Cross-Training Pharmacy Professionals as Community Health Workers.

Community health workers (CHWs) are health professionals that connect the populations they serve to health services. They play a valuable role in assessing patients' needs, linking patients with health and human resources, educating patients toward achieving optimal health, and advocating for their patients to have accessible resources to improve their health and wellbeing. Pharmacies are readily accessible and frequently utilized health locations that could employ CHWs. We describe a program to cross-train pharmacy professionals as CHWs. Pharmacy professionals were recruited to sign up for a 13-week CHW core competencies course that was offered in partnership with the state university Continuing Education Workforce Training. From March 2022 to June 2023, 23 pharmacy professionals completed the course. Post-course and program evaluations were completed by 10 participants, and they showed positive responses to their participation in the program. Participants appreciated learning the role of a CHW, and noted increased skills, and awareness of additional tools and resources. Participants reported 47 referrals to chronic disease programs and community resources. The program pilot results show successful partnerships for cross-training pharmacy professionals as CHWs. Cross-trained pharmacy professionals provide benefits to the communities they serve, by being a valuable resource for their patients.

Individual and community preparedness to disasters and pandemics in Idaho Falls: A cross sectional analysis.

Communities form an integral component of disaster and pandemic preparedness. This study aimed to explore disaster/pandemic preparedness-with a special focus on coronavirus disease 2019 (COVID-19)-at the household and community level among residents within 50 miles of Idaho Falls. A structured online survey questionnaire was distributed, resulting in 924 responses from participants over 18 years of age. The results highlighted that 29 and 10 percent of participants were not prepared to deal with disasters and pandemics, respectively. Most participants trusted healthcare professionals (61 percent) for information about COVID-19, followed by scientists (46 percent) and local health departments (26 percent). The overall preparedness to disasters/pandemics at the community level was 50 percent. Males, participants older than 35 years, and participants with paid employment had higher odds of being prepared for disasters, whereas higher education was associated with higher preparedness for pandemics. This study highlights the need for better household and community disaster and pandemic preparedness.

Comparison of Access to Primary Care Medical and Dental Appointments Between Simulated Patients Who Were Deaf and Patients Who Could Hear.

Importance: Primary medical and dental clinics may accept fewer people who are deaf as patients than persons who can hear, and clinics may deny requests by patients who are deaf for American Sign Language (ASL) interpretation at appointments when necessary, creating diminished access to primary medical and dental care. Objective: To compare the rate at which patients who are deaf are offered primary care medical or dental appointments with the rate at which appointments are offered to patients who can hear in a real-world context. Design, Setting, and Participants: This cross-sectional study used a simulated patient (SP) call audit method. Simulated patients (4 who could hear and 4 who were deaf) followed a call script in which an adult sought to establish care, requesting new patient appointments from a statewide stratified random sample of clinicians listed in the Idaho Medical and Dental Associations member databases at 445 clinics (334 primary care and 111 general dentistry) throughout Idaho. Simulated patients who were deaf also requested interpreting services at the appointment. Calls were made between June 7 and December 6, 2018. Data analysis was conducted from December 2019 to April 2020. Exposures: Simulated patients who were deaf or could hear called primary care medical or dental clinics from the sampling frame and requested an appointment, supplying the same basic information. In addition, SPs who were deaf requested that an ASL interpreter be provided by the clinic for the appointment. Main Outcomes and Measures: Rates of new appointments offered and, for SPs who were deaf, whether ASL interpreter services were confirmed for the appointment. Results: Two male and 2 female SPs who could hear were successful on 210 occasions (64.4%) when requesting a new patient appointment compared with 2 male and 2 female SPs who were deaf who were successful on 161 occasions (49.1%) (P < .001). Simulated patients who could hear were nearly 2 times more likely to secure appointments than were SPs who were deaf (adjusted odds ratio, 1.88; 95% CI, 1.27-2.79). For SPs who were deaf, 80 unsuccessful appointment requests (48.2%) were associated with a request for interpretation. Conclusions and Relevance: The findings suggest that in a statewide representative sample, access to primary medical and dental care for patients who are deaf is significantly reduced. Patients who are deaf may not receive an appointment if they request interpreter services, even when such services are required to provide effective communication.

A multiplex microsphere IgG assay for SARS-CoV-2 using ACE2-mediated inhibition as a surrogate for neutralization

The COVID-19 pandemic has highlighted the challenges inherent to the serological detection of a novel pathogen such as SARS-CoV-2. Serological tests can be used diagnostically and for surveillance, but their usefulness depends on their throughput, sensitivity and specificity. Here, we describe a multiplex fluorescent microsphere-based assay, 3Flex, that can detect antibodies to three major SARS-CoV-2 antigens--spike (S) protein, the spike ACE2 receptor-binding domain (RBD), and nucleocapsid (NP). Specificity was assessed using 213 pre-pandemic samples. Sensitivity was measured and compared to the Abbott ARCHITECT SARS-CoV-2 IgG assay using serum samples from 125 unique patients equally binned (n = 25) into 5 time intervals ([≤]5, 6 to 10, 11 to 15, 16 to 20, and [≥]21 days from symptom onset). With samples obtained at [≤]5 days from symptom onset, the 3Flex assay was more sensitive (48.0% vs. 32.0%), but the two assays performed comparably using serum obtained [≥]21 days from symptom onset. A larger collection (n = 534) of discarded sera was profiled from patients (n = 140) whose COVID-19 course was characterized through chart review. This revealed the relative rise, peak (S, 23.8; RBD, 23.6; NP, 16.7; in days from symptom onset), and decline of the antibody response. Considerable interperson variation was observed with a subset of extensively sampled ICU patients. Using soluble ACE2, inhibition of antibody binding was demonstrated for S and RBD, and not for NP. Taken together, this study described the performance of an assay built on a flexible and high-throughput serological platform that proved adaptable to the emergence of a novel infectious agent.

Ask and ye shall not receive: Interpreter-related access barriers reported by Deaf users of American sign language.

BACKGROUND: Healthcare providers are mandated to provide reasonable accommodations for Deaf users of American Sign Language (ASL) accessing healthcare services, including ASL interpreters. Provision of accommodations improves access and provider/patient communication. OBJECTIVE: Describe the types, frequency, severity, and trends in healthcare access complications experienced by Deaf patients. METHODS: A six-year retrospective review of complaints (n = 108) filed regarding interpreter provision in healthcare settings with the Idaho Council for the Deaf and Hard of Hearing by Deaf users of ASL was conducted and summarized. An analysis of demographic and language factors associated with interpreter-related barriers and whether the complaint was resolved was performed using multivariate logistic regression. RESULTS: Reasons for complaints of interpreter-related barriers to care included: 48.2% were "told an interpreter was not available"; 28.7% received an unqualified interpreter; interpreter was promised but not provided (18.5%). Factors independently associated with having been promised an interpreter were: medical clinics (vs. dental) (OR 3.92 95%CI 1.18-12.98), and complaints filed later in the study period (OR 1.55 per year 95%CI 1.19-2.01). For each additional year during the study period, complaints were 1.6 times (95%CI 1.15-2.22) more likely to have an interpreter promised but not provided. Patients from rural areas were less likely to have their complaints satisfactorily resolved (OR 0.18 95%CI 0.06-0.55). CONCLUSION: Deaf patients experience various interpreter-related barriers throughout the process of accessing healthcare and communicating with providers/staff, though further regional and nationwide documentation is warranted.

Clinical Care Coordination in Medically Complex Pediatric Cases: Results From the National Survey of Children With Special Health Care Needs.

This study uses a secondary analysis of the 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) to describe care coordination (CC) for children with medical complexity (CMC). Chi-square test, t test, and multivariate logistic regression statistical tests are used to determine the relationships and differences between sources of CC and factors associated with receiving clinic-based CC for CMC and their family. Among CMC, 66.47% received no CC support and 25.73% received clinic-based CC. In multivariate models, families reporting dissatisfaction with communication between health care providers or reporting family-centered care were less likely to receive clinic-based CC. Families were more likely to receive clinic-based CC if they had younger children, lower household income, and greater school absenteeism. Clinic-based CC is associated with improved communication between health providers but must become more family-centered and minimize student absenteeism for the CMC population.

Interventions for tobacco use cessation in people living with HIV and AIDS.

BACKGROUND: Tobacco use is highly prevalent amongst people living with HIV/AIDS (PLWHA) and has a substantial impact on morbidity and mortality. OBJECTIVES: To assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO in June 2015. We also searched EThOS, ProQuest, four clinical trial registries, reference lists of articles, and searched for conference abstracts using Web of Science and handsearched speciality conference databases. SELECTION CRITERIA: Controlled trials of behavioural or pharmacological interventions for tobacco cessation for PLWHA. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted all data using a standardised electronic data collection form. They extracted data on the nature of the intervention, participants, and proportion achieving abstinence and they contacted study authors to obtain missing information. We collected data on long-term (greater than or equal to six months) and short-term (less than six months) outcomes. Where appropriate, we performed meta-analysis and estimated the pooled effects using the Mantel-Haenszel fixed-effect method. Two authors independently assessed and reported the risk of bias according to prespecified criteria. MAIN RESULTS: We identified 14 studies relevant to this review, of which we included 12 in a meta-analysis (n = 2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy.There was moderate quality evidence from six studies for the long-term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.72 to 1.39) with no evidence of heterogeneity (I(2) = 0%). The pooled long-term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short-term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I(2) = 42%). Abstinence in the control group at short-term follow-up was 8% (n = 67/848) and in the intervention group was 13% (n = 118/937). The effect of tailoring the intervention for PLWHA was unclear. We further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. We failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study. AUTHORS' CONCLUSIONS: There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long-term. There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short-term abstinence. Despite this, tobacco cessation interventions should be offered to PLWHA, since even non-sustained periods of abstinence have proven benefits. Further large, well designed studies of cessation interventions for PLWHA are needed.

Secondhand smoke exposure and serum cotinine levels among current smokers in the USA.

BACKGROUND: Secondhand smoke (SHS) likely provides additional exposure to nicotine and toxins for smokers, but has been understudied. Our objective was to determine whether SHS exposure among smokers yields detectable differences in cotinine levels compared with unexposed smokers at the population level. METHODS: Using the US National Health and Nutrition Examination Survey (NHANES) for the years 1999-2012, we compared serum cotinine levels of 4547 current adult cigarette smokers stratified by self-reported SHS exposure sources (home and/or work) and smoking intensity. A weighted multivariable linear regression model determined the association between SHS exposure and cotinine levels among smokers. RESULTS: Smokers with SHS exposure at home (43.8%) had higher cotinine levels (ß=0.483, p≤0.001) compared with those with no SHS exposure at home after controlling for the number of cigarettes smoked per day and number of days smoked in the previous 5 days, survey year, age, gender and education. Smokers with SHS exposure at work (20.0%) did not have significantly higher cotinine levels after adjustment. The adjusted geometric mean cotinine levels of light smokers (1-9 cigarettes per day) with no SHS exposure, exposure at work only, home only, and both home and work were 52.0, 62.7, 67.2, 74.4 ng/mL, respectively, compared with 219.4, 220.9, 255.2, 250.5 ng/mL among moderate/heavy smokers (≥10 cigarettes per day). CONCLUSIONS: Smokers living in residences where others smoke inside the home had significantly higher cotinine levels than smokers reporting no SHS exposure, regardless of individual smoking intensity. Future research should target the role that SHS exposure may have in nicotine dependence, cessation outcomes and other health impacts among smokers.

Correlates of unprotected sex by client type among female sex workers that inject drugs in Tijuana and Ciudad Juarez, Mexico.

AIMS: Risk environment factors may influence unprotected sex between female sex workers who are also injection drug users (FSW-IDUs) and their regular and non-regular clients differently. Our objective is to identify correlates of unprotected vaginal sex in the context of client type. METHODS: A cross-sectional survey of 583 FSW-IDUs in Tijuana and Ciudad Juarez, Mexico, was analyzed using negative binomial regression to determine physical, social, economic, and policy risk-environment factors that affect the frequency of unprotected sex with regular and non-regular clients. RESULTS: Median number of unprotected vaginal sex acts in the past month among FSW-IDUs and their regular and non-regular clients was 11 (IQR 3-30) and 13 (IQR 5-30), respectively. Correlates differed by site and client type and were most closely associated with the risk environment. In Tijuana, social factors (e.g., injecting drugs with clients) were independently associated with more unprotected sex. Factors independently associated with less unprotected sex across client type and site included social and economic risk environment factors (e.g., receiving more money for unprotected sex). In the policy risk environment, always having free access to condoms was independently associated with less unprotected sex among non-regular clients in Tijuana (Risk rate ratio = 0.64; 95% confidence interval 0.43-0.97). CONCLUSIONS: Primarily physical, social, and economic risk-environment factors were associated with unprotected vaginal sex between FSW-IDUs and both client types, suggesting potential avenues for intervention.

The Association between active and passive smoking and latent tuberculosis infection in adults and children in the united states: results from NHANES.

BACKGROUND: Few studies assessing the relationship between active and passive smoking and tuberculosis have used biomarkers to measure smoke exposure. We sought to determine the association between active and passive smoking and LTBI in a representative sample of US adults and children. METHODS: We used the 1999-2000 US National Health and Nutrition Examination Survey (NHANES) dataset with tuberculin skin test (TST) data to assess the association between cotinine-confirmed smoke exposure and latent tuberculosis infection (LTBI) among adults ages ≥20 years (n = 3598) and children 3-19 years (n = 2943) and estimate the prevalence of smoke exposure among those with LTBI. Weighted multivariate logistic regression was used to measure the associations between active and passive smoking and LTBI. RESULTS: LTBI prevalence in 1999-2000 among cotinine-confirmed active, passive, and non-smoking adults and children was 6.0%, 5.2%, 3.3% and 0.3%, 1.0%, 1.5%, respectively. This corresponds to approximately 3,556,000 active and 3,379,000 passive smoking adults with LTBI in the US civilian non-institutionalized population in 1999-2000. Controlling for age, gender, socioeconomic status, race, birthplace (US vs. foreign-born), household size, and having ever lived with someone with TB, adult active smokers were significantly more likely to have LTBI than non-smoking adults (AOR = 2.31 95% CI 1.17-4.55). Adult passive smokers also had a greater odds of LTBI compared with non-smokers, but this association did not achieve statistical significance (AOR = 2.00 95% CI 0.87-4.60). Neither active or passive smoking was associated with LTBI among children. Among only the foreign-born adults, both active (AOR = 2.56 (95% CI 1.20-5.45) and passive smoking (AOR = 2.27 95% CI 1.09-4.72) were significantly associated with LTBI. CONCLUSIONS: Active adult smokers and both foreign-born active and passive smokers in the United States are at elevated risk for LTBI. Targeted smoking prevention and cessation programs should be included in comprehensive national and international TB control efforts.

Smoke-free college campuses: no ifs, ands or toxic butts.

OBJECTIVE: To better estimate the burden of toxic cigarette butt waste and create awareness of the hazardous nature of cigarette butts on two large university campuses in San Diego by organizing and conducting student cigarette butt clean-up activities. METHODS: Two separate campus-wide clean-ups were conducted by student volunteers at San Diego State University (SDSU) and at University of California San Diego (UCSD) between April and July 2010. RESULTS: In 1 h, 63 volunteers at SDSU collected 23,885 butts; 6525 cigarette butts were collected in 1 h by 17 volunteers at UCSD. The average number of cigarette butts picked up per individual was 379.1 at SDSU and 383.8 at UCSD (range 25-1030 per volunteer). CONCLUSIONS: The amount of cigarette waste on college campuses nationally may be quite substantial given the many thousands of cigarette butts gathered at each of the San Diego institutions. In just 10 s on average a volunteer could locate, walk to, pick up and put a cigarette butt in the collection bag and then begin looking for another discarded butt, indicating the saturation of cigarette butts on campus. Smoke-free policies on campus could have far-reaching effects not only in reducing smoking behaviour on campus and ground clean-up costs, but also on the environment. Campus cigarette waste clean-ups can be utilized to call attention to the issue of cigarette butt waste in the environment.

A comparative study of the culture of thinness and nutrition transition in university females in four countries.

The purpose of this study was to examine the nutrition transition in four countries with respect to body dissatisfaction and eating styles. The target population for this study was college students in China (n=207), Japan (n=865), Jordan (n=322), and the United States (n=432). A cross-sectional survey was used to assess eating styles, disordered eating attitudes and behaviors, body esteem and dissatisfaction, and media influence. Results indicated that the Chinese sample was in an earlier stage of the nutrition transition, followed by Japan, Jordan, and the US. Interestingly, Jordanian and Chinese students exhibited the lowest level of body dissatisfaction. However, Jordanian students exhibited high levels of restrained eating similar to those seen in the Japanese and American students. The Japanese sample demonstrated a complex relationship between the culture of thinness, body dissatisfaction and eating styles. However the US sample reflected the expected levels of body dissatisfaction, high levels of restrained eating, emotional eating, and disordered eating attitudes and behaviors. Implications and suggestions for further research are discussed.

Young urban women and the nutrition transition in Jordan.

OBJECTIVE: To determine the nutrition transition stage of female Jordanian college students. DESIGN: A cross-sectional survey was used to assess eating styles, disordered eating attitudes and behaviours, body esteem and dissatisfaction, and media influence. SETTING: Public and private universities in Jordan. SUBJECTS: A total of 255 subjects were recruited through a government-initiated youth campaign. RESULTS: The majority of participants had a normal BMI (70.6%) with almost all (99.4%) reporting restrained eating behaviour. Scores on the Eating Attitudes Test (EAT-26) indicated that 45.2% of these female college students should be screening for eating disorders. Subscales of the Body Esteem Scale (BES) showed that these women did not have substantial body esteem issues and mean scores on the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) indicated that overall these women did not feel the media was dictating the way their body should look. Where Jordanian women did feel pressure from Western media, there was a 6.7-fold increase in the likelihood that they wanted to lose weight. In addition, 48.2% of the female college students desired to lose weight and 14.4% desired weight gain, indicating a certain level of body dissatisfaction. CONCLUSIONS: With low levels of overweight and obesity and a propensity towards eating based on external hunger cues, college-aged Jordanian women may be less advanced in their development through the nutrition transition than the general population of women. However, high levels of restrained eating and disordered eating attitudes and behaviours indicate the need for an intervention to address healthy weight-loss strategies, assess eating disorders and help maintain healthy body esteem.

Drug use among street children and non--street children in the Philippines.

This study characterizes the prevalence of drug use among Filipino street children compared with Filipino non-street children. A cross-sectional survey was administered to 311 street children and 528 non-street children aged 13 to 17 years. Participants were enrolled through 4 nonprofit organizations and 3 high schools located in Manila, Philippines. After adjustment for age and sex, street children with little or no contact with their families were 2.0 (95% confidence interval [CI] = 1.7-2.3) times more likely to smoke tobacco, 1.3 (95% CI = 1.2-1.5) times more likely to use alcohol, 36.7 (95% CI = 16.4-82.0) times more likely to use inhalants, and 5.5 (95% CI = 3.6-8.2) times more likely to use illegal drugs than their non-street counterparts. Street children who maintained contact with their families, compared with non-street children, were 8.7 (95% CI = 3.9-19.4) times more likely to use inhalants and 2.8 (95% CI = 1.7-4.6) times more likely to use illegal drugs. There was no significant difference in tobacco or alcohol use between street children who maintained contact with their families and non-street children. All street children were significantly more likely to have been given or sold a drug in the past 30 days and to have received drug education compared with non-street children. Filipino street children are at greater risk of abusing drugs than are non-street children, with street children who do not maintain family contact being at greatest risk.

Factors and barriers influencing influenza vaccination among students at Brigham Young University.

BACKGROUND: To identify the prevalence of influenza vaccination and factors associated with vaccination among students at Brigham Young University. MATERIAL/METHODS: A Cross-sectional survey of seven general education classes, size 30 to 200 students each, was conducted the week of November 25, 2007. A 34 item paper-pencil questionnaire was administered, taking 5-10 minutes to complete. The response rate was 90%, with 421 completed surveys. RESULTS: Prevalence of influenza vaccination was 12% in the current influenza season. Influenza vaccination was significantly influenced by place of work, frequency of being around children, place of residence, and selected area of academic study. Students that received the influenza vaccination were more motivated by perceived severity of influenza than by perceived risk of contracting the illness. Physicians or nurses were the most influential at encouraging influenza vaccination, followed by parents, then the university or student health center, and then the media. The percentage of students that received influenza vaccination information from physicians or nurses was 14%, from parents was 15%, from the student health center was 25%, and from the general media was 45%. CONCLUSIONS: Influenza vaccination is low among college students, but impacted by perceived severity of the illness, place of employment or residence, and who encourages influenza vaccination.

Sequence and structure of the extrachromosomal palindrome encoding the ribosomal RNA genes in Dictyostelium.

Ribosomal RNAs (rRNAs) are encoded by multicopy families of identical genes. In Dictyostelium and other protists, the rDNA is carried on extrachromosomal palindromic elements that comprise up to 20% of the nuclear DNA. We present the sequence of the 88 kb Dictyostelium rDNA element, noting that the rRNA genes are likely to be the only transcribed regions. By interrogating a library of ordered YAC clones, we provide evidence for a chromosomal copy of the rDNA on chromosome 4. This locus may provide master copies for the stable transmission of the extrachromosomal elements. The extrachromosomal elements were also found to form chromosome-sized clusters of DNA within nuclei of nocodazole-treated cells arrested in mitosis. These clusters resemble true chromosomes and may allow the efficient segregation of the rDNA during mitosis. These rDNA clusters may also explain the cytological observations of a seventh chromosome in this organism.