The Propagation of Race and Racial Differences as Biological in Preclinical Education

Modern scientific research has demonstrated that race is a social construct rather than a biological construct. Yet, medical education research suggests that medical faculty still sometimes characterize race and racial differences as biological during lectures. To explore this dynamic, we reviewed (1) how race is presented in the preclinical curriculum of an undergraduate medical institution and (2) how preclinical faculty both define race and attribute disparate health outcomes to race. In part 1 of the study, the authors conducted a retrospective summative content analysis of all first-year preclinical lectures during the 2018-2019 academic year. In part 2, the authors administered a survey to preclinical faculty on the understanding of race, and responses were assessed through conventional content analysis. A number of faculty suggested a biological basis for racial differences during lectures, though survey results suggested that the majority characterize race as a social construct. Faculty knowledge of race and racial differences as a social construct was not reflected in the majority of the curricular analysis. Instead, the lectures showed that faculty predominantly discussed race without context (e.g., as a standalone epidemiological statistic or an unexplained factor of risk, diagnosis, prognosis, or treatment), or with a biological context. We conclude that there is a discrepancy between preclinical faculty knowledge of race and the presentation of race and racial differences in lectures. This discrepancy has implications on medical education. We offer possible explanations for this discrepancy as well as resources for preclinical faculty development to bridge this gap.

Alterations in Glucose Effectiveness and Insulin Dynamics: Polycystic Ovary Syndrome or Body Mass Index

BACKGROUND/AIMS

To delineate the relationship of polycystic ovary syndrome (PCOS), obesity, and hyperandrogenism (HA) with glucose and insulin dynamics in adolescents across a broad body mass index (BMI).

METHODS

Seventy-four PCOS subjects (aged 16 years) and 82 controls (aged 16 years) were evaluated by an oral glucose tolerance test. Subjects were categorized by BMI: normal weight (21 ± 0.4), overweight/obesity (OO; 33 ± 1.0), and severe obesity (SO; 48 ± 1.4). Indices of glucose and insulin dynamics were determined. Multiple linear regression analysis was used to evaluate the contribution of PCOS, HA, and BMI to these indices.

RESULTS

BMI was significantly associated with systolic and diastolic blood pressure and insulin resistance. A significant interaction between BMI and PCOS and indices of post-glucose load was observed. The mean difference in peak glucose, early glucose response, area under the curve for glucose, and glucose effectiveness (SgIo) between PCOS and control subjects was significantly different between OO and SO. In PCOS subjects, testosterone was positively associated with BMI, fasting insulin, early insulin response, and diastolic blood pressure, and negatively associated with SgIo.

CONCLUSIONS

Abnormal glucose dynamics in adolescents with PCOS is mainly due to SO. The combination of PCOS and SO has a synergistic effect on glucose dynamics when compared to all other groups.

Polycystic Ovary Syndrome in Adolescents

Polycystic ovary syndrome (PCOS) is a familial heterogeneous disorder affecting 6% to 10% of reproductive-age women. The use of criteria developed for adult women is problematic for the adolescent girl because the clinical features associated with PCOS are normal pubertal events. The recent consensus statement on PCOS in adolescents stated that hyperandrogenism and oligomenorrhea need to persist for at least 2 years to consider the diagnosis of PCOS. Although insulin resistance, hyperinsulinism, and obesity are often associated with PCOS, these features are not considered valid diagnostic criteria. Recent genomewide association studies implicate genetic loci involved in the hypothalamic-pituitary-ovarian axis.

Altered decorin and Smad expression in human fetal membranes in PPROM

Humans with Ehlers-Danlos syndrome, a subtype of which is caused by abnormal decorin expression, are at increased risk of preterm birth due to preterm premature rupture of fetal membranes (PPROM). In the mouse model, the absence of decorin leads to fetal membrane abnormalities, preterm birth, and dysregulation of decorin's downstream pathway components, including the transcription factor p-Smad-2. However, the role of decorin and p-Smad-2 in idiopathic human PPROM is unknown. Fetal membranes from 20-25 pregnancies per group were obtained as a cross-sectional sample of births at one institution between January 2010 and December 2012. The groups were term, preterm without PPROM, and preterm with PPROM. Immunohistochemical analysis of fetal membranes was performed for decorin and p-Smad-2 using localization and quantification assessment. Decorin expression is developmentally regulated in fetal membranes and is decreased in preterm birth with PPROM compared to preterm birth without PPROM. In preterm with PPROM samples, the presence of infection is associated with significant decorin downregulation compared to preterm with PPROM samples without infection. The preterm with PPROM group exhibited decreased p-Smad-2 staining compared to both the term controls and the preterm-without-PPROM group. Our findings suggest that dysregulation of decorin and its downstream pathway component p-Smad-2 occurs in fetal membranes during the second trimester in pathological pregnancies, thus supporting a role for decorin and p-Smad-2 in the pathophysiology of fetal membranes and adverse pregnancy outcomes. These findings may lead to the discovery of new targets for the diagnosis and treatment of PPROM.