Download Vol 4-Spring 2014 - Latino Medical Student Association

Latino Medical Student
Association
Annual journal Volume 4
Founded to represent, support, educate and unify Latino(a) Medical Students
Table of Contents
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Page 2: 2014 National Conference Welcome
Page 3: Art Corner
Page 4: National Coordinator Report and Bio’s
Page 7: N.H.M.A.- History and Greetings
Page 10: Chapter Spotlight
Page 12: 2013 Mentor of the Year
Page 14: Policy Editorial
Page 16: Student Abstracts
Page 31: Health Professionals
Abstracts
• Page 37: Journal Articles
• Page 45: About the Editors
L.M.S.A. Mission
To unify all Latino medical students into one organization to provide a voice for underrepresented medical students with the goal of actively promoting recruitment and retention
of Latino students of all educational and professional levels, to educate medical students
on Latino health issues, to advocate for the rights of Latinos in health care, and to provide
leadership opportunities for Latinos.
www.lmsa.net
L.M.S.A. Journal Pg 1
Welcome to Houston fo the
9th Annual LMSA National Conference!
About the Artist:
Kathy Amortegui is a Latino Artist based out of
Las Vegas, Nevada. Born and raised in Bogota,
Colombia, she currently works in the Economics Department at the University of Las Vegas, Nevada Lee Bussiness
School. She has been an artist most of her life studying at
several arts schools in Latin America such as the Guerrero
schools of Arts ,the Chico school of art, and the David
Manzour art school as well as collaborating with multiple
private art professors from the Latin and European Community for six years. In addition, she is involved in the
latino communiy by paticipating in several charity events
as well as teaching English to underserved hispanic immigrants through several programs in the Las Vegas and
Clark County area. For further information, please email
the artist at [email protected]
On behalf of the Southwest Region, it is our pleasure to welcome you to our home! Although it is the first time
Houston has the honor of hosting this conference, it is actually the second time that the National Conference
has been held in the Southwest Region (back in 2007 when our organization was known as the National Network of Latin American Medical Students or NNLAMS). From that time, our region has seen a veritable revival
of LMSA culminating in the conference you see today.
When our regional board sat down to plan the theme of the 9th annual conference, we began with a discussion
of LMSA itself; its mission, goals, and ideals. Now more than ever we see the landscape of healthcare changing
before our eyes, affecting our entire community from the youngest patient to the oldest doctor. Our hope lies in
each other as we grow, learn from each other, and together build a better future for our patients and communities.
As you listen to the speakers and participate in the workshops, please take time to reach out to your fellow
LMSA members from within your region, or another region entirely. Make contacts, exchange emails, and network. We are only as strong as we are united, and it is through our combined efforts that we can truly realize our
potential.
Lastly, we would like to recognize and thank our two hosting institutions, Baylor College of Medicine and the
University of Texas Health and Science Center at Houston whose support made this conference possible!
Kathy Amortegui. Bolivian Girl. Oil in Canvas
¡Bienvenidos!
The LMSA Southwest 2014 Conference Committee
About the Artist:
Eduardo Torres is a design and art professor born in
Mexico city who studied plubic relations, art and graphic
design. In the 80’s, Mr Torres immigrated to Los Angeles through a publication company and studied Radio
and Television broadcasting. He was named department
head of art and publishing in the Los Angeles college.
Mr. Torres has been in several art expos specialising in
the the real of art realisim. Currently he resides in Las
Vegas, NV and teaches classes in Oil, Acrylic, Pastel and
Muralistic theory while being heavily involved in the latin community through art classes for autistic youth. He
may be reached at : [email protected]
www.lmsa.net
L.M.S.A. Journal Pg 2
www.lmsa.net
L.M.S.A. Journal Pg 3
National Cordinator’s Bio
Dr. Galvis is currently serving his second term as National
from
Alvaro E. Galvis, Ph.D. , MS4 2013-2014 National Coordinator
Dear LMSA membership.
The 2013-2014 leadership has taken LMSA into new and exciting avenues that we could have not dreamt of five years ago. When
the regions decided to unify under the LMSA name in 2009, our hope was to become the leading voice of Latino medical students
throughout the nation. Today, we have seen tremendous expansion through our younger regions of the Southeast and Southwest, we
are continuing to develop our pre-medical societies (LMSA-PLUS) and we have established out first LMSA Student Policy Section
that has allowed any LMSA member to help influence the direction of organization (Please visit http://lmsa.net/policy/) . This year
we are also celebrating the 5th independent National Conference in our newest region of the Southwest from April 25th-27th.
Currently, we are working hard in developing further the infrastructure of LMSA and a closer collaboration with NHMA Council of
Residents (COR) , Young Physicians (YP) and Executive Board (EB). To highlight a few key aspects of these new developments:
1) LMSA and all groups of NHMA (COR, YP and EB) will create one master database of its leadership and form working groups
President of the Latino Medical Student Association. He is a
fourth year medical student at the University of California,
Irvine School of Medicine (UCI SOM). He has been involved
with the LMSA since his first year of medical school in 2005,
holding various positions including three terms as Southern
CEO of the LMSA-West region. He received a BA in Religious
Studies and a BS in Biology in 2002 from Santa Clara University. He is a member of both the Medical Scientist Training
Program (MSTP) and Program in Medical Education for the
Latino Community (PRIME-LC) at UCI SOM. He successfully defended his PhD dissertation entitled “An RNA Lariat
Intermediate in HIV-1 cDNA Synthesis” with the Department
of Molecular Biology and Biochemistry in February 2014. Dr.
Galvis has also been involved in the UCI SOM Admissions
Committee since 2007. He has always been a strong advocate
of health for all underserved communities and increasing the
number of minorities in medicine. He wants to devote his career
to the well-being of others and upholding the mission of LMSA.
within across the board equivalent positions (e.g. publication chairs of all the organizations will have their own committee to collaborate on newsletter/ publications).
2) LMSA will be expanding its Alumni Board into the LMSA Physician Advisory Board. Dr. Elizabeth Homan-Sandoval has ac-
Amanda Lynn Hernandez is an MD/PhD candidate at Yale
University pursuing her doctoral research in neuroscience and
immunology and planning to complete a medical residency in
neurology. Her doctoral thesis aims to characterize putative
environmental factors mediating Multiple Sclerosis, work for
which she was recently awarded the prestigious National Institute of Health Ruth L. Kirschstein National Research Service
Award. Born and raised in the Bronx, NY, Amanda is of Puerto
Rican decent and was the first in her family to complete college.
She attended Columbia University in the City of New York and
graduated in 2008 with BA in Neuroscience and Psychology.
Following completion of her degree Amanda pursued research
full-time for one year prior to matriculating at Yale. Upon arriving at Yale’s Medical Scientist Training Program, Amanda
became intimately involved within the Latino community. Currently the LMSA National Vice-President, Amanda has held
numerous executive board positions within LMSA National
and has served as the Northeast-LMSA Regional Co-Chair for
the past 4 years. Outside of her LMSA involvement, Amanda
has been passionately engaged in the Yale Latino community
as a Graduate Assistant at La Casa, Yale’s Latino Cultural Center, where she mentors over 50 undergraduate students. Outside
of her academic and community pursuits, Amanda is an avid
Crossfitter and actively competes within the state of Connecticut.
cepted being LMSA’s co-executive director alongside Dr. Rueben Font.
3) In the upcoming summer LMSA will be launching its new website and membership database.
4) LMSA and NHMA have signed a new MOU that includes $1000 for each regional conference and an additional $2000 for the
National Conference. NHMA will support the travel of the two regional presidents alongside the president and vice-president to the
NHMA conference.
At this time I would like to take a moment to thank a few key leaders in LMSA: Orlando Sola and Ankeeta Mehta for their leadership in the development of the Policy Section, Dr. Emma Olivera for her contributions to the Board, Jose Cruz for his work in
developing the programing for GLAS 2013, Dr. Rueben Font in hos first year as executive director and Amanda Hernandez our
2014-2015 National President.
I hope you are excited about the new developments as LMSA continues to grow and expand into new avenues. I look forward to
seeing many of you at our annual conference in Houston, TX.
Sincerely,
Alvaro E. Galvis, Ph.D. , MS4
UCI School of Medicine
M.D. candidate Class of 2015
Medical Scientist Training Program
Program in Medical Education for the Latino Community
Vice-President, LMSA
National President, Latino Medical Student Association
www.lmsa.net
L.M.S.A. Journal Pg 4
www.lmsa.net
L.M.S.A. Journal Pg 5
N.H.M.A. Spotlight
Medical School
A Brief History of the National Hispanic Medical Association
Office of Diversity and Inclusion
The University of Texas Medical School at Houston is committed to diversity and inclusion of
each member of the Medical School family – be they students, faculty, staff or patients.
Headed by LaTanya Love, M.D., assistant professor of pediatrics, and Pedro Mancias,
associate professor of pediatric neurology, the goal is to serve Houston’s populace through
medical education, patient care, and research that is inclusive.
Specific goals of the office include increasing scholarships, improving recruitment and
retention of minority faculty, enhancing the cultural competence curriculum and providing
institutional support for diversity and inclusion.
713-500-5040 Main
713-500-0604 Fax
6431 Fannin Street, G.300
Houston, TX 77030
www.med.uth.tmc.edu/diversity
www.lmsa.net
L.M.S.A. Journal Pg 6
www.lmsa.net
dent Scholarship Fund.
In 2006, N.H.M.A. contracted with firms to conduct
feasibility studies to develop the
strategy for sustainable growth.
A first step in this strategy was
the establishment of an association of State Medical Societies
which N.H.M.A. would develop
through its Childhood Obesity
Education Projects and new portal (HispanicHealth.info).
In 2008, N.H.M.A. completed a National Hispanics and
Health Disparities Summit Series
in NY, CA and TX with H.H.S.
O.M.H. that brought together
300 stakeholders from public and
private sectors to provide consensus recommendations for Federal
policy for public health prevention, access to care, and diversity
in the health professions for the
next 5 years. These recommendations were presented to Senator
Kennedy led Senate health care
reform committee, Congress and
with President Obama’s Transition team.
In 2009, N.H.M.A. Board
of Directors worked more formally with L.M.S.A. as it signed an
agreement and invited L.M.S.A.
to serve on its Board. In 2010,
NHMA developed its Council of
Residents and next plans to develop the Council of Young Physicians.
health research. The following
year, N.H.M.A. convened its First
Annual National Conference
honoring regional pioneer Hispanic physicians who had been
advocates for their communities. In October 1998, Dr. Rios
became the Executive Director
of N.H.M.A. after receiving Federal funding through a Cooperative Agreement with the H.H.S.
Office of Minority Health, followed by support from foundations and the private sector for
a variety of programs, including
launching the Hispanic-Serving
Health Professional Schools student internship program, the
N.H.M.A. Leadership Fellowship,
the N.H.M.A. Resident Leadership Fellowship, the N.H.M.A.
Medical Student Mentorship, the
N.H.M.A. Public Health Fellowship, the N.H.M.A. Research Network, the Cultural Competence
Graduate Medical Education
Curriculum Project, the National Hispanic Health Leadership
Summit, and the Congressional
Hispanic Health Briefing Series.
In 2005, N.H.M.A. completed a strategic review and expanded its Board of Directors to
include nationally recognized
leaders in the health sector; established its foundation’s, National Hispanic Health Foundation
(N.H.H.F.) affiliation and office
with NYU’s Wagner Graduate
School of Public Service, Corporate Advisory Council and its
Hispanic Health Professional Stu-
The National Hispanic
Medical Association (N.H.M.A.),
a 501c6 association, was developed in 1994 in Washington,
DC as a result of a meeting of
Presidents of Hispanic medical
societies. During the meeting it
was decided an organization was
needed to fill a void in Washington, DC – the need for a voice for
Hispanic/Latino physicians as advocates for Hispanic health with
the Federal government. This
decision grew from a history of
organizing efforts dating back to
the 1960s when Hispanic medical
students formed regional associations and local societies focused
on social and charitable activities.
As a young medical student, Elena Rios established the California
Chicano/Latino Medical Student
Association in 1983, its Supernetwork Program to link with 25
premed clubs, and in 1987, the
National Latin American Medical
Student Network.
Beginning in 1995, the
Department of Health and Human Services (H.H.S.) Health
Resources and Services Administration supported N.H.M.A. to
convene 5 regional meetings with
Hispanic health leaders around
the country with recommendations that shaped the initial policy priorities of the N.H.M.A.
Board of Directors: increasing
access for Hispanics to quality
health care, pipeline diversity in
medical education, and Hispanic
L.M.S.A. Journal By Elena V. Rios, MD/M.S.P.H.
Pg 7
N.H.M.A. Mission:
NHMA COUNCIL OF RESIDENTS
MISSION: To empower Hispanic physicians
to improve the health of Hispanic populations
with Hispanic medical societies, resident and
medical student organizations, and public and
private partners.
The mission of the NHMA is
to empower Hispanic physicians to lead efforts to improve the health of Hispanic
and other underserved populations in collaboration
with the state, regional and
local level Hispanic medical
societies, resident and medical student organizations,
and other public and private sector partners.
Dr. Elena V. Rios, M.D./M.S.P.H.
Dr. Rios is the President/CEO of N.H.M.A., whose
mission is to represent Latino physicians in the United
States and work towards improvement of Latino health. NHMA COR Spotlight-by Dr Lopez-Mena MD
The goal of the National Hispanic Medical Association Council of Residents is
to build the foundation of residents in
NHMA, with support and opportunities
for professional development, mentorship, leadership, and networking.
One of our other core missions however,
is to build a strong pipeline from LMSA
to NHMA COR. We believe that we
have strengthened this pipeline tremendously this past year through dedicated
mentorship of medical students. Once
again NHMA COR has collaborated with
LMSA to have residents present on panels regarding mentoring, achieving the
residency of your choice and community
engagement and empowerment at every
LMSA Regional conference.
The strong collaboration this past year
culminated with the first annual Student Policy Section at this year’s National
NHMA Conference March 28-30th in
Washington D.C. In an effort to extend
LMSA’s tradition of leadership within
the Latino community the Policy Section
aimed to teach participants about advocacy through health policy. The Student
Policy Section featured workshops for
students and residents, structured and
informal mentoring opportunities and
experience in developing and legislating
initiatives in health policy. The policy secwww.lmsa.net
terested in a workshop at your institution
please contact us. We will also be holding
a membership drive throughout the nation to increase resident participation and
voice in NHMA.
tion adapted a resolution-based policy referendum. Resolutions were collected from
LMSA members and shared on an online
forum open to comments and suggestions
from the general LMSA membership and
associated organizations. The policy development process culminated in the 2014
Congress of Delegates, where a regionally
elected policy committee presented submitted resolutions to be debated and voted
on by LMSA Delegates.
It has been an honor to serve as the NHMA
Council of Residents National Chair this
year. I look forward to continuing to build
strong relationships with LMSA students
throughout the country in my future role
as LMSA Physician Advisory Board member. We sincerely hope that you will continue on in your organizational participation and join us in NHMA in our shared
goals of decreasing health disparities in the
Latino community and promoting Latino
participation in medicine. Felicitaciones
on your outstanding National Conference!
In addition, this year’s National NHMA
conference titled “Affordable Care Act &
Best Practices for Hispanics” also gave
medical students and residents to become
up to date with the current happenings regarding the Affordable Care Act. Amongst
many things we learned how health care innovations and the Affordable Care Act are
influencing health care reform’s prevention
and public health strategies; we reviewed
community-based research that focuses on
knowledge and policy strategies that show
promise of eliminating health disparities;
and identified cultural competence, literacy, and language services programs for
medical education and health care delivery.
L.M.S.A. Journal COR was created in 1994 to serve as an interest group of NHMA
The NHMA COR seeks to increase mentorship through the Resident Mentorship Program. Objectives include:
*Reaching out to graduating medical students, current residents and fellows to become registered members and join our committees.
*Offering mentorship workshops, facilitating mentorship matches between physicians and trainees.
*Networking
COR also offers professional development through training and leadership fellowship to promote
leadership development.
*Emphasizes knowledge and skills necessary to take a leadership role in health policy development and advocacy at local, state, and national levels on issues of importance to the health of the
Hispanic community.
REGISTER NOW:
Early Birds Ends March 1
www.nhmamd.org
Members of COR may become leaders at multiple levels:
*Executive Board Officer
* Regional Representative
* State Representative
* Member of committee
NATIONAL HISPANIC MEDICAL ASSOCIATION
1920 L ST NW, Suite 725
Washington, DC 20036
To become a COR member, visit www.nhmamd.org
Phone: 202 628 5895
Fax: 202 628 5898
Email: [email protected]
www.facebook.com/NHMACOR
Lastly, in the fall NHMA COR will be
hosting workshops at local institutions
throughout the five regions, in order to further promote networking, mentoring, and
professional development. If you are in
NHMA 18TH Annual
Conference
March 28-30, 2014
Marriott Wardman Park
Hotel, Washington, DC
“The Affordable Care
Act & Best Practices in
Health Care for Hispanics”
Capitol Hill Visit, Poster
Presentations, & Resident Workshops
Pg 8
www.lmsa.net
L.M.S.A. Journal Pg 9
quarter of the Latino population, most medical schools in our region do not even know that LMSA exists. Although students in this
region are highly motivated, they often lack the connection and support that a national network provides. Despite the lack of a unifying
force however, individual chapters of LMSA survived, growing in number and eventually reaching out to the national organization.
Chapter spotlight
The story of the LMSA Southwest region cannot be told without including Ray Méndez, the acting LMSA President from 2006-2008. He
contacted the Latino student groups at the major medical schools in the Southwest region, calling for a face-to-face House of Delegate
meeting to help “re-establish” centralized communication within the region. He personally flew down from Illinois to meet with us on
November 5, 2011 at the University of Texas –Southwestern. With his guidance, we “re-formed” the LMSA SW Regional Board, started
the process of drafting our constitution, and most importantly, reconnected with students from different medical schools in our region!
LMSA
From the beginning, the story of LMSA has been a story familiar to anyone of Hispanic or Latino origins. Many people, many cultures,
yet with a kinship few others share. Our foods are different, our music is different, and our accents are different. We all come from
different countries, cultures, and backgrounds both from our family history and from our current lives, yet we are all united our goals
and ideals. The last time the Southwest Region held a national conference was in 2007, and we were known as NNLAMS. Above you
can see a pamphlet from that very conference, with
our current website juxtaposed. While many things
have changed, you will notice that the mission of our
organization has remained the same:
To unify all Latino medical students into one organization
To provide a voice for underrepresented medical students
To actively promote recruitment and retention of Latino students at all levels
To educate medical students on Latino health issues
To advocate for the rights of Latinos in health care
To provide leadership opportunities for Latinos
To promote volunteerism in the Latino community
Later than year, several of us met up at the National LMSA Conference in Boston – a true inspiration and vision for the future of our
fledgling SW Regional Chapter.
Several members of the 2011-2012 SW Regional Board reunited for GLAS 2012 in September – a wonderful learning experience as well
as the final push for organizing our 1st LMSA SW Regional Conference! he first LMSA-Southwest Regional Conference was held on
October 13, 2012 at Doctors Hospital Renaissance. Our theme “Salud En La Frontera”: Inspiring Future Leaders Through Mentorship
and Education reflected the culmination of many months of hard work from the conference organizers and the potential for growth in
our region.
We were thrilled to have over 75 medical students representing 7 medical schools and 30 undergraduates from University of Texas – Pan
American in attendance!
With one year under our belt, we continued to refresh our organization by electing the new officers for the LMSA-Southwest Executive
Board. Between October 2012 and April 2014 we have been quite busy!
The first LMSA-SW Networking event in May 2013 brought together students from UT-Houston, UTMB, UT-SW and Baylor College of
Medicine as well as residents and faculty members from the Houston area.
As you can see, we are growing not just in size (numbers), but in strength (the connections among different institutions). We are very
excited to host the 2014 National LMSA Conference in our region and hope that the theme “Creciendo Juntos!” serves as an inspiration
for all LMSA Regions and LMSA National organization to look forward to the future together.
In this very way, LMSA has overcome myriad hurdles in communication, continuity, name changes,
and logo changes spanning groups from around the
country. Despite the hurdles, we can be proud that
over the years our mission has remained unchanged
as the unifying force of our various chapters. By persevering over several years, in 2008 from the alphabet soup of NNLAMS/LMSA/NBLHO emerged the
unifying and overarching title, Latino Medical Student Association (LMSA).
Best,
Giselle Dutcher
Co-President, LMSA-Southwest
LMSA Southwest
On the regional level – the Southwest region of LMSA
has historically suffered significantly from a lack of communication and high student officer turnover. These factors among many led to the fragmentation of the Southwest region shortly after the 2007 National Conference
and resulted in a loss of communication with the national
organization. Though the Southwest contains roughly a
Members of LMSA-Southwest at the 2013 GLAS
Conference,
pictured with keynote speaker Dr. Raul Ruiz.
www.lmsa.net
L.M.S.A. Journal Caption: 1st LMSA-SW HoD Meeting, November 5, 2011 – Representatives from UT
Attendees at “Salud en la Frontera” - the 2012 LMSA Southwest
SW, UT San Antonio, Baylor College of Medicine, UTMB, LSU-Shreveport, Texas
Regional Conference – proudly wearing LMSA-SW T-shirts! The 2011-2012
A&M, TCOM
Executive Board Members are wearing gray LMSA-SW fleeces.
Pg 10
www.lmsa.net
L.M.S.A. Journal Pg 11
Mentor of the year 2013
Biography of a Great Leader
Dr. Phil DeChavez. “
Philip M. DeChavez M.D. M.P.H. was
born of humble beginnings. His experience growing up on the west side of San Antonio, Texas was
a driving factor in his life, as he both experienced
and bore witness to the hardships Latinos face
in education and the everyday. After graduating
from high school, he enlisted in the Army and
served as a combat medic in Operation Desert
Storm. The first in his family to attend college,
he received his Bachelor’s of Science degree from
Morgan State University, graduating Summa
Cum Laude as valedictorian. Dr. DeChavez then
went on to pursue his medical degree and complete his internship at the University of Pennsylvania. After completing his residency in Family Medicine, he received his Masters of Public
Health at Harvard University as a Commonwealth Fund Fellow in Minority Health Policy.
Throughout his career, Dr. DeChavez maintained
a dedication to helping Latinos in both higher education and the world at large. His commitment
to social justice drove him to research and develop educational programs aimed at increasing the
number of underrepresented minorities in higher education and grants such as an National Institute of Health study of minority drug use. During
his time at Penn, he was influential in the development of the Center for Hispanic Excellence: La
Casa Latina, and for his service to the minority
community he was awarded the Helen O. Dickens prize. At Harvard, he acted as an Executive
Committee Member and Graduate Student Advisor for Concilio Latino, an umbrella organization
for Latino associations at the university that provided a forum for these groups to come together
and discuss issues critical to Latino students. Dr.
www.lmsa.net
DeChavez also worked at the Boston Public Health
Commission, focusing on the Mayor’s effort to reduce racial and ethnic disparities throughout the
city. While serving as Medical Director at MCIFramingham, a medium-security correctional facility for female offenders, he volunteered his time
as the primary medical care doctor at the Justice
Resource Institute Swansea Wood School, a specialized school serving adolescents who have struggled with significant medical and mental illnesses.
Dr. DeChavez is remembered as a champion of
the underdog, always rooting for the successes of
those who had the world against them and advocating for the voiceless. For more than a decade, he played an active role in LMSA, joining
as a medical student and serving as its National Executive Director until his death in 2012.
His legacy lives on in those he mentored
throughout his life, including middle schoolers, high school students, undergraduates, medical students, and his own brothers and sister.
L.M.S.A. Journal Pg 12
www.lmsa.net
L.M.S.A. Journal Pg 13
Cultivating Latino Policymakers to Ensure
Health Care for
By Bryce Spitze, MPH & Orlando Sola, MPH
quarter of uninsured Latinos will
fall in the dreaded Medicaid Gap,
left without access to public or
private sources of insurance.
How did Latino health advocates
allow this to happen? While most
contend that politics is politics
and compromises must be made,
some argue that our representatives merely lack the political
fortitude to negotiate the complex issues that affect our patients
and their families. Thus, as Latino
health advocates, physicians, and
concerned citizens, we must promote our patients’ interests by
finding brave new leaders.
Great potential exists in the thousands of aspiring Latino health
professionals rising through
America’s schools right now.
These are the intelligent, powerful, yet compassionate individuals that have witnessed with their
own eyes the effects that poorly
conceived policies have on their
families. They should be the ones
sitting at the negotiation tables.
For who could better articulate
the injustice of a state rejecting
the Medicaid expansion than the
daughter of parents who fall into
the Medicaid Gap?
In light of the recent failures in the
ACA, the need for passionate and
informed Latino health advocates
has never been more apparent.
The Latino Medical Student Association is taking this message to
With over 53 million in the United
States, and more than 50,000 gaining the right to vote each month,
Latinos are becoming increasingly
influential in the American political sphere. Democrats’ promises
of reform in areas ranging from
immigration to health care have
led to consistent political support from the Latino community.
President Barak Obama rode this
wave of support through two general elections, signing the Affordable Care Act into law to answer
calls for equity in medicine. Yet
the minority groups that supported President Obama throughout his political career, Latinos
amongst them, have not had their
needs met.
Even when the law was first
signed, the ACA was fraught with
exclusions for millions of Latinos. For instance, the issue of
undocumented immigrants was
so politically charged that they
were intentionally left out of the
bill. Because of this, even those
who earn enough money will not
be allowed to purchase a plan in
the insurance exchanges. Millions
more fully documented Latinos
lost their chance at coverage when
the Supreme Court decided that
the Medicaid expansion was an
unlawful coercion of the states.
Now, with 21 states rejecting the
Medicaid expansion, nearly a
www.lmsa.net
L.M.S.A. Journal heart and will debut its new Student Policy Section this March
in Washington, DC. Students
and medical professionals of all
ethnicities will meet to provide
the networking, mentoring and
academic resources necessary to
train the future physician leaders of the Latino community.
By preparing our youth, Latinos
and other marginalized groups
can ensure that future health reform in our country will address
the still-growing disparities in
medicine.
Pg 14
www.lmsa.net
L.M.S.A. Journal Pg 15
Student Abstracts
Prenatal Care for Farmworkers in South Florida
J. Mazzurco, OMS-III, M.P.H.(1)
S. Zhang, OMS-III(1) M.I. Fernandez, PhD(1)
(1) Nova Southeastern University College of Osteopathic Medicine
Introduction: In the US, there is an estimated 3 million farmworkers; 22% of which are female, and the majority is of childbearing
age (NCFH, 2012). In the Southeast, the greatest number of farmworkers resides in the state of Florida. Due to their working and
living conditions, farmworkers are at increased risk of injury and illness. However, numerous barriers lead them to have among the
lowest levels of healthcare access and utilization. Lack of accessible health care can be particularly problematic for farmworkers who
have increased need for care, such as pregnant women. Lack of adequate and timely prenatal care has been associated with negative
maternal and newborn health outcomes. Understanding farmworkers’ experiences in accessing and engaging in prenatal care will
advance efforts to promote prenatal care services for this at-risk, understudied population.
Celebrate
Methodology: A bilingual researcher from the study population recruited 100 farmworker women in community venues. One hundred percent of the eligible women agreed to participate. After obtaining written informed consent, the researcher administered an
interview survey consisting of 53 items. The interviewer read each question and answer choices out loud and the participant selected
her response, which the interviewer recorded on a paper form. The interview survey explored the experience of female farmworkers
with prenatal care during their pregnancy in the past two years. We used past literature to design the interview, which we then pilot
tested on farmworker women. Our analysis focused on analyzing timely and adequate prenatal care, and maternal and newborn
outcomes. All statistical analyses were done using SPSS version 20. The research protocol was approved by NSU IRB. Results: The majority (97%), of participants entered prenatal care during the first trimester of their pregnancy, and (90%) received
5-10 or 5-15 prenatal care visits. Support for prenatal care was provided by emergency Medicaid. Only 3% of women paid out-ofpocket for their prenatal care. Only 7% of women had problems during delivery, including anemia, and excessive hemorrhage. In
addition, 94% of participants delivered their babies vaginally. None of the babies were of low birth weight and none died during
childbirth
.
Conclusion: Overall, the majority of our participants received adequate and timely prenatal care. Furthermore, the majority of
participants experienced positive maternal and newborn outcomes. Our results differed from previous studies that found a lack of
adequate prenatal care for farmworker women, and high percentages of negative health outcomes. Our positive outcomes may be
in a large part attributed to the availability of emergency Medicaid that allowed participants to access prenatal care services. These
results point to the importance of maintaining and enhancing these programs to help ensure that all pregnant women have access
to prenatal care.
National Center for Farmworker Health [NCFH]. (2012). Farmerworker Health FactSheet. Retrieved October 28, 2012, from http://
www.ncfh.org/docs/fs-Migrant%20Demographics.pdf
At Johns Hopkins Bayview, we believe that
diversity creates strength. By fostering a
diverse and inclusive culture
“The heart of Bayview
throughout the program and
will remain in every
the medical center, we attract
resident who has
the best and brightest
trained here.”
students from all walks of life,
and help them become healers
- Linda Mobula, M.D.
Class of 2011
and leaders in medicine. Along
the way, they build relationships with faculty, staff, and other
residents that last a lifetime. We hope you’ll take the opportunity
to talk to our residents and learn more for yourself.
Please visit our website at
http:/www.hopkinsmedicine.org/jhbmc/imresidency or call 410-550-0526 for
more information.
Training Healers and Leaders in Medicine
www.lmsa.net
L.M.S.A. Journal Pg 16
www.lmsa.net
L.M.S.A. Journal Pg 17
HIV/AIDS Care Delivery in Dominican Republic – The Need for Capacity-building
Felipe Cameroamortegui1, Pamela Castro1, Altagracia Nolascoc3, James R. Hillard124., Reza Nassiri12
College of Osteopathic Medicinea1 , Institute of International Health2, Michigan State University, East Lansing, Michigan,
USA; Municipal Hospital of Boca Chica – Centro Atencion Integral de VIH/SIDA, Boca Chicac, Dominican Republic3;
College of Human Medicine4, Michigan State University
Introduction: The United Nations estimates the HIV /AIDS prevalence in the Caribbean is the second highest in the world after SubSaharan Africa. 75% of these cases reside in Dominican Republic and Haiti. The epidemic seen in the country reflects a complex interplay of factors such as socioeconomic, health disparities, unsafe sexual practices, lack of health education and geographic proximity to
Haiti. The prevalence of HIV/AIDS in Haiti is almost three times that of the Dominican Republic.
HYPOTHESIS: Identification
implementation.
of gaps and organizational capacity building would contribute to the impact of HIV care delivery
Methods: In this study, we designed questionnaires which were used for 52 HIV outpatients and 15 healthcare providers. The objectives
of such questionnaires were to identify barriers and obstacles perceived by various healthcare professionals in the delivery of HIV/AIDS
medical care. The study was conducted at the Boca Chica Clinic located in Dominican Republic. Boca Chica is known in the country for
having the highest prevalence of HIV/AIDS in the Dominican Republic primarily through sex workers and drug abuse.
Results: Our results indicate that lack of transportation, the number of clinic service hours, and long waiting time were some of the
urgent issues that patients were confronted with. Conversely, our data shows that in the same clinic, only 43% of providers were aware of
national HIV programs aimed at collecting HIV data and 14 % were not aware of the existence of these programs at all. Even though the
resting 43 % were aware, they lacked knowledge of how these programs worked and the services they provided.
Conclusion: We concluded that geographical distances, lack of resources, and limited amount of hours of operation offered by the clinic
were some of the key capacity-building issues. Furthermore, our observation indicates lack of effective implementation programs add to
the complexity of HIV care services in the community of Boca Chica. Our study warrants a more robust national policy and implementation in the Dominican Republic to enhance capacity-building in HIV/AIDS care delivery.
Role of Inflammasome Components in Innate Immune Response Against T. cruzi Infection in
Chagasic Cardiomyopathy Patients
Effectiveness of Using Non-Clinicians in Delivering a Brief Smoking Cessation Intervention in the Emergency Department
Maria Dueñas BS, Ashley Colucci BS, Renee Fruchter BS, Ellie Grossman MD MPH
Primary Author Status: 4th year Medical Student
Background: Tobacco remains the leading preventable cause of morbidity and mortality. Prior studies have shown that Emergency
Department (ED) patients typically smoke at rates exceeding that of the general population, are interested in quitting and often have
limited access to primary care. However, a busy ED can be a difficult setting to implement preventive-health interventions. In this study,
we describe a pilot initiative using non-clinician volunteers to deliver a brief smoking cessation intervention to ED patients who smoke.
Methods: We trained a cohort of college-aged volunteers to assess adult patients for use of tobacco products in the Bellevue Hospital
ED and proactively refer interested smokers to the NYS Quitline. All patients were offered printed information about resources to help
them quit smoking. We collected information about the number of patients approached, the number who reported using tobacco and
nicotine products, and acceptance of referral to the Quitline. We collected follow-up reports from the NYS Quitline and also attempted
to contact all smokers at least once via phone approximately one month after ED visit. These follow-up reports provided information
about use of smoking cessation pharmacotherapy, quit attempts, and smoking status.
Results: During the two-month intervention period in summer 2013, we screened 1550 adult patients for tobacco use. Of
those screened, 414 (26.7%) had used tobacco in the past 30 days. 353 smokers filled out an intake form; of these, 69.9%
were male, 29.8% female and 0.3% transgender. Mean (±SD) age was 42.8 years (±13.1). Among these smokers, English
(84.3%) and Spanish (8.5%) were the preferred languages. Nicotine product use included cigarettes (94%), electronic cigarettes (8.5%), cigars (6.9%), and pipes (1.9%). Among cigarette users, 40.3% reported smoking <5 cigarettes/day, 31.8% 5-10
cigarettes/day, 20.3% 11-20 cigarettes/day, 4.9% 21-30 cigarettes/day and 2.6% >30 cigarettes/day. 133 (32.1%) completed
a fax-to-quit referral form for the NYS Quitline. The NYS Quitline reported follow-up data for 101 patients, and of these,
26 (24.8%) had completed a Quitline telephone encounter. The Quitline reported that 15 (57.7%) had already quit smoking, 9 (34.6%) wanted to quit smoking and 2 (7.7%) were not ready to quit yet. Our program reached a total of 86 patients
for 1-month follow-up, and 51 (59.3%) reported tobacco use within last 7 days while 31 (36%) claimed abstinence. Fifty
patients reported a quit attempt lasting longer than 24 hours since their ED visit.
Conclusions: Trained volunteers are able to deliver a brief smoking cessation intervention in the ED and can feasibly refer
patients to the NYS Quitline. This brief intervention, consistent with evidence-based guidelines for tobacco dependence
treatment, is acceptable to patients undergoing treatment in a busy urban safety-net hospital ED.
HG Mendoza1, N Dey1, MP Zago2, S Nunez3, X Wan1, NJ Garg1, 4
1Department of Microbiology and Immunology,2IPE- CONICET-UNSa,3Servicio de Cardiología, Hospital San Bernardo, Salta, Argentina,4Faculty of the Institute for Human Infections and Immunity, Center for Tropical Diseases and Sealy Center for
Vaccine Development, University of Texas Medical Branch, Galveston TX.
(956) 371-5252
[email protected]
Chagas disease caused by T. cruzi is endemic in Latin America and an emerging disease in the US and other developed countries. The
clinical course of the disease can be broadly categorized into three stages— Initial, Intermediate, and Chronic. Chagas disease pathogenesis has previously been shown to be associated with inflammatory responses including ROS production. In this study, we exam- ined
key events related to innate immune responses in Chagasic patients. Previously, RNA isolated from T. cruzi infected macrophages was
used to profile the expression of 84 key genes involved in innate immunity as well as in toll-like and NOD-like receptor signaling by
RT-PCR arrays (QIAGEN Inc., CA).Twelve genes expressing inflammasome components (AIM2, NLRP3, NLRC5), toll-like receptors
(TLR2,TLR9), adaptor molecules (MYD88), cytokines or chemokines (TNF-α, IL1-β, CCL2, CXCL1, CXCL2), and cellular transcription factors (NFκB-1A) were selected based on the results of the RT-PCR arrays for further analysis in Chagasic patients. Real Time PCR
was performed to quantify differential expression of these selected genes in peripheral blood mononuclear cells (PBMCs) isolated from
patients in various stages of Chaga’s disease along with PBMCs isolated from normal healthy individuals. We saw an upregulation of gene
expression of various receptors, transcription factors and inflammasome components during the later stages of Chagas disease. However,
due to the small pool of patients used in this project, it is difficult to generate a definite statement regarding differential gene expression
in specific stages of Chagas disease.
www.lmsa.net
L.M.S.A. Journal Pg 18
Localization of the Virulence Regulator AtxA in Bacillus anthracis Cells
Joaquin A. Villegas Inurrigarro, Theresa M. Koehler, PhD
Department of Microbiology and Molecular Genetics, UTHSC at Houston
Bacillus anthracis is a spore-forming Gram-positive bacterium that resides in soil but can cause anthrax disease upon entry
into mammal hosts. The anthrax toxin proteins are critical virulence factors of the bacterium. Transcription of the toxin
genes requires the trans-acting regulator AtxA (anthrax toxin activator). Ongoing studies of AtxA function suggest that
protein activity is controlled by the phosphoenolpyruvate: carbohydrate phosphotransferase system (PTS), a system used
by many bacteria for sugar uptake. The central amino acid sequence of AtxA is comprised of putative PTS-regulatory domains that are thought to be phosphorylated by the PTS. The carboxy-terminal region of AtxA shows amino acid sequence
similarity to protein EIIB. EIIB is a component of the PTS that is well-studied in the non-pathogen B. subtilis. EIIB in B.
subtilis and other bacteria is membrane-associated, and part of the sugar permease complex. I hypothesized that AtxA
associates with the membrane via its EIIB domain. I investigated the localization of AtxA using direct fluorescence microscopy and immunofluorescence microscopy. To asses AtxA localization, I constructed a B. anthracis strain carrying a recombinant gene encoding a green fluorescent protein (GFP)-tagged AtxA. Unfortunately, AtxA activity assays showed that
the GFP-AtxA protein was inactive. Also the recombinant protein formed inclusion bodies within cells. I also attempted
to detect His- and Flag-tagged AtxA proteins using immunofluorescence microscopy. However, the fluorescence of cells
expressing these proteins was indistinguishable from background fluorescence. In future studies, we will use anti-AtxA
antibody and/or try an alternative imaging protocol.
www.lmsa.net
L.M.S.A. Journal Pg 19
Cost analysis of retrospectively identified cohort of patients
Melissa Esparza; Daniel Beckerman (UC Berkeley); S. Samuel Bederman, MD PhD FRCSC (UC Irvine); Matt Callahan,
MSBA; Serena S. Hu, MD; Shane Burch, MD; Vedat Deviren, MD; Bobby Tay, MD; Praveen V. Mummaneni, MD; Dean
Chou, MD; Christopher P. Ames, MD; Sigurd H. Berven, MD
University of California, San Francisco
Objective: The purpose of this paper is to analyze the determinants of direct costs for single-level lumbar fusions and to identify potential
areas for cost reduction.
Background: Health care expenditures for the diagnosis and treatment of spine conditions are increasing more rapidly than other areas
of health expenditures. There is high variability in the cost and surgical management of spine pathologies.
Methods: Adult patients who underwent primary single-level lumbar fusion between fiscal years 2008-2012 met inclusion criteria. Patients were excluded if they underwent multiple surgeries, corpectomy, kyphectomy, disc replacement, surgery for tumor or infection,
or had incomplete cost data. Demographic data, clinical data, and direct cost data in the categories of supplies, services, room and care,
and pharmacy, were collected for each patient. Analysis of variance was performed to compare differences in costs between the five surgical approaches utilized. The Tukey Honest Significant Difference method was used to perform pairwise comparisons between approach
types.
Results: The cohort included 532 patients. Direct costs ranged from $8,286-$73,727 (median=$21,781; mean=$22,890 ± $6,323). Surgical approach was an important determinant of cost. The mean direct cost was highest for circumferential fusions and lowest for cage-less
posterior spinal fusions. The difference in mean direct cost between transforaminal lumbar interbody fusions, anterior lumbar interbody
fusions, and lateral transpsoas fusions was not statistically significant. Surgical supplies were the highest category of spending, accounting
for 44% of direct costs. Spinal implants were the primary component of supply costs. Comorbidities were an important contributor
to variability in cost.
Conclusion: The costs of spinal surgery are highly variable. Important cost-drivers in our analysis included surgical approach, implants,
operating room time, and length of hospital stay. Areas of high cost and high variability offer potential targets for cost savings and
quality improvements.
Literature review of cost-effectiveness analyses of new technologies in spine surgery
Melissa Esparza, BA; Serena S. Hu, MD; Shane Burch, MD; Todd Lansford, MD; Sigurd H. Berven, MD
University of California, San Francisco
Objective: The purpose of this article is to present the concept of economic evaluation of new technologies in spine surgery as a factor to
guide an evidence-based approach for their consideration for adoption into clinical practice.
Summary of Background Data: The adoption and implementation of new technologies is a primary driver of the increasing rates of
spending in spinal care. New technologies should be assessed by their ability to optimize value by improving outcomes or reducing costs
over time.
Methods: The literature was reviewed for economic evaluations of new technologies in spinal care. Four areas were chosen for further
review: 1) circumferential versus posterolateral spinal fusions; 2) total disc replacement versus arthrodesis for degenerative disc disease;
3) bone morphogenic protein versus autograft in spinal fusions; and 4) vertebroplasty for osteoporotic vertebral compression fractures.
Results: Cost-utility analysis shows circumferential fusion to be dominant over a posterolateral approach in that it was more effective
and less costly over time. The value of bone morphogenic protein compared to iliac crest bone graft, and of lumbar and cervical total disc
replacement compared to fusion, remains inconclusive and may vary with respect to patient demographics and cost calculations. A lack
of sustainable outcomes with the use of vertebroplasty indicates that it is not a value-adding intervention for the treatment of osteoporotic
vertebral compression fractures.
Conclusions: The adoption of new technologies in spine surgery should be guided by evidence showing that the technology adds value to
our health care system by significantly improving outcomes or decreasing costs over time.
www.lmsa.net
L.M.S.A. Journal Pg 20
TTUHSC at El Paso is seeking Board Certified
Physicians in the area of Emergency Medicine to
become part of its team of professionals. The
Department of Emergency Medicine staffs the
Emergency Room of University Medical Center El
Paso, a level one-trauma center with approximately
60,000 visits annually. The department also assists
in training medical students from the TTUHSC
Paul L. Foster SOM. Appointments will be at the
Instructor level, or above, as deemed appropriate.
Please contact Christine Carbajal at 915-215-4609
or [email protected] for more
information.
www.lmsa.net
L.M.S.A. Journal Pg 21
Evaluation of Risk Factors related to Non-communicable Diseases in Adult Community of
Escondido, Bani Municipality in November 2011-January 2012.
Iván Ramírez De Oleo , David Vargas Mena Dr. López Emilton
Escuela De Medicina, Instituto Technologico de Santo Domingo
Introduciton: The profile of the disease throughout the world is changing at an amazingly fast pace, especially in low and middle income.
The old notions about the nature of chronic disease, its incidence, risk factors and underlying risk populations are no longer valid. The
spread of non-communicable chronic diseases (NCD) is a global crisis. In almost all countries and in all income groups, men, women
and children are at risk of these diseases.
Methodology: The study was descriptive, prospective and cross-sectional, population is adults between 45-64 years of age. A protocol for
data collection, which was applied to 100 persons who met the inclusion criteria, which were chosen at random was used.
Results and conclusions: There was a 71% physical inactivity in the community. 59% of people had a body mass index above normal
values , of which 30% were overweight. 34 % had a medical history of hypertension, and 10% of diabetes. 14% of the sample smoked.
88% of men had not have a rectal exam for the diagnosis of prostate cancer, 67 % of women had not have mammogram and 47% had not
have a Pap test. Daily consumption of fruits and vegetables was 25 %.
Students for a Better Healthcare System (SBHS): Educating the general public on the
Affordable Care Act.
Matt Meizlish, Priscilla Wang, Lorenzo Sewanan, Sean Maroongroge, Kyle Ragins, Giulio Rottaro
Yale School of Medicine
BACKGROUND / SPECIFIC AIMS: The success of current health care reform depends upon quality information reaching those who
can benefit most. Students for a Better Healthcare System (SBHS) is a campaign started by Yale medical students, mobilizing students
around the country to engage their communities on issues of health care reform. We have three major goals: (1) to explain the context
and content of the Affordable Care Act (ACA) and connect community members with opportunities to enroll in health insurance, (2) to
begin a broader dialogue about health care reform, and (3) to develop a nationally replicable campaign model.
METHODS: (1) Developing 25-minute, visually appealing, accessible presentations, one tailored to community members and one to
health care providers, and accompanying English/Spanish informational flyers. (2) Forming community partnerships and delivering
interactive presentations in settings like community colleges, churches, and hospital staff meetings. (3) Working with health officials and
providers to connect patients with enrollment opportunities. (4) Expanding this campaign to other universities.
COLLAGENOUS GASTRITIS: AN UNUSUAL PRESENTATION
Anup Shah B.S., Gilad Birnbaum BA, F. Lyone Hochman M.D. – Baylor College of Medicine
Case Report: A 67 year old African American female with history of GERD, COPD, diabetes, hypertension, hyperlipidemia and anemia
complains of one month nausea and vomiting with meals, dark stools, weakness and mild weight loss. She denied fever, night sweats,
abdominal pain, or change in bowel movements. Her symptoms improved with Prilosec and vomiting. Patient has a history of gastric
ulcers and cholecystectomy eight years prior. Recent colonoscopy was negative. Family history is significant for father with colon and
lung cancer and mother with breast cancer. Examination was significant for epigastric tenderness.
CT was unremarkable and EGD showed diffuse inflammation but unlike the typical antral gastirits, the fundus was most severely affected demonstrating severe hemorrhage and nodularity. Biopsies showed thick collagenous bands within the subepithelium as well as
significant inflammatory infiltrate in the lamina propria consistent with the rare diagnosis of collagenous gastritis. Biopsies were negative for H.pylori, intestinal metaplasia, or malignancy.
Patient was initially started on prednisone and was switched to oral budesonide. Patient reported weight gain and significant improvement of her symptoms.
Discussion: Collagenous gastritis was first described in 1989 and since then there have been less than 40 reported cases in the literature,
with a majority in the pediatric population. (1) Collagenous gastritis is a histological diagnosis characterized by thick subepithelial collagen bands (>10 µm) and infiltration of inflammatory cells in the lamina propria. (2) There are two phenotypes of collagenous gastritis
described in the literature. The pediatric phenotype is localized to the gastric mucosa and presents with anemia, abdominal pain and
gastric mucosal nodularity; The adult phenotype is complicated by collagenous colitis and therefore presents as chronic watery diarrhea. (3) Our patient appears to be the first case describing an adult patient presenting with the pediatric phenotype. The patient had a
history significant for anemia and epigastric tenderness but no evidence of collagenous colitis. Our patient’s weight loss and symptoms
improved with steroid therapy. (4) The long term course and prognosis of collagenous gastritis is still unknown and it may be of great
interest for these patients to undergo regular follow up and testing.
References:
Clinical outcome of pediatric collagenous gastritis: case series and review of literature. Hijaz NM, Septer SS, Degaetano J, Attard TM.
World J Gastroenterol. 2013 Mar 7;19(9):1478-84.
Matsumoto Y, Kurahara K, Ooshiro Y et al. Collagenous gastritis in a young Japanese woman, report of a case. Stom. Intest. 2011; 46
(9): 1389-96
Lagorce-Pages C, Fabiani B, Bouvier R, Scoazec J-Y, Durand L, Flejou J-F. Collagenous gastritis: a report of six cases. Am J Surg Pathol.
2001;25:1174-1179
Wang HL, Shah AG, Yerian LM, Cohen RD, Hart J., Collagenous gastritis: an unusual association with profound weight loss., Arch
Pathol Lab Med. 2004 Feb;128(2):229-32.
RESULTS / CONCLUSIONS: We have delivered presentations to over 500 people in New Haven, receiving excellent feedback (98% of
52 post-presentation survey participants felt the ACA would benefit them). We have developed systems to connect uninsured patients
in local clinics with trained enrollment “Assisters”. We’ve also begun expanding our campaign to student groups nationwide interested
in using our resources and model to mobilize their communities. We look forward to working with our new partners toward a better
American health care system, one community and one conversation at a time.
www.lmsa.net
L.M.S.A. Journal Pg 22
www.lmsa.net
L.M.S.A. Journal Pg 23
IDENTIFYING NOVEL COMPLEXIN INTERACTIONS THROUGH FORWARD
GENETICS.
Francesco E. Michelassi and Jeremy Dittman. Department of Physiology, Biophysics, and Systems Biology, Weill Cornell
Graduate School of Medical Sciences, New York, NY, 10021.
Tightly regulated neurotransmitter release is crucial for a functioning nervous system. Release occurs when vesicles filled with neurotransmitter fuse to the presynaptic plasma membrane, a process that is driven by the SNARE proteins. The small protein complexin
(CPX-1) regulates vesicle fusion by binding to the SNARE proteins to inhibit spontaneous neurotransmitter release. Biochemical methods have identified the ternary SNARE bundle as the only binding partner of CPX-1, while genetic and physiological evidence suggests
that CPX-1 may have interactions with other proteins. In order to find transient, low affinity binding that may not be apparent by traditional biochemical methods, this study uses a forward genetics screening approach in Caenorhabditis elegans to identify novel CPX-1
interactions in vivo. CPX-1 knockout worms (cpx-1) paralyze rapidly in the presence of acetyl cholinesterase inhibitors. cpx-1 worms
are mutagenized with either EMS or ENU, and their F2 progeny are immersed in aldicarb, an acetyl cholinesterase inhibitor. F2 worms
that continue to move in the presence of aldicarb, demonstrating the acquisition of mutations counteracting the cpx-1 phenotype, are
selected and cultured. Selected worms are exposed to levamisole, an agonist of the worm acetyl choline receptor to identify and exclude
worms with mutations in the post-synapse. Mutations in the genome resulting in pre-synaptic changes are located with Snip-SNP mapping, and implicated genes are sequenced. One of the hits from our screen, tau1, appears to be a mutation in UNC-13, a synaptic protein
that is known to interact with many partners, including one of the SNARE proteins, syntaxin. These results suggest that CPX-1 and
UNC-13 function in the same pathway at the synapse, though more research is required to determine if they interact with each other.
New Jersey Personal Responsibility Education Program (NJ PREP): Decreasing Pregnancy
and Sexually Transmitted Infections
(STIs) in Teens
Karen Grisales Omara Cardoza
Kean University, Department of Physical Education, Recreation and Health
OBJECTIVE: This study evaluated the longitudinal effectiveness of the program “Reducing the Risk - Building Skills to Prevent Pregnancy, STD and HIV”, an evidence based program designed to decrease adolescent pregnancy and sexually transmitted infections in
two New Jersey State identified, high risk municipalities.
METHODS: During the 2012- 2013 academic year, the curriculum was implemented in health classes with ethnic minority college
research assistants co-facilitating the lessons with the health teachers. A cohort of 283 predominantly ninth grade students participated
in the program. Participants completed baseline, post- and 3- month follow-up surveys. The study used randomized control and intervention groups of students in the two high schools in New Jersey.
RESULTS: By the end of the 2012-13 academic year, 130 participants completed the Reducing the Risk Knowledge Survey before and after the program. The average score prior to the program was 61.2. After the program, the average score was 71.3. This change indicated
that the participants knowledge significantly increase at a .001 level. 91% percent of program participants who reported being sexually
inexperienced at baseline reported they’ve continued to delay initiation of sexual intercourse after program completion. 95% percent of
our program participants who reported being sexually inexperienced at baseline reported they’ve continued to delay initiation of sexual
intercourse 3 months after program completion. 39% percent of our program participants who reported being sexually active at baseline
reported abstaining from sexual activity during the 3 months following program participation.
CONCLUSION: Overall, the Reducing the Risk program was effective in presenting a strong and active approach in reducing the risk
to teenage pregnancy and protecting against HIV and other STDs. The program was more effective in delaying sexual debut with 9th
graders than with 11th graders. Further research is needed to determine what strategies are successful in delaying sexual debut with
upper classmen.
www.lmsa.net
L.M.S.A. Journal Pg 24
High occurrence of gastrointestinal problems in Puerto Rican male patients with
Hermansky-Pudlak Syndrome
Oscar Alejandro García1; Stephanie Bermúdez1; Edwin P. Campoverde1; Paloma R. Sánchez1; Verόnica Santiago1; Leslie Seijo1; Karen R. Velarde1; Enid Rivera, MD2; Mόnica Santiago, MD3; Donna Appell4; Irvin Maldonado1.
Department of Biomedical Sciences and Research, San Juan Bautista School of Medicine, Caguas, Puerto Rico1; Professor and Director of Hematology and Oncology, Department of Pediatrics, University of Puerto Rico School of Medicine,
San Juan, Puerto Rico2; Hematology and Medical Oncology Department, San Juan City Hospital, San Juan, Puerto Rico3;
Founder and President of Hermansky-Pudlak Syndrome Network, New York, New York.4
Introduction: Hermansky-Pudlak Syndrome (HPS) is a rare autosomal recessive disorder that results in oculocutaneous albinism,
platelet abnormalities, as well as ceroid accumulation in different organs. HPS occurs globally at an estimated prevalence of 1:500,000 to
1:1,000,000 in the non-Puerto Rican population. In Puerto Rico, HPS is notably more frequent with approximately 1 of every 22 people
carrying the gene and a prevalence of 1:1,800 in the Northwestern region.
Methodology: In this pilot study, we conducted a survey in the Northwestern area of Puerto Rico to investigate the different initial
symptoms experienced among HPS patients. A total of 47 patients were surveyed: 26 females, 21 males.
Results: Our study shows that HPS patients may experience several gastrointestinal (GI) symptoms such as inflammatory bowel disease, irritable bowel syndrome and gastroesophageal disease. Approximately 38% (n=17) of the patients from this population presented
with gastrointestinal symptoms as an initial symptom. The data demonstrated that 48% of males (n=10) experienced GI problems as
an initial symptom as opposed to 19% of females (n=5). Males were 2.5 times more likely to present with GI symptoms than females.
Additionally, males presented a higher recurrence of GI symptoms as opposed to females (52% vs. 27%).
Conclusion: Our results suggest that males with HPS in the Northwestern region of Puerto Rico have a higher tendency to present and
persist with GI complications than females. In the future, we plan to expand our survey to a larger number of HPS patients in order to
obtain statistically significant results. Similarly, it would be helpful to identify why some HPS patients do not present with GI complications.
Continuous Renal Replacement in Pediatric Patients with Acute and Acute-on-chronic
Liver Failure
Keila De La Garza, Alyssa Riley, Poyyapakkam Srivaths, Carolyn Smith, Mary N Watson, Amelia Allstead, Helen Currier,
Ayse Akcan Arikan
Baylor College of Medicine
Acute and acute-on-chronic liver failure (LF) can lead to multiple organ failure and associated acute kidney injury (AKI) requiring
renal replacement (CRRT) therapy in the pediatric population. AKI in LF is multifactorial; common etiologies are hepatorenal syndrome, nephrotoxic medications, abdominal compartment physiology, and intrinsic renal dysfunction. The natural progression of this
disease process is detrimental with high mortality despite maximum support. We retrospectively reviewed charts of patients with LF
who received CRRT for primary or secondary LF-related complications from 2011-2013 at our institution. There were 45 patients, 31
% were male; mean age was 6.7 ± 7.2 years. 19 of 45 patients (42%) were less than 2 years old. All patients were mechanically ventilated
and mean length of ventilation was 19.2 ± 14.5 days. The mean length of hospital stay was 52.8 ± 44.5 days. 64% received at least one
vasoactive amine. CRRT was provided as continuous venovenous hemodiafiltration (CVVHDF). Blood-primed circuits were used in
all patients weighing less than 15 kg. Regional anticoagulation with citrate was used for all stand-alone CRRT. Median length of CVVHDF was 9 days (IQR 5, 20). 28 patients died (62%). Eleven patients received intermittent hemodialysis as well as CRRT, 6 of these
were converted to IHD at PICU discharge, three patients liberated from IHD and one patient remained IHD dependent at hospital discharge. The two other patients who are IHD dependent are still in-house. All of the patients who required IHD at PICU discharge were
less than 2 years old. The average percent fluid overload (FO%= total fluid in-total fluid out/PICU admission weight) was 21.3 ± 19%
at CRRT initiation. Nine patients had a FO %> 25%, 6 of these died and the other three remained IHD dependent at PICU discharge.
Only 19 patients had complete information available regarding citrate toxicity, of these, seven were noted to have “citrate lock” by nephrologists in the charts. Common interventions were decreasing citrate dose, increasing diffusive clearance, and transiently stopping
citrate (2 patients). No treatments were interrupted because of citrate toxicity. LF-related AKI requiring CRRT has a very high mortality and high morbidity. Younger cohort of patients makes CRRT treatment technically challenging and may necessitate further IHD at
PICU discharge. Long term close follow-up of these patients is essential. Regional citrate anticoagulation seems safe in this population
although further studies are needed.
www.lmsa.net
L.M.S.A. Journal Pg 25
Discovering Regulators of Tumor Antigen Presentation on Major Histocompatability
Complex I
Elliott Brea12, Eusebio Manchando Robles1, Qing Xiang1, Ron Gejman12, Ralph Garippa1, Scott Lowe1,
David A. Scheinberg12
1, Sloan Kettering Institute, New York, NY 10065
2 Weill Cornell Medical College, New York, NY 10065
together
we build a brighter future.
Specific immunotherapies for cancer continue to gain interest as effective therapeutic strategies. A number of intracellular T cell epitopes have been identified as potential therapeutic targets in cancer. However, the mechanisms underlying the presentation of tumor
antigens are poorly understood and difficult to regulate. Another limitation of targeting these tumor antigens with therapies such as
adoptive T-cell therapies, CAR therapy, tumor vaccines, or TCR-like antibodies is the limited cell surface presentation of tumor antigens on major histocompatibility complex molecules (MHC-I,) which may limit their clinical efficacy. We propose that genes involved
in epitope presentation can be discovered in a loss of function screen using specific antibodies to MHC-I and a TCR-like antibody
targeting a model tumor antigen (the intracellular oncoprotein WT1). ESK1 is a new monoclonal antibody that detects a nine amino
acid peptide derived from WT1 that is presented in the context of HLA-A02 on the cellular surface. Utilizing a pooled RNAi knockdown screen, genes leading to alterations in HLA-A02 expression in a WT1 positive/HLA-A02 positive human mesothelioma cell
line have been identified. Preliminary hits have been validated to confirm previously published data on regulators of MHC-I; novel
gene products were also discovered. Using a TCR-like antibody can be a powerful tool for identifying regulators of antigen presentation, which can have broad implications in multiple diseases with pathophysiology related to antigen presentation, including cancer,
autoimmune disease, and infectious disease.
Our vision is
an ambitious one…
to end disparities,
help everyone
get the care they need,
Clinica Tepati: Establishing A Preventive Care Model in Diabetes Care and Management
and make better
health a reality for all.
Alberto F, Mayorquin MD P, Orozco M, Fancher MD MPH TL
UC Davis School of Medicine
Background: Though national policies have increased access to insurance, student-run free clinics remain integral in providing care
for the poor and uninsured. Today there are over 110 clinics that currently operate across the United States; yet, little data exists
on the quality of care being delivered at such sites. Since 1979, Clinica Tepati in Sacramento has been offering primary care to the
uninsured Latino community. Staffed with UC Davis Medical students, undergraduate volunteers and physician-volunteers, Clinica
focus includes diabetes management.
Objective: The aim of this study to assess the extent to which Clinica Tepati meets national 2012 Health Effectiveness Data and Information Set (HEDIS) standards for outpatient diabetic care.
Method: In a retrospective chart review, diabetes management was assessed by comparing quality-of-care indicators such as Blood
Pressure, HBAIC Screening and control, LDL Screening and control nephropathy screening, retinopathy referrals and foot exams.
Results: Clinic rates of such diabetes quality-of-care indicators ranged from 30% to 99%, Areas of strength include Clinica’s screening in HBAIC, LDL, Retinopathy, Nephropathy, and Foot Exams. Areas for improvement include management of HBA1C, LDL, and
smoking cessation.
Conclusion: Challenges to improving these areas include the yearly turnover of medical volunteer positions, and increase training
of future physicians in managing obesity and chronic disease. To overcome these challenges, strategies to introduce new diabetesspecific checklist into Clinica’s Electronic Medical Records may strengthen weaknesses at Clinica.
Kaiser Permanente Residency & Fellowship Programs
ALLERGY, CARDIOLOGY, COMMUNITY MEDICINE, DIAGNOSTIC RADIOLOGY,
ELECTROPHYSIOLOGY, EMERGENCY MEDICINE, FAMILY MEDICINE,
GASTROENTEROLOGY, GERIATRICS, GLOBAL HEALTH PROGRAM,
HOSPICE PALLIATIVE CARE, INTERNAL MEDICINE, INTERNAL MEDICINE/MPH,
INTERNAL MEDICINE/PREVENTATIVE MEDICINE, NEPHROLOGY, NEUROLOGY,
OB/GYN, OTOLARYNGOLOGY, ORTHO SPORTS MEDICINE, PEDIATRICS, PODIATRY,
PSYCHIATRY, RADIATION ONCOLOGY, SPORTS MEDICINE, SURGERY, UROLOGY
Clerkships are available in various specialties and locations.
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Toxicity in the City of Angels: Environmental Health Disparities
in South Los Angeles
Progression of Vasculopathy in Children with Sickle Cell Disease and Abnormal Transcranial Doppler Ultrasonography:
Rates and Predictors
Ernesto Villaseñor, Jr., Abby Kinchy , Kim Fortun
Science and Technology Studies Department, Rensselaer Polytechnic Institute
Exposure to toxic pollution has been exacerbated throughout many communities in the US as a result of development, but garner less
attention in low-income, inner-city communities. Research suggest that exposure to a polluted environment results in poor health outcomes. Research also suggest that poor health outcomes are a result of lack of education in addition to not having sufficient access to
health resources. As we can see, it is not a single issue that contributes to poor health outcomes, but the intersections among them. Los
Angeles County is not immune to these issues: numerous cases have indicated a disproportionate burden on already disadvantaged minority populations who are affected by other psychosocial stressors in the South and Eastern part of LA County. This study looked at the
intersectional root causes behind environmental health disparities as caused by industry development and presence in South and East LA
County. The Exide Technologies Battery Plant case that is ongoing in LA County was used as a case study to understand environmental
health, justice, and pollution by the affected members of the community. This study included, but was not limited to, the following: a
literature review of environmental health disparities in South LA; developing a new definition of environmental justice and health, in
addition to how members of the affected communities understood environmental health inequalities; looking at the failures to include
important markers of toxic pollution/environmental inequalities in the findings/policy development of asthma/respiratory illnesses and
other chronic diseases by government agencies in LA County; and the history of the environmental justice movement among vulnerable
communities in LA County.
High occurrence of gastrointestinal problems in Puerto Rican male patients with
Hermansky-Pudlak Syndrome
Oscar Alejandro García1; Stephanie Bermúdez1; Edwin P. Campoverde1; Paloma R. Sánchez1; Verόnica Santiago1; Leslie
Seijo1; Karen R. Velarde1; Enid Rivera, MD2; Mόnica Santiago, MD3; Donna Appell4; Irvin Maldonado1.
Department of Biomedical Sciences and Research, San Juan Bautista School of Medicine, Caguas, Puerto Rico1; Professor
and Director of Hematology and Oncology, Department of Pediatrics, University of Puerto Rico School of Medicine, San
Juan, Puerto Rico2;
Hematology and Medical Oncology Department, San Juan City Hospital, San Juan, Puerto Rico3; Founder and President of
Hermansky-Pudlak Syndrome Network, New York, New York.4
Introduction: Hermansky-Pudlak Syndrome (HPS) is a rare autosomal recessive disorder that results in oculocutaneous albinism, platelet abnormalities, as well as ceroid accumulation in different organs. HPS occurs globally at an estimated prevalence of 1:500,000 to
1:1,000,000 in the non-Puerto Rican population. In Puerto Rico, HPS is notably more frequent with approximately 1 of every 22 people
carrying the gene and a prevalence of 1:1,800 in the Northwestern region.
Methodology: In this pilot study, we conducted a survey in the Northwestern area of Puerto Rico to investigate the different initial symptoms experienced among HPS patients. A total of 47 patients were surveyed: 26 females, 21 males.
Tatiana M. Villatoro1, Janet Kwiatkowski2, Deirdra Terrell3
San Juan Bautista School of Medicine1, The Children’s Hospital of Philadelphia2, The University of Oklahoma Health
Sciences Center 3
Background: Children with sickle cell disease (SCD) and an abnormal transcranial Doppler (TCD) ultrasound have a high risk of stroke.
Chronic transfusion therapy decreases the risk of stroke; however, some children have continued progression of cerebral blood vessel
narrowing and/or silent cerebral infarcts despite treatment.
Objective(s): To study the rate of progression of silent infarcts (by magnetic resonance imaging- MRI) and cerebral vessel stenosis (by
magnetic resonance angiography- MRA) in children with SCD and abnormal TCD and to identify potential risk factors for progression
of cerebral blood vessel stenosis and/or silent infarcts.
Data and Methods/Skills Learned: A cohort study with both retrospective and prospective components of subjects with SCD-SS or Sbeta0 thalassemia and abnormal TCD from the Children’s Hospital of Philadelphia Sickle Cell Center was performed. Medical and laboratory information was obtained from patient charts and all magnetic resonance imaging (MRIs) and angiography (MRAs) reports were
reviewed. MRI was classified as abnormal if silent infarct(s) were present and MRA as abnormal if stenosis or occlusion of any vessels
was present. Presence or absence of progressive changes and time to progression were recorded. T-tests and chi-square analyses were
used to explore potential factors associated with progression.
Results: Twenty-seven children with mean age 7.82 years (range 2.86 to 16.90 y) at diagnosis of abnormal TCD were studied. The mean
highest qualifying abnormal TCD velocity was 213 cm/s, (median 208 cm/s, range 200 to 241 cm/s). Of 27 patients, 4 (15%) had an abnormal baseline MRI, 3 (11%) had an abnormal baseline MRA, 13 (48%) had both abnormal baseline MRI and MRAs, and 7 (26%) had
normal baseline MRI and MRAs. Of 26 subjects with follow-up studies, the average follow-up time was 7.78 years (median 7.61 y, range
3.54 to 12.99 years). The mean number of follow-up MRI/A per subject was 5 (range 0 to 9). 17 participants (65%) showed progression
of cerebral vasculopathy or infarcts at a mean time of 4.49 years (median 4.02 y, range of 0.35 to 9.29 years) after starting transfusion treatment. Of the 17 who showed progression, 8 had abnormal baseline MRI/As and 4 had normal baseline MRI/As (p=NS). Of the 17 that
showed an initial progression, 5 (29%) continued to progress. In addition, 1 child developed an intracranial hemorrhage 8.92 years after
starting transfusions; this subject had progression of vasculopathy prior to the event. We found no association of baseline TCD velocity
or baseline MRI/A results with risk of progression; however, there was a trend towards higher risk of progression in children who were
younger at initial diagnosis (7.05 vs. 9.73y, p=0.07).
Conclusion: Silent infarcts and/or cerebral vessel stenosis/occlusion were found commonly in this cohort of children with abnormal
TCD. Progression of cerebral disease also was common, even with transfusion therapy. We are currently assessing risk of progression
based on the extent of MRI/A abnormalities at baseline and associated factors including method of transfusion and average hemoglobin
and hemoglobin S levels.
Results: Our study shows that HPS patients may experience several gastrointestinal (GI) symptoms such as inflammatory bowel disease,
irritable bowel syndrome and gastroesophageal disease. Approximately 38% (n=17) of the patients from this population presented with
gastrointestinal symptoms as an initial symptom. The data demonstrated that 48% of males (n=10) experienced GI problems as an initial
symptom as opposed to 19% of females (n=5). Males were 2.5 times more likely to present with GI symptoms than females. Additionally,
males presented a higher recurrence of GI symptoms as opposed to females (52% vs. 27%).
Conclusion: Our results suggest that males with HPS in the Northwestern region of Puerto Rico have a higher tendency to present and
persist with GI complications than females. In the future, we plan to expand our survey to a larger number of HPS patients in order to obtain statistically significant results. Similarly, it would be helpful to identify why some HPS patients do not present with GI complications.
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Determining the role of G-protein signaling in Drosophila midgut peristalsis
Total Ileocolic Intussusception Causing Rectal Perforation - A Case Report
Camilo Doig Acuña, Columbia University Medical Center
Genetics & Development Dept.
Ohlstein Laboratory
Miel Sundararajan, Bryan M. Pham, Patricio Lau, MD, Erik P. Askenasy, MD
Baylor College of Medicine, Department of Surgery
Introduction: Intussusception is rare outside the pediatric population, with only 5% of cases occurring in adults. While in children intussusception often benign and responsive to radiologic reduction, in adults intussusception is frequently associated with a lead point, often
malignancy. We present a case of total ileocolic intussusception causing rectal perforation secondary to a cecal mass.
Case History: A 61 year old male initially presented with abdominal pain, reflux, and irregular bowel movements. An obstructive colonic
adenocarcinoma was seen on colonoscopy. He refused treatment at that time and represented 10 months later with similar symptoms
at which time a CT scan revealed interval development of colocolonic intussusception secondary to the cecal cancer. The patient again
refused treatment.
Shortly thereafter, the patient presented to the emergency department with symptoms of intestinal obstruction. He consented to surgery
and was taken to the operating room where rectal perforation secondary to an intussuscepted cecal mass was appreciated. Also appreciated was a very floppy and hyper-mobile colon. Because it could not be reduced, a total abdominal colectomy with end ileostomy was
performed.
Discussion: Total ileocolic intussusception has been reported only a handful of times in the literature. It is believed that a lack of retroperitoneal fixation as well as highly mobile flexures may lead to this condition. Our patient displayed these findings supporting this
hypothesis.
Adult intussusception often presents as acute obstruction and necessitates prompt surgical intervention. If it can be reduced, then a hemicolectomy can be performed; if not, total abdominal colectomy is warranted.
CADASIL – A disease of young
Little is known about the mechanisms controlling digestive motility, the failure of which underlies a variety of conditions such as irritable
bowel syndrome, chronic intestinal pseudo-obstruction and gastroparesis. D. Melanogaster is an excellent model for study due to its short
generational time and elegant genetics. Based on previously published data, enteroendocrine cells play a role in intestinal peristalsis in
Drosophila. Neuropeptides secreted by enteroendocrine cells may act via associated G-protein coupled receptors (GPCRs) to influence
intestinal muscle movement. Given the significant homology between GPCRs in Drosophila and humans, identification of the role of
these receptors in flies may lead to an increased understanding of human mechanisms. This could open the door to the eventual development of drugs targeting GPCR mechanisms in digestive disease.
In this experiment, the technique of RNA interference (RNAi) was used to block the expression of G-protein subunits in intestinal muscle
of Drosophila using the Mef2 muscle-specific driver. Fly stocks carrying Mef2 and a temperature-sensitive gal80 repressor (gal80ts) were
crossed to stocks carrying RNAi against specific genes for the common G-protein subunits α, β and γ. Wild-type yellow-white flies and
flies carrying Mef2 alone were used as controls.
Digestion time and midgut contractility were compared across these mutant lines and against control groups using stool assays and
observational dissections. Stool assays were performed using dyed food to measure time between ingestion and defecation. Flies with
RNAi were compared to wild-type and Mef2 strains. Preliminary results are inconclusive, as RNAi flies had rapid intestinal transit, but
there were not significant differences from the control group. Possible confounders may include influences by temperature, a weak RNAi
construct or an insufficiently robust driver. Alternative protocols are being explored to overcome these barriers.
Hematology/Oncology
Suneel Kumar, MD; Brian Contreras, MS1
University of Illinois at Urbana-Champaign College of Medicine
Boston Children’s Hospital/Dana-Farber Cancer Institute
Introduction: Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is the most
common heritable cause of stroke and vascular dementia in adults. It is caused by mutations of the NOTCH3 gene on the short arm of
chromosome 19. An MRI is able to detect signs of the disease years prior to clinical manifestation of disease.
Case Presentation: A 64-year-old Caucasian female with history of diabetes, COPD and multiple TIAs (on Warfarin for stroke prophylaxis) presented with altered mental status. The family had noticed unusual behaviors in recent months including erratic driving, sexual
promiscuity, undressing in public places, urinating on floor, memory loss. Her husband had died 8 months back and son died 3 months
back. Recently she overdosed on Coumadin and got admitted with GI bleed and she set her house on fire accidentally. The MRI brain
showed acute small focal infarctions in the bifrontal periventricular deep white matter and old infarcts in both hemispheres. A transesophageal Echocardiogram showed a small PFO. The workup for other causes of strokes such as prothrombin gene mutation, factor V
Leiden, antithrombin III levels were all negative. Neuropsychological evaluation revealed significant cognitive impairment consistent
with vascular dementia. Genetic testing for CADASIL was performed since the patient had a nephew with this disorder. This revealed
NOTCH3 gene mutation. A repeat MRI brain after 6 months showed deep parenchymal chronic ischemic changes within cerebral hemispheres bilaterally, pons and right cerebellar hemisphere with evidence of interval progression. Patient has been continued on Warfarin
for stroke prophylaxis, admitted in an assisted living for a supervised living. The family members were referred for genetic counseling.
Discussion: The prevalence of CADASIL in the U.S. is about 2 per 100,000. This may be an underestimate as the disorder is misdiagnosed, particularly in areas where cardiovascular disease and multiple sclerosis are highly prevalent. Mutations in the Notch 3 gene cause
and abnormal accumulation of Notch 3 at the cytoplasmic membrane of vascular smooth muscle cells in cerebral vessels. The patients
usually present with ischemic episodes TIAs/CVAs, cognitive deficits, migraine with aura, psychiatric disturbances. No specific treatment
is available, however; anti-platelet agents such as aspirin might slow down the disease and help prevent strokes.
Conclusion: CADSIL should be considered in deferential in young patients with multiple TIAs/CVAs and early age dementia when other
common causes for such events are absent. The family members should be referred for genetic counseling.
Pediatric Hematology/Oncology Fellowship Program
Harvard Medical School
Boston, MA
The Division of Hematology/Oncology at the Boston Children’s Hospital/Dana-Farber
Cancer Institute seeks qualifies applicants for fellowship training in Hematology/Oncology.
The fellowship program is designed to train academic hematologists and oncologists, and
provides broad clinical experience and extensive research training in basic science and/or
clinical investigation.
Contact:
David A. Williams, MD
Chief, Division of Hematology/Oncology and
Boston Children's Hospital
300 Longwood Ave, Karp 08125.3
Boston, MA 02115
Phone - 617.919.2697
Fax - 617-730-0868
Email: [email protected]
For more information, please visit our website:
http://www.danafarberbostonchildrens.org/For-Physicians/Fellowship-Overview.aspx
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L.M.S.A. Journal Pg 30
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Health status and stigmatization level of individuals living with a mental illness in the community of Las Tablas, Matanzas, in the Province of Peravia, Dominican Republic: a descriptive study November 2011–January 2012.
Health Professional Abstracts
Improvement of District-Level Maternal Mortality Reporting with Reproductive Age
Mortality Survey (RAMOS)
Elisa Warner, Rachael Ward, Bradley Iott, Judy Idrovo, Frank Anderson, and Joseph
Adomako
Minorities in Health Disparities International Research Training, Center for Human Growth and Development,
University of Michigan, Ann Arbor, Michigan, 48104
Objective: To investigate maternal deaths in the Kuntanase region using the reproductive age mortality survey (RAMOS) in all community households in which a woman of reproductive age (WRA) has died and identify the most commonly reported causes of the
pregnancy-related deaths.
Methods: A 6-question RAMOS survey was piloted with the relatives of 357 deceased WRA who died between January 2008 and July
2013 and compared to the number of recorded deaths confirmed by the maternal mortality review committee to assess current maternal mortality surveillance systems. The maternal mortality ratio was calculated to make this comparison.
Results: Of the 357 interviews conducted, 132 of the deaths were identified to have been due to pregnancy-associated reasons that will
be further investigated via a verbal autopsy. Utilizing the 6 question RAMOS the maternal mortality ratio was found to have increased
from 128.4 to 206.5 per 100,000 live births supporting the hypothesis that there is large underreporting of maternal deaths in the region.
Conclusion: The 6 questions RAMOS appears to be a practical method for monitoring maternal deaths. With the help of community
health workers a better understanding of maternal mortality in rural Ghana can help improve maternal mortality surveillance systems
in this region. Future work should include pilot testing in other under-resourced areas and parts of the world.
AGE AND EDUCATION ANALYSIS ON ALCOHOL CONSUMPTION AMONGST
LATINA AND NON-LATINA WOMEN IN SOUTHERN CALIFORNIA
Kristen Brañes, 4th year Biological Sciences Major, Helena Do, 4th year Biological Sciences Major, Kenneth Huynh, 3rd
year Biological Sciences Major, Shahram Lotfipour, MD, MPH, Craig Anderson, PhD,
Wirachin Ying Hoonpongsimanont, MD
University of California, Irvine, Department of Emergency Medicine
Background: Recent studies have confirmed that white women report the highest prevalence of alcohol use and binge drinking compared
to women of any other race/ethnicity group, consisting of Latinas, Asians, and African-Americans. In this study we analyze the quantity of alcohol consumed depending on age and education-level of the Latina and non-Latina subjects in Southern California. Through
analysis we can determine which specific female population is more at-risk to alcohol dependency. The findings will provide us with aid
to foresee, prevent, and manage alcohol dependency.
MethodsThis study uses data from a Computerized Screening and Brief Intervention tablet consisting of questions relevant to the data
findings found in this study. The data findings include; Age, education-level, Race/Ethnicity, and many questions concerning the subject’s
alcohol consumption. The Brief Intervention takes place in the Emergency Department of UC Irvine. Although not a population sample,
Emergency Department patients come from a large range in economic background, sex, education level, and age.
Results Highest percent of non-drinkers are amongst Asians, followed by Hispanics. The majority of White females drink within the
National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommendations. There were fewer non-drinkers, but fewer drinks per
day among drinkers with females who received a high-school degree or at-least an associate’s degree compared to females who did not
complete high school. After age 40 the amount of drinks consumed per day decreases significantly. Lastly, Spanish-speaking Latina subjects were found to have considerably less quantity of consumption compared to English-speaking Latina subjects.
Cynthia Ángeles, Robert Pantaleón, Cristina Rivera. ** Dr. Rafael Johnson.*
*Medical Psychiatrist.
** Medical students from escuela de medicina, instituto technologico de Santo Domingo
INTRODUCTION: A mental illness is a psychological or behavioral pattern that is generally associated with distress or disability, and
which is not considered part of a person’s normal development or part of that person’s culture. Important aspects like the living conditions of those suffering from a mental illness, their physical and psychological health status, socioeconomic level and knowledge about
their condition were studied in this investigation; likewise, it was also determined the percentage of these patients that felt stigmatized by
others due to their condition. Las Tablas is a small community, located in the municipality of Matanzas, Province of Peravia, Dominican
Republic.
OBJECTIVES: 1) Determine the stigmatization level towards individuals with a chronic mental illness residing in Las Tablas. 2) Evaluate
the general health situation of patients with a chronic mental illness living in Las Tablas. 3) Assess the knowledge about chronic mental
illnesses of the general population in Las Tablas.
MATERIAL AND METHODS: Two surveys were used, one was applied to 100 randomly selected residents of the community of Las
Tablas over the age of 18; another survey was applied to individuals suffering from a chronic mental illness or to a close family member.
RESULTS: 52% of respondents considered people with mental disease to be dangerous to others. Most interviewees were aware that
alcohol use (81%) and illicit drug use (89%) could increase the risk of manifesting a mental illness and 65% of the population consulted
believed witchcraft as a cause of mental illness. 88% considered people with mental disease not to be blamed for their condition. Only 1
out of the 7 patients with a mental illness to reside in the community had medical insurance (14.3%). All individuals with a mental illness
(100%) had been victims of some kind of offensive conduct. 43% agreed to feeling generally discriminated against by society.
CONCLUSIONS: There’s a great lack of knowledge of mentally ill individuals concerning their condition. Having a family member with
a mental illness affects negatively the way people see and treat people with a mental illness in the community. Regardless of educational
level, most people understand that individuals with a mental illness can study and work as others. Most patients with a mental illness say
the way their family treats them had changed since the disease manifested. Education of the population and individuals with a mental
disease is advised, looking to reduce stigma against mental disease and getting people with a mental illness to know more about their
condition and how to live with it and overcome it.
Knowledge, Attitudes and Practices about danger signs in mothers of children under five
years in the community of Boca Canasta, Peravia province in the period November 2011 January 2012.
Br. Sheila M. Collado Marmolejos , Br. Indhira De la cruz Alcántara, Dr. Emilton Lopez
Instituto Tecnologico de Santo Domingo
Children under 5 years who have one or more danger signs in general are in a serious situation. Despite knowing that mothers do not turn
immediately to health centers we cannot state if they are able to identify the danger signs when these arise. Determine what knowledge,
beliefs, practices and attitudes about danger signs have the mothers of children younger than 5 years in the community of Boca Canasta,
Peravia. The study was prospective, descriptive and analytical type of cross section. We used a data collection protocol, which was applied
to a sample of 101 women who met the inclusion criteria, these mothers were chosen randomly. 62% of mothers admitted not knowing
the danger signs, while the 38% that said knew the danger signs actually had a misconception. 75% of mothers go to health centers for
other signs that are not classified by IMCI danger signs, fever being the most frequent with 25%; of those classified by IMCI the sign
vomits everything occupy 22%. 62% of mothers incorrectly handles diarrhea putting their children on a diet, further more this percentage of mothers believes that the administration of intravenous serum is better than the administration of oral serum, another mistaken
belief. Mothers do not have knowledge of danger signs and this conditions their attitudes and practices in the presence of disease in their
children. We recommend carrying out information, education and communication campaigns on the subject, use of materials to educate
mothers so they develop the skills to identify their seriously ill children on time.
Conclusion-This study provides data proving that English-Speaking Latina, White, and African-American women are most at risk to
alcohol dependence. Additional studies on Asian and Spanish-Speaking Latina women can help reason why they can control and limit
their alcohol consumption. The analysis and comparison of both groups can help provide methods in helping the female group that is at
most risk of alcohol dependency. Alcohol education programs that target this population will prove to be most effective.
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Pediatric Hospitalists Assessing Postpartum Depression during Infant Inpatient Admissions
M. Trost1, MD, K. Torreblanca1, DO, H. Avila2, and J. DeSena2
Assistant Professor of Clinical Pediatrics, Department of Hospital Medicine, Children’s Hospital Los Angeles (CHLA)1,
Year II Medical Student Keck School of Medicine, Los Angeles California2
Goal: The American Academy of Pediatrics recommends that pediatricians screen mothers for symptoms of postpartum depression at
their infant’s clinic visits. This often does not occur due to time constraints, lack of physician comfort, or chronically ill children unable
to make outpatient appointments. The primary goal of our study is to show screening for postpartum depression can be effective when
infants are hospitalized. We hypothesize this will capture moms who missed screening; and that an intervention we provide for those at
risk will result in reduced depressive symptoms and increased maternal-child bonding.
Methods: Women with a child age >2 weeks and <1 year of age admitted to CHLA are eligible for our study. Enrolled mothers complete
questionnaires including the validated Edinburgh Postpartum Depression Scale (EPDS). If the score is greater than or equal to 10, they
are at risk for postpartum depression and we provide education and mental health referral. We follow up with phone calls in 3 and 6
months. Moms are asked if they pursued further evaluation with either their doctor, one of the resources given, or another method.
We also re-administer the EPDS and maternal-infant bonding screens to compare with original scores. Based on previously reported
incidence rates we calculated our sample size to be 310. We need to complete phone follow up with 55 mothers screening positive on the
EPDS to show an effect of our intervention.
Results: This study is ongoing and my role has been participating in the hospital screening process, entering data, and conducting follow
up calls. To date we have enrolled 217 subjects with 63 (29%) screening at risk for postpartum depression. Only 28 (13%) report they had
been previously screened for depression in the outpatient setting.
Conclusion: Postpartum depression impacts both the child’s development and mother’s health. Demographic data we are collecting may
show factors such as decreased rates of breastfeeding, or certain medical problems in the child, associated with risk for postpartum depression. Further data analysis is needed to determine if our intervention has long-term benefit.
THE WARREN ALPERT MEDICAL SCHOOL
OF BROWN UNIVERSITY VALUES DIVERSITY
459 total students
• 23% underrepresented in medicine
• 54% women
• 101 undergraduate institutions
• 41 states, 5 countries represented
776 residents and fellows
2,172 campus and hospital-based faculty
Visit the Office of Diversity
and Multicultural Affairs at
http://brown.edu/academics/
medical/diversity
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Rural Medicina Academy: A Multidisciplinary Rural Health Professions Pipeline Program at
the University of Illinois College of
Medicine at Rockford
Journal Articles
Natalia Suarez, National Center for Rural Health Professions
Introduction/Background: The lack of underrepresented minorities (URMs) in the healthcare workforce is a major cause of health disparities among ethnic and racial minorities in the US. This workforce gap is the result of obstructions in the K-12 educational system such
as unequal educational resources, disparities in learning outcomes, disparities in high school completion rates, low aspirations among
URM youth, and lack of positive role models and parental support. Innovative and nontraditional paths such as K-16 pipeline programs
targeting URMs have shown to be an effective way to address this health professions shortage.
Objective: The purpose of this paper is to describe the programmatic components of The Rural Medicina Academy (RMA), a health career awareness pipeline program targeting underrepresented minority (URM) youth. We highlight its partnership with the University of
Illinois College of Medicine at Rockford (UI COM-R) Latino Medical Student Association Rockford chapter (LMSA Rockford). We find
that our LMSA Rockford/RMA partnership not only aims to enhance health career awareness among RMA’s young participants, but also
fosters mentorship roles and community engagement, and ultimately healthcare delivery for the Latino community.
Methods: The RMA incorporates a core curriculum comprised of four tracks: 1) Exploring Health Professions; 2) Understanding Health
Disparities; 3) Professional Skills Development; and 4) Cultural Competency. The RMA’s programmatic components are: 1) K-16 Workshops, 2) Summer Scholars Internship Program, 3) Native American Pathways Program, and 4) Early-Bird and After-School Sessions. In
addition, the RMA is involved in outreach efforts, such as K-12 career fairs and community-led health fairs.
Results: At large, the RMA has reached over 600 participants between spring 2013 and spring 2014 by means of RMA programmatic
components, including nine workshops, one pilot Summer Scholars program, three early-bird/after-school programs, one Native American Pathways Program, and 14 community outreach initiatives in two urban counties, two rural counties, and two out-of-state Native
American/American Indian reservations.
The Summer Scholars program evaluation found that the program increased students’ health career awareness and interest, as well as their
understanding on different health topics. Pre- and post-assessments found that all (100%) participants indicated that helping people is a
key reason why they want to pursue a health career, followed by job prestige (33.34% increase) and work environment (22.23% increase).
Our preliminary findings indicate that the Summer Scholars pilot program has succesfully given participants a candid portray of health
careers, as well as shown its influence on a community’s health and well-being.
Conclusion: Future studies should further explore URMs educational journeys by looking into matters such as what and who inspired
URMs to pursue their education track, barriers encountered, and availability of support systems. Examining these issues will help researchers, educators, and institutional agents better understand the perspectives and experiences of URM students, identify their unique
needs and challenges, as well as provide information for culturally competent institutional programming initiatives.
Band cupping: report of two cases
Tim Soeken,1MS, Angelina Espino Barros Palau,23 MD, Michael Morgan23MD, PhD, Andrew G Lee,12345MD.
1. Baylor College of Medicine, Houston, TX (Department of Ophthalmology, AGL: Adjunct Professor) 2. Department of
Ophthalmology, Houston Methodist Hospital, Houston, TX 3. Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, TX (AGL: Clinical Professor) 4. Department of Ophthalmology; The University of Iowa Hospitals and Clinics, Iowa City, IA (Adjunct Professor) 5. Department of Ophthalmology, The University
of Texas Medical Branch, Galveston, TX. (Adjunct Professor)
Abstract
Importance: The concept of optic nerve
“band atrophy” associated with bi-temporal hemianopsia was first described in 1980.
Bilateral band or “bow-tie” atrophy has
since then been described in association to
optic chiasm compression, usually secondary to pituitary adenoma, craniopharyngioma, or meningioma. Given that these
cases are scarce in the current literature, we
add two new cases of band cupping associated with anterior visual pathway (AVP)
compressive lesions.
Observations: The first patient presented
with a 7 year history of painless progressive bilateral vision loss, worse in the left
eye. On fundoscopy, the patient had band
cupping OD and diffuse optic cupping
OS. Subsequent MRI showed a large mass
consistent with a pituitary macroadenoma.
The second patient presented complaining
of bilateral vision loss. Fundoscopy showed
disc cupping more prominent nasally and
temporally in both eyes. MRI revealed a
mass lesion involving the optic chiasm with
extension to the right optic tract and bilateral optic nerves consistent with an optic
pathway glioma.
Conclusions and Relevance: Band cupping
is clearly distinct from glaucoma cupping.
The presence of band cupping should alert
the clinician of the possibility of an underlying compressive lesion.
Introduction
www.lmsa.net
L.M.S.A. Journal Pg 36
The concept of optic nerve “band atrophy”
associated with bi-temporal hemianopsia
was first described by Unsold and Hoyt in
1980. The authors examined a cross-section
of the distal optic nerve and found a distinct pattern of band atrophy. They conwww.lmsa.net cluded that a lesion affecting nerve fiber
bundles at the nasal side of the optic nerve
would affect exclusively the temporal field
of vision.1 Bilateral band or “bow-tie” atrophy has since then been amply described
in association to optic chiasm compression,
usually secondary to pituitary adenoma,
craniopharyngioma, or meningioma. Unilateral band atrophy has been seen in optic
tract syndrome (OTS) where a contralateral optic tract compressive, traumatic, demyelinating, or vascular lesion damages the
crossing nasal fibers as well as the unilateral
non-crossing temporal fibers.2
Although band atrophy is a commonly described finding in chiasmal compressive
lesions, the presence of band cupping has
not been widely reported. We present two
new cases of band cupping associated with
anterior visual pathway (AVP) compressive
lesions.
Case 1
A 60 year old woman presented complaining of painless progressive bilateral vision
loss, worse in the left eye. At symptom onset 7 years prior, she was seen by an optometrist, but was only correctable to 20/50.
Visual field testing was undertaken 4 years
later by her optometrist. It showed nonspecific scatter in the right eye, and the left
eye was judged unreliable. She sought care
with another optometrist who referred her
immediately for evaluation by neuro-ophthalmology.
visual field testing showed a temporal
hemianopia OD and only a relatively preserved nasal island OS. On fundoscopy, the
patient had band cupping OD and diffuse
optic cupping OS. The remainder of the examination was unremarkable (Figure 1).
The junctional scotoma raised concern for
a suprasellar mass, and subsequent MRI
showed a mass consistent with a pituitary
macroadenoma (Figure 2). The patient was
referred to neurosurgery and subsequently
underwent resection. Pathology showed
staining for FSH and LH consistent with a
gonadotropin secreting pituitary macroadenoma. The patient’s post-operative course
was remarkable for panhypopituitarism
with diabetes insipidus managed medically
and a cerebrospinal fluid leak that resolved
with conservative management.
Case 2
An 18 year old healthy Hispanic female
presented to the neuro-ophthalmology
clinic complaining of bilateral vision loss.
She was seen by an optometrist who noticed optic disc cupping and an anomalous
automated visual field. She was told she was
a glaucoma suspect, but should seek neuroophthalmologic examination.
Examination revealed a best corrected visual acuity of 20/20– OU. Color vision was
preserved in both eyes. Pupils were symmetric and briskly reactive to light and
accommodation. She did, however, have
a trace RAPD OS. Automated visual field
testing suggested a left homonymous hemiExamination revealed visual acuity 20/30 anopsia, denser in the left eye, as well as a
OD and, with eccentric fixation, 20/80 OS. possible OD temporal defect. Fundoscopy
Color vision in the right eye was preserved, showed disc cupping bilaterally. Cupping
14/14 Ishihara plates, but left eye testing was more prominent nasally and temporalrevealed severe dyschromatopsia with 0/14 ly in both eyes although a clearly preserved
plates correct. She had a relative afferent superior-inferior rim was more evident in
pupillary defect (RAPD) OS. Automated the left eye. OCT was consistent with pre
L.M.S.A. Journal Pg 37
dominant band atrophy and cupping OS,
but showed a more diffuse atrophy OD
(Figure 1). The remainder of the examination was unremarkable.
The atypical disc cupping as well as the
non-glaucomatous visual field raised concern for a chiasmal compressive lesion.
MRI brain and orbit with and without
contrast was ordered and revealed a mass
lesion involving the optic chiasm with extension to the right optic tract and bilateral
optic nerves (Figure 2). Its appearance was
consistent with an optic pathway glioma.
The patient was referred to neuro-surgery
for further discussion of treatment options.
The patient opted for close observation and
is being followed with repeat brain imaging.
Comment
Optic disc cupping has been reported to
occur in less than 10% of compressive lesions. It has been sometimes described as
“glaucoma type cupping” with cases being
misdiagnosed and treated as normal tension glaucoma.3 Proposed criteria to help
differentiate between compressive lesions
and glaucoma include a younger age at
presentation, worse visual acuity, vertically
aligned visual field defects, neuroretinal
rim pallor, mismatch between the degree of
disc cupping and visual or visual field loss,
the presence of an RAPD, and rapid progression.4
Band atrophy is a specific type of optic disc
atrophy that is typically observed in patients with intracranial mass lesions which
compress on the optic nerve, optic chiasm,
or optic tract.1,2 When the mass lesion
compresses the AVP, there is eventually
retrograde degeneration of axonal nerve
fibers. Due to the established pathways of
retinal ganglion cell fibers from the retina
to the lateral geniculate nucleus, observed
atrophy and cupping patterns can be correlated to compressive lesions in these locations. Band atrophy is not a feature of glaucoma and should always prompt further
evaluation.
ping in the contralateral eye. She had been
complaining of vision loss for seven years
before being diagnosed with a pituitary
macroadenoma. In retrospect, the presence
of this atypical cupping pattern might have
alerted the clinician to the possibility of an
underlying compressive lesion. The second
patient presented with visual fields and
ON cupping atypical for glaucoma. Bilateral band cupping was consistent with the
underlying chiasmal optic glioma. To our
knowledge, these would be only the second
and third cases describing band cupping in
compressive AVP lesions.5
THese Hands
will cure
diseases
noT yeT known
In summary, band cupping, in addition
to band atrophy, is another differentiating
sign of chiasmal compression and OTS. It
is clearly distinct from glaucoma cupping
where the superior and inferior RNFL are
more affected. The presence of band cupping should therefore alert the clinician of
the possibility of an underlying compressive lesion.
These hands belong to a student at Baylor College
of Medicine. Every day they ask questions. Explore
facts. Master new skills. These are the hands of the
future. Eager to analyze, solve and cure. Like all
at Baylor College of Medicine, these hands are
giving life to possible.
References
1. Unsöld R, Hoyt WF. Band atrophy of
the optic nerve. The histology of temporal hemianopsia. Arch Ophthalmol.
1980;98:1637-8.
2. Newman SA, Miller NR. Optic tract
syndrome: neuroophthalmologic considerations. Arch Ophthalmol 1983; 101:1241–
1250.
3. Ahmed II, Feldman F, Kucharczyk W,
Trope GE. Neuroradiologic screening
in normal-pressure glaucoma: Study results and literature review. J Glaucoma
2002;11:279-86.
4. Greenfield DS, Siatkowski RM, Glaser
JS, Schatz NJ, Parrish RK II. Cupped disc.
Who needs neuroimaging? Ophthalmology
1998;105:1866-74.
5. Hildebrand GD, Russell-Eggitt I, Saunders D, Hoyt WF, Taylor DS. Bow-tie cupping: a new sign of chiasmal compression.
Arch Ophthalmol. 2010;128:1625-6.
We present two cases of band cupping associated with compressive lesions of the
crossing nasal axonal fibers at the optic
chiasm and optic tract. In addition to the
expected band atrophy, nasal and temporal
pathologic cupping was clearly observed
in both cases. The first patient had band
cupping in one eye but a more diffuse cupwww.lmsa.net
Proud sponsor of the Latino Medical Student Association.
Visit bcm.edu/possible to see all that’s possible.
L.M.S.A. Journal Pg 38
www.lmsa.net
L.M.S.A. Journal Pg 39
ANALYSIS ON ALCOHOL CONSUMPTION AMONGST LATINA AND NON-LATINA
WOMEN IN SOUTHERN CALIFORNIA
Brañes, Kristen, Shahram Lotfipour, MD, MPH, Wirachin Ying Hoonpongsimanont, MD
University of California, Irvine, Department of Emergency Medicine
The purpose of this study is to analyze alcohol consumption trends amongst Latina
and non-Latina women in Southern California. Previous studies analyzing trends
between different ethnicities show that
Latinos (males and females) have a higher
consumption rate of alcohol. However this
does not stand correct when analyzing
only the female population. Recent studies
have confirmed that white women report
the highest prevalence of alcohol use and
binge drinking compared to women of any
other race/ethnicity group, consisting of
Latinas, Asians, and African-Americans. In
this study we analyze the quantity of alcohol consumed per day, AUDIT score, and
language spoken depending on age and education-level of the Latina and non-Latina
subjects in Southern California. Research
associates approached the patients involved
in this study in the Emergency Department.
Through analysis we can determine which
specific female population is more at-risk
to alcohol dependency. These findings will
provide us with findings that aid to foresee,
prevent, and manage alcohol dependency.
Identifying the specific population vulnerable to alcohol dependency is the first step
to knowing where to improve assistance.
Interest in alcohol consumption amongst
women has increased throughout the
years due to cultural adjustments. Men
and women may have similar consumption quantity but studies have proven that
there are twice as many alcohol dependent
men than there are women (Alvanzo 2011).
Despite this drastic difference there continues to be an increase in alcohol dependent
females. For example, females born from
1944 to 1953 drink more than females that
were born from 1934 to 1943, especially
amongst 48 and 57 year olds. Studies have
shown that this may be explained by the
shock of World-War II, affecting White and
Hispanic women the most (Grucza, 2008).
Female alcoholics are under-identified in
primary care settings. Women deal with
stigma that place barriers to their treatment and are under-represented in specialized treatment settings (Grucza, 2008).
Due to this barrier, females with alcohol
related problems are more vulnerable to
www.lmsa.net
severe health issues than males. For example, birth defects and developmental
disabilities of newborns to mothers who
consumed alcohol during pregnancy (Marchetta 2012). Due to abundant social and
cultural changes, the stigma of drinking behavior amongst women has reduced within
the past few years. However, reduction to
the barriers alcoholic women face has not
been focused on (Grucza, 2008). The purpose of this study is to identify which specific female population is most vulnerable
and provide aid in identifying and aiding
the female population to abolish this barrier. It was hypothesized that, in general,
Latina females (from Mexico and other
Latino countries) would contain the least
non-drinkers amongst women, followed by
black females due to economic class.
MATERIALS AND METHODS
All experiments were carried out in accordance with the Institutional Review Board
at the University of California, Irvine, and
were consistent with Federal guidelines.
Computerized Alcohol and Brief Intervention (CASI) study was approved by the Institutional Review Board (IRB) on August
4th, 2011. Screening started January 15,
2012. The data collection takes place in the
Emergency Department (ED) of the University of California, Irvine Medical Center
(UCIMC). The Emergency Medicine Research Associates Program (EMRAP) contributes to the data collection for this study.
Undergraduate research associates screen
all patients entering the ED everyday of the
week from 8am to 12am.
CASI began collecting data on January 15th
2012. Questions including the patient’s age,
education-level, race/ethnicity, and few
questions concerning the patient’s alcohol consumption were gradually added by
2012. Data collection for this study began
November 5th, 2012 and ended December
31st 2014. The research associates screened
a total of 791 females, from which, 21 subjects are Spanish-speaking.
Of the three categories, percent drinkers,
drink per day an audit score was observed
to conduct a statistical analysis. This aided
in demonstrating a trend of alcohol consumption amongst Latinas, and non-Latinas/Hispanics (including Native Americans, Black, Asians, more than one race,
and those who did not state their race).
Inclusion/Exclusion Criteria
All Spanish and English-Speaking patients who are cognitive, able to provide
written consent and over the age of 18 are
eligible to be enrolled into the study. If
patients do not fit the above requirements
they are excluded from our study and not
approached by the research associate. All
patients are required to sign a consent
and a Health Insurance Portability and
Accountability Act (HIPAA) form prior
to starting the questions provided in the
computerized tablet.
Data collection
The computerized tablet provides the
patient with questions concerning their
race/ethnicity, gender, education level,
and their alcohol consumption. Since the
questions are computerized this facilitates
data collection and provides the CASI
research team with accurate statistics for
every question asked. The data collection
for this study occurred from November
5th 2012 to December 31, 2014. During
this time period 791 females, including 21
Spanish-Speaking females were screened
and enrolled into our study. When data
was collected for this study, we noticed
that for some categories, such as the quantity of drinks-per day, were not normally
distributed. To resolve this complication,
we used a Kruskal-Wallis rank test to
compare groups with one another. After
completing the questions provided by
CASI, patients are given a score generated
by the Alcohol Use Disorders Identification Test (AUDIT). This score is used to
determine if a patient does not drink, is
at-risk, or a dependent alcohol consumer.
From the 791 females, we analyzed data
according to three categories; the subject’s
race/ethnicity, education-level, and age.
L.M.S.A. Journal Pg 40
Alcohol Use Disorders Identification Test
(AUDIT)
The World Health Organization uses AUDIT as an assessment tool to identify hazardous drinking habits and dependency
symptoms. AUDIT is time efficient and
takes approximately six minutes. After taking CASI, the AUDIT score is provided to
both the patient and the research associate.
This score ranges from 0-30, and categorizes all patients into three different groups.
Patients who score from 0-10 are non-dependent and not hazardous; 8-19 are classified as hazardous drinkers; with a score
of 20 or more are considered dependent
drinkers and suggested to attend programs
that can help them control their drinking
habits. Only patients with an AUDIT score
from 8-19 are eligible to be enrolled in the
study. Enrolled patients are then asked to
complete follow-up questions.
Follow-up questions
There are a total of 3 follow-up questionnaires given one week, 3 months and 6
months from the date they were enrolled
into the study. The questions are completed
via phone or email. The follow-up includes
the same questions patients completed during their stay at the ED. The one-week follow-up demonstrates short-term improvement and both the 3-month and 6-month
demonstrates long-term improvement of
all patients enrolled in the study.
(43.96%). Sixty-seven percent of NonHispanic Whites and 64.29% other NonHispanics admit to drinking, although they
were not identified as dependent or at-risk
to alcohol dependency. Non-Hispanic
Whites and Non-Hispanic others rank the
highest amongst female drinkers. Despite
the high percentage of drinking amongst
whites, further analysis demonstrates that
the majority of White females (48%) drink
within the National Institute on Alcohol
Abuse and Alcoholism (NIAAA) recommendations, which is one drink or less per
day.
Drinks-per-day among drinking women by
education
It was determined that 53% nondrinkers
are women who did not complete high
school, while only 32% women who completed at least a associates degree were nondrinkers. Amongst drinking women, 68%
women have completed their associate’s
degree, 58% have completed their highschool degree, and 46% have not completed
high school.
The goal is to create behavioral change
within the community regarding alcohol
use by performing screening and brief intervention using CASI. Currently, CASI is
considered a standard of care at UC Irvine
Medical Center.
RESULTS
From November 2012 to December 2014,
791 females were enrolled into CASI. The
791 females include 21 Spanish-speakers.
All patients were provided with the same
questions and categorized depending on
the language they spoke, education level,
race/ethnicity, and AUDIT score. Of the
total 791 female patients enrolled in the
study, 311 were non-drinkers and 480 were
drinkers.
There was a significant difference when
drinkers and non-drinkers were compared.
The highest percentages of non-drinkers
are amongst Asians (52%), followed by Latinas, which includes women from Mexican (44.76%) and other Latin countries
www.lmsa.net Drinks per day by language among
drinking Latinas
Figure 2. Drinks per day and language
spoken. (n=188, p=0.0031)
Among Latinas, Spanish-speakers drank
fewer drinks per day.
Analyzing the amount of drinks consumed per day amongst all race/ethnicities was difficult because of the uneven
distribution. In order to compare groups
we needed to use the Kruskal-Wallis
rank test and determined that the Asians,
again, drank the least (2.13 drinks per
day) while the Latinas drank second
most (2.68 drinks per day). Whites show
that their average drink per day is 2.18,
which is very close to the Asians’ alcohol
consumption per day. Therefore, among
female drinkers, the two Latina groups
drank more than non-Hispanic White,
Asian, and non-Hispanic other women.
Figure 1. Drinks-per-day among women by
education. (n=480, p-value=0.0317)
Among drinking women, the number of
drinks per day was higher for women who
did not complete high school and lowest for
women who completed at least an associates degree.
L.M.S.A. Journal Pg 41
Audit score by language among drinking
Latinas
Figure 3. Language spoken and AUDIT
Score. (n=188, p=0.0148)
Among drinking Latinas, the audit score
was lower (2.5) for Spanish-speakers than
English-speakers (4.7).
Figure 4. Language spoken and AUDIT
score (n=188, p=0.0148)
Among drinking Latinas, the audit score
was lower for Spanish-speakers than English-speakers.
DISCUSSION
The results found from this study clarifies
that non-Latino/Hispanic white females
admit to consuming more alcohol than Latino, or other non-Latino/Hispanic females
(Asians and/or Blacks). Although it was
originally believed that Latinas drink more
www.lmsa.net than non-Latinas, it can be understood that
cultural change is influencing their health
and health behaviors. Spanish-speaking
Latina’s seems to be more strongly attached
to the Latino/Hispanic culture and tend not
to drink as much as the non-Latina white
females. There are studies that encourage public health programs that are aimed
at Hispanic to consider the importance of
cultural change and diversity within and
across Hispanic subpopulations (Black
1993). Clinical practices that advise women
about the dangers associated with drinking
while pregnant, coupled with communitylevel interventions that reduce alcoholrelated harms, are necessary to mitigate
Alcohol-exposed pregnancies (AEP) risk
among women of childbearing age and to
achieve the Healthy People 202 objectives
(Marchetta 2012)
liaison in the Adult CASI team thanks too
the past coordinators, Armaan Rowther
and Lynne Le. I am grateful for the present liaison, Chris Gilani and Anum Iqbal
who continue to encourage me and make
me feel welcomed in EMRAP. I’d also like
to thank all research associates in EMRAP
and faculty that work in the ED, they have
contributed a lot throughout my learning
experience while in EMRAP. I would lastly like to thank my family for constantly
supporting me with surpassing my endeavors throughout my life.
One limitation we encountered was the
small sample size. There were only 188 Latinas enrolled into the study. We are continuing to enroll Spanish-speaking patients
but have a lower success rate due to the language barrier between the patient and the
research associates. Research associates do
not feel comfortable approaching the patients incase further questions about the
study are asked but are unable to respond.
The process of overcoming this barrier is
difficult. We now have Spanish scripts and
audio; despite this research associates continue to have difficulty approaching Spanish-speaking patients.
Grucza RA, Bucholz KK, John PR, Bierut
LJ, Secular Trends in the Lifetime Prevalence of Alcohol Dependence in the United States: A Re-Evaluation. Alcohol Clin
Exp Res. May 2008. Pages 763-770.
This study provides data proving that English-Speaking Latina, White, and AfricanAmerican women are most at risk to Alcohol dependence. Additional studies on
Asian and Spanish-Speaking Latina women
can help understand reasons why they can
control and limit their alcohol consumption. The analysis and comparison of both
groups can help provide methods in helping the female group that is at most risk
of alcohol dependency. Alcohol education
programs that target this population will
prove to be most effective.
LITERATURE CITED
Black SA, Markides KS, Acculturation
and alcohol consumption in Puerto Rican, Cuban-American, and MexicanAmerican women in the United States.
Am J Public Health. 1993 Pages 890–893.
Alvanzo AAH, Storr CL, Flair LL, Green
KM, Wagner FA, Crum RM, Race/Ethnicity and sex differences in progression
from drinking initiation to the development of alcohol dependence. Drug Alcohol Depend. November 1, 2011. Pages
375-382.
Marchetta CM, Denny CH, Floyd L, Cheal NE, Sniezek JE, Alcohol use and binge
drinking among women of childbearing
age—United States, 2006-2010. MMWR
Morb Mortal Weekly Report. July 20,
2012. Pages 534-538.
L.M.S.A. Journal Sarah Carlson, MS2 and Michael Henry, MS2
Loyola University Chicago, Stritch School of Medicine
Background
With an increasingly diverse patient population in the United States, the need for language proficiency in languages other than
English is greater than it has ever been in
the past. With limited time and resources,
medical students may find that learning a
second language amidst the rigorous medical school curriculum is seemingly impossible. In addition to this challenge, organizing official courses, finding the budget to
pay teachers, and writing a curriculum that
is worthy of elective credit is difficult for
administrative faculty in medical schools.
Keeping these challenges in mind, Loyola
University Chicago Stritch School of Medicine has implemented a Peer-Led Medical
Spanish Program in which first and second
year medical students organize curriculum
and teach classes focused on Medical Spanish to their peers. Teachers earn elective
credit for their efforts, and students receive
the benefit of courses tailored specifically
to their needs without paying any extra tuition.
Methods
The following “Eight Step Sequence” has
been used at Stritch for over five years. The
success and maintenance of our Peer-Led
Medical Spanish Program supports the effectiveness of these methods:
1. Recognize the need
According to a report issued by the US Census Bureau in April of 2010, 55.4 million or
20% of the US population 5 years old and
older spoke a language other than English
at home. Of this 20%, 62% or 34.5 million
people spoke Spanish. If these 34.5 million
individuals speaking Spanish at home also
speak English fluently, the need for bi-lingual health care providers would be minimal. However, 47.4% spoke English less
than “very well” with respondents between
the ages of 41 and 64 and those 65 and older
reporting the lowest English speaking abilities.1 Due to the sensitive nature of personal medical information, family members—
particularly young family members—are
not suitable medical interpreters. Further,
the use of trained medical interpreters can
ACKNOWLEDGEMENTS
I would like to thank Dr. Wirachin
Hoonpongsimanont (MD), and Dr. Shahram Lotfipour for continuously supporting
me for the past two years in the Emergency
Medicine Research Associates Program
(EMRAP). My learning experience has
vastly accelerated thanks to my position as
Peer-Led Medical Spanish: An Instructional Guide
Pg 42
www.lmsa.net
add time and cost to already rushed patient
encounters. Therefore, a Spanish speaking
physician can save time and money while
maintaining the doctor-patient relationship. Starting a peer-led Medical Spanish
program provides students the opportunity to improve their medical Spanish and
gain realistic expectations of the care they
can and cannot provide in the Spanish language.
2. Establish a certification program
When students pass all three phases of
certification, they are given a special
“Hablo Español” name badge, priority at
predominantly Spanish speaking clinical sites, a notation on the transcript, and
recognition of competency in the Dean’s
letter. More detailed information about
our certification process can be found at
http://www.stritch.luc.edu/medspanish/
content/certification.
Perhaps the worst potential outcome of a
Medical Spanish program would be giving
students a false confidence in their Spanish
speaking abilities leading to dangerous patient care. Indeed, ad hoc interpreters such
as health care providers have been shown
to commit significantly more potentially
clinically significant errors when compared
to trained hospital interpreters2 underscoring the importance of a rigorous certification process. The certification process used
by Stritch medical students not only tests a
student’s knowledge of medical vocabulary
and ability to give directions and medical
advice, but it also evaluates the student’s
fluency, pronunciation, customer service,
and interpretation skills as well as the student’s ability to adjust his or her language
based on the age, gender, and educational
status of the patient. There are 3 testing
components to certification:
1. Clinician Cultural and Linguistic Assessment – Spanish (CCLA): A one-hour phone
exam developed by Kaiser Permanente and
administered by ALTA Language Services
simulating primary care encounters.
2. Qualified Bilingual Staff Assessment –
Spanish (QBS): A one-hour phone exam
developed by Kaiser Permanente and administered by ALTA Language Services
that directly measures medical vocabulary
as well as sight translation, medical diagnosis and instructions, customer service, and
social conversation.
3. Spanish Objective Structured Clinical
Exam (OSCE): An unprompted complete
history and physical with a standardized
patient in Spanish developed and administered by Stritch School of Medicine Faculty.
3. Incentivize medical student teachers
L.M.S.A. Journal Establishing a teaching elective to earn
credit has been an essential part of the
success that Medical Spanish has seen at
Stritch. As it stands today, medical students who complete the teaching elective
requirements earn two weeks of elective
credit toward fourth year. This is a recognized teaching elective that also earns
mention in students’ Dean’s letters as they
apply to residency programs. With the establishment of the elective, we secured administrative support while also providing
a tangible benefit for students that commit to teaching Medical Spanish. The following requirements must be met to earn
the teaching credit:
Teachers must plan and teach at least 20
lesson plans during their first and second
year of medical school.
Teachers must create a portfolio of their
lesson plans, including a reflection that
is to be completed at the conclusion of
each class reflecting upon what activities
or teaching methods worked well, which
didn’t, and how they could improve this
lesson in the future.
Teachers must attend at least one Medical
Spanish workshop each semester. (These
workshops are developed by the Medical Spanish Coordinators in conjunction
with faculty input. In the past, topics have
included strategies to engage adult learners, teaching methods for foreign language instruction, and many others.)
Teachers must attend Spanish teachers’
meetings, usually one per semester.
Teachers must evaluate at least two other peer teachers and fill out the required
evaluation form.
Pg 43
Teachers must be evaluated by at least two
different Medical Spanish teachers and that
evaluator must complete the required form.
As long as the medical student Spanish instructor completes the above requirements,
he or she will earn the elective credit, in addition to including the teaching elective on
his or her Dean’s letter and resume.
4. Develop a curriculum
Developing a curriculum has been an ongoing project at Stritch since the initiation
of the Medical Spanish Program. In the past
few years, teachers have worked to create a
set of Learning Objectives for each week
and each level. Learning Objectives clearly
identify the goals of that week’s class, and
teachers plan their lesson focusing on these
goals. Establishing clear goals has helped
classes to remain organized and proceed
in a logical manner throughout the course
of the year. Furthermore, if a student must
miss a class, the teacher can easily provide
the Learning Objectives and lesson plan
for the week so the student does not fall
behind. In the past years, Medical Spanish
teachers have found that following a textbook is not always the best option for the
class, although it can be a helpful resource.
The Medical Spanish program has used the
texts listed at the bottom in the past. These
texts can help teachers to develop ideas and
focus their teaching strategy, but the Learning Objectives that have been specifically
created for the Medical Spanish program
are designed to directly target medical student’s needs for communicating with patients.
Textbooks
Level 1 Fraser-Molina, Maria and Constanza Gomez-Joines. ¿Qué le duele? 2nd
edition.
Level 2: Kechikian, Claudia. Quick and
Easy Medical Spanish. McGraw-Hill. New
York, 2006.
Levels 3: Ortega, Pilar. Spanish and The
Medical Interview.
5. Incentivize student attendance
Every year, maintaining attendance in the
Medical Spanish courses is a challenge.
Early in the year, medical students are eager
to join many activities and get involved as
much as possible. However, as the year progresses, it is inevitable that students stop attending classes due to other commitments,
exam studying, shadowing, and a variety of
other reasons. Currently, students do not
www.lmsa.net
earn elective credit for attending Medical
Spanish classes at Stritch, so it can be difficult for students to maintain motivation for
weekly attendance throughout the school
year. To solve this problem, Medical Spanish has worked with our Center for Community and Global Health (CCGH) to develop one type of incentive. Every summer,
upwards of 50 first year medical students
travel to developing countries on International Service Immersion trips (ISI). Many
of the ISI sites are in Spanish-speaking
countries, and therefore, CCGH has recognized the importance of Spanish language
skills for traveling to these locations. For
the past couple of years, CCGH has helped
to subsidize some of the costs of the trip if
the student attended 90% of Medical Spanish courses throughout the year. As one
example, thirteen students traveled to Bolivia in the summer of 2013, and all thirteen
students on this particular trip attended
90% of Medical Spanish classes throughout
the course of the year; therefore, all thirteen students received additional funding.
Nearly all of these students cited the ISI
incentive as a significant motivating factor
for continued attendance. While monetary
incentives may not be possible in all situations, developing some type of incentive for
students to continually attend class is essential for a successful program—without
students, there is no class!
6. Collaborate within the school
Piggybacking off of existing programs will
allow your school’s peer-led Medical Spanish program to do more than it could on
its own. In the past, our program has used
the expertise of our Academic Center for
Excellence to help our student teachers
address the needs of adult learners in the
classroom. Our Clinical Skills Center has
also provided our program with transcripts
of standardized patient encounters in Spanish and opened up the Center for Clinical
Skills for students to practice patient histories and exams in Spanish. Recently, our
program has expanded to incorporate Marcella Niehoff School of Nursing students
into the existing Medical Spanish classes.
We have seen our attendance numbers increase and project to have higher retention
rates as well.
The Medical Spanish program at Stritch
is constantly seeking ways to provide
new opportunities for students to practice their language skills. One opportunity that is currently offered to teachers
and advanced students is translating at
Loyola’s Access to Care Clinic. This clinic
is run by Loyola medicine residents and
attending medicine physicians, and they
are constantly in need of help translating
for Spanish-speaking patients. Interested
students are able to sign up for 1-2 three
hour shifts per month. During that shift,
students are given the opportunity to
translate for patients, while also practicing their history taking and physical exam
skills. We are fortunate to work with excellent residents and physicians who are
eager to assist students with their skills.
Not only is this an excellent opportunity
to practice Spanish communication skills,
but it offers another atmosphere in which
students can hone the necessary skills for
taking a thorough history and developing
proper physical exam techniques. Physicians and patients are grateful for the
help that Medical Spanish students offer
to their clinic, and students are excited to
utilize this opportunity!
For a program to continue, it must transition well. From year to year, student leadership positions change. The one constant
is our Medical Spanish Advisory Board
which consists of our Senior Associate
and Assistant Deans of Medical Education, Director of the Center for Community and Global Health (CCGH), as well
as other members of the Office of Medical
Education and CCGH.
Every year, the advisory board meets with
the outgoing Program Director(s) for a
report on how the year went. The board
also meets with the incoming program
leader(s) to discuss goals for the upcoming year. Applications for positions are
submitted every spring and interviews
are conducted by the program leader(s).
Past teachers make up the majority of applicants.
Discussion:
Establishing a Peer-Led Medical Spanish Program is not without its challenges.
Maintaining student attendance throughout the year, incentivizing teachers, and
L.M.S.A. Journal hard-earned skills into practice. If there is
not an additional elective credit or monetary incentive for students, perhaps there
can be recognition on their Dean’s letter for
completion of the courses. There are a variety of ways in which these goals can be met,
but these challenges should be anticipated
and addressed when beginning a Peer-Led
Medical Spanish Program. Overcoming
these challenges and starting a Peer-Led
Medical Spanish Program provides a tangible and valuable skill to medical students in
the clinical years and beyond. This program
should be considered for implementation
in medical schools across the country.
pretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111:6–14.
References:
1. Shin, H. B. and Kominski, R. A.. “Language Use in the United States: 2007.” April
2010. ACS-12.
2. Flores G, et al. Errors in medical inter-
About the Editors
8. Structured transition 7. Provide opportunities for practice and
service
creating a certification program were some
of the most significant problems faced
when our program began, and many of
these continue to be ongoing challenges.
Establishing a certification program recognized by your institution’s hospitals and
clerkship sites is essential for the program.
Without a way to qualify students’ Spanishspeaking abilities, there is a risk of putting
patient safety in jeopardy if the student
interpreter is not qualified. Establishing
objective benefits is key to recruiting and
keeping teachers as well. Whether it’s elective credit, Honors in Global Health, or
some other type of distinction, the work
that Medical Spanish teachers put into the
program needs to be recognized. Additionally, there needs to be an objective benefit to
medical students if they are to add another
commitment on top of their first and second year curriculum. For these reasons, it
is essential that earning the Medical Spanish certification is recognized by clerkship
sites so that students are able to put their
Pg 44
Felipe Camero, OMSII Michigan State University,
DO/MPH Candidate-Publication Co-Chair LMSA and
main editor of journal.
Born and raised in Bogota Colombia, I came to the US when
I was 16 years old. Upon graduating from high school, I enlisted
in the US Navy as a hospital corpsman which exposed
me to medicine worldwide. After my military service, I did
my undergrad at the University of South Florida were I was
a spanish interpreted at the Universities free clinic as well
as worked with veteran patients at the veterans hospital.
Upon my acceptance to MSU, I continue my commitment
to Latino Community by being a spanish coordinator in the
medical missions to Peru and Guatemala, participating in
an elective to Costa Rica and became a healthfair coordinator
for MSU’s community integrative medicine group as
well as served as a lead researcher in an HIV project to the
Dominican Republic.
www.lmsa.net
L.M.S.A. Journal Pg 45
Pamela Castro, OMS II Michigan State University,
DO/MPH Candidate-Public Relations Committee Chair
LMSA and co-editor of journal.
Born and raised in Lima, Peru, I came to the US to attend college. I
graduated from the Florida State University with a business degree and
did my premedical education at the University of South Florida. During my undergraduate studies, I became heavily involved with Latino
Healthcare by managing a free healthcare clinic for the underserved.
Upon my acceptance to medical school, I continued my passion to help
the Hispanic communities by serving as a Spanish coordinator in medical missions to Peru and Guatemala, the main student coordinator to a
Costa Rica medical elective, an executive board member of the Lansing
Latino Health Alliance, participated n a public health project in Huaraz,
Peru and acted as lead researcher in an HIV Project to the Dominican
Republic.
Abner Antonio Murray, MSTP III Case Western Reserve University School of
Medicine MD/ Ph. D. Candidate-Publication Co-Chair LMSA journal
contributor
I was born in Santo Domingo, Dominican Republic and raised in Miami,
Florida. I graduated from Florida International University (FIU) with a
Bachelor of Science in Biology. As a MARC U-STAR and Ronald E. McNair
Fellow at FIU, I conducted research on the translational initiation strategies
of mammalian Orthoreoviruses. In addition, I functioned as the outreach
and events coordinator, at Missionary Ministry “Anchor of Salvation” International, a nonprofit organization based in Miami, Florida. I was involved
in organizing over 30 medical mission trips to Central, South America, and
the Caribbean where medical and counseling services were provided free of
cost to the most indigent Latin American communities. In 2011, I enrolled
in the Medical Scientist Training Program at Case Western Reserve University in Cleveland, Ohio. Currently, I am beginning my Ph. D. in molecular
virology at the Case Western Reserve University Center for AIDS Research
El Poder de la Diferencia
The Power of Difference
Diversity is central to our core values. As a world-class academic
medical and research center, OHSU educates, employs and
cares for people from many cultural and linguistic
backgrounds, belief systems and experiences.
Dr Ruben Font MD
LMSA Executive Officer -Peer Review Coordinator
Current plans for LMSA: Work on organizing logistical opeartions,
membership development, continue to develop the southwest region
Future plans: Solidify the pipeline from highschool level to graduate level; continue working with NHMA to help with this pipeline and create
more physicians to be part of the NHMA membership core. Continue to
promote NHMA events, internship, opportunities for medical student;
continue to raise funding for LMSA scholarship fund; eventually would
like to see an LMSA leadership summer internship/retreat of some sort.
www.ohsu.edu/diversity
www.lmsa.net
L.M.S.A. Journal Pg 46
www.lmsa.net
L.M.S.A. Journal Pg 47
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L.M.S.A. Journal Pg 49
LMSA follows in the tradition of numerous minority group associations
made to create a forum for networking, exchange of ideas and support
between Latino Medical Students across the United States. In this spirit
the LMSA annual journal supplies a forum for members and non-members to write about their experiences in school and life in general. In one
unified voice we all shout the mantra: “Adelante!”