Differences in typical-use contraceptive failure rates between long-acting reversible contraception (LARC; such as intrauterine devices [IUDs] and implants) and shorter-acting methods (depot medroxyprogesterone acetate [DMPA], pills, rings, and male condoms) are often the focus of contraceptive counseling, but assessments of contraceptive counseling have not focused on contraceptive effectiveness over time. To assess 3-year continuation and typical-use contraceptive failure rates for 7 reversible contraceptive methods provided with access barriers removed. The HER Salt Lake Contraceptive Initiative was a 3-year prospective longitudinal cohort study (September 2015 to March 2017, with follow-up data collected through June 2020). Participants (new contraceptive users 18-45 years who indicated they wanted to avoid pregnancy for at least 1 year) enrolled at 4 family planning clinics in Salt Lake County, Utah, and received person-centered contraception counseling and same-day access to the reversible contraceptive method of their choice. Data were analyzed from June 2024 to February 2026. The exposure was contraceptive method selected at baseline (copper IUD, DMPA, implant hormonal IUD, condoms, pill, or ring). The outcome was experiencing a contraceptive failure, defined as an unintended pregnancy (self-reported or identified through electronic medical record) experienced while using a contraceptive method in the previous 4 weeks. Method-specific continuation and failure rates were calculated using a life table analysis. Among 4275 contraceptive users (1759 [41%] aged 20-24 years), 96 pregnancies resulting from contraceptive failures of methods initiated at baseline were identified. Of all participants, 529 (11%) selected a copper IUD, 558 (13%) selected DMPA, 823 selected an implant (19%), 1025 (24%) selected a hormonal IUD, 52 (<1%) selected condoms, 1065 (25%) selected pills, and 223 (5%) selected the ring. Cumulative continuation at 3 years included 741 hormonal IUD users (72%), 455 implant users (55%), 321 copper IUD users (61%), 186 DMPA users (33%), 75 ring users (34%), 376 pill users (35%), and 8 male condom (15%). Three-year contraceptive failure rates per 100 person-years were 0.7 (95% CI, 0.4-1.1) for hormonal IUD users, 0.8 (95% CI, 0.5-1.3) for implant users, 1.1 (95% CI, 0.6-1.8) for copper IUD users, 1.1 (95% CI, 0.6-2.1) for DMPA users, 1.4 (95% CI, 0.6-3.2) for ring users, 1.6 (95% CI, 1.1-2.3) for pill users, and 2.6 (95% CI, 0.5-10.0) for male condom users. In this cohort study of individuals initiating a contraceptive method following person-centered contraceptive counseling and removal of access barriers, low 3-year contraceptive failure rates were observed for all methods, and shorter-acting methods had lower failure rates than previously reported typical use rates. These findings suggest that removing access barriers to preferred contraceptive methods may support access to clinician-dependent LARC methods, like IUDs and implants, and improve the contraceptive effectiveness of user-controlled, shorter-acting methods.
Mesh Integration (MINT) index was previously proposed and validated in the short term as a standardised objective method of evaluating in vivo hernia mesh behaviour. The primary aim was to validate the degradation domain of the mesh integration (MINT) index over a 1-year period using a porcine model, with the secondary aim of determining integration and fibrosis scores after extended implantation. Six brands of mesh were implanted into three Landrace-White pigs within the retrorectus space. Post-mortems were performed at 1 year. All mesh-tissue samples were subjected to standardised testing specified by MINT. Previous 3-month study conditions were fully replicated. Mesh was successfully implanted into all pigs, with an unremarkable 1-year natural history. There were no difficulties at post-mortem. Visually, all meshes were highly integrated. The 1-year degradation scores obtained were consistent with changes expected in absorbable meshes. Since study methodology, study conditions and mesh lot numbers were identical, the current study data were combined with the previous 3-month study for statistical analysis. Multi-level regression analysis with maximum likelihood was performed, and model diagnostics were conducted. Non-linear models achieved better fit to data than linear models, namely asymptotic for integration ( - 2 L L = 76.46 , R 2 = 0.971 , R M S E = 0.370 ), biexponential for fibrosis ( - 2 L L = 127.57 , R 2 = 0.941 , R M S E = 0.517 ) and logistic regression for degradation ( - 2 L L = 199.83 , R 2 = 0.984 , R M S E = 0.817 ). Rationale and limitations to interpretation of the study results were extensively discussed. The degradation domain of the MINT index has been validated at 1 year. The versatility of the MINT index platform could potentially be used to summarise existing literature evidence on in vivo mesh behaviour.
Retrospective comparative study using prospectively collected data from a multicenter adult spinal deformity (ASD) registry across six centers, with propensity score (PS) matching to compare surgical versus nonoperative management. To compare 2-year patient-reported outcomes and serious adverse events after surgical versus nonoperative management of adult spinal deformity (ASD). Randomized trials comparing operative and nonoperative treatment for ASD are rarely feasible, and ASD presents heterogeneous clinical and radiographic features, complicating treatment decisions. Propensity score methods can reduce measured confounding and strengthen comparative effectiveness estimates from observational cohorts. Consecutive adults meeting radiographic criteria for ASD were identified from six participating centers. The primary endpoint was change in Oswestry Disability Index (ODI) at 2 years; secondary endpoints included SRS-22 outcomes. Propensity scores for surgery were estimated using logistic regression including age, sex, body mass index, major Cobb angle, pelvic incidence-lumbar lordosis mismatch, global tilt, pelvic tilt, baseline ODI, and SRS-22 total score. One-to-one nearest-neighbor matching (caliper 0.25) generated balanced pairs. Outcomes were compared within the matched cohort. Among 764 screened patients, 580 were eligible (338 surgical; 242 nonoperative). Propensity score matching produced 160 well-balanced pairs (n=320). In the matched cohort, mean age was ~45 years in both groups. At 2 years, ODI improvement was greater after surgery than after nonoperative care (-19.4±14.2 vs. -4.2±12.3; P<0.001); 72% of surgical patients versus 29% of nonoperative patients achieved a clinically meaningful ODI improvement (≥15 points; P<0.001). SRS-22 outcomes favored surgery, including higher 2-year SRS-22 total score (3.95±0.67 vs. 3.46±0.75; P<0.0001) and a higher proportion achieving MCID for SRS-22 total score (81.3% vs. 36.9%; P<0.001). In a multicenter PS-matched ASD cohort largely representing younger patients with mild-to-moderate baseline impairment, surgery was associated with superior 2-year disability and HRQoL outcomes compared with nonoperative care.
This study evaluated 68 third-year veterinary students' subjective and objective stress level changes at baseline (laboratory orientation session), prior to (pre-task), and following (post-task) a laboratory-simulated ovariohysterectomy (OVH) using a surgical simulation trainer. Using a pre-post experimental design, salivary alpha amylase (sAA) and cortisol (sC) samples were evaluated as markers of the students' physiologic stress response over three time points. NASA task load index (NASA-TLX) scores were correlated to salivary biomarker results. There was no association for change in salivary biomarkers accounting for age, gender, or NASA-TLX scores. However, stress levels did change based on sampling timing compared with performing the simulated OVH. sAA levels were lowest at baseline and increased post-task (p < 0.050). sC levels were highest at baseline and decreased pre-task (p < 0.016) and post-task (p < 0.001). sC levels were highest at baseline (average 77th percentile) and decreased pre-task (average 71st percentile) and post-task (average 52nd percentile). Veterinary students performing a simulated OVH demonstrated high baseline levels of subjective and objective stress. However, sC levels decreased significantly following the simulated OVH, and sAA levels followed a normal circadian rhythm following OVH completion. These findings suggested that students with adequate resources, such as a strong surgical skills foundation, can assess a surgical task as a challenge, which can result in learning. Further evaluation of implementation of surgical simulation trainers and investigation into the role of stress on performance is indicated to support this group of learners.
Papillary thyroid cancer has an established favorable outcome with a 10-year overall survival of more than 90%, but the chances of recurrences are as high as 20%. Traditionally, all intermediary-risk and high-risk category patients undergo vigorous follow-up. A sensitive risk stratification system may predict the patients requiring stringent postoperative surveillance. The present study is a retrospective cohort study of papillary thyroid cancer operated and systematically followed for a median period of 135.5 months. The outcomes at the end of the follow-up period were determined based on American Thyroid Association (ATA) guidelines (2015). We used American Joint Committee on Cancer (AJCC) risk stratification (8 th edition), ATA risk stratification (2015), and a modified dynamic risk stratification system. The disease status in the first year of the follow-up was used for reclassification. The overall survival was 95.1%, but the incidence of adverse outcomes which included disease-specific mortality, structural incomplete responses, and biochemical incomplete responses was 11.2% (n: 23). The modified dynamic risk stratification had higher accuracy in predicting the outcomes. Patients who had excellent responses in the first year of follow-up are unlikely to develop adverse events in the future. However, those who had overt or evident distant metastases at the time of diagnosis require vigilant surveillance.
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Six years since the emergence of SARS-CoV-2, the newer variants of the virus continue to have long-term health effects. The aim of the study was to investigate persistent symptoms, cognitive impairment, and clinical and paraclinical predictors of long COVID in individuals infected during the Omicron wave. We conducted a clinical case-control study including participants with persistent symptoms up to 13 months after confirmed SARS-CoV-2 Omicron infection (long COVID or LC group) and antibody-verified never-infected controls (NI group). A total symptom score based on a 24-item questionnaire was strongly associated with increased odds of long COVID (adjusted odds ratio (aOR) 1.21, 95% CI 1.13-1.30, p < 0.001). Sub-analysis showed particularly strong associations for fatigue, cognitive impairment, neurological symptoms, and symptoms from the cardiopulmonary and musculoskeletal systems. Both mental impairment and fatigue independently predicted long COVID (aOR 1.27, 95% CI 1.14-1.42, p < 0.001, and aOR 1.27, 95% CI 1.11-1.46, p < 0.001, respectively). Additionally, a higher number of self-reported infections during the follow-up period increased the odds of long COVID (aOR 1.57, 95% CI 1.06-2.34, p = 0.025), though this was not reflected in antibiotic use. Finally, blood analyzes showed that lower white blood cell counts were associated with increased odds of long COVID in women, but not in men, however the clinical significance of this finding remains uncertain. One year after Omicron infection, a subset of people continue to experience a substantial symptom burden, particularly fatigue, cognitive impairment, and mental well-being, and a higher frequency of intercurrent infections.
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The goal of antiretroviral therapy is to achieve and sustain the suppression of human immunodeficiency virus (HIV) viral load. In this study, we aimed to identify risk factors for low-level viremia (LLV) and examine their association with clinical outcomes in South Korea. We retrospectively reviewed the medical records of patients with human immunodeficiency virus infection registered at Seoul Medical Center and Hallym University Sacred Heart Hospital between 2014 and 2023. LLV was defined as at least two consecutive HIV RNA measurements of 40-199 copies/mL taken more than 4 weeks apart. Patients with LLV were compared with those who maintained virological suppression (viral load < 40 copies/mL). Of the 381 patients included in the analysis, 15 (3.94%) experienced LLV. Compared with patients who maintained virological suppression, patients with LLV more frequently had an initial viral load ≥ 500,000 copies/mL (P < 0.01). No significant differences were observed between the groups in the rates of virological rebound, new-onset acquired immune deficiency syndrome-defining conditions, or mortality. Multivariable logistic regression identified an initial viral load ≥ 500,000 copies/mL as an independent risk factor for LLV (adjusted odds ratio, 4.735; 95% confidence interval, 1.505-14.897). A high viral load was a significant risk factor for LLV. Large multicenter studies are required to further investigate risk factors and clinical implications of LLV in people living with HIV.
To expand the tripartite mission to advance health equity, academic medical centers (AMCs) need to look outside their walls. In 2018, Stanford's primary care division launched the Community Partnership Program (CPP) between their AMC and local safety-net community health centers (CHCs) to support the goals of meaningful community engagement and addressing local clinic capacity needs. The CPP embeds Stanford physician faculty in local CHCs through service agreements. This study aimed to characterize the experiences of CHC leaders and faculty involved in the CPP to better understand barriers and facilitators to program implementation and assess its success as a community-responsive partnership. Stanford's CPP faculty (n = 9/15) and representative CHC leadership (n = 9/11) from five partner CHCs participated in the study. The National Academy of Medicine's Assessing Community Engagement Conceptual Model guided an explanatory mixed methods study: cross-sectional survey followed by semi-structured interviews. A modified Enage for Equity Community Engagement Survey identified high- and low-scoring variables (Likert scale:1-strongly disagree/never to 5-strongly agree/always). Qualitative assessment explored facilitators and barriers to program implementation and success. Overwhelmingly, both CHC leaders and faculty (n = 18) highlighted the CPP's positive role in making their work meaningful (4.78 (0.5)) and trusting the partners they work with (4.50 (0.5)). Sufficient time (3.61 (1.0)) and financial support (3.33 (1.4)) to engage in the CPP were the lowest scoring variables. Qualitative results highlighted the importance of communication, trust, and institutional buy-in, the value of community-academic bridges, increased access to clinical care, development of community-aligned solutions, and the partnership's positive impact on well-being. A model of community-academic partnership with primary care faculty embedded in safety-net CHCs can be successful from both AMC and CHC perspectives. These findings offer pragmatic lessons that can support other AMCs in building their own capacity for equity-focused collaboration grounded in community-engaged principles.
Retrospective analysis of prospectively collected database. Adult spinal deformity (ASD) has increasingly been treated with minimally invasive surgical (MIS) techniques. The authors sought to identify factors associated with delayed deterioration of ODI between 1 and 2 years postoperatively following minimally invasive surgery (MIS) for adult spinal deformity (ASD). Coronal malalignment is known to be associated with patient disability but the extent to which coronal alignment is associated with delayed deterioration after circumferential MIS surgery for ASD is unknown. A retrospective analysis of prospectively collected data from the Minimally Invasive Surgery International Spine Study Group (MIS-ISSG) was conducted, including 67 patients who underwent circumferential MIS for ASD with one and two-year follow-ups. The patient cohort was dichotomized by identifying patients who reported higher ODI scores at 2 years than 1 year (somewhat improved) and compared with patients who reported stable or improved ODI over the same time course (very improved). Preoperative and postoperative factors influencing ODI changes were analyzed, focusing on radiographic outcomes and complications. Of the 67 patients, 31 reported an increase in ODI at two years compared with one year but these patients continued to show an improvement in ODI compared to preoperative baseline. Statistical analyses revealed no significant differences in baseline demographic, surgical, or preoperative characteristics between the "somewhat improved" (2-year ODI>1-year ODI) and "very improved" (2 y ODI≤1 y ODI) cohorts (P>0.05). However, the somewhat improved group had a significantly higher mean central sacral vertical line (CSVL) at all follow-up intervals (6-week CSVL mean 36.26 mm in the Somewhat improved group versus 22.8 mm in the very improved group, P=0.01). Early post-operative coronal malalignment is associated with delayed changes in functional outcomes following MIS for ASD.
Congenital lipoid adrenal hyperplasia (lipoid CAH) is caused by pathogenic variants in STAR, encoding steroidogenic acute regulatory protein (StAR). In affected 46,XX patients, progressive cholesterol ester accumulation in the ovaries during puberty leads to premature ovarian insufficiency and, in approximately one-third of cases, large ovarian cysts or ovarian torsion requiring surgical intervention. These complications may relate to elevated gonadotropin levels, yet no preventive strategy exists. We report a 46,XX female with classic form of lipoid CAH who underwent gonadotropin suppression with a gonadotropin-releasing hormone (GnRH) analog followed by estrogen and progestin administration, with longitudinal monitoring of the ovarian morphology. An 18-year-old Japanese female was diagnosed with lipoid CAH neonatally after presenting with failure to thrive, skin hyperpigmentation, hyponatremia, and hyperkalemia. Computed tomography revealed bilateral adrenal hyperplasia with low attenuation consistent with lipid accumulation. Genetic analysis identified compound heterozygous pathogenic STAR variants: p.Gln258* and p.Glu218Val. Glucocorticoid and mineralocorticoid replacement was initiated. The patient exhibited spontaneous breast development at age 10 years with pubertal gonadotropin responses and mildly elevated ovarian volume with a large ovarian cyst. After informed discussions with the guardians regarding the risks of ovarian complications, subcutaneous leuprorelin acetate was started at age 10 years 4 months and continued until age 15 years 7 months. Transdermal estradiol was introduced at at age 14 years, and oral norethindrone was added at 14 years 11 months, after which regular cycles were established. Before leuprorelin therapy, the maximum ovarian cyst diameter was 13 mm (right), exceeding the +2.0 standard deviation (SD) threshold for age; this decreased to 6 mm within 6 months of treatment and remained within the reference range thereafter. Ovarian volumes decreased from 3.1 mL (right) and 1.7 mL (left) before therapy to 1.1 mL and 1.0 mL at 12 months, respectively. At age 18 years, no large ovarian cysts, ovarian hypertrophy, or torsion had developed. This is the first reported case of lipoid CAH managed with GnRH analog-mediated gonadotropin suppression followed by estrogen and progestin administration. Despite a large ovarian cyst and mildly elevated ovarian volume at baseline, both measures improved and were maintained within the normal range over eight years of follow-up. This approach may be useful not only for preventing ovarian complications but also for improving and sustaining normal ovarian morphology, and warrants further evaluation, although its long-term effects on bone health, uterine maturation, and fertility require careful assessment.
Hip fracture is common among older adults and is associated with considerable morbidity and mortality; it is nearly twice as common in those with dementia, who may also experience worse postfracture outcomes. Time spent at home is an important quality-of-life indicator, but this outcome has not been previously examined following hip fracture in older adults with and without dementia. To compare days at home and survival for the year after hip fracture among older adults with and without dementia and to identify factors associated with fewer days at home among those with dementia. This longitudinal cohort study used national administrative data from 100% of Medicare beneficiaries from 2012 to 2021 to identify community-dwelling older adults (aged ≥65 years) with and without dementia hospitalized for a hip fracture. Data were analyzed from January 1, 2012, to December 31, 2021. Hip fracture hospitalization. Days at home and survival at 30 days, 6 months, and 1 year after hip fracture. Among 1 756 388 Medicare beneficiaries hospitalized for hip fracture, the mean [SD] age was 82.5 [8.1] years, 1 237 193 (70.4%) were female, 65 889 [3.8%] were Black or African American, 93 362 [5.3%] were Hispanic, 1 547 090 [88.1%] were non-Hispanic White, and 513 698 (29.2%) had dementia. In the year following hip fracture, older adults with dementia died 50.3 days earlier than those without dementia (adjusted mean [SD] days, 264.6 [143.2] vs 314.9 [107.3]). Those with dementia who survived 1 year after fracture had 53.9 fewer days at home compared with those without dementia (adjusted mean [SD] days, 263.8 [129.5] vs 317.7 [72.9]) due to more time in skilled nursing (adjusted mean [SD] days, 38.2 [55.8] vs 24.2 [37.4]) and long-term care facilities (adjusted mean [SD] days, 52.5 [111.5] vs 12.4 [53.7]). Findings were similar at 1 and 6 months. Among individuals with dementia, Medicaid eligibility, rural residence, geographic region, and being aged 85 years or older were associated with the fewest days at home at 1 year. In this cohort study, older adults with dementia had shortened survival and more time in skilled nursing or long-term care facilities after hip fracture than those without dementia. Differences in days at home were associated with structural and socioeconomic factors among those with dementia, with implications for health system policy, prognostic counseling, and discussions about long-term care needs in this population.
Diabetic foot ulcer (DFU) is a severe complication of diabetes that often leads to amputation and high mortality, yet survival outcomes and risk factors after DFU-related amputation remain poorly understood particularly in Indonesia. This study aims to determine the incidence rate (IR), survival rate and to identify factors associated with the survival of amputation among patients having DFU in Indonesia. This retrospective cohort study included Type 2 Diabetes Mellitus (T2DM) patients with DFU admitted to the Margono Hospital in Central Java Indonesia. The primary outcome of this study was the times since diagnosis of DFU to amputation. This study outcome was conducted for 5-year survival (2019-2024), IR and survival rate of amputation. Multiple cox regression was performed to investigate factors associated with survival, quantified by adjusted hazard ratios (AHR) and their 95% CIs. This cohort comprised 878 DFU patients and followed up for 1,350.55 person-year within the study period. The overall amputation IR was 14.22 per 100 person-year (95% CI: 12.34-16.38) with the highest IR/100 population was 85.68 (95% CI: 73.49-99.90) occurred in the gangrene group. The overall survival rate within 1-year, 3-year and 5-year was 76.14% (95%CI: 72.82-79.11), 72.77% (95%CI: 69.08-76.10) and 71.18% (95% CI: 67.22-74.75) respectively with the highest five-year survival rates were observed among patients with cardiovascular disease (94.37%, 95% CI: 85.17-97.93). Factors that were associated with survival included patients who receiving insulin therapy (AHR: 5.51; 95% CI: 3.73-8.14), residing in rural areas (AHR: 4.14; 95% CI: 1.70-10.12), patients without neuropathy (AHR: 2.40; 95% CI: 1.30-4.42), those with underweight or normal BMI (AHR: 2.04; 95% CI: 1.40-2.98), and those without hypertension (AHR: 1.52; 95% CI: 1.03-2.22). The study revealed that the rate of amputations was relatively high and highest survival rate was patients with cardiovascular disease. Receiving insulin therapy, staying in rural area, no-neuropathy, underweight and normal weight and no-hypertension showed more likely to amputation. Early detection of comorbidities is recommended to prevent amputation among patients with DFU.
Lower-limb muscle thickness assessed by point-of-care ultrasound (POCUS) is emerging as a prognostic marker in older adults, but evidence in patients with hip fracture is limited. This study aimed to investigate whether POCUS of the vastus lateralis (VL) muscle could predict one-year all-cause mortality in older adults with hip fracture, and to identify the VL thickness cut-off with the highest prognostic performance. We conducted a prospective observational study involving patients ≥ 65 years hospitalized for proximal hip fracture at Careggi University Hospital, Florence, Italy, between January 2024 and July 2024 Participants underwent comprehensive geriatric assessment and VL POCUS within 24 h of admission. The study outcome was one-year all-cause mortality. Predictive performance of VL thickness was assessed using ROC curve analysis and multivariate logistic regression. Among 154 patients (mean age 86.5 years, 70.1% female), one-year mortality was 42.2%. Mortality was associated with older age, functional and motor impairment, frailty, malnutrition, and higher comorbidity burden. ROC analysis demonstrated good predictive ability of VL thickness (AUC = 0.702), with a cut-off value of < 1.12 cm providing the best discriminative performance (sensitivity 68%, specificity 64%). Patients with reduced VL thickness showed higher mortality (57.9% vs 26.9%, p < 0.001). VL thickness < 1.12 cm independently predicted mortality, after adjusting for age, nutritional status, pre-fracture functional level and comorbidity burden. In older adults hospitalized for hip fracture, VL thickness of < 1.12 cm independently predicted one-year all-cause mortality, suggesting a potential role of muscle POCUS as a prognostic tool in the orthogeriatric setting.
ObjectiveThis study aimed to assess the prevalence of anemia in Hungary between 2019 and 2022 as detailed data in this regard was not available.MethodsThis retrospective, observational, cross-sectional study enrolled 85628 patients with a median age of 63 (44-76 interquartile range) years admitted to the Emergency Department of the University of Pécs, Hungary, between January, 2019, and December, 2022.ResultsThe overall prevalence of anemia was 22.68%. The prevalence of anemia did not change significantly during the study period (2019: 22.30%; 2020: 22.88%; 2021: 22.55%; 2022: 23.00%). However, the prevalence of severe anemia (Hgb<8g/dL) was higher compared to 2019, in each year (2019:2.00%; 2020:2.52%; 2021:2.60%; 2022:2.47%, p<0.001). The increase was observed in each analyzed year among the elderly male patients and in 2021 and 2022 among the elderly female patients. The rising number of patients with COVID-19 diagnosis presenting severe anemia may have contributed to this change. Among all anemic patients, the overall prevalence of microcytic and macrocytic anemia accounted for one-third, while hypochromic and hyperchromic anemia for half of the cases. Hypochromic anemia prevalence decreased and normochromic anemia prevalence increased significantly in each year. The prevalence of microcytic anemia decreased in the year 2020 compared to 2019, the changes being observed among the female patients only.ConclusionsOver the study period, anemia affected approximately one-quarter of the patients each year, while the proportion of severe anemia increased, especially in the elderly.
Loss to follow-up is among the most important sources of bias in clinical research. Thus, the purpose of this study was to identify factors associated with a failure to complete a 2-year follow-up after shoulder surgery. We hypothesized that older patients would demonstrate higher follow-up rates and that patients who underwent instability surgery would have lower follow-up rates. A retrospective chart review was conducted on 1,028 consecutive patients who underwent shoulder surgery performed by a single surgeon between 2017 and 2022. All patients were contacted by the surgeon via telephone, text message, and email at 2 years postoperatively. Variables analyzed included demographic characteristics, insurance status, surgical procedure type, Social Deprivation Index (SDI), and distance from the surgical site to home. Multivariable logistic regression analysis was performed to determine which factors were associated with 2-year follow-up. Of the 1,028 patients, 507 (49%) completed a 2-year follow-up. The mean patient age was 51 years, 585 patients (57%) were male, and 443 patients (43%) were female. Ninety-four percent of patients were White. Patients who completed follow-up were older (mean age, 53 compared with 49 years; p < 0.001), more likely to have undergone an arthroplasty, and more often insured by Medicare. Loss to follow-up was associated with instability surgery, Medicaid or Workers' Compensation insurance, and missing preoperative visual analog scale (VAS) pain scores. SDI scores and distance from the surgical site were not significant predictors. Age was a covariate of both surgery type and insurance status. In the multivariable model, younger age (odds ratio [OR], 0.99; p < 0.001) and missing VAS scores (OR, 1.51; p = 0.001) independently predicted loss to follow-up, whereas current alcohol use (OR, 0.74; p = 0.024) was associated with lower odds of loss to follow-up. Older age emerged as the most significant predictor of follow-up adherence. Older patients, often undergoing arthroplasty and covered by Medicare, were more likely to complete follow-up. These findings highlight the need for targeted strategies to improve follow-up rates among younger patients, particularly those undergoing instability surgeries, as well as patients with Medicaid and Workers' Compensation insurance. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Male-perpetrated intimate partner violence (IPV) against women is a global crisis, particularly in low- and middle-income countries (LMICs) due to restrictive gender norms. Stigma against infertility and childlessness could increase women's vulnerability to IPV. This study analyzed data from the Demographic Health Survey, including 93,734 ever-in-union, HIV-negative women aged 20-49 years across 16 LMICs. Logistic regressions, adjusted for survey design and covariates, compared lifetime and past-year IPV exposures (any, physical, sexual, emotional) across infertile women, women without children, and women with children. The prevalence of any lifetime and past-year IPV was 40.6% and 30.4%, respectively. Infertile women showed a non-significant difference in their odds of experiencing any IPV compared to women with children (Lifetime: aOR = 0.93, 95%CI 0.71-1.21; Past-year: aOR = 0.94, 95%CI 0.71-1.25). Women without children had lower odds of lifetime IPV (aOR = 0.71, 95%CI 0.58-0.86), with odds of past-year any IPV non-significant (aOR = 0.81, 95%CI 0.66-1.00). The study found alarmingly high prevalence of male-perpetrated IPV among women in LMICs, irrespective of fertility status. Findings highlight the need for universal IPV prevention and support that are inclusive of all women, including families and communities, emphasizing routine screening and support within primary and community healthcare, regardless of women's reproductive experiences.
This study assessed differences in blood pressure control rates and systolic blood pressure (SBP) values at Cook County Health (CCH) implementing the AMA MAP™ Hypertension quality improvement program, with the goal of identifying variations across demographic subgroups including race, ethnicity, sex and age. We conducted a retrospective cohort study at CCH, comparing a 2-year historical pre-intervention with a subsequent 2-year period encompassing implementation and post implementation. Within each demographic subgroup, control rates were calculated as proportion of patients with controlled blood pressure. Univariate analyses assessed changes in blood pressure (BP) control over time. Prevalence ratio estimates were calculated to understand likelihood of having controlled blood pressure. Paired t-tests evaluated within-group changes in SBP, and an ANCOVA was conducted to compare SBP changes between groups while adjusting for baseline SBP. Overall, blood pressure control rates increased over time. However, Black patients were less likely than White patients to have controlled blood pressure both before (PR 0.91 [CI: 0.87-0.96]) and after (PR 0.96 [0.92-0.99]) the implementation of the program. SBP improved across all demographic groups, including Hispanic (-5.74 [CI:6.19- -5.29]) and Non-Hispanic patients (-4.92 [-5.21- -4.63]), White (-5.96 [CI: -6.45- -5.47]) and Black (-4.80 [CI: -5.11- -4.49]) patients, and patients 45-64 years of age (-5.79 [CI: -6.12- -5.46]) and patients 65-85 years of age (-4.31 [CI: -4.68- -3.94]). The AMA MAP™ Hypertension quality improvement program led to improvements in blood pressure control; however, gaps persisted in SBP values between ethnicity, race and age.
The PARTNER trials played a key role in the expansion of transcatheter aortic valve replacement (TAVR) for severe aortic valve stenosis (AS), shaping international practice guidelines. We assessed the evolution of AS management in France between 2010 and 2022, and the impact of PARTNER trials and European guideline updates on TAVR use. Characteristics of patients, facilities and TAVR valves, and post-procedure events were also described. We conducted a nationwide cohort study using the French Health Data System (SNDS), including patients aged 18 years or older hospitalized for AS and receiving a first TAVR or surgical aortic valve replacement (SAVR) from 2010 to 2022. ARIMA models were used to study the impact of PARTNER trials and European guideline updates on TAVR use. Among 255,453 procedures, 109,739 were TAVR (N2010: 1,389; N2022: 16,770). No significant change in the proportion of TAVR was associated with PARTNER trials or European guideline updates (p ≥ 0.125). Median age and EuroSCORE II proxy were 83.0 years and 2.2 in TAVR group and 72.0 years and 1.4 in SAVR group. Approximately 60% of the TAVR and SAVR procedures were performed in public facilities. Latest valve generations replaced progressively earlier ones, with 62.5% being balloon-expandable. Mortality decreased over time in both groups, while length of stay and intensive care unit admissions decreased only in TAVR group. This 13-year nationwide overview highlights the growing uptake of TAVR in France, likely driven by clinical practice and procedural innovation rather than guidelines. Further analyses will compare efficacy and safety between TAVR and SAVR.