957. Evaluation of Chagas Disease Knowledge Among Providers Caring for At-risk People with HIV

Abstract Background Chagas disease (CD) is underdiagnosed in the United States due to limited healthcare provider awareness of the disease. Improving provider CD knowledge is important because >200,000 people living in the US are estimated to have CD, and 20-30% of those will develop related cardiac or gastrointestinal disease. People with HIV (PWH) and CD additionally are at risk for CD reactivation, which carries a >70% mortality rate. Methods The overall objective of this quality improvement project was to improve provider knowledge of CD prior to implementation of a CD screening initiative at a large HIV clinic in Houston, TX where >5,000 PWH are seen annually (~60% Latinx). We administered the survey to providers at this clinic before and after a 1-hour CD educational session, which included information about CD epidemiology, risk factors, transmission, screening, diagnostic strategies, and available treatments. Results Of 33 providers who took the pre-survey (16 faculty, 14 fellows, and 3 medical students), 27 (81.8%) completed all questions. Of 21 providers who took the post-survey (12 faculty, 6 fellows, and 3 medical students), 19 (90.5%) completed all questions. We identified the following CD knowledge gaps (i.e., questions initially answered incorrectly by >25% in the pre-educational session survey): CD transmission, regions of CD endemicity, CD risk factors, organ systems impacted by CD in PWH, and CD testing/follow-up procedures. In the post-educational session survey, we observed significant improvement in providers’ knowledge of CD epidemiology (correct selection of estimated number of people living with CD in the US improved from 26.7% to 90.5%, Fisher’s exact p< 0.0001), transmission (correct selection of “mother-to-child” answer improved from 73.3% to 100%, p=0.0150), and selection of correct CD testing answers improved from 51.9% to 85%, p=0.0286. Conclusion Improved CD awareness among healthcare providers and reliable systematic screening protocols are important in at-risk populations. Through simple administration of a 1-hour educational session, we identified and improved several CD knowledge gaps. We noted significant improvement in providers’ confidence in their CD knowledge, specifically in epidemiology, transmission, and diagnostic and screening testing. Disclosures All Authors: No reported disclosures

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1165. Seroprevalence of Chagas Disease among Latin American Children Living in New York

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1358 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S674-S674

Author(s):

Andrew S Handel ◽

Harriet Hellman ◽

Egar Flores ◽

Christy Beneri

Keyword(s):

United States ◽

Risk Factors ◽

New York ◽

Latin America ◽

Chagas Disease ◽

Latin American ◽

Rapid Test ◽

The United States ◽

Suffolk County ◽

The Us

Abstract Background Approximately 300,00 individuals in the United States are estimated to have Chagas disease. To date, only one seroprevalence study in the US has included children. Diagnosis during childhood prevents irreversible sequelae and is better tolerated than during adulthood. Seropositive children may be difficult to identify, as those infected vertically may have never visited an endemic region. We sought to identify children with Chagas disease through a pilot study of serology and risk factors. Methods Participants were recruited from Stony Brook University Hospital (SBUH) or an ambulatory pediatric office, both in Suffolk County, New York (population: 1,476,000; 20.2% Hispanic or Latino). Study participants were 1 - 25 years old, resided in Suffolk County, and either the child and/or the child’s mother was born in or had long-term residence (≥ 3 years) in Latin America. T. cruzi serum IgG was determined with a Chagatest ELISA (Weiner Lab) or a Chagas Detect Plus Rapid Test (InBios). Positive screens were confirmed with a second serologic test at the CDC. Participants completed a survey of demographics and Chagas disease knowledge and risk factors, in English or Spanish. Descriptive statistics were applied. SBUH IRB provided study approval. Results We enrolled 93 children (Table 1). Three (3.2%) had a positive IgG screen, of which only one had a confirmed infection (1.1%). This was a 17-year-old who had lived in a rural adobe home and moved to the US at 8 years old. No children or their mothers recalled being bitten by or seeing triatomine insects in their Latin American homes. Of 27 children whose mothers had been screened for infection, 13 were born to 3 mothers with confirmed Chagas disease; all 13 children were seronegative. Of 8 participants reporting other family members with Chagas disease, all were seronegative. Demographics of 93 participants screened for Chagas disease SD standard deviation; US: United States Conclusion Without reliable tools for identifying those at greatest risk of Chagas disease, universal screening of children born in high-risk Latin American regions remains a reasonable strategy. In addition, screening mothers born in Latin America is likely a more cost-efficient means to evaluate second-generation children. A tremendous knowledge gap of pediatric Chagas disease in the US remains. Disclosures All Authors: No reported disclosures

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THU0442 GOUT AND HEART FAILURE IN THE US: A NATIONAL PERSPECTIVE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3905 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 458.2-458

Author(s):

G. Singh ◽

M. Sehgal ◽

A. Mithal

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Confidence Intervals ◽

Burden Of Illness ◽

Average Length ◽

Private Insurance ◽

Significant Risk ◽

Case Fatality ◽

The United States ◽

The Us

Background:Heart failure (HF) is the eighth leading cause of death in the US, with a 38% increase in the number of deaths due to HF from 2011 to 2017 (1). Gout and hyperuricemia have previously been recognized as significant risk factors for heart failure (2), but there is little nationwide data on the clinical and economic consequences of these comorbidities.Objectives:To study heart failure hospitalizations in patients with gout in the United States (US) and estimate their clinical and economic impact.Methods:The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. We examined all inpatient hospitalizations in the NIS in 2017, the most recent year of available data, with a primary or secondary diagnosis of gout and heart failure. Over 69,800 ICD 10 diagnoses were collapsed into a smaller number of clinically meaningful categories, consistent with the CDC Clinical Classification Software.Results:There were 35.8 million all-cause hospitalizations in patients in the US in 2017. Of these, 351,735 hospitalizations occurred for acute and/or chronic heart failure in patients with gout. These patients had a mean age of 73.3 years (95% confidence intervals 73.1 – 73.5 years) and were more likely to be male (63.4%). The average length of hospitalization was 6.1 days (95% confidence intervals 6.0 to 6.2 days) with a case fatality rate of 3.5% (95% confidence intervals 3.4% – 3.7%). The average cost of each hospitalization was $63,992 (95% confidence intervals $61,908 - $66,075), with a total annual national cost estimate of $22.8 billion (95% confidence intervals $21.7 billion - $24.0 billion).Conclusion:While gout and hyperuricemia have long been recognized as potential risk factors for heart failure, the aging of the US population is projected to significantly increase the burden of illness and costs of care of these comorbidities (1). This calls for an increased awareness and management of serious co-morbid conditions in patients with gout.References:[1]Sidney, S., Go, A. S., Jaffe, M. G., Solomon, M. D., Ambrosy, A. P., & Rana, J. S. (2019). Association Between Aging of the US Population and Heart Disease Mortality From 2011 to 2017. JAMA Cardiology. doi:10.1001/jamacardio.2019.4187[2]Krishnan E. Gout and the risk for incident heart failure and systolic dysfunction. BMJ Open 2012;2:e000282.doi:10.1136/bmjopen-2011-000282Disclosure of Interests: :Gurkirpal Singh Grant/research support from: Horizon Therapeutics, Maanek Sehgal: None declared, Alka Mithal: None declared

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Great Britain and the United States: Two nations divided by an attitude?

English Today ◽

10.1017/s0266078418000329 ◽

2018 ◽

Vol 34 (4) ◽

pp. 21-28

Author(s):

Carmen Ebner

Keyword(s):

United States ◽

Great Britain ◽

United States Of America ◽

The United States ◽

British English ◽

Doctoral Thesis ◽

Linguistic Differences ◽

The Us ◽

Selection Of ◽

Similar Search

Having studied attitudes towards usage problems such as the notorious split infinitive or the ubiquitous literally in British English as part of my doctoral thesis, I was intrigued by the sheer lack of scientific studies investigating such attitudes. What was even more intriguing was to discover that the same field and the same usage problems seem to have received a different treatment in the United States of America. While my search for previously conducted usage attitude studies in Great Britain has largely remained fruitless, besides two notable exceptions which I will discuss in detail below (see Section 3), a similar search for American usage attitude studies resulted in a different picture. Considerably more such studies seem to have been conducted in the US than in Great Britain. On top of cultural and linguistic differences between these two nations, it seems as if they also hold different attitudes towards studying attitudes towards usage problems. Now the following question arises: why do we find such contradictory scientific traditions in these two countries? In this paper, I will provide an overview of a selection of American and British usage attitude studies. Taking into account differences between the American and British studies with regard to the number of usage problems studied, the populations surveyed and the methods applied, I will attempt to capture manifestations of two seemingly diverging attitudes towards the study of usage problems. By doing so, I will provide a possible explanation for the lack of attention being paid to usage attitudes in Great Britain.

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Abstract WMP60: Temporal Trends in Incidence, Prevalence and Epidemiological Characteristics of Cerebral Venous Thrombosis in the United States

Stroke ◽

10.1161/str.51.suppl_1.wmp60 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Fadar Otite ◽

Smit Patel ◽

Richa Sharma ◽

Pushti Khandwala ◽

Devashish Desai ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Cerebral Venous Thrombosis ◽

The United States ◽

P Value ◽

Joinpoint Regression ◽

The Us ◽

Epidemiological Characteristics ◽

Over Time ◽

Age And Sex

Background: The primary aim of this study is to describe current trends in racial-, age- and sex-specific incidence, clinical characteristics and burden of cerebral venous thrombosis (CVT) in the United States (US). Methods: Validated International Classification of Disease codes were used to identify all adult new cases of CVT (n=5,567) in the State Inpatients Database of New York and Florida (2006-2016) and all cases of CVT in the entire US from the National Inpatient Sample 2005-2016 (weighted n=57,315). Incident CVT counts were combined with annual US Census data to compute age and sex-specific incidence of CVT. Joinpoint regression was used to evaluate trends in incidence over time. Results: From 2005-2016, 0.47%-0.80% of all strokes in the US were CVTs but this proportion increased by 70.4% over time. Of all CVTs over this period, 66.7% were in females but this proportion declined over time (p<0.001). Pregnancy/puerperium (27.4%) and cancer (11.8%) were the most common risk factors in women, while cancer (19.5%) and central nervous trauma (11.3) were the most common in men. Whereas the prevalence of pregnancy/puerperium declined significantly over time in women, that of cancer, inflammatory conditions and trauma increased over time in both sexes. Annual age and sex-standardized incidence of CVT in cases/million population ranged from 13.9-20.2, but incidence varied significantly by sex (women: 20.3-26.9; men 6.8-16.8) and by age/sex (women 18-44yo: 24.0-32.6%; men: 18-44yo: 5.3-12.8). Age and sex-standardized incidence also differed by race (Blacks:18.6-27.2; whites: 14.3-18.5; Asians: 5.1-13.8). On joinpoint regression, incidence increased across 2006-2016 but most of this increase was driven by increase in all age groups of men (combined annualized percentage change (APC) 9.2%, p-value <0.001), women 45-64 yo (APC 7.8%, p-value <0.001) and women ≥65 yo (APC 7.4%, p-value <0.001). Incidence in women 18-44 yo remained unchanged over time . Conclusion: The epidemiological characteristics of CVT patients in the US is changing. Incidence increased significantly over the last decade. Further studies are needed to determine whether this increase represents a true increase from changing risk factors or artefactual increase from improved detection.

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Picture Perfect Pups: How Do Attributes of Photographs of Dogs in Online Rescue Profiles Affect Adoption Speed?

Animals ◽

10.3390/ani10010152 ◽

2020 ◽

Vol 10 (1) ◽

pp. 152 ◽

Cited By ~ 1

Author(s):

Mizuho Nakamura ◽

Navneet Dhand ◽

Bethany Wilson ◽

Melissa Starling ◽

Paul McGreevy

Keyword(s):

Risk Factors ◽

At Risk ◽

Natural Environment ◽

Factors Associated ◽

Lengths Of Stay ◽

The Creation ◽

Labrador Retrievers ◽

Selection Of

To increase the public’s awareness of and exposure to animals needing homes, PetRescue, Australia’s largest online directory of animals in need of adoption, lists all currently available animals from rescue and welfare shelters nationwide. The current study examined the photographs in the PetRescue online profiles of the three most common breeds within these data, namely, Staffordshire bull terriers (n = 3988), Labrador retrievers (n = 2246), and Jack Russell terriers (n = 2088), to identify the inferred preferences of potential adopters. By investigating the attributes of these photographs, we were able to identify visual risk factors associated with protracted lengths of stay (LOS). The longest stays were associated with dogs with erect ears and those photographed in a natural environment, i.e., 18.32 days and 19.57 days, respectively. Dogs photographed in a kennel and with mouths closed had the shortest LOS, i.e., 11.54 d and 14.44 d, respectively. Heightened awareness of the roles of photographic attributes in generating interest among potential adopters may increase the speed of adoption by guiding the creation of online profiles and selection of photos to optimise the promotion of dogs at risk of long stays.

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Incidence of and Risk Factors for Nosocomial Bloodstream Infections in Adults in the United States, 2003

Infection Control and Hospital Epidemiology ◽

10.1086/606167 ◽

2009 ◽

Vol 30 (11) ◽

pp. 1036-1044 ◽

Cited By ~ 31

Author(s):

Omar M. AL-Rawajfah ◽

Frank Stetzer ◽

Jeanne Beauchamp Hewitt

Keyword(s):

United States ◽

Risk Factors ◽

Case Fatality Rate ◽

Nationwide Inpatient Sample ◽

Hospital Admissions ◽

Case Fatality ◽

The United States ◽

Fatality Rate ◽

The Us ◽

National Estimates

Background.Although many studies have examined nosocomial bloodstream infection (BSI), US national estimates of incidence and case-fatality rates have seldom been reported.Objective.The purposes of this study were to generate US national estimates of the incidence and severity of nosocomial BSI and to identify risk factors for nosocomial BSI among adults hospitalized in the United States on the basis of a national probability sample.Methods.This cross-sectional study used the US Nationwide Inpatient Sample for the year 2003 to estimate the incidence and case-fatality rate associated with nosocomial BSI in the total US population. Cases of nosocomial BSI were defined by using 1 or more International Classification of Diseases, 9th Revision, Clinical Modification codes in the secondary field(s) that corresponded to BSIs that occurred at least 48 hours after admission. The comparison group consisted of all patients without BSI codes in their NIS records. Weighted data were used to generate US national estimates of nosocomial BSIs. Logistic regression was used to identify independent risk factors for nosocomial BSI.Results.The US national estimated incidence of nosocomial BSI was 21.6 cases per 1,000 admissions, while the estimated case-fatality rate was 20.6%. Seven of the 10 leading causes of hospital admissions associated with nosocomial BSI were infection related. We estimate that 541,081 patients would have acquired a nosocomial BSI in 2003, and of these, 111,427 would have died. The final multivariate model consisted of the following risk factors: central venous catheter use (odds ratio [OR], 4.76), other infections (OR, 4.61), receipt of mechanical ventilation (OR, 4.97), trauma (OR, 1.98), hemodialysis (OR, 4.83), and malnutrition (OR, 2.50). The total maximum rescaled R2 was 0.22.Conclusions.The Nationwide Inpatient Sample was useful for estimating national incidence and case-fatality rates, as well as examining independent predictors of nosocomial BSI.

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Supporting Families and Providers When Suicide Occurs

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118794037 ◽

2018 ◽

Vol 36 (3) ◽

pp. 264-265

Author(s):

Susan Carla Stone

Keyword(s):

United States ◽

Risk Factors ◽

At Risk ◽

Risk Factor ◽

Suicide Attempt ◽

Young Woman ◽

Complicated Grief ◽

The United States ◽

Major Risk Factor

Death by suicide has increased in the United States. Experts have identified risk factors that may identify those at risk. It is understood that depression is one of the major risk factor. The families and community are the secondary victims when a suicide attempt or completion is made, and they are at risk for complicated grief. Recently, our team was consulted for the case of a young woman with a catastrophic suicide attempt.

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Risk factors for cardiovascular disease among Mexican-American adults in the United States and Mexico: a comparative study

Salud Pública de México ◽

10.21149/spm.v56i2.7335 ◽

2014 ◽

Vol 56 (2) ◽

pp. 197 ◽

Cited By ~ 14

Author(s):

Leo S Morales ◽

Yvonne N Flores ◽

Mei Leng ◽

Noémie Sportiche ◽

Katia Gallegos-Carrillo ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Mexican American ◽

Hdl Cholesterol ◽

The United States ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Men And Women ◽

The Us ◽

Low Hdl

Objective. To compare cardiovascular disease (CVD) risk factors in a cohort of Mexican health workers with representative samples of US-born and Mexico-born Mexican-Americans living in the US. Materials and methods. Data were obtained from the Mexican Health Worker Cohort Study (MHWCS) in Mexico and the National Health and Nutrition Examination Survey (NHANES) IV 1999-2006 in the US. Regression analyses were used to investigate CVD risk factors. Results. In adjusted analyses, NHANES participants were more likely than MHWCS participants to have hypertension, high total cholesterol, diabetes, obesity, and abdominal obesity, and were less likely to have low HDL cholesterol and smoke. Less-educated men and women were more likely to have low HDL cholesterol, obesity, and abdominal obesity. Conclusions. In this binational study, men and women enrolled in the MHWCS appear to have fewer CVD risk factors than US-born and Mexico-born Mexican-American men and women living in the US.

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Trends and Risk Factors for Leishmaniasis among Reproductive Aged Women in the United States

International Journal of MCH and AIDS (IJMA) ◽

10.21106/ijma.478 ◽

2021 ◽

Vol 10 (2) ◽

pp. 166-173

Author(s):

Chioma Ikedionwu ◽

Deepa Dongarwar ◽

Courtney Williams ◽

Evelyn Odeh ◽

Maylis Nkeng Peh ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Global Health ◽

Protective Factor ◽

Private Insurance ◽

The United States ◽

Reproductive Age ◽

Women Of Reproductive Age ◽

The Us ◽

Clinical Awareness

Background and Objective: Leishmaniasis, a neglected tropical disease, is endemic in several regions globally, but commonly regarded as a disease of travelers in the United States (US). The literature on leishmaniasis among hospitalized women in the US is very limited. The aim of this study was to explore trends and risk factors for leishmaniasis among hospitalized women of reproductive age within the US. Methods: We analyzed hospital admissions data from the 2002-2017 Nationwide Inpatient Sample among women aged 15-49 years. We conducted descriptive statistics and bivariate analyses for factors associated with leishmaniasis. Utilizing logistic regression, we assessed the association between sociodemographic and hospital characteristics with leishmaniasis disease among hospitalized women of reproductive age in the US. Joinpoint regression was used to examine trends over time. Results: We analyzed 131,529,239 hospitalizations; among these, 207 cases of leishmaniasis hospitalizations were identified, equivalent to an overall prevalence of 1.57 cases per million during the study period. The prevalence of leishmaniasis was greatest among older women of reproductive age (35-49 years), Hispanics, those with Medicare, and inpatient stay in large teaching hospitals in the Northeast of the US. Hispanic women experienced a statistically significant increased odds of leishmaniasis diagnosis (OR, 1.80; 95% CI, 1.19-4.06), compared to Non-Hispanic (NH) White women. Medicaid and Private Insurance appeared to serve as a protective factor in both unadjusted and adjusted models. We did not observe a statistically significant change in leishmaniasis rates over the study period. Conclusion and Global Health Implications: Although the prevalence of leishmaniasis among women of reproductive age appears to be low in the US, some risk remains. Thus, appropriate educational, public health and policy initiatives are needed to increase clinical awareness and timely diagnosis/treatment of the disease. Copyright © 2021 Ikedionwu, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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The United States and Elections in Africa (2015–2018)

10.31132/2412-5717-2019-46-1-58-98 ◽

2019 ◽

pp. 58-98 ◽

Cited By ~ 1

Author(s):

Andrey Urnov

Keyword(s):

United States ◽

Democratic Republic Of Congo ◽

The United States ◽

African Countries ◽

The Us ◽

Global Leader ◽

The Usa ◽

The Right ◽

Selection Of

As a self-proclaimed “Global Leader” the United States have made “the assertion, advancement, support and defense of democracy” throughout the world one of the pillars of their foreign policy. This aim invariably figures in all Washington’s program documents pertaining to Africa. A major component of these efforts is an assistance to regular, free and fair elections. The selection of arguments cited to justify such activities has been done skilfully. In each specific case it is emphasized that the United States do not side with any competing party, stand “above the battle”, work for the perfection of electoral process, defend the rights of opposition and rank and file votes, render material and technical help to national electoral committees. Sounds irreproachable. However, the real situation is different. The study of the US practical activities in this field allows to conclude that Washington has one-sidedly awarded itself a role of a judge and supervisor of developments related to elections in the sovereign countries of Africa, tries to control the ways they are prepared and conducted. These activities signify an interference into the internal affairs of African states. The scale and forms of such interference differ and is subjected to tasks the USA try to resolve in this or that country on the national, regional or global levels. However, everywhere it serves as an instrument of penetration and strengthening of the US influence, enhancing the US political presence in African countries. The right of the US to perform this role is presented as indisputable. Sceptics are branded as opponents of democracy. The author explores the US positions and activities connected with elections in Africa during the last years of B.Obama and first two years of D.Trump presidencies. He shows how their policy have been implemented on the continental level and in regard to several countries – South Sudan, Libya, Democratic Republic of Congo, Burundi, Rwanda, Nigeria, Somali, Kenya, Uganda.

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