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Identifying commonalities and differences between EHR representations of PASC and ME/CFS in the RECOVER EHR cohort
Full text linkBackground: Shared symptoms and biological abnormalities between post-acute sequelae of SARS-CoV-2 infection (PASC) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) could suggest common pathophysiological bases and would support coordinated treatment efforts. Empirical studies comparing these syndromes are needed to better understand their commonalities and differences.
Methods: We analyzed electronic health record data from 6.5 million adult patients from the National COVID Cohort Collaborative. PASC and ME/CFS diagnostic groups were defined based on recorded diagnoses, and other recorded conditions within the two groups were used to train separate machine learning-driven computable phenotypes (CPs). The most predictive conditions for each CP were examined and compared, and the overlap of patients labeled by each CP was examined. Condition records from the diagnostic groups were also used to statistically derive condition clusters. Rates of subphenotypes based on these clusters were compared between PASC and ME/CFS groups.
Results: Approximately half of patients labeled by one CP are also labeled by the other. Dyspnea, fatigue, and cognitive impairment are the most-predictive conditions shared by both CPs, whereas other most-predictive conditions are specific to one CP. Recorded conditions separate into cardiopulmonary, neurological, and comorbidity clusters, with the cardiopulmonary cluster showing partial specificity for the PASC groups.
Conclusions: Data-driven approaches indicate substantial overlap in the condition records associated with PASC and ME/CFS diagnoses. Nevertheless, cardiopulmonary conditions are somewhat more commonly associated with PASC diagnosis, whereas other conditions, such as pain and sleep disturbances, are more associated with ME/CFS diagnosis. These findings suggest that symptom management approaches to these illnesses could overlap.The UMass Center for Clinical and Translational Science (UMCCTS), UL1TR001453, helped fund this study.No embarg
Measuring associations between hormonal entropy, the prevalence of vasomotor symptoms, and menstrual dynamics
No full textThis study investigates whether deviations in the regularity/complexity of urinary sex hormones relative to textbook 'gold standard' (GS) menstrual cycle patterns are associated with vasomotor symptom (VMS) occurrence and how these relationships might relate to differences in hormonal profiles. 549 midlife women provided daily urine-based measurements of follicle-stimulating hormone (FSH), estrogen conjugates (E1C), pregnanediol glucuronide (PDG), and luteinizing hormone (LH) over a complete menstrual cycle. Distribution and fuzzy entropy (DistEn, FuzzEn) were used to gauge hormone regularity/complexity, emphasizing structural complexity and temporal unpredictability respectively. Entropy metrics were classified as being elevated or lowered relative to the GS and then evaluated in relation to VMS prevalence. These same entropy classifications were used to evaluate hormone profiles by referencing 11 dynamics indicative of normal or reproductively aging cycles. Elevated entropy was positively associated with the likelihood of VMS for PDG-DistEn and E1C-DistEn and negatively associated for PDG-FuzzEn, E1C-FuzzEn, and LH-FuzzEn. Lowered entropy was negatively associated with VMS likelihood for LH-FuzzEn and PDG-FuzzEn and positively associated for FSH-FuzzEn and E1C-DistEn. Entropy analysis provides useful insight into menstrual cycle dynamics and their associations with VMS. Specifically, entropy can identify different underlying states of hormonal dysregulation associated with increased VMS occurrence, potentially providing insights into VMS causes and treatments. Furthermore, entropy metrics for PDG show potential in gauging degrees of reproductive aging, which could help in addressing health risks associated with late/early menopause. Finally, entropy may contribute towards efforts in understanding how a woman's VMS experience will progress through the menopause transition.No embarg
Evaluating the Prevalence of Suicide Risk Screening Practices in Accredited Hospitals
Full text linkBackground: The Joint Commission's National Patient Safety Goal (NPSG) on suicide prevention (NPSG.15.01.01) requires accredited hospitals to screen all patients aged 12 years and older who are being evaluated or treated for behavioral health conditions as their primary reason for care for suicidal ideation using a validated screening tool. Some hospitals have expanded screening to include nonbehavioral health care patients.
Methods: This cross-sectional observational study explored the prevalence and challenges of suicide risk screening practices among Joint Commission-accredited hospitals. An online questionnaire was sent to 859 general medical/surgical hospitals. Chi-square tests were used to evaluate differences in response rates, and responses were adjusted by hospital characteristics (bed capacity, location, system, and teaching status).
Results: A total of 284 (33.1%) hospitals responded. The majority (n = 225 [79.2%]) reported screening all patients hospitalwide, and 185 (65.1%) had implemented a suicide prevention framework that includes protocols for positive screens and risk assessment. Challenges for implementing a comprehensive universal suicide risk screening and assessment protocol included insufficient staffing and lack of secure environments for at-risk patients. Of the 59 organizations not conducting hospitalwide screening, 94.9% indicated multiple reasons, including negative impact on workflow (30 [50.8%]), burden on providers (30 [50.8%]), not a requirement (29 [49.2%]), and workflow feasibility (28 [47.5%]).
Conclusion: Results suggest the majority of accredited hospitals have implemented suicide risk screening practices that exceed current Joint Commission requirements. The lack of sufficient resources to adequately address patients who screen positive for suicide risk remains a key challenge to universal screening.No embarg
Where are all the job candidates?: geographic considerations for early career librarian recruitment in health sciences libraries
No full textAnecdotal evidence suggests that hiring managers and hiring committees are seeing small numbers of applicants for vacancies at their health sciences libraries, making recruitment difficult. Several challenges are often cited for this, but little has been said about geographic considerations. Our objective was to analyze early career health sciences job postings in the United States for one year, and identify any geographic disparities relevant to recruitment. We explored medical and health science librarian job postings from MLA's website, ALA's joblist, medlib-l, and caucus listservs, which were compiled from January to December 2023. Early career postings were determined based on predefined criteria. Based on the medical/health science librarian job postings from 2023, there were 216 total postings including 105 early career positions (requiring one year or less of experience), reflecting approximately 49% of all job postings during this period. A plurality of early career postings (27%) were located in the Mid-Atlantic region while the fewest (5%) were from the Mountain West. Researchers analyzed the early career postings finding that instruction (67%) and reference (58%) duties were most prominent. Geography is important, as a new LIS graduate living in a region with fewer opportunities may be forced to move in order to obtain a medical library position, and optimal approaches to recruitment will vary depending on the employer's location. As this highlights just one aspect of the challenge, there are further research directions that may be taken from this analysis.No embarg
A New CAHPS Measure of Patient Experiences With Mental Health and Substance Use Care
No full textObjective: To examine the psychometric characteristics of a survey about the experiences of people seeking mental health care and substance use services, the CAHPS Outpatient Mental Health (MH) survey.
Study settings and design: Field tests were conducted in two Northeastern states-one among a state's Medicaid enrollees and the other in family medicine practices where psychologists and social workers were collocated with primary care providers. The survey asked about psychiatric medicines and counseling services received in the last 6 months.
Data sources and analytic sample: In each study, questionnaires were mailed to sampled patients with an option to complete a web survey. Study 1 included 5508 Medicaid enrollees 21 years and older from four health plans. Study 2 included 3328 patients 18 years and older who visited one of four family medicine practices. Samples included patients with mental health or substance use disorders or both.
Principal findings: Response rates were 9.98% (n = 470) and 13.00% (n = 416) for the Medicaid and family medicine surveys, respectively. About 20% of respondents reported difficulty getting appointments with mental health medicine prescribers. From 10% to 30% of respondents had difficulties finding a counselor, and 15% reported problems making appointments with counselors. Many respondents reported no mental health care in the last 6 months. Composite measures for communication with counselors had excellent internal consistency, but the measure for access to counseling services was modest (0.68 and 0.52 for the two studies). Inter-unit reliability (IUR) was modest for the survey (IUR for all measures was lower than 0.60; highest for rating of counselors).
Conclusions: Both studies had uniformly good distributions of responses to specific questions, although communication and respect questions about counselors were positively skewed. The survey performs better for respondents with any mental health condition and less well for those with only substance use disorders.No embarg
Integrating Legal Aid into HIV Care: Evaluating the Impact of a Medical-Legal Partnership on Viral Suppression Outcomes
No full textSocial and structural determinants of health (SSDoH), including legal challenges related to housing, employment, and public benefits, often obstruct HIV care adherence and viral suppression. Medical-Legal Partnerships (MLPs) have emerged as a promising structural intervention to mitigate these barriers but are underutilized in HIV service settings. This feasibility and acceptability trial evaluated the impact of an MLP intervention compared to treatment-as-usual (TAU) among people with HIV (PWH) in Philadelphia, Pennsylvania. Two matched service organizations were randomized to MLP or TAU. The MLP included interdisciplinary training, standardized legal screening by peer navigators, and integration of legal services from a legal aid organization. A total of 202 participants were enrolled using a multi-pronged recruitment strategy that included venue-based outreach, online recruitment methods, and peer referrals. Kaplan-Meier survival analyses and logistic regressions assessed the time to viral suppression and likelihood of achieving undetectable viral load at 3 and 6 months. Participants in the MLP site achieved undetectable viral load faster than those in the TAU site in both conservative and robust survival analyses. At 3-month follow-up, MLP participants were significantly more likely to achieve viral suppression (OR = 2.42, 95% CI: 1.06, 5.49, p = .03). Although the 6-month odds ratio was reduced (OR = 2.28, 95% CI: 0.79, 6.57), it did not reach statistical significance. Findings suggest that MLPs can accelerate viral suppression among PWH by addressing health-harming legal needs. This study supports the integration of legal services into HIV care as a promising strategy to improve outcomes and reduce disparities.No embarg
Prevalence of Chronic Overlapping Pain Conditions in Participants With Chronic Low Back Pain Enrolled in a Pragmatic Trial of Mindfulness-Based Stress Reduction
No full textBackground: Chronic low back pain (cLBP) is extremely common and is one of the Chronic Overlapping Pain Conditions (COPCs), 10 conditions thought to have similar underlying pathophysiology. Little is known about the prevalence and co-occurrence of cLBP with other commonly accepted conditions referred to as COPCs.
Methods: We assessed participants enrolled in a pragmatic trial of mindfulness-based stress reduction for cLBP to determine the prevalence of co-occurring COPCs using a validated COPC screener. We compared psychosocial and physical functioning among participants with only cLBP and participants with cLBP and additional COPCs using Student's t-tests, chi-squared tests and multivariable linear regression.
Results: Among 285 enrollees (age range: 18-88 years, mean age: 52.2 years, SD = 15.3), 272 (95%) reported pain outside the upper and lower back region. One hundred and twenty-nine people (45%) had one COPC, and 68 (24%) had two or more COPCs not including cLBP. The most common COPCs were irritable bowel syndrome (n = 56, 20%); myalgia encephalomyelitis/chronic fatigue syndrome (n = 54, 19%); and fibromyalgia (n = 42, 15%).
Conclusion: We found strong differences when comparing people with cLBP alone to those with cLBP and COPCs. People with COPCs reported more pain symptoms, higher levels of anxiety, depression, fatigue and scored worse across measures of physical functioning and pain symptoms. An additional COPC was associated with a 7.6-point increase in fatigue scores (95% CI: 5.6, 9.7) on a T-score metric (mean = 50, SD = 10).
Significance statement: Compared to people with low back pain alone, individuals with additional chronic pain experienced more severe pain symptoms, more anxiety, depression and fatigue. In this sample of people with cLBP, overlapping pain conditions were common, affecting 45% of people.
Registration number and registry name: Clinicaltrials.gov identifier NCT04129450.No embarg
Quantification and Analysis of Laser Peripheral Iridotomies in the United States from 2000 to 2021
Full text linkAIM: To analyze the number of laser peripheral iridotomies (LPIs) performed from 2000 to 2021 in the United States.
MATERIALS AND METHODS: The Centers for Medicare and Medicaid Services Part B National Summary database was queried to obtain deidentified records of patients who underwent LPI between 2000 and 2021, and patients who underwent cataract surgery between 2011 and 2021. Annual total allowed services and charges were collected for CPT 66761 (LPI), and CPT 66982 and 66984 (cataract surgery). Annual inflation rates and population data were obtained from the US Bureau of Labor Statistics and the World Bank.
RESULTS: The number of LPIs performed increased 58.8% from 64,935 in 2000 to 1,03,113 in 2008, remained fairly constant between 2009 and 2015, and declined 35.4% from 96,495 in 2016 to 62,376 in 2021. Allowed services per 10,000 people increased 47.37% from 2.301 in 2000 to 3.391 in 2008 before declining 44.59% to 1.879 in 2021. The US population increased 17.6% over the time period. LPI average allowed charge was 376.77 in 2007, decreased to 275.47 in 2019 to $280.33 in 2021. The average allowed charge decreased 10.1%, while the rate of cumulative inflation was 53%. Total annual allowed charge decreased 13.6% from 2000 to 2021, unadjusted for inflation.
CONCLUSION: From 2000 to 2021, the number of LPIs performed in the United States declined while population increased. Potential drivers include results of scientific studies that recommended early cataract surgery and observing patients with primary angle closure suspects (PACS), a shift in physician sentiment of the LPI risk-benefit ratio, and economic forces. Finally, the COVID-19 pandemic may have contributed to the decrease in LPIs in 2020 and 2021.
CLINICAL SIGNIFICANCE: The number of LPIs performed in the United States declined over the last 20 years, while the population has increased. Factors, such as influential studies recommending early cataract extraction and monitoring patients without LPI, shifting doctor sentiments, and economic factors may have affected LPI rates.
HOW TO CITE THIS ARTICLE: Maheshwari A, Sarrafpour S, Jayaram R, Quantification and Analysis of Laser Peripheral Iridotomies in the United States from 2000 to 2021. J Curr Glaucoma Pract 2025;19(4):208-215.No embarg
Barriers to Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children
No full textIntroduction: Half of individuals eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a federal nutrition program, are not enrolled. This dissertation examines associations between (1) national policy change, (2) neighborhood opportunity, and (3) experiences of racial discrimination on WIC participation, with a focus on children of Hispanic, non-Hispanic Black, and immigrant mothers.
Methods: The data for this study were drawn from the 2013-2024 iterations of Children’s HealthWatch, an annual cross-sectional study among mothers with children ages 0-4. Aim 1 is an interrupted time series analysis examining differences in WIC participation by maternal nativity after a federal policy (the public charge rule) was changed. Aim 2 is a cross-sectional study of the association between neighborhood opportunity, measured by the Child Opportunity Index, and WIC participation. Aim 3 is a cross-sectional study which describes the association between experiencing racial discrimination and dropping out of WIC.
Results: After the public charge rule changed, WIC participation decreased significantly faster among children of immigrant mothers with a shorter length of residence in the US, relative to children of US-born mothers. The prevalence of WIC participation was significantly higher among respondents from lower opportunity neighborhoods compared to higher opportunity ones. Lifetime experiences of racial discrimination were significantly associated with WIC drop-out.
Conclusions: All three factors evaluated were significantly associated with WIC participation, which can inform targeted outreach strategies. Further studies that employ community-engaged approaches are needed to understand and improve the WIC experience among all mothers and children to increase enrollment and participation.Biochemistry and Molecular Biotechnology1 year2026-09-1
Incidence and predictors of Woven EndoBridge (WEB) shape modification following treatment of intracranial aneurysms in a large multicenter study
Full text linkThe Woven EndoBridge (WEB) device is FDA-approved for the treatment of bifurcation aneurysms. Despite its wide popularity, it has been under scrutiny for its association with potential aneurysm recanalization and retreatment due to device shape modification. This study aims to analyze the shape modification rate of WEB devices and identify factors associated with this phenomenon, as well as its correlation with aneurysm retreatment. We conducted a retrospective review of the WorldWide WEB Consortium database, including adult patients treated for intracranial aneurysms with the WEB device. We assessed aneurysm occlusion using the WEB Occlusion Scale and defined WEB shape modification as a percentage reduction in the distance between two WEB markers. Logistic regression and Cox proportional hazards models were utilized to evaluate predictors of shape modification and retreatment. Kaplan-Meier curves were used to estimate the time-dependent probability of no or minor shape modification. A total of 405 patients were analyzed, with minor and major shape modification occurring in 31.4% and 10.1% of cases, respectively. Major shape modification was associated with lower rates of adequate occlusion (70.7%) compared to no or minor shape modification (86.6%) and a higher rate of retreatment (26.8% vs. 8.1%). Predictors of major shape modification included the presence of daughter sac, bifurcation aneurysms, absence of immediate flow stagnation, and a WEB width minus aneurysm width ratio ≤ 0.5. The probability of no or minor shape modification declined within the first 25 months and stabilized thereafter. WEB device shape modification is a significant predictor of aneurysm occlusion efficacy and retreatment. Recognizing the factors influencing shape modification can guide treatment decisions and follow-up protocols to improve patient outcomes.No embarg