Assessing Perspectives on Systemic Racism in an Academic Hospital Medical Group: The ARCH Project.

BACKGROUND: Wisconsin residents experience significant racial inequities in health outcomes. OBJECTIVES: The University of Wisconsin School of Medicine and Public Health Division of Hospital Medicine wanted to assess providers' perspectives on systemic racism and gauge their receptiveness to participating in anti-racism training, in conjunction with development and implementation of anti-racism curriculum. METHODS: Existing anti-racism curriculum was adapted to be delivered remotely. Division providers were asked to complete a 9-question survey at the beginning of the curriculum. RESULTS: At baseline, a majority of respondents believed that racial health disparities exist and should be discussed through employer-sponsored training. Respondents generally did not feel confident in their abilities to address racism. CONCLUSIONS: Providers were supportive of anti-racism training in the workplace and feel it is congruent with the public health mission of hospital medicine physicians.

Explaining racial and ethnic disparities in cholesterol screening.

OBJECTIVE: To determine whether racial and ethnic disparities in cholesterol screening persist after controlling for socioeconomic status, access to care and language. METHODS: Data were obtained from the 2011 Behavioral Risk Factor Surveillance System for men aged 35 and older and women aged 45 and older in accordance with the United States Preventive Services Task Force guidelines. Self-reported cholesterol screening data are presented for 389,039 respondents reflecting over 141million people. Sequential logistic regression models of the likelihood of never having been screened are presented adjusted for demographic characteristics, health status, behavioral risk factors, socioeconomic status, health care access, and questionnaire language. RESULTS: A total of 9.1% of respondents, reflecting almost 13million individuals, reported never having been screened. After adjustment for socioeconomic status, health care access and Spanish language, disparities between whites and Blacks and Hispanics, but not Asians and Pacific Islanders, were eliminated. CONCLUSIONS: Lower socioeconomic status, lack of healthcare access and language barriers explained most of the racial and ethnic disparities in cholesterol screening. Expanding insurance coverage, simplifying cardiac risk assessment and improving access to culturally and linguistically appropriate care hold the greatest promise for improving cardiovascular disease screening and treatment for vulnerable populations.

Long-term survival of transplanted stem cells in immunocompetent mice with muscular dystrophy.

Satellite cells refer to resident stem cells in muscle that are activated in response to damage or disease for the regeneration and repair of muscle fibers. The use of stem cell transplantation to treat muscular diseases has been limited by impaired donor cell survival attributed to rejection and an unavailable stem cell niche. We isolated a population of adult muscle mononuclear cells (AMMCs) from normal, strain-matched muscle and transplanted these cells into delta-sarcoglycan-null dystrophic mice. Distinct from other transplant studies, the recipient mice were immunocompetent with an intact endogenous satellite cell pool. We found that AMMCs were 35 times more efficient at restoring sarcoglycan compared with cultured myoblasts. Unlike cultured myoblasts, AMMC-derived muscle fibers expressed sarcoglycan protein throughout their entire length, consistent with enhanced migratory ability. We examined the capacity of single injections of AMMCs to provide long-term benefit for muscular dystrophy and found persistent regeneration after 6 months, consistent with augmentation of the endogenous stem cell pool. Interestingly, AMMCs were more effectively engrafted into aged dystrophic mice for the regeneration of large clusters of sarcoglycan-positive muscle fibers, which were protected from damage, suggesting that the stem cell niche in older muscle remains permissive.