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BACKGROUND Public health measures to control the COVID-19 pandemic have led to feelings of loneliness among older adults, which, prior to COVID, has been associated with subsequent morbidity and mortality. We sought to identify differences in feelings of loneliness, sadness, and social disconnection early in the pandemic across racial groups, and possible mitigating factors. METHODS We performed a cross-sectional analysis using the weighted nationally-representative Medicare Current Beneficiaries Survey COVID-19 supplement, collected summer 2020. We included all Medicare beneficiaries over 65 who did not respond by proxy. We examined changes in loneliness, sadness, or feelings of social disconnection. Multivariable logistic regression models accounted for sociodemographic variables, access to primary care and the internet, and history of depression or dementia. RESULTS Among 8125 beneficiaries, representative of 43.7 million Medicare beneficiaries, 22.6% reported loneliness or sadness, and 37.1% feeling socially disconnected. In fully-adjusted models, Hispanic/Latinx beneficiaries were most likely to report loneliness or sadness (OR = 1.3, CI: 1.02-1.65; P = 0.02) and Black beneficiaries were least likely to report feeling socially disconnected (OR = 0.55; CI: 0.42-0.73; P

ImportanceBlack students remain underrepresented in medicine despite national efforts to increase diversity in the physician workforce. Historically Black College and University (HBCU) students play a vital role in increasing representation in the workforce. Currently, there is a paucity of literature understanding the impact of COVID-19 on premedical students from HBCUs. Understanding the adverse impact of the pandemic on HBCU students is essential to inform strategies that promote holistic medical school admissions and increased diversity, equity, and inclusion in the medical workforce.ObjectiveTo explore premedical advisors' perspectives on the impact of the COVID-19 pandemic on HBCU premedical students pursuing admission to medical school.Design, Setting, and ParticipantsIn this qualitative study, semistructured interviews of HBCU premedical advisors were performed from March 2020 to March 2021. One-on-one interviews were conducted with 21 advisors with a depth of experience as advisors, varied educational backgrounds, and diverse geographic representation. Data analysis was performed from March 2021 to December 2021.Main Outcomes and MeasuresThe experiences of HBCU premedical students during the COVID-19 pandemic from the perspective of the premedical advisor.ResultsAmong the 21 participants, 13 (62%) were female, 15 (71%) were Black or African American, 11 (52%) had a doctorate degree, and 7 (33%) had more than 10 years of experience as advisors. Participants described 3 major themes: (1) balancing academic responsibilities with family demands; (2) distraction, disruption, and isolation in the virtual learning environment; and (3) harmful impact of new stressors for HBCU applicants in the medical school admissions process.Conclusions and RelevanceIn this qualitative study of HBCU advisors to premedical students, advisors described how the COVID-19 pandemic adversely affected undergraduate HBCU premedical students; students faced family hardships, challenges with virtual learning, and uncertainty in the medical school admissions process. These findings suggest that medical schools should continue to create direct interventions to address the challenges that HBCU students faced during the height of the pandemic and as longitudinal consequences of the pandemic. Addressing these issues may improve physician workforce representation and promote more equitable patient care for underserved communities disproportionately affected by COVID-19 and other health disparities.

The COVID-19 pandemic magnified several long-standing problems in nursing homes, including issues within the nursing home workforce. Issues include staffing shortages, high turnover, low pay, inadequate training, poor treatment and limited access to resources. Research suggests that workforce issues of these kinds have the potential to significantly threaten and further increase disparities in the quality of care for nursing home residents. Thus, solutions are needed that ensures the nursing home workforce receives adequate investment so that these critical personnel are able to more effectively do the work that they do. In this presentation, workforce issues salient within the nursing home setting will be elaborated and potential solutions to mitigating these issues will be discussed.

BackgroundJail incarceration rates are positively associated with mortality at the county level. However, incarceration rates vary within counties, limiting the generalisability of this finding to neighbourhoods, where incarceration may have the greatest effects.MethodsWe performed a cross-sectional analysis of census tract-level state imprisonment rates in New York State (2010) and life expectancy data from the US Small-area Life Expectancy Estimates Project (2010–2015). We modelled fixed-effects for counties and controlled for tract-level poverty, racial makeup, education, and population density from the American Community Survey (2010–2014), and violent crime data from the New York City Police Department (2010). We also examined interactions between incarceration rate and poverty, racial makeup, and population density on life expectancy.ResultsLife expectancy at the highest quintile of incarceration was 5.5 years lower than in the lowest quintile, and over 2 years lower in a fully-adjusted model. Census tract-level poverty and racial makeup both moderated the association between incarceration and life expectancy.ConclusionCensus tract-level incarceration is associated with lower life expectancy. Decarceration, including alternatives to incarceration, and release of those currently incarcerated, may help to improve life expectancy at the neighbourhood level.

The Asian race represents one of the fastest growing racial groups in the United States that have unique health-care issues and barriers to services. Despite being the second largest racial group among medical students, Asians represent a markedly smaller proportion of leadership. Greater inclusion may facilitate Asian-related curriculum content development, community-engaged research, and increased services for Asian communities. This article explores Southeast and East Asian American (AA) medical students’ perceptions of and challenges toward pursuing academic medicine careers. We collected quantitative and qualitative data among 138 participants. Factors that increased trainees’ interests include collaboration with others, teaching and research opportunities, and influential role models/mentors. Interventions identified to overcome perceived challenges include exposure to senior-level race-concordant role models and mentors, enhancement of communication skills, and informed career discussions between parents and trainees. Such interventions may engage more AA trainees into academia and facilitate their growth as leaders.

Women and underrepresented racial/ethnic minority faculty (URM) are critical to developing inclusive learning environments. Career counselors can benefit from understanding the factors influencing women’s and URMs’ interest in academic careers, as this population remains markedly underrepresented in academic medicine. A mixed methods study was conducted among medical students and residents yielding 643 survey and 121 focus group participants. Participants were diverse by gender and race/ethnicity. Themes included (a) factors influencing career interest, (b) influential others, (c) timing of career interest, and (d) career expectations. Findings show differences among women, URM, and dominant-identity groups. Implications include how career development programs and institutional diversity policies and practices should consider developing and offering activities that support (a) mentoring—especially for women trainees, (b) learning how to align academia and community engagement and scholarship—especially for URM trainees, and (c) senior leadership development support for women and URM trainees.

Background: Overdose education and naloxone distribution (OEND) to people at risk of witnessing or experiencing an opioid overdose has traditionally been provided through harm reduction agencies. Expanding OEND to inpatient general medical settings may reach at-risk individuals who do not access harm reduction services and have not been trained. An OEND program targeting inpatients was developed, piloted, and evaluated on 2 general medicine floors at Montefiore Medical Center, a large urban academic medical center in Bronx, New York. Methods: The planning committee consisted of 10 resident physicians and 2 faculty mentors. A consult service model was piloted, whereby the primary inpatient care team paged the consult team (consisting of rotating members from the planning committee) for any newly admitted patient who had used any opioid in the year prior to admission. Consult team members assessed patients for eligibility and provided OEND to eligible patients through a short video training. Upon completion, patients received a take-home naloxone kit. To evaluate the program, a retrospective chart review over the first year (April 2016 to March 2017) of the pilot was conducted. Results: Overall, consults on 80 patients were received. Of these, 74 were eligible and the consult team successfully trained 50 (68%). Current opioid analgesic use of ≥50 morphine milligram equivalents daily was the most common eligibility criterion met (38%). Twenty-four percent of patients were admitted for an opioid-related adverse event, the most common being opioid overdose (9%), then opioid withdrawal (8%), skin complication related to injecting (5%), and opioid intoxication (2%). Twenty-five percent had experienced an overdose, 35% had witnessed an overdose in their lifetime, and 83% had never received OEND previously. Conclusions: Integrating OEND into general inpatient medical care is possible and can reach high-risk patients who have not received OEND previously. Future research should identify the optimal way of implementing this service.

Purpose Histology, the science of cells and tissues at the microscopic level, is an integral component of most dental and medical curricula and is often taught using both traditional and novel computer-based didactic approaches. The purpose of this study was to analyse the strategies used by dental and medical students when studying this very visual and challenging subject. Methods Data were collected from 75 dental and 143 medical students, who had almost identical histology learning resources at their disposal. Results When compared with their medical counterparts, dental students view histology as a more difficult subject and as less relevant for their future career. Whereas dental students, who are required to attend class unlike medical students, made more use of in-classroom learning opportunities, they did not take as much advantage of out-of-classroom resources. In addition, dental students reported a significantly higher tendency than medical students to work together, rather than to study alone. Discussion Small differences in the dental versus the medical learning environment associate with several observed differences in learning strategies that are adopted by dental and medical students. Conclusions These differences should be considered when teaching the subject of histology to dental or to medical students.

Histology is a traditional core basic science component of most medical and dental education programs and presents a didactic challenge for many students. Identifying students that are likely to struggle with histology would allow for early intervention to support and encourage their learning success. To identify student characteristics that are associated with learning success in histology, three first-year medical school classes at the University of Michigan (>440 students) were surveyed about their educational background, attitudes toward learning histology, and their use of histology learning strategies and resources. These characteristics were linked with the students' quiz and examination results in histology. Students who reported previous experience in histology or pathology and hold science or biomedical science college degrees usually did well in histology. Learning success in histology was also positively associated with students' perception that histology is important for their professional career. Other positive indicators were in-person participation in teacher-guided learning experiences, specifically lecture and laboratory sessions. In contrast, students who relied on watching histology lectures by video rather than going to lectures in-person performed significantly worse. These characteristics and learning strategies of students who did well in this very visual and challenging study subject should be of help for identifying and advising students early, who might be at risk of failing a histology course or component.

Histology or microanatomy is an integral component of most first year medical curricula. As histology is heavily based on the review and analysis of images, modern educational resources are increasingly used for teaching this subject. These novel didactic approaches often supplement more traditional offerings of the material, such as lectures and laboratory sessions. After completion of their M1 histology component, University of Michigan medical students participated in a voluntary survey about their study habits and their use of various histology learning resources and how this usage changed over time. The data presented in this analysis demonstrate a strong preference of these students for studying histology with electronic rather than traditional learning resources. In particular, students’ use of scheduled didactic opportunities decreased over the progression of the course. Students also exhibited a strong inclination to study histology individually rather than in study groups. These reported insights in students’ preferences suggest a need to develop and update educational tools for teaching this very visual subject.

Polycystic ovary syndrome (PCOS) is a complex genetic disease characterized by heritable reproductive and metabolic abnormalities. Genetic variants associated with the reproductive phenotype have been mapped to the fibrillin-3 (FBN3) gene and to a novel transcription factor-7-like 2 (TCF7L2) locus (rs11196236 G). The association of these genetic variants with metabolic phenotypes was investigated in 31 PCOS and 18 control women of European ancestry. The insulinogenic index during an oral glucose tolerance test (ΔI30/ΔG30) and insulin secretion rates at the maximal dose during a graded-glucose infusion (ISRmax) were used as indexes of insulin secretion. Endogenous glucose production (EGP) and insulin sensitivity (M/I) were determined during a euglycemic clamp. The disposition index (DI) was calculated using M/I and ΔI30/ΔG30 or ISRmax. Compared with noncarriers (n = 10) and control (n = 10), M/I was decreased (P = 1.1 × 10(-5)) in heterozygous and homozygous PCOS carriers (n = 14) of rs11196236 G and this variant predicted M/I (partial r(2) = 0.34, P = 0.005) in a regression analysis. Postabsorptive EGP tended to be higher (P = 0.040) in heterozygous and homozygous PCOS carriers of the FBN3-associated allele (n = 12), allele 8 of D19S884 (FBN3(+)), compared to PCOS noncarriers (n = 19). PCOS carriers of the rs12255372 T (TCF7L2 Caucasian type 2 diabetes mellitus (T2D) locus) had no significant associated metabolic phenotypes. We conclude that rs11196236 G TCF7L2 variant is associated with peripheral insulin resistance in PCOS but this effect is not seen in control women. The FBN3 risk allele may be associated with changes in basal glucose homeostasis in PCOS. These findings require replication in additional PCOS cohorts.

Diversity efforts in the academic medicine workforce have often neglected the identification and inclusion of lesbian, gay, bisexual, and transgender (LGBT) health professionals. Many of these professionals have served as educators, researchers, administrators, and leaders at their academic institutions, but their perspectives on the barriers to and facilitators of pursuing academic careers, as well as the perspectives of trainees, have not been explored.We applied a purposeful convenience sampling strategy to collect quantitative and qualitative data among LGBT health care professionals (HCP) and trainees. The authors identified trends in data using bivariate analyses and consensual qualitative research methods.We analyzed data from 252 surveys completed by HCPs and trainees and a subset of 41 individuals participated in 8 focus groups. Among survey participants, 100% identified as lesbian, gay, and bisexual (LGB) or queer; 4.5% identified along the trans-spectrum; 31.2% identified as a racial or ethnic minority; 34.1% identified as faculty; and 27.4% as trainees. Eighty-one percent of trainees were interested in academia and 47% of HCPs held faculty appointments. Overall, 79.4% were involved in LGBT-related educational, research, service, or clinical activities. Facilitators of academic careers included engagement in scholarly activities, mentorship, LGBT-specific networking opportunities, personal desire to be visible, campus opportunities for involvement in LGBT activities, and campus climate inclusive of LGBT people. Barriers included poor recognition of LGBT scholarship, a paucity of concordant mentors or LGBT networking opportunities, and hostile or non-inclusive institutional climates.LGBT trainees and HCPs contribute significantly to services, programs, and scholarship focused on LGBT communities. LGBT individuals report a desire for a workplace environment that encourages and supports diversity across sexual orientation and gender identities. Institutional policies and programming that facilitate LGBT inclusion and visibility in academia may lead to greater faculty work satisfaction and productivity, higher retention and supportive role modeling and mentoring for the health professions pipeline.

Histology is a traditional component of many biomedical education programs. This project set out to find common characteristics among students, who did well or were challenged by histology and to exam the effectiveness of different teaching approaches. Three M1 classes at the University of Michigan were surveyed about their educational background, attitudes towards learning histology, and use of learning strategies. These characteristics were correlated with students' histology exam results. This analysis demonstrated a preference of students to use electronic over traditional learning tools. A positive indicator is in-person participation in teacher-guided learning experiences. Students watching lectures by video rather than going to lectures performed significantly worse. A preliminary analysis of what influences the efficiency of live lectures versus video recording indicates that frequent interruptions of the learning process correlate with decreased scores. These results indicate that the effectivene...