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Social Determinants of Health among Individuals Receiving Opioids for Pain Management.
No full textOBJECTIVE: Individuals receiving opioids for pain management are at risk for negative outcomes. However, it is not clear whether social determinants of health (SDOH) predict outcomes a year after starting a prescription opioid. The purpose was to examine associations between SDOH with psychiatric-, pain-, and opioid-related outcomes at a 12-month follow-up.
METHODS: Participants (N=783) with a new period of 30-90-day opioid use completed baseline and 12-month follow-up questionnaires regarding SDOH, depressive symptoms, pain severity, pain interference, and opioid use. Multivariate adjusted models estimated the association between SDOH and outcomes.
RESULTS: Participants had a mean age of 53.4 years (SD=11.9), 71.2% White race, and 69.9% women. Older age (OR=0.97; 0.95, 0.99) and Black race (OR=0.45; 0.27, 0.76) were inversely associated with depression, while being widowed/divorced/separated (OR=1.72; 1.01, 2.91) and lacking college education (OR=2.43; 1.25, 4.73) were positively associated with depression. Women (OR=1.56; 1.12, 2.18) and lower income (OR=2.09; 1.14, 3.85) were associated with greater odds of opioid use, while unemployment was associated with lower odds of opioid use at 12 months (OR=0.55; 0.34, 0.89). Older age (OR=0.95; 0.91, 0.99) was inversely associated with opioid use concerns while disability (OR=4.59; 1.60, 13.11) was positively associated.
DISCUSSION: Several SDOH variables were associated with poorer functioning at baseline and 12-months after individuals were prescribed an opioid. It may be useful for clinicians to screen for SDOH to identify higher-risk individuals
A technology-based intervention to reduce alcohol use after metabolic and bariatric surgery: feasibility, acceptability, and preliminary outcomes
No full textBACKGROUND: Patients who undergo metabolic and bariatric surgery (MBS) are at increased risk for an alcohol use disorder. A technology-based intervention, rooted in motivational interviewing, could broadly reach patients after MBS and has the potential to reduce alcohol use.
OBJECTIVE: Examine the feasibility, acceptability, and preliminary outcomes of a technology-based intervention to reduce alcohol use delivered after MBS.
SETTING: Health system.
METHODS: Participants (N = 60) who were 3-18 months post-MBS were randomized to the intervention or treatment-as-usual control group. The tailored intervention consisted of 2 (15-minute) sessions of interactive web-based content followed by 3-months of daily text messaging. Participants completed baseline and a postintervention assessment (91.7% retention).
RESULTS: Participants were primarily female (90%), White (55.0%) or Black (43.3%), with a mean age of 44.6 years (SD = 10.4). Of those randomized to the intervention (n = 24), 83.3% (n = 20) began the intervention and 95% (n = 19) completed it. The majority of participants rated all intervention components positively and 100% agreed that other patients would use the intervention. The intervention group reported a significant increase in level of motivation to avoid alcohol use from baseline to postintervention (P = .02), whereas the control group did not show a significant change (P = .73). At the postintervention, the intervention group had significantly fewer participants endorsing alcohol use than the control group (43.5% versus 75%; X(2) = 5.63, P = .02).
CONCLUSION: A technology-based intervention delivered after MBS was feasible, acceptable, and showed promising preliminary outcomes for increasing motivation to avoid alcohol use as well as reducing alcohol use
HLA variation associated with peanut allergy and anaphylaxis among non-Hispanic Black individuals
No full textBACKGROUND: Peanut is a major cause of food allergy. HLA genes have been consistently associated with peanut allergy in association studies. To date, however, there have been very few genetic studies of peanut allergy in non-Hispanic Black (Black) individuals, a group disproportionately affected by food allergy.
OBJECTIVE: Our aim was to study the relationship between HLA alleles and peanut allergy among Black individuals.
METHODS: The analysis consisted of Black participants from the Study of Asthma-Related Phenotypes and Pharmacogenomic Interactions by Race-Ethnicity (SAPPHIRE), a large cohort of individuals from metropolitan Detroit. At the time of enrollment, participants provided detailed food allergy histories, including symptoms. Four-digit resolution HLA allele calls were made using whole genome sequence data.
RESULTS: The cases consisted of 119 individuals with reported peanut allergy and 59 individuals with peanut-related anaphylaxis; the comparison group consisted of 2640 individuals without reported food allergy.
CONCLUSIONS: In a cohort of Black individuals, this study independently identified the same associations of peanut allergy and HLA that were previously observed in non-Hispanic White individuals. Our findings suggest that specific HLA binding groove amino acid polymorphisms may confer similar peanut allergy risk across population groups and HLA alleles
Grand Challenges for Skin Health Revisited: The International League of Dermatological Societies (ILDS) Skin Disease Atlases
No full textReduction of hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with the use of twice daily alcohol-based nasal antiseptic in intensive care units
No full textBACKGROUND: A 191-bed hospital within a Midwest health care system experienced an increase in hospital acquired Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. In response, the hospital sought a targeted intervention for MRSA prevention within 2 intensive care units using an alcohol based nasal antiseptic.
METHODS: In August 2021, Infection Prevention and Control (IPC) partnered with Nursing and the alcohol-based nasal antiseptic product vendor to implement the product in the 2 units. Nasal antiseptic was administered twice daily. To measure process adherence, a report was created within the electronic medical record to track compliance. Patient tracking and communication of data reports to nurse leadership by IPC began shortly afterward.
RESULTS: MRSA standardized infection ratios (SIR) declined with an SIR of 1.18 in 2021 to an SIR of 0.90 in 2023. The total number of MRSA cases decreased from 2021 to 2022 with 4 cases and 1 case, respectively.
DISCUSSION: Barriers were identified, including personnel permitted to administer alcohol-based antiseptic, product location, and administration documentation. As these were addressed, compliance in administration began to increase. Manually tracking compliance was later replaced with an automated report for sustainability purposes. Options available to analyze the data were limited due to lack of control data.
CONCLUSION: Implementation of universal decolonization using twice daily alcohol based nasal antiseptic can be accomplished and assessed with the development of an electronic data tracking process
The life cycle of infection prevention and antimicrobial stewardship projects and interventions: the dynamic interplay of implementation and de-implementation science (Part I of II)
No full textIn Antimicrobial Stewardship and Infection Prevention and Control, programmatic goals often strive to achieve clinical benefit by practice change in the direction of doing less. Practically, this may include reducing the number of tests ordered, encouraging shorter and more narrow courses of antimicrobials, or discontinuing practices that are no longer contextually appropriate. Because promoting practice change in the direction of doing less is a critical aspect of day-to-day operations in Antimicrobial Stewardship and Infection Prevention and Control, the goals of this Society for Healthcare Epidemiology Research Committee White Paper are to provide a roadmap and framework for leveraging principles of implementation and de-implementation science in day-to-day practice. Part II of this series focuses on some practical case studies, including real-world examples of applied de-implementation science to promote discontinuation of practices that are ineffective, overused, or no longer effective
The Prevalence of Various Autoimmune Comorbidities in Patients with Inflammatory Bowel Disease
No full textIntroduction: Patients with inflammatory bowel disease (IBD) are at increased risk of developing other autoimmune disorders due to possible shared genetic, environmental, and immunological mechanisms. While autoimmune diseases are frequently observed in patients with IBD, data quantifying their inpatient prevalence and their association with outcomes such as mortality remain limited.
Methods: National Inpatient Sample (NIS) 2016-2020 and International Classification of Diseases 10th Version, Clinical Modification (ICD-10-CM) diagnosis codes were used to identify patients with IBD and autoimmune conditions. A multivariate logistic regression analysis to identify an association between various autoimmune diseases and various IBDs was performed.
Results: The study population included 141,478,025 patients. An association was found between 24 autoimmune conditions and IBD.
Conclusions: Our study identified autoimmune comorbidities that are more prevalent in IBD patients. We found that polymyositis, AIHA, ITP, and thrombotic microangiopathy are associated with a higher risk of in-hospital mortality. Psoriasis and hypothyroidism are associated with a lower risk of in-hospital mortality. Further studies are needed to explore the mechanisms responsible
Vonoprazan and amoxicillin dual therapy versus bismuth-based therapy for Helicobacter pylori eradication: a systematic review and meta-analysis of randomized controlled trials
No full textINTRODUCTION: Helicobacter pylori infection can cause peptic ulcer disease, chronic gastritis, primary gastric lymphoma, and gastric cancer. Treatment with bismuth-based quadruple therapy is typically the first line of treatment but can be challenging due to increased pill burden and adverse effects, leading to nonadherence to therapy. Recent studies have shown that vonoprazan can be used in combination with amoxicillin as a potential treatment option. We conducted a systematic review and meta-analysis to assess the efficacy and tolerability of vonoprazan-based dual therapy as compared to bismuth-based therapy (BBT).
METHODOLOGY: We conducted a comprehensive search of multiple electronic databases including PubMed, Embase, and Cochrane Library to identify randomized controlled studies assessing vonoprazan and amoxicillin (VA) in comparison to BBT for H. pylori treatment in adults \u3e18 years of age. Studies with pediatric populations, written in languages other than English, or without control groups were excluded.
RESULTS: Out of the 1968 citations, 9 studies including 2039 patients were included in the final analysis. There were 463 and 481 men in the VA and the BBT groups, respectively. The mean age ranged from 38.1 to 48.7 years in the VA group and from 38.6 to 46.1 in the BBT group. The VA group had an eradication rate similar to that of the BBT group (odds ratio [OR]: 0.32, 95% confidence interval [CI]: 0.26-0.40; P = 0.08). The VA group had a lower incidence of total adverse events than the BBT group (OR: 0.32, 95% CI: 0.26-0.40; P = 0.0001), including a reduced occurrence of nausea and vomiting (OR: 0.42, 95% CI: 0.28-0.65; P = 0.0001). There was no difference in compliance between the VA and BBT groups (OR: 1.16, 95% CI: 0.76-1.76; P = 0.50).
CONCLUSION: Our study showed a similar eradication rate of H. pylori but a significantly lower incidence of adverse events in the VA group compared with the BBT group. Our analysis suggests that a VA-based regimen is an acceptable treatment option for H. pylori patients who cannot tolerate BBT
TriMag Microrobots: 3D-Printed Microrobots for Magnetic Actuation, Imaging, and Hyperthermia
No full textMicrorobots hold immense potential in biomedical applications, including drug delivery, disease diagnostics, and minimally invasive surgeries. However, two key challenges hinder their clinical translation: achieving scalable and precision fabrication, and enabling non-invasive imaging and tracking within deep biological tissues. Magnetic particle imaging (MPI), a cutting-edge imaging modality, addresses these challenges by detecting the magnetization of nanoparticles and visualizing superparamagnetic nanoparticles (SPIONs) with sub-millimeter resolution, free from interference by biological tissues. This capability makes MPI an ideal tool for tracking magnetic microrobots in deep tissue environments. In this study, TriMag microrobots are introduced: 3D-printed microrobots with three integrated magnetic functionalities-magnetic actuation, magnetic particle imaging, and magnetic hyperthermia. The TriMag microrobots are fabricated using an innovative method that combines two-photon lithography for 3D printing biocompatible hydrogel structures with in situ chemical reactions to embed the hydrogel scaffold with Fe(3)O(4) nanoparticles for good MPI contrast and CoFe(2)O(4) nanoparticles for efficient magnetothermal heating. This approach enables scalable, precise fabrication of helical magnetic hydrogel microrobots. The resulting TriMag microrobots, with the synergistic effects of Fe(3)O(4) and CoFe(2)O(4) nanoparticles, demonstrate efficient magnetic actuation for controlled movement, precise imaging via MPI for imaging and tracking in biological fluid and organs, including porcine eye and mouse stomach, and magnetothermal heating for tumor ablation in a mouse model. By combining these capabilities, the fabrication and imaging approach provides a robust platform for non-invasive monitoring and manipulation of microrobots for transformative applications in medical treatment and biological research
Placental epigenetic clocks derived from crowdsourcing: Implications for the study of accelerated aging in obstetrics
No full textEpigenetic gestational age acceleration has been implicated in obstetric syndromes including preeclampsia, yet robust conclusions require accurate and unbiased epigenetic age models. Herein, we curated 1,842 public placental methylomes and organized a DREAM challenge to develop models of gestational age. Participants were blinded to the test data that we generated from 384 placentas encompassing normal and complicated pregnancies. Models developed during and post-challenge compared favorably to existing models in terms of accuracy, yet they were better calibrated throughout gestation and indicated that reports of accelerated epigenetic aging in preterm preeclampsia were likely due to modeling artifacts. The models show that accelerated aging is associated with a decrease in birthweight percentiles in male neonates delivered at term. By contrast, preterm accelerated aging was protective against delivery of a small-for-gestational-age neonate regardless of fetal sex. This work informs our understanding of the fetal sex-dimorphic role of the placenta epigenome in obstetrics