Survival Disparities Between Border and Non-border Counties in Colorectal Cancer Patients Using The TCR

Along the US Texas Mexico border constant migration, developing medical infrastructure and income disparity leads to poorer access to healthcare and poorer health outcomes. Given 32 of the 254 counties in TX are on the border with roughly 9.8% of the Texas residing in these counties (2.8 million people), this represents a significant population susceptible to adverse health outcomes. We investigate comparisons between border and non-border counties as well as how sociodemographic and diagnostic criterion influence survival of colorectal cancer. Data was obtained from the Texas Department of State Health Service’s TCR. Patients were 18 or older and excluded for incomplete information regarding age, sex, diagnosis yr., site of diagnosis, or poverty level. Descriptive statistics were calculated. Kaplan-Meier and Cox Proportional Hazards Analysis was performed with SAS v9.4. The majority were non-border cases (91.4%), 60+ (69.2%), and white (67.3%). Along border counties the reported cases was 68.5% Hispanic. There was a difference in median OS months in males non-border to border counties (56.0 vs 49.0; p \u3c 0.0001) without adjustment. After adjustment the hazard of death was lower for border counties (HR = 0.95 95% CI 0.92-0.99 p = 0.0058) after stratification of counties by poverty level in counties with poverty between 20-100%. This study found evidence that border males had lower survival times than their non-border counterparts. A counterintuitive result that poorer counties along the border had lower hazards of survival was found. Further investigation of causal factors (screening) and comparison to the national border experience is warranted

Exploration of Potential Risk Factors For Texas County COVID-19 Infection Rates

There have been over 2 million COVID-19 cases within the United States. When considering where infections take place, there appears to be variability between states and even between counties (Gardner 2020). To understand the reasons underlying this phenomenon, we used Texas county data on Covid-19 infection rates and utilized auxiliary data such as age, race, gender, diabetes and obesity rates, temperature, humidity, median household income, metropolitan or rural designation, and poverty rates to see what confers greater risk for higher total infection at a county level. Our study found a positive relationship between diabetes and obesity rates and COVID-19 infection rates, and a negative relationship between the rates of lower educational status and COVID-19 infection rates. Further studies should investigate the underlying mechanisms regarding why those with diabetes, obesity, or a High School Diploma or less are more susceptible to COVID-19 infection as well as the role that population density and different stay-at-home policies affected infection rates in each county

QTc Cutoff, Gender, Race and Age on Reporting of Prolonged QTc

Background The aim of the study is to evaluate the association of QTc cutoff, gender, race, and age on reporting of QTc interval prolongation. Methods Retrospective study of 147 patients admitted to our hospital or ER visit from January 2016 to May 2020. Simple descriptive statistics and longitudinal linear mixed model was performed on the 213 total observations from 147 patients. Results The average age of the patients was 65 (±17.8, 18-98) years. Females were 32% (n=47) and Hispanics 78.4% of sample. QTc prolongation was reported in 65% (n=138) of the 213 EKG’s. Calculated 90th and 99th percentile for QTC is 522 and 586 milliseconds respectively. Unadjusted, QTc \u3e 480 millisecond is 1.7 times more likely to be reported as prolongation (p=0.08) while, QTc \u3e90th is 2.37 times more likely to be reported as a prolongation (p=0.07). With every year increase in age, the interpretation of prolonged QTc is 2% less likely (OR= 0.98, p= 0.04). After adjusting for age and gender, reporting of prolongation is 2.38 times more likely with QTc \u3e480 milliseconds (p=0.01) and 2.66 times more likely with QTc \u3e90th percentile (p=0.06). Conclusion For the same value of QTc, the odds of reporting of QTc prolongation is less likely for older patients. After adjusting for age and gender, the odds of prolonged QTc reporting is more than two times higher for \u3e480 and \u3e522 milliseconds. Our study provides evidence that greater guidance on prolongation reporting should be considered to ensure more consistent reporting of prolongation

Suicide Risk in Patients with Type II Diabetes

Introduction: The comorbidity of mental and physical disorders represents a major challenge for health care worldwide. The comorbidity of depression and diabetes can be seen as a prototypical example of mental/physical comorbidity. The prevalence of both conditions is growing, with depression twice as frequent in people with diabetes compared with those without diabetes. [1] The prevalence of depressive disorders in diabetics is the general range of 10% to 15%, which is approximately twice as high as the prevalence of depression in non-diabetics. [1] For instance, diabetic patients, and during the course of the disease, are most likely to experience depressive symptoms that might ultimately lead to suicidal ideation or suicide.[2] Insulin therapy, DM of long duration, and unsatisfactory glycemic control were identified as risk factors for SI in Type 1 (T1DM) and Type 2 (T2DM). [3] Among others, suicide risk includes also gender, developmental, and substance abuse determinants. [3] A meta-analysis done by Anderson RJ et al., (2001) indicated that on average 27% of women with diabetes developed depressive disorders, which was roughly one-third higher than for men with diabetes, of whom 18% developed depression. The higher rates for women was partially due to women experiencing more negative life events, significant hormonal changes during the perinatal period. Migration is also associated with higher rates of depression, higher rates of diabetes, and higher rates of comorbidity of depression and diabetes in migrants.[1] Freeman et al. (2017), showed a significant association between suicide intent and gender where \u27Serious Suicide Attempts\u27 (SSA) were rated significantly more frequently in males than females. Economic crises resulting in unemployment and decreased personal income have been correlated with increases in suicide, particularly in males. [4, 5] Other factors include: Living alone, high introversion, traumatic events in adulthood, interpersonal stressors, loss/bereavement, extreme hopelessness, helplessness and worthlessness, or defeat and entrapment, which may result from depressive psychopathology. [4] Continuing with prior studies examining depression and comorbid conditions, the aim of this study is to explore the association of suicidality and contributing risk factors in patients with uncontrolled type II diabetes in a sample from the Rio Grande Valley, represented mostly by Mexican-Americans and Hispanics. Methods: The Salud y Vida program is one based in Cameron County focused on assisting patients with type 2 diabetes. The Salud y Vida program holds as its vision that underserved participants with type 2 diabetes mellitus will achieve improved self-management and health following participation in the Chronic Care Management Program. Using a sample of 501 participants from the SYV cohort, chi-square analysis and logistic regression was performed to explore the association between the risk factors and suicidality. Significance was determined using a p-value of 0.05 along with a clinically relevant finding. Suicidality was assessed using the PHQ-9 (Patient Health Questionnaire-9). As no non-diabetic patients were involved with the program, years of living with diabetes was categorized in quartiles, with Q1 serving as the reference group. The distribution of diabetes years for all included patients was Q1 10-34 yrs.; Q2 35-40 yrs.; Q3 41-48 yrs.; Q4 49 -65 yrs. Results: The average age of patients was 50.6 years with a range of 20 to 75. Roughly 70% of patients were between 40 and 59. Females made up 371 (74.1%) of the patients, with 92% (n=458) of all patients self-reporting as Hispanic. About 92% of patients were classified as overweight (n=142; 28.9%) or obese (n=307; 62.5%). The majority of patients also reported a monthly income $4000 or less (n=422; 87.7%). Before adjustment age, BMI, depression within the last 2 weeks and years of diabetes were associated with suicidal ideation. After adjustment, an interaction between age and diabetes years was found. For males, those in Q2 for diabetes years had 6.8 times the odds of suicidal ideation (OR = 6.8, 95% CI 1.26 – 36.7, p = 0.0260), with no difference for Q3 and Q4. For females however, the opposite trend was found with those in Q4 having a reduction of 63% of suicidal ideation relative to those in Q1 (OR = 0.37, 95% CI 0.13 – 1.04; p = 0.0587). Both M and F displayed a similar result with depression and suicidality with those reporting more depression having higher odds of suicidal ideation. Females also displayed a slight age affect with women 50 to 59 having 2.74 times the odds of suicidal ideation relative to those 60+ (p = 0.0428). Discussion: Our study is consistent with prior findings with depression being strongly linked to suicidal ideation. Consistent with previous research of Gomez-Peralta et al., we also found that age and years of diabetes was also influential with suicidal ideation. Gomez-Peralta et al. a high prevalence of suicidal behavior in patients with type 2 diabetes that were younger, had depression and normal BMI were found to be risk factors of suicide attempt in these patients. However, our study found that there was a difference with how M and F responded with only one age grouping in women displaying higher odds of suicidality (50 to 59) when comparing age groups. We also found that yrs. of diabetes was associated with greater odds of suicidal ideation for males, while the effect is reversed in females. Our study is limited in that non-diabetic patients were not included and females are over represented. Conclusion: Our study supports that M and F with diabetes display patterns with suicidal ideation consistent by age and depression. However, we found that the number of years of being diabetic attenuated suicidality for females, while seemed to exacerbate the condition in females. Future direction should explore this topic in a larger and potentially more diverse group demographically to explore if this finding persists

Trusted Sources of Health Information During the COVID-19 Pandemic

Background: As the role of media has evolved with display and consumption of health information, the need to decipher the quality of the information has become exceedingly important. This became more important during the covid-19 pandemic, when information was being formulated and released nearly real-time. Prior to the pandemic, government agencies, health professionals and authorities were generally trusted sources of information. Additionally, information passed more casually through family and acquaintances was also something people tended to rely upon. This paper explores the self-reported trustworthiness of different health information sources during the pandemic and also seeks to rank the importance from health information consumers. Methods: The study employed the COVID-19 Impact on Health and Well-being Survey (IHWS) created by members of UTRGV. Inside the IHWS demographic information was collected along with questions on trusted sources on health information. To be included for analysis all trusted sources questions needed to be complete; 640 of 836 observations were used. Using Principal Component Analysis (PCA) important factors on trusted sources of health information were created. Descriptive statistics were created and stratified by the PCA factors. Multivariable regression was then used to explore if sociodemographic (age, race, sex, education, income) variables were associated with mean factor scores. An alpha of 0.05 was used to determine significance. SAS 9.4 was used to perform all analysis. Results: The factors identified were Government/Non-Profits/News Outlets (F1), Family/Friends/social media(F2), Health Professionals (F3). The cumulative variance explained by the three factors was 67.1%. The majority of respondents were female (n=492, 78.2%), Hispanic (n=353, 55.3%), and college graduates (n=480, 75.1%). Age was associated with all factors, with younger respondents having less trust in sources. Income group was associated with F1 and F2, with higher incomes showing more trust in these factors. Race was associated with F1 with Caucasians showing less trust than Hispanics and other race groupings. Discussion: This research found three important factors on grouping trusted sources of information with domain specificity. The most important factor was government/non-profits/news outlets. Differences were found across sociodemographic across the factors demonstrating tailored informational dissemination might be more effective based on these characteristics

Disparity in outcomes of melanoma adjuvant immunotherapy by demographic profile

Background: Randomized comparisons have demonstrated survival benefit of adjuvant immunotherapy in node-positivemelanoma patients but have limited power to determine if this benefit persists across various demographic factors. Materials & methods: We assessed the impact of demographic factors on the survival benefit of adjuvant immunotherapy in a database of 38,189 node-positive melanoma patients using the Kaplan–Meier method and Cox proportional hazards models. Results: All assessed demographic factors other than race significantly impacted survival of node-positive melanoma patients in univariate analysis. In multivariable analysis, only the age group interacted with immunotherapy. Conclusion: Analysis of this large database of unselected node-positive melanoma patients demonstrated a positive survival benefit of immunotherapy across all demographic factors assessed and the impact was greater for patients 65 years of age and older

Predicting USMLE Step 2 Scores Using Results from the NBME Shelf Exams

Background In February of 2020 the sponsors of the USMLE examinations, which includes the NBME and the Federation of State Medical Boards (FSMB) decided to change the scoring system of the USMLE Step 1 from a three-digit numeric score to a Pass/Fail outcome1. The basis of this change was made to “address concerns about Step 1 scores impacting student well-being and medical education”2. Historically, the three-digit numeric score from Step 1 has been one of the top determining factors for admission into residency3. This change will cause a shift in the priority of objective and subjective factors about applicants that residency program directors use to assess medical students. The purpose of this study is to further assess the correlation between core clerkship NBME Shelf exam scores with performance on the USMLE Step 2. Predicting performance on the USMLE Step 2 is of more importance now that the Step 1 scoring system was changed to a Pass/Fail outcome. We expect that the scores on the NBME shelf exams will be correlated to the overall performance on USMLE Step 2, further supporting the conclusions of the previous study by Zahn et al4. Methods Data containing students’ performance on the USMLE Step 2 and NBME Shelf exams was obtained from Blackboard and One45. In order to protect student confidentiality, data will be de-identified at the point of collection by supervising faculty. From the clerkship assessment score (professionalism, clinical knowledge, shelf exam, etc.) each component will be standardized and converted into a z-score. The NBME Shelf Exams and USMLE Step 2 score will also be converted into a standardized z-score. Standardized USMLE Step 2 T-scores will be substituted in place of NBME Shelf T-scores and final grading computation will analyze the frequency of each grade type (Honors, High Pass, Pass, Fail). Linear regression will be used to determine the correlation between USLME Step 2 scores and performance on the Clerkship Shelf Exams. To assess the effect size of the regression equation, a squared correlation coefficient (R2) will be computed between scores of the USLME Step 2 and NBME Shelf Exams. Results Data collection complete after update to IRB research proposal was approved. Data analysis underway with preliminary results expected in early Spring 2021. Conclusion Further analysis of the data is required for proper conclusions to be drawn

Exploration of factors in faith and their association with depression and anxiety during the COVID-19 pandemic

Background: Depression and anxiety are two of the most common mental health conditions afflicting a wide range of populations. They have been found to cause not only mental distress but also lead to poorer health outcomes. Research has sought to find the causes and risk factors regarding these conditions to better prevent their development and treat them adequately. Religions and faith, measured in various forms have been shown to both attenuate or exaggerate these effects. This research seeks to identify how self-reported faith was shown to be associated with the development and severity of depression and anxiety during the early months of the pandemic. Methods: Using the COVID-19 Impact on Health and Well-being Survey (IHWS) created by members of UTRGV. Validated instruments (FAITH scale, PHQ9 and GAD7) were used to construct faith factors and depression and anxiety measures. Descriptive statistics were created for all covariates and stratified by faith favors. Chi-square analysis was performed to examine the association between all covariates and faith factors. A final model using binary logistic regression explored how the self-reported faith factors were associated with anxiety and depression adjusted for all other covariates. An alpha of 0.05 was used to determine significance unless otherwise noted. SAS 9.4 was used to perform all analysis. Results: The majority of respondents were female (n=485, 78.6%), Hispanic (n=349, 56.0%), and college graduates (n=472, 75.9%). Overall, the proportion of moderate to severe depression and anxiety 9.6% and 19.2% respectively. Faith Factors (self-reported faith intensity, service attendance and weekly hours of prayer/meditation) were not associated with depression. Service attendance was associated with reduced anxiety in adjusted and unadjusted analysis. The odds of moderate to severe anxiety was 103% higher (OR=2.02 95% CI 1.12 = 3.70) for those who attended services monthly or less versus those who attended weekly or more. Discussion: Prior research has shown that positive faith and religious experiences generally attenuate depression and anxiety. This research found during the pandemic positive faith expression, service attendance and weekly prayer and meditation didn’t attenuate depression, but weekly or more service attendance did reduce moderate to severe anxiety

Factors associated with meeting physical activity guidelines during the COVID-19 pandemic

Introduction: The COVID-19 pandemic impacted individual physical activity levels. Less is known regarding how factors such as sociodemographic and built environment were associated with physical activity engagement during the pandemic. Understanding these factors is critical to informing future infectious disease mitigation policies that promote, rather than hinder physical activity. The purpose of this study was to assess predictors of physical activity levels during the beginning of the pandemic (April-June 2020), including Stay-at-Home length and orders, neighborhood safety, and sociodemographic characteristics. Methods: Data included 517 participants who responded to an anonymous online survey. Physical activity was assessed with a modified Godin Leisure-time exercise questionnaire. We used logistic regression models to estimate unadjusted and adjusted odds ratios (aOR) and their 95% confidence intervals (CI) for the associations between independent variables (e.g., demographic variables, neighborhood safety, COVID Stay-at-Home order and length of time) and physical activity levels that did not meet (i.e., \u3c 600 metabolic equivalents of task [MET]-minutes/week) or met guidelines (i.e., ≥ 600 MET-minutes/week). We used R-Studio open-source edition to clean and code data and SAS V9.4 for analyses. Results: Most participants were 18-45 years old (58%), female (79%), Hispanic (58%), and college/post-graduates (76%). Most (70%) reported meeting physical activity guidelines. In multivariate-adjusted analyses stratified by income, in the highest income bracket (≥ $70,000) pet ownership was associated with higher odds of meeting physical activity guidelines (aOR = 2.37, 95$40,000). Within this lowest income bracket, we also found that a lower level of education was associated with reduced odds of meeting physical activity guidelines. Discussion: We found that perceived neighborhood safety, education and pet ownership were associated with meeting physical activity guidelines during the early months of the COVID-19 pandemic, but associations differed by income. These findings can inform targeted approaches to promoting physical activity during subsequent waves of COVID-19 or future pandemics

Follow Up Care For Heart Failure Patients And Association With Hospital Readmission

Background: The CDC reports 6.5 million adults in the US have Heart failure (HF) with yearly costs topping 30 billion. HF patients admitted to Valley Baptist (VB) are readmitted 26% of the time, which is close to the national average of 23% [1]. Standard of care for HF patients is remote nursing care for 30 days from discharge. A hospitalization for any reason within 30 days is considered a “readmission”. On October 1, 2019 at VB remote nursing care changed from weekly house visits to weekly phone calls. The aim of the study is to evaluate the effectiveness of this policy change on readmission rates. Methods: We performed a retrospective chart review using all patients admitted with HF from August 1, 2019 to January 31, 2020 at VB. A final sample of 170 patients was collected. Variables considered for the study were readmission, time to readmission (days), age (yrs), length of stay (LOS), in hospital education and follow up care (FU). Descriptive statistics [mean (SD) and n (%)] were created overall and stratified by readmission. Binary logistic regression was used to assess the association with readmission and time to admission. Final adjusted ORs are reported to explore how FU care is associated with readmission. Results: The average age of patients was 68.8 (yrs) with the mean LOS 5.5 days. During hospital stay, 54.1% (92/170) of all patients received education; 29.3 % (27/92) of them received it through a skilled nurse in the Progressive Coronary Care Unit (PCCU) while 70.7% received it from the primary nurse. Readmission rates were 31.7 % before nursing care changed from weekly house visits to weekly phone calls and 19.3% afterwards (p = 0.0633). There was no evidence FU Care produces a disparity in readmission rates after adjustment (in-home visits vs phone calls) OR = 1.75 (95% CI 0.84 – 3.66, p = 0.1363). Conclusions: Our study supports the change in FU care produced no disparity in readmission rates, which may result in lower costs to FU care with new policy. In-home visits were more prevalent with readmissions than phone calls; As a limitation for our analysis, we were unable to determine if CHF severity determined what patients received hospital education from skilled nursing staff which could have introduced selection bias. 1. Khera, R., et al., Evaluation of 30-day hospital readmission and mortality rates using regression-discontinuity framework. Journal of the American College of Cardiology, 2019. 74(2): p. 219-234