Health Medical Center Research Articles

Exploring how the lack of inclusive approaches to neurodiversity and invisible disabilities in the workplace creates significant health disparities

U.S. Organizations that neglect to support and provide resources for employees with invisible disabilities and neurodiversity exacerbate health disparities by perpetuating systemic barriers to access and accommodation. Invisible disabilities are physical, mental, or neurological conditions that are not immediately apparent to others but can significantly impact an individual's daily activities and quality of life. Neurodiversity refers to the concept that neurological differences, such as autism, ADHD, and dyslexia, are natural variations of the human brain and should be recognized and respected as part of human diversity. Without accommodations and inclusive policies, employees with invisible disabilities may face heightened stress, decreased productivity, and an increased likelihood of burnout, leading to negative impacts on physical and mental health. Additionally, the failure to recognize and value neurodiversity in the workplace contributes to feelings of alienation and marginalization among affected employees, further exacerbating disparities in health outcomes and overall well-being. This article presents the results of intervention action research (IAR) conducted by a management consultant within a large university with a medical school and health center. The aim was to improve the organization's culture regarding valuing neurodiversity and employees with invisible disabilities. Through a comprehensive assessment of organizational structure, policies, and practices, data was gathered via interviews, surveys, and document analysis, engaging stakeholders, including faculty, staff, administrators, and students. Findings revealed significant challenges and opportunities, leading to collaborative efforts with university leadership to address communication gaps, workflow inefficiencies, and resource allocation disparities. With approximately forty-two million Americans facing invisible disabilities encompassing a wide range of physical and mental conditions, the necessity for inclusive approaches transcending traditional definitions becomes evident. Embracing neurodiversity and challenging ableism in the workplace is crucial for fostering an organizational culture that respects the inherent value of all individuals.

A Content Analysis of #Childhoodcancer Chatter on X.

Over a half million children are living with cancer in the United States. Social media platforms offer unique opportunities for cancer communication by public health organizations as well as health care providers, scientists, patients, and caregivers. Given the dearth of research on childhood cancer communication, the present study aimed to examine the nature of tweets on the social media platform X (formerly Twitter) that used the hashtag #childhoodcancer, the types of these tweets that attracted the most retweets, the types of users tweeting about childhood cancer (e.g., individuals, health care professionals), and the nature of tweets made by the different types of users. We performed a content analysis of tweets we captured on X via NCapture in October and December 2022. Of the 3217 tweets captured, we randomly sampled 1000 eligible tweets and manually double-coded them. Interrater agreement was 83% (κ = 0.75). Results revealed six themes in the tweets, including fundraising (21.2%), advocacy (20.2%), motivational (17.5%), educational (15.3%), science (12.8%), and shout-outs (12.1%). Motivational, advocacy, and science tweets attracted more retweets than fundraising tweets and shout-outs (p < 0.001). Individuals (i.e., patients, caregivers, and advocates tweeting on their own behalf) and nonprofit organizations made a majority of the tweets at 41.5% and 38.6%, respectively, followed by health care professionals (8.7%), academic and/or medical centers (4.2%), and for-profit companies (3.5%). Childhood cancer communication on X is dominated by individuals doing advocacy and fundraising. X may provide important opportunities for public health messaging and science communication about childhood cancer.

Systemic lupus erythematosus is a risk factor for having multiple subtypes of cutaneous lupus erythematosus.

Patients with cutaneous lupus erythematosus (CLE) can present with one or multiple different subtypes of CLE. There is limited understanding of the prevalence and associated risk factors for having multiple CLE subtype diagnoses. This study characterized the frequency and risk factors for having multiple CLE subtypes. This was a cross-sectional study of 319 patients with CLE enrolled in the University of Texas Southwestern Cutaneous Lupus Registry seen in outpatient dermatology clinics at the University of Texas Southwestern Medical Center and Parkland Health from January 1, 2009 to December 31, 2021. Demographic and clinical information was collected from each subject and compared using univariate and multivariable logistic regression analyses. 59 subjects (18.5%) were diagnosed with two or more CLE subtypes. Univariate analyses identified statistically significant differences in rates of systemic lupus erythematosus (SLE) diagnosis, history of positive anti-nuclear antibody, arthritis, renal disorder, and serositis in patients with multiple CLE subtype diagnoses. In the multivariable analysis, SLE diagnosis was found to be statistically significant. Our study showed that almost one out of five CLE patients have multiple CLE subtypes, with SLE diagnosis being a significant risk factor. Clinicians can monitor CLE patients for developing multiple subtypes and account for systemic manifestations and laboratory abnormalities associated with SLE.

Incidence and risk factors regarding atherosclerotic cardiovascular disease in middle-aged and elderly people with HIV treated in Chongqing, China

BackgroundAtherosclerotic cardiovascular disease (ASCVD) has become an increasingly common cause of death among people living with HIV (PLHIV) receiving successful antiretroviral therapy (ART). In Chongqing, approximately half of the PLHIV were middle-aged or elderly, and their diets were mainly high in salt, spices and oil; however, there is still a lack of relevant research on the risk factors and whether the disease burden of ASCVD is greater in these areas. This study was to investigate the risk of ASCVD in middle-aged and elderly PLHIV receiving ART and analyze the factors influencing high risk.MethodsA cross-sectional study was conducted at Chongqing Public Health Medical Center. Questionnaire surveys, physical examinations and laboratory examinations were used to collect information from PLHIV aged ≥ 45 years. Pooled cohort equations (PCEs) were used to calculate the 10-year ASCVD risk and analyze the influencing factors. The 10-year ASCVD risk score was used to define patients in the low-risk subgroup (< 7.5%) and high-risk subgroup (≥ 7.5%), and the risk factors were compared between the two groups.ResultsIn total, 463 PLHIV (median age 55.0 years, male 68.5%) were included, and the median duration of ART was 45.0 (15.0, 70.3) months. Of the 463 PLHIV, 13 (2.8%) had a known history of ASCVD. In the present study, 153 PLHIV (33.0%) were classified into the high-risk group, and 310 PLHIV (67.0%) were classified into the low-risk group. Compared with the low-risk group, the high-risk group was more likely to be female, older age, live in urban areas, be unemployed, have poor sleep quality, have higher low-density lipoprotein cholesterol (LDL-c), have higher total cholesterol (TC), and have diabetes and hypertension; however, coffee consumption was associated with a low risk of ASCVD. In addition, there were no differences in HIV viral load, CD4 + T-cell count, or duration on ART, or ART regimes between the two groups. According to multiple logistic regression, older age [odds ratio (OR) = 62.469, 95% CI 27.456, 142.134], female sex [OR = 9.635, 95% CI 4.384, 21.179], higher LDL-c levels [OR = 1.018, 95% CI 1.000, 1.036], accompanied hypertension [OR = 8.642, 95% CI 3.373, 22.143] and diabetes [OR = 10.806, 95% CI 3.787, 30.834] were found to be independent risk factors for the 10-year risk of ASCVD.ConclusionsThe overall 10-year ASCVD risk is great for middle-aged and elderly PLHIV in Chongqing, China. The risk factors for the 10-year risk of ASCVD were older age, female sex, elevated LDL-c level, and coexisting hypertension and diabetes.

Human immunodeficiency virus/acquired immune deficiency syndrome antiretroviral therapy initiated on the same day in treatment-naïve people with human immunodeficiency virus: A comparative study of efficacy and regimen.

Rapid initiation of antiretroviral therapy (ART) is recommended by guidelines, however, real-world studies of same-day initiation of ART in China are limited, and an optimal treatment regimen has yet to be identified. The study aims to provide a realistic reference for rapid initiation of ART. We retrospectively analyzed the clinical data of treatment-naïve people with human immunodeficiency virus (PWHs) who were diagnosed and prescribed same-day ART initiation from January 1, 2021 to December 31, 2022 at Chongqing Public Health Medical Center. PWHs voluntarily chose an ART regimen that divided them into two groups: National Free Antiretroviral Treatment Program (NFATP)-recommended regimens group (2 nucleoside reverse transcriptase inhibitors+non-nucleoside reverse transcriptase inhibitors/protease inhibitors) and bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) group. The primary endpoint was the virological outcome of the two groups for same-day ART initiation at 24weeks and 48weeks. The secondary endpoints included changes in CD4 counts, maintenance of the original ART regimen at 48weeks, and lipid levels and renal function at 48weeks. A total of 255 PWHs were included in the study, including 131 (51.4%) in the NFATP group and 124 (48.6%) in the BIC/FTC/TAF group. The overall virological suppression rates at 24weeks and 48weeks were 78.2% (165/211) and 95.4% (207/217), respectively. At 24weeks, the virologic suppression rate in the NFATP group was lower than that in the BIC/FTC/TAF group (65.3% [66/101] vs . 90.0% [99/110], P <0.001). The median increase in the CD4 count was 198.0 (126.0-300.0) cells/μL at 24weeks, with 182.0 (108.0-245.0) cells/μL in the NFATP group and 219 (132.0-316.0) cells/μL in the BIC/FTC/TAF group ( P =0.035). At 48weeks, there was no significant difference in the virological suppression rate or CD4 count between the groups. The 48-week initial ART regimen retention rates and treatment retention rates were significantly higher in the BIC/FTC/TAF group than in the NFATP group (91.1% (113/124) vs . 71.8% (94/131), 99.2% (118/119) vs . 93.0% (120/129), respectively). In terms of safety, there were no significant changes from baseline in levels of creatinine, estimated glomerular filtration rate (eGFR), or lipids in either group at 48weeks. ART initiation on the day of diagnosis is effective, safe, and feasible, with satisfactory rates of virologic suppression, 48-week initial ART regimen retention rates, and treatment retention rates in treatment-naïve PWHs. In our study, the early virologic suppression rate, CD4 cell counts, and treatment retention of the BIC/FTC/TAF regimens were significantly better than those of the NFATP regimens.

Investigating the relationship between the anxiety of contracting corona virus and the symptoms of obsessive-compulsive disorder with the mediating role of mental confusion and emotion regulation in health care center employees

Introduction: anxiety caused by the Corona virus transmission are highly prevalent among medical staff, so this study aims to determine the relationship between the anxiety of affected by infectious diseases and the symptoms of obsessive-compulsive disorder with the mediating role of mental confusion and emotion regulation. MethodS and Materials: This study was carried out based on correlational method in the form of modeling of structural equations, in which 350 male and female employees working in the health and treatment centers of Neyshabur city were selected through available sampling. Data collection tools included Madsley Practical Obsession Scale, Corona Alipour Anxiety Questionnaire, Criver, Solly and Esomil's Deliberate and Automatic Disorientation Questionnaire, and Gross and John's Emotion Regulation Questionnaire. After completing the questionnaires, data analysis using Modeling of structural equations was done with Lisrel and SPSS softwares. Results: between the anxiety and obsessive symptoms with r = 0.576, between mental confusion and obsessive symptoms with r = 0.553, between mental confusion and anxiety with r = 0.481, There is a significant direct relationship at the level p&gt;0.01. But between emotional regulation and obsessive symptoms with r = -0.643, between emotional regulation and anxiety with r = -0.495, between emotional regulation and mental confusion with r = -0.611 there is an inverse significant relationship. Also, the results showed the role of two mediating variables of mental confusion and emotional regulation in the relationship between corona anxiety and obsessive symptoms. Conclusion: The model of the relationship between the anxiety caused by the transmission of the corona virus and the symptoms of obsessive-compulsive disorder according to the mediation of mental disorientation and emotion regulation has a good fit that with the increase in the number of emotions and defeat in regulating one's emotions, the symptoms of obsessive-compulsive disorder and confusion mental health also increases in the treatment staff. According to these findings, it is expected that health managers and medical centers will pay special attention to the psychological well-being of the personnel working in different parts of this profession.

Bilateral pulvinar responsive neurostimulation for bilateral multifocal posteriorly dominant drug resistant epilepsy.

To describe four cases of Responsive Neurostimulation (RNS) in the bilateral pulvinar nuclei (PUL) in individuals with drug resistant epilepsy (DRE). This will show that due to widespread PUL connectivity, bilateral PUL RNS may be an option for some individuals with bilateral multifocal epilepsy. This study comprises two centers' experience with bilateral PUL RNS for DRE. Patients treated with bilateral PUL RNS at Westchester Medical Center (Valhalla, NY) and Corewell Health (Grand Rapids, MI) between the years 2019 and 2022 were analyzed and described. Presented here are methods for target selection, device programming, and clinical outcomes. Two patients with Lennox-Gastaut phenotype (aged 13 and 21 years) with posteriorly dominant discharges were implanted with bilateral PUL electrodes. Additionally, two patients (aged 20 and 31 years) with independent left and right occipital bilateral multifocal seizure onsets were implanted with bilateral RNS devices targeting the ipsilateral PUL and ipsilateral occipital cortex. Subclinical and clinical seizures were captured by RNS electrocorticography (ECoG) in all patients. RNS implantation and treatment was well-tolerated without adverse effects in all patients. Relative to baseline, two patients had 25% and 50% reduction in disabling seizures, and two patients had 71% and 100% reduction in disabling seizures. Stimulation paradigms utilized high frequency stimulation in both Lennox-Gastaut phenotype patients. Low frequency (individualized to the terminal ictal frequencies) stimulation was effective in the two bioccipital patients. RNS with electrode placement targeting bilateral PUL is safe, and no adverse effects have been attributable to the pulvinar electrode placement. PUL responsive neurostimulation is potentially effective for patients with bilateral multifocal, posteriorly dominant DRE. Both high and low frequency responsive stimulation are treatment options. Longer follow-up will shed light on the ultimate reduction of seizure burden. We describe four cases where stimulation devices were placed in the Pulvinar area of the thalamus (central sensory area in the brain). This is very unique and different location than where these devices are typically placed. These patients all had great outcomes with marked seizure reduction, demonstrating that this placement is both safe and effective.

Intention Versus Implementation: Diversity, Equity, Inclusion, and Justice Efforts at Your Clinical Practice.

Diversity, equity, inclusion, and justice (DEIJ) are important factors to be considered in medical education, academic and community health centers, and health care policy. DEIJ efforts have been shown to have a strong influence in advancing health equity, yet these efforts tend to fall on a small group of providers, usually of historically marginalized or minority backgrounds (eg, race and ethnicity, gender identity, sexual orientation, religion). To combat this inequity, more research needs to be done to identify where the burden is falling and what strategies can be set in place to counteract this taxing imbalance. Providers should educate themselves on the anti-DEIJ legislation sweeping across the country, recogniz- ing the misinformation, and advocating for efforts pushing back against this movement. Providers can also advocate for ways their institution or practice can reduce the burden for historically marginalized providers by supporting recognition of DEIJ-related efforts in traditional promotional measures or taking on activities allowing for participation in scholarly work that will advance careers. [Pediatr Ann. 2024;53(10):e354-e357.].

MEDICAL-SOCIAL ASPECTS OF OPHTHALMOLOGICAL PATHOLOGY: A VARIOUS VIEW OF THE PROBLEM

Background. Is due to the importance of a full-fledged healthy visual perception for the quality of life and working capacity of different age categories of the population. Forecast calculations by international experts prove the presence of ophthalmic pathology growing trends in the spread, according to which by 2050, almost a third of the planet's population will have impaired vision. The effective organization of medical care in terms of providing services to patients with complaints of impaired vision should take into account modern world trends, be comprehensive with the involvement of medical specialists (ophthalmologists, family doctors) and public health centers, public organizations and associations. Aim: to find out the ophthalmic pathology modern medical and social aspects, the results of research in the developed countries in the world regarding the peculiarities of the formation of the burden eyes diseases and its accessory apparatus. Materials and methods. Scientific publications on the risk factors and significance of visual impairments, especially in childhood and adolescence, medical and social aspects of their impact on work capacity, socialization and quality of life of patients of various ages served as material for the study. The research methods were: system approach and system analysis, content analysis, bibliosemantic method. Results. Prove the prospects for the implementation of medical and preventive strategies in the provision of primary and specialized ophthalmic medical care, taking into account the significant medical and social burden of ophthalmopathology, the distribution of nosologies by class of eyes diseases and its accessory apparatus, which are most often found in certain age groups, is given. It has been proven that the prevalence of ophthalmic pathology increases with age, its highest levels are registered in the age group of 65 years and older. Conclusion. The important medical and social significance of visual functions disorders at different ages potentially threatens the emergence of disability, disruption of ophthalmic patients socialization and work capacity. The growing medical and social importance of eye diseases in our time puts forward new requirements for the organization of providing ophthalmic care to various segments of the population.

HIV drug resistance: analysis of viral genotypes and mutation loci in people living with HIV in Chongqing, China (2016–2023)

BackgroundLarge-scale HIV genotype drug resistance study has not been conducted in Chongqing.MethodsA retrospective study was conducted on people living with HIV(PLWH) who received HIV-1 genotype resistance testing at Chongqing Public Health Medical Center from May 2016 to June 2023. The HIV-1pol gene was amplified through RT-PCR and analyzed in terms of genotypic drug resistance.ResultsOf the 3015 PLWH tested for HIV-1 drug resistance, 1405 (46.6%) were resistant to at least one antiviral drug. Among non-nucleoside reverse transcriptase inhibitors (NNRTIs), 43.8% were resistant, compared to 29.5% for nucleoside reverse transcriptase inhibitors (NRTIs) and 3.4% for protease inhibitors (PIs). V179D/E and K103N/S were identified as the common mutation sites in the NNRTIs class of drugs, M184V/I and K65R/N were reported as the most common mutation sites in NRTIs, while thymidine analogue mutation (TAM) group was identified in 373 samples. L10FIV was the most common mutation in PIs. The dominant HIV-1 subtype was CRF07_BC.ConclusionsThe high prevalence of HIV-1 drug resistance in Chongqing underscores the imperative for rigorous surveillance of the local HIV epidemic. Furthermore, TAMs are associated with HIV-1 multidrug resistance, and timely detection of drug resistance is helpful to reduce the emergence and spread of such drug-resistant strains.

Correlation of Patient-Reported Social Determinants of Health With Census Tract Measures of Socioeconomic Disadvantage in Patients With GI Cancers in Eastern North Carolina.

Investigating the impact of social determinants of health (SDOHs) on cancer care in large populations relies on census estimates. Routine clinic SDOH screening provides timely patient-level information which could inform best practices. This study evaluated the correlation between patient-reported SDOH needs and population-level census tract measures. This was a retrospective cross-sectional study of a cohort of adult patients with GI malignancy screened for SDOHs such as financial insecurity, transportation, and food insecurity during initial outpatient evaluation at East Carolina University (formerly Vidant) Health Medical Center in Greenville, NC (November 2020-July 2021). Primary outcomes included number and severity of identified SDOH needs and area deprivation index (ADI) and census tract measures for each patient. Spearman rank correlations were calculated among patient-level needs and between patient-level needs and similar census tract measures. Of 112 patients screened, 58.9% self-identified as White (n = 66) and 41.1% as Black (n = 46). A total of 50.5% (n = 54) resided in a rural county. The collective median state ADI rank was 7 (IQR, 5-9). The median household income was $38,125 in US dollars (USD) (IQR, $31,436-$48,934 [USD]). Only 12.5% (n = 14) reported a moderate or severe financial need. Among reported needs, financial need moderately correlated with food insecurity (coefficient, 0.46; P < .001) and transportation (coefficient, 0.45; P < .001). Overall, census tract measures and reported needs poorly correlated. Lack of transportation correlated with percentage of households without a vehicle (coefficient, 0.18; P = .03) and limited access to healthy foods (coefficient, 0.18; P = .04). Given the poor correlation between reported and census needs, population-level measures may not accurately predict patient-reported needs. These findings highlight the importance of SDOH screening in the clinical setting to reduce health disparities and identify opportunities to improve care delivery.

Determining Deviation of the Growth Pattern of Preterm Infants and Its Causes According to the Fenton Growth Chart: A Longitudinal Follow-up Study

Background: Birth weight is a crucial indicator of infant health. In Iran, child growth monitoring for children under six years old is integrated into the healthcare system. However, existing growth charts have limitations in accurately representing preterm infants. Objectives: This study was conducted to determine the frequency of postnatal growth retardation and its causes in preterm infants from hospitalization to six months after birth. Methods: After informing parents, we recruited 255 preterm singleton infants born at the Afzalipour Medical Education and Health Center in Kerman, Iran, over one year. The Fenton growth chart was used to compare the anthropometric characteristics of the infants at birth, and at ages 7, 14, and 28 days, and then monthly up to 6 months. A special questionnaire also recorded the type of feeding, length of hospital stay, use of mechanical ventilation and oxygen, duration of total parenteral nutrition (TPN), and associated causes and complications. Results: The mean Z-score weights at birth, discharge, one month, three months, and six months were -0.34, -1.19, -0.85, -0.94, and -1.79, respectively. The mean Z-score heights at birth, discharge, one month, three months, and six months were 0.74, 0.20, -0.07, -0.79, and -2.5, respectively. Additionally, the mean Z-scores for head circumference at birth, discharge, one month, and three months were 0.41, -0.19, -0.53, and -1.17, respectively. Deviation from the Fenton preterm growth chart was detected in 109 infants (42.7%) at the time of discharge, 79 infants (31%) at one month, 82 infants (32.2%) at three months, and 134 infants (52.5%) at six months of age. Conclusions: The weight at discharge and the length of NPO [due to surgical problems, feeding intolerance, necrotizing enterocolitis (NEC), etc.] were significantly inversely related. Preterm infants grow more slowly in hospitals, so their longitudinal growth data should be interpreted carefully. The incidence of postnatal growth failure can be reduced by improving NICU quality, optimizing nutrition, and increasing enteral feeding rates.

Enhanced diagnosis of pulmonary tuberculosis through nucleotide MALDI-TOF MS analysis of BALF: a retrospective clinical study

To evaluate the diagnostic accuracy of matrix-assisted laser desorption ionization time-of-flight mass spectrometry based on nucleotide (nucleotide MALDI-TOF MS) on bronchoalveolar lavage fluid (BALF) from suspected pulmonary tuberculosis (PTB) patients. A retrospective study was conducted on suspected PTB patients (total of 960) admitted to Chongqing Public Health Medical Center between May 2021 and January 2022. The sensitivity, specificity, positive predictive value, negative predictive value (NPV) and area under the curve values of nucleotide MALDI-TOF MS as well as smear microscopy, Mycobacterium Growth Indicator Tube 960 culture (MGIT culture), and Xpert MTB/RIF were calculated and compared. Total of 343 presumed PTB cases were enrolled. Overall, using the clinical diagnosis as reference, the sensitivity and NPV of nucleotide MALDI-TOF MS was 71.5% and 43.1%, respectively, significantly higher than smear microscopy (22.6%, 23.2%), MGIT culture (40.6%, 18.9%), Xpert MTB/RIF (40.8%, 27.9%). Furthermore, nucleotide MALDI-TOF MS also outperformed over Xpert MTB/RIF and MGIT culture on smear-negative BALFs. Approximately 50% and 30% of patients benefited from nucleotide MALDI-TOF MS compared with smear and MGIT culture or Xpert MTB/RIF, respectively. This study demonstrated that the analysis of BALF with nucleotide MALDI-TOF MS provided an accurate and promising tool for the early diagnosis of PTB.

Pediatric Facial Fractures: A Multi-Institutional Level 1 Trauma Center Analysis of Incidence, Interventions, and Outcomes.

Retrospective chart review. The management of pediatric facial fractures presents distinctive considerations compared to adults. This study aims to provide a unique perspective on the correlations between the mechanism of injury, types of facial fractures, and fracture interventions and management utilized in 2 North Carolina Level 1 Trauma Centers to determine the optimal management options for this patient population. An IRB-approved retrospective chart review was performed of pediatric facial trauma patients ages <18 years old between January 2020 and December 2022 at Atrium Health Wake Forest Baptist Medical Center and Atrium Health Charlotte Medical Center. Data on patient demographics, mechanism of injury, facial fractures, interventions, and outcomes were collected. Of 2,977 pediatric facial trauma patients, 582 patients sustained at least 1 facial fracture at the time of injury. Adolescents were significantly less likely to be transferred from outside institutions and to be admitted for further care (P = 0.002). Adolescents experienced higher levels of residual symptoms following initial discharge (P = 0.001) and were less likely to have a symptom resolution within 1 year (P < 0.0001). Neonates and infants were significantly more likely to receive conservative interventions and to sustain calvarium and skull base fractures (P < 0.0001). This study identifies differences in pediatric age groups related to transfers, admittance, fracture type, management, and outcomes. Our data suggests adolescent patients may experience a higher incidence of residual symptoms with lower levels of symptom resolution within 1 year. Further investigation into these differences may elicit optimized methods of fracture management in pediatric age groups and allow for effective, individualized care with improved long-term outcomes.

Factors Associated With Nonprescription of Oseltamivir for Infant Influenza Over 9 Seasons.

The Centers for Disease Control and Prevention (CDC) recommends oseltamivir phosphate for children <2 years old with confirmed or suspected influenza as they are at high risk for complications. We analyzed infant characteristics associated with nonprescription of oseltamivir over 9 years. We conducted a retrospective electronic health record (EHR) review of infants <12 months old born between January 1, 2012 and December 31, 2019 within the University of Pittsburgh Medical Center health system in Southwestern Pennsylvania who had >2 well-child visits during their first year. Infants with a confirmed positive test for influenza were included in the analysis. Factors associated with infant oseltamivir nonprescription were assessed using multivariable logistic regression. Of 457 infants with confirmed influenza, 86% were prescribed oseltamivir. The proportion of infants prescribed oseltamivir increased from an average of 64.6% during the 2012-2016 influenza seasons to 90.4% during the 2016-2020 influenza seasons. Infants were more likely to not be prescribed oseltamivir if they experienced >2 days of influenza symptoms (odds ratio (OR): 9.4, 95% CI: 4.8, 18.7, P < .001), were diagnosed during the 2012-2016 influenza seasons (OR: 4.2, 95% CI: 1.8, 9.5, P < .001), tested positive for influenza via a multiplex/reverse transcriptase polymerase chain reaction test (OR: 6.7, 95% CI: 2.7, 16.3, P < .001; OR: 2.7, 95% CI: 1.1, 7.1; P = .04), or did not have a fever at point-of-care (OR: 2.3, 95% CI: 1.2, 4.6, P = .01). Adherence to CDC influenza antiviral treatment guidelines for infants is high and improved over time. However, the provision of targeted education to providers may further improve oseltamivir prescribing practices for high-risk children <12 months of age.

Assessing the quality of life in patients with drug-resistant tuberculosis: a cross-sectional study

BackgroundThis study investigated the current status of the quality of life (QOL) of drug-resistant tuberculosis (DR-TB) patients in Nanjing, China, and analyzed the influencing factors.MethodsThe survey was conducted among patients with DR-TB who were hospitalized in the tuberculosis department of the Second Hospital of Nanjing (Nanjing Public Health Medical Center) from July 2022 to May 2023. The Chinese version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire was used to investigate the QOL levels of patients with DR-TB, and a multiple linear regression model was used to analyze the QOL influencing factors.ResultsA total of 135 patients participated in the study; 69.6% were male, the average age was 46.30 ± 17.98 years, 13.33% had an education level of elementary school or below, and 75.56% were married. The QOL scores were 51.35 ± 17.24, 47.04 ± 20.28, 43.89 ± 17.96, and 35.00 ± 11.57 in the physiological, psychological, social, and environmental domains, respectively. The differences between the four domain scores and the Chinese normative results were statistically significant (P < 0.05). The results of multiple linear regression analysis showed that the factors related to the physiological domain included residence, family per-capita monthly income, payment method, adverse drug reactions (ADRs), and comorbidities; psychological domain correlates included educational level, family per-capita monthly income, course of the disease, and caregivers; social domain correlates included age and comorbidities; and factors related to the environmental domain included age, education level, and comorbidities.ConclusionsIn Nanjing, China, patients with younger age, higher education level, living in urban areas, high family per-capita monthly income, no adverse drug reactions, no comorbidities, and having caregivers have better quality of life. Future interventions to improve the quality of life of patients with drug-resistant tuberculosis could be tailored to a specific factor.

Clinical features and viral load variations of Mpox: a retrospective study in Chongqing, China

PurposeSince May 2022, Mpox has spread extensively outside of Africa, posing a serious threat to the health of people globally, and particularly to the men who have sex with men (MSM) population. Chongqing, a province in Southwest China, has relatively large MSM and people living with HIV (PLWH) populations, presenting conditions conducive to the wide dissemination of Mpox. In this study, we investigated the clinical characteristics of Mpox patients among MSM and PLWH in Chongqing, aiming to inform the development of targeted prevention, control, and treatment strategies for Mpox.MethodWe evaluated the clinical characteristics, travel history, time of onset, distribution and number of skin lesions of Mpox patients admitted to the Chongqing Public Health Medical Center between September 2022 and October 2023. Meanwhile, a series of clinical samples were collected and the pathogen of interest was identified as Mpox virus using quantitative polymerase chain reaction (qPCR). The results were presented in the form of cycle thresholds (Ct), which help to approximate the quantification of viral load.ResultsAs of October 11, 2023, the Chongqing Public Health Medical Center reported a total of nine Mpox virus infections. All the patients identified were male and belonged to the MSM population, among whom seven (77.8%) were living with HIV, and maintained a preserved immune system while achieving viral suppression via effective ART. We observed no discernible clinical differences between MSM with Mpox with or without HIV, and no fatalities were recorded. Viral loads were observed to be higher in samples taken from the skin than those from the throat, nasopharynx, blood, or semen.ConclusionIn this retrospective study, the clinical manifestations of MPXV infection appeared consistent among MSM patients, regardless of HIV status. Elevated MPXV viral loads in the skin and mucosal tissues, particularly at genital and anal sites, indicate that transmission is more likely to occur via direct physical contact as opposed to respiratory pathways or through exposure to bodily fluids.

Diagnosis of Coccidioidomycosis with the Second-Generation Miravista IgG and IgM Enzyme Immunoassay and the Role of Adding Miravista Coccidioides Antigen Detection to Immunodiagnostic Assays.

In the present study, we validate and compare the second-generation Miravista Coccidioides IgG and IgM enzyme immunoassays (EIA) (MiraVista Diagnostics [MVD] Ab EIA) to Meridian Diagnostics Coccidioides IgG and IgM EIA (Meridian Ab EIA), immunodiffusion (ID) and complement fixation (CF). We also evaluated whether the addition of Coccidioides antigen testing to anti-Coccidioides antibody testing increased the sensitivity for the diagnosis of currently active coccidioidomycosis. We retrospectively studied 555 patients evaluated at Valleywise Health Medical Center between January 2013 and May 2017 for whom coccidioidomycosis was suspected and samples were submitted to MVD for testing. Specimens were tested for antigen in the MVD antigen enzyme immunoassay (MVD Ag EIA) and for IgG and IgM antibodies with MVD and Meridian Diagnostics EIAs. ID and CF were obtained from medical records. Sensitivity and specificity were 83.0% and 91.1% or MVD Ab EIA, 69.3% and 99.7% for Meridian Ab EIA, 85.4% and 100% for ID and 65.5% and 100% for CF. Combined MVD antigen and antibody detection by EIA and ID resulted in increased sensitivity in disseminated and pulmonary disease (MVD Ag/MVD Ab: 100%, 88.3%; MVD Ag/Meridian Ab: 98.2%, 78.6%; and MVD Ag/ID: 100%, 91.7%). The detection of antibodies by MVD EIA was more sensitive than Meridian EIA or CF but similar to ID. This study supports the use of antigen testing in immunocompromised patients and those with suspected disseminated disease. Furthermore, the addition of antigen detection by EIA to antibody detection resulted in higher sensitivity of all serological tests.

Experiences of Leaders in Diversity, Equity, and Inclusion in US Academic Health Centers

The murder of George Floyd in 2020 spurred an outpouring of calls for racial justice in the United States, including within academic medicine. In response, academic health centers announced new antiracism initiatives and expanded their administrative positions related to diversity, equity, and/or inclusion (DEI). To understand the experiences of DEI leaders at US allopathic medical schools and academic health centers, ie, the structure of their role, official and unofficial responsibilities, access to resources, institutional support, and challenges. This qualitative study used key informant interviews with participants who held formal DEI positions in their school of medicine, health system, or department. Interviews were conducted from December 2020 to September 2021. Transcripts were coded using a phenomenographic approach, with iterative concurrent analysis to identify thematic categories across participants. Data were analyzed from January to December 2021. Formal DEI role. Questions elicited reflection on the responsibilities of the role and the strengths and challenges of the unit or office. A total of 32 participants (18 of 30 [56%] cisgender women; 16 [50%] Black or African American, 6 [19%] Latinx or Hispanic, and 8 [25%] White) from 27 institutions with a mean (range) of 14 (3-43) years of experience in medical education were interviewed. More than half held a dean position (17 [53%]), and multiple participants held 2 or more titled DEI roles (4 [13%]). Two-thirds self-identified as underrepresented in medicine (20 [63%]) and one-third as first generation to attend college (11 [34%]). Key themes reflected ongoing challenges for DEI leaders, including (1) variability in roles, responsibilities, and access to resources, both across participants and institutions as well as within the same position over time; (2) mismatch between institutional investments and directives, including insufficient authority, support staff, and/or funding, and reduced efficacy due to lack of integration with other units within the school or health system; (3) lack of evidence-based practices, theories of change, or standards to guide their work; and (4) work experiences that drive and exhaust leaders. Multiple participants described burnout due to increasing demands that are not met with equivalent increase in institutional support. In this qualitative study, DEI leaders described multiple institutional challenges to their work. To effectively address stated goals of DEI, medical schools and academic centers need to provide leaders with concomitant resources and authority that facilitate change. Institutions need to acknowledge and implement strategies that integrate across units, beyond one leader and office. Policymakers, including professional organizations and accrediting bodies, should provide guidance, accountability mechanisms, and support for research to identify and disseminate evidence for best practices. Creating statements and positions, without mechanisms for change, perpetuates stagnation and injustice.

The number needed to biopsy for cutaneous melanoma in academic dermatology clinics.

A standard metric for melanoma detection is the number needed to biopsy (NNB). This metric has been used to evaluate practicing dermatologists, dermatology advanced practice professionals, and primary care providers. This metric, however, has rarely been applied to residency clinics. We aimed to determine the NNB at the University of Colorado residency clinics. Moreover, we sought to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on NNB. This study is a retrospective analysis of biopsies performed from 2016 to 2022 at the Denver Health Medical Center and the Rocky Mountain Regional Veteran Affairs dermatology clinics. Differential diagnosis at the time of biopsy was searched for keywords including melanoma, melanoma in situ, and lentigo maligna. Skin biopsies that included re-excisions were excluded. The NNB was subsequently generated by dividing the number of biopsied lesions with suspected melanoma by the number of histologically confirmed melanomas. The data was further separated by pre-COVID-19 (2016-February 2020), COVID-19 shutdown period (March 2020-July 2020), and post-COVID-19 (March 2020-present). Demographic data, including age, sex, race, and Fitzpatrick type, were collected. There were 2230 biopsies with suspected melanoma in the differential diagnosis at both clinic sites from 2016 to 2022. Of these, 362 were histologically confirmed melanoma. Total NNB was 6.16. The pre-COVID-19 NNB was 5.86, and the post-COVID-19 NNB was 6.91. Residency clinics have NNB similar to published values of practicing dermatologists. Furthermore, within these clinics, the impact of the COVID-19 pandemic was appreciated by a relative, although statistically insignificant, increase in NNB.