Hepatitis C virus care cascade in persons experiencing homelessness in the United States in the era of direct-acting antiviral agents: A scoping review.

The hepatitis C virus (HCV) care cascade has been well characterized in the general United States population and other subpopulations since curative medications have been available. However, information is limited on care cascade outcomes in persons experiencing homelessness. The main objective of this study was to map the available evidence on HCV care cascade outcomes in people experiencing homelessness in the U.S. in the era of direct-acting antiviral agents (DAAs). Primary and secondary outcomes included linkage to care (evaluation by a provider that can treat HCV) and sustained virologic response (SVR) or cure. Exploratory outcomes included other cascade data, like treatment initiation, which precedes SVR. PubMed was the primary database accessed for this scoping review. We characterized the HCV care cascade in people experiencing homelessness using sources of evidence published in 2014 onwards that reported the proportions of persons who were linked to care, achieved SVR, and completed other cascade steps. We synthesized our results into a scoping review. The proportion of persons linked to care among chronically infected cohorts with unstable housing ranged from 29.3% to 88.7%. Among those chronically infected, 5%-58.8% were started on DAAs and 5%-50% achieved SVR. In conclusion, these results show that persons experiencing homelessness achieve high rates of linkage to care in non-specialist community-based settings compared to the general U.S. population pre-DAAs. However, DAA initiation was found to be a rate-limiting step along the care cascade, resulting in commensurate low rates of cure.

The Association Between Risk Behaviors and Vaping Among Youth in New Mexico.

CONTEXT: Electronic-cigarette use, or vaping, among youth has increased substantially in recent years. Tobacco smoking shows a strong association with other risk behaviors, but the association between vaping and other risk behaviors has rarely been explored. We examine the relationship between youth vaping and substance use, risky driving behaviors, and lack of bicycle helmet use. PROGRAM: Data from the 2015 and 2017 New Mexico Youth Risk and Resiliency Survey were analyzed to evaluate the association between the use of e-cigarettes and other youth risk behaviors. Study participants were high school students, grades 9 to 12. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). EVALUATION: A majority of students reported ever using e-cigarettes (54%). In 2015, e-cigarette users were more likely than nonusers to be Hispanic (65% vs 54%, P ≤ .001) and 16 years of age or older (58% vs 42%, P = .018). We found strong, statistically significant associations between e-cigarette use and not wearing a bicycle helmet (OR = 2.62, 95% CI: 1.95-3.51), texting while driving (OR = 2.18, 95% CI: 1.79-2.66), driving after drinking (OR = 2.95, 95% CI: 1.61-5.40), current marijuana use (OR = 6.38, 95% CI: 4.65-8.76), current painkiller use (OR = 2.47, 95% CI: 1.63-3.77), and current heroin use (OR = 0.15, 95% CI: 0.06-0.33). Driving after drinking was not significantly associated with e-cigarette use in 2017. DISCUSSION: E-cigarette use is associated with multiple other risk behaviors among youth. Further research should focus on environmental and policy efforts to reduce access to e-cigarettes by youth as well as interventions that address the underlying causes of the constellation of risk behaviors.

Association Between Self-Reported Dyspnea and Depressive Symptoms in New Mexico Uranium Workers.

New Mexico has the largest number of former uranium workers, mostly racial/ethnic minorities. Uranium workers are at risk for dyspnea secondary to mine dust exposure. The association between dyspnea and depressive symptoms has not been well examined in occupational minority cohorts. This study evaluated the associations between dyspnea (measured by the modified Medical Research Council Questionnaire) and depressive symptoms (measured by the Patient Health Questionnaire-2) in former uranium workers screened by the New Mexico Radiation Exposure Screening & Education Program. The subjects were mostly elderly, rural-residing, minority males. Dyspnea was commonly reported; however, depressive symptoms were uncommon. At baseline, former workers experiencing higher levels of dyspnea were more than 3 times likely to endorse depressive symptoms than those with no or mild dyspnea. Longitudinal analysis failed to determine an association between change in dyspnea and concomitant change in depressive symptoms. Dyspnea and depressive symptoms were associated cross-sectionally in former uranium workers.

Association between Spirometric Parameters and Depressive Symptoms in New Mexico Uranium Workers.

BACKGROUND: Uranium workers are at risk of developing lung disease, characterized by low forced expiratory volume in one second (FEV1) and/or forced vital capacity (FVC). Previous studies have found an association between decreased lung function and depressive symptoms in patients with pulmonary pathologies, but this association has not been well examined in occupational cohorts, especially uranium workers. METHODS: This cross-sectional study evaluated the association between spirometric measures and depressive symptoms in a sample of elderly former uranium workers screened by the New Mexico Radiation Exposure Screening & Education Program (NM-RESEP). Race- and ethnicity-specific reference equations were used to determine predicted spirometric indices (predictor variable). At least one depressive symptom [depressed mood and/or anhedonia, as determined by a modified Patient Health Questionnaire-2 (PHQ-2)], was the outcome variables. Chi-square tests and multivariable logistic regression models were used for statistical analyses. RESULTS: At least one depressive symptom was self-reported by 7.6% of uranium workers. Depressed mood was reported over twice as much as anhedonia (7.2% versus 3.3%). Abnormal FVC was associated with at least one depressive symptom after adjustment for covariates. There was no significant interaction between race/ethnicity and spirometric indices on depressive symptoms. CONCLUSIONS: Although depressive symptoms are uncommonly reported in uranium workers, they are an important comorbidity due to their overall clinical impact. Abnormal FVC was associated with depressive symptoms. Race/ethnicity was not found to be an effect modifier for the association between abnormal FVC and depressive symptoms. To better understand the mechanism underlying this association and determine if a causal relationship exists between spirometric indices and depressive symptoms in occupational populations at risk for developing lung disease, larger longitudinal studies are required. We recommend screening for depressive symptoms for current and former uranium workers as part of routine health surveillance of this occupational cohort. Such screening may help overcome workers' reluctance to self-report and seek treatment for depression and may avoid negative consequences to health and safety from missed diagnoses.

Uranium Workers Demonstrate Lower Lobe Predominant Irregular Pneumoconiotic Opacities on Chest Radiographs.

BACKGROUND: There is a paucity of literature on the chest radiographic findings in uranium workers. OBJECTIVE: To characterize the chest radiographic findings of pneumoconiosis in a New Mexican cohort of uranium workers. METHODS: The most recent results from chest radiographs were abstracted in this cross-sectional study. RESULTS: Radiographs showed small pneumoconiotic opacities of profusion score of ≥ 1/0 in 155/429 (36.1%) uranium workers. The most common shape/size of the primary and secondary opacities was s (90.3%) and t (83.7%) types, respectively. Lower lung zones were the most affected. American Indians were the population group at greatest odds for having profusion score ≥ 1/0 (O.R. 2.65, 95% C.I. 1.61, 4.36). CONCLUSIONS: Uranium workers' pneumoconiosis is associated with predominantly lower lobe, irregular, and small opacities. Clinical providers and policymakers must consider uranium workers' pneumoconiosis in the differential diagnosis for lower lobe-predominant interstitial lung disease, in the appropriate exposure setting.

Ultraviolet radiation exposure, vitamin D, and cancer.

This paper reviews briefly the evidence for an association between various measures of UV radiation (UVR) exposure and the development of cancer. Issues such as data quality, study design, measurement variation, comparability of studies, and quantification of UV exposure in relation to skin cancer are discussed. A range of exposure, based on skin type, might be appropriate: from 5 min a day three times a week for light-skinned individuals and 10 min a day three times a week for darker-skinned individuals. These exposures translate into 13 h per year, for a light-skinned individual, leading to 650 h of exposure from birth to age 50.

Assimilating Traditional Healing Into Preventive Medicine Residency Curriculum.

Comprehensive cultural competency includes knowledge and awareness of culturally based healing and wellness practices. Healthcare providers should be aware of the individual patient's beliefs, culture, and use of culturally based health practices because patients may adopt such practices for general wellness or as adjunct therapies without the benefit of discussion with their healthcare provider. This article describes the culturally based traditional healing curriculum that has been implemented in the University of New Mexico Public Health and General Preventive Medicine Residency Program in order to fulfill this knowledge necessity. Curricular elements were added in a stepwise manner starting in 2011, with the full content as described implemented starting in 2013. Data were collected annually with evaluation of the full curriculum occurring in 2015. New Mexico has a diverse population base that includes predominantly Hispanic and Native American cultures, making the inclusion of curriculum regarding traditional healing practices very pertinent. Residents at the University of New Mexico were educated through several curricular components about topics such as Curanderismo, the art of Mexican Folk Healing. An innovative approach was used, with a compendium of training methods that included learning directly from traditional healers and participation in healing practices. The incorporation of this residency curriculum resulted in a means to produce physicians well trained in approaching patient care and population health with knowledge of culturally based health practices in order to facilitate healthy patients and communities.

Clinical Informatics Board Specialty Certification for Physicians: A Global View.

Clinical informatics workforce development is a high priority for medicine. Professional board certification for physicians is an important tool to demonstrating excellence. The recent recognition of clinical informatics as a subspecialty board in the U.S. has generated interest and excitement among the U.S. informatics community. To determine the extent of similar programs in countries around the world, we performed literature searches with relevant keywords and internet searches of websites of informatics societies around the world for mentions or descriptions of certifications and reviewed publicly available sources. The U.S. certification was prominent in the recent published literature. Germany and Belgium have long-standing certifications with South Korea and Sri Lanka considering similar programs. This is the first global view of clinical informatics board certification for physicians. Training and certification for non-physician informatics professionals in allied areas are widespread. Official recognition and certification for physicians and all informatics professionals represents a key component of capacity building and a means of addressing the shortage of a skilled informatics workforce. Wider adoption of certification programs may further attracting talent and accelerate growth of the field.

Occupational injury mortality: New Mexico 1998-2002.

BACKGROUND: The current study characterizes patterns of occupational injury fatalities in New Mexico for the 5-year period 1998-2002. METHODS: The study applied methods developed by the Council of State and Territorial Epidemiologists/National Institute for Occupational Safety and Health (CSTE/NIOSH) Occupational Health Indicator Work Group and compared the relative strength and weakness of two different datasets (CFOI and NMVRHS) for occupational injury fatality surveillance. RESULTS: Annual occupational injury mortality rates ranged from 4.4 to 7.6 per 100,000 employed persons aged 16 and over compared to annual US rates of 4.0-4.6 per 100,000. Risk factors for higher mortality rates included age over 65 years, self-employment, non-US citizenship, being African-American or Hispanic, and occurrence in rural counties. The top industry for fatality rate was mining followed by transportation, public utilities, agriculture, and construction. CONCLUSIONS: Applying CSTE/NIOSH Occupational Health Indicator protocol and using both CFOI and NMVRHS data improved the characterization of occupational injury mortality and the setting of priorities for prevention intervention.