The Effect of an Intersectionality Elective on the Perceived Self-Efficacy of Medical Students in Addressing Health Inequity

Background: Intersectionality is a theoretical framework that contextualizes an individual’s experience as more than the sum of their cultural identifiers. Aims: The current study investigates the effect of a 10-week intersectionality curriculum supplemented with student-led discussions on medical students’ self-efficacy in addressing bias and health inequity. Methods: First- and second-year medical students volunteered to participate in a ten-week pilot elective entitled “Intersectionality in Medicine.” Participants enrolled in the course were required to complete a ten-minute online pre-elective and post-elective survey. Results: Results showed that after completing the elective, medical students were significantly more confident in identifying their personal biases, assessing the needs of low socioeconomic status populations, increased ability to find relevant resources for different ethnic/cultural groups, and identifying microaggressions that occur in the healthcare setting. Conclusions: This research highlights how using intersectionality as a framework for understanding and addressing health inequity can create greater awareness and self-perceived efficacy in medical students. Collectively, this research has implications for medical school curricula and training students for a diverse patient population

Genes in human obesity loci are causal obesity genes in C. elegans

Obesity and its associated metabolic syndrome are a leading cause of morbidity and mortality in the United States. Given the disease's heavy burden on patients and the healthcare system, there has been increased interest in identifying pharmacological targets for the treatment and prevention of obesity. Towards this end, genome-wide association studies (GWAS) have identified hundreds of human genetic variants associated with obesity. The next challenge is to experimentally define which of these variants are causally linked to obesity, and could therefore become targets for the treatment or prevention of obesity. Here we employ high-throughput in vivo RNAi screening to test for causality 293 C. elegans orthologs of human obesity-candidate genes reported in GWAS. We RNAi screened these 293 genes in C. elegans subject to two different feeding regimens: (1) regular diet, and (2) high-fructose diet, which we developed and present here as an invertebrate model of diet-induced obesity (DIO). We report 14 genes that promote obesity and 3 genes that prevent DIO when silenced in C. elegans. Further, we show that knock-down of the 3 DIO genes not only prevents excessive fat accumulation in primary and ectopic fat depots but also improves the health and extends the lifespan of C. elegans overconsuming fructose. Importantly, the direction of the association between expression variants in these loci and obesity in mice and humans matches the phenotypic outcome of the loss-of-function of the C. elegans ortholog genes, supporting the notion that some of these genes would be causally linked to obesity across phylogeny. Therefore, in addition to defining causality for several genes so far merely correlated with obesity, this study demonstrates the value of model systems compatible with in vivo high-throughput genetic screening to causally link GWAS gene candidates to human diseases. Author summary Human GWAS have identified hundreds of genetic variants associated with human obesity. The genes being regulated by these variants at the protein or expression level represent potential anti-obesity targets. However, for the vast majority of these genes, it is unclear whether they cause obesity or are coincidentally associated with the disease. Here we use a high-throughput genetic screening strategy to test in vivo in Caenorhabditis elegans the potential causal role of human-obesity GWAS hits. Further, we combined the results of the genetic screen with analyses of mouse and human GWAS databases. As a result, we present 17 genes that promote or prevent C. elegans obesity, and the early onset of organismal deterioration and death associated with obesity. Further, the sign of the correlation between the expression levels of the human genes and their associated clinical traits matches, for the most part, the phenotypic effects of knocking down these genes in C. elegans, suggesting conserved causality and pharmacological potential for these genes

Facilitators to cervical cancer screening in a minority, urban, underserved population

Objectives: Cervical cancer has markedly declined due to widespread use of screening, but Hispanic women continue to bear a disproportionate amount of the cervical cancer burden due to under-screening. Previous studies have explored barriers to screening but have failed to identify targetable facilitators in this group. We aimed to assess facilitators to cervical cancer screening among a predominantly urban, Hispanic population who presented to a no-cost, community-based clinic. Methods: Patients completed demographic and health information, a validated social determinants of health (SDOH) screen, and a self-reported facilitators survey on factors which enabled them to present to clinic. Descriptive statistics were conducted to assess patients’ sociodemographic characteristics, SDOH, and perceived facilitators. Results: 124 patients were included. 98 % were Hispanic, 90 % identified Spanish as their preferred language, and 94 % had no insurance. Median age was 41. 31 % of patients reported a history of abnormal screening. On SDOH, over 80 % of patients screened positive in at least one domain, with the most common being food insecurity (53 %) and stress (46 %). The most frequently reported facilitator was encouragement from a family member/friend (30 %). 26 % of patients reported time off from work and 25 % reported availability of child/elder care as facilitators. Conclusions: Identifying facilitators among patients who present for cervical cancer screening is critical to designing care plans to reach all populations. Our survey showed that the single greatest facilitator to patients presenting for cervical cancer screening was encouragement from a family member/friend. These findings suggest that increasing community involvement and awareness may help to improve cervical cancer screening in a minority, urban, underserved population