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Alternative and Complementary Medicine Commons™
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Articles 31 - 60 of 378
Full-Text Articles in Alternative and Complementary Medicine
Antidiabetic Properties Of Prickly Pear (Opuntia Ficus-Indica) Fruit Extract, Kenzy Aidan Joseph Mckay
Antidiabetic Properties Of Prickly Pear (Opuntia Ficus-Indica) Fruit Extract, Kenzy Aidan Joseph Mckay
The Undergraduate Research Journal
Diabetes mellitus is a metabolic disorder that claims 1.5 million lives annually. Opuntia ficus-indica, commonly known as the prickly pear, has been commonly used in traditional folk medicine for its hypoglycemic properties. It has been claimed that it has antimicrobial and antioxidant properties as well. The plant is native to Mexico and is commonly found in the middle east and India and folk medicine from all of these areas have been using prickly pear medicinally for years. To test these claims an extract of locally sourced Opuntia ficus-indica was prepared using the flesh and seeds of the fruit. The …
Functional Foods In Society, Annie Lin, Carolyn Jackson
Functional Foods In Society, Annie Lin, Carolyn Jackson
Faculty Books and Book Chapters
This booklet captures highlights from our Functional Foods in Society in-person activities, where NSU Graduate Nutrition students explore food as medicine through hands-on learning.
Inside, you'll find simple, nourishing dishes and activities using ingredients like anti-inflammatory spices, phytonutrients, quality proteins, and healthy fats.
We hope this inspires you to bring more intention, joy, and nourishment into your everyday meals!
Bibliography, Mary P. Bennett
Bibliography, Mary P. Bennett
Faculty/Staff Personal Papers
Bibliography of publications by Mary Bennett.
Empowering Birth: Comparing Nurse-Led Holistic And Pharmacologic Pain Relief Approaches, Jessica C. Moore
Empowering Birth: Comparing Nurse-Led Holistic And Pharmacologic Pain Relief Approaches, Jessica C. Moore
Nursing | Student Research Posters
Childbirth is often described as one of the most meaningful experiences in a woman’s life. During this time, effective pain management is essential not only for reducing discomfort, but also for improving maternal satisfaction and minimizing unnecessary obstetric interventions. While childbirth is frequently approached as a purely physical process, it is inherently holistic, influenced by cultural, social, psychological, and emotional factors.
Growing evidence highlights the value of incorporating and educating patients and providers on non-pharmacologic strategies such as breathing techniques, massage, aromatherapy, hydrotherapy, positioning ,ambulation, and continuous emotional support.
For example, a study in Sweden that found that a group …
Integrating Lifestyle Medicine Into Undergraduate Nursing Education, Lyndsay Wright
Integrating Lifestyle Medicine Into Undergraduate Nursing Education, Lyndsay Wright
DNP Research Projects
Abstract
Objective: Lifestyle Medicine (LM) effectively addresses the lifestyle-related diseases that contribute most to global morbidity, mortality, and healthcare spending. However, nurses and nursing students struggle with maintaining healthy lifestyles themselves, with LM and health behavior change strategies insufficiently taught in nursing education. Method: A quasi-experimental study with a pre-test and post-test design examined the effects of an LM educational intervention on undergraduate nursing students’ knowledge of LM and intentions for health behavior change. Data were collected using demographic questions, an LM knowledge (LMK) questionnaire, the Lifestyle Medicine Assessment (LMA), and a modified Intention to Change Behavior Scale …
The Potential Of Vitamin D As An Adjunct Therapy For Eczema, Kimberly Hill
The Potential Of Vitamin D As An Adjunct Therapy For Eczema, Kimberly Hill
Graduate Research Projects
No abstract provided.
A Nurse-Driven Protocol To Increase Music Therapy Referrals To Manage Patient Pain And Anxiety In The Medicine Intensive Care Unit, Ashley Fox
DNP Projects
Background: Critically ill patients often suffer from pain and anxiety. Music therapy is a safe and effective treatment option. However, most nurses never receive education or training on it, resulting in a lack of awareness of its value and its actual usage in care.
Purpose: The purpose of this project was to increase the number of music therapy referrals to manage pain and anxiety in eligible medicine intensive care unit (MICU) patients via a music therapy protocol that increased nurses’ knowledge, attitudes, and skills related to the use of music as an alternative treatment option for pain and anxiety in …
Evaluating The Superiority Of Multimodal Analgesia Over Opioid-Based Analgesia In Postoperative Pain Management For Total Knee Arthroplasty: A Comprehensive Integrative Review, Janna Smith, Mahdi Mofazali, Nya-Qien Smith
Evaluating The Superiority Of Multimodal Analgesia Over Opioid-Based Analgesia In Postoperative Pain Management For Total Knee Arthroplasty: A Comprehensive Integrative Review, Janna Smith, Mahdi Mofazali, Nya-Qien Smith
Master's Projects
With total knee arthroplasty (TKA), postoperative pain management is so important for optimal recovery and patient outcomes. This integrative review evaluates the effectiveness of multimodal analgesia (MMA) compared to traditional opioid-based analgesia in reducing pain and opioid consumption post-TKA. Research shows that MMA is very effective at providing adequate pain relief, reducing side effects, and also decreasing opioid use. MMA also addresses both the specific needs of individual patients and the broader public health issue of opioid dependence. However, a significant barrier to widespread adoption is the absence of standardized protocols. This review sets forth the importance of coming up …
The Endocannabinoid System Signaling, A Precursor To Homeostasis: A Scoping Review, Madison Sikyta, Jeff G. Konin, Matthew Kutz
The Endocannabinoid System Signaling, A Precursor To Homeostasis: A Scoping Review, Madison Sikyta, Jeff G. Konin, Matthew Kutz
Internet Journal of Allied Health Sciences and Practice
The Endocannabinoid System is a physiological system in the body that includes several receptors and ligands. Due to its relatively recent discovery, there is a need for healthcare professionals to be formally educated on the function of this system in the body. The endocannabinoid system is seen as having an increased research interest since the early 1990s given its current status of uncertainty amongst many. The goal of this scoping review is to provide a synoptic analysis of how the Endocannabinoid System functions and integrates within and between different systematic relationships in the body.
Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West
Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West
Adultspan Journal
This qualitative study aimed to address the gap in the research related to end-of-life counseling by exploring the experiences of counselors working with clients at end of life. While counseling literature and education are lacking regarding end of life, many counselors will work alongside clients approaching death. The purpose of this study was twofold: (a) to better understand the nuanced experiences of counselors providing end-of-life counseling and (b) to explore the supports and preparations helpful for counselors to provide end-of-life counseling. A narrative approach, using the Listening Guide (Gilligan, 2015), was employed to analyze and present the stories of three …
Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego
Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego
Adultspan Journal
The onset of the COVID-19 pandemic set in motion a rapid expansion of mental health services offered via telehealth. With this rapid expansion came the need to examine how policy and practice should be shaped in a future where telehealth is considered common in counseling practice. For counselors to understand how to support older adult clients in using telehealth services, they must understand telehealth policy. Following the eligibility of licensed counselors to participate in Medicare, counselors need to stay abreast of regulatory changes regarding restrictions and regulations on use of telehealth for mental and behavioral health services, including video and …
Real-World Impact Of Acupuncture On Analgesics And Healthcare Resource Utilization In Breast Cancer Survivors With Pain, Dina Quan Ng, Sanghoon Lee, Richard T. Lee, Yun Wang, Alexandre Chan
Real-World Impact Of Acupuncture On Analgesics And Healthcare Resource Utilization In Breast Cancer Survivors With Pain, Dina Quan Ng, Sanghoon Lee, Richard T. Lee, Yun Wang, Alexandre Chan
Pharmacy Faculty Articles and Research
Background
This study evaluated the real-world impact of acupuncture on analgesics and healthcare resource utilization among breast cancer survivors.
Methods
From a United States (US) commercial claims database (25% random sample of IQVIA PharMetrics® Plus for Academics), we selected 18–63 years old malignant breast cancer survivors experiencing pain and ≥ 1 year removed from cancer diagnosis. Using the difference-in-difference technique, annualized changes in analgesics [prevalence, rates of short-term (< 30-day supply) and long-term (≥ 30-day supply) prescription fills] and healthcare resource utilization (healthcare costs, hospitalizations, and emergency department visits) were compared between acupuncture-treated and non-treated patients.
Results
Among 495 (3%) acupuncture-treated patients (median age: 55 years, stage 4: 12%, average 2.5 years post cancer diagnosis), most had commercial health insurance (92%) and experiencing musculoskeletal pain (98%). Twenty-seven …
What Are The Most Effective Non-Pharmacologic Practices For The Management Of Primary Insomnia In Adults?, Alexis Myhre
What Are The Most Effective Non-Pharmacologic Practices For The Management Of Primary Insomnia In Adults?, Alexis Myhre
Theses and Graduate Projects
Objective: Primary insomnia is a mental health condition in which individuals struggle with falling asleep, staying asleep or early morning awakenings. As there are many treatments available that claim to help those with primary insomnia, this review looks specifically at therapy, exercise and acupuncture as management strategies.
Methods: This is a review of 15 peer-reviewed, randomized controlled trials completed in 2018 or later with one additional study completed in 2010. Also, there are four non primary insomnia based studies used to support the efficacy of alternative therapies to cognitive behavioral therapy (CBT). All the studies used in this review come …
Cruising Speed: Our Journal's 10-Year Voyage, Dennis J. Baumgardner, Joe Grundle
Cruising Speed: Our Journal's 10-Year Voyage, Dennis J. Baumgardner, Joe Grundle
Journal of Patient-Centered Research and Reviews
In this invited editorial, two long-tenured editors for the Journal of Patient-Centered Research and Reviews recount the publication’s many impactful contributions to the medical literature over its first 10 years.
What Are The Lessons Learned From A Survivorship Trial During The Pandemic?, Alanna J. Horowitz, Sharneet J. Sandhu, Sherry J. Guo, Gabriel Barreto-D'Silva, Leonardo Barreto-D'Silva, Krishna Gunturu
What Are The Lessons Learned From A Survivorship Trial During The Pandemic?, Alanna J. Horowitz, Sharneet J. Sandhu, Sherry J. Guo, Gabriel Barreto-D'Silva, Leonardo Barreto-D'Silva, Krishna Gunturu
The Lahey Journal
Purpose: The American Cancer Society (ACS) has acknowledged the importance of maintaining a healthy diet and engaging in regular physical activity for cancer survivors. While studies have found that adherence to these guidelines improves long-term quality of life, several studies showed that up to 70% of cancer survivors do not meet the standards. The purpose of this pilot study is to determine the effectiveness of a multi-disciplinary survivorship clinic (MDSC) in helping patients adhere to the ACS survivorship guidelines and its impacts on quality of life (QOL).
Methods: Primary objective of the study is to encourage cancer patients to adhere …
Bowel Clean Out Prior To Intrathecal Baclofen Pump Implantation: Effects On Acute Post-Operative Gastrointestinal Complications, Amanda Lindenberg, Sathya Vadivelu, Brittni Walton, Matthew J. Mclaughlin
Bowel Clean Out Prior To Intrathecal Baclofen Pump Implantation: Effects On Acute Post-Operative Gastrointestinal Complications, Amanda Lindenberg, Sathya Vadivelu, Brittni Walton, Matthew J. Mclaughlin
Research Days
Background: Intrathecal baclofen (ITB) pumps have been used for management of spasticity and dystonia There is limited data on immediate post-operative complications such as GI adverse events after surgery for ITB pump related procedures. This study aimed to compare patients who underwent a pre-operative bowel cleanout to those who did not and the relationship with post-operative nausea, vomiting and constipation requiring an escalation of their bowel regimen.
Design: Retrospective cohort study.
Setting: Pediatric acute care hospital.
Participants: All patients who underwent new ITB pump and/or catheter placement from January 2015-December 2022.
Interventions: Preoperative bowel clean out. Main
Outcome Measure: Quantity …
Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou
Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou
Adultspan Journal
The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …
Between Nsaids, Local Anesthetics, And Non-Medicinal Analgesics, Which Method Is The Most Effective At Providing Pain Relief During Iud Insertions For Nulliparous And Multiparous Women?, Natali Sharma
Rowan-Virtua Research Day
Objective: One major barrier for usage of intrauterine devices (IUD) includes a widespread sense of fear regarding pain during insertion of this contraception. By researching the most effective IUD insertion analgesics available and standardizing these pain management methods, women may be less fearful of obtaining IUDs.
Methods: A comprehensive literature review was conducted using Scopus, PubMed, Web of Science, EMBASE and Cochrane Library to compare methods of pain relief during IUD insertions. Outcomes measured include the pain management method used, the dosage administered, the pain experienced by patients evaluated using a Visual Analog Scale (VAS) prior to insertion …
Interactive Distraction Techniques Versus Midazolam In Anxiolysis In Pediatric Patients: A Systematic Review And Meta-Analysis, Uzay Cagatay, Jon Elias, Alexander King
Interactive Distraction Techniques Versus Midazolam In Anxiolysis In Pediatric Patients: A Systematic Review And Meta-Analysis, Uzay Cagatay, Jon Elias, Alexander King
Rowan-Virtua Research Day
Background: Many pediatric patients experience high levels of anxiety prior to undergoing surgery. Midazolam is currently one of the most commonly used sedative drugs in the pediatric preoperative environment. A number of studies have evaluated the use of non-pharmacological methods of relaxing pediatric patients prior to surgery, known as ‘Interactive Distraction’. These techniques involve using various methods of distracting the child from the preoperative anesthetic procedures. Some examples of these methods involve giving the patient an iPad with which they can play video games. There have yet to be any systematic reviews comparing the usage of Midazolam alone against utilizing …
Can Nutritional Supplements Benefit Patients Receiving Treatment For Neurodegenerative Disorders?, Russell Levi, Saad Ahmed, Zachary Harris
Can Nutritional Supplements Benefit Patients Receiving Treatment For Neurodegenerative Disorders?, Russell Levi, Saad Ahmed, Zachary Harris
Rowan-Virtua Research Day
As the prevalence of neurocognitive disorders rises globally, developing new methodologies of prevention and treatment is crucial. This literature review examines the efficacy of adding nutritional supplements, specifically nootropics, with traditional pharmacological regimens on various neurocognitive and neurodegenerative disorders. Primary, peer-reviewed research, including both human and animal studies, was assesed to determine if there was a benefifical, minimal, or detrimental effect on symptom progression. The inclusion criteria focused on studies that evaluated the reduction in disease markers or symptoms following supplement use. The findings reveal that natural supplements generally support disease management. Significant improvements were noted with specific combinations like …
Nutrition And Exercise Resources For Uninsured Patient Populations, Sabrina Marie Paparo, Samantha Plasner, Runi Patel, Wendy Briaguez
Nutrition And Exercise Resources For Uninsured Patient Populations, Sabrina Marie Paparo, Samantha Plasner, Runi Patel, Wendy Briaguez
Rowan-Virtua Research Day
Proper nutrition and exercise is integral for the prevention and management of chronic diseases such as type two diabetes, hypertension, high cholesterol, and cardiovascular disease. However, health care disparities in the United States, such as lack of access to primary health care, has been an ever growing problem. The purpose of this study is to determine if there is a correlation between being uninsured and having worse health outcomes, and to determine if there is a need for accessible nutrition and/or exercise resources for this population. To conduct this research, a survey was distributed at the Cherry Hill Free Clinic …
Biopsychosocial Case Report, David F. Lo, Gaurav Kumar, Don D. Shamilov
Biopsychosocial Case Report, David F. Lo, Gaurav Kumar, Don D. Shamilov
Rowan-Virtua Research Day
Ms. R, a 32-year-old Hispanic female, suffers from severe anxiety exacerbated by a car accident and past struggles with depression and substance use. Evaluation reveals hypothyroidism, mild anemia, and GAD as the primary diagnosis. Factors contributing to her condition include genetic predispositions, medical issues, and social stressors. Treatment involves pharmacotherapy, psychotherapy, and monitoring her physiological health. Research on wearable data for GAD severity offers potential insights for her treatment. A holistic approach, considering biological, psychological, and social factors, guides her tailored treatment plan for overall well-being.
Brain Connectivity Pattern Changes Associated With Psychedelic-Assisted Psychotherapy, Prince Patel, Samrat Gollapudi, Brian Joseph Mathew, Bhaumik Patel
Brain Connectivity Pattern Changes Associated With Psychedelic-Assisted Psychotherapy, Prince Patel, Samrat Gollapudi, Brian Joseph Mathew, Bhaumik Patel
Rowan-Virtua Research Day
Psychedelic-assisted psychotherapy (PAP) has shown promising therapeutic benefits for various psychiatric disorders, but the underlying neural mechanisms remain unclear. This study aimed to investigate the effects of psychedelics on brain connectivity patterns using functional magnetic resonance imaging (fMRI). A comprehensive literature search was conducted in PubMed and Google Scholar databases using relevant keywords related to psychedelics, connectivity, therapy, and fMRI. Only studies involving major psychedelic compounds (LSD, psilocybin, ayahuasca) and measuring outcomes via fMRI were included.
The findings from the reviewed studies suggest that psychedelics induce acute disruptions in normal large-scale brain network patterns, leading to a compromised modular but …
Health Benefits Of Saccharomyces Boulardii As A Probiotic, Devashri Parikh, Maftuna Kurbonnazarova, Ravij Upadhyay, Andrea Iannuzzelli
Health Benefits Of Saccharomyces Boulardii As A Probiotic, Devashri Parikh, Maftuna Kurbonnazarova, Ravij Upadhyay, Andrea Iannuzzelli
Rowan-Virtua Research Day
Saccharomyces boulardii (SB), a budding yeast, within the Saccharomyces genus. It commonly used as a probiotic that has been isolated from lychee and mangosteen fruit. S. boulardii is not known to acquire resistant genes and does not last in the intestine after 3-5 days of discontinuing the ingestion. The clinical efficacy of this probiotic yeast is known to improve various diarrhea such as pediatric diarrhea, antibiotic-associated diarrhea, acute diarrhea, and traveler’s diarrhea. Additionally, when used as an adjuvant to treatment for Helicobacter pylori and Clostridium difficile infections, it improves bacterial eradication, prevents relapse, reduces adverse reactions and treatment-associated diarrhea.
Several …
The Correlation Of Consistent Exercise With Depressive Symptoms, John Gericke, Tara Pellegrino, Robert Steer
The Correlation Of Consistent Exercise With Depressive Symptoms, John Gericke, Tara Pellegrino, Robert Steer
Rowan-Virtua Research Day
Background: Depression is a major health issue that affects an estimated 350 million people worldwide. Typically, depression is associated with individuals who follow a poor diet and are physically inactive. Exercise is one form of treatment for depression and has been shown to reduce the risk of depression and protect against the onset of depression. The PHQ-9 Depression Score is a tool used to screen individuals for depression on a scale from 0-27. The goal of this study is to identify a relationship between consistent exercise and depression symptoms.
Methods: An original Qualtrics survey was created to be distributed with …
Efficacy Of Osteopathic Manipulative Medicine As A Non-Pharmacological Approach For Alleviating Pain And Muscle Stiffness In Patients With Multiple Sclerosis And A Comparison To Conventional Medical Interventions, Maduka Gunasinghe, Shannon Mckee
Efficacy Of Osteopathic Manipulative Medicine As A Non-Pharmacological Approach For Alleviating Pain And Muscle Stiffness In Patients With Multiple Sclerosis And A Comparison To Conventional Medical Interventions, Maduka Gunasinghe, Shannon Mckee
Rowan-Virtua Research Day
Multiple Sclerosis (MS) is a progressive neurological condition characterized by a range of debilitating symptoms, including muscle stiffness, fatigue, spasticity, tremors, and gait disturbance. Traditional treatments often face adherence challenges and escalating costs, prompting the exploration of alternative interventions like Osteopathic Manipulation Techniques (OMT). While the effectiveness of OMT in MS remains underexplored, initial studies suggest promising outcomes, such as improved mobility, reduced fatigue, and enhanced range of motion. Specifically, indirect OMT techniques like counterstain, myofascial release, and muscle energy techniques have shown efficacy in addressing muscle tension, spasticity, and gait abnormalities. Integrating OMT into MS management may offer a …
Health Disparities Among Adults With Disabilities, Kirsten Carlberg, Madison Plone, Chrismely Castro, Nayarith Lopez
Health Disparities Among Adults With Disabilities, Kirsten Carlberg, Madison Plone, Chrismely Castro, Nayarith Lopez
Rowan-Virtua Research Day
Background: According to the Centers for Disease Control (CDC), 27% of adults in the United States (US) live with a disability. These disabilities are often accompanied by poorer health outcomes with adults with disabilities reporting higher rates of obesity, diabetes, and cardiovascular disease. This review aims to characterize rates of disability among young adults in Camden County, New Jersey.
Methods: Data was collected from the CDC and United States Census and analyzed using Microsoft Excel 365.
Results: In 2022, 9.7% of residents of Camden County aged 18-34 were reported as disabled while the rate was 8.3% of US residents nationwide. …
Investigating The Therapeutic Potential Of Soursop In Treating Hematologic Malignancies, Sabrina Marie Paparo, Rebeca Mendoza, Robert Chitren, Omar Al-Odat, Emily Nelson, Subash Jonnalagadda, Roger Strair, Manoj Pandey
Investigating The Therapeutic Potential Of Soursop In Treating Hematologic Malignancies, Sabrina Marie Paparo, Rebeca Mendoza, Robert Chitren, Omar Al-Odat, Emily Nelson, Subash Jonnalagadda, Roger Strair, Manoj Pandey
Rowan-Virtua Research Day
Acute Myeloid Leukemia (AML) and Multiple Myeloma (MM) are hematologic malignancies that originate in the bone marrow and account for approximately 1.3% and 2% of cancer cases, respectively. AML is characterized by an accumulation of myeloblasts, or immature myeloid cells, that have the potential to spread to the peripheral blood. There is an uncontrolled proliferation of plasma cells in the bone marrow in MM. While the current treatment options for both AML and MM show promise in achieving initial remission, it is unfortunately common for patients to experience relapse and develop drug resistance. There is a theory that relapse and …
Fregoli Case Report, Don D. Shamilov, David F. Lo, Gaurav Kumar
Fregoli Case Report, Don D. Shamilov, David F. Lo, Gaurav Kumar
Rowan-Virtua Research Day
Fregoli Syndrome is a rare delusional disorder in the psychotic spectrum named after Italian actor Leopoldo Fregoli. Existing reports focus on clinical aspects and standard treatments, leaving gaps in understanding complexity and tailored interventions. This case report contributes comprehensive analysis of a young adult male with Fregoli syndrome and emphasizes interplay of psychopathology, neurocognition, and psychosocial factors. This report highlights a holistic approach, including differential diagnosis and psychosocial dynamics and aims to improve diagnostic considerations and personalized treatment strategies for better patient outcomes.
Spot The Signs - Comunicación Es Lo Más Importante, Daniel Rios, Victoria Wong Murray, Alexus Weatherspoon, Amy Palen, Kenneth W. Stagliano, Stephen M. Scheinthal
Spot The Signs - Comunicación Es Lo Más Importante, Daniel Rios, Victoria Wong Murray, Alexus Weatherspoon, Amy Palen, Kenneth W. Stagliano, Stephen M. Scheinthal
Rowan-Virtua Research Day
Opiate overdose is an unfortunately common risk factor for suicide; suicide attempts accounted for an estimated 30% of fatal opioid overdoses during the pandemic. As a result, the Rowan School of Osteopathic Medicine Department of Psychiatry developed an Integrated Mental Health Awareness and Suicide Prevention program targeted at members of the community and frontline workers to increase awareness and provide brief interventions, which demonstrated an improvement of 89% in our English-speaking attendees.
Spanish is the most common non-English language in New Jersey, with an estimated 1.3 million speakers. Hispanic patients also frequently experience culturally bound stigmas, so it is vital …