Performance of Fracture Risk Assessment Tools by Race and Ethnicity: A Systematic Review for the ASBMR Task Force on Clinical Algorithms for Fracture Risk.

The American Society of Bone and Mineral Research (ASBMR) Professional Practice Committee charged an ASBMR Task Force on Clinical Algorithms for Fracture Risk to review the evidence on whether current approaches for differentiating fracture risk based on race and ethnicity are necessary and valid. To help address these charges, we performed a systematic literature review investigating performance of calculators for predicting incident fractures within and across race and ethnicity groups in middle-aged and older US adults. We included English-language, controlled or prospective cohort studies that enrolled US adults aged >40 years and reported tool performance predicting incident fractures within individual race and ethnicity groups for up to 10 years. From 4838 identified references, six reports met eligibility criteria, all in women. Just three, all from one study, included results in non-white individuals. In these three reports, non-white women experienced relatively few major osteoporotic fractures (MOFs), especially hip fractures, and risk thresholds for predicting fractures in non-white women were derived from risks in the overall, predominantly white study population. One report suggested the Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD) overestimated hip fracture similarly across race and ethnicity groups (black, Hispanic, American Indian, Asian, white) but overestimated MOF more in non-white than White women. However, these three reports were inconclusive regarding whether discrimination of FRAX or the Garvan calculator without BMD or of FRAX with BMD for MOF or hip fracture differed between white versus black women. This uncertainty was at least partly due to imprecise hip fracture estimates in black women. No reports examined whether ratios of observed to predicted hip fracture risks within each race or ethnicity group varied across levels of predicted hip fracture risk. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Case report: Managing multisystem inflammatory syndrome in children (MIS-C) in Lao People's Democratic Republic, a success story.

Introduction: Multisystem inflammatory syndrome in children (MIS-C) is believed to be one of the most important life-threatening complications of COVID-19 infection among children. In any setting, early recognition, investigations, and management of MIS-C is crucial, but it is particularly difficult in resource-limited settings (RLS). This is the first case report of MIS-C in Lao People's Democratic Republic (Lao PDR) that was promptly recognized, treated, and resulted in full recovery with no known complications despite the resource limitations. Case presentation: A healthy 9-year-old boy presented to a central teaching hospital fulfilling the World Health's Organization's MIS-C criteria. The patient had never received a COVID-19 vaccine and had a history of COVID-19 contact. The diagnosis was based upon the history, changes in the patient's clinical status, and response to treatment and negative testing and response to treatment for alternative diagnoses. Despite management challenges relating to limited access to an intensive care bed and the high cost of IVIG; the patient received a full course of treatment and appropriate follow-up cares post discharge. There were several aspects to this case that may not hold true for other children in Lao PDR. First, the family lived in the capital city, close to the central hospitals. Second, the family was able to afford repeated visits to private clinics, and the cost of IVIG, and other treatments. Third, the physicians involved in his care promptly recognized a new diagnosis. Conclusions: MIS-C is a rare but life-threatening complication of COVID-19 infection among children. The management of MIS-C requires early recognition, investigations, and interventions which may be difficult to access, cost-prohibitive, and further increase demand on healthcare services that are already limited in RLS. Nevertheless, clinicians must consider means for improving access, determine which tests and interventions are worth the cost, and establishing local clinical guidelines for working within resource constraints while awaiting additional assistance from local and international public health systems. Additionally, using COVID-19 vaccination to prevent MIS-C and its complication for children may be cost-effective.

Gender Distribution of Authors of Evaluation Letters for Promotion at One Medical School.

PURPOSE: Women remain underrepresented in key leadership positions and advanced ranks in academic medicine. This study examines the numbers of men and women letter writers for promotion candidates during a 5-year period across departments, tracks, ranks, and candidate gender. METHOD: A descriptive study characterized the gender of evaluation letter writers for candidates for promotion to associate or full professor at the University of Minnesota Medical School between 2015 and 2020. Letter writer and candidate gender were characterized by self-identified pronouns in the faculty biography or dossier. Letter writer gender was described by candidate department, promotion track, rank, terminal degree, and gender. RESULTS: Among 299 candidates for promotion, 172 (58%) were men and 127 (42%) were women; dossiers included 3,995 evaluation letters. Across all years, men wrote more letters than women (external letters, range, 69% in 2019-2020 to 75% in 2015-2016; internal letters, range, 67% in 2018-2019 to 77% in 2015-2016). Candidates in the family medicine and pediatrics departments had the highest percentages of letters written by women (44% and 40%, respectively). No differences were found in the number of women letter writers by candidate promotion track; however, differences were found by candidate rank (associate professor, 30%; full professor, 23%) and terminal degree (MD/DO, 25%; PhD, 33%; MD-PhD, 20%). Regardless of candidate gender, most evaluation letters were written by men. Women candidates had 15% to 20% more letters authored by women than men candidates (34%-40% vs 18%-23%). CONCLUSIONS: The gender pattern of letter writers may reflect implicit biases regarding gender and perceived leadership status, expertise, and success. Adopting policies that promote or require gender diversity among letter writers for promotion candidates may provide an opportunity to encourage faculty to seek diverse networks and recognize the achievements of women faculty.

The Stanford Global Health Media Fellowship: Training the Next Generation of Physician Communicators to Fight Health Misinformation.

PROBLEM: The COVID-19 pandemic and the spread of related health misinformation, especially on social media, have highlighted the need for more health care professionals to produce and share accurate health information to improve health and health literacy. Yet, few programs address this problem by training health care professionals in the art of science writing and medical journalism. APPROACH: Created in 2011, the Stanford Global Health Media Fellowship aims to train medical students and residents in public communication strategies. Each year, 1 physician-in-training is selected to complete the fellowship, which includes 3 rotations: (1) 1 academic quarter at Stanford's Graduate Program in Journalism, (2) 3 to 5 months with a national news network (previously NBC and ABC, now CNN), and (3) a placement at an international site. During the year-long program, fellows also complete a capstone project tackling a global health equity issue. OUTCOMES: Since 2011, 10 fellows have completed the program, and they have acquired skills in reporting, writing, multimedia, social media, and medical communications. During the news network rotation, they have completed more than 200 medical news pieces and improved the quality of the health information in a myriad of other pieces. Alumni have continued to write and report on medical stories throughout residency, other fellowships, and as practicing physicians. One alumnus is now a medical news producer at CNN. NEXT STEPS: Expanding high-quality training in medical journalism for physicians through partnerships with journalism schools; communications departments; and local, national, and international journalists can greatly improve physicians' ability to communicate with the public. It also has the potential to greatly improve the health information the public receives. Educators should consider embedding mass health communications training in medical education curricula and increasing opportunities for physicians to engage with diverse public audiences.

Introducing Mass Communications Strategies to Medical Students: A Novel Short Session for Fourth-Year Students.

PROBLEM: The World Health Organization calls on all with quality medical information to share it with the public and combat health misinformation; however, U.S. medical schools do not currently teach students effective communication with lay audiences about health. Most physicians have inadequate training in mass communication strategies. APPROACH: In August 2018, a novel 90-minute class at the University of Minnesota Medical School introduced fourth-year medical students to basic skills for communicating with lay audiences through mass media. Instructors were physicians with experience interacting with the general public via radio, op-ed articles, social media, print media, television, and community and legislative advocacy. After a 20-minute lecture and sharing of instructors' personal experiences, students completed two 30-minute small-group activities. They identified communications objectives and talking points for a health topic, drafting these as Tweets or an op-ed article outline, then presented talking points in a mock press conference with their peers, practicing skills just learned. Pre- and postsurveys documented students' previous engagement and comfort with future engagement with mass media messaging. OUTCOMES: Over 1 week, 142 students participated in 6 separate classes, and 127 completed both pre- and postsurveys. Before the course, only 6% (7/127) of students had comfortably engaged with social media and 14% (18/127) had engaged with traditional media in their professional roles. After the course, students self-reported an increase in their comfort, perceived ability, and likelihood of using specific communications skills to advocate for their patients (all P < .001). NEXT STEPS: The course will be expanded into a 5-session thread for third- and fourth-year medical students spread over 2 years. This thread will include meeting physicians who engage with lay audiences, identifying best practices for mass health communication, identifying bias and misinformation, "dos and don'ts" of social media, and communication skills for legislative advocacy.

Global Health Education during the COVID-19 Pandemic: Challenges, Adaptations, and Lessons Learned.

Global health education programs should strive continually to improve the quality of education, increase access, create communities that foster excellence in global health practices, and ensure sustainability. The COVID-19 pandemic forced the University of Minnesota's extensive global health education programs, which includes a decade of hybrid online and in-person programing, to move completely online. We share our experience, a working framework for evaluating global health educational programming, and lessons learned. Over the decades we have moved from a predominantly passive, lecture-based, in-person course to a hybrid online (passive) course with an intensive hands-on 2-week requirement. The pandemic forced us to explore new active online learning models. We retained our on-demand, online passive didactics, which used experts' time efficiently and was widely accessible and well received. In addition, we developed a highly effective synchronous online component that we felt replaced some of the hands-on activities effectively and led us to develop new and innovative "hands-on" experiences. This new, fully online model combining quality asynchronous and synchronous learning provided many unanticipated advantages, such as increasing access while decreasing our carbon footprint dramatically. By sharing our experience, lessons learned, and resources, we hope to inspire other programs likewise to innovate to improve quality, access, community, and sustainability in global health, especially if these innovations can help decrease negative aspects of global health education such as its environmental impact.

Pediatric Critical Care in Resource Limited Settings-Lessening the Gap Through Ongoing Collaboration, Advancement in Research and Technological Innovations.

Pediatric critical care has continued to advance since our last article, "Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned" was written just 3 years ago. In that article, we reviewed the history, current state, and gaps in level of care between low- and middle-income countries (LMICs) and high-income countries (HICs). In this article, we have highlighted recent advancements in pediatric critical care in LMICs in the areas of research, training and education, and technology. We acknowledge how the COVID-19 pandemic has contributed to increasing the speed of some developments. We discuss the advancements, some lessons learned, as well as the ongoing gaps that need to be addressed in the coming decade. Continued understanding of the importance of equitable sustainable partnerships in the bidirectional exchange of knowledge and collaboration in all advancement efforts (research, technology, etc.) remains essential to guide all of us to new frontiers in pediatric critical care.

12 Tips for Engaging Medical Students in Health Communications.

This article was migrated. The article was marked as recommended. The proliferation of misinformation during the COVID-19 pandemic provides a clear example of the harms that can occur when medical professionals do not engage with the public regarding health topics. To address this need for accessible, accurate medical information, we taught medical students a COVID-19-specific curriculum tailored to sharing this information with the lay public via social media. Through active learning, students developed their understanding of disease-specific pathophysiology, prevention techniques, treatments, and public health interventions while practicing new skills in public communication as health professionals. After two cohorts completed the course, students' high-quality medical information about COVID-19 reached >100,000 viewers. To further broaden the impact, we shared the course curriculum through the Association of American Medical College (AAMC) iCollaborative. This curriculum provides a model for future engagement of medical students in health communication with lay audiences.

HIV/AIDS and associated conditions among HIV-infected refugees in Minnesota, 2000­2007.

In 2010, the requirement for human immunodeficiency virus (HIV) testing of adult refugees prior to US resettlement was removed, thus leading to a potential for missed diagnosis. We reviewed refugee health assessment data and medical charts to evaluate the health status of HIV-infected refugees who arrived in Minnesota during 2000-2007, prior to this 2010 policy change. Among 19,292 resettled adults, 174 were HIV-infected; 169 (97%) were African (median age 26.4 (range: 17-76) years). Charts were abstracted for 157 (124 (79%) with ≥ 1 year of follow-up). At initial presentation, two of 74 (3%) women were pregnant; 27% became pregnant during follow-up. HIV clinical stage varied (59%, asymptomatic; 11%, mild symptoms; 10%, advanced symptoms; 3%, severe symptoms; 17%, unknown); coinfections were common (51 tuberculosis, 13 hepatitis B, 13 parasites, four syphilis). Prior to arrival 4% had received antiretrovirals. Opportunistic infections were diagnosed among 13%; 2% died from AIDS-related causes. Arrival screening may be needed to identify these HIV-infected refugees and prevent HIV-related morbidity and mortality.

Tricarbonyl(chlorodiphenylstannyl){η-[2-(dimethylamino)ethyl]cyclopenta-dienyl}molybdenum.

Reaction of the tricarbon-yl{η(5)-[2-(dimethyl-amino)eth-yl]cyclo-penta-dien-yl}molybdenum anion and dichlorido-diphenyl-stannane affords the title compound, [MoSn(C(6)H(5))(2)Cl(C(9)H(14)N)(CO)(3)], which exhibits a four-legged piano-stool geometry with chlorido-diphenyl-stannyl ligands unperturbed by the pendant 2-(dimethyl-amino)ethyl groups. The Mo-Sn bond length [2.7584 (5) Å] and the distortion of the tetra-hedral tin coordination geometry are similar to those observed in related tin-substituted tricarbonyl-molybdenum and -tungsten complexes.