Trends and Risk Factors for Leishmaniasis among Reproductive Aged Women in the United States.

BACKGROUND AND OBJECTIVE: Leishmaniasis, a neglected tropical disease, is endemic in several regions globally, but commonly regarded as a disease of travelers in the United States (US). The literature on leishmaniasis among hospitalized women in the US is very limited. The aim of this study was to explore trends and risk factors for leishmaniasis among hospitalized women of reproductive age within the US. METHODS: We analyzed hospital admissions data from the 2002-2017 Nationwide Inpatient Sample among women aged 15-49 years. We conducted descriptive statistics and bivariate analyses for factors associated with leishmaniasis. Utilizing logistic regression, we assessed the association between sociodemographic and hospital characteristics with leishmaniasis disease among hospitalized women of reproductive age in the US. Joinpoint regression was used to examine trends over time. RESULTS: We analyzed 131,529,239 hospitalizations; among these, 207 cases of leishmaniasis hospitalizations were identified, equivalent to an overall prevalence of 1.57 cases per million during the study period. The prevalence of leishmaniasis was greatest among older women of reproductive age (35-49 years), Hispanics, those with Medicare, and inpatient stay in large teaching hospitals in the Northeast of the US. Hispanic women experienced a statistically significant increased odds of leishmaniasis diagnosis (OR, 1.80; 95% CI, 1.19-4.06), compared to Non-Hispanic (NH) White women. Medicaid and Private Insurance appeared to serve as a protective factor in both unadjusted and adjusted models. We did not observe a statistically significant change in leishmaniasis rates over the study period. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Although the prevalence of leishmaniasis among women of reproductive age appears to be low in the US, some risk remains. Thus, appropriate educational, public health and policy initiatives are needed to increase clinical awareness and timely diagnosis/treatment of the disease.

Mental Health Services in the United States Public High Schools.

BACKGROUND: Mental health services in the United States public schools are an important component of the academic success of a student. Not all schools, however, have the necessary personnel and funding to offer such services. METHODS: In this paper, we provide an analysis of data collected from schools in 3 geographic locations. Comparisons were made of the availability of personnel to assess and treat mental health disorders in students enrolled in city, urban, and suburban schools, with over 10,000 schools represented. The data were part of the 2015 to 2016 School Survey on Crime and Safety. RESULTS: Accessibility of mental health practitioners and reasons that limited efforts of a school to provide the services were assessed. Statistically significant differences were identified by school location, demonstrating that those in rural communities were most challenged providing diagnostic assessment and treatment for students by school mental health professionals, for several reasons. CONCLUSIONS: Increased state and county funding to support mental health practitioners in public high schools is one suggestion to address mental health disorders in students. Other strategies are offered for timely and appropriate diagnoses and treatment for mental health disorders that may impact the quality of life of a student for a lifetime.

Racial/Ethnic Disparities in the Burden of HIV/Cervical Cancer Comorbidity and Related In-hospital Mortality in the USA.

OBJECTIVE: The purpose of this study was to determine whether cervical cancer is a risk factor for early mortality among women with HIV and whether racial/ethnic disparity predicted in-hospital death among women living with HIV and diagnosed with cervical cancer. METHODS: We conducted a population-based study using the National Inpatient Sample (NIS) database comprising hospitalized HIV-positive women with or without cervical cancer diagnosis, from 2003 through 2015. We compared trends in the rates of cervical cancer, in-hospital death, and years of potential life lost (YPLL) by race/ethnicity. RESULTS: We identified 2,613,696 women with HIV, and among them, 5398 had cervical cancer. The prevalence of cervical cancer (per 10,000) was 9.3 for NH-Whites, 30.9 among NH-Blacks, and 30.2 for Hispanics. Rates of cervical cancer over time diminished significantly only among NH-Whites (average annual percent change (AAPC), - 5.8 (- 9.7, - 1.8)), and YPLL in women with cervical cancer decreased significantly only in NH-Whites (AAPC, - 6.2 (- 10.1, - 2.0)). Cervical cancer was associated with increased odds of in-hospital death overall (OR 2.24 (1.59-3.15)) and among NH-Blacks (OR 2.03 (1.30-3.18)) only. CONCLUSIONS: NH-Blacks and Hispanics with HIV remain at increased risk for concurrent diagnosis of cervical cancer compared with NH-Whites. Moreover, NH-Black women with HIV and cervical cancer are at greatest risk for in-hospital death. The findings emphasize the need for a more robust prevention strategy among minority women to reduce the high burden of HIV/cervical cancer and related mortality.

Utilization of Stainless Steel Crowns by Pediatric and General Dentists.

Purpose: Dental caries affects 23 percent of U.S. children aged two to five years old. 1 Stainless steel crowns (SSCs) are used for extensive caries and offer greater longevity than other restorations; however, disparity exists between pediatric and general dentists in restoration type provided. The purpose of this study was to evaluate utilization of stainless steel crowns among pediatric and general dentists by reviewing insurance claims. Methods: Data were obtained from a commercial dental insurance claims data warehouse from more than 50 dental insurance plans and multiple carriers in the United States for children 12 years old and younger. Data were examined for treatment of the primary dentition using SSCs or direct restorations. A generalized linear mixed effects model tested differences in the utilization of SSCs by general dentists (GDs) versus pediatric dentists (PD). Results: The data included 107,487 GDs and 5,395 PDs. The records included 2,555,726 claims for direct restorations and 440,423 claims for SSCs. PDs are more likely to place SSCs compared to GDs (odds ratio equals 3.2; P<0.0001). Conclusions: Pediatric dentists are more likely to restore carious primary dentitions with stainless steel crowns than general dentists. Perhaps increased training at the dental undergraduate level and access to more continuing education courses for general dentists would increase the utilization of SSCs.

Self-reported body shape and bone mineral density in a sample of African-American women.

Osteoporosis is a chronic disease that increases the risk of fractures. There are demonstrated ethnic differences in the risks and consequences of osteoporosis. Body shape, defined as either android or gynoid, might be linked to the physiological changes that are associated with menopause, which are a time of worsening bone loss and increased risk for osteoporosis. This study investigated the associations between self-reported body shapes and clinically measured hip neck and lumbar spine bone mineral density (BMD) in a group of peri-menopausal African-American women. Data from 71 women (N = 71) were gathered from a previously conducted parent study on the risks for osteoporosis and hormone replacement therapy (HRT). A multivariate regression model demonstrated that there was a positive association between self-reported android body shape and a higher hip neck BMD among study participants. The multivariate regression model was adjusted for demographics and for other risk factors.

Strategies for Recruitment of Healthy Premenopausal Women into the African American Nutrition for Life (A NULIFE) Study.

BACKGROUND: Although African American women have an overall lower incidence of breast cancer, African American women <40 years of age are more likely than Caucasian women of all ages and postmenopausal African American women to be diagnosed with breast cancer and exhibit tumor characteristics associated with poorer survival. To begin to address this disparity, studies must be conducted to examine breast cancer preventive factors in this subpopulation of women. However, the strategies needed to recruit younger African American women have not been well defined. METHODS: In this study, we assessed methods used for recruiting and retaining healthy premenopausal African American women into the African American Nutrition for Life (A NULIFE) Study. The number of women contacted, enrolled, and retained by each recruitment strategy and the efficiency of individual strategies were calculated. RESULTS: Overall, recruitment through social networking was most effective in contacting large numbers of healthy premenopausal African American women. The worksite recruitment method was the most efficient recruitment strategy employed, with a ratio of 40%. The study participants (n = 164) were more likely to be >or=35 years of age and have completed some college. Additionally, the interpersonal relationships recruitment approach proved most efficient (33%) in retaining participants who completed the yearlong study. CONCLUSIONS: The findings from this study add to the evolving research literature on minority recruitment strategies for research studies but specifically address effective recruitment of healthy young premenopausal African American women. The results demonstrate the need to use multiple recruitment strategies when recruiting this subgroup of African American women.

An examination of public school safety measures across geographic settings.

BACKGROUND: Violence at a school can have a negative impact on the health of students, teachers, administrators, and others associated with the school and surrounding community. The use of weapons in school buildings or on school grounds accounts for the majority of violent deaths, particularly among males. This national trend suggests the need for a more concerted effort to improve safety and prevent violence. This article reports the use of 13 safety measures in US public schools in 4 geographic regions (Northeast, Midwest, South, and West) and 3 community settings (urban, suburban, and rural). METHODS: Data representing 16,000 schools reported in the Educational Longitudinal Survey of 2002-2004 were analyzed. Data were self-reported by school administrators. RESULTS: Of the various safety measures assessed, fire alarms and extinguishers were consistently reported regardless of the geographic region or community setting of the school. Other than measures for fire safety, schools throughout the country routinely used exterior light and student lockers as safety measures. There was a significant difference by geographic region and community setting in the use of safety measures that required specific personnel, namely a security guard and an adult to direct a guest to sign in. CONCLUSION: Recognizing the patterns of violence at public high schools, administrators working with students, other school personnel, and community partners may consider more combinations of the safety measures within their institutions together with local resources and services to improve safety and reduce violence.

Development of a health risk factors questionnaire for Chinese and Vietnamese residents of the Houston, Texas area.

The purpose of the Asian American Health Needs Assessment (AsANA) project was to collect information on the health risks, behaviors, and beliefs among Chinese and Vietnamese residents in the Houston area, two of the largest Asian American subgroups in Texas. The first phase of the project was to develop the AsANA survey instrument, which was adapted from the Texas Community Health Survey, a condensed version of the Behavioral Risk Factors Surveillance System. This report describes the steps used in adapting, modifying and developing the survey instrument, and provides insights, which may assist other investigators conducting similar research.

Survivors of domestic violence: demographics and disparities in visitors to an interdisciplinary specialty clinic.

Although the traditional response to domestic violence has been undertaken by legal and human service agencies, this societal issue has become increasingly recognized as a national public health concern. While identification and intervention in cases of domestic violence are widely recommended, little data exist on intervention outcomes. This retrospective study describes similarities and disparities in sociodemographic variables, health status, referral characteristics, and management strategies among patients referred to a specialty clinic for survivors of domestic violence.

Recruiting participants from a community of Bangladeshi immigrants for a study of spousal abuse: an appropriate cultural approach.

In this article, the authors describe a recruitment strategy used to enroll female Bangladeshi immigrants into a study of spousal abuse, crucial in the process of identifying abuse in this community. The researchers used a qualitative method involving a three-staged process designed for sampling and recruiting for focus groups and in-depth interviews. The Bangladeshi women declined participation in either of these qualitative genres, but the modified and adapted strategies proved effective in recruiting participants from the tightly knit immigrant community. Key to the success of the effort was the involvement of a Bangladeshi investigator, unspecified time to establish rapport with key informants and representatives of the larger community, and maintaining contact with the target population after completion of the project.

Osteoporosis among perimenopausal African-American women: the relationship between sources of information and levels of knowledge about osteoporosis.

The aim of this study is to increase awareness of the occurrence of osteoporosis in perimenopausal African-American women. This quantitative study was designed to measure African-American women's knowledge of osteoporosis and to determine on what sources of information about osteoporosis African-American women rely Aside from demographic variables, other data were collected to determine which sources of information about osteoporosis African-American women use, whether they know that osteoporosis is a preventable disease, and whether there is a relationship between sources of information and the level of knowledge about osteoporosis among these women. Participants consisted of 45 perimenopausal African-American women from 42 to 52 years of age residing in Houston, Texas Data were utilized from an ongoing research project. Analysis of the data presented suggests that there is an association between specific sources of information and the level of knowledge about osteoporosis in this age group of African-American women.