Knowledge and perceived competence with sexual and gender minority healthcare topics among medical students and medical school faculty.

BACKGROUND: Despite changes in social attitudes in the United States over the last decade, sexual and gender minority (SGM) individuals continue to face significant health disparities, driven partly by disproportionately higher rates of self-reported discrimination and harassment when seeking healthcare. Historically, physicians have received little to no required training on how to provide sensitive, competent care to SGM patients, and continue to demonstrate poor competency with SGM topics despite calls for increased education and published guidelines to promote competency. The present study aimed to investigate competency with SGM topics among both faculty and medical students at one institution. METHODS: The authors distributed an anonymous online survey (2020-2021) to medical students and student-facing faculty at one allopathic medical school in the United States. The objective of the study was to evaluate knowledge, clinical skills, and self-reported competence with SGM topics. RESULTS: Of survey respondents, 223 medical students and 111 faculty were included in final analysis. On average, medical students were significantly more likely to answer General Knowledge questions correctly (97.2%) compared to faculty (89.9%). There were no significant differences in responses to Clinical Knowledge questions between medical students and faculty. however medical students were significantly more likely to report competence with eliciting a thorough sexual history, and faculty were significantly more likely to report receiving adequate clinical training and supervision to work with lesbian, gay, and bisexual patients. CONCLUSIONS: Medical students demonstrated significantly higher general knowledge about SGM topics compared to faculty. Medical students and faculty demonstrated similarly low average clinical knowledge, with percent correct 65.6% for students and 62.7% for faculty. Despite significant differences in general knowledge and low clinical knowledge, medical students and faculty self-reported similar levels of competence with these topics. This indicates insufficient curricular preparation to achieve the AAMC competencies necessary to care for SGM patients.

Time to Diagnosis of Autism Spectrum Disorders in Children with Coexisting Developmental Behavioral Disorders.

OBJECTIVE: Our study evaluates whether having an alternate developmental behavioral disorder (DBDs) diagnosis before diagnosis of autism spectrum disorders (ASD) is associated with delays in diagnosis in a nationally representative sample. METHODS: Data were obtained from the 2011 National Survey of Pathways to Diagnosis and Services, a survey of children aged 6 to 17 years with ASD, developmental delay, or intellectual disability. A total of 1049 children met inclusion criteria for this study. Of these, 799 children were identified as "late" diagnosis if >12 months elapsed between the age parents reported concerns to a provider and age of ASD diagnosis and 250 as "timely" diagnosis if the gap was ≤12 months. Univariate and multivariate logistic regressions were used to look for association between having an alternate DBDs diagnosed before ASD and "timely" versus "late" ASD diagnosis. RESULTS: The mean time elapsed between the age parents reported concerns to a provider and age of ASD diagnosis was 51 months for children with an alternate DBDs diagnosis before receiving ASD diagnosis and 29 months for those diagnosed with alternate DBDs concurrently with ASD. Having alternate DBDs diagnosis before diagnosis with ASD was associated with "late" ASD diagnosis as follows: developmental delay (adjusted odds ratio [aOR,] 3.46; 95% confidence interval [CI], 1.86-6.42; p < 0.001), intellectual disability (aOR, 9.75; 95% CI, 3.0-31.60; p = 0.04), attention-deficit disorder (aOR, 11.07; 95% CI, 3.43-35.71; p < 0.001), depression (aOR, 8.05; 95% CI, 1.07-60.03; p = 0.0495), and behavioral conduct disorder (aOR, 9.9; 95% CI, 3.55-27.62; p < 0.001). CONCLUSION: These findings highlight the importance of research to improve the early diagnosis of ASD even in the presence of coexisting developmental behavioral disorders.

Predictors of Inpatient Morbidity and Mortality After 1- and 2-Level Anterior Cervical Diskectomy and Fusion Based on the National Inpatient Sample Database From 2006 Through 2010.

Spine procedures, including anterior cervical diskectomy and fusion (ACDF), are more commonly being performed in an outpatient setting to maximize value. Early complications after ACDF are rare but can have devastating consequences. The authors sought to determine risk factors for inpatient complications after 1-and 2-level ACDF by performing a retrospective review of the National Inpatient Sample (NIS) administrative database from 2006 through 2010. A total of 78,771 patients were identified. Multivariate logistic regression analysis was performed to identify preoperative risk factors for medical and surgical complications, including mortality, airway compromise, new neurologic deficit, and surgical-site infection. Inpatient mortality and overall complication rates were 0.074% and 3.73%, respectively. The risk of any medical complication was 3.13%. Airway compromise, neurologic deficit, and surgical-site infection occurred in 0.75%, 0.05%, and 0.04% of cases, respectively. Chronic kidney disease was the strongest predictor of mortality, with an odds ratio (OR) of 11.14 (P<.001). Airway complication was associated with age older than 65 years, male sex, myelopathy, diabetes mellitus, anemia, bleeding disorder, chronic obstructive pulmonary disease, obesity, and obstructive sleep apnea (P<.05). Preoperative diagnosis of myelopathy was most strongly associated with an increased rate of neurologic complication (OR, 6.67; P<.001). Anemia was associated with a significantly increased rate of surgical-site infection, with an OR of 14.34 (P<.001). Age older than 65 years; certain medical comorbidities, particularly kidney disease and anemia; and a preoperative diagnosis of myelopathy are associated with increased risk of early complication following ACDF surgery. Surgeons should consider these risk factors when deciding to perform ACDF surgery in an outpatient setting. [Orthopedics. 2021;44(5):e675-e681.].

Wearable Activity Monitor Use Is Associated With the Aerobic Physical Activity Guidelines and Walking Among Older Adults.

PURPOSE: To examine wearable activity monitor (WAM) use and its association with meeting the 2008 aerobic Physical Activity Guidelines (PAG) and walking among older adults. DESIGN: Cross-sectional. SETTING: FallStyles 2015 national consumer panel survey. SAMPLE: 1,317 U.S. adults aged ≥ 60 years. MEASURES: Self-reported WAM use, meeting aerobic PAG, and walking. Covariates included age, sex, race/ethnicity, education level, marital status, annual household income, and geographic region of the country. ANALYSIS: Chi-square tests to examine associations between WAM use and respondent demographic characteristics. Logistic regressions to explore associations between WAM use and meeting aerobic PAG and walking adjusted for demographics (e.g., education, income). RESULTS: Among older adults, 8.0% were current WAM users and 11.3% were past WAM users. Current WAM use was most prevalent among those aged 65-74 (16.6%), females (9.4%), college graduates (13.8%), and those with incomes $75,000-$99,999 (14.8%). Current WAM users were more likely than never WAM users to report meeting aerobic PAG (OR: 3.98; 95% CI: 2.07, 7.66) and walking (OR: 3.90; 95% CI: 1.57, 9.69). Past and never WAM use were not associated with meeting aerobic PAG or walking. CONCLUSION: We found current WAM use is associated with meeting the aerobic PAG and walking among older adults. Further longitudinal research is needed to understand whether WAM could promote increased PA among older adults.

Healthy-Weight Kindergarten Children with Autism Spectrum Disorder May Become Overweight and Obese during the First Few Years of Elementary School.

Analysis of a population-based, nationally-representative longitudinal sample from the Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 identified an increase in healthy-weight children with autism spectrum disorder becoming overweight and obese between first and second grade, thus identifying a critical period for early prevention and treatment.

Factors Associated with Resilience in Families of Children with Autism Spectrum Disorder.

OBJECTIVES: Families of children with autism spectrum disorder (ASD) report high levels of stress and poor psychological functioning. Resilience serves to buffer these challenges. Little is known about the factors associated with resilience in these families. METHODS: Data from the National Survey of Children's Health (NSCH) 2016 were used to investigate independent child, parent, and health care factors associated with resilience in families of children with ASD. We used the NSCH's family resilience composite derived from 4 survey questions focused on (1) communication, (2) working together to solve problems, (3) drawing on strengths, and (4) staying hopeful during difficult times. We defined family resilience as high or low based on the number of questions answered "all of the time" or "most of the time" versus "some of the time" or "none," respectively. Using survey weights, univariate and multivariate logistic regression analyses identified associations of child, parent, and health care factors with low family resilience. RESULTS: We analyzed data representing 1151 children with ASD. Low resilience was reported in 32% of families. Low family resilience was significantly associated with parent factors such as not having someone to turn to for support, cutting work hours, and feeling "child hard to care for"; child ASD-related factors such as moderate ASD severity; and health care factors such as lack of satisfaction in communications with providers. CONCLUSION: The findings highlight specific vulnerabilities in families of children with ASD that are associated with low family resilience. Intervention approaches that have the ability to improve overall family resilience should be carefully considered.

High School Athletic Directors Report Poor Compliance With Concussion Reporting and Medical Clearance in Massachusetts.

PURPOSE: To assess statewide prevalence of medical access, concussion reporting, and concussion clearance rates of high school athletic departments in Massachusetts after the implementation of state-wide concussion legislation. METHODS: A random sample of 50 athletic directors (ADs) from Massachusetts high schools with an enrollment of >150 students was selected. A 10-minute electronic survey about access to athletic trainers and physicians, and concussion reporting and clearance practices was administered. Responses were anonymous. RESULTS: The response rate was 80% (n = 40). In total, 90% of respondents were male. Median age and experience of respondents was 52 years old and 10 years, respectively. The median school size was 637 students, represented from all Massachusetts geographic athletic districts. ADs disclosed that on average, 12% (95% confidence interval 7%-20%) of concussions go unreported at their schools. In total, 16% of respondents reported that at least 1 in 4 of concussed athletes at their school returned to play without appropriate medical clearance, and 5% of ADs reported that not all of their coaches had undergone any form of concussion training. Overall, 55% of high schools do not have access to a full-time athletic trainer and 50% do not have a team physician; 20% have affiliations with an orthopaedic surgeon and 8% with a neurologist. CONCLUSIONS: Despite new regulations in Massachusetts, high school ADs report concussion reporting and clearance that are less than 100%. Less than one half of all Massachusetts high schools report access to a full-time athletic trainer or formal relationship with a school physician. CLINICAL RELEVANCE: Investigating compliance with Massachusetts school athletics safety regulations could help identify a need for reform of policies designed to help schools keep student athletes safer in situations where a concussion may have occurred.

An Evaluation of Risk Factors for Patient "No Shows" at an Urban Joint Arthroplasty Clinic.

BACKGROUND: Patient physical health and provider financial health are both affected when patients are unable to attend scheduled clinic appointments. The purpose of this study is to identify risk factors for patients missing appointments to better target interventions to improve appointment attendance. METHODS: We reviewed scheduled arthroplasty appointments at an urban academic orthopaedic clinic over a 3-year period. We collected information including sex, race, distance to clinic, language, insurance, median income of home zip code, appointment day, time, precipitation, and temperature. Mixed-level multiple logistic regression was used to model the odds of missing appointments in Stata v14. RESULTS: Overall, 8,185 visits for 3,081 unique patients were reviewed and 90.7% of appointments were attended. After controlling for time and day of appointment, distance from the clinic, and the primary language spoken, patients with government insurance were two times as likely to miss an appointment compared with privately insured patients. White patients were two times as likely to attend scheduled appointments compared with black/Hispanic patients. Younger patients (<50 years) and older patients (>73 years) were 2.7 times and 1.8 times, respectively, more likely to miss appointments compared with those aged between 65 and 72 years. Appointments on the most temperate days were more likely to be missed, and those on the coldest days (14°F to 36°F) and warmest days (69°F to 89°F) were less likely to be missed. DISCUSSION: Appointment no shows are associated with sociodemographic and environmental factors. This information is valuable to help better delineate novel ways to better serve these patient populations.

Hospital Stays and Medical Expenses Increase Nationwide Among Patients With Septic Arthritis of the Shoulder Who Inject Drugs.

The authors determined the proportion of patients nationwide with septic arthritis of the shoulder who inject drugs, evaluated differences in hospitalization outcomes and charges between patients with and without injection drug use (IDU), and quantified demographic trends among patients with IDU from 2000 to 2013. Nationally representative data of patients with a principal discharge diagnosis of shoulder septic arthritis were obtained from the Nationwide Inpatient Sample 2000-2013. Using published algorithms, the authors classified septic arthritis of the shoulder as related or unrelated to IDU. They compared length of stay, leaving against medical advice, number of procedures, and mortality rates between the 2 groups, using regression models to control for age, sex, and race. Fifteen percent (95% confidence interval [CI], 13.6%-16.5%) of septic arthritis cases were associated with IDU. From 2000 to 2013, shoulder septic arthritis associated with IDU increased 4-fold. After controlling for age, sex, and race, individuals who inject drugs stayed in the hospital for 3.7 more days (95% CI, 2.4-5.0), incurred an average of $13,250 more charges for medical care (95% CI, $2635-$23,866), and were 5.54 times more likely (95% CI, 3.22-9.55) to leave against medical advice than those without IDU. From 2000 to 2013, there was an increase in the proportion of patients with IDU-related septic arthritis of the shoulder between 35 and 54 years old and 55 and 64 years old, and an increase in the proportion who were white. Injection drug use-related shoulder septic arthritis is linked to suboptimal inpatient outcomes and greater resource use. [Orthopedics. 2020;43(4):e270-e277.].

Factors Determining Home Versus Rehabilitation Discharge Following Primary Total Joint Arthroplasty for Patients Who Live Alone.

Patients who are discharged home following primary hip and knee arthroplasty have lower associated costs and better outcomes than patients who are discharged to skilled nursing facilities (SNFs). However, patients who live alone are more likely to be discharged to an SNF. We studied the factors that determine the discharge destination for patients who live alone after total joint arthroplasty (TJA) at an urban tertiary care academic hospital between April 2016 and April 2017. We identified 127 patients who lived alone: 79 (62.2%) were sent home, and 48 (37.8%) were sent to an SNF after surgery. Patients who went home versus to an SNF differed in age, employment status, exercise/active status, patient expectation of discharge to an SNF, ASA score, and the length of stay. After controlling for expectations of discharge to an SNF (OR: 28.98), patients who were younger (OR: 0.03) and employed (OR: 6.91) were more likely to be discharged home. In conclusion, the expectation of discharge location was the strongest predictor of discharge to an SNF even after controlling for age and employment. Future research should include a multi-hospital approach to strengthen the validity of our findings and investigate additional factors that impact discharge destination.

Injection Drug Use in Patients With Spinal Epidural Abscess: Nationwide Data, 2000 to 2013.

STUDY DESIGN: Retrospective review of the Healthcare Cost and Utilization Project National Inpatient Sample, 2000 to 2013. OBJECTIVE: To determine the proportion of spinal epidural abscess (SEA) cases that were related to injection drug use (IDU) and to compare length of stay, leaving against medical advice, paralysis, cauda equina syndrome, radiculitis, and in-hospital mortality between SEA cases with and without IDU. SUMMARY OF BACKGROUND DATA: The US opioid epidemic impacts all aspects of healthcare, including spinal surgeons. Although injection drug use (IDU) is a risk factor for spinal epidural abscess (SEA), IDU among SEA patients and its effect on clinical outcomes is not well understood. METHODS: Cases aged 15 to 64 with principal diagnosis of SEA were classified as IDU-related (IDU-SEA) or non-IDU-related (non-IDU-SEA) using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for illicit drug use and hepatitis C. We determined the proportion of SEA patients with IDU and compared length of stay, leaving against medical advice, paralysis, cauda equina syndrome, radiculitis, and in-hospital mortality between IDU-SEA and non-IDU-SEA patients. RESULTS: From 2000 to 2013, there were 20,425 admissions with a principal diagnosis of SEA (95% confidence interval (CI), 19,281-21,568); 19.1% were associated with IDU (95% CI, 17.7%-20.5%). The proportion of white IDU-SEA cases increased by 2.4 percentage points annually (95% CI, 1.4-3.4). After adjusting for age, sex, and race, IDU-SEA patients stayed a mean of 6.7 more days in the hospital (95% CI, 5.1-8.2) and were 4.8 times more likely to leave against medical advice (95% CI, 2.9-8.0). Mean hospital charges for IDU-SEA patients were $31,603 higher (95% CI: $20,721-$42,485). Patients with IDU-SEA were less likely to have cauda equina syndrome (adjusted odds ratio, 0.48, 95% CI, 0.26-0.87). CONCLUSION: IDU-SEA patients stay in the hospital longer and more often leave against medical advice. Providers and hospitals may benefit from exploring how to better facilitate completion of inpatient treatment and achieve superior outcomes. LEVEL OF EVIDENCE: 3.

Comparing Reported Complication Rates in Shoulder Arthroplasty Between 2 Large Databases.

Large databases are commonly used to analyze surgical outcomes. Recent studies have suggested that there are differences in complication rates between databases across certain procedures, but the reasons for these differences are not fully understood. The goal of this study was to compare complications of shoulder arthroplasty across databases as well as to interpret the causes of any differences. The authors compared complication rates for shoulder arthroplasty as reported by the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) and the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2006 to 2010. The authors then restricted NIS data solely to hospitals that also contributed to NSQIP to provide a more direct comparison of the patient populations. The authors identified 48,287 discharges reported in NIS and 1679 discharges reported in NSQIP for patients who underwent shoulder arthroplasty. The complication rate for shoulder arthroplasty was significantly higher in the NIS population (12.6%; 95% confidence interval, 12.0%-13.2%) than in the NSQIP population (5.60%; 95% confidence interval, 4.59%-6.81%). When NIS data were restricted solely to hospitals that also participated in NSQIP, the rate of complications remained higher, at 13.4% (95% confidence interval, 11.2%-15.8%), and the rate increased relative to the nonrestricted data. The databases compared in this study had statistically significant differences in reported complication rates for shoulder arthroplasty. This difference persisted when NIS data were restricted to hospitals that also participated in NSQIP, suggesting that differences in database design contribute to important differences in data. Orthopedic surgeons and administrators must use caution when using complication rates derived from large database studies. [Orthopedics. 2020;43(2):113-118.].

Treatment Outcomes in Septic Arthritis of the Foot and Ankle in People Who Inject Drugs.

BACKGROUND: Although injection drug use (IDU) is a known risk factor for septic arthritis (SA) of the foot and ankle (F&A), disease and hospitalization outcomes are poorly characterized. We evaluated national trends, demographic characteristics, and hospitalization outcomes of SA of the F&A in people who inject drugs vs those who do not. METHODS: Using the Nationwide Inpatient Sample, we identified all patients aged 15-64 with a principal discharge diagnosis of SA of the F&A from 2000 to 2013 and evaluated if they were related or unrelated to IDU. We assessed differences in demographic characteristics and in-hospital outcomes in these groups. RESULTS: From 2000 to 2013, there were an estimated 14,198 hospitalizations for SA of the F&A in the United States, and 11% were associated with IDU (SA-IDU). Compared to SA unrelated to IDU, people with SA-IDU were significantly more likely to be younger, black, and have Medicaid or no insurance. People with SA-IDU were significantly more likely to leave against medical advice (9.7% vs 1.4%, P < .001), have a longer length of stay (9.2 vs 6.8 days, P < .001), and incur increased hospital charges ($58 628 vs $38 876, P = .005). People with SA-IDU were significantly less likely to receive an arthroscopy (1.5% vs 6.5%, P < .001) or arthrotomy (2.2% vs 11.0%, P < .001) of the foot. CONCLUSION: People with SA-IDU of the F&A had suboptimal hospitalization outcomes with greater costs. Recognizing risk factors and proactively addressing potential complications of substance use disorder in the hospital should be prioritized by the orthopedic community. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Risk Factors for Tibial Component Oversizing in Total Knee Arthroplasty among African Americans.

Incidences and risk factors for tibial component oversizing in total knee arthroplasty (TKA) have been well described, predominantly in Caucasian samples. Component oversizing has been linked to variations in proximal tibial shape and morphology, which has been found to be objectively different in African Americans compared with Caucasians. These anthropometric differences may affect the conformity of modern TKA systems to the anatomy of African Americans undergoing TKA. We sought to investigate the incidence and risk factors for tibial baseplate oversizing in an exclusively African American population undergoing TKA with a symmetric tibial baseplate. We reviewed the records of self-reported African American patients who had undergone a primary TKA at a single academic institution between 2005 and 2016. The primary outcome was incidence of tibial baseplate oversizing in the coronal and sagittal planes as determined by a single set of appropriately rotated postoperative orthogonal radiographs. Logistic regression models identified trends in oversizing within the population based on age, sex, body mass index (BMI), and TKA model. Among all 525 knees being evaluated, the occurrences of medial and lateral overhang were 14.2 and 15.2%, respectively. Increase in age was associated with lower risk of medial tibial overhang (odds ratio = 0.97 for each 1-year increase in age). Simple linear regression models described a linear relationship between BMI and overhang, with every one-unit increase in BMI, medial tibial overhang is 0.031 mm higher and posterior tibial overhang is 0.062 mm higher. Mediolateral oversizing was approximately twice more likely in females than males. Among TKA models used, the Stryker Triathlon had the least risk for mediolateral oversizing and the P.F.C. SIGMA demonstrated the least propensity for anteroposterior oversizing. To conclude, incidence of mediolateral tibial oversizing in this population was common. Previously identified variables affecting proximal tibial morphology, including age, body morphotype, and gender, may be equally applicable to the conformity of tibial baseplates in this population. Surgeons must pay particular attention to avoid mediolateral tibial oversizing in this population, especially in obese and older patients.

Comparing Inpatient Complication Rates between Octogenarians and Nonagenarians Following Primary and Revision Total Hip Arthroplasty in a Nationally Representative Sample 2010-2014.

We compared inpatient postoperative complication rates between octogenarians and nonagenarians undergoing primary and revision total hip arthroplasty (THA). We used inpatient admission data from 2010-2014 from the Nationwide Inpatient Sample (NIS). We compared the rates at which nonagenarians and octogenarians developed each complication in the inpatient setting following both primary THA (PTHA) and revision THA (RTHA). A total of 40,944 inpatient admissions were included in our study which extrapolates to a national estimate of 199,793 patients. A total of 185,799 (93%) were octogenarians and 13,994 (7%) were nonagenarians. PTHA was performed on 155,669 (78%) and RTHA was performed on 44,124 (22%) of the patients. Nonagenarians undergoing PTHA required transfusions significantly more frequently (33.13% v. 24.0%, p < 0.001) and developed urinary tract infection (5.14% v. 3.92%, p = 0.012) and acute kidney injury (5.50% v. 3.57%, p < 0.001) significantly more frequently than octogenarians. Nonagenarians undergoing RTHA required transfusions significantly more frequently (51.43% v. 41.46%, p < 0.001) and developed urinary tract infection (19.66% v. 11.73%, p < 0.001), acute kidney injury (13.8% v. 9.66%, p < 0.001), pulmonary embolism (1.24% v. 0.67%, p = 0.031), postoperative infection (1.89% v. 1.11%, p = 0.023), sepsis (3.59% v. 2.43%, p = 0.021) and other postoperative shock (1.76% v. 1.06%, p = 0.036) significantly more frequently than octogenarians. Nonagenarians undergoing RTHA also had a significantly higher inpatient mortality rate (3.28% v. 1.43%, p < 0.001) than octogenarians. Orthopedic surgeons and primary care providers can use these findings to help counsel both their octogenarian and nonagenarian patients preoperatively when considering THA. Our analysis can help these patients better understand expected inpatient complication rates and assist them in deciding whether to pursue surgical intervention when applicable.

Older age and larger cyst size in children with spontaneous rupture of periorbital dermoid cysts.

We analyzed clinical and histopathologic data of 97 pediatric patients who underwent excision of dermoid cysts. On review, 16.5% of the sample population demonstrated localized chronic inflammatory changes, including the presence of giant cells and epithelial disruption. These features were considered indicative of prior cyst rupture. Age at time of initial presentation was significantly older and cyst size was significantly larger in patients with histopathologic signs of previous rupture. Longer time to presentation and time to excision were associated with increased odds of spontaneous rupture.

Prospective Observational Study Comparing Sepsis-2 and Sepsis-3 Definitions in Predicting Mortality in Critically Ill Patients.

BACKGROUND: Sepsis definitions have evolved, but there is a lack of consensus over adoption of the most recent definition, Sepsis-3. We sought to compare Sepsis-2 and Sepsis-3 in the classification of patients with sepsis and mortality risk at 30 days. METHODS: We used the following definitions: Sepsis-2 (≥2 systemic inflammatory response syndrome criteria + infection), Sepsis-3 (prescreening by quick Sequential Organ Failure Assessment [qSOFA] of ≥2 of 3 criteria followed by the complete score change ≥2 + infection), and an amended Sepsis-3 definition, iqSOFA (qSOFA ≥2 + infection). We used χ 2 or Wilcoxon rank-sum tests, receiver-operator characteristic curves, and survival analysis. RESULTS: We enrolled 176 patients (95% in an intensive care unit, 38.6% female, median age 61.4 years). Of 105 patients classified by Sepsis-2 as having sepsis, 80 had sepsis per Sepsis-3 or iqSOFA (kappa = 0.72; 95% confidence interval [CI], 0.62-0.82). Twenty-five (14.8%) died (20 of 100 with sepsis per Sepsis-2 [20%], and 20 of 77 [26.0%] with sepsis per Sepsis-3 or iqSOFA). Results for Sepsis-3 and iqSOFA were identical. The area under the curve of receiver-operator characteristic (ROC) curves for identifying those who died were 0.54 (95% CI, 0.41-0.68) for Sepsis-2, 0.84 (95% CI, 0.74-0.93) for Sepsis-3, and 0.69 (95% CI, 0.60-0.79) for iqSOFA (P < .01). Hazard ratios for death associated with sepsis were greatest for sepsis or septic shock per Sepsis-3. CONCLUSIONS: Sepsis-3 and iqSOFA were better at predicting death than Sepsis-2. Using the SOFA score might add little advantage compared with the simpler iqSOFA score.

Chronic Prescription Opioid Use Before and After Total Hip and Knee Arthroplasty in Patients Younger Than 65 Years.

BACKGROUND: Opioids are commonly prescribed to patients with painful and symptomatic degenerative joint disease preoperatively as a nonoperative intervention to reduce patients' symptoms and pain. The goal of total joint arthroplasty (TJA) is to reduce or eliminate the painful symptoms of degenerative joint disease. Due to the addictive property of opioid medications, some patients may develop a pattern of chronic opioid use after TJA. METHODS: We used MarketScan Commercial Claims and Encounters database to identify 125,019 patients (age <65 years) who underwent total knee arthroplasty (TKA) and total hip arthroplasty (THA) between 2009 and 2012. During the study period, opioid use was analyzed 3 months before surgery and at 12 months after surgery. We defined chronic opioid use as having 2 or more opioid prescriptions filled within any 6-week period. Multivariate logistic regression was used. RESULTS: Of the 24,127 patients who were chronic prescription opioid users before surgery, 72% were no longer chronic users 1 year after surgery. Of the 100,892 patients who were nonusers before surgery, 4% became chronic users within 1 year after surgery. TKA and hospital stay longer than 3 days were significant risk factors of persisting chronic opioid use after surgery, while age played a mixed role in predicting change of opioid use. CONCLUSION: Using our definition of chronic use, overall chronic opioid use decreased from 19% to 9% after TJA. Patients were more likely to cease chronic opioid use after TJA (72%) than to become chronic users (4%).

Assessment of urogenital schistosomiasis knowledge among primary and junior high school students in the Eastern Region of Ghana: A cross-sectional study.

BACKGROUND: Knowledge of urogenital schistosomiasis can empower individuals to limit surface water contact and participate in mass drug administration campaigns, but nothing is currently known about the schistosomiasis knowledge that schoolchildren have in Ghana. We developed and implemented a survey tool aiming to assess the knowledge of urogenital schistosomiasis (treatment, transmission, prevention, symptoms) among science teaches and primary and junior high school students in the Eastern Region of Ghana. METHODS: We developed a 22-question knowledge survey tool and administered it to 875 primary and 938 junior high school students from 74 schools in 37 communities in the Eastern Region of Ghana. Teachers (n = 57) answered 20 questions matched to student questions. We compared knowledge scores (as percent of correct answers) across topics, gender, and class year and assessed associations with teacher's knowledge scores using t-tests, chi-squared tests, univariate, and multivariate linear regression, respectively. RESULTS: Students performed best when asked about symptoms (mean±SD: 76±21% correct) and prevention (mean±SD: 69±25% correct) compared with transmission (mean±SD: 50±15% correct) and treatment (mean±SD: 44±23% correct) (p<0.0005). Teachers performed best on prevention (mean±SD: 93±12% correct, p<0.0005) and poorest on treatment (mean±SD: 69±16% correct, p<0.001). When listing five facts about urogenital schistosomiasis, teachers averaged 2.9±1.2 correct. Multiple regression models suggest that gender, class year, teacher score, and town of residency explain ~27% of variability in student scores. On average, junior high school students outperformed primary school students by 10.2 percentage points (CI95%: 8.6-11.8); boys outperformed girls by 3.5 percentage points (CI95%: 2.3-4.7). CONCLUSIONS: Our survey parsed four components of student and teacher knowledge. We found strong knowledge in several realms, as well as knowledge gaps, especially on transmission and treatment. Addressing relevant gaps among students and science teachers in UGS-endemic areas may help high-risk groups recognize risky water contact activities, improve participation in mass drug administration, and spark interest in science by making it practical.

Parental concern regarding obesity in children with autism spectrum disorder in the United States: National Survey of Children's Health 2016.

BACKGROUND: The prevalence of obesity in children with autism spectrum disorder (ASD) exceeds that of the general population, but the level of parental concern about obesity in these children is unexplored. OBJECTIVE: We estimate the prevalence of obesity in children 10-17 years in the redesigned National Survey of Children's Health (NSCH) 2016, and compare parental concern about obesity between parents of children with and without ASD. METHODS: The nationally representative NSCH 2016 oversampled parents of children with parent-report of special health care needs, including ASD. Parents opted to complete the survey via the web or surface mail. Following report of their child's height and weight, parents were asked "Are you concerned about their weight?" Response options included: "Yes, it's too high," "Yes, it's too low," or "No, I am not concerned." Obesity (>95th percentile BMI) was defined using the 2000 CDC growth reference. We used logistic regression to compare odds of obesity, and odds of parental concern, between children with and without ASD. RESULTS: In 24,251 children, ASD (n = 699) increased obesity risk after adjusting for age, sex, and race/ethnicity (OR = 1.54, 95%CI: 1.11, 2.14). ASD medication did not significantly affect obesity. ASD increased obesity concern (OR = 2.17, 95%CI: 1.53, 4.81) among parents with obese children. Parents of boys with obesity and ASD had less obesity concern if he was taking medication for ASD (OR = 0.258, 95%CI: 0.09, 0.78). CONCLUSION: While the prevalence of obesity is elevated in children with ASD, parental obesity concern is high, suggesting opportunities for the development of parent-focused obesity prevention and treatment interventions for this population.