Iraqi Muslim Women and Primary Healthcare Providers' Perspectives and Experiences in the Clinic Visit in the Western United States.

Immigrants to the U.S. are subject to healthcare disparities due to differences in language, culture, religion, and gender. Clinic visits are particularly challenging for both health providers and patients due to communication barriers, expectations of the visit that are informed by past experiences, strongly held values, and gender. This qualitative study used critical ethnography and postcolonial feminism to explore perceptions and experiences of 15 Iraqi Muslim women with refugee backgrounds and 10 primary healthcare providers as they shared about their clinical encounters. Semi-structured interviews and field notes were analyzed with a postcolonial feminist framework that highlighted perspectives of health providers and Iraqi Muslim women in regard to representation, gender, and values. Health providers were aware of the need for gender-concordant care and preservation of modesty for Muslim patients. Gaps in care stemmed from a need for greater understanding of values and expectations. Improvement in the quality of care requires a venue for open discourse between providers, staff, and patients to improve mutual understanding.

Anemia Management in Rural Haitian Children: A Mixed Methods Study.

INTRODUCTION: We examined factors influencing anemia outcomes in rural children following implementation of a prevention program. METHOD: Mixed methods study of children, parents, and clinicians utilized statistical modeling and content/ethnographic analysis. Retrospective chart abstraction evaluated treatments administered and measured hemoglobin in children aged 6 to 59 months (n = 161). Prospective interviews/questionnaires examined parent (n = 51) and clinician (n = 19) perceptions. RESULTS: Anemia prevalence decreased by 21.2%. Predictors of increased hemoglobin were clinic visit number and age at first visit. Once anemia improved, children were likely to remain improved (P = .65). Despite favorable program perceptions, stakeholders emphasized ecological barriers, including social disadvantage and local practices. DISCUSSION: Socioeconomic factors prevented guideline concordant behaviors. Persistent attention to intrapersonal, interpersonal, and community social determinants is a sine qua non for successfully managing the epidemic. The first step to provide culturally congruent care is to explicitly acknowledge that guideline-concordant behaviors are often complex.

Ethical Considerations for Short-Term Global Health Projects.

Various types of health professional volunteers from high-income nations are increasingly engaged in short-term global health projects in low- and middle-income countries. The goal of global health projects is to improve health for all people and address health inequities. Short-term projects lasting days to months can create challenges for volunteers and hosts. Despite attempting to do good, volunteer efforts may unwittingly cause harm to host organizations by planning projects without consideration for the local infrastructure, the community, and the health care staff. Although well-intentioned and often beneficial, volunteer efforts can fail to provide adequate follow-up or may disrupt or override local health efforts. In some low-resource settings, dire health needs and lack of supervision may result in volunteers practicing beyond their professional scope. Recently published guidelines, competencies, and position statements have addressed ethical behaviors for short-term global health experiences. Partnerships that are founded on principles of justice and autonomy provide an avenue for mutual collaboration. Short-term global health projects that focus on host needs are likely to strengthen local capacity to improve health outcomes. This article reviews guidelines for short-term global health experiences and addresses the ethical principles for planning effective projects.

Two cases of abnormal liver function associated with H1N1 infection in pregnancy.

Two patients with recent H1N1 virus infection in pregnancy were found to have raised transaminases. They have both had a mild illness and have recovered with no adverse effects, and one has delivered a healthy baby while the other is still pregnant. We suggest that the deranged transaminase concentrations were directly linked to the viral infection in the first patient as the abnormal blood results predated treatment. The second case is less clear.

The effect of vigorous exercise during pregnancy.

Pregnant women without medical or obstetric problems should be encouraged to exercise. The paucity of experimental data on exercise in pregnancy forces recommendations to be drawn from a synthesis of available information. Vigorous exercise during pregnancy seems to pose no adverse maternal or neonatal outcomes. Nonetheless, the safety of vigorous exercise necessitates surveillance of fetal growth, the woman's weight, nutritional intake, and exercise duration and intensity.

Nutritional counseling for vegetarians during pregnancy and lactation.

A woman's nutritional status directly affects pregnancy outcome and the quality of breast milk after birth. Clinicians who provide prenatal care have an important role in assessing the nutritional status of women and directing them to appropriate resources while respecting their choices. Vegetarian and vegan diets may present with unique nutrient deficiencies that can be addressed during prenatal nutritional counseling.

Helicobacter pylori and severe nausea and vomiting during pregnancy.

Helicobacter pylori is a bacterial infection of the stomach, which may aggravate nausea and vomiting in pregnancy. Studies have found conflicting evidence of the role of H. pylori in severe nausea and vomiting in pregnancy and hyperemesis gravidarum. Several women suffering from weight loss and experiencing continued nausea and vomiting were tested for H. pylori antibody during their pregnancy. This article reviews the outcomes of women with both positive and negative H. pylori tests, the treatment of H. pylori, and its controversial role in managing severe nausea and vomiting in pregnancy.