Associations between Statin Use and Glaucoma in the All of Us Research Program.

PURPOSE: To investigate associations between statin use and glaucoma in the 2017 to 2022 All of Us (AoU) Research Program. DESIGN: Cross-sectional, population-based. PARTICIPANTS: 79 742 adult participants aged ≥40 years with hyperlipidemia and with electronic health record (EHR) data in the AoU database. METHODS: Hyperlipidemia, glaucoma status, and statin use were defined by diagnoses and medication information in EHR data collected by AoU. Logistic regression analysis was performed to evaluate the association between statin use and glaucoma likelihood. Logistic regression modeling was used to examine associations between glaucoma and all covariates included in adjusted analysis. Serum low-density lipoprotein cholesterol (LDL-C) was used to assess hyperlipidemia severity. Analyses stratified by LDL-C level and age were performed. MAIN OUTCOME MEASURES: Any glaucoma as defined by International Classification of Diseases codes found in EHR data. RESULTS: Of 79 742 individuals with hyperlipidemia in AoU, there were 6365 (8.0%) statin users. Statin use was associated with increased glaucoma prevalence when compared with statin nonuse (adjusted odds ratio [aOR]: 1.13, 95% confidence interval [CI]: 1.01-1.26). Higher serum levels of LDL-C were associated with increased odds of glaucoma (aOR: 1.003, 95% CI: 1.003, 1.004). Statin users had significantly higher LDL-C levels compared to nonusers (144.9 mg/dL versus 136.3 mg/dL, P value < 0.001). Analysis stratified by LDL-C identified positive associations between statin use and prevalence of glaucoma among those with optimal (aOR = 1.39, 95% CI = 1.05-1.82) and high (aOR = 1.37, 95% CI = 1.09-1.70) LDL-C levels. Age-stratified analysis showed a positive association between statin use and prevalence of glaucoma in individuals aged 60 to 69 years (aOR = 1.28, 95% CI = 1.05-1.56). CONCLUSIONS: Statin use was associated with increased glaucoma likelihood in the overall adult AoU population with hyperlipidemia, in individuals with optimal or high LDL-C levels, and in individuals 60 to 69 years old. Findings suggest that statin use may be an independent risk factor for glaucoma, which may furthermore be affected by one's lipid profile and age. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Racial and Ethnic Differences in the Prevalence and Treatment Patterns for Neovascular Glaucoma in the American Academy of Ophthalmology IRIS® Registry.

PURPOSE: To examine racial and ethnic differences in the prevalence and treatment patterns for neovascular glaucoma (NVG) in at-risk individuals in the American Academy of Ophthalmology (Academy) IRIS® Registry (Intelligent Research in Sight). DESIGN: Observational retrospective cohort study. PARTICIPANTS: Eyes in the IRIS Registry with a retinal ischemia based on a history of proliferative diabetic retinopathy, retinal vein occlusion, and/or ocular ischemic syndrome. METHODS: Race and ethnicity was defined as Asian, Black, Hispanic/Latino, non-Hispanic White, and other/unknown. In eyes with retinal ischemia, the outcome was NVG. In eyes with NVG, outcomes included treatment of retinal ischemia with pan-retinal photocoagulation (PRP), and surgery to lower intraocular pressure (IOP) with trabeculectomy, tube shunt, and cyclophotocoagulation (CPC). Covariates included age, sex, region of residence, insurance type, smoking status, and systemic and ocular comorbidities. Cox proportional hazards regression was used to examine adjusted associations between race and ethnicity and NVG and each type of NVG treatment. MAIN OUTCOME MEASURES: Incidence of NVG, PRP, trabeculectomy, tube shunt, CPC, and any IOP-lowering surgery. RESULTS: Of 312 106 eyes with retinal ischemia, there were 5885 (1.9%) with NVG. Compared to eyes of individuals who identified as non-Hispanic White, eyes of individuals who were Black and Hispanic/Latino had higher hazards of NVG in adjusted analyses (hazards ratio [HR] = 1.28, 95% confidence interval [CI] = 1.15-1.43 [for Black]; HR = 1.32, 95% CI = 1.17-1.47 [for Hispanic/Latino]). Compared with eyes of individuals who were non-Hispanic White, there was higher hazards of trabeculectomy in eyes of individuals who were Hispanic/Latino (adjusted HR = 1.91, 95% CI = 1.08-3.39) and higher hazards of tube shunt (adjusted HR = 1.35, 95% CI = 1.07-1.69) and of any IOP-lowering surgery (adjusted HR = 1.29, 95% CI = 1.09-1.53) in eyes of individuals who were Black. There were no statistically significant differences in the hazards of PRP or CPC. CONCLUSIONS: Eyes of Black and Hispanic/Latino individuals with retinal ischemia in the IRIS Registry had higher likelihood of NVG and of IOP-lowering surgery for NVG. Further study is needed to examine the medical and social factors that preclude optimal management of diabetic eye disease, in order to prevent its blinding complications. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Population-Level Associations Between Visual Impairment and Functional Difficulties in California.

PURPOSE: The prevalence of visual impairment is increasing, and there is a need to understand the functional implications. Using the American Community Survey (ACS) data, this study examined the relationship between visual impairment and functional difficulties in California. METHODS: Using the 2010-2014 and 2015-2019 ACS 5-year estimates from the U.S. Census, data were obtained for visual impairment and functional difficulties including hearing, cognitive, ambulatory, self-care, and independent living difficulties. The prevalence of vision impairment and each functional difficulty was calculated on the Medical Service Study Area (MSSA) level in California. Unadjusted and adjusted linear regression models were performed to estimate the association between visual impairment and each functional difficulty, adjusting for age, sex, race and ethnicity, education level, English-speaking ability, poverty status, health insurance status, and urbanity of residence location. RESULTS: The prevalence of visual impairment in California was 2.3% (659,502 of 28,794,572) in 2010-2014 and 2.3% (709,353 of 30,231,767) in 2015-2019 among the population ≥ 18 years old. There were statistically significant associations between the prevalence of vision impairment and increased prevalence of all functional difficulties, with the most positive correlation observed with ambulatory difficulty (slope estimate 0.58 ± 0.072 for 2010-2014 and 0.78 ± 0.082 for 2015-2019 for ambulatory difficulty). CONCLUSIONS: There may be population-level impacts of functional consequences from vision impairment, suggesting the need for neighborhood-level investigation and policy-based interventions to address the burden of vision impairment on the population level.

Psychometric evaluation of the Symptom-Checklist-K-9 among U.S. working-age adults with psychiatric disabilities.

PURPOSE: The Symptom Checklist 90-Revised (SCL-90-R; Derogatis, 1992) is a widely used self-report measure of psychiatric symptoms (Prinz et al., 2013), but it is longer than many screening measures used in certain settings. Recently, a nine-item form of the SCL-90-R, the Symptom-Checklist-K-9 (SCL-K-9), has been gaining traction despite the limited research examining its psychometric properties in the United States. The purpose of this study is to conduct a psychometric evaluation of the SCL-K-9 scores in U.S. working-age adults with psychiatric disabilities. DESIGN: Six hundred and thirty participants with self-reported psychiatric disabilities completed the SCL-K-9 and other psychosocial self-report measures. Confirmatory factor analysis (CFA) was conducted to evaluate the SCL-K-9 scores' dimensionality. Coefficient omega was used to assess the scores' internal consistency. Convergent and discriminant validity were assessed by examining the strength and direction of correlation coefficients between the SCL-K-9 and other psychosocial measures. Measurement invariance across sex, age, and primary diagnostic groups was also examined. RESULTS: CFA revealed a one-factor solution with satisfactory reliability (coefficient omega = .828). Convergent validity was supported by the relatively high correlation coefficients between the SCL-K-9 with neuroticism, self-stigma, and psychiatric disability acceptance, and discriminant validity by relatively low correlation coefficients with perceived social stigma and hope. Full measurement invariance for sex and partial invariance for diagnostic groups was supported. CONCLUSIONS: Overall, this study provides preliminary reliability and validity evidence for the SCL-K-9 scores among U.S. working-age adults with psychiatric disabilities. Further investigation is warranted to support its use for research and treatment progress monitoring in recovery-oriented care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Unidimensional versus multidimensional: A bifactor factor structure of the Self-Stigma Scale-Short (SSS-S) among U.S. adults with psychiatric disabilities.

OBJECTIVE: This study aimed to examine the psychometric properties of the English version of the Self-Stigma Scale-Short (SSS-S), a nine-item self-report self-stigma measurement, among U.S. adults with psychiatric disabilities. METHOD: We obtained reliability and validity evidence from a sample of 275 adults with psychiatric disabilities. RESULTS: Exploratory factor analysis (EFA; n = 139) yielded a two-factor solution that accounts for 64.97% of the variance. Confirmatory factor analysis (CFA; n = 136) was conducted to compare alternative solutions, including a single-factor model, a two-correlated-factor model, a three-correlated-factor model, and a bifactorial model. The CFA results supported the bifactor S·I - 1 model as a superior latent factor structure for the SSS-S. The coefficient ω of the SSS-S was .94, indicating excellent internal reliability. Concurrent validity of the SSS-S was supported by significant positive correlations with societal stigma and psychiatric symptom severity, and negative correlations with psychiatric disability acceptance, general self-efficacy, and hope. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The overall findings concluded that the English version of the SSS-S demonstrated reliable and valid scores and a primarily unidimensional structure of self-stigma among U.S. adults with psychiatric disabilities. Given the adverse impact of self-stigma and its relationships with recovery-related constructs shown in this study, the routine use of the SSS-S is recommended in psychiatric rehabilitation settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining racial disparity in psychotic disorders related ambulatory care visits: an observational study using national ambulatory medical care survey 2010-2015.

BACKGROUND: One of the most consistent research findings related to race and mental health diseases is the disproportionately high rate of psychotic disorder diagnoses among people of color, specifically people of African descent. It is important to examine if a similar pattern exists among specific psychotic disorders. We aimed to examine the racial/ethnic differences in ambulatory care visits diagnosed with schizophrenia-spectrum disorders (SSDs). METHODS: We analyzed data from the National Ambulatory Medical Care Survey (NAMCS) 2010-2015. The study sample included physician office-based visits by individuals diagnosed with SSDs, including schizophrenia, schizoaffective, and unspecified psychotic disorder (n = 1155). We used descriptive and bivariate analysis by race/ethnicity and three multinomial logistic regression models to test the association between the SSDs and race/ethnicity, adjusting for age, gender, insurance, disposition, medication Rx, and co-morbidity, considering the design and weight. RESULT: Of the 1155 visits for SSDs, 44.8% had schizophrenia, 37.4% had schizoaffective disorder diagnosis, and 19.0% had unspecified psychosis disorder. We found significant racial disparities in the diagnosis of SSDs. Black patients were overrepresented in all three categories: schizophrenia (24%), schizoaffective disorder (17%), and unspecified psychosis disorder (26%). Also, a notable percentage of Black patients (20%) were referred to another physician in cases of schizophrenia compared to other ethnoracial groups (p < 0.0001). Moreover, we found a significant disparity in insurance coverage for schizoaffective disorder, with a higher percentage of Black patients (48%) having Medicaid insurance compared to patients from other ethnoracial groups (p < 0.0001). Black patients had nearly twice the odds of receiving a diagnosis of schizophrenia compared to White patients [AOR = 1.94; 95% CI: 1.28-2.95; P = 0.001]. However, they had significantly lower odds of being diagnosed with schizoaffective disorder [AOR = 0.42, 95% CI: 0.26-0.68; P = 0.003]. Race/ethnicity was not associated with receiving an unspecified psychosis disorder. CONCLUSIONS: Our results show that SSDs, more specifically schizophrenia, continue to burden the mental health of Black individuals. Validation of our findings requires rigorous research at the population level that reveals the epidemiological difference of SSDs diagnoses in different race/ethnicity groups. Also, advancing our understanding of the nature of disparity in SSDs diagnoses among the Black population requires disentangling etiologic and systemic factors in play. This could include psychological stress, the pathway to care, services use, provider diagnostic practice, and experiencing discrimination and institutional and structural racism.

Social Vulnerability, Prevalence of Glaucoma, and Incidence of Glaucoma Surgery in the California Medicare Population.

PURPOSE: To examine associations of Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) scores with prevalence of glaucoma and incidence of glaucoma surgery in 2019 California Medicare beneficiaries. DESIGN: Retrospective cross-sectional study. PARTICIPANTS: 2019 California Medicare beneficiaries ≥ 65 years old with part A and part B coverage. METHODS: The exposure of interest was SVI score, which was assessed overall and by themes. Outcomes included prevalence of glaucoma in the study population and incidence of glaucoma surgery in beneficiaries with glaucoma. Logistic regression modeling was performed to assess associations between quartiles of each type of SVI score, prevalence of glaucoma, and incidence of glaucoma surgery, controlling for age, sex, race/ethnicity, Charlson Comorbidity Index score, pseudophakia, and age-related macular degeneration. MAIN OUTCOME MEASURES: Prevalence of any glaucoma, primary open angle glaucoma (POAG), secondary open angle glaucoma (SOAG), and angle closure glaucoma in all beneficiaries. Incidence of any glaucoma surgery, trabeculectomy, tube shunt, minimally invasive glaucoma surgery (MIGS), and cyclophotocoagulation (CPC) in beneficiaries with glaucoma. RESULTS: Of 5 725 245 beneficiaries in the total study population, there were 215 814 (3.8%) with any glaucoma, and of those with glaucoma, 10 135/215 814 (4.7%) underwent glaucoma surgery. In adjusted analyses for overall SVI score, where higher levels of SVI refer to higher levels of social vulnerability, there were decreased odds of any glaucoma (adjusted odds ratio [aOR] = 0.83; 95% confidence interval [CI] = 0.82, 0.84 for Q4 vs. Q1), POAG (aOR = 0.85; 95% CI = 0.84, 0.87 for Q4 vs. Q1), and SOAG (aOR = 0.59; 95% CI = 0.55, 0.63 for Q4 vs. Q1) in higher (Q4) vs. lower (Q1) SVI quartile. There were increased odds of any glaucoma surgery (aOR = 1.19; 95% CI = 1.12, 1.26 for Q4 vs. Q1), MIGS (aOR = 1.24; 95% CI = 1.15, 1.33 for Q4 vs. Q1), and CPC (aOR = 1.49; 95% CI = 1.29, 1.76 for Q4 vs. Q1) for higher (Q4) vs. lower (Q1) SVI quartile. CONCLUSIONS: In the 2019 California Medicare population, there were variable associations between SVI score, prevalence of glaucoma, and incidence of glaucoma surgery. Further investigation is needed to understand the role of social, economic, and demographic factors in glaucoma care on the individual and structural levels. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Racial/ethnic and gender disparity in the severity of NAFLD among people with diabetes or prediabetes.

Aim: Non-alcoholic fatty liver disease (NAFLD) exhibits a racial disparity. We examined the prevalence and the association between race, gender, and NAFLD among prediabetes and diabetes populations among adults in the United States. Methods: We analyzed data for 3,190 individuals ≥18 years old from the National Health and Nutrition Examination Survey (NHANES) 2017-2018. NAFLD was diagnosed by FibroScan® using controlled attenuation parameter (CAP) values: S0 (none) < 238, S1 (mild) = 238-259, S2 (moderate) = 260-290, S3 (severe) > 290. Data were analyzed using Chi-square test and multinomial logistic regression, adjusting for confounding variables and considering the design and sample weights. Results: Of the 3,190 subjects, the prevalence of NAFLD was 82.6%, 56.4%, and 30.5% (p < 0.0001) among diabetes, prediabetes and normoglycemia populations respectively. Mexican American males with prediabetes or diabetes had the highest prevalence of severe NAFLD relative to other racial/ethnic groups (p < 0.05). In the adjusted model, among the total, prediabetes, and diabetes populations, a one unit increase in HbA1c was associated with higher odds of severe NAFLD [adjusted odds ratio (AOR) = 1.8, 95% confidence level (CI) = 1.4-2.3, p < 0.0001; AOR = 2.2, 95% CI = 1.1-4.4, p = 0.033; and AOR = 1.5, 95% CI = 1.1-1.9, p = 0.003 respectively]. Conclusion: We found that prediabetes and diabetes populations had a high prevalence and higher odds of NAFLD relative to the normoglycemic population and HbA1c is an independent predictor of NAFLD severity in prediabetes and diabetes populations. Healthcare providers should screen prediabetes and diabetes populations for early detection of NAFLD and initiate treatments including lifestyle modification to prevent the progression to non-alcoholic steatohepatitis or liver cancer.

Associations Between Niacin Intake and Glaucoma in the National Health and Nutrition Examination Survey.

PRCIS: This study examined the association between dietary niacin intake and glaucoma in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Increased niacin intake was associated with lower odds of glaucoma overall and among women. PURPOSE: To examine the association between dietary niacin intake and glaucoma in the 2005-2008 NHANES. MATERIALS AND METHODS: This cross-sectional study included adult participants of the 2005-2008 NHANES. The exposure was dietary niacin intake, which was examined as a continuous and categorical variable. The outcome was glaucoma as defined by regraded disc images. Covariates included age, sex, race/ethnicity, education level, income, body mass index, smoking status, alcohol use, cardiovascular disease, diabetes mellitus, daily energy intake, vitamin B2 and B6 consumption, and macular degeneration. Adjusting for all covariates, logistic regression was performed to examine the association between niacin intake and glaucoma in the overall population and stratified by sex. RESULTS: The weighted population included 5371 individuals (109,734,124 weighted), of whom 55 (1.0%) had glaucoma. Each 1 mg increase in niacin intake was associated with a 6% decreased odds of glaucoma odds [adjusted odds ratio (aOR) = 0.94, 95% CI = 0.90, 0.98]. Among women, increased niacin intake was associated with decreased odds of glaucoma both with niacin as a continuous (aOR = 0.89, 95% CI = 0.80, 0.99 per 1 mg increase in niacin intake) and binary variable (aOR = 0.35, 95% CI = 0.14, 0.90 for higher vs lower niacin intake). CONCLUSIONS: In the 2005-2008 NHANES population, higher levels of niacin intake were associated with decreased odds of glaucoma overall and in women. Further studies are needed to examine the potential protective effects of niacin on glaucoma risk.

Predictors of hospital readmissions in adult patients with sickle cell disease.

BACKGROUND: Sickle cell disease (SCD) is the most common inherited blood disorder, affecting primarily Black and Hispanic individuals. In 2016, 30-day readmissions incurred 95,445 extra days of hospitalization, $152 million in total hospitalization costs, and $609 million in total hospitalization charges. OBJECTIVES: 1) To estimate hospital readmissions within 30 days among patients with SCD in the State of California. 2) Identify the factors associated with readmission within 30 days for SCD patients in California. METHODS: We conducted a retrospective observational study of adult SCD patients hospitalized in California between 2005 and 2014. Descriptive statistics and logistic regression models were used to examine significant differences in patient characteristics and their association with hospital readmissions. RESULTS: From 2,728 individual index admissions, 70% presented with single admission, 10% experienced one readmission, and 20% experienced ≥ two readmissions within 30 days. Significant predictors associated with zero vs. one readmission were male gender (OR=1.37, CI: 1.06-1.77), Black ethnicity (OR=3.27, CI: 1.71-6.27) and having Medicare coverage (OR=1.89, CI: 1.30-2.75). Lower likelihood of readmission was found in those with a Charlson Comorbidity index of three or more (OR=0.53, CI: 0.29-0.97). For zero vs. ≥ two readmissions, significant predictors were male gender (OR=1.43, CI: 1.17-1.74), Black ethnicity (OR=6.90, CI: 3.41-13.97), Hispanic ethnicity (OR=2.33, CI: 1.05-5.17), Medicare coverage (OR=3.58, CI: 2.68-4.81) and Medi-Cal coverage (OR=1.70, CI: 1.31-2.20). Lower likelihood for having two or more readmissions were associated with individuals aged 65+ (OR=0.97, CI: 0.96-0.98) and those with self-payment status (OR=0.32, CI: 0.12-0.54). CONCLUSIONS: In California, male, Black, and Hispanic patients, as well as those covered by Medicare or Medi-Cal, were found to have an increased risk of hospital readmissions. Redirecting outpatient goals to address these patient populations and risk factors is crucial for reducing readmission rates.

Association Between Geographic Distribution of Eye Care Clinicians and Visual Impairment in California.

Importance: The association between availability of eye care clinicians and visual impairment, a condition presenting with increased morbidity and health care costs, has not been thoroughly studied. Objective: To examine associations between the geographic distribution of eye care clinicians and visual impairment in California. Design, Setting, and Participants: This survey-based cross-sectional study included ophthalmologists and optometrists licensed in California in 2018 and 2020 as well as respondents to the 2014 to 2018 American Community Survey (ACS) by California counties and Medical Service Study Areas (MSSAs). Data were analyzed from August 2020 to December 2021. Main Outcomes and Measures: Prevalence of visual impairment by county and MSSA. Exposures: The number of eye care clinicians was determined based on the number of member ophthalmologists of the American Academy of Ophthalmology in 2018 and optometrists listed in the 2020 Blue Book of Optometrists in California. The prevalence of visual impairment was determined using questionnaire data from the American Community Survey. Linear regression was used to assess multivariable associations between number of eye care clinicians and visual impairment by MSSA. Results: A total of 30 068 581 California residents were included; 15 253 655 (50.7%) were female, and 5 314 389 (17.7%) were 65 years and older. The overall number of eye care clinicians was 22.18 clinicians per 100 000 residents. The overall prevalence of visual impairment was 2411.07 residents with visual impairment per 100 000 residents. San Francisco County had the highest number of eye care clinicians per 100 000 residents (39.24 clinicians per 100 000 residents). Four counties had no eye care clinicians (Alpine, Mariposa, Inyo, and Sierra counties). For every increase of 1 eye care clinician per 100 000 residents, there was a mean (SE) decrease of 3.90 (1.39) persons with visual impairment per 100 000 residents in adjusted analyses. Conclusions and Relevance: In this cross-sectional study, a higher number of eye care clinicians was potentially associated with lower prevalence of visual impairment in California. Additional studies are needed to assess eye care clinician availability on a national and global scale and strategies to improve access to eye care.

Distance Learning During COVID-19 Mitigates Learning Loss for Interprofessional Education.

SUMMARY STATEMENT: On-site interprofessional education (IPE) simulation is primarily used to teach students teamwork, communication, and crisis resource management. Participants view it as an educational environment in which to acquire and consolidate skills. Virtual IPE simulation is traditionally seen as an opportunity to supplement, complement, and reinforce on-site IPE (OI). We used VI as the sole simulation method during the COVID-19 pandemic to provide IPE because of constraints of social distancing. The VI resulted in substantially achieving similar learning outcomes to OI. This suggests that VI, which has the advantage of being cheaper and more easily scalable than OI, may be an effective remote learning modality for IPE.

Association Between E-Cigarette Use and Visual Impairment in the United States.

PURPOSE: To determine whether there is an association between e-cigarette use and visual impairment in the United States adult population. DESIGN: Cross-sectional. METHODS: In this population survey study, we reviewed 1,173,646 adults ≥18 years of age from all 50 United States and 3 U.S. territories with self-reported responses to the Center for Disease Control and Prevention's 2016-2018 Behavioral Risk Factor Surveillance System (BRFSS) annual telephone survey. We reviewed e-cigarette use (current, former, or never), as assessed by the questions: "Have you ever used an e-cigarette or other electronic vaping product, even just one time, in your entire life?" and "Do you now use e-cigarettes or other electronic vaping products every day, some days, or not at all?" The primary outcome measure was visual impairment, defined as a binary outcome "yes" or "no" to the question, "Are you blind or do you have serious difficulty seeing, even when wearing glasses?" RESULTS: After excluding missing data, there were 1,173,646 participants. The adjusted odds ratio of visual impairment in current e-cigarette users compared with never e-cigarette users was 1.34 (95% confidence interval [CI] 1.20-1.48), and in former e-cigarette users was 1.14 (95% CI 1.06-1.22). In the subgroup of 662,033 never users of traditional cigarettes (weighted 59.6% of study population), the adjusted odds ratio of visual impairment in current e-cigarette users compared with never e-cigarette users was 1.96 (95% CI 1.48-2.61) and in former e-cigarette users was 1.02 (95% CI 0.89-1.18). CONCLUSIONS: Current compared with never e-cigarette usage was associated with a higher odds of visual impairment in the BRFSS 2016-2018 population, independent of traditional cigarette use.

Sex-Specific Differences in the Association Between Race/Ethnicity and NAFLD Among US Population.

Non-alcoholic fatty liver disease (NAFLD) is spreading worldwide, with a racial/ethnic disparity. We examined the gender role in the racial/ethnic difference in NAFLD in the US population. We analyzed data for 3,292 individuals ≥18 years old from NHANES 2017-2018, a representative sample of the non-institutionalized adult population in the US. Exclusions were subjects with elevated transferrin level, chronic hepatitis B or C, excessive alcohol use, or prescription medications that might cause hepatic steatosis. NAFLD was diagnosed by FibroScan® using controlled attenuation parameter (CAP) values: S0 <238, S1 = 238-259, S2 = 260-290, S3 >290. Data were analyzed using Chi square and multinomial regression. The overall prevalence of NAFLD was 47.9% [S2 = 16.1%, and S3 = 31.8%]. The prevalence of S3 was highest among Mexican Americans (46%), lowest among Blacks (22.7%), 29.9% in other Hispanics and 32.1% in Whites (p < 0.05). It was higher among Mexican American males (54.1%) compared to Mexican American females (37.7%) (p < 0.05). In the adjusted model, Mexican Americans were two times more likely than Whites to have S2 and S3 (p < 0.05). Only male Mexican Americans had higher odds of S2 and S3 relative to male White (p < 0.05). Males had higher odds of S3 relative to non-menopausal females (p < 0.05). There was no difference in the odds of S2 or S3 NAFLD among the menopausal females with or without hormone therapy relative to non-menopausal females (p > 0.05). While Mexican Americans had the highest prevalence of severe NAFLD relative to the other racial/ethnic groups, only male Mexican Americans, but not females, had higher likelihood of both moderate and severe NAFLD relative to Whites. Interventions that specifically target Mexican American males are needed to increase awareness about NAFLD and its prevention.

Reassessment of the Hispanic Disparity: Hepatic Steatosis Is More Prevalent in Mexican Americans Than Other Hispanics.

Hepatic steatosis (HS) is a growing problem in adults worldwide, with racial/ethnic disparity in the prevalence of the disease. The purpose of this study was to characterize the racial/ethnic prevalence of the stages (normal/mild [S0/S1], moderate [S2], and severe [S3]) of HS in Mexican Americans and other Hispanics compared to other racial/ethnic groups. We analyzed data for 5,492 individuals 12 years and older from the newly released National Health and Nutrition Examination Survey 2017-2018, which is a representative sample of the US adult population. HS was diagnosed by FibroScan using controlled attenuation parameter values: S0, <238; S1, 238-259; S2, 260-290; S3, >290. We analyzed the data using the bivariate chi-squared test and multinomial regression. The prevalence of HS overall was 46.9% (S2,16.6%; S3, 30.3%). The prevalence of S3 was highest among Mexican Americans (42.8%), lowest among Blacks (21.6%), 27.6% in other Hispanics, and 30.6% in Whites (P < 0.05). Mexican Americans were about 2 times more likely than Whites to have S2 and S3, while other Hispanics showed no difference from Whites. In an adjusted model, the common risk factors of S2 and S3 were male sex, older ages, high waist-to-hip ratio, body mass index ≥25, and high triglycerides (P < 0.05). Other risk factors for S3 were hemoglobin A1c ≥5.7 and highly sensitive C-reactive protein ≥10 mg/dL (P < 0.05). Conclusion: Our study challenges the paradigm that HS is higher in Hispanics overall; rather, our data show that HS is higher in Mexican Americans and not non-Mexican American Hispanics.

Schizophrenia hospitalization in the US 2005-2014: Examination of trends in demographics, length of stay, and cost.

ABSTRACT: Primarily we aimed to examine the crude and standardized schizophrenia hospitalization trend from 2005 to 2014. We hypothesized that there will be a statistically significant linear trend in hospitalization rates for schizophrenia from 2005 to 2014. Secondarily we also examined trends in hospitalization by race/ethnicity, age, gender, as well as trends in hospitalization Length of Stay (LOS) and inflation adjusted cost.In this observational study, we used Nationwide Inpatient Sample data and International Classification of Diseases, Eleventh Revisions codes for Schizophrenia, which revealed 6,122,284 cases for this study. Outcomes included crude and standardized hospitalization rates, race/ethnicity, age, cost, and LOS. The analysis included descriptive statistics, indirect standardization, Rao-Scott Chi-Square test, t-test, and adjusted linear regression trend.Hospitalizations were most prevalent for individuals ages 45-64 (38.8%), African Americans were overrepresented (25.8% of hospitalizations), and the gender distribution was nearly equivalent. Mean LOS was 9.08 days (95% confidence interval 8.71-9.45). Medicare was the primary payer for most hospitalizations (55.4%), with most of the costs ranging from $10,000-$49,999 (57.1%). The crude hospitalization rates ranged from 790-1142/100,000 admissions, while the US 2010 census standardized rates were 380-552/100,000 from 2005-2014. Linear regression trend analysis showed no significant difference in trend for race/ethnicity, age, nor gender (P > .001). The hospitalizations' overall rates increased while LOS significantly decreased, while hospitalization costs and Charlson's co-morbidity index increased (P < .001).From 2005-2014, the overall US hospitalization rates significantly increased. Over this period, observed disparities in hospitalizations for middle-aged and African Americans were unchanged, and LOS has gone down while costs have gone up. Further studies addressing the important disparities in race/ethnicity and age and reducing costs of acute hospitalization are needed.

Factor structure, internal reliability, and construct validity of the Brief Resilience Scale (BRS): A study on persons with serious mental illness living in the community.

OBJECTIVES: Resilience, the ability to bounce back from a stressful situation, is a valuable asset for aiding adults with serious mental illness (SMI) in navigating the recovery process. People with SMI experience stress, including traumatic experiences at disproportionate rates. The purposes of this study were to examine the factor structure, internal reliability, and construct validity of the Brief Resilience Scale (BRS) among adults with SMI living in the community. DESIGN: A cross-sectional survey design was used. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and correlational analyses were employed. METHODS: Three hundred fifteen adults with SMI were recruited for two studies (Sample 1, n = 122; Sample 2, n = 193) from three states. All participants completed the BRS along with nearly identical positive psychology- and psychopathology-related measures. RESULTS: EFA revealed the BRS was unidimensional and explained 61.20% of the variance. Results from seven CFA models suggested a bifactor structure for the BRS, which fit the data best. Internal reliability of the BRS was computed to be within acceptable ranges (α = .87, ω = .90). The BRS was positively correlated with measures of positive coping and life satisfaction, providing convergent validity. Divergent validity was supported by negative correlations between the BRS and measures of psychiatric symptoms, succumbing, and self-stigma. CONCLUSIONS: The BRS is a valid measure that can be used by clinical and research professionals to assess levels of resilience in adults with SMI at baseline and across time. PRACTITIONER POINTS: The Brief Resilience Scale (BRS) was developed to measure a person's ability to bounce back from stressful situations. The BRS was examined in adults with serious mental illness living in the community. The BRS presented a bifactor structure measuring resilience (an outcome) and correlated with positive psychology- and psychopathology-related measures. The BRS can be used by practitioners to assess levels of resilience in their clients at baseline and over time to evaluate the effectiveness of therapeutic interventions.

How Clinically Relevant Is C-Reactive Protein for Blacks with Metabolic Syndrome to Predict Microalbuminuria?

Background: The metabolic syndrome (MetS) is associated with elevated urinary albumin (UA) excretion and C-reactive protein (CRP). However, potential differences in CRP levels on the association between individual components of the MetS and microalbuminuria (MA; 30-300 µg/mL) and/or UA (0-300 µg/mL) by race/ethnicity is unknown. Methods: We analyzed National Health and Nutrition Examination Surveys (NHANES) data, (1999-2010) for adults (≥20 years of age) with the MetS (N = 5700). The Sobel-Goodman mediation test examined the influence of CRP on the association between individual MetS components and both MA and UA by race/ethnicity. We applied machine learning models to predict UA. Results: CRP mediated the association between waist circumference (WC) and MA in Whites and Hispanics but not in Blacks. However, in general, the proportion of the total effect of MetS components on UA, mediated by CRP, was: 11% for high-density lipoprotein cholesterol (HDL-C) and 40% for WC (P < 0.001). In contrast to MA, the mediation effect of CRP for WC and UA was highest for Blacks (94%) compared with Whites (55%) or Hispanics (18%), P < 0.05. The prediction of an elevated UA concentration was increased in Blacks (∼51%) with the MetS when CRP was added to the random forest model. Conclusions: CRP mediates the association between UA and both HDL-C and WC in Whites and Blacks and between UA and WC in Hispanics. Moreover, the machine learning approach suggests that the incorporation of CRP may improve model prediction of UA in Blacks. These findings may favor screening for CRP in persons with the MetS, particularly in Blacks.

Reversal of age-associated oxidative stress in mice by PFT, a novel kefir product.

INTRODUCTION: Oxidative stress is a key contributor to aging and age-related diseases. In the present study, we examine the protective effects of PFT, a novel kefir product, against age-associated oxidative stress using aged (10-month-old) mice. METHODS: Mice were treated with PFT orally at a daily dose of 2 mg/kg body weight over 6 weeks, and antioxidant status, protein oxidation, and lipid peroxidation were studied in the brain, liver, and blood. RESULTS: PFT supplementation significantly reduced the oxidative stress biomarkers malondialdehyde (MDA) and nitric oxide; reversed the reductions in glutathione (GSH) levels, total antioxidant capacity (TAC), and anti-hydroxyl radical (AHR) content; enhanced the antioxidant enzyme activities of glutathione peroxidase (GPx), catalase (CAT), and superoxide dismutase (SOD); inhibited the liver enzyme levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT); significantly reduced triglyceride (TG), total cholesterol (TC), and low density lipoprotein (LDL) levels; and significantly elevated high density lipoprotein (HDL) levels. Interestingly, PFT supplementation reversed the oxidative changes associated with aging, thus bringing levels to within the limits of the young control mice in the brain, liver, and blood. We also note that PFT affects the redox homeostasis of young mice and that it is corrected post-treatment with PFT. CONCLUSION: Our findings show the effectiveness of dietary PFT supplementation in modulating age-associated oxidative stress in mice and motivate further studies of PFT's effects in reducing age-associated disorders where free radicals and oxidative stress are the major cause.

Prevalence and Predictors of Nonalcoholic Steatohepatitis Using Multiple Non-Invasive Methods: Data from NHANES III.

Objective: Patients with nonalcoholic steatohepatitis (NASH) are at risk for developing cirrhosis and hepatic cancer. Currently, the definitive gold-standard method of diagnosing NASH is a liver biopsy, an invasive and costly method. Our objective was to compare three non-invasive methods of identifying NASH by using data on 10,007 subjects from NHANES III (1988-1994) to determine the prevalence and variables associated with NASH, as defined by each non-invasive method. Methods: We used ultrasound data to identify subjects with moderate-to-severe hepatic steatosis, of whom we identified the NASH population using either the HAIR score, the NASH liver fat score, or the Gholam score, each of which had been validated with liver biopsy. We performed multinomial logistic regression to compare each NASH population to the normal population (those with no-to-mild hepatic steatosis). Results: We identified 1136 (9.5%) subjects as having NASH by at least one method and 219 (1.8%) were identified by all 3 methods. Independent of the non-invasive method used, Mexican-Americans (MA) had the highest prevalence of NASH. All three methods identified significant risk factors for NASH (p<0.05), including: elevated waist-to-hip ratio, elevated levels of C-peptide, total cholesterol, or C-reactive protein (CRP). Conclusion: We conclude that the combined non-invasive methods can help identify candidates with a high likelihood of being diagnosed with NASH. Health care providers can screen people with the combined non-invasive methods for the risk factors and identify candidates for interventions, including exercise and/or referral to biopsy.