Search

Background: Human immunodeficiency virus (HIV) and hepatitis C (HCV) screening and human papillomavirus (HPV) vaccine uptake remain suboptimal. To improve HIV and HCV screening and HPV vaccination, the authors implemented a quality improvement project in three southwestern Pennsylvania family medicine residency practices., Methods: From June 1 to November 30, 2021, participating practices used universal screening and vaccination guidelines and chose from multiple strategies at the office (for example, standing orders), provider (for example, multiple forms of provider reminders), and patient (for example, incentives) levels derived from published literature and tailored to local context. Age-eligible patients for each recommendation with at least one in-person office visit during the intervention period were included. To assess the interventions' effect, the authors obtained testing and vaccination data from the electronic health record for the intervention period, contrasted it with identical data from June 1 to November 30, 2020, and used logistic regression controlling for patient age, sex, and race to determine differences in screening and vaccination between intervention and baseline periods., Results: A total of 14,920 and 15,523 patients were eligible in the baseline and intervention periods, respectively. Following the intervention, HIV lifetime screening but not first-time screening for patients 13-64 years old was significantly higher (78.9% vs. 76.1%, p = 0.004, and 39.6% vs. 36.6%, p = 0.152, respectively, adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 1.06-1.38). HCV lifetime screening for patients 18-79 years old was significantly higher postintervention (62.5% vs. 53.5%, p < 0.001, aOR 1.51, 95% CI 1.4-1.64). For patients 9-26 years old, no change in HPV initiation was observed, but the percentage of patients who completed their HPV vaccinations in the observed period was significantly higher postintervention (7.0% vs 4.6%, p = 0.006, aOR 1.58, 95% CI 1.14-2.2). During the postintervention period, the researchers identified 0 new HIV diagnoses and 48 HCV diagnoses (19 eligible for treatment)., Conclusion: Family medicine residency office-based multistrategy efforts appear to successfully increase patient uptake of HIV and HCV screenings and maintain HPV vaccination rates., (Copyright © 2024 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

Body mass index (BMI) requirements for gender-affirming surgeries (GAS) present an obstacle to gender transition for many transgender and gender diverse (TGD) people. Furthermore, TGD people have unique barriers and preferences in managing their weight that must be considered. TGD patients frequently present to their endocrinologists for individualized, gender-affirming support to meet BMI cutoffs for GAS. This Approach to the Patient article combines expertise from several disciplines, including gender-affirming hormone management, weight management, mental health, gynecology, and plastic surgery. Multidisciplinary management considerations are offered for clinicians to assist TGD patients with obesity navigate BMI requirements to access GAS., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Obesity is a common condition and a major cause of morbidity and mortality. Fortunately, weight loss treatment can reduce obesity-related complications. This review summarizes the evidence-based strategies physicians can employ to identify, prevent, and treat obesity, including best practices to diagnose and counsel patients, to assess and address the burden of weight-related disease including weight stigma, to address secondary causes of weight gain, and to help patients set individualized and realistic weight loss goals and an effective treatment plan. Effective treatments include lifestyle modification and adjunctive therapies such as antiobesity medications and metabolic and bariatric surgery., Competing Interests: Disclosures: All relevant financial relationships have been mitigated. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M24-0583.

Transgender and gender diverse (TGD) adults are more likely to have obesity compared to cisgender peers. Based on surveys, the TGD population experiences disparities in healthy lifestyle behaviors (e.g., physical activity, screen time) compared to reference groups. They also face significant socioeconomic and healthcare barriers to accessing affirming care and gender minority stress, potentially contributing to increased weight. Gender-affirming hormone therapy is associated with changes in body composition and increased weight, which may impact cardiometabolic risk trajectory. Obesity can also be a barrier to gender-affirming surgeries, and affirming weight management services tailored to TGD patients are an important gap in healthcare to address. This Perspective briefly reviews current literature on the unique barriers experienced by TGD people and their identified needs regarding weight management interventions. It also suggests areas for future research to best fill this gap in healthcare and research while supporting the provision of lifesaving gender-affirming care., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Competing Interests: Drs. Ahn and Taormina are the 2023-2024 Obesity Medicine Fellow representatives to the Obesity Medicine Fellowship Council (OMFC). Dr. Tchang, an OMFC member, co-directs the Obesity Medicine fellowship program at Weill Cornell Medicine, and Drs. Srivastava, Schmidt and Kaplan currently serve as the Vice-Chair, Administrative Director, and Chair of the OMFC, respectively.

Objectives: Incomplete subspecialty referrals, whether unscheduled or unattended, represent unmet patient needs and an opportunity to improve patient safety and experiences. Our objectives were to describe the rates of appointment scheduling and visit attendance after pediatric subspecialty referral and to examine patient and systems factors associated with scheduled referrals and attended appointments., Methods: We conducted a retrospective review of referrals within a network of 52 primary and urgent care sites from November 2016 to October 2017. We included referrals for children ≤17 years old referred to medical or surgical subspecialists. We examined patient and health systems factors associated with (1) appointment scheduling and (2) visit attendance., Results: Of 20 466 referrals, 13 261 (65%) resulted in an appointment scheduled within 90 days and 10 514 (51%) resulted in a visit attended within 90 days. In adjusted analyses, referral to surgical subspecialists was associated with an increased likelihood of appointment scheduling but a decreased likelihood of visit attendance. Compared with appointments scheduled within 7 days, appointments with intervals from referral to scheduled appointment exceeding 7 days were associated with decreasing likelihood of visit attendance (adjusted odds ratio 8-14 days 0.48; 95% confidence interval 0.37-0.61). Patient factors associated with decreased likelihood of both appointment scheduling and visit attendance included African American race, public insurance, and lower zip code median income., Conclusions: Patient and system factors were associated with variation in appointment scheduling and visit attendance. Decreased interval to appointment was significantly associated with visit attendance. These factors represent targets for interventions to improve referral completion., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2019 by the American Academy of Pediatrics.)

Purpose: Previous research suggests that prolonged sitting may acutely reduce cerebral blood flow velocity (CBFv). The purpose of this study was to evaluate the effects of alternating standing and sitting vs prolonged sitting on CBFv., Methods: This randomized crossover study enrolled working adults (N=25) with pre-to-stage 1 hypertension not using antihypertensive medications, and a body mass index from 25 to < 40 kg/m 2 . Subjects participated in two simulated workday conditions: 1) sitting continuously (SIT), and 2) alternating standing and sitting every 30 min (SS). Beat-to-beat systolic, mean and diastolic CBFv were recorded bilaterally for 1 min via insonation of the middle cerebral artery using transcranial Doppler ultrasonography before (morning), between (midday) and following (afternoon) two 3-hr 40 min work periods., Results: Mean±SD age was 42±12 years, blood pressure (BP) was 132±9/83±8 mmHg, and BMI was 32±5 kg/m 2 . Cerebrovascular hemodynamics did not differ across condition (P>0.05). There were, however, significant nonlinear effects of time (decrease from morning to midday; increase from midday to afternoon) on systolic CBFv (P=0.014), mean CBFv (P=0.001), diastolic CBFv (P=0.002), and pulsatility index (P=0.038). When overall time effects were evaluated during each time interval, mean and diastolic CBFv significantly decreased morning to midday and all CBFv increased from midday to afternoon. When separated by condition, significant time effects were observed for all CBFv during SIT (P<0.02) but not SS (P>0.05)., Conclusions: In individuals with elevated BP and BMI, CBFv significantly decreased by midday and increased by afternoon, especially during a workday of prolonged sitting. Future studies should evaluate the combination of frequent walks and a sit-stand desk to break up prolonged sitting., Competing Interests: Conflict of Interest Dr. Gibbs discloses funding from Humanscale. Drs. Perdomo, Kowalsky, Balzer and Mr. Taormina disclose no conflicts of interest.

Background: Limited research examines the influence of sit-stand desks on ratings of discomfort, sleepiness, and fatigue. This study evaluated the time course of these outcomes over 1 day., Methods: Adults (N = 25) completed a randomized cross-over study in a laboratory with two 8-hour workday conditions: (1) prolonged sitting (SIT) and (2) alternating sitting and standing every 30 minutes (SIT-STAND). Sleepiness was assessed hourly. Discomfort, physical fatigue, and mental fatigue were measured every other hour. Linear mixed models evaluated whether these measures differed across conditions and the workday. Effect sizes were calculated using Cohen's d., Results: Participants were primarily white (84%) males (64%), with mean (SD) body mass index of 31.9 (5.0) kg/m 2 and age 42 (12) years. SIT-STAND resulted in decreased odds of discomfort (OR = 0.37, P = .01) and lower overall discomfort (β = -0.19, P < .001, d = 0.42) versus SIT. Discomfort during SIT-STAND was lower in the lower and upper back, but higher in the legs (all Ps< .01, d = 0.26-0.42). Sleepiness (β = -0.09, P = .01, d = 0.15) and physical fatigue (β = -0.34, P = .002, d = 0.34) were significantly lower in SIT-STAND. Mental fatigue was similar across conditions., Conclusions: Sit-stand desks may reduce acute levels of sleepiness, physical fatigue, and both overall and back discomfort. However, levels of lower extremity discomfort may be increased with acute exposure.

Objective: Reducing prolonged sitting at work has been recommended by an expert panel, but whether intermittent standing improves vascular health is unclear. We aimed to test whether using a sit-stand desk could reduce blood pressure (BP) and pulse wave velocity (PWV) during a simulated workday., Methods: Overweight/obese adults with pre-to-Stage 1 hypertension completed a randomized crossover study with two simulated workday conditions: STAND-SIT (alternating standing and sitting condition every 30 min) and SIT (continuous sitting condition). Oscillometric BP was measured hourly. Carotid-femoral, carotid-radial, and carotid-ankle PWV were measured in the morning, mid-day, and late afternoon using tonometry., Results: Participants [n = 25, 64% male, 84% white, mean (SD) age: 42 (12) years] had average resting SBP of 132 (9) mmHg and DBP of 83 (8) mmHg. In linear mixed models, STAND-SIT resulted in a significantly lower DBP (mean ± SE: -1.0 ± 0.4 mmHg, P = 0.020) and mean arterial pressure (MAP) (-1.0 ± 0.4 mmHg, P = 0.029) compared with SIT. SBP (-0.9 ± 0.7 mmHg, P = 0.176) was not different across conditions. Carotid-ankle PWV was significantly lower during the STAND-SIT vs. SIT condition (-0.27 ± 0.13 m/s, P = 0.047), whereas carotid-femoral PWV (-0.03 ± 0.13 m/s, P = 0.831) and carotid-radial PWV (-0.30 ± 0.18 m/s, P = 0.098) were not. Changes in MAP partially explained changes in PWV., Conclusion: Interrupting prolonged sitting during deskwork with intermittent standing was a sufficient stimulus to slightly, but statistically significantly, decrease DBP, MAP, and carotid-ankle PWV. Though the clinical significance of the observed effects is modest, regular use of a sit-stand desk may be a practical way to lower BP and PWV while performing deskwork.