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Potential regional variations in effects of COVID-19 on federally mandated, program-specific evaluations by the Scientific Registry of Transplant Recipients (SRTR) have been controversial. SRTR January 2022 program evaluations ended transplant follow-up on March 12, 2020, and excluded transplants performed from March 13, 2020 to June 12, 2020 (the "carve-out"). This study examined the carve-out's impact, and the effect of additionally censoring COVID-19 deaths, on first-year posttransplant outcomes for transplants from July 2018 through December 2020. Program-specific hazard ratios (HRs) for graft failure and death estimated under two alternative scenarios were compared with published HRs: (1) the carve-out was removed; (2) the carve-out was retained, but deaths due to COVID-19 were additionally censored. The HRs estimated by censoring COVID-19 deaths were highly correlated with those estimated with the carve-out alone (r2  = .96). Removal of the carve-out resulted in greater variation in HRs while remaining highly correlated (r2  = .82); however, little geographic impact of the carve-out was observed. The carve-out increased average HR in the Northwest by 0.049; carve-out plus censoring reduced average HR in the Midwest by 0.009. Other regions of the country were not significantly affected. Thus, the current COVID-19 carve-out does not appear to impart substantial bias based on the region of the country.

Objective: To examine the relationship between COVID-19-related distress and mental health among first-year college students. Participants: Data for this longitudinal study (n = 727) were collected before the school year (August 2019), end of fall semester (December 2019), and soon after the university suspended in-person instruction (April 2020). Methods: We used multivariable log-linear and logistic regressions to examine continuous and dichotomous outcomes on the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale. Results: The most consistent predictor of during-pandemic mental health was feeling extremely isolated (versus not at all), which was associated with increased symptom severity of depression (proportional change[95% CI] = 2.43[1.87, 3.15]) and anxiety (2.02[1.50, 2.73]) and greater odds of new moderate depression (OR[95% CI] = 14.83[3.00, 73.41]) and anxiety (24.74[2.91, 210.00]). Greater COVID-19-related concern was also related to increased mental health symptoms. Conclusions: Results highlight the need for mental health services during crises that lead to social isolation.

M-bridge was a sequential multiple assignment randomized trial (SMART) that aimed to develop a resource-efficient adaptive preventive intervention (API) to reduce binge drinking in first-year college students. The main results of M-bridge suggested no difference, on average, in binge drinking between students randomized to APIs versus assessment-only control, but certain elements of the API were beneficial for at-risk subgroups. This paper extends the main results of M-bridge through an exploratory analysis using Q-learning, a novel algorithm from the computer science literature. Specifically, we sought to further tailor the two aspects of the M-bridge APIs to an individual and test whether deep tailoring offers a benefit over assessment-only control. Q-learning is a method to estimate decision rules that assign optimal treatment (i.e., to minimize binge drinking) based on student characteristics. For the first aspect of the M-bridge API (when to offer), we identified the optimal tailoring characteristic post hoc from a set of 20 candidate variables. For the second (how to bridge), we used a known effect modifier from the trial. The results of our analysis are two rules that optimize (1) the timing of universal intervention for each student based on their motives for drinking and (2) the bridging strategy to indicated interventions (i.e., among those who continue to drink heavily mid-semester) based on mid-semester binge drinking frequency. We estimate that this newly tailored API, if offered to all first-year students, would reduce binge drinking by 1 occasion per 2.5 months (95% CI: decrease of 1.45 to 0.28 occasions, p < 0.01) on average. Our analyses demonstrate a real-world implementation of Q-learning for a substantive purpose, and, if replicable in future trials, our results have practical implications for college campuses aiming to reduce student binge drinking.

The purpose of this study was to determine whether maternal urinary phthalate metabolite concentrations are associated with the development of higher blood pressure or pregnancy-induced hypertension (PIH). Participants were women without chronic hypertension who enrolled in The Infant Development and the Environment Study, a prospective pregnancy cohort conducted at four U.S. academic medical centers from 2010-2012. Prenatal records were reviewed to obtain blood pressure measurements and diagnoses of PIH (gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome, defined as hemolysis, elevated liver enzymes, and low platelet count). Complete-case analyses used multivariable linear and logistic regression for analysis of blood pressure measurements and PIH diagnoses, respectively. In the final dataset (N = 668), higher concentrations of first-trimester monoethyl phthalate (MEP) and mono-3-carboxypropyl phthalate (MCPP) and third-trimester mono-isobutyl phthalate (MiBP) were significantly associated with a medical chart diagnosis of PIH. First-trimester mono-n-butyl phthalate (MBP) and MEP along with the sum of di-(2-ethylhexyl) phthalate metabolites (∑DEHP) were each associated with increased systolic blood pressure across pregnancy. In conclusion, several phthalate metabolite concentrations were significantly associated with PIH and greater increases in systolic blood pressure across pregnancy.

BackgroundPreconception life style and health play a pivotal role in positively impacting the health of a pregnancy, and this includes the reduction of exposure to endocrine-disrupting chemicals such as phthalates. We have previously demonstrated that women planning a pregnancy with assisted reproductive technology (ART) have lower phthalate metabolite concentrations than their non-ART-using counterparts.ObjectiveTo determine whether women who intended to become pregnant had lower phthalate metabolite concentrations than those who had an unintended pregnancy, or whether change in phthalate exposure across pregnancy differed between these two groups.MethodsA total of 721 women enrolled in The Infant Development and Environment Study (TIDES), a multicentre US prospective pregnancy cohort; 513 (71%) indicated their pregnancy was planned. Urine samples from first- and third-trimester visits were analysed for 10 specific-gravity-adjusted, natural-log-transformed phthalate metabolites. Simple and multivariable linear regression, adjusting for centre, race, age, income, marital status, and parity, were employed to determine whether phthalate metabolite concentrations differed by pregnancy intention.ResultsIn bivariate analyses, the geometric mean concentrations of all first-trimester and most third-trimester phthalates were higher in women with unplanned pregnancies. However, after covariate adjustment, only first-trimester monoisobutyl phthalate (MiBP) remained associated with pregnancy intention, and the association changed direction such that unplanned pregnancies had lower MiBP concentrations (ß -0.18, 95% CI -0.35, -0.02).ConclusionsWe did not find evidence of a difference in phthalate exposure between pregnancy planners and non-planners.

Patients are not always aware of listing criteria and offer acceptance across transplant programs. Factors such as age and body mass index can impact access to transplants as centers have different candidate criteria. Therefore, we created a transplant center search tool (transplantcentersearch.org) (TCST) to help patients find comparative information on transplant programs. We conducted a cross‐over randomized controlled trial (RCT) to assess whether the TCST improved comprehension compared to the existing Scientific Registry of Transplant Recipients website among adults seeking kidney transplants at two centers. To assess comprehension participants were asked to use the TCST and the SRTR website to identify which transplant program within a prespecified area had the most recipients over 70 years of age; and which programs had the most recipients with BMI >40. Participants were asked to provide qualitative feedback on using both websites. Sixty‐eight candidates participated in the RCT. Participants were more likely to identify the correct program when using the TCST compared to the existing SRTR website (OR 8.13, 95% CI 1.87–35.33). Participants stated they preferred the TCST over the SRTR website (52.9% vs. 25.0%, respectively, p = 0.009). With increased comprehension, patients would be better equipped to identify programs that transplant patients like them. Trial Registration: ClinicalTrials.gov identifier: NCT03610555 [ABSTRACT FROM AUTHOR]

In 2023, the field of kidney transplantation faced both successes and challenges. A record 28,142 total kidney transplants were achieved in the United States, largely due to an increase in deceased donor kidney transplants (DDKTs). While the number of adult candidates listed for DDKT slightly increased, it remained below the level in 2019, with 11.4% of candidates waiting 5 years or more. Across racial and ethnic groups, Black adult candidates had the largest increase in DDKT rate in 2023, in parallel with the Organ Procurement and Transplantation Network policy to modify waiting time (implemented January 5, 2023). Following increases in death rates during the COVID-19 pandemic, pretransplant mortality declined in 2023 across various age, race and ethnicity, sex, and blood type categories, although mortality continued to vary substantially by donation service area. The rate of deceased donor kidneys that were recovered for transplant but not transplanted (nonuse) increased to a notable high of 27.9%, from 26.6% in 2022, with even higher rates for biopsied kidneys (41.4%), those from donors aged 65 years or older (72.2%), and kidneys with a kidney donor profile index of 85% or higher (72.5%). In contrast, nonuse of kidneys recovered from hepatitis C virus nucleic acid test-positive donors declined to 27.2% in 2023, from 43.0% in 2017, likely reflecting more common use of protocols incorporating direct-acting antiviral therapy. Disparities in access to living donor kidney transplant (LDKT) persist and particularly affect non-White and publicly insured patients. Delayed graft function has risen over the past decade, but appears to have plateaued, at 26.1% overall for adult recipients in 2023. Five-year graft survival rates were 90.0% for LDKT compared with 82.2% for DDKT in recipients aged 18-34 years, and 80.2% for LDKT versus 66.1% for DDKT in those aged 65 years or older., (Copyright © 2025. Published by Elsevier Inc.)

Background Expedited partner therapy (EPT) for chlamydia can be an important public health tool to treat the sex partners of newly diagnosed individuals, especially when those sex partners are women of reproductive ages. Untreated and repeat chlamydia infections increase a woman's risk for subfertility. This study aimed to determine the knowledge of EPT, and the factors associated with EPT knowledge, among reproductive-aged women. Methods Women aged 18-40 years were recruited for a community sample from a large state fair; 871 women completed a questionnaire for this study. Women reported on their knowledge of sexually transmitted infections, and about their knowledge and attitudes toward EPT. Using a hypothetical example, women were asked if they would accept EPT. Results This community sample of reproductive-aged women found overwhelming hypothetical support for chlamydia testing, partner notification, and partner treatment. However, only 12% of women reported having heard of EPT prior to the survey; once EPT was described, there were high levels of support for EPT and the belief that EPT could reduce chlamydia rates. Half of the women strongly agreed that EPT could reduce chlamydia rates, and 48% supported the state law allowing for EPT. Working in the healthcare field was the only independent determinant of prior EPT knowledge, increasing the odds of hearing about EPT by more than 2.5-fold. Conclusions Despite overwhelming support of the tenets of EPT, our results indicate that prior knowledge of EPT is low among women, meaning that education about EPT is needed for those outside of the healthcare field.