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ObjectiveWe modelled individual vulnerability to STI using personal history of infection and neighbourhood characteristics.MethodsRetrospective chlamydia and gonorrhoea data of reported confirmed cases from Kalamazoo County, Michigan for 2012 through 2014 were analysed. Unique IDs were generated from the surveillance data in collaboration with local health officials to track the individual STI histories. We then examine the concept that individuals with similar STI histories form a ‘peer’ group. These peer group include: (1) individuals with a single chlamydia; (2) individuals with single gonorrhoea; (3) individuals with repeated cases of one type of STI and (4) individuals that were diagnosed with both infections during the study period. Using Kernel density estimation, we generated densities for each peer group and assigned the intensity of the infection to the location of the individual. Finally, the individual vulnerability was characterised through ordinary least square regression (OLS) using demographics and socioeconomic variables.ResultsIn an OLS regression adjusted for frequency of infection, individual vulnerability to STI was only consistently significant for race and neighbourhood-level socioeconomic status (SES) in all the models under consideration. In addition, we identified six areas in three townships in Kalamazoo County that could be considered for unique interventions based on overlap patterns among peer groups.ConclusionsThe results provide evidence that individual vulnerability to STI has some dependency on individual contextual (race) and exogenous factors at the neighbourhood level such as SES, regardless of that individual’s personal history of infection. We suggest place-based intervention strategies be adopted for planning STI interventions instead of current universal screening of at-risk populations.

Introduction Adults with vision loss often have difficulties reading prescription drug labels. An aspect of label readability that has not been well explored is the effect of container shape on the readability of the label. The research question addressed is: Does container shape affect the readability of prescription drug labels for persons with reduced visual acuity?Methods A repeated-measure, single-factor design with within-subject control was used with 23 adults with visual acuity of 20/60 or less. Individuals were recruited from southwest Michigan. Participants read 3 unique prescription drug labels on 4 differently shaped containers (flat, box, small cylinder, large cylinder) in block randomized order, for a total of 12 trials. The amount of time needed to locate and read aloud 6 pieces of label information and number of errors made in reading were measured, as well as each participant's preference in container shapes.Results A statistically significant difference was found between the mean number of seconds required to read flat container labels (flat and box shape, M= 54.62 seconds, SD= 23.8) and round containers (small and large cylinder shape, M= 64.46 seconds, SD= 36.3). No statistically significant effect of container type was found on the number of mistakes made in reading the label information, Wald ?2(3) = .71, p= 0.871. Seventy-eight percent of the participants chose the flat container as their preferred shape. Only 1 participant selected the box as his or her top choice.Discussion Containers with flat surfaces (flat and box) were easier to read, measured by speed, compared to containers with round surfaces (small and large cylinders). Although the study participants overwhelmingly preferred flat containers to the boxes, little difference was found between the two shapes in the amount of time that was needed to read labels affixed to them.Implications for practitioners Individuals with vision loss may need more time to read prescription drug labels affixed to the more typical cylindrical containers compared to flat ones.

Grip strength is a measure of overall muscle strength and has been found to be a predictor of disability and mortality. Almost 3 in 4 adults aged 65 years and older have multiple chronic conditions, known as multimorbidity. Normative data for grip strength have commonly been reported on healthy convenience samples that may not accurately represent the population of interest. Grip strength values of US adults, utilizing a nationally representative data set based on the number of chronic diseases, would be beneficial to health care providers who serve adults with multimorbidity. The purpose of this study was to describe grip strength values of adults in the United States, based on gender, age, and the number of chronic diseases.

Objectives. To efficiently help communities prevent and manage diabetes, health departments need to be able to target populations with high risk but low resources To aid in this process, we mapped county-level diabetes-related rates and resources/use using publicly available secondary data to identify Michigan counties with high diabetes prevalence and low or no medical and/or community resources.Methods. We collected county-level diabetes-related rates and resources from Web-based sources and mapped them using geographic information systems (GIS) software. Data included age-adjusted county diabetes rates, diabetes-related medical resource and resource use (i.e., the number of endocrinologists and percentage of Medicare patients with diabetes who received hemoglobin A1c testing in the past year), community resources (i.e., the number of certified diabetes self-management education and diabetes support groups), as well as population estimates and demographics (e.g., rural residence, education, poverty, and race/ethnicity). We created GIS maps highlighting areas that had higher-than-median rates of disease and lower-than-median resources. We also conducted linear, logistic, and Poisson regression analyses to confirm GIS findings.Results. There were clear regional trends in resource distribution across Michigan. The 15 counties in the Upper Peninsula were lacking in medical resources but higher in community resources compared with the 68 counties in the Lower Peninsula. There was little apparent association between need (diabetes prevalence) and diabetes-related resources/use. Specific counties with high diabetes prevalence and low resources were easily identified using GIS mapping.Conclusion. Using public data and mapping tools identified diabetes health-service shortage areas for targeted public health programming.

This article presents the findings of a secondary analysis of the National Longitudinal Transition Study 2 that explored the predictive association between training in access technology and performance on the Woodcock-Johnson Tests of Academic Achievement: III. The results indicated that the use of access technology had a limited predictive relationship to performance on tests. Practical implications are discussed.

We investigated knowledge, attitudes, and behaviors of prescribers concerning piperacillin-tazobactam use at 4 Emory University-affiliated hospitals. Discussions during focus groups indicated that the participants' perceived knowledge of clinical criteria for appropriate piperacillin-tazobactam use was inadequate. Retrospective review of medical records identified inappropriate practices. These findings have influenced ongoing interventions aimed at optimizing piperacillin-tazobactam use.

Psychosocial factors arising from socioeconomic disadvantage and discrimination may contribute to the excess risk of elevated blood pressure in AfricanAmericans. The purpose of this study was to assess the association of social support and stress with blood pressure in a communitybased sample of 25 to 50yearold black adults in Pitt County, NC. A stratified random sample of dwellings was selected in 1988, and 1,784 black adults 80 of those eligible were interviewed. Analyses were sex specific and adjusted for age, obesity, and waisthip ratio. In separate analyses of emotional support, instrumental support, and stress with blood pressure, all associations were in the predicted direction inverse for support, direct for stress but were stronger for systolic than for diastolic blood pressure. Differences in systolic blood pressure associated with low support or high stress ranged from 5.2 to 3.6 mmHg in women and 3.5 to 2.5 mmHg in men. In simultaneous regression analyses of support and stress, each of the separate effects was reduced for women, but a sizable aggregate effect of low support and high stress remained 7.2 mmHg 95 confidence limits 1.3, 13.1 for systolic blood pressure and 4.0 mmHg 95 confidence limits 0.1, 7.9 for diastolic blood pressure.