United States

Background: 
Vitiligo affects an estimated 0.5–2% of individuals worldwide and is characterized by cutaneous depigmentation. Recent studies suggest that autoimmune mechanisms in vitiligo extend beyond the skin, including ocular inflammation and auditory dysfunction. Notably, a nationwide Korean cohort of over 140,000 vitiligo patients found significantly elevated risks of dry eye, cataracts, and glaucoma compared with matched controls. However, comprehensive data from diverse U.S. adult populations remain scarce.

Objective: 
To determine whether adults with vitiligo have increased odds of developing ocular and auditory comorbidities compared with matched controls.

Methods: 
We conducted a retrospective, matched case–control study using de‑identified EHR data from the NIH All of Us Research Program. We identified cases based on the presence of ≥2 EHR visits with ICD‑10 L80 codes. Controls were matched 4:1 on age, sex, race/ethnicity, and duration of follow-up. We identified ocular outcomes (dry eye syndrome, uveitis, cataracts, glaucoma, retinal diseases, visual impairment) and auditory outcomes (sensorineural and sudden hearing loss, Ménière’s disease, benign paroxysmal positional vertigo, vestibular neuronitis) via validated ICD‑10 codes. Multivariate logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Covariates included body mass index, Charlson Comorbidity Index (CCI), cumulative systemic steroid exposure, hypertension, diabetes, dyslipidemia, and chronic kidney disease. CCI is a validated score that assigns weighted points to chronic conditions based on ICD-10 codes in order to quantify baseline comorbidity burden.

Results: 
A total of 842 vitiligo cases and 3,368 matched controls were identified. Patients with vitiligo had lower BMI (28.91 vs 29.72 kg/m²; p=0.005), higher rates of long‑term steroid exposure (78.3% vs 56.6%; p&lt;0.001), and higher proportions of CCI&gt;1 (90.1% vs. 78.9%, p&lt;0.001). Patiens with vitiligo patients exhibited higher unadjusted prevalence of any ocular comorbidity (43.2% vs 31.5%) and any auditory comorbidity (20.8% vs 15.9%). In fully adjusted models, vitiligo was associated with dry eye syndrome (aOR 1.39; 95% CI 1.13–1.71; p=0.002), anterior uveitis (aOR 3.00; 95% CI 1.18–7.64; p=0.021), cataracts (aOR 1.22; 95% CI 1.02–1.46; p=0.030), overall retinal disease (aOR 1.27; 95% CI 1.01–1.60; p=0.042), and other retinopathies (aOR 1.39; 95% CI 1.04–1.87; p=0.026). No adjusted associations persisted for any auditory comorbidity (aOR 1.04; 95% CI 0.85–1.27; p=0.703).

Conclusion: 
This large, multiethnic U.S. cohort demonstrates that vitiligo is independently associated with a spectrum of ocular comorbidities but not with auditory disorders. These findings underscore the need for routine ophthalmologic screening in patients with vitiligo and suggest that interdisciplinary care models may optimize long‑term visual health in this population.


AMA Research Challenge 2025 

Ocular and Auditory Comorbidities in Adults with Vitiligo: A Retrospective Case–Control Study

Welcome to the **largest national, multi-specialty research** event featuring research from nearly 700 medical students, residents, fellows, and international medical graduates.

Use the buttons below or navigation menu to access the event.
<br><br><br>


[![](https://assets.underline.io/uploads/markdown_image/1/image/3e33a8c754cc49610b30950617d813e7.png)](https://underline.io/events/434/sessions?searchGroup=all)
<br>
[![](https://assets.underline.io/uploads/markdown_image/1/image/551404d429c4e274f9a54cbdd7081918.png)](https://underline.io/events/434/posters?searchGroup=all)
<br>
[![](https://assets.underline.io/uploads/markdown_image/1/image/677d92f566b880cebd36905fc738fc10.png)](https://underline.io/events/434/lounge)
<br>
[![](https://assets.underline.io/uploads/markdown_image/1/image/c7392833c7261c3874c5b43fa2f4df19.png)](https://underline.io/events/434/help-desk)
<br><br>

#### Event Details

The 2023 American Medical Association Research Challenge includes a poster symposium hall and a semifinals hall with the top scored research. **Log in at any time throughout the event to:**

* **View posters and presentations** on a variety of topics and specialties
* **Score posters in the semifinals** to help decide the top five finalists (AMA member exclusive opportunity)
* **Connect with participants** and provide feedback to help advance their research
* **Attend education sessions** with physician experts on key research topics

At the conclusion of this event, the AMA will announce the top five finalists who will advance to the AMA Research Challenge finals, present their research to an elite panel of judges, and compete to win a $10,000 grand prize sponsored by Laurel Road.<br><br>

### Grand Prize Sponsor

AMA would like to thank Laurel Road for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road is not involved in the judging or scoring process to select the winner. The winner will be announced on February 4, 2024 during the AMA Research Challenge finals. Payment of the grand prize will be directly from Laurel Road. See the AMA Research Challenge Official Rules for terms and conditions.

![](https://assets.underline.io/uploads/markdown_image/1/image/611e331d4a0eba0920f240cfc04b4d77.png)

<br><br>

**There is no registration fee for this event! **

Register to explore research in a variety of topics. AMA members get exclusive access to score posters in the semifinals.

**Please use this link [here](https://www.ama-assn.org/about/events/ama-research-challenge) to register for free.**

Registration Is Required

AMA Research Challenge 2023

Join the AMA Research Challenge poster symposium and semifinals to explore top research posters, score posters in the semifinals (an AMA member exclusive opportunity) and attend education sessions with experienced physicians to learn tips to advance your research and career. 

Background: 
Vitiligo affects an estimated 0.5–2% of individuals worldwide and is characterized by cutaneous depigmentation. Recent studies suggest that autoimmune mechanisms in vitiligo extend beyond the skin, including ocular inflammation and auditory dysfunction. Notably, a nationwide Korean cohort of over 140,000 vitiligo patients found significantly elevated risks of dry eye, cataracts, and glaucoma compared with matched controls. However, comprehensive data from diverse U.S. adult populations remain scarce.

Objective: 
To determine whether adults with vitiligo have increased odds of developing ocular and auditory comorbidities compared with matched controls.

Methods: 
We conducted a retrospective, matched case–control study using de‑identified EHR data from the NIH All of Us Research Program. We identified cases based on the presence of ≥2 EHR visits with ICD‑10 L80 codes. Controls were matched 4:1 on age, sex, race/ethnicity, and duration of follow-up. We identified ocular outcomes (dry eye syndrome, uveitis, cataracts, glaucoma, retinal diseases, visual impairment) and auditory outcomes (sensorineural and sudden hearing loss, Ménière’s disease, benign paroxysmal positional vertigo, vestibular neuronitis) via validated ICD‑10 codes. Multivariate logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Covariates included body mass index, Charlson Comorbidity Index (CCI), cumulative systemic steroid exposure, hypertension, diabetes, dyslipidemia, and chronic kidney disease. CCI is a validated score that assigns weighted points to chronic conditions based on ICD-10 codes in order to quantify baseline comorbidity burden.

Results: 
A total of 842 vitiligo cases and 3,368 matched controls were identified. Patients with vitiligo had lower BMI (28.91 vs 29.72 kg/m²; p=0.005), higher rates of long‑term steroid exposure (78.3% vs 56.6%; p<0.001), and higher proportions of CCI>1 (90.1% vs. 78.9%, p<0.001). Patiens with vitiligo patients exhibited higher unadjusted prevalence of any ocular comorbidity (43.2% vs 31.5%) and any auditory comorbidity (20.8% vs 15.9%). In fully adjusted models, vitiligo was associated with dry eye syndrome (aOR 1.39; 95% CI 1.13–1.71; p=0.002), anterior uveitis (aOR 3.00; 95% CI 1.18–7.64; p=0.021), cataracts (aOR 1.22; 95% CI 1.02–1.46; p=0.030), overall retinal disease (aOR 1.27; 95% CI 1.01–1.60; p=0.042), and other retinopathies (aOR 1.39; 95% CI 1.04–1.87; p=0.026). No adjusted associations persisted for any auditory comorbidity (aOR 1.04; 95% CI 0.85–1.27; p=0.703).

Conclusion: 
This large, multiethnic U.S. cohort demonstrates that vitiligo is independently associated with a spectrum of ocular comorbidities but not with auditory disorders. These findings underscore the need for routine ophthalmologic screening in patients with vitiligo and suggest that interdisciplinary care models may optimize long‑term visual health in this population.


poster

Congratulations to all the researchers who have qualified for the AMA Research Challenge virtual poster symposium and semifinals!

Welcome to the **largest national, multi-specialty research event** featuring research from nearly 1,000 medical students, residents, fellows, and international medical graduates across six topic areas - basic science, clinical and translational research, clinical vignettes, health systems science, medical education, and public health and health policy.

#### Access the Event
Use the buttons below or navigation menu to access the event. 

[![](https://assets.underline.io/markdown_image/1/image/d4076f2146939317a29eb9f69c53ad41.png)](https://underline.io/events/506/sessions?searchGroup=all)
[![](https://assets.underline.io/markdown_image/1/image/6bcee0b523a4874c4292ca0415d88dde.png)](https://underline.io/events/506/posters?searchGroup=all)

#### Event Details
The 2025 AMA Research Challenge includes the following symposium halls:
* **Semifinals hall:** Features research from 54 medical students, residents and international medical graduates that received top scores during first round scoring. 
* **Poster symposium hall:** Features research from nearly 1,000 medical students, residents and international medical graduates categorized by topics and subtopics.

**Here’s how to participate:**
* **View posters and presentations** on a variety of topics and specialties
* **Score posters in the semifinals** to help decide the top five finalists (AMA member exclusive opportunity)
* **Connect with presenters** and provide feedback to help advance their research
* **New this year: Watch live poster presentations** by topic area and engage directly with researchers

At the conclusion of this event, the AMA announced the top five finalists who advanced to the AMA Research Challenge final round, presented their research to an elite panel of judges, and competed to win a $10,000 grand prize presented by Laurel Road.

**Addison Shenk, a fourth-year medical student from Edward Via Virginia College of Osteopathic Medicine, was the winner of the 2025 AMA Research Challenge and was awarded the grand prize of $10,000, presented by Laurel Road.**

#### A message from Dr. Bobby Mukkamala, AMA President
<div style="position: relative; width: 100%; padding-bottom: 56.25%; height: 0; overflow: hidden;">
  <iframe 
    src="https://underline.io/embed/136894-ama-video?t=0"
    title="AMA Welcome Video"
    allowfullscreen
    style="position: absolute; top: 0; left: 0; width: 100%; height: 100%; border: 0;">
  </iframe>
</div>


#### Recognized Institutions
In 2025, 1,400 abstracts were submitted across six topic areas representing 174 medical schools and more than 150 residency and health care institutions. [See if your institution is represented this year!](https://drive.google.com/file/d/1eFrTqCmCeobx9pr5drJK2hllvsIpFNOY/view?usp=drive_link)

#### Grand Prize Sponsor
AMA would like to thank Laurel Road, a brand of KeyBank, for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road and KeyBank are not involved in winner selection process. The winner will be announced during the AMA Research Challenge final round. Payment of the grand prize will be directly from Laurel Road/KeyBank. See the [AMA Research Challenge Official Rules for terms and conditions](https://www.ama-assn.org/system/files/research-challenge-official-rules.pdf).

[![](https://assets.underline.io/uploads/markdown_image/1/image/611e331d4a0eba0920f240cfc04b4d77.png)](https://www.laurelroad.com/)

#### Code of Conduct
<html>
AMA has a code of conduct for its meetings – we ask all attendees to adhere to this code to participate in this year’s meeting. Please read and <a href="https://www.ama-assn.org/about/code-conduct" target="_blank">learn more here</a> about your conduct requirements.
<br><br>
	</html>
	

#### Semifinals Judges

You need to log in with the email address you registered with. Access credentials have been sent to your email. 

Please be sure to check your spam and other email folders if you do not see an email confirmation right away.

Need help? Contact us at <support@underline.io>.

Please log in to explore this event.

If you have used the AMA Research Challenge platform previously, please click the ‘Log-in’ button below. If you do not remember your password, please click “forgot password” and follow prompts to reset your password. After resetting your password, please refresh your webpage to access the platform. 

Register to explore research in a variety of topics. AMA members get exclusive access to score posters in the semifinals. 

**Please use [this link here](https://www.ama-assn.org/member-benefits/events/ama-research-challenge) to register for free. **

Join the AMA Research Challenge poster symposium and semifinals to explore top research posters and score posters in the semifinals (an AMA member exclusive opportunity).

Background 

Shoulder injuries are common in adolescent athletes, particularly in overhead and contact sports. However, comparative data on sport-specific risk profiles remain limited. This study aimed to create risk profiles using strength and range-of-motion (ROM) of the shoulder across high school athletes in baseball, softball, female basketball, female wrestling, and male wrestling.

Methods 

We conducted a cross-sectional analysis of 247 high school athletes (159 male, 88 female) from three Utah schools between November 2023 and April 2025. Bilateral shoulder ROM and isometric strength were assessed using goniometry and handheld dynamometry. Primary outcomes included ER:IR strength ratio, internal rotation (IR) asymmetry, and total arc of motion (TROM) asymmetry. Athletes were classified as “at risk” if they met any of the following thresholds: ER:IR ratio < 0.75, IR deficit > 20°, or TROM asymmetry > 10°. Chi-square tests were used for between-group comparisons. 

Results 

Of the 247 athletes, 57 played baseball, 38 softball, 26 girls’ basketball, 24 girls’ wrestling, and 102 male wrestling. The most prevalent risk factor was ER:IR strength ratio < 0.75, observed in 45% of male wrestlers, 42% of female wrestlers, and 27% of girls’ basketball players. TROM asymmetry > 10° was most common in softball athletes (63%), followed by girls’ basketball (35%) and girls’ wrestling (33%). IR deficits > 20° were uncommon (≤12%) across all groups. Overall, 66% of male wrestlers and 63% of female wrestlers met at least one risk criterion. Significant between-sport differences were observed for ER:IR ratio (p < 0.001) and TROM asymmetry (p = 0.011), but not for IR deficit (p = 0.83). 

Conclusion 

Distinct sport-specific shoulder risk patterns were identified among adolescent athletes. ER:IR strength imbalance was most common in wrestlers, TROM asymmetry in softball and basketball players, and IR deficits were infrequent. These findings support the need for targeted screening and individualized preventive strategies to address modifiable shoulder injury risk in youth athletes. 



Sport-Specific Shoulder Risk Profiles in Adolescent Athletes: A Cross-Sectional Study

Background: Retinal detachment (RD) is a vision-threatening emergency requiring prompt surgical intervention with pars plana vitrectomy (PPV) (first-line), and/or scleral buckling (SB). PPV removes vitreous and repairs retinal detachment internally, while SB indents the sclera externally to reattach the retina. Though primary surgery is often successful, reoperations for detachments increase risks of permanent vision loss. This study identifies key anatomical predictors for indications of adjunctive SB to optimize single-surgery success rate (SSSR).

Methods: This retrospective cohort study (2010–2023) analyzed 3,528 RD repairs, including PPV alone (n = 2,811), SB alone (n = 163), and PPV+SB (n = 554). The primary outcome was SSSR at 3 months. Anatomical predictors included detachment extent (quadrants: Q1=superior nasal, Q2=superior temporal, Q3=inferior temporal, Q4=inferior nasal), macular status, lens status, gender, and prior ocular history. Chi-square tests compared outcomes; subgroup analyses excluded SB-only cases (secondary analysis).

Results:
Overall SSSR was 86.4% for PPV alone versus 89.5% for PPV+SB (p= 0.044). SB-only achieved 89.6% SSSR (p=0.321 vs PPV+SB).

Macular status: PPV+SB significantly outperformed PPV alone in macula-on detachments (93.5% vs 87.2%, p=0.005) but not macula-off cases (86.2% vs 85.9%, p=0.886).

Lens status: Phakic eyes benefited from PPV+SB (89.7% vs 85.3%, p=0.036), while pseudophakic eyes showed no difference (88.9% vs 87.3%, p=0.489).

Regional patterns: PPV+SB superiority was present when: Q3/Q4 were involved (Q3: 89.8% vs 84.9%, p=0.014; Q4: 89.7% vs 84.0%, p=0.013) and when Q1/Q2 were spared (Q1 absent: 90.6% vs 86.0%, p=0.025; Q2 absent: 92.5% vs 86.2%, p=0.009).

Panretinal detachments showed no significant PPV+SB benefit (84.9% vs 78.8%, p=0.249), whereas limited detachments trended positively (90.5% vs 87.2%, *p* = 0.052).

Demographics: Females had higher SSSR with PPV+SB (90.7% vs 84.5%, p=0.020), unlike males (88.7% vs 87.5%, p=0.533).

Conclusion: Adjunctive SB is associated with improved SSSR in specific anatomical contexts: macula-on detachments, phakic eyes, female patients, and detachments involving inferior quadrants (Q3/Q4) or sparing superior quadrants (Q1/Q2). These findings support selective SB use in RD repair, tailored to patient-specific anatomical risk profiles to avoid reoperations and improve visual outcomes.

Adjunctive Scleral Buckling with Pars Plana Vitrectomy for Retinal Detachment: Impact on Single-Surgery Success Rates by Anatomical Predictors

Chronic Shoulder Pain as a Herald of Advanced Small Cell Neuroendocrine Carcinoma
Background:
Small cell neuroendocrine carcinoma (SCNC) most commonly originates in the lung but can come from many organs. It typically presents with pulmonary symptoms such as cough, shortness of breath, or hemoptysis. We present a case of extensive-stage SCNC initially misattributed to benign shoulder pathology, ultimately requiring emergent chemotherapy intervention. Musculoskeletal pain as the sole initial manifestation presented a rare and challenging diagnostic scenario.
Case presentation:
A 51-year-old male with a 15-pack-year smoking history and family history of malignancies (mother with rectal cancer at age 48, and brother with head and neck cancer) presented with 2 months of right scapular and bilateral arm pain, initially managed with NSAIDs and chiropractic care. Symptoms progressed to right arm weakness, nocturnal pain, and 20-pound unintentional weight loss. Physical examination revealed right arm weakness (4/5) and numbness with otherwise stable vital signs apart from hypertension.
Initial CT abdomen obtained revealed extensive hepatic lesions suspicious for metastatic disease. Subsequent MRI cervical spine demonstrated osseous lesion in clivus and T1 vertebral body. Further evaluation with PET-CT showed FDG-avid metastatic involvement of the liver and numerous bones in the body, and significant neck and mediastinal lymphadenopathy. Notably, bone lesions were CT-occult, undetectable on prior imaging. Given the concerning imaging findings and rapid clinical progression, emergent chemotherapy was initiated due to the high risk of impending organ dysfunction from extensive tumor burden. Liver biopsy results demonstrate SCNC, supported by a high Ki-67 (70%) indicating rapid proliferation, positive synaptophysin confirming neuroendocrine differentiation, and elevated serum chromogranin A, further consistent with small cell neuroendocrine carcinoma. The patient demonstrated good initial tolerance to carboplatin/etoposide therapy with a plan to add immunotherapy after the first cycle.
Discussion:
This case highlights SCNC's potential to present atypically as isolated musculoskeletal pain, demonstrating how CT imaging may underestimate metastatic burden while PET-CT reveals more extensive disease. The diagnostic challenge is particularly acute in high-risk patients with significant smoking histories and familial cancer predisposition. These findings underscore the importance of maintaining clinical suspicion for malignancy even in the absence of classic symptoms, as earlier recognition can significantly impact patient outcomes.

Chronic Shoulder Pain as a Herald of Advanced Small Cell Neuroendocrine Carcinoma

Background
A massive brain abscess caused by otogenic Klebsiella pneumoniae is a neurological emergency in the United States and worldwide. We present a rare case of an otogenic massive brain abscess caused by Klebsiella pneumoniae to guide clinicians in establishing a prompt diagnosis and preventing significant morbidity and mortality.
Case Presentation
A 23-year-old male with a past medical history of uncontrolled type 1 diabetes and a recent presentation for otitis media was brought to the emergency department unresponsive. On initial examination, he was non-verbal, showed abnormal posturing to painful stimuli, and had a purulent, pinkish discharge from his left ear. He was found to be in Diabetic ketoacidosis. CT Head without contrast revealed a 5.8 cm x 4.9 cm left temporoparietal lobe abscess with significant edema, a 1.4 cm midline shift and extensive left-sided mastoiditis. Blood culture revealed Rhodotorula mucilaginosa and Aureobasidium. An emergent craniotomy evacuated 120 mL of purulent material, which grew otogenic Klebsiella pneumonia. Due to rapid pathogen identification, patient's condition stabilized with drainage of abscess, antibiotics, and comprehensive management.
Discussion
Otogenic Klebsiella pneumoniae is rarely considered as a cause of brain abscesses. A report from the Centers for Disease Control and Prevention identified only one case of Klebsiella pneumoniae as a cause of pediatric brain abscess between January 2016 and August 2022. Due to its rarity, the CDC's Active Bacterial Core surveillance system, which tracks invasive bacterial diseases, does not currently include Klebsiella pneumoniae. However, a massive brain abscess can be caused by otogenic Klebsiella pneumoniae in patients with diabetic ketoacidosis or any immunocompromised states, leading to high morbidity and mortality. 
Conclusion
This case report underscores the importance of including Klebsiella pneumoniae in the differential diagnosis of otogenic brain abscess, especially in the setting of DKA or other immunocompromised states. Early neuroimaging, prompt surgical intervention, and targeted antimicrobial therapy are critical for improving outcomes in these life-threatening infections. Clinicians should maintain a high index of suspicion for atypical pathogens to reduce diagnostic delays and prevent severe neurological sequelae.




Massive Brain Abscess Caused by Otogenic Klebsiella pneumoniae in a Young Adult with Diabetic Ketoacidosis

Background:
Complex Regional Pain Syndrome (CRPS) Type I is a chronic pain condition that often follows trauma without identifiable nerve damage. It is marked by severe pain, autonomic changes, and motor dysfunction, including contractures. Diagnosis is clinical, often delayed, and management can be challenging. A multidisciplinary approach combining pharmacologic, interventional, and rehabilitative strategies is essential for optimizing outcomes.
Case Presentation:
A 32-year-old French-speaking male with latent tuberculosis presented with progressive pain, cramping, and contracture of the right upper extremity (RUE) two months after a fall. He described constant 10/10 pain, primarily from elbow to wrist, with minimal relief from medications including acetaminophen, oxycodone, baclofen, gabapentin, and duloxetine.
On examination, he had severe muscle spasms, tenderness at MCP joints, and was unable to extend his hand. Imaging (MRI of the brain, cervical/thoracic spine, and shoulder X-rays) was unremarkable. EMG suggested a possible upper motor neuron process but was limited due to contracture.
Despite corticosteroid injections and oral medications, his symptoms progressed. A stellate ganglion block on July 11 provided temporary relief (pain reduced from 10/10 to 2/10). A second block on July 16 followed by ketamine infusion and clonidine patch further reduced pain (0– 2/10) and spasms (~50%).
After an interdisciplinary meeting, the patient was found to meet the Budapest Criteria for CRPS Type I, Stage 3. As such, arm manipulation under anesthesia and interscalene catheter placement for continuous analgesia. Post-procedural methadone provided additional relief.
Discussion:
This case highlights the diagnostic and therapeutic complexity of CRPS Type I. The patient experienced chronic, disproportionate pain and progressive motor dysfunction following minor trauma. Despite comprehensive evaluation, no structural or neurologic cause was identified. Multimodal therapy—including nerve blocks, ketamine, and physical therapy—provided only temporary improvement. Functional disability and psychosocial stressors further complicated management.

Complex Regional Pain Syndrome Type I Presenting with Upper Extremity Contracture in a Young Adult

Background
Link Health is a Boston based organization that streamlines the enrollment process in financial assistance benefits, such as the Affordable Connectivity Program (ACP) and Lifeline, for low income individuals through in-person and digital enrollment. Studies from the US Government Accountability Office find that over two-thirds of individuals abandon their initial Lifeline applications. These deficits in Lifeline enrollment mirror ACP enrollment, as the same National Verifier (NV) system was used in both programs. This study seeks to explore LH’s sign-up methods (digital vs in-person), across Massachusetts and Texas to better understand the modalities of Link Health’s current success in enrollment into the ACP and Lifeline programs. 

Methods
Between November 2022 and March 2025, LH participants enrolled in-person at federally qualified health centers or remotely via text-messaging. In-person, patient navigators (PNs) educate participants on available programs, assess their eligibility, and address any questions. Demographic data is collected and stored in a Firebase dashboard. Participants are thereafter directed to the FCC NV site to complete the eligibility verification. Digital enrollments are completed through LH’s webpage and additional information is collected through SMS messages from remote navigators. Remote navigators proceed to offer step by step assistance through the NV application platform.

Results
In Massachusetts, 752 ACP sign-ups were recorded. 183 (24.30%) of those were completed digitally, 543 (72.20%) were completed in-person, and 26 (3.50%) were completed via a combination of in-person and digital sign-up methods. Lifeline enrollment in Massachusetts was much larger with 2195 sign-ups. 1178 (53.66%) were digital, 996 (45.38%) were in-person, and 21 (0.01%) used both in-person and digital sign ups. 

In Texas, a newer target state for LH, 363 ACP sign-ups were recorded. Of these enrollments, 174 (47.90%) were digital, 185 (51.00%) in-person, and 4 (1.10%) a combination of in-person and digital sign-up. There were an additional 56 sign ups for Lifeline, with 52 (92.86%) being digital and 4 (7.14%) being in-person. 

Conclusion
Link Health highlights the significant improvements in remote sign-up rates for ACP and Lifeline programs in Massachusetts and Texas. Initially, Massachusetts benefited from a higher level of in-person engagement due to a greater number of Link Health-associated clinics and a larger PN workforce. However, as remote communication methods with patients became more efficient and streamlined, digital sign-up rates soared. These results affirm that digital outreach is not only feasible but critical for expanding participation and ensuring equitable access to essential resources.

Comparing Digital and In-Person Enrollment Modalities for ACP and Lifeline: Evaluating Link Health’s Outreach in Massachusetts and Texas

Objective:
This is an observational descriptive epidemiological study. We aim to examine global patterns and trends in brain and CNS cancer incidence and mortality using GLOBOCAN 2022 data, analyzing how socioeconomic development, measured by the Human Development Index (HDI), influences these rates and identifying potential mediating factors that explain this association.

Background:
Brain and central nervous system (CNS) cancers pose a significant and complex global health challenge, despite accounting for less than 2% of all cancer diagnoses worldwide. These malignancies are particularly notable for their devastating impact, characterized by high mortality rates and significant challenges in treatment and patient care. Emerging epidemiological research suggests a compelling connection between economic development and brain cancer incidence and mortality, prompting a deeper investigation into the underlying factors, such as healthcare capacity, environmental exposures, and population health that influence these patterns.

Methods:
We obtained brain and CNS cancer incidence and mortality data for 193 countries from GLOBOCAN 2022 and classified countries according to their Human Development Index rankings from lowest to highest development levels. Analysis confirmed that countries with higher HDI scores demonstrated significantly greater brain cancer incidence and mortality rates compared to less developed nations. We hypothesized that several factors might explain this pattern, including better diagnostic capabilities, healthcare infrastructure, population health characteristics, and environmental exposures. We collected data on healthcare workforce density (neurosurgeons, pathologists), diagnostic technology availability (MRI scanners), health system factors (universal coverage, number of clinical trials, radiotherapy availability), population metrics (life expectancy, obesity prevalence, height), and environmental variables (air pollution, radon exposure). Statistical regression models were used to identify which factors best account for the observed relationship between development level and brain cancer burden.

Results:
Higher HDI rankings demonstrated significant positive correlations with both brain and CNS cancer incidence and mortality rates. Among all variables analyzed, population height, life expectancy at birth, and pathologist density showed the strongest positive correlations with both incidence and mortality of brain and CNS tumors. Healthcare system factors, including radiotherapy availability, universal health coverage, and neurosurgeon density, also demonstrated significant associations, though with slightly lower correlation strength. MRI availability was significantly correlated, but less strongly than other healthcare capacity measures. In contrast, the number of clinical trials for brain malignancies and national radon activity showed no significant correlation with incidence or mortality, and air pollution levels were weakly negatively correlated, suggesting limited relevance in this global dataset. These results suggest that both population-level demographic factors and health system capacity help explain the observed link between higher socioeconomic development and greater reported brain tumor burden, while some environmental exposures and research activity appear to play a minimal mediating role in this relationship.

Conclusion:
Healthcare infrastructure and population health indicators substantially explain the higher brain cancer burden observed in more developed countries. These findings suggest that the relationship between socioeconomic development and brain cancer incidence reflects complex interactions between diagnostic capacity, healthcare access, and population-level health characteristics rather than solely representing differences in disease occurrence.

Understanding Longitudinal Incidence & Mortality of Malignant Brain Tumors Through the Lens of Socioeconomic Development: A Global Analysis

Background
Research has shown that dismissal of pain and medical gaslighting remain prevalent issues in healthcare. The current medical education system has increasingly emphasized cultural competence, communication skills and empathy training. Medical gaslighting and dismissal of symptoms have been shown to be associated with decreased trust in healthcare providers, which can subsequently lead to poorer health outcomes.
The objective of this narrative review is to explore the systemic factors that contribute to dismissal of pain in adolescents and young adults and the impact caused by those factors.
Methods
A narrative review of recent literature (2005-2025) was conducted.
Inclusion criteria were: 
Peer-reviewed original research articles, systematic reviews or graduate theses.
Studies that focus on adolescents or young adults based on the World Health Organization (WHO) definition (ages 10 to 30).
Articles addressing patient experience of pain or dismissal of pain by healthcare professionals, parents or other caregivers.
Exclusion criteria were:
Studies limited to the adult population over the age of 30
Articles not in English or not available in full text
Themes from the included studies were synthesized and investigated to identify key contributors to dismissal of pain in adolescents and young adults and to identify any associated outcomes.

Results
Studies have found that between 10% and 54% of adolescents and young adults report having experienced at least one instance of dismissal of pain. Studies also report female gender, identifying as Black and neurodiversity status are associated with reporting more instances of dismissal of pain. 
Conclusion
Our review revealed that dismissal of pain is common among adolescents and young adults with a disproportionately higher prevalence among female, Black and neurodivergent patients. These findings mirror broader patterns reported in the general adult population. Pain dismissal is associated with negative psychosocial outcomes such as the feeling of anger, hostility, self-doubt and isolation. It may also cause strains in the physician-patient relationships and loss of trust in the healthcare providers. 
Given the relational consequences of pain dismissal, there is a need to further investigate possible long-term mental health impacts of pain dismissal in adolescence and young adulthood.
Currently, there is a lack of standard tools for assessing pain dismissal. Developing such tools would enable more accurate measurement and monitoring of pain dismissal. Moreover, developing strategies such as healthcare provider education on pain dismissal to improve communication and validation of patient experiences may reduce potential negative clinical outcomes.


Prevalence and Outcomes of Systemic Dismissal of Pain in Adolescents and Young Adults



Abstract Title: Lung Cancer Screening Among Medicaid Older Adults in New Jersey, 2017-2022 



Background: Routine lung cancer screenings (LCS) were disrupted during the COVID-19 pandemic due to safety restrictions and the diversion of resources for COVID-19 diagnoses. Though the literature has reviewed differences in lung cancer screening rates among distinct groups depending on racial or ethnic minorities or socioeconomic factors, little is known about the impact of the disruption on vulnerable patient populations, particularly the Medicaid population following peak pandemic years. The study objective is to examine LCS rates for pre and post pandemic among New Jersey Medicaid enrollees. This is important because the Medicaid population often have higher risk factors for lung cancer such as smoking and face greater barriers to healthcare, so this enables us to better understand if screening initiatives are working and how they can be improved. 



Methods: This descriptive analysis uses secondary data from the Medicaid Management Information System to estimate the LCS rate among Medicaid enrollees ages 50-75 in New Jersey, 2017-2022. LCSs were identified using the low-dose CT claims code. Results were stratified by socioeconomic factors. Bivariate analysis was performed to assess within-group differences. 



Results*: During the 6-year period, April 2020 had the lowest LCS rate. Rates rebounded and surpassed pre-pandemic levels by August 2020. Comparing 2019 to 2022, the annual screening rate almost doubled, with rate increases across all demographic and regional variables. Key findings were: (1) The younger group (50-64 years old) consistently had higher screening rates than the older (65-75); (2) Non-Hispanic Black enrollees had the greatest increase in rates; (3) The dually eligible (Medicare and Medicaid) screening rate tripled; and (4) Screening rate varied by geographic region, with the Shore region being the highest. 



* In accordance with the project Data Use Agreement, analyses (e.g., rates) are subject to review and comment by the New Jersey Medicaid agency. The analyses are currently under review, and the point estimates will be available for public release prior to the September AMA symposium. 



Conclusion: This study demonstrates success in one state to surpass previous LCS rates. There remains work to be done, however, as LCS is still underutilized compared to other routine cancer screenings. Health organizations can capitalize on the recent increased interest in lung health due to the pandemic and USPTSF lung cancer screening guideline expansion to encourage the use of LCS to reduce cancer mortality. 



Medicaid Lung Cancer Screenings in New Jersey, 2017-2022

Background: Our work describes the clinical course of a patient who developed disseminated coccidiomycosis infection of the central nervous system, resulting in swelling of the central cord at the level of the cervical spine. This, combined with craniocervical adhesions, was observed to block the flow of cerebrospinal fluid (CSF) such that intrathecal antifungals delivered via an intracranial Ommaya reservoir proved insufficient for the treatment of extracranial disease. 

Observations: As the first-ever reported case of an Ommaya reservoir placed in the lumbar spine for treatment of central nervous system coccidiomycosis, this 48-year-old male demonstrated dramatic improvement in upper and lower extremity function after only a few weeks of intrathecal antifungal therapy. With rates of coccidiomycosis infection skyrocketing over the past decade, our clinical study demonstrates the utility of this critical method of drug delivery, previously untapped for the treatment of disseminated coccidiomycosis. 

Lessons: Several months after placement, the lumbar Ommaya and catheter remain patent and functional, despite initial concern that the catheter would become clogged due to the high protein content of CSF from coccidioides infection, as well as subsequent treatment. This clinical study proves intrathecal antifungals delivered via lumbar Ommaya are a viable treatment method to help combat the increasing number of central nervous system cases.

Premium content

Next from AMA Research Challenge 2025

Sport-Specific Shoulder Risk Profiles in Adolescent Athletes: A Cross-Sectional Study

Similar lecture

Assessment of Infection Risk in vitiligo patients undergoing dialysis for end-stage renal disease: A retrospective cohort study