Publications by authors named "Lucia M Calthorpe"

4 Publications

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Lessons From Learners: Adapting Medical Student Education During and Post-COVID-19.

Acad Med 2021 May 4. Epub 2021 May 4.

M.R.H. Castro is a third-year medical student, University of California San Francisco School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0002-2085-4893. L.M. Calthorpe is a third-year medical student, University of California San Francisco School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0002-0496-9471. S.E. Fogh is associate professor, Department of Radiation Oncology, University of California San Francisco School of Medicine, San Francisco, California. S. McAllister is a third-year medical student, University of California San Francisco School of Medicine, San Francisco, California. C.L Johnson is a third-year medical student, University of California San Francisco School of Medicine, San Francisco, California. E.D. Isaacs is professor of emergency medicine, Department of Emergency Medicine, University of California San Francisco, San Francisco, California. A. Ishizaki is manager, Clinical Microsystems Clerkship, University of California San Francisco School of Medicine, San Francisco, California. A. Kozas is curriculum coordinator, Clinical Microsystems Clerkship, University of California San Francisco School of Medicine, San Francisco, California. D. Lo is assistant professor of medicine, Division of Geriatrics, Department of Medicine, University of California San Francisco School of Medicine; and Department of Geriatrics and Extended Care, San Francisco Veterans Affairs Health Care System, San Francisco, California. S. Rennke is professor of medicine, Division of Hospital Medicine, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California. J. Davis is professor of medicine and associate dean for curriculum, University of California San Francisco School of Medicine, San Francisco, California. A. Chang is professor of medicine, Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California.

In response to the COVID-19 pandemic, many medical schools suspended clinical clerkships and implemented newly adapted curricula to facilitate continued educational progress. While the implementation of these new curricula has been described, an understanding of the impact on student learning outcomes is lacking. In 2020, the authors followed Kern's 6-step approach to curricular development to create and evaluate a novel COVID-19 curriculum for medical students at the University of California San Francisco School of Medicine and evaluate its learning outcomes. The primary goal of the curriculum was to provide third- and fourth-year medical students an opportunity for workplace learning in the absence of clinical clerkships, specifically for students to develop clerkship-level milestones in the competency domains of practice-based learning and improvement, professionalism, and systems-based practice. The curriculum was designed to match students with faculty-mentored projects occurring primarily in virtual formats. A total of 126 students enrolled in the curriculum and completed a survey about their learning outcomes (100% response rate). Of 35 possible clerkship-level milestones, there were 12 milestones for which over half of students reported development, in competency domains including practice-based learning and improvement, professionalism, and interpersonal and communication skills. Thematic analysis of students' qualitative survey responses demonstrated 2 central motivations for participating in the curriculum: identity as physicians-in-training, and patient engagement. Six central learning areas were developed during the curriculum: interprofessional teamwork, community resources, technology in medicine, skill-building, quality improvement, and specialty-specific learning. This analysis demonstrates that students can develop competencies and achieve rich workplace learning through project-based experiential learning, even in virtual clinical workplaces. Furthermore, knowledge of community resources, technology in medicine, and quality improvement were developed through the curriculum more readily than in traditional clerkships, and could be considered as integral learning objectives in future curricular design.
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http://dx.doi.org/10.1097/ACM.0000000000004148DOI Listing
May 2021

The association between preterm birth and postpartum mental healthcare utilization among California birthing people.

Am J Obstet Gynecol MFM 2021 Apr 28;3(4):100380. Epub 2021 Apr 28.

University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon).

Background: While mental health conditions such as postpartum depression are common, little is known about how mental healthcare utilization varies after term versus preterm delivery.

Objective: This study aimed to determine whether preterm birth is associated with postpartum inpatient and emergency mental healthcare utilization.

Study Design: The study sample was obtained from a database of live-born neonates delivered in California between the years of 2011 and 2017. The sample included all people giving birth to singleton infants between the gestational age of 20 and 44 weeks. Preterm birth was defined as <37 weeks' gestation. Emergency department visits and hospitalizations with a mental health diagnosis within 1 year after birth were identified using International Classification of Diseases codes. Logistic regression was used to compare relative risks of healthcare utilization among people giving birth to preterm infants vs term infants, adjusting for the following covariates: age, race or ethnicity, parity, previous preterm birth, body mass index, tobacco use, alcohol or drug use, hypertension, diabetes mellitus, adequacy of prenatal care, education, insurance payer, and the presence of a mental health diagnosis before birth. Results were then stratified by mental health diagnosis before birth to determine whether associations varied based on mental health history.

Results: Of our sample of 3,067,069 births, 6.7% were preterm. In fully adjusted models, compared with people giving birth to term infants, people giving birth to preterm infants had a 1.5 times (relative risk; 95% confidence interval, 1.4-1.7) and 1.3 times (relative risk; 95% confidence interval, 1.2-1.4) increased risk of being hospitalized with a mental health diagnosis within 3 months and 1 year after delivery, respectively. People giving birth to preterm infants also had 1.4 times (95% confidence interval, 1.3-1.5) and 1.3 times (95% confidence interval, 1.2-1.4) increased risk of visiting the emergency department for a mental health diagnosis within 3 months and 1 year after birth, respectively. Stratifying by preexisting mental health diagnosis, preterm birth was associated with an elevated risk of mental healthcare utilization for people with and without a previous mental health diagnosis.

Conclusion: We found that preterm birth is an independent risk factor for postpartum mental healthcare utilization. Our findings suggest that screening for and providing mental health resources to birthing people after delivery are crucial, particularly among people giving birth to preterm infants, regardless of mental health history.
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http://dx.doi.org/10.1016/j.ajogmf.2021.100380DOI Listing
April 2021

Differences in the prevalence of childhood adversity by geography in the 2017-18 National Survey of Children's Health.

Child Abuse Negl 2021 Jan 18;111:104804. Epub 2020 Nov 18.

University of California, San Francisco, Department of Pediatrics, Division of Pediatric Hospital Medicine, 3333 California St, San Francisco, CA, 94118, United States; University of California, San Francisco, Center for Health and Community, 3333 California St, San Francisco, CA, 94118, United States. Electronic address:

Background: Previous efforts to examine differences in adverse childhood experiences (ACEs) exposure by geography have yielded mixed results, and have not distinguished between urban, suburban, and rural areas. Additionally, few studies to date have considered the potentially moderating role of geography on the relationship between ACEs and health outcomes.

Objective: To examine differences in exposure to ACEs by geography, and determine whether geography moderates the relationship between ACE exposure and health outcomes (overall health, asthma, attention deficit hyperactivity disorder (ADHD), and special health care needs).

Participants And Setting: The cross-sectional 2017-18 National Survey of Children's Health (NSCH).

Methods: Distributions of individual and cumulative ACEs by geography (urban, suburban, rural) were compared using chi-squared tests. Logistic regression was used to determine the association between geography and exposure to 4 + ACEs, and to explore whether the relationship between ACEs and health outcomes varied by geography, adjusting for sociodemographic covariates.

Results: Adjusting for covariates, rural residency was associated with 1.29 times increased odds of exposure to 4 + ACEs (95 % CI: 1.00, 1.66) compared to suburban residency. Statistically significant evidence for an interaction between geography and ACE exposure on overall health was not observed, but urban status was observed to increase the association between ACEs and asthma.

Conclusions: This analysis demonstrates a higher ACE burden in rural compared to suburban children. These findings underscore the importance of ACE screening and suggest investment of healthcare resources in the historically underserved rural population.
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http://dx.doi.org/10.1016/j.chiabu.2020.104804DOI Listing
January 2021

Age at menarche associated with subsequent educational attainment and risk-taking behaviours: the Pelotas 1982 Birth Cohort.

Ann Hum Biol 2020 Feb 7;47(1):18-24. Epub 2020 Feb 7.

MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.

Earlier age at menarche (AAM), a marker of puberty timing in females, has been associated with a higher likelihood of adolescent risk-taking behaviours and variably associated with educational attainment. To examine the association between AAM and educational attainment in the Pelotas, Brazil, 1982 Birth Cohort. AAM was categorised as Early (7-11 years), Average (12-13 years), or Late (14+ years). Primary outcome: years of education (age 30). Secondary outcomes: risk-taking behaviours, adult income and school grade failure. In adjusted models, compared to Average AAM, Late AAM was associated with 0.64 fewer years of education (95% CI: -1.15, -0.13). Early AAM was associated with earlier age at first sexual intercourse (-0.25 years; 95% CI: -0.39, -0.12), whereas Late AAM was associated with 17% lower adult income (0.83; 95% CI: 0.71, 0.95) and 0.31 years older age at first alcohol consumption (95% CI: 0.10, 0.52). Our findings confirm the association between earlier puberty timing in females and a greater likelihood of risk-taking behaviours in this setting of recent secular changes towards earlier puberty. However, the association between Late AAM and lower education was surprising and may support a psychosocial rather than biological link between puberty timing and educational outcomes.
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http://dx.doi.org/10.1080/03014460.2020.1715476DOI Listing
February 2020