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Rivadeneira MF, Moncayo AL, Tello B, Torres AL, Buitrón GJ, Astudillo F, Fredricks TR, Grijalva MJ. A Multi-causal Model for Chronic Malnutrition and Anemia in a Population of Rural Coastal Children in Ecuador. Matern Child Health J 2020; 24:472-482. [PMID: 31838668 PMCID: PMC7078138 DOI: 10.1007/s10995-019-02837-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Chronic malnutrition and anemia are prevalent in developing countries. This research aimed to determine the prevalence of chronic malnutrition and anemia and their associated factors in children under five using a multi-causal model in a rural community in the coast of Ecuador. METHODS The study included 314 children under 5 years old who were residents of San Isidro, Ecuador. Indicators of chronic malnutrition and anemia were identified. Mothers/caregivers were surveyed on socio-economic and environmental conditions, feeding and care practices, access to health services and biological characteristics. Bivariate and multivariable Poisson regression were performed. RESULTS The prevalence was 12.42% (n = 39) for chronic malnutrition and 16.98% (n = 54) for anemia. There was a significant and independent association between chronic malnutrition and family income less than $80 USD per month (Prevalence Ratio [PR] = 2.74, 95% CI 1.04, 7.20), maternal height less than 150 cm (PR 3.00, 95% CI 1.69, 5.32) and residence in a household with more than 4 children (PR 3.05, 95% CI 1.48, 6.29). Anemia was 2.57 times higher (95% CI 1.17, 5.65) in children with more than two episodes of diarrhea in the last 6 months. Prenatal care (5 to 8 visits) provided a protective effect for anemia (PR 0.48, 95% CI 0.27, 0.89). CONCLUSIONS FOR PRACTICE Findings support the need for comprehensive interventions targeted toward chronic malnutrition and anemia in children from rural coastal communities. Improvement of socioeconomic conditions, family planning, prenatal care and reduction of diarrheal diseases should be prioritized.
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Affiliation(s)
- María F Rivadeneira
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Ana L Moncayo
- Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador.
| | - Betzabé Tello
- Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Ana L Torres
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Gladys J Buitrón
- Escuela de Ciencias Físicas y Matemática, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Fabricio Astudillo
- Escuela de Geografía, Facultad de Ciencias Humanas, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Todd R Fredricks
- Department of Family Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701, USA
| | - Mario J Grijalva
- Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
- Infectious and Tropical Disease Institute, Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701, USA
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Abstract
IN BRIEF In this feasibility study, we evaluated the impact of a contact-based education patient panel in an Endocrine and Metabolism course on second-year medical students' diabetes attitudes and diabetes stigma. Prior to the patient panel, some medical students harbored stigma toward people with diabetes, thus confirming patients' reports in the literature of diabetes stigma on the part of health care professionals. Importantly, the one-time contact-based educational approach improved students' diabetes attitudes and reduced diabetes stigma.
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Affiliation(s)
- Elizabeth A. Beverly
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- The Diabetes Institute, Ohio University, Athens, OH
| | - Emily H. Guseman
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- The Diabetes Institute, Ohio University, Athens, OH
| | - Laura L. Jensen
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
- The Diabetes Institute, Ohio University, Athens, OH
| | - Todd R. Fredricks
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
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Beverly EA, Fredricks TR, Leubitz A, Oldach BR, Kana D, Grant MD, Whipps J, Guseman EH. What can family medicine providers learn about concussion non-disclosure from former collegiate athletes? BMC Fam Pract 2018; 19:128. [PMID: 30053841 PMCID: PMC6064086 DOI: 10.1186/s12875-018-0818-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/10/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Despite the risks, concussion symptoms often go underreported by athletes, leading to delayed or forgone treatment and increased potential for concussion recurrence. One of the most serious long-term consequences of sports-related concussions is Chronic Traumatic Encephelopathy (CTE), a disorder associated with progressive neurological deterioration. The purpose of this study was to explore former collegiate athletes' understanding of concussions and motivations behind concussion non-disclosure in order to better assist family medicine providers in screening for and managing a history of concussions. METHODS Informed by the theoretical framework Social Cognitive Theory, we conducted focus groups with former collegiate athletes using a field-tested discussion guide. Discussions were transcribed, coded, and analyzed via content and thematic analyses using NVivo 10 software. RESULTS Thirty-two former collegiate athletes (24.5 ± 2.9 years old, 59.4% female, 87.5% white) participated in 7 focus groups. Three predominant themes emerged: 1) Concussions are Part of the Game: Participants believed that concussions were part of sports, and that by agreeing to play a sport they were accepting the inherent risk of concussions. Importantly, many were not familiar with concussion symptoms and what constituted a concussion; 2) Hiding Concussion Symptoms: Participants said they often hid concussion symptoms from coaches and trainers in order to avoid being taken out of or missing games. Participants were able to hide their concussions because most symptoms were indiscernible to others; and 3) Misconceptions about Concussions in Low Contact Sports: Several participants did not understand that concussions could occur in all sports including low contact or noncontact sports. The former athletes who participated in low contact sports and experienced concussions attributed their concussions to personal clumsiness rather than their sport. CONCLUSIONS Family medicine providers as well as coaches, athletic trainers, teachers, and parents/guardians should reinforce the message that concussions can occur in all sports and inform patients about the signs and symptoms of concussions. Further, providers should ask all patients if they engaged in high school or collegiate athletics; and if yes, to describe their hardest hit to their head in order to obtain a complete medical history.
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Affiliation(s)
- Elizabeth A. Beverly
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701 USA
- The Diabetes Institute, Ohio University, Athens, OH 45701 USA
| | - Todd R. Fredricks
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701 USA
| | - Andrew Leubitz
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701 USA
| | - Benjamin R. Oldach
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701 USA
| | - Daniel Kana
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701 USA
| | | | | | - Emily H. Guseman
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701 USA
- The Diabetes Institute, Ohio University, Athens, OH 45701 USA
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Abstract
UNLABELLED Phenomenon: Trigger warnings are verbal statements or written warnings that alert students in advance to potentially distressing material. Medical education includes numerous subjects frequently identified as triggers, such as abuse, rape, self-injurious behaviors, eating disorders, drug and alcohol addiction, and suicide. Thus, exploring medical students' perceptions of trigger warnings may provide a valuable perspective on the use of these warnings in higher education. APPROACH As part of a larger descriptive, cross-sectional survey study on medical education, we assessed 1st- and 2nd-year medical students' perceptions of trigger warnings in the preclinical curriculum. Five questions specific to trigger warnings explored students' knowledge, prior experience, and perceptions of trigger warnings in medical education. Frequencies of individual question responses were calculated, and qualitative data were analyzed via content and thematic analyses. FINDINGS Of the 424 medical students invited to participate, 259 completed the survey (M = 24.8 years, SD + 3.4, 51.4% female, 76.1% White, 53.7% 1st-year students). Few students (11.2%) were aware of the term trigger warning and its definition. However, after being presented with a formal definition on the online survey, 38.6% reported having had a professor use one. When asked whether they supported the use of trigger warnings in medical education, respondents were distributed fairly equally by response (yes = 31.0%, maybe = 39.2%, no = 29.7%). Qualitative analysis revealed three themes: (a) Trigger Warnings Allow Students to Know What is Coming and Prepare Themselves: Respondents believed that trigger warnings would benefit students with a history of trauma by providing them additional time to prepare for the material and, if appropriate, seek professional help; (b) Students Need to Learn How to Handle Distressing Information: Respondents agreed that they needed to learn and cope with highly sensitive material because they would be confronted with difficult and unexpected situations in clinical practice; and (c) Trigger Warnings Help Students Understand the Severity of the Material: Respondents felt that trigger warnings may help students understand the severity of the material being covered and increase awareness about trauma and its effects on health and well-being. Insights: Findings did not reach consensus for or against the use of trigger warnings in medical school; however, students emphasized the importance of learning how to cope with distressing material. Trigger warnings may represent a teaching tool to facilitate classroom discussions about the severity of trauma-related material and problem-focused coping strategies.
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Affiliation(s)
- Elizabeth A Beverly
- a Department of Family Medicine , Ohio University Heritage College of Osteopathic Medicine , Athens , Ohio , USA
| | - Sebastián Díaz
- a Department of Family Medicine , Ohio University Heritage College of Osteopathic Medicine , Athens , Ohio , USA
| | - Anna M Kerr
- a Department of Family Medicine , Ohio University Heritage College of Osteopathic Medicine , Athens , Ohio , USA
| | - Jane T Balbo
- a Department of Family Medicine , Ohio University Heritage College of Osteopathic Medicine , Athens , Ohio , USA
| | - Kayla E Prokopakis
- b Department of Medicine , Ohio University Heritage College of Osteopathic Medicine , Athens , Ohio , USA
| | - Todd R Fredricks
- c Department of Family Medicine , Ohio University Heritage College of Osteopathic Medicine , Athens , Ohio , USA
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Fredricks TR, Gibson C, Essien F, Benseler JS. Therapeutic Hypothermia to Treat a Newborn With Perinatal Hypoxic-Ischemic Encephalopathy. J Osteopath Med 2017; 117:393-398. [PMID: 28556862 DOI: 10.7556/jaoa.2017.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Hypoxic-ischemic encephalopathy is caused by neonatal asphyxia and can lead to mortality or long-term neurodevelopmental morbidity in neonates. Therapeutic hypothermia (TH) is one of the few effective ways to manage mitigating neurologic sequelae. The authors describe the case of a neonate who had a perinatal hypoxic insult and sustained no long-term sequelae after being treated with TH. It is important that osteopathic physicians who provide obstetric and gynecologic, perinatal, and emergency medical care are able to recognize a perinatal hypoxic event, understand the stratification of hypoxic-ischemic encephalopathy risk factors, and implement early TH protocols.
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Beverly EA, Ivanov NN, Court AB, Fredricks TR. Is diabetes distress on your radar screen? J Fam Pract 2017; 66:9-14. [PMID: 28188312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Diabetes distress, which affects almost half of those with diabetes, contributes to worsening glycemic control. Recognizing and responding to it is essential.
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Affiliation(s)
- Elizabeth A Beverly
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA.
| | - Nedyalko N Ivanov
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Autumn B Court
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Todd R Fredricks
- Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
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Fredricks TR, Benseler JS. Aortic Root Aneurism Found in a 42-Year-Old Epitomizes the Importance of Auscultation in Routine Exams. Aerosp Med Hum Perform 2016; 87:487-92. [PMID: 27099088 DOI: 10.3357/amhp.4431.2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bicuspid aortic valve disease (BAV) is the most common cardiac valve pathology. BAV is associated with aortic root disorders. The literature has few case reports identifying this condition during routine physical exam. CASE REPORT A 42-yr-old military reservist flight medic presented for his annual military flight physical. He was found to have a faint cardiac murmur. His past family and medical history were remarkable for familial essential hypertension and being told at age 9 that he had a "murmur." He was referred for cardiology consultation, echocardiography, stress testing, and a computerized tomography angiogram (CTa), which identified BAV with a 4.3-cm aortic root aneurysm. A follow-up at 1 yr was recommended. In the interim he developed severe aortic valve insufficiency, a 4.6-cm aortic root aneurysm. The valve and aortic root were repaired and a single left anterior descending coronary artery lesion was bypassed during surgery. The flight medic made a full recovery but was not returned to flight status. DISCUSSION This case emphasizes the importance of periodic reassessment by thorough history and careful cardiac auscultation during flight physicals. BAV aortopathy is an uncommon condition seen in the military aviation community. Most flight surgeons will not have the opportunity to identify it specifically via auscultation. This patient had over nine annual flight physicals prior to the one reported and no pathology was ever identified through routine auscultation. The potential role of point-of-care ultrasound (POCUS) for survey of vascular and valve status of aviation personnel merits further research.
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Fredricks TR, Nakazawa M. Dry bulb temperature effects on crew well-being in long-duration ad hoc platform flights. Aerosp Med Hum Perform 2015; 86:125-30. [PMID: 25946737 DOI: 10.3357/amhp.3954.2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE U.S. combat activities in Iraq and Afghanistan saw the implementation of multiple ad hoc systems incorporated onto commercial aerial platforms for supporting operations. The use of manned platforms, many of which were never intended for the long-duration missions to which they have been applied, has had human factor and aviation life support equipment (ALSE) implications. The physiological stress-inducing nature of high temperatures (> 40 C) is one such concern. This study assessed cockpit temperatures in one such platform during actual combat missions over Iraq. METHODS Three missions were flown in Iraq during 2011 on an ad hoc aerial platform and dry bulb temperature readings were recorded periodically at head height at different crew stations. Relative humidity was also recorded. RESULTS Temperatures demonstrated wide variability during mission profiles, ranging from > 40°C to 15°C. Ground heat-soaked cabin temperatures were measured as high as 48°C. High temperatures could be experienced for up to an hour prior to departure. DISCUSSION While ad hoc aerial platform use has operational merits, the lack of adequate crew life support systems on such platforms can pose thermal risks to the aircrews. More detailed investigation is needed to determine core temperature response of aircrews during such operations and platform specific ALSE requirements to better support aircrew mission effectiveness.
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Fredricks TR. Health care as a "right". J Am Osteopath Assoc 2013; 113:127-129. [PMID: 23412674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Fredricks TR. Joining forces: military perspectives for osteopathic medical education. J Am Osteopath Assoc 2012; 112:649. [PMID: 23055463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Fredricks TR. Efficacy of a physician's words of empathy: an overview of state apology laws. J Am Osteopath Assoc 2012; 112:405-406. [PMID: 22802537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Fredricks TR. Medical business education in colleges of osteopathic medicine. J Am Osteopath Assoc 2010; 110:679. [PMID: 21135201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Fredricks TR. The anachronistic fight for osteopathic distinctiveness. J Am Osteopath Assoc 2010; 110:512-553. [PMID: 20876835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Fredricks TR. Understanding insurance: will a public option or co-op get us where we want? J Am Osteopath Assoc 2010; 110:423-487. [PMID: 20805546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Fredricks TR. Protecting patients and maintaining professional sovereignty in the midst of intrusive government change. J Am Osteopath Assoc 2009; 109:622-651. [PMID: 20023218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Fredricks TR. Shoulder manipulation by DOs. Am Fam Physician 1991; 44:1992. [PMID: 1746383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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