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BACKGROUND: Hypertension is a risk factor for experiencing left ventricular ejection fraction (LVEF) declines during receipt of potentially cardiotoxic breast cancer (BC) treatment. We sought to determine whether the hypertension stage is associated with LVEF decline during BC treatment. METHODS: Across 24 centers, cardiac magnetic resonance measures of LVEF and brachial arterial blood pressure (BP) measurements were performed in women with stages I to III BC before and 3 months after initiating potentially cardiotoxic chemotherapy. Using multivariable analysis, we assessed in a blinded fashion the association between 3-month ΔLVEF and precancer treatment American Heart Association/American College of Cardiology stages of hypertension. RESULTS: Among 204 women, age averaged 56±1 years with 75% being White and 20% of Black race. Participants received anthracycline (45.6%), trastuzumab (22.5%), cyclophosphamide (52.9%), or paclitaxel (50%). After accounting for pretreatment LVEF, diabetes status, tobacco use, age, the number of antihypertensive medications, and body mass index, those with stage II hypertension experienced an LVEF decline of −2.89% ([95% CI, −0.69% to −5.19%]; P =0.01) relative to individuals with normal BP. Other stages saw nonsignificant declines relative to normal BP to elevated BP (−1.63% [95% CI, −0.62% to 3.88%]; P =0.16) and stage I hypertension (−0.94% [95% CI, −0.90% to 2.78%]; P =0.32). CONCLUSIONS: Compared with women receiving treatment for BC with normal BP, there is a stronger association of decline in LVEF in women with stage II hypertension relative to women with other hypertension stages. This raises the possibility that stage along with hypertension presence may be associated with an increased risk for the LVEF decline among women receiving potentially cardiotoxic chemotherapy for BC. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02791581 and NCT01719562. [ABSTRACT FROM AUTHOR]

BACKGROUND: Perioperative telemedicine use has increased as a result of the COVID-19 pandemic and may improve access to surgical care. However, studies assessing outcomes in populations at risk for digital-health disparities are lacking. We sought to characterize the pre- and postoperative outcomes for rural patient populations being assessed for hernia repair and abdominal wall reconstruction with telehealth. METHODS: Patients undergoing telehealth evaluation from March 2020 through May 2021 were identified. Rurality was identified by zip code of residence. Rural and urban patients were compared based on demographics, diagnosis, treatment plan, and visit characteristics and outcomes. Downstream care use related to supplementary in-person referral, and diagnostic testing was assessed. RESULTS: Three hundred-seventy-three (196 preoperative, 177 postoperative) telehealth encounters occurred during the study period (rural: 28% of all encounters). Rural patients were more likely to present with recurrent or incisional hernias (90.0 vs 72.7%, p = 0.02) and advanced comorbidities (American Society of Anesthesiologists status score > 2: 73.1 vs 52.1%, p = 0.009). Rural patients derived significant benefits related to time saved commuting, with median distances of 299 and 293 km for pre- and postoperative encounters, respectively. Downstream care use was 6.1% (N = 23) for additional in-person evaluations and 3.4% (N = 13) for further diagnostic testing, with no difference by rurality. CONCLUSIONS: Perioperative telehealth can safely be implemented for rural populations seeking hernia repair and may be an effective method for reducing disparities. Downstream care use related to additional in-person referral or diagnostic testing was minimally impacted in both the preoperative and postoperative settings. These findings suggest that rurality should not deter surgeons from providing telemedicine-based surgical consultation for hernia repair. [ABSTRACT FROM AUTHOR]

Background: Prevalence of Chlamydia trachomatis and risk factors for infection are not well described in male college students enrolled in the Reserved Officer Training Corps (ROTC). Goal: The goal was to determine prevalence of C. trachomatis infection, percentage of asymptomatic infections, and risk factors for infection in a population of male college ROTC students. Study Design: We conducted a prevalence survey of C. trachomatis infection and risk factors using urine ligase chain reaction and questionnaire. Participants were 1443 ROTC male college cadets at Ft. Lewis, Washington, from June to July 2001. Results: Prevalence of C. trachomatis infection was 31 of 1252 (2.48%); 93.6% of the infections were asymptomatic. Black race, exposure to a partner with a prior sexually transmitted disease, and self-reported symptoms were significant risk factors. Conclusions: The prominence of asymptomatic infection in a male population with comparatively !ow prevalence suggests that risk factor rather than clinically based screening could be beneficial in this population. [ABSTRACT FROM AUTHOR]