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Abstract Background Language barriers play significant roles in quality of healthcare. Limited studies have examined the relationships between Spanish language and quality of intrapartum care. The objective was to determine the association between primary Spanish language and quality of intrapartum care so as to further inform best practices for non-English speaking patients in the labor and delivery setting. Methods We used the 2016 Listening to Mothers in California survey data, which included a statewide representative sample of women who gave birth in hospitals. Our analytical sample included 1202 Latina women. Multivariable logistic regression was used to examine the association between primary language (monolingual English vs. monolingual Spanish vs. bilingual Spanish/English) and perceived discrimination due to language, perceived pressure for medical interventions, and mistreatment during labor, adjusting for maternal sociodemographics and other maternal and neonatal factors. Results Over one-third of the study population spoke English (35.6%), less than one-third spoke Spanish (29.1%), and greater than one-third spoke bilingual Spanish/English (35.3%). Overall, 5.4% of Latina women perceived discrimination due to language spoken, 23.1% perceived pressure for any medical intervention, and 10.1% experienced either form of mistreatment. Compared to English-speakers, Spanish-speakers were significantly more likely to report discrimination due to language (aOR 4.36; 95% CI 1.15–16.59), but were significantly less likely to experience pressure for certain medical interventions (labor induction or cesarean delivery) during labor (aOR 0.34; 95% CI 0.15–0.79 for induction; aOR 0.44; 95% CI 0.18–0.97 for cesarean delivery). Bilingual Spanish/English-speakers also significantly reported discrimination due to language to a lesser extent than monolingual Spanish-speakers (aOR 3.37; 95% CI 1.12–10.13). Any form of Spanish language (monolingual or bilingual) was not significantly associated with mistreatment. Conclusions Spanish language may contribute to experiences of discrimination during intrapartum care among Latina women. Future research is needed to explore perceptions of pressure, discrimination and mistreatment, among patients with limited English proficiency.

Burn care continues to improve and larger total body surface area (TBSA) burn survival is increasing. These survivors require more extensive care than smaller burns and are at higher risk for wound/scar-related complications. Prior work has shown low rates of follow-up for burn survivors linked to socioeconomic factors such as housing insecurity and substance use. There are limited studies that evaluate socioeconomic factors that contribute to follow-up and reconstructive surgery rates in massively burned patients. Patients who survived to discharge with >50% TBSA burns and planned return to the treating institution were included in the study. Univariate and multivariate analyses were performed on the data collected. Sixty-five patients were included with an average TBSA of 63.1%. Fifty-three patients (81.5%) attended at least one follow-up appointment with median of 4 follow-up appointments. Younger patients (33 ± 9 vs 44 ± 11; P = .0006), patients with larger TBSA burns (65 ± 13 vs 55 ± 5%; P = .02), those with private insurance, and those without housing insecurity (1.8% vs 45.4%; P = .003) were more likely to follow up. On multivariate regression analysis, patients with housing insecurity were independently associated with lack of follow-up (OR: 0.009; CI: 0.00001-0.57). Thirty-five patients had at least one reconstructive surgery and 31 patients had reconstructive surgery after discharge. No patients with housing insecurity underwent reconstructive surgery. Follow-up rates in massive burns were higher than reported for smaller TBSA burns and more than half received reconstructive surgery. Housing-insecure patients should be targeted for improved follow-up and access to reconstructive surgery., (Published by Oxford University Press on behalf of the American Burn Association 2024.)

Despite progress, breast cancer remains the most feared disease among women. In the USA alone, the incidence is now almost 300,000 new cancers per year, a rate that has nearly doubled in the last 30 years. Most women survive, but over 40,000 women a year still die of their disease National Cancer Institute [Internet]. [cited 2024 Nov 4]. Cancer of the Breast (Female) - Cancer Stat Facts. Available from: https://seer.cancer.gov/statfacts/html/breast.html. It is the most diagnosed cancer among women and the second leading cause of cancer death. Important disparities exist in breast cancer outcomes among African American women, where women die of breast cancer at higher rates, are diagnosed younger, and at a more advanced stage. We are proposing a radical shift in our thinking about breast cancer prevention with an aspiration to dramatically lower breast cancer incidence. Most breast cancers are driven by steroid hormones. Throughout the life course, women are offered an array of hormonal treatments for menstrual cycle control, family planning, in vitro fertilization, postpartum weaning, and menopausal symptom management. There are mixed data on the extent to which each of these may contribute to increased or decreased risk for breast cancer. These endocrine manipulations could represent a great opportunity to potentially reduce breast cancer incidence and improve quality of life for survivors. To date, they have not been designed to explicitly reduce breast cancer risk. A new holistic approach will require scientists, drug developers, breast oncologists, obstetricians, gynecologists, endocrinologists, radiologists, and family medicine/internists to work together toward the common goal of reducing breast cancer risk while addressing other critical issues in women's health., Competing Interests: Conflict of interest DY reports research funding from Boehringer Ingelheim and Fusion Pharmaceuticals; and is a consultant for Martell Diagnostics. CH reports institutional research funding from AstraZeneca, Gilead, Seagen/Pfizer and Olema; individual consulting fees for running ad boards, moderating lectures, speaking/presenting fees from AstraZeneca, Seagen/Pfizer, Gilead and Olema; and travel support from Olema. JG is an executive employee of Dana Faber Cancer Institute; participation on Fiduciary Board at American Association for Cancer Research; and participation on the Scientific Advisory Board at The James P. Wilmot Foundation, Inc. and Earli Inc. LE reports funding from Merck & Co.; participation on an advisory board for Blue Cross Blue Shield; and personal fees from UpToDate; unpaid board member of QLHC. All other authors declare no competing interests., (© 2024. The Author(s).)

Background: Almost half of all women in the US experience intimate partner violence (IPV) in their lifetime. The US Preventive Services Task Force recommends IPV screening paired with intervention for women of reproductive age. We aim to understand clinical practices and policies that are beneficial, detrimental, or insufficient to support survivors of IPV in a safety-net healthcare system., Methods: We sampled 45 women who were 18-64 years old, had experienced IPV within the prior year and were patients in the San Francisco Health Network. We conducted in-depth, semi-structured interviews to elicit their perspectives on disclosing IPV and obtaining support within the healthcare system. We analyzed our data using thematic analysis and grounded theory practices informed by ecological systems theory., Findings: We identified four themes regarding factors that impeded or facilitated discussing and addressing IPV across interpersonal and systemic levels relating to relationship-building, respect, autonomy and resources. (1) Interpersonal barriers included insufficient attention to relationship-building, lack of respect or concern for survivor circumstances, and feeling pressured to disclose IPV or to comply with clinicians' recommended interventions. (2) Interpersonal facilitators consisted of patient-centered IPV inquiry, attentive listening, strength-based counseling and transparency regarding confidentiality. (3) Systemic barriers such as visit time limitations, clinician turn-over and feared loss of autonomy from involvement of governmental systems leading to separation from children or harm to partners, negatively affected interpersonal dynamics. (4) Systemic facilitators involved provision of resources through IPV universal education, on-site access to IPV services, and community partnerships., Conclusions: Women experiencing IPV in our study reported that relationship-building, respect, autonomy, and IPV-related resources were essential components to providing support, promoting safety, and enabling healing in the healthcare setting. Successful trauma-informed transformation of healthcare systems must optimize interpersonal and systemic factors that improve survivor wellbeing while eliminating barriers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Aims: Interprofessional education (IPE) is an accreditation requirement in many health professional programs. A semester-long community-based stroke support group was designed with participation from faculty and health professional students in the occupational therapy, physical therapy, speech and language pathology, and therapeutic recreation programs. Objectives centered on measuring student perception of stroke and interprofessional collaboration., Methods: A mixed-methodology using a concurrent triangulation design included a faculty developed pretest-posttest survey and focus group. The Student Perceptions of Interprofessional Clinical Education Revised (SPICE-R2) was given in the final two semesters., Results: 45 students were involved in the program from 2016 to 2019. Findings were significant for all items on the pretest- posttest survey indicating students improved on their perception of stroke, the roles of other professions, and the value of interprofessional teamwork and team-based practice. Thematic analysis revealed that students identified the differences in stroke impact among participants and the importance of using a team approach in meeting participants' goals., Conclusion: Faculty and student participation in IPE delivery models coupled with perceived community benefit may positively impact program sustainability and improve student perceptions of interprofessional collaboration.

Aims: Faculty in the healthcare professions are engaging their students in a variety of interprofessional education (IPE) experiences. One such experience is a one-time IPE event, performed over 2 consecutive years by 2 different cohorts, involving 342 students in occupational therapy, physical therapy, speech-language pathology, and therapeutic recreation. The aim was to provide students with the opportunity to learn about the impact of a stroke, the rehabilitation process, the rehabilitation team and their own profession, as well as incorporating the Core Competencies for Interprofessional Collaborative Practice., Methods: The event had 3 separate components: a small group discussion on a pre-assigned case of a patient who had a stroke, a patient panel, and a clinician panel., Results: All answers to the survey questions taken by students who attended the IPE event improved significantly at posttest (p<0.001). The IPE event was well received by the students (89.0% reported that the overall experience was good-excellent)., Conclusion: This one-time event involving four health professions was successful in exposing the students to IPE.

Whether children should be offered genetic testing for cancer risk is much debated but young voices are rarely heard in these conversations. The current study explored perspectives of genetic testing held by adolescents and emerging adults in families with Li Fraumeni syndrome (LFS). Twelve 12- to 25-year-olds in families with LFS completed qualitative interviews for this study. All believed that testing should be offered for children but many qualified this statement saying parental approval would be needed and testing should be optional. Genetic testing was seen as way to learn of risk status, allow for disease prevention efforts, and reduce uncertainty and anxiety. Perceived disadvantages included negative emotions associated with the testing result. Participants generally felt that children should be involved in the testing decision, but that parents could unilaterally decide to have a child tested in certain circumstances (e.g., young age, high risk). All who were aware of having been tested and of their test result (n = 7; 4 positive) said testing had no negative impact on their outlook and they agreed with the decision to undergo testing. Implications of these findings for clinical practice and future research are discussed.

Introduction: To enhance the quality of neurosurgery consultations, triage, and transport decisions between a Level I trauma service neurosurgery program at the University of New Mexico Hospital and referring hospitals, a secure Health Insurance Portability and Accountability Act (HIPAA)-compliant Web-based system was developed, to which digital neurological images could be sent for review by a neurosurgeon for consultation or patient transfer. Based upon prior experience of neurosurgery, it was predicted that 25% of transfer requests would be avoided if the neurosurgeons reviewed the computerized tomography scans at the time of a transfer request. In addition, it was predicted in 25% of the case that changes in management recommendations would take place independent of the transfer decision., Methods: The program was designed to allow referring hospitals to transmit digital images to the Web site, providing consulting doctors with additional patient information. This project analyzed the neurosurgeons' responses to questions designed to determine if transport or management decisions were altered when using this telehealth program in response to a request for consultation or transfer from a rural facility., Results: Analysis of the responses of the consulting neurosurgeons revealed that, after viewing the images, 44% of the potential transfers were avoided and 44% of consulted cases resulted in management recommendation changes independent of the transfer decision., Conclusions: Use of the system resulted in improved triage and changes in transfer or management recommendations. A significant number of potential transfers were avoided, resulting in transport cost avoidance, more effective use of resources, and more appropriate use of the neurosurgery service as well as improved patient preparation.

Sediment, water, and fish gut samples taken at three sites near the headwaters of the San Marcos River, Texas, were analyzed for salmonellae Salmonella spp. by culture and molecular techniques. While enrichment cultures from sediment and water samples from the two uppermost sites were negative for salmonellae in polymerase chain reaction analyses, both sediment and water samples were positive at the downstream site. At all sites, salmonellae were present in the guts of different fishes (e.g., largemouth bass Micropterus salmoides, channel catfish Ictalurus punctatus, common carp Cyprinus carpio, and suckermouth catfish Hypostomus plecostomus). The highest percentage of detection (33% of analyzed fish) occurred at the downstream site, whereas detection percentages at the upper two sites were 18% and 17%. Detection of salmonellae was usually limited to one segment of the gut (i.e., upper or lower part). Serovars were highly variable among individuals and differed between the upper and lower gut in the only individual (a common carp) that had salmonellae in both gut segments. In situ hybridization demonstrated that salmonellae were normally associated with particulate material in the gut and occurred in highly variable numbers ranging from an occasional organism to a majority of the gut microbe population. These results demonstrate the presence of different serovars of potentially human pathogenic salmonellae among four ecologically distinct fishes within natural environments. They also suggest that salmonellae are not components of the indigenous microbial community in fish intestines but rather are ingested with particulate material.