Addressing food insecurity in rural primary care: a mixed-methods evaluation of barriers and facilitators.

BACKGROUND: Food insecurity (FI) is associated with negative health outcomes and increased healthcare utilization. Rural populations face increased rates of FI and encounter additional barriers to achieving food security. We sought to identify barriers and facilitators to screening and interventions for FI in rural primary care practices. METHODS: We conducted a mixed-methods study using surveys and semi-structured interviews of providers and staff members from rural primary care practices in northern New England. Survey data were analyzed descriptively, and thematic analysis was used to identify salient interview themes. RESULTS: Participants from 24 rural practices completed the survey, and 13 subsequently completed an interview. Most survey respondents (54%) reported their practices systematically screen for FI and 71% reported food needs were "very important" for their patients and communities. Time and resource constraints were the most frequently cited barriers to screening for and addressing FI in practices based on survey results. Interview themes were categorized by screening and intervention procedures, community factors, patient factors, external factors, practice factors, process and implementation factors, and impact of FI screening and interventions. Time and resource constraints were a major theme in interviews, and factors attributed to rural practice settings included geographically large service areas, stigma from loss of privacy in small communities, and availability of food resources through farming. CONCLUSIONS: Rural primary care practices placed a high value on addressing food needs but faced a variety of barriers to implementing and sustaining FI screening and interventions. Strategies that utilize practice strengths and address time and resource constraints, stigma, and large service areas could promote the adoption of novel interventions to address FI.

The Scope of Multimorbidity in Family Medicine: Identifying Age Patterns Across the Lifespan.

INTRODUCTION: Multimorbidity rates are both increasing in prevalence across age ranges, and also increasing in diagnostic importance within and outside the family medicine clinic. Here we aim to describe the course of multimorbidity across the lifespan. METHODS: This was a retrospective cohort study across 211,953 patients from a large northeastern health care system. Past medical histories were collected in the form of ICD-10 diagnostic codes. Rates of multimorbidity were calculated from comorbid diagnoses defined from the ICD10 codes identified in the past medical histories. RESULTS: We identify 4 main age groups of diagnosis and multimorbidity. Ages 0 to 10 contain diagnoses which are infectious or respiratory, whereas ages 10 to 40 are related to mental health. From ages 40 to 70 there is an emergence of alcohol use disorders and cardiometabolic disorders. And ages 70 to 90 are predominantly long-term sequelae of the most common cardiometabolic disorders. The mortality of the whole population over the study period was 5.7%, whereas the multimorbidity with the highest mortality across the study period was Circulatory Disorders-Circulatory Disorders at 23.1%. CONCLUSION: The results from this study provide a comparison for the presence of multimorbidity within age cohorts longitudinally across the population. These patterns of comorbidity can assist in the allocation to practice resources that will best support the common conditions that patients need assistance with, especially as the patients transition between pediatric, adult, and geriatric care. Future work examining and comparing multimorbidity indices is warranted.

Hurricanes pose a substantial risk to New England forest carbon stocks.

Nature-based climate solutions (NCS) are championed as a primary tool to mitigate climate change, especially in forested regions capable of storing and sequestering vast amounts of carbon. New England is one of the most heavily forested regions in the United States (>75% forested by land area), and forest carbon is a significant component of climate mitigation policies. Large infrequent disturbances, such as hurricanes, are a major source of uncertainty and risk for policies relying on forest carbon for climate mitigation, especially as climate change is projected to alter the intensity and extent of hurricanes. To date, most research into disturbance impacts on forest carbon stocks has focused on fire. Here, we show that a single hurricane in the region can down between 121 and 250 MMTCO2e or 4.6%-9.4% of the total aboveground forest carbon, much greater than the carbon sequestered annually by New England's forests (16 MMTCO2e year-1). However, emissions from hurricanes are not instantaneous; it takes approximately 19 years for downed carbon to become a net emission and 100 years for 90% of the downed carbon to be emitted. Reconstructing hurricanes with the HURRECON and EXPOS models across a range of historical and projected wind speeds, we find that an 8% and 16% increase in hurricane wind speeds leads to a 10.7- and 24.8-fold increase in the extent of high-severity damaged areas (widespread tree mortality). Increased wind speed also leads to unprecedented geographical shifts in damage, both inland and northward, into heavily forested regions traditionally less affected by hurricanes. Given that a single hurricane can emit the equivalent of 10+ years of carbon sequestered by forests in New England, the status of these forests as a durable carbon sink is uncertain. Understanding the risks to forest carbon stocks from disturbances is necessary for decision-makers relying on forests as a NCS.

Experiences of Stigma and Discrimination Compounded by Intersecting Identities among Individuals Receiving Medication for Opioid Use Disorder.

Stigma and discrimination create barriers to care among people receiving medication for opioid use disorder (MOUD). We report qualitative findings from a mixed methods study guided by three aims: to explore (1) intersecting identities of people receiving MOUD (2) how individuals experience stigma and discrimination and (3) helpful resources in addressing cumulative experiences of multiple forms of disadvantage. We conducted interviews with 25 individuals in three treatment centers in the Northeast United States and identified six themes: (1) Living with multiple socially marginalized identities and addiction; (2) Loss; (3) "It's everywhere": Discrimination and stigma; (4) A "damaged" identity, (5) Positive responses to negative experiences: Facing reality and becoming accountable, and (6) Experiencing treatment and identifying supportive interventions. Findings highlight the complexity of intersecting, marginalized social positions. Future work should look beyond one-size-fits-all approaches to care and recognize individual vulnerabilities and strengths for improving outcomes among those experiencing OUD.

A profile of urban agricultural growers, organizations, their needs, and challenges in the Northeastern United States.

Urban agriculture is increasingly valued as a strategy for improving quality of life in cities, but urban growers face challenges and often lack coordinated support from governments and the agricultural industry. We surveyed urban growers through an online survey, primarily in the Northeastern United States, to develop a profile of growers and associated organizations, assess the current state of urban agriculture, and determine how universities could help meet their needs. A total of 394 respondents completed the survey and most urban growers were white (non-Hispanic) and younger than 45 years old. Women and men were in almost equal proportion. Urban growers were well-educated, but most did not receive a degree in agriculture. Urban agriculture in our study area was dominated by relatively small non-profit organizations and home and community gardens were the most common types of organizations. Urban agricultural organizations want to improve environmental sustainability and socio-cultural conditions through food access and security, regardless of their tax status. Urban growers face diverse barriers and challenges and the most ubiquitous barriers and challenges reported by respondents were related to availability of land and long-term access in urban areas. Many respondents received low revenue or were operating at a net loss even though they reported diverse income streams. Respondents need a wide range of training, including in traditional agricultural topics as well as financial management and business trainings. Universities can play a key role in promoting urban agriculture by offering training and research. Workforce development is a large priority among universities, so urban growers should regularly be consulted, and the results shared with career and workforce development professionals and researchers in urban areas to identify training and research that meets the needs of stakeholders.

Breastfeeding Attitudes and Social Support Among Christian African Americans.

Purpose: To describe the breastfeeding attitudes and subjective norms of breastfeeding among African American Christians from the New England region. Study Design and Methods: A study was conducted using an online survey. Participants were recruited from four Christian churches in the New England region during the summer of 2021. Responses from direct questions about exclusive breastfeeding histories were tabulated. Open-ended question responses were analyzed using thematic analysis. Two results were merged to make the conclusions. Results: Participants (n = 101) aged 18-44 years (62.3%), college graduates (72.3%), and Catholics (71.4%) responded. Participants were willing to recommend six months of exclusive breastfeeding practice to relatives (89.9%) and friends/peers (87.9%) and support relatives (94.0%) and friends/peers (94.8%) to practice exclusive breastfeeding for 6 months. Breastfeeding attitude themes included beneficial and natural and receiving breastfeeding support. Subjective norms of breastfeeding themes included receiving support for breastfeeding; Christian leadership, teachings, and communal engagements; and gaps in Christian influence. Conclusion: The African American Christian community may be an emergent agent of breastfeeding social support for African American Christian women who chose to breastfeed. Health professionals should collaborate with African American Christian leadership to initiate programs to promote breastfeeding among African American Christian women in the United States.

What impact has the Centre of Research Excellence in Digestive Health made in the field of gastrointestinal health in Australia and internationally? Study protocol for impact evaluation using the FAIT framework.

INTRODUCTION: The need for public research funding to be more accountable and demonstrate impact beyond typical academic outputs is increasing. This is particularly challenging and the science behind this form of research is in its infancy when applied to collaborative research funding such as that provided by the Australian National Health and Medical Research Council to the Centre for Research Excellence in Digestive Health (CRE-DH). METHODS AND ANALYSIS: In this paper, we describe the protocol for applying the Framework to Assess the Impact from Translational health research to the CRE-DH. The study design involves a five-stage sequential mixed-method approach. In phase I, we developed an impact programme logic model to map the pathway to impact and establish key domains of benefit such as knowledge advancement, capacity building, clinical implementation, policy and legislation, community and economic impacts. In phase 2, we have identified and selected appropriate, measurable and timely impact indicators for each of these domains and established a data plan to capture the necessary data. Phase 3 will develop a model for cost-consequence analysis and identification of relevant data for microcosting and valuation of consequences. In phase 4, we will determine selected case studies to include in the narrative whereas phase 5 involves collation, data analysis and completion of the reporting of impact.We expect this impact evaluation to comprehensively describe the contribution of the CRE-DH for intentional activity over the CRE-DH lifespan and beyond to improve outcomes for people suffering with chronic and debilitating digestive disorders. ETHICS AND DISSEMINATION: This impact evaluation study has been registered with the Hunter New England Human Research Ethics Committee as project 2024/PID00336 and ethics application 2024/ETH00290. Results of this study will be disseminated via medical conferences, peer-reviewed publications, policy submissions, direct communication with relevant stakeholders, media and social media channels such as X (formely Twitter).

Prevalence of Powassan Virus Seropositivity Among People with History of Lyme Disease and Non-Lyme Community Controls in the Northeastern United States.

Introduction: Lyme disease (LD) affects ∼476,000 people each year in the United States. Symptoms are variable and include rash and flu-like symptoms. Reasons for the wide variation in disease outcomes are unknown. Powassan virus (POWV) is a tick-borne flavivirus that causes disease ranging from asymptomatic infection to encephalitis, neurologic damage, and death. POWV and LD geographic case distributions overlap, with Ixodes species ticks as the common vectors. Clinical ramifications of coinfection or sequential infection are unknown. Objectives: This study's primary objective was to determine the prevalence of POWV-reactive antibodies in sera samples collected from previously studied cohorts of individuals with self-reported LD history residing in the Northeastern United States. As a secondary objective, we studied clinical differences between people with self-reported LD history and low versus high POWV antibody levels. Methods: We used an enzyme-linked immunosorbent assay (ELISA) to quantify IgG directed at the POWV envelope (E) protein domain III in 538 samples from individuals with self-reported LD history and 16 community controls. The samples were also tested with an ELISA assay to quantify IgG directed at the POWV NS1 protein. Results: The percentage of individuals with LD history and possible evidence of POWV exposure varied depending on the assay utilized. We found no significant difference in clinical symptoms between those with low or high POWV IgG levels in the in-house assay. Congruence of the EDIII and NS1 assays was low with only 12% of those positive in the in-house EDIII ELISA testing positive in the POWV NS1 ELISA. Conclusions: The results highlight the difficulty in flavivirus diagnostic testing, particularly in the retrospective detection of flavivirus exposure. The findings suggest that a prospective study with symptomatic patients using approved clinical testing is necessary to address the incidence and clinical implications of LD and POWV co-infection or sequential infection.

Evidence-Based Storytelling for a Strategic Roadmap to Promote Cancer Prevention via Adolescent HPV Vaccination in Northern New England.

Vaccination rates for the human papillomavirus (HPV) among rural youth in northern New England lag those of more urbanized areas. Reasons include a lack of available medical offices, time constraints, perceptions of vaccines and HPV, and, to a smaller degree, delays caused by the COVID-19 pandemic. We have a responsibility to increase vaccinations in these communities. To do so, vaccination experts recommend addressing the three C's of vaccination hesitation: confidence, complacency, and convenience. With this framework as our foundation, in this article we detail a plan to address these important elements, and we add several more C's: clinics, communication, collaboration, community, capacity, and commitment to the list as we discuss the essential pieces-human, infrastructural, and perceptual-needed to create and promote successful, community-supported, school-based HPV vaccination clinics to serve youths aged nine to 18. We then integrate research and storytelling science into an innovative Persuasion Playbook, a guide for local opinion leaders to use in creating evidence-based, pro-vaccine messages on the community level to promote the clinics via evidence-based, pro-vaccination messages.

Using monitoring and mechanistic modeling to improve understanding of eutrophication in a shallow New England estuary.

Anthropogenic nutrient loading has resulted in eutrophication and habitat degradation within estuaries. Study of eutrophication in estuaries has often focused on larger systems, while there has been increasing interest in understanding the governing processes in smaller systems. In this study, we incorporate both monitoring data and mechanistic modeling to improve our understanding of eutrophication in a small, shallow New England estuary. High-frequency continuous and discrete water quality samples were collected from 2018 to 2020 along a salinity gradient and at varying depth to provide temporal and spatial resolution of the system. Conditions of this estuary were simulated using the Hydrological Simulation Program - FORTRAN (HSPF) and the Water Quality Analysis Simulation Program (WASP) to develop a mechanistic, numerical fate and transport model. Our findings suggest complex hydrodynamics with three distinct salinity gradients and variability in salinity concentration upstream. Simulated and observed nutrient trends demonstrated decreasing total nitrogen concentration moving downstream and low total phosphorus concentration throughout the system. Simulated nutrient depletion and shading via macroalgae suggest their importance in similar modeling initiatives. Dynamic spatiotemporal variability in dissolved oxygen concentrations ([DO]) resulted from hydrodynamic and ecological processes such as large, rapid swings in phytoplankton. Carbonaceous biological oxygen demand was suggested to be the driver of hypoxia in surface waters, while sediment oxygen demand may drive low [DO] in the stratified, benthic waters. These findings suggest that the coordination of monitoring and modeling was important to understanding the governing mechanisms of eutrophication and hypoxia. Insights from this study could be used to support regional management strategies to increase [DO], improve water clarity, and recover indigenous seagrass beds. This work has the potential to inform future study and management of small, complex estuaries.

Urinary mutagenicity and bladder cancer risk in northern New England.

The etiology of bladder cancer among never smokers without occupational or environmental exposure to established urothelial carcinogens remains unclear. Urinary mutagenicity is an integrative measure that reflects recent exposure to genotoxic agents. Here, we investigated its potential association with bladder cancer in rural northern New England. We analyzed 156 bladder cancer cases and 247 cancer-free controls from a large population-based case-control study conducted in Maine, New Hampshire, and Vermont. Overnight urine samples were deconjugated enzymatically and the extracted organics were assessed for mutagenicity using the plate-incorporation Ames assay with the Salmonella frameshift strain YG1041 + S9. Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) of bladder cancer in relation to having mutagenic versus nonmutagenic urine, adjusted for age, sex, and state, and stratified by smoking status (never, former, and current). We found evidence for an association between having mutagenic urine and increased bladder cancer risk among never smokers (OR = 3.8, 95% CI: 1.3-11.2) but not among former or current smokers. Risk could not be estimated among current smokers because nearly all cases and controls had mutagenic urine. Urinary mutagenicity among never-smoking controls could not be explained by recent exposure to established occupational and environmental mutagenic bladder carcinogens evaluated in our study. Our findings suggest that among never smokers, urinary mutagenicity potentially reflects genotoxic exposure profiles relevant to bladder carcinogenesis. Future studies are needed to replicate our findings and identify compounds and their sources that influence bladder cancer risk.

Examining sexual minority engagement in recovery community centers.

INTRODUCTION: Research indicates that sexual minority (SM) individuals with alcohol and other drug use disorders may underutilize recovery resources generally but be more likely to use recovery community centers (RCCs). To inform recovery supports, this study characterized SM and heterosexual RCC members by demographics and clinical and recovery support service utilization. METHODS: Cross-sectional secondary analyses compared SM and heterosexual RCC members in the northeastern U.S. (n = 337). Qualitative analyses coded the top three recovery facilitators. RESULTS: Of the 337 participants (Meanage[SD] = 40.98[12.38], 51.8 % female), SM RCC members were more likely than heterosexuals to endorse lifetime psychiatric diagnoses and emergency department mental health treatment (p < .01). RCC service utilization and qualitatively derived recovery facilitators were mostly consistent across groups. CONCLUSIONS: RCCs engaged SM individuals in recovery in ways consistent with heterosexuals. Despite otherwise vastly similar demographic characteristics across sexual identity, findings suggest a need for additional mental health resources for SM individuals in recovery.

The Northern New England Rapid Deployment Valve Experience: Survival and Procedural Outcomes From 2015 to 2021.

OBJECTIVE: The optimal approach and choice of initial aortic valve replacement (AVR) is evolving in the growing era of transcatheter AVR. Further survival and hemodynamic data are needed to compare the emerging role of rapid deployment (rdAVR) versus stented (sAVR) valve options for AVR. METHODS: The Northern New England Cardiovascular Database was queried for patients undergoing either isolated AVR or AVR + coronary artery bypass grafting (CABG) with rdAVR or sAVR aortic valves between 2015 and 2021. Exclusion criteria included endocarditis, mechanical valves, dissection, emergency case status, and prior sternotomy. This resulted in a cohort including 1,616 sAVR and 538 rdAVR cases. After propensity weighting, procedural characteristics, hemodynamic variables, and survival outcomes were examined. RESULTS: The breakdown of the overall cohort (2,154) included 1,164 isolated AVR (222 rdAVR, 942 sAVR) and 990 AVR + CABG (316 rdAVR, 674 sAVR). After inverse propensity weighting, cohorts were well matched, notable only for more patients <50 years in the sAVR group (4.0% vs 1.9%, standardized mean difference [SMD] = -0.12). Cross-clamp (89 vs 64 min, SMD = -0.71) and cardiopulmonary bypass (121 vs 91 min, SMD = -0.68) times were considerably longer for sAVR versus rdAVR. Immediate postreplacement aortic gradient decreased with larger valve size but did not differ significantly between comparable sAVR and rdAVR valve sizes or overall (6.5 vs 6.7 mm Hg, SMD = 0.09). Implanted rdAVR tended to be larger with 51% either size L or XL versus 37.4% of sAVR ≥25 mm. Despite a temporal decrease in pacemaker rate within the rdAVR cohort, the overall pacemaker frequency was less in sAVR versus rdAVR (4.4% vs 7.4%, SMD = 0.12), and significantly higher rates were seen in size L (10.3% vs 3.7%, P < 0.002) and XL (15% vs 5.6%, P < 0.004) rdAVR versus sAVR. No significant difference in major adverse cardiac events (4.6% vs 4.6%, SMD = 0.01), 30-day survival (1.5% vs 2.6%, SMD = 0.08), or long-term survival out to 4 years were seen between sAVR and rdAVR. CONCLUSIONS: Rapid deployment valves offer a safe alternative to sAVR with significantly decreased cross-clamp and cardiopulmonary bypass times. Despite larger implantation sizes, we did not appreciate a comparative difference in immediate postoperative gradients, and although pacemaker rates are improving, they remain higher in rdAVR compared with sAVR. Longer-term hemodynamic and survival follow-up are needed.

Excess natural-cause mortality in US counties and its association with reported COVID-19 deaths.

In the United States, estimates of excess deaths attributable to the COVID-19 pandemic have consistently surpassed reported COVID-19 death counts. Excess deaths reported to non-COVID-19 natural causes may represent unrecognized COVID-19 deaths, deaths caused by pandemic health care interruptions, and/or deaths from the pandemic's socioeconomic impacts. The geographic and temporal distribution of these deaths may help to evaluate which explanation is most plausible. We developed a Bayesian hierarchical model to produce monthly estimates of excess natural-cause mortality for US counties over the first 30 mo of the pandemic. From March 2020 through August 2022, 1,194,610 excess natural-cause deaths occurred nationally [90% PI (Posterior Interval): 1,046,000 to 1,340,204]. A total of 162,886 of these excess natural-cause deaths (90% PI: 14,276 to 308,480) were not reported to COVID-19. Overall, 15.8 excess deaths were reported to non-COVID-19 natural causes for every 100 reported COVID-19 deaths. This number was greater in nonmetropolitan counties (36.0 deaths), the West (Rocky Mountain states: 31.6 deaths; Pacific states: 25.5 deaths), and the South (East South Central states: 26.0 deaths; South Atlantic states: 25.0 deaths; West South Central states: 24.2 deaths). In contrast, reported COVID-19 death counts surpassed estimates of excess natural-cause deaths in metropolitan counties in the New England and Middle Atlantic states. Increases in reported COVID-19 deaths correlated temporally with increases in excess deaths reported to non-COVID-19 natural causes in the same and/or prior month. This suggests that many excess deaths reported to non-COVID-19 natural causes during the first 30 mo of the pandemic in the United States were unrecognized COVID-19 deaths.

"At the End of the Day it's Their choice": An Exploratory Qualitative Study of Pregnancy Options Counseling.

This study's purpose was to explore the current models and approaches of pregnancy options counseling across three types of agency settings in a Northeastern state. Additionally, this study aimed to determine if individuals who receive pregnancy options counseling obtained medically factual, non-directive, and non-biased information needed to make informed decisions related to their pregnancy decisions. Using qualitative research methodology, semi-structured interviews were conducted with 10 participants across three different agency settings in one state in the Northeastern United States. Results indicated agencies shared a definition of pregnancy options counseling. Outcomes also suggest agency type impacted how pregnancy options counseling was delivered, as variations were found in education provided to patients. Lastly, the interviews imply no standardized model or training for pregnancy options counselors is currently being used.

Emergence of Thelaziosis Caused by Thelazia callipaeda in Dogs and Cats, United States.

We report 2 autochthonous feline thelaziosis cases caused by the eyeworm Thelazia callipaeda and discuss the spread among dogs in the northeastern United States. Phylogenetic analysis suggests the parasite was introduced from Europe. Adopting a One Health approach is needed to limit further spread of T. callipaeda eyeworms in North America.

Preoperative Communication Between Anesthesia, Surgery, and Primary Care Providers for Older Surgical Patients.

BACKGROUND: Suboptimal communication between clinicians remains a frequent driver of preventable adverse health care-related events, increased costs, and patient and physician dissatisfaction. METHODS: Cross-sectional surveys on preoperative interspecialty communication, tailored by stakeholder type, were administered to (1) primary care providers in northern New England, (2) anesthesia providers working in the perioperative clinic of a tertiary rural academic medical center, (3) surgeons from the same center, and (4) older surgical patients who underwent preoperative assessment at the same center. RESULTS: In total, 107/249 (43.0%) providers and 103/265 (39.9%) patients completed the survey. Preoperative communication was perceived as logistically challenging (59.8%), particularly across health systems. More than 77% of anesthesia and surgery providers indicated that they communicate frequently or sometimes, but 92.5% of primary care providers indicated that they rarely or never communicate with anesthesia providers. Some of the most common reasons for preoperative communication were discussion of complex patients, perioperative medication management, and optimization of comorbidities. Although 96.1% of older surgical patients reported that preoperative communication between providers is important, only 40.4% felt that their providers communicate very or extremely well. Many patients emphasized the importance of preoperative communication between providers to ensure transfer of critical clinical information. CONCLUSION: Surgeons and anesthesiologists infrequently communicate with primary care providers in one rural tertiary center, in contrast to patient expectations and values. These study results will help identify priorities and potentially resolvable barriers to bridging the gap between the inpatient perioperative and outpatient primary care teams. Future studies should focus on strategies to improve communication between hospital and community providers to prevent complications and readmission.

Clinical presentation and outcomes of Helicobacter heilmannii gastritis in children in the New England region of the United States.

OBJECTIVE: To describe the clinical, endoscopic, histologic, and treatment outcomes of Helicobacter heilmannii (H. heilmannii) associated gastritis in children in the New England region of the United States. METHODS: Retrospective study of children (1-18 years) with H. heilmannii identified on gastric mucosal biopsies from two pediatric centers over a 21-year period, January 2000-December 2021. Cases were identified by querying pathology databases at each institution. Demographic and clinical data were obtained from the medical record. Endoscopic and histologic findings were extracted from endoscopy and pathology reports, respectively. RESULTS: Thirty-eight children were diagnosed with H. heilmannii-associated gastritis during the study period. The mean age at diagnosis was 10.1 ± 5.3 years, and 25/38 (66%) cases were male. Abdominal pain (32%) and nausea with or without vomiting (26%) were the most common symptoms. Thirty-two children (84%) had endoscopic findings including gastric nodularity (55%) and erythema (26%). All children had histologic signs of chronic gastritis, including those with normal endoscopic exams. Antibiotic regimens used for treating Helicobacter pylori were frequently prescribed. Of the 17 children who underwent a follow-up endoscopy (range 2-68 months), 15 (88%) did not have H. heilmannii identified on gastric biopsies. CONCLUSION: H. heilmannii was an infrequent but potential cause of epigastric abdominal pain and nausea in our cohort of New England children. While morphologically distinct from H. pylori, the bacteria can result in similar endoscopic and histologic findings of nodularity and chronic gastritis, respectively. The rate of eradication, as assessed by histology following treatment with H. pylori therapies, was below the 90% recommended goal for antimicrobial therapies.

Child-focused infant and early childhood mental health consultation: Shifting adult attributions to reduce the risk for preschool expulsion.

Infant and early childhood mental health consultation (IECMHC) in early care and education (ECE) settings is a promising approach to support young children. Although research on the effects of IECMHC is encouraging, it is limited by the complexities of the systems in which IECMHC is implemented and the variability in IECMHC models. The current study aims to clearly articulate a statewide, child-focused, short-term IECMHC model, assess consultee satisfaction, examine the effects of consultation on children's functioning in the school and home settings, and evaluate changes in teacher perceptions associated with expulsion risk following consultation. In total, 268 children ages 1-5 (69% White, 75% male) and their family and school caregivers participated in consultation in a New England state, and 95 children and caregivers were included in an evaluation subsample. Of this subsample, teachers and ECE administrators, but not families, indicated significant improvement in children's functioning from referral to end of consultation. There was also a significant decrease in children's risk of expulsion, as measured by teachers' perceptions associated with expulsion decisions. This study contributes to the IECMHC literature by providing results specific to a child-focused model of consultation and highlighting the possible role of adult attributions for children in ECE.

La consulta de salud mental infantil y la temprana niñez (IECMHC) en los entornos de cuidados y educación tempranos (ECE) es un acercamiento prometedor para apoyar a los niños pequeños. A pesar de que la investigación sobre los efectos de IECMHC es alentadora, está limitada por las complejidades de los sistemas dentro de los cuales se implementa IECMHC y la variabilidad en los modelos de IECMHC. El presente estudio se propone articular claramente un modelo de IECMHC para todo el estado, con enfoque en el niño y a corto plazo, evaluar la satisfacción que quienes participan de la consulta, examinar los efectos de la consulta sobre el funcionamiento de los niños en la escuela y en el entorno del hogar, así como evaluar los cambios en las percepciones de los maestros asociadas con los riesgos de expulsión después de la consulta. En total, 268 niños de edad 1­5 (69% blancos, 75% varones) y sus familias y quienes les cuidaba en la escuela participaron en la consulta en un estado de Nueva Inglaterra, y se incluyó a 95 niños y sus cuidadores en una evaluación de un subgrupo muestra. De este subgrupo muestra, los maestros y los administradores de ECE, pero no las familias, indicaron significativas mejorías en el funcionamiento de los niños desde la referencia hasta el final de la consulta. Se dio también una significativa disminución en el riesgo de expulsión de los niños, tal como se midió por medio de las percepciones de los maestros asociadas con las decisiones de expulsión. Este estudio contribuye a la literatura informativa sobre IECMHC por medio de ofrecer resultados específicos al modelo de consulta enfocado en el niño y subrayar el posible papel de las atribuciones del adulto para los niños en ECE.

La consultation de santé mentale du nourrisson et de la petite enfance (Infant and early childhood mental health consultation abrégé en anglais IECMHC) dans des contextes éducatifs et de crèches (abrégé ici CEC selon le français) est une approche prometteuse pour le soutien aux jeunes enfants. Bien que les recherches sur les effets de l'IECMHC sont encourageantes, elles sont limitées par les complexités des systèmes dans lesquels l'IECMHC est mise en oeuvre et la variabilité des modèles de l'IECMHC. Cette étude s'est donné pour but de clairement articuler un modèle IECMHC au niveau de l'état, focalisé sur l'enfant et à court terme, d'évaluer la satisfaction de la personne consultée, d'examiner les effets de la consultation sur le fonctionnement des enfants à l'école et à la maison, et d'évaluer les changements dans les perceptions de l'enseignant liée au risque d'expulsion après la consultation. En tout 268 enfants âgés de 1­5 ans (69% blancs, 75% garçons) et leur famille et les personnes prenant soin d'eux à l'école ont participé à une consultation dans un état de nous Nouvelle Angleterre (aux Etats­Unis), et 95 enfants et personnes prenant soin d'eux ont été inclus dans un sous­échantillon d'évaluation. Dans ce sous­échantillon les enseignants et administrateurs CEC, mais pas les familles, ont fait état d'une amélioration important dans le fonctionnement des enfants du moment de la référence à la fin de la consultation. Il n'a pas de baisse importante du risque d'expulsion des enfants, mesurée par les perceptions des enseignants liées aux décisions d'expulsion. Cette étude contribue aux recherches sur l'IECMHC en offrant des résultats spécifiques à un modèle de consultation focalisé sur l'enfant et en mettant en lumière le rôle possible des attributions adultes pour les enfants dans les CEC.

Cerebrospinal fluid metagenomics has greatest added value as a test for Powassan virus among patients in New England with suspected central nervous system infection.

Cerebrospinal fluid (CSF) metagenomic next generation sequencing (mNGS) can detect diverse pathogens in patients with central nervous system infection. Due to its high cost and unclear clinical utility, it is typically reserved for patients with unrevealing routine workups. A multi-center retrospective analysis of real-world CSF mNGS was performed involving orders between 2017 and 2022 at a large New England healthcare system. CSF mNGS was performed 64 times with 17 positive results (27 %). In 11/17 positive samples (65 %), the infectious agent had not been previously detected using routine methods. Arboviruses (n = 8) were the most frequently detected agents, particularly Powassan virus (n = 6). Results changed therapy in 3/64 cases (5 %). Positive results were associated with immunodeficiency (p = 0.06), especially anti-B-cell therapy (p = 0.02), and earlier sample collection (p = 0.06). The association with compromised humoral immunity was stronger in the arbovirus and Powassan virus subgroups (p = 0.001), whose constituents were older than the overall cohort and had higher mortality rates.