Establishing the Hormonal Relationship between Polycystic Ovary Syndrome and Hypothyroidism: A Literature Review

Here is the abstract of our newest accepted publication, Please follow the link below!

http://msrj.chm.msu.edu/wp-content/uploads/2020/08/MSRJ2019187.pdf

Deborah Anuoluwapo Aina, Saba University School of Medicine, Devens, MA, USA, Dutch Caribbean

Objective: The aim of this literature review is to evaluate the hormonal relationship between polycystic ovary syndrome and hypothyroidism.

Methods: Electronic databases such as Ebscohost and PubMed were searched, using words and phrases specific to the topic. Journal articles were filtered for publications from no earlier than 2008 to ensure accuracy and relevance.

Results: Anti-thyroid peroxidase antibodies and thyroid-stimulating hormone were significantly higher in polycystic ovary syndrome patients compared to controls (P<0.05). Polycystic ovary syndrome patients also had a statistically significant higher prevalence of autoimmune thyroiditis (P=0.035) and subclinical hypothyroidism (P=0.0133) compared to controls. In polycystic ovarian syndrome patients with thyroid-stimulating hormone levels ≥2.5 mIU/L, a significantly increased insulin resistance (P=0.007) and a significantly decreased insulin sensitivity (P=0.003) were observed compared to same patients with thyroid-stimulating hormone levels <2.5 mIU/L. Serum triglycerides were significantly higher in polycystic ovary syndrome patients with subclinical hypothyroidism compared to same patients with normal thyroid function (P=0.013). A significant positive correlation was present between luteinizing hormone and thyroid volume (P=0.007) and between anti-thyroid peroxidase antibodies and thyroid volume (P<0.0001). With thyroid hormone replacement, there was a significant increase in insulin sensitivity and free T3 /T4 levels, with a corresponding decrease in serum thyroid-stimulating hormone, prolactin, estradiol, insulin resistance, and free testosterone in polycystic ovary syndrome patients with untreated hypothyroidism. The polycystic-appearing ovaries and ovarian volumes in these patients also significantly regressed (P<0.05).

Conclusion: Polycystic ovary syndrome is associated with hypothyroidism. Hence, achieving euthyroidism may improve the clinical and morphologic characteristics of polycystic ovary syndrome.

Keywords: PCOS, hypothyroidism, levothyroxine, polycystic ovary, hormone, thyroid, autoimmune, insulin resistance

Ultrasound vs CT for Diagnosing Acute Appendicitis and Appendicitis Treatment Altering Conditions

Interested in imaging modalities and their effectiveness in diagnostics?  Read the abstract and click the link below for our newest accepted publication!

 

Ultrasound vs CT for Diagnosing Acute Appendicitis and Appendicitis Treatment Altering Conditions

Christopher Borowy, MS-IV1*, Luke Rond, D.O2, John Ashurst, D.O2, and Stefan Merrill, M.D2
1Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
2Department of Emergency Medicine, Kingman Regional Medical Center, Kingman, AZ, USA

Introduction: Acute appendicitis is the most common cause of atraumatic abdominal pain in children over 1 year of age. Even though diagnostic imaging modalities have evolved over the past 20 years, accurate diagnosis of acute appendicitis still presents as a challenge. Computed tomography (CT) is currently the most commonly used radiographic test for acute appendicitis. Unlike CT, ultrasound (US) does not require ionizing radiation which is harmful to the patient. Even though the specificity of US has been well studied in acute appendicitis, CT is still commonly requested after a positive US. Till date, there has been no published research evaluating the utility of US in changing management in appendicitis.

Purpose: The purpose of the study is to compare the ability of US and CT to diagnose pathology proven acute appendicitis and to predict Appendicitis Treatment Altering Conditions (ATAC).

Methods: This is a retrospective cohort study that compares the positive predictive value (PPV) and the ATAC rate of US and CT when diagnosing acute appendicitis.

Results: There were 432 appendicitis cases reported between 1 October 2012 and 30 June 2017. Of those cases, 409 were diagnosed by CT and 23 were diagnosed by US. The PPV of both modalities was above 90% (CT = 97%, US = 95%), and the ATAC rates were statistically similar (CT = 14%, US = 22%, P = 0.21).

Conclusion: The study supports that a positive US for appendicitis is as diagnostic as a positive CT. Therefore, adding on a CT scan after a positive US does not help recognize other sources of intra-abdominal pathology that would negate doing a laparoscopy.

Keywords: US, ultrasound, CT, CAT, ATAC, appendicitis, sensitivity, positive predictive value, PPV

 

Transfemoral Aortic Valve-in-Valve Replacement in Patient with Aortic Root Pseudoaneurysm

Another new and interesting article from our Fall 2019 Issue!  Read the abstract below and click on the link for the full article.

Transfemoral Aortic Valve-in-Valve Replacement in Patient with Aortic Root Pseudoaneurysm (Click link for full PDF)

 

Authors: Mark A. Nolan, P.E., M.Eng1, Stephane Leung Wai Sang, M.D., MSc2

Background: Transcatheter aortic valve replacement (TAVR) was successfully performed to treat aortic regurgitation (AR) in a patient with a failed aortic valve replacement complicated by aortic root pseudoaneurysm.

Case Presentation: A 92-year-old male presented with acute decompensated congestive heart failure secondary to AR of a previously implanted stentless aortic bioprosthesis, complicated by a 2.5 x 1.7 cm pseudoaneurysm of the aortic root.

Conclusions: Complex aortic root and valve disease can be safely and effectively addressed through the use of TAVR in high-risk patients. The presence of a pseudoaneurysm should not preclude successful TAVR.

 

Association between Total Knee Arthroplasty and Subtalar Joint Changes: A Cadaver Study

New article from the MSRJ 2019 Fall issue is now up on the site! Read the abstract or click on the link below for the full article.

Association between Total Knee Arthroplasty and Subtalar Joint Changes: A Cadaver Study (Click link for full PDF article)

Authors: Dominick J. Casciato, B.A.1*, Natalie A. Builes, B.A.2, Luis A. Rodriguez Anaya, DPM1, Bibi N. Singh, DPM1

Background: Total knee arthroplasty (TKA) has become the procedure of choice for those suffering from debilitating degenerative joint disease of the knee; however, new research suggests that functional changes in the rearfoot occur following the procedure to compensate for gait changes. This pilot study investigates subtalar joint (STJ) changes in cadavers with TKAs.

Methods: Four embalmed cadavers with a unilateral TKA were disarticulated at the STJ and the calcaneal articular facets were imaged. The length, width, and area of these facets ipsilateral to the joint replacement were measured using image analysis software and compared to the contralateral side.
Results: All cadavers exhibited evidence of anatomical changes at the STJ. Moreover, a transition to an anatomically unstable STJ was observed.

Conclusions: This study suggests that biomechanical compensation at the STJ may result in anatomical changes in the joint in which form of the joint follows function. Though this pathology may have developed prior to such arthroplasty, the unilateral nature of the facet changes emphasizes the need to further investigate and address gait abnormalities before and after joint replacement to optimize biomechanics in the arthritic knee.

 

 

 

Malignant Chondroid Syringoma of the Foot – A Case Report

Authors: Megan Masten, MS41*, Raouf Mikhail, MD2

Author Affiliations:

1Michigan State University College of Human Medicine, Flint, Michigan, United States
2Surgical Oncologist, Hurley Medical Center, Flint, Michigan

Full Text Article PDF

*Corresponding Author: Megan Masten; mastenme@msu.edu

Key Words: Malignant; chondroid; syringoma; foot; adnexal cancer; cutaneous tumor

Abstract:

Background: This case report is about a very rare tumor – a malignant chondroid syringoma. The objective of this piece is to review both the case presented along with the current literature on cutaneous adnexal tumors.

Case Presentation: The patient is a 73-year-old Caucasian female with a past medical history of treated colon and breast cancer who presented with a 2-year history of a slow-growing, painful cutaneous lesion on the medial aspect of her right foot. The patient presented to her primary care physician (PCP) for right foot pain, which was attributed to bunions. The PCP encouraged the patient to see a podiatrist for this issue. Upon presentation to the podiatrist, the patient had a right foot biopsy. The pathology report showed a mixed malignant chondroid syringoma with positive margins. A re-excision to ensure complete removal was recommended. The patient presented to surgical oncology and subsequently she underwent complete excision of the right foot mass. At the time of her last visit, 7 months postoperatively, the patient continued to have issues with wound healing and continuous drainage of her surgical wound.

Discussion: This case differs from much of the current literature surrounding cutaneous adnexal tumors as it is a malignant chondroid syringoma of the foot, which is exceedingly rare. There are only three other published case reports of similar malignancies in similar places. This case study is important due to the uniqueness of the case. This case serves as a reminder of the importance of biopsy for diagnosis prior to management, as it is unlikely that such rare soft tissue tumors can be diagnosed without biopsy.

Conclusion: The take away lesson of the case is that it is important to biopsy unknown masses, and to have follow up with specific specialists.

Published: Spring, 2019

References:

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the looking glass: an examination of malignant cutaneous adnexal tumors. Arch Dermatol 2011; 147(9): 1058–62.
doi: 10.1001/archdermatol.2011.229

2. Malik R, Saxena A, Kamath N. A rare case of malignant chondroid syringoma of scalp. Indian Dermatol Online
J 2013; 4(3): 236–8.

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a very rare case report. Indian J Pathol Microbiol 2017;
60(3): 428–30.

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5. American Joint Committee on Cancer TNM staging system for cutaneous squamous cell carcinoma. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

6. Lu H, Chen L, Chen Q, Shen H, Liu Z. A rare large cutaneous chondroid syringoma involving a toe: a case report. Medicine 2018; 97(5): e9825.

7. Madi K, Attanasio A, Cecunjanin F, Garcia R, Vidershayn A, Lucido, J. Chondroid syringoma of the foot: a rare diagnosis.
J Foot Ankle Surg 2016; 55: 373–8.

8. Sundling R, Logan D. Chondroid syringoma: a case report in the foot and ankle. Foot Ankle Specialist 2016; 10: 167–9.

9. Kazakov DV, McKee PH, Michal M, Kacerovska D. Cutaneous adnexal tumors. 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins Health; 2012.

10. Conill C, Toscas I, Morilla I, Mascaró JM. Radiation therapy as a curative treatment in extraocular sebaceous carcinoma. Br J Dermatol 2003; 149(2): 441–2.

11. Duke WH, Sherrod TT, Lupton GP. Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited). Am J Surg Pathol 2000; 24(6): 775–84. 12. Tolkachjov SN, Hocker TL, Camilleri MJ, Baum CL. Mohs micrographic surgery in the treatment of trichilemmal

carcinoma: the Mayo Clinic experience. J Am Acad Dermatol 2015; 72(1): 195.

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14. Metzler G, Schaumburg-Lever G, Hornstein O, Rassner G. Malignant chondroid syringoma: immunohistopathology. Am J Dermatopathol 1996; 18: 83–9.

15. Webb JN, Stott WG. Malignant chondroid syringoma of the thigh. Report of a case with electron microscopy of the tumour. J Pathol 1975; 116: 43–6.

16. Mathiasen RA, Rasgon BM, Rumore G. Malignant chondroid syringoma of the face: a first reported case. Otolaryngol Head Neck Surg 2005; 133: 305–7.

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Primary Intestinal Lymphangiectasia: A Case Report

Authors: Ridwaan Albeiruti1*, MD, Patrick Gleeson2, MD, Theodore Kelbel3, MD, Tracy Fausnight, MD3

Author Affiliations:

1Department of Medicine, West Virginia University, Morgantown, WV; Department of Internal Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA; 2Department of Internal Medicine, Temple University, Philadelphia, PA, USA; 3Helen DeVos Children’s Hospital, Spectrum Health, Grand Rapids, MI, USA

Full Text Article PDF

*Corresponding Author: Ridwaan Albeiruti; albeiru4@msu.edu

Key Words: primary intestinal lymphangiectasia; Waldmann’s disease; protein-losing enteropathy

Abstract:

Primary intestinal lymphangiectasia (Waldmann’s disease) is a rare protein-losing enteropathy which is mostly seen in young children. A 22-month-old male baby presented with a 1-week history of abdominal distension, chronic loose stools, recurrent ear infections, and failure to thrive. He had edematous eyelids and non-pitting edema of his hands and feet. The patient was diagnosed via endoscopic visualization and biopsy of the lymphangiectasia in the small bowel. He was managed through dietary restriction with a high-protein, low-fat diet. The patient subsequently had resolution of the diarrhea and an increase in albumin and total protein on labs. We describe a rare case of primary intestinal lymphangiectasia and highlight its clinical presentation, diagnosis, and treatment.

Published: Spring, 2019

References:

1. Vignes S, Bellanger J. Primary intestinal lymphangiectasia (Waldmann’s disease). Orphanet J Rare Dis 2008; 3: 5.
doi: 10.1186/1750-1172-3-5

2. Wen J, Tang Q, Wu J, Wang Y, Cai W. Primary intestinal lymphangiectasia: four case reports and a review of the literature. Dig Dis Sci 2010; 55(12): 3466–72. doi: 10.1007/ s10620-010-1161-1

3. Hokari R, Kitagawa N, Watanabe C, Komoto S, Kurihara C, Okada Y, et al. Changes in regulatory molecules for lymphangiogenesis in intestinal lymphangiectasia with enteric protein loss. J Gastroenterol Hepatol 2008; 23(7 Pt 2): e88–95. doi: 10.1111/j.1440-1746.2007.05225.x

4. Katoch P, Bhardwaj S. Lymphangiectasia of small intestine presenting as intussusception. Indian J Pathol Microbiol 2008; 51(3): 411–12.

5. Dierselhuis MP, Boelens JJ, Versteegh FG, Weemaes C, Wulffraat NM. Recurrent and opportunistic infections in children with primary intestinal lymphangiectasia. J Pediatr Gastroenterol Nutr 2007; 44(3): 382–5. doi: 10.1097/01. mpg.0000233192.77521.2f

6. Ingle SB, Hinge Ingle CR. Primary intestinal lymphangiectasia: minireview. World J Clin Cases 2014; 2(10): 528–33. doi: 10.12998/wjcc.v2.i10.528

7. Xinias I, Mavroudi A, Sapountzi E, Thomaidou A, Fotoulaki M, Kalambakas A, et al. Primary intestinal lymphangiectasia: is it always bad? Two cases with different outcome. Case Rep Gastroenterol 2013; 7(1): 153–63. doi: 10.1159/000348763

Comparing Student Satisfaction with Traditional and Modular Group Peer-Tutoring Session

Authors:

Jeff Cross, MD1, Rodney Nyland PhD2, Sarah Lerchenfeldt, PharmD, BCPS, BCOP3

Author Affiliations:

1Oakland University William Beaumont School of Medicine, Rochester, MI, USA
2Department of Organizational Leadership, School of Education and Human Services, Oakland University, Rochester, MI, USA
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA

Full Text Article PDF

*Corresponding Author: Jeff Cross; Jcross818@gmail.com

Key Words: education; medical; teaching; tutoring

Abstract:

Background: Our allopathic medical school has utilized a peer-tutoring program since inception in 2011, where second-year medical students teach first-year students in 2-h lecture-style review sessions. In 2015, an alternative format was implemented using four, repeating 30-min modules. This study was designed to compare student satisfaction with both approaches.

Methods: An online survey was emailed to students graduating in 2018 (n = 97) and 2019 (n = 127).

Results: A total of 72 (32.6%) responding students were included in the study, 35 from the class of 2018 (Co2018) and 37 from the class of 2019 (Co2019). Fewer Co2018 students, who received traditional instruction, were ‘very satisfied with the session timing’ compared with Co2019 students, who received the modular format (proportion difference: 0.42; P < 0.001, 95% confidence interval [CI] [0.21–0.63]). Co2018 students were more likely than Co2019 students to stop attending because their time was better utilized another way (proportion difference: 0.22; P = 0.054, 95% CI [-0.003 to 0.45]).

Conclusions: Students preferred the session length and timing of the modular format. Future studies are warranted to evaluate the effectiveness of this approach.

Published: Spring, 2019

References:

1. Benè KL, Bergus G. When learners become teachers:
a review of peer teaching in medical student education.
Fam Med 2014; 46(10): 783–7.

2. Sobral DT. Cross-year peer tutoring experience in a medical school: conditions and outcomes for student tutors. Med Educ 2002; 36(11so): 1064–70. doi: 10.1046/j.1365-2923.2002. 01308.x

3. Buckley S, Zamora J. Effects of participation in a cross year peer tutoring programme in clinical examination skills on volunteer tutors’ skills and attitudes towards teachers and teaching. BMC Med Educ 2007; 7(1): 20. doi: 10.1186/ 1472-6920-7-20

4. Yu TC, Wilson NC, Singh PP, Lemanu DP, Hawken SJ, Hill AG. Medical students-as-teachers: a systematic review of peer- assisted teaching during medical school. Adv Med Educ
Pract 2011; 2: 157–72. doi: 10.2147/amep.s14383

5. Lockspeiser TM, O’Sullivan P, Teherani A, Muller J. Understanding the experience of being taught by peers:
the value of social and cognitive congruence. Adv Heal Sci Educ 2008; 13(3): 361–72. doi: 10.1007/s10459-006-9049-8

6. Ten Cate O, Durning S. Peer teaching in medical education: twelve reasons to move from theory to practice. Med Teach 2007; 29(6): 591–9. doi: 10.1080/01421590701606799

7. Santee J, Garavalia L. Peer tutoring programs in health professions schools. Am J Pharm Educ 2006; 70(3): 70.
doi: 10.5688/aj700370

8. Swindle N, Wimsatt L. Development of peer tutoring services to support osteopathic medical students’ academic success. J Am Osteopath Assoc 2015; 115(11): e14–19. doi: 10.7556/jaoa.2015.140

9. Brown G, Manogue M. AMEE medical education guide
no. 22: refreshing lecturing: a guide for lecturers. Med Teach 2001; 23(3): 231–44. doi: 10.1080/01421590120043000

A Needs Assessment Pilot Study of Patients with High Utilization in an Academic Inpatient Setting

Authors:

Alexander S. Roseman, M.D.1*, Hannah Thompson, M.D.1, Audrey Jiang, BS1, Lisa Obasi, BA1, Andrew M. Pattock, BS1, Jamie P. Schlarbaum, BS1, Daniel R. Wells, BS1, Andrew P.J. Olson, M.D.2,3

Author Affiliations:

1University of Minnesota Medical School, Minneapolis, MN, USA
2Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
3Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA

Full Text Article PDF

*Corresponding Author: Alexander S. Roseman; alexander.rosemanMD@baystatehealth.org

Key Words: needs assessment; high utilization; super utilizers; high utilizers; academic medical centers

Abstract:

Background: A disproportionate amount of health care spending in the United States is attributed to a small subset of patients who employ inpatient and emergency department (ED) services. While patients with high ED utilization have previously been well- described, patients seen in an inpatient academic medical setting may differ with regard to demographics, medical conditions, and social factors.

Objectives: We aimed to characterize patients with high utilization in an academic inpatient setting for the purpose of identifying unmet needs.

Setting and Patients: Adults aged 18–80 were eligible for inclusion if they had more than three admissions to a general medicine service of an academic medical center within a large health care system. Patients who were admitted for pregnancy, oncology, trauma, or surgical procedures for acute conditions or were diagnosed with dementia or encephalopathy were excluded. Twenty-six patients met inclusion/exclusion criteria and were approached to be interviewed, of which 13 agreed to be interviewed. Measurements: Face-to-face administration of a self-reported survey assessing unmet needs regarding services for medical or mental health needs, access to health care, housing, transportation, or legal services, and any other barriers to health the respondent identified.

Results: All of those surveyed had health insurance and regular visits with primary care providers (mean 14 visits per 12 months). The most prevalent medical conditions identified were depression (85%) and chronic pain (77%). In addition, patients self-identified having an average of 2.2 chronic conditions. Financial struggles were common as 62% of the respondents reported annual incomes of <$12,000, and 77% were unemployed over the previous 12 months.

Conclusion: These results indicate unique clinical and social characteristics associated with high readmission rates at one academic medical center, suggesting the need for additional patient-centered research of this population to aid in the development of novel strategies to reduce over-utilization and improve health.

Published: Spring, 2019

References:

1. LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med 2010; 56(1): 42–8. doi: 10.1016/j.annemergmed.2010.01.032
2. Harris LJ, Graetz I, Podila PS, Wan J, Waters TM, Bailey JE. Characteristics of hospital and emergency care super-utilizers with multiple chronic conditions. J Emerg Med 2016; 50(4): e203–14. doi: 10.1016/j.jemermed.2015.09.002
3. Statistical Brief #190. Healthcare Cost and Utilization Project (HCUP). May 2016. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/ statbriefs/sb190-Hospital-Stays-Super-Utilizers-Payer-2012.jsp (accessed 10/14/2016)
4. Ronksley PE, Kobewka DM, McKay JA, Rothwell DM, Mulpuru S, Forster AJ. Clinical characteristics and preventable acute care spending among a high cost inpatient population. BMC Health Serv Res 2016; 16: 162–5. doi: 10.1186/ s12913-016-1418-2
5. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42(2): 377–81. doi: 10.1016/j. jbi.2008.08.010

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8. Blank FS, Li H, Henneman PL, Smithline HA, Santoro JS, Provost D, et al. A descriptive study of heavy emergency department users at an academic emergency department reveals heavy ED users have better access to care than average users. J Emerg Nurs 2005; 31(2): 139–44. doi: 10.1016/j.jen.2005.02.008

9. Stockbridge EL, Suzuki S, Pagan JA. Chronic pain and health care spending: an analysis of longitudinal data from the Medical Expenditure Panel Survey. Health Serv Res 2015; 50(3): 847–70. doi: 10.1111/1475-6773.12263
10. Von Korff M, Lin EHB, Fenton JJ, Saunders K. Frequency and priority of pain patients’ health care use. Clin J Pain 2007; 23(5): 400–8. doi: 10.1097/AJP.0b013e31804ac020

11. Blyth FM, March LM, Brnabic AJM, Cousins MJ. Chronic pain and frequent use of health care. Pain 2004; 111(1–2): 51–8. doi: 10.1016/j.pain.2004.05.020

12. Hunt KA, Weber EJ, Showstack JA, Colby DC, Callaham ML. Characteristics of frequent users of emergency departments. Ann Emerg Med 2006; 48(1): 1–8. doi: 10.1016/j. annemergmed.2005.12.030

13. Mautner DB, Pang H, Brenner JC, Shea JA, Gross KS, Frasso 335 R, et al. Generating hypotheses about care needs of high
utilizers: lessons from patient interviews. Popul Health Manag
2013; 16(Suppl 1): S26–33. doi: 10.1089/pop.2013.0033; 10.1089/pop.2013.0033

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Expert Opinions on Healthcare for Immigrants in Norway

Authors:

Andrea Kubicki1, Haben Debessai1, Megan Masten1, Reena Pullukat1, Kirsten Salmela1

Author Affiliations:

1College of Human Medicine, Michigan State University, East Lansing, MI, USA

Full Text Article PDF

*Corresponding Author: Megan Masten; mastenme@msu.edu

Key Words: Norway; healthcare; immigrant; barriers to care; language

Abstract:

Background: Documented immigrants eligible to stay in Norway for more than 6 months can enroll in the universal healthcare system for full healthcare services, such as acute, chronic, and preventative care.1 All other non-citizens only have access to emergency services. With an increasing influx of immigrants to Norway, it is advantageous to evaluate the Norwegian healthcare system, how documented and undocumented immigrants utilize the system, and any barriers they may face when doing so. The aim of this study is to identify barriers to healthcare for immigrants in Norway in order to better address them in the future.

Methods: Sixteen subjects with knowledge of immigrant healthcare in Norway were interviewed. Participants were asked the same standardized four questions; answers were audio-recorded, transcribed, and analyzed.

Results: Major themes that emerged included the following: (1) universal access is a benefit once accepted into the system, (2) timeliness is an issue, (3) chronic disease and mental health are common immigrant-specific health issues, and (4) language and lack of cultural competency are major barriers to care.

Conclusion: There is a need for improved translation services and cultural competency as the immigrant population in Norway increases.

Published: Spring, 2019

References:

1. Goth UG, Berg JE. Migrant participation in Norwegian health care. A qualitative study using key informants.
Eur J Gen Pract 2010; 17(1): 28–33. doi:10.3109/1381478 8.2010.525632.

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Int Migrat 1992; 30 (Special Issue: Migration and Health in
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5. CooperB. Migrant quality, not quantity. Washington, DC: Migration Policy Institute. 2005. Available from: https://www.migrationpolicy.org/article/norway-migrant-quality-not- quantity [cited 16 July 2018].

6. Large diversity in little Norway. ssb.no. Available from: https://www.ssb.no/en/befolkning/artikler-og-publikasjoner/ large-diversity-in-little-norway. Published 2019 [cited 21 March 2019].

7. Abebe DS. Public health challenges of immigrants in Norway: a research review. NAKMI Report 2010; 2.

8. Eli K, Ytrehus S. Barriers to health care access among undocumented migrant women in Norway. Soc Health Vulnerability 2015; 6(1): 28668.

9. This is Norway 2016: what the figures say. pp. 1–2. Statistics Norway. Available from: https://www.ssb.no/a/histstat/norge/ this-is-norway-2016.pdf [cited 15 August 2016].

10. Heim T. Problems of general practitioner’s care of migrants. Misunderstandings – Not only because of language. MMW Fortschr Med 2004; 146: 4–6.

11. Priebe S, Sandhu S, Dias S, Gaddini A, Greacen T,
Ioannidis E, et al. Good practice in health care for migrants: views and experiences of care professionals in 16 European countries. BMC Public Health 2011; 11(1): 187.

12. Jensen NK, Nielsen SS, Krasnik A. Expert opinion on best practices “in the delivery of healthcare services to immigrants in Denmark”. Dan Med Bull 2011; 57(8): A4170.

13. Mladovsky P. Migrant health in the EU. Eurohealth London 2007; 13(1): 9.

14. Wachtler C, Brorsson A, Troein M. Meeting and treating cultural difference in primary care: a qualitative interview study. Fam Pract 2005; 23(1): 111–15.

Opioid Safety Education in Adolescent Students

Authors:

Alexandra K. Feiertag, B.A.1*, Catherine A. Martin, M.D.1,2, Gregory E. Guenthner, M.L.I.S.2

Author Affiliations:

1College of Medicine, University of Kentucky, Lexington, KY, USA
2Department of Psychiatry, University of Kentucky, Lexington, KY, USA

Full Text Article PDF

*Corresponding Author: Alexandra K. Feiertag; alex.feiertag@uky.edu

Key Words: opioid; overdose; safety; education; adolescent

Abstract:

Purpose: Opioid overdoses profoundly impact thousands of families across the United States. Behind this issue lies the accessibility of opioid prescriptions right inside our medicine cabinets. Our goal was to educate adolescent students in Kentucky schools about this matter because they comprise a vulnerable population.

Methods: Pre- and posttestings were used to analyze 26 adolescents’ knowledge, attitudes, and awareness regarding opioid overdoses pre- and post-intervention.

Results: Adolescents displayed significantly improved results from pre-test to post-test. Overdose Knowledge scores improved by 16% from pre- to post-intervention (p = 0.01). Attitude to Act scores improved by 35% (p = 0.03). Drug Disposal Awareness scores improved by 54% (p < 0.01).

Conclusions: This study demonstrates that education improves adolescents’ opioid overdose knowledge, attitudes, and awareness. The evidence shows that there are educational gaps that should be filled by teaching adolescents about the opioid epidemic and providing them with resources.

Published: Spring, 2019

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