Electronic medical record (EMR) systems in primary care present an opportunity to address frailty, a significant health concern for older adults. Researchers in the UK used Read codes to develop a 36-factor electronic frailty index (eFI), which produces frailty scores for patients in primary care settings.

We aimed to translate the 36-factor eFI to a Canadian context.

We used manual and automatic mapping to develop a coding set based on standardized terminologies used in Canada to reflect the 36 factors of the eFI. Manual mapping was completed independently by two coders, followed by group consensus among the research team. Automatic mapping was completed using Apelon TermWorks. We then used EMR data from the British Columbia Canadian Primary Care Sentinel Surveillance Network. We searched structured data fields related to diagnoses and reasons for patient visits to develop a list of free text terms associated with any of the 36 factors.

A total of 3768 terms were identified; 3021 were codes. A total of 747 free text terms were identified from 527,521 reviewed data entries. Of the 36 frailty factors, 24 were captured mostly by codes; 7 mostly by free text; and 4 approximately equally by codes and free text. Three key findings emerged from this study: (1) It is difficult to capture frailty using only standardized terminologies currently used in Canada and a combination of standardized codes and free text terms better captures the complexity of frailty; (2) EMRs in primary care can be better optimized; (3) Output from this study allows for the development of a frailty screening algorithm that could be implemented in primary care settings to improve individual and system level outcomes related to frailty.

Racial, ethnic, and socioeconomic disparities persist in posttraumatic stress disorder (PTSD), which are partly attributed to minoritized women being trauma-exposed, while also contending with harmful contextual stressors. However, few have used analytic strategies that capture the interplay of these experiences and their relation to PTSD. The current study used a person-centered statistical approach to examine heterogeneity in trauma and contextual stress exposure, and their associations with PTSD and underlying symptom dimensions, in a diverse sample of low-income postpartum women.

Using a community-based sample of Black, Hispanic/Latina, and White postpartum women recruited from five U.S. regions (n = 1577), a latent class analysis generated profiles of past-year exposure to traumatic events and contextual stress at one month postpartum. Regression analyses then examined associations between class membership and PTSD symptom severity at six months postpartum as a function of race/ethnicity.

A four-class solution best fit the data, yielding High Contextual Stress, Injury/Illness, Violence Exposure, and Low Trauma/Contextual Stress classes. Compared to the Low Trauma/Contextual Stress class, membership in any of the other classes was associated with greater symptom severity across nearly all PTSD symptom dimensions (all ps < 0.05). Additionally, constellations of exposures were differentially linked to total PTSD symptom severity, reexperiencing, and numbing PTSD symptoms across racial/ethnic groups (ps < 0.05).

A person-centered approach to trauma and contextual stress exposure can capture heterogeneity of experiences in diverse, low-income women. Moreover, racially/ethnically patterned links between traumatic or stressful exposures and PTSD symptom dimensions have implications for screening and intervention in the perinatal period.

In ESCAPE-TRD (NCT04338321), a randomized, open-label, rater-blinded, long-term, phase 3b trial, augmentation with esketamine nasal spray (ESK) demonstrated increased probability of achieving meaningful clinical benefit versus quetiapine extended release (QUE XR) in patients (pts) with treatment-resistant depression (TRD). This subgroup analysis of ESCAPE-TRD evaluated the incidence, duration, and impact of treatment-emergent adverse events (TEAEs) on treatment discontinuation in adults with TRD treated with ESK or QUE XR according to US prescribing information.

Pts aged 18-64 years were randomly assigned to receive flexibly dosed ESK (56 or 84 mg) or QUE XR (150-300 mg), both consistent with US label dosing and in combination with an ongoing oral antidepressant. The incidence and duration of the most commonly occurring TEAEs, as well as the most common TEAEs leading to treatment discontinuation, were summarized descriptively. All randomly assigned participants receiving ≥1 dose of study drug were included in the safety analyses.

Among the 636 pts included in the subgroup analysis, 316 and 320 were randomly assigned to ESK and QUE XR, respectively; 314 and 316 were included in the safety population. In the combined acute and maintenance phases, TEAEs occurred in 92.0% of pts in the ESK group and 78.5% of pts in the QUE XR group. The most commonly reported TEAEs with ESK or QUE XR in the combined acute and maintenance phases were dizziness (47.1% and 7.9%, respectively), headache (25.5% and 13.0%, respectively), somnolence (15.0% and 23.4%, respectively), and nausea (29.9% and 3.2%, respectively). Across all TEAE events reported in >5% of pts in either arm, 91.8% (5831 of 6351) resolved within 1 day in the ESK arm compared to 11.6% (90 of 776) with QUE XR. For specific TEAE events of clinical interest for ESK, same-day resolution rates for increased blood pressure, sedation, and dissociation in the ESK group were 93.5% (116 of 124), 96.2% (127 of 132), and 99.6% (740 of 743), respectively. The majority of TEAEs of clinical interest in the ESK group that occurred on the same day of dosing resolved within the first 2 hours after dosing. For the most frequently reported TEAEs with QUE XR, same-day resolution rates for somnolence, headache, and fatigue were 7.8% (8 of 103), 49.2% (29 of 59), and 9.5% (4 of 42), respectively. Fewer pts treated with ESK discontinued treatment due to TEAEs compared to QUE XR (4.4% versus 10.6%).

Safety data from this subgroup analysis were consistent with the overall study population as well as the known tolerability profile of each treatment. TEAEs were reported at higher incidence with ESK than with QUE XR; however, the majority of TEAEs occurring with ESK were transient in nature and did not result in a higher rate of treatment discontinuation compared to QUE XR.

Janssen Scientific Affairs, LLC

To understand the characteristics of food environments in the Pacific region, and the broader economic, policy and sociocultural surroundings that influence food choices and interventions to improve food environments for Pacific communities.

Systematic searches were conducted for articles related to food environments or factors influencing food choices from 1993 to 2024 in five academic databases, Google, Google Scholar and relevant organisations’ websites. Studies were included if they meet the eligibility criteria. Two authors independently reviewed the title and abstract of identified articles. Full-text screening was conducted before data were extracted from eligible studies. A narrative analysis was informed by an existing food environments framework.

Pacific Island countries or territories that are a member of the Pacific Community (SPC).

Not applicable.

From the sixty-six included studies (of 2520 records screened), it was clear that food environments in the Pacific region are characterised by high availability and promotion of ultra-processed unhealthy foods. These foods were reported to be cheaper than healthier alternatives and have poor nutritional labelling. Food trade and investment, together with sociocultural and political factors, were found to contribute to unhealthy food choices. Policy interventions have been implemented to address food environments; however, the development and implementation of food environment policies could be strengthened through stronger leadership, effective multisectoral collaboration and clear lines of responsibility.

Interventions focused on improving physical, economic, policy and sociocultural influences on food choices should be prioritised in the Pacific region to improve the food environment and mitigate barriers to healthy eating.

Children with left aortic arch and aberrant right subclavian artery may present with either respiratory or swallowing symptoms beyond the classically described solid-food dysphagia. We describe the clinical features and outcomes of children undergoing surgical repair of an aberrant right subclavian artery.

This was a retrospective review of children undergoing repair of an aberrant right subclavian artery between 2017 and 2022. Primary outcome was symptom improvement. Pre- and post-operative questionnaires were used to assess dysphagia (PEDI-EAT-10) and respiratory symptoms (PEDI-TBM-7). Paired t-test and Fisher’s exact test were used to analyse symptom resolution. Secondary outcomes included perioperative outcomes, complications, and length of stay.

Twenty children, median age 2 years (IQR 1–11), were included. All presented with swallowing symptoms, and 14 (70%) also experienced respiratory symptoms. Statistically significant improvements in symptoms were reported for both respiratory and swallowing symptoms. Paired (pre- and post-op) PEDI-EAT-10 and PEDI-TBM-7 scores were obtained for nine patients, resulting in mean (± SD) scores decreasing (improvement in symptoms) from 19.9 (± 9.3) to 2.4 (± 2.5) p = 0.001, and 8.7 (± 4.7) to 2.8 (± 4.0) p = 0.006, respectively. Reoperation was required in one patient due to persistent dysphagia from an oesophageal stricture. Other complications included lymphatic drainage (n = 4) and transient left vocal cord hypomobility (n = 1).

Children with a left aortic arch with aberrant right subclavian artery can present with oesophageal and respiratory symptoms beyond solid food dysphagia. A thorough multidisciplinary evaluation is imperative to identify patients who can benefit from surgical repair, which appears to be safe and effective.

Leveraging the National COVID-19 Cohort Collaborative (N3C), a nationally sampled electronic health records repository, we explored associations between individual-level social determinants of health (SDoH) and COVID-19-related hospitalizations among racialized minority people with human immunodeficiency virus (HIV) (PWH), who have been historically adversely affected by SDoH.

We retrospectively studied PWH and people without HIV (PWoH) using N3C data from January 2020 to November 2023. We evaluated SDoH variables across three domains in the Healthy People 2030 framework: (1) healthcare access, (2) economic stability, and (3) social cohesion with our primary outcome, COVID-19-related hospitalization. We conducted hierarchically nested additive and adjusted mixed-effects logistic regression models, stratifying by HIV status and race/ethnicity groups, accounting for age, sex, comorbidities, and data partners.

Our analytic sample included 280,441 individuals from 24 data partner sites, where 3,291 (1.17%) were PWH, with racialized minority PWH having higher proportions of adverse SDoH exposures than racialized minority PWoH. COVID-19-related hospitalizations occurred in 11.23% of all individuals (9.17% among PWH, 11.26% among PWoH). In our initial additive modeling, we observed that all three SDoH domains were significantly associated with hospitalizations, even with progressive adjustments (adjusted odds ratios [aOR] range 1.36–1.97). Subsequently, our HIV-stratified analyses indicated economic instability was associated with hospitalization in both PWH and PWoH (aOR range 1.35–1.48). Lastly, our fully adjusted, race/ethnicity-stratified analysis, indicated access to healthcare issues was associated with hospitalization across various racialized groups (aOR range 1.36–2.00).

Our study underscores the importance of assessing individual-level SDoH variables to unravel the complex interplay of these factors for racialized minority groups.