Predicting Unplanned Readmissions to the Intensive Care Unit in the Trauma Population.

Background: Unplanned readmission to intensive care units (UR-ICU) in trauma is associated with increased hospital length of stay and significant morbidity and mortality. We identify independent predictors of UR-ICU and construct a nomogram to estimate readmission probability. Materials and Methods: We performed an IRB-approved retrospective case-control study at a Level I trauma center between January 2019 and December 2021. Patients with UR-ICU (n = 175) were matched with patients who were not readmitted (NR-ICU) (n = 175). Univariate and multivariable binary linear regressionanalyses were performed (SPSS Version 28, IBM Corp), and a nomogram was created (Stata 18.0, StataCorp LLC). Results: Demographics, comorbidities, and injury- and hospital course-related factors were examined as potential prognostic indicators of UR-ICU. The mortality rate of UR-ICU was 22.29% vs 6.29% for NR-ICU (P < .001). Binary linear regression identified seven independent predictors that contributed to UR-ICU: shock (P < .001) or intracranial surgery (P = .015) during ICU admission, low hematocrit (P = .001) or sedation administration in the 24 hours before ICU discharge (P < .001), active infection treatment (P = .192) or leukocytosis on ICU discharge (P = .01), and chronic obstructive pulmonary disease (COPD) (P = .002). A nomogram was generated to estimate the probability of UR-ICU and guide decisions on ICU discharge appropriateness. Discussion: In trauma, UR-ICU is often accompanied by poor outcomes and death. Shock, intracranial surgery, anemia, sedative administration, ongoing infection treatment, leukocytosis, and COPD are significant risk factors for UR-ICU. A predictive nomogram may help better assess readiness for ICU discharge.

Overcoming Health Information Inequities: Valley fever Information Repertoires Among Vulnerable Communities in California.

Although Valley fever represents a growing public health challenge for Central and Southern Californian residents, awareness remains severely limited. The California Department of Public Health (CDPH) ran a cross-platform campaign to mitigate this awareness gap and impact prevention behavior. This study evaluates exposure to the CDPH campaign, followed by an examination of the information consumption patterns associated with key health outcomes. Results suggest that the CDPH campaign successfully improved knowledge accuracy, reduced misperceptions, and increased the likelihood of prevention behavior. Using an information repertoire lens revealed a more nuanced account. Most information repertoires positively influenced accurate knowledge retention and prevention behavior compared to those who were not exposed. The most diverse information repertoire, including interpersonal and media channels, was associated with increased knowledge accuracy, affective risk concerns, personal susceptibility, and prevention behavior. However, exposure to this repertoire was also associated with greater misperceptions. In addition, medical professional and radio-based repertoires positively influenced personal susceptibility perceptions. Overall, this research illustrates the importance of examining not only the general outcomes of health campaigns but also the patterns of information acquisition - particularly when working with underserved communities whose health information consumption preferences may not be comprehensively reflected in the literature.

From Watching to Calling: Linking Variations in an Entertainment-Education Storyline with Calls to a Health Hotline.

Substantial gaps exist in the theoretical conceptualization and practical development of entertainment-education, as studies often fail to account for the ways in which intrinsic message characteristics influence subsequent behavior. These gaps served as the impetus for an international collaborative project that evaluated Vencer el Miedo ("Overcome the Fear"), a Spanish-language program that aired in Mexico from January to March 2020. The telenovela was produced with the aim of improving sexual and reproductive health knowledge and behaviors by modeling effective ways to discuss and negotiate safer sex practices. The show was accompanied by a telephone hotline called OrientaSEX operated by professional counselors from MEXFAM, Planned Parenthood's Mexican affiliate. Utilizing an interrupted time series analysis of calls made to OrientaSEX (N = 11,878) and focusing on changes in the volume of calls and the identity of callers following key moments in the storyline, the findings support the central role played by transitional characters and their similarity to audience members. Implications of these results for the theory and practice of entertainment-education are discussed.

Effect of Timing of Readmission to the ICU on Mortality in Trauma Patients Requiring Critical Care.

ICU readmission is associated with increased mortality. The primary goal of our investigation was to determine the impact of early ICU readmission on mortality and to identify clinical factors which contribute to early ICU readmission in the trauma population. We retrospectively reviewed 175 patients admitted to ICU in a single, academic Level I Trauma Center from January 2019 to December 2021. Early readmission was defined as readmission within 72 hours of discharge and late readmission as after 72 hours. Early readmission mortality rate was 2.8 times higher than late readmission. Statistically significant variables in early readmission were more operations >2 hours, shorter initial length of stay in ICU, lower hematocrit and paCO2 on ICU discharge, and presence of a psychiatric diagnosis. Additional prospective research is needed to guide the development of practice guidelines that reduce frequency, morbidity, and mortality associated with ICU readmission in the trauma population.

Drama, Intrigue, and Discussion: The Role of Telenovelas in Facilitating Conversations about Reproductive Health in Mexican Households.

This study examines the role of an entertainment-education intervention in informing Mexican adolescents and parents about sexual and reproductive health-related discussion and information-seeking. A survey of young adult (N = 491) and parent (N = 223) viewers of the Spanish-language program Vencer el Miedo assessed the influence of exposure to the telenovela's storylines regarding these issues. Heavy viewing of the program predicted adolescent information-seeking about contraceptives via three distinct channels. Additionally, some effects were recorded for parent viewers, and parent-child co-viewing emerged as a significant moderator of communication about one reproductive health topic. Overall, these findings suggest that entertainment-education programs tailored to Mexican culture and the experiences of Mexican families can bring about attitudinal and behavioral changes across the age spectrum, an outcome that is particularly important given the relatively low rates of contraceptive knowledge and use among adolescents across the country.

At the Eye of the Hurricane! Perioperative Management of an Unoptimized Metastatic Pheochromocytoma Presenting for Emergency Neurosurgery.

Metastatic pheochromocytoma (PCC) is a rare entity arising from extra-adrenal tissue. We report the perioperative management of a young woman presenting with metastatic PCC to the vertebral body resulting in vertebral collapse and spinal cord compression necessitating emergency surgery. There are no reports of anesthetic management of a patient with unoptimized metastatic PCC presenting for emergency neurosurgery under general anesthesia. Our anesthetic goals were to maintain a deep anesthetic plane with stable hemodynamics, facilitate intraoperative neuromonitoring, manage catecholamine surges during anesthetic induction, tumor resection, and manage perioperative massive blood loss. The successful perioperative management of metastatic PCC has become possible with the vast armamentarium of anesthetic drugs and intraoperative advanced monitoring techniques. In addition, our role in understanding the pathophysiology and course of the disease is essential to ensure low morbidity and mortality of such cases in their most vulnerable perioperative period.

The Effect of an Entertainment-Education Intervention on Reproductive Health of Young Women of Color.

While teen pregnancy rates in the United States have been declining for decades, they remain the highest of all western countries. Within the U.S., Black and Latina teens experience disproportionate rates of unplanned pregnancy. Plan A is an entertainment-education video intervention that was developed to help address these disparities, in part by emphasizing the ability of young cisgender women to control when they become pregnant by using an effective contraception method. The intervention was developed in close collaboration with the target audience (Black and Latina women aged 18-19) to ensure that it was relevant, engaging, and motivational. We conducted an online study to: (a) investigate the effects of Plan A on attitudes toward the contraception methods covered in the video; (b) whether these effects varied by race/ethnicity or age, and; (c) if identification with characters in the video mediated these effects. The study used a posttest-only design where participants were randomly assigned to watch Plan A or to a neutral control condition. The sample included Black, Latina, and non-Latina White women aged 16 to 19 (N= 242), with younger and White women included for comparison purposes. Results indicated that exposure to Plan A significantly improved attitudes toward long-acting reversible contraceptives (LARCs) among all age groups and among young Black and Latina women, but not White women. These findings may be explained by participant's identification with the Black and Latina lead characters - both of whom model positive reproductive health behaviors.

Evaluating the Impact of Attempts to Correct Health Misinformation on Social Media: A Meta-Analysis.

Social media poses a threat to public health by facilitating the spread of misinformation. At the same time, however, social media offers a promising avenue to stem the distribution of false claims - as evidenced by real-time corrections, crowdsourced fact-checking, and algorithmic tagging. Despite the growing attempts to correct misinformation on social media, there is still considerable ambiguity regarding the ability to effectively ameliorate the negative impact of false messages. To address this gap, the current study uses a meta-analysis to evaluate the relative impact of social media interventions designed to correct health-related misinformation (k = 24; N = 6,086). Additionally, the meta-analysis introduces theory-driven moderators that help delineate the effectiveness of social media interventions. The mean effect size of attempts to correct misinformation on social media was positive and significant (d = 0.40, 95% CI [0.25, 0.55], p =.0005) and a publication bias could not be excluded. Interventions were more effective in cases where participants were involved with the health topic, as well as when misinformation was distributed by news organizations (vs. peers) and debunked by experts (vs. non-experts). The findings of this meta-analysis can be used not only to depict the current state of the literature but also to prescribe specific recommendations to better address the proliferation of health misinformation on social media.