Leveraging an Implementation Science Framework to Adapt and Scale a Patient Navigator Intervention to Improve Mammography Screening Outreach in a New Community.

Helping Her Live (HHL) is a community health worker-led outreach model that navigates women from vulnerable communities to mammography screening and diagnostic follow-up. The objective of this study was to evaluate HHL implementation on the southwest side of Chicago. HHL has been implemented on the west side of Chicago since 2008, where it has increased mammogram completion and diagnostic follow-up rates among Black and Hispanic women from resource poor communities. In 2014, HHL was translated to the southwest side of Chicago; implementation success was evaluated by comparing outreach, navigation request, and mammogram completion metrics with the west side. During January 2014-December 2015, outreach was less extensive in the southwest setting (SW) compared to the benchmark west setting (W); however, the proportion of women who completed mammograms in SW was 50%, which compared favorably to the proportion observed in the benchmark setting W (42%). The distribution of insurance status and the racial and ethnic makeup of individuals met on outreach in the W and SW were significantly different (p < 0.0005). This successful expansion of HHL in terms of both geographic and demographic reach justifies further studies leveraging these results and tailoring HHL to additional underserved communities.

HIV testing prevalence in selected Chicago community areas: the importance of local-level data.

While data on HIV testing prevalence is readily available at the national, state, and more rarely at the city level, few data are available on HIV testing at the community level, where public health initiatives may be most effectively implemented. Community-level data are necessary given that city, state, and national estimates mask variation occurring at the community level in large urban areas. This type of data is crucial for informing education efforts both within the community and among providers. The current study uses the Sinai Community Health Survey 2.0, a cross-sectional, population-based probability survey of adults in selected Chicago communities to determine the prevalence of ever tested for HIV by community area, sex, race/ethnicity, and age (n = 1496). Across the surveyed community areas, ever tested prevalence ranged from a low of 35% in Norwood Park (predominantly White) to a high of 85% in North Lawndale (predominantly Black). Ever tested differences by community area were statistically significant (Rao Scott chi-square p = 0.003). Across the sampled communities, 65% of females, 55% of males, 80% of Blacks, 62% of Puerto Ricans, 53% of Mexicans, and 44% of Whites had ever been tested for HIV (Rao Scott chi-square p < 0.01). Ever tested prevalence was highest in the 35-44 age group (72%) and lowest in the 65+ age group (33%) (Rao Scott chi-square p = 0.001). Local-level HIV screening data are integral to understanding where (geographically and among which sub-populations) additional services are needed and may also help in directing and securing funding for such services. The evidence suggests that success in identifying and linking HIV positive individuals to care is most likely to be found through a combination of healthcare- and non-healthcare-based initiatives. Ideally, efforts will be coordinated to encompass both of these settings.

Diagnosis and management of congenital hypothyroidism associated with pseudohypoparathyroidism.

UNLABELLED: Hypothyroidism is a particular condition observed in pseudohypoparathyroidism (PHP), a rare disorder characterized by parathyroid (PTH) resistance leading to hypocalcemia and hyperphosphatemia associated with a GNAS (guanine nucleotide-binding protein α-subunit) mutation (PHP1A) or epimutation (PHP1B). To determine the presence of hypothyroidism at birth we conducted a retrospective study in our cohort of patients presenting with either PHP1A (n = 116) or PHP1B (n = 99). We also investigated patients presenting at birth with congenital hypothyroidism (CH) and a eutopic thyroid gland for phosphocalcium abnormalities suggesting PTH resistance and PHP. Our study reveals CH as the earliest diagnostic clue for PHP1A, but not for PHP1B. We estimated the frequency of CH at birth to be between 8 and 34% in patients presenting with PHP1A. The elevation of phosphatemia and PTH concentration precedes hypocalcemia in PHP1A. Conversely, the frequency of PHP1A in patients presenting CH is dramatically low. This may be due to the low prevalence of PHP1A which remains unknown. CONCLUSIONS: Subclinical and overt hypothyroidism can occur in PHP1A patients at birth many years before PTH resistance becomes clinically apparent. Although such cases appear to be rare, some pediatric patients with unexplained CH are likely to benefit from measuring calcium, phosphorus, and PTH for extended periods of time.