Trauma-Informed Primary Care

Samyukta Mullangi By SAMYUKTA MULLANGI MD, MBA, DANIEL W. BERLAND MD, and SUSAN DORR GOOLD MD, MHSA, MA Jenny, a woman in her twenties with morbid obesity (not her real name), had already been through multiple visits with specialists, primary care physicians (PCPs), and the emergency department (ED) for unexplained abdominal pain. A plethora of tests could not explain her suffering. Monthly visits with a consistent primary care physician also had little impact on her ED visits or her pain. Some clinicians had broached the diagnosis of functional abdominal pain related to her central adiposity, and recommended weight loss. This suggestion inevitably led her to become defensive and angry. Though our standard screen for safety at home had been completed long ago, I wanted to probe further, knowing that many patients with obesity, chronic pain and other chronic conditions have suffered an adverse childhood – or adulthood – experience (ACE). Yet, I hesitated. Would a busy primary care setting offer enough latitude for me to ask about a history of trauma when it can occur in so many forms, in so many ways and at different times of life? Furthermore, suppose she did report a history of trauma or adverse experience. What then? Would I be able to help her? Nonetheless, I began: “Jenny, many patients with symptoms like yours have been abused, either emotionally, physically, or sexually, or neglected in their past. Sometimes they have suffered loss of a lo...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Medical Practice Patients Physicians Adverse Childhood Experience primary care Social Determinants of Health Trauma Source Type: blogs

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Publication date: Available online 13 December 2019Source: Progress in Neuro-Psychopharmacology and Biological PsychiatryAuthor(s): Rebecca McMillan, Rachael Sumner, Anna Forsyth, Doug Campbell, Gemma Malpas, Elizabeth Maxwell, Carolyn Deng, John Hay, Rhys Ponton, Frederick Sundram, Suresh MuthukumaraswamyAbstractA single subanaesthetic dose of ketamine rapidly alleviates the symptoms of major depressive disorder (MDD). However, few studies have investigated the acute effects of ketamine on the BOLD pharmacological magnetic resonance imaging (phMRI) response and EEG spectra. In a randomised, double-blind, active placebo-co...
Source: Progress in Neuro Psychopharmacology and Biological Psychiatry - Category: Psychiatry Source Type: research
es DU Abstract Human t-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy (HAM) is a progressive neurological disease whose diagnosis is defined by clinical manifestations and seropositivity for HTLV-1 infection. Cognitive impairment (CI) is considered to occur after spinal impairment. A 51-year-old HTLV-1-infected man classified as an asymptomatic carrier presented difficulties in listening comprehension and executive memory. He was assessed for central auditory processing (CAP), cognition (event-related auditory evoked potential [P300]), and otoneurological functions (galvanic vestibular-evoked myogen...
Source: The American Journal of Tropical Medicine and Hygiene - Category: Tropical Medicine Authors: Tags: Am J Trop Med Hyg Source Type: research
In this report we conclude normal inflammatory markers cannot be used as exclusion criteria for the disease. We also review the body of literature to summarise the key features of the condition to assist clinicians in its diagnosis.
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
Publication date: January 2020Source: The Annals of Thoracic Surgery, Volume 109, Issue 1Author(s): Akiko Tanaka, Zain Al-Rstum, Samuel D. Leonard, Bri’Ana D. Gardiner, Ibrahim Yazij, Harleen K. Sandhu, Charles C. Miller, Hazim J. Safi, Anthony L. EstreraBackgroundWe reviewed the efficacy of intraoperative intercostal nerve cryoanalgesia for pain control in patients undergoing descending and thoracoabdominal aortic aneurysm repairs.MethodsDuring 2013 and 2017, 241 patients underwent descending and thoracoabdominal aortic aneurysm repair. Of those, 38 patients were treated with intraoperative cryoanalgesia to the inte...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Authors: Laine MK, Kautiainen H, Gissler M, Pennanen P, Eriksson JG Abstract There is a lack of data about the influence of sunshine hours on the prevalence for gestational diabetes mellitus (GDM). The aim of this study was to evaluate whether the prevalence of GDM varied according to hours of daily sunshine during the first trimester. The study cohort (N = 6189) consists of all primiparous women with a Finnish background who delivered between 2009 and 2015 living in Vantaa city, Finland. Data on births and maternal characteristics were obtained from National Health Registers. Data on sunshine hours were obtained f...
Source: International Journal of Circumpolar Health - Category: International Medicine & Public Health Tags: Int J Circumpolar Health Source Type: research
Publication date: Available online 14 December 2019Source: Trends in Food Science &TechnologyAuthor(s): Elisangela Aparecida Nazario Franco, Ana Sanches-Silva, Regiane Ribeiro-Santos, Nathália Ramos de MeloAbstractBackgroundFiber intake has been associated with a lower risk of developing various chronic diseases such as metabolic diseases (e.g. obesity, diabetes, dyslipidemia). In this line, psyllium presents a high content of soluble fiber, associated with health benefits.Scope and approachThe aim of this review is to evaluate the scientific evidence of psyllium health benefits. The nutritional properties of ps...
Source: Trends in Food Science and Technology - Category: Food Science Source Type: research
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Source: Public Health Reports - Category: International Medicine & Public Health Tags: Public Health Rep Source Type: research
We describe various retinal image datasets that can be used for deep learning purposes. Applications of deep learning for segmentation of optic disk, optic cup, blood vessels as well as detection of lesions are reviewed. Recent deep learning models for classification of diseases such as age-related macular degeneration, glaucoma, and diabetic retinopathy are also discussed. Important critical insights and future research directions are given.
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Conclusion: The AHD and CSA were reliably measured in the true AP radiographic view. Both radiographic features (AHD35°) were able to confirm the presence of a major RC pathology. However, the AHD
Source: The Physician and Sportsmedicine Online - Category: Sports Medicine Tags: Phys Sportsmed Source Type: research
ConclusionDespite a focus on individualisation and exercise adherence, barriers remained in the longer term. Strong therapeutic alliance during treatment appeared to facilitate adherence to exercise and general physical activity. The findings highlight ongoing physiotherapy support and therapeutic alliance as targets for future adherence-enhancing interventions for exercise in older adults with knee pain.
Source: Journal of Physiotherapy - Category: Physiotherapy Source Type: research
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