Southern Medical Journal最新文献

Objectives: This study aimed to evaluate the trends in syphilis prevalence in Lubbock County, Texas, from 2018 to 2022 and identify significant changes over time. In addition, it sought to assess the relationship between syphilis trends and the coronavirus disease 2019 (COVID-19) pandemic, comparing local patterns to state-level data.

Methods: Data on COVID-19 cases in Lubbock County and Texas from 2018-2022 were obtained from the City of Lubbock Health Department and the Texas Department of State Health Services. Joinpoint regression analysis was conducted to identify statistically significant changes in the linear trends of the prevalence of syphilis and COVID-19 over time and evaluate disparities in these temporal trends.

Results: There were significant changes in the growth of the number of syphilis cases that coincided with increasing trends in COVID-19. The growth in the trend for these two infections was largely parallel. A similar relationship between syphilis and COVID-19 was observed for the state of Texas, although the growth in the trends of syphilis from 2020 to 2022 was higher in Lubbock County than the growth for Texas.

Conclusions: The data indicate a notable relationship between the growth in the prevalence of syphilis and COVID-19 in Lubbock County and Texas from 2018 to 2022, with estimates for Lubbock County being more pronounced than Texas.

Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately 100 million individuals in the United States. Previous studies have reported a significant association between obesity and MASLD. The objective of our study was to examine the relationship between obesity and population-level trends in MASLD prevalence among US adults aged 20 years and older.

Methods: We conducted a retrospective analysis of serial cross-sectional data from the National Health and Nutrition Examination Survey cycles (1999-2018). MASLD was defined using two criteria: (1) US Fatty Liver Index (USFLI) ≥30 or (2) cardiometabolic risk factors (≥1) with controlled attenuation parameter ≥288 dB/m (2017-2018 only). Temporal trends in the prevalence of MASLD and obesity were analyzed using logistic regression with the midpoint of a 2-year survey cycle as a continuous independent variable. Adjusted odds ratios (ORs) quantified obesity's association with MASLD trends, controlling for age, sex, race/ethnicity, and survey design variables.

Results: Among 17,824 participants, 36.62% were obese (body mass index ≥30 kg/m²) and 33.49% met MASLD criteria (USFLI ≥30). MASLD prevalence increased from 30.20% (95% confidence interval [CI] 26.57%-33.83%) in 1999-2000 to 38.64% (95% CI 35.47%-41.80%) in 2017-2018 mirroring rising obesity rates (30.26%-43.51%). MASLD prevalence varied significantly across different demographics, with the highest rates observed in older adults, males, and Mexican Americans. Obesity was associated with a 14.05-fold higher odds of MASLD (95% CI 12.62-15.65).

Conclusions: MASLD prevalence trends closely parallel the obesity epidemic, with obesity strongly associated with MASLD risk. The differential prevalence rates among older adults, males, and Mexican Americans highlight the need for targeted prevention strategies, including obesity management.

Objectives: Food insecurity has been rising in the United States, disproportionally affecting populations with no insurance, low socioeconomic status, and racial minorities. It is associated with overall poorer health, especially in terms of glycemic control, mental health, and cardiovascular disease. Addressing it is critical because although studies show its significance, most physicians do not screen for different social determinants of health, including food insecurity.

Methods: A cross-sectional study of household food security status was performed on 209 patients from June to August 2021 at the University of Florida's Springhill Clinic (run by Internal Medicine) and the Equal Access Clinic, a student-run free clinic. The US Department of Agriculture's Spanish and English versions of the Household Food Security Survey were used. The χ² tests were used to determine whether the number of respondents in each food security category varied significantly by sex, age group, primary language, presence of children in the home, insurance status, and clinic site.

Results: Among the 209 participants, food insecurity was reported by 23.4% of patients. The only statistically significant sociodemographic factors that corresponded to food security status levels were the patient's insurance status and clinic site. A total of 82.6% of insured patients were food secure, whereas only 65.2% of uninsured patients were food secure. A total of 14.5% of Equal Access Clinic patients experience severe food insecurity, whereas 0% of patients at the Springhill Clinic do. The χ² tests determined that the number of respondents in each food security category varied significantly by insurance status (P = 0.01).

Conclusions: This study highlights the prevalence of food insecurity at primary care clinics, especially student-run clinics. Although limited by sample size and cultural barriers of the given survey, the findings emphasize the gap in standardized screening protocols for food security and the importance of physician sensitivity. Addressing this topic can improve food security and the health benefits that follow through early intervention.

Objectives: The Rio Grande Valley (RGV) is a developing clinical research region characterized by its distinctive demographic profile that offers an opportunity to investigate diverse health issues. This pilot investigation sought to evaluate the demographic and clinical characteristics linked to bone metastases and primary malignant bone neoplasms (PMBNs) in patients from the RGV and to compare the frequency of these conditions with the US general population.

Methods: This was a retrospective chart review in which data were gathered from the University of Texas Rio Grande Valley UTHealth electronic database from January 1, 2018 to September 4, 2024. Various statistical analyses were performed to assess the demographic and clinical data.

Results: Individuals in the RGV are more likely to develop a PMBN (P < 0.0163) but less likely to have bone metastasis (P < 0.0015) compared with the general US population. Regarding bone metastases and PMBN, although not statistically significant, patients with bone metastasis were 10 years older on average and exhibited a lower body mass index (-1.7 kg/m²) and weight (-17.6 kg) than those with PMBN.

Conclusions: Our initial research indicates age and body weight variations among individuals with bone metastases and PMBN in the RGV, as well as differences in frequency of bone metastases and PMBN in this medically underserved region compared with the general US population. Despite the limited sample size, our results necessitate further exploration in a larger cohort to elucidate any demographic and clinical differences in bone metastases and PMBN subtypes in medically underserved areas.

Objectives: Recent literature suggests that hospitalization may lead to new-onset type 2 diabetes mellitus (NODM2). Understanding this relationship is crucial for developing interventions that could reduce long-term complications and healthcare costs associated with DM2 and major adverse cardiovascular events (MACE). This systematic review and meta-analysis aims to assess the incidence of NODM2 and MACE in patients after hospitalization.

Methods: With the assistance of the Mayo Clinic Libraries, we searched MEDLINE, Cochrane, and Scopus for medical literature reporting the incidence of NODM2 and the presence of MACE in hospitalized patients from database inception to March 2024. The systematic review and meta-analysis were performed according to the guidelines of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guidelines.

Results: Among the 168,673 patients from 25 studies, 7677 developed NODM2 after hospitalization (4.5%). The pooled incidence rate was 9.8% (95% confidence interval 5.5%-14.1%, P < 0.001). An exploratory analysis comparing patients' glycemic statuses showed a significantly increased risk of NODM2 development after hospitalization among patients with impaired glucose tolerance or stress hyperglycemia compared to normoglycemia group. Only one eligible study reported any MACE outcomes, and meta-analysis could not be performed to assess the effects of hospitalization on MACE.

Conclusions: This study highlights the high rate of NODM2 development after hospitalization. Growing evidence suggests that it may lead to long-term metabolic complications, particularly in patients who experienced dysglycemia during illness.

Objectives: Female sexual dysfunction (FSD) refers to problems with desire, arousal, orgasm, or pain, affecting approximately 12% of US women. Although FSD can be managed in primary care, most primary care clinicians do not regularly treat it. This survey of primary care clinicians practicing at a large US health system assessed perspectives on managing sexual dysfunction compared with other conditions, knowledge of prevalence of sexual dysfunction, and which specialty should be responsible for treating FSD.

Methods: We described the distribution of clinicians' survey responses. Of the 527 invited, 80 completed the survey (response rate: 15%). Most were women (68%), physicians (52%), and had >15 years of experience (43%).

Results: The majority (88%) reported treating FSD is as important as treating other conditions that affect quality of life. Two-thirds reported disorders of desire, arousal, and orgasm could be managed in primary care, and 64% believed that pain with intercourse, typically addressed by Obstetrics/Gynecology, should be handled in primary care. Most primary care clinicians believed that treating FSD was at least as important as treating other conditions, yet up to one-third believed this responsibility should be left to a different specialty.

Conclusions: Educational interventions targeting primary care clinicians may increase the number who take on FSD management.

Objectives: Hospital rounding practices have shifted away from being conducted at the patient's bedside to favor rounding in workrooms. Prior studies assessing learner attitudes toward bedside rounds largely focused on its educational value for residents, with less attention paid to medical students or other relevant domains in the learner experience. We sought to comprehensively capture resident and medical student perceptions of bedside rounds and their effects on various key domains, as well as elucidate common barriers to bedside rounding.

Methods: All residents and medical students who participated in teaching rounds in Internal Medicine at one large academic medical center in 2024 were invited to complete a voluntary anonymous survey. Participants also had the opportunity to partake in structured qualitative interviews, which were analyzed using a constructivist grounded theory approach to examine learners' perspectives on the impact of rounding setting on each of the key domains.

Results: Seventy-seven residents and 112 medical students completed the survey (response rates of 45% and 39%, respectively), and 18 interviews were conducted (10 residents and 8 medical students). Overall, both residents and medical students had a majority preference for either table or hybrid rounding over bedside rounding in nearly every domain.

Conclusions: Medical students overall identified more positive aspects of bedside rounding, particularly in regard to its potential to introduce opportunities for teaching or improved patient care. These findings may help institutions develop guidelines and faculty development practices for improving learner receptivity and engagement with bedside rounds.