WMJ : official publication of the State Medical Society of Wisconsin最新文献

Introduction: Chlamydia and gonorrhea are the most commonly reported bacterial communicable diseases in Wisconsin, with rising incidence rates despite effective treatments. Examining demographic trends can inform public health strategies.

Methods: We analyzed Wisconsin Electronic Disease Surveillance System data (2010-2022) to assess chlamydia and gonorrhea incidence by sex, age, and race.

Results: From 2010 through 2022, chlamydia rates in Wisconsin rose 4.9% (415.5 to 435.9 per 100 000), while gonorrhea rates increased 62.8% (90.7 to 147.7 per 100 000). Among females 15 to 24 years old, chlamydia rates declined 12.0% (3308.5 to 2912.8 per 100 000) but increased 30.1% (203.1 to 264.2 per 100 000) among females 25 years old and older. Gonorrhea rates rose 6.3% (574.7 to 610.6 per 100 000) in females 15 to 24 years old but nearly doubled (47.4 to 82.0 per 100 000) for those 25 and older. Among males 15 to 24 years old, chlamydia rates increased 10.7% (1046.4 to 1158.8 per 100 000) and increased 47.7% in males 25 years old and older (130.7 to 193.1 per 100 000). Gonorrhea rates rose 52.2% in males 15 to 24 years old (295.7 to 450.1 per 100 000) and rose 226.8% in males 25 years old and older (40.7 to 133.0 per 100 000). In 2010, chlamydia rates were 14 times higher and gonorrhea rates nearly 40 times higher among Black individuals compared to White individuals, narrowing to 11 and 30 times higher, respectively, by 2022.

Conclusions: Chlamydia and gonorrhea incidence rates have risen across most populations in Wisconsin but disproportionately affect Black individuals, with the largest racial disparities seen in the nation. While chlamydia rates remained stable among young females, they increased among males and older adults. Gonorrhea rates surged across nearly all groups. These findings highlight the need for targeted interventions to expand screening, address structural barriers to health care, and reduce disparities.

Introduction: Community paramedicine (CP) is an expanding area of interest within the field of emergency medical services. Few studies have established operational metrics and outcome measures for CP programs. We aimed to evaluate change in 911 use and operational metrics among patients enrolled in a pilot, fire department-based, CP program.

Objective: The purpose of this study was to determine if the ongoing CP program decreased unscheduled emergency health care utilization among high utilizers. It was hypothesized that the implementation of community paramedicine visits would reduce 911 calls among this cohort.

Methods: A retrospective cohort study of adults enrolled in a CP program during 2016 to 2020 was performed. Patients were enrolled in the CP program if they frequently used a community emergency department or 911 services. This was defined as greater than 4 uses in the past 12 months. A select group of experienced paramedics received targeted training in relevant concepts. Paramedics frequently contacted patients via both in-home visits and phone calls based on perceived clinical need. Through a review of electronic medical records, we collected patient demographic and clinical information and program operational metrics. The primary outcome of interest was the change in 911 use after enrollment. These 2 groups were compared using a paired t test.

Results: Of 33 patients who met inclusion criteria, 29 were successfully enrolled. Pre-enrollment 911 calls averaged 31.8 calls per month. Post-enrollment 911 calls averaged 14.2 calls per month. Average calls per month decreased by 54.2% (P = .003) post-enrollment, a reduction of 207 calls per year across the cohort. Length of program enrollment also was found to have a greater impact on 911 call reduction.

Conclusions: A fire-department based CP program effectively reduced 911 calls for high utilizer emergency medical services and emergency department patients by 54.2%. Program participation for 6 months or longer was associated with greater reductions in 911 calls, regardless of the number of existing comorbidities.

Introduction: Inherited retinal degenerations (IRDs) are genetically driven disorders affecting retinal photoreceptors, the retinal pigment epithelium, bipolar cells, and other retinal structures. This study aimed to compare characteristics of pediatric versus adult patients at the time of initial presentation to a tertiary care IRD clinic.

Methods: A retrospective chart review of 527 patients diagnosed with IRDs was conducted. Data collected included age at presentation, diagnosis, ocular and systemic characteristics, demographics, distance from home to the clinic, and type of referring provider.

Results: High hyperopia, high myopia, high astigmatism, congenital syndactyly, and developmental delay were more common among pediatric patients. Adult patients more frequently presented with reduced central vision, peripheral vision loss, color vision deficits, nyctalopia, flashes/floaters, cataracts, and family history of cataracts. Compared to a control population, adult IRD patients had higher rates of cardiac conditions, lower prevalence of obesity, and similar rates of diabetes. No significant differences were found in type of referring provider or proximity to the clinic.

Discussion: Distinct clinical and familial characteristics were associated with age at presentation. Pediatric patients often exhibited refractive and developmental features, while adults presented with progressive vision symptoms. Despite assumptions, geographic proximity did not significantly influence age at presentation, suggesting other barriers to care.

Conclusions: This study identifies characteristics associated with pediatric and adult presentation in patients with IRDs. Better understanding of these patterns may improve early recognition, clinician education, and timely treatment.

Introduction: The incidence of early-onset rectal cancer has increased over the past 3 decades and the causes are unknown. Neighborhood socioeconomic status, a measure of social and economic characteristics in a given area, may be associated with early-onset rectal cancer through environments that affect diet, exercise, and health care utilization. We investigated the association between neighborhood-level socioeconomic status and age at rectal cancer diagnosis in Wisconsin.

Methods: We utilized data on 172 rectal cancer patients from the Carbone Cancer Center rectal cancer registry. We measured neighborhood socioeconomic status using the Area Deprivation Index, derived from 17 census measures of education, employment, income, and housing, standardized at the state and national levels. Linear and logistic regression models were employed to estimate the association between the Area Deprivation Index and age at diagnosis.

Results: Of the 172 cases of rectal cancer, 47 (27%) were considered early-onset (<50 years). Null associations were observed between the Area Deprivation Index and age at diagnosis using the national- and state-standardized index. Moreover, estimates using the nationally standardized index suggested lower odds of early-onset rectal cancer in lower socioeconomic status neighborhoods (ORQ5 = 0.11, 95% CI, 0.01-1.89).

Conclusions: This study initiates research investigating the association between area-level socioeconomic status and early-onset rectal cancer. While we find no association between the Area Deprivation Index and early-onset rectal cancer, we posit these findings are due to the characteristics of our sample. Future studies are needed to comprehensively explore associations between social factors and early rectal cancer outcomes.

Introduction: Educating medical students about the importance of integrating public health into their careers is challenging.

Methods: Medical student demographics, weekly written reflections, and course evaluations for a storytelling-based, public health-oriented elective were reviewed.

Results: Compared to students who did not enroll in the course, enrolled students were more likely to be female (71% vs 48%, P = 0.001). Student reflections revealed 2 major themes: (1) public health can be integrated into any specialty career; (2) career paths are often nonlinear. Students were highly satisfied with the course (mean 6.5, scale 1-7).

Discussion: Courses aiming to inspire medical students to integrate public health into their career should consider a similar storytelling approach.

Background: Alcohol-related mortality is an increasing public health concern in the United States. To date, no study has considered trends in alcohol-related deaths during the full COVID-19 pandemic period.

Methods: We analyzed deaths from Wisconsin vital statistics to explore the relationship between the pandemic period and any changes in alcohol-related mortality.

Results: In Wisconsin, the pandemic period was associated with additional alcohol-related mortality above and beyond a previously reported upward trend.

Discussion: We show that the COVID-19 pandemic was associated with exacerbated alcohol-related mortality in Wisconsin. Alcohol use may need to be considered as an additional public health risk in future pandemic scenarios.

Introduction: Vogt-Koyanagi-Harada (VKH) disease is an autoimmune condition affecting both ocular and extraocular systems. This case highlights the need for research into the epidemiology and pathophysiology of VKH.

Case presentation: A 23-year-old cisgender Hispanic female presented to our tertiary care center with severe headache, eye pain, vision changes, photophobia, hearing loss with tinnitus, phonophobia, nausea, vomiting, and vertigo. She was diagnosed with VKH disease.

Discussion: This report shares a case of VKH disease in the Midwestern United States. A 2023 Northwestern University study highlights the orphan nature of the disease; even with a small sample size, that study proved to be a larger cohort in studies of VKH.

Conclusions: This report contributes to the growing literature documenting VKH disease. Especially in diagnoses associated with certain racial groups, a broad differential diagnosis is essential, as delay in diagnosis may result in irreversible sequelae. Prompt coordination with colleagues may reduce subsequent morbidity and mortality.

Introduction: The use of structured documentation via auto-populated discrete fields is important to facilitate medical decision-making, research, and quality improvement. If these fields are not filed properly, they will appear "empty," leaving behind incomplete documentation. Examples include past medical history (PMH), past surgical history (PSH), family history (FH), and active hospital problems (AHP).

Objectives: Our SMART aim was to decrease the incidence of "no PMH/PSH/FH/AHP on file" in history and physical notes (H&Ps) at our single children's hospital from 7.9%, 18.7%, 8.3%, and 17.0%, respectively, to less than 5% over 4 months.

Methods: A multidisciplinary team utilized quality improvement methodology. The population included all encounters admitted to pediatric hospital medicine. The outcome measure was percentage of H&Ps with "no PMH/PSH/FH/AHP on file." The process measure was percentage of H&Ps using the proper template. Interventions included a clinical decision support tool in H&P templates to display a hard stop if "no PMH/SH/FH/AHP on file" appears and documentation education. Statistical process control charts were used to analyze measures.

Results: "No PMH/PSH/FH/AHP on file" decreased from baseline to 1.2%, 2.2%, 2.9%, and 4.2%, respectively, showing special cause variation. H&P template use remained high at 87.2%.

Conclusions: The creation of a simple clinical decision support tool was associated with a decreased incidence of "no PMH/PSH/FH/AHP on file," achieving our goal. Utilizing automatic clinical decision support reduced the need to rely on education to cause a change, an important element of our tool. Future steps include implementation of a hard stop in other required areas of discrete documentation and ongoing evaluation of sustained change.