Residents Of Metropolitan Area Research Articles

P-1947. Risk of Severe COVID-19 Reinfection among Persons Hospitalized with a Primary COVID-19 Infection, Minneapolis-St. Paul, Minnesota

Abstract Background SARS CoV-2 continues to circulate broadly making it important to understand risk factors for severe illness when reinfection occurs. We used CDC COVID-19 Hospitalization Surveillance Network (COVID-NET) data to assess reinfection, hospitalization at reinfection (hospitalized reinfection) and ICU admission at reinfection (ICU reinfection) by underlying medical conditions and ICU admission at primary infection. Methods Nonpregnant adults hospitalized 3/9/2020 - 9/30/2021 were identified through COVID-NET, surveillance that includes Minneapolis-St. Paul metropolitan area residents with a positive SARS-CoV-2 result during or ≤ 14 days before admission. Cases were matched to all reports of persons positive for SARS-CoV-2 to identify reinfections, defined as a positive SARS-CoV-2 test > 90 days after the initial positive result through 4/17/2024. Logistic regression was used to assess reinfection and severity of reinfection adjusted for age, sex, race/ethnicity, and vaccination status (aOR). Results 6,434 hospitalized persons met the COVID-NET case definition for their primary infection; 1,189 (18%) had a reinfection. 356 (30%) of the reinfection cases were hospitalized and 51 (14%) of those hospitalized had ICU admission. Having any underlying condition was associated with reinfection (aOR 1.62, 95% CI 1.18, 2.23) and hospitalized reinfection (aOR 2.16, 95% CI 1.27, 3.69). Cardiovascular disease was associated with reinfection (aOR 1.72, 95% CI 1.28, 2.31). Cardiovascular disease (aOR 3.03, 95% CI 1.87, 4.90), blood disorders (aOR 2.42, 95% CI 1.03, 5.37), and renal disease (aOR 1.85, 95% CI 1.12, 3.06) were associated with hospitalized reinfection. All 51 ICU reinfections and 14 reinfection deaths had an underlying condition. Primary ICU admission was not associated with reinfection or hospitalized reinfection but was associated with ICU reinfection (aOR 5.26, 95% CI 1.65, 16.73). Conclusion Among patients hospitalized with COVID-19, underlying conditions and primary ICU admission were associated with severe outcomes during reinfection. These results highlight the continued importance of prevention strategies like vaccination and treatment to mitigate severe illness among patients at highest risk. Disclosures All Authors: No reported disclosures

Factors associated with post acute care utilization after mastectomy for breast cancer patients.

Although the demand for care immediately after mastectomy is rising, and such medical services are referred to as post-acute care (PAC), there is limited evidence on the factors influencing PAC choices among these patients in Korea. A total of 106,670 patients diagnosed with breast cancer and undergoing mastectomy were extracted from the Central Cancer Registry data from 2012 to 2019 using Public Cancer Library data of KCURE. PAC was defined as utilization of long-term care hospital (LTCH), hospital-based nursing care (HBNC), or HBC (hospital-based care) within 2 months post-surgery. Multinomial logistic regression was used to identify factors associated with different types of PAC utilization. The utilization patterns of different types of PAC within 2 months after mastectomy were associated with age, income, cancer severity, and particularly the region of residence (Metropolitan; HBNC, OR 0.16, 95% CI 0.10-0.26; LTCH, OR 2.35, 95% CI 2.21-2.50; HBC, OR 2.17, 95% CI 1.97-2.39), as well as the location (capital areas; HBNC, OR 12.46, 95% CI 4.97-31.25; LTCH, OR 1.21, 95% CI 1.15-1.28; HBC, OR 1.90, 95% CI 1.74-2.07) and type of the hospital (tertiary hospital; HBNC, OR 13.70, 95% CI 7.86-23.86; LTCH, OR 1.45, 95% CI 1.37-1.53; HBC, OR 3.38, 95% CI 3.00-3.80) where the surgery was performed. In this study, we found the factors associated with PAC utilization on mastectomy patients. Our study found that middle-aged breast cancer patients, residents of metropolitan or rural areas, and those who underwent surgery at hospitals in capital area were particularly associated with higher utilization of inpatient-related PAC services. Breast cancer patients with higher income, older adults, metropolitan residents, patients who underwent breast cancer surgery at metropolitan hospitals, and those treated at tertiary hospitals were strongly associated with higher utilization of HBNC services. Identifying factors that determine the use of PAC has meaningful implications for patients and healthcare systems.

Accessibility assessment of three housing states in barcelona’s metropolitan area. Tackling the 15-minute city concept and the Diputació de Barcelona requirements

Almost half of Barcelona’s Metropolitan Area residents have difficulties accessing services and facilities daily. Taking this into account and adding the fact that a huge percentage of these people are forced to use motorized vehicles as their transportation, the concept of the 15-minute city remains cut off from reality. In this context, one of the most common built urban morphologies is housing states, designed with the only function to dwell and leaving behind all the other daily basic needs. From this framework, this project seeks to measure the level of accessibility in three housing states in Barcelona's Metropolitan Area (Can Ros, Sud-Oest del Besòs and Canaletes) to evaluate the lack of reachability to basic equipments and services. Also, it is intended to analyze the relationship with the level of accessibility to public transport. All the research has been performed following the 15-minute city concept and the standards proposed by the Diputació de Barcelona. The obtained results after applying this many-sided methodology show that none of the studied areas reaches the required amount of accessibility to fundamental amenities. Nevertheless, some differences are evidenced between the sites revealing a correlation with their locations. Moreover, the relation between the accessibility to services with public transport is not determined by the given factors, letting a path for future research. Almost half of Barcelona’s Metropolitan Area residents have difficulties accessing services and facilities daily. Taking this into account and adding the fact that a huge percentage of these people are forced to use motorized vehicles as their transportation, the concept of the 15-minute city remains cut off from reality. In this context, one of the most common built urban morphologies is housing states, designed with the only function to dwell and leaving behind all the other daily basic needs. From this framework, this project seeks to measure the level of accessibility in three housing states in Barcelona's Metropolitan Area (Can Ros, Sud-Oest del Besòs and Canaletes) to evaluate the lack of reachability to basic equipments and services. Also, it is intended to analyze the relationship with the level of accessibility to public transport. All the research has been performed following the 15-minute city concept and the standards proposed by the Diputació de Barcelona. The obtained results after applying this many-sided methodology show that none of the studied areas reaches the required amount of accessibility to fundamental amenities. Nevertheless, some differences are evidenced between the sites revealing a correlation with their locations. Moreover, the relation between the accessibility to services with public transport is not determined by the given factors, letting a path for future research.

Black and White Demographic Patterns of Gun Ownership and Suicide, 2021

Objective We use 2021 data to compare the demographic patterns of adult White and Black gun ownership with their respective race-specific rates of firearm, non-firearm and total suicide, and the percentage of suicides using firearms. Methods Data on gun ownership came from a nationally representative sample of over 19,000 respondents to the 2021 National Firearms Survey. Both race-specific gun ownership and suicide rates were stratified by respondent demographics—sex (male, female), census region (Northeast, South, Midwest, West), urbanicity (metropolitan or non-metropolitan), and age (18-29, 30-44, 45-59, 60+). Results White adults reported higher rates of gun ownership than did Black adults (33% vs 24%) but a firearm was used in a similar percentage of suicides (56% vs 58%). The demographic patterns of gun ownership of White and Black adults were similar—those least likely to report owning firearms were females, those living in the Northeast, residents of metropolitan areas, and younger adults. But the suicide patterns were somewhat different—whereas suicide rates among White adults were highest among older Whites and among Whites in non-metropolitan areas, suicide rates among Black adults were highest among younger Blacks and similar in metropolitan and non-metropolitan areas. Conclusions The self-reported levels and patterns of Black gun ownership cannot explain why such a high percentage of Black suicides are firearm suicides or why firearm and total suicide rates of Black adults fall so dramatically with age.

Disparities in Colorectal Cancer Screening Before and After the Onset of the COVID Pandemic.

Colorectal cancer (CRC) screening is underutilized among those with lower socioeconomic status and in racial and ethnic minoritized populations who have been disproportionately impacted by COVID. To compare disparities in CRC screening before and after the onset of the COVID pandemic among privately insured individuals. Retrospective cohort study using deidentified claims data from the USA between January 1, 2017, and December 31, 2022. Blue Cross Blue Shield beneficiaries aged 50-75years with average risk of CRC. Mean screening use was compared by demographic and area-level socioeconomic factors between the periods preceding (January 1,2017 to February 28,2020) and following (July 1,2020 to December 31,2022) the onset of the COVID pandemic. Difference-in-differences analysis was used to evaluate changes in screening differences. Our study included 21,724,223 beneficiaries. Compared to males, females had higher screening in both periods (p < 0.05), and this sex difference in screening increased 1.63% (95% confidence interval [CI]: 1.32%, 1.94%) following the onset of the pandemic. Compared to residents in areas with high socioeconomic status (SES), low SES area residents had lower screening (p < 0.001) during both periods. Furthermore, this difference grew 4.32% (95% CI, 3.76%, 4.88%) during the post-onset period. Metropolitan area residents had higher screening than non-metropolitan area residents during both periods (p < 0.001); however, this difference decreased 0.77% (95% CI, 0.34%, 1.20%) during the post-onset period. Among beneficiaries with high risk of CRC, the difference in screening based on social deprivation index and metropolitan area status increased 6.99% (95% CI, 5.77%, 8.20%) and 1.82% (95% CI, 0.88%, 2.74%), respectively. Among privately insured individuals, CRC screening after the COVID pandemic recovered unevenly based on sex, area-level socioeconomic measures, and metropolitan area status, with pre-pandemic disparities persisting and even worsening for some of the factors.

Survival Outcomes of U.S. Patients with CMML: A Two-Decade Analysis from the SEER Database.

Background: Chronic Myelomonocytic Leukemia (CMML) is a rare and aggressive form of leukemia with characteristics of both myeloproliferative neoplasms (MPNs) and myelodysplastic syndromes (MDSs). This study aims to explore the clinical features, survival outcomes, and prognostic factors in CMML patients over the past 20 years using a large sample. Methods: The study data from 4124 patients diagnosed with CMML between 2000 and 2017 were sourced from the SEER database. Demographic and clinical characteristics, along with overall and cancer-specific mortality, were examined. Factors with a p-value < 0.01 in univariate Cox regression were included in the multivariate Cox model to identify independent prognostic factors, with hazard ratios (HRs) greater than one indicating adverse outcomes. Results: The majority of the cohort were male (61.57%), and most diagnoses occurred between ages 60-79 (55.16%), with a small percentage under 40 (1.41%). Non-Hispanic whites represented the largest racial group (79.03%). Multivariate analysis showed higher mortality in males, those aged 80+, residents in metropolitan areas with populations between 250,000 and 1 million, single or widowed individuals, and those who underwent chemotherapy. Conversely, lower mortality was associated with an annual income of $75,000+. Conclusions: CMML remains a rare and highly aggressive hematologic disorder. This U.S.-based retrospective cohort study identified male gender, advanced age, single or widowed status, and chemotherapy as independent poor prognostic factors. While it is expected that older patients and those requiring chemotherapy would have a poorer prognosis, the higher mortality risk in single or widowed patients, as well as males, warrants further investigation. The early involvement of family and community support may help reduce mortality in these groups, suggesting a need for larger prospective studies to explore these associations further.

Low-cost urban heat environment sensing device with Android platform for digital twin

The proper monitoring of heat and meteorological variables is essential for the well-being of residents of metropolitan areas. It is challenging to configure spatial heat variations in complex urban environments, even though the temporal variation of urban heat flux has been measured at several designated monitoring stations. Neither the budget nor existing techniques for efficient urban heat monitoring are sufficient for a digital twin of the urban heat environment. As a result, we have developed a low-cost monitoring system that can be easily integrated into a portable pedestrian device, kickboard, or electric bike. With this system, citizens can collect information about urban heat, such as air temperature, surface temperature, relative humidity, barometric pressure, light intensity, and micro-geophysical features including topological aspects and mobile information (e.g., three-dimensional accelerations). Citizens can participate in daily scientific activities using these devices, which facilitate data acquisition and information exchange in urban digital twin environments.

Epidemiology of Inherited Retinal Diseases in Korea: A National Health Information Database Analysis (2011-2020)

Purpose: We evaluated the incidence and prevalence of inherited retinal diseases (IRDs) in Korea using a national database.Methods: This retrospective study used the National Health Information Database to enroll patients with IRDs (registration code V209) between January 2011 and December 2020. Incidence and prevalence of IRDs were analyzed and stratified by age, sex, geographic location, and socioeconomic status.Results: During the study period, 10,228 patients were diagnosed with IRD, yielding an annual incidence rate of 1.60–2.35 per 100,000 individuals. In 2020, the prevalence of IRD reached 27.1 cases per 100,000 individuals. Initial diagnoses were primarily concentrated in Seoul (44.4%), metropolitan areas (29.4%), and Gyeonggi province (12.1%). Notably, less than 50% of patients received their initial diagnosis in their home region, except for residents of Seoul (94.0%), metropolitan areas (76.8%), and Jeju Island (70.8%). The incidence of IRDs was higher among the top 25% income bracket, compared to other income levels.Conclusions: Our study provides the first nationwide, population-based estimates of IRD incidence and prevalence in Korea. Our findings reveal significant regional and socioeconomic disparities in IRD healthcare access, emphasizing the need for targeted interventions.

Understanding How Green Space Naturalness Impacts Public Well-Being: Prospects for Designing Healthier Cities.

Statement of problem: Urbanization has brought significant advancements in human well-being; however, it poses challenges to urban green spaces (UGSs), affecting environmental quality and public health. Research gap: Previous studies have established the importance of UGSs for urban well-being but have not sufficiently explored how the naturalness of these spaces-ranging from untouched natural areas to human-designed landscapes-affects mental health outcomes in the context of developing countries, particularly Brazil. Purpose: This study aimed to bridge the research gap by investigating the relationship between the degree of naturalness in UGSs and mental health among residents of Brazilian metropolitan areas. Method: Data were collected through an online survey involving 2136 respondents from various Brazilian urban regions. The study used Welch's ANOVA and Games-Howell post hoc tests to analyze the impact of UGS naturalness on mental health, considering depression, anxiety, and stress levels. Results and conclusions: The findings revealed that higher degrees of naturalness in UGSs significantly correlate with lower levels of mental distress. These results underscore the necessity of integrating natural elements into urban planning to enhance public health. Practical implications: Urban planners and policymakers are encouraged to prioritize the preservation and creation of naturalistic UGSs in urban environments to improve mental health outcomes. Future directions: Further research should explore the specific attributes of naturalness that most contribute to well-being and examine the scalability of these findings across different cultural and environmental contexts.

Remote Physiologic Monitoring Use Among Medicaid Population Increased, 2019-21.

Remote physiologic monitoring use increased more than 1,300percent from 2019 to 2021, and use varied by state. This increase was driven by a small number of (predominantly internal medicine) providers. Female beneficiaries, residents of metropolitan areas, and people diagnosed with diabetes or hypertension had the highest rates of use.

Abstract P376: Comparison of Heart Failure Admission Rates Between Rural-Urban Continuum Code Designations

Introduction: Approximately 6 million adults in the US have heart failure (HF) and, from 2012 to 2030, the prevalence is estimated to increase by 46%. In 2017, the prevalence of HF among rural residents was 40% higher than among residents of small metropolitan and urban areas and this gap has continued to grow. However, only examining differences among metropolitan vs nonmetropolitan statistical areas or urban vs rural areas means it is impossible to understand within rural variation. Hypothesis: We assessed the hypothesis that county-level HF admission rates would differ by Rural-Urban Continuum Code (RUCC). Methods: Using 2017 data from the Healthcare Cost and Utilization Project, this cross-sectional study investigated the association between RUCC designation and county-level HF admission rates (number of admissions with a principal diagnosis of HF per 100,000 population aged 18+). The sample included 826 counties across 13 states. Rural, Urban, and Metro designations were defined through RUCCs. One-way ANOVA was performed to identify overall differences in HF admission rates across RUCC designations, with post-hoc pairwise comparisons performed using Tukey’s HSD. Results: There was a statistically significant difference in HF admission rates between at least two groups ( F (817, 8)=[13.99, p &lt;.001]). Results from 13 of the 36 pairwise comparisons were statistically significant ( Table ). Conclusion: We identified statistically significant differences in county-level HF hospital admission rates by RUCC. Metro counties had significantly higher HF admission rates than urban and rural counties, but differences across rural counties were not observed. HF prevalence is higher among rural Americans than those in urban and metro areas, but HF hospital admission rates in rural counties are much lower. Further research is needed to investigate the drivers of these differences in prevalence and healthcare utilization.

Abstract C113: Geographic variation in low-dose computed tomography scanning for lung cancer screening in the United States

Abstract Background: Early detection using low-dose computed tomography scanning reduces lung cancer specific mortality by 20%. Despite its efficacy and its recommendation by the United States Preventive Services Task Force, the uptake of lung cancer screening (LCS) among high-risk individuals (aged 55–80 years with a &amp;gt;30-pack-year smoking history and who currently smoke or have quit within the previous 15 years) remains low. The purpose of this study was to assess whether LCS uptake varies by geographic location. Methods: Data for this study were obtained from the 2019 Behavioral Risk Factor Surveillance System. After excluding ineligible subjects, 10,242 subjects were included in the final analysis. Multivariable logistic regression models were used to model the associations between the predictor and the outcome variable, adjusting for potential confounders. Results: In metropolitan statistical areas, individuals who reside outside the center city are less likely to receive LCS than those who reside in the center city (OR: 0.65; 95% CI: 0.43 – 0.98). Stratifying the data by race/ethnicity, we found a non-significant difference between Whites who reside in the center city and those outside the center city in LCS uptake (OR: 0.69; 95% CI: 0.45 – 1.06). Among Blacks (OR:0.10; 95% CI: 0.02 – 0.59) and other minorities (OR:0.10; 95% CI: 0.02 – 0.63), individuals who reside outside the center city are less likely to receive LCS than their respective counterparts residing in the center city. Nevertheless, we found a non-significant difference in LCS uptake between urban and rural counties (OR: 1.06; 95% CI: 0.76-1.48).Conclusions: LCS uptake is related to metropolitan statistical area (residents in the center city vs. outside the center city), but it is modified by race/ethnicity. This finding has important implications for policy makers and program planners in helping them design more effective interventions to promote LCS targeting racial/ethnic minorities residing outside the center city. Citation Format: Abdi T. Gudina, Lee A. Kehoe, Sara Hardy, Charles S. Kamen, Paula Cupertino. Geographic variation in low-dose computed tomography scanning for lung cancer screening in the United States [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C113.

Sociodemographic Factors and Screening CT Colonography Use Among Medicare Beneficiaries.

BACKGROUND. Approximately one-third of the eligible U.S. population have not undergone guideline-compliant colorectal cancer (CRC) screening. Guidelines recognize various screening strategies to increase adherence. CMS provides coverage for all recommended screening tests except CT colonography (CTC). OBJECTIVE. The purpose of this study was to compare CTC and other CRC screening tests in terms of associations of utilization with income, race and ethnicity, and urbanicity in Medicare fee-for-service beneficiaries. METHODS. This retrospective study used CMS Research Identifiable Files from January 1, 2011, through December 31, 2020. These files contain claims information for 5% of Medicare fee-for-service beneficiaries. Data were extracted for individuals 45-85 years old, and individuals with high CRC risk were excluded. Multivariable logistic regression models were constructed to determine the likelihood of undergoing CRC screening tests (as well as of undergoing diagnostic CTC, a CMS-covered test with similar physical access as screening CTC) as a function of income, race and ethnicity, and urbanicity while controlling for sex, age, Charlson comorbidity index, U.S. census region, screening year, and related conditions and procedures. RESULTS. For 12,273,363 beneficiary years (mean age, 70.5 ± 8.2 [SD] years; 2,436,849 unique beneficiaries: 6,774,837 female beneficiaries, 5,498,526 male beneficiaries), there were 785,103 CRC screenings events, including 645 for screening CTC. Compared with individuals living in communities with per capita income of less than US$25,000, individuals in communities with income of US$100,000 or more had OR for undergoing screening CTC of 5.73, optical colonoscopy (OC) of 1.36, sigmoidoscopy of 1.03, guaiac fecal occult blood test or fecal immunochemical test of 1.50, stool DNA of 1.43, and diagnostic CTC of 2.00. The OR for undergoing screening CTC was 1.00 for Hispanic individuals and 1.08 for non-Hispanic Black individuals compared with non-Hispanic White individuals. Compared with the OR for undergoing screening CTC for residents of metropolitan areas, the OR was 0.51 for residents of micropolitan areas and 0.65 for residents of small or rural areas. CONCLUSION. The association with income was substantially larger for screening CTC than for other CRC screening tests or for diagnostic CTC. CLINICAL IMPACT. Medicare's noncoverage for screening CTC may contribute to lower adherence with CRC screening guidelines for lower-income beneficiaries. Medicare coverage of CTC could reduce income-based disparities for individuals avoiding OC owing to invasiveness, need for anesthesia, or complication risk.

Pedestrianisation as a step in a societal transformation? An analysis of support and opposition in Brussels

Brussels (Belgium) is one of several major cities with a recent emblematic pedestrianisation project aiming to give public space ‘back to people’. Wondering whether these initiatives represent ‘cracks in the system’ of car dominance, we studied how support for the pedestrianisation has evolved across society, taking into account people's socio-economic and mobility attributes as well as geographical scale. We conducted surveys before and after implementation among metropolitan area residents, people employed in the area and passers-by through online and face-to-face surveys. Findings show a strong increase in overall support, both for the pedestrianisation the central boulevards (now with a majority now in favour) as for a further roll-out. Residential location nearby the pedestrianised centre is identified as a factor of support, but most importantly, habitual car use and remain strong predictive factors of opposition, confirming the various descriptions in literature of automobility as a tenacious socio-technical system.

General health literacy, COVID-19-related health literacy, and protective behaviors: evidence from a population-based study in Japan.

Health literacy (HL) can be regarded as a key element of non-pharmaceutical interventions used in emergency responses. The present study aimed to determine the associations of combinations of general HL and COVID-19-related HL with COVID-19 protective behaviors and healthy lifestyle behaviors. A questionnaire survey was conducted from December 2020 to January 2021 among residents in Japanese metropolitan areas. Valid responses were received from 1,443 residents. The levels of HL were categorized into four groups: low level in both HLs (reference), high level in general HL only, high level in COVID-19-related HL only, and high level in both HLs. The total scores of eight COVID-19 protective behaviors were dichotomized into low and high adherence. Healthy lifestyle behaviors included healthy and balanced diet, adequate sleep, and regular exercise. Poisson regression analyses were conducted to examine the associations between the HL groups and high adherence to COVID-19 protective behaviors. High level in COVID-19-related HL only was associated with high adherence to COVID-19 protective behaviors [prevalence ratio (PR), 1.25; 95% confidence interval (CI), 1.09-1.45], while high level in general HL only was associated with healthy and balanced diet (PR, 1.49; 95% CI, 1.04-2.13), adequate sleep (PR, 1.46; 95% CI, 1.02-2.10), and regular exercise (PR, 2.00; 95% CI, 1.29-3.13). High level in both HLs showed the highest prevalence of high adherence to COVID-19 protective behaviors and healthy lifestyle behaviors. These findings indicate that COVID-19-related HL and general HL can both be considered to enhance protective behaviors.

Exploring nurse practitioner practice in Australian rural primary health care settings: A scoping review.

Australians in rural areas experience limited access to services and poorer health outcomes than residents of metropolitan areas. Nurse practitioners (NPs) were introduced in 2000 to reduce pressure on the health system, address workforce shortages and improve rural populations' access to health care services. This scoping review sought to identify, examine and synthesise research evidence of NP practice in Australian rural primary health care services to better understand how NPs are addressing service gaps in rural areas and to identify existing gaps in our knowledge. Peer-reviewed and grey literature from July 2012 to June 2022 was accessed from seven electronic databases, grey literature and hand searching of reference lists and citations. From 154 articles, 19 articles of relevance were identified. Several projects describe the processes required for success, whilst others reported the challenges and barriers encountered. Limited research evidence of rural NP practice exists with a significant gap about how roles operate and their value in primary health care. Uptake and envisaged benefits of rural primary health care NP roles have yet to be realised, with barriers to implementing and sustaining NP roles persisting. Low-level awareness with ambiguity at health service and community level adversely impact on systematic implementation of NP roles. Robust evaluations demonstrating the value of NP skills and practice are needed in combination with bipartisan support from all levels of health care and government providing adequate funding to enable effective implementation of NP roles in poorly resourced rural areas.

Randomized intervention to assess the effectiveness of an educational video on organ donation intent among Hispanics in the New York metropolitan area.

The Hispanic community has a high demand for organ donation but a shortage of donors. Studies investigating factors that could promote or hinder organ donation have examined emotional video interventions. Factors acting as barriers to organ donation registration have been classified as: (1) Bodily integrity; (2) medical mistrust; (3) "ick"-feelings of disgust towards organ donation; and (4) "jinx"-fear that registration may result in one dying due to premeditated plans. We predict that by providing necessary information and education about the donation process via a short video, individuals will be more willing to register as organ donors. To determine perceptions and attitudes regarding barriers and facilitators to organ donation intention among Hispanic residents in the New York metro politan area. This study was approved by the Institutional Review Board at Northwell Health. The approval reference number is No. 19-0009 (as presented in Supplementary material). Eligible participants included Hispanic New York City (NYC) residents, 18 years of age and above, who were recruited voluntarily through Cloud Research and participated in a larger randomized survey study of NYC residents. The survey an 85-item Redcap survey measured participant demographics, attitudes, and knowledge of organ donation as well as the intention to register as an organ donor. Attention checks were implemented throughout the survey, and responses were excluded for those who did fail. Participants were randomly assigned two-between subject conditions: To view a short video on organ donation and then proceed to complete the survey (i.e., video first) and view the same video at the end of the survey (video last). No intra-group activities were conducted. This study utilized an evidenced-based emotive educational intervention (video) which was previously utilized and was shown to increase organ donation registration rates at the Ohio Department of Motor Vehicles. Results were analyzed using Jamovi statistical software. Three hundred sixty-five Hispanic individuals were included in the analysis. Once consent was obtained and participants entered the survey (the survey sample is presented in Supplementary material), participants were asked to report on demographic variables and their general impression of organ donation after death. The video depicted stories regarding organ donation after death from various viewpoints, including from the loved ones of a deceased person who died waiting for a transplant; from the loved ones of a deceased person whose organs were donated upon death; and, from those who were currently waiting for a transplant. Using a binomial logistic regression, the analysis provides information about the relationship between the effects of an emotive video and the intention to donate among Hispanic participants who were not already registered as donors. The willingness to go back and register was found to be significantly more probable for those who watched the emotive video before being asked about their organ donation opinions (odds ratio: 2.05, 95% confidence interval: 1.06-3.97). Motivations for participation in organ donation were also captured with many stating the importance of messages coming from "people like me" and a message that highlights "the welfare of those in need". Overall, the findings suggest that using an emotive video that addresses organ donation barriers to prompt organ donation intentions can be effective among the Hispanic populous. Future studies should explore using targeted messaging that resonates with specific cultural groups, highlighting the welfare of others. This study suggests that an emotive educational intervention is likely to be effective in improving organ donation registration intent among the Hispanic population residing in NYC.

CMS Extends Virtual Supervision of Residents to End of Year

CMS Extends Virtual Supervision of Residents to End of Year

Adult Cancer-Related Emergency Department Utilization: An Analysis of Trends and Outcomes From Emergency Departments in Maryland and New York.

To explore emergency department (ED) visits by adults with cancer and to estimate associations between inpatient admissions through the ED and mortality with sociodemographic and clinical factors within this cohort. We conducted a retrospective, pooled, cross-sectional analysis of the Healthcare Cost and Utilization State Emergency Department Databases and State Inpatient Databases for Maryland and New York from January 2013 to December 2017. We examined inpatient admissions through the ED and mortality using frequencies. Among patients with cancer, multivariable regressions were used to estimate sociodemographic and clinical factors associated with inpatient admissions and outpatient ED and inpatient mortality overall. Among 22.7 million adult ED users, 1.3 million (5.7%) had at least one cancer-related diagnosis. ED visit rates per 100,000 population increased annually throughout the study period for patients with cancer and were 9.9% higher in 2017 compared with 2013 (2013: 303.5; 2017: 333.6). Having at least one inpatient admission (68.7% v 20.5%; P < .001) and inpatient or ED mortality (6.5% v 1.0%; P < .001) were higher among ED users with cancer compared with those without. Among patients with cancer, being uninsured (adjusted odds ratio, 0.52; 95% CI, 0.44 to 0.62) compared with having Medicare coverage and non-Hispanic Black (adjusted odds ratio, 0.86; 95% CI, 0.80 to 0.92) compared with non-Hispanic White were associated with decreased odds of inpatient admissions. In contrast, patients with cancer without health insurance, non-Hispanic Black patients, and residents of nonlarge metropolitan areas and of areas with lower household incomes had increased odds of mortality. High inpatient admissions through the ED and mortality among adult patients with cancer, coupled with an increase in cancer-related ED visit rates and observed disparities in outcomes, highlight the need to improve access to oncologic services to contain ED use and improve care for patients with cancer.

Geographical variation in the use of private health insurance in a predominantly publicly-funded system

We provide evidence of geographical variations in the use of private health insurance (PHI) in Italy. Our study offers an original contribution, using a 2016 dataset on the use of PHI amongst a population of more than 200,000 employees of a major company. The average claim per enrolee was €925, representing approximately 50% of public health expenditure per capita, primarily for dental care (27.2%), specialist outpatient services (26.3%) and inpatient care (25.2%). Residents in northern regions and metropolitan areas respectively claimed reimbursements for €164 and €483 more than those in southern regions and in non-metropolitan areas. Both supply and demand factors can explain these large geographical differences. The study suggests the urgency for policymakers to address the considerable disparities in the Italian healthcare system, revealing the overall social, cultural and economic conditions that shape the demand for healthcare.