Knowledge and Provision of Care to Transgender People by Obstetrician-Gynecologists in Hawai'i.

Obstetrician-gynecologists (OBGYNs) are often involved in caring for transgender patients but may not be equipped with knowledge about transgender-specific care. The aim of this study was to assess the knowledge base and comfort level of OBGYNs in Hawai'i with regard to health care for transgender people. This was a cross-sectional survey of OBGYNs in the American College of Obstetricians and Gynecologists (ACOG) Hawai'i section. The survey was distributed in-person and electronically to a listserv of OBGYNs between October 2017 and August 2018. This survey assessed practice environment, experience with transgender care, and knowledge of health care needs and recommendations for transgender patients. The response rate to this survey was 28%. Approximately half of respondents worked within the University of Hawai'i system and 47% were private practitioners. A majority (79%) of the respondents had unisex restroom facilities in their offices; however, only a fifth of respondents had gender-inclusive intake forms. Respondents were more comfortable providing care for trans men, people who were assigned female sex at birth but identify as male, compared to trans women, people who were assigned male sex at birth but identify as female (53% vs 38%). Knowledge of preventive care was variable. Most respondents had limited knowledge regarding gender-affirming hormone therapy and requirements for gender affirming surgery (67% and 52% respectively). Despite their limited experience, OBGYNs in Hawai'i demonstrated a willingness to provide care for transgender patients. Efforts should be made to educate OBGYNs on quality care for transgender people, particularly gender affirming hormone therapy.

Online health information seeking, low atrial fibrillation-related quality of life, and high perceived efficacy in patient-physician interactions in older adults with atrial fibrillation.

Background: Little is known about online health information-seeking behavior among older adults with atrial fibrillation (AF) and its association with self-reported outcomes. Objective: To examine patient characteristics associated with online health information seeking and the association between information seeking and low AF-related quality of life and high perceived efficacy in patient-physician interaction. Methods: We used data from the SAGE-AF (Systematic Assessment of Geriatric Elements in AF) study, which includes older participants aged ≥65 years with AF and a CHA2DS2-VASc risk score ≥2. To assess online health information seeking, participants who reported using the Internet were asked at baseline if they used the Internet to search for advice or information about their health in the past 4 weeks (not at all vs at least once). Atrial Fibrillation Effect on Quality of Life and Perceived Efficacy in Patient-Physician Interactions questionnaires were used to examine AF-related quality of life (QOL) and patient-reported confidence in physicians. Logistic regression models were used to examine demographic and clinical factors associated with online health information seeking and associations between information seeking and low AF-related QOL (AFEQT <80) and high perceived efficacy for patient-physician interactions (PEPPI ≥45). Results: A total of 874 online participants (mean age 74.5 years, 51% male, 91% non-Hispanic White) were studied. Approximately 60% of participants sought health information online. Participants aged 74 years or older and those on anticoagulation were less likely, while those with a college degree were more likely, to seek online health information after adjusting for potential confounders. Participants who sought health information online, compared to those who did not, were significantly more likely to have a low AF-related QOL, but less likely to self-report confidence in patient-physician interaction (aOR = 1.56, 95% CI: 1.15-2.13; aOR = 0.68, 95% CI: 0.49-0.93, respectively). Conclusion: Clinicians should consider barriers to patient-physician interaction in older adults who seek health information online, encourage shared decision-making, and provide patients with a list of online resources for AF in addition to disease education plans to help patients manage their health.

Diagnostic Utility of Radiomics in Thyroid and Head and Neck Cancers.

Radiomics is an emerging field in radiology that utilizes advanced statistical data characterizing algorithms to evaluate medical imaging and objectively quantify characteristics of a given disease. Due to morphologic heterogeneity and genetic variation intrinsic to neoplasms, radiomics have the potential to provide a unique insight into the underlying tumor and tumor microenvironment. Radiomics has been gaining popularity due to potential applications in disease quantification, predictive modeling, treatment planning, and response assessment - paving way for the advancement of personalized medicine. However, producing a reliable radiomic model requires careful evaluation and construction to be translated into clinical practices that have varying software and/or medical equipment. We aim to review the diagnostic utility of radiomics in otorhinolaryngology, including both cancers of the head and neck as well as the thyroid.

The ALOHA Study: Intimate Partner Violence in Hawai'i's Lesbian, Gay, Bisexual, and Transgender Community.

The Centers for Disease Control and Prevention describes intimate partner violence (IPV) as a serious, preventable problem. The ALOHA (Assessing Lesbian, Gay, Bisexual, and Transgender [LGBT] Violence in Hawai'i) Study examines IPV in Hawai'i's LGBT community. The study's primary outcome is to determine the prevalence of IPV in Hawai'i's LGBT community, and secondary outcomes are to determine the prevalence of help-seeking behavior, associations between IPV and demographics, and associations between help-seeking behavior and demographics. This cross-sectional study included 477 subjects who self-identified as Hawai'i residents and LGBT. The percentages of overall IPV, physical IPV, and sexual IPV were 68.8%, 54.1%, and 49.3%, respectively. Blacks were most likely to report a history of physical IPV (OR=4.93, 95%CI: 1.95-12.47). Blacks (OR=2.49, 95%CI: 1.13-5.74), Native Hawaiians and Pacific Islanders (OR=2.14, 95%CI: 1.30-3.52), and cisgender females (OR=2.27, 95%CI: 1.29-3.45) were more likely to report a history of sexual IPV than other groups. Among victims of physical and sexual IPV, 9.9% and 9.6% sought help, respectively, and transgender and gender non-conforming individuals were the most likely to seek help (physical IPV: 30.8%, sexual IPV: 28.6%). Hawai'i's LGBT community has an extremely high prevalence of IPV and a very low prevalence of help-seeking behavior. This translates into a large number of victims who are left without support. Additional research is needed to fully understand the details of IPV within Hawai'i's LGBT community and the barriers to help-seeking so that potential solutions may be identified.