Health History Research Articles

Marginalized measures: The harmonization of diversity in precision medicine research.

The production of large, shareable datasets is increasingly prioritized for a wide range of research purposes. In biomedicine, especially in the United States, calls to enhance representation of historically underrepresented populations in databases that integrate genomic, health history, demographic and lifestyle data have also increased in order to support the goals of precision medicine. Understanding the assumptions and values that shape the design of such datasets and the practices through which they are constructed are a pressing area of social inquiry. We examine how diversity is conceptualized in U.S. precision medicine research initiatives, specifically attending to how measures of diversity, including race, ethnicity, and medically underserved status, are constructed and harmonized to build commensurate datasets. In three case studies, we show how symbolic embrace of both diversity and harmonization efforts can compromise the utility of diversity data. Although big data and diverse population representation are heralded as the keys to unlocking the promises of precision medicine research, these cases reveal core tensions between what kinds of data are seen as central to 'the science' and which are marginalized.

Non-invasive Anemia Detection and Prediagnosis

Background Anemia is a significant global health concern, often stemming from iron deficiency or deficiencies in folate, vitamins B12, and A. Anemia disproportionately impacts vulnerable populations like children, adolescent girls, and pregnant or postpartum women. Purpose Anemia is a serious public health issue, impairing productivity, cognitive development, and increasing mortality rates. Anemia is usually detected through blood tests measuring hemoglobin levels, but non-invasive solutions are rquired to lower discomfort, enhance accessibility, and allow for regular monitoring. These methods are essential for early detection in vulnerable populations. Methodology The research methodology involves extracting valuable information from nail images using data mining algorithms. The focus is on calculating the percentage of blue- and red-stained cells within specific regions of interest in the nail images. Machine-learning algorithms are employed to transform these data into actionable insights for disease diagnosis. Results The system demonstrates effectiveness in accurately detecting anemia and providing prediagnosis reports to healthcare providers. The reports include comprehensive information such as patient symptoms, health history, test results, and the doctor’s preliminary assessment. This aids in timely and accurate treatment decisions. Conclusion This research showcases the potential of image processing and machine learning in improving anemia diagnosis and facilitating personalized healthcare interventions.

The Association between the Firmicutes/Bacteroidetes Ratio and Body Mass among European Population with the Highest Proportion of Adults with Obesity: An Observational Follow-Up Study from Croatia.

Background/Objectives: The phyla Firmicutes and Bacteroidetes are the main constituents of the gut microbiota. An imbalance in the gut microbiota is a sign of dysbiosis, and the Firmicutes-to-Bacteroidetes ratio has been proposed to be a marker of it, especially in the context of obesity. Since Croatia is the country with one of the highest obesity rates in Europe, a pilot observational study was conducted. The aim of the study was to investigate the validity of this potential biomarker in a methodological study using sample processing, DNA sequence analysis and characterization of recruited participants, including various health factors. Methods: A study involving Croatian population was conducted. Participants age, body weight, gender, health history and lifestyle factors were recorded. Gut microbiota composition was analyzed using 16S rRNA sequencing. The F/B ratio was calculated and evaluated in the context of health factors. Statistical analysis was performed to detect the possible association of F/B ratio and excess body weight (kg) and possible impact of certain lifestyle factors. Results: No association between the F/B ratio and excess body weight (kg) was found. Excess body weight was significantly associated with higher age, male gender, and history of appendectomy. No significant health predictors of the F/B ratio were found, but weight gain was positively associated with a higher average F/B ratio. Conclusions: Although this study could not confirm the predictive value of the F/B ratio or any other phyla-related biomarker for excess body weight in the study population, it demonstrated interesting insights into the obesity-associated gut microbiota.

Ranking and Contextual Selection

Context-Sensitive Simulation-Based Decisions When There Is No Time to Simulate Stochastic simulation is a powerful tool for discovering system design decisions that are the best possible (optimal) when averaged over real-world uncertainty. However, in applications such as personalized medicine and web content optimization, even better decisions can be made if they are tailored to specific, contemporaneous covariate information, such as patient health history and user reading habits. Unfortunately, in these and similar applications, there is no time to perform a refined simulation optimization. In “Ranking and Contextual Selection,” Keslin, Nelson, Pagnoncelli, Plumlee, and Rahimian use off-the-shelf simulation optimization methods to create a database of covariates and associated decisions that form a covariate-to-decision classifier and an upper confidence bound on its optimality gap when applied to covariates not in the database. A realistic example of web page assortment optimization is presented using a data set from Yahoo!.

Disparities in pain management among transgender patients presenting to the emergency department for abdominal pain.

Transgender and gender-diverse (TGD) individuals have a gender identity or expression that differs from the sex assigned to them at birth. They are an underserved population who experience health care inequities. Our primary objective was to identify if there are treatment differences between TGD and cisgender lesbian/gay/bisexual/queer (LGBQ) or heterosexual individuals presenting with abdominal pain to the emergency department (ED). Retrospective observational cohort study of patients ≥12 years of age presenting to 21 EDs within a health care system with a chief complaint of abdominal pain between 2018 and 2022. TGD patients were matched 1:1:1:1 to cisgender LGBQ women and men and cisgender heterosexual women and men, respectively. Propensity score matching covariates included age, ED site, mental health history, and gastrointestinal history. The primary outcome was pain assessment within 60 min of arrival. The secondary outcome was analgesics administered in the ED. We identified 300 TGD patients, of whom 300 TGD patients were successfully matched for a total cohort of 1300 patients. The median (IQR) age was 25 (20-32) years and most patients were treated in a community ED (58.2%). There was no difference between groups in pain assessment within 60 min of arrival (59.0% TGD vs. 63.2% non TGD, p = 0.19). There were no differences in the number of times pain was assessed (median [IQR] 2 [1-3] vs. 2 [1-4], p = 0.31) or the severity of pain between groups (5.5 [4-7] vs. 6 [4-7], p = 0.11). TGD patients were more likely to receive nonsteroidal anti-inflammatory drugs (32.0% vs. 24.9%, p = 0.015) and less likely to receive opioids than non-TGD patients (24.7% vs. 36.9%, p = <0.001). TGD and nonbinary patients, along with LGBQ cisgender women (24.7%) and heterosexual cisgender women (34%), were less likely to receive opioids than LGBQ cisgender men (54%) and heterosexual cisgender men (42.3%, p < 0.01). There was no difference in frequency of pain assessment, regardless of gender identity or sexual orientation. More cisgender men, compared to TGD and cisgender women, received opioids for their pain.

Adiposity throughout Adulthood and Risk of Young Onset Breast Cancer Tumor Subtypes in the Young Women's Health History Study.

The role of adult adiposity in young-onset breast cancer (YOBC) subtype risk is not well understood. In this population-based case(n=1812)-control(n=1381) study of invasive YOBC (aged <50 years), cases were identified from the Los Angeles County and Metropolitan Detroit SEER registries, 2010-2015. Area-based, frequency-matched controls were sampled from the 2010 Census. General adiposity (body mass index (BMI)) and central adiposity (waist circumference (WC), waist-to-height ratio (WHtR)) across adulthood and covariates were collected from in-person interviews and measurements. Odds ratios (ORs) and 95% confidence intervals (CIs) for adiposity and YOBC tumor subtypes (i.e., luminal A, luminal B, HER2+, triple negative (TN)) were calculated, overall and by parity, using multivariable weighted logistic regression. Obese young adult BMI was inversely associated with luminal A YOBC (OR=0.35, 95% CI 0.16-0.79); other subtype associations were non-significant. Similarly, adult overweight and obese BMIs were inversely associated with luminal A (respectively OR=0.66, 95% CI 0.48-0.91 and OR=0.59, 95% CI 0.46-0.87), but not other subtypes. Conversely, larger WC was associated with higher odds of luminal B and TN YOBC (respectively OR=1.48, 95% CI 1.01-2.15 and OR=2.48, 95% CI 1.52-3.88), but not other subtypes (with similar results for WHtR); highest odds were among parous women. Findings show greater general adult adiposity is associated with reduced odds of luminal A YOBC, while greater central adiposity is associated with increased odds of luminal B and TN YOBC, particularly among parous women. Additional studies of central adiposity and YOBC subtype risk, especially incorporating pregnancy history, are warranted.

Association Between Health History Flags And Medal Outcomes Among Elite Athletes Participating In International Competition

Association Between Health History Flags And Medal Outcomes Among Elite Athletes Participating In International Competition

Neuropsychiatric symptoms of patients two years after experiencing severe COVID-19: A mixed observational study

BackgroundThe impact of SARS-CoV-2 infection (COVID-19) on mental health has not been extensively studied in the medium and long term. This study assessed how clinical, biological, and social factors affect mental health in patients who recovered from severe COVID-19. The evaluation was done 90 days after hospital discharge and followed up at 12 and 24 months. MethodsA retrospective-prospective cohort mixed observational study was conducted on patients over 18 years of age who required hospitalization in Internal Medicine or ICU for severe COVID-19 pneumonia during 2020 and 2021. Demographic information, clinical variables, and data for the scales were obtained from electronic medical records and telephone interviews. For comparisons of the different variables in each clinical variable (insomnia, depression, anxiety), the Student's t-test for independent samples has been used (normal distribution); otherwise, the Mann–Whitney test will be used. All tests and intervals will be performed with a confidence level of 95. Fisher's exact or Pearson's Chi-square test has been used as appropriate for qualitative variables. Results201 patients were recruited. 37.3% presented insomnia, 22.4% anxiety, and 21.4% depressive symptoms. A direct association was established between female sex and depressive symptoms. Psychotropic history, fatigue, and C-reactive protein levels (CRP) were correlated with depression. Anosmia and ageusia, CRP, cognitive symptoms, and dyspnea predicted insomnia. Sex, orotracheal intubation (OTI), pain, fatigue, mental health history, and academic level were independent predictors of anxiety. High percentages of depressive, anxiety, and insomnia symptoms were detected in the second month after discharge and persisted at 12 and 24 months. The fatigue variable maintained a significant relationship with depressive symptoms at 2, 12 and 24 months. A possible limitation could be recall bias in retrospective data collection. ConclusionsThis is a novel study to follow up on mental health for two years in patients with severe COVID-19. Clinical, biological, and psychosocial variables could be predictors of depressive symptoms, anxiety, and insomnia. The psychiatric symptoms persisted throughout the 2-year follow-up. These findings are critical for the follow-up of these patients and open the possibility of further studies in the medium and long term.

Predicting the Presence of Pain in Youth Baseball Pitchers Using the Concept of Biomechanical Efficiency.

Increases in peak shoulder distraction force and peak elbow valgus torque may influence throwing-arm pain and injury risk in youth pitchers. The purpose of this study was to determine whether shoulder distraction force and elbow valgus torque while accounting for anthropometrics and pitch velocity can predict the presence of pain in youth baseball pitchers. It was hypothesized that throwing-arm pain could be predicted using the concept of biomechanical efficiency, where a pitcher who is less efficient (having higher force or torque with the same pitch velocity) is more likely to experience pain. Descriptive laboratory study. A total of 38 youth baseball pitchers (mean age, 13.3 ± 1.7 years) were divided into a pain group and pain-free group based on presence of throwing-arm pain as reported on a health history questionnaire. Each pitcher threw 3 maximal-effort fastballs to a catcher at regulation distance, and kinematics were measured using an electromagnetic motion-capture system (minimum 100 Hz). Height and weight as well as mean peak shoulder distraction force, peak elbow valgus torque, and pitch velocity across the 3 trials were evaluated. Logistic regression analyses determined whether shoulder distraction force or elbow valgus torque could predict the presence of throwing-arm pain when holding anthropometrics (body weight for shoulder distraction force; body weight and height for elbow valgus torque) and pitch velocity constant. Shoulder distraction force significantly predicted the presence of throwing-arm pain after accounting for body weight and pitch velocity (χ2 = 9.49; P = .023). Specifically, for every 1-N increase in peak shoulder distraction force while holding body weight and pitch velocity constant, there was a 0.6% increased likelihood of experiencing throwing-arm pain. Elbow valgus torque could not predict the presence of pain when holding body weight, height, and pitch velocity constant. The models demonstrated that increases in peak shoulder distraction forces when holding pitch velocity and body weight constant increased a youth baseball pitcher's likelihood of experiencing throwing-arm pain. The study results support the concept of the biomechanical efficiency framework by offering evidence that maintaining pitch velocity with a lower joint load led to a lower likelihood of pain. Results suggest that practicing efficient movement strategies can decrease the likelihood of experiencing throwing-arm pain while maintaining performance.

Ottawa's Burden: Fort Churchill and Military Nursing in Northern Canada, 1945–1975

Between 1949 and 1964, Canada's Department of National Defence owned and operated the Fort Churchill Military Hospital in northern Manitoba. As one of only two military hospitals in the country to treat civilian patients, the other being Whitehorse, Fort Churchill played a unique and critical role in the provision of federal health services in the postwar period. This article centres the experiences of military nurses in the Hudson Bay area of northern Canada, using the rise and fall of Fort Churchill's hospital, to investigate Ottawa's approach to medical governance. Military medicine is more than a wartime or overseas phenomenon, and it is incumbent upon medical historians to consider domestic military contexts in peacetime as a crucial component of Canada's twentieth century health history.

The longitudinal trajectory of depression and anxiety across the perinatal period

The understanding of long-term depression and anxiety trajectories across the perinatal periods is lacking. This longitudinal study investigated the change trajectories of both depressive and anxiety symptoms, as well as the associations of their trajectories over five years. The study included nulliparous participants (N = 163, Mage = 33.47, SDage = 3.53) with self-reported depressive and anxiety symptoms collected via questionnaires at 30- and 35 weeks' gestation, 1.5, 3, 6, 12, 24, and 60 months postpartum. Data were analysed using structural equation latent growth modelling with and without covariates. Symptoms of depression increased significantly during pregnancy (p < .001), and both depression and anxiety symptoms increased during postpartum (p-values<.001). A previous mental health history was significantly associated with greater depressive symptomology (p = .001), and White individuals (compared to non-White) tended to have greater depression and anxiety symptoms during pregnancy (p-values<.05). At 30- and 35-weeks' gestation, 6 weeks postpartum, 3, 6, 12, 24 months, and 5 years postpartum 2.5 %, 2.0 %, 4.6 %, 4.0 %, 7.3 %, 5.6 %, 3.5 % and 8.0 % of participants had clinically significant depressive symptoms and 6.1 %, 8.5 %, 7.1 %, 12.0 %, 11.9 %, 8.1 %, 7.9 %, and 28 % had clinically significant anxiety symptoms. This study highlights the need to assess both depression and anxiety in perinatal care, and to identify individuals who may require intervention.

Mediating effect of health literacy on social support and self-care ability in older patients undergoing percutaneous coronary stent implantation.

Health literacy refers to individual skills to access, process, understand, and use health information to stay healthy. Social support is a multi-faceted construct including of perceived, enacted, and structural support dimensions and negative social reactions. This study explored the mediating effect of health literacy on social support and self-care ability in older patients undergoing percutaneous coronary stent implantation (PCI). Between December 2021 and March 2022, a total of 249 older patients who underwent PCI in our hospital were included in this cross-sectional study using the convenience sampling method. The demographic and health history of patients was collected by questionnaire. Exercise of self-care agency scale (ESCA), chronic disease health literacy management scale (HeLMS) and social support rating scale (SSRS) were also analyzed and their correlations were evaluated. This study indicated that the total scores of health literacy, self-care ability and social support after PCI were 85.96±20.03, 82.82±27.65 and 25.3±4.93, respectively. Correlation analysis showed that health literacy, social support and self-care ability were positively correlated. Both social support (P=0.003) and health literacy (P=0.03) could positively predict self-care ability. Health literacy played a partial mediating role between social support and self-care ability, and the mediating effect was 0.015, accounting for 7.32% of the total effect. The health literacy and social support are at the high levels, and the self-care ability of PCI patients is at a medium level. The health literacy of older patients after PCI is the ability of social support and self-care ability. Medical staff can enhance the health literacy of patients by improving their level of social support, and then promote their self-care ability.

Family history and cancer risk study (FOREST): A clinical trial assessing electronic patient-directed family history input for identifying patients at risk of hereditary cancer

BackgroundHereditary cancer syndromes cause a high lifetime risk of early, aggressive cancers. Early recognition of individuals at risk can allow risk-reducing interventions that improve morbidity and mortality. Family health history applications that gather data directly from patients could alleviate barriers to risk assessment in the clinical appointment, such as lack of provider knowledge of genetics guidelines and limited time in the clinical appointment. New approaches allow linking these applications to patient health portals and their electronic health records (EHRs), offering an end-to-end solution for patient-input family history information and risk result clinical decision support for their provider. MethodsWe describe the design of the first large-scale evaluation of an EHR-integrable, patient-facing family history software platform based on the Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources (SMART on FHIR) standard. In our study, we leverage an established implementation science framework to evaluate the success of our model to facilitate scalable, systematic risk assessment for hereditary cancers in diverse clinical environments in a large pragmatic study at two sites. We will also evaluate the success of the approach to improve the efficiency of downstream genetic counseling resulting from pre-counseling pedigree generation. ConclusionsOur research study will provide evidence regarding a new care delivery model that is scalable and sustainable for a variety of medical centers and clinics. Trial registrationThis study was registered on ClinicalTrials.gov under NCT05079334 on 15 October 2021.

Gun Ownership for Safety/Protection and Unsecure Firearm Storage Practices: Suicide Risk and Prevention among U.S. Army Servicemembers

Introduction: 2021 had the highest number firearm suicide deaths in U.S. history, with veterans representing 62.4% of firearm suicide deaths. The study objective is to understand motivations for firearm ownership, storage practices, history of mental health disorders and suicide risk in servicemembers, as reported by family members. Methods. Data were obtained from a case-control psychological autopsy study of 135 suicide decedents in the U.S. Army compared to a probability sample of 255 living controls, who are also service members weighted to be representative of the Army. Next-of-kin and Army supervisor informants participated in structured interviews and assessed reasons for firearm ownership, and storage practices. The military medical record provided mental health history of suicide decedents. A subsample of 123 personal firearm owners (n = 31 cases and n = 92 living controls) addressed the study objectives. Multivariable logistic regression analyses were constructed to examine predictors of unsecured firearm storage practices. Results: Family members reported safety/protection as the main reason for suicide decedents’ firearm ownership, which was significantly associated with unsecure firearm storage practices (OR = 3.8, 95% CI, 1.65, 8.75, x2 = 9.88, p = 0.0017). Ownership for safety/protection and lifetime history of Generalized Anxiety Disorder (GAD) from the military medical record (OR = 3.65, 95% CI, 1.48 – 9.02, x2 = 7.89 p = 0.0050) predicted unsecure storage. Conclusions: Ownership for safety/protection and the presence of clinically significant anxiety predicted unsecure firearm storage practices. Future research examining motivations for gun ownership for safety/protection, anxiety, and unsecure storage practices may help target interventions to prevent suicide.

Study on Environmental and Health History Risk Factors for Pneumonia Cases in Toddlers at Motui Health Center

Introduction: Pneumonia case data in North Konawe Regency / 1000 Toddlers in 2017 found 121 cases, in 2018 found 175 cases, in 2019 increased found 162 cases for 2020 decreased by 158 cases and in 2021 found increased with a total of 240 cases from 888 toddlers handled by health workers. The purpose of this study was to analyze the Risk Factors of Toddler Health History and Environment on Pneumonia Cases in Toddlers in the Motui Health Center Work Area. Method: The study used a quantitative method with an observational approach using a Case Control Study design. This study was conducted from March 1 to May 1, 2023. The sample size for each group was at least 46 samples. The comparison of case and control samples is 1: 1. The total sample is 92 respondents with a simple random sampling technique, using the SPSS 26 statistical test. Result: The health history of toddlers has a risk of 8.67 times for the occurrence of pneumonia, environmental conditions have a risk of 8.91 times for the occurrence of pneumonia in toddlers in the Motui Health Center Work Area. Conclusion: The need for a North Konawe District Health Service specifically for handling infectious disease programs.

Usability, Engagement, and Report Usefulness of Chatbot-Based Family Health History Data Collection: Mixed Methods Analysis.

Family health history (FHx) is an important predictor of a person's genetic risk but is not collected by many adults in the United States. This study aims to test and compare the usability, engagement, and report usefulness of 2 web-based methods to collect FHx. This mixed methods study compared FHx data collection using a flow-based chatbot (KIT; the curious interactive test) and a form-based method. KIT's design was optimized to reduce user burden. We recruited and randomized individuals from 2 crowdsourced platforms to 1 of the 2 FHx methods. All participants were asked to complete a questionnaire to assess the method's usability, the usefulness of a report summarizing their experience, user-desired chatbot enhancements, and general user experience. Engagement was studied using log data collected by the methods. We used qualitative findings from analyzing free-text comments to supplement the primary quantitative results. Participants randomized to KIT reported higher usability than those randomized to the form, with a mean System Usability Scale score of 80.2 versus 61.9 (P<.001), respectively. The engagement analysis reflected design differences in the onboarding process. KIT users spent less time entering FHx information and reported more conditions than form users (mean 5.90 vs 7.97 min; P=.04; and mean 7.8 vs 10.1 conditions; P=.04). Both KIT and form users somewhat agreed that the report was useful (Likert scale ratings of 4.08 and 4.29, respectively). Among desired enhancements, personalization was the highest-rated feature (188/205, 91.7% rated medium- to high-priority). Qualitative analyses revealed positive and negative characteristics of both KIT and the form-based method. Among respondents randomized to KIT, most indicated it was easy to use and navigate and that they could respond to and understand user prompts. Negative comments addressed KIT's personality, conversational pace, and ability to manage errors. For KIT and form respondents, qualitative results revealed common themes, including a desire for more information about conditions and a mutual appreciation for the multiple-choice button response format. Respondents also said they wanted to report health information beyond KIT's prompts (eg, personal health history) and for KIT to provide more personalized responses. We showed that KIT provided a usable way to collect FHx. We also identified design considerations to improve chatbot-based FHx data collection: First, the final report summarizing the FHx collection experience should be enhanced to provide more value for patients. Second, the onboarding chatbot prompt may impact data quality and should be carefully considered. Finally, we highlighted several areas that could be improved by moving from a flow-based chatbot to a large language model implementation strategy.

Co-Occurring Mental and Physical Health Conditions Among Older Adults With and Without Post-traumatic Stress Disorder: A Case Control Study.

Rates of post-traumatic stress disorder (PTSD) among older adults range from 0.4%-4.5%. Research examining PTSD in adults has demonstrated numerous associations between physical and mental health conditions; however, these are less well characterized in older adults. The current study aimed to identify base rates of such conditions among older adults with and without a history of PTSD. In a case control design using the National Alzheimer's Coordinating Center Uniform Data Set, adults 65 years or older from the United States who endorsed either the presence or absence of PTSD were matched by age to assess between-group differences (N = 472; 236 pairs). We examined differences across self-reported sociodemographics and physical health, mental health, and substance use histories. More participants with a history of PTSD identified as Hispanic, non-white, non-married, and functionally independent. Compared to individuals without a history of PTSD, significantly more individuals with a history of PTSD had histories of depression, anxiety, substance abuse, Parkinson's disease, seizures, insomnia, and TBI. Among participants without PTSD history, only 14.7% reported a history of TBI, compared to 41.1% of individuals with PTSD history. Findings showed expected trends toward worse physical and mental health among older adults with self-reported PTSD. There was a striking difference in the frequency of TBI history between participants with and without PTSD. These findings underscore a need to assess for PTSD among older adults, particularly those reporting a history of TBI.

Influence of Preexisting Conditions and Concussion History on Postconcussion Symptom Severity and Recovery Time in Collegiate Athletes.

Mental health conditions and concussion history reported by a collegiate athlete may contribute to prolonged recovery and symptom severity after concussion. This work examined the potential associations among concussion history, preexisting conditions, and sex relative to initial symptom severity and recovery duration following sport-related concussion (SRC) in a cohort of Division 1 National Collegiate Athletic Association athletes. This prospective cohort study analyzed symptom severity, recovery, and return-to-play (RTP) times reported post-SRC using data collected as part of the Pac-12 Concussion Assessment, Research and Education Affiliated Program and Health Analytics Program. Health history questionnaires that included self-reported history of preexisting conditions were completed at baseline. When consented athletes were diagnosed with a concussion, daily postconcussion symptom scores were evaluated until an athlete was clinically determined to be asymptomatic. Generalized linear and Cox proportional hazards models were used to determine associations between preexisting conditions and recovery and RTP times. Ninety-two concussions met inclusion criteria. Notable differences in initial symptom severity existed between females and males who had mood disorders (effect size [d] = 0.51) and attention-deficit hyperactivity disorder (ADHD; d = 0.93). The number of previous concussions was a strong predictor of athletes reporting preexisting mood disorders, depression, anxiety, and ADHD (p = 0.008-0.04). Females with ≥2 previous concussions required more days to RTP than males (d = 0.31-0.72). Weekly recovery and RTP probabilities substantially differed between athletes who did or did not have learning disorders (LDs; hazard ratio [HR]Recovery = 0.32, HRRTP = 0.22, d = 1.96-2.30) and ADHD (HRRecovery = 3.38, HRRTP = 2.74, d = 1.71-4.14). Although no association existed between concussion history and acute symptom severity, collegiate athletes with a history of concussion had higher probabilities of reporting depression, mood disorders, anxiety, and ADHD. Having ADHD or LDs likely strongly affects time to recovery and RTP for collegiate athletes.

Smoked, smokeless, and poly-tobacco use during pregnancy in relation to infant mortality in Cambodia: Findings from a nationwide sample.

Maternal cigarette smoking during pregnancy is an established risk factor for adverse maternal, fetal, and infant outcomes. In contrast, maternal smokeless tobacco use (i.e. e-cigarettes, snus, betel quid, iqmik) during pregnancy has a more complex risk profile due to its potential use as a smoking cessation aid or to reduce the harm from smoking tobacco. The overall aim of this study was to investigate the association between smoked, smokeless, and poly-tobacco (smoked + smokeless) use during pregnancy and infant mortality, in a national sample of women in Cambodia. The study used data from the National Adult Tobacco Survey of Cambodia (NATSC) that employed sampling methods and tobacco survey items from the CDC Global Adult Tobacco Survey but also included a supplement on reproductive health and birthing history. We selected 5342 women of the NATSC who reported complete data on at least one pregnancy, and our unit of analysis was the 15998 pregnancies from these women. We conducted a multivariable logistic regression to relate tobacco use to infant mortality. Taylor linearized variance estimators were used to account for clustering by sampling unit and mother. We found that smokeless tobacco in the form of a betel quid was the most common form of tobacco used during pregnancy. In multivariable logistic regression, we found increased odds of infant death for all tobacco use categories (smoked, smokeless), but that the strongest effects were seen for habits that included smokeless tobacco (relative to never use of tobacco in any form): exclusive use of smokeless tobacco (adjusted odds ratio, AOR=2.08; 95% CI: 1.15-3.76), and poly-tobacco use (AOR=5.68; 95% CI: 1.03-31.46). In more detailed analyses that considered the composition of the betel quid (tobacco, areca nut/leaf, slaked lime), we found that even chewing of tobacco leaves with no processing or additives was associated with a three-fold increase in odds of infant death relative to a never user (AOR=3.05; 95% CI: 1.45-6.45). We found that even among those pregnant women who limited their nicotine habit to chewing tobacco leaves with no processing or additives, there remained higher odds of fetal or infant death from that pregnancy.

Qualitative Insights Into Healthcare Professionals’ Perceived Barriers in Providing Equitable and Patient-Centered Care to Members of the LGBTQI+ Community in Greece

LGBTQI+ individuals often face health disparities, with encumbered outcomes. We investigated the perspectives of a wide range of Greek health professionals using a battery of questionnaires examining LGBTQI+ health-related knowledge, attitudes, and clinical preparedness, while exploring the potential challenges they face when providing care for LGBTQI+ patients via qualitative analysis of their free text answers. In total, 220 health professionals participated, including physicians, nurses, dentists, physiotherapists, social workers, nutritionists, medical laboratory professionals, pharmacists, radiographers, and health promotion specialists. Four main themes were revealed concerning the barriers to providing equitable and patient-centered care to LGBTQI+ individuals: (1) Inadequate knowledge (1a. Distinctive health issues of the LGBTQI+ community, 1b. Community-related terminology), (2) Insufficient communication skills (2a. General approach of LGBTQI+ patients, 2b. Addressing LGBTQI+ individuals, 2c. Managing critical attitudes of colleagues/third parties), (3) Personal perceptions (3a. Attitudes toward the LGBTQI+ community, 3b. Perceptions on the necessity of sexual health history), and (4) Ambiguous bureaucratic procedures. Self-identification, contact with community members in personal life, as well as LGBTQI+ patients’ openness during the encounter were reportedly enabling inclusive care. Most participants (83.2%) expressed willingness for further training on LGBTQI+ health issues. Going forward, study participants identified this field, in conjunction with communication skills, as important areas of focus for training health providers and empowering them to provide equitable, patient-centered, high-quality care to the LGBTQI+ community.