Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are significant public health concerns, especially given the risks for disease interactions. Rates of HCV and HIV are increasing, especially in rural areas. Local health departments (LHDs) play an important role in rural health care, offering screening, testing, and treatment for HCV and HIV. Gaps persist in LHD resources for meeting these demands, especially in Appalachia and the US South.
To explore HCV/HIV screening, testing, and treatment approaches and perspectives in south-central Appalachian North Carolina, structured telephone questionnaires were administered to communicable disease nurses and other health department staff directly involved in screening and testing. Mixed-methods data analyses were conducted and triangulated with stakeholders.
Eighteen participants representing 19 counties completed the questionnaire, achieving a saturation sample. Participants reported barriers to screening and testing, including housing insecurity, lack of transportation and insurance, unemployment, and the isolation of living in a rural area. Divergence in perceptions of barriers between public health regions emerged, as did perceptions of who is at risk and use of stigmatizing language about people at risk for HCV/HIV.
This study highlights the impact of LHD behaviors and perceptions on screening and testing, and offers recommendations to improve HCV/HIV screening and testing accessibility in south-central Appalachia, a high-risk region.
This study highlights the impact of LHD behaviors and perceptions on screening and testing, and offers recommendations to improve HCV/HIV screening and testing accessibility in south-central Appalachia, a high-risk region.
Compliance with coronavirus disease 2019 (COVID-19) guidelines, including the use of masks and social distancing and vaccinations, has been poor. Our study examined what factors may identify those who will be more or less compliant, especially in regard to those with identified higher risk.
A telephone survey of 200 adult patients from two practices, one general internal medicine and the other rheumatology, was performed in May and June 2021. Questions included age, sex, perception of immunocompetence, smoking history, mask and social distancing compliance, COVID-19 symptoms and/or test-proven infection, and immunization status for COVID-19. Those agreeing to participate also underwent chart review for body mass index, physician-assessed immunocompetence, and diabetes mellitus.
No clinical factors approached statistical significance for the prediction of compliance or noncompliance. Compliance with mask and social distancing highly correlated with vaccination and avoidance of infection, however.
Attempts to improve compliance cannot be focused on any of the particular groups examined in this study.
Attempts to improve compliance cannot be focused on any of the particular groups examined in this study.
Increasing healthcare access is a Healthy People 2030 priority. This study examined healthcare access from the residents' perspective in the two most rural counties in the United States and compared the findings with data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) in rural and urban counties in Alabama.
We conducted an in-person population-based survey using cluster sampling within census tracts assessing health insurance coverage, having a usual primary care provider, having had a routine healthcare visit within the past year, and barriers to care.
Among the 395 participants, 81.4% indicated having health insurance coverage, which was slightly lower than the BRFSS data for rural (87.6%) and urban counties in Alabama (87%); 89.6% of respondents indicated having a usual primary care provider compared with 84.3% of rural and 77.2% of urban residents; and 83.2% of participants indicated having had a routine healthcare visit in the last year compared with 77.3% of rural and 77.6% of urn, BRFSS data continue to offer a reliable picture of healthcare access in rural areas.
Racial disparities in preexisting diabetes mellitus (PDM) and gestational diabetes mellitus (GDM) remain largely unexplored. We examined national PDM and GDM prevalence trends by race/ethnicity and the association between these conditions and fetal death.
This was a retrospective cross-sectional analysis of 69,539,875 pregnancy-related hospitalizations from 2002 to 2017 including 674,040 women with PDM (1.0%) and 2,960,797 (4.3%) with GDM from the US Nationwide Inpatient Sample Survey. Joinpoint regression was used to evaluate trends in prevalence. Survey logistic regression was used to evaluate the association between exposures (PDM and GDM) and outcome.
Overall, the average annual increase in prevalence was 5.2% (95% confidence interval [CI] 4.2-6.2) for GDM and 1.0% (95% CI -0.1 to 2.0) for PDM, during the study period. Hispanic (average annual percentage change 5.3, 95% CI 3.6 - 7.1) and non-Hispanic Black (average annual percentage change 0.9, 95% CI 0.1 - 1.7) women had the highest average annual percentage increase in the prevalence of GDM and PDM, respectively. https://www.selleckchem.com/products/myf-01-37.html After adjustment, the odds of stillbirth were highest for Hispanic women with PDM (odds ratio 2.41, 95% CI 2.23-2.60) and decreased for women with GDM (odds ratio 0.51, 95% CI 0.50-0.53), irrespective of race/ethnicity.
PDM and GDM prevalence is increasing in the United States, with the highest average annual percentage changes seen among minority women. Furthermore, the reasons for the variation in the occurrence of stillbirths among mothers with PDM and GDM by race/ethnicity are not clear and warrant additional research.
PDM and GDM prevalence is increasing in the United States, with the highest average annual percentage changes seen among minority women. Furthermore, the reasons for the variation in the occurrence of stillbirths among mothers with PDM and GDM by race/ethnicity are not clear and warrant additional research.
Morning report is one of the central activities of internal medicine residency education. The two most common morning report formats are scripted reports, which use preselected cases with prepared didactics, and unscripted reports in which a case is discussed without preparation. No previous study has compared these two formats.
We conducted a prospective observational study of morning report conducted at 10 academic medical centers across the United States.
A total of 198 case-based morning reports were observed. Of these, 169 (85%) were scripted and 29 (15%) were unscripted. Scripted reports were more likely to present a case with a known final diagnosis (89% vs 76%,
0.04), use electronic slides (76% vs 52%,
0.01), involve more than 15 slides (55% vs 3%,
< 0.001), and reference the medical literature (61% vs 34%,
0.02), including professional guidelines (32% vs 10%,
0.02) and original research (25% vs 0%,
0.001). Scripted reports also consumed more time in prepared didactics (8.0 reports consume more time in the early diagnostic process, including history, physical examination, and differential diagnosis. Residency programs interested in emphasizing these aspects of medical education should encourage unscripted morning reports.
Although high-stakes interviews are critically important for residents to obtain competitive fellowships, few formalized programs targeting interviewing skills exist. Previous studies demonstrate that mock interviews increase medical students' and healthcare professionals' confidence and improve match rates, but little research has been conducted among medical residents. The objective of our study was to increase trainees' confidence entering fellowship interviews and prepare them for commonly encountered questions via a mock interview program.
Emory Internal Medicine residency leaders designed a voluntary mock interview program focused on 103 residents (64% of the overall cohort) pursuing fellowship training (median 36, range 30-37/year) from 2018 to 2020. Administrative staff scheduled eight associate program director interviewers for 75 hours of interviews for 3 years (mean 3.6 hours per interviewer per year), ensuring program feasibility. Interviewers underwent faculty development and used a standardid scalable, and may be adopted to benefit trainees in any graduate medical education program.
The primary aim was to assess whether children have difficulty distinguishing similar-sounding novel words. The secondary aim was to assess what task characteristics might hinder or facilitate perceptual discrimination.
Three within-subjects experiments tested ninety-nine 3- to 5-year-old children total. Experiment 1 presented two cartoon characters each saying a novel word. Children were asked to report whether they said the same word or different words. Words were identical (e.g., deev/deev), were dissimilar (deev/vush), differed in onset consonant voicing (deev/teev), or differed in vowel tenseness (deev/div). Experiment 2 added accuracy feedback after each trial to remind children of task instructions. Experiment 3 interspersed many "same" trials containing a repeating standard word to assess the role of bottom-up stimulus support on difference detection.
The
scores were highest for dissimilar words, next highest on different-vowel pairs, and lowest on different-consonant pairs. Performance was better with repeated standard stimuli (Experiment 3) than without (Experiment 1). Benefits for repeated task instructions (Experiment 2) were marginal. Exploratory analyses comparing these results to findings in a word-learning study using the same stimuli suggest an imperfect match to how easily children can learn similar-sounding words.
Overall, similar-sounding novel words are challenging for children to discriminate perceptually, although discrimination scores exceeded chance for all levels of similarity. Clinically speaking, same/different tests may be less sensitive to sound discrimination than change/no-change tests.
https//doi.org/10.23641/asha.20151848.
https//doi.org/10.23641/asha.20151848.
This study examined whether there is an association between continuous care rehabilitation (CR) and the risk of fracture hospitalization among people with Parkinson's disease (PwP) aged >75 years with mild-to-moderate care needs level.
A retrospective study design based on the merging of medical claims and long-term care insurance claims data was used. Before propensity score matching, of the 2177 participants, 222 received continuous CR, whereas 1955 did not. After matching using a 14 ratio, we identified 222 patients in the CR group and 888 patients in the non-CR groups. We carried out a survival analysis to clarify the association between CR and the risk of fracture hospitalization.
After matching, there was a significant difference between the CR and non-CR groups in 3 years (stratified log-rank test by age P=0.036) and in 4 years (stratified log-rank test by age P=0.011). The CR group was significantly associated with delays of hospital admission due to fracture within 3 years (hazard ratio 0.54their activities of daily living are still intact and cognitive function has not deteriorated. Geriatr Gerontol Int 2022; 22 628-634.