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Optimizing Medical Education: Integrating Palpation and Radiologic Imaging in Simulation Labs
No full textPurpose:
UNTHSC’s Regional Simulation Lab has created many opportunities for faculty to move beyond traditional, classroom-based approaches to an advanced, simulation-based learning environment. Unfortunately, there is minimal literature regarding the effective integration of distinct skills given that these sophisticated technologies can portray case scenarios that require the successful application of several skill sets.
The investigators will utilize approximately 10 – 15 minutes of the two hours of time scheduled in the year two GI course, to support students in integrating the two primary skill sets introduced 'separately' earlier. This instructional activity will provide students an opportunity to simultaneously see CT and Ultrasound scans representing an abnormal abdominal finding while simultaneously palpating (on a high-fidelity abdominal simulator) the associated abnormal physical examination findings.
Methods:
UNTHSC utilizes a post-course evaluation tool collecting student feedback for continuous quality assurance of its curriculum. This year's post-course evaluation questions contain both a standardized set of questions and an additional set of questions designed to gather student opinions about how the course might be improved. Included in the survey were two sets of questions about the skills developed in this two-hour GI training activity.
The first set of questions is about the adequacy of the time spent in: 1) Ultrasound training in isolation, 2) abdominal palpation training in isolation, 3) the simultaneous training of both Ultrasound and CT images, and palpation training. The second set of questions represents student opinion regarding the percentage of the two hours of instructional activity that should be spent with 4) Ultrasound training in isolation, 5) abdominal palpation training in isolation, and 6) simultaneous training in both Ultrasound and CT images, and palpation.
Results:
Our findings, based upon a survey of 99 students, reveal the value of integrating palpation with radiologic imaging more than performing either skill in isolation. The survey suggests that students would prefer spending about three times longer in the lab integrating these two skill sets compared to the original 15 minutes allocated.
Conclusion:
While traditionally topics in medical education are delivered to students in a piecemeal fashion, with the focus on mastering each skill in isolation before moving on to the next, this survey demonstrates that students value more opportunities to integrate various skills as they are first being introduced. This provides students with a more realistic understanding of how to use the resources they will have in the clinical setting to arrive at a diagnosis. This notion is further supported by the open-ended feedback solicited from the participants. In their comments, there is a strong desire for a more case-based approach to learning, in which students have the autonomy to work to solve a patient problem and dictate their diagnostic process in a more realistic, linear fashion rather than learning by simple demonstration and repetition. While more research is needed, these results demonstrate the value students place in integrating emerging simulation technology with pre-clinical medical education to help prepare students for their role in the clinical environment
Increases in Adolescent Mental Health Disorders and Antidepressant Prescriptions following the COVID-19 pandemic at HSC Clinics in Fort Worth, Texas
No full textPurpose: The COVID-19 pandemic exposed adolescents to unpredictable events including quarantines, school closures, and loss of loved ones, bringing a sense of fear, anxiety, and social isolation. This led to short-term and long-term mental health effects for adolescents. Most literature conducted throughout the pandemic showed an increase in depressive and anxiety symptoms in the adolescent population world-wide. This research aims to determine if these trends are seen in the specific population in Fort Worth, Texas at HSC clinics.
Methods: Patient data from HSC Pediatrics and HSC Pediatric Mobile Clinic from 2019-2022 for ages 12-18 years old was pulled from EMR, NextGen, into Excel (n=18,359). Only the patient’s first visit each year was included (n=6,285). The data set was filtered into 3 categories: Depression, Anxiety, and Depression and Anxiety. The first visit each year for every patient who completed the PHQ-9 was included using the qualitative “Detail” data (n=3,479). A separate data set for the same patients on Antidepressant medications was used. Using Excel’s tools, totals and percentages were calculated for number of patients seen, ages, gender, race, ethnicity, PHQ-9, and medications.
Results: Overall, the percentage of patient’s seen for all 3 categories increased from 2019 to 2022 despite less patients being seen since 2019. The greatest increase was seen in Depression from 2020 (10.71%) to 2021 (17.71%) from 2019 (4.93%). Patients with anxiety increased each year from 2019 (3.10%) to 2022 (11.98%). Over less than a half of patients completed the PHQ-9 from 2019 (990) to 2020 (455), however the percentage of patients who scored “Moderately Severe Depression” and “Severe Depression” increased from 2019-2020. The greatest increase was seen in “Mild Depression” from 2020 (24.84%) to 2021 (30.68%). Those who scored “None” decreased each year with 10.46% decrease from 2019 to 2022. Only “Moderately Severe Depression” increased each year. The number of patients prescribed antidepressant medications increased each year from 2019 to 2022 with the largest increase seen in those prescribed Escitalopram/Lexapro.
Conclusion: The increase in Depression and Anxiety and antidepressant prescriptions in the adolescent population poses new challenges for providers, clinics, in-patient psych facilities, and families. To increase access to care and prevent no-show visits, telehealth visits can be implemented. Given the rise in mental health disorders in the adolescent population, training in Pediatric mental health and resources like Child Psychiatry Access Network (CPAN) should be more readily available. For each category, fewer patients were seen in 2020, possibly due to social distancing, fear of contracting COVID-19, and/or decreased clinic availability. Another limitation could be a lack of reporting due to parent vs. child reporting, lack of awareness, family values, and/or societal pressures. To prevent missed diagnoses or symptoms, more proactive screening is necessary. Additionally, approximately 1,000 fewer patients were seen in 2022 than 2019. Continued research into the long-term mental health effects from the pandemic is necessary to determine how to treat this generation now and in the future, as well as what certain subpopulations are more susceptible to not seek care or follow-up
Evaluation of a bi-modal therapy in a model of cerebral ischemia
No full textPurpose: Ischemic strokes are a significant contributor to cardiovascular-related deaths in the U.S. Currently, pharmacological interventions are limited to alteplase, an FDA-approved thrombolytic agent, or a surgical procedure known as a thrombectomy. However, their effectiveness is limited by a narrow therapeutic window and incomplete reperfusion rates. Our research explores an alternative strategy centered around PNU-120596 (PNU), a positive allosteric modulator of the alpha7 nicotinic acetylcholine receptor (a7 nAChR), which has shown promise in previous studies in a male rat stroke model. The a7 nAChR is expressed in various central nervous system cells, and studies suggest that PNU directly promotes neuroprotection in these cells. Furthermore, research indicates increased expression of the a7 nAChR in immune cells, specifically in activated inflammatory CD4 T-cells, a cell crucial in stroke studies. We hypothesize that PNU is a bi-modal therapeutic agent, addressing neuronal loss and inflammatory responses, presenting a unique advantage.
Methods: This study aims to provide insight into PNU's efficacy and regulatory role in stroke-induced inflammatory CD4 T-cells. The study will assess PNU treatment's efficacy in promoting stroke recovery in transient middle cerebral artery (tMCAO) mice, a murine stroke model, and investigate how PNU modulates stroke-induced inflammatory CD4 T-cells, examining their suppression, neuronal survival, and alleviation of the disease using mixed cortical cultures. Mice that had undergone the tMCAO procedure were administered 20mg/kg of PNU immediately after reperfusion, and brain tissue was collected 24 and 72 hours post-tMCAO for infarct analysis. Spleen and cervical lymph nodes were collected at the same time points for flow cytometry analysis.
Results: PNU reduces stroke infarct when administered immediately after tMCAO, and brain tissue is collected 24 hours post-tMCAO. However, protection is lost when the same dose is administered, and brain tissue is collected 72 hours post-tMCAO. No significant changes in levels of CD4 T-cell percentages were seen in the spleen or cervical lymph nodes at both time points.
Conclusion: This study suggests that PNU reduces infarct volume immediately 24 hours post-tMCAO, but the protection is lost at 72 hours post-tMCAO. However, subsequent studies are necessary to assess the efficacy of PNU at longer time points with different dosages.Texas Center for Health Disparitie
Contact angle, a potential screening tool for anticancer drug delivery systems and breast cancer tumor tissues.
No full textResearch Appreciation Day Award Winner - School of Biomedical Sciences, 2024 Department of Pharmaceutical & Pharmacotherapy Award - 1st PlacePurpose: Breast cancer is one the most commonly diagnosed cancers in the United States and the second leading cause of cancer death among women. Despite progress in treatments and early detection reducing mortality, there is a continuous increase in annual cases, particularly among certain patient populations, causing persistent health disparities. The tumor extracellular matrix (ECM), which provides mechanical support, modulates the microenvironment, and supplies signaling molecules for cancer growth, has been linked to breast cancer health disparities. In this study, we propose an innovative approach to characterize and quantify the physiochemical properties of breast cancer ECM. Additionally, we hypothesize that drug delivery nano-therapies' interactions with tumor ECM can be quantified using this method. We aim to understand how drug delivery systems, such as liposomal doxorubicin (Doxil®), interact with ECM and affect breast cancer therapy outcomes.
Methods: Liposomes with different Doxil-like compositions (varying PEG content, molecular weight, and end-cap group) were prepared using the thin-film layer hydration method followed by sonication for particle size reduction. De-identified breast cancer fixed tissue sections (with demographic data) purchased from US Biomax Inc. were deparaffinized in xylene, ethanol, and water in consecutive washing cycles. Tissues were decellularized by up to three freeze-thaw cycles in water. Water contact angles were measured on decellularized tissue sections using a customized optical goniometer. Tissue sections were treated with liposomes by incubating them for 2 min in liposomal suspensions and rinsed with DI water 3 times.
Results: Liposomes reduce the water contact angle on glass slides and tissue sections in a concentration-dependent and composition-dependent manner. Doxil-like liposomes decrease the water contact angle for concentrations higher than 0.5 mg/ml. This reduction increases proportionally as the concentration rises, reaching a plateau for concentrations higher than 1.5 mg/ml. Peg-free liposomes exhibit the lowest activity in contact angle reduction, suggesting PEG's central role in the surfactant-like activity of liposomes. Changes in PEG end-cap and molecular weight, influence both liposome surface activity and tissue retention. The contact angle varies among different tissues, with a notable tendency for fibrotic tissues, such as metastatic tumor tissue, to have a higher contact angle and therefore higher hydrophobicity. PEGylated liposomes are more retained by metastatic tissues and highly hydrophobic tissues, indicating that PEG enhances liposome adsorption in more hydrophobic environments.
Conclusion: The contact angle method for tumor ECM characterization developed in our laboratory enables the quantification of tumor ECM features through a liquid-solid dynamic interaction approach. Our data highlight and quantify the importance of PEG as a surface molecule on contact angle-measured interactions between anti-cancer liposomes and breast cancer tumors, consistent with clinical testing of Doxil® where the inclusion of PEG was crucial for therapeutic efficacy. In addition to liposome composition, tumor type (grade or metastatic) can be quantified with this method, permitting an increased understanding of the role tissue surface properties play in the efficacy of anti-cancer nano-therapies. The described method can serve as a preclinical tool to screen drug delivery systems and predict their efficacy by quantifying their target tissue interactions
Pre-weaning craniofacial development in mice with Osteogenesis Imperfecta
No full textThe craniofacial region plays a pivotal role in various physiological functions, including mastication, speech, and respiration. Early life behaviors have a profound role in shaping adult structure and function. In the early stages of life, all mammals undergo the transition from suckling to mastication, a period coinciding with rapid cranial biomineralization. Osteogenesis imperfecta (OI), a genetic disorder that impacts the production of type I collagen, disrupts biomineralization, leading to craniofacial growth differences affecting overall quality of life. This study investigates the preweaning craniofacial growth trajectory in mice OI (the OIM mouse) compared to unaffected wild type (WT mice). We hypothesize that mice with OI will exhibit smaller overall size and greater craniofacial variation than WT mice due to the abnormal collagen synthesis during skull development.
Micro-CT based geometric morphometric analyses of the OIM mouse model (B6C3Fe a/a-Col1a2oim/J) were used to compare craniofacial size and shape differences at birth (P0; n=27 OIM / 20 WT) and postnatal days 7 (P7; n=21/21) and 14 (P14; n=16/20). The SlicerMorph package for 3D Slicer software was used to generate landmark point clouds for the cranium and mandible. Dimension ratios were calculated as width/length for the crania. Principal component analysis with Procrustes ANOVA were used to examine differences between genotypes at each time point, and a canonical variate analysis (CVA) used to identify shape features that maximize the distinction between genotypes across all time points.
Results reveal the development of significant differences in both shape and size between the genotypes following birth. At birth, size and shape are similar between genotypes. However, by P7 and P14, OIM mice are significantly (p<0.05) smaller and display pronounced shape changes (p<0.001) characterized by larger neurocranium and shorter viscerocranium. Additionally, OIM mice have significant mandibular alterations by P7 (p<0.001) - shorter ramus, more posterior position of the coronoid, and shorter and wider dental arcade. All of these changes align with the suckling developmental stage, suggesting changes in the ratio of growth between the neurocranium and the viscerocranium during early life.
Widening the neurocranium while shortening the viscerocranium during this critical developmental stage alters the masticatory muscle line of action, consequently, influences the health of individuals with OI. These findings underscore the suckling stage’s significance in shaping the foundational structures for later life, providing insights into OI craniofacial development, and suggest potential benefits to directing interventions toward an earlier time point for more effective treatment of OI.National Science Foundation BA-DDRIG (BCS-2236027), UNTHSC Preclinical Imaging Core Pilot Grant, UNTHSC Department of Physiology & Anatomy SEED Gran
Evidence-based guidelines for the interpretation of the 9-item Concise Health Risk Tracking - Self-Report (CHRT-SR(9)) measure of suicidal risk
Get PDFBACKGROUND: The 9-item Concise Health Risk Tracking - Self-Report (CHRT-SR(9)) is a widely used patient-reported outcome measure of suicidal risk. The goal of this article is to provide an evidence-based interpretation of the CHRT-SR(9) total score in terms of four clinically actionable categories of suicidal risk (none, mild, moderate, and severe). METHODS: Data from two large programs involving adolescents and adults were combined in this paper. In these studies, the CHRT-SR(9) was anchored against an independent measure of suicidal risk, the suicide item (Item #9) in the Patient Health Questionnaire (PHQ-9), with categories 0 (none), 1 (mild), 2 (moderate), and 3 (severe). In the combined data (n = 1945), we calculated the cumulative percentage of data across these four categories and the percentile score of the CHRT-SR(9) total score that corresponded to these percentages; from this, we developed ranges of the CHRT-SR(9) total score that corresponded to the four categories of Item #9 of PHQ-9. We also calculated similar ranges for two broad subscales of the CHRT-SR(9) total score; Propensity and Suicidal Thoughts. To assess the robustness of our findings, we repeated the analysis at another timepoint across studies. RESULTS: Findings indicated that the CHRT-SR(9) total score (range: 0-36) can be categorized as none (0-14), mild (15-21), moderate (22-26), and severe (27-36). Similar categories were calculated for the Propensity and Suicidal Thoughts subscales. The findings were the same when repeated at another timepoint. CONCLUSION: This categorization of the CHRT-SR(9) total score can place patients into clinically meaningful and actionable categories of suicidal risk.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This manuscript was funded by the Texas Youth Depression and Suicide Research Network (TX-YDSRN), a research initiative of the Texas Child Mental Health Care Consortium (TCMHCC). The TCMHCC was created by the 86th Texas Legislature and, in part, funds multi-institutional research to improve mental health care for children and adolescents in Texas. The TX-YDSRN is implemented under the leadership of the central UT Southwestern Hub (Madhukar Trivedi, M.D., Principal Investigator; Sarah Wakefield, M.D., Medical Director (Texas Tech University Health Science Center Lubbock), Abu Minhajuddin, PhD, Data/Statistics Lead, Lynnel Goodman, PhD, Scientific Lead, and Holli Slater, PhD, Operations Lead). The development of the VitalSign6 program was funded in part by the Center for Depression Research and Clinical Care (CDRC) at UT Southwestern, The Rees-Jones Foundation, and the Meadows Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations. The University of Texas Southwestern Medical Center holds a copyright on the CHRT. At the time of publishing, the CHRT is available without charge to non-commercial users. Fees may apply to commercial users, IT companies, funded academic users, or healthcare organizations. Requests for information and licensing of the CHRT should be sent to M.H.T. ([email protected])
Molecular modeling and binding function of the RGS12 PDZ domain variant associated with familial bipolar disorder
No full textPurpose –
Bipolar disorder (BD) is a highly heritable neuropsychiatric disease characterized by recurrent episodes of depression and mania. BD is considered one of the most vexing health disorders to medicate appropriately, yet affects ~2% of U.S. adults and is the most costly mental health condition for American health insurers nationwide [1]. In reporting the whole-exome sequencing of 81 individuals from 27 multiply-affected BD families, Forstner et al. [2] discovered a single nucleotide polymorphism co-segregating with BD in the gene encoding “Regulator of G protein Signaling” (RGS) type 12, predicted to cause a missense change (arginine-59 to glutamine) in the sequence of the encoded protein’s PDZ domain. RGS proteins are negative regulators of neurotransmitter signaling via G protein-coupled receptors (GPCRs) [3], specifically serving to accelerate signaling shutoff by increasing the GTP hydrolysis rate of GPCR-associated G-alpha subunits [4]. In prior mouse genetics studies, the Siderovski lab has demonstrated that RGS12 acts to regulate kappa opioid receptor signaling and extracellular dopamine levels in the basal ganglia of the brain, and that RGS12 is able to bind to various protein targets in neurons, such as the kinase MEK2 via its PDZ domain. To address whether the R59Q amino-acid variation in the RGS12 PDZ domain associated with BD affects the function of the RGS12 protein, molecular modeling and biochemical binding experiments were performed.
Methods –
Schrodinger’s software suite of molecular modeling and dynamics tools was employed to create structural models of the R59Q variant of RGS12’s PDZ domain, starting from the published NMR-derived structure of the domain with wildtype sequence (i.e., Protein Data Bank record id 2KV8). Desmond molecular dynamics software was used to relax both structural models and then assess their overall stability over 50 nanoseconds of elapsed simulation. Models of the wildtype and R59Q variant PDZ domain bound to short polypeptides from the C-termini of candidate RGS12-interacting proteins were similarly created and molecular dynamics simulations performed. Both PDZ domains were expressed as glutathione-S-transferase (GST) fusion proteins by E. coli cultures, purified by fast protein liquid chromatography (FPLC), and then tested for their binding to biotinylated polypeptides from the C-termini of candidate RGS12-interacting proteins using surface plasmon resonance (SPR).
Results and Conclusion –
The position of the missense change within RGS12 was not predicted to directly engage the polypeptide binding-site of the PDZ domain; however, when tested using SPR, the fusion protein bearing the R59Q-substituted PDZ domain exhibited less binding affinity for target polypeptide partners than the wildtype sequence. These initial in silico and in vitro findings suggest that the R59Q variant associated with BD may lead to reduced RGS12 protein function in vivo.
References:
[1] PMID: 35816713; DOI: 10.7326/AITC202207190
[2] PMID: 32066727; PMCID: PMC7026119; DOI: 10.1038/s41398-020-0732-y
[3] PMID: 21737532; PMCID: PMC3141876; DOI: 10.1124/pr.110.003038
[4] PMID: 20351284; PMCID: PMC2872438; DOI: 10.1073/pnas.0912934107External Funding Source: National Institute on Drug Abuse R01 DA048153 (to D.P.S.
Annexin A2 mediated TNBC metastasis via small extracellular vesicles: A multi-faceted omics-based characterization
No full textPurpose – Triple-negative breast cancer (TNBC), the most aggressive subtype of breast cancer poses a high risk of metastasis due to a lack of targeted therapy and reliance on conventional treatment approaches. Among the organs susceptible to metastasis, the lungs are most frequently affected sites, accounting for approximately 60% of cases. Extracellular vesicles (EV) play a crucial role in establishing a pre-metastatic niche (PMN) for tumor cell homing to secondary sites. Identifying the tumor-derived EV-specific cargo that may potentially alter the lung microenvironment could establish an understanding of the molecular targets contributing to lung PMN development and consequently improving the poor TNBC prognosis and diagnosis. TNBC exhibits elevated expression of Annexin A2 (AnxA2), a plasma and endosome membrane-associated protein. The abundant expression of AnxA2 in tumor tissues and EVs derived from TNBC patients is correlated with poor overall survival and poor distant metastasis-free survival. In previous studies, depletion of AnxA2 protein levels in TNBC-derived EVs resulted in an altered PMN establishment, leading to significantly lower metastatic lesions in the lungs and brain in in vivo system. We aim to evaluate the molecular effects mediated by AnxA2 in TNBC-derived EVs and their cargo that aid the PMN formation and identify underlying molecular targets creating a favorable microenvironment by interaction with lung stroma. Methods and Results – To assess the role of AnxA2 in TNBC lung metastasis, we utilized a lung selective metastatic TNBC cell line, MDA MB 4175 (LM2). We used the shRNA-mediated stable knockdown technique to downregulate AnxA2 protein levels in LM2 cells. We then performed expressional analysis as well as its cell surface functionality using a plasmin generation assay. Additionally, we conducted tumor cell functional assays such as proliferation and invasion assays. Decreased AnxA2 protein levels in LM2 cells significantly reduced its plasmin generation, proliferative ability, and invasive potential. Subsequently, we isolated cell derived small EVs using differential ultracentrifugation and characterized them following the MISEV 2018 guidelines. We confirmed the purity, yield, size, presence of EV-enriched proteins (ESCRT, Hsp, CD9, CD81), and absence of negative proteins (Calnexin, GM130). We then subjected the EVs to quantitative proteomic analysis and identified the differentially expressed proteins upon AnxA2 depletion. We further exposed the healthy lung stromal fibroblasts and the local less-aggressive TNBC cells with EVs to assess the differences in local and distant site uptake and cargo transfer mediated by AnxA2. Conclusion – This comprehensive approach will determine the novel EV-associated proteins that act as functional regulators in promoting TNBC metastasis to the lungs. [This work is supported by the NCI R01CA220273 awarded to Dr. Jamboor K. Vishwanatha]NCI R01CA220273 awarded to Dr. Jamboor K. Vishwanath
Changes in Cerebral Mitochondrial Function in Postpartum Dams Exposed to a Low-resource Environment during Weaning
No full textBackground: Postpartum depression is a serious mental-health condition, affecting over 14% of all mothers in the U.S. Poverty, a lack of educational and economic resources, is a major determinant of adult mental health. In the U.S., poverty impacts 11% of adults, with a greater incidence in women of childbearing age (roughly 16%) and postpartum women (roughly 14%). While pregnancy and poverty separately increase risks of developing depression, few studies have combined these conditions to determine their role in the development of depression. Further, no studies have explored mechanisms contributing to depression following pregnancy and poverty. However, cerebral mitochondrial dysfunction (C-mtDys) may be one mechanism. The aim of this study is to examine C-mtDys in postpartum (PP) dams exposed to the limited-bedding-nesting (LBN) model in rats, which reduces their nesting material to simulate a low-resource environment. We hypothesize that PP dams in the LBN model will exhibit C-mtDys and elevated oxidative stress. Methods. Pregnant Sprague-Dawley rats gave birth naturally and were divided randomly into LBN (n =2) or control (n = 2) groups. LBN dams were exposed to the LBN model from PD 2 through PD 9. To validate the success of the LBN model, entropy scores, which are a measure of behavior unpredictability, were recorded for each dam. At 17 weeks PP, equivalent to 8 years PP in humans, brains were collected and used to isolate mitochondria through differential centrifugation. Mitochondrial function was evaluated via respiration (mtRes) using respiratory states. Oxidative stress in the whole brain was examined through H2O2 and total antioxidant capacity biochemical assays. Results. LBN PP dams displayed higher entropy scores (1.10 ± 0.04 v. 0.79 ± 0.04, p < 0.05), as expected based on prior literature, serving as validation of the model. At 17 weeks, PP LBN dams had reduced mtRes in all states, including the basal state (176.09 ± 5.90 v. 360.70 ± 7.73 pmol/s/mg, ns), State 2 (1044.72 ± 14.00 v. 1703.00 ± 18.10 pmol/s/mg, ns), State 3 (3843.27 ± 31.86 v. 6705.72 ± 37.54 pmol/s/mg, ns) and State 4 (776.83 ± 13.65 v. 1533.54 ± 16.46 pmol/s/mg, ns). PP LBN dams exhibited reduced total antioxidant capacity by roughly 20% (54.10 ± 1.24 v. 63.04 ± 0.99 mM Trolox) and elevated H2O2 by roughly 50% (2.12 ± 0.52 v. 1.35 ± 0.28 nM/mg, ns). Summary. In summary, preliminary data shows C-mtDys via reduced mtRes in PP dams exposed to an impoverished environment during weaning. Furthermore, this study suggests that decreased mtRes could contribute to increased oxidative stress in the brain. Elevated oxidative stress may cause damage at the cellular and circuitry levels in the brain that could facilitate the development of depression later in life. Future studies will further examine C-mtDys, oxidative stress, and depressive behaviors in PP dams exposed to LBN. This study is significant because it identifies C-mtDys as a possible mechanism causing depression after exposure to both pregnancy and poverty.American Heart Association Early Career Development Award [AHA 18CDA34110264 (Cunningham)]
One Key Question at JPS Health Network: Pregnancy Intention as a Predictor of Pregnancy and Birth Outcomes
No full textResearch Appreciation Day Award Winner - Texas College of Osteopathic Medicine, 2024 Honors Student Research AwardPurpose: One Key Question® (OKQ) is a patient-centered screening tool used in routine visits by asking, “Would you like to become pregnant within the next year?” with the goal of preventing unintended pregnancy. We aim to examine the effectiveness of the OKQ at a safety-net hospital by resulting pregnancy rates in the following year. Methods: We examined 5,318 OKQ responses from 8/1/2017 through 1/31/2021 and analyzed resulting pregnancies through 1/31/2022. We compared age category, race and ethnicity, and payor class on likelihood to answer “No” to OKQ, be on birth control, and become pregnant within a year (if answered no to OKQ), stratified by visit type (postpartum vs. well-woman). Chi squared tests assessed associations between these variables. Results: Almost all of the women responded “No” to the OKQ (96%), with 5.6% of those women becoming pregnant within the year. Most women responding were Hispanic (56%), ages 25-34 (51%) and at a postpartum visit (87%). Women at postpartum visits responding “No” to OKQ were less likely to be on birth control compared to women at well-woman visits (39% vs. 79%). Overall, being on birth control differed by race and ethnicity (p= <.0001) and age category (p= <.0001), but not by payor class. Conclusions: OKQ offers insight into continuing patient-centered education regarding pregnancy intention and birth control status to prevent unintended pregnancies and potential adverse pregnancy and birth outcomes