RESUMO
OBJECTIVE: This study aimed to determine health care disparities in evaluation and admission among underserved racial and ethnic minority groups presenting with cardiovascular complaints during the first postpartum year according to patient and provider demographics. STUDY DESIGN: A retrospective cohort study was performed on all postpartum patients who sought emergency care between February 2012 and October 2020 in a large urban care center in Southeastern Texas. Patient information was collected according to International Classification of Diseases 10th Revision codes and individual chart analysis. Race, ethnicity, and gender information were self-reported for both patients on hospital enrollment forms and emergency department (ED) providers on their employment records. Statistical analysis was performed with logistic regression and Pearson's chi-square test. RESULTS: Of 47,976 patients who delivered during the study period, 41,237 (85.9%) were black, Hispanic, or Latina and 490 (1.1%) presented to the ED with cardiovascular complaints. Baseline characteristics were similar between groups; however, Hispanic or Latina patients were more likely to have had gestational diabetes mellitus during the index pregnancy (6.2 vs. 18.3%). There was no difference in hospital admission between groups (17.9% black vs. 16.2% Latina or Hispanic patients). There was no difference in the hospital admission rate by provider race or ethnicity overall (p = 0.82). There was no difference in the hospital admission rate when a patient was evaluated by a provider of a different race or ethnicity (relative risk [RR] = 1.08, CI: 0.6-1.97). There was no difference in the rate of admission according to the self-reported gender of the provider (RR = 0.97, CI: 0.66-1.44). CONCLUSION: This study illustrates that disparities did not exist in the management of racial and ethnic minority groups who presented to the ED with cardiovascular complaints during the first postpartum year. Patient-provider discordance in race or gender was not a significant source of bias or discrimination during the evaluation and treatment of these patients. KEY POINTS: · Adverse postpartum outcomes disproportionately affect minorities.. · There was no difference in admissions between minority groups.. · There was no difference in admissions by provider race and ethnicity..
RESUMO
As a non-limbic structure, the human thalamus is the most important modulator of the limbic system. The hypothalamus plays vital roles in the survival of species by regulating fear, learning, feeding behavior, circadian rhythm, sociosexual and reproductive activities of the limbic system through connections with the thalamus. The detailed anatomy of the pathways responsible for mediating these responses, however, is yet to be determined. The mammillothalamic tract is known as the major direct thalamo-hypothalamic connection in the primates including the human brain connecting the ventral thalamus to the dorsal hypothalamus. Multiple dissection animal studies revealed additional connections specially from the dorsal thalamus to the ventral hypothalamic nuclei. Diffusion weighted imaging may be helpful in better visualizing the surgical anatomy of this additional connectivity noninvasively. This study aimed to investigate the utility of high spatial and high angular resolution diffusion weighted tractography technique for mapping the trajectory of this dorsal thalamic connectivity with the ventral hypothalamus in the human brain. We studied 30 healthy human subjects. Using a high-resolution diffusion weighted tractography technique, for the first time, we were able to delineate and reconstruct the trajectory of the dorsal thalamo-hypothalamic tract (DTH). We further revealed the close relationship of the DTH, fornix and hippocampus in healthy adult human brain.
