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Cureus May 2024Introduction The management of maxillofacial trauma can be challenging in different unique clinical presentations. While maxillofacial fractures vary in location based...
Introduction The management of maxillofacial trauma can be challenging in different unique clinical presentations. While maxillofacial fractures vary in location based on the mechanism of injury, the mandibular fracture is noted to be one of the most common facial fractures. The objective of this study was to explore the differences in injury patterns, outcomes, and demographics of isolated traumatic mandibular fractures between incarcerated and general populations. Methods This retrospective study analyzed consecutive patients presenting for trauma care from January 1, 2010, to December 31, 2020, at the Arrowhead Regional Medical Center (ARMC). Patients 18 years and older were included in this study. Patients diagnosed with mandibular fracture as the primary diagnosis at admission and discharge were identified using the International Classification of Disease, Ninth and Tenth Revision (ICD-9, ICD-10) Code. Patient demographics were extracted from their electronic medical records and included race, marital status, and insurance status. Results A total of 1080 patients with confirmed mandibular fractures were included in the final analysis. Among these patients, 87.5% (n=945) were males, 40% (n=432) of the patients were Hispanic, and the average age was 31.55 years old. The most common mechanism of injury was blunt trauma secondary to assault. Compared to the general population with mandibular fracture, the incarcerated patients with mandibular fracture were more likely to be males (96.1% vs 86.1% for incarcerated population vs. general population respectively, p=0.0005). No other variables were statistically different between these two groups. Conclusion The evidence from this study suggests that the patterns, outcomes, and demographics of mandibular fracture in both incarcerated and general populations are similar.
PubMed: 38883043
DOI: 10.7759/cureus.60458 -
Transplantation Direct Jul 2024Systemic barriers to posttransplant care, including access to immunosuppressant medications, contribute to higher rates of kidney transplant failure in racial...
BACKGROUND
Systemic barriers to posttransplant care, including access to immunosuppressant medications, contribute to higher rates of kidney transplant failure in racial minorities. Matching donor and recipient HLA alleles reduce allorecognition, easing reliance on immunosuppression. We hypothesize that 0-antigen mismatch transplants may provide stronger protection against graft loss in racial minorities.
METHODS
We compared adult, single-organ, deceased-donor kidney transplants in the United States from 2007 to 2016 by degree of HLA mismatch (0- versus ≥1-antigen mismatch). We examined time-to-allograft failure, with death as a competing event, using multivariable Weibull models, stratified by recipient race (White versus non-White), and evaluated the interaction between mismatch and recipient race. We used Kaplan-Meier imputation to account for competing risk of death.
RESULTS
We analyzed 102 114 transplants (median follow-up, 5.6 y; 16 862 graft losses, 18 994 deaths). Zero-antigen mismatch was associated with improved allograft survival (adjusted subdistribution hazard ratio [sHR] 0.80; 95% confidence interval [CI], 0.75-0.85). When stratified by recipient race, the effect of 0-antigen mismatch was more pronounced in White (unadjusted sHR 0.78; 95% CI, 0.72-0.83) versus non-White recipients (sHR 0.88; 95% CI, 0.79-0.99; interaction = 0.04). The differential effect was attenuated after adjusting for covariates (sHR 0.78; 95% CI, 0.73-0.84 versus sHR 0.87; 95% CI, 0.77-0.98; interaction = 0.10).
CONCLUSIONS
Zero-antigen mismatch transplants conferred a 20% risk reduction in allograft loss, which was similar between non-White and White recipients. This may reflect an increased degree of mismatch at other HLA alleles and non-HLA alleles in non-White recipients or because of the extent of systemic barriers to healthcare borne by minority recipients.
PubMed: 38881747
DOI: 10.1097/TXD.0000000000001653 -
Perception Jun 2024A variety of evidence shows that social categorization of people based on their race can lead to stereotypical judgements and prejudicial behaviour. Here, we explore the...
A variety of evidence shows that social categorization of people based on their race can lead to stereotypical judgements and prejudicial behaviour. Here, we explore the extent to which trait judgements of faces are influenced by race. To address this issue, we measured the reliability of first impressions for own-race and other-race faces in Asian and White participants. Participants viewed pairs of faces and were asked to indicate which of the two faces was more dominant or which of the two faces was more trustworthy. We measured the consistency (or reliability) of these judgements across participants for own-race and other-races faces. We found that judgements of dominance or trustworthiness showed similar levels of reliability for own-race and other-race faces. Moreover, an item analysis showed that the judgements on individual trials were very similar across participants from different races. Next, participants made overall ratings of dominance and trustworthiness from own-race and other-race faces. Again, we found that there was no evidence for an ORE. Together, these results provide a new approach to measuring trait judgements of faces and show that in these conditions there is no ORE for the perception of dominance and trustworthiness.
PubMed: 38881389
DOI: 10.1177/03010066241258204 -
Journal of Clinical Epidemiology Jun 2024Long COVID (LC) refers to persistent symptoms after acute COVID-19 infection, which may endure for months or years. LC affects millions of people globally, with...
BACKGROUND AND OBJECTIVE
Long COVID (LC) refers to persistent symptoms after acute COVID-19 infection, which may endure for months or years. LC affects millions of people globally, with substantial impacts on quality of life, employment, and social participation. Ensuring access to effective, patient-centered care for LC demands evidence, grounded in inclusive representation of those affected by the condition. Yet survey studies frequently under-represent people with the most disabling disease presentations and racially and socio-economically marginalized groups. We aimed to describe a patient-engaged approach to developing a survey to inform public LC healthcare, and to assess its implementation in terms of enabling participation by diverse LC patients in Brazil.
METHODS
Survey development was iterative, achieved through an interdisciplinary collaboration among researchers including people living with LC, and grounded in three guiding principles: (1) evidence-based; (2) inclusive, intersectional, and patient-centered understanding of chronic illness and research participation; and (3) sensitivity to the context of healthcare access.
RESULTS
The product of our collaboration was a longitudinal survey using a questionnaire assessing: LC symptoms; their clinical and functional evolution; and impacts on quality of life, household income, health service access, utilization, and out-of-pocket expenses. We illustrate how we operationalized our three principles through survey content, instrument design, and administration. 651 participants with diverse LC symptoms, demography, and socio-economic status completed the survey. We successfully included participants experiencing disabling symptoms, Black and mixed race participants, and those with lower education and income.
CONCLUSION
By centering patient experience, our novel, principles-based approach succeeded in promoting equity, diversity, and inclusion in LC survey research. These principles guiding patient-engaged collaboration have broad transferability. We encourage survey researchers working on chronic illness and in other contexts of marginalization and inequality to adopt them.
PubMed: 38880435
DOI: 10.1016/j.jclinepi.2024.111423 -
American Journal of Men's Health 2024Men aged 27 to 45 are eligible for human papillomavirus (HPV) vaccination as of 2019, yet relatively little is known about whether they have received or intend to...
Men aged 27 to 45 are eligible for human papillomavirus (HPV) vaccination as of 2019, yet relatively little is known about whether they have received or intend to receive it. We conducted a cross-sectional, online survey among fathers aged 27 to 45 between March and April 2022, to assess associations between HPV vaccination awareness, behaviors, intentions, and psychosocial constructs from the Health Belief Model. We examined the characteristics of those who had (a) heard of the HPV vaccine, (b) already received ≥ 1 dose, and (c) intentions for future vaccination among those who had never been vaccinated. Among 400 men who completed the survey, 32% were not aware of the HPV vaccine. Among those who were aware, 41% had received ≥ 1 dose. Sixty-three percent of unvaccinated men reported that they intended to get vaccinated in the future. Multivariable logistic regression analyses revealed that age and race/ethnicity were associated with having been vaccinated previously. Among the unvaccinated, multivariable logistic regression analyses revealed that those with a higher perceived risk of HPV-associated cancer had 3.73 greater odds of reporting they would seek vaccination compared to those with lower perceived risk (95% confidence interval [CI] = [1.28, 12.3]). We did not find perceived benefits, barriers, or decision self-efficacy to be related to future vaccine intentions. Since recommendations for this group include shared clinical decision-making, public health efforts should focus on raising awareness of vaccine eligibility, emphasizing risk factors for HPV-associated cancers so that individuals have an accurate perception of risk, and encouraging conversation between men and their providers.
Topics: Humans; Male; Papillomavirus Vaccines; Adult; Cross-Sectional Studies; Middle Aged; Fathers; Health Knowledge, Attitudes, Practice; Intention; Papillomavirus Infections; Surveys and Questionnaires; Vaccination
PubMed: 38879825
DOI: 10.1177/15579883241258823 -
Scientific Reports Jun 2024Recent advancements in machine learning and deep learning have revolutionized various computer vision applications, including object detection, tracking, and...
Recent advancements in machine learning and deep learning have revolutionized various computer vision applications, including object detection, tracking, and classification. This research investigates the application of deep learning for cattle lameness detection in dairy farming. Our study employs image processing techniques and deep learning methods for cattle detection, tracking, and lameness classification. We utilize two powerful object detection algorithms: Mask-RCNN from Detectron2 and the popular YOLOv8. Their performance is compared to identify the most effective approach for this application. Bounding boxes are drawn around detected cattle to assign unique local IDs, enabling individual tracking and isolation throughout the video sequence. Additionally, mask regions generated by the chosen detection algorithm provide valuable data for feature extraction, which is crucial for subsequent lameness classification. The extracted cattle mask region values serve as the basis for feature extraction, capturing relevant information indicative of lameness. These features, combined with the local IDs assigned during tracking, are used to compute a lameness score for each cattle. We explore the efficacy of various established machine learning algorithms, such as Support Vector Machines (SVM), AdaBoost and so on, in analyzing the extracted lameness features. Evaluation of the proposed system was conducted across three key domains: detection, tracking, and lameness classification. Notably, the detection module employing Detectron2 achieved an impressive accuracy of 98.98%. Similarly, the tracking module attained a high accuracy of 99.50%. In lameness classification, AdaBoost emerged as the most effective algorithm, yielding the highest overall average accuracy (77.9%). Other established machine learning algorithms, including Decision Trees (DT), Support Vector Machines (SVM), and Random Forests, also demonstrated promising performance (DT: 75.32%, SVM: 75.20%, Random Forest: 74.9%). The presented approach demonstrates the successful implementation for cattle lameness detection. The proposed system has the potential to revolutionize dairy farm management by enabling early lameness detection and facilitating effective monitoring of cattle health. Our findings contribute valuable insights into the application of advanced computer vision methods for livestock health management.
Topics: Animals; Cattle; Lameness, Animal; Cattle Diseases; Algorithms; Support Vector Machine; Image Processing, Computer-Assisted; Deep Learning; Machine Learning; Video Recording
PubMed: 38877097
DOI: 10.1038/s41598-024-64664-7 -
American Journal of Preventive Medicine Jun 2024Youth experience significant mental health (MH) needs, and gender- and racially/ethnically-diverse youth are less likely than peers to receive care. School-based health...
INTRODUCTION
Youth experience significant mental health (MH) needs, and gender- and racially/ethnically-diverse youth are less likely than peers to receive care. School-based health centers (SBHCs) are a healthcare delivery model that may decrease disparities. This study examined the role of SBHCs in reducing disparities in MH care receipt among SBHC clients.
METHODS
Data from electronic health records of 5,396 youth ages 12 to 21 years who visited 14 SBHCs in one California county from 2021-2023 were analyzed in 2023-2024 using multiple logistic regression to assess disparities in MH care receipt and depression screenings.
RESULTS
Receipt of MH care from SBHCs varied significantly by gender but not age, sexual orientation, or race/ethnicity. Compared to female clients, males had reduced odds (AOR: 0.50) and gender-diverse clients had higher odds (AOR: 2.70) of receiving MH care. For receipt of depression screenings, male clients had reduced odds (AOR: 0.86); Latino clients had higher odds than white clients (AOR: 1.80); and older adolescents and young adults had higher odds than younger adolescents (AORs: 1.44 and 1.45, respectively). Receipt of follow-up MH care after a positive depression result varied only by gender, with male clients having reduced odds (AOR: 0.63).
CONCLUSIONS
SBHCs may reach youth who are traditionally less likely to seek care in other settings, including racially/ethnically- and gender-diverse youth. As in other settings, engaging males in healthcare is an area for improvement. These findings help to demonstrate the potential of SBHCs for decreasing disparities in mental health care.
PubMed: 38876296
DOI: 10.1016/j.amepre.2024.06.004 -
Revista Brasileira de Psiquiatria (Sao... Jun 2024This is the first part of two documents prepared by experts for the Brazilian S20 mental health report. These reports outline strategies aimed at addressing the...
This is the first part of two documents prepared by experts for the Brazilian S20 mental health report. These reports outline strategies aimed at addressing the exacerbated mental health challenges arising from a post-pandemic world. Ongoing psychiatric epidemiology research has yielded evidence linking mental health with intricate social determinants, including gender, race/ethnicity, racism, socioeconomic status, social deprivation, and employment, among others. More recently, the focus has expanded to also encompass violence and social oppression. By prioritizing prevention and early intervention, harnessing technology, and fostering community support, we can mitigate the long-term impact of mental disorders emerging in life. Utilizing evidence-based practices and forging partnerships between the health and education sectors, S20 countries can promote health and safety of their student population, thereby paving the way for a more promising future for the next generations. The first document focuses on addressing the mental health concerns of vulnerable populations, catering to the needs of children, youth, and aging populations, assessing the current state of alcohol and drug addictions, scaling up psychosocial interventions in primary care, exploring the potential integration of health and educational systems, and emphasizing the imperative adoption of human rights in mental health policies.
PubMed: 38874935
DOI: 10.47626/1516-4446-2024-3706 -
JAMA Network Open Jun 2024Little nationally representative research has examined Papanicolaou testing rates from before the pandemic in 2019 through the COVID-19 pandemic in 2022. Papanicolaou...
IMPORTANCE
Little nationally representative research has examined Papanicolaou testing rates from before the pandemic in 2019 through the COVID-19 pandemic in 2022. Papanicolaou testing rates among rural females are a concern as they have historically had lower screening rates than their urban counterparts.
OBJECTIVE
To examine the receipt of a Papanicolaou test in the past year among US females overall and females residing in rural and urban areas in 2019, 2020, and 2022.
DESIGN, SETTING, AND PARTICIPANTS
This repeated cross-sectional study used data from 3 years of the Health Information National Trends Survey (HINTS), a nationally representative survey that asks respondents about cancer screenings, sources of health information, and health and health care technologies. Study participants were females aged 21 to 65 years. Individuals who received a Papanicolaou test more than 1 to 3 years prior to a HINTS interview were excluded as they were likely not due for a Papanicolaou test.
EXPOSURES
Survey year (2019, 2020, and 2022) and rural or urban residence were the main exposure variables.
MAIN OUTCOMES AND MEASURES
Self-reported receipt of a Papanicolaou test within the past year.
RESULTS
Among the 188 243 531 (weighted; 3706 unweighted) females included in the analysis, 12.5% lived in rural areas and 87.5% in urban areas. Participants had a mean (SE) age of 43.7 (0.27) years and were of Hispanic (18.8%), non-Hispanic Asian (5.2%), non-Hispanic Black (12.2%), non-Hispanic White (59.6%), or non-Hispanic other (4.1%) race and ethnicity. In 2022, unadjusted past-year Papanicolaou testing rates were significantly lower among rural vs urban residents (48.6% [95% CI, 39.2%-58.1%] vs 64.0% [95% CI, 60.0%-68.0%]; P < .001). Adjusted odds of past-year Papanicolaou testing were lower in 2022 than 2019 (odds ratio, 0.70; 95% CI, 0.52-0.95; P = .02).
CONCLUSIONS AND RELEVANCE
This repeated cross-sectional study found that past-year Papanicolaou testing rates were lower in 2022 than 2019, pointing to a need to increase access to screenings to prevent an uptick in cervical cancer incidence. Rural-vs-urban differences in 2022 indicate a need to specifically target rural females.
Topics: Humans; Female; Uterine Cervical Neoplasms; Middle Aged; Adult; Early Detection of Cancer; Cross-Sectional Studies; Rural Population; Papanicolaou Test; Urban Population; Aged; United States; COVID-19; Young Adult; Vaginal Smears; SARS-CoV-2
PubMed: 38874926
DOI: 10.1001/jamanetworkopen.2024.17094 -
JAMA Network Open Jun 2024Medical overutilization contributes to significant health care expenditures and exposes patients to questionably beneficial surgery and unnecessary risk.
IMPORTANCE
Medical overutilization contributes to significant health care expenditures and exposes patients to questionably beneficial surgery and unnecessary risk.
OBJECTIVES
To understand public attitudes toward medical utilization and the association of these attitudes with beliefs about cancer.
DESIGN, SETTING, AND PARTICIPANTS
In this cross-sectional survey study conducted from August 26 to October 28, 2020, US-based, English-speaking adults were recruited from the general public using Prolific Academic, a research participant platform. Quota-filling was used to obtain a sample demographically representative of the US population. Adults with a personal history of cancer other than nonmelanoma skin cancer were excluded. Statistical analysis was completed in July 2022.
MAIN OUTCOME AND MEASURES
Medical utilization preferences were characterized with the validated, single-item Maximizer-Minimizer Elicitation Question. Participants preferring to take action in medically ambiguous situations (hereafter referred to as "maximizers") were compared with those who leaned toward waiting and seeing (hereafter referred to as "nonmaximizers"). Beliefs and emotions about cancer incidence, survivability, and preventability were assessed using validated measures. Logistic regression modeled factors associated with preferring to maximize medical utilization.
RESULTS
Of 1131 participants (mean [SD] age, 45 [16] years; 568 women [50.2%]), 287 (25.4%) were classified as maximizers, and 844 (74.6%) were classified as nonmaximizers. Logistic regression revealed that self-reporting very good or excellent health status (compared with good, fair, or poor; odds ratio [OR], 2.01 [95% CI, 1.52-2.65]), Black race (compared with White race; OR, 1.88 [95% CI, 1.22-2.89]), high levels of cancer worry (compared with low levels; OR, 1.62 [95% CI, 1.09-2.42]), and overestimating cancer incidence (compared with accurate estimation or underestimating; OR, 1.58 [95% CI, 1.09-2.28]) were significantly associated with maximizing preferences. Those who believed that they personally had a higher-than-average risk of developing cancer were more likely to be maximizers (23.6% [59 of 250] vs 17.4% [131 of 751]; P = .03); this factor was not significant in regression analyses.
CONCLUSIONS AND RELEVANCE
In this survey study of US adults, those with medical maximizing tendencies more often overestimated the incidence of cancer and had higher levels of cancer-related worry. Targeted and personalized education about cancer and its risk factors may help reduce overutilization of oncologic care.
Topics: Humans; Female; Male; Neoplasms; Cross-Sectional Studies; Middle Aged; Adult; United States; Surveys and Questionnaires; Patient Preference; Health Knowledge, Attitudes, Practice; Aged
PubMed: 38874925
DOI: 10.1001/jamanetworkopen.2024.17098