Braden Hexom

Optimizing global health experiences in emergency medicine residency programs: a consensus statement from the Council of Emergency Medicine Residency Directors 2011 Academic Assembly global health specialty track

BackgroundAn increasing number of emergency medicine (EM) residency training programs have residents interested in participating in clinical rotations in other countries. However, the policies that each individual training program applies to this process are different. To our knowledge, little has been done in the standardization of these experiences to help EM residency programs with the evaluation, administration and implementation of a successful global health clinical elective experience. The objective of this project was to assess the current status of EM global health electives at residency training programs and to establish recommendations from educators in EM on the best methodology to implement successful global health electives.MethodsDuring the 2011 Council of Emergency Medicine Residency Directors (CORD) Academic Assembly, participants met to address this issue in a mediated discussion session and working group. Session participants examined data previously obtained via the CORD online listserve, discussed best practices in global health applications, evaluations and partnerships, and explored possible solutions to some of the challenges. In addition a survey was sent to CORD members prior to the 2011 Academic Assembly to evaluate the resources and processes for EM residents’ global experiences.ResultsRecommendations included creating a global health working group within the organization, optimizing a clearinghouse of elective opportunities for residents and standardizing elective application materials, site evaluations and resident assessment/feedback methods. The survey showed that 71.4% of respondents have global health partnerships and electives. However, only 36.7% of programs require pre-departure training, and only 20% have formal competency requirements for these global health electives.ConclusionsA large number of EM training programs have global health experiences available, but these electives and the trainees may benefit from additional institutional support and formalized structure.

New academic partnerships in global health: innovations at Mount Sinai School of Medicine.

Global health has become an increasingly important focus of education, research, and clinical service in North American universities and academic health centers. Today there are at least 49 academically based global health programs in the United States and Canada, as compared with only one in 1999. A new academic society, the Consortium of Universities for Global Health, was established in 2008 and has grown significantly. This sharp expansion reflects convergence of 3 factors: (1) rapidly growing student and faculty interest in global health; (2) growing realization-powerfully catalyzed by the acquired immune deficiency syndrome epidemic, the emergence of other new infections, climate change, and globalization-that health problems are interconnected, cross national borders, and are global in nature; and (3) rapid expansion in resources for global health. This article examines the evolution of the concept of global health and describes the driving forces that have accelerated interest in the field. It traces the development of global health programs in academic health centers in the United States. It presents a blueprint for a new school-wide global health program at Mount Sinai School of Medicine. The mission of that program, Mount Sinai Global Health, is to enhance global health as an academic field of study within the Mount Sinai community and to improve the health of people around the world. Mount Sinai Global Health is uniting and building synergies among strong, existing global health programs within Mount Sinai; it is training the next generation of physicians and health scientists to be leaders in global health; it is making novel discoveries that translate into blueprints for improving health worldwide; and it builds on Mount Sinais long and proud tradition of providing medical and surgical care in places where need is great and resources few.

Impact of Mental Health Training on Village Health Workers Regarding Clinical Depression in Rural India

Abstract Village health worker (VHW) programs are known to be effective means of promoting health of communities. Comprehensive rural health project in India recently trained VHWs to identify, refer, and help people with mental health issues. This study evaluated knowledge, attitude, and behavior of VHWs regarding depression. Cluster sampling was used including all 36 VHWs trained in mental health. Among these, 24 were available and willing to participate in the study. Five FGDs were conducted among 24 VHWs, and the results were analyzed qualitatively. Four out of five groups were able to diagnose the presented case correctly as depression. VHWs were able to identify many symptoms and to suggest management options for depression. They showed supportive and empathetic attitudes towards depressed patients. VHWs are likely to be useful at identifying and assisting people with depression in the communities with lack of adequate resources provided they receive ongoing training and supervision.

Cross-sectional survey of malaria prevalence in tsunami-affected districts of Aceh Province, Indonesia

BackgroundMalaria is endemic to Indonesia. However, there are few prevalence data available from Aceh Province because of the long-standing separatist conflict and decentralization of the public health system. The Mentor Initiative, which specializes in malaria control in humanitarian emergencies, was one of the non-governmental organizations to respond to the 2004 Indian Ocean tsunami in Aceh. Data on malaria prevalence were gathered to guide and evaluate programmatic efforts.FindingsThe Mentor Initiative conducted community-based malaria prevalence surveys in 2005 and 2006 in five districts along the tsunami-affected western coastline. A total of 11,763 individuals in 3,771 households were tested. The overall slide positivity rate in 2005 and 2006 for all Plasmodium species was 2.1% (n = 252, 95% CI 1.9%-2.4%). Slide positivity rates ranged from 0 to 55% among villages. Overall, 57% of the 252 cases were infected with P. falciparum (n = 144, 95% CI 51.0%-63.3%), and 40.1% were infected with P. vivax (n = 101, 95% CI 34.0%-46.1%), with 0.03% (n = 7, 95% CI 0.8%-4.8%) being mixed infections. Males were significantly more likely to be affected than females (2.8% vs 1.5%, p < 0.01). Infection was more common in those over the age of 5 (2.3% vs. 0.6%, p < 0.01).ConclusionsLocal prevalence data are needed to design effective community-based malaria control programs, as endemicity varies greatly within districts. Certain villages were found to be hyperendemic, with slide positivity rates far higher than average in Indonesia. There is a need for ongoing malaria surveillance in Aceh Province to monitor prevention and treatment efforts.

Evaluation of an Obstetric Ultrasound Curriculum for Midwives in Liberia.

Point‐of‐care ultrasound is an effective tool for clinical decision making in low‐ and middle‐income countries, but lack of trained providers is a barrier to its utility in these settings. In Liberia, given that midwives provide most prenatal care, it is hypothesized that training them in prenatal ultrasound through an intensive condensed training course is both feasible and practical.

Exploration of Global Health Careers Across the Medical Fields

BACKGROUND Despite expansion of interest among American medical students in global health (GH), academic medical centers face multiple obstacles to the development of structured GH curricula and career guidance. To meet these demands we sought to provide a systematic analysis of the accounts of GH experts. METHODS We developed a collaborative, interview-based, qualitative analysis of GH experiences across six career-related themes that are relevant to medical students interested in GH: justification, medical education, economics, research prospects, law and ethics, and work-life balance. Seven GH faculty members were interviewed for 30-90 minutes using sample questions as guidelines. We applied a grounded theory approach to analyze the interview transcripts to discover an emerging theory pertinent to GH trainees. FINDINGS Regarding justification, 4 respondents defined GH as work with the underserved irrespective of geographic location; 5 respondents found sustainability imperative; and all respondents believe GH creates better physicians. Respondents identified many physician competencies developed through GH medical education, with 5 respondents agreeing that work with underserved populations has transformative potential. Concerning economics, 3 respondents acknowledged GHs popularity among trainees, resulting in increased training opportunities, and 2 respondents emphasized an associated deficiency in program quality. All respondents described career models across specialties. Four respondents noted funding challenges when discussing research prospects. Within the theme of laws and ethics, 4 respondents perceived inadequate accountability, and 6 respondents identified ways to create accountability. Finally, 6 respondents recognized family demands can compromise ones GH career and thus work-life balance. CONCLUSION Despite diverse perspectives on the meaning and sustainability of GH work, this analysis provides a nascent framework that may inform curricular development for GH trainees. Suggestions are offered for elaborating this framework to fully exploit the transformative potential of GH training in medical education.

Sickle-cell disease

The signs and symptoms of sickle cell disease are caused by the sickling of red blood cells. When red blood cells sickle, they break down prematurely, which can lead to anemia. Anemia can cause shortness of breath, fatigue, and delayed growth and development in children. The rapid breakdown of red blood cells may also cause yellowing of the eyes and skin, which are signs of jaundice. Painful episodes can occur when sickled red blood cells, which are stiff and inflexible, get stuck in small blood vessels. These episodes deprive tissues and organs, such as the lungs, kidneys, spleen, and brain, of oxygen-rich blood and can lead to organ damage. A particularly serious complication of sickle cell disease is high blood pressure in the blood vessels that supply the lungs (pulmonary hypertension), which can lead to heart failure. Pulmonary hypertension occurs in about 10 percent of adults with sickle cell disease.