United States

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.

AMA Research Challenge 2022

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

Welcome to the largest national, multi-specialty research event **featuring research from 750 medical students, residents and fellows, and international medical graduates.**


#### Event Details
The 2022 American Medical Association Research Challenge includes a poster symposium hall and a semifinals hall with the top scored research. Log in at any time throughout the event to:
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At the conclusion of this event, the AMA will announce the top five finalists who will advance to the AMA Research Challenge finals, present their research to an elite panel of judges and compete to win a $10,000 grand prize sponsored by Laurel Road.
 

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 **Speakers**
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Ricardo Correa, MD, EdD
![](https://assets.underline.io/uploads/markdown_image/1/image/5f9437ab87861538bf02b9ca7c0d926e.jpg)
Stuart M. Greenstein, MD
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Stephanie Strohbeen, MD
 
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Jessica Li, MD/PhD Candidate
![](https://assets.underline.io/uploads/markdown_image/1/image/9950ef2e0237f54cb3d8280334d42491.jpg)
Charles Lopresto, DO

### Sponsor
AMA would like to thank Laurel Road for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road is not involved in the judging or scoring process to select the winner. The winner will be announced on Dec. 7 during the AMA Research Challenge finals. Payment of the grand prize will be directly from Laurel Road. See the AMA Research Challenge Official Rules for terms and conditions.

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Welcome to the largest national, multi-specialty research event featuring research from 750 medical students, residents and fellows, and international medical graduates.


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

poster

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 


Association of Cutaneous Manifestations with Admission Duration Among Dengue
Fever Patients in Rural, Underserved Philippines

Association of Cutaneous Manifestations with Admission Duration Among Dengue Fever Patients in Rural, Underserved Philippines

Background
Systemic isotretinoin is a highly effective treatment for severe and refractory acne but carries risk for serious adverse effects such as teratogenicity. The United States’ risk mitigation system, iPLEDGE, requires all patients on isotretinoin therapy to complete monthly tasks including follow-up visits with their prescriber, and patients with childbearing potential must additionally undergo monthly pregnancy testing. The onset of the COVID-19 pandemic presented an opportunity to reduce the isotretinoin gender gap, as updated regulations shifted to permit at-home pregnancy testing and telehealth visits for monthly follow-ups.

Methods
We performed a single-center analysis to determine whether gender differences in isotretinoin prescription changed at our institution during the initial months of the pandemic. Data was obtained from an institutional database. Inclusion criteria were dermatology encounters during which an adult patient (age>18) was prescribed isotretinoin or topical retinoids for acne. Gender identity originated from patient-reported demographics. Fisher’s exact tests with alpha set to 0.05 were used to compare odds of isotretinoin prescription for male and female patients, with control groups comprised of patients receiving topical retinoids for acne. Odds ratios were compared for the pandemic period (June 1, 2020 to January 22, 2021) versus the pre-pandemic period (June 1, 2019 to January 22, 2020). Odds ratios were also compared between telehealth visits and in-person visits during the pandemic period.

Results
We found that male predominance of isotretinoin prescriptions was greater during the pandemic compared to pre-pandemic (odds ratios: 4.13 vs. 2.86). Furthermore, male patients were more likely to utilize telehealth compared to in-person visits relative to female patients (odds ratios: 6.00 vs. 3.62).

Conclusion
Despite the newly introduced flexibilities of telehealth and remote pregnancy testing, gender inequity in receiving isotretinoin treatment persisted during the pandemic. Many factors may influence the relative decreased access to isotretinoin among female patients including patient and provider preference. Future work should examine factors influencing the prescription of isotretinoin to female patients, as well as identify opportunities to improve policies that promote safe isotretinoin use while minimizing gender inequity.

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

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