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Background: Breastfeeding provides many short- and long-term health benefits for mothers and their infants and is a particularly relevant strategy for women who experience Gestational Diabetes Mellitus (GDM) during pregnancy. However, breastfeeding rates are generally lower amongst this group of women than the general population. This review's objective is to identify the factors that influence breastfeeding by exploring the experiences and outcomes of women in in high-income health care contexts when there is a history of GDM in the corresponding pregnancy. Methods: A comprehensive search strategy explored the electronic databases Medline, CINAHL, Web of Science and Scopus for primary studies exploring breastfeeding practices for papers published between January 2011 and June 2023. All papers were screened independently by two researchers with included papers assessed using the Crowe Critical Appraisal tool. Findings were analysed using a narrative synthesis framework. Results: From an initial search result of 1037 papers, 16 papers representing five high-income nations were included in this review for analysis – the United States of America (n = 10), Australia (n = 3), Finland (n = 1), Norway (n = 1), and Israel (n = 1). Fifteen papers used a quantitative design, and one used a qualitative design. The total number of participants represented in the papers is 963,718 of which 812,052 had GDM and 151,666 did not. Women with an immediate history of GDM were as likely to initiate breastfeeding as those without it. However, they were more likely to have the first feed delayed, be offered supplementation, experience delayed lactogenesis II and or a perception of low supply. Women were less likely to exclusively breastfeed and more likely to completely wean earlier than the general population. Maternity care practices, maternal factors, family influences, and determinants of health were contextual and acted as either a facilitator or barrier for this group. Conclusion: Breastfeeding education and support need to be tailored to recognise the individual needs and challenges of women with a history of GDM. Interventions, including the introduction of commercial milk formula (CMF) may have an even greater impact and needs to be very carefully considered. Supportive strategies should encompass the immediate and extended family who are major sources of influence. [ABSTRACT FROM AUTHOR]

Background: The Patient Protection and Affordable Care Act (ACA) established the Hospital Quality Initiative in 2010 to enhance patient safety, reduce hospital readmissions, improve quality, and minimize healthcare costs. In response, this study aims to systematically review the literature and conduct a meta-analysis to estimate the average cost of procedure-specific 30-day risk-standardized unplanned readmissions for Acute Myocardial Infarction (AMI), Heart Failure (HF), Pneumonia, Coronary Artery Bypass Graft (CABG), and Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA). Methods: Eligibility Criteria: This study included English language original research papers from the USA, encompassing various study designs. Exclusion criteria comprise studies lacking empirical evidence on hospital financial performance. Information Sources: A comprehensive search using relevant keywords was conducted across databases from January 1990 to December 2019 (updated in March 2021), covering peer-reviewed articles and gray literature. Risk of Bias: Bias in the included studies was assessed considering study design, adjustment for confounding factors, and potential effect modifiers. Synthesis of Results: The review adhered to PRISMA guidelines. Employing Monte Carlo simulations, a meta-analysis was conducted with 100,000 simulated samples. Results indicated mean 30-day readmission costs: USD 16,037.08 (95% CI, USD 15,196.01–16,870.06) overall, USD 6852.97 (95% CI, USD 6684.44–7021.08) for AMI, USD 9817.42 (95% CI, USD 9575.82–10,060.43) for HF, and USD 21,346.50 (95% CI, USD 20,818.14–21,871.85) for THA/TKA. Discussion: Despite the financial challenges that hospitals face due to the ACA and the Hospital Readmissions Reduction Program, this meta-analysis contributes valuable insights into the consistent cost trends associated with 30-day readmissions. Conclusions: This systematic review and meta-analysis provide comprehensive insights into the financial implications of 30-day readmissions for specific medical conditions, enhancing our understanding of the nexus between healthcare quality and financial performance. [ABSTRACT FROM AUTHOR]

Introduction: This study explores the association between self-perceived personal and community changes due to COVID-19 and health among vulnerable primary care patients experiencing multiple chronic conditions. Methods: Between September 2017 and February 2021, we obtained data from 2,426 primary care patients managing multiple chronic conditions from across the United States. We assessed the relationship between self-perceived personal and community changes due to COVID-19 and change in health measured by the PROMIS-29 mental and physical health summary scores, GAD-7 (anxiety), andPHQ-9 (depression), and DASI (functional capacity) adjusting for relevant demographic, neighborhood characteristics, and county covariates. Results: After adjustment, self-perceived personal and community changes due to COVID-19 were associated with significantly worse mental health summary scores (ß = -0.55; 95% Confidence Interval (CI) = -0.72, -0.37), anxiety (ß = 0.28; 95% CI = 0.16, 0.39), depression (ß = 0.35; 95% CI = 0.22, 0.47), and physical health summary scores (ß = -0.44; 95% CI = 0.88, 0.00). There was no association with functional capacity (ß = - 0.05; 95% CI = -0.16, 0.05). Discussion: Among adults managing multiple chronic conditions, self-perceived personal and community changes due to COVID-19 were associated with health. This vulnerable population may be particularly susceptible to the negative effects of COVID-19. As we do not know the long-term health effects of COVID, this paper establishes a baseline of epidemiological data on COVID-19 burden and health among primary care patients with multiple chronic conditions. [ABSTRACT FROM AUTHOR]

Background: Revision rates and outcome measures after anterior cruciate ligament reconstruction (ACLR) with suture tape as an internal brace is not well-documented because of the emerging nature of the technique. Hypothesis: ACLR with internal bracing (IB) would lead to decreased revision ACLR compared with traditional ACLR while exhibiting comparable patient outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 200 patients were included in this study. Patients aged between 13 and 39 years at the time of surgery who underwent primary autograft ACLR with IB between 2010 and 2020 and were enrolled in our institution's registry with a minimum of 2-year follow-up were identified and matched 1 to 1 with a non-internal brace (no-IB) group based on concomitant procedures and patient characteristics. Pre- and postoperatively, patients completed the Knee injury and Osteoarthritis Outcome Score, Marx activity rating scale, Veterans RAND 12-Item Health Survey, and visual analog scale for pain. Knee laxity measurements via the KT-1000 arthrometer were included in the pre- and postoperative objective clinical assessments. Results: A total of 100 IB patients were matched with 100 no-IB patients based primarily on concomitant procedures and secondarily on patient characteristics. The IB group underwent significantly fewer revision ACLRs (1% vs 8%; P =.017). Even though the no-IB group had a significantly longer mean final follow-up time (48.6 months [95% CI, 45.4-51.7] vs 33.4 months [95% CI, 30.3-36.5]; P <.001), the time elapsed from the original ACLR to the revision did not differ significantly between groups, and the mean ages for the IB and no-IB groups were comparable (19 vs 19.9 years). All postoperative patient-reported outcome scores between the 2 groups were comparable and significantly improved postoperatively except for the Marx score, which significantly decreased stepwise for both groups postoperatively. KT-1000 measurements significantly improved in both groups after surgery with the IB and no-IB cohorts yielding comparable results at the manual maximum pull (0.97 vs 0.65 mm). Conclusion: ACLR with IB resulted in a significantly decreased risk of revision ACLRs while maintaining comparable patient-reported outcomes. Therefore, incorporating an internal brace into ACLR appears to be safe and effective within these study parameters. [ABSTRACT FROM AUTHOR]

INTRODUCTION Despite the existence of numerous studies highlighting the adverse effects of smoking on kidney function, the investigation of the correlation between serum cotinine and chronic kidney disease (CKD) remains inconclusive due to insufficient evidence. Consequently, the primary objective of this study was to ascertain the association between serum cotinine levels and CKD. METHODS This study analyzed data from 10900 Americans participating in the National Health and Nutrition Examination Survey between 2005 and 2016. The independent variable under investigation was log serum cotinine, while the dependent variable was the presence of CKD. To investigate the potential linear and non-linear correlations between serum cotinine and CKD, logistic regression models and generalized additive models (GAM) were employed. Furthermore, stratified analyses and interaction tests were conducted to evaluate potential disparities in the relationship between serum cotinine and CKD, based on sex. RESULTS The median age in the study participants was 49.28 ± 17.96 years, and the median log serum cotinine (ng/mL) was -0.54 ± 1.68. The prevalence of CKD was found to be 17.04%. Multifactorial regression analysis did not show a statistically significant association between log serum cotinine and CKD (OR=1.02; 95% CI: 0.98--1.06, p=0.4387). A statistically significant non-linear association between log serum cotinine and CKD was also not observed in the GAM analysis (p nonlinear value=0.091). Subgroup analyses revealed sex differences in the association between log serum cotinine and CKD. Briefly, males had a positive association between log serum cotinine and incident CKD (OR=1.08; 95% CI: 1.02--1.15, p=0.0049). In females, there was a U-shaped association between log serum cotinine and CKD, with an optimal inflection point for log serum cotinine of -0.30 (serum cotinine=0.5 ng/mL). CONCLUSIONS Cross-sectional analyses of NHANES data showed gender differences in the association between serum cotinine and the development of CKD. [ABSTRACT FROM AUTHOR]

Background WHO estimates that seasonal influenza epidemics result in three to five million cases of severe illness (hospitalisations) every year. We aimed to improve the understanding of influenza-associated hospitalisation estimates at a national and global level. Methods We performed a systematic literature review of English- and Chinese-language studies published between 1995 and 2020 estimating influenza-associated hospitalisation. We included a total of 127 studies (seven in Chinese) in the meta-analysis and analyzed their data using a logit-logistic regression model to understand the influence of five study factors and produce national and global estimates by age groups. The five study factors assessed were: 1) the method used to calculate the influenza-associated hospitalisation estimates (rateor time series regression-based), 2) the outcome measure (divided into three envelopes: narrow, medium, or wide), 3) whether every case was laboratory-confirmed or not, 4) whether the estimates were national or sub-national, 5) whether the rates were based on a single year or multiple years. Results The overall pooled influenza-associated hospitalisation rate was 40.5 (95% confidence interval (CI) = 24.3-67.4) per 100 000 persons, with rates varying substantially by age: 224.0 (95% CI = 118.8-420.0) in children aged 0-4 years and 96.8 (95% CI = 57.0-164.3) in the elderly aged >65 years. The overall pooled hospitalisation rates varied by calculation method; for all ages, the rates were significantly higher when they were based on rate-based methods or calculated on a single season and significantly lower when cases were laboratory-confirmed. The national hospitalisation rates (all ages) varied considerably, ranging from 11.7 (95% CI = 3.8-36.3) per 100 000 in New Zealand to 122.1 (95% CI = 41.5-358.4) per 100 000 in India (all age estimates). Conclusions Using the pooled global influenza-associated hospitalisation rate, we estimate that seasonal influenza epidemics result in 3.2 million cases of severe illness (hospitalisations) per annum. More extensive analyses are required to assess the influence of other factors on the estimates (e.g. vaccination and dominant virus (sub)types) and efforts to harmonize the methods should be encouraged. Our study highlights the high rates of influenza-associated hospitalisations in children aged 0-4 years and the elderly aged 65+ years. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study aims to assess the relationship between use of tobacco products and taste and smell disorders. METHODS A secondary dataset analysis of cross-sectional data from the National Health Interview Survey (NHIS) 2021 survey cycle, a nationally representative annual cross-sectional interview of non-institutionalized US civilians, was used. Participants' senses of smell and taste are assessed using self-reported questions. Participants were categorized into five groups based on their tobacco use: nontobacco users; cigarettes only; e-cigarettes only; cigar, pipe, or smokeless tobacco; and poly-tobacco product users. Disorders were defined as any self-reported difficulty in smelling, tasting, or reporting unpleasant odors or persistent tastes. Weighting procedures were used to estimate the national prevalence of taste, smell, and other disorders, stratified by tobacco products used. Adjusted logistic regression models were used to determine the association between tobacco products used and taste or smell compared to non-tobacco users. RESULTS A total of 40.2 million US adults reported experiencing smell or taste disorders. Nearly one in 10 adults reported a taste disorder (9.8%), and 13.4% indicated a smell disorder. The prevalence of taste or smell disorder was higher among females (17.5%), Hispanics (19.5%), individuals identified as 'other' racial minorities (21.1%), and lower income groups (21%). Compared to non-tobacco users, the highest odds of experiencing smell or taste disorders were among poly-tobacco product users (adjusted odds ratio, AOR=1.44; 95% CI: 1.31-1.58), followed by e-cigarette-only users (AOR=1.38; 95% CI: 1.02-1.87), cigarette-only smokers (AOR=1.17; 95% CI: 1.04-1.32), and users of cigars, pipes, or smokeless tobacco (AOR=1.15; 1.00; and 1.33; respectively). CONCLUSIONS Tobacco product use was associated with an increased risk of smell and taste disorders. The rising use of e-cigarettes among adolescents and young adults is particularly concerning given the limited understanding of the sensory effects of e-cigarettes and their growing popularity among younger populations. The study findings highlight the need for interventions aimed at reducing tobacco use of all kinds. [ABSTRACT FROM AUTHOR]

Simple Summary: HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) is unique amongst oropharyngeal cancers in its high responsiveness to treatment and its lower mortality rate. As a result, numerous clinical trials have been conducted to identify treatment modalities and protocols. In order for these trials to have meaningful impact on HPV-associated OPSCC patients, proper demographic representation by trial participants is essential. The aim of our systematic review and meta-analysis was to assess the demographics of trial participants for HPV-associated OPSCC clinical trials and compare them with those reported by national databases. We determined that clinical-trial participants were predominately non-smoking white men, with tonsils as the primary tumor site. These findings reflect the demographics reported by the National Cancer Database. Our results imply that HPV-associated OPSCC clinical trials appropriately represent the target population and offer immense benefit. The objective of our paper was to answer the following question: how do patients with HPV-related oropharyngeal squamous cell carcinoma OPSCC (Population) enrolled in clinical trials (Intervention), compared with national database reports of HPV-associated OPSCC patients (Comparison), present demographically (Outcome)? We conducted a systematic review and meta-analysis of studies pertaining to clinical trials of HPV-associated OPSCC and participant demographics in the United States. PubMed, Scopus, CINAHL, and the Cochrane Library were searched from inception to 2 February 2022. Studies of overlapping participant cohorts and/or studies conducted outside of the United States were excluded. Primary outcomes were patient age, sex, and race. Secondary outcomes were smoking history, alcohol history, history of prior cancer, and tumor origin site. Meta-analysis of single means (mean, N for each study, and standard deviation) for age, pack years, and smoking years was performed. Pooled prevalence rates of gender, race, alcohol history, tobacco history, and tumor origin site were expressed as a percentage, with 95% confidence intervals. Meta-analysis found patients to be predominately non-smoking white males, with tumors originating from the tonsil. Our findings reflected the demographics reported by the National Cancer Database (NCDB) for HPV-associated OPSCC. This indicates that HPV-associated OPSCC patients are appropriately represented in clinical trial demographics. [ABSTRACT FROM AUTHOR]

Background: Both the consumption of breastmilk in infancy and a person's season of birth influences his or her health, educational, professional, and behavioral outcomes. Further, season of birth effects differ by sex. However, current research, for the most part, neglects to examine if season of birth and breastfeeding are related. This paper examines the impact of sex-based variations in season of birth on breastfeeding likelihood and duration in the U.S. Methods: Using data from children born to female respondents of the National Longitudinal Survey of Youth 1979 (born between 1970 and 2012), this study examines with Probit, Negative Binomial, and Ordinary Least Squares (OLS) regressions if a child's season of birth and sex are correlated with breastfeeding incidence and duration. The breastfeeding incidence and duration data are self-reported by the mother. Results: Season of birth has a small but statistically significant impact on the incidence and duration of breastfeeding, which varies depending on the sex of the infant. Mothers giving birth to sons in the spring are 13.5% less likely to breastfeed than those giving birth to sons in the winter (with a p - value of 0.0269). Mothers with daughters born in the summer or fall (autumn) breastfeed slightly longer than mothers with daughters born in the spring. On average, mothers of summer-born daughters breastfeed 4.1% longer (with a 95% confidence interval of 0.3 - 7.8) and those with fall-born daughters 3.8% longer (with a 95% confidence interval of 0 - 7.5). Mothers giving birth to daughters in the spring are also significantly less likely to reach the breastfeeding six-week duration target (compared to fall and winter births) and the one-year duration target (compared to fall births). Conclusions: These findings suggest that the costs and benefits of breastfeeding an infant vary with the season of birth and the sex of the child. This finding could explain some of the season of birth effects previously identified in the literature. Further, policymakers seeking to increase breastfeeding rates should consider the reduced breastfeeding rates and durations for children born in the spring. [ABSTRACT FROM AUTHOR]

Despite widespread discussion and public policy support for workplace wellness programs in the United States, their diffusion has been slow. Using data from the 2017 Workplace Health Administration Survey, this paper explored the importance of establishment characteristics, unionization, and strategic choice in the adoption of workplace health initiatives and employee participation in these programs. An ordinary least squares analysis revealed that unionization (β = 1.59, 95% CI = 1.20–1.97, p < 0.001) and management support (β = 1.67, 95% CI = 1.25–2.10, p < 0.001) were the strongest predictors of the number of programs adopted by an establishment. In logistic regression analyses of nine workplace wellness programs, it was also found that unionization and management were the strongest predictors of the adoption of these programs. Management support was also correlated with employee participation of in nutrition (OR = 2.66, 95% CI = 1.23–5.71, p < 0.05) and obesity programs (OR = 3.66, 95% CI = 1.03–12.97, p < 0.05). [ABSTRACT FROM AUTHOR]

U.S. organizations seek to provide interns with positive socialization experiences such that their internships may lead to job offer acceptances. This study presents a process model examining how developmental relationships shape interns' experiences and outcomes. Utilizing a sample of 6,802 recent graduates from across 200 U.S. colleges and universities who completed an internship, the study found that supervisor support indirectly influences an intern's decision to accept a job offer through learning and intern satisfaction. Findings further show that interns benefit from developmental relationships such as mentors since mentor status buffered the decrements in learning when supervisor support was low. This study contributes to the growing internship literature that draws upon early socialization and newcomer adaptation by examining the critical role developmental relationships play in the experiences of interns. [ABSTRACT FROM AUTHOR]

INTRODUCTION The FDA's 'The Real Cost' tobacco prevention campaign aimed to counter tobacco marketing efforts directed toward children and youths. Our objectives were to explore the associations between exposure to the FDA's campaign and cigarette risk perception among the US adolescent population, and between exposure and cigarette smoking curiosity among adolescents who never smoked cigarettes. METHODS We analyzed 3 cycles of National Youth Tobacco Survey (NYTS 2018-2020, n=53738). Multivariable logistic regression models were fitted to measure the relationship between campaign exposure and cigarettes risk perception (among all), as well as the relationship between campaign exposure and cigarette curiosity (among cigarette never smokers). RESULTS Majority of youths have reported exposure to the campaign 63% between 2018-2020. The odds of youths perceiving cigarettes as risky were 1.6 times higher among exposed compared to those not exposed (adjusted odds ratio, AOR=1.60; 95% CI: 1.43-1.79). There were some racial disparities in risk perceptions among Hispanics and Non-Hispanic Blacks across exposure groups. Exposure was associated with higher cigarettes curiosity odds among Hispanic youths who never smoked (AOR=1.26; 95% CI: 1.10-1.44) compared to their Non-Hispanic White peers. CONCLUSIONS The FDA's 'The Real Cost' campaign had exposure levels deemed essential for population-level perceptions change. Exposure was associated with youths having higher risk perceptions about the negative health outcomes related to cigarette smoking. However, students that never smoked were more curious about smoking with campaign exposure. Therefore, future health communication plans should consider both the potential benefits and possible unintended consequences prior to launching such campaigns. [ABSTRACT FROM AUTHOR]

Though preventable, children with disabilities have a high risk of victimization, contributing to worsening health conditions. Hence, this study examined the exposure of school-age children with mental, emotional, developmental, or behavioral (MEDB) disorder to bully victimization. This study used the 2018 National Survey of Children's Health (NSCH) data of 23,494 children ages 5–17 to estimate multilevel logistic regression with fixed and random effects. Children's health conditions were treated as level one variables, while family poverty level and neighborhood characteristics such as vandalism and presence/absence of recreational centers were treated as level two variables. The paper presents the prevalence of bullying victimization among children with at least one disorder (MDBB = 39.5%), anxiety (20.6%), depression (10.8%), ADD/ADHD (18.3%), behavioral problems (14.9%), learning disability (11.9%), Tourette syndrome (0.5%), developmental delay (10.1%), Autism spectrum disorder (4.6%), speech disorder (10.7), and intellectual disability (1.6%), respectively. Bullying victimization was positively associated with anxiety (AOR = 1.995, 95% CI = 1.634–2.436), depression (AOR = 2.688, 95% CI = 2.031–3.557), developmental delay (AOR = 1.804, 95% CI = 1.422–2.288), but inversely associated with Autism spectrum disorder (AOR = 0.614, 95% CI = 0.399–0.946). Neighborhood disorganization and poverty were also associated with bullying victimization. The NSCH data suggests that children with disabilities in the US had a higher prevalence rate of victimization. Consequently, effective bullying prevention strategies that can protect and improve children's quality of life with special needs should be prioritized. [ABSTRACT FROM AUTHOR]

Background: Equal-tailed confidence intervals that maintain nominal coverage (0.95 or greater probability that a 95% confidence interval covers the true value) are useful in interval-based statistical reliability standards, because they remain conservative. For age-adjusted death rates, while the Fay–Feuer gamma method remains the gold standard, modifications have been proposed to streamline implementation and/or obtain more efficient intervals (shorter intervals that retain nominal coverage). Methods: This paper evaluates three such modifications for use in interval-based statistical reliability standards, the Anderson–Rosenberg, Tiwari, and Fay–Kim intervals, when data are sparse and sample size-based standards alone are overly coarse. Initial simulations were anchored around small populations (P = 2400 or 1200), the median crude all-cause US mortality rate in 2010–2019 (833.8 per 100,000), and the corresponding age-specific probabilities of death. To allow for greater variation in the age-adjustment weights and age-specific probabilities, a second set of simulations draws those at random, while holding the mean number of deaths at 20 or 10. Finally, county-level mortality data by race/ethnicity from four causes are selected to capture even greater variation: all causes, external causes, congenital malformations, and Alzheimer disease. Results: The three modifications had comparable performance when the number of deaths was large relative to the denominator and the age distribution was as in the standard population. However, for sparse county-level data by race/ethnicity for rarer causes of death, and for which the age distribution differed sharply from the standard population, coverage probability in all but the Fay–Feuer method sometimes fell below 0.95. More efficient intervals than the Fay–Feuer interval were identified under specific circumstances. When the coefficient of variation of the age-adjustment weights was below 0.5, the Anderson–Rosenberg and Tiwari intervals appeared to be more efficient, whereas when it was above 0.5, the Fay–Kim interval appeared to be more efficient. Conclusions: As national and international agencies reassess prevailing data presentation standards to release age-adjusted estimates for smaller areas or population subgroups than previously presented, the Fay–Feuer interval can be used to develop interval-based statistical reliability standards with appropriate thresholds that are generally applicable. For data that meet certain statistical conditions, more efficient intervals could be considered. [ABSTRACT FROM AUTHOR]

Black adolescents in the United States have experienced an increase in suicidal thoughts and behaviors (STBs). Since Black adolescents are overrepresented in the youth punishment system, more research is needed to investigate correlates of STBs for this population. The purpose of this paper is to explore and establish correlates of individual, family, and community risk and protective factors and their relationship to lifetime STBs in a national sample of Black youth with arrest histories. Guided by an intersectional eco-behavioral lens, we investigated individual, family and contextual risk and protective factors for STBs among a national sample of justice-involved Black youth aged 12–17 with a history of arrest (n = 513). We used logistic regression models to test risk and protective factors for STBs. Among the sample, 9.78% endorsed suicidal ideation, and 7.17% endorsed a previous suicide attempt. Further, gender (female) and depression severity were risk factors for STBs, while positive parenting and religiosity were protective factors for STBs. School engagement was associated with lower levels of suicidal ideation. The findings suggest suicide prevention and intervention efforts should identify developmentally salient risk and protective factors to reduce mental health burden associated with STBs and concurrent alleged law-breaking activity of Black youth. [ABSTRACT FROM AUTHOR]

Introduction: Prior to the COVID-19 pandemic, telehealth utilization was growing slowly and steadily, although differentially across medical specialties in the United States. The pandemic dramatically expanded physician use of telehealth, but our understanding of how much telehealth use has changed in primary care in the United States, the correlates of physician telehealth uptake, and the frequency with which primary care physicians intend to use telehealth after the pandemic are unknown. This paper is designed to assess these important questions. Methods: Using data from an original national survey of 625 primary care physicians conducted from May 14 to May 25, 2021, we investigate the frequency of physician telehealth use before and during the pandemic and intended use after the pandemic. We also assess the correlates of changes in telehealth use by physicians, comparing telehealth use before the pandemic to use during and after the pandemic. Results: The proportion of primary care physicians using telehealth often, jumped from 5.3% (95% CI 3.5, 7.0) before the pandemic to 46.2% (95% CI 42.3, 50.2) during the pandemic. More importantly, over 70% of physicians intended to use telehealth at least occasionally after the pandemic compared to just 18.7% before, with younger physicians, physicians without telehealth training in medical school, and Asian physicians most likely to increase their telehealth use long-term. Discussion: The COVID-19 pandemic has spurred expansion in telehealth use by primary care physicians that will continue to shape care delivery well beyond the pandemic. Policy change could be needed to facilitate this growth of telehealth long-term. [ABSTRACT FROM AUTHOR]

Principled methods with which to appropriately analyze missing data have long existed; however, broad implementation of these methods remains challenging. In this and 2 companion papers (Am J Epidemiol. 2018;187(3):576-584 and Am J Epidemiol. 2018;187(3):585-591), we discuss issues pertaining to missing data in the epidemiologic literature. We provide details regarding missing-data mechanisms and nomenclature and encourage the conduct of principled analyses through a detailed comparison of multiple imputation and inverse probability weighting. Data from the Collaborative Perinatal Project, a multisite US study conducted from 1959 to 1974, are used to create a masked data-analytical challenge with missing data induced by known mechanisms. We illustrate the deleterious effects of missing data with naive methods and show how principled methods can sometimes mitigate such effects. For example, when data were missing at random, naive methods showed a spurious protective effect of smoking on the risk of spontaneous abortion (odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.19, 0.93),while implementation of principled methods multiple imputation (OR = 1.30, 95% CI: 0.95, 1.77) or augmented inverse probability weighting (OR = 1.40, 95% CI: 1.00, 1.97) provided estimates closer to the "true" full-data effect (OR = 1.31, 95% CI: 1.05, 1.64). We call for greater acknowledgement of and attention to missing data and for the broad use of principled missing-data methods in epidemiologic research. [ABSTRACT FROM AUTHOR]

Introduction Collabo RATE is a brief patient survey focused on shared decision making. This paper aims to (i) provide insight on facilitators and challenges to implementing a real-time patient survey and (ii) evaluate Collabo RATE scores and response rates across multiple clinical settings with varied patient populations. Method All adult patients at three United States primary care practices were eligible to complete Collabo RATE post-visit. To inform key learnings, we aggregated all mentions of unanticipated decisions, problems and administration errors from field notes and email communications. Mixed-effects logistic regression evaluated the impact of site, clinician, patient age and patient gender on the Collabo RATE score. Results While Collabo RATE score increased only slightly with increasing patient age ( OR 1.018, 95% CI 1.014-1.021), female patient gender was associated with significantly higher Collabo RATE scores ( OR 1.224, 95% CI 1.073-1.397). Clinician also predicts Collabo RATE score (random effect variance 0.146). Site-specific factors such as clinical workflow and checkout procedures play a key role in successful in-clinic implementation and are significantly related to Collabo RATE scores, with Site 3 scoring significantly higher than Site 1 ( OR 1.759, 95% CI 1.216 to 2.545) or Site 2 (z=−2.71, 95% CI −1.114 to −0.178). Discussion This study demonstrates that Collabo RATE can be used in diverse primary care settings. A clinic's workflow plays a crucial role in implementation. Patient experience measurement risks becoming a burden to both patients and administrators. Episodic use of short measurement tools could reduce this burden. [ABSTRACT FROM AUTHOR]

Background: Nicotine vaping products (NVPs) are increasingly popular worldwide. They may provide public health benefits if used as a substitute for smoking, but may create public health harms if used as a gateway to smoking or to discourage smoking cessation. This paper presents the Smoking and Vaping Model (SAVM), a user-friendly model which estimates the public health implications of NVPs in the USA. Methods: SAVM adopts a cohort approach. We derive public health implications by comparing smoking- and NVP-attributable deaths and life-years lost under a No-NVP and an NVP Scenario. The No-NVP Scenario projects current, former, and never smoking rates via smoking initiation and cessation rates, with their respective mortality rates. The NVP Scenario allows for smoking- and NVP-specific mortality rates, switching from cigarette to NVP use, separate NVP and smoking initiation rates, and separate NVP and smoking cessation rates. After validating the model against recent US survey data, we present the base model with extensive sensitivity analyses. Results: The SAVM projects that under current patterns of US NVP use and substitution, NVP use will translate into 1.8 million premature smoking- and vaping-attributable deaths avoided and 38.9 million life-years gained between 2013 and 2060. When the NVP relative risk is set to 5%, the results are sensitive to the level of switching and smoking cessation rates and to a lesser extent smoking initiation rates. When the NVP relative risk is raised to 40%, the public health gains in terms of averted deaths and LYL are reduced by 42% in the base case, and the results become much more sensitive to variations in the base case parameters. Discussion: Policymakers, researchers, and other public health stakeholders can apply the SAVM to estimate the potential public health impact of NVPs in their country or region using their own data sources. In developing new simulation models involving NVPs, it will be important to conduct extensive sensitivity analysis and continually update and validate with new data. Conclusion: The SAVM indicates the potential benefits of NVP use. However, given the uncertainty surrounding model parameters, extensive sensitivity analysis becomes particularly important. [ABSTRACT FROM AUTHOR]

Context: Although it has been suggested that developmental and sociological factors play a role in concussion reporting, the empirical evidence related to this is limited. Objective: To examine the influences of sex, school level, school location, concussion-reporting history, and socioeconomic status on concussion-related knowledge, attitudes, and reporting intentions among middle school and high school athletes. Design: Cross-sectional study. Setting: Master students and High School athletes attending pre-participation examinations (PPEs) were asked to complete paper-based surveys. Patients or Other Participants: Overall, 541 athletes representing 18 sports returned fully completed surveys. Main Outcome Measure(s): Outcomes were concussionrelated knowledge, perceived seriousness, positive feelings about reporting, and self-reporting intentions. We examined group differences in these outcomes across levels of the explanatory variables of sex, school level (middle school versus high school), school location (urban versus rural), concussion self-reporting history (yes or no), and socioeconomic status (free or reduced-price lunch versus no free or reduced-price lunch) using Wilcoxon rank sum tests. Then we used multivariable ordinal logistic regression models to identify predictors of higher score levels for each outcome. Odds ratio (OR) estimates with 95% confidence intervals (Cis) excluding 1.00 were deemed significant. Results: Odds of higher levels of knowledge were higher in urban versus rural school student-athletes (ORAdjusted = 1-81; 95% Cl = 1.03, 3.17), and lower in student-athletes on free or reduced-price lunch versus those not on free or reduced-price lunch (ORAd¡usted = 0.52; 95% Cl = 0.36, 0.77). Similarly, odds of higher levels of seriousness were lower in male versus female student-athletes (ORAdjusted = 0.48; 95% Cl = 0.32, 0.72). Further, odds of higher levels of self-reporting intentions were lower among male versus female student-athletes (ORAdjUSted = 0.53; 95% Cl = 0.37, 0.75). Conclusions: Developmental and sociological factors were differentially associated with concussion-related knowledge, attitudes, and self-reporting intentions. These results can inform medical providers, parents, and coaches with regard to contextspecific clinical assessments of concussion symptoms. [ABSTRACT FROM AUTHOR]

INTRODUCTION E-cigarette use among youth and young adults remains of public health concern. Pod-based e-cigarettes, including JUUL, significantly changed the e-cigarette landscape in the US. Using an online survey, we explored the socio-behavioral correlates, predisposing factors, and addictive behaviors, among young adult pod-mod users within a University in Maryland, USA. METHODS In total, 112 eligible college students aged 18--24 years, recruited from a University in Maryland, who reported using pod-mods were included in this study. Participants were categorized into current/non-current users based on past- 30-day use. Descriptive statistics were used to analyze participants' responses. RESULTS The mean age of the survey participants was 20.5 ± 1.2 years, 56.3% were female, 48.2% White, and 40.2% reported past-30-day (current) use of pod-mods. The mean age of first experimentation with pod-mods was 17.8 ± 1.4 years, while the mean age of regular use was 18.5 ± 1.4 years, with the majority (67.9%) citing social influence as the reason for initiation. Of the current users, 62.2% owned their own devices, and 82.2% predominantly used JUUL and menthol flavor (37.8%). A significant proportion of current users (73.3%) reported buying pods in person, 45.5% of whom were aged <21 years. Among all participants, 67% had had a past serious quit attempt. Among them, 89.3% neither used nicotine replacement therapy nor prescription medications. Finally, current use (adjusted odds ratio, AOR=4.52; 95% CI: 1.76--11.64), JUUL use (AOR=2.56; 95% CI: 1.08-6.03), and menthol flavor (AOR=6.52; 95% CI: 1.38-30.89) were associated with reduced nicotine autonomy, a measure of addiction. CONCLUSIONS Our findings provide specific data to inform the development of public health interventions targeted at college youth, including the need for more robust cessation support for pod-mod users. [ABSTRACT FROM AUTHOR]

Background There is a lack of evidence on whether combined lifestyle factors mediate the association between family income and all-cause mortality, as well as the joint relations between family income and lifestyle factors with mortality. Methods Using data on family income and lifestyle factors of participants in the US National Health Interview Survey 2016-2018, we performed multivariable logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CI) for the association of all-cause mortality with said data. Results We included 73729 participants with a mean age of 47.1 years (standard deviation (SD)=18.0), 51% of whom were women and 65% of whom were non-Hispanic Whites. There were 2284 deaths documented. After multivariable adjustment, middle-income participants had an OR of 0.73 (95% CI=0.61-0.88) for mortality, while high-income participants had an OR of 0.47 (95% CI=0.37-0.60) compared with low-income participants. We found that lower all-cause mortality was related to higher lifestyle scores. Adults from high-income families with lifestyle scores of 3 and 4 had an OR for mortality of 0.44 (95% CI=0.30-0.65) compared to those from low-income families and lifestyle scores of 0 or 1. When comparing those in highest vs lowest income groups in the mediation analysis, 9.8% (95% CI=7.4-13.0) of the relation for all-cause mortality was mediated by lifestyles. Adults from high-income families with lifestyle scores of 3 or 4 had an OR of 0.23 (95% CI=0.17-0.33) for mortality compared with those from low-income families and lifestyle scores of 0 or 1. Conclusions A lower risk of all-cause mortality was linked to higher family income and healthier lifestyles. Furthermore, lifestyle factors mediated a small proportion of the association between family income and mortality among US adults. Economic disparity in health may not be eliminated by changing only one's lifestyle. Therefore, besides promoting a healthy lifestyle, we should stress how family income inequality affects health outcomes. [ABSTRACT FROM AUTHOR]

Background The Systolic Blood Pressure Intervention Trial (SPRINT) from the US and the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial from China have consistently demonstrated clinical benefits from intensive blood pressure (BP) treatment among elderly adults with hypertension. However, we have little data on the generalisability and potential implications of a scale-up of intensive BP treatment to all eligible elderly in the US and China. Methods We used two nationally representative data sets from China (Health and Retirement Longitudinal Study (CHALRS), 2011-2012) and the US (National Health and Nutrition Examination Survey (NHANES), 2007-2012) and linked them with CHARLS follow-up data (2013) and the National Death Index (1999-2015), respectively. We estimated the percentage, number, and characteristics of elderly (≥60 years old) meeting the STEP and SPRINT eligibility criteria, and deaths that would be prevented or postponed with the implementation of intensive BP treatment. Results Among the Chinese adults aged 60 years and over, 38.89% (95% confidence interval (CI) = 36.97-40.84) or 85.39 (95% CI = 81.14-89.64) million subjects met the STEP criteria, and 40.90 million (47.90%) adults were not taking antihypertensive medications. In the US, 23.77% (95% CI = 22.32%-25.28) or 12.46 (95% CI = 11.68-13.24) million elderly were eligible for the SPRINT, and 5.78 million (46.36%) were untreated. Overall, 0.07 (95% CI = 0.06-0.08) million deaths in the US and 0.31 (95% CI = 0.25-0.39) in China would be averted annually if intensive BP treatment was implemented, while 120 000 and 680 000 of hypotension cases would be identified yearly in the US and China, respectively. Conclusions A substantial percentage of Chinese and the US elderly meet the eligibility criteria for STEP and SPRINT. If intensive BP treatment was adopted, 70 000 and 310 000 deaths would be prevented or postponed yearly in the US and China, respectively. [ABSTRACT FROM AUTHOR]

Background Diabetes is more prevalent among overweight/obese individuals, but has become a significant public health challenge among normal-weight populations. In this meta-analysis, we aimed to estimate diabetes/prediabetes incidence and its temporal trends by weight status. Methods PubMed, Embase, Web of Science, and Cochrane Library were searched until 8 December 2021. Prospective cohort studies reporting diabetes incidence by baseline body mass index (BMI) categories in adults were included. The median year of data collection was used to assess the temporal trends. Subgroup analyses and meta-regression were also performed. Results We included 94 studies involving 3.4 million adults from 22 countries. The pooled diabetes incidence in underweight, normal-weight, and overweight/obese adults was 4.5 (95% confidence interval (CI)=2.8-7.3), 2.7 (95% CI=2.2-3.3), and 10.5 (95% CI=9.3-11.8) per 1000 person-years, respectively. The diabetes incidence in low- and middle-income countries (LMICs) was higher than in high-income countries among normal-weight (5.8 vs 2.0 per 1000 person-years) or overweight/obese (15.9 vs 8.9 per 1000 person-years) adults. European and American regions had a higher diabetes incidence than the non-Western areas, regardless of weight status. Underweight diabetes incidence decreased significantly from 1995-2000 to 2005-2010. Diabetes incidence in normal-weight populations has increased continuously since 1985 by an estimated 36% every five years. In overweight/obese adults, diabetes incidence increased between 1985-1990 and 1995-2000, stabilised between 2000 and 2010, and spiked suddenly after 2010. Conclusions Diabetes incidence and its temporal trends differed by weight status. The continuous upward trend of diabetes incidence among overweight/obese individuals requires urgent attention, particularly in LMICs. Furthermore, diabetes among normal-weight individuals is becoming a significant public health problem. [ABSTRACT FROM AUTHOR]

Background Comparing body fat and the effect of body fat on metabolic abnormalities in Chinese and USA teenagers may provide clues for the early prevention and control of cardiovascular disease (CVD). We aimed to compare the prevalence of glucose and lipid metabolism abnormalities, body fat amount and distribution, and the effect of body fat on glucose and lipid metabolism in Chinese and US teenagers. Methods We included 5424 Chinese teenagers (48.5% male) from the China Child and Adolescent Cardiovascular Health (CCACH) study and 8704 USA teenagers (55.6% male) from the USA National Health and Nutrition Examination Survey (NHANES). Blood lipid, blood glucose, and body fat indicators were obtained using the same standardised measurements. Results The prevalence of dyslipidaemia in Chinese teenagers was of those in the USA (hypercholesterolaemia = 3.5% vs 7.4%; high low-density lipoprotein cholesterol (LDL-C) = 3.6% vs 5.0%; low high-density lipoprotein cholesterol (HDL-C)=9.9% vs 14.3%; hypertriglyceridaemia=3.7% vs 10.1%) (P<0.05). However, with the increase in body mass index (BMI), the prevalence of high LDL-C increased more in Chinese than in US teenagers, even exceeding them in the obese group (2.7% in non-overweight to 9.7% in overweight group in China, P<0.05; 3.5% in non-overweight to 6.5% in the obese group in the USA, P<0.05). The prevalence of impaired fasting glucose was higher in China than in the USA (28.0% vs 17.5%, P<0.05). Besides, Chinese adolescents are more likely to accumulate fat in the abdomen, and the per-unit fat increase would bring a higher risk of dyslipidaemia in Chinese boys than in USA boys. Conclusions Dyslipidaemia was more prevalent in US teenagers than in Chinese teenagers, but with the increase in BMI, the prevalence of high LDL-C increased more in Chinese than in US teenagers. Impaired fasting glucose (IFG) was significantly more prevalent in China than in the USA. The unfavoured body fat and higher risk of body fat on metabolic disorders in Chinese teenagers suggest that Chinese teenagers should pay more attention to the adverse effect of body fat on metabolic abnormalities. [ABSTRACT FROM AUTHOR]

Background Obesity, which has reached the scale of a global pandemic, is a leading cause of premature death. It is unclear to what extent its effect on mortality was driven by blood pressure or glucose levels in people of different ethnicities. Methods We conducted a causal mediation analysis to estimate the mediation effect of blood pressure and glucose between body mass index (BMI) or waisthip ratio (WHR) on mortality based on data from the China Kadoorie Biobank (CKB) (n = 458 385) and US National Health and Nutrition Examination Survey (NHANES) (1999-2008, n = 20 726). Results The WHR's effect on mortality was mediated by blood pressure and glucose in the CKB data set by 38.7% (95% confidence interval (CI) = 34.1, 43.2) and 36.4% (95% CI = 31.6, 42.8), whereas in NHANES by 6.0% (95% CI = 2.3, 8.3) and 11.2% (95% CI = 4.7, 22.7), respectively. For associations between BMI and mortality in subjects with overweight or obesity, the mediator proportion of blood pressure and glucose was 49.4% (95% CI = 40.1, 62.5) and 16.9% (95% CI = 13.6, 22.9) in CKB and 9.10% (95% CI = 2.2, 25.9) and 16.7% (95% CI = 7.3, 49.0) in NHANES, respectively. We stratified the patients by their blood glucose, blood pressure level, or both into four groups. The effect of WHR on mortality was comparable across subgroups in either cohort. The associations between BMI and mortality were stronger in patients with higher blood pressure in CKB (P = 0.011) and blood glucose in NHANES (P = 0.035) in patients with overweight and obesity. Conclusions The relationship between WHR and mortality in the CKB data set was potentially caused by blood pressure and glucose to a much greater extent than in the NHANES one. The effect of BMI influenced by blood pressure was significantly higher among Chinese individuals with overweight and obesity. These results implicate a different intervention strategy is required for blood pressure and blood glucose in China and US to prevent obesity and obesity-related premature death. [ABSTRACT FROM AUTHOR]

Background. Although the burden of stroke in terms of mortality and disability has been well documented in previous years, data after 2000 are limited. Therefore, the aim of this paper was to identify the epidemiology of stroke in the US and EU5 nations from data published in 2000 and later. Methods. Data from literature databases and online sources were collated to identify information relating to the incidence, prevalence, and mortality of stroke from the year 2000 onwards. Results and Conclusions. Twenty-three data sources were identified. The incidence of andmortality due to stroke both increase with age and are greater in males compared to females. Stroke is a common problem and likely to worsen in the US and EU5 as their populations age. However, pre-2000 trends of decreasing stroke mortality over time have continued after 2000, reflecting a consistent improvement in the treatment and care of patients with stroke. [ABSTRACT FROM AUTHOR]

This paper proposes an alternative formulation for the Sen-Shorrocks-Thon (SST) index of poverty intensity that is appropriate for survey data with sampling weights. It also decomposes the SST index into the poverty rate, the average poverty gap ratio among the poor, and the overall Gini index of poverty gap ratios. To account for sampling variation in estimates of poverty intensity, this paper uses the bootstrap method to compute confidence intervals and presents international comparisons using Luxembourg Income Study (LIS) data from the 1970s to the 1990s. Cross-sectional and longitudinal analyses indicate that the percentage change in poverty intensity can be approximated by the sum of percentage changes in the poverty rate and average poverty gap ratio, since changes in the overall Gini index of poverty gap ratios are negligible. In the early 1970s poverty intensity in Canada and the United States was almost indistinguishable, but in the 1970s Canadian poverty intensity decreased. Large increases in poverty intensity occurred in the 1980s in the United States, the United Kingdom, and Sweden. [ABSTRACT FROM AUTHOR]

Context/problem: Comparative analysis of relative and absolute mortality differentials between socioeconomic groups are now available. These show consistently increasing relative increases in mortality differentials but complex trends in absolute mortality differentials. Objective: This paper provides an analysis of relative and absolute trends in mortality by cause of death and socioeconomic group (SEG) from 1984 to 2008 among men and active women aged 30-64 years in Ireland and compares these results with recent European and US studies to give an overview of trends. Methods: This paper uses mortality data from the Irish Central Statistics Office from 1984 to 2008 to calculate standardized death rates by age, sex, socioeconomic status and cause of death showing trends in SEG inequalities in mortality in Ireland. These show which specific causes of death are driving all-cause mortality trends. Results: SEG differentials in all-cause mortality among men and women have been increasing since the 1980s. Some of this increase reflects larger falls in cardiovascular causes among advantaged groups, but the trend is largely accounted for by increasing inequalities in mortality in digestive, neoplasm and external causes of deaths. Conclusions: These findings are in line with international findings that show that socioeconomic differentials in digestive, neoplasm and external cause deaths are driving general socioeconomic differentials in all-cause mortality. External cause deaths may have been influenced by levels of economic activity, particularly in construction, during the economic boom among manual workers. Furthermore, deaths from digestive diseases during the 1990s and 2000s may well be the result of increases in liver disease associated with excessive alcohol consumption. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown significant associations between individual fat-soluble vitamins (FSVs) and metabolic syndromes (MetS). However, evidence on the multiple FSVs co-exposure and MetS odds is limited. Given that individuals are typically exposed to different levels of FSVs simultaneously, and FSVs can interact with each other. It's necessary to explore the association between multiple FSVs co-exposure and MetS odds. This study aims to address this gap in general U.S. adults aged ≥ 20 years. Methods: We conducted a cross-sectional study utilizing data from the National Health and Nutrition Examination Surveys (NHANESs) 2003–2006 and 2017–2018. Three FSV, including vitamin A (VA), vitamin E (VE), and vitamin D (VD), and MetS diagnosed according to the ATP III guidelines were selected as exposure and outcome, respectively. Multivariable-adjusted logistic model was used to explore the associations of individual FSV exposure with MetS odds and MetS components. Restricted cubic splines were performed to explore the dose–response relationships among them. The quantile g-computation method was adopted to explore the associations of multiple FSVs co-exposure with MetS odds and MetS components. Results: The presented study included a total of 13,975 individuals, with 2400 (17.17%) were diagnosed with MetS. After adjusting for various confounders, a positive linear pattern was observed for serum VA and VE and MetS associations. Serum VD was found to be negatively associated with MetS in a linear dose–response way. For each component of MetS, higher serum VA and VE were associated with higher triglyceride and high-density lipoprotein; higher serum VD was negatively associated with triglyceride, blood pressure, and fasting plasma glucose. MetS odds increased by 15% and 13%, respectively, in response to one quartile increase in FSVs co-exposure index (qgcomp) in the conditional model (OR = 1.15, 95%CI: 1.06, 1.24) and the marginal structural model (OR = 1.13, 95%CI: 1.06, 1.20). Besides, co-exposure to VA, VE, and VD was positively associated with triglyceride, high-density lipoprotein, and blood pressure levels. Conclusion: Findings in the present study revealed that high serum VA and VE levels were associated with elevated MetS odds, while serum VD was inversely associated with MetS odds. FSVs co-exposure was positively associated with MetS odds. [ABSTRACT FROM AUTHOR]

To mitigate COVID-19 exposure risks in methadone clinics, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary modification of regulations in March 2020 to permit, with state concurrence, extended take-home methadone doses. The modification allowed for up to 28 days of take-home methadone for stable patients and 14 days for those less stable. Using both interrupted time series and difference-in-differences methods, this study examined the association between the policy change and fatal methadone overdoses, comparing states that permitted the expansion of take-home doses with states that did not. The findings suggest the pandemic emergency take-home policy did not increase methadone-involved mortality. [ABSTRACT FROM AUTHOR]

Hypertensive disorders of pregnancy are a leading cause of pregnancy-related morbidity and mortality. The primary objective of this study was to compare the frequency of documentation of postpartum blood pressure through remote blood pressure monitoring with text-message delivered reminders versus office-based follow-up 7–10 days postpartum. The secondary objective was to examine barriers and facilitators of both care strategies from the perspectives of individuals who experienced a hypertensive disorder of pregnancy. We conducted a randomized controlled trial at a tertiary care academic medical center in the southeastern US with 100 postpartum individuals (50 per arm) from 2018 to 2019. Among 100 trial participants, blood pressure follow-up within 7–10 days postpartum was higher albeit not statistically significant between postpartum individuals randomized to the remote assessment intervention versus office-based standard care (absolute risk difference 18.0%, 95% CI −0.1 to 36.1%, p = 0.06). Patient-reported facilitators for remote blood pressure monitoring were maternal convenience, clarity of instructions, and reassurance from the health assessments. These positive aspects occurred alongside barriers, which included constraints due to newborn needs and the realities of daily postpartum life. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is widely recognized for its potential to reduce childhood obesity. However, research investigating these benefits in children breastfed for a short duration (up to 6 months) remains limited despite this being a common practice globally. Methods: This study focused on a population breastfed for 6 months or less to determine the potential benefits of short-term breastfeeding for preventing childhood obesity. Data were collected from five survey cycles of an US-based population study (the National Health and Nutrition Examination Survey (NHANES)), spanning 2009–2020. A sample of 3,211 children aged 2–6 years was selected, including 1,373 never breastfed and 1,838 ever breastfed. Logistic regression analysis examined the direct association between short-term breastfeeding and childhood obesity. Subsequent subgroup analyses were conducted. Additionally, stratified logistic regression explored the relationship between childhood obesity and the introduction of other early nutrition in both ever-breastfed and never-breastfed children. Results: Overall, breastfeeding for 6 months or less did not directly prevent childhood obesity. However, among participants with older mothers (aged 35 or above), short-term breastfeeding was associated with a lower risk of childhood obesity compared to never being breastfed (OR 0.31, 95% CI: 0.17, 0.59). Similarly, children aged 3–4 years who were breastfed for > 3 ~ 6 months exhibited a lower obesity risk (OR 0.56, 95% CI: 0.35, 0.89). In ever-breastfed children, delayed infant formula introduction was linked to a lower risk of obesity (P-trend < 0.05: introduction at age ≤ 1 vs. >1 ~ 3 vs. >3 months). Conversely, for non-breastfed children, introducing milk (other than breast milk or formula) later (≥ 12 versus < 12 months) and introducing alternatives to whole cow's milk were associated with lower obesity risks (OR 0.54, 95% CI: 0.37, 0.78; OR 0.21, 95% CI: 0.08, 0.60, respectively). Notably, these trends were not observed in ever-breastfed children. Conclusions: Short-term breastfeeding may offer some benefits in preventing childhood obesity for specific populations. Additionally, it could potentially mitigate risks associated with the introduction of formula and cow's milk at inappropriate times. [ABSTRACT FROM AUTHOR]

Background: The impact on cardiovascular health is lost when a patient does not obtain a newly prescribed lipid-lowering medication, a situation termed "initial medication nonadherence" (IMN). This research summarizes the published evidence on the prevalence, associated factors, consequences, and solutions for IMN to prescribed lipid-lowering medication in the United States. Methods: A systematic literature search using PubMed and Google Scholar, along with screening citations of systematic reviews, identified articles published from 2010 to 2021. Studies reporting results of IMN to lipid-lowering medications were included. Studies that evaluated non-adult or non-US populations, used weaker study designs (e.g., case series), or were not written in English were excluded. Results: There were 19 articles/18 studies that met inclusion and exclusion criteria. Estimates of the prevalence of IMN to newly prescribed lipid-lowering medications ranged from 10 to 18.2% of patients and 1.4–43.8% of prescriptions (n = 9 studies). Three studies reported prescriber and patient characteristics associated with IMN. Hispanic ethnicity, Black race, lower Charlson Comorbidity Index score and no ED visits or hospitalization were associated with IMN. Lipid lowering prescriptions from primary care providers were also associated with IMN. Four studies described patient-reported reasons for IMN, including preference for lifestyle modifications, lack of perceived need, and side effect concerns. Four intervention studies reported mixed results with automated calls, live calls, or letters. One study reported worse clinical outcomes in patients with IMN: higher levels of low-density lipoprotein and greater risk of emergency department visits. Conclusions: Up to one-fifth of patients fail to obtain a newly prescribed lipid-lowering medication but there is limited information about the clinical consequences. Future research should assess outcomes and determine cost-effective approaches to address IMN to lipid-lowering therapy. [ABSTRACT FROM AUTHOR]

Research on COVID-19 vaccine hesitancy and misinformation endorsement among Spanish-speaking Americans is limited. This cross-sectional study used a Spanish-language survey from May–August 2021 among 483 Spanish speakers living in the US and Puerto Rico. We applied multivariable Poisson regression with robust error variances to assess the association between independent variables and binary outcomes for vaccine acceptance versus hesitance, as well as misinformation endorsement. Vaccine acceptance was associated with COVID-19 risk perception score (PR = 1.7 high vs. low perceived risk), opinion of government transparency (PR = 2.2 very transparent vs. not transparent), and trust in vaccine information (PR = 1.8 high vs. low). There was also an interaction between time spent on social media and social media as a main source of COVID-19 information (p = 0.0484). Misinformation endorsement was associated with opinion about government transparency (PR = 0.5 moderately vs. not transparent), trust in vaccine information (PR = 0.5 high vs. low trust), social media impact on vaccine confidence (PR = 2.1 decreased vs. increased confidence), distrust vaccines (PR = 1.9 distrust vs. trust), using vaccine information from Facebook (PR = 1.4 yes vs. no), and time spent on social media by those using social media as main source of COVID-19 vaccine information (p = 0.0120). Vaccine acceptance in respondents with high misinformation endorsement scores was 0.7 times those with low scores. These findings highlight the importance of effective information dissemination, the positive role of social media, and government transparency in boosting vaccine uptake among Spanish speakers in the US. [ABSTRACT FROM AUTHOR]

Background: Early detection of autism spectrum disorder (ASD) has the potential to significantly reduce the impact of the condition, however previous reviews have found little evidence to support screening programs for ASD in young children. Methods: We conducted a review with the aim of updating evidence on 3 aspects: (a) diagnostic stability of ASD in young children; (b) accuracy of ASD screening tools in young children; and (c) the benefits of early interventions in screen-detected young children with ASD. Results: A total of 33 studies were included in our review. Five studies looking at diagnostic stability reported estimates ranging from 71.9% to 100%, however the majority only included a follow-up of 24 months and all studies raised concerns regarding the risk of bias due particularly to lack of blinding, sample size, and patient flow. A total of 25 studies, reported in 26 articles, were identified that reported accuracy data on 11 screening tools. Most of the reports were concerned with versions of M-CHAT, reporting sensitivity estimates from 0.67 to 1.0; however, many of these were deemed to be of high risk of bias due to lack of blinding and follow-up. Four studies reported on early interventions in screen-detected children; however, the majority did not find significant improvements on the relevant outcomes. Conclusions: Overall, the evidence on screening for ASD in young children captured by this review is not conclusive regarding the 3 aspects of screening in this population. Future studies should attempt to ensure blinded diagnostic assessments, include longer follow-up periods and limit attrition. [ABSTRACT FROM AUTHOR]

(1) Background: Body dysmorphic disorder (BDD) presents significant challenges in aesthetic and reconstructive plastic surgery, impacting patient outcomes and well-being. Understanding its prevalence and associated factors is crucial for effective patient care. (2) Methods: A systematic review of national and international databases on body dysmorphic disorder, plastic surgery, cosmetic surgery, reconstructive surgery, and prevalence yielded 999 studies between 1878 and April 2024. Inclusion criteria focused on studies reporting prevalence while excluding those with small sample sizes (<20 participants), unclear diagnostic criteria for BDD, and non-English accessibility. (3) Results: A meta-analysis using a random effects model was conducted on 65 studies involving 17,107 patients to estimate the prevalence of BDD. The overall estimated prevalence of BDD was 18.6%; 10,776 (62.9%) were females, with a mean age of 35.5 ± 11.7 years. Subgroup meta-analysis found significant variability in effect sizes across countries and types of specialty, of which Brazil showed the highest proportion and dermatology exhibited the smallest. Meta-regression analysis found no significant relationship between the year of publication and prevalence rates. (4) Conclusions: Our findings update the current literature on BDD prevalence in aesthetic and reconstructive plastic surgery. We emphasize the importance of proactive screening and multidisciplinary care approaches to address the complex challenges posed by patients with BDD. Further research is needed to explore evolving trends in BDD prevalence and factors influencing its expression across different cultural contexts. [ABSTRACT FROM AUTHOR]

Background: Emergency departments (EDs) provide care to ethnically diverse populations with multiple health‐related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines ethnic‐specific 12‐month rates of physical IPV by severity and their association with drinking and other sociodemographic and personality correlates in an urban ED sample. Methods: Research assistants surveyed patients at an urban ED regarding IPV exposure as well as patterns of alcohol and drug use, psychological distress, adverse childhood experiences (ACEs), and other sociodemographic features. Results: The survey (N = 1,037) achieved an 87.5% participation rate. About 23% of the sample reported an IPV event in the past 12 months. Rates were higher (p < 0.001) among blacks (34%), whites (31%), and multiethnic (46%) respondents than those among Asians (13%) and Hispanics (15%). Modeled results showed that black respondents were more likely than Hispanics (reference) to report IPV (adjusted odds ratio [AOR] = 1.69, 95% confidence interval [CI] = 1.98–2.66, p < 0.05) and that respondents' partner drinking was associated with IPV (AOR = 1.85, 95% CI = 1.25–2.73, p < 0.01) but respondents' drinking was not. Use of illicit drugs, younger age, impulsivity, depression, partner problem drinking, ACEs, and food insufficiency were all positively associated with IPV. Conclusions: There was considerable variation in IPV rates across ethnic groups in the sample. The null results for the association between respondents' drinking and IPV was surprising and may stem from the relatively moderate levels of drinking in the sample. Results for ethnicity, showing blacks as more likely than Hispanics to report IPV, support prior literature. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the extent, if any, that the association between socio-ecological parameters and physical activity may be influenced by common method bias (CMB). Methods: This study took place between February and May of 2017 at a Southeastern University in the United States. A randomized controlled experiment was employed among 119 young adults. Participants were randomized into either group 1 (the group we attempted to minimize CMB) or group 2 (control group). In group 1, CMB was minimized via various procedural remedies, such as separating the measurement of predictor and criterion variables by introducing a time lag (temporal; 2 visits several days apart), creating a cover story (psychological), and proximally separating measures to have data collected in different media (computer-based vs. paper and pencil) and different locations to control method variance when collecting self-report measures from the same source. Socio-ecological parameters (self-efficacy; friend support; family support) and physical activity were self-reported. Results: Exercise self-efficacy was significantly associated with physical activity. This association (β = 0.74, 95% CI: 0.33-1.1; P = 0.001) was only observed in group 2 (control), but not in group 1 (experimental group) (β = 0.03; 95% CI: -0.57-0.63; P = 0.91). The difference in these coefficients (i.e., β = 0.74 vs. β = 0.03) was statistically significant (P = 0.04). Conclusion: Future research in this field, when feasible, may wish to consider employing procedural and statistical remedies to minimize CMB. [ABSTRACT FROM AUTHOR]

Background: Family caregivers are family members or friends of care recipients who assist with activities of daily living, medication management, transportation, and help with finances among other activities. As a result of their caregiving, family caregivers are often considered a population at risk of experiencing increased stress, isolation, and loneliness. During the COVID-19 pandemic in the US, social isolation and decrease in social activities were a top concern among older adults and their family caregivers. Using secondary analysis of survey data as part of a multi-site implementation trial of a caregiver skills training program, we describe differences in caregiver experiences of loneliness before and during the COVID-19 pandemic. Methods: Health and wellbeing surveys of family caregivers were collected on 422 family caregivers of veterans before and during COVID-19. Logistic regression modeling examined whether the loneliness differed between caregiver groups pre vs during COVID-19, using the UCLA 3-item loneliness measure. Rapid directed qualitative content analysis of open-ended survey questions was used to explore the context of how survey responses were affected by the COVID-19 pandemic. Results: There were no significant differences in loneliness between caregivers pre vs during COVID-19. In open-ended responses regarding effects of COVID-19, caregivers described experiencing loneliness and social isolation; why they were unaffected by the pandemic; and how caregiving equipped them with coping strategies to manage negative pandemic-related effects. Conclusion: Loneliness did not differ significantly between pre vs during COVID-19 caregivers. Future research could assess what specific characteristics are associated with caregivers who have resiliency, and identify caregivers who are more susceptible to experiencing loneliness. Understanding caregiver loneliness could assist other healthcare systems in developing and implementing caregiver support interventions. [ABSTRACT FROM AUTHOR]

This study used the National Survey on Drug Use and Health to assess a nationally representative sample (N = 4596) weighted to represent 35.2 million adults with DSM-5 criteria-determined substance use disorders (SUDs). This study explored substance use treatment utilization in 2020, emphasizing populations with high vulnerability (e.g., criminal justice involvement (CJI) through parole or probation, polysubstance use, severe mental illness, and HIV/STI). Substance use treatment was broadly defined (any inpatient, outpatient/doctor's office, self-help/other for alcohol/drugs). Our results indicated that among adults with SUDs in 2020, 7 million (20%) had multiple SUDs, 1.75 million (5%) had CJI, 5.3 million (15%) had a severe mental illness, and 1.8 million (5%) had a diagnosis of HIV/STI in the last year. Only 7% of individuals with SUD sought any substance use treatment in the past year. CJI (aOR: 13.39, 95% CI: [7.82, 22.94]), serious mental illness (aOR: 3.27, 95% CI: [1.93, 5.55]), and having both 2 (aOR: 2.10, 95% CI: [1.29, 3.42]) or 3 or more SUDs (aOR: 3.46, 95% CI: [1.82, 6.58]) were all associated with a greater likelihood of receiving treatment. Marriage (aOR: 0.43, 95% CI: [0.25, 0.74]) and having an income twice the poverty threshold (aOR: 0.53, 95% CI: [0.29, 0.94]) were associated with reduced odds of receiving any substance use treatment. Compared to those 18 to 25, older individuals had increased odds (2-4 times) of receiving treatment. Interventions are crucially needed to increase access to treatment among those with SUDs. [ABSTRACT FROM AUTHOR]

Background: High‐income countries offer social assistance (welfare) programs to help alleviate poverty for people with little or no income. These programs have become increasingly conditional and stringent in recent decades based on the premise that transitioning people from government support to paid work will improve their circumstances. However, many people end up with low‐paying and precarious jobs that may cause more poverty because they lose benefits such as housing subsidies and health and dental insurance, while incurring job‐related expenses. Conditional assistance programs are also expensive to administer and cause stigma. A guaranteed basic income (GBI) has been proposed as a more effective approach for alleviating poverty, and several experiments have been conducted in high‐income countries to investigate whether GBI leads to improved outcomes compared to existing social programs. Objectives: The aim of this review was to conduct a synthesis of quantitative evidence on GBI interventions in high‐income countries, to compare the effectiveness of various types of GBI versus "usual care" (including existing social assistance programs) in improving poverty‐related outcomes. Search Methods: Searches of 16 academic databases were conducted in May 2022, using both keywords and database‐specific controlled vocabulary, without limits or restrictions on language or date. Sources of gray literature (conference, governmental, and institutional websites) were searched in September 2022. We also searched reference lists of review articles, citations of included articles, and tables of contents of relevant journals in September 2022. Hand searching for recent publications was conducted until December 2022. Selection Criteria: We included all quantitative study designs except cross‐sectional (at one timepoint), with or without control groups. We included studies in high income countries with any population and with interventions meeting our criteria for GBI: unconditional, with regular payments in cash (not in‐kind) that were fixed or predictable in amount. Although two primary outcomes of interest were selected a priori (food insecurity, and poverty level assessed using official, national, or international measures), we did not screen studies on the basis of reported outcomes because it was not possible to define all potentially relevant poverty‐related outcomes in advance. Data Collection and Analysis: We followed the Campbell Collaboration conduct and reporting guidelines to ensure a rigorous methodology. The risk of bias was assessed across seven domains: confounding, selection, attrition, motivation, implementation, measurement, and analysis/reporting. We conducted meta‐analyses where results could be combined; otherwise, we presented the results in tables. We reported effect estimates as standard mean differences (SMDs) if the included studies reported them or provided sufficient data for us to calculate them. To compare the effects of different types of interventions, we developed a GBI typology based on the characteristics of experimental interventions as well as theoretical conceptualizations of GBI. Eligible poverty‐related outcomes were classified into categories and sub‐categories, to facilitate the synthesis of the individual findings. Because most of the included studies analyzed experiments conducted by other researchers, it was necessary to divide our analysis according to the "experiment" stage (i.e. design, recruitment, intervention, data collection) and the "study" stage (data analysis and reporting of results). Main Results: Our searches yielded 24,476 records from databases and 80 from other sources. After screening by title and abstract, the full texts of 294 potentially eligible articles were retrieved and screened, resulting in 27 included studies on 10 experiments. Eight of the experiments were RCTs, one included both an RCT site and a "saturation" site, and one used a repeated cross‐sectional design. The duration ranged from one to 5 years. The control groups in all 10 experiments received "usual care" (i.e. no GBI intervention). The total number of participants was unknown because some of the studies did not report exact sample sizes. Of the studies that did, the smallest had 138 participants and the largest had 8019. The risk of bias assessments found "some concerns" for at least one domain in all 27 studies and "high risk" for at least one domain in 25 studies. The risk of bias was assessed as high in 21 studies due to attrition and in 22 studies due to analysis and reporting bias. To compare the interventions, we developed a classification framework of five GBI types, four of which were implemented in the experiments, and one that is used in new experiments now underway. The included studies reported 176 poverty‐related outcomes, including one pre‐defined primary outcome: food insecurity. The second primary outcome (poverty level assessed using official, national, or international measures) was not reported in any of the included studies. We classified the reported outcomes into seven categories: food insecurity (as a category), economic/material, physical health, psychological/mental health, social, educational, and individual choice/agency. Food insecurity was reported in two studies, both showing improvements (SMD = −0.57, 95% CI: −0.65 to −0.49, and SMD = −0.41, 95% CI: −0.57 to −0.26) which were not pooled because of different study designs. We conducted meta‐analyses on four secondary outcomes that were reported in more than one study: subjective financial well‐being, self‐rated overall physical health, self‐rated life satisfaction, and self‐rated mental distress. Improvements were reported, except for overall physical health or if the intervention was similar to existing social assistance. The results for the remaining 170 outcomes, each reported in only one study, were summarized in tables by category and subcategory. Adverse effects were reported in some studies, but only for specific subgroups of participants, and not consistently, so these results may have been due to chance. Authors' Conclusions: The results of the included studies were difficult to synthesize because of the heterogeneity in the reported outcomes. This was due in part to poverty being multidimensional, so outcomes covered various aspects of life (economic, social, psychological, educational, agency, mental and physical health). Evidence from future studies would be easier to assess if outcomes were measured using more common, validated instruments. Based on our analysis of the included studies, a supplemental type of GBI (provided along with existing programs) may be effective in alleviating poverty‐related outcomes. This approach may also be safer than a wholesale reform of existing social assistance approaches, which could have unintended consequences. [ABSTRACT FROM AUTHOR]

Zavegepant is a novel gepant administered as a nasal spray approved in the United States at a 10 mg dose for the acute treatment of migraine with or without aura in adults. The cardiovascular safety of zavegepant nasal spray was assessed in both single‐ascending dose (SAD) and multiple‐ascending dose (MAD) studies in healthy participants. The SAD study included 72 participants (54 active/18 placebo) who received 0.1–40 mg zavegepant or placebo. The MAD study included 72 participants (56 active/16 placebo) who received 5–40 mg zavegepant or placebo for 1–14 days. Plasma zavegepant pharmacokinetics and electrocardiographic (ECG) parameters (Fridericia‐corrected QT interval [QTcF], heart rate, PR interval, ventricular depolarization [QRS], T‐wave morphology, and U‐wave presence) were analyzed pre‐ and post‐zavegepant administration. Using pooled data from the SAD and MAD studies, the relationship between time‐matched plasma zavegepant concentrations and QTc interval was assessed using a linear mixed‐effects model to evaluate the potential for QTc interval prolongation. Results showed that single and multiple doses of zavegepant had no significant impact on ECG parameters versus placebo, and there was no concentration‐dependent effect on QTcF interval. The estimated slope of the plasma zavegepant concentration‐QTcF model was −0.053 ms per ng/mL with a 90% confidence interval of −0.0955 to −0.0110 (p = 0.0415), which is not considered clinically meaningful. At doses up to four times the recommended daily dose, zavegepant does not prolong the QT interval to any clinically relevant extent. [ABSTRACT FROM AUTHOR]

Background: The Fire service Organizational Culture of Safety (FOCUS) survey is an assessment tool comprised of psychometrically validated metrics of safety climate, safety behavior, and downstream outcomes (organizational and injury) that are specific to the U.S. fire and rescue service. Methods: This analysis consists of a descriptive summary of two independent survey waves (FOCUS 1.0 and 2.0). The fire departments included in these survey waves were from convenience sampling (n1.0 = 275; n2.0 = 170). In addition to department level characteristics, we examined individual level characteristics for firefighters and EMS providers in participating departments (n1.0 = 22,719; n2.0 = 16,882). We conducted regression analyses to examine the associations between safety climate and safety behaviors, organizational outcomes, and safety outcomes. All analyses were stratified by organization type (career, volunteer). Results: Our analysis indicated that a majority of respondents were males (90.7%FOCUS 1.0; 90.4%FOCUS 2.0), non-officers (68.4%FOCUS 1.0; 66.4%FOCUS 2.0), and non-Hispanic Whites (70.8%FOCUS 1.0; 69.5%FOCUS 2.0). For both samples there was a higher prevalence of injuries among individuals in career departments (nFOCUS 1.0 = 3778 [17.5%]; nFOCUS 2.0 = 3072 [18.7%]) than volunteer departments (nFOCUS 1.0 = 103 [8.8%]; nFOCUS 2.0 = 34 [7.4%]). We observed an approximate 10-point difference between the mean scores of Management Commitment to Safety for career and volunteer departments in both samples. We observed associations for two organizational outcomes, Safety Behavior and Job Satisfaction, with Management Commitment to Safety and Supervisor Support for Safety overall and when stratified by organization type. We observed a decrease in the odds of injuries associated with a one-unit increase in Management Commitment to Safety (OR1.0 overall: 0.98, 95% CI 0.97–0.99; OR2.0 volunteer: 0.90, 95% CI 0.85–0.95) and Supervisor Support for Safety (OR1.0 overall: 0.95, 95% CI 0.93–0.97; OR1.0 career: 0.95, 95% CI 0.92–0.98). Conclusions: From our current study, and a prior analysis of a geographically stratified random sample of U.S. fire departments, we identified that from all the organizational outcomes, job satisfaction was most consistently associated with FOCUS safety climate. Further, firefighters in our samples consistently rated Supervisor Support for Safety higher than Management Commitment to Safety. Future interventions should support fire departments in improving their departmental Management Commitment to Safety and maintaining their Supervisor for Safety. [ABSTRACT FROM AUTHOR]

6–11-year-old children provide a critical window for physical activity (PA) interventions. The Virtual Fitness Buddy ecosystem is a precision health PA intervention for children integrating mixed reality technology to connect people and devices. A cluster randomized, controlled trial was conducted across 19 afterschool sites over two 6-month cohorts to test its efficacy in increasing PA and decreasing sedentary behavior. In the treatment group, a custom virtual dog via a mixed reality kiosk helped children set PA goals while sharing progress with parents to receive feedback and support. Children in the control group set PA goals using a computer without support from the virtual dog or parents. 303 children had 8+ hours of PA data on at least one day of each of the 3 intervention time intervals. Conversion of sedentary time was primarily to light-intensity PA and was strongest for children with low baseline moderate-to-vigorous PA than children above 45 min of baseline moderate-to-vigorous PA. Findings suggest that the VFB ecosystem can promote sustainable PA in children and may be rapidly diffused for widespread public health impact. [ABSTRACT FROM AUTHOR]

Medical coding impacts patient care quality, payor reimbursement, and system reliability through the precision of patient information documentation. Inadequate coding specificity can have significant consequences at administrative and patient levels. Models to identify and/or enhance coding specificity practices are needed. Clinical records are not always available, complete, or homogeneous, and clinically driven metrics to assess medical practices are not logistically feasible at the population level, particularly in non-centralized healthcare delivery systems and/or for those who only have access to claims data. Data-driven approaches that incorporate all available information are needed to explore coding specificity practices. Using N = 487,775 hospitalization records of individuals diagnosed with dementia and discharged in 2022 from a large all-payor administrative claims dataset, we fitted logistic regression models using patient and facility characteristics to explain the coding specificity of principal and secondary diagnoses of dementia. A two-step approach was produced to allow for the flexible clustering of patient-level outcomes. Model outcomes were then used within a Poisson binomial model to identify facilities that over- or under-specify dementia diagnoses against healthcare industry standards across hospitalizations. The results indicate that multiple factors are significantly associated with dementia coding specificity, especially for principal diagnoses of dementia (AUC = 0.727). The practical use of this novel risk-adjusted metric is demonstrated for a sample of facilities and geospatially via a U.S. map. This study's findings provide healthcare facilities with a benchmark for assessing coding specificity practices and developing quality enhancements to align with healthcare industry standards, ultimately contributing to better patient care and healthcare system reliability. [ABSTRACT FROM AUTHOR]

Ensuring diagnostic performance of artificial intelligence (AI) before introduction into clinical practice is essential. Growing numbers of studies using AI for digital pathology have been reported over recent years. The aim of this work is to examine the diagnostic accuracy of AI in digital pathology images for any disease. This systematic review and meta-analysis included diagnostic accuracy studies using any type of AI applied to whole slide images (WSIs) for any disease. The reference standard was diagnosis by histopathological assessment and/or immunohistochemistry. Searches were conducted in PubMed, EMBASE and CENTRAL in June 2022. Risk of bias and concerns of applicability were assessed using the QUADAS-2 tool. Data extraction was conducted by two investigators and meta-analysis was performed using a bivariate random effects model, with additional subgroup analyses also performed. Of 2976 identified studies, 100 were included in the review and 48 in the meta-analysis. Studies were from a range of countries, including over 152,000 whole slide images (WSIs), representing many diseases. These studies reported a mean sensitivity of 96.3% (CI 94.1–97.7) and mean specificity of 93.3% (CI 90.5–95.4). There was heterogeneity in study design and 99% of studies identified for inclusion had at least one area at high or unclear risk of bias or applicability concerns. Details on selection of cases, division of model development and validation data and raw performance data were frequently ambiguous or missing. AI is reported as having high diagnostic accuracy in the reported areas but requires more rigorous evaluation of its performance. [ABSTRACT FROM AUTHOR]

Background: It is uncertain if mean platelet volume and periodontitis are related. The objective of this study was to examine the association between levels of mean platelet volume and moderate/severe periodontitis in adult persons who inhabit the U.S. Methods: We screened 6,809 people from the National Health and Nutrition Examination Survey (NHANES 2009–2012). Mean platelet volume was measured in the Mobile Examination Centers (MECs) using the Beckman Coulter analyzer. The category of periodontitis was defined by the CDC/AAP using clinical periodontal parameters. Multiple logistic regression models were employed to examine the distribution for covariate differences across the various independent groups. Four models were employed to examine the relationship between mean platelet volume level and periodontitis. Smoothed curve fitting was utilized to confirm the linearity of the relationships. To determine the impact of factors on the connection between MPV and periodontitis, subgroup analysis and interaction testing were utilized. Results: Results from the multiple logistic regression analysis indicate a significant association between moderate/severe periodontitis and the mean platelet level, even after considering any potential confounding variables (OR = 1.090, 95% CI: 1.019–1.166, P-value = 0.01211). Additionally, those in the upper tertile of mean platelet volume levels had a 21.6% higher probability of developing periodontitis when compared with those in the least tertile of mean platelet levels (OR = 1.216, 95% CI:1.052–1.406, P-value = 0.00816). Moreover, it showed a positive correlation between mean platelet volume (MPV) and moderate/severe periodontitis. Subgroup analyses indicated a positive association between the level of mean platelet volume and moderate/severe periodontitis among individuals who were under 60 years of age, had low income, were obese, never smoked, were heavy drinkers, had hypertension, and had no cardiovascular disease (p < 0.05). However, none of the subgroups exhibited significant interactions (p for interaction > 0.05). Conclusion: A correlation has been found between mean platelet volume levels and periodontal disease in individuals residing in the United States. [ABSTRACT FROM AUTHOR]

Background: This study aims to thoroughly study the connection between congenital heart disease (CHD) and neurodevelopmental disorders (NDDs) through observational and Mendelian randomization (MR) designs. Methods: This observational study uses data from the National Survey of Children's Health (2020–2021). Multivariable logistic regression and propensity score matching (PSM) were performed to analyze the association. PSM was used to minimize bias for covariates such as age, race, gender, maternal age, birth weight, concussion or brain injury, preterm birth, cerebral palsy, Down syndrome, and other inherited conditions. In MR analyses, inverse variance-weighted measures, weighted median, and MR-Egger were employed to calculate causal effects. Results: A total of 85,314 children aged 0–17 were analyzed in this study. In regression analysis, CHD (p = 0.04), the current heart condition (p = 0.03), and the severity of current heart condition (p < 0.05) had a suggestive association with speech or language disorders. The severity of current heart condition (p = 0.08) has a potential statistically significant association with attention deficit hyperactivity disorder(ADHD). In PSM samples, ADHD(p = 0.003), intellectual disability(p = 0.012), and speech or language disorders(p < 0.001) were all significantly associated with CHD. The severity of current heart condition (p < 0.001) also had a significant association with autism. MR analysis did not find causality between genetically proxied congenital cardiac malformations and the risk of NDDs. Conclusions: Our study shows that children with CHD have an increased risk of developing NDDs. Heart conditions currently and severity of current heart conditions were also significantly associated with these NDDs. In the future, we need to try more methods to clarify the causal relationship between CHD and NDDs. [ABSTRACT FROM AUTHOR]