National Email Communication Platforms May Indicate or Contribute to Gender Disparities: Preliminary Analysis of an Academic Medicine Listserv.

Background: Gender disparities are well documented in the academic medicine literature and have been shown to impact representation, rank, and leadership opportunities for women. Social media platforms, including electronic mailing lists (listservs), may contribute to disparities by differentially highlighting or promoting individuals' work in academic and public health settings. Because of this, they provide a record by which to assess the presence of gender disparities; therefore, they become tools to identify gender differences in the frequency or pattern of representation. This study examines the representation of women in academic medicine electronic communications by analyzing weekly email listserv announcements of the American Association of Medical Colleges (AAMC). Materials and Methods: A mixed methods approach was used to analyze listserv communications during two time periods, 2012-2014 and 2018-2019. Each email contained multiple announcements. Individual achievement messages were selected, categorized by gender, and coded with one of three action categories: departures, appointments, and other mentions. Additionally, each notice was coded by professional setting (media, professional organizations, medical school/research, health care systems, public health, and government). Results: We analyzed a total of 5701 announcements in the AAMC communication listserv. Men represented 73.2% (N = 4171) and women 26.8% (N = 1530) of the total announcements. During 2012-2014, 24.0% of announcements were about women, while in the 2018-2019 sample, 35.7% of announcements were about women (p < 0.001). Overall, women were underrepresented in departure-focused messages compared to messages with an appointment or other focus in the sample. The prevalence of women in announcements from the 2012-2014 and 2018-2019 samples also varied based on setting. Conclusions: Findings support the presence of gender disparities in these sets of listserv communications. While social media overall is not considered to be a source of complete information, this study analyzed the same listserv communication by the same organization over the entire period, thereby providing a window into the frequency and type of representation of women's professional activity in academic medicine.

Iwankapiya American Indian pilot clinical trial: Historical trauma and group interpersonal psychotherapy.

American Indians face pervasive trauma exposure, collective histories of communal suffering, and elevated risk for depression and posttraumatic stress disorder. In addition to socioeconomic barriers, access to culturally responsive treatment is limited, which may compromise treatment engagement. The Iwankapiya study piloted the Historical Trauma and Unresolved Grief Intervention (HTUG), combined with Group Interpersonal Psychotherapy (IPT), to reduce symptoms of depression and related trauma and grief. The study hypothesized that HTUG + IPT would lead to greater group engagement and decreased depression and related symptoms compared with IPT-Only. American Indian adults (n = 52) were randomized into one of two 12-session interventions, HTUG + IPT or IPT-Only, at two tribal sites: one Northern Plains reservation (n = 26) and one Southwest urban clinic (n = 26). Standardized measures assessed depression, posttraumatic stress disorder, grief, trauma, and substance use. Data were collected at screening, baseline, end of intervention, and 8 weeks postintervention; depression and group engagement measures were also collected at Weeks 4 and 8 of the intervention. Depression scores significantly decreased for both treatments, but there were no significant differences in depression between the two groups: IPT-Only (30.2 ± 6.4 at baseline to 16.7 ± 12.1 at follow-up) and HTUG + IPT (30.2 ± 8.1 at baseline to 19.9 ± 8.8 at follow-up). However, HTUG + IPT participants demonstrated significantly greater group engagement. Postintervention, clinicians expressed preference for HTUG + IPT based upon qualitative observations of greater perceived gains among participants. Given the degree of trauma exposure in tribal communities, these findings in a relatively small sample suggest HTUG should be further examined in context of treatment engagement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Postapplication Advisement for U.S. Medical School Reapplicants: One School's Program.

PROBLEM: Reapplicants make up over one-quarter of U.S. medical school applicants. Postapplication advisement (PAA) can provide potential reapplicants with concrete strategies for improvement, a contextualized basis for their scores, and a realistic idea of their chances for success. However, more data showing the effectiveness of PAA and an analysis of best practices are needed for PAA programs to be more widely adopted. APPROACH: In 2010, the University of New Mexico School of Medicine (UNM SOM) created a PAA program that involves a postapplication seminar (PAS), mandatory self-assessment and action plan development, and an individual consult with an admissions dean to prepare participants for reapplication. OUTCOMES: From 2010 to 2016, 892 applicants who interviewed and were rejected at UNM SOM were eligible to participate in PAA. Of these, 478 (53.6%) chose to participate in PAA over the seven-year period. Males had a higher participation rate (246/430; 57.2%) compared with females (232/461; 50.3%; P = .04). African Americans had a higher participation rate (12/17; 70.6%) and American Indian/Alaska Natives had a lower participation rate (17/64; 26.6%) than any other race/ethnicity. Of reapplicants who were subsequently accepted, 140/178 (78.7%) attended PAS and a consult, and 7/178 (3.9%) attended PAS only, compared with 31/178 (17.4%) of subsequently accepted reapplicants who did not participate in any PAA (P < .001). NEXT STEPS: Additional research should focus on the best approach for assisting reapplicants with prioritizing areas for improvement in their application. Demographic data may be used to target outreach to specific populations.

A Cardiovascular Health Intervention for Spanish Speakers: The Health Literacy and ESL Curriculum.

Spanish speakers in the United States are in need of effective interventions that address both cardiovascular disease (CVD) and health literacy. However, the literature lacks interventions that have used and evaluated a strategies that focus on both, particularly at the community level. The aim of this study was to explore the effect of a health literacy curriculum on cardiovascular health behavior among Spanish speaking adults. It used a randomized controlled pre-posttest design. Participants included Hispanic adults with a low-to-intermediate level of English proficiency. The intervention group received the health literacy and English as a second language (ESL) Curriculum with CVD specific content, while the control group received a conventional ESL curriculum. Tools included the Spanish Cardiovascular Health Questionnaire (CSC), the test of functional health literacy in adults (TOFHLA), and the Combined English Language Skills Assessment. Analysis of change scores included independent sample t test and multiple linear regression. A total of 155 participants completed the study. There was a significant greater improvement for the intervention group in change of CSC score from pretest to posttest (P = 0.049) compared to controls. The study also found significantly improved TOFHLA (P = 0.011), however it did not find a relationship between changes in CVD behavior and health literacy or English proficiency. The Health Literacy and ESL Curriculum constitutes a valuable resource for addressing the cardiovascular health, literacy, and language needs of Spanish-speaking adults. Interventions that take a multilevel education and health approach may be more effective in addressing the needs of immigrants. Research should further explore the interactions between CVD behavior, health literacy, and English proficiency.

Stability of Phosphatidylethanol in Dry Blood Spot Cards.

BACKGROUND: The analysis of phosphatidylethanol, a promising direct ethanol metabolite, in dry blood spots (PEth-DBS) is advantageous due to ease of storage, transportation and minimal invasiveness of capillary blood collection. One potential application of PEth-DBS is to confirm prenatal alcohol exposure in newborns suspected of FASD; however, stability of PEth-DBS is largely unknown. METHODS: Phlebotomized samples from 31 adults with a history of alcoholism, admitted to the University of New Mexico Emergency Department, were analyzed for blood alcohol content and pipetted onto DBS cards (13 spots per patient). The first spot was analyzed within 2 weeks of collection for a baseline PEth; the remaining 12 spots were allocated into three temperature conditions (room temperature, 4°C, -80°C) for the repeated measures analysis. In addition, 5 newborn DBS samples with a baseline PEth>LOD were obtained from a prospective cohort at UNM and re-analyzed at 4 months after storage at -80°C. A mixed linear model was fitted to examine the effects of temperature, time and temperature-time interaction on PEth degradation over the first 9 months. RESULTS: The baseline PEth levels were 592.8 ± 86.7 ng/ml and 18.3 ± 4.8 ng/ml in adult and newborn samples, respectively. All DBS samples remained positive in successive samples in all temperature conditions. Results of mixed linear model demonstrated a significant effect of temperature (P < 0.001) on PEth degradation over 9 months. CONCLUSIONS: PEth-DBS appears to be relatively stable, especially when stored at lower temperatures. These initial results are encouraging and highlight the PEth-DBS potential in retrospective assessment of alcohol exposure.

The effect of prenatal alcohol co-exposure on neonatal abstinence syndrome in infants born to mothers in opioid maintenance treatment.

OBJECTIVE: This study examined the effects of prenatal alcohol exposure (PAE) on the incidence and severity of neonatal abstinence syndrome (NAS). STUDY DESIGN: For this pilot study, 70 pregnant women on opioid maintenance therapy (OMT) were recruited from a perinatal substance abuse clinic. Subjects were categorized into three study groups based on the timing of alcohol use during pregnancy as assessed by repeated self-reported measures and a comprehensive panel of ethanol biomarkers. NAS outcomes included: duration of hospital stay, the need for pharmacological treatment of NAS, newborn age at the initiation of NAS treatment, duration of treatment and cumulative methadone dose administered. RESULTS: The study included a large proportion of ethnic minorities (81.4% Hispanic, 5.7% American Indian), women with less than a high school education (52.2%) and unplanned pregnancy (82.9%). In multivariate analysis, PAE was not associated with NAS outcomes; however, one newborn diagnosed with fetal alcohol syndrome (FAS) demonstrated much more severe NAS compared to other PAE infants. Interestingly, 3rd trimester PAE was associated with a higher prevalence of microcephaly (62.5%) compared to the PAE abstaining group (36.8%; p = 0.08). CONCLUSION: In this study, PAE was not associated with NAS severity; however, further examination in a larger study is needed.

Practice-based assessment of tobacco usage in southwestern primary care patients: a Research Involving Outpatient Settings Network (RIOS Net) study.

PURPOSE: Primary care clinicians rely, perhaps erroneously, on general population-based data about risk factors to help form their strategies for allocating time in the brief primary care encounter. We conducted a case study using rates of tobacco usage among people presenting for primary care to explore comparability to general population-based rates. METHODS: Clinicians in RIOS Net, a practice-based research network, gathered data on tobacco use for all patients presenting during a 2-week period. We compared those data to population-based data by gender and ethnicity. RESULTS: Ninety-one primary care clinicians reported data on 2442 patients. Primary care smoking rates differed in important ways from general population-based rates. Hispanic women smoked at more than twice the national population-based rate (25% vs 12%). Youth smoked at higher rates as well, particularly young Native American men. CONCLUSIONS: Patients seen in primary care differ in important ways in rates and patterns of tobacco usage when compared with rates reported in population-based surveys. These differences could have important implications for preventive care within the context of multiple competing demands in the primary care encounter.

Training effective interpreters for diabetes care and education: a new challenge.

PURPOSE: This article describes a pilot project to improve knowledge, attitudes, and skills of ad hoc interpreters working with Native American diabetes patients with limited English proficiency. METHODS: Case-based studies reflecting clinical situations were developed. Key concepts and terms from the cases were translated into the Navajo language and carefully back translated using the newly standardized Navajo diabetes terminology. Twenty-two health care workers from 2 Indian Health Service facilities were recruited for a pilot study to compare the performance of interpreters trained in a formal workshop using the case studies with that of interpreters who independently reviewed a video made from the training. RESULTS: Workshop participants noted significant improvements in their knowledge and comfort level in interpretation of diabetes concepts but not about unrelated topics; the independent study group perceived less improvement. CONCLUSION: Formal training for interpreters working with diabetes patients should be considered by diabetes educators working in settings where medical interpreters are needed. Diabetes educators should encourage back translation of key diabetes concepts to understand exactly what is being said to patients. Those working with multiple interpreters should make sure there are opportunities for interpreters to discuss translations of key concepts with each other and the educators so that translations are accurate and consistent among interpreters. Independent study did not appear to be an effective way to improve the ability of interpreters to translate current diabetes concepts accurately.

Emotional responses to APO E genotype disclosure for Alzheimer disease.

The purpose of our study is to assess the emotional responses to disclosing APO E genotype to asymptomatic older adults at increased risk for Alzheimer disease (AD). This is a longitudinal cohort study of volunteer subjects who were aged 50 years or over, asymptomatic for (AD), had a family history of AD, passed a psychological assessment, and participated in pre- and post-test genetic counseling and three follow-up visits over 10 months. We analyzed responses by three emotional constructs: depressed, worried, and relieved. Three hundred and twenty-eight subjects were screened, 76 received their APO E genotype. When emotional responses occurred it was immediate, between baseline and the 1 month follow-up. Emotional reactions did not change significantly past 1 month. Our results suggest that for emotionally stable persons, disclosing results of their APO E genotype, high risk subjects did not report more depression or worry and low risk subjects felt relieved by knowing the results. Future studies should evaluate the risks of disclosure to family members involved in the diagnostic work-up of a relative and include subjects from a broader range of emotional stability and socioeconomic background.