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Accessibility to Gender Affirming Treatments for Transgender Patients in New Jersey
Get PDFBackground: The literature clearly indicates that gender affirming treatments, such as gender reassignment surgery, counseling, exogenous hormones, and feminization/masculinization surgery, are highly effective and beneficial for transgender patients.
Purpose: The purpose of this review was to assess the barriers to accessing gender affirming treatments in New Jersey.
Methods: This review utilized the PubMed database and Google searches to gather information. The search terms included LGBTQ healthcare, LGBTQ Medicaid, transgender treatment, transgender healthcare, top surgery New Jersey, New Jersey Medicare and Medicaid, and transgender Health Insurance in New Jersey.
Results: New Jersey State Medicaid covers both gender affirming surgery and hormone replacement therapy. Additionally, New Jersey provides statewide protection for both patients seeking care and doctors providing care. Among recent legislative bans in other states, New Jersey is a ‘safe state’ for those seeking care. However, a major barrier to accessing this care is the lack of physicians/care clinics that provide or advertise care in New Jersey.
Conclusion: New Jersey is in dire need of physicians and medical institutions that openly treat transgender patients, particularly in coastal and central New Jersey. New Jersey physicians need to increase their online presence to be ‘searchable’ so that transgender patients can find providers for treatment
Alpha 7 Nicotinic Acetylcholine Receptor Expression in the Hippocampus of Patients with Schizophrenia
No full textBackground: Schizophrenia (SZ) is a heterogenous psychiatric condition characterized by disruptions in cognition, social activity, affect, and perception often associated with a varied combination of positive and negative symptoms. The pathophysiology behind SZ remains poorly elucidated. Earlier reports have cited the importance of the alpha 7 nicotinic acetylcholine receptors (α7nAChR) in the hippocampus and the receptor’s association with auditory sensory gating and cognitive function. Specifically, variations in the expression and functionality of α7nAChR can be linked to auditory hallucinations experienced by patients with SZ and several therapies have been researched that target α7nAChRs. However, there are very few primary research articles that directly measure α7nAChR expression in the hippocampus of patients with SZ. Earlier reports have used an indirect method of α-bungarotoxin labeling for investigating α7nAChR expression and failed to provide conclusive data. Therefore, a need was established to directly measure α7nAChR expression in the hippocampus and surrounding temporal cortex of patients with SZ.
Methods: We obtained formalin-fixed paraffin-embedded postmortem brain samples from the hippocampus and surrounding temporal cortex from subjects with SZ (n=19) and age-matched controls (n=24) from the Maryland Brain Collection and NIH NeuroBioBank. We are using an immunohistochemistry (IHC) approach, and the sections were probed with anti-α7nAChR antibodies. We have scanned the slides using an Aperio Slide Scanner at 20X (Leica BIOSYSTEMS). Next, we performed a semi-quantitative image analysis utilizing Color Deconvolution V9 tool (Aperio ImageScope, Leica BIOSYSTEMS) to develop color deconvolution heat maps for IHC images. The extent of α7nAChR immunoreactivity was compared between the SZ and age-matched control groups.
Hypothesis: The expression of α7nAChR in the hippocampus is perturbed in SZ compared to age-matched controls.
Results: A semi-quantitative analysis of the IHC data shows an increase in α7nAChR expression in the SZ samples compared to age-matched controls.
Conclusion: Our semi-quantitative data with a small sample size suggests perturbed α7nAChR expression in patients with SZ and therein, its potential role in mediating SZ-related pathophysiological and behavioral changes
Barriers to Healthcare Access Between English and Spanish Speakers in an Underserved Population
Get PDF• According to the NJ State Department of Health, Atlantic County has higher rates of smoking, respiratory disease, hypercholesterolemia, as well as death rates due to coronary heart disease, HIV, and all cancers compared to the NJ state average1,2.
• With over 20% of Atlantic County\u27s population identifying as Hispanic, Spanish speakers encounter greater obstacles compared to their English-speaking counterparts in accessing healthcare services and improving health outcomes1,2 .
• Existing research indicates that various factors, including health insurance coverage, proximity to healthcare facilities, transportation options, health literacy levels, and trust in the medical profession, significantly influence access to healthcare services5,6 .
• It is crucial that healthcare initiatives understand barriers to accessing healthcare for Spanish speakers to ensure effective communication, improved health outcomes, and enhanced patient satisfaction
Between NSAIDs, Local Anesthetics, and Non-medicinal Analgesics, Which Method is the Most Effective at Providing Pain Relief During IUD Insertions for Nulliparous and Multiparous Women?
Get PDFObjective: One major barrier for usage of intrauterine devices (IUD) includes a widespread sense of fear regarding pain during insertion of this contraception. By researching the most effective IUD insertion analgesics available and standardizing these pain management methods, women may be less fearful of obtaining IUDs.
Methods: A comprehensive literature review was conducted using Scopus, PubMed, Web of Science, EMBASE and Cochrane Library to compare methods of pain relief during IUD insertions. Outcomes measured include the pain management method used, the dosage administered, the pain experienced by patients evaluated using a Visual Analog Scale (VAS) prior to insertion of the tenaculum and post insertion of the IUD.
Results: Results relating to lidocaine analgesics showed inconsistent efficacies. Particularly, the use of lidocaine-prilocaine cream was evaluated to be the most substantial in lowering IUD insertion pain, followed by paracervical lidocaine, as evaluated by a holistic meta-analysis assessing 38 randomized controlled trials.
The effectiveness of NSAIDs, including naproxen, diclofenac potassium and ibuprofen, demonstrated diverse outcomes in this review. While ibuprofen failed to achieve a statistically significant reduction of pain during IUD insertion, tramadol demonstrated a substantial analgesic effect compared to naproxen and placebo group.
Inhaled lavender, verbal analgesics and the use of a cold compress did not produce a notable reduction in pain scores. The use of transabdominal ultrasound guidance during IUD insertion demonstrated a significant decrease in VAS pain perception compared to the traditional insertion method.
Conclusions: These results emphasize the potential of lidocaine-prilocaine cream and specific NSAIDs for pain management, while also stressing the need for further research to optimize administration methods, dosages, and combinations for improved pain reduction during the procedure
The intersection of Interprofessional Education and One Health: A qualitative study in human and veterinary medical institutions
Get PDFInterprofessional Education (IPE) and One Health are two common and overlapping frameworks for teaching collaborative practice. IPE is common at human medical institutions, while One Health is more common in graduate and veterinary programs. The connection between IPE and One Health is still being explored both in scholarship and in real-world professional settings. This prospective, qualitative research study examines the intersection of IPE and One Health at institutions that are members of the Clinical and Translational Science Award (CTSA) One Health Alliance (COHA). COHA consists of veterinary schools partnered with medical institutions through the National Institutes of Health CTSA funding mechanism with the specific goal of advancing the understanding of diseases shared by humans and animals. Twenty-four interviews were conducted with professionals across eight professions. Subjects noted that some of the biggest barriers to IPE education were awareness, accessibility, efficacy, and implementation beyond the classroom. Competency across multiple institutions and a consistent, validated evaluation tool were noted to be lacking. Interviews highlighted a lack of a shared mental model for IPE and One Health across the medical professions, major hurdles for implementation in professional curricula, and a disconnection between bridging IPE and One Health to the workforce and global challenges. Future work in this area may be focused on assessing the IPE and One Health offerings beyond COHA institutions, giving a more holistic understanding on how IPE and One Health are being deployed. One Health can be operationalized through the adoption of IPE principles and practices into curriculum. This research is critical to educate others on current applications, role, and definitions of One Health and IPE. The ultimate goal of this work is to help cultivate transdisciplinary leaders in the human and animal medicine who will have the skills to solve systemic problems
Dermoid Cyst – Presenting with LLQ Abdominal Pain
Get PDFOvarian cysts are fluid-filled structures that may be defined as simple or complex and are often discovered incidentally on imaging. Their etiology can range from physiologically normal (such as follicular or luteal cysts) to ovarian malignancies. They are more common in the reproductive years secondary to endogenous hormonal production however may also occur at any age. Simple cysts more commonly occur among all age groups; mixed cystic and solid and completely solid ovarian lesions however have rates of increased malignancy. The most independent risk factor is age; therefore, post-menopausal women should have proper follow-up secondary to this risk. Some risk factors include infertility treatment, hypothyroidism, pregnancy, tobacco use, tubal ligation and tamoxifen. Among women of reproductive age, ovarian cysts are functional and benign. However, ovarian cysts are prone to complications, some of which include pelvic pain, cystic rupture, hemorrhage and ovarian torsion, which require prompt management
Effects of Exercise on the Cardiovascular Health of Adolescents and Young Adults With Down Syndrome
No full textIntroduction: It is known that the incidence of Down Syndrome has increased over time and that this condition is associated with congenital heart defects, lower cardiorespiratory capacity, and increased rates of obesity and type 2 diabetes. It has been shown that individuals who have congenital heart defects but not Down Syndrome have increased cardiorespiratory function after engaging in exercise. Unfortunately, the role of exercise in improving cardiovascular health outcomes among individuals with DS is not yet fully understood.
Results: Exercise has been found to improve several health outcomes among individuals with Down Syndrome. For example, moderate to vigorous treadmill exercises increased the maximum heart rates and maximal oxygen consumption of those with this condition. Participants engaged in circuit training and plyometrics also experienced increases in peak minute ventilation and aerobic capacity. Lastly, aerobic and resistance training both reduced systolic, diastolic, and mean blood pressures among individuals with Down Syndrome.
Conclusions: These results show that exercise is effective at improving cardiovascular health outcomes among adolescents and young adults with Down Syndrome. However, few studies have investigated these effects, and larger sample sizes and more studies that focus on Down Syndrome patients with congenital heart defects are needed to draw more generalizable conclusions. It is imperative that we create exercise interventions that will maximize cardiovascular health outcomes among this population
Evaluation of the Efficacy of Novel Drugs and Combinations Against Extensively- and Pan-Drug Resistant Acinetobacter baumannii Isolates
Get PDFAcinetobacter baumannii, a Gram-negative, nosocomial, opportunistic pathogen is commonly infectious in immunocompromised patients. More specifically patients develop healthcare-associated infections (HAI) spanning beyond sepsis, pneumonia, meningitis, and urinary tract infections. Due to its rapid ability to acquire antibiotic resistance, it has raised the necessity to discern a novel therapeutic treatment that can be effectively used against the multidrug resistant (MDR) A. baumannii. Cooper University Hospital (CUH) faced an increased case load of patients that were infected with MDR A. baumannii. The patient isolates obtained from CUH were highly resistant to the 22 standard-of-care antibiotics. With the recent introduction of novel antibiotics released onto the market, the possibility of antimicrobial synergism between old and new drugs was tested. We tested to see if drug synergy existed between levofloxacin and cefepime, and levofloxacin and amikacin. We also studied the potency and potential synergism of the newer drug cefiderocol in combination with the 22 standard-of-care antibiotics. Levofloxacin and amikacin showed limited efficacy as a drug combination making it an ineffective option in a clinical setting. However, levofloxacin and cefepime showed promise as an effective therapeutic combination. Experimental studies with cefiderocol showed contamination, requiring future evaluation with cefiderocol. We plan to further explore the drug combination levofloxacin and cefepime against other patient isolates in the collection. Obtaining useful dual antibiotic therapies can provide clinicians with an immediate resource to help treat patients with highly drug-resistant A. baumannii infections
Investigating the Factors That Lead to Sports Related Injuries in Children
Get PDFThis project’s focus is to investigate if playing contact versus non-contact sports at a young age leads to more sports related injuries and to identify which factors correlate with increased injury rate in order to develop the most effective prevention and treatment methods. Data was collected through a survey including questions that delve deeper to quantify the amount of strain being put on the youth athlete’s body such as hours played a week, level of competitiveness, weeks played in a year, contact versus non-contact sport, and number of sports played. The following set of questions then addressed the actual injury by considering which sport caused it, the location of the injury, length of recovery, recovery methods, and if reinjury occurred. Prior research states that even though exercise has positive implications on health, youth athletes have a greater prevalence of sports injury specifically musculoskeletal injuries since they are still developing. In conclusion, males experienced a greater number of injuries during a contact sport, while females experienced a greater number of injuries during a non-contact sport. Overall, an increase in the number of seasons played in a year and number of training sessions per week resulted in more injuries. In the future, it would be ideal if this data could help create guidelines for training youth athletes to prevent injuries by raising awareness of which factors lead to a significant increase in injuries
Investigating the Link Between Preeclampsia/Eclampsia in Mothers and Cardiovascular Risk Among Their Neurodivergent Children
Get PDFPreeclampsia/Eclampsia are common gestational conditions among pregnant women. These individuals have hypertension after 20 weeks of gestation, proteinuria/end-stage organ disease, and may have seizures. These conditions can put the mother and fetus at risk.1,2 A review of literature investigates whether an association exists between congenital heart defects (CHD), and maternal preeclampsia/eclampsia in the neurotypical and neurodivergent population. The Rowan-Virtua Regional Integrated Special Needs (RISN) Center patient population was used to investigate whether maternal preeclampsia/eclampsia is indicative of higher congenital heart disease (CHD) in their neurodivergent children to achieve better quality of care. As a first step towards exploring the relationship between preeclampsia/eclampsia and CHD in the neurodivergent population, the current literature was reviewed. Retrospective Chart Reviews were also conducted. Preliminary data indicates that common congenital cardiac anomalies among the neurodivergent population whose mothers experienced preeclampsia/eclampsia are Tetralogy of Fallot, Bicuspid Aortic Valve, Atrial Septal Defect, Ventricular Septal Defect, and Pulmonic Stenosis. More studies need to be done on the neurodivergent population to determine whether a strong association exists between congenital cardiovascular anomalies and maternal preeclampsia/eclampsia