Identifying the Need for and Availability of Evidence-Based Care for Sexually Transmitted Infections in Rural Primary Care Clinics.

BACKGROUND: Increasing rates of bacterial sexually transmitted infections (STIs) may lead to increased HIV rates, as the STI and HIV epidemics are syndemic. Centers for Disease Control and Prevention guidelines recommend including extragenital (i.e., rectal and/or pharyngeal) STI screenings for certain populations at increased risk of STIs and concurrent infections with HIV. METHODS: A descriptive study was conducted by interviewing staff members from 4 rural primary care clinics in areas of high need for STI and HIV services in South Carolina. Qualitative data about their clinical practices in 2021 were obtained. The primary outcome was to determine the awareness and availability of health care services associated with STI and HIV care in these locations. RESULTS: Clinics in target counties provided limited STI and HIV testing and treatment services, especially for populations at risk of infection, indicating the need for additional clinical training and professional development for all clinic staff. Specifically, only 1 of 4 clinics provided extragenital STI testing, and no clinics reported prescribing preexposure prophylaxis. CONCLUSIONS: Rural primary care clinics can fill important gaps in the availability of STI and HIV services with appropriate support and incentives. Findings from this study may aid in facilitating policy (state Medicaid agency) and program (state health department) decisions related to STI and HIV testing and treatment.

Understanding the role of wild ruminants in anthelmintic resistance in livestock.

Wild ruminants are susceptible to infection from generalist helminth species, which can also infect domestic ruminants. A better understanding is required of the conditions under which wild ruminants can act as a source of helminths (including anthelmintic-resistant genotypes) for domestic ruminants, and vice versa, with the added possibility that wildlife could act as refugia for drug-susceptible genotypes and hence buffer the spread and development of resistance. Helminth infections cause significant productivity losses in domestic ruminants and a growing resistance to all classes of anthelmintic drug escalates concerns around helminth infection in the livestock industry. Previous research demonstrates that drug-resistant strains of the pathogenic nematode Haemonchus contortus can be transmitted between wild and domestic ruminants, and that gastro-intestinal nematode infections are more intense in wild ruminants within areas of high livestock density. In this article, the factors likely to influence the role of wild ruminants in helminth infections and anthelmintic resistance in livestock are considered, including host population movement across heterogeneous landscapes, and the effects of climate and environment on parasite dynamics. Methods of predicting and validating suspected drivers of helminth transmission in this context are considered based on advances in predictive modelling and molecular tools.

Using Cumulative Impact Assessment as a Smokescreen in New South Wales Alcohol Harm Reduction Laws: A Commentary.

In 2020 the New South Wales Liquor Act was amended to allow the Independent Liquor and Gaming Authority (ILGA) to approve new liquor authorisations in parts of the Sydney CBD otherwise subject to a freeze. The vehicle for this was called Cumulative Impact Assessment (CIA). The Amendment added promotion of business vitality to an established list of considerations previously set out by ILGA in its Guideline (6) on social impact assessment. The strategy set out in a new Guideline (18) appears to use an impartial and objective methodology while advocating reliance on intangible criteria and selective use of data in order to increase applicant chances of success against a rebuttable presumption against approval. While CIA is an established method in other professional areas, its use in the amendment influenced by the industry risks exacerbating alcohol-related harm.

Building power through reindigenization: Sharing the story of Menikanaehkem.

Culture shapes and animates how community organizing is understood and carried out in specific contexts. Many frameworks for examining organizing, however, do not effectively attend to the influences of culture. Greater understanding of how culture can be imbued in organizing can help to ground it in the social realities of organizing participants and can advance approaches to organizing that honor the past and present of specific cultures. This study details local culturally grounded community organizing work rooted in Indigenous, and specifically Menominee, culture. First, it provides a description of the formation of the organization Menikanaehkem in the Menominee Nation and includes examples of how current organizing practices of Menikanaehkem build from long-standing Menominee cultural practices. It then highlights the reinvigoration of cultural practices, or re-indigenization, as an important goal for community power building in Menikanaehkem. It ends with a discussion of the importance of culture in frameworks for understanding, analyzing, and promoting organizing as an endeavor to advance well-being in a way that also interrupts cycles of structural oppression, such as legacies of settler colonialism.

Public Health versus Alcohol Industry Compliance Laws: A Case of Industry Capture?

This article confirms that industry compliance and enforcement processes are an essential consideration in the growing pantheon of legal and commercial determinants of public health. While alcohol control laws vary between individual jurisdictions, their development and application are confronted by a common threat of undue industry influence or capture. This necessitates a greater understanding of this phenomenon to better inform a collective and effective international public health response. New South Wales Australia, has developed a layer of alcohol industry compliance laws in the form of disciplinary schemes. This article critically explicates the first of these, the Violent Venues Scheme (VVS), to determine the nature and extent of any capture. This would significantly compromise harm minimisation statutory objects and disrupt the democratic process and the rule of law. In contrast, an influential industry identity, attributed the earlier last drinks laws, VVS and a related scheme as causing the alleged destruction of Sydney's nighttime economy and fun. The research also analyses the indispensible role of a neoliberal paradigm in legitimising exclusive relationships between governments and industry. This is indelibly imprinted on the alcohol regulatory landscape.

Legislative Capture: A Critical Consideration in the Commercial Determinants of Public Health.

Contemporary public health literature contains an increasing emphasis on the commercial determinants of health including the influence of unhealthy food, beverage and tobacco industries on government harm prevention policy agendas and global sustainable development goals. Effective capture by the industries of the crucial legislative process associated with the harm prevention initiatives would have a detrimental impact on public health. This article proposes a qualitative multi-spectrum prototype legislative capture test with broad application to a range of industries and jurisdictions at all levels of government where legislative capture may be suspected. It is predicated on a finding of significant encroachment of the public interest (PI) by special interest groups and reciprocating beneficial conduct between the lawmakers and the group. The test is populated from a critical case study of key New South Wales (NSW) alcohol industry statutory amendments within a doctrinal and social inquiry/power framework. It relies upon parliamentary records and secondary data to analyse critically the 2015 "fit for purpose" (FFP) reforms to NSW alcohol supply laws and their consistency with the PI and other constitutional safeguards. It aligns the reforms with other research relating to the magnitude of alcohol and gambling industry political donations and the operation of the alcohol outlet post reform approval process. The application of the test to the case study finds that the 2015 FFP amendments are indicative of legislative capture and associated clientele corruption - critical new considerations in the commercial determination of health. It also identifies the commodification of the PI.

Rational Social Impact Assessment of Alcohol Outlets: Slip Sliding Away.

In 2004 legislators in New South Wales relied on Australia's National Competition Policy to change the reason for determining alcohol outlet approvals from a "needs" to a "harm minimisation" basis. This was predicated on the application of a rational social impact assessment (SIA) process. Within a short time, however, the volume of liquor licence applications began to erode that intention and the delays that applicants encountered placed politicians under pressure to fast-track the process. Subsequent liquor legislation retained the statutory obligation on decision-makers to ensure no overall detrimental social impact associated with the approval of an alcohol outlet licence. However, legislative amendments to the approval process reduced the number and kinds of licences and authorisations to which the social impact test applied and encouraged other shortcuts which undermine the validity of these assessments. The resulting statutory approval system in practice relegates SIA to an exception rather than the rule and has revealed the relative weakness of SIA as a public health safeguard.

How Incarceration Influences Native-Born Black Men's Risk of Obesity.

Objective: To build upon research that investigates the health significance of familial and former incarceration with special emphasis on obesity risk among native-born Black (ie, African American) men. Methods: We analyzed data from the 2001-2003 National Survey of American Life (NSAL), focusing on native-born Black men (n=1140), the demographic group that bears the brunt of mass incarceration. The outcome of interest was obesity as measured by body mass index (BMI)>30. Principal predictors were familial and former incarceration, and their statistical interaction. Results: In survey-adjusted binomial logistic regression models, familial incarceration appeared an unimportant predictor; whereas, former incarceration associated with a lower risk of obesity. However, former incarceration modifies the association between familial incarceration and obesity, such that native-born Black men experiencing both familial and former incarceration were significantly more likely to be obese. Conclusions: Public health researchers should treat former incarceration with greater care in studies including native-born Black men because time spent incarcerated has lingering physical health significance.

Exome sequencing a review of new strategies for rare genomic disease research.

The journey related to genomic information access and utilization by researchers and clinicians has barely begun to be travelled. There remains a broad horizon in the research and clinical arenas for fulfillment of that journey. Exciting is the potential depth and breadth of research, clinical applications, and more personalized medicine, that remain on the horizon. Exome sequencing has clarified the responsibilities of over 130 genes, greatly expanding the medical genetics database and enabling the development of orphan disease-based pharmaceuticals. Our research focus was to review >50 literature sources that related to rare genomic disease research and exome sequencing, as well as the new research and diagnostic strategies that were utilized. Using a systems approach, under discussion are ciliopathy, dermatology, otorhinolaryngology, immunology, gastroenterology, hematopoiesis, metabolic diseases, and the cardiovascular system. Also discussed are genetic, syndromic, and mitochondrial exome research. Recommendations for future research will also be discussed.

Farmers' knowledge of Q fever and prevention approaches in New South Wales.

OBJECTIVE: To identify what New South Wales (NSW) farmers know about Q fever to inform preventive approaches. DESIGN: Thematic analysis of qualitative data gathered through semi-structured individual interviews, focus groups and a community meeting. SETTING: Rural communities in NSW, Australia. PARTICIPANTS: A total of 25 farmers participated in individual interviews (n = 4) or three focus groups, each with seven participants (n = 21). A further 27 persons, were involved in a community meeting. MAIN OUTCOME MEASURES: Themes derived from the interviews, focus groups and community meeting. RESULTS: Knowledge variations regarding Q fever risk and transmission highlight a need for improved risk communication. Vaccination was viewed as the preferred prevention approach; barriers were raised including time, costs, access to screening/vaccination and General Practitioner (GP) knowledge about Q fever. Local vaccination initiatives were supported. CONCLUSIONS: Strengthening existing GP knowledge and services leading to expanded provision of screening/vaccination could improve the coverage of Q fever vaccine in endemic NSW farming and rural communities.

Developing a guide for community-based groups to reduce alcohol-related harm among African migrants.

Issue addressed Alcohol-related harm is an issue of concern for African migrant communities living in Australia. However, there has been little information available to guide workers in developing culturally sensitive health promotion strategies. Methods A three-step approach, comprising a literature review, community consultations and an external review, was undertaken to develop a guide to assist organisations and health promotion groups working with African migrant communities to address alcohol-related harms. Discussion There was a high level of agreement between the three steps. Addressing alcohol harms with African migrant communities requires approaches that are sensitive to the needs, structures and experiences of communities. The process should incorporate targeted approaches that enable communities to achieve their resettlement goals as well as strengthening mainstream health promotion efforts. Conclusions The resource produced guides alcohol harm prevention coalitions and workers from the first steps of understanding the influences of acculturation and resettlement on alcohol consumption, through to planning, developing and evaluating an intervention in partnership with communities. So what? This paper advances knowledge by providing a precise summary of Australian African migrant focused alcohol and other drug research to date. It also describes a three-step approach that aimed to incorporate a diversity of community views in the creation of a health promotion and community capacity-building resource.

Helminth Prevalence in European Deer with a Focus on Abomasal Nematodes and the Influence of Livestock Pasture Contact: A Meta-Analysis.

Deer are susceptible to infection with parasitic helminths, including species which are of increasing economic concern to the livestock industry due to anthelmintic drug resistance. This paper systematically collates helminth prevalence data from deer across Europe and explores patterns in relation to host and parasite species, as well as landscape factors. A livestock pasture contact index (LPCI) is developed to predict epidemiological overlap between deer and livestock, and hence to examine deer helminth fauna in the context of their surrounding environment. Fifty-eight studies comprising fallow (Dama dama), red (Cervus elaphus), roe (Capreolus capreolus) and sika (Cervus nippon) deer were identified. Deer populations in "likely" contact with livestock pasture had a higher mean prevalence of the abomasal nematodes Haemonchus contortus, Ostertagia ostertagi, Teladorsagia circumcincta and Trichostrongylus axei (p = 0.01), which are common in livestock and not primarily associated with deer. Roe deer populations had a higher prevalence of T. circumcincta (p = 0.02) and T. axei (p = 0.01) than fallow deer and a higher prevalence of H. contortus than both red (p = 0.01) and fallow deer (p = 0.02). Liver fluke and lungworm species were present sporadically at low prevalence, while the abomasal nematode Ashworthius sidemi occurred locally at high prevalence. Insights from this research suggest that deer helminth fauna is reflective of their surrounding environment, including the livestock species which inhabit areas of shared grazing. This is explored from an epidemiological perspective, and the prospect of helminth transmission between wild and domestic hosts is discussed, including drug-resistant strains, alongside the role of helminths as indicators relevant to the transmission of other pathogens at the wildlife-livestock interface.

A molecular assessment of Ostertagia leptospicularis and Spiculopteragia asymmetrica among wild fallow deer in Northern Ireland and implications for false detection of livestock-associated species.

BACKGROUND: Wild deer populations utilizing livestock grazing areas risk cross-species transmission of gastrointestinal nematode parasites (GINs), including GINs with anthelmintic resistance (AR) traits. Wild deer have been shown to carry problematic GIN species such as Haemonchus contortus and Trichostrongylus species in the UK, but the presence of livestock GINs in Northern Ireland deer populations is unknown. Also, is it not known whether AR traits exist among GINs of deer such as Ostertagia leptospicularis and Spiculopteragia asymmetrica in pastureland where anthelmintics are heavily used. METHODS: Adult-stage GIN samples were retrieved from Northern Irish wild fallow deer abomasa. Individual specimens were subject to a species-specific PCR analysis for common sheep and cattle GIN species with ITS-2 sequence analysis to validate species identities. In addition, the beta-tubulin gene was subject to sequencing to identify benzimidazole (BZ) resistance markers. RESULTS: ITS-2 sequencing revealed O. leptospicularis and S. asymmetrica, but species-specific PCR yielded false-positive hits for H. contortus, Teladorsagia circimcincta, Trichostrongylus axei, T. colubriformis, T. vitrinus and Ostertagia ostertagi. For beta-tubulin, O. leptospicularis and S. asymmetrica yielded species-specific sequences at the E198 codon, but no resistance markers were identified in either species at positions 167, 198 or 200 of the coding region. DISCUSSION: From this report, no GIN species of significance in livestock were identified among Northern Ireland fallow deer. However, false-positive PCR hits for sheep and cattle-associated GINs is concerning as the presence of deer species in livestock areas could impact both deer and livestock diagnostics and lead to overestimation of both GIN burden in deer and the role as of deer as drivers of these pathogens. ITS-2 sequences from both O. leptospicularis and S. asymmetrica show minor sequence variations to geographically distinct isolates. AR has been noted among GINs of deer but molecular analyses are lacking for GINs of wildlife. In producing the first beta-tubulin sequences for both O. leptospicularis and S. asymmetrica, we report no BZ resistance in this cohort. CONCLUSIONS: This work contributes to genetic resources for wildlife species and considers the implications of such species when performing livestock GIN diagnostics.

Patterns of HIV Disclosure and its Impact on the HIV Care Continuum Among Black Men who Have Sex With Men in South Carolina.

Addressing the psychosocial concerns of Black men who have sex with men (MSM), such as HIV disclosure, is critical for effective HIV treatment efforts. Black MSM living with HIV experience multiple psychosocial challenges, such as "triple stigma" due to their sexual orientation, racial minority status, and HIV status, which hinder their HIV disclosure and subsequent HIV care-seeking behavior. Our study sought to examine the HIV disclosure patterns and their impact on the HIV care continuum among Black MSM using a qualitative approach. Semi-structured interviews were carried out among 28 Black MSM aged ≥18 years old living in South Carolina. A thematic analysis process was employed for data analysis. The emerging themes of facilitators of HIV disclosure included the sense of personal responsibility to disclose one's HIV status within the context of a relationship and having other family members living with HIV, while the barriers included fear of family rejection or religious reasons. A few participants preferred to disclose to friends due to the less shame in sharing their status to friends than other confidants (e.g., family members). HIV disclosure was found to be a facilitator for linkage to care and retention in care through social support obtained from disclosure confidants. Helping patients to identify a single person (e.g., family member) to share their HIV status may offer equivalent benefits to wider disclosure. Interventions occurring at multiple levels (e.g., targeting religious groups) and within multiple contexts are needed to promote HIV disclosure and improve clinical outcomes in the Black MSM community.

Viral Racism via Videos: A Study of Asians' Experiences of Interpersonal Discrimination Because of COVID-19.

This study analyzes five publicly posted videos wherein Asians experience interpersonal discrimination because of COVID-19. We think social scientists ignore how videos provide data for investigating interpersonal discrimination. We characterize the videos according to multiple features including context, characteristics, and responses of individuals involved, type of threat or mistreatment, and level of psychological and physical harm. We then summarize features across the videos. Among other things, analyses uncover implicit, explicit, and historically specific anti-Asian sentiment alongside evidence perpetrators are men and bystanders do not intervene typically. The Discussion contrasts Asians' experiences of interpersonal discrimination because of COVID-19 against the interpersonal and institutional discrimination faced by American Indians, blacks, and Hispanics in the United States. That contrast brings Asians' positionality into sharp relief.

Paleoeconomy more than demography determined prehistoric human impact in Arctic Norway.

Population size has increasingly been taken as the driver of past human environmental impact worldwide, and particularly in the Arctic. However, sedimentary ancient DNA (sedaDNA), pollen and archaeological data show that over the last 12,000 years, paleoeconomy and culture determined human impacts on the terrestrial ecology of Arctic Norway. The large Mortensnes site complex (Ceavccageadgi, 70°N) has yielded the most comprehensive multiproxy record in the Arctic to date. The site saw occupation from the Pioneer period (c. 10,000 cal. years BP) with more intensive use from c. 4,200 to 2,000 cal. years BP and after 1,600 cal. years BP. Here, we combine on-site environmental archaeology with a near-site lake record of plant and animal sedaDNA. The rich animal sedaDNA data (42 taxa) and on-site faunal analyses reveal switches in human dietary composition from early-Holocene fish + marine mammals, to mixed marine + reindeer, then finally to marine + reindeer + domesticates (sheep, cattle, pigs), with highest reindeer concentrations in the last millennium. Archaeological evidence suggests these changes are not directly driven by climate or variation in population densities at the site or in the region, but rather are the result of changing socio-economic activities and culture, probably reflecting settlers' origins. This large settlement only had discernable effects on its hinterland in the last 3,600 years (grazing) and more markedly in the last 1,000 years through reindeer keeping/herding and, possibly domestic stock. Near-site sedaDNA can be linked to and validate the faunal record from archaeological excavations, demonstrating that environmental impacts can be assessed at a landscape scale.

"Yes We Can!" The Mental Health Significance for U.S. Black Adults of Barack Obama's 2008 Presidential Election.

This study examines the mental health significance of Barack Obama's 2008 presidential election for black adults. His election was a milestone moment. Hence, we expect black adults would experience improved mental health after the first self-identified black person wins election to the most powerful position in the United States. Using nationally representative survey data from the Behavioral Risk Factor Surveillance System (BRFSS), we address this expectation by predicting poor mental health days that black adults report pre-election and post-election. We find no overall difference in poor mental health days between the time periods. However, a statistical interaction between gender and time period demonstrates black men report 1.01 fewer poor mental health days after the election, whereas black women report .45 more poor mental health days after the election.

'Effectiveness of Continuing Professional Development' project: a summary of findings.

This article reports on a study examining continuing professional development (CPD) for consultant doctors. The aim of the study was to identify what promotes or inhibits the effectiveness of CPD and met the following objectives: comparing and contrasting the experiences of CPD across the range of specialties; identifying and describing the range of different models of CPD employed across the different specialties and clinical contexts; considering the educational potential of reflective practice in CPD and its impact on professional practice and exploring how different professionals judge the effectiveness of current CPD practices. Using a mixture of qualitative (interviews, letters, observation) and quantitative (online questionnaire) methods, the views of CPD providers and users were surveyed. Findings suggested that the effectiveness of CPD, as inferred from the comments made by interviewees and questionnaire respondents, relates to the impact on knowledge, skills, values, attitudes, behaviours and changes in practice in the work place. The quality of CPD was seen as inextricably linked to any improvements in the quality of the professional practices required for service delivery. There was widespread consensus as to the value of learning in professional settings. There was recognition that there needs to be a move away from tick boxes to the in-depth identification of learning needs and how these can be met both within and external to the work place, with learning being adequately enabled and assessed in all locations. In conclusion, it can be said that CPD is valued and is seen as effective when it addresses the needs of individual clinicians, the populations they serve and the organisations within which they work. However, the challenge for CPD may lie in the dynamic interaction between educational opportunities and service delivery requirements, as there may be occasions where they vie with each other for resources.

Exploring the Role of Empathy in Understanding the Social-Cognitive Profile for Individuals Referred for Autism Spectrum Disorders Assessment in Adulthood.

This study explored the social-cognitive profile of 173 adults referred for an autism assessment. We considered key dimensional traits (autism, empathy and systemising) to understand social cognition in adults diagnosed with an autism spectrum condition compared with those who were referred for, but did not receive a diagnosis. There were no significant social cognitive differences between groups on measures of emotion recognition and social inference. Adults with a confirmed diagnosis, however, reported fewer empathising traits which were positively associated with social-cognitive understanding. Empathising partially mediated the relationship between diagnostic group and social-cognition. Lower empathising traits in individuals diagnosed in adulthood may be important in understanding challenges with social adaptability. The findings have implications for assessment and highlight the role of empathy in developing social understanding in autism.

A tale of two generations: Maternal skin color and adverse birth outcomes in Black/African American women.

We examined how sociopolitical context (marked by generational cohort) and maternal skin color interacted to influence preterm delivery (PTD) rates in sample of Black women. Data were from 1410 Black women, ages 18-45 years, residing in Metropolitan Detroit, MI enrolled (2009-2011) in the Life-course Influences on Fetal Environments (LIFE) Study. Because we hypothesized that generational differences marked by changes in the sociopolitical context would influence exposure to racism, we categorized women into two cohorts by maternal birth year: a) Generation X, 1964-1983 and b) Millennial, 1984-1993. Descriptive results showed similar PTD rates by generational cohort, Generation X: 16.3% vs. Millennials: 16.1%. Yet, within each generation, PTD rates varied by women's skin tone (categorized: light, medium, and dark brown). Poisson regression models confirmed a significant interaction between generational cohort and maternal skin tone predicting PTD (P = 0.001); suggesting a salubrious association between light brown skin tone (compared to medium and dark) and PTD for Generation X. However, Millennials with medium and dark brown skin experienced lower PTD rates than their light Millennial counterparts. Research should consider sociopolitical context and the salience of skin tone bias when investigating racial health disparities, including those in perinatal health.