Preventive Care Research Articles

Value-Based Care: Implications for nursing.

The concept of value-based care (VBC) shifts the focus from volume to quality in healthcare. For nursing, this means focusing on patient outcomes, preventive care, and cost efficiency. This article discusses the critical role of nurses in VBC, particularly in coordinating care, improving patient satisfaction, and driving overall healthcare effectiveness and value.

Integrated Care for People Living With Rare Disease: A Scoping Review on Primary Care Models in Organization for Economic Cooperation and Development Countries.

Individually rare, rare diseases are collectively common resulting in frequent health system use. Navigating the health system persists as a challenge. Primary care provides longitudinal contact with the health system and is placed to provide integrated rare-disease-care. This scoping review used Joanna Briggs Institute and PRISMA methods with a Consolidated Framework for Implementation Research based data extraction tool to find how integrated rare-disease-care is delivered, enablers and barriers to the same, in primary care settings in contemporary literature in OECD countries. The Primary Care Provider (PCP) role varies from routine primary care to shared-rare-disease-care models. In the 26 papers, the most frequently cited PCP roles included involvement in diagnosis (n = 14), care coordination (n = 16), primary and preventative care (n = 18), management of components of rare-disease-care (n = 13), and treatment monitoring (n = 10). Individuals whose PCP was actively involved in their care were reported to have shortened diagnostic delay, improved transitions of care across the lifespan, reduced unplanned utilization of emergency and hospital services, comprehensive psychosocial care, improved quality of life across environments including home, school and work and improved palliative care experiences. Sufficient communication from specialists, information, resources, time and reimbursement for complex care are still needed. Future integrated-rare-disease-care models should be developed by, or with, PCPs.

Implementation of a Pharmacist-Driven Contraception Service at a Safety-Net Health-System

Background: Access to safe, effective, and appropriate contraception significantly reduces the rates of unintended pregnancies; however, this preventative care is not always easily accessible. There is a high patient demand for contraception visits that is often delayed or unmet due to lack of access to traditional providers. Pharmacists are highly accessible and can help manage this high demand, yet clinical pharmacists as providers of contraception services remains a gap in published literature. Objective: Develop and implement a pharmacist-led contraception service at a safety-net health-system. Methods: A comprehensive pharmacist-led clinical contraception service was created to improve patient access. To support this project, a collaborative practice agreement (CPA) was developed and enhancements were built into an electronic medical record. The CPA allowed the pharmacist to complete contraception-related interventions such as ordering urine pregnancy tests, prescribing hormonal and emergency contraceptives, and manage adverse effects. The piloting pharmacist was available at the Narcotics Treatment Program (NTP) clinic one half-day each week for scheduled and same-day visits. Results: Within the initial five half-day clinic sessions at NTP, the pharmacist had written seven prescriptions, including three for emergency contraceptives. Of all patients seen for this service at NTP, only one had been using a method of contraception consistently prior to their visit. Conclusion: The interventions that were able to be made by the pharmacist highlighted the need for improved access to contraceptives. Pharmacist-managed services in sexual and reproductive health can help fill this gap. Patients also self-reported ease of access as a benefit to this service.

Immigrant experiences of harm in sexual and reproductive healthcare in Spain.

The medical encounter represents a site where patients may be harmed, with intersecting vulnerabilities shaping the risk and nature of this harm. Sexual and reproductive healthcare is an important site for exploring this dynamic. Questions concerning how immigrant women experience sexual and reproductive healthcare abound, with researchers and practitioners calling for greater attention to a population whose experiences are underrepresented in existing literature. As a case site, Spain is a high migration country with a stressed healthcare system where 'good' biomedical outcomes are complicated by institutional and routinised failures in patient care. Semi-structured interviews were conducted with 121 respondents concerning health experiences since immigrating to Spain. This paper draws from 69 respondents, primarily from the Philippines, the Americas, and Europe. Overarching themes included: 1) practitioners expressing dismissive attitudes; 2) practitioners behaving inappropriately and with prejudice; 3) practitioners failing to respect patient autonomy and consent; 4) practitioners mistreating patients during procedures. These issues recurred across treatment contexts, including diagnosis, routine examinations, preventative care, pre-natal care, abortion, pregnancy loss, and childbirth. Consequences include delayed and missed care, physical and psychological harm, and implications regarding migratory, medical, and reproductive futures. Informed by feminist scholarship, this study considers the identities, relations, and practices which contour this institutionally produced harm. The study provides recommendations for improvements in medical training and clinical practice based on identified failures in the care of immigrant patients.

Practice and challenge of age-friendly functional restoration of stomatognathic system based on the strategy of functional tooth loss.

Geriatric oral health care encounters significant challenges with the increase in the proportion of older individuals. Age-related changes in the dentition, muscles, and joints result in a decline in objective masticatory function, subjective restoration requirements, and acceptability among the elderly population, with individual variations influenced by systemic health. Considering functional requirements, the adaptability of stomatognathic and systemic health conditions, health economics and other factors, the authors believe that it should not be limited to the conventional "one-to-one" strategy for replacing missing teeth in geriatric prosthodontics. There is an urgent need for a precise and adaptable restoration strategy that is more suitable for older individuals. The proposal of a new concept of functional tooth loss updates the minimal restoration standards for elderly patients and establishes the theory of age-friendly functional restoration. Based on the restoration strategy of functional tooth loss, this paper proposes a new concept termed "age-friendly functional restoration of the stomatognathic system", which integrates treatment considerations including endodontics, periodontology, mucosa, muscles, temporomandibular joint, and systemic health. Efforts should be made in four areas as follows. Firstly, the "assessment of accessible function" should be enhanced by considering the interrelationship between stomatognathic and systemic health. Secondly, the "evaluation of appropriate function" is supposed to be optimised in view of subjective needs and objective evaluation of the stomatognathic system. Moreover, the "formulation of treatment plans" needs to be accomplished with the aid of assistive technologies, such as artificial intelligence, to accurately exert appropriate functional restoration. Lastly, the "management and maintenance of health" is likely to be strengthened through follow-ups, propaganda and education, and preventive healthcare, so as to improve quality of life and ultimately achieve healthy ageing among older individuals.

Low-dose colchicine for stroke prevention: a systematic overview of systematic reviews and meta-analyses.

Stroke incidence remains a significant concern despite optimized prevention strategies. Colchicine shows potential for improving stroke prevention globally. To summarize efficacy and safety estimates from systematic reviews and meta-analyses (SRMAs) of randomized controlled trials (RCTs) comparing colchicine to usual care or placebo for stroke prevention. We conducted an overview of SRMAs according to the Preferred Reporting Items for Overviews of Reviews guidelines through a systematic search in Pubmed, Embase, and the Cochrane Library. Statistical analysis was performed using RevMan Web. Heterogeneity was assessed with I² statistics. Thirty-two studies were included. Colchicine significantly reduced stroke recurrence (RR 0.46; 95% CI 0.41-0.52; p < 0.0001; I² = 0%; OR 0.44, 95% CI 0.36-0.55; p < 0.0001; I² = 0%) but increased gastrointestinal adverse events (RR 1.54, 95% CI 1.33-1.79; p < 0.0001; I² = 63%; OR 1.60, 95% CI 1.08-2.38; p = 0.0007; I² = 82%). Most SRMAs (93.75%) showed reduced stroke incidence (RR 0.26-0.54), while 65.22% reported increased gastrointestinal events (RR 1.05-2.66). No significant differences were observed in mortality, infection or cancer rates. Overall quality was appraised as high in 28.12%, moderate in 6.25%, low in 40.06%, and critically low in 25% of SRMAs. Data were primarily derived from seven RCTs with low risk of bias. Moderate-quality evidence supports colchicine's benefits and reasonable safety for preventing stroke among high-risk populations. However, stroke was not the primary endpoint in analyzed studies. RCTs directly assessing colchicine for stroke prevention are warranted.

The prevalence of hypoxaemia in paediatric and adult patients in health-care facilities in low-income and middle-income countries: a systematic review and meta-analysis.

Hypoxaemia (low oxygen saturation in blood) is a key predictor of in-hospital mortality, affecting people of all ages with many different conditions. Early detection and treatment of hypoxaemia are critical, but there are few data to quantify hypoxaemia burden outside the child pneumonia population. We aimed to estimate hypoxaemia prevalence for adults and children with acute illness attending health facilities in low-income and middle-income countries (LMICs). We conducted a systematic review and meta-analysis, searching MEDLINE, PubMed, Embase, Cumulated Index in Nursing and Allied Health Literature, Index Medicus, and Google Scholar for studies reporting hypoxaemia prevalence among patients attending health facilities. We included articles with original data on peripheral blood oxygen saturation (SpO2), from an LMIC, published between Jan 1, 1998, and Jan 10, 2023. We included studies in acutely unwell people of any age and with any condition, but excluded those admitted to intensive care units, receiving perioperative care, or attending hospital for preventive or chronic care. We assessed study quality using Joanna Briggs Institute's Checklist for Prevalence Studies. Two reviewers independently conducted title and abstract screening, full-text review, data extraction, and quality assessment, requesting summary data from authors. We reported pooled prevalence of hypoxaemia (typically defined as SpO2 <90%) overall and by condition, using a random-effects meta-analysis model. This study is registered with PROSPERO, CRD42019136622. We identified 9173 unique records from searches and included 213 in meta-analyses involving 601 757 participants. The majority of studies were from the World Bank regions of sub-Saharan Africa (108 [51%] of 213) or south Asia (58 [27%]). The pooled prevalence of hypoxaemia among admitted patients was 24·5% (95% CI 19·9-29·4) for neonates (aged 0-28 days), 12·1% (10·0-14·4) for children (aged 1 month-17 years), and 10·8% (4·9-18·7) for adults (aged ≥18 years). Hypoxaemia prevalence was highest in neonatal and primary respiratory conditions but still common in many other conditions. Hypoxaemia was associated with 4·84 (95% CI 4·11-5·69) times higher odds of death than no hypoxaemia. Hypoxaemia is common across all age groups and a range of primary respiratory and other critical illnesses and is strongly associated with death. These estimates will inform oxygen-related strategies and programmes, and integration of pulse oximetry and oxygen into clinical guidelines, service structures, and strategies for maternal, neonatal, child, adolescent, and adult health. Bill & Melinda Gates Foundation, the ELMA Foundation, and Unitaid.

Disparities in incidence and mortality of colorectal cancer in Appalachian Kentucky.

33 Background: Since the late 1990s, both the incidence and mortality of invasive colorectal cancer (CRC) have decreased across the United States, including in Kentucky. Despite this, CRC incidence and mortality are above national average in Kentucky. Over the last two decades, a disparity in CRC incidence and mortality has emerged between Appalachian Kentucky (AK), a distinct eastern region, and Non-Appalachian Kentucky (NAK). This disparity is attributed to differences in social and structural determinants of health (SSDH) between these populations. Methods: Age-adjusted CRC incidence and mortality rates (2016-2020) for both Kentucky and the U.S. were obtained from the National Cancer Institute’s public database. Data from the Kentucky Cancer Registry were used to compare CRC incidence and mortality rates in AK and NAK counties from 1994-2021. Incidence rate ratio analyses across discrete time periods demonstrated statistical differences between these regions. Results: Compared to national data (2016-2020), Kentucky's CRC age-adjusted incidence and mortality rates were significantly higher: 45.9 vs. 36.5/100,000, 25.8%, for incidence, and 16.2 vs. 13.1/100,000, 23.7%, for mortality (both p&lt;0.0001). From 1995-2003 incidence and 1994-2003 mortality of CRC, were higher in NAK, these rates eventually decreased and equalized between NAK and AK. By 2010-2015 both incidence and mortality rates were higher in AK, 55.8 vs 48/100,000, 16.3%, (p=&lt;0.0001) and 20.1 vs 15.8/100,000, 27.2%, (p=&lt;0.0001) respectively. The most recent data (2016-2021) shows that these significant disparities persist, with AK’s incidence and mortality 51.8 vs 44.1/100,000, 17.5% (p=&lt;0.0001) and mortality 19.0 vs 15.1/100,000, 25.8% (p=&lt;0.0001) higher, respectively. Conclusions: While CRC rates have decreased nationwide and in Kentucky, a pronounced gap in both incidence and mortality has developed between Appalachian and Non-Appalachian Kentucky. Appalachian counties—which are more rural and impoverished—face greater barriers to accessing preventive healthcare, contributing to this disparity. Additionally, AK has higher rates of obesity, poverty, smoking, and lower educational attainment and screening rates . Recent public health efforts, such as promoting stool-based screening and increasing preventive care discussions, aim to reduce these disparities. However, delays in CRC screenings during the COVID-19 pandemic— resulting in approximately 1.7 million missed colonoscopies nationally— may have skewed the most recent data, necessitating further analysis in the coming years.

Decrease in provider stigma is associated with improved quality health indicators among individuals receiving methadone in primary care centers in Ukraine.

People who inject drugs experience poor health and social outcomes which improve with opioid agonist therapies like methadone, yet provider stigma may influence healthcare utilization. In Ukraine, integrating methadone into primary care centers (PCCs) provides an opportunity to examine provider stigma and its impact on patient outcomes. This sub-analysis included patients randomized to receive methadone in PCCs as part of an implementation trial in which the control group received methadone in specialty addiction clinics in Ukraine. Methadone integration in PCCs was supported through continuous tele-education for providers. Provider stigma towards people who inject drugs, methadone, and attitudes towards evidence-based practices were assessed at baseline, 12, and 24 months using standardized scales (range 1-10). Patient-level outcomes were measured bi-annually over 24 months using a quality health indicator (QHI) score, a percentage of guideline-concordant primary and specialty health services accessed. Linear mixed-effects models examined the changes in provider stigma and attitudes, and the association of these measures with patient outcomes. The sample included 583 patients and the 112 providers in 24 clinics. Provider fear and stereotypes toward people who inject drugs improved significantly, by 0.6 (95 % CI 0.2-1.1) and 0.4 points (95 % CI 0.1-0.8), respectively, as did preference for methadone over abstinence-based treatment (0.7 points, 95 % CI 0.2-1.1). A 1-point improvement in provider prejudice correlated with a 7.0-point increase (95 % CI: 1.1-13.0) in patient primary care QHI scores at 12 months, while improved attitudes towards evidence-based practices were associated with an 8.3-point increase (95 % CI: 1.1-13.0). Preference for methadone maintenance over abstinence was associated with a 3.7-point increase (95 % CI: 0.6-6.7) in specialty care QHI scores at 12 months, and reduced stereotypes were associated with a 10.9-point increase (95 % CI: 1.2-20.7) at 24 months. Integrating methadone into PCCs with the support of provider tele-education may reduce provider stigma, particularly fear and stereotypes, toward people who inject drugs and methadone maintenance. Reducing provider stigma has the potential to improve patient outcomes through increased access to preventive care and screenings.

An Innovative Clinic-Based Intervention to Improve Adolescent Access to Sexual and Mental Health Services: The Total Teen Program.

Adolescents encounter numerous healthcare access barriers, leading to poor health outcomes. Researchers developed the Total Teen (TT) program to improve access to sexual and reproductive health (SRH) and mental health (MH) services in settings providing adolescents and young adults (12-25) health services. This pilot study assessed the TT's impact on care across three settings: school-based health clinics, a federally qualified health center, and an adolescent health clinic for 12 weeks. Sociodemographic data, including age, race/ethnicity, gender, and insurance status, were collected. MH was assessed using patient health questionnaire (PHQ)-9 and generalized anxiety disorder (GAD)-2 scales, and sexual health was evaluated based on CDC guidelines and additional evidence-based questions. One-on-one time, confidential consultations, SRH and MH micro visits, and referrals measured access. Descriptive statistics, Pearson Chi-square tests, and Kruskal-Wallis tests compared site outcomes, while logistic regression models adjusted for age, gender, race, and site. Four hundred and fifty-one participated in the TT program across the three sites. Concerning micro visits and referrals, being male was associated with lower depression rates (P = .0003) and generalized anxiety disorder (P = .0099). Being males also predicted micro visit receipt (P = .0199). Concerning SRH micro visits, higher sexual behavior scores (P < .0001) were significantly associated with a greater likelihood of utilizing SRH micro visits. Results indicate that TT improves access to SRH and MH services and referrals for at-risk adolescents. Findings underscore the importance of integrating SRH and MH services into routine adolescent care and involving health organizations and providers as key stakeholders in enhancing preventive healthcare access.

Use of oral health services among pregnant women and associations with gestational diabetes and hypertensive disorders of pregnancy: Insights from the 2016-2020 Pregnancy Risk Assessment Monitoring System.

The authors examined whether use of preventive oral health care services or visits to a dentist or dental clinic for problems during pregnancy is associated with gestational diabetes and hypertensive disorders of pregnancy. Data from the 2016-2020 Pregnancy Risk Assessment Monitoring System, comprising 206,080 unweighted responses, were analyzed using descriptive statistics and multivariable logistic regression. The regression estimates were adjusted for sociodemographic and lifestyle characteristics, health history, geography, and survey year. Women who received a diagnosis of gestational diabetes (7.0%) or hypertensive disorders of pregnancy (13.3%) had lower rates of preventive oral health care and visits to a dentist or dental clinic for problems during pregnancy than those who did not have these health outcomes. Women who did not receive preventive oral health care had 1.13-fold greater odds (95% CI, 1.06 to 1.20) of having gestational diabetes and 1.08-fold greater odds (95% CI, 1.03 to 1.13) of having hypertensive disorders of pregnancy than those who did. Lack of needed visits to a dentist or dental clinic during pregnancy was associated with 1.28-fold greater odds (95% CI, 1.13 to 1.44) of having hypertensive disorders of pregnancy than in women without dental problems. Using oral health care preventive services and visits to a dentist or dental clinic for problems during pregnancy was associated with decreased odds of having gestational diabetes and hypertensive disorders of pregnancy. Health care professionals should emphasize the importance of obtaining oral health care services to promote oral and overall health among pregnant women. Dentists need to improve their knowledge and willingness to treat pregnant women, especially those with pregnancy complications.

De Novo exposomic geospatial assembly of chronic disease regions with machine learning & network analysis.

Determining spatial relationships between diseases and the exposome is limited by available methodologies. aPEER (algorithm for Projection of Exposome and Epidemiological Relationships) uses machine learning (ML) and network analysis to find spatial relationships between diseases and the exposome in the United States. Using aPEER we examined the relationship between 12 chronic diseases and 186 pollutants. PCA, K-means clustering, and map projection produced clusters of counties derived from pollutants, and the Jaccard correlation between these clusters with chronic disease geography (defined as groups of counties with high chronic disease prevalence rates) was calculated. Disease-pollution correlation matrices were used together with network analysis to identify the strongest disease-pollution relationships. Results were compared to LISA, Moran's I, univariate, elastic net, and random forest regression. aPEER produced 68,820 human interpretable maps with distinct pollution-derived regions, and acetaldehyde/benzo(a)pyrene was found to be strongly associated with hypertension (J=0.5316, p=3.89×10-208), stroke (J=0.4517, p=1.15×10-127), and diabetes mellitus (J=0.4425, p=2.34×10-127); formaldehyde/glycol ethers with COPD (J=0.4545, p=8.27×10-131); and acetaldehyde/formaldehyde with stroke mortality (J=0.4445, p=4.28×10-125). Methanol, acetaldehyde, and formaldehyde formed distinct regions in the southeast United States (which correlated with both the Stroke and Diabetes Belts) which were strongly associated with multiple chronic diseases. Pollutants predicted chronic disease geography with similar or superior areas under the curve compared to SDOH and preventive healthcare models (determined with random forest and elastic net methods). Conventional geospatial analysis methods did not identify these geospatial relationships, highlighting aPEER's utility. aPEER identified a pollution-defined geographical region associated with chronic disease, highlighting the role of aPEER in epidemiological and geospatial analysis, and exposomics in understanding chronic disease geography. This work was primarily funded by the BPHC, NHLBI (R03 HL157890) and the CDC, and this work was funded in part by grants from the NIH (U01 HG007691, R01 HL155107, and HL166137), the American Heart Association (AHA24MERIT1185447), and the EU (HorizonHealth 2021 101057619) to JL.

The Association of Social Deprivation Index and Contraception Care in a Statewide Contraceptive Access Initiative.

To examine the association of social deprivation index (SDI) and contraception care in a statewide contraceptive access initiative (PATH4YOU) in Indiana. A cross-sectional analysis was performed to examine associations of participant's chosen appointment type and contraceptive method with age and social deprivation index (SDI). Of the 1201 participants, 45.2% chose a short-acting contraception, 76.9% received in-person care. Those within the highest SDI quartile (greatest social deprivation) chose in-person care (93.1% vs. 63.4%) and long-acting contraception (62.8% vs. 35.6%) when compared to participants within the lowest quartile (p<0.01). This was confirmed by multivariable analysis, which showed that as SDI quartiles increased, OR for in-person care and long-acting contraception increased. Participant chosen type of appointment and contraceptive method were associated with levels of social deprivation. NCT05216003 IMPLICATIONS: Analysis of appointment type and contraceptive method within a statewide contraceptive initiative in Indiana (PATH4YOU) was done and showed differences based on social deprivation quartiles. Those living in geographic areas of greatest social deprivation chose in-person care (vs. telehealth) and long-acting contraception.

A novel framework to build saliva-based DNA methylation biomarkers: Quantifying systemic chronic inflammation as a case study.

Accessible and non-invasive biomarkers that measure human ageing processes and the risk of developing age-related disease are paramount in preventative healthcare. Here, we describe a novel framework to train saliva-based DNA methylation (DNAm) biomarkers that are reproducible and biologically interpretable. By leveraging a reliability dataset with replicates across tissues, we demonstrate that it is possible to transfer knowledge from blood DNAm to saliva DNAm data using DNAm proxies of blood proteins (EpiScores). We apply these methods to create a new saliva-based epigenetic clock (InflammAge) that quantifies systemic chronic inflammation (SCI) in humans. Using a large blood DNAm human cohort with linked electronic health records and over 18,000 individuals (Generation Scotland), we demonstrate that InflammAge significantly associates with all-cause mortality, disease outcomes, lifestyle factors, and immunosenescence; in many cases outperforming the widely used SCI biomarker C-reactive protein (CRP). We propose that our biomarker discovery framework and InflammAge will be useful to improve understanding of the molecular mechanisms underpinning human ageing and to assess the impact of gero-protective interventions.

Association Between Periodontal Health Status and Pregnancy and Delivery Complications in Type 1 Diabetes Mellitus Pregnant Women: A Case-Control Study.

To assess the association between periodontal health and pregnancy or delivery complications in type 1 diabetic (TIDM) and non-diabetic pregnant women. 15 TIDM and 15 non-diabetic primiparous women were enrolled in the prospective case-control study. We compared periodontal status, levels of glycosylated hemoglobin (HbA1c), gestational week of birth, birth weight of a newborn and pregnancy or delivery complications between the groups. TIDM pregnant women gave birth statistically significantly earlier (2 weeks) (p = 0.034), but not before the 37th week of gestation. The odds ratio (OR) for pregnancy or delivery complications was ~ 5 times greater (95% CI: 1.1-26.4; p = 0.033) and for Caesarean section (C-section) ~ 6 times greater (95%CI: 1.2-30.7; p = 0.032) in TIDM group. The association between periodontal disease (PD) and pregnancy or delivery complications was not statistically significant in either group. The presence of TIDM (p = 0.002; R2 = 0.28), a higher bleeding-on-probing/full-mouth bleeding score (FMBS) (p = 0.043; R2 = 0.14), and a higher level of HbA1c (p = 0.026; R2 = 0.16) were statistically significantly more often associated with an earlier gestational week of birth. Higher levels of HbA1c were statistically significantly positively associated with a higher frequency of pregnancy or delivery complications (p = 0.024) and a higher frequency of C-section (p = 0.051). There are strong indications that both endocrinological and periodontal therapy should form a part of preventive prenatal care.

Transportation Insecurity, Social Support, and Adherence to Cancer Screening.

Transportation insecurity and lack of social support are 2 understudied social determinants of health that contribute to excess morbidity, mortality, and acute health care utilization. However, whether and how these social determinants of health are associated with cancer screening has not been determined and has implications for preventive care. To determine whether transportation insecurity or social support are associated with screening adherence for colorectal, breast, and cervical cancer. This cohort study used data from the publicly available 2018 in-person National Health Interview Survey (NHIS) comprising a noninstitutionalized, civilian adult population of the United States. Participants included adults eligible for colorectal, breast, or cervical cancer screening who participated in the in-depth NHIS interview (1 selected per household). Data were acquired in December 2023 and analyzed through July 31, 2024. Transportation insecurity, represented dichotomously as adults who reported that they have or have not delayed medical care in the past year due to transportation difficulties, and neighborhood social support, represented as factor scores derived from 4 Likert-type questions. The primary outcome was adherence to the US Preventive Services Task Force screening recommendations in place during 2018 for colorectal, breast, and cervical cancer. In 2018, of 25 417 NHIS respondents (55% female), 660 (3%) reported delaying medical care because they did not have transportation. In fully adjusted models, transportation insecurity was associated with adherence to breast cancer screening (odds ratio [OR], 0.59 [95% CI, 0.40-0.86]) but not to colorectal (OR, 0.87 [95% CI, 0.65-1.15]) or cervical (OR, 0.73 [95% CI, 0.46-1.13) cancer screening. Social support was associated with colorectal (OR, 1.12 [95% CI, 1.06-1.17]) and breast (OR, 1.13 [95% CI, 1.05-1.22]) cancer screening but not with cervical cancer screening (OR, 1.01 [95% CI, 0.93-1.10]). There were no significant interactions between transportation insecurity and social support for any cancer screening. The presence of transportation insecurity was associated with a 41% reduction in the odds of breast cancer screening. Clinicians should consider screening for transportation needs at the time of mammography referral, as patients may be eligible for programs that can assist with medical transportation needs.

Quercetin triggers cell apoptosis-associated ROS-mediated cell death and induces S and G2/M-phase cell cycle arrest in KON oral cancer cells

BackgroundPlant flavonoids such as quercetin are useful for both the therapeutic and preventive care of a variety of illnesses. Nevertheless, their antitumor efficacy against KON oral cancer is still unknown. Therefore, the aim of this investigation was to examine quercetin’s anti-growth, anti-migrative, and anti-invasive characteristics. The cell cycle arrest property and mitochondrial function disruption of quercetin were also investigated. Additionally, the cellular mechanism responsible for inducing apoptosis and the anti-metastasis mechanism were identified.MethodsKON cells were treated with quercetin in order to test the anticancer activity of this compound. The MTT colorimetric assay was used to examine the cell viability of the treated cells in comparison to MRC-5 fibroblast cells. After being exposed to the detrimental effects of quercetin, the morphology of the KON cells was examined using DAPI and FDA double staining, as well as Hoechst 33,258 and AO double staining. Annexin V-FITC with a flow cytometer and DCFDA labeling were used to detect apoptosis induction and the ROS production associated with cell death. Quercetin’s ability to stop the cell cycle was evaluated via PI staining and the flow cytometer. The examination included anti-proliferative, anti-migration, and anti-invasion activities. Values for the transepithelial electrical resistance, or TEER, were measured. Ultimately, the mechanisms of action of the apoptotic markers and genes implicated in the metastatic process were clarified.ResultsQuercetin treatment reduced the vitality of KON cells and had minimal effect on MRC cells. Following quercetin treatment, the characterization of apoptosis and cell death in KON cells was observed. When quercetin was applied to KON cells, the generation of ROS increased. Furthermore, it was discovered that quercetin increased the percentage of dead cells and cell cycle arrests in the S and G2/M phases. Moreover, quercetin inhibited KON cells’ capacity for migration and invasion in addition to their effects on cell stability and structure. As a result of identifying the mechanism responsible for inducing apoptosis and preventing metastasis, quercetin was found to downregulate the expression of BCL-2/BCL-XL while increasing the expression of BAX. TIMP-1 expression was upregulated while MMP-2 and MMP-9 were downregulated. Quercetin’s anticancer properties and specific mechanisms of action in relation to KON cells were clarified.ConclusionQuercetin is greatly cytotoxic in oral cancer cells, triggering cells undergoing apoptosis and ROS-mediated cell death, possessing S and G2/M cell cycle arrest properties, and exhibiting anti-metastatic activities. Finally, this discovery opens up a wide range of possibilities for developing an anti-oral cancer drug and further investigating its effectiveness in vivo and in clinical trials as an alternative cancer treatment.

595. The Effect of Herpes Zoster Vaccination on New Diagnoses of Dementia: A Quasi-randomized Study in Australia

Abstract Background We have recently provided evidence from a quasi-randomized study in Wales that herpes zoster (HZ) vaccination reduced the incidence of new dementia diagnoses. This study used a similar quasi-randomization in Australia to determine the effect of HZ vaccination on new dementia diagnoses over 7.5 years.Figure 1:Eligibility for a free herpes zoster (HZ) vaccine reduces dementia diagnosesIn panel (a), a regression discontinuity is plotted, where the forcing variable is the number of weeks from the cutoff (November 2, 1936) and the outcome is dementia diagnoses (in percentages). The triangular dots indicate dementia diagnoses for the comparison group, scaled up by the intercept for the main cohort. Panel (b) describes this effect for different follow-up periods, and panel (c) shows the effect for different grace periods. Methods In Australia, starting on November 1 2016, live-attenuated HZ vaccination was provided for free to individuals aged 70 to 79 years of age. Thus, those whose 80th birthday was just a few days prior to November 1 2016 never became eligible, whereas those whose 80th birthday was a few days later were eligible for one year. There is no reason to expect that these population groups who differ in their age by only a minute degree should differ in any of their dementia-related characteristics. We used detailed primary healthcare records (provided by PenCS) with week-of-birth information from 65 general practices across Australia. We analyzed our data using a comparative regression discontinuity design, with dementia diagnoses from older birth cohorts serving as a comparison group. Results Of 108,670 patients in our data, 15,297 were born between November 2 1928 and November 2 1944. At baseline, patients were well-balanced across the date-of-birth eligibility threshold (November 2 1936) for HZ vaccination in their preventive health services uptake and chronic disease diagnoses. There was an abrupt increase of 13.2 (95% CI: [8.7, 17.6], p = 0.001) percentage points in the probability of ever receiving HZ vaccination between patients born shortly before versus shortly after the eligibility threshold. Eligibility for a free HZ vaccination caused a 3.9 percentage point (95% CI: [1.7, 6.1], p = 0.001) decrease in the probability of receiving a new dementia diagnosis over 7.5 years. Being eligible for HZ vaccination did not affect the probability of taking up other preventive health services (including other vaccinations) nor do we find consistent evidence that it affected the probability of receiving any of the twenty most common disease diagnoses in our data. Conclusion In conjunction with our findings from Wales, these results from Australia constitute robust evidence that live-attenuated HZ vaccination may delay or prevent dementia. Disclosures All Authors: No reported disclosures

P-1297. Screening and vaccination for tetanus, hepatitis A, and hepatitis B in individuals with substance use disorders, hospitalized at a U.S. integrated healthcare system

Abstract Background Hepatitis A (HAV), hepatitis B virus (HBV), and tetanus are common vaccine preventable diseases among individuals with substance use disorders (SUDs). Inpatient encounters are frequent for this population thus represent an important opportunity for preventive care. However, up-to-date data on screening and vaccination for this high-risk population are lacking in the inpatient setting.Table 1.Characteristics of 465,282 individuals hospitalized at Kaiser Permanente Southern California between 2010 and 2023 with a history of substance use disordera At the time of index dateb Does not include 17 individuals identified as "Other" sexc In the 24 months prior to index dated In the 12 months prior to index datee Any time prior to index date Methods Using electronic health records at Kaiser Permanente Southern California (KPSC), we included adults hospitalized between 01/2010 and 06/2023 (study period), with a diagnosis code for SUDs within 2 years prior to index date (first hospitalization admission date during study period). We identified those at risk for HAV and HBV at index date by labs, and evaluated vaccination during any hospitalization or within 90 days of hospital discharge (surveillance period) during study period for tetanus, HAV and HBV.Table 2.Screening and vaccination for tetanus, hepatitis A, and hepatitis B among 465,282 individuals hospitalized at Kaiser Permanente Southern California with a history of substance use disorder between 2010 and 2023a Index date is defined as the date of the first hospital admission (including observation visits lasting &amp;gt;24 hours and emergency department visits) during the study period, with a diagnosis code for substance use disorder within 2 years priorb “At-risk for tetanus” is defined as no history of tetanus vaccination within 10 years prior to index date and no history of booster dose if the initial vaccination was completed &amp;gt;10 years prior to index datec “At-risk for HAV infection” is defined as no history of ≥2 dose of HAV vaccination, no history of positive test result for HAV IgG, HAV total Ab, and no history of HAV IgM prior to index dated Follow-up is defined as time period from the index date to the end of KPSC membership, the end of study period (i.e., June 30, 2023), or death, whichever comes firste “At risk for HBV infection” is defined as no history of ≥3 dose of HBV vaccination, no history of positive test result for HBV sAb, and no active of HBV infection (HBV viral load, or HBV sAg) prior to index date Results We identified 465,282 individuals meeting the study criteria (42% female, 45% non-Hispanic white, mean age 48 years [SD 19]) (Table 1). For tetanus, 79% completed ≥1 dose prior to index date, and 71% received a booster within 10 years prior to index date (Table 2). Among those at risk for tetanus at index date, 61% were vaccinated during a surveillance period, after median 2 (IQR 1, 5) hospitalizations since index date. For HAV, 15% completed vaccination prior to index date. Among those at risk for HAV, 2% were screened for immunity at any hospitalization during follow-up; 1% were vaccinated during a surveillance period, after median 3 (IQR 1, 7) hospitalizations since index date. For HBV, 21% completed and 6% partially completed vaccine series prior to index date. Among those at risk for HBV at index date, 2% and 5% were screened for immunity and active infection, respectively, at any hospitalization during follow-up; 3.2% were vaccinated during a surveillance period, after median 3 (IQR 1, 6) hospitalizations since index date. Conclusion Few with SUDs were screened or vaccinated for tetanus, HAV, or HBV during a hospitalization or at subsequent visits, after a median 2 - 3 hospitalizations after index date. This represents an opportunity for improvement in preventive care and vaccination for this high-risk population in the inpatient setting. Disclosures Jennifer H. Ku, PhD MPH, GSK: Grant/Research Support|Moderna: Grant/Research Support Yuqian M. Gu, MS, GSK: Grant/Research Support Yi Luo, PhD, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Rulin C. Hechter, MD, PhD, MS, Gilead Sciences: Grant/Research Support Bradley Ackerson, MD, Dynavax: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support

P-461. Positive Aging Consultations: A Model for Expanding Geriatric HIV Care

Abstract Background People living with HIV (PWH) experience geriatric syndromes commonly found in much older populations and may benefit from geriatrician consultation. We aim to describe a referral-based model at the University of Colorado. Methods The Positive Aging Consultations, a referral-based model, sought to connect high-risk PWH ≥ 50 years old with geriatric care. High-risk patients (experiencing geriatric syndromes, polypharmacy, multimorbidity, or advance care planning needs) were referred for geriatric consultation at the UCHealth Seniors Clinic; those taking ≥ 10 medications were referred for clinical pharmacy consultation. Patients were screened for functional status, preventative care, socioenvironmental factors (living situation, food access, transportation, social support, and elder abuse), and cognitive/mental health concerns (depression, anxiety, and memory loss). Geriatricians placed orders or communicated recommendations to the patient’s primary HIV provider. HIV providers completed a survey about their experience with the program. Additional data was collected via chart review. Results From January 2018 to July 2019, 11 patients underwent geriatric consultation. The average age was 69 years old (SD=7; range 59-80). Geriatricians most often made recommendations regarding referral to other health or community-based services (n=9), medication changes (n=8), osteoporosis screening (n=6), and memory loss management (n=5). Advance directives were discussed in all visits. All but one HIV provider (n=7) said they would refer patients to the program in the future. Conclusion The Positive Aging Consultations program improved access to geriatric care with minimal setup costs, but with limited uptake over a one-year period. Limitations of the program included low utilization, lack of longitudinal geriatric care, geriatrician shortage, and potential financial barriers. Disclosures Kristine M. Erlandson, MD MS, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|ViiV: Advisor/Consultant