Southern Medical Journal最新文献

Objectives: Despite advances in therapies and educational initiatives, pediatric allergy disorders, including asthma, allergic rhinitis, and eczema, continue to pose substantial health challenges. Understanding the social determinants of health (SDoH) linked with these conditions is a critical area of research due to their multifactorial nature. This study aimed to assess the SDoH influencing pediatric allergy disorders in central Florida, specifically examining four groups of children: with asthma only, with eczema only, with both asthma and eczema, and a control group without these conditions.

Methods: An electronic survey was distributed to parents of children diagnosed as having asthma, eczema, or both, who received evaluations at Nemours Children's Health in Orlando, Florida. The patients were categorized into four groups: asthma only, eczema only, co-occurring asthma and eczema, and a control group. A subgroup consisted of patients with asthma and allergic rhinitis.

Results: The survey revealed a significant prevalence of SDoH disparities, with 61.2% of respondents reporting at least one factor. A notable distinction emerged in parental employment status (P < 0.001). In the group of patients with allergic rhinitis, housing instability was an important factor.

Conclusions: Investigating the central Florida pediatric population provided crucial insights into the social determinants affecting pediatric allergy disorders. The study highlighted significant health disparities, particularly in parental employment status and housing instability, underscoring the critical role of social factors in these conditions. These findings emphasize the need for targeted interventions addressing social determinants to improve health outcomes for children with allergy disorders.

The renin-angiotensin-aldosterone system (RAAS) is a complex regulator comprising hormones, proteins, and enzymes. The discovery of the RAAS and its pharmacological manipulation has been essential in the management of cardiovascular diseases, including hypertension. Beyond the benefits of hypertension, RAAS inhibition has implications for heart failure, atherosclerotic disease, and kidney disease. This review discusses the history and mechanism of RAAS inhibition, cardiovascular benefits, affordability, and potential future pharmacological therapies.

Effective early mentoring is essential for propelling academic careers. There is a growing cohort of junior faculty with advanced skills in medical education and research; these individuals need both mentoring and the opportunity to take on mentorship roles. Generalists who pursue advanced training in medical education or clinical research often enter junior faculty positions alongside recent residency graduates, leaving their skillset untapped. Junior faculty with advanced training are challenged to establish their expertise and set themselves apart. By leveraging their unique skills as near-peer mentors, these individuals can build connections and reach career goals more cohesively and rapidly. In this perspective, we review the skills necessary for junior faculty with advanced career training to balance effectively the dual roles of mentee and near-peer mentor, as well as how departments can best support these unique new faculty members.

Objective: The purpose of this study was to survey current physicians in Kentucky to evaluate their management of patients with substance use disorder (SUD), with a focus on the identification of their referral methods for linkage to SUD treatment and recovery support services.

Methods: A cross-sectional study was performed through a developed survey that was administered by e-mail to all 12,152 in-state physicians licensed in Kentucky; 524 responded. Addiction specialists, emergency physicians, and psychiatrists were categorized separately; family medicine and internal medicine (FM/IM) physicians were combined into one category; all of the other specialties were grouped into an "Other" category. The results were analyzed using descriptive statistics and cross-tabulations.

Results: Of the 524 respondents, 271 (52%) said that they treated patients with SUD. Despite this, approximately 30% of them said that they do not screen for SUD. Across all specialties (except for addiction and psychiatry), many providers refer patients with SUD to treatment without prescribing any kind of treatment themselves. FM/IM physicians have a similar percentage to both addiction specialists and psychiatrists when analyzing the number of their patients who are willing to accept treatment; however, only approximately 30% of FM/IM physicians know about Kentucky's treatment and recovery placement Web site with near-real-time vacancies by geographic location with multiple filter options called FindHelpNowKY.org.

Conclusions: There are gaps in screening and linkage to care, especially in internal medicine and family medicine physicians. Work is necessary to increase screening, build provider capacity to treat, and increase knowledge of SUD treatment and recovery resources in Kentucky.

Objective: Pulmonary embolism (PE) is the third leading cause of cardiovascular death. The objective of this study was to examine the current management of pulmonary embolism at a single academic institution.

Methods: With institutional review board approval, we conducted a retrospective chart review of 805 encounters among 775 patients presenting with acute PE from January 1, 2016 to June 30, 2019. We used American Heart Association guidelines for PE risk stratification.

Results: In total, 409 patients were given the low-risk designation, 377 of these patients (92%) were anticoagulated with heparin or enoxaparin, and 32 patients (8%) were given a direct oral anticoagulant alone. There were two in-hospital mortalities (0.5%) in the low-risk group; 322 patients were in the true intermediate-risk category (ie, did not progress to high risk), and 320 patients received anticoagulation with heparin or enoxaparin (99.4%). Seventy-three patients (22%) received catheter-directed thrombolysis. There were eight in-hospital mortalities (2.5%) among the intermediate-risk group; eight intermediate-risk patients progressed to high-risk during their hospital stay, resulting in 6 in-hospital mortalities (75%) in this group. There were 66 patients designated as high-risk upon presentation. Sixty patients (91%) received heparin for anticoagulation and 47 patients (71%) required advanced therapies. Fourteen high-risk patients (21%) had bleeding complications, and there were 26 (39%) in-hospital mortalities.

Conclusions: The management of PE has evolved, and proper risk stratification is key. Largely speaking, low- and intermediate-risk patients can be treated with anticoagulation, whereas patients with severe right ventricular strain and hemodynamic instability may require more advanced therapies.

Objectives: Liver fibrosis represents a common sequela of nonalcoholic fatty liver disease (NAFLD) and other chronic liver diseases. Noninvasive liver fibrosis scores (LFSs) aim to evaluate the severity of liver fibrosis. Whether LFSs can predict the risk of future cardiovascular events (CVEs) remains unclear. This systematic review aimed to clarify the association between liver fibrosis and CVEs by studying the value of LFSs, namely the Fibrosis-4 (FIB-4) Index for Liver Fibrosis score and the NAFLD Fibrosis Score (NFS), for predicting CVEs.

Methods: PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant prospective studies. Retrieved articles were screened to confirm their eligibility for the systematic review. We evaluated the quality of the included studies using the National Institutes of Health tool.

Results: Twelve studies of high to fair quality were included in this systematic review. Of note, 10/12 studies reported an independent association between high LFSs and the risk of CVEs, cardiovascular mortality, and all-cause mortality (all P < 0.05). In addition, an advanced histological grade of liver fibrosis (grade 3 or 4) was suggestive of CVE occurrence. NAFLD also appeared to be associated with a higher risk of CVEs at any severity of fibrosis (all P < 0.05).

Conclusions: The findings of this review suggest that liver fibrosis in patients with NAFLD is an independent predictor of future adverse CVEs, cardiovascular mortality, and all-cause mortality. Noninvasive and easy-to-perform LFSs, including FIB-4 score and the NFS, appear useful in predicting such events in patients with a spectrum of cardiovascular diseases and the general population without known cardiovascular disease.

Objectives: The 2022 Dobbs v Jackson Women's Health Organization US Supreme Court decision dramatically shifted the legal landscape in health care, leaving state legislatures to redefine the ethics of medical practice. As gold-standard medical procedures become banned and criminalized, physicians are facing heightened legal uncertainty and grappling with moral dilemmas of where and how to practice. This study aimed to quantitatively assess trends in legal concern among medical students and identify correlations with decision making regarding future medical training.

Methods: To assess the impact of the Dobbs decision on trainees, a 24-item RedCAP survey was distributed to 72 medical schools assessing both geographic residency preferences and level of legal concern surrounding 10 abortion provision scenarios. Level of concern was assessed on a 3-point Likert scale from "not at all concerned" to "very concerned." To observe overall trends, an average level of concern score was computed by assigning numeric values to responses and averaging the scores for each respondent.

Results: In total, 2298 medical students completed the survey and were included in the analysis. Students identifying with she/her pronouns and as Asian or studying in abortion-protected states had significantly higher levels of concern. Moreover, respondents located in abortion-restricted states with high levels of legal concern were more likely than their peers to indicate wanting to move to abortion-protected states for residency.

Conclusions: Individuals with heightened proximity to reproductive healthcare may face greater ethical and moral dilemmas as they seek future career opportunities in a post-Roe v Wade world. These data suggest that they seem highly responsive to moving out of abortion-restricted states, indicating that the Dobbs decision, and the legal landscape it has created, may further exacerbate disparities in reproductive health care.