ABSTRACT Background: Few studies have focused on early alcohol, tobacco and drug use prior to 18 years of age and their relationship with anxiety; while no study has checked the gender differences of these factors with anxiety. Methods: This study included 6,057 adults with anxiety in the past year and 71,868 controls from the combined data of 2013 and 2014 National Survey on Drug Use and Health (NSDUH). The weighted multiple logistic regression analyses were used to estimate the associations of early alcohol, tobacco and drug use prior to 18 years of age with anxiety. The odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. Results: The overall prevalence of anxiety was 6.8% (4.4% and 9.1% for males and females, respectively). Weighted multiple logistic regression showed that cigarettes use, inhalant use, marijuana use and other illicit drugs use revealed significant associations with anxiety (OR = 1.18, 95% CI = 1.04-1.33, OR = 1.31, 95% CI = 1.10-1.56, OR = 1.16, 95% CI = 1.01-1.32, and OR = 1.31, 95% CI = 1.17-1.48, respectively). Stratified by gender, cigarettes use, inhalant use, marijuana use and other illicit drugs use were associated with anxiety in females only. Conclusion: Early tobacco and drug use prior to 18 years of age were found to be associated with increased odds of adult anxiety and that such associations differed by gender.

Stroke increases neurogenesis (birth of new neurons) through upregulation of ciliary neurotrophic factor (CNTF), a potent neurogenic cytokine made almost exclusively in the central nervous system. Previous study found that CNTF is induced and needed to stimulate neurogenesis in the subventricular zone (SVZ) of mouse brain in a stroke model. CNTF also has a neuroprotective function. Focal adhesion kinase (FAK), protein tyrosine kinase 2, is ubiquitously expressed in various cell types and mediates cell adhesion and migration. We previously discovered that systemic inhibition of FAK upregulates CNTF expression in the SVZ, making FAK a pharmacological target to increase CNTF to promote neurogenesis and neuroprotection after stroke. This study examined whether systemic FAK inhibitor treatment after stroke regulates SVZ neurogenesis and neuroprotection using a middle cerebral artery occlusion (MCAO) to induce a stroke in adult male C57BL/6 mice. A filament was inserted in the external carotid artery and then fed through the carotid bifurcation into the internal carotid artery to the base of the middle cerebral artery. After 30 minutes of occlusion, the filament was removed to restore blood flow. Mice were randomly assigned to receive 3 daily doses of saline or FAK inhibitor (FAK14, i.p., 3 mg/kg) and treatment started at 6 hours, 12 days, or 58 days after MCAO. Because CNTF has a neuroprotective function, the amount of tissue damage was analyzed to compare treatment groups. The neuroprotective role of FAK14 was examined by measuring MCAO-induced infarction. The infarct size was measured using the absence of NeuN (neuronal cell marker) and GFAP (activated astrocytes) and presence of CD68 (activated microglia). FAK14 given at 6 hours post-stroke reduced the infarct size to 38% of the uninjured side of the brain compared to 46% with saline. Proliferating cells were labeled by injecting bromodeoxyuridine (BrdU, 50 mg/kg), the mice were processed 2 h after the last BrdU injection, and proliferated cells in the SVZ were counted with unbiased stereology. There were no significant differences in the total numbers of BrdU+ cells between saline and FAK14 at 3, 14 and 60 days. Future studies are needed to confirm the levels of CNTF at the various times of treatment. If there is no difference in CNTF expression or increased expression of counteracting cytokines, no difference in neurogenesis between groups would be expected. The neuroprotective effect of FAK14 during the acute phase following injury could provide novel pharmacological options to stroke patients extending the current therapeutic treatment window.

Introduction: The Centers for Disease Control and Prevention found that each year over three million people are treated for fall injuries, and of those three million, one in five falls causes serious injury. One clinical report stated only 37% of elderly patients are asked about falls in the primary care setting. The report found barriers to further fall-related care were due to the many factors that go into assessing if a patient is a fall-risk. Thus, assessing the fall risk for a large elderly population can be both challenging and time-consuming. The purpose of this study is to evaluate the effectiveness of assessing fall risk with the Theoretical Timed Up and Go (T-TUG), using Wave 1 of the Irish Longitudinal Database (TILDA). The validation was done by comparing the T-TUG results to that of the Impairments survey and activities of daily living (ADLs) found in the TILDA. Methods: The data used in this study were obtained from Wave 1 of the TILDA. The TILDA is a survey-designed longitudinal study on aging done on a national scale in Ireland. Study participants who passed inclusion criteria were divided into those who had reported falling in the previous year (N=1221) and those who had not (N=4857). The T-TUG is a fall-risk calculator developed from the NSHAP database, with a multiple regression function using the Timed Up and Go as the dependent variable, and age, gender, body mass index, and over the counter and prescription drugs as the predictor variables. The NSHAP regression coefficients were combined with the TILDA participant parameters defined above to calculate new T-TUG scores for the TILDA cohort. Differentiation between the fall and no fall groups for the T-TUG, ADLs and Impairments survey were done using the Mann-Whitney U Test (p < 0.05). Receiver Operator Characteristics (ROC) curve analyses were done to identify cut-off points, sensitivities, and specificities differentiating the fall and no fall groups for these assessments. Results: Mann-Whitney analysis demonstrated that the fall group scores were statistically different from the no fall group for all three assessments (p-value < 0.001). As determined by AUC, the ROC analysis indicated that the T-TUG (AUC=0.570, p Conclusion: All assessments evaluated were effective at differentiating participants within this database reporting a fall within the last year from those who had not. Whereas the T-TUG and Impairments survey were equally effective at detecting true fallers and non-fallers, the ADLs were much more effective at detecting non-fallers. The T-TUG has the potential to be an EMR based fall risk calculator and could be invaluable as an institutional triage tool.

Objective Safety-net clinics such as health department family planning (HD) and federally qualified health centers (FQHCs) provide free or low-cost contraceptive care to low-income and uninsured populations. Integration of contraceptive focused training within safety-net clinics is essential to deliver comprehensive, patient-centered contraceptive care. In SC, HDs receive Title X funding, which requires providing training to staff. However, due to different funding policies, trainings may be less available to FQHC staff which creates gap in care. This study examined perceptions of impact of trainings on overall performance and patient care among safety-net clinics in South Carolina (SC) that received externally funded contraceptive trainings for healthcare providers and clinic staff. The key focus of this study was to identify the perceptions of training among clinical staff and providers in HDs and FQHCs in SC. Our study showed that when equal funding opportunities were provided, it expanded the opportunity of positive impact. Method Key informant interviews were conducted among 58 individuals, 31 HD and 27 FQHC clinic staff and system leaders in 2019. Interview questions assessed the respondent’s perception of trainings on overall performance and patient care. Formal informed consent was obtained before the interview and participation was voluntary. Interviews were conducted privately via phone by study staff at East Tennessee State University. The interview recordings were transcribed and coded with QSR International’s NVivo 12 qualitative data analysis software. A codebook was developed, and inter-rater reliability and consensus coding methodologies were utilized to ensure consistency of coding. Results The majority of HD and FQHC respondents identified improved quality of services and infrastructure as positive impacts of provided trainings (N=14 and N=12, respectively). Additionally, four respondents from FQHC sectors mentioned that training increased capacity for contraceptive provision. Challenges with staffing capacity such as not having time for training were mentioned as a negative perception among both sectors. Perception of impact of training on patient care were positive among most respondents (N=44). Most respondents from both sectors indicated improved capacity for patient counseling as a positive impact of training (N=26). Two FQHC respondents mentioned that training led to implementing best practices. Conclusion Positive perception of contraceptive training on overall performance and patient care have been identified throughout this study. Federal funding provides support for training implementation but restrictions in funding due to policy changes and different funding mechanisms limit some clinics. Although external funding provides support; this does not ensure the sustainability of trainings after completion of the funding period which can create gaps in care and contraceptive provision. Future research should focus on training sustainability models such as Train-the-Trainer to ensure continuity of positive impact in local and state levels.

Prescription drug misuse is growing among college students. According to the U.S. Department of Justice, 559 full-time college students begin non-medically using prescription pain relievers every day. Within the last 12 months, nearly 12% of college students reported using prescription medications prescribed to a different person. Count It! Lock It! Drop It! is an initiative of the Coffee County Anti-Drug Coalition in Coffee County, Tennessee that educates the public on how prescription drug misuse can be prevented by counting, locking, and disposing of unused or expired medication. In collaboration with Count It! Lock It! Drop It! developers, a multi-pronged campaign using printed flyers and posters, residence hall door hangers, residence hall advisor t-shirts, campus yard signs, as well as digital and social media was developed and implemented in fall 2017 at East Tennessee State University. The objectives of this study were to: 1) assess exposure to the Count It! Lock It! Drop It! campaign among college students; and 2) examine perceptions and behaviors concerning medication storage and disposal among college students. A cross-sectional, online survey was conducted in November-December of 2017. Study participants were recruited from a series of listservs and included students 18 years of age and older currently enrolled at the University (n=274). Study variables included if and how students were exposed to the campaign, if they possessed expired or unused medications, if they counted, locked, or disposed of medication, and the likelihood of completing these tasks. Descriptive analyses were conducted using SPSS, version 24. Students reported print materials such as flyers as the most common channel of exposure. Among students reporting unused or expired medications in their household, a small percentage locked medication in a secure location in the past 30 days (13.7%), with a smaller percentage counting medication in the past 30 days (4.8%). The most common method of disposal was to discard of medication in the household trash, while the least common was to give to a friend or family member. Only 7.7% donated medications at a live take-back event, while 23.1% donated at a permanent disposal location. Students’ intentions for counting, locking, and disposing of medications varied. More students strongly disagreed than agreed that counting medications would become part of a two-week routine. More students disagreed than agreed with placing medications in a secure location, but results were more evenly dispersed relative to those for counting medications. Students generally agreed with disposing of expired or unused medications. Overall, this study suggests printed materials are a good way to reach college students for the Count It! Lock It! Drop It! initiative, that students do not commonly count or secure medications, and that students do not agree that counting or securing medications will be part of their standard routine.

Introduction: Oral health impacts much more than a person’s teeth and smile. Research indicates a connection between oral health and illnesses like cardiovascular disease and depression. Poor oral health could lead to social stigmatization and affects a person’s quality of life. Increased dental visits help detect and treat dental disease and offer opportunities for preventive care. Notably, the proportion of older adults in Tennessee is rapidly increasing, coupled with the growing complexity of older adults’ dental treatment. The first aim of this longitudinal study was to examine the prevalence of dental care visits among older persons (≥60 years) in Tennessee from 2010 to 2018. Our second aim was to examine the determinants of dental care visits among our target population. Methods: This study used five even years of Behavioral Risk Factor Surveillance system (BRFSS) data including years 2010, 2012, 2014, 2016, and 2018. BRFSS is a network of health-related telephone surveys conducted by all 50 states, the District of Columbia, and participating US territories. Our data was limited to Metropolitan and Micropolitan statistical areas, including East, Middle, and West Tennessee, while focusing on seniors (≥60 years old). Descriptive statistics were conducted. Weighting was conducted to account for the complex sampling design. Logistic regression analysis was performed to determine the factors associated with dental clinic visits among Tennessee seniors from 2010 to 2018. A p-value<0.05 was considered statistically significant. Results: The current study comprised of 5,362 Tennessee seniors. The year 2012 had the most seniors (1,324) and 2018 had the least number of seniors (787). About 64% of participants visited dentists or dental clinics within the past year while 18% reported that their last dental visit was ≥ 5 years ago. The percentage of older individuals visiting dental clinics within one year gradually decreased from 76.46% in 2010 to 71.17% in 2018. The majority of participants were females (51.7%), Whites (81.3%), never-smokers (46.3%), had good/better health (71.2%), and were located in Middle Tennessee (43.5%). Approximately 19% of Tennessee seniors removed all their permanent teeth. Logistic regression showed that those more likely to visit dentists or dental clinics included females (OR: 1.40; 95% CI: 1.11-1.77), former smokers (OR: 2.23; 95% CI: 1.46-3.41), never-smokers (OR: 2.21;95% CI: 1.46-3.35), individuals who had some college education (OR: 1.64 ;95% CI: 1.11-2.44), and graduated from college (OR: 2.74; 95% CI: 1.78-4.20). Likewise, individuals with a higher level of socioeconomic status, including a high income of $>50,000 (OR: 5.49; 95%CI: 3.60-8.36), were more likely to report dental visits. Conversely, Blacks (OR: 0.60; 95% CI: 0.43-0.82), participants with fair/poor health (OR: 0.67; 95% CI: 0.51-0.84), and those that have never-married (OR: 0.46;95% CI: 0.29-0.74) were less likely to report dental visits. Conclusions: The percent of Tennessee seniors visiting dental clinics within one year has gradually decreased from 76.46% in 2010 to 71.17% in 2018. The factors associated with a higher likelihood of seeking dental care include non-smoking status, identifying as females, and high socioeconomic status. Effective interventions to improve dental visits should take the identified factors into account.

The clinical consequences of ionizing radiation exposure remain one of the leading causes of death in the United States. Much research has been carried out to discover a potential countermeasure for acute radiation syndrome (ARS) without success. The United States Food and Drug Administration (US FDA) has not accepted any effective and harmless ionizing radiation therapy agents (radioprotectors) for treating ARS. It has recently been discovered that g-tocotrienol (GT-3), one of the E vitamers chiefly present in palm oil, has radioprotective abilities in mice and nonhuman primate (NHP) models. Though GT-3 is one of the most promising countermeasures discovered, the separation and purification from other vitamers or its matrix is difficult. This has limited its characterization, derivatization, and biomedical application. We have therefore designed novel chromatographic methods to optimize separation and purification. Thin layer chromatography (TLC) was used to ascertain the best solvent system for column chromatography (CC). Exactly 8% ethyl acetate in hexane employed in TLC and CC resulted in good separation (Rf ≥ 0.3) and purification. Various fractions presumed to contain GT-3 were collected and analyzed to confirm the exact structure using 1H NMR, 13C NMR, DEPT, and GC-MS. Results obtained so far have revealed the exact structure of the compound. However, some traces of impurities have been indicated by the NMR outcomes; therefore, high-performance liquid chromatography (HPLC) will be used to maximize GT-3 purification. This present study will be instrumental in elucidating the biochemical structure of various complex plant bioactive components that are hard to isolate and analyze. It is envisioned that this work will help to erase the knowledge deficit in medicinal chemistry and assist in the development of new medications for ARS.

After the COVID-19 pandemic, a rural K-8 school faced unique challenges due to its isolated location. Faculty members reported increased use of social media and other online communication by students. In addition, the staff noticed an increase in bullying, stress, and a greater need for mental health resources. In partnership with Quillen College of Medicine, a group of 5 medical students implemented lessons from the Alberta Health Services Junior High Mental Health Kit curriculum. Overall, the mission was to improve student attitudes and skills related to healthy relationships, stress, mental illness, cyber bullying, substance abuse, and hope. Analysis of research survey data showed that there was a significant change in students’ overall wellness (p=0.04108) and knowledge of healthy strategies to cope with stress (p=0.03709) after the intervention.

Introduction: HIV remains a leading cause of death globally, with over two-thirds of the cases in sub-Saharan Africa. Zimbabwe, a country located in East Africa, part of Sub-Saharan Africa, ranks in the top five countries with the highest prevalence of HIV in Africa (HIV prevalence in Zimbabwe estimated as 21.4% in 2019). Previous studies demonstrated HIV testing prevalence of 66.9% in East Africa. This study aimed to assess the prevalence of HIV testing amongst women of reproductive age in Zimbabwe, alongside some predictors of HIV testing amongst this population. Methods: Cross-sectional study design using the 2015 Demographic and Health Surveys (DHS) data for women aged 15-49. The prevalence of HIV testing as the outcome variable and the highest educational level, age at first sex, current marital status, and condom use as the predictor variables of interest were assessed. Descriptive statistics (frequencies, percents) and test of significance (using Chi-squared test)were conducted. Bivariate and multivariate logistic regression were completed to assess for the independent relationship between each predictor variable and HIV testing prevalence and, all predictor variables and HIV testing prevalence, respectively. Odds ratio estimates, 95% confidence intervals and p-values werereported. All analyses were performed using the Statistical Analysis System (SAS) version 9.4. The initial sample size included 9955 women. However, the effective sample size used in the statistical analysis was 7130 after accounting for missing variables. Results: About 9 in 10 women in the sample had ever been tested for HIV. Secondary education was the most prevalent highest level of education (64%). About 67% women had their first sex at age 15-19; peak incidence seen at ages 17 and 18 (15.3%). Multivariate analysis showed statistically significant associations between all independent variables and HIV testing (P-value Conclusion: Increasing highest educational level, age at first sex and condom use in Zimbabwe would likely increase the prevalence of HIV testing further. Focused education on the importance of HIV testing before the age of 15 will be beneficial in ensuring HIV testing as soon as sexual intercourse is established. Policy efforts are needed to address these HIV testing predictors. Causality is not implied.

Background. In-hospital mortality is a measure recognized by US Agency for Healthcare Quality to represent quality of care within hospitals, that accounts for mortality based on three indicators: 1. select medical conditions and procedures; 2. procedures linked with questions of use (misuse, over/under use); 3. high volume procedures traditionally associated with lower mortality rates. Understanding how different comorbidity models measure in-hospital mortality is essential not only for determining patient health status in the hospital setting, but also help to regulating mortality risk and mortality risk predictions. One of the most widely used discriminatory models is the Charlson model, which predicts the risk of mortality within one year of hospitalization of patients with various comorbidities using CCSR codes for ICD-10 diagnoses which is quantified by the c-statistics, represented by the area under the curve (AUC). Objectives. To adapt a comorbidity index model to the National Inpatient Sample (NIS) database of 2020 to predict 1-year mortality for patients admitted with select ICD-10 codes of diagnoses. Methods Our study analysis examined mortality with comorbidity using the Charlson model in a sample population of estimated 5,533,477 adult inpatients (individuals ≥18 years of age). A multivariate logistic regression model was constructed with in-hospital mortality as the outcome variable and identifying predictor variables as defined by the Clinical Classifications Software Refined Variables (CCSR) codes for selected ICD-10 diagnoses (Table 3). Descriptive statistics and the base logistic regression analyses were conducted using SAS statistical software version 9.4. To avoid overpowering and avoid variables attaining statistical significance while only marginally changing the outcome, a subsample (n=100,000) was randomly selected from the original data set. Ultimately, 20 CCSR variables with p-values <0.20 from the base simple logistic regression models were included in the subsequent backward stepwise logistic regression analysis. Results Table 1 shows the prevalence of the selected diagnoses for our analysis. Anemia (28.32%), pulmonary disease (asthma, COPD, pneumoconiosis;21.88%), and diabetes without complications (19.47%) were the three most prevalent conditions among hospitalized patients. Table 2 shows the results of the base logistic regression analysis conducted, which excluded connective tissue/rheumatologic disorders, peptic ulcer disease, anemia, diabetes with complications, and human immunodeficiency as predictors of inpatient mortality. Results of the backward stepwise regression analysis revealed that severe liver disease/hepatic failure ([adjusted odds ratio (aOR): 10.50, (CI: 10.40-10.59)], acute myocardial infarction ([2.85, (2.83-2.87)] and malnutrition ([2.15, (2.14-2.16)] were three most important risk factors and had the highest impact on inpatient mortality (p-value <0.0001). However, smoking history, obesity, and liver disease were negatively associated with inpatient mortality. The c-statistic or the area under the curve (AUC) for the final model was 0.752. Conclusion Our findings, based on Charlson modeling procedures, indicate that independent variables representative of comorbidity with the strongest 1-year risk of mortality were among patients with ICD-10 codes relating to: severe liver disease/hepatic failure, acute myocardial infarction, and malnutrition. Hence, relevant stakeholders (patients, family members, and healthcare providers) can utilize this knowledge to advance models of care and prevention strategies that limit disease progression and improve patient outcomes.