Cross-Sectional Association of Patient Language and Patient-Provider Language Concordance with Video Telemedicine Use Among Patients with Limited English Proficiency.

BACKGROUND: Telemedicine's dramatic increase during the COVID-19 pandemic elevates the importance of addressing patient-care gaps in telemedicine, especially for patients with limited English proficiency. OBJECTIVE: To examine the associations of patient language and patient-provider language concordance with telemedicine visit type (video versus telephone visit). DESIGN: Cross-sectional automated data study of patient-scheduled primary care telemedicine appointments from March 16, 2020, to October 31, 2020. SETTING: Northern California integrated healthcare delivery system. PARTICIPANTS: All 22,427 completed primary care telemedicine visits scheduled by 13,764 patients with limited English proficiency via the patient portal. MEASUREMENTS: Cross-sectional association of electronic health record-documented patient language (Spanish as referent) and patient-provider language concordance with patients' choice of a video (versus telephone) visit, accounting for patient sociodemographics, technology access, and technology familiarity factors. RESULTS: Of all patient-scheduled visits, 34.5% (n = 7747) were video visits. The top three patient languages were Spanish (42.4%), Cantonese (16.9%), and Mandarin (10.3%). Adjusting for sociodemographic and technology access and familiarity factors and compared to patients speaking Spanish, video visit use was higher among patients speaking Cantonese (OR = 1.34, 95% CI: 1.18-1.52), Mandarin (OR = 1.33, 95% CI: 1.16-1.52), or Vietnamese (OR = 1.27, 95% CI: 1.09-1.47), but lower among patients speaking Punjabi (OR = 0.75, 95% CI: 0.75, 0.62-0.91). Language concordance was associated with lower video visit use (OR = 0.86, 95% CI: 0.80-0.93) and moderated associations of speaking Spanish, Cantonese, and Korean with video visit use. In addition, for all language groups, those with prior video visit use were more likely to re-use video visits compared to those with no prior use (p < .05 for all languages except Hindi with p = 0.06). CONCLUSIONS: Among linguistically diverse patients with limited English proficiency, video telemedicine use differed by specific language. Disaggregating patient subpopulation data is necessary for identifying those at greatest risk of being negatively impacted by the digital divide.

Effect of Electronic and Mail Outreach From Primary Care Physicians for COVID-19 Vaccination of Black and Latino Older Adults: A Randomized Clinical Trial.

Importance: COVID-19 morbidity is highest in Black and Latino older adults. These racial and ethnic groups initially had lower vaccination uptake than others, and rates in Black adults continue to lag. Objectives: To evaluate the effect of outreach via electronic secure messages and mailings from primary care physicians (PCPs) on COVID-19 vaccination uptake among Black and Latino older adults and to compare the effects of culturally tailored and standard PCP messages. Design, Setting, and Participants: This randomized clinical trial was conducted from March 29 to May 20, 2021, with follow-up surveys through July 31, 2021. Latino and Black individuals aged 65 years and older from 4 Kaiser Permanente Northern California (KPNC) service areas were included. Data were analyzed from May 27, 2021, to September 28, 2021. Interventions: Individuals who had not received COVID-19 vaccination after previous outreach were randomized to electronic secure message and/or mail outreach from their PCP, similar outreach with additional culturally tailored content, or usual care. Outreach groups were sent a secure message or letter in their PCP's name, followed by a postcard to those still unvaccinated after 4 weeks. Main Outcomes and Measures: The primary outcome was time to receipt of COVID-19 vaccination during the 8 weeks after initial study outreach. KPNC data were supplemented with state data from external sources. Intervention effects were evaluated via proportional hazards regression. Results: Of 8287 included individuals (mean [SD] age, 72.6 [7.0] years; 4665 [56.3%] women), 2434 (29.4%) were Black, 3782 (45.6%) were Latino and preferred English-language communications, and 2071 (25.0%) were Latino and preferred Spanish-language communications; 2847 participants (34.4%) had a neighborhood deprivation index at the 75th percentile or higher. A total of 2767 participants were randomized to culturally tailored PCP outreach, 2747 participants were randomized to standard PCP outreach, and 2773 participants were randomized to usual care. Culturally tailored PCP outreach led to higher COVID-19 vaccination rates during follow-up compared with usual care (664 participants [24.0%] vs 603 participants [21.7%]; adjusted hazard ratio (aHR), 1.22; 95% CI, 1.09-1.37), as did standard PCP outreach (635 participants [23.1%]; aHR, 1.17; 95% CI, 1.04-1.31). Individuals who were Black (aHR, 1.19; 95% CI, 1.06-1.33), had high neighborhood deprivation (aHR, 1.17; 95% CI, 1.03-1.33), and had medium to high comorbidity scores (aHR, 1.19; 95% CI, 1.09-1.31) were more likely to be vaccinated during follow-up. Conclusions and Relevance: This randomized clinical trial found that PCP outreach using electronic and mailed messages increased COVID-19 vaccination rates among Black and Latino older adults. Trial Registration: ClinicalTrials.gov Identifier: NCT05096026.

Aislamiento de células mesenquimales del ligamento periodontal de premolares extraídos. Método simplificado / Isolation of periodontal ligament stem cells from extracted premolars. Simplified method

Resumen: El ligamento periodontal es un tejido conectivo fibroso, de origen ectomesenquimal que contiene una población de células troncales postnatales multipotenciales, con capacidad clonogénica y alto índice de proliferación. Se ha conseguido cultivar células troncales postnatales multipotenciales a través de diferentes métodos de extracción, con algunos problemas técnicos. Por esta razón, se compararon seis diferentes métodos a fin de mejorar el aislamiento de células primarias del ligamento periodontal. Se aislaron células troncales postnatales multipotenciales a partir de 36 premolares sanos, que se cultivaron en medio de Eagle modificado por Dulbecco (BioWest) completo (adicionado con L-glutamina, 10% de suero fetal bovino y 1% de antibiótico) y en condiciones estándares de cultivo. Se realizaron los ensayos para proliferación celular mediante la técnica de 3-(4,5-dimetiltiazol-2-il)-2,5difeniltetrazolio, migración celular a través de la prueba de lesión del cultivo, y se evaluó su diferenciación osteogénica. Los cultivos realizados por triplicado con cada una de las técnicas publicadas, nos condujo a obtener una población mínima de células que fueron susceptibles a contaminarse. Se realizó con el «método simplificado¼: por digestión enzimática y cultivo de explantos, con las células troncales postnatales multipotenciales obtenidas se observó una proliferación durante 14 días en condiciones estándares de cultivo ascendente, en las pruebas de migración las células troncales postnatales multipotenciales cubrieron totalmente la superficie lesionada a las 72 horas, se observó expresión positiva de CD90 en más del 80% de las células; expresión positiva a CD73 en un 70%, CD105 en un 60% y vimentina en un 90% de la población, así como un marcaje negativo a CD11b y CD45. Se observó una diferenciación osteogénica positiva a los 14 días mediante la expresión positiva a RUNX2 en al menos el 15% de las células y a osteocalcina en un 90%, así como las pruebas positivas a rojo de alizarina. Con los resultados obtenidos, podemos afirmar que el método simplificado permite aislar una población de células mesenquimales, que se pueden obtener a partir de premolares sanos extraídos.

Abstract: Periodontal ligament is a fibrous connective tissue of ectomesenchymal origin which contains a multipotent postnatal stem cells population with clonogenic capacity and high proliferation index. Multipotent postnatal stem cells population culture has been achieved through several extraction methods, nevertheless some technical problems have been encountered. For this reason, in the present study, 6 different methods were compared so as to improve isolation of primary periodontal ligament cells. Multipotent postnatal stem cells population were isolated from 36 healthy premolars, which were then cultured in complete Dulbecco m odified Eagle medium (BioWest) (added with L-glutamine, 10% fetal bovine serum and 1% antibiotic), in standard culture conditions. Assays for cell proliferation were conducted with 3-(4,5 dimethylthiazol-2-yl)-2,5 diphenyltetrazolium technique as well as cell migration through crop injury test, after which osteogenic differentiation was assessed. Cultures were performed in triplicate with each of the published techniques; thus we were able to obtain a minimum population of cells susceptible to contamination. The «simplifled method¼ was conducted through explant enzymatic digestion and culture: with obtained multipotent postnatal stem cells population, a 14 day proliferation was observed in standard conditions of ascendant culture; in migration tests, multipotent postnatal stem cells population totally covered injured surfaces after 72 hours. CD90 positive expression was observed in over 80% of all cells; CD73 positive expression was found in 70% of cells, CD105 in 60% and vimentin in 90% of the population, as well as negative marking to CD11b and CD45. Positive osteogenic differentiation was observed after 14 days, through positive expression to RUNX2 in at least 15% of cells, and to osteocalcin in 90% as well as positive test to alizarin red. Based on obtained results we were able to affirm that the simplified method allows to isolate a population of mesenchymal cells, which might be obtained from extracted healthy premolars.

Acupuncture as an Adjunct Treatment for Primary Dysmenorrhea: A Comparative Study.

BACKGROUND: Primary dysmenorrhea occurs 40%-50% in women of reproductive age. Acupuncture may assist treatment of menstrual pain. OBJECTIVE: This study compared the effects of the acupuncture program Chongmai, or Thoroughfare Vessel (TV), to sham acupuncture on primary dysmenorrhea. METHODS: The current authors selected 3 groups of 10 patients each with primary dysmenorrhea for this comparative, prospective longitudinal study. The first group was treated at the TV points, the second group underwent sham acupuncture, and the third group (control) did not receive any kind of acupuncture. All groups were allowed to use steroidal anti-inflammatory drugs (NSAIDs). Menstrual pain was measured using a visual analogue scale (VAS). The results were analyzed using a Student's-t test in GraphPad Prism 5.0. Acupuncture needles were applied at the following TV acupuncture points: (1) Gongsun (SP 4); (2) Qichong (ST30); (3) Neiguan (PC 6); and (4) Baihuanshu (BL 30), the metameric action point of the pelvic area. Electrical stimulation was applied through each needle at 120 Hz for 40 minutes. RESULTS: TV acupuncture, sham acupuncture, and/or NSAIDs substantially reduced pain in all 10 patients in each respective group (100%). TV acupuncture treatment reduced the symptoms of primary dysmenorrhea, and symptoms were reduced for at least 6 months. Application of needles at simulated points away from the TV acupuncture program did not reduce pain significantly. CONCLUSIONS: TV acupuncture treatment can reduce the symptoms of primary dysmenorrhea, and the effect can last for 6 months.

Estimating prenatal syphilis and HIV screening rates for commercially insured women.

OBJECTIVE: Although routine serologic testing for syphilis and human immunodeficiency virus (HIV) for all pregnant women is recommended by the Centers for Disease Control and Prevention and many health professional organizations, little is known about the extent of prenatal syphilis and HIV screening rates among commercially insured pregnant women. METHODS: A claims database for a large commercially insured population was analyzed to estimate syphilis and HIV screening rates for pregnant women who were continuously enrolled in the same health insurance plan during 1998 and 1999 in 13 U.S. states. Diagnostic and procedural services were used to determine pregnancy status, receipt of prenatal care, and syphilis and HIV testing during pregnancy. RESULTS: Of 13,250 identified pregnancies, 12,156 (92%) were among women who had prenatal visits; 8368 (63%) included claims for syphilis testing; and 4411 (33%) included claims for HIV testing. Of the 8368 pregnancies with syphilis testing, 6326 (76%) included syphilis tests that were performed during the initial prenatal visit. Of the 4411 pregnancies with HIV testing, 3168 (72%) included HIV testing on the initial prenatal visit. Of 4249 pregnancies with syphilis and HIV testing, 3146 (74%) included HIV testing and syphilis testing on the initial prenatal visit. CONCLUSIONS: Most HIV and syphilis tests had been provided during initial prenatal visits among women who had HIV and syphilis testing. Prenatal screening rates for syphilis and HIV identified through claims were lower than expected. This may be due to deficiencies in documentation of syphilis and HIV screening in administrative databases or actual screening rates. Further investigation is needed to determine how accurately claims data can measure actual screening practices.

Syphilis outbreak among Hispanic immigrants in Decatur, Alabama: association with commercial sex.

BACKGROUND: Despite national progress in syphilis control, increases in rates have recently occurred, and syphilis is still an endemic problem in the southern United States. An outbreak of infectious syphilis among Hispanics was identified in Decatur, Alabama. GOAL: An investigation was initiated to describe the outbreak and to assist with prevention activities. STUDY DESIGN: We reviewed case interview records and syphilis surveillance data. The Morgan County Health Department (MCHD) performed voluntary door-to-door syphilis screening in neighborhoods where a large number of cases had been identified. During screening activities, sociodemographic and behavioral data were collected. RESULTS: From June 2000 to February 2001, 49 cases of syphilis were reported; 26 (53%) were primary or secondary, 17 (35%) were early latent, and 6 (12%) late latent. Of the early syphilis cases, 70% were male and half were Hispanic; 93% of cases were linked to commercial sex and 70% of female cases reported crack cocaine use. During the screening, 172 individuals completed a questionnaire; 70% of participants were male, 83% were Hispanic, 17% of Hispanic participants spoke English, 21% reported sex with a commercial sex worker, and 8 (5%) had positive syphilis serology. Among men, factors associated with commercial sex were not having a regular partner (odds ratio [OR], 3.9; confidence interval [CI], 1.1-14.3), not living with a family member in the United States (OR, 4.5; CI, 1.6-12.8), and having visited their country of origin since arrival to the United States (OR, 9.2; CI, 2.3-36.5). CONCLUSIONS: Factors contributing to this outbreak were crack cocaine use and increased prostitution in close proximity to the Hispanic community. At present, there are an increasing number of Hispanic immigrants in the United States, the majority of whom do not speak English. To prevent similar outbreaks in the future, public health officials need to be aware of the health and health education needs of these populations.

Racial and ethnic disparity in low birth weight in Syracuse, New York.

This case-racial and ethnic disparity in low birth weight-is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine. Low birth weight is a leading cause of infant mortality. Unfortunately, despite declining rates of infant mortality, racial and ethnic disparities in both low birth weight and infant mortality rates persist. In this teaching case, a clinical vignette is used to draw attention to this public health priority in Syracuse, New York. Students learn essential epidemiology skills such as identifying limitations of sources of data and calculating relative risks, using the example of low birth weight. In performing these skills, students also identify etiologies for such disparity. Finally, students discuss interventions that, when implemented, may decrease infant mortality rates.

Sexually transmitted disease in adolescents.

This case-sexually transmitted diseases in adolescents-is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine. Sexually transmitted diseases (STDs) are common among adolescents. This case focuses on the population-based prevention of STDs. The case begins with clinical, diagnostic, and laboratory management of an adolescent female diagnosed with gonorrhea. Students then examine how the diagnosis of an STD can be used as an opportunity to provide preventive care and counseling on safer sexual behaviors. Questions addressing HIV testing and counseling are included in this section. Students proceed to explore how the diagnosis and reporting of an STD calls for interaction, such as partner notification, between clinical providers and public health departments. Finally, students are provided with actual information from local focus groups on attitudes and behaviors of high-risk adolescents. At the conclusion of the case, they are asked to interpret the data and formulate strategies to decrease gonorrhea rates in the community.

Future applications of case-based teaching in population-based prevention.

The Case-Based Series in Population-Oriented Prevention (C-POP) introduced in this supplement to the American Journal of Preventive Medicine provides a set of tools to integrate clinical- and community-based prevention into interactive teaching cases. These cases, which address recommended core competencies in prevention education, have been taught to both medical students and preventive medicine residents. Initial experience with the cases indicates that this method is a promising tool to enhance prevention education in medical schools and primary care residencies. Because prevention education is essential in other fields, such as public health and nursing, extension of this approach to other professional schools is possible. Such extension is feasible because the cases are designed to be adaptable for different levels of education, flexible to be tailored to local situations, and expandable to accommodate changes in the field. In addition, the cases can be made accessible to all educators through a national library and in interactive web-based format. This article describes how the C-POP series can be used to strengthen prevention education for a wide audience of physician and nonphysician learners.