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Gender norms have been posited to impact intimate partner violence (IPV), but there is scant evidence of the longitudinal association between community-level gender norms and IPV. Using longitudinal data on 3,965 married girls surveyed in India, we fitted mixed-effects ordinal and binary logistic regression models for physical IPV intensity and occurrence of sexual IPV. We found a 26% increase in the odds that women experience frequent physical IPV per one unit increase in greater community-level equitable gender norms. We did not find an association between community-level equitable gender norms and sexual IPV. Findings suggest that the relationship between gender norms and physical and sexual IPV differs, indicating the need for tailored interventions for different types of IPV., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Ultraprocessed foods (UPFs) comprise >50% of United States adults' energy intake, with the proportion of calories from UPFs increasing over time and the proportion of unprocessed/minimally processed foods (MPFs) decreasing over time. Whether UPFs are primarily consumed at home (AH) or away from home (AFH) is important to inform policies and messages to improve dietary quality., Objectives: We examined trends in consumption of UPFs and MPFs AH and AFH in a nationally representative sample of United States adults and within sociodemographic subgroups., Methods: Data are from 34,628 adults (aged ≥20 y) with two 24-h dietary recalls from the 2003-2018 National Health and Nutrition Examination Survey. We examined trends over time in intake from MPFs and UPFs as a proportion of total energy intake and as a proportion of AH energy intake and AFH energy intake using generalized linear models adjusted for sex, age, race/ethnicity, education, and household income. We examined differences in trends by sociodemographic subgroups using interaction terms and stratified models., Results: Overall, and for most demographic subgroups, UPFs comprised >50% of AH energy intake and >50% of AFH energy intake, with UPFs increasing and MPFs decreasing over time as a proportion of energy intake AH and AFH. The proportion of total energy intake from UPFs increased for food consumed AH (33.6%-37.1%, P-trend < 0.001), but not for UPFs consumed AFH (19.5%-18.8%, P-trend = 0.88). From 2003-2004 to 2017-2018, the proportion of total energy intake from MPFs declined for foods consumed AH (23.6%-20.8%, P-trend <0.001) and AFH (9.7%-7.5%, P-trend <0.001). Interaction terms testing differences in trends of MPF and UPF intake AH and AFH by sociodemographic subgroups were mostly nonsignificant., Conclusions: Findings highlight the ubiquity and increasing proportion of UPFs in United States adults' diets regardless of whether foods are consumed AH or AFH., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Background: Evidence is limited as to whether outcomes differ between patients with tricuspid regurgitation (TR) treated with tricuspid transcatheter edge-to-edge repair (T-TEER) versus surgical tricuspid valve repair. We aimed to compare outcomes between these 2 approaches., Methods: We analyzed the data on Medicare fee-for-service beneficiaries aged 65 to 99 years with TR who underwent T-TEER or isolated surgical repair between July 2016 and December 2020. The primary outcome was 2-year all-cause mortality. Other outcomes included in-hospital mortality and permanent pacemaker implantation as well as 2-year heart failure hospitalization and tricuspid valve reintervention. A propensity score matching weight analysis was used to adjust for potential confounders., Results: A total of 1143 patients were included (409 T-TEER versus 734 surgery). The proportion of T-TEER cases increased from 2% in the third quarter of 2016 to 67% in the last quarter of 2020 among all isolated TR procedures. After adjustment for potential confounders, we found no evidence that 2-year all-cause mortality differs between patients treated with T-TEER versus surgical repair (adjusted hazard ratio, 0.84 [95% CI, 0.63-1.13]). Patients treated with T-TEER experienced lower in-hospital mortality (2.5% versus 12.5%, P <0.001) and permanent pacemaker implantation rates (0.0% versus 12.7%, P <0.001) than those treated by surgical repair. At 2 years, we found no differences in heart failure hospitalizations, but tricuspid valve reinterventions were more frequent in the T-TEER group (subdistribution hazard ratio, 8.03 [95% CI, 2.87-22.48])., Conclusions: Among Medicare beneficiaries with TR, the 2-year mortality rate was comparable between T-TEER and surgical repair. T-TEER showed advantages in perioperative outcomes, including lower in-hospital mortality and pacemaker implantation rates, whereas tricuspid valve reinterventions were more frequent in the T-TEER group. Further studies are necessary to refine indications, patient selections, and optimal timing for intervention with either treatment strategy., Competing Interests: Dr Latib has been a consultant and serves on the Advisory Board of Medtronic, Abbott, Boston Scientific, Edwards Lifesciences, V-Dyne, NeoChord, Nyra Medical, Tioga, Shifamed, and Philips. Dr Kaneko has received consulting fees from Edwards Lifesciences, Medtronic, 4C Medical, CardioMech, and Cook Medical; and has been a speaker for Abbott and Baylis. Dr Zajarias has received consulting fees from Edwards Lifesciences. Dr Elmariah has received consulting fees from Edwards Lifesciences and Medtronic. Dr Takayama has received consulting fees from Artivion and Edwards Lifesciences. Dr Tsugawa serves on the board of directors of M3, Inc. Study sponsors were not involved in study design, data interpretation, writing, or the decision to submit the manuscript for publication. The other authors report no conflicts.

Introduction: Unexpected out-of-pocket (OOP) costs for preventive care reduce future uptake. Because adherence to service guidelines differs by patient populations, understanding the role of patient demographics and social determinants of health (SDOH) in the incidence and size of unexpected cost-sharing is necessary to address these disparities. This study examined the associations between patient demographics and cost-sharing for common preventive services., Methods: This cross-sectional study used a national sample of insurance claims for recommended preventive services provided to privately insured adult patients between 2017 and 2020. The relationships between patient demographics and OOP costs were adjusted for service type, insurance type, geographic location, and time trends using regression analysis. Analyses were conducted in 2024., Results: The sample included 1,736,063 unique preventive care encounters of 1,078,010 individuals. Among preventive encounters, 40.3% resulted in OOP costs. Lower-educated patients had 9.4% (OR=1.094; 95% CI=1.082, 1.106) higher odds of incurring OOP costs than patients with college degrees. Low-income patients (annual household income of $49,999 or less) had 10.7% (OR=0.893; 95% CI=0.880, 0.906) lower odds of incurring OOP costs than high-income patients. Conditional on incurring costs, lower educated patients paid $15.07 (95% CI= -$15.24, -$14.91) less than higher educated patients, and low-income patients paid $11.76 (95% CI=$11.58, $11.95) more than high-income patients. Significant differences across racial and ethnic groups were observed., Conclusions: The likelihood and size of OOP costs for preventive care varied considerably by patient demographics; this may contribute to inequitable access to high-value care., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The lack of automated tools for measuring care quality limits the implementation of a national program to assess guideline-directed care in heart failure with reduced ejection fraction (HFrEF)., Objectives: The authors aimed to automate the identification of patients with HFrEF at hospital discharge, an opportunity to evaluate and improve the quality of care., Methods: The authors developed a novel deep-learning language model for identifying patients with HFrEF from discharge summaries of hospitalizations with heart failure at Yale New Haven Hospital during 2015 to 2019. HFrEF was defined by left ventricular ejection fraction <40% on antecedent echocardiography. The authors externally validated the model at Northwestern Medicine, community hospitals of Yale, and the MIMIC-III (Medical Information Mart for Intensive Care III) database., Results: A total of 13,251 notes from 5,392 unique individuals (age 73 ± 14 years, 48% women), including 2,487 patients with HFrEF (46.1%), were used for model development (train/held-out: 70%/30%). The model achieved an area under receiver-operating characteristic curve (AUROC) of 0.97 and area under precision recall curve (AUPRC) of 0.97 in detecting HFrEF on the held-out set. The model had high performance in identifying HFrEF with AUROC = 0.94 and AUPRC = 0.91 on 19,242 notes from Northwestern Medicine, AUROC = 0.95 and AUPRC = 0.96 on 139 manually abstracted notes from Yale community hospitals, and AUROC = 0.91 and AUPRC = 0.92 on 146 manually reviewed notes from MIMIC-III. Model-based predictions of HFrEF corresponded to a net reclassification improvement of 60.2% ± 1.9% compared with diagnosis codes (P < 0.001)., Conclusions: The authors developed a language model that identifies HFrEF from clinical notes with high precision and accuracy, representing a key element in automating quality assessment for individuals with HFrEF., Competing Interests: Funding Support and Author Disclosures This study was supported by research funding awarded to Dr Khera by the Yale School of Medicine and grant support from the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) under the award K23HL153775. Dr Ahmad is a consultant for Sanofi Aventis, Amgen, and Cytokinetics; and has received research funding from Boehringer Ingelheim, AstraZeneca, Cytokinetics, and Relypsa. Dr Nadkarni has consultancy agreements with AstraZeneca, BioVie, GLG Consulting, Pensieve Health, Reata, Renalytix, Siemens Healthineers and Variant Bio; has received research funding from Goldfinch Bio, and Renalytix; has received honoraria from AstraZeneca, BioVie, Lexicon, Daiichi Sankyo, Meanrini Health, and Reata; has patents or royalties with Renalytix; owns equity and stock options in Pensieve Health and Renalytix as a scientific cofounder; owns equity in Verici Dx; has received financial compensation as a scientific board member and advisor to Renalytix; has served on the advisory board of Neurona Health; and has served in an advisory or leadership role for Pensieve Health and Renalytix. Dr Ahmad has received grants from the Agency for Healthcare Research and Quality, NIH/NHLBI, and American Heart Association; and has received personal fees from Teladoc, Livongo, and Pfizer, outside of the submitted work. Dr Krumholz works under contract with the Centers for Medicare and Medicaid Services to support quality measurement programs; was a recipient of a research grant from Johnson and Johnson, through Yale University, to support clinical trial data sharing; was a recipient of a research agreement, through Yale University, from the Shenzhen Center for Health Information for work to advance intelligent disease prevention and health promotion; collaborates with the National Center for Cardiovascular Diseases in Beijing; receives payment from the Arnold and Porter Law Firm for work related to the Sanofi clopidogrel litigation, from the Martin Baughman Law Firm for work related to the Cook Celect IVC filter litigation, and from the Siegfried and Jensen Law Firm for work related to Vioxx litigation; chairs a Cardiac Scientific Advisory Board for UnitedHealth; was a member of the IBM Watson Health Life Sciences Board; is a member of the Advisory Board for Element Science, the Advisory Board for Facebook, and the Physician Advisory Board for Aetna; and is the cofounder of Hugo Health, a personal health information platform, and cofounder of Refactor Health, a health care AI-augmented data management company. Dr Khera is an Associate Editor of JAMA; receives support from the NHLBI of the NIH (under awards R01HL167858 and K23HL153775) and the Doris Duke Charitable Foundation (under award 2022060); has received research support, through Yale, from Bristol Myers Squibb, Novo Nordisk, and BridgeBio; is a coinventor of U.S. Pending Patent Applications 63/562,335, 63/177,117, 63/428,569, 63/346,610, 63/484,426, 63/508,315, and 63/606,203; and is a co-founder of Ensight-AI, Inc and Evidence2Health, health platforms to improve cardiovascular diagnosis and evidence-based cardiovascular care. Dr Nargesi has received funding from the NHLBI under award number T32HL007604. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025. Published by Elsevier Inc.)

Background: There have been over 670 million confirmed cases of SARS-CoV-2 infection globally, resulting in over 6.87 million deaths. With approximately 0.1 %-6.8 % experiencing reinfection. This retrospective cohort study aimed to compare the risk of short-term circulatory and respiratory sequelae between SARS-CoV-2 reinfection and initial infection, and assess the impact of vaccination., Method: Data from the TriNetX US Collaborative network (2020-2022) were used to create two cohorts based on reinfection status. The main outcome assessed were medical utilization, circulatory and respiratory symptoms, and circulatory and respiratory diseases. The Kaplan-Meier method was used to compare the risks between two cohorts. Four subgroup analyses (vaccination status, age, sex, race) and six sensitivity analyses (rigorous definition, modified exclusion criteria, treatment, different COVID-19 variants timeline, address survivorship bias, and E-value calculation) were also conducted., Results: The reinfection cohort showed a significant reduction in medical utilization [ Hazard ratio, HR: 0.867, (95 % confidence interval, CI:0.839-0.896) for hospitalization, 0.488 (0.418-0.570) for critical care services, and 0.476 (0.360-0.629) for mechanical ventilation], lower risk of circulatory diseases [ HR: 0.701 (95 % CI:0.637-0.772), 0.695 (0.583-0.829), 0.660 (0.605-0.719), 0.741 (0.644-0.854), 0.614 (0.535-0.705), and 0.758 (0.656-0.876) for ischemic heart disease, inflammatory heart disease, dysrhythmias, venous thromboembolism, other cardiac disorders, and cerebrovascular diseases, respectively], and lower risk of respiratory diseases such as pneumonia, other acute lower respiratory infections, asthma, and hypoxemia [HR: 0.302 (95 % CI: 0.273-0.333), 0.811 (0.686-0.958), 0.791 (0.735-0.850), and 0.392 (0.338-0.455), respectively]. The vaccinated reinfection cohort showed no significant differences in medical utilization, circulatory diseases, or respiratory conditions but had a higher risk of breathing abnormalities. breathing abnormalities [HR: 1.195 (95 % CI:1.087-1.313)]., Conclusions: The individuals who experienced reinfection exhibited milder short-term sequelae in the circulatory and respiratory systems. Vaccine administration protects against cardiovascular or respiratory systems., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This work was supported by funding from Chung Shan Medical University Hospital (grant number CSH-2022-A-023, CSH-2023-C-005). The funders had no role in designing and conducting the study, the collection, analysis, interpretation of the data, or the approval of the manuscript., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Study Objective: Physician experiences with new care models like the virtual observation unit in emergency departments (EDs) can offer important insights. Virtual observation unit leverages telehealth, remote monitoring, and mobile integrated health to enable home-based ED-level care. We explored physicians' experience with delivering care in the virtual observation unit and perceived effect of this new model., Methods: We conducted semistructured in-depth interviews with 10 emergency physicians who staffed the newly launched virtual observation unit in an academic hospital. We conducted a thematic analysis, which involved identifying and examining codes that describe important themes in the data., Results: Three themes emerged in terms of emergency physicians' experience with the virtual observation unit: (1) forming a deeper connection with patients as the virtual observation unit allowed them to spend more time with patients and care for patients in the patients' home environment; (2) increased appreciation for interprofessional and interspecialty care as the virtual observation unit presented opportunities to work closely with nurses, paramedics, and primary care physicians; and (3) (surmountable) programmatic challenges related to dealing with multipronged technology and finding the right patient with an appropriate clinical condition and acceptance of home-based care. These experiences then contributed to positive perceptions of patient-physician interactions and increased job satisfaction among physicians who participated in the virtual observation unit., Conclusion: Physicians who staffed the virtual observation unit in our context reported largely positive experiences. Policymakers and administrators should consider benefits to physician wellbeing and cultivating interprofessional and interspecialty care when making decisions about funding telehealth and care models like the virtual observation unit., (Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Competing Interests: All authors have no financial conflicts of interest.

Many patients who receive treatment for opioid use disorder (OUD) report experiencing chronic pain (CP), which is associated with high levels of ongoing nonmedical opioid use and low retention in OUD treatment. In pilot studies of patients with OUD receiving buprenorphine or methadone who had CP, cognitive behavioral therapy (CBT) attenuated nonmedical opioid use compared with treatment-as-usual (TAU), but patients in both treatment arms exhibited similar pain improvements. Adding exercise and stress reduction to this model may augment pain-related outcomes. With funding from National Institutes of Health, we plan to conduct a randomized clinical trial of 316 patients with OUD and CP to test the effectiveness of TAU compared with Stepped Care for Patients to Optimize Whole Recovery (SC-POWR) to reduce nonmedical opioid use and pain (primary outcomes) (Aim 1) and decrease pain intensity and interference, alcohol use, anxiety, depression and stress, and improve sleep (secondary outcomes) (Aim 2). Eligible participants will be randomized to receive TAU (buprenorphine or methadone and at least once a month individual or group counseling) or SC-POWR (ie, TAU and up to 12 CBT sessions) for 24 weeks. Based on prespecified nonresponse criteria, SC-POWR may be stepped up at week 6 to receive onsite weekly group sessions of exercise (Wii Fit, Tai Chi) and "stepped up" again at week 15 to receive weekly group sessions of stress reduction (relaxation training, auricular acupuncture). They will be followed for another 24 weeks to evaluate durability of treatment response for illicit opioid use, alcohol use, pain, anxiety, depression, stress, sleep, and retention in medications for OUD (Aim 3)., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The Medicaid coverage "cliff" occurs when Medicare beneficiaries with household income exceeding 100% of the federal poverty level lose eligibility for supplemental Medicaid coverage. Using a regression discontinuity design with data from Medical Expenditure Panel Survey and National Health and Nutrition Examination Survey for 2007-2019, we demonstrate that the cliff increases out-of-pocket spending by 25% and the probability of experiencing problems paying medical bills by 44.4% without decreases in overall health care spending. However, there is evidence that near-poor Medicare beneficiaries changed behavior in response to the cliff, increasing the use of high-value diagnostic and preventive testing by 8.8% and enrollment in a more affordable plan by 12.2%. The cliff does not encourage healthy behavior., (© 2024 John Wiley & Sons Ltd.)

Objective: This study aimed to characterize the perceived priorities of state and county policy makers for youth mental health services and the factors that influence those priorities., Methods: Mental health agency officials (N=338; N=221 state officials, N=117 county officials) representing 49 states completed a Web-based survey in 2019-2020. On 5-point scales, respondents rated the extent to which 15 issues were priorities for their agency in providing youth mental health services and the extent to which nine factors influenced those priorities., Results: Suicide was identified as the highest priority (mean±SD rating=4.38±0.94), followed by adverse childhood experiences and childhood trauma and then increasing access to evidence-based treatments. Budget issues (mean=4.27±0.92) and state legislative priorities (mean=4.01±0.99) were perceived as having the greatest influence on setting priorities., Conclusions: These findings provide insights into youth mental health policy priorities and can be used to guide implementation and dissemination strategies for research and program development within state and county systems., Competing Interests: Dr. Nelson was an employee of Merck and ViiV Healthcare during manuscript development and owns stock in GlaxoSmithKline. The other authors report no financial relationships with commercial interests.

The Arab Bedouin ethnic minority is considered one of the most vulnerable populations in Israel due to socio-cultural factors that affect their healthcare utilization patterns. By adopting the intersectionality perspective, this research aims to identify gaps and barriers to Bedouins' healthcare services (HCS) utilization, as perceived by healthcare professionals (HCP) serving this community. A qualitative study was conducted from June 2019 to January 2022, involving in-depth semi-structured interviews with thirty-two HPCs working in hospitals and community health centers/clinics in Bedouin villages and towns in Southern Israel. Reflective Thematic Analysis (RTA) was used to analyze the collected data, and trustworthiness was ensured through audit, reflexivity, and peer debriefing. Findings revealed that healthcare professionals noted gaps that hinder HCS accessibility and utilization. This study found that the intersection of physical, financial, language, health literacy, and gender barriers with issues of trust, stigma, and deep-rooted socio-cultural norms and beliefs affect Bedouin healthcare accessibility. Additionally, Bedouin women are particularly vulnerable subgroups who were impacted differently by these barriers. In conclusion, our research highlights the necessity of targeted interventions to improve healthcare access for Bedouin minority populations, particularly tailoring HCS to the women subgroup within the Bedouin community. Suggested interventions include health literacy-enhancing educational initiatives, addressing medication affordability, and approaches to mitigate cultural and gendered hindrances to HCS. These insights have broader relevance for shaping health policies and strategies that bridge healthcare disparities among global minority populations., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

From January 2008 to December 2018, 1348 HIV-exposed infants were born in Porto Alegre, Brazil; 18.8% had adverse infant outcomes (AIO) including vertical transmission (1.9%), stillbirth/neonatal death (4.0%) and loss to follow-up before HIV diagnosis (12.9%). Timing of maternal HIV diagnosis was not associated with AIO but absent antiretroviral therapy use was. Lack of maternal antiretroviral therapy use is a significant risk factor for AIO., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Many patients are unable to identify members of their hospital care team and experience confusion regarding some medical terminology used during hospitalization, including descriptions of the structure of their inpatient care team. This cross-sectional study sought to (1) examine inpatients' understanding of the role of a hospitalist and (2) assess inpatients' familiarity with other medical terminology commonly used in the hospital. We surveyed 172 patients admitted to the hospital medicine service at two academic medical centers. We found that almost half (47%) of respondents were unfamiliar with the term and/or role of a hospitalist, while the remaining patients had varied understanding of the role. Several other medical terms were frequently misunderstood (such as "NPO," "PA," and "Attending"). Ongoing efforts are needed to improve communication to ensure that hospitalized patients understand the hospitalist's role and the medical terms shared with them., (© 2024 Society of Hospital Medicine.)

Study Design: Retrospective cohort study., Objective: To characterize variation in dexamethasone and remdesivir use over time among hospitals., Background: Little is known about hospital-level variation in COVID-19 drug treatments in a large and diverse network in the United States., Methods: We selected individuals hospitalized with COVID-19 across 163 hospitals between February 23, 2020 and October 31, 2021 from using the HCA CHARGE, an electronic health record repository from a network of community health care facilities in the United States. We quantified receipt of dexamethasone, remdesivir, and combined use of dexamethasone and remdesivir during the hospital stay. We used 2-level logistic regression models to determine the intraclass correlation coefficient (ICC) at the hospital level, adjusting for patient and hospital characteristics. The ICC shows the proportion of total variation in drug use accounted for by hospitals., Results: Among 161,667 individuals hospitalized with COVID-19, 73.0% were treated with dexamethasone, 49.1% with remdesivir, and 45.0% with both dexamethasone and remdesivir. The proportion of variation in dexamethasone use was 12.7% (adjusted ICC: 0.127), 8.5% for remdesivir, and 11.3% for combined drug use, indicating low interhospital variation. In the fully adjusted models, between-facility variation in dexamethasone use declined from 34.1% in February-March 2020 to 11.3% in January-March 2021 and then increased to 17.3% in July-October 2021. The variation in remdesivir use remained relatively stable during the study period., Conclusions: During the first 2 years of the pandemic, there was relatively consistent use of dexamethasone and remdesivir across the hospitals examined. Consistent adoption and implementation of treatment guidelines across the hospitals examined may have led to a decrease in variation in drug usage over time., Competing Interests: K.M.A. was supported by a National Heart, Lung, and Blood Institute Pharmacoepidemiology T32 Training Program (T32HL139426). After the completion of her involvement in this work, she joined Pfizer Inc. as a full-time employee and holds stock in Pfizer Inc. B.T.G. reports receiving funding from the John Templeton Foundation. Also, is a member of the FDA Pulmonary-Asthma Drug Advisory Committee, and reports personal fees from Janssen Research and Development LLC, Gilead Sciences Inc, and Atea Pharmaceuticals. H.B.M. was supported by the National Institute on Aging (K01 AG070329). G.C.A. is the past Chair of the U.S. Food and Drug Administration’s Peripheral and Central Nervous System Advisory Committee and a co-founding Principal and equity holder in Stage Analytics. A.W.W. reports personal fees from Gore and grants to the institution from Genentech and Pfizer. J.F.B. reports equity and entitlement to future royalties from miDiagnostics. These arrangements have been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. The remaining authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background Context: Venture capital (VC) plays a vital role in advancing spinal surgery technologies, driven by the growing burden of spinal disorders and high healthcare costs. Despite increasing interest, trends in VC funding for spinal surgery remain understudied., Purpose: This study aimed to examine temporal and thematic trends in VC investments in spinal surgery companies from 2000 to 2023., Study Design/setting: A retrospective cross-sectional study analyzing VC investment trends in privately held US-based spinal surgery companies., Methods: Using the PitchBook database, we analyzed 1001 VC investments in 227 spinal surgery companies between 2000 and 2023. Investments were categorized into surgical devices, noninvasive devices, biotechnology, surgical software, and clinical services. Total and annual investments were quantified in USD., Results: From 2000 to 2023, $5.37 billion was invested in spine surgery, with nonsurgical devices receiving the largest share (42.6%), followed by surgical devices (26.3%) and biotechnology (22.2%). Annual investment increased by 1782%, with a decline in 2023 likely due to macroeconomic factors., Conclusions: VC funding in spinal surgery has grown significantly, especially in noninvasive technologies. Further research is needed to assess the long-term impact of these investments and explore alternative financing models., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Currently there is no detailed, internationally agreed protocol defined to evaluate antimicrobial susceptibility testing (AST) for Legionella pneumophila (required to establish epidemiological cut-off value or "ECOFF" boundaries); therefore, antimicrobial resistance in these isolates cannot be defined. AST methods utilising media containing activated charcoal as an ingredient, to enable Legionella growth, are unreliable as noted in an internationally authored opinion paper and a new gold standard is required. Here we define a detailed protocol for broth microdilution (BMD) using defined cell culture collection-deposited control reference strains (Philadelphia-1 and Knoxville-1) as well as two accessible reference strains with moderately (lpeAB-carrying) and markedly (23S rRNA mutation-carrying) elevated azithromycin minimum inhibitory concentration (MIC). The defined protocol enables up to eight L. pneumophila strains to be set up on a single 96-well plate per antimicrobial tested. Initial ranges to routinely capture an MIC for these reference strains using clinically relevant antimicrobials azithromycin (0.01-0.25 mg/L), levofloxacin (0.008-0.03 mg/L), lefamulin (0.01-2 mg/L), rifampicin (0.0002-0.0008 mg/L) and doxycycline (0.25-16 mg/L) following incubation for 48 h at 37 °C in a shaking incubator have been empirically determined. Establishment of this internationally agreed protocol sets the scene for the next step: validation and comparison of antimicrobial ranges between international Legionella reference laboratories to establish putative resistance cut-off thresholds for these clinically relevant antimicrobials., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Professor Owen B. Spiller, and all associated authors reports financial support was provided by European Society of Clinical Microbiology and Infectious Diseases. Max Sewell reports financial support was provided by Cardiff University. Professor Owen B. Spiller, and all associated authors reports equipment, drugs, or supplies was provided by Nabriva Therapeutics AG. Susanne Paukner reports financial support was provided by Nabriva Therapeutics AG. Susanne Paukner reports a relationship with Nabriva Therapeutics AG that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background and Objectives: Despite marijuana's association with adverse pregnancy and birth outcomes, its use during pregnancy increased over the last two decades. During this period, medical marijuana has been legalized in 38 states and the District of Columbia. States with legalized medical marijuana have observed increased marketing of marijuana and related products. This study aims to examine the association between state-level medical marijuana legalization and marijuana use during pregnancy in the United States., Methods: Using the 2015-2021 National Survey on Drug Use and Health, we evaluated the association between marijuana use in the past month among currently pregnant mothers (N = 4338) and legalized medical marijuana in their state of residence. Survey-weighted descriptive, bivariate, and multivariable logistic regression analyzes were performed., Results: About 5.7% of pregnant women reported using marijuana in the past month, and 59.0% lived in a state where medical marijuana was legalized across 2015-2021. Compared to those living in states without marijuana legalization, more pregnant women living in states with marijuana legalization reported using marijuana (4.6% vs. 6.5%). In the multivariable model, pregnant women residing in states with medical marijuana legalization were more likely to use marijuana than residents of states without legalization (adjusted Odds Ratio: 1.56; 95% Confidence Interval: 1.11-2.18)., Conclusion and Scientific Significance: This is the first known study to find that pregnant women living in states where medical marijuana is legalized are more likely to use marijuana during pregnancy. Pregnant women should be informed of adverse pregnancy and birth outcomes linked to marijuana use during pregnancy., (© 2024 The Author(s). The American Journal on Addictions published by Wiley Periodicals LLC on behalf of The American Academy of Addiction Psychiatry (AAAP).)

Background: Telehealth is a rapidly growing modality for expanding healthcare access, especially in the post-COVID-19 era. However, telehealth requires high-quality broadband, thus making broadband a social determinant of health. The objective of this study was to evaluate the association between broadband access and telehealth utilization across the United States during the COVID-19 pandemic., Methods: Using a cross-sectional, ecological study design, we merged county-level data on broadband capacity (Microsoft's Rural Broadband Initiative), telehealth utilization among Medicare Fee-for-Service beneficiaries from January through September 2020 (CareJourney), and county-level socioeconomic characteristics (Area Health Resources Files). Multivariable linear regression was used to estimate the association between broadband capacity, county-level characteristics, and telehealth utilization., Results: Among the 3107 counties, those with the greatest broadband availability (quintile 5) had 47% higher telehealth utilization compared to counties with the least broadband availability (quintile 1). In the adjusted model, a 1 standard deviation (SD) increase in broadband access was associated with a 1.54 percentage point (pp) increase in telehealth utilization (P < 0.001). Rural county designation (-1.96 pp; P < 0.001) and 1 SD increases in average Medicare beneficiary age (-1.34 pp; P = 0.001), number of nursing home beds per 1000 individuals (-0.38 pp; P = 0.002), and proportion of Native Americans/Pacific Islanders (-0.59 pp; P < 0.001) were associated with decreased telehealth utilization., Conclusion: The association between broadband access and telehealth utilization and the decreased telehealth utilization in rural areas highlight the importance of broadband access for healthcare access and the need to continue investing in broadband infrastructure to promote equitable healthcare access across populations., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Ambrish A. Pandit was a PhD candidate at the University of Arkansas for Medical Sciences when this study was conducted and is currently employed at Amerisource Bergen Corporation, Conshohocken, Pennsylvania, U.S.A. Rest of the author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Although co-occurring cognitive impairment and physical disability in older adults is common, there is little understanding of how this group perceives their ability to do their daily activities. This study used photovoice to explore how older adults with MCI/early dementia and physical disability without and with care partners (dyads) perceive challenges with their daily activities. Photovoice is a visual research methodology to capture participants' insight on aspects of their daily lives. No known studies have taken this approach to explore the experiences of older adults with MCI/early dementia and co-occurring physical disability. We used a cross-sectional, exploratory research design to understand participants' ( n = 12) experiences in their home environment. Photos and participant thoughts on the photos were categorized based on the Blackfoot Breath of Life Theory and the Hierarchy Model of Needs in Dementia, an adaptation of Maslow's Model. Notable findings included: awareness of physical/cognitive difficulties by older adults, solutions for ADL difficulty in persons with MCI/early dementia, care partners' difficulty recognizing pain without the presence of severe emotional or physical responses, reducing mood severity, and self-esteem needs met with structured, memory-issue adapted, meaningful activities. Older adults with co-occurring physical disability and MCI/early dementia identified both physiological and psychological needs despite challenges impacting their cognition. Photovoice evoked daily situations of these individuals and revealed the importance of developing individualized intervention elements for older adults with dementia and physical disability., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Risk factors for progression of adenovirus (AdV)-associated bronchiolitis (AdV-B) to post-infectious bronchiolitis obliterans (PIBO) are poorly defined. We aimed to investigate this in a multicenter cohort., Methods: A multicenter hospital-based analysis included children admitted with AdV-B in Jerusalem during 2016-2022. A case-control analysis included AdV-PIBO patients in Jerusalem during 2005-2023. Cases were compared to randomly assigned controls admitted with AdV-B without progression to AdV-PIBO. Multivariate analysis with logistic regression was used., Results: The annual incidence of AdV-B admissions and AdV-PIBO increased during 2016-2022, during which 1522 children were admitted with AdV-B and 8 developed AdV-PIBO (0.5%). Of 30 AdV-PIBO cases identified during 2005-2023, available data were compared for 25 of them (72% boys; mean age ± standard deviation 1.2 ± 0.8 years) and 139 controls (66% boys; mean age 1.0 ± 0.6 years, p = 0.5 for age). Jewish ethnicity was more common in the AdV-PIBO versus control group (92% vs. 66%, p = 0.009), as were oxygen supplementation (84% vs. 45%, p < 0.001), noninvasive ventilation (20% vs. 4%, p = 0.004), consolidations on chest X-ray (44% vs. 19%, p = 0.011), and lymphopenia (92% vs. 46%, p < 0.001). Combining Jewish ethnicity, lymphopenia, consolidations, and prolonged admission as independent risk factors yielded positive and negative predictive values of 68.8% and 90.5%, respectively., Conclusion: These findings emphasize the urgent need for targeted preventive and management strategies. The identification of Jewish ethnicity as a risk factor may imply a genetic contribution to Adv-PIBO risk., (© 2024 Wiley Periodicals LLC.)

Purpose: Less than 50% of people with HIV (PWH) in the United States are retained in care, a key step along the HIV care continuum. We examined the impact of geographic access to care on retention in care for urban and rural PWH., Methods: We used Medicaid claims and clinician data (Medicaid Analytic eXtract and MAX Provider Characteristics, 2009-2012) for 13 Southern states plus the District of Columbia. We calculated drive time from the enrollees' ZIP Code Tabulation Area to their usual source of care. We used generalized estimating equations to examine the association between drive time to care >30 min (versus ≤30 min) and retention in care, overall and stratified by rurality. In sensitivity analysis, we examined the definition of retention in care, states included in the analysis, and enrollee- and care-related characteristics., Findings: The sample included 49,596 PWH. Overall, the association between drive time >30 min and retention was significant, but small (adjusted odds ratio [aOR] 1.01, 95% confidence interval [CI] 1.00, 1.01) and was not significant in urban areas; however, the significance and direction of the association differed in sensitivity analysis. In rural areas, driving >30 min to care was associated with 7% higher odds of retention in care (aOR 1.07, 95% CI 1.05, 1.08) and this association remained significant and positive in nearly all sensitivity analyses., Conclusions: For PWH in rural areas, greater drive time is consistently associated with greater retention in care. Disentangling the mechanisms of this relationship is a future research priority., (© 2024 The Author(s). The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.)

Background: Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation., Objectives: Develop and validate criteria that identify appropriate HBPC target populations., Research Design: A modified Delphi process was used to achieve expert consensus on criteria for identifying HBPC target populations. All criteria were defined and validated using linked data from Medicare claims and the National Health and Aging Trends Study (NHATS) (cohort n=21,727). Construct validation involved assessing demographics and health outcomes/expenditures for selected criteria., Subjects: Delphi panelists (n=29) represented diverse professional perspectives. Criteria were validated on community-dwelling Medicare beneficiaries (age ≥70) enrolled in NHATS., Measures: Criteria were selected via Delphi questionnaires. For construct validation, sociodemographic characteristics of Medicare beneficiaries were self-reported in NHATS, and annual health care expenditures and mortality were obtained via linked Medicare claims., Results: Panelists proposed an algorithm of criteria for HBPC target populations that included indicators for serious illness, functional impairment, and social isolation. The algorithm's Delphi-selected criteria applied to 16.8% of Medicare beneficiaries. These HBPC target populations had higher annual health care costs [Med (IQR): $10,851 (3316, 31,556) vs. $2830 (913, 9574)] and higher 12-month mortality [15% (95% CI: 14, 17) vs. 5% (95% CI: 4, 5)] compared with the total validation cohort., Conclusions: We developed and validated an algorithm to define target populations for HBPC, which suggests a need for increased HBPC availability. By enabling objective identification of unmet demands for HBPC access or resources, this algorithm can foster robust evaluation and equitable expansion of HBPC., Competing Interests: B.L. serves on clinical advisory boards for Patina Health, Medzed, and Pager. The remaining authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Vaccine hesitancy and a distrust of the COVID-19 vaccine is widespread in many African nations, stemming from historic medical abuses and low confidence in governments. While studies have examined drivers of vaccine hesitancy in Africa, little is known about vaccine spillover effects: how prior experiences with vaccines influence individuals' confidence in vaccines and future vaccination behaviors., Methods: In a large online survey conducted across three African countries (Kenya, N = 1545; Nigeria, N = 1557; South Africa, N = 1588), we examined five measures of vaccine spillover: how experiences with the COVID-19 vaccination process influenced respondents' confidence in the safety, efficacy, and importance of all vaccines approved for use in their country, and the likelihood of vaccinating themselves or their children in the future. Multivariate binary logistic regression analyses were conducted to determine factors associated with each of the five outcome measures., Results: Large numbers of individuals in all three countries experienced positive vaccine spillover: becoming more likely to vaccinate in the future and experiencing greater confidence in vaccines, due to their prior experiences with the COVID-19 vaccination process. The highest positive spillover effects were observed in Kenya, with 71 % reporting a greater likelihood of vaccinating themselves in the future, compared to just 60.1 % of Nigerian respondents and 51.7 % of South African respondents. Multivariate models provide evidence that demographic correlates of positive vaccine spillover vary across nations; however, prior vaccination, misinformation endorsement, and confidence in government both consistently predict spillover in all three nations., Conclusion: These findings suggest that while drivers of vaccine spillover are country specific, strategies to address COVID-19 misinformation and to strengthen individuals' trust in government may help facilitate greater vaccine uptake in the future., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This project was funded by the Scowcroft Institute for International Affairs at the Bush School of Government and Public Service at Texas A&M University. All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aims: To measure the association between state cannabis policies and use among adults and youth in the United States from 2002 to 2019, given rapid policy liberalization and complex state cannabis policy environments., Design: Repeated cross-sectional time series analysis. Three sets of models assessed the linear association between the Cannabis Policy Scale (CPS), an aggregate measure of 17 state cannabis policy areas that weights each policy by its efficacy and implementation rating, and prevalence of cannabis use. The first included year and state fixed effects; the second added state-level controls; the third replaced state fixed effects with state random effects. Standard errors were clustered at the state level in all models., Setting and Participants: United States., Measurements: Past-month prevalence of cannabis use is from the National Survey on Drug Use and Health Small Area Estimates, a nationally and state-representative cross-sectional survey of household population ages 12 and older for years 2002-2003 to 2018-2019. Exposure data include the CPS., Findings: A 10 percentage-point increase in the CPS (i.e. greater cannabis policy restrictiveness) was associated with lower past-month use prevalence by 0.81 (95% confidence interval [CI] = -1.05 to -0.56) to 0.97 (95% CI = -1.19 to -0.75) percentage-points for the population ages 12 years and older. When models were stratified by age, a 10 percentage-point increase in the CPS was associated with a 0.87 (95% CI = -1.13 to -0.61) to 1.04 percentage-point (95% CI = -1.03 to -0.84) reduction in past-month use prevalence for adults ages 18 years and older, and a 0.17 (95% CI = -0.24 to -0.09) to 0.21 percentage-point (95% CI = -0.35 to -0.07) reduction for youth ages 12-17 years., Conclusions: More restrictive US cannabis policies appear to be associated with reduced cannabis use for both adults and youth., (© 2024 RAND Corporation and The Author(s). Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Objective: To quantify how many patient scheduled hours would result in a 40-h work week (PSH40) for ambulatory physicians and to determine how PSH40 varies by specialty and practice type., Methods: We calculated PSH40 for 186 188 ambulatory physicians across 395 organizations from November 2021 through April 2022 stratified by specialty., Results: Median PSH40 for the sample was 33.2 h (IQR: 28.7-36.5). PSH40 was lowest in infectious disease (26.2, IQR: 21.6-31.1), geriatrics (27.2, IQR: 21.5-32.0) and hematology (28.6, IQR: 23.6-32.6) and highest in plastic surgery (35.7, IQR: 32.8-37.7), pain medicine (35.8, IQR: 32.6-37.9) and sports medicine (36.0, IQR: 33.3-38.1)., Discussion: Health system leaders and physicians will benefit from data driven and transparent discussions about work hour expectations. The PSH40 measure can also be used to quantify the impact of variations in the clinical care environment on the in-person ambulatory patient care time available to physicians., Conclusions: PSH40 is a novel measure that can be generated from vendor-derived metrics and used by operational leaders to inform work expectations. It can also support research into the impact of changes in the care environment on physicians' workload and capacity., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Purpose: Acute stroke is a serious, time-sensitive condition requiring immediate medical attention. Emergency medical services (EMS) routing and direct transport of acute stroke patients to stroke centers improves timely access to care. This study aimed to describe EMS stroke routing and transports by rurality in North Carolina (NC)., Methods: We conducted a retrospective study using existing data on EMS transports of suspected stroke patients in NC in 2019. The primary study outcome was EMS bypass of the nearest hospital for transport to a nonnearest hospital, determined by geographic information systems (GIS) analysis. Incident addresses were geocoded to census tracts and classified as urban, suburban, or rural by Rural-Urban Commuting Area codes. We compared the frequency of bypass and estimated additional transport times by urban, suburban, and rural incident locations., Findings: Of 3666 patients, 1884 (51%) EMS transports bypassed the nearest hospital. Bypass occurred less often for rural EMS incidents (39%) compared to those in urban (57%) and suburban (63%) tracts. The estimated additional transport time for rural bypasses of nonendovascular-capable stroke centers for endovascular-capable stroke centers was a median of 25 min (interquartile range 13-33)., Conclusions: Using GIS analysis, we found nearly half of EMS transports of suspected stroke patients in NC bypassed the nearest hospital, including noncertified hospitals and stroke centers. Bypasses occurred less often in rural areas, though incurred significantly longer transport times, compared to urban areas. These findings are important for regional stroke system planning, especially for improving rural access to acute stroke care., (© 2024 National Rural Health Association.)

Background: Most patients in specialty drug treatment programs that are not federally licensed Opioid Treatment Programs (OTPs) programs do not receive medications for opioid use disorder (MOUD)., Methods: We linked results from a survey of non-OTP treatment program directors in New Jersey (n = 81) to statewide administrative records of admissions for opioid use to those programs between July 2021-June 2022. Using multi-level regression, we examined the association of three types of factors with planned MOUD use: program survey responses, client-level factors, and program-level client characteristic mix., Results: Of 9583 opioid treatment admissions in non-OTP settings, 41 % included treatment plans involving MOUD. Programs where directors reported staff concerns about buprenorphine's efficacy or diversion had a lower proportion of clients with planned MOUD, as did programs reporting too little physical space to prescribe. Being self-referred to treatment, unemployed and not looking for work, aged 30-49, heroin use (vs. prescription opioid use), and stimulant use in addition to opioids, were positively associated with planned MOUD; while non-Medicaid insurance, and Black and Hispanic race/ethnicity, were negatively associated with planned MOUD. Clients were more likely to have planned MOUD if their programs had a higher proportion of clients aged 30 or older, heroin as primary "drug of abuse," stimulant use, and not working but actively looking for work., Conclusion: Findings suggest addressing program staff attitudes toward buprenorphine could help increase planned MOUD. There is also a need to improve access for clients with non-Medicaid insurance, address within-program race and ethnic disparities, and address employment-related barriers to medication., Competing Interests: Declaration of competing interest This research was supported by a grant from Bloomberg Philanthropies. The authors have no interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To measure contemporary trends in the prevalence of short interpregnancy interval (IPI) births in the United States., Methods: We conducted a repeated cross-sectional analysis using 2016-2022 natality data from the National Vital Statistics System. We included all singleton live births to individuals with at least one prior live birth. We examined trends over time in short IPIs less than 18 months, as well as for specific durations within this time frame (less than 6 months, 6-11 months, and 12-17 months), using linear probability models that estimated changes in the prevalence of each IPI duration over time. We then estimated the prevalence of each short IPI duration by maternal race and ethnicity, socioeconomic characteristics (age, education, insurance payer at delivery), and geography (U.S. census region, state of residence)., Results: The study sample included 14,770,411 singleton live births to individuals with at least one prior live birth in 2016-2022. Roughly a third (29.8%) of births had an overall IPI of less than 18 months (5.0% less than 6 months, 11.0% 6-11 months, and 13.8% 12-17 months). For IPIs less than 6 months, a slight statistical decline in prevalence was identified over the study period in unadjusted and adjusted models (adjusted annual percentage point change -0.02, 95% CI, -0.03 to -0.02). Slight statistical increases in the prevalence of IPIs of 6-11 and 12-17 months were identified in unadjusted models but were no longer significant and reversed direction in adjusted models, respectively. Long-standing inequities in the distribution of the shortest IPIs (less than 6 months) were stable compared with prior work across the indicators examined in this study., Conclusion: Overall, it appears the prevalence of short IPIs has remained stable between 2016 and 2022., Competing Interests: Financial Disclosure Jamie R. Daw reports that money was paid to their institution from the NIH, The Commonwealth Fund, and the Medicaid and CHIP Payment and Access Commission. The other authors did not report any potential conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To test the impact of virtual care usage on quality metrics used for performance measurement., Background: Virtual care improves access to primary care; however, the quality of care must not be adversely impacted by its use., Methods: This is a mixed-design etiologic study using data from patients receiving primary care in a large, regional health system from January 2020 through December 2021. Eligible patients had at least one primary care contact. Eligible physicians had 10 or more patient contacts. The quartile of virtual visits per physician per month is calculated as the percentage of total visits conducted by phone or video (Q1 is the lowest). Six metrics used for value-based reimbursement were chosen for modeling with generalized linear mixed models., Results: The data included 200,090 patients of 683 physicians in 42 clinics over 24 months. Virtual care usage peaked in April 2020 at 78% and then stabilized at 18%. The blood pressure metric was met in 66% (95% CI: 63%-69%) of physician months in Q1 and 65% (95% CI: 63%-68%) in Q4 ( P = 0.003). The hemoglobin A1c metric was met in 73% (95% CI: 70%-76%) of physician months in Q1 and 72% (95% CI: 69%-75%) in Q4, not a significant difference. Breast cancer screening completion and colon cancer screening completion did not differ across virtual care quartiles. Medicare annual wellness visits were completed in 55% (95% CI: 50%-60%) of Q1 physician months and 54% in each of Q2, Q3, and Q4 ( P < 0.0001)., Conclusions: Some quality metrics were modestly impacted by high virtual primary care usage; the absolute differences in rates were small. This may provide reassurance to physicians and their health systems that telemedicine use may not adversely impact quality metrics., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: There are long-standing differences in profitability between rural and urban hospitals. Prior to the COVID-19 Public Health Emergency (PHE), rural hospital profitability was decreasing, while urban hospital profitability was increasing. During the PHE, the Federal Government provided billions of dollars of support to hospitals. Given the prepandemic differences in trends in profitability, it is likely that the PHE funding had different effects on rural hospitals and urban hospitals., Methods: This study uses 2015-2023 Medicare cost report data from acute-care hospitals to assess the impact of COVID-19 PHE funding on hospital profitability. We employ descriptive Kruskal-Wallis and chi-square tests and an interrupted time series analysis to evaluate the effect of PHE funding on operating margins for a stratified sample of rural prospective payment system (PPS), urban PPS, and critical access hospitals (CAHs)., Results: We found that the PHE funding was associated with significant increases in operating margins, with rural PPS hospitals experiencing similar increases compared to urban PPS hospitals, and CAHs surpassing both rural and urban PPS hospitals in their margin values. However, if PHE funding had not been provided, our evidence suggests operating margins for all hospitals in 2022-2023 would have been below prepandemic levels., Discussion: This preliminary analysis portrays the importance of the PHE government funding in supporting hospitals during the pandemic, and shows declining profitability trends without the funds. Rural PPS hospitals fare the worst suggesting continued need for financial support if the trend continues., (© 2024 National Rural Health Association.)

Background: Despite research linking chemical and physical restraints to negative outcomes including unplanned intubations and psychological distress, there is little guidance for their use in the care of trauma patients. We used institutional data to describe recent trends in chemical and physical restraint in the emergency department evaluation and treatment of trauma patients and to identify characteristics associated with their use., Methods: This study includes adult trauma activations at a United States urban level I trauma center from January 2016 to July 2022. Data were collected from the trauma registry and medical record. We assessed the use of chemical restraints and physical restraints during care provided in the trauma resuscitation bay and emergency department. We assessed trends over time graphically and with logistic regression. We used multivariable regression models to evaluate associations between restraint use and patient and clinical characteristics and the outcomes of ICU admission, hospitalization duration, and mortality., Results: Of the 8,112 patients, most were male (74.8 %), White (55.8 %), and privately insured (35.2 %). Overall, 8.1 % were restrained with 7.1 % chemically restrained and 2.7 % physically restrained. Overall restraint use increased 254 % (p < 0.001) from 2016 to 2022 driven primarily by a 460 % (p < 0.001) increase in chemical restraint use including a 630 % increase in ketamine administrations (p < 0.001). Use of restraints was associated with pre-existing psychotic disorders, intoxication, altered mental status, increasing injury severity, and Medicaid insurance (p < 0.001). Chemical restraint administration was associated with a 3.5 percentage point (95 %CI 1.1-5.9; p = 0.004) increase in the probability of ICU admission and a 1.0 day (95 %CI 0.6-1.4; p < 0.001) increase in hospitalization duration., Conclusions: In this institutional study, nearly one-in-twelve trauma patients were restrained during emergency department evaluation and treatment. Restraint utilization increased during the study driven primarily by increases in ketamine and restraints utilized during trauma bay evaluation and resuscitation. Future research should assess the generalizability of these findings. It is important that rigorous guidelines are established to ensure the safe and effective use of restraints in trauma., Competing Interests: Declaration of competing interest The authors have no conflicts of interest or disclosures to report., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: The opioid overdose crisis requires strengthening treatment systems with innovative technologies. How people use telehealth for opioid use disorder (OUD) is evolving and differs in rural versus urban areas, as telehealth is emerging as a local resource and complementary option to in-person treatment. We assessed changing trends in telehealth and medication for OUD (MOUD) and pinpoint locations of low telehealth and MOUD access., Methods: We used national data from the Mental health and Addiction Treatment Tracking Repository (2016-2023) to identify specialty outpatient SUD treatment facilities in the United States (N = 83,988). We modeled the availability of telehealth using multilevel multivariable logistic regression, adjusting for covariates. We included a 3-way interaction to test for conditional effects of rurality, the number of MOUD medication types dispensed, and year. We included two random effects to account for clustering within counties and states., Findings: We identified 495 facilities that offered both telehealth and all three MOUD medication types (methadone, buprenorphine, naltrexone) in 2023, clustered in the eastern United States. We identified a statistically significant 3-way interaction (p < 0.0001), indicating that telehealth in facilities that did not offer MOUD shifted from more telehealth in rural facilities in earlier years to more telehealth in urban facilities in later years., Conclusions: Treatment facilities that offer both telehealth and all three MOUD medication types may improve access for hard-to-reach populations. We stress the importance of continued health system strengthening and technological resources in vulnerable rural communities, while acknowledging a changing landscape of increased OUD incidence and MOUD demand in urban communities., (© 2024 National Rural Health Association.)

Purpose: To examine the relationship between living arrangements and discharge disposition, and how this relationship differs by the rural or urban characteristics of the patient's residence among home health care patients with Alzheimer's disease and related dementia (ADRD)., Methods: This retrospective study used the 2019 Outcome and Assessment Information Set and the Master Beneficiary Summary File. Our study was based on 531,269 Medicare fee-for-service patients with ADRD. We used linear probability regression models to examine the relationship between discharge disposition (to the community vs. an institution) and living arrangements, including an interaction term for rural-urban residence., Findings: Patients in rural areas (19.8%) were more likely to live alone than those in urban areas (15.2%). Our main results show that patients living at home with others (coefficient: -0.02, p-value < 0.001) or alone (coefficient: -0.03, p-value < 0.001) were less likely to be discharged to the community compared to patients who lived in congregate settings. Also, for patients with ADRD who lived in rural areas, living at home with others (rural*home with others; coefficient: -0.02, p-value < 0.001) or living alone (rural*home alone; coefficient: -0.03, p-value<0.001) were associated with additional lower probabilities of being discharged to their communities., Conclusions: A multidimensional approach considering living arrangements to support home health care patients with ADRD could be critical to achieving better health outcomes. Furthermore, implementing area-specific target interventions could be important for improving the care and health of patients with ADRD as well as reducing rural-urban disparities in discharge disposition., (© 2024 The Author(s). The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.)

The current economic burden of cardiovascular (CV)-related hospitalizations grouped by diagnoses and procedures in the United States has not been well characterized. The objective was to identify current trends in CV-related hospitalizations, procedural utilization, and health care costs using the most recent 6 years of hospitalization data. A retrospective analysis of discharge data from the National Inpatient Sample database was conducted to determine trends in CV-related hospitalizations, costs, and procedures for each year from 2016 to the most recent available dataset, 2021. Total CV-related costs were adjusted to and reported in 2023 dollars. In 2021, there were 4,687,370 CV-related hospitalizations at a cost of $108 billion. Heart failure hospitalizations accounted for the highest costs at $18.5 billion, followed by non-ST-elevation myocardial infarction at $11.2 billion and stroke at $10.9 billion. Significant upward trends in costs from 2016 to 2021 were observed for heart failure, stroke, atrial fibrillation, ST-elevation myocardial infarction, chest pain, hypertensive emergency, ventricular tachycardia, aortic dissection, sudden cardiac death, pericarditis, supraventricular tachycardia, and pulmonary heart disease. Over the 6 observational years, total costs increased by over $10 billion, representing a 10% increase. However, the increases were not linear, as there was a significant increase of 6.5% from 2018 to 2019, then a decrease of over 7% from 2019 to 2020, followed by an increase of approximately 6% from 2020 to 2021. By 2030, total CV-related costs are projected to reach $131.3 billion. For all years, coronary procedures were the most performed, followed by extracorporeal membrane oxygenation, non-bypass peripheral vascular surgery, pacemaker placement, and coronary artery bypass graft surgery. Both transcatheter aortic valve replacement and MitraClip procedures demonstrated significant upward trends from 2016 to 2021. Overall, from the years 2016 to 2021, CV-related hospitalizations, costs, and procedures demonstrated upward trends. In conclusion, CV disease remains a high burden in the hospital setting with tremendous health care costs., Competing Interests: Declaration of competing interest Dr. Parikh receives unrelated research support from Bayer, Infraredx (Nipro), and Abbott Vascular, and consulting fees from Abbott Vascular. Dr. Fonarow reports consulting for Abbott, Amgen, AstraZeneca, Bayer, Boehinger Ingelheim, Cytokinetics, Eli Lilly, Johnson & Johnson, Medtronic, Merck, Novartis, and Pfizer. Dr. Benharash received proctoring fees from AtriCure Inc. The remaining authors have no competing interests to declare., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Competing Interests: HH serves without remuneration on an external advisory board of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, on the International Advisory Board of the University of Vienna, and on the external Executive Advisory Committee of the Sylvester Comprehensive Cancer Center, University of Miami Health System, and as a member of the Standing Advisory Group on Nuclear Applications of the International Atomic Energy Agency. Until Oct 31, 2024, HH also served without remuneration on the Scientific Committee of the German Cancer Research Center (DKFZ) and the Board of Trustees of the DKFZ. She is remunerated for serving on the Board of Directors of Ion Beam Applications and receives stock options for serving on the Board of Directors of iCAD. Her work is partly supported by funding to her institution (Memorial Sloan-Kettering Center support grant/core grant P30 CA008748) from the US National Institutes of Health (NIH)–National Cancer Institute (NCI). JOP reports uncompensated service as President of the Swiss Society of Nuclear Medicine, service to the World Federation of Nuclear Medicine and Biology as the focal point for technical collaboration with WHO, and service as the President of Section and Board of Nuclear Medicine of the European Union of Medical Specialists. AM reports that her work is partly supported by funding to her institution (Memorial Sloan-Kettering Center support grant/core grant P30 CA008748) from NIH–NCI. BA reports support for attending meetings or travel from the International Society of Radiology and the American College of Radiology. AMS reports institutional research funding from the Australian National Health and Medical Research Council, Medical Research Future Fund, and National Imaging Facility; patents planned, issued or pending for his role as an inventor of antibodies to HER2, ADAMs, EGFR, and Ephs; uncompensated participation on data safety monitoring or advisory boards for Telix and ImunOs; uncompensated service as a board member for the Australia and New Zealand Society of Nuclear Medicine and World Federation of Nuclear Medicine and Biology and as theme chair of the National Imaging Facility; stock holdings as founder and Director of Certis Therapeutics; and research and trial funding to his institution from Telix, Clarity, Fusion, Antengene, EMD Serono, ITM, Avid/Lily, Medimmune, and Cyclotek. All other authors declare no competing interests.

The purpose of this study was to explore the experiences of LGBTQ + young people in mental healthcare and to understand their perspectives on what affirmative mental healthcare practice should look like. Between June and September of 2023, interviews were conducted with LGBTQ + young people ages 18-26 years in Los Angeles and Seattle. Interviews lasted 30 to 60 min and were transcribed verbatim for thematic analysis (N = 28). Four themes were developed from analysis of the interviews: (1) disconnection from community and self as an impetus for seeking formal mental healthcare; (2) marginalization during mental health service encounters; (3) the therapeutic power of belonging and mattering in the mental healthcare system; and (4) mutual human connection as the foundation for affirming mental healthcare experiences. Affirmative mental healthcare was defined by LGBTQ + young adults as free of judgment with priority placed on the therapeutic power of genuine human connection. The need for trans-specific mental healthcare was also highlighted. Participants also expressed a preference for providers with shared identities and experiences to alleviate feelings of isolation and increase feelings of connectivity. Mental health providers should emphasize connectivity and empathy to offer affirming care with LGBTQ + clients, such asking about client preferences for care, developing knowledge about sexuality and gender identity, and acknowledging provider limitations or knowledge gaps. Improving access to affirmative mental healthcare for LGBTQ + young adults (e.g., workforce development, training requirements) is needed to address the disparities in mental healthcare., Competing Interests: Declarations. Reporting Guidelines: COREQ Conflict of Interest: The authors have no conflicts of interest related to the contents of this article to disclose., (© 2024. The Author(s).)

Purpose: To assess whether neighborhood-level measures of policing are spatio-temporally associated with psychiatric hospialization among adolescents and young adults in New York City, and whether this association varies by neighborhood racial composition., Methods: We derived population-based measures of policing from the New York City Police Department (NYPD), psychiatric hospitalization from Statewide Planning and Research Cooperative System (SPARCS) data, and socio-demographic data from the American Community Survey (ACS), aggregated by month and ZIP Code Tabulation Area (ZCTA) from 2006 to 2014. Multi-level negative binomial regression models assessed hospitalization-time of youth aged 10-24 as the dependent variable and the rate of policing events as the primary independent variable, adjusting for neighborhood poverty, unemployment, and educational attainment. Multiplicative interaction was assessed between policing and tertiles of the percentage of Black residents., Results: A total of 11,900,192 policing incidents and 2,118,481 person-days of hospitalization were aggregated to 19,440 ZCTA-months. After adjusting for neighborhood-level sociodemographic characteristics, an increase in one policing incident per 1,000 residents was associated with a 0.3% increase in the rate of youth psychiatric hospitalization time (IRR 1.003 [1.001-1.005]). Neighborhood racial composition modified this effect; not only was the rate of psychiatric hospitalization and policing higher in neighborhoods with a higher proportion of Black residents, but the association between these was also significantly higher in neighorhoods with a larger share of Black residents compared with predominantly non-Black neighborhoods., Conclusion: Neighborhoods experiencing higher rates of policing during the study period experienced higher burdens of psychiatric hospitalization among adolescent and young adult residents. This association was larger in neighborhoods of color which have been disproportionately targeted by "hot spot" and order-maintenance policing practices and policies., Competing Interests: Declarations. Ethics approval: This study was approved by the Institutional Review Boards of Columbia University, protocol #AAAS9566. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

As the recognition of Post-Intensive Care Syndrome (PICS&#95; grows, providers and health systems have sought ways to assess for treat PICS after hospitalization. Multidisciplinary ICU recovery clinics represent a centralized approach for care delivery after critical illness. These clinics provide care in a variety of models, depending on resources and the needs of a particular patient population., Competing Interests: Disclosure Dr V. Danesh has research funding from the NIH, United States (NIH/NIA R21AG080339). Dr C.M. Sevin has received funding related to post ICU care from the NIH, PCORI, United States, The Society of Critical Care Medicine, and the Department of Defense, United States. No specific funding for this project., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Prcis: Patients with migraine showed a significantly increased risk of developing open angle glaucoma (OAG) in the Korean population, without significant differences according to the presence of aura. Our results suggest the presence of migraine as a possible risk factor for OAG., Purpose: Previous studies have reported that migraine headaches may be one of the possible risk factors for open angle glaucoma (OAG); however, a consensus has not been reached regarding the association between OAG and migraine. In this study, we examined the risk of developing OAG in migraine patients using a 12-year nationwide cohort., Materials and Methods: In this study, data from the Korean National Health Insurance Service-National Sample Cohort database from 2002 to 2015 was used to perform a retrospective cohort study. The study included 1,103,302 subjects, out of which 41,148 were diagnosed with migraine during 2003-2008 and were categorized as the migraine group, while 205,741 patients were selected as controls through propensity score matching at a 1:5 ratio. Subjects with migraine or OAG was ascertained based on the KCD code. Multivariate Cox regression analysis was used to evaluate the hazard rate of OAG onset in the migraine group, and subgroup analysis was performed to identify any differences based on sex and age., Results: Multivariate Cox regression analysis showed that the incidence of OAG was significantly greater among patients with migraine than among patients in the comparison group [hazard ratio (HR): 1.238; 95% CI: 1.160-1.132, P < 0.001]. Moreover, the risk of developing OAG compared with subjects without migraine did not differ according to the presence of an aura (migraine with aura: HR: 1.235; 95% CI: 1.137-1.342, P < 0.001; migraine without aura: HR: 1.248; 95% CI: 1.143-1.363, P < 0.001). In subgroup analyses, the patients with migraine under 40-year-old were found to have a greater hazard rate (HR: 1.576, 95% CI: 1.268-1.957) of developing OAG in contrast with patients with migraine and over 40-year-old (HR: 1.167, 95% CI: 1.089-1.250) when compared with the corresponding nonmigraine patients., Conclusion: This study showed that migraine is a significant risk factor for OAG onset in the Korean population, and the presence of aura did not affect the HR of OAG development., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Diabetes technologies, including continuous glucose monitors, insulin pumps, and automated insulin delivery systems offer the possibility of improving glycemic outcomes, including reduced hemoglobin A1c, increased time in range, and reduced hypoglycemia. Given the rapid expansion in the use of diabetes technology over the past few years, and touted promise of these devices for improving both clinical and psychosocial outcomes, it is critically important to understand issues in technology adoption, equity in access, maintaining long-term usage, opportunities for expanded device benefit, and limitations of the existing evidence base. We provide a brief overview of the status of the literature-with a focus on psychosocial outcomes-and provide recommendations for future work and considerations in clinical applications. Despite the wealth of the existing literature exploring psychosocial outcomes, there is substantial room to expand our current knowledge base to more comprehensively address reasons for differential effects, with increased attention to issues of health equity and data harmonization around patient-reported outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The aim of the study was to examine the relationship between opioid use disorder (OUD)-related service trajectories during pregnancy and postpartum emergency department (ED) and hospitalizations., Methods: We used the Merative MarketScan Commercial Claims and Encounters Database (2013-2021) to identify a cohort of pregnant individuals with OUD. We used group-based multitrajectory modeling to identify opioid-related treatment and service trajectories during pregnancy and examined their association with postpartum ED and hospital utilization., Results: Seven opioid-related treatment and service trajectories were identified in our cohort of 2,531 pregnant individuals with OUD. Compared to individuals initiating medications for OUD (MOUD) halfway through pregnancy but maintaining high adherence without ancillary services, those receiving only services throughout pregnancy had a higher risk of postpartum ED visits (HRED = 1.34). This latter group also faced significantly higher risks of postpartum hospitalizations, compared to adherent MOUD use (proportion of days covered ≥80%) alone, both throughout or in the latter half of pregnancy (HRHOS = 1.93; HRHOS = 1.60), and patients without MOUD or services (HRHOS = 1.43). Individuals initiating MOUD late in pregnancy with poor adherence and infrequent service use faced significantly higher risks of postdelivery hospitalization compared to consistent MOUD users throughout pregnancy (HRHOS = 2.33), or in the latter half, with or without services (HRHOS = 2.02; HRHOS = 1.93), and those not receiving MOUD or services (HRHOS = 1.73)., Conclusions: Adherent MOUD use either throughout pregnancy or the latter half of pregnancy, irrespective of other service use, was associated with better postpartum outcomes defined by fewer ED visits and hospitalizations., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 American Society of Addiction Medicine.)

Competing Interests: Competing interests: None declared.

Objective: To compare the neurological outcomes of out-of-hospital cardiac arrest due to anaphylaxis (OHCA-A) and cardiac causes (OHCA-C)., Design: Retrospective observational study., Setting: Japanese nationwide dataset from 2012 to 2021., Participants: In total, 153 890 patients were included in this study, of which 331 had OHCA-A and 153 559 had OHCA-C., Outcome Measures: The primary outcome was a favourable neurological outcome 1 month after cardiac arrest. The secondary outcome was survival at 1 month., Results: Patients with OHCA-A had a significantly higher favourable neurological outcome rate (24.2% vs 11.7%, p<0.001) and higher survival rate at 1 month (33.2% vs 16.1%, p<0.001) than patients with OHCA-C. Multivariable logistic regression analysis revealed that OHCA-A was associated with higher odds of favourable neurological outcomes (adjusted OR (adj OR): 1.86; 95% CI 1.34 to 2.59) and survival at 1 month (adj OR: 2.43; 95% CI 1.78 to 3.31). Similarly, the propensity score-matched cohort showed favourable neurological outcomes in patients with OHCA-A (OR: 2.91; 95% CI 1.83 to 4.65)., Conclusion: Compared with OHCA-C, OHCA-A is associated with favourable neurological outcomes and warrants more aggressive resuscitation efforts., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)