American journal of medicine open最新文献

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What are the attitudes of medical students and housestaff towards health advocacy? A physician-led voter registration initiative and health advocacy survey 医学生和家政人员对健康宣传的态度是什么?一项由医生主导的选民登记倡议和健康倡导调查

American journal of medicine open

Pub Date : 2022-12-01 DOI: 10.1016/j.ajmo.2022.100023

Robert J DeGrazia Jr , Serena Ogunwole , Ting-Jia Lorigiano , Jessica Bienstock , Craig Evan Pollack

Background

Compared to the general population, physicians have been shown to be less engaged in civic participation and less likely to vote. However, perspectives of current trainees on health advocacy remain under-explored.

Objective

To investigate perspectives on a physician led voter registration initiative and identify current beliefs of physicians in training and medical students regarding physician health advocacy.

Design

Cross sectional survey performed at a single urban academic center.

Participants

A total of 366 medical students, residents, and fellows voluntarily participated in the survey out of a total of 1,719 available (21% response rate).

Main Measures

We examined the current perceptions surrounding health advocacy among medical students and physicians in training and how this was impacted by the COVID-19 pandemic. Responses were analyzed using Chi-square analysis and logistic regression.

Key Results

The voter registration code was scanned 131 times prior to the 2020 Presidential elections. Barriers to hospital-based voter registration included lack of time, lack of fit into the workflow and forgetting to ask. Over half of internal medicine-based residents and fellows (51%) and medical students (63%) agreed that physicians should be involved in helping patients register to vote compared to 34% of surgical-based trainees. A large majority (87%) indicated that the COVID-19 pandemic made it more necessary for physicians to be involved in politics.

Conclusion

A high proportion of medical students and housestaff across specialties report an obligation to be involved in health advocacy, though there were differing views towards direct involvement in voter registration.

与一般人群相比，医生被证明较少参与公民参与，也不太可能投票。然而，目前受训人员对保健宣传的看法仍未得到充分探讨。目的调查医生领导的选民登记倡议的观点，并确定当前培训医生和医学生对医生健康宣传的看法。设计在单个城市学术中心进行的横断面调查。参与者共有366名医学生、住院医师和研究员自愿参与了调查，调查对象共有1719人(21%的回复率)。我们调查了医学生和实习医生目前对健康宣传的看法，以及这种看法是如何受到COVID-19大流行的影响的。采用卡方分析和逻辑回归对反应进行分析。在2020年总统大选之前，选民登记代码被扫描了131次。在医院进行选民登记的障碍包括缺乏时间、不适应工作流程以及忘记询问。超过一半的内科住院医师和研究员(51%)以及医学生(63%)认为医生应该参与帮助患者登记投票，而只有34%的外科实习生持同样观点。绝大多数人(87%)表示，2019冠状病毒病大流行使医生更有必要参与政治。结论尽管对直接参与选民登记有不同的看法，但高比例的医学生和各专业的家政人员报告有义务参与健康宣传。

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引用次数: 0

“Association between electronic cigarette use and fragility fractures among US adults” contains significant errors “美国成年人使用电子烟与脆性骨折之间的关系”包含重大错误

American journal of medicine open

Pub Date : 2022-12-01 DOI: 10.1016/j.ajmo.2022.100017

Nantaporn Plurphanswat, Brad Rodu

引用次数: 0

Gun-related mortality in children- Seeing past Geography 儿童与枪支有关的死亡率——看过去的地理

American journal of medicine open

Pub Date : 2022-07-01 DOI: 10.1016/j.ajmo.2022.100021

S. Chipkin

引用次数: 0

Cardiovascular risk, fatty liver disease, glucose and insulin curve among prediabetes phenotypes in Peruvian population 秘鲁人群糖尿病前期表型的心血管风险、脂肪肝疾病、葡萄糖和胰岛素曲线

American journal of medicine open

Pub Date : 2022-06-01 DOI: 10.1016/j.ajmo.2022.100007

Jesus Rocca-Nación , Maria Calderon

Aims

To describe the cardiovascular risks, fatty liver disease, and glucose and insulin curve among prediabetes phenotypes (PPh) in Peruvian population.

Methods

A study was carried out using a secondary database of a series of patients with identified risk factors for diabetes mellitus type 2 in one clinic in Lima, Peru. Patients were divided according with the OGTT in impaired glucose 2h or IGT(Pph1), impaired fasting glucose or IFG(Pph3) or both(Pph2).

Results

259 patients were identified for analysis, 149 of whom had normal OGTT, 94 had prediabetes (36.3%), and 16 diabetes (6.2%). We found that 37(39.4%), 37(39.4%) and 20(21.2%) presented Pph1, Pph-2 and Pph-3 respectively. Most of the cardiovascular risks and hepatic function comparison showed no difference in our study sample groups. However, we found that Pph2 showed significantly higher abnormalities in HDL-c, triglycerides, hepatic steatosis, and HOMA-IR compared with normal OGTT group (p < 0.05). Interestingly, this difference was not seen with the other phenotypes. Also, hepatic steatosis was higher in Pph2 compared to Pph3 (p < 0.05). HOMA-IR was high in Phenotype 2 compared with Phenotype 1. Regarding hepatic steatosis, this was high in all prediabetes phenotypes, however we found this to be of statistical significance in Pph2 compared to Pph3 (p < 0.01).

Conclusions

In general, prediabetes phenotypes show a similar association with cardiovascular risk factors and hepatic steatosis, however, Pph2 show more differences in specific comparisons. We believe that this study is a starting point for further investigation to understand prediabetes in Peruvian population and be able to improve disease risk stratification.

目的描述秘鲁人群糖尿病前期表型(PPh)的心血管风险、脂肪肝疾病和葡萄糖和胰岛素曲线。方法采用二级数据库对秘鲁利马一家诊所的一系列具有2型糖尿病危险因素的患者进行研究。根据OGTT分为血糖2h或IGT(Pph1)、空腹血糖或IFG(Pph3)或两者(Pph2)。结果259例患者中OGTT正常149例，糖尿病前期94例(36.3%)，糖尿病16例(6.2%)。结果显示，37个(39.4%)、37个(39.4%)和20个(21.2%)分别表达Pph1、pph2和pph3。大多数心血管风险和肝功能比较在我们的研究样本组中没有差异。然而，我们发现与正常OGTT组相比，Pph2在HDL-c、甘油三酯、肝脂肪变性和HOMA-IR方面表现出明显更高的异常(p <0.05)。有趣的是，这种差异在其他表型中没有发现。此外，与Pph3相比，Pph2的肝脂肪变性更高(p <0.05)。表型2的HOMA-IR高于表型1。关于肝脂肪变性，这在所有糖尿病前期表型中都很高，但我们发现这在Pph2中与Pph3相比具有统计学意义(p <0.01)。结论总的来说，糖尿病前期表型与心血管危险因素和肝脏脂肪变性具有相似的相关性，但Pph2在特异性比较中表现出更大的差异。我们认为，这项研究是一个起点，为进一步调查了解秘鲁人群的前驱糖尿病，并能够改善疾病风险分层。

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引用次数: 0

Acute but not chronic heart failure is associated with higher mortality among patients hospitalized with pneumonia: An analysis of a nationwide database 急性而非慢性心力衰竭与肺炎住院患者较高的死亡率相关:一项全国数据库分析

American journal of medicine open

Pub Date : 2022-06-01 DOI: 10.1016/j.ajmo.2022.100013

Essa Hariri , Niti G. Patel , Elias Bassil , Milad Matta , Pei-Chun Yu , Quinn R. Pack , Michael B. Rothberg

Background

Among patients admitted for pneumonia, heart failure (HF) is associated with worse outcomes. It is unclear whether this association is due to acute HF exacerbations, complex medical management, or chronic co-morbid conditions.

Methods

This is a retrospective cohort study of patients admitted between July 2010 and June 2015 at 651 US hospitals with a principal diagnosis of either pneumonia or secondary diagnosis of pneumonia with a primary diagnosis of respiratory failure or sepsis. Comorbidities were identified by ICD-9 codes and medical management by daily charge codes. Patients were categorized according to the presence and acuity of admission diagnosis of HF. In-hospital mortality was the primary outcome. Secondary outcomes included length of stay, hospital cost, ICU admission, use of mechanical ventilation, vasopressors and inotropes. Logistic regression was used to study the association of outcomes with presence and acuity of HF.

Results

Of 783,702 patients who met inclusion criteria, 212,203 (27%) had a diagnosis of HF. Of these, 56,306 (26.5%) had acute while 48,188 (22.7%) had chronic HF on admission; 51% had a diagnosis of unspecified HF. In multivariable-adjusted models, having any HF was associated with increased mortality (OR 1.35 [1.33 - 1.38]) compared to those without HF; increased mortality was associated with acute HF (OR 1.19 [1.15 - 1.22]) but not chronic HF (OR 0.92 [0.89 - 0.96]).

Conclusion

The worse outcomes for pneumonia patients with HF appear due to acute HF exacerbations. Adjustment for HF without accounting for chronicity could lead to biased prognostic and billing estimates.

背景:在因肺炎入院的患者中，心力衰竭(HF)与较差的预后相关。目前尚不清楚这种关联是由于急性心衰加重、复杂的医疗管理还是慢性合病所致。方法:这是一项回顾性队列研究，纳入2010年7月至2015年6月在651家美国医院住院的患者，主要诊断为肺炎或继发诊断为肺炎，主要诊断为呼吸衰竭或败血症。用ICD-9编码识别合并症，用每日收费编码识别医疗管理。根据HF的存在程度和入院诊断的敏锐度对患者进行分类。住院死亡率是主要结局。次要结局包括住院时间、住院费用、ICU入院率、机械通气、血管加压药物和肌力药物的使用。采用Logistic回归研究结果与心衰存在和急性程度的关系。结果在783,702例符合纳入标准的患者中，有212,203例(27%)诊断为HF。其中56,306例(26.5%)为急性心衰，48,188例(22.7%)为慢性心衰;51%的患者诊断为不明HF。在多变量调整模型中，与没有HF的患者相比，有HF的患者与死亡率增加相关(OR为1.35 [1.33 - 1.38]);死亡率增加与急性HF相关(OR为1.19[1.15 - 1.22])，但与慢性HF无关(OR为0.92[0.89 - 0.96])。结论急性心衰加重是肺炎合并心衰患者预后较差的原因。在不考虑慢性因素的情况下调整心力衰竭可能导致有偏差的预后和计费估计。

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引用次数: 1

Peak performance: Putting type 1 diabetes management recommendations for athletes to the test 巅峰表现:对运动员的1型糖尿病管理建议进行测试

American journal of medicine open

Pub Date : 2022-06-01 DOI: 10.1016/j.ajmo.2022.100011

Bradley Grightmire, Wajd Alkabbani, John-Michael Gamble

Background

Athletes with type 1 diabetes (T1D) face unique challenges to maintain optimal glucose levels and therefore require tailored guidance from their healthcare providers. Herein, we aim to summarize and compare recommendations targeted at T1D management in athletes in commonly used clinical practice guidelines and topical position statements. The objective is to assess if the available recommendations are comprehensive enough for athletes to apply to high-performance sport.

Methods

From seven clinical practice guidelines and positions statements, we identified recommendations relevant to athletes with T1D, based on a specific hierarchy. For included recommendations, we extracted relevant information including the year of publication, author(s), chapter name or number, text for the recommendation, and level of evidence. Based, on the clinical topic covered, we grouped included recommendations to five themes.

Results

We screened a total of 126 recommendations, of which 60 recommendations were included. The National Athletic Trainers’ Association provided the highest number of recommendations relevant to athletes with T1D (n = 27). Insulin modifications was the most covered clinical theme (n = 18). The 2018 Diabetes Canada and 2021 American Diabetic Association guidelines linked recommendations directly with levels and grades of evidence. None of the recommendations had level 1 or grade A evidence. Three recommendations from Diabetes Canada reported level 2, grade B evidence. American Diabetic Association reported 1 recommendation with grade B evidence, and 2 recommendations with grade C evidence.

Conclusions

There is an opportunity for expansion of clinical practice guidelines to increase the depth and breadth of recommendations for high performance athletes with T1D.

患有1型糖尿病(T1D)的运动员面临着维持最佳血糖水平的独特挑战，因此需要医疗保健提供者提供量身定制的指导。在此，我们的目的是总结和比较常用的临床实践指南和局部立场声明中针对运动员T1D管理的建议。目的是评估现有的建议是否足够全面，以供运动员应用于高性能运动。方法从七个临床实践指南和立场声明中，我们根据特定的层次确定了与T1D运动员相关的建议。对于纳入的推荐，我们提取了相关信息，包括出版年份、作者、章节名称或编号、推荐文本和证据水平。基于所涵盖的临床主题，我们将包括的建议分为五个主题。结果共筛选推荐126条，纳入推荐60条。国家运动训练师协会提供了与T1D运动员相关的最多的建议(n = 27)。胰岛素修饰是涉及最多的临床主题(n = 18)。2018年加拿大糖尿病和2021年美国糖尿病协会指南将建议与证据的水平和等级直接联系起来。这些建议都没有1级或A级证据。加拿大糖尿病协会(Diabetes Canada)的三项建议报告了2级B级证据。美国糖尿病协会报告了1项B级证据推荐，2项C级证据推荐。结论:有机会扩大临床实践指南，以增加对高性能T1D运动员的推荐的深度和广度。

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引用次数: 0

Epidemiological trends of youth firearm mortality in the U.S. States, 2010-2019 2010-2019年美国青少年枪支死亡流行病学趋势

American journal of medicine open

Pub Date : 2022-06-01 DOI: 10.1016/j.ajmo.2022.100006

James H. Price , Jagdish Khubchandani

引用次数: 0

Pitfalls in the use of mobile wireless devices in healthcare: Distraction, errors, procrastination, and burnout 在医疗保健中使用移动无线设备的陷阱:分心、错误、拖延和倦怠

American journal of medicine open

Pub Date : 2022-06-01 DOI: 10.1016/j.ajmo.2022.100010

Nidhi Gupta

引用次数: 0

Stable high-sensitivity cardiac troponin T levels and the association with frailty and prognosis in patients with chest pain 胸痛患者稳定的高敏心肌肌钙蛋白T水平与虚弱和预后的关系

American journal of medicine open

Pub Date : 2021-01-01 DOI: 10.1016/j.ajmo.2021.100001

Love S. Strandberg , Andreas Roos , Martin J. Holzmann

Background

Chronic myocardial injury is defined by stable high-sensitivity cardiac troponin (hs-cTn) levels above the 99th percentile value, which may be a sign of a biologically aged heart. This study investigated the association between frailty and chronic myocardial injury.

Methods

In a cohort of patients with chest pain and stable hs-cTnT levels measured 2011–2014, we included all patients who were assessed by two scoring systems measuring frailty. Adjusted odds ratios (ORs) were calculated to estimate the risk of frailty at different hs-cTnT levels (referent: hs-cTnT ≤ 14 ng/l). Cox regression was used to estimate risks of death and cardiovascular events in relation to frailty status and hs-cTnT levels (referent: non-frail and hs-cTnT ≤ 14 ng/l).

Results

A total of 979 patients were included, of whom 269 (27%) had chronic myocardial injury. The risk of being frail was almost four times higher in patients with chronic myocardial injury, compared with patients in the reference group (hs-cTnT ≥ 30 ng/l: OR: 3.69, 95% CI: 2.02-6.76). During a follow-up of 4.3 years, 275 (28%) patients died. Mortality risks increased with increasing hs-cTnT levels and degree of frailty, being increased four-fold in frail patients with hs-cTnT levels ≥ 30 ng/l (HR: 4.07, 95% CI: 2.42-6.86).

Conclusions

Stable hs-cTnT levels are associated with the degree of frailty, and frailty measurements could help to identify patients with stable hs-cTnT levels who are at a high risk of death. The findings support the hypothesis that chronic myocardial injury could be a marker of a biologically aged heart.

慢性心肌损伤的定义是稳定的高灵敏度心肌肌钙蛋白(hs-cTn)水平高于第99个百分位数，这可能是心脏生物学老化的标志。本研究探讨了衰弱与慢性心肌损伤之间的关系。方法在2011-2014年测量的胸痛且hs-cTnT水平稳定的患者队列中，我们纳入了所有采用两种虚弱评分系统评估的患者。计算调整优势比(ORs)来估计不同hs-cTnT水平(参考值:hs-cTnT≤14 ng/l)时的衰弱风险。使用Cox回归来估计与虚弱状态和hs-cTnT水平(参考:非虚弱和hs-cTnT≤14 ng/l)相关的死亡和心血管事件风险。结果共纳入979例患者，其中慢性心肌损伤269例(27%)。与对照组相比，慢性心肌损伤患者体弱的风险几乎高出4倍(hs-cTnT≥30 ng/l: OR: 3.69, 95% CI: 2.02-6.76)。在4.3年的随访期间，275例(28%)患者死亡。死亡风险随着hs-cTnT水平和虚弱程度的增加而增加，hs-cTnT水平≥30 ng/l的虚弱患者死亡风险增加4倍(HR: 4.07, 95% CI: 2.42-6.86)。结论稳定的hs-cTnT水平与衰弱程度相关，衰弱程度的测量有助于识别具有稳定hs-cTnT水平的高危死亡患者。这一发现支持了慢性心肌损伤可能是心脏生物学老化标志的假设。

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引用次数: 1

Association between electronic cigarette use and fragility fractures among US adults 美国成年人使用电子烟与脆性骨折之间的关系

American journal of medicine open

Pub Date : 2021-01-01 DOI: 10.1016/j.ajmo.2021.100002

Dayawa D. Agoons , Batakeh B. Agoons , Kelechi E. Emmanuel , Firdausi A. Matawalle , Jessica M. Cunningham

Background

The popularity of electronic cigarette (e-cigarette) use continues to rise in the United States. While conventional cigarette smoking is an established risk factor for osteoporosis and osteoporotic fracture, the effects of e-cigarette use on bone health are unknown. We aimed to examine the association between e-cigarette use and fragility fractures.

Research Design and Methods

We pooled 2017–2018 data from the National Health and Nutrition Examination Survey (NHANES). We included men and women with complete information on key variables. E-cigarette use was categorized as either never or ever users. Ever users were further classified as former and current users. Fragility fracture was defined as a composite of self-reported fracture of the hip, spine or wrist which resulted from minimal trauma such as a fall from standing height or less.

Results

Of 5569 participants, there were 4519 (81.2%) never e-cigarette users, 1050 (18.8%) ever e-cigarette users, and 444 (8.0%) with self-reported fragility fracture. In adjusted models, ever e-cigarette users had a 46% higher prevalence of self-reported fragility fractures compared to never users (aPR: 1.46, 95% CI: 1.12, 1.89). We also observed a higher prevalence of fragility fractures among former and current e-cigarette users compared to never users (aPR: 1.89, 95% CI: 1.44, 2.48 and aPR: 1.77, 95% CI: 1.04, 3.02 respectively).

Conclusion

E-cigarette use was associated with a higher prevalence of self-reported fragility fracture. These findings suggest that e-cigarette use may be harmful to bone health. These data highlight the critical need for longitudinal studies exploring the potential effect(s) of e-cigarette use on bone health.

在美国，电子烟(电子烟)的普及程度持续上升。虽然传统吸烟是骨质疏松症和骨质疏松性骨折的已知危险因素，但使用电子烟对骨骼健康的影响尚不清楚。我们的目的是研究电子烟使用与脆性骨折之间的关系。研究设计与方法我们汇集了2017-2018年国家健康与营养检查调查(NHANES)的数据。我们纳入了男性和女性，并提供了关键变量的完整信息。电子烟的使用分为从不使用和从不使用。曾经用户进一步分为以前用户和现在用户。脆性骨折被定义为自报告髋部、脊柱或手腕骨折的复合骨折，由最小的创伤(如从站立高度跌落或更低)引起。结果在5569名参与者中，有4519人(81.2%)从未使用过电子烟，1050人(18.8%)曾经使用过电子烟，444人(8.0%)自我报告患有脆性骨折。在调整后的模型中，曾经吸过电子烟的人自我报告的脆性骨折的患病率比从未吸过电子烟的人高46% (aPR: 1.46, 95% CI: 1.12, 1.89)。我们还观察到，与从未使用过电子烟的人相比，以前和现在的电子烟使用者中脆性骨折的患病率更高(aPR: 1.89, 95% CI: 1.44, 2.48和aPR: 1.77, 95% CI: 1.04, 3.02)。结论:电子烟的使用与自我报告的脆性骨折发生率较高有关。这些发现表明，使用电子烟可能对骨骼健康有害。这些数据强调了纵向研究探索电子烟使用对骨骼健康的潜在影响的迫切需要。

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