Obtaining and Sharing Medical Literature, 1780–1820

The quest for timely medical literature was a concern for elite as well as rural physicians in the United States, as evidenced by comments from Drs. Benjamin Rush of Philadelphia; Benjamin Vaughan of Hallowell, Maine; and Lyman Spalding of Portsmouth, New Hampshire. It was the focus of an 1800 correspondence about the new cowpox (vaccination) between Barker and John G. Coffin of Boston who, in 1823, would found and edit the Boston Medical Intelligencer, precursor to the Boston Medical and Surgical Journal, now the New England Journal of Medicine; smallpox inoculation is also discussed. Topics include obtaining and sharing medical books and journals, the importance of both personal correspondence and newspapers for dissemination of medical information, problems with and for booksellers, medical nationalism, and publishing by subscription.

M87. PREVALENCE OF AUTOIMMUNE DISEASES IN INDIVIDUALS WITH PRIMARY PSYCHOTIC DISORDERS AT BOSTON MEDICAL CENTER

Background The prevalence of autoimmune diseases is higher among individuals with psychiatric illnesses than in the general population. It is unknown if the prevalence of autoimmune diseases differs among people with different primary psychotic disorders. Our objective was to assess whether the prevalence of autoimmune diseases differs among people with schizophrenia/schizoaffective disorder, affective (bipolar/depression) psychosis, and other psychotic disorders (delusional, brief psychotic, schizophreniform, or unspecified psychosis). Methods For our cross-sectional study, we used International Classification of Diseases (ICD) codes to identify individuals with primary psychotic disorders/unspecified psychoses who received treatment at Boston Medical Center between October 2003 and May 2019. Individuals with other/unspecified psychosis with an organic cause and individuals with unspecified psychosis, brief psychotic disorder with coinciding drug withdrawal, post-partum psychosis, or drug-induced mental illness, confusion, or seizure were excluded. Autoimmune diseases were categorized as systemic or as one of seven organ-specific subgroups (dermatological, endocrinological, gastroenterological, hematological, non-systemic connective tissue, and neurological). Multivariable logistic regression was used to compare differences in prevalence of autoimmune diseases among individuals with different psychoses adjusting for age, sex, and race. We also considered sex and race-stratified analyses. Results Of the 13,938 individuals (mean age = 43 years; 58% male) diagnosed with psychosis, 55% had schizophrenia, 17% had affective psychosis, and 29% had other/unspecified psychosis. Overall, nearly 9% of individuals with psychosis had at least one autoimmune disease (8% with schizophrenia, 11% with affective psychosis, and 8% with other/unspecified psychosis). The most prevalent autoimmune disease subgroups were systemic (39%), dermatological (26%), and endocrinological (23%). Compared to individuals with schizophrenia, individuals with affective psychosis had increased odds of having any autoimmune disease (OR: 1.38; 95% CI: 1.17, 1.63), dermatological autoimmune diseases (OR: 1.55; 95% CI: 1.15, 2.07), or endocrinological autoimmune diseases (OR: 1.56; 95% CI: 1.14, 2.12). Compared to individuals with schizoaffective as the only psychosis diagnosis, individuals with affective psychosis had increased odds of having any autoimmune disease (OR: 1.31; 95% CI: 1.03, 1.66) and individuals with schizophrenia had decreased odds of having neurological autoimmune diseases (OR: 0.46; 95% CI: 0.23, 0.96). Among individuals with any psychotic disorder, females were 95% more likely to have any autoimmune disease (OR: 1.95; 95% CI: 1.72, 2.20). No racial differences were observed overall; however, compared to individuals who identified as white, individuals who identified as Black, Hispanic, and Asian had decreased odds of having gastroenterological autoimmune diseases (OR: 0.52; 95% CI: 0.35, 0.76), neurological autoimmune diseases (OR: 0.32; 95% CI: 0.10, 0.83), and systemic autoimmune diseases (OR: 0.25; 95% CI: 0.04, 0.80), respectively, while Black individuals had increased odds of having systemic autoimmune diseases (OR: 1.45; 95% CI: 1.17, 1.81). Discussion The prevalence of autoimmune diseases varied among people with different primary psychotic disorders, and certain associations were modified by sex and race. Clinicians may consider additional screening for autoimmune diseases among individuals with psychosis.

3532 Vitamin D assay utilization and outcomes in pregnant women in an urban safety net medical center: a retrospective cohort study

OBJECTIVES/SPECIFIC AIMS: The goals of this retrospective cohort study is threefold: 1) to assess how many pregnant women at Boston Medical Center from 2012 to 2017 have had their vitamin D status checked prior to and during pregnancy, 2) determine associations between vitamin D levels, birth outcomes and demographics and 3) assess how many of those found to have lower than satisfactory vitamin D levels (<30ng/mL) received interventions, including receiving vitamin D supplementation and/or being referred to an appropriate specialist such as an endocrinologist or a nutritionist. METHODS/STUDY POPULATION: Our study population is mothers over age 18 who received care at Boston Medical Center during their pregnancy from 2012 to 2017. Our primary outcomes are vitamin D utilization rates and associations between vitamin D levels with clinical outcomes during pregnancy and at birth. Secondary outcomes are demographic predictors of mothers who receive vitamin D testing and those who have complications associated with low vitamin D. We will conduct multiple linear regressions to check for associations between vitamin D levels, birth outcomes and demographic variables. We will adjust vitamin D levels with maternal BMI. De-identified clinical data was gathered from Boston University Medical Center’s (BUMC) Clinical Data Warehouse. This retrospective study was approved with a HIPAA waiver by the BUMC Institutional Data Warehouse. All statistical analysis was completed using SAS version 9.4 and was primarily done by the student PI and reviewed by Dr. Hossein, the co-investigator who is trained as a statistician and geneticist. The team also utilized Boston University’s Biostatistics, Epidemiology & Research Design (BERD) team to check the feasibility of the statistical methods. RESULTS/ANTICIPATED RESULTS: We anticipate that our descriptive demographic data will reflect the medical center’s predominantly black/Hispanic and low-income profile. Based on previous literature, we expect low vitamin D levels to have positive associations with gestational diabetes, pre-eclampsia, and preterm birth. Analyses are currently actively in progress and we expect to have results before the ACTS conference date in March, 2019. DISCUSSION/SIGNIFICANCE OF IMPACT: Vitamin D is an essential part of the human body system. It is well documented in current literature that vitamin D is correlated with bone health, mental health and maternal health. Moreover, there is evidence that maternal vitamin D supplementation prevents vitamin D deficiency in newborns. Previous literature suggests that low vitamin D may be associated with gestational diabetes, pre-eclampsia, and pre-term births. Boston Medical Center is Massachusetts’ largest urban medical center and acts as its only safety-net hospital, serving predominantly low-income and socially marginalized patient populations. There is limited existing research on assessment of maternal vitamin D in urban hospital settings. Pregnant women rarely receive vitamin D screenings as part of their prenatal checkups as current national and regional guidelines do not require pregnant women to be screened for vitamin D deficiency or insufficiency. The results will demonstrate the potential effects vitamin D supplementation, or lack thereof, in expectant mothers living in urban, safety net communities. We hope to inform prenatal care practices and attitudes of vitamin D supplementation in maternal health with the results of our study.