ABSTRACT
Background: Dementia affects more women than men. This suggests sex steroid-dependent structural and functional differences between male and female brains. Natural and iatrogenic changes to women's reproductive health may correlate with risk for dementia. Objective: To identify surrogate markers of key transitions within the reproductive axis that could correlate with dementia pathology in women. Specific Research Question: Could examination of the reproductive axis from birth to senescence expand our understanding of the gender predominance of dementia in women? Proxy measurements for fetal origins, reproduction, and age-related effects on estrogen-dependent tissues were collected to study dementia risk in women. Methods: Deidentified data were collected from 289 older Caucasian female patients from an out-patient clinic in Kansas City, Missouri. Women patients 65 years and older were offered the opportunity to join the study and written consent was obtained from all participants. Data were collected from 2017 to 2019. Results: Our subjects ranged in age from 65 to 98 years old, with a mean of 76 years old. Spearman correlation analysis showed significant correlation between dementia status and age (r = 0.219, p = 0.000), Fitzpatrick skin phototype (r = -0.141, p = 0.019), birth order (r = 0.151, p = 0.028), current height as measured in the office (r = -0.215, p = 0.001), and maximum height per patient recall (r = -0.173, p = 0.005). Results from the logistic regression model show that specific predictors of risk for dementia were age (odds ratio [OR] = 1.082 [1.034-1.132]; p = 0.0007), Fitzpatrick skin phototype 1 versus 3 (OR = 8.508 [1.075-67.313]; p = 0.0227), and current height (OR = 0.766 [0.642-0.915]; p = 0.0032). Of the four variables related to fetal origins: maternal age, number of siblings, birth order, and age difference between the subject and the next older sibling, none were found to be statistically significant. Since age is a significant predictor of risk for dementia, it was included as a covariate in the aforementioned logistic regression models. Conclusions: Our results showed that dementia in Caucasian women was associated with age, lower Fitzpatrick phototype, and current height. Dementia-related pathological processes in the brain may accrue over a woman's lifetime.
ABSTRACT
BACKGROUND: Preventing and reducing risky alcohol use and its side effects remains a public health priority. Discussing alcohol use with patients can be difficult; dedicated training for health care providers is needed to facilitate these conversations. A Web-based alcohol screening and brief intervention (SBI), comprising didactic and skills application training, was designed for physician assistant students. OBJECTIVE: This paper details experiences and outcomes in developing an alcohol SBI training curriculum and coordinating virtual encounters with standardized patients. We also explain challenges faced with developing an alcohol SBI training and a Web-based learning management site to fit the needs of 5 different physician assistant programs. METHODS: Training development comprised 3 phases-precourse, development, and implementation. The precourse phase included developing the initial training curriculum, building a website, and testing with a pilot group. The development phase refined the training curriculum based on user feedback and moved into a three-component module: didactic training module, guided interactive encounter with a simulated patient, and live encounter with a standardized patient. A learning management system website was also created. In the implementation phase, 5 physician assistant schools incorporated the Web-based training into curricula. Each school modified the implementation method to suit their organizational environment. Evaluation methods included pre- and postchange over time on trainee attitudes, knowledge, and skills (confidence) on talking to patients about alcohol use, trainee self-reported proficiency on the standardized patient encounter, standardized patient evaluation of the trainee proficiency during the alcohol use conversation, user evaluation of the type of technology mode for the standardized patient conversation, and overall trainee satisfaction with the Web-based training on alcohol SBI. RESULTS: Final evaluation outcomes indicated a significant (P<.01) change over time in trainee knowledge and skills (confidence) in the conduct of the alcohol SBI with a standardized patient, regardless of the program implementation method. Trainees were generally satisfied with the Web-based training experience and rated the use of the videoconference medium as most useful when conducting the alcohol SBI conversation with the standardized patient. Training that included a primer on the importance of screening, individual participation in the Web-based didactic alcohol SBI modules, and virtual encounters with standardized patients through a university-based simulation center was the most widely accepted. Successful implementation included program investment and curriculum planning. Implementation barriers involved technical challenges with standardized patient encounters and simulation center logistics, and varying physician assistant school characteristics. CONCLUSIONS: Development and implementation of Web-based educational modules to educate health care professionals on alcohol SBI is effective, easy to reproduce, and readily accessible. Identifying challenges affecting development, implementation, and utilization of learned techniques in practice, enhances facilitation of learning and training efficacy. As the value of technology-based learning becomes more apparent, reports detailing what has worked versus what has not may help guide the process.
