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Background: Obese African American women under-appraise their body mass index (BMI) classification and report fewer weight loss attempts than women who accurately appraise their weight status. This cross-sectional study examined whether physician-informed weight status could predict weight self-perception and weight self-regulation strategies in obese women., Methods: A convenience sample of 118 low-income women completed a survey assessing demographic characteristics, comorbidities, weight self-perception, and weight self-regulation strategies. BMI was calculated during nurse triage. Binary logistic regression models were performed to test hypotheses., Results: The odds of obese accurate appraisers having been informed about their weight status were six times greater than those of under-appraisers. The odds of those using an "approach" self-regulation strategy having been physician-informed were four times greater compared with those using an "avoidance" strategy., Discussion: Physicians are uniquely positioned to influence accurate weight self-perception and adaptive weight self-regulation strategies in underserved women, reducing their risk for obesity-related morbidity.

Background: Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) have been proven effective in improving hemoglobin A1c (HbA1c) and in reducing hypoglycemia in patients with type 1 diabetes mellitus (T1DM). It is not clear, however, if CGM provides further efficacy and safety benefits beyond SMBG in the management of T1DM., Methods: MEDLINE (1966-November 2009), COCHRANE REGISTRY (all years), and EMBASE (1980-November 2009), and article bibliographies were searched for randomized controlled trials (RCTs) investigating the use of CGM in patients with T1DM, with clinical outcomes, including HbA1c and hypoglycemia and/or hyperglycemia., Results: Fourteen RCTs met eligibility criteria [n = 1188 patients, 97.4% with T1DM, age 29.0 ± 14.3 years, diabetes duration 11.7 ± 7.0 years, and baseline HbA1c 8.3 ± 0.8% (mean ± standard deviation)]. Compared with SMBG, the use of CGM was associated with a greater reduction in HbA1c [-0.3% (confidence interval: 0.4, -0.2), p < .0001]. The number of hypoglycemic events was not significantly different between the CGM and SMBG groups (0.52 ± 0.52 versus 0.52 ± 0.63 events/day, p = .5), but duration of hypoglycemia was shorter for the CGM group (75 ± 39 versus 89 ± 19 min/day), with an incremental reduction of hypoglycemia duration of -15.2 min/day, p < .0001. Continuous glucose monitoring also resulted in a shorter duration of hyperglycemia than SMBG (172 ± 125 versus 217 ± 152 min/day, p = .04)., Conclusions: The use of CGM is associated with improvement in metabolic control in T1DM, with significant short- and long-term reductions in HbA1c and reduction in the duration of periods of hypoglycemia and hyperglycemia versus SMBG., (© 2012 Diabetes Technology Society.)

The Morehouse School of Medicine (MSM) Research Centers in Minority Institutions (RCMI) Center of Excellence in Clinical and Translational Research has developed a research web-portal to foster research development and collaborations. We describe the role of focus groups (FG). Research faculty and staff were organized into three groups by research interest. Each FG discussion had five steps: Brainstorming, Reporting, Card-sorting, Priority-setting, and Discussions. Integration of top priorities across each FG culminated in a final priority-setting step. Each FG generated 45 to 50 unique ideas during brainstorming that were categorized into 10 to 12 unique categories. Final priority-setting captured six top items for the initial design of the portal: ability to identify researchers working on similar research; common data management tools; access to clinical trials information; participant recruitment tools; secure access to research databases; and financial support. Focus groups allowed for a discovery period that generated common themes for the design and customization of the web-portal.

Background and Aims: The metabolic syndrome (MetS) is a clustering of cardio-metabolic risk factors for cardiovascular disease. It is important to identify individuals with the MetS early and initiate interventions long before adverse conditions occur. Our previous studies found that missing or incomplete data that should be entered into the electronic health record (EHR) by nursing staff could lead to the under-diagnosis of the MetS. This study aimed to determine whether a five-component intervention to improve EHR data entry would increase the completeness of data, particularly height, weight, and blood pressure, needed to diagnose the MetS., Design: Quasi-experimental design with pre-test, intervention, and post-test sessions., Setting: Two family medicine residency training clinics serving mainly African-American patients in Atlanta, Georgia, United States., Subjects and Methods: Four nurses and four certified medical assistants attended pre-test, intervention, and post-test sessions. Data of 279 patients at pre-test and 246 patients at post-test were collected and analysed. The pre-test and post-test data completion rates of data entry were compared using rates and Wald chi(2)-test., Main Outcome Measures: Rate of patients with information documented in the EHR on blood pressure, weight, and height at pre-test and post-test., Results: There was a statistically significant increase in the recording of height from pre-test to post-test (46.6% versus 96.7%, P <0.001) and the recording of blood pressure from pre-test to post-test (96.8% versus 99.2%, P <0.05)., Conclusions: The intervention led to an improvement in the entry of pertinent EHR data among nurses and medical assistants in this primary care setting. This increase improved the ability to identify patients who met the criteria for the MetS.

Background: The incidence of and mortality from invasive pneumococcal disease are significantly higher in children with sickle cell disease than in the general pediatric population. The objective of this population-based study was to assess the effect of pneumococcal conjugate vaccine on rates of invasive pneumococcal disease among children with sickle cell disease., Patients and Methods: Records, including the history of pneumococcal conjugate vaccine administration, of 1247 children born after 1983 residing in metropolitan Atlanta, Georgia, with confirmed hemoglobinopathies were linked to an active surveillance database for invasive pneumococcal disease for the period of January 1, 1995, through January 1, 2003. The incidence of invasive pneumococcal disease and the percentage of rate reduction were estimated before and after pneumococcal conjugate vaccine licensure. Survival analysis was used to estimate the effect of pneumococcal conjugate vaccine on invasive pneumococcal disease rates while accounting for herd immunity., Results: A significant decline in invasive pneumococcal disease in children with sickle cell disease < or = 10 years of age was noted after pneumococcal conjugate vaccine licensure, from 1.7 infections per 100 person-years (1995-2000) to 0.5 infections per 100 person-years (2001-2002), which represents a 68% reduction. The effectiveness of > or = 1 dose of pneumococcal conjugate vaccine was estimated by crude analysis to be 84.5% and by stratified survival analysis to be 81.4% when controlling for the presence of herd immunity in the 2 years after pneumococcal conjugate vaccine licensure. Serotype 6A invasive pneumococcal disease represented 36% of invasive pneumococcal disease before pneumococcal conjugate vaccine licensure and 0% after pneumococcal conjugate vaccine licensure, suggesting a protective effect against this pneumococcal conjugate vaccine-related serotype., Conclusions: Invasive pneumococcal disease significantly decreased in children with sickle cell disease < or = 10 years of age after pneumococcal conjugate vaccine licensure. Pneumococcal conjugate vaccine was effective even when controlling for herd immunity. Extending guideline recommendations for catch-up vaccination beyond 4 years of age should be considered.

Background: Increased C-reactive protein (CRP) concentration and insulin resistance (IR) are associated with increased rates of adverse cardiovascular events. We sought to examine the relationship of CRP with surrogate measures of IR among nondiabetic adults in the US., Methods: We conducted analyses using data from the National Health and Nutrition Examination Survey 1999-2002. We analyzed a nationally representative sample of 2514 men and nonpregnant women age > or = 20 years who were non-Hispanic white, non-Hispanic black, or Mexican American., Results: After adjustment for age, sex, race/ethnicity, smoking status, systolic blood pressure, and serum concentrations of HDL cholesterol, LDL cholesterol, and triglyceride, CRP was significantly associated with 10 IR measures (all P values <0.01). The strength of the association attenuated after further adjustment for waist circumference (change in adjusted regression coefficients ranging from 60.0% to 75.1%). The association of CRP with each IR surrogate was similar (standardized regression coefficient ranges from 0.06 to 0.09). The association of CRP (>3 vs <1 mg/L) with the homeostasis model for assessment of IR (> or = 75th vs <75th percentile) was statistically significant among people with a body mass index > or = 30 kg/m(2) (odds ratio, 2.6; 95% CI, 1.3-5.1) or with a body mass index <25 kg/m(2) (odds ratio, 2.5; 95% CI, 1.5-4.2)., Conclusions: CRP was significantly associated with the surrogate measures of IR among nondiabetic adults. Obesity may play an important role in the association of CRP with IR in this nationally representative sample.

Purpose: To better understand the nature and effective delivery of quality health-care globally, this paper aims to study the role of quality leadership on patient care quality (PCQ) delivered in hospitals, including the intervening role of technology integration and two country-level factors – national culture and infrastructure development – in North America (Canada, Mexico and the USA). Design/methodology/approach: PCQ comprises four facets: interpersonal, technical, environmental and administrative quality. Using survey data and interdisciplinary theoretical support (e.g. quality management and the Global Leadership and Organizational Behavior Effectiveness Project [GLOBE] model of national culture), this paper tested for moderated mediation between hospital quality leadership and the four-facet PCQ model with technology integration as the mediator and national culture and infrastructure development as moderators. Findings: Results show that technology integration partially mediates the relationship between hospital quality leadership and PCQ and that national culture and infrastructure development shape the role of hospital quality leadership on PCQ. Hence, these national factors must be considered holistically to understand the impact of hospital quality leadership on patient care. Practical implications: To improve PCQ, hospital leaders should broaden their understanding of quality health-care to include technology integration and an awareness of cultural and institutional differences across nations. Originality/value: This paper used primary data from hospital quality leaders and the four-facet PCQ conceptualization across three large North American nations, offering a more global understanding of service quality in health-care. [ABSTRACT FROM AUTHOR]

Objectives: This study's objectives were to determine the national prevalence of anemia in pregnancy (AIP) in the United States, compare racial differences in the prevalence, compare the AIP risk factor profiles between non-Hispanic whites and non-Hispanic blacks, and to analyze the associations between AIP and some maternal and fetal/neonatal complications between whites and blacks., Methods: The data used were from the United States natality data files (1995 through 2000), which included 23,654,695 live births. All mothers diagnosed with AIP, defined as hemoglobin-concentration < 10 g/dl, were included. The cohorts were analyzed in two groups. The "whole group" (WG) comprised all women in the data set who had anemia status reported. The "low-risk group" (LRG) comprised women with low-risk factors for AIP. Race was determined by mothers' skin colors and racial self-identifications. Logistic regression was used to explore associations between race and AIP while controlling for other covariates., Results: The national prevalence of AIP among the general population was 21.55/1,000 among the WG and 11.51/1,000 among the LRG. Among the WG, the prevalence of AIP was two times higher among non-Hispanic blacks (35.38/1,000) than among non-Hispanic whites (18.02/1,000). Among the LRG, the prevalence was 1.94 times higher among non-Hispanic blacks (20.44/1,000) than among non-Hispanic whites (10.63/1,000). The other risk factor profiles for AIP were similar among the races. Many serious maternal and fetal/neonatal complications occurred more frequently among anemic patients when compared with non-anemic patients., Conclusions: The results of this study showed that black race was significantly associated with higher risk of AIP. The other risk factor profiles of AIP were significantly similar between whites and blacks. This study also confirmed that AIP was significantly associated with some serious maternal and fetal/neonatal complications. The findings of this study indicate that race is an important risk factor of AIP.

Introduction: Disparities in health care are maintained by three primary factors: 1) patient factors which include multiple risk factors and comorbidities; 2) healthcare practitioner factors comprising inconsistent application of practice guidelines due to a limited database of clinical trials of effective therapies in African Americans and other underrepresented minorities; and 3) barriers in the healthcare delivery system resulting in poor access to care. The Morehouse School of Medicine Community Physicians' Network (CPN) was established to address disparities in health care by focusing on provider-specific strategies., Objectives: To: 1) use disease-specific registries to identify treatment gaps and facilitate quality improvement processes among CPN practices; 2) develop practice-specific and guideline-based educational messages to promote quality care; 3) engage and train CPN-physicians for participation in approved NIH, other government, and industry-supported clinical protocols; and 4) develop a data repository of all CPN-sponsored clinical trials that include significant numbers of African Americans and other underrepresented minorities., Methods: The disease-specific outpatient registries will have the following features: 1) data structures and data elements will use standard database codes and a data dictionary; 2) HIPPA-compliant data abstraction and data transfer tool; 3) baseline chart review to establish practice patterns and provide practice-specific feedback; 4) annual update of registry; 5) data registry and repository maintained on Morehouse School of Medicine's secure servers; 6) registry publications will include only aggregate data, without identification of contributing practices; 7) an electronic medical records platform will be encouraged as the ultimate data management tool for CPN practices. In addition, up to three continuing medical education (CME) programs each year will feature national speakers and promote evidence-based practice guidelines., Results: Eighty-five primary care and subspecialty practices are actively enrolled in CPN with a total of 385,000 annual outpatient visits. The makeup of insurance status is: HMO/PPO (45%); Medicare only (19%); Medicare HMO (11%); Medicare plus (8%); Medicaid (6%); Uninsured (11%)., Conclusions: The Community Physicians' Network will address specific gaps in the health care of African-American and other minority patients by promoting quality care among its members and by facilitating participation in approved clinical trial protocols. The unique academic community partnership is consistent with the NIH roadmap goal of eliminating healthcare disparities.

This cross-sectional study sought to determine the prevalence of cognitive impairment among African-American patients with congestive heart failure (CHF). We studied 100 African-American CHF patients (aged 55-87 years) in New York Heart Association classes II-IV, who are enrolled in an ongoing, randomized, controlled trial, evaluating the effectiveness of a telemonitoring intervention to improve access to ambulatory care for heart failure patients. These CHF patients were recruited from an inner-city practice, rural physician practices and an urban physician practice in Atlanta. The Mini-Mental Status Examination (MMSE) was used to measure cognition. Cognitive impairment was defined as a MMSE score of less than 24. The crude prevalence of cognitive impairment was 10% in this population of African Americans with CHF. The results of multivariate logistic regression analysis indicated an increase in odds of cognitive impairment with increasing age [odds ratio (OR) = 1.10 and 95% confidence interval, 1.00-1.20; p=0.042]. There was no significant relationship between cognitive impairment and gender, education status, depression and severity of CHF. This study indicates that cognitive impairment is relatively prevalent among African Americans with CHF, but lower than previously reported among Caucasians with CHF.

Purpose: Before implementing a new prevention curriculum, the authors assessed the prevention practices and attitudes of community family physicians in North Carolina who precepted third-year family medicine clerkship students., Method: An 18-item questionnaire was mailed to 165 preceptors during the 1995-96 academic year. The questionnaire explored the preceptors' levels of preparation to counsel patients, the types of prevention services they offered, and their levels of success in modifying patients' behaviors. The survey was re-sent to non-respondents., Results: The response rate was 70% (n = 112); of these 75% were men and 55% had graduated after 1987. Over 60% of the preceptors "almost always" offered services in smoking cessation, exercise, diet and nutrition, and age-specific services (range 62-86%). Over 50% felt "very prepared" to counsel patients regarding smoking cessation, sexually transmitted diseases, depression, exercise, alcohol use, and age-specific services (range 53-74%). However, the preceptors in this study felt pessimistic about their success in getting patients to change their behaviors. Preceptors who had graduated more recently offered more preventive services for smoking cessation, alcohol use, and illicit drugs than did earlier graduates., Discussion: Although North Carolina preceptors were pessimistic about their success in changing patients' behaviors regarding prevention, they were confident about their knowledge and skills to provide these services. This information was used to modify a prevention curriculum for third-year medical students.

Purpose: To determine whether students' performances in a pre-admission program predicted whether participants would (1) apply to medical school, (2) get accepted, and (3) graduate., Method: Using prospectively collected data from participants in the University of North Carolina at Chapel Hill's Medical Education Development Program (MEDP) and data from the Association of American Colleges Student and Applicant Information Management System, the author identified 371 underrepresented minority (URM) students who were full-time participants and completed the program between 1984 and 1989, prior to their acceptance into medical school. Logistic regression analysis was used to determine whether MEDP performance significantly predicted (after statistically controlling for traditional predictors of these outcomes) the proportions of URM participants who applied to medical school and were accepted, the timeliness of graduating, and the proportion graduating. Odds ratios with 95% confidence intervals were calculated to determine the associations between the independent and outcome variables., Results: In separate logistic regression models, MEDP performance predicted the study's outcomes after statistically controlling for traditional predictors with 95% confidence intervals., Conclusions: Pre-admission programs with similar outcomes can improve the diversity of the physician workforce and the access to health care for underrepresented minority and economically disadvantaged populations.

The association between the percent change in first-year and total underrepresented minority student enrollment and the presence of preadmission programs at Liaison Committee on Medical Education (LCME) accredited medical schools was assessed before and during successful legal and legislative challenges to affirmative action. The percent change in under-represented minority student enrollment was determined by comparing enrollment data for the academic years 1993-94 and 1996-97. Schools were categorized as having either a negative or positive percent change in their enrollment of underrepresented minority students. Logistic regression was used to determine the association of the percent change in under-represented minority student enrollment and the presence of a preadmission program while controlling for schools' financial support and the presence of postbaccalaureate programs. Fifty-six percent of the included medical schools had preadmission programs. Schools with a positive percent change were significantly more likely to have preadmission programs compared with schools with a negative percent change. There was no association between the presence of preadmission programs and the percent change in total enrollment. These results indicate that the presence of preadmission programs is positively associated with increases in first-year underrepresented minority student enrollment during the successful challenges to affirmative actions.

This article investigates the possible effects of minority status, presence of a Minority Affairs Office or Student National Medical Association (SNMA) Chapter, level of indebtedness, and number of years (4 to 5) to complete medical school on specialty choice of minority medical students. The 5-year experiences of 20 medical schools in the southern region (including three in Puerto Rico) were examined via a questionnaire. Information was sought for African Americans, Afro-Caribbean, Mexican American, other minority, and nonminority students. Minority graduates entered the specialities of internal medicine, pediatrics, and family medicine in far greater numbers than any other speciality. Also, the percentage of minorities who entered these fields was greater than the percentage of non-minorities. Conversely, minorities were significantly underrepresented in the surgical subspecialties and radiology. Additional study is needed to further examine the medical school experience for indications of why the clustering in primary care specialities occurs. Moreover, while most schools had some kind of minority affairs organization, few were active in the writing of the Dean's letter. Other suggestions to assure adequate minority representation across specialties include early exposure to the different specialties and subspecialties for minority students, a mentorship program with practicing physicians, and stronger recruitment of minorities into underrepresented specialties.

Heart failure (HF) is a major health burden worldwide, with approximately half of HF patients having a comorbid cognitive impairment (CI). However, it is still unclear how CI develops in patients with HF. In the present study, a mice model of heart failure was established by ligating the left anterior descending coronary artery. Echocardiography 1 month later confirmed the decline in ejection fraction and ventricular remodeling. Cognitive function was examined by the Pavlovian fear conditioning and the Morris water maze. HF group cued fear memory, spatial memory, and learning impairment, accompanied by activation of glial cells (astrocytes, microglia, and oligodendrocytes) in the hippocampus. In addition, the mitochondrial biogenesis genes TFAM and SIRT1 decreased, and the fission gene DRP1 increased in the hippocampus. Damaged mitochondria release excessive ROS, and the ability to produce ATP decreases. Damaged swollen mitochondria with altered morphology and aberrant inner-membrane crista were observed under a transmission electron microscope. Finally, Akt/mTOR signaling was upregulated in the hippocampus of heart failure mice. These findings suggest that activation of Akt/mTOR signaling, glial activation, and mitochondrial dynamics imbalance could trigger cognitive impairment in the pathological process of heart failure mice. [ABSTRACT FROM AUTHOR]

Latinx physician rates are lower than non-Latinx white physicians. Many pathway programs to careers in medicine have been established for underrepresented students, yet few focus on premedical college education or undergraduate pathway programs, which marks a critical junction in the commitment to and preparation for application to medical school. Moreover, little is known about the program components which prepare and support learners. Framed by Swail's Model for Persistence and Achievement, we characterize how a given program's components impact support and growth for participating students. Using the process step of the Context, Input, Process, and Product evaluation model, we conducted focus groups at the end of the program, with four cohorts of student participants between 2019 and 2022. Focus groups identified strengths and limitations in content and delivery to improve program effectiveness and plan for the future of a program. We used thematic analysis, following an inductive approach, to analyze data from transcribed focus groups. A total of 66 of 81 (81.5%) students participated in focus groups. Students described that supportive program components include long-term mentorship and advising that builds trust, academic preparation for medical school, early exposure to clinical career exploration, tools to articulate students' personal narrative, methods to recognize and address challenging situations in the professional environment, community leadership development, and leveraging health policy and advocacy to empower students to create systems change within communities. Our findings affirm and provide a needed account of program components known to be contributors to student success in undergraduate pathway programs. Our evaluation also characterizes additional supportive processes not discussed elsewhere. Our findings contribute to knowledge about development and implementation of undergraduate pathway programs and the components by which these programs create opportunities for success among underrepresented students aspiring to careers in medicine. [ABSTRACT FROM AUTHOR]

A mounting body of evidences suggests that patients with chronic heart failure (HF) frequently experience cognitive impairments, but the neuroanatomical mechanism underlying these impairments remains elusive. In this retrospective study, 49 chronic HF patients and 49 healthy controls (HCs) underwent brain structural MRI scans and cognitive assessments. Cortical morphology index (cortical thickness, complexity, sulcal depth and gyrification) were evaluated. Correlations between cortical morphology and cognitive scores and clinical variables were explored. Logistic regression analysis was employed to identify risk factors for predicting 3-year major adverse cardiovascular events. Compared with HCs, patients with chronic HF exhibited decreased cognitive scores (p < .001) and decreased cortical thickness, sulcal depth and gyrification in brain regions involved cognition, sensorimotor, autonomic nervous system (family-wise error correction, all p values <.05). Notably, HF duration and New York Heart Association (NYHA) demonstrated negative correlations with abnormal cortex morphology, particularly HF duration and thickness in left precentral gyrus (r = -.387, p = .006). Cortical morphology characteristics exhibited positive associations with global cognition, particularly cortical thickness in left pars opercularis (r = .476, p < .001). NYHA class is an independent risk factor for adverse outcome (p = .001). The observed correlation between abnormal cortical morphology and global cognition suggested that cortical morphology may serve as a promising imaging biomarker and provide insights into neuroanatomical underpinnings of cognitive impairment in patients with chronic HF., (© 2024 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population is rapidly growing in the United States. Despite sexual violence being a persistent and significant public health issue, research on this topic among AANHPIs is lacking. The study objective is to conduct a systematic scoping review on the published literature on non-partner sexual violence among AANHPIs to identify gaps and priorities to inform actionable research. The systematic review was conducted following the PRISMA Protocol for Systematic Reviews. Database searches were conducted of MEDLINE, Embase, PsycINFO, and Cochrane Central of Clinical Trials, along with and AgeLine and CINAHL for peer-reviewed articles describing non-partner sexual violence among AANHPIs. The search was limited to articles in English published after 1990. Each citation was reviewed by two trained independent reviewers, with a third researcher resolving any conflicts. Of the 998 articles screened and subsequently 496 full-text articles assessed for eligibility, 38 articles were included in the final analysis. The majority of studies did not report disaggregated data for AANHPI subgroups, with most focusing on East Asian subgroups and little evidence on NHPI communities. Most studies were cross-sectional, quantitative, and employed non-probability sampling. There was a lack of studies on effectiveness of interventions and validity of sexual violence-related measures. Our review provides a first step in mapping the extant literature on non-partner sexual violence among this underserved and under-researched population and will serve as a guide for future research, policy, and intervention. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is associated with multiple organ dysfunction and many comorbidities. Its incidence is high among the elderly and is a major health burden worldwide. Cognitive impairment (CI) is highly prevalent in older patients with HF, which is an abnormality in one or more of the items of cognition, attention, memory, language, psychomotor function, and visual spatial acuity. Studies have shown that the incidence of CI in HF patients is between 13 and 54%, and patients with both conditions have poor self-care ability and prognosis, as well as increased mortality rates. However, the mechanisms of CI development in HF patients are still unclear. In this review, we describe the epidemiology and risk factors as well as measures of improving CI in HF patients. We update the latest pathophysiological mechanisms related to the neurocognitive changes in HF patients, expounding on the mechanisms associated with the development of CI in HF patients. [ABSTRACT FROM AUTHOR]

Black medical students perceived significantly more stressors than white medical students in a predominantly white medical school environment (P=0.001). Black medical students perceived fewer social supports than white medical students, but not significantly fewer (P=0.224). There was no significant difference between mean systolic and diastolic blood pressure levels for the low and high stress groups (P=0.302 and 0.844, respectively). The total degree of perceived stressors did not predict systolic and diastolic blood pressure when controlling for potential confounders (0.050.25 and 0.1

This longitudinal study of medical students assessed the relationship between their mental and social well-being, the discrepancy between their expectations and the reality of the learning environment, and social support, after controlling for baseline characteristics that may affect students' perceptions. Finding, at the end of the first year, that the quality of the learning environment was better than expected was positively associated with social well-being but negatively associated with mental well-being. Finding less stress than expected was positively associated with both mental and social well-being. Social support had only a direct positive association with social well-being. There was a suggestion, although it was not statistically significant, of a negative association between social support and mental well-being and a positive interaction between social support and students' perception of the environment's quality. These findings suggest that stressors and mediators of stress may show specificity for health outcomes.

Transcutaneous electrical nerve stimulation (TENS) has been reported to reduce the use of narcotic analgesic medication for pain relief in the postoperative period. This study compares the use of narcotic analgesics and the occurrence of postoperative complications in 205 patients who underwent gastric bypass surgery for control of obesity. Seventy-four patients used TENS for postoperative pain relief. The control group comprised 131 patients who did not use TENS. There were no statistically significant differences in the use of narcotic analgesic medication and the occurrence of postoperative complications between the experimental group and the control group.

Objective: To determine the burden and identify correlates of female sexual dysfunction (FSD) among women with prediabetes (PreD) and type 2 diabetes (T2D) enrolled in the Diabetes Prevention Program (DPP) Outcomes Study (DPPOS)., Methods: The DPPOS visit included the Female Sexual Function Index (FSFI) to determine sexual function. Of 1464 participants, 1320 (90%) completed the (FSFI) and 426 were sexually active. A backward selection multivariable logistic regression model estimated the odds of FSD for sociodemographic, clinical, and diabetes-related covariates., Results: One hundred and eighty-five (43%) had a score of ≤26.55 and met the criteria for FSD. After adjustment for DPP treatment and age, urinary incontinence (UI) (odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.15-3.17) and hysterectomy (OR = 1.89, 95% CI = 1.01-3.53) were associated with increased odds of FSD. Increased body mass index was protective for FSD (OR = 0.93 per kg/m 2 , 95% CI = 0.89-0.96). Michigan Neuropathy Screening Instrument-based peripheral neuropathy (mean±SD scores 1.1±1.3 vs. 0.9±1.1, p < 0.0001) and Electrocardiogram (ECG)-based autonomic dysfunction measures (mean ± SD heart rate levels 64.3 ± 6.8 vs. 65.6 ± 10.2, p = 0.008) were associated with FSD. There were no differences in diabetes rates between women who did (66.5%) and did not (66%) have (p = 0.7)., Conclusions: FSD is prevalent in women with PreD and T2D. Our findings suggest that FSD is associated with neuropathic complications commonly observed in PreD and T2D., (© 2024 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.)

(1) Background: Despite iron intake recommendations, over a quarter of pregnant individuals have iron deficiency. Lactobacillus plantarum 299v enhances iron absorption in non-pregnant populations and may have positive effects in pregnancy among those with sufficient iron stores; however, no studies have evaluated the effect of Lp299v on maternal and neonatal iron status among individuals at risk for iron deficiency anemia in pregnancy. Thus, this study aims to assess the feasibility and preliminary efficacy of daily oral Lp299v maternal supplementation among diverse pregnant individuals. (2) Methods: In this double-blind placebo-controlled randomized supplementation feasibility study, participants were randomized to probiotic Lp299v + prenatal vitamin with iron or placebo + prenatal vitamin with iron from 15–20 weeks of gestation through delivery. (3) Results: Of the 20 enrolled and randomized participants, 58% (7/12) from the Lp299v group and 75% (6/8) from the placebo group were retained. Adherence to supplementation was 72% for Lp299v/placebo and 73% for the prenatal vitamin. A slower decline in maternal hematological and iron parameters across pregnancy was observed in the Lp299v group compared to placebo. (4) Conclusions: Lp299v may be a tolerable therapy during pregnancy and has the potential to affect maternal and neonatal hematological and iron status. [ABSTRACT FROM AUTHOR]

Background: Anemic pregnant women, especially those with severe anemia, will be at risk of low physical activity, increased maternal morbidity and mortality. Furthermore, both pregnant women and their neonates have negative effects including fetal anemia, low birth weight, premature delivery, restriction of intrauterine development, and perinatal mortality. Anemia can be effectively avoided and easily detected in a timely manner. The aim of this work was early detection and treatment of iron deficiency anemia among pregnant women attending Diarb Negm centeral hospital. Methods: Cross-sectional study was conducted in Obstetrics and Gynecology and clinical pathology department Diarb Negm Central Hospital from January 2018 till June 2018 at on 269 pregnant women C.B.C was done for them non iron deficiency anemia was 164 pregnant women (61%) Iron deficiency anemia was 105 pregnant women (39%) mild cases 62 maderate cases 41 and sever cases 2 oral treatment was given for mild cases IV & Im Iron was given for moderate cases and Blood transfusion for sevener cases. Results: In our study, prevalence of IDA in study participants was 18.6%. Nearly half of anemic patients had moderate anemia, which is higher than the World Health Organization (WHO) median prevalence rate of 32.6 percent. Conclusions: The majority of cases of anemia are this research, socioeconomic determinants. Therefore, in women attending for delivery at term, they should be considered as major risk factors of anemia. These women should be encouraged to start antenatal care early after conception in order to allow enough time to restore iron stores. [ABSTRACT FROM AUTHOR]

Objectives: Determine how a shift-based schedule to accommodate more students affects learning, performance, and satisfaction with the Obstetrics and Gynecology (OBG) rotation. Methods: The study was conducted among third year OBG medical students with a triangular convergent cross-sectional approach. A new shift-based schedule was implemented. After each rotation, an online survey was conducted using a convenience sampling. Student scores on the National Board of Medical Examiner (NBME) OBG subject exam were analyzed using paired t test. Survey data was analyzed using two sample t test. The relationship between survey responses and exam score findings were described. Data from shift-schedule students was compared to traditional schedule students from the prior academic year. Results: A statistically significant improvement was seen for average NBME score for shift-schedule students during the beginning portion (groups 1-3) of the academic year (M=80, SD=6.9) compared to traditional (M=75.7, SD=7.3) [t (145) =3.69, p =.001]. A similar pattern was not seen in subsequent groups (groups 4-6). Shift-schedule students also showed a statistically significant improvement in their perception of learning (t (183) =-2.54, p =.012). Parallel results were seen for belonging, manageable workload, time to study, and engaging meaningfully. Using this model, we increased rotation capacity from 24 to 30 students per group (20%). Conclusions: Shift based scheduling allows 20% increase in capacity. Exam scores and student learning outcomes were similar or better than traditional schedule controls. [ABSTRACT FROM AUTHOR]

Introduction-Anemia in pregnancy is one of the gravest world health crises affecting one fourth of the world population, mainly children and women of the reproductive age. The onset of anemia is attributed to two major classifications being 'Nutritional'-meaning deficiency of minerals and vitamins, and 'Nonnutritional' corresponding to infection and hemoglobinopathies. The only micronutrient mandatorily required supplementing to fill the gap between the dietary intake and the demand is iron. Micronutrient's iron, folate, and vitamins are very vital for the proper growth of the fetus during pregnancy. The diverse consequences of nutritional anemia are recurrent abortion, recurrent fetal loss, congenital abnormalities, preterm labour, reduced birth weight and neonatal and maternal mortalities. Methodology. It's an empirical, longitudinal, prospective, and comparative study using a structured questionnaire on the target group of the urban population in the city of Ajmer city. Results and Conclusion. Assessing BMI, there were 51.61% of anemic rich pregnant women who were considered malnourished as they belonged to the group with BMI < 18.4 kg/m2 whereas among the poor anemic pregnant women it was 75.87% women under this BMI. Evaluating the poor non-anemic pregnant women, nearly 16.98% of women belonged to BMI < 18.4 kg/m2 category and 8.95% of the rich non-anemic women who had their BMI < 18.4 kg/m2. Among the rich non-anemic pregnant women, there were 37.74% who came under the category of overweight having BMI >23kg/m2 and only 3.77% of poor non-anemic women grouped under over weight. The mean+SD of Hb at third trimester of the rich and poor pregnant women was 10.4+1.02 and 9.0+0.02 respectively. [ABSTRACT FROM AUTHOR]

Classroom sociology is a powerful discipline that helps students develop a sense of identity, achieve success, and experience well-being while building a strong community in the classroom. Teachers who can see beneath the surface and are aware of classroom sociology create a better and more just learning environment for learners, especially in primary education. This study focuses on improving teachers' classroom sociology and social justice awareness. Researchers designed a four-week in-service classroom sociology program for primary school teachers. The program aimed to improve the teachers' awareness and behaviours in terms of classroom sociology and social justice. This applied research was conducted using an in-service program intervention with 12 primary school teacher participants. Data was collected from in-class observations, teacher ethnography notes, participant evaluations, and classroom observations. Initially, participants were more focused on academic performance and teaching routines and largely ignored the social context of the classroom. At the end of the study, teacher participants' awareness of classroom sociology and social justice increased, and both their attitudes towards their students and their teaching methods changed in a positive manner. [ABSTRACT FROM AUTHOR]

Background: Exploring the perceptions of underrepresented in medicine (URiM) students about the medical education curriculum and learning environment could optimize their education outcomes. The current study delineated perceptions of URiM medical students about the unique elements and characteristics of an impactful medical education program that create a positive, supportive learning environment culture. Methods: We conducted in-depth interviews with 15 URiM students between January 2018 and April 2018. Interviewees were recruited from an accredited medical education program in Historically Black Colleges and Universities (HBCUs). The University is also a member of the Hispanic Association of Colleges and Universities in the U.S. The main question that guided the study was, "What do URiM students at a Historically Black Colleges and Universities (HBCU) medical school believe would make a medical education program (MEP) impactful?" We used the grounded theory analytical approach and performed content analysis via qualitative thematic evaluation. Results: Of 112 enrolled medical students (MS), 15 verbally consented to participation. We identified four general themes and several subthemes. The themes include 1) Grounding learning in the community; 2) Progressive system-based practice competency; 3) Social justice competency and 4) Trauma-informed medical education delivery. Theme 1 included the following subthemes (a) community engagement, and (b) student-run clinic, mobile clinic, and homeless clinic rotations. Theme 2 includes (a) interprofessional learning and (b) multidisciplinary medicine for cultivating a 'just' healthcare system. Theme 3 includes (a) longitudinal social justice curriculum, (b) advocacy, and (c) health disparity research. Theme 4 had the following subdomains (a) early and ongoing mentoring and (b) provision of supportive policies, services and practices to maximize learning and mental health. Conclusion: Our learners found that social justice, trauma-informed, community-based curricula are impactful for URiM learners. These findings highlight the need for further research to assess the impact of permeating the championship culture, community cultural wealth, and transformational education in all aspects of the MEP in providing a supporting and positive learning environment for URiM students. [ABSTRACT FROM AUTHOR]

Iron deficiency and/or iron deficiency anemia (IDA) complicate nearly 50% of pregnancies globally, negatively impacting both maternal and fetal outcomes. Iron deficiency can cause a range of symptoms that range from aggravating to debilitating including fatigue, poor quality of life, pagophagia, and restless leg syndrome. Iron deficiency and IDA are also associated with maternal complications including preterm labor, increased rates of cesarean delivery, postpartum hemorrhage, and maternal death. Fetal complications include increased rates of low birth weight and small for gestational age newborns. Prenatal maternal anemia has also been associated with autism spectrum disorders in the neonate, although causation is not established. Deficiency in the newborn is associated with compromised memory, processing, and bonding, with some of these deficits persisting into adulthood. Despite the prevalence and consequences associated with iron deficiency in pregnancy, data show that it is routinely undertreated. Due to the physiologic changes of pregnancy, all pregnant individuals should receive oral iron supplementation. However, the bioavailability of oral iron is poor and it is often ineffective at preventing and treating iron deficiency. Likewise, it frequently causes gastrointestinal symptoms that can worsen the quality of life in pregnancy. Intravenous iron formulations administered in a single or multiple dose series are now available. There is increasing data suggesting that newer intravenous formulations are safe and effective in the second and third trimesters and should be strongly considered in pregnant individuals without optimal response to oral iron repletion. [ABSTRACT FROM AUTHOR]

The role that the superwoman schema (SWS) plays in U.S. Black women's perceptions of barriers (biological, psychological, and sociological) to healthy weight management is unknown. This exploratory study examined whether 122 women classified as normal weight, overweight or obese differed in their perceptions of types of barriers and if the SWS predicted perceived barriers to weight management. Women classified as obese reported more barriers than those classified as normal weight. The SWS uniquely positively predicted perceived psychological and sociological barriers. Our findings suggest that the SWS may play a vital role in the self-management of weight in U.S. Black women. [ABSTRACT FROM AUTHOR]

Anemia during pregnancy is known to be associated with an increased risk of antenatal and/or postnatal depression, as well as adverse pregnancy outcomes. However, there are few studies evaluating psychological health throughout the antepartum and postpartum periods in women with anemia in early pregnancy. This study analyzed data collected by the Korean Pregnancy Outcome Study, a multicenter prospective cohort study conducted in South Korea, to determine the impact of anemia during the first trimester on birth outcomes and maternal mental health during pregnancy and postpartum. Hemoglobin levels were measured during the first trimester, and psychological health was evaluated at 12, 24, and 36 gestational weeks and 4–6 weeks postpartum. Anxiety and depression were defined using the Hospital Anxiety and Depression Scale and the Edinburgh Postnatal Depression Scale, respectively. Among 4067 Korean participants, 119 (2.9%) were diagnosed with anemia during the first trimester. Incidences of anxiety and depression did not differ over the pregnancy period between those with and without anemia during the first trimester. However, postpartum anxiety and depression were significantly more common in participants with anemia than in those without (p < 0.05, both). Hence, obstetricians should pay attention to postpartum mental health in women with anemia during the first trimester. [ABSTRACT FROM AUTHOR]

In May 2003, Madrid established the universal newborn screening (NBS) for sickle cell disease (SCD). However, there are no studies resembling the evolution of a SCD neonate cohort followed according to national guidelines in Spain. The aim of this study is to describe the morbimortality and the stroke prevention programme in patients diagnosed by SCD NBS in Madrid. This is a multicentre, observational, prospective cohort study between 2003 and 2018; 187 patients diagnosed with SCD were included (151 HbSS, 6 HbSβ 0 , 27 HbSC, 3 HbSβ +), and median follow-up was 5.2 years (0.03-14.9). There were 5 deaths: 2 related to SCD in patients with severe genotype (HbSS/HbSβ 0 ). Overall survival reached 95% and SCD-related survival 96.8%. The most frequent events were fever without focus, vaso-occlusive crises and acute chest syndromes. Eight strokes occurred in 5 patients which led to a 90.7% stroke-free survival in severe genotype patients (first stroke rate, 0.54 per 100 patient-years). Transcranial Doppler (TCD) was performed in 95% of eligible patients; 75% of children with pathological TCD remained stroke-free. Regarding HbSS/HbSβ 0 patients, 50.1% received hydroxyurea and 9.5% haematopoietic stem cell transplantation. This study reflects the evolution of Madrid SCD cohort and provides morbimortality data similar to other developed countries., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)