The role of patient and family advisory boards in promoting greater attention to patient social needs by U.S. acute care hospitals.

BACKGROUND: There is growing attention to individual-level patient social needs such as unstable housing and food insecurity. Such considerations, however, have historically been the purview of public health and have not been a priority of more traditional health care delivery organizations, such as acute care hospitals. PURPOSE: The purpose of this study was to examine whether the presence of patient and family advisory boards (PFABs) among acute care community hospitals was associated with screening for and programs to address patient social needs. METHODS: We used a secondary data set derived from the American Hospital Association's 2020 and 2021 annual surveys, along with multinomial and negative binomial regression models to assess the relationship between the presence/absence of a PFAB and the likelihood of offering and the number of areas addressed by social needs screening programs. RESULTS: More than half (55.9%) of all responding hospitals reported having a PFAB in 2020 (55.9%) and 2021 (52.7%). The presence of a PFAB among hospitals was significantly associated with patient social needs screening, more areas addressed by programs, and more types of partners to address these needs. CONCLUSIONS: Community hospitals with a PFAB have more robust programs and partnerships to address patient social needs. PRACTICE IMPLICATIONS: Hospital leaders should consider going beyond simply establishing programs to address social needs but also consider comprehensiveness of these programs to recognize the intersectionality of social needs. One way to do this is to formally establish a PFAB to help hospitals better identify and prioritize the needs in local communities and design social needs programs/solutions that are patient- and family-centric.

Magnetic work environments: Patient experience outcomes in Magnet versus non-Magnet hospitals.

BACKGROUND: The term Magnet hospital is an official designation ascribed by the American Nurses Credentialing Center for hospitals that meet specific criteria indicating they have a "magnetic work environment" for nurses. The objective of the Magnet designation is to encourage hospitals to design work in such a way as to attract and retain high-quality nurses and thus improve the quality of patient care. Empirical research has demonstrated that hospitals who earn a Magnet designation appear to have nurses who are more satisfied and committed to their work environments. Although research on whether patients are more satisfied with their care in these hospitals is still in its infancy, preliminary studies suggest that patients receiving care at Magnet-designated hospitals report more positive care experiences. PURPOSE: This study used a large secondary survey data set to explore the extent to which inpatient perceptions differed between Magnet and non-Magnet hospitals. METHODOLOGY: Ordinal logistic and multinomial logistic regression analyses were used to examine whether Magnet hospital status and positive nurse communication are related to overall hospital rating and willingness of patients to recommend the hospital. RESULTS: Results indicated that patients treated at a Magnet hospital and patients who rated nurses' communication highly were significantly more satisfied and more likely to say they would recommend the hospital. CONCLUSIONS: Evidence from this study suggests that it would be worthwhile for hospital leaders to consider organizational policies and practices consistent with the criteria put forth for Magnet hospital designation.

Human papillomavirus (HPV) and influenza vaccine behavior among Muslim women in the United States.

In this study, we examined vaccination behaviors-single dose human papillomavirus (HPV) vaccination, triple dose HPV vaccination, and influenza vaccination-among Muslim women residing in the United States. Using logistic regression models, we analyzed self-reported survey. We found that respondents had lower rates of HPV vaccination and higher rates of influenza vaccination, relative to the general American population. The respondents in our sample who reported contraceptive use had higher odds of vaccination. In this study the authors provide a springboard for the enhancement of patient-centered care through better understanding of health behaviors and cultural preferences of underrepresented communities in research.

Alcohol Use, High Risk Behaviors, and Experiences of Discrimination Among Transgender Women in the Dominican Republic.

Objectives: This study examines associations between alcohol use, high risk sexual behaviors, and experiences of stigma among transgender women across the Dominican Republic. Data from the 2015 Transgender Health Needs Study were analyzed using bivariate analyses (N = 291). Results: High rates of stigma, verbal abuse, alcohol use, and sex work are found and are associated with each other. Almost 45% of regular alcohol users are engaging in sex work (43.6%), compared with 31.1% of the non-regular alcohol users (χ2=4.82, p < .05). Having sex under the influence of alcohol is statistically associated with high risk behaviors, such as engaging in sex work, sometimes or never using a condom when receiving anal sex, and higher numbers of sexual partners. Furthermore, transgender women who have had sex under the influence of alcohol report statistically significantly higher levels of verbal abuse, discrimination, and levels of perceived transgender stigma. Conclusions/Importance: Findings suggest that although anti-discrimination laws exist, policies may not protect transgender women from experiencing stigma and discrimination at work, potentially forcing them to seek alternative careers and engage in behaviors that expose them to greater personal risk and harm. This intersection of factors may indicate a notable public health gap in transgender health in the Dominican Republic.

Sex work, social support, and stigma: Experiences of transgender women in the Dominican Republic.

Background: Transgender populations, and especially those in resource-limited settings, are at an elevated risk of experiencing stigma and discrimination. Aims: This study sought to examine the relationship between parental, familial, and other social support, experiences of stigma and discrimination, quality of life, and sex work in a national sample of transgender women in the Dominican Republic (n = 291). Methods: Descriptive analyses for the outcome variable, sex work, as well as for measures associated with socio-demographics, social support, stigma, quality of life, and experiences of abuse and violence were performed. Bivariate analysis examined differences between respondents involved in sex work and those not involved in sex work. Results: We found that participation in sex work was associated with low social support and quality of life and increased experiences of stigma, discrimination, and abuse. Specifically, Dominican transgender women involved in sex work received less social support than their non-sex working peers; they experienced heightened arguments and problems with non-parental family members, professors or bosses, classmates, and close friends, as well of loss of friendships. Involvement in sex work was also associated with higher levels of stigma and discrimination, lower quality of life, and experiences of sexual abuse, torture, and experiences of attempted murder on one's life. Discussion: Transgender women participating in sex work require more rather than less social support from family members and loved ones, especially in areas where workplace discrimination policies that affect transgender individuals are nebulous, such as the Dominican Republic.

Examining the Relationship Between Individual Characteristics, Community-Level Traits, Multidimensional Empowerment, and Maternal Health Care Utilization in the Islamic Republic of Pakistan.

Introduction The Islamic Republic of Pakistan's maternal mortality ratio is particularly high, and the nation ranks 126 out of 149 countries on the Human Development Report-Gender Inequality Index. This is because Pakistani women have low levels of empowerment, make limited economic contributions, and underutilization of maternal health care. The aim of this study is to create a multidimensional index of women's empowerment and assess the association between this index and maternal health care utilization in Pakistan, controlling for individual characteristics and community-level traits. Methods Data from the 2012-2013 Pakistan Demographic and Health Surveys were employed to investigate the relationship between this index and the latent construct of maternal health care utilization. Results Using exploratory factor analysis, four indicators of maternal health care utilization were loaded onto a single latent factor. Multivariate analyses found support for the association between empowerment and health care utilization, despite adjustments for individual and area level factors. Positive associations between education, wealth, and maternal health care utilization were found. Conclusions Although we find support for the association of educational attainment with maternal health care utilization, the multidimensional women's empowerment index was independently a consistent associate of maternal health care utilization. This illustrates a complex mechanism with both-education and empowerment, being necessary for improved maternal health care utilization. Policy makers seeking to improve outcomes should expand their focus beyond simply improving rates of education to examining effects of cultural norms which constrain the independence of women in making decisions about their own health care.

Muslim Women's use of contraception in the United States.

BACKGROUND: American Muslim women are an understudied population; thus, significant knowledge gaps exist related to their most basic health behaviors and indicators. Considering this, we examined American Muslim women's contraception utilization patterns. METHODS: Self-reported data collected in late 2015 were analyzed. Women who identified as Muslim, were at least 18 years old, sexually active, and current residents of the United States (n = 224) met the inclusion criteria. Convenience sampling was employed. Multivariate logistic regression models estimated associations between demographics, marital status, ethnicity, nativity, health insurance, religious practice, and contraception use. RESULTS: Identifying as Muslim, in general, was significantly associated with greater odds of using contraception in general and condoms compared to American Muslim women who identify as Sunni. Identifying as Shia was associated with greater odds of using oral contraceptive pills relative to Sunni respondents. South Asian ethnicity was associated with higher odds of using oral contraceptive pills compared to those of Middle Eastern or North African ethnicity. CONCLUSIONS: Findings suggest American Muslim women's contraception utilization patterns share certain similarities with both American women in general and disadvantaged racial and ethnic minority groups in the United States, implying that factors that influence American Muslim women's use of contraceptives are possibly countervailing and likely multifaceted. More research is needed to accurately identify associates of contraceptive use in this population. This work serves as a starting point for researchers and practitioners seeking to better understand reproductive health decision in this understudied population.

Correlates of interorganizational relationship strategies among critical access hospitals.

BACKGROUND: Interorganizational relationships (IORs) between hospitals and other health care providers have many potential benefits for critical access hospitals (CAHs) that operate in resource-constrained environments. Given the potential benefits of IORs, especially for CAHs, it is important to identify the conditions that support or hinder IOR development. However, most research examining IORs isolates individual types of relationships while ignoring the practical reality that many hospitals participate in a portfolio of relationships simultaneously. PURPOSE: The aim of the study was to examine the IOR strategies of CAHs as a function of market and organizational characteristics. METHODOLOGY: The sample consisted of CAHs operating in the United States between the years 2002 and 2012. For each year, hospitals were assigned to one of four mutually exclusive IOR categories: (a) no IOR, (b) vertical IOR only, (c) horizontal IOR only, and (d) both vertical and horizontal IOR. Organizational characteristics were categorized as structural, operational, and financial. Environmental characteristics were categorized as sociodemographic, physical, and health delivery system-related. A multinomial logistic regression model was used to assess the relationship between IOR strategies and organizational and environmental characteristics, with results reported as average marginal effects. RESULTS: Approximately 41% of the CAHs were pursuing a combined vertical and horizontal IOR strategy, 20% were pursuing a vertical IOR-only strategy, 18% were pursuing a horizontal IOR-only strategy, and 21% were not engaged in an IOR strategy. Among the organizational characteristics, the type of IOR strategy used by a hospital varied as a function of ownership, total margin, days cash on hand, number of community orientation activities, and census. In contrast, among the environmental characteristics, only the number of community health centers in the community was associated with the type of IOR strategy pursued. CONCLUSION: CAHs' construction of IOR portfolios may be more dependent on organizational attributes than by environmental conditions.

Associates of Neonatal, Infant and Child Mortality in the Islamic Republic of Pakistan: A Multilevel Analysis Using the 2012-2013 Demographic and Health Surveys.

Objectives Pakistan is one of five nations contributing to half of the world's child mortality and holds under-five mortality rates which are nearly double global targets. Reasons for this shortfall include civil conflicts, political uncertainty, low education, poverty, rural-urban disparities, and limited health care access. The aim of this study was to explore associations between individual characteristics, community factors, and child mortality in Pakistan. Methods Data were derived from the 2012 to 2013 Pakistan Demographic and Health Survey, and included 7399 live births and 380 child deaths. Multivariate, multilevel logistic regression was used to model risk of neonatal, infant and under-five child deaths. Results Seventy-one percent of child deaths occurred during the neonatal period. Significant factors (p < 0.05) associated with lower odds of child mortality included adhering to recommended minimum of 24 months interpregnancy interval and higher household wealth. These were significant for neonatal (OR 0.448; 0.871), infancy (OR 0.465; 0.881), and under-five deaths (OR 0.465; 0.879). Employed mothers had higher odds of neonatal (OR 1.479), infant (OR 1.506), and child mortality (OR 1.459). Likewise, women living in consanguineous marriages had higher odds of infant (OR 1.454) and under-five deaths (OR 1.381). Children in Balochistan, Punjab, and Sindh, regions disproportionately poor, rural with low levels of education, were at highest risk of dying. Conclusions for Practice Findings may assist in designing targeted interventions, developing appropriate public health messaging, and implementing policies designed to lower child mortality. Focusing on lowering rates of maternal poverty, increasing opportunities for education, and improving access to health care could assist in reducing child mortality in Pakistan.

Federally Qualified Health Centers' Screening for Social Risk Factors and Health Outcomes.

Federally Qualified Health Centers (FQHCs) are ideally positioned to identify and address health-related social needs, but little is understood about the relationship between social risk factor (SRF) screening and health outcomes. We studied 1352 FQHCs from the 2019 Uniform Data System. Ordinary least squares regression was used to estimate the relationship between SRF screening and the percentage of patients with adequately controlled diabetes and hypertension. Results show 71% of the FQHCs in the sample collected SRFs. FQHCs' screened for SRFs had higher percentages of patients with adequately controlled diabetes (69.5% vs 67.0%, P < .001) and hypertension (63.8% vs 59.4%, P < .001) relative to FQHCs not collecting SRFs.

Measuring symptoms in community-dwelling older adults: the psychometric properties of a brief symptom screen.

BACKGROUND: With aging, the probability of experiencing multiple chronic conditions has increased, along with symptoms associated with these conditions. Symptoms form a central component of illness burden, and distress. To date, most symptom measures have focused on a particular disease population. OBJECTIVE: We aimed to develop and evaluate a simple symptom screen using data obtained from a representative sample of community-dwelling older adults. METHODS: Psychometric analyses were conducted on 10 self-reported dichotomous symptom indicators collected during in-person interviews from a sample of 1000 community-dwelling older adults. Symptoms included shortness of breath, feeling tired or fatigued, problems with balance or dizziness, perceived weakness in legs, constipation, daily pain, stiffness, poor appetite, anxiety, and anhedonia. RESULTS: Over one third of the individuals (37.4%) had 5 or more concurrent symptoms. Stiffness and feeling tired were the most common symptoms. Confirmatory factor analyses were performed on the 10 symptoms for single factor and bifactor (physical and affective) models of symptom reporting. Goodness-of-fit indices indicated better fit for the bifactor model (χdf=10=89.6; P<0.001), but the practical significance of the improvement in fit was negligible. Differential item functioning analyses showed some differences of relatively high magnitude in location parameters by race; however, because the differential item functioning was in different directions, the impact on the overall measure was most likely lessened. CONCLUSIONS: Among community-dwelling older adults, a large proportion experienced multiple co-occurring symptoms. This Brief Symptom Screen can be used to quickly measure the overall symptom load in older adult populations, including those with multiple chronic conditions.

Clinical Outcomes in COVID-19 Patients Treated with Immunotherapy.

Introduction: The full impact of COVID-19 infections on patients with cancer who are actively being treated with chemotherapy or immune checkpoint inhibitors (ICIs) has not been fully defined. Our goal was to track clinical outcomes in this specific patient population. Methods: We performed a retrospective chart review of 121 patients (age > 18 years) at the University of Alabama at Birmingham from January 2020 to December 2021 with an advanced solid malignancy that were eligible to be treated with ICIs or on current therapy within 12 months of their COVID-19 diagnosis. Results: A total of 121 patients were examined in this study, and 61 (50.4%) received immunotherapy treatment within 12 months. One quarter of the patients on ICIs passed away, compared to 13% of the post-chemotherapy cohort. Patients who were vaccinated for COVID-19 had lower mortality compared to unvaccinated patients (X2 = 15.19, p < 0.001), and patients with lower ECOG (0.98) were associated with lower mortality compared to patients with worse functional status (0.98 vs. 1.52; t = 3.20; p < 0.01). Conclusions: COVID-19-related ICI mortality was higher compared to patients receiving chemotherapy. However, ICI cessation or delay is unwarranted as long there has been a risk−benefit assessment undertaken with the patient.

Serological Confirmed Syphilis Among Transgender Women in Dominican Republic.

Purpose: Transgender women (TW) in the Dominican Republic (DR) are at high risk for syphillis infection. Although treatable, infection rates remain at epidemic proportions. Methods: In 2016, we conducted a national survey, with serological sampling of TW in the DR (n=255). Results: In our sample, syphillis seropositivity was 47.45%. There was a statistically significant association between age (t=-2.93, df, p<0.01), arrest history (χ 2=8.15, p<0.01), exposure to violence (χ 2=3.73, p<0.05), and syphilis seropositivity. Multivariate analyses show TW arrested in the past 6 months have higher odds of seropositivity (odds ratio=2.05, confidence interval: 1.04-4.06, p<0.05). Conclusions: There is a need for education and public health campaigns focused on TW specifically.

HIV Testing Among Muslim Women in the United States: Results of a National Sample Study.

Purpose: More than one million Americans are living with human immunodeficiency virus (HIV), and less than half of Americans have ever accepted an HIV test. There are no national HIV testing estimates for Muslim Americans, an underserved and often stigmatized population. Considering the lack of HIV testing estimates for this population, we conducted an exploratory study on HIV testing and potential associates in American Muslim women from across the United States. Methods: We applied logistic regression models to examine the Muslim Women's Health Project data, collected in 2015 (N=218). Results: Health care engagement and intimate partner violence were significantly associated with having been tested for HIV. Respondents using contraceptives received an influenza vaccination, and received an abnormal pap test had more than two times higher odds of having been tested for HIV (odds ratio [OR]=2.56, OR=2.43, OR=2.93, respectively; p<0.05 all). Having been sexually abused was associated with more than two times higher odds of having been tested for HIV (OR=2.49; p<0.05). Conclusion: Respondents reported higher rates of HIV testing as compared with the general public, signaling HIV knowledge, engagement in preventative health care, and possibly HIV risk. Scholars and practitioners should not assume that Muslim patients are at low risk for HIV and do not engage in HIV-risk behaviors. Thus, assumptions about Muslims women's willingness to accept HIV testing should be further examined to elucidate HIV risk among this population.

HIV knowledge among cisgender female sex workers of Haitian descent working at the border of Haiti and Dominican Republic.

In this brief report, we aim to assess levels of HIV mis-information among cisgender Haitian female sex workers engaged in sex work at the Haiti and Dominican Republic border. We conducted bivariate analyses on the 2014 Border Study on Sex Workers comparing responses from female sex workers on the Haiti side of the border to those from their peers on the Dominican Republic side (N=212). Prevention of HIV acquisition by correct and consistent condom use with each sex act was correctly endorsed by 90.5% of female sex workers in Haiti but only 57.0% of their peers in Dominican Republic (χ2=32.28, p<0.001); 84.1% of respondents in Haiti correctly identified that HIV can be transmitted through a single unprotected sexual act, compared to 52.3% in Dominican Republic (χ2=25.2, p<0.001). Significantly higher percentages of female sex workers in Dominican Republic correctly responded that HIV can be transmitted in pregnancy, compared to respondents in Haiti (96.5% vs. 71.4%; χ2=21.42, p<0.001). Higher percentages of respondents in Dominican Republic correctly answered that HIV can be transmitted through needle sharing, relative to respondents in Haiti (100.0% vs 89.7%; χ2=9.45, p<0.01). Respondents in Dominican Republic more accurately rejected the possibility of transmission through food or through mosquito bites, compared to respondents in Haiti (95.4% vs. 81.8%, χ2=8.51, p<0.01; 97.7% vs. 86.5%, χ2=7.81, p<0.01, respectively). Findings indicate that if HIV knowledge is examined aggregating responses to individual questions, then elements of misinformation may remain unaddressed. For example, we found significant differences in correct answers ranging from 16.7% to 100.0%.

Transgender Women in Dominican Republic: HIV, Stigma, Substances, and Sex Work.

Exposure to stigma, violence, sex work, and substance use are associated with increased HIV risk, but relationships between these factors have not been fully elucidated among transgender women whose data are often aggregated with men who have sex with men and other sexual and gender minorities. Considering this gap, we aimed to identify a serologically confirmed HIV estimate for transgender women and examine the relationships between stigma, sex work, substance use, and HIV among a national sample of transgender women in Dominican Republic. We analyzed biomarkers and self-report data from the third wave of Dominican Republic's Encuesta de Vigilancia y Comportamiento con Vinculación Serológica, employing logistic and negative binomial regression to estimate models (n = 307). HIV rate was 35.8%. Nearly 75% of respondents engaged in sex work. Over 20% reported experiencing violence; 61.6% reported being stigmatized. Participation in sex work was associated with higher levels of stigma [incidence rate ratio (IRR): 1.70, p < 0.05]. Respondents who experienced violence had over three times higher odds of living with HIV relative to respondents who had not been victimized [odds ratio (OR): 3.15, p < 0.05]. Marijuana users were less likely to experience stigma compared with cocaine users (IRR: 1.72, p < 0.05), and a higher risk of alcohol dependency was associated with higher odds of experiencing violence (OR: 1.17, p < 0.001). Findings illustrate the importance of disaggregating data collected from transgender women compared with other sexual and gender minorities to ascertain subpopulation-specific estimates and indicate an urgent need to implement structural interventions and policies to protect transgender women's health and their human rights.

Inpatient Telehealth and Coronavirus Disease 2019 Outcomes: Experiences in Alabama.

Background: During the early months of the coronavirus disease 2019 (COVID-19) pandemic, hospitals were concerned about preserving personal protective equipment. UAB Hospital Medicine designed a strategy to outfit acute care patient rooms on a COVID-19 unit with telemedicine technology to allow for remote clinician rounding. Objective: To describe one hospital's experience with inpatient telehealth and compare outcomes between patients with and without inpatient telehealth visits. Design and Methods: Retrospective chart review of patients admitted to UAB Hospital Medicine with COVID-19 between March 16, 2020 and April 24, 2020. Logistic and negative binomial regression models were used to examine the relationship between telehealth visits and the likelihood of a subsequent transfer to the intensive care unit (ICU), ventilation, and number of ICU days. Clinician interviews provided additional insight into the telehealth implementation. Findings: One-quarter of the patients received a telehealth visit. Half were admitted to the ICU, and one-third received ventilation. Regression models did not identify statistically significant differences in transfer to the ICU, number of ICU days, and ventilation between patients with and without telehealth visits. Older age and increased respiratory rate were associated with higher odds of ICU admission. Patients with a cough were associated with lower odds of ventilation and fewer ICU days. Discussion: Implementation challenges included difficulties associated with assisting patients with operating the tablets. However, clinicians noted that there was a great benefit to patients being able to see an unmasked physician. Furthermore, the telehealth program proved to be a viable strategy for connecting patients in isolation with their families. Findings can inform the future development of inpatient telemedicine strategies.

Female Sex Workers' Experiences of Violence and Substance Use on the Haitian, Dominican Republic Border.

Background: Female sex workers (FSW) are socially and economically marginalized, and this vulnerability can be exacerbated when they hold the intersectional identity of also being an immigrant, such as in the case of Haitian FSWs in the Dominican Republic. Objective: Considering that half of migratory young women and girls relocating across the Latin American and Caribbean region do so without their families, increasing the likelihood of experiencing abuses, our primary objective was to test the hypothesis that Haitian FSWs in the Dominican Republic have higher odds of being physically abused by sexual partners compared to Haitian FSWs in Haiti. Methods: We conducted bivariate analyses and multivariate analyses on 2014 Hispaniola Sex Workers Study (N = 232). Findings: Approximately 80% of Haitian FSWs in the Dominican Republic reported experiencing violence by a regular partner (80.3%), compared with 60.0% of Haitian FSWs in Haiti (χ2 = 11.34, p < 0.001). Controlling for socio-demographics, substance use, childhood abuse, and sexual behaviors, Haitian FSWs in Haiti maintained lower odds of experiencing violence by a regular partner (OR:0.37, p < 0.01) and higher odds of experiencing violence from a coworker (OR:6.38, p < 0.001) compared to FSWs in the Dominican Republic. Using sex to avoid arrest is associated with higher odds of experiencing violence by a client and violence by a coworker (OR:2.18, p < 0.05; OR:3.74, p < 0.001; respectively). Accepting payment in the form of drugs/alcohol is associated with higher odds of experiencing physical violence by a regular partner but lower odds of experiencing violence by a client (OR:3.99, p < 0.05; OR:0.43, p < 0.05; respectively). Conclusions: Assuming health is a human right, then practitioners and scholars must actively collaborate to fortify vulnerable populations against injurious structural and sociocultural forces examining the intersectionality and compound effects of multiple stigmatized identities, in this study being an FSW and an immigrant, that moderate the potential positive effects of public health interventions.

Assessing Human Immunodeficiency Virus (HIV) Prevention Through Knowledge and Condom Use Among Female Sex Workers at the Border of Haiti and Dominican Republic.

Geographic border studies are relatively scare, but have the potential to inform bilateral health policies that affect the well-being of female sex workers (FSWs) who work at these borders as well as those individuals who solicit their services, both groups being at high risk for human immunodeficiency virus (HIV). We applied bivariate and multivariate techniques to examine FSWs' HIV knowledge and condom use across three partner types, at the Haiti Dominican Republic border, using data from the Study on Sex Workers (n = 241, 2014). Condom use was significantly lower among FSWs on the Haitian side of the border compared to the Dominican side, yet levels of HIV knowledge were similar; specifically, 81% of respondents on the Dominican side reported using condoms every time they had sex with a client, compared to 38% of peers in Haiti (p < 0.001). After introducing controls, FSWs in Haiti continued to have lower odds of using condoms with clients (p < 0.001), noncommercial partners (p < 0.001), and regular partners (p < 0.05) compared to peers in the Dominican Republic. This unique border study highlights disparities in FSWs' condom use regardless of HIV knowledge. The lack of consistent condom use by FSWs in Haiti has the potential to exacerbate the HIV epidemic at the border and impact both nations' HIV incidence rates.

Evidence that patient-centered medical homes are effective in reducing emergency department admissions for patients with depression.

The patient-centered medical home (PCMH) has increasingly been touted as one means of integrating behavioral health and primary care and more holistically caring for patients with chronic disease. With its whole person orientation, the PCMH presents an opportunity to reduce emergency department visits for patients with depression by focusing on the patient and his/her health care needs, facilitating communication among providers and patients, and improving patients' access to care providers across settings. This study examines the relationship between PCMH capacity - defined as the ability to offer a service identified as a component part of the PCMH - and the number of emergency department visits for patients with depression. Health plan claims data, self-report data from physician practices on their PCMH characteristics, and the Area Resource File were analyzed. Results show that overall PCMH capacity is associated with fewer emergency department visits for patients with depression, and interpersonal aspects of the PCMH in particular, were associated with fewer emergency department visits while technical capabilities were not. Interpersonal activities that facilitate care coordination, patient engagement, and connect patients with community resources might be more effective in keeping patients out of the emergency department for unnecessary reasons as compared to technical activities focused on reporting and information management.