Assessment of Reasons for Ownership and Attitudes About Policies Among Firearm Owners With and Without Children.

Importance: Given the dangers that firearms in the home pose to children, it is critical to engage parents in effective firearm safety counseling. This requires a broader understanding of how the presence of children in the home is associated with motivations surrounding gun ownership. Objective: To examine the association of having children in the home and gun owners' attitudes and beliefs. Design, Setting, and Participants: This cross-sectional survey study analyzed data from the National Lawful Use of Guns Survey conducted in 2019. A representative sample of 3698 adult gun owners nationwide were randomly invited to participate, with a 56.5% survey response rate. Survey responses were weighted to account for survey nonresponse and selection bias, and comparison groups were matched by age. Statistical analysis was performed in 2020. Main Outcomes and Measures: Reasons for gun ownership, symbolic meaning of guns, and attitudes toward gun policies. Results: Of the 2086 respondents, 383 (18.4%) had children in the home, 68.7% (95% CI, 66.4%-71.0%) were male, 8.2% (95% CI, 6.8%-9.7%) were Black, 76.3% (95% CI, 73.8%-78.6%) were White, 79.4% (95% CI, 77.5%-81.2%) were living in metropolitan areas, 51.3% (95% CI, 48.9%-53.8%) identified as Republican; 34.7% (95% CI, 32.6%-36.9%) were aged 60 years or older. Despite the majority of respondents feeling safe in their local communities (respondents with children: 93.4% [95% CI,: 89.3%-96.0%]; without children: 88.9% [95% CI, 87.0%- 90.6%]), 92.3% (95% CI, 87.0%-95.6%) of respondents with children stated the primary reason for gun ownership was to protect their family, compared with 68.6% (95% CI, 65.2%-71.8%) of respondents without children. On logistic regression analysis, having children in the home remained an independent factor associated with reasons for gun ownership. Gun owners with children were more likely than those without children to feel that guns make them feel more valuable to their family (23.5% [95% CI, 18.9%-28.8%] vs 17.0% [95% CI, 15.0%-19.2%]). Among those with children, 35.2% (95% CI, 30.0%-40.8%) believed gun laws should be more strict compared with 40.7% (95% CI, 38.1%- 43.3%) of those without children. Conclusions and Relevance: These findings suggest that acknowledging parental motivations for gun ownership is a pivotal component of educational efforts toward firearm injury prevention. These findings can guide clinicians to engage in effective individual counseling and community level efforts to reduce pediatric gun injuries.

Quality of Life After Thyroidectomy for Hashimoto Disease in Patients With Persistent Symptoms.

OBJECTIVES: To determine whether thyroidectomy improves quality of life in patients with Hashimoto thyroiditis with persistent symptoms despite biochemical euthyroidism. METHODS: A retrospective cohort study was conducted of patients undergoing thyroidectomy for Hashimoto thyroiditis at our institution between 2014 and 2018. The following variables were collected: age, race, body mass index, preoperative symptoms, preoperative thyroid peroxidase antibody titer, thyroglobulin antibody titer, thyroid-stimulating hormone, free thyroxine, specimen weight, and histologic presence of thyroiditis. Outcomes included general health score on the Short Form 36 (SF-36) Health and responses to a questionnaire addressing postoperative disease management. RESULTS: A total of 19 patients were included in the study, 18 of whom were female with a mean age of 48 years. The majority of patients were Caucasian. There were no significant differences between the postoperative general health scores of the patients with Hashimoto thyroiditis and scores from a healthy control population (66.9 vs 74.1; 95% CI: -16.9 to +2.5, P = .16). There were also no differences between groups within the 7 SF-36 subscores. Elevation in preoperative thyroperoxidase antibody correlated with lower reported postoperative energy levels (r = -0.63, P = .016) and emotional well-being (r = -.55, P = .041); 87.5% of respondents reported being moderately or extremely happy with their decision to proceed with surgery. CONCLUSIONS: Quality of life in patients with Hashimoto thyroiditis who undergo thyroidectomy is equivalent to the general population, and the majority are satisfied with surgery. Thyroidectomy is a consideration for patients with persistent symptoms despite optimization on medical therapy.

Pre-Operative Antithyroid Antibodies in Differentiated Thyroid Cancer.

OBJECTIVE: To evaluate the significance of antithyroglobulin and antithyroid peroxidase antibody levels associated with locoregional metastatic disease in patients with well-differentiated thyroid cancer. METHODS: Patients underwent initial treatment for well-differentiated thyroid cancer at our institution between 2014 and 2018. The following variables were collected: age, sex, pre-operative thyroid-stimulating hormone, thyroglobulin, antithyroglobulin antibody (TgAb), antithyroid peroxidase antibody (TPOAb), the extent of surgery, T-stage, N-stage, extrathyroidal extension (ETE), extranodal extension (ENE), lymphovascular invasion, and multifocal disease. The relationships between disease status and pre-operative TPOAb, TgAb, thyroglobulin, and thyroid-stimulating hormone were analyzed. RESULTS: A total of 405 patients (mean age, 52 years) were included in the study, of which 66.4% were women. Elevated TgAb was associated with the presence of lymph node metastases (LNM) in both the central and lateral neck (P < .01), with a stronger correlation to N1b versus N1a disease (P = .03). The presence of ETE was inversely related to the TgAb titer (P = .03). TPOAb was associated with a lower T-stage (P = .04), fewer LNM (P = .04), and a lower likelihood of ETE (P = .02). From multivariable analysis, TgAb ≥40 IU/mL was an independent predictive factor for a higher N-stage (P < .01 for N0 vs N1; P = .01 for N1a vs N1b), and ENE (P < .01). TPOAb ≥60 IU/mL was associated with a lower T-stage (P = .04 for T <3) and absence of ETE (P = .01). CONCLUSION: Elevated pre-operative TgAb was an independent predictor of nodal metastases and ENE, while elevated TPOAb was associated with a lower pathologic T- and N-stage. Pre-operative antithyroid antibody titers may be useful to inform the disease extent and features.