Bridging the Gap: Evaluation of an Electrocardiogram Curriculum for Advanced Practice Clinicians.

Background: Training programs for advanced practice providers (APP) often have significant variability in their curriculum, including electrocardiogram (ECG) education. Despite limitations in formal ECG training, APPs in the emergency department (ED) may be the first practitioner to interpret an ECG. Foundations of Emergency Medicine (FoEM) offers free, open-access curricula that are widely used for resident education. We sought to improve APP ECG interpretation skills by implementing the FoEM ECG I course. Methods: This was a single-site, pre- and post-intervention study of 23 APPs at our high-acuity, urban ED. In the fall of 2020, APP learners enrolled in a FoEM ECG I course led by faculty and senior resident instructors. The course consisted of six virtual, small-group, active-learning ECG workshops. Participants completed a 15-question multiple-choice test before, immediately after, and six months post-intervention to quantify knowledge acquisition. Additionally, a pre- and post-intervention knowledge, attitudes, and practices survey was administered on ECG interpretation skills and to evaluate the course. We evaluated change in ECG knowledge scores using a Wilcoxon signed-rank test. Changes in self-assessed knowledge were evaluated using an ordinal logistic mixed-effects regression. Results: A total of 23 APPs enrolled in the course. Knowledge assessments showed APPs improved from the pre-test (median 9/15, interquartile range [IQR] 7-11) to the post-test (median 12/15, IQR 10-13; P = 0.001). Test scores did not significantly change from the post-test to the delayed post-test (median 12/15, IQR 12-13; P = 0.30). Respondents' subjective rating of their skill did not significantly change (P = 0.06). Respondents reported no change in their likelihood of approaching an attending when uncertain of the correct interpretation of an ECG (P = 0.16). Overall, 91% were satisfied with the course and 96% agreed that the course difficulty was appropriate. Conclusion: The FoEM ECG course provided a standardized curriculum that improved APP knowledge for interpreting ECGs. Despite this, the course did not alter APPs' willingness to approach physicians for guidance with interpretation of abnormal ECGs. These findings may inform expansion of this concept for other programs who desire formalized APP ECG education.

Foundations of Emergency Medicine: Impact of a Standardized, Open-access, Core Content Curriculum on In-Training Exam Scores.

Introduction: Learners frequently benefit from modalities such as small-group, case-based teaching and interactive didactic experiences rather than passive learning methods. These contemporary techniques are features of Foundations of Emergency Medicine (FoEM) curricula, and particularly the Foundations I (F1) course, which targets first-year resident (PGY-1) learners. The American Board of Emergency Medicine administers the in-training exam (ITE) that provides an annual assessment of EM-specific medical knowledge. We sought to assess the effect of F1 implementation on ITE scores. Methods: We retrospectively analyzed data from interns at four EM residency programs accredited by the Accreditation Council for Graduate Medical Education. We collected data in 2021. Participating sites were geographically diverse and included three- and four-year training formats. We collected data from interns two years before (control group) and two years after (intervention group) implementation of F1 at each site. Year of F1 implementation ranged from 2015-2018 at participating sites. We abstracted data using a standard form including program, ITE raw score, year of ITE administration, US Medical Licensing Exam Step 1 score, Step 2 Clinical Knowledge (CK) score, and gender. We performed univariable and multivariable linear regression to explore differences between intervention and control groups. Results: We collected data for 180 PGY-1s. Step 1 and Step 2 CK scores were significant predictors of ITE in univariable analyses (both with P < 0.001). After accounting for Step 1 and Step 2 CK scores, we did not find F1 implementation to be a significant predictor of ITE score, P = 0.83. Conclusion: Implementation of F1 curricula did not show significant changes in performance on the ITE after controlling for important variables.

Long-term effects of the COVID-19 pandemic on children's physical activity and sedentary behavior.

Background: During the early months of the COVID-19 pandemic, decreases in physical activity (PA) and increases in sedentary behavior (SB) were reported among children in the United States (U.S.). This follow-up analysis examines 13-month effects of the COVID-19 pandemic on children's PA and SB one year into the pandemic. Methods: Parents of 5-13-year-old children in the U.S. (N = 71) reported on their child's PA and SB during the early COVID-19 period (April-May 2020) and again 12-14 months later (June-July 2021). Results: Paired t-tests showed significant within-subject reductions in SB minutes per day (M diff = -86.20, t = 3.26, p < 0.01) but no changes in PA minutes per day. Separate mixed-model repeated-measures analysis of covariance procedures found that within-subject changes in PA and SB did not differ by child sex or age. Conclusion: As COVID-19 restrictions lessened, there were more opportunities for children to reduce SB, but there were still barriers to engage in PA.

RaT race: A standardized open-access education resource provides a structured resident-as-teacher experience.

Objectives: There is no unified approach for training residents to be teachers. Foundations of Emergency Medicine (FoEM) is a national program that provides free resident education in emergency medicine (EM) utilizing small-group, case-based instruction delivered by individual program faculty and residents. This study seeks to explore the FoEM resident-as-teacher (RaT) experience. Methods: We conducted a mixed-methods study of FoEM faculty site leaders and resident teachers in 2022. Site leaders completed an online survey consisting of multiple-choice, completion, and free-response items. We calculated descriptive statistics and applied a thematic qualitative analysis to free-response items. We conducted semistructured interviews with resident teachers. Interview transcripts were analyzed using a thematic approach with a constructivist-interpretivist paradigm. Results: A total of 133 of 180 (74%) site leaders completed the survey and 11 resident teachers were interviewed. Forty-nine (37%) programs utilize resident instructors. The frequency of residents teaching and degree of faculty supervision varied. Commonly identified advantages include reinforcement of core content for resident teachers (44/49), structured format (35/49), and reduced need for faculty instructors (30/49). The most commonly identified challenges include variable instruction by residents (33/49) and challenge to providing feedback on teaching (20/49). Resident teachers identified benefits including strengthening residency community, improved EM knowledge, and greater teaching skills. For nearly all resident participants, FoEM RaT impacted their career goals by affirming their interest in teaching. Conclusions: The FoEM curricular model appears to be a valuable and feasible method to incorporate a RaT experience into EM residency training programs.

Motivational Profile as a Predictor of Physical Activity Among US Adults During the Early Months of the COVID-19 Pandemic: A Daily Diary Study.

This study used a daily diary approach to examine associations between day-level physical activity (PA) behavior, PA-specific motivational profile, and days since the COVID-19 national emergency declaration during the early months (April-June 2020) of the pandemic. A total of 468 US adults (Mage = 34.8 y, 79% female) participated in a 28-day smartphone-based daily diary study assessing PA. A baseline survey assessed PA and motivation for PA using the Behavioral Regulation in Exercise Questionnaire. Multilevel linear regression models examined the main effects and interactions of motivational profile and time (days since the US March 13, 2020, COVID-19 national emergency declaration) on daily PA minutes. Latent profile analysis identified 4 distinct motivational profiles for PA among this sample: profile 1: high amotivation (n = 100, 21%); profile 2: low controlled motivation (n = 55, 12%); profile 3: high external regulation (n = 47, 10%); and profile 4: moderate autonomous motivation (n = 266, 57%). After controlling for baseline PA, there were significant interactions between profile and time on daily PA (-0.21, P < .01). Profile 2 showed greater decreases in daily PA minutes over time than profile 1 (b = -0.29, P < .01). Profiles 3 and 4 did not indicate significant decreases in PA compared with profile 1 (b = 0.14, P = .31 and b = -0.16, P = .05, respectively). Contrary to previous research, individuals with lower controlled or moderate autonomous motivation demonstrated the largest decreases in PA over time, whereas individuals with higher amotivation or external regulation demonstrated smaller decreases over time. These findings suggest that external motivation may have provided short-term protection against declines in PA observed during early months of the COVID-19 pandemic.

The combined effect of motivational interviewing and wearable fitness trackers on motivation and physical activity in inactive adults: A randomized controlled trial.

Despite overwhelming adoption of wearable fitness trackers (WFT), it is unclear if they affect physical activity (PA) engagement or PA motivation. We hypothesized that combining a WFT with an effective intervention, motivational interviewing (MI), would positively influence both motivation and PA. A 12-week randomized controlled trial was conducted in 40 adults who did not meet PA recommendations. The four conditions were: a PA education (Educational control, n = 10), a WFT (WFT, n = 10), bi-weekly MI sessions (MI, n = 10), or both interventions (WFT+, n = 10). Motivation and PA were measured through an online survey and actigraphy pre- and post-intervention. Both the WFT+ and MI groups improved autonomous forms and decreased controlled forms of motivation. They also had higher basic psychological needs scores when compared to the Education group post-intervention. We detected no changes in PA. High autonomous motivation at baseline predicted higher post-intervention PA in the WFT+ group but predicted lower post-intervention PA in the WFT group. Results suggests that MI alone or with a WFT can improve basic psychological needs and autonomous forms of motivation for PA, but not PA participation. Individual differences in motivation at baseline may moderate the effect of a WFT on PA. This study was registered at clinicaltrials.gov (NCT490014).

A Systematic Review of the Associations of Adiposity and Cardiorespiratory Fitness With Arterial Structure and Function in Nonclinical Children and Adolescents.

PURPOSE: To summarize the evidence on associations of adiposity and cardiorespiratory fitness (CRF) with arterial structure and function in nonclinical children and adolescents. METHODS: Two researchers conducted a search in 5 electronic databases in April 2022 to find studies in nonclinical youth (age 5-17.9 y) reporting multivariable associations. Studies were eligible if adiposity and/or CRF were used as the predictor and arterial structure and/or function was the outcome. The Quality Assessment Tool for Quantitative Studies was used to assess methodological quality for experimental studies, and a modified version was used for observational studies. RESULTS: Ninety-nine studies (72.7% cross-sectional) were included. Ninety-four assessed associations between adiposity and arterial outcomes, most using overall body proportion (n = 71), abdominal (n = 52), or whole-body adiposity (n = 40). Most evidence was inconsistent or nonsignificant, but 59 studies suggested higher abdominal adiposity and worse body proportion were associated with adverse arterial outcomes. Twenty-one assessed associations between CRF and arterial outcomes, with findings inconsistent. Most evidence was rated weak in quality. CONCLUSION: While high adiposity may contribute to poor arterial outcomes, evidence is limited regarding CRF. Future studies should disentangle these associations by studying youth with healthy adiposity but poor CRF, or vice versa, using longitudinal or experimental study designs.

Bacterial Vaginosis and Prospective Ultrasound Measures of Uterine Fibroid Incidence and Growth.

BACKGROUND: Uterine fibroids often cause intolerable symptoms leading to invasive treatments, most commonly hysterectomy. Reproductive tract infections are hypothesized to influence uterine fibroid development, but few studies exist, especially for the highly prevalent condition bacterial vaginosis (BV). Both fibroids and BV have documented racial-ethnic disparities, with higher burden in Blacks. METHODS: With prospective data from a community-based study (four standardized ultrasound examinations over 5 years) in young Black women, we examined baseline BV associations with fibroid incidence and growth. We computed adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incidence comparing BV and no BV (Nugent score ≥7 vs. <7) using Cox proportional hazards models among 1027 women fibroid-free at baseline. Fibroid growth associations were based on linear mixed models estimating volume change between ultrasounds indexed to 18 months. We then expressed BV association as estimated percent difference in growth per 18 months, comparing exposed and unexposed. RESULTS: There were n = 247 incident fibroids and 1181 growth measures; average fibroid growth per 18 months was a 78% (95% CI: 69 to 87) increase in volume. BV prevalence was 51% and not associated with fibroid incidence (aHR: 1.0, 95% CI: 0.80 to 1.4) or growth (estimated % difference in growth, -3% (95% CI: -12 to 6). CONCLUSIONS: In this first study (to our knowledge) of ultrasound-monitored fibroid development and Nugent-assessed BV, we found no evidence to support the hypothesis that BV increased risk of fibroid incidence or growth or BV's role in the high burden of fibroids in Black women.

Development, Implementation, and Evaluation of an Open Access, Level-Specific, Core Content Curriculum for Emergency Medicine Residents.

BACKGROUND: Leaders in graduate medical education must provide robust clinical and didactic experiences to prepare residents for independent practice. Programs traditionally create didactic experiences individually, requiring tremendous resources with variable content exposure and quality. OBJECTIVE: We sought to create and implement a free, open access, learner-centric, level-specific, emergency medicine (EM) residency curriculum. METHODS: We developed Foundations of Emergency Medicine (FoEM) Foundations I and II courses using Kern's model of curriculum development. Fundamental topics were identified through content guidelines from the American Board of Emergency Medicine. We incorporated learner-centric strategies into 2 flipped classroom, case-based courses targeting postgraduate year (PGY) 1 and PGY-2 residents. The curriculum was made freely available online in 2016. Faculty and resident users were surveyed annually for feedback, which informed iterative refinement of the curriculum. RESULTS: Between 2016 and 2020, registration for FoEM expanded from 2 sites with 36 learners to 154 sites and 4453 learners. In 2019, 98 of 102 (96%) site leaders and 1618 of 2996 (54%) learners completed the evaluative survey. One hundred percent of responding leaders and 93% of learners were "satisfied" or "very satisfied" with FoEM content. Faculty and residents valued FoEM's usability, large volume of content, quality, adaptability, organization, resident-faculty interaction, and resident-as-teacher opportunities. Challenges to implementation included resident attendance, conference structure, technology limitations, and faculty engagement. CONCLUSIONS: We developed and implemented a learner-centric, level-specific, national EM curriculum that has been widely adopted in the United States.

Utilization Pattern for Eculizumab Among Children With Hemolytic Uremic Syndrome.

Background: Hemolytic uremic syndrome (HUS) is a complex disease with multi-organ involvement. Eculizumab therapy is recommended for treatment of complement mediated hemolytic uremic syndrome (cHUS). However, there are few studies evaluating eculizumab therapy among children with HUS. The primary objectives of the study were to describe and identify factors associated with eculizumab therapy in children with HUS. Design/Methods: This large, retrospective, multi-center, cohort study used the Pediatric Health Information System (PHIS) database to identify the index HUS-related hospitalization among patients ≤18 years of age from September 23, 2011 (Food and Drug Administration approval date of eculizumab) through December 31, 2018. Multivariate analysis was used to identify independent factors associated with eculizumab therapy during or after the index hospitalization. Results: Among 1,885 children included in the study, eculizumab therapy was noted in 167 children with a median age of 3.99 years (SD ± 4.7 years). Eculizumab therapy was administered early (within the first 7 days of hospitalization) among 65% of children who received the drug. Mortality during the index hospitalization among children with eculizumab therapy was 4.2 vs. 3.0% without eculizumab therapy (p = 0.309). Clinical factors independently associated with eculizumab therapy were encephalopathy [odds ratio (OR) = 3.09; p ≤ 0.001], seizure disorder (OR = 2.37; p = 0.006), and cardiac involvement (OR = 6.36, p < 0.001). Conclusion(s): Only 8.9% of children received eculizumab therapy. Children who presented with neurological and cardiac involvement with severe disease were more likely to receive eculizumab therapy, and children who received therapy received it early during their index hospitalization. Further prospective studies are suggested to confirm these findings.

The association between douching, genital talc use, and the risk of prevalent and incident cervical cancer.

While human papillomavirus is the primary cause of cervical cancer, other factors may influence susceptibility and response to the virus. Candidates include douching and talcum powder applied in the genital area. We used Cox proportional hazards models to estimate confounder-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) in the Sister Study (2003-2009), a US cohort of women aged 35-74. We considered pre-baseline (n = 523) and incident (n = 31) cervical cancers. Douching at ages 10-13 was positively associated with pre-baseline cervical cancer (HR 1.32, 95% CI 0.86-2.03), though the association was not statistically significant. We did not observe an association between adolescent talc use and pre-baseline cervical cancer (HR 0.95, 95% CI 0.76-1.19). Douching in the year before enrollment was positively associated with incident cervical cancer (HR 2.56, 95% CI 1.10-5.99). The association between recent genital talc use and incident cervical cancer was positive, but not statistically significant (HR 1.79, 95% CI 0.78-4.11). The observed positive association between douching and incident cervical cancer is consistent with previous retrospective case-control studies. In the first study to examine genital talc use and cervical cancer, we did not see evidence of an association.

Impact of the COVID-19 pandemic on emergency medicine education: Insights from faculty and residents.

OBJECTIVES: The COVID-19 pandemic continues to impact health systems across the United States and worldwide in an unprecedented way; however, its influence on frontline medical trainees' educational experiences is unknown. Our objective was to determine the effects of COVID-19 on emergency medicine (EM) training programs and residents. METHODS: We performed a mixed-methods cross-sectional survey study of faculty and residents at programs registered with Foundations of Emergency Medicine. Participants completed an online survey consisting of closed and open-ended response items. We reported descriptive statistics for discrete and continuous data. Free-response data were analyzed qualitatively using a thematic approach. RESULTS: Ninety-two percent of faculty (119/129) and 47% (1,965/4,154) of residents responded to our survey. We identified three major themes related to effects on learning: 1) impact on clinical training, 2) impact on didactic education, and 3) impact on the trainee. Nearly all residencies (96%, 111/116) allowed residents to work with patients suspected of having COVID-19, although fewer (83%, 96/115) allowed residents to intubate them. We found that 99% (1918/1928) of residents experienced virtual didactics. Faculty and trainees noted multiple educational challenges and strategies for adaptation. Trainees also expressed concerns about stress and safety. CONCLUSION: COVID-19 has impacted EM education in many ways including clinical training, didactic education, and trainee emotional state and concentration. Challenges and suggested solutions for learning in the virtual environment were also identified. While the pandemic continues to evolve and impact EM residents in various ways, our results may inform strategies to support medical educators and trainees during pandemics or other periods of significant disruption or crisis.

Herpes Simplex Virus Type 2 Seroprevalence and Incidence and Growth of Ultrasound-Diagnosed Uterine Fibroids in a Large Population of Young African-American Women.

Reproductive tract infections have long been hypothesized to be risk factors for development of uterine fibroids, but few studies have investigated the issue. In our 2016 cross-sectional analysis from the Study of Environment, Lifestyle and Fibroids (2010-2018), a large Detroit, Michigan, community-based cohort study of 23- to 35-year-old African-American women with ultrasound fibroid screening, we found no association between a very prevalent reproductive tract infection, herpes simplex virus type 2 (HSV-2), and fibroids. With prospective data from the cohort (ultrasounds performed every 20 months over 5 years), we examined HSV-2's associations with fibroid incidence (among 1,208 women who were fibroid-free at baseline) and growth (among women with fibroids at baseline or diagnosed during the study). Using Cox proportional hazards models, we computed adjusted hazard ratios and 95% confidence intervals for fibroid incidence comparing HSV-2-seropositive women with HSV-2-seronegative women. The influence of HSV-2 infection on growth was assessed on the basis of the difference in fibroid size between successive ultrasounds (1,323 growth measures) using a linear mixed model, estimating the percent difference in growth scaled to 18 months. HSV-2 seropositivity was not associated with fibroid incidence (adjusted hazard ratio = 0.88, 95% confidence interval: 0.69, 1.12) or growth (estimated growth difference = 3.1%, 95% confidence interval: -5.8, 13.0). Women can be reassured that HSV-2 infection is unlikely to increase their risk of fibroid-related health problems, given these longitudinal measures.

Bacterial Vaginosis-Associated Bacteria and Uterine Fibroids: A Nested Case-Control Study.

BACKGROUND: Reproductive tract infections are hypothesized to influence uterine fibroid development, yet few studies have investigated the common condition of bacterial vaginosis (BV). The literature is currently limited to data using self-report of BV. METHODS: We conducted a nested case-control study of 200 women (100 cases and 100 controls) from a large study of 23- to 35-year-old African American women, 1310 of whom were fibroid-free and prospectively followed up for 5 years to identify incident fibroids with standardized ultrasound examinations. We used quantitative polymerase chain reaction, an objective molecular method, to assess 9 BV-associated and 4 Lactobacillus species from vaginal swab specimens. We used hierarchical logistic regression to compute odds ratios and 95% confidence intervals to examine associations between bacterial species (both individually and grouped as (1) "optimal" Lactobacillus and (2) BV-associated species) with fibroid incidence and number. We also examined vaginal imbalance (quantitatively more BV-associated bacteria than optimal Lactobacilli). RESULTS: Contrary to our hypothesis, we found no increase in fibroid incidence or number among women with more BV-associated bacteria. High imbalance (only BV-associated bacteria, no optimal Lactobacillus bacteria) was actually inversely associated with fibroid incidence (odds ratio, 0.38; 95% confidence interval, 0.17-0.81). CONCLUSIONS: This is the first study of ultrasound-detected incident fibroids and molecular vaginal bacterial assessment. We found no evidence that BV-associated bacteria increase the risk of fibroid incidence or number.

Douching or Perineal Talc Use and Prevalent Fibroids in Young African American Women.

Background: Black women are at an increased risk of developing fibroids, but the cause is unclear. Douching and perineal talc use are common lifestyle exposures among Black women, and may be risk factors for fibroid development. Materials and Methods: This cross-sectional study consisted of Black women 23-35 years of age in the metropolitan Detroit area (n = 1693) without prior diagnoses of fibroids and intact uteri. Main exposures were ever douching (yes/no) and any perineal talc use (ever/never). Main outcomes were prevalent fibroids at baseline (yes/no) and total fibroid volume at baseline (no fibroids/

Mycoplasma genitalium and Bacterial Vaginosis-Associated Bacteria in a Non-Clinic-Based Sample of African American Women.

BACKGROUND: Mycoplasma genitalium is associated with adverse reproductive problems. However, prevalence estimates from studies that screen women not seeking care are rare. Studies have reported co-occurrence of M. genitalium with bacterial vaginosis (BV), but no prior study of specific BV-associated bacteria has been conducted in African Americans whose reproductive tract infection burden is high. METHODS: Using quantitative polymerase chain reaction, we screened vaginal swabs for M. genitalium, 9 BV-associated bacteria, and 4 Lactobacillus species from 200 participants drawn from a cohort of African Americans 23 to 35 years old. Sexual history, herpes serostatus, and Nugent score had been assessed. Prevalence of M. genitalium was computed. The associations of other vaginal bacteria with M. genitalium were examined with binomial regression. RESULTS: M. genitalium prevalence was 18%. Detection and quantity of 2 BV-associated bacteria were significantly associated with a higher prevalence of M. genitalium (Leptotrichia/Sneathia: detection prevalence ratio (PR) of 2.9 [95% confidence interval {CI}, 1.1-7.7] and quantity PR of 1.2 [95% CI, 1.0-1.3]; Megasphaera phylotype 1: detection PR of 2.2 [95% CI, 1.2-4.2] and quantity PR of 1.1 [95% CI, 1.0-1.2]). Increased quantity of L. iners was also positively associated with M. genitalium (PR, 1.3 [95% CI, 1.0-1.8]). Nugent ≥7, herpes serostatus, and lifetime number of sex partners were not associated with M. genitalium. CONCLUSIONS: Specific BV-associated microbes and L. iners were associated with M. genitalium, but Nugent ≥7 was not. Studies are needed to confirm a high prevalence of M. genitalium in African Americans and to understand its interactions with other vaginal bacteria.

Disparities by Skin Color Among Young African-American Women.

OBJECTIVE: Light-skin disadvantage (hypothesized to result from resentment by darker-skinned individuals) has been described in majority African-American populations but is less studied than dark-skin disadvantage. We investigated both light- and dark-skin disadvantage in a contemporary African-American study population. METHODS: We used skin reflectance and questionnaire data from 1693, young African-American women in Detroit, Michigan, and dichotomized outcomes as advantaged/disadvantaged. We compared outcomes for women with light vs. medium skin color with prevalence differences (PDs) and 95% confidence intervals (CIs), and dark-skin disadvantage with prevalence ratios (PRs) and 95% CIs for a 10-unit increase in skin color. RESULTS: There was little evidence for light-skin disadvantage, but darker skin was associated with disadvantage across socioeconomic, health, and psychosocial domains. The strongest associations were for SES, but even controlling for SES, other associations included higher body mass index (PR 1.14 95% CI 1.08-1.20) and more stressful events (PR 1.10 95% CI 1.01-1.20). CONCLUSIONS: Dark-skin disadvantage was the predominant form of colorism. Skin color metrics in public health research can capture more information than simple racial/ethnic categories, and such research could bring awareness to the deep-rooted colorism in society.

Genital Chlamydia trachomatis Seroprevalence and Uterine Fibroid Development: Cohort Study of Young African-American Women.

Few studies have investigated the 1930s hypothesis that reproductive tract infections are risk factors for fibroid development. In our 2017 cross-sectional analysis from the Study of Environment, Lifestyle, and Fibroids (2010-2018), a large Detroit community-based cohort of 23-35 year-old African-American women with ultrasound fibroid screening, we found an inverse association between seropositivity for genital Chlamydia trachomatis (gCT) infection and fibroids. With prospective data from the cohort (standardized ultrasounds every 20 months over 5 years), we examined gCT's associations with fibroid incidence (among 1158 women fibroid-free at baseline) and growth. We computed adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incidence by gCT serostatus using Cox proportional hazards models. GCT's influence on growth was assessed by estimating the difference between fibroid size change for seropositive vs. seronegative between successive ultrasounds (1254 growth measures) using a linear mixed model. Growth was scaled to change over 18 months. GCT seropositivity was not associated with fibroid incidence (aHR, 1.0 95% CI: 0.79, 1.29) or growth (4.4%, 95% CI: -5.02, 14.64). The current evidence based on both biomarker gCT data, which can capture the common undiagnosed infections, and prospective ultrasound data for fibroids suggests that Chlamydia is unlikely to increase fibroid risk.

Effects of Motivational Interviewing and Wearable Fitness Trackers on Motivation and Physical Activity: A Systematic Review.

OBJECTIVE: To systematically review the impacts of Wearable Fitness Trackers (WFTs), Motivational Interviewing (MI), and Self Determination Theory (SDT)-based interventions on physical activity (PA) and motivation for PA. DATA SOURCE: Manuscripts published between 2008 and 2018 in PubMed, Web of Science, CABAbstracts, and SPORTDiscus database were reviewed. STUDY INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria were original pilot studies, randomized controlled trials (RCT), cross-sectional studies, qualitative assessments, prospective cohort studies, longitudinal observational studies, and pretest posttest designs published in peer-reviewed journals. DATA EXTRACTION: Studies were evaluated by 2 independent researchers for inclusion. DATA SYNTHESIS: Extracted data were synthesized in a tabular format and narrative summary. RESULTS: Twenty-six studies met final inclusion criteria, 10 addressed WFT use and PA behavior, 4 investigated WFT use and its association with motivation for PA, and 10 examined SDT and/or MI and their effect on motivation for PA and/or PA behavior. Finally, 2 studies addressed SDT-based MI, WFT use, and the combined effect on PA behavior. CONCLUSIONS: While SDT-based interventions and MI positively impact motivation for PA and PA behavior, WFTs revealed mixed results. Wearable Fitness Trackers prove effective among individuals not currently meeting PA guidelines but have little impact on other populations. Self Determination Theory, MI, and WFTs use provides a promising combination of interventions to increase PA among sedentary individuals, though research is limited.

Adapting online education resources to meet the needs of an emergency medicine training programme in a pilot feasibility study.

This article was migrated. The article was marked as recommended. Introduction: Online resources are available to enhance emergency medicine training programmes. The aim of this study was to evaluate the feasibility of using online case-based resources created in the United States in a New Zealand emergency medicine training programme. Methods: Evaluation data were collected from junior doctors and educators after they participated in the programme. Data sources included research notes and questionnaire responses. The data were analysed qualitatively using a general inductive approach. Results: Evaluation feedback from 19 junior doctors and 14 educators was interpreted to suggest that the online resource, with minor adaptations, was feasible to use in a New Zealand emergency medicine training programme. Findings indicated that educators were able to modify the materials to modify to meet local requirements, however, the opportunity to include a cultural component was missed. Participants appreciated the case-based format and felt that they established a safe and encouraging learning environment with each other. Participants were able to develop a systematic approach to emergency situations and identify red flags related to deteriorating patients. Discussion and Conclusion: Evaluation findings indicate that adapting an online-sourced curriculum is feasible to educators and acceptable to junior doctors and educators participating in a single New Zealand based Emergency Medicine training program. Educators in other international training settings may find the lessons learned helpful when adapting online resources to address the learning needs of their junior doctors. Next steps are to evaluate the impact of this resource on the knowledge and skills learned by junior doctors and any changes in their care for patients in emergency medicine situations.