Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Purpose: Subconjunctival hemorrhage (SCH) is usually a benign ocular disorder that causes painless, redness under the conjunctiva. However, since SCH and acute coronary syndrome (ACS) share many vascular risk factors, studies have suggested that these two disorders may be significantly associated with each other, and evaluate the concomitance of ACS in patients with SCH.Methods: This population-based cohort study, enrolled 35,260 Taiwanese patients, and used the Taiwan National Health Insurance Research Database to identify patients with ACS and SCH. Outcomes were compared between the with and without SCH groups. The study population was followed until the date of ACS onset, the date of withdrawal, death, or December 31st 2013, whichever came first.Results: Of the 85,925 patients identified with SCH between 1996 and 2013, 68,295 were excluded based on the study's exclusion criteria, and a total of 17,630 patients with SCH who were diagnosed by ophthalmologists between 2000 and 2012 were eligible for analysis. After 1:1 propensity score matching for 5-year age groups, gender, and the index year, the results showed that SCH was more common in the 40–59 age group (53.82%) and females (58.66%). As for the ACS-related risk factors, patients with diabetes mellitus (aHR = 1.58, 95% CI = [1.38, 1.81]), hypertension (aHR = 1.71, 95% CI = [1.49, 1.96]) and patients taking aspirin (aHR = 1.67, 95% CI = [1.47, 1.90]) had a notably higher risk of ACS. However, it was found that there were no significant differences in the occurrence of ACS between the non-SCH and SCH patients.Conclusion: This results of this study regarding the risk factors and epidemiology of SCH and ACS were in keeping with previously reported findings. However, the results revealed no significant association between SCH and ACS.
In Reply As Bai et al note, general surgery has historically been a (White, cisgendered, heterosexual) male-dominated field. Our data indicate lack of inclusion is experienced by many with minoritized identities in surgery, including lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) physicians. We agree that this lack of inclusion likely leads LGBTQ+ residents to withhold their identity. In our survey of 85.6% of all residents training in accredited general surgery programs, 305 (4.8%) self-identified as LGBTQ+, and 394 residents did not answer or selected "prefer not to answer." Based on US Census data and prior work 1 demonstrating that more than half of LGBTQ+ surgery residents choose not to disclose their identity, we too suspect our study undercounts LGBTQ+ surgery residents and therefore underestimates LGBTQ+-based mistreatment. Even if residents are able to avert mistreatment by withholding LGBTQ+ identity, the inability to authentically express one's identity causes psychological distress and difficulty connecting with colleagues. 2 Therefore, an environment in which it is safe to disclose identity is essential to the well-being of LGBTQ+ trainees.A growing body of literature supports improved patient outcomes with physician diversification. Physicians from minoritized groups are more likely to work with underserved communities, improving access to care. 3 Patient-physician identity concordance reduces morbidity and mortality for patients with minoritized identities. 4,5 Even care provided by physicians who are not from minoritized groups likely improves because exposure to colleagues from minoritized groups durably reduces their biases. 6 Thus, developing strategies to foster and support a diverse surgical workforce is our moral imperative, not only for the sake of LGBTQ+ surgeons, but for all patients.We are currently working with programs across the US to develop targeted interventions to address mistreatment and well-being for the Surgical Education Culture Optimization Through Targeted Interventions Based on National Comparative Data (SECOND) Trial. Although we urge all programs, and certainly those in other countries, to be mindful of their local cultural context (eg, in the acceptance and construction of LGBTQ+ identities) as they implement our interventions within their training environments, we submit that the following principles are universal: (1) Representation matters. Many training and/or physician organizations do not query sexual orientation or gender identity, making disparities challenging to scope and normalizing invisibility. Diversification of training programs, from both a resident and faculty standpoint, is critical. To this end, resources that support the work, well-being, and therefore recruitment and retention of LGBTQ+ surgeons should be made available. (2) As Bai et al highlight, more education is needed for both trainees and faculty. Content should address basic vocabulary and rules of respectful conduct (eg, Why do pronouns matter? Wha...
ObjectivesThe association of migraine with the risk of certain cancer has been reported. The aim of this pilot study was to examine the associations between migraine and the onset of head and neck cancers (HNC).Materials and MethodsA total of 1755 individuals were identified through a nationwide population‐based cohort registry in Taiwan between 2000 and 2013. The primary end point variable was new‐onset head and neck cancers in patients with migraine versus non‐migraine controls. Cox proportional hazard regression was used to derive the risk of HNC. Subgroup analyses were performed to determine subpopulations at risk of migraine‐associated HNC. Sub‐outcome analyses were carried out to provide the subtypes of migraine‐associated HNC. Propensity score matching was utilized to validate the findings.ResultsA total of four patients out of 351 patients with migraine and seven out of 1404 non‐migraine controls developed HNC. The incidence of HNC was higher in patients with migraine than that in non‐migraine controls (108.93 vs. 48.77 per 100,000 person‐years) (adjusted hazard ratio, aHR = 2.908, 95% CI = 0.808–10.469; p = 0.102). The risk of HNC in patients with migraine with aura (aHR = 5.454, 95% CI = 0.948–26.875; p = 0.264) and without aura (aHR = 2.777, 95% CI = 0.755–8.473; p = 0.118) was revealed. The incidence of non‐nasopharyngeal HNC secondary to migraine (112.79 per 100,000 person‐years) was higher than that of nasopharyngeal cancer secondary to migraine (105.33 per 100,000 person‐years).ConclusionA higher incidence of HNC was observed in a small sample of patients with migraine, especially in those with migraine with aura. Migraine‐associated HNC included non‐nasopharyngeal HNC. Studies with a larger sample are needed to confirm the finding of the high risk of HNC in people with migraine.
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