Research

Internalized HIV-related stigma undermines mental health, quality of life, and engagement in care among people living with HIV (PLHIV), yet data from Vietnam remain limited. We analyzed data from the 2020 PLHIV Stigma Index, a cross-sectional study conducted in seven provinces. Participants were recruited primarily from public outpatient HIV treatment clinics and through limited chain referral. Internalized stigma was assessed using the 6-item Internalized AIDS-Related Stigma Scale (IARSS); scores of 5-6 were classified as high internalized stigma. Among 1,623 participants (mean age 34.6 years, 74.6% male), the IARSS showed acceptable internal consistency (Cronbach's alpha = 0.74), and 29.4% had high internalized stigma. In the multivariable logistic regression, secondary/high school education (adjusted odds ratio [aOR]: 0.47, 95% confidence interval [CI]: 0.35-0.65), university/tertiary education (aOR: 0.34, 95% CI: 0.22-0.52), and more than 5 years since HIV diagnosis (aOR: 0.66, 95% CI: 0.49-0.89) were associated with lower odds of high internalized stigma. Higher odds were observed among participants with depression/anxiety symptoms (aOR: 2.02, 95% CI 1.56-2.62), those unaware of their partner's HIV status (aOR: 1.79, 95% CI 1.21-2.65), and those reporting community stigma or discrimination in the prior 12 months (aOR: 1.49, 95% CI 1.06-2.09); internalized stigma also varied by province. Internalized stigma remains common among PLHIV in Vietnam and appears shaped by psychological, relational, community, and geographic factors. Integrated mental health, stigma-reduction, and context-responsive interventions may help reduce internalized stigma.

Background: Anaphylaxis is a life-threatening allergic reaction that requires prompt epinephrine and post-treatment management. Guidelines recommend prescribing epinephrine at discharge from the emergency department (ED), yet results of studies show lower-than-recommended prescribing rates and variable ED lengths of stay (LOS). Large-scale analyses of adult anaphylaxis care in U.S. EDs remain limited. Objective: The objective was to estimate the proportion of adults discharged from U.S. EDs with an epinephrine prescription, characterize ED LOS, and identify predictors of these outcomes. Methods: We analyzed 2013-2015 and 2018-2022 National Hospital Ambulatory Medical Care Survey-ED visits for adults ages ≥ 18 years diagnosed with anaphylaxis who were discharged home. Outcomes were (1) epinephrine prescription at discharge and (2) ED LOS < 4 hours. Patients who arrived by emergency medical services (EMS) were excluded for LOS analysis. Multivariable log-binomial regression estimated risk ratios (RR) between outcomes and clinical predictors. Results: Among 609 ED visits, 14% resulted in an epinephrine prescription at discharge (95% confidence interval [CI], 10%-18%). The median (interquartile range) LOS was 138 minutes (80-199 minutes), with 83% discharged within 4 hours (95% CI, 78%-87%). Older adults (≥42 years) and Hispanic patients were less likely to receive an epinephrine prescription (RR 0.47 [95% CI, 0.25-0.90]; RR 0.34 [95% CI, 0.12-0.95], respectively). Rural visits were more likely to have LOS < 4 hours (RR 1.12 [95% CI, 1.02-1.23]). Conclusion: Epinephrine prescribing at discharge was infrequent across the full cohort, whereas ED LOS was typically brief among the patients who did not arrive by EMS. Older adults and Hispanic patients were less likely to receive epinephrine, and rural visits had shorter LOS. These findings highlight potential disparities in discharge prescribing and ED management of adult anaphylaxis in U.S. EDs.

Per- and polyfluoroalkyl substances (PFAS) and metals are ubiquitous environmental contaminants that have been individually linked to childhood adiposity, but their combined effects remain understudied. In the Project Viva cohort (n = 845), we evaluated joint associations of six first-trimester PFAS in plasma and five essential and six nonessential metals in erythrocytes with child and adolescent body mass index (BMI) z-scores and dual-energy X-ray absorptiometry (DXA) total and truncal fat mass indices. We used Bayesian kernel machine regression to evaluate joint associations of PFAS and metals with adiposity. Higher prenatal PFAS and nonessential metal mixture levels were significantly associated with higher mid-childhood and early adolescent BMI z-scores (75th vs 50th percentile: 0.17 [95% Credible Interval (CrI): 0.06, 0.28]; 0.14 [95% CrI: 0.02, 0.25]) and DXA total fat mass (0.17 kg/m2 [0.05, 0.30]; 0.20 kg/m2 [0.07, 0.32]), but not adiposity in late adolescence. Children with lower levels of the prenatal essential metal mixture had higher early and late adolescent DXA total fat mass (25th vs 50th percentile: 0.13 [0.04, 0.22]; 0.08 [0.01, 0.16]). Our findings underscore the importance of considering concurrent prenatal exposures across multiple chemical classes when evaluating environmental influences on child adiposity.

BACKGROUND: Unplanned readmission within 30 days following colorectal surgery occurs in up to 20% of older patients (≥65 years), representing a significant clinical and economic burden. Designing effective interventions to reduce readmission depends on whether risk factors are modifiable or actionable. This study identified and categorized the drivers of readmission, with a specific focus on actionable factors.

METHODS: We analyzed data from 49,021 elective colectomy and proctectomy cases aged ≥65 years and discharged home in the National Surgical Quality Improvement Program from 2016 to 2020 using univariate and multivariable logistic regression. We categorized factors associated with readmission in 4 groups: (1) comorbidities, (2) preoperative clinical characteristics and geriatric vulnerabilities, (3) surgical stressors, and (4) postoperative complications before discharge. We restricted our analytic cohort to patients aged ≥65 years who were initially discharged to their home. The primary outcome was a composite of unplanned readmission or 30-day mortality.

RESULTS: Unplanned readmission occurred in 4,569 (9.3%) of this sample; an additional 76 patients (0.2%) died within 30 days without a prior readmission, yielding a composite adverse outcome of 4,645 (9.5%). Among comorbidities, chronic heart failure (strongest predictor) (odds ratio, 1.96; 95% confidence interval, 1.49-2.53), insulin-dependent diabetes (odds ratio, 1.52; 95% confidence interval, 1.35-1.7), and chronic obstructive pulmonary disease (odds ratio, 1.38; 95% confidence interval, 1.23-1.55) were most strongly associated with readmission. Geriatric vulnerabilities included total functional dependence (strongest predictor) (odds ratio, 2.81; 95% confidence interval, 1.24-6.35) and preoperative hypoalbuminemia (<3.0 g/dL; odds ratio, 1.75; 95% confidence interval, 1.47-2.08). Surgical stressors-ostomy creation (odds ratio, 1.83; 95% confidence interval, 1.69-1.99), prolonged operations (>240 minutes; odds ratio, 1.87; 95% confidence interval, 1.71-2.05)-and complications (ileus: odds ratio, 5.56; 95% confidence interval, 5.16-5.98; and acute renal failure: odds ratio, 6.09; 95% confidence interval, 2.82-13.16) also increased risk.

DISCUSSION: Readmissions in older adults reflect the interplay of medical, geriatric, and surgical risks, some of which are modifiable or actionable. A holistic approach that integrates perioperative optimization (eg, malnutrition), proactive comorbidity control (eg, diuretic and insulin management), and tailored postdischarge monitoring and support may mitigate readmission rates.