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ObjectiveThe Department of Veterans Affairs' (VA) electronic health records (EHR) offer a rich source of big data to study medical and health care questions, but patient eligibility and preferences may limit generalizability of findings. We therefore examined the representativeness of VA veterans by comparing veterans using VA healthcare services to those who do not.MethodsWe analyzed data on 3051 veteran participants age ≥ 18 years in the 2019 National Health Interview Survey. Weighted logistic regression was used to model participant characteristics, health conditions, pain, and self-reported health by past year VA healthcare use and generate predicted marginal prevalences, which were used to calculate Cohen's d of group differences in absolute risk by past-year VA healthcare use.ResultsAmong veterans, 30.4% had past-year VA healthcare use. Veterans with lower income and members of racial/ethnic minority groups were more likely to report past-year VA healthcare use. Health conditions overrepresented in past-year VA healthcare users included chronic medical conditions (80.6% vs. 69.4%, d = 0.36), pain (78.9% vs. 65.9%; d = 0.35), mental distress (11.6% vs. 5.9%; d = 0.47), anxiety (10.8% vs. 4.1%; d = 0.67), and fair/poor self-reported health (27.9% vs. 18.0%; d = 0.40).ConclusionsHeterogeneity in veteran sociodemographic and health characteristics was observed by past-year VA healthcare use. Researchers working with VA EHR data should consider how the patient selection process may relate to the exposures and outcomes under study. Statistical reweighting may be needed to generalize risk estimates from the VA EHR data to the overall veteran population.

BAFF, a vital B cell survival and differentiation factor, has three receptors: B‐cell maturation antigen (BCMA), transmembrane activator and CAML interactor (TACI) and BR3. Although B cells are greatly reduced in B6.Baff−/− (which harbour no BAFF) and B6.Br3−/− mice (which harbour supra‐normal levels of BAFF), the distributions of B cell subsets and relationships between Foxp3+ and CD4+ cells in these mice differ. Using a large panel of B6 congenic knockout and/or transgenic mice, we demonstrate that (1) supra‐normal levels of BAFF per se do not explain the phenotypic differences between B6.Baff−/− and B6.Br3−/− mice; (2) B cells are expanded in B6.Taci−/− mice, with preferential expansion of follicular (FO) B cells at the expense of CD19+CD21−/loCD23−/lo B cells but without the preferential expansion of Foxp3+ cells observed in B6 mice bearing a Baff transgene; (3) despite no expansion in total B cells, percentages of FO B cells and marginal zone B cells are higher and percentages of CD19+CD21−/loCD23−/lo B cells are lower in young B6.Bcma−/− mice, consistent with the inability of B6.Br3−/−.Taci−/− mice to recapitulate the B cell profile of B6.Baff−/− mice; and (4) percentages of Foxp3+ cells in B6.Br3−/−.Taci−/− mice are intermediate between those in B6.Br3−/− and B6.Taci−/− mice despite the B cell profile of B6.Br3−/−.Taci−/− mice strongly resembling that of B6.Br3−/− mice. Collectively, our findings point to a non‐redundant role for each of the BAFF receptors in determining the ultimate lymphocyte profile of the host. This may have clinically relevant ramifications in that the degree that a candidate therapeutic agent blocks engagement of any given individual BAFF receptor may affect its clinical utility. [ABSTRACT FROM AUTHOR]

Heavy drinking can cause medical problems for individuals with HIV, and drinking despite medical contraindications indicates problem use. However, little is known about which individuals with HIV drink despite knowledge of health problems. This study utilizes two subsamples of individuals with HIV from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III): those reporting at least one drink (a) in their lifetime (n = 205) or (b) in the past year (n = 166). Participants reported on drinking despite health problems and psychopathology in the past year and in their lifetime, and family history of alcohol problems. Individuals with a drug use disorder (Adjusted Odds Ratios [AORs] = 3.56-12.65), major depressive disorder (AORs = 10.18-10.55), or a family history of alcohol problems (AORs = 33.60-96.01) were more likely to drink despite health problems. Anxiety and personality disorders did not increase risk. Individuals with HIV with drug use disorders or major depressive disorder are more likely to drink despite health problems. Individuals with a family history of alcohol problems were also more likely to do so, although further research is needed given large confidence intervals. Future research should consider how to help these individuals avoid alcohol-related harm. [ABSTRACT FROM AUTHOR]

Heavy drinking among HIV-infected individuals is associated with health complications. Health-behavior self-efficacy may be characteristically low among this population or negatively affected by HIV-infected status. We assessed whether self-efficacy to resist drinking increased during brief educational and motivational drinking-reduction interventions within HIV primary care and whether increases in self-efficacy predicted drinking among HIV-infected heavy drinkers. Results indicate that increases in self-efficacy from baseline to end-of-intervention inversely predicted drinking at end-of-intervention and at follow-up. Findings suggest that brief treatment interventions within HIV primary care may promote self-efficacy and that increases in self-efficacy predict initiation and maintenance of drinking reductions among HIV patients. [ABSTRACT FROM AUTHOR]

Objective: Heavy drinking poses serious risks to individuals with HIV, hepatitis C virus (HCV), and especially HIV/HCV coinfection. We adapted the National Institute on Alcohol Abuse and Alcoholism Clinician's Guide to address HIV/HCV coinfection and paired this with the "HealthCall" smartphone app to create an intervention tailored to HIV/HCV. After formative work and pretesting with HIV/HCV coinfected heavy drinkers, we conducted a pilot trial to determine potential of this new intervention for decreasing drinking. Method: A sample of 31 HIV/HCV coinfected heavy drinkers were randomly assigned to either intervention (n = 16) or control (n = 15; psychoeducation and brief advice) conditions. All participants completed a 60-day program consisting of approximately 25-minute-long baseline sessions and brief 5-10-minute booster sessions at 30 and 60 days, as well as an assessment-only follow-up at 90 days. Outcomes were measured using the Timeline Followback at baseline, 30, 60, and 90 days. Generalized linear models were used for analysis. Results: Intervention participants drank fewer mean drinks per drinking day at 60 days (incidence rate ratio [IRR] = 0.43, p = .03) and 90 days (IRR = 0.34, p < .01). Intervention participants also reported fewer drinking days at 90 days (mean difference = 34.5%; p < .01). Self-efficacy differed between groups during intervention (p < .05). Conclusions: Although our sample was small, our results suggested lower drinking among participants who received a modified Clinician's Guide intervention plus use of the smartphone app HealthCall, in comparison with education and advice alone. A larger study is indicated to further examine this brief, disseminable intervention for HIV/HCV coinfected drinkers. [ABSTRACT FROM AUTHOR]

Objective: We assessed the contributions of B cell and T cell subsets to the disparate clinical outcomes in NZM.Baff -/- and NZM.Br3 -/- mice., Methods: We assessed in NZM wild-type, NZM.Baff -/- , and NZM.Br3 -/- mice numbers and percentages of B cells and subsets, T cells and subsets, and in vivo proliferation and survival of forkhead box P3 (Foxp3) + cells by fluorescence-activated cell sorting. Relationships between percentages of Foxp3 + cells and numbers of CD19 + and CD4 + cells were assessed by linear regressions., Results: In each age and sex cohort, percentages and numbers of CD19 + cells were similar in NZM.Baff -/- and NZM.Br3 -/- mice. Percentages of CD3 + and CD4 + cells were greater in NZM.Br3 -/- than in NZM.Baff -/- mice, with the CD4 to CD3 cell ratios being greater in NZM.Br3 -/- than in NZM.Baff -/- mice and percentages of Foxp3 + cells in NZM.Br3 -/- mice being lower than in NZM.Baff -/- mice. Percentages of Foxp3 + cells correlated positively with CD19 + cells in NZM.Baff -/- mice but negatively in NZM.Br3 -/- mice. In vivo proliferation and survival of Foxp3 + cells were lower in NZM.Baff -/- mice than in NZM.Br3 -/- mice., Conclusion: Differences between NZM.Baff -/- and NZM.Br3 -/- mice in Foxp3 + cells and their relationships with CD19 + cells may have more to do with their divergent clinical outcomes than do differences in numbers of B cells. These unexpected findings suggest that B cell activating factor (BAFF)-B cell maturation antigen (BCMA) or BAFF-Transmembrane activator and calcium-modulator and cyclophilin ligand interactor (TACI) interactions may help drive development of clinical systemic lupus erythematosus (SLE) even under conditions of considerable B cell depletion. Insufficient blocking of BAFF-BCMA and BAFF-TACI interactions may lie at the heart of incomplete clinical response to BAFF-targeting agents in human SLE., (© 2024 The Author(s). ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Background: Transesophageal echocardiography can be a useful monitor during noncardiac surgery, in patients with comorbidities and/or undergoing procedures associated with substantial hemodynamic changes. The goal of this study was to investigate if transesophageal-echocardiography-related knowledge could be acquired during anesthesia residency., Methods: After institutional review board approval, a prospective observational study was performed in two anesthesiology residency programs. After a 41-week didactic transesophageal-echocardiography-education curriculum residents' exam scores were compared to baseline. The educators' examination was validated against the National Board of Echocardiography's Examination of Special Competence in Advanced Perioperative Transesophageal Echocardiography., Results: After the 41-week course, clinical anesthesia (CA)-3 exam scores increased 12% compared to baseline ( P = .03), CA-2 scores increased 29% ( P = .007), and CA-1 scores increased 25% ( P = .002). Pearson correlation coefficient between the educators' exam score and the special competence exam percentile rank was 0.69 ( P = .006). Pearson correlation coefficient between the educators' exam score and the special competence exam scaled score was 0.71 ( P = .0045)., Conclusions: The 41-week course resulted in significant increases in exam scores in all 3 CA-classes. While didactic knowledge can be learned by anesthesiology residents during training, it requires significant time and effort. It is important to educate residents in echocardiography, to prepare them for board examinations and to care for the increasingly older and sicker patient population. Further work needs to be done to determine optimal methods to provide such education., Competing Interests: Conflicts of interest: Nikolaos J. Skubas, MD, DSc, is a member of the National Board of Echocardiography’s writing committee for the Basic Examination in Transesophageal Echocardiography., (© 2020 Society for Education in Anesthesia.)