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Introduction & Objectives: Hypospadias is the most common congenital malformation of the penis. There has been a lot of recent controversy in certain countries as to whether operating on distal hypospadias is warranted, and when this should occur. Proximal hypospadias, however, is much less common, with a putative aetiology within the male programming window of the first trimester. It has an association with differences of sexual development (DSD) when diagnosed alongside cryptorchidism and the operative approach is technically more challenging. The European Association of Urology (EAU) recommends initial repair between 6-18 months of age. Material(s) and Method(s): We prospectively gathered data from 24 consecutive toilet-trained children (3-7 years) who were initially listed for proximal hypospadias repair, but who were delayed as a result of resource limitations and the ongoing supply chain effects of COVID-19. The patients were operated between July 2020 and July 2022 with a mean follow-up of 7 months (3-24months). These were compared with a cohort of 16 patients who underwent proximal hypospadias repair between 12-18 months of age in the same institution. Both single and staged procedures were included. Institutional review board approval was obtained. Patients who had previously been operated on as an infant, or who were diagnosed with a DSD, or had an associated diagnosed neuropsychiatric developmental disorder were excluded. Pre-, peri- and post-operative data were statistically compared. Result(s): Overall, 40 children underwent a total of 75 primary procedures for their proximal hypospadias (7x single stage;31 x 2-stage;2 x 3-stage). All patients had an indwelling catheter placed post-operatively, were on antibiotic prophylaxis and oxybutynin for bladder spasms. Morphine was not used post-operatively in any case. Apart from age, there were no significant demographic or racial differences between these groups. The toilettrained cohort was associated with a higher rate of urethrocutaneous fistulas (58% vs. 31%;p=0.11), catheter/stent trauma (79% vs. 6%;p<0.001), pain (54% vs. 12%;p<0.01), constipation (75% vs. 37%;p=0.02). Both Likert Scales (4 vs. 8) and parental net promoter scores (-25 vs. +68.75) were worse for the toilet trained cohort compared to the infant cohort. There were no differences in glans dehiscence, or residual chordee between both groups. Conclusion(s): Primary proximal hypospadias repair is associated with a higher degree of perioperative complications in toilet-trained kids and lower levels of parental satisfaction. These cases are not deemed to be suitable to be managed conservatively and should be offered treatment within the 6-18 months window adjusted for gestational age as endorsed by the EAU.Copyright © 2023.
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Introduction: COVID-19 pandemic has been associated with increased rates of de-pression, anxiety, and suicidal ideation. Individuals with mental illnesses are disproportionately affected by additional complex health issues. This study aims to examine the knowledge and impact of COVID-19 among patients with mental disorders at the Harris County Psychiatric Center (HCPC). Method(s): A retrospective review of surveys was conducted for patients with mental illness at HCPC. Participants were surveyed on demographics, COVID-19 knowledge, and COVID-19 healthcare impact. The data were analyzed with SPSS 20 for Windows at a 0.05 significance level. Result(s): A total of 46 patients were included in the study. We found that the patient population with mental disorders has different methods of obtaining information regarding COVID-19 and practices varying safety measures. To be precise, more women (52.2%) than men (21.7%) learned about COVID-19 through family and friends (p=0.032). More Hispanic (21.4%) compared to non-Hispanic (0%) patients learned about COVID-19 through resources from the World Health Organization (WHO) (p=0.032). Fewer African American (AA) patients avoided contact with people who were sick (39% vs. 81%) Caucasian (p=0.01) and (100%) Asian/Native American/Pacific Islander [ANAPI] patients (p=0.04). We found more non-Hispanic (50.0%) vs. Hispanic (7.1%) patients reported that their personal time (time outside of work) was unchanged by COVID-19 (p=0.007). More Hispanic (57.1%) vs. non-Hispanic (17.9%) patients reported increased time with family members (p=0.009). Compared to Hispanic patients, more non-Hispanic patients reported unchanged difficulty scheduling appoint-ments (46.4% vs. 7.1%) (p=0.015), obtaining prescription (71.4% vs. 35.7%) (p=0.045), and finding housing placement (53.6% vs. 21.4%) (p=0.047). Furthermore, more Caucasian compared to AA patients reported more changes in how they feel (35.7% vs. 76.2%) (p=0.033), anxiety (52.6% vs. 0%) (p=0.002), stress (47.4% vs. 7.7%) (p=0.024), and sadness (30% vs. 0%) (p=0.031). Finally, more ANAPI (67%) compared to AA patients (0%) reported increased anxiety (p=0.025). Conclusion(s): Our findings suggest that African American patients report less knowledge of COVID-19 prevention and less impact on their mental health by the pandemic compared to other racial groups. Our findings suggest that African American patients may have limited knowledge of COVID-19 prevention compared to other races, Caucasian and Asian/Native American/Pacific Islander patients may have increased mood changes, and Hispanic patients may be experiencing more healthcare inequality amidst the pandemic. However, further inves-tigation of the impending ramifications of the pandemic is warranted.Copyright © 2023 Bentham Science Publishers.
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Background The COVID-19 pandemic prompted a major surge in telehealth practices, including the increased utilization of remote Pulmonary Artery Pressure (PAP) among cardiologists worldwide. This study aimed to assess the sociodemographic differences in the utilization of the CardioMEMS HF system for remote PAP monitoring in patients with Heart Failure in the USA. Methods The National inpatient sample database of the USA was queried for all patients with HF who received the CardioMEMS HF system between 2016 and 2019. Multiple logistic regression models were subsequently performed to investigate the socio-demographic factors influencing remote pulmonary artery pressure measurements. Results A total of 1540 patients had a CardioMEMS device for remote PAP monitoring between 2016 and 2019. Following a multivariate analysis accounting for potential confounders, we noted that the use of remote PAP was lower in women vs. men (Adjusted odds ratio (AOR): 0.65, CI 0.52 - 0.82, p < 0.001). Patients who lived in low (AOR: 0.38, CI 0.25 - 0.57, p < 0.001), medium (AOR: 0.57, CI 0.40 - 0.82, p = 0.003), and high-income neighborhoods (AOR: 0.60, CI 0.44 - 0.82, p < 0.001), were also less likely to have remote PAP compared to patients who lived in very high-income neighborhoods. There was no racial difference or association between device use and primary insurance payer. Conclusion There are inequities in the utilization of remote PAP monitoring amongst the Heart Failure population within the USA.Copyright © 2023 American College of Cardiology Foundation
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Background: Older adults with pre-existing health conditions such as cancer are at higher risks of COVID-related morbidity and mortality. Moreover, the pandemic has triggered new sources of anxiety and stress impairing their quality of life (QoL), such as fear of infection, financial challenges, and social isolation. The goal of this study is to evaluate the changes in QoL of breast cancer patients and survivors during the pandemic and assess whether racial/ethnic minority patients were disproportionately affected. As the COVID-19 vaccines become available, another goal of the study is to examine the vaccination rate and symptoms after vaccination among patients of different racial/ethnic groups. Method(s): Two waves of surveys were sent out to the breast cancer patients registered in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort (ChiMEC) via RedCap in the summers of 2020 and 2021 with response rates of > 48%. To measure anxiety and stress, we calculated an overall score (ranging from 0-44) using 11 questions on a 5-point Likert scale, with lower score representing better QoL. The questions were adopted from existing item banks, and the items showed good internal consistency (Cronbach's alpha = 0.84). The second survey also contained questions on vaccination status, concerns, and symptoms after vaccination. Result(s): In the first wave of survey in 2020, no significant racial differences were found in the anxiety/stress scores among the 1300 breast cancer patients. In the second wave of survey in 2021, 1348 patients responded, with 66% of them also respondents of the previous survey. Compared to 2020, the average anxiety/stress score in 2021 decreased from 13.2 to 12.2 for White patients, while increased from 12.8 to 13.6 for Black patients. Mixed effects models showed that the scores worsened significantly for Black patients while improved significantly for White patients. Compared to Whites, Black patients were significantly less confident to find medical help and keep up with work/home responsibilities, while significantly more likely to feel isolated and overwhelmed, and more frequently worried about being sick and going to hospitals. The racial differences in the anxiety/stress scores became insignificant after adjusting for annual household income in multivariate linear mixed effect models. In terms of Covid-19 vaccination, 92.2% of the respondents got vaccinated, with no significant racial/ethnic difference. However, there were more Black patients who had not decided yet or did not respond to this question (Table). The major concerns for patients were the long-term and short-term side effects of the vaccines. In terms of symptoms after vaccination, the most reported symptoms were pain at injection site (62.0%), tiredness (50.2%) and muscle or body aches (30.8%). Conclusion(s): Through a longitudinal study, we found that although the anxiety/stress scores of our patients remained moderate, White patients were having improved QoL while Black patients were doing worse. A third wave of survey is planned in the summer of 2022 to further examine this trend. In our study, the vaccination rates were very high among all racial/ethnic groups and the symptoms after vaccination were similar to the ones demonstrated in the general population. We hope that this information can proactively address some patients' concerns about getting vaccinated.
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SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Previous studies have demonstrated that Black patients with acute respiratory distress syndrome (ARDS) have significantly higher mortality than white patients. However, the mechanisms underlying these differences are unknown. We sought to determine if there are racial differences in the delivery of prone positioning (PP) and low tidal volume ventilation (LTVV). We hypothesized that compared to white patients, Black patients would have similar rates of LTTV but lower rates of PP, because of racial differences in family communication and that PP is more likely to be discussed with families than LTTV. METHODS: We performed a retrospective cohort study of Black and white patients with ARDS with and without COVID-19 who underwent mechanical ventilation (MV) in any of five hospitals of one health system from March 2020 to July 2020. We included patients with P:F < 150 at the time of or within 24 hours of intubation. The primary exposure was self-reported race. The primary outcome variables were (1) PP at any time during hospitalization and (2) percentage of time of the first 72 hours of MV with tidal volumes (Vt) < 6.5 ml/kg ideal body weight. We performed unadjusted analyses comparing patient characteristics and outcomes between black and white patients, and adjusted analyses of outcomes using multivariable regression including age, sex, Sequential Organ Failure Assessment (SOFA score), COVID status, height, and weight as covariates. RESULTS: The cohort included 71 (43%) white patients and 94 (57%) Black patients. Patients had a median age of 63 (IQR 53 to 72), 82 (50%) were male, and median SOFA score at the start of MV was 11 (IQR 8 to 13). Among all patients, 38/71 (54%) of white patients vs 39/94 (41%) of Black patients received PP (p=0.125). Black patients received Vt < 6.5 ml/kg ideal body weight for a median of 96% of the first 72 hours of MV, compared to 82% in white patients (p=0.08). After adjusting for COVID, BMI, sofa, age, gender, Black race was not significantly associated with lower likelihood of PP (OR 0.69, 95% CI 0.33-1.43, p 0.32), but was associated with increased adherence to LTVV (mean difference 12.9%, p-value 0.039). CONCLUSIONS: In this retrospective study of patients with ARDS, we found that Black race was not associated with receipt of PP but was associated with higher adherence to LTVV, contrary to our hypotheses. However, our study is limited by a small sample size in a single health system and a predominance of patients with COVID-19 with higher rates of adherence to evidence-based care for ARDS. Delivery of PP and LTVV may not explain racial differences in outcomes for COVID-19 ARDS;however, further research is required to understand the mechanisms underlying worse outcomes among black patients with ARDS. CLINICAL IMPLICATIONS: Further research is required to better understand the causes of worse outcomes in Black patients with ARDS. DISCLOSURES: No relevant relationships by Barry Fuchs No relevant relationships by Lilian Iglesias No relevant relationships by Meeta Kerlin No relevant relationships by Rachel Kohn No relevant relationships by Allyson Lieberman No relevant relationships by Stefania Scott No relevant relationships by Gary Weissman
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BACKGROUND: Food insecurity is an important social determinant of health that links to various health conditions and exacerbated by the COVID- 19 pandemic. Our previous (unpublished) study showed a progress on the food scarcity prevalence among US adults after December 2020 when US economy started recovering quickly. We developed a hypothesis that the rapid US economic recovery has had a greater impact on the food scarcity in the vulnerable groups (Hispanic/Black). METHODS: We conducted a secondary data analysis of nationwide US adults using Household Pulse Survey (HPS) from the US Census Bureau. HPS asks about impacts of COVID-19 pandemic on daily lives among US adults. Bi- weekly data tables summarize national estimates of food security and racial differences in their responses. Food scarcity is defined as those reporting “sometimes” or “often” not enough to eat in the last 7 days. We performed multi group interrupted time series analysis to compare the effect of US economic recovery that began in December 2020 on the racial disparity in food scarcity. We chose the vulnerable group (Black/Hispanic) as the treatment group and White as the control group. RESULTS: Among nearly 250,000,000 US adults per 2 weeks, 63% was White, followed by 17% Hispanic, and 5% Black. The food scarcity rate in the control group was incremental by 0.3% per 2 weeks in the pre-intervention period (b = 0.003, p < 0.001) but it started decreasing by 0.4% per 2 weeks in the post-intervention period (b = -0.004, p < 0.001). Figure shows the effect of economic recovery on the food scarcity rate between races. Black/Hispanic group had 0.10- point higher rate of food scarcity at the beginning (b = 0.10, p < 0.001) but showed an additional 0.5%-point decrement per 2 weeks in food scarcity rate on top of the baseline effect of 0.4% decrement (b = -0.005, p = 0.019) in the post- intervention. CONCLUSIONS: The gap in food scarcity between White and Hispanic/ Black groups decreased after US economy started recovering in December 2020. Our results indicate that the economic recovery provided the vulnerable group with additional benefits to reduce food scarcity.
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Background. Research has reported that African American (AA) cancer patients with COVID-19 had a higher hospitalization rate than their white counterparts. Because the severity of COVID-19 is partly related to existing chronic diseases, one of the speculations is that racial differences in COVID-19 severity are attributable to AA cancer patients having a higher prevalence of chronic illnesses. Our study aimed to assess the impact of existing chronic diseases on the racial differences in hospitalization and length of hospitalization in COVID-19 cancer patients in Louisiana. Methods. We linked cancer cases diagnosed in 2015-2019 from the Louisiana Tumor Registry (LTR) with the statewide COVID-19 data to identify COVID-19 patients who had been previously diagnosed with cancer. We also identified chronic illnesses (i.e., heart disease, peripheral vascular and cerebrovascular diseases, pulmonary disease, renal disease, liver disease, diabetes, and others) from 2012-2020 hospital discharge data and LTR data. Age and census tract level poverty were at the time of COVID-19 diagnosis. Bivariate and multivariable logistic regressions were used to exam the association of race with hospitalization after adjusting for socio-demographic and chronic illnesses. The multivariable Poisson model was used to assess the racial disparity in length (in days) of hospitalization. Results. Of 6,518 COVID-19 cancer patients, there were 30.8% AA, 68.4% whites, and 0.8% other races. AA, male, older, residing in high poverty, and patients with chronic illnesses were more likely (P<0.05) to be hospitalized. The odds of hospitalization was 87.2% higher among AA patients than white patients in bivariate analysis. After adjusting for age, gender, poverty, obesity, smoking status, and chronic illnesses, the odds of hospitalization was still higher for AA than white patients (OR=1.81;95% CI: 1.55-2.09). The length of hospital stay for AA was more (P<0.05) than whites After adjusting for the same covariates. Conclusion. Sociodemographic factors and chronic illnesses are associated with the severity of COVID-19 among cancer patients. However, AA COVID-19 cancer patients have significantly higher odds of hospitalization and longer hospital stays even when controlling these factors. More research is warranted to determine underlying factors of the observed racial disparities.
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Background: The COVID-19 pandemic has led to major disruptions in healthcare and delays in endoscopy. While recent AGA guidelines suggest against routine pre-endoscopy SARSCoV2 testing, many endoscopy practices continue to require testing of all asymptomatic individuals. We hypothesized that SARS-CoV2 testing may disproportionately affect minority groups. The aim of this study was to assess racial differences in endoscopy cancellation rates attributable to SARS-CoV2 testing requirements. Methods: We conducted a retrospective chart review of cancelled endoscopic procedures between 3/1/21 to 9/7/21 from our hospital which mandated a negative SARS-CoV2 RT-PCR test within 72-hours prior to endoscopy. Data was collected on age, race (based on self-report), gender, procedure type/location, primary language, indication, and source of referral. Cancellations related to SARS-CoV2 testing included: test not completed, test not resulted, patient declined to obtain test, or positive test result. Multiple logistic regression was used to control for potential confounders on race and cancellation. Statistics were performed in JMP Pro 14.0.0. This project was IRB approved. Results: Of 847 cancelled procedures, 300 were randomly selected for chart review (for feasibility purposes). After excluding repeat patients and erroneous cancellations, 255 cases remained for analysis (Table 1). SARS-CoV2 testing requirements accounted for 19% of cancellations (Table 2). Of 112 completed tests, only 7 were positive leading to procedure cancellation. Non-Hispanic Black patients were significantly more likely to have procedure cancellations related to SARS-CoV2 testing (OR: 3.4, 95% CI 1.7, 6.7). This group was also less likely to present for their procedure (OR: 2.3, 95% CI 1.2, 4.1);however, there was no difference in provider initiated cancellations. Other factors including age, gender, procedure type, procedure location, primary language, gastroenterology referral, and indication (screening or diagnostic) were not associated with testing-related cancellations. Controlling for potential confounders of age, gender, endoscopy location, and language did not change the association of race and testing-related cancellations. Discussion: Blacks had higher rates of pre-endoscopy cancellations due to SARS-CoV2 testing requirements compared to non-Blacks which may lead to further delays in care. Similar to prior studies, Blacks also had higher no show rates for endoscopy, which is partly explained by socioeconomic factors. However, the additional requirement of pre-procedure testing disproportionately impacted Black patients. Health care systems mandating pre-endoscopy testing should recognize how this requirement may worsen inequities in care and contribute to poor health outcomes among people of color or other marginalized groups. (Table Presented) (Table Presented)