Development of a Global Health Curriculum at Christiana Care Health System: An Independent Academic Health Center and Member of the Delaware Health Sciences Alliance

Work in Progress (16 PowerPoint slides) The Global Health Program at Christiana Care Health System (CCHS) is an innovative, multi-disciplinary educational program seeking to improve the public health knowledge base and skills of interested health professionals through didactic, simulation and clinical experiences. A recent AAMC survey revealed 30% ofU.S.medical students participated in an international elective in 2006 versus 15% in 1997. In a resident survey at CCHS in 2010, 70% of residents responded that it was important to have global health education. These figures indicate an increasing interest in global health during residency training. In order to draw interest from a variety of backgrounds, we developed a multi-disciplinary global health training program. The curriculum is designed to include CCHS staff and our colleagues at other Delaware Health Sciences Alliance (DHSA) institutions, includingNemoursA.I.DuPontHospitalfor Children,ThomasJeffersonUniversityand the University of Delaware. The core curriculum consists of a monthly lecture series, including local and guest speakers. The lectures are recorded and accessible to CCHS affiliates via intranet. In addition, we plan to incorporate a journal club, a skills workshop and develop a global health site to foster an international partnership and resident elective rotations. Since the program began in August 2011, we have had five meetings. Attendance has steadily increased in number and diversity; attendees now include undergraduates, medical students, residents, fellows, attending physicians, nurses, administrators and medical librarians. We initiated a post-meeting survey at our December meeting which demonstrated a mean increase in the level of awareness of the topic by 27%. Global health awareness allowsU.S.based health professionals to be more culturally competent and effective in advocating for the needs of the underserved in their own communities. By inviting all disciplines at multiple institutions we hope to create a community that supports and sustains global health. Learning Objectives: At the end of this session, participants will: 1. Identify the importance of a global health curriculum for training residents that are culturally aware and equipped to work in underserved populations both locally and abroad. 2. Acquire the information to initiate a global health program in a teaching hospital. 3. Learn how to incorporate a multi-disciplinary approach to global health education

Viruses

In this multicentre cohort study, we evaluated the risks of maternal ZIKV infections and adverse pregnancy outcomes among exposed travellers compared to women living in areas with ZIKV circulation (residents). The risk of maternal infection was lower among travellers compared to residents: 25.0% (n = 36/144) versus 42.9% (n = 309/721); aRR 0.6; 95% CI 0.5-0.8. Risk factors associated with maternal infection among travellers were travelling during the epidemic period (i.e., June 2015 to December 2016) (aOR 29.4; 95% CI 3.7-228.1), travelling to the Caribbean Islands (aOR 3.2; 95% CI 1.2-8.7) and stay duration \textbackslashtextgreater2 weeks (aOR 8.7; 95% CI 1.1-71.5). Adverse pregnancy outcomes were observed in 8.3% (n = 3/36) of infected travellers and 12.7% (n = 39/309) of infected residents. Overall, the risk of maternal infections is lower among travellers compared to residents and related to the presence of ongoing outbreaks and stay duration, with stays \textbackslashtextless2 weeks associated with minimal risk in the absence of ongoing outbreaks

Can Recurrent Pregnancy Loss Be Prevented by Antithrombotic Agents?

Antithrombotic agents encompass two classes of drugs: antiplatelet agents and anticoagulant agents. Antiplatelet agents prevent platelets from aggregating and forming blood clots. This chapter explores the evidence for use of these agents in preventing recurrent pregnancy loss (RPL) in women with and without a diagnosed thrombophilia. The presence of a thrombophilia can increase the risk of multiple adverse pregnancy outcomes. The initial studies that found an association between RPL and inherited thrombophilias were small case-control studies and meta-analyses. Multiple prospective studies exist looking at the effect of anticoagulants on successful pregnancy outcome in women with RPL and no inherited thrombophilia. Many trials have been performed examining the combination of antiplatelet agent aspirin in women with RPL and without a history of inherited thrombophilia. M. Tulppala et al. originally looked at aspirin versus placebo for women with RPL and no history of thrombophilia and found no difference with aspirin treatment in live births between the groups

A survey of the knowledge, attitudes and practices on Zika virus in New York City

Abstract Background Over 900 travel-associated Zika virus cases have been identified in New York City (NYC), New York. A survey was administered in NYC adapted from the Knowledge, Attitudes, and Practices (KAP) survey on Zika virus developed by the World Health Organization (WHO). Methods A standardized, self-administered, anonymous questionnaire was administered to a convenience sample in Manhattan and the Bronx from June 30th, 2016 to October 21st, 2016. Responses were grouped into six domains based on the content and structure of the questions and were summarized using descriptive statistics or converted into a continuous knowledge score and assessed for associations with pregnancy status and travel history using linear regression. Results There were 224 respondents with a mean age of 33 (SD ± 11.6) with 77% (170/224) female and 24% (51/224) pregnant. The majority (98% (213/217)) were unable to identify all of the symptoms associated with acute Zika virus infection and all modes of transmission (97% (213/219)). Most participants (85% (187/219)) identified mosquitoes as a mode of transmission. 95% (116/122) reported an association between Zika virus and microcephaly. The most concerning aspect of Zika virus in 46% (91/200) was the risk of disabilities to babies, and risk of sexual transmission (25% (49/200)). When asked what precautions pregnant persons should to reduce the risk of transmission when traveling to a Zika endemic region, only 27% (50/185) identified using condoms during intercourse or refraining from intercourse while pregnant. Knowledge of Zika transmission is significantly positively associated with pregnancy status, but not with travel history. Conclusion Our results indicate an overall poor understanding of Zika virus symptoms and possible complications, transmission modes, and current recommended prevention guidelines. Pregnancy is positively associated with Knowledge of Zika Transmission, but not other knowledge scores. Reported travel history to Zika endemic regions is not significantly associated with Zika knowledge. There is a need for implementing future public health interventions that particularly focus on protection against Zika transmission, that Zika is sexually transmitted, and risks that the Guillain-Barré Syndrome poses a risk to adults

Additional file 1: of A survey of the knowledge, attitudes and practices on Zika virus in New York City

Elaborated Statistical Analysis Methods. Provides detailed information regarding the organization of questions into domains and the statistical methods used in analysis. (DOCX 39 kb