The Application of Exercise Prescription Education in Medical Training

Objective: Physical inactivity is a significant contributor to many acute and chronic medical conditions. While the dangers of physical inactivity are well understood and physicians have a desire to address them, a lack of education in exercise prescription (ERx) may be a barrier to properly prescribing exercise to patients. The aim of this research was to explore the need for ERx education amongst students and physicians in training and determine the effectiveness of ERx didactic. Methods: A one hour curriculum was developed based on the American College of Sports Medicine principles of ERx. Pre- and post-surveys were administered immediately before and after curriculum session to Wayne State School of Medicine medical students and residents to assess perceived ERx education level and confidence levels for prescribing aerobic and anaerobic exercise to patients. Virtual curriculum sessions were held over Zoom. Results: A total of 144 pre-survey and 119 post-survey results were analyzed. Mean perceived ERx education level significantly increased from 4.67/10 + 1.98 to 7.35/10 + 1.56 (P\u3c.001). Mean confidence level discussing PA with patients, ability to answer exercise related questions, confidence level in ability to prescribe aerobic exercise, and ability to prescribe anaerobic exercise significantly increased in all groups and overall (P\u3c.001) Conclusion: A one-hour session to educate medical students and residents on how to write an ERx improved perceived knowledge and confidence in this subject matter. Further study is needed to determine long term knowledge retention and the impact on ERx behavioral practice in a patient care setting

Chronic Use of Non-Medical Abdominal Compressors: Medical and Psychological Implications

The popularity of waist cinchers, shapewear, abdominal binders, corsets, and waist trainers has increased in the population. Although corsets have been part of western fashion since the 18th century, abdominal compressors remain in style even today. In 2018, sales for shapewear worldwide were estimated at 2.26 billion USD. 1 Despite its popularity, shapewear safety and medical effects have not been widely studied. In 1968, “Pantygirdle Syndrome” was described, attributing vulvitis, urethritis, and urinary tract infections to materials used from the “pantygirdle”. 2 The article describes that the girdle caused gastrointestinal symptoms with diaphragmatic and stomach displacement causing gastro-esophageal reflux disease that resolved with girdle loosening. 3 Physicians related abdominal compression garments to the development of dyspnea, syncope, GERD, esophagitis, colon infarction, leg thrombophlebitis, varicose ulcers, and deep vein thrombosis. 6 Despite commentary, evaluation, and recognition of medical side effects with chronic use of shapewear and abdominal compression garments, there is a paucity of literature that describes who wears shapewear, for which reasons, and associated adverse effects from shapewear use. The purpose of this study is to describe the population of women that choose to wear shapewear and aims to: Better understand modern-day usage of modern forms of shapewear Assess why women wear shapewear and their shapewear usage habits Assess for medical associations and potential complications with acute and or chronic abdominal compression Evaluate if certain psychological conditions increase the use of shapewear or other abdominal compressor

Impact of a Health Fair on Student Organizations Providing Care to the Detroit Hispanic/Latinx Community and Barriers Affecting Patients of a Student-Run Clinic Primarily Serving this Population

Current literature shows Hispanic/Latinx populations in the U.S. face health inequities. Amigos Medicos (AM) Clinic, located in Southwest Detroit, is a student-run free clinic that addresses these issues through preventive health screenings. We hosted a health fair in 2022 and invited other student organizations in efforts to connect the community to resources. Our aim is to identify specific barriers faced by our population in receiving health care and to identify the impact of participation in the fair on those organizations. One survey was administered to patients attending clinic that identified health barriers they face. The other survey was administered to student organizations four months after the fair to assess representatives’ experiences. Data administered to organizations showed all (100%) student organization representatives believed the health fair brought increased awareness to the Detroit population about their respective student organization. The most identified limitations reported by the organizations in serving the community were financial constraints (43%) followed by limited space/resources (14%) and lack of volunteers (14%). Our response rate for the survey administered at the clinic is approximately 38% and data collection is ongoing. 66.67% of patients reported they do not have health insurance. 44% reported visiting a community clinic and 22% visit the Emergency Department. 22% indicated that lack of health insurance, language barriers, lack of transportation, or long wait-time for appointments increased the difficulty of accessing healthcare. Our research not only demonstrates unique challenges in working with Hispanic/Latinx populations but also the needs and barriers faced by the community

Medical Student Perspectives on Opioid Use Disorders: An Innovative MAT Waiver Training Integration during IM Clerkships

The opioid epidemic in the US has become a major issue in healthcare. In 2017, there was an estimated 72,306 drug overdose related deaths and Emergency Departments (ED) nationally saw a 30% increase in opioid related overdoses. Innovative programs can help ensure patients are offered optimal treatment options. Most primary care physicians self-report they lack the skills to identify and appropriately treat substance abuse disorders (SUDs). Studies have suggested that the best solution is to improve medical school curricula, which translates to better educated future physicians. Unfortunately, due to timing and exposure constraints, most medical school programs do not provide the necessary information to successfully manage and treat SUDs in practice. To prescribe buprenorphine, an 8-hour Medication Assisted Treatment (MAT) training must be completed. Only 35,604 of the approximate 800,000 US physicians (\u3c3%) are registered to prescribe buprenorphine. We implemented an innovative approach to provide students with the skills to understand how to prescribe buprenorphine and build confidence to medically manage opioid use disorders in the future. By completing the training students will be eligible for a their MAT waiver upon obtaining their permanent license. Prior to integrating the training into the internal medicine clerkship, a preliminary study similar in nature was performed that focused on first and second year medical students perspectives. The results were analyzed and presented, and based on the positive results of the study, it was decided to implement the study into the internal medicine clerkship during the third year of medical school

A Scoping Review: Overview of Current Respectful Maternity Care Research by Research Approach and Study Location

Introduction: Disrespectful care during childbirth contributes to poor health outcomes, perpetuates disparities, and encourages childbirth outside of healthcare facilities. To measure disrespectful care, investigators use many research approaches. Most research has focused on low/low-middle income countries. This scoping review aims to 1) summarize current research and research approaches to analyze whether these approaches identify the same types of mistreatment and 2) identify gaps in current research analyzing disrespectful care during childbirth. Methods: Following PRISMA guidelines, this review utilized search terms to filter articles from the Pubmed database. Using specific criteria, articles were then excluded by title and abstract, then full article review. Included articles were organized by research approach and analyzed for study location and the presence of 9 types of mistreatment. Results: 102 included articles were organized by research approach, including direct labor observation, survey, interview, and focus groups, yielding 144 total studies to account for articles with more than one research approach. Each research approach identified all 9 types of mistreatment, with neglect/abandonment, verbal mistreatment, and physical mistreatment reported the most. Low-income countries represented 134/144 studies, with most research centered in East Africa and India. High-income countries represented only 7% of research. Discussion: This review is the first to organize current respectful maternity care research by research approach and study location. Analysis of study location shows gaps in research, particularly among high-income countries. Further research, particularly in high-income countries, is necessary to better this global health concern

Periodicities in the high-mass X-ray binary system RXJ0146.9+6121/LSI+61 235

The high-mass X-ray binary RX J0146.9+6121, with optical counterpart LS I+61°235 (V831 Cas), is an intriguing system on the outskirts of the open cluster NGC 663. It contains the slowest Be type X-ray pulsar known with a pulse period of around 1400 s and, primarily from the study of variation in the emission line profile of Hα, it is known to have a Be decretion disc with a one-armed density wave period of approximately 1240 d. Here we present the results of an extensive photometric campaign, supplemented with optical spectroscopy, aimed at measuring short time-scale periodicities. We find three significant periodicities in the photometric data at, in order of statistical significance, 0.34, 0.67 and 0.10 d. We give arguments to support the interpretation that the 0.34 and 0.10 d periods could be due to stellar oscillations of the B-type primary star and that the 0.67 d period is the spin period of the Be star with a spin axis inclination of 23+10−8 degrees. We measured a systemic velocity of −37.0 ± 4.3 km s−1 confirming that LS I+61°235 has a high probability of membership in the young cluster NGC 663 from which the system's age can be estimated as 20–25 Myr. From archival RXTE All Sky Monitor (ASM) data we further find ‘super’ X-ray outbursts roughly every 450 d. If these super outbursts are caused by the alignment of the compact star with the one-armed decretion disc enhancement, then the orbital period is approximately 330 d

Haplotype analysis suggest common founders in carriers of the recurrent BRCA2 mutation, 3398delAAAAG, in French Canadian hereditary breast and/ovarian cancer families

BACKGROUND: The 3398delAAAAG mutation in BRCA2 was recently found to recur in breast and/or ovarian cancer families from the French Canadian population of Quebec, a population that has genetic attributes consistent with a founder effect. To characterize the contribution of this mutation in this population, this study established the frequency of this mutation in breast and ovarian cancer cases unselected for family history of cancer, and determined if mutation carriers shared a common ancestry. METHODS: The frequency was estimated by assaying the mutation in series of French Canadian breast cancer cases diagnosed before age 41 (n = 60) or 80 (n = 127) years of age, and ovarian cancer cases (n = 80) unselected for family history of cancer by mutation analysis. Haplotype analysis was performed to determine if mutation carriers shared a common ancestry. Members from 11 families were analyzed using six polymorphic microsatellite markers (cen-D13S260-D13S1699-D13S1698-D13S1697-D13S1701-D13S171-tel) spanning approximately a 3.6 cM interval at the chromosomal region 13q13.1, which contains BRCA2. Allele frequencies were estimated by genotyping 47 unaffected female individuals derived from the same population. Haplotype reconstruction of unaffected individuals was performed using the program PHASE. RESULTS: The recurrent BRCA2 mutation occurred in 1 of 60 (1.7%) women diagnosed with breast cancer before 41 years of age and one of 80 (1.3%) women with ovarian cancer. No mutation carriers were identified in the series of breast cancer cases diagnosed before age 80. Mutation carriers harboured one of two haplotypes, 7-3-9-3 – [3/4]-7, that varied with marker D13S1701 and which occurred at a frequency of 0.001. The genetic analysis of D13S1695, a polymorphic marker located approximately 0.3 cM distal to D13S171, did not favour a genetic recombination event to account for the differences in D13S1701 alleles within the haplotype. Although mutation carriers harbour genotypes that are frequent in the French Canadian population, neither mutation-associated haplotype was plausible in reconstructed haplotypes of 47 individuals of French Canadian descent. CONCLUSION: These results suggest that mutation carriers share a related ancestry; further supporting the concept that recurrent BRCA1 and BRCA2 mutations in the French Canadian population could be attributed to common founders. This finding provides further support for targeted screening of recurrent mutations in this population before large-scale mutation analyses are performed

Collaborative International Research in Clinical and Longitudinal Experience Study in NMOSD.

Objective: To develop a resource of systematically collected, longitudinal clinical data and biospecimens for assisting in the investigation into neuromyelitis optica spectrum disorder (NMOSD) epidemiology, pathogenesis, and treatment. Methods: To illustrate its research-enabling purpose, epidemiologic patterns and disease phenotypes were assessed among enrolled subjects, including age at disease onset, annualized relapse rate (ARR), and time between the first and second attacks. Results: As of December 2017, the Collaborative International Research in Clinical and Longitudinal Experience Study (CIRCLES) had enrolled more than 1,000 participants, of whom 77.5% of the NMOSD cases and 71.7% of the controls continue in active follow-up. Consanguineous relatives of patients with NMOSD represented 43.6% of the control cohort. Of the 599 active cases with complete data, 84% were female, and 76% were anti-AQP4 seropositive. The majority were white/Caucasian (52.6%), whereas blacks/African Americans accounted for 23.5%, Hispanics/Latinos 12.4%, and Asians accounted for 9.0%. The median age at disease onset was 38.4 years, with a median ARR of 0.5. Seropositive cases were older at disease onset, more likely to be black/African American or Hispanic/Latino, and more likely to be female. Conclusions: Collectively, the CIRCLES experience to date demonstrates this study to be a useful and readily accessible resource to facilitate accelerating solutions for patients with NMOSD

Prenatal Air Pollution Exposure and Newborn Blood Pressure

Background: Air pollution exposure has been associated with increased blood pressure in adults. Objective: We examined associations of antenatal exposure to ambient air pollution with newborn systolic blood pressure (SBP). Methods: We studied 1,131 mother–infant pairs in a Boston, Massachusetts, area pre-birth cohort. We calculated average exposures by trimester and during the 2 to 90 days before birth for temporally resolved fine particulate matter (≤ 2.5 μm; PM2.5), black carbon (BC), nitrogen oxides, nitrogen dioxide, ozone (O3), and carbon monoxide measured at stationary monitoring sites, and for spatiotemporally resolved estimates of PM2.5 and BC at the residence level. We measured SBP at a mean age of 30 ± 18 hr with an automated device. We used mixed-effects models to examine associations between air pollutant exposures and SBP, taking into account measurement circumstances; child’s birth weight; mother’s age, race/ethnicity, socioeconomic position, and third-trimester BP; and time trend. Estimates represent differences in SBP associated with an interquartile range (IQR) increase in each pollutant. Results: Higher mean PM2.5 and BC exposures during the third trimester were associated with higher SBP (e.g., 1.0 mmHg; 95% CI: 0.1, 1.8 for a 0.32-μg/m3 increase in mean 90-day residential BC). In contrast, O3 was negatively associated with SBP (e.g., –2.3 mmHg; 95% CI: –4.4, –0.2 for a 13.5-ppb increase during the 90 days before birth). Conclusions: Exposures to PM2.5 and BC in late pregnancy were positively associated with newborn SBP, whereas O3 was negatively associated with SBP. Longitudinal follow-up will enable us to assess the implications of these findings for health during later childhood and adulthood. Citation: van Rossem L, Rifas-Shiman SL, Melly SJ, Kloog I, Luttmann-Gibson H, Zanobetti A, Coull BA, Schwartz JD, Mittleman MA, Oken E, Gillman MW, Koutrakis P, Gold DR. 2015. Prenatal air pollution exposure and newborn blood pressure. Environ Health Perspect 123:353–359; http://dx.doi.org/10.1289/ehp.130741

Large-Scale Phenotyping of an Accurate Genetic Mouse Model of JNCL Identifies Novel Early Pathology Outside the Central Nervous System

Cln3Δex7/8 mice harbor the most common genetic defect causing juvenile neuronal ceroid lipofuscinosis (JNCL), an autosomal recessive disease involving seizures, visual, motor and cognitive decline, and premature death. Here, to more thoroughly investigate the manifestations of the common JNCL mutation, we performed a broad phenotyping study of Cln3Δex7/8 mice. Homozygous Cln3Δex7/8 mice, congenic on a C57BL/6N background, displayed subtle deficits in sensory and motor tasks at 10–14 weeks of age. Homozygous Cln3Δex7/8 mice also displayed electroretinographic changes reflecting cone function deficits past 5 months of age and a progressive decline of retinal post-receptoral function. Metabolic analysis revealed increases in rectal body temperature and minimum oxygen consumption in 12–13 week old homozygous Cln3Δex7/8mice, which were also seen to a lesser extent in heterozygous Cln3Δex7/8 mice. Heart weight was slightly increased at 20 weeks of age, but no significant differences were observed in cardiac function in young adults. In a comprehensive blood analysis at 15–16 weeks of age, serum ferritin concentrations, mean corpuscular volume of red blood cells (MCV), and reticulocyte counts were reproducibly increased in homozygous Cln3Δex7/8 mice, and male homozygotes had a relative T-cell deficiency, suggesting alterations in hematopoiesis. Finally, consistent with findings in JNCL patients, vacuolated peripheral blood lymphocytes were observed in homozygous Cln3Δex7/8 neonates, and to a greater extent in older animals. Early onset, severe vacuolation in clear cells of the epididymis of male homozygous Cln3Δex7/8 mice was also observed. These data highlight additional organ systems in which to study CLN3 function, and early phenotypes have been established in homozygous Cln3Δex7/8 mice that merit further study for JNCL biomarker development