HIV/AIDS stigma manifestations during clinical interactions with MSM in Puerto Rico.

HIV/AIDS stigma can have detrimental effects on physician/patient interactions when manifested by health professionals. Unfortunately, HIV/AIDS stigma is usually manifested in an intersectional manner with other pre-existing stigmas, including stigma towards men who have sex with men (MSM). Therefore, our study aimed to examine the behavioral manifestations of HIV/AIDS stigma among physicians in training during simulated clinical interactions with MSM, and explore the interrelation between HIV/AIDS stigma attitudes and behaviors. We implemented an experimental design using Standardized Patient simulations with a sample of 100 physicians in training in Puerto Rico. Results show a significant difference in the two groups' means (p<.001), with a higher number of stigma behaviors in the HIV MSM patient condition (M=6.39) than the common cold control condition (M=5.20). Results evidence that stigma manifestations towards MSM with HIV may continue to be an obstacle for public health in Puerto Rico, and that medical training to prevent stigma is still needed.

HIV/AIDS and intersectional stigmas: Examining stigma related behaviours among medical students during service delivery.

HIV/AIDS stigma remains a major global health issue with detrimental consequences for people with HIV/AIDS (PWHA), especially when manifested by health professionals. Research on HIV/AIDS stigma has documented negative attitudes towards PWHA among health professionals. However, fewer studies have examined how HIV/AIDS stigma is manifested behaviourally during clinical interactions and how it interacts with other stigmas (i.e. drug use, sexism, homophobia). This study aimed to: (1) examine behavioural manifestations of HIV/AIDS stigma among medical students during clinical interactions, and (2) explore HIV/AIDS stigma intersectionality with other stigmas. We implemented an experimental design using Standardised Patient (SP) simulations, observational techniques, and quantitative questionnaires. A total of 237 medical students engaged in SP encounters with three experimental scenarios: (1) PWHA infected via illegal drug use, (2) PWHA infected via unprotected heterosexual relations, (3) PWHA infected via unprotected homosexual relations. They also interacted with a person with common cold (control condition). Results evidenced statistically significant differences between the experimental and control simulation, with higher number of stigma behaviours manifested towards experimental conditions. Results also evidence higher HIV/AIDS stigma towards MSM when compared to the drug user and heterosexual woman SP's. We discuss the implications of these findings for training of medical students.

Beyond negative attitudes: Examining HIV/AIDS stigma behaviors in clinical encounters.

HIV/AIDS related stigma remains a major global health issue with detrimental consequences for the treatment and health of people with HIV/AIDS (PWHA), especially when manifested by health professionals. Research on HIV/AIDS stigma has successfully documented negative attitudes towards PWHA among health professionals. However, fewer studies have examined how stigma is manifested behaviorally by health professionals during clinical interactions. Therefore, this study aimed to: (1) examine the behavioral manifestations of HIV/AIDS stigma among physicians in training during clinical interactions, and (2) document the interrelation between HIV/AIDS stigma attitudes and behaviors. We implemented an experimental design using Standardized Patient (SP) simulations, observational techniques, and quantitative questionnaires. The sample consisted of 66 physicians in training in Puerto Rico who engaged in SP encounters with two scenarios: (1) PWHA infected via illegal drug use (experimental condition), and (2) a person with a common cold (control condition). Results evidenced statistically significant differences between both simulations (p = .047), with a higher number of stigma behaviors manifested in the experimental condition. HIV/AIDS stigma attitudes were not correlated with stigma behaviors. Negative emotions associated with drug use were positively associated with drug-related stigmatizing behaviors.

Cystic adnexal mass in a 16-year-old female: Ovarian pathology or complication of a Müllerian anomaly?

Patient: Female, 16 Final Diagnosis: Pelvic mass Symptoms: None Medication: None Clinical Procedure: CT • MRI Specialty: Diagnostic radiology • pediatrics. OBJECTIVE: Unusual presentation of unknown etiology, Rare disease, Mistake in diagnosis. BACKGROUND: Müllerian anomalies encompass a wide variety of malformations in the female genital tract, usually associated with renal and anorectal malformations. Of these anomalies, approximately 11% are uterus didelphys, which occurs when midline fusion of the müllerian ducts is arrested to a variable extent. CASE REPORT: We report the case of a 16-year-old female with uterine didelphys, jejunal malrotation, hematometra, hematosalpinx, and bilateral subcentimeter homogenous circular cystic-like renal lesions, who initially presented with left lower quadrant abdominal pain, non-bloody vomiting, and a history of irregular menstrual periods. Initial CT was confusing for an adnexal cystic mass, but further imaging disclosed the above müllerian anomalies. CONCLUSIONS: Müllerian anomalies may mimic other, more common, adnexal lesions; thus, adequate evaluation of suspicious cystic adnexal masses with multiple and advanced imaging modalities such as MRI is essential for adequate diagnosis and management.

Integration of high-fidelity simulator in third-year paediatrics clerkship.

BACKGROUND: Simulation in medicine is a useful tool for assessing clinical competencies. The liaison committee on medical education expects students to have simulation experiences in the curriculum. The integration of simulators has been encouraged for clinical clerkships. The use of the human simulator in a safe environment should result in enhanced teamworking, communication and critical thinking skills. CONTEXT: During the academic year 2007-08, a formative activity using the simulator was implemented in the paediatrics clerkship. The objectives included exposing students to an emergent general paediatric medical scenario using the human simulator. It was imperative that students would adequately go through the critical thinking process. INNOVATION: The paediatrics clerkship has incorporated a formative activity using the high-fidelity simulator. A faculty member debriefed the students, and feedback was offered. A total of 124 students participated in the activity. Ninety-eight percent agreed that the use of the simulator in a scenario such as the one presented allowed for a better understanding of the clinical issues studied in the clerkship. More than 85 percent of the students recommended the integration of the simulator in other major clinical clerkships. Performance in the objective structured clinical exam (OSCE) at the end of the clerkship has improved after the implementation of this formative activity. IMPLICATIONS: The use of the high-fidelity simulator during the paediatrics clerkship has been identified as an excellent teaching tool. This formative activity has been deemed successful by the students, who feel that it serves as an extra tool to strengthen learned concepts and skills.

Knowledge and misconceptions about immunizations among medical students, pediatric, and family medicine resident.

BACKGROUND: Previous research has indicated that, despite being the most trusted source of health information, medical students, residents and other health related professionals lack accurate and current knowledge regarding immunization practices. OBJECTIVE: To evaluate medical students and primary care resident knowledge about immunizations. METHODS: Self-administered survey given to students from four medical schools, Pediatrics residents (2 training programs) and Family Medicine residents (2 programs). Data was analyzed using Statistix 8.0. One-way ANOVA test was used to compare means, and a p-value less than 0.05 was considered statistically significant. RESULTS: Participants (N=376) included 3rd (64%) and 4th (18%) year medical students and a homogenous distribution of 1st, 2nd and 3rd year residents. The mean percent of correct answers about immunizations was 61%. The participants showed poor knowledge about indications (62% correct answers), contraindications (46% correct answers) and myths (71% correct answers). Knowledge about immunizations correlated with higher levels of education (p < 0.01). Most participants identified conferences (72%) as their primary source to learn about immunizations followed by books (48%) and the internet (36%). They referred poor exposure to immunizations in clinical settings. CONCLUSIONS: Most medical students do not have the expected knowledge about immunization indications and contraindications. Residents were not proficient in immunization contraindications. Both groups had an adequate understanding about vaccination myths. Efforts towards ensuring adequate exposure to immunizations education during training years are needed in order to eliminate one of the barriers to adequate immunizations in children.

Respiratory illness in late preterm infants during the first six months of life.

UNLABELLED: Late preterm infants are physiologically immature and at risk for respiratory complications. The study's objective was to determine the incidence of respiratory illnesses in a group of preterm infants (33-35 weeks) during the first six months of life. METHODS: Parents were contacted by phone in the six months period after participating in an educational program and a short survey was performed. RESULTS: None of the infants required admission to the intensive care unit in the newborn period. According to parents, 71% of the babies had a common cold, 9% bronchiolitis, and 3% pneumonia. Fifty four percent of the babies visited the emergency room due to respiratory illnesses and (12%) required admission. CONCLUSION: Late preterm infants present respiratory illnesses during the first months of life which result in medical expenditures, emergency room visits, and hospital admissions. Educational interventions about preventive measures are needed to decrease the morbidity associated to these illnesses.