Articles: ninos.
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The Human Development Index (HDI)-a composite metric encompassing a population's life expectancy, education, and income-is used widely for assessing and comparing human development and wellbeing at the country level, but does not account for within-country inequality. In this study of the USA, we aimed to adapt the HDI framework to measure the HDI at an individual level to examine disparities in the distribution of wellbeing by race and ethnicity, sex, age, and geographical location. ⋯ State of Washington and National Institute on Minority Health and Health Disparities.
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Over the past several decades, the overweight and obesity epidemic in the USA has resulted in a significant health and economic burden. Understanding current trends and future trajectories at both national and state levels is crucial for assessing the success of existing interventions and informing future health policy changes. We estimated the prevalence of overweight and obesity from 1990 to 2021 with forecasts to 2050 for children and adolescents (aged 5-24 years) and adults (aged ≥25 years) at the national level. Additionally, we derived state-specific estimates and projections for older adolescents (aged 15-24 years) and adults for all 50 states and Washington, DC. ⋯ Bill & Melinda Gates Foundation.
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The platypnea orthodeoxia syndrome is a rare clinical entity combining positional dyspnea and arterial oxygen desaturation during the transition to orthostatism, reversible on return to decubitus. The most frequent etiology of this syndrome is the presence of a patent foramen ovale (PFO) responsible for a right-to-left intracardiac shunt, the severity of which results in significant functional disability and a risk of death from hypoxia. ⋯ The platypnea orthodeoxia syndrome associated with a patent foramen ovale often suffers from delayed diagnosis. Advanced age and co-morbidities should not prevent patients from undergoing percutaneous PFO closure, as the clinical benefit is important.
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The first class at USUHS took its initial course in medical ethics in 1977. I directed this course until recently when COVID first emerged. In this piece, I review what these students were taught during the last 5 of 8 class sessions involving the military, genetic, reproduction, student ethics, and the Holocaust. I discuss here the content of these sessions, the rationales of these contents, key lessons learned, and future directions and challenges. This review provides readers with information regarding some of the faculty brought in to provide these lectures, and key points they emphasized. It also summarizes the more subtle points regarding ethics that it was hoped students would gain and use throughout their medical careers and lifetimes. ⋯ Medical ethics is now taught in all medical schools but at USUHS this education must include traditional core medical topics and military medical issues as well. A challenge posed throughout the course was whether to emphasize what ethical and professional behaviors would be expected of students in their later military careers or to challenge them to engage in original analysis of ethical questions that had no self-evident answers. The decision was made in most cases to encourage students having materials to discuss and debate in their discussion groups, especially since they would learn what was expected of them in their military roles from multiple other sources. The priming for these discussions in the presentations seemingly succeeded in engaging the students and in provoking relevant debate throughout all of these cases. This learning is highly important in that in the future in both medicine and the military new unanticipated ethical issues will continue to arise. Since there will be no self-evident best ethical answers to these issues, those tasked with and thus seeking to resolve them will have to depend on having the optimal ethical skills for approaching and resolving these issues. This course sought to initiate this process, engaging these students and moving them hopefully to want to increase their skills in analyzing ethical dilemmas as they continue to progress throughout their military careers.
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The Veterans Health Administration (VHA) Epilepsy Centers of Excellence (ECoE) was established in 2008 to provide specialized care for veterans with epilepsy. Although established more than a decade ago, there has been no systematic evaluation of the ECoE's performance in key mission areas. We evaluated their performance in several key mission areas-clinical care, research, education, and outreach-since inception to evaluate their success in meeting the initial mandate. ⋯ Our analysis reveals progressive growth and improvements in the ECoE mission areas of clinical care, research, education, and outreach. Clinical utilization data have shown growth since inception, while also leading to lower mortality rates and lower costs per patient, fulfilling the organizational mandate to improve the care of veterans with epilepsy. There is substantial activity in research, education, and outreach. The ECoE governance hierarchy aims to facilitate smooth resource allocation both regionally and for the key mission areas. Our findings can help policymakers assess and prioritize future ECoE initiatives, while other clinical care organizations can seek to model their care based on the ECoE.