RESUMO
Antiracism education (ARE) is critical in developing culturally competent physicians. At our institution, the Sidney Kimmel Medical College (SKMC) at Thomas Jefferson University in Philadelphia, United States, the Office of Diversity and Inclusion Initiatives and Educational Leadership created and examined a map of its ARE curriculum. Our efforts were meant to describe our local educational processes with regards to ARE; we did not intend to compare our curriculum and its outputs to national benchmarks. To this effect, diversity deans of other local Philadelphia-area medical schools were queried on their respective ARE maps and educational offerings. Potential changes to SKMC's ARE would be considered, but no other school that was queried had a formal ARE map in place. While all schools had a variety of lectures, modules, and electives, none appeared to have a systematic method to teach ARE. As a result, modifications to SKMC's ARE were made based on an intrinsic examination of its own ARE map. Changes that were made included modifying a pre-clerkship lecture on "Racism and Microaggressions" to a small group discussion session. Additionally, a clerkship-specific lecture on "Bias and Microaggressions" was changed from four 1-hour lectures to 90 minutes of lecture followed by a 2-hour small group session, to reduce content redundancy and promote more student reflection. For both of these changes, faculty participated in a newly developed faculty development session. To guide prospective work, a multidisciplinary task force was created to include formal student input in the process of examining ARE. Future directions to query institutions outside the Philadelphia region for their ARE offerings will also be considered.
RESUMO
Background: While studies have identified the negative cardiovascular effects of obesity, the effects of obesity on youth athletes are less studied. This study investigates the associations between obesity in youth athletes and exercise activity and exertional cardiac symptoms. Methods: The HeartBytes National Youth Database produced by Simon's Heart, a nonprofit that organizes adolescents' sports pre-participation examinations (PPEs), was used. This database contains demographic data, exercise-related symptoms, and electrocardiogram data obtained during PPEs. BMI was converted to percentiles, with obesity defined as BMI ≥95th percentile. Outcomes were evaluated using a chi-squared test with odds ratios (ORs) and 95% confidence intervals (CIs). Results: Of 7363 patients, there were 634 individuals with obesity. Youth athletes within normal weight ranges (5th-85th percentile) had higher exercise rates than those with underweight, overweight, or obesity (p < 0.001 for each). Athletes with obesity had higher odds of exertional symptoms overall (OR: 1.63 [CI: 1.36-1.96]; p < 0.001). However, for athletes who exercised >10 hours a week, there was no association between obesity and exertional symptoms. Athletes with obesity had higher odds of elevated blood pressure (OR: 5.35 [CI: 2.00-14.30]; p < 0.001) and hypercholesterolemia (OR: 3.84 [CI: 2.51-5.86]; p < 0.001). Conclusions: In this dataset, obesity in youth athletes is associated with decreased physical activity and increased exertional symptoms in general. Obesity is not associated with exertional symptoms in athletes who participated in higher weekly physical activity. Further studies are needed to elucidate the cause-effect relationship of these findings.