The COVID-19 pandemic created significant disruptions in the diagnosis and treatment of breast cancer (BC). Several public health measures were taken with limited evidence on their potential impact. In this observational study, we sought to compare the incidence of BC, treatment patterns, and mortality during 2020 versus 2018 and 2019.

Using the Surveillance, Epidemiology, and End Results program, we identified 37,834 patients with ductal carcinoma in situ (DCIS) and 199,594 with invasive BC between 2018 and 2020. We assessed age-adjusted incidence rates of DCIS and invasive BC as cases per 100,000, treatment patterns, and mortality in 2020 versus 2018 and 2019.

From 2019 to 2020, the incidence of female DCIS decreased from 36.4 to 31.0, and the incidence of female invasive BC decreased from 184.2 to 166.6. Among females, the relative reductions in incidence from 2019 to 2020 were 14.8% for DCIS, 12.1% for stage I, 5.8% for stage II, 2.6% for stage III, and 1.9% for stage IV. Comparing 2020 to 2018-2019 in invasive BC, we observed significant changes in treatment patterns with decreased use of surgery or radiation and increased use of chemotherapy. The 12-month mortality rates were 4.49%, 4.37%, and 4.57% for 2018, 2019 and 2020, respectively. In the Cox model, there were no significant differences in mortality between patients diagnosed in 2020 versus 2018 or 2019.

During 2020, the incidence of BC decreased significantly. There were reductions in surgery and radiation use, but not in chemotherapy. Although vaccines were largely unavailable and COVID-19 treatments were in development, we saw no differences in 12-month mortality in 2020 versus prior years. The impact on BC-specific outcomes requires further follow-up.

The coronavirus disease-2019 (COVID-19) pandemic caused disruptions in cancer screening and diagnosis, including colorectal cancer. Given disparities in cancer and COVID-19 faced by historically disadvantaged minorities, we examined changes in disparities in colorectal cancer screening and diagnosis in the COVID era.

In a cohort study using the Veterans' Affairs Health Care System (VAHCS) from 2018 through 2021, we quantified colonoscopies, fecal occult blood tests (FOBT), and new diagnoses of colorectal cancer (CRC) by month from 1 March 2018 to 31 December 2021. We compared the pre-COVID (before 1 March 2020) to the COVID (1 March 2020 and after) era. We graphed temporal trends by age, sex, race, ethnicity, rural-urban, and socioeconomic status (SES). Logistic regression was used to evaluate temporal trends after adjusting for confounders.

During the study period, there were about 900,000 colonoscopies, 1.4 million FOBTs, and > 30,000 new diagnoses of CRC. Colonoscopies and new CRC decreased dramatically during the early COVID era to < 10% and < 60% of pre-COVID rates, respectively. Although we identified a modest increase in disparities of colonoscopy use among Black and Latino patients in the early COVID era, these increased disparities did not persist in adjusted analysis. We did not identify changes in disparities in FOBT use or new CRC diagnoses.

We did not identify increased disparities in CRC screening or diagnoses by age, sex, race, ethnicity, geographic region, or SES in the VAHCS. These results indicate a potential strength of the VAHCS and require further study in additional cancers and healthcare systems.

The study aimed to examine the association between self-perceptions of aging (SPA) and delayed and/or forgone care (DFC) among older adults in the US during the COVID-19 pandemic, and to assess how SPA and DFC are associated with change in self-rated health status. A cross-sectional study of community-dwelling US adults (≥50 years) was conducted using the 2020 Health and Retirement Study data. Two separate multivariable logistic regression models were conducted to assess the study objectives. The final unweighted sample was 4079. Negative SPA were associated with DFC (adjusted odds ratio (aOR): 1.03, 95% CI: 1.01-1.04). DFC and negative SPA were associated with worsened health status compared to respondent's previous interview wave (aOR: 1.44, 95% CI: 1.10-1.87 and aOR: 1.06, 95% CI: 1.04-1.08, respectively). Health promotion efforts should be implemented to foster positive SPA among older adults in the US to encourage timely use of healthcare.

The legalization of cannabis for both recreational and medicinal purposes in numerous states across the United States has resulted in increased accessibility and usage rates. With Tetrahydrocannabinol (THC) potency in cannabis products on the rise, concerns regarding associated health implications, including syncope, have emerged.

This study aims to explore the prevalence and characteristics of cannabis-associated syncope among adolescents and young adults presenting to emergency departments (EDs).

Utilizing data from the National Electronic Injury Surveillance System (NEISS) from 2019 to 2022, a cross sectional study was employed. The sample consisted of adolescents and young adults aged 15-24 years presenting with cannabis-associated injuries, and also screened for syncope.

Cases of cannabis-associated injuries were identified, and those presenting with syncope were analyzed. Epidemiological analyses were conducted to estimate prevalence ratios (PR).

Among the study sample of individuals aged 15-24, 24,922 presented with cannabis-associated injuries, with 5400 of those also screening positive for syncope. The majority of injuries treated were to the head and neck, with falls being the most prevalent mechanism of injury. Comparisons between syncopal and non-syncopal injuries revealed distinct clinical profiles, with approximately 21.7 % of cannabis-associated injuries accompanied by syncope. Moreover, the prevalence of syncope among cannabis users was found to be significantly elevated compared to non-cannabis users (PR = 8.6, 95 % CI 7.1-10.2).

Syncope is a prevalent condition among adolescents and young adults seeking treatment in emergency departments for cannabis-associated injuries. The clinical relevance of cannabis associated syncope as it pertains to cardiovascular anomalies needs further study. As cannabis legislation, usage patterns, and products continue to evolve, a well informed medical care community will be essential.

We aimed to assess the clinical and epidemiological impacts of the coronavirus disease 2019 pandemic on the number of ophthalmology outpatient department (oOPD) visits. PubMed and EMBASE were searched for literature published between January 1, 2020, and December 5, 2022. The extracted data were pooled using a random-effects model. The primary outcome was the number of oOPD visits. Of the 335 screened articles, 21 and 16 were included in the qualitative and quantitative syntheses, respectively. Among the 16 studies included in the meta-analysis, 7 involving 4,204,209 individuals reported the number of oOPD visits during the pandemic. Compared with the number of pre-pandemic visits, the numbers of oOPD visits declined to 58.1% (95% confidence interval [CI], 0.378-0.784) and 29.8% (95% CI 0.130-0.465) during the pandemic and lockdown, respectively. The proportions of female patient visits decreased from 50.9 to 47.8% and from 48.3 to 42.3% during the pandemic and lockdown, respectively. The proportions of adult visits increased from 86.3 to 89.6% and decreased from 90.6 to 80.1% during the pandemic and lockdown, respectively. The decrease in oOPD visits during the pandemic may have caused delays in diagnosis and treatment, potentially exacerbating the existing ocular diseases.

This study investigates the perceived accessibility of healthcare services among older adults in Lithuania during the COVID-19 pandemic. The study is significant as it sheds light on geographical, organizational, and financial healthcare access issues encountered by the older population.

Conducted in January 2024, the study involved an anonymous questionnaire survey of 1,503 Lithuanian residents aged 65 and older.

The most frequently utilized healthcare services were consultations with a general practitioner (75.4%) 22.0% of respondents reported not receiving any healthcare services. 53.5% respondents were satisfied with travel time to specialists. Common challenges included difficulties in getting appointments with specialists (53.9%) and dentists (36.2%). Financial barriers led to unmet healthcare needs: 12.6% of the respondents did not receive needed services, 12.8% did not undergo recommended tests, and 14.2% did not purchase prescribed medications. Healthcare services were less accessible to elders with lower education, lower incomes, and those who self-rated health poorly (p < 0.05).

Most respondents received the healthcare they needed during the pandemic and rated geographical access positively. However, some problems in organizational and financial access were disclosed. The observed social gradient indicates that socioeconomic factors significantly influence healthcare access, potentially increasing vulnerability among certain groups.

Hand form and function play a vital role in daily living, and even minor trauma can significantly impair quality of life. There is a current paucity of data regarding hand burn patient and injury characteristics, particularly in urban areas in the United States. As the field of hand surgery expands, a demographic understanding of patients with severe injury potentially requiring surgical management is imperative. The aim of this study was to define the epidemiological characteristics of burn injuries involving the hand that were admitted to a large New York City burn center.

A retrospective review of the electronic health record was conducted to identify all patients admitted to our burn center with burn injury involving the hand from August 2020 to December 2023. Patient demographics, injury etiology and characteristics, and hospital course details were recorded and analyzed.

We identified 96 admitted patients with 140 hand burn injuries, with a patient median age of 38 years. Female patients presented to the hospital significantly later after initial injury than male patients and were more likely to suffer from flame-related injury. The median length of stay for initial admission was 17.5 days, with longer length of stay associated with hypertension comorbidity. Patients experiencing homelessness demonstrated higher rates of psychiatric disorder, substance use, and current smoking. Length of follow-up was positively correlated with estimated household income. Compared to the general city population, the patient cohort was made up of a lower percentage of "White alone" and "Asian alone" race categories and higher percentage of persons experiencing homelessness.

We report the clinical and social characteristics of burn patients with hand involvement admitted to a large urban burn center. Hand burn injuries have distinct risk factors and morbidity implications, and consideration for higher-risk groups is imperative for optimal prevention, acute management, and long-term support.

This study examined the effects of direct-to-consumer alcohol home delivery (DTC) policies enacted in response to the COVID-19 pandemic on online searches for alcohol delivery and alcohol-related harms in the United States.

Google Trends data (2019-2023) were used to assess weekly relative search volume (RSV) for three terms reflecting 1) DTC and 2) potential harms associated with expanded DTC: alcohol delivery, alcohol poisoning, and alcoholic. RSV for each term was extracted for states representing four DTC policy contexts (no DTC [South Carolina], no change in existing DTC policy [Pennsylvania], new DTC policy [Georgia], expanded DTC policy [California]). Interrupted times series analyses evaluated the effect of time and policy implementation on RSV in states introducing or expanding DTC policies, while linear regressions evaluated the effect of time where DTC policies did not change.

There was a significant positive effect of time on RSV for alcohol delivery in the state that introduced a new DTC policy (β = 0.1, p = 0.02), with RSV declining over time following policy implementation (β = -0.1, p = 0.001). In the state that expanded DTC policy, alcohol delivery RSV increased immediately after policy expansion (β = 20.9, p < 0.001) and declined in subsequent months (β = -1.5, p < 0.001). RSV for alcohol-related harms fluctuated across states.

Online search interest related to alcohol delivery and harms varied post-DTC policy implementation. These findings highlight the potential of search trends to provide real-time insights into public health impacts of evolving alcohol policies.

The threats to human health from wildfires and wildfire smoke (WFS) in the United States (US) are increasing due to continued climate change. A growing body of literature has documented important adverse health effects of WFS exposure, but there is insufficient evidence regarding how risk related to WFS exposure varies across individual or community level characteristics. To address this evidence gap, we utilized a large nationwide database of healthcare utilization claims for emergency department (ED) visits in California across multiple wildfire seasons (May through November, 2012-2019) and quantified the health impacts of fine particulate matter <2.5 μm (PM2.5) air pollution attributable to WFS, overall and among subgroups of the population. We aggregated daily counts of ED visits to the level of the Zip Code Tabulation Area (ZCTA) and used a time-stratified case-crossover design and distributed lag non-linear models to estimate the association between WFS and relative risk of ED visits. We further assessed how the association with WFS varied across subgroups defined by age, race, social vulnerability, and residential air conditioning (AC) prevalence. Over a 7 day period, PM2.5 from WFS was associated with elevated risk of ED visits for all causes (1.04% (0.32%, 1.71%)), non-accidental causes (2.93% (2.16%, 3.70%)), and respiratory disease (15.17% (12.86%, 17.52%)), but not with ED visits for cardiovascular diseases (1.06% (-1.88%, 4.08%)). Analysis across subgroups revealed potential differences in susceptibility by age, race, and AC prevalence, but not across subgroups defined by ZCTA-level Social Vulnerability Index scores. These results suggest that PM2.5 from WFS is associated with higher rates of all cause, non-accidental, and respiratory ED visits with important heterogeneity across certain subgroups. Notably, lower availability of residential AC was associated with higher health risks related to wildfire activity.

To explore the receipt of mental health education, assessment, and referrals, and mental health service use among individuals with vestibular disorders. Patients with vestibular disorders living in the US, Australia, Canada, and the UK were surveyed through social media forums. Questionnaires assessed demographics, anxiety (Generalized Anxiety Disorder-7), depression (Center for Epidemiological Studies Depression-10), dizziness (Dizziness Handicap Inventory), and type of professional providing mental health education, assessment, referral, and treatment. The 226 participants were largely White (90%), educated (67% holding an associate's degree or higher) women (88%) with an average age of 45 who self-identified as having chronic vestibular symptoms (78%), as opposed to episodic ones (22%). Fifty-two percent reported never receiving verbal education, written education (69%), mental health assessment (54%), or referral (72%). Participants were more likely to receive mental health treatment in the past if they had received verbal resources and/or referrals from clinicians. The majority of patients with vestibular disorders report that medical professionals have not provided education, mental health assessment, or a mental health referral.

The COVID-19 pandemic significantly disrupted healthcare services as individuals avoided medical facilities to reduce the risk of infection. Despite Taiwan's effective public health measures and low SARS-CoV-2 case numbers in 2020, emergency department (ED) utilization patterns still changed, particularly for cases with acute ischemic heart events. This study investigated how the pandemic influenced medical avoidance in such cases and assessed potential collateral damage and adverse outcomes in an ED that managed limited COVID-19 instances during this period.

An observational cross-sectional study was conducted on adult ED visits at a tertiary hospital from January 2017 to December 2020, focusing on symptoms associated with acute ischemic heart events and complications. Data was retrospectively collected from electronic medical records (EMRs), including demographics, clinical characteristics, visit times, discharge times, disposition types, triage levels, International Classification of Diseases-9th Revision (ICD-9) and International Classification of Diseases-10th Revision (ICD-10)-based diagnoses, and vital signs.

The study observed a 20-30% decline in adult ED visits in 2020, with a notable 29% decrease in semi-urgent (level 3) triage visits from February to May. The largest declines occurred among patients aged 80 and above, with reductions up to 44.4% in March. Acute ischemic heart cases decreased in early 2020 but rebounded by April and May. However, acute ischemic heart-related complications increased consistently throughout the year, particularly in January (61% vs 77%, p=0.02) and October (59% vs 77%, p=0.04).

These findings highlight the indirect impact of the pandemic on critical care access, even in regions with low prevalence. Medical avoidance reduced ED visits but increased the risk of complications of acute ischemic heart. Addressing barriers to timely care and implementing targeted response strategies are essential to ensure access to life-saving treatments and mitigate long-term adverse health consequences during public health crises.

To examine differences between patients treated in integrated systems of care and patients treated outside of such systems during the COVID pandemic in the use of primary and preventive care, emergency services, inpatient services, and mortality.

Data are used from all enrollees in traditional Medicare aged 66 and older.

Difference-in-differences estimates are calculated from the pre-COVID time period (January 2019-February 2020) to the initial COVID time period (March-May 2020) and the ongoing COVID time period (June 2020-December 2021) for patients treated by primary care physicians working in a health system versus not, and by the type of health system.

Medicare claims data are used to measure monthly claims for office and telehealth visits, mammography, colon cancer screening, inpatient/emergency department visits, and death. Patients are assigned to primary care physicians using common algorithms. Physician membership in a health system is determined from a previously generated dataset.

Relative to the pre-COVID period, patients treated in health systems fared no better in maintaining primary care access than patients treated outside of such systems (DID estimate on receipt of office care or telehealth visit = -4%; p < 0.001). In the ongoing COVID time period, non-COVID mortality rose by less in health systems (DID estimate = -0.9%; p < 0.001) and health system patients experienced a greater decline in the use of the emergency department (DID estimate = -1.2%; p < 0.001) and emergency/urgent inpatient care for non-COVID conditions less (DID estimate = -0.7%; p < 0.001).

Health systems were associated with reduced occurrence of death and adverse medical events, although the effect magnitudes are modest. This reduction appears unrelated to the use of primary care and should be considered in the context of our evolving understanding of the advantages and disadvantages of health systems.

Background/Objectives: The COVID-19 pandemic impacted healthcare systems globally, disrupting the management and treatment of acute ischemic stroke (AIS). Understanding how AIS admissions, treatments, and outcomes were affected is critical for improving stroke care in future crises. The objective of this work was to assess the COVID-19 pandemic's impact on AIS admissions, treatment patterns, complications, and patient outcomes in the U.S. from 2016 to 2021, focusing on differences between pre-pandemic (2016-2019) and peri-pandemic (2020-2021) periods. Methods: This is a retrospective cohort study using the National Inpatient Sample (NIS) database, analyzing weighted discharge records of AIS patients over six years. Data encompass U.S. hospitals, including urban, rural, teaching, and non-teaching facilities. The study included AIS patients aged 18 and older (N = 3,154,154). The cohort's mean age was 70.0 years, with an average hospital stay of 5.1 days and an adjusted mean cost of $16,765. Men comprised 50.5% of the cohort. We analyzed temporal trends in AIS hospitalizations from 2016 to 2021, comparing pre- and peri-COVID-19 periods. The primary outcome was the AIS admissions trend over time, with secondary outcomes including reperfusion therapy utilization, intubation rates, discharge disposition, and complications. Trends in risk factors and NIH Stroke Scale (NIHSS) severity were also evaluated. Results: AIS admissions rose from 507,920 in 2016 to 535,694 in 2021. Age and sex distribution shifted, with a growing proportion of male AIS cases (from 49.8% to 51.4%) and a decrease in mean age from 70.3 to 69.7 years. Although not statistically significant, White patients were the majority (68.0%), though their proportion declined as Black, Hispanic, and Asian/Pacific Islander cases increased. Reperfusion therapy, especially mechanical thrombectomy, rose from 2.2% to 5.6% over the study period. Intubation rates increased from 4.8% pre-COVID-19 to 5.5% peri-COVID, with higher rates among COVID-positive patients. NIHSS severity declined over time, with severe strokes (NIHSS ≥ 16) decreasing from 14.5% in 2017 to 12.6% in 2021. Conclusions: The COVID-19 pandemic brought significant shifts in AIS patterns, with younger, more diverse patients, increased reperfusion therapy use, and rising complication rates. These changes underscore the importance of resilient healthcare strategies and resource allocation to maintain stroke care amid future public health emergencies.

The coronavirus pandemic was a major event that severely disrupted the health care system in the USA. Understanding the impact, especially among socioeconomically disadvantaged individuals, is necessary for informing health care and public health policy. This study evaluates changes in adequate prenatal care (PNC) across education levels after the 2020 pandemic.

The key outcome was adequate PNC utilization using the Kotelchuck index. A repeated cross-sectional study of before and after the COVID pandemic among individuals with low educational attainment compared to those with a college degree or above was used to estimate changes in adequate PNC use.

A decrease in adequate PNC use after 2020 was greater (-4.4%) for less than high school graduation, compared to higher education levels (-2.0% to -0.8%). The difference in adjusted changes reaffirmed that having less than high school graduation was associated with a greater decrease in adequate PNC by -3.7 percentage points (95%CI -5.8, -1.5) compared to obtaining college degrees after 2020.

Disparities in access to care are persistent and further deteriorate among individuals of low educational attainment after the 2020 pandemic. An innovative, robust healthcare model is vital to reduce barriers to and disparities in access to care.

Heart disease poses a significant health and economic burden in the U.S., with considerable variations in outcomes across different racial and ethnic groups. The COVID-19 pandemic has further highlighted the disparities in healthcare utilization and costs associated with heart disease.

The authors used the 2021 Merative MarketScan Medicaid claims database to estimate the medical costs and healthcare utilization associated with heart disease by racial and ethnic groups and COVID-19 diagnosis status. This study focused on individuals aged ≥18 years continuously enrolled in a noncapitated insurance plan in 2021. The outcome measures included total medical expenditures and healthcare utilization, including the numbers of emergency department visits and inpatient admissions and length of inpatient stay. The authors employed a generalized linear model with a family of gamma and log links for medical costs, and a negative binomial regression was used for healthcare utilization. Three-way interactions of heart disease, COVID-19 diagnosis, and race and ethnicity categories were implemented after adjusting for age, sex, and comorbidities. The authors reported average marginal effects with 95% CIs.

Among 1,008,166 Medicaid beneficiaries, 8% had heart disease in 2021. The cost associated with heart disease was $10,819 per beneficiary in 2021 (95% CI=10,292; 11,347; p<0.001). The cost was $15,840 (95% CI=14,389; 17,291; p<0.001) for non-Hispanic Black individuals; $9,945 (95% CI=9,172; 10,718; p<0.001) for non-Hispanic White; and $8,511 (95% CI=7,490; 9,531; p<0.001) for Hispanic individuals. Individuals with a COVID-19 diagnosis ($19,638) had $9,541 (95% CI=7,049; 12,032; p<0.001) higher costs associated with heart disease than those without COVID-19 ($10,098) (p<0.001). Individuals with heart disease had higher numbers of emergency department visits (0.937 per beneficiary, 95% CI=0.913; 0.960), inpatient admissions (0.463 per beneficiary, 95% CI=0.455; 0.471), and average length of stay (2.541 days per admission, 95% CI=2.405; 2.677) than those without heart disease.

The study's findings showed that costs and healthcare utilization associated with heart disease are substantial in all racial and ethnic groups and the highest among non-Hispanic Black individuals. Furthermore, individuals with a COVID-19 diagnosis had approximately 2 times higher costs associated with heart disease than individuals without a COVID-19 diagnosis.

Previous studies have shown an increase in blood pressure during the coronavirus disease 2019 (COVID-19) pandemic even among patients receiving antihypertensive treatment. This study aims to evaluate the association between equivalized annual household income and refraining from regular medical visits for hypertensive patients since the COVID-19 outbreak. We analyzed data from the Japan COVID-19 and Society Internet Survey (JACSIS), including 2832 hypertensive patients aged 20-79 years from the 2020 survey and at least one survey between 2021 and 2023. They were categorized into lower-income ( Collapse

The threat of the H5N1-influenza virus prompts reflection on COVID-19 pandemic experiences. This paper integrates insights from a first responder using the Cynefin framework to advocate for an adaptive strategic approach to future pandemics. Balancing individual freedoms with containment measures serves to leverage the human capital needed for rapid learning and resource distribution. The Cynefin framework aids in understanding complex problem-solving dynamics which involve varying degrees of order and chaos. Hierarchies in the ordered world support heterarchies which explore the unordered world. Both operate within scale free human systems which must adapt to existential challenges such as pandemics. Experience leading to knowledge and understanding occurs simultaneously at all dimensions of human existence. Ultimately, adaptive leadership and decentralized decision-making, supported by the best available knowledge, enable effective pandemic management and restoration of normal societal functions.

Filipinos in the U.S. have worse colorectal cancer screening rates and outcomes than non-Hispanic Whites, despite 85% of Filipinos being proficient in English and having insurance rates, education, and incomes that exceed those of the general population. To begin to address this disparity, the authors used conjoint analysis-a method that assesses complex decision making-to better understand Filipinos' preferences for the different colorectal cancer screening test options.

The authors conducted a conjoint analysis survey among unscreened Filipinos aged ≥40 years at average risk for colorectal cancer to determine the relative importance of screening test attributes in their decision making (e.g., modality, effectiveness at reducing colorectal cancer risk, bowel prep). The authors also performed simulations to estimate the proportion of people who would prefer to do an annual fecal immunochemical test or colonoscopy every 10 years for their screening.

Overall, 105 Filipinos completed the survey; most respondents were female (74.3%) and aged 40-49 years (84.8%). The authors observed that test modality was the most important factor in respondents' decision making. After conducting simulations using the conjoint analysis data, the authors noted that 70 (66.7%) Filipinos preferred to do an annual fecal immunochemical test for their screening, whereas 35 (33.3%) wanted to do a colonoscopy every 10 years.

The authors found that 2 in 3 Filipinos prefer fecal immunochemical test to colonoscopy for their colorectal cancer screening. To address colorectal cancer disparities in the Filipino community, investigators, health systems, public health agencies, and community organizations need to develop culturally tailored, sustainable interventions, and such programs may want to focus on improving education on and access to fecal immunochemical test.

Cerebrovascular disease (CEVD) accounts for the second leading cause of death worldwide. Despite recent advancements in treatment strategies, the prevalence and cost associated with CEVD are rising. Atherosclerosis significantly contributes to CEVD risk by restricting cerebral blood flow, leading to ischemic stroke. This study aims to analyze trends in atherosclerosis-associated CEVD mortality in the United States from 1999 to 2020 to inform targeted prevention and management strategies.

We examined death certificates sourced from the CDC WONDER database, from 1999 to 2020 to identify atherosclerosis-associated CEVD mortality. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes were reported.

A total of 325,401 deaths occurred from CEVD among adults with atherosclerosis from 1999 to 2020 in the US. The overall AAMR initially inclined from 10.9 in 1999 to 12.6 in 2001, followed by a decrease to 4.2 in 2016, and then a rise till 2020 was observed. Males had consistently higher AAMRs than females throughout the study period (Men = 11.9 vs Women = 10.1). When stratified by race, AAMRs were highest among non-Hispanic (NH) Whites (6.9), followed by NH American Indian/Alaska Native (10.9), NH Blacks/African Americans (6.6), Hispanics (4.9), and lastly by Asian/Pacific Islanders (4.2). The Western region had the highest mortality (AAMR: 7.7).

The CEVD mortality rates of adults with atherosclerosis- are increasing in the adult U.S.

This underscores the need for increased screening, aggressive management, and subsequent surveillance of patients at risk.

Previous studies have demonstrated lower total joint arthroplasty utilization rates and worse postoperative outcomes among non-White patients. Our study examined whether these disparities exist in the setting of a diverse population.

This retrospective study included patients with a self-reported race who underwent total knee (TKA) or hip (THA) arthroplasty procedures in a racially diverse county. Patients who did not identify as White or Hispanic/Latino were excluded from the study due to small sample sizes. Demographic, intra and postoperative outcome differences were calculated. A multivariate logistic regression was developed to examine the association between patients' race and undesired postoperative outcomes.

Five hundred fifty-five patients were included in our study with 490 identifying as non-Hispanic/Latino White (88.8%) and 65 as Hispanic/Latino (11.2%). Hispanic/Latino-identifying patients were significantly younger (61.9 ± 12.79 versus 68.58 ± 9.00 years), had lower Charlson Comorbidity Index scores, and were more likely to use non-Medicare/Medicaid insurance. We observed no differences between our cohorts in postoperative adverse events, emergency department visits, and hospital readmissions. Patients' self-identified race was not correlated with undesired postoperative outcomes.

Although Hispanic/Latino-identifying patients constitute 50.2% of the county population of our study cohort, they accounted for only 11.2% of the patients in our study. This is noteworthy considering the lack of evidence suggesting a decreased prevalence of osteoarthritis among individuals of different races and ethnicities. Further, the demographic differences we observed suggest an exclusive Hispanic/Latino patient population utilizing TKA or THA procedures. Future studies controlling for risk factors and less invasive treatment options may explain these disparities.

Given the continued disruption of the coronavirus disease 2019 (COVID-19) pandemic throughout 2021, we aimed to assess for continued implications of the altered healthcare landscape on non-small cell lung cancer (NSCLC) presentation and treatment in the second year of the pandemic.

This was a retrospective cohort study using the United States National Cancer Database (2019-2021). Demographic, cancer-related, and treatment variables were compared between patients diagnosed in the pre-pandemic year [2019], pandemic-year-one [2020], and pandemic-year-two [2021]. Multivariate logistic regression was performed to control for the impact of demographics on oncologic variables, and then for the impact of oncologic variables on treatment modalities and outcomes.

Of 376,193 NSCLC cases, 135,649 (36.1%) were pre-pandemic, 119,338 (31.7%) were pandemic-year-one, and 121,206 (32.2%) were pandemic-year-two. Compared to the pre-pandemic year, patients diagnosed in pandemic-year-two had risk-adjusted increases in clinical T stage [odds ratio (OR) =1.017; 95% confidence-interval (CI): 1.003-1.031], N stage (OR =1.048; 95% CI: 1.033-1.063), M stage (OR =1.044; 95% CI: 1.028-1.060), and overall stage (OR =1.038; 95% CI: 1.023-1.052). Additionally, compared to the pre-pandemic year, patients diagnosed in pandemic-year-two continue to see risk-adjusted increases in time from diagnosis to staging (OR =1.044; 95% CI: 1.017-1.072), to first treatment (OR =1.143; 95% CI: 1.133-1.154), to surgery (OR =1.117; 95% CI: 1.093-1.141) and to systemic therapy (OR =1.021; 95% CI: 1.924-1.039).

Compared to the pre-pandemic year, patients diagnosed with NSCLC in the United States during pandemic-year-two continue to present at later clinical stage and experience delays to treatment. The oncologic and treatment characteristics of NSCLC have not returned to pre-pandemic baseline in the United States, possibly due to compounding delays to diagnosis and treatment and a growing back log of cases.

Evidence to guide the application of damage control laparotomy (DCL) in emergency surgery patients is limited. We assessed whether DCL use for emergent small bowel or colon surgery increased over time and its impact on outcomes. We hypothesized that DCL would be utilized more often in patients with significant comorbidities or septic shock with improved outcomes.

National Surgical Quality Improvement Program (NSQIP) data on DCL patients from 2014 to 2020 were used. Endpoints were incidence of DCL, in-hospital mortality, hospital length of stay (LOS), complications, and 30-day readmission over time. P-values < 0.05 were considered statistically significant.

DCL incidence increased over time (OR = 1.07 [1.05-1.08], p < 0.001). Presence of pre-operative septic shock increased over the years (OR = 1.04 [1.01-1.07], p = 0.007). Mortality, readmission, and post-operative septic complications did not change over the study period. Average LOS significantly decreased over time (OR = 0.93 [0.92-0.95], p < 0.001).

The odds of a surgeon using DCL increased by 7% each year. Although pre-operative septic shock incidence increased, LOS decreased over time while mortality remained unchanged.

In the United States, Black and Hispanic patients have substantially worse maternal outcomes than non-Hispanic White patients. The goals of this study were to evaluate the association between the coronavirus disease-2019 (COVID-19) pandemic and maternal outcomes, and whether Black and Hispanic patients were disproportionately affected by the pandemic compared to White patients.

Multivariable logistic regression was used to examine in the United States the association between maternal outcomes (severe maternal morbidity, mortality, failure-to-rescue, and cesarean delivery) and the weekly hospital proportion of COVID-19 patients, and the interaction between race, ethnicity, payer status, and the hospital COVID-19 burden using US national data from the Vizient Clinical Database between 2017 and 2022.

Among 2484,895 admissions for delivery, 457,992 (18.4%) were non-Hispanic Black (hereafter referred to as Black), 537,867 (21.7% were Hispanic), and 1489,036 (59.9%) were non-Hispanic White (hereafter referred to as White); mean (standard deviation [SD]) age, 29.9 (5.8). Mortality (adjusted odds ratio [AOR], 2.72; 95% confidence interval [CI], 1.28-5.8; P = .01) and failure-to-rescue (AOR, 2.89; 95% CI, 1.36-6.13, P = .01), increased during weeks with a COVID-19 burden of 10.1% to 20.0%, while rates of severe maternal morbidity and cesarean delivery were unchanged. Compared to White patients, Black and Hispanic patients had higher rates of severe maternal morbidity ([Black: OR, 1.97; 95% CI, 1.85-2.11, P < .001]; [Hispanic: OR, 1.37;95% CI, 1.28-1.48, P < .001]), mortality ([Black: OR, 1.92; 95% CI, 1.29-2.86, P < .001]; [Hispanic: OR, 1.51;95% CI, 1.01-2.24, P = .04]), and cesarean delivery ([Black: OR, 1.58; 95% CI, 1.54-1.63, P < .001]; [Hispanic: OR, 1.09;95% CI, 1.05-1.13, P < .001]), but not failure-to-rescue. Except for Black patients without insurance (1.3% of the patients), the pandemic was not associated with increases in maternal disparities. Odds of mortality (AOR, 1.96; 95% CI, 1.22-3.16, P = .01) and failure-to-rescue (AOR, 3.67; 95% CI, 1.67-8.07, P = .001) increased 2.0 and 3.7-fold, respectively, in Black patients without insurance compared to White patients with private insurance for each 10% increase in the weekly hospital COVID-19 burden.

In this national study of 2.5 million deliveries in the United States, the COVID-19 pandemic was associated with increases in maternal mortality and failure-to-rescue but not in severe maternal morbidity or cesarean deliveries. While the pandemic did not exacerbate disparities for Black and Hispanic patients with private or Medicaid insurance, uninsured Black patients experienced greater increases in mortality and failure-to-rescue compared to insured White patients.

Senility has been shown to negatively impact health outcomes. While national stressors have altered death trajectories for numerous diseases, little is known about the impact of the COVID-19 pandemic on senility-related outcomes.

To evaluate the impact of the COVID-19 pandemic on senility-related mortality in the United States.

This is a retrospective analysis of US decedents with documented senility-related death using the CDC WONDER database. We estimated annual trends in senility-related age-adjusted mortality rates (AAMR) from 1999 to 2020 using log-linear regression models. Calculation of excess deaths attributable to the COVID-19 pandemic was completed by comparison of actual 2020 mortality rates and estimated 2020 mortality using average annual percentage changes.

A total of 510 819 senility-related deaths were identified. AAMR declined by 9.76%, from 7.48 in 1999 to 6.75 deaths per 100 000 in 2020. Year 2020 showed a marked increase in mortality, with 1.13 excess deaths per 100 000 population attributable to the COVID-19 pandemic. The COVID-19 pandemic contributed to an additional burden of mortality across both sexes, resulting in an estimated 1.18 and 0.99 per 100 000 excess deaths among females and males, respectively. The excess death rates per 100 000 for Black, White, Asian/Pacific Islander, and American Indian/Alaska Native populations were 1.84, 1.05, 0.99, and 1.16, respectively. The impact on US census regions was reflected in excess death rates, with the Northeastern, Midwestern, Southern, and Western regions seeing 1.27, 1.27, 1.39, and 0.31 excess deaths per 100 000, respectively.

These findings suggest that the pandemic had an association with excess senility-related mortality. Further investigation is warranted to identify factors that impact senility-related outcomes.

As the COVID-19 pandemic emerged in March 2020, the New York State Office of Mental Health received funding from the Federal Emergency Management Agency to implement the agency's Crisis Counseling Assistance and Training Program statewide. Because COVID-19 infections were disproportionately affecting minority communities of color, engagement strategies that prioritized contracting with community agencies that were already well established in the most highly affected racial-ethnic minority neighborhoods were used. This approach to outreach successfully made engagement and counseling support available to Black and Hispanic citizens, at levels significantly exceeding their proportional representation in the state population. These efforts identify an opportunity for a postpandemic paraprofessional workforce to address general medical health and mental health inequities in underresourced racial-ethnic minority communities.

Peripheral artery disease (PAD) affects >12 million Americans and poses significant financial burdens on patients, but the relationship between delayed/forgone (D/F) care and resource use in this population is unknown. We sought to assess the relationship between D/F care, resource use, and health care expenditures among patients with PAD.

Adults with PAD in the United States were identified in the Medical Expenditure Panel Survey for years 2007 to 2017. Unweighted counts of reasons for D/F care were tabulated. Proportions of patients with ≥1 emergency department (ED), ≥1 inpatient, ≥1 outpatient, and >5 office-based encounters were compared using Rao-Scott adjusted χ2 tests. Annual per capita total, out-of-pocket, ED, inpatient, outpatient, office-based visits, and prescription medication expenditures were compared using two-part econometric models.

The study cohort included 2,926,654 patients with PAD. Among the 264,172 patients with PAD (9%) reporting D/F care, 41.2% of patients cited financial barriers as the primary reason for D/F care. There were greater proportions of patients with ≥1 ED visits (52% vs 31%; P < .001), ≥1 outpatient hospital visits (56% vs 43%; P = .004), and >5 office-based visits (81% vs 71%; P = .04) among those reporting D/F care vs those who did not. Patients with D/F care had $7742 (95% confidence interval, $3170-$12,314; P = .001) greater per capita total and $5156 (95% confidence interval, $692-$9,619; P = .02) greater per capita inpatient expenditures per year than patients without D/F care.

D/F care is associated with increased resource use and health care expenditures among patients with PAD. Further work is needed to elucidate the underlying causes of D/F care and mitigate financial burdens on patients with PAD.

Annual mammography screening declined year-on-year during the COVID-19 pandemic through 2021. This study examined changes in 2022 compared with 2018 in the national prevalence of self-reported up-to-date mammography.

Using 2018 to 2022 data from the Center for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, we assess relative changes defined as annual prevalence ratios (aPR) in the SR receipt of past-year and up-to-date (UTD) breast cancer screening (biannual mammography in women of ages 50-74 years) during the third year of the COVID-19 pandemic overall and by sociodemographic characteristics.

UTD breast cancer screening declined for the first time since 2018 [2018 compared with 2022, from 78.7%-76.6%; aPR, 0.97; 95% confidence interval (CI), 0.96-0.98] despite a small increase in past-year breast cancer screening from 2020 to 2022 (57.9%-59.6%; aPR, 1.03; 95% CI, 1.01-1.05). This translated to 747,791 fewer women reporting UTD with recommended breast cancer screening in 2022 versus 2018. UTD breast cancer screening declines between 2018 and 2022 were largest for American Indian/Alaska Native women (74.8%-62.2%; aPR, 0.83; 95% CI, 0.74-0.93), women with less formal educational attainment (< high school: 73.1%-65.5%; aPR, 0.9; 95% CI, 0.85-0.95), and women without a usual source of care (48%-42.9%; aPR, 0.85; 95% CI, 0.78-0.92).

Previously noted pandemic-related declines in past-year breast cancer screening now reflect in women reporting being UTD, with the largest declines in American Indian/Alaska Native women and those with lower socioeconomic status.

Future studies should monitor screening prevalence in relation to breast cancer diagnostic stage overall and by sociodemographic groups.

Medical-legal partnerships (MLPs) are innovative, promising models that integrate legal service providers and medical professionals to prevent, detect, and address legal, social, and economic needs arising from social inequities that may negatively impact health. The COVID-19 pandemic impacted health care systems across the United States. MLP workflows and legal services were also interrupted by COVID-19 infection prevention and control measures such as no-visitor policies, social distancing, and the cancellation of non-emergent or routine health care services.

We sought to describe the impact of COVID-19 on legal services provided by an MLP by exploring case types and services provided prior to the COVID-19 pandemic and during the pandemic.

This is an examination of MLP services provided at a Midwestern academic medical center comparing data from three years prior to the pandemic (2017-2019) to three years during the pandemic (2020-2022).

The MLP is a collaboration between the University of Nebraska Medical Center/Nebraska Medicine (an academic medical center) and Legal Aid of Nebraska and Iowa Legal Aid (legal service providers).

Case data was drawn from individuals who were MLP patient-clients between 2017 and 2022.

The main outcome measures were the number of cases and categories and types of legal services provided by the MLP.

Consistent across time, we found that on average 494 cases were closed each year. Consumer/finance cases decreased significantly from pre-COVID-19 to during the pandemic, while family cases increased significantly during the pandemic. Cases related to income maintenance increased across time.

Through the COVID-19 pandemic experience and understanding the case mix, MLPs and health care champions can be better prepared to understand some of the challenges that may occur and changes that may be necessary to better serve patient-clients during a public health emergency.

The COVID-19 pandemic provided an ideal scenario for studying the care of the elderly population, we implemented a tool named the Geriatric Measure (GM) tool to determine the severity and need for hospitalization. The objective of the study is to evaluate if the results of a brief Geriatric Measure tool are associated with mortality and other outcomes among older adults with COVID-19 treated in the emergency department. Retrospective observational cohort study. Participants were older adults (65 years and over) who required hospitalization for SARS CoV2 pneumonia. Patients were evaluated with the GM tool and were followed-up until death or discharge and associations between GM tool scores and mortality and other outcomes were assessed. A total of 275 patients were included. The proportion of patients who died increased with every category of the GM tool. Patients in category 1 (fit with good functional status) had a mortality of 24.7% versus those in category 4 (frail with poor functional status) who had a mortality of 51%. Our results show an association between our GM tool and mortality among older adults with pneumonia caused by SARS CoV2 and treated in the emergency department, and highlight the need of individualizing care for older patients.

Little is known about how the COVID-19 pandemic affected cancer screenings among American Indian people residing in California and Oklahoma, 2 states with the largest American Indian populations. We assessed rates and factors associated with cancer screenings among American Indian adults during the pandemic.

From October 2020 through January 2021, we surveyed 767 American Indian adults residing in California and Oklahoma. We asked participants whether they had planned to obtain screenings for breast cancer, cervical cancer, and colorectal cancer (CRC) from March through December 2020 and whether screening was postponed because of COVID-19. We calculated adjusted odds ratios (AORs) for factors associated with reasons for planned and postponed cancer screening.

Among 395 participants eligible for breast cancer screening, 234 (59.2%) planned to obtain the screening, 127 (54.3%) of whom postponed it. Among 517 participants eligible for cervical cancer screening, 357 (69.1%) planned to obtain the screening, 115 (32.2%) of whom postponed it. Among 454 participants eligible for CRC screening, 282 (62.1%) planned to obtain CRC screening, 80 of whom (28.4%) postponed it. In multivariate analyses, women who lived with a child (vs did not) had lower odds of planning to obtain a breast cancer screening (AOR = 0.6; 95% CI, 0.3-1.0). Adherence to social distancing recommendations was associated with planning to have and postponement of cervical cancer screening (AOR = 7.3; 95% CI, 0.9-58.9). Participants who received (vs did not receive) social or financial support had higher odds of planning to have CRC screening (AOR = 2.0; 95% CI, 1.1-3.9).

The COVID-19 pandemic impeded completion of cancer screenings among American Indian adults. Interventions are needed to increase the intent to receive evidence-based cancer screenings among eligible American Indian adults.

The Health Resources and Services Administration (HRSA) began collecting data on intimate partner violence (IPV) and human trafficking (HT) in the 2020 Uniform Data System (UDS). We examined patients affected by IPV and HT served by HRSA-funded health centers in medically underserved US communities during the COVID-19 pandemic.

We established a baseline and measured trends in patient care by analyzing data from the 2020 (N = 28 590 897) and 2021 (N = 30 193 278) UDS. We conducted longitudinal ordinal logistic regression analyses to assess the association of care trends and organization-level and patient characteristics using proportional odds ratios (PORs) and 95% CIs.

The number of clinical visits for patients affected by IPV and HT decreased by 29.4% and 88.3%, respectively, from 2020 to 2021. Health centers serving a higher (vs lower) percentage of pediatric patients were more likely to continuously serve patients affected by IPV (POR = 2.58; 95% CI, 1.01-6.61) and HT (POR = 6.14; 95% CI, 2.06-18.29). Health centers serving (vs not serving) patients affected by IPV were associated with a higher percentage of patients who had limited English proficiency (POR = 1.77; 95% CI, 1.02-3.05) and Medicaid beneficiaries (POR = 2.88; 95% CI, 1.48-5.62), whereas health centers serving (vs not serving) patients affected by HT were associated with a higher percentage of female patients of reproductive age (POR = 15.89; 95% CI, 1.61-157.38) and urban settings (POR = 1.74; 95% CI, 1.26-2.37).

The number of clinical visits for patients affected by IPV and HT during the COVID-19 pandemic declined. Delayed care will pose challenges for future health care needs of these populations.

The literature highlights the importance of the needs of family members of critical patients in emergency departments. Understanding these needs helps to alleviate psychological distress and contribute to the patients' recoveries. This study aimed to examine the psychological distress and needs of family members of critical patients in emergency departments.

A cross-sectional design was used to collect data using the Depression, Anxiety, and Stress Scale-21, the Critical Care Family Needs Inventory for the Emergency Department, and the Needs Met Inventory questionnaire from a convenience sample of 170 family members of critical patients. Descriptive analysis and importance-performance analysis were applied to analyze the data.

The results showed that 52.4% of family members reported mild to extremely severe levels of depression, 60% reported mild to extremely severe levels of anxiety, and 53.5% had mild to extremely severe levels of stress. Anxiety showed a significant negative correlation with comfort needs (r = -0.17) and support needs being met (r = -0.16). The importance-performance analysis showed that the coordinates for support needs were in quadrant IV, signifying a higher level of importance perceived by family members but a lower level of the needs being met.

Providing the assessment and necessary support to alleviate psychological distress will help enhance the ability of the emergency department to meet families' needs.

To address the extent to which Federally Qualified Health Centers (FQHCs) and independent and provider-based Rural Health Clinics (RHCs) were using telehealth prior to and during the COVID-19 pandemic.

A nationally representative 5% sample of Medicare Fee-for-Service beneficiaries who used outpatient services at FQHCs and RHCs were identified within the 2019-2021 5% Medicare Limited Data Set Outpatient and Carrier files. Rural-Urban Continuum Codes were used to identify rural-urban clinic locations. Logistic regression included three-way interaction terms for time, rurality, and clinic type.

Telehealth use curbed the decline in outpatient visits for all clinic types during the pandemic. Telehealth use declined as the pandemic continued in 2021 yet remained higher than pre-pandemic levels. FQHCs had higher telehealth use (18%-31%) than RHCs (8%-14%) in 2020-2021. Across all years, tele-behavioral health was the primary venue for originating and distant site providers. Overall, 19%-34% of originating site providers were psychiatrists and 10%-31% were primary care providers. Likely due to patients sheltering-in-place (at home), 2020-2021 distant site providers were largely primary care providers. Urban FQHCs experienced the largest increase in telehealth use during the pandemic (24.6% increase in urban, 14.4%-15.8% in rural) followed by rural ID_RHCs (10.2%-11.7%). RHCs were less likely to provide telehealth services than FQHCs during the pandemic.

Telehealth played a key role in facilitating access to health services during the height of the pandemic (2020-2021). Telehealth flexibilities were associated with greater telehealth use among FQHCs and RHCs but did not make up for the overall decline in health service use.

In this article we explore how people who experienced a stroke, transient ischaemic attack, or heart attack sought health care during the COVID-19 lockdown periods. Semi-structured interviews were conducted with 27 patients admitted to hospital between March 2020 and May 2021, and one carer who was recruited from cardiac and stroke rehabilitation services in two large acute NHS trusts in England. Drawing on concepts of candidacy, illness and moral work, we discuss how people's sense-making about their symptoms fundamentally shaped both their decisions about seeking help and the impact of COVID-19 on help seeking. Risk perception and interactional ritual chain theory allow further exploration of constructing symbols of national identity in times of crises, managing risk and levels of acceptable risk and critique of ambiguous national messaging over accessing health-care services for people with emergency health-care needs. Our findings have wider implications for supporting access into health care for those with life-threatening conditions under highly publicised strain on the health system, including winter pressure and staff strikes, as well as policymaking and public messaging.

To analyze the influence of daily activity-related factors associated with COVID-19 infection on the occurrence of acute angle closure (AAC).

A multicenter hospital-based study was conducted at 23 ophthalmic centers in 17 provincial-level regions across China to recruit patients with confirmed AAC during the post-lockdown time of COVID-19 (P-TOC) from Dec 7, 2022, to Jan 17, 2023, and three lockdown time of COVID-19 (TOC) periods, which included the TOC-2022 (Sep 7, 2022 - Dec 6, 2022), TOC-2021(Sep 7, 2021 - Jan 6, 2022) and TOC-2020 (Sep 7, 2020 - Jan 6, 2021). Patient information, including demographic, a questionnaire on daily activity changes during the AAC period, COVID-19 history, and eye examination results, was collected.

The study involved 3216 AAC cases, with 76.2% being female and 78.9% aged over 60 years. AAC occurrences during P-TOC was nearly tripled compared to the corresponding months in TOC-2021 and TOC-2020. Patients with AAC comorbidity and COVID-19 had significantly higher water intake (37.3% vs. 2.2%, p < 0.001) and poorer sleep quality (49.16% vs. 4.07%, p < 0.001) than those without COVID-19 comorbidity, while about 58.4% of these patients received antipyretic analgesic drugs for symptom management. The COVID-19 group showed higher intraocular pressure as well as worse uncorrected distance visual acuity, when compared to non-COVID-19 patients.

The relationship between AAC occurrence and daily activity factors associated with COVID-19 suggests that patient management should account for changes in daily activities.

"Medical deserts" are areas with low healthcare service levels, challenging the access, quality, and sustainability of care. This qualitative narrative review examines how artificial intelligence (AI), particularly large language models (LLMs), can address these challenges by integrating with e-Health and the Internet of Medical Things to enhance services in under-resourced areas. It explores AI-driven telehealth platforms that overcome language and cultural barriers, increasing accessibility. The utility of LLMs in providing diagnostic assistance where specialist deficits exist is highlighted, demonstrating AI's role in supplementing medical expertise and improving outcomes. Additionally, the development of AI chatbots offers preliminary medical advice, serving as initial contact points in remote areas. The review also discusses AI's role in enhancing medical education and training, supporting the professional development of healthcare workers in these regions. It assesses AI's strategic use in data analysis for effective resource allocation, identifying healthcare provision gaps. AI, especially LLMs, is seen as a promising solution for bridging healthcare gaps in "medical deserts," improving service accessibility, quality, and distribution. However, continued research and development are essential to fully realize AI's potential in addressing the challenges of medical deserts.

Mental health disorders have historically accounted for significant morbidity, health care provision, disability, and attrition from military service. From 2019 through 2023, a total of 541,672 active component service members of the U.S. Armed Forces were diagnosed with at least 1 mental health disorder. Crude annual incidence rates of at least 1 mental health disorder decreased from 2019 to 2020, but then increased continually from 2021 until 2023. Most incident mental health disorder diagnoses during the study period were attributable to adjustment disorders, anxiety disorders, depressive disorders, 'other' mental health disorders, and alcohol-related disorders. Efforts to assist and treat service members should continue to promote help-seeking behavior to improve their psychological and emotional well-being and reduce the burden of mental health disorders, especially as rates have been increasing since the COVID-19 pandemic. Annual incidence rates for service members diagnosed with at least 1 mental health disorder increased from 2021 through 2023, coincident with the COVID-19 pandemic. Incidence rates for anxiety disorder and post-traumatic stress disorder increased substantially from 2019 to 2023, nearly doubling during that period.

Background: Diabetes and hypertension are major global health challenges aggravated by COVID-19's impact on healthcare and lifestyle factors. This study aims to compare the prevalence and associated socio-demographic factors of these conditions before and after the pandemic (2019 vs. 2022). Materials and Methods: We used data from Italy's "Aspects of Daily Life" survey; 74,294 adults were included. Results: Results show a rise in diabetes prevalence from 7.76% in 2019 to 8.49% in 2022 (p < 0.05), while hypertension did not show this. Logistic regression analysis for the years 2019 and 2022 revealed a statistically significant association between the year 2022 and increased odds of diabetes (OR = 1.08, p = 0.008). BMI's role as a risk factor intensified, with higher odds ratios (ORs) for both conditions in overweight and obese individuals in 2022. For example, obesity-related ORs for diabetes increased from 2.45 (95%CI 1.73-3.47) in 2019 to 3.02 (95%CI 2.09-4.35) in 2022, and for hypertension from 2.86 (95%CI 2.28-3.58) to 3.64 (95%CI 2.87-4.61). Lower education levels also showed a greater association with hypertension risk in 2022; subjects with only middle or high school diplomas had significantly higher ORs than individuals with higher education; there was a non-significant trend in 2019. However, diabetes risk associated with lower education remained stable and significant in both years. Conclusions: These findings suggest that the pandemic may have increased risk factors for diabetes and hypertension, particularly BMI and educational level, compared with the literature on the increased burden of chronic diseases during COVID-19.

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Early detection via routine CRC screening can significantly lower risks for CRC-specific morbidity and mortality. Public health initiatives between 2000 and 2015 nearly doubled CRC screening rates for some US adults. However, screening rates remain lowest for adults aged 45-49 years (20%), patients of safety net health care facilities (42%), adults without insurance (44%), and other subgroups compared with national averages (72%). Given the evolving landscape of digital health care and trends in web-based health information-seeking behaviors, leveraging online medical record (OMR) systems may be an underutilized resource to promote CRC screening utilization. Recognizing trends in OMR usage and patient demographics may enhance digital inclusion-a key social determinant of health-and support equitable web-based interventions aimed at boosting CRC screening across diverse populations.

This study examined the association of accessing an OMR with CRC screening utilization and corresponding sociodemographic characteristics of US adults.

In 2023, we conducted a secondary data analysis using a pooled, weighted sample from Health Information National Trends Survey (HINTS) 5 cycles, 2, 3, and 4 (2018-2020), a nationally representative survey assessing how US adults access and use health-related information. We analyzed the association between sociodemographic characteristics, medical conditions, OMR access, and CRC screening behaviors via logistic regression.

The sample included adults aged 45-75 years (N=5143). The mean age was 59 (SD 8) years for those who reported CRC screening and 52 (SD 6) years for those never screened. Nearly 70% (4029/5143) of participants reported CRC screening and 52% (2707/5143) reported OMR access in the past year. Adjusted odds of CRC screening were higher among non-Hispanic African American or Black adults than among non-Hispanic White adults (odds ratio [OR] 1.76, 95% CI 1.22-2.53), adults who accessed an OMR (OR 1.89, 95% CI 1.45-2.46), older individuals (OR 1.18, 95% CI 1.16-1.21), the insured (OR 3.69, 95% CI 2.34-5.82), and those with a professional or graduate degree versus those with a high school diploma or less (OR 2.65, 95% CI 1.28-5.47). Individuals aged 65-75 years were significantly more likely (P<.001) to be screened (1687/1831, 91%) than those aged 45-49 years (190/610, 29%).

Promoting OMR access, especially among the most disadvantaged Americans, may assist in reaching national screening goals. Emphasis should be placed on the mutability of OMR use compared with most other statistically significant associations with CRC screening behaviors. OMR access provides an intervenable means of promoting CRC education and screening, especially among those facing structural barriers to cancer diagnoses and care. Future research should focus on tailored and accessible interventions that expand OMR access, particularly for younger populations.

Measures to curb the spread of SARS-CoV-2 impacted not only COVID-19 dynamics, but also other infectious diseases, such as dengue in Brazil. The COVID-19 pandemic disrupted not only transmission dynamics due to changes in mobility patterns, but also several aspects of surveillance, such as care seeking behavior and clinical capacity. However, we lack a clear understanding of the overall impact on dengue in different parts of Brazil and the contribution of individual causal drivers. In this study, we estimated the gap between expected and observed dengue cases in each Brazilian state from March to April 2020 using an interrupted time series design with forecasts from machine learning models. We then decomposed the gap into the contributions of pandemic-induced changes in disease surveillance and transmission dynamics, using proxies for care availability and care seeking behavior. Of 25 states in the analysis, 19 reported fewer dengue cases than predicted and the gap between expected and observed cases was largely explained by excess under-reporting, as illustrated by a reduction in observed cases below expected levels in early March 2020 in several states. A notable exception is the experience in the Southern states, which reported unusually large dengue outbreaks in 2020. These estimates of dengue case counts adjusted for under-reporting help mitigate some of the data gaps from 2020. Reliable estimates of changes in the disease burden are critical for anticipating future outbreaks.

While the lasting effect of the COVID-19 pandemic continues to unfold, the impact on adolescents undergoing bariatric surgery remains unseen.

We examined the impact of the pandemic on adolescents undergoing metabolic bariatric surgery.

Academic hospital, New York, NY.

A single-institution review of prospectively collected data evaluated adolescents who underwent laparoscopic sleeve gastrectomy between 2010 and 2023, forming two cohorts: pre-COVID (before March 1, 2019) and COVID (after March 1, 2020). Absolute and percent weight loss and body mass index (BMI) change at 6 and 12 months postsurgery were compared between cohorts. Multivariable linear regression models were constructed to estimate the association between weight loss, adjusting for age, gender, ethnicity, and BMI.

A total of 358 patients were included: 245 in the pre-COVID cohort and 113 in the COVID cohort. There were no significant differences in baseline characteristics. There were no significant differences between cohorts at 6 months in weight loss (21.6 kg vs. 22.5 kg, P = .43), percent weight loss (18% vs. 18%, P = .63), and BMI change (8.0 vs. 8.4, P = .39) which was maintained at 12 months. In multivariate models, after adjusting for age, gender, ethnicity, and baseline BMI, undergoing surgery during the pandemic was not associated with a difference in weight loss or BMI change at 6 and 12 months postoperatively.

Despite the severe societal impact of the COVID-19 pandemic, laparoscopic sleeve gastrectomy remained a durable intervention for adolescent obesity, with no observed differences in weight loss in patients undergoing surgery during the pandemic compared to prepandemic.

The objective of this study is to identify variables associated with clinical outcomes after urologic transfers before and during the COVID pandemic.

After IRB approval, a retrospective chart review was performed on adult patients transferred to our institution from 01/01/2018 to 12/31/2019 ("pre-COVID") and from 01/02/2020 to 12/31/2022 ("COVID"). We identified demographics, origin hospitals, ICD-10 pre- and post-transfer diagnoses, distance of transfer, and post-transfer CPT codes.

During the study period, our adult urology service accepted 160 transfers with a mean patient age of 71 years. A total of 49/160 (30%) of subjects made up the "pre-COVID" cohort and 111/160 (70%) made up the "COVID" cohort. There were 11/111 (10%) transfers of >100 miles in the COVID period but 0/49 in the pre-COVID period (p = 0.02). Patients from the COVID period waited on average 1.2 days longer for a procedure after transfer compared to pre-COVID period (p = 0.03). The time until a patient's surgical procedure after transfer was a significant predictor of length of stay > 5 days (OR 1.91, CI 1.43 - 2.58, p < 0.01). Different diagnosis upon re-evaluation after transfer was associated with a decreased rate of subsequent readmission (OR 0.30, CI 0.09-0.97, p = 0.05).

Long-distance transfer, even >100 miles (which we termed "mega-transfers"), was a new pandemic-related phenomenon at our institution. Delays in definitive care and changes in diagnoses after transfer were associated with readmission and length of stay. Our findings illustrate the importance of inter-institutional communication, diagnostic accuracy, and post discharge planning when managing transfer patients.