Search

Background: The prevalence of type 2 diabetes is increasing with the burden disproportionately falling on older adults and racial/ethnic minorities. Older adults with diabetes show greater cognitive decline and there are disparities in cognitive function by race/ethnicity that can be explained by social determinants such as wealth. Objective: To understand whether there is a differential relationship between wealth and cognitive function by race/ethnicity among older U.S. adults with diabetes. Methods: Data on 9,006 adults aged 50+ with diabetes from the Health and Retirement Study (2006–2016) were analyzed. The primary outcome, cognitive function, was a score ranging from range 0–27 categorized as: normal [12–27], mild cognitive impairment (MCI) [7–11], and dementia including Alzheimer's disease [0–6]. Three modeled outcomes were: 1) normal versus MCI, 2) normal versus dementia, 3) MCI versus dementia. Wealth was log transformed and used as continuous and binary (≥median,

Racial/ethnic and sex concordance between patients and providers has been suggested as an important consideration in improving satisfaction and increasing health equity. We aimed to guide local efforts by understanding the relationship between satisfaction with care and patient–provider racial/ethnic and sex concordance within our academic medical center's primary care clinic. Methods: Satisfaction data for encounters from August 2016 to August 2019 were matched to data from the medical record for patient demographics and comorbidities. Data on 33 providers were also obtained, and racial/ethnic and sex concordance between patients and providers was determined for each of the 3672 unique encounters. The primary outcome was top-box scoring on the CGCAHPS overall satisfaction scale (0–8 vs. 9–10). Generalized mixed-effects logistic regression, including provider- and patient-level factors as fixed effects and a random intercept effect for providers, were used to determine whether concordance had an independent relationship with satisfaction. Results: 89.0% of the NHW-concordant pairs and 90.4% of the Minority Race/Ethnicity-concordant pairs indicated satisfaction, while 90.1% of the male-concordant and 85.1% of the female-concordant pairs indicated satisfaction. When fully adjusted, the female-concordant (OR = 0.58, 95% CI 0.35–0.94) and male-discordant (OR = 0.68, 95% CI 0.51–0.91) pairs reported significantly lower top-box satisfaction compared to the male-concordant pairs. Significant differences did not exist in racial/ethnic concordance. Conclusions: In this sample, differences in sex concordance were noted; however, patient- and provider-level factors may be more influential in driving patient satisfaction than race/ethnicity in this health system. [ABSTRACT FROM AUTHOR]

Objective: To understand the relationship between perceived discrimination, allostatic load, and all‐cause mortality; and to determine whether allostatic load is a mediator in the relationship between perceived discrimination and all‐cause mortality among an older adult US population. Methods: Data from the Health and Retirement Study (2006–2012) was analyzed. Cox proportional hazard models were used to investigate the relationship between all‐cause mortality and perceived discrimination, and all‐cause mortality and allostatic load. Linear regression models were used to investigate the relationship between perceived discrimination and allostatic load. A mediation model with perceived discrimination and allostatic loads as independent variables was used to determine the association with all‐cause mortality. Results: There were 5062 adults over the age of 50 included in the analysis. The relationship between perceived discrimination and allostatic load was statistically significant (b:0.14, [95%CI 0.10,0.19]; p < 0.001). The relationship between perceived discrimination and all‐cause mortality was statistically significant (HR: 1.12, [95%CI 1.03,1.22]; p = 0.01). The relationship between allostatic load and all‐cause mortality was statistically significant (HR: 1.11, [95%CI 1.08,1.13]; p < 0.001). The mediation model resulted in a decrease in hazard ratio and loss of statistical significance for perceived discrimination (HR: 1.09, [95%CI 0.98,1.21]; p = 0.13) when allostatic load (HR: 1.17, [95%CI 1.10,1.24]; p < 0.001) was added to the Cox regression model, indicating full mediation. Conclusions: Allostatic load fully mediates the relationship between perceived discrimination and all‐cause mortality. Understanding the role of allostatic load in this relationship provides an additional implication for screening and indications for tighter control of the modifiable components of allostatic load by healthcare providers, especially among individuals who experience discrimination. [ABSTRACT FROM AUTHOR]

In response to the growing evidence that hypertension may play a significant role in the development of cardiovascular disease (CVD) in bonobos, the Great Ape Heart Project established a finger blood pressure (BP) monitoring protocol for zoo‐housed bonobos. The ability to monitor BP without the use of anesthesia provides more opportunities to detect potential hypertension in its early stages allowing for therapeutic intervention that may slow the progression of CVD. No BP reference ranges exist for bonobos due to the lack of an established protocol, the difficulty of measuring BP in animals, and small sample size of zoo‐housed bonobos. By working with all 8 institutions in North America that care for bonobos, it was possible to (1) investigate the feasibility of using finger BP devices, and (2) establish BP trends for male and female bonobos. Data were collected from May 2016 to March 2019. Zoos were asked to train for and collect BP measurements from any bonobos willing to participate, regardless of age, sex, or health status as well as to report on the quality of the training and measurements obtained. At the start of the study, the North American bonobo population consisted of 74 bonobos ages 5 years and older at 8 institutions. All 8 institutions submitted at total of 3656 BP readings from 50 bonobos (n = 23 females, n = 27 males; ages 5−51 years) representing 67.57% of the trainable population ages 5 years and older. Of the readings submitted, 2845 were determined to be good quality, reliable BP readings (77.81% useful BP measurements) for 36 of the 50 adult bonobos submitted for this study (59.01% of the adult population ages 10−51 years) but showed limitations in the protocol for the younger population. BP trend analysis showed significant differences between bonobos that were not on medication versus those treated with cardiac medications, with those on cardiac mediations having significantly higher systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure (p ≤ 0.001 for all comparisons). Systolic BP generally increased over age classes (10−19, 20−29, 30−39, 40+ years). Highlights: By working with all 8 institutions in North America that care for bonobos, the Great Ape Heart Project established a finger blood pressure (BP) monitoring protocol for zoo‐housed bonobos. The ability to monitor BP without the use of anesthesia provides more opportunities to detect potential hypertension in its early stages allowing for therapeutic intervention that may slow the progression of cardiovascular disease. [ABSTRACT FROM AUTHOR]

There is limited data regarding the role of direct laryngoscopy and rigid bronchoscopy (DLRB) in infants with failed extubations. Pediatric otolaryngologists are frequently consulted to perform DLRB in infants with failed extubations. To determine the DLRB findings in infants with failed extubations and the interventions performed based on these findings. A retrospective chart review was performed on infants less than 12 months old undergoing DLRB for failed extubations from January 2013–June 2017 at a tertiary care children's hospital. Data was collected on age, birth weight, perinatal complications, comorbid conditions, number of failed extubations, length of most recent intubation, operative findings, and subsequent interventions, including tracheostomy. Descriptive and comparative analyses were performed. Of the 62 subjects who met study criteria, median age at DLRB was 3.0 months, corrected age was 1.0 months, gestational age was 27.1 weeks, birth weight was 0.97 kg, and number of failed extubations was 2.0. About 80% had respiratory distress at birth requiring intubation, and 76% carried a diagnosis of bronchopulmonary dysplasia (BPD). The median number of days intubated prior to DLRB was 27. Twenty-seven percent of subjects had no significant abnormal findings on DLRB, and 26% had subglottic stenosis. The majority (74%) underwent tracheostomy. Eighteen percent of subjects had an initial intervention for abnormal DLRB finding(s) other than tracheostomy and were able to avoid tracheostomy as a future intervention. Tracheostomy placement was associated with a diagnosis of BPD (RR 1.78, 95% CI 1.02, 3.10), having a birth weight less than 0.71 kg (RR 1.45, CI 1.01, 2.10), and being intubated for 48 or more days prior to DLRB (RR 1.57, 95% CI 1.05, 2.36); it was not associated with the number of failed extubations prior to DLRB. Infants with failed extubations commonly had abnormal findings on airway evaluation by DLRB. Most children in this population still required tracheostomy placement, but about 20% were able to have an alternate intervention and avoid tracheostomy. • Many infants with failed extubations have abnormal bronchoscopy findings. • The majority of infants with failed extubations require tracheostomy. • About 20% of infants with failed extubations can avoid tracheostomy. [ABSTRACT FROM AUTHOR]