It's great for those chef-driven, owned restaurant concepts that you really could pick from about 20 or 30. We have about 92 beers on tap here at Falling Rock. If you're interested in craft beer, Denver is definitely the destination of the United States. Stoic and Genuine is my newest restaurant in Denver Union Station. I love the renovation inside the station itself. It's an incredible transformation of that historic building. They really took care to bring back that era of what it looked like as a train station. So all light rail, buses, and even Amtrak will be coming out of there. It's our pathway to DIA, which takes you to the world. Some of the great places downtown are these historic hotels. One is the Brown Palace. The other is the Oxford Hotel. Also in our neighborhood is the Tattered Cover, which is one of the most amazing bookstores. You just have that really fun boutique feel when you walk in. It's just the volume that we have here that makes downtown Denver special. There's really a lot of activity for shopping, too. Larimer Square gives you that kind of feeling like Rockefeller Center might in New York. It's the only historic block that still has all the historic buildings. Larimer Square has some really fun little boutiques that I think you can get some unique gifts. I always take people to Rock Mount Ranch Wear. They're attributed with popularizing the Snap Front Western shirt. From rock stars to ranchers, it's people who are looking for something quintessentially Colorado. If I had one word for downtown Denver, it'd be exciting. Active. Historic but emerging. Very funky, be very artsy. It's kind of the heart of this city. It's also a melting pot of our Denver culture. So if you're coming down here, you're getting a real sense of Denver. It's just a constant stream of unexpected surprises here. The downtown Denver area is unique. Here there's just so much more to do. There's plenty of historic sites, brand new businesses, museums, and cultural events happening every month. Denver is an extremely active city. It's an excellent place to try just about anything. People have come down here both to live and to play. It's full of shops, restaurants. It's really made it an enjoyable place to hang out. The changes to the downtown area are amazing. From Larimer Square into 16th Street Mall. 16th Street Mall is a really diverse area. Each block is a little bit different and unique. I really enjoy the Denver pavilions which has an open air concept that combines outdoorsy Colorado but also a very urban feel. There's the Hard Rock Cafe, Jazz at Jack's. You can also catch a film at the United Artists Theater. I stopped by the iHeart Denver store in the Denver pavilions. You can find a real gambit. Gift items, fine art pieces, prints, t-shirts, and jewelry. All made by local designers, artists, or creative minded businesses. Denver has a public art ordinance that allocates 1% of any new capital improvement project to public art. So when you're walking around downtown, you will see a large piece or some sort of art installation in almost every building and plaza. 14th Street in the Convention Center area has been revitalized just recently. The Denver Performing Arts Complex is one of the largest in the country. It takes up four city blocks. You can catch the symphony, the opera, the ballet. It really runs the gamut of popular music to classical. Then you can go a little farther down and hit the MCA. They're just very unique, very innovative with their shows. One of the nicest features about Lodo is the scale. Downtown Denver in general is extremely walkable. If you look at where Coors Field is, even to the Pepsi Center. Lodo is also very bike friendly. We had one of the first electronic bike share systems. B-cycle stations, you can get on one, you can use it all over town. The heart of the city really is downtown. You have lots of bars, dance clubs, to places with really great views like the View House. And nice rooftop decks, like the Tavern. Denver's just great for those chef-driven, owned restaurant concepts that you really could pick from about 20 or 30. We have about 92 beers on tap here at Falling Rock. If you're interested in craft beer, Denver is definitely the destination of the United States. Stoic & Genuine is my newest restaurant in Denver Union Station. I love the renovation inside the station itself. It's an incredible transformation of that historic building. They really took care to bring back that era of what it looked like as a train station. So all light rail, buses, and even Amtrak will be coming out of there. It's our pathway to DIA, which takes you to the world. Some of the great places downtown are these historic hotels. One is the Brown Palace, the other is the Oxford Hotel. Also in our neighborhood is the Tattered Cover, which is one of the most amazing bookstores. You just have that really fun boutique feel when you walk in. It's just the volume that we have here that makes downtown Denver special. There's really a lot of activity for shopping, too. Larimer Square gives you that kind of feeling like Rockefeller Center might in New York. It's the only historic block that still has all the historic buildings. Larimer Square has some really fun little boutiques that I think you can get some unique gifts. I always take people to Rockmount Ranchwear. They're attributed with popularizing the snap front western shirt. From rock stars to ranchers, it's people who are looking for something quintessentially Colorado. If I had one word for downtown Denver, it'd be exciting. Active. Historic but emerging. Very funky, be very artsy. It's kind of the heart of this city. It's also a melting pot of our Denver culture, so if you're coming down here, you're getting a real sense of Denver. It's just a constant stream of unexpected surprises here. The downtown Denver area is unique. Here there's just so much more to do. There's plenty of historic sites, brand new businesses, museums, and cultural events happening every month. Denver is an extremely active city. It's an excellent place to try just about anything. People have come down here both to live and to play. It's full of shops, restaurants. It's really made it an enjoyable place to hang out. The changes to the downtown area are amazing, from Larimer Square into 16th Street Mall. 16th Street Mall is a really diverse area. Each block is a little bit different and unique. I really enjoy the Denver Pavilions, which has an open-air concept that combines outdoorsy Colorado but also a very urban feel. There's the Hard Rock Cafe, Jazz at Jack's. You can also catch a film at the United Artists Theater. I stopped by the iHeart Denver store in the Denver Pavilions. You can find a real gambit, gift items, fine art pieces, prints, t-shirts, and jewelry, all made by local designers, artists, or creative-minded businesses. Denver has a public art ordinance that allocates 1% of any new capital improvement project to public art. So when you're walking around downtown, you will see a large piece or some sort of art installation in almost every building and plaza. 14th Street in the Convention Center area has been revitalized just recently. The Denver Performing Arts Complex is one of the largest in the country. It takes up four city blocks. You can catch the symphony, the opera, the ballet. It really runs the gamut of popular music to classical. Then you can go a little farther down and hit the MCA. They're just very unique, very innovative with their shows. One of the nicest features about Lodo is the scale. Downtown Denver, in general, is extremely walkable. If you look at where Coors Field is, even to the Pepsi Center. Lodo is also very bike-friendly. We had one of the first electronic bike share systems. B-cycle stations, you can get on one, you can use it all over town. Good afternoon, and welcome to the oral poster presentation session. I'm Lorraine Young, the chair of ACPM's Scientific Review Committee. The Scientific Review Committee is responsible for judging scientific abstracts submitted to the annual Preventive Medicine Conferences. And I want to take this opportunity to thank the committee members for their help in reviewing all of the scientific abstracts submitted for Preventive Medicine 2021. Today we are delighted to showcase three of our poster presentations. These oral presentations are prerecorded. Please type in your questions in the chat box as you listen to the presentations. And after the last presentation, all three presenters will be available to answer your questions in the chat box. So without further ado, here are today's presentations. Our first presentation is titled, Rural-Urban Differences in Depression, Firearm Ownership, and Firearm Suicide Risk. It will be presented by Dr. Sabrina Murphy. Dr. Murphy is a resident from the University of Wisconsin Preventive Medicine Residency. Our second presentation is titled, Prevalence of Metformin Prescriptions for Individuals with Pre-Diabetes. The presenters are Alejandro Hughes and Dr. Tamkeen Khan. Mr. Hughes is a data analyst at the American Medical Association, and Dr. Khan is a senior economist at the American Medical Association. And our third presentation is titled, SARS-CoV-2 Infection Rates Among Undergraduates Quarantined Following Exposure to a Roommate with COVID-19. The presenter is Dr. Colin Pitts, who is the chief resident at the University of Wisconsin Preventive Medicine Residency. Thank you for joining us today. And here is our first presentation. Hello, my name is Sabrina Murphy. I'm a chief resident at the University of Wisconsin Preventive Medicine Residency Program. And the title of my abstract is Rural Urban Differences in Depression, firearm ownership, and firearm suicide risk. A little about myself, I have a background in pediatric. After completing two years of a pediatric residency in Central Wisconsin, and then I switched over to preventive medicine and public health. I obtained my master's of public health online through George Washington University, and will be completing my public health and general preventive medicine residency at the end of June. I came into this field wanting to explore more about how residency in a rural area can affect health outcomes. And this interest led me to this project to be developed in partnership with the Survey of the Health of Wisconsin. Just a little bit about the Survey of the Health of Wisconsin, also known as SHO. It was established in 2008 by the University of Wisconsin School of Medicine and Public Health. Today, SHO continues to serve as a vital population health research infrastructure. It gathers important health information and can support multiple broad research projects that's relevant to a varied Wisconsin population. SHO collects data on a representative sample of the state's residents on a periodic annual basis. Given that the census estimates that 30% of the state's population classified as living in a rural setting, the SHO program offered me a unique look into this understudied rural community and to how, and especially when it comes to health and health determinants. So partnering with SHO, I thought to develop a study that focused on comparing rural and urban population. So the background of the study highlights that national data shows suicide rates are high in rural areas compared to more urban ones. And this disparity is often attributed to many socioeconomic factors associated with rural residents or rural residency. Some previous studies have been done showing that the prevalence of depression is slightly but significantly higher in residents of rural areas while other studies have shown that depression prevalence is actually the same. When it comes to suicide and rural residents, urban residents, as well as suicide attempts involving firearms, when we talk about how much death will result, when we talk about across all suicide attempts, when there's not a firearm involved, 4% will result in death. When we have gun suicide, those statistics are flipped actually. Approximately 90% of gun suicide attempts end up being suicide attempts. So my team and I wanted to look at these two risk factors, depression and firearm ownership, using the show data to see if these risk factors are more prevalent in those with a more rural residence compared to a more urban one. So the aim of our research is to look at the relationship between place of residence, depression, and firearm ownership. So we're going to look at the relationship between place of residence, depression, and firearm ownership. First, we started with weighted data to provide a descriptive analysis of the participants based on their residence using the rural urban commuting areas or RUCA seven category classification into a four category classification. And you can see that on figure one. We then defined a new and novel variable by combining the previously two studied risk factors of depressive symptoms and owning a firearm by them into a single exposure. This new variable, we then called firearm suicide risk. This would then identify people in the show data set who may be at higher risk for firearm suicide as they screen positive for depressive symptoms and they owned a firearm. So this slide shows the weighted data results. At the top is the written format of the results as it appears on the poster. And then at the bottom, it's the same results but in a table. So looking at the table, it shows along the top, here, the weighted percents of self-reported depression symptoms in the first column, firearm ownership in the second column, and the combined variable, combining the two risks together to make its own variable is the firearm suicide risk, which are those individuals who own a firearm and have self-reported depression symptoms. And then we have along the side of the table, the rows broken up by the residency, the four category groupings, we created started with the urban core, suburban, rural, and isolated rural. So we see that the isolated rural group had a slightly higher self-reported depression symptoms, so it's slightly higher. However, a significantly increased rates of firearm ownership. And then we looked at, as well as an increase in our variable of the firearm suicide risk and the P-value over there. So we are going to go on to the next table. And when we look at this table, this slide is showing the results from the multiple logistic regression model that we ran, looking at the association between place of residence and the new variable firearm suicide risk. This is the table that's on the poster. So looking at the top, we see it shows the odds ratio after recontrols for age, gender, race, smoking status, and access to care when we needed it. And that's in the first column right here, and those variables are down below. And then the next column is the 95% confidence interval, and in the third column is the P-value. Again, looking on the side of the table, in the rows, we see that the residency groups divided up by suburban rural and isolated rural, with the reference group being the urban core. So when we look at the individuals living in isolated rural areas, compared to the urban core, we found that they are three times more likely to be at risk for firearm suicide compared to urban core individual. And this is even after controlling for certain factors. So although the rural group did have slightly higher rates of depressive symptoms, the primary driver behind the increased firearm suicide risk that we saw seemed to be firearm ownership. This is important because public health professionals should be aware of the increased risk of firearm suicide posed by the combination of depression and firearm ownership, and advocate for innovative suicide prevention strategies within the rural communities. So our conclusion of our study showed that individuals living in isolated rural areas are at higher risk for firearm suicide, mostly attributed to the significantly higher rates of firearm ownership. Support for this work was provided to the Preventive Medicine Residency Program by the Wisconsin Partnership Program, the Middleton VA Hospital, and the School of Medicine and Public Health. Good afternoon, everyone. On behalf of the American Medical Association, I am Tiamkeen Khan, and I'm joined today by my colleague Alejandra Hughes, and we would like to welcome you to our presentation on the prevalence of metformin prescriptions for individuals with pre-diabetes. It is well known among the healthcare field that type 2 diabetes is a growing concern. 30 million adults across the country have this condition, which is about 10 percent of our population being diagnosed, but another 3 percent of our population still has diabetes and is undiagnosed with the disease. Preventing type 2 diabetes can begin with the identification of prediabetes, a condition characterized by blood glucose levels that are elevated but not high enough to be classified as diabetes. About one-third of the adults in our country have prediabetes, and almost 90 percent of these individuals don't know they have it. At the AMA, one of our strategic focus areas is to improve health outcomes across the nation by preventing new cases of type 2 diabetes. For the past several years, we've been working with healthcare organizations across the nation to help them identify and manage their patients at risk. We've engaged with health systems in establishing a comprehensive assessment and guided process that allows them to track their patients with prediabetes and target improvements in patient outcomes. We try to establish clinical linkages to structured, evidence-based lifestyle change programs, such as the ones offered through the CDC's National Diabetes Prevention Program. These programs are modeled after the DPP research study and subsequent translational studies to prevent or delay the onset of type 2 diabetes. And finally, we're working towards developing, testing, and disseminating relevant tools and resources to support the planning and implementation of a diabetes prevention strategy. Some of these resources include establishing an evidence-based through the research, such as the work we're going to be presenting today. The AMA works closely with physicians, their care teams, and healthcare organizations in helping them identify patients at risk for type 2 diabetes through testing for abnormal glucose in accordance with the guideline recommendations. We also promote informing and educating these patients with prediabetes about their condition. We believe everyone with prediabetes should be aware of their condition and take action to reduce their risk of progressing to diabetes. We promote engagement and shared decision-making and provide evidence-based treatment that is most suitable for their patients, whether it's a referral to a lifestyle change program, medical nutrition therapy, and prescriptions of medications. And finally, we support patients with their treatment plan and promote self-management and self-monitoring of risk. With that overview, I would like to now pass the presentation on to my colleague Alejandra Hughes, who will be diving into the further details of our research. Thanks, Kimki. As she mentioned, I'm going to be talking about our work on describing metformin prescription usage in high-risk patients with prediabetes. A bit of quick background, over one-third of the U.S. adult population meets the criteria for prediabetes. The annual conversion rate from prediabetes to type 2 diabetes ranges from 6 to 11 in prospective studies. However, numerous studies have also shown that incidence of type 2 diabetes can be reduced or delayed through lifestyle change programs like the National DPP or metformin therapy in certain patients. The American Diabetes Association recommends metformin therapy be considered for certain populations with prediabetes listed below, those with a BMI of 35 or greater. Those under age 60 or women with a history of gestational diabetes. The objective of our study was to measure metformin prescription prevalence among the first two groups, BMI over 35 or those under age 60 in a commercially insured population. Unfortunately, we were unable to include women with a history of gestational diabetes due to low counts in our study population. Our data come from the IBM MarketScan research database of commercial claims. This includes EHR and claims data on outpatient and inpatient records, laboratory values, and drug prescriptions. We excluded patients with a history of type 2 diabetes and stage renal disease, those under 18, and those who had a type 2 diabetes diagnosis within the subsequent one or three years of their initial laboratory result. Our primary outcome was a receipt of a metformin prescription within the subsequent one or three years of a lab value in the prediabetes range, focusing on fasting plasma glucose for A1Z results. The ranges are shown below. For patients with multiple lab results, we use the initial or first lab result to determine their age. BMI classification was determined by those who had a BMI result plus or minus one year from that initial laboratory result. The study flow is shown on the right. As you can see, this database contains 4.1 million patients, and we ended up with a total study population of over 53,000. This table is showing some descriptives of our population with at least one lab result in the prediabetes range. The majority were female, nearly two-thirds over the age of 55. Approximately 15% had a BMI of over 35. In this population, progression from prediabetes to type 2 diabetes within one year was 5%, and 13% when that window was extended to three years. Our main results are shown in the table below. The first two columns are patients with no type 2 diabetes within one year of their initial lab, and the percentage who have a metformin prescription within one year of that initial lab. The last two columns are the same with the absence of a type 2 diabetes diagnosis and metformin prescription windows extended from one to three years. Overall, 2.4% of patients with prediabetes had a metformin prescription within one year. For patients meeting the ADA criteria of under age 60 or BMI over 35, prevalence was 2.4% and 10.4% within one year, respectively. When we extended this window to three years, prevalence for both groups increased to 3.9% and 14%, respectively. This slide is showing density plots for A1c laboratory results all in the prediabetes range. The left panel shows age cutoffs for men in red and women in blue at age 60. The right panel shows BMI cutoffs at 35, also men in red and women in blue. You can see differences by gender for both groups of under age 60 and those with a BMI of over 35 with men tending to have higher A1c values in our population. Similar to the previous slide, this is showing fasting plasma glucose laboratory results all in the prediabetes range again. Men shown in red tend to skew higher than women shown in blue in both the under age 60 and over 35 BMI groups. So to summarize, we found that prevalence of metformin prescription within one year was very similar to the overall population compared to one of the high risk groups, those under age 60. When we extended this window to three years, prescription prevalence increases range from 1.5 to 3.6 percentage points. This positive trend indicates a potential delay in treatment among these populations. This is particularly concerning given the relatively high rate of transitioning from prediabetes to type 2 diabetes. Future research can help inform our understanding of implementing effective care management strategies for preventing type 2 diabetes. A couple of limitations to be aware of. Many of the patients in this population, approximately 45%, did not have a BMI recorded. The conclusions and results are limited to commercially insured adults, and the study population may not be nationally representative. Finally, more recent years of data, specifically 2017 and 2018, may have reduced sample size due to contracting changes within the IBM market scan database. Thank you all for listening. Good afternoon. I'm Dr. Colin Pitts, Chief Resident of the Preventive Medicine Residency Program at the University of Wisconsin-Madison. My poster is titled, SARS-CoV-2 Infection Rates Among Undergraduates Quarantined Following Exposure to a Roommate with COVID-19. This particular university decided to resume some level of in-person classes and also opened up their dorms. Due to the suspected risk of roommates of positive cases, the university decided to make a policy decision to immediately quarantine the roommate of a positive case without waiting for the usual contact tracing. This assessment looked at what that risk was to help inform and evaluate that policy decision. Over the next couple of minutes, I'll break this up into a more presentable format for you. Here is a bird's-eye view of the poster presentation. A little bit about me. I'd gone to the University of Minnesota for medical school, and while there, accepted a scholarship to the Navy. I completed internship in family medicine at Camp Pendleton and then chose to go operational. I went to the Marine Aircraft Logistics Squadron 2-6 for two years, and after that, transferred to 2nd Marine Division. I was a battalion surgeon for 2-8, where I did some interesting training and deployed to Southeast Asia. Upon return, I was requested to be the acting regimental surgeon of 8th Marine Regiment, at which point I had left the military shortly after that. I came to the University of Wisconsin to the Preventive Medicine Residency Program, where I spent the first year working primarily on the MPH, and also working with the Well Woman Program, a comprehensive cancer control program in Wisconsin. I was actually at the Wisconsin Department of Health Services with the chief medical officers when the first confirmed case of COVID-19 in Wisconsin was reported. A month later, my MPH classes were virtual, emergency orders were enacted, and we began to really get into the bulk of the COVID-19 pandemic. As I finished up my MPH, I spent some time with the nurse triage lines, setting up various call systems, and being a subject matter expert of what they could be at that time. As spring ended and summer began, this particular large Midwestern University decided to open their classes. I then spent my time with the Wisconsin State Lab of Hygiene, Wisconsin Vet Diagnostic Laboratory, trying to get the tests set up, get the FDA, EUAs for those tests, working with housing and conference centers to set the policies and procedures for quarantine and isolation. I did interviews with TV and radio, and I created, maintained, and evaluated a surveillance system for off-campus residents through the fall semester. In addition, I was responsible for surveying the health of students in isolation and provided patient care as needed to isolation and quarantine housing students. In addition to the patient care, I actually tested the students in quarantine. That's where this data came from. They were tested twice a week while in quarantine at this time. So as I mentioned, for this fall 2020 semester, here's a look at the campus overall test positivity. Between October 9th and November 24th, the test positivity overall was between 0.8 and 2.8 percent. Approximately 5,400 students in housing, and they're required to test with SARS-CoV-2 twice, sorry, weekly using observed self-collection nasal swabs. The reason this time period was chosen is we're outside this large peak at beginning where a number of campus-wide mitigation efforts were enacted, including the isolation, quarantine, and specific dorms. During this first time period, we were also testing, required testing, every other week for housing students. After this time period, because a number of students left at Thanksgiving and did not come back, we went there and we actually had the capacity to test twice a week. Test positive students were isolated in a separate dorm and 24 hours of their test collection. We maintained a separate quarantine hotel, and in close contact, the positive cases were identified through contact tracing and quarantine. When this policy decision was made, the contact tracing actually took three to five days. During the summertime period, we did not have the staff feed and training yet to turn that around any quicker, and that was about the state average of that time. During this time period, contacts were actually traced within 24 hours of test positive. As I mentioned before, the university policy required that roommates of test positive students quarantine immediately, and this was really to try to get around some of the limitations of contact tracing. Mainly for our student population, it was participation. They needed to be able to answer their phone, and surprisingly or unsurprisingly, a large number of students would not actually tell anybody who they were in contact with, or they had no idea where they could have gotten this infection. So the aim of our study was to evaluate this policy, the immediate quarantine of roommates of positive cases, by comparing the infection rates between roommates of positive cases and close contacts who were contact traced. There was 141 students that were tested and quarantined within the first four days of quarantine. We knew why they were being referred to quarantine. Confidence intervals was calculated using binomial exact, relative risk was calculated using stationary exact test. Now I'll walk you through this chart here. Essentially, we have our exposure type on the left side in that first column. Roommates and contact trace, not roommates. Some but not all roommates were contact traced. They're contact traced, they're still just categorized as a roommate, because that was the information we had first. And then whether or not they had positive tests, negative tests, and then the totals. As you can see for roommates, there's 20 positive tests of 95 total students tested within those first four days, or 21%. For those contact trace that are not roommates, two out of the 46 tested positive, or 4.4%. So I can remind you that campus average at that time was between 0.8 and 2.8%. Overall, the relative risk was 4.8, p value of 0.012 for roommates compared to contact trace that were not roommates. So overall, after quarantine to a positive roommate, student had a high chance of testing positive. The high test positivity supported our policy decision to immediately quarantine roommates with no cases. There were some limitations with the way this was performed. And we had no extra information regarding the date and method of exposure. And that really makes it unclear if the high positivity is due to transmission from one roommate to another, or from other common exposures. Overall, information data that was gained out of this guide and shape our quarantine isolation and testing procedures for the second semester. I'd like to acknowledge that support for this program was provided by the Scott's Partnership Program, Milton VA Hospital, the School of Medicine, Public Health, and American Cancer Society. Thank you.

residence

depression

firearm ownership

rural areas

urban areas

metformin prescriptions

prediabetes

SARS-CoV-2 infection rates

quarantined