Significant Difference In Odds Research Articles

Obesity Paradox in the Burn Patient.

Despite the fact that obesity is a known risk factor for comorbidities and complications, there is evidence suggesting a survival advantage for patients classified by body mass index (BMI) as overweight or obese. Investigated in various clinical areas, this "Obesity Paradox" has yet to be explored in the burn patient population. We sought to clarify whether this paradigm exists in burn patients. Data collected on 519 adult patients admitted to an American Burn Association Verified Burn Center between 2009 and 2017 was utilized. Univariable and multivariable logistic regression were used to determine the association between in-hospital mortality and BMI classifications (underweight <18.5 kg/m2, normal 18.5 to 24.9 kg/m2, overweight 25-29.9 kg/m2, obesity class I 30 to 34.9 kg/m2, obesity class II 35 to 39.9 kg/m2, and extreme obesity >40 kg/m2). For every kg/m2 increase in BMI, the odds of death decreased, with an adjusted odds ratio of 0.856 (95% confidence interval [CI] 0.767 to 0.956). When adjusted for total BSA (TBSA), being obesity class I was associated with an adjusted odds ratio of mortality of 0.0166 (95% CI 0.000332 to 0.833). The adjusted odds ratio for mortality for underweight patients was 4.13 (95% CI 0.416 to 41.055). There was no statistically significant difference in odds of mortality between the normal and overweight BMI categories. In conclusion, the obesity paradox exists in burn care: further investigation is needed to elucidate what specific phenotypic aspects confer this benefit and how these can enhance the care of burn patients.

645 Black and White Patients With Inflammatory Bowel Disease Demonstrate Similar Biologic Use Patterns With Medicaid Insurance

INTRODUCTION: Prior studies have indicated that significant disparities exist when comparing black and white patients with inflammatory bowel disease (IBD), including increased emergency department visits and difficulty accessing specialists for Crohn's disease (CD) and ulcerative colitis (UC). The primary objective of this study was to compare any use of IBD-specific therapies among black and white patients with Medicaid Insurance, where race is self-reported at enrollment and patients have uniform insurance coverage. Among patients with CD who underwent surgery, we also aimed to evaluate postoperative therapies. METHODS: We performed a retrospective cohort study, analyzing data from the Medicaid Analytic Extract from four states (CA, GA, NC, and TX) between 2007 and 2014. We compared the use of IBD-specific therapies between black and white patients with IBD, including specific analyses of postoperative therapy among patients with CD. We performed bivariate analyses and multivariable logistic regression, adjusting for potential confounders. RESULTS: We identified 14,735 patients with IBD [4,672 black race (32%), 8,277 CD (58%)]. Among all 14,375 patients, 64% received at least one IBD-specific medication. Black patients were significantly more likely to receive therapy with an immunomodulator (20% vs. 15%, P &lt; 0.001), an anti-tumor necrosis alpha (anti-TNF) therapy (23% vs. 18%, P &lt; 0.001), combination therapy with an anti-TNF and an immunomodulator (4% vs. 3%, P &lt; 0.001) and prednisone (43% vs. 38%, P &lt; 0.001, Table 1). In multivariable analysis, there was no significant difference in odds of anti-TNF use by race for CD [adjusted Odds Ratio (aOR) 1.13, 95% Confidence Interval (CI): 0.99-1.28] or UC (aOR 1.12, 95% CI: 0.96-1.32, Table 2). Black patients with CD were more likely to receive combination therapy (aOR 1.50, 95% CI: 1.15-1.96). Among 398 patients undergoing surgery for CD, black patients received earlier postoperative therapy with an anti-TNF (median 94 days vs. 132 days, P = 0.023) and azathioprine (median 53 days vs. 92 days, P = 0.024), with no significant difference noted in use of methotrexate in the post-operative period. CONCLUSION: In patients with Medicaid Insurance, where access to IBD-specific therapy should be similar for all individuals, there was no significant disparity by race in the utilization of IBD-specific therapies. Access to comparable insurance benefits may aid significantly in resolving apparent healthcare disparities.

Does time matter? cross–sectional evaluation of mhealth program enrollment duration on healthy behaviors among key populations in Lomé

Context: Key populations (KP) in Togo, including men who have sex with men and female sex workers, experience disproportionately high rates of HIV prevalence. In response to this situation, USAID/West Africa and FHI360 established the PACTE–VIH regional HIV/AIDS project, which utilized mobile health (mHealth) to send reminders to enrolled participants on ways to reduce the risk of HIV infection. While mHealth programs are known to be effective in improving HIV–related health behavior outcomes, the role of length of time enrolled in a mHealth program is not well understood. Methods: To assess whether there was a relationship between time enrolled in the PACTE–VIH mHealth program and adoption of HIV prevention behavior, we use data from an operations research study conducted in Lomé, Togo, in 2016 with 1005 KP and employ logistic regression analysis. Results: The odds of adopting prevention behaviors were higher with each additional month enrolled in the program (OR: 1.62; 95% CI 1.19–2.20). Fully adjusted (age and marital status) logistic regression models demonstrated no significant difference in odds of adopting prevention behavior between enrollment times of less than six months and any category greater than six months. Conclusion: Time does matter for adoption of HIV prevention behaviors. However, more studies are needed to better understand what length of time enrolled in a program truly affects behavioral outcomes.

Length of Stay and Disposition of Patients Undergoing Elective Spine Surgery in Maryland: Impact of the Global Budget Revenue Program

Abstract INTRODUCTION The State of Maryland implemented an All-Payer Global Budget Revenue (GBR) program in 2014. The policy shifted hospital reimbursement from diagnosis related groups (DRG) to set annual budgets prior to each fiscal year with the goal of reducing cost and utilization while improving patient outcomes. No studies have evaluated the impact on patients undergoing spine surgery, a growing population that can exhibit high costs. METHODS A retrospective review was conducted utilizing the Maryland Health Services Cost Review Commission Public use dataset to evaluate differences in hospital length of stay (LOS), 30 d readmissions, and disposition locations of patients undergoing elective spine surgery at hospitals under the GBR Program in Maryland from 2012 to 2018. Hierarchical regression modeling was used to evaluate the outcomes prior to and following policy implementation. Outcomes included mean LOS, odds of readmission, and the relative risk of discharge to home with home health care (HHC) or rehabilitation (Rehab) compared to home. Covariates included sex, age, race, complexity, and mortality risk. RESULTS A total of 31 068 records of elective spine surgery from 2012 to 2018 were identified. There was a statistically significant decrease in readmission rates following implementation of the global budget program, 2.57% to 2.02% P = .001. However, when clustering on hospitals, there was no significant difference in odds of readmission following policy implementation, Adjusted OR 0.76 (95% CI 0.48, 1.22). There was a statistically significant increase in the ratio of relative risks of discharge to HHC or Rehab comparing the period following policy implementation to before was 1.62 (95% CI 1.17, 2.23) and 2.07 (95% CI 1.38, 3.12), respectively. CONCLUSION A preliminary analysis demonstrates no change in hospital utilization, but an increase in risk of being discharged with ancillary services or to rehabilitation among spine fusion patients following policy implementation. Further analysis is warranted to determine changes in trends to inform future policies.

Safety of Intra-articular Hyaluronic Acid Injections in Osteoarthritis: Outcomes of a Systematic Review and Meta-Analysis.

BackgroundSome controversy exists regarding the safety of intra-articular hyaluronic acid (IAHA) in the management of osteoarthritis (OA).ObjectiveThe objective of this study was to re-assess the safety profile of IAHA in patients with OA, through a comprehensive meta-analysis of randomized, placebo-controlled trials.MethodsA comprehensive literature search was undertaken in the databases MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus. Randomized, double-blind, placebo-controlled, parallel-group trials that assessed adverse events (AEs) with IAHA in patients with OA were eligible for inclusion. Authors and/or study sponsors were contacted to obtain the full report of AEs. The primary outcomes were overall severe and serious AEs, as well as the following MedDRA System Organ Class (SOC)-related AEs: gastrointestinal, cardiac, vascular, respiratory, nervous system, skin and subcutaneous tissue disorders, musculoskeletal, renal and urinary disorders, infections and infestations, and hypersensitivity reaction.ResultsDatabase searches initially identified 1481 records. After exclusions according to the selection criteria, 22 studies were included in the qualitative synthesis, and nine studies having adequate data were ultimately included in the meta-analysis. From the studies excluded according to the pre-specified selection criteria, 21 with other pharmacological OA treatments permitted during the trials were a posteriori included in a parallel qualitative synthesis, from which eight studies with adequate data were finally included in a parallel meta-analysis. Since this meta-analysis was designed to assess safety, the exclusion criterion on concomitant anti-OA medication was crucial. However, due to the high number of studies that allowed mainly concomitant oral non-steroidal anti-inflammatory drugs (NSAIDs), we decided to include them in a post hoc parallel analysis in order to compare the results from the two analyses. No statistically significant difference in odds was found between IAHA and placebo for all types of SOC-related disorders, except for infections and infestations, for which significantly lower odds were found with IAHA compared with placebo, both overall (odds ratio [OR] = 0.61, 95% confidence interval [CI] 0.40–0.93; I2 = 0%) and in studies without concomitant anti-OA medication (OR = 0.49, 95% CI 0.27–0.89). There were significant increased odds of reporting serious AEs with IAHA compared with placebo, both overall (OR = 1.78, 95% CI 1.21–2.63; I2 = 0%) and in studies with concomitant anti-OA medication (OR = 1.78, 95% CI 1.10–2.89), but not in studies without concomitant anti-OA medication (OR = 1.78, 95% CI 0.92–3.47).ConclusionsUsing the available data on studies without any concomitant anti-OA medication permitted during clinical trials, IAHA seems not to be associated with any safety issue in the management of OA. However, this evidence was associated with only a “low” to “moderate” certainty. A possible association with increased risk of serious AEs, particularly when used with concomitant OA medications, requires further investigation.Electronic supplementary materialThe online version of this article (10.1007/s40266-019-00657-w) contains supplementary material, which is available to authorized users.

93 The BMI Paradox in Burn Patients

Despite the fact that obesity is a known risk factor for comorbidities and complications, there is evidence suggesting a survival advantage for patients classified by body mass index (BMI) as overweight or obese. Investigated in various clinical areas, this “BMI paradox” has yet to be explored in the burn patient population. We sought to clarify whether this paradigm exists in burn patients. Data collected on 519 adult patients admitted to an American Burn Association/American College of Surgeons Verified Burn Center between 2009 and 2017 was utilized. Univariable and multivariable logistic regression were used to determine the association between in-hospital mortality and the National Heart, Lung and Blood Institute(NIH) BMI classifications (underweight <18.5 kg/m2, normal 18.5–24.9 kg/m2, overweight 25–29.9 kg/m2, obesity class I 30–34.9 kg/m2, obesity class II 35–39.9 kg/m2 and extreme obesity >40 kg/m2). The mean BMI of inpatients treated for burns was 29.56 (SD 10.64). For every kg/m2 increase in BMI, the odds of death decreased, with an adjusted odds ratio 0.82 (95% CI 0.71–0.96; p<0.01). When adjusted for total burn surface area, being in the obese class I rather than the normal classification was associated with an adjusted odds ratio of mortality of 0.032 (95% CI 0.0012 - 0.92; p<0.05), whereas having a BMI >40 kg/m2 had an odds ratio of 0.00. The adjusted odds ratio if underweight was 12.11 (95%CI 1.55–94.62; p<0.05). There was no statistically significant difference in odds of mortality between a normal and an overweight BMI. The “BMI paradox” exists in burn care. Further investigation is needed to elucidate what specific phenotypic aspects confer this benefit and how these can enhance the care of burn patients. Alters understanding of predictors of outcome.

Pharmacokinetic effects of endotracheal, intraosseous, and intravenous epinephrine in a swine model of traumatic cardiac arrest

IntroductionLimited prospective data exist regarding epinephrine's controversial role in managing traumatic cardiac arrest (TCA). This study compared the maximum concentration (Cmax), time to maximum concentration (Tmax), plasma concentration over time, return of spontaneous circulation (ROSC), time to ROSC, and odds of ROSC of epinephrine administered by the endotracheal (ETT), intraosseous (IO), and intravenous (IV) routes in a swine TCA model. MethodsForty-nine Yorkshire-cross swine were assigned to seven groups: ETT, tibial IO (TIO), sternal IO (SIO), humeral IO (HIO), IV, CPR with defibrillation (CPRD), and CPR only. Swine were exsanguinated 31% of their blood volume and cardiac arrest induced. Chest compressions began 2 min post-arrest. At 4 min post-arrest, 1 mg epinephrine was administered, and blood specimens collected over 4 min. Resuscitation continued until ROSC or 30 min elapsed. ResultsThe Cmax of IV epinephrine was significantly higher than the TIO group (P = 0.049). No other differences in Cmax, Tmax, ROSC, and time to ROSC existed between the epinephrine groups (P > 0.05). Epinephrine levels were detectable in two of seven ETT swine. No significant difference in ROSC existed between the epinephrine groups and CPRD group (P > 0.05). Significant differences in ROSC existed between all groups and the CPR only group (P < 0.05). No significant differences in odds of ROSC were noted. ConclusionsThe pharmacokinetics of IV, HIO, and SIO epinephrine were comparable. Endotracheal epinephrine absorption was highly variable and unreliable compared to IV and IO epinephrine. Epinephrine appeared to have a lesser role than volume replacement in resuscitating TCA.

The combined effect of physical activity and sedentary behavior on subclinical atherosclerosis: a cross-sectional study among Mexican Americans

BackgroundPhysical activity and sedentary behavior are considered independent risk factors for chronic disease. However, we do not fully understand their interrelation with key health outcomes such as subclinical atherosclerosis. This study examines the combined effects of sedentary behavior and physical activity on carotid intima-media thickness (cIMT) and presence of carotid plaque in a Mexican American population on the Texas-Mexico border.MethodsThis cross-sectional study was conducted using retrospective data from a sample (n = 612) of participants from the Cameron County Hispanic Cohort. Carotid ultrasound was used to measure cIMT and presence of carotid plaque. Self-reported questionnaires were used to assess leisure time physical activity and sedentary behavior (TV/movie sitting and total sitting). A series of multivariable regression models were used to assess study aims. An interaction term between physical activity and sedentary behavior was included in models for each respective outcome. Models were controlled for demographic and health-related variables.ResultsThere were no significant associations found between physical activity, sedentary behavior and mean cIMT, or cIMT thickness ≥ 75th percentile for age and gender. However, there was a significant interaction between physical activity and TV/movie sitting with presence of carotid plaque. Participants who reported moderate levels of physical activity had significantly lower odds for presence of plaque compared to participants with no activity when TV/movie sitting time was ≤3 h per day. However, there was no significant difference in odds for presence of plaque between physical activity groups when TV/movie sitting exceeded 3 h/day. These results were consistent with models examining total sitting time.ConclusionsOur results indicate that for Mexican Americans, there is a combined effect of sedentary behavior and physical activity on presence of carotid plaque. Participating in moderate physical activity is optimal for having lower levels of carotid plaque in addition to avoiding excessive levels of TV/movie sitting (≥3 h/day) and/or total sitting (≥8.5 h/day).

Brain MRI and cognitive function seven years after surviving an episode of severe acute malnutrition in a cohort of Malawian children.

To assess differences in cognition functions and gross brain structure in children seven years after an episode of severe acute malnutrition (SAM), compared with other Malawian children. Prospective longitudinal cohort assessing school grade achieved and results of five computer-based (CANTAB) tests, covering three cognitive domains. A subset underwent brain MRI scans which were reviewed using a standardized checklist of gross abnormalities and compared with a reference population of Malawian children. Blantyre, Malawi.ParticipantsChildren discharged from SAM treatment in 2006 and 2007 (n 320; median age 9·3 years) were compared with controls: siblings closest in age to the SAM survivors and age/sex-matched community children. SAM survivors were significantly more likely to be in a lower grade at school than controls (adjusted OR = 0·4; 95 % CI 0·3, 0·6; P &lt; 0·0001) and had consistently poorer scores in all CANTAB cognitive tests. Adjusting for HIV and socio-economic status diminished statistically significant differences. There were no significant differences in odds of brain abnormalities and sinusitis between SAM survivors (n 49) and reference children (OR = 1·11; 95 % CI 0·61, 2·03; P = 0·73). Despite apparent preservation in gross brain structure, persistent impaired school achievement is likely to be detrimental to individual attainment and economic well-being. Understanding the multifactorial causes of lower school achievement is therefore needed to design interventions for SAM survivors to thrive in adulthood. The cognitive and potential economic implications of SAM need further emphasis to better advocate for SAM prevention and early treatment.

983P - Risk of cancer associated death in younger vs older patients with FIGO stage I endometrial cancer

Background: Although age is considered a traditional risk factor for relapse in stage I endometrial cancer, whether it impacts endometrial cancer-related death is unclear. We aimed to assess disease risk factors, overall survival (OS), disease-free survival (DFS), and cancer-specific survival, in patients > =70 (OP) vs. <70 (YP) years of age with or without adjuvant therapy. Methods: We reviewed medical records of all patients who underwent surgery for stage I endometrial cancer between 2000 and 2013 in British Columbia, Canada. Descriptive, logistic regression, multivariate Cox regression and competing risks analyses were used to evaluate patient outcomes. Results: 365 OP and 1063 YP were included (n = 1428). No significant differences were found between OP and YP with regards to disease risk factors such as stage IB disease and lymphovascular invasion (LVI). However, OP had higher odds of non-endometrioid histology (OR 1.88, p < 0.001). 22 (6%) OP and 78 (7.3%) YP received adjuvant chemotherapy (CT); 120 (32.9%) OP and 290 (27.3%) YP received adjuvant radiotherapy (RT). When adjusted for histology, LVI and grade, YP were more likely to receive CT (OR 2.10, p = 0.009); no significant difference in odds of receiving RT was found between YP and OP (OR 0.86, p = 0.33). OP experienced higher odds of relapse (OR 1.95, p = 0.001) and worse OS (HR 4.12, p < 0.001) and DFS (HR 2.18, p < 0.001) than YP after adjusting for risk factors. 10-year OS (endometrioid: 61.9 vs 89.2%; non-endometrioid: 46.1 vs 85.8%, p < 0.001) and DFS (endometrioid: 86.7 vs 91.9%; non-endometrioid: 69.6 vs 84.5%, p < 0.001) were worse for OP. Controlling for risk factors, OP experienced a higher incidence of endometrial cancer-related death than YP (HR = 2.09, p < 0.001). Conclusions: In patients with stage I endometrial cancer, patients > =70 years had higher odds of having non-endometrioid histology as well as relapse and death due to endometrial cancer, yet were less likely to receive adjuvant CT. Appropriate adjuvant therapy should be considered regardless of age, as recurrent disease is still a significant cause of mortality in older patients with stage I endometrial cancer. Legal entity responsible for the study: BC Cancer. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

A Propensity Score Analysis of Clostridium difficile Infection among Adult Trauma Patients.

Clostridium difficile infection (CDI) is now the most common cause of health-care-associated infection and carries a mortality rate ranging from 5-30%. Previously, trauma patients in whom CDI developed were thought to represent a unique younger at-risk population. This study aimed to establish the incidence of CDI among adult trauma patients. We hypothesized that these patients would have increased risk of death, intensive care unit (ICU) length of stay (LOS), and hospital LOS compared with trauma patients without CDI. A retrospective study of all adult trauma patients admitted for greater than 48 hours to a single Level I trauma center between 2014 and 2016 was conducted. Analysis was performed using 1-to-5 propensity score matching with the aim to analyze the relationship between CDI, death, and other outcome variables. Between 2014 and 2016, of 4893 trauma patients admitted for >48 hours, 27 (0.6%) patients received a diagnosis of CDI. These patients had a mean age of 55.6 years, mean injury severity score (ISS) of 22.4, and mortality rate of 9.1%. Of these patients, 22 were able to find appropriate propensity score matches. After adjusting for important covariables, there was no significant difference in death between CDI and non-CDI patients (odds ratio = 0.39, 95% confidence interval [CI]: 0.06-2.57, adjusted p = 0.66). In addition, there was no significant difference in ICU LOS between the two groups (relative mean [RM]: 1.55, 95% CI: 1.04-2.33, adjusted p = 0.0971). The CDI patients, however, did have a significantly longer hospital LOS, compared with non-CDI patients (RM = 1.39, 95% CI: 1.16-1.66, adjusted p = 0.0017). Among trauma patients admitted >48 hours CDI occurred at a rate of 0.6%, much lower than anticipated. Patients in whom CDI developed had a significantly longer hospital LOS however, had no significant difference in odds of mortality or ICU LOS compared to patients without CDI.

Odds of talking to healthcare providers as the initial source of healthcare information: updated cross-sectional results from the Health Information National Trends Survey (HINTS)

BackgroundPeople use a variety of means to find health information, including searching the Internet, seeking print sources, and talking to healthcare providers, family members, and friends. Doctors are considered the most trusted source of health information, but people may be underutilizing them in favor of searching the Internet.MethodsA multinomial logistic regression of cross-sectional data from Cycle 4 of the Health Information National Trends Survey (HINTS) was conducted. Independent variables included gender, age, rurality, cancer history, general health, income, race, education level, insurance status, veteran status, Internet use, and data year; the dependent variable was the first chosen source of health information.ResultsThe most frequent initial source of health information was the Internet, and the second most frequent was healthcare providers. There were significant differences in odds of using healthcare providers as the first source of health information. Those likely to use doctors as their initial source of health information were older adults, black adults, adults with health insurance, those who do not use the Internet, and adults who do not have a college degree.ConclusionsPeople who use healthcare providers as the first source of health information may have better access to health care and be those less likely to use the Internet. Doctors may have to provide more information to those who do not use the internet and spend time verifying information for those who do use health information from the internet.

Importance of household-level risk factors in explaining micro-epidemiology of asymptomatic malaria infections in Ratanakiri Province, Cambodia

Heterogeneity in malaria risk is considered a challenge for malaria elimination. A cross-sectional study was conducted to describe and explain micro-epidemiological variation in Plasmodium infection prevalence at household and village level in three villages in Ratanakiri Province, Cambodia. A two-level logistic regression model with a random intercept fitted for each household was used to model the odds of Plasmodium infection, with sequential adjustment for individual-level then household-level risk factors. Individual-level risk factors for Plasmodium infection included hammock net use and frequency of evening outdoor farm gatherings in adults, and older age in children. Household-level risk factors included house wall material, crop types, and satellite dish and farm machine ownership. Individual-level risk factors did not explain differences in odds of Plasmodium infection between households or between villages. In contrast, once household-level risk factors were taken into account, there was no significant difference in odds of Plasmodium infection between households and between villages. This study shows the importance of ongoing indoor and peridomestic transmission in a region where forest workers and mobile populations have previously been the focus of attention. Interventions targeting malaria risk at household level should be further explored.

Abstract P189: Factors Associated With Stenosis on Invasive Coronary Angiography for Persons Living With Human Immunodeficiency Virus (PLWH): The HIV Electronic Comprehensive Cohort of CVD Complications (HIVE-4CVD)

Background: Persons living with HIV (PLWH) have greater risks for atherosclerotic cardiovascular disease (ASCVD) than uninfected persons. However, data are sparse regarding HIV-specific factors associated with coronary atherosclerosis. Methods: HIVE-4CVD is an electronic data repository of demographic and clinical data collected during the routine clinical care of 5041 PLWH and 10082 uninfected controls frequency matched on age, sex, race, zip code, and clinic location receiving care at Northwestern Medicine from 1/1/2000 to 5/17/2017. Using validated natural language extraction algorithms, we analyzed data on coronary stenosis severity for the 286 PLWH and 266 uninfected controls in HIVE-4CVD who underwent coronary angiography. Stenosis severity was recorded as the highest percentage of stenosis noted for each patient in each artery (LAD, LCx, RCA). Multivariable logistic regression models adjusted for demographics and CVD risk factors were used to evaluate odds of significant (≥50%) coronary stenosis (1) for PLWH versus uninfected controls and (2) across different levels of HIV viremia and immune suppression among PLWH. Results: Of the 286 PLWH and 266 uninfected controls undergoing coronary angiography, 205 (55.4%) PLWH vs. 165 (44.6%) uninfected controls had diagnoses of myocardial infarction (p=0.02). The location and severity of coronary stenoses did not differ significantly for PLWH vs. uninfected controls; mean maximal overall stenosis and mean maximal LAD, RCA, and LCx stenoses were 52.3% vs. 50.2% (p=0.52), 44.5% vs. 42.3% (p=0.48), 37.0% vs. 36.1% (p=0.78) and 31.4% vs. 31.6% (p=0.95) respectively. There was no significant difference in odds of having significant coronary stenosis for PLWH vs. uninfected controls (multivariable-adjusted OR 1.15, 95% CI 0.79-1.70). Among PLWH, peak HIV viral load was associated with borderline significantly greater odds of ≥50% coronary stenosis after adjustment for demographics, CVD risk factors, and HIV therapies (OR 1.07 per 10-fold greater peak HIV viral load, 95% CI 1.00-1.14, p=0.04), but lower Nadir CD4+ T cell count (&lt;200 vs. ≥200 cells/mm 3 ) was not (OR 1.05, 95% CI 0.74-1.48, p=0.79). Conclusions: There was no consistent or significant difference in severity of coronary artery stenosis among PLWH and uninfected controls undergoing invasive coronary angiography in the course of routine clinical care. Higher peak HIV viral load is associated with borderline significantly greater odds of having significant coronary stenosis among PLWH undergoing invasive coronary angiography.

Long-term effect of prenatal exposure to malnutrition on risk of schizophrenia in adulthood: Evidence from the Chinese famine of 1959–1961

BackgroundSchizophrenia is a common major mental disorder and prenatal nutritional deficiency may increase its risk. We aimed to investigate long-term impact of prenatal exposure to malnutrition on risk of schizophrenia in adulthood using the Chinese famine of 1959–1961 as a natural experiment. MethodsWe obtained data from the Second National Sample Survey on Disability implemented in 31 provinces in 2006, and restricted our analysis to 387,093 individuals born from 1956 to 1965. Schizophrenia was ascertained by psychiatrists based on the International Statistical Classification of Diseases, Tenth Revision. Famine severity was defined as cohort size shrinkage index. The famine effect on adult schizophrenia was estimated by difference-in-difference models, established by examining the variations of famine exposure across birth cohorts. ResultsCompared with the reference cohort of 1965, famine cohorts (1959–1962) had significantly higher odds (OR: 1.84; 95% CI: 1.13, 3.00; P = 0.014) of schizophrenia in the rural population. After adjusting for multiple covariates, this association remained significant (OR: 1.82; 95% CI: 1.11, 2.98; P = 0.018). We did not observe statistically significant differences in odds of schizophrenia among famine cohorts compared with the reference cohort in the urban population. ConclusionsPrenatal malnutrition exposure has a detrimental impact on risk of schizophrenia in adulthood in the rural population. Further studies were needed to investigate corresponding mechanisms on this topic.

Abstract WP180: Recanalization Predicts Prognosis After Cerebral Venous Thrombosis: A Systematic Review and Meta-analysis

Background: Guidelines recommend a 3-12 month duration of anticoagulation for cerebral venous thrombosis (CVT) and a repeat venogram at 3-6 months to assess recanalization. However, the relationship between recanalization and prognosis is not well defined. We performed a systematic review and meta-analysis to clarify the association between venous recanalization and prognosis in CVT. Methods: We performed a literature search to identify all published studies that evaluated recanalization and prognosis in adult patients with a diagnosis of CVT treated with anticoagulation. Studies were identified using MEDLINE and EMBASE databases (1946 - 2017). Recanalization was ascertained by repeat venogram (CT, MR or conventional) and degree of recanalization was characterized as complete, partial or absent. Prognosis was defined using the modified Rankin Scale (mRS, 0-1 = excellent outcome). Results: We found 675 articles and conference abstracts. Thirty-five were appropriate for full-text review and 11 had information regarding recanalization and clinical outcome, accounting for 450 subjects in total. All but one study had clinical and neuro-imaging reassessments within 12 months. Eighty-five percent had complete or partial recanalization within one year. Eighty-seven percent had an excellent outcome (mRS 0-1). As compared with complete or partial recanalization, those with no recanalization had a significantly increased odds of an mRS of 2-6 (OR 3.3, 95% CI 1.5 - 7.2, p=0.003). There was no significant difference in odds of worse prognosis for those with partial recanalization versus full recanaliation. No recanalization also carried a higher odds of CVT recurrence (OR 7.2, 95% CI 1.5 - 33, p=0.01) and chronic headache (OR 3.8, 95% CI 1.6 - 9.0, p=0.002). Conclusion: Absence of recanalization is associated with a poorer prognosis in CVT patients. There does not appear to be a dose-response relationship with regards to degree of recanalization (partial versus complete) and prognosis.

Access to Electronic Personal Health Records Among Patients With Multiple Chronic Conditions: A Secondary Data Analysis.

BackgroundIn the United States, national incentives for offering access to electronic personal health records (ePHRs) through electronic means are geared toward creating a culture of patient engagement. One group of patients who stand to benefit from online access to ePHRs is the growing population with multiple chronic conditions (MCC). However, little is known about the current availability and use of ePHRs and patient portals among those managing MCC.ObjectiveThe aim was to determine the associations between number of chronic conditions and sociodemographic characteristics and usage of ePHRs, and to assess how the public’s use of ePHRs varies across subpopulations, including those with MCC.MethodsThis study used data collected from the 2014 Health Information National Trends Survey (HINTS), and assessed differences in use of ePHRs between those with and without MCC (N=3497) using multiple logistic regression techniques. Variables associated with health care systems (insurance status, having a regular provider) and patient-reported self-efficacy were included in the statistical models.ResultsThose with MCC (n=1555) had significantly higher odds of accessing their records three or more times in the past year compared to those reporting no chronic conditions (n=1050; OR 2.46, 95% CI 1.37-4.45), but the overall percentage of those with MCC using ePHRs remained low (371 of 1529 item respondents, 25.63% weighted). No difference in odds of accessing their records was found between those reporting one chronic condition (n=892) and those reporting none (n=1050; OR 1.02, 95% CI 0.66-1.58). Significant differences in odds of accessing ePHRs were seen between income and age groups (P<.001 and P=.05, respectively), and by whether respondents had a regular provider (P=.03).ConclusionsWe conclude that ePHRs provide a unique opportunity to enhance MCC patient self-management, but additional effort is needed to ensure that these patients are able to access their ePHRs. An increase in availability of patient access to their ePHRs may provide an opportunity to increase patient engagement and support self-management for all patients and especially those with MCC.

Unconditional government cash transfers in support of orphaned and vulnerable adolescents in western Kenya: Is there an association with psychological wellbeing?

BackgroundOrphaned and vulnerable adolescents (OVA) in sub-Saharan Africa are at greater risk for adverse psychological outcomes compared with their non-OVA counterparts. Social interventions that provide cash transfers (CTs) have been shown to improve health outcomes among young people, but little is known about their impact on the psychological wellbeing of OVA.ObjectiveAmong OVA in western Kenya, we assessed the association between living in a household that received monthly unconditional government CTs and psychological wellbeing.MethodsWe examined the likelihood of depression, anxiety, post-traumatic stress symptoms (PTSS) and positive future outlook among 655 OVA aged between 10 and 18 years who lived in 300 randomly selected households in western Kenya that either received or did not receive unconditional monthly CTs.ResultsThe mean age was 14.0 (SD 2.4) years and 329 (50.2%) of the participants were female while 190 (29.0%) were double orphans whose biological parents were both deceased. After adjusting for socio-demographic, caregiver, and household characteristics and accounting for potential effects of participant clustering by sub-location of residence, OVA living in CT households were more likely to have a positive future outlook (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.08, 1.99), less likely to be anxious (OR 0.57, 95% CI 0.42, 0.78), and less likely to have symptoms of post-traumatic stress (OR 0.50, 95% CI 0.29, 0.89). We did not find statistically significant differences in odds of depression by CT group.ConclusionOVA in CT households reported better psychological wellbeing compared to those in households not receiving CTs. CT interventions may be effective for improving psychological wellbeing among vulnerable adolescents in socioeconomically deprived households.

Influence of weight at enterostomy reversal on surgical outcomes in infants after emergent neonatal stoma creation

PurposeNeonates after emergent enterostomy creation frequently require reversal at low weight because of complications including cholestasis, dehydration, dumping, failure to thrive, and failure to achieve enteral independence. We investigated whether stoma reversal at low weight (< 2.5kg) is associated with poor surgical outcomes. MethodsPatients who underwent enterostomy reversal from 2005 to 2013 at less than 6months old were identified in our institutional database. Only patients who underwent emergent enterostomy creation (i.e. for necrotizing enterocolitis or spontaneous perforation) were included. Demographics, disease process, comorbidities, stoma type, reversal indication, operative details, and complications were examined. Patients were categorized by weight at reversal of less than 2kg, 2.01–2.5kg, 2.51–3.5kg, and greater than 3.5kg. Data were analyzed using univariable and multivariable regression with significance level of p<0.05. The primary outcome examined was major morbidity, defined as the presence of anastomotic leak, obstruction, hernia, EC fistula, perforation, wound infection, sepsis, or death. ResultsEighty-nine patients met inclusion criteria. Demographics (sex, ethnicity, surgical disease process, reversal indication, and ASA score) were similar. The lowest weight group had lower gestational age (p<0.001) and birth weight (p=0.005), and contained a higher proportion of jejunostomies to ileostomies (p=0.013). On univariable analysis, only incisional hernia was significantly different as a complication between weight groups. On multivariable analysis controlling for gestational age and ASA, there was no significant difference in odds of major operative morbidity between groups. ConclusionsEnterostomy reversal at lower weight may not be associated with increased risk of perioperative complications. Early stoma reversal may be acceptable when required for progression of neonatal care. Level of evidenceLevel III, Treatment Study (Retrospective comparative study).

Association between birth route and late-onset sepsis in very preterm neonates.

To evaluate the association between birth route and late-onset sepsis (LOS), and coagulase-negative Staphylococcal (CONS)-related LOS in preterm neonates. In this observational study, data from 20,038 infants born between 22 and 32 weeks' gestation and admitted to Canadian neonatal intensive care units between 2010 and 2014 were analyzed retrospectively. The impact of birth route on LOS was assessed using univariate analysis and multiple logistic regression. A total of 8218 neonates were born via vaginal route and 11,820 via cesarean section. Incidence rates of LOS for infants born vaginally and via a cesarean section were 13.1 and 13.2%, respectively, and there was no significant difference in odds of LOS between the groups (adjusted odds ratio (AOR): 0.99; 95% CI 0.87 to 1.12); however, the odds of CONS sepsis were higher in the cesarean group (AOR: 1.15; 95% CI: 1.01 to 1.32). Birth route did not have an impact on LOS, but was associated with CONS-related LOS.