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BACKGROUND: Low vitamin D serum levels represent an additional risk factor for end-stage renal disease (ESRD)-associated bone disorders. The aim of this study was to evaluate the prevalence of vitamin D defi ciency in both the summer and winter seasons, as well as to defi ne the associated risk factors, and to establish the link between secondary hyperparathyroidism and circulating 25-hydroxy vitamin D (25 [OH]-D) serum levels.METHODS: Seventy-eight hemodialysis (HD)-requiring ESRD outpatients living in Buenos Aires, Argentina, age 57.2 Ϯ 2.07 years (21-86 years) were evaluated at the end of summer (SUM) and the end of winter (WIN). Then 25 (OH)-D, serum calcium (Ca), intact parathormone, ionized Ca (Ca ϩϩ ), phosphate, alkaline phosphatase, creatinine, C-reactive protein, and serum albumin were evaluated. The participants were evaluated according to the 25 (OH)-D levels following KDOQI guidelines. The participants were assigned to 2 groups according to their Karnofsky scores for functional capacity (FC): FC 1-2 (normal physical capacity full-time to only part-time) and FC 3-4 (limited capacity only for self care to needs permanent assistance). CONCLUSIONS: Fifty percent of the HD-requiring ESRD patients showed 25 (OH)-D insuffi ciency/defi ciency. This fi nding was more frequent in winter. Women and older patients were at higher risk. Those individuals displaying optimal 25 (OH)-D levels showed better health indicators for HD-requiring ESRD patients. FC assessed through the Karnofsky score was a useful clinical parameter able to identify patients at risk of 25 (OH)-D defi ciency. In our population, renal disease-associated secondary hyperparathyroidism did not correlate with vitamin D defi ciency.

The presence of insurance, namely Medicaid, does not equate to diagnosis and management of conditions that affect trauma outcomes. Medicaid is associated with worse pre-trauma health maintenance and a greater risk of infection.

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Of the 11,147 admitted trauma patients, 14.5% had a pre-injury PI diagnosis. The PI patients were older (61.5 ± 0.5 vs. 54.3; p < 0.001), more often female (56% vs. 39.1%; p < 0.001), and had no difference in blunt mechanism rates (88.4% vs. 89.9%; p = 0.06) or median ISS (9 vs. 9; p = 0.06). There was no difference between PI and non-PI patients in pre-injury diabetes mellitus (13.4% vs. 12.7%; p = 0.4), steroid use (2.5% vs. 1.9%; p = 0.1), but patients with PI were more likely to be obese (15.7% vs. 13.6%; p = 0.03). Patients with PI were more likely to have an infection develop (10.4% vs. 7.5%; p < 0.001). The most common infection in both groups was UTI (6.9% vs. 4.2%; p < 0.001). Compared with non-PI patients, adjusting for age, gender, ISS, diabetes mellitus, and obesity, patients with PI were more likely to have an infection develop (odds ratio 1.3, 95% confidence interval = 1.1-1.5) Conclusions: Patients with an underlying PI are at increased risk of having a UTI after traumatic injury. This study identifies a previously unknown independent risk factor for UTIs in patients with trauma. This stresses the need for increased awareness and attention to this vulnerable population.

BackgroundSexually transmitted disease (STD) rates continue to rise in the United States (US). Over half of all new STDs occur in adolescents and young adults (AYA). Few studies have evaluated how sexual behaviors such as number of partners or condom use may contribute to this increase. We aimed to determine the association of sexual behaviors and condom use with STD incidence over time among AYA.MethodsWe reviewed all AYA ages 13–26 years attending a public STD clinic in Rhode Island from 2013–2017. We reviewed demographic and behavioral data including age, gender identity, risk group, race, ethnicity, insurance status, sexual behaviors, substance use, self-reported STD/HIV diagnosis (lifetime, past year), condom use, and HIV/STD testing results. We report proportions in 2013 and 2017, and performed trend analyses (Cocharn-Armitage test for categorical variables and Kruskal–Wallis trend test for continuous variables) to determine trends over time.ResultsA total of 3,822 AYA visited the clinic during the study time period. An increasing trend was observed for: multiple (≥5) partners (29% of AYA in 2013 vs. 38% in 2017, P < 0.001), self-reported past year and lifetime STD diagnosis (12 vs. 21%, P < 0.001 and 19 vs. 33%, P < 0.001, respectively), and lab-documented diagnosis of any STD (15 vs. 25%, P < 0.001), syphilis (2 vs. 5%, P = 0.006), any chlamydia (11 vs. 20%, P = 0.001), and any gonorrhea (3 vs. 8%, P = 0.008). A decreasing trend was observed for: white race (66% in 2013 vs. 43% in 2017, P < 0.001), uninsured (73 vs. 53%, P < 0.001), condomless sex during oral as well as vaginal/anal sex (22 vs. 10%, P = 0.001 and 16 vs. 8%, P = 0.001, respectively), and self-reported HIV diagnosis (2.5% to 0.9%, P = 0.016).ConclusionAmong AYA, risk behaviors such as condomless sex and multiple partners increased significantly from 2013–2017, which may be contributing to an increase in STDs. Increased public health efforts are needed to promote education and other interventions to address behaviors associated with STD transmission.Disclosures All authors: No reported disclosures.