Belatacept with time-limited tacrolimus coimmunosuppression modifies the 3-year risk of eplet mismatch in kidney transplantation.

Solid organ transplant donor-recipient eplet mismatch has been correlated with donor-specific antibody (DSA) formation, antibody-mediated rejection, and overall rejection rates. However, studies have been predominantly in patients on tacrolimus-based immunosuppression regimens and have not fully explored differences in ethnically and racially diverse populations. Evidence indicates that patients on belatacept have lower rates of DSA formation, suggesting mediation of the immunogenicity of mismatched human leukocyte antigen polymorphisms. We performed a retrospective, single-center analysis of class II eplet disparity in a cohort of kidney transplant recipients treated using belatacept with tacrolimus induction (Bela/TacTL) or tacrolimus regimens between 2016 and 2019. Bela/TacTL (n = 294) and tacrolimus (n = 294) cohorts were propensity score-matched with standardized difference <0.15. Single-molecule eplet risk level was associated with immune event rates for both groups. In Cox regression analysis stratified by eplet risk level, Bela/TacTL immunosuppression was associated with a decreased rate of DSA (hazard ratio [HR] = 0.4), antibody-mediated rejection (HR = 0.2), and rejection (HR = 0.45). In the low-risk group, cumulative graft failure was lower for patients on Bela/TacTL (P < .02). Analysis of eplet mismatch burden may be a useful adjunct in identifying high-risk populations with increased immunosuppression requirements and should encourage the design of allocation rules to incentivize lower-risk pairings without negatively impacting equity in access.

Soft Wireless Bioelectronics Designed for Real-Time, Continuous Health Monitoring of Farmworkers.

Hotter summers caused by global warming and increased workload and duration are endangering the health of farmworkers, a high-risk population for heat-related illness (HRI), and deaths. Although prior studies using wearable sensors show the feasibility of employing field-collected data for HRI monitoring, existing devices still have limitations, such as data loss from motion artifacts, device discomfort from rigid electronics, difficulties with administering ingestible sensors, and low temporal resolution. Here, this paper introduces a wireless, wearable bioelectronic system with functionalities for continuous monitoring of skin temperature, electrocardiograms (ECG), heart rates (HR), and activities, configured in a single integrated package. Advanced nanomanufacturing based on laser machining allows rapid device fabrication and direct incorporation of sensors with a highly breathable substrate, allowing for managing excessive sweating and multimodal stresses. To validate the device's performance in agricultural settings, the device is applied to multiple farmworkers at various operations, including fernery, nursery, and crop. The accurate data recording, including high-fidelity ECG (signal-to-noise ratio: >20 dB), accurate HR (r = 0.89, r2 = 0.65 in linear correlation), and reliable temperature/activity, confirms the device's capability for multiparameter health monitoring of farmworkers.

Predictors of progression through the cascade of care to a cure for hepatitis C patients using decision trees and random forests.

BACKGROUND: This study uses machine learning techniques to identify sociodemographic and clinical predictors of progression through the hepatitis C (HCV) cascade of care for patients in the 1945-1965 birth cohort in the Southern United States. METHODS: We compared sociodemographic and clinical variables between groups of patients for three care outcomes: linkage to care, initiation of antiviral treatment, and virologic cure. A decision tree model and random forest model were built for each outcome. RESULTS: Patients were primarily male, African American/Black or Caucasian/White, non-Hispanic or Latino, and insured. The average age at first HCV screening was 60 years old, and common medical diagnoses included chronic kidney disease, fibrosis and/or cirrhosis, transplanted liver, diabetes mellitus, and liver cell carcinoma. Variables used in predicting linkage to care included age at first HCV screening, insurance at first HCV screening, race, fibrosis and/or cirrhosis, other liver disease, ascites, and transplanted liver. Variables used in predicting initiation of antiviral treatment included insurance at first HCV screening, gender, other liver cancer, steatosis, and liver cell carcinoma. Variables used in predicting virologic cure included insurance at first HCV screening, transplanted liver, and ethnicity. CONCLUSION: These patients have a high hepatic health burden, likely reflecting complications of untreated HCV and highlighting the urgency to cure HCV in this birth cohort. We found differences in HCV care outcomes based on sociodemographic and clinical variables. More work is needed to understand the mechanisms of these differences in care outcomes and to improve HCV care.

A modified physiological strain index for workplace-based assessment of heat strain experienced by agricultural workers.

BACKGROUND: As global temperatures rise, increasing numbers of individuals will work in hot environments. Interventions to protect their health are critical, as are reliable methods to measure the physiological strain experienced from heat exposure. The physiological strain index (PSI) is a measure of heat strain that relies on heart rate and core temperature but is challenging to calculate in a real-world occupational setting. METHODS: We modified the PSI for use in field settings where resting temperature and heart rate are not available and used the modified physiological strain index (mPSI) to describe risk factors for high heat strain (mPSI ≥ 7) experienced by agricultural workers in Florida during the summers of 2015 through 2017. mPSI was calculated for 221 workers, yielding 465 days of data. RESULTS: A higher heat index (ß = 0.185; 95% CI: 0.064, 0.307) and higher levels of physical activity at work (0.033; 95% CI: 0.017, 0.050) were associated with a higher maximum mPSI. More years worked in US agriculture (-0.041; 95% CI: -0.061, -0.020) were protective against a higher maximum mPSI. Out of 23 workdays that a participant experienced a maximum mPSI ≥ 7, 22 were also classified as strained by at least one other measure of high heat strain (core temperature [Tc] >38.5°C, sustained heart rate >(180 - age), and mean heart rate > 115 bpm). CONCLUSIONS: This study provides critical information on risk factors for elevated heat strain for agricultural workers and suggests a practical approach for using PSI in field-based settings.

Analyzing the predictors of health care utilization in the agricultural worker population using decision tree analysis: Does language matter?

OBJECTIVES: To analyze the predictors of health care utilization among respondents to the National Agricultural Worker Survey. Specifically, we hypothesized that English proficiency would predict utilization of health care services within the last 2 years. METHODS: Using the 2015-2016 National Agricultural Worker Survey, we performed a secondary data analysis to analyze the predictors of health care utilization within the last 2 years in the United States' agricultural worker population. Data were cleaned and analyzed using decision tree analysis, which produced a classification tree model that was trained on 90% of the data and validated on 10%. RESULTS: Exposure to English was not a predictor of health care utilization in our classification tree. The first major partition that predicted utilization was insurance status. Additional partitions were on age, gender, hypertension diagnosis, and public aid. CONCLUSIONS: By partitioning on insurance status and use of public aid, the decision tree provided evidence that systemic factors are key determinants of health care utilization in the agricultural worker community. This highlights the importance of agencies that connect agricultural workers with resources that provide insurance and improve access to health care. This is especially important given that agricultural workers are one of the highest risk groups for occupational injury or death in the United States.

Examining Agricultural Workplace Micro and Macroclimate Data Using Decision Tree Analysis to Determine Heat Illness Risk.

OBJECTIVE: This study was designed to examine the associations between regional weather data and agricultural worksite temperatures in Florida. METHODS: Florida farmworkers (n = 105) were each monitored using iButton technology paired with simultaneous data from regional weather stations. Conditional inference tree models were developed for (1) regional environmental temperatures and iButton (worksite) temperatures, and (2) regional heat index (HI) and iButton HI. RESULTS: Worksite temperatures were partitioned by regional temperature at the primary node of 29.1°C. Worksite HI was partitioned at nodes of 33.0°C, 36.0°C, 37.0°C, and 40.0°C. The nodes at 33.0°C and 40.0°C mirror the National Weather Service's category entry points for "extreme caution" and "danger" regarding the risk of developing heat-related illness. CONCLUSION: Regional weather data have the potential to provide estimations of worksite environmental conditions allowing employers to quickly implement strategies to protect workers.

A Quantitative assessment of a 4-year intervention that improved patient counseling through improving medical student health.

OBJECTIVE: Despite efforts to produce healthier physicians and patients, there are no published experiments where health promotion interventions throughout medical school have been compared with a control group regarding the school environment, students' personal health practices, and students' patient counseling practices. DESIGN: Using the Class of 2002 as controls, we performed a 4-year pilot study of a personal health promotion intervention on the Class of 2003 at Emory University School of Medicine (EUSM). We focused on improving the actual and perceived healthfulness of the educational milieu, and on improving their personal and clinical practices about diet, tobacco, exercise, and alcohol use. Data were collected at freshman and ward orientations and during a senior rotation (n(controls) = 110, 109, 100 and n(treatment) = 114, 104, 106; all response rates greater than 90%). RESULTS: Students receiving the intervention perceived EUSM as a healthier environment than did control students. By senior year, control males reported twice the tobacco use reported by males in the intervention (43% vs 22%, P = .02), although they had previously reported very similar levels (31% vs 29%, P = .8). Diet, exercise, and tobacco counseling practices were positively related to the intervention; alcohol was inversely related to the intervention. CONCLUSIONS: In this pilot, compared with controls, the intervention positively affected medical students' perceptions of their school health promotion environment, reduced tobacco use among male students and, to some extent, improved their patient counseling practices. Such a medical school-based health promotion intervention shows promise and should be studied in a broader setting.

Predictors of US medical students' prevention counseling practices.

OBJECTIVE: To understand predictors of medical students' prevention counseling practices. METHODS: We surveyed medical students (n=2316 individuals) in the Class of 2003 at freshman orientation, and again at entrance to wards and senior year in a nationally representative sample of 16 US medical schools (response rate=80.3%). MAIN OUTCOME MEASURES: Perceived relevance of prevention counseling and seniors' frequency of prevention counseling. RESULTS: Healthier personal practices (p<0.0001), intention to become a primary care practitioner (p=0.0007), and attending a medical school that encouraged healthy personal practices (p=0.002) significantly predicted the frequency with which seniors reported currently counseling patients about preventive interventions (using a validated measure). Perceived counseling relevance was also significantly predicted by intention to become a primary care practitioner (p<0.0001), attending a school that encouraged healthy personal practices (p=0.0007), being earlier in one's training (p<0.0001), more interested in prevention (p<0.0001), female (p<0.0001), non-White (p=0.007), and by having healthy personal practices (p=0.008). CONCLUSIONS: Several of the variables predicting physician counseling also predict US medical students' reporting counseling (especially personal health practices and specialty type). In addition, the avidity with which medical schools encourage students to be healthy significantly influences their reported patient counseling. These findings can give a fresh, evidence-based direction to help create physicians who counsel patients about prevention.

Adverse health consequences that co-occur with depression: a longitudinal study of black adolescent females.

OBJECTIVE: The purpose of this study was to identify adverse health consequences that may co-occur with depression among black female adolescents. METHODS: Adolescents were recruited from high-risk neighborhoods in Birmingham, Alabama. The sample comprised 460 black female adolescents (aged 14-18 years) who completed assessments at baseline and at 6 and 12 months. Only adolescents who consistently scored above the threshold for depression at all 3 assessments (n = 76) or below the threshold at all 3 assessments (n = 174) were included (N = 250) in the data analysis. Within this sample, adolescents who were depressed were compared with those who were not depressed with respect to the following health consequences: low self-esteem, emotional abuse, physical abuse, verbal abuse, poor body image, and antisocial behavior. RESULTS: Using generalized estimating equations and controlling for covariates, depressed adolescents were 5.3 times more likely to report low self-esteem, 4.3 times more likely to report emotional abuse, 3.7 times more likely to report being physically abused, and almost 3 times as likely to report being verbally abused. Furthermore, depressed adolescents were more than twice as likely to report poor body image and nearly twice as likely to report engaging in antisocial behaviors. CONCLUSIONS: The findings suggest that a broad range of adverse health consequences may accompany depression among black female adolescents. Physicians need to be alert to the co-occurrence of depression and low self-esteem; emotional, physical, and verbal abuse; poor body image; and antisocial behaviors among this population.

Validation of a brief diet survey instrument among medical students.

Our objective was to assess the reproducibility and accuracy of fat and of fruit and vegetable items on a 43-item food frequency questionnaire (FFQ) previously self-administered by students at 16 US medical schools. Five in-person, 24-hour recalls were administered between two FFQ administrations to 88 medical students. Reported fat intake decreased from the first (34.7%) to the second (33.1%) FFQ administration ( P <.001); the reproducibility correlation was r =0.63. Fat intake from recalls (28.4%) was lower than that from the FFQ (33.8%, P <.001). The Pearson correlation was r =0.36. Fruit and vegetable servings per day were 3.9 and 3.7 from the first and second FFQ, respectively ( P =.5); the reproducibility correlation was r =0.77. Fruit and vegetable servings were marginally higher from recalls (4.3) than from the FFQ (3.8, P =.06). The Pearson correlation for fruit and vegetable servings was r =0.50. This brief FFQ provides acceptably reproducible and valid estimates of fruit and vegetable servings per day among most groups of medical students, but overestimates fat as a percentage of energy intake.