Joshua Fogel

Introduction and Hypothesis Misconceptions about pelvic organ prolapse occur among Hispanic women. We develop and validate a novel scale measuring misconceptions about pelvic organ prolapse (POP) among Hispanic women. Methods A cross-sectional survey of 406 Hispanic women was conducted. Participants completed 11 items about POP misconceptions, the Prolapse and Incontinence Knowledge Questionnaire (PIKQ-POP), and the Short Acculturation Scale for Hispanics (SASH). Principal component analysis was used. Results The Pelvic Organ Prolapse Misconceptions Scale (POPMS) had two subscales: personal habits and sequelae (PHS) and treatment approaches (TA), with high internal reliability (KR-20 = 0.90 and 0.81, respectively). The POPMS PHS and TA subscales were each positively correlated (both r = 0.25, p < 0.001) with general POP knowledge of the PIKQ-POP. College-educated women had higher mean scores on the PHS (p < 0.001) and TA (p = 0.01) than those not college educated. The correlations and mean scores indicate acceptable criterion validity. Misconceptions were common: 44% answered all PHS items incorrectly, and 56% answered all TA items incorrectly. The PIKQ-POP was positively associated with three SASH acculturation subscales (all p < 0.001). The POPMS was not associated with any of the three SASH acculturation subscales. Conclusions In conclusion, the POPMS is a valid and reliable instrument to measure misconceptions about POP in Hispanic women. Importantly, while general POP knowledge correlates with acculturation, misconceptions do not. This shows that misinformation may persist even in more acculturated individuals. We recommend that clinicians consider administering the POPMS scale to their Hispanic patients. This will allow clinicians to better understand their patients’ misconceptions about POP.

Introduction: Simulation-based training is increasingly used to teach respiratory interventions, but limited studies have evaluated its impact on both non-invasive positive pressure ventilation (NIPPV) and supplemental oxygen delivery systems. We assessed changes in internal medicine residents’ knowledge and attitudes before and after a simulation-based training program. Methods: This is a retrospective study of a simulation-based training program. There were 78 internal medicine residents from postgraduate first year (PGY1), postgraduate second year (PGY2), and postgraduate third year (PGY3) who participated in a one-hour training session, including lecture and three simulation stations covering oxygen delivery devices, high-flow nasal cannula, and bi-level positive airway pressure/continuous positive airway pressure (BIPAP/CPAP). Pre- and post-training questionnaires assessed attitudes and knowledge. Results: Attitudes for comfort level or recognition increased after training (all p < 0.001), and attitudes for needing more training decreased after training (all p < 0.001). Specific knowledge increased after training with percentage-point differences ranging from 48.7% to 60.3% for all of the questions (all p < 0.001). Case scenario knowledge increased after training with percentage-point differences ranging from 29.4% to 48.7% (all p < 0.001). Knowledge differences between postgraduate years were mostly eliminated after training. All residents rated the training highly. Conclusion: Simulation-based training improved attitudes and knowledge for both oxygen modalities and NIPPV. PGY1 and PGY2 residents achieved knowledge levels similar to PGY3 residents after the training. We recommend incorporating simulation-based respiratory training into residency programs to improve resident competency for both oxygen modalities and NIPPV.

Use of specialized devices such as a continuous glucose monitor (CGM) for patients with diabetes are most beneficial if patients attend their follow-up appointment. We evaluated the use of a social media reminder system for patient attendance to a CGM follow-up appointment. A retrospective analysis compared use of social media appointment reminders to paper-based reminders among 171 patients with diabetes receiving a CGM at a public hospital in suburban New York City. The multivariate logistic regression analysis for the outcome of attendance at an outpatient follow-up visit adjusted for demographic and health variables. The social media reminder group (88.2%, n = 60/68) had a significantly (P < 0.001) greater percentage of attendance at the follow-up appointment than the traditional reminder group (60.2%, n = 62/103). Almost all from the social media reminder group used WhatsApp (98.5%, n = 67). Multivariate logistic regression analysis showed increased odds of social media appointment reminders for attendance (odds ratio = 4.35; 95% confidence interval, 1.70, 11.16; P = 0.002). Social media reminders were associated with increased outpatient appointment attendance for patients with diabetes using CGMs. We recommend wider use of social media platforms, especially WhatsApp, by health care facilities for their reminder systems to improve outpatient appointment attendance among patients with diabetes.

Objective: To investigate the association of dietary and psychological health variables with infertility. Methods: A cross-sectional survey was administered to non-pregnant women aged 18-34 years. Data were collected on dietary topics (practices, formal diets, psychological beliefs) and psychological health (depression, anxiety, stress). Covariates included demographics and medical history. Infertility was defined as self-reported clinical diagnosis or lack of conception for more than one year with at least 18 months elapsed time since the last birth. Multivariate logistic regression was used to identify independent predictors of infertility. Results: Among 398 participants, 149 (37.4%) met the criteria for infertility. In multivariate analysis, the belief of being overweight (OR 2.59; 95% CI: 1.40-4.81) was significantly associated with infertility, whereas other dietary variables were not. Moderate-to-severe anxiety (OR 2.01; 95% CI: 1.08-3.72) and high perceived stress (OR 1.86; 95% CI: 1.07-3.23) were also significantly associated with infertility, while depression showed no significant association. Conclusion: We recommend that clinicians adopt a comprehensive approach to early infertility evaluation that includes not only formal screening for psychological health status, but also psychological aspects of diet. Such early identification and lifestyle interventions in these domains may improve reproductive outcomes and enhance patient care.

BACKGROUND: Radiation exposure is one of the most adverse occupational hazards faced by interventional cardiologists. Various arterial access sites have shown to yield different operator radiation exposure during diagnostic cardiac catheterization. METHODS: This single-center randomized controlled trial assessed the cumulative radiation exposure and normalized radiation exposure at 4 different anatomic locations (thorax, abdomen, left eye, and right eye) of the primary operator when using the left radial artery (LRA) approach compared with a uniform hyper-adducted right radial artery (HARRA) approach. Patients (n=534) were randomized to LRA (n=269) or HARRA (n=265). During diagnostic catheterization, real-time radiation dosimeters were placed on the thorax, abdomen, left eye, and right eye of each operator. RESULTS: Cumulative radiation measurements were as follows: thorax (LRA, 9.66±8.57 microsieverts [μSv] versus HARRA, 12.27±7.09 μSv; P P P P =0.01). Normalized radiation measurements were: thorax (LRA, 0.38±0.35 versus HARRA, 0.49±0.24; P P P P =0.02). LRA had lower subclavian tortuosity than HARRA (15.6% versus 32.5%, P <0.001). CONCLUSIONS: The LRA was associated with significantly less cumulative and normalized radiation exposure to the thorax, abdomen, left eye, and right eye of the primary operator compared with HARRA during diagnostic cardiac catheterization. Operators should consider using LRA more frequently than HARRA for diagnostic cardiac catheterization as this approach can reduce occupational radiation exposure. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05833516.

Background: Bereavement support can benefit caregivers suffering from the loss of a loved one. We report successes and challenges of a randomized clinical trial comparing cognitive behavioral therapy (CBT) to supportive care counseling for caregivers. Methods: We recruited caregivers of individuals who previously received palliative care treatment and were now deceased. The study was conducted in a public hospital in New York City predominantly serving low-income patients. Treatments were either CBT or supportive care counseling. Treatment consisted of eight sessions over six months. Outcomes were measured at three and six months. Outcomes were the Bereavement Experience Questionnaire-24 (BEQ-24) which contains three subscales of existential loss/emotional needs, guilt/blame/anger, and preoccupation with thoughts of deceased and the Patient Health Questionnaire-9 (PHQ-9) which measures depressive symptoms. Results: Only two people were enrolled in the trial and 101 people declined to participate. For both CBT and supportive care counseling, there were reduced bereavement symptoms for BEQ-24 existential loss/ emotional needs, BEQ-24 preoccupation with thoughts of deceased, and PHQ-9 depressive symptoms from baseline to six months. For supportive care counseling, BEQ-24 guilt/blame/anger increased from baseline to six months while CBT had the same value from baseline to six months. The most common reason (87.1%) for declining to participate was that support was available elsewhere. Conclusions: Both treatment approaches appear beneficial for improving bereavement and depressive symptoms except for BEQ-24 guilt/blame/anger. Clinicians recruiting those with bereavement from public hospitals serving low-income patients may find it challenging to recruit participants.

Objective: Contraception use and follow-up visit data from before and in two periods during the coronavirus disease-2019 (COVID-19) pandemic were compared to investigate change in behavior. Material and Methods: A retrospective study of women aged 18-49 years from New York City during three one-year time periods: preCOVID-19 pandemic [(COV-PRE); n=4,2611, early COVID-19 pandemic when the COVID-19 vaccine was not available [(COV-VACNO); n=3,3651, and later COVID-19 pandemic when the COVID-19 vaccine was available [(COV-VACAV); n=4,1701. Results: There were higher odds of implant use [odds ratio (OR): 1.42, 95% confidence interval (CI): 1.05, 1.93, p=0.021 during COV-VACNO. There were lower odds for any contraception (OR: 0.88, 95% CI: 0.79, 0.98, p<0.001) or intrauterine device (IUD) (OR: 0.73, 95% CI: 0.61, 0.86, p<0.001) use during COV-VACAV. No differences occurred for bilateral tubal ligation, pill, patch, injection, medical elective abortion, or surgical elective abortion. There was a greater percentage of follow-up visits for any contraception (p=0.02) and IUD (p=0.02) use during COV-VACNO and COV-VACAV than COV-PRE. Conclusion: When COVID-19 vaccines were unavailable, there were higher odds for use of implants. Once COVID-19 vaccines were available, there were lower odds for any contraception and IUD use. These findings highlight changes in behavior in terms of contraceptive concerns and preferences during a public health crisis that should be planned for by healthcare providers. (J Turk Ger Gynecol Assoc. 2024; 25: 200-6)

Objectives: Endocrine disorders often coexist with mental health issues. Little is known about patient beliefs regarding endocrinologists' involvement in mental health screening. We studied the beliefs of patients with endocrine disorders regarding endocrinologists' asking about mental health and whether patients perceive that endocrinologists are capable of recognizing mental health concerns. Methods: This was a cross-sectional survey of 500 adults with endocrine disorders with either diabetes mellitus or glandular diseases of the thyroid, adrenal, pituitary, or gonads conducted at a public hospital endocrinology clinic near New York City. Depressive symptoms were measured with the Patient Health Questionnaire-9 scale and anxiety symptoms were measured with the Generalized Anxiety Disorder-7 scale. Results: More than half of those surveyed expressed interest in their endocrinologist asking about mental health, depression, anxiety, and/or psychosocial stress. The belief that an endocrinologist can determine whether a patient has mental health issues, depression, anxiety, and psychosocial stress had mean values between neutral and agree. Patients who wanted their endocrinologist to ask about these topics had significantly (all analyses P < 0.001) greater depressive and/or anxiety symptoms than those who did not want their endocrinologist to ask about these topics. Conclusions: Many patients with endocrine disorders want endocrinologists to ask about their mental health. We recommend that endocrinologists consider incorporating mental health screening for depression and anxiety into routine patient care because many patients would welcome this approach.

Studies using estimated blood loss show the association of either human papillomavirus (HPV) or cervical intraepithelial neoplasia (CIN) with postpartum hemorrhage (PPH). We study the association of HPV or CIN with either blood loss or PPH as measured by the more precise measure of quantitative blood loss (QBL). We retrospectively studied 2,334 peripartum women with a documented Pap smear prior to delivery. The main predictor variable had categories for HPV and CIN as compared to normal cytology. Covariates included demographics, medical/surgical history, and pregnancy variables. Model 1 included the whole sample. Model 2 included only those with an operative vaginal delivery or a cesarean delivery. Outcome measures were QBL and PPH measured by QBL. We found in model 1 that those HPV positive and those with CIN were each not significantly associated with QBL. In model 2, those HPV positive were significantly associated with increased QBL (B = 0.11, SE = 0.05, p = 0.047), while CIN was not significantly associated with QBL. In model 1, those HPV positive and those with CIN were each not significantly associated with PPH. In model 2, those HPV positive were significantly associated with increased odds for PPH (OR:11.03, 9% CI:1.77, 68.74, p = 0.01) while CIN was not significantly associated with PPH. In conclusion, the presence of HPV was positively associated with an increase in the QBL and PPH at time of delivery for those with operative vaginal and cesarean deliveries. We suggest that clinicians take HPV results of Pap smears into consideration when considering a patient’s risk of PPH.

Objectives: Socioeconomic characteristics may be associated with cesarean section (CS) rates. We probe the relationship between socioeconomic variables and primary cesarean section (PCS) by studying indicators of socioeconomic status (SES) in a population-based study in New York City. Methods: This was a retrospective study of all 80,506 women in New York City who gave birth to a live child...