Daily life involves the successful completion of dual task walking activities and is a dynamic integration of motor and cognitive skills to meet environmental and postural demands to avoid a fall. Older Veterans face greater cognitive decline risk, greater comorbidities, and poorer health than non-veterans and have a higher age-related fall risk. Non-immersive VR motor-cognitive treadmill (VR-TM) training can improve balance, walking, and fall risk in older adults but has not been studied in older Veterans and has been largely studied in neurological populations. This pilot study proposed to investigate the acceptance and feasibility of using VR-TM among older Veterans with a history of falls or documented fall risk. Thirty community-dwelling older Veterans aged 65-to-88 years (26 male, 4 female) consented and twenty-three completed this single-arm pilot study. Participants received 14 treatment sessions over 7-weeks using a VR-TM system to walk over virtual obstacles on a treadmill. Balance performance, walking endurance, quality of life (QOL), fear of falling and balance confidence were assessed pre- and post-training. A satisfaction survey was conducted post-training. Descriptive statistics examined fall incidence prior to training and over a six-month retention. Paired t-test and Wilcoxon signed-ranked test performed on the twenty-three completers examined longitudinal change at significance level P = 0.05. The Mini Balance Evaluation Systems Test (Mini-BESTest) had a statistically significant change (20.9 ± 4.20; 23.13 ± 3.03; P = 0.01) and six participants had a 4-point improvement reflective of a minimal clinically important difference (MCID). The Activities-specific Balance Confidence scale improved post-training (65.18 ± 21.68; 73.04 ± 18.40; P = 0.02) and four participants had a > 18

Introduction Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), is characterized by persistent or new symptoms lasting three months or more after acute infection. Approximately 4% of U.S. adults are affected, with fatigue and muscle weakness among the most common symptoms. Chronic inflammation and nutritional imbalances are thought to contribute to long-COVID symptomatology. The Long-COVIDiet Study was designed to test the effectiveness of a whole-diet approach—grounded in the Dietary Guidelines for Americans, 2020–2025 —that emphasizes nutrient-dense, anti-inflammatory foods and select supplements. The trial evaluates the impact of this dietary intervention, quantified through a diet quality score, on fatigue, muscle strength, physical function, and biomarkers of nutritional and inflammatory status in older adults with long COVID. Methods and analysis Fifty-six participants aged ≥50 years with long COVID, moderate-to-severe fatigue, and suboptimal diet quality will be recruited from the Baltimore, Maryland area. Participants will be randomized 1:1 to either a dietary intervention arm or an attention-control arm. The intervention includes individualized dietary counseling (eight biweekly sessions) and 16 weekly online group sessions with a registered dietitian, emphasizing anti-inflammatory and nutrient-rich foods. The control group attends matched weekly sessions on non-dietary healthy aging topics. Primary outcomes are fatigue and diet quality, assessed at baseline, 12 weeks, and 16 weeks. Secondary outcomes include muscle mass, grip strength, and physical function; exploratory outcomes include nutritional and inflammatory biomarkers. Analyses will follow the intention-to-treat principle, with linear regression and mixed-effects models evaluating changes across timepoints. Ethics and dissemination The study was approved by the University of Maryland, Baltimore Institutional Review Board (HP-00106745). Written informed consent will be obtained from all participants. Results will be disseminated through peer-reviewed publications, scientific conferences, and plain-language summaries on the study website. Trial registration number ClinicalTrials.gov Identifier: NCT05977179 .

BACKGROUND:Effect of junctional reflux on the venous clinical severity score in patients with insufficiency of the great saphenous vein (JURY) study proved that venous clinical severity scores (VCSS) are similar in patients with great saphenous vein (GSV) reflux, with or without saphenofemoral junction (SFJ) reflux. Most studies testing the efficacy of endovenous ablation have simply required the presence of truncal reflux for inclusion, and limited data exist on whether junctional reflux impacts benefit. JURY-2 hypothesizes that patients with GSV reflux, with or without SFJ reflux, will derive similar benefit from endovenous ablation. METHODS:JURY-2 was a prospective longitudinal multicenter study of patients undergoing GSV ablation. INCLUSION CRITERIA:18 to 80 years age, reflux of ≥0.5 seconds in ≥2 contiguous segments of the GSV above the knee, and C2 or C3 disease. EXCLUSION CRITERIA:prior deep vein thrombosis; prior vein ablation on the index leg; concomitant obstruction of the iliocaval system; or known renal, hepatic, or cardiac failure. The primary outcome, sample size, and analytic plan were determined pre hoc. The primary outcome was the 3-month postprocedural change in VCSS. The outcome in patients with isolated GSV reflux vs combined GSV and SFJ reflux was considered equivalent if the difference in VCSS change-scores was within the minimum detectable change of ±1.4 points. Change scores were also compared between groups. The multivariable regression model adjusted for baseline VCSS, demographic, clinical, and therapeutic covariates. Statistical analyses were two-tailed, and P < .05 was considered significant. RESULTS:A total of 252 patients were enrolled; most were female (75.00%) and White (78.57%). Of them, 207 patients (82.14%) had combined SFJ+GSV reflux, whereas 45 (17.86%) had isolated GSV reflux. Thermal ablation was used predominantly in both groups, but more so in the SFJ+GSV reflux group (77.78% vs 57.78%). GSV ablation was successful in nearly all cases (99.51% in the SFJ+GSV reflux group; 100% in the isolated GSV reflux group) with no complications. Both groups demonstrated a significant reduction in postprocedural VCSS (6.17 ± 2.20 to 1.86 ± 2.04). The change score in the SFJ+GSV reflux group was equivalent to the GSV group 3 months after endovenous ablation (a difference of -0.54 between groups, 95% confidence interval: -1.36, +0.27). There was no statistical difference in the VCSS change-scores between the two groups (P = .12). CONCLUSIONS:In this prospective multicenter study with full accounting of important clinical covariates, patients with isolated GSV reflux derived equivalent benefit after endovenous ablation compared with those with combined GSV+SFJ reflux. These data support the clinical recommendation that venous ablation must be guided by symptomatic severity rather than the presence or absence of junctional reflux.

OBJECTIVE:Short- or long-term periprocedural clopidogrel, with or without aspirin, is standard of care after several endovascular interventions. However, clopidogrel fails to prevent platelet aggregation in 15% to 50% of the population due to mutations in the CYP2C19 gene. Two methodologies, CYP2C19 genotyping and platelet function testing (PFT), predict clopidogrel response, but their utility in preventing complications after endovascular interventions is underappreciated. This meta-analysis (1) characterizes current literature on genotyping and PFT as means of identifying clopidogrel response and (2) evaluates the impact of abnormal clopidogrel response on postprocedural ischemic complications (stent thrombosis, restenosis, reintervention, amputation, revascularization, transient ischemic attack/stroke, or myocardial infarction) and bleeding complications. METHODS:We conducted a systematic review and meta-analysis of papers reporting CYP2C19 genotyping or PFT to assess clopidogrel response in patients undergoing noncoronary endovascular interventions. A total of 272 papers were screened. After excluding 263 papers, nine articles remained. We described the distribution of poor responders obtained using genotyping and PFT. We compared the odds of developing ischemic complications in poor vs normal clopidogrel responders. We compared the odds of developing bleeding complications in hyper-responders vs normal clopidogrel responders. RESULTS:Four papers assessing clopidogrel response by genotyping and three by PFT reported on ischemic complications. The mean prevalence of poor response was 43.2% ± 10.1% by genotyping and 23.2% ± 8.9% by PFT. All patients received postprocedural clopidogrel. Cumulative ischemic complication rates were 35.1% for poor responders and 14.0% for normal responders. Higher odds of ischemic complications were observed in poor clopidogrel responders identified by genotyping (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 2.1-3.8, P < .001) or by PFT (OR: 6.3, 95% CI: 2.0-20.0, P = .02). Three papers assessed bleeding complications in patients undergoing neuroendovascular interventions. There was no difference in the odds of major bleeding events between hyper-responders and normal responders (OR: 6.2, 95% CI: 0.6-61.7, P = .12). The low number of papers precluded a formal comparison of effectiveness of genotyping vs PFT in predicting complications. CONCLUSIONS:Among patients receiving clopidogrel after endovascular interventions, poor responders experience ischemic complications more frequently. Genotyping chips and PFT assay kits are commercially available and effectively detect poor clopidogrel responders. Genotyping has the advantage of detection before clopidogrel initiation. Rigorous studies are needed to establish the preferred testing modality and to determine whether test result-driven modification of antiplatelet therapy reduces periprocedural complications.

OBJECTIVE:Hospitalization increases venous thromboembolism (VTE) risk, and over one-half of all VTE events occur after hospital admission. Current decisions on post-hospitalization VTE prophylaxis are not evidence-based. The duration of enhanced risk after hospitalization, in surgical and medical patients, is not well-known. In this meta-analysis, we evaluated the rates of post-hospitalization VTE over time in patients that underwent surgery during their hospitalization and those that did not. METHODS:A literature search was performed through November 2023 using PubMed, EMBASE, and Cochrane. Studies examining the incidence of VTE in hospitalized patients during a specified period following hospitalization were included. Studies were excluded if they focused on nonhospitalized patients, failed to define the follow-up duration, or did not report the incidence of VTE. Screening and data collection was conducted by two reviewers. RESULTS:From a total of 1504 studies screened, 57 were included. Overall, 9,152,616 patients were included; of these, 1,232,627 were followed for 30 days, 28,522 for 45 days, 2,515,940 for 90 days, and 5,375,527 were followed beyond 90 days. The pooled incidence of VTE during the first 45 days was 0.3% (95% confidence interval [CI], 0.2%- 0.4%) among surgical patients and 4.6% (95% CI, 4.3%-4.9%) among medical patients. The pooled incidence of VTE during the first 90 days was 1.3% (95% CI, 0.7%-2.3%) in surgical patients and 2.9% (95% CI, 2.0%-4.1%) in medical patients. Beyond 90 days (between 180 and 1020 days), the pooled incidence of VTE was 1.0% (95% CI, 0.4%-2.3%) in the surgical cohort, compared with 2.3% (95% CI, 1.6%-3.5%) in the medical cohort. CONCLUSIONS:The post-hospitalization 90-day VTE rate was found to be low for both surgical and medical patients; the risks beyond 90 days was found to be only slightly lower. VTE risk in surgical patients is predominantly short-term and diminishes following recovery from surgery. Conversely, medical patients exhibit a prolonged VTE risk, likely related to persistence of clinical risk factors.

Background Nearly half of all veterans are 65 years and older, and they have a higher prevalence of functional disabilities compared to the nonveteran population. Balance impairments resulting in injurious falls are a leading cause of morbidity and mortality in older adults. Instability or fear of falling can significantly reduce physical activity and social participation, even in the absence of falls. Dysmobility is a leading factor in long-care admissions, and therefore, maintenance of mobility throughout aging is crucial. Recent evidence indicates lower extremity muscle weakness as a key risk factor for falls, with lower limb muscle strength and quality being critical for balance recovery. The primary hip abductors, the gluteus maximus, medius, and minimus, are particularly essential for balance recovery. Objective This study aims to test the hypothesis that adding neuromuscular electrical stimulation (NMES) to a multimodality balance intervention (MMBI) will yield greater reductions in fall risk and improvements in muscle and mobility function compared with MMBI alone. Methods This randomized controlled trial will enroll 80 veterans aged 55 years and older at risk for falls (defined by a four-square step test [FSST] time >12 seconds, history of falls, or fear of falling). Participants will be randomized to receive either NMES + MMBI or MMBI alone. The 12-week outpatient center–based intervention will include 3 sessions per week, focusing on hip abductor strength, balance, and mobility. Assessments will occur at baseline, postintervention, and at 6- and 12-month follow-ups. Primary outcomes include fall risk and dynamic balance, measured by FSST and hip abductor strength using a Biodex dynamometer. Secondary outcomes will examine muscle composition through computed tomography (CT) scans and assess gait variability parameters. Results This study was funded on January 1, 2022, with a data collection period from April 1, 2022, to December 31, 2026. As of March 2025, we have screened 100 potential participants and excluded 38. Out of the 61 participants enrolled to date, 21 have completed the 12-month follow-up, 32 have completed the 6-month follow-up, and 41 have completed the posttesting. A total of 4 participants are currently in the intervention phase; 1 has just completed the baseline testing, while 15 have been dropped from the study. Conclusions This trial will be the first large, randomized controlled trial to evaluate NMES as an adjunct to an MMBI for fall prevention in older veterans. If successful, NMES combined with hip abductor strengthening and balance training could provide a low-cost, scalable solution to reduce falls, improve balance and mobility, and decrease health care costs related to falls in older adults. This study will address a critical gap in knowledge about the effectiveness of NMES in enhancing rehabilitation outcomes for fall prevention. Trial Registration ClinicalTrials.gov NCT04969094; https://clinicaltrials.gov/study/NCT04969094 International Registered Report Identifier (IRRID) DERR1-10.2196/68082

Background/Objectives: Long COVID-19 is characterized by persistent symptoms lasting three months or more following SARS-CoV-2 infection. Nutrition has emerged as a modifiable factor influencing recovery trajectories and symptom burden; however, existing evidence remains fragmented across diverse study designs and populations. This scoping review synthesized global evidence on the role of diet and nutrition in managing long COVID-19 symptoms and supporting recovery. Methods: Following PRISMA-ScR and Joanna Briggs Institute guidelines for scoping reviews, we searched major biomedical databases for studies published between 2020 and 2025. Eligible studies examined dietary intake, nutritional status, or nutrition-related interventions in adults with long COVID-19. Results: After duplicates were removed, 1808 records were screened, resulting in 50 studies that met the inclusion criteria—27 intervention studies and 23 observational studies. Nutritional exposures included micronutrients (e.g., vitamins D, K2), amino acids (e.g., L-arginine), multinutrient formulations, microbiota-targeted therapies (e.g., probiotics, synbiotics), nutritional status, diet quality, and whole-diet patterns (e.g., the Mediterranean diet). Approximately 76% of studies reported improvements in long COVID-19-related symptoms such as fatigue, mood disturbances, physical function, and markers of inflammation. Conclusions: Diet and nutrition may support long COVID-19 recovery by targeting inflammation and the gut microbiome to alleviate symptoms and improve functional outcomes. Well-powered trials of whole-diet approaches, combined with targeted supplementation, are needed to confirm their potential as scalable, accessible tools for post-COVID-19 recovery and management.

BACKGROUND:The COVID-19 pandemic has had a profound impact on older adults, particularly those with existing comorbidities. To inform targeted healthcare strategies for this heterogeneous group, this study seeks to analyze and compare mortality trends among various geriatric age groups within the Veterans Affairs healthcare system, both during the COVID-19 era and the pre-COVID era, while accounting for demographic and clinical factors such as age, gender, race, and comorbidities. METHODS:In this retrospective cohort study using Veterans Affairs Informatics and Computing Infrastructure data, two samples were analyzed: Veterans alive during the pre-COVID era (January 2019-December 2019) and during the COVID era (January 2020-December 2020). Propensity score matching was used to control for age, sex, race, body mass index, and comorbidities. RESULTS:The primary outcome was mortality. Odds ratios (ORs) and 95% confidence intervals were calculated to compare mortality across age groups. Unmatched analyses, adjusted for age, sex, race, body mass index, and comorbidities, showed that mortality significantly increased during the COVID era for age groups 70-79 (OR 1.38), 80-89 (OR 1.14), and 90-99 (OR 1.20), all with p values < 0.0001. No significant increase was observed in centenarians (OR 1.10, 95% confidence interval 0.90-1.35, p = .345). Matched analysis confirmed these findings. CONCLUSIONS:In a large cohort of older Veterans, COVID-19 had a significant impact on mortality in older adults aged 70-99, highlighting the need for targeted public health interventions. The lack of significant increase in mortality for centenarians is notable and warrants further study to identify possible protective factors in this unique population.

BackgroundFoot ulcers are a common complication of diabetes, often resulting from peripheral neuropathy and inadvertent trauma. Poor healing is exacerbated by peripheral arterial disease and poor glycemic control. Off-loading, a key treatment, leads to prolonged immobility. Patients rarely regain baseline mobility. Mobility is crucial to improve glycemia, promote vascular health, and improve immobility as it leads to nursing home admissions. There is limited research on exercise during ulcer remission. ObjectiveThis pilot study will assess the feasibility and acceptability of a home-based exercise regimen aimed at safely increasing mobility and function, focusing on improving lower extremity strength, tissue perfusion, and glycemic control. MethodsVeterans aged ≥50 years with a recently healed diabetic plantar foot ulcer receiving care in the US Department of Veterans Affairs (VA) Maryland Health Care System and enrolled in a remote temperature-sensing mat program will be eligible. Potential participants will be identified via administrative codes used for the Prevention of Amputation in Veterans Everywhere directive, as well as using the VA’s Podimetrics SmartMat dashboard. In this pilot study, 25 veterans will be randomized (in a 3:1 ratio) to a 12-week home-based exercise regimen or standard of care. Participants will undergo tests for gait speed, knee extension strength, cutaneous perfusion, and community mobility. The intervention group will participate in internet-based videoconference exercise classes twice a week led by the study team and home cycling 3 times a week. The control group will receive standard-of-care guidance. Outcome measures will include feasibility; acceptability; and changes in gait speed, physical activity levels, and strength. ResultsThis study was funded on July 1, 2024, with data collection planned from October 1, 2024, to March 31, 2026. The protocol was approved by the University of Maryland Institutional Review Board on May 13, 2024, and by the Baltimore VA Research and Development Committee on June 13, 2024. As of June 12, 2025, 12 participants have been enrolled in the study, and 6 (50%) participants have been randomized. Recruitment is expected to continue through December 2025. ConclusionsThis project has potential for clinical rehabilitation translation. If it is found to be feasible and acceptable, the exercise intervention will be tested in a future multisite randomized clinical trial to assess its impact on mobility, cardiovascular events, and ulcer recurrence. Trial RegistrationClinicalTrials.gov NCT06312579; https://clinicaltrials.gov/ct2/show/NCT06312579 International Registered Report Identifier (IRRID)DERR1-10.2196/71237

OBJECTIVE:In the United States, the incidence of hospital-associated venous thromboembolism (VTE) has been found to be higher among Blacks compared with Whites. However, the reason for this difference is not well-understood. Here, we utilize a large, nationwide cohort to evaluate the clinical factors that may contribute to the difference in rates of VTE in Black vs White patients. METHODS:We analyzed consecutive first hospital admissions of Black and White patients to all Veterans Affairs facilities from January 2016 to December 2021. We first compared VTE rates between White and Black patients within 90 days of hospital admission, identified 11 potential confounders for the relationship between race and VTE, and used these to develop a series of adjusted logistic regression models predicting the development of VTE. Odds ratios (ORs) obtained from these models were compared to examine the relationship between race, potential confounding variables, and VTE. RESULTS:The study cohort consisted of 142,456 patients (mean age, 54 years; 84.7% male), of whom 28.5% (n = 40,632) were Black and 71.5% (n = 101,824) were White. Of the cohort, 2.4% developed a VTE within 90 days (n = 3455), and the rate of VTE was higher in Black patients (2.7%) compared with White patients (2.3%; P < .001). A total of 12 models were developed to examine individual confounders of the relationship between race and VTE. In all models, Black race was associated with increased odds of VTE (OR, 1.06-1.17). The strength of this association remained unchanged in the range of OR 1.13 to 1.16 after adjusting for major covariates including social deprivation index, blood type, and surgery type. When adjusting for hemoglobin, the OR for the association between Black race and VTE was reduced. An inverse correlation was observed between Black race and hemoglobin, with Pearson and Spearman correlation coefficients of -0.17 and -0.180, respectively. CONCLUSIONS:In this cohort of hospitalized patients, Black race is a major risk factor for VTE, independent of social deprivation, blood type, and surgery. This effect may be modulated by hemoglobin, suggesting a potential clinical etiology underlying the trends observed between VTE and race.

Objective Intraprocedural atheroembolization during carotid artery stenting (CAS) can be reduced through careful patient selection, consideration of vascular anatomy and lesion characteristics, operator and institutional experience, peri-procedural antithrombotic and antiplatelet therapy, and use of embolic protection. However, CAS can also result in stroke as the stent is deployed and embolic protection withdrawn. The free-cell area of most closed-cell stents is <5 mm2, and ≥5 mm2 for open-cell stents. The larger area may permit escape of more atheromatous debris. Comparisons of clinical outcomes between closed-cell and open-cell stents have been inconclusive. The aim of this study is to compare clinical outcomes associated with CAS using open-cell vs closed-cell stents. Methods The CREST-2-Registry (C2R) enrolls asymptomatic and symptomatic patients for whom CAS is favored because of high risk for surgery or patient preference. C2R implements operator- and site-credentialing, careful lesion selection, and standardized procedural protocols. Patient characteristics, procedural details, and outcomes are recorded. Interventionists may use United States Food and Drug Administration-approved devices including open-cell stents (Rx Acculink [Abbott Vascular], Precise Pro Rx [Cordis-Cardinal Health], and Protégé Rx [Medtronic/Covidien]), or closed-cell stents (XACT [Abbott Vascular] and Wallstent Monorail Endoprosthesis [Boston Scientific]). Multivariable logistic regression was used to assess relate stent cell configuration to peri-procedural (30-day) stroke or death (SD). Results Of 5307 procedures performed by 163 interventionists across 101 clinical centers, 2054 (38.7%) received open-cell stents, and 3253 (61.3%) received closed-cell stents. In the periprocedural period, 91 patients (1.7%) experienced a stroke (3 were fatal), and 16 patients died without experiencing strokes (0.4%). After adjusting for age, sex, symptomatic status, and case urgency, and for effect-modification by indication, periprocedural SD was significantly higher when an open-cell stent was placed in a primary lesion compared with closed-cell stents (3.5 events per 100 procedures using open-cell stents [95% confidence interval [CI], 2.6-4.7] vs 2.2% [95% CI, 1.6-3.0] using closed-cell stents (odds ratio, 1.59; 95% CI, 1.13-2.23; P < .01). Periprocedural SD was not significantly different between stent types when placed in a restenotic lesion (1.2% [95% CI, 0.4-3.3]) using open-cell stents vs 4.0% (95% CI, 2.2-7.2) using closed-cell stents (odds ratio, 0.31; 95% CI, 0.09-1.01; P = .052). Conclusions Stent design influences periprocedural stroke or death in carotid stenting. Closed-cell stents are associated with a lower event rate when treating primary atherosclerosis, but not in the setting of restenosis.

This study aimed to identify predictors of time to first interruption in treatment (IIT) and predictors of ever being interrupted in ART treatment among PLHIV in Nigeria using a national longitudinal dataset that covers all PEPFAR-funded implementing partners to inform national strategies to prevent IIT. This retrospective cohort study used data from Nigeria's National Data Repository (NDR). The NDR is a de-identified longitudinal database of over 1.9 million PLHIV who received ART in Nigeria beginning in 2004 and is owned by the Federal Ministry of Health (FMoH). The NDR contains patient-level demographics, clinic visits, laboratory, and ART prescription and refill data uploaded at least monthly. The data extracted for this study were obtained from electronic medical record systems of 2,226 public facilities offering HIV care in the country. In this study, we investigated the predictors of treatment interruption using data from the national HIV treatment program. We identified sets of predictors of first interruption in treatment using the logistic regression and these to be consistent in predicting time to first interruption including sex, anchor drug in ART regimen, recorded HIV viral load, recorded CD4 cell count, WHO clinical staging, functional status, last measured weight, highest education attained, occupation, marital status, year enrolled in care, pre and post surge, pre and post-COVID and residing in a state capital, Lagos, or the federal capital territory (FCT) (capital city dweller) versus other locations (non capital city dweller). Age grouping was the only variable that was predictive only for time to first interruption but not for having a first interruption. To reduce the risk of IIT it is important to target interventions preemptively. We have highlighted the need for tailored interventions that address the unique needs of PLHIV in Nigeria. Targeted interventions focusing on those with a combination of risk factors could include education, counseling, supportive services, and monitoring and outreach.

Background/Purpose: Studies have demonstrated existing racial and ethnic disparities in multiple aspects of pediatric oncology. The purpose of this study was to examine how racial and ethnic disparities in mortality among pediatric oncology patients have changed over time. We examined mortality by race and ethnicity over time within the Surveillance, Epidemiology, and End Results (SEER) registry. Methods: Patients <20 years-old from 1975 to 2016 (n = 49,861) were selected for the analysis. Demographic characteristics, cancer diagnosis, and mortality data were extracted. Patients were divided by race and ethnicity: 1) non-Latino White, 2) Black, 3) Latino, and 4) Other Race. The interaction between race/ethnicity and decade was evaluated to better understand how disparities in mortality have changed over time. Results: Unadjusted mortality among all cancers improved significantly, with 5-year mortality decreasing from the 1970s to the 2010s (log-rank: p < 0.001) for all race/ethnicity groups. However, improvements in mortality were not equal, with 5-year overall survival (OS) improving from 62.7 % in the 1970s to 87.5 % (Delta = 24.8 %) in the 2010s for White patients but only improving from 59.9 % to 80.8 % (Delta = 20.9 %) for Black patients (p < 0.01). The interaction between Race/Ethnicity and decade demonstrated that the Hazard Ratio (HR) for mortality worsened for Black [HR (95 % Confidence Interval): 1.10 (1.05-1.15) and Latino [1.11 (1.07-1.17)] patients compared to White, non-Latino patients. Conclusion: There has been a dramatic improvement in survival across pediatric oncology patients since 1975. However, the improvement has not been shared equally across racial/ethnic categories, with overall survival worsening over time for racial/ethnic minorities compared to White patients. Level of Evidence: III. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BACKGROUND:The coronavirus disease-2019 (COVID-19) pandemic caused disruptions in cancer screening and diagnosis, including colorectal cancer. Given disparities in cancer and COVID-19 faced by historically disadvantaged minorities, we examined changes in disparities in colorectal cancer screening and diagnosis in the COVID era. PATIENTS AND METHODS:In a cohort study using the Veterans' Affairs Health Care System (VAHCS) from 2018 through 2021, we quantified colonoscopies, fecal occult blood tests (FOBT), and new diagnoses of colorectal cancer (CRC) by month from 1 March 2018 to 31 December 2021. We compared the pre-COVID (before 1 March 2020) to the COVID (1 March 2020 and after) era. We graphed temporal trends by age, sex, race, ethnicity, rural-urban, and socioeconomic status (SES). Logistic regression was used to evaluate temporal trends after adjusting for confounders. RESULTS:During the study period, there were about 900,000 colonoscopies, 1.4 million FOBTs, and > 30,000 new diagnoses of CRC. Colonoscopies and new CRC decreased dramatically during the early COVID era to < 10% and < 60% of pre-COVID rates, respectively. Although we identified a modest increase in disparities of colonoscopy use among Black and Latino patients in the early COVID era, these increased disparities did not persist in adjusted analysis. We did not identify changes in disparities in FOBT use or new CRC diagnoses. CONCLUSIONS:We did not identify increased disparities in CRC screening or diagnoses by age, sex, race, ethnicity, geographic region, or SES in the VAHCS. These results indicate a potential strength of the VAHCS and require further study in additional cancers and healthcare systems.

Objectives:The Numerical Rating Scale is widely used for patient-reported appraisals of pain intensity; however, scale properties have limited utility for assessing chronic pain. Specifically, single pain ratings demonstrate high intraindividual variability. We propose an efficient alternative, termed hurdle analysis, separately analyzing zero and nonzero pain ratings. Methods:This retrospective study of 23,480 US Veterans diagnosed with low back pain (LBP) included 2.1 million unique pain ratings. Marginal distributions comprised of all pain ratings for each individual were parametrized with usual and hurdle analysis methods to holistically assess scale utilization. Results:The population was 87% male and 13% female; 41% Black, 38% White, and 2% Hispanic; modal age range was 65 years to 84 years (45 years-64 years) for men (women). Focusing on statistically informative records, ie, those with ≥100 pain ratings (22% of the total), the median [interquartile range] pain rating was 3.5 [2.3-4.7] (4.0 [3.0-5.1]) for men (women). Marginal distributions were non-normal, with zero being the modal value in 79% (73%) of men (women). In hurdle analysis, the average proportion of zeroes was 0.39 (0.31) for men (women); the average nonzero pain rating was 5.9 [5.1-6.6] (6.0 [5.3-6.7]) for men (women). The nonzero averages, in contrast to standard averages, were normally distributed for the population and compared with data showed less bias and variance. Conclusion:Analysis of clinical pain ratings from Veterans with LBP with hurdle analysis yielded improved estimates of pain when-pain-is-present (ie, nonzero pain) and also demonstrated the variable presence of pain in this population. Further study of this approach appears warranted.