Antifungal prophylaxis against invasive Candida and Aspergillus infection in adult heart transplant recipients: protocol for a systematic review and meta-analysis.

INTRODUCTION: Invasive fungal infections (IFI) can contribute to increased mortality and morbidity rates after heart transplant in adults. The most common causes are Aspergillus and Candida species. There is uncertainty on how effective antifungal prophylaxis is against Candida spp infections and limited guidance on the prevention of Aspergillus spp infections. This systematic review and meta-analysis will assess the literature to see if antifungal prophylaxis reduces the incidence of IFI after heart transplant in adults. METHODS AND ANALYSIS: This systematic review protocol follows the Preferred Reporting Items for Systematic reviews and Meta Analysis guidelines. A systematic search of the Cochrane Library, Web of Science, Scopus, Embase, MEDLINE, and Proquest databases will be undertaken. Reference lists of retrieved publications and conference abstracts will also be searched. Title, abstract and full-text screening will be undertaken by two reviewers. Discrepancies will be resolved by a third reviewer. Studies with paediatric patients, multi-organ transplants, or patients with a second heart transplant will be excluded, along with those who do not have clear definitions and diagnostic criteria for IFI. Risk of bias will be assessed using the Cochrane Risk of Bias 2 tool and the Risk of Bias in Non-randomised Studies of Interventions tool. A meta-analysis will be carried out, but if studies are not deemed to be sufficiently similar, only a narrative synthesis will be undertaken. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review as primary data will not be collected. The results of the review will be disseminated through publication in an academic journal and scientific conferences. PROSPERO REGISTRATION NUMBER: CRD42024516588.

Unlocking the combined action of Mentha pulegium L. essential oil and Thym honey: In vitro pharmacological activities, molecular docking, and in vivo anti-inflammatory effect.

Mentha pulegium L., a plant widely embraced for its therapeutic properties by populations worldwide, including Morocco, has long been recognized for its potential in treating various ailments. This study aims to comprehensively evaluate the antioxidant, anti-inflammatory, and dermatoprotective properties of essential oil derived from M. pulegium, and thyme honey as well as their combined effects. To unravel the chemical composition, a rigorous GC-MS analysis was conducted. Subsequently, we examined their antioxidant potential through three distinct assays: DPPH●, hydrogen peroxide assay, and xanthine oxidase assay. The anti-inflammatory properties were scrutinized through both in vitro and in vivo experiments. Simultaneously, the dermatoprotective efficacy was investigated in vitro by evaluating tyrosinase inhibition. Our findings revealed that pulegone constitutes the predominant compound in M. pulegium essential oil (MPEO), constituting a remarkable 74.82 % of the composition. Significantly, when the essential oil was combined with thym honey, it exhibited superior anti-inflammatory and dermatoprotective effects across all in vivo and in vitro tests. Moreover, our in silico molecular docking analysis hinted at the potential role of cyclohexanone, 3-methyl, an element found in the MPEO, in contributing to the observed outcomes. While this study has unveiled promising results regarding the combined in vitro, in vivo and in silico biological activities of the essential oil and honey, it is imperative to delve further into the underlying mechanisms through additional experimentation and alternative experimental methods. Understanding these mechanisms in greater detail will not only enhance our comprehension of the therapeutic potential but also pave the way for the development of innovative treatments and applications rooted in the synergy of these natural compounds. Furthermore, it would be advantageous to test different possible combinations using experimental design model. Moreover, it would be better to test the effect of single compounds of MPEO to clearly elucidate their efficiency. MPEO alone or combined with thyme honey may be a useful for the development of novel biopharmaceuticals.

Detailed description of multidisciplinary prehabilitation in patients admitted to nerve sparring radical prostatectomy - A randomized feasibility study protocol.

Background: Localized prostate cancer treated with radical prostatectomy is highly effective, though severe side-effects are common after the surgery. Prehabilitation is an approach to optimize patient's physical and mental resources before surgery, to improve postoperative outcomes. The feasibility of a multi-modal home-based prehabilitation program, delivered using telehealth in patients awaiting radical prostatectomy is unknown. This paper describes the development of a prehabilitation program for patients awaiting radical prostatectomy. Method: A model by The Medical Research Council for developing and evaluating complex interventions (MRC Framework) was used in the development process. The Template for Intervention Description and Replication (TIDieR) checklist was applied for ensuring sufficient description of the interventions. A total of 40 patients will be randomized to either intervention or control group. Patients in the control group will follow standard care. The 4-week prehabilitation programme consists of exercise, pelvic floor exercise, sexual counseling, stress management and nutritional support. The interventions are home-based and delivered using telehealth. Feasibility outcomes will include recruitment, attrition rates, adherence, safety and suitability. Conclusion: We have developed a multimodal prehabilitation programme, which has the potential to bring tangible health benefits to men with prostate cancer awaiting radical prostatectomy. The results of the feasibility study will inform the design of a fully powered randomized controlled trial.

Bridging Gaps: Analyzing Breast Imaging-Reporting and Data System (BI-RADS) 0 Rates and Associated Risk Factors in Disproportionally Affected Communities.

Introduction Disparities in access to breast cancer screening led to the creation of the Linda Fenner 3D Mobile Mammography Center (LFMMC), successfully increasing screening for uninsured women in Miami-Dade. However, a higher-than-expected rate of inconclusive mammograms (Breast Imaging-Reporting and Data System (BI-RADS) 0) was found, which could lead to unnecessary procedures, stress, costs, and radiation. Methods In this retrospective cross-sectional study, we analyzed data from 3,044 uninsured women aged over 40 (younger if positive family history of breast cancer) from Miami-Dade without breast symptoms or breast cancer history. Women's demographic characteristics, primary language spoken, body mass index (BMI), use of hormone replacement therapy and birth control, history of benign biopsy, breast surgery, family breast cancer, and menopausal status were assessed as potential risk factors for an inconclusive (BI-RADS 0) screening mammogram result. Multivariable logistic regression analyses were used to evaluate associations. Results The average age of women was 51 years (SD = 9); 59% were White, and 30% were African American. The overall frequency of BI-RADS 0 was 35%. Higher odds of BI-RADS 0 were found for women who were younger, single, premenopausal, and with benign biopsy history. Conversely, obesity and breast implant history decreased the odds of BI-RADS 0. Conclusion We found a high frequency of BI-RADS 0 in the LFMMC sample. Potential reasons include a higher risk for breast cancer or a younger sample of women screened. Future research should explore radiologists' reasoning for assigning BI-RADS 0 results and testing alternative screening strategies for younger women.

Assessment of smoking care by stroke specialists in patients with recent TIA and minor stroke: an international prospective registry-based cohort study.

OBJECTIVES: The objectives are to assess smoking abstinence and its effects on vascular risk and to report tobacco-cessation counselling and pharmacotherapy use in patients who had a recent minor stroke or transient ischaemic attack (TIA). DESIGN AND SETTING: The TIA registry.org project is a prospective, observational registry of patients with TIA and minor stroke that occurred in the previous 7 days with a 5-year follow-up, involving 61 sites with stroke specialists in 21 countries (Europe, Asia, Latin America and Middle East). Of those, 42 sites had 5-year follow-up data on more than 50% of their patients and were included in the present study. PARTICIPANTS: From June 2009 through December 2011, 3847 patients were eligible for the study (80% of the initial cohort). OUTCOMES: Tobacco counselling and smoking-cessation pharmacotherapy use in smoking patients were reported at discharge. Association between 3-month smoking status and risk of a major cardiovascular event (MACE) was analysed with multivariable Cox regression model. RESULTS: Among 3801 patients included, 835 (22%) were smokers. At discharge, only 35.2% have been advised to quit and 12.5% had smoking-cessation pharmacotherapy prescription. At 3 months, 383/835 (46.9%) baseline smokers were continuers. Living alone and alcohol abuse were associated with persistent smoking; high level of education, aphasia and dyslipidaemia with quitting. The adjusted HRs for MACE at 5 years were 1.13 (95% CI 0.90 to 1.43) in former smokers, 1.31 (95% CI 0.93 to 1.84) in quitters and 1.31 (95% CI 0.94 to 1.83) in continuers. Using time-varying analysis, current smoking at the time of MACE non-significantly increased the risk of MACE (HR 1.31 (95% CI 0.97 to 1.78); p=0.080). CONCLUSION: In the TIAregistry.org, smoking-cessation intervention was used in a minority of patients. Surprisingly, in this population in which, at 5 years, other vascular risk factors were well controlled and antithrombotic treatment maintained, smoking cessation non-significantly decreased the risk of MACE.

Low-dose aspirin prophylaxis to prevent hypertensive disorders of pregnancy after in vitro fertilisation: a scoping review protocol.

INTRODUCTION: Pregnancies resulting from in vitro fertilisation are associated with an increased risk of developing hypertensive disorders of pregnancy, such as preeclampsia, when compared with naturally conceived pregnancies. OBJECTIVE: The efficacy of aspirin prophylaxis to reduce the incidence of preeclampsia is well established in naturally conceived pregnancies identified as high risk for developing preeclampsia. However, the efficacy of aspirin to reduce the rate of preeclampsia for all pregnancies resulting from in vitro fertilisation remains uncertain, although in vitro fertilisation conception is a well-known risk factor for preeclampsia. Therefore, the purpose of this scoping review is to provide a comprehensive overview of the current literature regarding the use of low-dose aspirin to prevent hypertensive disorders of pregnancy after in vitro fertilisation. INCLUSION CRITERIA: This review will identify all peer-reviewed published articles including pregnant women who underwent embryo transfer after in vitro fertilisation and were prescribed low-dose aspirin to reduce the risk of hypertensive disorders of pregnancy. METHODS: We have devised a comprehensive search strategy to systematically identify pertinent studies published from January 2000 until May 2024, within the Medline (PubMed interface), Embase and Scopus databases. The search strategy is based on the keywords 'aspirin,' 'pregnancy-induced hypertension,' and ('in vitro fertilization' OR 'oocyte donation' OR 'embryo transfer' OR 'donor conception'). Two reviewers will independently screen the titles, abstracts and full-text articles to select the relevant articles, using the Covidence software. ETHICS AND DISSEMINATION: No patients are involved in this study. This study aims to be published in a peer-reviewed journal and could be presented at a conference.

The CATERPILLAR-study: An assessor blinded randomized controlled trial comparing a taurolidine-citrate-heparin lock solution to a heparin-only lock solution for the prevention of central-line associated bloodstream infections in paediatric oncology patients.

BACKGROUND: Taurolidine-citrate(-heparin) lock solutions (TCHL) are suggested as a promising and safe method for the prevention of central line-associated bloodstream infections (CLABSI). AIM: To investigate the efficacy TCHL for the prevention of CrLABSI in paediatric oncology patients. METHODS: An assessor blinded randomized controlled trial at the Princess Máxima Centre for paediatric oncology, the Netherlands, was performed from 2020-2023. Paediatric oncology patients receiving a tunnelled central venous access device (CVAD) were eligible. A total of 462 patients was required to compare the TCHL to the heparin-only lock (HL). Patients were followed-up for the first 90 days after CVAD insertion. The primary outcome was the incidence of the first CLABSI from CVAD insertion until the end of follow-up. Intention-to-treat and per-protocol analyses were performed. FINDINGS: In total, 232 were randomized in the HL and 231 in the TCHL-group. A total of 47 CLABSIs were observed. The intention-to-treat analysis showed that a CLABSI was observed in 26 (11.2%) of the HL-group patients versus 21 (9.1%) of the TCHL-group patients; incidence rate ratio (IRR) of 0.81 (CI95%0.46-1.45), in favour of the TCHL-group. The per-protocol analysis showed that a CLABSI was observed in 10 (7.9%) of the HL-group patients versus 6 (4.8%) of the TCHL-group patients; IRR of 0.59 (CI95%0.21-1.62) in favour of the TCHL-group. Adverse events were more common in the TCHL-group but rarely reported. CONCLUSION: No difference was detected between the TCHL and HL in the incidence of CLABSI in paediatric oncology patients. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT05740150.

[THE ROLE OF PEDAGOGY IN THE PROFESSIONAL ACTIVITY OF A MODERN DOCTOR].

The relevance of the study of the role of pedagogical knowledge in the professional activity of a modern doctor is due to the reform of the domestic health care system and the reorientation of medical workers from the treatment of diseases to preventive medicine and the promotion of a healthy lifestyle. The purpose of the work is to consider the role of pedagogy in the professional activity of a modern doctor. The article discusses the directions of building a model of interaction between a doctor and a patient. In conclusion, it is concluded that the achievements of pedagogical science, ensuring the harmonious development of personality, are also important for their use in the practical professional activity of a modern doctor, especially from the point of view of teaching patients and educating them to self-preservation behavior. Therefore, pedagogy today plays an important role in the system of training medical personnel and acts as a subject, the study of aspects of which is aimed at integrating pedagogical knowledge into the process of training a modern doctor.

Interactive voice response (IVR) for tobacco cessation: a systematic review.

OBJECTIVE: To summarise the uses, outcomes and implementation of interactive voice response (IVR) as a tobacco cessation intervention. DATA SOURCES: A systematic review was conducted. Searches were performed on 3 May 2023. The strategies used keywords such as "tobacco cessation", "smoking reduction" and "interactive voice recording". Ovid MEDLINE ALL, Embase, APA PsycINFO, CINAHL, Cochrane Library and Web of Science were searched. Grey literature searches were also conducted. STUDY SELECTION: Titles and abstracts were assessed by two independent reviewers. Studies were included if IVR was an intervention for tobacco cessation for adults; any outcomes were reported and study design was comparative. Any abstract included by either reviewer proceeded to full-text review. Full texts were reviewed by two independent reviewers. DATA EXTRACTION: Data were independently extracted by two reviewers using a standardised form. The Risk of Bias Tool for Randomised Trials and the Risk of Bias in Non-Randomised Studies of Interventions tools were used to assess study quality. DATA SYNTHESIS: Of 308 identified abstracts, 20 moderate-quality to low-quality studies were included. IVR was used standalone or adjunctly as a treatment, follow-up or risk-assessment tool across populations including general smokers, hospitalised patients, quitline users, perinatal women, patients with cancer and veteran smokers. Effective studies found that IVR was delivered more frequently with shorter follow-up times. Significant gaps in the literature include a lack of population diversity, limited implementation settings and delivery schedules, and limited patient and provider perspectives. CONCLUSIONS: While the evidence is weak, IVR appears to be a promising intervention for tobacco cessation. However, pilot programmes and research addressing literature gaps are necessary.

Extended high-frequency hearing loss among Afro-Colombian adolescents from a rural area in Colombia: a cross-sectional study.

OBJECTIVES: Research trends concerning hearing loss within teen rural populations are limited and current evidence suggests that extended high-frequency audiometry can be a sensitive tool to detect subclinical hearing loss. Moreover, current research emphasises the importance of representing different ethnic populations in science. This study aimed to determine the prevalence of acquired hearing loss through conventional pure-tone (0.25-8 kHz) and extended high frequency (EHF) (9-20 kHz) audiometry in Afro-Colombian adolescents from a rural area in Colombia. DESIGN: Observational, cross-sectional study. PARTICIPANTS: 230 Afro-Colombian adolescents aged 13-17 years who attended high school in a rural population from Cartagena, Colombia. INTERVENTIONS: Otoscopic examination, conventional (0.25-8 kHz) and EHF (9-20 kHz) audiometry tests were performed during February-March 2021. Sociodemographic and associated factor questionnaires were also applied to assess probable factors associated with EHF hearing loss. MAIN OUTCOME MEASURES: Prevalence of acquired hearing loss using conventional and EHF audiometry, and factors associated with hearing loss. RESULTS: Of 230 adolescents who met the eligibility criteria, 133 (57.82%) were female. The mean age was 15.22 years (SD: 1.62). The prevalence of hearing loss in at least one ear assessed with conventional audiometry was 21.30% and with EHF audiometry 14.78%. The main abnormal otoscopic findings included: neotympanum (1.30%), myringosclerosis (0.87%) and monomeric scars (0.43%). Factors associated with a higher probability of EHF hearing loss found through logistic regression were older age (prevalence ratio (PR): 1.45; 95% CI 1.16 to 1.80), attending the 'Picó' four or more times a month (PR: 6.63; 95% CI 2.16 to 20.30), attending bars more than three times a month (PR: 1.14; 95% CI 1.03 to 1.59) and self-reported hearing difficulties (PR: 1.24; 95% CI 1.22 to 4.05). CONCLUSIONS: Our results suggest that acquired hearing loss is already widespread among this young rural population.

Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: a scoping review of systematic reviews.

BACKGROUND: Musculoskeletal injuries can cause distress, and distress is associated with delayed recovery. Numerous interventions have been developed to facilitate recovery from injury, and several systematic reviews evaluate the efficacy of these interventions for reducing psychological distress. OBJECTIVES: This scoping review aims to map the synthesised evidence for the relationship between treatment interventions and distress-related outcomes following acute injury. The objectives were (1) to describe the types of interventions that have been evaluated in relation to distress-related outcomes following accidental injury, (2) to examine the scope of distress-related outcomes that have been measured in relation to these interventions and (3) to explore the range of clinical professions that deliver these interventions. DESIGN: We searched nine electronic databases and grey literature (to 21 April 2022). We included any systematic review reporting on the relationship between interventions delivered in the time following injury and distress-related outcomes. Data relevant to the specific objectives of this scoping review were extracted and described using narrative synthesis. RESULTS: From 8412 systematic reviews imported for screening, 8266 unique records were screened. 179 were selected for full-text review. 84 systematic reviews were included in the study. Interventional types were pharmacological, psychological, exercise based, physical/manual therapies, virtual reality based, multimodal and workplace based. Interventions were delivered digitally, face to face and using virtual reality by a variety of healthcare professionals, including doctors, nurses, psychologists and physiotherapists. The most frequently reported distress-related variables included anxiety, depression, post-traumatic stress disorder diagnosis. CONCLUSION: A wide range of interventions may help to mitigate distress following acute accidental musculoskeletal or orthopaedic injury. Even interventions that were not designed to reduce distress were found to improve distress-related outcomes. In view of the important role of distress in recovery from injury, it is recommended that distress-related variables are measured as core outcomes in the evaluation of treatments for acute injuries.

Assessing environmental injustice in Kansas City by linking paediatric asthma to local sources of pollution: a cross-sectional study.

OBJECTIVE: A grassroots environmental-justice organisation in Kansas City has been examining the disproportionate exposure to air pollution experienced by residents living fenceline to the largest classification railyard in the USA. Prior analyses showed limited increased risk for asthma exacerbation for patients with asthma living closer to toxic release inventory (TRI) facilities and railyards. In this study, we assessed geographical asthma and environmental disparities, to further explore community-level disparities. DESIGN: This is a cross-sectional study of population-level asthma rates, which included rates for all asthma encounters and acute asthma encounters (urgent care, emergency department, inpatient admission). Distances from census-tract centroids to nearest TRI facilities, railyards and highways were calculated. The association between asthma rates and distances was examined using Kendall's τ correlation and multivariable Poisson regression models. SETTING: We used electronic medical record data from the regional paediatric hospital, census and Environmental Protection Agency (EPA) air monitoring data. PARTICIPANTS: Patients with 2+ asthma encounters during the EPA study timeframe were identified. RESULTS: Residential distance from railyards exhibited a significant negative correlation with overall (-0.36 (CI -0.41 to -0.32)) and acute (-0.27 (CI -0.32 to -0.22)) asthma rates. Asthma rates were elevated among tracts north of the closest railyard (incident rate ratio: 1.38; CI 1.35 to 1.41) when compared with southern directionality. An increased distance from the nearest railyard of 3 km was associated with a decrease in overall asthma rates of 26%. CONCLUSION: Significant negative associations between proximity to all pollution source types and asthma rates were observed. This community-level research has served as a tool for community engagement and will be used to support proposed local policy. Environmental justice work addresses local concerns involving small, limited datasets, if the data exist at all. The academic epidemiological platform may reconsider acceptable approaches to small population research in order to better serve communities with the most need.

Identifying suicidal risk factors in the French Overseas Territories with multimethod psychological autopsy (AUTOPSOM): a mixed-methods study protocol.

INTRODUCTION: Understanding suicide in more isolated territories is a challenge because of the entanglement of cultural identity with historical, geographical and sociocultural specificities. This knowledge is a necessary precondition for the implementation of targeted prevention strategies in regions such as the French overseas territories (FOT), where data concerning suicidal risk factors is still incomplete. We aim to untangle sociocultural and clinical suicide risk factors by integrating a novel anthropological and psycholinguistic approach into the psychological autopsy method. This article describes the protocol of the clinical study 'Contribution of Psychological Autopsy to the Understanding of Suicidal Behaviours in Overseas France' (AUTOPSOM study), designed to identify common or new specific suicide risk factors in four FOT. METHODS AND ANALYSIS: A multicentre epidemiological study will be carried out in four FOTs (French Polynesia, Martinique, La Reunion and French Guiana) and at a comparison site in mainland France (La Somme). The methodology will be based on a mixed-methods (quantitative and qualitative) approach using a psychological autopsy to collect clinical data and life events in the deceased's life. We implemented an exploratory multimethod strategy that combines a succession of epidemiological, anthropological, psycholinguistic and psychological methods with a semiautomated analysis of the discourse of relatives bereaved by suicide. ETHICS AND DISSEMINATION: The study protocol (first version) was approved by the French Ethics Committee (CPP OUEST II, approval #22.04267.000122) and the Ethics Committee of French Polynesia (JOPF of 5 April 2022; CEPF opinion n°91 of 29 March 2022). The overall results and the perspectives established at the end of the study will be communicated to the bereaved relatives according to their will and serve for local suicide prevention purposes. TRIAL REGISTRATION NUMBER: NCT05773898.

Nutrition as a military capability to deliver human advantage: more people, more ready, more of the time.

Soldiers must achieve high-level mission-preparedness to endure extended periods of physical and cognitive activity, with unpredictable recovery, in all environments. Nutrition provides the foundation for health and performance. Militaries have not maximised the strategic and financial value that considering nutrition as a military capability could deliver. A whole system approach to military nutrition, based on the prepare-perform-recover human capability cycle phases, is presented. Trainee nutrition requirements, through to very-high-readiness forces undertaking arduous roles at reach, must be specifically addressed. Promoting military performance diets in the prepare phase, through practitioner-supported nutrition education and food provision, will ensure mission readiness and mitigate ill health. Delivering nutrition in field settings in the perform phase-through smaller/lighter, nutritionally optimised rations and smart packaging technologies-will improve utility and minimise waste. Strategic dietary supplement use can provide a mission performance-enhancing adjunct to a food-first philosophy. Impact value chain analysis of military nutrition capability investments could support cost-benefit measurement.

Place of residence and blood sugar testing practices among men: insights from the 2021 Madagascar demographic and health survey.

BACKGROUND: In 2021, Madagascar had approximately 13,919 people living with diabetes, with 66.1% of cases being undiagnosed. The implication is that this population are at high risk of developing diabetes complications which will affect their quality of life. However, promoting the uptake of screening practices such as the blood glucose test among the asymptomatic population would offer a chance to reduce the prevalence of undiagnosed diabetes in the country. This study examined the association between place of residence and blood sugar testing practices among men in Madagascar. METHODS: Secondary data from the men recode file of the 2021 Madagascar Demographic and Health Survey (MDHS) was used. A sample of 9,035 were used for the analysis. Descriptive and multivariate analyses were performed in STATA version 14. The results are presented in adjusted odds ratio (AOR) with the corresponding 95% confidence interval. RESULTS: Only 5.83% reported to have ever had their blood glucose/sugar tested by a health professional. Residing in rural areas was associated in lower likelihood of undergoing a test to check one's blood sugar level [AOR = 0.23; 95%CI = 0.19-0.28] compared to those in urban areas. This association remained consistent even after adjusting for the effects of covariates [AOR = 0.67; 95%CI = 0.52-0.86]. CONCLUSION: We conclude that place of residence plays a significant role in influencing men's decision to test their blood glucose level. It is, therefore, imperative for the Madagascar Public Health Department to liaise with the government to bridge the rural-urban disparities in terms of accessibility to blood glucose testing services. Practically, this can be achieved by instituting community-based health services centers in the rural areas of Madagascar to mitigate the rural-urban disparities. Also, health education campaigns to raise men's awareness about the need to test their blood glucose level must necessarily target older men, those without formal education, those without health insurance, and men who have been diagnosed with hypertension.

Community Health Benefits Through a Student-Run Nonprofit Pediatric Wellness Clinic.

Purpose Community screening programs have been in effect since they were utilized in the 19th century at county fairs. A free pediatric health screening program was created by an osteopathic medical school in South Carolina in collaboration with a pediatric dental outreach organization to engage the local underserved community and train community-minded medical professionals. This study sought to demonstrate the efficacy and need for a student-run monthly pediatric health screening program in an underserved pediatric demographic. Methods A retrospective study of preexisting de-identified data obtained from a student-run health screening program was analyzed to determine the efficacy of the screening program in detecting chronic health risk factors in children in an underserved population. Patients were recruited through a partnership with a free dental clinic for underserved and uninsured children. Patients who attended the clinic were offered the opportunity to have a free, comprehensive health assessment following their dental visit. The function of this program was unique in that uninsured, underserved patients were provided free dental care and a free health assessment. Pediatric patients were screened for basic health information such as weight, height, BMI, vision, cardiovascular health, hypertension, asthma (reported via questionnaire by either the parent or child when applicable), nutrition, and lead poisoning (via questionnaire). The program also offered families additional support by connecting them to local resources and answering any questions they had about their children's health. Data from 14 health screening events was collected for quality improvement and efficacy monitoring. Descriptive analyses were performed. Results and analysis The health screening program assessed 124 children between October 2021 and March 2023 over 14 health screening events. The patients ranged from one year old to 26 years old, with a mean age of 9.65 years. Patients were predominantly Hispanic (79.67%). About one-third (27.64%) of children who were screened had positive findings associated with increased risk for chronic disease. Nearly half (43.90%) of families that were screened requested further information on ways to obtain health insurance and regular primary care services (utilized Access Health). Of the one-third of children with positive risk factors, 12.20% reported positive findings associated with asthma. Of the patients with positive risk factors, 8.94% had vision abnormalities, most of whom had not been seen by an ophthalmologist. This preliminary analysis will be followed by a secondary analysis that further investigates patient demographics (primarily Hispanic) as well as age distribution across various risk factors. Conclusion This pediatric health screening program has demonstrated a basic level of efficacy by successfully identifying increased risk for chronic disease in the underserved pediatric population. The need for these screening events was highlighted by the identification of untreated positive findings.

Dose-response associations of the American Heart Association's new "Life's essential 8" metrics with all-cause and cardiovascular mortality in a nationally representative sample from the United States.

BACKGROUND: Our aim was to examine the prospective dose-response associations of American Heart Association's (AHA) LIFE's Essential 8 (LE8) score and number of cardiovascular health (CVH) factors with high score with all-cause and cardiovascular disease (CVD) related mortality. METHODS: We pooled 6 consecutive waves of the National Health and Nutrition Examination Survey (NHANES) comprising rounds between 2007 and 2008 and 2017-2018. We calculated hazard ratios (HRs) and conducted restricted cubic splines models to assess the dose-response association of LE8 score and CVH factors with all-cause and CVD mortality. RESULTS: Analyses included 23,531 adults aged 18 years and over (mean [SD] age, 43.6 [16.7] years; 11,979 [51%] female; 8960 [38.1%] non-Hispanic white individuals) with a median follow-up of 7.3 years (IQR 4.3-10.1), corresponding to 168,033 person-years. The dose-response analyses showed a significant inverse curvilinear trend for the association between LE8 score with all-cause and CVD mortality. The optimal risk reduction for all-cause mortality was found at 100 points of the LE8 Score (HR, 0.50; 95% CI, 0.27-0.93) compared to the reference (median LE8 score [62.5 points]). Moreover, the dose-response association between LE8 and CVD mortality also exhibited a significant inverse curvilinear association up to 90 points (HR, 0.41; 95% CI, 0.17-0.99). Optimal levels of LE8 score may be able to avert around 40% of the annual all-cause and CVD deaths among the US adult population. CONCLUSIONS: Best-case scenario of CVH may reduce around 40% of the all-cause and CVD annual mortality among adults in the United States.