Time to surgery and outcomes following open reduction and internal fixation of both-bone forearm fractures.

PURPOSE: To determine the effect of time to surgery on outcomes following open reduction and internal fixation (ORIF) of both-bone forearm fractures (BBFFs). METHODS: Ninety-nine patients who underwent ORIF of BBFFs in a single academic medical center over a 16-year time period were retrospectively reviewed. Demographic and clinical data including age, sex, current smoking status, time from injury to surgery (tsurg), presence of open injury, polytrauma status, and complications were obtained. Radiographs of the affected extremity were reviewed for fracture morphology, reduction quality, and time to union (or presence of nonunion). In addition to descriptive statistics, Chi-square and Wilcoxon-Mann-Whitney tests were used to compare categorical and interval, respectively, with a significance level of 0.05. RESULTS: A tsurg > 48 h was associated with increased rate of delayed unions (tsurg < 48 h: 25% vs tsurg > 48 h: 59%, p = 0.03), but not complications (tsurg < 48 h: 44% vs tsurg > 48 h: 47%, p = 0.79). Open BBFFs were not associated with increased rates of delayed unions (closed: 16% vs open: 19%, p = 0.77) or complications (closed: 42% vs open: 53%, p = 0.29). A trend toward increased time to union with tsurg > 48 h was also seen, but did not reach significance (tsurg < 48 h: 13.5 weeks vs tsurg > 48 h: 15.7 weeks, p = 0.11). CONCLUSION: A tsurg > 48 h is associated with an increased rate of delayed union, but not complications, after ORIF of BBFFs. LEVEL OF EVIDENCE: Therapeutic Level III (Retrospective Cohort).

The Capacity of HIV Care Facilities to Implement Strategies Recommended by the Ending the HIV Epidemic Initiative: The Medical Monitoring Project Facility Survey.

BACKGROUND: Data are needed to assess the capacity of HIV care facilities to implement recommended Ending the HIV Epidemic activities. SETTING: US HIV care facilities. METHODS: We analyzed 2021 survey data from 514 facilities that were recruited from a census of facilities providing care to a national probability sample of US adults with HIV. We present weighted estimates of facility characteristics, services, and policies and estimates of the proportion of all US HIV patients attending these facilities. RESULTS: Among HIV care facilities, 37% were private practices, 72% were in areas with population >1 million, and 21% had more than 1000 HIV patients. Most provided preexposure prophylaxis (83%) and postexposure prophylaxis (84%). More than 67% of facilities provided HIV-specific stigma or discrimination training for all staff (covering 70% of patients) and 66% provided training on cultural competency (covering 74% of patients). A majority of patients attended facilities that provided on-site access to HIV/sexually transmitted infection (STI) transmission risk reduction counseling (89%); fewer had on-site access to treatment for substance use disorders (35%). We found low provision of on-site assistance with food banks or meal delivery (14%) and housing (33%). Approximately 71% of facilities reported using data to systematically monitor patient retention in care. On-site access to adherence tools was available at 58% of facilities; 29% reported notifying patients of missed prescription pickups. CONCLUSION: Results indicate some strengths that support Ending the HIV Epidemic-recommended strategies among HIV care facilities, such as high availability of preexposure prophylaxis/postexposure prophylaxis, as well as areas for improvement, such as provision of staff antistigma trainings and adherence supports.

Trends in preexposure prophylaxis use among sex partners as reported by persons with HIV - United States, May 2015-June 2020.

OBJECTIVE: To estimate trends in the proportion of sexually active U.S. adults with HIV (PWH) reporting an HIV-discordant sexual partner taking preexposure prophylaxis (PrEP) and proportion of partners taking PrEP. DESIGN: The Medical Monitoring Project is a complex sample survey of U.S. adults with diagnosed HIV. METHODS: We used annual cross-sectional data collected during June 2015-May 2020 to estimate the annual percentage change (EAPC), overall and by selected characteristics, in reported partner PrEP use among PWH with HIV-discordant partners (N = 8707) and reported PrEP use among these partners (N = 15 844). RESULTS: The proportion of PWH reporting PrEP use by one or more HIV-discordant sex partner rose 19.5% annually (11.3 to 24.4%). The prevalence rose from 6.0 to 17.4% (EAPC, 25.8%) among Black PWH, 10.1 to 26.0% (EAPC, 19.5%) among Hispanic/Latino PWH, and 20.8 to 34.6% (EAPC, 16.3%) among White PWH. Among MSM with HIV, the prevalence increased from 9.6 to 32.6% (EAPC, 28.2%) among Black MSM, 16.6 to 36.0% (EAPC, 15.6%) among Hispanic/Latino MSM, and 24.9 to 44.1% (EAPC, 17.9%) among White MSM. Among HIV-discordant sex partners, the proportion reported to be taking PrEP increased 21.1% annually (7.8 to 18.8%). Reported PrEP use rose from 4.9 to 14.2% (EAPC, 29.9%) among Black partners, 6.5 to 16.8% (EAPC, 20.3%) among Hispanic/Latino partners, and 12.7 to 26.1% (EAPC, 17.0%) among White partners. CONCLUSIONS: One in five HIV-discordant sexual partners of PWH was reported to be taking PrEP. PrEP use rose among all examined populations, although the increases did not eliminate disparities in PrEP use.

Analyzing the Proliferation of Social Media Use Among Orthopaedic Surgery Residency Programs.

Social media can influence how students and residents learn about and select graduate medical education programs. COVID-19-related travel restrictions forced residencies to adapt their recruitment strategies. The objective of our investigation was to characterize the prevalence of social media use by orthopaedic surgery residency programs and to examine any change over time before the COVID-19 pandemic and leading up to the 2020 to 2021 virtual interview season. METHODS: The Fellowship and Residency Electronic Interactive Database was queried for all orthopaedic surgery residency programs (N = 164). We performed a cross-sectional analysis on the use of Facebook, Twitter, and Instagram by orthopaedic surgery residency programs in May 2019, July 2020, and November 2020. Orthopaedic surgery residency programs were systematically identified on each of the social media platforms. Descriptive statistics were used to facilitate comparisons between the time points. RESULTS: Seventy-six social media accounts were identified in May 2019 compared with 239 in November 2020-a greater than 300% increase in 19 months. The prevalence of residency programs using Facebook increased from 21.3% in May 2019 to 30.5% in July 2020 to 36.0% in November 2020. Similar increases in prevalence were identified for Twitter (15.2%-31.7% then 43.9%) and Instagram (9.1% to 37.2% to 65.9%). In May 2019, we identified 35 programs with Facebook accounts, 26 with Twitter accounts, and 15 with Instagram accounts. By November 2020, this increased to 59 Facebook accounts, 72 Twitter accounts, and 108 Instagram accounts. This corresponds to an expansion in the use of each platform by 69%, 177%, and 620% for Facebook, Twitter, and Instagram, respectively. CONCLUSIONS: The use of social media by academic orthopaedic surgery residency programs increased substantially over the study period. The adoption of Instagram seems to be occurring at the fastest rate. Social media may represent a useful tool in resident recruitment, but the platform must be carefully selected and planned to avoid unintended dilemmas.

Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students - 19 States and Large Urban School Districts, 2017.

Transgender youths (those whose gender identity* does not align with their sex†) experience disparities in violence victimization, substance use, suicide risk, and sexual risk compared with their cisgender peers (those whose gender identity does align with their sex) (1-3). Yet few large-scale assessments of these disparities among high school students exist. The Youth Risk Behavior Survey (YRBS) is conducted biennially among local, state, and nationally representative samples of U.S. high school students in grades 9-12. In 2017, 10 states (Colorado, Delaware, Hawaii, Maine, Maryland, Massachusetts, Michigan, Rhode Island, Vermont, Wisconsin) and nine large urban school districts (Boston, Broward County, Cleveland, Detroit, District of Columbia, Los Angeles, New York City, San Diego, San Francisco) piloted a measure of transgender identity. Using pooled data from these 19 sites, the prevalence of transgender identity was assessed, and relationships between transgender identity and violence victimization, substance use, suicide risk, and sexual risk behaviors were evaluated using logistic regression. Compared with cisgender males and cisgender females, transgender students were more likely to report violence victimization, substance use, and suicide risk, and, although more likely to report some sexual risk behaviors, were also more likely to be tested for human immunodeficiency virus (HIV) infection. These findings indicate a need for intervention efforts to improve health outcomes among transgender youths.

Sexual Intercourse Among High School Students - 29 States and United States Overall, 2005-2015.

Early initiation of sexual activity is associated with having more sexual partners, not using condoms, sexually transmitted infection (STI), and pregnancy during adolescence (1,2). The majority of adolescents initiate sexual activity during high school, and the proportion of high school students who have ever had sexual intercourse increases by grade; black students are more likely to have ever had sexual intercourse than are white students (3). The proportion of high school students overall who had ever had sexual intercourse did not change significantly during 1995-2005 (53.1% to 46.8%) (Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, unpublished data). To assess whether changes have occurred in recent years in the proportion of high school students who have ever had sexual intercourse, CDC examined trends overall and by grade, race/ethnicity, and sex among U.S. high school students, using data from the 2005-2015 national Youth Risk Behavior Surveys (YRBSs) and data from 29 states* that conduct the YRBS and have weighted data. Nationwide, the proportion of high school students who had ever had sexual intercourse decreased significantly overall and among 9th and 10th grade students, non-Hispanic black (black) students in all grades, and Hispanic students in three grades. A similar pattern by grade was observed in nearly half the states (14), where the prevalence of ever having had sexual intercourse decreased only in 9th grade or only in 9th and 10th grades; nearly all other states saw decreases in some or all grades. The overall decrease in the prevalence of ever having had sexual intercourse during 2005-2015 is a positive change in sexual risk among adolescents (i.e., behaviors that place them at risk for human immunodeficiency virus, STI, or pregnancy) in the United States, an overall decrease that did not occur during the preceding 10 years. Further, decreases by grade and race/ethnicity represent positive changes among groups of students who have been determined in previous studies to be at higher risk for negative outcomes associated with early sexual initiation, such as greater numbers of partners, condom non-use, teen pregnancy, and STI (1-3). More work is needed to understand the reasons for these decreases and to ensure that they continue.