Publications

BACKGROUND

To explore associations between health status, contraceptive counseling and contraceptive use.

METHODS

Women aged 18-50 visiting one of 4 primary care clinics were invited to complete surveys after their visit. Perceived health status was measured using a 5-point scale. Among those considered at risk of unintended pregnancy, logistic regression was used to investigate associations between health status and contraceptive counseling and use.

FINDINGS

Women reporting poorer health had decreased odds of receiving some contraceptive counseling at their visit (aOR=0.62, CI=0.39, 0.97) and using some contraception at last intercourse (aOR=0.63, CI=0.41, 0.97) compared to women reporting better health. However, among women with poorer health, receipt of counseling about hormonal contraception was associated with increased odds of using hormonal methods (aOR=8.22, CI=1.77, 38.19). Only 7% of women in poorer health received counseling on highly effective reversible contraception.

CONCLUSIONS

Women in poorer health may be at risk of adverse reproductive health outcomes and should receive counseling on safe hormonal and highly effective reversible contraceptives.

PURPOSE

To determine the prevalence and requirements of structured, longitudinal, nondegree global health (GH) programs (e.g., certificates, tracks, concentrations) in U.S. MD-granting medical schools.

METHOD

In March 2011, two reviewers independently searched the Web sites of all 133 U.S. MD-granting medical schools and reviewed Google search results seeking evidence of, information about, and the requirements of structured GH programs. The authors excluded programs that were not open to medical students, granted a degree, and/or required medical students to extend training time.

RESULTS

Of 133 institutions analyzed, 32 (24%) had evidence of a structured GH program. Of the 30 (94%) programs for which the authors could find further information online, 16/30 (53%) were administered by the medical school, whereas 13/30 (43%) were administered by a different entity within the university; 1/30 (3%) was jointly administered. All 30 of the programs required additional didactic course work. The median number of courses was 4 (range: 1-12). Of the 30 schools with GH programs, 22 (73%) required an international experiential component, but only 12/30 (40%) specifically required an international clinical experience. Only 1 school (3%) directly addressed language or cultural proficiency.

CONCLUSIONS

Although structured GH programs were offered at one-quarter of U.S. medical schools, little standardization across programs existed in terms of requirements for didactic, clinical, scholarly, and cultural components. Online GH program information is not easily accessible, but it may be valuable in the development of new structured programs, the refinement of programs that already exist, and students' selection of medical schools.

Anti-N-methyl-D-aspartate receptor (NMDA-R) encephalitis, first characterized in 2005, is a neurological disease with prominent psychiatric features that frequently involves the consultation of psychiatrists. Since its discovery, the rate of diagnosis of new cases has increased rapidly and several epidemiological studies now confirm that NMDA-R encephalitis may be as common as many other prominent infectious etiologies of encephalitis. We describe a case of a young woman presenting initially with psychotic and mood symptoms who was found to have anti-NMDA-R encephalitis. We further provide details of her treatment and prolonged recovery process after hospital discharge with a review of the literature and discussion of the epidemiology, symptomology, diagnosis, and management of both the neurologic and psychiatric manifestations of this condition. Last, we contextualize the importance of anti-NMDA-R encephalitis for psychiatrists, highlighting the role for psychiatrists in establishing the initial diagnosis as well as in providing ongoing psychiatric care.