Southern Medical Journal最新文献

Objectives: The objectives of the study were to provide a descriptive assessment of patient and hospital characteristics among individuals with an opioid use disorder (OUD) diagnosis in North Carolina and the seven western North Carolina counties and to identify rates of selected psychiatric/physical health outcomes associated with OUD and treatment gaps in medications for opioid use disorder (MOUD).

Methods: Using the State Inpatient Database (SID), analyses were conducted to identify OUD and MOUD-related discharges between 2000 and 2020. Descriptive statistics and rates of OUD per 1000 discharges were calculated. Statistical significance for rates of OUD and non-OUD cases was determined using 95% confidence intervals. Variables indicating OUD diagnosis, MOUD participation, and comorbidities were identified.

Results: The seven selected counties in North Carolina had a total of 396,183 hospitalizations between 2000 and 2020. Apart from Macon County, the overall county-level prevalence rates of OUD were consistently higher than that of the state. Compared with North Carolina, the median hospital length of stay and hospital charges for OUD patients in the seven counties were consistently higher than those for non-OUD discharges. Significant MOUD treatment gaps were observed in the seven counties.

Conclusions: The impact of the opioid epidemic is still pervasive in North Carolina, particularly in the seven western countries. The high rates of OUD and comorbid conditions in tandem with treatment shortages pose serious public health threats in these rural communities. Policies, funding, and programmatic efforts should prioritize the expansion of MOUD and other treatment efforts, including crisis services, harm reduction services, and recovery programs. Public health needs assessment that involves both patients and stakeholders should be carried out to deliver targeted health services and deploy necessary resources in this medically underserved region.

Military sexual trauma (MST) significantly impacts the health and well-being of women veterans in the US military, where women constitute 16.3% of active-duty service members. Despite policy advancements, MST remains prevalent, with profound implications for mental and physical health. MST encompasses sexual assault and harassment, affecting 38% of women and 4% of men in the military. It is linked to higher rates of posttraumatic stress disorder, depression, substance use disorders, and physical health issues such as cardiovascular disease and chronic pain. In addition, MST survivors face social functional impairments, including difficulties in family relationships, occupational performance, and educational achievements. The military environment, characterized by close living quarters and hierarchical power dynamics, exacerbates the risk and consequences of MST. Survivors often experience institutional betrayal and fear of retaliation, hindering reporting and access to support. Effective interventions must address these unique challenges, emphasizing trauma-informed care, social support, and systemic changes to promote gender equity and accountability. Leveraging technology, such as mobile applications and online interventions, can enhance access to care and support for MST survivors. Comprehensive prevention and intervention strategies, coupled with policy reforms and cultural shifts within the military, are crucial for mitigating the impacts of MST and supporting the recovery and well-being of women veterans. The objective of this narrative review is to examine the health impacts and systemic challenges of MST among women veterans, advocating for trauma-informed care and policy reform.

Objectives: The purpose of this study was to provide a description of the physician assistant (PA) workforce in Kentucky and the perspective of current Kentucky PA students regarding factors to influence rural work. This study intends to provide insights into the practice patterns of Kentucky PAs and alumni and desires of current students to assist policy leaders in understanding the impact that PAs could have on this medically underserved part of the country.

Methods: The Kentucky Board of Medical Licensure database of licensed PAs and physicians was used to locate all currently practicing PAs in Kentucky and PA graduates from a large public university in Kentucky, 2016-2022. These practice locations were used to demonstrate movement of PA alumni before school matriculation, current practice areas by Health Professional Shortage Area and Medically Underserved Areas/Populations by counties and area of specialty. A cross-sectional survey was given to PA students at a large public university in Kentucky aimed at assessing the perceptions and influential factors regarding the PA profession and personal employment opportunities among PA students.

Results: There are 1649 PAs who have active licenses in Kentucky and practice in 92 counties with 28 counties with no PAs; 42.5% of Kentucky PAs serve primary care Health Professional Shortage Areas and 20.0% serve in Medically Underserved Areas/Populations. The most common areas of practice are emergency medicine (14.5%) and internal medicine (14.5%). PAs from rural areas had significantly higher odds of holding a rural license compared with those from metropolitan areas (odds ratio, 6.42; Z = 6.76; P < 0.00001). Students reported choosing the PA profession due to length of education, work-life balance, and career mobility.

Conclusions: Addressing the critical healthcare access issue in the southern United States will require innovation and utilization of the entire healthcare team. With 34% of PAs working in rural counties in Kentucky, policy leaders need to focus on methods to incentivize the next generation of PA providers to rural counties. As the dependency on nonphysician providers increases, future policy decisions and research needs to center around PA practice patterns and understanding of the needs of the next generation of providers.

Objectives: The coronavirus disease 2019 pandemic exacerbated mental and physical health issues in the United States. Due to various lockdown procedures to curb the spread of the virus, indoor gatherings were severely restricted, intensifying stress and anxiety.

Methods: We used nationally representative data from the 2021 Crime, Health, and Politics Survey sampled from the National Opinion Research Center's AmeriSpeak panel. To explore pandemic-safe options to relieve negative health outcomes, we studied how access to and use of green and blue spaces were related to self-rated physical and mental health (ie, memory) during the pandemic.

Results: Most of the logistic regressions show no relationships between access to green or blue spaces and the health outcomes (except for access to blue spaces and physical health), but we find positive associations between use of green and blue spaces with overall physical health and memory.

Conclusions: Access to green or blue spaces is not necessarily enough to create a relationship with overall physical health and memory-actually using these areas is a key component to their association with positive health outcomes.

High-sensitivity C-reactive protein (hs-CRP) is a key marker of inflammation, predominantly produced by hepatocytes and various tissues, including intracardiac tissue, atherosclerotic plaques, and vascular smooth muscles. The biomarker serves as a crucial element of innate immunity and rises in response to various disease processes, including infections and cancers. This rise is triggered by the release of cytokines, primarily interleukin-6, tumor necrosis factor, and interleukin-1β. The utility of hs-CRP in clinical practice is being further explored, particularly regarding its role in cardiovascular disease, a leading cause of morbidity and mortality globally. Studies have demonstrated that elevated hs-CRP levels are associated with an increased risk of myocardial infarction (MI) and other cardiovascular events. hs-CRP has been suggested to play a role in the development of atrial and ventricular arrhythmias post-MI, although further research is needed to fully clarify this relationship. hs-CRP has been proposed as a potential biomarker for the early detection of post-MI events and be used for cardiovascular disease risk stratification, categorizing individuals into low-, intermediate-, and high-risk groups. In this study, we discuss the role of hsCRP in predicting adverse outcomes in various cardiovascular conditions, highlighting its potential as a valuable biomarker in clinical practice.

Objective: Colorectal cancer (CRC) is the third most common cancer worldwide and the second most common cause of cancer death for men and women combined. It is estimated that in 2024, 53,010 people will have died from CRC. The objective of this study was to analyze online interest in CRC screening in Florida.

Methods: Google Trends was queried for "colorectal cancer screening," "fecal occult blood test," and "colonoscopy" from 2004 to the present. The relative search volume (RSV) ranged from 0 to 100, with 0 meaning no interest and 100 signifying maximum popularity.

Results: Google Trends analysis revealed variations in interest for CRC screening, fecal occult blood test as a screen, and colonoscopy across Florida metropolitan areas. Gainesville consistently ranked high for all three terms. Interest peaked for screening in 2009 and 2022, for fecal occult blood test in 2024, and for colonoscopy in 2007. Related search terms focused on screening guidelines, procedures, and preparation.

Conclusions: Google Trends can provide a useful tool for evaluating interest in Florida for CRC screening, which is important because there are screening disparities across Florida counties compared with national and state averages. By identifying areas with lower search interest, healthcare providers and public health organizations can target community interventions based on the specific barriers faced by residents in each metropolis.

There has been an uptrend in patients taking Artri King, an over-the-counter supplement marketed for joint pain despite Food and Drug Administration warnings of it containing undeclared substances such as diclofenac and dexamethasone. Despite the popularity of this supplement, there is a lack of awareness of the deleterious, adverse effects. To our knowledge, there has not been a systematic review evaluating outcomes of patients taking Artri King. A comprehensive literature search was performed from major databases from inception to June 17, 2024, including case studies or case series investigating outcomes of patients taking Artri King as a supplement or treatment. A total of 16 patients (12 female and 4 male) from 10 studies were included in our literature review, with four of those patients being from our home institution. Patients presented with a wide variety of chief complaints, but fragility fractures were the most common at our home institution. The average duration of Artri King use was 16.67 months (at our home institution) versus 13.35 months for the rest. Overall, 75% of the patients included were diagnosed as having Cushing syndrome. Serious adverse effects of taking Artri King include Cushing syndrome, adrenal insufficiency, and worsening hyperglycemia. Clinicians should obtain a thorough drug and supplement history, and we recommend informing patients of the serious adverse effects associated with Artri King and advise against its use.

Objectives: Sexual and gender minority (SGM) communities at increased risk of human immunodeficiency virus (HIV) may be underprescribed preexposure prophylaxis (PrEP), but PrEP research on SGM communities other than transgender women and cisgender men who have sex with men is limited. We sought to better understand SGM individuals' vulnerability to HIV acquisition and awareness and perceptions of PrEP in North Carolina, with a focus on SGM groups less often included in research.

Methods: We administered a 37-item online survey to adult SGM participants, examining differences in perceived and behavioral HIV risk based on self-reported behaviors. We also compared PrEP awareness, prescriptions, and stigma between SGM identities and used logistic regression to examine associations between HIV risk and PrEP use.

Results: In total, 372 participants completed the survey. Although 30.9% reported behaviors that increase the likelihood of HIV acquisition, only 9.5% perceived their risk as elevated. Most (78.5%) were aware of PrEP, but only 15.1% had been prescribed PrEP. PrEP stigma was most pervasive among cisgender women. Nonbinary and queer participants were more likely to have experienced mistreatment by a provider (20.3%, P < 0.0001; 19.2%, P < 0.01) and avoid care fearing mistreatment (31.9%, P < 0.001; 27.7%; P < 0.001) compared with the entire sample.

Conclusions: PrEP is prescribed at low rates across many SGM communities, with misperception of HIV risk, PrEP stigma, and mistreatment in health care identified as important barriers. Healthcare providers should take steps to create a safe environment for SGM patients and ask all patients about HIV risk factors and provide information about PrEP regardless of sexual orientation or gender identity.