Background We examine factors related to general health and health behavior, including smoking, that may be associated with binge drinking, drinking ‘at risk’ and potential for alcohol use disorder among young adults of Mexican ancestry. Methods 2191 young adult emergency department (ED) patients (18–30) of Mexican ancestry in a public hospital proximate to the US/Mexican border were interviewed using health surveys including questions on general health, drinking, smoking and drug use. Results 37% of the study participants reported binge drinking, 38% were “at risk” alcohol users above NIAAA guidelines and 22% were RAPS positive (indicating potential for alcohol use disorder). Smoking was reported by 31%, marijuana use by 16%, and other drug use by 9%. Multiple variable models revealed that smoking was the strongest factor predicting binge drinking. Those who smoked were 3.1(p<0.0001) times more likely to binge drink. Other factors independently associated with binge drinking were age 22–25 year old (OR=1.5, p=0.003), male gender (OR=1.5, p=0.0001), and ED visit for injury (OR=1.4, p=0.007). Conclusions There is a strong association of smoking and binge drinking; hence brief interventions for young Hispanics should be designed to include discussion of avoidance of binge drinking and smoking which could improve the efficacy of these interventions.
Objectives: In 2016, a national consensus conference created the National Clinical Assessment Tool for Medical Students in Emergency Medicine (NCAT-EM), a standardized end-of-shift assessment tool. We report the first large-scale analysis of professionalism concerns collected from May 2017 through December 2018 by a multisite consortium using the NCAT-EM. Our primary objective was to characterize the nature and frequency of professionalism concerns. Our secondary objective was to identify characteristics associated with giving or receiving a professionalism flag. Methods:The consortium database includes assessments for all students on EM clerkships at participating sites. This report presents descriptive statistics about the frequency of different flags, the distribution of flags among different student categories, assessor and student characteristics, and distribution of global assessment scores on assessments citing concerns. We used Fisher's exact test to look for associations between the frequency of professionalism flags and the sex of the students and assessors and across student categories. We used logistic regression to look for relationships between professionalism concerns and global assessment scores as well as intent to apply in EM.Results: We screened 6,768 assessments of 784 students by 719 assessors from 13 sites. After excluding assessments without flags and assessments with apparent data entry errors, we analyzed 57 (0.8%) assessments containing 79 flags. The most frequent flags were punctuality (25/79, 31.6%) and initiative (20/79, 25.3%). Few students received flags (42/784, 5.4%). Few assessors flagged concerns (41/719, 5.7%). We detected no correlation between the frequency of flags and whether a student was applying in EM or between the sex of students and assessors. Global scores of lower one-third appeared more often in assessments with a flag (30/57, 52.6% vs. 233/6,711, 3.5%).Conclusions: Only 5.4% of students received flags. Punctuality and initiative accounted for a majority of citations. Professionalism flags correlated strongly with lower global assessment scores.
Abstract. Emergency physicians constantly have multiple ethical obligations in the emergency department. They must understand these sometimes conflicting obligations and learn to prioritize. A case discussion is presented that exemplifies the conflict between patient privacy and society's right to know.Specific aspects of HIV testing and obtaining patient consent are presented. Teaching physicians are encouraged to use such common cases for ''ethics case discussion.''
rate of new HIV infections among Latinas is 4.2 times higher than that of white females [1]. Understanding HIV risk behaviors within the Hispanic female population could be of value to limit HIV transmission. For Latinas, unsafe sexual behavior with an HIV infected male is the primary route of HIV acquisition [1]. HIV positive males may not be aware of their HIV status or even if they are aware, more than 13% report unprotected sex with women [2]. According to the CDC 1 in 8 HIV infected individuals are unaware they are infected [3]. Greater knowledge of Latinas' sex behaviors and associated risk factors is needed to inform preventive efforts.Little is known about HIV sex risk behaviors among women Emergency Department (ED) patients. Factors that can greatly influence sexual behavior such as age, ethnic, racial and cultural background varies considerably by ED location. A review of literature on prevalence of HIV among ED patients demonstrates that ED patients can have a relatively high prevalence, up to >1% [4][5][6][7][8][9][10]. A substantial proportion of ED patients report engaging in HIV sex risk behaviors. In a Boston ED, 70% of substance users reported engaging in sex without a condom in the past 30 days, and 36% reported having sex without a condom with a casual sex partner [11]. In a New York ED, 37.6% of patients reported engaging in one or more HIV risk behaviors and among participants who reported only one sexual partner, a seemingly "low risk" population, 15.0% of women reported that their usual sexual partner had other concurrent partners in the past year [12]. In another ED, 50.2% of women reported having unprotected vaginal or anal sex and 4.3% of women reported having unprotected sex with men who had sex with another man in the past ten years [13].To date no studies have surveyed unsafe, sexual activity among Latina ED patients. Among Latinas, immigrants may be even less enabled to protect themselves due to their lack of empowerment within machismo cultures [14]. El Paso is a major city on the US/ Mexico border. El Paso's population is 80.7% Hispanic with many new and recent immigrants primarily of Mexican origin [15]. In El Paso, the HIV diagnosis rate for Latinas was 7.4/100,000 in 2013,
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