Predictors of emergency preparedness among parents in Hawaii: A cross-sectional survey

OBJECTIVE

To determine factors predicting emergency preparedness (EP) behaviors among Hawaii parents.

METHODS

A cross-sectional online survey of parents of children (age 0-12 years) living in Honolulu, Hawaii in March 2023 examined associations with 1) having an EP kit (supplies for use during emergencies) and 2) having a family emergency plan (what to do, where to go, how to communicate during emergencies) with demographics/household characteristics and theoretical constructs of the Health Belief Model. A multivariable regression model obtained odds ratios and 95% confidence intervals.

RESULTS

Participants (N=278) were mainly female (84%), college-educated (68%), and were similar in diverse racial/ethnic composure (White, 13.3%) to the overall Honolulu County. Logistic regression determined participants with lower perceived susceptibility to disasters, greater time barriers, and those who needed help to prepare for emergencies were less likely to have an EP kit. Among participants without an EP kit, a website able to create personalized instructions for household EP would be useful. Participants who needed help to prepare for emergencies were less likely to have a family emergency plan.

CONCLUSION

Future interventions should focus on evidence-based strategies that improve self-efficacy associated with developing EP kits and family emergency plans.

COVID-19 Stroke Apical Lung Examination Study 2: a national prospective CTA biomarker study of the lung apices, in patients presenting with suspected acute stroke (COVID SALES 2)

BACKGROUND

Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19.

OBJECTIVE

To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients.

METHODS

In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed.

RESULTS

CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality.

CONCLUSION

Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage.

Daily Moderate-to-Vigorous Activity of Native Hawaiians and Pacific Islanders and Seven Asian Subgroups by Types of Activities, American Time Use Survey, 2010-2019

The study used the American Time Use Survey data from 2010 to 2019 to compare the daily moderate-to-vigorous activity of Native Hawaiians and Pacific Islanders (NHPI) and seven Asian ethnic subgroups. Adults aged 24 years and older were included. The study analyzed activities from sports and recreation, household activities, and all activities carried out during the day. Outcomes were determined by the completion of 30 min or more of moderate-to-vigorous activity and the type of activity carried out in the day. Significant ethnic differences were observed for sports and recreation but not for household activities and not for all activities carried out during the day. Of the ethnic populations, NHPI were the least active, and Asian Indians and Chinese were the most active. A majority achieved 30 min or more of moderate-to-vigorous activity during the day from all their activities. Physical activity from household activities exceeded physical activity from sports and recreation. The most physically active group was adults over the age of 65 years, perhaps reflecting more time to exercise or greater concerns about their health. For sports and recreation, exercising with someone doubled the minutes of moderate-to-vigorous activity. The results emphasize the importance of activities performed around the household in addition to sports and recreation and the benefit of exercising with someone. Ethnic populations may be receptive to interventions that emphasize activities they are performing in their daily lives.

Promoting Health Research among Underrepresented Students through the HUI SRC

The Hawai'i Pacific University Undergraduate Infrastructure Student Research Center (HUI SRC) is focused on increasing participation of historically underrepresented populations, such as Native Hawaiians, other Pacific Islanders (NHPI), and Filipinos, in tomorrow's biomedical and health research workforce. This is achieved by promoting engagement and competency in entrepreneurial biomedical and health research among undergraduate students. The HUI SRC was modeled after the Morgan State University ASCEND SRC funded by the National Institute of General Medical Sciences. The HUI SRC is rooted in the Hawaiian cultural values of ho'oku'i, hui pu'ana, and lokahi, referring to the physical gathering space of the Student Research Center and the joining of people together around a unifying theme, in this case the pursuit of science. It is committed to intentionally engaging Indigenous knowledge and ways of doing in decolonizing research. This article describes the project and presents evaluation findings of the first year of implementation of the HUI SRC. The center was effective in increasing undergraduate students' science identity, academic self-concept, social self-concept, social support, peer support, and self-efficacy. These HUI SRC findings highlight the potential impact of undergraduate SRCs in expanding the pipeline of biomedical and health researchers from underrepresented populations, particularly among NHPI and Filipinos.

Inventory of Survey Databases for Native Hawaiian, Pacific Islander, and Filipino Health Disparities Research

The aim of this scoping review was to assist researchers who want to use survey data, either in academic or community settings, to identify and comprehend health disparities affecting Native Hawaiian (NH), Pacific Islander (PI), and/or Filipino populations, as these are groups with known and numerous health disparities. The scoping review methodology was used to identify survey datasets that disaggregate data for NH, PI, or Filipinos. Healthdata.gov was searched, as there is not an official index of databases. The website was established by the United States (US) Department and Health and Human Services to increase accessibility of health data for entrepreneurs, researchers, and policy makers, with the ultimate goal of improving health outcomes. Using the search term 'survey,' 332 datasets were retrieved, many of which were duplicates from different years. Datasets were included that met the following criteria: (1) related to health; (2) disaggregated NH, PI, and/or Filipino subgroups; (3) administered in the US; (4) publicly available; (5) individual-level data; (6) self-reported information; and (7) contained data from 2010 or later. Fifteen survey datasets met the inclusion criteria. Two additional survey datasets were identified by colleagues. For each dataset, the dataset name, data source, years of the data availability, availability of disaggregated NH, PI, and/or Filipino data, data on health outcomes and social determinants of health, and website information were documented. This inventory of datasets should be of use to researchers who want to advance understanding of health disparities experienced by NH, PI, and Filipino populations in the US.

Systematic Review for Survey Instruments to Measure Cultural Identification of Native Hawaiians, Pacific Islanders, and Filipinos

Numerous studies have used survey instruments to measure the degree of cultural identity/identification for a racial group to examine how they identify with their heritage or cultural group. However, only a few systematic reviews have summarized the survey instruments for Native Hawaiians, Pacific Islanders, and Filipinos. This systematic review aimed to summarize reliable and validated survey instruments that assessed the cultural identity/identification of Native Hawaiians, Pacific Islanders, and Filipinos in 3 steps: (1) identifying studies that meet the inclusion and exclusion criteria; (2) evaluating the psychometric properties of the instrument with reported validity and reliability test results; and (3) summarizing the selected studies. A search was conducted in PubMed, PsycINFO, Web of Science, and Health and Psychosocial Instruments databases for published articles related to the cultural identification for the 3 racial groups. Sixteen unique articles met the inclusion/exclusion criteria: 7 for Filipinos, 3 for Native Hawaiians, 1 for Pacific Islanders, 2 for Asian Americans, and 3 for non-specific Indigenous people. Three reviewers assessed the psychometric properties of the 16 articles using the pre-determined criteria and summarized the survey instruments and study outcomes. All the selected articles discussed their survey instrument's validity. This review can serve as a resource for researchers who want to apply a culturally tailored survey instrument for Native Hawaiians, Pacific Islanders, and Filipinos in their research studies.

Modeling Poverty and Health for Native Hawaiian and Pacific Islander and Asian Ethnic Populations

This study examined differences in poverty and health among Native Hawaiians and Pacific Islanders (NHPI) and 6 disaggregated Asian ethnic subgroups and an aggregated Other Asian category. Participants were followed longitudinally for 2 years using data from 2009 to 2019 from the Current Population Survey, a monthly survey conducted by the Census Bureau. Having 2 years of data enabled the study to assess both prevalence of poverty and fair/poor health in only 1 of the 2 years and in both years. For NHPI, 13.5% were in poverty 1of the 2 years and 7.1% in both years. Asian ethnicities showed high variability ranging from a low of 6.4% for 1 year and 1.9% for 2 years among Asian Indians to 16.0% for 1 year and 6.3% for 2 years among Vietnamese. Fair/poor health also showed ethnic variability, made most apparent after age-sex adjustment in regression models. For poverty, after adjustment, Asian Indians, Filipinos and Japanese had significantly lower odds of being in poverty at least 1 year than NHPI. For having fair/poor health, Asian Indians and Japanese experienced lower odds than NHPI for both 1 and 2 years and Filipinos for 1 year, after age/sex adjustment. The results emphasize the diversity of Asian and Pacific Islander populations, the variability of poverty over time, and the importance of using disaggregated data to understand ethnic differences in poverty and health. These findings can be used to inform future modeling of social determinants on poverty and health among NHPI and Asian subgroups.

Preferred Location for Human Papillomavirus Self-Sampling for Cervical Cancer Screening

OBJECTIVE

To examine associations among women's preferred locations for human papillomavirus (HPV) self-sampling in relation to their demographic, social, and health characteristics and their perceived benefits and concerns regarding this procedure.

DESIGN

Cross-sectional, descriptive survey.

SETTING

Online distribution between March 2022 and April 2022.

PARTICIPANTS

People who were assigned female sex at birth and were eligible for cervical cancer screening (N = 367: cis-gender women, n = 364; another gender identity, n = 3).

METHODS

We used quota sampling to obtain a racially and ethnically diverse sample. We conducted bivariate analyses to examine differences in participants' preferred locations for HPV self-sampling by sociodemographic and health characteristics. We used a multinomial logistic regression model to examine the associations between preferred HPV self-sampling location, characteristics of participants, and perceived benefits and concerns regarding this procedure.

RESULTS

In our sample, 43% (n = 158) of participants preferred HPV self-sampling at the office of a health care provider, 50% (n = 182) preferred HPV self-sampling anywhere (office or home), and 7% (n = 27) did not feel comfortable with HPV self-sampling anywhere. Participants 39 to 45 years of age were more likely to prefer HPV self-sampling anywhere (office or home) than participants 27 to 32 years of age, OR = 2.47, 95% confidence interval (CI) [1.21, 5.06]. Participants who preferred HPV self-sampling anywhere perceived greater benefit related to limited geographic access to a clinic compared to those who preferred office only, OR = 1.82, 95% CI [1.08, 3.07]. Participants who preferred HPV self-sampling anywhere had less concern related to performing the procedure accurately than those who preferred office only, OR = 0.44, 95% CI [0.31, 0.62].

CONCLUSION

HPV self-sampling is an alternative strategy to increase cervical cancer screening. As providers consider implementation of HPV self-sampling, our findings suggest that office and home-based collection strategies should be considered to increase access to cervical cancer screening.

Proteomic basis of mortality resilience mediated by FOXO3 longevity genotype

FOXO3 is a ubiquitous transcription factor expressed in response to cellular stress caused by nutrient deprivation, inflammatory cytokines, reactive oxygen species, radiation, hypoxia, and other factors. We showed previously that the association of inherited FOXO3 variants with longevity was the result of partial protection against mortality risk posed by aging-related life-long stressors, particularly cardiometabolic disease. We then referred to the longevity-associated genotypes as conferring "mortality resilience." Serum proteins whose levels change with aging and are associated with mortality risk may be considered as "stress proteins." They may serve as indirect measures of life-long stress. Our aims were to (1) identify stress proteins that increase with aging and are associated with an increased risk of mortality, and (2) to determine if FOXO3 longevity/resilience genotype dampens the expected increase in mortality risk they pose. A total of 4500 serum protein aptamers were quantified using the Somalogic SomaScan proteomics platform in the current study of 975 men aged 71-83 years. Stress proteins associated with mortality were identified. We then used age-adjusted multivariable Cox models to investigate the interaction of stress protein with FOXO3 longevity-associated rs12212067 genotypes. For all the analyses, the p values were corrected for multiple comparisons by false discovery rate. This led to the identification of 44 stress proteins influencing the association of FOXO3 genotype with reduced mortality. Biological pathways were identified for these proteins. Our results suggest that the FOXO3 resilience genotype functions by reducing mortality in pathways related to innate immunity, bone morphogenetic protein signaling, leukocyte migration, and growth factor response.

Socialization, Relaxation, and Leisure across the Day by Social Determinants of Health: Results from the American Time Use Survey, 2014-2016

This study used the American Time Use Survey (ATUS) to examine socialization, relaxation, and leisure activities throughout the day as related to social determinants of health (SDOH). The study population was adults aged 25 years and older who participated in the ATUS in 2014-2016, the most recent years for collecting SDOH. Descriptive analyses provide characteristics of the study population. Graphical analyses display socialization by SDOH across the hours of the day based on adjusted regression models. Quasi-binomial models analyzed the association between the numbers of minutes of various activities and SDOH. Associations between SDOH and sleeplessness (yes or no) were explored using logistic regression. For much of the day, being female, having less education, living in poverty, and having food insecurity were associated with more time socializing and relaxing. The major activities under socializing and relaxation are watching television and movies. Having a college degree was strongly associated with increased minutes of sports activity, whereas living in poverty and food insecurity were associated with fewer minutes. Less education, living in poverty, and having food insecurity were associated with sleeplessness. A possible mechanism of the effects of SODH on health is by its altering of the patterns of daily life.

Assessment of Perioperative Sleep Characteristics Using Subjective and Objective Methods: A Secondary Analysis of Prospective Cohort Study

Perioperative sleep disturbances may impact healing and negatively affect the patient's perception of well-being. Therefore, accurately assessing postoperative sleep characteristics is necessary to treat sleep disturbances. This study is a secondary data analysis of research investigating the association between sleep and cognition in a perioperative setting. This study compares sleep characteristics between the St. Mary's Hospital Sleep Questionnaire and WatchPAT, a portable sleep apnea testing device. The goal of this study is to compare an objective measurement of sleep quality (WatchPAT) with a traditional questionnaire. One hundred and one patients who underwent elective, noncardiac surgical procedures wore a WatchPAT and completed the St. Mary's Hospital Sleep Questionnaire for three nights: two preoperative and one postoperative night. In the preoperative period, a Bland-Altman analysis showed an agreement Watch PAT and the St Mary's hospital sleep questionnaire except for sleep fragmentation. A good to fair correlation during the preoperative period was observed with both sleep latency and total sleep time. In the postoperative period, no correlation was observed between the St. Mary's Hospital Sleep Questionnaire data and WatchPAT data. Our study indicates that some potential factors affecting sleep and cognition such as admission type, depression, anesthesia type, and sleep apnea may limit patients' ability to report their sleep characteristics after surgery. Therefore, relying solely on one sleep assessment method is not advisable.

A text-mining study on emotional cognition, understanding, and preventative behaviors during the COVID-19 pandemic

BACKGROUND

This study aimed to look at emotions perceived about the attributes, prevention, diagnosis, and treatment of infectious diseases related to coronavirus disease (COVID-19) that were widespread across the world and identify their relevance to knowledge about infectious diseases and preventative behaviors.

METHODS

Texts to measure emotional cognition were selected through a pre-test, and 282 people were chosen as participants based on the survey conducted for 20 days from August 19 to August 29, 2020, created with Google Forms. IBM SPSS Statistics 25.0 was used for the primary analysis, and the SNA package in R (version 4.0.2) was utilized to conduct the network analysis.

RESULTS

It was found that universal negative emotions such as feeling "anxious" (65.5%), "afraid" (46.1%), and "scared" (32.7%) commonly appeared among most people. Also, they were found to be feeling both positive ("caring" [42.3%] and "strict" [28.2%]) and negative ("frustrating" [39.1%] and "isolated" [31.0%]) emotions about efforts to prevent and curb the spread of COVID-19. In terms of emotional cognition for the diagnosis and treatment of such diseases, "reliable" (43.3%) took the biggest ratio among the replies. The level of understanding about infectious diseases showed differences in emotional cognition, thereby affecting people's emotions. However, no differences were found in the practice of preventative behaviors.

CONCLUSIONS

Emotions associated with cognition in the context of pandemic infectious diseases have been found to be mixed. Furthermore, it can be seen that feelings vary depending on the degree of understanding of the infectious disease.

Parental Decision Making Regarding COVID-19 Vaccines for Children under Age 5: Does Decision Self-Efficacy Play a Role?

BACKGROUND

COVID-19 vaccines are now available under Emergency Use Authorization for children ages 6 months to 5 years. We examined parents' intentions to vaccinate their children under the age of 5 years and assessed whether their confidence in making an informed decision about vaccination (decision self-efficacy) was associated with these intentions.

METHOD

We conducted a cross-sectional online survey of U.S. parents between 23 March and 5 April 2022. We examined associations between parental intention to vaccinate their young children (

RESULTS

Of the 591 parents in this sample, 49% indicated that they intended to vaccinate their child(ren), 29% reported that they would not, and 21% were undecided. In bivariate analyses, race/ethnicity, health insurance, flu vaccination in the past 12 months, and parental COVID-19 vaccination status were significantly related to parental intention to vaccinate their child(ren). In the multivariable analyses, which controlled for these factors, parents who intended to vaccinate their child(ren) had greater confidence in their ability to make informed decisions about COVID-19 vaccinations compared to those who were unsure about vaccination. Each one standard deviation in the Decision Self-Efficacy score was associated with a 39% increase in intention to vaccinate one's child versus being unsure about vaccination (AOR 1.39, 95% CI 1.09, 1.77).

CONCLUSIONS

Parents who are unsure about vaccinating their children against COVID-19 may benefit from interventions designed to increase their ability to obtain, understand, and utilize information to make informed decisions.

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Key Words

• SARS-CoV-2 (COVID-19)
• decision self-efficacy
• health behaviors
• parents
• vaccination
• vaccine confidence

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MESH Headings Collapse

Grants

• U54MD007601 NIH HHS
• U54 MD007601 NIMHD NIH HHS

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Affiliation(s)

Jennifer D. Allen Department of Community Health, Tufts University School of Arts and Sciences, 574 Boston Ave, Medford, MA 02155, USA
Masako Matsunaga Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
Eunjung Lim Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
Gregory D. Zimet Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Suite 1001, Indianapolis, IN 46202, USA
Kimberly H. Nguyen Department of Public Health and Community Medicine, Tufts University Medical School, 136 Harrison Ave, Boston, MA 02111, USA
Holly B. Fontenot Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, 2528 McCarthy Mall, Webster Hall, Honolulu, HI 96822, USA

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Increasing the Self-Confidence of School Nurses to Respond to Emergency Situations

BACKGROUND

School nurses have various degrees of experience responding to respiratory or cardiac emergencies, and most only receive Basic Life Support training every 2 years as required. The goal of the study was to assess school nurses' confidence and competence in emergency situations before and after engaging in emergency preparedness high-fidelity simulations.

METHOD

This mixed methods study used a pre-/postsimulation survey design for a group of school nurses (N = 40) in the State of Hawaii. The pre- and postsimulation survey assessed professional demographics and measured confidence. After the presimulation survey, nurses participated in a 1-day training that included two separate emergency simulations using high-fidelity equipment. In addition, education was provided on the program's standardized emergency supply bags with equipment and their use during an emergency. The postsimulation survey was distributed 5 days after the educational intervention.

RESULTS

All confidence items significantly improved after the simulation session. Nurses noted the value of the training and hands-on simulation experience.

CONCLUSION

Simulation is a useful tool for increasing school nurses' confidence in responding to emergencies occurring on school campuses. [J Contin Educ Nurs. 2023;54(2):71-77.].

Potentially preventable hospitalizations and super-utilization of inpatient services among patients with chronic kidney disease in Hawai'i

BACKGROUND

Chronic kidney disease (CKD) is linked to high morbidity and mortality and increased hospitalization burden. If appropriately managed in the outpatient setting, ambulatory care-sensitive conditions (ACSCs) do not lead to hospitalization. Hospitalizations due to ACSCs are considered as potentially preventable hospitalizations. Patients with recurrent hospitalizations are considered as super-utilizers of inpatient services. The aim of this study is to determine prevalence of potentially preventable hospitalizations and super-utilization of inpatient services among patients with CKD in Hawai'i.

METHODS

Hawai'i statewide inpatient data (2015-2017) were used to identify adult CKD patients with hospitalizations during a 12-month period from the first recorded date of CKD. The associations between the potentially preventable hospitalizations and super-utilization and other key patient demographic and clinical variables (sex, age, ethnicity, insurance type, Charlson comorbidity index (CCI), county of residence, and homelessness indicator) were analyzed using bivariate analysis. Multivariable logistic regression was utilized to assess the associations between the potentially preventable hospitalizations and patient variables.

RESULTS

Approximately 2% of patients reported potentially preventable hospitalizations, and a total of 12.3% patients reported super-utilization. Out of all CKD-specific ACSC hospitalizations, 74.2% were due to heart failure and 25.8% were due to hyperkalemia. Patients who reported super-utilization were more likely to report potentially preventable hospitalization (OR: 5.98, 95%CI: 4.50-7.93) than patients who did not report super-utilization.

CONCLUSION

This study showed prevalence of potentially preventable hospitalizations and high inpatient utilization among CKD patients in Hawai'i. Heart failure and hyperkalemia were the two major causes of CKD-specific ACSC hospitalizations in this cohort. Effective strategies should be employed to improve the outpatient CKD management to reduce hospitalizations and in turn reduce cost.

Knowledge and Attitudes of Guam Residents towards Cancer Clinical Trial Participation

(1) Background: Currently there are no cancer clinical trials in Guam, where CHamoru people suffer the highest rates of cancer mortality, and interest to do so is growing. This study investigated the knowledge and attitudes of Guam residents towards cancer clinical trial participation prior to implementation. (2) Methods: A telephone survey was developed, tested, and conducted among Guam resident adults, 18 years of age and older. Survey questions were summarized by descriptive statistics. Logistic regression models were used to investigate the associations between Guam residents' demographics and their clinical trial knowledge and attitudes. Adjusted odds ratios (aOR) and associated 95% confidence intervals (CI) were calculated. (3) Results: One hundred fifty-two people participated in the survey, most of whom were CHamoru (47.0%). Fifty-three percent had heard the term 'clinical trial'; 73.7% would take part in a trial if they had cancer; and 59.9% believed they would receive good quality treatment from a trial offered in Guam. CHamoru were more likely than Whites to associate out-of-pocket expenses with clinical trial participation (aOR = 5.34, 95% CI = 1.68-17.00). Physician ethnicity was important to 30% of non-Whites and significantly associated with those who spoke a language other than English (aOR = 3.40, 95% CI = 1.29-8.95). Most people (65.0%) did not believe clinical trials participants were 'guinea pigs'. (4) Conclusion: Though knowledge about cancer clinical trials is limited, attitudes were primarily positive towards participating in cancer clinical trials offered in Guam. Future delivery of cancer clinical trials will benefit from identifying potential barriers to recruitment and adopting an approach suited to Guam's population.

Short-term risk prediction after major lower limb amputation: PERCEIVE study

BACKGROUND

The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery.

METHODS

The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance.

RESULTS

Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679).

CONCLUSION

Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.

Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with prostate cancer

The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of prostate cancer was published in 2020. It was therefore decided, by both the ESMO and the Singapore Society of Oncology (SSO), to convene a special, virtual guidelines meeting in November 2021 to adapt the ESMO 2020 guidelines to take into account the differences associated with the treatment of prostate cancer in Asia. These guidelines represent the consensus opinions reached by experts in the treatment of patients with prostate cancer representing the oncological societies of China (CSCO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug access restrictions in the different Asian countries. The latter were discussed when appropriate. The aim is to provide guidance for the optimisation and harmonisation of the management of patients with prostate cancer across the different regions of Asia.

Vessel wall magnetic resonance and arterial spin labelling imaging in the management of presumed inflammatory intracranial arterial vasculopathy

Optimal criteria for diagnosing and monitoring response to treatment for infectious and inflammatory medium–large vessel intracranial vasculitis presenting with stroke are lacking. We integrated intracranial vessel wall MRI with arterial spin labelling into our routine clinical stroke pathway to detect presumed inflammatory intracranial arterial vasculopathy, and monitor disease activity, in patients with clinical stroke syndromes. We used predefined standardized radiological criteria to define vessel wall enhancement, and all imaging findings were rated blinded to clinical details. Between 2017 and 2018, stroke or transient ischaemic attack patients were first screened in our vascular radiology meeting and followed up in a dedicated specialist stroke clinic if a diagnosis of medium–large inflammatory intracranial arterial vasculopathy was radiologically confirmed. Treatment was determined and monitored by a multi-disciplinary team. In this case series, 11 patients were managed in this period from the cohort of young stroke presenters (<55 years). The median age was 36 years (interquartile range: 33,50), of which 8 of 11 (73%) were female. Two of 11 (18%) had herpes virus infection confirmed by viral nucleic acid in the cerebrospinal fluid. We showed improvement in cerebral perfusion at 1 year using an arterial spin labelling sequence in patients taking immunosuppressive therapy for >4 weeks compared with those not receiving therapy [6 (100%) versus 2 (40%) P = 0.026]. Our findings demonstrate the potential utility of vessel wall magnetic resonance with arterial spin labelling imaging in detecting and monitoring medium–large inflammatory intracranial arterial vasculopathy activity for patients presenting with stroke symptoms, limiting the need to progress to brain biopsy. Further systematic studies in unselected populations of stroke patients are needed to confirm our findings and establish the prevalence of medium–large artery wall inflammation.

Diet quality predicts hypertensive disorders of pregnancy in Asian and Pacific Islander Cohort

Background: There is limited data on diet quality during pregnancy and its impact on hypertensive disorders of pregnancy (HDP). Aim: Examine the association with diet quality and development of HDP in an Asian and Pacific Islander Cohort Methods: Pregnant women from the 4 largest ethnic groups in Hawai'i were recruited for participation. Participants completed a food frequency questionnaire during each trimester. Adherence to three diet quality indices (DQIs) were scored-The Healthy Eating Index (HEI), The Alternate Mediterranean Diet score (aMED), and the Dietary approaches to Stop Hypertension (DASH) score. Mean scores were compared among those who did and did not develop HDP. Logistic Regression models were used to examine the association between diet quality and HDP accounting for confounders (age, parity, obesity, ethnicity, gestational weight gain). Results: Among 55 participants with complete follow-up, there was a high incidence of HDP (23%). There was no significant change of DQIs over time. Non-Hispanic White participants had higher DQIs than Filipinas, Japanese, or Native Hawaiians (not statistically significant). Across gestation, participants who did not have HDP had better diet quality than those who did. Logistic regression showed that HEI and DASH indices are predictive of HDP development, with the high DASH diet score having the greatest reduced odds. Every point higher of DASH diet score portended approximately 30% reduced odds of developing HDP. Conclusions: The DASH diet had the strongest association with reduced odds of HDP, but better diet quality in any of the indices was also predictive.

The prevalence of mild cognitive impairment by aspects of social isolation

OBJECTIVES

This study describes the prevalence of mild cognitive impairment (MCI) across different aspects of social isolation among adults 65 years or older.

METHODS

In this cross-sectional study, we utilized the Wave 3 data from the National Social Life, Health, and Aging Project (NSHAP). MCI was defined as a Montreal Cognitive Assessment (MoCA) score less than 23. Prevalence of MCI was calculated for above and below average social disconnectedness (SD), perceived isolation (PI), and demographic variables age, gender, race/ethnicity, education, and household income.

RESULTS

The overall prevalence [and 95% confidence interval] of MCI was 27.5% [25.5-29.6]. The high prevalence of MCI was found in those who had above average SD (32.0% [29.1-34.9]), above average PI (33.3% [29.7-36.8]), were older in age (43.1% [38.9-47.3]), male (28.7% [25.9-31.5]), Black (61.1% [52.5-69.6]), had less than a high school education (66.3% [58.9-73.8]), or were in the lowest income group (46.2% [39.7-52.7]). Those with above average SD or PI had a higher prevalence of MCI in almost all demographics, compared to those with below average SD or PI. Those who were Black or African American or had less than a high school education did not have a greater prevalence of MCI when SD was above average.

DISCUSSION

This current study adds to the body of literature that links SD and PI to MCI and sheds light on the possible existing socio-demographic disparities. Groups with greater than average SD or PI tend to have a higher prevalence of MCI. Further studies are needed to establish a causal association of SD and PI with MCI.

Impact of the COVID-19 Pandemic on the Hawai'i Nursing Workforce: A Cross-sectional Survey

The coronavirus disease (COVID-19) pandemic has placed extraordinary strain on health care systems. This has led to increased stress among health care workers, and nurses in particular, which has had a negative impact on their physical and psychosocial wellbeing. This is likely to negatively impact the nursing workforce at the state and national levels as the pandemic continues. The purpose of this study was to assess whether nurses licensed in Hawai'i have considered leaving the workforce. A cross-sectional online survey was conducted among Hawai'i nurses at all levels of licensure, with 421 responding. Of these nurses, 97 (23.0%) reported considering leaving the workforce, with safety (39.2%) and family/caregiver strain (32.0%) being the most common reasons. Reconsidering whether they should stay employed in their current roles (Odds ratio [OR] 2.05; 95% CI 1.56 - 2.69) and fear to continue providing direct patient care (OR 1.97; 95% CI 1.54 - 2.54) were associated with increased odds of having considered leaving the workforce. Based on these results, the State of Hawai'i and local health care organizations need to adjust their nursing workforce estimates and address how to alleviate nurses' stressors and safety concerns to mitigate a potential workforce shortage. Research is needed to develop interventions to support and empower nurses in their current roles but also address future emergency preparedness.

Evaluation of Access to Care Barriers and Their Effect on General Health Status Among Native Hawaiian and Pacific Islander Adults

There is a paucity of information on access to care barriers faced by Native Hawaiian and Pacific Islander (NHPI) community. This study utilized the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS) data to evaluate access to care barriers among NHPI population and their effect on general health status. Access to care barriers were categorized as financial barrier (affordability) and non-financial barriers (availability, accommodation, acceptability, and accessibility). Overall, 13.7% reported of the fair/poor general health and over 30% reported at least one access to care barrier. Logistic regression model was used to evaluate how financial and non-financial barriers affect general health status, adjusting for socio-demographic variables such as age, poverty threshold, and marital status and health-related variables such as smoking status and chronic health conditions. Those who reported financial barrier (21.2%) were more likely to be in fair/poor general health (odds ratio 2.25, 95% confidence interval 1.43-3.56). Non-financial barrier, reported by 20.0% of the study population, was found to be not associated with general health status after adjusting for socio-demographic and health-related variables. Improving access to care among NHPI community could be achieved by identifying and addressing the barriers, which in turn could lead to improvement in the general health status among NHPI community.

Factors Related to Pediatric Readmissions of Four Major Diagnostic Categories in Hawai`i

Readmissions are a key quality measure for health care decision making and understanding variables associated with readmissions has become a crucial research area. This study identified patient-level factors that might be associated with pediatric readmissions using a database that included inpatient data from 2008 to 2017 from Hawai`i. Four major diagnostic categories with the most pediatric readmissions in the state were identified: respiratory, digestive, mental, and nervous system diseases and disorders. The associations between readmission and patient-level variables, such as age, sex, race/ethnicity, insurance status, and Charlson Comorbidity Index (CCI), were determined for each diagnosis and for overall readmissions. CCI and insurance were the strongest predictors when all diagnoses were combined. However, for some diagnoses, there was weak or no association between CCI, insurance, and readmission. This suggests that diagnosis-specific analysis of predictors of readmission may be more useful than looking at predictors of readmission for all diagnoses combined. While this study focused on patient variables, future studies should also incorporate how hospital variables may also be related to diagnosis.

321 Surgery Induction Guidebook – an Aid to a Successful Transition

Aim

There is a 4–12% increase in mortality following the August change over in the National Health Service (NHS) UK. A well-structured induction programme is mandatory to improve both the competency and confidence of new junior doctors. This activity was designed to evaluate and improve the induction process in Pilgrim Hospital by introducing an induction guidebook. It aimed to provide a sustainable and reliable source of information to junior doctors.

Method

An initial survey in the department assessed the needs and identified the information required for the guidebook. An induction guidebook was designed and circulated during the changeover. A feedback survey was conducted after the six months of the initial Induction guidebook release, to know the usefulness of components of the induction guidebook and identify any gaps to improve the guidebook.

Results

A total of 15 participants completed the feedback survey. 47% (7) found the induction guidebook beneficial and 53.3 % (8) found it ‘slightly beneficial'. Similarly, only 1 participant (6.7%) rated the guidebook to be “of minor importance”, while 53% (8) rating it “very important” part of induction. The feedback for the contents of the book was also encouraging with suggestions.

Conclusions

The guidebook proved to be a valuable source in helping new doctors during times of transition to adjust to the local system and improve the induction process. It provided information about local guidelines, job overview, team structure, IT, useful contacts, and other relevant information. We recommend the departmental guidebook as a vital part of local departmental induction during the changeover.

Vascular inflammation in patients with obstructive sleep apnoea and coronary artery disease shown on coronary computed tomography angiography attenuation

Funding Acknowledgements

Type of funding sources: None.

Introduction

Obstructive sleep apnoea (OSA) is associated with increased plaque burden in coronary artery disease (CAD), but the role of vascular inflammation in this relationship is unclear. Coronary computed tomography angiography (CTA) enables surrogate assessment of systemic inflammation via subcutaneous adipose tissue attenuation (ScAT-a), and of coronary inflammation via epicardial adipose tissue volume and attenuation (EAT-v and EAT-a) and pericoronary adipose tissue attenuation (PCAT-a).

Purpose

To investigate whether vascular inflammation is increased in patients with severe OSA and high plaque burden.

Methods

Patients with clinically indicated polysomnography and coronary CTA were included. Severe OSA was classified as apnoea/hypopnoea index (AHI) &gt;30. High plaque burden was defined as a CT-Leaman score (CT-LeSc) &gt;8.3. Patients with both severe OSA and high plaque burden were defined as ‘Group 1’, all other patients were classified as ‘Group 2’. ScAT-a, EAT-a, EAT-v and PCAT-a were assessed on semi-automated software.

Results

A total of 91 patients were studied (59.3 ± 11.1 years). Severe OSA was associated with high plaque burden (p = 0.02). AHI correlated with CT-LeSc (r = 0.24, p = 0.023). Group 1 had lower EAT-a and PCAT-a compared to Group 2 (EAT-a: -87.6 vs. -84.0 HU, p = 0.01; PCAT-a: -90.4 vs. -83.4 HU, p &lt; 0.01). However, among patients without high plaque burden, EAT-a was increased in patients with severe OSA versus mild-moderate OSA (-80.3 vs. -84.0 HU, p = 0.020). On multivariable analysis, EAT-a independently associated with severe OSA and high plaque burden (p &lt; 0.02), and PCAT-a associated with severe OSA and high plaque burden, and hypertension (all p &lt; 0.01).

Conclusions

EAT attenuation is decreased in patients with severe OSA and high plaque burden but increased in patients with severe OSA and low plaque burden. These divergent results suggest coronary inflammation may be increased in OSA independent of CAD, but larger studies are required to validate these findings.

Relation of incident chronic disease with changes in muscle function, mobility, and self-reported health: Results from the Health and Retirement Study

The primary objective was to learn the extent that muscle function, mobility, and self-reported health decline following incident diabetes, stroke, lung problem, and heart problems. A secondary objective was to measure subsequent recovery following the incident events. A longitudinal panel study of the natural history of four major chronic diseases using the Health and Retirement Study, a nationally representative sample of adults over age 50 years. People first interviewed from 1998-2004 were followed across five biannual exams. The study included 5,665 participants who reported not having diabetes, stroke, lung problems, and heart problems at their baseline interview. Their mean age was 57.3 years (SD = 6.0). They were followed for an average of 4.3 biannual interviews. Declines and subsequent recovery in self-reported health, muscle function, and mobility were examined graphically and modeled using negative binomial regression. The study also measured the incidence rates and prevalence of single and multiple chronic diseases across the follow-up years.Self-reported health and muscle function declined significantly following incident stroke, heart problems, lung problems, and multiple chronic diseases. Mobility declined significantly except following incident diabetes. Self-reported health improved following incident multiple chronic conditions, but recovery was limited compared to initial decline. Population prevalence after five follow-up waves reached 9.0% for diabetes, 8.1% for heart problems, 3.4% for lung disease, 2.1% for stroke, and 5.2% for multiple chronic diseases. Significant declines in self-reported health, muscle function, and mobility occurred within two years of chronic disease incidence with only limited subsequent recovery. Incurring a second chronic disease further increased the declines. Early intervention following incident chronic disease seems warranted to prevent declines in strength, mobility, and perceptions of health.

Undergraduate nursing students' COVID-19 vaccine intentions: A national survey

Introduction

In December 2020, the first two COVID-19 vaccines were approved in the United States (U.S.) and recommended for distribution to front-line personnel, including nurses. Nursing students are being prepared to fill critical gaps in the health care workforce and have played important supportive roles during the current pandemic. Research has focused on vaccine intentions of current health care providers and less is known about students’ intentions to vaccinate for COVID-19.

Methods

A national sample of undergraduate nursing students were recruited across five nursing schools in five U.S. regions in December 2020. The survey measured perceived risk/threat of COVID-19, COVID-19 vaccine attitudes, perceived safety and efficacy of COVID-19 vaccines, sources for vaccine information and level of intention to become vaccinated [primary, secondary (i.e., delayed), or no intention to vaccinate].

Results

The final sample consisted of 772 students. The majority (83.6%) had intentions to be vaccinated, however of those 31.1% indicated secondary intention, a delay in intention or increased hesitancy). The strongest predictors of primary intention were positive attitudes (OR = 6.86; CI = 4.39–10.72), having lower safety concerns (OR = 0.26; CI = 0.18–0.36), and consulting social media as a source of information (OR = 1.56; CI = 1.23–1.97). Asian (OR = 0.47; CI = 0.23–0.97) and Black (OR 0.26; CI = 0.08–0.80) students were more likely to indicate secondary intention as compared to primary intention. Students in the Midwest were most likely to indicate no intention as compared to secondary intention (OR = 4.6; CI = 1.32–16.11).

Conclusions

As the first two COVID-19 vaccines were approved/recommended in the U.S. nursing students had overall high intentions to vaccinate. Findings can guide development of educational interventions that reduce concerns of vaccine safety that are delivered in a way that is supportive and affirming to minoritized populations while being respectful of geo-political differences.

Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with renal cell carcinoma

The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of renal cell carcinoma was published in 2019 with an update planned for 2021. It was therefore decided by both the ESMO and the Singapore Society of Oncology (SSO) to convene a special, virtual guidelines meeting in May 2021 to adapt the ESMO 2019 guidelines to take into account the ethnic differences associated with the treatment of renal cell carcinomas in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with renal cell carcinoma representing the oncological societies of China (CSCO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug access restrictions in the different Asian countries. The latter were discussed when appropriate.

Assessing licensed nurses COVID-19 vaccine attitudes and intentions: a cross-sectional survey in the state of Hawaii

Nurses are the largest single occupation of health care providers and at greatest risk for exposure to and acquisition of Coronavirus Disease 2019 (COVID-19). In December 2020, nurses in Hawaii were recruited for an online survey that measured perceived risk/threat of COVID-19, vaccine attitudes, and perceived safety of COVID-19 vaccines, as well as level of intention: primary, secondary (i.e., delayed), or no intention to vaccinate. The final sample consisted of 423 nurses. Participants were primarily Asian (27.9%) and White (45.2%). The majority were 18-50 years (65.5%) and female (87.0%), held an RN license (91.7%), and identified as a staff nurse (57.7%) in the hospital setting (56.7%). Among participants, 52.3% indicated primary intention, 27.9% secondary intention, and 19.9% no intention to vaccinate. The strongest predictors of any level of intention were greater positive attitudes toward COVID-19 vaccination and lower concerns related to COVID-19 vaccine safety. Findings can guide interventions to support vaccine acceptance for those who initially decline vaccination.

The impact of diabetes and osteoarthritis on the occurrence of stroke, acute myocardial infarction, and heart failure among older adults with non-valvular atrial fibrillation in Hawaii: a retrospective observational cohort study

Background

To date, little is known about cardiovascular disease risks among older adults with non-valvular atrial fibrillation by their association with diabetes and osteoarthritis status, based on longitudinal data with substantial amounts of non-white individuals. The objective of this study was to examine the risks for three cardiovascular diseases: stroke, acute myocardial infarction (AMI), and heart failure (HF), by diabetes and osteoarthritis status among older adults with non-valvular atrial fibrillation in Hawaii.

Methods

We conducted a retrospective observational cohort study for older adults (65 years and older) with non-valvular atrial fibrillation using the Hawaii Medicare data 2009–2017. Their risks for the three cardiovascular diseases by diabetes and osteoarthritis status (diabetes, osteoarthritis, diabetes and osteoarthritis, and without diabetes and osteoarthritis) were examined by multivariable Cox proportional hazard regression models.

Results

The analysis included 19,588 beneficiaries followed up for a maximum of 3288 days (diabetes: n = 4659, osteoarthritis: n = 1978, diabetes and osteoarthritis: n = 1230, without diabetes and osteoarthritis: n = 11,721).  Among them, those diagnosed with the cardiovascular diseases were identified (stroke: diabetes n = 837, osteoarthritis n = 315, diabetes and osteoarthritis n = 184, without diabetes and osteoarthritis n = 1630)(AMI: diabetes n = 438, osteoarthritis n = 128, diabetes and osteoarthritis n = 118, without diabetes and osteoarthritis n = 603)(HF: diabetes n = 2254, osteoarthritis n = 764, diabetes and osteoarthritis n = 581, without diabetes and osteoarthritis n = 4272). After adjusting for age, sex, race/ethnicity, and other potential confounders, those with diabetes and osteoarthritis had higher risks for HF (hazard ratio: 1.21 95% confidence interval: 1.10–1.33) than those without diabetes and osteoarthritis. They also had higher risks than those with osteoarthritis for HF. Those with diabetes had higher risks for all three cardiovascular diseases than the other three groups.

Conclusions

Variation in cardiovascular disease risks for older adults with non-valvular atrial fibrillation in Hawaii exists with diabetes and osteoarthritis status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11247-0.

The risk of diabetes after giving birth to a macrosomic infant: data from the NHANES cohort

Aims

Gestational diabetes (GDM) increases the risk of developing type 2 diabetes and thus warrants earlier and more frequent screening. Women who give birth to a macrosomic infant, as defined as a birthweight greater than 9 lbs. (or approximately 4000 g), are encouraged to also get early type 2 diabetes screening, as macrosomia may be a surrogate marker for GDM. This study investigates whether a macrosomic infant, as defined as 9lbs, apart from GDM, increases the risk for diabetes later in life.

Methods

Data on parous women from the National Health and Nutrition Examination Survey (NHANES) 2007–2016 were utilized. Rates of diabetes were compared in those with and without macrosomic infants in Rao-Scott’s chi-square test. Multiple logistic regression was used to test the independent effect of macrosomia on type 2 diabetes controlling for the confounding covariates and adjusting for the complex sampling design. To investigate how onset time affects diabetes, we implemented Cox proportional hazard regressions on time to have diabetes.

Results

Among 10,089 parous women, macrosomia significantly increased the risk of maternal diabetes later in life in the chi-square test and logistic regression. Independent of GDM, women who deliver a macrosomic infant have a 20% higher chance of developing diabetes compared to women who did not. The expected hazards of having type 2 diabetes is 1.66 times higher in a woman with macrosomic infant compared to counterparts.

Conclusions

Women who gave birth to a macrosomic infant in the absence of GDM should be offered earlier and more frequent screening for type 2 diabetes.

Dietary Quality Associated with Self-Reported Diabetes, Osteoarthritis, and Rheumatoid Arthritis among Younger and Older US Adults: A Cross-Sectional Study Using NHANES 2011-2016

Background: To date, few studies have compared the dietary quality of US adults with diabetes mellitus (DM), osteoarthritis (OA), and rheumatoid arthritis (RA) by age groups. Methods: This study used cross-sectional data from adult participants from National Health and Nutrition Examination Survey 2011–2016 to identify dietary quality measured by Healthy Eating Index (HEI)-2015 total and component scores and self-reported disease status for DM, OA, and RA. Associations between the disease status and HEI-2015 total/component scores among younger adults aged 20–59 years (n = 7988) and older adults aged 60 years and older (n = 3780) were examined using logistic regression models. These accounted for the complex survey design and were adjusted for self-reported disease status, sex, race/ethnicity, education levels, income status, weight status, physical activity levels, and smoking status. Results: Among younger adults, 7% had DM, 7% had OA, and 3% had RA. Among older adults, 20% had DM, 32% had OA, and 6% had RA. Moderate added sugar intake was associated with diabetes in all adults. Excess sodium intake was associated with DM among younger adults. Inadequate seafood and plant protein intake was associated with RA among younger adults, while a poor overall dietary pattern was associated with RA among older adults. Conclusions: The dietary quality of US adults varied by self-reported DM, OA, and RA status, and each varied by age group.