BACKGROUND:Social determinants of health (SDOH) influence access to nutrition, healthcare, and living conditions and may contribute to pediatric anemia. Anemia in children is particularly concerning because delayed identification can lead to developmental and long-term health consequences. Despite their potential impact, SDOH are not explicitly recognized as risk factors in current AAP anemia screening guidelines. Identifying whether SDOH predict anemia risk may facilitate earlier detection and treatment. OBJECTIVE:To determine whether specific SDOH domains predict an increased risk of anemia in pediatric patients in primary care settings. METHODS:Pediatric patients (<18 years) presenting for routine or acute primary care visits and their caregivers were recruited. Caregivers completed a validated SDOH screener, and tcHgb measurements were obtained. A retrospective chart review provided demographic and clinical data. Associations between tcHgb and numeric variables were assessed using Spearman correlations; categorical variables were analyzed with Kruskal-Wallis or Wilcoxon rank sum tests. Regression analysis evaluated tcHgb as the outcome with SDOH risk as the predictor, adjusting for age, sex, race, and insurance type. Analyses were conducted using SAS v9.4. RESULTS:Among 248 families, 186 children (75%) had at least one identified social need. The most common were financial strain (31.85%), food insecurity (25.00%), cognitive disabilities (21.77%), language and literacy barriers (21.05%), and mental health concerns (18.11%). Mean (SD) tcHgb was 12.7 (1.2) g/dL, with a median of 2.0 [0.5, 3.0] positive SDOH domains when present. TcHgb was not associated with age, BMI, or sex but differed by insurance type. Each additional SDOH concern was associated with a 0.29 g/dL decrease in tcHgb (p < .0001). CONCLUSION:SDOH risk factors are significantly associated with lower hemoglobin levels in pediatric patients, with cumulative social needs conferring increased anemia risk. Incorporating SDOH screening into pediatric primary care may improve early identification and outcomes for children at risk of anemia.

Introduction: Subjective social status (SSS), which describes one's perceived hierarchical rank, may provide a more accurate prediction of health than traditional socioeconomic measures. The specific relationship between SSS and breastfeeding outcomes is understudied. Our objectives were to: (1) investigate factors associated with SSS, (2) assess the relationship between prenatal SSS and any or exclusive breastfeeding at 3 and 6 months, and (3) evaluate the relationship between prenatal SSS and breastfeeding duration. Methods: Overall, 2,870 participants from the Canadian Healthy Infant Longitudinal Development birth cohort data were included. Prenatal SSS was self-ranked at 18 weeks' gestation using the MacArthur Scale and categorized as low (1-5), moderate (6-7), and high (8-10) SSS. Any and exclusive breastfeeding were categorized at 3 and 6 months postpartum, along with breastfeeding duration. Multivariable logistics and linear regression were conducted. Results: After adjusting for race, education, income, marital status, employment, and parity, the odds of exclusive breastfeeding at 3 months were 1.51 times higher [95% confidence interval (CI): 1.18, 1.94] in the high SSS group than in the low SSS group. The likelihood of any breastfeeding at 6 months was 1.45 times higher [95% CI: 1.10, 1.92] in the moderate SSS group than the low SSS group. Women with high SSS breastfed for approximately 42 days longer than women with low SSS. Conclusion: SSS was associated with exclusive breastfeeding at 3 months, any breastfeeding at 6 months, and breastfeeding duration. SSS may offer a more patient-centered indicator of health, informing targeted interventions for individuals at risk of suboptimal breastfeeding outcomes.

Early access to health care is essential to avert morbidity and mortality. A telemedicine and medication delivery service (TMDS) is an innovative solution to address this need; however, pathways to scalability are unclear. We sought to evaluate a scalable pediatric TMDS. A TMDS in Haiti was configured for scalability by triaging severe cases to hospital-level care, nonsevere cases with higher clinical uncertainty to in-person examinations at households, and nonsevere cases with low clinical uncertainty to medication delivery alone. This design was evaluated in a prospective cohort study conducted among pediatric patients 10 years old or younger. Clinical and operational metrics were compared with a formative reference study in which all nonsevere patients received an in-person examination. The primary outcomes were rates of clinical improvement/recovery and in-person care seeking at 10 days. In total, 1,043 cases were enrolled in the scalable TMDS mode, and 19% (190) of nonsevere cases received an in-person examination; 382 cases were enrolled in the reference study, and 94% (338) of nonsevere cases received an in-person examination. At 10 days, rates of improvement were similar for the scalable and reference modes. Rates of participants who sought follow-up care were 15% in the scalable mode and 24% in the reference mode. In the context of a 5-fold reduction of in-person examinations, participants in the scalable mode had noninferior rates of improvement at 10 days. These findings highlight an innovative and now scalable solution to improve early access to health care without compromising safety.

Background: Artificially sweetened beverages (ASBs) are commonly recommended as a substitute for sugar-sweetened beverages (SSBs) in dietary counseling. Childhood obesity, associated with comorbidities like type 2 diabetes (T2D), has risen alongside increased consumption of both SSBs and ASBs. Metformin, a common treatment for pediatric T2D, affects GDF-15, a hormone involved in weight regulation. This pilot study examines the impact of ASBs on the therapeutic effects of metformin in pediatric patients with obesity and prediabetes, focusing on growth differentiation factor 15 (GDF-15) as a potential mediator. Methods: Forty-six children aged 10-21 years were randomized into two groups: one consuming non-sweetened beverages (USB) and the other consuming ASBs during a 12-week metformin intervention. Results: While the USB group showed a greater decrease in the point estimate for mean BMI (-0.55 +/- 1.49 USB vs. -0.23 +/- 1.60 ASB) and an increase in the point estimate for mean GDF-15 (33.40 +/- 58.34 in USB vs. 19.77 +/- 85.87 in ASB), these differences were not statistically significant (p = 0.6). As a hypothesis-generating exercise, change in insulin resistance was explored. While again lacking statistical power, we observed that more participants in the USB group showed improvements in insulin resistance. Conclusions: Additional studies are needed to fully elucidate the impact of non-nutritive sweeteners on metabolic health and treatment outcomes in pediatric obesity.

Background: Human papillomavirus (HPV) vaccination is crucial for preventing HPV-related cancers, yet vaccination rates remain suboptimal, particularly in Florida. Social influence, including family and peer support, may shape parental decisions to vaccinate their children. In this study, we examined the role of social networks (online and offline) in parental intention to vaccinate their 11- to 12-year-old children against HPV. Methods: We conducted a cross-sectional survey among 746 parents in Florida as part of the Text & Talk trial (2022–2023). Among other questions, parents reported on their intention to vaccinate, perceived social norms, and support received from up to three reported confidants. We performed logistic regression and multivariable analyses to assess the relationship between network support, social norms, and vaccination intent. Results: Seventy percent of parents intended to vaccinate their children. Greater support from the first reported confidant was significantly associated with higher vaccination intention (OR = 1.30, p < 0.0001). Perceived norms among friends (p = 0.01) and higher overall network support (p < 0.0001) were also predictive of intent. The higher the percentage of reported family members, the higher the support received for the vaccine (p = 0.04). Conclusions: Social support, particularly from close confidants and peers, plays a critical role in shaping parental HPV vaccination decisions while accounting for perceived social norms. Public health interventions can leverage peer networks alongside family support to enhance HPV vaccine uptake.

Background and Aims: Biases in healthcare pose challenges for inflammatory bowel disease (IBD) patients from underrepresented races and ethnicities. Our study aimed to assess the quality of and access to care among underrepresented racial and ethnic populations using a diverse database. Methods: We used the OneFlorida Data Trust, representing over half of Florida's population. We performed a retrospective study from 2012 to 2020. Advanced IBD therapies included a prescription of at least 1 biologic agent or tofacitinib. Disease activity markers included C-reactive protein (CRP), hemoglobin (Hgb), albumin, and white blood cell (WBC). Regression analyses compared the rates of medication use, healthcare utilization, and disease severity by race and ethnicity. Geographic distribution of advanced IBD therapy was analyzed at the county level. Results: Our study included 10 578 patients. Hispanic patients utilized more biologics than non-Hispanic White (NHW) patients (odds ratio [OR]: 1.3, P < .0001). Non-Hispanic Black patients utilized more steroids than NHW (OR: 1.2, P = .0004). Hispanics had fewer visits to emergency departments (EDs) and fewer admissions compared with NHW (OR: 0.7 and 0.6, respectively; P < .0001). Non-Hispanic Black patients visited ED more frequently than NHW patients (OR: 1.3, P < .0001). Hispanics had lower disease activity markers than NHW based on CRP (OR: 0.5, P = .005), Hgb (OR: 0.4, P < .0001), albumin (OR: 0.7, P < .0001), and WBC (OR: 0.5, P < .0001). Geographic distribution of advanced IBD therapy showed clustered areas in southern and northern Florida. Conclusions: Our data show an improved access to care pattern in Hispanic patients. However, disparities still exist, and this is evident in the healthcare utilization trends observed among non-Hispanic Black patients.

Objective To develop and evaluate a guideline for a paediatric telemedicine and medication delivery service (TMDS).Methods A clinical guideline for paediatric telemedicine was derived from the World Health (WHO) Organization Integrated Management of Childhood Illness (IMCI) Handbook. The guideline was deployed at a TMDS in Haiti and evaluated through a prospective cohort study; children ≤10 years were enrolled. For non-severe cases, paired virtual and in-person examinations were conducted at the call centre and household; severe cases were referred to the hospital. The performance of virtual examination components were evaluated by comparison with the paired in-person examination findings (reference).Results A total of 391 cases were enrolled. Among the 320 cases with paired examinations, no general WHO danger signs were identified during in-person examinations; 5 cases (2%) required hospital referral due to problem-specific danger signs or other reasons for escalation. Cohen’s kappa for the virtual designation of mild cases was 0.78 (95% CI: 0.69 to 0.87). The sensitivity and specificity of a virtually reported fever were 91% (95% CI: 87% to 96%) and 69% (95% CI: 62% to 76%), respectively; the sensitivity and specificity of virtually reported ‘fast breathing’ were 47% (95% CI: 21% to 72%) and 89% (95% CI: 85% to 94%), respectively. Kappa for ‘no’ and ‘some’ dehydration indicated moderate congruence between virtual and in-person examinations (0.69; 95% CI: 0.41 to 0.98). At 10 days, 273 (95%) of the 287 cases reached by phone were better/recovered.Conclusion Critical components of the virtual examination (triage, danger signs and dehydration assessment) performed well despite varied performance among the problem-specific components. The study and associated resources represents formative steps towards an evidence-based paediatric telemedicine guideline built on WHO clinical principles. In-person examinations for select cases were important to address limitations with virtual examinations and identify cases for escalation.Trial registration number NCT03943654.

The ADA recommends to screen for NASH and liver fibrosis individuals with type 2 diabetes (T2DM), obesity (OB) and/or elevated alanine aminotransferase (ALT). However, recent studies have questioned the clinical value of measuring ALT and AST for the detection of patients at risk of nonalcoholic fatty liver disease (NAFLD) or advanced liver fibrosis or cirrhosis. The aim of this study was to assess the clinical value of ALT and AST ≥40 IU/L, or their lower cut-offs ≥30 IU/L as recommended by recent AACE guidelines, to screen populations at risk. To this end, we recruited 714 participants (age: 56 ± 11 years, male: 42%; BMI: 30.8 ± 6.5 kg/m2; T2DM: 35%; A1c: 6.0 ± 1.2%) from primary care or endocrinology clinics, unaware of having NAFLD/fibrosis. Screening for NAFLD included laboratory tests and imaging with elastography (steatosis by controlled attenuation parameter [CAP]; fibrosis by liver stiffness measurement [LSM]). Elevated transaminases were more common in patients with vs. without T2DM, with ALT ≥40 IU/L occurring in 13% vs. 8% and AST in 9% vs. 3% of patients (both p<0.05). If using a cutoff of ≥30 IU/L: 25% vs. 18% and 20% vs. 13%; respectively (both p<0.05). Elevated ALT ≥30 IU/L was the highest in patients with T2DM and OB (n=164) vs. controls (without T2DM or OB; n=269; 27% vs 15%; p=0.02). The sensitivity for diagnosing steatosis by ALT or AST was very low, with ALT and AST ≥40 IU/L present in only 16% and 9%, respectively. However, steatosis by imaging (CAP) was often present if ALT or AST were high (81 and 90%, respectively). An ALT ≥40 IU/L was also not useful for diagnosing patients with fibrosis of any stage (LSM ≥7.0), missing the diagnosis in 63% of patients, and this did not improve when examining only those with more advanced fibrosis (≥F3) being elevated in only 40%. Conclusions: Plasma aminotransferases are of limited diagnostic value when screening patients with T2DM for NAFLD or fibrosis. This supports the ADA recent guidelines for using FIB-4 and additional noninvasive testing for screening. Disclosure A. Ortiz Rocha: None. E. Godinez Leiva: None. S. Kalavalapalli: None. R. Lomonaco: None. S.S. Shetty: None. S.A. Marangi: None. E. Valdez Saenz: None. S. Shrestha: None. M.A. Gonzalez: None. X. Chi: None. M.J. Gurka: None. D. Barb: None. K. Cusi: Research Support; Echosens, Inventiva. Consultant; Poxel SA. Research Support; LabCorp, Zydus. Consultant; Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns. Funding National Institutes of Health (R01120331-01A1)

ABSTRACT Objective Despite the emergence of telemedicine as an important model for healthcare delivery, there is a lack of evidence-based telemedicine guidelines, especially for resource-limited settings. We sought to develop and evaluate a guideline for a pediatric telemedicine and medication delivery service (TMDS). Methods A prospective cohort study was conducted at a TMDS in Haiti; children ≤10 years were enrolled. Among non-severe cases, paired virtual and in-person exams were conducted at the call center and household; severe cases were referred to the hospital. The primary outcome was the performance of the virtual exam compared to the in-person exam (reference standard). Findings A total of 391 cases were enrolled. Among 320 cases with paired exams, no general World Health Organization (WHO) danger signs were identified at the household; problem-specific danger signs were identified in 6 cases (2%). Cohen’s kappa for the designation of mild cases was 0.78 (95%CI 0.69-0.87). Among components of the virtual exam, the sensitivity and specificity of a reported fever were 91% (87%-96%) and 69% (62%-74%), respectively; the sensitivity and specificity of ‘fast breathing’ were 47% (21%-72%) and 89% (85%-94%), respectively. Kappa for dehydration assessments indicated moderate congruence (0.69; 95%CI 0.41-0.98). At 10 days, 95% (273) of the 287 cases reached were better/recovered. Conclusion This study, and resulting guideline, represents a formative step towards an evidence-based pediatric telemedicine guideline built on WHO clinical principles. In-person exams for select cases were important to address limitations with virtual exams and identify cases for escalation.

Diabetes is a strong predictor of worse outcomes in nonalcoholic fatty liver disease (NAFLD), such as cirrhosis, CVD, and overall mortality. However, its true prevalence in clinical practice, and the role of obesity contributing to fibrosis, remain unclear. To this end, we recruited 759 patients without known NAFLD (35% with T2DM; age: 56 ± 11 years; BMI: 30.8 ± 6.5 kg/m2; female 59 %; ethnicity: Caucasian 75%, AA 14%, other 11%) attending outpatient endocrine/primary care clinics. We measured: 1) Routine laboratories; 2) Liver fat (CAP score ≥ 274 dB/m) and fibrosis (liver stiffness measurement or LSM) by elastography. The prevalence of NAFLD in T2DM was 68% vs. 44% in those without T2DM (p<0.05). Comparing patients with vs. without T2DM, the presence of any liver fibrosis (LSM ≥7 kPa or F≥1) was 20% vs. 6%, of clinically significant fibrosis (LSM ≥8 kPa [moderate-to-severe] = F≥2) was 12% vs. 4%, and advanced fibrosis (LSM ≥ 9.7 kPa = F3/F4) was 7% vs. 1%, respectively (all p<0.05). Obesity in T2DM promoted a much higher prevalence of steatosis (80% vs. 47% in T2DM without obesity) and of moderate-to-severe fibrosis (17% vs. 3%, respectively, both p<0.05). In people without T2DM, obesity also played a major role regarding steatosis (obese: 66 % vs. non-obese: 28%) and moderate-to-severe fibrosis (F≥2: 8% vs. 1%, respectively; both p<0.05). Worse glycemic control in people with T2DM (A1c ≥7.0% vs. <7.0%) led to a higher prevalence of steatosis (75% vs. 62%) and of fibrosis (24% vs 18%; both p<0.05). In multiple regression analysis, with a 95% CI, obesity in T2DM was the most significant risk factor for steatosis (OR 2.8, 1.9-4.2) and fibrosis (OR 3.4, 2.1-5.3). Conclusion: People with T2DM are at a very high risk of hepatic steatosis and severe fibrosis. Obesity is a major risk factor for worse disease, even in the absence of diabetes. These findings strongly support recent ADA recommendations to screen people with T2DM and obesity and cardiometabolic risk factors for moderate-to-severe fibrosis. Disclosure E.Valdez saenz: None. D.Barb: None. A.Sharma: None. K.Cusi: Consultant; Poxel SA, Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns, Research Support; Echosens, Inventiva, LabCorp, Zydus. E.Godinez leiva: None. R.Lomonaco: None. S.Kalavalapalli: None. S.A.Marangi: None. M.A.Gonzalez: None. A.Ortiz rocha: None. X.Chi: None. M.J.Gurka: None. Funding National Institutes of Health (R01120331-01A1)

Background: Kawasaki disease is characterized by high fever, rash, cervical lymphadenopathy, conjunctival injection, oral mucous membrane changes and swelling of the extremities followed by skin sloughing. Despite >50 years of study, no bacterial, viral or other infectious agent has been consistently associated with the illness. The lockdown and social distancing for COVID-19 in March 2020 led to a marked decrease in respiratory virus circulation. This provided an “experiment of nature” to determine whether Kawasaki disease would decline in parallel. Methods: Discharge ICD-10 diagnosis codes were obtained from the Vizient Clinical Data Base for Kawasaki disease and respiratory viruses, and analyzed for the age group < 5 years. Weekly respiratory virus positivity data were also obtained from BioFire Diagnostics. Results: Common enveloped respiratory viruses declined precipitously from April 2020 through March 2021 to levels at or below historical seasonal minimum levels. Kawasaki Disease declined about 40% compared with 2018–2019, which is distinctly different from the pattern seen for the enveloped respiratory viruses. Strong seasonality was seen for Kawasaki disease as far back as 2010, and correlated most closely with respiratory syncytial virus, human metapneumovirus and less so with influenza virus suggesting there is a baseline level of Kawasaki disease activity that is heightened during yearly respiratory virus activity but that remains at a certain level even in the near total absence of respiratory viruses. Conclusions: The striking decrease in enveloped respiratory viruses after lockdown and social distancing was not paralleled by a comparable decrease in Kawasaki disease incidence, suggesting a different epidemiology.

Purpose: Within the United States, human papillomavirus (HPV) vaccination rates remain low. We examined HPV vaccine recommendation practices among Florida clinicians by assessing variability in: (1) recommendation priorities by patient characteristics and (2) concordance with best practices. Methods: In 2018 and 2019, we conducted a cross-sectional survey incorporating a discrete choice experiment among primary care clinicians (MD/DO, APRN, and PA). We used linear mixed-effects models to determine the importance of patient characteristics (age, sex, time in practice, and chronic condition) and parental concerns. We compared clinician endorsement of predetermined constructs with reported vaccine recommendation statements.Results: Among 540 surveys distributed, 272 were returned and 105 reported providing preventive care to 11-to 12-year-olds (43% response rate). Among completing clinicians, 21/99 (21%) did not offer the HPV vaccine. Among clinicians offering the vaccine (n = 78), 35%-37% of each decision to recommend the vaccine was based on the child's age (15 vs. 11 years). For closed-ended questions, most clinicians endorsed best practices including emphasizing cancer prevention (94% for girls and 85% for boys; p = .06), vaccine efficacy (60% both sexes), safety (58% girls and 56% boys), impor-tance at 11-12 years (64% both sexes), and bundling vaccines (35% girls and 31% boys). When clinicians reported their typical recommendation, fewer clinicians incorporated best practices (59% cancer prevention, 5% safety, 8% the importance at 11-12 years, and 8% bundling vaccines).Discussion: HPV vaccination recommendation strategies among Florida clinicians somewhat aligned with best practices. Alignment was higher when clinicians were explicitly asked to endorse constructs versus provide recommendations.(c) 2023 Society for Adolescent Health and Medicine. All rights reserved.

Diabetes is a strong predictor of worse outcomes in nonalcoholic fatty liver disease (NAFLD), such as cirrhosis, CVD, and overall mortality. However, its true prevalence in clinical practice, and the role of obesity contributing to fibrosis, remain unclear. To this end, we recruited 759 patients without known NAFLD (35% with T2DM; age: 56 ± 11 years; BMI: 30.8 ± 6.5 kg/m2; female 59 %; ethnicity: Caucasian 75%, AA 14%, other 11%) attending outpatient endocrine/primary care clinics. We measured: 1) Routine laboratories; 2) Liver fat (CAP score ≥ 274 dB/m) and fibrosis (liver stiffness measurement or LSM) by elastography. The prevalence of NAFLD in T2DM was 68% vs. 44% in those without T2DM (p&lt;0.05). Comparing patients with vs. without T2DM, the presence of any liver fibrosis (LSM ≥7 kPa or F≥1) was 20% vs. 6%, of clinically significant fibrosis (LSM ≥8 kPa [moderate-to-severe] = F≥2) was 12% vs. 4%, and advanced fibrosis (LSM ≥ 9.7 kPa = F3/F4) was 7% vs. 1%, respectively (all p&lt;0.05). Obesity in T2DM promoted a much higher prevalence of steatosis (80% vs. 47% in T2DM without obesity) and of moderate-to-severe fibrosis (17% vs. 3%, respectively, both p&lt;0.05). In people without T2DM, obesity also played a major role regarding steatosis (obese: 66 % vs. non-obese: 28%) and moderate-to-severe fibrosis (F≥2: 8% vs. 1%, respectively; both p&lt;0.05). Worse glycemic control in people with T2DM (A1c ≥7.0% vs. &lt;7.0%) led to a higher prevalence of steatosis (75% vs. 62%) and of fibrosis (24% vs 18%; both p&lt;0.05). In multiple regression analysis, with a 95% CI, obesity in T2DM was the most significant risk factor for steatosis (OR 2.8, 1.9-4.2) and fibrosis (OR 3.4, 2.1-5.3). Conclusion: People with T2DM are at a very high risk of hepatic steatosis and severe fibrosis. Obesity is a major risk factor for worse disease, even in the absence of diabetes. These findings strongly support recent ADA recommendations to screen people with T2DM and obesity and cardiometabolic risk factors for moderate-to-severe fibrosis. Disclosure E.Valdez saenz: None. D.Barb: None. A.Sharma: None. K.Cusi: Consultant; Poxel SA, Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns, Research Support; Echosens, Inventiva, LabCorp, Zydus. E.Godinez leiva: None. R.Lomonaco: None. S.Kalavalapalli: None. S.A.Marangi: None. M.A.Gonzalez: None. A.Ortiz rocha: None. X.Chi: None. M.J.Gurka: None. Funding National Institutes of Health (R01120331-01A1)

Background and Aims:Late adolescents and young adults (AYA) with inflammatory bowel disease (IBD) are a vulnerable population as they transition to adult healthcare. We aim to provide a real-world data on their healthcare utilization patterns and medication use through a large database. Methods:We performed a retrospective cohort study from January 1, 2012, to June 30, 2020, using OneFlorida Data-Trust, an electronic health record-based data repository representing over half of the Florida population. Outcomes of interest included demographics, healthcare utilization, medications, and disease severity. Chi-square tests and logistic regression were used to compare the rates of medication use, healthcare utilization, and disease severity by age groups. Results:The number of patients who met our inclusion criteria was 10,578 with 2731 (25.8%) in the 17-25-year-old group. AYA patients had fewer ambulatory visits vs children (90% vs 95%; P value <.05). AYA patients were admitted more frequently from emergency facilities vs children (22.3% vs 10.9%; P value <.05). AYA patients received steroids more often than adults and younger patients (48.9% vs 45.3 vs 44.3% P value <.05, respectively). AYA patients received more narcotic (41.1% vs 22.3 % P value <.05) and antidepressant prescriptions (15.9% vs 9.5%; P value <.05) compared with children. With advancing age, a decrease in biologic use was noted (51% vs 40% vs 25.4% P value <.05, respectively). Conclusion:AYA patients with IBD have higher rates of hospital admissions from emergency department, fewer ambulatory health visits and they receive more steroids compared to children. Our study demonstrates the need for age-specific IBD programs for AYA patients.

Clinical practice guidelines suggest that patients with prediabetes (preDM) are at a higher risk of NAFLD and liver fibrosis, among other high-risk groups. However, there is limited data available. The aim of this study was to examine the prevalence of liver steatosis and fibrosis in preDM in unselected patients attending their regular outpatient visits, unaware of having NAFLD. To this end, we recruited 711 middle-aged patients in whom elastography was performed to screen for liver fibrosis (liver stiffness measurement or LSM, 1º outcome) and for steatosis (CAP: ≥274 dB/m, 2º outcome). Among them, 127 had preDM, 254 T2DM and 330 were healthy controls (CON). The 3 groups were matched for age, gender and BMI. The prevalence of NAFLD (by CAP) was higher in T2DM (67%) and preDM (54%) vs. CON: 40% (both p&lt;0.01 vs. CON). Overall, the OR 95% CI for steatosis in preDM vs. CON was 1.64, 1.05-2.58 (p&lt;0.01). Steatosis also increased in preDM independent of obesity (non-obese [OB] CON: 26% vs. non-OB preDM: 38% vs. non-OB T2DM: 47%; p &lt;0.05 vs. CON). The prevalence of any liver fibrosis (LSM ≥7.0 = ≥F1) was 3-fold higher among preDM vs. CON (6% and 2%, p=0.015), but significantly lower than in T2DM (17%; p&lt;0.001). Moderate-to-severe fibrosis (≥F2) also happened more often in preDM 5% vs. CON 1% (in T2DM = 9%; both vs. CON p&lt;0.01). Obesity led to a higher prevalence of NAFLD in T2DM (78%) and in preDM (71% vs. 26% in non-OB CON; p&lt;0.01). Obesity increased the prevalence of liver fibrosis in preDM and T2DM (increasing from 1% [non-OB] to 13% [OB] and from 4% to 23%, respectively; both p &lt;0.05) with the majority having F≥2 (10% and 13%, respectively). Prediabetes with obesity vs. CON with obesity had a 3-fold rate of liver fibrosis (3.35, 1.04-10.82; p&lt;0.001). Conclusion: Prediabetes is associated with a high prevalence rate of NAFLD and liver fibrosis, both increasing significantly in the presence of obesity. Prediabetes deserves screening and fibrosis risk stratification to prevent cirrhosis, in particular, in the presence of obesity. Disclosure E.Godinez leiva: None. M.A.Gonzalez: None. L.Mansour: None. M.M.Calvet: None. D.Barb: None. A.Mathews: None. A.Sharma: None. K.Cusi: Consultant; Poxel SA, Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns, Research Support; Echosens, Inventiva, LabCorp, Zydus. R.Lomonaco: None. S.Shrestha: None. S.A.Marangi: None. X.Chi: None. S.Kalavalapalli: None. S.S.Shetty: None. A.Ortiz rocha: None. E.Valdez saenz: None. Funding National Institutes of Health (R01120331-01A1)

ABSTRACTObjectiveDetermine the clinical safety and feasibility of implementing a telemedicine and medication delivery service (TMDS) to address gaps in nighttime healthcare access for children in low-resource settings.MethodsWe implemented a TMDS in Haiti called ‘MotoMeds’: (i) A parent/guardian of a child ≤10 years contacted the call center (6pm-5am). (ii) A provider used paper clinical decision support tools to triage the case as mild, moderate, or severe. Severe cases were referred to emergency care. For non-severe cases, call center providers gathered clinical findings to generate an assessment and plan. (iii) For households within the delivery zone, a provider and driver were dispatched with medications/fluids; the provider performed a paired in-person exam. For households outside the delivery zone, the family received phone consult alone. All families received a follow-up call at 10-days. Data were analyzed for clinical safety and feasibility.ResultsA total of 391 cases were enrolled from September 9th, 2019 to January 19th, 2021; 89% (347) received a household visit. Most cases were triaged as mild or moderate (92%; 361). Among the severe cases, 83% (20) sought subsequent referred care. The most common complaint was a respiratory problem (63%; 246). At 10-days, 95% (329) of parents reported their child’s condition as “improved” or “recovered”. Ninety-nine percent (344) rated the TMDS as “good” or “great”. The median phone consultation was 20 minutes, time to arrival at the household was 73 minutes and total workflow per case was 114 minutes.ConclusionThe TMDS was a feasible healthcare delivery model with high rates of improved clinical status at 10-days.Study registration (clinicaltrials.gov)NCT03943654

Introduction: Novel prevention programs are developed to address the increase in e-cigarette use (vaping) among children. However, it remains paramount to test their feasibility in rural settings. This pilot study implemented and evaluated the feasibility and outcomes of two innovative programs, CATCH My Breath and smokeSCREEN, among youth in rural settings in Florida.Methods: We conducted four focus groups with youth aged 11-17 recruited from 4-H rural clubs in Florida. In a subsequent randomized trial, we recruited 82 youth participants and assigned them to one of three arms: CATCH My Breath, smokeSCREEN, or control. CATCH My Breath and smokeSCREEN participants attended online group intervention sessions while the control group received educational material. Pre- and post-surveys were administered to all participants to assess knowledge, susceptibility, perceived positive outcomes and risk perceptions related to tobacco and e-cigarette use. Other feasibility parameters were also assessed.Results: Focus group discussions provided insights about feasibility and informed the implementation of both interventions in terms of delivery format, scheduling of sessions and incentives. After the intervention, CATCH My Breath participants significantly improved their general tobacco-related knowledge (post-pre = 16.21-12.92 = 3.3, p <.01) and risk perceptions towards other flavored tobacco products (post-pre = 19.29-17.71 = 1.6, p <.05). smokeSCREEN participants significantly improved their general tobacco knowledge (post-pre = 18.77-13.77 = 5.0, p <.01), knowledge about e-cigarettes (post-pre = 9.08-6.31 = 2.8, p <.01) and risk perception towards e-cigarettes (post-pre = 24.69-21.92 = 2.8, p <.05).Conclusions: This study demonstrated feasibility of delivering the interventions via participant engagement, participants' willingness to be randomized, assessment of outcome measures, and exploration of different recruitment methods. Despite the potential positive influence of CATCH My Breath and smokeSCREEN on youth participants, further evaluation with larger samples is needed.