•Increasing HPV mediated disease results in increasing number of patients requiring oropharyngectomy after prior radiation.•Functional outcomes are an important facet of shared decision making for ...treatment algorithms.•Pre-operative clinical factors can help to predict post-operative functional outcomes.
The validity of hemoglobin A1c (HgbA1c) is undergoing increasing scrutiny in the advanced CKD/ESRD (chronic kidney disease/end‐stage renal disease) population, where it appears to be discordant from ...other glycemic indices. In the Glycemic Indices in Dialysis Evaluation (GIDE) Study, we sought to assess correlation of HgbA1c with casual glucose, glycated albumin, and serum fructosamine in a large group of diabetic patients on dialysis. From 26 dialysis facilities in the United States, 1758 diabetic patients (hemodialysis = 1476, peritoneal dialysis = 282) were enrolled in the first quarter of 2013. The distributions of HgbA1c and the other glycemic indices were analyzed. Intra‐patient coefficients of variation and correlations among the four glycemic indices were determined. Patients with low HgbA1c values were both on higher erythropoietin (ESA) doses and more anemic. Serum glucose exhibited the highest intra‐patient variability over a 3‐month period; variability was modest among the other glycemic indices, and least with HgbA1c. Statistical analyses inclusive of all glycemic markers indicated modest to strong correlations. HgbA1c was more likely to be in the target range than glycated albumin or serum fructosamine, suggesting factors which may or may not be directly related to glycemic control, including anemia, ESA management, and iron administration, in interpreting HgbA1c values. These initial results from the GIDE Study clarify laboratory correlations among glycemic indices and add to concerns about reliance on HgbA1c in patients with diabetes and advanced kidney disease.
Background
Bariatric surgery is the most effective treatment for morbid obesity; however, there may be significant unanticipated psychosocial effects following surgery. Prior studies have identified ...a threefold increase in the incidence of alcohol use disorder (AUD) after Roux-en-Y gastric bypass (RYGB). With sleeve gastrectomy (SG) now comprising over 50% of primary bariatric operations, the degree to which patients who undergo SG develop AUD remains unknown. We sought to characterize the patients and incidence of AUD following SG compared to RYGB.
Methods
This study used prospectively collected data from a state-wide quality collaborative. The presence of AUD was determined using the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C), with a score ≥ 4 in men and ≥ 3 in women suggestive of AUD. We used bivariate Chi-square tests for categorical variables and independent samples
t
tests for continuous variables. We used multivariable logistic regression to identify patient characteristics that may predispose patients to development of AUD at 1 and 2 years after surgery.
Results
The overall prevalence of AUD in our population (
n
= 5724) was 9.6% preoperatively, 8.5% at 1 year postoperatively, and 14.0% at 2 years postoperatively. The preoperative, 1-year, and 2-year prevalence of AUD for SG were 10.1%, 9.0%, and 14.4%, respectively. The preoperative, 1-year, and 2-year postoperative prevalence of AUD for RYGB were 7.6%, 6.3%, and 11.9%, respectively. Predisposing patient factors to AUD development included higher educational level (
p
< 0.01) and higher household income (
p
< 0.01).
Conclusions
This is first large, multi-institutional study of AUD following SG. The prevalence of alcohol use disorder in patients undergoing SG and RYGB was similar pre- and postoperatively. The majority of patients developed AUD following their second postoperative year. Understanding the timing and incidence of alcohol use disorder in patients undergoing SG—the most commonly performed bariatric operation in the United States—is critical to providing appropriate counseling and treatment.
We assessed whether multiple psychosocial factors are additive in their relationship to sexual risk behavior and self-reported HIV status (i.e., can be characterized as a syndemic) among young ...transgender women and the relationship of indicators of social marginalization to psychosocial factors.
Participants (n = 151) were aged 15 to 24 years and lived in Chicago or Los Angeles. We collected data on psychosocial factors (low self-esteem, polysubstance use, victimization related to transgender identity, and intimate partner violence) and social marginalization indicators (history of commercial sex work, homelessness, and incarceration) through an interviewer-administered survey.
Syndemic factors were positively and additively related to sexual risk behavior and self-reported HIV infection. In addition, our syndemic index was significantly related to 2 indicators of social marginalization: a history of sex work and previous incarceration.
These findings provide evidence for a syndemic of co-occurring psychosocial and health problems in young transgender women, taking place in a context of social marginalization.
Background
Do workers follow their self‐interest by minimizing injury risk in their employment decision? If so, employers could use injury reduction as a recruitment and retention strategy. This ...study explores whether injury incidence is associated with turnover in Montana's Oil and Gas industry.
Methods
A panel data set of Unemployment Insurance and Workers' Compensation administrative records from 2010 to 2015 was used to model the relationship between turnover and injury claim rates at the firm level.
Results
Total turnover and injury rates were found to be positively related while injury rates and separation rates had no such association. Quarters in which the employer experienced a severe injury had a 3.3 percentage point increase in separation rates.
Discussion
The findings suggest that injured workers contribute to increased turnover, but coworker turnover does not increase with increased injury rates in the firm. Secondary findings suggest a relationship between recent hires and increased injury rates, although further investigation is required.
The academic beginnings of nudge theory are credited to a book by Thaler and Sunstein2 in 2008. The theory was embraced by politicians and policy-makers leading to the setting up of the Behavioural ...Insights Team or ‘Nudge Unit’ in the United Kingdom.1 The approach has been embraced in public health, markets, medicine and even in public toilets. The positioning of a fake fly in the Amsterdam airport urinals, an example of what has become known as ‘choice architecture’, is cited by Thaler and Sunstein. The fly, strategically placed in the urinals, reduced spillage by 80%.2 How then might nudge theory impact on some of the challenges encountered in professional education? Is an educator well-placed to be a ‘choice architect’? How might we discern between ethical interventions that come under the umbrella of ‘nudge’ and those that would be better described as ‘shove’, manipulation or coercion?
Abstract
Date Presented 04/20/2023
Children with unilateral weakness may demonstrate improved functional goal achievement with less dosage requirement when constraint-induced movement therapy (CIMT) ...is paired with transcutaneous auricular vagus nerve stimulation (taVNS), indicating less burden to participants and encouraging translation to OT clinical practice.
Primary Author and Speaker: Patricia Coker-Bolt
Additional Authors and Speakers: Elizabeth Humanitzki
Contributing Authors: Kelly McGloon, Julia Schoeder Brennan, Annie Cribb, Bashar W. Badran, Mark George, Dorothea Jenkins
Abstract
Background
It is not known whether reductions in socioeconomic and racial disparities in incidence of invasive pneumococcal disease (defined as the isolation of Streptococcus pneumoniae from ...a normally sterile body site) noted after pneumococcal conjugate vaccine (PCV) introduction have been sustained.
Methods
Individual-level data collected from 20 Tennessee counties participating in Active Bacterial Core surveillance over 19 years were linked to neighborhood-level socioeconomic factors. Incidence rates were analyzed across 3 periods—pre–7-valent PCV (pre-PCV7; 1998–1999), pre–13-valent PCV (pre-PCV13; 2001–2009), and post-PCV13 (2011–2016)—by socioeconomic factors.
Results
A total of 8491 cases of invasive pneumococcal disease were identified. Incidence for invasive pneumococcal disease decreased from 22.9 (1998–1999) to 17.9 (2001–2009) to 12.7 (2011–2016) cases per 100 000 person-years. Post-PCV13 incidence (95% confidence interval CI) of PCV13-serotype disease in high- and low-poverty neighborhoods was 3.1 (2.7–3.5) and 1.4 (1.0–1.8), respectively, compared with pre-PCV7 incidence of 17.8 (15.7–19.9) and 6.4 (4.9–7.9). Before PCV introduction, incidence (95% CI) of PCV13-serotype disease was higher in blacks than whites (17.3 15.1–19.5 vs 11.8 10.6–13.0, respectively); after introduction, PCV13-type disease incidence was greatly reduced in both groups (white: 2.7 2.4–3.0; black: 2.2 1.8–2.6).
Conclusions
Introduction of PCV13 was associated with substantial reductions in overall incidence and socioeconomic and racial disparities in PCV13-serotype incidence.
In this laboratory- and population-based study, we describe how the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) is associated with substantial reductions in both overall incidence and socioeconomic and racial disparities in vaccine-type invasive pneumococcal disease incidence, representing a major public health achievement.
Objectives:
Between 2003 and 2013, the rate of neonatal abstinence syndrome (NAS)—a postnatal drug withdrawal syndrome—in Tennessee increased approximately 10-fold. NAS surveillance is relatively ...new, and underestimation associated with surveillance has not been described. We compared data from the Tennessee NAS public health surveillance system (TNSS) with a second source of NAS data, hospital discharge data system (HDDS), and estimated the true number of infants with NAS using capture-recapture methods.
Methods:
We obtained NAS data on cases of NAS among Tennessee infants from TNSS and HDDS from January 1, 2013, through December 31, 2016. We matched cases of NAS identified in TNSS to cases identified in HDDS. We estimated the true number of infants with NAS by using the Lincoln-Peterson estimator capture-recapture methodology.
Results:
During the study period, 4070 infants with NAS were reported to TNSS, and 5321 infants with NAS were identified in HDDS; 2757 were in both data sets. Using capture-recapture methods, the total estimated number of infants with NAS during the study period was 7855 (annual mean = 1972; estimated range = 1531-2427), which was 93% more than in TNSS and 48% more than in HDDS. Drugs used for the medication-assisted treatment of substance use disorder were the most commonly reported substances associated with NAS (n = 2389, 59%).
Conclusions:
TNSS underestimated the total burden of NAS based on the capture-recapture estimate. Case-based public health surveillance is important for monitoring the burden of and risk factors for NAS and helping guide public health interventions.
Abstract
Background
Injection drug use (IDU) is an established but uncommon risk factor for candidemia. Surveillance for candidemia is conducted in East Tennessee, an area heavily impacted by the ...opioid crisis and IDU. We evaluated IDU-associated candidemia to characterize the epidemiology and estimate the burden.
Methods
We assessed the proportion of candidemia cases related to IDU during January 1, 2014–September 30, 2018, estimated candidemia incidence in the overall population and among persons who inject drugs (PWID), and reviewed medical records to compare clinical features and outcomes among IDU-associated and non-IDU candidemia cases.
Results
The proportion of IDU-associated candidemia cases in East Tennessee increased from 6.1% in 2014 to 14.5% in 2018. Overall candidemia incidence in East Tennessee was 13.5/100 000, and incidence among PWID was 402–1895/100 000. Injection drug use-associated cases were younger (median age, 34.5 vs 60 years) and more frequently had endocarditis (39% vs 3%). All-cause 30-day mortality was 8% among IDU-associated cases versus 25% among non-IDU cases.
Conclusions
A growing proportion of candidemia in East Tennessee is associated with IDU, posing an additional burden from the opioid crisis. The lower mortality among IDU-associated cases likely reflects in part the younger demographic; however, Candida endocarditis seen among approximately 40% underscores the seriousness of the infection and need for prevention.
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