RESUMO
BACKGROUND AND OBJECTIVES: Multilevel factors drive health disparities experienced by sexual and gender minority (SGM) populations. We developed a 3-hour symposium focusing on care for SGM youth to address this. The symposium was a free, extracurricular event open to the public, with an emphasis on health professional students and providers from all disciplines and involved interprofessional didactic and interactive components. METHODS: Participants completed optional retrospective pre/postsurveys immediately and 10-months postsymposium. Surveys contained Likert-scale questions addressing five indicators of symposium effectiveness related to knowledge, confidence, and comfort in providing care for SGM populations. We used 1-tailed paired t tests to evaluate the effectiveness of the symposium, and analysis of variance tests to compare differences by professional role. RESULTS: Of 208 individuals who attended the symposium, 67 completed the initial survey, and 23 completed the 10-months postsymposium survey. Participants reported significantly higher ( P<.001) scores across all five measures of effectiveness from pre- to immediately postsymposium, and remained at significantly higher ( P<.05) scores across all measures from presymposium to 10 months postsymposium, except for comfort recommending care for SGM pediatric patients or clients. CONCLUSION: Results suggest that the symposium improved participants' perceived effectiveness in serving SGM pediatric patients, although selection bias is a concern. Dissemination of educational approaches that incorporate interprofessional didactic and active learning components may help improve workforce capacity to improve SGM health.
RESUMO
BACKGROUND: The antibody response to pertussis vaccination in rheumatoid arthritis is unknown, a concerning omission given the relatively low efficacy of the pertussis vaccine, a rise in pertussis infections, and a general increased susceptibility to infection in rheumatoid arthritis. Additionally, the contributions from an intrinsically dysregulated immune system in rheumatoid arthritis and immune-suppressing medications to the response to pertussis vaccination is poorly defined. This study examines antibody titers against pertussis in vaccinated rheumatoid arthritis patients and controls as well as evaluates potential contributions from demographic factors, immune suppressing medications, and reactivity against citrullinated pertussis. METHODS: Serum IgG titers against native and citrullinated pertussis and tetanus were quantified by enzyme-linked immunosorbent assay in rheumatoid arthritis subjects and controls who were vaccinated within 10 years. Titers were compared by t-test and percent immunity by Fisher's exact test. Multivariable logistic regression was used to identify clinical factors that correlate with native pertussis titers. RESULTS: Compared to controls, rheumatoid arthritis subjects had lower titers against pertussis, but not tetanus, and reduced immunity to pertussis. These results were even more prominent at 5-10 years post-vaccination, when rheumatoid arthritis patients had 50% lower titers than controls and 2.5x more rheumatoid arthritis subjects were not considered immune to pertussis. Multiple logistic regression demonstrated that female sex and methotrexate use, but not TNF inhibiting medications, correlated with reduced immunity to pertussis. Finally, rheumatoid arthritis patients had higher IgG titers against citrullinated pertussis than native pertussis. CONCLUSIONS: Pertussis titers are lower in vaccinated rheumatoid arthritis patients with evidence for contributions from female sex, a citrulline-biased immune response, and methotrexate use.