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Background: Rising rates of opioid use disorder (OUD), usually via injection, has resulted in younger patients being diagnosed with infective endocarditis (IE), with unique treatment challenges. Methods: This retrospective ecological study analyzed hospital discharge and home health records from 2016 to 2022 in South Carolina (SC). Cases of IE with concurrent coding for OUD were identified. Differences in patient demographics, hospital characteristics, length of care days, and charges by OUD status were determined using chi-square or t-tests. IE hospitalization rates by OUD status, year, and age group were calculated, and linear regression was used to determine differences by year. Results: There were 8601 acute-care hospitalization records for IE from 2016 to 2022 in the SC dataset, of which 1180 (13.7%) had concurrent OUD coding. Statistically significant differences between patients with and without OUD were identified for sex, age group, race, resident rurality, average number of comorbidities, disposition status, and year (all p < 0.01). The incidence rate of IE increased from 2.5/100,000 in 2016 to 6.9/100,000 in 2022 in patients aged 36 to 49 years with OUD (p = 0.02). Patients with IE and OUD who were discharged home had significantly longer lengths of stay in acute care hospitals (32.9 vs. 15.3 days; p < 0.01) and excessive hospital charges ( $308,874 vs. $ 188,862) compared to those without OUD. Conclusions: Major changes have occurred in the demographics of IE in SC. The increasing incidence rate of IE in younger adults with OUD coupled with prolonged stays at acute care hospitals pose challenges to the healthcare system that require creative solutions.

Background: For people with muscular dystrophy (MD) health care access is crucial and utilization is expected to be high. A multidisciplinary approach is needed for optimal management of symptoms of this rare condition. Regular primary care, specialty care, therapy, and medicine use can improve quality of care and reduce need for emergency treatment and hospitalization. We analyzed health insurance and administrative data to test for racial disparities in regular care use among teenagers and young adults with MD. Methods: We used South Carolina Medicaid and other administrative data for individuals aged 15–24 years to determine annual health care utilization patterns for individuals with MD by race. We studied adolescents and young adults with MD because this age group represents a time when the condition is typically intensifying and the transition from pediatric to adult care is expected. We used Generalized Estimating Equation models to analyze longitudinal utilization data conditional on other factors that may lead to utilization differences. Results: Race is correlated with health care utilization among adolescents and young adults with MD. Blacks have lower overall utilization, and less primary care, therapy, and specialist care use but higher incidence of hospitalization and emergency treatment use compared with whites and also to other races. The most striking disparity was the use of outpatient services. Blacks utilized these services 50% less compared with whites and 70% less compared with others. Even in regression analysis, where we take into account individual unobserved factors and allow clustering at the individual level, these differences remained and were in most cases statistically significant. Conclusions: Our results indicate that there are differences in health care utilization by race even when individuals have access to the same health care benefits. This means simply offering coverage to individuals with MD may not be sufficient in eliminating health disparities. Future studies will be needed to examine other possible sources of these racial disparities, such as resource awareness, health knowledge, or access barriers such as transportation.

This population-based cohort study examines the appropriateness of antibiotic prescribing in South Carolina via aggregated pharmacy claims data matched with diagnosis codes from medical claims. Inappropriate antibiotic prescribing decreased from 30.2% in 2012 to 22.6% in 2017 ( P < 0.001) and was more common in adults >40 years old.

Validation-study data were analysed to investigate retention interval (RI) and prompt effects on the accuracy of fourth-grade children’s reports of school-breakfast and school-lunch (in 24-h recalls), and the accuracy of school-breakfast reports by breakfast location (classroom; cafeteria). Randomly selected fourth-grade children at ten schools in four districts were observed eating school-provided breakfast and lunch, and were interviewed under one of eight conditions created by crossing two RIs (‘short’ – prior-24-hour recall obtained in the afternoon and ‘long’ – previous-day recall obtained in the morning) with four prompts (‘forward’ – distant to recent, ‘meal name’ – breakfast, etc., ‘open’ – no instructions, and ‘reverse’ – recent to distant). Each condition had sixty children (half were girls). Of 480 children, 355 and 409 reported meals satisfying criteria for reports of school-breakfast and school-lunch, respectively. For breakfast and lunch separately, a conventional measure – report rate – and reporting-error-sensitive measures – correspondence rate and inflation ratio – were calculated for energy per meal-reporting child. Correspondence rate and inflation ratio – but not report rate – showed better accuracy for school-breakfast and school-lunch reports with the short RI than with the long RI; this pattern was not found for some prompts for each sex. Correspondence rate and inflation ratio showed better school-breakfast report accuracy for the classroom than for cafeteria location for each prompt, but report rate showed the opposite. For each RI, correspondence rate and inflation ratio showed better accuracy for lunch than for breakfast, but report rate showed the opposite. When choosing RI and prompts for recalls, researchers and practitioners should select a short RI to maximise accuracy. Recommendations for prompt selections are less clear. As report rates distort validation-study accuracy conclusions, reporting-error-sensitive measures are recommended.

Background Rare conditions can be catastrophic for families and the implications for public health can be substantial. Our study compared basic surveillance through active medical record review with a linked administrative data file to assess the number of cases of two rare conditions, fragile X syndrome (FXS) and muscular dystrophy (MD) in a population. Methods Two methods of data collection were used to collect information from five counties comprising two standard metropolitan statistical areas of South Carolina. The passive system relied mostly on health claims data using ICD-9 CM diagnostic codes. The active system relied on a nurse abstracting records from a list of all licensed physicians with specialties in neurology, orthopedics, and genetics. Results There were 141 FXS cases and 348 MD cases that met the case definitions using active surveillance. Additional cases were found for both conditions but they were determined to not be true cases. After linking the actively collected MD and FXS cases to passive datasets, we found that the estimated total numbers of cases were similar to using capture-recapture analysis; the positive predictive values for cases identified in the passive system were 56.6% for MD and 75.7% for FXS. Conclusions Applying capture-recapture methods to passively collected surveillance data for rare health conditions produced an estimate of the number of true cases that was similar to that obtained through active data collection.

We compared hospital encounters between adolescents and young adults with fragile X syndrome (FXS) to peers with intellectual disability (ID) from other causes, autism spectrum disorder (ASD), and a comparison group without these conditions matched by gender, age, and insurance coverage. Those with FXS, ASD, or ID were more likely to have had hospital encounters. In terms of age groups, we found mental illness hospitalizations decreased during adulthood as compared to adolescence for those with FXS, and we found that for conditions unrelated to FXS (e.g., respiratory, genitourinary, gastroenteritis, and pneumonia) adolescents had higher rates of hospitalization compared to their peers with FXS, ID, or ASD. We analyzed epilepsy, common among people with FXS and designated as an ambulatory care sensitive condition that can be treated outside the hospital, and found that people with FXS, ID, and ASD had higher odds of hospitalization due to epilepsy in both age groups than did the comparison group.

Background/Objectives: To investigate the relationship of reporting accuracy in 24-h dietary recalls to child-respondent characteristics—cognitive ability, social desirability, body mass index (BMI) percentile and socioeconomic status (SES). Subjects/Methods: Fourth-grade children (mean age 10.1 years) were observed eating two school meals and interviewed about dietary intake for 24 h that included those meals. (Eight multiple-pass interview protocols operationalized the conditions of an experiment that crossed two retention intervals—short and long—with four prompts (ways of eliciting reports in the first pass)). Academic achievement-test scores indexed cognitive ability; social desirability was assessed by questionnaire; height and weight were measured to calculate BMI; nutrition-assistance program eligibility information was obtained to index SES. Reported intake was compared to observed intake to calculate measures of reporting accuracy for school meals at the food-item (omission rate; intrusion rate) and energy (correspondence rate; inflation ratio) levels. Complete data were available for 425 of 480 validation-study participants. Results: Controlling for manipulated variables and other measured respondent characteristics, for one or more of the outcome variables, reporting accuracy increased with cognitive ability (omission rate, intrusion rate, correspondence rate, P <0.001), decreased with social desirability (correspondence rate, P <0.0004), decreased with BMI percentile (correspondence rate, P =0.001) and was better by higher- than by lower-SES children (intrusion rate, P =0.001). Some of these effects were moderated by interactions with retention interval and sex. Conclusions: Children’s dietary-reporting accuracy is systematically related to such respondent characteristics as cognitive ability, social desirability, BMI percentile and SES.

Background Data from a dietary-reporting validation study with fourth-grade children were analyzed to investigate a possible relationship of body mass index (BMI) with daily participation in school meals and observed energy intake at school meals, and whether the relationships differed by breakfast location (classroom; cafeteria). Methods Data were collected in 17, 17, and 8 schools during three school years. For the three years, six, six, and seven of the schools had breakfast in the classroom; all other schools had breakfast in the cafeteria. Information about 180 days of school breakfast and school lunch participation during fourth grade for each of 1,571 children (90% Black; 53% girls) was available in electronic administrative records from the school district. Children were weighed and measured, and BMI was calculated. Each of a subset of 465 children (95% Black; 49% girls) was observed eating school breakfast and school lunch on the same day. Mixed-effects regression was conducted with BMI as the dependent variable and school as the random effect; independent variables were breakfast participation, lunch participation, combined participation (breakfast and lunch on the same day), average observed energy intake for breakfast, average observed energy intake for lunch, sex, age, breakfast location, and school year. Analyses were repeated for BMI category (underweight/healthy weight; overweight; obese; severely obese) using pooled ordered logistic regression models that excluded sex and age. Results Breakfast participation, lunch participation, and combined participation were not significantly associated with BMI or BMI category irrespective of whether the model included observed energy intake at school meals. Observed energy intake at school meals was significantly and positively associated with BMI and BMI category. For the total sample and subset, breakfast location was significantly associated with BMI; average BMI was larger for children with breakfast in the classroom than in the cafeteria. Significantly more kilocalories were observed eaten at breakfast in the classroom than in the cafeteria. Conclusions For fourth-grade children, results provide evidence of a positive relationship between BMI and observed energy intake at school meals, and between BMI and school breakfast in the classroom; however, BMI and participation in school meals were not significantly associated.

Background This article investigated (1) parental response accuracy of fourth-grade children's school-meal participation and whether accuracy differed by children's body mass index (BMI), sex, and race, and (2) the relationship between BMI and school-meal participation (based on parental responses). Methods Data were from four cross-sectional studies conducted from fall 1999 to spring 2003 with fourth-grade children from 13 schools total. Consent forms asked parents to report children's usual school-meal participation. As two studies' consent forms did not ask about lunch participation, complete data were available for breakfast on 1,496 children (51% Black; 49% boys) and for lunch on 785 children (46% Black; 48% boys). Researchers compiled nametag records (during meal observations) of meal participation on randomly selected days during children's fourth-grade school year for breakfast (average nametag days across studies: 7-35) and for lunch (average nametag days across studies: 4-10) and categorized participation as \"usually\" (≥ 50% of days) or \"not usually\" (< 50% of days). Weight and height were measured. Concerning parental response accuracy, marginal regression was used with agreement between parental responses and nametag records as the dependent variable; independent variables were BMI, age, sex, race, and study. Concerning a relationship between BMI and school-meal participation, marginal regression was used with BMI as the dependent variable; independent variables were breakfast participation, lunch participation, age, sex, race, and study. Results Concerning breakfast participation and lunch participation, 74% and 92% of parents provided accurate responses, respectively. Parental response accuracy was better for older children for breakfast and lunch participation, and for Black than White children for lunch participation. Usual school-meal participation was significantly related to children's BMI but in opposite directions -- positively for breakfast and inversely for lunch. Conclusions Parental response accuracy of children's school-meal participation was moderately high; however, disparate effects for children's age and race warrant caution when relying on parental responses. The BMI results, which showed a relationship between school-meal participation (based on parental responses) and childhood obesity, conflict with results from a recent article that used data from the same four studies and found no significant relationship when participation was based on nametag records compiled for meal observations.

Background Epidemiological studies suggest individuals with severe mental illness (SMI), including schizophrenia, schizoaffective, and bipolar‐related disorders may be at higher risk for cognitive decline or dementia, but studies on dementia prevalence in this group, particularly in the U.S. public psychiatry sector, are limited. The South Carolina Alzheimer's Disease Registry is the oldest and most comprehensive of three statewide population‐based registries of Alzheimer's Disease and Related Disorders (ADRD) in the U.S. This registry will be utilized to assess the prevalence of dementia in adults with SMI and other associated clinical outcomes. Method Characteristics, prevalence of ADRD, and health outcomes of individuals, age 55+ years seen by the South Carolina Department of Mental Health (SCDMH) between fiscal years (FY) 2018‐2022 is analyzed by linking patient data between databases, described in Figure 1. Healthcare outcome is analyzed by linking to patient data from the South Carolina Revenue and Fiscal Affairs (RFA) data warehouse and the Registry. SCDMH IRB approval was obtained. Data in individuals with SMI and ADRD was compared to age/sex/race‐matched persons with SMI without ADRD and analyzed. Results will be stratified or adjusted by diagnosis group to understand the impact of these factors on cognitive comorbidity prevalence, mortality, and health care utilization. Result 24,291 individuals with SMI received clinical services at SCDMH during the study period. 64.8% of individuals with SMI were female, 58% were White, 37.6% were Black. During the study period, the yearly percentage of individuals with SMI who were reported in the Alzheimer's Registry ranged from 9.7‐17%. The prevalence of AD was higher in individuals with schizophrenia vs. other SMI diagnoses (Figure 2), p <0.0001. Mortality rates were higher in individuals with SMI and ADRD vs. SMI only (Figure 3), p <0.0001. Conclusion ADRD in SMI is prevalent, and associated with increased mortality. ADRD is more prevalent in individuals with schizophrenia than other SMI. Future research on ADRD within SMI populations can inform patient care, service delivery, and long‐term healthcare outcomes.