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Iturralde E, Rubinsky AD, Nguyen KH, Anderson C, Lyles CR, Mangurian C. Serious Mental Illness, Glycemic Control, and Neighborhood Factors within an Urban Diabetes Cohort. Schizophr Bull 2024; 50:653-662. [PMID: 37597839 DOI: 10.1093/schbul/sbad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2023]
Abstract
BACKGROUND AND HYPOTHESIS Serious mental illness (SMI) may compromise diabetes self-management. This study assessed the association between SMI and glycemic control, and explored sociodemographic predictors and geographic clustering of this outcome among patients with and without SMI. STUDY DESIGN We used electronic health record data for adult primary care patients with diabetes from 2 San Francisco health care delivery systems. The primary outcome was poor glycemic control (hemoglobin A1c >9.0%), which was modeled on SMI diagnosis status and sociodemographics. Geospatial analyses examined hotspots of poor glycemic control and neighborhood characteristics. STUDY RESULTS The study included 11 694 participants with diabetes, 21% with comorbid SMI, of whom 22% had a schizophrenia spectrum or bipolar disorder. Median age was 62 years; 52% were female and 79% were Asian, Black, or Hispanic. In adjusted models, having schizophrenia spectrum disorder or bipolar disorder was associated with greater risk for poor glycemic control (vs participants without SMI, adjusted relative risk [aRR] = 1.24; 95% confidence interval, 1.02, 1.49), but having broadly defined SMI was not. People with and without SMI had similar sociodemographic correlates of poor glycemic control including younger versus older age, Hispanic versus non-Hispanic White race/ethnicity, and English versus Chinese language preference. Hotspots for poor glycemic control were found in neighborhoods with more lower-income, Hispanic, and Black residents. CONCLUSIONS Poor diabetes control was significantly related to having a schizophrenia spectrum or bipolar disorder, and to sociodemographic factors and neighborhood. Community-based mental health clinics in hotspots could be targets for implementation of diabetes management services.
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Affiliation(s)
- Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Anna D Rubinsky
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Academic Research Services, Information Technology, University of California San Francisco, San Francisco, CA, United States
| | - Kim H Nguyen
- Department of Medicine, Center for Vulnerable Populations at ZSFG, University of California San Francisco, San Francisco, CA, United States
| | - Chelsie Anderson
- Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Courtney R Lyles
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Center for Vulnerable Populations at ZSFG, University of California San Francisco, San Francisco, CA, United States
| | - Christina Mangurian
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Center for Vulnerable Populations at ZSFG, University of California San Francisco, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
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Henderson K, Reihm J, Koshal K, Wijangco J, Sara N, Miller N, Doyle M, Mallory A, Sheridan J, Guo CY, Oommen L, Rankin KP, Sanders S, Feinstein A, Mangurian C, Bove R. A Closed-Loop Digital Health Tool to Improve Depression Care in Multiple Sclerosis: Iterative Design and Cross-Sectional Pilot Randomized Controlled Trial and its Impact on Depression Care. JMIR Form Res 2024; 8:e52809. [PMID: 38488827 PMCID: PMC10980989 DOI: 10.2196/52809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/27/2023] [Accepted: 11/24/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND People living with multiple sclerosis (MS) face a higher likelihood of being diagnosed with a depressive disorder than the general population. Although many low-cost screening tools and evidence-based interventions exist, depression in people living with MS is underreported, underascertained by clinicians, and undertreated. OBJECTIVE This study aims to design a closed-loop tool to improve depression care for these patients. It would support regular depression screening, tie into the point of care, and support shared decision-making and comprehensive follow-up. After an initial development phase, this study involved a proof-of-concept pilot randomized controlled trial (RCT) validation phase and a detailed human-centered design (HCD) phase. METHODS During the initial development phase, the technological infrastructure of a clinician-facing point-of-care clinical dashboard for MS management (BRIDGE) was leveraged to incorporate features that would support depression screening and comprehensive care (Care Technology to Ascertain, Treat, and Engage the Community to Heal Depression in people living with MS [MS CATCH]). This linked a patient survey, in-basket messages, and a clinician dashboard. During the pilot RCT phase, a convenience sample of 50 adults with MS was recruited from a single MS center with 9-item Patient Health Questionnaire scores of 5-19 (mild to moderately severe depression). During the routine MS visit, their clinicians were either asked or not to use MS CATCH to review their scores and care outcomes were collected. During the HCD phase, the MS CATCH components were iteratively modified based on feedback from stakeholders: people living with MS, MS clinicians, and interprofessional experts. RESULTS MS CATCH links 3 features designed to support mood reporting and ascertainment, comprehensive evidence-based management, and clinician and patient self-management behaviors likely to lead to sustained depression relief. In the pilot RCT (n=50 visits), visits in which the clinician was randomized to use MS CATCH had more notes documenting a discussion of depressive symptoms than those in which MS CATCH was not used (75% vs 34.6%; χ21=8.2; P=.004). During the HCD phase, 45 people living with MS, clinicians, and other experts participated in the design and refinement. The final testing round included 20 people living with MS and 10 clinicians including 5 not affiliated with our health system. Most scoring targets for likeability and usability, including perceived ease of use and perceived effectiveness, were met. Net Promoter Scale was 50 for patients and 40 for clinicians. CONCLUSIONS Created with extensive stakeholder feedback, MS CATCH is a closed-loop system aimed to increase communication about depression between people living with MS and their clinicians, and ultimately improve depression care. The pilot findings showed evidence of enhanced communication. Stakeholders also advised on trial design features of a full year long Department of Defense-funded feasibility and efficacy trial, which is now underway. TRIAL REGISTRATION ClinicalTrials.gov NCT05865405; http://tinyurl.com/4zkvru9x.
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Affiliation(s)
- Kyra Henderson
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer Reihm
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kanishka Koshal
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jaeleene Wijangco
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Narender Sara
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Nicolette Miller
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Marianne Doyle
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Alicia Mallory
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Judith Sheridan
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Chu-Yueh Guo
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Lauren Oommen
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine P Rankin
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Stephan Sanders
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Anthony Feinstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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Harper CC, Yarger J, Mangurian C, Hopkins K, Rossetto I, Elmes S, Hecht HK, Sanchez A, Hernandez R, Shokat M, Steinberg JR. Mental Health Distress and Delayed Contraception Among Older Adolescents and Young Adults. J Womens Health (Larchmt) 2024. [PMID: 38465503 DOI: 10.1089/jwh.2023.0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background: Symptoms of mental distress increased sharply during the COVID-19 pandemic, especially among older adolescents and young adults. Mental health distress may make it more challenging for young people to seek other needed health care, including contraception. This study explored the association of symptoms of depression, anxiety, and stress with delays in getting a contraceptive method or prescription. Materials and Methods: Data from a supplementary study (May 15, 2020-March 20, 2023) to a cluster randomized trial in 29 sites in Texas and California were used. The diverse study sample included community college students assigned female at birth of ages 18-29 years (n = 1,665 with 7,023 observations over time). We measured the association of depression (CES-D [Center for Epidemiologic Studies Depression Scale]) or anxiety and stress (DASS-21 [Depression Anxiety Stress Scales]) symptoms with delayed contraceptive care-seeking with mixed-effects multivariable regression with random effects for individual and site. We controlled for age and sociodemographic factors important for access to care. Results: Over one-third of participants (35%) reported they delayed getting the contraceptive method they needed. Multivariable regression results showed increased odds of delayed contraceptive care among participants with symptoms of depression (adjusted odds ratio [aOR] 1.58, 95% confidence interval [CI] 1.27-1.96). Likewise, delays were associated with anxiety and stress symptoms (aOR 1.46, 95% CI 1.17-1.82). Adolescents were more likely to delay seeking contraception than young adults (aOR 1.32, 95% CI 1.07-1.63). Conclusions: Results showed a strong association between mental distress and delayed contraception. Interventions are needed to increase contraceptive access for young people delaying care, along with supportive mental health care services, including for adolescents who face elevated odds of delay. ClinicalTrials.gov Identifier: NCT03519685.
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Affiliation(s)
- Cynthia C Harper
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, California, USA
| | - Jennifer Yarger
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, California, USA
| | - Christina Mangurian
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco, California, USA
| | - Kristine Hopkins
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | - Irene Rossetto
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | - Sarah Elmes
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, California, USA
| | - Hannah K Hecht
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, California, USA
| | - Audrey Sanchez
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | | | - Mitra Shokat
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Julia R Steinberg
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
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Mangurian C, Brindis CD. Take these steps to accelerate the path to gender equity in health sciences. Nature 2024; 627:S21. [PMID: 38480972 DOI: 10.1038/d41586-024-00757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
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Henderson K, Reihm J, Koshal K, Wijangco J, Miller N, Sara N, Doyle M, Mallory A, Sheridan J, Guo CY, Oommen L, Feinstein A, Mangurian C, Lazar A, Bove R. Pragmatic phase II clinical trial to improve depression care in a real-world diverse MS cohort from an academic MS centre in Northern California: MS CATCH study protocol. BMJ Open 2024; 14:e077432. [PMID: 38401894 PMCID: PMC10895222 DOI: 10.1136/bmjopen-2023-077432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/25/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION Depression occurs in over 50% of individuals living with multiple sclerosis (MS) and can be treated using many modalities. Yet, it remains: under-reported by patients, under-ascertained by clinicians and under-treated. To enhance these three behaviours likely to promote evidence-based depression care, we engaged multiple stakeholders to iteratively design a first-in-kind digital health tool. The tool, MS CATCH (Care technology to Ascertain, Treat, and engage the Community to Heal depression in patients with MS), closes the communication loop between patients and clinicians. Between clinical visits, the tool queries patients monthly about mood symptoms, supports patient self-management and alerts clinicians to worsening mood via their electronic health record in-basket. Clinicians can also access an MS CATCH dashboard displaying patients' mood scores over the course of their disease, and providing comprehensive management tools (contributing factors, antidepressant pathway, resources in patient's neighbourhood). The goal of the current trial is to evaluate the clinical effect and usability of MS CATCH in a real-world clinical setting. METHODS AND ANALYSIS MS CATCH is a single-site, phase II randomised, delayed start, trial enrolling 125 adults with MS and mild to moderately severe depression. Arm 1 will receive MS CATCH for 12 months, and arm 2 will receive usual care for 6 months, then MS CATCH for 6 months. Clinicians will be randomised to avoid practice effects. The effectiveness analysis is superiority intent-to-treat comparing MS CATCH to usual care over 6 months (primary outcome: evidence of screening and treatment; secondary outcome: Hospital Anxiety Depression Scale-Depression scores). The usability of the intervention will also be evaluated (primary outcome: adoption; secondary outcomes: adherence, engagement, satisfaction). ETHICS AND DISSEMINATION University of California, San Francisco Institutional Review Board (22-36620). The findings of the study are planned to be shared through conferences and publishments in a peer-reviewed journal. The deidentified dataset will be shared with qualified collaborators on request, provision of CITI and other certifications, and data sharing agreement. We will share the results, once the data are complete and analysed, with the scientific community and patient/clinician participants through abstracts, presentations and manuscripts. TRIAL REGISTRATION NUMBER NCT05865405.
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Affiliation(s)
- Kyra Henderson
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Jennifer Reihm
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Kanishka Koshal
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Jaeleene Wijangco
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Nicolette Miller
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Narender Sara
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Marianne Doyle
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Alicia Mallory
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Judith Sheridan
- Patient Stakeholder, University of California San Francisco, San Francisco, California, USA
| | - Chu-Yueh Guo
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Lauren Oommen
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Christina Mangurian
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Ann Lazar
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Riley Bove
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
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Mangurian C, Spector ND, Shim RS. Centering Women of Color to Promote Excellence in Academic Medicine. N Engl J Med 2024; 390:102-104. [PMID: 38198175 DOI: 10.1056/nejmp2309206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Christina Mangurian
- From the Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco School of Medicine, and the Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (C.M.), and the Department of Psychiatry and Behavioral Sciences, University of California, Davis (R.S.S.) - all in California; and the Department of Pediatrics and Executive Leadership in Academic Medicine, Drexel University College of Medicine, Philadelphia (N.D.S.)
| | - Nancy D Spector
- From the Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco School of Medicine, and the Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (C.M.), and the Department of Psychiatry and Behavioral Sciences, University of California, Davis (R.S.S.) - all in California; and the Department of Pediatrics and Executive Leadership in Academic Medicine, Drexel University College of Medicine, Philadelphia (N.D.S.)
| | - Ruth S Shim
- From the Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco School of Medicine, and the Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (C.M.), and the Department of Psychiatry and Behavioral Sciences, University of California, Davis (R.S.S.) - all in California; and the Department of Pediatrics and Executive Leadership in Academic Medicine, Drexel University College of Medicine, Philadelphia (N.D.S.)
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Hubbard A, Sudler A, Alves-Bradford JME, Trinh NH, Emmerich AD, Mangurian C. Building a Diverse Psychiatric Workforce for the Future and Helping Them Thrive: Recommendations for Psychiatry Training Directors. Child Adolesc Psychiatr Clin N Am 2024; 33:57-69. [PMID: 37981337 DOI: 10.1016/j.chc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
The COVID-19 pandemic and murder of Mr George Floyd served as catalysts for examining antiracism efforts in psychiatry training programs and health care systems. Our recruitment and retention of Black, Indigenous, and other racial/ethnic minority psychiatry trainees has not met the demand for care and does not represent the communities served. Training directors at a critical juncture in creating systemic changes to recruitment, retention, policies, and curricular competencies to address ongoing inequities and disparities in health care. We describe several strategies and considerations for training directors in supporting a diverse psychiatric workforce.
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Affiliation(s)
- Asale Hubbard
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA 94107, USA; San Francisco VA Health Care System
| | - Andrew Sudler
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA 94107, USA
| | | | - Nhi-Ha Trinh
- Massachusetts General Hospital Department of Psychiatry
| | | | - Christina Mangurian
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA 94107, USA.
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Riano NS, Wesson P, Vittinghoff E, Cournos F, Dilley J, Mangurian C. HIV Viral Suppression Among Psychiatric Inpatients with Schizophrenia in San Francisco: A Retrospective Cohort Study. J Health Care Poor Underserved 2024; 35:1-7. [PMID: 38661855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
People with schizophrenia are at increased risk for contracting HIV and face higher mortality rates compared with the general population. Viral suppression is key to HIV care, yet little is known about this metric among people with HIV and schizophrenia. A chart review was conducted among people with HIV/AIDS and schizophrenia living in San Francisco who had received inpatient mental health services between 2010 and 2016. Demographic, laboratory, medication, encounter, and discharge data were collected, and were compared with all people living with HIV in San Francisco (PLWH-SF). Among 153 people living with HIV and comorbid schizophrenia, 77% were virally suppressed, compared to 67% for all PLWH-SF. Viral suppression for people with comorbid HIV and schizophrenia living in San Francisco appears higher than PLWH-SF. Further research is needed to confirm the association and mechanisms behind better treatment outcomes for people living with HIV and comorbid schizophrenia.
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Sosa JA, Mangurian C. Addressing Eldercare to Promote Gender Equity in Academic Medicine. JAMA 2023; 330:2245-2246. [PMID: 37983061 DOI: 10.1001/jama.2023.23743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
This Viewpoint argues for an expansion of paid family leave policies to include eldercare as a way to support the well-being of faculty members, retain physicians, and promote gender equity in academic medicine.
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Affiliation(s)
- Julie Ann Sosa
- Department of Surgery, School of Medicine, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Christina Mangurian
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco
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Abstract
Objective There has been an increase in Child Psychiatry Access Programs (CPAP) across the United States to address the national child and adolescent psychiatry workforce shortage by supporting pediatric primary care providers (PCPs) in providing mental health services. The objective of this systematic review is to synthesize the expanding literature on CPAPs. Method A systematic literature search was conducted in PubMed, PsycInfo, Embase, and Web of Science databases to identify articles published from database inception to April 6, 2022, to identify CPAPs, defined as programs with mental health specialists providing rapid remote mental health consultation services to pediatric PCPs. Study outcomes included program adoption, provider experience, patient and caregiver experience, program cost, and patient mental health. Results None of the 33 included studies were randomized controlled trials. Most of the studies (n = 30) focused on program adoption and provider experience (n = 18). Few studies examined patient and caregiver experience (n = 2), program cost(n = 4), or patient mental health (n = 4) outcomes. CPAPs showed year-over-year growth in adoption and were generally well-received by providers and caregivers. Health care provision costs were quite varied. No articles reported on changes in patient mental health according to validated measures. Heterogeneity in the methodological quality, study design, and outcomes used to evaluate CPAPs hindered comparison among programs. Conclusion Rigorous research on the impact of CPAPs is lacking. Findings show high provider satisfaction with CPAPs, yet few studies examine patient-level mental health outcomes. CPAPs and funding agencies should consider prioritizing and investing in research to build the evidence base for CPAPs. Diversity & Inclusion Statement One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. Clinical trial registration information Child Psychiatry Access Programs: A Systematic Review; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020146410; CRD42020146410.
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Affiliation(s)
- Chuan-Mei Lee
- University of California, San Francisco
- Stanford University School of Medicine
| | | | | | | | | | | | - Christina Mangurian
- University of California, San Francisco
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital
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Rennels C, Murthy SG, Handley MA, Morris MD, Alldredge BK, Dahiya P, Jagsi R, Kerns JL, Mangurian C. Informal Caregiving Among Faculty at a Large Academic Health Sciences University in the United States: an Opportunity for Policy Changes. Acad Psychiatry 2023:10.1007/s40596-023-01885-4. [PMID: 37821717 DOI: 10.1007/s40596-023-01885-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE This article aims to determine the prevalence of caregiving among faculty at a large academic health sciences institution, to examine the effect of gender and other demographic and professional covariates on caregiving status, and to explore caregiver-generated policy recommendations. METHOD A cross-sectional, mixed-methods survey was collected from June through August 2018. Participants were faculty within one of the institution's health professional schools (dentistry, medicine, nursing, or pharmacy) receiving at least 50% salary from the institution. In addition to demographic information, we collected academic series and rank, and assessed association between covariates on caregiving status using logistic regression. We analyzed open-ended responses using thematic analysis to identify themes in caregiver barriers and policy suggestions. RESULTS Among 657 eligible respondents, 11.4% were informal caregivers. Women were more likely to be caregivers than men (aOR 2.53, 95% CI: 1.40, 4.78), as were older faculty. Caregivers identified unsupportive climate or unrealistic work expectations, concern about career advancement, insufficient information about policies, and concern about colleague burden as barriers to support. Suggestions for workplace support included improved leave policies, increased flexibility, caregiver resource support, improved clarity and dissemination of policy information, and financial support. CONCLUSIONS Women faculty are more likely to be informal caregivers, exacerbating disparities within academic medicine for promotion and retention among women faculty. Institutions might include caregiving status in annual burnout surveys to guide the development of structural support and policies for extension of family leave beyond childbearing (or catastrophic leave), flexibility in work hours, and subsidized eldercare services.
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Affiliation(s)
- Carolyn Rennels
- University of California San Francisco, San Francisco, CA, USA
| | - Snehal G Murthy
- University of California San Francisco, San Francisco, CA, USA
| | | | - Meghan D Morris
- University of California San Francisco, San Francisco, CA, USA
| | | | - Priya Dahiya
- University of California San Francisco, San Francisco, CA, USA
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Santhosh L, Vo A, Wick C, Mourad M, Sarkar U, Jagsi R, Mangurian C. Policies to Support Lactation at Highly Ranked US Medical Schools. JAMA Netw Open 2023; 6:e2340048. [PMID: 37889493 PMCID: PMC10611993 DOI: 10.1001/jamanetworkopen.2023.40048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023] Open
Abstract
This cross-sectional study analyzes lactation support policies at the top 50 US schools of medicine.
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Affiliation(s)
- Lekshmi Santhosh
- Division of Pulmonary/Critical Care Medicine, Department of Medicine, University of California, San Francisco
| | - Ashley Vo
- University of California San Francisco School of Medicine, San Francisco
| | - Caroline Wick
- University of California Campus Life Services, San Francisco
| | - Michelle Mourad
- Division of Hospital Medicine, University of California, San Francisco
| | - Urmimala Sarkar
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
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Cutter CM, Szczygiel LA, Jones RD, Perry L, Mangurian C, Jagsi R. Strategies to Support Faculty Caregivers at U.S. Medical Schools. Acad Med 2023; 98:1173-1184. [PMID: 37257023 DOI: 10.1097/acm.0000000000005283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To describe the policies, processes, and programs at U.S. medical schools to support faculty caregivers before and in response to the COVID-19 pandemic. METHOD In 2021, the Doris Duke Charitable Foundation and founding members of the COVID-19 Fund to Retain Clinical Scientists (FRCS) Collaborative launched and supported the COVID-19 FRCS program to recognize medical schools and their efforts to strengthen policies, processes, and programs supporting biomedical faculty with family caregiving responsibilities in the context of COVID-19-related impacts. The authors conducted a qualitative conceptual content analysis of the deidentified, open-ended responses submitted by institutions in their applications to the COVID-19 FRCS program and summarized the reported strategies using recurring patterns and common approaches. RESULTS Fifty-four institutions applied to the COVID-19 FRCS program in 2021 and were included in this study. COVID-19-related impacts on biomedical faculty included stymied career progression and academic productivity, exacerbated career-caregiving time conflicts, adverse effects on family and personal well-being and mental health, increased financial hardships, and amplified faculty caregiver stigma. The described policies, processes, and programs to support faculty caregivers fell into 4 domains: support for dependent care, career and workplace flexibility, career development support, and institutional culture change to reduce stigma. COVID-19-related modifications spanned these domains with remote and flexible work manifesting as disruptive changes. Strategies to support women and underrepresented in medicine faculty, who bear a disproportionate burden of caregiving responsibilities, centered on career development support and institutional culture change. The projected durability of the enacted changes varied by institution and across strategies. CONCLUSIONS The COVID-19 pandemic presents a disruptive opportunity to translate lessons learned into positive change to better support faculty caregivers, particularly women and underrepresented in medicine faculty. This study's findings provide a framework to guide sustainable change to support equity, diversity, and vitality in the academic biomedical workforce.
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Affiliation(s)
- Christina M Cutter
- C.M. Cutter is assistant professor, Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lauren A Szczygiel
- L.A. Szczygiel is qualitative analyst, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Rochelle DeCastro Jones
- R.D. Jones is research area specialist senior, Center for Bioethics & Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lydia Perry
- L. Perry is research area specialist associate, Center for Bioethics & Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Christina Mangurian
- C. Mangurian is professor, Departments of Psychiatry & Behavioral Sciences and Epidemiology & Biostatistics, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California
| | - Reshma Jagsi
- R. Jagsi is the Lawrence W. Davis Professor and chair, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
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Mensah MO, Owda D, Ghanney Simons EC, Holaday LW, Bonner SN, Mangurian C, Ross JS. US Postgraduate Trainee Racial, Ethnic, and Gender Representation and Faculty Compensation By Specialty. JAMA 2023; 330:872-874. [PMID: 37535361 PMCID: PMC10401393 DOI: 10.1001/jama.2023.14139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/10/2023] [Indexed: 08/04/2023]
Abstract
This study compares postgraduate trainee racial, ethnic, and gender representation and faculty compensation for 21 clinical specialties using 2015-2022 data.
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Affiliation(s)
- Michael O. Mensah
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Dalia Owda
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut
| | - Efe C. Ghanney Simons
- Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles
| | - Louisa W. Holaday
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine
| | - Joseph S. Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Mangurian C, Fitelson E, Devlin M, Pumar M, Epel E, Dahiya P, Mayer LES, Jackson-Triche M. Envisioning the Future of Well-Being Efforts for Health Care Workers-Successes and Lessons Learned From the COVID-19 Pandemic. JAMA Psychiatry 2023; 80:962-967. [PMID: 37494012 DOI: 10.1001/jamapsychiatry.2023.2355] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Importance The National Academy of Medicine's National Plan for Health Workforce Well-Being provides recommendations for supporting the mental health and well-being of health care workers. This article aims to guide implementation of National Academy of Medicine recommendations by describing 2 programs at Columbia University Irving Medical Center and the University of California, San Francisco (UCSF), designed early in the COVID-19 pandemic to respond to the behavioral health needs of the health care workforce. The development of these programs, their similarities and differences, and the key lessons learned are discussed. Observations The well-being programs, CopeColumbia and UCSF Cope, shared key elements. Both efforts were led by their respective departments of psychiatry and used similar frameworks. Teams created strategic cross-university partnerships to share difficulties and successes across both programs. Moreover, both programs addressed compounding stressors of racial and political unrest, evaluated program components, and created resources for employee self-management. CopeColumbia and UCSF Cope differed in approaches to identifying high-risk employees and formal assessment and treatment pathways. From the authors' experience implementing these programs and having knowledge regarding health care workforce burnout, this article offers recommendations for the development of well-being programs. These include structural changes and resources to promote group and individual well-being emphasizing equity and justice, intentional involvement of psychiatry on well-being leadership teams, and bold efforts to destigmatize mental health care alongside clear paths to mental health treatment. Conclusions and Relevance The impact of the COVID-19 pandemic revealed a need for institutions to support the mental health and emotional well-being of health care workers. By outlining the development and implementation of 2 well-being programs in large academic health care settings and making recommendations to promote workforce well-being, it is the authors' hope that leaders will be empowered to carry forward critical changes. Most importantly, implementing plans now will provide the resilience needed both for the long shadow of the pandemic and future crises.
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Affiliation(s)
- Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco
- Department of Biostatistics and Epidemiology, University of California, San Francisco, San Francisco
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco
| | - Elizabeth Fitelson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Michael Devlin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- New York State Psychiatric Institute, New York
| | - Margo Pumar
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco
| | - Elissa Epel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco
| | - Priya Dahiya
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco
| | - Laurel E S Mayer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- New York State Psychiatric Institute, New York
| | - Maga Jackson-Triche
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco
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Thomas MD, Vittinghoff E, Koester KA, Dahiya P, Riano NS, Cournos F, Dawson L, Olfson M, Pinals DA, Crystal S, Walkup J, Shade S, Mangurian C, Arnold EA. Examining the Impact of State-Level Factors on HIV Testing for Medicaid Enrollees With Schizophrenia. J Acquir Immune Defic Syndr 2023; 94:18-27. [PMID: 37229531 PMCID: PMC10524352 DOI: 10.1097/qai.0000000000003225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/22/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND People with schizophrenia experience unique barriers to routine HIV testing, despite increased risk of HIV compared with the general US population. Little is known about how health care delivery system factors affect testing rates or whether there are testing differences for people with schizophrenia. SETTING Nationally representative sample of Medicaid enrollees with and without schizophrenia. METHODS Using retrospective longitudinal data, we examined whether state-level factors were associated with differences in HIV testing among Medicaid enrollees with schizophrenia compared with frequency-matched controls during 2002-2012. Multivariable logistic regression estimated testing rate differences between and within cohorts. RESULTS Higher HIV testing rates for enrollees with schizophrenia were associated with higher state-level Medicaid spending per enrollee, efforts to reduce Medicaid fragmentation, and higher federal prevention funding. State-level AIDS epidemiology predicted more frequent HIV testing for enrollees with schizophrenia versus controls. Living in rural settings predicted lower HIV testing, especially for people with schizophrenia. CONCLUSION Overall, state-level predictors of HIV testing rates varied among Medicaid enrollees, although rates were generally higher for those with schizophrenia than controls. Increased HIV testing for people with schizophrenia was associated with coverage of HIV testing when medically necessary, higher Centers for Disease Control and Prevention prevention funding, and higher AIDS incidence, prevalence, and mortality when compared with controls. This analysis suggests that state policymaking has an important role to play in advancing that effort. Overcoming fragmented care systems, sustaining robust prevention funding, and consolidating funding streams in innovative and flexible ways to support more comprehensive systems of care delivery deserve attention.
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Affiliation(s)
- Marilyn D. Thomas
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine 550 16th St 2 floor, San Francisco, CA 94158
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine 675 18th St, San Francisco, CA 94107
| | - Eric Vittinghoff
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine 550 16th St 2 floor, San Francisco, CA 94158
| | - Kimberly A. Koester
- Department of Medicine, University of California San Francisco, School of Medicine 533 Parnassus Ave, San Francisco, CA 94143
| | - Priya Dahiya
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine 675 18th St, San Francisco, CA 94107
| | - Nicholas S. Riano
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine 675 18th St, San Francisco, CA 94107
- Department of Psychological Science, School of Social Ecology, University of California Irvine, 2220 Social and Behavioral Sciences Gateway, 214 Pereira Dr, Irvine, CA 92617
| | - Francine Cournos
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons 630 W 168th St, New York, NY 10032
- Department of Epidemiology, Columbia University Mailman School of Public Health 722 W 168th St, New York, NY 10032
| | - Lindsey Dawson
- KFF (Kaiser Family Foundation) 185 Berry St #2000, San Francisco, CA 94107
| | - Mark Olfson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons 630 W 168th St, New York, NY 10032
- Department of Epidemiology, Columbia University Mailman School of Public Health 722 W 168th St, New York, NY 10032
- New York State Psychiatric Institute 1051 Riverside Dr, New York, NY 10032
| | - Debra A. Pinals
- Department of Psychiatry, University of Michigan Medical School 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Steven Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University 112 Paterson St, New Brunswick, NJ 08901
| | - James Walkup
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University 112 Paterson St, New Brunswick, NJ 08901
- Graduate School of Applied and Professional Psychology, Rutgers University 152 Frelinghuysen Rd, Piscataway, NJ 08854
| | - Starley Shade
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine 550 16th St 2 floor, San Francisco, CA 94158
| | - Christina Mangurian
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine 550 16th St 2 floor, San Francisco, CA 94158
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine 675 18th St, San Francisco, CA 94107
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital 2789 25th St, San Francisco, CA 94110
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco 490 Illinois Street 7 Floor, San Francisco, CA 94158
| | - Emily A. Arnold
- Department of Medicine, University of California San Francisco, School of Medicine 533 Parnassus Ave, San Francisco, CA 94143
- Center for AIDS Prevention Studies, University of California San Francisco 550 16th St 3rd floor, San Francisco, CA 94158
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Thomas MD, Calmasini C, Khela H, Mobley TM, Rose Mayeda E, Mangurian C, Barnes LL, Gilsanz P, Whitmer RA, Glymour MM. The impact of attending historically Black colleges and universities on cognitive decline in Black adults: A longitudinal analysis in the KHANDLE and STAR cohorts. Alzheimers Dement 2023; 19:3426-3434. [PMID: 36800287 PMCID: PMC10432571 DOI: 10.1002/alz.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Black students attending predominantly White institutions (PWIs) versus historically Black colleges and universities (HBCUs) report more harmful discrimination and develop worse mental health outcomes, potentially offsetting the established benefits of college for lowering dementia incidence. METHODS Black participants in two cohorts (the Kaiser Healthy Aging and Diverse Life Experiences [KHANDLE] and the Study of Healthy Aging in African Americans [STAR]) who had attended college (N = 716) self-reported the college name (classified as HBCU vs. PWI) and completed three waves of executive function (EF) and verbal episodic memory (VEM) assessments. HBCU effects on cognitive level and decline were estimated using adjusted linear mixed-effects models. RESULTS HBCU (vs. PWI) attendees averaged better EF (β = 0.05 [-0.22, 0.32]) and VEM (β = 0.21 [-0.06, 0.46]) at age 70 though neither association was statistically significant. HBCU attendance was associated with slightly faster VEM decline (β = -0.03 [-0.05, 0.00]). DISCUSSION Harmonized analyses with larger studies are needed to estimate important effects of HBCU attendance. HIGHLIGHTS Higher education is robustly linked to lower dementia risk, yet Black-White inequities persist among college-educated adults. Black students attending predominantly White institutions (PWIs) versus historically Black colleges and universities (HBCUs) report more harmful discrimination and develop worse mental health outcomes, which may offset the established benefits of college for lowering dementia incidence. HBCU (vs. non-HBCU) attendees averaged better executive function and verbal episodic memory (VEM) at average age 70, though confidence intervals were wide and associations were not statistically significant, and averaged slightly faster decline in VEM. Harmonized analyses using larger nationally representative studies are likely needed to avoid underestimating the health effects of HBCU attendance.
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Affiliation(s)
- Marilyn D. Thomas
- University of California, San Francisco, School of Medicine, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA, USA
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Camilla Calmasini
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Harmon Khela
- Johns Hopkins University, Departments of Biology and of Public Health Studies, Baltimore, MD, USA
| | - Taylor M. Mobley
- Department of Epidemiology, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Christina Mangurian
- University of California, San Francisco, School of Medicine, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA, USA
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Paola Gilsanz
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Rachel A. Whitmer
- Kaiser Permanente Division of Research, Oakland, CA, USA
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
- Alzheimer’s Disease Research Center, University of California Davis Health, Sacramento, CA, USA
| | - M. Maria Glymour
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
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Abstract
OBJECTIVE The authors investigated associations between rates of contact with individuals in distress during field visits by mobile crisis teams and client and referral source characteristics. METHODS In this retrospective observational study of an urban mobile crisis program, call logs (N=2,581) were coded for whether an attempted field visit resulted in a client evaluation. Logistic regression analyses examined potential associations with client age, gender, race-ethnicity, primary language, living situation, insurance, and referral source. RESULTS Contact was made with 77% of adults and 97% of children referred to mobile crisis teams. Field visit contact rates differed by age. Unsuccessful visits were more likely when the referral source was from institutional settings than from individuals. CONCLUSIONS Approximately one-quarter of attempted field visits with adults by an urban mobile crisis team were not completed, particularly among referrals from institutional settings. As mobile crisis services proliferate, field visit contact rate could be a key performance metric for these critical services.
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Affiliation(s)
- Matthew L Goldman
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Andrea N Ponce
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Marilyn Thomas
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Stephanie Felder
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Stephen Wu
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Rachel Loewy
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
| | - Christina Mangurian
- San Francisco Department of Public Health, San Francisco (Goldman, Felder, Wu); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman, Ponce, Thomas, Loewy, Mangurian)
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Walkup J, Thomas MD, Vittinghoff E, Hermida R, Crystal S, Arnold EA, Dahiya P, Olfson M, Cournos F, Dawson L, Dilley J, Bazazi A, Mangurian C. Characteristics and Trends in HIV Testing Among Medicaid Enrollees Diagnosed as Having Schizophrenia. Psychiatr Serv 2023; 74:709-717. [PMID: 36852552 PMCID: PMC10329993 DOI: 10.1176/appi.ps.20220311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE People with schizophrenia have more HIV risk factors and higher rates of HIV infection than the general U.S. population. The authors aimed to examine HIV testing patterns in this population nationally and by demographic characteristics and presence of high-risk comorbid conditions. METHODS This retrospective longitudinal study compared HIV testing between Medicaid-only enrollees with schizophrenia and without schizophrenia during 2002-2012 (N=6,849,351). Interrupted time series were used to analyze the impacts of the 2006 federal policy change recommending expanded HIV testing. Among enrollees with schizophrenia, multivariable logistic regression was used to estimate associations between testing and both demographic characteristics and comorbid conditions. Sensitivity analyses were also conducted. RESULTS Enrollees diagnosed as having schizophrenia had consistently higher HIV testing rates than those without schizophrenia. When those with comorbid substance use disorders or sexually transmitted infections were excluded, testing was higher for individuals without schizophrenia (p<0.001). The federal policy change likely increased testing for both groups (p<0.001), but the net change was greater for those without schizophrenia (3.1 vs. 2.2 percentage points). Among enrollees with schizophrenia, testing rates doubled during 2002-2012 (3.9% to 7.2%), varied across states (range 17 percentage points), and tripled for those with at least one annual nonpsychiatric medical visit (vs. no visit; adjusted OR=3.10, 95% CI=2.99-3.22). CONCLUSIONS Nationally, <10% of enrollees with schizophrenia had annual HIV testing. Increases appear to be driven by high-risk comorbid conditions and nonpsychiatric encounters, rather than by efforts to target people with schizophrenia. Psychiatric guidelines for schizophrenia care should consider HIV testing alongside annual metabolic screening.
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Affiliation(s)
- James Walkup
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Marilyn D Thomas
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Eric Vittinghoff
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Richard Hermida
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Emily A Arnold
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Priya Dahiya
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Mark Olfson
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Francine Cournos
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Lindsey Dawson
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - James Dilley
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Alexander Bazazi
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
| | - Christina Mangurian
- Institute for Health, Health Care Policy, and Aging Research (Walkup, Hermida, Crystal) and Graduate School of Applied and Professional Psychology (Walkup), Rutgers University, New Brunswick, New Jersey; Department of Epidemiology and Biostatistics (Thomas, Vittinghoff, Mangurian), Department of Psychiatry and Behavioral Sciences (Thomas, Dahiya, Dilley, Bazazi, Mangurian), and Center for AIDS Prevention Studies (Arnold), University of California San Francisco School of Medicine, San Francisco; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Olfson, Cournos); New York State Psychiatric Institute, New York City (Olfson); Kaiser Family Foundation, Washington, D.C. (Dawson)
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20
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Jackson-Triche M, Vetal D, Turner EM, Dahiya P, Mangurian C. Meeting the Behavioral Health Needs of Health Care Workers During COVID-19 by Leveraging Chatbot Technology: Development and Usability Study. J Med Internet Res 2023; 25:e40635. [PMID: 37146178 PMCID: PMC10263106 DOI: 10.2196/40635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/23/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, health care systems were faced with the urgent need to implement strategies to address the behavioral health needs of health care workers. A primary concern of any large health care system is developing an easy-to-access, streamlined system of triage and support despite limited behavioral health resources. OBJECTIVE This study provides a detailed description of the design and implementation of a chatbot program designed to triage and facilitate access to behavioral health assessment and treatment for the workforce of a large academic medical center. The University of California, San Francisco (UCSF) Faculty, Staff, and Trainee Coping and Resiliency Program (UCSF Cope) aimed to provide timely access to a live telehealth navigator for triage and live telehealth assessment and treatment, curated web-based self-management tools, and nontreatment support groups for those experiencing stress related to their unique roles. METHODS In a public-private partnership, the UCSF Cope team built a chatbot to triage employees based on behavioral health needs. The chatbot is an algorithm-based, automated, and interactive artificial intelligence conversational tool that uses natural language understanding to engage users by presenting a series of questions with simple multiple-choice answers. The goal of each chatbot session was to guide users to services that were appropriate for their needs. Designers developed a chatbot data dashboard to identify and follow trends directly through the chatbot. Regarding other program elements, website user data were collected monthly and participant satisfaction was gathered for each nontreatment support group. RESULTS The UCSF Cope chatbot was rapidly developed and launched on April 20, 2020. As of May 31, 2022, a total of 10.88% (3785/34,790) of employees accessed the technology. Among those reporting any form of psychological distress, 39.7% (708/1783) of employees requested in-person services, including those who had an existing provider. UCSF employees responded positively to all program elements. As of May 31, 2022, the UCSF Cope website had 615,334 unique users, with 66,585 unique views of webinars and 601,471 unique views of video shorts. All units across UCSF were reached by UCSF Cope staff for special interventions, with >40 units requesting these services. Town halls were particularly well received, with >80% of attendees reporting the experience as helpful. CONCLUSIONS UCSF Cope used chatbot technology to incorporate individualized behavioral health triage, assessment, treatment, and general emotional support for an entire employee base (N=34,790). This level of triage for a population of this size would not have been possible without the use of chatbot technology. The UCSF Cope model has the potential to be scaled, adapted, and implemented across both academically and nonacademically affiliated medical settings.
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Affiliation(s)
- Maga Jackson-Triche
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | | | - Eva-Marie Turner
- UCSF Health, University of California, San Francisco, San Francisco, CA, United States
| | - Priya Dahiya
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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21
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Mensah MO, Ghanney Simons EC, Mangurian C, Ross JS. US Post-Graduate Residency Competitiveness, Trainee Diversity, and Future Salary Among 12 Clinical Specialties. J Gen Intern Med 2023; 38:1567-1569. [PMID: 36357730 PMCID: PMC10160250 DOI: 10.1007/s11606-022-07868-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/21/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Michael O Mensah
- National Clinician Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Efe C Ghanney Simons
- Department of Urology, David Geffen School of Medicine (DGSOM), University of California, Los Angeles (UCLA), Los Angeles, USA
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Joseph S Ross
- Section of General Medicine and National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, USA
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22
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Roubinov D, Griffith KA, Simone NL, Alvarez SE, Thomas M, Mangurian C, Jagsi R. Gender Composition in Biomedical Research Grant Submissions and Grant Review Panels Before Versus During the COVID-19 Pandemic. J Womens Health (Larchmt) 2023; 32:471-477. [PMID: 36795988 PMCID: PMC10329151 DOI: 10.1089/jwh.2022.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Purpose: This study examined the gender composition of career development award applicants and grant review panels during the pandemic compared with that beforehand. Methods: Data were collected from 14 Health Research Alliance (HRA) organizations, which fund biomedical research and training. HRA members provided the gender of grant applicants and grant reviewers during the pandemic (April 1, 2020, to February 28, 2021) and prepandemic (April 1, 2019, to February 29, 2020). The signed-rank test compared medians and the chi square test compared the overall gender distribution. Results: The total number of applicants was similar during the pandemic (N = 3,724) and prepandemic (N = 3,882) periods, as was the percentage of women applicants (45.2% pandemic vs. 44.9% prepandemic, p = 0.78). The total number of men and women grant reviewers declined during the pandemic (N = 856) compared with that pre-pandemic (N = 1,689); this decrease was driven by a change for the largest funder. Also driven by changes for this one funder, the percentage of total grant reviewers who were women increased significantly during the pandemic (45.9%) compared with that during prepandemic (38.8%; p = 0.001), but the median percentage of women grant reviewers across organizations remained similar during the pandemic (43.6%) and prepandemic periods (38.2%; p = 0.53). Conclusions: In a sample of research organizations, the gender composition of grant applicants and grant review panels remained similar, except for the review panel composition for one large funder. Given evidence from other studies that have revealed gender differences in other career and life experiences of scientists during the pandemic, ongoing evaluation of women's representation in grant submission and review mechanisms is essential.
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Affiliation(s)
- Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Kent A. Griffith
- Center for Cancer Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicole L. Simone
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Marilyn Thomas
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory School of Medicine and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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23
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Abstract
In this narrative medicine essay, a psychiatrist finds that the difficulties she had helping her parents obtain Paxlovid seemed a common experience among her colleagues, so she offers patients and the medical community suggestions on how to simplify the process.
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Affiliation(s)
- Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Department of Biostatistics and Epidemiology, University of California, San Francisco
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24
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Burns CJ, Russell CB, Griffith KA, Mangurian C, Johnson TRB, Jagsi R. Gender Differences of Endowed Professorship in Obstetrics and Gynecology Departments at Top Academic Institutions. J Womens Health (Larchmt) 2023; 32:39-46. [PMID: 36126297 DOI: 10.1089/jwh.2022.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Gender equity is a critical issue in academic medicine. Whether there is equitable access to the prestige and resources of endowed professorships merits evaluation. We investigated this question in obstetrics and gynecology, a field that focuses on the health of women and in which women are much better represented than other specialties of medicine. Materials and Methods: We compiled a list of the top 25 United States departments of obstetrics and gynecology and contacted department chairs (and used department websites) to obtain lists of faculty and their positions. Scopus, department websites, and National Institutes of Health (NIH) RePORTER were used to collect h-Index, number of publications and citations, graduation year, degrees, gender, and NIH-funding. We conducted a bivariate comparison of endowed professorship attainment by gender using a chi-square test and created a multiple variable regression model. Results: Of the 680 obstetrics and gynecology faculty across 23 departments that had endowed chairs, 64 out of 400 women (16%) and 66 out of 280 men (24%) held endowed chairs (p = 0.01). The multivariable model suggested no independent gender difference in attainment of an endowed chair after adjusting for covariates. Conclusion: To our knowledge, this study is the first to examine gender as a variable in endowed chair allocation in top obstetrics and gynecology academic departments. Our findings suggest a significant gender difference in the allocation of endowed chairs. That difference is driven by gender differences in academic rank, graduation year, publications, and funding. To promote the intraprofessional equity necessary to optimally advance women's health, further research and intervention are necessary.
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Affiliation(s)
| | - Colin B Russell
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kent A Griffith
- University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Timothy R B Johnson
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Gender and Women's Studies Department, College of Literature, Science and the Arts, University of Michigan, Ann Arbor, Michigan, USA
| | - Reshma Jagsi
- University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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25
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Hwong AR, Chagwedera DN, Thomas M, Niu G, Quan J, Vittinghoff E, Schillinger D, Newcomer JW, Gonzalez A, Essock S, Mangurian C. CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care. BMC Psychiatry 2022; 22:687. [PMID: 36348280 PMCID: PMC9644536 DOI: 10.1186/s12888-022-04293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with serious mental illness often do not receive guideline-concordant metabolic screening and human immunodeficiency virus (HIV) testing, contributing to increased morbidity and premature mortality. This study evaluates the effectiveness of CRANIUM (Cardiometabolic Risk Assessment and treatment through a Novel Integration model for Underserved populations with Mental illness), an intervention to increase metabolic screening and HIV testing among patients with serious mental illness in a community mental health clinic compared to usual care. METHODS The study used a quasi-experimental design, prospectively comparing a preventive care screening intervention at one community mental health clinic (n = 536 patients) to usual care at the remaining clinics within an urban behavioural health system (n = 4,847 patients). Psychiatrists at the intervention site received training in preventive health screening and had access to a primary care consultant, screening and treatment algorithms, patient registries, and a peer support specialist. Outcomes were the change in screening rates of A1c, lipid, and HIV testing post-intervention at the intervention site compared to usual care sites. RESULTS Rates of lipid screening and HIV testing increased significantly at the intervention site compared to usual care, with and without multivariable adjustment [Lipid: aOR 1.90, 95% CI 1.32-2.75, P = .001; HIV: aOR 23.42, 95% CI 5.94-92.41, P < .001]. While we observed a significant increase in A1c screening rates at the intervention site, this increase did not persist after multivariable adjustment (aOR 1.37, 95% CI .95-1.99, P = .09). CONCLUSIONS This low-cost, reverse integrated care model targeting community psychiatrist practices had modest effects on increasing preventive care screenings, with the biggest effect seen for HIV testing rates. Additional incentives and structural supports may be needed to further promote screening practices for individuals with serious mental illness.
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Affiliation(s)
- Alison R Hwong
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA. .,UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | | | - Marilyn Thomas
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Grace Niu
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | - Judy Quan
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | - Dean Schillinger
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.,UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - John W Newcomer
- Thriving Mind South Florida, Miami, FL, USA.,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Ana Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Susan Essock
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Department of Psychiatry, Columbia University, New York, NY, USA
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.,UCSF Philip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA
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26
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Ogbu-Nwobodo L, Shim RS, Vinson SY, Fitelson EM, Biggs MA, McLemore MR, Thomas M, Godzich M, Mangurian C. Mental Health Implications of Abortion Restrictions for Historically Marginalized Populations. N Engl J Med 2022; 387:1613-1617. [PMID: 36300980 DOI: 10.1056/nejmms2211124] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lucy Ogbu-Nwobodo
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Ruth S Shim
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Sarah Y Vinson
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Elizabeth M Fitelson
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - M Antonia Biggs
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Monica R McLemore
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Marilyn Thomas
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Micaela Godzich
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Christina Mangurian
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
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27
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Hwong AR, Vittinghoff E, Thomas M, Hermida R, Walkup J, Crystal S, Olfson M, Mangurian C. Breast Cancer Screening Rates Among Medicaid Beneficiaries With Schizophrenia. Psychiatr Serv 2022; 74:497-504. [PMID: 36226372 PMCID: PMC10104476 DOI: 10.1176/appi.ps.20220163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Women with serious mental illness are more likely to be diagnosed as having late-stage breast cancer than women without serious mental illness, suggesting a disparity in screening mammography. This study aimed to compare screening mammography rates in a nationally representative sample of Medicaid beneficiaries with and without schizophrenia. METHODS Medicaid Analytic eXtract files, 2007-2012, were used to identify a cohort of women ages 40-64 with schizophrenia who were eligible for Medicaid but not Medicare (N=87,572 in 2007 and N=114,341 in 2012) and a cohort without schizophrenia, frequency-matched by age, race-ethnicity, and state (N=97,003 in 2007 and N=126,461 in 2012). Annual screening mammography rates were calculated and adjusted for demographic characteristics and comorbid conditions. Multivariable logistic regression was used to estimate the association between beneficiary characteristics and screening mammography rates. RESULTS In 2012, 27.2% of women with schizophrenia completed screening mammography, compared with 26.8% of the control cohort. In the schizophrenia cohort, American Indian/Alaskan Native women had significantly lower odds of receiving mammography (OR=0.82, p=0.02) than White women, whereas Hispanic/Latina women had higher odds (OR=1.16, p<0.001). Women with schizophrenia and a nonalcohol-related substance use disorder had lower odds of receiving mammography (OR=0.74, p<0.001) than women without a substance use disorder. Having at least one medical visit in the past year (vs. no visits) increased the odds of receiving screening mammography (OR=5.08, p<0.001). CONCLUSIONS Screening mammography rates were similar between Medicaid-insured women with and those without schizophrenia. Interventions to increase uptake may need to focus on improving socioeconomic conditions and primary care engagement for vulnerable populations, regardless of psychiatric condition.
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Affiliation(s)
- Alison R Hwong
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Eric Vittinghoff
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Marilyn Thomas
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Richard Hermida
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - James Walkup
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Stephen Crystal
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Mark Olfson
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
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Roubinov D, Haack LM, Folk JB, Rotenstein L, Accurso EC, Dahiya P, Ponce AN, Nava V, Maldonado Y, Linos E, Mangurian C. Gender Differences in National Institutes of Health Grant Submissions Before and During the COVID-19 Pandemic. J Womens Health (Larchmt) 2022; 31:1241-1245. [PMID: 36112424 PMCID: PMC9527056 DOI: 10.1089/jwh.2022.0182] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction: Emerging data suggest that the COVID-19 pandemic has disproportionately impacted women in academic medicine, potentially eliminating recent gains that have been made toward gender equity. This study examined possible pandemic-related gender disparities in research grant submissions, one of the most important criteria for academic promotion and tenure evaluations. Methods: Data were collected from two major academic institutions (one private and one public) on the gender and academic rank of faculty principal investigators who submitted new grants to the National Institutes of Health (NIH) during COVID-19 (March 1st, 2020, through August 31, 2020) compared with a matched period in 2019 (March 1st, 2019, through August 31, 2019). t-Tests and chi-square analyses compared the gender distribution of individuals who submitted grants during the two periods of examination. Results: In 2019 (prepandemic), there was no significant difference in the average number of grants submitted by women compared with men faculty. In contrast, women faculty submitted significantly fewer grants in 2020 (during the pandemic) than men. Men were also significantly more likely than women to submit grants in both 2019 and 2020 compared with submitting in 2019 only, suggesting men faculty may have been more likely than their women colleagues to sustain their productivity in grant submissions during the pandemic. Discussion: Women's loss of extramural funding may compound over time, as it impedes new data collection, research progress, and academic advancement. Efforts to support women's research productivity and career trajectories are urgently needed in the following years of pandemic recovery.
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Affiliation(s)
- Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Lauren M. Haack
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Johanna B. Folk
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Lisa Rotenstein
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Erin C. Accurso
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Priya Dahiya
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Andrea N. Ponce
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Vanessa Nava
- Program for Clinical Research and Technology, Department of Dermatology, Stanford University, Stanford, California, USA
| | - Yvonne Maldonado
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Eleni Linos
- Program for Clinical Research and Technology, Department of Dermatology, Stanford University, Stanford, California, USA
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
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Lee CM, Lutz J, Khau A, Lin B, Phillip N, Ackerman S, Steinbuchel P, Mangurian C. Pediatric Primary Care Perspectives of Mental Health Services Delivery during the COVID-19 Pandemic. Children 2022; 9:children9081167. [PMID: 36010056 PMCID: PMC9406881 DOI: 10.3390/children9081167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022]
Abstract
Due to a national shortage of child and adolescent psychiatrists, pediatric primary care providers (PCPs) are often responsible for the screening, evaluation, and treatment of mental health disorders. COVID-19 pandemic stay-at-home orders decreased access to mental health care and increased behavioral and emotional difficulties in children and adolescents. Despite increased demand upon clinicians, little is known about mental health care delivery in the pediatric primary care setting during the pandemic. This focus group study explored the experiences of pediatric PCPs and clinical staff delivering mental health care during the pandemic. Transcripts from nine focus groups with San Francisco Bay Area primary care practices between April and August 2020 were analyzed using a thematic analysis approach. Providers expressed challenges at the patient-, provider-, and system-levels. Many providers reported increased patient mental health symptomatology during the pandemic, which was often intertwined with patients’ social determinants of health. Clinicians discussed the burden of the pandemic their own wellness, and how the rapid shift to telehealth primary care and mental health services seemed to hinder the availability and effectiveness of many resources. The findings from this study can inform the creation of new supports for PCPs and clinical staff providing mental health care.
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Affiliation(s)
- Chuan Mei Lee
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, USA;
- Clinical Excellence Research Center, School of Medicine, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
- Correspondence: ; Tel.: +1-415-476-7000 or +1-415-502-6361
| | - Jessica Lutz
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Allyson Khau
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Brendon Lin
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Nathan Phillip
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Sara Ackerman
- Department of Social and Behavioral Sciences, University of California San Francisco, 490 Illinois St., Floor 12, Box 0612, San Francisco, CA 94143, USA;
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., 2nd Floor, San Francisco, CA 94158, USA
| | - Petra Steinbuchel
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, USA;
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., 2nd Floor, San Francisco, CA 94158, USA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, 2789 25th St., San Francisco, CA 94110, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., San Francisco, CA 94158, USA
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Mangurian C, Thomas MD, Mitsuishi F, Goldman LE, Niu G, Handley MA, Riano NS, Hwong A, Essock S, Dilley J, Newcomer JW, Schillinger D. Lessons Learned From a New Reverse-Integration Model to Improve Primary Care Screening in Community Mental Health Settings. Psychiatr Serv 2022; 73:942-945. [PMID: 35138129 PMCID: PMC9357142 DOI: 10.1176/appi.ps.202100177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors sought to describe a reverse-integration intervention aimed at improving preventive health screening in a community mental health clinic. The intervention, CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness), integrated primary care services into a large urban community mental health setting. It was implemented in 2015 and included a patient-centered team, population-based care, emphasis on screening, and evidence-based treatment. CRANIUM's strengths included provider acceptability, a patient-centered approach, sustained patient engagement, and economic feasibility. Challenges included underutilized staff, registry maintenance, and unanticipated screening barriers. The CRANIUM reverse-integration model can be feasibly implemented and was acceptable to providers.
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Affiliation(s)
- Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Marilyn D Thomas
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Fumi Mitsuishi
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - L Elizabeth Goldman
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Grace Niu
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Margaret A Handley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Nicholas S Riano
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Alison Hwong
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Susan Essock
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - James Dilley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - John W Newcomer
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Dean Schillinger
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Mangurian, Thomas, Mitsuishi, Niu, Riano, Hwong, Dilley), and Department of Epidemiology and Biostatistics (Mangurian, Handley), University of California, San Francisco (UCSF); Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital (Goldman, Handley, Schillinger); Department of Psychiatry, Columbia University, New York City (Essock); Department of Psychiatry, Washington University School of Medicine, St. Louis, and Thriving Mind South Florida, Miami (Newcomer). Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
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Affiliation(s)
- Maga Jackson-Triche
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Francine Cournos, M.D., and Stephen M. Goldfinger, M.D., are editors of this column
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco. Francine Cournos, M.D., and Stephen M. Goldfinger, M.D., are editors of this column
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Thomas MD, Calmasini C, Seblova D, Lapham S, Peters K, Prescott CA, Mangurian C, Glymour MM, Manly JJ. Postsecondary Education and Late-life Cognitive Outcomes Among Black and White Participants in the Project Talent Aging Study: Can Early-life Cognitive Skills Account for Educational Differences in Late-life Cognition? Alzheimer Dis Assoc Disord 2022; 36:215-221. [PMID: 35791067 PMCID: PMC9420770 DOI: 10.1097/wad.0000000000000519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/27/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Higher education consistently predicts improved late-life cognition. Racial differences in educational attainment likely contribute to inequities in dementia risk. However, few studies of education and cognition have controlled for prospectively measured early-life confounders or evaluated whether the education late-life cognition association is modified by race/ethnicity. METHODS Among 2343 Black and White Project Talent Aging Study participants who completed telephone cognitive assessments, we evaluated whether the association between years of education and cognition (verbal fluency, memory/recall, attention, and a composite cognitive measure) differed by race, and whether these differences persisted when adjusting for childhood factors, including the cognitive ability. RESULTS In fully adjusted linear regression models, each additional year of education was associated with higher composite cognitive scores for Black [β=0.137; 95% confidence interval (CI)=0.068, 0.206] and White respondents (β=0.056; CI=0.034, 0.078) with an interaction with race ( P =0.03). Associations between education and memory/recall among Black adults (β=0.036; CI=-0.037, 0.109) and attention among White adults (β=0.022; CI=-0.002, 0.046) were nonsignificant. However, there were significant race-education interactions for the composite ( P =0.03) and attention measures ( P <0.001) but not verbal fluency ( P =0.61) or memory/recall ( P =0.95). CONCLUSION Education predicted better overall cognition for both Black and White adults, even with stringent control for prospectively measured early-life confounders.
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Affiliation(s)
- Marilyn D Thomas
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
- University of California, San Francisco, School of Medicine, Department of Psychiatry and Behavioral Sciences, San Francisco, CA, USA
| | - Camilla Calmasini
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | | | - Susan Lapham
- American Institutes for Research, Washington, DC, USA
| | - Kelly Peters
- American Institutes for Research, Washington, DC, USA
| | | | - Christina Mangurian
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
- University of California, San Francisco, School of Medicine, Department of Psychiatry and Behavioral Sciences, San Francisco, CA, USA
| | - M. Maria Glymour
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
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Linos E, Lasky-Fink J, Halley M, Sarkar U, Mangurian C, Sabry H, Linos E, Jagsi R. Impact of Sexual Harassment and Social Support on Burnout in Physician Mothers. J Womens Health (Larchmt) 2022; 31:932-940. [PMID: 35730998 DOI: 10.1089/jwh.2021.0487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Burnout affects >50% of physicians, especially women. This study aimed to examine how negative workplace interactions can predict burnout, and whether positive social interactions can mitigate risk. Materials and Methods: In a study of 1627 physician mothers who responded to a survey by the Physician Moms Group, an online Facebook group, we first examined the association between workplace sexual harassment and burnout. In an embedded experiment, we then measured the causal impact of priming perceived social support and connectedness on the three dimensions of employee burnout. Results: Two-thirds of respondents reported having experienced sexual harassment in the past year. Sexual harassment by patients was associated with 0.27 points higher emotional exhaustion, one dimension of burnout (95% confidence interval [CI] 0.12-0.41), equivalent to the predicted impact of an additional 22 weekly work hours on emotional exhaustion. Sexual harassment by patients was also associated with 0.40 points higher patient depersonalization, another dimension of burnout (95% CI 0.27-0.53). Sexual harassment by colleagues was associated with 0.16 points higher emotional exhaustion (95% CI 0.02-0.30), but not other dimensions of burnout. We found no significant relationship between experiences of sexual harassment and levels of personal accomplishment (the third dimension of burnout) among this sample. Priming physician mothers to reflect on their connectedness with other physician mothers significantly increased their sense of personal accomplishment. The priming intervention did not yield a significant effect on emotional exhaustion or depersonalization. Conclusions: Negative and positive social interactions each affect different dimensions of burnout. Sexual harassment-a pervasive type of negative social interaction-strongly predicts emotional exhaustion and depersonalization. Reflecting on social connectedness-a type of positive social interaction-can improve one's sense of personal accomplishment with an effect similar in magnitude to more intensive in-person interventions, suggesting that social connectedness through online groups merits further consideration as a tool to mitigate burnout.
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Affiliation(s)
- Elizabeth Linos
- Goldman School of Public Policy, University of California, Berkeley, Berkeley, California, USA
| | - Jessica Lasky-Fink
- Goldman School of Public Policy, University of California, Berkeley, Berkeley, California, USA
| | - Meghan Halley
- Center for Biomedical Ethics, Stanford University, Stanford, California, USA
| | - Urmimala Sarkar
- Department of Medicine and Epidemiology, University of California, San Francisco, San Francisco, California, USA.,Department of Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Christina Mangurian
- Department of Biostatistics, University of California, San Francisco, San Francisco, California, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.,Department of Behavioral Sciences and Epidemiology, University of California, San Francisco, San Francisco, California, USA
| | - Hala Sabry
- Emergency Medicine, CEP America, Apple Valley, California, USA
| | - Eleni Linos
- Department of Dermatology and Epidemiology, Stanford University, Stanford, California, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Roselin D, Lee J, Jagsi R, Blair-Loy M, Ira K, Dahiya P, Williams J, Mangurian C. Medical Student Parental Leave Policies at U.S. Medical Schools. J Womens Health (Larchmt) 2022; 31:1403-1410. [PMID: 35704286 DOI: 10.1089/jwh.2022.0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: As medical training occurs during prime childbearing years, parental leave policies may affect the career and family choices of medical students. Materials and Methods: This cross-sectional study builds on existing research by quantifying the prevalence of formal policies for parental leave in highly ranked United States Medical Degree granting institutions, and analyzing the characteristics of those policies, with the objective of identifying existing best practices for future policy adopters to consider. Results: Only 14% of the medical schools reviewed had substantive, stand-alone parental leave policies, and the majority of schools had leave of absence policies without mention of parental leave. Discussion: Leveraging the authors' legal and medical expertise, this analysis highlights existing best practices for medical school leadership to consider, as they examine and develop their policies. Best practices utilized by institutions with the most robust parental policies include adopting a formal and public parental policy, providing a parental enrolled academic adjustment option, guaranteeing approval to take and return from leave/academic adjustment, and continuing health care and financial aid benefits. Given the role of childbearing as a factor associated with gender disparities in academic medicine, and potential impact on racial disparities for students of color, medical school leadership should consider implementation of best practice parental policies to promote equity and wellness of their students. In fact, the deficit of robust parental leave policies in most highly ranked schools may contribute to existing gender and racial disparities in violation with antidiscrimination law. Strengthening policies could increase equity in medical education with positive impacts on the patient population.
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Affiliation(s)
- Danielle Roselin
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Jessica Lee
- Center for WorkLife Law, Hastings College of the Law, University of California, San Francisco, California, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Blair-Loy
- Department of Sociology, Center for Research on Gender in STEMM, University of California, San Diego, San Diego, California, USA
| | - Kim Ira
- Center for WorkLife Law, Hastings College of the Law, University of California, San Francisco, California, USA
| | - Priya Dahiya
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Joan Williams
- Center for WorkLife Law, Hastings College of the Law, University of California, San Francisco, California, USA
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, Center for Vulnerable Populations, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (UCSF), San Francisco, California, USA
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Hemmat S, Khoong EC, Olazo K, Sharma AE, Mangurian C, Fernandez A, Sarkar U. Using incident reporting to understand and characterize sexual harassment of physicians by patients. J Gen Intern Med 2022; 37:2093-2095. [PMID: 34254222 PMCID: PMC9198129 DOI: 10.1007/s11606-021-07004-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Shirin Hemmat
- Department of Internal Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Elaine C Khoong
- Department of Internal Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA.,Division of General Internal Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA.,Center for Vulnerable Populations, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Kristan Olazo
- Department of Internal Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA.,Division of General Internal Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA.,Center for Vulnerable Populations, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Anjana E Sharma
- Center for Vulnerable Populations, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA.,Department of Family and Community Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Christina Mangurian
- Center for Vulnerable Populations, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Alicia Fernandez
- Department of Internal Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA.,Division of General Internal Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA.,Center for Vulnerable Populations, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Urmimala Sarkar
- Department of Internal Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA. .,Division of General Internal Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA. .,Center for Vulnerable Populations, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA.
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Bloyd C, Murthy S, Song C, Franck LS, Mangurian C. National Cross-Sectional Study of Mental Health Screening Practices for Primary Caregivers of NICU Infants. Children 2022; 9:children9060793. [PMID: 35740730 PMCID: PMC9221644 DOI: 10.3390/children9060793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 12/02/2022]
Abstract
Universal screening for postpartum mood and anxiety disorders (PMADs) has been recommended for all new parents at outpatient postpartum and well-child visits. However, parents of newborns admitted to the NICU are rarely able to access these services during their infant’s prolonged hospitalization. The objective of this study was to determine the prevalence of mental health screening and treatment programs for parents or other primary caregivers in NICUs across the country. In this cross-sectional study, US NICU medical directors were invited to complete an online survey about current practices in mental health education, screening, and treatment for primary caregivers of preterm and ill infants in the NICU. Comparative analyses using Fisher’s exact test were performed to evaluate differences in practices among various NICU practice settings. Survey responses were obtained from 75 out of 700 potential sites (10.7%). Of participating NICUs, less than half routinely provided caregivers with psychoeducation about mental health self-care (n = 35, 47%) or routinely screened caregivers for PPD or other mental health disorders (n = 33, 44%). Nearly one-quarter of the NICUs did not provide any PMAD screening (n = 17, 23%). Despite consensus that postpartum psychosocial care is essential, routine mental health care of primary caregivers in the NICU remains inadequate.
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Affiliation(s)
- Cooper Bloyd
- School of Medicine, University of California, San Francisco, CA 94143, USA; (C.B.); (S.M.)
- Department of Pediatrics, University of California, San Francisco, CA 94143, USA
| | - Snehal Murthy
- School of Medicine, University of California, San Francisco, CA 94143, USA; (C.B.); (S.M.)
| | - Clara Song
- Southern California Permanente Medical Group, Pasadena, CA 91188, USA;
| | - Linda S. Franck
- School of Nursing, University of California, San Francisco, CA 94143, USA;
| | - Christina Mangurian
- School of Medicine, University of California, San Francisco, CA 94143, USA; (C.B.); (S.M.)
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA 94143, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA
- Correspondence: ; Tel.: +1-415-206-5925; Fax: +1-415-206-8942
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Affiliation(s)
- Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | | | - Elissa Epel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
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Jia L, Rooney MK, Jacobson CE, Griffith KA, Mangurian C, Jagsi R, Markham MJ. Factors Associated With Endowed Chair Allocation in Medical Oncology in the United States. JNCI Cancer Spectr 2022; 6:pkac036. [PMID: 35657340 PMCID: PMC9165554 DOI: 10.1093/jncics/pkac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/09/2022] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
To explore persisting gender disparities across leadership roles in medicine, we examined factors associated with holding endowed chairs in US oncology divisions. In 2019, we identified 95 academic oncology divisions, using the Oncology Division Chiefs and Department Chairs listing in the American Society of Clinical Oncology myConnection forum. We collected public information on gender, degree, total National Institutes of Health funding as principal investigator, H-indices, publication and citation numbers, and graduation year and constructed a multivariable logistic regression model. All statistical tests were 2-sided. We identified 1087 oncology full professors. Of these, 287 (26.4%) held endowed chairs: 60 of 269 women (22.3%) vs 227 of 818 men (27.8%) (P = .08). On multivariable analysis, greater research productivity and National Institutes of Health funding were associated with having an endowed chair (P < .001), whereas gender was not (P = .45). Though sample size was limited, if gender differences are in fact smaller in certain subspecialties than other fields of internal medicine, insights might emerge to guide efforts to promote equity.
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Affiliation(s)
- Lena Jia
- Washington University School of Medicine, St Louis, MO, USA
| | - Michael Kevin Rooney
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Kent A Griffith
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Reshma Jagsi
- Department of Radiation Oncology and The Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Kalet A, Libby AM, Jagsi R, Brady K, Chavis-Keeling D, Pillinger MH, Daumit GL, Drake AF, Drake WP, Fraser V, Ford D, Hochman JS, Jones RD, Mangurian C, Meagher EA, McGuinness G, Regensteiner JG, Rubin DC, Yaffe K, Ravenell JE. Mentoring Underrepresented Minority Physician-Scientists to Success. Acad Med 2022; 97:497-502. [PMID: 34495889 DOI: 10.1097/acm.0000000000004402] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
As the nation seeks to recruit and retain physician-scientists, gaps remain in understanding and addressing mitigatable challenges to the success of faculty from underrepresented minority (URM) backgrounds. The Doris Duke Charitable Foundation Fund to Retain Clinical Scientists program, implemented in 2015 at 10 academic medical centers in the United States, seeks to retain physician-scientists at risk of leaving science because of periods of extraordinary family caregiving needs, hardships that URM faculty-especially those who identify as female-are more likely to experience. At the annual Fund to Retain Clinical Scientists program directors conference in 2018, program directors-21% of whom identify as URM individuals and 13% as male-addressed issues that affect URM physician-scientists in particular. Key issues that threaten the retention of URM physician-scientists were identified through focused literature reviews; institutional environmental scans; and structured small- and large-group discussions with program directors, staff, and participants. These issues include bias and discrimination, personal wealth differential, the minority tax (i.e., service burdens placed on URM faculty who represent URM perspectives on committees and at conferences), lack of mentorship training, intersectionality and isolation, concerns about confirming stereotypes, and institutional-level factors. The authors present recommendations for how to create an environment in which URM physician-scientists can expect equitable opportunities to thrive, as institutions demonstrate proactive allyship and remove structural barriers to success. Recommendations include providing universal training to reduce interpersonal bias and discrimination, addressing the consequences of the personal wealth gap through financial counseling and benefits, measuring the service faculty members provide to the institution as advocates for URM faculty issues and compensating them appropriately, supporting URM faculty who wish to engage in national leadership programs, and sustaining institutional policies that address structural and interpersonal barriers to inclusive excellence.
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Affiliation(s)
- Adina Kalet
- A. Kalet is professor and Stephen and Shelagh Roell Endowed Chair, Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Wauwatosa, Wisconsin; ORCID: https://orcid.org/0000-0003-4855-0223
| | - Anne M Libby
- A.M. Libby is professor and vice chair for academic affairs, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado; ORCID: https://orcid.org/0000-0002-4564-9407
| | - Reshma Jagsi
- R. Jagsi is Newman Family Professor and deputy chair, Department of Radiation Oncology, and director, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-6562-1228
| | - Kathleen Brady
- K. Brady is professor and vice president for research, Medical University of South Carolina, Charleston, South Carolina; ORCID: https://orcid.org/0000-0002-3944-8051
| | - Deborah Chavis-Keeling
- D. Chavis-Keeling is executive director, Administration, Finance, and Operations, Clinical and Translational Science Institute, and director, Administrative Core, Clinical and Translational Science Award, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0002-1528-8532
| | - Michael H Pillinger
- M.H. Pillinger is professor of medicine and director, Translational Research Education and Careers Unit, Clinical and Translational Science Institute, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0003-3168-1542
| | - Gail L Daumit
- G.L. Daumit is Samsung Professor of Medicine and vice chair, Clinical and Translational Research, Department of Medicine, Johns Hopkins University, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-0717-0216
| | - Amelia F Drake
- A.F. Drake is Newton D. Fischer Distinguished Professor of Otolaryngology/Head and Neck Surgery, director, University of North Carolina Craniofacial Center (School of Dentistry), and executive associate dean of academic programs, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wonder Puryear Drake
- W.P. Drake is professor of medicine and pathology, microbiology, and immunology, Robert A. Goodwin Jr. Director in Medicine, and director, Sarcoidosis Center of Excellence, Vanderbilt University School of Medicine, Nashville, Tennessee; ORCID: https://orcid.org/0000-0001-9406-3130
| | - Victoria Fraser
- V. Fraser is Adolphus Busch Professor of Medicine and chair, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; ORCID: https://orcid.org/0000-0001-6251-0733
| | - Daniel Ford
- D. Ford is professor of medicine and director, Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, Maryland
| | - Judith S Hochman
- J.S. Hochman is Harold Snyder Family Professor of Cardiology, associate director, Leon H. Charney Division of Cardiology, senior associate dean for clinical sciences, and codirector, Clinical and Translational Science Institute, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0002-5889-5981
| | - Rochelle D Jones
- R.D. Jones is a research area specialist intermediate, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Christina Mangurian
- C. Mangurian is professor of psychiatry and vice chair for diversity and health equity, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), affiliate faculty, UCSF Philip R. Lee Institute for Health Policy Studies, and core faculty, UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California; ORCID: https://orcid.org/0000-0002-9839-652X
| | - Emma A Meagher
- E.A. Meagher is professor, medicine and pharmacology, and vice dean and chief clinical research officer, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-1841-4570
| | - Georgeann McGuinness
- G. McGuinness is professor and vice chair of academic affairs, senior vice chair of radiology, associate dean for mentoring and professional development, and director, clinical faculty mentoring, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0002-5326-9180
| | - Judith G Regensteiner
- J.G. Regensteiner is professor, Judith and Joseph Wagner Chair in Women's Health Research, director, Center for Women's Health Research, and director, Office of Women in Medicine and Science, University of Colorado School of Medicine, Aurora, Colorado; ORCID: https://orcid.org/0000-0002-9331-3908
| | - Deborah C Rubin
- D.C. Rubin is William B. Kountz Professor of Medicine, professor of developmental biology, and associate director of faculty affairs, Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri; ORCID: https://orcid.org/0000-0002-4192-909X
| | - Kristine Yaffe
- K. Yaffe is professor of psychiatry, neurology, and epidemiology, University of California, San Francisco, Weill Institute for Neurosciences, and Roy and Marie Scola Endowed Chair and vice chair of research in psychiatry, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0003-0919-3825
| | - Joseph E Ravenell
- J.E. Ravenell is associate professor, Departments of Population Health and Internal Medicine, associate dean for diversity affairs and inclusion, and director, Diversity in Research, Perlmutter Cancer Center, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0001-7024-3460
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Abstract
Although the number of Hispanic/Latina women earning medical degrees has increased in recent years, the article by Anaya and colleagues in this issue highlights their stark underrepresentation in the U.S. physician workforce. In this Invited Commentary, the authors provide context on proposed drivers of underrepresentation, including bias, discrimination, harassment, and other structural barriers, which are amplified for women with multiple minoritized identities. They summarize the 2020 National Academies of Sciences, Engineering, and Medicine recommendations for supporting women in science, technology, engineering, mathematics, and medicine (STEMM) fields, including committed leadership, dedicated financial and human resources, data-driven accountability, and use of an intersectional approach to address the challenges faced by individuals who encounter multiple forms of bias and discrimination. The authors also provide additional recommendations and highlight innovative new National Institutes of Health funding opportunities to promote diversity in the scientific workforce. They argue that more research is needed to identify and best implement institutional practices that increase representation and retention of Latina women and other women with minoritized identities in STEMM fields.
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Affiliation(s)
- Carolyn I Rodriguez
- C.I. Rodriguez is associate dean, Office of Academic Affairs, associate chair of diversity and inclusion, and associate professor, Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California
| | - Reshma Jagsi
- R. Jagsi is the Newman Family Professor and deputy chair, Department of Radiation Oncology, and director, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Christina Mangurian
- C. Mangurian is professor and vice chair for diversity and health equity, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, California
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Thomas MD, Vittinghoff E, Crystal S, Walkup J, Olfson M, Khalili M, Dahiya P, Keenan W, Cournos F, Mangurian C. Hepatitis C Screening Among Medicaid Patients With Schizophrenia, 2002-2012. Schizophr Bull Open 2022; 3:sgab058. [PMID: 35059641 PMCID: PMC8763570 DOI: 10.1093/schizbullopen/sgab058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective Although people with schizophrenia are disproportionately affected by Hepatitis C virus (HCV) compared to the general population, HCV screening among US Medicaid recipients with schizophrenia has not been characterized. Following 1998 CDC recommendations for screening in high-risk populations, we estimated the proportion of Medicaid recipients with and without schizophrenia screened for HCV across states and over time. Examining patterns of screening will inform the current public health imperative to test all adults for HCV now that safer and more effective treatments are available. Methods Data are drawn from 1 353 424 Medicaid recipients aged 15–64 years with schizophrenia and frequency-matched controls from 2002 to 2012. Participants with known HCV infection one year prior and those dual-eligible for Medicare were excluded. Multivariable logistic regression estimated associations between predictor variables and HCV screening. Results HCV screening was low (<4%) but increased over time. Individuals with schizophrenia consistently showed higher screening compared to controls across years and states. Several demographic and clinical characteristics predicted higher screening, especially comorbid HIV (OR = 6.5; 95% CI = 6.0–7.0). Outpatient medical care utilization increased screening by nearly double in 2002 (OR = 1.8; CI = 1.7–1.9) and almost triple in 2012 (OR = 2.7; CI = 2.6–2.9). Conclusions Low screening was a missed opportunity to improve HCV prevention efforts and reduce liver-related mortality among people with schizophrenia. Greater COVID-19 disease severity in HCV patients and the availability of effective HCV treatments increase the urgency to improve HCV screening. Eliminating Medicaid restrictions and expanding statewide HIV policies to include HCV would have multiple public health benefits, particularly for people with schizophrenia.
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Affiliation(s)
- Marilyn D Thomas
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Weill Institute for Neurosciences, University of California San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, CA, USA
| | - Stephen Crystal
- Rutgers University Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
| | - James Walkup
- Rutgers University Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
| | - Mark Olfson
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Mandana Khalili
- Division of Gastroenterology and Hepatology, Department of Medicine, School of Medicine, University of California San Francisco, CA, USA
| | - Priya Dahiya
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Weill Institute for Neurosciences, University of California San Francisco, CA, USA
| | - Walker Keenan
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Francine Cournos
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Weill Institute for Neurosciences, University of California San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, CA, USA.,Center for Vulnerable Populations at ZSFG, University of California San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, CA, USA
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Riano NS, Borowsky HM, Arnold EA, Olfson M, Walkup JT, Vittinghoff E, Cournos F, Dawson L, Bazazi AR, Crystal S, Mangurian C. HIV Testing and Counseling at U.S. Substance Use Treatment Facilities: A Missed Opportunity for Early Identification. Psychiatr Serv 2021; 72:1385-1391. [PMID: 34126780 PMCID: PMC8639611 DOI: 10.1176/appi.ps.202000524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to determine the availability and national distribution of HIV testing and counseling at substance use treatment facilities in the United States. METHODS Analyses of data from the 2018 National Survey of Substance Abuse Treatment Services assessed HIV testing and counseling availability in U.S. substance use treatment facilities (excluding those in U.S. territories). Facilities were subcategorized by availability of mental health services and medication for opioid use disorders and compared by using logistic models. Descriptive statistics were calculated to characterize the availability of HIV testing and counseling by state, state HIV incidence, and facility characteristics. RESULTS Among U.S. substance use treatment facilities (N=14,691), 29% offered HIV testing, 53% offered HIV counseling, 23% offered both, and 41% offered neither. Across states, the proportions of facilities offering HIV testing ranged from 9.0% to 62.8%, and the proportion offering counseling ranged from 19.2% to 83.3%. In only three states was HIV testing offered by at least 50% of facilities. HIV testing was significantly more likely to be offered in facilities that offered medication for opioid use disorder (48.0% versus 16.0% in those not offering such medication) or mental health services (31.2% versus 24.1% in those not offering such services). Higher state-level HIV incidence was related to an increased proportion of facilities offering HIV testing. CONCLUSIONS Only three in 10 substance use treatment facilities offered HIV testing in 2018. This finding represents a missed opportunity for early identification of HIV among people receiving treatment for substance use disorders.
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Affiliation(s)
- Nicholas S Riano
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Hannah M Borowsky
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Emily A Arnold
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Mark Olfson
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - James T Walkup
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Eric Vittinghoff
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Francine Cournos
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Lindsey Dawson
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Alexander R Bazazi
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Stephen Crystal
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
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Thomas MD, Calmasini C, Seblova D, Manly JJ, Lapham S, Peters K, Prescott CA, Mangurian C, Glymour MM. Differential impact of educational attainment on later life cognition by race/ethnicity in the Project Talent Aging Study. Alzheimers Dement 2021. [DOI: 10.1002/alz.056353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Susan Lapham
- American Institutes for Research Washington DC USA
| | - Kelly Peters
- American Institutes for Research Washington DC USA
| | | | | | - M Maria Glymour
- University of California, San Francisco San Francisco CA USA
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44
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Guan A, Thomas M, Vittinghoff E, Bowleg L, Mangurian C, Wesson P. An investigation of quantitative methods for assessing intersectionality in health research: A systematic review. SSM Popul Health 2021; 16:100977. [PMID: 34869821 PMCID: PMC8626832 DOI: 10.1016/j.ssmph.2021.100977] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
Intersectionality is a theoretical framework that investigates how interlocking systems of power and oppression at the societal level influence the lived experiences of historically and socially marginalized groups. Currently, there are no consistent or widely adopted quantitative methods to investigate research questions informed by intersectionality theory. The objective of this systematic review is to describe the current landscape of quantitative methods used to assess intersectionality and to provide recommendations on analytic best practices for future research. We searched PubMed, EMBASE, and the Web of Science in December 2019 to identify studies using analytic quantitative intersectionality approaches published up to December 2019 (PROSPERO CRD42020162686). To be included in the study, articles had to: (1) be empirical research, (2) use a quantitative statistical method, (3) be published in English, and (4) incorporate intersectionality. Our initial search yielded 1889 articles. After screening by title/abstract, methods, and full text review, our final analytic sample included 153 papers. Eight unique classes of quantitative methods were identified, with the majority of studies employing regression with an interaction term. We additionally identified several methods which appear to be at odds with the key tenets of intersectionality. As quantitative intersectionality continues to expand, careful attention is needed to avoid the dilution of the core tenets. Specifically, emphasis on social power is needed as methods continue to be adopted and developed. Additionally, clear explanation of the selection of statistical approaches is needed and, when using regression with interaction terms, researchers should opt for use of the additive scale. Finally, use of methods that are potentially at odds with the tenets of intersectionality should be avoided.
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Affiliation(s)
- Alice Guan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Marilyn Thomas
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa Bowleg
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, USA
| | - Christina Mangurian
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, USA
| | - Paul Wesson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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45
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Reed G, Ahmad SR, Khoong EC, Olazo K, Jagsi R, Mangurian C, Sarkar U. Evaluation of Sexual Harassment Policies at Medical Institutions to Understand Attention to Harassment of Physicians by Patients. JAMA Netw Open 2021; 4:e2135131. [PMID: 34787660 PMCID: PMC8600387 DOI: 10.1001/jamanetworkopen.2021.35131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This quality improvement study assesses the policies of top US medical centers for addressing sexual harassment of physicians by patients.
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Affiliation(s)
- Gabriela Reed
- Department of Internal Medicine, University of California, San Francisco
| | - Sarah R. Ahmad
- Division of Headache Medicine, Department of Neurology, University of California, San Francisco
| | - Elaine C. Khoong
- Department of Internal Medicine, University of California, San Francisco
- Division of General Internal Medicine, University of California, San Francisco
- Center for Vulnerable Populations, University of California, San Francisco
| | - Kristan Olazo
- Department of Internal Medicine, University of California, San Francisco
- Division of General Internal Medicine, University of California, San Francisco
- Center for Vulnerable Populations, University of California, San Francisco
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Christina Mangurian
- Center for Vulnerable Populations, University of California, San Francisco
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Urmimala Sarkar
- Department of Internal Medicine, University of California, San Francisco
- Division of General Internal Medicine, University of California, San Francisco
- Center for Vulnerable Populations, University of California, San Francisco
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46
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Murthy S, Haeusslein L, Bent S, Fitelson E, Franck LS, Mangurian C. Feasibility of universal screening for postpartum mood and anxiety disorders among caregivers of infants hospitalized in NICUs: a systematic review. J Perinatol 2021; 41:1811-1824. [PMID: 33692474 PMCID: PMC8349842 DOI: 10.1038/s41372-021-01005-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/16/2021] [Accepted: 02/09/2021] [Indexed: 01/31/2023]
Abstract
This systematic review evaluated the feasibility of implementing universal screening programs for postpartum mood and anxiety disorder (PMAD) among caregivers of infants hospitalized in the neonatal intensive care unit (NICU). Four moderate quality post-implementation cohort studies satisfied inclusion criteria (n = 2752 total participants). All studies included mothers; one study included fathers or partners. Screening included measures of depression and post-traumatic stress. Screening rates ranged from 48.5% to 96.2%. The incidence of depression in mothers ranged from 18% to 43.3% and was 9.5% in fathers. Common facilitators included engaging multidisciplinary staff in program development and implementation, partnering with program champions, and incorporating screening into routine clinical practice. Referral to mental health treatment was the most significant barrier. This systematic review suggests that universal PMAD screening in NICUs may be feasible. Further research comparing a wider range of PMAD screening tools and protocols is critical to address these prevalent conditions with significant consequences for parents and infants.
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Affiliation(s)
- Snehal Murthy
- School of Medicine, University of California, San Francisco, CA, USA
| | - Laurel Haeusslein
- Benioff Children's Hospital Oakland, University of California, San Francisco, CA, USA
| | - Stephen Bent
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Elizabeth Fitelson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Linda S Franck
- School of Nursing, University of California, San Francisco, CA, USA
| | - Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
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47
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Riley ED, Dilworth SE, Satre DD, Silverberg MJ, Neilands TB, Mangurian C, Weiser SD. Factors Associated With Symptoms of Depression and Anxiety Among Women Experiencing Homelessness and Unstable Housing During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2117035. [PMID: 34259851 PMCID: PMC8281009 DOI: 10.1001/jamanetworkopen.2021.17035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study examines symptoms of depression and anxiety among women experiencing homelessness and unstable housing during the COVID-19 pandemic.
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Affiliation(s)
- Elise D. Riley
- Department of Medicine, University of California, San Francisco
| | | | - Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | | | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco
| | - Sheri D. Weiser
- Department of Medicine, University of California, San Francisco
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48
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Tolou-Shams M, Folk J, Stuart B, Mangurian C, Fortuna L. Rapid creation of child telemental health services during COVID-19 to promote continued care for underserved children and families. Psychol Serv 2021; 19:39-45. [PMID: 34110866 PMCID: PMC8660922 DOI: 10.1037/ser0000550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The COVID-19 pandemic prompted the rapid transformation of child mental health services from mostly in-person to fully remote delivery at an urban safety-net hospital. No-show rates substantially declined when implementing video visits, and the volume of service delivery was unchanged compared to prepandemic in-person visits. In addition, no-show rates for telehealth sessions did not increase over time. Recommendations for telehealth quality assurance and improvement to best respond to children and families with existing mental health needs and limited resources during disasters and in their aftermath are suggested. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
- Division of Infant Child and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Johanna Folk
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
- Division of Infant Child and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Barbara Stuart
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
- Division of Infant Child and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
- Department of Epidemiology & Biostatistics, University of California San Francisco
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco
| | - Lisa Fortuna
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
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49
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Garcia ME, Goldman EL, Thomas M, Chan S, Mitsuishi F, Schillinger D, Mangurian C. Accuracy of Primary Care Medical Home Designation in a Specialty Mental Health Clinic. Psychiatr Q 2021; 92:601-607. [PMID: 32829448 PMCID: PMC8774075 DOI: 10.1007/s11126-020-09829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To assess whether primary care medical homes (PCMHs) are accurately identified for patients receiving care in a specialty mental health clinic within an integrated public delivery system. This study reviewed the electronic records of patients in a large urban mental health clinic. The study defined 'matching PCMH' if the same primary care clinic was listed in both the mental health and medical electronic records. This study designated all others as 'PCMH unknown.' This study assessed whether demographic factors predicted PCMH status using chi-square tests. Among 229 patients (66% male; mean age 49; 36% White, 30% Black, and 17% Asian), 72% had a matching PCMH. Sex, age, race, psychiatric diagnosis, and psychotropic medication use were not associated with matching PCMH. To improve care coordination and health outcomes for people with severe mental illness, greater efforts are needed to ensure the accurate designation of PCMHs in all mental health patient electronic records.
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Affiliation(s)
- Maria E Garcia
- Center for Aging in Diverse Communities, Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, USA.
| | - Elizabeth L Goldman
- Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Marilyn Thomas
- Department of Epidemiology, University of California, Berkeley, CA, USA
| | - Stephen Chan
- Department of Medicine, University of California, Davis, CA, USA
| | - Fumi Mitsuishi
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Dean Schillinger
- Division of General Internal Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Christina Mangurian
- Department of Psychiatry, San Francisco General Hospital, University of California, San Francisco, CA, USA
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50
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Halley MC, Mathews KS, Diamond LC, Linos E, Sarkar U, Mangurian C, Sabry H, Goyal MK, Olazo K, Miller EG, Jagsi R, Linos E. The Intersection of Work and Home Challenges Faced by Physician Mothers During the Coronavirus Disease 2019 Pandemic: A Mixed-Methods Analysis. J Womens Health (Larchmt) 2021; 30:514-524. [PMID: 33761277 DOI: 10.1089/jwh.2020.8964] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: The coronavirus disease 2019 (COVID-19) pandemic has presented extreme challenges for health care workers. This study sought to characterize challenges faced by physician mothers, compare differences in challenges by home and work characteristics, and elicit specific needs and potential solutions. Methods: We conducted a mixed-methods online survey of the Physician Moms Group (PMG) and PMG COVID19 Subgroup on Facebook from April 18th to 29th, 2020. We collected structured data on personal and professional characteristics and qualitative data on home and work concerns. We analyzed qualitative data thematically and used bivariate analyses to evaluate variation in themes by frontline status and children's ages. Results: We included 1,806 participants in analysis and identified 10 key themes. The most frequently identified need/solution was for Community and Government Support (n = 545, 47.1%). When comparing frontline and nonfrontline physicians, those on the frontline more frequently raised concerns about Personal Health and Safety (67.8% vs. 48.4%, p < 0.001), Organizational Communication and Relationships (31.8% vs. 23.8%, p < 0.001), and Family Health and Safety (27.2 vs. 16.6, p < 0.001), while nonfrontline physicians more frequently addressed Patient Care and Safety (56.4% vs. 48.2%, p < 0.001) and Financial/Job Security (33.8% vs. 46.9%, p < 0.001). Participants with an elementary school-aged child more frequently raised concerns about Parenting/Homeschooling (44.0% vs. 31.1%, p < 0.001) and Work/Life Balance (28.4 vs. 13.7, p < 0.001), and participants with a preschool-aged child more frequently addressed Access to Childcare (24.0 vs. 7.7, p < 0.001) and Spouse/Partner Relationships (15.8 vs. 9.5, p < 0.001), when compared to those without children in these age groups. Conclusions: The physician workforce is not homogenous. Health care and government leaders need to understand these diverse challenges in order to meet physicians' professional and family needs during the pandemic.
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Affiliation(s)
- Meghan C Halley
- Center for Biomedical Ethics, Stanford University, Stanford, California, USA
| | - Kusum S Mathews
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lisa C Diamond
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Medicine, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth Linos
- Goldman School of Public Policy, University of California, Berkeley, California, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Science, Weill Institute for Neurosciences, University of California, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Hala Sabry
- Emergency Medicine Physician, Vituity, Founder of Physician Moms Group and CEO of Physician Digital Services, Claremont, California, USA
| | - Monika K Goyal
- Department of Pediatrics, Children's National Hospital, George Washington University, Washington, District of Columbia, USA.,Department of Emergency Medicine, Children's National Hospital, George Washington University, Washington, District of Columbia, USA
| | - Kristan Olazo
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Emily G Miller
- Center for Biomedical Ethics, Stanford University, Stanford, California, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eleni Linos
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA.,Department of Epidemiology by Courtesy, Stanford University School of Medicine, Stanford, California, USA
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