Examining Parity among Black and Hispanic Resident Physicians

BackgroundThe US physician workforce does not represent the racial or ethnic diversity of the population it serves.ObjectivesTo assess whether the proportion of US physician trainees of Black race and Hispanic ethnicity has changed over time and then provide a conceptual projection of future trends.DesignCross-sectional, retrospective, analysis based on 11 years of publicly available data paired with recent US census population estimates.ParticipantsA total of 86,303 (2007–2008) to 103,539 (2017–2018) resident physicians in the 20 largest US Accreditation Council for Graduate Medical Education resident specialties.Main MeasuresChanges in proportion of physician trainees of Black race and Hispanic ethnicity per academic year. Projected number of years it will then take, for specialties with positive changes, to reach proportions of Black race and Hispanic ethnicity comparable to that of the US population.Key ResultsAmong the 20 largest specialty training programs, Radiology was the only specialty with a statistically significant increase in the proportion of Black trainees, but it could take Radiology 77 years to reach levels of Black representation comparable to that of the US population. Obstetrics/Gynecology, Emergency Medicine, Internal Medicine/Pediatrics, and Orthopedic Surgery demonstrated a statistically significant increase in the proportion of Hispanic trainees, but it could take these specialties 35, 54, 61, and 93 years respectively to achieve Hispanic representation comparable to that of the US population.ConclusionsAmong US residents in the 20 largest specialties, no specialty represented either the Black or Hispanic populations in proportions comparable to the overall US population. Only a small number of specialties demonstrated statistically significant increases. This conceptual projection suggests that current efforts to promote diversity are insufficient.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06650-7.Key Words: Accreditation Council for Graduate Medical Education, physician workforce, workforce diversity     

Correlation of acute tubular injury in reperfusion biopsy with renal transplant outcomes

Acute tubular injury (ATI) is common at reperfusion, but its relationship to graft outcomes is unclear. Prior studies lack standardization of morphological assessments and included elements of acute and chronic tubular injury. This study aimed to evaluate the impact of ATI on graft outcomes. Reperfusion biopsies from 2004 to 2009 were retrospectively reviewed. ATI was assessed by a new standardized scoring system. We also assessed chronic injury (CI) by the Banff criteria. Outcomes evaluated included glomerular filtration rate (GFR) at 1 and 5 years and delayed graft function (DGF), acute rejection (AR), graft and patient survival. ATI did not correlate with DGF, AR, graft or overall survival. Mild–moderate ATI was not predictive of GFR post‐transplant. Moderate–severe CI was associated with lower GFR at 5 years with a mean difference of ?7.14 mL/min/1.73 m² (P=.04) and overall survival (HR 2.44, P=.01). Other predictors of graft function included donor age, DGF, and AR. Histologic criteria of ATI at implantation in the absence of donor demographics or clinical information do not provide sufficient predictability in outcomes after transplantation. On the other hand, histologic assessment of CI correlates with GFR and overall survival.     

“Abortion—It Is My Own Body”: Women's Narratives About Influences on Their Abortion Decisions in Ghana

Globally, abortion has emerged as a critical determinant of maternal morbidity and mortality. The Ghana government amended the country's abortion law in 1985 to promote safe abortion. This article discusses the findings of a qualitative study that explored the decision-making experiences of 28 female abortion seekers aged between 15 and 30 years in Ghana. Key findings from the study are that individuals claimed autonomy in their abortion decisions; underlying the abortion decisions were pragmatic concerns such as economic difficulties, child spacing, and fear of parental reaction. In conclusion, we examine the health implications of Ghanaian women's abortion decisions.     

Maternal nutritional knowledge and child nutritional status in the Volta region of Ghana

The relationship between mother's nutritional knowledge, maternal education, and child nutritional status (weight-for-age) was the subject of investigation in this study. The data were collected in Ghana on 55 well nourished and 55 malnourished mother-child pairs. A questionnaire designed to collect data on mother's knowledge and practices related to child care and nutrition was administered to the mothers. Data on mother's demographic and socio-economic characteristics as well as child anthropometric data were also collected. A nutrition knowledge score was calculated based on mother's responses to the nutrition related items. Bivariate analysis gave significant associations between child nutritional status and the following variables: time of initiating of breastfeeding, mother's knowledge of importance of colostrum and whether colostrum was given to child, age of introduction of supplementary food, and mother's knowledge about causes of kwashiorkor. The two groups also showed significant differences in their nutrition knowledge scores. Maternal formal education, and marital status were also found to be associated with child nutritional status in bivariate analyses. Further analysis with logistic regression revealed that maternal nutrition knowledge was independently associated with nutritional status after the effects of other significant variables were controlled for. Maternal education on the other hand was not found to be independently associated with nutritional status. These results imply that mother's practical knowledge about nutrition may be more important than formal maternal education for child nutrition outcome.     

丙型肝炎和自身免疫性肝炎自身抗体的特点分析

目的分析自身抗体在丙型病毒性肝炎和自身免疫性肝炎中的特点方法应用间接免疫荧光法（IIF），检测233例丙型肝炎（HCV）患者和45例自身免疫性肝炎（AIH）患者血清中相关的自身抗体。结果233例HCV患者自身抗体检测阳性率分别为抗核抗体（ANA）44．6％（104／233）、抗平滑肌抗体（SMA）18．0％（42／233）、抗线粒体抗体（AMA）14．2％（33／233）、抗肝肾微粒体抗体（抗LKM-1）1．7％（4／233）、抗肝特异性蛋白抗体（LSP）10．7％（25／233）、抗细胞骨架抗体（CS）7．7％（18／233）、抗胃壁细胞抗体（APCA）6．0％（14／233）、抗心肌抗体（AHRA）6．9％（16／233）。HCV组和AIH组ANA和SMA检测结果比较，HCV组ANA、SMA抗体1：100滴度阳性率分别为69．2％、27．9％，ANA及SMA抗体以低滴度为主，AIH组ANA及SMA抗体则以高滴度为主（62．2％、28．9％）。ANA抗体高滴度（1：1000）的HCV患者ALT、ASr、Tbil、GGT、IgM的水平明显高于低滴度（1：100）患者（P〈0．05），而IgA和IgG两组间比较差异无统计学意义。AIH组抗LKM-1检测阳性率高于HCV组。结论丙型肝炎患者血清中存在多种自身抗体但滴度较低，自身免疫性肝炎患者自身抗体滴度较高，HCV引起的自身免疫紊乱是造成机体免疫损伤、加重丙肝病毒血症的一个极其重要因素。     

侵及鼻腔鼻窦的罕见巨大肌上皮癌病例分析

目的探讨鼻腔鼻窦肌上皮癌的诊治要点,防范误诊误治。方法对行手术切除的1例巨大鼻腔鼻窦肌上皮癌的临床资料进行回顾性分析,并复习国内外相关文献。结果本例为56岁男性,因左侧面部凸出巨大肿物3年余,肿物表面间断出血1个月入院。根据专科查体情况及鼻窦CT、MRI检查结果考虑来源于小涎腺的多形性腺瘤恶变或其他罕见肿瘤。经充分术前准备,包括多学科会诊、备足血源、术前肿瘤血管栓塞,术中完整切除一重3 kg、约24.5 cm×16.0 cm×12.0 cm大小的肿瘤。术后病理诊断:肌上皮癌(侵及鼻腔鼻窦)。结论鼻科医师应警惕单侧鼻腔鼻窦病变,加强对肌上皮癌病理特点及免疫组织化学的认识,以期对该病早诊断、早治疗。     

Estimating the Number of Young Black Men who have Sex with Men (YBMSM) on the South Side of Chicago: Towards HIV Elimination within US Urban Communities

The rate of HIV infection among young Black men who have sex with men (YBMSM) aged 16–29 is increasing significantly in the United States. Prevention in this population would considerably impact future health-care resources given the need for lifelong antiretrovirals. A YBMSM population estimate is needed to assist HIV prevention program planning. This analysis estimates the number of YBMSM aged 16–29 living on the south side of Chicago (SSC), the Chicago HIV epicenter, as the first step in eliminating HIV in this population. Three methods were utilized to estimate the number of YBMSM in the SSC. First, an indirect approach following the formula a = k/b; where a = the estimated number of YBMSM, k = the average YBMSM HIV prevalence estimate, and b = the YBMSM population-based HIV seropositivity rate. Second, data from the most recent National Survey of Family Growth (NSFG) was used to estimate the proportion of Black men who report having sex with a man. Third, a modified Delphi approach was used, which averaged community expert estimates. The indirect approach yielded an average estimate of 11.7 % YBMSM, the NSFG yielded a 4.2 % (95 % CI 2.28–6.21) estimate, and the modified Delphi approach yielded estimates of 3.0 % (2.3–3.6), 16.8 % (14.5–19.1), and 25 % (22.0–27.0); an average of 14.9 %. The crude average of the three methods was 10.2 %. Applied to SSC, this results to 5,578 YBMSM. The estimate of 5,578 YBMSM represents a group that can be feasibly reached with HIV prevention efforts. Population estimates of those most at risk for HIV will help public health officials allocate resources, offering potential for elimination of new HIV cases.