Missed Opportunity: Neuroradiology Training Programs and Social Media.

OBJECTIVE. The purpose of this study was to ascertain the degree to which the academic neuroradiology community is embracing social media in its messaging. The hypothesis was that, compared with peer neurosurgery and neurology programs, a majority of neuroradiology programs would actively engage through Facebook and Twitter accounts. MATERIALS AND METHODS. An Internet search was conducted for Facebook, Twitter, LinkedIn, and Instagram accounts for the 75 National Resident Matching Program-registered U.S. neuroradiology fellowship programs and their division chiefs and for the neurosurgery and neurology social media accounts of the same institutions. The content and audience responses of the neuroradiology accounts were categorized. RESULTS. Only 8 of 75 neuroradiology programs had one or more social media accounts. Neurosurgery (odds ratio, 5.9; 95% CI, 2.5-14.0) and neurology (odds ratio, 3.2; 95% CI, 1.3-7.9) had a significantly greater social media presence than neuroradiology did. Larger neuroradiology programs (five or more fellowship positions) had significantly greater likelihood (odds ratio, 7.6,; 95% CI, 1.6-36.4) of having social media accounts compared with those with fewer than five positions. Division chiefs had accounts on LinkedIn more than other media. Few neuroradiology chiefs actively engaged professionally on Facebook and Twitter. Most neuroradiology programs used social media more for recruitment and program information than for education, research, or patient information. CONCLUSION. Most neuroradiology training programs do not have social media accounts and do not use social media for education, engagement, recruitment, or research promulgation. Neurosurgery and neurology programs have more but still limited World Wide Web representation. There is an opportunity for neuroradiology programs to have greater impact in this arena.

Prevalence and Distribution of E-Cigarette Use Among U.S. Adults: Behavioral Risk Factor Surveillance System, 2016.

Background: Contemporary data on the prevalence of e-cigarette use in the United States are limited. Objective: To report the prevalence and distribution of current e-cigarette use among U.S. adults in 2016. Design: Cross-sectional. Setting: Behavioral Risk Factor Surveillance System, 2016. Participants: Adults aged 18 years and older. Measurements: Prevalence of current e-cigarette use by sociodemographic groups, comorbid medical conditions, and states of residence. Results: Of participants with information on e-cigarette use (n = 466 842), 15 240 were current e-cigarette users, representing a prevalence of 4.5%, which corresponds to 10.8 million adult e-cigarette users in the United States. Of the e-cigarette users, 15% were never-cigarette smokers. The prevalence of current e-cigarette use was highest among persons aged 18 to 24 years (9.2% [95% CI, 8.6% to 9.8%]), translating to approximately 2.8 million users in this age range. More than half the current e-cigarette users (51.2%) were younger than 35 years. In addition, the age-standardized prevalence of e-cigarette use was high among men; lesbian, gay, bisexual, and transgender (LGBT) persons; current combustible cigarette smokers; and those with chronic health conditions. The prevalence of e-cigarette use varied widely among states, with estimates ranging from 3.1% (CI, 2.3% to 4.1%) in South Dakota to 7.0% (CI, 6.0% to 8.2%) in Oklahoma. Limitation: Data were self-reported, and no biochemical confirmation of tobacco use was available. Conclusion: E-cigarette use is common, especially in younger adults, LGBT persons, current cigarette smokers, and persons with comorbid conditions. The prevalence of use differs across states. These contemporary estimates may inform researchers, health care policymakers, and tobacco regulators about demographic and geographic distributions of e-cigarette use. Primary Funding Source: American Heart Association Tobacco Regulation and Addiction Center, which is funded by the U.S. Food and Drug Administration and National Heart, Lung, and Blood Institute.

Housing and Food Insecurity, Care Access, and Health Status Among the Chronically Ill: An Analysis of the Behavioral Risk Factor Surveillance System.

BACKGROUND: The proportion of the United States population with chronic illness continues to rise. Understanding the determinants of quality of care-particularly social determinants-is critical to the provision of care in this population. OBJECTIVE: To estimate the prevalence of housing and food insecurity among persons with common chronic conditions and to assess the independent effects of chronic illness and sociodemographic characteristics on (1) housing and food insecurity, and (2) health care access hardship and health status. DESIGN: Cross-sectional study. PARTICIPANTS: We used data from the 11 states and one territory that completed the social context module of the 2015 Behavioral Risk Factor Surveillance System (BRFSS). MAIN MEASURES: We estimated the prevalence of housing and food insecurity among patients with cancer, stroke, cardiovascular disease, and chronic lung disease. Logistic regression models were used to assess the independent effects of housing and food insecurity, chronic conditions, and demographics on health care access and health status. KEY RESULTS: Among the chronically ill, 36.71% (95% CI: 35.54-37.88) experienced housing insecurity and 30.60% (95% CI: 29.49-31.71) experienced food insecurity. Cardiovascular and lung disease increased the likelihood of housing (OR 1.69, 95% CI: 1.07-2.66 and OR 1.71, 95% CI: 1.12-2.60, respectively) and food insecurity (OR 1.75, 95% CI: 1.12-2.73 and OR 1.78, 95% CI: 1.20-2.63, respectively). Housing and food insecurity significantly increased the risk of health care access hardship. Being insured or having an income level above 200% of the federal poverty level significantly reduced the likelihood of access hardship, while female gender significantly increased the likelihood. CONCLUSIONS: Chronic illness independently affects housing and food insecurity. In turn, food and housing anxiety leads to reduced access to care, likely due to cost concerns, and correlates with poorer health. A more complete understanding of the pathways by which chronic illness influences social determinants and clinical outcomes is needed.

Incidence and predictors of early adulthood pre-diabetes/type 2 diabetes, among Iranian adolescents: the Tehran Lipid and Glucose Study.

PURPOSE: To evaluate the incidence and predictors of early adulthood pre-diabetes/type 2 diabetes (T2D) among Iranian adolescents during a median follow-up of 9.2 yr. METHOD: A total of 2563 subjects aged 10-19 yr, without pre-diabetes/T2D at baseline, were entered in the study. Pre-diabetes was defined as those with fasting plasma glucose (FPG) 5.6 to <7 mmol/L. T2D was defined as anti-T2D drug consumption or FPG ≥7 mmol/L. Multivariate Cox-proportional analysis was applied to examine the association between different risk factors that showed attained statistical significance < 0.2 in univariate analysis, with incident pre-diabetes/T2D. Same method was repeated on 1803 subjects with complete parental data to find the relation between parental risk factors and pre-diabetes/T2D. RESULT: The mean age of participants was 14.45 ± 2.78 yr, and 53.6% were female. During follow-up 208 cases of pre-diabetes/T2D occurred, resulting in an incidence rate of 9.61 per 1000 person-years. Multivariate-adjusted hazard ratios (HRs) for incident pre-diabetes/T2D showed significant risk for 1 standard deviation increase in FPG and body mass index with corresponding HR of 1.89 (1.6-2.23) and 1.435 (1.080-1.905), respectively. Among parental potential risk factors, the paternal history of T2D was independently associated with increased risk for pre-diabetes/T2D in the adolescence (HR = 1.63(1.02-2.60)). CONCLUSION: About 1% of Iranian adolescents developed pre-diabetes/T2D each year. Among the non-modifiable risk factors paternal history of T2D and, among modifiable risk factors, the presence of general adiposity as well as the higher level of FPG should be considered among adolescents for development of pre-diabetes/T2D later in the young adulthood.

Vanishing pelvic mass: Decidualized endometriosis during pregnancy.

A 40-year-old woman without history of endometriosis was found to have 10 cm pelvic mass on the routine first trimester ultrasound. Magnetic resonance imaging (MRI) of the pelvis demonstrated a large solid mass abutting the rectum which raised the concern for malignancy. Transrectal biopsy of the mass was performed with histopathology result of decidualized endometriosis. Patient continued her pregnancy and had cesarean section at 39 weeks. Interestingly, no mass was found when obstetrician performed pelvic examination after delivery in the operative room. This case is a unique presentation of endometriosis during pregnancy in a patient with no prior history of endometriosis. Large size and abutment of the rectum by the decidualized endometriosis on MRI led to misinterpretation as malignancy. Our case highlights complexity of the deep infiltrative endometriosis (DIE) during pregnancy which can misguide the providers, lead to unnecessary procedures and unwanted complications.

Breast, Cervical, and Colorectal Cancer Screening Adherence: Effect of Low Body Mass Index in Women.

Purpose: Health-related behaviors among underweight women have received less attention than overweight and obese women in the United States. Our purposes were to estimate the rate and modifiers of breast, cervical, and colorectal cancer screening adherence among underweight women and compare it to other body mass index (BMI) categories. Materials and Methods: We used sampling weighted data from 2016 Behavioral Risk Factor Surveillance System (BRFSS) of age-eligible women (breast cancer screening, n = 163,164; cervical, n = 113,883 and colorectal, n = 128,287). We defined breast, cervical, and colorectal cancer screening using the US Preventive Services Task Force (USPSTF) guidelines. We calculated the prevalence of screening among four BMI categories (underweight <18.5, normal weight ≥18.5 to <25, overweight ≥25 to <30, and obese ≥30). Logistic regression models assessed the independent effect of BMI on screening adherence. Results: Underweight women had significantly lower breast (62.9%), cervical (67.5%), and colorectal (62.6%) cancer screening rates compared to other BMI categories. In logistic regression models, being underweight was associated with decreased odds of breast (odds ratio [OR] = 0.66; 95% confidence interval [CI] = 0.49-0.88) and cervical (OR = 0.54, 95% CI = 0.34-0.84), but not colorectal (OR = 0.88; 95% CI = 0.66-1.18) cancer screening adherence. We did not demonstrate a significant association between obesity and screening rates for any of the three cancers. Underweight women reported higher rates of smoking and lower levels of educational attainment, income, and insurance coverage compared to all other groups. Higher rates of chronic illness and health access hardship were observed among underweight women. Conclusion: BMI variably affects cancer screening. Compared to normal-weight women, being underweight is associated with breast and cervical cancer screening nonadherence. Promoting breast and cervical cancer screening among this currently underserved population may reduce future disparities.

Modifiers of Cancer Screening Prevention Among Sexual and Gender Minorities in the Behavioral Risk Factor Surveillance System.

PURPOSE: Increasing social acceptance of sexual and gender minorities may not translate to parity in health care access and health outcomes. Sexual orientation and gender identity (SOGI) may continue to contribute to differences in preventive health behavior including cancer screening. Our purpose was to estimate the independent effect of SOGI on breast, cervical, and colorectal cancer screening adherence. METHODS: We used sampling weighted data from 2016 Behavioral Risk Factor Surveillance System. We defined breast, cervical, and colorectal cancer screening using the US Preventive Services Task Force guidelines. All survey data were self-reported including demographic and medical information. We calculated the prevalence of screening by sexual orientation (straight, lesbian or gay, bisexual) and gender identity (cisgender, transgender). The term "sexual and gender minorities" in our study refers to lesbian or gay, bisexual, and transgender individuals. Logistic regression models assessed independent effect of SOGI on screening adherence. RESULTS: Prevalence of breast, cervical, and colorectal cancer screening varied significantly by SOGI. After adjusting for other variables, bisexual persons had significantly lower odds (odds ratio [OR] = 0.60, 95% confidence interval [CI] = 0.38-0.93) of breast cancer screening adherence. Lesbian or gay persons had significantly decreased likelihood (OR = 0.53, 95% CI = 0.29-0.95) of cervical cancer screening adherence. Although rate of colorectal cancer screening adherence varied significantly by SOGI, we did not find an independent effect of SOGI and colorectal cancer screening adherence after adjusting for other variables. No independent effect of gender identity categories on breast, cervical, and colorectal cancer screening adherence was detected. Social determinants of health, such as health care access and insurance, that disproportionately disadvantaged bisexual individuals independently influenced screening adherence. CONCLUSIONS: SOGI can affect cancer screening adherence. Bisexual individuals had worse health care access and socioeconomic hardships among sexual and gender minorities. Given the independent effects of social determinants of health on cancer screening adherence, more attention needs to be paid to sexual and gender minorities, especially bisexual population.

Underrepresentation of Women on Radiology Editorial Boards.

PURPOSE: Women in radiology are known to be underrepresented in academic leadership positions. We sought to determine if women are appropriately represented on editorial boards and editor-in-chief positions compared with their authorship contributions. MATERIALS AND METHODS: We assessed the first and senior authorship male versus female gender breakdown of manuscripts published in nine high-impact American radiology journals 1 month per year from 2002 to 2017. We looked at the gender of the first authors, senior authors, editorial board members, and editors-in-chief of these journals to see if there was a gender discrepancy. RESULTS: We assessed 3,702 first authors, 3,702 senior authors, and 9,400 editorial board members. Women were underrepresented on the editorial boards compared with their first-authored manuscript contribution in our sample of articles from every journal for every year and were underrepresented compared with their senior-authored manuscript contributions in 119 of 139 (85.6%) journal-years. The percentage of women as first authors (mean = 29.3 ± 9.9), senior authors (mean = 20.7 ± 8.1), and editorial board members (mean = 13.4 ± 6.5) showed major differences (P < .001). This gap did not significantly narrow over the 16 years of study. Notably, there was no woman as editor-in-chief for any of the journal-years. CONCLUSION: There is a gender gap in the composition of editorial boards in radiology compared with authorship contributions by women. Given the implications of editorial board assignment and editorship on women's academic advancement, journals may wish to consider strategies that will narrow the gap.

Access to Lung Cancer Screening Services: Preliminary Analysis of Geographic Service Distribution Using the ACR Lung Cancer Screening Registry.

PURPOSE: Lung cancer has the highest mortality rate among all types of cancer in the United States. The National Lung Screening Trial demonstrated that low-dose CT for lung cancer screening decreases both lung cancer-related mortality and all-cause mortality. Currently, the only CMS-approved lung cancer screening registry is the Lung Cancer Screening Registry (LCSR) administered by the ACR. The aims of this study were to assess access to lung cancer screening services as estimated by the number and distribution of screening facilities participating in the LCSR, by state, and to evaluate state-level covariates that correlate with access. METHODS: The ACR LCSR list of participating lung cancer screening facilities was used as a proxy for the availability of lung cancer screening facilities in each state. Additionally, we normalized the number of facilities by state by the number of screening-eligible individuals using Behavioral Risk Factor Surveillance System data. State-level demographics were obtained from the 2015 Behavioral Risk Factor Surveillance System: poverty level, insured population, unemployed, black, and Latino. State-specific lung cancer incidence and death rates, number of active physicians per 100,000, and Medicare expenditure per capita were obtained. Linear regression models were performed to examine the influence of these state-level covariates on state-level screening facility number. QGIS, an open-source geographic information system, was used to map the distribution of lung cancer screening facilities and to estimate the nearest neighbor index, a measure of facility clustering within each state. RESULTS: As of November 18, 2016, 2,423 facilities participated in the LCSR. When adjusted by the rate of screening-eligible individuals per 100,000, the median population-normalized facility number was 15.7 (interquartile range, 10.7-19.3). There was a positive independent effect (coefficient = 12.87; 95% confidence interval, 10.93-14.8) between state-level number of screening facilities and rate of screening-eligible individuals per 100,000. There were no significant correlations between number of facilities and lung cancer outcomes, state demographic characteristics, or physician supply and Medicare expenditure. In most states, facilities are clustered rather than dispersed, with a median nearest neighbor index of 0.65 (interquartile range, 0.51-0.81). CONCLUSIONS: Facility number correlated with the rate of screening-eligible individuals per 100,000, a measure of the at-risk population. Alignment of screening facility number and distribution with other clinically relevant epidemiologic factors remains a public health opportunity.