Search

Background Emergency departments (EDs) play an essential role in the timely initiation of HIV post-exposure prophylaxis (PEP) for sexual assault victims. Methods Retrospective analysis of sexual assault victims evaluated and offered HIV PEP in an urban academic ED between January 1, 2005 and January 1, 2018. Data on demographics, comorbidities, nature of sexual assault, initial ED care, subsequent healthcare utilization within 28 days of initial ED visit, and evidence of seroconversion within 6 months of the initial ED visit were obtained. Predictors of subsequent ED visit and follow-up in the infectious diseases clinic were evaluated using logistic regression analysis. Results Four hundred twenty-three ED visits met criteria for inclusion in this study. Median age at ED presentation was 25 years (IQR 21–34 years), with the majority of victims being female (95.5%), Black (63.4%), unemployed (66.3%) and uninsured (53.9%); psychiatric comorbidities (38.8%) and substance abuse (23.6%) were common. About 87% of the patients accepted HIV PEP (368 of 423 ED visits). Age (OR 0.97, 95% CI 0.94–0.99, p = 0.025) and sexual assault involving >1 assailant (OR 0.48, 95% CI 0.26–0.88, p = 0.018) were associated with lower likelihood of HIV PEP acceptance. Ten patients (2.7%) followed up with the infectious disease clinic within 28 days of starting HIV PEP; 70 patients (19%) returned to the ED for care during the same time period. Psychiatric comorbidity (OR 2.48, 95% CI 1.43–4.30, p = 0.001) and anal penetration (OR 2.02, 95% CI 1.10–3.70, p = 0.024) were associated with greater likelihood of repeat ED visit; female gender (OR 0.30, 95% CI 0.11–0.85, p = 0.023) was associated with lower likelihood of repeat visit. Completion of HIV PEP was documented for 14 (3.3%) individuals. Conclusions While ED patient acceptance of HIV PEP after sexual assault was high, infectious disease clinic follow-up and documented completion of PEP remained low. Innovative care models bridging EDs to outpatient clinics and community support services are needed to optimize transitions of care for sexual assault victims, including those receiving HIV PEP.

This study employs risk terrain modeling to identify the spatial correlates of aggravated assault and homicide in St. Louis, MO. We build upon the empirical literature by (1) replicating recent research examining the role of vacancy in the concentration of criminal violence and (2) examining whether the environmental correlates of violence vary between north and south St. Louis, a boundary that has long divided the city along racial and socioeconomic lines. Our results indicate that vacancy presents a strong, consistent risk for both homicide and aggravated assault and that this pattern emerges most clearly in the northern part of the city which is majority African American and has suffered chronic disinvestment. The concentration of criminal violence in South City is driven primarily by public hubs including housing, transportation, and schools. Our results underscore the importance of vacancy as a driver of the spatial concentration of violent crime and point to potential heterogeneity in risk terrain modeling results when applied to large metropolitan areas. Situational crime prevention strategies would be well served to consider such spatial contingencies as the risk factors driving violent crime are neither uniformly distributed across space nor uniform in their impact on criminal violence.

Introduction Women with gestational diabetes are 7 times more likely to develop type 2 diabetes and require lifelong diabetes screening. Loss of health coverage after pregnancy, as occurs in states that did not expand Medicaid, limits access to guideline-driven follow-up care and fosters health inequity. This study aims to understand the factors associated with the receipt of postpartum diabetes screening for women with gestational diabetes in a state without Medicaid expansion. Methods Electronic health record and Medicaid claims data were linked to generate a retrospective cohort of 1,078 women with gestational diabetes receiving care in Federally Qualified Health Centers in Missouri from 2010 to 2015. In 2019–2020, data were analyzed to determine the factors associated with the receipt of recommended postpartum diabetes screening (fasting plasma glucose, 2-hour oral glucose tolerance test, or HbA1c in specified timeframes) using a Cox proportional hazards model through 18 months of follow-up. Results Median age in this predominantly urban population was 28 (IQR=24−33) years. Self-reported racial or ethnic minorities comprised more than half of the population. Only 9.7% of women were screened at 12 weeks, and 20.8% were screened at 18 months. Prenatal certified diabetes education (adjusted hazard ratio=1.74, 95% CI=1.22, 2.49) and access to public transportation (adjusted hazard ratio=1.70, 95% CI=1.13, 2.54) were associated with increased screening in a model adjusted for race/ethnicity, the total number of prenatal visits, the use of diabetes medication during pregnancy, and a pregnancy-specific comorbidity index that incorporated age. Conclusions This study underscores the importance of access to public transportation, prenatal diabetes education, and continued healthcare coverage for women on Medicaid to support the receipt of guideline-recommended follow-up care and improve health equity.

Background The national rate of syphilis has increased among persons who inject drugs (PWID). Missouri is no exception, with increases in early syphilis (ES), congenital syphilis, and PWID, especially in nonurban counties. Methods Disease intervention specialist records for ES cases in Missouri (2012–2018) were examined. Drug use was classified as injection drug use (IDU) (opioid or methamphetamine) or non-IDU (opioid, methamphetamine, or cocaine). Rates were compared based on residence, sex of sex partner, and drug use. Results Rates of ES in Missouri increased 365%, particularly in small metropolitan and rural areas (1170%). Nonurban areas reported a higher percentage of persons with ES who used injection drugs (12%–15%) compared with urban regions (2%–5%). From 2012 to 2018, women comprised an increasing number of ES cases (8.3%–21%); 93% of women were of childbearing age. Increasingly more women in rural areas with ES also reported IDU during this time (8.4%–21.1%). Conclusions As syphilis increases in small metropolitan and rural regions, access to high-quality and outreach-based sexual health services is imperative. Healthcare policy to equip health departments with harm reduction services and drug treatment resources offers an opportunity to impact both syphilis increases as well as health outcomes associated with IDU.

Background Emergency Departments (EDs) are a care source for patients with sexually transmitted diseases (STDs). St. Louis, MO reports among the highest rates of gonorrhea and chlamydia infection. We examined STD treatment in a high-volume urban ED, in St. Louis MO, to identify factors that may influence treatment. Methods A retrospective chart review and analysis was conducted on visits to a high volume, academic ED in St. Louis, MO where patients received a gonorrhea/chlamydia nucleic acid amplification test (NAAT) with a valid matching test result over two years. Using multiple logistic regression, we examined available predictors for under and overtreatment. Results NAATs were performed on 3.3% of all ED patients during the study period. Overall prevalence was 6.9% for gonorrhea (95% CI: 6.2, 7.7) and 11.6% for chlamydia (95% CI: 10.6, 12.5). Race was not a statistically significant predictor for undertreatment but Black patients were significantly more likely to be overtreated compared to White patients. (OR 1.83, 95% CI: 1.5, 2.2). Females were more likely to be undertreated when positive for infection compared to males (OR 7.34, 95% CI: 4.8, 11.2) and less likely to be overtreated when negative for infection (OR 0.27, 95% CI: 0.2, 0.3). Conclusion The burden of STDs in a high-volume academic ED was significant and treatment varied across groups. Attention should be paid to particular groups, specifically women and patients reporting Black as their race, to ensure appropriate treatment is administered. Patients would benefit from targeted STD management protocols and training in the ED.

The objective of this study is to evaluate whether pregnant women receive appropriate treatment, undertreatment, or overtreatment in the emergency department (ED) when they are tested for chlamydia and gonorrhea as compared to non-pregnant women. In a retrospective cohort study, we analyzed visits made to an urban ED from 1 July 2012 to 30 June 2014, with testing for chlamydia and gonorrhea (n = 3908). Using multiple logistic regression, we compared undertreatment and overtreatment in women controlling for pregnancy, age, race, and sexually transmitted infection International Statistical Classifications of Diseases (ICD)-9 coded diagnosis. Pregnant women were significantly more likely to be undertreated when positive for infection as compared to non-pregnant women (OR 2.94; 95% CI, 1.47–5.95) and significantly less likely to be overtreated when negative for infection (OR 0.40; 95% CI, 0.31–0.53) as compared to non-pregnant women. Pregnant women may not be receiving appropriate treatment when they present to the ED with chlamydia or gonorrhea. Attention should be paid to this group when administering chlamydia and gonorrhea treatment to ensure appropriate care and follow-up.

International audience; Fougerite, the natural green rust, first discovered in soils and universally considered as responsible for the blue-green colour of gleys and an indicator of reducing conditions, has been recently considered as a key mineral for life's emergence in the alkaline hydrothermal vents theory. It inherits all of the reactive properties of layered double hydroxides in its hydrated interlayer but also the specific reactivity of mixed Fe(II)-Fe(III) compounds, including redox reactivity with metals and metalloids. Along with its structural and compositional analogy with metallo-enzymes, all these properties have stimulated research on the possible role of fougerite as a membrane, and a catalytic engine, especially where gradients of pH, redox potential and temperature favour mixing of chemically contrasted reactants, such as at hydrothermal systems. Although the presence of fougerite, however difficult to detect, has never been reported at alkaline hydrothermal systems, we have thermodynamically evaluated whether the environmental conditions met in such modern oceanic systems are compatible with the formation of fougerite. Data on fluids from the Lost City hydrothermal field (30°N, Mid Atlantic ridge, Seyfried et al. (2015)) support the reducing nature of this environment, close to the lower limit of stability of water at 90 °C and 80 atm. Calculations show that equilibrium with amakinite, the rare ferrous analogue of brucite, is more likely than equilibrium with brucite. This allows for computing in situ pH values close to 8 and thus mildly alkaline, while pH measured on board on vent fluids at 25 °C is higher than 10. This is in favour of the occurrence of ferrous hydroxide deeper in the root of the hydrothermal system where temperature is higher and pH are lower compared to seafloor vents where the fluids discharge. Secondary oxidation of amakinite, thanks to the recurrent circulation of seawater in the hydrothermal conduits, will necessarily lead to fougerite formation. To deepen this question, several lines of investigation are finally proposed, including e.g., the stability of fougerite at elevated temperatures and pressures, its reactivity with key elements for life such as C, N, P, Mo, Ni, S etc. and its potential role for free energy conversion and basic functions of metabolism.

The coronavirus disease of 2019 (COVID-19) pandemic declared by the World Health Organization on March 11, 2020 impacted healthcare services with provider and patient cancellations, delays, and patient avoidance or delay of emergency department or urgent care. Limited data exist on the population proportion affected by delayed healthcare, which is important for future healthcare planning efforts. Our objective was to evaluate the impact of the COVID-19 pandemic on healthcare service cancellations or delays and delays/avoidance of emergency/urgent care overall and by population characteristics.This was a cross-sectional study.Our sample (n = 2314) was assembled through a phone survey from 8/12/2020-10/27/2020 among non-institutionalized St. Louis County, Missouri, USA residents ≥18 years. We asked about provider and patient-initiated cancellations or delays of appointments and pandemic-associated delays/avoidance of emergency/urgent care overall and by participant characteristics. We calculated weighted prevalence estimates by select resident characteristics.Healthcare services cancellations or delays affected ∼54% (95% CI 50.6%-57.1%) of residents with dental (31.1%, 95% CI 28.1%-34.0%) and primary care (22.1%, 95% CI 19.5%-24.6%) being most common. The highest prevalences were among those who were White, ≥65 years old, female, in fair/poor health, who had health insurance, and who had ≥1 medical condition. Delayed or avoided emergency/urgent care impacted ∼23% (95% CI 19.9%-25.4%) of residents with a higher prevalence in females than males.Healthcare use disruptions impacted a substantial proportion of residents. Future healthcare planning efforts should consider these data to minimize potential morbidity and mortality from delayed care.

The true prevalence of COVID-19 is difficult to estimate due to the absence of random population-based testing. To estimate current and past COVID-19 infection prevalence in a large urban area, we conducted a population-based survey in St. Louis County, Missouri.The population-based survey of active infection (PCR) and seroprevalence (IgG antibodies) of adults (≥18 years) was conducted through random-digit dialing and targeted sampling of St. Louis County residents with oversampling of Black residents. Infection prevalence of residents was estimated using design-based and raking weighting.Between August 17 and October 24, 2020, 1245 residents completed a survey and underwent PCR testing; 1073 residents completed a survey and underwent PCR and IgG testing or self-reported results. Weighted prevalence estimates of residents with active infection were 1.9% (95% CI, 0.4%-3.3%) and 5.6% were ever infected (95% CI, 3.3%-8.0%). Overall infection hospitalization and fatality ratios were 4.9% and 1.4%, respectively.Through October 2020, the percentage of residents that had ever been infected was relatively low. A markedly higher percentage of Black and other minorities compared to White residents were infected with COVID-19. The St. Louis region remained highly vulnerable to widespread infection in late 2020.

Throughout the 20th century, chemists and mineralogists acquired basic data experimentally to characterize the enthalpies of formation of many inorganic and organic constituents identified on Earth. These works gave birth to thermodynamic databases, which are an essential link between thermodynamic chemical modeling and mobilities of elements in solutions in different pH and redox conditions. If, as a first approximation, we can be satisfied with the values accumulated in the literature, quickly, when we study a particular system, we notice inconsistencies, contradictory results or even the propagation of errors over time. To illustrate our point of view, two examples of such anomalies concerning major elements of Earth crust: Al, Fe, Si and H 2 O, will be developed. The first example concerns the Al 2 O 3-Si0 2-H 2 O system with the Halloysite-Kaolinite-Gibbsite parageneses. By this example, we show that in the literature, there is only one experimental value for the enthalpy of halloysite formation. However, by over-interpretation of the system and in particular in the definition of the degree of hydration of halloysite, other values have been proposed for this mineral. Based on these values, there are inconsistencies, which do not explain certain parageneses observed in nature. Aluminum condensation in solution and its polymerization explains its solubility is more than 100 times the classical value based upon the monomeric model. The Gibbsite-Kaolinite-Quartz system was thus reevaluated. The second example concerns the Fe(OH) 2-H 2 O system under alkaline conditions. In the literature, three solubility curves of Fe (OH) 2 are proposed. By acquiring new data in the laboratory, it was possible to demonstrate that the three curves were valid. The explanation was obtained from the analysis of the speciation of Fe in solution, which leads to different condensation pathways of the solution to the hydroxide. In this case too, in reducing and alkaline conditions, Fe(II) solubility is 100 times larger when polymerization occurs than predicted on the basis of the monomeric model. A better knowledge of speciation in solution is thus required to link thermodynamic properties of minerals and mobilities of elements in natural environments differing by P, T, pH and redox conditions.

Background In the US, health policies accompanying the COVID-19 pandemic led to restricted healthcare access and decreased clinical services. Low public health funding was a barrier to accessing sexual healthcare before the pandemic and intensified during restrictions. Surveillance of the sexual healthcare landscape can inform program development to improve sexual health. Methods We collected information from clinics offering STI testing in the St. Louis region, Missouri, USA twice during 2020: in the spring during the first pandemic lockdown and in the fall as restrictions eased. Clinics were interviewed about sexual health services and categorized into three categories: open fully with no changes; modified if hours open and/or the ability to accept walk-ins were reduced; or fully closed. We also collected chlamydia rates by zip code and categorized zip codes as low (0–174 cases per 100,000); medium (175–653); or high (654–1291) prevalence. Results Of the 112 clinics, 47 are federally qualified health centers (serve the un-and underinsured); 16 were local public health authorities; and the remaining 49 include community, school, and private settings. In the fall, 29% of clinics were open, 55% modified, 5% closed compared with spring when 7% of clinics were open, 63% were modified, 17% were closed. There was a 450% and 200% increase in the number of clinics that were open in high and medium prevalence zip codes respectively in the fall compared to the spring. Forty-nine clinics remain modified or closed in medium and high prevalence zip codes. Discussion The COVID pandemic has a significant effect on sexual health care in a metropolitan region of the US; that effect is lasting, especially in areas of medium and high chlamydia rates. Health systems must consider how the pandemic has impacted care provided for all major public health problems, including STIs/HIV or risk worsening sexual health.

L’eau est un enjeu majeur dans de nombreuses régions du monde du fait de besoins en forte croissance, mais aussi de la rareté et de la dégradation des ressources disponibles. L’agriculture étant le premier usager de la ressource en eau, la durabilité de la gestion de l’eau en milieu rural est cruciale. Elle nécessite de dépasser les approches sectorielles, encore largement en cours malgré divers courants appelant à une gestion intégrée, territoriale ou adaptative de la ressource. Prenant acte que la mise en œuvre des concepts proposés par ces différents courants est rarement effective et qu’il est plus pragmatique de rechercher la meilleure coordination possible entre les parties prenantes de la gestion de l’eau, cet ouvrage collectif analyse les enjeux, outils et démarches permettant de faciliter et d’accompagner cette coordination. En effet, une coordination effective et acceptée nécessite des méthodes et outils pour informer sur l’état de la ressource et des usages, rendre visible l’importance des enjeux, évaluer les effets et les expliquer, structurer les échanges, et élaborer et discuter des actions de gestion. L’ouvrage aborde la gestion de l’eau en milieu rural en termes d’objectifs et de démarche, puis fait un panorama large des outils, des méthodes et des données actuellement disponibles. Enfin, il décrit des exemples de mises en œuvre dans différents cas d’étude. Cet ouvrage de synthèse s’adresse à un public large allant des chercheurs, étudiants et enseignants en gestion de l’eau aux professionnels concernés par sa mise en œuvre.