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Ryus CR, Yang D, Brackett A, Barnett L, Boatright D. Examining trends in emergency medicine journals' publications about racism. Acad Emerg Med 2024; 31:339-345. [PMID: 38097532 DOI: 10.1111/acem.14852] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 03/12/2024]
Abstract
OBJECTIVE In recent years, the academic medicine community has produced numerous statements and calls to action condemning racism. Though health equity work examining health disparities has expanded, few studies specifically name racism as an operational construct. As emergency departments serve a high proportion of patients with social and economic disadvantage rooted in structural racism, it is critically important that racism be a focus of our academic discourse. This study examines the frequency at which four prominent emergency medicine journals, Annals of Emergency Medicine, Academic Emergency Medicine, the American Journal of Emergency Medicine, and the Western Journal of Emergency Medicine, publish on health disparities and racism. METHODS This is a descriptive analysis measuring the frequency of publications on health disparities and racism in U.S.-based emergency medicine journals from 2014 to 2021. The search strategies for the concepts of "racism" and "health disparities" used a combination of MeSH and keywords. These search strategies were developed based on prior literature and the MEDLINE/PubMed Health Disparities and Minority Health Search Strategy. Articles identified through the PubMed search were then reviewed by two authors for final inclusion. RESULTS Since 2014, a total of 6248 articles were published by the four emergency medicine journals over the 8-year study period. Of those, 82 research papers that focused on health disparities were identified and only 16 that focused on racism. Most emergency medicine publications on racism and health disparities were in 2021. CONCLUSIONS Our findings suggest that the national discourse on racism and calls to action within emergency medicine were followed by an increase in publications on health disparities and racism. Continued investigation is needed to evaluate these trends moving forward.
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Affiliation(s)
- Caitlin R Ryus
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - David Yang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alexandria Brackett
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lindsay Barnett
- Yale University Library, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dowin Boatright
- Ronald O. Perelman Department of Emergency Medicine, New York University, New York, New York, USA
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Veverka MC, Ryus CR, Gerardo CJ, Bernstein SL, Limkakeng AJ. Fixing the leaky physician-scientist pipeline: Integrated-dedicated research period programs in emergency medicine. AEM Educ Train 2023; 7:e10919. [PMID: 38037629 PMCID: PMC10685392 DOI: 10.1002/aet2.10919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 12/02/2023]
Abstract
Emergency physicians (EPs) are well positioned to perform medical research. EPs are exposed to a wide range of disease types, medical specialties, and treatment modalities. Furthermore, emergency medicine (EM) serves as the safety net for the U.S. health care system. The diverse exposure provides a vast opportunity for EP to perform many worthwhile research projects. Yet, EM has historically had the lowest amount of funding and a lower number of National Institutes of Health-funded research projects. Many suggest the etiology is a "leaky" educational pipeline with loss of many potential physician-scientists over the training and development course. Current research training options for the EM physician-scientist includes MD-PhD, 4-year EM residency program and postresidency fellowships. While each has its advantages and disadvantages, we describe an additional educational alternative of EM physician-scientists, which we have named the integrated-dedicated research period within an EM residency. We describe the features of these programs and preliminary results from the graduates and current trainees.
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Affiliation(s)
| | | | | | - Steven L. Bernstein
- Yale University School of MedicineNew HavenConnecticutUSA
- Dartmouth School of MedicineHanoverNew HampshireUSA
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Yang D, Panthagani K, Ryus CR, Nelson AR, Wright D, Sherak R, Bernstein SL, D'Onofrio G. Yale Emergency Scholars (YES) Program: A model for expanding emergency medicine research capacity. Acad Emerg Med 2023; 30:1179-1182. [PMID: 37436420 DOI: 10.1111/acem.14777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/19/2023] [Accepted: 07/08/2023] [Indexed: 07/13/2023]
Affiliation(s)
- David Yang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kristen Panthagani
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Caitlin R Ryus
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alexander R Nelson
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Donald Wright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Raphael Sherak
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Steven L Bernstein
- Department of Emergency Medicine, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Ryus CR, Janke AT, Kunnath N, Ibrahim AM, Rollings KA. Association of Hospital Discharge Against Medical Advice and Coded Housing Instability in the US. J Gen Intern Med 2023; 38:3082-3085. [PMID: 37369893 PMCID: PMC10593638 DOI: 10.1007/s11606-023-08240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/11/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Caitlin R Ryus
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Alexander T Janke
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy/Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Kunnath
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Andrew M Ibrahim
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
- Taubman College of Architecture & Urban Planning, University of Michigan, Ann Arbor, MI, USA
| | - Kimberly A Rollings
- Health & Design Research Fellowship Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Salhi RA, Macias-Konstantopoulos WL, Ryus CR. From the Editors - Future Directions to Strengthen the Emergency Department Safety Net. West J Emerg Med 2023; 24:919-920. [PMID: 37788032 PMCID: PMC10527835 DOI: 10.5811/westjem.60719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 10/04/2023] Open
Affiliation(s)
- Rama A Salhi
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts,
| | | | - Caitlin R Ryus
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
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Ryus CR, Janke AT, Granovsky RL, Granovsky MA. A National Snapshot of Social Determinants of Health Documentation in Emergency Departments. West J Emerg Med 2023; 24:680-684. [PMID: 37527393 PMCID: PMC10393461 DOI: 10.5811/westjem.58149] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Documentation and measurement of social determinants of health (SDoH) are critical to clinical care and to healthcare delivery system reforms targeting health equity. The SDoH are codified in the International Classification of Disease 10th Rev (ICD-10) Z codes. However, Z codes are listed in only 1-2% of inpatient charts. Little is known about the frequency of Z code utilization specifically among emergency department (ED) patient populations nationally. METHODS This was a repeated cross-sectional analysis of ED visit data in the United States from the Nationwide Emergency Department Sample from 2016-2019. We characterized the use of Z codes and described associations between Z code use and patient- and hospital-level factors including the following: age; gender; race; insurance status; ED disposition; ED size; hospital urban-rural status; ownership; and clinical conditions. We calculated unadjusted odds ratios for likelihood of Z code reporting for each ED visit. RESULTS Of approximately 140 million ED visits per year, 0.65% had an associated Z code in 2016, rising to 1.17% by 2019. Visits were more likely to have an associated Z code for adults age <65, male, Black, Medicaid or self-pay patients, and patients admitted to the hospital. Larger EDs, those in metropolitan areas, academic centers, and government-run hospitals were more likely to report Z codes. The most commonly associated clinical conditions were as follows: schizophrenia spectrum and other psychotic disorders; depressive disorder; and alcohol-related disorders. CONCLUSION There is a paucity of Z code documentation in the health records of ED patients, although use is uptrending. Further research is warranted to better understand the drivers of clinicians' use of Z codes and to improve on their utility.
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Affiliation(s)
- Caitlin R. Ryus
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Alexander T. Janke
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy/Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Rachel L. Granovsky
- University of California San Francisco, Institute for Health and Aging, San Francisco, California
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Rollings KA, Kunnath N, Ryus CR, Janke AT, Ibrahim AM. Association of Coded Housing Instability and Hospitalization in the US. JAMA Netw Open 2022; 5:e2241951. [PMID: 36374498 PMCID: PMC9664259 DOI: 10.1001/jamanetworkopen.2022.41951] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Housing instability and other social determinants of health are increasingly being documented by clinicians. The most common reasons for hospitalization among patients with coded housing instability, however, are not well understood. OBJECTIVE To compare the most common reasons for hospitalization among patients with and without coded housing instability. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, retrospective study identified hospitalizations of patients between age 18 and 99 years using the 2017 to 2019 National Inpatient Sample. Data were analyzed from May to September 2022. EXPOSURES Housing instability was operationalized using 5 International Classification of Diseases, 10th Revision, Social Determinants of Health Z-Codes addressing problems related to housing: homelessness; inadequate housing; discord with neighbors, lodgers, and landlords; residential institution problems; and other related problems. MAIN OUTCOMES AND MEASURES The primary outcome of interest was reason for inpatient admission. Bivariate comparisons of patient characteristics, primary diagnoses, length of stay, and hospitalization costs among patients with and without coded housing instability were performed. RESULTS Among the 87 348 604 hospitalizations analyzed, the mean (SD) age was 58 (20) years and patients were more likely to be women (50 174 117 [57.4%]) and White (58 763 014 [67.3%]). Housing instability was coded for 945 090 hospitalizations. Hospitalized patients with housing instability, compared with those without instability, were more likely to be men (668 255 patients with coded instability [70.7%] vs 36 506 229 patients without [42.3%]; P < .001), younger (mean [SD] age 45.5 [14.0] vs 58.4 [20.2] years), Black (235 355 patients [24.9%] vs 12 929 158 patients [15.0%]), Medicaid beneficiaries (521 555 patients [55.2%] vs 15 541 175 patients [18.0%]), uninsured (117 375 patients [12.4%] vs 3 476 841 patients [4.0%]), and discharged against medical advice (28 890 patients [8.4%] vs 451 855 patients [1.6%]). The most common reason for hospitalization among patients with coded housing instability was mental, behavioral, and neurodevelopmental disorders (475 575 patients [50.3%]), which cost a total of $3.5 billion. Other common reasons included injury (69 270 patients [7.3%]) and circulatory system diseases (64 700 patients [6.8%]). Coded housing instability was also significantly associated with longer mean (SD) hospital stays (6.7 [.06] vs 4.8 [.01] days) and a cost of $9.3 billion. Hospitalized patients with housing instability had 18.6 times greater odds of having a primary diagnosis of mental, behavioral, and neurodevelopmental disorders (475 575 patients [50.3%] vs 4 470 675 patients [5.2%]; odds ratio, 18.56; 95% CI, 17.86 to 19.29). CONCLUSIONS AND RELEVANCE In this cross-sectional study, hospitalizations among patients with coded housing instability had higher admission rates for mental, behavioral, and neurodevelopmental disorders, longer stays, and increased costs. Findings suggest that efforts to improve housing instability, mental and behavioral health, and inpatient hospital utilization across multiple sectors may find areas for synergistic collaboration.
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Affiliation(s)
- Kimberly A. Rollings
- Health and Design Research Fellowship Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Nicholas Kunnath
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Caitlin R. Ryus
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Alexander T. Janke
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy/Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Andrew M. Ibrahim
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor
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Abstract
IMPORTANCE The perspectives of gay, lesbian, bisexual (sexual minority [SM]) students about their medical school learning environment and how they relate to burnout is poorly understood. OBJECTIVE To understand SM medical students' perceptions of the medical school learning environment and how this is associated with reported burnout. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included medical students graduating from Association of American Medical Colleges (AAMC)-accredited allopathic US medical schools in 2016 and 2017 and responding to the AAMC Graduation Questionnaire. Data analysis was conducted from June 2021 to March 2022. EXPOSURES Sexual orientation, based on self-identification, and categorized as bisexual, gay or lesbian, or heterosexual or straight. MAIN OUTCOMES AND MEASURES Primary outcomes included burnout as measured by Oldenburg Burnout Inventory for Medical Students (OLBI-MS; two 24-point scales [range, 0-48], with higher scores indicating greater burnout) and student perceptions of the medical school learning environment (0-5-point scales for emotional climate [range, 0-20] and student-faculty interactions [range, 0-15], with higher scores indicating more positive perceptions). Logistic regression was used to model the association between burnout, SM status, and learning environment while controlling for demographic characteristics. RESULTS A total of 25 757 respondents (12 527 [48.6%] women; 5347 [20.8%] Asian; 2255 [8.8%] underrepresented in medicine; 15 651 [60.8%] White; 10 726 [41.6%] aged ≤26 years) were included in the analysis: 568 (2.2%) self-identified as bisexual, 854 (3.3%) as gay or lesbian, and 24 335 (94.5%) as heterosexual or straight. Both bisexual students and gay or lesbian students reported less favorable perceptions of their learning environments than heterosexual students (mean [SD] emotional climate score, bisexual students: 8.56 [3.29]; gay or lesbian students: 9.22 [3.33]; heterosexual or straight students: 9.71 [3.20]; P < .001; mean [SD] faculty-student interaction score, bisexual students: 13.46 [3.69]; gay or lesbian students: 14.07 [3.45]; heterosexual or straight students: 14.32 [3.37]; P < .001). Bisexual and gay or lesbian students were more likely to be in the top quartile for burnout scores (bisexual: odds ratio [OR], 1.71; 95% CI, 1.42-2.07; P < .001; gay or lesbian: OR, 1.53; 95% CI, 1.31-1.79; P < .001). This association was attenuated when accounting for student perceptions of the learning environment (bisexual: OR, 1.37; 95% CI, 1.11-1.67; P < .001; gay or lesbian: OR, 1.42; 95% CI, 1.19-1.68; P < .001), with poorer perceptions of the medical school learning environment associated with higher burnout symptoms. CONCLUSIONS AND RELEVANCE In this cross-sectional study, SM students had less favorable perceptions of the medical school learning environment compared with heterosexual students. Results suggest the medical school environment may be associated with higher rates of burnout in SM students. Future research should explore interventions to improve the learning environment for SM students.
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Affiliation(s)
- Caitlin R. Ryus
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth A. Samuels
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Stephen Huot
- Office of Graduate Medical Education, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Ryus CR, Yang D, Tsai J, Meldrum J, Ngaruiya C. Using community-based participatory research methods to inform care for patients experiencing homelessness: An opportunity for resident education on health care disparities. AEM Educ Train 2021; 5:S121-S125. [PMID: 34616985 PMCID: PMC8480493 DOI: 10.1002/aet2.10681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/24/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
People experiencing homelessness (PEH) suffer higher burdens of chronic illnesses, have higher rates of emergency medicine (ED) use and hospitalization, and ultimately are at increased risk for premature death compared to housed counterparts. Structural racism contributes to a disproportionate burden of homelessness among people of color. PEH experience not only significant medical concerns but also complex social needs that need to be addressed concurrently for effective healing, issues that have been magnified by the COVID-19 pandemic. As health disparities and structural racism intersect among PEH, it is critically important to develop PEH-centered interventions to improve care and health outcomes as part of an effort to dismantle racism. One opportunity to address these disparities in care for PEH is through training ED physicians on methods for identifying and intervening on the unique needs of vulnerable patient groups. The Accreditation Council for Graduate Medical Education has outlined health quality pathways in the clinical learning environment to address health disparities. Community-based participatory research (CBPR) is particularly well suited for this scenario as it allows experiential learning for trainees to work with and understand a diverse group of stakeholders, to deepen their knowledge of local health disparities, and to lead research and measure outcomes of interventions to tackle health disparities. In this paper, we highlight the utility of CBPR in fostering experiential learning for EM residents on tackling health disparities and the importance of community collaboration in trainee-led interventions for comprehensive ED care.
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Affiliation(s)
- Caitlin R. Ryus
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - David Yang
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Jennifer Tsai
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Jonathan Meldrum
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Christine Ngaruiya
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
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Seelig S, Ryus CR, Harrison RF, Wilson MP, Wong AH. Cryptococcal Meningoencephalitis Presenting as a Psychiatric Emergency. J Emerg Med 2019; 57:203-206. [PMID: 31014972 DOI: 10.1016/j.jemermed.2019.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Organic conditions can often mimic neuropsychiatric disorders, leading to delays in diagnosis and treatment for the most vulnerable populations presenting to the emergency department (ED). CASE REPORT Here we discuss a case of cryptococcal meningoencephalitis seemingly consistent with psychosis on initial evaluation, and present strategies to recognize and treat this condition. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Due to the indolent time course of this disease, initial symptoms of altered mental status and personality changes may be attributed to drug use or psychiatric illness before more overt evidence for increased intracranial pressure and neurologic infection develops. It is important for emergency clinicians to maintain a high level of suspicion for this condition in at-risk patients and reassess them frequently during their ED visit.
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Affiliation(s)
- Sandra Seelig
- Department of Emergency Medicine, Yale-New Haven Hospital, New Haven, Connecticut
| | - Caitlin R Ryus
- Department of Emergency Medicine, Yale-New Haven Hospital, New Haven, Connecticut
| | - Raquel F Harrison
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Michael P Wilson
- Department of Emergency Medicine, Behavioral Emergencies Research (DEMBER) Lab, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Montgomery P, Ryus CR, Dolan CS, Dopson S, Scott LM. Sanitary pad interventions for girls' education in Ghana: a pilot study. PLoS One 2012; 7:e48274. [PMID: 23118968 PMCID: PMC3485220 DOI: 10.1371/journal.pone.0048274] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 09/21/2012] [Indexed: 11/18/2022] Open
Abstract
Background Increased education of girls in developing contexts is associated with a number of important positive health, social, and economic outcomes for a community. The event of menarche tends to coincide with girls' transitions from primary to secondary education and may constitute a barrier for continued school attendance and performance. Following the MRC Framework for Complex Interventions, a pilot controlled study was conducted in Ghana to assess the role of sanitary pads in girls' education. Methods A sample of 120 schoolgirls between the ages of 12 and 18 from four villages in Ghana participated in a non-randomized trial of sanitary pad provision with education. The trial had three levels of treatment: provision of pads with puberty education; puberty education alone; or control (no pads or education). The primary outcome was school attendance. Results After 3 months, providing pads with education significantly improved attendance among participants, (lambda 0.824, F = 3.760, p<.001). After 5 months, puberty education alone improved attendance to a similar level (M = 91.26, SD = 7.82) as sites where pads were provided with puberty education (Rural M = 89.74, SD = 9.34; Periurban M = 90.54, SD = 17.37), all of which were higher than control (M = 84.48, SD = 12.39). The total improvement through pads with education intervention after 5 months was a 9% increase in attendance. After 3 months, providing pads with education significantly improved attendance among participants. The changes in attendance at the end of the trial, after 5 months, were found to be significant by site over time. With puberty education alone resulting in a similar attendance level. Conclusion This pilot study demonstrated promising results of a low-cost, rapid-return intervention for girls' education in a developing context. Given the considerable development needs of poorer countries and the potential of young women there, these results suggest that a large-scale cluster randomized trial is warranted. Trial Registration Pan African Clinical Trials Registry PACTR201202000361337
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Affiliation(s)
- Paul Montgomery
- Centre for Evidence Based Intervention, University of Oxford, Oxford, Oxfordshire, United Kingdom.
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