Sex difference in the associations of socioeconomic status, cognitive function and brain volume with dementia in old adults: Findings from the OASIS study.

Background: Sex differences in the association of cognitive function and imaging measures with dementia have not been fully investigated while sex-based investigation of dementia has been discussed. Understanding sex differences in the dementia-related socioeconomic, cognitive, and imaging measurements is important for uncovering sex-related pathways to dementia and facilitating early diagnosis, family planning, and cost control. Methods: We selected data from the Open Access Series of Imaging Studies with longitudinal measurements of brain volumes on 150 individuals aged 60 to 96 years. Dementia status was determined using the Clinical Dementia Rating (CDR) scale, and Alzheimer's disease was diagnosed as a CDR of ≥ 0.5. Generalized estimating equation models were used to estimate the associations of socioeconomic, cognitive and imaging factors with dementia in men and women. Results: Lower education affected dementia more in women than in men. Age, education, Mini-Mental State Examination (MMSE), and normalized whole-brain volume (nWBV) were associated with dementia in women whereas only MMSE and nWBV were associated with dementia in men. Lower socioeconomic status was associated with a reduced estimated total intracranial volume in men, but not in women. Ageing and lower MMSE scores were associated with reduced nWBV in both men and women. Conclusions: The association between education and prevalence of dementia differs in men and women. Women may have more risk factors for dementia than men.

Postdischarge Adverse Events Among Neonates Admitted to the Neonatal Intensive Care Unit.

OBJECTIVES: We aimed to determine the rate of postdischarge adverse events (AEs), classify the types of postdischarge AEs, and identify risk factors for postdischarge AEs among neonates admitted to the neonatal intensive care unit (NICU). STUDY DESIGN: This was a prospective cohort study of neonates admitted to the NICU from February 2017 through June 2019. We enrolled 170 neonates from a level 4 NICU who were being discharged home and whose parents can speak English and could be contacted after discharge. The main outcome of the study was postdischarge AEs based on structured telephone interviews, health record review, and adjudication by 2 blinded, trained physicians using a previously established methodology. RESULTS: Fourteen percent of 170 neonates admitted to the NICU experienced postdischarge AEs, with 48% being either preventable or ameliorable. Adverse drug events and procedural complications comprised most of the AEs (48%), but most of the preventable and ameliorable AEs were due to management, therapeutic, or diagnostic errors. Seventy-nine percent of neonates who suffered an AE experienced either a readmission to the hospital or an emergency department visit. Neonates admitted to a level 4 NICU from another NICU (level 1, 2, or 3) (adjusted odds ratio, 3.62; 95% confidence interval, 1.27-12.60; P = 0.01) and those 28 to 36 weeks (adjusted odds ratio, 11.38; 95% confidence interval, 1.67-127.98; P = 0.01) had a significantly higher risk of AEs at discharge. CONCLUSIONS: Neonates discharged from a level 4 NICU were at high risk for experiencing postdischarge AEs. The identification of AE types and risk factors can be used to guide efforts to develop interventions to improve neonatal patient safety during the postdischarge period.

Sagittal abdominal diameter and its socioeconomic correlates: perspective of sex differences.

BACKGROUND: Sagittal abdominal diameter (SAD) is an anthropometric index associated with visceral adiposity. It remains unclear whether SAD and its socio-economic correlates differ in women and men, which limits the epidemiological and clinical applications of the SAD measurement. The aims of this study are to examine the sex differences in SAD and its socio-economic correlates. METHODS: A complex stratified multistage clustered sampling design was used to select 6975 men and 7079 women aged 18 years or more from the National Health Nutrition and Examination Survey 2011-2016, representative of the US civilian non-institutionalized population. SAD was measured in accordance to the standard protocols using a two-arm abdominal caliper. The sex differences in SAD and its socio-economic correlates were evaluated by performing weighted independent t tests and weighted multiple regression. RESULTS: SAD was lower in women than in men in the entire sample, as well as in all the subgroups characterized by age, race, birth place, household income, and body mass index except for non-Hispanic blacks and those with household income < $20,000. Adjusted for other characteristics, age, birth place, household income, and body mass index were associated with SAD in both women and men. Black women were associated with higher SAD then white women (p < .0001), and Hispanic and Asian men were associated with lower SAD than white men (both p < .01). Women born in other countries were more likely to have lower SAD than women born in the US (p < .0001), and so were men (p = .0118). Both women and men with a household income of <$75,000 had higher SAD than those with an income of over $75,000. The associations of age, race, and household income with SAD differed in women and men. CONCLUSION: SAD is lower in women than in men, in the general population as well as in the most socio-economic subgroups. While socio-economic correlates of SAD are similar in women and men, the associations of age, race, and household income with SAD vary across sex.

Post-Discharge Adverse Events Among African American and Caucasian Patients of an Urban Community Hospital.

BACKGROUND: Patient safety during the post-discharge period is a major public health concern. Racial differences on incidence and risk factors associated with post-discharge adverse events (AEs) are understudied. The aim of the study was to examine the differences on the incidence of post-discharge AEs and the associated risk factors between African American and Caucasian patients. METHODS: This was a prospective cohort study of patients at risk for post-discharge AEs from December 2011 to October 2012. We included 589 patients who were African American or Caucasian and discharged home from an urban community hospital. The patients spoke English and could be contacted after discharge for evaluation. Two nurses performed 30-day post-discharge telephone interviews, and two physicians adjudicated health records to determine AEs using a previously established methodology. RESULTS: African American patients had a slightly higher incidence of post-discharge AEs than Caucasian patients (30.6 vs. 29.9%), although the difference did not show statistical significance. The multivariable logistic regression model indicated that post-discharge AEs were associated with timely follow-up and the number of secondary discharge diagnoses. In subgroup analyses of the risk factors in each racial group separately, only timely follow-up ambulatory visits were associated with post-discharge AEs. CONCLUSION: Post-discharge AEs were experienced by a large proportion of both African American and Caucasian patients, and there was no statistically significant difference in these proportions by race.

Interprofessional education during an autism session.

Interprofessional education (IPE) gained a strong foothold in the beginning of the twenty-first century as an effort to improve care to patients through enhanced teamwork. The aim of this study was to compare attitudes and experiences of the learners, which included graduate students, physicians in training, and practicing healthcare professionals, before and after an interprofessional clinical practice (IPCP) six-h autism didactic and experiential training session. The training session consisted of a 1-h lecture on Autism Spectrum Disorder (ASD), a 2-h behavior review meeting consisting of four different case study discussions among the learners, a 1-h lunch, a 1-h therapy session with children diagnosed with ASD, and a 1-h discussion among the learners. The IPCP learners (n = 63) completed a pre- and post-learning questionnaire of the Readiness for Interprofessional Learning Scale (RIPLS) and 12 Statements instruments and both showed an overall significant improvement in the learners interprofessional education after completing the training session. This study was able to show that students, professional trainees, and practicing professionals from different backgrounds led by an expert in the field can exchange ideas and role perceptions in an interprofessional didactic and experiential session, and develop improved attitudes toward IPCP. Moving forward, interprofessional education research needs to focus more on professional trainees and practicing professionals working together in combined didactic and experiential environments for children diagnosed with ASD.

Racial/ethnic disparity in the associations of smoking status with uncontrolled hypertension subtypes among hypertensive subjects.

BACKGROUND: Racial/ethnic differences in the associations of smoking with uncontrolled blood pressure (BP) and its subtypes (isolated uncontrolled systolic BP (SBP), uncontrolled systolic-diastolic BP, and isolated uncontrolled diastolic BP (DBP)) have not been investigated among diagnosed hypertensive subjects. METHODS: A sample of 7,586 hypertensive patients aged ≥18 years were selected from the National Health and Nutrition Examination Survey 1999-2010. Race/ethnicity was classified into Hispanic, non-Hispanic white, and non-Hispanic black. Smoking was categorized as never smoking, ex-smoking, and current smoking. Uncontrolled BP was determined as SBP≥140 or DBP≥90 mm Hg. Isolated uncontrolled SBP was defined as SBP≥140 and DBP<90 mm Hg, uncontrolled SDBP as SBP≥140 and DBP≥90 mm Hg, and isolated uncontrolled DBP as SBP<140 and DBP≥90 mm Hg. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of uncontrolled BP and its subtypes were calculated using weighted logistic regression models. RESULTS: The interaction effect of race and smoking was significant after adjustment for the full potential confounding covariates (Adjusted p = 0.0412). Compared to never smokers, current smokers were 29% less likely to have uncontrolled BP in non-Hispanic whites (OR = 0.71, 95% CI = 0.56-0.90), although the likelihood for uncontrolled BP is the same for smokers and never smokers in Hispanics and non-Hispanic blacks. Current smokers were 26% less likely than never smokers to have isolated uncontrolled SBP in non-Hispanic whites (OR = 0.74, 95% CI = 0.58-0.95). However, current smoking is associated with an increased likelihood of uncontrolled systolic-diastolic BP in non-Hispanic blacks, and current smokers in this group were 70% more likely to have uncontrolled systolic-diastolic BP than never smokers (OR = 1.70, 95% CI = 1.10-2.65). CONCLUSION: The associations between current smoking and uncontrolled BP differed over race/ethnicity. Health practitioners may need to be especially vigilant with non-Hispanic black smokers with diagnosed hypertension.

The association of post-discharge adverse events with timely follow-up visits after hospital discharge.

OBJECTIVE: There has been little research to examine the association of post-discharge adverse events (AEs) with timely follow-up visits after hospital discharge. We aimed to examine whether having a timely follow-up outpatient visit would reduce the risk for post-discharge AEs. METHODS: This was a methods study of patients at risk for post-discharge AEs from December 2011 through October 2012. Five hundred and forty-five patients who were under the care of hospitalist physicians and were discharged home from a community hospital, spoke English, and could be contacted after discharge were evaluated. The aim of the study was to examine the association of post-discharge AEs with timely follow-up visits after hospital discharge based on structured telephone interviews, health record review, and adjudication by two blinded, trained physicians using a previously established methodology. RESULTS: We observed a higher incidence of AEs with patients that had their first follow-up visit within 7 days after hospital discharge (33.5% vs. 23.0%, p = 0.007). This effect was attenuated somewhat but remained significant when adjusted for several patient factors (adjusted OR 1.33, 95% confidence interval 1.16-2.71). CONCLUSION: This observational study paradoxically showed an increase in post-discharge AEs with early follow-up, likely a result of confounding by indication and/or information bias that could not be completely adjusted for. This study illustrates the potential hazards with conducting observational studies to determine the efficacy of various transitional care interventions, such as early follow-up, where risk for confounding by indication is high.

Post-Discharge Adverse Events Among Urban and Rural Patients of an Urban Community Hospital: A Prospective Cohort Study.

BACKGROUND: There has been little research to examine post-discharge adverse events (AEs) in rural patients discharged from community hospitals. OBJECTIVE: We aimed to determine the rate of post-discharge AEs, classify the types of post-discharge AEs, and identify risk factors for post-discharge AEs in urban and rural patients. DESIGN: This was a prospective cohort study of patients at risk for post-discharge adverse events from December 2011 through October 2012. PATIENTS: Six hundred and eighty-four patients who were under the care of hospitalist physicians and were being discharged home, spoke English, and could be contacted after discharge, were admitted to the medical service. Patients were stratified as urban/rural using zip code of residence. Rural patients were oversampled to ensure equal enrollment of urban and rural patients. MAIN MEASURES: The main outcome of the study was post-discharge AEs based on structured telephone interviews, health record review, and adjudication by two blinded, trained physicians using a previously established methodology. RESULTS: Over 28% of 684 patients experienced post-discharge AEs, most of which were either preventable or ameliorable. There was no difference in the incidence of post-discharge AEs in urban versus rural patients (ARR 1.04 95% CI 0.82-1.32 ), but post-discharge AEs were associated with hypertension, type 2 diabetes mellitus, and number of secondary discharge diagnoses only in urban patients. CONCLUSIONS: Post-discharge AEs were common in both urban and rural patients and many were preventable or ameliorable. Potentially different risk factors for AEs in urban versus rural patients suggests the need for further research into the underlying causes. Different interventions may be required in urban versus rural patients to improve patient safety during transitions in care.

Prevalence and changes of untreated isolated systolic hypertension among non-Hispanic black adults in the United States.

Isolated systolic hypertension (ISH) is a growing health concern in the United States (US) black population. The stratified prevalence of untreated ISH has not been fully investigated in non-Hispanic blacks. Cross-sectional data on 4625 non-Hispanic blacks aged ⩾18 years were collected from the National Health and Nutrition Examination Survey 1999-2010, representing a probability sample of the US civilian noninstitutionalized black population. The 6-year prevalence of ISH and 95% confidence intervals (CIs) were estimated by conducting weighted frequency and logistic procedures. The prevalence of untreated ISH was 11.2% among non-Hispanic black adults in 1999-2010. Individuals who received lower education (high school or below) had higher prevalence of untreated ISH than those with higher education (12.8% (95% CI: 11.3-14.2%) vs. 9.0% (95% CI: 7.5-10.6%)). The prevalence of untreated ISH was higher in young men than in young women (4.3% (95% CI: 3.3-5.4%) vs. 1.8% (95% CI: 0.9-2.7%)), and higher in middle-aged adults with lower education than in middle-aged adults with higher education (14.1% (95% CI: 11.4-16.7%) vs. 7.7% (95% CI: 5.5-9.8%)). Compared with 1999-2004, the prevalence of untreated ISH in 2005-2010 decreased for old individuals (27.7% vs. 40.8%), old men (24.4% vs. 40.0%) and old individuals who received higher education (21.4% vs. 40.7%). Untreated ISH is more prevalent in old blacks, and significant reduction of the prevalence in this group suggests that public health interventions, lifestyle modifications or health awareness are in the right direction.

Microalbuminuria, macroalbuminuria and uncontrolled blood pressure among diagnosed hypertensive patients: the aspect of racial disparity in the NHANES study.

Accumulating evidence reveals that albuminuria may exacerbate uncontrolled blood pressure (BP) in hypertensive patients. However, racial differences in the associations of albuminuria with uncontrolled BP among diagnosed hypertensives have not been evaluated. A total of 6147 diagnosed hypertensive subjects aged ≥ 18 years were collected from the National Health and Nutrition Examination Survey 1999-2008 with stratified multistage sampling designs. Odds ratios (ORs), relative ORs and 95% confidence intervals (CIs) in uncontrolled BP, and the different effects of microalbuminuria and macroalbuminuria on continuous BP were estimated using weighted logistic models and linear regression models. Hypertensive subjects with microalbuminuria and macroalbuminuria were more likely to have uncontrolled BP and higher average systolic BP (SBP) in all individual racial groups. Microalbuminuria was associated with isolated uncontrolled SBP in non-Hispanic blacks and whites, and macroalbuminuria was associated with isolated uncontrolled SBP and diastolic BP (DBP) and high average DBP only in non-Hispanic blacks. Compared with non-Hispanic whites, non-Hispanic blacks and Mexicans had lower associations of microalbuminuria with uncontrolled BP (relative OR = 0.68, 95% CI = 0.48-0.97 for blacks vs whites; relative OR = 0.62, 95% CI = 0.42-0.93 for Mexicans vs. whites) and isolated uncontrolled SBP (relative OR = 0.62, 95% CI = 0.43-0.90 for blacks vs. whites; relative OR = 0.45, 95% CI = 0.29-0.71 for Mexicans vs. whites). The association of microalbuminuria with uncontrolled BP was lower in non-Hispanic blacks and Mexicans than in non-Hispanic whites. Health providers need to improve care for mildly elevated albumin excretion rates in non-Hispanic white hypertensive patients while maintaining the quality of care in non-Hispanic blacks and Mexicans.

Racial disparities in cardiovascular risk factors among diagnosed hypertensive subjects.

Racial disparities in cardiovascular disease (CVD) have become a matter of national concern. We investigated racial disparities and trends in glycosylated hemoglobin, high-density lipoprotein (HDL), C-reactive protein, plasma homocysteine, albuminuria, and other risk factors among 4758 diagnosed hypertensive subjects age 18 years or older from the National Health and Nutrition Examination Survey, 1999-2006. Compared with non-Hispanic whites, Hispanics, and non-Hispanic blacks were more likely to have uncontrolled blood pressure (BP) (Hispanics odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.21-2.07; blacks OR: 1.42, 95% CI: 0.21-1.67), elevated glycosylated hemoglobin (Hispanics OR: 2.70, 95% CI: 1.89-3.87; blacks OR: 2.17, 95% CI: 1.70-2.77), albuminuria (Hispanics OR: 2.36, 95% CI: 1.71-3.27; blacks OR: 1.80, 95% CI: 1.47-2.20), and less likely to have central obesity (Hispanics OR: 0.68, 95% CI: 0.51-0.91; blacks OR: 0.70, 95% CI: 0.58-0.84). Blacks had lower risks of elevated serum cholesterol (OR: 0.81, 95% CI: 0.67-0.98) and low HDL (OR: 0.76, 95% CI: 0.61-0.94) than whites. The risk of high serum homocysteine was lower in Hispanics and higher in blacks compared with whites (Hispanics OR: 0.64, 95% CI: 0.46-0.90; blacks OR: 1.36, 95% CI: 1.14-1.63). These results highlight the need for targeted interventions to aggressively treat uncontrolled BP, elevated glycosylated hemoglobin in Hispanic and black hypertensive subjects, and high serum homocysteine in blacks, to reduce disparities in CVD risk factors and CVD-associated morbidity and mortality.

Validity of selected AHRQ patient safety indicators based on VA National Surgical Quality Improvement Program data.

OBJECTIVES: To examine the criterion validity of the Agency for Health Care Research and Quality (AHRQ) Patient Safety Indicators (PSIs) using clinical data from the Veterans Health Administration (VA) National Surgical Quality Improvement Program (NSQIP). DATA SOURCES: Fifty five thousand seven hundred and fifty two matched hospitalizations from 2001 VA inpatient surgical discharge data and NSQIP chart-abstracted data. STUDY DESIGN: We examined the sensitivities, specificities, positive predictive values (PPVs), and positive likelihood ratios of five surgical PSIs that corresponded to NSQIP adverse events. We created and tested alternative definitions of each PSI. DATA COLLECTION: FY01 inpatient discharge data were merged with 2001 NSQIP data abstracted from medical records for major noncardiac surgeries. PRINCIPAL FINDINGS: Sensitivities were 19-56 percent for original PSI definitions; and 37-63 percent using alternative PSI definitions. PPVs were 22-74 percent and did not improve with modifications. Positive likelihood ratios were 65-524 using original definitions, and 64-744 using alternative definitions. "Postoperative respiratory failure" and "postoperative wound dehiscence" exhibited significant increases in sensitivity after modifications. CONCLUSIONS: PSI sensitivities and PPVs were moderate. For three of the five PSIs, AHRQ has incorporated our alternative, higher sensitivity definitions into current PSI algorithms. Further validation should be considered before most of the PSIs evaluated herein are used to publicly compare or reward hospital performance.

Addressing postdischarge adverse events: a neglected area.

BACKGROUND: Postdischarge safety is an area that has long been neglected. Recent studies from the United States and Canada found that about one in five patients discharged home from the general internal medicine services of major teaching hospitals suffered an adverse event. METHODS: MEDLINE, Cochrane databases, and reference lists of retrieved articles were used in a literature search of articles published from 1966 through May 2007. FINDINGS: Patient safety research has focused mostly on adverse events in hospitalized patients. Although some data are available about the ambulatory setting, even fewer studies have been done focusing on adverse events following hospital discharge. Only two studies conducted in North America have examined the incidence rate of all types of postdischarge adverse events. On the basis of the available evidence, key areas of opportunity to improve postdischarge care are as follows: (1) improving transitional care, (2) improving information transfer through strategic use of electronic health records, (3) medication reconciliation, (4) improving follow-up of test results, and (5) using screening methods to identify patients with adverse events. DISCUSSION: Limited evidence suggests that about one in five internal medicine patients suffers an adverse event after discharge from a North American hospital. The risk of postdischarge adverse events should be recognized by patient safety experts as an important area of concern.

Evaluating the patient safety indicators: how well do they perform on Veterans Health Administration data?

BACKGROUND: The Patient Safety Indicators (PSIs), an administrative data-based tool developed by the Agency for Healthcare Research and Quality, are increasingly being used to screen for potential in-hospital patient safety problems. Although the Veterans Health Administration (VA) is a national leader in patient safety, accurate information on the epidemiology of patient safety events in the VA is still unavailable. OBJECTIVES: Our objectives were to: (1) apply the AHRQ PSI software to VA administrative data to identify potential instances of compromised patient safety; (2) determine occurrence rates of PSI events in the VA; and (3) examine the construct validity of the PSIs. METHODS: We examined differences between observed and risk-adjusted PSI rates in the VA, compared VA and non-VA PSI rates, and investigated the construct validity of the PSIs by examining correlations of the PSIs with other outcomes of VA hospitalizations. RESULTS: We identified 11,411 PSI events in the VA nationwide in FY'01. Observed PSI rates per 1000 discharges ranged from 0.007 for "transfusion reaction" to 155.5 for "failure to rescue." There were significant, although small, differences between VA and non-VA risk-adjusted PSI rates. Hospitalizations with PSI events had longer lengths of stay, higher mortality, and higher costs than those without PSI events. CONCLUSIONS: Our results suggest that the PSIs may be useful as a patient safety screening tool in the VA. Our PSI rates were consistent with the national incidence of low rates; however, differences between VA and non-VA rates suggest that inadequate case-mix adjustment may be contributing to these findings.