Social Determinants, Blood Pressure Control, and Racial Inequities in Childbearing Age Women With Hypertension, 2001 to 2018.

Background Hypertension is an important modifiable risk factor of serious maternal morbidity and mortality. Social determinants of health (SDoH) influence hypertension outcomes and may contribute to racial and ethnic differences in hypertension control. Our objective was to assess SDoH and blood pressure (BP) control by race and ethnicity in US women of childbearing age with hypertension. Methods and Results We studied women (aged 20-50 years) with hypertension (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg or use of antihypertensive medication) in the National Health and Nutrition Examination Surveys 2001 to 2018. SDoH and BP control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg) were examined by race and ethnicity (White race, Black race, Hispanic ethnicity, and Asian race). Using multivariable logistic regression, odds of uncontrolled BP by race and ethnicity were modeled, adjusting for SDoH, health factors, and modifiable health behaviors. Responses on hunger and affording food determined food insecurity status. Across women of childbearing age with hypertension (N=1293), 59.2% were White race, 23.4% were Black race, 15.8% were Hispanic ethnicity, and 1.7% were Asian race. More Hispanic and Black women experienced food insecurity than White women (32% and 25% versus 13%; both P<0.001). After SDoH, health factor, and modifiable health behavior adjustment, Black women maintained higher odds of uncontrolled BP than White women (odds ratio, 2.31 [95% CI, 1.08-4.92]), whereas Asian and Hispanic women showed no difference. Conclusions We identified racial inequities in uncontrolled BP and food insecurity among women of childbearing age with hypertension. Further exploration beyond the SDoH measured is needed to understand the inequity in hypertension control in Black women.

Our Whole Lives for Hypertension and Cardiac Risk Factors-Combining a Teaching Kitchen Group Visit With a Web-Based Platform: Feasibility Trial.

BACKGROUND: Hypertension (HTN) affects millions of Americans. Our Whole Lives: an eHealth toolkit for Hypertension and Cardiac Risk Factors (OWL-H) is an eHealth platform that teaches evidence-based lifestyle strategies, such mindfulness and cooking skills, to improve self-management of HTN. OBJECTIVE: The primary goal of this pilot study was to evaluate the feasibility of OWL-H combined with teaching kitchen medical group visits (TKMGVs) in a low-income population of participants with HTN. METHODS: We conducted a pre-post 8-week study to assess the feasibility of a hybrid program (a web-based 9-module self-management program, which includes mindfulness and Mediterranean and Dietary Approaches to Stop Hypertension diet) accompanied by 3 in-person TKMGVs among patients with HTN. Data including demographics, platform use, and satisfaction after using OWL-H were examined. Outcome data collected at baseline and 8 weeks included the Mediterranean Diet Questionnaire, Hypertension Self-Care Profile Self-Efficacy Instrument, Blood Pressure Knowledge Questionnaire, and the number of self-reported blood pressure readings. For the statistical analysis, we used descriptive statistics, paired sample t tests (1-tailed), and qualitative methods. RESULTS: Of the 25 enrolled participants, 22 (88%) participants completed the study. Participants' average age was 57 (SD 12.1) years, and 46% (11/24) of them reported a household income

Developing a curriculum to improve cardiology fellows' training in pregnancy and cardiovascular disease.

BACKGROUND: Exposure to pregnant women with cardiovascular disease (CVD) during cardiology fellowship training is limited and without a standard curriculum in the United States. The authors sought to evaluate a dedicated curriculum to teach management of CVD in pregnancy to improve general cardiology fellowship training. METHODS: The authors developed a dedicated CVD in pregnancy curriculum for the general cardiology fellows at a large academic medical center in the fall of 2019. Fellows' knowledge was assessed via a board-style examination and exposure and attitudes related to the care of pregnant women with CVD were evaluated with a needs assessment questionnaire before and after the curriculum. RESULTS: Of the 17 fellows who participated in the curriculum, 12 completed the needs assessment pre-curriculum and 9 post-curriculum. The mean (SD) number of pregnant women with CVD cared for by each fellow in the inpatient and outpatient settings were 0.75 (1.29) and 0.56 (0.73), respectively. After the curriculum, all fellows reported awareness of available resources to treat pregnant women with CVD, while a majority disagreed that they receive regular exposure to pregnant patients with CVD in their training. The authors observed significant increases in fellows' confidence in their knowledge of normal cardiovascular physiology of pregnancy, physical exam skills, and ability to care for pregnant women with valvular disease and arrhythmias from pre to post-curriculum. A total of 15 fellows completed the board-style exam pre-curriculum and 15 post-curriculum. Fellows' performance on the board-style examination improved slightly from before to after the curriculum (64.0 to 75.3% correct, p = 0.02). CONCLUSIONS: A dedicated curriculum improved cardiology fellows' knowledge to recognize and treat CVD in pregnancy and improved confidence in caring for this unique patient population.

Cystic fibrosis and sinusitis in children: outcomes and socioeconomic status.

OBJECTIVES: Although chronic sinusitis is prevalent in children with cystic fibrosis (CF), little is known regarding pulmonary outcomes following endoscopic sinus surgery (ESS). Furthermore, lower socioeconomic status (SES) is associated with increased morbidity in children with CF. The investigators evaluated the impact of surgery and SES on pulmonary function tests (PFTs) in children with CF and rhinosinusitis. STUDY DESIGN: Longitudinal, retrospective cohort study. SETTING: Urban tertiary CF center. SUBJECTS AND METHODS: Children with CF ages 0 to 21 evaluated for sinusitis between 1998 and 2008 were analyzed. Children were grouped according to surgery status (ESS or no ESS). Medicaid (MA) insurance was used as a proxy for lower SES. PFTs (percent predicted forced vital capacity [FVC%predicted] and percent predicted forced expiratory volume in 1 second [FEV1%predicted]) were recorded over years. Multivariate linear regression models and interaction terms (ESS and MA) were used to analyze PFTs. RESULTS: Of 62 patients evaluated, 21 (34%) underwent ESS, and 16 (26%) had MA. Polyps were more common in the ESS group (86% vs 32%, P < .001). FEV1%predicted and FVC%predicted were lower at all times for children with MA (P < .001). After adjustment for MA, mean FEV1%predicted was higher for the ESS group at all time points (P < .02), and mean FVC%predicted was higher at 1 and 2 years (P = .02, P = .01). Compared with the nonsurgical group, children without MA undergoing ESS had higher mean FEV1%predicted at all 3 follow-up visits (P ≤ .05).Children with MA who underwent ESS had higher mean FVC%predicted at 1 year (P = .04) and higher mean FEV1%predicted preoperatively and at 1 year (P ≤ .01). CONCLUSIONS: Children with CF and sinusitis who undergo ESS experience some increase in PFTs over time, although this change is not uniform. Children with CF and sinusitis who are from lower socioeconomic backgrounds have lower PFTs over time regardless of surgical intervention.