The Effect of a Mock Medical Visit on Refugee Health Self-Efficacy and Medical Trainee Communication Apprehension.

INTRODUCTION: As refugees adjust to a new country, their health care can take a toll. Refugees may have difficulty navigating a new health care system and experience low health self-efficacy. Another potential contributor is inadequate medical trainee curriculum addressing refugee health. METHODS: We devised simulated clinic experiences called mock medical visits. Surveys were utilized before and after the mock medical visits to assess the Health Self-Efficacy Scale for refugees and the Personal Report of Intercultural Communication Apprehension for trainees. RESULTS: Health Self-Efficacy Scale scores increased from 13.67 to 15.47 (P = 0.08, n = 15). Personal Report of Intercultural Communication Apprehension scores decreased from 27.1 to 25.4 (P = 0.40, n = 10). DISCUSSION: While our study did not reach statistical significance, the overall trends suggest mock medical visits can be a valuable tool to increase health self-efficacy in refugee community members and decrease intercultural communication apprehension in medical trainees.

Astrocyte-secreted factors modulate the developmental distribution of inhibitory synapses in nucleus laminaris of the avian auditory brainstem.

Nucleus laminaris (NL) neurons in the avian auditory brainstem are coincidence detectors necessary for the computation of interaural time differences used in sound localization. In addition to their excitatory inputs from nucleus magnocellularis, NL neurons receive inhibitory inputs from the superior olivary nucleus (SON) that greatly improve coincidence detection in mature animals. The mechanisms that establish mature distributions of inhibitory inputs to NL are not known. We used the vesicular GABA transporter (VGAT) as a marker for inhibitory presynaptic terminals to study the development of inhibitory inputs to NL between embryonic day 9 (E9) and E17. VGAT immunofluorescent puncta were first seen sparsely in NL at E9. The density of VGAT puncta increased with development, first within the ventral NL neuropil region and subsequently throughout both the ventral and dorsal dendritic neuropil, with significantly fewer terminals in the cell body region. A large increase in density occurred between E13­15 and E16­17, at a developmental stage when astrocytes that express glial fibrillary acidic protein (GFAP) become mature. We cultured E13 brainstem slices together with astrocyte-conditioned medium (ACM) obtained from E16 brainstems and found that ACM, but not control medium, increased the density of VGAT puncta. This increase was similar to that observed during normal development. Astrocyte-secreted factors interact with the terminal ends of SON axons to increase the number of GABAergic terminals. These data suggest that factors secreted from GFAP-positive astrocytes promote maturation of inhibitory pathways in the auditory brainstem.