Considerations for Modernized Criminal HIV Laws and Assessment of Legal Protections Against Release of Identified HIV Surveillance Data for Law Enforcement.

In November 2018, the Centers for Disease Control and Prevention distributed guidance to funded agencies under its Integrated HIV Surveillance and Prevention Programs Initiative to support the implementation of the program's third strategy: HIV transmission cluster investigation and outbreak response efforts. Cluster detection seeks to identify persons infected with HIV (diagnosed and undiagnosed) who are linked to infections in single or related sexual and injection drug networks. Identifying expanding clusters allows public health personnel to intervene directly where active HIV transmissions occur.However, in the context of HIV infection where most US states have enacted criminal exposure laws, these efforts have sparked concerns about the protection of HIV surveillance data from court order or subpoena for law enforcement purposes. The Centers for Disease Control and Prevention calls for funded agencies to evaluate relevant confidentiality laws to ensure that these are sufficient to protect the confidentiality of HIV surveillance data from use by law enforcement.We present four often overlooked factors about the criminalization of HIV exposure and HIV surveillance data protections that should be considered in statutory assessments.

Choosing the harder road: Naming the challenges for families in person-centred planning.

Person-centred planning (PCP) has underpinned disability service provision in many Western countries for the past 30 years. For many people with an intellectual disability, family members are central to this process and are important allies in facilitating positive change. This article presents findings from an evaluation of a family resourcing and capacity building project in New South Wales (NSW), Australia. Accounts from families show the merits of such work, but family efforts can be undermined by apathy and discrimination to disability from extended family, community and service providers. Asking families to be the primary support in PCP initiatives may potentially ignore the impacts of structural and psycho-emotional disablism on all family members. For families to support people with intellectual disability in PCP, there is a need to acknowledge and respond to the material, cultural and personal challenges for all family members in planning processes.

Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study.

BACKGROUND: Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. OBJECTIVE: This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. METHODS: This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). RESULTS: This study is part of an array of pilots within a European Union funded project, entitled "GATEKEEPER," conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. CONCLUSIONS: In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52957.

"They wanted to know what it was like through my eyes": Patients and carers views, experiences, and perceptions of active involvement in the delivery of an undergraduate pharmacy curriculum.

INTRODUCTION: There is an increasing policy and practice imperative for involving patients and carers in health-related undergraduate courses. The School of Pharmacy and Life Sciences at Robert Gordon's University, United Kingdom launched a module where patients and carers are actively involved in the delivery of the curriculum by sharing their experiences of their condition and its management with final year student pharmacists. This study aimed to evaluate this initiative by exploring patients' and carers' views and experiences of their active involvement in the delivery and their perceptions of potential future involvement in the design of the pharmacy curriculum. METHODS: Face-to-face semi-structured interviews were carried out with patients and carers who were actively involved in the delivery of the pharmacy course. The interview schedule was developed based on the research aim, an extensive literature review, and peer discussion before it was piloted. All interviews were digitally recorded and thematically analysed by two independent researchers. RESULTS: Seven of eight patients and carers involved in the module agreed to be interviewed. Five themes were identified: reasons for engagement with active teaching, perceived impact of active teaching on students, perceived impact of active teaching on patients and carers themselves, perceived opportunity to improve care of future patients, and challenges and suggestions for improvement. CONCLUSIONS: Overall, patients and carers had a positive view of their active involvement with delivering the undergraduate pharmacy curriculum; they were however unsure about involvement in curriculum design.

An innovative method of data analysis: Using art as a lens through which to view pharmacy undergraduate students' learning and assessment practices.

BACKGROUND: It has been argued in the literature that pharmacy is a unique integration of art and science. This paper addresses the art aspect of this and draws on the existence of multiple philosophies, theories and belief systems and describes the methodological process of use fine art (paintings) as a lens through which to view thematic data about a 'scientific' concept; a method which appears to be unique in the literature. OBJECTIVES: To explore pharmacy students' assessment practices and any influence on their learning practices. To explore how feedback influences pharmacy students' learning practices. To determine whether the affective dimension impacts on pharmacy students' learning. To evaluate whether fine can art be used as a lens to make sense of thematic data. METHODS: Data collection took the form of individual semi-structured interviews and was underpinned by an interpretivist qualitative approach. Analysis of data involved exploring the themes relating to assessment. Initially, thematic analysis of the data was carried out using an inductive approach and mind-mapping then Pierre Bonnard's art was used as a 'lens' through which to view the themes. RESULTS: Eighteen pharmacy students in one UK School of Pharmacy were interviewed. Themes relating to assessment practices which are discussed in this paper and compared to Pierre Bonnard's paintings are: conceptions of assessment (compared with Coffee), the impact of the nature of assessment on learning practices (compared with Dining Room in the Country), feedback (compared with Nude in a Mirror), strategies used in assessment practices (compared with The French Window), the affective dimension of assessment (compared with Red Roos at Le Cannet) and assessment constrains free-thinking (compared with The White Interior). CONCLUSIONS: Using Bonnard's art in analysis has provided an additional way of extending the analysis of participant's assessment practices. Aligning with Bonnard's technique of foregrounding the unexpected or diverting attention away from the obvious has allowed illumination of these practices and previously un-noticed aspects of pharmacy students' learning practices. There were a number of new insights gained from using this approach as well limitations. By attending to a different perspective that art brings, we have been able to see how assessment practices link to learning as pharmacy students.

Using the Community Readiness Model to select communities for a community-wide obesity prevention intervention.

To build on a growing interest in community-based obesity prevention programs, methods are needed for matching intervention strategies to local needs and assets. We used the Community Readiness Model (CRM), a structured interview guide and scoring system, to assess community readiness to act on childhood obesity prevention, furthering a replication study of a successful intervention. Using the CRM protocol, we conducted interviews with 4 stakeholders in each of 10 communities of similar size, socioeconomic status, and perceived readiness to implement a community-wide obesity prevention intervention. Communities were in California, Florida, Illinois, Massachusetts, New York, North Carolina, Pennsylvania, and Tennessee. The 4 stakeholders were the mayor or city manager, the school superintendent, the school food service director, and a community coalition representative. Interviews were recorded and professionally transcribed. Pairs of trained reviewers scored the transcriptions according to CRM protocol. The CRM assesses 9 stages of readiness for 6 dimensions: existing community efforts to prevent childhood obesity, community knowledge about the efforts, leadership, community climate, knowledge about the issue, and resources. We calculated an overall readiness score for each community from the dimension scores. Overall readiness scores ranged from 2.97 to 5.36 on the 9-point scale. The mean readiness score, 4.28 (SD, 0.68), corresponds with a "preplanning" level of readiness. Of the 6 dimensions, community climate varied the least (mean score, 3.11; SD, 0.64); leadership varied the most (mean score, 4.79; SD, 1.13). The CRM quantified a subjective concept, allowing for comparison among 10 communities. Dimension scores and qualitative data from interviews helped in the selection of 6 communities for a replication study.

Exploring survey participation, data combination, and research validity in a substance use study: an application of hierarchical linear modeling.

A sound decision regarding combination of datasets is critical for research validity. Data were collected between 1996 and 2000 via a 99-item survey of substance use behaviors. Two groups of 7th-12th grade students in predominately White communities are compared: 166,578 students from 193 communities with high survey participation and 41,259 students from 65 communities with lower participation. Hierarchical logistic models are used to explore whether the two datasets may be combined for further study of community-level substance use effects. "Scenario analysis" is introduced. Results suggest the datasets may reasonably be combined. Limitations and further research are discussed.

Using Artifacts and Qualitative Methodology to Explore Pharmacy Students' Learning Practices.

Objective. To explore the use of artifacts and material objects in accessing what learning means to pharmacy students, what their learning practices are, and their assumptions about what it means to master the pharmacy curriculum. Methods. Data collection was qualitative and took the form of individual semi-structured interviews with students in a Master of Pharmacy program. Participants were asked to select three artifacts (a photograph, an object, a song, a picture, or something else) that represented what learning as a pharmacy student meant to them and bring them to the interview. The interviews were conducted using both the abstracts and a semi-structured interview plan constructed as a mind map. Flexibility was applied to changing the sequence of themes, and additional probing questions were asked. Data were analyzed thematically using mind mapping and, subsequently, theoretical constructs were applied to make sense of the analysis. Results. Nineteen interviews were conducted. Findings were grouped into five distinct themes: study practices or strategies adopted, rituals associated with learning and studying, pharmacy knowledge, motivation for learning, and ways of learning. Each of these identified themes was summarized and illustrations from the data given. The affective dimensions of learning were a strong emergent theme throughout the data. Conclusion. The use of artifacts in the research process afforded in-depth insight into the specific study practices adopted by a group of pharmacy students. Qualitative methods can be useful in surfacing students' learning practices and difficulties faced in their negotiation of the pharmacy curriculum.

Individual and contextual effects of school adjustment on adolescent alcohol use.

This paper examines the effect of a student's own school adjustment as well as the contextual level of school adjustment (the normative level of school adjustment among students in a school) on students' self-reported use of alcohol. Using a dataset of 43,465 male and female 8th grade students from 349 schools across the contiguous United States who participated in a national study of substance use in rural communities between 1996 and 2000, multilevel latent covariate models were utilized to disentangle the individual-level and contextual effects of three school adjustment variables (i.e., school bonding, behavior at school, and friend's school bonding) on alcohol use. All three school adjustment factors were significant predictors of alcohol use both within and between schools. Furthermore, this study demonstrated a strong contextual effect: Students who attended schools where the overall level of school adjustment was higher reported lower levels of alcohol use even after taking their own school adjustment into account. The results demonstrate the importance of both a student's own level of school adjustment and the normative level of school adjustment among students in the school on an adolescent's use of alcohol. Differences in school adjustment across schools were quite strongly related to an adolescent's own alcohol use, indicating that school adjustment is an important aspect of school climate. Initiatives aimed at improving school climate may have beneficial effects on students' alcohol use.

A survey of the teaching and assessment of undergraduate psychiatry in the medical schools of the United Kingdom and Ireland.

BACKGROUND: Individual medical schools currently decide on the content and delivery of their undergraduate psychiatry curriculum, so there is probably significant variation in the students' experience of the speciality during the medical course and in the extent to which they develop the appropriate skills and knowledge base. AIM: To ascertain how the teaching of undergraduate psychiatry differs across UK and Irish medical schools. METHODS: The educational lead for psychiatry at each medical school in the United Kingdom and Ireland completed a questionnaire providing factual information on the teaching structure, contents and assessment methods in their current psychiatry curriculum. RESULTS: Some aspects of the curriculum were consistent across the medical schools with other areas showing great variability. The course content was broadly similar but the assessment, length of experience and course structure differed. CONCLUSION: There are significant differences in how psychiatry is taught to undergraduate students in the United Kingdom and Ireland and although all the curricula are evaluated by the General Medical Council, further study is required to see if this has any effect on the levels of competency achieved.

Current issues in undergraduate psychiatry education: the findings of a qualitative study.

BACKGROUND: Recruitment into psychiatry is correlated with the quality of undergraduate medical school teaching programmes and with a commitment of major resources to teaching students. There is an extensive literature related to attitudes towards psychiatry but less on the learning and teaching of psychiatry. AIMS: To identify the current issues in undergraduate psychiatric education in the UK for lead teachers at UK medical schools. METHOD: Semi-structured telephone interviews with psychiatric leads at UK medical schools. A total of 26 participants were interviewed from 23 different medical schools. RESULTS: Three key areas of problems were identified: issues related to teaching personnel (e.g. conflict of time), teaching resources and impact of teaching on recruitment (e.g. role models; stigma). Eight potential solutions to address the problems were identified and these included improving the quality of teaching, improving the perceived value of the discipline and recruiting teachers. CONCLUSION: There are several problems facing teachers in psychiatry but the teachers are also able to identify solutions which need support from both education and health if they are to be implemented.

Service user perspectives about their roles in undergraduate medical training about mental health.

BACKGROUND: Current policy states that 'service users and carers should be involved in planning, providing and evaluating training for all health care professionals. We wished to explore service users' views regarding undergraduate psychiatry. AIMS: We aimed to explore user perspectives on the specific role of service users in the delivery of teaching psychiatry. METHOD: The study design was qualitative and used focus groups. The study took place in a community context with one focus group in Leeds, Leicester, Lincoln and Nottingham. Four focus groups were run with a total of 28 participants (16 women and 12 men, all white). No exclusion criteria were applied. The lead of each group were contacted and they then recruited volunteers from their membership. RESULTS: The key findings were that participants felt that service users could play important roles in contextualising the part mental health plays in people's lives; dispel myths and fantasies about mental health; offer positive aspects of mental health to counterbalance the media; illustrate diversity within mental health and hope and recovery. Participants also identified the potential challenges to their participation including vulnerabilities especially at critical points in people's illnesses; perceived credibility - lack of support from some involved in academic roles; lack of appropriate training and support and issues of power and lack of genuine partnership in the planning and delivery of teaching. They were favourable about the development of guidelines as long as they involved a range of perspectives. CONCLUSIONS: Service users present a range of ways in which they could be involved to enhance the educational experience of medical students in psychiatry.

Community readiness to promote Latinas' participation in breast cancer prevention clinical trials.

The high breast cancer (BC) mortality rates that exist among Hispanic women (Latinas) are a health disparity burden that needs to be addressed. Prevention clinical trials are a burgeoning area of cancer prevention efforts and may serve to promote parity. Unfortunately, Latinas, along with other ethnic minority women, continue to be under-represented in this form of research. Previous studies have examined individual barriers to ethnic minorities' participation, but none have assessed community factors contributing to Latinas' under-representation in these studies. The present study addressed these limitations from a community perspective by exploring which factors might inhibit Latinas' participation in clinical trials, specifically BC prevention trials. Using the Community Readiness Model (CRM), 19 key informants were interviewed in four communities, two rural and two urban, in Colorado, USA. The key informant assessment involved a semistructured interview that measured the level of community readiness to encourage participation in BC prevention activities. The results reflected a community climate that did not recognise BC as a health problem that affected Latinas in participating communities. Compared to other healthcare priorities, participation in BC prevention clinical trials was considered a low priority in these communities. Overall, leadership and community resources were not identified or allocated to encourage the participation of Latinas. The results highlight the lack of awareness regarding clinical trials among both community members and leaders. According to the CRM, strategies to enhance awareness at multiple levels in the community are necessary. This study demonstrates how the CRM can be used to better understand a community's perspective on BC, and specifically, the under-representation of Latinas in clinical trials.

Prevalence of dating violence and victimization: regional and gender differences.

This report examines (1) the prevalence of dating violence victimization from a national sample of rural adolescents and (2) patterns by gender and region. Analyses are based on 20,274 adolescents who reported violence victimization using the Community Drug and Alcohol Survey. The relationship of dating violence with gender and region was assessed with HLM5 using Bernoulli's logistic regression. Approximately 16% of adolescents reported being a victim of dating violence. Females reported higher incidence of victimization than males. Dating violence is more prevalent in the South. While it is important to address the underlying values in society that may contribute to dating violence, it is equally productive to include regional and cultural values.

Inflammation and wound healing: the role of bacteria in the immuno-regulation of wound healing.

Wound healing is a sequence of complex events, an imbalance of which can result in a failure of the wound to heal, with significant implications for patients and health care services alike. Although the exact mechanism that underlies these events is not fully understood, inflammatory processes and the innate immune system play a vital role, not only in normal wound healing but also in the pathophysiology of delayed wound healing. These defense mechanisms are affected by underlying disease states and medical conditions, for example, diabetes, venous insufficiency, and the inflammation associated with acute trauma. Importantly, however, these processes are also modulated in health by bacteria within the wound. This article examines the role of the mediators of inflammation involved in the wound-healing process and discusses the function of these mediators when normal healing fails. The reaction of the wound to bacterial contamination and the effect of bacteria on wound healing are also discussed.

Community readiness: the journey to community healing.

Community readiness is a research-based theory that provides a basic understanding of the intervention process in communities. This theory allows us to accurately describe the developmental level of a community relative to a specific issue or problem. In order to move the community toward implementing and maintaining efforts that are effective and sustainable, community mobilization must be based on involvement of multiple systems and utilization of within-community resources and strengths. Successful local prevention and intervention efforts must be conceived from models that are community-specific, culturally relevant, and consistent with the level of readiness of the community to implement an intervention. The community readiness model is an innovative method for assessing the level of readiness of a community to develop and implement prevention programming. It can be used as both a research tool to assess distribution of levels of readiness across a group of communities or as a tool to guide prevention efforts at the individual level. This tool has proven useful in addressing a gamut of problems ranging from health and nutritional issues to environmental and social issues. The model identifies specific characteristics related to different levels of problem awareness and readiness for change.

Child mental health practitioners' knowledge and experiences of children's educational needs and services.

The improved joint working between child and adolescent mental health services (CAMHS) and schools is a policy priority. Although there have been a range of school-based initiatives and studies on teachers' awareness of mental health issues, there has been limited evidence on the training needs of CAMHS practitioners. The aim of this study was to explore how much CAMHS staff know about educational issues and how confident they feel working collaboratively with education colleagues. Ninety-six staff from four specialist CAMHS completed a questionnaire with 40 items on perceptions of knowledge, practice and attitudes towards educational issues and services, and three case vignettes. Despite the fact that participants reported frequent contact with children with education-related needs and with education services, they also highlighted concerns about their level of training and skills in this regard. Perceptions of knowledge and attitudes significantly predicted response to case vignettes. Previous training and experience were associated with knowledge, but did not predict case vignettes scores. The results suggest that training of CAMHS staff should be integral to all services in helping improve their understanding of school and education systems, improve clinical skills in detecting education-related mental health problems, and develop strategies in increasing joint working.

Use of ephedra among rural-dwelling U.S. adolescents.

Prior to 2004, ephedra had been readily available to adolescents. Due to reports that use of ephedra produced a number of serious adverse consequences, including death, sales of the compound became illegal in the United States on April 12, 2004. Data are presented from a random sample of 156,050 students in grades 7 through 12 from 185 rural communities across the United States who completed the Community Drug and Alcohol Survey. This study provides a valuable epidemiological benchmark of reported rates of lifetime prevalence of ephedra by adolescents living in rural America before the sale of the drug became illegal (data were collected between 1996 and 2001). While there were small regional, racial, and gender differences, rates of adolescent use were, in general, very low. The highest rates of ephedra use were found among youth using other drugs, particularly stimulants. The study's limitations and implications are discussed.

Disparities in Community Readiness for HIV/AIDS prevention.

HIV and AIDS as a community(1) issue have not been dealt with extensively in the literature. One model that offers promise for development of effective prevention and intervention efforts is the Community Readiness Model, a nine-stage model that assesses the level of readiness of a community to develop and implement prevention programming. Data are presented from a Community Readiness assessment of 30 rural U.S. communities: 10 African American, 10 Mexican American, and 10 White non-Mexican American. Four to five key respondent interviews were conducted via telephone in each community using the Community Readiness Assessment protocol during 1999-2000. Limitations of the study and implications for prevention are discussed. This study was funded by the National Institute on Drug Abuse.

Disparities in young adolescent inhalant use by rurality, gender, and ethnicity.

Inhalant use is of increasing concern as rates appear to be rising among young adolescents and gender differences narrowing. Data from 20,684 Mexican American and White non-Hispanic seventh- and eighth-grade males and females from the Western United States and 15,659 African American and White non-Hispanic seventh- and eighth-grade males and females from states in the southeastern United States collected via in-school surveys from 1996 to 2000 were analyzed using a variety of statistical techniques including multilevel modeling. Questions addressed in the study included: Does inhalant use vary by level of rurality? What effect does the ethnic composition of the community have on inhalant use and does this effect differ by an individual's ethnicity? Do males use more inhalants than females and does the level of use by males and females differ by individual ethnicity, ethnicity of the community, or level of rurality? Do males and females of different ethnicities initiate inhalant use at different ages? Limitations of the study and implications of findings for prevention are discussed and areas of future research are suggested. This study was funded by the National Institute on Drug Abuse.