An Equity Response to COVID-19 in Allegheny County, Pennsylvania: The Development and Work of the Black Equity Coalition.

From the onset of the pandemic in the United States, racial disparities in COVID-19 outcomes have been evident. In April 2020, several events prompted a concerned group of colleagues to form the Black Equity Coalition (BEC), a Black-led coalition in Allegheny County, Pennsylvania, which brings together professionals from multiple sectors who aim to ensure an equitable response to the COVID-19 pandemic. Several significant milestones have been achieved, and this article describes the development, functioning, and outcomes of the Coalition in the first 15 months of operation (April 2020-June 2021). COVID-19 was the reason for such an unprecedented effort, but this BEC infrastructure will be needed long after COVID-19 is controlled. In addition to short-term activities and reactive measures to prevent and mitigate COVID-19 in Black populations, the BEC is serving as a crucial link between government, health care stakeholders, and communities to produce long-term systemic change.

Trauma and Behavioral Health Care for Patients with Chronic Pain.

Chronic pain is a public health problem that affects millions of people; however, those with comorbid behavioral health issues are overrepresented in that number. Although pain can be caused by a variety of factors, it has traditionally been associated directly with physical pathology. We know there is variation in how patients report pain whether in the presence or absence of physical pathology; therefore, pain must be viewed as a complex issue. In this article, the authors review the relationship between pain and mental illness and discuss strategies and various modalities for addressing pain in the primary care setting.

Teaching Brief Motivational Interventions for Diabetes to Family Medicine Residents.

BACKGROUND AND OBJECTIVES: As time and resource constraints grow in primary care, so does the value of efficient strategies to promote patient self-management, particularly for chronic diseases such as diabetes mellitus (DM). To that end, incorporating motivational interviewing (MI) into clinical practice has been shown to improve outcomes for patients with DM. Brief motivational interventions (BMI) draw from MI and may be integrated into more concise office visits. Little research has investigated strategies for BMI training for family medicine residents, particularly in the care of patients with DM. This study evaluates the impact of BMI training on improving DM self-management. METHODS: Family medicine residents were trained in BMI for DM over four sessions, then implemented BMI during routine office visits for 1 year. Pre- and post-implementation surveys were compared between residents who received BMI training and those who did not. RESULTS: After BMI training, residents' self-reported use of MI-adherent approaches to managing unhealthy behaviors in patients with DM doubled, and knowledge of MI increased by nearly 50%. BMI-trained residents showed 19% improvement in the application of MI skills, using an objective measure of open-response questions to behavioral change statements. CONCLUSIONS: After fewer than four training sessions in BMI, residents not only improved in their ability to apply motivational skills but also altered their clinical approaches to counseling patients with DM. BMI can also be used to evoke health behavior changes, thereby improving self-management. Training family medicine residents in BMI is effective and can be easily incorporated into a residency curriculum.

Reducing Racial Disparities in Influenza Vaccination Among Children With Asthma.

INTRODUCTION: A multifaceted intervention to raise influenza vaccination rates was tested among children with asthma. METHODS: In a pre/post study design, 18 primary care practices implemented the 4 Pillars Immunization Toolkit along with other strategies. The primary outcome was the difference in influenza vaccination rates at each practice among children with asthma between the baseline year (before the intervention) and at the end of year 2 (after the intervention), both overall and by race (White vs. non-White). RESULTS: Influenza vaccination rates increased significantly in 13 of 18 practices. The percentage of vaccinated non-White children increased from 46% to 61% (p < .01), and the percentage of vaccinated White children increased from 58% to 65% (p < .001). Likelihood of vaccination was significantly lower for non-White children before the intervention (odds ratio = 0.66; 95% confidence interval = 0.59-0.73; p < .001), but this difference was eliminated after the intervention (odds ratio = 0.95; 95% confidence interval = 0.85-1.05; p = .289). DISCUSSION: A multi-strategy, evidence-based intervention significantly increased influenza vaccination uptake and reduced racial disparities among children with asthma.

Sexually transmitted diseases.

Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases, remain a growing worldwide problem and public health issue. This article covers the epidemiology of STIs, the history and physical findings, screening guidelines, and the general plan to combat STIs. Prevention is discussed using the latest information from the Centers for Disease Control and Prevention and other references. Infections discussed from the standpoint of cause, epidemiology, risk factors, clinical disease, diagnosis, and treatment include gonorrhea, Chlamydia trachomatis, Trichomonas vaginalis, syphilis, chancroid, Herpes simplex, lymphogranuloma venereum, granuloma inguinale, Herpes papilloma virus, Molluscum contagiosum, and pubic lice.