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Burnett JR, De Lima B, Wang ES, McGarry K, Kim DI, Kisielewski M, Manley K, Desai SS, Eckstrom E, Henry TL. How Are We Teaching Advocacy? A National Survey of Internal Medicine Residency Program Directors. J Gen Intern Med 2024:10.1007/s11606-024-08753-3. [PMID: 38710862 DOI: 10.1007/s11606-024-08753-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/29/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Although internal medicine (IM) physicians accept public advocacy as a professional responsibility, there is little evidence that IM training programs teach advocacy skills. The prevalence and characteristics of public advocacy curricula in US IM residency programs are unknown. OBJECTIVES To describe the prevalence and characteristics of curricula in US IM residencies addressing public advocacy for communities and populations; to describe barriers to the provision of such curricula. DESIGN Nationally representative, web-based, cross-sectional survey of IM residency program directors with membership in an academic professional association. PARTICIPANTS A total of 276 IM residency program directors (61%) responded between August and December 2022. MAIN MEASUREMENTS Percentage of US IM residency programs that teach advocacy curricula; characteristics of advocacy curricula; perceptions of barriers to teaching advocacy. KEY RESULTS More than half of respondents reported that their programs offer no advocacy curricula (148/276, 53.6%). Ninety-five programs (95/276, 34.4%) reported required advocacy curricula; 33 programs (33/276, 12%) provided curricula as elective only. The content, structure, and teaching methods of advocacy curricula in IM programs were heterogeneous; experiential learning in required curricula was low (23/95, 24.2%) compared to that in elective curricula (51/65, 78.5%). The most highly reported barriers to implementing or improving upon advocacy curricula (multiple responses allowed) were lack of faculty expertise in advocacy (200/276, 72%), inadequate faculty time (190/276, 69%), and limited curricular flexibility (148/276, 54%). CONCLUSION Over half of US IM residency programs offer no formal training in public advocacy skills and many reported lack of faculty expertise in public advocacy as a barrier. These findings suggest many IM residents are not taught how to advocate for communities and populations. Further, less than one-quarter of required curricula in public advocacy involves experiential learning.
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Affiliation(s)
- Joel R Burnett
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA.
| | - Bryanna De Lima
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA
| | - Emily S Wang
- UT Health San Antonio Long School of Medicine, San Antonio, TX, USA
| | - Kelly McGarry
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Daniel I Kim
- University of California, Riverside School of Medicine, Riverside, CA, USA
| | | | - Kelsi Manley
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA
| | - Sima S Desai
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA
| | - Elizabeth Eckstrom
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA
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Henry TL, Olakunle OE. The Physician's Role in Countering Medical Misinformation Through Advocacy. Popul Health Manag 2024. [PMID: 38577915 DOI: 10.1089/pop.2024.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
- Tracey L Henry
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Oreoluwa E Olakunle
- Doctor of Medicine Program, Emory University School of Medicine, Atlanta, Georgia, USA
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Scott SR, Henry TL. Is End of Race-Conscious Admissions the Beginning of an Historically Black Colleges and University Renaissance? Popul Health Manag 2024. [PMID: 38563627 DOI: 10.1089/pop.2024.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Shani R Scott
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tracey L Henry
- Division of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Henry TL, Rollin FG, Olakunle OE. How to Create a Diversity, Equity, and Inclusion Curriculum: More Than Checking a Box. Ann Fam Med 2024; 22:154-160. [PMID: 38527815 DOI: 10.1370/afm.3078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/30/2023] [Accepted: 10/16/2023] [Indexed: 03/27/2024] Open
Abstract
We are beginning to accept and address the role that medicine as an institution played in legitimizing scientific racism and creating structural barriers to health equity. There is a call for greater emphasis in medical education on explaining our role in perpetuating health inequities and educating learners on how bias and racism lead to poor health outcomes for historically marginalized communities. Diversity, equity, and inclusion (DEI; also referred to as EDI) and antiracism are key parts of patient care and medical education as they empower health professionals to be advocates for their patients, leading to better health care outcomes and more culturally and socially humble health care professionals. The Liaison Committee on Medical Education has set forth standards to include structural competency and other equity principles in the medical curriculum, but medical schools are still struggling with how to specifically do so. Here, we highlight a stepwise approach to systematically developing and implementing medical educational curriculum content with a DEI and antiracism lens. This article serves as a blueprint to prepare institution leadership, medical faculty, staff, and learners in how to effectively begin or scale up their current DEI and antiracism curricular efforts.
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Affiliation(s)
- Tracey L Henry
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Francois G Rollin
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
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Bakdash L, Abid A, Gourisankar A, Henry TL. Chatting Beyond ChatGPT: Advancing Equity Through AI-Driven Language Interpretation. J Gen Intern Med 2024; 39:492-495. [PMID: 37904073 PMCID: PMC10897100 DOI: 10.1007/s11606-023-08497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/16/2023] [Indexed: 11/01/2023]
Abstract
Medical interpretation is an underutilized resource, despite its legal mandate and proven efficacy in improving health outcomes for populations with low English proficiency. This disconnect can often be attributed to the costs and wait-times associated with traditional means of interpretation, making the service inaccessible and burdensome. Technology has improved access to translation through phone and video interpretation; with the acceleration of artificial intelligence (AI) large language models, we have an opportunity to further improve interpreter access through real-time, automated translation. The impetus to utilize this burgeoning tool for improved health equity must be combined with a critical view of the safety, privacy, and clinical decision-making risks involved. Physicians must be active participants and collaborators in both the mobilization of AI tools to improve clinical care and the development of regulations to mitigate harm.
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Affiliation(s)
- Leen Bakdash
- Emory University School of Medicine, Atlanta, GA, 30322, USA.
| | - Areeba Abid
- Emory University School of Medicine, Atlanta, GA, 30322, USA
| | | | - Tracey L Henry
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Sanchez-Medina MC, Del Rio C, Henry TL. Making mentoring more impactful for URiM students. J Natl Med Assoc 2023; 115:463-465. [PMID: 37574356 DOI: 10.1016/j.jnma.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/26/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Abstract
Mentorship has been proven to be a valuable vehicle to fight the disparity of diverse representation in medicine. Given the numerous findings that a more diverse medical profession leads to better patient outcomes, we believe fostering mentorship of URiM medical students is in the best interest for patients and the field of medicine. In our manuscript, we illustrated tenets of mentorship that result in effective mentoring of URiM students by any physician regardless of race, ethnicity, or background. This piece reflects upon our personal experiences with structured mentorship programs, results of similar programs at other universities, and ties in a broader conversation of the value of institutional support of mentorship programs. Given the urgency to increase diversity and, ultimately, belonging in not only medical education but also our physician workforce, this piece is highly relevant. This piece is intended to inspire and increase more opportunities for more incoming URiM students to be mentored at the start of their medical journey.
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Affiliation(s)
| | - Carlos Del Rio
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Georgia; Hubert Department of Global Health, Emory Center for AIDS Research, Rollins School of Public Health, Co-Director, Atlanta, Georgia
| | - Tracey L Henry
- Division of General Medicine, Emory University School of Medicine, Faculty Office Bldg, Suite 408, Atlanta, Georgia
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Britz JB, O'Loughlin KM, Henry TL, Richards A, Sabo RT, Saunders HG, Tong ST, Brooks EM, Lowe J, Harrell A, Bethune C, Moeller FG, Krist AH. Rising Racial Disparities in Opioid Mortality and Undertreatment of Opioid Use Disorder and Mental Health Comorbidities in Virginia. AJPM Focus 2023; 2:100102. [PMID: 37790667 PMCID: PMC10546578 DOI: 10.1016/j.focus.2023.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction There were more than 100,000 fatal drug overdoses in the U.S. in 2021 alone. In recent years, there has been a shift in opioid mortality from predominantly White rural communities to Black urban communities. This study aimed to identify the Virginia communities disproportionately affected by the overdose crisis and to better understand the systemic factors contributing to disparities in opioid mortality. Methods Using the state all-payer claims database, state mortality records, and census data, we created a multivariate model to examine the community-level factors contributing to racial disparities in opioid mortality. We used generalized linear mixed models to examine the associations between socioecologic factors and fatal opioid overdoses, opioid use disorder diagnoses, opioid-related emergency department visits, and mental health diagnoses. Results Between 2015 and 2020, racial disparities in mortality widened. In 2020, Black males were 1.5 times more likely to die of an opioid overdose than White males (47.3 vs 31.6 per 100,000; p<0.001). The rate of mental health disorders strongly correlated with mortality (β=0.53, p<0.001). Black individuals are not more likely to be diagnosed with opioid use disorder (β=0.01, p=0.002) or with mental health disorders (β= -0.12, p<0.001), despite higher fatal opioid overdoses. Conclusions There are widening racial disparities in opioid mortality. Untreated mental health disorders are a major risk factor for opioid mortality. Findings show pathways to address inequities, including early linkage to care for mental health and opioid use disorders. This analysis shows the use of comprehensive socioecologic data to identify the precursors to fatal overdoses, which could allow earlier intervention and reallocation of resources in high-risk communities.
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Affiliation(s)
- Jacqueline B. Britz
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Kristen M. O'Loughlin
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Tracey L. Henry
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Alicia Richards
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Roy T. Sabo
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Heather G. Saunders
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | - Sebastian T. Tong
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - E. Marshall Brooks
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Jason Lowe
- Division of Behavioral Health, Virginia Department of Medical Assistance (DMAS), Richmond, Virginia
| | - Ashley Harrell
- Division of Behavioral Health, Virginia Department of Medical Assistance (DMAS), Richmond, Virginia
| | - Christine Bethune
- Division of Behavioral Health, Virginia Department of Medical Assistance (DMAS), Richmond, Virginia
| | - F. Gerard Moeller
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia
| | - Alex H. Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
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Leung TI, Sagar A, Shroff S, Henry TL. Can AI Mitigate Bias in Writing Letters of Recommendation? JMIR Med Educ 2023; 9:e51494. [PMID: 37610808 PMCID: PMC10483302 DOI: 10.2196/51494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
Letters of recommendation play a significant role in higher education and career progression, particularly for women and underrepresented groups in medicine and science. Already, there is evidence to suggest that written letters of recommendation contain language that expresses implicit biases, or unconscious biases, and that these biases occur for all recommenders regardless of the recommender's sex. Given that all individuals have implicit biases that may influence language use, there may be opportunities to apply contemporary technologies, such as large language models or other forms of generative artificial intelligence (AI), to augment and potentially reduce implicit biases in the written language of letters of recommendation. In this editorial, we provide a brief overview of existing literature on the manifestations of implicit bias in letters of recommendation, with a focus on academia and medical education. We then highlight potential opportunities and drawbacks of applying this emerging technology in augmenting the focused, professional task of writing letters of recommendation. We also offer best practices for integrating their use into the routine writing of letters of recommendation and conclude with our outlook for the future of generative AI applications in supporting this task.
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Affiliation(s)
- Tiffany I Leung
- Department of Internal Medicine (adjunct), Southern Illinois University School of Medicine, Toronto, ON, Canada
- JMIR Publications, Toronto, ON, Canada
| | - Ankita Sagar
- CommonSpirit Health, Chicago, IL, United States
- Creighton University School of Medicine, Omaha, NE, United States
| | - Swati Shroff
- Division of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, United States
| | - Tracey L Henry
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
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Chen A, Ayub MH, Mishuris RG, Rodriguez JA, Gwynn K, Lo MC, Noronha C, Henry TL, Jones D, Lee WW, Varma M, Cuevas E, Onumah C, Gupta R, Goodson J, Lu AD, Syed Q, Suen LW, Heiman E, Salhi BA, Khoong EC, Schmidt S. Telehealth Policy, Practice, and Education: a Position Statement of the Society of General Internal Medicine. J Gen Intern Med 2023; 38:2613-2620. [PMID: 37095331 PMCID: PMC10124932 DOI: 10.1007/s11606-023-08190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023]
Abstract
Telehealth services, specifically telemedicine audio-video and audio-only patient encounters, expanded dramatically during the COVID-19 pandemic through temporary waivers and flexibilities tied to the public health emergency. Early studies demonstrate significant potential to advance the quintuple aim (patient experience, health outcomes, cost, clinician well-being, and equity). Supported well, telemedicine can particularly improve patient satisfaction, health outcomes, and equity. Implemented poorly, telemedicine can facilitate unsafe care, worsen disparities, and waste resources. Without further action from lawmakers and agencies, payment will end for many telemedicine services currently used by millions of Americans at the end of 2024. Policymakers, health systems, clinicians, and educators must decide how to support, implement, and sustain telemedicine, and long-term studies and clinical practice guidelines are emerging to provide direction. In this position statement, we use clinical vignettes to review relevant literature and highlight where key actions are needed. These include areas where telemedicine must be expanded (e.g., to support chronic disease management) and where guidelines are needed (e.g., to prevent inequitable offering of telemedicine services and prevent unsafe or low-value care). We provide policy, clinical practice, and education recommendations for telemedicine on behalf of the Society of General Internal Medicine. Policy recommendations include ending geographic and site restrictions, expanding the definition of telemedicine to include audio-only services, establishing appropriate telemedicine service codes, and expanding broadband access to all Americans. Clinical practice recommendations include ensuring appropriate telemedicine use (for limited acute care situations or in conjunction with in-person services to extend longitudinal care relationships), that the choice of modality be done through patient-clinician shared decision-making, and that health systems design telemedicine services through community partnerships to ensure equitable implementation. Education recommendations include developing telemedicine-specific educational strategies for trainees that align with accreditation body competencies and providing educators with protected time and faculty development resources.
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Affiliation(s)
- Anders Chen
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St, Box 356421, Seattle, WA, 98195, USA.
| | - Mariam H Ayub
- Division of General Internal Medicine, MedStar Georgetown University Hospital, Georgetown University Medical Center, Washington, DC, USA
| | - Rebecca G Mishuris
- Digital, Mass General Brigham, Somerville, MA, USA
- Division of General Internal Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Jorge A Rodriguez
- Division of General Internal Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Kendrick Gwynn
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Community Physicians, Baltimore, MD, USA
| | - Margaret C Lo
- Division of General Internal Medicine, Department of Medicine, University of Florida College of Medicine, Malcom Randall VAMC, Gainesville, FL, USA
| | - Craig Noronha
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Tracey L Henry
- Division of General Internal Medicine, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Danielle Jones
- Division of General Internal Medicine, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Wei Wei Lee
- Section of General Internal Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Malvika Varma
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- New England VA GRECC, Boston VA Medical Center, Boston, MA, USA
| | - Elizabeth Cuevas
- Division of Academic Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Chavon Onumah
- Division or General Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Reena Gupta
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - John Goodson
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy D Lu
- Division of General Internal Medicine, Denver Health and Hospital Authority, Denver, CO, USA
- Department of Medicine, University of Colorado, Aurora, CO, USA
| | - Quratulain Syed
- Birmingham-Atlanta VA GRECC, Atlanta VA Medical Center, Atlanta, GA, USA
| | - Leslie W Suen
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Erica Heiman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bisan A Salhi
- Department of Emergency Medicine, Drexel University College of Medicine, Reading, PA, USA
| | - Elaine C Khoong
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Stacie Schmidt
- Division of General Internal Medicine, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA
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Henry TL, Freeman CD, Sheth A, Jenkins L, Olakunle OE, Adeagbo S, Sanchez-Medina MC, Alcegueire K, Rodríguez J. Making an Impact with E.M.P.A.C.T. Engage, Mentor Prepare, Advocate, Cultivate, and Teach: An Innovative Pilot Mentoring Program Evaluation for Students Underrepresented in Medicine. Adv Med Educ Pract 2023; 14:803-813. [PMID: 37496711 PMCID: PMC10368113 DOI: 10.2147/amep.s400547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/08/2023] [Indexed: 07/28/2023]
Abstract
Purpose Medicine has yet to increase the representation of historically excluded persons in medicine to reflect the general population. The lack of support and guidance in the medical training of these individuals is a significant contributor to this disparity. The Engage, Mentor, Prepare, Advocate for, Cultivate, and Teach (EMPACT) Mentoring program was created to address this problem by providing support for learners who are historically underrepresented in medicine (URiM) as they progress through medical school. Methods The EMPACT Pilot Program was formed and conducted during the 2019-2020 academic year. A total of 19 EMPACT mentorship groups were created, each consisting of two mentors and four medical student mentees. Additionally, four professional development workshops were held along with a final Wrap-up and Awards event. Pre and post pilot program surveys along with surveys after each workshop and focus groups were conducted with a random selection of program participants. Results When compared to data from before and after the implementation of the EMPACT program, there were statistically significant differences (p < 0.05) in EMPACT mentees reporting they agree or strongly agree they felt ready to handle their clinical rotations (28% to 65%), felt the need to have an advocate (85% to 47%), possessed insight on day-to-day activities of an attending (26% to 56%) and felt a sense of community (79% to 94%). Mentors revealed an increase in their awareness of the concepts of microaggressions and imposter phenomenon. Finally, both groups felt an increase in their support system and sense of community at the school of medicine. Conclusion Despite COVID-19 limitations, the EMPACT program met its goals. We effectively supported URiM medical students through mentorship, networking, and community.
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Affiliation(s)
- Tracey L Henry
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Christian D Freeman
- University of California San Francisco, Department of Obstetrics and Gynecology, San Francisco, CA, USA
| | - Anisha Sheth
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Lauren Jenkins
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Oreoluwa E Olakunle
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Segun Adeagbo
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Josué Rodríguez
- Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Van Doren VE, Spencer ML, Resnick D, Agrawal SS, Garcia MLW, Desai K, Fazal A, Sadjadi R, Rollin FG, Henry TL. Health Justice Standards in Graduate Medical Education: Moving from Performative to Concrete Change. J Gen Intern Med 2023; 38:1705-1708. [PMID: 36729085 PMCID: PMC9894507 DOI: 10.1007/s11606-023-08047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Inadequate support for underrepresented-in-medicine physicians, lack of physician knowledge about structural drivers of health, and biased patient care and research widen US health disparities. Despite stating the importance of health equity and diversity, national physician education organizations have not yet prioritized these goals. AIM To develop a comprehensive set of Health Justice Standards within our residency program to address structural drivers of inequity. SETTING The J. Willis Hurst Internal Medicine Residency Program of Emory University is an academic internal medicine residency program located in Atlanta, Georgia. PARTICIPANTS This initiative was led by the resident-founded Churchwell Diversity and Inclusion Collective, modified by Emory IM leadership, and presented to Emory IM residents. PROGRAM DESCRIPTION We used an iterative process to develop and implement these Standards and shared our progress with our coresidents to evaluate impact. PROGRAM EVALUATION In the year since their development, we have made demonstrable progress in each domain. Presentation of our work significantly correlated with increased resident interest in advocacy (p<0.001). DISCUSSION A visionary, actionable health justice framework can be used to generate changes in residency programs' policies and should be developed on a national level.
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Affiliation(s)
- Vanessa Elizabeth Van Doren
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
- J. Willis Hurst Internal Medicine Residency Program, Emory University School of Medicine, Atlanta, GA, USA.
| | - Mark L Spencer
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- J. Willis Hurst Internal Medicine Residency Program, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel Resnick
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- J. Willis Hurst Internal Medicine Residency Program, Emory University School of Medicine, Atlanta, GA, USA
| | - Shub S Agrawal
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- J. Willis Hurst Internal Medicine Residency Program, Emory University School of Medicine, Atlanta, GA, USA
| | - Mackenzie L W Garcia
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- J. Willis Hurst Internal Medicine Residency Program, Emory University School of Medicine, Atlanta, GA, USA
| | - Krisha Desai
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- J. Willis Hurst Internal Medicine Residency Program, Emory University School of Medicine, Atlanta, GA, USA
| | - Amara Fazal
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- J. Willis Hurst Internal Medicine Residency Program, Emory University School of Medicine, Atlanta, GA, USA
| | - Raha Sadjadi
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- J. Willis Hurst Internal Medicine Residency Program, Emory University School of Medicine, Atlanta, GA, USA
| | - Francois G Rollin
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Tracey L Henry
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Chen A, Ghosh A, Gwynn KB, Newby C, Henry TL, Pearce J, Fleurant M, Schmidt S, Bracey J, Jacobs EA. Society of General Internal Medicine Position Statement on Social Risk and Equity in Medicare's Mandatory Value-Based Payment Programs. J Gen Intern Med 2022; 37:3178-3187. [PMID: 35768676 PMCID: PMC9485310 DOI: 10.1007/s11606-022-07698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022]
Abstract
The Affordable Care Act (2010) and Medicare Access and CHIP Reauthorization Act (2015) ushered in a new era of Medicare value-based payment programs. Five major mandatory pay-for-performance programs have been implemented since 2012 with increasing positive and negative payment adjustments over time. A growing body of evidence indicates that these programs are inequitable and financially penalize safety-net systems and systems that care for a higher proportion of racial and ethnic minority patients. Payments from penalized systems are often redistributed to those with higher performance scores, which are predominantly better-financed, large, urban systems that serve less vulnerable patient populations - a "Reverse Robin Hood" effect. This inequity may be diminished by adjusting for social risk factors in payment policy. In this position statement, we review the literature evaluating equity across Medicare value-based payment programs, major policy reports evaluating the use of social risk data, and provide recommendations on behalf of the Society of General Internal Medicine regarding how to address social risk and unmet health-related social needs in these programs. Immediate recommendations include implementing peer grouping (stratification of healthcare systems by proportion of dual eligible Medicare/Medicaid patients served, and evaluation of performance and subsequent payment adjustments within strata) until optimal methods for accounting for social risk are defined. Short-term recommendations include using census-based, area-level indices to account for neighborhood-level social risk, and developing standardized approaches to collecting individual socioeconomic data in a robust but sensitive way. Long-term recommendations include implementing a research agenda to evaluate best practices for accounting for social risk, developing validated health equity specific measures of care, and creating policies to better integrate healthcare and social services.
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Affiliation(s)
- Anders Chen
- Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Arnab Ghosh
- Department of Medicine, Weill Cornell Medical College of Columbia University, New York, NY, USA
| | - Kendrick B Gwynn
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Community Physicians, Baltimore, MD, USA
| | - Celeste Newby
- Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Tracey L Henry
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Jackson Pearce
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - Stacie Schmidt
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Jennifer Bracey
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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13
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Goldstein RS, Greenhouse AR, Om A, Ward CR, Marshburn L, Bradley CD, Henry TL, George M. Advocacy in Action: a Comprehensive Student-Led Proactive Outreach to Patients at Highest Risk. J Gen Intern Med 2022; 37:2661-2668. [PMID: 35233708 PMCID: PMC8887657 DOI: 10.1007/s11606-021-07319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/08/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION COVID-19 disrupted access to critical healthcare and resources for many, especially affecting patients at safety-net hospitals who rely on regular care for multiple complex conditions. Students realized they could support patients from the sidelines by helping navigate abrupt healthcare changes and proactively addressing needs at home. AIM To comprehensively identify and meet the clinical and social needs of Atlanta, Georgia's patients at highest risk, left without their usual access to healthcare, through proactive telephonic outreach. SETTING AND PATIENTS Medical and Physician's Assistant students from Emory and Morehouse Schools of Medicine partnered with Grady Health System, Atlanta's safety-net hospital. Artificial intelligence prioritized over 15,000 patients by risk of morbidity and mortality from COVID-19. PROGRAM DESCRIPTION In this novel program, students performed telephonic outreach to thousands of patients at highest risk of poor outcomes from COVID-19. Students used a custom REDCap form that served as both a call script and data collection tool. It provided step-by-step guidance to (1) screen for COVID-19 and educate on prevention; (2) help patients navigate health system changes to fill gaps in care; and (3) identify and address social needs. Based on patients' responses, the form prompted tailored reminders for next steps and connections to medical and social resources. PROGRAM EVALUATION In the program's first 16 months, students made 7,988 calls, of which 3,354 were answered. Over half (53%) of patients had at least one need requiring action: 48% health and 16% social. DISCUSSION This proactive, novel initiative identified substantial clinical and social need among patients at highest risk for poor outcomes and filled a pressing health system gap exacerbated by COVID-19. Simultaneously, interprofessional students gained applied exposure to health systems sciences. This program can serve as a model for rapid, cost-effective, high-yield outreach to promote patient health at home both during and beyond the pandemic.
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Affiliation(s)
| | | | - Anjali Om
- Emory University School of Medicine, Atlanta, GA, USA
| | - Carson R Ward
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Tracey L Henry
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Maura George
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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14
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Wiley Z, Kulshreshtha A, Li D, Kubes J, Kandiah S, Leung S, Kobaidze K, Shin SR, Moanna A, Perkins J, Hogan M, Sims KM, Amzat T, Cantos VD, Elutilo-Ayoola T, Hanna J, Harris NM, Henry TL, Iheaku O, Japaridze M, Lanka V, Johnson TA, Mbaezue N, Rebolledo PA, Sexton ME, Surapaneni PK, Franks N. Clinical characteristics and social determinants of health associated with 30-day hospital readmissions of patients with COVID-19. J Investig Med 2022; 70:1406-1415. [PMID: 35649686 PMCID: PMC9195155 DOI: 10.1136/jim-2022-002344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 12/15/2022]
Abstract
COVID-19 readmissions are associated with increased patient mortality and healthcare system strain. This retrospective cohort study of PCR-confirmed COVID-19 positive adults (>18 years) hospitalized and readmitted within 30 days of discharge from index admission was performed at eight Atlanta hospitals from March to December 2020. The objective was to describe COVID-19 patient-level demographics and clinical characteristics, and community-level social determinants of health (SDoH) that contribute to 30-day readmissions. Demographics, comorbidities, COVID-19 treatment, and discharge disposition data were extracted from the index admission. ZIP codes were linked to a demographic/lifestyle database interpolating to community-level SDoH. Of 7155 patients with COVID-19, 463 (6.5%) had 30-day, unplanned, all-cause hospital readmissions. Statistically significant differences were not found in readmissions stratified by age, sex, race, or ethnicity. Patients with a high-risk Charlson Comorbidity Index had higher odds of readmission (OR 4.8 (95% CI: 2.1 to 11.0)). Remdesivir treatment and intensive care unit (ICU) care were associated with lower odds of readmission (OR 0.5 (95% CI: 0.4 to 0.8) and OR 0.5 (95% CI: 0.4 to 0.7), respectively). Patients residing in communities with larger average household size were less likely to be readmitted (OR 0.7 (95% CI: 0.5 to 0.9). In this cohort, patients who received remdesivir, were cared for in an ICU, and resided in ZIP codes with higher proportions of residents with increased social support had lower odds of readmission. These patient-level factors and community-level SDoH may be used to identify patients with COVID-19 who are at increased risk of readmission.
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Affiliation(s)
- Zanthia Wiley
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ambar Kulshreshtha
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dong Li
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Julianne Kubes
- Office of Quality and Risk, Emory Healthcare, Atlanta, Georgia, USA
| | - Sheetal Kandiah
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Serena Leung
- Kaiser Permanente of Georgia, Atlanta, Georgia, USA
| | - Ketino Kobaidze
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Abeer Moanna
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Health Care System, Decatur, Georgia, USA
| | - Jonathan Perkins
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew Hogan
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kanika M Sims
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Tolu Amzat
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valeria D Cantos
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Jasmah Hanna
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nadine M Harris
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - Tracey L Henry
- Division of General Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Onyinye Iheaku
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mariam Japaridze
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Vaishnavi Lanka
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Nkechi Mbaezue
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Paulina A Rebolledo
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mary Elizabeth Sexton
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Nicole Franks
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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15
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Syed Q, Schmidt S, Powell RE, Henry TL, Connolly N, Cowart JB, Newby C. Gerrymandering and Political Determinants of Health. Popul Health Manag 2022; 25:568-570. [DOI: 10.1089/pop.2021.0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Stacie Schmidt
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Primary Care, Grady Hospital, Atlanta, Georgia, USA
| | - Rhea E. Powell
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tracey L. Henry
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy Connolly
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
| | | | - Celeste Newby
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
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16
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Freeman CD, Guissé NF, Ceasar DR, Fakunle O, Fonseca CA, Fraz F, Gillis RP, Harris NM, Nichols AC, Oboh O, Henry TL. Reflections From Underrepresented in Medicine Applicants on the 2020 Virtual Interview Season. J Grad Med Educ 2022; 14:155-157. [PMID: 35463158 PMCID: PMC9017269 DOI: 10.4300/jgme-d-21-00674.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Christian D. Freeman
- Christian D. Freeman, MD, is a PGY-1, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco
| | - Ndéye F. Guissé
- Ndéye F. Guissé, MD, is a PGY-1, Department of Orthopaedic Surgery, Washington University in St. Louis
| | - D'Andrea R. Ceasar
- D'Andrea R. Ceasar, MD, is a PGY-1, Department of Anesthesiology, University of Texas Health McGovern Medical School
| | - Omolola Fakunle
- Omolola Fakunle, MD, is a PGY-1, Department of Orthopaedic Surgery, Cleveland Clinic
| | - Camille A. Fonseca
- Camille A. Fonseca, MD, MPH, is a PGY-1, University of Chicago Comer Children's Hospital
| | - Farsam Fraz
- Farsam Fraz, MD, is a PGY-1, Department of Obstetrics and Gynecology, Stanford Medicine
| | - Reba P. Gillis
- Reba P. Gillis, MD, MBS, is a PGY-1, Department of Emergency Medicine, Yale School of Medicine
| | - Nile M. Harris
- Nile M. Harris, MD, is a PGY-1, Department of Emergency Medicine, Emory University School of Medicine
| | - Alana C. Nichols
- Alana C. Nichols, JD, MD, is a PGY-1, Department of Medicine and Pediatrics, University of Alabama at Birmingham
| | - Osose Oboh
- Osose Oboh, MD, MPH, is a PGY-1, Department of Medicine, Johns Hopkins University
| | - Tracey L. Henry
- Tracey L. Henry, MD, MPH, MS, is an Associate Professor of Medicine, Department of Medicine, Emory University School of Medicine
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Henry TL, Britz JB, Louis JS, Bruno R, Oronce CIA, Georgeson A, Ragunanthan B, Green MM, Doshi N, Huffstetler AN. Health Equity: The Only Path Forward for Primary Care. Ann Fam Med 2022; 20:175-178. [PMID: 35165088 PMCID: PMC8959751 DOI: 10.1370/afm.2789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/09/2022] Open
Abstract
The 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report on Implementing High-Quality Primary Care identifies 5 high-level objectives regarding payment, access, workforce development, information technology, and implementation. Nine junior primary care leaders (3 internal medicine, 3 family medicine, 3 pediatrics) invited from broad geographies, practice settings, and academic backgrounds used appreciative inquiry to identify priorities for the future of primary care. Highlighting the voices of these early career clinicians, we propose a response to the report from the perspective of early career primary care physicians. Health equity must be the foundation of the future of primary care. Because Barbara Starfield's original 4 Cs (first contact, coordination, comprehensiveness, and continuity) may not be inclusive of the needs of under-resourced communities, we promote an extension to include 5 additional Cs: convenience, cultural humility, structural competency, community engagement, and collaboration. We support the NASEM report's priorities and its focus on achieving health equity. We recommend investing in local communities and preparatory programs to stimulate diverse individuals to serve in health care. Finally, we support a blended value-based care model with risk adjustment for the social complexity of our patients.Appeared as Annals "Online First" article.
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Affiliation(s)
- Tracey L Henry
- Emory University School of Medicine, Division of General Medicine and Geriatrics, Atlanta, Georgia
| | - Jacqueline B Britz
- Virginia Commonwealth University, Department of Family Medicine and Population Health, Richmond, Virginia
| | - Joshua St Louis
- Department of Family Medicine, Tufts University School of Medicine, Boston, Massachusetts; Lawrence Family Medicine Residency, Lawrence, Massachusetts
| | | | - Carlos Irwin A Oronce
- Veterans Affairs Advanced Health Services Research Fellowship, Greater Los Angeles VA Healthcare System, Los Angeles, California.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | | | | | | | - Neeti Doshi
- University of California San Francisco Department of Pediatrics, San Francisco, California
| | - Alison N Huffstetler
- Virginia Commonwealth University, Department of Family Medicine and Population Health, Richmond, Virginia
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18
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Hampton-Anderson JN, Carter S, Fani N, Gillespie CF, Henry TL, Holmes E, Lamis DA, LoParo D, Maples-Keller JL, Powers A, Sonu S, Kaslow NJ. Adverse childhood experiences in African Americans: Framework, practice, and policy. ACTA ACUST UNITED AC 2021; 76:314-325. [PMID: 33734797 DOI: 10.1037/amp0000767] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adverse childhood experiences (ACEs) disproportionately impact African Americans because of profound subjection to historical-systemic oppression in addition to personal and intergenerational trauma exposure. This article utilizes a biopsychosocial-cultural framework to understand the correlates of ACE exposure in African Americans and attends to the cultural factors that contribute to resilience. We review the evidence base for culturally informed, preventive-interventions, as well as strategies for bolstering this work by capitalizing on cultural strengths that are salient in the African American community. We also highlight pertinent policy initiatives guided by recent strategic outlines by the Centers for Disease Control and Prevention. These policies provide the backdrop for the recommendations offered to facilitate the healthy biopsychosocial development of individuals and families. These recommendations can contribute to the expansion and creation of new policies that aim to strengthen individual coping in the face of adversity, enhance family bonds and resilience, and promote community capacity to reduce ACE exposure in African Americans. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University
| | | | - Tracey L Henry
- Division of General Medicine and Geriatrics, Emory University
| | | | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University
| | - Devon LoParo
- Department of Psychiatry and Behavioral Sciences, Emory University
| | | | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University
| | - Stan Sonu
- Division of General Medicine and Geriatrics, General Pediatrics and Adolescent Medicine, Preventive Medicine, Emory University
| | - Nadine J Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University
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19
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Schiff JR, Fiorillo BP, Sadjadi R, Henry TL, Gruen JK, Gensler LM. Confabulation, amnesia and motor memory loss as a presentation of apparent ITPR1 antibody autoimmune encephalitis. BMJ Case Rep 2021; 14:e244316. [PMID: 34531236 PMCID: PMC8449935 DOI: 10.1136/bcr-2021-244316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 12/16/2022] Open
Abstract
A 59-year-old woman presented to the hospital with acute, hypoactive altered mental status. Her symptoms had begun 3 days prior when she developed hallucinations, urinary and faecal incontinence, and somnolence. She also exhibited confabulations, amnesia, motor memory loss and a wide-based gait. Medical, psychiatric and neurological evaluations including imaging and laboratory workup were unrevealing. Treatment for possible Wernicke encephalopathy and psychosis with high-dose intravenous thiamine and antipsychotic medications did not lead to improvement. After discharge, a send-out cerebrospinal fluid autoimmune encephalitis panel resulted positive for the newly identified neuronal inositol triphosphate receptor one (ITPR1) antibody. This prompted readmission for intravenous steroids, plasmapheresis and intravenous immunoglobulin, which yielded mild clinical improvement. Here, we describe confabulations and psychiatric symptoms as novel manifestations of the primary presentation of anti-ITPR1 encephalitis in an effort to promote faster recognition of this disease and early initiation of treatment in suspected cases.
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Affiliation(s)
- Julia R Schiff
- Department of Internal Medicine, Emory University, Atlanta, Georgia, USA
| | - Benjamin P Fiorillo
- Department of Anesthesia and Critical Care, Emory University, Atlanta, Georgia, USA
| | - Raha Sadjadi
- Department of Internal Medicine, Emory University, Atlanta, Georgia, USA
| | - Tracey L Henry
- Department of Internal Medicine, Emory University, Atlanta, Georgia, USA
| | - Judah K Gruen
- Department of Internal Medicine, Emory University, Atlanta, Georgia, USA
| | - Lauren M Gensler
- Department of Internal Medicine, Psychiatry, Emory University, Atlanta, Georgia, USA
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20
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Okosun IS, Airhihenbuwa C, Henry TL. Allostatic load, metabolic syndrome and self-rated health in overweight/obese Non-Hispanic White, non-Hispanic Black and Mexican American adults. Diabetes Metab Syndr 2021; 15:102154. [PMID: 34186341 DOI: 10.1016/j.dsx.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 11/21/2022]
Abstract
AIM This study examined the associations of high allostatic load (h_ALS) and metabolic syndrome (MetS) with and self-rated poor health (SRPH) in overweight/obese non-Hispanic White (NHW), non-Hispanic Black (NHB), and Mexican American (MA) adults. METHODS The 2015-16 and 2017-18 US National Health and Nutrition Examination Survey data (n = 4403) were used for this study. RESULTS Rates of h_ALS in overweight/obese NHW, NHW, and MA participants were 56.9%, 58.8%, and 51.9%, respectively (P < .05). The corresponding rates for MetS were 26.9%, 31.9%, and 46.5%, respectively. High ALS was associated with 2.19 (95% CI: 1.87-4.59), 1.82 (1.42-2.58), and 1.47 (95% CI: 1.08-1.64) increased odds of SRPH in overweight/obese NHW, NHB, and MA, respectively, after adjusting for age, education, gender, income, lifestyle behaviors, and marital status. The corresponding values for MetS were 1.86 (95% CI: 1.54-2.40), 2.77 (95% CI: 1.36-5.63), and 1.22 (95% CI: 1.06-2.32), respectively. CONCLUSIONS The effect of h_ALS on SRPH was much stronger in NHW, while the effect of MetS was strongest among NHB overweight/obese adults. The result of this study provides further evidence in favor of race/ethnic-tailored interventions, including education and weight control to reduced risks of bodywear and tear and SRPH.
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Affiliation(s)
- Ike S Okosun
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
| | - Collins Airhihenbuwa
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Tracey L Henry
- Division of General Medicine and Geriatrics. Emory University School of Medicine, Atlanta, GA, 30303, USA
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21
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Mulligan MJ, Henry TL, Bracey JE. Protecting and Expanding Medicaid Access: Confronting Health Disparities Compounded by COVID-19. Popul Health Manag 2021; 24:640-642. [PMID: 33794136 DOI: 10.1089/pop.2021.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew J Mulligan
- General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tracey L Henry
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer E Bracey
- Division of Hospital Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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22
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Alcegueire K, Henry TL. It Is Time to Address the Needs of Socioeconomically Disadvantaged Medical Students. Acad Med 2021; 96:15. [PMID: 33394656 DOI: 10.1097/acm.0000000000003796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Kara Alcegueire
- Intern, Holy Cross Hospital, University of Miami, Fort Lauderdale, Florida;
| | - Tracey L Henry
- Assistant professor of medicine, Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia
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23
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Kuy S, Tsai R, Bhatt J, Chu QD, Gandhi P, Gupta R, Gupta R, Hole MK, Hsu BS, Hughes LS, Jarvis L, Jha SS, Annamalai A, Kotwal M, Sakran JV, Vohra S, Henry TL, Correa R. Focusing on Vulnerable Populations During COVID-19. Acad Med 2020; 95:e2-e3. [PMID: 32639264 PMCID: PMC7363379 DOI: 10.1097/acm.0000000000003571] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- SreyRam Kuy
- Assistant professor, Department of Surgery, Baylor College of Medicine, Houston, Texas;
| | - Raymond Tsai
- Assistant clinical professor, Department of Family Medicine, University of California, San Francisco, San Francisco, California
| | - Jay Bhatt
- Internist, geriatrician, and former Chief Medical Officer, American Hospital Association, Chicago, Illinois
| | - Quyen D Chu
- Chief, Division of Surgical Oncology, and Edward & Freda Green Professor in Surgical Oncology, Department of Surgery, LSU-Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Pritesh Gandhi
- Associate chief medical officer, People's Community Clinic, Austin, Texas
| | - Rohit Gupta
- Medical student, Baylor College of Medicine, Houston, Texas
| | - Reshma Gupta
- Medical director of population care and value, Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Michael K Hole
- Assistant professor of pediatrics, population health, and public policy, Department of Pediatrics, The University of Texas at Austin, Austin, Texas
| | - Benson S Hsu
- Associate professor of pediatrics, Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Lauren S Hughes
- Director, Farley Health Policy Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lenore Jarvis
- Clinical assistant professor of pediatrics, The George Washington University School of Medicine and Health Sciences, and Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Sachin Sunny Jha
- Assistant clinical professor, Department of Anesthesiology, University of Southern California, Los Angeles, California
| | | | - Mansi Kotwal
- Clinical assistant professor of pediatrics, The George Washington University School of Medicine and Health Sciences, and Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Joseph V Sakran
- Director, Emergency General Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Sameer Vohra
- Chair, Department of Population Science and Policy, and assistant professor of pediatrics, medical humanities, and law, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Tracey L Henry
- Assistant health director, Grady Primary Care Center, and assistant professor, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ricardo Correa
- Program director, Endocrinology, Diabetes, and Metabolism Fellowship, University of Arizona College of Medicine-Phoenix, and Phoenix Veterans Affairs Medical Center, Phoenix, Arizona
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Henry TL, Elahi S, Nallapaneni S, Ngoc Dinh LT, Revoredo IC, Okosun IS. Disparities in Mental Health Status and Mental Health Services Use in US Born and non-US Born Populations: Findings from a Nationally Representative Sample. J Natl Med Assoc 2020. [DOI: 10.1016/j.jnma.2020.09.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cahill E, Schmidt SR, Henry TL, Kumar G, Berney S, Bussey-Jones J, Girard AW. Qualitative research study on addressing barriers to healthy diet among low-income individuals at an urban, safety-net hospital. BMJ Nutr Prev Health 2020; 3:383-386. [PMID: 33521548 PMCID: PMC7841836 DOI: 10.1136/bmjnph-2020-000064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background Some American households experience food insecurity, where access to adequate food is limited by lack of money and other resources. As such, we implemented a free 6-month Fruit and Vegetable Prescription Program within a large urban safety-net hospital. Methods 32 participants completed a baseline and postintervention qualitative evaluation about food-related behaviour 6 months after study completion. Deductive codes were developed based on the key topics addressed in the interviews; inductive codes were identified from analytically reading the transcripts. Transcripts were coded in MAXQDA V.12 (Release 12.3.2). Results The information collected in the qualitative interviews highlights the many factors that affect dietary habits, including the environmental and individual influences that play a role in food choices people make. Participants expressed very positive sentiments overall about their programme participation. Conclusions A multifaceted intervention that targets individual behaviour change, enhances nutritional knowledge and skills, and reduces socioeconomic barriers to accessing fresh produce may enhance participant knowledge and self-efficacy around healthy eating. However, socioeconomic factors remain as continual barriers to sustaining healthy eating over the long term. Ongoing efforts that address social determinants of health may be necessary to promote sustainability of behaviour change.
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Affiliation(s)
- Erin Cahill
- Emory University School of Public Health, Atlanta, Georgia, USA
| | - Stacie R Schmidt
- Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tracey L Henry
- Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gayathri Kumar
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sara Berney
- North Carolina State University School of Public and International Affairs, Raleigh, North Carolina, USA
| | - Jada Bussey-Jones
- Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amy Webb Girard
- Emory University School of Public Health, Atlanta, Georgia, USA
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Chu Q, Correa R, Henry TL, McGregor KA, Stoklosa H, Robinson L, Jha S, Annamalai A, Hsu BS, Gupta R, Patton DU, Moreno-Walton LA, Butts C, Chai C, Kuy S. Reallocating ventilators during the coronavirus disease 2019 pandemic: Is it ethical? Surgery 2020; 168:388-391. [PMID: 32616345 PMCID: PMC7205622 DOI: 10.1016/j.surg.2020.04.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Quyen Chu
- Surgical Oncology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA
| | - Ricardo Correa
- Department of Medicine, University of Arizona College of Medicine-Phoenix and Phoenix VAMC, Phoenix, AZ
| | - Tracey L Henry
- Grady Primary Care Center, Emory University School of Medicine, Atlanta, GA
| | - Kyle A McGregor
- Lankenau Institute for Medical Research, Thomas Jefferson University, Philadelphia, PA
| | - Hanni Stoklosa
- Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Sachin Jha
- Department of Anesthesia, University of Southern California, Los Angeles, CA
| | | | - Benson S Hsu
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, SD
| | | | | | - Lisa A Moreno-Walton
- Department of Emergency Medicine, Louisiana State University - New Orleans, New Orleans, LA
| | - Christine Butts
- Department of Emergency Medicine, Louisiana State University - New Orleans, New Orleans, LA
| | - Christy Chai
- Department of Surgery, Baylor College of Medicine, Houston, TX
| | - SreyRam Kuy
- Department of Surgery, Baylor College of Medicine, Houston, TX
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Gawey B, Tannu M, Rim J, Sperling L, Henry TL. Statin-Induced Necrotizing Autoimmune Myopathy. JACC Case Rep 2020; 2:440-443. [PMID: 34317259 PMCID: PMC8311592 DOI: 10.1016/j.jaccas.2019.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 01/13/2023]
Abstract
Statin-induced necrotizing autoimmune myopathy (SINAM) is an exceptionally rare yet devastating complication of statin therapy that can occur at any time after initiation. It should be considered in patients who develop proximal muscle weakness and marked elevated creatine phosphokinase while taking statin therapy. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Brent Gawey
- Department of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Manasi Tannu
- Department of Hospital Medicine, Emory University Hospital, Atlanta, Georgia
| | - Jeeyon Rim
- Department of Hospital Medicine, Emory University Hospital, Atlanta, Georgia
| | - Laurence Sperling
- Department of Preventative Cardiology, Emory Clinic, Atlanta, Georgia
| | - Tracey L Henry
- Divison of General Medicine and Geriatrics, Grady Memorial Hospital, Atlanta, Georgia
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Henry TL, Jetty A, Petterson S, Jaffree H, Ramsay A, Heiman E, Bazemore A. Taking a Closer Look at Mental Health Treatment Differences: Effectiveness of Mental Health Treatment by Provider Type in Racial and Ethnic Minorities. J Prim Care Community Health 2020; 11:2150132720966403. [PMID: 33089752 PMCID: PMC7585881 DOI: 10.1177/2150132720966403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To estimate racial/ethnic differences in the extent to which mental health treatment is obtained from mental health providers, primary care physicians (PCPs), or both and to examine the effects of provider type on change in mental component scores (MCS) of the SF-12 on different race/ethnic groups. METHODS Secondary data analysis of 2008 to 2015 Medical Expenditure Panel Survey (MEPS). Non-institutionalized civilian US population, aged 18 to 64 (N = 62 558). Based on counts of all mental health visits in a calendar year, we identified patients who obtained care from PCPs, mental health provider, PCP and mental health providers and other providers and examined changes in MCS by type of care. RESULTS 9.9% of Non-Hispanic Whites obtained mental health treatment, compared to 5.0% for Hispanics, 5.3% for Blacks and 5.5% for Other Races (P < .001). Non-Hispanic Blacks and non-Hispanic "Other" were more likely than other groups to obtain care from mental health providers only (P = .017). All obtaining care solely from PCP had better mental health (mean (se)) MCS: 43.2(0.28)) than those obtaining care solely from mental health provider (39.8 (0.48)), which in turn was higher than for those obtaining care from both PC and MH providers (38.5 (0.31), (P < .001). CONCLUSION Even when diagnosed with a mental health disorder, Hispanics and Blacks were less likely to seek mental health treatment than Whites, highlighting the continuing disparity. Future research should focus on understanding how and what aspects of integrated care models and other mental health delivery models that reduce disparities and provide greater accessibility.
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Affiliation(s)
| | | | | | | | - Allie Ramsay
- Emory University School of Medicine, Atlanta, GA, USA
| | - Erica Heiman
- Emory University School of Medicine, Atlanta, GA, USA
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Henry TL, Schmidt S, Lund MB, Haynes T, Ford D, Egwuogu H, Schmitz S, McGregor B, Toomer L, Bussey-Jones J. Improving Depression Screening in Underserved Populations in a Large Urban Academic Primary Care Center: A Provider-Centered Analysis and Approach. Am J Med Qual 2019; 35:315-322. [PMID: 31701768 DOI: 10.1177/1062860619884639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Screening for depression is paramount to identify patients with depression and link them to care, yet only 29% of patients in the primary care center (PCC) were screened for depression in 2016. A baseline survey identified provider barriers to depression screening, including lack of time, support staff, and referral resources. The purpose of this project was to increase depression screening in the PCC using the Patient Health Questionnaire (PHQ-2/9). The authors created an educational program for staff and providers that included referral resources, treatment guidelines, and a decision-support tool in the electronic medical record. A retrospective chart review was performed, from January 2016 to June 2017, to determine the percentage of patients who received annual depression screening. During the program, the PCC saw an increase in depression screening rates. Thus, it is possible to overcome barriers to depression screening in a primary care setting by providing resources and education to clinicians.
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Okosun IS, Okosun B, Lyn R, Henry TL. Chronic medical conditions based obesity phenotypes: A two-step cluster analysis of a representative sample of obese American adults. Diabetes Metab Syndr 2019; 13:2897-2905. [PMID: 31425954 DOI: 10.1016/j.dsx.2019.07.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/29/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Although obesity is a heterogeneous disease, little is known regarding chronic medical conditions (CMCs) that defines variability in obese populations. The characterization of obese populations using CMCs rather than categorization using BMI alone can advance understanding of obesity. The aims of this study are to phenotype obesity in a large representative sample of non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican American (MA) obese adults using CMCs, and assess relationship between resulting phenotypes and self-rated health (SRH). METHODS Sex-specific two-step cluster analysis was used to phenotype obese participants (n = 12,547) to CMC-based clusters. The prevalence of CMCs and lifestyle risk factors in each cluster was assessed. Sex and race/ethnic specific association between cluster membership and SRH was determined using odds ratio (OR) from logistic regression analysis. RESULTS Distinct subgroups of obese men and women were observed: moderate dyslipidemic healthy young obese men, hypertensive-dyslipidemic middle-age obese men, hypertensive young obese men, hypertensive-dyslipidemic-asthmatic middle-age obese men, and syndemic elderly obese men, healthy young obese women, hypertensive-dyslipidemic middle-age obese women, dyslipidemic young adult obese women, syndemic middle-age obese women, and syndemic elderly obese women. Participants in the more CMCs symptomatic clusters reported high rates of behavioral risk factors and showed significantly greater odds of poor SRH than participants in the less symptomatic clusters. Compared to obese persons who are asymptomatic for CMCs, syndemic elderly obese and women men had much higher increased ORs for poor SRH with values of 3.88 [95% CI = 2.41-6.26], 3.96 [95% CI = 1.86-8.30] and 7.25 [95% CI = 2.41-9.6] for NHW, NHB and MA men, respectively. The corresponding ORs for women are 4.08 [95% CI = 2.71-6.14], 4.01 [95% CI = 2.40-6.69], and 2.62 [95% CI = 1.32-5.19], respectively. CONCLUSION Obesity treatment and intervention should consider heterogeneity within obese persons and pay greater attention to obesity related co-morbidities and metabolic manifestations.
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Affiliation(s)
- Ike S Okosun
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
| | - Bryan Okosun
- Department of Molecular and Cellular Biology, Kennesaw State University, Kennesaw, GA, USA
| | - Rodney Lyn
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Tracey L Henry
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Abstract
Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) is a rare pulmonary disorder characterised by classic radiological findings and symptoms of obstructive lung disease. DIPNECH is considered a precursor to carcinoid tumours in the lungs. In this case, we describe a patient with years of unexplained dry cough presenting with 2 weeks of progressive nausea and vomiting, and found to have massive hepatomegaly on examination. By CT-PE, she was diagnosed with DIPNECH, and abdominal MRI revealed metastatic carcinoid tumours. Despite its non-specific presentation, DIPNECH has characteristic radiological findings of mosaic attenuation with numerous pulmonary nodules. DIPNECH requires early identification and close surveillance to prevent progression to carcinoid tumours. Thus, it is critical for frontline providers to consider this diagnosis as part of their differential when other common causes of obstructive lung disease have been ruled out.
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Affiliation(s)
- Kristen Flint
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chengcheng Ye
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tracey L Henry
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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McGregor B, Belton A, Henry TL, Wrenn G, Holden KB. Improving Behavioral Health Equity through Cultural Competence Training of Health Care Providers. Ethn Dis 2019; 29:359-364. [PMID: 31308606 DOI: 10.18865/ed.29.s2.359] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Racial/ethnic disparities have long persisted in the United States despite concerted health system efforts to improve access and quality of care among African Americans and Latinos. Cultural competence in the health care setting has been recognized as an important feature of high-quality health care delivery for decades and will continue to be paramount as the society in which we live becomes increasingly culturally diverse. Unfortunately, there is limited empirical evidence of patient health benefits of a culturally competent health care workforce in integrated care, its feasibility of implementation, and sustainability strategies. This article reviews the status of cultural competence education in health care, the merits of continued commitment to training health care providers in integrated care settings, and policy and practice strategies to ensure emerging health care professionals and those already in the field are prepared to meet the health care needs of racially and ethnically diverse populations.
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Butkus R, Doherty R, Bornstein SS, Carney JK, Cooney T, Engel L, Gantzer HE, Henry TL, Lenchus JD, McCandless BM, Quinton J, Southworth M, Valdrighi A, Wallace MA. Reducing Firearm Injuries and Deaths in the United States: A Position Paper From the American College of Physicians. Ann Intern Med 2018; 169:704-707. [PMID: 30383132 DOI: 10.7326/m18-1530] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
For more than 20 years, the American College of Physicians (ACP) has advocated for the need to address firearm-related injuries and deaths in the United States. Yet, firearm violence continues to be a public health crisis that requires the nation's immediate attention. The policy recommendations in this paper build on, strengthen, and expand current ACP policies approved by the Board of Regents in April 2014, based on analysis of approaches that the evidence suggests will be effective in reducing deaths and injuries from firearm-related violence.
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Affiliation(s)
- Renee Butkus
- American College of Physicians, Washington, DC (R.B., R.D.)
| | - Robert Doherty
- American College of Physicians, Washington, DC (R.B., R.D.)
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Daniel H, Erickson SM, Bornstein SS, Kane GC, Gantzer HE, Henry TL, Lenchus JD, Li JM, McCandless BM, Nalitt BR, Viswanathan L, Murphy CJ, Azah AM, Marks L. Women's Health Policy in the United States: An American College of Physicians Position Paper. Ann Intern Med 2018; 168:874-875. [PMID: 29809243 DOI: 10.7326/m17-3344] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this position paper, the American College of Physicians (ACP) examines the challenges women face in the U.S. health care system across their lifespans, including access to care; sex- and gender-specific health issues; variation in health outcomes compared with men; underrepresentation in research studies; and public policies that affect women, their families, and society. ACP puts forward several recommendations focused on policies that will improve the health outcomes of women and ensure a health care system that supports the needs of women and their families over the course of their lifespans.
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Affiliation(s)
- Hilary Daniel
- American College of Physicians, Washington, DC (H.D., S.M.E.)
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Butkus R, Serchen J, Moyer DV, Bornstein SS, Hingle ST, Kane GC, Carney JK, Gantzer HE, Henry TL, Lenchus JD, Li JM, McCandless BM, Nalitt BR, Viswanathan L, Murphy CJ, Azah A, Marks L. Achieving Gender Equity in Physician Compensation and Career Advancement: A Position Paper of the American College of Physicians. Ann Intern Med 2018; 168:721-723. [PMID: 29710100 DOI: 10.7326/m17-3438] [Citation(s) in RCA: 212] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Women comprise more than one third of the active physician workforce, an estimated 46% of all physicians-in-training, and more than half of all medical students in the United States. Although progress has been made toward gender diversity in the physician workforce, disparities in compensation exist and inequities have contributed to a disproportionately low number of female physicians achieving academic advancement and serving in leadership positions. Women in medicine face other challenges, including a lack of mentors, discrimination, gender bias, cultural environment of the workplace, imposter syndrome, and the need for better work-life integration. In this position paper, the American College of Physicians summarizes the unique challenges female physicians face over the course of their careers and provides recommendations to improve gender equity and ensure that the full potential of female physicians is realized.
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Affiliation(s)
- Renee Butkus
- American College of Physicians, Washington, DC (R.B., J.S.)
| | - Joshua Serchen
- American College of Physicians, Washington, DC (R.B., J.S.)
| | - Darilyn V Moyer
- American College of Physicians, Philadelphia, Pennsylvania (D.V.M.)
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Daniel H, Bornstein SS, Kane GC, Carney JK, Gantzer HE, Henry TL, Lenchus JD, Li JM, McCandless BM, Nalitt BR, Viswanathan L, Murphy CJ, Azah AM, Marks L. Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper. Ann Intern Med 2018; 168:577-578. [PMID: 29677265 DOI: 10.7326/m17-2441] [Citation(s) in RCA: 293] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Social determinants of health are nonmedical factors that can affect a person's overall health and health outcomes. Where a person is born and the social conditions they are born into can affect their risk factors for premature death and their life expectancy. In this position paper, the American College of Physicians acknowledges the role of social determinants in health, examines the complexities associated with them, and offers recommendations on better integration of social determinants into the health care system while highlighting the need to address systemic issues hindering health equity.
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Affiliation(s)
- Hilary Daniel
- American College of Physicians, Washington, DC (H.D.)
| | | | - Gregory C Kane
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (G.C.K.)
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Rosen LB, Rocha Pereira N, Figueiredo C, Fiske LC, Ressner RA, Hong JC, Gregg KS, Henry TL, Pak KJ, Baumgarten KL, Seoane L, Garcia-Diaz J, Olivier KN, Zelazny AM, Holland SM, Browne SK. Nocardia-induced granulocyte macrophage colony-stimulating factor is neutralized by autoantibodies in disseminated/extrapulmonary nocardiosis. Clin Infect Dis 2014; 60:1017-25. [PMID: 25472947 DOI: 10.1093/cid/ciu968] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Nocardia species cause infections in both immunocompromised and otherwise immunocompetent patients, although the mechanisms defining susceptibility in the latter group are elusive. Anticytokine autoantibodies are an emerging cause of pathogen-specific susceptibility in previously healthy human immunodeficiency virus-uninfected adults, including anti-granulocyte macrophage colony-stimulating factor (GM-CSF) autoantibodies with cryptococcal meningitis. METHODS Plasma from patients with disseminated/extrapulmonary nocardiosis and healthy controls was screened for anticytokine autoantibodies using a particle-based approach. Autoantibody function was assessed by intranuclear staining for GM-CSF-induced STAT5 phosphorylation in normal cells incubated with either patient or normal plasma. GM-CSF-mediated cellular activation by Nocardia was assessed by staining for intracellular cytokine production and intranuclear STAT5 phosphorylation. RESULTS We identified neutralizing anti-GM-CSF autoantibodies in 5 of 7 patients studied with central nervous system nocardiosis and in no healthy controls (n = 14). GM-CSF production was induced by Nocardia in vitro, suggesting a causative role for anti-GM-CSF autoantibodies in Nocardia susceptibility and dissemination. CONCLUSIONS In previously healthy adults with otherwise unexplained disseminated/extrapulmonary Nocardia infections, anti-GM-CSF autoantibodies should be considered. Their presence may suggest that these patients may be at risk for later development of pulmonary alveolar proteinosis or other opportunistic infections, and that patients may benefit from therapeutic GM-CSF administration.
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Affiliation(s)
- Lindsey B Rosen
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Nuno Rocha Pereira
- Nephrology and Infectious Diseases Research and Development Group, INEB (I3S), University of Porto Department of Infectious Diseases, São João Hospital Center, Porto, Portugal
| | | | | | - Roseanne A Ressner
- Walter Reed National Military Medical Center Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Julie C Hong
- Department of Allergy/Immunology, Permanente Medical Group, Kaiser Permanente Northwest, Clackamas, Oregon
| | - Kevin S Gregg
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | | | | | | | - Leonardo Seoane
- Department of Pulmonary and Critical Care Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana
| | | | - Kenneth N Olivier
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Adrian M Zelazny
- Department of Microbiology Service, Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland
| | - Steven M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sarah K Browne
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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Basu Ray I, Henry TL, Davis W, Alam J, Amedee RG, Pinsky WW. Consolidated academic and research exposition: a pilot study of an innovative education method to increase residents' research involvement. Ochsner J 2012; 12:367-372. [PMID: 23267266 PMCID: PMC3527867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Internal medicine residents at the Ochsner Clinic Foundation stay engaged with clinical work and have difficulty initiating and completing research and publishing their scholarly activities. Commonly cited barriers include lack of knowledge about institutional research programs, lack of confidence regarding medical writing skills, lack of time, and failure to understand the value of research. The residency directors at Ochsner initiated the Consolidated Academic and Research Exposition (CARE) program to teach basic research skills and encourage residents' interest and productivity in research. METHODS The CARE program includes 4 core components: house staff mentoring and the Resident Career Development Program, a journal club, medical writing instruction, and research engagement. Particular emphasis is given to projects that could be completed within a 1-month period and result in publication, enabling residents to use a 1-month elective rotation during their first postgraduate year. The sessions are mandatory for residents, except for those on specified rotations, including the critical care service and the night float rotation and those who are postcall. RESULTS In 2010-2011, 6 residents submitted abstracts to the Louisiana Chapter of the American College of Physicians Associates meeting; 2 abstracts were accepted for presentation. In 2011-2012, there were 14 submissions, 4 of which were accepted for presentation. In 2010-2011, there were 4 submissions to the Southern Hospitalist Conference, which increased to 7 submissions in 2011-2012. The second best presentation award at the Southern Hospitalist Conference was also earned by a resident of this institution. The program saw a 110% total increase in scholarly activity from 2010-2011 to 2011-2012. DISCUSSION The CARE program has been in existence for approximately 1 year. Preliminary results were tabulated based on research proposals, posters, abstracts, case reports, and presentations submitted and/or accepted at leading medical conferences over the past year as compared to the same period 1 year ago. Residents, based on the Accreditation Council for Graduate Medical Education Resident Survey responses, were more satisfied with the opportunities provided to them to participate in research or scholarly activities. Our preliminary results suggest that an organized, structured research curriculum in internal medicine residency programs is critical to promoting, initiating, and completing scholarly activity during a residency program. CONCLUSION Ochsner's CARE program has appreciably enhanced internal medicine residents' interest in research-related activity, resulting in a significant increase in resident-authored research papers, abstracts, posters, and case reports being accepted at leading national medical conferences.
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Affiliation(s)
| | | | - William Davis
- Department of Rheumatology
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Jawed Alam
- Institute of Translational Research
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Ronald G. Amedee
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - William W. Pinsky
- Ochsner Health System, and
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
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Matsubara E, Bryant-Thomas T, Pacheco J, Henry TL, Poeggeler B, Herbert D, Cruz-Sanchez F, Chyan YJ, Smith MA, Perry G, Chain DG, Neria E, Shoji M, Abe K, Leone A, Grundke-Iqbal I, Wilson GL, Ghiso J, Williams C, Refolo LM, Pappolla MA. Melatonin increases survival and inhibits oxidative and amyloid pathology in a transgenic model of Alzheimer's disease. J Neurochem 2003. [DOI: 10.1046/j.1471-4159.2003.01997.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pappolla MA, Bryant-Thomas TK, Herbert D, Pacheco J, Fabra Garcia M, Manjon M, Girones X, Henry TL, Matsubara E, Zambon D, Wolozin B, Sano M, Cruz-Sanchez FF, Thal LJ, Petanceska SS, Refolo LM. Mild hypercholesterolemia is an early risk factor for the development of Alzheimer amyloid pathology. Neurology 2003; 61:199-205. [PMID: 12874399 DOI: 10.1212/01.wnl.0000070182.02537.84] [Citation(s) in RCA: 227] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Epidemiologic and experimental data suggest that cholesterol may play a role in the pathogenesis of AD. Modulation of cholesterolemia in transgenic animal models of AD strongly alters amyloid pathology. OBJECTIVE To determine whether a relationship exists between amyloid deposition and total cholesterolemia (TC) in the human brain. METHODS The authors reviewed autopsy cases of patients older than 40 years and correlated cholesterolemia and presence or absence of amyloid deposition (amyloid positive vs amyloid negative subjects) and cholesterolemia and amyloid load. Amyloid load in human brains was measured by immunohistochemistry and image analysis. To remove the effect of apoE isoforms on cholesterol levels, cases were genotyped and duplicate analyses were performed on apoE3/3 subjects. RESULTS Cholesterolemia correlates with presence of amyloid deposition in the youngest subjects (40 to 55 years) with early amyloid deposition (diffuse type of senile plaques) (p = 0.000 for all apoE isoforms; p = 0.009 for apoE3/3 subjects). In this group, increases in cholesterolemia from 181 to 200 almost tripled the odds for developing amyloid, independent of apoE isoform. A logistic regression model showed consistent results (McFadden rho2 = 0.445). The difference in mean TC between subjects with and without amyloid disappeared as the age of the sample increased (>55 years: p = 0.491), possibly reflecting the effect of cardiovascular deaths among other possibilities. TC and amyloid load were not linearly correlated, indicating that there are additional factors involved in amyloid accumulation. CONCLUSIONS Serum hypercholesterolemia may be an early risk factor for the development of AD amyloid pathology.
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Matsubara E, Bryant-Thomas T, Pacheco Quinto J, Henry TL, Poeggeler B, Herbert D, Cruz-Sanchez F, Chyan YJ, Smith MA, Perry G, Shoji M, Abe K, Leone A, Grundke-Ikbal I, Wilson GL, Ghiso J, Williams C, Refolo LM, Pappolla MA, Chain DG, Neria E. Melatonin increases survival and inhibits oxidative and amyloid pathology in a transgenic model of Alzheimer's disease. J Neurochem 2003; 85:1101-8. [PMID: 12753069 DOI: 10.1046/j.1471-4159.2003.01654.x] [Citation(s) in RCA: 225] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Increased levels of a 40-42 amino-acid peptide called the amyloid beta protein (A beta) and evidence of oxidative damage are early neuropathological markers of Alzheimer's disease (AD). Previous investigations have demonstrated that melatonin is decreased during the aging process and that patients with AD have more profound reductions of this hormone. It has also been recently shown that melatonin protects neuronal cells from A beta-mediated oxidative damage and inhibits the formation of amyloid fibrils in vitro. However, a direct relationship between melatonin and the biochemical pathology of AD had not been demonstrated. We used a transgenic mouse model of Alzheimer's amyloidosis and monitored over time the effects of administering melatonin on brain levels of A beta, abnormal protein nitration, and survival of the mice. We report here that administration of melatonin partially inhibited the expected time-dependent elevation of beta-amyloid, reduced abnormal nitration of proteins, and increased survival in the treated transgenic mice. These findings may bear relevance to the pathogenesis and therapy of AD.
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Affiliation(s)
- Etsuro Matsubara
- Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
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