Developing a Text Messaging Intervention to Prevent Binge and Heavy Drinking in a Military Population: Mixed Methods Development Study

BACKGROUND

Alcohol misuse is the fourth leading cause of death in the United States and a significant problem in the US military. Brief alcohol interventions can reduce negative alcohol outcomes in civilian and military populations, but additional scalable interventions are needed to reduce binge and heavy drinking. SMS text messaging interventions could address this need, but to date, no programs exist for military populations.

OBJECTIVE

We aimed to develop an SMS text messaging intervention to address binge and heavy drinking among Airmen in Technical Training in the US Air Force.

METHODS

We implemented a 2-phase, mixed methods study to develop the SMS text messaging intervention. In phase 1, a total of 149 respondents provided feedback about the persuasiveness of 49 expert-developed messages, preferences regarding message frequency, timing and days to receive messages, and suggested messages, which were qualitatively coded. In phase 2, a total of 283 respondents provided feedback about the persuasiveness of 77 new messages, including those developed through the refinement of messages from phase 1, which were coded and assessed based on the Behavior Change Technique Taxonomy (BCTT). For both phases, mean persuasiveness scores (range 1-5) were calculated and compared according to age (aged <21 or ≥21 years) and gender. Top-ranking messages from phase 2 were considered for inclusion in the final message library.

RESULTS

In phase 1, top-rated message themes were about warnings about adverse outcomes (eg, impaired judgment and financial costs), recommendations to reduce drinking, and invoking values and goals. Through qualitative coding of suggested messages, we identified themes related to warnings about adverse outcomes, recommendations, prioritizing long-term goals, team and belonging, and invoking values and goals. Respondents preferred to receive 1 to 3 messages per week (124/137, 90.5%) and to be sent messages on Friday, Saturday, and Sunday (65/142, 45.8%). In phase 2, mean scores for messages in the final message library ranged from 3.31 (SD 1.29) to 4.21 (SD 0.90). Of the top 5 highest-rated messages, 4 were categorized into 2 behavior change techniques (BCTs): valued self-identity and information about health consequences. The final message library includes 28 BCTT-informed messages across 13 BCTs, with messages having similar scores across genders. More than one-fourth (8/28, 29%) of the final messages were informed by the suggested messages from phase 1. As Airmen aged <21 years face harsher disciplinary action for alcohol consumption, the program is tailored based on the US legal drinking age.

CONCLUSIONS

This study involved members from the target population throughout 2 formative stages of intervention development to design a BCTT-informed SMS text messaging intervention to reduce binge and heavy drinking, which is now being tested in an efficacy trial. The results will determine the impact of the intervention on binge drinking and alcohol consumption in the US Air Force.

Disparities in Noninvasive Traditional and Advanced Testing for Coronary Artery Disease: Findings from the INCAPS-COVID 2 Study

The COVID-19 pandemic disrupted the delivery of cardiovascular care, including noninvasive testing protocols and test selection for the evaluation of coronary artery disease (CAD). Trends in test selection in traditional versus advanced noninvasive tests for CAD during the pandemic and in countries of varying income status have not been well studied. The International Atomic Energy Agency conducted a global survey to assess the pandemic-related changes in the practice of cardiovascular diagnostic testing. Site procedural volumes for noninvasive tests to evaluate CAD from March 2019 (prepandemic), April 2020 (onset), and April 2021 (initial recovery) were collected. We considered traditional testing modalities, such as exercise electrocardiography, stress echocardiography, and stress single-photon emission computed tomography, and advanced testing modalities, such as stress cardiac magnetic resonance, coronary computed tomography angiography, and stress positron emission tomography. Survey data were obtained from 669 centers in 107 countries, reporting the performance of 367,933 studies for CAD during the study period. Compared with 2019, traditional tests were performed 14% less frequently (recovery rate 82%) in 2021 versus advanced tests, which were performed 15% more frequently (128% recovery rate). Coronary computed tomography angiography, stress cardiac magnetic resonance, and stress positron emission tomography showed 14%, 25%, and 25% increases in volumes from 2019 to 2021, respectively. The increase in advanced testing was isolated to high- and upper middle-income countries, with 132% recovery in advanced tests by 2021 compared with 55% in lower income nations. The COVID-19 pandemic exacerbated economic disparities in CAD testing practice between wealthy and poorer countries. Greater recovery rates and even new growth were observed for advanced imaging modalities; however, this growth was restricted to wealthy countries. Efforts to reduce practice variations in CAD testing because of economic status are warranted.

Longitudinal Pilot Evaluation of the Gut Microbiota Comparing Patients With and Without Chronic Kidney Disease

OBJECTIVE

The gut microbiota contributes to metabolic diseases, such as diabetes and hypertension, but is poorly characterized in chronic kidney disease (CKD).

DESIGN AND METHODS

We enrolled 24 adults within household pairs, in which at least one member had self-reported kidney disease, diabetes, or hypertension. CKD was classified based on estimated glomerular filtration rate < 60 mL/min/1.73 m2 or urine-albumin-to-creatinine ratio of ≥ 30 mg/g. Participants collected stool and dietary recalls seasonally over a year. Gut microbiota was characterized using 16s rRNA and metagenomic sequencing.

RESULTS

Ten participants had CKD (42%) with a median (interquartile range) estimated glomerular filtration rate of 49 (44, 54) mL/min/1.73 m2. By 16s rRNA sequencing, there was moderate to high intraclass correlation (ICC = 0.63) for seasonal alpha diversity (Shannon index) within individuals and modest differences by season (P < .01). ICC was lower with metagenomics, which has resolution at the species level (ICC = 0.26). There were no differences in alpha or beta diversity by CKD with either method. Among 79 genera, Frisingicoccus, Tuzzerella, Faecalitalea, and Lachnoclostridium had lower abundance in CKD, while Collinsella, Lachnospiraceae_ND3007, Veillonella, and Erysipelotrichaceae_UCG_003 were more abundant in CKD (each nominal P < .05) using 16s rRNA sequencing. Higher Collinsella and Veillonella and lower Lachnoclostridium in CKD were also identified by metagenomics. By metagenomics, Coprococcus catus and Bacteroides stercoris were more and less abundant in CKD, respectively, at false discovery rate corrected P = .02.

CONCLUSIONS

We identified candidate taxa in the gut microbiota associated with CKD. High ICC in individuals with modest seasonal impacts implies that follow-up studies may use less frequent sampling.

Decreasing alcohol use among young adults presenting for service in the U.S. Air Force: An epidemiological surveillance study

U.S. surveys demonstrate recent decreases in the prevalence of alcohol use and binge drinking among young adults. The current study aims to determine whether similar trends are evident in a similarly aged cohort of service members in the US Air Force to inform ongoing prevention efforts. Participants were 103,240 Air Force personnel in entry-level training between 2016 and 2019. Participants anonymously completed the AUDIT (Alcohol Use Disorder Identification Test) regarding their pre-service drinking. Logistic regression analyses and the Cochran-Armitage test were conducted to measure population trends over the study duration with stratification by age (<21 vs. ≥21) and evaluation of specific alcohol behaviors. Between 2016 and 2019, the proportion of young service members endorsing any alcohol use significantly decreased for both the <21 group (i.e. from 38.9% to 32.6%) and the ≥21 group (i.e. from 80.6% to 77.5%). Among those who endorsed drinking, a decrease over time in binge use was also observed from 46.6% to 37.8% for the <21 group and from 34.2% to 27.5% for the ≥21 group. Responses to other specific alcohol risk items and total AUDIT scores also demonstrated decreases. Binge use and risky drinking remained disproportionately common among those under the legal drinking age. It is encouraging to observe a shift toward abstinence and decreased binge use among this population of young military recruits. However, given the risk for many adverse health and legal consequences in this population, more work is needed to prevent problematic drinking, especially among those under the legal drinking age.

Sexy, trashy, cool: Perceptions of electronic cigarette users across sociodemographic groups and E-cigarette use among United States Air Force Airmen

E-cigarette use has increased in recent years. Military personnel have higher rates of e-cigarette use than civilian populations, with 15.3% of Air Force recruits using e-cigarettes. The current study assessed associations between perceptions of e-cigarette users and current use of e-cigarettes, and differences in sociodemographic characteristics to determine if there were different beliefs among different groups to inform intervention development among these straight-to-work young adults. Participants (N = 17,314) were United States Air Force Airmen (60.7% White, 29.7% women) who completed a survey during their first week of Technical Training. Regression results indicated that identifying as a man (B = 0.22, SE = 0.02), identifying as Black (B = 0.06, SE = 0.02), reporting younger age (B = -0.15, SE = 0.02), having less education (B = -0.04, SE = 0.02), and current e-cigarette use (B = 0.62, SE = 0.02) were associated with endorsing more positive e-cigarette user perceptions. Identifying as a woman (B = -0.04, SE = 0.02) and being younger (B = -0.06, SE = 0.02) were associated with endorsing more negative perceptions of e-cigarette users. Current e-cigarette use was inversely associated with negative e-cigarette user perceptions (B = -0.59, SE = 0.02). Differences across groups were found for individual e-cigarette user characteristics. Future intervention strategies among Airmen may benefit from addressing e-cigarette user perceptions to change use behaviors, as these perceptions may result in stigmatized beliefs related to e-cigarette users.

Impact of diarrhoea and acute respiratory infection on environmental enteric dysfunction and growth of malnourished children in Pakistan: a longitudinal cohort study

Background

Diarrhoea and acute respiratory infections (ARI) are assumed to be major drivers of growth and likely contribute to environmental enteric dysfunction (EED), which is a precursor to childhood malnutrition. In the present study, we checked the correlation between diarrhoeal/ARI burden and EED using a novel duodenal histological index.

Methods

Between November 2017 and July 2019, a total of 365 infants with weight-for-height Z scores (WHZ score) of <-2 were enrolled, and 51 infants with WHZ scores of >0 and height-for-age Z scores (HAZ scores) of >-1 were selected as age-matched healthy controls. Morbidity was assessed weekly and categorised as the total number of days with diarrhoea and acute respiratory infection (ARI) from enrolment until two years of age and was further divided into four quartiles in ascending order.

Findings

The HAZ declined until two years of age regardless of morbidity burden, and WHZ and weight-for-age Z scores (WAZ scores) were at their lowest at six months. Sixty-three subjects who had a WHZ score <-2 and failed to respond to nutritional and educational interventions were further selected at 15 months to investigate their EED histological scores with endoscopy further. EED histological scores of the subjects were higher with increasing diarrhoeal frequency yet remained statistically insignificant (p = 0.810).

Interpretation

There was not a clear correlation between diarrhoea and ARI frequency with growth faltering, however, children with the highest frequency of diarrhoea had the highest EED histological scores and growth faltering.

Funding

Bill and Melinda Gates Foundation and The National Institutes of Health.

Comparison of In-person FPMRS-directed Pelvic Floor Therapy Program Versus Unsupervised Pelvic Floor Exercises Following Prostatectomy

OBJECTIVE

To compare comprehensive continence outcomes in patients receiving pelvic floor muscle training (PFMT) vs standard unsupervised home pelvic floor exercise therapy (UPFE).

METHODS

As part of the UVA prostatectomy functional outcomes program, participating patients complete a 12-month PFMT program under FPMRS specialist supervision. We performed a retrospective review of prospectively collected longitudinal outcomes in patients receiving PFMT vs UPFE through 12-month follow-up. Primary study outcome was ICIQ-MLUTS SUI domain score (SDS). Secondary outcomes included daily pad use (PPD), SUI Cure (SDS=0), and quality of life score (IIQ-7). Multilevel mixed effects linear regression was used to model SDS over time.

RESULTS

Analysis included 40 men. No difference in patient characteristics was seen in comparison of PFMT vs UPFE cohorts (P = NS, all comparisons). Mean predicted SDS was significantly better in the PFMT vs UPFE cohorts at 6-month (0.81 ± 0.21 vs 1.75 ± 0.34, respectively) (P = .014) and 12-month (0.72 ± 0.17 vs 1.67 ± 0.30, respectively) (P = .004) time points. At 12-month follow-up, 11 (55%) vs 4 (20%) patients reported absence of SUI in PFMT vs UPFE cohorts, respectively. Predicted probabilities of SUI cure in PFMT vs UPFE cohorts at 12months were 0.52 ± 0.14 vs 0.23 ± 0.13, respectively (P = .14). At 12-month follow-up, the mean predicted PPD and IIQ score was 0.19 ± 0.10 vs 0.79 ± 0.33 and 2.86 ± 0.86 vs 2.55 ± 1.07 in PFMT vs UPFE cohorts, respectively (P = NS).

CONCLUSION

In-person, FMPRS-directed PFMT is associated with improved SUI domain scores following robotic-assisted laparoscopic prostatectomy, a finding durable through 12-month follow-up.

Increased stroke severity and mortality in patients with SARS-CoV-2 infection: An analysis from the N3C database

BACKGROUND

Studies from early in the COVID-19 pandemic showed that patients with ischemic stroke and concurrent SARS-CoV-2 infection had increased stroke severity. We aimed to test the hypothesis that this association persisted throughout the first year of the pandemic and that a similar increase in stroke severity was present in patients with hemorrhagic stroke.

METHODS

Using the National Institute of Health National COVID Cohort Collaborative (N3C) database, we identified a cohort of patients with stroke hospitalized in the United States between March 1, 2020 and February 28, 2021. We propensity score matched patients with concurrent stroke and SARS-COV-2 infection and available NIH Stroke Scale (NIHSS) scores to all other patients with stroke in a 1:3 ratio. Nearest neighbor matching with a caliper of 0.25 was used for most factors and exact matching was used for race/ethnicity and site. We modeled stroke severity as measured by admission NIHSS and the outcomes of death and length of stay. We also explored the temporal relationship between time of SARS-COV-2 diagnosis and incidence of stroke.

RESULTS

Our query identified 43,295 patients hospitalized with ischemic stroke (5765 with SARS-COV-2, 37,530 without) and 18,107 patients hospitalized with hemorrhagic stroke (2114 with SARS-COV-2, 15,993 without). Analysis of our propensity matched cohort revealed that stroke patients with concurrent SARS-COV-2 had increased NIHSS (Ischemic stroke: IRR=1.43, 95% CI:1.33-1.52, p<0.001; hemorrhagic stroke: IRR=1.20, 95% CI:1.08-1.33, p<0.001), length of stay (Ischemic stroke: estimate = 1.48, 95% CI: 1.37, 1.61, p<0.001; hemorrhagic stroke: estimate = 1.25, 95% CI: 1.06, 1.47, p=0.007) and higher odds of death (Ischemic stroke: OR 2.19, 95% CI: 1.79-2.68, p<0.001; hemorrhagic stroke: OR 2.19, 95% CI: 1.79-2.68, p<0.001). We observed the highest incidence of stroke diagnosis on the same day as SARS-COV-2 diagnosis with a logarithmic decline in counts.

CONCLUSION

This retrospective observational analysis suggests that stroke severity in patients with concurrent SARS-COV-2 was increased throughout the first year of the pandemic.

Tobacco quitline performance: Comparing the impacts of early cessation and proactive re-engagement on callers' smoking status at follow-up at 12 months

INTRODUCTION

While tobacco Quitlines are effective in the promotion of smoking cessation, the majority of callers who wish to quit still fail to do so. The aim of this study was to determine if 12-month tobacco Quitline smoking cessation rates could be improved with re-engagement of callers whose first Quitline treatment failed to establish abstinence.

METHODS

In an adaptive trial, 614 adult smokers, who were active duty, retired, and family of military personnel with TRICARE insurance who called a tobacco Quitline, received a previously evaluated and efficacious four-session tobacco cessation intervention with nicotine replacement therapy (NRT). At the scheduled follow-up at 3 months, callers who had not yet achieved abstinence were offered the opportunity to re-engage. This resulted in three caller groups: 1) those who were abstinent, 2) those who were still smoking but willing to re-engage with an additional Quitline treatment; and 3) individuals who were still smoking but declined re-engagement. A propensity score-adjusted logistic regression model was generated to compare past-7-day point prevalence abstinence at 12 months post Quitline consultation.

RESULTS

Using a propensity score adjusted logistic regression model, comparison of the three groups resulted in higher odds of past-7-day point prevalence abstinence at follow-up at 12 months for those who were abstinent at 3 months compared to those who re-engaged (OR=9.6; 95% CI: 5.2-17.8; Bonferroni adjusted p<0.0001), and relative to those who declined re-engagement (OR=13.4; 95% CI: 6.8-26.3; Bonferroni adjusted p<0.0001). There was no statistically significant difference in smoking abstinence between smokers at 3 months who re-engaged and those who declined re-engagement (OR=1.39; 95% CI: 0.68-2.85).

CONCLUSIONS

Tobacco Quitlines seeking to select a single initiative by which to maximize abstinence at follow-up at 12 months may benefit from diverting additional resources from the re-engagement of callers whose initial quit attempt failed, toward changes which increase callers' probability of success within the first 3 months of treatment.

TRIAL REGISTRATION

This study is registered at clinicaltrials.gov (NCT02201810).

Impact of enteropathogens on faltering growth in a resource-limited setting

Introduction

Environmental enteropathy is an important contributor to childhood malnutrition in the developing world. Chronic exposure to fecal pathogens leads to alteration in intestinal structure and function, resulting in impaired gut immune function, malabsorption, and growth faltering leading to environmental enteropathy.

Methods

A community-based intervention study was carried out on children till 24 months of age in Matiari district, Pakistan. Blood and fecal specimens were collected from the enrolled children aged 3-6 and 9 months. A real-time PCR-based TaqMan array card (TAC) was used to detect enteropathogens.

Results

Giardia, Campylobacter spp., enteroaggregative Escherichia coli (EAEC), Enteropathogenic Escherichia coli (EPEC), Enterotoxigenic Escherichia coli (ETEC), and Cryptosporidium spp. were the most prevailing enteropathogens in terms of overall positivity at both time points. Detection of protozoa at enrollment and 9 months was negatively correlated with rate of change in height-for-age Z (ΔHAZ) scores during the first and second years of life. A positive association was found between Giardia, fecal lipocalin (LCN), and alpha 1-Acid Glycoprotein (AGP), while Campylobacter spp. showed positive associations with neopterin (NEO) and myeloperoxidase (MPO).

Conclusion

Protozoal colonization is associated with a decline in linear growth velocity during the first 2 years of life in children living in Environmental enteric dysfunction (EED) endemic settings. Mechanistic studies exploring the role of cumulative microbial colonization, their adaptations to undernutrition, and their influence on gut homeostasis are required to understand symptomatic enteropathogen-induced growth faltering.

Predictors of Re-Engagement after Relapse in a Tobacco Quit Line Intervention: Secondary Analysis from a Randomized Clinical Trial

People who smoke often make several quit attempts before successfully maintaining abstinence. Therefore, incorporating re-engagement for people who fail to initially quit could increase quit attempts and ultimately increase cessation rates. Within the context of quit line-based interventions, it remains unknown what characteristics are associated with re-engagement. The purpose of this study was to assess associations between demographic and motivational characteristics, tobacco use, and initial intervention engagement with re-engagement in a tobacco quit line intervention. Among 372 adults who reported smoking three months after initiating a quit line-facilitated quit attempt as part of a larger randomized clinical trial, associations between personal characteristics (e.g., age, gender, nicotine dependence, and confidence in their ability to quit smoking) and initial intervention engagement (number of completed counseling sessions and use of nicotine replacement therapy (NRT)) with re-engagement (accepting an offer to re-initiate the quit line intervention) were determined using multivariable logistic regression modeling. Compared to non-White participants, White participants had lower odds of re-engaging (OR: 0.42, 95% CI: 0.23, 0.75). Number of initial counseling sessions completed was associated with re-engaging. NRT use during the initial intervention was not associated with re-engaging. Initial intervention engagement is important in the process of re-engagement, specifically attending counseling sessions. Exploration of associations between initial intervention engagement and potentially modifiable motivational factors is needed to be potentially leveraged in future interventions to maintain continued engagement in cessation among adults who smoke.

Dupilumab Use Is Associated With Protection From Coronavirus Disease 2019 Mortality: A Retrospective Analysis

We previously found that type 2 immunity promotes coronavirus disease 2019 (COVID-19) pathogenesis in a mouse model. To test relevance to human disease, we used electronic health record databases and determined that patients on dupilumab (anti-interleukin [IL]-4R monoclonal antibody that blocks IL-13 and IL-4 signaling) at the time of COVID-19 infection had lower mortality.

Where, When, and How Alcohol Use Occurs During Air Force Technical Training

INTRODUCTION

Alcohol use is prevalent among military personnel, with many engaging in binge drinking behaviors. Military trainees are unique, in that they experience an enforced alcohol ban for 8 weeks while in Basic Military Training. However, they are also typically young adults, who consume alcohol at higher rates than any other age group. The current study aimed to describe alcohol consumption among trainees, determine when, where, and with whom Airmen drank for the first time during Technical Training, and if these patterns were significantly different based on descriptive norms (i.e., beliefs about how many other individuals engage in a certain behavior) related to alcohol use, given that most military members consume alcohol. Last, we aimed to determine if alcohol consumption or potential alcohol use disorders were significantly different based on descriptive norms.

MATERIALS AND METHODS

Airmen (n = 599) were recruited at Joint Base San Antonio-Fort Sam Houston during their last week of Technical Training to complete a survey. Study procedures were approved by the 59th Medical Wing Institutional Review Board. Participants were asked about their beliefs related to how many other Airmen drink alcohol (i.e., less than 50%, 50%, or greater), their own experiences with alcohol (e.g., how much they drink compared with consumption before military service, blackouts after drinking during Technical Training), and when, where, and with whom they consumed alcohol for the first time after beginning military training.

RESULTS

Over half of the Airmen reported not engaging in drinking behaviors during Technical Training. Among those who reported drinking one or more drinks during Technical Training, most reported drinking the same amount or less than they did prior to Basic Military Training. The majority of Airmen reported that they had "maybe" experienced blackouts from drinking since Technical Training. Most Airmen drank for the first time with another someone who was not an Airman, at a restaurant, home, or other place off base, and while they were on leave. Results indicated no significant differences between groups related to beliefs about how many Airmen drink during Technical Training and where, when, and with whom Airmen drank for the first time since joining the Air Force. There were also no differences in Alcohol Use Disorders Identification Test scores or drinks per week between these normative belief groups.

CONCLUSIONS

Almost half of Airmen resume drinking after alcohol restrictions are lifted during Technical Training but maintain low numbers of drinks consumed per week and low risk for alcohol use disorders, which may indicate that this is an opportune time for intervention to prevent alcohol consumption from escalating over time. Airmen reported drinking for the first time with another Airman off base during leave. Focusing on how Airmen navigate alcohol-related decision-making while their responsibilities are reduced, or how other Airmen influence their decisions to engage in risky drinking, may help prevent alcohol use rates from increasing post-enforced ban.

Patterns of Fruit and Vegetable Intake in Adults With and Without Chronic Kidney Disease in the United States

OBJECTIVE

To characterize patterns of fruit and vegetable (F&V) intake in US adults with and without chronic kidney disease (CKD).

METHODS

We used 24-hour dietary recall data from multiple cycles of the National Health and Nutrition Examination Survey spanning 3 groups from 1988 to 2018 (1988-1994; 2003-2010; 2011-2018). We categorized F&Vs based on food processing and phytochemical content. We assessed patterns of F&Vs using latent class analysis and compared intake patterns across the 3 temporal cohorts and CKD status using weighted multinomial logistic regression.

RESULTS

Four similar patterns of F&Vs emerged in each cycle: Overall Low Intake, High Unprocessed, High Ultra-Processed, and Moderate Processed F&Vs. The Overall Low Intake pattern was most prevalent in all cohorts and CKD groups. After adjustment for demographic variables and selected health conditions, participants with compared to without CKD were more likely to be classified as Overall Low Intake in each cohort, although this was not significant in the National Health and Nutrition Examination Survey 2011-2018.

CONCLUSIONS

Low consumption of F&Vs was more common in patients with CKD. Longitudinal studies are needed to determine if low intake is a risk factor for, or response to, CKD.

Examination of Tobacco-Related Messaging and Tobacco Use over Time among U.S. Military Young Adults

Background: People from minoritized populations have historically been targeted by tobacco companies. Little is known about exposure to tobacco-related messages among military personnel from disadvantaged backgrounds. Objectives: The current study aimed to examine exposure to tobacco-related messaging across many nicotine products and through a variety of mediums (i.e., family, friends, advertisements, event promotions, social media) among diverse military populations and use one year later in a sample of young adults who recently enlisted in the U.S. Air Force. Methods: In this study, 8,901 U.S. Air Force trainees reported on demographics, tobacco use, and exposure to positive tobacco messages from social sources (i.e., friends, family, social media) and environmental sources (i.e., advertisements and promotions). Tobacco use was reported one-year later. Results: Compared to others of the same reported racial/ethnic background, Latino/a/x (Relative Risk Ratio [RRR] = 1.354, 95% CI: [1.145, 1.563]) and multiracial (RRR = 1.594, 95% CI: [1.173, 2.016]) participants who were exposed to positive tobacco messages from social sources were significantly more likely to report tobacco product use at one-year follow-up than those who were not exposed to social messages. Exposure to positive tobacco messages from environmental sources were not significantly associated with tobacco use one year later. Conclusions: Social messages may play an important role in increasing risk of tobacco use among some minoritized populations. Cultural as well as systemic factors could be addressed in future tobacco prevention programs to decrease the potency of positive tobacco-related social messages among Latino/a/x and multiracial communities.

The impact of COVID-19 on clinical outcomes among acute myocardial infarction patients undergoing early invasive treatment strategy

BACKGROUND

The implications of coronavirus disease 2019 (COVID-19) infection on outcomes after invasive therapeutic strategies among patients presenting with acute myocardial infarction (AMI) are not well studied.

HYPOTHESIS

To assess the outcomes of COVID-19 patients presenting with AMI undergoing an early invasive treatment strategy.

METHODS

This study was a cross-sectional, retrospective analysis of the National COVID Cohort Collaborative database including all patients presenting with a recorded diagnosis of AMI (ST-elevation myocardial infarction (MI) and non-ST elevation MI). COVID-19 positive patients with AMI were stratified into one of four groups: (1a) patients who had a coronary angiogram with percutaneous coronary intervention (PCI) within 3 days of their AMI; (1b) PCI within 3 days of AMI with coronary artery bypass graft (CABG) within 30 days; (2a) coronary angiogram without PCI and without CABG within 30 days; and (2b) coronary angiogram with CABG within 30 days. The main outcomes were respiratory failure, cardiogenic shock, prolonged length of stay, rehospitalization, and death.

RESULTS

There were 10 506 COVID-19 positive patients with a diagnosis of AMI. COVID-19 positive patients with PCI had 8.2 times higher odds of respiratory failure than COVID-19 negative patients (p = .001). The odds of prolonged length of stay were 1.7 times higher in COVID-19 patients who underwent PCI (p = .024) and 1.9 times higher in patients who underwent coronary angiogram followed by CABG (p = .001).

CONCLUSION

These data demonstrate that COVID-19 positive patients with AMI undergoing early invasive coronary angiography had worse outcomes than COVID-19 negative patients.

Predictors of Cessation Outcomes Among Older Adult Smokers Enrolled in a Proactive Tobacco Quitline Intervention

OBJECTIVES

To identify predictors of older adults' likelihood of quitting following engagement in a proactive tobacco quit line.

METHODS

Older (>60 years) participants (N = 186) enrolled in a four-session quit line with 8-weeks of nicotine replacement therapy reported demographics, beliefs, and information about tobacco use. Point prevalence abstinence was reported at 3 and 12-months.

RESULTS

In final models, endorsement of quitting to take control of one's life and confidence in quitting were positively associated with 3-month cessation (OR = 1.74, 95% CI = 1.16, 2.62; OR = 1.75, 95% CI = 1.21, 2.52, respectively). At 12 months, stronger endorsement of quitting to take control of one's life and decreased nicotine dependence were associated with higher cessation (OR = 1.51, 95% CI = 1.05, 2.17; OR = 0.84, 95% CI = 0.71,0.99, respectively).

DISCUSSION

For tobacco cessation among older adults, programs should provide additional support to those with higher nicotine dependence, promote quitting self-efficacy, and encourage quitting as means to gain control of life and health.

Change in parathyroid hormone levels from baseline predicts hypocalcemia following total or completion thyroidectomy

BACKGROUND

This study aims to identify the strongest predictor of postoperative hypocalcemia following thyroid surgery.

METHODS

Study of patients who underwent total/completion thyroidectomy. No patients received postoperative calcium supplementation. Demographic and perioperative data were collected including preoperative baseline parathyroid hormone (PTH) levels, PTH levels at 30 min and 6 h post-excision, and 18 h post-excision calcium levels.

RESULTS

Of 124 patients studied, 20.2% developed temporary hypocalcemia (Ca <8.5 mg/dL at 18 h post-excision). In multivariate analyses, absolute PTH levels at 30 min and 6 h post-excision as well as change in PTH from baseline at 30 min and 6 h post-excision were statistically significantly associated with postoperative hypocalcemia. Per 10 units decrease in PTH from baseline at 30 min post-excision, the risk of developing temporary hypocalcemia increases by 17%.

CONCLUSION

Absolute PTH levels and change in PTH from baseline at 30 min and 6 h post-excision predict hypocalcemia after total or completion thyroidectomy.

Association Between Periodontal Disease and Cardiovascular Disease (from the NHANES)

As observational studies support the association between periodontal disease (PD) and cardiovascular diseases (CVDs), we examined this relationship using the National Health and Nutrition Examination Survey 2013 to 2014 data. This cross-sectional study involved 2,830 adult participants, aged ≥30 years who underwent a home interview, followed by a standardized assessment at a mobile examination center from 2013 to 2014. PD was defined using the new classification scheme issued by American Academy of Periodontology Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions in 2017, and CVD was defined as the composite of coronary artery disease and stroke. The gathered data were subjected to weighted statistical analysis to examine the relation between CVD prevalence and PD. The sample (mean age 51.5 ± 13.6 years) comprised 50.1% men and 69.5% White participants. Stage I (mild/subclinical), II (moderate), and III to IV (severe) PD was noted in 16.7% (95% confidence interval [CI] 12.7 to 21.7), 57.4% (95% CI 53.9 to 60.9), and 25.9% (95% CI 21.4 to 30.8) of the participants, respectively. Patients with stage III and IV PD were more likely to have CVD than those with stage I (adjusted odds ratio 3.59, 95% CI 1.12 to 11.54, p = 0.03). Similarly, participants who reported fair/poor gum health were more likely to have CVD than those who reported excellent/very good gum health (adjusted odds ratio 2.17, 95% CI 0.98 to 4.79, p = 0.055). In conclusion, the data from the National Health and Nutrition Examination Survey 2013 to 2014 demonstrated that PD severity is associated with CVD risk. However, the information gathered by trained professionals during periodontal examinations is a more reliable predictor of PD-CVD associations compared with self-reported measures of oral health.

Abstract TMP17: Demographics, Characteristics, And Outcomes Of Stroke Patients With Concurrent Sars-cov-2 Infection From March 1, 2020 To February 28, 2020: An Analysis From The N3c Database

Background: Studies have shown that patients with ischemic stroke (IS) and concurrent COVID-19 have increased stroke severity. These analyses were limited by use of prepandemic era controls or by utilization of a sample from the early pandemic period when stroke care delivery was affected by lockdown. Studies on the severity of hemorrhagic stroke (HS) in patients with concurrent COVID-19 are few and limited by small sample sizes.

Methods: Using the National Institute of Health (NIH) National COVID Cohort Collaborative (N3C) database, we identified patients diagnosed with stroke between Mar 1, 2020 - Feb 28, 2021. Hospitalized stroke patients with concurrent COVID-19 (stroke within 3 months after or one week prior to positive SARS-COV-2 PCR or AG lab test) were matched to all other hospitalized stroke patients in a 1:3 ratio. Nearest neighbor matching with a caliper of 0.25 was used for most clinical and demographic factors; exact matching for race/ethnicity and site. Within our matched sample, we used Poisson regression to calculate stroke severity incident rate ratio (IRR).

Results: Our query identified 10,394 patients hospitalized with IS with available NIHSS scores upon admission (802 with concurrent COVID-19 and 9,592 without) and 2138 patients hospitalized with HS (181 with concurrent COVID-19 and 1957 without). Average NIHSS was greater in concurrent groups with both IS and HS (11.1 vs 7.68, p < 0.001 and 15.7 vs 11.7, p < 0.001 respectively). Propensity matched analysis also demonstrated that stroke patients with concurrent COVID-19 had increased initial NIHSS (IS: IRR = 1.4, 95% CI:1.3-1.5, p-value < 0.001; HS: IRR = 1.3, 95% CI:1.2-1.5, p < 0.001). Average NIHSS in both IS and HS patients was greater in the Mar-Apr 2020 epoch than in all other 2 month epochs studied in these respective groups.

Conclusions: This analysis suggests that the association between increased stroke severity and concurrent COVID-19 that was observed during the early pandemic was present throughout the pandemic as stroke care utilization normalized. Further work will center on the interaction between COVID-19 illness severity and stroke severity.

Prevention of Alcohol-related Incidents in the U.S. Air Force: Results From a Cluster Randomized Trial

BACKGROUND

Alcohol misuse poses significant public health concerns in the U.S. Military. An Alcohol Misconduct Prevention Program (AMPP), which includes a brief alcohol intervention (BAI) session, plus random breathalyzer program, has been shown to reduce alcohol-related incidents (ARIs) among Airmen undergoing training.

PURPOSE

The current study sought to examine whether a booster BAI administered at the end of Airmen's training reduced ARIs out to a 1-year follow-up.

METHODS

Participants were 26,231 U.S. Air Force Technical Trainees recruited between March 2016 and July 2018. Participants were cluster randomized by cohort to two conditions: AMPP + BAI Booster or AMPP + Bystander Intervention. The primary analysis was a comparison of the interventions' efficacies in preventing Article 15 ARIs at a 1-year follow-up, conducted using a generalized estimating equations logistic regression model controlling for covariates.

RESULTS

There was no significant difference by condition in Article 15 ARIs at the 1-year follow-up (P = .912).

CONCLUSIONS

Findings suggest that a booster may not be necessary to produce maximum effects beyond the initial AMPP intervention. It is also possible that alcohol behaviors changed as a result of the intervention but were not captured by our outcome measures. Future research should consider alternative outcomes or participant-tracking measures to determine whether a different or more intensive BAI booster is effective. The majority of Article 15 ARIs were for underage drinking; therefore, developing an intervention focused on this problem behavior could lead to large reductions in training costs in the military.

Dual and polytobacco use after a period of enforced tobacco cessation

The current study aimed to assess single product, dual, and polytobacco use in a young adult military population and how an enforced tobacco ban during training impacts these behaviors. Participants were 810 U.S. Airmen who reported tobacco use as civilians. Participants completed baseline and one-year follow-up surveys about their tobacco use from 2016 to 2019. Each product used by a participant was assigned a score based on their frequency of use, which were summed to create a total score. Change scores were calculated by determining the difference between baseline and follow-up frequency scores. Tobacco frequency score and the categorical change (e.g., increased, decreased) were compared between groups using t-tests and Chi-squared tests, respectively, adjusting for clustering effects by squadron and base. Among single product users, 44.58% quit using tobacco products, 47.1% remained single product users, and 8.32% became dual or polytobacco users. Among dual users, 39.1% quit, 43.1% became single product users, 14.2% remained dual users, and 3.7% became polytobacco users. Among polytobacco users, 29.9% quit, 43.4% became single product users, 17.9% became dual users, and 8.8% continued poly-tobacco use. Most participants reduced the number and frequency of tobacco products used. Implementing stringent policies that further restrict tobacco use may decrease tobacco product use or frequency of use.

Bile Acid Profiling Reveals Distinct Signatures in Undernourished Children with Environmental Enteric Dysfunction

BACKGROUND

Intestinal inflammation and malabsorption in environmental enteric dysfunction (EED) are associated with early childhood growth faltering in impoverished settings worldwide.

OBJECTIVES

The goal of this study was to identify candidate biomarkers associated with inflammation, EED histology, and as predictors of later growth outcomes by focusing on the liver-gut axis by investigating the bile acid metabolome.

METHODS

Undernourished rural Pakistani infants (n = 365) with weight-for-height Z score (WHZ) < -2 were followed up to the age of 24 mo and monitored for growth, infections, and EED. Well-nourished local children (n = 51) were controls, based on consistent WHZ > 0 and height-for-age Z score (HAZ) > -1 on 2 consecutive visits at 3 and 6 mo. Serum bile acid (sBA) profiles were measured by tandem MS at the ages of 3-6 and 9 mo and before nutritional intervention. Biopsies and duodenal aspirates were obtained following upper gastrointestinal endoscopy from a subset of children (n = 63) that responded poorly to nutritional intervention. BA composition in paired plasma and duodenal aspirates was compared based on the severity of EED histopathological scores and correlated to clinical and growth outcomes.

RESULTS

Remarkably, >70% of undernourished Pakistani infants displayed elevated sBA concentrations consistent with subclinical cholestasis. Serum glycocholic acid (GCA) correlated with linear growth faltering (HAZ, r = -0.252 and -0.295 at the age of 3-6 and 9 mo, respectively, P <0.001) and biomarkers of inflammation. The proportion of GCA positively correlated with EED severity for both plasma (rs = 0.324 P = 0.02) and duodenal aspirates (rs = 0.307 P = 0.06) in children with refractory wasting that underwent endoscopy, and the proportion of secondary BA was low in both undernourished and EED children.

CONCLUSIONS

Dysregulated bile acid metabolism is associated with growth faltering and EED severity in undernourished children. Restoration of intestinal BA homeostasis may offer a novel therapeutic target for undernutrition in children with EED. This trial was registered at clinicaltrials.gov as NCT03588013.

Donor Morbidity Is Equivalent Between Right and Left Hepatectomy for Living Liver Donation: A Meta-Analysis

Maximizing liver graft volume benefits the living donor liver recipient. Whether maximizing graft volume negatively impacts living donor recovery and outcomes remains controversial. Patient randomization between right and left hepatectomy has not been possible due to anatomic constraints; however, a number of published, nonrandomized observational studies summarize donor outcomes between 2 anatomic living donor hepatectomies. This meta-analysis compares donor-specific outcomes after right versus left living donor hepatectomy. Systematic searches were performed via PubMed, Cochrane, ResearchGate, and Google Scholar databases to identify relevant studies between January 2005 and November 2019. The primary outcomes compared overall morbidity and incidence of severe complications (Clavien-Dindo >III) between right and left hepatectomy in donors after liver donation. Random effects meta-analysis was performed to derive summary risk estimates of outcomes. A total of 33 studies (3 prospective and 30 retrospective cohort) were used to identify 7649 pooled patients (5993 right hepatectomy and 1027 left hepatectomy). Proportion of donors who developed postoperative complications did not significantly differ after right hepatectomy (0.33; 95% confidence interval [CI], 0.27-0.40) and left hepatectomy (0.23; 95% CI, 0.17-0.29; P = 0.19). The overall risk ratio (RR) did not differ between right and left hepatectomy (RR, 1.16; 95% CI, 0.83-1.63; P = 0.36). The relative risk for a donor to develop severe complications showed no differences by hepatectomy side (Incidence rate ratio, 0.97; 95% CI, 0.67-1.40; P = 0.86). There is no evidence that the overall morbidity differs between right and left lobe donors. Publication bias reflects institutional and surgeon variation. A prospective, standardized, multi-institutional study would help quantify the burden of donor complications after liver donation.

Gut integrity and duodenal enteropathogen burden in undernourished children with environmental enteric dysfunction

Environmental enteric dysfunction (EED) is a subclinical condition of intestinal inflammation, barrier dysfunction and malabsorption associated with growth faltering in children living in poverty. This study explores association of altered duodenal permeability (lactulose, rhamnose and their ratio) with higher burden of enteropathogen in the duodenal aspirate, altered histopathological findings and higher morbidity (diarrhea) that is collectively associated with linear growth faltering in children living in EED endemic setting. In a longitudinal birth cohort, 51 controls (WHZ > 0, HAZ > −1.0) and 63 cases (WHZ< -2.0, refractory to nutritional intervention) were recruited. Anthropometry and morbidity were recorded on monthly bases up to 24 months of age. Dual sugar assay of urine collected after oral administration of lactulose and rhamnose was assessed in 96 children from both the groups. Duodenal histopathology (n = 63) and enteropathogen analysis of aspirate via Taqman array card (n = 60) was assessed in only cases. Giardia was the most frequent pathogen and was associated with raised L:R ratio (p = 0.068). Gastric microscopy was more sensitive than duodenal aspirate in H. pylori detection. Microscopically confirmed H. pylori negatively correlated with HAZ at 24 months (r = −0.313, p = 0.013). Regarding histopathological parameters, goblet cell reduction significantly correlated with decline in dual sugar excretion (p< 0.05). Between cases and controls, there were no significant differences in the median (25^th, 75^th percentile) of urinary concentrations (μg/ml) of lactulose [27.0 (11.50, 59.50) for cases vs. 38.0 (12.0, 61.0) for controls], rhamnose [66.0 (28.0, 178.0) vs. 86.5 (29.5, 190.5)] and L:R ratio [0.47 (0.24, 0.90) vs. 0.51 (0.31, 0.71)] respectively. In multivariable regression model, 31% of variability in HAZ at 24 months of age among cases and controls was explained by final model including dual sugars. In conclusion, enteropathogen burden is associated with altered histopathological features and intestinal permeability. In cases and controls living in settings of endemic enteropathy, intestinal permeability test may predict linear growth. However, for adoption as a screening tool for EED, further validation is required due to its complex intestinal pathophysiology.

EED is a subclinical condition of compromised gut integrity secondary to frequent and repeated exposure to enteropathogens in global settings with a high prevalence of undernutrition. In this study, we reported association of gut mucosal architecture with a dual sugar intestinal permeability assay (lactulose-rhamnose) in Pakistani children. In the presence of duodenal enteropathogens, features such as chronic inflammation, intra-epithelial lymphocytosis, enterocyte injury and Paneth cell reduction were consistently observed. When comparing undernourished cases and controls living in the same setting, we found urinary excretion of the sugars was similar among groups; however, variability in HAZ among children at 24 months was partially explained by a model that includes excretion values.

Mucosal Genomics Implicate Lymphocyte Activation and Lipid Metabolism in Refractory Environmental Enteric Dysfunction

BACKGROUND & AIMS

Environmental enteric dysfunction (EED) limits the Sustainable Development Goals of improved childhood growth and survival. We applied mucosal genomics to advance our understanding of EED.

METHODS

The Study of Environmental Enteropathy and Malnutrition (SEEM) followed 416 children from birth to 24 months in a rural district in Pakistan. Biomarkers were measured at 9 months and tested for association with growth at 24 months. The duodenal methylome and transcriptome were determined in 52 undernourished SEEM participants and 42 North American controls and patients with celiac disease.

RESULTS

After accounting for growth at study entry, circulating insulin-like growth factor-1 (IGF-1) and ferritin predicted linear growth, whereas leptin correlated with future weight gain. The EED transcriptome exhibited suppression of antioxidant, detoxification, and lipid metabolism genes, and induction of anti-microbial response, interferon, and lymphocyte activation genes. Relative to celiac disease, suppression of antioxidant and detoxification genes and induction of antimicrobial response genes were EED-specific. At the epigenetic level, EED showed hyper-methylation of epithelial metabolism and barrier function genes, and hypo-methylation of immune response and cell proliferation genes. Duodenal coexpression modules showed association between lymphocyte proliferation and epithelial metabolic genes and histologic severity, fecal energy loss, and wasting (weight-for-length/height Z < -2.0). Leptin was associated with expression of epithelial carbohydrate metabolism and stem cell renewal genes. Immune response genes were attenuated by giardia colonization.

CONCLUSIONS

Children with reduced circulating IGF-1 are more likely to experience stunting. Leptin and a gene signature for lymphocyte activation and dysregulated lipid metabolism are implicated in wasting, suggesting new approaches for EED refractory to nutritional intervention. ClinicalTrials.gov, Number: NCT03588013. (https://clinicaltrials.gov/ct2/show/NCT03588013).

Association Between the Framingham Risk Score and Carotid Artery Intima-Media Thickness in Patients With Human Immunodeficiency Virus

Cardiovascular diseases (CVD) are more prevalent among HIV-infected subjects. We examined the associations between carotid artery intima-media thickness (CIMT), conventional CVD risk factors, and HIV-related risk factors among Hispanics with HIV infection. This cross-sectional study involved 96 consecutive HIV patients on stable antiretroviral therapy and without history of CVD in a university-based outpatient clinic who underwent carotid ultrasound evaluation. Increased CIMT was defined as common carotid artery-CIMT values greater than or equal to seventy-fifth percentile for the patient's age, sex, and race/ethnicity based on CIMT nomograms from large population studies. The sample was comprised of 96 Hispanic Americans aged 39.7 ± 11.9, 89% of whom were men, 64% were on a protease inhibitor, and 11% had increased CIMT (95% confidence intervals 5.9% to 19.6%). In univariable analysis, increased CIMT was significantly associated (p <0.05) with older age, metabolic syndrome, intermediate/high Framingham risk score, HIV infection duration ≥5 years, integrase inhibitors, and protease inhibitors. In multivariable analysis, only Framingham risk score (p = 0.009) was independently associated with increased CIMT. The median common carotid artery-CIMT value was significantly greater in patients with intermediate/high compared with those with low Framingham risk score (0.60 vs 0.49 mm; p <0.001). In conclusion, given the significant association between increased CIMT and Framingham risk score, adherence to prevention guidelines to reduce CVD risk factor burden in this population is strongly recommended.

Clinical characteristics and outcomes of patients requiring prolonged inotropes after left ventricular assist device implantation

Limited data exist regarding patients with continuous-flow left ventricular assist device (LVAD) support who require long-term inotropes. Our primary objective was to evaluate the clinical characteristics and all-cause mortality of LVAD recipients with prolonged inotrope use (PIU). Secondary endpoints were to compare predictors of PIU, mortality, risk of late re-initiation of inotropes, time to gastrointestinal bleed (GIB), infection, and arrhythmias. Retrospective cohort study was conducted on adult patients with primary continuous-flow LVADs implanted from January 2008 to February 2017 and the patients were followed up through February 2018. We defined PIU as ≥14 days of inotrope support. Kaplan-Meier method, competing risk models and Cox proportional hazard models were used. Final analytic sample was 203 patients, 58% required PIU, and 10% were discharged on inotropes. There was no difference in preimplant characteristics. One-year survival rate was 87% if no PIU required, 74% if PIU required, and 72% if discharged on inotropes. PIU was associated with longer length of stay and higher incidence of GIB. We found no association between PIU and late re-initiation of inotropes, infection or arrhythmias. Adjusted hazard risk of death was increased in patients with PIU (HR = 1.66, P = .046), older age (HR = 1.28, P = .031), and higher creatinine levels (HR = 1.60, P = .007). Prolonged inotrope use is frequently encountered following LVAD implantation and is associated with adverse prognosis but remains a therapeutic option. Inability to wean inotropes prior to hospital discharge is a marker of patients at particularly higher risk of mortality following LVAD implantation.

Outcomes of a Multicomponent Culturally Tailored Cervical Cancer Screening Intervention Among Underserved Hispanic Women (De Casa en Casa)

Hispanic women have almost double the cervical cancer incidence and are twice as likely to die from cervical cancer compared with non-Hispanic White women. Cervical cancer is preventable with screening, and based on available data, multiple component screening interventions have been proposed as a strategy to maximize screening, but such studies are lacking. We sought to test the effectiveness of a multicomponent screening intervention for primary prevention and early detection of cervical cancer among underserved Hispanic women. We conducted a prospective community-based cervical cancer screening intervention utilizing a quasi-experimental design. The intervention was theory based, delivered by bilingual community health workers, combined education and reduction of noneconomic barriers, and addressed economic barriers. Components included outreach, education, provision of no-cost Papanicolaou and human papillomavirus screening, on-site diagnostic and treatment colposcopy, and patient navigation with tracking to facilitate screening, diagnosis, and treatment. The main outcome was self-reported screening. We recruited 300 intervention group and 299 control group participants. Mean age of the sample was 44.7 years. The majority were Hispanic (98%), born in Mexico (79%), and had a Spanish-language preference (86%). In intention-to-treat analyses, the intervention group had a relative risk of screening of 14.58 (95% confidence interval = 8.57-24.80, p < .001) compared with the control group. A multilevel, multiple component culturally tailored bilingual cervical cancer screening intervention combining education, navigation, and no-cost screening can significantly increase cervical cancer screening uptake in a high-risk, underscreened population and has the potential to affect cervical cancer health disparities.

Group Versus Individual Culturally Tailored and Theory-Based Education to Promote Cervical Cancer Screening Among the Underserved Hispanics: A Cluster Randomized Trial

Purpose:

To determine whether group education is as effective as individual education in improving cervical cancer screening uptake along the US–Mexico border.

Design:

Cluster randomized controlled study.

Setting:

El Paso and Hudspeth Counties, Texas.

Participants:

Three hundred women aged 21 to 65 years, uninsured, due for a Pap test, no prior history of cervical cancer or hysterectomy.

Intervention:

Theory-based, culturally appropriate program comprised of outreach, educational session, navigation services, and no-cost cervical cancer testing.

Measures:

Baseline, immediate postintervention, and 4-month follow-up surveys measured knowledge and theoretical constructs from the Health Belief Model, Theory of Reasoned Action, and the Social Cognitive Theory.

Analysis:

Relative risk regression analyses to assess the effects of educational delivery mode on the uptake of screening. Mixed effect models to analyze changes in psychosocial variables.

Results:

One hundred and fifty women assigned to each educational group; 99% Hispanic. Of all, 85.7% completed the follow-up survey. Differences in screening rate at follow-up were analyzed by education type. Overall screening rate at follow-up was 73.2%, no significant difference by education type (individual: 77.6%, group: 68.9% P = .124). Significant increases among group education at follow-up for knowledge, perceived susceptibility, perceived seriousness, and subjective norms and significant decrease for perceived benefits.

Conclusion:

This study provides evidence to support the effectiveness of group education to promote cervical cancer screening among vulnerable Hispanic women and offers an additional method to address cervical cancer disparities.

The Association of Background Parenchymal Enhancement at Breast MRI with Breast Cancer: A Systematic Review and Meta-Analysis

BackgroundThe higher level of background parenchymal enhancement (BPE) at breast MRI has the potential for early detection and prediction of the risk of breast cancer. However, conflicting findings have been reported about the association between the level of BPE at breast MRI and the presence of breast cancer.PurposeTo evaluate the association between qualitative and quantitative BPE at dynamic contrast material-enhanced MRI and breast cancer among populations with average risk and high risk separately.Materials and MethodsA retrospective meta-analysis of observational studies comparing either qualitative or quantitative assessments of BPE in women with and women without breast cancer was performed for studies published through July 2018. Pooled odds ratios (ORs) or standardized mean differences and 95% confidence intervals (CIs) were estimated by using DerSimonian-Laird random-effects models. The heterogeneity across the studies was measured by using the statistic I ². Sensitivity analyses were conducted to test this association according to different study characteristics. P values less than or equal to 5% were considered to indicate statistically significant results.ResultsEighteen studies comprising 1910 women with breast cancer and 2541 control participants were included in the analysis. Among women with high risk, at least moderate BPE (OR, 1.6; 95% CI: 1.0, 2.6; P = .04) or at least mild BPE (OR, 2.1; 95% CI: 1.5, 3.0; P < .001) was associated with higher odds of breast cancer. Furthermore, women with breast cancer showed a higher average BPE percentage compared with control participants with high risk (standardized mean difference, 0.5; 95% CI: 0.2, 0.9; P = .001). No association was observed between at least mild BPE level (P = .15) or at least moderate BPE level (P = .38) and the presence of breast cancer among the population with average risk.ConclusionA higher level of background parenchymal enhancement measured at breast MRI is associated with the presence of breast cancer in women with high risk, but not in women with average risk.© RSNA, 2019Online supplemental material is available for this article.See also the editorial by Mann and Pinker in this issue.

Tiempo de Vacunarte (time to get vaccinated): Outcomes of an intervention to improve HPV vaccination rates in a predominantly Hispanic community

The purpose of this study was to evaluate effects of a culturally tailored evidence-based HPV vaccine educational intervention on psychosocial factors and vaccine completion in a largely low-income Hispanic population. Our study is a prospective community based intervention utilizing a prepost design. We recruited individual's dwelling in a border community aged 18-26 years or parents/guardians of children aged 9-17 years who had not completed the HPV vaccine series. We recruited 2380 participants between June 2015 and February 2018. We included 1796 participants in the final analysis. Mean age of the sample was 22.8 years (SD2.60). Majority of participants 63.99 were female and self-identified as Hispanic (97.4%). A total of 3192 vaccines were administered with an overall vaccine completion rate of 39.8%; 31.6% among adult participants compared to 48.7% among children. The Intervention significantly improved HPV knowledge by 61.66%, HPV awareness by 19.45%, Intention to vaccinate by 13.85%. For both adults and children being born in Mexico significantly improved the odds of vaccine completion (AOR: 2.154 95% CI: 1.439-3.224), while for adults only pre-intervention perceived benefits remained significant (AOR 1.101, CI: 1.002-1.210) and in children the main factor was parental perceived susceptibility of their child (AOR: 1.257 CI: 1.001-1.578). A Community based multicomponent HPV vaccine intervention significantly improved HPV immunization rates in a largely Hispanic population. Factors that affect completion of the HPV series are different among adults and children.

Comparison of perioperative bariatric complications using 2 large databases: does the data add up?

BACKGROUND

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database is a prospective clinical database that looks at short-term (30-day) outcomes of bariatric surgery. The Texas Inpatient Public Use Data File (PUDF) is an administrative database that uses hospital discharge information to compile data on admission and discharge diagnoses.

OBJECTIVE

To determine interdatabase reliability for common bariatric complications.

SETTING

University hospital, United States METHODS: The Texas Inpatient PUDF and MBSAQIP were queried for patients undergoing sleeve gastrectomy and gastric bypass in the year 2015. Admission diagnoses of morbid obesity with a discharge diagnosis of bariatric surgery status and also the International Classification of Diseases 9 Clinical Modification and Current Procedural Terminology procedure codes for bariatric surgeries were queried. The same postoperative complications were examined in both databases.

RESULTS

There were 137,291 patients in MBSAQIP and 9474 patients in the PUDF undergoing bariatric surgery. Patients in the PUDF had greater adjusted and unadjusted odds ratio for acute renal failure, cardiac arrest and postoperative myocardial infarction, pneumonia, progressive renal failure and postoperative sepsis.

CONCLUSION

There is a significant difference in the rates of perioperative complications of bariatric surgery when different databases are used. If surgeons are to be graded or potentially financially affected by these outcome metrics, the proper use of and interpretation of data is paramount and quality monitoring organizations should not use only administrative databases as the primary method to measure quality.

Health literacy of student pharmacists

INTRODUCTION

The primary purpose of this study was to assess the health literacy levels of doctorate of pharmacy students. A secondary objective was to determine if a correlation exists between age, degree prior to pharmacy school, work experience, and health literacy status among these students.

METHODS

Participants were first year doctorate of pharmacy students at an accredited college of pharmacy in the Southwestern United States. The design was cross-sectional. Health literacy scores were collected using the Newest Vital Sign (NVS) in English. Health literacy was dichotomized with a score of 0-3 indicating inadequate and 4-6 indicating adequate. A two sample t-test or Fisher's exact test was used to compare cofactors between health literacy groups.

RESULTS

Of the 72 first year students, 64 (88.9%) participated. The median NVS score was 5 (lower quartile 5, upper quartile 6). Nearly 90% of students (n = 57) obtained a score of ''always adequate literacy.'' Student age, having a degree before pharmacy school, nor healthcare work experience were significantly different between the two groups.

DISCUSSION

If students enter pharmacy school with a high level of health literacy, they may have difficulties relating to and appropriately educating patients with low health literacy. Knowing this information, we can tailor our teaching about health literacy in curriculums to include strategies that assist students to understand what patients with low heath literacy may experience when interacting with the healthcare system.

CONCLUSIONS

Nearly all student pharmacists in the study displayed high health literacy and no correlations to collected characteristics were noted.

Aggression toward Familiar People, Strangers, and Conspecifics in Gonadectomized and Intact Dogs

Gonadectomy is widely used to treat and prevent behavior problems including the aggressive behavior of dogs. The aim of this study was to determine whether aggressive behavior toward familiar people, strangers, or other dogs was significantly different in dogs gonadectomized at various ages vs. intact dogs using the Canine Behavioral Assessment Research Questionnaire (C-BARQ) with multivariate analysis. Of 15,370 initial surveys, those for dogs reported to have been gonadectomized at less than 6 weeks of age or to correct a behavior problem, and those with incomplete answers to questions regarding independent or dependent variables were excluded, leaving 13,795 for the analysis of aggressive behavior toward familiar people: 13,498 for aggressive behavior toward strangers and 13,237 for aggressive behavior toward dogs. Aggressive behavior was defined (a) using mean scores for all questions on the C-BARQ for aggressive behavior (range 0–4) and (b) comparing dogs with no aggressive behavior (all questions answered 0) to dogs with moderate or severe aggression (at least one score of 2, 3, or 4). Data for intact dogs were compared with those for dogs gonadectomized at 6 months or less, 7–12 months, 11–18 months, and >18 months. Neither gonadectomy nor age at gonadectomy showed an association with aggression toward familiar people or dogs. However, there was a low but significant increase in the odds of moderate or severe aggression toward strangers for all gonadectomized dogs compared with intact dogs, but this effect was driven entirely by data for dogs gonadectomized at 7–12 months of age, which were 26% more likely to demonstrate aggression toward strangers. This large, comprehensive study of the relationships between gonadectomy and aggressive behavior in dogs demonstrates that when the many factors affecting aggressive behavior are considered, there is no evidence that gonadectomy at any age alters aggressive behavior toward familiar people or dogs, and there is only a minimal increase in aggression toward strangers. Given the increasing evidence of significant negative health effects of gonadectomy, there is an urgent need to systematically examine other means of preventing unwanted procreation, such as vasectomy and hysterectomy.

Analysis of small sample size studies using nonparametric bootstrap test with pooled resampling method

Experimental studies in biomedical research frequently pose analytical problems related to small sample size. In such studies, there are conflicting findings regarding the choice of parametric and nonparametric analysis, especially with non-normal data. In such instances, some methodologists questioned the validity of parametric tests and suggested nonparametric tests. In contrast, other methodologists found nonparametric tests to be too conservative and less powerful and thus preferred using parametric tests. Some researchers have recommended using a bootstrap test; however, this method also has small sample size limitation. We used a pooled method in nonparametric bootstrap test that may overcome the problem related with small samples in hypothesis testing. The present study compared nonparametric bootstrap test with pooled resampling method corresponding to parametric, nonparametric, and permutation tests through extensive simulations under various conditions and using real data examples. The nonparametric pooled bootstrap t-test provided equal or greater power for comparing two means as compared with unpaired t-test, Welch t-test, Wilcoxon rank sum test, and permutation test while maintaining type I error probability for any conditions except for Cauchy and extreme variable lognormal distributions. In such cases, we suggest using an exact Wilcoxon rank sum test. Nonparametric bootstrap paired t-test also provided better performance than other alternatives. Nonparametric bootstrap test provided benefit over exact Kruskal-Wallis test. We suggest using nonparametric bootstrap test with pooled resampling method for comparing paired or unpaired means and for validating the one way analysis of variance test results for non-normal data in small sample size studies. Copyright © 2017 John Wiley & Sons, Ltd.

Replication of genome-wide association study (GWAS) susceptibility loci in a Latino bipolar disorder cohort

OBJECTIVES

Recent genome-wide association studies (GWASs) have identified numerous putative genetic polymorphisms associated with bipolar disorder (BD) and/or schizophrenia (SC). We hypothesized that a portion of these polymorphisms would also be associated with BD in the Latino American population. To identify such regions, we tested previously identified genetic variants associated with BD and/or SC and ancestral haploblocks containing these single nucleotide polymorphisms (SNPs) in a sample of Latino subjects with BD.

METHODS

A total of 2254 Latino individuals were genotyped for 91 SNPs identified in previous BD and/or SC GWASs, along with selected SNPs in strong linkage disequilibrium with these markers. Family-based single marker and haplotype association testing was performed using the PBAT software package. Empirical P-values were derived from 10 000 permutations.

RESULTS

Associations of eight a priori GWAS SNPs with BD were replicated with nominal (P≤.05) levels of significance. These included SNPs within nuclear factor I A (NFIA), serologically defined colon cancer antigen 8 (SDCCAG8), lysosomal associated membrane protein 3 (LAMP3), nuclear factor kappa B subunit 1 (NFKB1), major histocompatibility complex, class I, B (HLA-B) and 5'-nucleotidase, cytosolic II (NT5C2) and SNPs within intragenic regions microRNA 6828 (MIR6828)-solute carrier family 7 member 14 (SLC7A14) and sonic hedgehog (SHH)-long intergenic non-protein coding RNA 1006 (LINC01006). Of the 76 ancestral haploblocks that were tested for associations with BD, our top associated haploblock was located in LAMP3; however, the association did not meet statistical thresholds of significance following Bonferroni correction.

CONCLUSIONS

These results indicate that some of the gene variants found to be associated with BD or SC in other populations are also associated with BD risk in Latinos. Variants in six genes and two intragenic regions were associated with BD in our Latino sample and provide additional evidence for overlap in genetic risk between SC and BD.

A prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct

BACKGROUND AND AIMS

The frequency of bacteremia during ERCP with cholangioscopy has not been well studied. There are no formal guidelines regarding antibiotic prophylaxis before ERCP with cholangioscopy. The aim was to estimate the frequency of bacteremia and subsequent infectious adverse events after ERCP with cholangioscopy.

METHODS

This prospective nonrandomized study performed in a single tertiary referral center included adult patients who were undergoing ERCP with cholangioscopic examination of the common bile duct. Blood cultures were drawn from patients before the procedure and 5 and 30 minutes after the procedure. Antibiotics were not given before or after the procedure. Patients were followed up after 24 hours and 1 week after the procedure for infectious adverse events. The primary outcome was bacteremia rate, and secondary outcomes were cholangitis rate and adverse events.

RESULTS

Fifty-seven patients were enrolled in the study with 60 procedures performed. The first procedure from each patient was considered in the analysis, and thus we included 57 patients with 57 procedures in this study analysis. Postprocedure bacteremia was seen in 5 of 57 procedures (8.8%; 95% confidence interval, 2.9%-19.3%). Four patients were readmitted with cholangitis (7.0%). Bacteremia was more common in patients who had cholangioscopy with biopsy sampling compared with patients who had cholangioscopy without biopsy sampling (P = .011). Cholangitis was significantly more common in patients with bacteremia than in those patients with a negative blood culture (P = .035).

CONCLUSION

ERCP with cholangioscopy is associated with a bacteremia rate of 8.8% and a cholangitis rate of 7.0%. Preprocedural antibiotics may be considered before cholangioscopy, especially if tissue acquisition with biopsy sampling is expected. (

CLINICAL TRIAL REGISTRATION NUMBER

NCT01673269.).

Gastric polyps: Association with Helicobacter pylori status and the pathology of the surrounding mucosa, a cross sectional study

AIM: To assess the endoscopic characteristics of gastric polyps and their association with Helicobacter pylori (H. pylori) status in a predominantly Hispanic population.

METHODS: We conducted a retrospective study of all esophagogastroduodenoscopies performed at our institution. Demographic, endoscopic and histopathological data were reviewed. Categorization of patients into Hispanic and Non-Hispanic was based on self-identification. Patients without resection/biopsy were not included in the analysis. Identification of polyps type was based on histological examination. One way analysis of variance was used to compare continuous variables among different polyp types and Fisher’s exact test was used compare categorical variables among polyp types. Unadjusted and adjusted comparisons of demographic and clinical characteristics were performed according to the H. pylori status and polyp type using logistic regressions.

RESULTS: Of 7090 patients who had upper endoscopy, 335 patients had gastric polyps (4.7%). Resection or biopsy of gastric polyps was performed in 296 patients (88.4%) with a total of 442 polyps removed or biopsied. Of 296 patients, 87 (29%) had hyperplastic polyps, 82 (28%) had fundic gland polyps and 5 (1.7%) had adenomatous polyps. Hyperplastic polyps were significantly associated with positive H. pylori status compared with fundic gland polyps (OR = 4.621; 95%CI: 1.92-11.13, P = 0.001). Hyperplastic polyps were also found to be significantly associated with portal hypertensive gastropathy compared with fundic gland polyps (OR = 6.903; 95%CI: 1.41-33.93, P = 0.0174). Out of 296 patients, 30 (10.1%) had a follow-up endoscopy with a mean duration of 26 ± 16.3 mo. Interval development of cancer was not noted in any of the patients during follow up period.

CONCLUSION: Gastric hyperplastic polyps were significantly associated with positive H. pylori status and portal hypertensive gastropathy as compared with fundic gland polyps.

Abstract P1-09-14: Improved outcome of breast cancer survivors participating in a multidisciplinary cancer survivorship program at Texas Tech University Health Sciences in El Paso, TX

Introduction: Breast Cancer (BC) survivors in El Paso, TX include a majority of Hispanics. We have previously reported that these survivors have decreased mental and physical health related Quality of Life (QOL). We sought to determine whether BC survivors would benefit from participating in a comprehensive multidisciplinary BC Survivorship Program at the Garbar Breast Care Center (GBCC), as determined by improvement of performance on the following validated questionnaires: 1) Patient Health Questionnaire 9(PHQ9), 2) General Anxiety Disorder 7 (GAD 7), and SF36 QOL questionnaires. Methods: After IRB approval, we recruited consecutive patients at our institution over 6 months starting October, 2013, and who are within the first 5 years post-diagnosis with Stages I-III BC and have completed surgery, chemotherapy and/or radiation therapy. Survivors were enrolled in the survivorship program staffed by an oncologist, a nurse practitioner, a nutritionist and a clinical psychologist. They participate in individual as well as group sessions. Survivors are initially screened for depression and generalized anxiety disorder using PHQ9 and GAD 7, in addition to assessing the patient’s QOL at baseline, and every 3 months. Survivors are provided with a personalized summary of all received treatment and follow up care plans; dietary counselling and individual meal plans, in addition to in-depth psychological assessment and an intervention using Mindfulness Based Stress Reduction. Results: 47 patients have been recruited so far and all but one completed baseline questionnaires;17 and 7 respectively had 3 and 6 months follow up visits. 94% were Hispanics. Mean age 54 years. 38% of participants were younger than 50 years of age; Stage 1 BC (36%), Stage 2 (36%), and stage 3 (28%) . 80% received chemotherapy ; and 68% had hormone receptor positive BC and received endocrine therapy. The scores at baseline were : PCS representing the mean for the SF-36 QOL Physical Health was 46.0, and the MCS for Mental Health was 44.0, both below the population norm (50.0). Mean scores for GAD 7 was 7.54 and for PHQ 9 7.33, both abnormal (&lt;5 on PHQ9 and GAD 7 are considered normal scores). At 3 months the scores were as follows: PCS 49.71, MCS 45.34, both improved (the higher the better); GAD7 5.18; and PHQ9 6.82 (both improved, the lower the better). At 6 months, same favorable trend continues: PCS 50.07 [SD 5.54, 44.29-53.35]; MCS 49.66 [SD 7.73, 38.93-62.41]; GAD7 5.00 (SD 3.70); and PHQ9 4.57 (SD 3.64).

Conclusion: BC survivors are benefiting from participating in the new BC Survivorship Program launched at Texas Tech in El Paso, TX. They have experienced improved mental and physical health related QOL, improved anxiety and depression by GAD7, and PHQ9, with scores reaching near normal values at 6 months into the program which continues to enroll BC survivors. This program represents a culturally appropriate model for Hispanic BC survivors. It is expected to continue to improve the quality of life of these patients, empower them in their transition from cancer treatment to survivorship and lead to improved psychosocial adjustment and normal social functioning with significant implication not only on survivors, but also on their families and the community.

Citation Format: Zeina Nahleh, Rebecca Pasillas, Alok Dwivedi, Azadeh Nasrazadani, Rosalinda Heydarian, Luis Sanchez, Indika Mallawaarachchi, Cecilia Ochoa, Edward Saltzstein. Improved outcome of breast cancer survivors participating in a multidisciplinary cancer survivorship program at Texas Tech University Health Sciences in El Paso, TX [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-14.

Clinical and pathological characteristics of Hispanic BRCA-associated breast cancers in the American-Mexican border city of El Paso, TX

Hispanics in El Paso, TX, a large American-Mexican border city constitute 85% of the population. Limited cancer research has been conducted in this population. We sought to study the prevalence of BRCA mutations among Hispanic patients of Mexican origin, identify reported Mexican founder or recurrent mutations, and study the breast cancer characteristics in mutation carriers.

METHODS

Hispanic women of Mexican descent with a personal history of breast cancer, who presented consecutively for genetic cancer risk assessment, were enrolled in an Institutional Review Board-approved registry and underwent BRCA testing based on national guidelines. The characteristics of tumors and patients with positive BRCA mutation were analyzed.

RESULTS

88 patients were screened; 18 patients (20%) were BRCA carriers. Among BRCA carriers, 72% were diagnosed with breast cancer at younger than 50 years, 61% had "Triple negative disease". BRCA carriers had a significantly higher Body Mass Index (BMI) than non-carriers. Thirteen patients had BRCA1 mutations and five had BRCA2 mutations. A total of 17 deleterious BRCA Mutations were observed. Seven have been previously reported as specific genes from Mexico as country of origin. Five new mutations in BRCA carriers of Mexican descent were identified.

CONCLUSION

Hispanic breast cancer patients of Mexican origin present at a younger age, and have predominantly triple negative tumors and high BMI. We identified 5 new mutations not reported previously in Hispanic BRCA carriers of Mexican descent. Interestingly, 41% of BRCA mutations identified have been reported as recurrent mutations in Hispanic individuals from Mexico as the country of origin. A more cost-effective approach to initial screening of Hispanic individuals based on country of origin is desirable and would potentially decrease the number of cases requiring complete sequencing.

Glucose Levels and Depression in Hispanic Patients Admitted to the Cardiovascular Intensive Care Unit

Depression is frequently associated with diabetes mellitus (DM) and may worsen DM-related morbidity and mortality. We determined the potential association of glucose levels with depression in Hispanic patients admitted to the Cardiovascular Intensive Care Unit. Patients were given the Center for Epidemiologic Studies—Depression scale survey within 24 hours of admission. Glycated hemoglobin and fasting blood glucose levels within 30 days of admission were extracted. The HbA1c levels remained significantly associated with both presence of depression and depression levels. Histories of DM, myocardial infarction, and percutaneous coronary intervention as well as baseline brain natriuretic peptide levels were also significantly associated with depression levels. The presence of a significant association between glucose levels and depression in Hispanic patients indicates that there is a need for optimal management of glycemic levels. This may then lead to better health outcomes in Hispanics with cardiovascular disease.