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Long-Mills E, Tumin D. Pediatric chronic pain and exposure to bullying as perpetrator or victim. Pain 2024; 165:1425. [PMID: 38739767 DOI: 10.1097/j.pain.0000000000003232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Em Long-Mills
- Department of Academic Affairs, Brody School of Medicine at East Carolina University, Greenville, NC, United States
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Vasquez-Rios V, Tumin D. Divisions of health equity in departments of obstetrics and gynecology: English proficiency. Am J Obstet Gynecol 2024:S0002-9378(24)00603-3. [PMID: 38761841 DOI: 10.1016/j.ajog.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/14/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Virginia Vasquez-Rios
- East Carolina University, Brody School of Medicine, 600 Moye Blvd., Greenville, NC 27834.
| | - Dmitry Tumin
- East Carolina University, Brody School of Medicine, Department of Academic Affairs, 600 Moye Blvd., Greenville, NC 27834
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Tumin D. Let's agree to disagree: The perils of studying agreement and prediction in small data sets. Acta Paediatr 2024; 113:1117. [PMID: 38528436 DOI: 10.1111/apa.17171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/15/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
- Department of Academic Affairs, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
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Fryar C, Mouro S, Whiteside JL, Tumin D. Effect of COVID-19 pandemic on same-day discharge for elective benign hysterectomy. Am J Obstet Gynecol 2024; 230:e92-e98. [PMID: 38181829 DOI: 10.1016/j.ajog.2023.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/05/2023] [Accepted: 12/26/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Caroline Fryar
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, 600 Moye Blvd., Greenville, NC 27834.
| | - Steven Mouro
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, 600 Moye Blvd., Greenville, NC 27834
| | - James L Whiteside
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, 600 Moye Blvd., Greenville, NC 27834
| | - Dmitry Tumin
- Department of Pediatrics and Department of Academic Affairs, Brody School of Medicine, East Carolina University, Greenville, NC
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Campbell KM, Tumin D, Linares JI, Morley CP. The Relationship Between the Social Mission Content of Medical School Mission Statements and Minority Faculty Representation Among Faculty and Senior Leadership. J Immigr Minor Health 2024; 26:334-340. [PMID: 37902901 DOI: 10.1007/s10903-023-01555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/01/2023]
Abstract
Medical schools with social missions have the potential to increase minority student interest in health disparities research. In previous work, the authors looked at the missions of medical schools to determine if they were associated with minority student representation. In this paper, the authors look at the representation of full-time faculty and senior leaders who are underrepresented in medicine in US medical schools. This study included all MD-granting medical schools in the US with available data on mission statement Social Mission Content (SMC) and faculty demographics. Data were analyzed for representation of faculty underrepresented in medicine (URM) among all faculty, among junior as compared to senior faculty, and among department chairs. In the 2013 data, Pearson correlation coefficients were calculated to characterize the association between SMC and contemporaneous URM faculty representation. In the 2014-2020 data, hierarchical linear models were used to estimate the association between SMC and the annual rate of change in URM faculty representation. In 2013, URM faculty accounted for 7.4% of all faculty at the median medical school, increasing to 8.4% in 2020. As of 2013, URM representation among junior faculty was 9.2% at the median school, 5.6% among senior faculty, and 4.3% among department chairs. The authors found a slow increase in the percentage of URM faculty members (but not department chairs). This trend did not vary between schools with lower vs. higher emphasis on a social mission (based on the mission statement). The increase in chair representation was determined to be associated with the type of the school, whether historically Black or Puerto Rican, and not precisely its mission.
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Affiliation(s)
- Kendall M Campbell
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Dmitry Tumin
- Department of Pediatrics, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Jhojana Infante Linares
- Department of Academic Affairs, Office of Data Analysis and Strategy, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Christopher P Morley
- Department of Public Health & Preventive Medicine, Department of Family Medicine, and Department of Psychiatry & Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
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Wormington SN, Best K, Tumin D, Li X, Desher K, Thiagarajan RR, Raman L. Survival and neurobehavioral outcomes following out-of-hospital cardiac arrest in pediatric patients with pre-existing morbidity: An analysis of the THAPCA out-of-hospital arrest data. Resuscitation 2024; 197:110144. [PMID: 38367829 DOI: 10.1016/j.resuscitation.2024.110144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
AIM Pre-arrest morbidity in adults who suffer out-of-hospital cardiac arrest (OHCA) is associated with increased mortality and poorer neurologic outcomes. The objective of this study was to determine if a similar association is seen in pediatric patients. METHODS We performed a secondary analysis of data from the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial. Study sites included 36 pediatric intensive care units across the United States and Canada. The study enrolled children between the ages of 48 hours and 18 years following an OHCA between September 1, 2009 and December 31, 2012. For our analysis, patients with (N = 151) and without (N = 142) pre-arrest comorbidities were evaluated to assess morbidity, survival, and neurologic function following OHCA. RESULTS No significant difference in 28-day survival was seen between groups. Dependence on technology and neurobehavioral outcomes were assessed among survivors using the Vineland Adaptive Behavior Scales-Second Edition (VABS-II), Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC). Children with pre-existing comorbidities maintained worse neurobehavioral function at twelve months, evidenced by poorer scores on POPC (p = 0.016), PCPC (p = 0.044), and VABS-II (p = 0.020). They were more likely to have a tracheostomy at hospital discharge (p = 0.034), require supplemental oxygen at three months (p = 0.039) and twelve months (p = 0.034), and be mechanically ventilated at twelve months (p = 0.041). CONCLUSIONS There was no difference in survival to 28 days following OHCA in children with pre-existing comorbidity compared to previously healthy children. The group with pre-existing comorbidity was more reliant on technology following arrest and exhibited worse neurobehavioral outcomes.
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Affiliation(s)
- Sierra N Wormington
- University of Texas Southwestern Medical Center, Department of Anesthesiology, Dallas, TX, USA
| | - Kathryn Best
- East Carolina University, Department of Pediatrics, Greenville, NC, USA
| | - Dmitry Tumin
- East Carolina University, Research Associate Professor, Department of Pediatrics, Greenville, NC, USA
| | - Xilong Li
- University of Texas Southwestern Medical Center, Department of Population and Data Science, Dallas, TX, USA
| | - Kaley Desher
- Emory University, Department of Pediatrics, Atlanta, GA, USA
| | | | - Lakshmi Raman
- University of Texas Southwestern Medical Center, Department of Pediatrics, Dallas, TX, USA.
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Crockett AK, Laden BF, Tumin D, Whiteside JL. Predictors of planned home birth before and during the COVID-19 pandemic. J Perinat Med 2024; 52:283-287. [PMID: 38296773 DOI: 10.1515/jpm-2023-0439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES To determine how demographic and clinical predictors of home birth have changed since the onset of the COVID-19 pandemic in the US. METHODS Using National Vital Statistics birth certificate data, a retrospective population-based cohort study was performed with planned home births and hospital births among women age ≥18 years during calendar years 2019 (pre-pandemic) and 2021 (pandemic-era). Birth location (planned home birth vs. hospital birth) was analyzed using univariate and multivariable logistic regression, systematically examining the interaction of each demographic and clinical covariate with study year. RESULTS After exclusions, a total of 6,087,768 birth records were retained for analysis, with the proportion of home births increasing from 0.82 % in 2019 to 1.24 % in 2021 (p<0.001). In the final multivariable logistic regression model of planned home birth, five demographic variables retained a statistically significant interaction with year: race and ethnicity, age, educational attainment, parity, and WIC participation. In each case, demographic differences between those having planned home births and hospital births became smaller (odds ratios closer to 1) in 2021 compared to 2019. CONCLUSIONS Planned home births increased by more than 50 % during the pandemic, with greater socioeconomic diversity in the pandemic-era home birth cohort. The presence of clinical risk factors remained a strong predictor of hospital birth, with no evidence that pandemic-era home births had a higher clinical risk profile as compared to the pre-pandemic period.
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Affiliation(s)
- Allison K Crockett
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Department of Obstetrics and Gynecology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Bethany F Laden
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - James L Whiteside
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Pasli M, Tumin D, Guffey R. Simulation-Based Analysis of Trial Design in Regional Anesthesia. Anesthesiol Res Pract 2024; 2024:6651894. [PMID: 38525205 PMCID: PMC10959581 DOI: 10.1155/2024/6651894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/01/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024] Open
Abstract
Background In regional anesthesia, the efficacy of novel blocks is typically evaluated using randomized controlled trials (RCTs), the findings of which are aggregated in systematic reviews and meta-analyses. Systematic review authors frequently point out the small sample size of RCTs as limiting conclusions from this literature. We sought to determine via statistical simulation if small sample size could be an expected property of RCTs focusing on novel blocks with typical effect sizes. Methods We simulated the conduct of a series of RCTs comparing a novel block versus placebo on a single continuous outcome measure. Simulation analysis inputs were obtained from a systematic bibliographic search of meta-analyses. Primary outcomes were the predicted number of large trials (empirically defined as N ≥ 256) and total patient enrollment. Results Simulation analysis predicted that a novel block would be tested in 16 RCTs enrolling a median of 970 patients (interquartile range (IQR) across 1000 simulations: 806, 1269), with no large trials. Among possible modifications to trial design, decreasing the statistical significance threshold from p < 0.05 to p < 0.005 was most effective at increasing the total number of patients represented in the final meta-analysis, but was associated with early termination of the trial sequence due to futility in block vs. block comparisons. Conclusion Small sample size of regional anesthesia RCTs comparing novel block to placebo is a rational outcome of trial design. Feasibly large trials are unlikely to change conclusions regarding block vs. placebo comparisons.
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Affiliation(s)
- Melisa Pasli
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Department of Academic Affairs, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Ryan Guffey
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, USA
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Semaan K, Frech A, Tumin D. Reciprocal Association Between Chronic Pain and Health Insurance Type in a Population-based Longitudinal Cohort Study. J Pain 2024:104503. [PMID: 38442837 DOI: 10.1016/j.jpain.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
Chronic pain is a widespread condition limiting adults' daily activities and labor force participation. In the United States, withdrawal from the workforce could be associated with loss of health insurance coverage, while lack of health insurance coverage can limit access to diagnosis and management of chronic health conditions. We used a longitudinal cohort study of middle-aged adults to investigate whether chronic pain is reciprocally associated with coverage by any insurance and type of insurance coverage over a 2-year period (2018 and 2020). Among 5,137 participants (median age of 57 years in 2018), 29% reported chronic pain in either year, while 9 to 10% were uninsured each year. Using multivariable cross-lagged logistic regression analysis, chronic pain in 2018 was not associated with having any insurance coverage in 2020, and lack of coverage in 2018 was not associated with chronic pain in 2020. In further analysis, we determined that public coverage, other (non-private) coverage, or no coverage in 2018 were associated with an increased risk of chronic pain in 2020; while chronic pain in 2018 increased the risk of coverage by public rather than private insurance 2 years later, as well as the risk of coverage by other (non-private) payors. The reciprocal association of non-private insurance coverage and chronic pain may be related to insufficient access to chronic pain treatment among publicly insured adults, or qualification for public insurance based on disability among adults with chronic pain. These results demonstrate that accounting for the type of health insurance coverage is critical when predicting chronic pain in US populations. PERSPECTIVE: In a longitudinal cohort study of middle-aged US adults, the use of public and other non-private insurance predicts future experience of chronic pain, while past experience of chronic pain predicts future use of public and other non-private insurance.
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Affiliation(s)
- Karen Semaan
- Brody School of Medicine at East Carolina University, Greenville, North Carolina.
| | - Adrianne Frech
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Cleveland, Ohio
| | - Dmitry Tumin
- Department of Pediatrics and Department of Academic Affairs, Brody School of Medicine at East Carolina University, Greenville, North Carolina
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Muhammad M, Tumin D. Parent Gender and Assessment of Children's Health. Clin Pediatr (Phila) 2024; 63:334-340. [PMID: 37148277 DOI: 10.1177/00099228231172669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Caregiver-reported data on children's health are typically provided by mothers. We investigated whether measures of children's health would significantly differ between mother and father respondents to a nationally representative survey. This study used de-identified data on children age 0 to 17 years from the 2016-2019 National Survey of Children's Health (NSCH). The primary exposure was whether the survey was completed by the child's father (cases) or mother (controls). Outcome variables included general health, special health care needs (SHCN), and unmet health care needs. We identified 85 191 children meeting inclusion criteria, of whom 35.1% had a father respondent. After propensity score matching, 27 738 children with a father respondent were matched to an equal size group of children with a mother respondent. On conditional logistic regression analysis of the matched sample, we found that poor health, SHCN, and unmet health care needs were less likely to be reported for children in the sample by father respondents.
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Affiliation(s)
- Mufida Muhammad
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
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Malhotra S, Hyer JM, Dalmacy D, Hayes D, Tumin D, Kirkby SE, Jonas DE, Bose-Brill S, Li SS. Preventive service utilization among adults with cystic fibrosis covered by private insurance is comparable to the general population. J Cyst Fibros 2024; 23:314-320. [PMID: 38220475 DOI: 10.1016/j.jcf.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/16/2023] [Accepted: 11/22/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND As the life expectancy of the cystic fibrosis (CF) population is lengthening with modulator therapies, diligent age-appropriate screening and preventive care are increasingly vital for long-term health and wellbeing. METHODS We performed a retrospective analysis comparing rates of receiving age- and sex-appropriate preventive services by commercially insured adult people with CF (PwCF) and adults without CF from the general population (GP) via the Truven Health MarketScan database (2012-2018). RESULTS We captured 25,369 adults with CF and 488,534 adults from the GP in the United States. Comparing these groups, we found that 43% versus 39% received an annual preventive visit, 28% versus 28% were screened for chlamydia, 38% versus 37% received pap smears every 3 years (21-29-year-old females), 33% versus 31% received pap smears every 5 years (30-64-year-old females), 55% versus 44% received mammograms, 23% versus 21% received colonoscopies, and 21% versus 20% received dyslipidemia screening (all screening rates expressed per 100 person-years). In age-stratified analysis, 18-27-year-old PwCF had a lower rate of annual preventive visits compared to adults in the same age group of the GP (27% versus 42%). CONCLUSIONS We discovered a comparable-to-superior rate of preventive service utilization in adults with CF relative to the GP, except in young adulthood from 18-27 years. Our findings establish the importance of meeting the primary care needs of adults with CF and call for development of strategies to improve preventive service delivery to young adults.
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Affiliation(s)
- Sankalp Malhotra
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - J Madison Hyer
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Secondary Data Core, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Djhenne Dalmacy
- Center for Biostatistics, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Secondary Data Core, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Don Hayes
- Division of Pulmonary Medicine, Cincinnati Children's Hospital and Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Stephen E Kirkby
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Daniel E Jonas
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, 3691 Ridge Mill Drive, Hilliard, Columbus, OH 43026, United States
| | - Seuli Bose-Brill
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, 3691 Ridge Mill Drive, Hilliard, Columbus, OH 43026, United States
| | - Susan S Li
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, 3691 Ridge Mill Drive, Hilliard, Columbus, OH 43026, United States; Department of Internal Medicine, University of South Carolina School of Medicine Greenville, 1809 Wade Hampton Blvd, Ste. 120, Greenville, SC 29609, United States.
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Greene Z, Tumin D, Kyle B. Measuring Medical Students' Inclusive Care for Sexual and Gender Minority Patients. Acad Med 2024; 99:242. [PMID: 38060406 DOI: 10.1097/acm.0000000000005585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
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Hana M, Memarian S, Tumin D. Familial Hemophagocytic Lymphohistiocytosis Due to PRF1 Mutation Triggered by Enterovirus. Clin Pediatr (Phila) 2024:99228241230818. [PMID: 38323534 DOI: 10.1177/00099228241230818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Affiliation(s)
- Marlin Hana
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Shadman Memarian
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Wright B, Fassler C, Tumin D, Sarno LA. Health System Encounters after Loss to Cardiology Follow-Up among Patients with Congenital Heart Disease. J Pediatr 2024; 268:113931. [PMID: 38311237 DOI: 10.1016/j.jpeds.2024.113931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To analyze receipt of care at other locations within a single rural academic health system after loss to follow-up in a cardiology clinic. STUDY DESIGN Patients with congenital heart defects seen in the clinic during 2018 and subsequently lost to cardiology follow-up were included in the study. We defined loss to follow-up as not being seen in the clinic for at least 6 months past the most recently recommended follow-up visit. Subsequent visits to other locations, including other subspecialty clinics, primary care clinics, the emergency department, and the hospital, were tracked through 2020. RESULTS Of 235 patients (median age 7 years, 136/99 female/male), 96 (41%) were seen elsewhere in the health system. Of 96 patients with any follow-up, 40 were seen by a primary care provider and 46 by another specialist; 44 were seen in the emergency department and 12 more were hospitalized. Patients with medical comorbidities or Medicaid insurance and those living closer to the clinic were more likely to continue receiving care within the same health system. CONCLUSIONS Patients with congenital heart defect are frequently lost to cardiology follow-up. Our study supports collaboration across specialties and between cardiology clinics and affiliated emergency departments to identify patients with congenital heart defect who have been lost to cardiology follow-up but remain within the health system. A combination of in-person and remote outreach to these patients may help them continue cardiology care.
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Affiliation(s)
- Brandon Wright
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Carly Fassler
- Brody School of Medicine at East Carolina University, Greenville, NC
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Lauren A Sarno
- Division of Pediatric Cardiology, Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC.
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15
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Whiteside JL, Tumin D, Hildebrand JP, Harris A. Determinants of Surgical Approach for Benign Outpatient Hysterectomy. J Minim Invasive Gynecol 2024; 31:123-130.e2. [PMID: 37984517 DOI: 10.1016/j.jmig.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/11/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
STUDY OBJECTIVE Identify determinants of the surgical approach to a benign, outpatient, minimally invasive hysterectomy. DESIGN A cross-sectional sample of patients undergoing outpatient hysterectomy between the 4th quarter of 2015 and the 4th quarter of 2022, excluding those with a diagnosis of gynecologic malignancy, was obtained from the Vizient Clinical Data Base. The primary outcome was surgical approach to hysterectomy that was analyzed using mixed-effects regression, including a surgeon-level random effects to capture unobserved surgeon-level differences influencing variation in surgical approach. SETTING The Vizient Clinical Data Base includes patient encounter data from >50 healthcare systems and >400 community hospitals and represents approximately 97% of academic medical centers in the United States. PATIENTS Women >18 years undergoing an outpatient benign hysterectomy. INTERVENTION Surgical approach to hysterectomy. MEASUREMENT AND MAIN RESULT The final sample included 411 208 cases performed by 6089 surgeons. Among observed variables, patient diagnosis, surgeon specialty, and insurance type were strongly associated with choice of approach. However, after controlling for patient, hospital, and observable surgeon characteristics, unobserved surgeon-level differences still accounted for 72% of the variance in the use of transvaginal hysterectomy (95% confidence interval, 71-73) and 85% of the variance in the use of robot-assisted total hysterectomy (95% confidence interval, 84-86). CONCLUSION The strongest determinant of surgical approach to a benign outpatient hysterectomy in the United States was not patient- or hospital-level variability, but unexplained differences across individual surgeons. This has implications in how surgeons are trained and incentivized to deliver high-value surgical care.
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Affiliation(s)
- James L Whiteside
- Department of Obstetrics and Gynecology (Drs. Whiteside and Hildebrand), East Carolina University, Brody School of Medicine, Greenville, NC.
| | - Dmitry Tumin
- Department of Pediatrics (Dr. Tumin), East Carolina University, Brody School of Medicine, Greenville, NC
| | - Jason P Hildebrand
- Department of Obstetrics and Gynecology (Drs. Whiteside and Hildebrand), East Carolina University, Brody School of Medicine, Greenville, NC
| | - Alyssa Harris
- Vizient Inc., Center for Advanced Analytics and Informatics, Chicago, IL (Ms. Harris)
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Abstract
Research participation has been increasingly emphasized in undergraduate medical education, but limited data are available to help students formulate realistic and attainable goals for scholarly productivity. This study provides an objective, all-specialty, nationally representative estimate of PubMed-indexed publications among the 2022 cohort of new interns in the USA, representing their scholarly productivity during medical school. Only 39% of interns included in the analysis had any publications during medical school, and mean number of publications (1.4 ± 3.9) was well below the mean self-reported total of abstracts, presentations, and publications attributed to the same cohort based on residency application data (7.9).
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Affiliation(s)
- Dmitry Tumin
- Department of Academic Affairs, Brody School of Medicine at East Carolina University, Greenville, NC USA
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC USA
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Crosh CC, Koripella A, Elleman C, Foley B, Tumin D, Anyigbo C. Early Literacy Developmental Activities and Pre-Kindergarten Learning Skills in the Context of Childhood Adversity. Acad Pediatr 2024:S1876-2859(24)00005-6. [PMID: 38218215 DOI: 10.1016/j.acap.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE School readiness (SR) encompasses a wide range of skills that affect children's ability to succeed in school and later in life. Shared reading is an important strategy that assists children in gaining SR skills, whereas adverse childhood experiences (ACEs) negatively affect a child's SR. This study assessed if early literacy developmental activities (shared reading, singing, or storytelling) were associated with improved SR among children with and without ACEs. METHODS 2020-2021 National Survey of Children's Health data were used for analysis. We identified children aged 3-5 years to assess their exposure to ACEs, participation in reading/storytelling/singing, and overall SR. RESULTS In a sample of 17,545 children, 29% of children were exposed to one or more ACEs. Seventy-seven percent of children with no ACEs received daily early literacy developmental activities compared to 23% of children who experienced any ACE. On ordinal logistic regression, daily early literacy developmental activities were associated with 56% greater odds of higher SR among children not exposed to ACEs (OR: 1.56; 95% CI: 1.29, 1.88; P < .01). Among children exposed to ACEs, daily early literacy developmental activities were also associated with higher SR (OR: 1.50; 95% CI: 1.06, 2.13; P = .02). CONCLUSIONS Shared reading, storytelling, and singing are associated with improved SR in both children who have and have not been exposed to ACEs. However, children exposed to ACEs had fewer experiences with early literacy developmental activities. Future efforts should address the barriers that limit shared reading, singing, or storytelling for children exposed to ACEs.
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Affiliation(s)
- Clare C Crosh
- Department of Pediatric Primary Care, Advocate Children's Hospital (CC Crosh), Oak Lawn, Ill
| | - Ananya Koripella
- Brody School of Medicine (A Koripella and D Tumin), East Carolina University, Greenville, NC
| | - Chloe Elleman
- University of Michigan Medical School (C Elleman), Univerasity of Michigan, Ann Arbor, Michigan
| | - Benjamin Foley
- Division of General and Community Pediatrics (B Foley and C Anyigbo), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dmitry Tumin
- Brody School of Medicine (A Koripella and D Tumin), East Carolina University, Greenville, NC
| | - Chidiogo Anyigbo
- Division of General and Community Pediatrics (B Foley and C Anyigbo), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (C Anyigbo), College of Medicine, University of Cincinnati, Cincinnati, Ohio.
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Zheng Y, Almeyda-Alejo Y, Tumin D, Redpath NSJ, Guillen-Hernandez J. Three or four doses of intravenous immunoglobulin G treatment for isoimmune hemolytic disease: A case series and literature review. J Neonatal Perinatal Med 2024; 17:153-158. [PMID: 38143377 DOI: 10.3233/npm-230070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Neonates affected by isoimmune hemolytic disease (HDN) are at risk of developing severe hyperbilirubinemia. Studies show that increasing levels of bilirubin impact neonatal neurodevelopment. To avoid complications associated with exchange transfusion, intravenous immunoglobulin G (IVIG) is used to treat hyperbilirubinemia. We included all infants who received more than two doses of IVIG treatment for isoimmune hemolytic disease. We analyzed the incidence of side effects associated with IVIG treatment and the rate of exchange transfusion. METHODS A retrospective chart review performed between October 2011-October 2022 at East Carolina University Health identified neonates who received more than two doses IVIG for HDN. Neonates of postmenstrual age greater than 28 days old, receiving less than three doses of IVIG or received IVIG for other indications were excluded. The occurrences of adverse events, demographics and use of other medical therapies were reviewed. RESULTS Eleven neonates were included in the case series. Most common cause of severe hyperbilirubinemia was attributed to ABO incompatibility. Six patients (54%) received three doses of IVIG, and five patients (45%) received four doses of IVIG with bilirubin levels decreasing below exchange transfusion. No treatment exceeding four doses of IVIG was reported, nor adverse events during treatment. CONCLUSIONS In this cohort of neonates with HDN, bilirubin levels decreased after treatment with multiple doses of IVIG. Future research on recommendations of optimal total number doses of IVIG to reduce the risk for exchange transfusion.
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Affiliation(s)
- Y Zheng
- Department of Neonatology, East Carolina University Health Medical Center, Greenville, NC, USA
| | - Y Almeyda-Alejo
- Department of Pediatrics, East Carolina University Health Medical Center, Greenville, NC, USA
| | - D Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - N S J Redpath
- Department of Neonatology, East Carolina University Health Medical Center, Greenville, NC, USA
| | - J Guillen-Hernandez
- Department of Neonatology, East Carolina University Health Medical Center, Greenville, NC, USA
- Department of Pediatrics, East Carolina University Health Medical Center, Greenville, NC, USA
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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19
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Zhang ZM, Smith-Johnson M, Tumin D. Contextual Influences on Nonresponse to Health Survey Questions About Sexual Orientation and Gender Identity. LGBT Health 2024; 11:66-73. [PMID: 37582286 DOI: 10.1089/lgbt.2022.0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Purpose: We examined the relationship between state context and survey nonresponse to sexual orientation (SO) and gender identity (GI) questions. Methods: We obtained data from the 2014-2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Item nonresponse was defined as selecting "don't know/not sure" or "refused" for each of two questions about SO and GI. Nonresponse patterns included responding to both SO and GI questions; responding only to the SO question (nonresponse to GI); responding only to the GI question (nonresponse to SO); and responding to neither question. State-level contextual measures included legal protections for lesbian, gay, bisexual, transgender, or other sexual or gender minority (LGBT+) people, LGBT+ social movement strength, and public opinion regarding LGBT+ issues. Results: The analysis included 1,459,525 respondents from 44 states (190 state-years). On weighted analysis, 96.5% of adults answered both SO/GI questions, 2.4% responded only to GI, 0.4% responded only to SO, and 0.7% responded to neither. The demographic profile of individuals with GI-only nonresponse differed markedly from the profile of adults with SO-only nonresponse. An increasingly favorable legal climate for LGBT+ people was associated with greater rates of response to SO and GI questions. However, a more LGBT+ friendly state climate measured by social movement strength or public opinion was not consistently associated with reduced SO and GI question nonresponse. Conclusion: Contextual factors have mixed association with nonresponse to SO and GI question on BRFSS surveys. Our results warrant continued development of health survey questionnaires to elicit accurate information on respondents' SO and GI.
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Affiliation(s)
- Zhe Meredith Zhang
- Department of Sociology & Criminology, University of Arkansas, Fayetteville, Arkansas, USA
| | | | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
- Department of Academic Affairs, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
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Furr M, Tumin D, Ferderber ML. Musculoskeletal Knowledge on the in-Training Examination Improves in Family Medicine Residents Participating in a Longitudinal Sports Medicine Clinical Track. J Med Educ Curric Dev 2024; 11:23821205241250145. [PMID: 38706938 PMCID: PMC11067680 DOI: 10.1177/23821205241250145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/10/2024] [Indexed: 05/07/2024]
Abstract
Objectives The study aims to assess the impacts of a sports medicine (SM) track on musculoskeletal (MSK) knowledge of family medicine (FM) residents. In-training examination (ITE) results were used to compare the MSK knowledge of FM residents with and without SM track participation. Methods A single-center, retrospective study was completed on 85 FM residents from the 2018 to 2024 graduating classes who completed the ITE from 2017 to 2021. Residents were categorized by participation in the SM track, where half a day of FM continuity clinic per week is replaced with an SM clinic, supervised by a fellowship-trained SM physician. ITE scores throughout training were compared between the 2 groups using mixed-effects regression. Results The ITE MSK scores increased among both SM track participants (+77 points/year, p = .001) and nonparticipants (+39 points/year, p = .001) throughout their training. By postgraduate year 3, SM track participants performed significantly better on the MSK portion of the ITE (+87 points compared to non-participants, p = .045). No significant difference in total ITE scores was seen between groups. Conclusions Our data demonstrates that participation in an SM track is associated with an increase in MSK knowledge of ITE, suggesting that an SM track may provide FM residents with a better understanding of MSK conditions.
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Affiliation(s)
- Micah Furr
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Moore A, Tumin D. Overlap of pain-related and general measures of disability among adults with chronic pain. Pain Pract 2024; 24:62-71. [PMID: 37534395 DOI: 10.1111/papr.13281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/10/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE Chronic pain is known to be correlated with disability. We aimed to determine the overlap between a general self-reported measure of disability and a measure of disability due to pain problems among adults with chronic pain. MATERIALS AND METHODS We used data from the National Health Interview Survey (NHIS) and analyzed respondents with chronic pain in the past 3 months. General disability was defined as being limited in the kind or amount of work one can do due to any physical, mental, or emotional problem. Pain-related disability was defined as pain limiting one's activity on "most days" or "every day." RESULTS Based on a sample of 6874 respondents with chronic pain, 58% had either kind of disability, including 9% who reported only pain-related, but not general disability; and 27% who reported both types of disability. Respondents reporting only pain-related, but not general disability tended to be younger and had lower rates of obesity, smoking, diabetes, and hypertension than respondents reporting both pain-related and general disability. DISCUSSION Among people with chronic pain, most people with disability are experiencing limitations related to pain problems. Assessment of disability without addressing pain interference has likely underestimated the disability burden in this population.
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Affiliation(s)
- Ashley Moore
- Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
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22
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Gorham TJ, Tumin D, Groner J, Allen E, Retzke J, Hersey S, Liu SB, Macias C, Alachraf K, Smith AW, Blount T, Wall B, Crickmore K, Wooten WI, Jamison SD, Rust S. Predicting emergency department visits among children with asthma in two academic medical systems. J Asthma 2023; 60:2137-2144. [PMID: 37318283 DOI: 10.1080/02770903.2023.2225603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/11/2023] [Indexed: 06/16/2023]
Abstract
Objective: To develop and validate a predictive algorithm that identifies pediatric patients at risk of asthma-related emergencies, and to test whether algorithm performance can be improved in an external site via local retraining.Methods: In a retrospective cohort at the first site, data from 26 008 patients with asthma aged 2-18 years (2012-2017) were used to develop a lasso-regularized logistic regression model predicting emergency department visits for asthma within one year of a primary care encounter, known as the Asthma Emergency Risk (AER) score. Internal validation was conducted on 8634 patient encounters from 2018. External validation of the AER score was conducted using 1313 pediatric patient encounters from a second site during 2018. The AER score components were then reweighted using logistic regression using data from the second site to improve local model performance. Prediction intervals (PI) were constructed via 10 000 bootstrapped samples.Results: At the first site, the AER score had a cross-validated area under the receiver operating characteristic curve (AUROC) of 0.768 (95% PI: 0.745-0.790) during model training and an AUROC of 0.769 in the 2018 internal validation dataset (p = 0.959). When applied without modification to the second site, the AER score had an AUROC of 0.684 (95% PI: 0.624-0.742). After local refitting, the cross-validated AUROC improved to 0.737 (95% PI: 0.676-0.794; p = 0.037 as compared to initial AUROC).Conclusions: The AER score demonstrated strong internal validity, but external validity was dependent on reweighting model components to reflect local data characteristics at the external site.
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Affiliation(s)
- Tyler J Gorham
- Information Technology Research & Innovation, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Judith Groner
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Elizabeth Allen
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Jessica Retzke
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Stephen Hersey
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Swan Bee Liu
- Information Technology Research & Innovation, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charlie Macias
- Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kamel Alachraf
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Aimee W Smith
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | | | | | | | - William I Wooten
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Shaundreal D Jamison
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Steve Rust
- Information Technology Research & Innovation, Nationwide Children's Hospital, Columbus, OH, USA
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Anyigbo C, Todd E, Tumin D, Kusma J. Health Insurance Coverage Gaps Among Children With a History of Adversity. Med Care Res Rev 2023; 80:648-658. [PMID: 37329285 DOI: 10.1177/10775587231180673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Health insurance stability among children with adverse childhood experiences (ACEs) is essential for accessing health care services. This cross-sectional study used an extensive, multi-year, nationally representative database of children aged 0 to 17 to examine the association between ACE scores and continuous or intermittent lack of health insurance over a 12-month period. Secondary outcomes were reported reasons for coverage gaps. Compared with children having 0 ACEs, those with 4+ ACEs had a higher likelihood of being part-year uninsured rather than year-round private insured (relative risk ratio [RRR]: 4.20; 95% CI: 3.25, 5.43), year-round public insured (RRR: 1.37; 95% CI: 1.06, 1.76), or year-round uninsured (RRR: 2.28; 95% confidence interval [CI]: 1.63, 3.21). Among children who experienced part-year or year-round uninsurance, a higher ACE score was associated with a greater likelihood of coverage gap due to difficulties with the application or renewal process. Policy changes to reduce administrative burdens may improve health insurance stability and access to health care among children who endure ACEs.
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Affiliation(s)
- Chidiogo Anyigbo
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emmalee Todd
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Jennifer Kusma
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago IL, USA
- Mary Ann & J.Milburn Smith Child Health Outcomes, Research and Evaluation Center; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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24
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Arthur L, Schiro S, Tumin D, Nakayama D, Toschlog E, Greene E, Waddell M, Longshore S. Shelter in Place and an Alarming Increase in Penetrating Trauma in Children and Concerning Decrease in Child Abuse. Am Surg 2023; 89:5386-5390. [PMID: 36583224 DOI: 10.1177/00031348221148361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND On March 14, 2020, schools across North Carolina (NC) closed in response to Covid-19, forcing completion of the school year at home. Most pediatric trauma occurs at home with a higher prevalence when children are out of school. We queried the state trauma database to assess if the 2020 "shelter in place" was associated with an increase in pediatric trauma statewide. METHODS The NC trauma database was queried for injuries in children (age < 18 yrs) from 13 March-1 August 2020, and the corresponding months of 2018 and 2019. The number and type of injuries were compared. We also queried the NC death certificate and child welfare databases. Data were analyzed by standard statistical methods using chi-squared or Kruskal-Wallis test. RESULTS Total pediatric trauma cases were lower during 2020 (71.6 per 100,000) compared to 2018 (92.4 per 100,000) and 2019 (80 per 100,000) (P < .001); however, average injury severity score (ISS) was higher (P = .001). A significant increase in firearm injuries were seen in 2020 (P = .016), with an increase in mortality (P = .08) and ISS (P = .013). The rate of child abuse trauma decreased in 2020 (P = .005) as did the number of child abuse and neglect reports (P < .001). There were also significant decreases in trauma due to sports, burns, falls, and motor vehicle accidents. CONCLUSION While overall pediatric trauma decreased during the Covid-19 pandemic, there was an alarming increase in penetrating injuries in children. Child abuse trauma and reports decreased, which is concerning for lower identification of abuse.
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Affiliation(s)
- Lauren Arthur
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Vidant Center of Trauma & Surgical Critical Care, Vidant Medical Center, Greenville, NC, USA
| | - Sharon Schiro
- UNC Department of Surgery, North Carolina Office of Emergency Medical Services, Chapel Hill, NC, USA
- UNC Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Don Nakayama
- UNC Department of Surgery, University of North Carolina Hospitals at Chapel Hill, Chapel Hill, NC, USA
| | - Eric Toschlog
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Vidant Center of Trauma & Surgical Critical Care, Vidant Medical Center, Greenville, NC, USA
| | - Erika Greene
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Vidant Center of Trauma & Surgical Critical Care, Vidant Medical Center, Greenville, NC, USA
| | - Megan Waddell
- Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, USA
| | - Shannon Longshore
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Vidant Center of Trauma & Surgical Critical Care, Vidant Medical Center, Greenville, NC, USA
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25
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Mouro S, Hamed JLC, Whiteside JL, Tumin D. Relevance of Uterine Weight for Predicting Surgical Complications in Minimally Invasive Benign Hysterectomy. J Minim Invasive Gynecol 2023; 30:976-982. [PMID: 37611741 DOI: 10.1016/j.jmig.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023]
Abstract
STUDY OBJECTIVES To describe the uterine weight threshold for increasing risk of complications after a laparoscopic hysterectomy using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. DESIGN Cross-sectional analysis using the American College of Surgeons NSQIP database from 2016 to 2021. SETTING American College of Surgeons NSQIP database. PATIENTS Patients undergoing minimally invasive hysterectomy for benign indications (N = 64 289). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Uterine weight was entered in grams and 30-day complications were abstracted from patient charts. In the analytic sample, median uterine weight was 135 grams (interquartile range, 90-215) and 6% of patients (n = 4085) experienced complications. Uterine weight performed very poorly in predicting complications on bivariate analysis (area under the receiver operating characteristics curve, 0.53; 95% confidence interval, 0.53-0.54). On multivariable analysis, a uterine weight cutoff of 163 grams was associated with higher odds of complications (odds ratio, 1.11; 95% confidence interval, 1.03-1.19; p = .003), but this threshold achieved only a 43% sensitivity and 62% specificity for predicting complications. CONCLUSIONS Uterine weight alone possessed negligible utility for predicting the risk of perioperative complications in minimally invasive hysterectomy.
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Affiliation(s)
- Steven Mouro
- Department of Obstetrics and Gynecology (Drs. Mouro and Whiteside), East Carolina University, Greenville, North Carolina.
| | - Jenna L Carter Hamed
- Brody School of Medicine (Ms. Carter Hamed), East Carolina University, Greenville, North Carolina
| | - James L Whiteside
- Department of Obstetrics and Gynecology (Drs. Mouro and Whiteside), East Carolina University, Greenville, North Carolina
| | - Dmitry Tumin
- Department of Pediatrics and Department of Academic Affairs (Dr. Tumin), East Carolina University, Greenville, North Carolina
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Guillen-Hernandez J, Kyllonen KC, Tumin D, Rodriguez RJ. The Use of Dexmedetomidine in Preterm Infants: A Single Academic Center Experience. J Pediatr Pharmacol Ther 2023; 28:628-634. [PMID: 38025141 PMCID: PMC10681088 DOI: 10.5863/1551-6776-28.7.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/06/2022] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Preterm newborns (PTNBs) often require sedation and analgesia. Dexmedetomidine (DEX) is used to provide sedation in extremely PTNBs, even though information on such use is limited. The objective of this research is to describe the use of DEX in these patients in a single academic center. METHODS This is a retrospective study of PTNBs receiving DEX from January 1, 2010, through December 31, 2018, at the Cleveland Clinic Children's Hospital, a tertiary academic center operating 2 Level III and 1 Level IV neonatal intensive care units (NICUs). Inclusion criteria were gestational age (GA) <36 weeks and receipt of DEX for >2 days. Adequacy of clinical response was based on achieving Neonatal Pain, Agitation and Sedation Scale (N-PASS) scores <3. Hypotension, bradycardia, and respiratory depression were recorded as the incidence as adverse events. RESULTS A total of 105 patients were included. The birth weight median was 870 g (IQR, 615-1507); the GA median was 26 weeks (IQR, 24-31). The duration of DEX infusion averaged 7 days. The DEX dose averaged 0.4 mcg/kg (IQR, 0.3-0.45). Bradycardia was observed in 35 patients (57%) weighting <1 kg and in 7 patients (18%) >1 kg (p < 0.01). There was no difference in the incidence of other adverse events between these groups. However, infants <1 kg required more pharmacologic interventions to maintain N-PASS score <3. CONCLUSIONS DEX was well tolerated overall and provided adequate sedation to PTNBs in this cohort. From this study, we recommend a starting dose of 0.2 to 0.4 mcg/kg/hr and titrating up hourly until adequate sedation is achieved.
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Affiliation(s)
- Juan Guillen-Hernandez
- Department of Pediatrics (JG-H, DT), Brody School of Medicine at East Carolina University, Greenville, NC
| | - Kay C. Kyllonen
- Department of Pharmacy (KCK), Cleveland Clinic Children’s Hospital, Cleveland, OH
| | - Dmitry Tumin
- Department of Pediatrics (JG-H, DT), Brody School of Medicine at East Carolina University, Greenville, NC
| | - Ricardo J. Rodriguez
- Department of Pediatric (RJR), Atrium Health Wake Forest Brenner Children’s Hospital, Winston Salem, NC
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27
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Hairr M, Tumin D, Greene E, Ledoux M, Longshore S. Facility Size and Risk Factors for Mortality in Pediatric Trauma. Am Surg 2023; 89:4508-4520. [PMID: 35977917 DOI: 10.1177/00031348221121555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric trauma outcomes can vary across facilities, yet evidence on the relationship between facility bed size and pediatric trauma outcomes has been mixed. We aimed to identify how facility bed size might modify the impact of patient-level risk factors on mortality in pediatric trauma. We hypothesized that patient-level risk factors would have a stronger association with mortality at smaller trauma centers, and a weaker association with mortality at larger centers. METHODS We used deidentified data obtained from the 2017-2018 Trauma Quality Programs registry, including patients ages 0-18 years of age who were admitted to the hospital. The primary outcome was in-hospital mortality. Facility bed size was dichotomized as large (>600 beds) vs small/medium (≤600 beds). Sensitivity analyses used 200 and 400 beds as alternative cutoffs. Interaction between facility bed size and patient characteristics was assessed using unadjusted logistic regression, with statistically significant interactions entered in a final, fully adjusted model. RESULTS The analysis included 171 810 patients (mean age 10 ± 5 years; 65%/35% male/female), including 28% treated in a large hospital and 1.2% who died during the hospitalization. Controlling for trauma center level (or subsetting to pediatric trauma centers only), larger bed size did not reduce mortality risk associated with patient characteristics such as injury mechanism, injury severity, or patient demographics. CONCLUSIONS Contrary to our hypothesis, greater facility bed size was not associated with reduced mortality risk associated with patient characteristics. Future studies are needed to identify hospital practices or characteristics that can attenuate the excess risk of known patient-level risk factors.
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Affiliation(s)
- Marsha Hairr
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | | | - Matthew Ledoux
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Shannon Longshore
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
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Peace J, Pooleri A, Frech A, Tumin D. Socioeconomic Characteristics Associated With the Development of Chronic Pain After Pain Interference Experienced in Early Adulthood. Clin J Pain 2023; 39:628-633. [PMID: 37440352 DOI: 10.1097/ajp.0000000000001149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Predictors of pain persistence have been identified among patients undergoing treatment for chronic pain or related conditions, but correlates of pain persistence in the general population remain underexplored. We identify socioeconomic variables associated with pain onset or persistence over a 6 to 10 year period in a nationally representative cohort. METHODS Using panel data from the National Longitudinal Survey of Youth-1997, we examined the presence of pain interference at age 29 and chronic pain at ages 35 to 39. Persistent pain was defined as pain present at both interview time points; new-onset pain was defined as pain not reported at age 29, but present at ages 35 to 39; and transient pain was defined as experiencing pain interference at age 29 with no report of chronic pain at ages 35 to 39. RESULTS Based on a sample of 6188 participants, we estimated that 4% experienced persistent pain, 11% experienced transient pain, and 7% experienced new-onset pain. Pain persistence was less likely among non-Hispanic Black respondents but more likely among formerly married respondents and those with poor health, health-related work limitation, or greater pain interference at the age 29 baseline. New-onset pain was most likely among female respondents, respondents with some college education, and respondents with poor self-rated health or obesity at baseline. DISCUSSION Development of chronic pain by the mid-late 30s was common among young adults experiencing pain interference at age 29. Race/ethnicity, gender, and educational attainment exhibited different associations with persistence as compared with new onset of pain problems.
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Affiliation(s)
- Jordan Peace
- Brody School of Medicine at East Carolina University
| | - Anand Pooleri
- ECU Health
- Department of Physical Medicine and Rehabilitation, Brody School of Medicine at East Carolina University
| | | | - Dmitry Tumin
- Department of Academic Affairs Brody School of Medicine at East Carolina University, Greenville NC
- Department of Social Medicine, Heritage College of Medicine at Ohio University-Cleveland campus, Cleveland OH
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Taylor K, Havinga J, Moore B, Tumin D, Bear K. Social Media as a Source of Medical Information for Parents of Premature Infants: A Content Analysis of Prematurity-Related Facebook Groups. Am J Perinatol 2023; 40:1629-1637. [PMID: 34666397 DOI: 10.1055/s-0041-1736539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Parents are increasingly turning to social media for medical recommendations. Our objective was to systematically examine posts on Facebook for parents of infants hospitalized in the neonatal intensive care unit (NICU) to analyze how advice on medical topics was requested and given, and whether this advice was potentially medically inappropriate. STUDY DESIGN One hundred Facebook groups were screened for study eligibility. In each group, up to 400 posts on medical topics were evaluated. The first 10 comments of each post were classified based on content and presence of medical advice. Appropriateness of advice was evaluated by a neonatologist. RESULTS Of 28 groups meeting study criteria, 10 permitted access for data collection. We identified 729 posts requesting medical advice of which 29% referenced the NICU period. Posts on diagnosis and development (30 and 32% of posts, respectively) were the most common topics, and most likely to receive advice (78 and 76% of posts on these topics, respectively). We identified 238 comments containing potentially inappropriate medical advice and 30 comments recommending going against medical advice. CONCLUSION Parents are utilizing Facebook as a source of support and medical information. Parents are most likely to give development-related advice from their own parenting experiences. The high percentage of posts requesting advice about diagnosis and development in the post-NICU stage suggests parents seek increased anticipatory guidance. KEY POINTS · Parents of premature infants use Facebook to obtain medical advice.. · Advice was at times potentially medically inappropriate.. · Much advice focused on the post-NICU period..
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Affiliation(s)
- Katherine Taylor
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Jaclyn Havinga
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina
- Division of Neonatology, Vidant Medical Center, Greenville, North Carolina
| | - Brittney Moore
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Kelly Bear
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina
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Aikman I, Wright B, Applegate S, Whitfield A, Alachraf K, Sridhar S, Tumin D, Syed S. Specialty follow -up care after hospital discharge of patients with multisystem inflammatory syndrome in children associated with COVID-19 from a rural tertiary-care hospital. Pediatr Neonatol 2023:S1875-9572(23)00177-8. [PMID: 37926596 DOI: 10.1016/j.pedneo.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/23/2022] [Accepted: 05/19/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The clinical features of Multisystem Inflammatory Syndrome in Children (MIS-C) have been well documented, but there is limited data regarding the short term and longitudinal outcomes of children living in rural areas. We report the demographic and clinical features, as well as the multi-specialty follow-up of patients with MIS-C served by a large tertiary care rural health system. METHODS Patients that met the Centers for Disease Control (CDC) case definition of MIS-C admitted between March 1, 2020, and March 31, 2021, were included in this case series. Manual chart review was used to report demographic characteristics, clinical, laboratory and radiologic features during acute hospitalization and multispecialty follow-up, and adherence to follow-up 6-10 weeks after hospital discharge. RESULTS Twenty-one patients with MIS-C were admitted at our center during the review period. Ninety percent of the cohort required intensive care during hospitalization. Of 19 patients with measured ejection fractions, 52 % had some degree of left ventricular dysfunction on admission; nine patients had electrocardiogram changes on admission. The majority of patients had elevated inflammatory markers during hospitalization. Most patients had resolution of symptoms, improvement in inflammatory markers, and normal cardiac function at the time of discharge. Follow-up with pediatric cardiology, hematology-oncology and infectious disease was indicated for most patients at discharge. Of these, 100 % of patients kept initial follow-up appointments with pediatric cardiology and infectious disease, while 94 % kept initial follow-up appointments with pediatric hematology-oncology. CONCLUSION Though most patients were critically ill during hospitalization, the majority had resolution of cardiac abnormalities and inflammatory markers at discharge and timely follow-up with multiple subspecialists after admission with MIS-C.
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Affiliation(s)
- Inga Aikman
- Division of Pediatric Critical Care and Hospital Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA; James and Connie Maynard Children's Hospital, Vidant Medical Center, Greenville, NC, USA; Department of Pediatrics, East Carolina University Brody School of Medicine, Greenville, NC, USA.
| | - Brandon Wright
- Department of Pediatrics, East Carolina University Brody School of Medicine, Greenville, NC, USA; Vidant Medical Center, Graduate Medical Education, Greenville, NC, USA
| | - Stacey Applegate
- Department of Pediatrics, East Carolina University Brody School of Medicine, Greenville, NC, USA; Division of Pediatric Cardiology, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Andrea Whitfield
- Department of Pediatrics, East Carolina University Brody School of Medicine, Greenville, NC, USA; Division of Pediatric Hematology-Oncology, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Kamel Alachraf
- East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Sruthipriya Sridhar
- Division of Pediatric Critical Care and Hospital Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA; James and Connie Maynard Children's Hospital, Vidant Medical Center, Greenville, NC, USA; Department of Pediatrics, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Dmitry Tumin
- East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Salma Syed
- Department of Pediatrics, East Carolina University Brody School of Medicine, Greenville, NC, USA; Division of Pediatric Infectious Disease, East Carolina University Brody School of Medicine, Greenville, NC, USA
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Pasli M, Tumin D. Children's Special Health Care Needs and Caregivers' Well-Being During the COVID-19 Pandemic. J Am Board Fam Med 2023; 36:731-738. [PMID: 37775326 DOI: 10.3122/jabfm.2022.220406r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/09/2022] [Accepted: 06/05/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Caregivers of children with special health care needs (SHCN) report worse self-rated health when compared with caregivers of children without SHCN and have experienced significant stress during the COVID-19 pandemic. We sought to determine whether COVID-19 pandemic-era declines in well-being among caregivers of children with SHCN were steeper than among caregivers of children without SHCN. METHODS We used 2020 to 2021 (pandemic-era, n = 89,560) and 2018 to 2019 (pre-pandemic, n = 57,927) data from the National Survey of Children's Health. Caregiver-reported physical and mental health outcomes were analyzed using multivariable ordinal logistic regression. RESULTS The pandemic era was associated with 26% higher odds of reporting worse mental health among caregivers of children with SHCN (95% confidence interval [CI]: +16%, +38%), and 20% higher odds of reporting worse mental health among caregivers of children without SHCN (95% CI: +15%, +26%). The magnitudes of these changes were not significantly different from one another (P = .341). CONCLUSIONS Although caregivers of children with SHCN faced significant burdens and increased stress during the pandemic, decline in self-rated mental health among this group was similar to the trend seen among caregivers of children without SHCN.
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Affiliation(s)
- Melisa Pasli
- From the Brody School of Medicine at East Carolina University, Greenville NC (MP), Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville NC (DT).
| | - Dmitry Tumin
- From the Brody School of Medicine at East Carolina University, Greenville NC (MP), Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville NC (DT)
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32
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Tumin D, Whiteside JL. Competitiveness of Obstetrics and Gynecology Residency Programs and Applicants. Obstet Gynecol 2023; 142:994-995. [PMID: 37734104 DOI: 10.1097/aog.0000000000005376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Dmitry Tumin
- Department of Academic Affairs, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - James L Whiteside
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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33
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Gray C, Infante Linares JL, Cunningham K, Tumin D. Scholarly Productivity of US Medical Schools Before and During the COVID-19 Pandemic. South Med J 2023; 116:812-818. [PMID: 37788815 DOI: 10.14423/smj.0000000000001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVES The coronavirus disease 2019 pandemic profoundly disrupted scientific research but was accompanied by a rapid increase in biomedical research focused on this new disease. We aimed to study how the academic productivity of US medical schools changed during the pandemic and what structural characteristics of medical schools were associated with trends in scholarly publication. METHODS Annual totals of publications for each US Doctor of Medicine-granting medical school were extracted for 2019 to 2021 from the Scopus database, and schools were categorized a priori as experiencing a sustained increase in publications, a transient increase in publications, or no increase in publications. Bivariate tests compared school characteristics among these three groups. RESULTS Of 139 Doctor of Medicine-granting medical schools, 79% experienced sustained growth in publications from 2019 to 2021, 6% experienced transient growth, and 14% experienced no growth. Sustained growth in publications was associated with being affiliated with a research-intensive university, larger faculty size, the presence of an Emergency Medicine residency, having higher baseline National Institutes of Health funding, and experiencing higher coronavirus disease 2019 infection rates in the local community during the early months of the pandemic. Among predominantly White institutions, a higher diversity of female faculty was associated with a higher likelihood of experiencing transient rather than sustained growth in publications. CONCLUSIONS Our results demonstrate that scientific output increased during the pandemic at most medical schools, despite significant barriers to research experienced by individual investigators. Further attention is needed to enhance equity in research opportunities, considering diverging trends in productivity between more- and less-advantaged schools, however.
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Affiliation(s)
| | | | | | - Dmitry Tumin
- the Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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Barclay AB, Moran K, Tumin D, Nichols KR. Pro-Con Debate: Consideration of Race, Ethnicity, and Gender Is Detrimental to Successful Mentorship. Anesth Analg 2023; 137:747-753. [PMID: 37712465 DOI: 10.1213/ane.0000000000006502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Anesthesiology remains a specialty with low representation of women or members of racial and ethnic groups considered underrepresented in medicine (UiM). In the United States, women account for 33% of anesthesiology residents, while physicians identifying as Black, African American, Latinx, American Indian, or Alaska Native account for approximately 10%. Underrepresentation of these groups is even more pronounced in academic anesthesiology, especially at the senior ranks and roles, such as department chairs. Leaders in the field have recently shared recommendations for how individual departments, medical schools, hospitals, and professional organizations can create and support a more diverse anesthesiology workforce. These commentaries have often stressed the importance of mentorship for supporting women and physicians from UiM groups, including mentorship of trainees and practicing anesthesiologists seeking to advance their careers. While the value of mentorship is undisputed, it remains a matter of controversy whether race, ethnicity, or gender should be explicitly considered by mentoring programs and individual mentors. In this article, we discuss whether and how race, ethnicity, and gender should be considered in the setting of mentorship programs and the formation of individual mentoring relationships, as well as some of the potential consequences that lie therein.
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Affiliation(s)
- Alicia B Barclay
- From the Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kenneth Moran
- From the Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Dmitry Tumin
- Departments of Pediatrics
- Academic Affairs, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Kimberley R Nichols
- Department of Anesthesiology
- Office of Medical Student Education, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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35
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Mohseni Z, Tumin D, Collier DN, Taft N, Lazorick S. Longitudinal Patterns of Beverage Intake in Treatment-Seeking Children with Obesity in Eastern NC Using the Validated BEVQ-15. Nutrients 2023; 15:4171. [PMID: 37836455 PMCID: PMC10648911 DOI: 10.3390/nu15194171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Sugar-sweetened beverage (SSB) consumption remains a major target for interventions to treat severe obesity in children. Understanding how total energy consumption is divided among different types of beverages remains unclear. This study retrospectively examined how the consumption of beverage calories (kcal) from 100% fruit juice and SSBs, and body mass index, assessed as a percent of the 95th sex- and age-specific percentile (%of 95BMI), changed during the treatment of children with obesity aged 2-18 years. Treatment was provided by an integrative multi-disciplinary team, comprising a physician, a dietician/ nutritionist and a behavioralist employing motivational interviewing and a small change approach to promote improved sustainable health habits and induce a net negative energy balance. The sample included 155 patients, with 341 visits. The median age was 11 years, 60% were girls, and there was a median follow-up of 3.1 months. At baseline, the median %of 95BMI was 135 and the median kcal/day intake was 436 from juice and 263 from SSB. For each additional 100 kcal consumed/day from SSB and juice, the %of 95BMI increased by 1.4 percentage points. In the follow-up, each additional month was associated with 7 fewer kcal/day from SSB and juice combined, with a 0.5 percentage point increase in %of 95BMI. Children in this treatment program consumed fewer calories from SSB over time, although the %of 95BMI did not decrease. SSBs other than soda accounted for the majority of beverage kcal intake, therefore potentially providing a targeted direction for interventions.
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Affiliation(s)
- Zahra Mohseni
- Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA;
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (D.T.); (D.N.C.); (N.T.)
| | - David N. Collier
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (D.T.); (D.N.C.); (N.T.)
| | - Natalie Taft
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (D.T.); (D.N.C.); (N.T.)
| | - Suzanne Lazorick
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (D.T.); (D.N.C.); (N.T.)
- Department of Public Health, Brody School of Medicine, East Carolina University, 115 Heart Dr, Mailstop 660, Greenville, NC 27834, USA
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36
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Tumin D, Crotty J, Aikman I, Leonard S. Cost and effectiveness in fostering resident physician scholarly activity. Can Med Educ J 2023; 14:140-141. [PMID: 37719394 PMCID: PMC10500395 DOI: 10.36834/cmej.76300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, North Carolina, USA
| | - Jennifer Crotty
- Department of Pediatrics, Brody School of Medicine, East Carolina University, North Carolina, USA
| | - Inga Aikman
- Department of Pediatrics, Brody School of Medicine, East Carolina University, North Carolina, USA
| | - Sarah Leonard
- Department of Pediatrics, Brody School of Medicine, East Carolina University, North Carolina, USA
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Aluko B, Mitchell AN, Tumin D, Zeldin E. Nation-wide decrease in the prevalence of pediatric chronic pain during the COVID-19 pandemic. Scand J Pain 2023; 23:608-612. [PMID: 36450241 DOI: 10.1515/sjpain-2022-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/10/2022] [Indexed: 07/21/2023]
Abstract
OBJECTIVES The COVID-19 pandemic was expected to increase prevalence and severity of chronic pain. We compared pandemic-era and pre-pandemic prevalence of chronic pain among children in the US. METHODS Data were obtained from the 2019 and 2020 National Survey of Children's Health, a web-or mail-based survey representative of children living in the US (n=20,359 in 2019; 29,159 in 2020). Caregiver-reported prevalence of chronic pain was compared between survey years using bivariate and multivariable methods. RESULTS The prevalence of chronic pain among US children decreased from 11 to 8% in the first year of the pandemic. Multivariable analysis adjusting for children's and caregivers' demographics and socioeconomic characteristics confirmed that in 2020, odds of caregiver-reported chronic pain declined by 33% (95% confidence interval: 23%, 42%; p<0.001). CONCLUSIONS The encouraging finding of a nationwide decrease in the prevalence of chronic pain calls into question initial predictions anticipating the pandemic to contribute to onset or persistence of chronic pain among children.
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Affiliation(s)
- Boluwatife Aluko
- Brody School of Medicine at East Carolina University, Greenville, USA
| | | | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, USA
| | - Evan Zeldin
- Department of Physical Medicine & Rehabilitation, Brody School of Medicine at East Carolina University, Greenville, USA
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Buckman C, Flowers A, Syed S, Tumin D. Gender Differences in Research Productivity of Academic Physicians Before and During the COVID-19 Pandemic. J Womens Health (Larchmt) 2023; 32:801-807. [PMID: 37204314 DOI: 10.1089/jwh.2022.0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Objective: The gendered impact of the COVID-19 on scientific productivity has been primarily studied in nonclinical academic fields. We investigated the gendered effect of the pandemic on diverse measures of research participation among physician faculty, who experienced an increase in clinical duties concomitant with pandemic-era challenges to research. Materials and Methods: Physician faculty employed in both 2019 (prepandemic) and 2021 (pandemic era) were identified at one U.S. medical school. Annual outcomes included scientific publications, Institutional Review Board (IRB)-approved protocols, and extramural funding submissions (funding data were unavailable for 2019). Mixed-effects Poisson regression models compared the pandemic impact by gender. Results: The study included 105 women and 116 men, contributing to 122 publications, 214 IRB protocols, and 99 extramural funding applications. Controlling for potential confounders such as faculty rank and track (tenure vs. nontenure), women's publication count increased by 140% during the pandemic (95% confidence interval [CI]: +40% to +310%, p = 0.001) but was unchanged among men (95% CI: -30% to +50%; p > 0.999). The number of IRB protocols decreased from 2019 to 2021, but to a greater extent among men than women. In 2021, there was no gender difference in the number of extramural funding submissions. Conclusions: Among physician faculty at our medical school, women achieved parity with men on multiple measures of scholarly activity, and women's research productivity outpaced that of men in the same faculty track and rank. Targeted initiatives to support research among women faculty, junior investigators, and clinical investigators may have helped avert exacerbation of prepandemic gender disparities in research participation.
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Affiliation(s)
- Cierra Buckman
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Allison Flowers
- Office of Faculty Affairs and Leadership Development, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Salma Syed
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
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Campbell KM, Tumin D, Infante Linares JL, Porterfield L, Kisel T. Changing Missions of Medical Schools and Trends in Medical Student Diversity. Fam Med 2023; 55:481-484. [PMID: 37450940 PMCID: PMC10622066 DOI: 10.22454/fammed.2023.928475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Improving diversity in the physician workforce continues to be a challenge and a priority for medical schools. Establishing a school-wide mission statement that addresses diversity, equity, and inclusion can help support efforts to increase the number of underrepresented in medicine (URM) graduates. METHODS In this study, we analyzed changes in medical school mission statements between 2013 and 2021 and correlated changes in mission statements with trends in URM student representation. We performed a web search of 136 medical schools' mission statements and categorized them based on whether they changed their mission statement to add diversity or equity language. We then obtained demographic data of enrolled students at each school and identified the percentage of students identifying as URM in each academic year. We used mixed-effects regression and pair fixed effects linear regression to examine trends in URM student representation and the association between URM student representation and whether a school added diversity and equity content to its mission statement. RESULTS We found that URM student representation increased by 0.4% per year at schools that added diversity and equity content to their mission statements. CONCLUSIONS Changing medical schools' mission statements to reflect values of diversity, equity, and inclusion was associated with an increase of less than a 1% per year in URM representation. More research is needed to explore relationships between URM representation and medical school mission statements.
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Affiliation(s)
| | | | | | | | - Tibor Kisel
- The University of Texas Medical BranchGalveston, TX
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40
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Muhammad M, Vang J, Tumin D. Association of Gaps in Health Insurance Coverage With Unmet Needs for Vision Care Among Adults in Ohio. JAMA Ophthalmol 2023; 141:488-492. [PMID: 37052915 PMCID: PMC10102916 DOI: 10.1001/jamaophthalmol.2023.0847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/16/2023] [Indexed: 04/14/2023]
Abstract
Importance Access to vision care is vital to diagnose and treat vision impairment and diseases. Previous studies found that currently uninsured adults have limited access to vision care. It is unclear whether a recent history (past 12 months) of gaps in insurance coverage likewise adversely affects access to vision care. Objective To determine whether gaps in insurance coverage within the past 12 months are associated with higher risk of unmet needs for vision care among adults in Ohio. Design, Setting, and Participants This cross-sectional study analyzed data for adults in Ohio from the 2021 Ohio Medicaid Assessment Survey (OMAS), which is conducted via web, telephone, and mail. Participants were residents 19 years or older who reported needing vision care or eyeglasses within the past 12 months. Exposures Insurance coverage over the past 12 months, classified as continuous private, continuous public, gap in coverage, or year-round uninsured. Main Outcomes and Measure Self-reported unmet need for vision care over the past 12 months. Results Based on a sample of 19 036 participants, we calculated that 4% of adults experienced recent coverage gaps (weighted total in the population, 180 259 of 4 518 841) while another 4% were year-round uninsured (187 552 adults). Unmet needs for vision care were reported by 13% (590 015 adults). On multivariable logistic regression, adults with gaps in coverage were at a higher risk of unmet vision care needs compared with adults who had continuous private coverage (odds ratio [OR], 2.9; 95% CI, 2.1-3.9; P < .001) or continuous public coverage (OR, 1.7; 95% CI, 1.3-2.4; P = .001). Conclusions and Relevance This study found that gaps in health insurance coverage were associated with increased risk of unmet vision care needs among adults in Ohio compared with continuous private or public coverage. Policies that protect the continuity of health insurance coverage may help reduce the rate of unmet needs for vision care.
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Affiliation(s)
- Mufida Muhammad
- Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Johnny Vang
- Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina
- Department of Academic Affairs, Brody School of Medicine at East Carolina University, Greenville, North Carolina
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Urbik V, Mohseni Z, Tumin D, Longshore S. In-person school attendance and adolescent exposure to injury-related risk behaviors during the COVID-19 pandemic in the United States. Prev Med 2023; 171:107502. [PMID: 37031909 PMCID: PMC10079588 DOI: 10.1016/j.ypmed.2023.107502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/11/2023]
Abstract
School closures during the COVID-19 pandemic have been reported to influence adolescents' behavioral health and may have altered their exposure to injury risk. We aimed to determine how in-person school attendance of individual adolescents in the United States during the pandemic was correlated with a range of risky health behaviors. We used self-reported data from adolescents 14-18 years old enrolled in grades 9-12 who participated in the 2020 Adolescent Behaviors and Experiences Survey. The exposure of interest was in-person vs remote school attendance in the previous 30 days. Risk behavior outcomes included not wearing a seatbelt when riding in a car; riding with someone who was drinking and driving; suffering intimate partner violence (IPV); forced sexual encounters; suicidal ideation; suicidal planning; electronic bullying; gun carrying; and physical fighting. Based on a multivariable analysis of 5202 students (65% attending school in-person) adjusted for age, sex, race, ethnicity, sexual orientation, parental unemployment, food insecurity, and homelessness, we found that in-person school attendance was associated with increased odds of every risk behavior except suicidal ideation and electronic bullying, with adjusted odds ratios ranging from 1.40 (95% confidence interval [CI]: 1.04, 1.88) for not wearing a seatbelt to 3.43 for IPV (95% CI: 1.97, 5.97). Our analyses demonstrate that in-person school attendance during the COVID-19 pandemic was associated with higher rates of risk behavior among adolescents. Further research is needed explore if this relationship is causal, and how these risks could be mitigated, as most adolescents have now returned to in-person schooling.
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Affiliation(s)
- Veronica Urbik
- Department of Pediatrics, Emory University, Atlanta, GA, United States of America.
| | - Zahra Mohseni
- Brody School of Medicine at East Carolina University, Greenville, NC, United States of America
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, United States of America
| | - Shannon Longshore
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, United States of America
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Whiteside JL, Tumin D, Hohmann SF, Harris A. Determinants of Cost for Outpatient Hysterectomy for Benign Indications in a Nationwide Sample. Obstet Gynecol 2023; 141:765-772. [PMID: 36897129 DOI: 10.1097/aog.0000000000005109] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/22/2022] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To identify surgeon-level variation in cost to produce an outpatient hysterectomy for benign indications in the United States. METHODS A sample of patients undergoing outpatient hysterectomy in October 2015 to December 2021, excluding those with a diagnosis of gynecologic malignancy, was obtained from the Vizient Clinical Database. The primary outcome was total direct hysterectomy cost, which is a modeled cost to produce care. Patient, hospital, and surgeon covariates were analyzed with mixed-effects regression, which included surgeon-level random effects to capture unobserved differences influencing cost variation. RESULTS The final sample included 264,717 cases performed by 5,153 surgeons. The median total direct cost of hysterectomy was $4,705 (interquartile range $3,522-6,234). Cost was highest for robotic hysterectomy ($5,412) and lowest for vaginal hysterectomy ($4,147). After all variables were included in the regression model, approach was the strongest of the observed predictors, but 60.5% of the variance in costs was attributable to unexplained surgeon-level differences, implying a difference in costs between the 10th and 90th percentiles of surgeons of $4,063. CONCLUSION The largest observed determinant of cost to produce an outpatient hysterectomy for benign indications in the United States is approach, but differences in cost are attributable primarily to unexplained differences among surgeons. Standardization of surgical approach and technique and surgeon awareness of surgical supply costs could address these unexplained cost variations.
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Affiliation(s)
- James L Whiteside
- Department of Obstetrics and Gynecology and the Department of Pediatrics, East Carolina University, Brody School of Medicine, Greenville, North Carolina, and Vizient Inc, Center for Advanced Analytics and Informatics, and the Department of Health Systems Management, Rush University, Chicago, Illinois
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Mannarino S, Tumin D, Kyle BN, Charles S. Educating Physicians for Competence in Caring for LGBTQ+ Patients. South Med J 2023; 116:373-375. [PMID: 37011589 DOI: 10.14423/smj.0000000000001536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
| | | | - Brandon N Kyle
- the Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University, Greenville
| | - Stephen Charles
- the Department of Education, Innovation, and Technology, Baylor College of Medicine, Temple, Texas
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Pooleri A, Yeduri R, Horne G, Frech A, Tumin D. Pain interference in young adulthood and work participation. Pain 2023; 164:831-837. [PMID: 36048525 DOI: 10.1097/j.pain.0000000000002769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/22/2022] [Indexed: 11/27/2022]
Abstract
ABSTRACT Chronic pain is associated with reduced work participation, but longitudinal data on the work impact of chronic pain are limited. We used data from the National Longitudinal Survey of Youth-1997 cohort to analyze how pain interference in early adulthood was associated with subsequent exit from the labor force in a longitudinal survey. Pain interference at age 29 and employment status were self-reported at subsequent biennial interviews. Exit from the labor force, return to employment, and development of new health-related work limitations after age 29 were analyzed using survival analysis methods. Among 5819 respondents, 10% and 3% endorsed "a little" or "a lot" of pain interference at age 29, respectively. During follow-up (median of 26 months until censoring or labor force exit), 43% of respondents had exited the labor force at least once and 10% developed a new work-related health limitation. The highest pain interference group (compared with no pain interference) had higher hazard of labor force exit (hazard ratio: 1.26; 95% confidence interval: 1.01-1.57; P = 0.044) and of developing new health-related work limitations (hazard ratio: 2.45; 95% confidence interval: 1.64-3.67; P < 0.001), with similar results for the group experiencing "a little" pain interference at age 29. In this nationally representative cohort, any level of pain interference reported at age 29 was found to predict increased hazards of subsequent labor force exit and health-related work limitation. Early identification and treatment of pain problems among young workers can help reduce burdens of future unemployment and disability.
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Affiliation(s)
- Anand Pooleri
- Department of Physical Medicine and Rehabilitation, Brody School of Medicine at East Carolina University, Greenville, NC, United States
| | - Rishita Yeduri
- Brody School of Medicine at East Carolina University, Greenville, NC, United States
| | - Gabrielle Horne
- Department of Sociology, East Carolina University, Greenville, NC, United States
| | - Adrianne Frech
- Department of Health Sciences, University of Missouri, Columbia, MO, United States
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, United States
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Campbell KM, Bright CM, Corral I, Tumin D, Linares JLI. Increasing Underrepresented Minority Students in Medical School: a Single-Institution Experience. J Racial Ethn Health Disparities 2023; 10:521-525. [PMID: 35088390 DOI: 10.1007/s40615-022-01241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Underrepresented minority student recruitment initiatives from medical school admissions and diversity offices can bring equity for those learners underrepresented in medicine. Measuring growth of the applicant pool helps determine the impact of such initiatives in helping diversify the healthcare workforce. AIM The authors evaluated underrepresented minority applicant pool growth at the Brody School of Medicine to determine whether predominantly White institutions or historically Black colleges and universities have accounted for the most growth in minority applicants in recent years. METHODS Outreach outcomes across the state were obtained by comparing applicant and matriculant demographics. Data on all applicants and matriculants were retrieved from the school's institutional records and classified according to student self-identification as underrepresented minority. Using Chi-square tests, authors aimed to determine whether the proportion of minority students increased among applicants and matriculants since 2016, the year of restructuring outreach. In further analysis, the number of graduates from historically Black colleges and universities as compared to minority graduates from predominantly White schools was evaluated. RESULTS The authors identified 7,848 applicants and 654 matriculants over the evaluation period. The proportion of learners identifying as underrepresented minority increased from 17% before 2016 (622/3,672) to 20% after 2016 (835/4,176; p = 0.001). The proportion of applicants who did not graduate from a historically Black college or university increased slightly after 2016 (89% of underrepresented minority applicants before 2016 vs. 92% of underrepresented minority applicants after 2016), but this increase was not statistically significant (p = 0.097). CONCLUSION Applicant growth has been more significant for underrepresented minority applicants from predominantly White institutions. Graduates of targeted historically Black colleges and universities who applied to Brody School of Medicine were better prepared, resulting in increased chances of admission.
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Affiliation(s)
- Kendall M Campbell
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, 77555, USA.
| | - Cedric M Bright
- Department of Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, 27858, USA
| | - Irma Corral
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, 27858, USA
| | - Dmitry Tumin
- Department of Pediatrics, Assistant Dean of Clinical and Educational Scholarship, Division of Academic Affairs, Brody School of Medicine, East Carolina University, Greenville, NC, 27858, USA
| | - Jhojana L Infante Linares
- Office of Data Analysis and Strategy, Division of Academic Affairs, Brody School of Medicine, East Carolina University, Greenville, NC, 27858, USA
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Mulkey M, Baggett AB, Tumin D. Readiness for transition to adult health care among US adolescents, 2016-2020. Child Care Health Dev 2023; 49:321-331. [PMID: 35993998 PMCID: PMC10087515 DOI: 10.1111/cch.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Adolescence is a critical period of transition from paediatric to adult health care, but readiness for this transition has been described as low in the general adolescent population. We aimed to investigate whether transition readiness improved over time among US adolescents and to examine associations between demographic and clinical characteristics and transition readiness over time. METHODS Deidentified caregiver-reported repeated cross-sectional data from the 2016-2020 National Survey of Children's Health were analysed for caregiver-reported measures of transition readiness among adolescents age 12-17 years. Logistic regression was used to identify trends in transition readiness and change over time in factors associated with this outcome. RESULTS Among 55 022 adolescents represented in the five survey years, the proportion meeting a composite definition of transition readiness increased from 15% (95% confidence interval [CI]: 14%, 16%) in 2016 to 19% (95% CI: 17%, 20%) in 2020. After multivariable adjustment, each additional year was associated with 12% greater odds of caregiver-reported transition readiness (95% CI: +8%, +15%; P < 0.001), and transition readiness was more likely for girls, older adolescents and adolescents with special health care needs. Associations between adolescent characteristics and transition readiness did not change over the study period. CONCLUSIONS Population-level caregiver-reported transition readiness among US adolescents has increased but remains low. Factors previously associated with transition readiness (age, sex, race and ethnicity, family income and presence of special health care needs) have persisted over recent years.
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Affiliation(s)
- Mackenzie Mulkey
- Department of Anthropology, East Carolina University, Greenville, North Carolina, USA
| | - A Brooke Baggett
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.,ECU Health Medical Center, Greenville, North Carolina, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
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Larkins MC, Khanchandani A, Tumin D, Greene E, Ledoux M, Longshore S. Outcomes of farm compared to nonfarm pediatric injuries: A propensity-matched analysis. J Rural Health 2023; 39:383-391. [PMID: 36076339 DOI: 10.1111/jrh.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Pediatric farm-related injuries are rare but tend to be severe relative to other types of pediatric injury and may result in worse clinical outcomes. However, the comparison of farm and nonfarm injuries is confounded by different injury mechanisms, patient characteristics, and treating facilities. Therefore, we used propensity score matching to compare outcomes of pediatric farm and nonfarm injuries in the United States. METHODS Data were obtained from the 2017-2019 Trauma Quality Program database. Farm as compared to nonfarm injury was defined as the location of an injury and served as the independent variable analyzed in this study. The outcome variables analyzed were in-hospital mortality, hospital length of stay (LOS), and admission to the intensive care unit (ICU). RESULTS We identified 2,040 farm injuries and 201,865 nonfarm injuries meeting inclusion criteria. In this cohort, the mortality rate was 1%, median LOS was 2 days, and 14% of patients were admitted to the ICU. In the propensity-matched analysis (including 2,039 farm cases matched to 2,039 nonfarm controls), farm as compared to nonfarm injuries were associated with 5% longer LOS (95% CI: 1%, 8%; P = .01), but not mortality or ICU admission. CONCLUSIONS In a propensity-matched analysis, pediatric farm injuries resulted in prolonged hospital stay compared to nonfarm injuries. Identifying patient- and health care system-level factors contributing to prolonged LOS may help optimize the care of children injured on farms.
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Affiliation(s)
- Michael C Larkins
- Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Ashish Khanchandani
- Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Erika Greene
- ECU Health Medical Center, Greenville, North Carolina, USA
| | - Matthew Ledoux
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Shannon Longshore
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
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Lancaster K, Tumin D, Campbell KM. Changes in sick leave utilization at an academic medical center during the COVID-19 pandemic. IJWHM 2023. [DOI: 10.1108/ijwhm-02-2022-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PurposeThe coronavirus disease 2019 (COVID-19) pandemic drastically changed work arrangements, but COVID-19's impact on employee leave utilization is unclear. The authors sought to understand how sick leave and vacation leave utilization changed during the pandemic among clinical and non-clinical departments at an academic medical center (AMC).Design/methodology/approachClinical departments were defined as work units with a primary mission of providing direct patient care. Per-person, per-month leave utilization data were obtained from the AMC's time-keeping system for 3 clinical departments and 4 non-clinical departments in the first 12 months of the pandemic and the preceding 12 months. Monthly data for each department were analyzed with mixed-effects regression.FindingsAvailable data represented 402 employees from 3 clinical departments and 73 employees from 4 non-clinical departments. The authors found no statistically significant change in sick leave utilization among either clinical or non-clinical departments. Vacation leave utilization decreased during the pandemic by 5.9 h per person per month in non-clinical departments (95% confidence interval [CI]: −8.1, −3.8; p < 0.001) and by 3.0 h per person per month in clinical departments (95% CI: −4.3, −1.7; p < 0.001).Originality/valueAmong employees in clinical departments, the authors found no increase in sick leave utilization and a decrease in vacation utilization. These findings are concerning for presenteeism, risk of burnout or understaffing resulting in workers' inability to take time away from work in clinical departments.
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Manns PZ, Buckman C, Tumin D, Mathai A, Dendy C. Rural Perspectives on Health Services for Transgender and Gender Diverse Youth. Health Promot Pract 2023:15248399221146805. [PMID: 36644838 DOI: 10.1177/15248399221146805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
As the world grows more diverse, physicians and public health practitioners must become adept at providing care to everyone, including people who identify as transgender or gender diverse (TGD). Although this population is growing in all age demographics, there is a large increase in young TGD individuals who require pediatric health care providers to improve their practices. While a few comprehensive care clinics have been established to serve the TGD community, they are mostly located in urban areas. In addition to the unique barriers faced by rural TGD youth, providers must care for their patients with limited resources. In this commentary, we offer a set of recommendations to improve provider education, build connections between the health system and community, address the fragmentation of health services in rural areas and improve the transition from pediatric to adult health care.
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Affiliation(s)
- Perice Z Manns
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Cierra Buckman
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Angie Mathai
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Colby Dendy
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
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Eubanks J, Tumin D, Peedin L. Prematurity, birth weight, and access to a medical home among school-aged children in the US: A cross-sectional survey. International Journal of Care Coordination 2023. [DOI: 10.1177/20534345231151222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction Prematurity and low birth weight (LBW) are associated with higher health care needs and higher health care utilization in the first few years of life. The aim of this cross-sectional study was to determine how prematurity and LBW were correlated with access to a medical home later in childhood, at ages 6–17 years. Methods Data were analyzed from the 2016–2018 National Survey of Children's Health. Non-institutionalized US children 6–17 years of age who had been born preterm were classified as very low birth weight (VLBW, <1500 g), LBW (1500–2500 g), and normal weight (NBW, >2500 g). Term-born NBW children were included as a reference group. Medical home access was determined according to caregiver report. Results The analysis included 64,597 infants (preterm VLBW n = 737; preterm LBW n = 2869; preterm NBW n = 3942; and term NBW n = 57,049). Based on this sample, 44% of children ages 6–17 years were estimated to receive care meeting the criteria of a medical home. On multivariable analysis, none of the preterm groups had higher likelihood of receiving care in a medical home compared to children born at term and NBW (odds ratios ranging from 0.75 to 0.95). Conclusions School-aged children born preterm and LBW were equally or less likely to receive care meeting the criteria of a medical home than children born at term and NBW. Although prematurity and LBW are associated with increased health care use early in the life course, this does not appear sufficient to help children establish and maintain access to a medical home.
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Affiliation(s)
- Jessica Eubanks
- Department of Pediatrics, Brody School of Medicine at East Carolina University (ECU), Greenville, NC, USA
- James and Connie Maynard Children's Hospital, ECU Health Medical Center, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University (ECU), Greenville, NC, USA
| | - Leslie Peedin
- Department of Pediatrics, Brody School of Medicine at East Carolina University (ECU), Greenville, NC, USA
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