"Our Hair, Our Strength, Our Identity": Native American reflections and what dermatologists can learn.

Issues of health equity are rightfully in the national spotlight. Here we present a narrative piece on the sacred importance of hair and its ties to cultural identity among many Native communities in the United States. We introduce unique values ascribed to hair in some Native cultures, and include examples of how hair has played an important role in both abuse and generational trauma for many individuals and families. By sharing experiences, we hope to illuminate perspectives often underrepresented, and to enable more culturally humble, responsive, and informed dermatologic care.

A Case of Chronic Undiagnosed 2:1 Isolated Atrial Flutter in a Patient With an Autoimmune Disease.

Atrial flutter (AFL) is typically associated with structural heart diseases or metabolic abnormalities. However, isolated symptomatic AFL, which occurs without abnormal heart anatomy, remains a rare occurrence and is underrepresented in the literature. This case report highlights the significance of recognizing and investigating symptoms suggestive of arrhythmias, especially in patients with autoimmune conditions.

Creating Socially Accountable Health Conferences: Guidance from Around the World.

BACKGROUND: Very little attention has been given to the social accountability of conferences, either in action or in scholarship, in particular, of scientific conferences. Concerns that have been raised include: (1) Local communities and regions suffer from ecological pressure caused by conferences, (2) There is limited value to the local community, (3) International conferences take place at locations irrelevant to the topics discussed; hence there is no connection with locals, and (4) It has been the observation of the authors that <10% of participants may come from the region where the conference is organized, which makes it challenging to make a "positive societal impact" locally. We conducted a natural experiment investigating the interactions between academia, conference organizers, and community leaders. METHODS: We utilized a case study approach to report on the outcomes of two 2022 annual international conferences that seek to improve community health. We used a mixed-methods approach of surveys and interviews. Thematic analysis was conducted to identify the key themes. RESULTS: We obtained 358 responses from all six World Health Organization regions. Results from both conferences were split into two categories: the why and the how. A strong consensus among participants is that bi-directional learning between conference organizers and local communities leads to shared understanding and mutual goals. The data emphasize that including communities in academic conferences helps us progress forward from intentions toward demonstrating accountability and reporting impact. DISCUSSION: A diversity of perspectives is needed to advance socially accountable health system transformation. Five best practices from conference participants are laid out as a framework to assist in the change: (1) Build trust, (2) provide funding for community member participation, (3) appreciation of local community knowledge, (4) involve the local community in the planning stages, and (5) make the local community part of the conference and learning.

55-year-old woman • unilateral nasal drainage • salty taste • nasal redness • recent COVID-19 nasal swabs • Dx?

► unilateral nasal drainage ► salty taste ► nasal redness ► recent COVID-19 nasal swabs.

Impact of a Culturally Grounded Running Program on Four Components of Wellness Among Indigenous Participants: A Pilot Study of the Running Medicine Program.

Movement as medicine is the premise behind Running Medicine (RM), a community-based wellness program that began in 2016 in New Mexico. RM is centered in the Indigenous traditions of running and is oriented to improving the four dimensions of wellness-mind, body, spirit, and social. Using retroactive surveys of RM's Spring 2019 participants, we investigated the program's effectiveness in the realms of physical, mental, spiritual, and social wellness. Based on data from participant surveys, RM appears to be effective at improving the four realms of wellness. Indigenous participants improved to a greater degree in mental and social wellness than non-Indigenous participants, while the opposite was true for physical and spiritual wellness. For both groups, the largest effect size among the four domains was seen in social wellness. Among our participants, this culturally grounded approach to wellness appears to be effective at improving the four realms of physical, mental, spiritual, and social wellness.

Blood Product Transfusion in Adults: Indications, Adverse Reactions, and Modifications.

Millions of units of blood products are transfused annually to patients in the United States. Red blood cells are transfused to improve oxygen-carrying capacity in patients with or at high risk of developing symptomatic anemia. Restrictive transfusion thresholds with lower hemoglobin levels are typically clinically equivalent to more liberal thresholds. Transfusion of plasma corrects clinically significant coagulopathy in patients with or at high risk of bleeding. Mildly abnormal laboratory coagulation values are not predictive of clinical bleeding and should not be corrected with plasma. Transfused platelets prevent or treat bleeding in patients with thrombocytopenia or platelet dysfunction. Cryoprecipitate is transfused to treat hypofibrinogenemia. Many adverse reactions can occur during or after blood product transfusion. Transfusion-associated circulatory overload (i.e., volume overload) is the most common cause of mortality associated with blood products. Modifications to blood products can prevent or decrease the risks of transfusion-related adverse reactions. It is critical to quickly recognize when a reaction is occurring, stop the transfusion, assess, and support the patient. Reporting a reaction to the blood bank is part of ensuring patient safety and supporting hemovigilance efforts.

Underinsurance before the implementation of the Affordable Care Act: From the Research Involving Outpatient Settings Network (RIOS Net).

BACKGROUND: As the Affordable Care Act (ACA) is implemented and many uninsured become insured, rates of underinsurance may persist or increase. This study was designed to estimate the rate of underinsurance in primary care safety net clinics serving low income, multiethnic populations in New Mexico. METHODS: Data were collected from 2 primary care clinics in an urban setting during a 2-week period in 2011 and 2012. Voluntary, anonymous, self-administered surveys were distributed to adult patients waiting to be seen by their doctor. Surveys were available in English and Spanish. RESULTS: Of those insured, 44% were underinsured. The underinsured comprised higher proportions of patients who were Hispanic, young, and poor; 39% reported fair or poor health, 23% reported that their health suffered from an inability to seek care because of cost, and 53% had either Medicaid or state coverage insurance. Patients with an income of ≤$25,000 were 8 times more likely to be underinsured. CONCLUSION: A high level of underinsurance was found in these safety net clinics. Because millions of Americans gain health care insurance benefits, monitoring whether the current reform provides adequate health care coverage or whether those with new and existing health care insurance are underinsured is critical.

Closing the door on pharma? A national survey of family medicine residencies regarding industry interactions.

PURPOSE: To assess the extent and type of interactions U.S. family medicine residencies permit industry to have with medical students and residents. METHOD: In 2008, the authors e-mailed a four-question survey to residency directors or coordinators at all 460 accredited U.S. family medicine residencies concerning the types of industry support and interaction permitted. The authors conducted quantitative and qualitative analyses of survey responses and written comments. Residencies that did not permit any industry food, gifts, samples, or support of residency activities were designated "pharma-free." RESULTS: The survey response rate was 62.2% (286/460). Among responding family medicine residencies, 52.1% refused drug samples, 48.6% disallowed industry gifts or food, 68.5% forbade industry-sponsored residency activities, and 44.1% denied industry access to students and residents at the family medicine center. Seventy-five residencies (26.2%) were designated as "pharma-free." Medical-school-based and medical-school-administered residencies were no more likely than community-based residencies to be pharma-free. Among the 211 programs that permitted interaction, 68.7% allowed gifts or food, 61.1% accepted drug samples, 71.1% allowed industry representatives access to trainees in the family medicine center, and 37.9% allowed industry-sponsored residency activities. Respondents commented on challenges inherent to limiting industry interactions. Many programs noted recent changes in plans or practices. CONCLUSIONS: Most family medicine residencies limit industry interaction with trainees. Because industry interactions can have adverse effects on rational prescribing, residency programs should assess the benefits and harms of these relationships.

The effect of study sponsorship on a systematically evaluated body of evidence of head-to-head trials was modest: secondary analysis of a systematic review.

OBJECTIVE: The objective of this study was to determine the effect of industry bias in a systematically reviewed body of evidence of head-to-head trials. STUDY DESIGN AND SETTING: We limited our analysis to published head-to-head randomized controlled trials of selective serotonin reuptake inhibitors (SSRIs) identified in a comparative effectiveness review. Two reviewers independently determined the status of funding for each trial. We classified drugs into one of two groups: (1) drugs associated with the funding source and (2) drugs not associated with the funding source. To determine the effect of any underlying industry bias, we conducted relative-benefit meta-analyses comparing the response rates of drugs when associated with the funding source with response rates of the same drugs when not associated with the funding source. RESULTS: Thirteen out of 20 studies (65%) numerically favored drugs associated with the funding source over drugs used as controls. The pooled response rates of SSRIs, when associated with the funding source, are significantly greater than those of the same SSRIs when not associated with the sponsor (relative benefit=1.07; 95% confidence interval=1.02-1.11). The difference, however, is likely to be not of clinical importance. CONCLUSIONS: The effect of industry bias in comparative effectiveness reviews might play a lesser role than in systematic reviews of placebo-controlled trials.

Misclassification of American Indian race in state cancer data among non-federally recognized Indians in North Carolina.

BACKGROUND: Equitable distribution of health care resources relies on accurate morbidity and mortality data, classified by race. Accurate classification is a problem, particularly for non-federally recognized American Indians (AI) receiving care outside of the Indian Health Service. METHODS: We identified counties in North Carolina that had the majority of AIs belonging to the 7 state-recognized, non-federally recognized tribes. We collaborated with the tribe in each county and compared the incident cases of cancer in the North Carolina Central Cancer Registry (NCCCR) to the tribal rolls. Data were analyzed to calculate what percent of names on both lists were not correctly identified as AI in the NCCCR. We corrected the NCCCR classification and calculated the percentage misclassified, then recalculated the cancer incidence rates for 4 major cancers (prostate, female breast, lung, and colorectal). We compared the recalculated rate to the original rate. RESULTS: There were 626 AIs on the tribal rolls; 112 (17.9%) were not identified as AI on the NCCCR list. Comparing 1996-2000 age-adjusted cancer incidence rates before and after reclassification, the increase in rates were prostate 41%, female breast 18%, lung 10%, and 11% for colorectal cancers. There was less than a 2% increase in cancer rates for the combined 4 sites for Blacks and Whites, before and after reclassification, and 19% for AIs. CONCLUSIONS: The study estimated 18% misclassification of non-federally recognized AIs in cancer registration in North Carolina, and determined an underestimation of cancer rates in the population. The underestimation of cancer burden among AIs in North Carolina may affect resources allocated for prevention, screening, and treatment programs, as well as funding for research.