Thematic Analysis of Third-Year Medical Student Reflections on Social Determinants of Health During Their Pediatric Clerkship: Emergent Themes and Topic Interconnectedness

Background. Social determinants of health (SDOH), as defined by the World Health Organization, are the “non-medical factors that influence health outcomes… the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” Studies have estimated that SDOH account for 30-55% of health outcomes. Understanding the impact of SDOH can be integrated into medical education in different formats, here we explore student reflections. Methods. In the 2021-2022 academic year, third-year medical students at a midwestern medical school submitted discussion board reflections on their experiences with SDOH during their 8-week pediatric clerkship. We analyzed de-identified posts to look for emergent themes that showcase the experiences and perceptions of medical students as they care for patients and learn about the socio-environmental factors in the community. Initial coding was built on a preliminary codebook drafted based on the medical school’s SDOH curriculum. Utilizing a grounded theory approach, we added new codes as novel topics and themes emerged. We then examined the relationships between the codes and SDOH categories outlined in the US Department of Health and Human Services Healthy People 2030 objectives. Results. Ninety-seven student discussion posts were analyzed. Our preliminary results demonstrate the two most common themes, social support and communication, together represented approximately 50% of all student responses. With the addition of the next two most frequently discussed topics, healthcare access and diet/nutrition, this set of themes comprises over 75% of student responses. Student responses also demonstrated the interconnectedness of SDOH categories through frequent overlap of categories during coding and analysis. Conclusion. Our study demonstrates the most common SDOH themes students identified during the pediatric clerkship involve social support, communication, access to care, and diet/nutrition. We found a multifactorial, connected nature of those themes as they impact patient health. This study validates the need for explicit education on SDOH topics during medical school so that future physicians are well-equipped to intervene or accommodate these factors throughout their careers. Future directions include comparing our results to preexisting social and educational frameworks and future cohort comparisons as curriculum evolves.https://digitalcommons.unmc.edu/chri_forum/1065/thumbnail.jp

Los Anticuerpos Monoclonales y Su Aplicabilidad Clínica

Los procesos de la evolución llegaron a una brillante solución. crearon una molécula adaptable que de por sí era capaz no sólo de activar el sistema de complemento y de estimular las células fagocíticas, sino además de adherirse al microorganismo invasor. Esta molécula adaptable presentaba tres regiones principales, dos afectadas con la comunicación con el complemento y los fagocitos (funciones biológicas), y uno relacionado con la unión al microorganismo como individuo (la función de reconocimiento externo). El organismo debe producir cientos de miles, o aun millones de moléculas adaptables con sitios de reconocimiento diferentes. Esta molécula adaptadora se conoce como anticuerpo

Cross-sectional survey of parental barriers to participation in pediatric participant research registries.

Research registries are a powerful tool for boosting recruitment into clinical trials. However, little is known about how parents approach the decision to enroll their child in a pediatric participant research registry (PPRR). We conducted in-person, written, or telephone surveys with parents/guardians of children hospitalized at Children's Hospital of Omaha, Nebraska to identify attitudes towards and barriers to enrollment in PPRRs. Overall, our population (N = 36) had positive attitudes toward PPRRs, with 77.8% (CI: 61.6, 88.4) of participants stating they were "somewhat" or "very" likely to enroll their child. Likelihood to enroll differed between various recruitment and enrollment methods, with participants stating they would be more likely to enroll their child in a PPRR if they were recruited by their child's primary care provider or a nurse in clinic (p = 0.02) and less likely to enroll if they were recruited through social media (p<0.001). Additionally, over 90% of participants who were likely to enroll their child in a PPRR (N = 28) were also willing to provide demographic, medical, and lifestyle information. However, these participants remained concerned about inappropriate sharing of their information with insurance or for-profit companies (53.6%, CI: 35.8, 70.4) and about receiving unwanted telephone calls from the registry (78.6%, CI: 60.0, 90.0). Parents are generally willing to enroll their child in a PPRR. However, to optimize enrollment, investigators must understand parental preferences for and concerns surrounding enrollment in a PPRR

Análisis histoquímico de células tumorales (cáncer de colon) tumor primario y metastático mediante lectinas biotiniladas

Of the different stages of cancer developing, the most threatening the metastasis, due to this, there has been great efforts in its studies and comprehension. We study the glycolalyz of primary colon tumors, and its metastasis to the sacrum, lymphatic ganglions and liver. Tumor samples from post-surgical patients of cancer were used. The cuts were fixed and incubated in PSA, DBA,UEA1, Jacaline and ECL. As controls we used inhibitory specified sugar. The biggest intensity corresponded to Jacaline in primary tumors and metastasis. PSA, ECL y UEA 1 reacted with less intensity. No difference was registered between primary tumors and the metastatic ones nor in the different metastasis. There was no reaction with the DBA. These results show no differences in the glycocalyz with the carbohydrates studied between the primary tumor and the metastasis. It is possible that the studies should continued with other lectins in the search of the molecules that carry the organ of selectivity the tumoral metastasis.De las etapas del desarrollo del cáncer la más amenazante es la metástasis, por lo que se han hecho esfuerzos en su estudio y comprensión. Nosotros estudiamos el glicocáliz de tumores primarios de colon y sus metástasis a sacro, ganglios linfáticos e hígado. Se utilizaron muestras tumorales de pacientes post quirúrgicos con cáncer de colon. Los cortes fueron fijados e incubados en PSA, DBA, UEA1, Jacalina y ECL. Como controles utilizamos azúcares inhibitorios específicos. La mayor intensidad correspondió a Jacalina en tumores primarios y metástasis. PSA, ECL, y UEA1 reaccionaron con intensidad menor. No se registraron diferencias entre los tumores primarios y metastáticos, y tampoco entre las diferentes metástasis. No hubo reacción con el DBA. Estos resultados no muestran diferencias en el Glicocáliz con la presencia de los carbohidratos estudiados entre el tumor primario y las metástasis. Es posible que se deban continuar los estudios con otras lectinas en la búsqueda de las moléculas que llevan a la selectividad por órgano de las metástasis tumorales