Introduction:The recent increase in natural disasters and mass shootings highlights the need for ... more Introduction:The recent increase in natural disasters and mass shootings highlights the need for medical providers to be prepared to provide care in extreme environments. However, while physicians of all specialties may respond in emergencies, disaster medicine training is minimal or absent from most medical school curricula in the United States. A voluntary Disaster Medicine Certificate Series (DMCS) was piloted to fill this gap in undergraduate medical education.Report:Beginning in August of 2017, second- and third-year medical students voluntarily enrolled in DMCS. Students earned points toward the certificate through participation in activities and membership in community organizations in a flexible format that caters to variable schedules and interests. Topics covered included active shooter training, decontamination procedures, mass-casualty triage, Incident Command System (ICS) training, and more. At the conclusion of the pilot year, demographic information was collected and a survey was conducted to evaluate student opinions regarding the program.Results:Sixty-eight second- and third-year medical students participated in the pilot year, with five multi-hour skills trainings and five didactic lectures made available to students. Forty-eight of those 68 enrolled in DMCS completed the retrospective survey. Student responses indicated that community partners serve as effective means for providing lectures (overall mean rating 4.50/5.0) and skills sessions (rating 4.58/5.0), and that the program created avenues for real-world disaster response in their local communities (rating 4.40/5.0).Conclusions:The DMCS voluntary certificate series model served as an innovative method for providing disaster medicine education to medical students.Kommor MB, Hodge B, Ciottone G. Development and implementation of a Disaster Medicine Certificate Series (DMCS) for medical students.Prehosp Disaster Med. 2019;34(2):197–202
The University of Louisville journal of respiratory infections, Jan 19, 2023
Background: Individuals face stigma associated with numerous health conditions. Stigma can arise ... more Background: Individuals face stigma associated with numerous health conditions. Stigma can arise rapidly during the early spread of a new disease, adding to the burden felt by those affected. COVID-19 can be used as an example to study stigma during the early phases of a pandemic. This narrative review is a descriptive analysis that tracks the ways in which COVID-19 stigma was discussed in the scholarly literature during the first year of the pandemic to understand how stigma was viewed in the context of a rapidly spreading pandemic. Methods: PubMed was used as a non-exhaustive sample of the literature. Searches for stigma and COVID-19 or SARS-CoV-2 were carried out in January 2021. To be included for review, articles had to be accessible in English, published on PubMed in 2019 or later, and focused on COVID-19/SARS-CoV-2, with at least a mention of stigma related to COVID-19. The included articles were then reviewed for chronological time, depth of emphasis on stigma, definition and interpretation of stigma, type of publication, and recommendations. Demographic features of the authors and studied populations were also tracked. Results: This review identified 321 articles on PubMed discussing stigma and COVID-19. Of these, 180 articles met inclusion criteria and were reviewed. The earliest publication included in the review was from April 2020. Authors from India, the USA, and China published the most articles related to COVID-19 and stigma. The most frequent forms of publication were cross-sectional studies, commentaries, and letters to the editor. In nearly half of the publications, stigma was one of several factors studied. All of the included publications described the negative impact stigma has on the community. Five major types of recommendations were noted: need for further research, dissemination of accurate health information, expansion of resources, policy and protocol changes, and community engagement. Conclusions: Stigma can have a profound impact on individuals affected by a disease, causing barriers to both treatment and attempts to stop disease spread. The stigma seen during the early days of COVID-19 provides useful information on pandemic-related stigma. The recommendations gleaned from this review can be helpful in the mitigation of disease-related stigma and used to slow the spread of stigma during the early stages of future pandemics.
Following a similar trend among United States (US) medical students, US resident physicians are i... more Following a similar trend among United States (US) medical students, US resident physicians are increasingly interested in pursuing global health education. Largely, residency education has lagged behind in addressing this demand. Time and curriculum requirements make meeting this need challenging. The Office of International Activities (OIA) at University of North Carolina-Chapel Hill (UNC-CH) was founded to provide support to students and residents in the area global health. In order to more fully understand resident physicians' attitudes and educational needs, a survey of incoming residents was undertaken. The OIA administered a survey for incoming first-year residents of all specialties in July 2012. The survey was administered over one month using Qualtrics® and the response rate was 60%. Although 42% of residents had had an international experience during medical school, only 36% reported they felt prepared to address issues of international public health, including travel medicine and immigrant health. Significant barriers to involvement in global health opportunities in residency education were identified, including lack of time, finances and mentorship. As has been previously documented for global health education for medical students, this study's residents saw significant barriers to international electives during residency, including lack of elective time, finances and family responsibilities. In response to the survey results, an interdisciplinary educational initiative was developed at our school. This included obtaining buy-in from core residency leadership, establishing a pathway to arrange experiences, competitive scholarships for travel, and initiation of interdisciplinary educational opportunities. Results may serve as a useful model for other academic centers in developed countries.
Morbidity and Mortality Weekly Report, Aug 12, 2022
, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).... more , this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Monkeypox, a zoonotic infection caused by an orthopoxvirus, is endemic in parts of Africa. On August 4, 2022, the U.S. Department of Health and Human Services declared the U.S. monkeypox outbreak, which began on May 17, to be a public health emergency (1,2). After detection of the first U.S. monkeypox case), CDC and health departments implemented enhanced monkeypox case detection and reporting. Among 2,891 cases reported in the United States through July 22 by 43 states, Puerto Rico, and the District of Columbia (DC), CDC received case report forms for 1,195 (41%) cases by July 27. Among these, 99% of cases were among men; among men with available information, 94% reported male-to-male sexual or close intimate contact during the 3 weeks before symptom onset. Among the 88% of cases with available data, 41% were among non-Hispanic White (White) persons, 28% among Hispanic or Latino (Hispanic) persons, and 26% among non-Hispanic Black or African American (Black) persons. Forty-two percent of persons with monkeypox with available data did not report the typical prodrome as their first symptom, and 46% reported one or more genital lesions during their illness; 41% had HIV infection. Data suggest that widespread community transmission of monkeypox has disproportionately affected gay, bisexual, and other men who have sex with men and racial and ethnic minority groups. Compared with historical reports of monkeypox in areas with endemic disease, currently reported outbreak-associated cases are less likely to have a prodrome and more likely to have genital involvement. CDC and other federal, state, and local agencies have implemented response efforts to expand testing, treatment, and vaccination. Public health efforts should prioritize gay, bisexual, and other men who have sex with men, who are currently disproportionately affected, for prevention and testing, while addressing equity, minimizing stigma, and maintaining vigilance for transmission in other populations. Clinicians should test patients with rash consistent with
The University of Louisville Journal of Respiratory Infections
Background: Individuals face stigma associated with numerous health conditions. Stigma can arise ... more Background: Individuals face stigma associated with numerous health conditions. Stigma can arise rapidly during the early spread of a new disease, adding to the burden felt by those affected. COVID-19 can be used as an example to study stigma during the early phases of a pandemic. This narrative review is a descriptive analysis that tracks the ways in which COVID-19 stigma was discussed in the scholarly literature during the first year of the pandemic to understand how stigma was viewed in the context of a rapidly spreading pandemic. Methods: PubMed was used as a non-exhaustive sample of the literature. Searches for stigma and COVID-19 or SARS-CoV-2 were carried out in January 2021. To be included for review, articles had to be accessible in English, published on PubMed in 2019 or later, and focused on COVID-19/SARS-CoV-2, with at least a mention of stigma related to COVID-19. The included articles were then reviewed for chronological time, depth of emphasis on stigma, definition and interpretation of stigma, type of publication, and recommendations. Demographic features of the authors and studied populations were also tracked. Results: This review identified 321 articles on PubMed discussing stigma and COVID-19. Of these, 180 articles met inclusion criteria and were reviewed. The earliest publication included in the review was from April 2020. Authors from India, the USA, and China published the most articles related to COVID-19 and stigma. The most frequent forms of publication were cross-sectional studies, commentaries, and letters to the editor. In nearly half of the publications, stigma was one of several factors studied. All of the included publications described the negative impact stigma has on the community. Five major types of recommendations were noted: need for further research, dissemination of accurate health information, expansion of resources, policy and protocol changes, and community engagement. Conclusions: Stigma can have a profound impact on individuals affected by a disease, causing barriers to both treatment and attempts to stop disease spread. The stigma seen during the early days of COVID-19 provides useful information on pandemic-related stigma. The recommendations gleaned from this review can be helpful in the mitigation of disease-related stigma and used to slow the spread of stigma during the early stages of future pandemics.
, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).... more , this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). On April 21, 2022, CDC issued a health advisory † encouraging U.S. clinicians to report all patients aged <10 years with hepatitis of unknown etiology to public health authorities, after identification of similar cases in both the United States (1) and Europe. § A high proportion of initially reported patients had adenovirus detected in whole blood specimens, thus the health advisory encouraged clinicians to consider requesting adenovirus testing, preferentially on whole blood specimens. For patients meeting the criteria in the health advisory (patients under investigation [PUIs]), jurisdictional public health authorities abstracted medical charts and interviewed patient caregivers. As of June 15, 2022, a total of 296 PUIs with hepatitis onset on or after October 1, 2021, were reported from 42 U.S. jurisdictions. The median age of PUIs was 2 years, 2 months. Most PUIs were hospitalized (89.9%); 18 (6.1%) required a liver transplant, and 11 (3.7%) died. Adenovirus was detected in a respiratory, blood, or stool specimen of 100 (44.6%) of 224 patients. ¶ Current or past infection with SARS-CoV-2 (the virus that causes COVID-19) was reported in 10 of 98 (10.2%) and 32 of 123 (26.0%) patients, respectively. No common exposures (e.g., travel, food, or toxicants) were identified. This nationwide investigation is ongoing. Further clinical data are needed to understand the cause of hepatitis in these patients and to assess the potential association with adenovirus. Clinicians and health departments began retrospectively and prospectively identifying PUIs on April 21, 2022. A PUI was defined as a person aged <10 years with elevated (>500 U/L) aspartate aminotransferase (AST) or alanine aminotransferase (ALT), an unknown etiology for the hepatitis, and onset on or after October 1, 2021. Comprehensive investigations of PUIs included rapid reporting of preliminary information, medical chart abstractions, caregiver interviews, laboratory testing, and tissue specimen examination. Upon identification of a PUI, jurisdictional health departments sent preliminary information (basic demographic information, date of hepatitis * These authors contributed equally to this report.
Pediatric refugees and immigrants may present with unusual diagnoses due to their extensive migra... more Pediatric refugees and immigrants may present with unusual diagnoses due to their extensive migration and potential harsh conditions in travel. Trauma and family separation add to the difficulty of obtaining a history of exposures. We report a case of one of the more commonly neglected tropical diseases, Leishmaniasis. A 15-year-old male refugee patient presented to the hospital with ulcerative lesions to his legs. His migration history was extensive, starting in Central Africa with travel to South America, followed by migration through Central America to Texas. The patient developed ulcerative lesions on his legs, and he was brought to the children's hospital by his refugee organization, where the diagnosis was ultimately confirmed as Leishmaniasis. Providers should become familiar with tropical diseases that refugees, as well as local populations, may acquire from travel. Specifically, pediatricians should become familiar with the more prevalent "neglected" tropical diseases as recommended by the World Health Organization.
In the following pages, I outline a global health education program and evaluation plan to be use... more In the following pages, I outline a global health education program and evaluation plan to be used by primary care graduate medicine programs. U.S. residents are increasingly interested in learning global health concepts and participating in international clinical activities, and many residency programs are seeking to support these interests with a formalized curriculum. In the past, residents in primary care specialties at the University of North Carolina (UNC) have had access to few resources for helping them learn about global health or assist them in planning international electives. Currently, the Office of International Activities at UNC is expanding the existing global health curriculum to meet the needs of residents. As part of this process, I first discuss the models for teaching global health currently in use at other institutions. I then describe the framework in which the curriculum will function and applicable educational theories. Next, I define goals and objectives sp...
Gianotti-Crosti syndrome (GCS) is a self-limiting, papular or papulovesicular, symmetric, acral e... more Gianotti-Crosti syndrome (GCS) is a self-limiting, papular or papulovesicular, symmetric, acral exanthem that typically presents subsequent to viral infection, bacterial infection, or immunization in a child 1 to 4 years old. The rash can persist for 2 to 10 weeks. Recent infection with Epstein-Barr virus is the most common serologic finding in patients who have developed GCS. The diagnosis is often made after the child has been unsuccessfully treated for a more common cause of an acral rash (eg, scabies). There are no pathognomonic laboratory or histopathologic findings. GCS, therefore, is still a clinical diagnosis of exclusion. The rash is self-limited, and treatment is usually not necessary. However, topical corticosteroids are anecdotally reported to reduce duration of rash. Oral antihistamines can be used to treat pruritus. Parents should be assured that resolution is almost always complete, scarring seldom occurs, and recurrence is rare.
Introduction:The recent increase in natural disasters and mass shootings highlights the need for ... more Introduction:The recent increase in natural disasters and mass shootings highlights the need for medical providers to be prepared to provide care in extreme environments. However, while physicians of all specialties may respond in emergencies, disaster medicine training is minimal or absent from most medical school curricula in the United States. A voluntary Disaster Medicine Certificate Series (DMCS) was piloted to fill this gap in undergraduate medical education.Report:Beginning in August of 2017, second- and third-year medical students voluntarily enrolled in DMCS. Students earned points toward the certificate through participation in activities and membership in community organizations in a flexible format that caters to variable schedules and interests. Topics covered included active shooter training, decontamination procedures, mass-casualty triage, Incident Command System (ICS) training, and more. At the conclusion of the pilot year, demographic information was collected and ...
Introduction:The recent increase in natural disasters and mass shootings highlights the need for ... more Introduction:The recent increase in natural disasters and mass shootings highlights the need for medical providers to be prepared to provide care in extreme environments. However, while physicians of all specialties may respond in emergencies, disaster medicine training is minimal or absent from most medical school curricula in the United States. A voluntary Disaster Medicine Certificate Series (DMCS) was piloted to fill this gap in undergraduate medical education.Report:Beginning in August of 2017, second- and third-year medical students voluntarily enrolled in DMCS. Students earned points toward the certificate through participation in activities and membership in community organizations in a flexible format that caters to variable schedules and interests. Topics covered included active shooter training, decontamination procedures, mass-casualty triage, Incident Command System (ICS) training, and more. At the conclusion of the pilot year, demographic information was collected and a survey was conducted to evaluate student opinions regarding the program.Results:Sixty-eight second- and third-year medical students participated in the pilot year, with five multi-hour skills trainings and five didactic lectures made available to students. Forty-eight of those 68 enrolled in DMCS completed the retrospective survey. Student responses indicated that community partners serve as effective means for providing lectures (overall mean rating 4.50/5.0) and skills sessions (rating 4.58/5.0), and that the program created avenues for real-world disaster response in their local communities (rating 4.40/5.0).Conclusions:The DMCS voluntary certificate series model served as an innovative method for providing disaster medicine education to medical students.Kommor MB, Hodge B, Ciottone G. Development and implementation of a Disaster Medicine Certificate Series (DMCS) for medical students.Prehosp Disaster Med. 2019;34(2):197–202
The University of Louisville journal of respiratory infections, Jan 19, 2023
Background: Individuals face stigma associated with numerous health conditions. Stigma can arise ... more Background: Individuals face stigma associated with numerous health conditions. Stigma can arise rapidly during the early spread of a new disease, adding to the burden felt by those affected. COVID-19 can be used as an example to study stigma during the early phases of a pandemic. This narrative review is a descriptive analysis that tracks the ways in which COVID-19 stigma was discussed in the scholarly literature during the first year of the pandemic to understand how stigma was viewed in the context of a rapidly spreading pandemic. Methods: PubMed was used as a non-exhaustive sample of the literature. Searches for stigma and COVID-19 or SARS-CoV-2 were carried out in January 2021. To be included for review, articles had to be accessible in English, published on PubMed in 2019 or later, and focused on COVID-19/SARS-CoV-2, with at least a mention of stigma related to COVID-19. The included articles were then reviewed for chronological time, depth of emphasis on stigma, definition and interpretation of stigma, type of publication, and recommendations. Demographic features of the authors and studied populations were also tracked. Results: This review identified 321 articles on PubMed discussing stigma and COVID-19. Of these, 180 articles met inclusion criteria and were reviewed. The earliest publication included in the review was from April 2020. Authors from India, the USA, and China published the most articles related to COVID-19 and stigma. The most frequent forms of publication were cross-sectional studies, commentaries, and letters to the editor. In nearly half of the publications, stigma was one of several factors studied. All of the included publications described the negative impact stigma has on the community. Five major types of recommendations were noted: need for further research, dissemination of accurate health information, expansion of resources, policy and protocol changes, and community engagement. Conclusions: Stigma can have a profound impact on individuals affected by a disease, causing barriers to both treatment and attempts to stop disease spread. The stigma seen during the early days of COVID-19 provides useful information on pandemic-related stigma. The recommendations gleaned from this review can be helpful in the mitigation of disease-related stigma and used to slow the spread of stigma during the early stages of future pandemics.
Following a similar trend among United States (US) medical students, US resident physicians are i... more Following a similar trend among United States (US) medical students, US resident physicians are increasingly interested in pursuing global health education. Largely, residency education has lagged behind in addressing this demand. Time and curriculum requirements make meeting this need challenging. The Office of International Activities (OIA) at University of North Carolina-Chapel Hill (UNC-CH) was founded to provide support to students and residents in the area global health. In order to more fully understand resident physicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attitudes and educational needs, a survey of incoming residents was undertaken. The OIA administered a survey for incoming first-year residents of all specialties in July 2012. The survey was administered over one month using Qualtrics® and the response rate was 60%. Although 42% of residents had had an international experience during medical school, only 36% reported they felt prepared to address issues of international public health, including travel medicine and immigrant health. Significant barriers to involvement in global health opportunities in residency education were identified, including lack of time, finances and mentorship. As has been previously documented for global health education for medical students, this study&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s residents saw significant barriers to international electives during residency, including lack of elective time, finances and family responsibilities. In response to the survey results, an interdisciplinary educational initiative was developed at our school. This included obtaining buy-in from core residency leadership, establishing a pathway to arrange experiences, competitive scholarships for travel, and initiation of interdisciplinary educational opportunities. Results may serve as a useful model for other academic centers in developed countries.
Morbidity and Mortality Weekly Report, Aug 12, 2022
, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).... more , this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Monkeypox, a zoonotic infection caused by an orthopoxvirus, is endemic in parts of Africa. On August 4, 2022, the U.S. Department of Health and Human Services declared the U.S. monkeypox outbreak, which began on May 17, to be a public health emergency (1,2). After detection of the first U.S. monkeypox case), CDC and health departments implemented enhanced monkeypox case detection and reporting. Among 2,891 cases reported in the United States through July 22 by 43 states, Puerto Rico, and the District of Columbia (DC), CDC received case report forms for 1,195 (41%) cases by July 27. Among these, 99% of cases were among men; among men with available information, 94% reported male-to-male sexual or close intimate contact during the 3 weeks before symptom onset. Among the 88% of cases with available data, 41% were among non-Hispanic White (White) persons, 28% among Hispanic or Latino (Hispanic) persons, and 26% among non-Hispanic Black or African American (Black) persons. Forty-two percent of persons with monkeypox with available data did not report the typical prodrome as their first symptom, and 46% reported one or more genital lesions during their illness; 41% had HIV infection. Data suggest that widespread community transmission of monkeypox has disproportionately affected gay, bisexual, and other men who have sex with men and racial and ethnic minority groups. Compared with historical reports of monkeypox in areas with endemic disease, currently reported outbreak-associated cases are less likely to have a prodrome and more likely to have genital involvement. CDC and other federal, state, and local agencies have implemented response efforts to expand testing, treatment, and vaccination. Public health efforts should prioritize gay, bisexual, and other men who have sex with men, who are currently disproportionately affected, for prevention and testing, while addressing equity, minimizing stigma, and maintaining vigilance for transmission in other populations. Clinicians should test patients with rash consistent with
The University of Louisville Journal of Respiratory Infections
Background: Individuals face stigma associated with numerous health conditions. Stigma can arise ... more Background: Individuals face stigma associated with numerous health conditions. Stigma can arise rapidly during the early spread of a new disease, adding to the burden felt by those affected. COVID-19 can be used as an example to study stigma during the early phases of a pandemic. This narrative review is a descriptive analysis that tracks the ways in which COVID-19 stigma was discussed in the scholarly literature during the first year of the pandemic to understand how stigma was viewed in the context of a rapidly spreading pandemic. Methods: PubMed was used as a non-exhaustive sample of the literature. Searches for stigma and COVID-19 or SARS-CoV-2 were carried out in January 2021. To be included for review, articles had to be accessible in English, published on PubMed in 2019 or later, and focused on COVID-19/SARS-CoV-2, with at least a mention of stigma related to COVID-19. The included articles were then reviewed for chronological time, depth of emphasis on stigma, definition and interpretation of stigma, type of publication, and recommendations. Demographic features of the authors and studied populations were also tracked. Results: This review identified 321 articles on PubMed discussing stigma and COVID-19. Of these, 180 articles met inclusion criteria and were reviewed. The earliest publication included in the review was from April 2020. Authors from India, the USA, and China published the most articles related to COVID-19 and stigma. The most frequent forms of publication were cross-sectional studies, commentaries, and letters to the editor. In nearly half of the publications, stigma was one of several factors studied. All of the included publications described the negative impact stigma has on the community. Five major types of recommendations were noted: need for further research, dissemination of accurate health information, expansion of resources, policy and protocol changes, and community engagement. Conclusions: Stigma can have a profound impact on individuals affected by a disease, causing barriers to both treatment and attempts to stop disease spread. The stigma seen during the early days of COVID-19 provides useful information on pandemic-related stigma. The recommendations gleaned from this review can be helpful in the mitigation of disease-related stigma and used to slow the spread of stigma during the early stages of future pandemics.
, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).... more , this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). On April 21, 2022, CDC issued a health advisory † encouraging U.S. clinicians to report all patients aged <10 years with hepatitis of unknown etiology to public health authorities, after identification of similar cases in both the United States (1) and Europe. § A high proportion of initially reported patients had adenovirus detected in whole blood specimens, thus the health advisory encouraged clinicians to consider requesting adenovirus testing, preferentially on whole blood specimens. For patients meeting the criteria in the health advisory (patients under investigation [PUIs]), jurisdictional public health authorities abstracted medical charts and interviewed patient caregivers. As of June 15, 2022, a total of 296 PUIs with hepatitis onset on or after October 1, 2021, were reported from 42 U.S. jurisdictions. The median age of PUIs was 2 years, 2 months. Most PUIs were hospitalized (89.9%); 18 (6.1%) required a liver transplant, and 11 (3.7%) died. Adenovirus was detected in a respiratory, blood, or stool specimen of 100 (44.6%) of 224 patients. ¶ Current or past infection with SARS-CoV-2 (the virus that causes COVID-19) was reported in 10 of 98 (10.2%) and 32 of 123 (26.0%) patients, respectively. No common exposures (e.g., travel, food, or toxicants) were identified. This nationwide investigation is ongoing. Further clinical data are needed to understand the cause of hepatitis in these patients and to assess the potential association with adenovirus. Clinicians and health departments began retrospectively and prospectively identifying PUIs on April 21, 2022. A PUI was defined as a person aged <10 years with elevated (>500 U/L) aspartate aminotransferase (AST) or alanine aminotransferase (ALT), an unknown etiology for the hepatitis, and onset on or after October 1, 2021. Comprehensive investigations of PUIs included rapid reporting of preliminary information, medical chart abstractions, caregiver interviews, laboratory testing, and tissue specimen examination. Upon identification of a PUI, jurisdictional health departments sent preliminary information (basic demographic information, date of hepatitis * These authors contributed equally to this report.
Pediatric refugees and immigrants may present with unusual diagnoses due to their extensive migra... more Pediatric refugees and immigrants may present with unusual diagnoses due to their extensive migration and potential harsh conditions in travel. Trauma and family separation add to the difficulty of obtaining a history of exposures. We report a case of one of the more commonly neglected tropical diseases, Leishmaniasis. A 15-year-old male refugee patient presented to the hospital with ulcerative lesions to his legs. His migration history was extensive, starting in Central Africa with travel to South America, followed by migration through Central America to Texas. The patient developed ulcerative lesions on his legs, and he was brought to the children's hospital by his refugee organization, where the diagnosis was ultimately confirmed as Leishmaniasis. Providers should become familiar with tropical diseases that refugees, as well as local populations, may acquire from travel. Specifically, pediatricians should become familiar with the more prevalent "neglected" tropical diseases as recommended by the World Health Organization.
In the following pages, I outline a global health education program and evaluation plan to be use... more In the following pages, I outline a global health education program and evaluation plan to be used by primary care graduate medicine programs. U.S. residents are increasingly interested in learning global health concepts and participating in international clinical activities, and many residency programs are seeking to support these interests with a formalized curriculum. In the past, residents in primary care specialties at the University of North Carolina (UNC) have had access to few resources for helping them learn about global health or assist them in planning international electives. Currently, the Office of International Activities at UNC is expanding the existing global health curriculum to meet the needs of residents. As part of this process, I first discuss the models for teaching global health currently in use at other institutions. I then describe the framework in which the curriculum will function and applicable educational theories. Next, I define goals and objectives sp...
Gianotti-Crosti syndrome (GCS) is a self-limiting, papular or papulovesicular, symmetric, acral e... more Gianotti-Crosti syndrome (GCS) is a self-limiting, papular or papulovesicular, symmetric, acral exanthem that typically presents subsequent to viral infection, bacterial infection, or immunization in a child 1 to 4 years old. The rash can persist for 2 to 10 weeks. Recent infection with Epstein-Barr virus is the most common serologic finding in patients who have developed GCS. The diagnosis is often made after the child has been unsuccessfully treated for a more common cause of an acral rash (eg, scabies). There are no pathognomonic laboratory or histopathologic findings. GCS, therefore, is still a clinical diagnosis of exclusion. The rash is self-limited, and treatment is usually not necessary. However, topical corticosteroids are anecdotally reported to reduce duration of rash. Oral antihistamines can be used to treat pruritus. Parents should be assured that resolution is almost always complete, scarring seldom occurs, and recurrence is rare.
Introduction:The recent increase in natural disasters and mass shootings highlights the need for ... more Introduction:The recent increase in natural disasters and mass shootings highlights the need for medical providers to be prepared to provide care in extreme environments. However, while physicians of all specialties may respond in emergencies, disaster medicine training is minimal or absent from most medical school curricula in the United States. A voluntary Disaster Medicine Certificate Series (DMCS) was piloted to fill this gap in undergraduate medical education.Report:Beginning in August of 2017, second- and third-year medical students voluntarily enrolled in DMCS. Students earned points toward the certificate through participation in activities and membership in community organizations in a flexible format that caters to variable schedules and interests. Topics covered included active shooter training, decontamination procedures, mass-casualty triage, Incident Command System (ICS) training, and more. At the conclusion of the pilot year, demographic information was collected and ...
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Papers by Bethany Hodge