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Context: Social determinants of health (SDOH) are economic, social, and political conditions that affect a person's overall health or the health of a group of people. Researchers have investigated the effects of SDOH on various diseases, such as asthma, obesity, and chronic stress, but few publications have been made regarding its effects on arthritis., Objectives: Our primary objective was to analyze the implications of SDOH on disease severity relating to pain levels and limitations experienced among people with diagnosed arthritis., Methods: We performed a cross-sectional analysis of the 2017 Behavioral Risk Factor Surveillance System (BRFSS). We included individuals who reported having arthritis, were over the age of 45, and who also completed the SDOH module. Pain scores from the four-question Arthritis Burden Module were correlated to question responses pertaining to SDOH to determine their associations., Results: For the analysis, our sample size was 25,682, with response rates varying slightly among the SDOH questions. Individuals diagnosed with arthritis were more likely to report functional limitations if they experienced food insecurity (χ 2 =234.0, p<0.001), financial instability (χ 2 =149.7, p<0.001), or frequent stress (χ 2 =297.6, p<0.001). Further, we found that individuals with arthritis experiencing any domain of SDOH reported higher mean pain scores than those not experiencing that domain, with the highest pain score difference among those reporting frequent stress (Coefficient: 1.93, CI=1.74-2.13, t=19.43, p<0.001)., Conclusions: Our results show that SDOH profoundly impact pain levels and limitations experienced by patients with arthritis. Although work has already begun to help alleviate burdens associated with SDOH, more research and actions are required to create equitable health throughout the population., (© 2023 the author(s), published by De Gruyter, Berlin/Boston.)

Context: Intimate partner violence (IPV) occurs when an intimate partner inflicts physical, sexual, and/or emotional assault with coercive control and is a traumatic experience with repercussions that can be exacerbated when a woman is pregnant. While screening for IPV during pregnancy is recommended to occur regardless of risk, less than 50% of pregnant women are screened., Objectives: Identifying clinical factors commonly associated with IPV during pregnancy may improve screening rates, thus our primary objective was to examine associations between IPV and maternal comorbidities., Methods: We conducted a cross-sectional analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 spanning 2016 through 2019. Bivariate and multivariable logistic regression was utilized to calculate adjusted odds ratios (AORs) to determine associations between IPV and diabetes, anxiety, hypertension, depression, asthma, polycystic ovary syndrome (PCOS), and thyroid disease., Results: More than 40% of women experiencing IPV reported a history of depression or anxiety. The occurrence of IPV was higher among women with depression (AOR 3.48, CI 3.14-3.85), anxiety (AOR 2.98, CI 2.64-3.37), hypertension (AOR 1.21, CI 1.02-1.44), and asthma (AOR 1.37; CI 1.17-1.59) than women without those respective conditions, but not among diagnoses of diabetes, PCOS, or thyroid disorders., Conclusions: Our findings show that pregnant individuals reporting having experienced IPV were more likely to report having certain comorbidities compared to those who did not report experiencing IPV. Given the low rates of screening, knowing clinically relevant associations may increase screening sensitivity among clinicians and, in turn, increase the likelihood that individuals experiencing IPV receive supportive care., (© 2023 the author(s), published by De Gruyter, Berlin/Boston.)

Context: Influenza-related hospitalization and mortality disproportionately affects the Hispanic population in the United States. Among other medical conditions in addition to influenza, Spanish-preferring Hispanics may be more affected than those who speak English., Objectives: The purpose of this study was to compare seasonal influenza vaccine uptake rates between Spanish-and English-preferring Hispanic US adults from 2017 to 2020., Methods: For this cross-sectional study, we extracted data from the Behavioral Risk Factor Surveillance System (BRFSS) from the 2017 through 2020 cycles. We calculated the population prevalence of individuals getting influenza vaccines per year, and among subpopulations based on language spoken, age, and sex. We then utilized chi-squared tests of independence to discover possible associations between these subpopulations per year. An alpha level of 0.05 was utilized in this study. Respondents were included if they identified as Hispanic, responded to questions regarding influenza vaccine uptake, and were grouped by the language of the survey returned, age, and sex., Results: Our results show that self-identified Hispanic individuals who were English-preferring had greater seasonal influenza vaccine uptake rates in the latter 2 years of our study for both sexes in the younger age group. Hispanic individuals over the age of 65 years (n=11,328) were much more likely to have received an influenza vaccine compared to younger individuals (n=34,109). In 2018, Spanish-preferring women over age 65 years (n=677) were more likely to have received a vaccine over English-preferring women (n=772)., Conclusions: Our findings showed that disparities exist between English- and Spanish-preferring Hispanic individuals and age groups. Language barriers may play a role in receiving influenza vaccines. The incorporation of medical translators may assist in reducing these disparities in influenza-related healthcare expenses, overall morbidity, and mortality., (© 2022 the author(s), published by De Gruyter, Berlin/Boston.)

Context: Asthma is the most common chronic disease affecting children in the United States. Goals for asthma management include symptom control, the ability to maintain a normal activity level, and minimizing adverse events., Objectives: The objective of this study is to analyze the number of children with asthma that are permitted to carry medications at school and without an asthma action plan., Methods: In this study, we analyzed the Center for Disease Control and Prevention (CDC) Asthma Call-back Survey (ACBS) to assess the prevalence of children in school allowed to carry medication and with asthma action plans. Utilizing the sampling weights provided, we estimated population prevalence by age group and urbanicity., Results: Results showed that, overall, 34.8% of students reported they were not allowed to carry asthma medications in school. Specifically, nearly 51% of children ages 5 to 9 and 33% of children ages 10 to 14 were reported not to be allowed to carry medications at school. Further, 58.2% of children did not have a written asthma action plan. Reported urbanicity was not significantly associated with access to medication at school (p=0.46) or having an asthma action plan (p=0.57)., Conclusions: In our study, more than one-third of students were not permitted to carry asthma medications and nearly three-fifths did not have a written asthma action plan. Therefore, we recommend partnerships between schools, healthcare professionals, students, and osteopathic family physicians to increase access to asthma action plans and medication in schools., (© 2022 the author(s), published by De Gruyter, Berlin/Boston.)

Context: Implementation of guideline-based Papanicolaou (Pap) smear screening, human papillomavirus (HPV) testing, and HPV vaccination has reduced cervical cancer (CC) rates up to 80%, yet prevention disparities continue to exist., Objectives: This study aims to analyze whether CC screening rates differ among women with comorbidities-body mass index (BMI) ≥30 kg/m 2 , diabetes mellitus, hypertension, cardiovascular disease, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, depression, or skin cancer-compared to women without these comorbidities., Methods: Combined 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) datasets were evaluated utilizing multivariate logistic regression models to determine the adjusted odds ratios (AORs) of persons having completed CC screening without comorbidities compared to those with individual diagnoses, as well as in those with multiple comorbidities (1, 2-4, 5+). Confidence intervals (CIs) were reported at 95%., Results: Among the 127,057 individuals meeting inclusion criteria, 78.3% (n = 83,242; n = 27,875,328) met CC screening guidelines. Multivariable regression showed that women who had a BMI ≥30 kg/m 2 were significantly less likely to have completed a CC screening (AOR: 0.90; CI: 0.83-0.97) as were those with COPD (AOR: 0.77; CI: 0.67-0.87) and kidney disease (AOR: 0.81; CI: 0.67-0.99). Conversely, women with skin cancer were significantly more likely to report CC screening (AOR: 1.22; CI: 1.05-1.43). We found no significant differences in CC screening completion rates by diagnosis of diabetes, hypertension, cardiovascular disease, arthritis, or depression nor between women lacking comorbidities compared to women with multiple comorbidities., Conclusions: Women with BMI ≥30 kg/m 2 , COPD, and kidney disease were less likely to complete CC screening, whereas women with skin cancer were more likely to complete CC screening. Additionally, diabetes mellitus, hypertension, cardiovascular disease, arthritis, and depression diagnoses did not significantly impact rates of CC screening. Physicians should be aware of the deviations in CC screening completion among patients with diagnoses to know when there may be an increased need for Pap tests and pelvic examinations. CC screening is critical to reduce mortality through early detection and prevention measures., (© 2022 Jordyn Austin et al., published by De Gruyter, Berlin/Boston.)

Context: "Spin" is a form of bias that involves highlighting study results in a way that presents the conclusions about benefit or efficacy beyond the scope of the data. Spin in the abstract of published studies has the potential to affect patient care, making investigations about its presence and prevalence important for readers., Objectives: To evaluate the most severe types of spin in the abstracts of systematic reviews and metaanalyses focused on percutaneous coronary intervention., Methods: Using a cross sectional study design, the authors searched MEDLINE and Embase with the terms "percutaneous coronary intervention," "percutaneous coronary revascularization," "PCI," "systematic review," "meta analysis," and "meta-analysis." To be considered for this study, the article must have (1) focused on PCI; (2) had either a systematic review or metaanalysis study design; (3) been conducted on human subjects; and (4) been available in English. Reviews were excluded if these criteria were not met. Each included article was assessed for the nine most severe types of spin as defined in a previously published article, as well as other study characteristics (type of intervention being compared, date the review was received, adherence of systematic review and/or meta-analysis to Preferred Reporting for Systematic Reviews or Metanalyses (PRISMA) guidelines, requirement of PRISMA guidelines by the publishing journal, the publishing journal's five-year impact factor, and sources of funding)., Results: Our database search retrieved 7,038 records; 2,190 duplicates were removed. Initial title and abstract screening led to the exclusion of 4,367 records, and an additional 281 records were excluded during full text screening. An arbitrary limit of 200 articles was applied for this analysis; five additional articles were excluded for ineligible study design, so 195 were included in our final analysis. Spin was present in the abstracts of 43 studies from that pool (22.1%). Spin type 3- selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention -occurred most frequently (29; 14.8%). The presence of spin was not associated with any of the extracted study characteristics., Conclusions: Our data showed that spin occurred in more than one in every five systematic reviews or metaanalyses of PCI. Spin has the potential to distort a reader's ability to translate the true findings of a study; therefore, efforts are needed to prevent spin from appearing in article summaries., (© 2021 Wesley Tanner Cole et al., published by De Gruyter, Berlin/Boston.)

Context: Each year, approximately 53,200 people die in the U.S. from colorectal cancer (CRC), indicating a need to increase screening efforts. Some studies have suggested mammography use is higher in patients with comorbid conditions, a reflection of increased follow up. Another study found that patients with obesity were less likely to be screened for CRC than nonobese patients. However, no study has assessed the impact of multiple comorbidities on CRC screening., Objectives: To analyze CRC screening rates in patients with comorbidities compared with healthy patients, and to assess whether the number of comorbid diagnoses impacted screening rates., Methods: A cross sectional analysis of patients who received CRC screening was performed using the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS). Respondents were classified as having had CRC screening if they answered "yes" to either of the following: "Have you ever had a blood stool test?" or "Have you ever had a sigmoidoscopy/colonoscopy?" Respondents younger than age 50 were excluded. A weighted multivariate logistic regression model was constructed to determine adjusted risk ratios (ARR). Confidence intervals (CI) were reported at 95%., Results: We identified 279,784 respondents who met inclusion criteria. Of those, 79.7% (sample n=222,879; population N=46,304,360) of respondents had received CRC screening. Patients with diabetes, hypertension, skin cancer, chronic obstructive pulmonary disease (COPD), arthritis, depression, and chronic kidney disease were significantly more likely to be screened than those without comorbidities. There was no statistically significant difference in screening rates between patients with and without cardiovascular disease. Compared with patients with zero comorbidities, those with one were significantly more likely to receive screening (ARR, 1.11; CI, 1.09-1.12) as were those with two to four (ARR, 1.2; CI, 1.18-1.22). Patients with five or more comorbidities were significantly less likely to be screened than those with two to four (ARR, 1.12; CI, 1.1-1.14)., Conclusions: Patients with one or more comorbidities were more likely to be screened than those without comorbidities, but those with five or more conditions were less likely to be screened than patients with two to four conditions. This indicates that physicians may be more fatigued and less likely to recommend CRC screening to patients with many comorbidities compared with patients diagnosed with only a few conditions. The results of this study add to the literature by identifying an interaction between the number of comorbidities and likelihood of being screened for CRC., (© 2021 Benjamin Greiner et al., published by De Gruyter, Berlin/Boston.)

Context: As a result of new developments in medicine, the need for evidence-based clinical practice guidelines (CPG) is of utmost importance. However, studies have shown that many medical societies are using low quality research to develop CPGs., Objectives: To evaluate the quality of research underlying the CPGs issued by the Infectious Diseases Society of America (IDSA)., Methods: We examined 29 CPGs issued between January 1, 2012 and December 31, 2019 and classified each by research quality according to levels reported by the CPG authors and previously specified by the IDSA: Levels I through III, corresponding to high, moderate, and low quality of evidence, respectively. Each ranking was cross-checked with a second researcher to improve inter-rater reliability. To analyze evolution of research quality over time, three updated CPGs were randomly selected and compared to their original versions. Chi-square analysis was then performed to determine statistical significance., Results: We evaluated the quality of research for 2,920 recommendations within the 29 CPGs that met our criteria and found that 418 (14%) were developed using high-quality (Level I) research from randomized, controlled trials. Of the remaining recommendations, 928 (32%) were based on moderate quality research (observational studies) and 1574 (54%) on low quality research (expert opinion). A Pearson chi-squared analysis indicated no-statistically significant difference between original guidelines or their subsequent updates for Clostridium difficile (χ2=0.323; n=85; degrees of freedom [df]=2; p=0.851), candidiasis (χ2=4.133; n=195; df=2; p=0.127), or coccidiomycosis (χ2=0.531; n=95; df=1; p=0.466)., Conclusions: The proportion of high-quality research underlying guideline recommendations is remarkably low, indicating that moderate and low quality evidence is still influencing infectious disease guidelines despite IDSA standards. Moreover, the quality of research has not significantly changed over time. IDSA CPGs are a formidable source of information for clinicians, but an increased number of quality studies should be utilized to further guide CPG development.

Context: The combination of osteoarthritis and rheumatoid arthritis affects nearly one-fourth of Americans. Many of the risk factors for arthritis are lifestyle related, such as obesity, physical activity, dietary behaviors, and alcohol and tobacco use., Objective: To analyze lifestyle behaviors of patients with vs. those without arthritis., Methods: A cross-sectional analysis of 2017 Behavioral Risk Factor Surveillance System (BRFSS) data was conducted on patients with and without a history of arthritis. Physical activity, smoking status, alcohol use, and dietary behaviors were extracted. Logistic regression models were constructed to calculate adjusted risk ratios (ARRs). All confidence intervals (CIs) were reported at 95%., Results: The median response rate for the 2017 BRFSS survey was 45.1% (sample n=292,808; population N=118,751,156). The overall prevalence of arthritis was 44% (n=128,850). Respondents with arthritis were significantly more likely to be physically inactive than nonarthritic respondents, with a significant gender interaction (male absolute risk reduction [ARR], 1.2 [CI, 1.15-1.25]; female ARR, 1.29 [CI, 1.24-1.33]). Those with arthritis were also more likely to be current smokers (ARR 1.1; CI, 1.05-1.15) and less likely to have attempted to quit smoking in the last 12 months (ARR, 0.91; CI, 0.87-0.96). Finally, men with arthritis were more likely to drink alcohol heavily (ARR, 1.14; CI, 1.02-1.27])., Conclusion: Patients with arthritis were more likely to be women, White, current smokers, and physically inactive, and to have poor mental health, lower education levels, and difficulty paying for healthcare and medications than those without arthritis. Further efforts should be made to address these findings through resource allocation in the care of patients with arthritis. Practitioners should also seek increased understanding of the psychological, social, and economic impacts of physical activity and smoking in patients with arthritis.