A qualitative assessment of structural barriers to prenatal care and congenital syphilis prevention in Kern County, California.

Congenital syphilis is the result of placental transmission from mother to fetus of Treponema pallidum. Although congenital syphilis is preventable through timely treatment, the rate of new infections in the United States (US) has increased each year since 2013, and is increasing at a noticeably greater pace in California (CA). Most research into congenital syphilis has focused on individual psychosocial and behavioral factors that contribute to maternal vulnerability for syphilis. The aim of this study was to evaluate structural barriers to prenatal care access and utilization and congenital syphilis prevention in Kern County, CA. Transcripts from 8 in-depth interviews with prenatal care providers and 5 focus group discussions with 42 pregnant and postpartum persons were examined using thematic analysis. Structural barriers experienced by pregnant and postpartum persons to prenatal care access and utilization included (1) burdens of poverty; (2) stigma around substance use in pregnancy; (3) citizenship status; (4) lack of healthcare coverage; (5) low sexual health literacy; and (6) gender inequality Structural barriers experienced by prenatal care providers in congenital syphilis prevention included (1) limited guidance on clinical management of syphilis in pregnancy; (2) decay in public health infrastructure; and (3) inadequate support for managing patients' social comorbidities. The response to congenital syphilis prevention will require an examination of the complex context of social determinants of health in which persons diagnosed with syphilis live in.

Traditional or technological? A cross sectional survey of oral contraceptive reminders in young adults.

OBJECTIVES: For patients relying only on oral contraceptive pills (OCPs) for pregnancy prevention, timely and correct usage of OCPs is essential. This study describes the prevalence of reminder systems used among our patients, the patient population that uses those reminder systems, and whether the reminder system was effective for the user in terms of not missing pills per pack. METHODS: We conducted a cross-sectional survey among 102 OCP users at 3 individual clinics in the UCLA Health System. To quantify OCP adherence, we used the unit pill pack to indicate one month's supply of OCPs. RESULTS: Majority of patients were young educated individuals who used OCPs for 1 year or longer. 44% of participants used strictly technology-based reminders including alarms, phone applications, and text-based systems. 25% of participants used only traditional reminders, including co-administration with other medications, location placement, and as part of a morning/evening routine. 6% of participants used a combination of technology-based and traditional reminders. 21% of participants did not rely on any reminder system for OCP self-administration. 4% of participants used "Other or Unknown" reminder systems. The majority of participants missed less than 2 pills in their pill pack. Those who relied on technological reminders missed pills more frequently than those who depended on traditional reminders. CONCLUSION: Our results indicate that despite growing prevalence of technology-based reminder systems, traditional reminders are as prevalent as the technology-based ones. There was no difference in the number of missed pills between the two groups. The study is limited by the use of convenience sampling. Our study sheds light on strategies that a majority young and educated patient population might use to increase OCP adherence.

Comparison of Repetitive Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation on Upper Limb Recovery Among Patients With Recent Stroke.

OBJECTIVE: To compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on upper limb function recovery among patients who recently had stroke. METHODS: Subjects with recent stroke (within 1 month) were randomized to rTMS (n=25) and tDCS (n=26) applied over the non-lesioned hemisphere for three sessions per week, followed by tailored upper limb rehabilitation training for a total of 2 weeks. The primary outcomes were changes in the Motor Assessment Scale (MAS), Fugl-Meyer arm score test, Nine-Hole Peg Test (9HPT), hand grip strength, and modified Barthel Index at weeks 2 and 4. Both therapists responsible for training and assessment were blinded to the intervention allocated. RESULTS: There was an improvement in all the motor performance scales among both groups (p<0.001). These improvements persisted at discharge. However, there was no significant difference in any of the assessment scales between the two groups. The rTMS group showed a statistically non-significant greater improvement in MAS, 9HPT, and handgrip strength than the tDCS group. CONCLUSION: Both interventions produce a statistically significant improvement in upper limb function. There was no statistically significant difference between the two intervention methods with respect to motor performance. It is suggested that a larger study may help to clarify the superiority of either methods.

At-a-glance - The role of opioid toxicity in suicide deaths in Alberta, 2000 to 2016. / Aperçu - Suicides et intoxication aux opioïdes en Alberta (2000-2016).

Given the current opioid crisis in Canada, there is interest in the role of opioid toxicity in suicide deaths, particularly in whether any observed patterns are similar to those of unintentional deaths. The present analysis examined characteristics of opioid-toxicity suicide, and its role in relation to other suicide methods, from 2000 to 2016 in Alberta. It does not appear that the opioid crisis has resulted in a disproportionately higher number of suicides in Alberta. Individuals who die from unintentional opioid toxicity and those who die by opioid-toxicity suicide are likely distinct populations, requiring nuanced public health responses for prevention.

RÉSUMÉ: Dans le cadre de la crise actuelle des opioïdes au Canada, il est important de s'intéresser au rôle joué par l'intoxication aux opioïdes dans les décès par suicide et, plus particulièrement, de déterminer si les tendances observées à cet égard sont similaires aux tendances observées pour les décès accidentels. Dans cette analyse, on examine les caractéristiques du suicide par intoxication aux opioïdes et la corrélation entre cette méthode et d'autres moyens de suicide entre 2000 et 2016 en Alberta. La crise des opioïdes ne semble pas avoir causé un nombre disproportionnellement élevé de suicides en Alberta. Les personnes qui décèdent des suites d'une intoxication accidentelle aux opioïdes et celles qui se suicident en s'intoxiquant avec des opioïdes constituent probablement des populations différentes, ce qui nécessite des interventions préventives nuancées en matière de santé publique.

Occupational rehabilitation services provided by a community workers health centre in Hong Kong: a case study.

BACKGROUND: In Hong Kong, the Employees' Compensation Ordinance (ECO), based on the model of the English Workmen's Compensation Act 1943, establishes a no-fault, non-contributory system for work injuries. It focuses merely on the minimum social expectation in compensating injured workers in monetary terms, but does not place much emphasis on prevention, rehabilitation and return to work policies for workers with injury. There is a need to reform an effective and comprehensive occupational rehabilitation system for workers with work injury in Hong Kong. METHODS: This paper presents a case study of a worker with work injury undergoing occupational rehabilitation through services provided in the local community setting by the Hong Kong Workers' Health Centre. RESULTS: The case study highlights some crucial factors and/or intervention modalities in facilitating workers' return to work, including timely intervention, work-site based rehabilitation, communication among different stakeholders, dynamics of company, rehabilitation counselling, community integration and individualized work resettlement. CONCLUSION: Without reviewing and revamping the current ECO, the goal to provide timely and effective occupational rehabilitation services for workers with injury could not be fully achieved.