Jordan C. Holter

By Jordan Holter, Christine Marchionni and Bankim Bhatt

Several studies, including the innovative 1998 ACE Study by CDC-Kaiser Permanente, have assessed the association among adulthood chronic disease and the prevalence of maladaptive, health-harming behaviors including: excessive alcohol use, tobacco use, physical inactivity, psychiatric illness including suicidal ideation or attempts, promiscuous sexual behavior (>50 sex partners), history of STI/STD and severe obesity (obesity (BMI > 35 kg/m2)), subsequent to an individual’s exposure to adverse childhood experiences (ACEs). Individuals that have encountered numerous instances of ACEs are almost twice as likely to die before the age of 75, demonstrating a dose-dependent relationship between the instances of ACEs and an increased morbidity/mortality in regard to chronic disease. This excerpt examines the contribution of ACEs to chronic disease and the consequential maladaptive behavior to said adversity, the consequential physiologic and biomolecular changes explained by the Biological Embedding of Childhood Adversity Model in addition to the implications of recounted ACEs on international health security in regard to concepts like conflict, displacement and food insecurity. The apparent association among adulthood chronic disease and ACEs demand changes that promote preventative processes as a means to address the implications these interconnections have on international health.

Part of the book: Contemporary Developments and Perspectives in International Health Security

By Jordan C. Holter, Christine Marchionni and James A. James III

The Coronavirus Disease 2019, regularly referred to as “COVID-19”, has had an unprecedented impact on not only the state of graduate medical education (GME) for post-doctoral trainees, but also their well-being and welfare. Trainees comprise approximately 14% of physicians in the United States. This crucial portion of personnel in healthcare has irrefutably represented the resilience that personifies the medical community. The prevalence of physical and emotional exertion by these trainees, necessitated by the pandemic, has precipitated behavioral health ailments like mood disorders including depression and anxiety, diminished satisfaction in their corresponding specialties and impaired their ability to achieve balance between professional and personal responsibilities. This excerpt examines the pervasiveness of the adverse psychosocial implications the COVID-19 pandemic has had on this susceptible practitioner population in addition to the examination of physical and emotional exhaustion that exacerbate physician burnout including the implementation of policies and procedures to address the emergent problem of physician burnout throughout the COVID-19 pandemic by the GME. Also, this excerpt examines the adaptation of GME, including the reformation and implementation of innovative policies and procedures that has incontestably created an imprint on medical education for descendants of ACGME residency and fellowship programs in the United States.

Part of the book: Contemporary Topics in Graduate Medical Education