UCLA Health Tip Sheet July/August 2023: Medical Students Pilot Antiracism Curriculum; Blood Test May Help Predict ER Outcomes; Declines in Colorectal Cancer Incidence Are Slowing

Newswise — Below is a brief roundup of news and story ideas from the experts at UCLA Health. For more information on these stories or for help on other stories, please contact us at [email protected].

Medical students pilot antiracism curriculum A new report finds adding a group of required discussion sessions can help first-year medical students build proficiency in addressing racism in medicine and building and antiracist skills. In the wake of police killings of unarmed African American citizens and the ever-present structural and interpersonal racism in healthcare, students and faculty at the UCLA David Geffen School of Medicine developed an antiracism curriculum to combat bias in medical settings. The curriculum was based on Ibram X. Kendi’s How to be an Antiracist and the course was composed of six two-hour seminars over the course of the year. The first-year medical students that participated were given a survey before and after the completion of the course. The second survey found that the students became more comfortable discussing racism with patients and addressing racism in patient care, and had a greater ability to identify strategies for discussing racism with patients after completing the course. The researchers say that the curriculum and subsequent findings may better equip medical students in addressing racism in health care. Read the study in Medical Science Educator.  

Blood test may help predict outcomes in emergency department admissions A new study links a part of the complete blood count (CBC) with risk of hospital admission and in-hospital mortality. The test is called red blood cell distribution width (RDW). It measures the variation in size of red blood cells. Researchers in the Department of Emergency Medicine at UCLA David Geffen School of Medicine conducted a retrospective analysis of more than 200,000 adult emergency department visits with complete blood count results from March 2013 to February 2022. The primary focus of the study was to explore the relationship between the initial RDW value obtained during the emergency visit and two key outcomes: hospital admission and in-hospital mortality. The researchers found that the RDW value was significantly higher in visits that resulted in hospital admission, and among those patients who were admitted, the RDW was even higher for those who required intensive care unit (ICU) stay or experienced in-hospital mortality. An RDW value above 16 achieved 90% specificity for hospital admission, while an RDW value above 18.5 achieved 90% specificity for in-hospital mortality. The study's findings align with previous research linking elevated RDW to increased mortality risk in conditions such as myocardial infarction, pulmonary embolism, heart failure, sepsis, and COVID-19. The current research, however, establishes the association of RDW with overall hospital admissions and in-hospital mortality across all-cause adult ED visits. The authors say while elevated RDW alone might not be sensitive enough to serve as a comprehensive diagnostic tool, using it in combination with other clinical information may help doctors be better equipped to predict hospital admissions and identify patients at risk of in-hospital mortality. Read the story published July 13 in JAMIA Open.

Advanced imaging uncovers complex 3D structure of vision's initial signals The first electrical signals of vision and hearing are transmitted by cells that are specifically designed to transduce light (photoreceptor cells) or mechanical (cochlear hair cells) stimuli. The signals are transmitted from the receptor cells across rather unusual synapses to secondary neurons. These synapses contain a dense structure that looks like a piece of ribbon in two-dimensions on the receptor side of the synapse. Synaptic vesicles cluster around the ribbons, which guide them to their release site. Despite their crucial role in sensory physiology, the three-dimensional ultrastructure of these synapses, especially the complex organization of the photoreceptor synapse, is not well understood. In a new study, scientists from three UC campuses (UCSB and UCSD, as well as UCLA) generated tomograms with intermediate-voltage electron microscopes to obtain 3-D images at nanoscale resolution to resolve the organization of rod photoreceptor synapses in normal and detached retinas.  This approach enabled the researchers to show that, in the normal retina, a single ribbon, shaped like a thick horseshoe, opposes a tetrad of post-synaptic processes from the secondary neurons. In addition, their novel approach enabled them to provide a 3-D perspective of the ultrastructural changes that occur in response to retinal detachment.  They say their analysis of these changes makes clear the importance of rapid retinal reattachment, following retinal detachment from injury. Read the study in the Journal of Neuroscience.

Declines in colorectal cancer incidence are slowing A study co-authored by UCLA Health gastroenterologists provides timely evidence to suggest the decades-long decline in incidence and mortality rates of CRC has slowed among adults in their 50s and 60s, in addition to the extensively reported increases among younger adults. The study also finds racial and ethnic disparities were apparent for Black persons, among whom incidence and mortality remain highest. The authors say their observations point to an urgent need to strengthen efforts to increase screening participation, identify novel risk factors, and address racial and ethnic disparities. Read the study in Clinical Gastroenterology and Hepatology

Nonalcoholic fatty liver disease: What we know Nonalcoholic fatty liver disease (NAFLD) is a rapidly growing public health concern and is the most common form of chronic liver disease in the United States. Prior studies have highlighted differences in NAFLD prevalence among various ethnicities, with the highest prevalence seen in Hispanics and the lowest prevalence seen in African Americans. Compared to non-Hispanic whites and Hispanics, African Americans have the lowest NAFLD prevalence despite equal or higher rates of diabetes and metabolic syndrome. The precise reasons are not known but are thought to be multifactorial, involving metabolic, genetic, and socioeconomic factors. A new review led by Sammy Saab, MD, MPH, medical director of the Pfleger Liver Institute, and medical director of the Adult Liver Transplant Program highlights potential explanations for the lower NAFLD prevalence, describes disease severity and frequency of complications, and discusses the frequency of liver transplantation for NASH in African Americans. Read the review in published in Clinical Liver Disease.

Physical activity appears to prompt the microbiome to inhibit appetite in people with high BMI A new study from Arpana Gupta, PhD, co-director of the Goodman-Luskin Microbiome Center, and colleagues explored whether physical activity can result in psychological benefits through the brain-gut microbiome (BGM) system in a population with high BMI. The study reports that higher physical activity was significantly associated with increased connectivity in inhibitory appetite control brain regions, while lower physical activity was associated with increased emotional regulation network connections. Higher physical activity was also associated with microbiome and metabolite signatures protective towards mental health and metabolic derangements. The greater resilience and coping and the lower levels of food addiction seen with higher physical activity may be explained by BGM system differences. Read the study, "Improved psychosocial measures associated with physical activity may be explained by alterations in brain-gut microbiome signatures," in Nature.