Routine Health Care Visits Research Articles

Impact of the medical fitness model on long term health outcomes in older adults

BackgroundPhysical inactivity is common among older adults and is associated with poor health outcomes. Medical fitness facilities provide a medically focused approach to physical fitness and can improve physical activity in their communities. This study aimed to assess the relationship between membership in the medical fitness model and all-cause mortality, health care utilization, and major adverse cardiac events in older adults.MethodsA propensity weighted retrospective cohort study linked individuals that attended medical fitness facilities to provincial health administrative databases. Older adults who had at least 1 year of health coverage from their index date between January 1st, 2005 to December 31st 2015 were included. Controls were assigned a pseudo-index date at random based on the frequency distribution of index dates in members. Members were stratified into low frequency attenders (< 1 Weekly Visits) and regular frequency attenders (> 1 Weekly Visits). Time to event models estimated the hazard ratios (HRs) for risk of all-cause mortality and major adverse cardiac event. Negative binomial models estimated the risk ratios (RRs) for risk of hospitalizations, outpatient primary care visits and emergency department visits.ResultsAmong 3,029 older adult members and 91,734 controls, members had a 45% lower risk of all-cause mortality (HR: 0.55, 95% CI: 0.50 – 0.61), 20% lower risk of hospitalizations (RR: 0.80, 95% CI: 0.75 – 0.84), and a 27% (HR: 0.72, 95% CI: 0.66 – 0.77), lower risk of a major adverse cardiovascular event. A dose–response effect with larger risk reductions was associated with more frequent attendance as regular frequency attenders were 4% more likely to visit a general practitioner for a routine healthcare visit (RR: 1.04, 95% CI: 1.01 – 1.07), but 23% less likely to visit the emergency department (RR: 0.87, 95% CI: 0.82 – 0.92).ConclusionsMembership at a medical fitness facility was associated with a decreased risk of mortality, health care utilization and cardiovascular events. The medical fitness model may be an alternative approach for public health strategies to promote positive health behaviors in older adult populations.

Evaluation of Screen Time in Children Under Five Years Old.

Due to the rapid advancement of technology, there has been a noteworthy increase in the diversity and abundance of activities involving children. The most effective methods to enhance and facilitate children's media interactions are to minimize, reduce, use with caution, and establish healthy patterns. We aimed to evaluate media exposure of children below five years of age. This is a prospective, observational, cross-sectional study that was conducted between December 2017 and September 2019 in Eskişehir, Türkiye. To assess the frequency of electronic device usage among children under the age of five, including televisions, laptops, tablets, and mobile phones, as well as its impact on their sleep patterns and physical measurements, and to evaluate families' understanding of the terms "screen time" and "back screen time," we developed a questionnaire. We analyzed a total of 731 questionnaires: 334 (45.7%) were girls, 397 (54.3%) were boys, and the mean age was 33.55±16.37 months. Upon examining the technical equipment accessible to the children in our study, we found that 98.6% possessed a television, 96.9% owned a mobile phone, 54% had a laptop, 49.5% had a tablet, and 34.1% possessed a gaming console. The study revealed the following proportions of electronic devices in children's rooms: 13% televisions, 11.9% tablets, 7.4% laptops, and 7% mobile phones. There has been a substantial increase in the amount of time they spend watching television and playing computer games among children who have at least one sibling. There was a statistically significant disparity between the television viewing periods and the body mass index of children older than two years old. Additionally, we have seen a significant disparity in the presence of media devices in children's bedrooms and the subsequent impact on their sleep duration and patterns throughout both nighttime and daytime. Around 65.8% of parents did not know of the concept of screen time, while 88.4% of parents did not know of the concept of back screen time. Parental compliance with the current guidelines for screen time is insufficient, among parents with children under the age of five, even though exposure to screens begins in the first months of life. Our analysis highlighted the necessity for parents to establish and enforce a unified and logical media usage policy for all children residing in the household. It is crucial to allocate sufficient time during the routine healthcare visit to discuss these recommendations.

A cross-sectional study on the prevalence of cardiovascular disease in elderly patients with long-term type 2 diabetes mellitus mainly attended in private clinics in Mexico. The CAPTURE study

BackgroundTo estimate the contemporary prevalence of established cardiovascular disease (CVD) in adults with type 2 diabetes (T2D) in Mexico.MethodsCAPTURE was a multinational, non-interventional, cross-sectional study across 13 countries from five continents. Standardized demographic and clinical data were collected from adults with T2D attending a single routine healthcare visit in primary or specialized care between December 2018 and September 2019. Data from Mexico are analyzed in this study.ResultsOf the 9,823 patients included in the CAPTURE study, 820 (8.3%) participants were from Mexico, mainly attended in private centers (29.3% in 6 specialized diabetes treatment centers and 70.7% in 26 primary care centers). The median age was 63.0 years, 52.6% were women, the duration of diabetes was 11.8 years and the average HbA1c 7.5%. The weighted prevalence [95% CI] of CVD and atherosclerotic CVD was 36.9% [34.1–39.6] and 29.5% [26.7–32.3], respectively. Additionally, the prevalence of coronary heart disease, heart failure, peripheral arterial disease and cerebrovascular disease was 23.1% [20.6–25-7], 8.4% [6.8–10.0], 5.0% [3.5–6.5] and 3.9% [2.6–5.2], respectively. Glucose lowering drugs were used in 88.5% of patients, being metformin the most commonly drug used (79.4%), followed by sulfonylureas (26.3%). SGLT-2 inhibitors and GLP1 receptor agonists were used in 15.5% and 3.9%, respectively.ConclusionsIn Mexico, nearly four out of ten patients with T2D mainly attended in private centers have CVD, particularly atherosclerotic CVD. Most patients were not taking glucose lowering drugs with proven CV benefit.

The psychosocial burdens of living with diabetes.

To better understand the prevalence of self-reported psychosocial burdens and the unmet needs identified by people with diabetes in relation to routine diabetes visits. An English language, online survey was distributed via social media, key stakeholder networks, charity and advocacy groups to adults with type 1 diabetes or type 2 diabetes. Survey items were designed by members of the FDA RESCUE Collaborative Community Governing Committee prior to pilot testing with potential participants. Descriptive statistical analyses were conducted, as well as thematic analyses on free-text responses using NVivo v14. Four hundred and seventy-eight participants completed the survey: 373 (78%) had type 1 diabetes, 346 (73%) identified as a woman and 433 (91%) were white. Most participants had experienced self-reported (rather than diagnosed) anxiety and depression (n = 323 and n = 313, respectively), as well as fear of low blood sugars (n = 294), low mood (n = 290) and diabetes-related distress (n = 257). Sixty-eight percent reported that diabetes had negatively affected self-esteem, 62% reported the feelings of loneliness, but 93% reported that friends/family/work colleagues were supportive when needed. Two hundred and seventy-two percent (57%) reported that their diabetes team had never raised the topic of mental health. The overwhelming majority stated that the best thing their diabetes team could do to help was to simply ask about mental well-being, listen with empathy and without judgement, and practice skills to understand psychosocial issues in diabetes. Integrating psychosocial discussions and support within routine healthcare visits is crucial to improve outcomes for people with diabetes. Such a biopsychosocial model of healthcare has long been advocated by regulatory bodies.

Knowledge and beliefs about oocyte cryopreservation for medical and social reasons in female students: a cross-sectional survey

BackgroundWith the increasing number of young women surviving cancer and a growing trend among highly educated women to postpone childbearing for educational or professional pursuits, there is a rising demand for egg freezing services to ensure a successful pregnancy. This study aims to assess the knowledge and beliefs surrounding oocyte cryopreservation, both for medical and social reasons, among female students in Tehran, Iran.MethodsAn online cross-sectional survey was carried out from March to August of 2022, involving a total of 1279 childless students pursuing master’s and doctoral degrees at universities in Tehran. The participants were between the ages of 18 and 38. Knowledge and beliefs about medical and social oocyte cryopreservation were assessed through Fertility Preservation Survey (FPS) instrument.ResultsThe mean age of the participants was 26.38 ± 4.9. The majority of students expected to be “30–34 years” when they become pregnant with their first child (41.1%, M: 30.3 ± 4.13 years) and “35–39 years” when they give birth to their last child (46.7%, M: 35.28 ± 4.18 years). The students agreed with preserving fertility with medical (93.3%) and social (86.9%) indications and believed the medical (95.1%) and social (87.4%) costs of cryopreservation should be covered by the healthcare system. Among the participants, 75.6% considered cost to be a definite or probable factor in their decision to pursue fertility preservation. The oncology team’s recommendation was identified as the most important factor in deciding on medical egg freezing (92.6%, M: 3.46 ± 0.71). The overall correct response rate for the knowledge questions was 57.7%. The majority of participants (95.5%) agreed that physicians should routinely provide information about egg freezing to women of childbearing age during their regular healthcare visits.ConclusionsThe research results revealed that female students in Tehran universities have a positive attitude towards medical and social egg freezing, but lack sufficient knowledge about the ideal timing of childbearing. Health professionals could provide detailed information about fertility preservation and age-related infertility as part of routine healthcare visits or reproductive health planning. Additionally, expanding supportive policies and incentives for childbearing established by the government to cover the costs of fertility preservation would be beneficial.

Obesity, obesity-related metabolic conditions, and risk of thyroid cancer in women: results from a prospective cohort study (Sister Study)

Thyroid cancer incidence has increased worldwide. Obesity trends may play a role, but the underlying biological pathways are not well-characterized. Therefore, we examined associations of excess adiposity and obesity-related metabolic conditions with thyroid cancer incidence. From the Sister Study, a cohort of sisters of women with breast cancer, we included 47,739 women who were cancer-free at baseline (2003-2009). Height, weight, waist and hip circumference, and blood pressure were measured at baseline and medical history was self-reported. Cox proportional hazards regression models were adjusted for age (time scale), race/ethnicity, smoking, baseline history of benign thyroid disease, and frequency of routine healthcare visits. During follow-up (median=12.5; max=15.9 years), 259 women reported incident thyroid cancer. Body mass index (BMI) (hazard ratio [HR]per-5 kg/m2=1.25, 95% CI=1.14-1.37), waist circumference (HRper-5 cm increase=1.11, 95% CI=1.06-1.15), and waist-to-hip ratio (HR≥0.85-versus-<0.85=1.49, 95% CI=1.14-1.94) were positively associated with thyroid cancer incidence, as were metabolic syndrome (HR=1.67, 95% CI=1.24-2.25), dyslipidemia (HR=1.46, 95% CI=1.13-1.90), borderline diabetes (HR=2.06, 95% CI=1.15-3.69), hypertension (HR=1.49, 95% CI=1.12-1.96), and polycystic ovary syndrome (PCOS, HR=2.10, 95% CI=1.20-3.67). These associations were attenuated with additional BMI adjustment, although dyslipidemia (HR=1.35, 95% CI=1.04-1.75) and PCOS (HR=1.86, 95% CI=1.06-3.28) remained associated with thyroid cancer incidence. Hypothyroidism was not associated with thyroid cancer. In this cohort of sisters of women diagnosed with breast cancer, excess adiposity and several obesity-related metabolic conditions were associated with thyroid cancer incidence. These findings provide insights into potential biological mechanisms linking obesity and thyroid cancer. This research was supported by the Intramural Research Program of the National Institutes of Health, National Cancer Institute and National Institute of Environmental Health Sciences (Z01-ES044005).

Post-Marketing Safety Surveillance of Quadrivalent Influenza Vaccine (VaxigripTetra) in Children Aged 6 to 35Months in South Korea.

The quadrivalent inactivated split-virion influenza vaccine (QIV; VaxigripTetra®) was initially licensed in South Korea in 2017 for immunization against seasonal influenza in those aged ≥ 3years, with the indicated age subsequently lowered to include those aged ≥ 6months in 2018. Here, to comply with South Korean licensure requirements, we undertook a post-marketing surveillance study to assess the safety of QIV in children aged 6-35months (i.e., extension of the previous age indication to include these young children) in routine clinical practice. A multicenter, observational, active safety surveillance of children aged 6-35months who received a single dose of QIV during a routine healthcare visit was undertaken in South Korea from 15June 2018 to 14June 2022. Solicited adverse events (AEs) and unsolicited non-serious AEs were recorded in diary cards, with serious adverse events (SAEs) notified to study investigators. This safety analysis included 676 participants. No AEs led to study termination, and no SAEs were reported. The most frequent solicited injection site reaction was pain in both the ≤ 23-month (12.2% [55/450]) and ≥ 24-month (15.5% [35/226]) age groups. The most frequent solicited systemic reactions were pyrexia and somnolence in the ≤ 23-month age group (6.0% [27/450] each), and malaise (10.6% [24/226]) in the ≥ 24-month age group. Overall, 208 (30.8%) participants experienced 339 unsolicited non-serious AEs, with nasopharyngitis the most common (14.1% [95/676]), and nearly all events (98.8% [335/339]) were considered unrelated to QIV. Grade3 solicited reactions and unsolicited non-serious AEs were reported in five (0.7%) and three (0.4%) participants, respectively, all of whom recovered by day7 after vaccination. This active safety surveillance study confirms that QIV is well tolerated in children aged 6-35months in routine clinical practice in South Korea. There were no safety concerns observed in these young children.

The Ohio State University Guardant Shield Colorectal Cancer Screening Project.

TPS3626 Background: Asymptomatic screening is an effective method for detecting early cancers when prognosis strongly depends on stage at time of diagnosis. Unscreened individuals often have a basic understanding of the importance and availability of colorectal cancer (CRC) screening but have concerns regarding the collection method of the currently available stool-based options or the invasiveness of direct visualization options that deter test completion. We hypothesize that offering a blood-based CRC screening test during a routine healthcare visit can increase screening adherence, especially within hard-to-reach populations and those hesitant about completing CRC screening. Methods: The Ohio State University Guardant Shield Colorectal Cancer Screening Project (NCT05716477) is a prospective study in the United States designed to recruit individuals who are currently engaging with mobile health clinics and are not up to date with CRC screening, with the aim of improving health in hard-to-reach populations. The study’s primary objective is to evaluate the acceptance of a commercially available blood-based CRC screening test (Shield, Guardant Health, USA) in individuals aged 45-84, who have existing appointments with a mobile health clinic, and are not up to date with guideline recommended CRC screening. The study team screens for eligibility criteria before the appointment and reaches out to the individual to begin the informed consent process. Positive blood-based test results will be triaged to colonoscopy for further evaluation. A post-study survey will be administered to consented individuals aimed to collect data on CRC screening knowledge which will be correlated to patient demographics and uptake. Acceptance will be defined as those approached and with completed specimen collection. Progress: The study initiated on October 25, 2022, with the first patient enrolled on December 20, 2022. Enrollment is expected to continue with a target enrollment of 300 individuals. Clinical trial information: NCT05716477 .

HIV Testing Preferences and Characteristics of Those Who Have Never Tested for HIV in the United States.

The initial phase of the federal Ending the HIV Epidemic in the U.S. (EHE) initiative prioritized efforts in 57 geographic areas. The US Centers for Disease Control and Prevention recommends persons aged 13 to 64 years be tested for HIV at least once as part of routine health care; however, it is unclear how effectively these testing recommendations have been implemented in EHE priority areas. In 2021 to 2022, we analyzed data from a Web-based, nationally representative survey of adults fielded in 2021. HIV testing preferences were compared by testing history, demographic characteristics, behaviors, and geography. An estimated 72.5% of US adults had never tested for HIV. Never testing was most prevalent among those aged 18 to 29 or those 50 years or older, non-Hispanic White persons, and those living in the Midwest. Among persons living in EHE priority areas and persons reporting at least one behavior that increases risk of HIV transmission, 69.1% and 48.0%, respectively, had never tested for HIV. The top 3 HIV testing preferences among never testers were as follows: testing for HIV during a routine health care visit (41.2%), testing at an urgent care or walk-in clinic (9.6%), and self-testing (8.1%). Most adults had not been tested for HIV, confirming that US Centers for Disease Control and Prevention recommendations are not being fully implemented, even in EHE priority areas. Moreover, most adults who never tested preferred testing in clinical settings, highlighting missed opportunities. As the EHE initiative continues to advance, it is critical to leverage preferred HIV testing modalities, such as routine testing in clinical settings or HIV self-testing.

Screening for Memory Concerns at the Well-Woman Visit.

Routine healthcare visits offer the opportunity to screen older adults for cognitive changes that accompany the earliest clinical stages of Alzheimer's disease (AD) including Mild Cognitive Impairment (MCI) and Subjective Cognitive Decline (SCD). It is well-established that women are at increased risk for AD and that many women see their gynecologist as their primary care doctor. Given this unique relationship, the Women's Preventive Services Initiative and the American College of Obstetrics and Gynecology now advocate for integrated care of women at all ages. Memory screening of older women should be paramount in this effort. Research is needed to determine which screening tools are most effective and practical. Here we assess the feasibility and utility of a subjective memory screener at the well-woman visit. Women aged 60 and above completed a 5-item screener at their well-woman visit at the Columbia University Integrated Women's Health Center (Table 1). Women who endorsed any item were considered to have a positive screen and were given the option to pursue clinical evaluation for memory concerns through the Division of Aging and Dementia. Only 8 of 354 women declined to complete the screener. Of the completed screeners, 16% (n = 56) were positive. The most frequently endorsed item was difficulty with memory or thinking compared to others the same age (8%, n = 28) (See Table 1). 44% (n = 24) of women with positive screens pursued referral, and six have been seen to date. One woman was diagnosed with MCI. Clinical impressions of the remainder were unremarkable. All six cases had family history of dementia or memory problems. The well-woman visit provides a key opportunity to routinely screen older women for early indicators of AD and treatable causes of cognitive impairment. Preliminary results support the feasibility and value of such screening as part of a comprehensive well-woman program. Early identification of women experiencing SCD will enable investigation into the cause of their memory concerns, and longitudinal monitoring of cognitive change. Future work should evaluate the added value of an objective cognitive screen to complement SCD screening and identify women who may benefit from further evaluation.

Time intervals and patient-level factors in oral cancer diagnostic pathways: An application of the WHO framework in India

BackgroundOral cancer, a leading cancer-site in India, is often detected at advanced stages. We evaluated the time intervals from first symptom to help-seeking and diagnosis among oral cancer patients. MethodologyIn this cross-sectional study, we recruited 226 consecutive oral cancer patients (mean age ( ± SD) 51.9 years ( ± 10.9); 81.9% men; 70.3% advanced stage) registered for diagnosis and treatment, between 2019 and 2021 at a cancer care centre in South India. We used WHO framework and previously standardized tools to record time intervals (appraisal, help-seeking and diagnostic) and baseline characteristics. We utilized multivariable logistic regression models to test the associations between ‘prolonged (i.e., over 1 month) time intervals’) and patient-level factors to estimate odds ratios (ORs) with 95% confidence intervals (CIs). ResultsOver a half of patients presented with prolonged appraisal (60%) and help-seeking intervals (57%), and a third (34%) reported prolonged diagnostic interval. Patients with no formal education, no routine healthcare visits, no self-reported risk factors, and those who did not perceive initial symptoms to be serious were 2–4 times more likely to have prolonged appraisal and help-seeking than the rest. High travel costs and self-decision for visiting healthcare facility prolonged help-seeking. Diagnostic interval was prolonged only among women OR= 2.7 (95% CI: 1.2–6.1)) and in patients whose first doctor’s opinion was ‘nothing to worry’ OR (=7.3 (95% CI: 2.6–20.5)). ‘Correct knowledge of cancer’ shortened appraisal and help-seeking intervals and ‘incorrect knowledge and negative beliefs’ prolonged diagnostic interval. ConclusionOur findings highlight that interventions targeting sociocultural and economic determinants, symptom awareness, sensitizing persons at risk (especially women) and primary care providers might reduce overall time to diagnosis. Further, patients without any known risk factors for oral cancer might be at-risk for prolonged appraisal interval. These might help inform ‘pull’ strategies for cancer control in India and similar settings.

PSAT294 Black Thyroid – Is It a Benign or a Malignant Finding?: A Case Report and Review of the Literature

Abstract Background Black thyroid is a rare condition with fewer than 70 cases reported around the globe. Black thyroid is seen almost exclusively in patients upon minocycline ingestion, and the process has previously been thought to be generally benign. Despite the favorable impact of this drug on thyroid function, several studies have reported an association between black thyroid and thyroid cancer. Herein, we report a black thyroid associated with papillary thyroid cancer. Clinical Case A 30-year-old woman with no significant medical history and no risk factors for thyroid cancer, but with a history of acne treated with minocycline for 2 months 10 years ago, came to the office for a thyroid nodule found during a routine healthcare visit. The patient was asymptomatic and euthyroid. Physical examination was unremarkable. The thyroid ultrasonography showed a 1.4 × 1.0 cm hypoechogenic solid nodule with irregular borders and microcalcifications located in the right lobe. No cervical lymph nodules were found. Fine-needle aspiration of the nodule displayed a Bethesda VI category. Total thyroidectomy was performed. No lymph node dissection was implemented. During surgery, the thyroid parenchyma was diffusely black in color, increased in size, and multinodular. The patient was uneventfully discharged on postoperative day 1. Histopathology revealed a diffuse black discoloration of the specimen with a well-defined 1.2×0.8×0.6 cm nodule in the right upper lobe with features of classic papillary thyroid carcinoma. Recently the patient was seen at his 3-month follow-up, and there were no signs or symptoms of recurrence or metastasis. Clinical lessons: Although several studies describe a higher incidence of malignancy (being papillary thyroid carcinoma the most frequently associated) in black thyroid compared to non-black thyroid glands, a causal relationship has never been proven. Perhaps in this case the thyroid ultrasonography screening triggered the overdiagnosis and subsequently the overtreatment. Finally, having a "black organ" can be distressing for patients. Therefore, we should be meticulous in explaining "this disturbing fact". Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Post-marketing Surveillance of a Quadrivalent Influenza Vaccine (VaxigripTetra) in South Korea.

IntroductionIn 2017, a quadrivalent inactivated split-virion influenza vaccine (QIV; Vaxigrip Tetra®, Sanofi) was licensed in South Korea for active immunization against influenza A and influenza B viruses in individuals aged 3 years or older, which was subsequently extended to individuals aged 6 months or older in 2018. Post-marketing surveillance trials are mandatory in South Korea to retain drug licensure. Here, we assessed the safety of QIV in routine clinical practice in South Korea.MethodsThis was an open, multicenter, observational, active safety surveillance study conducted between 20 June 2017 and 19 June 2021 at 10 study sites in South Korea in individuals aged 3 years or older who received a single dose of QIV during a routine healthcare visit. The participants or their legally acceptable representatives were instructed to record any adverse reactions (solicited events) and unsolicited non-serious adverse events (AE) in diary cards, and notify study investigators in case of serious adverse events (SAE).ResultsOverall, 663 participants were included in this study. There were no AEs leading to study termination, and no SAEs reported. Injection site pain (278 [41.9%]) was the most frequent solicited injection site reaction, with myalgia (250 [37.7%]) and malaise (236 [35.6%]) the most frequent solicited systemic reactions. Grade 3 solicited injection site and systemic reactions were reported by 8 (1.2%) and 13 (2.0%) participants, respectively; most participants with solicited reactions recovered without the need for further action. Overall, 39 (5.9%) participants experienced 49 unsolicited non-serious AEs with the most frequently reported being nasopharyngitis (19 [2.9%]). Grade 3 unsolicited non-serious adverse events were reported in 1 (0.2%) participant. None of the unsolicited non-serious AEs were considered to be related to QIV.ConclusionThis post-marketing surveillance study confirms that QIV is well tolerated and has an acceptable safety profile in routine practice in South Korea. No unexpected safety concerns were identified.Trial RegistrationClinicalTrials.gov identifier NCT05406180.

Asking parents about babbling at 10 months produced valid answers but did not predict language screening result 2 years later.

AimWe evaluated the concurrent and predictive validity of questions to parents of 10‐month‐old children about babbling.MethodsChildren with at least one native Swedish‐speaking parent were eligible for inclusion in this prospective longitudinal study. The parents were asked three questions about babbling at a routine healthcare visit. If parents reported a lack of canonical babbling (CB), children were assessed by a speech and language pathologist to evaluate the questions' concurrent validity. We then examined whether the babbling questions predicted which children would fail the routine language screening at 2.5/3 years.ResultsFifteen of the 1126 children lacked CB according to the parent responses and the expert assessment confirmed 12 of these cases, providing a concurrent validity of 80%. The sensitivity to predict routine language screening was 8% (95% confidence interval 3–17), and the positive predictive value was 40% (95% confidence interval 20%–65%). However, only six of the children lacking CB at 10 months were among the 71 children who failed later language screening.ConclusionThis study suggests that the babbling questions could be included in the 10‐month surveillance at the child health services as valid measures of babbling development, but they cannot predict language screening result at 2.5/3 years.

Users of cannabis-only are less likely to accept brief interventions than other substance use profiles in a sample of people living with HIV/AIDS.

Research has shown that people living with HIV/AIDS (PLWHA) engage in increased rates of substance use, which has a number of potential negative health outcomes. Increased legalization of cannabis is likely to further increase the availability and use of cannabis in this population. Efforts have been made to integrate screening and intervention resources as part of an individual's routine healthcare visits. Though brief approaches such as Screening and Brief Intervention (SBIRT) have shown promise in addressing alcohol use, results are mixed in addressing cannabis use. The present study investigated how individuals reporting cannabis use responded to an invitation to engage in a brief negotiated intervention (BNI). PLWHA participated in a self-administered tablet computer-based version of SBIRT. Patients screened as having at-risk, high-risk, or dependent substance use (N = 331) were eligible to receive the BNI. Of these patients, 101 reported cannabis-only use, with or without alcohol. Binary logistic regressions controlling for Alcohol Use Disorders Identification Test and Drug Abuse Screening Test score and demographics, found that cannabis-only use was significantly related to declining the BNI. Cannabis-only engagement predicts lower BNI acceptance rates than other substance use profiles; inappropriate screening tools may be one reason for this discrepancy. Implications and directions for future research are discussed. Findings are relevant in modifying SBIRT for cannabis use. To our knowledge, this is the first work to evaluate acceptance of brief interventions for cannabis as compared to other substances and brief intervention acceptance in a sample of PLWHA.

Association of Cesarean Delivery with Trajectories of Growth and Body Composition in Preschool Children.

This study aimed to examine the association of cesarean delivery with trajectories of growth and body composition in preschool children. This ambidirectional cohort study was conducted between 2017 and 2020 in China. Information on the delivery mode, weight, and length/height of the children measured at routine healthcare visits was obtained from maternal and child health records. For three years while in kindergarten, children’s body mass index (BMI), fat mass index (FMI), fat-free mass index (FFMI), and percentage of body fat (FM%) were repeatedly measured. A BMI z score (zBMI) was calculated and standardized to WHO measures, and overweight and obesity were defined using the WHO reference. After adjustment for maternal age, maternal education, annual family income, prepregnancy BMI, gestational weight gain, gravidity, parity, gestational age, child sex, birthweight, breastfeeding duration, and the parent-reported dietary intake of the children, children born via cesarean delivery (n = 1992) versus those born vaginally (n = 1578) had higher zBMI growth rates beyond 36 months (β: 0.003; 95% CI: 0.001, 0.005 SD units/month) and elevated levels of FMI (β: 0.097; 95% CI: 0.026, 0.168 kg/m2), FM% (β: 0.402; 95% CI: 0.058, 0.745%) and zBMI (β: 0.073; 95% CI: 0.012, 0.133 units), but not FFMI (β: 0.022; 95% CI: −0.022, 0.066 kg/m2). The adjusted OR of overweight and obesity was 1.21 (95% CI: 1.04, 1.40). Cesarean delivery likely elevated zBMI growth rates and increased the risk of overweight and obesity in preschool children, with the elevation of fat mass but not fat-free mass.

The Differential Impact of Medicaid Expansion on Disparities in Outcomes Following Peripheral Vascular Intervention

Peripheral artery disease (PAD) disproportionately affects nonwhite, Hispanic/Latino, and low socioeconomic status patients, who are less likely to have insurance and routine healthcare visits. Medicaid expansion (ME) has improved insurance rates and access to care, potentially benefitting these patients. We sought to assess the impact of ME on disparities in outcomes after peripheral vascular intervention (PVI) for PAD. A retrospective analysis of prospectively-collected Vascular Quality Initiative PVI procedures between 2011 and 2019 was conducted. The sample was restricted to first-record procedures in adults under the age 65 in states that expanded Medicaid on January 1, 2014 (ME group) or had not expanded before January 1, 2019 (non-expansion [NE] group). ME and NE groups were compared between pre-expansion (2011-2013) and post-expansion (2014- 2019) time periods to assess baseline demographic and operative differences. We used difference-in-differences multivariable logistic regression adjusted for patient factors and clinical center and year fixed effects. Our primary outcome was 1-year major amputation. Secondary outcomes included trends in presentation, 30-day mortality, 1-year mortality, and 1-year primary and secondary patency. Outcomes were stratified by race and ethnicity. We examined 34,313 PVI procedures, including 20,378 with follow-up data. Rates of Medicaid insurance increased post-expansion in ME and NE states (ME 16.7% to 23.0%, P<0.001; NE 10.0% to 11.9%, P=0.013) while rates of self-pay decreased in ME states only (ME 4.6% to 1.8%, P<0.001; NE 8.1% to 8.4%, P=0.620). Adjusted difference-in-differences analysis revealed lower odds of urgent/emergent PVI among all patients and all nonwhite patients in ME states post-expansion compared to NE states (all: odds ratio [OR] 0.53 [95% confidence interval 0.33-0.87], P=0.011; nonwhite: OR 0.41 [0.19-0.88], P=0.023). No differences were observed for 1-year major amputation (OR 0.70 [0.43-1.14], P=0.152), primary patency (OR 0.93 [0.63-1.38], P=0.726), or secondary patency (OR 1.29 [0.69-2.41], P=0.431). Odds of 1-year mortality were higher in ME states post-expansion compared to NE states (OR 2.50 [1.07-5.87], P=0.035), although 30-day mortality was not different (OR 2.04 [0.60-6.90], P=0.253). Notably, odds of 1-year major amputation among Hispanic/Latino patients decreased in ME states post-expansion compared to NE states (OR 0.11 [0.01-0.86], P=0.036). ME was associated with lower odds of 1-year major amputation among Hispanic/Latino patients who underwent PVI for PAD. ME was also associated with lower odds of urgent/emergent procedures among patients overall and nonwhite patients specifically. However, 1-year mortality increased in the overall cohort. Further study is needed to corroborate our findings that ME may have benefits for certain underserved populations with PAD.

Contemporary (2019) prevalence of cardiovascular disease in adults with type 2 diabetes in Brazil: the cross-sectional CAPTURE study

BackgroundType 2 diabetes (T2D) is a known risk factor for cardiovascular disease (CVD), and CVD is a major cause of mortality in patients with T2D. The CAPTURE study investigated the contemporary (2019) prevalence of established CVD in adults with T2D around the world. We report the findings from Brazil.MethodsThe multinational, non-interventional, cross-sectional CAPTURE study was conducted across 13 countries from five continents. The current manuscript explores data for the CAPTURE study sample in Brazil. Standardized demographic and clinical data were collected from adults with T2D aged ≥ 18 years attending a single routine healthcare visit in primary or specialized care between December 2018 and September 2019. Data were analyzed descriptively.ResultsData from 912 adults with T2D were collected in the CAPTURE study in Brazil, with 822 patients from primary care and 90 patients from specialized care. Median (interquartile range [IQR]) patient characteristics were as follows: age 64 years (57; 71), diabetes duration 11 years (6; 19), glycated hemoglobin 7.7% (6.7; 9.1), and body mass index 29.5 kg/m2 (26.4; 33.5); 59% were female. The CVD prevalence and atherosclerotic CVD prevalence in the Brazil sample were 43.9% (95% confidence interval [CI] 40.9; 46.8) and 37.6% (95% CI 34.7; 40.5), respectively. The majority of patients with CVD had atherosclerotic CVD (85.8%). For the specific CVD subtypes, coronary heart disease prevalence was 27.9% (95% CI 25.2; 30.5), heart failure was 12.4% (95% CI 10.4; 14.4), cerebrovascular disease was 8.7% (95% CI 6.8; 10.5), and carotid artery disease was 3.4% (95% CI 2.3; 4.5). Glucagon-like peptide-1 receptor agonists and/or sodium-glucose co-transporter-2 inhibitors with proven cardiovascular benefit were prescribed to 15.5% of patients with CVD, compared with 18.4% of patients without CVD.ConclusionsCAPTURE was the first multinational, standardized study to provide contemporary data on CVD prevalence in adults with T2D in Brazil, and it demonstrated that almost one in two adults with T2D had established CVD. Except for carotid artery disease, the prevalence of all CVD subtypes in adults with T2D in Brazil appeared higher than the global CAPTURE prevalence.Trial registration NCT03786406, NCT03811288

COVID-19 and Its Impact on Older Adults’ Routine and Urgent Health Care Visits

The COVID-19 pandemic has led to increased strains on the rapidly increasing aging population’s mental, emotional, and physiological health. COVID-19, which belongs to a family of respiratory viruses, was first detected in China before spreading to other parts of the globe. Due to underlying health conditions and weakened immune systems, the aging population is at greater risk for contracting COVID-19. To better prepare for a future pandemic, it is necessary to explore the psychosocial impacts of limited human interactions to make the aging population feel safer while mitigating harm to their mental and emotional health. The purpose of this study is to highlight the experiences of the aging population with COVID-19, including psychosocial, behavioral responses to the pandemic, and older adults’ overall well-being. We surveyed a total of 203 adults 55 and older regarding their experiences with the pandemic. Survey components included the COVID-19 Household Environment Scale (Behar-Zusman, Chavez, & Gattamorta, ND), selected items from the COVID-19 Impact Study and open-ended questions, the Generalized Anxiety Disorder Assessment (Williams et al., 2006), and the UCLA Loneliness Scale (Russell, Peplau, & Ferguson, 1978). Preliminary analyses indicate that most participants had not experienced any COVID-19 symptoms, nor did they know anyone who had passed away from the virus. However, participants did report loneliness and less family cohesion because of the pandemic. Findings from this study will be used to help older adults cope with the impact of the current pandemic and future pandemics.

Association between Neighborhood Disadvantage and Health Status/Healthcare Utilization in Survivors of Blood or Marrow Transplantation (BMT) - a BMTSS Report

Background: Living in a disadvantaged neighborhood (reflecting neighborhood-level social determinants of health) is associated with poor health outcomes. BMT survivors remain at a high risk of long-term and late-occurring chronic health conditions that require anticipatory management. We hypothesized that neighborhood disadvantage would be associated with poor health status as reported by the BMT survivors, as well as poor utilization of the healthcare system.Methods: We leveraged data from BMTSS - a retrospective cohort study examining long-term outcomes among individuals who survived ≥2y following BMT performed at three institutions between 1974 and 2014. Participants in this analysis underwent a single BMT and completed the BMTSS survey, which captures sociodemographic characteristics and chronic health conditions. We graded chronic health conditions using CTCAE v5.0, and calculated a summative index that takes into account the number and grades of the conditions, where a higher score indicates more/worse conditions. The survey also captured self-reported health status (“In general would you say your health is: excellent, very good, good, fair or poor?”) and healthcare utilization (“When was your most recent routine check-up? <1y ago, 1-2y ago, 2-5y ago, ≥5y ago, never”). Neighborhood disadvantage was measured using the Area Deprivation Index (ADI), a validated composite indicator based on 17 US Census measures and percentiled as 0 (least deprived) to 100 (most deprived). BMT survivors were linked to ADI via census block group using home address at survey completion. Using multivariable ordered logit regression, we modeled the association between ADI and the odds of worse self-reported health or a longer time since a routine healthcare visit. Models were adjusted for available clinical factors (primary cancer diagnosis, donor source, conditioning intensity, chronic health conditions, chronic graft vs. host disease (GvHD), time from BMT) and individual-level sociodemographic characteristics (age at survey, sex, payor, race/ethnicity, education, income, marital status).Results: The cohort included 2,893 BMT survivors; median age at BMT was 47y (IQR: 30-58); median follow-up time was 9y (IQR: 5-16). Table 1 summarizes patient characteristics. Median ADI ranged from 14.0 in patients rating their health as excellent to 28.5 in those rating their health as poor, and from 21.0 in patients with visits <1y ago to 34.0 in patients reporting no visits [Fig 1]. In multivariable analyses, the odds of reporting worse health were higher for patients residing in more disadvantaged neighborhoods (OR per_unit_higher_ADI=1.005, p=0.003). Thus, for our cohort, a patient living in the most disadvantaged neighborhood (ADI=100) had 1.65 times the odds of reporting poor health compared to a patient living in the least disadvantaged neighborhood (ADI=1). Further, the odds of a longer time since the last routine physician visit were higher for patients living in more disadvantaged neighborhoods (OR per_unit_higher_ADI=1.007, p<0.001). Thus, a patient living in the most disadvantaged neighborhood had twice the odds (OR=2.06) of reporting no visits compared to a patient living in the least disadvantaged neighborhood.Conclusions: Conditional on surviving 2 or more years after BMT, living in a disadvantaged neighborhood was associated with poorer self-reported health and a longer time interval since a routine healthcare visit, after adjusting for self-reported individual socioeconomic indicators and chronic health conditions. The significant association between area deprivation and poorer self-reported health persisted after controlling for prior health care utilization. Our findings suggest that health status and access to healthcare are associated with characteristics of the built and social environment and deserve detailed examination in order to inform multi-level interventions that include policy. [Display omitted] DisclosuresArora: Syndax: Research Funding; Kadmom: Research Funding; Pharmacyclics: Research Funding.