 (OR0.84 95%0.72-0.97). (4) Conclusions: Walking frequency improved over time among people with asthma. Differences in PA were detected by age, sex, self-rated health status, and BMI. Asthma was associated with less LTPA and a lower number of walking days ≥2.

Constitutional and Index Assessment of the Physical Development of Young People in the Altai Krai

The aim of the study was to comprehensively assess the indicators of physical development of adolescents subject to the assigned medical commission and young men subject to the military medical commission living in the Altai Krai, taking into account their motor activity by the index method.Material and methods. The study involved 1,186 young people of the Altai Krai aged 14–19 years. Among them there were 558 teenagers subject to the assigned medical commission and 628 young men subject to the military medical commission. Within each group, subgroups were identified in relation to motor activity. Each participant of the study gave voluntary informed written consent. The examination included the determination of 44 anthropometric parameters of the human body.Results. The studied adolescents and young men were harmoniously developed, however, the persons subject to medical commission, in the majority had an asthenic type, while the persons subject to military medical commission had normosthenic without taking into account motor activity. In the group of people with high motor activity, a strong physique was observed. The percentage of hypotrophy was higher in individuals with average motor activity in both study groups. A proportional type of fat deposition was observed in both study groups, however, in persons with average motor activity, the percentage of persons with a gynoid type of deposition was higher. Persons subject to military medical commission had higher Tanner Index scores. During the intragroup analysis, higher indicators of this index were noted in the group of people with high motor activity.Conclusion. The results of the study conducted in groups of adolescents and young men subject to assigned medical commission and military medical commission living in the Altai Krai show the heterogeneity of the study groups. Increased motor activity contributes to the androgenization of adolescents and adolescents in general, an increase in the chest, an increase in body weight.

Effect of tenofovir alafenamide in combination with and without integrase inhibitors on weight gain, diabetes, and hypertensive disorders of pregnancy

ObjectivesWe sought to determine if tenofovir alafenamide (TAF) was associated with excessive weight gain, diabetes (DM), and hypertensive disorders of pregnancy (HDP) in persons with HIV. Study designThis is a retrospective cohort study of pregnant persons with HIV prescribed antiretroviral therapy (ART) during the period of 01/01/2009 to 12/31/2020. Main outcomes measuresχ2 tests were used to compare the proportion of persons with excessive weight gain, DM, and HDP according to ART regimens. Excess total gestational weight gain was calculated using BMI and Institute of Medicine recommendations for weight gain in pregnancy. HDP included gestational hypertension and preeclampsia. Logistic regression models were used to determine predictors of excessive weight gain, DM, and HDP. ResultsWe identified 189 pregnant persons prescribed ART with (30) and without TAF (159). The percentage of persons with excessive gestational weight gain was not significantly different in persons prescribed TAF (32 %) and other ART (17 %), p = 0.2. Persons prescribed TAF were more likely to have HDP (30 %) compared to other ART (9 %), p = 0.001. In the adjusted analysis, DM [aOR 6.2 (95 % CI 1.2–32.7)] and TAF exposure [aOR 3.2 (95 % CI 1.0–8.9)] were significantly associated with HDP. ConclusionDespite similar gestational weight gain, persons with HIV prescribed TAF were more likely to have HDP. Further understanding of the metabolic and cardiovascular impact of ART recommended for use during pregnancy is needed.

#5772 ESTIMATING CKD PREVALENCE AND INCIDENCE USING CROSS-SECTIONAL GERMAN CLAIMS DATA IN PERSONS AGED 70+

Abstract Background and Aims Little is known about trends over time and anticipated improvements in CKD diagnosis after the implementation of the Kidney Disease – Improving Global Outcomes (KDIGO) guidelines in 2012. We investigated CKD prevalence and incidence over time using claims data in persons aged 70+. Method We assessed CKD prevalence and incidence biennially in cross-sectional claims data of the German health insurance fund “AOK Nordost” for persons aged 70+ between 2012 and 2018. Data are available for n = 62,200 persons per year and were sampled equally distributed for five age strata (70-74, 75–79, 80–84, 85–89, ≥90) and for sex. CKD prevalence and incidence were estimated in 2012, 2014, 2016, and 2018 using in- and outpatient ICD-10 diagnoses (N18.3, N18.4, N18.5, N18.8, N18.9, N19). Incidence was defined as prevalent cases without a diagnosis in the four quarters preceding their first CKD diagnosis over all persons at risk (i.e., who were not prevalent in the respective previous year). Results are shown in total (standardized by age and sex using nationwide demographic distributions for a respective year) as well as stratified by age and sex. Cochran-Armitage test was applied to test time trends for incidence and prevalence from 2012–2018. Results Claims data-based CKD prevalence showed a significant constant increase from 0.18 in 2012 to 0.26 in 2018 (p &amp;lt;0.001). This time trend in CKD prevalence was consistent among all age and sex strata (Figure 1). Over the same time period, CKD incidence increased from 0.06 to 0.08 (p &amp;lt;0.001), while the percentage of persons at risk decreased from 0.81 to 0.72 between 2012 and 2018 due to increasing prevalence (Table 1). Both prevalence and incidence estimates were higher in males compared to females in all age strata (Figure 1). Conclusion The present cross-sectional analysis in claims data allows novel insights of CKD prevalence and incidence among older adults in Germany. CKD prevalence increased constantly over time after the introduction of the KDIGO guidelines in 2012. For CKD incidence, we detected only a small increase over the observation period. The extent of time trends for CKD incidence might be underestimated due to increasing prevalence.

Competing (ac)counts of disability: situating prevalence studies in Zambian disability policymaking

Research is a critical starting point for public policy. For disability policy, the calculation of prevalence – the percentage of persons with disabilities in a population – has attracted significant attention. Multiple disability prevalence studies have been conducted in Zambia. We used data from semi-structured interviews about research and the policy process with twelve Zambian disability policy stakeholders to explore perspectives about disability prevalence research and policymaking. Policy stakeholders, disability advocates and policymakers, expressed more interest in prevalence than in other types of research. Participants perceived prevalence research according to three competing priorities: inclusion (‘Involve us [for] good results’), pragmatism (‘We have to use that [number]’), and granularity (‘We need details’). Participants discounted the value of prevalence research that conflicted with their priorities. Better understanding of stakeholder perspectives of disability prevalence can illuminate ways that these perspectives influence the use of research evidence in disability policy making.

Implementing physical activity vital sign as a self-reported measure of physical activity in patients with multiple sclerosis in a clinical setting.

Routinely assessing exercise levels during clinical visits may be a starting point for clinicians to support physical activity inpersons with multiple sclerosis (MS). To evaluate the feasibility and findings of routinely implementing a self-reported physical activity vital sign during clinical visits. Retrospective database review. Outpatient academic MS center. All adult patients of our MS center with confirmed MS presenting for an in-person or telemedicine clinic visit with a physician or nurse practitioner. None. A standard physical activity vital sign representing minutes per week of moderate-to-vigorous exercise was collected. Percentage of persons with MS with a recorded physical activity vital sign was retrospectively evaluated along with demographic characteristics and key findings. Ninety-three percent of patients with MS at our center had a physical activity vital sign recorded in at least one visit, and 86% at the most recent visit. Of 1560 patients with a recorded physical activity vital sign, 24.3% of patients were consistently active (≥150 min/week of exercise), 20.8% were consistently inactive (0 min/week), and the remaining 54.9% were inconsistently active. The physical activity vital sign was inversely associated with BMI (p < .001) and 25-foot walk test times (p < .001), but not associated with biological sex or age. Approximately a quarter of patients with MS with a documented physical activity vital sign met national aerobic exercise guidelines of 150 min/week per the U.S. Department of Health and Human Services. Routine implementation of the physical activity vital sign at our MS center was feasible and helped identify inactive patients who may benefit from physical activity counseling.

PREVALENCE OF BLOOD GROUPA2 AMONG GROUPAAND AB DONORS

The ABO blood group antigens are clinically signicant and their discovery by Landsteiner in 1900 paved way for the performance of safe blood transfusions. These antigens are characterized by their distinct carbohydrate structures attached to the glycoprotein or glycolipid membranes of red blood cells (RBCs). Their expression can also be detected on various human cell and tissue surfaces including sensory neurons, vascular endothelium and platelets. [1] Subgroups of the ABO antigens occur and are characterized by reduced quantities of the antigens on the RBCs and saliva of secretors. [2] Landsteiner &amp; Levine subdivided blood group A into their principal subgroups, A1 and A2. The presence of Asubgroups is due to genetic variations in the coding region which leads to diminished amounts of A substance and higher amounts of H substance on red blood cells. There are weaker subgroups than A2 which do not frequently occur but when present; they show a characteristic decreased Aantigen sites on their RBC and a corresponding increased H antigen activity. [3] The difference between subgroups A1 and A2 is seen in their reactivity with the Dolichos biflorus lectin. The Dolichos lectin specically agglutinates A1 cells, leaving the A2 cells unagglutinated. The ABO antibodies occur naturally in the sera of individuals who do not have the corresponding antigens and can cause haemolysis in-vivo. They are mostly immunoglobulin M (IgM). These antibodies through complement activation can cause severe, life-threatening transfusion reactions due to incompatible ABO blood transfusions. Anti-A1 antibody appears as an atypical cold agglutinin in the sera of few people with group A2 or A2B who do not have the corresponding antigen.[4] One to eight percent of persons with blood group A2 and about 22-35% of persons with group A2B have serum anti-A1. These antibodies may cause discrepancies in ABO blood grouping which can further result in HTR.[5] Rare cases of haemolytic transfusion reaction due to anti-A1 have been reported.[4] It is estimated that about 80% of individuals with antigen A are A1 while the remaining 20% are A2. [5] Among Indians, the frequency of subgroup A2 among group A individuals is 6.58% whiles that of A2B among group AB is 8.99%.[6] Knowledge of the frequency and distribution of blood subgroup A2 will help to enhance blood compatibility testing, population genetic studies, investigation of transfusion reactions, studying disease associations and resolving some medico-legal issues.[7]

Recommended and Prevalent Use of Glucagon-like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter-2 Inhibitors in a National Population-Based Sample.

LettersApril 2023Recommended and Prevalent Use of Glucagon-like Peptide-1 Receptor Agonists and Sodium–Glucose Cotransporter-2 Inhibitors in a National Population-Based SampleShichao Tang, PhD, Hui Shao, PhD, Mohammed K. Ali, MD, Ping Zhang, PhDShichao Tang, PhDDivision of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GeorgiaSearch for more papers by this author, Hui Shao, PhDDepartment of Family and Preventive Medicine, School of Medicine, and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GeorgiaSearch for more papers by this author, Mohammed K. Ali, MDDepartment of Family and Preventive Medicine, School of Medicine, and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GeorgiaSearch for more papers by this author, Ping Zhang, PhDDivision of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GeorgiaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-3051 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: The 2022 consensus report from the American Diabetes Association and European Association for the Study of Diabetes recommended using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among persons with type 2 diabetes (T2D) who have established or are at high risk for atherosclerotic cardiovascular disease (ASCVD), and using sodium–glucose cotransporter-2 inhibitors (SGLT2is) among those with T2D who have established ASCVD, chronic kidney disease, or heart failure or are at high risk for ASCVD (level A evidence) (1).Objective: To estimate, using nationally representative data, the number and percentage of persons with T2D who would meet the recommended criteria and were ...

Development and evaluation of a Massive Open Online Course (MOOC) for healthcare professionals on malnutrition in older adults

BackgroundEducation about malnutrition in older adults is often lacking in the curricula of healthcare professionals. Massive open online courses (MOOCs) are an innovative form of education that can potentially improve the knowledge of healthcare professionals. Objectives(1) to describe the development of a MOOC on malnutrition in older adults and (2) to evaluate the MOOC on the basis of knowledge gained. DesignThe MOOC was developed by following a structured approach. For the evaluation of the MOOC, a cross-sectional descriptive study was conducted. ParticipantsOverall, 1288 nurses, dietitians, medical doctors and other healthcare professionals participated in the evaluation study. MethodsAfter performing a comprehensive literature review, two dietitians specialised in geriatrics developed a summary of potentially important content of the MOOC. Nine European malnutrition experts from different professional areas were then asked to contribute their expertise. The specific MOOC content was developed based on the recent literature and evidence-based guidelines. For the evaluation of the MOOC, a questionnaire with 41 questions was developed. Results were analysed using descriptive statistics and chi-square tests. ResultsThe final MOOC consists of five modules with 15 learning videos and supplementary material. The percentage of persons with good malnutrition knowledge increased from 76.1 % to 89.9 % (p < 0.001), while the percentage of persons with fair or little malnutrition knowledge decreased (p < 0.001). The course significantly improved the participants' knowledge of specific malnutrition topics, namely, methods and instruments to determine the nutritional status of older people, interventions to improve oral intake, medical nutrition and multidisciplinary cooperation (p < 0.001). Overall, 91.5 % of the participants rated the quality of the course as very good or good. ConclusionMOOCs may be an effective tool that can be used to improve knowledge in healthcare professionals. This provides new opportunities for successful multidisciplinary malnutrition management in clinical practice.

COVID-19 Progression: A County-Level Analysis of Vaccination and Case Fatality in Mississippi, USA.

The COVID-19 pandemic has created a severe upheaval in the U.S., with a particular burden on the state of Mississippi, which already has an exhausted healthcare burden. The main objectives of this study are: (1) to analyze the county-level COVID-19 cases, deaths, and vaccine distribution and (2) to determine the correlation between various social determinants of health (SDOH) and COVID-19 vaccination coverage. We analyzed COVID-19-associated data and county-level SDOH factors in 82 counties of Mississippi. The cumulative COVID-19 and socio-demographic data variables were grouped into feature and target variables. The statistical and exploratory data analysis (EDA) was conducted using Python 3.8.5. The correlation between the target and feature variables was performed by Pearson Correlation analysis. The heat Map Correlation Matrix was visually presented to illustrate the correlation between each pair of features and each target variable. Results indicated that people of Asian descent had the highest vaccination coverage of 77% fully vaccinated compared to 52%, 46%, 42% and 25% for African Americans, Whites, Hispanics, and American Indians/Alaska Natives, respectively. The county-level vaccination rate was significantly higher among the minority populations than the White population. It was observed that COVID-19 cases and deaths were positively correlated with per capita income and negatively correlated with the percentage of persons without a high school diploma (age 25+). This study strongly demonstrates that different SDOH factors influence the outcome of the COVID-19 vaccination rate, which also affects the total number of COVID-19 cases and deaths. Vaccine promotion should be given to all populations regardless of race and ethnicity to achieve uniform acceptance. Therefore, statewide policy recommendations focusing on specific community needs should help achieve health equity in COVID-19 vaccination management.

Polypharmacy and multiple sclerosis: A population-based study

Background: Little is known about polypharmacy and multiple sclerosis (MS). Objectives: To estimate polypharmacy prevalence in a population-based MS cohort and compare persons with/without polypharmacy. Methods: Using administrative and pharmacy data from Canada, we estimated polypharmacy prevalence (⩾5 concurrent medications for >30 consecutive days) in MS individuals in 2017. We compared the characteristics of persons with/without polypharmacy and described the number of polypharmacy days, the most common medication classes contributing to polypharmacy and hyper-polypharmacy prevalence (⩾10 medications). Results: Of 14,227 included individuals (75% women), mean age = 55.4 (standard deviation (SD): 13.2) years; 28% (n = 3995) met criteria for polypharmacy (median polypharmacy days = 273 (interquartile range (IQR): 120–345)). Odds of polypharmacy were higher for women (adjusted odds ratio (aOR) = 1.14; 95% confidence intervals (CI):1.04–1.25), older individuals (aORs 50–64 years = 2.04; 95% CI:1.84–2.26; ⩾65 years = 3.26; 95% CI: 2.92–3.63 vs. <50 years), those with more comorbidities (e.g. ⩾3 vs. none, aOR = 6.03; 95% CI: 5.05–7.22) and lower socioeconomic status (SES) (e.g. most (SES-Q1) vs. least deprived (SES-Q5) aOR = 1.64; 95% CI: 1.44–1.86). Medication classes most commonly contributing to polypharmacy were as follows: antidepressants (66% of polypharmacy days), antiepileptics (47%), and peptic ulcer drugs (41%). Antidepressants were most frequently co-prescribed with antiepileptics (34% of polypharmacy days) and peptic ulcer drugs (27%). Five percent of persons (716/14,227) experienced hyper-polypharmacy. Conclusion: More than one in four MS persons met criteria for polypharmacy. The odds of polypharmacy were higher for women, older persons, and those with more comorbidities, but lower SES.

HIV Testing Services Outcomes in CDC-Funded Health Departments During COVID-19.

Organizations offering HIV prevention services have reported interruptions during the COVID-19 pandemic. The national extent of these interruptions and their public health impact remain largely unexplored. Using data from 60 state and local health departments, we compared HIV testing services outcomes in calendar years 2019 and 2020, including the number of Centers for Disease Control and Prevention (CDC)-funded HIV tests conducted, the percentage of persons with newly diagnosed HIV infection (ie, HIV positivity), and the percentage linked to HIV medical care within 30 days after new diagnoses (ie, linkage to care) using χ2 and robust Poisson models. We also assessed the independent associations between the pandemic period (ie, March-December 2020) and the number of COVID-19 cases with monthly HIV testing services outcomes using multivariable robust Poisson models. There was a 46.0% (P < 0.001) reduction in the number of CDC-funded HIV tests conducted in 2020 (n = 1,255,895) compared with 2019 (n = 2,324,421). Although there were fewer persons with newly diagnosed HIV in 2020 (n = 5581 vs. n = 7739 in 2019), HIV positivity was greater in 2020 (0.4% vs. 0.3% in 2019; adjusted prevalence ratio [aPR] = 1.33, 95% confidence interval [CI]: 1.05 to 1.69). When adjusting for the monthly number of COVID-19 cases, the pandemic period was associated with a 56% reduction in the number of monthly CDC-funded HIV tests (adjusted rate ratio = 0.44, 95% CI: 0.37 to 0.52) but 28% higher monthly HIV positivity (aPR = 1.28 95% CI: 1.16 to 1.41) and 10% higher linkage to care (aPR = 1.10, 95% CI: 1.02 to 1.18). Despite increased HIV positivity, a drastic reduction in the number of CDC-funded HIV tests was observed in 2020, affecting the ability to identify persons with newly diagnosed HIV. CDC and health departments will need to expand testing strategies to cover tests not conducted in 2020 while adapting to the continuing pandemic.A visual abstract is available for this article at: http://links.lww.com/QAI/B941.

Time Lag between COVID-19 Diagnosis and Symptoms Onset for Different Population Groups: Evidence That Self-Testing in Schools Was Associated with Timely Diagnosis among Children.

Early identification of COVID-19 cases has been vital for reducing transmission and enabling treatment. In Greece, in autumn 2021 when Delta was the predominant circulating variant, unvaccinated citizens had to be tested before attending activities, and self-testing was required twice a week for students (5–17 years). Here, we describe the time of diagnosis by age group and possible exposure to assess testing strategies (September to November 2021). Information on the presence of symptoms at the time of diagnosis was available for 69,298 cases; 24,855 (36%) were asymptomatic or tested the same day as onset (early diagnosis), 21,310 (31%) reported testing one day after, and 23,133 (33%) did so two or more days after the onset of symptoms. The median lag was 2 days (1–14). Early diagnosis significantly differed among age groups (p-value < 0.001) and was higher among children. For every one-year increase of age, the odds of an early diagnosis were reduced by 1%. Cases exposed during training activities or in settings such as accommodation centers and hospitals were more frequently diagnosed early. The percentage of persons having a positive self-test before a rapid test/PCR diagnosis ranged from 7% in the age group of 60 years and above to 86% in the age group of 5–17 years. The provision of self-tests in schools and increased testing in closed settings led to an earlier diagnosis and probably to a decreased transmission of the virus in the period during which Delta was the predominant variant in Greece. However, more effort is needed for early diagnosis of adults in the community, especially after the onset of symptoms.

Changes in Migration and Mortality Among Patients With Kidney Failure in Puerto Rico After Hurricane Maria

On September 20, 2017, one of the most destructive hurricanes in US history made landfall in Puerto Rico. Anecdotal reports suggest that many persons with kidney failure left Puerto Rico after Hurricane Maria; however, empirical estimates of migration and health outcomes for this population are scarce. To assess the changes in migration and mortality among patients with kidney failure in need of dialysis treatment in Puerto Rico after Hurricane Maria. This cross-sectional study used an interrupted time-series design of 6-month mortality rates and migration of 11 652 patients who received hemodialysis or peritoneal dialysis care in Puerto Rico before Hurricane Maria (before October 1, 2017) and/or during and after Hurricane Maria (on/after October 1, 2017). Data analyses were performed from February 12, 2019, to June 16, 2022.. Number of unique persons dialyzed in Puerto Rico per quarter; receipt of dialysis treatment outside Puerto Rico per quarter; and 6-month mortality rate per person-quarter for all persons undergoing dialysis. Hurricane Maria. The entire study sample comprised 11 652 unique persons (mean [SD] age, 59 [14.7] years; 7157 [61.6%] men and 4465 [38.4%] women; 10 675 [91.9%] Hispanic individuals). There were 9022 patients with kidney failure and dialysis treatment before and 5397 patients after Hurricane Maria. Before the hurricane, the mean quarterly number of unique persons dialyzed in Puerto Rico was 2834 per quarter (95% CI, 2771-2897); afterwards it dropped to 261 (95% CI, -348 to -175; relative change, 9.2%). The percentage of persons who had 1 or more dialysis sessions outside of Puerto Rico in the next quarter following a previous dialysis in Puerto Rico was 7.1% before Hurricane Maria (95% CI, 4.8 to 9.3). There was a significant increase of 5.8 percentage points immediately after the hurricane (95% CI, 2.7 to 9.0). The 6-month mortality rate per person-quarter was 0.08 (95% CI, 0.08 to 0.09), and there was a nonsignificant increase in level of mortality rates and a nonsignificant decreasing trend in mortality rates. The findings of this cross-sectional study suggest there was a significant increase in the number of people receiving dialysis outside of Puerto Rico after Hurricane Maria. However, no significant differences in mortality rates before and after the hurricane were found, which may reflect disaster emergency preparedness among dialysis facilities and the population with kidney failure, as well as efforts from other stakeholders.