Zeitschriftenartikel zum Thema „Ross Valley Medical Clinic“

Nagwakas ang araw Lupa’t dagat, langit, pumanaw Tahan na, Humimlay Siyanawa — JF Lapeña, Tahan Na, Humimlay The continuing COVID-19 pandemic has directly or indirectly claimed the lives of countless colleagues, friends, and family. I personally thought my tears had run dry as people I knew and loved died throughout the past year, but the wells of grief run deep, even as the plague continues its scourge as of this writing. Especially when fellow front-liners fall, the haunting bugle call echoes the finality of death: “day is done, gone the sun, from the lake, from the hills, from the sky.”1 Of my original fellow office-bearers in the Philippine Association of Medical Journal Editors (PAMJE), two have passed on: Dr. Gerard “Raldy” Goco and Jose Ma. “Joey” Avila.2 Even in our Philippine Society of Otolaryngology - Head and Neck Surgery, I do not recall us dedicating so many passages in issues past as we do now, with tributes to Dr. Elvira Colmenar, Dr. Ruben Henson Jr., Dr. Marlon del Rosario, and Dr. Oliverio Segura. Our Philippine Medical Association Central Tagalog Region (PMA-CTR) has lost more than its share of physicians: Dr. Joseph Aniciete, Dr. Patrocinio Dayrit, and Dr. Rhoderick Presas of the Caloocan City Medical Society; Dr. Mar Cruz, Dr. Mayumi Bismarck, and Dr. Edith Zulueta of the Marikina Valley Medical Society; Dr. Kharen AbatSenen of the Valenzuela City Medical Society; Dr. Romy Encanto and Dr. Cosme Naval of the San Juan Medical Society; Dr. Roberto Anastacio and Dr. Encarnacion Cabral of the Makati Medical Society; and Dr. Amy Tenedero and Dr. Neil Orteza of the Pasay Parañaque Medical Society. The rest of the PMA has lost over 145 physicians due to, or during, the pandemic. As healthcare workers, how do we deal with their deaths, the inevitability of more deaths, and the very real prospect of our own deaths during these trying times? How do we continue our work of saving lives in our overcrowded hospitals and community-based clinics while dealing with grief and facing our own fears for ourselves and our families? Over 50 years ago, Elisabeth Kübler-Ross formulated a model of dying with five stages of coping with impending loss of life (denial, anger, bargaining, depression and acceptance) based on her work with dying patients at the University of Chicago, and these have become widely considered as phases of grief that people go through when faced with the prospect of their own death (or as a response to any major life change).3 By focusing “on dying, rather than death,” her work “shifted attention of religious thinkers, pastors, and authors of personal testimonies onto the themes and framework she offered” and “her legacy was to offer a fresh way to think and speak about dying, death and grieving.”4 Whether, and how we might appropriate her framework in order to cope with our personal and collective experiences during this pandemic, a pandemic that is arguably worse than any worst case scenario ever imagined, is another matter altogether. Does the framework even apply? The very nature of the COVID-19 pandemic is changing how people die -- in ambulances, makeshift tents and long queues outside overflowing hospitals, or en route to distant hospitals with vacancies (with patients from the National Capitol Region travelling to as far away as Central and Northern Luzon or Southern Tagalog and Bicol), or in their own homes (as people with “mild” symptoms are encouraged to monitor themselves at home, often rushing in vain to be admitted in hospitals with no vacancies when it is already too late) -- and “we have to make difficult decisions regarding resuscitation, treatment escalation, and place of care,”5 or of death. The new normal has been for COVID-19 patients to die alone, and rapidly so, within days or even hours, with little time to go through any process of preparation. Friends and family, including spouses, parents, and children, are separated from the afflicted, and even after death, the departed are quickly cremated, depriving their loved ones of the usual rites and rituals of passage. In most cases, wakes and novenas for the dead can only be held virtually, depriving the grieving loved ones of the support and comfort that face-to-face condolences bring. Indeed, the social support systems that helped people cope with death have been “dismantled, and the cultural and religious rituals that help us process grief also stripped away.”5 Amidst all this, “we must ensure that humanity, community, and compassion at the end of life are sustained,” and that “new expressions of humanity help dispel fear and protect the mental health of bereaved families.”6 What these expressions might be, and whether they can inspire hope in the way that community pantries7 have done remains to be seen. But develop these expressions we must, for our sakes as for the sake of our patients. The “hand of God” -- two disposable latex gloves filled with warm water and tied around the hand of a woman with COVID-19 to alleviate her suffering by nurse technician Araújo Cunha at the Vila Prado Emergency Care Unit in São Paulo is one such poignant expression.8 Ultimately, we must develop such expressions for and among ourselves as well. As healthcare workers, our fears for ourselves, our colleagues, and our own loved ones “are often in conflict with professional commitments” and “given the risks of complicated grief,” we “must put every effort into (our) own preparation for these deaths as well as into (our) own healthy grieving.”9 We cannot give up; our profession has never been as needed as it is now. True, we can only do so much, and so much more is beyond our control. But to this end, let us imagine the soothing, shushing “tahan na” (don’t cry) we whisper to hush crying infants, coupled with the calming invitation “humimlay” (lay down; rest; sleep). Yes, the final bugle call may echo the finality of death, but it can simultaneously reassure us that “all is well, safety rest, God is nigh!”1

Purpose: Engagement of patients in the HIV care continuum and adherence to antiretroviral therapy (ART) continue to limit successful viral suppression. Innovative practices to improve this continuum and ameliorate potential physician shortages are needed. The objective of this evaluation was to determine the clinical benefits of incorporating pharmacy resident involvement on a multidisciplinary team in caring for patients with HIV. Methods: A single-center pre–post cohort pilot evaluation was conducted at the Tennessee Valley Healthcare Systems VA Medical Center. Patients were enrolled in an HIV pharmacotherapy clinic implemented by an ambulatory care pharmacy resident. The primary end point of the evaluation was the percentage of patients achieving an undetectable plasma HIV viral load after enrollment. Secondary end points included change from baseline in CD4 T-cell count and self-reported adherence. Results: A total of 55 patients were seen in the HIV pharmacotherapy clinic over a 28-week evaluation period. Of those patients with detectable viral load at enrollment, 70% reached viral suppression during follow-up, with a significant 0.75 log10 decrease in the median viral load ( P < .0001 for both). The median CD4 T-cell count increased from 464 to 525 cells/mm3 ( P = .01). Reported adherence, assessed using the Visual Analogue adherence Scale (VAS) increased significantly ( P = .0001). Conclusion: After enrollment in an HIV pharmacotherapy clinic, a significant decrease in viral load was seen, as were improvements in secondary end points of CD4 T cells and adherence. These data demonstrate the clinical benefits of pharmacy resident involvement on a multidisciplinary team in caring for patients with HIV.

Background National guidelines for the provision of HIV pre-exposure prophylaxis (PrEP) to reduce a person’s risk of acquiring HIV were made available in 2014. We created a pharmacist-managed HIV PrEP clinic in a community pharmacy setting at Kelley-Ross Pharmacy in Seattle, WA, USA. Methods: The clinic operates under a collaborative drug therapy agreement based on these guidelines. This allows pharmacists to initiate and manage tenofovir disoproxil fumarate/emtricitabine under the supervision of a physician medical director. Results: Between March 2015 and February 2018, 714 patients were evaluated and 695 (97.3%) initiated PrEP. Five hundred and thirteen (74%) patients began medication the same day as their initial appointment. Of the prescriptions filled in our pharmacy, 90% of patients had a mean proportion of days covered (PDC) greater than 80%, and 98% had a zero-dollar patient responsibility per month, including uninsured individuals. 19% of patients were lost to follow up, with an effective drop-out rate of 25%. Two hundred and seven diagnoses of sexually transmissible infections were made. There were no HIV seroconversions in the service. Conclusion: The pharmacist-managed PrEP clinic proved to be a successful alternative model of PrEP care, with high initiation rates and low drop-out and lost-to-follow-up rates. This may benefit individuals who do not access PrEP in traditional health care settings or where PrEP access is scarce. Financial sustainability of the model was dependent on the ability of pharmacists in the clinic to bill insurance plans for their services in accordance with Washington State legislative changes requiring commercial insurances to recognise pharmacists as providers.

Background: Chronic kidney disease (CKD) patients who live far (>30 miles) from their nephrologist experience lower rates of clinic visit adherence, limited access to treatment, and higher rates of hospitalization and mortality than patients who live in close proximity to their nephrologist. Strategies to minimize disparities between urban and remotely located CKD patients are needed. The purpose of this study was to determine whether adherence to clinic visits and clinical outcomes in the remote management of CKD via telenephrology is comparable to in-person conventional care. Methods: Renal clinic adherence and composite outcomes of death, end-stage renal disease (ESRD), or doubling of serum creatinine (Cr) were measured in geographically remote Hudson Valley VA Medical Center (HVVAMC) CKD patients enrolled in telenephrology (n = 112) and CKD patients enrolled in the Bronx VAMC renal clinic (n = 116). Results: Prior to implementing the telenephrology service, 53.1% of scheduled visits of rural HVVAMC patients to the Bronx VAMC renal clinic were either cancelled or were “no-shows.” This was reduced by nearly half (28.5%) after instituting telenephrology (p < 0.001). Moreover, the frequency of attending appointments was greater in the telenephrology (71.9%) vs. in-person Bronx VA cohort (61.0%). The incidence of the composite outcome of death, ESRD, or doubling of Cr was similar between both groups (p = 0.96) over 2 years of follow-up. Conclusions: Remote CKD care delivered through telenephrology improves renal clinic visit adherence while delivering comparable renal outcomes. Application of this technology is a promising method to provide access to care to rural CKD patients and to minimize the disparity between urban/rural patients.

Objective: To determine the prevalence of depression–anxiety disorders and the degree to which physicians prescribed antidepressants for Aboriginal and non-Aboriginal populations living in a remote rural community in British Columbia in 2001. Methods: To obtain data for our main outcome measures, we retrospectively reviewed the charts of 2375 patients living in the Bella Coola Valley as of September 2001 and attending the Bella Coola Medical Clinic. Results: The 2001 prevalence rate of depression–anxiety disorders in the Bella Coola Valley was 7.5% (177/2375). Depression was the most common problem (86%) in these patients. Women had a higher rate of depression–anxiety disorders (10.3%) than did men (4.7%) ( P < 0.001). Non-Aboriginal people had a slightly higher rate (8.5%) than did Aboriginal people (6.3%); however, the difference was not statistically significant. Antidepressant medications were commonly prescribed for chronic pain and insomnia. The general pattern of antidepressant medication use in 2001 among both Aboriginal and non-Aboriginal people living in the Bella Coola Valley was as follows: peak use of antidepressants was in the middle to late years; the rate for women was roughly double the rate for men; and proportionately more Aboriginal people, especially the women, were taking antidepressants. Conclusions: Depression–anxiety disorder prevalence rates for Aboriginal and non-Aboriginal populations are similar. When using antidepressant medication prescriptions as a community health indicator, health care administrators should be aware that antidepressant medications are commonly prescribed for conditions other than depression–anxiety disorder.

Healthcare services and the expected need for expansion has fueled the need to take a look into the immediate future for the Roanoke valley. Building a healthy environment for the citizens of the valley does not only include bricks and mortar. The facilities are very important, but a healthy community begins from within. Roanoke county has taken the initiative to institute a wellness center for our 900 plus employees. We have always been supportive of our local healthcare providers, Carilion Clinic and Lewis-Gale Medical Center, but taking a pro-active part will lead to many positive results. We have already realized a reduction in healthcare claims and a corresponding decrease in the overall payment of these. Our wellness center operation has resulted in less time loss from work due to illness, an overall healthy workforce and most importantly an educated employee regarding their personal healthcare situation. We realize that a healthy workforce is a more productive one.Healthcare education and preventive care programs such as eating healthy foods and exercise translates into lower health insurance premiums for individuals as well as the County.

The development of a medical home is an integral component in decreasing health disparities among disenfranchised communities. Mobile health clinics contribute to increasing access to health services, promoting health education, and improving care coordination especially among low income rural patients. This problem based solution, case study describes the experience of a University-community based partnership in the development of a mobile clinic model within ambulatory Community Medical Health. In 2014, a university based, nursing program initiated, mobile health unit was created to offer basic medical care to rural health areas in the Central Valley. The following case describes how this was accomplished, what outcomes were tracked and what lessons were gleamed as a means of improving the process for future endeavors or as a model to others looking to develop a similar project. Over the past two years the mobile health unit has shown the increased need for medical services as evident by an increase of patient visits in these areas. In addition, implementation results and considerations are discussed including key process indicators, limitations and future model directions.

191 Background: Advance directives (AD) are critical to understanding a patient’s wishes should they be unable to communicate. Lacking these documents may lead to decreased knowledge regarding end-of-life wishes, and hinder end-of-life care. Having an AD uploaded into the electronic medical record (EMR) ensures these documents are available to all providers. This project sought to improve, from a cohort of patients with documented discussions regarding ADs, the proportion with the document in the EMR. At Valley-Mount Sinai Comprehensive Cancer Care, baseline data analysis shows only 20% of clinic patients for whom an AD was documented had an AD uploaded to their EMR. Methods: This project was created through the ASCO Quality Training Program and sought to increase the proportion of AD’s in patient’s EMR's. The current workflow of obtaining AD's at Valley-Mount Sinai was first identified. In our setting, the medical assistant (MA) asks new patient if they have an AD and uploads the AD into the chart if available. Following a structured cause and effect exercise, two Plan-Do-Study-Act (PDSA) cycles were prioritized. The first, beginning 10/15/18, required that the new patient nurse navigator discuss the value of AD’s with the patient when scheduling initial visits. The second PDSA, completed 11/12/18 for the MA’s, was an educational session reviewing AD’s and how to discuss them. Results: Pre- and post-intervention data is depicted in the Table. At baseline, 20% of the 114 patients with existing AD discussions had these documents uploaded into their EMR. After PDSA-2, 37.1% of the 78 patient cohort had an AD uploaded. Conclusions: Through clinical education and revising the current process, this project increased uploading AD’s into EMR’s from 20% to 37.1%. This demonstrates that small but effective interventions can increase the proportion of patients with AD’s in their charts. Future PDSA’s will focus on patient and RN education to further improve these numbers. [Table: see text]

Background: Mental health and its related problems are growing concerns over the world. The early onset of emotional and behavioral problem in the young children is related to a variety of health and behavior problems in adolescence. It is a challenging all over the world to determine the epidemiology of childhood mental disorders. Objective: The aim of this study is to sort out the prevalence and predominance of mental illness and their onset of age and sex among the child and adolescent who attended in the child guidance clinic in TUTH. Methodology: A retrospective study of a total of 539 consecutive cases of child and adolescent attended in Child Guidance Clinic TUTH. Diagnosis was made according to the criteria of Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision. Result: The cases from the age of 0.4 year to 21 years with mean age 8.85±4.08 years. Significantly majority were boys (n=343, 63.6%) and most of from out of the Kathmandu valley (n=300, 53.2%). Significantly most case referred from ENT OPD of TUTH (n=97, 18%) and mental retardation was the commonest (n=81, 15%) followed by conversion disorder (n=77, 14.3%) and anxiety spectrum disorder (n=63, 11.7%) Conclusion: Boys are common in mental illness among child and adolescents. The common diagnoses among child and adolescent are mental retardation, conversion disorder, anxiety spectrum disorders and Autism spectrum disorder. Journal of Nobel Medical College Vol. 2, No.1 Issue 3 Nov.-April 2013 Page 55-63 DOI: http://dx.doi.org/10.3126/jonmc.v2i1.7677

Staphylococcus aureus is a common component of skin flora of healthy adults. However, it can cause serious infections such as bloodstream infections, pneumonia, or bone and joint infections. Methicillin-resistant Staphylococcus aureus (MRSA) is known to cause hospital- (HA-MRSA) and community-acquired (CA-MRSA) infections worldwide. Asia is reported to have highest prevalence rates of HA-MRSA and CA-MRSA. As there were very less number of epidemiological studies being done in Malaysia, this study aimed to determine the prevalence of MRSA infection among the healthcare undergraduates who will be engaging with patients soon. We analyzed nasal swabs of students from a private medical institution in Klang Valley, Malaysia. Methicillin-resistance was accessed by sensitivity to the Oxacillin and Cefoxitin disks. In a total of 151 healthcare undergraduates, 117 of them were found positive for Staphylococcus aureus. Among the latter, 21 samples (13.9%) were resistant to Oxacillin and Cefoxitin. Our data shows significant high percentage of MRSA infection and therefore prevention strategies for MRSA need to be developed for the healthcare students before they engage with patients in clinic setting. Keywords: MRSA, nasal swab, healthcare undergraduates, Oxacillin.

Dr Henry Shimizu was a dedicated Canadian plastic surgeon with Japanese roots who spent his career practicing in Edmonton at the University of Alberta Hospital. He relished the opportunity to share his expertise by training residents and medical students. Dr Shimizu completed his plastic surgery training in the United States and was central to establishing the plastic surgery training program in Edmonton. Beyond clinical practice, Dr Shimizu was a prominent advocate in his community, serving as the Chairman of the Redress committee for Japanese internment. As a talented painter, he had produced magnificent oil paintings based on childhood recollections as an internee in the Slocan Valley. Dr Shimizu has made significant contributions to Canadian plastic surgery serving as president of the Canadian Society of Plastic Surgeons in 1978. His clinic work and dedication to the community at large were recognized with the Order of Canada in 2004 and more recently an honorary degree from the University of Victoria. Dr Shimizu continues to golf, paint, and travel in his retirement. He is happily married to his wife Joan and is the proud father of 4 children and 6 grandchildren.

Introdução: A procura excessiva nos serviços de urgência/emergência geralmente se dá devido a problemas que poderiam ser solucionados nos serviços de atenção básica à saúde. Os usuários procuram o serviço de emergência muitas vezes por desconhecerem a finalidade deste, gerando enormes filas de espera. Objetivos: Descrever o perfil sociodemográfico e clínico dos usuários de um pronto socorro (PS) de uma instituição do Vale do Paraíba. Métodos: O estudo segue a abordagem quantitativa, do tipo descritivo, transversal e de caráter documental, fundamentado na análise de dados coletados diretamente das Fichas de Atendimentos dos pacientes atendidos no PS. A amostra consistiu de 774 atendimentos nos meses de janeiro, fevereiro e março de 2015. Resultados: Observou-se que 39% dos pacientes tinham entre 19 e 25 anos de idade, 55% eram do sexo feminino, 63% eram pertencentes à cidade de Aparecida, 82% eram da zona urbana, 98% tinham prescrição médica, 34% não realizaram os exames, 29% tinham hipótese diagnóstica de sintomas gripais, 81% dos pacientes tiveram alta e 16% dos pacientes tinham histórico clínico de cefaleia. Conclusão: Os atendimentos apontaram para a necessidade de orientação dos usuários na utilização do serviço de atenção básica.Palavras-Chave: Urgência e emergência; Atendimento em pronto-socorro; Enfermagem em emergênciaABSTRACTIntroduction: The over going in the emer-gency service is usually because of the problems which could be solved at the primary health service. The patients look for the emergency service many times because they do not know exactly the finality, which results in a huge waiting line. Aims: To describe the clinic and soci-odemographic profile of the emergency users in an institution in Vale do Paraíba, São Paulo, Brazil. Methods: A quantitative, descriptive, transversal, the character documental, based on the data analysis collected from the attendance sheets of the patients who went to the emergency. The sample of this study was 774 attendances in the months of January, February, and March of 2015. Results: It was observed that 39% of the patients were between 19 and 25 years old, 55% female gender, 63% were from the city of Aparecida (Brazil), 82% were from the urban area, 98% had medical recipe, 34% did not do the exami-nation, 29% had symptoms of flu, 81% of the patients had been discharged from the hospital, and 16% of the patients had got a headache. Conclusion: The attendance showed the need of clients’ education to use the services in the primary health area.Keywords: Emergency department; ER visits; Emergency nursing

Background: Although auditory processing disorder (APD) is a widely recognized impairment, its prevalence and demographic characteristics are not precisely known in the pediatric population. Purpose: To examine the demographic characteristics of children diagnosed with APD at a tertiary health-care facility and the prevalence of pediatric APD. Research Design: A cross-sectional study. Study Sample: A total of 243 children (149 boys and 94 girls) who were referred to the Nemours Audiology Clinics in the Delaware Valley for an APD evaluation. The mean ages were 9.8 yr for boys and 9.7 yr for girls. Out of 243 children referred for an APD evaluation, 94 children exhibited one or more auditory processing deficits in the areas of auditory closure, auditory figure ground, binaural integration, binaural separation, and temporal processing. Data Collection and Analysis: Demographic and audiological data, clinical history (parental reports on prenatal and postnatal information, birth weight and height, medical and developmental history, otologic/audiological history, education information, behavioral characteristics), and results of the APD test battery were retrospectively obtained from the electronic medical records of each participant. The prevalence of APD was estimated using the total number of students enrolled in the same school attended by each participant in the 2011 academic year as cohort. Results: The prevalence of APD was 1.94 per 1,000 children in this study. We found that prevalence of APD among the children who attended private schools was more than two times higher than the children who attended public schools. The results also revealed that the majority of children referred to the clinics were Caucasian (85.6%), whereas minority groups were underrepresented for this geographical area with only 3.7% of Hispanic or Latino children and 5.8% of Black or African American children. Conclusions: The estimated prevalence of APD in the current study was lower than the previously published estimates. The difference might be due to the diagnosis criteria of APD among studies as well as the use of school enrollment number as the referenced population to estimate prevalence in our study. We also found a significant difference in APD prevalence depending on the school types. The findings of higher prevalence rates among the children attending private schools and higher proportion of Caucasians children referred for APD evaluation suggest that more children among those in public schools and in the Hispanic and African American groups should have been referred for an APD evaluation. Hence, the current estimate is likely an underestimate of the actual APD prevalence. The low percentage of Hispanic or African American children referred to the clinic for APD evaluations may be related to the socioeconomic status and linguistic differences among the concerned families. The results of this study raise the importance of adapting the APD test battery for children with a different linguistic background as well as increasing awareness of available clinical resources to all families in our area.

Abstract Hemophilia A is an X-linked recessive genetic bleeding disorder resulting in a lack of clotting factor VIII. Although this disorder primarily affects males, a female who inherits one affected X chromosome from a parent becomes a carrier of hemophilia. While it is widely believed that carriers are asymptomatic, some of these women have mild hemophilia, defined by ISTH as a circulating factor VIII level > 0.5 to 0.40 IU/ml or 5 - 40 % of normal. (White et al Thromb Haemost 2001) Data demonstrates hemophilia A carriers have the same risk for bleeding as a male with mild hemophilia A at the corresponding factor level. Carriers report significantly more bleeding events than non-carriers from small wounds and after invasive procedures, and their bleeding tendency is inversely correlated to their factor level. (Plug et al Blood 2006) Carriers have been shown to demonstrate decreased joint range of motion, soft tissue and osteochondral changes on MRI, consistent with subclinical joint bleeds leading to structural abnormalities in their joints. (Gilbert et al Haemophilia 2014). Additionally, carriers have been shown to report higher scores on pictorial blood assessment charts, a semi-quantitative measure of menstrual blood loss. (Kadir et al Haemophilia 1999) We report here a unique patient population from our Owyhee Indian Health Hemophilia Treatment Center Outreach Clinic on the Duck Valley Indian Reservation in Owyhee, NV. On this reservation, a German Immigrant with hemophilia A married 2 women of the Shoshone Indian Tribe, and they had 14 children (8 females and 6 males). The family tree reveals after four generations there are currently 162 descendants with the same hemophilia A gene mutation, which has been identified. Factor VIII levels in the female family members range from 7% to 50%. The male hemophilia A patients are treated on demand with plasma-derived factor VIII products, currently Koate-DVI, for traumatic events, and prophylactically for medical or dental procedures, or surgery. Approximately 20-25% of the female carriers in this population have been treated with plasma-derived FVIII concentrates, currently Koate-DVI, for childbirth and surgeries. Additionally, all female carriers from teenage years to age 30 are treated with desmopressin acetate nasal spray (Stimate) for menorrhagia and are treated with oral aminocaproic acid (Amicar) for nose bleeds and soft tissue bleeds. Carriers of hemophilia A with factor VIII levels in the range observed in this family, particularly when symptomatic, should receive the diagnosis of "mild hemophilia". Their propensity for developing subclinical as well as clinical bleeding needs to be recognized to assure the receive treatment appropriate to their symptomatology. The low levels of FVIII observed in this family are likely due to extreme lyonization associated with their particular gene mutation. Familial low levels of FVIII can also be seen in some forms of type 2 von Willebrand Disease secondary to poor FVIII binding and a shortened half-life. However, since VWD is inherited in an autosomal recessive pattern, males would not selectively have the severity observed here. Optimal diagnostic and therapeutic strategies as well as many other aspects concerning mild hemophilia remain to be clarified. Additional studies to define these findings are underway. Disclosures Berkowitz: Pfizer: Membership on an entity's Board of Directors or advisory committees; Bayer: Membership on an entity's Board of Directors or advisory committees; Kedrion: Membership on an entity's Board of Directors or advisory committees; NovoNordisk: Speakers Bureau; Baxter: Speakers Bureau. Federizo:Emergent: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees; Baxalta: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Biogen Idec: Membership on an entity's Board of Directors or advisory committees; Octapharma: Membership on an entity's Board of Directors or advisory committees; Kedrion: Membership on an entity's Board of Directors or advisory committees. Bergman:Kedrion Biopharma: Employment. Ulsh:Kedrion Biopharma: Employment.

BACKGROUND: Financial and regulatory incentives stemming from the Health Information Technology for Economic and Clinic Health Act have encouraged and, hence, increased the availability of online patient portals ('portals') that connect to electronic health records. Through portals, caregivers have direct access to portions of their child's medical record. Direct access is intended to engage caregivers in treatment and, consequently, to improve disease management. However, demonstrated associations between portal use and engagement in care is limited within pediatrics and non-existent in pediatric oncology. Caregivers of children with cancer have increased anxiety in response to their child's diagnosis and treatment (Myers et al, Cancer, 2014). Allowing caregivers swift access to results via portals may reduce anxiety for some, however, complicated written material may exacerbate anxiety and cause confusion (Schultz, et al, Pediatric Blood & Cancer, 2018). Furthermore, differences in sociodemographic variables between portal users and non-users potentially highlights widening healthcare disparities. Little is known about the use of portals by caregivers of children with cancer or what effect use may have on caregivers. As a first step, this study sought to examine whether sociodemographic and clinical care variables are associated with portal activation in a pediatric oncology sample. METHODS: Data were extracted from the electronic health records of pediatric oncology patients diagnosed or treated for their first known cancer within Nemours Center for Cancer and Blood Disorders in the Delaware Valley from January 1, 2012 through June 30, 2017. Sociodemographic variables (patient age, gender, race, preferred language, insurance, zip-code), clinical characteristics (cancer type, date of diagnosis, total number of laboratory and radiology tests within the study period), and portal activation date were gathered. A cost of living index (COLI) was computed using zip-code data. Cancer type was classified as "liquid" or "solid" based on chemotherapy and radiology follow-up procedures. Those who activated the portal more than 30 days before a cancer diagnosis were excluded from evaluation to better isolate portal activation related to cancer diagnosis. Data were summarized with descriptive statistics. Chi-square and independent samples t-tests compared those who did and did not activate the portal. RESULTS: The initial sample included 445 children; 73 families activated the portal more than 30 days before cancer diagnosis. Of the remaining 372 patients, 197 families (53%) activated the portal. Those who activated did not differ from those who did not in regard to patient age, gender, COLI, or type of cancer. Those who were of non-majority race, spoke a language other than English, and did not have private insurance were overrepresented among those who did not activate (TABLE). Families of children undergoing more radiology and lab tests were more likely to activate. For those who activated the portal, 39% did so within 1 month of diagnosis (day -30 to day +30), 13% did so from day +31 to +90, 36% did so from day +91 to +365, and 11% did so greater than 366 days post diagnosis. CONCLUSION: There are significant differences in patient portal activation by race, preferred language, and type of insurance. These results suggest sociodemographic disparities in portal activation, similar to patterns found in our pediatric primary care network (Ketterer et al, Academic Pediatrics, 2013). In that sample, however, only 26% of patients activated accounts in contrast to the 53% of families in pediatric oncology activating accounts. In our sample, while general type of cancer was not associated with portal activation, greater burden of treatment evaluation was. This study is the initial step in a program of research evaluating the use, utility, and outcomes of portal use in pediatric oncology. Further work will include evaluation of patterns of portal usage along with evaluations of health literacy and portal related anxiety. As portals become more ubiquitous, we must better understand how they are used and mitigate any disparities in or ill effects of access to this information. Disclosures No relevant conflicts of interest to declare.

US–Mexico border communities are uniquely vulnerable to human immunodeficiency virus (HIV) transmission given the economic and social challenges these communities face. We surveyed low-income, predominantly Latinx residents receiving sexually transmitted infection testing and/or HIV/acquired immune deficiency syndrome (AIDS) care in the lower Rio Grande Valley of southernmost Texas about their experiences of food insecurity. Participants aged 18 years and over took a self-administered survey available in English or Spanish in a clinic waiting room ( N = 251). Ordinary least squares regression results suggested that those with a prior HIV/AIDS diagnosis reported a response for food insecurity that was approximately 0.67 points higher than peers without a prior HIV/AIDS diagnosis (coefficient = 0.67; p < 0.05), even when adjusting for sociodemographic characteristics, social support, perceived discrimination, and neighborhood environment. Interaction results between age and HIV status indicated that younger individuals living with HIV/AIDS experienced uniquely higher food insecurity; those who reported a prior HIV/AIDS diagnosis experienced an additional reduction in food insecurity by approximately 0.06 points for each additional year of age (age × HIV/AIDS interaction coefficient = −0.06; p < 0.05). Community programs serving low-income populations should consider screening for and intervening on food insecurity, especially among young adults living with HIV/AIDS.

The Rio Grande Valley (RGV) in South Texas has one of the highest prevalence of obesity and type 2 diabetes (T2D) in the United States (US). We report for the first time the T2D prevalence in persons with HIV (PWH) in the RGV and the interrelationship between T2D, cardiometabolic risk factors, HIV-related indices, and antiretroviral therapies (ART). The PWH in this study received medical care at Valley AIDS Council (VAC) clinic sites located in Harlingen and McAllen, Texas. Henceforth, this cohort will be referred to as Valley AIDS Council Cohort (VACC). Cross-sectional analyses were conducted using retrospective data obtained from 1,827 registries. It included demographic and anthropometric variables, cardiometabolic traits, and HIV-related virological and immunological indices. For descriptive statistics, we used mean values of the quantitative variables from unbalanced visits across 20 months. Robust regression methods were used to determine the associations. For comparisons, we used cardiometabolic trait data obtained from HIV-uninfected San Antonio Mexican American Family Studies (SAMAFS; N = 2,498), and the Mexican American population in the National Health and Nutrition Examination Survey (HHANES; N = 5,989). The prevalence of T2D in VACC was 51% compared to 27% in SAMAFS and 19% in HHANES, respectively. The PWH with T2D in VACC were younger (4.7 years) and had lower BMI (BMI 2.43 units less) when compared to SAMAFS individuals. In contrast, VACC individuals had increased blood pressure and dyslipidemia. The increased T2D prevalence in VACC was independent of BMI. Within the VACC, ART was associated with viral load and CD4+ T cell counts but not with metabolic dysfunction. Notably, we found that individuals with any INSTI combination had higher T2D risk: OR 2.08 (95%CI 1.67, 2.6; p &lt; 0.001). In summary, our results suggest that VACC individuals may develop T2D at younger ages independent of obesity. The high burden of T2D in these individuals necessitates rigorously designed longitudinal studies to draw potential causal inferences and develop better treatment regimens.

Abstract Background Undernutrition and cardiac disease are interconnected in a vicious cycle. Little is known about the effect of undernutrition on cardiac disease among children in low- and middle-income countries (LMICs). This study aimed to assess magnitude of undernutrition and associated factors among children with cardiac disease at University of Gondar hospital, northwest Ethiopia. Method This hospital-based cross-sectional study included children with cardiac disease presenting to the pediatric outpatient clinic at University of Gondar Hospital, Ethiopia. A self-administered questionnaire was administered to participating families, and medical records were reviewed. All participants who fulfill the inclusion criteria were included. Anthropometric measurements were made and the presence of malnutrition was diagnosed according to the WHO criteria. Associated factors of undernutrition analyzed by using binary logistic regression model. Variables with p-value ≤0.2 in bivariate analysis were fitted to the final multivariable analysis and those variables with p-value ≤0.05 were considered as having statistically significant association to the outcome variable. AOR and 95% confidence interval was calculated to assess the strength of association between the variables. Result A total of 269 patients participated in the study. 177 (65.7%) were undernourished, of whom 96 (54.5%) were underweight, 70 (39.7%) were stunted, and 95 (53.9%) were wasted. Pulmonary hypertension (adjusted odds ratio [AOR] = 3.82, 95%CI 1.80–8.10), NYHA/modified Ross class III and IV heart failure (AOR = 4.64, 1.69–12.72) and cardiac chamber enlargement (AOR = 2.91, 1.45–5.66) were associated with undernutrition. Conclusion Undernutrition is common among children with cardiac disease in northern Ethiopia. Children with pulmonary hypertension, high-grade heart failure, and cardiac chamber enlargement may warrant close follow-up for malnutrition.