Findings among Indigenous participants of the Tracks survey of people who inject drugs in Canada, Phase 4, 2017-2019.

BACKGROUND: The Tracks survey of people who inject drugs (PWID) collected data in 14 sentinel sites across Canada (2017-2019). These findings describe the prevalence of human immunodeficiency virus (HIV), hepatitis C and associated risk behaviours among Indigenous participants. METHODS: Information regarding socio-demographics, social determinants of health, use of prevention services and testing, drug use, risk behaviours, and HIV and hepatitis C testing, care and treatment was collected through interviewer-administered questionnaires. Biological samples were tested for HIV, hepatitis C antibodies and hepatitis C ribonucleic acid (RNA). Descriptive statistics were calculated and reviewed by an Indigenous-led advisory group using the Two-Eyed Seeing approach. RESULTS: Of the 2,383 participants, 997 were Indigenous (82.9% First Nations, 14.9% Métis, 2.2% Inuit). Over half (54.5%) were cisgender male and the average age was 38.9 years. A large proportion (84.0%) reported their mental health as "fair to excellent". High proportions experienced stigma and discrimination (90.2%) and physical, sexual and/or emotional abuse in childhood (87.5%) or with a sexual partner (78.6%). Use of a needle/syringe distribution program (90.5%) and testing for HIV (87.9%) and hepatitis C (87.8%) were high. Prevalence of HIV was 15.4% (78.2% were aware of infection status) and 36.4% were hepatitis C RNA-positive (49.4% were aware of infection status). CONCLUSION: High rates of HIV and hepatitis C were identified. Challenges in access to and maintenance of HIV and hepatitis C care and treatment were noted. This information informs harm reduction strategies, including the need to scale-up awareness of prophylaxis in a culturally relevant manner.

Understanding Genomic Knowledge in Rural Appalachia: The West Virginia Genome Community Project.

PURPOSE: Rural communities have limited knowledge about genetics and genomics and are also underrepresented in genomic education initiatives. The purpose of this project was to assess genomic and epigenetic knowledge and beliefs in rural West Virginia. SAMPLE: A total of 93 participants from three communities participated in focus groups and 68 participants completed a demographic survey. The age of the respondents ranged from 21 to 81 years. Most respondents had a household income of less than $40,000, were female and most were married, completed at least a HS/GED or some college education working either part-time or full-time. METHOD: A Community Based Participatory Research process with focus groups and demographic questionnaires was used. FINDINGS: Most participants had a basic understanding of genetics and epigenetics, but not genomics. Participants reported not knowing much of their family history and that their elders did not discuss such information. If the conversations occurred, it was only during times of crisis or an illness event. Mental health and substance abuse are topics that are not discussed with family in this rural population. CONCLUSIONS: Most of the efforts surrounding genetic/genomic understanding have focused on urban populations. This project is the first of its kind in West Virginia and has begun to lay the much needed infrastructure for developing educational initiatives and extending genomic research projects into our rural Appalachian communities. By empowering the public with education, regarding the influential role genetics, genomics, and epigenetics have on their health, we can begin to tackle the complex task of initiating behavior changes that will promote the health and well-being of individuals, families and communities.

A course for nurses to handle difficult communication situations. A randomized controlled trial of impact on self-efficacy and performance.

OBJECTIVE: to evaluate the impact of a communication skills course for nurses on how to handle difficult communication situations in their daily work. METHODS: a 7-h course was developed using a construct of "Awareness, Feelings, Listen, Solve" (AFLS). A pedagogy of experiential, learner-centered learning was adopted. The course evaluation used a randomized controlled design with pre- and post-measures of self-efficacy and performance. RESULTS: forty-one nurses volunteered and thirty-three nurses completed all assigned parts of the study. On self-assessment, there was significant improvement for self-efficacy (F=24.43, p<0.001), but not for emotional awareness. On performance, there was no significant improvement between intervention and control groups (F=3.46, p=0.073). CONCLUSION: a short course for nurses on handling difficult communication situations achieved significant improvements in self-efficacy but not in performance. PRACTICE IMPLICATIONS: teaching communication skills in community-based settings is important for the safety and effectiveness of patient care. Sponsoring organizations should weigh trade-offs between feasibility and achievement of measurable improvements in performance. One possible approach is to focus on specific communication skills rather than a full suite of skills.

The subversion of urine drug testing.

Since government and private industry have instituted urine drug testing to ensure a drug-free work force, an industry dedicated to subverting the results of those tests has developed. This article describes that industry, the types of products it markets, and efforts to curb the sale of those products.

The U.S. Mandatory Guidelines for Federal Workplace Drug Testing Programs: current status and future considerations.

The U.S. Department of Health and Human Services (HHS) drug testing standards were published in 1988 and revised in 1994, 1998, and 2004. In 2004, significant revisions defining, standardizing, and requiring specimen validity testing on Federal employee donor urine specimens were included. In a separate notice, HHS proposed to establish scientific and technical guidelines for the Federal Workplace Drug Testing Program to: (1) permit laboratory testing of hair, oral fluid, and sweat patch specimens in addition to urine specimens for marijuana, cocaine, phencyclidine, opiates (with focus on heroin), and amphetamines [including methylenedioxymethamphetamine (MDMA), methylenedioxyethamphetamine (MDEA), methylenedioxyamphetamine (MDA)]; (2) permit use of on-site point of collection test (POCT) devices to test urine and oral fluid at collection sites; (3) permit use of instrumented initial test (screening only) facilities [IITF] to quickly identify negative specimens; and (4) add training requirement for collectors, on-site testers, and MROs. This proposal was published in the Federal Register on 13 April 2004, with a 90-day public comment period. The Substance Abuse and Mental Health Services Administration, HHS, reviewed those comments and is preparing the Final Notice that will define the requirements for such testing, including: specimen collection procedures, custody and control procedures that ensure donor specimen identity and integrity, testing facility, initial and confirmatory test cutoff concentrations, analytical testing methods, result review and reporting, evaluation of alternative medical explanations for presence of drug or metabolite in the donor's specimen, and laboratory certification issues. Voluntary pilot performance testing (PT) programs for each specimen type are on-going since April 2000 to determine how to prepare PT materials for specimens other than urine to evaluate laboratories' ability to routinely achieve accuracy and precision required. Certification programs will be developed using the current urine drug testing National Laboratory Certification Program model. The addition of accurate and reliable workplace drug testing using hair, oral fluid, and sweat patch specimens will complement urine drug testing, and aid in combating industries devoted to suborning drug testing through adulteration, substitution, and dilution. For example, hair testing may detect chronic drug use for up to 90 days and be useful in pre-employment situations; oral fluid testing may detect drug use in past hours and be useful in post-accident situations; sweat patch testing may be useful in follow-up drug testing and treatment programs; POCTs and IITFs may be most useful for quickly identifying specimens that are negative for drugs and indicate that the specimen is valid.

Urine pH: the effects of time and temperature after collection.

The Mandatory Guidelines for Federal Workplace Drug Testing Programs provide criteria for specimen validity testing, including urine pH cut-offs, to report a urine specimen as adulterated or invalid. Since the urine pH criteria for invalid classifications, > or = 3 and < 4.5 or > or = 9 and < 11, became effective in November 2004, a number of specimens with results within the upper invalid limits, typically in the range of 9.1 to 9.3, have been reported with no evidence of adulteration. This study evaluated the hypothesis that these pH findings were the result of exposure to increased environmental temperatures during specimen standing and transport. Indeed, increased storage temperatures were associated with increased urine pH, with the magnitude of the change related to both storage time and temperature. The pH values of specimens stored at -20 degrees C are relatively stable, whereas pH results > 9 are achieved at storage temperatures of room temperature or higher. It is noteworthy that no condition(s) produced a specimen with a pH > 9.5. Degradation of nitrogenous urine analytes is most likely responsible for the noted increases in pH. These findings are intended to supplement information used by the Medical Review Officers who are responsible for interpreting such marginally invalid pH results.

Comparison of parental report of blood lead testing in children enrolled in Medicaid with Medicaid claims data and blood lead surveillance reports.

The purposes of this study were to identify the congruence of blood lead testing based on parental self-reports with Medicaid claims and blood lead surveillance records, and to determine factors associated with agreement between parental reports of blood lead tests and Medicaid claims or blood lead surveillance records. Data were obtained from a cross-sectional mailed survey of a randomly selected sample of parents of children 1-2 years old enrolled in Medicaid (n=532) and from existing Medicaid claims and blood lead surveillance records. Fifty-six percent of survey respondents reported their child had a blood lead test completed. Of these, only 56% could be confirmed with Medicaid claims/blood lead surveillance data. Logistic regression analysis revealed the odds of blood lead testing per parental report confirmed with Medicaid claims/blood lead surveillance data were 2.6 times greater if the child had > or =3 provider visits, 2.5 times greater if parents reported receiving a reminder about blood lead testing, 2.2 times greater if parents reported receiving information about lead poisoning, 1.6 times greater if residing in an urban county, and 1.5 times greater if the child was more than 2 years old. In conclusion, parents are not always aware if their child had a blood lead test. Information and reminders about blood lead testing should be distributed to parents of young children enrolled in Medicaid and frequently reviewed by healthcare providers.

The impact of legislation and secular trends on newborn length of stay for Medicaid infants in Ohio.

OBJECTIVES: To examine the impact of state legislation mandating minimum maternal and newborn length of stay (LOS). STUDY DESIGN: By using Medicaid claims data linked to vital statistics files, LOS, and "short stay" (

Relationship between early primary care and emergency department use in early infancy by the medicaid population.

OBJECTIVE: To examine the relationship between the use and type of primary care and visits to the emergency department (ED) in early infancy by healthy infants who are Medicaid recipients. DESIGN: A population-based cohort study using a database linking birth certificate data to Medicaid claims. PARTICIPANTS: A total of 151 464 full-term infants born in Ohio to mothers receiving Medicaid from July 1, 1991, through June 30, 1998. MAIN OUTCOME MEASURES: The primary outcome of interest was the occurrence of an ED visit within 91 days of the neonate's birth. Bivariate and multivariate analyses were performed to determine the effect of early linkage with primary care (within 21 days of birth) on ED use in early infancy. RESULTS: Only 53% of the infants had a documented primary care visit within 21 days of birth. Twenty-eight percent of infants had at least 1 ED visit within 91 days of birth and 9% had more than 1 visit. The mean age of the neonate at the first ED visit was 39.7 days. Fifteen percent of primary care visits within 21 days of birth occurred at a hospital-based primary care clinic. After adjusting for maternal, infant, and residency characteristics and temporal differences, early primary care linkage was associated with a 16% increase in the likelihood of ED use. When the primary care visit occurred in a hospital-based primary care clinic, it was associated with a 27% increase in the likelihood of ED use. CONCLUSION: Contrary to our expectations, early primary care linkage did not result in a decreased risk of ED use.

Substance abuse in the workplace: epidemiology, effects, and industry response.

The Substance Abuse and Mental Health Services Administration's National Household Survey on Drug Abuse (NHSDA) reveals self-reported information on illicit drug and alcohol use among full-time, part-time, and unemployed U.S. workers, including information on workplace policies, workers' health, productivity, absenteeism, job turnover rates, accidents, and injuries. Selected statistics from 1985, 1993, and 1999 NHSDAs are reviewed in this chapter, with focus on the effectiveness and outcomes of a comprehensive Drug-Free Workplace Program, including industry and employee response and the effects of a drug testing program.