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From Inflammation to Flooding: COVID-19, Asthma, and Pulmonary Edema
No full textThe respiratory system, like many other body systems, undergoes significant changes during pregnancy to support the needs of the growing fetus. This article begins by providing a detailed overview of these normal physiologic changes, highlighting how the respiratory system adjusts to the increased metabolic demands and altered hormonal environment of pregnancy. The article will then cover updated guidelines for managing asthma, the most common respiratory condition affecting pregnant individuals. Lastly, we will briefly touch on pulmonary edema in pregnancy, reviewing possibly etiologies and risk factors as well as diagnosis and management.No embarg
Progress and inequality in child immunization in 38 African countries, 2000-2030: A spatio-temporal Bayesian analysis at national and sub-national levels
No full textBackground: Monitoring progress and inequality in childhood immunization coverage at both national and sub-national levels is essential for refining equity-oriented health programs and ensuring equitable access to care towards achieving global targets in African countries.
Methods and findings: Using approximately 1 million records from 104 nationally representative Demographic and Health Surveys (DHS) conducted in 38 African countries (2000-2019), we estimated childhood immunization coverage for key indicators (BCG, MCV1, DPT3, Polio3, and Full immunization), stratified by socioeconomic status. Variations of Bayesian spatio-temporal analysis using Besag, Besag-York-Mollié (BYM) and BYM2 models were employed to assess and project the trends from 2000 to 2030. We evaluated the probability of achieving Universal Health Coverage (80% coverage) and Immunization Agenda (90% coverage) by 2030, at national and sub-national levels. Finally, we conducted a comprehensive inequality analysis using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) to assess changes over the study period. Childhood immunization coverage improved significantly across most African countries from 2000 to 2019. However, projections suggest that 12 countries are unlikely to achieve global targets for full immunization by 2030 at the national level if current trends continue. Notably, high-Socio-Demographic Index (SDI) countries such as South Africa, Egypt, and Congo Brazzaville are projected to miss immunization targets across all sub-national regions. While socioeconomic inequalities were widespread in 2000, they are projected to decline or stabilize in 36 countries by 2030, with Eswatini, Morocco, Rwanda, and Burkina Faso expected to eliminate disparities. In contrast, Nigeria and Angola are projected to face increasing inequalities or persistent large gaps. Regional disparities in both coverage and inequality remain pronounced, particularly in Central and Western Africa, where coverage remains low and inequality remains high despite overall national-level improvements. The analysis was limited to DHS surveys 2000-2019, excluding more recent data during the COVID-19 period and potentially overestimating trends in data-sparse settings.
Conclusions: This study highlights both progress and persistent challenges in childhood immunization coverage, along with inequalities across 38 African countries. Persistent regional disparities and socioeconomic inequalities require multifaceted strategies that account for demographic, geographic, economic, and political factors to ensure equitable immunization. Greater efforts are needed to close these gaps and support global health goals for the African nations.No embarg
Examining Veterans', Doulas', and VA Maternity Care Coordinators' Perceptions and Experiences With a Community-based Doula Pilot Program
No full textObjective: Racial disparities in maternal morbidity and mortality are well-documented and remain a pressing public health problem in the United States. Racial disparities in maternal health have also been noted among veterans receiving community-based maternity care benefits from the Department of Veterans Affairs (VA). Previous studies of doula care among minoritized racial groups have indicated lower rates of preterm and cesarean births, more positive feelings about childbirth experiences, and lower admissions to the neonatal intensive care unit. To assess whether doula care might be beneficial for veterans enrolled in VA care, we launched a small pilot study at two VA medical centers working in conjunction with community-based doula agencies. Therefore, the overarching objective of this study was to assess veterans', doulas', and VA maternity care coordinators' (MCC) perceptions and experiences with a community-based doula program aimed at improving maternal outcomes.
Methods: Telephone or video interviews were conducted with veterans, doulas, and VA MCCs who had participated in the doula care program. Interviews were recorded, transcribed, and analyzed using content analysis techniques. Major themes and representative quotes were derived from the analyses.
Results: Twenty-eight veterans, seven doulas, and two VA MCCs enrolled in the doula study and participated in interviews. Four major themes were identified: 1) veterans' previous negative birth experiences promoted desire for doula care, 2) veterans had positive pregnancy experiences with doula care, 3) doulas empowered veterans to advocate for themselves during pregnancy, and 4) VA MCCs welcomed doula partnerships.
Conclusion: Veterans expressed high levels of satisfaction with the doula care program. VA MCCs noted that a doula care program was an important addition to the existing VA MCC program and allowed MCCs to feel that they had an additional partner in caring for pregnant veterans.No embarg
Multimorbidity and the Cancer Trajectory of Older Adults with Mutiple Myeloma
No full textBackground: Multiple myeloma (MM) primarily affects adults over age 65. In addition, the prevalence of multimorbidity, or co-occurring chronic conditions, increases with age. However, it is unknown how patterns of multimorbidity are defined in older adults with MM, and how they are associated with first-line treatment selection and survival in this population.
Methods: This research utilized the NCI Surveillance, Epidemiology, and End Results (SEER) database linked with Medicare claims (SEER-Medicare). Participants included ~11,000 individuals aged ≥65 diagnosed with MM (2007-2017). Hierarchical cluster analysis classified patients into groups reflecting clinically distinct patterns of multimorbidity. The association between multimorbidity patterns and type of first-line treatment received for MM was evaluated using modified Poisson regression models. Kaplan-Meier estimation and Cox proportional hazards regression were used to quantify the association between multimorbidity patterns and five-year survival.
Results: We identified three distinct patterns of multimorbidity: cardiometabolic and multisystem multimorbidity, musculoskeletal and psychiatric multimorbidity, and relatively minimal multimorbidity. Patients with cardiometabolic and multisystem multimorbidity were less likely to receive triplet drug regimens than those with minimal multimorbidity. The cardiometabolic and multisystem multimorbidity pattern was associated with the greatest risk of overall and MM-specific mortality.
Conclusion: This dissertation characterized the underlying patterns of concurrent chronic conditions in an older adult population with MM, and identified substandard first-line treatment administration and poor survival outcomes in patients with high multimorbidity burden. Findings help to emphasize segments of the population that may require tailored healthcare approaches to optimize cancer care outcomes.Population Health Sciences2 year
"What Program Directors Think" VI: Results of the 2024 Survey of the APDR Part 1
No full textRationale and objectives: The Association of Program Directors in Radiology (APDR) surveys its members for data gathering on educational practices and challenges in radiology residency training including changes in the residency application process.
Materials and methods: This was an observational, cross-sectional study using a Web-based survey. Members of the 2022-2023 Annual Survey Committee developed survey questions resulting in 40 items, including demographic data. The survey was distributed by email to all active members of the APDR in January and February of 2024. In this paper, analysis of the radiology program directors' (PD) use of information in the supplemental application to the Electronic Residency Application Service® (ERAS), including the latest changes in preference signaling is presented.
Results: Responses were collected electronically, tallied using Qualtrics software, tabulated or summarized. The total survey response rate was 31% (84/247). The results of this survey were presented at the annual Association of University Radiologists meeting in Boston, MA (April 2024).
Conclusion: Survey results find preference signaling in ERAS® useful and support the recent increase in the number of signals using the two-tiered system. PDs see no significant difference in applicant competitiveness in the gold and silver signal cohorts. Other information in the ERAS supplemental application, such as applicants' geographic preferences and meaningful experiences, are most impactful on an applicants' chances of receiving an interview in the absence of a preference signal.No embarg
COVID-19 symptoms associated with smoking and vaping tobacco and cannabis: A cross-sectional analysis
Get PDFOBJECTIVE: Characterize symptoms observed among people using nicotine and/or cannabis compared to non-users using an institutional respiratory illness symptom checker.
METHODS: Cross-sectional study (April 2020-August 2021) using University of California San Francisco (UCSF) COVID-19 & Flu Symptom Checker online self-triage tool measuring current tobacco and cannabis use, symptom prevalence and associations with self-reported severe dyspnea, using multivariable logistic regression.
RESULTS: Excluding those with emergent symptoms requiring immediate medical evaluation, of 10,904 patients, 729 (6.7%) self-reported current nicotine or cannabis use. People smoking and/or vaporizing nicotine or cannabis reported constitutional, ear/nose and throat, respiratory, and gastrointestinal symptoms more frequently than non-users. Current vaping (aOR = 1.89, 95% CI 1.23, 2.81) and co-use of nicotine/cannabis (aOR = 2.00, 95% CI 1.26, 3.09) were associated with higher odds of dyspnea, adjusting for comorbidities and demographic factors.
CONCLUSION: People using nicotine or cannabis products had increased frequencies of self-reported COVID-19 symptoms and dyspnea. Current vaporizer use may not be associated with a difference in self-reported respiratory symptoms compared to smoking tobacco. Including tobacco and cannabis use in symptom checkers may enhance risk stratification and clinical decision-making during future respiratory virus outbreaks.No embarg
Exploring Social Media Use Among Medical Students Applying for Residency Training: Cross-Sectional Survey Study
Get PDFBackground: Since the COVID-19 pandemic, residency candidates have moved from attending traditional in-person interviews to virtual interviews with residency training programs. This transition spurred increased social media engagement by residency candidates, in an effort to learn about prospective programs, and by residency programs, to improve recruitment efforts. There is a paucity of literature on the effectiveness of social media outreach and its impact on candidates' perceptions of residency programs.
Objective: We aimed to determine patterns of social media platform usage among prospective residency candidates and social media's influence on students' perceptions of residency programs.
Methods: A cross-sectional survey was administered anonymously to fourth-year medical students who successfully matched to a residency training program at a single institution in 2023. These data were analyzed using descriptive statistics, as well as thematic analysis for open-ended questions.
Results: Of the 148 eligible participants, 69 (46.6%) responded to the survey, of whom 45 (65.2%) used social media. Widely used social media platforms were Instagram (19/40, 47.5%) and Reddit (18/40, 45%). Social media influenced 47.6% (20/42) of respondents' opinions of programs and had a moderate or major effect on 26.2% (11/42) of respondents' decisions on program ranking. Resident-faculty relations and social events showcasing camaraderie and wellness were the most desired content.
Conclusions: Social media is used by the majority of residency candidates during the residency application process and influences residency program ranking. This highlights the importance of residency programs in leveraging social media usage to recruit applicants and provide information that allows the candidate to better understand the program.No embarg
Angiographic Occlusion After Flow Diversion of Ruptured and Unruptured Intracranial Aneurysms Using the Flow Redirection Endoluminal Device-X: A Multicenter Analysis
No full textBackground and objectives: Flow diversion induces progressive aneurysm occlusion by reducing blood flow across the aneurysm neck over time. Various factors, including comorbid conditions, aneurysm characteristics, and stent design, have been shown to affect occlusion rates after flow diversion. Our study analyzed predictors of angiographic occlusion after flow diversion of intracranial aneurysms using the Flow Redirection Endoluminal Device with X-technology (FRED-X).
Methods: This was a multicenter study of ruptured and unruptured aneurysms treated at 6 participating institutions across the United States. Data were collected on patient-specific factors and aneurysm characteristics. Angiographic occlusion was assessed using the Raymond Roy Occlusion Classification. Multivariate logistic regression was used to analyze predictors of complete angiographic occlusion at either the 6- or 12-month follow-up.
Results: One hundred forty-four patients with 152 aneurysms met criteria for inclusion. A total of 69.4% of patients (n = 100) achieved complete occlusion. The average age of the cohort that achieved complete occlusion was 56.2 years, and 84% (n = 84) was female. On univariate analysis, aneurysm laterality, partial thrombosis of the aneurysm sac, proximal and distal diameters of the parent artery, and procedure time were significantly associated with complete angiographic occlusion. On multivariate analysis, parent artery diameter distal to the aneurysm was associated with 0.46-fold decreased odds of complete occlusion (95% CI: 0.26-0.78, P < .002). One patient in the incompletely occluded cohort underwent retreatment using the Pipeline Shield at 7 months after the initial flow diversion procedure using the FRED-X.
Conclusion: Our study identified that parent artery diameter distal to the aneurysm was associated with decreased odds of aneurysm occlusion after flow diversion using the FRED-X. This adds to the literature on the importance of device sizing during flow diversion. Further prospective studies could help validate these findings.No embarg
Circulating causal protein networks linked to future risk of myocardial infarction
No full textVariations in blood protein levels have been linked to numerous complex diseases, including cardiovascular conditions. These associations highlight the intricate interplay between local and systemic factors in cardiovascular disease development, emphasizing the need for a comprehensive, systems-level understanding of its etiology. To address this, we develop a causal network inference framework using data from one of the largest serum proteomics studies to date, comprising measurements of 7523 serum proteins in the prospective, population-based Age, Gene/Environment Susceptibility-Reykjavik Study (AGES) cohort of 5376 older adults. Using cis-acting protein quantitative trait loci (pQTLs) as instrumental variables within a causal inference framework designed to mitigate hidden confounding, we identify 185 high-confidence causal serum protein subnetworks collectively interacting with 5611 targets. Several subnetworks, many forming hierarchical frameworks of directional relationships, are significantly associated with multiple cardiometabolic traits and with future risk of myocardial infarction and its long-term complication, heart failure.No embarg
COVID-19 vaccine barriers among pregnant and lactating refugee women: a case study
Get PDFIntroduction: Pregnant and lactating refugee women rank among the groups least likely to vaccinate against COVID-19. This qualitative study explores their reasons for COVID-19 vaccine hesitancy.
Methods: Between June 2023 and January 2024, cultural health navigators (CHNs) employed by one hospital system conducted in- depth interviews with COVID-19 vaccine-hesitant pregnant and lactating refugee women from five language groups (Arabic, Burmese, Kinyarwanda, Somali, and Swahili). The team also conducted in-depth interviews and a focus group with the five CHNs to further understand community-level factors influencing refugee women's vaccine hesitancy. All qualitative data were analyzed using inductive thematic analysis.
Results: Participants expressed fear of long-term health effects, especially of becoming infertile or of their babies dying, as the primary reasons for not vaccinating. Others reported their perceptions that COVID-19 is no longer a significant health concern. CHNs described the role of social media in spreading misinformation about the vaccine, leading to vaccine hesitancy. Some unanticipated themes that emerged included the role of men in vaccine decision-making and the fear of disrespecting their healthcare provider by declining the vaccine.
Discussion: Study results indicated the need to continue to combat misinformation about the COVID-19 vaccine amongst pregnant and lactating refugee women and the need to take a community-based approach to increase vaccine trust. For example, community health workers or CHNs can provide patient education to increase vaccine trust. Trusted civil organizations could disseminate messages targeting vaccine misinformation spread on social media platforms. Additionally, digital storytelling in refugees' native languages can be a helpful dissemination tool to increase vaccine education and combat misinformation and vaccine hesitancy.No embarg