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Purpose: Given rising demand for gender affirmation surgery (GAS), lesbian, gay, bisexual, transgender, queer, and others' (LGBTQ+) patient care, and sexual and gender minority (SGM) representation in plastic surgery, we sought to analyze integrated residency programs' posts for LGBTQ+ content. Methods: Programs were identified from the American Council of Academic Plastic Surgeons website. Accounts were searched for on Instagram, Facebook, and Twitter. Posts uploaded through June 24, 2021 were analyzed. Mann-Whitney U- and Kruskal-Wallis tests were used to compare content between programs. Results: Of 82 programs, 76 (92.7%), 31 (37.8%), and 30 (36.6%) have Instagram, Facebook, and Twitter accounts, respectively. Two hundred eighty-one (1.3%) posts displayed LGBTQ+ content, including educational (29.9%), research (17.4%), news (11.0%), resident interests (10.7%), pride/diversity (9.6%), posts to attract applicants/patients (7.5%), operative/clinic cases (6.8%), faculty spotlights (6.4%), and patient testimonials (1.1%). One hundred eighty-one (64.4%) posts described GAS overall, 42 (23.2%) described top, 32 (17.7%) described genital, and 32 (17.7%) described facial surgery. Instagram and Facebook have more LGBTQ+ content than Twitter (p≤0.037). Newly accredited programs have significantly more LGBTQ+ content on Facebook (p=0.036). Programs in the West, having more perceived prestige, or GAS fellowships tended to have more LGBTQ+ content. Conclusion: Despite growing demand for GAS and thus training, 1% of content on plastic surgery residency social media accounts is LGBTQ+ related. Reasons for lack of representation require further investigation but may include (1) limited GAS and LGBTQ+ patient exposure during training or (2) lack of SGM inclusivity for residents, faculty, and patients.
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BACKGROUND: The transgender patient population is expanding, and gender affirming surgery (GAS) volume is increasing. Accurate, comprehensive, and easily navigable resources on GAS are lacking. We aim to evaluate the readability of online materials for specific gender affirming surgical procedures to identify mechanisms of improving information access for transgender patients. MATERIALS AND METHODS: "Facial feminization", "facial masculinization", "MTF breast augmentation", "FTM chest masculinization", "MTF vaginoplasty", "metoidioplasty", and "FTM phalloplasty" were searched on Google. Per keyword, the first 75 text-containing results were included. Text was analyzed for reading difficulty using the Flesch-Kincaid Reading-Ease (FKRE) test and grade level using the Flesch-Kincaid Grade Level (FKGL) formula, Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), and Coleman-Liau Index (CLI). Scores were compared using independent t-and ANOVA tests (α = 0.05). RESULTS: Mean readability scores (FKRE 37.44) and grade-levels (FKGL 12.87, GFI 15.61, SMOG 11.91, CLI 15.00) correlated with college-level difficulty. Masculinizing surgical materials were more difficult to read than feminizing ones (p ≤ 0.023). Top surgery materials were easier to read than facial and genital surgery materials (p ≤ 0.013). Specifically, chest masculinization resources were more difficult to read than those for breast augmentation (p ≤ 0.006). No differences were found between facial feminization and masculinization surgery resources, nor between resources for different gender affirming genital surgeries. CONCLUSION: Online GAS materials are written above the recommended 6th grade reading-level, with resources for transgender men being significantly more challenging to understand. Improving readability of online resources can help overcome barriers to care for the transgender patient population.
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Compétence informationnelle en santé , Chirurgie de changement de sexe , Mâle , Humains , Féminisation , Smog , Compréhension , InternetRÉSUMÉ
ABSTRACT: Television tip-over injuries have been designated a top-five hidden home hazard by the United States Consumer Product Safety Commission. In this study the authors utilize the National Electronic Injury Surveillance System (NEISS) Database to provide an updated look at television-related head and neck injuries in the United States pediatric population. The NEISS Database was accessed for all television-related head and neck injury reports from January 2000 to December 2018 in patients under 18 years of age. Demographic data including age, sex, and race were also obtained. Narrative descriptions of each injury were also individually reviewed and categorized by specific type of injury. Miscoded reports were excluded. Between January 2000 and December 2018, 5944 NEISS reports of television-related injuries met inclusion criteria, corresponding to an estimated total of 159,785 injuries nationally during this period. The average patient age at time of evaluation was 4.11 years with a male predominance of 61.3%. Total number of injuries - and weighted national estimates - remained relatively stable between 2000 and 2006, peaking in 2009 (450 reported cases, 12,004 estimated national total). Between 2009 and 2018 the number of reported injuries, and corresponding national estimates, saw a 75.8% and a 72.1% decrease, respectively. Television-related head and neck injuries have declined dramatically in the United States since 2009. The underlying cause of this decline is likely multifactorial, and additional steps to improve the safety of these products are necessary to continue to ensure the safety of all children in the United States.
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Traumatismes du cou , Plaies et blessures , Adolescent , Enfant , Bases de données factuelles , Service hospitalier d'urgences , Femelle , Humains , Mâle , Traumatismes du cou/épidémiologie , Traumatismes du cou/étiologie , Télévision , États-Unis/épidémiologieRÉSUMÉ
INTRODUCTION: The stage of maturation of the pediatric facial skeleton at the time of injury has a significant impact on both facial fracture patterns and management strategies. For instance, the relative prominence of the pediatric cranium during the early years of life affords protection to the structures of the midface, whereas delayed aeration of the frontal sinuses may predispose younger patients to frontal bone fractures. The dentition status of a pediatric patient may have similar implications in the setting of facial fracture. In this study, the authors examine the effect of dentition status on facial fracture patterns and management strategies at an urban, level 1 trauma center. METHODS: A retrospective chart review was performed for all cases of facial fracture occurring in the pediatric patient population at a level 1 trauma center (University Hospital in Newark, NJ) between 2002 and 2014. A database including patient demographics, facial fracture, and concomitant injury patterns, and operative management data was constructed and analyzed. RESULTS: A total of 72 patients with mixed dentition met inclusion criteria for our study and were compared against patients with primary (nâ=â35) and permanent (nâ=â349) dentition. The mean age at presentation was 9.2âyears, with a male predominance of 68%. The most common fracture etiology was pedestrian struck accident (nâ=â23), fall (nâ=â21), motor vehicle collision (nâ=â12), and assault (nâ=â9). The most frequently identified facial fractures were that of the orbit (nâ=â31), mandible (nâ=â21), nasal bone (nâ=â19), and frontal sinus (nâ=â14). Additionally, 8 Le Fort and 4 nasoorbitoethmoid fractures were identified. Twenty-one patients (29%) required operative management for 1 or more facial fractures. Operative intervention was required in 38% of mandibular fractures, with 6 patients requiring only maxillomandibular fixation and 2 requiring open reduction and internal fixation with titanium plating. Nine cases of orbital fracture (29%) were managed operatively - 4 with absorbable plates, 3 with Medpor implants, and 8 with titanium plating. Management of all nasal fractures requiring operative intervention was accomplished through closed reduction. Concomitant injuries included traumatic brain injury (TBI) (nâ=â35), skull fracture (nâ=â24), intracranial hemorrhage (ICH) (nâ=â20), and long bone fracture (nâ=â12). Seventeen patients required admission to the intensive care unit. Patients with mixed dentition were significantly more likely to sustain frontal sinus and Le Fort fractures (Pâ<â0.01), as well as skull fracture, ICH, and TBI (Pâ<â0.01) as compared to those with permanent dentition. CONCLUSIONS: The dentition status of a pediatric patient may have significant implications in both patterns of injury and operative management strategies in the setting of acute facial trauma. Our study finds that Le Fort and frontal sinus fractures were significantly more common in patients with mixed dentition. Severe concomitant injuries such as ICH and TBI were also significantly more likely in this cohort. A patient's dentition status may also play a role in the decision for ridged fixation of mandibular and orbital fractures, as well as the method of maxillomandibular fixation in maxillary and mandibular alveolar fracture.
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Denture mixte , Fractures du crâne , Denture , Os de la face/chirurgie , Femelle , Humains , Mâle , Études rétrospectives , Fractures du crâne/chirurgieRÉSUMÉ
There is an absence of literature regarding nasoorbitoethmoid (NOE) facial fractures. Although NOE fractures are uncommon, there are a significant number in the pediatric population. These fractures also often occur in conjunction with other facial fractures because the NOE region adjoins the nose, orbit, maxilla, and cranium. They can also be a harbinger for more serious concerns such as traumatic brain injury and intracranial hemorrhage. For this reason, NOE fractures can be highly complicated and a challenge to manage. We aim to define the etiologies and patterns of NOE fractures to guide hospital and surgical management strategies. From 2001 to 2014, 15 pediatric patients were identified as having sustained an NOE fracture. Four (26.7%) of the patients were female and 11 (68.8%) were male. Average age was 11.40. The most common etiologies recorded were motor vehicle accident (n = 8), pedestrian struck (n = 3), and assault (n = 2). Orbital fracture (n = 13), nasal fracture (n = 13), and frontal sinus fracture (n = 10) were the most commonly associated facial fractures sustained alongside NOE fracture. Several patients sustained traumatic brain injury (n = 11) and loss of consciousness (n = 13). The mean Glasgow Coma Score was 10.5. In addition, eight required intubation and five required a surgical airway. Thirteen of the patients were admitted to the ICU and eight required surgical management for their fractures. Titanium plates were most commonly used (n = 4) for surgical management. Alternatively, resorbable implants were used for two patients. The remaining two were treated with closed reduction.