Utilization of street-based COVID-19 vaccination clinics in Phoenix's homeless population.

The novel Coronavirus (COVID-19) is a highly contagious viral illness that has caused the most significant global health crisis in recent human history. Individuals experiencing homelessness represent one of the more vulnerable populations for COVID-19 infection and morbidity. Amongst individuals experiencing homelessness in Phoenix, a student-led interprofessional organization called Street Medicine Phoenix (SMP) sought to both reduce the risk of COVID-19 transmission and morbidity/mortality related to infection. Through collaborations with the Maricopa County Department of Public Health and various community organizations, SMP developed a format for street-based vaccination clinics. SMP deployed these clinics on numerous occasions to the streets directly surrounding the community homeless shelter, allowing SMP to vaccinate individuals directly in their encampments. Through SMP's efforts starting in February 2021, 400 individuals experiencing homelessness have received at least one COVID-19 vaccine. Challenges encountered included low health literacy, lack of established rapport and trust, low vaccine confidence, difficulty verifying patients' vaccination status, difficulty obtaining sufficient information from patients to create a record in the Arizona State Immunization Information System (ASIIS), monitoring patients post-vaccination, transporting vaccine supplies from encampment to encampment, and lack of patient awareness of the mobile vaccine clinic services. Despite challenges, SMP's outreach efforts have demonstrated the feasibility and importance of mobile public health services to reach homeless encampments, particularly mobile vaccination clinics in response to disease outbreaks, and the necessity of strategic partnerships with community agencies to effectively meet the needs of underserved populations.

Mpox Case Reports in an Urban Homeless Population and a Proof of Concept for a Street-Based Mobile Mpox Vaccination Clinic.

Mpox is a new public health outbreak that particularly threatens the homeless population. Street Medicine Phoenix (SMP) is a student-led interprofessional volunteer organization that provides medical care and other essential services to individuals experiencing homelessness in Phoenix, Arizona. In addition to core services such as wound care; health screenings (blood pressure and blood glucose.); vision screenings; HIV testing; naloxone education and distribution; flu, COVID-19, and Hepatitis A vaccinations; and community resource referrals, SMP began offering mpox education and vaccination at outreach events. During an outreach event shortly after the onset of the mpox outbreak, SMP identified 2 suspected mpox cases. Accordingly, SMP has partnered with the Maricopa County Public Health Department to set up mobile mpox vaccination clinics on the streets outside of Phoenix Arizona's largest homeless shelter. We share the details of these 2 cases along with our early efforts vaccinating individuals experiencing homelessness for mpox via our mobile vaccination clinic. Our experiences demonstrate the importance of community agencies providing direct outreach to underserved populations where they are at, particularly the homeless population, to address public health concerns such as emerging disease outbreaks like mpox. In addition, these cases highlight the potential significant impact that street medicine programs can have on their respective homeless communities in the context of infectious disease mitigation and emphasize the importance of partnerships with local health departments.

Education without walls: Using a street medicine program to provide real-world interprofessional learning.

Interprofessional education (IPE) is a core component of the curricula for many healthcare and social work training programs and has been shown to increase student self-efficacy, communication skills, and attitudes toward other professions. Street medicine programs expand options for teaching interprofessional, team-based care of vulnerable populations, such as those experiencing homelessness. Street Medicine Phoenix is an interprofessional team of health professions students and faculty that provides outreach to Phoenix's homeless population. This study demonstrates the impact of volunteering in our street medicine program on the perceived development of interprofessional skills and behaviors. Volunteer teams, with representatives from medicine, nursing, social work, physical therapy, occupational therapy, public health, and undergraduate studies, completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) before and after semester-long, monthly outreach events. Results demonstrate statistically significant improvements in overall ICCAS scores for all volunteers, but there was no relationship between number of shifts completed and ICCAS score improvement. Based on these findings, street medicine programs could be considered as an option for providing interprofessional learning to students in healthcare and social work degree programs. Street medicine outreach can supplement didactic and simulation skill-building activities in the IPE curricula with point of care, real-world experiential learning.

Sex differences and phase of light cycle modify chronic stress effects on anxiety and depressive-like behavior.

The experiment examined whether sex differences and the phase of the light cycle modified how chronic restraint stress influenced anxiety and depressive-like behavior. Rats were restrained (6h/d/21d) and tested on the open field (OF), elevated plus maze (EPM), forced swim test (FST), and sucrose preference (SP) test. Chronic stress increased anxiety in both males and females in different tasks during the dark phase, but not in the light phase. When tested during the dark, chronic stress decreased time and grid crossings in the center arena of the OF in males, whereas chronic stress decreased open arm entries and time in the EPM in females. For OF and EPM, an anxiety index calculation confirmed that chronic stress increased anxiety measures when taking into consideration locomotion metrics. For the FST and SP, chronic stress had a tendency to alter the immobility index and sucrose preference in both sexes, but did not reach statistical significance alone. Therefore, a separate z-score was computed for each task and summed to represent a combined z-score of depressive-like behavior. In the light phase, chronic stress increased depressive-like behavior in males, but decreased depressive-like behavior in females. Chronic stress had no statistically significant effects on depressive-like behavior in the dark phase, although the pattern of chronic stress effects on depressive-like behavior in females was similar for both light cycle phases. The results indicate that chronic restraint stress effects on anxiety and depressive-like behavior depend upon the type of task, phase of the light cycle and sex of the individual.

Chronic stress, cyclic 17ß-estradiol, and daily handling influences on fear conditioning in the female rat.

Chronic stress and estrogens alter many forebrain regions in female rats that affect cognition. In order to investigate how chronic stress and estrogens influence fear learning and memory, we ovariectomized (OVX) female Sprague-Dawley rats and repeatedly injected them (s.c.) with 17ß-estradiol (E, 10 µg/250 g or sesame oil vehicle, VEH). Concurrently, rats were restrained for 6 h/d/21 d (STR) or left undisturbed (CON). Rats were then fear conditioned with 4 tone-footshock pairings and then after 1 h and 24 h delays, given 15 tone extinction trials. Regardless of E treatment, chronic stress (VEH, E) facilitated freezing to tone during acquisition and extinction following a 1h delay, but not during extinction after a 24 h delay. E did not influence freezing to tone during any phase of fear conditioning for either the control or chronically stressed rats, but did influence contextual conditioning that may have been carried predominately by the STR group. In the second experiment, we investigated "handling" influences on fear conditioning acquisition, given the disparate findings from the current study and previous work (Baran, Armstrong, Niren, & Conrad, 2010; Baran, Armstrong, Niren, Hanna, & Conrad, 2009). Female rats remained gonadally-intact since E did not influence tone fear conditioning. Indeed, brief daily handling (1-3 m/d/21 d) facilitated acquisition of fear conditioning in chronically stressed female rats, and either had no effect or slightly attenuated fear conditioning in controls. Thus, chronic stress impacts amygdala-mediated fear learning in both OVX- and gonadally-intact females as found previously in males, with handling significantly influencing these outcomes.

Chronic stress and sex differences on the recall of fear conditioning and extinction.

Chronic stress effects and sex differences were examined on conditioned fear extinction. Male and female Sprague-Dawley rats were chronically stressed by restraint (6 h/d/21 d), conditioned to tone and footshock, followed by extinction after 1 h and 24 h delays. Chronic stress impaired the recall of fear extinction in males, as evidenced by high freezing to tone after the 24 h delay despite exposure to the previous 1 h delay extinction trials, and this effect was not due to ceiling effects from overtraining during conditioning. In contrast, chronic stress attenuated the recall of fear conditioning acquisition in females, regardless of exposure to the 1 h extinction exposure. Since freezing to tone was reinstated following unsignalled footshocks, the deficit in the stressed rats reflected impaired recall rather than impaired consolidation. Sex differences in fear conditioning and extinction were observed in nonstressed controls as well, with control females resisting extinction to tone. Analysis of contextual freezing showed that all groups (control, stress, male, female) increased freezing immediately after the first tone extinction trial, demonstrating contextual discrimination. These findings show that chronic stress and sex interact to influence fear conditioning, with chronic stress impairing the recall of delayed fear extinction in males to implicate the medial prefrontal cortex, disrupting the recall of the fear conditioning acquisition in females to implicate the amygdala, and nonstressed controls exhibiting sex differences in fear conditioning and extinction, which may involve the amygdala and/or corticosterone levels.