Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-25 (of 25 Records) |
Query Trace: Wisdom A[original query] |
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Evaluation of interventions to improve timely hepatitis B birth dose vaccination among infants and maternal tetanus vaccination among pregnant women in Nigeria
Kanu FA , Freeland C , Nwokoro UU , Mohammed Y , Ikwe H , Uba B , Sandhu H , An Q , Asekun A , Akataobi C , Adewole A , Fadahunsi R , Wisdom M , Akudo OL , Ugbenyo G , Simple E , Waziri N , Vasumu JJ , Bahuli AU , Bashir SS , Isa A , Ugwu G , Obi EI , Binta H , Bassey BO , Shuaib F , Bolu O , Tohme RA . Vaccine 2024 42 (24) 126222 BACKGROUND: Nigeria has the largest number of children infected with hepatitis B virus (HBV) globally and has not yet achieved maternal and neonatal tetanus elimination. In Nigeria, maternal tetanus diphtheria (Td) vaccination is part of antenatal care and hepatitis B birth dose (HepB-BD) vaccination for newborns has been offered since 2004. We implemented interventions targeting healthcare workers (HCWs), community volunteers, and pregnant women attending antenatal care with the goal of improving timely (within 24 hours) HepB-BD vaccination among newborns and Td vaccination coverage among pregnant women. METHODS: We selected 80 public health facilities in Adamawa and Enugu states, with half intervention facilities and half control. Interventions included HCW and community volunteer trainings, engagement of pregnant women, and supportive supervision at facilities. Timely HepB-BD coverage and at least two doses of Td (Td2+) coverage were assessed at baseline before project implementation (January-June 2021) and at endline, one year after implementation (January-June 2022). We held focus group discussions at intervention facilities to discuss intervention strengths, challenges, and improvement opportunities. RESULTS: Compared to baseline, endline median vaccination coverage increased for timely HepB-BD from 2.6% to 61.8% and for Td2+ from 20.4% to 26.9% in intervention facilities (p < 0.05). In comparison, at endline in control facilities median vaccination coverage for timely HepB-BD was 7.9% (p < 0.0001) and Td2+ coverage was 22.2% (p = 0.14). Focus group discussions revealed that HCWs felt empowered to administer vaccination due to increased knowledge on hepatitis B and tetanus, pregnant women had increased knowledge that led to improved health seeking behaviors including Td vaccination, and transportation support was needed to reach those in far communities. CONCLUSION: Targeted interventions significantly increased timely HepB-BD and Td vaccination rates in intervention facilities. Continued support of these successful interventions could help Nigeria reach hepatitis B and maternal and neonatal tetanus elimination goals. |
Dimensions of wisdom perception across twelve countries on five continents
Rudnev M , Barrett HC , Buckwalter W , Machery E , Stich S , Barr K , Bencherifa A , Clancy RF , Crone DL , Deguchi Y , Fabiano E , Fodeman AD , Guennoun B , Halamová J , Hashimoto T , Homan J , Kanovský M , Karasawa K , Kim H , Kiper J , Lee M , Liu X , Mitova V , Nair RB , Pantovic L , Porter B , Quintanilla P , Reijer J , Romero PP , Singh P , Tber S , Wilkenfeld DA , Yi L , Grossmann I . Nat Commun 2024 15 (1) 6375 Wisdom is the hallmark of social judgment, but how people across cultures recognize wisdom remains unclear-distinct philosophical traditions suggest different views of wisdom's cardinal features. We explore perception of wise minds across 16 socio-economically and culturally diverse convenience samples from 12 countries. Participants assessed wisdom exemplars, non-exemplars, and themselves on 19 socio-cognitive characteristics, subsequently rating targets' wisdom, knowledge, and understanding. Analyses reveal two positively related dimensions-Reflective Orientation and Socio-Emotional Awareness. These dimensions are consistent across the studied cultural regions and interact when informing wisdom ratings: wisest targets-as perceived by participants-score high on both dimensions, whereas the least wise are not reflective but moderately socio-emotional. Additionally, individuals view themselves as less reflective but more socio-emotionally aware than most wisdom exemplars. Our findings expand folk psychology and social judgment research beyond the Global North, showing how individuals perceive desirable cognitive and socio-emotional qualities, and contribute to an understanding of mind perception. |
Overdose prevention activities led by local public health departments, 2019-2023
Wisdom A , Haddad S , Govindu M , Higgins F , Filion N , Sullivan K , Rooks-Peck C . Subst Abuse Treat Prev Policy 2024 19 (1) 29 BACKGROUND: Drug overdose deaths in the United States increased to historic levels in recent years, with provisional estimates indicating more than 111,000 deaths in the 12 months ending July 2023. In 2019, the Centers for Disease Control and Prevention's Division of Overdose Prevention in collaboration with the National Association of City and County Health Officials, funded local health departments (LHDs) to work on overdose prevention activities. This paper aims to: 1) describe the overdose prevention activities that LHDs implemented during the four eighteen-month funding cycles; 2) identify programmatic successes and areas of opportunity for LHDs to consider when implementing future overdose prevention activities; and to 3) inform policy considerations and future overdose prevention programming at the local level. METHODS: We used programmatic data to identify overdose prevention activities implemented by 45 LHDs. Activities were double-coded according to the social-ecological model and the U.S. Department of Health and Human Services Overdose Prevention Strategies and Guiding Principles. We analyzed final codes to identify distribution and overlap of the Strategies and Guiding Principles across the social ecological model co-occurrences. RESULTS: Approximately 55.9% (n=123) of the 220 overdose prevention activities that were coded took place at the community level, 32.3% (n=71) at the individual level, 8.6% (n=19) at the relationship level, and 3.2% (n=7) at the policy level. Most of the activities were coded as coordination, collaboration, and integration (n=52, 23.6%), harm reduction (n=51, 23.1%), data and evidence (n=47, 21.4%) or reducing stigma (n=24, 10.9%). Few activities were related to primary prevention (n=14, 6.4%), equity (n=14, 6.4%), recovery support (n=11, 5.0%), and evidence-based treatment (n=7, 3.2%). CONCLUSIONS: Localities have primarily implemented activities focused on the community and individual levels, with most of these centered around coordination, collaboration, and integration; harm reduction; or data and evidence. This study identified gaps in overdose prevention for LHDs related to treatment and health equity and that more interventions should be implemented at the relationship and policy levels. Continuing these efforts is important as LHDs explore opportunities to enhance and expand their work in various strategy areas across the social ecology. Findings from this study may be used to inform localities as they design and implement future overdose prevention activities. |
Barriers and facilitators to hepatitis B birth dose vaccination: Perspectives from healthcare providers and pregnant women accessing antenatal care in Nigeria
Freeland C , Kanu F , Mohammed Y , Nwokoro UU , Sandhu H , Ikwe H , Uba B , Asekun A , Akataobi C , Adewole A , Fadahunsi R , Wisdom M , Akudo OL , Ugbenyo G , Simple E , Waziri N , Vasumu JJ , Bahuli AU , Bashir SS , Isa A , Ugwu GO , Obi EI , Binta H , Bassey BO , Shuaib F , Bolu O , Tohme RA . PLOS Glob Public Health 2023 3 (6) e0001332 Nigeria is estimated to have the largest number of children worldwide, living with chronic hepatitis B virus (HBV) infection, the leading cause of liver cancer. Up to 90% of children infected at birth develop chronic HBV infection. A birth dose of the hepatitis B vaccine (HepB-BD) followed by at least two additional vaccine doses is recommended for prevention. This study assessed barriers and facilitators of HepB-BD administration and uptake, using structured interviews with healthcare providers and pregnant women in Adamawa and Enugu States, Nigeria. The Consolidated Framework for Implementation Sciences Research (CFIR) guided data collection and analysis. We interviewed 87 key informants (40 healthcare providers and 47 pregnant women) and created a codebook for data analysis. Codes were developed by reviewing the literature and reading a subsample of queries line-by-line. The overarching themes identified as barriers among healthcare providers were: the lack of hepatitis B knowledge, limited availability of HepB-BD to vaccination days only, misconceptions about HepB-BD vaccination, challenges in health facility staffing capacity, costs associated with vaccine transportation, and concerns related to vaccine wastage. Facilitators of timely HepB-BD vaccination included: vaccine availability, storage, and hospital births occurring during immunization days. Overarching themes identified as barriers among pregnant women were lack of hepatitis B knowledge, limited understanding of HepB-BD importance, and limited access to vaccines for births occurring outside of a health facility. Facilitators were high vaccine acceptance and willingness for their infants to receive HepB-BD if recommended by providers. Findings indicate the need for enhanced HepB-BD vaccination training for HCWs, educating pregnant women on HBV and the importance of timely HepB-BD, updating policies to enable HepB-BD administration within 24 hours of birth, expanding HepB-BD availability in public and private hospital maternity wards for all facility births, and outreach activities to reach home births. |
American Indian and Alaska Native Knowledge and Public Health for the Primary Prevention of Missing or Murdered Indigenous Persons
Satter DE , Mercer Kollar LM , O'Gara 'Djik Sook D , Public Health Writing Group on Missing or Murdered Indigenous Persons Various Public Health Experts . Dep Justice J Fed Law Pract 2021 69 (2) 149-188 Violence against American Indian and Alaska Native (AIAN) women, children, two-spirit individuals,(1) men, and elders is a serious public health issue. Violence may result in death (homicide), and exposure to violence has lasting effects on the physical and mental health of individuals, including depression and anxiety, substance abuse, chronic and infectious diseases, and life opportunities, such as educational attainment and employment. All communities are affected by some form of violence, but some are at an increased risk because of intergenerational, structural, and social factors that influence the conditions in communities where people live, learn, work, and play. Using a violence prevention public health approach, we discuss the role public health can play in addressing and preventing the prevalence of missing or murdered indigenous persons (MMIP).(2) This paper is written as a public health primer and includes a selective overview of public health and Native public health research. It also includes case studies and Native experts' reflections and suggestions regarding the use of public health knowledge and theory, as well as Native knowledge and cultural practices to combat violence. An effective public health prevention approach is facilitated by complex, contextual knowledge of communities and people, including individual and community risk factors, as well as protective factors in strengthening Native communities and preventing MMIP. Public health promotes and protects the health of people and the communities where they live, learn, work, and play. To prevent violence, public health seeks to create safe, stable, and nurturing relationships and environments for all people. MMIP affects communities, families, and loved ones, and its victims may be women and girls, children, men, two-spirit individuals, and elders. Violence is defined as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation."(3) Violence, including adverse childhood experiences (ACEs), has a lasting impact on health, spanning injury, disease outcomes, risk behaviors, maternal and child health, mental health problems, and death.(4) This paper serves as a public health primer to prevent MMIP. MMIP context is provided by weaving public health, research, and applied examples from AIAN experts, best practices in public health, and legal approaches using traditional wisdom and culture. Woven throughout the text, author perspectives are provided as applied examples to contextualize and complement the topics raised based on the individual experiences of several authors. |
"Make Stories That Will Always Be There": Eagle Books' appeal, sustainability, and contributions to public health, 2006-2022
Satterfield D , DeBruyn L , Lofton T , Francis CD , Zoumenou V , DeCora L , Wesner C . Prev Chronic Dis 2023 20 E26 PURPOSE AND OBJECTIVES: We aimed to determine why the Eagle Books, an illustrated series for American Indian and Alaska Native (AIAN) children to address type 2 diabetes, remain viable long after their release. We sought to answer 2 questions: Why did the books maintain popularity? What factors have sustained them? INTERVENTION APPROACH: Type 2 diabetes burgeoned in the US after World War II, compounding a long legacy of injustices for AIAN peoples. By the 1980s, their rates soared above those of White people. Concerned for future generations, Tribal Leaders suggested that the Centers for Disease Control and Prevention and Indian Health Service use traditional storytelling to teach children about staying healthy. Public health interventions are most effective when culture and history are integrated into health education, particularly stories to address a relatively new disease for AIAN peoples. EVALUATION METHODS: From 2008 through 2013, we conducted a case study among 8 tribal communities to evaluate the uptake of the Eagle Books across Indian Country. To understand the Eagle Books' sustained appeal, in 2022 we reanalyzed the original case study themes and analyzed for the first time themes that emerged from evaluation results in the Eagle Books' program literature. These were programs that had independently evaluated their use of the Eagle Books and published their findings. RESULTS: Outcomes demonstrated continuous application of the Eagle Books in diverse community interventions, influencing children's healthy choices. Community implementers described sustainability components, such as the books' versatility, flexibility of use, and availability online and in print. IMPLICATIONS FOR PUBLIC HEALTH: Historical, social, economic, and environmental health determinants intersect with biological and behavioral factors to weave a complex web of causation for type 2 diabetes, beginning early in life. Compelling, colorful stories reflecting traditional wisdom and respect for Western and Indigenous science - through the eyes of a wise eagle, a clever rabbit, a tricky coyote, and kids in T-shirts and sneakers - can positively influence community health. |
State and Local Chronic Disease Programs Adapt and Pivot to Address Community Needs During the COVID-19 Pandemic: Examples From CDC Funded SPAN, REACH, and HOP Programs.
O'Toole TP , René Lavinghouze S , Pejavara A , Petersen R . Health Promot Pract 2022 23 12s-20s This supplement issue of Health Promotion Practice (HPP), “Reducing Chronic Disease through Physical Activity and Nutrition: Public Health Practice in the Field” (https://journals.sagepub.com/toc/hppa/23/1_suppl) has a focus on publishing practice wisdom from the field of nutrition, physical activity, and obesity programs. Publishing the practitioner’s perspective facilitates reducing gaps in literature, enhancing education of partners and decision makers, increasing knowledge translations, and improving the evidence base for addressing public health challenges. Practice wisdom draws upon public health practitioners’ experiences and expertise in developing, improving, or adapting practices to implement public health intervention programs (Chen et al., 2011; Dunet et al., 2013). HPP publication allows for a broader, more enduring dissemination of practice wisdom while building upon prior progress. |
From practice to publication: The promise of writing workshops
Lavinghouze SR , Kettel Khan L , Auld ME , Sammons Hackett D , Brittain DR , Brown DR , Greaney E , Harris DM , Maynard LM , Onufrak S , Robillard AG , Schwartz R , Siddique S , Youngner CG , Wright LS , O'Toole TP . Health Promot Pract 2022 23 21s-33s Practitioners in health departments, university extension programs, and nonprofit organizations working in public health face varied challenges to publishing in the peer-reviewed literature. These practitioners may lack time, support, skills, and efficacy needed for manuscript submission, which keeps them from sharing their wisdom and experience-based evidence. This exclusion can contribute to literature gaps, a failure of evidence-based practice to inform future research, reduced ability to educate partners, and delays in advancing public health practice. Our article describes the writing workshops offered to Division of Nutrition, Physical Activity, and Obesity (DNPAO), Centers for Disease Control and Prevention (CDC) funded programs in 2021. This project consisted of three 60-minute introductory writing webinars open to all recipients, followed by a Writing for Publications workshop, an 8- to 9-week virtual learning/writing intensive for selected writing team applicants. The Society for Public Health Education staff, consultants, and CDC/DNPAO staff developed, refined, and presented the curriculum. The workshop for public health practitioner writing teams was offered to two cohorts and included extensive coaching and focused on potential submission to a Health Promotion Practice supplement, "Reducing Chronic Disease through Physical Activity and Nutrition: Public Health Practice in the Field" (see Supplemental Material), which was supported by CDC/DNPAO. We describe the webinars, the workshop design, modifications, evaluation methods and results. |
Five priority public health actions to reduce chronic disease through improved nutrition and physical activity
O'Toole TP , Blanck HM , Flores-Ayala R , Rose K , Galuska DA , Gunn J , O'Connor A , Petersen R , Hacker K . Health Promot Pract 2022 23 5s-11s Welcome to this supplemental issue of Health Promotion Practice (HPP), “Reducing Chronic Disease through Physical Activity and Nutrition: Public Health Practice in the Field” (https://journals.sagepub.com/toc/hppa/23/1_suppl), which is entirely devoted to practice-based wisdom from the field of nutrition, physical activity, and obesity programs. The specific aims of this supplement are to advance public health research and practice by showcasing innovative community-centered interventions, implementation, adaptations, and evaluations employed by the Centers for Disease Control and Prevention (CDC), Division of Nutrition, Physical Activity, and Obesity (DNPAO) (www.cdc.gov/nccdphpd/dnpao/index.html) cooperative agreement recipients: State Physical Activity and Nutrition Program (SPAN, DP18-1807) (www.cdc.gov/nccdphp/dnpao/state-local-programs/span-1807/index.html), Racial and Ethnic Approaches to Community Health (REACH, DP18-1813) (www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/index.htm), and the High Obesity Programs (HOP, DP18-1809) (www.cdc.gov/nccdphp/dnpao/state-local-programs/hop-1809/high-obesity-program-1809.html). |
Improving partnerships between public health and public safety to reduce overdose deaths: An inventory from the CDC overdose data to action funding initiative
Mital S , Wisdom AC , Wolff JG . J Public Health Manag Pract 2022 28 S279-s285 Rates of drug overdose deaths are high and growing. Innovative strategies, such as partnerships between public health and public safety (PH/PS) agencies, are needed to curb these trends. Support for PH/PS partnerships as an overdose prevention strategy is growing; however, little information exists on the makeup of activities within this strategy. The US Centers for Disease Control and Prevention's (CDC's) Overdose Data to Action (OD2A) cooperative agreement supports innovative and comprehensive overdose surveillance and prevention activities across the United States. Within OD2A, funded states, counties/cities, and territories may implement PH/PS partnerships to reduce overdose deaths. An inventory of PH/PS activities described in OD2A recipients' year 2 annual progress reports was conducted. These activities were abstracted for PH/PS partners' roles, intended audience, deliverables, objectives, stage of overdose risk addressed, and type of strategy implemented. The inventory revealed that 49 of the 66 funded jurisdictions planned 109 PH/PS activities. Most aimed to bridge knowledge, data, and service gaps and intervened at higher levels of overdose risk. This analysis highlights opportunities to adapt and expand cross-sector overdose prevention efforts across the overdose risk continuum. |
The Martinsburg Initiative: A collaboration between public safety, public health, and schools to address trauma and substance use
Wisdom AC , Villamil V , Govindu M , Kursey M , Peppard L , Bates RA , Myrick A , Snyder C , Noonan RK . J Public Health Manag Pract 2022 28 S355-s358 The Martinsburg Initiative (TMI) is a community-based model developed in Martinsburg, West Virginia, that implements a comprehensive approach to adverse childhood experiences and substance use prevention and mitigation by leveraging partnerships in public health and health care, public safety, and education. TMI receives coordinated federal funding and technical assistance from the Centers for Disease Control and Prevention, the Washington-Baltimore High Intensity Drug Trafficking Agency, and the National Association of County and City Health Officials to integrate evidence-based and promising strategies. It advances such strategies by translating them for implementation within the community, evaluating the reach and potential impact of the model, and by engaging key stakeholders. Preliminary results describing program reach and short-term outcomes collected for a subset of the interventions during implementation are presented. The model uses touchpoints across multiple community sectors in the city of Martinsburg to break the cycle of trauma and substance use across the life span. |
Adverse childhood experiences and overdose: Lessons from overdose data to action
Wisdom AC , Govindu M , Liu SJ , Meyers CM , Mellerson JL , Gervin DW , DePadilla L , Holland KM . Am J Prev Med 2022 62 S40-s46 INTRODUCTION: Adverse childhood experiences and overdose are linked in a cycle that affects individuals and communities across generations. The Centers for Disease Control and Prevention's Overdose Data to Action cooperative agreement supports a comprehensive public health approach to overdose prevention and response activities across the U.S. Exposure to traumatic events during childhood can increase the risk for myriad health outcomes, including overdose; therefore, many Overdose Data to Action recipients leveraged funds to address adverse childhood experiences. METHODS: In 2021, an inventory of Overdose Data to Actionfunded activities implemented in 2019 and 2020 showed that 34 of the 66 recipients proposed overdose prevention activities that support people who have experienced adverse childhood experiences or that focus on preventing the intergenerational transmission of adverse childhood experiences. Activities were coded by adverse childhood experience prevention strategy, level of the social ecology, and whether they focused on neonatal abstinence syndrome. RESULTS: Most activities among Overdose Data to Action recipients occurred at the community level of the socialecologic model and under the intervene to lessen harms adverse childhood experience prevention strategy. Of the 84 adverse childhood experiencerelated activities taking place across 34 jurisdictions, 44 are focused on neonatal abstinence syndrome. CONCLUSIONS: Study results highlight the opportunities to expand the breadth of adverse childhood experience prevention strategies across the social ecology. Implementing cross-cutting overdose and adverse childhood experiencerelated activities that span the socialecologic model are critical for population-level change and have the potential for the broadest impact. Focusing on neonatal abstinence syndrome also offers a unique intervention opportunity for both adverse childhood experience and overdose prevention. |
Revising conventional wisdom about histoplasmosis in the United States
Benedict K , Toda M , Jackson BR . Open Forum Infect Dis 2021 8 (7) ofab306 Studies performed during the 1940s-1960s continue to serve as the foundation of the epidemiology of histoplasmosis given that many knowledge gaps persist regarding its geographic distribution, prevalence, and burden in the United States. We explore 3 long-standing, frequently cited, and somewhat incomplete epidemiologic beliefs about histoplasmosis: (1) histoplasmosis is the most common endemic mycosis in the United States, (2) histoplasmosis is endemic to the Ohio and Mississippi River Valleys, and (3) histoplasmosis is associated with bird or bat droppings. We also summarize recent insights about the clinical spectrum of histoplasmosis and changes in underlying conditions associated with the severe forms. Continuing to identify prevention opportunities will require better epidemiologic data, better diagnostic testing, and greater awareness about this neglected disease among health care providers, public health professionals, and the general public. © 2021 Published by Oxford University Press on behalf of Infectious Diseases Society of America 2021. |
State-led opioid overdose prevention efforts: Challenges, solutions and lessons learned from the CDC Prevention for States Program (PfS)
Underwood N , Rooks-Peck C , Ali N , Wisdom A , Costa O , Robinson A , Mells J , Bacon S . Subst Abus 2021 42 (2) 1-22 Background: The Centers for Disease Control and Prevention's Prevention for States (PfS) program funded 29 state health departments to prevent opioid overdose by implementing evidence-based prevention strategies. The objectives of this analysis were to describe the scope of activities implemented across the four PfS strategies and identify implementation challenges. Methods: PfS recipients submitted annual progress reports (APRs) to state support staff at CDC from 2015 to 2017. APR data were used to calculate the number of required and optional activities implemented under each PfS strategy. APR data were qualitatively analyzed using a systematic content analysis approach to identify key implementation challenges. Results: From 2015 to 2017, PfS recipients implemented 177 activities across four strategies from 2015 to 2017. Cross-cutting implementation challenges were (1) multi-sector collaboration, (2) lack of knowledge and misperceptions about opioid used disorder (OUD) among some partners and local communities and; (3) management and access to opioid data among PfS recipients. Conclusions: PfS recipients implemented an array of prevention interventions to address the opioid overdose crisis and encountered several cross-cutting implementation challenges. Challenges and state driven solutions over the course of implementing PfS led to several lessons learned and actions that CDC enacted to continue to support and expand overdose prevention. |
Adverse childhood experiences and stimulant use disorders among adults in the United States
Tang S , Jones CM , Wisdom A , Lin HC , Bacon S , Houry D . Psychiatry Res 2021 299 113870 Recent data indicate a resurgence of stimulant use and harms in the United States; thus, there is a need to identify risk factors to inform development of effective prevention strategies. Prior research suggests adverse childhood experiences (ACEs) are common among individuals using stimulants and may be an important target for prevention. National Epidemiological Survey on Alcohol and Related Conditions was used to estimate prevalence of ACEs among U.S. adults using amphetamine-type stimulants (ATS), cocaine, or both. Multivariable logistic regression examined associations between ACEs and stimulant use and use disorders. Among adults reporting lifetime ATS use, 22.1% had ≥4 ACEs, 24.9% had 2-3 ACEs, 22.4% had 1 ACE, 30.6% reported no ACEs. Among adults with lifetime ATS use disorder, 29.3% reported ≥4 ACEs, 28.7% reported 2-3 ACEs, 21.6% reported 1 ACE, and 20.4% reported no ACEs. Multivariable logistic regression found a significant relationship between number of ACEs and stimulant use and use disorders. In conclusion, we found a strong relationship between increasing ACE exposures and stimulant use and use disorders. Advancing comprehensive strategies to prevent ACEs and treating underlying trauma among those using stimulants holds great promise to reduce stimulant use and its health and social consequences in the United States. |
Kiss and tell: Limited empirical data on oropharyngeal Neisseria gonorrhoeae among men who have sex with men and implications for modeling
Bernstein KT , Chesson H , Kirkcaldy RD , Marcus JL , Gift TL , Aral SO . Sex Transm Dis 2017 44 (10) 596-598 An extraordinary claim requires extraordinary proof. - Marcello Truzzi | In this issue of Sexually Transmitted Diseases, Zhang and colleagues make two bold assertions. First, they conclude that kissing accounts for over 70% of gonorrhea in men who have sex with men (MSM). Second, they suggest that a mouthwash with high efficacy against oropharyngeal N. gonorrhoeae could substantially reduce the overall gonorrhea prevalence in MSM. Although anecdotal reports of N. gonorrhoeae transmission through kissing exist, conventional wisdom is that gonorrhea transmission through kissing happens rarely, if at all. It is important to clarify that Zhang and colleagues present no empirical evidence of transmission by kissing. Instead, they conclude that kissing must be an important mode of transmission because otherwise their model could not replicate current data on oropharyngeal gonorrhea prevalence among MSM in Australia. Although mathematical models such as that of Zhang and colleagues are vital to the field of STD research, a common limitation of these models is a scarcity of data to inform their construction. | For science to advance, however, we must be open to new ideas and challenges to conventional wisdom. In fact, over the past decades, we have come to understand that oropharyngeal gonorrhea is more common and more likely to be transmitted to other anatomic sites than was previously thought. Thus, it is conceivable that oropharyngeal infections could play a key role in sustaining gonorrhea in MSM via kissing, as suggested by Zhang and colleagues. If so, it is also plausible that a mouthwash with efficacy against oropharyngeal gonorrhea could have a notable population-level impact on gonorrhea. One of the most useful contributions of their modeling exercise is to highlight the numerous unanswered questions related to how a mouthwash-based intervention may affect community-level gonorrhea prevalence. Below, we identify several areas of inquiry that are critical to the development of a more lucid epidemiology of gonorrhea. |
Using a programmatic mapping approach to plan for HIV prevention and harm reduction interventions for people who inject drugs in three South African cities
Scheibe A , Shelly S , Lambert A , Schneider A , Basson R , Medeiros N , Padayachee K , Savva H , Hausler H . Harm Reduct J 2017 14 (1) 35 BACKGROUND: Stigma, criminalisation and a lack of data on drug use contribute to the "invisibility" of people who inject drugs (PWID) and make HIV prevention and treatment service delivery challenging. We aimed to confirm locations where PWID congregate in Cape Town, eThekwini and Tshwane (South Africa) and to estimate PWID population sizes within selected electoral wards in these areas to inform South Africa's first multi-site HIV prevention project for PWID. METHODS: Field workers (including PWID peers) interviewed community informants to identify suspected injecting locations in selected electoral wards in each city and then visited these locations and interviewed PWID. Interviews were used to gather information about the accessibility of sterile injecting equipment, location coordinates and movement patterns. We used the Delphi method to obtain final population size estimates for the mapped wards based on estimates from wisdom of the crowd methods, the literature and programmatic data. RESULTS: Between January and April 2015, we mapped 45 wards. Tshwane teams interviewed 39 PWID in 12 wards, resulting in an estimated number of accessible PWID ranging from 568 to 1431. In eThekwini, teams interviewed 40 PWID in 15 wards with an estimated number of accessible PWID ranging from 184 to 350. The Cape Town team interviewed 61 PWID in 18 wards with an estimated number of accessible PWID ranging between 398 and 503. Sterile needles were only available at one location. Almost all needles were bought from pharmacies. Between 80 and 86% of PWID frequented more than one location per day. PWID who reported movement visited a median of three locations a day. CONCLUSIONS: Programmatic mapping led by PWID peers can be used effectively to identify and reach PWID and build relationships where access to HIV prevention commodities for PWID is limited. PWID reported limited access to sterile injecting equipment, highlighting an important HIV prevention need. Programmatic mapping data show that outreach programmes should be flexible and account for the mobile nature of PWID populations. The PWID population size estimates can be used to develop service delivery targets and as baseline measures. |
Nonfasting sample for the determination of routine lipid profile: Is it an idea whose time has come?
Rifai N , Young IS , Nordestgaard BG , Wierzbicki AS , Vesper H , Mora S , Stone NJ , Genest J , Miller G . Clin Chem 2016 62 (3) 428-35 For many years the determination of a routine lipid profile (total, LDL, and HDL cholesterol and triglycerides) has been done routinely in the clinical laboratory using a blood specimen that is collected in the fasting state. The rationale for such a requirement includes 1) the postprandial changes in lipoprotein composition known to occur, particularly the increases in triglycerides (TG)10 concentration which have a direct relation to the meal fat and carbohydrate content, 2) the clinically significant effects of increased TG (>400 mg/dL; 4.5 mmol/L) on the calculation of LDL cholesterol (LDL-C) when using the Friedewald equation, and 3) the use of fasting samples for lipid measurement in many clinical trials and epidemiological studies on which treatment goals are based. However, because most of each person's lifetime is spent in the postprandial state, the wisdom of collecting a fasting sample to determine future risk of cardiovascular disease has been challenged. In addition, recent evidence has demonstrated that nonfasting TG concentrations are a better predictor of future coronary events compared to fasting TG, in both men and women. The Danish Society for Clinical Biochemistry, in 2009, and the UK National Institute of Clinical Excellence (NICE), in 2014, recommended the use of a nonfasting specimen for the determination of routine lipid profile; both entities acknowledge that in certain situations a fasting sample is required. The European Atherosclerosis Society and the European Federation of Clinical Chemistry and Laboratory Medicine will be making a similar recommendation. In contrast, the 2013 guidelines released by the American College of Cardiology/American Heart Association (ACC/AHA) preferred a fasting specimen for lipid testing. Such inconsistencies in published guidelines will complicate the interpretation of the literature and confound metaanalyses. The decision of whether to use a fasting or nonfasting sample, however, will be driven not only by the strong epidemiologic and clinical evidence and the convenience to clinicians and patients but also by the reliability of the analytical techniques used in the measurement of these analytes. To address this issue, we invited a group of experts consisting of cardiologists, epidemiologists, clinical researchers, and clinical chemists to share their views on this topic. |
Uncovering the role of antibiotics in the transmission of multidrug-resistant organisms
McDonald LC . JAMA Intern Med 2015 175 (4) 633-4 Conventional wisdom has suggested two distinct categories of epidemiologic risk factors in the development of Clostridium difficile infection (CDI): factors that increase the risk of transmission of C. difficile and factors that disrupt the patient’s lower intestinal microbiota, a major host defense against infection. This host defense function may be best understood in terms of the expression of these microorganisms collective and representative genome, known as the microbiome. Although antibiotics appear to be the major disruptive force of the microbiome in hospitalized patients, there is evidence that other medications such as proton pump inhibitors and antidepressants, as well as chronic conditions such as obesity1, may also be associated with microbiome disruption and/or CDI. In addition to increasing the risk for infection, the microbiome disruption from antibiotics may also increase C. difficile transmission via increased likelihood of asymptomatic colonization and, once colonized, increasing clonal expansion and domination of the microbiota by C. difficile. Meanwhile, there is increasing evidence pointing to the importance of asymptomatic carriers in the transmission of C. difficile in hospitals. However, few studies have examined the epidemiology of antibiotics effecting transmission of C. difficile between patients, something Brown et al have addressed in this issue of JAMA Int Med.2 | This study examined an individual acute care hospital cohort over 4 years, capturing both individual level risk factors such as age, gender, previous admission, and inpatient medication exposures including but not limited to antibiotic exposures. In addition, average characteristics of the ward or unit population over the 46-month study period were recorded including mean age and antibiotic, chemotherapeutic, and antacid medications in days of therapy (DOT)/100 patient-days, as well as mean feeding tube use. Other ward and unit-level risk factors included patient density and hand hygiene compliance. Multivariable models and, most importantly, a multilevel model, were constructed in which patient factors and ward factors were examined together in regard to their increasing risk of CDI. |
Critique and lessons learned from using multiple methods to estimate population size of men who have sex with men in Ghana
Quaye S , Fisher Raymond H , Atuahene K , Amenyah R , Aberle-Grasse J , McFarland W , El-Adas A . AIDS Behav 2015 19 Suppl 1 S16-23 Population size estimation of key populations at risk of HIV is essential to every national response. We implemented population size estimation of men who have sex with men (MSM) in Ghana using a three-stage approach within the 2011 Ghana Men's Study: during the study's formative assessment, the larger integrated bio-behavioral surveillance (IBBS) survey; and during the stakeholder meeting. We used six methods in combination within the three-stage approach (literature review, mapping with census, unique object multiplier, service multiplier, wisdom of the crowd, and modified Delphi) to generate size estimates from 16 locations (4 IBBS survey sites and 12 other locations) and used the estimates from the 16 sites to extrapolate the total MSM population size of Ghana. We estimated the number of MSM in Ghana to be 30,579 with a plausible range of 21,645-34,470. The overall estimate suggests that the prevalence of MSM in Ghana is 0.48 % of the adult male population. Lessons learned are shared to inform and improve applications of the methods in future studies. |
Psychological stress as a trigger for herpes zoster: might the conventional wisdom be wrong?
Harpaz R , Leung JW , Brown CJ , Zhou FJ . Clin Infect Dis 2014 60 (5) 781-5 The causes for zoster remain largely unknown. Psychological stress is one commonly-considered risk factor. We used self-controlled case series methods to look for increases in zoster following death or catastrophic health event occurring in a previously-healthy spouse. We found no increase, although this stressor led to increased mental health visits. |
Implementing the CDC's Colorectal Cancer Screening Demonstration Program: wisdom from the field
Rohan EA , Boehm JE , Degroff A , Glover-Kudon R , Preissle J . Cancer 2013 119 Suppl 15 2870-83 BACKGROUND: Colorectal cancer, as the second leading cause of cancer-related deaths among men and women in the United States, represents an important area for public health intervention. Although colorectal cancer screening can prevent cancer and detect disease early when treatment is most effective, few organized public health screening programs have been implemented and evaluated. From 2005 to 2009, the Centers for Disease Control and Prevention funded 5 sites to participate in the Colorectal Cancer Screening Demonstration Program (CRCSDP), which was designed to reach medically underserved populations. METHODS: The authors conducted a longitudinal, multiple case study to analyze program implementation processes. Qualitative methods included interviews with 100 stakeholders, 125 observations, and review of 19 documents. Data were analyzed within and across cases. RESULTS: Several themes related to CRCSDP implementation emerged from the cross-case analysis: the complexity of colorectal cancer screening, the need for teamwork and collaboration, integration of the program into existing systems, the ability of programs to use wisdom at the local level, and the influence of social norms. Although these themes were explored independently from 1 another, interaction across themes was evident. CONCLUSIONS: Colorectal cancer screening is clinically complex, and its screening methods are not well accepted by the general public; both of these circumstances have implications for program implementation. Using patient navigation, engaging in transdisciplinary teamwork, assimilating new programs into existing clinical settings, and deferring to local-level wisdom together helped to address complexity and enhance program implementation. In addition, public health efforts must confront negative social norms around colorectal cancer screening. |
Are benefits conferred with greater socioeconomic position undermined by racial discrimination among African American men?
Hudson DL , Bullard KM , Neighbors HW , Geronimus AT , Yang J , Jackson JS . J Mens Health 2012 9 (2) 127-136 BACKGROUND: Conventional wisdom suggests that increased socioeconomic resources should be related to better health. Considering the body of evidence demonstrating the significant association between racial discrimination and depression, we examined whether exposure to racial discrimination could attenuate the positive effects of increased levels of socioeconomic position (SEP) among African Americans. Specifically, this paper investigated the joint interactive effects of SEP and racial discrimination on the odds of depression among African Americans. METHODS: Racial discrimination was measured using two measures, major and everyday discrimination. Study objectives were achieved using data from the National Survey of American Life, which included a nationally representative sample of African Americans (n= 3570). Logistic regression models were used to estimate the effects of SEP and racial discrimination on the odds of depression. RESULTS: Reports of racial discrimination were associated with increased risk of depression among African American men who possessed greater levels of education and income. Among African American men, significant, positive interactions were observed between education and experiences of major discrimination, which were associated with greater odds of depression (P= 0.02). Additionally, there were positive interactions between income and both measures of racial discrimination (income x everyday discrimination, P= 0.013; income x major discrimination, P= 0.02), which were associated with increased odds of depression (P= 0.02). CONCLUSIONS: It is possible that experiences of racial discrimination could, in part, diminish the effects of increased SEP among African American men. (2012 WPMH GmbH.) |
Testing rules of thumb and the science of health literacy
Baur C , Ostrove N . Ann Intern Med 2011 155 (2) 129-30 Achieving perfect health outcomes would be easy if a particular treatment always cured the targeted disease, regardless of whether the disease occurred in a 47-year-old white man with high blood pressure and high cholesterol levels, an 18-year-old black woman with type 1 diabetes, or a 72-year-old Asian man with prostate cancer. Yet, as the emerging field of personalized medicine acknowledges, there are powerful interactions between individual characteristics and responses to treatment (1). Consequently, even when we are fortunate enough to have high-quality evidence, outcomes for specific situations can be difficult to predict and “rules of thumb” may not prove reliable. In the face of uncertainty, we must do our best to give patients and the public clear advice about what they can do to maintain and improve their health. Two articles in this issue (2, 3) remind us to rethink the conventional wisdom and rules of thumb that guide communication with patients. | The study by Woloshin and Schwartz (3) raises numerous questions about the most effective way to present probabilities about medication-related outcomes to lay people. Although previous studies have led to the conventional wisdom that lay people understand natural frequencies better than they understand percents (4), Woloshin and Schwartz's findings suggest the opposite. However, given that these findings stem from a single study that focused on the risks and benefits of prescription drugs, it would be premature to consider them as a definitive challenge to the idea that we should avoid percents when communicating risk estimates to lay people. Further study is needed in diverse populations about various health-related topics to answer such questions as, “Under what circumstances are percents better?” “When do natural frequencies win out?” “Is there a way to identify patients who might understand one construct better than the other?” |
The three Es of healthy swimming
Hlavsa MC , Beach MJ . J Environ Health 2011 73 (9) 26-7 Thankfully, none of us has to know everything or go it alone in public health. | We have colleagues with different | backgrounds who can share their knowledge | and wisdom to help address emerging public | health threats. We, as epidemiologists, are fortunate that our Centers for Disease Control | and Prevention (CDC) environmental health | colleagues, Charles Otto and Pat Bohan, have | taught us to view outbreak investigations and | other recreational water illness (RWI) issues | with an environmental health perspective and | use a systems-based approach to problem solving. Recreational water illnesses (RWIs) are | caused by pathogens transmitted by ingesting, | inhaling aerosols of, or having contact with | contaminated water in pools, hot tubs, interactive fountains, lakes, rivers, oceans, and so | forth. RWIs can also be caused by chemicals | in the water or those that volatilize from the | water and cause indoor air quality problems. | At state and local public health agencies, environmental health specialists like New York | State’s Doug Sackett bring emerging issues to | our attention and remind us of the need to | balance science with what is practical and feasible. One of the many great insights we have | taken from working with Doug is his belief | in the three Es—education, engineering, and | enforcement—to combat public health challenges, including RWIs |
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