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Editorial: Post-stroke cognitive decline and dementia: unraveling mechanisms, models, and biomarkers
Full text linkThe Association Between Perceived Discrimination and Body Mass Index (BMI) Among Asian American Women Before and During the COVID-19 Pandemic
Full text linkWe examined the association between perceived discrimination and body mass index (BMI) in Asian American (AA) women before and during the COVID-19 pandemic. The data used were from the Epidemiology/Epigenetics of Asian Women's Action for Resilience and Empowerment (Epi AWARE) study, which enrolled 157 AA women aged 18 to 59 between December 2019 and September 2022. Two sets of questions measured everyday" (e.g., "How often do people act as if you are dishonest?") and "lifetime" (e.g., "unfair treatment due to your race at school") discrimination. Responses were combined, creating a cumulative score, and dichotomized into "no" versus "any" discrimination. Self-reported height and weight were used to calculate BMI, dichotomized as <25 kg/m(2) and >/=25 kg/m(2). Multivariable binomial regression estimated risk ratios (RRs) and 95% confidence intervals (95% CIs). Overall, women reporting any versus no discrimination were more likely to be classified as having a BMI >/= 25 kg/m(2) (RR = 2.09; 95% CI: 1.06-4.13). The RR for women who responded during the COVID-19 pandemic (20 March 2020 or later) was 2.65 (95% CI: 0.82-8.58); the RR for pre-pandemic response was 1.93 (95% CI: 0.75-5.01). Our data suggest that experiences of racism may impact BMI among AA women. Further research is needed to identify mechanisms and design appropriate interventions."This research was funded by the Boston University Center for Innovation in Social Work & Health (CISWH), the Boston University School of Public Health (SPH), the Boston University School of Social Work (SSW) Research Collaboration Development Pilot Funding, and the National Institute of Health (NIH) [grant number R21MD013542]
Social disconnectedness and depressive symptoms across age groups: findings from a non-probability sample of employed U.S. adults
No full textBACKGROUND: Rates of social disconnectedness and depression have intensified in recent years. Yet, little is known about how they relate to one another across different age groups. This study assessed the relationship between social disconnectedness and depressive symptoms among U. S. adults of varying ages using an internet-delivered survey data collected between November 2021 and January 2022 from a non-probabilistic national sample of 2,496 employed adults aged 18-89 years. METHODS: Participants completed Upstream Social Interaction Risk Scale (U-SIRS-13) and the Patient Health Questionnaire short version (PHQ-2). Within each of five age groups (18-29, 30-39, 40-49, 50-59, 60+), descriptive statistics and Pearson's r correlations were calculated for U-SIRS-13 and PHQ-2. Subsequently, logistic regression models were fitted to assess the relationship between the U-SIRS-13 and PHQ-2 (a score of 3 or greater indicated possible depression), controlling for sociodemographic covariates. RESULTS: The prevalence of possible depression among participants was 31.6%, which ranged from 46.8% (ages 18-29) to 10.5% (ages 60+). U-SIRS-13 and PHQ-2 had significant associations in all age groups (Pearson's r range: 0.283-0.275, p < 0.001). Holding sociodemographic covariates constant, higher U-SIRS-13 scores were consistently associated with increased odds of possible depression across age groups (Odds Ratio range: 1.24-1.50, p < 0.001). While possible depression was more prevalent among younger age groups (18-29 and 30-39), the relationship between social disconnectedness and possible depression was stronger among older age groups (40-49, 50-59, and 60+). CONCLUSION: This finding supports that regardless of age, individuals who experience higher levels of social disconnectedness are more likely to have possible depression Coordinated efforts are needed to address depressive symptomology and facilitate meaningful interactions with others in all age groups.The author(s) declare that no financial support was received for the research and/or publication of this article
Body Dysmorphic Disorder Presenting as Alopecia Anxiety: A Case Report
No full textBackground: Body dysmorphic disorder (BDD) involves a preoccupation with a nonexistent or insignificant physical defect that causes clinically significant distress and impacts a patient's daily functioning. We present a case of a patient with body dysmorphia that manifested as anxiety about hair loss. Case Information: A 48-year-old otherwise healthy female presented to the dermatology clinic with the chief complaint of 8 months of hair loss. She had been seen previously by 2 other dermatologists. She brought 28 pages of paperwork to her first appointment detailing previous work-up, including four separate skin punch biopsies consistent with androgenetic, non-cicatricial (non-scarring) alopecia. Other lab work was largely unremarkable. This patient counted each hair she lost, reporting about 100 strands daily. This was severely distressing, and she was losing sleep worrying that her hair loss would scar, sleeping only 4 hours the night before her first appointment. She sees a therapist regularly and feels they have a therapeutic relationship. Despite multiple biopsies suggesting non-scarring alopecia, and a normal appearance of the hair and scalp, this patient continued to worry that she may have scarring alopecia, and she continued to request more biopsies. The patient was scheduled for close interval follow ups to monitor her condition and regularly address concerns. Despite this, she continued to call the office and presented for multiple emergency work-in visits without clinical change. She presented to yet another Dermatologists office and underwent an additional scalp biopsy. The result was limited by the superficial nature of the sample. It was read as likely an acneiform or folliculitis-like process, however an inflammatory condition such as frontal fibrosing alopecia could not be ruled out. The report recommended correlating the findings clinically, but the patient has anchored on this statement, disregarding prior work-up and the clinically reassuring picture. Conclusions: The prevalence of Body Dysmorphic Disorder (BDD) is estimated to be between 11-13% among dermatology patients. In many cases, the imperfection of concern is imperceptible to other people. Consequently, patients may lack sympathy from their family and friends, leading to social friction and isolation. Studies indicate that individuals with BDD are more likely to experience suicidal thoughts and to make suicide attempts compared to healthy individuals and patients with eating disorders, OCD, or anxiety disorders. Thus, it is imperative for clinicians to assess for signs of psychiatric distress and evaluate risk of harm to self or others. Treatment for BDD typically includes a combination of behavioral modification, stress management, psychotherapy, and SSRIs or antipsychotics. Close follow-ups are indicated to monitor for clinical progression and to provide assurance of their essentially normal appearance. Patients may anchor on Dermatopathology results, such as in this case, where the patient is certain she has “androgenetic alopecia” because one report could not rule it out. This highlights the importance of working not only with therapists and psychiatrists, but also having a collaborative relationship with pathologists to ensure clear understanding of the disease and clinicopathologic implications
Total Knee Arthroplasty in Patients with Cardiomyopathy: A Large Matched Cohort Analysis
No full textPurpose: Cardiomyopathy is defined as a myocardial disorder that results in poor cardiac functioning due to structural or physiological abnormalities. Various etiologies of cardiomyopathy, ranging from myocarditis to hypertrophic cardiomyopathy, have been correlated to poor health outcomes and higher complications for medical procedures. Cardiomyopathy. This study examines the impact of cardiomyopathy on the demographic and immediate postoperative outcomes in patients following total knee arthroplasty (TKA). The hypothesis was that cardiomyopathy patients would have high rates of complications within 30 days of the TKA, revisions, and higher 30- and 90-day readmission rates. Methods: Patient data was collected from a large commercial insurance database called PearlDiver. Patients were assigned under Current Procedural Terminology for patients who underwent TKA (CPT-27447) and those who underwent revisions for TKA (CPT-27486, CPT-27487). Cardiomyopathy patients were assigned clinical modification diagnosis codes using the International Classification of Diseases, 9th and 10th Revision. Thirty preoperative demographic and thirty-four 30-day postoperative variables were identified using ICD-9, ICD-10, and CPT codes and compared in TKA patients with cardiomyopathy and TKA patients without cardiomyopathy. A matched and unmatched univariant analysis was conducted to compare these two populations using a 1:1 propensity match algorithm. Patients were matched based on age range, gender, Elixhauser and Charlson Comorbidity index, and comorbidity diagnosis of diabetes, obesity, and tobacco use. Results: In total, 1,659,610 patients were included in this study, and 167,116 TKA patients had a prior diagnosis of a form of cardiomyopathy. TKA patients with cardiomyopathy had a 1.512 higher rate of being male (p<0.0001) and were of older age (p<0.0001) than patients without cardiomyopathy. Cardiomyopathy patients had lower rates of commercial/private insurance (p<0.0001) but a 1.1871 higher rate of Medicare (p<0.0001). Cardiomyopathy patients had higher Charlson scores (p<0.0001), Elixhauser scores (p<0.0001), and comorbidity rates of diabetes (p<0.0001), obesity (p<0.0001) and tobacco use (p<0.0001). Following matching, cardiomyopathy patients had 1.2268 and 1.134 higher 30-day and 90-day readmission rates, respectively (p<0.0001). Cardiomyopathy patients had a 1.1946 and 1.2732 higher 30-day and 2-year revision surgeries, respectively (p<0.0016 & P<0.0001). Complications with the implant was more common in cardiomyopathy patients as well (p<0.0001). Complications rates of respiratory failure (p < 0.0001), urinary tract infection (p < 0.0001), postoperative shock (p < 0.0001), infection (p < 0.0001), pulmonary embolism (p < 0.0001), deep vein thrombosis (p < 0.0001), wound complication (p < 0.028), acute kidney injury (p < 0.0001), acute myocardial infarction (p < 0.0001), cardiac arrest (p < 0.0001), arrhythmias (p < 0.0001), congestive heart failure (p < 0.0001), hematoma/hemorrhage (p < 0.0001), pneumonia (p < 0.0001) and increasing amount of transfusions (p < 0.0001) were more common in cardiomyopathy patients. Conclusion: Comparatively, cardiomyopathy patients following TKA had significantly higher rates of complications, revisions, and readmissions. As a result, this confirms the hypothesis that cardiomyopathy patients have higher complications, revisions, and readmission rates. Therefore, orthopedic surgeons should consider how patients with cardiomyopathy have a higher chance of poor health outcomes and proactively take measures to reduce these anticipated complications
Analysis of the Impact of GLP-1 Receptor Agonists (GLP-1 RAs) on Asthma Medication Utilization on Members within a Commercial Population
No full textBackground: Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RAs) are currently approved for treating type 2 diabetes mellitus and obesity, with additional FDA-approved indications in both sleep apnea and NASH. Consequently, a 2021 landmark study compared asthma exacerbation rates and symptoms in individuals prescribed GLP-1 RAs versus other diabetes medications. This study revealed fewer asthma exacerbations in GLP-1 RAs users compared to those on other diabetes medications further emphasizing, GLP-1 RA’s potential benefit in asthmatic diabetic patients. Therefore, it is necessary to evaluate the use of GLP-1 RAs in combination with asthma medications. Objective: To compare the change in the amount, average strengths, and days’ supply of asthma medication(s) when used with a GLP-1 RAs in three study groups: continuers (≤ six months prior to the first period), new starts, and late new starts. The analysis will be conducted between commercial plans in time-periods 10/01/22 to 9/30/23 and 10/01/23 to 9/30/24, for the purpose of this study. Methods: This retrospective study will examine the utilization trends of prescription claims data. For an accurate analysis, the cohort size will remain consistent across both time-periods. The asthma medication classes of interest are inhaled corticosteroids (ICSs), long-acting muscarinic antagonists (LAMAs), inhaled corticosteroids/long-acting beta agonists (ICS/LABAs), inhaled corticosteroids/long-acting beta agonists/long-acting muscarinic antagonists (ICS/LABA/LAMAs), short-acting beta agonists (SABAs), short-acting beta agonists/inhaled corticosteroids (SABA/ICSs), short-acting beta agonists/long-acting muscarinic antagonists (SABA/LAMAs). The GLP-1 RAs of interest are those indicated for diabetes and weight loss approved between the years of 2005 to 2023. In this study, immunotherapies for asthma will be excluded. Results: Pending. Discussion: While this study is not a clinical trial designed to establish causal relationships, it provides valuable insights into the potential changes in asthma medication usage when concurrently used with a GLP-1 RA. Thus, a beneficial reduction in overall medication utilization may offer cost-savings for asthma management in both members and the clients CVS Caremark serve
"Community Health Initiatives: Reducing Black Maternal Mortality through Empowerment and Education"
No full textBackground: Black Maternal Mortality refers to the well-being of Black women during the prenatal period, pregnancy, and the postnatal period. Black people represent 14% of the US population. However, Black women were 3 times more likely to die of causes directly related to pregnancy than White women in 2024. Women need comprehensive primary care before, during, and after pregnancy, but many women live in areas where healthcare services are scarce. Objective: The objective of this study was to review the literature on black maternal mortality outcomes across four states and to examine the impact of community health programs and initiatives on reducing Black maternal mortality rates. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, we systematically searched electronic databases, for publications from 2019 to 2024 for studies that reported Medicaid related maternal outcomes for 4 states in the top 10 list for highest maternal mortality rates- Mississippi, New Jersey, New York, and Texas. Two reviewers independently screened all titles and abstracts. When the information provided by title and abstract was insufficient to decide on inclusion or exclusion, full-text versions were retrieved and evaluated. All included papers were reviewed in full. To examine community health programs, a review of existing literature was performed to identify documented Black maternal health community programs in the 4 states. Academic databases such as PubMed and Google Scholar were searched using keywords like "Black maternal health," "community programs," "New York," "New Jersey," "Texas," and "Mississippi." Relevant articles, reports, and case studies were reviewed and analyzed. A summary table was developed, and all included studies were then summarized. Results: A total of 40 articles were retrieved. Studies have found that lacking health insurance is associated with lower levels of pregnancy care use. New York had the highest eligibility level with household incomes up to 405% of the poverty level. Texas had the highest rate of non-insured people. Black infants in Mississippi were nearly twice as likely as white infants to die over the past decade, according to a report by the state Department of Health. In New Jersey studies have shown that black infants are more than three times more likely than a White infant to die before their first birthday. Due to a lack of Medicaid expansion, the maternal mortality rates were lowered among all states. Regarding community health programs, findings highlight the effectiveness of community-driven initiatives in promoting health awareness, preventive care, and early intervention. Conclusion: This study provides an understanding of the landscape of Black maternal health community programs in New York, New Jersey, Texas, and Mississippi towards the identification of best practices and areas for improvement. By focusing on education, empowerment, and access to healthcare services, these community programs aim to bridge the gap in health disparities. Preliminary results from our systematic review indicate that Medicaid expansion and targeted community health programs significantly contribute to reducing Black maternal mortality rates by providing essential health education and resources. Future research should explore the long-term impact of these initiatives
The Impact of Continuous Glucose Monitoring (CGM) on Glucose Control among Adults with Uncontrolled Diabetes in a Charity Outpatient Clinic
No full textObjective: To evaluate the impact of CGM facilitated by an interdisciplinary collaboration team on patients with uncontrolled diabetes at a charity outpatient clinic. Methods: A pre-post quasi-experimental design was adopted. We collected data from adults (N = 72) with Diabetes Mellitus between January 2020 and October 2023 at an outpatient charity clinic. Baseline and post-intervention measurements at 3 months included glucose levels within the therapeutic range (70-180 mg/dL), below range (< 70), above range (>180 mg/dL), and A1c levels, all collected at the initiation of CGM intervention. Percent point differences between pre- and post-intervention outcomes were analyzed using t-tests and multivariable ordinary least squares (OLS) regressions. Results: The average age of participants was 51.11 years (SD = 12.57), with 69.4% identifying as Hispanic/Latino and 62.5% as female. A majority (76.4%) of the patients were uninsured. Over the 3-month period, the median number of pharmacist-led CGM visits was 2. At 3 months, the average time glucose levels remained within the therapeutic range increased by 5.15 (p < 0.01), while time spent above the range decreased by 5.19 (p = 0.08). The mean A1c levels decreased by 1.8% (p < 0.01) following CGM monitoring. OLS regression analysis indicated that CGM visits had a significant positive impact, with time within range increasing by 5.39 (SE = 1.83, p < 0.01) and time above range decreasing by 5.57 (SE = 1.94, p < 0.01). Conclusions: Interprofessional collaboration in combination with CGM monitoring was associated with significant improvements in glucose control among underserved group
Atypical Imaging and Neurological Progression of Balamuthia Mandrillaris Encephalitis in Pediatric Patient – A Case Report
No full textBackground: Balamuthia mandrillaris is a free-living amoebic agent affecting the central nervous system or skin with a 95% mortality rate, eventually manifesting as granulomatous amoebic encephalitis (GAE) or meningoencephalitis in both immunocompetent and immunocompromised individuals of all ages. Neuroimaging typically depicts ring-enhancing lesions, multi-focal lesions, and edema in various regions of the brain. This rare amoebic encephalitis is difficult to diagnose due to non-specific symptoms and imaging. Case Presentation: We present a five-year-old female who was admitted after experiencing two weeks of daily fevers, emesis, and lethargy. The patient’s initial work-up revealed symmetric diffusion restriction in the medial basal ganglia. Extensive autoimmune and infectious workup was conducted which was initially unrevealing, with eventual expansion to amoebic testing. Treatment with anti-amoebic agents was initiated while free-living Amoebic PCR Panel was pending. Imaging demonstrated progressive worsening particularly around intraventricular regions. Balamuthia mandrillaris was confirmed. Her neurologic status continued to worsen despite treatment and she progressed to cerebral herniation. Conclusion: Our patient had atypical MRI imaging, which made early diagnosis of B. mandrillaris infection challenging. She did not present with the typical reported imaging findings of ring-enhancing granulomas or multi-focal lesions. Consistent with other presentations of Balamuthia, she had non-specific clinical symptoms with headache, emesis, fever, and altered mental status. Patients in the United States present with a more aggressive form of encephalitis, without cutaneous lesions. Earlier diagnosis has the potential to provide earlier treatment and affect patient outcomes, thus recognition of atypical imaging findings may be crucial
Expansion of the Rapid Stabilization Pathway: Re-examining Length of Stay and Readmissions Among Psychiatrically Hospitalized Adolescents
No full textBackground: Suicide is the second leading cause of death for children ages 10-14 and the third leading cause of death for adolescents ages 15-24 (CDC, 2020). The increasing demand for psychiatric emergency services and the number of inpatient beds that stay static or decrease pose a danger to patients waiting for inpatient care (National Association of State Mental Health Program Directors, 2017). However, the task of increasing inpatient beds is difficult due to high costs, restricted physical space, and shortage of staffing (Mundt, 2021). The rapid stabilization pathway for crisis care offers a more feasible solution that decreases the length of inpatient stays, allowing more patients to access existing beds (Sams, 2023). The rapid stabilization pathway is rooted in the principles of Acceptance & Commitment Therapy and Narrative Therapy. It is designed to be completed within a 3-4 day admission with intensive family and individual therapy. This intervention can decrease the length of stay without increasing the readmission rate in adolescent psychiatric inpatients (Sams, 2023). Since the pilot, more mental health therapists have been trained and resources to carry out the protocol since the pilot offers promising results in the current analysis. The comparison of the pilot study to the existing data will allow for a better understanding of the intervention's efficacy. Objective: This study re-examines the differences in inpatient readmissions and length of stay from the pilot to current data to evaluate the efficacy of the Rapid Stabilization Pathway. Results: The demographics of both the pilot and current study groups are similar. The mean age of the pilot group was 14.4, while the current group was 14.5. The pilot group's gender is majority female (73.3%), which is similar to the current group's (70%). The most prevalent race in both groups is white (76.7%, 76.2%). The comparison of the readmissions data at 1 month and3 months post-discharge from the pilot to the current study showed no significant differences. There is also no significant difference between the length of stay from the pilot study to the current study (p = 0.285). Conclusion: The Rapid Stabilization Pathway is an acute, intensive intervention that effectively decreases the length of stay for psychiatric inpatient adolescents without an associated increase in readmissions. This is more attainable to implement rather than increasing the financial and physical burden on the current infrastructure, offering potential cost savings for patients and the hospital with shorter stays. Its expansion to more patients beyond the pilot study shows promising results for its efficacy. The intervention can be expanded to other psychiatric hospitals to safely treat and discharge more patients and increase access to psychiatric beds