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Sobotka SA, Lynch E, Liao C, Graham RJ, Msall ME. Autism and neurodevelopmental disability risks in children with tracheostomies and ventilators. Pediatr Pulmonol 2024; 59:1380-1387. [PMID: 38426806 DOI: 10.1002/ppul.26921] [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: 10/17/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND/OBJECTIVE Infants who survive prematurity and other critical illnesses and require continued invasive mechanical ventilation (IMV) postdischarge (at home) are at high risk of developmental delays and disabilities. Studies of extremely preterm cohorts (<28-week gestation) demonstrate rates of 25% for intellectual disability (ID) and 7% for autism spectrum disorder (ASD). Rates of ASD and ID in children with IMV are unknown. This study aimed to determine neurodevelopmental disability risk in a cohort of children with postdischarge IMV. DESIGN/METHODS A consecutive series of children with IMV were assessed 1 month, 6 months, and 1 year after discharge. Cognitive, social, and communicative domains were assessed by a Developmental and Behavioral Pediatrician using (1) clinical adaptive test/clinical linguistic and auditory milestone scale (CAT/CLAMS) of the capute scales; (2) pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT); and (3) modified checklist for autism in toddlers, revised (MCHAT-R). Red flag signs and symptoms of ASD using DSM-V criteria were noted. Longitudinal testing was reviewed. Expert consensus impressions of evolving ASD and/or ID were determined. RESULTS Eighteen children were followed for 1 year; at 1 year, the median age (range) was 23 (17-42) months. Children were 44% male, 33% non-Hispanic White, 39% non-Hispanic Black, and 28% Hispanic. Fifteen (83%) children were prematurity survivors. Median (range) developmental quotients (DQs): full-scale DQ 59 (11-86), CAT DQ 66.5 (8-96), and CLAMS DQ 49.5 (13-100). Twelve (67%) children were highly suspicious for ASD and/or evolving ID. CONCLUSIONS/SIGNIFICANCE This cohort of children with at-home IMV demonstrates a higher risk of ASD and ID than prior premature cohorts. Larger investigations with longer follow-up are needed.
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Affiliation(s)
- Sarah A Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
| | - Emma Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
| | - Chuanhong Liao
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Robert J Graham
- Department of Anesthesiology, Critical Care and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael E Msall
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
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2
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Lombardi BM, de Saxe Zerden L, Greeno C. Federally Qualified Health Centers Use of Telehealth to Deliver Integrated Behavioral Health Care During COVID-19. Community Ment Health J 2024; 60:215-223. [PMID: 36547816 PMCID: PMC9774057 DOI: 10.1007/s10597-022-01070-1] [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: 06/03/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
Federally qualified health centers (FQHCs) that provide comprehensive health services, including integrated behavioral health (IBH), transitioned to deliver care via telehealth during the COVID-19 pandemic. This study explored how FQHCs adapted IBH services using telehealth. A mixed-method design was used, pairing a survey disseminated to FQHC administrators with a structured interview. Of the 46 administrators who participated in the survey, 14 (30.4%) reported delivering IBH using telecommunication prior to the pandemic. Since COVID-19, almost all of the FQHCs surveyed used telecommunication to deliver IBH (n = 44, 95.7%). Nine interviews with FQHC administrators resulted in the four themes: telehealth was essential; core components of IBH were impacted; payment parity and reimbursement were a concern; and telehealth addressed workforce issues. Findings confirm the necessity of telehealth for FQHCs during COVID-19. However due to the lack of co-location, warm-handoffs and other core components of IBH were limited.
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Affiliation(s)
- Brianna M Lombardi
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Dr, 27514, Chapel Hill, NC, USA.
| | - Lisa de Saxe Zerden
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St., CB #3550, 27516, Chapel Hill, NC, USA
| | - Catherine Greeno
- School of Social Work, University of Pittsburgh, 4200 Fifth Ave., Pittsburgh, PA, 15260, USA
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3
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Msall ME. Family Reflections on a Lifecourse Journey after Neonatal Intensive Care: Neurodiversity, Enablement and Hope. Children (Basel) 2024; 11:165. [PMID: 38397277 PMCID: PMC10887092 DOI: 10.3390/children11020165] [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] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/22/2023] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
In 1969, my sister Christianne was born late preterm with a genetic disorder and given a very pessimistic prognosis. I will describe, from a family perspective, some lifecourse lessons about neurodiversity using the World Health Organization International Classification Model of Functioning (WHO-ICF). This model emphasizes that, in communicating about the complexity of outcomes of disability, attention must be paid to facilitators and barriers for optimizing health, functioning in daily life, and participation in the community. I will describe several developmental lifecourse lessons learned in negotiating fragmented systems of health, education, and community care. I will suggest ways to improve physician-parent communication, focusing on enablement to decrease a family's sense of isolation and despair. I have benefitted from my parents' archives, discussions with all my seven sisters (including Christianne), and discussions with my brother and sister-in law. They all have provided invaluable feedback from a family perspective during Christianne's lived lifecourse journey with neurodiversity.
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Affiliation(s)
- Michael E Msall
- Section of Developmental Pediatrics, JP Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, Comer Children's Hospital, University of Chicago Medicine, 950 East 61st Street Suite 207, Chicago, IL 60637, USA
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Cueto V, González Cueto V, Alzate-Duque L, Natale-Pereira A. Language Proficiency and Delay of Care During the COVID-19 Pandemic: Cross-Sectional Analysis of Low-Income Women in Newark. J Gen Intern Med 2024; 39:159-162. [PMID: 37884832 PMCID: PMC10817871 DOI: 10.1007/s11606-023-08424-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/12/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Victor Cueto
- Division of Internal Medicine-Pediatrics, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Vivian González Cueto
- Department of Public Affairs & Administration, California State University, Hayward, CA, USA
| | - Luis Alzate-Duque
- Division of General Internal Medicine, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ana Natale-Pereira
- Division of General Internal Medicine, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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5
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Kaul CM, Cohen GM, Silverstein M, Wallach AB, Diago-Navarro E, Holzman RS, Foote MK. Understanding the Relationship Between Antiviral Prescription Data and COVID-19 Incidence in New York City: A Retrospective Cohort Study. Open Forum Infect Dis 2023; 10:ofad281. [PMID: 37333721 PMCID: PMC10270561 DOI: 10.1093/ofid/ofad281] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/21/2023] [Indexed: 06/20/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused more than 675 million confirmed cases and nearly 7 million deaths worldwide [1]. While testing for COVID-19 was initially centered in health care facilities, with required reporting to health departments, it is increasingly being performed in the home with rapid antigen testing [2]. Most at-home tests are self-interpreted and not reported to a provider or health department, which could lead to delayed reporting or underreporting of cases [3]. As such, there is a strong possibility that reported cases may become a less reliable indicator of transmission over time.
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Affiliation(s)
- Christina M Kaul
- Correspondence: Christina M. Kaul, MD, MS, NYU Grossman School of Medicine, 462 1st Avenue, NBV 16S 5-13, New York, NY 10016 (); or Mary K. Foote, MD, MPH, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101 ()
| | | | - Matthew Silverstein
- New York City Department of Health and Mental Hygiene, New York, New York, USA
| | | | | | | | - Mary K Foote
- Correspondence: Christina M. Kaul, MD, MS, NYU Grossman School of Medicine, 462 1st Avenue, NBV 16S 5-13, New York, NY 10016 (); or Mary K. Foote, MD, MPH, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, NY 11101 ()
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Kebaetse MB, Conteh B, Kebaetse M, Mokone GG, Nkomazana O, Mogodi MS, Wright J, Falama R, Winston K. Design of a Learning Development Program to Support First-Year Undergraduate Medical Students in the Transition to a PBL Curriculum. Med Sci Educ 2023; 33:755-765. [PMID: 37501812 PMCID: PMC10368596 DOI: 10.1007/s40670-023-01790-3] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 07/29/2023]
Abstract
While the evaluation of learning development interventions needs to be considered carefully and included at the curriculum design stage, there is limited literature on the actual design of interventions, especially on how these designs evolve and improve over time. This paper describes the evolution of a learning development program intended to support first-year medical students adjusting to a problem-based learning curriculum. We used a design-based research approach, articulating our theoretical grounding and incorporating students' voices to develop an "optimal" intervention for the specific challenges in our context. We describe lessons learned around four aspects: students' growth and development, teachers' professional growth and development, program design principles, and the emergent components of a learning development program. Overall, our students describe the Learning Success Program as adding value by enabling the adoption of a repertoire of skills and strategies for learning management. Additionally, the incremental nature of design-based research allowed for the development of a context-specific program that considers students' voices through needs assessment and feedback on the program offerings. It has also provided an opportunity for the professional development of teachers through feedback from classroom practice, reflection, and the literature. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-023-01790-3.
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Affiliation(s)
- Masego B. Kebaetse
- Department of Medical Education, University of Botswana, Gaborone, Botswana
| | - Brigid Conteh
- Communication and Study Skill Unit, University of Botswana, Gaborone, Botswana
| | - Maikutlo Kebaetse
- Department of Biomedical Sciences, University of Botswana, Gaborone, Botswana
| | | | | | - Mpho S. Mogodi
- Department of Medical Education, University of Botswana, Gaborone, Botswana
| | - John Wright
- Department of Biomedical Sciences, University of Botswana, Gaborone, Botswana
| | - Rosemary Falama
- Department of Medical Education, University of Botswana, Gaborone, Botswana
| | - Kalman Winston
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
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Weitlauf AS, Broderick N, Alacia Stainbrook J, Slaughter JC, Taylor JL, Herrington CG, Nicholson AG, Santulli M, Dorris K, Garrett LJ, Hopton M, Kinsman A, Morton M, Vogel A, Dykens EM, Pablo Juárez A, Warren ZE. A Longitudinal RCT of P-ESDM With and Without Parental Mindfulness Based Stress Reduction: Impact on Child Outcomes. J Autism Dev Disord 2022; 52:5403-5413. [PMID: 35040001 PMCID: PMC9289080 DOI: 10.1007/s10803-021-05399-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
This randomized controlled trial (NCT03889821) examined Mindfulness Based Stress Reduction (MBSR) in conjunction with the Parent-implemented Early Start Denver Model (P-ESDM). A previous report described improved metrics of parental distress (Weitlauf et al. in Pediatrics 145(Supplement 1):S81-S92, 2020). This manuscript examines child outcomes. 63 children with ASD (< 36 months) and their parents received 12 P-ESDM sessions. Half of parents also received MBSR. Longitudinal examination of whole sample means revealed modest improvements in autism severity, cognitive, and adaptive skills. There was not a significant time × group interaction for children whose parents received MBSR. Future work should examine more proximal markers of child or dyadic change to enhance understanding of the impact of providing direct treatment for parents as part of early intervention initiatives.
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Affiliation(s)
- Amy S Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Neill Broderick
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Alacia Stainbrook
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Julie Lounds Taylor
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Amy G Nicholson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madeline Santulli
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin Dorris
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Michelle Hopton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy Kinsman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary Morton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ashley Vogel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elisabeth M Dykens
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - A Pablo Juárez
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - Zachary E Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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8
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Raphael E, Glymour MM, Chambers HF. Trends in prevalence of extended-spectrum beta-lactamase-producing Escherichia coli isolated from patients with community- and healthcare-associated bacteriuria: results from 2014 to 2020 in an urban safety-net healthcare system. Antimicrob Resist Infect Control 2021; 10:118. [PMID: 34380549 PMCID: PMC8359060 DOI: 10.1186/s13756-021-00983-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of infections caused by extended-spectrum beta-lactamase producing Escherichia coli (ESBL-E. coli) is increasing worldwide, but the setting in which this increase is occurring is not well defined. We compared trends and risk factors for ESBL-E. coli bacteriuria in community vs healthcare settings. METHODS We collected electronic health record data on all patients with E. coli isolated from urine cultures in a safety-net public healthcare system from January 2014 to March 2020. All analyses were stratified by healthcare-onset/associated (bacteriuria diagnosed > 48 h after hospital admission or in an individual hospitalized in the past 90 days or in a skilled nursing facility resident, N = 1277) or community-onset bacteriuria (bacteriuria diagnosed < 48 h after hospital admission or in an individual seen in outpatient clinical settings without a hospitalization in the past 90 days, N = 7751). We estimated marginal trends from logistic regressions to evaluate annual change in prevalence of ESBL-E. coli bacteriuria among all bacteriuria. We evaluated risk factors using logistic regression models. RESULTS ESBL-E. coli prevalence increased in both community-onset (0.91% per year, 95% CI 0.56%, 1.26%) and healthcare-onset/associated (2.31% per year, CI 1.01%, 3.62%) bacteriuria. In multivariate analyses, age > 65 (RR 1.88, CI 1.17, 3.05), male gender (RR 2.12, CI 1.65, 2.73), and Latinx race/ethnicity (RR 1.52, CI 0.99, 2.33) were associated with community-onset ESBL-E. coli. Only male gender (RR 1.53, CI 1.03, 2.26) was associated with healthcare-onset/associated ESBL-E. coli. CONCLUSIONS ESBL-E. coli bacteriuria frequency increased at a faster rate in healthcare-associated settings than in the community between 2014 and 2020. Male gender was associated with ESBL-E. coli bacteriuria in both settings, but additional risks-age > 65 and Latinx race/ethnicity-were observed only in the community.
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Affiliation(s)
- Eva Raphael
- Department of Epidemiology and Biostatistics , University of California, San Francisco, San Francisco, CA, USA.
- Department of Family and Community Medicine , University of California, San Francisco, San Francisco, CA, USA.
- Zuckerberg San Francisco General Hospital, 995 Potrero Avenue, Ward 83, San Francisco, CA, 94110, USA.
| | - M Maria Glymour
- Department of Family and Community Medicine , University of California, San Francisco, San Francisco, CA, USA
| | - Henry F Chambers
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
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D de la Cruz MS, Smith RS, Silverio AE, Casola AR, Kelly EL. What we learned in the development of a third-year medical student curricular project. Perspect Med Educ 2021; 10:167-170. [PMID: 33502749 PMCID: PMC8187514 DOI: 10.1007/s40037-021-00648-x] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
The application of continuous systems improvement in medical education can provide actionable information for curriculum development, improvement, and future planning (as reported by Bowe and Armstrong, Acad Med 92:585-92, 2017). After receiving a medical education grant, we developed a curriculum to teach medical students how to use quality improvement (QI) to address health disparities in vulnerable populations. During the process of developing and implementing this curriculum, we learned several lessons.One of the major surprises was that our proposed project work took much longer to complete than anticipated. This was mainly because we did not have the right team assembled from the beginning. Specifically, we were missing a team member with evaluation expertise, and therefore we did not devise a systematic process for evaluation and assessment. Without periodic checks or timely assessments built into our curriculum design, we received feedback from students after it was too late to implement changes. We realized that our initial research design had some methodological flaws, which we later rectified.We encountered additional technical challenges during the curriculum implementation. We struggled with various online learning platforms. Through this, we learned the importance of being knowledgeable upfront about the features of learning platforms and adaptable to changing educational technologies. We also learned our curriculum could and should evolve to meet the needs of our learners and faculty. Moving forward, we realize the benefit of applying a quality improvement process to our curriculum development and implementation, which will help us to continuously transform medical education for future health care needs.
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Affiliation(s)
- Maria Syl D de la Cruz
- Department of Family & Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
| | - Rashida S Smith
- Department of Family & Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexis E Silverio
- Department of Family & Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Allison R Casola
- Department of Family & Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Erin L Kelly
- Department of Family & Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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Bryant KB, Blyler CA, Fullilove RE. It's Time for a Haircut: a Perspective on Barbershop Health Interventions Serving Black Men. J Gen Intern Med 2020; 35:3057-3059. [PMID: 32180133 PMCID: PMC7572982 DOI: 10.1007/s11606-020-05764-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
Black men in the USA experience disproportionate cardiovascular disease mortality compared to their white counterparts, in part due to an excess of uncontrolled hypertension. A promising intervention to address these disparities involves the direct pharmacologic management of hypertension by clinical pharmacists in Black male patrons of barbershops, as demonstrated in the Los Angeles Barbershop Blood Pressure Study (LABBPS). Despite the observed reduction in systolic blood pressure of > 20 mmHg after 1 year, the feasibility of scaling up such an intervention to a regional or national platform remains uncertain. Here we explore the success of LABBPS in the context of prior barbershop interventions and theorize the most important aspects driving the observed reductions. We further make a case for prioritizing preventive care in nontraditional settings in an effort to reduce health disparities.
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Affiliation(s)
- Kelsey B Bryant
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA.
| | - C Adair Blyler
- Hypertension Center of Excellence, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert E Fullilove
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
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Power ML, Snead C, Reed EG, Schulkin J. Integrating evolution into medical education for women's health care practitioners. Evol Med Public Health 2020; 2020:60-67. [PMID: 32382419 PMCID: PMC7196338 DOI: 10.1093/emph/eoaa009] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/24/2022] Open
Abstract
Evolution is a fundamental principle in biology; however, it has been neglected in medical education. We argue that an evolutionary perspective is especially important for women's health care providers, as selection will act strongly on reproductive parameters, and the biological costs of female reproduction are generally more resource expensive than for men (e.g. due to gestation and lactation) with greater effects on health and wellbeing. An evolutionary perspective is needed to understand antibiotic resistance, disease and health risks associated with mismatches between our evolved adaptations and current conditions, the importance of the microbiome and the maternal role in how infants acquire and develop their early-life microbiome (vaginal birth, lactation), and the importance of breastmilk as a biochemical signal from mothers to their babies. We present data that obstetrician-gynecologists' views regarding the inclusion of evolution within their training is generally positive, but many barriers are perceived. Requiring coursework in evolutionary biology with an emphasis on evolutionary medicine prior to enrollment in medical school may be a solution.
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Affiliation(s)
- Michael L Power
- Smithsonian National Zoological Park and Conservation Biology Institute, Washington, DC 20013-7012, USA
- American College of Obstetricians and Gynecologists, Washington, DC 20024-2188, USA
| | - Carrie Snead
- American College of Obstetricians and Gynecologists, Washington, DC 20024-2188, USA
| | - Eda G Reed
- Smithsonian National Zoological Park and Conservation Biology Institute, Washington, DC 20013-7012, USA
- Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jay Schulkin
- Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA 98195, USA
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