Building Climate Change into Medical Education: A Society of General Internal Medicine Position Statement.

Building expertise in climate and planetary health among healthcare professionals cannot come with greater urgency as the threats from climate change become increasingly apparent. Current and future healthcare professionals-particularly internists-will increasingly need to understand the interconnectedness of natural systems and human health to better serve their patients longitudinally. Despite this, few national medical societies and accreditation bodies espouse frameworks for climate change and planetary health-related education at the undergraduate (UME), graduate (GME), and continuing (CME) medical education level. As a community of medical educators with an enduring interest in climate change and planetary health, the Society of General Internal Medicine (SGIM) recognizes the need to explicitly define structured educational opportunities and core competencies in both UME and GME as well as pathways for faculty development. In this position statement, we build from the related SGIM Climate and Health position statement, and review and synthesize existing position statements made by US-based medical societies and accreditation bodies that focus on climate change and planetary health-related medical education, identify gaps using Bloom's Hierarchy, and provide recommendations on behalf of SGIM regarding the development of climate and planetary health curricula development. Identified gaps include (1) limited systematic approach to climate and planetary health medical education at all levels; (2) minimal emphasis on learner-driven approaches; (3) limited focus on physician and learner well-being; and (4) limited role for health equity and climate justice. Recommendations include a call to relevant accreditation bodies to explicitly include climate change and planetary health as a competency, extend the structural competency framework to climate change and planetary health to build climate justice, proactively include learners in curricular development and teaching, and ensure resources and support to design and implement climate and planetary health-focused education that includes well-being and resiliency.

Cognitively Based Compassion Training for HIV Immune Nonresponders-An Attention-Placebo Randomized Controlled Trial.

OBJECTIVE: Chronic inflammation is associated with increased morbidity and mortality for people with HIV (PWH). Psychological stress is an important contributor to this chronic inflammation. We hypothesized that a cognitively based compassion training (CBCT) approach could reduce inflammation and psychological stress in immune nonresponder PWH. DESIGN: An attention-placebo randomized controlled trial design to evaluate the acceptability of CBCT among PWH and its effects on key aspects of stress and immune function compared with an active-attention control group (NCT02395289). METHODS: This study was conducted at an HIV clinic in Atlanta, Georgia. Eligible individuals determined by (1) adherence to antiretroviral therapy for at least a year, (2) virologic suppression; and (3) stable CD4+ T-cell counts <350 cells/µL were randomized in a 2:1 ratio to either CBCT or control in 2 study periods: April-May, 2016, and September-December, 2016. Psychological measures and inflammatory biomarkers associated with HIV disease progression (IL-1ß, TNF-α, sCD14, IL-6, and IL-10) were obtained for all study participants at baseline and at the time of study completion. RESULTS: We found a significant association between CBCT practice time engagement and fold reduction in IL-6 and TNF-α levels. There was no association between CBCT practice time and other biomarkers markers assessed (IL-1ß, sCD14, and IL-10). These changes were coincident with significant increases in self-reported psychological well-being and HIV disease acceptance and in benefits for CBCT participants. We also observed fewer instances of virologic failure for those in the CBCT arm compared with controls. CONCLUSIONS: CBCT is a novel and feasible nonmedication-based intervention that could reduce inflammation and psychological stress in PWH.

Estimates of the direct cost per case and overall burden of trichomoniasis for the employer-sponsored privately insured women population in the United States, 2001 to 2005.

BACKGROUND: Little is known about the direct medical cost and overall burden of trichomoniasis among women in the United States. METHODS: We extracted insurance claims for trichomoniasis for 2001 to 2005 from the MEDSTAT MarketScan database using International Classification of Diseases, ninth revision codes. The analysis was restricted to outpatient care and prescription drug claims for women in 4 age categories; under 15, 15 to 24, 25 to 34, and 35 to 64. We used Current Procedures Terminology codes to analyze diagnostic methodologies. All costs were adjusted to 2005 US dollars. RESULTS: The average outpatient and prescription drug costs per episode for all ages were 97 dollars and 9 dollars, respectively. The resulting average total cost per episode was 101 dollars (about 50% did not have drug costs). Average total cost among women aged 15 to 24 years (120 dollars) was significantly (P < 0.01) higher than all other age categories. The estimated annual economic burden was 6.8 million dollars among privately insured women and 18.9 million dollars among all women from the United States. The incidence rate for female enrollees (all ages) having claims was 91 per 100,000 enrollees. Incidence rates were highest for women aged 25 to 29 years (185 per 100,000), followed by women aged 20 to 24 years (166 per 100,000). The most common diagnostic procedure seemed to be wet mount, but nonspecificity of Current Procedures Terminology codes inhibited the analysis of diagnostic methodologies. CONCLUSION: The estimated economic burden was highest among reproductive age women (15-34 years). Our estimated economic burden represents a lower-bound estimate because it was based on direct medical costs only.