Key Demographics Research Articles

Perspectives on Current Attitudes, Enablers, and Barriers to Obtaining Surgical Informed Consent for Doctors-in-Training.

Background Surgical informed consent (SIC) is paramount in modern-day litigious surgical practice, yet numerous complaints remain about the consenting process.This paperinvestigated current attitudes, enablers, and barriers to obtaining SIC in clinical practice for doctors-in-training (DiT). Methodology Self-reported SIC practice among DiT (N=1,652) across three metropolitan health service regions in Western Australia (WA) was surveyed using a de-identified 20-item multiple response ranking, dichotomous quantitative and qualitative online survey. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 27 (IBM Corp., Armonk, NY, USA). Results The response rate was 23% (n=380). There was an even distribution of key demographics across all three health regions; the median postgraduate year (PGY) was two. Only 57.4% of DiT strongly felt comfortable and confident obtaining a SIC. Of the responders,67.4% correctly identified key SIC components. There were significant positive associations between comfort and confidence with obtaining SIC and the seniority level of the DiT (p<0.001), identification of SIC components (p<0.001), and prior training in SIC (p<0.001). Most DiTs highlighted the necessity for formal SIC training with a preference for interactive workshops supported by e-learning modules. Conclusions Most DiTs can identify the key factors that constitute a valid SIC; however, the practical conversion of this skill could be better. The key enablers to improved SIC techniques were well-supported departments, with further training and clear guidelines within the institutions. The identified barriers were time constraints, inexperience, and a lack of senior support. Future practices and interventions should address these key barriers while promoting the enablers of sustainable and efficient SIC practice.

Digital Rectal Examination: Perspectives on Current Attitudes, Enablers, and Barriers to Its Performance by Doctors-in-Training.

Background Digital rectal examination (DRE) is a valuable diagnostic tool for diagnosing multiple conditions, but its use has declined in practice. This study sought to provide perspectives on current attitudes, enablers, and barriers to performing DRE for doctors-in-training (DiTs) and explore strategies to improve and facilitate consistent, efficient, and effective execution of DRE.​​​​​​​ Methodology Self-reported DRE practice among DiTs (n = 1,652) across three metropolitan health service regions in Western Australia was surveyed using a de-identified multiple-response ranking, dichotomous quantitative and qualitative survey. Data were analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Results A total of 452 (27%) DiTs responded to the survey, with an even distribution of key demographics between regions and specialties. The median post-graduate year was 2. Half of DiTs reported being comfortable with performing DRE. Most had training in medical school (71%), while 9.7% had no training in DRE. Chaperone availability, perceived invasiveness, and lack of confidence were key barriers; key enablers were formal training and senior colleague/departmental support. The multivariate logistic regression showed that DiTs who reported being comfortable in performing DRE were significantly and independently associated with being a high-volume practitioner (p < 0.001), confident in diagnosing benign (p < 0.001) or malignant pathology (p < 0.001), perceived adequate DRE training (p < 0.001), prior formal DRE training (p = 0.007), and surgical subspeciality interest (p = 0.030). Conclusions Low levels of confidence and comfort in the performance of DRE among DiTs have resulted in the underutilization of a critical diagnostic tool. Future curriculum and departmental clinical practice interventions should address barriers while promoting enablers.

Exploring the impact of remoteness on people with head and neck cancer: Utilisation of a state-wide dataset.

Living in regional/rural areas can impact outcomes for people with head and neck cancer (HNC). Using a comprehensive state-wide dataset, the impact of remoteness on key service parameters and outcomes for people with HNC was examined. Retrospective quantitative analysis of routinely collected data held within the Queensland Oncology Repository. Quantitative methods (descriptive statistics, multivariable logistic regression and geospatial analysis). All people diagnosed with HNC in Queensland, Australia. The impact of remoteness was examined in 1991 people (1171 metropolitan, 485 inner-regional, 335 rural) with HNC cancer diagnosed between 2013 and 2015. This paper reports key demographics and tumour characteristics (age, gender, socioeconomic status, First Nations status, co-morbidities, primary tumour site and staging), service use/uptake (treatment rates, attendance at multidisciplinary team review and timing to treatment) and post-acute outcomes (readmission rates, causes of readmission and 2-year survival). In addition to this, the distribution of people with HNC across QLD, distances travelled and patterns of readmission were also analysed. Regression analysis revealed remoteness significantly (p < 0.001) impacted access to MDT review, receiving treatment, and time to treatment commencement, but not readmission or 2-year survival. Reasons for readmission did not differ by remoteness, with dysphagia, nutritional inadequacies, gastrointestinal disorders and fluid imbalance indicated in the majority of readmissions. Rural people were significantly (p < 0.0001) more likely to travel to care and to readmit to a different facility than provided primary treatment. This study provides new insights into the health care disparities for people with HNC residing in regional/rural areas.

The RESECT study: Factors associated with overall survival (OS) and relapse-free survival (RFS) among patients with stages I–III resected NSCLC without known EGFR mutations.

8541 Background: Approximately one-third of patients with Stages I–III resected non-small-cell lung cancer (NSCLC) do not survive 5 years from diagnosis. This retrospective observational study analyzed factors associated with OS and real-world (rw) RFS among Stage I–III NSCLC patients before the introduction of immuno-oncology (IO) treatment. Methods: We analyzed data from the US CancerLinQ database for adult patients with no known EGFR mutations and no other cancers, who were diagnosed with Stage I–III NSCLC from 2014–2019 and had surgical resection within 140 days after initial diagnosis. 3081 patients met the study criteria of whom 1677 were Stage I, 853 were Stage II, and 551 were Stage III; 4 Stage I patients who received neoadjuvant or perioperative treatment were excluded (too few for analysis). Most patients received surgery only (71.5%); the rest also received adjuvant (24.7%), neoadjuvant (2.4%) or perioperative (1.5%) treatment, most often chemotherapy ± radiotherapy. Key demographics, clinical characteristics, treatment patterns, and relevant 2-way interactions were considered for inclusion in the model, based on Cox regression analyses and medical insights. Multivariable Cox regression analysis (backwards selection, p&lt;0.05) was used to model OS and rwRFS. Results: In the multivariable analyses (in which no Stage I patients with neoadjuvant or perioperative treatment were included), factors associated with both OS and rwRFS (p&lt;0.05) were disease stage, race, ethnicity, year of diagnosis, ECOG performance status, and neoadjuvant treatment. Factors associated with OS (p&lt;0.05), but not rwRFS, were age, sex, time from diagnosis to surgery, and type of surgery. Factors associated with rwRFS (p&lt;0.05), but not OS, were geographic region, nodal status, and adjuvant treatment in Stage II and III patients but not Stage I patients. Conclusions: This study identified several risk factors associated with OS and rwRFS, many of which are known. Notably, in this analysis, neoadjuvant treatment was associated with both improved OS and rwRFS in Stage II–III patients and was not evaluable in Stage I patients. However, adjuvant treatment was only associated with improved rwRFS, and only in Stage II–III patients. Based on these findings, there remains an unmet need for Stage I–III NSCLC patients. The recent introduction of IO treatment in this setting may help improve patient outcomes.

D-CRSE: Diminishing chemotherapy related side effects through patient education.

e24148 Background: Patient (pt) education materials regarding self-management of cytotoxic chemotherapy related side effects are lacking at Penn State Cancer Institute (PSCI), resulting in patients using disreputable sources. We created a brochure that educates patients on common side effects, tools to address the problems themselves, information on when to contact their oncologist, and guidance on when to visit the ED. The aim of our pilot study is to evaluate the feasibility at PSCI and subsequently improve pt related outcomes and quality of life through pt education. Methods: Chemotherapy naïve pts with breast or gastrointestinal (GI) cancer were enrolled from November 2021-December 2022. At the baseline visit, pts were consented, given the brochure and asked to complete surveys. The Emotional Thermometer Scale (ETS) evaluates mental health, measuring distress, anxiety, depression, and anger while the Memorial Symptom Assessment Scale (MSAS) evaluates symptoms commonly seen with chemotherapy. MSAS means were also broken down into physical, psychological, and global distress index (GDI) subsets. Pts filled out the same surveys at their 6 and 12 week visits to assess change over time. Results: 40 pts completed the baseline surveys, and 36 of them had at least one additional visit. Some key demographics were: 82.2% female, 17.8% male, 22.2% GI cancer (71.4% colonic adenocarcinoma, 14.3% rectal adenocarcinoma, 14.3% anal squamous cell carcinoma), 77.8% breast cancer (81.8% ductal carcinomas, 9.1% lobular carcinomas, 9.1% invasive metaplastic carcinoma, 52.5% ER+, 42.5% PR+, 22.5% HER2+), and 27.5% of patients underwent concurrent therapies with chemotherapy. Table 1 summarizes the mean score comparisons from baseline to 6 and 12 weeks for the ETS and MSAS. We observed significantly decreased psychological symptoms at week 12 compared to baseline (p = 0.023), while physical symptoms did not change significantly (p = 0.21). Conclusions: We successfully conducted a pilot study distributing a standardized educational brochure, thus demonstrating feasibility of this intervention. Measured psychological symptoms decreased over time, while physical symptoms did not, which aligns with side effect progression from cumulative chemotherapy burden. We plan to expand standardized pt education materials to other cancer types, incorporate digital educational tools, and further explore pt education barriers. Clinical trial information: NCT04694794 .[Table: see text]

Género Y Sexualidad: A Nationwide Study of the Social Determinants of Latine Gender Difference in HIV Testing

Latine communities comprise 18% of the U.S. population but account for 27% of all new HIV infections in 2019. Arguably, a key ingredient to reducing HIV infection rate is knowing one’s status. A precursor to knowing is actually getting tested for HIV. The more information one has concerning how social determinants serve as conduits and barriers to getting testing, the more beneficial to all communities, especially marginalized ones. To help fill this knowledge gap, this article utilizes critical race theory and intersectionality as theoretical frameworks, employs secondary analysis of the Latine sample within the Behavioral Risk Factor Surveillance data from the Centers for Disease Control and Prevention, as well as hierarchical logistical regression modeling to examine the relative impact of health and healthcare, substance use, and key demographics on whether or not a respondent gets tested for HIV. Furthermore, to examine gender differences across these relationships for Latine adults, analyses are performed first for both genders and then separately for male and female respondents.

NOVEL TARGETED HEALTH PSYCHOLOGY CLINIC REFERRAL IMPROVES BLOOD PRESSURE: PRELIMINARY RESULTS OF A RETROSPECTIVE STUDY

Objective: Despite hypertension medications being widely available, many patients do not have adequately controlled blood pressure. Consequently, alternative interventions are required to support patients. Recently, we have established a novel health psychology clinic to provide additional support to help patients improve blood pressure control. This retrospective study compared outcomes before and after referral to a targeted health psychology clinic. Our aim was to determine the effectiveness of this novel clinic on patient outcomes with a view to improving the service and support rollout in other departments. Design and method: Patient notes referred to the Health Psychology clinic were reviewed from October 2020 to December 2022 (audit number: 11703). Patient data was linked anonymised and details reflecting key outcomes, demographics and specific psychology interventions were extracted. Results: In the preliminary findings, 11 patients were included for analysis. Patient age ranged from 28-79 years, 18% were female and 45% were White. Patients were prescribed a mean of 3.1 hypertension medications. The mean time between the first blood pressure reading and final reading was 44.1±27.8 weeks, with a mean number of 6.6±6 visits to the clinic. Interventions were tailored to each patient's need. Four patients were supported with anxiety management, three used biofeedback and three used breathing techniques. Two patients were supported with weight management, with one patient losing 31.7kg in 6 months. The mean systolic blood pressure (SBP) change was -11.55±17.78 mmHg (P = 0.0568), and diastolic blood pressure (DBP) was -5.80±13.15 mmHg (P = 0.1965). Two patients had increased blood pressure for unknown reasons. When these two cases were removed from analysis, the overall mean changes for SBP were -18.11±11.30 mmHg (P = 0.0013) and -9.88± 11.03mmHg for DBP (P = 0.0690). Of these blood pressure readings, 7 were conducted in the office, 2 at home, and 1 with 24hour ABPM. Conclusions: Our preliminary findings show that targeted psychological support for hypertensive patients experiencing difficulties with anxiety or depression may improve blood pressure. Health psychology interventions may be suitable to support patients where medication alone does not support optimum hypertension management. Further large prospective studies are needed to confirm these findings.

Identifying and describing trajectories of alcohol use frequency and binge drinking frequency among those age 15-30 in a national cohort of U.S. adolescents: a group-based trajectory modeling approach.

Analyzing long-term trajectories of alcohol use has the potential to strengthen policy and intervention priorities and timing. We identified and described trajectories of alcohol use and binge drinking frequency from mid-adolescence to early adulthood and measured the association of the role of early drinking initiation with trajectory membership. Longitudinal cohort study SETTING: United States PARTICIPANTS: The National Longitudinal Survey of Youth 1997 is a nationally representative cohort of youth age 12-16 at baseline. The analytic sample included individuals who participated in >2 annual interviews between age 15 and 30 (n=8,809). Participants self-reported the number of days in the past 30 days they: (1) drank alcohol and (2) binge drank [>5 drinks in one occasion]. We used group-based trajectory modeling to identify distinct trajectories from age 15-30 of past 30-day drinking and past 30-day binge drinking. Using multinomial logistic regression, we evaluated associations between early drinking initiation (≤14 years) and key demographics with trajectory membership. We identified 5 past 30-day drinking groups: late-escalating (16.0%), moderate-frequency (19.0%), high-frequency (11.1%), low-frequency (35.4%) and no/infrequent (18.4%). Early drinking initiation (versus later) was associated with higher odds of membership in the moderate (adjusted multinomial odds ratio [aMOR] = 4.32; 95% confidence interval [CI]: 3.65, 5.12) and high-frequency groups (aMOR = 4.17; 95%CI: 3.50, 4.97) than in the no/infrequent comparator trajectory. We identified 5 groups with distinct binge drinking frequency patterns: later escalating (9.9%), high-frequency (3.9%), low frequency (28.7%), earlier onset (9.5%), and no/infrequent (48.0%). Early initiation was associated with increased odds of membership in earlier onset and high-frequency groups compared with the no/infrequent group. For both outcomes additional differences in probability of group membership were identified by gender, racial identity, parental factors (religiosity, high school completion), and household characteristics (household size, income, and region of residence). Youth in the United States appear to follow heterogeneous drinking and binge drinking trajectories from adolescence into adulthood. These may include higher-use trajectories as well as trajectories with different escalation timing (e.g., earlier vs. later). Early initiation of drinking may increase risk of membership in higher- and earlier-use trajectory groups.

Comparing water quality valuation across probability and non‐probability samples

AbstractWe compare water quality valuation results from a probability sample and two opt‐in non‐probability samples, MTurk and Qualtrics. The samples differ in some key demographics, but measured attitudes are strikingly similar. For valuation models, most parameters were significantly different across samples, yet many of the marginal willingness to pay were similar across samples. Notably, for non‐marginal changes there were some differences by samples: MTurk values were always significantly greater than the probability sample, as were Qualtrics values for changes up to about a 20% improvement. Overall, the evidence is mixed, with some key differences but many similarities across samples.

Integrated algorithm combining plasma biomarkers and cognitive assessments accurately predicts brain β-amyloid pathology

BackgroundAccurate prediction of cerebral amyloidosis with easily available indicators is urgently needed for diagnosis and treatment of Alzheimer’s disease (AD).MethodsWe examined plasma Aβ42, Aβ40, T-tau, P-tau181, and NfL, with APOE genotypes, cognitive test scores and key demographics in a large Chinese cohort (N = 609, aged 40 to 84 years) covering full AD spectrum. Data-driven integrated computational models were developed to predict brain β-amyloid (Aβ) pathology.ResultsOur computational models accurately predict brain Aβ positivity (area under the ROC curves (AUC) = 0.94). The results are validated in Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. Particularly, the models have the highest prediction power (AUC = 0.97) in mild cognitive impairment (MCI) participants. Three levels of models are designed with different accuracies and complexities. The model which only consists of plasma biomarkers can predict Aβ positivity in amnestic MCI (aMCI) patients with AUC = 0.89. Generally the models perform better in participants without comorbidities or family histories.ConclusionsThe innovative integrated models provide opportunity to assess Aβ pathology in a non-invasive and cost-effective way, which might facilitate AD-drug development, early screening, clinical diagnosis and prognosis evaluation.

Dimensions of controversy: Investigating the structure of public support for universal basic income in the Netherlands

AbstractAs interest in universal basic income (UBI) policy has peaked in recent years, the study of public support for such a policy is rapidly developing. While recent studies recognise the multidimensionality of the UBI proposal, we still know little about to what extent support for UBI is unambiguously supported or rejected. We show that the public holds distinct but related opinions towards three dimensions of UBI: universalism, redistribution and unconditionality. The higher and lower educated are equally ambivalent towards the policy, suggesting a lack of political entrenchment towards UBI in Dutch society. Post hoc comparisons show that key demographics and constituencies support some dimensions while rejecting others, enabling both compromise and division on the issue. Despite these distinct controversies, however, the strong correlation between attitudinal dimensions suggests that survey experiments tend to overstate the degree of multidimensionality by ignoring the strong commonalities in support for policy aspects.

Consultation Rate and Mode by Deprivation in English General Practice From 2018 to 2022: Population-Based Study

The COVID-19 pandemic has had a significant impact on primary care service delivery with an increased use of remote consultations. With general practice delivering record numbers of appointments and rising concerns around access, funding, and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and modes (ie, face-to-face versus remote). This paper describes trends in consultation rates in general practice in England for key demographics before and during the COVID-19 pandemic. We explore the use of remote and face-to-face consultations with regard to socioeconomic deprivation to understand the possible effect of changes in consultation modes on health inequalities. We did a retrospective analysis of 9,429,919 consultations by general practitioners, nurses, or other health care professionals between March 2018 and February 2022 for patients registered at 397 general practices in England. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national data sets. Negative binomial models were used to predict consultation rates and modes (ie, remote versus face-to-face) by age, sex, and socioeconomic deprivation over time. Overall consultation rates increased by 15% from 4.92 in 2018-2019 to 5.66 in 2021-2022 with some fluctuation during the start of the COVID-19 pandemic. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups, but the extent varies by age. Consultation rates increased with increasing levels of deprivation. Socioeconomic differences in consultation rates, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18, indicating more consultations in the most deprived), effectively narrowing relative differences between deprivation quintiles. This trend remains when stratified by sex, but the difference across deprivation quintiles is smaller for men. The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultation rates compared to the least deprived. The substantial increases in consultation rates observed in this study imply an increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas.

Purchase Intent and Appeal of ENDS Products among Current, Former and Never Ever Users of Tobacco Products in the U.S.

SUMMARY Background and objectives The last decade has seen extensive research into electronic nicotine delivery systems (ENDS) such as e-cigarettes. Although some studies assess ENDS’ potential benefits, there is a paucity of studies that provide population-level estimates of purchase intent or product appeal among various tobacco user groups, or that have examined the impact of different product characteristics on those variables. Methods Purchase intent and product appeal ratings were analyzed from six online studies for multiple sub-brands of Vuse vapor products (including different flavors, nicotine levels, and device styles). The sample in each study was weighted to represent the adult U.S. population of current established, former established, and never established cigarette smokers on five key demographics; providing population-level estimates. Results Results for purchase intent and appeal are remarkably consistent. Ratings of purchase intent and appeal are higher for current tobacco users (current established cigarette smokers, current established non-cigarette tobacco users, and current tobacco experimenters) than for former and never ever tobacco users. Conclusions and scientific significance These findings show that varying sub-brands of an e-cigarette has little or no impact on population level purchase intent and appeal ratings across tobacco user groups. Additionally, greater variability in ratings among current tobacco experimenters than other tobacco user groups is discussed as well as correlations between measures. This paper provides the first population estimates of both purchase intent and product appeal for various ENDS products among adult tobacco users and nonusers; information that is critical for evaluating the impact on public health. [Contrib. Tob. Nicotine Res. 32 (2023) 34–42]

Retrospective evaluation of factors affecting successful fit testing of respiratory protective equipment during the early phase of COVID-19

ObjectivesRespiratory protective equipment is critical to protect healthcare workers from COVID-19 infection, which includes filtering facepiece respirators (FFP3). There are reports of fitting issues within healthcare workers, although the factors...

Protective Associations between Supportive Environment and Suicidality among Minority and Majority Adolescents

Objective To examine the association between supportive environments and adolescent suicidal behavior, especially among marginalized minority groups. Methods Participants included 12,196 middle and 16,981 high school students who completed the 2019 Vermont Youth Risk Behavior Survey. Multiple logistic regression models were used to assess the association between three protective factors that were part of a supportive environment (feeling like they matter to people in their community, usually eating dinner at home, having a trusted adult) and suicidality (plan or attempt), controlling for key demographics (sex, sexual orientation, gender identity, and race/ethnicity). Moderating effects of demographics were also explored. Results All supportive environment variables were protective of making a suicide plan and making a suicide attempt (ORs < 0.75, p-values < 0.005). Students of minority identities were significantly more likely to make a suicide plan (middle school ORs: 1.34–3.51, p-values < 0.0005; high school ORs: 1.19–3.38, p-values < 0.02) and attempt suicide (middle school ORs: 1.42–3.72, p-values < 0.006; high school ORs: 1.38–3.25, p-values < 0.0005) compared to students with majority demographic characteristics. Generally, the associations between having a supportive environment and suicidality did not vary within sexual orientation, gender identify, or race/ethnicity subgroups, suggesting that these supportive environment factors were more universally protective. However, a few associations were stronger among students in the majority demographic groups. Conclusions These data suggest that having a supportive environment is protective of suicidality for adolescents from both majority and minority demographic groups. HIGHLIGHTS A supportive environment is protective of adolescent suicide plan and attempt. Minority sexual, gender, and racial identities are risk factors for suicidality. Minority and majority students are protected by supportive environments.

198 Meta-analysis of Transgender Exclusion from PrEP Clinical Trials

OBJECTIVES/GOALS: To evaluate access to Pre-Exposure Prophylaxis (PrEP) medications for transgender individuals examining how systemic and sociocultural obstacles play a role. Additionally, analyzing the impact of trans-exclusion in clinical trials investigating PrEP efficacy on the trans-HIV care model. METHODS/STUDY POPULATION: By examining the clinicaltrials.gov database, inclusion and exclusion criteria will be collected for Phase III trials of FTC/TAF (Descovy) and FTC/TDF (Truvada) as PrEP for Human Immunodeficiency Virus (HIV). Secondly, trends of physicians’ prescription of PrEP will be analyzed to track post-approval usage and deduce the acceptance and adherence of PrEP by transgender patients. Thirdly, post-approval marketing strategies of PrEP medications will be documented to see key demographics that biopharmaceutical companies are targeting. Finally, relevant literature about trans healthcare will be analyzed to identify key short fallings to support conclusions and justify recommendations for greater transgender clinical trial enrollment and reformations to current standard practices. RESULTS/ANTICIPATED RESULTS: After a preliminary literature review of published Phase III trials for Descovy and Truvada , there is a marked lack of transgender patient enrollment. Contemporary literature argues that this lag in enrollment has downstream effects on trust and acceptance of PrEP as safe and effective by cohorts in the transgender community. The examination of prescribing information for Descovy and Truvada for PrEP reveals a minimal effort to advise doctors of the increased risk for infection in the transgender demographic. Through continued research, I expect to elaborate on the cross-discipline impacts of trans-exclusion, including increased rates of HIV infection, sociocultural and financial barriers to PrEP, and stigmatizing doctor interactions with transgender patients. DISCUSSION/SIGNIFICANCE: The current trans-HIV treatment paradigm lags behind in its sensitivity and nuance, preventing the most equitable distribution of care. Only with more inclusion of transgender individuals in clinical trials can we hope to promote greater awareness and trust for PrEP as effective for HIV.

Racial and gender disparities among highly successful medical crowdfunding campaigns

There has been growing recognition of the popularity of medical crowdfunding and research documenting how crowdfunding arises from, and contributes to, social and health inequities. While many researchers have surmised that racism could well play a role in medical crowdfunding campaign outcomes, research on these dynamics has been limited. No research to date has examined these dynamics among the most successful medical crowdfunding campaigns, focusing instead on average users’ experiences or specific patient subpopulations. This paper analyzes key characteristics and demographics of the 827 most successful medical crowdfunding campaigns captured at a point in time in 2020 on the popular site GoFundMe, creating the first demographic archetype of “viral” or highly successful campaigns. We hypothesized that this sample would skew towards whiter, younger populations, more heavily represent men, and reflect critical illnesses and accidents affecting these populations, in addition to having visually appealing, well-crafted storytelling. Analysis supported these hypotheses, showing significant levels of racial and gender disparities among campaigners. While white men had the greatest representation, Black and Asian users, and black women in particular, were highly underrepresented. Like other studies, we find evidence that racial and gender disparities persist in terms of campaign outcomes as well. Alongside this quantitative analysis, a targeted discourse analysis revealed campaign narratives and comments reinforced racist and sexist tropes of selective deservingness. These findings add to growing calls for more health research into the ways that social media technologies shape health inequities for historically marginalized and disenfranchised populations. In particular, we underscore how successful crowdfunding campaigns, as a both a means of raising funds for health and a broader site of public engagement, may deepen and normalize gendered and racialized inequities. In this way, crowdfunding can be seen as a significant technological amplifier of the fundamental social causes of health disparities.

Neurosurgeons Deliver Similar Quality Care Regardless of First Assistant Type: Resident Physician versus Nonphysician Surgical Assistant

There are limited data evaluating the outcomes of attending neurosurgeons with different types of first assistants. This study considers a common neurosurgical procedure (single-level, posterior-only lumbar fusion surgery) and examines whether attending surgeons deliver equal patient outcomes, regardless of the type of first assistant (resident physician vs. nonphysician surgical assistant [NPSA]), among otherwise exact-matched patients. The authors retrospectively analyzed 3395 adult patients undergoing single-level, posterior-only lumbar fusion at a single academic medical center. Primary outcomes included readmissions, emergency department visits, reoperation, and mortality within 30 and 90days after surgery. Secondary outcome measures included discharge disposition, length of stay, and length of surgery. Coarsened exact matching was used to match patients on key demographics and baseline characteristics known to independently affect neurosurgical outcomes. Among exact-matched patients (n=1402), there was no significant difference in adverse postsurgical events (readmission, emergency department visits, reoperation, or mortality) within 30days or 90days of the index operation between patients who had resident physicians and those who had NPSAs as first assistants. Patients who had resident physicians as first assistants demonstrated a longer length of stay (mean: 100.0 vs. 87.4hours, P<0.001) and a shorter duration of surgery (mean: 187.4 vs. 213.8minutes, P<0.001). There was no significant difference between the two groups in the percentage of patients discharged home. For single-level posterior spinal fusion, in the setting described, there are no differences in short-term patient outcomes delivered by attending surgeons assisted by resident physicians versus NPSAs.

Adult golf cart injuries: A rising hazard off the course

Objective Golf carts are increasingly being used as a means of transportation for travel in neighborhoods, city areas, and unpaved surfaces. The catchment area of our regional trauma center has seen an increase in golf cart use for transportation. In fact, Georgia has recently changed legislation to support the growing need for more defined laws around golf cart use. This study aims to further evaluate injury and outcome patterns in the adult population of northeast Georgia. Methods We performed a retrospective review of adult golf cart injured patients from 2018 to 2022. We evaluated key demographics, such as age and gender, along with the length of stay, Glasgow Coma Scale (GCS), and Injury Severity Score (ISS). Outcomes included the injury type. Results The results showed that orthopedic injuries were the most common (n = 24). Most patients were in the driver’s seat (76%). Ejection from the golf cart was common (82%). Geriatric patients, 65 and older, had an increased length of stay compared to patients under the age of 65 (10 vs 3.9 days). Conclusion Based on these results, future work includes injury prevention, increased awareness of injury patterns in prehospital and hospital settings, and communities updating their ordinances.

Investigating posttraumatic stress disorder among COVID-19 recovered patients: A cross-sectional study

BackgroundDuring the 21st century, pandemics have emerged frequently and become more challenging. Coronavirus disease (COVID-19) is among the most prominent examples. A considerable public health issue following the pandemic is posttraumatic stress disorder (PTSD). COVID-19-recovered patients are highly susceptible to developing PTSD. Earlier epidemic studies showed a high prevalence of trauma-exposed people as a result of infectious diseases. This research aimed to quantify the estimated prevalence of PTSD and its contributing variables among COVID-19-recovered patients in Bangladesh. MethodsThis was a cross-sectional research carried out through an e-survey comprising 326 individuals (69.0% male; mean age = 37.97 ± 13.02 years; age range = 18–76 years) and conducted between September 2020 to January 2021. The online survey included a section for gathering participant's informed permission as well as sections on key demographics and way of life, and social supports during the suffering period from acute COVID-19, as well as a PTSD Checklist for DSM-5 (PCL-5) to examine PSTD. Descriptive statistics and multiple regression analyses were performed. Results: The prevalence estimates of PTSD ranged between 36 and 41% based on three predefined cut-offs. As per multiple linear regression analysis, PTSD was much more common among those who took part and reported being middle-aged/older adults (≥40 years), having lower S.E.S., and who slept more (>9 h/day). In addition, PTSD was negatively associated (p <0.05) with the social support of family members/friends/relatives, and colleagues in working settings; while positively correlated with health care providers. Conclusion: The current investigation revealed a considerably higher level of PTSD among COVID-19-recovered patients. The findings suggest extending the mental health services, other covariates, and immediate intervention among national and international COVID-19 recovered patients.