Racial and Ethnic Disparities in Excess All-Cause Mortality in the First Year of the COVID-19 Pandemic.

Research on the COVID-19 pandemic in the United States has consistently found disproportionately high mortality among ethnoracial minorities, but reports differ with respect to the magnitude of mortality disparities and reach different conclusions regarding which groups were most impacted. We suggest that these variations stem from differences in the temporal scope of the mortality data used and difficulties inherent in measuring race and ethnicity. To circumvent these issues, we link Social Security Administration death records for 2010 through 2021 to decennial census and American Community Survey race and ethnicity responses. We use these linked data to estimate excess all-cause mortality for age-, sex-, race-, and ethnicity-specific subgroups and examine ethnoracial variation in excess mortality across states and over the course of the pandemic's first year. Results show that non-Hispanic American Indians and Alaska Natives experienced the highest excess mortality of any ethnoracial group in the first year of the pandemic, followed by Hispanics and non-Hispanic Blacks. Spatiotemporal and age-specific ethnoracial disparities suggest that the socioeconomic determinants driving health disparities prior to the pandemic were amplified and expressed in new ways in the pandemic's first year to disproportionately concentrate excess mortality among racial and ethnic minorities.

Risk factors for head and neck cancer in more and less developed countries: Analysis from the INHANCE consortium.

OBJECTIVE: We analyzed the pooled case-control data from the International Head and Neck Cancer Epidemiology (INHANCE) consortium to compare cigarette smoking and alcohol consumption risk factors for head and neck cancer between less developed and more developed countries. SUBJECTS AND METHODS: The location of each study was categorized as either a less developed or more developed country. We compared the risk of overall head and neck cancer and cancer of specific anatomic subsites associated with cigarette smoking and alcohol consumption. Additionally, age and sex distribution between categories was compared. RESULTS: The odds ratios for head and neck cancer sites associated with smoking duration differed between less developed and more developed countries. Smoking greater than 20 years conferred a higher risk for oral cavity and laryngeal cancer in more developed countries, whereas the risk was greater for oropharynx and hypopharynx cancer in less developed countries. Alcohol consumed for more than 20 years conferred a higher risk for oropharynx, hypopharynx, and larynx cancer in less developed countries. The proportion of cases that were young (<45 years) or female differed by country type for some HNC subsites. CONCLUSION: These findings suggest the degree of industrialization and economic development affects the relationship between smoking and alcohol with head and neck cancer.

Long-Term Intracoronary Structural and Vasomotor Assessment of the ABSORB Bioresorbable Vascular Scaffold.

We systematically categorized the longer-term (≥3 years) structural and functional characteristics of the ABSORB bioresorbable vascular scaffold (BVS) using optical coherence tomography imaging and coronary vasomotor reactivity testing and further compared the functional characteristics of BVS stented versus remote coronary segments. A total of 92 patients (mean age 56.4 ± 9.7 years, 22.8% women) who underwent percutaneous coronary intervention (76% with acute coronary syndrome) using the ABSORB BVS (112 lesions) were included. Optical coherence tomography analysis (38,790 visible struts) comprised in-segment quantitative lumen/plaque and semiquantitative plaque composition analysis of the neointimal pattern. Epicardial endothelium-dependent and-independent vasomotion was defined as any vasodilatation at low/intermediate intracoronary dose of acetylcholine (ACh) and nitroglycerine, assessed using quantitative coronary angiography. At a median time of 3.2 years follow-up, 79.8% of BVS segments still demonstrated visible struts with a predominant neointimal fibrotic healing pattern in 84% of BVS segments, with 99.5% of struts demonstrating coverage with apposition. Compared with remote segments, BVS segments demonstrated less endothelium-dependent vasodilatation at low (p = 0.06) and intermediate ACh doses (p = 0.04). Hypertension, longer time interval from index percutaneous coronary intervention, and the degree of in-BVS segment neointimal volume (p <0.03 for all) were each independently associated with abnormal BVS endothelium-dependent vasomotor function. Endothelium-independent function was more likely preserved in non-BVS (remote) segments compared with BVS segments (p = 0.06). In conclusion, at 3+ years post-ABSORB BVS insertion, the rate of complete scaffold resorption was low and residual strut presence was high, with a dominant fibrous healing response contributing toward neointimal hyperplasia and endothelium-dependent and-independent vasomotor dysfunction.

Response error and the Medicaid undercount in the current population survey.

OBJECTIVE: To measure the Medicaid undercount and analyze response error in the 2007-2011 Current Population Survey Annual Social and Economic Supplement (CPS ASEC). DATA SOURCES/STUDY SETTING: Medicaid Statistical Information System (MSIS) 2006-2010 enrollment data linked to the 2007-2011 CPS ASEC person records. STUDY DESIGN: By linking individuals across datasets, we analyze false-negative error and false-positive error in reports of Medicaid enrollment. We use regression analysis to identify factors associated with response error in the 2011 CPS ASEC. PRINCIPAL FINDINGS: We find that the Medicaid undercount in the CPS ASEC ranged between 22 and 31% from 2007 to 2011. In 2011, the false-negative rate was 40%, and 27% of Medicaid reports in CPS ASEC were false positives. False-negative error is associated with the duration of enrollment in Medicaid, enrollment in Medicare and private insurance, and Medicaid enrollment in the survey year. False-positive error is associated with enrollment in Medicare and shared Medicaid coverage in the household. CONCLUSIONS: Survey estimates of Medicaid enrollment and estimates of the uninsured population are affected by both false-positive response error and false-negative response error, and these response errors are non-random.

Health-Care Costs, Glycemic Control and Nutritional Status in Malnourished Older Diabetics Treated with a Hypercaloric Diabetes-Specific Enteral Nutritional Formula.

Diabetes-specific formulas are an effective alternative for providing nutrients and maintaining glycemic control. This study assesses the effect of treatment with an oral enteral nutrition with a hypercaloric diabetes-specific formula (HDSF) for one year, on health-care resources use, health-care costs, glucose control and nutritional status, in 93 type-2 diabetes mellitus (T2DM) malnourished patients. Changes in health-care resources use and health-care costs were collected the year before and during the year of intervention. Glucose status and nutritional laboratory parameters were analyzed at baseline and one-year after the administration of HDSF. The administration of HDSF was significantly associated with a reduced use of health-care resources, fewer hospital admissions (54.7%; p < 0.001), days spent at hospital (64.1%; p < 0.001) and emergency visits (57.7%; p < 0.001). Health-care costs were reduced by 65.6% (p < 0.001) during the intervention. Glycemic control (short- and long-term) and the need of pharmacological treatment did not change, while some nutritional parameters were improved at one year (albumin: +10.6%, p < 0.001; hemoglobin: +6.4%, p = 0.026). In conclusion, using HDSF in malnourished older type-2 diabetic patients may allow increasing energy intake while maintaining glucose control and improving nutritional parameters. The use of health-care resources and costs were significantly reduced during the nutritional intervention.

Health factors related to physical activity among children and adolescents: results from Spanish National Health Surveys 2006 and 2011/12.

PURPOSE: To describe the prevalence of physical activity during leisure time among children ages 6-14 in 2006 and 2011/12. DESIGN AND METHODS: A cross-sectional study used individualized data for children 6-14 years of age from the Spanish National Health Surveys in 2006 (n = 5,108 children) and 2011/12 (n = 3,265 children). RESULTS: Leisure time decreased between 2006 and 2011/12(p < .05). Variables associated with increased physical activity were: normal weight (odds ratio [OR] = 1.87; 95% confidence interval [CI]: 1.37-2.57), children perceived to be in good health by their parents (OR = 2.03;95% CI: 1.43-2.87), and less than 2 hr of screen time per day(OR = 2.00; 95% CI: 1.61-2.47). PRACTICE IMPLICATIONS: Primary care-based nurses are essential to improving adherence to physical activity.

Assessment of ovarian cycles in the African elephant (Loxodonta africana) by measurement of salivary progesterone metabolites.

Monitoring ovarian cycles through hormonal analysis is important in order to improve breeding management of captive elephants, and non-invasive collection techniques are particularly interesting for this purpose. However, there are some practical difficulties in collecting proper samples, and easier and more practical methods may be an advantage for some institutions and/or some animals. This study describes the development and validation of an enzymeimmunoassay (EIA) for progestins in salivary samples of African elephants, Loxodonta africana. Weekly urinary and salivary samples from five non-pregnant elephant cows aged 7-12 years were obtained for 28 weeks and analyzed using EIA. Both techniques correlated positively (r = 0.799; P < 0.001), and the cycle characteristics obtained were identical. The results clearly show that ovarian cycles can be monitored by measuring progestins from salivary samples in the African elephant. This is a simple and non-invasive method that may be a practical alternative to other sampling methods used in the species.

Manejo de la medicación en el adulto mayor al alta hospitalaria / Medication management in the elderly at discharge

Objetivo: Identificar el manejo de la medicación en el adulto mayor al alta hospitalaria de una institución privada de Monterrey, N.L. México y su asociación con las características individuales edad, escolaridad, sexo y polifarmacia. Material y método: Diseño descriptivo correlacional, muestra de 162 adultos mayores seleccionados a través de un muestreo probabilístico sistemático. Se utilizó el instrumento MedMaIDE para identificar deficiencias en el manejo de la medicación en el adulto mayor. Resultados: La media de medicamentos prescritos fue de 7 (DE= 3.33); un 26.5% de los participantes presentaron al menos una deficiencia en el manejo de su medicación. Los resultados fueron similares para hombres y mujeres, las deficiencias se asociaron con la edad (rs =0.240; p = 0.001), escolaridad (rs= -0.158; p = 0.04) y polifarmacia (rs= 0.370; p =0.001). Conclusión: Se encontró un déficit en la medicación de los adultos mayores. Estos resultados deben ser considerados en el desarrollo de intervenciones dirigidas a garantizar que el plan de alta incluya educación para el manejo de la medicación en el hogar.

Objective: Identify the medication management in the elderly at discharge from a private institution of Monterrey; NL México and the association with age, education, sex and polypharmacy individual characteristics. Method: A descriptive, correlational design was used with a sample of 162 older adults selected through a systematic probability sampling. The MedMaIDE instrument was used. Results: The average number of drugs prescribed was 7 (SD= 3.33), 26.5% of participants had at least one deficiency in the management of their medication. The results were similar for men and women, the deficiencies were associated with age (rs =0.240; p = 0.001), education (rs= -0.158; p = 0.04), and polypharmacy (rs= 0.370; p =0.001). Conclusion: We found a deficit in the elderly medication. These results should be considered in the development interventions to ensure that the discharge plan includes education for medication management at home.

Perceptions of the safety of oral contraceptives among a predominantly Latina population in Texas.

BACKGROUND: Fear of side effects and previous negative experiences are common reasons for contraceptive nonuse. STUDY DESIGN: We collected information about perceptions of oral contraceptive (OC) safety from 1271 women 18-49 years old in El Paso, TX, and compared their responses to a medical evaluation by a nurse practitioner. We also asked participants about their interest in obtaining OCs over the counter (OTC). RESULTS: Among 794 women potentially at risk of unintended pregnancy, 56.0% said that OCs were medically safe for them. Reasons given for OCs being unsafe were related to fears of side effects and prior negative experiences rather than true contraindications. Older women and participants recruited at the less affluent recruitment site were significantly more likely to report that OCs were medically unsafe for them (p<.05). Nonusers who thought OCs were medically unsafe for them were as likely to be medically eligible for use as current hormonal users. Among nonusers or nonhormonal users and potential OC candidates (n=601), 60.2% said they would be more likely to use OCs if they were available OTC. CONCLUSIONS: Women's perception of OC safety does not correlate well with medical eligibility for use. More education about the safety and health benefits of hormonal contraception is needed. OTC availability might contribute to more positive safety perceptions of OCs compared to a prescription environment.

Assessment of synthetic chimeric multiple antigenic peptides for diagnosis of GB virus C infection.

The use of synthetic peptides of both structural and nonstructural proteins of GB virus C (GBV-C) has been studied for the development of new systems to diagnose infection caused by this virus. In an attempt to increase the antigenicity of linear peptide sequences, chimeric multiple antigenic peptides (MAPs) containing epitopes from E2, NS4, and NS5 GBV-C proteins have been synthesized. The synthetic constructs were evaluated by ELISA to establish whether the epitopes in chimeric branched peptides are more efficiently recognized by the specific antibodies compared to the monomeric linear sequences. Moreover, we have investigated the application of a commercial biosensor instrument for the detection of antibodies against the GBV-C in human serum samples. The results of the immunoassays reported in this work highlight the usefulness of synthetic tetrameric branched peptides containing sequences from envelope and nonstructural GBV-C proteins for the diagnosis of GBV-C infection. The potential clinical value of the MAP(4)(E2-NS5a) for the serodiagnosis of GBV-C infection was demonstrated, thus providing the basis for performing prevalence studies of the infection among the hemodialyzed and hepatitis C virus (HCV)-infected population.