Background
Although bariatric surgery is the most effective treatment for obesity and weight-related comorbid diseases, utilization rates are disproportionately low among non-white patients. We ...sought to understand if variation in baseline characteristics or access to care exists between white and non-white patients.
Methods
Using a statewide bariatric-specific data registry, we evaluated all patients who underwent bariatric surgery between 2006 and 2020 and completed a preoperative baseline questionnaire, which included a question about self-identification of race. Patient characteristics, co-morbidities, and time from initial preoperative clinic evaluation to date of surgery were compared among racial groups.
Results
A total of 73,141 patients met inclusion criteria with 18,741 (25.5%) self-identified as non-white. These included Black/African American (
n
= 11,904), Hispanic (
n
= 3448), Asian (
n
= 121), Native Hawaiian/Pacific Islander (
n
= 41), Middle Eastern (
n
= 164), Multiple (
n
= 2047) and other (
n
= 608). Non-white males were the least represented group, accounting for only 4% of all bariatric cases performed. Non-white patients were more likely to be younger (43.0 years vs. 46.6 years,
p
< 0.0001), disabled (16% vs. 11.4%,
p
< 0.0001) and have Medicaid (8.4% vs. 3.8%,
p
< 0.0001) when compared to white patients, despite having higher rates of college education (78.0% vs. 76.6,
p
< 0.0001). In addition, median time from initial evaluation to surgery was also longer among non-white patients (157 days vs. 127 days,
p
< 0.0001), despite having higher rates of patients with a body mass index above 50 kg/m
2
(39.0% vs. 33.2%,
p
< 0.0001).
Conclusions
Non-white patients undergoing bariatric surgery represent an extremely diverse group of patients with more socioeconomic disadvantages and longer wait times when compared to white patients despite presenting with higher rates of severe obesity. Current guidelines and referral patterns for bariatric surgery may not be equitable and need further examination when considering the management of obesity within diverse populations to reduce disparities in care—of which non-white males are particularly at risk.
To investigate the presence of viable but non-culturable Listeria monocytogenes during survival on parsley leaves under low relative humidity (RH) and to evaluate the ability of L. monocytogenes to ...recover from VBNC to culturable state under satured humidity. Under low RH (47-69%) on parsley leaves, the initial number of L. monocytogenes populations counted on non selective media (10⁹ L. monocytogenes per leaf on TSA) was reduced by 6 log₁₀ scales in 15 days, whereas number of viable L. monocytogenes counted under the microscope was reduced by 3-4 log₁₀ scales, indicating the presence of VBNC cells. This was demonstrated on three L. monocytogenes strains (EGDe, Bug 1995 and LmP60). Changing from low to 100% RH permitted an increase of the culturable counts of L. monocytogenes and this growth was observed only when residual culturable cells were present. Moreover, VBNC L. monocytogenes inoculated on parsley leaves did not become culturable after incubation under 100% RH. Dry conditions induced VBNC L. monocytogenes on parsley leaves but these VBNC were likely unable to recover culturability after transfer to satured humidity. Enumeration on culture media presumably under-estimates the number of viable L. monocytogenes on fresh produce after exposure to low RH.
Dependence increases the likelihood of adverse consequences of cannabis use, but its aetiology is poorly understood.
To examine adolescent precursors of young-adult cannabis dependence.
Putative risk ...factors were measured in a representative sample (n=2032) of secondary students in the State of Victoria, Australia, six times between 1992 and 1995. Cannabis dependence was assessed in 1998, at age 20-21 years.
Of 1601 young adults, 115 met criteria for cannabis dependence. Male gender (OR=2.6, P < 0.01), regular cannabis use (weekly: OR=4.9; daily: OR=4.6, P=0.02), persistent antisocial behaviour (linear effect P=0.03) and persistent cigarette smoking (linear effect P=0.02) independently predicted cannabis dependence. Neither smoking severity (P=0.83) nor persistent psychiatric morbidity (linear effect P=0.26) independently predicted dependence. Regular cannabis use increased risk only in the absence of persistent problematic alcohol use.
Weekly cannabis use marks a threshold for increased risk of later dependence, with selection of cannabis in preference to alcohol possibly indicating an early addiction process.
Mass casualty events (MCE) are an infrequent occurrence to most daily healthcare systems however these incidents are the causation for new hospital preparedness and the development of coordinated ...emergency services. The broad support and operational plans outside the hospital include emergency medical services, local law enforcement, government agencies, and city officials. Modern-day hospital disaster preparedness goals include scheduled training for healthcare personnel to ensure effective and accurate triage for a high-volume of injured patients. This MDT collaboration strengthens the emergency response to optimize the delivery of life-saving care during MCEs. This review identifies the clinical importance of the interdisciplinary team interactions and the lessons learned from past MCE experiences, strengthening healthcare system readiness for such critical incidents.
Abstract
Background
As of mid-2021, Australia’s only nationwide coronavirus disease 2019 (COVID-19) epidemic occurred in the first 6 months of the pandemic. Subsequently, there has been limited ...transmission in most states and territories. Understanding community spread during the first wave was hampered by initial limitations on testing and surveillance. To characterize the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibody seroprevalence generated during this time, we undertook Australia’s largest national SARS-CoV-2 serosurvey.
Methods
Between June 19 and August 6, 2020, residual specimens were sampled from people undergoing general pathology testing (all ages), women attending antenatal screening (20–39 years), and blood donors (20–69 years) based on the Australian population’s age and geographic distributions. Specimens were tested by Wantai total SARS-CoV-2-antibody assay. Seroprevalence estimates adjusted for test performance were produced. The SARS-CoV-2 antibody-positive specimens were characterized with microneutralization assays.
Results
Of 11 317 specimens (5132 general pathology; 2972 antenatal; 3213 blood-donors), 71 were positive for SARS-CoV-2-specific antibodies. Seroprevalence estimates were 0.47% (95% credible interval CrI, 0.04%–0.89%), 0.25% (CrI, 0.03%–0.54%), and 0.23% (CrI, 0.04%–0.54%), respectively. No seropositive specimens had neutralizing antibodies.
Conclusions
Australia’s seroprevalence was extremely low (<0.5%) after the only national COVID-19 wave thus far. These data and the subsequent limited community transmission highlight the population’s naivety to SARS-CoV-2 and the urgency of increasing vaccine-derived protection.
SARS-CoV-2 seroprevalence was very low (<0.5%) in Australia following the first epidemic wave in March-April 2020, demonstrating the success of control measures implemented at the time. Results also emphasize the crucial role of vaccination, as the vast majority of the Australian population had no infection-derived protection against SARS-CoV-2.
Heart failure increases the risk of death in acute pulmonary embolism (PE). The role of the left ventricle (LV) in acute PE is not well defined.
To identify the prevalence of LV systolic dysfunction, ...morphology, and prognosis of the LV during an acute PE.
Retrospective study (26-months) of patients diagnosed with an acute PE presenting with LV systolic dysfunction at the University of Maryland.
Among 769 acute PE patients, 78 (10.5 %) had LV systolic dysfunction and 42 (53.8 %) had history of cardiac disease. Patients without history of cardiac disease were younger (mean age SD 54.9 16.8 vs. 62.6 16.6; p = 0.04), had a higher BMI (31.2 12.2 vs. 29.2 7.7; p = 0.005), and less hypertension (20 34.5 % vs. 38 65.5 %; p = 0.0005).
A massive PE was most common in patients without history of cardiac disease (822.2 % vs. 24.7 %, p = 0.02). There was no difference in clot burden, but right ventricular strain was more frequently seen in patients without history cardiac disease in the initial CT (p = 0.001). The median troponin and lactate were similar in both groups.
In 41 patients with follow-up echocardiograms, improvement in LVEF% was observed in patients without cardiac history (median Δ LVEF% IQR; 20 6.2–25.0). While patients with cardiac disease did not demonstrate similar changes (median Δ LVEF% IQR; 0 −5–17.5; p = 0.01). In hospital mortality was 12.8 % with no difference between both groups (p = 0.17).
Pulmonary embolism can be associated with LV systolic dysfunction, even in patients without history of cardiac disease.
Patients with diabetes and comorbid depression have an increased risk of complications. In a repeated panel cross-sectional study, we investigated the effect of depression care on glycemic control ...for adults with diabetes. Local health plan provided secondary data (N=29,227) that contained depression information and overall health risk calculated by Johns Hopkins ACG software using diagnosis code, visits, and medication claims. This data was matched with A1c, demographics, and neighborhood characteristics.
Study outcome is A1c change. Predictor of interest is depression treatment: (1) no depression in either year, (2) new onset is not treated in prior year but treated in sequential year, (3) past is treated in one year and none in sequential year, and (4) persistent is received treatment in both years. Covariates are age, sex, health risk, insurance types, and neighborhood characteristics. The analysis is a multiple linear regression model using a difference-in-differences framework. Adjusting for covariates, new onset of depression treatment was associated with better diabetes control, A1c decreased by 0.072 (p=0.025), compared to no depression. Compared to no depression, past depression treatment was associated with lower diabetes control, A1c increased by 0.071 (p=0.007). Persistent depression treatment had A1c change not different from no depression group (p=0.731).
Among patients with diabetes, past depression treatment appeared to have poorer glycemic control compared with those not depressed. New onset of depression treatment appeared to improve glycemic control. New diagnosis of depression increased patient contact with provider. A decline in diabetes control among patients received depression treatment in the past, may be related to a change in contact with provider. Future studies could investigate whether patient visit with providers was affected by a change in depression and examine if A1c testing rate correlates with health service utilization.
Disclosure
H.N. Fu: None. A.M. Raiter: None. C. Carlin: None. K.A. Peterson: None.
Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R18DK110732)
High-quality, culturally safe antenatal care has an important role in improving health outcomes of Aboriginal and Torres Strait Islander people. We sought to describe Aboriginal women’s experiences ...of antenatal care in the Kimberley region of Western Australia, to better understand current systems and opportunities for enhancing antenatal care.
Throughout the Kimberley, 124 Aboriginal women who had accessed antenatal care in 2015–2018 were recruited. They provided qualitative data during a health assessment or standalone interview. Transcripts were descriptively coded and thematically analysed.
Most women expressed that overall they had a positive antenatal care experience. Key themes were the importance of positive relationships with antenatal care providers, the valuable role of family support during the antenatal period, challenges travelling for care and limitations of the Patient Assisted Travel Scheme, communication of pregnancy related information, and the provision of services. Almost all antenatal care providers described were non-Aboriginal. A few women spoke about involvement of Aboriginal Health Workers in their antenatal care, including recommending expansion of these roles.
The experiences shared by these Aboriginal women in the Kimberley contribute to broader evidence of a need to improve culturally safe antenatal care delivery for Aboriginal Australian women. Although excellent care was provided by a number of dedicated midwives, there were few Aboriginal antenatal staff and significant staff turnover. To improve the quality of care more local Aboriginal antenatal care providers, and additional support for the large number of women and their families required to travel, are required.
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