Social Factors Associated with Congenital Syphilis in Missouri.

BACKGROUND: Congenital syphilis disproportionately affects individuals impacted by adverse social determinants of health. Understanding these determinants may help facilitate holistic care. METHODS: We performed a retrospective review of mother-infant dyads with potential congenital syphilis in a Missouri hospital system. Cases were classified per Centers for Disease Control and Prevention clinical scenarios. Information was collected regarding demographics, prenatal care, substance use, and other social factors. Dyads with confirmed/highly probable or possible congenital syphilis ("congenital syphilis outcomes") were compared to those with less likely/unlikely congenital syphilis ("non-congenital syphilis outcomes") using descriptive statistics. RESULTS: We identified 131 dyads with infant dates of birth from 12/2015-6/2022: 74 (56%) with congenital syphilis outcomes and 56 (43%) with non-congenital syphilis outcomes. Most mothers were Black/African American (n = 84, 65%) and lived in areas with high Social Vulnerability Indices. Many had inadequate prenatal care (n = 61, 47%) and/or substance use histories (n = 55, 42%). Significant associations with congenital syphilis outcomes included limited prenatal care (OR 3.01, 95% CI 1.38-6.56), no prenatal care (OR 16.08, 95% CI 1.96-132.11), substance use (OR 3.42, 95% CI 1.61-7.25), housing instability (OR 3.42, 95% CI 1.39-8.38), and justice system interactions (OR 2.29, 95% CI 1.00-5.24). Substance use correlated with prenatal care adequacy (p < 0.001). 30% of infants with congenital syphilis outcomes were taken into protective custody. CONCLUSIONS: Adverse social determinants of health are common in dyads impacted by congenital syphilis. Health systems should consider interdisciplinary programming to improve testing and linkage to care. Future studies should evaluate social support for congenital syphilis prevention and management.

Brief Report: Substance Use Care Continuum in Women With and Without HIV in the Southern United States.

BACKGROUND: Substance use (SU) contributes to poor outcomes among persons living with HIV. Women living with HIV (WWH) in the United States are disproportionately affected in the South, and examining SU patterns, treatment, and HIV outcomes in this population is integral to addressing HIV and SU disparities. METHODS: WWH and comparable women without HIV (WWOH) who enrolled 2013-2015 in the Women's Interagency HIV Study Southern sites (Atlanta, Birmingham/Jackson, Chapel Hill, and Miami) and reported SU (self-reported nonmedical use of drugs) in the past year were included. SU and treatment were described annually from enrollment to the end of follow-up. HIV outcomes were compared by SU treatment engagement. RESULTS: At enrollment, among 840 women (608 WWH, 232 WWOH), 18% (n = 155) reported SU in the past year (16% WWH, 24% WWOH); 25% (n = 38) of whom reported SU treatment. Over time, 30%, 21%, and 18% reported SU treatment at 1, 2, and 3 years, respectively, which did not significantly differ by HIV status. Retention in HIV care did not differ by SU treatment. Viral suppression was significantly higher in women who reported SU treatment only at enrollment ( P = 0.03). CONCLUSIONS: We identified a substantial gap in SU treatment engagement, with only a quarter reporting treatment utilization, which persisted over time. SU treatment engagement was associated with viral suppression at enrollment but not at other time points or with retention in HIV care. These findings can identify gaps and guide future strategies for integrating HIV and SU care for WWH.

Leveraging CD4 Cell Count at Entry Into Care to Monitor Success of Human Immunodeficiency Virus Prevention, Treatment, and Public Health Programming in the Greater St Louis Area Between 2017 and 2020.

CD4 cell count at entry into human immunodeficiency virus (HIV) care is a useful indicator of success of multiple steps in HIV public health programming. We demonstrate that CD4 cell count at care initiation was stable in St Louis between 2017 and 2019 but declined in 2020. Missouri efforts in the Ending the HIV Epidemic plan should focus on rapidly identifying individuals with undiagnosed HIV infection.

State-level clustering in PrEP implementation factors among family planning clinics in the Southern United States.

Background: Availability of PrEP-providing clinics is low in the Southern U.S., a region at the center of the U.S. HIV epidemic with significant HIV disparities among minoritized populations, but little is known about state-level differences in PrEP implementation in the region. We explored state-level clustering of organizational constructs relevant to PrEP implementation in family planning (FP) clinics in the Southern U.S. Methods: We surveyed providers and administrators of FP clinics not providing PrEP in 18 Southern states (Feb-Jun 2018, N = 414 respondents from 224 clinics) on these constructs: readiness to implement PrEP, PrEP knowledge/attitudes, implementation climate, leadership engagement, and available resources. We analyzed each construct using linear mixed models. A principal component analysis identified six principal components, which were inputted into a K-means clustering analysis to examine state-level clustering. Results: Three clusters (C1-3) were identified with five, three, and four states, respectively. Canonical variable 1 separated C1 and C2 from C3 and was primarily driven by PrEP readiness, HIV-specific implementation climate, PrEP-specific leadership engagement, PrEP attitudes, PrEP knowledge, and general resource availability. Canonical variable 2 distinguished C2 from C1 and was primarily driven by PrEP-specific resource availability, PrEP attitudes, and general implementation climate. All C3 states had expanded Medicaid, compared to 1 C1 state (none in C2). Conclusion: Constructs relevant for PrEP implementation exhibited state-level clustering, suggesting that tailored strategies could be used by clustered states to improve PrEP provision in FP clinics. Medicaid expansion was a common feature of states within C3, which could explain the similarity of their implementation constructs. The role of Medicaid expansion and state-level policies on PrEP implementation warrants further exploration.

Substance Use Treatment Utilization Among Women With and Without Human Immunodeficiency Virus.

Background: Substance use (SU) contributes to poor health outcomes, yet limited data exist to inform strategies to optimize SU treatment among persons with human immunodeficiency virus (HIV). We describe SU and SU treatment utilization among women with and without HIV in the Women's Interagency HIV Study (WIHS). Methods: We included data from women enrolled in WIHS from 2013 to 2020. Current SU was self-reported, nonmedical use of drugs in the past year, excluding use of only marijuana. SU treatment utilization was self-reported use of a drug treatment program in the past year. Multivariable regression models were used to investigate associations between participant characteristics and SU treatment. Results: Among 2559 women (1802 women living with HIV [WWH], 757 women without HIV), 14% reported current SU. Among those with current SU (n = 367), 71% reported crack/cocaine followed by 40% reporting opioids, and 42% reported any treatment in the past year. The most common treatments were methadone (64%), Narcotics Anonymous (29%), inpatient programs (28%), and outpatient programs (16%). Among women using opioids (n = 147), 67% reported methadone use in the past year compared to 5% using buprenorphine/naloxone. Multivariable analysis showed lower odds of treatment utilization among WWH with concurrent alcohol or marijuana use. Visiting a psychiatrist/counselor was associated with higher odds of treatment. Among WWH, SU treatment was not associated with HIV-related clinical outcomes. Conclusions: Treatment utilization was high, especially for methadone use. Our results highlight opportunities for accessing SU treatment for WWH, such as the need to prioritize buprenorphine and comprehensive, wraparound services in HIV care settings.

Human Immunodeficiency Virus Pre-Exposure Prophylaxis Knowledge, Attitudes, and Self-Efficacy Among Family Planning Providers in the Southern United States: Bridging the Gap in Provider Training.

Background: Pre-exposure prophylaxis (PrEP) is an effective human immunodeficiency virus (HIV) prevention intervention, but its access and use are suboptimal, especially for women. Healthcare providers provision of PrEP is a key component of the Ending the HIV Epidemic initiative. Although training gaps are an identified barrier, evidence is lacking regarding how to tailor trainings for successful implementation. Title X family planning clinics deliver safety net care for women and are potential PrEP delivery sites. To inform provider training, we assessed PrEP knowledge, attitudes, and self-efficacy in the steps of PrEP care among Title X providers in the Southern United States. Methods: We used data from providers in clinics that did not currently provide PrEP from a web-based survey administered to Title X clinic staff in 18 Southern states from February to June 2018. We developed generalized linear mixed models to evaluate associations between provider-, clinic-, and county-level variables with provider knowledge, attitudes, and self-efficacy in PrEP care, guided by the Consolidated Framework for Implementation Research. Results: Among 351 providers from 193 clinics, 194 (55%) were nonprescribing and 157 (45%) were prescribing providers. Provider ability to prescribe medications was significantly associated PrEP knowledge, attitudes, and self-efficacy. Self-efficacy was lowest in the PrEP initiation step of PrEP care and was positively associated with PrEP attitudes, PrEP knowledge, and contraception self-efficacy. Conclusions: Our findings suggest that PrEP training gaps for family planning providers may be bridged by addressing unfavorable PrEP attitudes, integrating PrEP and contraception training, tailoring training by prescribing ability, and focusing on the initiation steps of PrEP care.

Brucellosis Initially Misidentified as Ochrobactrum anthropi Bacteremia: A Case Report and Review of the Literature.

Automated identification systems may misidentify Brucella, the causative agent of brucellosis, which may be re-emerging in the United States as the result of an expanding feral swine population. We present a case of Brucella suis likely associated with feral swine exposure that was misidentified as Ochrobactrum anthropi, a phylogenetic relative.

Prolonged Symptoms After COVID-19 Infection in Outpatients.

We review 127 encounters for polymerase chain reaction-confirmed coronavirus disease 2019 (COVID-19) infection at a multidisciplinary outpatient clinic. We describe the symptomatology, time course, exam, and radiographic findings in this population. Patients with COVID-19 can experience persistent symptoms, primarily respiratory in nature, which can be severe enough to warrant hospitalization.

How Far We've Come, How Far We Have to Go: a Review of Advances in Antimicrobial Stewardship in the Veterans Health Administration.

PURPOSE OF REVIEW: This review highlights several of the successes in antimicrobial stewardship seen in the largest integrated healthcare system in the USA, the Veterans Health Administration. RECENT FINDINGS: Since deploying antimicrobial stewardship programs on a national scale in the Veterans Health Administration, decreases in overall antimicrobial use and Clostridioides difficile infections have been observed. Concurrent infection prevention initiatives have also contributed to these improvements in the Veterans Health Administration. SUMMARY: By embracing multidisciplinary stewardship teams, focusing on education and research in the field of antimicrobial stewardship, and leveraging the vast data available within the national system, the Veterans Health Administration has made substantial advances in antimicrobial stewardship.

When perception is reality: Resident perception of faculty gender parity in a university-based internal medicine residency program.

INTRODUCTION: Although women have entered medical school and internal medicine residency programs in significant numbers for decades, women faculty remain underrepresented in senior and departmental leadership roles. How residents perceive this gender disparity is unknown. We sought to assess resident perception of gender parity among departmental leadership and teaching faculty in our internal medicine department, and to determine the actual gender distribution of those faculty roles. METHODS: An anonymous cross-sectional survey was distributed to evaluate resident perception of gender representation of various faculty roles. Using conference schedules, resident evaluations, and our department website, we determined the actual representation of women faculty in department leadership roles, and in clinical and educational activities. RESULTS: 88 of 164 residents (54%) responded. Women residents were less likely than men to perceive that women faculty were equally represented in department leadership (45% men agreed vs. 13% women, p < 0.05), clinical teaching roles (55% men agreed vs. 28% women, p < 0.05), or facilitating educational conferences (45% men agreed vs. 28% women, p = 0.074). In 2017, the internal medicine department at our institution comprised 815 faculty members, 473 men (58%) and 342 women (42%). At that time, women faculty held 5% of senior departmental leadership positions and 21% of educational leadership positions. During the year preceding survey distribution, women faculty attended on internal medicine inpatient wards for 33% of the total number of weeks, staffed 20% of morning reports, and facilitated 28% of noon conferences. DISCUSSION: Women residents in our internal medicine training program perceived a gender disparity among faculty in leadership and educational positions to a greater extent than male residents. The perception of women trainees was accurate. In addition to disproportionate underrepresentation in leadership positions, women faculty were underrepresented in prominent educational positions, including attending on inpatient services and serving as discussants at educational conferences.

Women's participation in the medical profession: insights from experiences in Japan, Scandinavia, Russia, and Eastern Europe.

Although much literature has focused on the status of female physicians in the United States, limited English-language studies have examined the role of women in the medical profession elsewhere in the world. This article synthesizes evidence regarding the status of female physicians in three purposively selected regions outside the United States: Japan, Scandinavia, and Russia and Eastern Europe. These three regions markedly differ in the proportion of female physicians in the workforce, overall status of the medical profession, cultural views of gender roles, and workforce policies. Through a review of studies and articles published between 1992 and 2012 examining women's representation, status measures such as salary and leadership positions, and experiences of female physicians, the authors discuss potential relationships between the representation of female physicians, their status in medicine, and the overall status of the profession. The findings suggest that even when women constitute a high proportion of the physician workforce, they may continue to be underrepresented in positions of leadership and prestige. Evolving workforce policies, environments, and cultural views of gender roles appear to play a critical role in mediating the relationship between women's participation in the medical profession and their ability to rise to positions of influence within it. These insights are informative for the ongoing debates over the impact of the demographic shifts in the composition of the medical workforce in the United States.

Embodying recovery: a qualitative study of peer work in a consumer-run service setting.

The use of peer support for persons with mental illness has been gaining force. While research has demonstrated the benefits of peer support, few studies have investigated the qualitative characteristics of how peer support aids persons recovering from mental illness. Therefore, this study sought to clarify the characteristics that constitute peer support and its contribution to recovery. We conducted ethnographic fieldwork and semi-structured interviews with nine peer advocates at a consumer-run organization in New York City, and identified three themes that describe how peer support influences recovery: transforming experience into expertise, understanding the mechanics of peer support, and launching peers towards their own recovery. Peer support plays a critical role in helping clients move beyond their patient role to an empowered sense of personhood. Additionally, the value of peer support highlights current deficiencies within the mental health system and how a bolder shift towards recovery might repair them.

Adverse effects of citrate/gold nanoparticles on human dermal fibroblasts.

Nanoscale engineering is one of the most dynamically growing areas at the interface between electronics, physics, biology, and medicine. As there are no safety regulations yet, concerns about future health problems are rising. We investigated the effects of citrate/gold nanoparticles at different concentrations and exposure times on human dermal fibroblasts. We found that, as a result of intracellular nanoparticle presence, actin stress fibers disappeared, thereby inducing major adverse effects on cell viability. Thus, properties such as cell spreading and adhesion, cell growth, and protein synthesis to form the extracellular matrix were altered dramatically. These results suggest that the internal cell activities have been damaged.