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The Certified Community Behavioral Health Clinic (CCBHC) demonstration is designed to increase access to comprehensive ambulatory care and crisis services, which may reduce emergency department (ED) visits and hospitalizations. This study examined whether the demonstration had an impact on ED visits and hospitalizations in Missouri, Oklahoma, and Pennsylvania. This difference-in-differences analysis used Medicaid claims data from 2015 to 2019 to examine service use during a 12-month baseline period and the first 24 months of the demonstration for beneficiaries who received care from CCBHCs and beneficiaries who received care from other behavioral health clinics in the same state, representing care as usual. Propensity score methods were used to develop treatment and comparison groups with similar characteristics. In Pennsylvania and Oklahoma, beneficiaries who received care from CCBHCs had a statistically significant reduction in the average number of behavioral health ED visits, relative to the comparison group (13% and 11% reductions, respectively); no impact on ED visits in Missouri was observed. The demonstration was associated with a statistically significant reduction in all-cause hospitalizations in Oklahoma, when the analysis used a 2-year rather than a 1-year baseline period, and also in Pennsylvania, when hospitalizations were truncated at the 98th percentile to exclude beneficiaries with outlier hospitalization rates. The CCBHC demonstration reduced behavioral health ED visits in two states, and the study also revealed some evidence of reductions in hospitalizations. [ABSTRACT FROM AUTHOR]

Background: Insufficient physical activity among urban youth increases risk of chronic disease.Purpose:This study assessed reported physical activity to determine when disparities in participation emerge and what ecologically guided factors are linked with high activity. Methods:We administered a cross-sectional survey to a diverse sample of 321 fourth-, sixth-, and eighth-graders measuring physical activity and a range of ecologically guided variables via self-report. Students who reported high versus low levels of physical activity were compared in bivariate and stepwise regression models stratified by gender and grade to elucidate factors associated with high physical activity. Results: The proportion of highly active students declined between fourth and sixth/eighth grade, driven largely by a decline in highly active girls. Unique factors were associated with high physical activity by grade or gender including self-efficacy among fourth-graders (adjusted odds ratio [aOR] ¼ 14.51, 95% confidence interval [CI], 1.60-131.84), social support among sixth- and eighth-graders (aOR ¼ 5.93, 95% CI, 2.04-17.29) and girls (aOR ¼ 9.03, 95% CI, 1.95-41.75), and perceived normal weight status among boys (aOR ¼ 6.62, 95% CI, 2.18-20.16). Discussion: Declines in physical activity among girls may initiate earlier than previously reported. Translation to Health Education Practice: School-based efforts to increase physical activity levels should be initiated as soon as fourth grade.

The Taeniidae tapeworms are a family of helminths that have a similar life cycle, with intermediate hosts developing characteristic cysts in visceral organs. We describe here a case in Pennsylvania, USA, of fatal Versteria infection in a muskrat (Ondatra zibethicus), which, to our knowledge, has not been reported to develop disease associated with infection. Postmortem examination revealed widespread tissue loss and replacement by solid-bodied cestode larvae with minimal adjacent inflammation in many visceral organs, most severe in the lungs, liver, and brain. Key morphologic features via histology included cephalic structures and short rostellar hooklets, which are characteristic for the genus. Genetic characterization confirmed the cestode as being an undescribed lineage of Versteria that has been implicated as the cause of severe morbidity and mortality in humans and nonhuman primates in North America. Considering the zoonotic significance of this pathogen, our report expands on the limited literature regarding disease caused by Versteria and emphasizes the need to identify the causative tapeworm more accurately, especially in rodent intermediate hosts given that previous reports do not have molecular confirmation of species. [ABSTRACT FROM AUTHOR]

Using diagnostic data and contemporary sampling efforts, we conducted surveillance for a diversity of pathogens, toxicants, and diseases of muskrats (Ondatra zibethicus). Between 1977 and 2019, 26 diagnostic cases were examined from Kansas and throughout the Southeast and Mid-Atlantic, USA. We identified multiple causes of mortality in muskrats, but trauma (8/26), Tyzzer's disease (5/6), and cysticercosis (5/26) were the most common. We also conducted necropsies, during November 2018—January 2019 Pennsylvania muskrat trapping season, on 380 trapper-harvested muskrat carcasses after the pelt was removed. Tissue samples and exudate were tested for presence of or exposure to a suite of pathogens and contaminants. Gastrointestinal tracts were examined for helminths. Intestinal helminths were present in 39.2% of necropsied muskrats, with Hymenolepis spp. (62%) and echinostome spp. (44%) being the most common Molecular testing identified a low prevalence of infection with Clostridium piliforme in the feces and Sarcocystis spp. in the heart. We detected a low seroprevalence to Toxoplasma gondii (1/380). No muskrats were positive for Francisella tularensis or Babesia spp. Cysticercosis was detected in 20% (5/26) of diagnostic cases and 15% (57/380) of our trapper-harvested muskrats. Toxic concentrations of arsenic, cadmium, lead, or mercury were not detected in tested liver samples. Copper, molybdenum, and zinc concentrations were detected at acceptable levels comparative to previous studies. Parasite intensity and abundance were typical of historic reports; however, younger muskrats had higher intensity of infection than older muskrats which is contradictory to what has been previously reported. A diversity of pathogens and contaminants have been reported from muskrats, but the associated disease impacts are poorly understood. Our data are consistent with historic reports and highlight the wide range of parasites, pathogens and contaminants harbored by muskrats in Pennsylvania. The data collected are a critical component in assessing overall muskrat health and serve as a basis for understanding the impacts of disease on recent muskrat population declines. [ABSTRACT FROM AUTHOR]

Infectious diseases, particularly of wildlife, are intrinsically linked to human and domestic animal health. Reports of sarcoptic mange in black bears (Ursus americanus) are increasing in multiple states in the USA and while the reason is unknown, mange in other species has been associated with immunosuppression from multiple causes. Serum from bears across Pennsylvania were collected to determine the seroprevalence of five pathogens important for animal and/or human health: Canine distemper virus (CDV), canine parvovirus (CPV), canine adenovirus-1 (CAV), Toxoplasma gondii, and Trichinella sp. from bears with sarcoptic mange as well as bears that were clinically normal. Several of these pathogens, particularly canine distemper virus, are associated with immunosuppression and secondary infections in other hosts. In addition to describing the seroprevalence and relating these findings to data from other regions, statistics were performed to determine if antibodies to any of these pathogens were associated with mange in bears. The overall seroprevalence to these pathogens was as follows: CDV 7.1% (17/240), CPV 16% (15/94), CAV 6.9% (6/87), Toxoplasma gondii 64.9% (194/299), and Trichinella spiralis 3.2% (7/220). While there was no association between mange and antibodies to these pathogens, infection with one or more of these pathogens has implications for bears, other wildlife, domestic animal, and human health. [ABSTRACT FROM AUTHOR]

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For two decades, the incidence and range of sarcoptic mange in black bears (Ursus americanus) in Pennsylvania has increased. The causative agent, Sarcoptes scabiei, can be directly or indirectly transmitted; therefore, data on environmental persistence is important for guiding management and public communications. The objective of this study was to determine the survival of S. scabiei at different temperatures. Full section skin samples and superficial skin scrapes were collected from bears immediately after euthanasia due to severe mange. After ~ 24 h on ice packs (shipment to lab), samples were placed in dishes at 0, 4, 18, or 30 °C and 60, 20, 12, and 25% relative humidity, respectively, and the percentage of mites alive, by life stage, was periodically determined. Humidity was recorded but not controlled. Temperature significantly affected mite survival, which was shortest at 0 °C (mostly ≤ 4 h) and longest at 4 °C (up to 13 days). No mites survived beyond 8 days at 18 °C or 6 days at 30 °C. Mites from full-thickness skin sections survived significantly longer than those from superficial skin scrapes. Adults typically survived longer than nymphs and larvae except at 30 °C where adults survived the shortest time. These data indicate that at cooler temperatures, S. scabiei can survive for days to over a week in the environment, especially if on host skin. However, these data also indicate that the environment is unlikely to be a long-term source of S. scabiei infection to bears, other wildlife, or domestic animals. [ABSTRACT FROM AUTHOR]

Sarcocystis sarcocysts are common in many species of domestic and wild animals. Here, we report sarcocystosis in muscles from 91 free range elk (Cervus elaphus) from Pennsylvania, USA, tested by histopathology, transmission electron microscopy (TEM), and DNA sequencing. Sarcocysts were detected in hematoxylin and eosin (HE)-stained sections from 83 of 91 (91.2%) elk, including 83/91 (91.2%) tongues and 15/17 (88.2%) hearts. With respect to age, sarcocysts were found in 0/5 calves, 8/9 (88.8%) yearlings, and 75/77 (97.4%) adults. Sarcocysts were identified in 62/69 (89.4%) females and 21/22 (91.2%) males. Associated lesions were mild and consisted of inflammatory foci around degenerate sarcocysts. There were two morphologically distinct sarcocysts based on wall thickness, thin (< 0.5 μm) and thick-walled (> 4.0 μm). Thin-walled sarcocysts had a TEM “type 2” and villar protrusions (vps), identical to Sarcocystis wapiti previously described from elk in western USA. This species was present both in tongue and heart samples and was detected in all infected elk. Thick-walled sarcocysts consisted of three morphologic variants, referred to herein as subkinds A, B, C. Subkind A sarcocysts were rare; only four sarcocysts were found in three elk. Histologically, they had a 5-8-μm thick wall with tufted vp. By TEM, the sarcocyst wall was “type 12” and appeared similar to Sarcocystis sybillensis, previously described from elk in USA. Subkind B, Sarcocystis sp.1 sarcocysts were also rare, found in only 1 elk. These sarcocysts had 6.7-7.3-μm-thick wall with TEM “type 15b” vp. Subkind C Sarcocystis sp.2 sarcocysts were more common (22/91). Morphologically, the sarcocyst wall was 6.1-6.8 μm thick and contained “type 10b” vp. Comparisons of ribosomal DNA loci with published sequences indicated all sarcocysts were similar to what has previously been isolated from cervid hosts across the northern hemisphere. Phylogenetic analysis placed the thin-walled S. wapiti within a strongly supported clade with S. linearis and S. taeniata, while the thick-walled cysts were very closely related to S. truncata, S. elongata, S. silva, and S. tarandi. Further sequencing is needed to produce molecular diagnostics to distinguish among these species. North American elk are hosts to multiple Sarcocystis species with diverse morphology, deriving from two separate evolutionary lineages. [ABSTRACT FROM AUTHOR]

This qualitative study examined the implementation of a reverse colocation pilot program that sought to integrate medical care in two community behavioral health agencies. To accomplish this, each agency hired a registered nurse, provided training for its staff to function as wellness coaches, and implemented a web-based tool for tracking consumer outcomes. The findings from two rounds of stakeholder discussions and consumer focus groups suggested that agencies successfully trained their staffs in wellness coaching, integrated nurses into agency functions, developed integrated care planning processes, and increased awareness of wellness among staff and consumers. Similar to other complex interventions, the agencies experienced challenges including difficulty establishing new procedures and communication protocols, discomfort among staff in addressing physical health concerns, difficulty building collaborative relationships with primary care providers, and modest uptake of the web-based tool. The study offers insights into the practical aspects of integrating care and makes recommendations for future efforts. [ABSTRACT FROM AUTHOR]

Insufficient physical activity among urban youth increases risk of chronic disease. PurposeThis study assessed reported physical activity to determine when disparities in participation emerge and what ecologically guided factors are linked with high activity. MethodsWe administered a cross-sectional survey to a diverse sample of 321 fourth-, sixth-, and eighth-graders measuring physical activity and a range of ecologically guided variables via self-report. Students who reported high versus low levels of physical activity were compared in bivariate and stepwise regression models stratified by gender and grade to elucidate factors associated with high physical activity. ResultsThe proportion of highly active students declined between fourth and sixth/eighth grade, driven largely by a decline in highly active girls. Unique factors were associated with high physical activity by grade or gender including self-efficacy among fourth-graders (adjusted odds ratio [aOR] = 14.51, 95% confidence interval [CI], 1.60–131.84), social support among sixth- and eighth-graders (aOR = 5.93, 95% CI, 2.04–17.29) and girls (aOR = 9.03, 95% CI, 1.95–41.75), and perceived normal weight status among boys (aOR = 6.62, 95% CI, 2.18–20.16). DiscussionDeclines in physical activity among girls may initiate earlier than previously reported. Translation to Health Education PracticeSchool-based efforts to increase physical activity levels should be initiated as soon as fourth grade. [ABSTRACT FROM AUTHOR]

This study examines how aspects of coalition functioning predict a coalition’s ability to promote high-quality implementation of evidence-based programs (EBPs). The study involved 62 Communities That Care (CTC) coalitions in Pennsylvania measured annually from 2003 to 2007. Findings indicate that the communities with higher levels of poverty and longer existing coalitions are related to lower support for high-quality EBP implementation. Several aspects of coalition functioning—including higher levels of funding; leadership strength; board efficiency; strong internal and external relationships; and fidelity to the CTC model—significantly predicted support for high-quality EBP implementation. Earlier measurements of coalition functioning (2003–2004 and 2005–2006) predicted EBP implementation (2007) more strongly than concurrent coalition assessments (2007). The discussion focuses on how coalitions and technical assistance providers can improve coalition support for the implementation of EBPs. [ABSTRACT FROM AUTHOR]

Reports on the extension of existing supervised-learning and unsupervised-clustering algorithms to allow document classification in Pittsburgh, Pennsylvania. Development of topic detection tracking (TDT) to increase information retrieval capabilities; patterns of temporal event distribution; Details on the categorization approaches. INSETS: The TDT program.;κNN and other text-categorization approaches..

From 2020 to 2023, we used diaries from squirrel hunters to estimate the prevalence of Cuterebra emasculator (Squirrel Bot Fly), which parasitize and burrow under the skin of chipmunks and tree squirrels and form bulges called "warbles", among 3 tree squirrel species in Pennsylvania. We received diaries from 1222 squirrel hunters who harvested 7356 squirrels, of which 249 (3.4%) were reported to have subcutaneous swellings consistent with warbles. Annual prevalence rates varied from 2.5% to 3.9%, were consistently highest during the first week of the hunting season (mid-September), and declined to near zero by December. Overall, warbles were more prevalent in Sciurus carolinensis (Eastern Gray Squirrel; 3.6%) than in S. niger (Eastern Fox Squirrel; 1.3%) and Tamiasciurus hudsonicus (American Red Squirrel; 0.0%). During the first 5 weeks of the squirrel-hunting season, squirrels harvested in southern latitudes had higher warble prevalence rates (6.4%) than in northern latitudes (4.1%), but no associations were observed between prevalence and physiographic province. Providing earlier hunting-season opportunities increased the likelihood that hunters would encounter squirrels with warbles than they did historically. Communications efforts should focus on educating hunters on the occurrence of warbles in squirrels in Pennsylvania, particularly during the early season, and on the lack of public health impacts of this disease on squirrel meat. [ABSTRACT FROM AUTHOR]