Search

Reduced complexity tools that provide a representation of both primarily emitted particulate matter with an aerodynamic diameter less than 2.5 μm (PM 2.5 ), secondarily formed PM 2.5 , and ozone (O 3 ) allow for a quick assessment of many iterations of pollution control scenarios. Here, a new reduced complexity tool, Pattern Constructed Air Pollution Surfaces (PCAPS), that estimates annual average PM 2.5 and seasonal average maximum daily average 8 h (MDA8) O 3 for any source location in the United States is described and evaluated. Typically, reduced complexity tools are not evaluated for skill in predicting change in air pollution by comparison with more sophisticated modeling systems. Here, PCAPS was compared against multiple types of emission control scenarios predicted with state-of-the-science photochemical grid models to provide confidence that the model is realistically capturing the change in air pollution due to changing emissions. PCAPS was also applied with all anthropogenic emissions sources for multiple retrospective years to predict PM 2.5 chemical components for comparison against routine surface measurements. PCAPS predicted similar magnitudes and regional variations in spatial gradients of measured chemical components of PM 2.5 . Model performance for capturing ambient measurements was consistent with other reduced complexity tools. PCAPS also did well at capturing the magnitude and spatial features of changes predicted by photochemical transport models for multiple emissions scenarios for both O 3 and PM 2.5 . PCAPS is a flexible tool that provides source-receptor relationships using patterns of air quality gradients from a training data set of generic modeled sources to create interpolated air pollution gradients for new locations not part of the training database. The flexibility provided for both sources and receptors makes this tool ideal for integration into larger frameworks that provide emissions changes and need estimates of air quality to inform downstream analytics, which often includes an estimate of monetized health effects.

Background: Hispanic adults with mental health conditions in the United States experience disproportionate access to and utilization of professional mental health treatment. This is believed to be in part due to systemic barriers and challenges, difficulty accessing care, cultural factors, and stigma. Studies to date have failed to examine these specific factors within the unique context of the Paso del Norte U.S.-Mexico border region., Methods: For this study, 25 Hispanic adults identifying primarily of Mexican descent participated in four focus groups exploring these topics. Three groups were facilitated in Spanish and one group in both English and Spanish. Focus groups followed a semi-structured format eliciting perspectives on mental health and mental illness, help-seeking, barriers and facilitators of help-seeking and treatment access, and recommendations for mental health agencies and providers., Results: Qualitative data analysis yielded the following themes: understanding of mental health and help-seeking; barriers to accessing care; mental health treatment facilitators; and recommendations for agencies, providers, and researchers., Conclusion: Findings from this study support the need for innovative mental health engagement strategies to reduce stigma, increase understanding of mental health, foster support systems, reduce individual and systemic barriers to seeking and accessing care, and to continue to engage communities in mental health outreach and research., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Mallonee, Escalante, Robles and Tucker.)

Purpose: The purpose of this article is to describe the development of the Maternal Health Learning and Innovation Center (MHLIC), a national initiative designed to enhance workforce capacity of maternal health professionals in the United States., Description: The mission of the MHLIC is to foster collaboration and learning among diverse stakeholders to accelerate evidence-informed approaches advancing equitable maternal health outcomes through engagement, innovation, and policy. Working to center equity in all efforts, the MHLIC builds workforce capacity through partnership, training, technical assistance, coaching, facilitation of peer learning, and a national resource repository., Assessment: The MHLIC employed several assessment strategies in its first year, including a baseline learning survey of awardees, a stakeholder survey of potential collaborators in maternal health, and advisory convenings. Internally the MHLIC team assessed its own intercultural development. Assessment results informed internal and external approaches to workforce development., Conclusions: Telehealth implementation, access to services for rural populations, racial inequities, and data use and dissemination were the primary gaps that awardees and other stakeholders identified. The MHLIC is unique in its collaborative design approach and the centering of equity as foundational to the structure, subject, and culture of its work. The MHLIC utilizes a collaborative approach that capitalizes on academic and practice partners' extensive expertise in maternal health systems. Key to the success of future maternal health efforts is workforce development that builds the awareness and capacity to advance racial and geographic equity for public health, community, and clinical professionals., (© 2022. The Author(s).)

Background: The effect of epidural/spinal anesthesia during labor on breastfeeding is unclear. Few studies had assessed whether or how medically assisted delivery (operative vaginal delivery or unscheduled cesarean birth) plays a mediating role. We aimed to examine whether the relationship between using epidural/spinal anesthesia and breastfeeding is mediated by increased medically assisted delivery among healthy nulliparous women., Methods: A secondary, cross-sectional analysis was conducted using US birth certificate data from 2016 (n = 381 199). Logistic regression was used to examine associations between factors. Structural equation modeling (SEM) was used to analyze the model fit of the path models and to quantify the direct, indirect, and total effect of anesthesia on breastfeeding at discharge, considering medically assisted delivery as a mediator., Results: Women who were administered epidural/spinal anesthesia were more likely to experience medically assisted delivery (adjusted odds ratio [AOR]: 95% confidence interval [CI] 3.01 (2.91-3.12)) and less likely to be breastfeeding at discharge (0.95 [0.92-0.98]). Operative vaginal and unscheduled cesarean deliveries were significantly associated with nonbreastfeeding at discharge (0.81 [0.77-0.84] and 0.81 [0.79-0.84], respectively). SEM revealed excellent model fit for our model. The indirect effect was significant (β = -0.038; 95% CI, -0.043 to -0.033), as was the total effect (β = -0.038; 95% CI, -0.043 to -0.033)., Conclusions: Epidural/spinal anesthesia is associated with nonbreastfeeding at discharge, mediated through medically assisted delivery. Health care providers should consider these risks and provide adequate support to help all parents attain their breastfeeding goals., (© 2021 Wiley Periodicals LLC.)

Abstract: The Produce Safety Rule of the Food Safety Modernization Act (FSMA) sets forth minimum standards for fruit and vegetable production in the United States. One provision states that growers must not harvest dropped produce because damage or ground contact may contaminate produce. In an unpublished survey of 2020 food safety inspections conducted by the Northeast Center to Advance Food Safety, handling of dropped produce covered by the FSMA was a common misunderstood and noncompliance issue among growers in the Northeast. In consideration of this provision's on-farm practicality, this review was conducted to evaluate the risks associated with dropped and drooping produce, to guide growers in making informed risk management decisions, and to answer the following questions: (i) what are the risk factors that influence transferability of pathogens from touching the ground to produce and (ii) what are the risks associated with harvesting dropped or drooping produce covered under the Produce Safety Rule? A search of online databases revealed 12 relevant publications, which highlighted moisture, contact time, and crop features as affecting contamination rates from a ground surface to a crop surface. Soil and mulch posed a differential risk, with bare soil generally presenting a lower risk than plastic mulch. The effects of other mulch types are unclear. Mulches may promote pathogen persistence in soil, although they may also protect produce from contaminated soils. These studies were limited in their scope and applicability and most did not directly address dropped produce. Research is needed to clarify the various effects of dropped and drooping produce, the impact of ground surface type on pathogen survivability and transfer, soil and crop features that facilitate contamination, and postharvest risks of harvesting dropped or drooping produce. A comprehensive understanding of these issues will guide growers in implementing preventive measures and better managing risk in a way practicable to each farm's unique conditions., (Published 2022 by the International Association for Food Protection.)

Introduction: People of color and low-income and uninsured populations in the United States have elevated risks of adverse maternal health outcomes alongside low levels of postpartum visit attendance. The postpartum period is a critical window for delivering health care services to reduce health inequities and their transgenerational effects. Evidence is needed to identify predictors of postpartum visit attendance in marginalized populations. Methods: We conducted a systematic review of the peer-reviewed literature to identify studies that quantified patient-, provider-, and health system-level predictors of postpartum health care use by people of color and low-income and uninsured populations. We extracted study design, sample, measures, and outcome data from studies meeting our eligibility criteria, and used a modified Cochrane Risk of Bias tool to evaluate risk of bias. Results: Out of 2,757 studies, 36 met our criteria for inclusion in this review. Patient-level factors consistently associated with postpartum care included higher socioeconomic status, rural residence, fewer children, older age, medical complications, and previous health care use. Perceived discrimination during intrapartum care and trouble understanding the health care provider were associated with lower postpartum visit use, while satisfaction with the provider and having a provider familiar with one's health history were associated with higher use. Health system predictors included public facilities, group prenatal care, and services such as patient navigators and appointment reminders. Discussion: Postpartum health service research in marginalized populations has predominantly focused on patient-level factors; however, the multilevel predictors identified in this review reflect underlying inequities and should be used to inform the design of structural changes.

Objectives: To compare receipt of contraception and method effectiveness in the early postpartum period among women with and without a recent preterm birth (PTB)., Methods: We used data from North Carolina birth certificates linked to Medicaid claims. We assessed contraceptive claims with dates of service within 90 days of delivery among a retrospective cohort of women who had a live birth covered by Medicaid between September 2011 and 2012 (n = 58,201). To estimate the odds of receipt of contraception by PTB status (24-36 weeks compared to 37-42 weeks [referent]), we used logistic regression and tested for interaction by parity. To estimate the relationship between PTB and method effectiveness based on the Center for Disease Control and Prevention Levels of Effectiveness of Family Planning Methods (most, moderate and least effective [referent]), we used multinomial logistic regression., Results: Less than half of all women with a live birth covered by Medicaid in North Carolina had a contraceptive claim within 90 days postpartum. Women with a recent PTB had a lower prevalence of contraceptive receipt compared to women with a term birth (45.7% vs. 49.6%). Women who experienced a PTB had a lower odds of receiving contraception. When we stratified by parity, women with a PTB had a lower odds of contraceptive receipt among women with more than two births (0.79, 95% CI 0.74-0.85), but not among women with two births or fewer. One-fourth of women received a most effective method. Women with a preterm birth had a lower odds of receiving a most effective method (0.83, 95% CI 0.77-0.88) compared to women with a term birth., Conclusions for Practice: Contraceptive receipt was low among women with a live birth covered by Medicaid in North Carolina. To optimize contraceptive use among women at risk for subsequent preterm birth, family planning strategies that are responsive to women's priorities and context, including a history of preterm birth, are needed., Significance: Access to free or affordable highly effective contraception is associated with reductions in preterm birth. Self-report data indicate that women with a very preterm birth (PTB) are less likely to use highly or moderately effective contraception postpartum compared to women delivering at later gestational ages. Using Medicaid claims data, we found that less than half of all women with a Medicaid covered delivery in North Carolina in 2011-2012 had a contraceptive claim within 90 days postpartum, and one fourth received a most effective method. Women with a PTB and more than two children were least likely to receive any method. Family planning strategies that are responsive to women's priorities and context, including a history of preterm birth, are needed so that women may access their contraceptive method of choice in the postpartum period.

Background: In recent years, educational leaders have proposed domains of educational excellence and corresponding metrics to objectively measure contributions of clinician-educators for promotion and tenure (P&T). The purpose of this study was to explore whether P&T committees in United States (US) have incorporated these recommendations into practice. Method: The authors conducted a survey of P&T leaders across institutions in US. Items included questions related to institutional tracks for P&T, domains included in promotional packets, metrics for their measurement, and use of an Educator's Portfolio (EP). Results: Respondents from 55 institutions completed the survey. The presence of a teaching academy/society was associated with the presence of a promotion track for clinician-educators ( p = 0.04). Only teaching activities (91%), assessment of learners (55%), and educational scholarship (51%) were required by a majority of institutions. Few institutions used objective methods for measuring impact and less than half (47%) required an EP. Discussion: These results highlight both progress in the recognition of clinician-educators while also suggesting discordance in the perspective of educational leaders and the practice of P&T committees. The authors advocate for establishing a national community of expert medical educators who may assist P&T committees in adopting consensus-based criteria and metrics to evaluate clinician-educators' contributions.

This report describes a cluster of 11 soldiers with vivax malaria among U.S. military personnel who trained at Dagmar North training area, near the demilitarized zone (DMZ), in the Republic of Korea (ROK) in 2015. Two cases were diagnosed in the ROK in 2015, one of whom subsequently experienced a relapse, and nine other cases were diagnosed in 2016, 8-11 months after the soldiers had returned to the U.S. Vivax malaria poses a health threat to U.S. Forces Korea operating near the DMZ in the ROK. Continuing and enhanced focus on force health protection measures in endemic zones is warranted.

Objective: This study examined the association between alcohol outlet density and male to female intimate partner violence (IPV)., Method: Data were analyzed from a national probability sample of males who reported a current heterosexual relationship (N=3194). Multinomial logistic regression was used to examine the likelihood of having perpetrated IPV., Results: High alcohol outlet density was associated with having perpetrated physical only IPV (odds ratio [OR]=2.51; 95% confidence interval [CI]: 1.21-5.20). Outlet density was not associated with greater odds of sexual IPV perpetration., Conclusions: Alcohol outlet density was found to be associated with perpetration of physical IPV. Developing environmental strategies with respect to alcohol outlets could potentially reduce perpetration of male-to-female physical IPV., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Performance-based outcomes such as the T-Test, Edgren Side Step Test (ESST), and Illinois Agility Test (IAT) have been used to assess agility in athletes and nonathletes; however, the reliability and validity of these tests have not been established. The purpose of this study was to establish the reliability and convergent construct validity of the ESST, T-Test, and IAT in young, nondisabled, physically active male servicemembers (SMs). Ninety-seven male Active Duty U.S. Army SMs completed the study. Statistically significant differences were not found between the ESST (p = 0.10), T-Test (p = 0.09), and IAT (p = 0.23) when administered twice within a 24 to 48 h period. These tests were found to have excellent interrater reliability and moderate to good test-retest reliability. A good positive relationship exists between the IAT and T-Test (r = 0.76, p < 0.001) and a moderate negative relationship exists between the ESST and both the T-Test (r = -0.69, p < 0.001) and IAT (r = -0.65, p < 0.001). The results suggest that these tests are valid measures of agility that uniquely assess movement in different planes, thus providing a comprehensive assessment of high-level mobility.

This study examined associations between unwanted sexual experiences and both physical disability and cognitive performance in a nationally representative sample of young adults. We used data from 11,878 participants (ages 26-32) in Waves I, III, and IV of the National Longitudinal Study of Adolescent Health (Add Health). Logistic regressions determined associations between physical disability and level of cognitive performance (using a modified Peabody Picture Vocabulary Test) and the odds of experiencing physically forced and nonphysically coerced sex. Approximately 24% of females and 4% of males reported unwanted sexual experiences. Compared to respondents without disabilities, females with a physical disability had greater odds of experiencing forced sex (OR = 1.49; 95% CI [1.06, 2.08]), whereas males with a physical disability had greater odds of coerced sex (OR = 1.90; 95% CI [1.02, 3.52]). Compared to those with average cognitive performance scores, females with scores above 110 had slightly higher odds of coerced sex (OR = 1.20; 95% CI [1.03-1.41]). Further research on pathways underlying these associations is needed to inform prevention efforts.

The safety and efficacy of 2% moxidectin/12.5% praziquantel oral gel administered at a rate of 0.4 mg moxidectin and 2.5 mg praziquantel/kg was studied in client-owned horses under field use conditions. Four hundred horses (300 treated with moxidectin/praziquantel oral gel and 100 treated with vehicle) were enrolled, feces were collected, and eggs were counted. Investigators as well as horse owners were masked to treatment assignment. No adverse reactions to treatment were observed in any horses. Moxidectin/praziquantel gel reduced Anoplocephala spp by more than 99% and provided a significant (P <.05) reduction (> 98%) in the strongyle egg count of treated horses.

Medication adherence in African-American and European-American pediatric renal transplant recipients was evaluated by four separate measures. Demographic and medical factors were analyzed. Based on pill count/refill history, European-American females were more compliant than their male counterparts. Based on self-ratings of compliance, African-American recipients were more compliant if they had vs. had not had dialysis experience prior to their transplant. These recipients also had higher self-ratings of compliance if their donors were cadaveric rather than living related.