Introduction: More magnesium in drinking water is associated with lower CVD risk, while more lead is associated with higher CVD risk. Rural US residents often rely on private well water, which has more variable concentrations of these substances than municipal water. Our previous work in Alabama demonstrated that more households reliant on private wells was associated with less hypertensive heart and stroke/cerebrovascular disease mortality. Although self-reported Black race is associated with higher CVD mortality, it is not a confounder for private well use, which depends on rurality of residence. However, it is unknown whether self-reported Black race may be an effect modifier for the protective associations with private well use. Hypothesis: In Alabama, the neighborhood-level relationship between high private well use and lower CVD mortality depends on percentage of self-reported Black residents. Methods: We used mortality data for Alabama Census block groups (CBGs) from 2016 to 2019 for 3 types of CVD: hypertensive heart disease, ischemic heart disease, and stroke/cerebrovascular disease. We estimated the rate ratio (RR) and 95% CIs for a 1 SD higher percentage of households reliant on private wells, adjusted for age group (45 - 54, 55 - 64, 65 - 74, and 75+ years) and rurality. We tested for interactions between the percentage of households reliant on private wells and the percentage of residents who reported Black only race on the 2020 Census. A p-value of 0.05 was considered statistically significant. Data were provided by the Alabama Department of Public Health, the EPA, and the US Census. Results: Median (1 st quartile, 3 rd quartile) percentage of households reliant on private wells in a CBG (n = 3,919) was 7% (0%, 38%). The percentage of Black residents was 18% (5%, 48%). The adjusted RRs for a higher percentage of households reliant on private wells differed by percentage of Black residents for hypertensive death and ischemic death. The protective association for higher percentages of households reliant on private wells was more protective in CBGs with higher percentages of Black residents (see Figure 1). Conclusions: The association between more private well use and hypertensive heart and ischemic heart disease mortality depended upon the percentage of Black residents. Further research is needed to understand whether some groundwater quality parameters, such as water hardness, may be more beneficial for Blacks than for Whites.

Alabama has the highest age-adjusted CVD mortality in the US. Despite this, our group showed that lower rates of hypertensive heart disease, ischemic heart disease, and stroke/cerebrovascular deaths were associated with higher percent private well use at the census block group (CGB) scale. The mechanism driving this association is unknown. Dietary nitrate has been associated with cardiovascular health benefits such as vasodilation and a decrease in myocardial infarction. Nitrate is also a common component in private well water. Therefore, we tested the hypothesis that CBGs with high percent private well use will have greater protective associations for CVD when median groundwater nitrate concentration is also high. The outcomes were hypertensive heart disease, ischemic heart disease, and stroke/cerebrovascular deaths from 2016 - 2019 in Alabama for age groups 45 - 54, 55 - 64, 65 - 74, and 75+ aggregated to the CBG scale (n = 3,924). Percent private well use and median nitrate concentration in each CBG were predictor variables in Poisson regression models, with additional adjustment by age group and rurality. We obtained percent private well use from the US Environmental Protection Agency’s domestic well dashboard. The United States Geological Survey (USGS) produced a 1km raster of shallow groundwater nitrate concentrations, and we calculated median nitrate concentration for each Alabama CBG. Results revealed that the protective associations between high percent well use and hypertensive heart disease and stroke/cerebrovascular mortality did not statistically significantly depend on median nitrate concentration. For example, the RR (95% CI) for a higher percentage of well users at the average nitrate level was 0.89 (0.83 to 0.95) for hypertensive heart disease, and the RR at the nitrate level 1 SD higher than the mean was 0.90 (0.85 to 0.95). Our findings may be due to low concentrations of nitrate included in our study (0.03 – 6.20 mg/L nitrate as N across all CBGs) compared to previous clinical studies on the blood pressure lowering effects of nitrates contained in beet root juice (~45 mg/L nitrate as N). In summary, in Alabama groundwater nitrate concentrations are likely not driving the protective association between percent private well use and hypertensive heart disease and stroke/cerebrovascular death in the state of Alabama. Future work will expand the study area to include geographic areas that have larger exposure ranges for nitrate.

Background: Rural populations in the United States face shorter life expectancies and higher cardiovascular mortality compared to urban populations. Understanding how the American Heart Association’s Life’s Essential 8 (LE8) metrics vary across urban and rural populations may assist in designing interventions to address cardiovascular health (CVH) among rural adults. Hypothesis: We hypothesized rural adults would have worse CVH, as measured by LE8, compared to urban and suburban adults. Methods: REGARDS is a national cohort of Black and White adults age 45 and older, enrolled from 2003-7. Data from participants who completed the home visit (2013–2016) and were not missing data on LE8 metrics were used for the present analysis. LE8 metrics were assessed through questionnaires, physical measurements, and lab data. The 2010 Rural-Urban Commuting Area (RUCA-7) codes were used to classify population density. Mean LE8 scores and individual metrics were examined across 7 RUCA classes ( isolated rural, other small rural, small rural core, other large rural, large rural core, other urban, and urban core ), using general linear modeling, adjusting for demographic characteristics, income, and education. Results: A total of 8,162 REGARDS participants were included in the present analysis. The majority resided in Urban Core areas (73.6%). REGARDS participants' distribution across the RUCA class was similar to the US Census data. (Table 1) Adjusting for demographic factors, LE8 scores increased with increasing urbanicity, with Other Small Rural and Isolated Rural areas having the lowest LE8 scores. Modest attenuation was observed after further adjustment for education and income. (Figure 1) No interactions by race or sex were observed. Individual LE8 metrics for diet, blood pressure, and blood glucose demonstrated similar trends across RUCA class, with improved metrics associated with increased urbanicity. Metrics for lipids, sleep, and smoking metrics did not differ by RUCA class. Conclusion: In this large cohort of adults from 48 contiguous US states, higher urbanicity was associated with higher mean LE8 scores, reflecting better CVH. This association with improved CVH was driven by better diet, blood pressure, and blood glucose scores. Understanding population-level differences in CVH across the country will inform the development of interventions to address poor CVH in rural populations.

BACKGROUND:Black, Indigenous, and other People of Color (BIPOC) women faculty are underrepresented in biomedical sciences and higher education. This disparity has been highlighted in previous studies to harm productivity, career progression, and well-being. This pilot study aimed to assess the perceived impact of a longitudinal well-being program for BIPOC women faculty, estimating its effects on well-being, burnout, and self-efficacy. METHODS:Full-time faculty in pharmacy or pharmaceutical science, identifying as BIPOC women, participated in this pilot repeated cross-sectional study of participants in a Well-Being Initiative, with the first cross-sectional study coming before a pilot intervention and the second cross-sectional coming after the pilot intervention. Cohort 1 engaged in a two-year program, while Cohort 2 participated for one year. Open-text questions assessed program impact on well-being, and inductive coding identified themes. Well-being, burnout, and self-efficacy were measured using the General Well-Being Index (WBI), Maslach Areas of Worklife Survey (AWS), 2-items from the Maslach Burnout Index-Human Services Survey (MBI-HSS), and General Self-Efficacy Survey (GSES). Descriptive statistics were calculated for primary and secondary outcomes. RESULTS:Sixteen participated in Cohort 1, and 18 participated in Cohort 2. Both cohorts reported a positive impact on well-being and a sense of community as a result of the program. Post-intervention median WBI decreased, and burnout and well-being risk declined (MBI: 24% and 28% point decrease at risk for burnout, WBI: median score 4 to 3 with 20% decreased risk for poor well-being, and median score 3 to 0.5 with a 61% point decrease at risk for poor well-being, for Cohorts 1 and 2, respectively). The AWS community subscale (Cohort 1) median score increased from 2.67 to 3.5, and values subscale (Cohort 2) median score increased 3.17 to 3.67, the largest increases. Cohort 2 exhibited improved self-efficacy (GSES median score change of 30 to 34). Participants reported the sense of community and connection built over the year(s) of the program, the ability to share of experiences from those further along in their career, having a safe space to be authentic with fellow participants, and the various sessions on creating self-care plans and maintaining core values as top themes of how program most benefited their well-being. Lessons learned and opportunities for improvement are addressed. CONCLUSION:Participants reported many of the key impacts were the program's ability to foster a sense of community and help them develop skills for personal and professional well-being. While higher baseline risks of poor well-being and burnout persist for BIPOC women faculty, positive trends emerged post-intervention. This study contributes to innovative strategies focused on supporting the well-being of BIPOC women faculty and lessons learned may inform and help refine future research. CLINICAL TRIAL NUMBER:Not applicable.

Background: Adequately assessing subclinical cardiovascular disease (CVD) risk is crucial to mitigate CVD globally. A functional and structural measure of subclinical CVD risk, arterial stiffness is commonly measured as pulse wave velocity (PWV). However, PWV is typically estimated using non-invasive devices that use different techniques and body segments for measurement, leading to concerns when comparing PWV from different devices. Two PWV measures that estimate central arterial stiffness include a heart-to-thigh PWV (htPWV) and carotid-femoral PWV (cfPWV). It is essential to determine the agreement between different devices, particularly those used in large population-based cohorts, because these cohort studies are key to understanding subclinical CVD risk factors. Methods: We compared PWV measurements between the VaSera (htPWV) and VICORDER (cfPWV) devices in generally healthy adults (18-84 years) during two separate visits. We recruited 60 participants, of which 58 had PWV data for both devices. At each visit, three measurements were taken with the VaSera at a supine posture and three at 25 degrees for the VICORDER. The closest two observations were averaged for each device, and average observations from both visits were used for analysis. Agreement was assessed via the intraclass correlation coefficient (ICC) from a two-level mixed effects model adjusted for visit, side, and device, and Bland-Altman plots. Results: The ICC between the VaSera and VICORDER was 0.83 [95% confidence interval: 0.76, 0.89]. On average, VaSera values were 2.27 [-4.17, -0.36] m/s lower than VICORDER values. Conclusion: There was good agreement between measures of PWV on the VaSera and VICORDER devices. However, VaSera measurements were consistently lower than VICORDER values. The good agreement between devices suggests that each devices is accurately classifying high vs. low arterial stiffness, but the large differences in values between devices suggests PWV measured by the devices would not be interchangeable/comparable.

Introduction: Cardiovascular disease (CVD) is the leading cause of mortality for women. Timely diagnosis of hypertension after a hypertensive disorder of pregnancy (HDP) provides an opportunity for CVD prevention. We assessed the association between blood pressure (BP) 15-90 days postpartum and incident hypertension after an HDP. Methods: This was a retrospective cohort study of women with an HDP between January 2014 and December 2017 at two health systems in the southeastern U.S. Cox proportional hazards models assessed the association of postpartum BP and incident hypertension 12 months postpartum. Covariates included type of HDP, gestational age at diagnosis, timing of measurement, comorbidities, and structural determinants of health. We excluded people with preexisting hypertension and without a BP measurement 15-90 days postpartum. Results: Out of 5657 women, only 2514 (44%) met the inclusion criteria as almost 40% (2125) did not have a BP check at 15-90 days postpartum. The hazards of incident hypertension were significantly higher for those with elevated systolic postpartum BP (1.70, 95% CI: 1.37 - 2.12) and more severe HDPs. The estimated cumulative incidence of hypertension among participants with postpartum BP of 110/65 mmHg was 4.7% (CI, 2.0% - 7.4%) and for those with BP 140/90, it was 13.0% (CI 5.6% - 19.8%). Conclusions: The risk of incident hypertension after an HDP is high in the first year postpartum. Despite this, for many participants, BP was not even measured within 15-90 days postpartum despite. Opportunities exist to improve care for individuals with HDPs. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UM1TR004406. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The IRBs from Duke University, University of North Carolina, and Auburn University approved this study with Duke University IRB being the primary. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data can be made available upon requests to the authors.

BACKGROUND:Timely diagnosis of hypertension provides an opportunity for cardiovascular disease prevention after a hypertensive disorder of pregnancy. We assessed the association between blood pressure 15 to 90 days postpartum and incident hypertension after a hypertensive disorder of pregnancy. METHODS:This was a retrospective cohort study of women with no preexisting hypertension and a hypertensive disorder of pregnancy between January 2014 and December 2017 at 2 health systems in the southeastern United States. Cox proportional hazards models assessed the association of postpartum blood pressure and incident hypertension over a median follow-up period of 9.9 months. Covariates selected via directed acyclic graph construction included type of hypertensive disorder, race, ethnicity, maternal age, smoking, body mass index, and gestational diabetes. RESULTS:Out of 5657 women, only 2520 (45%) met the inclusion criteria; 39% (1584) of otherwise eligible individuals did not have a blood pressure check at 15 to 90 days postpartum. The hazards of incident hypertension during follow-up were significantly higher for those with higher systolic postpartum blood pressure (1.81 [95% CI, 1.46-2.24]). The estimated cumulative incidence of hypertension over the first 12 months of follow-up among participants with a blood pressure of 110/65 mm Hg was 4.5% (95% CI, 2.8%-6.1%), and with blood pressure 140/90, it was 12.0% (95% CI, 8.4%-17.2%). CONCLUSIONS:The risk of incident hypertension after a hypertensive disorder of pregnancy is high in the first year postpartum especially for those with elevated systolic blood pressure postpartum. Despite this, for many participants, blood pressure was not measured within 15 to 90 days postpartum.

In longitudinal studies, the devices used to measure exposures can change from visit to visit. Calibration studies, wherein a subset of participants is measured using both devices at follow-up, may be used to assess between-device differences (ie, errors). Then, statistical methods are needed to adjust for between-device differences and the missing measurement data that often appear in calibration studies. Regression calibration and multiple imputation are two possible methods. We compared both methods in linear regression with a simulation study, considering various real-world scenarios for a longitudinal study of pulse wave velocity. Regression calibration and multiple imputation were both essentially unbiased, but correctly estimating the standard errors posed challenges. Multiple imputation with predicted mean matching produced close agreement with the empirical standard error. Fully stochastic multiple imputation underestimated the standard error by up to 50%, and regression calibration with bootstrapped standard errors performed slightly better than fully stochastic multiple imputation. Regression calibration was slightly more efficient than either multiple imputation method. The results suggest use of multiple imputation with predictive mean matching over fully stochastic imputation or regression calibration in longitudinal studies where a new device at follow-up might be error-prone compared to the device used at baseline.

BACKGROUND:Hypertension in preterm infants can result in life-threatening outcomes. However, there is limited evidence to guide the pharmacologic management of hypertension in preterm infants. Without population-level studies of the pharmacologic strategies that clinicians currently employ for hypertension in preterm infants, studies investigating the benefits and risks of these strategies cannot be performed. METHODS:A retrospective, cross-sectional study was conducted at a single academic medical centerto determine the most prevalent antihypertensive medication used for first-line, second-line, and adjunctive pharmacologic management among preterm infants with hypertension. The study sample included patients with a postnatal age less than 1 year at hospital discharge, gestational age at birth less than 37 weeks, and treated with an antihypertensive medication between July 2010 and December 2022. The prevalence of each antihypertensive medication used for each stage of pharmacologic management was estimated, and prevalences were compared using prevalence ratios. Bayesian multinomial regression was used to estimate prevalence ratios and 95% credible intervals (CIs). RESULTS:Out of 751 possibly eligible patient encounters obtained, 134 encounters were identified across 120 patients that met the inclusion criteria. Second-line and adjunctive pharmacologic management were used in 6 and 12 encounters, respectively. Propranolol had the highest prevalence for each stage of pharmacologic management: 61% for first-line (95% CI: 53-69%); 40% for second-line (95% CI: 14-70%); and 47% for adjunctive pharmacologic management (95% CI: 24-72%). As a first-line pharmacologic management, propranolol was 4.8 times (95% CI: 2.9-7.7) as prevalent as the second most prevalent medication (captopril). CONCLUSION:In a large academic hospital, propranolol was the most commonly used medication for first-line antihypertensive pharmacologic management among preterm infants. The most prevalent medication used for second-line and adjunctive pharmacologic management was inconclusive.

Background: Among preterm infants (< 12 months postnatal age and born < 37 weeks gestation), oscillometric systolic blood pressure (SBP) measurements are error-prone. However, some preterm infants have “gold standard” SBPs measured using an arterial line, in addition to the error-prone oscillometric SBPs. Objective: To compare different statistical methods to calibrate oscillometric SBPs to mimic arterial line SBPs Methods: We sampled participants from an existing pilot study of preterm infants treated with an antihypertensive therapy at the University of Alabama at Birmingham. Participants' data was obtained from the hospital's data warehouse for electronic medical records. Participants for this analysis had at least one arterial line SBP measurement, and for each of these "gold standard" measurements we identified the closest paired oscillometric SBP measurement (<10 minutes apart). We also collected participant factors such as race (white vs. black/African American), gender, gestational age at birth (weeks), postnatal age at arterial line SBP measurement (weeks), and whether the participant had received an antihypertensive medication. We predicted the arterial line SBPs from oscillometric SBPs and covariates using linear regression, linear regression with restricted cubic splines, random forest, and Bayesian additive regression trees (BART). Prediction errors were calculated using 10-fold cross-validation. We used complete case analysis. Results: We identified 822 measurements among 28 participants. Ten of 28 (36%) participants were black and 13 of 28 (46%) were female. The median (Q1, Q3) gestational age at birth was 33 (29, 35) weeks. The root mean squared error for predicting arterial line SBP from oscillometric SBP by itself was 17.1 mmHg. The root mean squared error of the predicted arterial line SPBs from different statistical methods varied little from the most error (linear regression with restricted cubic splines: 13.5 mmHg) to the least error (BART: 12.6 mmHg), meaning that any calibration resulted in at least a 21% reduction in error compared to the oscillometric SBPs. BART tended to underpredict the arterial line SBPs that were above 100 mmHg. Conclusions: Among preterm infants, statistical calibration is a viable strategy for reducing the variability of error-prone oscillometric SBPs. The different statistical models performed similarly in this small pilot study, but a larger sample size using additional important variables (e.g., birth weight) is required to confirm this finding.

The study aimed to evaluate how maternal pre-pregnant body mass index (BMI) impacts participant recruitment and retention. Participants were enrolled in a longitudinal study between 30 and 36 weeks of pregnancy as having normal weight (pre-pregnant BMI ≥ 18.5 and <25 kg/m2) or obesity (pre-pregnant BMI ≥ 30.0 kg/m2). Recruitment channels included Facebook, email, newspaper, phone calls, radio advertisements, flyers, and word-of-mouth. The stages of recruitment included eligibility, consent, and completion. Pearson’s chi-square tests were used to evaluate the relationship between BMI and enrollment outcomes. Recruitment yielded 2770 total prospective participants. After screening, 141 individuals were eligible, 83 consented, and 60 completed the study. Facebook was the most successful method for identifying eligible pregnant patients with obesity, while a higher percentage of participants recruited through word-of-mouth and flyers consented to the study. Pre-pregnant BMI was significantly associated with the stage of recruitment completed by the participant (p = 0.04), whereby individuals eligible for the study with obesity were less likely to consent and complete study visits. We demonstrated that maternal obesity was significantly associated with enrollment outcomes in a longitudinal birth cohort study. This study showed that pre-pregnancy BMI influenced study participation. Therefore, tailored recruitment strategies to enhance the recruitment and enrollment of individuals with obesity in maternal-infant health research may be necessary.

Introduction: Racial discrimination is a chronic stressor that may contribute to cardiovascular disease (CVD) disparities in non-Hispanic Black (NHB) adults. Compared to non-Hispanic White adults, NHB adults experience greater perceived discrimination (PD), chronic perceived stress (PS), and burden of CVD risk. However, associations between PD, PS, and CVD risk, measured as arterial stiffness (AS), have not been tested in a population-based study of NHB adults in the US, limiting our understanding of whether and how CVD prevention initiatives should target PD and PS. Purpose: Determine the association between PD and AS, and whether this association is modified by biological sex and mediated by PS. Hypothesis: We hypothesized a direct association between PD and AS and that associations will be stronger in females and mediated by PS. Methods: Study sample included 594 NHB adults with complete data who participated in the Jackson Heart (JHS) and Atherosclerosis Risk in Communities (ARIC) studies’ shared cohort. PD (lifetime, everyday, and burden of lifetime discrimination) and PS were measured at JHS baseline (2000-2004). AS was measured at ARIC Visit 5 (2011-2013). PD and PS were coded as continuous variables. Effect modification was evaluated by including an interaction term between sex and PD in fully adjusted models. Mediation was assessed via the natural indirect effects from the CAUSALmed procedure. Models were adjusted for age, sex, body mass index (BMI), blood pressure medication, diabetes status, and mean arterial pressure (MAP). Results: Participants had a mean [95% confidence interval (95%CI)] age of 64.7 [64.3, 65.1] years, BMI of 30.1 [29.7, 30.6] kg/m 2 ; 69% (410 of 594) were female, 24% (143 of 594) had diabetes, and 70% (416 of 594) had hypertension. Mean [95%CI] total scores for everyday, lifetime, and burden of lifetime PD were 1.96 [1.89, 2.03], 2.97 [2.81, 3.14], and 2.28 [2.21, 2.34], respectively. Mean [95%CI] AS, measured as pulse wave velocity, was 12.42 [12.15, 12.70] m/s. A 1-unit increase in lifetime PD score was associated with a decrease in AS ( β =- 0.30 [-0.57, -0.02] m/s ). The association remained after adjusting for demographics and clinical characteristics ( β= -0.29 [-0.55, 0.02] m/s ), but was no longer statistically significant when including MAP ( β= -0.21 [-0.46, 0.05] m/s ). There were non-significant associations between everyday PD and burden of lifetime PD and AS. There was no evidence of effect modification by sex or mediation by PS. Conclusion: Higher lifetime PD, but not everyday PD or burden of lifetime PD, was associated with lower AS in crude models. However, the association was attenuated to non-significance when adjusted for MAP, suggesting the association between PD and AS may be pressure-dependent. Future studies characterizing PD’s role in CVD risk development in other geographical regions and NHB populations.

Background: NAFLD is highly prevalent with limited treatment options. Bile acids (BAs) increase in the systemic circulation and liver during NAFLD progression. Changes in plasma membrane localization and zonal distribution of BA transporters can influence transport function and BA homeostasis. However, a thorough characterization of how NAFLD influences these factors is currently lacking. This study aimed to evaluate the impact of NAFLD and the accompanying histologic features on the functional capacity of key hepatocyte BA transporters across zonal regions in human liver biopsies. Methods: A novel machine learning image classification approach was used to quantify relative zonal abundance and plasma membrane localization of BA transporters (bile salt export pump [BSEP], sodium-taurocholate cotransporting polypeptide, organic anion transporting polypeptide [OATP] 1B1 and OATP1B3) in non-diseased (n = 10), NAFL (n = 9), and NASH (n = 11) liver biopsies. Based on these data, membrane-localized zonal abundance (MZA) measures were developed to estimate transporter functional capacity. Results: NAFLD diagnosis and histologic scoring were associated with changes in transporter membrane localization and zonation. Increased periportal BSEP MZA (mean proportional difference compared to non-diseased liver of 0.090) and decreased pericentral BSEP MZA (−0.065) were observed with NASH and also in biopsies with higher histologic scores. Compared to Non-diseased Liver, periportal OATP1B3 MZA was increased in NAFL (0.041) and NASH (0.047). Grade 2 steatosis (mean proportional difference of 0.043 when compared to grade 0) and grade 1 lobular inflammation (0.043) were associated with increased periportal OATP1B3 MZA . Conclusions: These findings provide novel mechanistic insight into specific transporter alterations that impact BA homeostasis in NAFLD. Changes in BSEP MZA likely contribute to altered BA disposition and pericentral microcholestasis previously reported in some patients with NAFLD. BSEP MZA assessment could inform future development and optimization of NASH-related pharmacotherapies.

The COVID-19 pandemic directly impacted well-being and healthcare delivery, but its indirect effects on health services utilization among pregnant women and new mothers remain less understood. Understanding how big events like pandemics impact health behaviors is essential for anticipating healthcare needs during future crises. This study examined how the perceived COVID-19 threat influenced health concerns and service utilization among 378 participants who were either pregnant or mothers of infants less than 12 months old, 18 years or older, and lived within a 50-mile radius of healthcare sites in the OneFlorida+ Clinical Research Consortium. An online Qualtrics survey assessed COVID-19 threat perception, distress related to health and resource concerns (e.g., access to medicine, baby supplies, mental and general healthcare, and social interactions), and changes to health service utilizations (e.g., induction schedule, hospital/birthing center choices, prenatal provider, and visit frequency) during the pandemic. Participants who perceived COVID-19 as a significant threat were more likely to report concerns about reduced access to general healthcare (p = 0.043). Pregnant participants, compared to mothers with infants under 12 months of age, expressed greater concern about reduced access to mental healthcare (p = 0.015). Additionally, the perceived COVID-19 threat was linked to changes in prenatal care providers and labor induction schedules (p < 0.001). These findings highlight the importance of integrating the perceived threat of pandemics or other major events into mental health screenings. Healthcare providers should proactively address potential changes in patient behavior during major events in anticipation of future crises.

Background Hypertensive disorders of pregnancy (HDP), including gestational hypertension, preeclampsia, and eclampsia, are risk factors for cardiovascular (CV) disease. Guidelines recommend that women with HDP be screened for the development of hypertension (HTN) within 6-12 months postpartum. However, the extent to which this early blood pressure (BP) screening is being performed and the impact on detection of CV risk factors is unknown. Methods Women with HDP and without pre-existing hypertension (HTN) who had at least 6 months of clinical follow-up were categorized by postpartum BP screening status: early BP screen (6-12 months after delivery) or late BP screen ( >= 12 months after delivery). Multivariable logistic regression identified factors associated with early screening. Multivariable Cox proportional hazards modeling examined the association between early screening and detection of incident CV risk factors: HTN, prediabetes, diabetes mellitus type 2, or hyperlipidemia. Results Among 4194 women with HDP, 1172 (28%) received early BP screening. Older age, pre-existing hyperlipidemia, diabetes, sickle cell disease, hypothyroidism, gestational diabetes, and delivery during or after 2014 were independently associated with early BP screening, whereas Hispanic ethnicity was associated with late BP screening. Early BP screening was most commonly performed at a primary care visit. After a median follow-up of 3.7 years, 1012 (24%) women had at least 1 new risk factor detected. Even after adjustment for baseline risk, women receiving early BP screening had a significantly higher rate of incident CV risk factor detection than women receiving late BP screening (56% vs 28%; adj. HR 2.70, 95%CI: 2.33-3.23, P < .001). Conclusions Early postpartum BP screening was performed in a minority of women with HDP, but was associated with greater detection of CV risk factors. More intensive postpartum CV screening and targeted interventions are needed to optimize CV health in this high -risk population of women with HDP. (Am Heart J 2024;273:130-139.)

IntroductionThe treatment of cancer is associated with high risk for toxicity and high cost. Strategies to enhance the value, quality, and safety of cancer care are often managed independently of one another. Oncology stewardship is a potential framework to unify these efforts and enhance outcomes. This landscape survey establishes baseline information on oncology stewardship in the United States.MethodsThe Hematology/Oncology Pharmacy Association (HOPA) distributed a 38-item survey composed of demographic, institutional, clinical decision-making, support staff, metrics, and technology sections to 675 HOPA members between 9 September 2022 and 9 October 2022.ResultsMost organizations (78%) have adopted general pharmacy stewardship practices; however, only 31% reported having established a formalized oncology stewardship team. More than 70% of respondents reported implementation of biosimilars, formulary management, and dose rounding as oncology stewardship initiatives in both inpatient and outpatient settings. Frequently cited barriers to oncology stewardship included lack of clinical pharmacist availability (74%), lack of oncology stewardship training (62%), lack of physician/provider buy-in (32%), and lack of cost-saving metrics (33%). Only 6.6% of survey respondents reported their organization had defined "value in oncology." Lack of a formalized stewardship program was most often cited (77%) as the rationale for not defining value.ConclusionsLess than one-third of respondents have established oncology stewardship programs; however, most are providing oncology stewardship practices. This manuscript serves as a call to action for stakeholders to work together to formalize oncology stewardship programs that optimize value, quality, and safety for patients with cancer.