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.

[MOBILE TECHNOLOGY AS A POTENTIAL TOOL IN RESEARCH ON STIGMA ASSOCIATED WITH HIV/AIDS AMONG MEDICAL STUDENTS]. / TECNOLOGÍA MÓVIL COMO HERRAMIENTA POTENCIAL EN LA INVESTIGACIÓN SOBRE ESTIGMA ASOCIADO AL VIH/SIDA ENTRE ESTUDIANTES DE MEDICINA.

The identification and reduction of manifestations of stigma associated with HIV/ AIDS among health professionals continues facing significant challenges. Some of these are the measurement of stigma in complex setting such as clinical scenarios. However, with the emergence of mobile technology in recent years, such as smartphones and tablets, possibilities for exploration and reduction of stigma manifestations are enhanced. This article aims to reflect on the ability of the iPad to help assess manifestations of stigma associated with HIV/AIDS within a controlled clinical setting with medical students. It is based on a research experience that was carried out to measure behavioral manifestations of stigma associated with HIV/AIDS among medical students in Puerto Rico. The study integrated the use of iPad in the data's collection, storage and analysis. This article highlights the use of existing applications (Apps) for iPad for the implementation of digital tools to measure stigma towards HIV/AIDS. In discussing the experience of researchers, the iPad's potential and it applications for research on stigma are highlighted. Also, implications for the use of mobile technology in social research are discussed.

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.

Father attitudes and knowledge about breastfeeding.

UNLABELLED: Studies have identified fathers' attitude as the strongest indicator of whether her partner will breastfeed. OBJECTIVE: To determine the attitudes and knowledge of fathers toward breastfeeding. METHODS: The study included 84 volunteer fathers who answered a survey. RESULTS: Mean age of participants was 27 years. Most fathers (88%) would like their partners to breastfeed. Most men (56%) reported that it is acceptable for a woman to breastfeed in public. Negative attitudes included feeling jealous about breastfeeding (10%), thinking that breastfeeding is bad for breasts (17%), breastfeeding makes breasts look ugly (26%), and breastfeeding separates the baby from the father (7%). A few misconceptions about breastfeeding were identified. CONCLUSIONS: Most fathers have positive attitudes towards breastfeeding. We should emphasize the importance of exclusive breastfeeding and clarify misconceptions that may cause early discontinuation of breastfeeding. Programs directed toward educating fathers will help them serve as sources of support for their partners.

Factors associated to continuing breastfeeding after returning to work in a group of mothers in Puerto Rico.

UNLABELLED: Working outside the home is related to lower rates of breastfeeding initiation and duration. Enacted laws promote and support breastfeeding in working places. OBJECTIVE: To determine factors associated to breastfeeding after returning to work. METHODS: Anonymous questionnaires distributed among breastfeeding working mothers. RESULTS: The study subjects were 100 mothers. Most of them (77%) worked for the government. Fifty-six percent continued breastfeeding after returning to work. In 33% of the workplaces there was an area designated for milk extraction.Thirty-six percent of employers allowed the 30 minute periods mandated by law for extraction. Factors associated to continuing breastfeeding were: working in the private setting, having a place designated for extraction, knowing that employers were mandated to have such a place, being allowed time for extraction, and knowing the laws protecting breastfeeding. CONCLUSIONS: There is need for more education to working mothers about their rights to continue breastfeeding after returning to work.

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.

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.

Minor head injury in children younger than two years of age: description, prevalence and management in the emergency room of the pediatric university hospital.

BACKGROUND: In children less than two years old, minor head trauma can result in intracranial injury. No known studies exist that determine the number of children younger than two years old who visit the emergency room (ER) due to minor head injury in Puerto Rico. OBJECTIVE: To determine the prevalence of children with minor head trauma and describe related issues. METHODS: Information was gathered from the medical records of children 0 to 2 years old who visited the University Pediatric Hospital ER from 2004-2006. Several factors were analyzed. RESULTS: From our 136 subjects, there was a male prevalence of 59%. The predominant reason for head injury was a fall (86%). There was abuse in 7% of the subjects. Eighty-five percent (85%) of injuries occurred at home. CONCLUSIONS: The most common etiology of head trauma was a fall at home. The prevalence of abuse in 7% of these children should alert physicians.

Knowledge about breastfeeding among a group of primary care physicians and residents in Puerto Rico.

Physicians have an essential role in promoting, protecting, and supporting breastfeeding as the ideal method of infant feeding. They are in an important position to promote breastfeeding but report difficulty in advising mothers with lactation problems. The purpose of this study is to assess knowledge about breastfeeding among primary care physicians and residents and identify potential barriers to its promotion. One hundred seventy-seven residents and physicians answered an anonymous questionnaire. The participants recognized breastfeeding benefits but 26% did not encourage exclusive breastfeeding. Mastitis, breast abscess, and the use of medications by the mother were considered contraindications to breastfeeding. Temporary breastfeeding discontinuation and bilirubin levels measurement were the preferred recommendations for the jaundiced infant. Most physicians received training in breastfeeding benefits although they report fair knowledge in myths, techniques, and contraindications. Physicians demonstrated to recognize breastfeeding benefits, but formal education is needed to eliminate barriers to breastfeeding promotion and support.