In recent times, healthcare providers have leveraged Instagram to share insights into their medical specialty, providing educational content to the public in a format distinct from traditional medical norms. However, the medical domain on Instagram lacks the same level of regulation, potentially resulting in the dissemination of inaccurate information3, impacting patient experiences and health outcomes. Our study aims to evaluate the quality and accuracy of obstetric anesthesia-related content on Instagram.
A search Instagram posts for #Epidural, #EpiduralAnalgesia, #ObAnesthesiologist and #ObstetricAnesthesia was conducted. Engagement metrics were used to quantify post content reach. Medical education videos were assessed for accuracy and PEMAT-A/V to evaluate understandability and actionability.
A total of 80 Instagram posts were analyzed, revealing a predominant focus on Medical Education(46%), followed by Provider Lifestyle(21%), Advertisement(16%), Research Articles(8%), Patient Experience(5%), and Medical Illustration(4%). In medical education content, 69% of posts were completely accurate, 28% were partially accurate or potentially misleading, and 3% were entirely inaccurate. When comparing video posts to picture posts: among video posts, 50% accurate information, 42% partially accurate or incomplete information, and 7% were entirely inaccurate. In contrast, picture posts demonstrated higher accuracy rates, with 81% being accurate, 19% partially accurate or potentially misleading, and none being inaccurate.
Our analysis illustrates diverse obstetric anesthesia-related content on Instagram. Future research should assess accuracy variations among different obstetric healthcare provider types on social media and provide strategies for healthcare providers to improve engagement, maintain accuracy, and navigate time constraints when sharing medical information.
Racial and ethnic minorities have historically experienced inequities in pain assessment and analgesia delivery, as well as worse perioperative outcomes. An equally diverse physician workforce is necessary to care for the needs of this population. Despite ACGME's interest in prioritizing expansion and support of a diverse workforce, the percentage of URiM Anesthesiology trainees is lagging behind the demographic shift in the US.
We extracted data from the Accreditation Council for Graduate Medical Education (ACGME) graduate medical education Data Resource Book from 2012 to 2022. We performed a Chi-squared analysis of the demographic data of Anesthesiology residents and subspecialty fellows by race and ethnicity then compared to US census demographics & AAMC Matriculant Data File.
Asian residents and fellows are overrepresented in nearly all categories, ie. Anesthesiology residency, Pediatric Anesthesia, Pain Medicine, Adult Cardiothoracic Anesthesia, Critical Care Medicine, and Colon & Rectal Surgery fellowship (all pp<0.001). Black, Hispanic, and Native American doctors are all underrepresented in Anesthesiology residency programs (p<0.001). At the fellowship level, Black candidates are underrepresented in Adult Cardiothoracic Anesthesia (p<.01), Pain Medicine (p<0.001), Pediatric Anesthesia (p<.05), and Critical Care (p<.001). Hispanic candidates are underrepresented in nearly all subspecialty programs: Colon & Rectal surgery (p<.001), Critical Care (p<.001), Obstetric Anesthesia (p<.05), Pediatric Anesthesia (p<.05), Pain Medicine (p<0.001), and Adult Cardiothoracic (p<.001).
The onus now lies with academic medical institutions to cultivate diversity by recruiting and retaining URiM trainees so that the field can better reflect the population and bridge the gap to healthcare equity.
Pancreatic ductal adenocarcinoma (PDAC) is currently the third-leading cause of cancer-related death in the United States. African Americans (AAs) with PDAC have worse survival in comparison to other racial groups. The COVID-19 pandemic caused significant stress to the healthcare system. We aim to evaluate the pandemic's impact on already known disparities in newly diagnosed patients with PDAC in Florida.
This is a retrospective analysis of newly diagnosed patients with PDAC in the OneFlorida+ Data Trust based upon date of diagnosis: Pre-pandemic (01/01/2017- 09/30/2019), Transition (10/01/2019-02/28/2020), and Pandemic (03/1/2020-10/31/2020). Primary endpoints are time to treatment initiation and rate of surgery and secondary endpoint is survival time. Disparities due to age, sex, race, and income were also evaluated. Chi-squared or Fisher's exact test when necessary, Kruskal-Wallis test, and Kaplan-Meier analysis with log-rank test were performed to compare the differences between the comparative groups for categorical, quantitative, and survival outcomes, respectively. Multivariable regression analyses were conducted to estimate the effects of cofactors.
934 patients with a median age of 67 years were included. There were 47.8% females and 52.2% males; 19.4% AA, 70.2% Caucasian, 10.4% Other race; median income was $53,551. While we observed a significant reduction in the diagnosis rate of new PDAC cases during the pandemic, there were no significant differences in demographic distributions among the three cohorts. Time to treatment did not significantly change from the pre-pandemic to the pandemic, and no difference was observed across all demographics. Rate of surgery increased significantly from the pre-pandemic (35.8%) to the pandemic (55.6%). AAs in the pre-pandemic cohort had a significantly lower rate of surgery of 25.0% compared to 41.7% in Caucasians. AAs, patients ≥ 67 years, and income < $53,000 had significantly higher hazards to death and shorter median survival time (mST).
While no differences in time to initial treatment are observed among the newly diagnosed PDAC patients, there remain significant disparities in the rate of surgery and overall survival. Observing a significant reduction in diagnosis rate and analyzing disparities can provide insight into the effect of a resource-restricting pandemic for patients with newly diagnosed PDAC.
Mixed cryoglobulinemia is a rare systemic vasculitis characterized by the presence of cryoglobulins precipitating at low temperatures. These proteins can impede blood flow, leading to a variety of symptoms such as purpura, skin ulcers, and multi-organ impairment in severe cases. This condition presents diagnostic challenges due to its variable clinical presentation and relatively rare nature. This report details the case of a 41-year-old African American female with end-stage renal disease (ESRD) on peritoneal dialysis, initially suspected to have calciphylaxis, who was ultimately diagnosed with mixed cryoglobulinemia.
The patient's clinical presentation of bilateral thigh and breast wounds associated with severe pain, prompted a thorough clinical workup. Punch biopsies were taken from areas of new retiform purpura and examined with H&E and Von Kossa staining. Extensive lab work and serological analysis were obtained to help identify the underlying etiology.
Biopsy examination was indicative of vasculopathy and comprehensive serologic analysis detected quantitative cryoglobulins, confirming non-infectious mixed cryoglobulinemia. Despite therapeutic interventions, the patient succumbed to complications associated with ESRD and secondary infections.
This case highlights the complexity of problems seen in ESRD patients on dialysis. When presented with a patient with ESRD with retiform purpura in fatty areas, calciphylaxis should be considered. If refractory or severe, a search for additional causes should be performed. Given its relatively rare nature, physicians must have a high index of suspicion to consider mixed cryoglobulinemia. Secondary complications in ESRD patients with retiform purpura are common, and continued surveillance for infectious complications is recommended.
Alcohol use among high school students, particularly high-risk drinking behaviors, are a significant public health concern. Substance use during adolescence is associated with increased risk of both acute and long-term adverse health outcomes. Sexual minority youth (SMY) are more likely to initiate alcohol use at a younger age and engage in binge drinking when compared to their heterosexual peers. There are also significant differences between the risky alcohol use behaviors among sexual minority identities. Recent research has suggested school-based victimization disproportionately impacts SMY and is associated with an increased risk of binge drinking. Through this study we hope to determine the association between binge drinking and sexual identity among high school students and assess if school-based victimization moderates this relationship
This cross sectional study utilized data from a nationally representative sample of United States high school students (n=26,675) collected in the 2017 and 2019 Youth Risk Behavior Survey. Logistic regression was used to assess the association between sexual minority identity and binge drinking. In addition, we tested for moderation of the relationship by school-based victimization.
When compared to their heterosexual peers, bisexual female students were significantly more likely to report binge drinking within the past 30 days. School-based victimization moderate this association.
Bisexual females are at a higher risk of participating in binge drinking when compared to their heterosexual counterparts. Our results suggest interventions to reduce school-based victimization may play an important role in addressing risky drinking behavior in this population.
Research has shown chronic diseases can be associated with suicide but there is limited data on suicide in cardiovascular disease (CVD). Given the substantial psychosocial, financial, quality of life, and health impact of CVD, we aimed to study suicide-related mortality in CVD.
We used Center for Disease Control Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access Multiple Cause of Death data from 1999 to 2019. Suicide and CVD related deaths in patients ≥ 25 years were identified. Proportionate suicide-related mortality (PSrM) was calculated as suicide-related deaths (listed with CVD) divided by all CVD-related deaths (irrespective of suicide) and reported as PSrM per 100,000 CVD-related deaths. Joinpoint regression was used to examine trend changes using annual percentage change (APC) overall and by sex, race/ethnicity, disease subtype, and age.
Overall, PSrM in CVD increased from 62.8 in 1999 to 90.5 in 2019. The PSrM increased from 1999 to 2002 with an associated APC of 6.2 (95 % CI, 0.0 to 12.7), remained stable from 2002 to 2005, increased from 2005 to 2013 with an APC of 4.8 (95 % CI, 3.4 to 6.3), and decreased from 2013 to 2019 with an APC of -2.1 (95 % CI, -3.6 to -0.5). Among racial/ethnic groups, PSrM was highest in non-hispanic (NH) White (103.8), then Hispanic or Latino (63.6), and then NH Black or African American individuals (29.2). PSrM was highest in the 25–39 years age group (858), then 40–54 years (382.8), 55–69 years (146.2), 70–84 years (55.9), and then 85+ (17). PSrM initially increased in men with APC (3.1 until 2013), women (4.1 until 2014), NH White individuals (3.9 until 2013), Hispanic or Latino (3.5 until 2014), ages 40–54 years (2.9 until 2013), 55–69 years (6.0 until 2013), then stabilized or decreased. AAMR increased in NH Black or AA individuals APC (1.0) and 25–39 years APC (1.4) from 1999 to 2019.
PSrM in CVD peaked in the early 2010s, with varying differences across sex, racial/ethnic, and age groups. Further research is needed to understand disparities and develop preventive strategies.
Previous studies have reported mixed results on the relationship between live births and cardiovascular disease among African American females, with few controlling for an inclusive list of major cardiovascular disease (CVD) risk factors and/or including a large population of African American female participants.
Data was from 3367 African American women, 21 and older, in the Jackson Heart Study. Myocardial Infraction (MI), Self-reported history of cardiac procedures, Coronary Heart Disease Status/History, Self-reported history of Carotid Angioplasty, Cardiovascular Disease history, and Heart Failure History were obtained from 2000 to 2004 interviews. Live births were self-reported. Chi-square test indicated a significant association between live births and the presence of CVD (p =.000). Logistic regression estimated the relationship between live births and cardiovascular events, adjusting for major cardiovascular risk factors.
After adjusting for hypertension status, current smoking status, cholesterol status, diabetes status, family history of heart diseases (mother), family history of heart disease (father), age, frequency of alcohol use in the past 12 months, and the average number of drinks per week in the past 12 months, there was no longer a significant relationship between live births and the risk of CVD (AOR 1.012, 95% CI, 1.009-1.015, p=.895).
The unadjusted significant relationship between live births and CVD events disappeared after adjusting for major CVD risk factors, which suggests that an association between live births and CVD is indirect and based on the distribution of CVD risk factors.
Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. It is a condition in which women without previously diagnosed diabetes mellitus exhibit high blood glucose levels during pregnancy. Hyperglycemia in pregnancy results in both maternal and fetal complications. The prevalence is rising worldwide. The study aimed to determine the prevalence of GDM and its correlates among women attending ANC at FMC Birnin Kebbi.
A cross sectional study was carried out among 130 women attending ANC at FMC, Birnin Kebbi. An interviewer administered semi-structured questionnaire was used to obtain the biodata and other relevant information which were imputed into an SPSS computer statistical software version 20 and analyzed.
The mean age of study participants was 27.4±4.5 years. Awareness of DM was high (90%), while that of GDM was low 41%. The major sources of information were friends/ neighbors (35%). However, only 35.2% had overall good knowledge for GDM. The prevalence of GDM and DM in pregnancy was 10% and 3.8% respectively. The major risk factors for GDM identified were; age, obesity and family of type 2 DM. The common complications identified associated from GDM/DM were; polyhydramnios, intrauterine fetal death and increase risk of Caesarean section.
From the study the prevalence of GDM is increasing with general poor knowledge of the condition. Hence, more public enlightenment programs are needed to improve the level of awareness among the populace and regular screening in all health facilities among the ANC patients.
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