Sexual Orientation and Functional Pain in U.S. Young Adults: The Mediating Role of Childhood Abuse

Objective: Pain without known pathology, termed ‘‘functional pain,’’ causes much school absenteeism, medication usage, and medical visits. Yet which adolescents are at risk is not well understood. Functional pain has been linked to childhood abuse, and sexual orientation minority youth (gay, lesbian, bisexual, ‘‘mostly heterosexual,’’ and heterosexual with same-sex sexual contact) are more likely to be victims of childhood abuse than heterosexuals, thus may be at greater risk of functional pain. Methods: We examined sexual orientation differences in past-year prevalence of functional headache, pelvic, and abdominal pain and multiple sites of pain in 9,864 young adults (mean age = 23 years) from a large U.S. cohort. We examined whether childhood abuse accounted for possible increased risk of functional pain in sexual minority youth. Results: Sexual minority youth, except for gays and lesbians, were at higher risk of functional pelvic and abdominal pain and multiple sites of pain than heterosexuals. Gay and lesbian youth had elevated prevalence only of abdominal pain. Childhood abuse accounted for 14% to 33% of increased experience of multiple sites of pain in minority youth. Conclusions: Youth who identify as ‘‘mostly heterosexual’’ or bisexual or who identify as heterosexual and have had samesex partners comprised 18% of our sample. Clinicians should be aware that patients with these orientations are at elevated risk of functional pain and may be in need of treatment for sequelae of childhood abuse. Conventional categorization of sexual orientation as heterosexual or homosexual may fail to distinguish a large number of youth who do not wholly identify with either group and may be at elevated risk of health problems

Is this the end for ranitidine? NDMA presence continues to confound

N-nitrosodimethylamine (NDMA), a probable human carcinogen, was discovered decades ago, although elevated levels in several widely used drugs were detected only recently. Several medications that are now known to contain NDMA have remained available, whereas ranitidine has been completely withdrawn from the market. In the following paper, we discuss the overview of events that led to the withdrawal of ranitidine and compare evidence and subsequent regulatory response of other medications also containing NDMA

GIE Editorial Board top 10 topics: advances in GI endoscopy in 2019

The American Society for Gastrointestinal Endoscopy\u27s GIE Editorial Board reviewed original endoscopy-related articles published during 2019 in Gastrointestinal Endoscopy and 10 other leading medical and gastroenterology journals. Votes from each individual member were tallied to identify a consensus list of 10 topic areas of major advances in GI endoscopy. Individual board members summarized important findings published in these 10 areas of disinfection, artificial intelligence, bariatric endoscopy, adenoma detection, polypectomy, novel imaging, Barrett\u27s esophagus, third space endoscopy, interventional EUS, and training. This document summarizes these “top 10” endoscopic advances of 2019

Physician Perspectives about Telemedicine: Considering the Usability of Telemedicine in Response to COVID-19

OBJECTIVE: Use of telemedicine in pediatric gastroenterology has increased dramatically in response to the COVID-19 pandemic. The goal of this study was to systematically assess the usability of telemedicine in the field of pediatric gastroenterology. METHODS: The previously validated Telehealth Usability Questionnaire (TUQ) was distributed to physician pediatric gastroenterologist members of NASPGHAN. Physician demographic and practice characteristics were collected. Data were analyzed using descriptive, linear mixed effect and ordinary least squares regression methods. RESULTS: One hundred sixty pediatric gastroenterologists completed the survey. The majority were from academic practice (77%) with experience ranging from trainee (11%) to over 20 years clinical practice (34%). Most (82%) had no experience with telemedicine prior to the pandemic. The average usability score (scale 1-5) was 3.87 (sigma = 0.67) with the highest domain in usefulness of telemedicine (mu = 4.29, sigma = 0.69) and physician satisfaction (mu = 4.13, sigma = 0.79) and the lowest domain in reliability (mu = 3.02, sigma = 0.87). When comparing trainees to attending physicians, trainees\u27 responses were almost 1 point lower on satisfaction with telemedicine (Trainee effect = -.97, Bonferroni adjusted 95% CI = -1.71 to -.23). CONCLUSION: Pediatric gastroenterologists who responded to the survey reported that the technology for telemedicine was usable, but trainees indicated lower levels of satisfaction when compared to attending physicians. Future study is needed to better understand user needs and the impacts of telemedicine on providers with different levels are experience to inform efforts to promote implementation and use of telemedicine beyond the pandemic