Feasibility and Acceptability of a Patient Navigation Intervention to Prevent Suicide in LGBTQ Youth and Young Adults

Background

Across Western countries, young LGBTQ+ individuals are at a four to seven-fold increased risk of attempting suicide, compared to the general public. Despite these substantial health disparities, no known empirically supported suicide prevention programs exist for this highly vulnerable population. Patient navigation (PN), as an intervention to assist people in overcoming barriers to care, paired with the Safety Planning Intervention (SPI), may be a promising intervention to target mechanisms (e.g., thwarted belongingness and suicide-related coping skills) that theoretically underlie suicide. The purpose of this presentation is to describe the developed intervention and present initial data on its feasibility and acceptability.

Methods

In collaboration with a Participatory Planning Group (PPG), an iterative process was used to develop a PN+SPI intervention to prevent suicide among at-risk LGBTQ+ youth and young adults. A mixed-methods case series was used to examine feasibility and acceptability of implementing the PN+SPI intervention over a three-month period of time.

Results

Theoretical models regarding suicidality and LGBTQ+ mental health along with PPG feedback have informed the development of the PN+SPI intervention, with 7 modules included in feasibility evaluation: 1) Introduction + SPI; 2) Minority Stress Psychoeducation; 3) Barriers to Mental Health Services; 4) Barriers to Community Resources; 5) Decision Making; 6) Crisis Intervention; and 7) Wrap Up.

Conclusions

This project has the potential for reducing mortality and morbidity due to suicide attempts among LGBTQ+ youth/emerging adults, who are one of the most vulnerable groups for attempting suicide globally. Given the brevity of the PN+SPI intervention and its emphasis on safety planning and accessing community resources, the PN+SPI intervention has high potential for wide dissemination and public health impact, should it demonstrate feasibility, acceptability, and preliminary efficacy.

Marketing mortality? Healthy vs. unhealthy food in television advertising

Background

Cardiovascular disease has been the leading killer of Americans since the Spanish flu pandemic of 1918, despite recent COVID-19 mortality. During this global pandemic, the social distancing and stay-at-home requests, there was increased television (TV) engagement, and media marketing has become more impactful in modifying consumer behaviors.

Purpose

We evaluated the healthfulness of food marketing in the United States (US), based on TV commercials most frequently aired on American primetime networks during the COVID-19 pandemic.

Methods

We reviewed a total of 104 TV commercials between 2020–2021 on network and cable programs dividing them into 4 categories: 1) fast-food chains, 2) brand-recognized individual items, 3) grocery chains, and 4) home-delivery meals. The food items displayed in each commercial were recorded and scored based on the previously validated healthful versus unhealthful nutrition scoring system (Sajita, et al., JACC 2017), assigning either positive or negative values for each food item in the commercial.

Results

We found that 58% of the commercials advertised food from fast-food chains (mean score = −2.82, indicating an average of nearly 3 more unhealthy items than healthy items per commercial), 27% were brand-recognized individual items (−0.86), 9% were grocery chains (−0.90), and 6% were for home-delivery meals (−0.33), with significant differences noted between fast-food and individual items, home deliveries and grocery chains (each p<0.0001).

Conclusions

This study demonstrated that commercial TV in the US routinely promotes the consumption of foods that are known in published medical literature to be unhealthy, particularly those underpinning cardiovascular disease and its risk factors. In order to prevent an increase in cardiovascular mortality during and after this global pandemic, we suggest regulation and or legislation to curtail the frequency and/or content of these commercials, and consider a ban on such advertising to children, similar to that previously employed in Canada and the European Union.

Funding Acknowledgement

Type of funding sources: None.

Common deletion variants causing protocadherin-α deficiency contribute to the complex genetics of BAV and left-sided congenital heart disease

Bicuspid aortic valve (BAV) with ~1%-2% prevalence is the most common congenital heart defect (CHD). It frequently results in valve disease and aorta dilation and is a major cause of adult cardiac surgery. BAV is genetically linked to rare left-heart obstructions (left ventricular outflow tract obstructions [LVOTOs]), including hypoplastic left heart syndrome (HLHS) and coarctation of the aorta (CoA). Mouse and human studies indicate LVOTO is genetically heterogeneous with a complex genetic etiology. Homozygous mutation in the Pcdha protocadherin gene cluster in mice can cause BAV, and also HLHS and other LVOTO phenotypes when accompanied by a second mutation. Here we show two common deletion copy number variants (delCNVs) within the PCDHA gene cluster are associated with LVOTO. Analysis of 1,218 white individuals with LVOTO versus 463 disease-free local control individuals yielded odds ratios (ORs) at 1.47 (95% confidence interval [CI], 1.13-1.92; p = 4.2 × 10-3) for LVOTO, 1.47 (95% CI, 1.10-1.97; p = 0.01) for BAV, 6.13 (95% CI, 2.75-13.7; p = 9.7 × 10-6) for CoA, and 1.49 (95% CI, 1.07-2.08; p = 0.019) for HLHS. Increased OR was observed for all LVOTO phenotypes in homozygous or compound heterozygous PCDHA delCNV genotype comparison versus wild type. Analysis of an independent white cohort (381 affected individuals, 1,352 control individuals) replicated the PCDHA delCNV association with LVOTO. Generalizability of these findings is suggested by similar observations in Black and Chinese individuals with LVOTO. Analysis of Pcdha mutant mice showed reduced PCDHA expression at regions of cell-cell contact in aortic smooth muscle and cushion mesenchyme, suggesting potential mechanisms for BAV pathogenesis and aortopathy. Together, these findings indicate common variants causing PCDHA deficiency play a significant role in the genetic etiology of common and rare LVOTO-CHD.

A study on the use of thermal imaging as a diagnostic tool for the detection of digital dermatitis in dairy cattle

Our aims were to (1) determine how interdigital skin temperature (IST), measured using infrared thermography, was associated with different stages of digital dermatitis (DD) lesions and (2) develop and validate models that can use IST measurements to identify cows with an active DD lesion. Between March 2019 and March 2020, infrared thermographic images of hind feet were taken from 2,334 Holstein cows across 4 farms. We recorded the maximum temperature reading from infrared thermographic images of the interdigital skin between the heel bulbs on the hind feet. Pregnant animals were enrolled approximately 1 to 2 mo precalving, reassessed 1 wk after calving, and again at approximately 50 to 100 d postpartum. At these time points, IST and the clinical stage of DD (M-stage scoring system: M1-M4.1) were recorded in addition to other data such as the ambient environmental temperature, height, body condition score, parity, and the presence of other foot lesions. A mixed effect linear regression model with IST as the dependent variable was fitted. Interdigital skin temperature was associated with DD lesions; compared to healthy feet, IST was highest in feet with M2 lesions, followed by M1 and M4.1 lesions. Subsequently, the capacity of IST measurements to detect the presence or absence of an active DD lesion (M1, M2, or M4.1) was explored by fitting logistic regression models, which were tested using 10-fold validation. A mixed effect logistic regression model with the presence of active DD as the dependent variable was fitted first. The average area under the curve for this model was 0.80 when its ability to detect presence of active DD was tested on 10% of the data that were not used for the model's training; an average sensitivity of 0.77 and an average specificity of 0.67 was achieved. This model was then restricted so that only explanatory variables that could be practically recorded in a nonresearch, external setting were included. Validation of this model demonstrated an average area under the curve of 0.78, a sensitivity of 0.88, and a specificity of 0.66 for 1 of the time points (precalving). Lower sensitivity and specificity were achieved for the other 2 time points. Our study adds further evidence to the relationship between DD and foot skin temperature using a large data set with multiple measurements per animal. Additionally, we highlight the potential for infrared thermography to be used for routine on-farm diagnosis of active DD lesions.

791 Using Audit Data to Inform and Guide COVID-19 Recovery: A Case for the Re-Introduction of Immediate Breast Cancer Reconstructions

Introduction

During the COVID-19 pandemic, operations performed in NHS hospitals were restricted. Breast cancer surgery remained vital, however, to reduce theatre capacity pressures and re-admission rates the procedures available were rationalised to keep the risk of complications low. Immediate breast reconstruction was stopped.

COVID-19 recovery meant careful reintroduction of complex surgeries, with competing interests from different surgical specialities for theatre capacity within the Trust. The psychological effects of breast cancer are significant. Therefore, it was important to advocate for our patients and ensure the reintroduction of this service.

Method

To strengthen our case, a retrospective audit of all immediate breast reconstruction outcomes was performed for cases during the 12 months preceding COVID-19.

Results

64 patients underwent immediate implant and Acellular Dermal Matrix (ADM) breast reconstruction. Five (7.8%) patients returned to theatre. One (1.5%) returned during their initial in-patient stay due to haematoma. Four patients (6.3%) returned between 3 and 12 weeks following their original surgery date. Infection rates were higher in smokers or those with a BMI >35.

Conclusions

These results were presented to management and the reconstruction services were re-introduced in our Trust with stringent inclusion criteria. We can therefore offer our patients an improved service that considers both physical and psychological health.

Early versus late tube feeding initiation after PEG tube placement: Does time to feeding matter?

BACKGROUND

Variation exists in the timing of tube feed initiation after percutaneous endoscopic gastrostomy (PEG) tube placement. The aim of our study was to review outcomes of early tube feed (ETF) versus late tube feed (LTF) initiation after PEG tube placement.

METHODS

We performed a retrospective review of all trauma patients who underwent PEG tube placement from 1/2014 to 12/2018. ETF was defined as initiation < 24 h and LTF > 24 h after placement. The primary outcome measure was feeding intolerance and secondary outcomes included post-operative complications. All statistical analyses were performed using standard statistical methods (e.g. Pearson's Chi-squared, Fisher's exact and Mann Whitney-U tests).

RESULTS

There were 295 patients (164 ETF and 131 LTF) that received a PEG tube at our level 1 trauma center. There was no difference with feeding intolerance at 12 h (5% vs. 4%; p = 0.88), 24 h (1% vs. 2%; p = 1.00), and 48 h (4% vs. 4%; p = 1.00). There was no difference when comparing intolerance symptoms such as nausea and vomiting (1% vs. 2%; p = 0.79), abdominal tenderness (2% vs. 3%; p = 0.76), high gastric residuals (2% vs. 2%; p = 1.00) and aspiration (0% vs. 2%; p = 0.39). There was no difference when comparing post-operative complications (4% vs. 8%; p = 0.21).

CONCLUSIONS

Early tube feeding after PEG placement is safe and equivalent to late tube feeding in the adult trauma population. Future prospective studies are warranted to establish the optimal timing for initiation of tube feeds after PEG tube placement.

An integrated addictions nursing subspecialty to expand the opioid use disorder and substance use disorder workforce

Introduction

In the U.S. approximately11.4 million misused prescription pain relievers; 2.1 million had an OUD in 2017. The Addictions Nursing Subspecialty was created to address this epidemic by expanding a workforce trained in OUD/SUD screening, treatment, and prevention. A curriculum was developed that included integrated/telehealth health care settings in medical and mental health provider shortage areas during their last nine months of training. Courses were developed and taught by aninterprofessional team of university faculty and informed by evidence-based guidelines/clinical competencies for effective OUD/SUD screening/prevention, assessment, treatment, and recovery. Courses were also offered as electives for nursing, clinical-counseling, social work, and other health science disciplines emphasizing an interdisciplinary approach to healthcare.

Objectives

Expand the OUD/SUD trained workforce in areas with high OUD/SUD mortality rates and high mental health provider shortages emphasizing team-based integrated care and telehealth settings.

Methods

Program curriculum was informed by evidence-based guidelines/clinical competencies for effective OUD/SUD screening/prevention, assessment, treatment, and recovery using integrated care. Competencies included: Core Competencies for Integrated Behavioral Health and Primary Care that have been set forth by the Center for Integrated Health Solutions, telehealth competencies outlined in the recommended competencies by the National Organization of Nurse Practitioner Faculties (NONPF), and Core Competencies for Addictions Medicine by the American Board of Addictions Medicine.

Results

Approximately 11 students enrolled in courses received additions integrated/telehealth health care settings. Students responded positively to evaluations regarding timely feedback, unique approach (i.e. intrative content, short videos and discussions).

Conclusions

The Addictions Nursing subspecialty will continue to be offered allowing enrollment for nurses twice a year.

Referral, Assessment and Use of Screening Measures Related to Autism Spectrum Disorder at a Tertiary Hospital Setting

Children with developmental concerns in Australia continue to experience inequitable healthcare and service-related delays, even when diagnostic risk is identified. This study sought to explore service and demographic pathway factors leading up to autism spectrum disorder (ASD) assessment, including value of screening measures applied at triage. Following a trial of centralised intake for referred young children with suspected ASD, observational, retrospective pathway data was explored using bivariate and regression analyses. The mean age of 159 children referred with autism symptoms was 3.6 years, and 64% were diagnosed with ASD. Service allocation was associated with diagnosis, whilst screening tool results were not. Improved pathways are needed to limit wasted waiting times and direct each child to needs-based services.

Infective aortic valve endocarditis in a cat with patent ductus arteriosus and perimembranous ventricular septal defect

A 3-year-old, male neutered, domestic short-haired cat presented for evaluation of respiratory distress. Transthoracic echocardiography revealed a left-to-right shunting ventricular septal defect, a left-to-right shunting patent ductus arteriosus, and a vegetative growth on the aortic valve leaflet consistent with aortic valve endocarditis. Because of poor response to therapy, the owner elected euthanasia, and a necropsy was performed. Gross necropsy examination confirmed the congenital cardiac defects, and aortic valve endocarditis was noted on the echocardiogram. Histopathological examination revealed diffuse interstitial pneumonia and evidence for systemic septic embolism including renal infarcts and brain microabscesses. To the authors' knowledge, this is the first case report of aortic valve endocarditis in a cat in association with congenital cardiac malformations.