United States

BACKGROUND
Hispanic reproductive age women have the second highest fertility rate in the United States in conjunction with higher rates of adolescent and unintended pregnancies. However, little is known about contraceptive choices within this population. Therefore, our study aims to assess the role of birthplace and language preference on contraceptive use.

METHODS
Using the 2017-2019 National Survey of Family Growth, we identified a nationally representative sample of Hispanic women (age 15-49). We compared the risk difference in contraceptive use between Hispanic immigrant Spanish speaking women to other Hispanic immigrant and non-immigrant English-speaking women. We also assessed methods of contraceptives in three categories: permanent, long-acting reversible contraception (LARC), and other less effective methods. 

RESULTS
Among the 1,664 Hispanic women, immigrant Spanish speaking women were 7.7% (95% CI 0.02- 15.3) less likely to use contraceptives than non-immigrant English speaking women. Immigrant Spanish speaking women were 17.7% (95% CI 0.4-35.0) and 19.0% (95% CI 9.0- 30.0) more likely than immigrant and non-immigrant English speaking women respectively to have permanent forms of contraception. Immigrant Spanish speaking women were 14.6% (95% CI 5.5- 23.7) less likely to use lower efficacy methods then non-immigrant English speaking women.

CONCLUSION
Our findings suggest immigrant Spanish speaking women have lower rates of contraceptive use with higher rates of permanent and lower rates of low efficacy contraception use. These findings suggest the potential need for more targeted reproductive and contraceptive education within Hispanic populations.

2022 AMA Research Challenge

The Influence of Language and Place of Birth on Use and Method of Contraception Among Reproductive Age Hispanic Women in the United States

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Charles Lopresto, DO

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Trauma Patient Perspectives on Crime Victim Compensation 
and Post-Discharge Implications

Background
No complete history of black women physicians in the United States exists, and what little mention is made of these women in existing histories is often brief or inaccurate. In my forthcoming book, TWICE AS HARD (Beacon Press, January 2023), I champion a new history, penning the long-erased stories of black women physicians in permanent ink. 

Methods
The primary research method was analysis of oral histories of 19th to 21st century black women physicians, including those that were collected by historians at various institutions like Harvard University and the University of Arkansas. Quantitative data on diversity in medical education and the physician workforce from the Association of American Medical Colleges was used to provide a broader perspective of the experiences of black women physicians. This project utilized an interdisciplinary approach, drawing secondary literature from the fields of African American studies, gender studies, medicine, education, and sociology.

Results
By focusing on the lived experience of black women physicians, some of the barriers that these black women faced, such as discriminatory practices of medical schools and hospitals, were uncovered. Nine (of the 22) physician-based oral histories were emphasized to give a more holistic perspective on individual physician’s lives. The physicians highlighted in the book include Dr. Rebecca Crumpler, the first black woman physician in the U.S., Dr. Edith Irby Jones, the first black person to attend a previously white-only medical school in the Jim Crow South, and Dr. Joycelyn Elders, the first black Surgeon General. The book also shows how the evolution of biomedicine and American society during this 150-year period has influenced these women’s journeys.

Conclusion
While the challenges that black women face to enter medicine has decreased over time, significant barriers persist. This is evident in their overall underrepresentation in medicine; black women make up less than 3% of physicians nationally. Medical institutions can help to reduce this underrepresentation through mentorship, advocacy, and support for the black women along this path. These strategies can also be expanded to other underrepresented minorities in medicine who share similar challenges with black women in medicine.

TWICE AS HARD: The Stories of Black Women Who Fought to Become Physicians from the Civil War to the 21st Century

Wastewater surveillance of SARS-CoV-2 has shown to be a valuable source of information regarding SARS-CoV-2 transmission and COVID-19 cases. Though the method has been used for several decades to track other infectious diseases, there has not been a comprehensive review outlining all of the pathogens surveilled through wastewater. The aim of this study is to identify what infectious diseases have been previously studied via wastewater surveillance prior to the COVID-19 Pandemic and identify common characteristics between the studies, as well as identify current gaps in knowledge.

Wastewater Surveillance for Infectious Diseases: A Systematic Review

Background
The COVID-19 pandemic has illuminated the United States (US) healthcare system’s lack of preparedness and put healthcare communities (HCs) at increased risk for adverse outcomes (e.g., discrimination and racism via microaggressions, hate crimes, or even death). In this study, we investigated 1) prevalence of discrimination; 2) the risk of microaggressions and hate crimes (MAHCs) experienced by healthcare workers (HCWSs); 3) which specific subpopulations were affected; 4) the driving factors of these attitudes and actions; and 5) perceived fear of COVID-related complications (e.g., infectivity, illness, death, and etc.).

Methods
A cross-sectional survey was disseminated to US HCs, incorporating the validated Everyday Discrimination Scale and assessing risk and driving factors behind MAHCs. Logistic regression was used to estimate risk of MAHCs among HCWSs before and during the pandemic.

Results
1218 participants were included, with 230 (19%) reporting an increase in everyday discrimination. Most common types of discrimination reported were verbal harassment (42%) and physical assault (25%) with suspected reasons for experiencing and witnessing MAHCs being race (16%), ethnicity (20%), and gender biases (18%). Furthermore, physicians [OR: 1.46 (95% CI: 1.07-1.99)], students [OR: 1.81 (95% CI: 1.03-3.17)], and other medical professionals [OR: 1.30 (95% CI: 0.96-1.77)] had higher risks of ever experiencing a MAHC compared to nurses after adjusting for gender, race, ethnicity, and age. Perceived risk and fear regarding COVID-19 infections were high for Asian/South Asian/Southeast Asian and Native Hawaiian/Pacific Islander HCWSs. Lastly, 19% of participants reported purchasing or knowing someone who purchased a firearm due to COVID-19 related safety concerns. 

Conclusion
COVID-19 has unmasked systemic maladies, especially for HCWSs, who possess a complex duality of roles as healers and potential carriers of disease and illness. More studies are needed to capture xenophobic and racist occurrences which are often overlooked and undocumented. These studies are imperative to inform the development of prevention and intervention programs that will combat systemic injustices and safeguard HCWSs from adverse outcomes.

Xenophobia & Racism: A National Study on the Experiences Among Healthcare Workers During COVID-19

Comparison of accuracy of SARS-CoV-2 rapid antigen tests with delta variant and omicron variant in children

ABSTRACT
Purpose: Cytomegalovirus (HCMV) is a common viral infection that shapes lifelong immunity. A history of infection with HCMV has been associated with many chronic diseases, including cancer. In addition, prospective cohort studies have established that HCMV is associated with all-cause mortality. However, there are limited data regarding HCMV and cancer mortality.
Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) III study (1988 -1994): subjects aged 18 to 98, who had HCMV serology results, did not report having cancer at baseline, and were eligible for mortality follow up (N= 14,498). Mortality was ascertained until December 2011 using National Death Index (NDI) linkage.
Results: The unadjusted risk of all-cancer mortality was higher in HCMV seropositive individuals (HR=2.74, 95% CI 2.05 -3.64). This association was attenuated after adjusting for age (HR =1.39, 95% CI 1.02 - 1.92), and other covariates (age, sex, race/ethnicity, smoking status, BMI, education, and C-reactive protein (CRP); HR=1.28, 95% CI 0.91 - 1.81). There was a statistically significant interaction between HCMV and sex (p=0.01): HCMV seropositivity was associated with increased cancer mortality in men (HR = 1.65, 95% CI 0.99 - 2.73) but not in women (HR=0.95, 95% CI 0.59 - 1.54).
Conclusion(s): Consistent with prior reports, HCMV seropositivity may be associated with an increased risk of cancer-related mortality but the association is partially driven by socioeconomic status and other risk factors. Future research is needed to determine whether HCMV is a risk factor for cancer, as well as identify the specific cancer types where HCMV increases mortality.



Cytomegalovirus and cancer-related mortality in the national health and nutritional examination survey

Hospital MRSA and C. difficile rates drop with COVID-19 precautions

As the novel COVID-19 pandemic was on the rise, its impact on the healthcare system was devastating. Patients became more reluctant to present to the hospital and elective procedures were being postponed for patient safety. We wanted to assess the effects of the COVID-19 pandemic on the door-to-device time in our small community hospital in the heart of Trenton, New Jersey. We created a retrospective study that evaluated all STEMI cases that presented to our institute from January 2018 until the end of May 2021. Our primary outcome was the door-to-device time. Secondary outcomes were the length of hospital stay, ICU admission, length of ICU stay, cardiac arrest, and death during the hospitalization. We studied 114 patients that presented with STEMI to our emergency department, 77 of these patients presented pre-COVID-19, and 37 presented post-COVID-19 pandemic. Our median door-to-device for STEMI cases pre and post-COVID-19 pandemic were 70 minutes (IQR 84-57) and 70 minutes (IQR 88-59) respectively with no significant difference found (P-value 0.55, Mann Whitney Test). It is, however, interesting to note that the number of STEMI admissions significantly decreased during the post-pandemic era. There are limitations to our study, most noticeably the number of STEMI cases at our small community hospital which limits its generalizability. Moreover, we did not assess other comorbidities which might have confounded our outcomes and we were also unable to follow patients post-discharge to assess the long-term sequela of their STEMI admission. Therefore, more dedicated studies of this clinical conundrum are required to further assess and implement guidelines for the future.

Comparison of STEMI Door-to-Device Time during the COVID-19 crisis in a New Jersey Inner City Community Hospital

Difference in Severity of Heart Failure in Rurual Versus Urban Patients at Time of Referral for Advanced Therapies

Effect on Recurrent Emergency Room Visits and Hospitalizations in Atrial Fibrillation Patients in a Dedicated Nurse Practitioner Led Atrial Fibrillation Clinic 


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The Influence of Language and Place of Birth on Use and Method of Contraception Among Reproductive Age Hispanic Women in the United States

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