Public Health Commons^™

The Balm Framework Of Clinical Excellence: An Adoptable Model For Sub-Saharan Africa., Taoreed Adegoke Azeez

Digital Journal of Clinical Medicine

Clinical excellence is the ability to provide rigorous, evidence-based, and rewarding care to the right patients. The BALM (brilliance, attitude, leadership, and materials) framework is a novel model for adjudicating clinical excellence. There are a few models and frameworks for evaluating clinical excellence, but each has its flaws and does not consider the peculiarities of economically-challenged regions such as sub-Saharan Africa. Coincidentally, such low-resource areas have an urgent need for a framework to assess clinical excellence because of their low health-related indices. The five-step mode of professional excellence is a well-recognised tool and was the model upon which the BALM …

Alkaptonuria Presenting With Back Pain: A Diagnostic Dilemma, Arnav Salar, Dyuksha Arora, Mahabaleshwar Mamadapur

Digital Journal of Clinical Medicine

Alkaptonuria is a rare inborn error of metabolism due to a deficiency of homogentisate 1,2 dioxygenase, resulting in homogentisic acid accumulation in tissues. It is characterised by homogentisic aciduria, ochronosis, and arthritis. We hereby discuss a 46-year-old male who presented with progressive lower back pain and polyarthralgia for ten years, initially diagnosed as ankylosing spondylitis. Characteristic skin pigmentation, ochronosis, and radiological findings led to the correct diagnosis of alkaptonuria. This case highlights the importance of considering alkaptonuria as a differential diagnosis for chronic back pain and arthritis, mainly when sacroiliac joints are spared, and ochronosis is present. While no cure …

Psychiatric Morbidity In Perinatal Women And Its Outcome In A Tertiary Care Hospital, Lakshmi Velayudam, Prathap Talwar, Kishor M, Harshitha Padmanabha

Digital Journal of Clinical Medicine

Background: Pregnancy and postpartum are a period of vulnerability in a women’s life for developing mental health problems. Perinatal psychiatric illness has various adverse outcome on maternal, neonatal and child health.

Objective: To study the prevalence of psychiatric disorders and its outcome among women in the perinatal period.

Method: It is a prospective study conducted at a tertiary care hospital where antenatal and postnatal women were screened for psychiatric disorder using patient health questionnaire-9 (PHQ-9) and Edinburgh Post Natal Depression Scale (EPDS) respectively. Total of 140 women diagnosed with psychiatric disorder were followed up for a year and outcome …

Exploring The Elective Experience: A Review Of The "Adult Psychiatry" Elective At A Medical College, Dyuksha Arora, Kishor M

Digital Journal of Clinical Medicine

This review delves into the motivations, experiences, and perceived advantages and disadvantages of undertaking the 'Adult Psychiatry' as an elective at JSS Medical College. Experiences from four students, two from the 2019 batch and two from the 2020 batch, provide a comprehensive overview of their elective.

Clozapine And Modified Electroconvulsive Therapy (M-Ect) In Treatment Resistant Schizophrenia (Trs) – A Case Report, Kareena Arora, Kishor M, Murali M R, Suhas K Mr

Digital Journal of Clinical Medicine

Schizophrenia is psychiatric disorder affecting less than 1% of population that can be devastating, characterized by positive, negative and cognitive symptoms. This can lead to significant functional impairment. Despite intensive and ongoing research, outcomes from best-practice treatment are often suboptimal. Unfortunately, not all the patients respond to antipsychotic medications. Overall estimates suggest that one-fifth to one-half of patients have treatment resistant schizophrenia (TRS).

TRS include failure sequential trial of two different antipsychotics with sufficient dose, duration and adherence as a minimum criterion. TRS represents major clinical challenge.

Clozapine is the only drug approved for TRS as it is the drug …

Internet Gaming Disorders Amongst Medical Undergraduates In Tamil Nadu, India - A Cross Sectional Study, Rejee Sneha Ebanezer, Sumedha K, Murugan V

Digital Journal of Clinical Medicine

Abstract

Background: Internet Gaming Disorder (IGD) or internet-related gaming addictions are characterized by severely impaired control over gaming affecting routine activities, followed by several psychological, physical and social issues. Budding medical undergraduates who are future health professionals might have positive effects on their studies and career goals when saved from internet gaming addictions. Hence, this study aimed to identify the proportion of medical undergraduate students and interns with internet gaming disorders studying in a private medical college and tertiary care hospital.

Setting: A tertiary care Hospital and Medical College, Tamil Nadu, India

Study design: Cross – sectional study.

Participants: Medical …

High Stakes And Hidden Risks: A Case Series On Pathological Gambling In Context With Affective Disorders And Substance Abuse, Avni Gupta, Namita Deka, Mahesh Kumar

Digital Journal of Clinical Medicine

Background: Pathological gambling is a non–substance-related addictive disorder, characterized by persistent preoccupation with gambling, impaired control, and continuation despite negative consequences. It is associated with financial losses, social and occupational dysfunction, and psychiatric comorbidities, including affective and substance use disorders. Although international prevalence estimates range from 1–2%, research in India remains limited, particularly with the rise of online gambling.

Methods: We report a case series of three individuals presenting to a tertiary-care psychiatry outpatient department with pathological gambling. Clinical assessments included detailed psychiatric evaluation, mental status examination, and psychometric assessments using the Hamilton Anxiety Rating Scale (HAM-A), Beck Depression Inventory …

A Comparative Study Of Venezuelan Immigrants’ Pre- And Post-Migration Concerns For Their Children In The United States And Colombia, Aigerim Alpysbekova, Pablo Montero-Zamora, Mary H Soares, Carolina Scaramutti, Sumeyra Sahbaz, Maria Duque, Tara Bautista, Maria Fernanda Garcia, Christopher P Salas-Wright, Mildred M Maldonado-Molina, Melissa M Bates, Augusto Pérez-Gómez, Juliana Mejía Trujillo, Eric C Brown, Seth J Schwartz

Faculty, Staff and Student Publications

Research suggests that forced migration may lead to cultural stress and psychological distress. However, little is known about immigrant parents' pre- and post-migration concerns for their children's welfare. The present study examined the concerns of Venezuelan parents who migrated to the United States versus those who migrated to Colombia, and whether post-migration concerns were related to cultural stressors, mental health, and cultural identity. A sample of 609 Venezuelan immigrants completed surveys and responded to an open-ended prompt asking about pre- and post-migration concerns for children's welfare. Lack of safety was the most common pre-migration concern for Venezuelans in the U.S., …

Like, Comment, Subscribe, And Share: An Investigation Of Emerging Adults’ Lived Experiences Of Relationship Information On Social Media, Marquitta Fields

Antioch University Dissertations & Theses

This qualitative study explores how emerging adults engage with relationship education content on social media platforms and the implications for promoting accessible myself in the personal lived experiences of participants while removing listener preconceptions, identifying psychological structures that explain their interactions with relationship content. The findings reveal that emerging adults use a variety of social media platforms, including Instagram, TikTok, Reddit, Facebook, Pinterest, and YouTube, to consume relationship information. Participants prioritize content that is authentic, relatable, and derived from personal experiences over generic or impersonal advice. They value content that encourages healthy communication, self-reflection, and personal growth. The study also …

Prevalence And Patterns Of Cardiovascular Risk Factors In Young Hypertensive Patients, *Raghu V S R Tanuku Dr., Major Venkata Shree Krishna Dr., Sreedhar Tanuku Dr

Digital Journal of Clinical Medicine

Hypertension ranks among the top ten causes of mortality, with around 4% attributed to hypertensive complications. High salt intake, Type 2 diabetes, smoking, elevated serum lipids, a sedentary lifestyle, a diet heavy in saturated fat, genetic predisposition, as well as stress are among the factors that contribute to hypertension. Hypertension affects about 1 billion people worldwide, with considerable differences between populations and ethnic groups [2]. The Framingham Heart Study indicates that a person's lifetime risk of developing hypertension is 90% if they are normotensive at age 55. According to the NHANES IV (4th National Health and Nutrition Examination Survey), the …

– Foreign Body Ingestion In Children(<12 Years) At A Tertiary Care Hospital: A Retrospective Cohort Study Studying Role Of Socioeconomic Status And Parental Supervision., Khyati Gupta, Gargi Rekhawar, Anisha Jain, Vishal D. Sawant, Sushma Save

Digital Journal of Clinical Medicine

Background- Foreign body ingestion is a long-standing problem concerning pediatric population. We aim to evaluate the correlation between the median time interval between ingestion of foreign body and arrival to the hospital with socioeconomic factors, effect of parental supervision and number of children in the family. We also aim to find out the deciding factors for proper selection of method of removal of ingested foreign bodies.

Methods- The data was collected from patient’s admission files, medical and endoscopic records. Chi-square test was used to calculate the corelation of time since ingestion with the socioeconomic status of family, method of removal …

Assessing Discharge Knowledge For Caregivers Of Newborn (Using Video Discharge Instructions As An Adjunct To Standard Written Instructions) In Covid Period – A Randomized Controlled Trial, Jayesh Yadav, Khyati Gupta, Vishal D. Sawant

Digital Journal of Clinical Medicine

Background: Studies have demonstrated that caregivers of newborn frequently face challenges in comprehending the instructions provided to them upon discharge. Video discharge instructions provide a clear and concise message and can potentially alleviate factors which have an impact on comprehension of caregivers like illiteracy, communication barriers and limited physician time. We aim to assess the impact of incorporating video-based discharge instructions on caregivers' comprehension of newborn care and post-discharge follow-up, specifically in the context of the COVID-19 pandemic.

Methods: Caregivers of newborn in the COVID times were randomized into written only and written with video discharge instruction groups; …

Comparison Of Empathy And Compassion Fatigue Among Mental Health And Non-Mental Health Professionals: A Cross-Sectional Study, Fathima Fiza K T, Anil Kakunje, Ashwini Dinkar

Digital Journal of Clinical Medicine

Background:

Empathy refers to the ability to understand and comprehend others' thoughts and emotions as if it's their own, evoked by witnessing and connecting to the other person’s emotional state. Compassion fatigue, a consequence of an empathetic reaction, is the mental and physical tiredness resulting from being a witness to the suffering of others. It can result in negative consequences ultimately affecting the quality of treatment. The purpose of the study was to compare the level of empathy and compassion fatigue among mental health, and non-mental health professionals.

Methods

A comparative cross-sectional study was conducted over one year using 88 …

A Previous Thyroidectomy- The Culprit Of Laryngospasm Several Years On!, Vyshnavi Sriram, Ashwini N, Chillara Meena

Digital Journal of Clinical Medicine

Laryngospasm is the sustained closure of the vocal cords resulting in partial or complete loss of airway patency. Among the several causes of laryngospasm, history of total thyroidectomy performed several years back, though reported, is a rare occurrence. We present here the case report of a lady with an uneventful intra operative course of a laparoscopic cholecystectomy who developed stridor and laryngospasm in the immediate post operative period. Evaluation revealed unilateral vocal cord palsy and hypocalcemia. Compensated unilateral recurrent laryngeal nerve palsy and asymptomatic hypocalcemia can exist in patients who have undergone total thyroidectomy and can result in stridor several …

Implementation Framework For Income Generating Activities Identified By Community Health Volunteers (Chvs): A Strategy To Reduce Attrition Rate In Kilifi County, Kenya., Roselyter Riang’A, Njeri Nyanja, Adelaide Lusambili, Eunice Muthoni, Cyprian Mostert, Anthony Ngugi, Joshua Ehrlich, Paul Clyde

Population Health, East Africa

Background; Despite the proven efficacy of Community Health Volunteers (CHVs) in promoting primary healthcare in low- and middle-income countries (LMICs), they are not adequately fnanced and compensated. The latter contributes to the challenge of high attrition rates observed in many settings, highlighting an urgent need for innovative compensation strategies for CHVs amid budget constraints experienced by healthcare systems. This study sought to identify strategies for implementing Income-Generating Activities (IGAs) for CHVs in Kilif County in Kenya to improve their livelihoods, increase motivation, and reduce attrition.

Methods; An exploratory qualitative research study design was used, which consisted of Focus group discussions …

The Uprmt Preserves Mitochondrial Import To Extend Lifespan, Jolaade Kalinowski, Elizabeth A Hintz, Chigozirim Izeogu

Faculty, Staff and Student Publications

The SARS-CoV-2 (COVID-19) pandemic introduced many challenges and nuances that have transformed medical practice and research. The uncertainty caused by COVID-19 led to inevitable challenges to patient-provider relationships. The ever-changing landscape of COVID-19 research and policy proved to be challenging for the medical community and patients. These challenges also exacerbated long-standing issues regarding patient-provider communication and trust. On the other hand, these challenges gave voice to a burgeoning patient advocacy community. Through social media, advocacy and patient organizing, patients harnessed their power and organized over challenges relating to COVID-19 fears and concerns, ramifications of "Long COVID," and much more. During …

"Why Does This Have To Be So Hard?": Perinatal Experiences From An Ecological Systems Approach, Caitlin Senk

Antioch University Dissertations & Theses

This study examines the lived experience of the perinatal population to understand how they can be supported from the lens of different ecological systems and what counselors can do to better serve people with uteruses during their perinatal experience. Furthermore, this study aims to utilize an inclusive framework for capturing the perinatal experience of people with uteruses and to explore barriers and facilitators to care through an ecological systems framework. Fifteen participants who have experienced infertility, conception, pregnancy, miscarriage, childbirth, stillbirth, and postpartum were recruited through various means throughout the United States. Thematic analysis was used, with semi-structured interviews and …

Fitness Consequences Of Depressive Symptoms Vary Between Generations: Evidence From A Large Cohort Of Women Across The 20th Century, Christopher I Gurguis, Renée A Duckworth, Nicole M Bucaro, Consuelo Walss-Bass

Faculty, Staff and Student Publications

Depression has strong negative impacts on how individuals function, leading to the assumption that there is strong negative selection on this trait that should deplete genetic variation and decrease its prevalence in human populations. Yet, depressive symptoms remain common. While there has been a large body of work trying to resolve this paradox by mapping genetic variation of this complex trait, there have been few direct empirical tests of the core assumption that there is consistent negative selection on depression in human populations. Here, we use a unique long-term dataset from the National Health and Nutrition Examination Survey that spans …

Stroke Survivors’ Telemedicine Experiences During The Covid-19 Pandemic: A Phenomenological Investigation, Barbara Kimmel, Annette Walder, Anette Ovalle, Chethan P Venkatasubba Rao, Sean I Savitz, Mark Goldberg, Steven Warach, Salvador Cruz-Flores, Daiwai M Olson, Jane A Anderson

Faculty, Staff and Student Publications

PURPOSE: This study aimed to describe stroke survivors' experiences receiving telemedicine visits at the Lone Star Stroke Consortium during the COVID-19 pandemic.

MATERIALS AND METHODS: A qualitative descriptive phenomenological design was applied to gather patients' telemedicine experiences through in-depth interviews, using a study guide. Audio-recorded interviews were conducted via ZOOM and transcribed verbatim. Two independent reviewers used the Giorgi descriptive method to analyze the data and search for the essence of stroke survivors' follow-up telemedicine experiences during the COVID-19 pandemic.

RESULTS: Fifteen underserved patients were recruited: mean age, 51.8 (15.7), and 9 (60%) females. Three themes emerged: (1) vivid memory …

Association Of Circulating Ketone Bodies With Cognitive Performance And Dementia In The Multi-Ethnic Study Of Atherosclerosis (Mesa), Parag Anilkumar Chevli, Christopher L Schaich, Alexis C Wood, Luqman A Tk, Anurag Mehta, Vardhmaan Jain, Margery Connelly, Suzanne Craft, Elad Shemesh, José A Luchsinger, Kathleen M Hayden, Bonnie Colleen Sachs, Timothy M Hughes, Michael D Shapiro

Faculty, Staff and Students Publications

Introduction

Growing interest centers on the association between circulating ketone bodies (KB) and cognitive function, notably in aging and neurodegenerative diseases.

Methods

Associations of plasma KB with incident dementia and cognitive performances were examined among Multi‐Ethnic Study of Atherosclerosis (MESA) participants. KB were measured using plasma samples collected following an overnight fasting at Exam 1 (2000–02) and detailed cognitive testing at Exam 5 (2010–2012, N = 4392), Exam 6 (2016–2018, N = 1838), and in MESA‐MIND (2019–2021, N = 2060).

Results

Over 16.7 years, a doubling of total KB was associated with a greater risk of incident dementia (hazard ratio …

An Appalachian Perspective On Suicide: A Focus On West Virginia’S Unique Context, Erin Delaney Caswell

Graduate Theses, Dissertations, and Problem Reports (ETD)

INTRODUCTION: The Appalachian region, spanning 13 states from New York to northern Mississippi, experiences the suicide rates in the United States (U.S.), underscoring a public health crisis exacerbated by persistent socioeconomic challenges. West Virginia (WV), the only state entirely within Appalachia, serves as a focal point for understanding the broader suicide crisis in the region, as WV has the highest suicide rates in the region. Moreover, the state has several unique socioeconomic factors, like increased poverty, lower educational attainment, limited access to healthcare, and a high prevalence of chronic pain and substance that may contribute to elevated rates of suicide. …

Overcoming The Unseen: Understanding Diverse Canadian Workers’ Well-Being During The Beginning Of The Coronavirus Pandemic, Tyler M. Pacheco

Theses and Dissertations (Comprehensive)

Canadian workers were severely affected by the onset of the coronavirus (COVID-19) pandemic. The rapid spread of the pathogen across Canada resulted in several work-related consequences (e.g., temporary/indefinite layoffs and business closures, mandatory working-from-home) that could have impacted workers’ well-being during this turbulent period. Research available at the start of this dissertation process, and even more recently published studies, primarily explored general trends in workers’ negative well-being during COVID-19, not examining the distinct realities that diverse workers, including more marginalized ones, may have experienced. Across three manuscripts, several theories from diverse disciplines (positive, developmental, community, and industrial-organizational psychology, public health) …

Body-Map Storytelling: A Qualitative Exploration Of The Lived Experiences Of Hospital Care Amongst Street Involved Youth, Chelsey Fedchenko

Theses and Dissertations (Comprehensive)

This social work study explores the experiences of hospital care amongst street-involved (SI) youth. Given that SI youth are at a higher risk for health-related harms and experience significant barriers to health care services, they are at an increased likelihood of hospitalization. Yet, inadequate health care support for SI youth remains a critical problem in Canada. While hospital care amongst adult homeless populations has been well studied interdisciplinary, there is a scarcity of research investigating the hospital care experiences amongst SI youth. The aim of this qualitative, arts-based study was to explore how street-life contributes to hospitalization, how SI youth …

Critical Dialogue And Capacity-Building Projects Reduced Alcohol And Substance Use In A Randomized Clinical Trial Among Formerly Incarcerated Men, Liliane Cambraia Windsor, Ellen Benoit, Carol Lee, Alexis Jemal, Kari Kugler, Douglas C Smith, Rogério M Pinto, Salma Musaad

Faculty, Staff and Students Publications

Background:

Rates of alcohol and/or substance use (ASU) among residents of predominantly Black and marginalized communities are similar to ASU rates in White communities. Yet ASU has worse consequences in predominantly Black and marginalized communities (e.g., higher incarceration).

Objective:

We randomized participants to one of 16 intervention conditions using a 2⁴ full factorial design to optimize a multilevel intervention reducing ASU among 602 formerly incarcerated men with substance-use-disorders (SUD). Candidate intervention components included (1) critical dialogue (CD; six weekly 2-hour-long group sessions vs. no CD sessions), (2) Quality of Life Wheel (QLW; six weekly 1-hour-long group sessions vs. no …

High-Risk Individuals And Naloxone Use: Implications For Thn Programs In Rural Appalachian Communities, Victor Garcia, Lisa Mccann, Erick Lauber, Christian Vaccaro, Melissa Swauger, Alex Daniel Heckert

Journal of Appalachian Health

Introduction: Take-home naloxone (THN) is being made available across rural Appalachia to curb opioid overdose fatalities. Despite this initiative, some opioid users do not possess naloxone, and if they do, do not administer it to others.

Purpose: Research findings on risk factors that contribute to opioid overdose are presented. These factors, identified in a sample of 16 overdose cases, are (1) early onset age of opioid use; (2) progressive opioid use; (3) a transition from pain medication to heroin and fentanyl; (4) fears of being arrested at a naloxone intervention if first responders are contacted, and (5) limited knowledge of …

Reducing Food Scarcity: The Benefits Of Urban Farming, S.A. Claudell, Emilio Mejia

Journal of Nonprofit Innovation

Urban farming can enhance the lives of communities and help reduce food scarcity. This paper presents a conceptual prototype of an efficient urban farming community that can be scaled for a single apartment building or an entire community across all global geoeconomics regions, including densely populated cities and rural, developing towns and communities. When deployed in coordination with smart crop choices, local farm support, and efficient transportation then the result isn’t just sustainability, but also increasing fresh produce accessibility, optimizing nutritional value, eliminating the use of ‘forever chemicals’, reducing transportation costs, and fostering global environmental benefits.

Imagine Doris, who is …

Para-Infectious Brain Injury In Covid-19 Persists At Follow-Up Despite Attenuated Cytokine And Autoantibody Responses, Benedict D Michael, Cordelia Dunai, Edward J Needham, Kukatharmini Tharmaratnam, Robyn Williams, Yun Huang, Sarah A Boardman, Jordan J Clark, Parul Sharma, Krishanthi Subramaniam, Greta K Wood, Ceryce Collie, Richard Digby, Alexander Ren, Emma Norton, Maya Leibowitz, Soraya Ebrahimi, Andrew Fower, Hannah Fox, Esteban Tato, Mark A Ellul, Geraint Sunderland, Marie Held, Claire Hetherington, Franklyn N Egbe, Alish Palmos, Kathy Stirrups, Alexander Grundmann, Anne-Cecile Chiollaz, Jean-Charles Sanchez, James P Stewart, Michael Griffiths, Tom Solomon, Gerome Breen, Alasdair J Coles, Nathalie Kingston, John R Bradley, Patrick F Chinnery, Jonathan Cavanagh, Sarosh R Irani, Angela Vincent, J Kenneth Baillie, Peter J Openshaw, Malcolm G Semple, Covid-Cns Consortium, Isaric4c Investigators, Leonie S Taams, David K Menon

Faculty, Staff and Student Publications

To understand neurological complications of COVID-19 better both acutely and for recovery, we measured markers of brain injury, inflammatory mediators, and autoantibodies in 203 hospitalised participants; 111 with acute sera (1-11 days post-admission) and 92 convalescent sera (56 with COVID-19-associated neurological diagnoses). Here we show that compared to 60 uninfected controls, tTau, GFAP, NfL, and UCH-L1 are increased with COVID-19 infection at acute timepoints and NfL and GFAP are significantly higher in participants with neurological complications. Inflammatory mediators (IL-6, IL-12p40, HGF, M-CSF, CCL2, and IL-1RA) are associated with both altered consciousness and markers of brain injury. Autoantibodies are more common …

Navigating Transitions: Cranialsacral Therapy, Occupational Therapy And Neuroregulation Strategies For Adjusting To A New Home, Carol J. Reshan

Journal of Transformative Touch

Report of working with a hyper-vigilant 9-year-old male with difficulty handling a transition to a new home. CST and sensory processing enhancement were utilized to help develop neuroregulation, enabling self-awareness, self-regulation, and personally directed life skills for maintaining a safe and alert state.

Policy Review And Recommendation For Secondary Education Np-Led Clinics In The Southeastern United States, Shiney Alex Jacob

Student Scholarly Projects

Secondary-level education involves adolescent children aged 11-12 years to 18-19 with unique healthcare needs. Their healthcare is of significant importance as they are transitioning to adulthood, and a majority of them lack access to primary healthcare needs. Advanced Practice Registered Nurses/Nurse Practitioners (APRNs/NPs) provide high-quality, cost-effective, and evidence-based care to people across the lifespan, and there is minimal utilization of their services in meeting the primary care needs of adolescents at the secondary school level. The purpose of the policy project was to determine if current policies and practices related to school health services in three southeastern states of the …

Identifying Locations Of Drug Overdose In Las Vegas To Implement The Cardiff Violence Prevention Model, John Girard, Shikha Pandey, Zack Bunn, Chris Papesh, Jacquelyn Cheun Phd, Ying Zhang

SMU Data Science Review

This paper will provide an innovative approach to drug overdose prevention programs. Using data from Las Vegas emergency departments, this paper will analyze geospatial trends of drug overdoses. Leveraging the Cardiff Violence Prevention Model, the information is shared with local law enforcement agencies and decision makers to empower them to make evidence-based strategies. This paper highlights the efficacy of a data-driven model in addressing public health issues and underscoring its ability for even broader implementation in urban settings. Findings will suggest significant implications for policymaking, crime prevention, and public health initiatives, demonstrating a step towards a safer Las Vegas.