Mitigating HIV health disparities: the promise of mobile health for a patient-initiated solution.

The HIV epidemic is an ongoing public health problem fueled, in part, by undertesting for HIV. When HIV-infected people learn their status, many of them decrease risky behaviors and begin therapy to decrease viral load, both of which prevent ongoing spread of HIV in the community. Some physicians face barriers to testing their patients for HIV and would rather their patients ask them for the HIV test. A campaign prompting patients to ask their physicians about HIV testing could increase testing. A mobile health (mHealth) campaign would be a low-cost, accessible solution to activate patients to take greater control of their health, especially populations at risk for HIV. This campaign could achieve Healthy People 2020 objectives: improve patient-physician communication, improve HIV testing, and increase use of mHealth.

Using text messages to improve patient-doctor communication among racial and ethnic minority adults: an innovative solution to increase influenza vaccinations.

Despite the 2010 CDC recommendation that all adults receive influenza vaccinations, in the 2013-2014 influenza season, only 35% of Blacks and 37% of Hispanics were vaccinated, compared to 40% of Whites. This disparity could be due to poor patient-doctor communication, among other barriers. Doctors provide more health information to active communicators; unfortunately, they perceive minority patients to be poor communicators. A novel way to prompt minority patients to better communicate with their doctors is through mHealth. Text messaging is a simple, low cost, mHealth platform widely-used among racial and ethnic minorities. A text message campaign could be effective in providing vaccine education and prompting patients to converse with their doctors about influenza vaccinations. Text prompts could improve patient communication, thus increasing their likelihood of vaccination. This campaign could accomplish Healthy People 2020 goals: increase influenza vaccination, improve patient-doctor communication, increase use of mHealth, and reduce health disparities.

Humanism Rounds: A Multifaceted "Back to Bedside" Initiative to Improve Meaning at Work for Internal Medicine Residents.

Introduction: Burnout is an increasingly prevalent problem among resident physicians. To address this problem, the Accreditation Council on Graduate Medical Education (ACGME) created the Back to Bedside initiative, supporting resident-driven projects focused on increasing direct interactions with patients. In 2017, Baylor College of Medicine (BCM) Internal Medicine Residency received a Back to Bedside grant to develop and implement "Humanism Rounds," a multifaceted program which sought to promote personal connections between residents and patients and foster reflection about patients' non-clinical stories, with the hopes of reducing burnout and increasing residents' sense of meaning at work. Materials and Methods: Between 2018 and 2020, internal medicine residents were instructed on and encouraged to participate in Humanism Rounds. The program included three components: taking a "human history," bedside rounds focused on non-clinical concerns, and sharing patient stories with colleagues ("celebrations"). Residents were surveyed using institutional and ACGME surveys regarding burnout, meaning at work, and the clinical learning environment. Results: Three hundred eleven institutional (response rate, 74%) and 328 AGCME (response rate, 78%) surveys were completed and analyzed. Residents who actively engaged with Humanism Rounds reported more meaning and fulfillment at work (p < 0.001). During the period of this project, ratings of the learning environment and personal callousness improved among subgroups of residents. Conclusions: Baylor College of Medicine Internal Medicine residents who engaged with Humanism Rounds reported more meaning and fulfillment in their work. This program describes a low-cost model for other specialties and institutions to strengthen human connections and improve residents' experience during training. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-024-02017-9.

Complete genome sequences of cluster F1 and cluster B1 Mycobacterium smegmatis phages Karhdo and Basato.

We present the complete genome sequences of Mycobacterium smegmatis phages Karhdo and Basato, isolated in Clark County, Nevada. The phages were isolated and annotated by students enrolled in undergraduate research courses over two semesters at the University of Nevada, Las Vegas.

Widening Health Disparities: Increasing Cholangiocarcinoma Incidence in an Underserved Population.

Background and Aims: Cholangiocarcinoma is a relatively rare malignancy with high mortality. In the U.S., incidence rates of cholangiocarcinoma have increased, particularly affecting younger age groups and Hispanic and Asian individuals. We investigated the incidence of cholangiocarcinoma in a largely under-represented, minority population. Methods: We performed a retrospective cohort study from 2005 to 2017 among adults in a county-funded healthcare system in Harris County, Texas. Incidence rate ratios were computed to compare age-standardized rates using U.S. standard population between 2 time periods: 2005-2011 and 2012-2017. Results: We identified 139 cholangiocarcinoma cases (64% intrahepatic, 36% extrahepatic). The median age at diagnosis was 57 years; 62% were Hispanic, and 56% were born outside the U.S. The incidence rate increased from 1.2 to 2.4 per 100,000 person-years (rate ratio 2.1 [95% confidence interval {CI}: 1.5, 3.0]). Hispanic individuals and those aged 40-69 years had the highest rate of incidence increase (respectively, rate ratio: 2.5 [95% CI: 1.6, 4.0] and rate ratio: 2.0 [95% CI: 1.2, 3.0]) between time periods. In 2012-2017, the risk of cholangiocarcinoma among patients with diabetes was 1.4 times relative to those without (relative risk: 1.4; 95% CI: 1.1, 1.5) and 1.2 times among those who were overweight/obese relative to those who were not (relative risk: 1.2; 95% CI: 1.1, 1.6). Conclusion: Incidence of cholangiocarcinoma doubled during the 12-year study period, with Hispanic and middle-aged individuals disproportionately affected. Individuals with diabetes mellitus and those who were overweight or obese had a high risk of being diagnosed with cholangiocarcinoma in the later time period. Further studies should focus on preventing and improving earlier diagnosis of cholangiocarcinoma among Hispanics.

Case reports: periurethral bulking agents and presumed urethral diverticula.

Urethral bulking agents are a commonly employed modality utilized for treatment of female stress urinary incontinence. These primarily collagen-based agents are placed in the proximal urethra to facilitate mucosal coaptation during increases of intra-abdominal stress. Several known complications of these agents exist, including urethral prolapse, retention, and urinary infection. Herein, we report two cases diagnosed as urethral diverticuli which were ultimately determined anatomic aberration secondary to prior bulking agent therapy. Recognition of this potential sequela of bulking agent placement is important for the female pelvic surgeon to recognize to avoid the morbidity of potential invasive interventions.

Patient-physician race concordance and its relationship to perceived health outcomes.

OBJECTIVES: Race concordance occurs when the race of a patient matches the race of his/ her physician and discordance occurs when races do not match. Previous research has suggested an association between race concordance and measures of patient satisfaction and health outcome. In this study, we examined the relationship between race concordance and perceived quality of care, self-reported general health, and the SF-12 measures of physical and mental health in a community-based sample of 2001 adults. DESIGN: Telephone interviews were conducted with randomly selected households sampled from commercial lists of phone numbers. ANALYSIS: The association of concordance with the outcomes was analyzed separately for African American (n = 1,125) and White (n = 876) respondents using bivariate analysis and multiple linear regression. RESULTS: After controlling for age, sex, income, education, insurance status, and type of insurance, we found that race concordance was only associated with general health for White respondents (P < .006). Whites with insurance were more likely to be concordant than Whites without insurance and African Americans without insurance were more likely to be concordant than African Americans with insurance. CONCLUSIONS: Settings that employ a larger number of African American physicians in Nashville, Tennessee are places that people without insurance are more likely to seek health care. For health satisfaction and perceived health status, socioeconomic status and access to quality health care are likely more important than whether one's physician is of a similar or dissimilar race.

Mobile Phones May Not Bridge the Digital Divide: A Look at Mobile Phone Literacy in an Underserved Patient Population.

PURPOSE: Mobile health (mHealth) has promise to improve patient access to disease prevention and health promotion services; however, historically underserved populations may have poor access to mobile phones or may not be aware of or comfortable using phone features. Our objectives were to assess mobile phone ownership and mobile phone literacy among low-income, predominately racial and ethnic minority patients. MATERIALS AND METHODS: We conducted a cross-sectional survey of a convenience sample of primary care patients in a publicly-funded clinic in Houston, TX. RESULTS: Of 285 participants, 240 owned a mobile phone and 129 owned a smartphone. The most common uses of phones were talk (89%) and text messaging (65%). Only 28% of smartphone owners had health apps. Younger age was significantly associated with smartphone ownership and use of smartphones for Internet browsing, social media, and apps. CONCLUSION: Our findings from a safety-net patient population represent trends in mobile phone ownership and literacy. Despite the single-site location of our study, the findings could be helpful to health promotion practitioners working with similar underserved populations. mHealth interventions should employ phone features that are accessible and familiar to the target audience to avoid denying intervention benefits to those with low mobile phone literacy and therefore widen health disparities.

A Proof of Concept Study Demonstrating the Feasibility of a Text Message Prompt for Hepatitis C Testing in the 1945-1965 Birth Cohort.

Purpose Despite national recommendations stating all individuals in the 1945-1965 "birth cohort" be tested for hepatitis C virus (HCV), testing rates remain low. The purpose of this proof of concept study was to assess the feasibility of text messaging to promote HCV testing among birth cohort patients. Methods Participants were assigned to receive a text message to promote HCV testing, or a general health message as a control. Participants were sent the message immediately prior to an upcoming appointment. Patients not enrolled in the study were in the standard-of-care group. To assess the impact of the text on HCV test orders on the appointment date participant charts were reviewed. Results The sample was largely non-Hispanic, Caucasian, and female. Of participants sent the HCV message (n = 22), 50.0% had a test ordered, compared to 41.7% and 27.5% in the control (n = 13) and standard-of-care groups (n = 69), respectively. Conclusion This proof of concept study demonstrated the feasibility of text messaging to promote HCV testing among birth cohort patients. Those receiving the HCV message were more likely to have an HCV test ordered compared to those who received no message, although this difference was not statistically significant. A larger study is needed to confirm these results.

Morphological and dimensional characteristics of dental arch in children with beta thalassemia major.

BACKGROUND AND OBJECTIVES: The aim of this study was to examine the arch dimensions of beta thalassemia major patients in comparison with normal individuals. MATERIALS AND METHODS: Dental arch dimensions were compared between thalassemic patients and normal individuals in the age group of 12-16 years in the maxillary and mandibular arch corresponding to each other regarding age, sex and Angle's molar relationship. A total number of sixty cases in each group were taken. Maxillary and mandibular impressions were made with alginate for all the sixty participants in each group and poured with die stone. Measurement of inter incisor, inter canine, inter premolar and intermolar arch width, arch depth, right anterior, right posterior, left anterior, and left posterior arch length was carried out from each cast using digital Vernier caliper. RESULTS: Unpaired t-test was used for comparison between the two groups. Statistically, a significant difference was found between the case and control groups in the maxillary arch in intercanine width, inter premolar width, intermolar width, right anterior arch length, right posterior arch length, and left anterior arch length. However, no statistically significant difference was found between the groups in inter incisor width, left posterior arch length, and arch depth in the maxillary arch. In the mandibular arch, statistically significant difference was found between the case and control groups in inter canine width, inter premolar width, inter molar width, and left anterior arch length. However, no statistically significant difference was found between the case and control groups in the mandibular arch in interincisor width, right anterior arch length, right posterior arch length, and left posterior arch length. CONCLUSION: Dental arch widths and arch lengths were significantly reduced in thalassemic patients as compared to normal individuals for the maxillary and mandibular arches.