Times Greater Odds Research Articles

Artificial intelligence to detect pulmonary congestion on chest computed tomography in consecutive dyspnoeic patients

Abstract Background Pulmonary congestion is a hallmark of acute heart failure (AHF), and essential for the diagnosis, treatment, and risk stratification. We have previously shown that a low-dose chest CT has four times greater odds than chest radiographs to detect pulmonary congestion. However, implementation is limited by shortage of radiologists. We hypothesized that artificial intelligence (AI) can detect pulmonary congestion on chest CT and aimed to develop and validate an AI-algorithm to detect pulmonary congestion on chest CT. Methods We extracted all chest CT-scans ordered acutely (N= 4840 unique patients) by medical departments at X Hospital from 2016-2021. A random subset of these CT-scans (N= 2187) was used to develop an AI-algorithm to detect pulmonary congestion, using the radiology reports as reference. The remaining subset (N= 1094) was used for internal validation. We externally validated the AI-algorithm in a different cohort (X), comprising of 236 consecutive dyspnoeic patients admitted to the emergency department, all examined with a low-dose, non-contrast chest CT (LDCT). The primary outcome was pulmonary congestion adjudicated by clinical on-call radiologists with access to the medical record, and two independent, blinded research thoracic radiologists. The default AHF thresholds for the optimal cut-off, rule-in threshold and rule-out threshold was established from the internal validation. Results Of 236 patients (median age 74 years, 57% male), 62 (26%), 64 (27%) and 60 (26%) had pulmonary congestion on LDCT evaluated by the on-call radiologists and the two thoracic research radiologists, respectively. The AI-algorithm included ten discriminating features of pulmonary congestion, and the results demonstrate an AUC of 0.95 [95%CI: 0.93-0.98] to predict pulmonary congestion by the on-call radiologists. The results were confirmed by the two expert research radiologists, with an AUC of 0.91 [95%CI: 0.88-0.95] and 0.94 [95%CI: 0.90-0.97], respectively. The sensitivity and specificity of the AI-default threshold was 89% [95%CI: 78-95%] and 89% [95%CI: 83-93%], respectively. The rule-in threshold demonstrated a sensitivity of 97% [95%CI: 86-100%] and the rule-out threshold had a specificity of 96% [95%CI: 92-98%], Figure 1. Conclusion We developed and validated a novel AI-algorithm with promising potential for the rapid automatic detection of pulmonary congestion as the underlying cause of dyspnoea in consecutive acute patients.

Incidence of acute transfusion reactions and associated factors among adult blood-transfused patients at Jimma University Medical Center, southwest Ethiopia: A cross-sectional study.

Acute transfusion reaction is mainly related to the infusion of blood or blood products resulting at any time within a day of the intervention. It ranges from a non-specific febrile episode to a life-threatening intravascular hemolysis. The severity of the reaction and the degree of morbidity are usually related to the degree of ABO incompatibility and the volume of blood transfused. Therefore, this study aimed to determine the incidence of acute transfusion reactions and its associated factors in Jimma University Medical Center, southwest Ethiopia. Institution-based cross-sectional study was conducted from 1 October to December 30, 2020. A total of 384 transfused patients were followed in this study. Socio-demographic and clinical data were collected through a structured questionnaire. Baseline measurement and 24-hour periodic vital signs monitoring were conducted after each transfusion. Four milliliters of venous blood were drawn after transfusion intervention from each distrusted patient for complete blood count, blood group phenotype, direct antihuman globulin test (DAT), and crossmatching. Data were entered into Epi data version 3.1 and analyzed using Statistical Package for Social Science software (SPSS) version 20. Descriptive statistics, and bivariable and multivariable logistic regression were employed to test the association between independent and dependent variables. A P value ≤ .05 was considered to indicate statistical significance. Acute transfusion reactions were diagnosed in 5.7% of patients, with most of these reactions were febrile nonhemolytic reactions (63.6%) followed by allergic (36.4%) reactions with mild clinical manifestations (27.3%). Transfusion history, transfused blood that was kept for more than 13 days, abortion history, and number of transfused units (≥3 units of blood/blood component) have 3.3, 3.85, 4.2, and 3.9 times greater odds, respectively, besides their significant association with the incidence of acute transfusion reactions. Patients with a history of previous transfusion, abortion, multi-unit transfusion, and patients transfused with blood stored for ≥14 days should be closely monitored. Starting a hemovigilance system of monitoring, collecting, and evaluating data on adverse effects of blood transfusion locally and nationally will decrease the occurrence of acute transfusion reactions.

COPD is associated with increased cardiovascular disease risk independent of phenotype.

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide that frequently presents with concomitant cardiovascular diseases. Despite the pathological distinction between individual COPD phenotypes such as emphysema and chronic bronchitis, there is a lack of knowledge about the impact of COPD phenotype on cardiovascular disease risk. Thus, this study aimed to utilize a nationally representative sample to investigate cardiovascular disease prevalence in patients with COPD with emphysema and chronic bronchitis phenotypes. Data from 31,560 adults including 2504 individuals with COPD, collected as part of the National Health and Nutrition Examination Survey (1999-2018), were examined. A significantly increased cardiovascular disease risk, including coronary heart disease, heart failure, myocardial infarction and stroke, was identified in patients with COPD among all disease phenotypes. Particularly, compared to those without COPD, individuals with chronic bronchitis presented with 1.76 (95% CI: 1.41-2.20) times greater odds, individuals with emphysema with 2.31 (95% CI: 1.80-2.96) times greater odds, while those with a concurrent phenotype (combined chronic bronchitis and emphysema) exhibited 2.98 (95% CI: 2.11-4.21) times greater odds of reporting cardiovascular diseases. Our data confirms that patients with COPD present an elevated risk of developing cardiovascular disease among all phenotypes, with the most marked increase being in those with concurrent chronic bronchitis and emphysema phenotypes. These findings emphasize the need for awareness and appropriate cardiovascular screening in COPD.

Molecular and serological prevalence of Leptospira spp. among slaughtered cattle and associated risk factors in the Bahr El Ghazal region of South Sudan

IntroductionLeptospirosis is a neglected emerging and zoonotic disease reported worldwide. This study sought to determine the molecular and serological prevalence of Leptospira spp. and the associated risk factors in slaughtered cattle from the Bahr El Ghazal region of South Sudan.Materials and methodsBetween January 16th and February 25th, 2023, blood and urine samples were collected from 402 cattle at the Lokoloko Municipal Slaughterhouse in Western Bahr El-Ghazal State. Serum samples were tested using the microscopic agglutination test (MAT), with a panel of 12 serovars (sv) from 12 serogroups (sg) and 4 species (spp) of Leptospira spp. These serovars had been previously identified in Sudan and the East African region. Simultaneously, 400 corresponding urine samples were screened using qualitative real-time polymerase chain reaction (PCR) to detect the shedding of Leptospira spp. in urine. To identify the associated risk factors, the age, sex, breed and body condition score of each sampled cattle was noted at the time of sampling and subsequently analysed using logistic regression models.ResultsAmong the 402 serum samples screened, a substantial 81.8% (329/402, 95% CI 77.9–85.3) displayed seropositivity for Leptospira spp. with a MAT titre ≥ 100. The prevalence of urine shedding determined by PCR was 6% (23/400, 95% CI 3.8–8.4), while probable recent leptospirosis with a MAT ≥ 1:800 was observed in 33.1% (133/402, 95% CI 28.6–37.8) of the cattle. Multiple reactions were detected in 34.8% (140/402, 95% CI 30.6–39.5) serum samples. The seropositivity was against L. borgpetersenii sg. Tarassovi (78.6%; 316/402, 95% CI 74.4–82.3), followed by L. borgpetersenii sg. Ballum at 20.4% (82/402, 95% CI, 16.7–24.4%), L. kirschneri sg. Autumnalis At 8.7% (35/402, 95% CI 5.7–11.7), L. interrogans sg. of Pomona at 7.0% (28/402, 95% CI 4.5–9.5), and L. interrogans sg. Hebdomadis was 5.0% (20/402, 95% CI 2.8–7.2). Several risk factors are associated with seropositivity. Older animals (≥ 2 years) had 2.0 times greater odds (95% CI 1.14–3.5) of being seropositive than younger animals (< 2 years), P-value = 0.016. Female animals demonstrated 2.1 times greater odds (95% CI 1.2–3.6) of seropositivity than males did (P-value = 0.008). Additionally, Felata/Mbororo cattle exhibited 2.4 times greater odds (95% CI 1.3–4.5) of being seropositive than did local Nilotic cattle (P-value = 0.005). The agreement between the MAT and PCR results was poor, as indicated by a kappa statistic value of 0.001 and a P-value of 0.913. But there was a moderate agreement between MAT high titres ≥ 800 and PCR positivity with a kappa statistic value = 0.501 and a P-value < 0.001.ConclusionIn addition to the high seroprevalence, Leptospira spp. were found in the urine of slaughtered cattle, suggesting that leptospirosis is endemic to the study area. This finding underscores the significance of cattle as potential sources of infection for slaughterhouse workers, the general public, and other animal species. To address this issue effectively in the Bahr El Ghazal Region and South Sudan, a comprehensive strategy involving a multidisciplinary approach is essential to minimize disease among animals, hence reducing potential zoonotic risks to humans.

Collegiate student-athletes use and knowledge of third-party tested nutritional supplements: An exploratory study.

Nutritional supplement use in athletes is common, accompanied by potential doping risk. Determine athletes' nutritional supplement and third-party tested (TPT) supplement use, supplement knowledge as well as factors influencing their behavior. Cross-Sectional Study. NCAA DI athletic departments. Student-athletes (n=410, 53% female, age 21.4±1.6 years). Survey questions addressed topics including nutritional supplement knowledge and use, TPT supplement knowledge, use and logo recognition and data were 11 stratified for sex differences. Athletes (91%) report the use of supplements, but the total number of supplements used (median and interquartile range, IQR) is lower in females (7, 4-11), than males (9, 4-12), with U=17960, p=0.01. A total of 48% (n=191, out of 402 responses) reported purchasing supplements outside of their athletic department, with significantly fewer females (40%, n=84) than males (56%, n=107) reporting this behavior (χ2=11.20, p<0.001). No association between TPT logo recognition and TPT use was seen (χ2=0.238, p=0.63). Of all athletes using supplements, 38% (n=140) reported "consistent TPT use", while females (36%, n=70) reported this less often than males (41%, n=70, χ2=0.952, p<0.32). No sex differences were seen for receiving nutritional counseling (89%, p=0.37), or the low nutritional supplement knowledge (<50%, p=0.38), however, males had 2.5 times greater odds at recognizing a TPT organization logo than females (OR=2.45, with 95% CI=1.58-3.79). Most athletes use nutritional supplements. Females report slightly fewer supplements than males, while also less frequently purchasing them outside their athletic department, potentially explaining the lower TPT logo recognition in female athletes.

Exploring the prevalence of depression, anxiety, and stress among university students in Bangladesh and their determinants

BackgroundDepression, anxiety and stress among university students present a growing global challenge. This study aims to explore the prevalence of depression, anxiety, and stress and identifying their associated factors among university students in Bangladesh. MethodsWe analyzed data of 738 university students collected through a cross-sectional survey. Outcome variables considered were depression, anxiety, and stress levels. Explanatory variables considered were several socio-demographic characteristics. Multinomial logistic regression analysis was employed to explore the association of the outcome variables with explanatory variables. ResultsWe found a notable prevalence of moderate to severe levels of depression, anxiety, and stress among university students in Bangladesh, ranging from 25 % to 71 %. Among students from extended families, there was a 32 % lower likelihood of experiencing moderate depression (relative risk ratio [RRR], 0.68; 95 % confidence interval [CI], 0.47–0.97) and a 35 % lower likelihood of experiencing stress (RRR, 0.65; 95 % CI, 0.44–0.97) compared to their counterparts without depression and stress. Furthermore, students enrolled in the business faculty reported a significantly higher likelihood of stress, with a 2.28 times greater odds (95 % CI, 1.32–3.93) compared to students in the Science and Engineering faculty. ConclusionThis study underscores the pressing necessity for tailored interventions to address the elevated prevalence of depression, anxiety, and stress among university students in Bangladesh. The findings accentuate the importance of recognizing diverse risk factors and implementing mental health support programs.

Screening for Unhealthy Alcohol Use Among Patients With Multiple Chronic Conditions in Primary Care

IntroductionUnhealthy alcohol use (UAU) increases risk for and exacerbation of chronic health conditions. As such, screening, prevention, and management of UAU is especially critical to improving health outcomes for patients with multiple physical or mental chronic health conditions (MCC). It is unclear to what extent multiple chronic condition (MCC) status is a barrier to screening for UAU in the primary care setting. We hypothesized that patients with MCC would be at lower odds of being screened for UAU compared with patients with no MCC. MethodsWe performed a secondary analysis of electronic health record data for patients from 67 primary care practices in Virginia (2020-2023). Using the Center for Medicare and Medicaid Services’ chronic disease framework, we classified patients by MCC status: no MCC, physical MCC (P-MCC), mental health MCC (MH-MCC), and physical & mental health MCC (P&MH-MCC). We used multiple logistic regressions with an added practice-level random effect to analyze the relationship between MCC status and odds of receiving an alcohol-related assessment, of being screened for UAU with a U.S. Preventive Services Task Force (USPSTF)-recommended instrument, and of screening positive for UAU within the past 2 years. ResultsWithin a final cohort of n= 11,789, a total of 6796 patients (58%) had MCC (29% P-MCC, 4% MH-MCC, and 25% P&MH-MCC). In all, 69% of patients were screened for UAU, while 16% were screened with a USPSTF-recommended instrument and 7% screened positive for UAU. Relative to those with no MCC, patients with P&MH-MCC had 0.9 times lower odds of receiving any screening for UAU [95% CI: (0.8, 1.0), p = 0.0240], while patients with only P-MCC or only MH-MCC had similar odds. There was no difference in odds of being screened with a USPSTF-recommended instrument based on MCC status. Patients with MH-MCC and P&MH-MCC had 1.8 and 1.5 times greater odds, respectively, of screening positive for UAU [95% CI: (1.3, 2.7), p= 0.0014) and 95% CI: (1.2, 1.8), p=0.0003)]. ConclusionAlthough patients with chronic mental health conditions were more likely to screen positive for UAU than patients without MCC, Virginia primary care patients with P&MH MCC were less likely to receive an alcohol-related assessment during the past 2 years. Given the overall modest rate of screening with a USPSTF-recommended instrument, further efforts are needed to create the conditions for high quality alcohol-related preventive service delivery in primary care, particularly for patients with high complexity and/or mental health conditions.

Hemoglobin Drop is Associated with Early Post-operative Stroke Following Revascularization Surgery for Moyamoya Disease.

Postoperative stroke is a potentially devastating neurological complication following surgical revascularization for Moyamoya disease. We sought to evaluate whether peri-operative hemoglobin levels were associated with the risk of early post-operative stroke following revascularization surgery in adult Moyamoya patients. Adult patients having revascularization surgeries for Moyamoya disease between 1999-2022 were identified through single institutional retrospective review. Logistic regression analysis was used to test for the association between hemoglobin drop and early postoperative stroke. In all, 106 revascularization surgeries were included in the study. A stroke occurred within 7 days after surgery in 9.4% of cases. There were no significant associations between the occurrence of an early postoperative stroke and patient age, gender, or race. Mean postoperative hemoglobin drop was greater in patients who suffered an early postoperative stroke compared with patients who did not (2.3±1.1g/dL vs. 1.3±1.1g/dL, respectively; P=0.034). Patients who experienced a hemoglobin drop post-operatively had 2.03 times greater odds (95% confidence interval, 1.06-4.23; P=0.040) of having a stroke than those whose hemoglobin levels were stable. Early postoperative stroke was also associated with an increase in length of hospital stay (P<0.001), discharge to a rehabilitation facility (P=0.014), and worse modified Rankin scale at 1 month (P=0.001). This study found a significant association between hemoglobin drop and early postoperative stroke following revascularization surgery in adult patients with Moyamoya disease. Based on our findings, it may be prudent to avoid hemoglobin drops in Moyamoya patients undergoing surgical revascularization.

Acceptance of digital phenotyping linked to a digital pill system to measure PrEP adherence among men who have sex with men with substance use.

Once-daily oral HIV pre-exposure prophylaxis (PrEP) is an effective strategy to prevent HIV, but is highly dependent on adherence. Men who have sex with men (MSM) who use substances face unique challenges maintaining PrEP adherence. Digital pill systems (DPS) allow for real-time adherence measurement through ingestible sensors. Integration of DPS technology with other digital health tools, such as digital phenotyping, may improve understanding of nonadherence triggers and development of personalized adherence interventions based on ingestion behavior. This study explored the willingness of MSM with substance use to share digital phenotypic data and interact with ancillary systems in the context of DPS-measured PrEP adherence. Adult MSM on PrEP with substance use were recruited through a social networking app. Participants were introduced to DPS technology and completed an assessment to measure willingness to participate in DPS-based PrEP adherence research, contribute digital phenotyping data, and interact with ancillary systems in the context of DPS-based research. Medical mistrust, daily worry about PrEP adherence, and substance use were also assessed. Participants who identified as cisgender male and were willing to participate in DPS-based research (N = 131) were included in this subsample analysis. Most were White (76.3%) and non-Hispanic (77.9%). Participants who reported daily PrEP adherence worry had 3.7 times greater odds (95% CI: 1.03, 13.4) of willingness to share biometric data via a wearable device paired to the DPS. Participants with daily PrEP adherence worry were more likely to be willing to share smartphone data (p = 0.006) and receive text messages surrounding their daily activities (p = 0.003), compared to those with less worry. MSM with substance use disorder, who worried about PrEP adherence, were willing to use DPS technology and share data required for digital phenotyping in the context of PrEP adherence measurement. Efforts to address medical mistrust can increase advantages of this technology for HIV prevention.

ALZHEIMER’S DISEASE AND RELATED DEMENTIAS DIAGNOSES IN THE US BY RACE, ETHNICITY, AND NATIVITY

Abstract Timely clinical diagnosis of ADRD is important for intervention, resource allocation, and mitigating safety concerns. While studies have examined ADRD diagnoses disparities by race/ethnicity, few include its intersection with nativity. Our aims were to: 1) estimate the odds of diagnosed ADRD among US- and foreign-born racial/ethnic groups compared to US-born White older adults and 2) compare US- and foreign-born older adults within each racial/ethnic group. We linked 2000-2017 National Health Interview Survey (NHIS) and 2001-2018 Medical Expenditure Panel Survey (MEPS) data (65+ years; n=38,033). Race/ethnicity and nativity were measured using NHIS data. Diagnosed ADRD was determined using ICD-9 (290/294/331/797) or ICD-10 (F01/F03/G30/G31) billing codes created from self-reported ADRD diagnoses during MEPS household interviews. Covariates were measured using MEPS data. US-born Black (OR=1.74; 95%CI=1.48-2.05), Hispanic (OR=1.62; 95%CI=1.14-2.29) and foreign-born Hispanic (OR=1.63; 95%CI=1.24-2.15) older adults had higher odds of diagnosed ADRD compared to US-born White older adults after adjusting for age and sex. Results were no longer significant among either Hispanic group after adjusting for education, health insurance, and access to care. However, after adjusting for education, health insurance, access to care, and chronic conditions, US-born Black older adults, but not foreign-born Black older adults, had 1.54 times greater odds (95%CI=1.27-1.87) of diagnosed ADRD compared to US-born White older adults. There were no statistically significant differences in ADRD diagnosis by nativity within each racial/ethnic minoritized group. Findings highlight the need for including nativity in studies comparing racial/ethnic groups to Whites to fully capture the burden of ADRD among US-born Black older adults.

Statistical Literacy in Hand and Upper-Extremity Patients

Statistical literacy is the ability of a patient to apply basic statistical concepts to their health care. Understanding statistics is a critical component of shared decision making. The purpose of this investigation was to define levels of statistical literacy in an upper-extremity (UE) patient population. We aimed to determine if patient demographics would be associated with statistical literacy. An electronic survey was administered to a consecutive series of UE patients at a single institution. We recorded baseline demographics, Single Assessment Numeric Evaluation scores, the Berlin Numeracy Test (BNT), and General Health Numeracy Test. We also included a surgical risk question, which asked: "Approximately 3% of patients who get carpal tunnel surgery develop an infection. If 100 patients get this surgery, how many would you expect to develop an infection?" A covariate-controlled adjusted odds ratio reflecting the association between each statistical literacy outcome measure and patient characteristics was reported. A total 254 surveys were administered, 148 of which were completed and included. Fifty percent of respondents had a high-school education or less. For the BNT, 78% scored in the bottom quartile, and 52% incorrectly answered all questions. For the General Health Numeracy Test, 34% answered 0 or 1/6 questions correctly. For the surgical risk question, 24% of respondents answered incorrectly. Respondents who had a college or graduate degree had 2.62 times greater odds (95% confidence interval, 1.09-6.32) of achieving a BNT score in a higher quartile than patients who did not have a college or graduate degree. Overall levels of statistical literacy are low for UE patients. When engaging in management discussions and shared decision making, UE surgeons should assume low levels of statistical literacy. Consideration of alternative formats, such as frequencies, video-based materials, and pictographs, may be warranted when discussing outcomes and risks of surgical procedures.

Flavored electronic nicotine delivery systems ads (2019–2020) on traditional U.S. Media by audience demographics

The tobacco industry has historically targeted flavored products to specific U.S. consumer segments, including young people, women, and systemically marginalized groups based on race, ethnicity, or sexual/gender identity. Existing research on target marketing is focused on cigarettes and smokeless tobacco. In contrast, studies of target marketing of electronic nicotine delivery systems (ENDS)—a growing segment of the U.S. tobacco product market – are much more limited. We analyzed data on 496 ENDS ads and audience demographics to explore the extent to which flavored ENDS ads on cable television (n = 25 ads), terrestrial radio (n = 412 ads), and in print consumer magazines (n = 59 ads) are targeted to different demographic groups based on age, sex, and race/ethnicity. We observed flavor-related content in one-quarter to one-third of ENDS ad occurrences during 2019–2020. Across all media outlets examined, audience age was an important factor in explaining the likelihood of ENDS ads containing flavor-related content. For example, within a television channel, there were 3.82 [95% confidence interval (CI): 1.39–10.49] times greater odds that an ENDS ad contained flavor-related content versus not for every 1% increase in the proportion of U.S. youth ages 6–17 watching a television show. In addition, there were 2.13 [95 %CI: 1.30–3.51] and 1.61 [95 %CI:1.60–1.63] times greater odds that an ENDS ad contained flavor-related content versus not in cable television and radio stations, respectively, for every 1% increase in the proportion of male audience members. Race/ethnicity was an important explanatory factor for the presence of flavor-related content on radio but not television ENDS ads. Our findings suggest differences in target marketing of flavored ENDS by media outlet and audience demographics.

Measuring effects of screen time on the development of children in the Philippines: a cross-sectional study

BackgroundScreen time in young children is discouraged because of its negative effects on their development. However, excessive screen media use has been rising, particularly during the global pandemic when stay-at-home mandates were placed on young children in several countries. This study documents potential developmental effects of excessive screen media use.MethodThis is a cross-sectional study. Participants were 24 to 36 month old Filipino children recruited through non-probable convenience sampling from August to October 2021. Regression analyses were performed to test the association between screen time and changes in scaled scores for skills and behaviors determined from the Adaptive Behavior Scale and to identify factors associated with increased screen media use.ResultsIncreased odds of excessive use of screen media of children by 4.19 when parents watch excessively and 8.56 times greater odds when children are alone compared to watching with a parent or other children. When adjusted for co-viewing, more than 2 h of screen time is significantly associated with decrease in receptive and expressive language scores. The effects on personal skills, interpersonal relationships and play and leisure skills were only statistically significant at 4 to 5 or more hours of screen time use.ConclusionThe study found that spending no more than 2 h screen time had minimal negative effects on development and that use beyond 2 h was associated with poorer language development among 2 year olds. There is less excessive screen media use when a child co-views with an adult, sibling or other child and when parents likewise have less screen time themselves.

Beyond Being Insured: Insurance Coverage Denial as a Major Barrier to Accessing Care During Pregnancy and Postpartum.

This study investigates the association between insurance coverage denial and delays in care during pregnancy and postpartum. An online survey was administered in March and April 2022 to women who were either pregnant or within 1 year postpartum (n = 1,113). The outcome was delayed care, measured at four time points: during pregnancy and 1 week, 2 to 6 weeks, and after 7 weeks postpartum. The key covariate was insurance coverage denial by providers during pregnancy. Delayed care due to having an unaccepted insurance and being "out-of-network" was more pronounced at 1 week postpartum with 3.37 times and 3.47 times greater odds and in 2 to 6 weeks postpartum with 5.74 times and 2.97 times greater odds, respectively. The association between insurance denial and delays in care encapsulated transportation, rural residency, time issues, and financial constraints. The findings suggest that coverage denial is associated with significant delays in care, providing practical implications for effective perinatal care.

Undiagnosed Alzheimer’s disease and related dementias among foreign‐born Middle Eastern and North African adults in the United States

AbstractBackgroundAlzheimer’s disease and related dementias (ADRD) disparities exist by race/ethnicity and nativity (Mehta &amp; Yeo, 2017). Non‐Hispanic blacks and Hispanics are more likely to have ADRD and to be undiagnosed than non‐Hispanic whites (Amjad et al., 2018; Gianattasio et al., 2019). The prevalence of undiagnosed ADRD among Middle Eastern and North African (MENA) adults in the US remains unknown. MENA men tend to report better health than women regardless of immigrant status (Read &amp; Reynolds, 2012). Our aims were to: 1) estimate and compare estimates of suspected undiagnosed ADRD among foreign‐born MENA adults compared to US‐ and foreign‐born non‐Hispanic whites and 2) compare estimates stratified by sex.MethodWe linked data from the 2000‐2017 National Health Interview Survey and 2001‐2018 Medical Expenditure Panel Survey (ages &gt; = 65 years, n = 23,981). ICD‐9 (290/294/331/797) and ICD‐10 (F03/G30) codes were used to measure ADRD diagnosis. Undiagnosed ADRD was suspected if a participant reported having a cognitive limitation without a corresponding ADRD diagnosis. Bivariate and multivariable logistic regression analyses adjusted for age, sex, and potentially modifiable risk factors (education, hearing loss, hypertension, depression, social isolation, and diabetes) were conducted.ResultThe prevalence of suspected undiagnosed ADRD was highest among foreign‐born MENA adults (15.8%) compared to US‐ (8.1%) and foreign‐born (11.8%) non‐Hispanic whites. The age‐adjusted and sex‐stratified prevalence of suspected undiagnosed ADRD was higher among MENA women (22.5%) than MENA men (9.3%) and lowest among US‐born white men (7.6%). In fully adjusted logistic regression models, foreign‐born MENA adults had 1.98 times greater odds (95% CI = 1.09‐3.60) of undiagnosed ADRD compared to US‐born non‐Hispanic whites. There were no differences between foreign‐born MENA men and US‐born non‐Hispanic white men. Foreign‐born MENA women had 2.89 times greater odds (95% CI = 1.49‐5.60) of undiagnosed ADRD compared to US‐born white women.ConclusionThis study contributes the first national estimates of suspected undiagnosed ADRD among MENA men and women. Furthermore, our study highlights that the underdiagnosis of ADRD among MENA adults may be driven by women. Results will help to facilitate policy decisions and advocate for resources to be allocated for interventions to improve the health of this underrepresented but increasingly visible minority population.

Examining the influence of tobacco control mass media campaign expenditure on the association between motivation to stop smoking and quit attempts: A prospective study in England

ObjectiveTo explore whether expenditure on national tobacco control mass media campaigns moderates the association between motivation to stop smoking and future quit attempts. MethodData were from 2601 people who smoke participating in a population survey with 12-month follow-up between April 2015 and February 2021. We used logistic regression to test associations of (i) baseline level of motivation to stop smoking, (ii) mean monthly tobacco control mass media campaign expenditure in England between baseline and follow-up, and (iii) their interaction, on past-year quit attempts assessed at 12-month follow-up. Covariates included age, sex, occupational social grade, and region. ResultsBetween baseline and follow-up, 38.6% of participants made a quit attempt. Each one-point increase in baseline motivation to stop smoking was associated with 1.37 times greater odds (95%CI = 1.31–1.43) of making a quit attempt over 12-month follow-up. Each one standard deviation increase in tobacco control mass media expenditure between baseline and 12-month follow-up was associated with 13% greater odds of making a quit attempt (95%CI = 1.05–1.23). There was no significant interaction between mass media expenditure and motivation to stop on quit attempts (OR = 1.01, 95%CI = 0.97–1.05); the data provided strong evidence for the null (Bayes factors = 0.07 and 0.04 based on expected effect sizes of OR = 1.5 and OR = 0.67, respectively). ConclusionsAmong people who smoke, self-reported level of motivation to stop strongly predicted whether they made a quit attempt in the subsequent year. Increased expenditure on tobacco control mass media campaigns was associated with increased quit attempts. The association between motivation and quit attempts did not differ according to tobacco control mass media expenditure over this period.

Moral injury associated with increased odds of past-year mental health disorders: a Canadian Armed Forces examination

ABSTRACT Background: Potentially morally injurious experiences (PMIEs) are common during military service. However, it is unclear to what extent PMIEs are related to well-established adverse mental health outcomes. Objective: The objective of this study was to use a population-based survey to determine the associations between moral injury endorsement and the presence of past-year mental health disorders in Canadian Armed Forces (CAF) personnel and Veterans. Methods: Data were obtained from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS). With a sample of 2,941 respondents, the weighted survey sample represented 18,120 active duty and 34,380 released CAF personnel. Multiple logistic regressions were used to assess the associations between sociodemographic characteristics (e.g. sex), military factors (e.g. rank), moral injury (using the Moral Injury Events Scale [MIES]) and the presence of specific mental health disorders (major depressive episode, generalized anxiety disorder, panic disorder, social anxiety disorder, PTSD, and suicidality). Results: While adjusting for selected sociodemographic and military factors, the odds of experiencing any past-year mental health disorder were 1.97 times greater (95% CI = 1.94–2.01) for each one-unit increase in total MIES score. Specifically, PTSD had 1.91 times greater odds (95% CI = 1.87–1.96) of being endorsed for every unit increase in MIES total score, while odds of past-year panic disorder or social anxiety were each 1.86 times greater (95% CI = 1.82–1.90) for every unit increase in total MIES score. All findings reported were statistically significant (p < .001). Conclusion: These findings emphasize that PMIEs are robustly associated with the presence of adverse mental health outcomes among Canadian military personnel. The results of this project further underscore the necessity of addressing moral injury alongside other mental health concerns within the CAF.

Adverse Maternal Experiences and Neonatal Abstinence Syndrome.

To propose a measure for adverse maternal experiences (AMEs) and examine if AMEs are independently associated with delivery of a neonatal abstinence syndrome (NAS) diagnosed infant. Using the Pregnancy Risk Assessment Monitoring System (PRAMS) stressful life events questions, we constructed a composite measure of AMEs. We conducted a retrospective analysis of linked Birth Certificate Data, Hospital Discharge Data and PRAMS data for 2012-2018 using the composite measure. Our analytic sample included 6358 singleton deliveries. We calculated prevalence of NAS and AMEs and prevalence odds ratio (POR) for delivery of an NAS-diagnosed infant adjusting for maternal sociodemographic characteristics, pre-pregnancy depression, prescription medicine 12months prior to pregnancy, and smoking during pregnancy. The overall prevalence of NAS in Delaware during 2012-2018 was 2.2% (95% CI 1.8-2.6); 9.5% (95% CI 8.7-10.2) of women reported AMEs. After adjustment, women with AMEs had 1.1 times greater odds (aPOR 2.1; 95% CI 1.3-3.3) to deliver a NAS-diagnosed infant as compared with women without AMEs. Although the cross-sectional nature of the study limits drawing any causal inferences, there are co-occurring factors that support plausibility of an association between AMEs and delivering NAS-diagnosed infants. Addressing AMEs, mental health and substance use screening and treatment as part of preconception and prenatal care may mitigate risks.

Associação entre funcionalidade e conhecimentos, atitudes e práticas de prevenção da covid-19 em pessoas idosas

Abstract Objective To analyze the association between functionality and knowledge, attitudes, and practices of COVID-19 prevention in the elderly population of Recife, Pernambuco, Brazil. Method A cross-sectional study with remote data collection conducted between June and September 2020, involving 144 elderly individuals of both sexes who were served at COVID-19 reference points in eight districts. The dependent variable, knowledge, attitudes, and practices related to COVID-19 prevention, collected through the CAP Survey, was constructed using Latent Class Analysis. The primary independent variable was functionality in Instrumental Activities of Daily Living, collected through the Lawton and Brody scale. Data analysis utilized chi-square tests and multiple multinomial logistic regression analysis, with a significance level of 5%. Results The majority of the participants, 44%, exhibited regular knowledge and attitudes with good COVID-19 prevention practices. Independent participants had 4.26 times greater odds (95% CI: 1.46; 12.38) of possessing excellent knowledge, attitudes, and prevention practices for the disease. Those with higher levels of education had 3.89 times greater odds (95% CI: 1.16; 12.99) of having excellent knowledge, attitudes, and practices compared to those with no education. Both comparisons considered a 95% confidence interval. Conclusion COVID-19 prevention was influenced by functionality, indicating that greater functional independence led to better prevention among the elderly. This understanding directs public policies and actions aimed at the importance of disease prevention in the elderly population, as well as promoting healthy aging.

The Relationship Between Posterior Tibial Slope and Pediatric Tibial Eminence Fractures

Background: Tibial eminence fractures are bony avulsions of the anterior cruciate ligament from its insertion on the intercondylar eminence. Numerous anatomic factors have been associated with anterior cruciate ligament injuries, such as posterior tibial slope, but there are few studies evaluating the association with tibial eminence fracture. Purpose: To compare posterior tibial slope of pediatric patients with and without tibial eminence fractures. We hypothesized that a steeper posterior tibial slope would be associated with tibial eminence fracture. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent surgical treatment of tibial eminence fracture were retrospectively identified between January 2000 and July 2021. Adults aged >20 years and those without adequate imaging were excluded. Controls without gross ligamentous or osseous pathology were identified. Descriptive information and Meyers and McKeever classification were recorded. Posterior tibial slope measurements were obtained by 2 independent orthopaedic surgeons twice, with measurements separated by 3 weeks. Chi-square tests and independent-samples t tests were used to compare posterior tibial slope and patient characteristics. Inter- and intrareviewer variability was determined via the intraclass correlation coefficient. Results: A total of 51 patients with tibial eminence fractures and 57 controls were included. By sex, tibial eminence fractures occurred among 34 male and 17 female patients with a mean age of 10.9 years. The posterior tibial slope among those with tibial eminence fractures (9.7°) was not significantly greater than that of controls (8.8°; P = .07). Male patients with a tibial eminence fracture had significantly steeper slopes compared with controls (10.0° vs 8.4°; P = .006); this difference was not observed between female patients and female controls. Patients with a slope ≥1 SD above the mean (12.0°) had 3.8 times greater odds (95% CI, 1.3-11.6; P = .017) of having a tibial eminence fracture. Male patients with a posterior tibial slope >12° had 5.8 times greater odds (95% CI, 1.1-29.1; P = .034) of having a tibial eminence fracture compared with male controls. Conclusion: Male patients undergoing surgical fixation of a tibial eminence fracture had an increased posterior tibial slope as compared with case-controls. Increased posterior tibial slope may be a risk factor for sustaining a tibial eminence fracture, although the clinical significance of this deserves further investigation.