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Rationale and Objectives: Mammography quality assurance programs have been in place for more than a decade. We studied radiologists' self-reported performance goals for accuracy in screening mammography and compared them to published recommendations.Materials and Methods: A mailed survey of radiologists at mammography registries in seven states within the Breast Cancer Surveillance Consortium (BCSC) assessed radiologists' performance goals for interpreting screening mammograms. Self-reported goals were compared to published American College of Radiology (ACR) recommended desirable ranges for recall rate, false-positive rate, positive predictive value of biopsy recommendation (PPV2), and cancer detection rate. Radiologists' goals for interpretive accuracy within desirable range were evaluated for associations with their demographic characteristics, clinical experience, and receipt of audit reports.Results: The survey response rate was 71% (257 of 364 radiologists). The percentage of radiologists reporting goals within desirable ranges was 79% for recall rate, 22% for false-positive rate, 39% for PPV2, and 61% for cancer detection rate. The range of reported goals was 0%-100% for false-positive rate and PPV2. Primary academic affiliation, receiving more hours of breast imaging continuing medical education, and receiving audit reports at least annually were associated with desirable PPV2 goals. Radiologists reporting desirable cancer detection rate goals were more likely to have interpreted mammograms for 10 or more years, and >1000 mammograms per year.Conclusion: Many radiologists report goals for their accuracy when interpreting screening mammograms that fall outside of published desirable benchmarks, particularly for false-positive rate and PPV2, indicating an opportunity for education. [ABSTRACT FROM AUTHOR]

Background and Objective: To assess the public's perception of pharmacists' involvement and role in cardiovascular disease prevention and management. Methods: A computer-assisted telephone interview of 505 households was conducted. The survey was administered to metropolitan, rural and remote residents over the age of 30 years. The interview had questions on the patient's general satisfaction with the quality of service provided by their regular community pharmacy, including factors such as location, professionalism, prices, product range and knowledge of the staff. The participants were asked if they thought pharmacists were capable of providing screening, testing and drug prescribing services for blood pressure and cholesterol, and how likely they would be to use these services through a pharmacy. The interview also included questions on how likely this person would be to seek advice on lifestyle changes and medications from various health professionals, including pharmacists. Results: The majority (97%) were satisfied with the service provided at their regular pharmacy. Those surveyed agreed or strongly agreed that pharmacists are capable of providing screening or testing for raised blood pressure (52%) and diabetes (51%), with a minority (38%) agreeing that pharmacists are capable of testing for raised cholesterol. The pharmacist's role with perceived highest capability by those surveyed was in providing advice on how to take medicines properly, with 90% of respondents willing to seek this advice from their pharmacist. A limited role by pharmacists was seen in the diagnosis of CVD and prescribing medications. In relation to the prevention of CVD, even though 76% of respondents believed that pharmacists are capable of providing advice on lifestyle changes (e.g. weight loss, smoking and alcohol intake), only 8% of current or past smokers had sought assistance to give up smoking at their pharmacy and while 69% of all respondents had sought help with weight control, only 3% of these had looked towards their pharmacy for assistance. Conclusion: There was belief by those Australians surveyed that community pharmacists are capable of providing screening for hypertension and diabetes. Through these services and in conjunction with counselling on CVD risk reduction, pharmacists may play an important role in the reduction of CVD, ultimately improving public health and decreasing the burden on Australia's health care system. However, at present pharmacists are not being fully utilized to deliver health promotion advice and contribute to the prevention of CVD. [ABSTRACT FROM AUTHOR]

Objective: To compare screening mammography and Pap testing among Chinese women in Seattle, Washington to Vancouver, and British Columbia.Methods: Using community-based sampling methods, trilingual female interviewers surveyed Chinese women in Seattle and Vancouver. Multiple preventive health behaviors and health care access variables were assessed. Mammography analysis included 409 women aged 50-74 years. Pap testing analysis included 973 women aged 20-69 years. Main outcome measures were ever use and use in the last 2 years of screening mammography and Pap testing.Results: Chinese women in Vancouver were younger, more educated and fluent in English. Unadjusted rates of mammography and Pap testing were similar between the two cities. Provider type was consistently associated with screening in both cities; female providers had the highest rates and Chinese male providers the lowest. Adjusted logistic regression analysis demonstrated similar mammography use in the two cities. However, for Pap testing, women in Seattle had higher odds of screening compared to Vancouver.Conclusion: Despite universal health care coverage and baseline characteristics typically associated with greater utilization of preventive screening services, Chinese women in Vancouver did not have higher rates of screening mammography and Pap testing compared to Chinese women in Seattle. [ABSTRACT FROM AUTHOR]

Background: Unfavorable health-related social needs (HRSNs) have the potential to worsen health and well-being and drive health disparities. Its associations with cardiovascular health (CVH), assessed by Life's Essential 8, have not been comprehensively examined among US adults., Methods and Results: We used the National Health and Nutrition Examination Survey 2011 to March 2020 data for adults aged ≥20 years. We grouped Life's Essential 8 scores as low (0-49), moderate (50-79), and high (80-100) CVH. We identified 8 unfavorable HRSNs and assigned a value of 1 for the unfavorable status of each. The number of unfavorable HRSNs was summed and ranged from 0 to 8, with higher numbers indicating more unfavorable HRSNs. We used multivariable linear and multinomial logistic regression to examine the association between HRSNs and CVH. A total of 14 947 participants were included (n=7340 male [49.3%]; mean [SE] age, 46.4 [0.35] years). A higher number of unfavorable HRSNs were associated with worse CVH: comparing adults with unfavorable HRSNs of 1-2, 3-4, and ≥5 to those with none, the fully adjusted prevalence ratios (95% CI) for low CVH were 1.42 (1.17-1.73), 2.11 (1.69-2.63), and 2.42 (1.90-3.08), respectively. The corresponding prevalence ratios (95% CI) for high CVH were 0.77 (0.68-0.87), 0.58 (0.49-0.67), and 0.46 (0.38-0.55). The associations were consistent across subgroups and in sensitivity analyses., Conclusions: There was a graded association between unfavorable HRSNs and a higher prevalence of low CVH or lower prevalence of high CVH. Public health interventions targeting HRSNs might reduce health disparities and promote CVH.

Background: Hypertension affects nearly half of US adults yet remains inadequately controlled in over three-quarters of these cases. This study aimed to assess the association between adherence to antihypertensive medications and total medical costs, health care use, and productivity-related outcomes., Methods and Results: We conducted cross-sectional analyses using MarketScan databases, which included individuals aged 18 to 64 years with noncapitated health insurance plans in 2019. Adherence was defined as ≥80% medication possession ratio for prescribed antihypertensive medications. We used a generalized linear model to estimate total medical costs, a negative binomial model to estimate health care use (emergency department visits and inpatient admissions), an exponential hurdle model to estimate productivity-related outcomes (number of sick absences, short-term disability, long-term disability), and a 2-part model to estimate productivity-related costs in 2019 US dollars. All models were adjusted for age, sex, urbanicity, census region, and comorbidities. We reported average marginal effects for outcomes related to antihypertensive medication adherence. Among 379 503 individuals with hypertension in 2019, 54.4% adhered to antihypertensives. Per person, antihypertensive medication adherence was associated with $1441 lower total medical costs, $11 lower sick absence costs, $291 lower short-term disability costs, and $69 lower long-term disability costs. Per 1000 individuals, medication adherence was associated with lower health care use, including 200 fewer emergency department visits and 90 fewer inpatient admissions, and productivity-related outcomes, including 20 fewer sick absence days and 442 fewer short-term disability days., Conclusions: Adherence to antihypertensives was consistently associated with lower total medical costs, reduced health care use, and improved productivity-related outcomes.

Background: There are no recent estimates for hypertension-associated medical expenditures. This study aims to estimate hypertension-associated incremental medical expenditures among privately insured US adults., Methods: We conducted a retrospective cohort study using IQVIA's Ambulatory Electronic Medical Records-US data set linked with PharMetrics Plus claims data. Among privately insured adults aged 18 to 64 years, hypertension was identified as having ≥1 diagnosis code or ≥2 blood pressure measurements of ≥140/90 mm Hg, or ≥1 antihypertensive medication in 2021. Annual total expenditures (in 2021 $US) were estimated using a generalized linear model with gamma distribution and log-link function adjusting for demographic characteristics and cooccurring conditions. Out-of-pocket expenditures were estimated using a 2-part model that included logistic and generalized linear model regression. Overlap propensity score weights from logistic regression were used to obtain a balanced sample on hypertension status., Results: Among the 393 018 adults, 156 556 (40%) were identified with hypertension. Compared with individuals without hypertension, those with hypertension had $2926 (95% CI, $2681-$3170) higher total expenditures and $328 (95% CI, $300-$355) higher out-of-pocket expenditures. Adults with hypertension had higher total inpatient ($3272 [95% CI, $1458-$5086]) and outpatient ($2189 [95% CI, $2009-$2369]) expenditures when compared with those without hypertension. Hypertension-associated incremental total expenditures were higher for women ($3242 [95% CI, $2915-$3569]) than for men ($2521 [95% CI, $2139-$2904])., Conclusions: Among privately insured US adults, hypertension was associated with higher medical expenditures, including higher inpatient and out-of-pocket expenditures. These findings may help assess the economic value of interventions effective in preventing hypertension., Competing Interests: None.

Background: The use of correctly-sized blood pressure (BP) cuffs is important to ensure accurate measurement and effective management of hypertension. The goals of this study were to determine the proportions of pregnant women that would require small, adult, large, and extra-large (XL) cuff sizes, and to examine the demographic characteristics associated with need for a large or XL cuff., Methods: This cross-sectional study analyzed 1,176 pregnant women (≥18 years) included in the National Health and Nutrition Examination Survey (NHANES) 1999-2006 cycles. Recommended BP cuff sizes, based on American Heart Association recommendations, were categorized by mid-arm circumference: small adult (≤26 cm), adult (>26 to ≤34 cm), large (>34 to ≤44 cm), and extra-large (XL) (>44 cm)., Results: Among US pregnant women, recommended cuff sizes were: 17.9% small adult, 57.0% adult, and 25.1% for large or XL. About 38.5% of non-Hispanic Black, 21.6% of Mexican American and 21.0% of non-Hispanic White pregnant women required a large or XL cuff. About 81.8% of women in the highest quartile for BMI required large or XL cuffs, which was significantly higher than women in other quartiles., Conclusion: Roughly one out of every four pregnant women required large or XL BP cuffs. The requirement for large or XL cuffs was highest among non-Hispanic Black women and women with the highest BMI. For pregnant women, measuring the arm circumference and selecting an appropriately-sized cuff is important to facilitate accurate blood pressure monitoring and hypertension management., (© Published by Oxford University Press on behalf of American Journal of Hypertension Ltd 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

The Western Himalayan mountains, with several riverine systems, are considered one of the most fragile environments in the world. Among them is Beas, a primary river that provides essential ecosystem benefits to thousands of indigenous people in North India. One of the major pollutants, microplastics (MPs), are ubiquitous contaminants, yet their occurrence in the Beas and ecological risk factors remain largely unexplored. Due to extensive tourism and urban-related burdens, the usage and release of enormous amounts of plastics and MPs into the Beas are apparent. Here, we investigated the extent of MPs pollution and subsequent environmental risks in water and sediments from Beas along a stretch of 300 km. Our results showed that MPs were abundant and widely distributed, with the abundance range (mean ± SE) being 46-222 (112.27 ± 12.43) items/L in water and 36-896 (319.47 ± 49.25) items/kg in sediment samples. We found significant differences in MPs' abundance in water but not sediments among the five sampling sites. There was a significant positive correlation between population size and the abundance of MPs, with the highest abundance in populated Kullu and the lowest loads at the remote Dhundi Glacier. Fibers and film were common morphotypes; most items measured <1 mm. Of the eleven polymers identified, the majority were polyethylene. The pollution load index ranged up to 4.99 (low-risk category); however, the polymer hazard index exceeded 1000 (highest-risk category), and the potential ecological risk index was 13,761 (extreme-risk category) at selected sites. This study fills a crucial knowledge gap and raises concerns about the possible impact on human health, as many riparian residents depend on Beas as their primary source of potable water. Our findings may assist governmental agencies in formulating comprehensive eco-friendly policies and advancing environmentally sustainable strategies in vulnerable locales adjoining the Beas waterway., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Age-adjusted mortality rates (AAMR) for cardiovascular diseases (CVD) increased in 2020 and 2021, and provisional data indicated an increase in 2022, resulting in substantial excess CVD deaths during the COVID-19 pandemic. Updated estimates using final data for 2022 are needed., Methods: The National Vital Statistics System's final Multiple Cause of Death files were analyzed in 2024 to calculate AAMR from 2010 to 2022 and excess deaths from 2020 to 2022 for U.S. adults aged ≥35 years, with CVD as the underlying cause of death., Results: The CVD AAMR among adults aged ≥35 years in 2022 was 434.6 deaths per 100,000 (95% CI=433.8, 435.5), which was lower than in 2021 (451.8 deaths per 100,000; 95% CI=450.9, 452.7). The most recent year with a similarly high CVD AAMR as in 2022 was 2012 (434.7 deaths per 100,000 population, 95% CI=433.8, 435.7). The CVD AAMR for 2022 calculated using provisional data overestimated the AAMR calculated using final data by 4.6% (95% CI=4.3%, 4.9%) or 19.9 (95% CI=18.6, 21.2) deaths per 100,000 population. From 2020 to 2022, an estimated 190,661 (95% CI=158,139, 223,325) excess CVD deaths occurred., Conclusions: In 2022, the CVD AAMR among adults aged ≥35 years did not increase, but rather declined from a peak in 2021, signaling improvements in adverse mortality trends that began in 2020, amid the COVID-19 pandemic. However, the 2022 CVD AAMR remains higher than observed before the COVID-19 pandemic, indicating an ongoing need for CVD prevention, detection, and management., (Published by Elsevier Inc.)

Background: People with HIV (human immunodeficiency virus; PWH) have higher rates of cardiovascular disease than people without HIV. However, limited information exists about hypertension prevalence and associated risk factors in PWH., Methods: This cross-sectional study included adult patients in the 2022 IQVIATM Ambulatory Electronic Medical Record-US data. HIV was identified based on ≥2 HIV diagnosis codes or a positive HIV test. Hypertension was identified by diagnosis codes, ≥2 blood pressure (BP) readings ≥130/80 mm Hg, or an antihypertensive medication prescription. Among those with hypertension, control was defined as the most recent BP < 130/80 mm Hg. Logistic models using the marginal standardization method were used to estimate adjusted prevalence ratios (aPR) of hypertension and hypertension control among all patients and PWH specifically, controlling for covariates., Results: Of 7,533,379 patients, 19,102 (0.3%) had HIV. PWH had higher hypertension prevalence (66% vs. 54%, aPR:1.14, 95% CI: 1.13-1.15) compared with people without HIV. Among persons with hypertension, PWH were more likely to have controlled hypertension (aPR: 1.10, 95% CI: 1.07-1.13) compared with people without HIV. Among PWH, those from the South were more likely to have hypertension (aPR: 1.07, 95% CI: 1.02-1.12) than PWH from the Northeast, while Black PWH were less likely to have controlled hypertension (aPR: 0.72, 95% CI: 0.67-0.77) than White PWH., Conclusions: PWH were more likely to have hypertension than people without HIV. Geographic and racial disparities in hypertension prevalence and control were observed among PWH. Optimal care for PWH includes comprehensive strategies to screen for, prevent, and manage hypertension., (© Published by Oxford University Press on behalf of American Journal of Hypertension Ltd 2024.)