Jacobs Institute of Women's Health
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Caregiver Perspectives on Discussing Immigration Legal Status in a Medical Setting
No full textMedical-legal partnerships (MLPs) address legal issues, including challenges around immigration status, that contribute to health outcomes. This study evaluated our MLP-a collaboration between our pediatric primary care center and nonprofit legal organization. We assessed patient/family comfort and acceptability of conversations regarding immigration legal needs as well as attitudes toward incorporating legal services in a health care setting. Fifty-one participants were surveyed during medical visits and more than 80% reported immigration status concerns, despite nearly half never having sought legal assistance. Most participants (74.5%) found conversations around legal topics very appropriate (on a 5-point Likert scale) and 75.8% were completely comfortable having these discussions in the medical context. The majority (94.1%) identified primary care sites as an appropriate location for these discussions. These results indicate that asking about immigration legal needs within a health care setting is acceptable among immigrant families and primary care centers can be effective sites to co-locate services
Together we are stronger : YPAR and Latinx immigrant youth resilience and resistance to oppressive immigration policies
No full textLatinx adolescents, representing 25% of the U.S. child population, face significant mental health challenges due to aggressive immigration enforcement and policies rooted in racism, nativism, and ethnocentrism. These systemic issues contribute to increased rates of sadness, hopelessness, and suicidal behaviors among Latinx adolescents. Addressing this crisis requires interventions that mitigate the harms of these policies and promote youth voice and agency to foster resilience and resistance and, ultimately, liberation from oppression. This study explores how Youth Participatory Action Research (YPAR) can empower Latinx immigrant youth to build resilience and resist oppressive systems threatening their well-being. Using a grounded theory qualitative approach, we examined the PARA Jóvenes YPAR project, which engaged 10 Latinx immigrant youth from a community with a history of aggressive immigration enforcement. Through triangulating in-depth interviews, facilitator reflections, and photovoice transcripts, we identified key YPAR components-near-peer mentorship, community building, cultural affirmation, creative expression, and critical inquiry-that promoted and supported youth in developing critical consciousness, cultural authenticity, self-knowledge, and connectedness. This study highlights the transformative potential of YPAR to promote mental health and liberation for Latinx immigrant youth impacted by immigration policies. It underscores the need for further research on its efficacy as an intervention
Standardization of Myasthenia Gravis Outcome Measures in Clinical Practice. A Report of the MGFA Task Force
No full textINTRODUCTION/AIMS: Myasthenia gravis (MG) specific outcome measures are being used in clinical trials to evaluate therapeutic effectiveness. These validated tools are also becoming a necessity in clinical practice, with payors in the US market often requiring them to be used to monitor disease state. There is considerable variation and subjectivity regarding their use. This study aimed to develop consensus-based recommendations for the standardization of MG specific outcome measures in clinical practice. METHODS: A panel of 10 US-based MG specialists developed consensus-based recommendations based on three rounds of formal voting using the UCLA-RAND appropriateness method after surveying myasthenia gravis clinicians and developing a focus group. RESULTS: Twenty one expert consensus statements based on six themes were developed following clinician survey result review and focus group theme development. Some key recommendations include: the MGFA Clinical Classification assesses disease at that examination and should be updated at intervals of 3-6 months to reflect current clinical status. MGFA PIS represents the overall clinical judgment of the evaluator without the requirement for a defined change in scores on any outcome measure. Patient-reported items, such as MG-ADL and MGC, should be referenced to the previous 1 week to optimize recall. Additional recommendations include scoring outcome measures in the presence of co-morbidity, scoring specific physical exam findings, and clarification regarding the administration of outcome measures. DISCUSSION: This method provided expert consensus-based recommendations for the use of MG-specific outcome measures and exam findings to help standardize how they are used in clinical practice
Cell crowding activates pro-invasive mechanotransduction pathway in high-grade DCIS via TRPV4 inhibition and cell volume reduction
No full textCell crowding is a common microenvironmental factor influencing various disease processes, but its role in promoting cell invasiveness remains unclear. This study investigates the biomechanical changes induced by cell crowding, focusing on pro-invasive cell volume reduction in ductal carcinoma in situ (DCIS). Crowding specifically enhanced invasiveness in high-grade DCIS cells through significant volume reduction compared to hyperplasia-mimicking or normal cells. Mass spectrometry revealed that crowding selectively relocated ion channels, including TRPV4, to the plasma membrane in high-grade DCIS cells. TRPV4 inhibition triggered by crowding decreased intracellular calcium levels, reduced cell volume, and increased invasion and motility. During this process, TRPV4 membrane relocation primed the channel for later activation, compensating for calcium loss. Analyses of patient-derived breast cancer tissues confirmed that plasma membrane-associated TRPV4 is specific to high-grade DCIS and indicates the presence of a pro-invasive cell volume reduction mechanotransduction pathway. Hyperosmotic conditions and pharmacologic TRPV4 inhibition mimicked crowding-induced effects, while TRPV4 activation reversed them. Silencing TRPV4 diminished mechanotransduction in high-grade DCIS cells, reducing calcium depletion, volume reduction, and motility. This study uncovers a novel pro-invasive mechanotransduction pathway driven by cell crowding and identifies TRPV4 as a potential biomarker for predicting invasion risk in DCIS patients
ASRA pain medicine narrative review and expert practice recommendations for gastric point-of-care ultrasound to assess aspiration risk in medically complex patients undergoing regional anesthesia and pain procedures
No full textGastric point-of-care ultrasound (POCUS) may offer clinical value in assessing aspiration risk among medically complex patients undergoing regional anesthesia and pain procedures. While the American Society of Anesthesiologists (ASA) preoperative fasting guidelines primarily apply to healthy individuals, medically complex populations often present with differing gastric emptying and aspiration risk. This narrative review, conducted by the American Society of Regional Anesthesia and Pain Medicine (ASRA-PM), adhered to PRISMA guidelines and was registered with PROSPERO. It focused on seven medically complex patient groups: those who are pregnant, obese, diabetic, have gastroesophageal reflux disease (GERD), are receiving emergency care, are enterally fed, or are taking GLP-1 receptor agonists (GLP-1RA). Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Practice recommendations were developed using an iterative expert consensus process, with final recommendations based on evidence strength, clinical relevance, and expert agreement. Findings support the use of gastric POCUS in patients in active labor, those undergoing urgent cesarean sections, and those with diabetes. Conditional support is given for obesity, emergency care, enteral feeding, and GLP-1RA use. Routine use is not recommended in non-laboring pregnancies, elective cesarean delivery, or GERD. While gastric POCUS may aid with aspiration risk evaluation, its use should complement clinical judgment. Implementation may be limited by practical and training constraints, requiring individualized decision-making. These recommendations serve as a foundation for future research and potential clinical guideline development. PROSPERO registration number: CRD42023445927
Socio-cultural context of road safety in youth: a scoping review
No full textRoad traffic injuries (RTIs) are a leading cause of death globally, disproportionately affecting youth in low- and middle-income countries (LMICs). While behavioral factors significantly contribute to RTIs, the role of socio-cultural norms remains understudied. This scoping review examines 75 studies (2000-2020) to explore how social norms (descriptive, injunctive, subjective, and collective) and cultural factors influence road safety behaviors among young people. Findings reveal that norms shape behaviors such as risky driving, helmet/seatbelt use, and compliance with traffic laws, often moderated by cultural contexts like gender, media, and religion. Peer and familial influences emerged as both risk and protective factors, while collective norms in certain communities reinforced harmful practices like drunk driving. Gaps persist in understanding the interplay between culture and norms, particularly in LMICs. The review highlights the need for culturally tailored interventions and further research to address socio-cultural determinants of road safety
Assessing the quality of childbirth care in Mexico: findings from the maternal eCohort
No full textBACKGROUND: In 2022, the Mexican Institute of Social Security (IMSS) launched the Comprehensive Women-Centered Maternal Health Care Model (AMIIMSS program) to improve maternal healthcare. This research evaluated the childbirth care quality, comparing outcomes between IMSS and private hospitals and between IMSS hospitals with high and low adherence to the AMIIMSS program, and assessed whether the type of healthcare provider and delivery, the content of care, and the occurrence of obstetric violence were associated with the perceived quality of childbirth care, after controlling for other relevant demographic and clinical covariates. METHODS: Data were collected from an observational IMSS-affiliated eCohort of pregnant women aged 18 to 49, focusing on their experiences, perceptions of healthcare quality, obstetric violence, and health outcomes. The analysis included Chi-square tests and multivariable linear regression. RESULTS: The study included 988 women; 14.9% went to private facilities for childbirth primarily because they perceived poor quality and past mistreatment at IMSS. C-sections rates were higher in private hospitals (92.5%) than at IMSS (51.3%). IMSS hospitals with high adherence to AMIIMSS program had a 10% lower C-section rate, and their care content was similar to that in private hospitals (85% of expected clinical actions). Complications affected 20.8% of women and 28% of newborns. The overall quality of care perceptions score was higher in private hospitals (mean 34.2, standard deviation 6.7) than at IMSS (mean 27.0, SD 6.7) on an 8-40-point scale. Delivering in private hospitals or at tertiary care facilities and receiving a higher care content was associated with better quality perceived by women. Whereas obstetric violence was associated with lower perceived quality. CONCLUSION: AMIIMSS improves women\u27s childbirth experiences but reveals weaknesses due to poor hospital adherence to the program and poor perceived quality. This underscores the need to strengthen the program\u27s pillars-training, infrastructure, regulatory adaptation, and women\u27s empowerment
Increased atherosclerosis in HIV-infected humanized mice is caused by a single viral protein, Nef
No full textAntiretroviral therapy (ART) suppresses HIV replication, reverses immunodeficiency, and reduces AIDS-related symptoms, but non-AIDS co-morbidities like cardiovascular diseases remain a major challenge for people living with HIV (PLWH). The pathogenic mechanisms driving these co-morbidities are poorly understood. We previously showed that the HIV protein Nef contributes to chronic inflammation in PLWH. Here, we explored Nef\u27s role in HIV-associated atherosclerosis using a novel model: HIV-infected humanized mice expressing a gain-of-function mutant of proprotein convertase subtilisin/kexin type 9 (PCSK9) and fed a high-fat diet. Comparing atherosclerosis in uninfected mice to those infected with Nef-positive or Nef-deficient HIV-1, we found that Nef exacerbates atherosclerotic changes by increasing inflammation. These results identify Nef as a key driver of HIV-related atherosclerosis and provide a platform for testing therapeutic interventions targeting Nef to mitigate cardiovascular risks in PLWH
Lessons Learned From Engaging Healthcare Providers in Research on Implementation of HIV Preexposure Prophylaxis
No full textBACKGROUND: Health care providers are critical for successful implementation of HIV preexposure prophylaxis (PrEP), but barriers to PrEP provision persist. Researchers must engage with providers to understand how to optimize PrEP delivery across settings. Yet researcher-provider collaborations can be challenging. To offer guidance on engaging providers in PrEP implementation research, we synthesized the experiences of researchers working with different types of providers on studies related to PrEP implementation that were funded as part of the US Ending the HIV Epidemic (EHE) initiative. SETTING: Geographic areas designated as high priority by the EHE initiative. METHODS: We defined providers broadly, including physicians, pharmacists, health educators, and peer navigators. Using thematic analysis from collaborative case reports by EHE study teams, we synthesized strategies, challenges, and successes related to provider engagement, with categorization into three stages of research: study development, recruitment, and data collection. RESULTS: Among 17 research teams invited, 9 contributed. Findings suggested that extensive resources (eg, time, professional networks, financial, and nonfinancial incentives) are required to engage clinical and nonclinical providers across all stages of PrEP implementation research, with the most intensive strategies required for recruiting clinical providers who are not yet providing PrEP. However, when effective strategies are deployed, this investment of resources can yield rich insights into PrEP implementation. CONCLUSIONS: The lessons learned by the investigators in our study can be applied to future EHE-funded projects, other HIV-prevention studies, and studies in other areas of health research to improve engagement of providers during all stages of the research process
Exploring empathy and patient-centered communication behaviors of third-year medical students during a clinical skills examination
No full textUNLABELLED: A previous study of third-year medical students\u27 empathy during a clinical skills assessment found that SPs rated female students higher than males, and male Black/African-Americans received the lowest empathy scores. Our objective was to analyze students\u27 patient-centered communication behaviors (PCCBs) to better understand those reported gender and racial/ethnic differences in empathy scores. METHODS: We examined 63 videos from the parent study, using discourse and content analysis to identify PCCBs during standardized patient (SP) encounters. Then, we determined which PCCBs significantly correlated with SP empathy ratings. Finally, we examined whether those significant PCCBs differed across third-year medical students\u27 gender and race/ethnicity. RESULTS: We identified 18 PCCBs, six of which significantly correlated with SP empathy ratings. Generally, women tended to use patient-centered communication than men, while Black/African American men used less than Asian/Pacific Islander or white men. CONCLUSION: In this exploratory, multiple methods study, we analyzed student discourse to better understand the reported gender and racial/ethnic differences in SP empathy scores. We found suggestions of gender and racial differences in behaviors related to patient-centered communication that need to be confirmed in larger, better-powered studies. PRACTICE IMPLICATIONS: If our findings are corroborated, understanding gender and race/ethnicity differences in PCCBs may help medical educators teach students patient-centered communication (PCC) in a more diverse, culturally situated way. Beneficial actions would include developing faculty to teach PCC with a multi-cultural emphasis and recruiting more minority faculty in our medical schools to model effective communication and empathy skills. In addition, the PCCBs we identified through discourse analysis in this study can provide educators with a tool for teaching doctor-patient communication. Educators can review students\u27 video encounters to provide specific and actionable feedback to promote PCC and empathy