Starting the Conversation About Healthcare Disparities.

Description The Accreditation Council for Graduate Medical Education (ACGME) put forth institutional requirements to implement healthcare disparity education in resident and fellow curricula in an effort to decrease these inequities. Healthcare disparities stem from many different factors. These may include access to care, insurance status, socioeconomic status, health literacy, language barriers, and the way healthcare systems function. These factors may have interactions that lead to poor health outcomes. As researchers and educators, we need to find a way to research these issues in more depth as well as teach these concepts to our resident physicians. Here, we discuss El Paso, Texas, a city located on the United States-Mexico border, which is predominately Latinx. We also discuss increased rates of diabetes, sexually transmitted diseases, and liver, stomach, and cervical cancers. Common obstacles to healthcare include language and literacy barriers, lack of transportation, and lack of healthcare professionals. We outline 4 strategies for change to address these disparities. By implementing these strategies in ACGME education for residents, healthcare disparities in the El Paso community can be addressed and eliminated.

Unilateral Labial Edema in a Female Adolescent: A Gynecologic Presentation of Rhabdomyolysis.

BACKGROUND: Rhabdomyolysis can be the result of vigorous physical activity. Typical signs and symptoms at presentation are muscle pain, weakness, or dark colored urine. There is no scientific literature associating rhabdomyolysis with gynecologic signs and symptoms. CASE: We present a case of a 16-year-old girl who presented to our pediatric emergency department with complaints of progressive left vulvar swelling. The patient underwent magnetic resonance imaging, which showed polymyositis in the rectus abdominus, external and internal obliques, and bilateral vastus lateralis muscles. Laboratory evaluation showed elevated liver transaminases, creatine kinase, and myoglobin serum levels. SUMMARY AND CONCLUSION: Exertional rhabdomyolysis is associated with muscular damage after vigorous exercise. This case is an example of a patient with rhabdomyolysis presenting with an unusual external gynecological manifestation, as unilateral labial edema.

Correlates of long-acting reversible contraception versus sterilization use in advanced maternal age.

PURPOSE: To identify correlates associated with choosing long-acting reversible contraception (LARC) over female sterilization (FS) from a subsample of women aged 35 to 44 years in a nationally representative survey. METHODS: We analyzed data from women aged 35 to 44 years from the 2011-2013 National Survey of Family Growth Female Respondent File (n = 1532). Data were analyzed using SAS 9.3 software. All analyses accounted for the complex survey sample design. Multinomial logistic regression was used to identify factors associated with choosing LARC versus FS. A domain analysis was performed focusing on women aged 35 to 44 years. RESULTS: Approximately 90% of the surveyed women had not received counseling or information about birth control in the past 12 months. Factors associated with using an LARC method versus FS were higher level of education, birth outside of the United States, and higher number of lifetime male sexual partners. Factors associated with using FS versus an LARC method were non-Hispanic black race and women who had not had a checkup related to using a birth control method in the last 12 months. CONCLUSIONS: The results of our study suggest that a large proportion of women of advanced maternal age in the United States have not received contraceptive counseling in the past 12 months. Providers should focus on providing comprehensive contraceptive and sterilization counseling to women aged 35 to 44 years, especially those using unreliable, reversible contraception.