Toxoplasmosis Encephalitis: A Cross-Sectional Analysis at a U.S. Safety-Net Hospital in the Late cART Era

Despite decreasing incidence of toxoplasmosis encephalitis(TE) among people living with HIV(PLWH) in the late antiretroviral era, U.S. safety-net hospitals still see significant numbers of admissions for TE. Little is known about this population, their healthcare utilization and long-term outcomes. We conducted an 8-year retrospective review of PLWH with TE at a safety-net hospital. Demographics, clinical characteristics, treatments, readmissions, and outcomes were collected. We used chi-squared test to evaluate 6-month all-cause readmission and demographic/clinical characteristics. Of 38 patients identified, 79% and 40% had a new diagnosis of TE and HIV respectively. 59% had 6-month all-cause readmission. Social factors were associated with readmission (uninsured (p = 0.036), Spanish as primary language (p = 0.017), non-adherence (p = 0.030)) and not markers of clinical severity (ICU admission, steroid-use, concomitant infections, therapeutic adverse events). Despite high readmission rates, at follow-up, 60% had a complete response, 30% had a partial response. Improving TE outcomes requires focus on culturally competent, coordinated care.

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Exposure to and Use of Electronic Cigarettes: Does Language Matter?

Ethnicity & Disease ◽

10.18865/ed.27.3.217 ◽

2017 ◽

Vol 27 (3) ◽

pp. 217 ◽

Cited By ~ 1

Author(s):

Paul Wada ◽

Chun Nok Lam ◽

Elizabeth Burner ◽

Sophie Terp ◽

Michael Menchine ◽

...

Keyword(s):

Los Angeles ◽

Electronic Cigarettes ◽

Native English Speakers ◽

Safety Net ◽

Cross Sectional Study ◽

English Speakers ◽

Foreign Born ◽

Cross Sectional ◽

Safety Net Hospital ◽

Chi Squared

Objectives: To determine whether patients who are English proficient become aware of e-cigarettes through different marketing tactics and have dissimilar patterns of use than patients who are non-English speaking.Design: This was a cross-sectional study surveying adult English- and Spanish-speaking patients. ANOVA and chi-squared tests were used to examine differences between groups.Setting: A large public, safety-net hospital in Los Angeles County, California.Results: Respondents (N=1899) were predominately Hispanic (78%), foreign-born (68%), and reported Spanish as a primary language (64%). Native English speakers reported the highest use of e-cigarettes (26%), followed by non-native (13%) and non- English speakers (2%) (P<.001). In terms of marketing, native and non-native English speakers were more likely to have friends and family as sources of e-cigarette information (P<.001). Native speakers were more likely to see advertisements for e-cigarettes on storefronts (P=.004) and on billboards (P<.001). Non-English speakers were most likely to learn about e-cigarettes on the news (P<.001) and in advertisements on the television and radio (P=.002). Differences in reasons for use were not significant between the three groups.Conclusions: Native and non-native English speakers become aware of e-cigarettes through different mechanisms and use e-cigarettes at a significantly higher rate than non-English speakers. These results highlight an opportunity for public health programs to concentrate on specific channels of communication that introduce patient populations to e-cigarettes to slow the spread of e-cigarette usage.Ethn Dis. 2017;27(3):217- 222; doi:10.18865/ed.27.3.217

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Quality of life, clinical characteristics and treatment adherence of people living with HIV/AIDS

Revista Latino-Americana de Enfermagem ◽

10.1590/0104-1169.3534.2508 ◽

2014 ◽

Vol 22 (6) ◽

pp. 994-1000 ◽

Cited By ~ 16

Author(s):

Ana Cristina de Oliveira e Silva ◽

Renata Karina Reis ◽

Jordana Almeida Nogueira ◽

Elucir Gir

Keyword(s):

Quality Of Life ◽

Treatment Adherence ◽

Clinical Characteristics ◽

World Health ◽

People Living With Hiv ◽

Cross Sectional ◽

Quality Of Life Scale ◽

Living With Hiv ◽

Hiv Aids

OBJECTIVES: to assess the quality of life of people living with HIV/AIDS and verify its association with clinical characteristics and treatment adherence.METHOD: cross-sectional study conducted in a hospital in the state of Paraíba, Brazil. A questionnaire was used to collect socio-demographic and clinical data. The quality of life scale proposed by the World Health Organization and a questionnaire to measure treatment adherence were used.RESULTS: of the 314 interviewees, 190 (60.5%) were male, aged 43 years on average, 121 (38.5%) had attended up to five years of schooling, 108 (34.4%) received up to two times the minimum wage, and 112 (35.7%) were on sick leave. In regard to clinical variables, individuals with an undetectable viral load scored higher in all the domains concerning quality of life, with statistically significant differences in three domains. Regarding treatment adherence, 235 (73.8%) presented poor adherence and those who strictly adhered to treatment obtained better scores in quality of life. The results show that quality of life is better among individuals adherent to ART. Supporting people to adhere to the antiretroviral treatment should be a persistent task of healthcare workers and other people participating in the treatment, such as family members and friends.

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Off label targeted therapy use in adolescents and young adults with sarcoma.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e21504 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e21504-e21504

Author(s):

Lisa M. Kopp ◽

Kathylynn Saboda ◽

Bhuvana Setty ◽

Mary Frances Wedekind ◽

Daniel Weiser ◽

...

Keyword(s):

Clinical Trials ◽

Targeted Therapy ◽

Clinical Characteristics ◽

Kinase Inhibitors ◽

Young Patients ◽

Complete Response ◽

Off Label ◽

Chi Squared ◽

The Mean ◽

Early Phase Clinical Trials

e21504 Background: Outcomes for patients with metastatic or recurrent sarcomas remains dismal with < 20% overall survival. Due to the rarity of sarcomas, the development, testing, and approval of new therapies takes years. Most early phase clinical trials are restricted to adults leaving young patients with limited options. Little is known about the prevalence and clinical characteristics of patients receiving off-label targeted therapy (OLTT). In this multi-institutional retrospective review we evaluated OLTT use in this population. Methods: Patients with recurrent sarcoma diagnosed between the years of 2008 – 2016 were identified at six institutions. Charts were reviewed for OLTT use and additional clinical characteristics. ANOVA [Analysis of Variance] and Kruskal Wallis Rank sum tests were used for normally and non-normally distributed continuous data. Categorical data was analyzed using chi-squared tests or fisher exact tests. Results: The prevalence of OLTT use was 29% for the patients included in our analysis. Of the 99 cases, the mean age for OLTT was 18 years, ranging 3 – 34 years. Nearly half had recurrent tumor in multiple sites at the time of OLTT use, and 64% did not undergo resection prior to OLTT. Lack of clinical trial availability was the most common reason for OLTT use (31% of cases). The most common OLTT drug class used were tyrosine kinase inhibitors. Progression in 81% of cases was the primary reason for stopping OLTT and toxicity limited use in 12% of cases. One case had a complete response, 5 cases had a partial response and 4 cases had stable disease per RECIST. Conclusions: OLTT use is exceedingly prevalent in patients with recurrent sarcoma. Clinical trials for children and adolescents with recurrent sarcoma will identify optimal agents to improve outcomes in this understudied population.

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Epidemiological and clinical characteristics of headache among medical students in Palestine: a cross sectional study

BMC Neurology ◽

10.1186/s12883-021-02526-9 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Firas Anaya ◽

Wala’a Abu Alia ◽

Feda’a Hamoudeh ◽

Zaher Nazzal ◽

Beesan Maraqa

Keyword(s):

Medical Students ◽

Clinical Characteristics ◽

Primary Headache ◽

Cross Sectional Study ◽

Stressful Situation ◽

Sectional Study ◽

Cross Sectional ◽

Chi Squared ◽

West Bank And Gaza ◽

Tension Type Headaches

Abstract Background Headache is one of the most disturbing complaints worldwide, negatively impacting social and regular life activities. In the background of stressful life in medical schools, adding to the stressful situation in Palestine, a developing country under occupation, this study investigated the prevalence and clinical characteristics of migraines and tension- type headaches among medical students from the Palestinian Universities in West Bank and Gaza. Methods A questionnaire-based cross-sectional study was conducted on all Palestinian Medical Students. Students were diagnosed based on ICHD-3 criteria. Demographic characteristics were compared by gender for each type of headache. Frequency, percentage, and mean ± SD. Pearson’s chi-squared test, independent t-test, and one-way ANOVA were used where needed. P-value < 0.05 was considered significant. Results The study included 806 medical students; 476 (59.0%) of them were female. TTH and migraine’s prevalence was 59.8 and 22%, respectively, with a higher prevalence among basic year students. The female to male ratio was 1:0.6 for both types of headaches. Sleep deprivation, physical activities, and altered sleep patterns were reported as the top triggering factors. Conclusions The results demonstrate that the prevalence of both subtypes’ primary headache is high among Palestinian medical students, with a higher prevalence among basic year students. The study also showed that these findings are higher than other studies among medical students in other countries.

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Epidemiological and Clinical Characteristics of Headache Among Medical Students in Palestine : A cross Sectional Study

10.21203/rs.3.rs-806338/v1 ◽

2021 ◽

Author(s):

Firas M. Anaya ◽

Wala’a Abu Alia ◽

Feda’a Hamoudeh ◽

Zaher A. Nazzal ◽

Beesan Maraqa

Keyword(s):

Medical Students ◽

Clinical Characteristics ◽

Primary Headache ◽

Cross Sectional Study ◽

P Value ◽

Stressful Situation ◽

Sectional Study ◽

Cross Sectional ◽

Chi Squared ◽

West Bank And Gaza

Abstract Background Headache is one of the most disturbing complaints worldwide, negatively impacting social and regular life activities.In the background of stressful life in medical schools, adding to the stressful situation in Palestine, a developing country under occupation, this study investigated the prevalence and clinical characteristics of migraines and tension headaches among medical students from the Palestinian Universities in West Bank and GazaMethods:A questionnaire-based cross-sectional study was conducted on all Palestinian Medical Students. Students were diagnosed based on ICHD-3 criteria. Demographic characteristics were compared by gender for each type of headache. Frequency, percentage, and mean ± SD. Pearson's chi-squared test, independent t-test, and one-way ANOVA were used where needed. P-value < 0.05 was considered significant.Results:The study included 806 medical students; 476 (59.0%) of them were female. TTH and migraine's prevalence was 59.8% and 22%, respectively, with a higher prevalence among basic year students. The female to male ratio was 1:0.6 for both types of headaches. Sleep deprivation, physical activities, and altered sleep patterns were reported as the top triggering factors.ConclusionsThe results demonstrate that the prevalence of both subtypes' primary headache is high among Palestinian medical students, with a higher prevalence among basic year students. The study also showed that these findings are higher than other studies among medical students in other countries.

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Universal screening for SARS-CoV-2 infection among pregnant women at Elmhurst Hospital Center, Queens, New York

PLoS ONE ◽

10.1371/journal.pone.0238409 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0238409

Author(s):

Sheela Maru ◽

Uday Patil ◽

Rachel Carroll-Bennett ◽

Aaron Baum ◽

Tracy Bohn-Hemmerdinger ◽

...

Keyword(s):

New York ◽

Pregnant Women ◽

Universal Screening ◽

Screening Program ◽

Safety Net ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Percentage Points ◽

Safety Net Hospital

Background Universal screening for SARS-CoV-2 infection on Labor and Delivery (L&D) units is a critical strategy to manage patient and health worker safety, especially in a vulnerable high-prevalence community. We describe the results of a SARS-CoV-2 universal screening program at the L&D Unit at Elmhurst Hospital in Queens, NY, a 545-bed public hospital serving a diverse, largely immigrant and low-income patient population and an epicenter of the global pandemic. Methods and findings We conducted a retrospective cross-sectional study. All pregnant women admitted to the L&D Unit of Elmhurst Hospital from March 29, 2020 to April 22, 2020 were included for analysis. The primary outcomes of the study were: (1) SARS-CoV-2 positivity among universally screened pregnant women, stratified by demographic characteristics, maternal comorbidities, and delivery outcomes; and (2) Symptomatic or asymptomatic presentation at the time of testing among SARS-CoV-2 positive women. A total of 126 obstetric patients were screened for SARS-CoV-2 between March 29 and April 22. Of these, 37% were positive. Of the women who tested positive, 72% were asymptomatic at the time of testing. Patients who tested positive for SARS-CoV-2 were more likely to be of Hispanic ethnicity (unadjusted difference 24.4 percentage points, CI 7.9, 41.0) and report their primary language as Spanish (unadjusted difference 32.9 percentage points, CI 15.8, 49.9) than patients who tested negative. Conclusions In this retrospective cross-sectional study of data from a universal SARS-Cov-2 screening program implemented in the L&D unit of a safety-net hospital in Queens, New York, we found over one-third of pregnant women testing positive, the majority of those asymptomatic. The rationale for universal screening at the L&D Unit at Elmhurst Hospital was to ensure safety of patients and staff during an acute surge in SARS-Cov-2 infections through appropriate identification and isolation of pregnant women with positive test results. Women were roomed by their SARS-CoV-2 status given increasing space limitations. In addition, postpartum counseling was tailored to infection status. We quickly established discharge counseling and follow-up protocols tailored to their specific social needs. The experience at Elmhurst Hospital is instructive for other L&D units serving vulnerable populations and for pandemic preparedness.

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Patient and Provider Perspectives on 30-Day Readmissions, Preventability, and Strategies for Improving Transitions of Care for Patients with HIV at a Safety Net Hospital

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958219827615 ◽

2019 ◽

Vol 18 ◽

pp. 232595821982761

Author(s):

Ank E. Nijhawan ◽

Robin T. Higashi ◽

Emily G. Marks ◽

Yordanos M. Tiruneh ◽

Simon Craddock Lee

Keyword(s):

Hospital Readmissions ◽

Case Manager ◽

Safety Net ◽

Transitions Of Care ◽

Hiv Positive ◽

People Living With Hiv ◽

Medical Provider ◽

Provider Perspectives ◽

Safety Net Hospital ◽

Reduction Strategies

Thirty-day hospital readmissions, a key quality metric, are common among people living with HIV. We assessed perceived causes of 30-day readmissions, factors associated with preventability, and strategies to reduce preventable readmissions and improve continuity of care for HIV-positive individuals. Patient, provider, and staff perspectives toward 30-day readmissions were evaluated in semistructured interviews (n = 86) conducted in triads (HIV-positive patient, medical provider, and case manager) recruited from an inpatient safety net hospital. Iterative analysis included both deductive and inductive themes. Key findings include the following: (1) The 30-day metric should be adjusted for safety net institutions and patients with AIDS; (2) Participants disagreed about preventability, especially regarding patient-level factors; (3) Various stakeholders proposed readmission reduction strategies that spanned the inpatient to outpatient care continuum. Based on these diverse perspectives, we outline multiple interventions, from teach-back patient education to postdischarge home visits, which could substantially decrease hospital readmissions in this underserved population.

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Long-term benefit of hepatitis C therapy in a safety net hospital system: a cross-sectional study with median 5-year follow-up

BMJ Open ◽

10.1136/bmjopen-2013-003231 ◽

2013 ◽

Vol 3 (9) ◽

pp. e003231 ◽

Cited By ~ 7

Author(s):

Amit G Singal ◽

Tushar D Dharia ◽

Peter F Malet ◽

Saleh Alqahtani ◽

Song Zhang ◽

...

Keyword(s):

Safety Net ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Hospital System ◽

System A ◽

Safety Net Hospital ◽

Term Benefit

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Willingness of Patients from an Urban Safety-Net Dermatology Clinic to Receive a COVID-19 Vaccine

SKIN The Journal of Cutaneous Medicine ◽

10.25251/skin.5.6.7 ◽

2021 ◽

Vol 5 (6) ◽

pp. 649-655

Author(s):

Hannah Mumber ◽

Daniela Del Campo ◽

Manuel Alvarado ◽

Jacqueline Watchmaker

Keyword(s):

Vaccine Development ◽

Safety Net ◽

Survey Study ◽

Cross Sectional ◽

Dermatology Clinic ◽

Safety Net Hospital ◽

Urban Safety ◽

Flu Vaccine ◽

Caucasian Patients ◽

To Receive

Background: While recent vaccine development has initiated a return to pre-COVID "normalcy" both in the dermatology clinic and worldwide, significant challenges remain regarding the public’s willingness to receive a COVID-19 vaccine. Dermatologists often discuss vaccinations with their patients and aid them in making evidence-based medical decisions. Previous studies have looked at the U.S. population’s willingness to receive a COVID-19 vaccine, but no studies have examined the dermatology patient population from an urban, safety-net hospital. Studies have shown that understanding the target audience is the first step towards increasing vaccine acceptance. Methods: A cross-sectional, telephone-based survey study was administered to 326 patients of an urban, safety-net hospital from July 2020 to August 2020 in order to assess willingness to obtain a COVID-19 vaccine. Results: Our survey study showed that 57.7% of patients with a recent dermatology appointment are willing to receive a COVID-19 vaccine and that safety concerns represent the main reason for patient hesitancy. Patients who do not regularly receive a flu vaccine, non-Caucasian patients, and those who know someone who tested positive for COVID-19 are less willing to receive a COVID-19 vaccine. Patients with a recent dermatology appointment are more willing to receive a COVID-19 vaccine than those who did not have a recent dermatology appointment. Conclusions: Our results provide dermatologists, especially those working in urban safety-net clinics, with key information about the attitude of patients toward the COVID-19 vaccine.

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Pharmacogenomics of hypertension in chronic kidney disease: the CKD-PGX study

Kidney360 ◽

10.34067/kid.0005362021 ◽

2021 ◽

pp. 10.34067/KID.0005362021

Author(s):

Michael T. Eadon ◽

Judith Maddatu ◽

Sharon M. Moe ◽

Arjun D. Sinha ◽

Ricardo Melo Ferreira ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Antihypertensive Agents ◽

Pressure Control ◽

Safety Net ◽

Uncontrolled Hypertension ◽

Cross Sectional ◽

Significant Difference ◽

Safety Net Hospital

Background: Patients with chronic kidney disease (CKD) often have uncontrolled hypertension despite polypharmacy. Pharmacogenomic drug-gene interactions (DGIs) may impact the metabolism or efficacy of antihypertensive agents. We report changes in hypertension control after providing a panel of 11 pharmacogenomic predictors of antihypertensive response. Methods: A prospective cohort with CKD and hypertension was followed to assess feasibility of pharmacogenomic testing implementation, self-reported provider utilization, and blood pressure control. The analysis population included 382 hypertensive subjects genotyped for cross-sectional assessment of DGIs and 335 subjects followed for 1 year to assess systolic (SBP) and diastolic blood pressure (DBP). Results: Most participants (58.2%) with uncontrolled hypertension had a DGI reducing the efficacy of > 1 antihypertensive agent. Subjects with a DGI had 1.85-fold (95% CI 1.2-2.8) higher odds of uncontrolled hypertension as compared to those without a DGI, adjusted for race, health system (safety net hospital versus other locations) and advanced CKD (eGFR < 30 ml/min). CYP2C9 reduced metabolism genotypes were associated with losartan response and uncontrolled hypertension (Odds Ratio 5.2, CI 1.9 -14.7). CYP2D6 intermediate or poor metabolizers had less frequent uncontrolled hypertension compared to normal metabolizers taking metoprolol or carvedilol (OR 0.55, CI 0.3-0.95). In 335 subjects completing 1 year follow-up, SBP (-4.0 mmHg, CI 1.6- 6.5) and DBP (-3.3 mmHg, CI 2.0-4.6) were improved. No significant difference in SBP or DBP change were found between individuals with and without a DGI. Conclusions: There is a potential role for the addition of pharmacogenomic testing to optimize antihypertensive regimens in patients with CKD.

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