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Aim: To examine the cost-effectiveness of adding finerenone to standard of care (SoC) for treating type 2 diabetes mellitus (T2DM)-related chronic kidney disease (CKD) in the United States., Materials and Methods: Based on the clinical data analysed by FIDELITY, we referenced the validated FINE-CKD model (Markov model) to evaluate the cost-effectiveness of SoC versus SoC + finerenone from the perspective of US payers. The model was cycled for 35 years in 4-month cycles, with cost and utility values derived from the published literature. The primary outcomes were incremental cost-effectiveness ratio (ICER) and quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the base-case results., Results: The treatment strategy of finerenone plus SoC led to gains of 6.95 QALYs and had a lifetime cost of $491 745.31. Compared to SoC, that strategy yielded 0.48 more QALYs at an added cost of $65 305.72. The ICER for finerenone was $135 257.06 per QALY, which is below the willingness-to-pay threshold of United States ($150 000/QALY). The results were sensitive to the hazard ratios associated with the efficacy of finerenone and its cost. Probabilistic sensitivity analyses showed that the probability that finerenone plus SoC would be cost-effective was 57.6%., Conclusions: For patients with T2DM-related CKD, adding finerenone to SoC may be a cost-effective option in the United States. Reasonable price reductions for finerenone could potentially benefit more patients., (© 2024 John Wiley & Sons Ltd.)

Introduction: Using the data taken from the National Health and Nutrition Examination Survey (NHANES) database, we explored the relationship between the dietary inflammatory index (DII) and low muscle mass (LMM) in adults., Methods: We examined 20,424 adults ≥ 20 years old from the 1999-2006 and 2011-2018 NHANES. We hypothesized that the DII is positively associated with the risk of LMM in adults. Regression, subgroup, and restricted cubic spline (RCS) analyses were used to determine the association between the DII and the risk of LMM., Results: Analyzing the DII as a continuous variable revealed that each unit increase in DII was associated with an 11% increase in the risk of LMM. When categorized by quartile grouping, the analysis indicated that individuals in the highest DII quartile exhibited a 1.78-fold higher risk of LMM compared to those in the lowest quartile (OR = 1.78, 95% CI: 1.45-2.18). The RCS analysis demonstrated that the risk of LMM remained stable for DII below 1.77, but increased sharply for DII of 1.77 or higher. Subgroup analysis further revealed that the impact of DII on LMM risk was more pronounced in individuals with a body mass index (BMI) of 25 kg/m 2 or greater., Conclusion: It is necessary to adjust the diet according to the DII to reduce the possibility of LMM and to prevent the occurrence of sarcopenia., Competing Interests: Declarations. Ethics approval and consent to participate: The NHANES protocols were approved by the National Center for Health Statistics (NCHS) Ethics Review Board and written informed consent was obtained from all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Depression impairs self-management in diabetic patients, exacerbates insulin resistance, and elevates glycated hemoglobin (HbA1c) levels, thereby increasing diabetes risk. This study analyzed data from 30,386 participants in the National Health and Nutrition Examination Survey (NHANES), assessing depression severity using the 9-item Patient Health Questionnaire (PHQ-9) and evaluating diabetes status through clinical markers such as HbA1c, random blood glucose, and fasting blood glucose. Participants were stratified by depression severity and diabetes status to examine the relationship between depression and diabetes risk. We applied descriptive statistics, logistic regression models, subgroup analyses, and restricted cubic spline (RCS) modeling to explore this association. The results revealed that greater depression severity was significantly associated with increased diabetes incidence, elevated HbA1c, fasting glucose, and insulin levels. Multivariate regression analysis confirmed a consistent positive correlation between depression severity and diabetes risk. Subgroup analyses further identified significant relationships between depression and various demographic and behavioral factors, including gender, race, BMI, smoking status, and prediabetic conditions. Additionally, the RCS model demonstrated a clear increase in diabetes risk with rising PHQ-9 scores. In conclusion, our study demonstrates that the severity of depression is positively correlated with the risk of diabetes, and this association may be closely linked to various glycemic and lipid metabolic parameters., Competing Interests: Declarations Ethics approval and consent to participate This study used publicly available summary data, and ethics approval was not necessary. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Intersection of gender and race and/or ethnicity in academic medicine is understudied; we aim to understand these factors in relation to scholarly achievements for neurology faculty. Methods: Faculty from 19 US neurology departments completed a survey (2021-2022) to report rank, leadership positions, publications, funded projects, awards, and speaker invitations. Regression analyses examined effects of gender, race, and their intersectionality on these achievements. Women, Black/Indigenous/People of Color (BIPOC), and BIPOC women were comparator groups. Results: Four hundred sixty-two faculty responded: 55% women, 43% men; 31% BIPOC, 63% White; 21% BIPOC women, 12% BIPOC men, 36% White women, 31% White men. Men and White faculty are more likely to be full professors than women and BIPOC faculty. The number of leadership positions, funded projects, awards, and speaker invitations are significantly greater in White compared to BIPOC faculty. Relative to BIPOC women, the number of leadership positions is significantly higher among BIPOC men, White women, and White men. Publication numbers for BIPOC men are lower, number of funded projects and speaker invitations for White women are higher, and number of awards among White men and White women is higher compared to BIPOC women. Discussion: Our study highlights that inequities in academic rank, award number, funded projects, speakership invitations, and leadership roles disproportionately impacted BIPOC women. More studies are needed to evaluate gender and race and/or ethnicity intersectionality effects on faculty achievements, reasons for inequities, recognition, and potential solutions.

Objective: To determine the geographic variability of Medicaid acceptance among allergists in the US., Study Design: Geospatial analysis predicted Medicaid acceptance across space, and a multivariable regression identified area-level population demographic variables associated with acceptance., Methods: We used the National Plan & Provider Enumeration System database to identify allergists. Medicaid acceptance was determined from lists or search engines from state Medicaid offices and calls to provider offices. Spatial analysis was performed using the empirical Bayesian kriging tool. Multivariate logistic regression was used to identify county-level characteristics associated with provider Medicaid acceptance., Results: Of 5694 allergists, 55.5% accepted Medicaid. Acceptance in each state ranged from 13% to 90%. Washington, Arizona, and the Northeast had lowest predicted proportion of both Medicaid acceptance and Medicaid acceptance per 10,000 enrollees. Overall, county-level characteristics were not associated with the likelihood of accepting Medicaid in multivariate analyses. Only the percentage of individuals living in poverty was associated with a higher likelihood of providers accepting Medicaid (OR, 1.245; 95% CI, 1.156-1.340; P < .001)., Conclusions: A barrier to accessing allergy-related health care is finding a provider who accepts a patient's insurance, which is largely variable by state. Lack of access to allergy care likely affects health outcomes for children with prevalent atopic conditions such as food allergy.

Existing research on the precise link between dietary niacin intake and erectile dysfunction (ED) is scarce. Thus, this study aimed to investigate the potential association between dietary niacin intake and the risk of ED. Multivariate logistic regression and restricted cubic splines (RCSs) were used to examine the relationship between dietary niacin intake and ED. Subgroup interaction analysis was performed to assess the impact of different subgroups on the study outcomes. In addition, 1:1 propensity score matching (PSM) was employed to adjust for potential confounding factors, ensuring the reliability of the results. The analyzed data were collected from the 2001-2004 National Health and Nutrition Examination Survey (NHANES) in the USA. The study encompassed 3184 adults, among whom 863 participants were identified as having ED. Following adjustments for potential confounders, the findings revealed that higher niacin intake, specifically in the highest tertile, was associated with a decreased risk of ED compared to that in the lowest tertile, showing an odds ratio (OR) of 0.56 (95% confidence interval [CI]: 0.37-0.85). Analysis of dose-response curves illustrated a negative correlation between dietary niacin intake and the risk of ED. Subgroup and interaction analyses fortified the consistency of these results. Furthermore, PSM corroborated the validity of the findings. This study suggests an inverse association between dietary niacin intake and the risk of ED. However, establishing a cause-and-effect relationship remains elusive, and defining the safe threshold of niacin intake to prevent ED requires further investigation., (Copyright © 2024 Copyright: ©The Author(s)(2024).)

Introduction: The use of antidepressants in major depressive disorder (MDD) has been reported to influence long-term risk of Alzheimer's disease (AD) and AD-related dementias (AD/ADRD), but studies are conflicting., Methods: We used inverse probability weighted (IPW) Cox models with time-varying covariates in a retrospective cohort study among midlife veterans with MDD within the US Veterans Affairs healthcare system from January 1, 2000 to June 1, 2022., Results: A total of 35,200 patients with MDD were identified. No associations were seen regarding the effect of being exposed to any antidepressant versus no exposure on AD/ADRD risk (events = 1,056, hazard ratio = 0.94, 95% confidence interval: 0.81 to 1.09) or the exposure to specific antidepressant classes versus no exposure. A risk reduction was observed for female patients in a stratified analysis; however, the number of cases was small., Discussion: Our study suggests that antidepressant exposure has no effect on AD/ADRD risk. The association in female patients should be interpreted with caution and requires further attention., Highlights: We studied whether antidepressant use was associated with future dementia risk. We specifically focused on patients after their first-ever diagnosis of depression. We used IPW Cox models with time-varying covariates and a large observation window. Our study did not identify an effect of antidepressant use on dementia risk. A risk reduction was observed in female patients, but the number of cases was small., (© 2024 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

The aim of this study is to assess the relationship between dietary intake of fatty acids and the age-related macular degeneration (AMD) in the United States population. Adult participants of the 2005-2008 National Health and Nutrition Examination Survey (NHANES) were included in this nationwide cross-sectional study. Dietary fatty acid intake was obtained from two 24-h dietary recall interviews. The intake of dietary fatty acids was analyzed as a continuous and categorical variable. AMD status was assessed using nonmydriatic fundus photographs. Univariate and multivariate logistic regression analyses were used to assess the association between dietary fatty acid intake and AMD. The unweighted population included 4702 individuals of whom 374 had AMD. After adjusting for relevant variables, each 1 unit increase (1 mg/1000 kcal) intake of EPA (OR: 0.996, 95% CI: 0.993-0.996, P = 0.018), DPA (OR: 0.976, 95% CI: 0.962-0.990, P = 0.002), and DHA (OR: 0.996, 95% CI: 0.994-0.999, P = 0.003) were significantly decreased odds of any AMD. The highest versus lowest quartile of EPA (OR: 0.476, P for trend < 0.001), DPA (OR: 0.467, P for trend = 0.005) and DHA (OR: 0.586, P for trend = 0.008) were negatively associated with the odds of any AMD. Subgroup analysis showed that higher quartiles of EPA (OR: 0.461, P for trend < 0.002), DPA (OR: 0.467, P for trend = 0.006) and DHA (OR: 0.578, P for trend = 0.007) exhibited a negative association with early AMD. The study found no significant association between the intake of dietary fatty acids, including n-3 PUFA, and the odds of late AMD. In the 2005-2008 NHANES population, higher dietary DHA, DPA and EPA intake associated with decreased odds of early AMD. However, no clear association was found between specific types of FAs and late AMD., (© 2024. The Author(s).)

Background: The association of total energy intake (EI) with all-cause mortality is uncertain as are the dependencies of this association on age and weight change history., Objectives: To identify an EI biomarker suitable for use in epidemiologic association studies and to study EI associations with total mortality in a Women's Health Initiative (WHI) cohort of postmenopausal United States females (1993-present)., Methods: EI biomarkers were developed based on doubly labeled water (DLW) total energy expenditure (TEE) and weight variation during the 2-wk DLW protocol period using the energy balance method in an embedded feeding study (n = 153). This along with 2 earlier WHI nutrition biomarker studies having TEE assessments (n = 1131 total), with 14.6 y (median) follow-up, constituted a prospective cohort for the study of EI and all-cause mortality., Results: An empirical biomarker for log(EI) was developed that had a correlation of 0.73 with log(feeding study-consumed EI). The overall association between EI and mortality was nonsignificant. The association, however, depended on age (P = 0.009), with lower EI associated with lower mortality at younger ages, and also on preceding weight change history (P = 0.03). Among participants with stable or increasing weight, mortality hazard ratios (95% confidence intervals [CIs]) for a 12% lower EI were 0.66 (95% CI: 0.51, 0.87) at age 60, 0.84 (95% CI: 0.72, 0.98) at age 70, and 1.06 (95% CI: 0.87, 1.29) at age 80. Corresponding values for participants having preceding weight loss were 0.83 (95% CI: 0.61, 1.12) at age 60, 1.05 (95% CI: 0.87, 1.26) at age 70, and 1.33 (95% CI: 1.08, 1.63) at age 80. A previously considered EI biomarker, using a theoretical model for variation in body fat and fat-free mass components over time, gave similar results following rescaling., Conclusions: Lower EI is associated with lower all-cause mortality among younger postmenopausal females with stable or increasing weight and with higher mortality among older females with weight loss. This study was registered with clinicaltrials.gov as NCT00000611., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Background: The Women's Health Initiative (WHI) randomized, controlled Dietary Modification (DM) trial of a low-fat dietary pattern suggested intervention benefits related to breast cancer, coronary heart disease (CHD), and diabetes. Here, we use WHI observational data for further insight into the chronic disease implications of adopting this type of low-fat dietary pattern., Objectives: We aimed to use our earlier work on metabolomics-based biomarkers of carbohydrate and protein to develop a fat intake biomarker by subtraction, to use the resulting biomarker to develop calibration equations that adjusts self-reported fat intake for measurement error, and to study associations of biomarker-calibrated fat intake with chronic disease risk in WHI cohorts. Corresponding studies for specific fatty acids will follow separately., Methods: Prospective disease association results are presented using WHI cohorts of postmenopausal women, aged 50-79 y when enrolled at 40 United States clinical centers. Biomarker equations were developed using an embedded human feeding study (n = 153). Calibration equations were developed using a WHI nutritional biomarker study (n = 436). Calibrated intakes were associated with cancer, cardiovascular diseases, and diabetes incidence in WHI cohorts (n = 81,954) over an approximate 20-y follow-up period., Results: A biomarker for fat density was developed by subtracting protein, carbohydrate, and alcohol densities from one. A calibration equation was developed for fat density. Hazard ratios (95% confidence intervals) for 20% higher fat density were 1.16 (1.06, 1.27) for breast cancer, 1.13 (1.02, 1.26) for CHD, and 1.19 (1.13, 1.26) for diabetes, in substantial agreement with findings from the DM trial. With control for additional dietary variables, especially fiber, fat density was no longer associated with CHD, with hazard ratio (95% confidence interval) of 1.00 (0.88, 1.13), whereas that for breast cancer was 1.11 (1.00, 1.24)., Conclusions: WHI observational data support prior DM trial findings of low-fat dietary pattern benefits in this population of postmenopausal United States women., Trial Registration Number: This study is registered with clinicaltrials.gov identifier: NCT00000611., (Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Objective: The study examined changes in acculturation level, socio-economic status, and their association with preventive dental service use, receipt of restorative, or surgical care, and unmet dental needs., Methods: Data from the Medical Expenditure Panel Survey (MEPS) for children aged 1 to 17 years from 2007 to 2015 were analysed. Firstly, a cross-sectional structural equation model (SEM) that included both a measurement model and a structural model was fitted simultaneously to obtain predicted latent variables for acculturation, socio-economic status (SES), dental service utilization, and unmet dental needs. Secondly, the change in acculturation, SES, dental service utilization, and unmet dental needs were calculated over two consecutive years within the same child. Finally, the structural model in these changes was fitted, and the indirect and direct pathways between acculturation and SES were tested with dental insurance as a mediator., Results: Data for 33 507 children in both panel years were analysed. An increase in family acculturation resulted in lower utilization of preventive dental service and more unmet dental need, with socio-economic status and dental insurance kept constant between the panel years, and after adjusting for race/ethnicity, gender, and age. In addition, increased acculturation was associated with higher SES, and a higher probability of having obtained dental insurance, both of which resulted in increased preventive dental service utilization and less unmet dental need. The positive direct effect and negative indirect effect of acculturation on unmet dental need cancelled each other out and resulted to almost zero total effect between acculturation and unmet dental need. Similarly, the negative direct effect and positive indirect effect of acculturation on preventive dental service cancelled each other out leading to a small increase in preventive dental service utilization., Conclusion: Children of immigrant families are at risk of inadequate access to dental care as their families becomes more acculturated, without increase in SES and access to dental insurance. This study supports policies that promote immigrant family's adequate access to dental insurance and employment to improve their socio-economic status., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Surgery trainees spend their prime fertility years in training, which leads to delays in childbearing, accompanying infertility challenges, and high-risk pregnancies. Literature report of institutional support for fertility preservation (egg/sperm freezing) and treatment is lacking. The cost is particularly prohibitive while receiving a resident physician salary. This study aimed to assess availability of fertility resources and institutional coverage of fertility services to US General Surgery Residents (GSR) and Breast Fellows., Methods: We composed and distributed a 26-question survey to GS residency and fellowship program directors nationwide to survey residents and fellows. Summary and descriptive statistics were tabulated, and categorical variables were analyzed using Pearson's chi square test., Results: A total of 234 US surgical trainees (male n = 75, female n = 155, unreported n = 4) completed the survey. Total of 12 % of trainees reported having been counseled on family planning/fertility treatment during training, and only 5.1% were counseled on fertility preservation. Perceived lack of support from program (p = 0.027) and counseling of fertility preservation (p = 0.009) were significantly associated with female gender. A minority (12.5%) reported having insurance coverage for fertility preservation and 26% had coverage of fertility treatment. In addition, 2.6% respondents pursued fertility preservation while in training and 33% reported they would pursue fertility preservation if it was covered by insurance., Conclusions: Fertility preservation is rarely discussed in US General Surgery residency programs. The large majority of GSR lacks awareness of insurance coverage of fertility preservation and treatment. Strong efforts are necessary to improve fertility education for GSR and insurance coverage to meet trainee's needs., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

BACKGROUND: As the United States transitions toward value-based payment, value assessment tools to measure the value of health care interventions are emerging. As the field evolves, it is important to evaluate how these tools are influencing treatment and coverage decisions. OBJECTIVE: To examine payer perceptions and use of US value assessment tools and identify how these tools inform payer decision-making. METHODS: A double-blind, web-based survey was conducted from June to July 2022 to assess health care payers' perceptions and use of value assessment tools developed by the American Society of Clinical Oncology, Drug Pricing Lab, Institute for Clinical and Economic Review (ICER), Innovation and Value Initiative, and National Comprehensive Cancer Network. RESULTS: 51 respondents completed the survey. 86% of payers were familiar with at least 4 of 5 value assessment tools. Both ICER and National Comprehensive Cancer Network tools are perceived as very useful for informing formulary decisions (57% and 49%, respectively). When selecting a value assessment tool, payers identified the inclusion of appropriate metrics and outcomes (92%), comparative clinical effectiveness information (88%), and reliance on rigorous, unbiased methods (86%) to be very/extremely important. Payers reported the inclusion of the patient, provider, and societal perspectives as lower importance (32%, 31%, and 20% identify these elements as very/extremely important, respectively). Payers reported using ICER evidence reports to both expand and restrict coverage decisions. To advance more useful and relevant value assessment tools, payers identified the need for greater stakeholder awareness of existing tools, and some recommended that value assessors increase the volume of assessments conducted. CONCLUSIONS: US health care payers perceive select value assessment tools to be useful for informing health care decisions. As policy momentum behind value assessment builds, additional examination of value assessment tools is needed to inform appropriate application of value assessment in US health care decision-making. DISCLOSURES : This study was funded by Xcenda/AmerisourceBergen. Ms Buelt, Ms Loo, Ms Westrich, and Drs Hydery and Zheng report employment with Xcenda/AmerisourceBergen. Drs Dharbhamalla and Graff report employment with AMCP.

Background: Asians and Pacific Islanders (API) exhibit increased incidence of nasopharyngeal carcinoma (NPC). However, they are often excluded when the disease is studied. Risk-factors and incidence are well-researched while cancer-specific mortality trends remain unclear. We aimed to determine whether insurance status modifies the association between race and cancer-specific mortality in NPC patients., Methods: This retrospective cohort study used secondary data analysis from the Surveillance, Epidemiology, and End Results Program database. Patients ≥18 years with histologically confirmed primary NPC from 2007 - 2016 were included. The main outcome assessed was 5-year survival and the main exposure variable was race (API, white, black). Insurance status was classified into uninsured, any Medicaid, and insured (with any insurance). Potential confounders included age, sex, marital status, stage at diagnosis, and surgical treatment. Adjusted Cox regression analysis was used to calculate hazard ratios (HR) and corresponding 95% confidence intervals (CI)., Results: 1610 patients were included (72.98% male, 27.02% female). 49.8% were API, 40.5% were Whites, and 9.8% Blacks. Maximum follow-up was 5-years. The adjusted hazards of 5-year cancer-specific death for API and Blacks compared with Whites were 0.77 (95% CI 0.62 - 0.96) and 0.92 (95% CI 0.65 - 1.31), respectively. Cases decreased with age in API and Blacks. 8.2% of cases had localized disease, 45.3% had local spread, and 44.6% had distant metastasis. Insurance status did not modify the association between race and mortality., Conclusion: Race is an important prognostic factor to account for in NPC patients. Investigating risk-factors and subtypes stratified by race may explain our findings.

Background: Evidence regarding the relationship between serum vitamin C levels and human papillomavirus (HPV) infection is limited. Therefore, this study aimed to investigate whether serum vitamin C levels are independently associated with HPV infection., Methods: Data for this cross-sectional study were obtained from the National Health and Nutrition Examination Survey 2003-2006. A total of 2174 women, 18-59 years of age, were enrolled in this study. The associations between serum vitamin C levels (continuous and categorical forms) and cervicovaginal HPV infection were estimated using weighted logistic regression., Results: The adjusted binary logistic regression showed that serum vitamin C was not associated with the risk of HPV infection after adjusting for age, race, poverty income ratio, alcohol consumption, smoking, body mass index, education, and health condition (odds ratio [OR] 0.998, 95% confidence interval [CI] 0.994-1.001). Serum vitamin C levels were converted from a continuous variable to a categorical variable for the analysis. Compared with the vitamin C deficiency and hypovitaminosis groups, there was a negative correlation between vitamin C and HPV infection when vitamin C was adequate (OR 0.7, 95% CI: 0.52-0.94); however, when the serum vitamin C level was inadequate and saturated, this negative correlation was weaker or nonexistent (OR 0.76, 95% CI 0.56-1.03 and OR 0.76, 95% CI 0.55-1.04, respectively). A nonlinear relationship was detected between vitamin C level and HPV infection. Furthermore, we performed subgroup analysis of different models and found that serum vitamin C concentration was negatively associated with HPV infection in women ≥ 25 years of age; however, in women < 25 years of age, serum vitamin C levels were not associated with HPV infection., Conclusion: The results from this United States nationally representative sample supported the hypothesis that there was a U-shaped relationship between serum vitamin C levels and HPV infection. Future studies are warranted to assess the association between vitamin C and HPV persistence and clarify the underlying mechanisms of these associations., (© 2022. The Author(s).)

Introduction: Asian American women have lower breast cancer incidence and mortality than their non-Hispanic White (NHW) counterparts. We sought to determine whether differences in screening practices could explain, in part, the variation in breast cancer detection rate., Methods: The 2015 National Health Interview Survey, an annual survey that is representative of the civilian, noninstitutionalized American population, was used to determine whether mammography usage was different between Asian and NHW women. Women ≥40 y of age who identified as either Asian or NHW were included., Results: A total of 7990 women ≥40 y of age (6.12% Asian, 93.88% NHW), representing 53,275,420 women in the population, were included in our cohort of interest; 71.49% of Asian and 74.46% of NHW women reported having had a mammogram within the past 2 y (P = 0.324). Controlling for education, insurance, family income, marital status, and whether they were born in the United States, Asians were less likely to have had a mammogram within the past 2 y than their NHW counterparts (odds ratio = 0.68; 95% confidence interval: 0.46-0.99, P = 0.047). Of patients who had an abnormal mammogram, there was no difference in the biopsy rate (20.35% versus 25.97%, P = 0.4935) nor in the rate of cancer diagnosis among those who had a biopsy (7.70% versus 12.86%, P = 0.211) between Asian and NHW women, respectively., Conclusions: Our findings suggest that the lower breast cancer incidence among the Asian population may, in part, be explained by a lower screening mammography rate in this population., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Shoulder injury related to vaccine administration (SIRVA) accounts for more than half of all claims received by the National Vaccine Injury Compensation Program. However, due to the difficulty of finding SIRVA cases in large health care databases, population-based studies are scarce., Objective: The goal of the research was to develop a natural language processing (NLP) method to identify SIRVA cases from clinical notes., Methods: We conducted the study among members of a large integrated health care organization who were vaccinated between April 1, 2016, and December 31, 2017, and had subsequent diagnosis codes indicative of shoulder injury. Based on a training data set with a chart review reference standard of 164 cases, we developed an NLP algorithm to extract shoulder disorder information, including prior vaccination, anatomic location, temporality and causality. The algorithm identified 3 groups of positive SIRVA cases (definite, probable, and possible) based on the strength of evidence. We compared NLP results to a chart review reference standard of 100 vaccinated cases. We then applied the final automated NLP algorithm to a broader cohort of vaccinated persons with a shoulder injury diagnosis code and performed manual chart confirmation on a random sample of NLP-identified definite cases and all NLP-identified probable and possible cases., Results: In the validation sample, the NLP algorithm had 100% accuracy for identifying 4 SIRVA cases and 96 cases without SIRVA. In the broader cohort of 53,585 vaccinations, the NLP algorithm identified 291 definite, 124 probable, and 52 possible SIRVA cases. The chart-confirmation rates for these groups were 95.5% (278/291), 67.7% (84/124), and 17.3% (9/52), respectively., Conclusions: The algorithm performed with high sensitivity and reasonable specificity in identifying positive SIRVA cases. The NLP algorithm can potentially be used in future population-based studies to identify this rare adverse event, avoiding labor-intensive chart review validation., (©Chengyi Zheng, Jonathan Duffy, In-Lu Amy Liu, Lina S Sy, Ronald A Navarro, Sunhea S Kim, Denison S Ryan, Wansu Chen, Lei Qian, Cheryl Mercado, Steven J Jacobsen. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 24.05.2022.)

Background and Objective: Hypoglycemia induced by direct-acting antiviral agents (DAAs) for chronic hepatitis C virus (HCV) infection is a rare but potentially life-threatening adverse reaction, which led to warnings by competent authorities. We therefore aimed to examine the hypoglycemic safety signal for DAAs., Methods: Reports to the US Food and Drug Administration Adverse Event Reporting System (FAERS) from 1 October 2012 to 31 March 2020 were analyzed. The Medical Dictionary for Regulatory Activities was used to identify hypoglycemia cases. A case by non-case disproportionality approach was used whereby reporting odds ratio (ROR) with 95% confidence intervals (CI) were calculated., Results: In HCV infection with diabetes patients, the cumulative frequency of hypoglycemic ADRs was 21.85/1000 for reports involving DAAs versus 13.50/1000 for reports involving other medications; For DAAs as a class drug, a nearly double increased reporting odds for hypoglycemia was observed (ROR: 1.63, 95% CI: 1.11-2.41). However, in DAAs subgroup analysis, only telaprevir (ROR: 1.66, 95% CI: 1.01-2.74) and elbasvir/grazoprevir (ROR: 2.25, 95% CI: 1.05-4.83) were associated with increased reporting risk of hypoglycemia during corresponding marketing period; when combined with insulins and sulfonylureas, DAAs were associated with increased reporting risk for hypoglycemia (ROR: 1.98, 95% CI: 1.36-2.88; ROR: 1.62, 95% CI: 1.06-2.48), but concomitant biguanides, dipeptidyl peptidase IV (DPP-4) inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1RAs) were not significant., Conclusions: This study supports the current recommendation for cautious about hypoglycemic risk relating to the use of DAAs. Treatment with DAAs and antidabetic agents (especially insulins and sulfonylureas) will increase hypoglycemia reporting risk. Physicians and pharmacists should be aware of this risk when prescribing DAAs for patients suffering from diabetes, advanced age or liver decompensation., (© 2021 John Wiley & Sons Ltd.)

Objective: To explore the associations between birth outcomes and blood pressure, and study the sex dimorphism of these associations., Methods: With a multistage cluster random sampling method, 62 168 children were recruited in seven provinces of China in September of 2013, with 32 064 boys and 30 104 girls, median age of 10.74 years and mean birth weight of 3.3 kg, 49 843 single birth(97%), 1339 twin(2.6%), 180 triplet or more(0.4%). Questionnaire investigation and physical examination were conducted in the present study. Weight, height and blood pressure were measured in the physical examination. Demographic characteristics, birth outcomes(including birth weight and number of births), dietary behavior, physical activities were measured by questionnaire. The widely used age-, gender-and height-specific high blood pressure standard developed by American CDC was used for the present study. Multivariate linear and logistic regression analysis were conducted to study the associations between birth outcomes and blood pressure level or high blood pressure(HBP), and also sex dimorphism of these associations was explored., Results: A total of 5933 children were categorized as having high blood pressure in the 62 168 participants(9.5%). With stratified analyses by birth weight category, only in the low-birth-weight strata birth weight was significantly inversely associated with systolic blood pressure(SBP) and diastolic blood pressure(DBP) with potential covariates adjusted(SBP: b=-1.628, 95%CI-2.571--0.685, P=0.001; DBP: b=-1.463, 95%CI-2.186--0.740, P&lt;0.001). While compared with the non-low birth weight children, low birth weight was not associated with higher risk of HBP(P&gt;0.05). Compared with those boys born as singleton, boys born as one of the twins have a 36.4% higher risk of HBP(OR=1.364, 95%CI 1.049-1.774), while in girls no such significant association was found. Additionally, compared with a term birth, overdue birth and preterm birth was not associated with higher risk of HBP(P&gt;0.05)., Conclusion: Birth weight and singleton or not were associated with childhood blood pressure levels and higher risk of high blood pressure, and some associations were sex specific. Gender differences should be paid attention to in the prevention and control of high blood pressure in children and adolescents in the future, and the prevention and control should be focused on low-birth weight children or twin boys.

Purpose: Given that the relationships between higher BMI and adverse health outcomes are nonconstant and most pronounced at either ends of the BMI distribution, we assess the association between neighborhood poverty and BMI at multiple points along the BMI distribution., Methods: Using data from the 1999 to 2015 Panel Study of Income Dynamics of Black and White adults in the United States, we estimate quantile regression models while jointly applying a marginal structural modeling approach to account for time-varying individual-level factors that may be simultaneously mediators as well as confounders., Results: Neighborhood poverty was not found to be associated with bodyweight at any point along the BMI distribution for Black or White males. However, high neighborhood poverty, compared to low neighborhood poverty, predicted increases in bodyweight for Black females at the lower end of the BMI distribution and for White females at the higher end of the BMI distribution. No association was found between neighborhood poverty and BMI at the mean., Conclusions: Results identify the most vulnerable subgroups, suggesting that White females at the higher end of the BMI distribution as well as Black females at the lower end of the BMI distribution are particularly sensitive to obesogenic environments., (Published by Elsevier Inc.)

Background: The epidemiological data on the use of aspirin in diabetic patients is very limited. The main purpose of this study is to examine the current status of aspirin use in the United States (US) and China in large representative populations., Methods: Data came from the National Health and Nutrition Examination Survey (NHANES) and China Hypertension Survey (CHS), two nationally representative cross-sectional studies., Results: The percentage of aspirin use was 73.8% in US diabetic patients with ASCVD, and the percentage of aspirin use in diabetic patients with high ASCVD risk was marginally higher in men ( p = .052), 54.5% in men and 37.1% in women. The percentages of aspirin use in diabetic patients with intermediate and low ASCVD risk were 55.1% and 35.0%, respectively. In China, the percentage of aspirin use in diabetic patients with ASCVD was 53.5%, and were 14.3%, 9.7%, and 3.2% among diabetic patients with high, intermediate, and low ASCVD risk, respectively., Conclusions: In summary, the percentage of aspirin use in primary prevention in US diabetic patients in men was higher than in women, and this percentage for primary and secondary prevention in US patients was higher than that in Chinese patients.

Objectives: To determine the patterns and time trends of dental services received and access to dental care among immigrant and US-born children living in the United States., Methods: We analyzed the nationally representative Medical Expenditure Survey data for 2007-2015. Survey weighted mean and frequency were calculated for all the years and for each year for the complete cohort and for the four subgroups of children categorized based on the child's and parents' birthplace (United States or Foreign). These groups were compared to detect differences in dental service received., Results: Overall 34,482 children aged <18 years were included in the analysis representing the weighted sample size of 564,255,643. Utilization of preventive dental services increased from 37.2 percent in 2007 to 44.4 percent in 2015 overall (P < 0.0001), with similar trend seen within all subgroups. Immigrant children compared to US-born children had higher numbers of surgical and restorative procedures (17 versus 16 per 100-person years, P = 0.03), fewer had at least one preventive dental visit in a year (32.8 percent versus 43.0 percent, P < 0.0001) and were less likely be unable to access dental care (3.0 percent versus 1.7 percent, P = 0.005). Fewer children had delayed access to dental care in recent years (2.0 percent in 2007 to 1.5 percent in 2015) and the decline was consistent in all the subgroups., Conclusion: Stratification into the different subgroups allowed for improved understanding of dental procedure utilization and dental services utilization in all subgroups increased over time. Immigrant children had lower utilization of preventive procedures and higher utilization of surgical and restorative procedures., (© 2020 American Association of Public Health Dentistry.)

Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Objectives: Community popular opinion leaders have played a critical role in HIV prevention interventions. However, it is often difficult to identify these 'HIV influencers' who are qualified and willing to promote HIV campaigns, especially online, because social media influencers change frequently. We sought to use an iterative deep learning framework to automatically discover HIV-related online social influencers., Design and Method: Out of 1.15 million Twitter users' data from March 2018 to March 2020, we extracted tweets from 1099 Twitter users who had mentioned the keywords 'HIV' or 'AIDS'. Two Twitter users determined to be 'online HIV influencers' based on their conversation topics and engagement were hand-picked by domain experts and used as a seed training dataset. We modelled social influence and discovered new potential influencers based on these seeds using a graph neural network model. We tested the model's precision and recall compared with other baseline model approaches. We validated the results through manual verification., Results: The model identified 23 new (manually verified) HIV-related influencers, including health and research organizations and local HIV advocates across the United States. Our proposed model achieved the highest accuracy/recall, with an average improvement of 38.5% over the other baseline models., Conclusion: Results suggest that iterative deep learning models can be used to automatically identify new and changing key HIV-related influencers online. We discuss the implications and potential of HIV researchers/departments applying this approach across online big data (e.g. hundreds of millions of social media posts per day) to help promote HIV prevention campaigns to affected communities., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: In the U.S., health insurance is a crucial determinant of the affordability of healthcare services and access to care. Population-based studies indicate Americans do not have an adequate understanding of their insurance plans and face difficulties navigating their health insurance coverage. The purpose of this pilot study is to collect qualitative data using a key informant interview format to learn about the acceptability, feasibility and implementation of a newly devised online health insurance navigation tool (HINT)., Results: A total of 57 Florida residents completed the 18-item HINT web-based survey tool and provided feedback on their experience, of which 63.2% were women, 40.7% Black race, and had average sample age of 46.9 years. Participants reported the web tool to be of good length, easy readability, relevant, and overall helpful for insurance selection. All respondents reported that they would use the tool themselves should they find themselves in the process of selecting an insurance plan and 98.2% of respondents reported that they would suggest the web tool to a family or friend. The average time it took to complete the questionnaire was 4 min and 20 s.The HINT tool met study criteria on feasibility, implementation, and acceptability among study participants.

Background: Thus far, the association of tumor size with prognosis in colon cancer has not been considered and has remained unclear. This study, therefore, aimed to investigate the association between tumor size as a continuous variable and prognosis in colon cancer using Cox models with restricted cubic splines., Methods: Using the Surveillance, Epidemiology, and End Results database, we selected 128,369 patients with colon cancer who underwent surgery. Overall survival and colon cancer-specific survival were separately analyzed, and tumor size was separately evaluated as a continuous variable and a categorical variable. To investigate the relationship after adjusting for covariates, we used the proportional hazards models. The restricted cubic splines model was used to determine the presence of nonlinear or linear association and flexibly visualize the association., Results: The adjusted covariate model showed that the hazard ratio of colon cancer rapidly increased with a tumor size of 4 cm and slowly increased with a tumor size larger than 4 cm. When tumor size was analyzed as a categorical variable, the multivariable-adjusted model demonstrated a nearly linear relationship between tumor size and hazard ratio regardless of overall survival or cancer-specific survival, and the hazard ratio of group 5 (4.1-5 cm) was nearly a turning point. Subgroup analysis with respect to lymph node metastasis showed that the relationship between tumor size and prognosis in colon cancer was evident in lymph node metastasis., Conclusion: There was a strong negative relationship between tumor size and prognosis in colon cancer. However, when tumor size was less than 4 cm, the relationship between tumor size and prognosis was steep compared with that when tumor size was larger than 4 cm, especially in lymph node metastasis., (Copyright © 2020. Published by Elsevier Inc.)

Competing Interests: Conflicts of interest None disclosed.

Objective: Mission of Mercy (MoM) events are scheduled to provide care to populations suffering from urgent needs and inadequate access to dental care in the United States. This study examined individual and county-level characteristics of MoM attendees and the factors associated with changes in the rate of attendance., Methods: Deidentified archival data for MoM events available from the America's Dentists Care Foundation (2013-2016) were analyzed. Summary statistics were calculated separately for each year. Chi-square test was performed to identify changes in attendance distribution over time. Poisson regression analyses were conducted to test changes in the rate of attendance with and without adjustment for county-level characteristics and history of prior MoM events., Results: Total numbers of attendees at Wisconsin MoM events were 1,560, 1,635, 1,187, and 951 in 2013, 2014, 2015, and 2016, respectively. Attendees were mostly female (>50%) and White (58%-81%), and mean age ranged between 36.5 and 39.2 y. The average travel distance ranged between 27 and 80 miles. Residents of counties where MoM events were held in previous years were more likely to attend another MoM event after adjusting for county distance to current location. After adjusting for dentists-to-population ratio, event history, and county distance to event location, we found that there was no statistically significant change in the rate of attendance from 2013 to 2016., Conclusions: Previous attendees with experience of attending a MoM event in their counties of residence were more likely to attend another MoM event. Higher rates of attendance were associated with shorter travel distances to MoM events., Knowledge Transfer Statement: The Mission of Mercy (MoM) events are promoted by local dental organizations to highlight the issue of access to dental care and bring greater awareness to the problem by providing urgent dental care to populations in need. Through the data-sharing practices and analyses, policy makers, dental health advocates, and program organizers will have a better understanding of the impact and reach of the program. Findings from this study will help to expand program practices, promote efficiency, and aid in the identification of appropriate event locations, innovative strategies, and public policies relevant to addressing access to dental care.

Background: This study aimed to compare the long-term survival of patients undergoing minimally invasive gastrectomy and those undergoing open gastrectomy for gastric adenocarcinoma (GA) in the United States and China., Methods: Data on patients with GA who underwent gastrectomy without neoadjuvant therapy were retrieved from prospectively maintained databases at Memorial Sloan Kettering Cancer Center (MSKCC) and Fujian Medical University Union Hospital (FMUUH). Using propensity score-matching (PSM), equally sized cohorts of patients with similar clinical and pathologic characteristics who underwent minimally invasive versus open gastrectomy were selected. The primary end point of the study was 5-year overall survival (OS)., Results: The study identified 479 patients who underwent gastrectomy at MSKCC between 2000 and 2012 and 2935 patients who underwent gastrectomy at FMUUH between 2006 and 2014. Of the total 3432 patients, 1355 underwent minimally invasive gastrectomy, and 2059 underwent open gastrectomy. All the patients had at least 5 years of potential follow-up evaluation. Before PSM, most patient characteristics differed significantly between the patients undergoing the two types of surgery. After PSM, each cohort included 889 matched patients, and the actual 5-year OS did not differ significantly between the two cohorts, with an OS rate of 54% after minimally invasive gastrectomy and 50.4% after open gastrectomy (p = 0.205). Subgroup analysis confirmed that survival was similar between surgical cohorts among the patients for each stage of GA and for those undergoing distal versus total/proximal gastrectomy. In the multivariable analysis, surgical approach was not an independent prognostic factor., Conclusions: After PSM of U.S. and Chinese patients with GA undergoing gastrectomy, long-term survival did not differ significantly between the patients undergoing minimally invasive gastrectomy and those undergoing open gastrectomy.

Background: Large population-based studies of risk factor for lung metastases at the presentation with primary osseous neoplasms are lacking and necessary. We aim to examine potential risk factors of lung metastases at presentation with primary osseous neoplasms using Surveillance, Epidemiology, and End Results (SEER) database tool., Methods: We collected patients diagnosed with primary osseous neoplasms between 2010 and 2015 from the SEER database. Patients were divided into two groups: patients with lung metastases or patients without lung metastases. Patient characteristics such as age, sex, race, tumor size, histologic types, histologic grade, and lung metastasis were collected. Univariate and multivariate logistic regression analyses were applied to determine which characteristics were risk factors for lung metastasis at diagnosis., Results: A total of 4459 patients were collected, and 507 patients had lung metastases at presentation. Data on age, race, gender, primary site, grade, tumor size, and histology types were enrolled into the multivariate logistic analysis. Higher grade (OR = 5.197, 95% CI 3.328 to 8.117), histology type (Ewing sarcoma: OR = 1.432, 95% CI 1.020 to 2.009; osteosarcoma: OR = 1.597, 95% CI, 1.073 to 2.377), and larger tumor size (≥ 5 cm: OR = 3.528, 95% CI 2.370 to 5.251) were associated with an increased risk of lung metastasis at presentation., Conclusion: Histology types (osteosarcoma and Ewing sarcoma) were related to a higher risk of lung metastases in primary osseous neoplasms patients. Patients with osteosarcoma and lager tumors or higher tumor grade were associated with higher possibility of lung metastases. Patients with Ewing sarcoma and larger tumors have more tendency of lung metastases. These patients are supposed to receive chest CT scans at the presentation with primary osseous neoplasms.

Objective: To examine trends and variations in billed and paid amounts for preventive dental procedures by race/ethnicity, age, and sex in Wisconsin dental Medicaid., Methods: We analyzed data from the 2001 to 2013 Wisconsin Medicaid claims database for preventive dental procedures for children and adults. Billed and paid amounts for preventive dental procedures were aggregated over a visit and adjusted for inflation based on the Medical Care Consumer Price Index produced by the Bureau of Labor Statistics for 2013. Quantile regression was used to examine the trends over time and the effect of patient demographics., Result: At the 50th and 75th percentiles, the overall billed amounts for preventive dental procedures were $84.97 and $105.53, and the paid amounts were $35.80 and $41.66, respectively. At the 75th percentile, there was a $2.24 increase per year in the billed amount and a $26.88 overall increase from 2001 to 2013. In the paid amount, there was a $1.34 decrease per year for an overall $16.07 decrease from 2001 to 2013. Billed and paid claims for racial/ethnic minority enrollees were $1 to $3 higher per visit at the 75th percentile when compared with those of Whites. Regarding the billed:paid ratio, White, African American, and Hispanic enrollees had values of 50% to 52%, whereas American Indians had the lowest value at 47.7%. At the 75th percentile, children aged 10 to 19 y had significantly higher billed ($26.73) and paid ($9.92) amounts than did adults aged 20 to 69 y., Conclusion: The billed amount increased over time, and the paid amount decreased after adjustment for inflation. In addition, there was a wide gap between billed and paid amounts over time., Knowledge Transfer Statement: This study highlights clear differences between paid and billed amounts in Wisconsin dental Medicaid. The financial health of dental practices is dependent on appropriate reimbursement for dental services provided; thus, information of this nature could serve as a proxy performance measure for access to preventive dental care. Findings from this study could be used by policy makers and dental Medicaid program managers to develop outcome metrics to improve access to preventive dental services.

Background and Objective: This project links population data to the Wisconsin Violent Death Reporting System (WVDRS) to determine the extent to which firearm possession criteria are being followed as well as the potential impact of the adoption of proposed possession criteria., Design and Study Population: Criminal justice data for WVDRS homicide suspects and victims and suicide decedents 2008-2011 and a sample of matched control group of driver's license holders (to characterise the state population) will be abstracted., Methods: Individual legal possession statuses (prohibited/not prohibited) under each current and expanded criterion will be determined. Proportions of interest will be calculated from two-way contingency tables, and tests between groups with categorical variables (eg, criterion is met or not) will be performed with Fisher's exact or binomial proportion tests. Tests between groups with continuous variables (eg, number of misdemeanours) will be performed by zero inflated negative binomial regression. Area under the receiver operating characteristic curve will be used to quantify the prediction accuracy of specific univariate or multivariate logistic model for prediction. Inverse probability weighting will be used for analyses that extend from matched controls to the general state population of license holders., Discussion: Linked data sets and partnerships are challenging, but necessary for comprehensive public health research. Results of this study will contribute knowledge on the proportion of prohibited suspects and suicide decedents that used firearms in violent deaths and, if applying expanded criteria would have increased prohibited persons. This study will also investigate risk and protective factors for being a victim of homicide., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Depression is estimated to affect more than 6.5 million Americans 65 years of age and older and compared with non-Latino whites older U.S. Latinos have a greater incidence and severity of depression, warranting further investigation of novel risk factors for depression onset among this population. We used data on 771/1,789 individuals ≥60 years of age from the Sacramento Area Latino Study on Aging (1998-2008) who were tested for cytomegalovirus (CMV), herpes simplex virus, varicella zoster, Helicobacter pylori, Toxoplasma gondii, and C-reactive protein (CRP) and interleukin-6 (IL-6) level. Among those without elevated depressive symptoms at baseline, we examined the association between each pathogen, inflammatory markers and incident depression over up to nearly 10 years of follow-up using discrete-time logistic regression. We found that only CMV seropositivity was statistically significantly associated with increased odds of incident depression (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.00-1.90) in the total sample as well as among women only (OR: 1.70, 95% CI: 1.01-2.86). These associations were not mediated by CRP or IL-6 levels. Our findings suggest that CMV seropositivity may serve as an important risk factor for the onset of depression among older U.S. Latinos, but act outside of inflammatory pathways., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Biomarkers provide potential to objectively measure the intake of nutrients and foods, and thereby to strengthen nutritional epidemiology association studies. However, there are only a few established intake biomarkers, mostly based on recovery of nutrients or their metabolites in urine. Blood concentration measures provide a potential biomarker source for many additional nutritional variables, but their use in disease-association studies requires further development., Objective: The aim of this study was to apply recently proposed serum-based carotenoid and tocopherol intake biomarkers and to examine their association with the incidence of major cardiovascular diseases, cancers, and diabetes in a subset of Women's Health Initiative (WHI) cohorts., Methods: Serum concentrations of α- and β-carotene, lutein plus zeaxanthin (L + Z), and α-tocopherol were routinely measured at baseline in a subset of 5488 enrollees in WHI cohorts. Intake biomarkers for these 4 micronutrients, obtained by combining serum concentrations with participant characteristics, were recently proposed using a 153-woman feeding study within WHI. These biomarker equations are augmented here to include pertinent disease risk factors and are associated with subsequent chronic disease incidence in this WHI subset., Results: HRs for a doubling of micronutrient intake differed only moderately from the null for the outcomes considered. However, somewhat lower risks of specific cardiovascular outcomes, breast cancer, and diabetes were associated with a higher intake of α- and β-carotene, lower risk of diabetes was associated with higher L + Z intake, and elevated risks of certain cardiovascular outcomes were associated with a higher intake of α-tocopherol. These patterns remained following the exclusion of baseline users of dietary supplements., Conclusions: Concentration biomarkers can be calculated from blood specimens obtained in large epidemiologic cohorts and applied directly in disease-association analyses, without relying on self-reported dietary data. Observed associations between carotenoid and tocopherol biomarkers and chronic disease risk could be usefully evaluated further using stored serum specimens on the entire WHI cohort. This study was registered at www.clinicaltrials.gov as NCT00000611., (Copyright © American Society for Nutrition 2019.)

White clover widely cultivated in China is one of the most important perennial leguminous forages in temperate and subtropical regions. There is a large quantity of white clover seeds imported into China each year for demands of high-quality grass seeds. Seedborne diseases may cause significant economic losses. DNA sequencing technologies allow for the direct estimation of microbial community diversity, avoiding culture-based biases. Therefore, we used 16S rRNA gene sequencing to investigate the bacterial communities in white clover seeds collected from four different countries. The results showed that a total of 484,715 clean reads were obtained for further subsequent analysis. In total, 341, 340, 382, and 297 operational taxonomic units were obtained at 3% distance cutoff in DB, MB, TB, and XB samples, respectively. The richness indexes revealed that TB sample from Argentina had the highest bacterial richness in four samples. Our results demonstrated that Proteobacteria was the dominant phyla in MB, TB, and XB; however, Bacteroidetes was the dominant phyla in DB. The dominant genus of DB was Prevotella (11.9%), while Sphingomonas was the major genus of MB (46.9%), TB (55.08%), and XB (47.2%) samples. These results provide useful information for seedborne diseases and transmission of bacteria from seed to seedling.

Background: Systems approaches in studying disease relationship have wide applications in biomedical discovery, such as disease mechanism understanding and drug discovery. The FDA Adverse Event Reporting System (FAERS) contains rich information about patient diseases, medications, drug adverse events and demographics of 17 million case reports. Here, we explored this data resource to mine disease comorbidity relationships using association rule mining algorithm and constructed a disease comorbidity network., Results: We constructed a disease comorbidity network with 1059 disease nodes and 12,608 edges using association rule mining of FAERS (14,157 rules). We evaluated the performance of comorbidity mining from FAERS using known disease comorbidities of multiple sclerosis (MS), psoriasis and obesity that represent rare, moderate and common disease respectively. Comorbidities of MS, obesity and psoriasis obtained from our network achieved precisions of 58.6%, 73.7%, 56.2% and recalls 87.5%, 69.2% and 72.7% separately. We performed comparative analysis of the disease comorbidity network with disease semantic network, disease genetic network and disease treatment network. We showed that (1) disease comorbidity clusters exhibit significantly higher semantic similarity than random network (0.18 vs 0.10); (2) disease comorbidity clusters share significantly more genes (0.46 vs 0.06); and (3) disease comorbidity clusters share significantly more drugs (0.64 vs 0.17). Finally, we demonstrated that the disease comorbidity network has potential in uncovering novel disease relationships using asthma as a case study., Conclusions: Our study presented the first comprehensive attempt to build a disease comorbidity network from FDA Adverse Event Reporting System. This network shows well correlated with disease semantic similarity, disease genetics and disease treatment, which has great potential in disease genetics prediction and drug discovery.

Introduction: The utility of radical prostatectomy (RP) for locally-advanced prostate cancer remains unknown. Retrospective data has shown equivalent oncologic outcomes compared to radiation therapy (RT). RP may provide local tumor control and prevent secondary interventions from local invasion, and may decrease costs., Materials and Methods: Using SEER-Medicare data from 1995-2011 we identified men with locally-advanced prostate cancer undergoing RP or RT. Rates of post-treatment diagnoses and interventions were identified using ICD-9 and CPT codes. Skeletal related events (SRE), androgen deprivation therapy (ADT) utilization, all-cause mortality, prostate cancer-specific mortality, and costs were compared., Results: A total of 8367 men with locally-advanced prostate cancer were identified (6200 RP, 2167 RT). RT was associated with increased urinary obstruction, hematuria, infection, and cystoscopic intervention while RP was associated with increased urethral stricture intervention and erectile dysfunction. Compared to RT, RP was associated with decreased all-cause mortality (3.1 versus 5.2 deaths/100-person-years, p < 0.001), prostate cancer-specific mortality (0.8 versus 2.0 deaths/100-person-years, p < 0.001), SREs (2.0 versus 3.4 events/100 person-years, p < 0.001), and ADT utilization overall (7.4 versus 33.8 doses/100-person-years, p < 0.001) and > 3 years after treatment (3.6 versus 4.6 doses/100-person-years, p < 0.001). Overall and cancer specific costs were significantly lower for RP versus RT., Conclusions: RT for locally-advanced prostate cancer has a higher incidence of mortality, secondary diagnoses and interventions, SRE, and ADT utilization compared to RP. This may lead to increased costs and have implications for quality of life. Our findings support the utility of RP in appropriately selected men with locally-advanced prostate cancer given the possible decreased morbidity and survival benefit.

Purpose: Glaucoma is a well-documented complication of corneal transplants, contributing significantly to ultimate visual loss. Reported incidence of glaucoma following corneal transplants is highly variable, and definitions of posttransplant glaucoma are inconsistent. Here we use glaucoma surgery as a more rigid and specific endpoint to compare rates following different corneal transplant surgeries., Design: Retrospective cohort study., Methods: A 5% random sample of Medicare beneficiaries from 2010-2013 was obtained and patients were identified with Current Procedural Terminology (CPT) codes for penetrating keratoplasty (PK), endothelial keratoplasty (EK), anterior lamellar keratoplasty (ALK), and keratoprosthesis (KPro). Rates of glaucoma surgery within the same year following the abovementioned corneal transplants were analyzed. Subgroup analyses included patients who carried preexisting glaucoma diagnoses prior to corneal transplant surgery., Results: There were 3098 patients who underwent corneal transplants during the study period, including 1919 EK, 1012 PK, 46 ALK, 32 KPro, and 89 both PK and EK. Rates of glaucoma surgery ranged from 6.1% to 9.4% in the corneal transplant groups, without statistically significant differences among groups. However, 10.0% of patients with preexisting glaucoma required glaucoma surgery following any transplant surgery, compared with 5.3% of patients without preexisting glaucoma. This included 12.4% of PK patients with preexisting glaucoma compared with 2.8% of PK patients without preexisting glaucoma (P < .01)., Conclusions: Despite literature suggesting that more angle-altering cornea surgeries confer higher risk, we found no statistically significant differences among various transplant groups. Patients with preexisting glaucoma, however, had higher risk of glaucoma surgery within the same year following corneal transplant surgery, which was especially pronounced in the PK group. These patients require special care when considering long-term effects of corneal transplants., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to examine trends and racial/ethnic disparities in antibiotic prescribing practices of dentists in the United States., Methods: The US Medical Expenditure Panel Survey data for 1996-2013 was analyzed. Information on patient sociodemographic characteristics, dental visits, receipt of dental procedures, and type of antibiotics prescribed following visits was obtained. Descriptive statistics were calculated separately for each year. Logistic regression analyses were conducted to identify associations during the period with and without adjustment for dental procedures and sociodemographic characteristics. Survey weights were incorporated to handle the sampling design., Results: Nationally, the number of antibiotic prescribed at dental visits was estimated to be higher by 842,749 (0.4 percent) at year 2013 compared to the prescription level at 2003 were the population sociodemographic distribution kept at 2013 level. On average, the odds of prescribing antibiotics following dental care increased with each decade of study (OR: 1.10; 95% CI: [1.04, 1.17]) after adjusting for sociodemographic characteristics and receipt of dental procedures. Compared to Whites, Blacks had 21 percent (95% CI: 11%, 31%) higher odds of receiving a prescription for antibiotics from a dentist after adjusting for dental procedure and other sociodemographic characteristics., Conclusions: The prescription of antibiotics following dental visits increased over time after adjustment for sociodemographic characteristics and dental procedure. The probability of being prescribed antibiotics by dentists was higher for Blacks compared to Whites., (© 2017 American Association of Public Health Dentistry.)

Background: The Affordable Care Act's Medicaid expansion has been heavily debated due to skepticism about Medicaid's ability to provide high-quality care. Particularly, little is known about whether Medicaid expansion improves access to surgical cancer care at high-quality hospitals. To address this question, we examined the effects of the 2001 New York Medicaid expansion, the largest in the pre-Affordable Care Act era, on this disparity measure., Study Design: We identified 67,685 nonelderly adults from the New York State Inpatient Database who underwent select cancer resections. High-quality hospitals were defined as high-volume or low-mortality hospitals. Disparity was defined as model-adjusted difference in percentage of patients receiving operations at high-quality hospitals by insurance type (Medicaid/uninsured vs privately insured) or by race (African American vs white). Levels of disparity were calculated quarterly for each comparison pair and then analyzed using interrupted time series to evaluate the impact of Medicaid expansion., Results: Disparity in access to high-volume hospitals by insurance type was reduced by 0.97 percentage points per quarter after Medicaid expansion (p < 0.0001). Medicaid/uninsured beneficiaries had similar access to low-mortality hospitals as the privately insured; no significant change was detected around expansion. Conversely, racial disparity increased by 0.87 percentage points per quarter (p < 0.0001) in access to high-volume hospitals and by 0.48 percentage points per quarter (p = 0.005) in access to low-mortality hospitals after Medicaid expansion., Conclusions: Pre-Affordable Care Act Medicaid expansion reduced the disparity in access to surgical cancer care at high-volume hospitals by payer. However, it was associated with increased racial disparity in access to high-quality hospitals. Addressing racial barriers in access to high-quality hospitals should be prioritized., (Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Despite the importance of understanding the fundamental determinants of Hispanic health, few studies have investigated how metropolitan segregation shapes the health of the fastest-growing population in the United States. Using 2006-2013 data from the National Health Interview Survey, we 1) examined the relationship between Hispanic metropolitan segregation and respondent-rated health for US-born and foreign-born Hispanics and 2) assessed whether neighborhood poverty mediated this relationship. Results indicated that segregation has a consistent, detrimental effect on the health of US-born Hispanics, comparable to findings for blacks and black-white segregation. In contrast, segregation was salutary (though not always significant) for foreign-born Hispanics. We also found that neighborhood poverty mediates some, but not all, of the associations between segregation and poor health. Our finding of divergent associations between health and segregation by nativity points to the wide range of experiences within the diverse Hispanic population and suggests that socioeconomic status and structural factors, such as residential segregation, come into play in determining Hispanic health for the US-born in a way that does not occur among the foreign-born., (© The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

We apply a marginal structural modeling (MSM) strategy to investigate the relationship between neighborhood poverty and BMI level among U.S. black and white adults. This strategy appropriately adjusts for factors that may be simultaneously mediators and confounders (e.g., income, health behavior), strengthening causal inference and providing the total (direct and indirect) neighborhood effect estimate. Short and long-term neighborhood poverty were positively associated with being overweight for both black and white women. No link was found for either black or white men. Socioeconomic and behavioral factors do not appear to be strong mediators. Sensitivity analyses suggest that the direction of point estimates is robust to unobserved confounding, though 95% confidence intervals sometimes included the null, particularly for white women. Compared to previous cross-sectional and longitudinal analyses, MSM results provide stronger evidence for a causal link between neighborhood poverty and body weight among women., (Published by Elsevier Ltd.)

Background: Although the Affordable Care Act (ACA) expanded Medicaid access, it is unknown whether this has led to greater access to complex surgical care. Evidence on the effect of Medicaid expansion on access to surgical cancer care, a proxy for complex care, is sparse. Using New York's 2001 statewide Medicaid expansion as a natural experiment, we investigated how expansion affected use of surgical cancer care among beneficiaries overall and among racial minorities., Study Design: From the New York State Inpatient Database (1997 to 2006), we identified 67,685 nonelderly adults (18 to 64 years of age) who underwent cancer surgery. Estimated effects of 2001 Medicaid expansion on access were measured on payer mix, overall use of surgical cancer care, and percent use by racial/ethnic minorities. Measures were calculated quarterly, adjusted for covariates when appropriate, and then analyzed using interrupted time series., Results: The proportion of cancer operations paid by Medicaid increased from 8.9% to 15.1% in the 5 years after the expansion. The percentage of uninsured patients dropped by 21.3% immediately after the expansion (p = 0.01). Although the expansion was associated with a 24-case/year increase in the net Medicaid case volume (p < 0.0001), the overall all-payer net case volume remained unchanged. In addition, the adjusted percentage of ethnic minorities among Medicaid recipients of cancer surgery was unaffected by the expansion., Conclusions: Pre-ACA Medicaid expansion did not increase the overall use or change the racial composition of beneficiaries of surgical cancer care. However, it successfully shifted the financial burden away from patient/hospital to Medicaid. These results might suggest similar effects in the post-ACA Medicaid expansion., (Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: The Institute of Medicine has recently prioritized access of quality cancer care to vulnerable persons including multimorbid patients. Despite promotional efforts to regionalize major surgical procedures to high-volume hospitals (HVHs), little is known about change in access to HVH over time among multimorbid patients in need of major cancer surgery. We performed a time-trend appraisal of access of multimorbid persons to HVH for major cancer surgery within a large nationally representative cohort., Methods: We identified 168,934 patients who underwent 6 major cancer surgeries from the Nationwide Inpatient Sample (1998 to 2010). Comorbidities were identified using Elixhauser's method. HVHs were defined as hospitals of highest procedure volumes that treated 1/3 of all the patients. Logistic regression models and predictive margins were used to assess the adjusted effects of comorbidity on receiving major cancer surgeries at HVH., Results: Of all, 45.7% of the patients had 2 comorbidities or more. Multimorbidity predicted decreased access to HVH for esophagectomy, total gastrectomy, pancreatectomy, hepatectomy, and proctectomy, but not for distal gastrectomy, after controlling for covariates. A comorbidity level by year interaction analysis also showed that little disparity existed for receiving distal gastrectomy at an HVH, whereas the predicted difference in probability of receiving any of the other 5 major cancer procedures remained prominent between the years 1998 and 2010., Conclusions: In this large 12-year time-trend study, multimorbid cancer patients have sustained low access to HVH for major cancer surgery across many oncologic resections. These results continue to reinforce and highlight the need for policy targeted research and intervention aimed at improving these access gaps., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Medicaid beneficiaries do not have equal access to high-volume centers for complex surgical procedures. We hypothesize there is a large Medicaid Gap between those receiving emergency general vs complex surgery at the same hospital., Methods: Using the Nationwide Inpatient Sample, 1998 to 2010, we identified high-volume pancreatectomy hospitals. We then compared the percentage of Medicaid patients receiving appendectomies vs pancreatectomies at these hospitals. Hospital characteristics associated with increased Medicaid Gap were evaluated using generalized estimating equation models., Results: A total of 602 hospital-years of data from 289 high-volume pancreatectomy hospitals were included. Median percentages of Medicaid appendectomies and pancreatectomies were 12.1% (interquartile range: 5.8% to 19.8%) and 6.7% (interquartile range: 0% to 15.4%), respectively. Hospitals that performed greater than or equal to 40 pancreatic resections per year had higher odds of having significant Medicaid Gap (odds ratio 2.3, 95% confidence interval 1.1 to 5.0)., Conclusions: Gaps exist between the percentages of Medicaid patients receiving emergency general surgery vs more complex surgical care at the same hospital and may be exaggerated in hospitals with very high volume of complex elective surgeries., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Owing to limited data on hospital resources consumed in caring for the oldest-old, we examined the use of pancreaticoduodenectomy (PD)-relevant hospital resources in patients of increasing age treated in high-volume hospitals participating in the University HealthSystem Consortium., Methods: Perioperative outcomes, resource use, and direct costs were compared across increasing age groups in 12,766 PDs (<70 years, n = 8,564; 70-79 years, n = 3,302; ≥80 years, n = 900) performed in 79 high-volume hospitals between 2010 and 2014. Linear regression models with and without covariate adjustments were used to assess the impact of older age., Results: The oldest-old experienced fewer readmissions and had equivalent intensive care unit use and mortality rates compared with both younger cohorts. However, those ≥80 years experienced more complications, blood transfusions, greater total parenteral nutrition (TPN) use, longer duration of stay, and higher direct hospital costs compared with those <70 years No differences were found between patients ≥80 years and those 70-79 years with respect to the administration of blood products, TPN, or the direct cost of PD., Conclusion: Our findings suggest the ability to deliver quality pancreatic surgical care to an aging population without strong associations to increased resource utilization. As the number of octogenarians undergoing PD continues to grow, the impact of this technically complex procedure on other important cancer care metrics, including patient-reported outcomes and quality of life, requires further assessment., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Total energy consumption and activity-related energy expenditure (AREE) estimates that have been calibrated using biomarkers to correct for measurement error were simultaneously associated with the risks of cardiovascular disease, cancer, and diabetes among postmenopausal women who were enrolled in the Women's Health Initiative at 40 US clinical centers and followed from 1994 to the present. Calibrated energy consumption was found to be positively related, and AREE inversely related, to the risks of various cardiovascular diseases, cancers, and diabetes. These associations were not evident in most corresponding analyses that did not correct for measurement error. However, an important analytical caveat relates to the role of body mass index (BMI) (weight (kg)/height (m)(2)). In the calibrated variable analyses, BMI was regarded, along with self-reported data, as a source of information on energy consumption and physical activity, and BMI was otherwise excluded from the disease risk models. This approach cannot be fully justified with available data, and the analyses herein imply a need for improved dietary and physical activity assessment methods and for longitudinal self-reported and biomarker data to test and relax modeling assumptions. Estimated hazard ratios for 20% increases in total energy consumption and AREE, respectively, were as follows: 1.49 (95% confidence interval: 1.18, 1.88) and 0.80 (95% confidence interval: 0.69, 0.92) for total cardiovascular disease; 1.43 (95% confidence interval: 1.17, 1.73) and 0.84 (95% confidence interval: 0.73, 0.96) for total invasive cancer; and 4.17 (95% confidence interval: 2.68, 6.49) and 0.60 (95% confidence interval: 0.44, 0.83) for diabetes., (© The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Research suggests that self-determination skills are positively correlated with factors that have been shown to improve academic achievement, but the direct relationship among self-determination, self-concept, and academic achievement is not fully understood. This study offers an empirical explanation of how self-determination and self-concept affect academic achievement for adolescents with learning disabilities after taking into consideration the covariates of gender, income, and urbanicity. In a nationally representative sample (N = 560), the proposed model closely fit the data, with all proposed path coefficients being statistically significant. The results indicated that there were significant correlations among the three latent variables (i.e., self-determination, self-concept, and academic achievement), with self-determination being a potential predictor of academic achievement for students with learning disabilities., (© Hammill Institute on Disabilities 2012.)