James K. Sullivan

Objective: To investigate associations between rheumatoid arthritis (RA), chronic lung diseases, and acute respiratory exacerbations.Methods: Using the multicenter prospective COPDGene cohort of current and former people who smoke, RA cases were identified using self-report and disease-modifying antirheumatic drug use. Interstitial lung abnormalities (ILA), bronchiectasis (BR), chronic obstructive pulmonary disease (COPD), and mucus plugging (MP) were identified via high-resolution computed tomography scans and spirometry and prevalences were compared among participants with and without RA. Risk of acute respiratory exacerbation over 10 years of follow-up was compared for those with and without RA and stratified by lung abnormality using multivariable Cox regression, accounting for competing mortality risk.Results: We analyzed 76 RA cases (mean age 64.0 years, 67.1% female) and 8,175 non-RA comparators (mean age 59.4 years, 46.2% female). RA cases vs non-RA comparators had higher prevalences of ILA (17.3% vs 7.1%, p=0.0002) and BR (35.5% vs 24.6%, p=0.027), but prevalences of COPD (46.1% vs 43.7%, p=0.69) and MP (36.8% vs 29.6%, p=0.17) were similar. RA was associated with higher risk of acute respiratory exacerbation than non-RA (adjusted HR 1.68, 95%CI 1.25 to 2.26), and those with RA and COPD had the highest risk (adjusted HR 3.57, 95%CI 2.15 to 5.94) compared to non-RA without COPD.Conclusion: In this large prospective study, people who smoke with RA were more likely to have ILA and BR than those without RA, but had similar prevalences of COPD and MP. Participants with RA, particularly those with COPD, had higher risk of acute respiratory exacerbation.

Multiple international reports, peer-reviewed studies, and medical organizations have documented that climate change, defined as rapid, long-term shifts in global temperatures and weather patterns driven primarily by human activities, such as the burning of fossil fuels, is already affecting human health and well-being. Recently, many health professional organizations have called on current and future health professionals to acquire the knowledge, skills, and agency to address this public health threat. The Climate Resources for Health Education (CRHE) project was created by students, trainees, and faculty through the Global Consortium on Climate and Health Education to address this gap. The CRHE program provides organized, comprehensive, evidenced-based, peer-reviewed, and freely accessible climate health learning resources that can be delivered in standalone sessions or integrated into existing curricula. This manuscript details the innovative, grassroots, and trainee-led approach to developing this educational resource, designed to support educators and learners to incorporate climate change and planetary health information into health curricula. To date, there have been more than 400 unique individuals consisting of trainees and faculty that have contributed to the CRHE project. A survey of a small subset of CRHE volunteers (34 respondents of 95 invited volunteers) demonstrated that CRHE participation had positive impact on reciprocal mentorship, knowledge gained in climate and health, and experience in curriculum development. In summary, the CRHE program is a comprehensive, free online resource that aims to help close the gap between the documented health impacts of climate change and the extent of its integration into medical education.

Communities in the Dominican Republic (DR) face increased natural disasters, poor air quality, food insecurity, and health impacts related to climate change. We evaluated the success of a train-the-trainer program to empower community leaders, women, and at-risk youth with the knowledge and skills to increase individual and community resilience in Cristo Rey, Dominican Republic. Three in-person two-day courses were conducted between July and August 2024 at the Universidad Iberoamericana. Each session included eight lectures and collaborative learning activities on climate change science, adaptation, resilience, and health impacts. Intra-group analyses comparing pre- and post-course surveys assessed participants’ climate change awareness, literacy, and communication and response skills. One hundred and four attendees participated in the survey study. Of the 100 participants with demographic data, 55% (n = 55) were 35 years old or younger, 70% (n = 70) identified as female, and 45% (n = 45) lived in Cristo Rey. The participants reported high baseline climate change awareness. Compared to before the course, the participants reported increased literacy regarding the environmental impacts of climate change relevant to the DR and the specific health impacts (p-value < 0.05) and increased climate change-related communication and response skills (p-value < 0.001). This study suggests competency-based, regional-specific courses deployed in a train-the-trainer model, have the potential to equip community members with knowledge to protect their health.

Background and Objective Older persons with low socioeconomic status in the United States have different and unique health needs compared to younger persons. As part of a student-led, interprofessional partnership, we performed a needs assessment of community dwelling older persons with low socioeconomic status in an urban location within Ohio, USA. Methods Three entities participated in the needs assessment: a student-run health clinic, a Federally Qualified Health Center, and an apartment complex of the study population. Health professional students from medical, dental, nursing, social work, nutrition, and physician assistant programs led the needs assessment process. The process consisted of multiple phases, which included preliminary literature review, survey development, data collection, and analysis. The final survey was multidisciplinary, with six content areas covered in 37 items. Results One hundred nineteen survey responses were received, and multiple areas of need were identified including food insecurity, dental care access, and mental health. 93% of participants had at least one unmet health need and 39% of respondents met our classification for high need. The needs of the local study population had key differences from previously published data in more generalized populations of older community-dwelling individuals in the United States, notably lower utilization of dental care (43% vs. 66%), increased prevalence of possible food insecurity (30% vs. 17%), and increased use of age-appropriate preventive cancer screening services. Conclusions Multiple areas of need were successfully identified through a student-led interprofessional needs assessment. Future student teams can address the identified needs, again through interprofessional collaborations. This process may have unique benefits to help build robust community-academic partnerships, while fostering interprofessional collaborative opportunities among healthcare students.

Black patients with systemic lupus erythematosus (SLE) face higher rates of morbidity and mortality compared to White patients. Long-term glucocorticoid use has been associated with worse health outcomes among patients with SLE. We sought to quantify chronic glucocorticoid use among Black and White patients with SLE within a prospective registry. Using enrollment data from a registry at a large academic institution, we compared glucocorticoid use among Black and White patients with SLE. Multivariable logistic regression of race and glucocorticoid use was performed, adjusting for covariates exhibiting a bivariate association with glucocorticoids at significance level p < 0.10. 114 White participants (mean age 45; standard deviation (SD) 15) and 59 Black participants (mean age 42; SD 14) were analyzed. White participants had mean SLEDAI-2K score of 3.7 (SD 5.2). Black participants had mean SLEDAI-2K scores of 6.3 (SD 6.0). Among Black participants, 43 (72%) utilized glucocorticoids compared to White participants 39 (34%) (unadjusted odds ratio (OR) 5.17; 95% confidence interval (CI) 2.59–10.33). We did not observe differences between unadjusted hydroxychloroquine (OR 0.69; 95% CI 0.28–1.65) or conventional disease-modifying anti-rheumatic drug (cDMARD) (OR 1.07; 95% CI 0.57–2.01) utilization among Black and White participants. SLEDAI-2K, disability, recent hospitalization, and past or present hydroxychloroquine or cDMARD use were included in a logistic regression model. Adjusting for covariates, Black participants were more likely to be on glucocorticoids (adjusted OR 5.69; 95% CI 2.17–14.96); p = 0.0004). Adjusting for disease activity and other medications, Black patients had more exposure to chronic glucocorticoids than White patients in the Cleveland Clinic SLE registry. These patients may face increased glucocorticoid-related morbidity, which could contribute significantly to long-term health outcomes and utilization of health care resources. Future research in larger, more diverse registries should be conducted to further characterize patterns of glucocorticoid use.

By changing the light distribution it is possible to double the apparent amount of light in a space without any increase in its overall luminance. If one simply assumes that the apparent amount of light in a space — its spatial brightness — is described by its mean luminance (or similar measures) then substantial errors may be made. We carried out two experiments, measuring the brightness of 19 different model spaces. Our results demonstrate that making light distributions more non-uniform can make spaces appear both significantly brighter and significantly darker, depending on how the light distribution is changed. This challenges most existing studies in the field that argue that non-uniformity of the luminance distribution simply makes spaces look darker. Indeed, the observed pattern in brightness between our conditions cannot be consistently explained by a simple measure of the uniformity of the luminance distribution. We thus reject all previously proposed models of light distribution and spatial brightness. The best explanation of this and the apparent disagreements in the literature over the effects of non-uniformity appears to be that spatial brightness is affected by the qualitative appearance of the luminances in the space. Light sources and non-luminous surfaces have different effects. We propose a ‘duel’-process model of spatial brightness in which it is the sum of two opposed processes: the effects of the surfaces, and the effects of the light source(s). Non-uniform patterns of surface reflectance and illumination tend to make a space appear brighter. Non-uniformity as a result of a large difference between luminance of the light source(s) and the surfaces makes a space appear darker. If the light source is hidden from direct view its darkening effect is removed, which can make the space appear significantly brighter. Depending on the relative strength of these two processes, a non-uniform luminance distribution may thus appear either brighter or darker than a more uniform distribution. Additionally, we highlight issues demonstrated in both the failure of models previously proposed by the literature, and our exploration of potential implementations of the ‘duel’-process model. It is very easy to produce a good correlation with a defensible metric that will not generalise to other data sets. A metric having a good correlation in a study provides very little reason to actually believe it. If we wish to develop a model of the effects of light distribution that we can trust, we need to demonstrate its robustness by testing its underlying assumptions and showing them to be well supported. As we show, there is a large variety of these that need to be worked through.

Medical schools face a challenge when trying to include new topics, such as climate change and health (CCH), in their curricula because of competing demands from more traditional biomedical content. At the same time, an understanding of CCH topics is crucial for physicians as they have clear implications for clinical practice and health care delivery. Although some medical schools have begun to incorporate CCH into curricula, the inclusion usually lacks a comprehensive framework for content and implementation. The authors propose a model for integrating CCH into medical school curricula using a practical, multistakeholder approach designed to mitigate competition for time with existing content by weaving meaningful CCH examples into current curricular activities. After the authors identified stakeholders to include in their curricular development working group, this working group determined the goals and desired outcomes of the curriculum; aligned those outcomes with the school’s framework of educational objectives, competencies, and milestones; and strove to integrate CCH goals into as many existing curricular settings as possible. This article includes an illustration of the proposed model for one of the curricular goals (understanding the impacts of climate change on communities), with examples from the CCH curriculum integration that began in the fall of 2020 at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. The authors have found that this approach does minimize competition for time with existing content and allows mapping of content to existing curricular competencies and milestones, while encouraging a broad understanding of CCH in the context of individual patients, populations, and communities. This model for curricular integration can be applied to other topics such as social determinants of health, health equity, disability studies, and structural racism.