Health-related needs of survivors of hypertensive disorders of pregnancy: implications for health communication interventions.

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are key contributors to maternal morbidity, mortality, and future risk of cardiovascular disease. This exploratory study aimed to unearth the health-related needs of women with a reported history of HDP by inquiring about preferences for care. METHOD: Deductive, qualitative analysis was conducted of HDP survivors' retrospective 'wishes' about the care received. RESULTS: In analyzing 244 open-ended, online survey responses, we identified a taxonomy of health-related needs arising across the trajectory of HDP: clinical information, needs requiring clinical knowledge, such as information about the etiology or prognosis of HDP; medical, needs associated with HDP intervention and management; logistical, needs regarding practical information, such as how to contact a provider or obtain the correct medical device; emotional, needs involving a desire for support or validation; and communication, needs for improved explanations and recognition of HDP. CONCLUSIONS: A taxonomy of diverse health-related needs may assist clinicians in approaching HDP patients more holistically. Additionally, opportunities exist for health communication research to inform standard approaches to HDP-related communication flowing from provider to patient.

#Preeclampsiasurvivor and symbolic interactionism in women's maternal health.

A hypertensive disorder of pregnancy and leading cause of maternal mortality worldwide, preeclampsia (PE) impacts approximately one in 25 pregnancies. Biomedical researchers continue to look for concrete causes and effective treatments for PE, but the experience of PE-the personal and socially constructed meanings surrounding the condition-remains under-researched. Using a symbolic interactionism approach, we examined Instagram posts accompanying the #preeclampsiasurvivor hashtag during Preeclampsia Awareness Month. Themes emerging from interpretive analysis of 98 posts (160 images) included the role of PE in redefining a woman's relationship to her body, reifying a woman's connection to her child, and illuminating the transitive aspects of a childbearing woman's identity. Additionally, PE survivors turned to Instagram to speak to an imagined, 'generalized sisterhood' of women sharing a common set of experiences. Our study is unique in its examination of the lived experiences of PE survivors.

A home visit program for low-income African American children with asthma: Caregivers' perception of asthma triggers and a gap in action.

PURPOSE: The goals are to gauge caregivers' knowledge of at-home asthma triggers and identify the areas on which educational campaigns can focus to alleviate a child's asthma symptoms. DESIGN AND METHODS: Families with children with moderate to severe asthmatic symptoms who had been recently hospitalized or in the emergency room were invited to participate in a home visit program. As part of the home visit, caregivers of the asthmatic children were asked a series of questions on asthma triggers and the measures for eliminating the triggers (N = 218). RESULTS: Findings show a gap between caregivers' perception of asthma triggers and the actions to mitigate or avoid such triggers. CONCLUSIONS: Overall findings show that home environments were suboptimal for the management and control of child asthma conditions. Knowledge about home triggers as well as the actions and efforts by caregivers and landlords to mitigate these was found to be inadequate. Even when caregivers are aware of the presence of at-home triggers, actions to minimize exposure to the trigger do not always follow due to a lack of power, resource, and knowledge. PRACTICE IMPLICATIONS: The findings raise the need for additional research to investigate the reasons for the lack of actions, advocacy for low-income families to live in a healthy environment, continued education and empowerment, and patient/caregiver-doctor partnership. Additionally, the provision of community support through community advocacy and training of culturally competent healthcare providers are needed for the successful management of pediatric asthma among African American children.

Discourse about human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) on Twitter: Lessons for public health education about OPC and dental care.

Objectives: Public understanding of human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) is minimally understood. Therefore uncovering communication gaps between the public and healthcare professionals regarding this disease is vital. Social media provide an unobtrusive way to understand public perception about health issues. Study design: Computer-assisted quantitative content analysis. Methods: Tweets about HPV-associated OPC (N = 3,112) were collected for 40 weeks using the standard real-time streaming Application Programming Interface (API). The collection of tweets was not limited to one specific geographic location but worldwide. All tweets were entered into nVivo 12.0 to conduct computer-assisted quantitative content analysis. We used an inductive method to develop a coding scheme and examined the frequency of specific keywords, terms, and phrases in texts. Results: Findings show that (a) the majority of discourse on Twitter focused on risk factors and prevention with little information on diagnosis, treatment, and prognoses; (b) many tweets promoted HPV vaccination among boys and emphasized the risk of HPV-associated OPC among males; (c) the role of dental care professionals in the prevention and detection of OPC minimally appeared; (d) the public referred to OPC as oral cancer, head and neck cancer, or throat cancer; and (e) health organizations in New Zealand, Australia, and the United Kingdom led the discussion on HPV-associated OPC on Twitter. Conclusions: The current study unravels the utility of social media data and data mining techniques in understanding public perception and understanding of HPC-associated OPC. The outcomes from the current study provide baseline knowledge of where communication gaps exist in terms of HPV-associated OPC, without which the planning of potential interventions and much-needed social media-based campaigns cannot be effectively undertaken.

A Case Study of Community-Academic Partnership in Improving the Quality of Life for Asthmatic Urban Minority Children in Low-Income Households.

Community-academic partnerships (CAPs) are being increasingly used to study and address health disparity issues. CAPs help to create new bodies of knowledge and innovative solutions to community problems, which benefits the community and academia. Supported by a grant, a partnership was formed between an academic research team and a community health organization to analyze and interpret data collected from the caregivers of asthmatic African American children living in urban low-income households. Using a case study approach, we discuss how we built a healthy CAP and the lessons learned from the process. Our analysis was guided by the six main factors that facilitate success in developing collaborative relationships, including (1) environment; (2) membership; (3) process and structure; (4) communication; (5) purpose; and (6) resources. Based on these six factors, we describe our collaboration process, challenges, and areas for improvement. We aimed to provide a "points-to-consider" roadmap for academic and community partners to establish and maintain a mutually beneficial and satisfactory relationship. Collaborating with community members and organizations provides unique opportunities for researchers and students to apply their skills and knowledge from textbooks and the classroom, engage with community members, and improve real-life community needs. Building a constructive CAP involves efforts, energy, and resources from both parties. The six major themes derived from our project offer suggestions for building a healthy, collaborative, and productive relationship that best serves communities in the future.

Teens' Social Media Engagement during the COVID-19 Pandemic: A Time Series Examination of Posting and Emotion on Reddit.

Research has rarely examined how the COVID-19 pandemic may affect teens' social media engagement and psychological wellbeing, and even less research has compared the difference between teens with and without mental health concerns. We collected and analyzed weekly data from January to December 2020 from teens in four Reddit communities (subreddits), including teens in r/Teenagers and teens who participated in three mental health subreddits (r/Depression, r/Anxiety, and r/SuicideWatch). The results showed that teens' weekly subreddit participation, posting/commenting frequency, and emotion expression were related to significant pandemic events. Teen Redditors on r/Teenagers had a higher posting/commenting frequency but lower negative emotion than teen Redditors on the three mental health subreddits. When comparing posts/comments on r/Teenagers, teens who ever visited one of the three mental health subreddits posted/commented twice as frequently as teens who did not, but their emotion expression was similar. The results from the Interrupted Time Series Analysis (ITSA) indicated that both teens with and without mental health concerns reversed the trend in posting frequency and negative emotion from declining to increasing right after the pandemic outbreak, and teens with mental health concerns had a more rapidly increasing trend in posting/commenting. The findings suggest that teens' social media engagement and emotion expression reflect the pandemic evolution. Teens with mental health concerns are more likely to reveal their emotions on specialized mental health subreddits rather than on the general r/Teenagers subreddit. In addition, the findings indicated that teens with mental health concerns had a strong social interaction desire that various barriers in the real world may inhibit. The findings call for more attention to understand the pandemic's influence on teens by monitoring and analyzing social media data and offering adequate support to teens regarding their mental health wellbeing.

Risk of developing major depressive disorder in polycystic ovary syndrome: a retrospective cohort study.

This study aimed to investigate the risk of developing major depressive disorder (MDD) in women with polycystic ovary syndrome (PCOS). As a population-based retrospective cohort study based on the Korean National Health Insurance Claims Database and National Health Information Database, newly diagnosed 26,251 women with PCOS with age matched 131,480 women without PCOS from 2007 to 2010 were followed longitudinally and the subsequent occurrence of newly onset MDD was evaluated. The risk of developing MDD in women with PCOS after adjusting for various confounding variables was higher compared to women without PCOS (hazard ratio [HR]1.34, 95% confidence intervals [CI] 1.29-1.40, p<.0001). Stratified by the body mass index, the risk of being admitted to the hospital due to MDD was the highest in the overweight PCOS (HR 2.53, 95% CI 1.71-3.76, p<.0001). The risk of developing MDD was higher in women with PCOS compared to women without PCOS. Maintenance of the appropriate body weight should be emphasised as the hazard ratio of developing MDD was higher in overweight women with PCOS.Impact statementWhat is already known on this subject? PCOS is a multisystem disorder associated with various comorbidities including diabetes mellitus, infertility and endometrial cancer.What do the results of this study add? Women with PCOS showed a higher risk of developing MDD compared to age matched women without PCOS in this multivariate analysis after adjusting for body-mass-index, smoking habit, socio-economic status, residential area, blood glucose, and blood cholesterol. The risk of being admitted to hospital due to MDD was the highest in PCOS with BMI ≥ 25.What are the implications of these findings for clinical practice and/or further research? PCOS should not be considered as a condition confined to ovulatory dysfunction and dermatologic problems, but the higher risk of developing MDD should be recognised. The importance of maintaining an appropriate BMI should be emphasised, as the risk of being admitted to the hospital due to MDD increased in overweight and obese women with PCOS.

The role of port site local anesthetic injection in laparoendoscopic single site surgery: a prospective randomized study.

OBJECTIVE: To investigate the role of port-site bupivacaine hydrochloride injection in laparoendoscopic single-site surgery (LESS) as a means of postoperative umbilical pain alleviation. METHODS: A total of 200 consecutive patients who underwent LESS from October 2018 to February 2019 were included in this randomized prospective case control study. The patients were alternatively assigned to either the study group (0.25% 10-mL bupivacaine hydrochloride injection at the 1.5-cm umbilical incision site after surgery) or the control group (no injection). All patients underwent surgery at the National Health Insurance Service Ilsan Hospital under the same operational setting by 3 board-certified gynecologists. Postoperative umbilical pain scores assessed using the visual analog scale were compared between the 2 groups as the primary outcome. Student's t-test, χ2 test, and a linear mixed model were used for the statistical analysis. A P-value of <0.05 was considered to be statistically significant. RESULTS: The patients' age, body mass index, and menopausal status; type of surgery performed; and need for additional trocar insertion exhibited a significant difference between the bupivacaine injection and non-injection groups. After adjusting for various confounding variables, the postoperative umbilical pain scores measured at postoperative 2-3 hours, 6-10 hours, 1 day, and 3 days did not exhibit a significant difference between the 2 groups. CONCLUSION: Port-site bupivacaine injection in LESS did not show any additive effect in alleviation of postoperative umbilical pain.

The impact of cancer information online on cancer fatalism: education and eHealth literacy as moderators.

One critical yet understudied concept associated with cancer information is cancer fatalism, i.e. deterministic thoughts about the cause of cancer, the inability to prevent it and the unavoidability of death upon diagnosis. The aim of this study is to understand how information seeking about cancer online influences cancer fatalism and whether and to what extent education and eHealth literacy moderate the relationship between them. Findings from an online survey of a nationally representative sample in the United States (N = 578) showed differential impacts of using the internet to search for information about cancer among the more and the less educated. For the less educated, more exposure to information about cancer via medical and health websites led to an increased level of cancer fatalism, whereas among the more educated, greater exposure lowered cancer fatalism. These differences were explained by the fact that the more educated were equipped with a higher level of eHealth literacy skills than the less educated. Findings show that only when one has necessary skills to apply digital resources can those resources help mitigate cancer fatalism. We suggest the need to enhance eHealth literacy skills among the less educated to reduce cancer fatalism.

Racial and Ethnic Makeup in Hospital's Social Media and Online Platforms: Visual Representation of Diversity in Images and Videos of Washington, D.C. Hospitals.

While hospitals' health promotion via social media has the potential to be a critical source of health information, research shows racial and ethnic disparities exist in health-related knowledge that may be, in part, related to media representation. The purpose of this study is to examine the racial and ethnic representation of people featured in Washington, D.C. hospitals' social media platforms to understand how hospitals embed cultural competency into their health communication. By comparing the diversity of images on hospitals' social media platforms with the demographics of hospitals' neighboring communities, the researchers intend to highlight opportunities to improve targeted health messaging to underserved communities, particularly Black and Hispanic communities. By analyzing the images and videos posted on the three most popular social media platforms - Facebook, Twitter, and YouTube - for a one-month period, the researchers found that Whites and Asians were over-represented while Hispanics were severely under-represented in hospitals' social media representation as compared to the community demographics. Increasing the diversity of minority representation on hospitals' social media-based health promotion may contribute to addressing the social disparities in healthcare.

Diagnostic performance of CA 125, HE4, and risk of Ovarian Malignancy Algorithm for ovarian cancer.

OBJECTIVE: We evaluated the diagnostic performance of CA 125, HE4, and ROMA for ovarian cancer in Koreans and set optimal cutoffs. METHOD: Serum levels of HE4 and CA 125 and the ROMA score were determined in 762 patients with benign gynecological disease and 70 with ovarian cancer. Receiver operating characteristic curves were constructed to calculate the areas under the curve (AUC). CA 125, HE4, and ROMA exhibiting maximum Youden index were determined, respectively, as the optimal cutoffs, and sensitivity and specificity were evaluated by applying those cutoffs. RESULTS: In benign diseases, CA 125 significantly increased in patients with uterine myoma, adenomyosis, endometrial pathology, or endometriosis, but HE4 only increased in patients with adenomyosis. For the diagnosis of ovarian cancer, the combination of CA 125, HE4, and age showed the highest AUC value of 0.892 in the premenopausal group, and ROMA demonstrated the best diagnostic performance, with an AUC of 0.935 in postmenopausal patients. When the optimal cutoff values for CA 125 and HE4 were applied, the sensitivities of CA 125, HE4, and ROMA in premenopausal women were all the same at 0.714, while the specificities were 0.841, 0.974, and 0.972, respectively. In the postmenopausal group, the sensitivities of these markers were 0.857, 0.804, and 0.929, and the specificities were 0.836, 0.887, and 0.800, respectively. CONCLUSION: Although all markers demonstrated good diagnostic performance, they varied depending on the pathologic types of benign diseases and ovarian cancer. For accurate diagnosis of ovarian cancer, CA 125, HE4, and ROMA should be used complementarily.

Demographic characteristics of labial adhesion in South Korea: a population-based study from 2010 to 2014.

OBJECTIVE: To investigate the demographic features of labial adhesion (LA) in South Korea. DESIGN: A population-based nationwide study. SETTING: Census population of South Korea. PARTICIPANTS: With the entire population of South Korea (n=47 990 761), patients under age 7 who were newly diagnosed with LA from January 2010 to December 2014 were included. MAIN OUTCOME MEASURE: The average incidence and the peak age of LA occurrence were estimated. RESULTS: A total of 4934 newly diagnosed LAs were analysed. The incidence of LA has constantly increased since 2008, the year that the Korean Developmental Screening Test for InfantsandChildren registry began. The average incidence of LA was 55.0 cases/100 000 person-years (95% CI 53.5 to 56.6). The highest incidence was 183.6 cases/100 000 person-years (95% CI 175.8 to 191.6) in the age group of13 to 24 months. The relative risk of acquiring LA in the age group of 13 to 24 months was 1.481 (95% CI 1.381 to 1.587) compared with the age group of 0 to 12 months. CONCLUSIONS: The demographic characteristics of LA including the average incidence and the highest incidence age group in South Korea were revealed in this nationwide, population-based study including a total of 4934 newly developed LA cases. Further studies are needed to reveal the natural disease course and the significance of diagnosing asymptomatic LA cases.

Current Status of Off-pump Coronary Artery Bypass Grafting in Patients with Multiple Coronary Artery Disease Compared with On-pump Coronary Artery Bypass Grafting: The Korean National Cohort Study.

BACKGROUND: Despite advance in off-pump coronary artery bypass (OPCAB) grafting, there are large debating issues regarding survival benefit between OPCAB and on-pump coronary artery bypass grafting (CABG). The aim of this study is to address appropriateness of OPCAB approach in patients with ischemic heart disease having multiple vessels using South Korea national cohort data. METHODS: To evaluate the safety and efficacy of OPCAB, we accessed all causes of death, late repeat revascularization, hospitalization for cerebrovascular accident (CVA), and new renal replacement therapy in patients who underwent isolated CABG with multiple grafting (≥2 grafts) and who were registered in the Korean Health Insurance Review and Assessment Service Database between April 2011 and September 2014. RESULTS: OPCAB was performed in 4,692 patients and on-pump CABG in 2,999 patients from 82 hospitals in South Korea. On multivariable analysis, on-pump CABG was associated with a significantly higher adjusted risk of overall all-cause death (hazard ratio [HR]: 1.876, 95% confidence interval [CI]: 1.587-2.216, p < 0.001) and initiation of new renal replacement therapy (HR: 1.618, 95% CI: 1.124-2.331, p = 0.009). However, we observed no significant difference in repeat revascularization and hospitalization for CVA between the two groups. In propensity score matching, matched patients (2,940 pairs) showed results similar to multivariable analysis that on-pump CABG was associated with a higher overall mortality and initiation of new renal replacement therapy (p < 0.001). CONCLUSION: In this study, we found that OPCAB was associated with better survival rates and renal preservation compared with on-pump CABG.

Risk factors and molecular features of sequence type (ST) 131 extended-Spectrum-ß-lactamase-producing Escherichia coli in community-onset female genital tract infections.

BACKGROUND: Escherichia coli (E. coli) is known to cause urinary tract infection (UTI) and meningitis in neonates, as well as existing as a commensal flora of the human gut. Extended-spectrum ß-lactamase (ESBL)-producing E. coli has increased in the community with the spread of CTX-M type ESBL-producing sequence type 131 (ST131)-O25-H30Rx E. coli clone. The role of ESBL-producing E. coli in female genital tract infection has not been elucidated. The clinical and molecular features of E. coli isolated from community-onset female genital tract infections were evaluated to elucidate the current burden in the community, focusing on the highly virulent and multidrug-resistant ST131 clone. METHODS: We collected and sequenced 91 non-duplicated E. coli isolates from the female genital tract of 514 patients with community-onset vaginitis. ESBL genotypes were identified by PCR and confirmed to be ESBL-producers by sequencing methods. ST131 clones were screened by PCR for O16-ST131 and O25b-ST131. Pulsed-field gel electrophoresis (PFGE) and PCR-based replicon typing (PBRT) were conducted in ESBL producers. Independent clinical risk factors associated with acquiring ESBL-producing E. coli and ST131 clone were analyzed using multivariate logistic regression analysis. RESULTS: Of the 514 consecutive specimens obtained from the infected female genital tract, 17.7% (91/514) had E. coli infection, of which 19.8% (18/91) were ESBL producers. CTX-M-15 was the most common type (n = 15). O25b-ST131 and O16-ST131 clones accounted for 15.4% (14/91) and 6.6% (6/91), respectively. In plasmid analysis, ten isolates succeeded in conjugation and plasmid types were IncFII (n = 4), IncFI (n = 3), IncI1-Iγ (n = 3) with one non-typable case. Compared to ESBL-nonproducing E. coli, ESBL-producing E. coli acquisition was strongly associated with recurrent vaginitis (OR 40.130; 95% CI 9.980-161.366), UTI (OR 18.915; 95% CI 5.469-65.411), and antibiotics treatment (OR 68.390; 95% CI 14.870-314.531). CONCLUSION: A dominant clone of CTX-M type ESBL-producing E. coli in conjugative plasmids seems to be circulating in the community and considerable number of ST131 E. coli in the genital tract of Korean women was noted. Sustained monitoring of molecular epidemiology and control of the high-risk group is needed to prevent ESBL-producing E. coli from spreading throughout the community.

Network Environments and Well-Being: An Examination of Personal Network Structure, Social Capital, and Perceived Social Support.

Previous studies have demonstrated the role of social networks, social capital, and social support in individuals' well-being. However, the ways in which these related constructs simultaneously influence one's well-being outcomes and relate to one another have not been closely examined. This study pays particular attention to the structural characteristics of personal networks, distinction between offline and online social capital, and different indicators of well-being outcomes. Based on survey data collected from 574 college students, the study found that two dimensions of personal networks-density and gender homophily-and social capital in the form of offline bonding capital explained perceived social support. Further, perceived social support consistently predicted well-being outcomes and played a mediating role between personal network density and well-being, as well as between offline bonding capital and well-being. The results offer implications for a more nuanced understanding of the role of individuals' interpersonal and social environments in well-being outcomes.

A case of uterus-like mass of the ovary associated with endometriosis.

•Coelomic metaplasia is considered to be one of the mechanisms resulting in endometriosis.•Intense ceolomic metaplasia resulted in a uterine like mass (ULM) acquiring the structural integrity of a miniature uterus.•ULM might be considered a rare manifestation in the spectrum of endometriosis development.

A Smoking Cessation Campaign on Twitter: Understanding the Use of Twitter and Identifying Major Players in a Health Campaign.

The current study examined the use of online social media for a health campaign. Collecting tweets (N = 1,790) about the recent smoking cessation campaign by the Centers for Disease Control and Prevention, the current study investigated the dissemination of health campaign messages on Twitter and answered questions from the process evaluation of health campaigns: who tweeted about the campaign, who played central roles in disseminating health campaign messages, and how various features of Twitter were used for sharing of campaign messages. Results showed that individuals and nonprofit organizations posted frequently about the campaign: Individuals and nonprofit organizations posted about 40% and 30% of campaign-related tweets, respectively. Although the campaign under investigation was steered by a government agency, nonprofit organizations played a vital role as mediators who disseminated campaign messages. The culture of retweeting demonstrated its particular usefulness for the dissemination of campaign messages. Despite the expectation that the use of social media would expand opportunities for engagement, actual two-way interactions were few or minimal. Drawn from the results, practical suggestions on how to strategize the use of Twitter for future health campaigns are discussed.

Usefulness of CA125 in the differential diagnosis of uterine adenomyosis and myoma.

OBJECTIVES: To evaluate the usefulness of CA125 levels in the differential diagnosis of adenomyosis and myoma. This has been addressed by few, if any, previous studies. STUDY DESIGN: Preoperative serum CA125 levels were measured in 2149 women who were diagnosed at total hysterectomy as having adenomyosis, myoma, endometriosis, and/or normal pelvis. Their medical records were retrieved and reviewed. RESULTS: The mean serum CA125 level in the adenomyosis patients was significantly greater than that in the patients diagnosed with myoma (65.21±96.60 U/mL vs.12.86±14.23 U/mL, respectively; P<0.001). In the differential diagnosis of adenomyosis and myoma, the cut-off serum CA125 level with the highest accuracy (78.8%) and highest diagnostic value (61.2%) was 19 U/mL. Using this cut-off value, the negative predictive value was 69.5%, and the positive predictive value was 76.5%. These results are clearly superior to those of the empirical single cut-off value of 35 U/mL. Receiver operating characteristic curve analysis revealed the area under the curve for differentiating adenomyosis from myoma was 0.776, indicating good diagnostic performance. CONCLUSION: In the differential diagnosis of adenomyosis and myoma, cut-off values for CA125, particularly the cut-off value of 19 U/mL, provide improved diagnostic performance. Serum CA125 testing can be performed during the initial screening of women with possible adenomyosis to differentiate this condition from myoma, although the diagnostic accuracy of using CA125 testing alone is limited.