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Patients' interest in and display of online PPC-related behaviors vary by age, race/ethnicity, education, income, Internet access/behaviors, and information type. These findings can inform efforts aimed at improving the use and adoption of eHealth technologies, which may contribute to a reduction in communication inequalities and health care disparities.

Phrenic nerve trauma in the absence of direct injury is unusual and may present diagnostic diYculty. Diaphragmatic paralysis resulting from phrenic nerve injury may closely mimic diaphragmatic rupture. This case highlights the value of magnetic resonance imaging in establishing diaphragmatic integrity and of ultrasonographic assessment during respiratory excursion in confirming diaphragmatic paralysis. In cases of non-contact injury involving torsional injury to the neck, an index of clinical awareness may help to establish the diagnosis of phrenic nerve trauma. (J Accid Emerg Med 2000;17:419-420) Keywords: phrenic nerve injury; blunt trauma Case report A 36 year old man was admitted to the accident and emergency department two hours after a road traYc accident. The patient was driving a car that had been struck on the nearside by another vehicle. The patient's vehicle had been stationary at the time of impact. The patient was wearing a seatbelt and reported that he had not struck his head. There was no history of loss of consciousness. He complained of pain in the head, neck and back. He had also briefly experienced paraesthesiae in the right hand but this had resolved by the time of arrival in the department.At primary survey his neck was immobilised in a hard collar. He was maintaining his airway, self ventilating with a respiratory rate of 20/minute and there was decreased air entry to the right lower zone. The trachea was central. Cardiovascular examination was normal. Oxygen saturation was 97% on air and an electrocardiograph was normal. Secondary survey demonstrated severe lumbar spine tenderness over T12 and L1 vertebrae but no obvious neurological deficit. Physical examination was otherwise normal. His past medical history was significant for a myocardial infarction one year previously.Radiographs of the cervical spine were normal. Lumbar spine films demonstrated a stable anterior wedge compression fracture of T12. Chest radiograph showed an elevated right hemi-diaphragm (fig 1). This was not evident on a chest film taken 12 months previously (fig 2). A provisional diagnosis of diaphragmatic rupture was made. Computed tomography demonstrated mild rotation of the axis of the liver (anti-clockwise rotation through the plane of the middle hepatic vein) compatible with diaphragmatic rupture. However, a magnetic resonance scan confirmed that the diaphragm was intact but elevated. Ultrasound scan with respiratory excursion demonstrated paralysis of the right hemidiaphragm.A diagnosis of right hemi-diaphragmatic paralysis secondary to phrenic nerve damage DiscussionTraumatic phrenic nerve injury is well recognised after both penetrating and blunt trauma to the neck. 1 2 In contrast, injury as a result of distraction or stretching of the nerve is rare. 3In several of these previous reports, a component of nerve damage may have been as a result of blunt trauma. There was no evidence of blunt trauma in this case with the mechanism of injury thought to be lateral hyperextension of the neck. There are...

BackgroundDespite decades of efforts to eliminate tuberculosis (TB) in the United States (US), TB still contributes to adverse ill health, especially among racial/ethnic minorities. According to the Centers for Disease Control and Prevention, in 2016, about 87% of the TB cases reported in the US were among racial and ethnic minorities. The objective of this study is to explore the risks for pregnancy complications and in-hospital death among mothers diagnosed with TB across racial/ethnic groups in the US.MethodsThis retrospective cohort study utilized National Inpatient Sample data for all inpatient hospital discharges in the US. We analyzed pregnancy-related hospitalizations and births in the US from January 1, 2002 through December 31, 2014 (n = 57,393,459). Multivariable logistic regression was applied to generate odds ratios for the association between TB status and the primary study outcomes (i.e., pregnancy complications and in-hospital death) across racial/ethnic categories.ResultsThe prevalence of TB was 7.1 per 100,000 pregnancy-related hospitalizations. The overall prevalence of pregnancy complications was 80% greater among TB-infected mothers than their uninfected counterparts. Severe pre-eclampsia, eclampsia, placenta previa, post-partum hemorrhage, sepsis and anemia occurred with greater frequency among mothers with a TB diagnosis than those without TB, irrespective of race/ethnicity. The rate of in-hospital death among TB patients was 37 times greater among TB-infected than in non-TB infected mothers (468.8 per 100,000 versus 12.6 per 100,000). A 3-fold increased risk of in-hospital death was observed among black TB-negative mothers compared to their white counterparts. No racial/ethnic disparities in maternal morbidity or in-hospital death were found among mothers with TB disease.ConclusionTB continues to be an important cause of morbidity and mortality among pregnant women in the US. Resources to address TB disease should also target pregnant women, especially racial/ethnic minorities who bear the greatest burden of the disease.

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Cardiopulmonary resuscitation in an inpatient pregnant woman is associated with improved survival compared with this procedure in nonpregnant women. Elucidating reasons behind this association could help to improve CPR outcomes in both pregnant and nonpregnant women.