An STI upsurge requires a nimble approach to care.

Being fluent in new guidelines helps you meet the challenges of changing disease prevalence, rising antibiotic resistance, and evolving social patterns.

Critical gaps in knowledge and implementation of recommendations by the US Preventive Services Task Force.

Introduction: The United States Preventive Services Task Force (USPSTF) has issued 31 recommendations applicable to non-pregnant adults. We hypothesized variability in knowledge and implementation of these recommendations among US family medicine resident physicians. Methods: We performed two electronic surveys: a local survey, and then a nationally-representative, multicenter, survey. We evaluated self-reported knowledge and implementation of USPSTF recommendations related to non-pregnant adults. Results: 84 family medicine residents from 40 residency programs across 25 states participated. Knowledge and implementation of recommendations varied widely. Most residents lacked knowledge relating to breast cancer chemoprophylaxis (9.9 % "known in detail" or "mostly know"), BRCA-related genetic counseling (BRCA-GC) referral (30 %), tuberculosis (TB) screening (41 %), and sexually transmitted infection (STI) counseling (45 %). There is virtually no implementation of recommendations for breast cancer chemoprophylaxis (90 % never/rarely implement). Many residents never/rarely implement recommendations for BRCA-GC referral (75 %), TB screening (62 %), and HIV pre-exposure prophylaxis (61 %). This remained true even for residents in their final year of training. Relative to their male counterparts, female physicians more frequently implemented recommendations for BRCA-GC referral (11 % vs 0 % always/often implement, p = 0.019), cervical cancer screening (100 % vs 83 %, p = 0.019), and folic acid supplementation (60 % vs 29 %, p = 0.007). Knowledge and implementation of recommendations were strongly related (ß = 0.75, 95 % CI 0.50-1.00, p < 0.001, Spearman R2 = 0.56). Conclusion: Critical gaps exist in resident knowledge and implementation of USPSTF recommendations. We discuss urgent implications for cancer prevention, public health, and health equity.

US-Born Black Women and Black Immigrant Women: an Exploration of Disparities in Health Care and Sociodemographic Factors Related to Low Birth Weight.

PURPOSE: This study explores whether nativity differences in health care and sociodemographic factors help to account for nativity differences in low birth weight (LBW) when comparing US-born Black women (USBW) to Black Immigrant women (BIW). METHODS: Bivariate analyses and multinomial nested logit (MNL) models were performed using the National Survey of Family Growth (NSFG) dataset. RESULTS: Statistically significant nativity differences between USBW and BIW were found across variables of LBW (p = .009), marital status (p < .001), education level (p < .001), receiving public assistance (p < .001), health care coverage (p < .001), age (p < .001), and poverty level income (p < .001). Results from the MNL models indicated that BIW were 91% less likely to have a LBW baby (p < .001). When accounting for other sociodemographic and health care related variables differing by nativity, although a statistically significant, narrowing gap between BIW and USBW was observed (OR = .12, p < .001), BIW were still less likely to have a LBW baby. CONCLUSIONS: Differences between USBW and BIW across sociodemographic variables and health care related factors related to adverse pregnancy outcomes were observed in this study. Controlling for the factors attenuated nativity differences but did not eliminate the differences on LBW. Future research should continue to explore this relationship.

The Adequacy of Prenatal Care in Rural Kansas Related to Distance Traveled.

Introduction: Prenatal care is essential for optimizing the health of a woman and her baby. Multiple factors have created barriers in the access to prenatal care in rural Kansas. Over 120 rural hospitals in the United States have closed since 2010, 5 in Kansas. Seventy-seven of the 105 Kansas counties do not have maternity care services. This study investigated differences in prenatal care received by women in rural Kansas counties related to distance traveled. Differences in timing of initiation of care, number of visits, and services received were compared between two cohorts: those who drove < 19 miles and those who drove ≥ 20 miles for prenatal care. Methods: A survey was distributed to women who had delivered a child in the last three years in rural Kansas at participating clinics. Measures of adequacy of prenatal care were determined with questions regarding timing of first prenatal visit, number of prenatal visits, and services received at visits. An index was created using these variables and compared between the two cohorts using two-tailed t-tests for continuous data and chi square analysis for categorical data. Results: Women who traveled ≥ 20 miles for prenatal care received statistically significant less services, and had less prenatal care visits in the second trimester and overall in their pregnancy compared to women who traveled < 19 miles for prenatal care. Rurality did not impact adequacy of prenatal care. Conclusions: Women traveling ≥ 20 miles to receive prenatal care had significantly fewer prenatal visits during their second trimester and overall in pregnancy and self-reported less prenatal care services. These results indicated the importance of lessening barriers to prenatal care in rural Kansas, such as transportation and financial barriers.

Student Perceptions and Use of Social Media as Residency Program Information.

BACKGROUND AND OBJECTIVES: Virtual residency interviews during the 2020 COVID-19 pandemic posed unique challenges to students and residency programs in the United States. We evaluated fourth-year medical students' perceptions of the virtual format and social media use to help select residency programs. We also assessed applicant utilization and perceived usefulness of our social media content. METHODS: We administered an anonymous, web-based survey study of interviewees at an urban, academic medical center residency program. We analyzed data using descriptive statistics. RESULTS: Seventy-five of 138 applicants completed the survey (response rate 54%). Most applicants reported worry about obtaining enough information about residency programs to apply (64%) and to rank programs (87%). Though more traditional information sources remain most prevalent, social media is now widely used to research residency programs (62%). CONCLUSIONS: Most applicants to this family medicine residency program used social media to gather information, but they expressed worry that it was enough. Virtual interviews are likely to remain postpandemic, creating challenges for residency programs and especially for their hopeful applicants. Programs seeking to provide well-rounded information for applicants should maintain a social media presence as part of their recruitment practices.

Prevalence and Correlates of Tobacco Smoking During the Perinatal Period Among Women Enrolled in a Midwestern WIC Program.

BACKGROUND: Perinatal tobacco smoking remains a public health concern and is associated with smoking related morbidity and mortality. This study aims to report the prevalence and correlates of smoking during pregnancy among low-income women. METHODS: The study sample comprised 729 pregnant women who were enrolled in a perinatal depression registry in a public health WIC program between 2013 and 2015. Smoking risks were obtained from the clinical USDA Risk Assessment. STATA 14.2 was used for analyses. RESULTS: 15.1% of women reported smoking during pregnancy. Compared to White women, Black women were less likely to smoke odds ratio (OR 0.45 [95% CI 0.25-0.81]). Foreign-born women and women living in non-smoking homes remained at a lower risk for smoking during pregnancy. IMPLICATIONS: Smoking during pregnancy is prevalent among low-income women. In addition to prenatal education on smoking cessation, supportive measures to help deliver smoking cessation interventions should be provided to household members.

Type 2 Diabetes Prevalence, Distribution and Risk Factors in St. Kitts and Nevis, West Indies.

OBJECTIVES: This study in collaboration with the St. Kitts & Nevis Ministry of Health (MOH) investigated the prevalence of type 2 diabetes and its risk factors, the second leading cause of death in the country. METHODS: Medical records of patients between the ages of 18 and 75 as of January 1, 2010 treated between January 1, 2010 and December 31, 2015 in the government-funded health centers (HCs) were eligible for inclusion (N = 2737). All HC visits (n = 4169) generated by a representative sample of patients (n = 761) were evaluated using Caribbean Public Health Association Public Health Association (CARPHA) guidelines for risk ranges. RESULTS: The prevalence of type 2 diabetes is 23% and is concentrated in the 45-64 year-old cohort. Though women outnumber men 3:1 in the sample, gender-prevalence rates are similar (23% and 22% respectively). There is also evidence that comorbidities are prevalent among diabetics (76%) and many nondiabetics are at risk of diabetes (20%). CONCLUSION: This study confirmed the MOH's concerns that type 2 diabetes presents local risk and brings into question historic assumptions that women are at greater risk of diabetes than men.

Effects of crude oil on survival and development in embryonated eggs in Callinectes sapidus Rathbun, 1896 (Decapoda, Portunidae).

Blue crabs, Callinectes sapidus Rathbun, 1896, are ubiquitous along the Atlantic and Gulf coasts of the USA. These organisms play an integral role in the ecosystems of the Gulf of Mexico (GOM), where not only are they a keystone species, but are also socioeconomically important. The survival of embryonated eggs is necessary to ensure adequate recruitment into the next generation. Because the 2010 Deepwater Horizon oil spill (DWH) occurred during the peak of the blue crab spawning season, the incident likely impacted blue crab embryos. In order to assess the effect of oil on embryonic growth and development, we collected embryonated eggs from seven different female blue crabs from the GOM throughout the spawning season and exposed them to an oil concentration of 500 ppb (the approximate concentration of oil at the surface water near the site of the Deepwater Horizon oil rig). Exposure to oil at this concentration caused a significantly larger proportion of prezoeae vs. zoeae to hatch from embryonated eggs in experiments lasting longer than 4 days. Exposure to oil did not significantly affect overall survival or development rate. The prezoeal stage is a little-studied stage of blue crab development. Though it may or may not be a normal stage of development, this stage has been found to occur in suboptimal conditions and has lower survival than zoeal stages. The larger proportion of prezoeae following prolonged exposure to oil thus indicates that crude oil at concentrations likely to be experienced by crabs after the DWH spill negatively impacted the development of blue crab embryos. In addition to providing insight into the effects of the DWH, this study sheds light on embryonic development in blue crabs, a critical, but poorly investigated phase of this important species' life cycle.

Evidence for alterations in stimulatory G proteins and oxytocin levels in children with autism.

The neurotransmitter oxytocin plays an important role in social affiliation. Low oxytocin levels and defects in the oxytocin receptor have been reported in childhood autism. However, little is known about oxytocin's post-receptor signaling pathways in autism. Oxytocin signals via stimulatory and inhibitory G proteins. c-fos mRNA expression has been used as a marker of OT signaling as well as of G protein signaling. Herein, we hypothesized that oxytocin and its signaling pathways would be altered in children with autism. We measured plasma oxytocin levels by ELISA, G-protein and c-fos mRNA by PCR, and G proteins by immunoblot in cultured peripheral blood mononuclear cells (PBMCs) in children with autism and in age-matched controls. Males with autism displayed elevated oxytocin levels compared to controls (p<0.05). Children with autism displayed significantly higher mRNA for stimulatory G proteins compared to controls (p<0.05). Oxytocin levels correlated strongly positively with c-fos mRNA levels, but only in control participants (p<0.01). Oxytocin, G-protein, and c-fos mRNA levels correlated inversely with measures of social and emotional behaviors, but only in control participants. These data suggest that children with autism may exhibit a dysregulation in oxytocin and/or its signaling pathways.