The Impact of the COVID-19 Pandemic on Food Access: Insights from First-Person Accounts in a Safety-Net Health Care System.

The COVID-19 pandemic disproportionately affected populations that were already facing socioeconomic disadvantages and limited access to health care services. The livelihood of millions was further compromised when strict shelter-in-place measures forced them out of their jobs. The way that individuals accessed food during the early stages of the COVID-19 pandemic drastically changed as a result of declines in household income, food chain supply disruptions, and social distance measures. This qualitative study examined the food access experiences of participants enrolled in a safety-net health care system-based, free, monthly fruit and vegetable market in the Metro Boston area during the first six months of the COVID-19 pandemic. The findings offer rich qualitative information to understand the financial repercussions of the pandemic on food access.

Cancer Screening Rates and Outcomes for Justice-Involved Individuals: A Scoping Review.

Individuals who have been incarcerated or under community supervision have elevated cancer mortality. This review summarizes existing knowledge on implementation and outcomes of cancer screening for justice-involved individuals to identify opportunities for reducing cancer disparities. This scoping review identified 16 studies published between January 1990 and June 2021 that reported cancer screening rates and outcomes in U.S. jails or prisons or for individuals under community supervision. Most studies evaluated cervical cancer screening, while fewer studies evaluated screening for breast, colon, prostate, lung, and hepatocellular cancers. Although incarcerated women are often up to date with cervical cancer screening, only about half had recent mammograms and only 20% of male patients were up to date with colorectal cancer screening. Justice-involved patients are at high risk of cancer, yet few studies have evaluated cancer screening for these populations and screening rates for many cancers appear low. The findings suggest that intensification of cancer screening for justice-involved populations may address cancer disparities.

Single haptic iris fixation of posterior chamber intraocular lens.

Single haptic iris fixation technique is used where there is a loss of 6 clock hours anterior capsular support. It helps the anterior segment surgeon to fix the intraocular lens to the iris on the side of absent capsular support and place the other haptic over the capsular support. A 10-0 polypropylene suture on a long-curved needle is only used to take a suture bite on the side of capsule loss. Meticulous automated anterior vitrectomy is done. Then, the suture loop below the iris is taken out and the loops are twirled multiple times around the haptic. The leading haptic is then gently glided behind the iris, and the trailing haptic is gently placed on the other side using forceps. The suture ends are trimmed and internalized into the anterior chamber and then externalized through the paracentesis using a Kuglen hook, and the knot is tied and secured.

Wilms Tumor 1-Driven Fibroblast Activation and Subpleural Thickening in Idiopathic Pulmonary Fibrosis.

Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease that is often fatal due to the formation of irreversible scar tissue in the distal areas of the lung. Although the pathological and radiological features of IPF lungs are well defined, the lack of insight into the fibrogenic role of fibroblasts that accumulate in distinct anatomical regions of the lungs is a critical knowledge gap. Fibrotic lesions have been shown to originate in the subpleural areas and extend into the lung parenchyma through processes of dysregulated fibroproliferation, migration, fibroblast-to-myofibroblast transformation, and extracellular matrix production. Identifying the molecular targets underlying subpleural thickening at the early and late stages of fibrosis could facilitate the development of new therapies to attenuate fibroblast activation and improve the survival of patients with IPF. Here, we discuss the key cellular and molecular events that contribute to (myo)fibroblast activation and subpleural thickening in IPF. In particular, we highlight the transcriptional programs involved in mesothelial to mesenchymal transformation and fibroblast dysfunction that can be targeted to alter the course of the progressive expansion of fibrotic lesions in the distal areas of IPF lungs.

Inflammatory Bowel Disease Guidelines for Corneal Refractive Surgery Evaluation.

Inflammatory bowel disease (IBD) is a chronic systemic inflammatory condition that can potentially adversely affect surgical outcomes in patients receiving elective ophthalmic procedures. In this case series, 21 eyes of 11 patients with ulcerative colitis or Crohn's disease underwent laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), or small incision lenticule extraction (SMILE). Their surgical outcomes were followed up for an average of 8.9 ± 4.6 months. All the patients in this study did well, with 100% of eyes corrected for distance vision achieving uncorrected distance visual acuity 20/20 by postoperative month three. Common symptoms noted during the postoperative period included dry eyes, irritation, foreign body sensation, and blurry vision, all of which improved in prevalence and severity over the follow-up period, and none of the patients experienced a flare-up of their disease. Despite the successful outcomes in these patients, the authors recognize the inherent risks of operating on patients with IBD. Currently, there are no consensus guidelines for clinicians to follow to ensure that they are adequately screening these patients for eligibility, so the authors are suggesting a relevant, focused review of systems, a brief IBD history-related questionnaire, and a preliminary surgical decision-making flowchart for use in surgical evaluation.

Facilitators and Barriers to Patient Attendance at a Free Health Center Produce Market.

INTRODUCTION: Patient participation in healthcare system‒sponsored efforts to address food insecurity varies widely. This mixed-methods study sought to understand the patient sociodemographic factors associated with and barriers and facilitators to the use of a monthly produce market held at Cambridge Health Alliance in partnership with The Greater Boston Food Bank. METHODS: Baseline surveys (N=715) were conducted from February 2019 to March 2020 before market attendance, followed by 1-year follow-up surveys (n=514) and qualitative interviews (n=45). Robust Poisson regression estimated associations between sociodemographic characteristics and market attendance. Analyses were conducted from 2021 to 2022. RESULTS: A total of 37.1% attended the market ≥1 time. Market attendance was associated with being aged 30-49 years (Risk Ratio (RR)=1.36, 95% CI=1.00, 1.86), having a monthly household income <$1,000 (RR=1.73, 95% CI=1.29, 2.32), identifying as Asian (RR=2.48, 95% CI=1.58, 3.89), having a preferred language for medical care other than English (RR=1.35, 95% CI=1.03, 1.76), being retired (RR=1.90, 95% CI=1.17, 3.08), and living in the city of the market's location (RR=1.36, 95% CI=1.12, 1.63). Barriers included limited time (28%), work conflict (23%), forgetfulness (23%), and not knowing market location/date (22%). Interviews revealed that accessibility barriers (e.g., limited market hours, transportation issues, competing demands, medical conditions, long lines) were obstacles to attendance, whereas access to novel, healthy foods motivated attendance. CONCLUSIONS: Healthcare-based food distributions have the potential to reach patients with unmet food needs who cannot or would not access other forms of food assistance. Time constraints, physical limitations, and transportation challenges impact attendance; program modifications are necessary to improve accessibility.

Effect of Video Counselling Versus Verbal Counselling on Patient's experience during phacoemulsification under topical anaesthesia.

Purpose: To evaluate the impact of video and verbal counselling on patients' undergoing phacoemulsification under topical anaesthesia. Methods: This is a prospective randomized controlled trial conducted at Aravind Eye Care System, Pondicherry, India. All patients had a 15 â€‹min one-on-one verbal counselling covering surgical technique, implant options, anaesthesia and payment options one day prior to surgery. On the day of surgery, patients were randomized into two groups; in the first group, patients were provided with video counselling and in the second group, patients were given verbal counselling prior to undergoing phacoemulsification under topical anaesthesia. Measurements of blood pressure, heart rate, respiration rate, and the Likert-scale anxiety rating were collected at preoperative, perioperative, and postoperative time points. Results: A group of 186 patients (aged 45-70 years) were provided video counselling via portable iPad before first-time phacoemulsification, and a second group of 186 patients underwent surgery with verbal counselling. Systolic and diastolic blood pressure measurements were lower in both the video and verbally counselled groups during the intraoperative time point. Furthermore, during the intraoperative period, 123 (66.1%) video counselled patients felt relaxed compared to 119 (64%) patients who were provided verbal counselling (P â€‹= â€‹0.6636). Patient cooperation during surgery was excellent in 76(40.9%) video counselled patients and 67(36%) verbally counselled patients (P â€‹= â€‹0.3374). 25.8% and 21% (P â€‹= â€‹0.2703) of patients experienced no pain during surgery in the video and verbal counselled groups respectively. Conclusions: Although measures such as pulse rate, respiratory rate and feelings of relaxation did not show significant differences among the two groups of video and verbal counselling, patients marked cooperation during surgery and furthermore, the level of anxiety is most reassuring.

Disparities in cancer prevalence, incidence, and mortality for incarcerated and formerly incarcerated patients: A scoping review.

BACKGROUND: Racial and ethnic minority status, structural racism, low educational attainment, and poverty are consistently associated with cancer disparities and with higher rates of incarceration. The objective of this scoping review is to conduct a qualitative synthesis of the literature on cancer prevalence, incidence, mortality, and disparities in these outcomes for incarcerated and formerly incarcerated patients, as this literature is fragmented and heterogenous. METHODS: This scoping review included Bureau of Justice Statistics reports and searched PubMed in May 2021 for all English language studies published between 1990 and 30 April 2021, that reported on cancer prevalence, incidence, or mortality for incarcerated or formerly incarcerated individuals in the United States. RESULTS: Twenty studies were selected. Data on cancer prevalence and incidence were scarce but suggested that incarcerated and formerly incarcerated patients have a similar overall risk of cancer diagnosis as the general population, but elevated risk of certain cancers such as cervical, lung, colorectal, and hepatocellular carcinoma for which effective prevention and screening interventions exist. Cancer mortality data in state and local jails as well as prisons were robust and suggests that both incarcerated and formerly incarcerated patients have higher cancer mortality than the general population. CONCLUSIONS: Incarcerated and formerly incarcerated patients likely have a higher risk of dying from cancer than the general population, but important gaps in our knowledge about the extent and drivers of disparities for this population remain. Additional research is needed to guide interventions to reduce cancer disparities for patients experiencing incarceration.

Corneal Donation: Current Guidelines and Future Direction.

PURPOSE: This review aims to outline current practices and guidelines of corneal donation and eye banking, describes the implications of COVID-19 and emerging diseases on the corneal donor pool, and discusses future trends to improve and increase the efficiency of the processes involved in corneal donation and eye banking. SUMMARY: Corneal screening, preservation, corneal storage, and prevention of systemic disease transmission from donor to recipient have been crucial in shaping the policies of the FDA and eye banks across the world. Eye banks globally have developed varying guidelines and criteria for evaluating the viability of donor corneas. Variables such as the age of the donor, medical history, and potential disease transmission are important screening parameters. While known infectious diseases may be transmissible through the cornea, emerging infectious diseases that are not well studied may be more transmissible than other infections. In particular, coronavirus has impacted corneal transplantation as SARS-CoV-2 expression has been detected in corneal tissue and conjunctiva. In recent years, partial-thickness corneal transplantations have been introduced. Lamellar grafts and other corneal layers are now utilized for transplantation of the specific areas that are damaged.

The Protective Effects of IL-31RA Deficiency During Bleomycin-Induced Pulmonary Fibrosis.

Idiopathic Pulmonary Fibrosis (IPF) is a severe fibrotic lung disease characterized by excessive collagen deposition and progressive decline in lung function. Th2 T cell-derived cytokines including IL-4 and IL-13 have been shown to contribute to inflammation and fibrotic remodeling in multiple tissues. Interleukin-31 (IL-31) is a newly identified cytokine that is predominantly produced by CD4 Th2 T cells, but its signaling receptor IL-31RA is primarily expressed by non-hematopoietic cells. However, the potential role of the IL-31-IL31RA axis in pulmonary inflammation and fibrosis has remained largely unknown. To determine the role of IL-31RA deficiency in pulmonary fibrosis, wildtype, and IL-31RA knockout mice were treated with bleomycin and measured changes in collagen deposition and lung function. Notably, the loss of IL-31 signaling attenuated collagen deposition and lung function decline during bleomycin-induced pulmonary fibrosis. The total lung transcriptome analysis showed a significant reduction in fibrosis-associated gene transcripts including extracellular matrix and epithelial cell-associated gene networks. Furthermore, the lungs of human IPF showed an elevated expression of IL-31 when compared to healthy subjects. In support, the percentage of IL-31 producing CD4+ T cells was greater in the lungs and PBMCs from IPF patients compared to healthy controls. Our findings suggest a pathogenic role for IL-31/IL-31RA signaling during bleomycin-induced pulmonary fibrosis. Thus, therapeutic targeting the IL-31-IL-31RA axis may prevent collagen deposition, improve lung function, and have therapeutic potential in pulmonary fibrosis.