Trends in Health Information Technology Use Among the US Population With and Without Cardiovascular Risk Factors, 2012-2018: Evidence From the National Health Interview Survey

BackgroundThe COVID-19 pandemic has required clinicians to pivot to offering services via telehealth; however, it is unclear which patients (users of care) are equipped to use digital health. This is especially pertinent for adults managing chronic diseases, such as obesity, hypertension, and diabetes, which require regular follow-up, medication management, and self-monitoring.ObjectiveThe aim of this study is to measure the trends and assess factors affecting health information technology (HIT) use among members of the US population with and without cardiovascular risk factors.MethodsWe used serial cross-sectional data from the National Health Interview Survey for the years 2012-2018 to assess trends in HIT use among adults, stratified by age and cardiovascular risk factor status. We developed multivariate logistic regression models adjusted for age, sex, race, insurance status, marital status, geographic region, and perceived health status to assess the likelihood of HIT use among patients with and without cardiovascular disease risk factors.ResultsA total of 14,304 (44.6%) and 14,644 (58.7%) participants reported using HIT in 2012 and 2018, respectively. When comparing the rates of HIT use for the years 2012 and 2018, among participants without cardiovascular risk factors, the HIT use proportion increased from 51.1% to 65.8%; among those with one risk factor, it increased from 43.9% to 59%; and among those with more than one risk factor, it increased from 41.3% to 54.7%. Increasing trends in HIT use were highest among adults aged >65 years (annual percentage change [APC] 8.3%), who had more than one cardiovascular risk factor (APC 5%) and among those who did not graduate from high school (APC 8.8%). Likelihood of HIT use was significantly higher in individuals who were younger, female, and non-Hispanic White; had higher education and income; were married; and reported very good or excellent health status. In 2018, college graduates were 7.18 (95% CI 5.86-8.79), 6.25 (95% CI 5.02-7.78), or 7.80 (95% CI 5.87-10.36) times more likely to use HIT compared to adults without high school education among people with multiple cardiovascular risk factors, one cardiovascular risk factor, or no cardiovascular risk factors, respectively.ConclusionsOver 2012-2018, HIT use increased nationally, with greater use noted among younger and higher educated US adults. Targeted strategies are needed to engage wider age, racial, education, and socioeconomic groups by lowering barriers to HIT access and use.     

Stage-related differences of mitotic and apoptotic indices,and bcl-2 protein expression in diffusely growing non-Hodgkin's lymphomas

The present study examined whether growth characteristics of diffusely growing non-Hodgkin's lymphomas (NHL) may differ as a function of stage. Among 105 NHL of various types and sub-types (REAL [Revised European-American Lymphoma] classification), localized (Ann Arbor pathologic stages I + II) lymphomas exhibited clearly higher indices for mitotic activity, apoptosis and cell turnover, as well as a significantly lower percentage of cells containing immunohistochemically detectable bcl-2 protein, than disseminated (stages III + IV) NHL. A similar pattern emerged when high-grade (Kiel classification) lymphomas only were evaluated. Low-grade NHL showed analogous, but less marked, stage-dependent characteristics, with the exception of median percentages of bcl-2⁺ cells, which remained comparable in all stages. Our findings are consistent with the notion that dissemination of diffusely growing NHL is usually associated with reduced cell turnover and, in high-grade lymphomas, with the generation of longer-lived cells. © 1996 Wiley-Liss, Inc.     

Barriers to antiretroviral therapy initiation for HIV-positive children aged 2–18 months in Swaziland

Although early antiretroviral therapy (ART) reduces HIV-related mortality in children by up to 75%, almost half of HIV-positive children younger than 1 year old in Swaziland do not initiate ART. This study was conducted to identify barriers to early ART initiation among HIV-positive infants. This was a case-control study among HIV-positive infants, aged 2 to 18 months, who either did not initiate ART (cases), or initiated ART (controls), during 18 months after testing. Multivariable logistic regression showed that infants who visited the clinic every month, or every 2 months, were 5.78 and 6.20 times more likely to initiate ART than those who visited less often (OR 5.78, 95% CI 1.82–18.33 and OR 6.20, 95% CI 1.30–29.60 respectively). Children who lived ≤30 and 31–60 minutes from the nearest clinic were 84% and 79% less likely respectively to initiate ART (OR 0.16, 95% CI 0.03–0.78 and OR 0.21, 95% CI 0.04–0.98) compared with those who lived more than 60 minutes away. Children who received immunisation after 6 months were 22.59 times more likely to initiate ART (OR 22.59, 95% CI 7.00–21.72) than those who did not. Infants of caregivers who had excellent or good relationships with their healthcare provider were 4.32 times more likely to initiate ART (OR 4.32, 95% CI 1.01–18.59) than those of caregivers who had average or poor relationships with healthcare providers. The significant predictors of ART initiation identified in this study should be regarded as priority areas for intervention among HIV-positive women in Swaziland.     

Role of hormones in acne vulgaris

Objective

To elucidate the role of endogenous hormones like testosterone, progesterone, estrogen, insulin-like growth factor, insulin and glucocorticoids in a common skin condition acne vulgaris.

Design and methods

We conducted a systematic review of the literature and abstracted the data for every published cut point.

Results

We screened more than 1000 studies and found that serum testosterone, progesterone, glucocorticoids, insulin and insulin-like growth factors are increased in patients with acne vulgaris and serum estrogen levels are low in patients.

Conclusions

Various endogenous hormones play important role in the pathogenesis of acne vulgaris. Thus, in the clinical practice it is important to evaluate serum levels of these hormones and patients must be treated accordingly to avoid serious endocrine disorders at an early age.     

Rare case of multi-drug resistant endometrial tuberculosis unveiled by DNA signature studies of the rpoB, katG and inhA genes

Tuberculosis has been an unrelenting scourge. Early diagnosis of genital tuberculosis is of paramount importance and has for long been a subject of concern. Asymptomatic presentation of the disease and failure of the present tests to accurately diagnose the disease has further exacerbated the scenario. We present a case of 29-year-old infertile female previously treated for skin tuberculosis with multidrug-resistant culture negative endometrial tuberculosis that was undiagnosed by the conventional microbiological techniques. PCR detected endometrial tuberculosis infection while sequencing confirmed the drug resistance pattern. We contend that molecular techniques can be used to define treatment in culture-negative tuberculosis. This illustrates the importance molecular techniques in early diagnosis of this asymptomatic insidious disease.