A guide to Cultural Competency for LGBTQ Patients

Cultural competency spans far beyond ideas of just race, ethnicity and cultural practices. One of the areas where additional competency is greatly needed is the field of LGBTQ patient care. Many LGBTQ individuals face unique challenges in the healthcare system including unconscious bias, discrimination, prejudice and altogether rejection. In addition, hetero-normative language and practices can cause patients to feel uncomfortable even before the care process really begins.

In an effort to advise health and social services agencies on best practices, the National LGBT Cancer Network has created a guide for effective competency training.  This can serve as a valuable tool for organizations looking to strengthen their practice and competency with LGBTQ populations. It can also provide useful information for individuals as well. For current and future physicians, being familiar with the practices outlined can help you become a training leader within your work place, and an advocate for better LGBTQ patient care.


Resources:

Best Practices in LGBTQ Cultural Competency Training 

National LGBT Cancer Network Website 

Kaiser Foundation Policy Brief: Health and Access to Care and Coverage for LGBT individuals in the U.S.

Read More

Infectious Disease in the News Pt. II: Enterovirus D68

Enteroviruses are single-stranded RNA viruses that commonly cause disease in the warmer months of the year.  Some of the better known enteroviruses include polio, Coxsackie A and B, and echovirus.  They can be found in the respiratory secretions and stool of an infected person.   Most infections with non-polio enteroviruses are asymptomatic or cause a brief febrile illness, but some have been associated with pleurodynia (inflammation  of the lining of the lung), myopericarditis (inflammation of the lining of the heart), acute hemorrhagic conjunctivitis, aseptic (non-bacterial) meningitis, encephalitis, herpangina (painful mouth blisters), and hand-foot-and-mouth disease.

Enterovirus D68 is one of more than 100 non-polio enteroviruses.  First identified in California in 1962, the virus caused sporadic illness similar to the common cold until August 2014 when cases of severe respiratory disease in children were diagnosed in the Midwest.  Since that time, cases have been reported from 43 states, the District of Columbia, and Canada.  Some have required hospitalization and respiratory support.  Children with asthma appear to be at increased risk for more severe respiratory illness.  There have also been reports of associated polio-like paralysis though this is less definitive. No antiviral medications are available to treat enteroviruses, and there are no vaccines to prevent disease (other than polio vaccine).

Like other respiratory viruses, D68 spreads from person to person through coughing, sneezing, or touching a surface previously touched by an infected person.  So, the best way to protect yourself and prevent spread is through good personal hygiene – hand-washing, avoiding touching your eyes, nose and mouth, not sharing cups or eating utensils, disinfecting commonly used surfaces, and covering coughs and sneezes with a tissue.

Resources:

Enterovirius D68 CDC Information page 

What Parents Need to Know (Healthy Children.org) 

Hand Washing: A Powerful Antidote to Illness (Healthy Children.org) 

Read More

A Closer look at Gender Pay Inequality

The American Association of University Women (AAUW) recently released their fall 2014 report "The Simple Truth About the Gender Pay Gap" that gives a great overview of pay inequality in America based on gender. The report looks closely at differences by race, specific occupations and within all 50 states. It also addresses common misconceptions about why this gap exists. Most importantly, it addresses how this often overlooked problem effects women and their families and why it is something that needs to be addressed, especially in light of the Paycheck Fairness act being blocked by the senate this past September. For many women equal pay could mean better life for themselves and their families, as higher income is associated with lower stress, greater autonomy and better overall health. Everyone has something to gain if we can get rid of the gender gap.

Resources: 
AAUW Gender Gap Summary Page

The Simple Truth About the Gender Pay Gap - Full Report 

Read More

More Protection From Ebola for Hospital Staff

Adding to our post from yesterday,  news has been circulating evaluating how hospitals are handling Ebola  and the risks it can pose to staff. Particularly, nurses have began to speak out ever since the Dallas nurse who was recently diagnosed Ebola (After treating the first patient in the U.S. to develop the disease)  was said to have contracted it through a "breach in protocol". Now, many are speaking out about the protocol in their own hospitals to spread awareness and cause change.  The article Ebola–RNs Call for Highest Standards for Protective Equipment, including Hazmat Suits and Training gives insight into what nurses are reporting across the country. It is hopeful as healthcare providers take a stand, both the hospitals and those in policy will work to make the handling of infectious diseases safer for both patients and the workers providing their care. 

Read More

Infectious Disease in the News Pt. I: Ebola

Ebola is caused by infection with one of five filovirus strains, a type of single-stranded RNA virus.  It can be transmitted to people from wild animals and further spreads via human-to-human transmission, causing severe, often fatal disease in humans and non-human primates.  Although its natural reservoir is unknown, fruit bats have been implicated. 

Ebola was first discovered in 1976 near the Ebola River in the Democratic Republic of the Congo. Over the years, sporadic outbreaks have occurred in remote African villages.  The current outbreak was first reported in March 2014.  It is the largest in history, involving both rural and urban areas in multiple countries in West Africa, and has been designated the first Ebola epidemic the world has ever known. Human-to-human transmission occurs via direct contact (through broken skin or mucous membranes) with blood, and other bodily fluids (e.g. saliva, stool, semen, breast milk) of infected people.  Contaminated surfaces and materials such as clothing and bedding also serve as sources of infection.     

Previously known as Ebola hemorrhagic fever because of the internal and external bleeding that can occur, the illness has an incubation period between exposure and the onset of clinical illness that ranges from 2-21 days.  Humans are not infectious until they develop symptoms which typically mimic a flu-like illness with the sudden onset of fever, fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and in some cases bleeding.  Leukopenia (low white blood cell counts), thrombocytopenia (low platelet counts), and elevated liver enzymes can be seen.   A definitive diagnosis can be made using specialized testing of blood samples (e.g. ELISA, RT-PCR, electron microscopy or cell culture) under maximum biological containment conditions. 

The average case fatality rate is ~50%, though can be as high as 90%.   There are no specific, proven therapies or vaccines for Ebola, though several health workers have been treated with ZMapp, an investigational product comprised of three humanized monoclonal antibodies.  There is also interest in empirically transfusing convalescent whole blood or plasma from patients who have recovered to patients with early Ebola disease.  Supportive care may improve survival, but this unfortunately is lacking in many African countries.  Gowns, gloves, masks and goggles or face shields should be worn by healthcare personnel and family members caring for ill patients, and hand washing should occur often. These have also been in short supply in Africa and strict infection control practices have been lacking. 

Current CDC recommendations for individuals who may have had contact with ill patients include isolation (staying at home and avoiding public contact) and monitoring daily temperatures and symptoms for 21 days to detect any potential illness as quickly as possible.  

Resources: 

CDC Ebola information page

Read More

Tis' the (Flu) Season! - Facts about the Flu and Dispelled Myths

Every September when we think about “back to school” season, we should also think about another season just around the corner - flu season.  Many people shrug off getting vaccinated against the flu with a variety of excuses like: “I never get the flu”, “the flu is just like a bad cold” or “I’d rather get the flu than get a flu shot which GIVES me the flu”.  So, let’s dispel some of these misconceptions.

How Dangerous is Influenza?

The flu is not just another cold.  In addition to making you feel absolutely miserable for days with fever, congestion, cough and body aches, it is far more dangerous than the common cold or other circulating upper respiratory infections.  Each year approximately 200,000 people in the U.S. are hospitalized due to influenza, and up to 49,000 die.  Compare that to the annual mortality from breast cancer (~40,000) or AIDS (~19,000) in the United States.  Although morbidity and mortality are generally highest among young children and adults over age 65, last year, 60% of hospitalizations occurred among adults between the ages of 18 and 64 – those who had vaccination rates of only 37%.    

When is Flu Season?

Flu seasons are unpredictable and vary from year to year in terms of timing, severity, and length.  Although influenza activity most commonly peaks in the U.S. between December and February, some years have seen cases begin as early as October and continue as late as May.

How is Flu Spread?

Influenza is spread by droplets up to 6 feet away through coughing, sneezing or talking. You can also get the flu by touching a surface or object that has flu virus on it and then touching your mouth or nose.  Most people know they can get the flu from patients and coworkers who are sick, but don’t realize they can spread it to others even if they don’t feel sick.  Most healthy adults can infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick.  Approximately 20% to 30% of people carrying the influenza virus have no symptoms.

Who Should Get Vaccinated?

CDC recommends a yearly flu vaccine(http://www.cdc.gov/flu/protect/vaccine/index.htm) for everyone 6 months of age and older, preferably by October, since it takes about two weeks after vaccination for an immune response to develop. 

Individuals at particularly high risk for influenza include:

• Children younger than 5 (especially those younger than 2 years of age)

•Adults 65 and older

•Pregnant women

•People with chronic health issues like asthma, diabetes, heart disease, cancer and HIV/AIDS.

Dispelling the Myths

“The flu vaccine can give you the flu”

Injectable flu vaccines contain inactivated, non-infectious virus particles.  Although the nasal spray vaccine does contains live flu virus, it is attenuated (weakened) in such a way to be able to stimulate immunity without causing illness.  People not only mistake the side effects of the vaccine for the flu but also erroneously attribute illness with other unrelated cold viruses to the flu. 

“I can take antibiotics if I get the flu”

Antibiotics only treat bacterial infections – not the influenza virus.  Although there are antiviral medications against the flu, to be effective in reducing the duration and severity of illness, they must be taken within 48 hours of the beginning of symptoms. 

“I don't need to get a flu shot every year”

Influenza viruses are constantly changing (mutating), so each year flu vaccines are updated to protect against the most common circulating viruses.  Although protection from the vaccine decreases over time, protection typically lasts about a year.

“Pregnant women should not get a flu shot”

Pregnant women and their offspring are at very high risk for complications from the flu.  Pregnant women are 7 times more likely to be hospitalized than non-pregnant women and account for 5% of all flu-related deaths.  All pregnant women should to be vaccinated with inactivated flu vaccine.   

“Getting the flu vaccination is all I need to do to protect myself from the flu.”

Besides vaccination, avoid contact with people who have the flu and wash your hands frequently!

Bottom Line

By getting vaccinated and practicing good personal hygiene, you not only help to protect yourself, but your family, friends and patients.

Read More

Thoughts on Feminism

Feminism is getting a lot of buzz lately, with many examples of violence and unequal treatment towards women flooding the airways. However, there are mixed ideas about what feminism is, who is a feminist and the ultimate goals surrounding the idea.

The answer is very simple. Feminism is an ideology that focuses on creating equal rights for women and feminine qualities. Traditionally, women have not had equal opportunities to many things (employment, voting, education), which caused feminist movements to develop. There have been significant and positive changes in women's rights, but there still strides to be made. Women are still paid less than men (for the same work) and experience violence on a much higher scale.  Because of factors such as these exist, the focus of feminist ideals is mostly on women. However, men are not excluded. Feminism seeks to defend men who are perceived as feminine from back lash that should not exist in the first place. Feminism tells us that it is okay for a man to express his feelings and he should not be afraid of being "less than a man". Feminism glorifies a man in his role as a father, instead of making him think that is a woman's job. Feminism does not come at the expense of men and NEVER seeks to put a man down simply for his chromosomal make up.

At the same time, feminism does not seek to control women, want them to dominate men, or force them into certain careers. If a woman wants to be a stay at home mother, that is great. Feminism wants to make sure that she has the resources to look after her children and that society does not devalue the hard work that she does.

Some people may have made you think otherwise in the past, but feminism is not a bad word. It is not just about women; it impacts men as well and won't be recognized without the help of men. Thankfully, we are seeing more attention being paid to this issue. From Emma Watson's speech for the He for She Campaign to Joseph Gordon Levitt's Re: Feminism video. However, it would be great to see these messages promoted beyond celebrities and national meetings.

Feminism needs to be an everyday word and practice. Gender equality is an essential step in improving the lives of all people. Remember, just because you do not personally feel that you face inequities does not mean that millions of people do not experiences them everyday.

Mentioned Links: 
He for She Campaign Website:  He For She.org 

Read More

Preventative Health Lecture Follow-up: Talking with Patients and Vaccinations

After Dr. Nunez’s informative and entertaining lecture on Women’s Health and Prevention Issues this afternoon, a few additional thoughts came to mind.  As she pointed out, sometimes there’s a little bit of a disconnect (or at least order of priorities) between what the patient is seeking help for and what the physician considers most urgent.  In the case presented, the patient was concerned about joint pain (osteoarthritis), but the physician would also be concerned about cardiovascular risk (hypertension, obesity, hyperlipidemia in a post-menopausal woman).  One way of trying to tie the two together to unite common goals might be to explain to the patient that weight loss (which would benefit her lipids and blood pressure control) would also likely ease the stress on her joints (knees) and decrease some of the pain she is experiencing.

On a different note, physicians often forget about vaccinations as an effective preventive care measure.  This patient should have been receiving annual flu vaccinations (as we all should) and should also be asked about the last time she received a tetanus vaccine.  If she is due for a tetanus shot (which many adults neglect/forget since it is received ~ every 10 years), she should receive Tdap.  This tetanus toxoid combined with pertussis vaccine is now recommended for all adults who have not already received it and is especially important for those who may have small children (e.g. grandchildren) in their household, since pertussis is most serious, even potentially fatal, in infants.  When she turns 60, she will be eligible for the shingles vaccine (ZOSTAVAX) and at age 65 for two pneumococcal vaccines (PREVNAR 13 and PNEUMOVAX 23, which are recommended to be given sequentially).  If she were part of a high risk group such as individuals with diabetes, heart disease, chronic liver or lung disease, pneumococcal vaccination would be administered at a younger age.  Guidelines are currently in flux with the availability of two vaccines now for adults, so stay tuned for the CDC to issue new guidelines soon!

Resources:

http://www.cdc.gov/vaccines/schedules/hcp/adult.html

Read More

Risk Factors For Heart Disease: Worse for Women & African Americans

A recent study reported in Health Day.com demonstrates the disparity felt by women and African Americans when it comes to risk factors for heart disease. In particular, diabetes and high blood pressure were found to be major contributors to this sex and race gap by increasing the chance for heart disease to develop significantly in these groups when compared to men in general.

When looking at combined risk from 5 factors (High cholesterol, smoking, high blood pressure, obesity and diabetes) blacks had an increased risk of 67% to develop heart disease as compared to 48% in whites. Women had a combined risk of 58% compared to 48% in men. These risks ultimately make these groups more likely to experience poor health outcomes, or even die from complications of heart disease and stroke.

 But why is this happening? From a clinical perspective, the article suggested that " this difference in risk could be due to the fact that heart disease has typically been considered a disease of white men, and doctors have not tackled contributing factors as much when they crop up in women and blacks." If this is the case, this image of the "typical" heart disease patient can be putting lives at risk. It is later suggested that doctors take risk factors more seriously in these populations since their chance for later development is higher.

Patients can also have an important role in bridging this gap. It is important to know your family history, be aware of the things you are at high risk for and  try your best to manage any risk factors you do have. If you don't feel like your doctor is taking your risk factors seriously, seek a second opinion. Remember, your family history does not have to be your biography. Ask your doctor what you can do to reduce your risk factors for heart disease. In some cases, small life changes can make a big difference.

Resources:

Original Article: Women, African Americans Hit Harder by Heart Disease Risk Factors, Heath Day.com

Article Referenced: Philly.com 

Article: How to Prevent and Control Coronary Heart Disease Risk Factors , NIH

Video: Heart Healthy Tips, 5 Superfoods 

Read More

Possible Health Benefits of Lower Bedroom Temperatures

You may want to think twice before turning down your air conditioner! An interesting study was released recently investigating the possible health benefits of sleeping in cooler temperatures at night. It is something we usually do not think about, but some are starting to think it can really make a difference. Specifically, researchers set out to see if it had an effect on stores of brown (good) fat which has the potential to improve metabolism.  Sponsored by the American Diabetes Association, researchers took 5 healthy young men and had them sleep in a controlled environment. During the course of the experiment, they had them all sleep in different room temperatures. It was found that when the temperature was cooler, significantly higher amounts of brown fat were found. This implies that there is possibility of metabolic benefit to sleeping in colder temperatures.

However, is the same true for women? We do not know. Since the study only included 5 men, it is impossible to know if the same results would have been found in a group of 5 women. With the possible metabolic benefits this study eludes to, it is hopeful that it will be repeated not only with women, but with a larger and more diverse group.

Resources:
Article abstract and link in PubMed

Article: Let's Cool it in the Bedroom  New York Times

Read More

Video Presentations from the Academy of Women's Health

The Academy of Women's Health is currently offering complimentary videos on their women's health website. Two talks are availible on two very interesting and important topics: fibroids and STD's. Click here to access the webpage including a short description of each talk, and a link to access them. Direct links to the YouTube videos of these talks have been posted below. Enjoy! 

Resources:

Video: Fibroids: New Options in Medical & Surgical Management

Video: Sexual Health: Do Ask, Do Tell

Academy of Women's Health Website

Read More

How Racial Stereotypes can Isolate Women Experiencing Infertility

The article Infertility, Endured Through a Prism of Race  from the New York times brings to light an issue that has gotten less attention than needed. This examined how racial stereotypes about conception can isolate minority women (specially African Americans) who are dealing with infertility. Stereotypes as well as cultural expectations, depict black women as very fertile and able to have children whenever they are ready. It is also not an issue that is talked about as much in the black community, and women of color are under-represented in the population of women seeking help to conceive.

This is the case even when black women on average, are twice as likely to experience problems with fertility as white women. However, those most often seeking help with issues of fertility are white women of higher income and education. It is explained that these women often have the best healthcare coverage and resources to work with, but this is not exclusively why they are the highest population utilizing these services. Even when all services were covered by insurance, black women were less likely to seek out fertility treatments. The article attributes this to a lack of resource information, cultural beliefs and bias from medical professionals. Many times black women are not given the same medical advising with doctors focusing more on STD's then issue of fertility.

For all women, it is important to make sure that fertility is not an issue you are experimenting alone. Speak to people you trust and your doctor about any problem you may be having. Seek out resources and talk to others who have gone through the same things. By being open and honest about your situation, you will not only help yourself but you may also help someone close to you who is dealing with the same thing.


Resources:
Article: Infertility Endured Through A Prism of Race - NY Times

Fertility for Colored Girls - Organization dedicated for fertility empowerment in African American women

Read More

Congratulations to DUCOM class of 2014!

Today, after four years of hard work (and many more preceding) Drexel University College of Medicine's class of 2014 got their degrees! WHEP congratulates you and we are happy to call you all doctors! Good luck on the journey ahead and never forget the valuable things you learned as a student at DUCOM!

A Special shout out goes to our pathway students! the students in the class of 2014 are truly special and all have great things in store for them. We are glad to have provided support for the last leg of your race. Go show the world what you are made of!

Read More

This week is National Women's Health Week!

Women's Health Week is May 11th-17th. It is a time to reflect on the advances that have been made in women's health, while focusing on the many areas that still need attention. It can also serve as a reminder for all women to check your health. Are you up to date on all of your primary care visits? Is there a concern that you've been meaning to get checked out? Is there a bad habit that you would like to quit? Don't wait! Now is the time to take charge of your health! If you are worried about the cost of a doctors visit, the ACA has made yearly check up's for women more affordable and on many health plans, completely free.

This week serves as a great reminder to stay healthy, but don't forget, it is important for women and the people around them to be concerned for their health everyday! 

Resources: 

Women's Health.gov - Women's week infographic

My Family Health Portrait - Keep track of your family history and 

share at your yearly doctors visits.

Read More

Celebrating Nurse and Teachers!

This week we celebrate two very important career fields; nursing and teaching . Nurses week is May 6th-12th this year while teachers appreciation week is May 5th- 9th. Take the time to thank and appreciate the nurses and teachers and all they do for us! And if you are a nurse or a teacher, we thank you!

Read More

Whats up WHEP: Transdisciplinary Research Projects

Congratulations to the Transdisciplinary Education within Women's Health elective students, class of 2014 for completing their research projects! We were very impressed by the quality of projects and the depth of discussion. You should all be proud of the work you did. We even had a student bring in some flowers to have Spring inside with us as we learned about important issues in women's health!


Current fourth year students... consider joining this great elective!

Read More

FDA Safety Warning for Laparoscopic Uterine Morcellation

Just last week, the FDA issued a communication about the possible dangers of Laparoscopic Uterine Power Morcellation for hysterectomy and myomectomy. This process is typically used to perform minimally invasive hysterectomys and to remove uterine fibroids (myomectomy). Morcellation divides the tissue that is being removed into smaller pieces so that they can be easily extracted though a small incision. However, it is estimated that about 1 in 350 women will have an undetected cancerous sarcoma when receiving this treatment, which may cause the cancer to spread to other parts of the lower body. The FDA therefore discourages the use of this treatment for women with fibroids. 

Physicians are advised not to use this type of treatment, especially for women with known or suspected uterine cancer. It is important to discuss in detail, all treatment options with patients who have uterine fibroids. Patients are encouraged to ask questions about the risk and benefits associated with all treatment options. If this is a procedure you have already had done and your removed cells tested negative for cancer, it is recommenced that you have a routine follow-up with your healthcare provider. 

Resources:

Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy: FDA Safety Communication

Information on Uterine Sarcoma

Uterine Fibroids Factsheet

Read More

¿Que es la depresión?

La vida tiene muchos altas y bajas pero cuando las bajas siguen mas de un par de semanas o meses y  le detiene de hacer su vida cotidiana, puede ser que este sufriendo de depresión. Esta condición es una enfermedad que puede afectar todos aspectos de su vida como su salud física, su humor y pensamientos. Es importante que sepa que esta condición es seria y no se trata de solo sentir triste por unas horas. Usted no tiene control sobre estos síntomas.

¿Cuales son los síntomas de depresión?

-          sentir ansiedad, tristeza

-          sentimientos de desesperanza

-          falta de interés en actividades que le gustaba antes

-          falta de energía

-          dificultad para mantener la concentración, memoria, y hacer decisiones

-          cambios en su sueno como dificultades en dormir, o durmiendo mas horas

-          comer muy poco o en mucho cantidad

-          pensamientos de suicidio

-          síntomas físicas que no se recuperan con medicamentos, como por ejemplo dolor de cabeza, dolor de panza, o dolor general

¿Como puede conseguir ayuda?

Si siente algunas de estas síntomas, avise a su medico, psicólogo,  o asistente social.  Pensamientos de suicidio puede lastimar a usted o a los que la aman. Si necesita hablar con alguien llame a 1-800-8255. En algunos momentos, puede ser que sienta que estas emociones son permanente pero estos van a pasar. Escribiendo sus pensamientos también puede ayudar. Es muy importante ver un medico para ver si necesita medicamentos.

¿Como puede ayudar a si mismo?

-          haga ejercicio o alguna actividad física

-          haga actividades que disfrutaba antes de tener estas síntomas, como ir al cine o a ala iglesia

-          establezca metas realísticas para si mismo

-          pase tiempo con la gente que la aman y con los que puede hablar con ellos

-          tenga paciencia con el progreso de su humor, puede ser que esto tome tiempo

-          posponga la decisiones importantes en su vida para después de sentirse mejor

-          tenga confidencia en su mejoramiento y transforme sus pensamientos negativos a unos positivos.

References:

http://toplarevista.files.wordpress.com/2013/12/quc3a9-es-la-depresic3b3n.jpg

http://www.womenshealth.gov/publications/our-publications/fact-sheet/depression.html#a

Read More

Alzheimers Aware: Essential For All Women

These days, Alzheimer's disease is familiar to most, but is often not on the radar for health conditions that older adults are concerned with. In reality, it is the 6th leading cause of death in the U.S., taking more lives then the more commonly monitored breast and prostate cancers combined.  It is also one of the most costly diseases, costing the US close to 215 billion dollars in healthcare costs.

Data from the 2014 Alzheimer's report shows that in several ways, women are at the center of the disease. In fact women make up almost two thirds of those diagnosed with Alzheimer's. Women are also the primary caregivers of this disease, with more than 60% being women. All of these caregivers contribute to billions of dollars of unpaid work hours due to care. This also takes away from time, advancement and benefits at the current job of many caregivers. The report goes on tho show that in general, Alzheimer's overall puts a greater strain the female population than males. Over the age of 60, women are twice as likely as men to develop the disease. So while Alzheimer's should be a concern to everyone,  elderly women and their family and friends should especially  know the signs, so Alzheimer's can be detected early if it does develop.

There is still  a lot left to left to learn about this disease, with much research to be done. Find out ways that you can help to get involved by clicking here and join the movement to eliminate Alzheimer's disease.