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Objective: The aim of this study was to explore gender and race-specific mortality and comorbidities associated with dementia hospitalizations among the oldest-old. Method: Using the 1999-2008 Nationwide Inpatient Sample, we identified the association between dementia mortality and hospital characteristics in the oldest-old population. Results: The oldest-old population was mostly comprised of Whites (81.1%) and women (76.0%), had shorter length of hospital stay (6.12 days), and lower hospital charges (US$18,770.32) than the young-old, despite the higher in-hospital mortality. Crude in-hospital mortality was higher for White males in the young-old population, followed by Hispanics and African Americans. However, Hispanic males had the highest mortality, followed by Whites then African Americans in the oldest-old group. After adjusting for different variables, these relationships did not change. Discussion: There should be a greater focus on potential pre-existing biases regarding hospital care in the elderly, especially the oldest-old and elderly minority groups.

The objectives of this study are 1) to depict the prevalence of moderate depressive symptoms (MDS) in adolescents living in California, 2) to examine the role of acculturation in reported MDS, and 3) to identify any relationship between acculturation, "needing emotional help," and "receiving psychological or emotional counseling," as reported by adolescents with MDS.We analyzed data from a cross-sectional population-based telephone survey for adolescents who completed the California Health Interview Survey (CHIS) in 2007, 2009, and 2011-2012. The primary predictor variable was level of acculturation. Outcome variables were 1) the presence of MDS, 2) whether participants needed help with emotional problems, and 3) whether they had received psychological or emotional counseling.Of the sample (n = 9816), 6.0% had MDS; 50% of these reported needing help for emotional problems, and 30% reported receiving psychological/emotional counseling. Multivariate analysis that included the interaction effects of race/ethnicity and acculturation showed that the latter was not associated with any of the outcome variables. However, Latino adolescent with MDS and moderate acculturation were less likely to report needing help for psychological/emotional problems, compared to their White counterparts with higher acculturation.Our findings suggest disparities in reporting depression symptoms and receiving psychological/emotional help are not driven by adolescents' acculturation levels. However, more studies are needed to clarify what cultural factors facilitate or inhibit moderately acculturated Latino adolescents from reporting needing help for psychological/emotional problems.

OBJECTIVE African Americans (AAs) and Hispanics have higher diabetes and end-stage renal disease but similar or lower early chronic kidney disease (CKD) compared with whites. Inflammation plays a critical role in the pathogenesis of diabetes-related CKD. We postulated that in contrast to the general population, AAs and Hispanics have a higher prevalence of early diabetic CKD and systemic inflammatory markers compared with whites. RESEARCH DESIGN AND METHODS We analyzed the National Health and Nutrition Examination Survey 1999–2008 of 2,310 diabetic patients aged ≥20 years with fasting plasma glucose (FPG) ≥126 mg/dL. We performed multiple linear regression among patients with early CKD (urinary albumin excretion [UAE] ≥30 μg/mL and estimated glomerular filtration rate ≥60 mL/min/1.73 m2) to test the relationship between UAE and C-reactive protein (CRP) by race/ethnicity, adjusting for demographics, diabetes duration, FPG, hemoglobin A1c, uric acid, white blood cell count, medication use, cardiovascular disease, and related parameters. RESULTS In patients with diabetes, the prevalence of early CKD was greater among Hispanics and AAs than whites (P < 0.0001). AAs had higher adjusted odds ratio (AOR) for CRP ≥0.2 mg/dL (AOR 1.81 [95% CI 1.19–2.78]), and Hispanics had higher AOR for UAE ≥30 μg/mL (AOR 1.65 [1.07–2.54]). In a regression model adjusted for confounding variables, there was a significant association between UAE and CRP in the mid-CRP tertile (CRP 0.20–0.56 mg/dL, P = 0.001) and highest CRP tertile (CRP ≥0.57 mg/dL, P = 0.01) for Hispanics, but only in the mid-CRP tertile (P = 0.04) for AAs, compared with whites. CONCLUSIONS AAs and Hispanics with diabetes have a higher prevalence of early CKD compared with whites, which is significantly associated with UAE and/or CRP.

OBJECTIVES/SPECIFIC AIMS: Our objective is to examine the relationship between depression, childhood asthma and family structure. METHODS/STUDY POPULATION: We analyzed data from The National Survey of Children’s Health 2011-2012 for the variables family structure, parent’s smoking, education, poverty, available emotional support, and children’s age, gender, race/ethnicity, asthma, physical/mental health, access to care, and insurance. Data were analyzed using multiple logistic regression in STATA 14 (sampling and weight). RESULTS/ANTICIPATED RESULTS: Of the 95,000 participants, 3.8% had depression, 5.1% had anxiety, 8.5% had emotional, developmental, or behavioral problem, 14.6% had asthma and 19% were single-parent family. Asthmatics had higher chance for depression relative to non-asthmatics (Adjusted Odds Ratio (AOR)=1.5, 95% confidence interval (CI)=1.2-1.8), p=0.001). Those living in a single-family home had higher chance for depression than those living in 2-parents homes (AOR=2.5, 95% CI=1.9-3.2), p=0.001). Other predictors were lack of emotional support, age, poverty

OBJECTIVES/SPECIFIC AIMS: Previous studies showed that 52% of smokers were unsuccessful in quitting smoking. Smoking in alcoholics is 2-3 times that of the general population with 50%-80% of alcoholics smoking regularly. Studies have linked several genetic variants to addiction. We examined the relation between successful quitting smoking, alcohol use, and genetic data for CYP2A6, CYP2B6, DRD2, DRD1 and GABRB1 alleles. METHODS/STUDY POPULATION: We analyzed data from NHANES III 1988-1994 for socioeconomic factors, physical activity, body mass index (BMI), alcohol status, successful quit smoking, and genetic data for CYP2A6, CYP2B6, DRD2, DRD1 and GABRB1 alleles. Multivariate logistic regression was used to examine the association between successful quit smoking and genotypes adjusting for other variables. Data were analyzed using SAS version 9.3 (design & weight). RESULTS/ANTICIPATED RESULTS: Of the 2,269 smokers, 57% were current smokers, 35% were heavy drinkers, 24% were both smokers & heavy drinkers and 41% successfully quitted smoking. Successfully quit smoking was associated with CYP2A6 (rs28399433-TG) (adjusted odds ratio (AOR) = 3.6, 95% confidence interval (CI) = 1.1-11.9, p = 0.03), CYP2B6 (rs2279343-AA and AG) (AOR = 2.3, 95%CI = 1.5-3.5, p = 0.0003 for AA & AOR = 2.3, 95%CI = 1.2-4.2, p = 0.01 for AG) and DRD1 (rs4532-AA) (AOR = 2.2, 95%CI = 1.01-4.6, p = 0.04). Among heavy drinkers, those with CYP2A6 (rs28399433-TG) and CYP2B6 (rs2279343-AA and AG) were more likely to successfully quit smoking and those with CYP2A6 (rs5031017-GG) and GABRB1 (rs1442099-CC) were less likely to successfully quit smoking (p

OBJECTIVES/SPECIFIC AIMS: The aim of the study is to examine the relation between dental fluorosis, serum and water levels of fluoride and Chronic Kidney Disease (CKD) among children. A link between dental fluorosis, fluoride level and CKD can be an indicator of the blind danger of fluoride toxicity that poses a great threat to the human health. METHODS/STUDY POPULATION: Dental fluorosis, serum and water levels of fluoride and CKD were examined in children 6-19 years old, using data from the National Health and Nutrition Examination Survey1999-2012 and 2013-2016. We used multiple logistic regression to adjust for the confounders (demographics, insurance, dental visit, and co-morbidity) to assess the relation between dental fluorosis, serum and water levels of fluoride and CKD. STATA 14.0 was used to analyze the data (sample design and weight). P < 0.05 is statistically significant. RESULTS/ANTICIPATED RESULTS: The prevalence of CKD was 13.9% and dental fluorosis was 34.3%. In the multivariate model, plasma fluoride level was independently associated with CKD (Adjusted Odds Ratio (AOR) = 1.68, 95% Confidence Interval (CI) = 1.06-2.68, p = 0.029) but not with dental fluorosis (AOR = 1.4, 95% CI = 0.87-2.2, p = 0.17) or water fluoride level (AOR = 0.91, 95% CI = 0.59-1.396, p = 0.659). DISCUSSION/SIGNIFICANCE OF IMPACT: Results indicated that serum fluoride level is independently associated with CKD but dental fluorosis and water fluoride level were not related to CKD. Increase awareness and screening for fluorosis in children are needed for early detection and prevention of organ damage. Prospective studies related to fluorosis and tissue damage are needed.

Objective. The aim of this study is to describe the traumatic brain injury (TBI) population and causes and identify factors associated with TBI hospitalizations and mortality in California.Methods. This is a cross-sectional study of 61,188 patients with TBI from the California Hospital Discharge Data 2001 to 2009. We used descriptive, bivariate, and multivariate analyses in SAS version 9.3.Results. TBI-related hospitalizations decreased by 14% and mortality increased by 19% from 2001 to 2009. The highest percentages of TBI hospitalizations were due to other causes (38.4%), falls (31.2%), being of age≥75years old (37.2%), being a males (58.9%), and being of Medicare patients (44%). TBIs due to falls were found in those age≤4years old (53.5%),≥75years old (44.0%), and females (37.2%). TBIs due to assaults were more frequent in Blacks (29.0%). TBIs due to motor vehicle accidents were more frequent in 15–19 and 20–24 age groups (48.7% and 48.6%, resp.) and among Hispanics (27.8%). Higher odds of mortality were found among motor vehicle accident category (adjusted odds ratio (AOR): 1.27, 95% CI: 1.14–1.41); males (AOR: 1.36, 95% CI: 1.27–1.46); and the≥75-year-old group (AOR: 6.4, 95% CI: 4.9–8.4).Conclusions. Our findings suggest a decrease in TBI-related hospitalizations but an increase in TBI-related mortality during the study period. The majority of TBI-related hospitalizations was due to other causes and falls and was more frequent in the older, male, and Medicare populations. The higher likelihood of TBI-related mortalities was found among elderly male≥75years old who had motor vehicle accidents. Our data can inform practitioners, prevention planners, educators, service sectors, and policy makers who aim to reduce the burden of TBI in the community. Implications for interventions are discussed.

Introduction: Alzheimer’s disease (AD) is a progressive neurodegenerative disease that results in cognitive impairment. As there are no treatments available so far, identification of risk factors are crucial. A link has been proposed between defective insulin signaling in the brain and the cognitive decline observed in AD. Our purpose is to determine the relationship between homeostatic model of insulin resistance (HOMA-IR) and cognitive status among population ≥50 years. Hypothesis: Increase in insulin resistance is associated with lower cognitive status in the population ≥50 years. Methods: We analyzed data from the NHANES 1999-2002 population ≥50 years. Cognitive status was measured by the digit symbol substitution exercise score. The main independent variable was HOMA-IR. We used bivariate analysis and multiple linear regression adjusting for age, gender, race, triglyceride levels, systolic and diastolic blood pressure, total cholesterol, LDL, HDL levels, and diabetes. SAS V9.3 was used to analyze the data taking into consideration the design, strata and weight. Results: Of the 2,975 participants ≥50 years old, 45% were male and 80% were white. The mean age was 70.5+/- 0.30 years. Their average HOMA-IR was 5.0+/- 0.54 and they had a mean of 48+/-0.99 correct score in the cognitive test. Adjusting for the confounding variables, HOMA-IR was associated with decline in cognitive status (adjusted B=-0.34, 95% confidence interval=-0.58 to - 0.09, p=0.01). Significant predictors of decline in cognitive status among population ≥50 years were older age, male gender, high systolic and low diastolic blood pressure, non-white race (p=0.01). The association between HOMA-IR and decline in cognitive status was also found among non-diabetic population ≥50 years old (adjusted B=-0.54, 95% confidence interval=-1.1 to - 0.02, p=0.04). Conclusions: In the national representative sample, Insulin resistance as measured by HOMA-IR was independently associated with lower cognitive status score among participants ≥50 years and also found among non-diabetic population. Prospective studies are needed to determine the causal relationship.

Introduction: Cognitive impairment in elderly is related to Alzheimer’s disease (AD). While an association is reported between cognitive function and lifestyle, conflicting results have been reported between folate and dementia and little is known of this relationship among elderly population in a national sample. Our purpose is to determine the relationship between folate intake and cognitive status among population ≥60 years in a representative sample of the National Health and Nutrition Examination Survey (NHANES). Hypothesis: folate intake are associated with cognitive status among population ≥60 years. Methods: We analyzed data from the NHANES 1999-2002. Cognitive status was measured by the digit symbol substitution exercise score. The main independent variables were folate intake. Folate intake was categorized into tertiles. We used multiple linear regression adjusting for age, gender, race, education, obesity, physical activity and co-morbidities. SAS V9.3 was used to analyze the data taking into consideration the design, strata and weight. Results: Of the 1,249 participants, 43% were male, 83% were white, 32% had less than high school education, 33% were obese, and 49.6% were not physically active. The mean age was 70± 0.45 years. Participants had a mean of 46±0.9 correct score in the cognitive test. Adjusting for the confounding variables, folate intake was associated with cognitive score (2nd tertile adjusted B=3.3 [95% confidence interval (CI)=1.4 and 5.2], p=0.002, and 3rd tertile adjusted B=2.5 [95% CI=0.60 and 4.3, p=0.013). Conclusions: Folate intake was independently associated with cognitive status score among participants ≥60 years old. More research is needed to determine the causal association.

Smoking is a major risk factor for diabetes and cardiovascular disease and may contribute to nonalcoholic fatty liver disease. We hypothesize that in the presence of nicotine, high-fat diet (HFD) causes more severe hepatic steatosis in obese mice. Adult C57BL6 male mice were fed a normal chow diet or HFD and received twice daily injections of nicotine (0.75 mg/kg body weight, ip) or saline for 10 wk. Light microscopic image analysis revealed significantly higher lipid accumulation in livers from mice on HFD plus nicotine (190 ± 19 μm(2)), compared with mice on HFD alone (28 ± 1.2 μm(2)). A significant reduction in the percent volume of endoplasmic reticulum (67.8%) and glycogen (49.2%) was also noted in hepatocytes from mice on HFD plus nicotine, compared with mice on HFD alone. The additive effects of nicotine on the severity of HFD-induced hepatic steatosis was associated with significantly greater oxidative stress, increased hepatic triglyceride levels, higher incidence of hepatocellular apoptosis, inactivation (dephosphorylation) of AMP-activated protein kinase, and activation of its downstream target acetyl-coenzyme A-carboxylase. Treatment with acipimox, an inhibitor of lipolysis, significantly reduced nicotine plus HFD-induced hepatic lipid accumulation. We conclude that: 1) greater oxidative stress coupled with inactivation of AMP-activated protein kinase mediate the additive effects of nicotine and HFD on hepatic steatosis in obese mice and 2) increased lipolysis is an important contributor to hepatic steatosis. We surmise that nicotine exposure is likely to exacerbate the metabolic abnormalities induced by high-fat intake in obese patients.

OBJECTIVES/SPECIFIC AIMS: Examine mental health service use and its correlates among depressed group in a national sample of population≥20 years old. METHODS/STUDY POPULATION: Analysis of data for adult≥20 years old from the NHANES 2006–2012. Depression was assessed using the 9-item PHQ. The use of mental health and antidepressant drug were used to indicate the service use. We utilized multiple logistic regressions to determine the independent association between service use and each independent variable (demographics, health status, food security, chronic conditions, and depression severity) controlling for other independent variables. Data were presented as adjusted odds ratio (AOR), 95% confidence interval (95% CI), and p-value of statistical significance. p-value ofppp

We examined thein vitroanti-human immunodeficiency virus (HIV) activity of MRN-100, an iron-based compound derived from bivalent and tervalent ferrates. MRN-100 action against HIV-1 (SF strain) was tested in primary cultures of peripheral blood mononuclear cells (MNC) by analyzing p24 antigen production and percent survival of MNC infected with HIV. MRN-100 at a concentration of 10% (v/v) inhibited HIV-1 replication in 11 out of 14 samples (79%). The percentage of suppression of p24 antigen was −12.3 to 100% at 10 days post-treatment. MRN-100 also exhibited a significant protective effect in the survival of HIV-1-infected MNC. MNC survival post-treatment was dose dependent, 70.4% ± 8.4, 83.6% ± 10.7 and 90% ± 11.4, at concentrations 2.5, 5 and 10% (v/v), respectively, as compared with 53% ± 4 for HIV-1-infected MNC without treatment. The effect was detected as early as 4 days and continued up to 11 days. Treatment with MRN-100 caused no significant change in proliferative response of MNC alone or cocultured with different mitogens: PHA and Con-A (activators of T cell function) and PWM (activator of CD4+T cell-dependent B cells). We concluded that MRN-100 possesses anti-HIV activityin vitroand without an increase in lymphocyte proliferation, MRN-100 may be a useful agent for treating patients with acquired immunodeficiency syndrome.

OBJECTIVE Many studies have been published on acute pancreatitis but few, if any, on extrapancreatic manifestations (EPM) in African Americans and Hispanics. We studied the effect of EPM on mortality in these 2 ethnic groups. METHODS Records of 760 acute pancreatitis patients (417 African-American and 343 Hispanic), ages 19-85 years, over a 15-year period were reviewed retrospectively. Data were analyzed for EPM and mortality. RESULTS Of the 760 patients, alcohol use was identified as the etiology in 53% of cases and gallstones in 42%. EPM were present in 148 patients (19.5%). Gastrointestinal bleeding (22%) was the most common EPM. Patients with EPM did not differ from patients without EPM on demographics or acute pancreatitis-related variables (P > 0.05). Patients with EPM had higher odds of having comorbidity relative to patients without EPM (OR = 2.9, CI = 2.0-4.2). Of 760 patients, 109 died (14%). However, mortality was significantly higher (26%) in patients with EPM in comparison to those without EPM (11%), P = 0.001. Controlling for other variables, patients with EPM had higher odds of mortality relative to patients without EPM (OR = 2.8, CI = 1.7-4.4). CONCLUSION Mortality was high in our patients compared with the literature (5%-10%). EPM increased the mortality significantly (26%).

1 Abstract : The beneficial effects of breast feeding, both for the mother and child, are well-known. However, there is evidence that breast feeding is on the decline in many developing countries. In 1991-92, a nationwide survey was conducted in Pakistan to collect baseline health information on a variety of maternal and child health issues. Several of the survey questions addressed breast feeding practices. Survey results indicate that fewer mothers are breast feeding their children, and that mothers who do breast-feed often supplement breast milk unnecessarily and/or stop breast feeding earlier. Undesirable breast feeding practices were found to be associated with urban residence, younger mother's age, and higher educational attainment. Possible explanations for the decline in breast feeding are explored and implications for the development of more effective breast feeding promotion campaigns are discussed.

1 Abstract: Diarrhea disease continues to rank as one of the leading causes of child mortality throughout the world. It is estimated that 1 billion episodes of diarrhea occur in young children each year, The World Health Organization has recommended the use of oral rehydration solution (ORS) for the treatment of dehydration associated with diarrhea. Numerous studies have documented the effectiveness of ORS in treating diarrhea and reducing mortality. Diarrheal disease in Pakistan has been identified as the major cause of child mortality in Pakistan, accounting for an estimated 200,000 - 300,000 deaths each year. This paper reports the results of a nationwide survey conducted in Pakistan to obtain information regarding the practices of mothers concerning child health care and factors that influence these practices. The purpose of the survey was to collect baseline data on a variety of issues, in order to develop effective health education programs and evaluate ongoing ones. Within the context of two theoretical models (diffusion of innovation and stages of change), adoption practices of the population with respect to use of ORT treatment are described and assessed. These results pose new challenges to health care professionals in their ability to influence and persuade adoption of effective public health practices. Recommendations are provided as how to modify the misconceptions of mothers with young children in the treatment of diarrhea.

Background No large population-based studies have been done on systemic lupus erythematosus (SLE) mortality trends in the United States. Objective To identify secular trends and population characteristics associated with SLE mortality. Design Population-based study using a national mortality database and census data. Setting United States. Participants All U.S. residents, 1968 through 2013. Measurements Joinpoint trend analysis of annual age-standardized mortality rates (ASMRs) for SLE and non-SLE causes by sex, race/ethnicity, and geographic region; multiple logistic regression analysis to determine independent associations of demographic variables and period with SLE mortality. Results There were 50 249 SLE deaths and 100 851 288 non-SLE deaths from 1968 through 2013. Over this period, the SLE ASMR decreased less than the non-SLE ASMR, with a 34.6% cumulative increase in the ratio of the former to the latter. The non-SLE ASMR decreased every year starting in 1968, whereas the SLE ASMR decreased between 1968 and 1975, increased between 1975 and 1999, and decreased thereafter. Similar patterns were seen in both sexes, among black persons, and in the South. However, statistically significant increases in the SLE ASMR did not occur among white persons over the 46-year period. Females, black persons, and residents of the South had higher SLE ASMRs and larger cumulative increases in the ratio of the SLE to the non-SLE ASMR (31.4%, 62.5%, and 58.6%, respectively) than males, other racial/ethnic groups, and residents of other regions, respectively. Multiple logistic regression showed independent associations of sex, race, and region with SLE mortality risk and revealed significant racial/ethnic differences in associations of SLE mortality with sex and region. Limitations Underreporting of SLE on death certificates may have resulted in underestimates of SLE ASMRs. Accuracy of coding on death certificates is difficult to ascertain. Conclusion Rates of SLE mortality have decreased since 1968 but remain high relative to non-SLE mortality, and significant sex, racial, and regional disparities persist. Primary funding source None.

OBJECTIVES/SPECIFIC AIMS: To diversify the biomedical research workforce by training postdoctoral scholars and junior faculty from 6 Minority Serving Institutions (MSIs) on practical research skills such as Critical and Creative Thinking, Formulating the Problem, Asking the Right Question, Grant Writing, and Team Science METHODS/STUDY POPULATION: In collaboration with our partners, we identified 11 topics where trainees lack research funding. Next, we identified instructors for these topics. We converted the topics to online module with modules ranging from 2 to 8 weeks. In working with an online education expert, we developed innovative online training using Moodle as the content management system. Scholars complete readings, videos, self-assessments and participate in discussion board each week. In addition, we have weekly synchronous sessions for each module. All scholars are required to take the grant writing module and 8 other modules. After each module, trainees complete a brief survey to evaluate the module. The leaders at the MSI participated in an intensive face-to-face training session on how to be a career coach so that they could be career coaches for the LEADS Scholars at their home institutions. RESULTS/ANTICIPATED RESULTS: In the first year, we selected 13 LEADS Scholars. All but 3 scholars elected to take every module. The 3 scholars did not enroll in the Peer Reviewing module. Results of the brief survey at the end of each module indicate that the scholars value each of the modules and rate them very highly. When 1 scholar wanted to leave the program, we decided to have a conference call with all of the LEADS Scholars to determine what was working and what was not working with the program. All scholars recognized the value of LEADS. Some scholars felt that the weekly synchronous session was too demanding as they have competing demands on their time. We consulted with the leadership at the MSI and decided to modify the requirements of the program such that every synchronous call was not required for successful completion of the module and to earn a badge. Scholars need to have at least 9 badges to earn a certificate. In addition to the training, we decided that scholars would also benefit from mock reviews of their grants. This will help them submit successful grants. We learned that the best way to serve the needs of the scholars is to work iteratively with the scholars and leadership to develop a successful program that most effectively meets their needs of the scholars and helps them launch a successful career. DISCUSSION/SIGNIFICANCE OF IMPACT: Postdoctoral scholars and junior faculty from MSI need practical research training to help launch their research career. We suspect that this is true of many institutions and plan to develop these modules so that they can be widely disseminated to other institutions.

Purpose and Scope To produce a Spanish/English animated video about diabetes; to qualitatively assess cultural and linguistic appropriateness; and to test effectiveness at improving diabetes health literacy among Latino/Hispanics. Methods Participatory research and animation production methods guided development of the video. Cultural appropriateness was assessed through focused discussion group methods. A prospective randomized controlled trial tested the effectiveness of the Spanish version at improving diabetes health literacy, compared to “easy to read” diabetes information from the National Institute of Diabetes and Digestive and Kidney Diseases. Functional health literacy was measured by the Short Test of Functional Health Literacy in Adults. Diabetes health literacy was measured by the Diabetes Health Literacy Survey (DHLS). Results No significant differences were recorded between experimental (n = 118) and control groups (n = 122) at baseline on demographic characteristics, Short Test of Functional Health Literacy in Adults score, or DHLS score. Fifty-eight percent of the study participants had inadequate functional health literacy. Mean DHLS score for all participants and those having adequate functional health literacy were 0.55 and 0.54, respectively (inadequate diabetes health literacy). When adjusting for baseline DHLS score, sex, age, and insurance status, DHLS scores improved significantly more in the experimental group than the control group (adjusted mean = 55% vs 53%, F = 4.7, df = 1, P = .03). Interaction between experimental group and health literacy level was significant ( F = 6.37, df = 2, P = .002), but the experimental effect was significant only for participants with inadequate health literacy ( P = .009). Conclusions The positive effect on DHLS scores suggests that animation has great potential for improving diabetes health literacy among Latinos having limited functional health literacy. A study is needed that targets participants with inadequate health literacy and that uses the English and Spanish versions of the video.

Septic shock (SS) and respiratory failure (RF) are serious complications after neurosurgical procedures. Research is limited in studying racial/ethnic disparities in incidence and mortality of SS and RF. The study aimed to determine the racial variation in incidence and mortality from SS and RF among elective neurosurgical patients in California.Data were analyzed from 206 902 admissions of elective neurosurgical patients in California from 2001 to 2009. Variables included race/ethnicity, age, gender, insurance, procedure site, and co-morbidities. We used descriptive, bivariate, and multivariate statistics in SAS v9·3.Septic shock incidence was 0·30/1000/year and case fatality (CF) was 47·7%. Respiratory failure incidence was 4·7/1000/year and CF was 26·2%. Blacks had higher SS and RF (0·6 and 7·9%, respectively) compared to Whites (0·2 and 4·3%, respectively) (Chi-square, P0·01). In the adjusted logistic regression model, Blacks had higher odds of SS (Adjusted Odds Ratio [AOR] = 1·56, 95% CI = 1·16-2·10) and RF (AOR = 1·22, 95% CI = 1·11-1·33) relative to Whites. Although, Blacks had higher mortality from SS (58·9%) and RF (30·1%) compared to Whites (45·2 and 26·4%, respectively; P0·05), the AORs were not statistically significant (P0·05).Blacks had a higher incidence of SS and RF. A higher percentage of black patients died from SS-related mortality, followed by Hispanics, than other groups. The attenuation of differences after statistical adjustment suggests the excess mortality may be due to age, site of the procedures, and having neoplastic disease. Our findings support the need for prospective studies to assess specific pre-operative interventions driven by age and co-morbidities that might reduce the risk of complications after neurosurgical procedures.

Compassion is the capacity for being moved by the suffering of others and wanting to help alleviate it. Compassion may mediate the health benefits and hazards of social networks and relationships. The monitoring and management of the level of compassion across social networks and relationships may be critical to the preservation of the health benefits and the prevention of the health hazards of social networks and relationships. We developed a 10-item self-report measure of compassion and evaluated its psychometric properties among 310 respondents drawn from the University and its surrounding communities. The mean total score was 3.62 (SD=1.09). The item-to-total correlations ranged from 0.50-0.71. The mean inter-item correlation was 0.33. The internal consistency was 0.82. The scale correlated well with the Sprecher and Fehr's Compassionate Love Scale (r=0.66; p=.000). Two method factors measuring the same construct explained 57% of the variance in the sample. The scale is user-friendly, easy to score, and characterized by good psychometric properties. It can be used to foster the understanding of the impact of the level of compassion on disease occurrence and outcomes across social networks and relationships.

Background Skin tags are common cutaneous lesions with an indefinite aetiology. Objectives To assess serum leptin, insulin resistance and metabolic syndrome in different body mass index (BMI) patients with skin tags. Methods Three equally distributed groups of patients with multiple skin tags: 30 normal BMI, 30 overweight and 30 obese were included. Controls were age-, gender- and BMI-matched healthy subjects. Serum leptin, insulin resistance based on homeostasis model assessment of insulin resistance (HOMA-IR) and metabolic syndrome were assessed in all groups. Results Number and extent of skin tags increase with the increase in BMI. Highest leptin levels were found in obese patients, with significant differences when compared to normal BMI and overweight patients. Similar findings existed in controls. Significantly higher leptin levels were found in obese patients compared to obese controls. HOMA-IR was significantly higher in all groups of patients compared to BMI-counterpart controls. Seventy-one per cent of patients fulfilled criteria of metabolic syndrome. Number of skin tags, leptin and HOMA-IR were significantly higher in patients with metabolic syndrome compared to patients without the syndrome. Positive correlations were found between serum leptin and HOMA-IR in obese patients and obese controls. Positive correlations were also found between number of skin tags and waist circumference in all groups of patients. Conclusions Serum leptin displays an association with obesity and insulin resistance. Assessment of HOMA-IR in patients with skin tags may serve as a useful approach for diagnosis of insulin resistance. Waist circumference is the only criteria of metabolic syndrome that correlates with number of skin tags.

To compare sitagliptin and thiazolidinediones as third-line oral antihyperglycemic agents among ethnic minority patients with poorly controlled type 2 diabetes mellitus.In an open-label, single-arm design, we treated type 2 diabetic patients who had suboptimal diabetes control on maximum tolerated dosages of metformin plus sulfonylureas with the addition of sitagliptin, 100 mg daily, and compared their responses with findings from a historical control group of similar patients treated with rosiglitazone, 8 mg daily, or pioglitazone, 45 mg daily, as their third-line oral agent. Patients were assessed bimonthly, and those who achieved hemoglobin A1c levels less than 7.5% at 4 months continued through 1 year of follow-up.One hundred eight patients were treated with sitagliptin, and 104 patients constituted the historical control group treated with rosiglitazone or pioglitazone. At baseline, sitagliptin- and thiazolidinedione-treated patients had identical hemoglobin A1c levels (mean ± SD) (9.4 ± 1.8% and 9.4 ± 1.9%, respectively) and similar known diabetes duration (6.7 ± 5.0 years and 7.6 ± 5.8 years, respectively). Hemoglobin A1c was reduced in both groups at 4 months (P.001), but the reduction was greater with thiazolidinediones than with sitagliptin (-2.0 ± 1.7% vs -1.3 ± 1.8%; P = .006), as was the proportion of patients achieving a hemoglobin A1c level less than 7.5% (62% vs 46%; P = .026). Of all patients achieving a hemoglobin A1c level less than 7.5% at 4 months, the same proportions in each group sustained their hemoglobin A1c level less than 7.5% by 12 months (59% vs 58%). Sitagliptin was well tolerated.Among ethnic minority patients with poorly controlled type 2 diabetes while taking maximum tolerated dosages of metformin and sulfonylureas, third-line add-on therapy with a thiazolidinedione controlled hyperglycemia more effectively than sitagliptin after 4 months.

This study examined the efficacy of arabinoxylan rice bran (MGN-3) in conjunction with an interventional therapy (IT) for the treatment of hepatocellular carcinoma patients.A total of sixty-eight patients with hepatocellular carcinoma (stages I and II) participated in the study. Patients were randomized to receive IT (30 patients, control group) or IT+MGN-3 (38 patients), and randomly divided into two groups using a computer-generated randomization list. Patients and investigators were blinded. IT included transarterial oily chemoembolization (TOCE) or a combination of TOCE and percutaneous ethanol injection treatment (PEIT).Patients in the IT+MGN-3 group showed: (i) lower recurrence of the disease, 31.6% (12/38), as compared to 46.7% (14/30) for the control; (ii) higher survival after the second year, 35%, as compared to 6.7% for the control; (iii) significantly lower alpha-fetoprotein level, a 38% decrease (p = 0.0001), as compared to baseline value, while the control showed no significant change; and (iv) a significant decrease in tumor volume, in contrast to the control, which showed no significant change. When the results were analyzed according to each IT modality, MGN-3+IT sub-groups displayed a greater response to treatment, in every aspect examined, than the IT sub-groups alone. However, the patients in the MGN-3+TOCE+PEIT sub-group demonstrated greater reduction in AFP levels and longer survival time than the MGN-3+TOCE sub-group.MGN-3 in conjunction with IT may be useful for the treatment of hepatocellular carcinoma and warrants further investigation in multiple clinical trials.

OBJECTIVES To assess the effect of a multicomponent intervention on parental knowledge, sun avoidance behaviors, and sun protection practices in children 3-10 years. METHODS A randomized trial at a pediatric clinic recruited 197 caregiver-child pairs (90% parents). Intervention included a brief presentation and brochure for the parent and educational video and sun protection incentives for the child. RESULTS Significant improvements were observed in sun protection practices and parental knowledge but not in sun avoidance behaviors. CONCLUSIONS Although results support the intervention's effect on parent-child pairs for sun protection practices and parental knowledge, increasing sun avoidance behaviors may require further study.

Summary Background Acne vulgaris is one of the commonest dermatological diseases and its pathogenesis is multifactorial. Objectives To determine the role of oxidative stress in acne vulgaris and to determine a possible link with the clinical severity. Methods Twenty-three patients with different grades of acne vulgaris and 23 age- and sex-matched controls were enrolled. Superoxide dismutase (SOD) activities and malondialdehyde (MDA) levels were measured spectrophotometrically at tissue and blood levels. Results There were no significant differences in SOD activities and MDA levels between patients and controls. However, significant differences were found in patients with severe acne in comparison with those with mild and moderate acne. Moreover, comparison between different patient subgroups and controls revealed statistically significantly higher SOD activities in patients with mild acne in comparison with patients with moderate and severe acne, and with controls. Furthermore, severe acne showed statistically significantly lower SOD activities and higher MDA levels when compared with other patient subgroups and controls. Conclusions Oxidative stress exists in patients with acne vulgaris and may play a role in aetiopathogenesis and/or progression of the disease. The addition of drugs with antioxidative effects seems to be valuable in the treatment of acne vulgaris.

Although abnormalities in hepatic biochemical tests are common in patients with acquired immunodeficiency syndrome (AIDS), overt jaundice is infrequent. The aim of this study was to investigate the etiology and outcome of jaundice in African-American and Hispanic patients with AIDS. We retrospectively reviewed medical records of 1,238 HIV-infected patients with abnormal liver chemistry over a 10-year period. Data were abstracted and analyzed for demography, medications, laboratory tests, abdominal ultrasonography, computerized tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC) and liver biopsy results. Of 1,238 patients with abnormal liver chemistry and HIV infection, 1,040 (84%) had AIDS. Of the 1,040 AIDS patients, 102 (10%) had jaundice (serum bilirubin >3 mg/dL). Of the 198 HIV-positive patients without AIDS and with abnormal liver chemistry, none had jaundice. The common causes of jaundice were drugs (29%) and infections (28%). Liver biopsy was performed in 20 AIDS patients, and the common findings included granulomas, Mycobacterium avium complex (25%) and Kaposi's sarcoma (25%). Of 102 patients with AIDS and jaundice, 72 (70%) died. Of the 198 patients without AIDS and without jaundice, 14 (7%) died. In conclusion, liver-associated enzyme abnormality was common among our patients with AIDS; however, jaundice was infrequent and associated with a high mortality; drugs, infections and alcohol were the common culprits.

To compare the percentage of diabetics admitted to the hospital due to hypoglycemia in 1990-1993 (period 1) to that in 1997-2000 (period 2).We analyzed data from the California Hospital Discharge Data Program. Eligibility included diabetic (ICD code 250) subjects agedor =25 years old who were hospitalized due to hypoglycemia (ICD Codes 250.8) during the periods 1990-1993 and 1997-2000. Data were analyzed by demographics and health insurance status.Of the 2,905,091 hospitalized diabetics, 50,017 (1.7%) were due to hypoglycemia. The percentage of hospitalization due to hypoglycemic varied by sex, age, race/ethnicity, and insurance status (P = .0001). Male, Hispanic, age 25-64 years, with Medical/Medicare insurance had higher odds of being hospitalized due to hypoglycemia relative to other groups (P.001). The percentage of diabetics hospitalized due to hypoglycemia increased from period 1 to period 2 (1.3% vs. 2.0%, P = .0001). Diabetics hospitalized in period 2 had higher adjusted odds of being hospitalized due to hypoglycemia relative to those admitted in period 1 (OR = 1.6, P.0001).Our data show an increase in the hospitalization due to hypoglycemia in diabetic patients. Enhanced patient education about self-monitoring of blood sugar and recognizing and treating the symptoms of hypoglycemia may help to minimize hypoglycemic hospitalizations.

BACKGROUND: Clostridium difficile-associated diarrhea (CDAD) has been increasingly diagnosed in hospitalized patients. The number of prescriptions for proton pump inhibitors (PPIs) has also increased significantly over time. Few studies have reported an association between CDAD and PPI use; however, the results are inconclusive. OBJECTIVE: To determine the relationship between CDAD and PPI use in African-American and Hispanic patients. METHODS: We retrospectively reviewed medical records of 640 cases with CDAD over nine years, diagnosed by the presence of C. difficile toxin in the stools. Age-/ sex-matched 650 patients with diarrhea but absent C. difficile toxin in stools were used as controls. RESULTS: Of the 640 cases, 576 (90%) received antibiotics and 32 (5%) received chemotherapy during the preceding three months. Of the 650 controls, 540 (83%) received antibiotics and 39 (6%) received chemotherapy during the preceding three months. CDAD was associated with the use of antibiotics or chemotherapy (OR = 2.3, 95% CI: 1.5-3.7). Of the 608 cases receiving antibiotics or chemotherapy, 274 (45%) also received PPI within the preceding three months. Of the 579 controls who received antibiotics or chemotherapy, 169 (29%) also received PPI within preceding three months. CDAD was associated with the use of PPI (OR = 2.0, 95% CI: 1.6-2.6). CONCLUSION: Our findings indicate that PPI may be an emerging and potentially modifiable risk factor for CDAD and point out the importance of vigilance in prescribing PPI, particularly to patients who are hospitalized, taking multiple antibiotics and suffering from multiple comorbidities.

Studies have shown that hepatitis C (HCV) is associated with type 2 diabetes mellitus (DM2) possibly due to insulin resistance and inflammation. Metabolic syndrome is a risk factor for DM2. Our objectives were to assess the relationship between HCV and metabolic syndrome and inflammatory markers. We used data from The Third National Health Nutrition and Examination Survey (NHANES-III). We excluded pregnant women, subjects with diabetes, those taking non-steroidal anti-inflammatory drugs, and those diagnosed with concomitant infection. We analyzed the data controlling for demographic variables, body mass index, use of contraceptives, had arthritis, and had gout. Among the 10,383 subjects, 2.3% had HCV and 16.7% had metabolic syndrome using the ATP III criteria. After controlling for the confounders, HCV was not associated with metabolic syndrome but associated with HOMA insulin resistance and inflammatory marker ferritin. Among subjects with both HCV and metabolic syndrome, the adjusted HOMA insulin level was higher than those without HCV and metabolic syndrome. In addition, the serum ferritin level was a strong predictor of HOMA insulin resistance. In clinical practice, serum ferritin can be obtained along with routine blood tests in any laboratory, and it has a potential to be a surrogate marker of insulin resistance in people with HCV and metabolic syndrome.

National surveillance for ectopic pregnancy (EP), the primary cause of maternal death in the first trimester, began in 1970. EP rates peeked during the late 1980s and have been highest for African Americans. However, limited reports on EP rates exist for other racial/ethnic groups.To report state-level, multicultural trends in EP rates from 1991 to 2000.Secondary data analysis of the California hospital discharge database collected by the Office of Statewide Health Planning and Development by using codes 633.0-633.9, from the International Classification of Diseases, Ninth Revision. EP rates are reported per 1000 pregnancies.From 1991 to 2000, 62,839 EP were reported in California. Mean EP rate was 11.2/1000, decreased from 15/1000 to 9.3/1000, and varied significantly by race/ethnicity and age. EP rates were highest among African Americans (25/1000) and lowest among Hispanics (7.7/1000); African Americans had higher odds of having EP relative to non-Hispanic Whites (odds ratio [OR] 2.14, 95% confidence interval [CI] 2.09-2.19). Women 35-44 years of age had the highest EP rates (17.6/1000) and higher odds of having EP compared to other age groups (OR 2.45, 95% CI 2.39-2.50). The highest rate of EP was found among African Americans 35-44 years of age (43.1/1000).The study showed declining EP rates in California for all groups but highlights disparities in EP rates and the attenuated rate of decline for African Americans, which places them at highest risk of death in the first trimester. This study demonstrates the usefulness of analyzing state-level data that may differ from aggregated national data when studying culturally diverse populations.

To determine the upper gastrointestinal (UGI) toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs), in African-American and Hispanic elderly patients.Inner-city community hospital.Retrospective review of records of 698 patients, 65 to 101 years old. Upper gastrointestinal (UGI) symptoms and history of NSAIDs consumption were recorded over a 12-year period. Twenty White and 25 Asian patients were excluded. Another 101 patients were excluded because of incomplete data or because endoscopy was not performed. Patients were stratified as NSAID-users or non-users, and the data were analyzed.Among the 552 patients, the most common lesion was gastro-duodenal erosions (34%), while common symptoms were abdominal pain (71%) and bleeding (54%). Both lesions and symptoms were higher among NSAID-users than non-users (P.05). Endoscopic therapy was given to 296 patients, and was successful in stopping the bleeding and/or delaying surgery in 70% of the patients. Helicobacter pylori tests were done in 238 patients, and were positive in 47% of the patients. Overall 144 deaths occurred (26%). Mortality was significantly higher among elderly patients who used NSAIDs compared to those who did not use them (P.05).Our study suggests a higher association between NSAID use and UGI toxicity than is reported in current literature. Patients suffering from UGI toxicity of NSAIDs may remain asymptomatic until complications occur, therefore a high index of suspicion and a low threshold for endoscopy are essential, especially in elderly patients. Avoiding NSAIDs whenever possible, substituting less toxic COX-2 inhibitors, monitoring risk, and providing cotherapy with proton pump inhibitors (PPI), or misoprostol, as suggested in the literature, may decrease NSAIDs associated morbidity and mortality in this patient population.

▪ Abstract Rapid, small surveys are routinely done in much of the developing world but are less common in the United States. We present as an example a rapid survey of immunization status and other factors in a predominantly Hispanic region in Los Angeles. The survey united county employees, students, and community volunteers, first to enumerate the eligible population and then to conduct in-person interviews. Sampling was done in two stages in a downtown region of Los Angeles. Over the course of two weekends and during clean-up the following week, volunteers and others enumerated 718 eligible children in 30 clusters (i.e. groups of blocks). At the second stage, also in two weekends with midweek clean-up, we selected by simple random sample 10 children per cluster. The parents or legal guardians of 270 children were interviewed about vaccination issues, including home presence of an immunization card. Nearly one fourth of the respondents did not have a home telephone number and thus would have been underrepresented in a telephone survey. Information from such rapid surveys is important for local program planning and evaluation.

PURPOSE: To assess the immunization status of young children in a predominantly Hispanic region in and around downtown Los Angeles, and factors associated with complete immunization by age 24 months. METHODS: The information was gathered in a two-stage cluster survey with probability proportionate to estimated size (PPS) sampling of 30 clusters at the first stage, and simple random sampling of a constant number of children at the second stage. Vaccination coverage was determined by a review of the home immunization (HI) card, or of clinic records. RESULTS: Of the 270 sampled children, 91.5% were Hispanic and 6.7% were Black. Home telephone numbers were not available in 24.8% of the homes, and 34.1% reported having no health insurance. Vaccination coverage was over 90% for the first three doses of Diphtheria, tetanus toxoids and pertussis/diphtheria, tetanus toxoids and acellular pertussis vaccine (DTP/DTaP)/Diphtheria and tetanus toxoids vaccine (DT), first two doses of poliovirus (Polio) vaccine, first dose of measles, mumps and rubella (MMR) vaccine, and first two doses of hepatitis B (Hep B) vaccine. Yet, by age 24 months, only 72.2% of the children had received the combined series of 4:3:1 (i.e., four DTP/DTaP/DT, three Polio, one MMR). This was further reduced to 64.4% for the combined series of 4:3:1:3:3 (i.e., four DTP/DTaP/DT, three Polio, one MMR, three Haemophilus influenzae type b (Hib), three Hep B). Factors associated with completed on-time vaccination were having an HI card available during the interview and being enrolled in Supplemental Nutrition Program for Women, Infants and Children (WIC). CONCLUSIONS: While vaccination levels for individual antigens were found to be high, more emphasis needs to be placed on getting preschool children vaccinated on-time according to the Recommended Childhood Immunization Schedule.

In the title compound, C19H25NO2, the 3-ethoxy-2-hydroxybenzaldehyde group is almost planar (r.m.s. deviation = 0.029 Å). An intramolecular O—H...N hydrogen bond generates anS(6) ring. There are no intermolecular hydrogen bonds.

Objective To determine the association between diabetes mellitus (DM) and marijuana use. Design Cross-sectional study. Setting Data from the National Health and Nutrition Examination Survey (NHANES III, 1988–1994) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. Participants The study included participants of the NHANES III, a nationally representative sample of the US population. The total analytic sample was 10 896 adults. The study included four groups (n=10 896): non-marijuana users (61.0%), past marijuana users (30.7%), light (one to four times/month) (5.0%) and heavy (more than five times/month) current marijuana users (3.3%). DM was defined based on self-report or abnormal glycaemic parameters. We analysed data related to demographics, body mass index, smoking status, alcohol use, total serum cholesterol, high-density lipoprotein, triglyceride, serum 25-hydroxy vitamin D, plasma haemoglobin A1c, fasting plasma glucose level and the serum levels of C reactive protein and four additional inflammatory markers as related to marijuana use. Main outcome measures OR for DM associated with marijuana use adjusted for potential confounding variables (ie, odds of DM in marijuana users compared with non-marijuana users). Results Marijuana users had a lower age-adjusted prevalence of DM compared to non-marijuana users (OR 0.42, 95% CI 0.33 to 0.55; p0.5 mg/dl) was significantly higher (p, Article summary Article focus We hypothesised that the prevalence of DM would be reduced in marijuana users due to the presence of one or more cannabinoids because of their immunomodulatory and anti-inflammatory properties. Key messages Marijuana use was associated with a decreased prevalence of DM. Prospective studies in rodents and humans are needed to determine a causal relationship between cannabinoid receptor activation and DM. Until those studies are performed, we do not advocate the use of marijuana in patients at risk for DM. Strengths and limitations of this study Population-based national representative sample of the USA. Cross-sectional data. Marijuana use was based on self-report, and self-report of illicit substances is often underestimated on self-reports. Self-report is subjected to recall bias. However, we expect that recall bias would be similar in those with DM as those without DM and would be unlikely to bias our results. Although current marijuana users were divided into heavy and light users based on the number of times they reported using marijuana per month, the amount of marijuana consumed, route of consumption (inhaled vs oral), duration of use and time when they quit were not reported.

In a retrospective survey of patients with fractures and dislocations attending the Accident department of a District General hospital, comparison was made between patients with fractures and dislocations in the hand and fractures and dislocations of other sites. Patients with hand injuries accounted for 28% of the total patients seen. They were more likely than other fracture patients to be male and between the ages of 10 and 40 years. Almost a quarter of hand injuries attended on Monday. Leisure activities outside the home formed the commonest aetiological factor. Only 66% of patients with hand injuries attended the Accident department within 24 hours of injury. The little finger was the commonest site of injury. This survey emphasizes the differences between hand injuries and injuries of other sites, identifies the risk factors for hand injuries and has implications for the management of hand injuries in a District General Hospital.

Introduction: Breast cancer (BC) is the most commonly diagnosed cancer among women in the United States. Immigrant underrepresented women are facing many challenges and barriers to knowledge, access to health care and preventive services. Few studies have examined factors associated with mammography screening among immigrant women in Southern California. Purpose: We examined factors associated with mammography screening among immigrant women in Southern California. Methods: A cross-sectional study of 517 immigrant women aged 40 years and older. The instrument included constructs from the Health Belief Model. The survey was conducted using a self administered questionnaire in the women's preferred language. The outcome variables were the percentage of women ages 40 and older who ever received a mammogram and the percentage of women who received a mammogram within the past year. Independent variables were demographics, frequency of visits to health care provider, and scores of the following variables: knowledge of BC symptoms and BC risk factors, perceived benefits, perceived health motivation and perceived barriers to obtaining a mammogram. We analyzed data using SPSS 15. Results: of the 517 women, 50% were Iranian, 15% were Arab, and 21% were Asian/South Asian. Twenty eight percent had family history of BC, 63% had a friend diagnosed with BC, and 47% had yearly visit to the health care provider. Ever had a mammogram was reported by 88% of the women and 73% reported they had mammogram within the last 12 months. Participants had low knowledge of BC symptoms (mean score=7, Standard Deviation [SD]=3.5, range=1-13) and low knowledge of BC risk factors (mean score=8, SD=3.6, range=1-21). Women showed high health motivation (mean score=4.4, SD=0.6, range=1-5) and low barriers (mean score=2.4, SD=0.6, range=1-5). Predictors of ever had a mammogram were age, having a friend who was diagnosed with BC, and having a high score of health motivation. Factors associated with having a mammogram within the past year were having frequent visits to the health care provider, having a higher score in knowledge of BC symptoms, and having a lower score of perceived barriers to obtaining a mammogram. Conclusions: The findings indicated that health care provider may influence the BC screening among immigrant women. There is a need for a culturally sensitive educational intervention to enhance the knowledge and awareness related to BC. This intervention can be provided through the health care provider and through the social support and family groups. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 864.

Objective To examine racial and ethnic differences in unmet need for vision care among children with special health care needs. Methods Cross-sectional data from the National Survey of Children with Special Health Care Needs were analyzed. The analytic sample was 14 070 children with special health care needs who needed eyeglasses or vision care in the previous year. Children who did not receive all the eyeglasses or vision care they needed were considered to have unmet need for vision care. Results Of the sample, 5.8%, representing approximately 198 600 children with special health care needs in the United States, had unmet need for vision care. Rates of unmet need ranged from 2.5% to 14.3% across the 7 racial and ethnic groups studied. Relative to whites, children of African American, Latino, and multiracial backgrounds had approximately twice the adjusted risk of unmet need, whereas American Indian or Alaskan Native children had a lower adjusted risk. Health care providers, school personnel, insurance coverage, and other factors also contributed to differences in the risk of unmet need, independently of child race/ethnicity. Conclusion Further research is needed to explain and address the causes of racial and ethnic differences in unmet need for vision care among children with special health care needs.

Background and purpose Severe acute pancreatitis occurs in about 10% of cases of acute pancreatitis, and is associated with high mortality. Many studies have been published about acute pancreatitis and organ failure, but few address this issue among African Americans and Hispanics. As most of our patients belong to these two ethnic groups, we studied the relationship between acute pancreatitis and organ failure in this population. Methods Our study included all patients diagnosed with acute pancreatitis over 15 years. Medical records of 760 (417 African American & 343 Hispanic) patients, ages 19–85 years were reviewed retrospectively. We abstracted and analyzed data related to demographics, etiology and type of pancreatitis, organ failure, and mortality. Results Of the 760 patient, 47% were male, 42% had biliary stones, 18% had necrotizing pancreatitis, and 24% had organ failure. Of the 182 patients with organ failure, 125 patients (69%) had multiple organ failure, whereas 57 patients (31%) had dysfunction of a single organ system. Cardiovascular system failure was the most common organ dysfunction (26%) among patients with single organ failure. The occurrence of organ failure varied significantly by age and type of pancreatitis (P 0.05). Of the 760 patients, 109 patients (14.3%) died. Patients with organ failure had a higher mortality (34%) compared with those without organ failure (6%) (OR = 23.7, 95% CI = 13.7–41.2) Mortality was higher among those with multiple organ failure (38%) compared with those with single organ failure type (25%). Mortality varied significantly by type of organ failure, being highest among those with pulmonary dysfunction (60%), followed by central nervous system dysfunction (36%) (P = 0.003). Conclusion Organ failure is a serious complication in patients with acute pancreatitis. Patients with multiple organ failure and those with pulmonary failure have higher mortality relative to other groups. Prevention and active treatment of organ failure may improve the outcome of patients with acute pancreatitis.