Potential Health Disparities in the Early Detection and Prevention of Pancreatic Cancer.

INTRODUCTION: Pancreatic cancer remains one of the deadliest cancers in the United States. Some types of pancreatic cysts, which are being detected more frequently and often incidentally on imaging, have the potential to develop into pancreatic cancer and thus provide a valuable window of opportunity for cancer interception. Although racial disparity in pancreatic cancer has been described, little is known regarding health disparities in pancreatic cancer prevention. In the present study, we investigate potential health disparities along the continuum of care for pancreatic cancer. METHODS: The racial and ethnic composition of pancreatic patients at high-volume centers in Indiana were evaluated, representing patients undergoing surgery for pancreatic cancer (n=390), participating in biobanking (972 pancreatic cancer patients and 1984 patients with pancreatic disease), or being monitored for pancreatic cysts at an early detection center (n=1514). To assess racial disparities and potential differences in decision-making related to pancreatic cancer prevention and early detection, an exploratory online survey was administered through a volunteer registry (n=708).  Results: We show that despite comprising close to 10% or 30% of the Indiana or Indianapolis population, respectively, African Americans make up only about 4-5% of our study cohorts consisting of patients undergoing pancreatic surgery or participating in biobanking and early detection. Analysis of online survey results revealed that given the hypothetical situation of being diagnosed with a pancreatic cyst or pancreatic cancer, the vast majority of respondents (>90%) would agree to undergo surveillance or surgery, respectively, regardless of race. Only a minority (3-12%) acknowledged any significant transportation, financial, or emotional barriers that would impact a decision to undergo surveillance or surgery. This suggests that the observed racial disparities may be due in part to the existence of other barriers that lie upstream of this decision point. CONCLUSION: Racial disparities exist not only for pancreatic cancer but also at earlier points along the continuum of care such as prevention and early detection. To our knowledge, this is the first study to document racial disparity in the management of patients with pancreatic cysts who are at risk of developing pancreatic cancer. Our results suggest that improving access to information and care for such at-risk individuals may lead to more equitable outcomes.

Retrospective Study of Psychiatric Hospitalizations in a West Texas Mental Health Treatment Facility during the COVID-19 Pandemic.

OBJECTIVES: The association between the coronavirus disease (COVID-19) pandemic and adverse mental health outcomes has been well documented; however, little is known about its impact in rural areas of the United States. This study aims to characterize and compare inpatient psychiatric admissions in West Texas before and during the initial months of the COVID-19 pandemic. METHODS: A retrospective study was conducted using the electronic health records of 1392 inpatient psychiatric admissions from period A (March 13, 2019-July 3, 2019) to period B (March 13, 2020-July 3, 2020). RESULTS: During period B, there was a significant increase in the length of stay (P < 0.01) compared with period A. The pandemic was associated with an increased history of psychiatric medication use (P < 0.01), substance use (P ≤ 0.01), and suicide risk at the time of admission (P < 0.01). Significant differences were found in employment status (P < 0.01), living situation (P < 0.01), and ethnicity (P = 0.03). CONCLUSIONS: Rural communities in West Texas experienced a decrease in psychiatric hospitalizations during the beginning of the COVID-19 pandemic, followed by an increase as lockdown restrictions began to lift; this warrants further investigation into healthcare service utilization during the pandemic.

Bioprosthetic Pulmonary Valve Dysfunction in Congenital Heart Disease.

BACKGROUND: We aim to identify the incidence and timing of dysfunction and failure of stented bioprosthetic valves in the pulmonary position in congenital heart disease patients. METHODS: A total of 482 congenital heart disease patients underwent 484 stented bioprosthetic pulmonary valve implantations between 2008 and 2018. There were 164 porcine valves (Porcine) and 320 bovine pericardial valves (Pericardial) implanted. Primary endpoints were survival, valve dysfunction, and valve failure. RESULTS: Pericardial valves were implanted in older patients (22.0, interquartile range [IQR] 14-33 vs 16.0, IQR 11-23 years, P < 0.001). Five-year survival (96.7% vs 97.9%) for the Pericardial and Porcine groups, respectively, were similar, P > 0.05. Forty-six (34%) Porcine and 75 (27%) Pericardial group patients met criteria for valve dysfunction at a median echocardiographic follow-up time of 7.43 years (IQR 4.1-9.5 years) and 3.26 years (IQR 1.7-4.7 years), respectively. More Pericardial group patients suffered from at least mild late PR while late median peak gradient was higher in the Porcine group, P < .001 for both. Risk factors for valve dysfunction included decreasing patient age for the entire cohort (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.00-1.04, P = .015) and lack of anticoagulation at discharge for the Porcine group (HR 3.06, 95% CI 1.03-9.10, P = .044) but not the Pericardial group. Five-year cumulative incidence of dysfunction was 39% for the Pericardial group and 17% for the Porcine group. CONCLUSIONS: Porcine stented and bovine pericardial stented valves can be implanted in the pulmonary position in all age groups safely. However, despite similar rates of valve failure, bovine pericardial stented valves have a higher incidence of valve dysfunction at mid-term follow-up.

Functional Status Change Among Infants, Children, and Adolescents Following Extracorporeal Life Support: a Multicenter Report.

In our retrospective multicenter study of patients 0 to 18 years of age who survived extracorporeal life support (ECLS) between January 2010 and December 2018, we sought to characterize the functional status scale (FSS) of ECLS survivors, determine the change in FSS from admission to discharge, and examine risk factors associated with development of new morbidity and unfavorable outcome. During the study period, there were 1,325 ECLS runs, 746 (56%) survived to hospital discharge. Pediatric patients accounted for 56%. Most common ECLS indication was respiratory failure (47%). ECLS support was nearly evenly split between veno-arterial and veno-venous (51% vs . 49%). Median duration of ECLS in survivors was 5.5 days. Forty percent of survivors had new morbidity, and 16% had an unfavorable outcome. In a logistic regression, African American patients (OR 1.68, p = 0.01), longer duration of ECLS (OR 1.002, p = 0.004), mechanical (OR 1.79, p = 0.002), and renal (OR 1.64, p = 0.015) complications had higher odds of new morbidity. Other races (Pacific Islanders, and Native Americans) (OR 2.89, p = 0.013), longer duration of ECLS (OR 1.002, p = 0.002), and mechanical complications (OR 1.67, p = 0.026) had higher odds of unfavorable outcomes. In conclusion, in our multi-center 9-year ECLS experience, 56% survived, 40% developed new morbidity, and 84% had favorable outcome. Future studies with larger populations could help identify modifiable risk factors that could help guide clinicians in this fragile patient population.

The Dispersion of Health Information-Seeking Behavior and Health Literacy in a State in the Southern United States: Cross-sectional Study.

BACKGROUND: The transmission of health information from in-person communication to web-based sources has changed over time. Patients can find, understand, and use their health information without meeting a health care provider and are able to participate more in their health care management. In recent years, the internet has emerged as the primary source of health information, although clinical providers remain the most credible source. The ease of access, anonymity, and busy schedules may be motivating factors to seek health information on the web. Social media has surfaced as a popular source of health information, as it can provide news in real time. The increase in the breadth and depth of health information available on the web has also led to a plethora of misinformation, and individuals are often unable to discern facts from fiction. Competencies in health literacy (HL) can help individuals better understand health information and enhance patient decision-making, as adequate HL is a precursor to positive health information-seeking behaviors (HISBs). Several factors such as age, sex, and socioeconomic status are known to moderate the association between HL and HISBs. OBJECTIVE: In this study, we aimed to examine the relationship between HL and HISBs in individuals living in a southern state in the United States by considering different demographic factors. METHODS: Participants aged ≥18 years were recruited using Qualtrics Research Services and stratified to match the statewide demographic characteristics of race and age. Demographics and source and frequency of health information were collected. The Health Literacy Questionnaire was used to collect self-reported HL experiences. SPSS (version 27; IBM Corp) was used for the analysis. RESULTS: A total of 520 participants met the criteria and completed the survey (mean age 36.3, SD 12.79 years). The internet was cited as the most used source of health information (mean 2.41, SD 0.93). Females are more likely to seek health information from physicians than males (r=0.121; P=.006). Older individuals are less likely to seek health information from the internet (r=-0.108; P=.02), social media (r=-0.225; P<.001), and friends (r=-0.090; P=.045) than younger individuals. Cluster analysis demonstrated that individuals with higher levels of HISBs were more likely to seek information from multiple sources than those with lower levels of HISBs (mean range 3.05-4.09, SD range 0.57-0.66; P<.001). CONCLUSIONS: Age and sex are significantly associated with HISB. Older adults may benefit from web-based resources to monitor their health conditions. Higher levels of HL are significantly associated with greater HISB. Targeted strategies to improve HISB among individuals with lower levels of HL may improve their access, understanding, and use of health information.

Outcomes for unplanned reinterventions following paediatric cardiac surgery for tetralogy of Fallot.

BACKGROUND: Advances in surgical techniques and post-operative management of children with CHD have significantly lowered mortality rates. Unplanned cardiac interventions are a significant complication with implications on morbidity and mortality. METHODS: We conducted a single-centre retrospective case-control study for patients (<18 years) undergoing cardiac surgery for repair of Tetralogy of Fallot between January 2009 and December 2019. Data included patient characteristics, operative variables and outcomes. This study aimed to assess the incidence and risk factors for reintervention of Tetralogy of Fallot after cardiac surgery. The secondary outcome was to examine the incidence of long-term morbidity and mortality in those who underwent unplanned reinterventions. RESULTS: During the study period 29 patients (6.8%) underwent unplanned reintervention, and were matched to 58 patients by age, weight and sex. Median age was 146 days, and median weight was 5.8 kg. Operative mortality was 7%, and 1-year survival was 86% for the entire cohort (cases and controls). Hispanic patients were more likely to have reinterventions (p = 0.04) in the unadjusted analysis, while Asian, Pacific Islander and Native American (p = 0.01) in the multi-variate analysis. Patients that underwent reintervention were more likely to have post-op arrhythmia, genetic syndromes and higher operative and 1-year mortality (p < 0.05). CONCLUSION: Unplanned cardiac interventions following Tetralogy of Fallot repair are common, and associated with increased operative, and 1-year mortality. Race, genetic syndromes and post-operative arrhythmia are associated with increased odds of unplanned reinterventions. Future studies are needed to identify modifiable risk factors to minimise unplanned reinterventions.

Adaptation and implementation of a parenting curriculum in a refugee/immigrant community using a task-shifting approach: a study protocol.

BACKGROUND: Delivering evidence-based interventions to refugee and immigrant families is difficult for several reasons, including language and cultural issues, and access and trust issues that can lead to an unwillingness to engage with the typical intervention delivery systems. Adapting both the intervention and the delivery system for evidence-based interventions can make those interventions more appropriate and palatable for the targeted population, increasing uptake and effectiveness. This study focuses on the adaptation of the SafeCare© parenting model, and its delivery through either standard implementation methods via community-based organizations (CBO) and a task-shifted implementation in which members of the Afghans, Burmese, Congolese community will be trained to deliver SafeCare. METHOD: An adaptation team consisting of community members, members of CBO, and SafeCare experts will engage a structured process to adapt the SafeCare curriculum for each targeted community. Adaptations will focus on both the model and the delivery of it. Data collection of the adaptation process will focus on documenting adaptations and team member's engagement and satisfaction with the process. SafeCare will be implemented in each community in two ways: standard implementation and task-shifted implementation. Standard implementation will be delivered by CBOs (n = 120), and task-shifted implementation will be delivered by community members (n = 120). All interventionists will be trained in a standard format, and will receive post-training support. Both implementation metrics and family outcomes will be assessed. Implementation metrics will include ongoing adaptations, delivery of services, fidelity, skill uptake by families, engagement/completion, and satisfaction with services. Family outcomes will include assessments at three time points (pre, post, and 6 months) of positive parenting, parent-child relationship, parenting stress, and child behavioral health. DISCUSSION: The need for adapting of evidence-based programs and delivery methods for specific populations continues to be an important research question in implementation science. The goal of this study is to better understand an adaptation process and delivery method for three unique populations. We hope the study will inform other efforts to deliver health intervention to refugee communities and ultimately improve refugee health.

Comparison of Invasive and Oscillometric Blood Pressure Measurement in Obese and Nonobese Children.

BACKGROUND: Obesity and hypertension are public health priorities, with obesity considered to be a potential cause of hypertension. Accurate blood pressure (BP) determination is required and often obtained by automated oscillometric cuff devices. We sought to determine the correlation of oscillometric measurement in children, and if obesity was associated with worse correlation between methods than nonobese children. METHODS: Retrospective matched case-controlled study of 100 obese (97-99th percentile) and 100 nonobese (25-70th percentile) children after cardiac surgery with simultaneous systolic, diastolic, and mean invasive and oscillometric measurements. Matching was 1:1 for age, sex, race, and Risk Adjustment for Congenital Heart Surgery-1 score. Intraclass correlation coefficients and Bland-Altman plots were used to determine agreement with 0.75 as threshold. RESULTS: Median age was 13 years (10-15). Agreement was low for systolic (0.65 and 0.61), diastolic (0.68 and 0.61), and mean measurements (0.73 and 0.69) (obese/nonobese). Bland-Altman plots demonstrated oscillometric BP measurements underestimated systolic hypertension (oscillometric readings lower than intra-arterial). Oscillometric measurements underestimated hypotension (systolic oscillometric measurements were higher than intra-arterial). This occurred in obese and nonobese patients. Correlation of oscillometric measurements was similar for nonobese and obese patients. CONCLUSIONS: In this first ever study of simultaneous BP measurement by oscillometric vs. intra-arterial in obese and nonobese children, correlation is below accepted norms. The correlation of oscillometric cuff measurements is not affected by habitus in children. There is less correlation between oscillometric measurements and intra-arterial measurements during hypertension or hypotension. Healthcare providers should be aware of the limitations of oscillometric measurements.

18-Fluorine-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in the Evaluation of the Great Masquerader Melioidosis: A Case Series.

Melioidosis is an emerging infectious disease in India. The disease has a crippling effect on the patient owing to its widespread dissemination and complications post bacteremia. The role of 18-fluorine-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is becoming increasingly important in terms of documenting the extent of disease and response to treatment. Herein, we present cases of two patients who were referred for a whole-body 18F-FDG PET-CT scan with a history of long-standing fever that went undiagnosed. 18F-FDG PET-CT scan was performed to evaluate pyrexia of unknown origin. A conclusion was reached after blood culture which showed the growth of Burkholderia pseudomallei - which is considered to be the cause of this rare but debilitating disease.

Cherubism: A Rare Fibro-Osseous Disorder Characterized and Diagnosed by one Stop Imaging with Technetium-99m Methylene Diphosphonate Bone Scintigraphy Integrated with Single-Photon Emission Computed Tomography-Computed Tomography.

Cherubism, a rare hereditary fibro-osseous lesion characterized by painless expansion of jaws, starts early in life manifesting itself fully in the second decade of life and is almost regressed in the third decade. Here, we report a sporadic case of Cherubism with clinico-radiological and scintigraphic presentation of its classical features for its disease rarity and single-photon emission computed tomography/computed tomography findings with review the literature.