Ventura County Health Care Agency

BACKGROUND:There is no specific treatment for sudden cardiac arrest (SCA) manifesting as pulseless electric activity (PEA) and survival rates are low; unlike ventricular fibrillation (VF), which is treatable by defibrillation. Development of novel treatments requires fundamental clinical studies, but access to the true initial rhythm has been a limiting factor.METHODS:Using demographics and detailed clinical variables, we trained and tested an AI model (extreme gradient boosting) to differentiate PEA-SCA versus VF-SCA in a novel setting that provided the true initial rhythm. A subgroup of SCAs are witnessed by emergency medical services personnel, and because the response time is zero, the true SCA initial rhythm is recorded. The internal cohort consisted of 421 emergency medical services-witnessed out-of-hospital SCAs with PEA or VF as the initial rhythm in the Portland, Oregon metropolitan area. External validation was performed in 220 emergency medical services-witnessed SCAs from Ventura, CA.RESULTS:In the internal cohort, the artificial intelligence model achieved an area under the receiver operating characteristic curve of 0.68 (95% CI, 0.61–0.76). Model performance was similar in the external cohort, achieving an area under the receiver operating characteristic curve of 0.72 (95% CI, 0.59–0.84). Anemia, older age, increased weight, and dyspnea as a warning symptom were the most important features of PEA-SCA; younger age, chest pain as a warning symptom and established coronary artery disease were important features associated with VF.CONCLUSIONS:The artificial intelligence model identified novel features of PEA-SCA, differentiated from VF-SCA and was successfully replicated in an external cohort. These findings enhance the mechanistic understanding of PEA-SCA with potential implications for developing novel management strategies.

Shelter-in-place orders during the COVID-19 pandemic created unmet health-related and access-related needs among older adults. We sought to understand the prevalence of these needs among community-dwelling older adults. We performed a retrospective chart review of pandemic-related outreach calls to older adults between March and July 2020 at four urban, primary care clinics: a home-based practice, a safety net adult medicine clinic, an academic geriatrics practice, and a safety net clinic for adults living with HIV. Participants included those 60 or older at three sites, and those 65 or older with a chronic health condition at the fourth. We describe unmet health-related needs (the need for medication refills, medical supplies, or food) and access-related needs (ability to perform a telehealth visit, need for a call back from the primary care provider). We performed bivariate and multivariate analyses to examine the association between unmet needs and demographics, medical conditions, and healthcare utilization. Sixty-two percent of people had at least one unmet need. Twenty-six percent had at least one unmet health-related need; 14.0% needed medication refills, 12.5% needed medical supplies, and 3.0% had food insecurity. Among access-related needs, 33% were not ready for video visits, and 36.4% asked for a return call from their provider. Prevalence of any unmet health-related need was the highest among Asian versus White (36.4% vs. 19.1%) and in the highest versus lowest poverty zip codes (30.8% vs. 18.2%). Those with diabetes and COPD had higher unmet health-related needs than those without, and there was no change in healthcare utilization. During COVID, we found that disruptions in access to services created unmet needs among older adults, particularly for those who self-identified as Asian. We must foreground the needs of this older population group in the response to future public health crises.

Under-reporting of elder financial abuse is partly due to failure of those around the victim to perceive the financial mistreatment as abuse. This study explored the effect of victim and perceiver factors on perception of elder financial abuse in the context of Routine Activity Theory (RAT). 488 older adults in Ventura County (CA) were surveyed about financial abuse using vignette method. In the study's Vignette 1, the amount of money taken, the type of frailty, and the relationship of perpetrator and victim were manipulated. In Vignette 2, the victim's age and relationship of perpetrator and victim were manipulated. Respondents' demographics (age, gender, education, and ethnicity) were collected. Logistic regression analyses revealed that children of the victim were least likely to be seen as committing abuse in both vignettes. In Vignette 1, there was an interaction of gender of respondent and the amount of money taken. In Vignette 2, non-Whites were less likely to perceive the signing over of the house as financial abuse. Respondents endorsed the concept of a special court with expertize in elder abuse as a way to increase the likelihood that they would report. Even though most financial abuse is perpetrated by family members, older adults are less likely to perceive a financial situation as abuse when it involves a child of the victim, thus making reporting and prevention less likely. The support for a specialty Elder Abuse Court (EAC) suggests that some reluctance to report is based on misgivings about punishing the perpetrator.

Determine the prevalence of substance use among pregnant women in five diverse communities utilizing the 4P's Plus screen for alcohol, tobacco, and other drug use. Pregnant women enrolled in prenatal care clinics in five communities were screened for substance use with the 4P's Plus. Those women with a positive screen underwent an assessment for substance use through a follow-up structured clinical interview conducted at the same prenatal visit. Among 7818 women in five communities, 2555 (32.7%) had a positive screen for substance use in pregnancy. Four of the communities conducted a follow-up assessment on all women with a positive screen (n = 1548). Among these women, 717 (15% of the total population) had continued use after learning of the pregnancy. Overall, 21% of the pregnant women used alcohol prior to recognition of the pregnancy, and 11% continued use after knowledge of the pregnancy. Among the 512 women who continued to use alcohol, 2% were drinking daily, 7% were drinking 3 to 6 days per week, 27% were drinking 1 to 2 days per week, and 63% were drinking less than 1 day per week. The rates of marijuana use and other illicit drug use among the women were 7 and 2%, respectively, prior to knowledge of pregnancy and dropped to 3 and 1% after learning of the pregnancy. The 4P's Plus identifies not only those pregnant women whose drinking or drug use is at a high enough level to impair daily functioning, but provides an opportunity for early intervention for the much larger group of women whose pregnancies are at risk from relatively small amounts of substance use.

This chapter summarizes the use of antidepressants and antimanic medications in children and adolescents. Antimanic medications that are also antiepileptics, such as carbamazepine, valproate, and clonazepam, are discussed here, but their pharmacological details are found in Chapter 12. The discussion on the use of antidepressants will focus on their use in mood disorders (for which they were originally introduced) and on their use in anxiety disorders, attention-deficit disorders, and enuresis.1–7 Since the first edition of this guide, more data concerning the use of selective or specific serotonin reuptake inhibitors (SSRIs) has become available, and treatment with more than one medication has become more common. This chapter will discuss the uses of SSRIs as well as combinations of medications in children and adolescents. Toxicity and treatment for toxicity will also be discussed.