Faculty Bibliography

OBJECTIVES/OBJECTIVE:To study the impact of an educational intervention on obstetrician-gynecologist clinicians' knowledge of racial and ethnic disparities in the menopause experience. METHODS:Twenty-five obstetrician-gynecologist physicians (residents, fellows, and attendings) at an academic medical center in New York, NY, completed the Achieving Menopausal Health Equity Network course, a brief web-based intervention consisting of four modules delivered through narrated didactic videos and interactive tools, a 10-item pretest and posttest, and a course evaluation survey. The primary outcome was a change in knowledge scores after the completion of the educational intervention. Item analysis was also performed to assess item discrimination, item difficulty, and response frequency. Feedback on modules was obtained, and thematic analysis was performed. RESULTS:In this study, 25 participants completed the educational intervention. There was a statistically significant increase in mean test scores after participation (pretest mean score=7.1/10 vs. posttest mean score=8.1/10, P =0.0021). The following themes emerged in thematic analysis: knowledge building with potential for practical application for clinicians and non-clinicians, clarity and relevance, and opportunities for growth for future iterations of the modules. CONCLUSIONS:This brief, online educational curriculum focused on racial and ethnic disparities in menopause significantly improved the knowledge of obstetrician-gynecologist clinicians at various levels of training and provides a useful model for introducing more formal training on menopause medicine for obstetrician-gynecologist clinicians.

BACKGROUND:Routine collection and use of sexual orientation and gender identity data can assist in understanding and addressing the health disparities that affect lesbian, gay, bisexual, transgender, queer+ (LGBTQ+), also known as sexual and gender minority, individuals and communities. This study explored the implementation of a culturally relevant sexual and gender minority/sexual orientation and gender identity training program at a National Cancer Institute (NCI)-Designated Comprehensive Cancer Center. METHODS:The training consisted of 6 in-person 15-minute modules or 3 virtual 30-minute modules that occurred during established high-reliability organization huddles attended by oncology faculty and staff. Module topics were (1) Building LGBTQ+ Knowledge & LGBTQ+ Cancer Disparities, (2) Creating an Inclusive Environment, (3) Recovering From Misgendering/Making Assumptions, (4) How to Receive & Respond to Feedback, (5) Witnessing & Responding to Discrimination, and (6) Making and Sustaining a Change. All high-reliability organization attendees were considered eligible for participation and were provided with pretraining and post-training surveys. Survey items included comfort caring for sexual and gender minority patients, practice collecting sexual orientation and gender identity data, knowledge of sexual and gender minority health, and demographics. RESULTS:A total of 344 individuals completed the presurvey and 187 completed the postsurvey. Postsurvey results demonstrated a statistically significant improvement in self-perceived knowledge about sexual and gender minority health (scale: 0-100, with 100 = highest; presurvey vs postsurvey, 69 vs 84; P < .001). Respondents also reported statistically significant improvements in confidence in engaging with sexual orientation and gender identity questions (53 vs 79, P < .001) as well as intention to collect patient sexual orientation and gender identity information (49 vs 75, P < .001). Notably, sexual orientation and gender identity data collection tracking demonstrated a 311% increase in sexual orientation and 262% in gender identity disclosure during the study period. CONCLUSION/CONCLUSIONS:Despite the availability of sexual orientation and gender identity data fields within electronic health records, sexual orientation and gender identity disclosure remains an ongoing nationwide problem. Use of culturally relevant sexual and gender minority/sexual orientation and gender identity training can help improve oncology staff and clinician sexual and gender minority knowledge and confidence when engaging patients with and subsequent documentation of sexual orientation and gender identity data, resulting in improvement of data completion.

OBJECTIVES/OBJECTIVE:We examined trends in the socioeconomic distribution of work schedules from 1990s to 2010s and how early adulthood disadvantages are associated work schedules over working age. METHODS:In a representative sample of U.S. workers(N = 3,328), we calculated recycled predictions of day, evening, night, and long shift prevalence associated with time-period. Logistic regression was used to analyze the association of non-day shifts with age and its variations by early adulthood disadvantage in U.S. baby boomers(N = 10,293). RESULTS:Between 1990s-2010s, evening shifts increased in adults without college education and night shifts increased in the lowest income quartile. Day shifts decreased in both groups. Being Black, not attending college, and poverty were associated with non-day shiftwork throughout working age. CONCLUSIONS:Evening and night shifts may have replaced day shifts in disadvantaged populations between 1990s-2010s. Early disadvantages may have sustained effects on work schedules.

IMPORTANCE/UNASSIGNED:Midlife vascular risk factors are associated with an elevated risk of dementia. However, the total contribution of vascular risk factors in midlife and late life with incident dementia is uncertain. OBJECTIVE/UNASSIGNED:To quantify the proportion of incident dementia attributable to modifiable vascular risk factors measured in midlife and late life and to examine differences by apolipoprotein ε4 genotype, self-reported race, and sex. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This was a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study using 33 years of follow-up (1987-2020). The setting included ARIC field centers (Jackson, Mississippi; Forsyth County, North Carolina; Minneapolis suburbs, Minnesota; Washington County, Maryland). Study baseline in Black and White participants with complete exposure and covariate data was set by age at risk factor measurement (45-54 years, 55-64 years, and 65-74 years). Data were analyzed from August 2023 to December 2024. EXPOSURES/UNASSIGNED:Hypertension (systolic blood pressure [BP] ≥130 mm Hg, diastolic BP ≥80 mm Hg, or use of medication for BP), diabetes (fasting glucose ≥126 mg/dL, nonfasting glucose ≥200 mg/dL, self-reported physician's diagnosis, or use of any diabetes medication), and current smoking (self-reported). MAIN OUTCOMES AND MEASURES/UNASSIGNED:Incident dementia. Population attributable fractions were estimated by age 80 years, and separately after 80 years, from having at least 1 vascular risk factor by age at risk factor measurement. RESULTS/UNASSIGNED:A total of 7731 participants were included in analysis of risk factors measured at age 45 to years (4494 female [58%]; 2207 Black [29%]; 5524 White [71%]), 12 274 contributed to analysis of risk factors measured at age 55 to 64 years (6698 female [55%]; 2886 Black [24%]; 9388 White [76%]), and 6787 contributed to analysis of risk factors measured at age 65 to 74 years (3764 female [56%], 1375 Black [20%]; 5412 White [80%]). There were 801, 995, and 422 dementia cases by 80 years, respectively. The fraction of dementia by 80 years attributable to at least 1 vascular factor at age 45 to 54 years was 21.8% (95% CI, 14.3%-29.3%), at 55 to 64 years was 26.4% (95% CI, 19.1%-33.6%), and at 65 to 74 years was 44.0% (95% CI, 30.9%-57.2%). Attributable fractions for these factors were higher in apolipoprotein ε4 noncarriers at age 55 years and older (range, 33.3%-61.4%), Black individuals at age 45 years and older (range, 25.5%-52.9%), and female individuals at age 55 years and older (range, 29.2%-51.3%). Only 2% to 8% of dementia cases after 80 years were attributable to these factors. CONCLUSIONS AND RELEVANCE/UNASSIGNED:Results of this cohort study suggest that between 22% and 44% of incident dementia cases by 80 years in the ARIC study were attributed to midlife and late-life vascular risk factors. Assuming causal relationships, maintaining optimal vascular health across the life course could mitigate a sizeable proportion of dementia risk by 80 years.

OBJECTIVE:Guatemala has one of the highest rates of maternal mortality in Central America. A total of 60% of births in Guatemala are attended by traditional Mayan birth attendants, or comadronas. Their prevalence in these communities makes them a valuable resource to bridge home births with safe prenatal care. The objective of this study was to evaluate a low-cost prenatal care training program for Guatemalan comadronas with the goal of improving maternal health outcomes in the region. METHODS:In this retrospective longitudinal cohort study, we examined the knowledge retention of comadronas enrolled in a 12-month prenatal care training program known as the School of PowHER (SOP). Recruited from the Lake Atitlán region of Guatemala by Saving Mothers, 501(c)(3) and the Guatemalan Ministry of Health, comadronas participated in a four-month didactic curriculum followed by a nine-month clinical curriculum. Pre- and post-tests were administered to assess learning outcomes over the study's duration (2014-2022), and test results were evaluated to assess the effectiveness of the SOP. RESULTS:A total of 123 women were recruited and enrolled in all eight graduating classes of the SOP from 2014, 2016-2019, and 2021-2022. An average, statistically significant improvement in didactic and clinical pre- and post-test scores was found across all years analyzed. CONCLUSION/CONCLUSIONS:The SOP is a low-cost, culturally appropriate, community-based model that empowers comadronas through knowledge and skill acquisition to improve local maternal health outcomes. This program proves effective at not only teaching comadronas prenatal health information and clinical skills, but also at promoting long-term retention of these skills.

Fetal iron status has long-lasting effects on neurodevelopmental outcomes and risk of psychopathology. Although prenatal exposure to maternal psychological stress has been linked to offspring peripheral iron status at birth, it is unknown whether maternal prenatal stress is related to fetal brain iron during gestation. We utilized 86 multi-echo functional magnetic resonance imaging (fMRI) scans from 52 fetuses (23 females; gestational age [GA] 24-38 weeks) to estimate R2* relaxometry as a proxy for fetal brain iron levels. Our results showed that greater maternal anxiety symptoms were associated with higher estimated fetal iron levels in the left cerebellar vermis after controlling for fetal sex and GA. Our finding suggests that fetal brain iron levels may be sensitive to exposure to maternal stress in utero. In a subset of participants with available infant outcome data (n = 31), no significant associations were found between fetal brain iron levels and later cognitive, language, and motor development during infancy. Overall, this study presents the first evidence of associations between maternal prenatal stress and fetal brain iron, which lays the groundwork for future investigations of biological embedding of prenatal maternal stress on the fetal brain and later neurodevelopment through prenatal iron accumulation as a potential mechanism.