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1.
BMC Res Notes ; 15(1): 347, 2022 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-36348439

RESUMO

OBJECTIVE: Gaps in sexually transmitted infection (STI) testing can lead to poor health outcomes due to untreated illness among youth living with HIV (YLHIV). Thus, the objective of this study is to examine STI testing behavior and outcomes among a sample of YLHIV in the southern United States. Clinical records of 139 YLHIV who received HIV care in Alabama (2017-2020) were evaluated for receipt of STI testing (gonorrhea, chlamydia, syphilis), prevalence of positive test results, and factors associated with testing outcomes (933 clinical visits). RESULTS: Nearly 80% of our sample identified as African American, most were 20-24 years, and about 60% reported detectable viral load at first visit during the study period. Just under 60% of cisgender male and transgender female clients reported receipt of at least one STI test, compared to less than 40% of cisgender females. Identifying as a cisgender male and having been diagnosed with HIV related to sex with men were associated with greater likelihood receiving STI testing. Cisgender males reported higher rates of positive syphilis test results than cisgender females; the highest rates of positive STI tests were among transgender females. Results underscore need for providers to promote routine STI testing to YLHIV.


Assuntos
Infecções por Chlamydia , Gonorreia , Infecções por HIV , Infecções Sexualmente Transmissíveis , Sífilis , Masculino , Adolescente , Feminino , Humanos , Estados Unidos , Sífilis/diagnóstico , Sífilis/epidemiologia , Alabama/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Gonorreia/diagnóstico , Programas de Rastreamento , Homossexualidade Masculina
2.
J Health Care Poor Underserved ; 33(4): 1949-1964, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36341672

RESUMO

PURPOSE: This study aimed (1) to investigate levels of technology device access and social media use among African Americans in rural Alabama, (2) to examine the prevalence of online health information-seeking behaviors, and (3) to identify associations of technology device access and social media use with online health information-seeking behaviors. METHODS: A convenience sample of 185 African Americans aged 18 and older was recruited from a rural county in Alabama. Multilinear regression was conducted to examine the associations. RESULTS: Nearly 60% of participants had access to the internet, smartphone, and tablets/computers. The prevalence of online health information-seeking behaviors was low. Technology device access was not associated with online health information-seeking behaviors, while more social networking sites were associated with more online health information-seeking behaviors. CONCLUSION: Public health interventions are needed to promote internet use for health purposes among rural African Americans. Offline health information services should also target those lacking internet access.


Assuntos
Comportamento de Busca de Informação , Área Carente de Assistência Médica , Mídias Sociais , Humanos , Afro-Americanos , Alabama , Internet , População Rural
3.
Am J Speech Lang Pathol ; 31(6): 2847-2860, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36327492

RESUMO

PURPOSE: Rural-living residents of Alabama depend on rural hospitals and clinics staffed with physicians and allied health professionals including speech-language pathologists (SLPs). The purpose of the exploratory study was to examine the speech-language pathology workforce in health care facilities in nonmetropolitan Alabama counties to determine potential disparities in access and identify medical SLP deserts for rural Alabamians. METHOD: The hospitals, rural health clinics, nursing homes, and rehabilitation centers for each of the 37 nonmetropolitan counties were identified through the 2020 Alabama Department of Public Health directories, and phone surveys were completed to determine medical SLP staffing at each facility. Descriptive statistics and regression analysis were conducted. RESULTS: The initial review yielded 229 rural health care facilities with 223 ultimately included in the analysis and 176 facilities completing a phone inquiry (76.68%). Sixty-one (35.88%) reported employing at least one SLP and no facility stated staffing SLP assistants. Linear regression indicated a positive, yet moderate effect size between the reported number of SLPs staffed within each county and specific population of the county (r 2 = .519). Anecdotally, facilities reported difficulty in hiring and retaining SLPs due to rural geographical location. CONCLUSIONS: The exploratory findings suggest disparities in access to behavioral communication and swallowing care for rural residents in the state. The methodology employed for data collection and analysis may be applied to other states and U.S. territories, in an effort to frame the issue nationally and support rural health care policy across the United States. Further investigation regarding the cost effectiveness of telepractice, the availability of broadband Internet access, the efficacy of community-based service delivery, and the effectiveness of incentivized rural SLP graduate programs is warranted to mitigate the disparities in access.


Assuntos
Transtornos da Comunicação , Disparidades em Assistência à Saúde , Serviços de Saúde Rural , Humanos , Alabama , Transtornos da Comunicação/terapia , Patologia da Fala e Linguagem
4.
J Vector Ecol ; 47(2): 210-216, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36314676

RESUMO

A statewide survey of the tick fauna found on deer, using harvested deer heads as the sample unit, was conducted during the Alabama hunting seasons of 2019-2020 and 2020-2021. Four species of ticks: Ixodes scapularis (n= 936, % of catch 69.1%), Amblyomma americanum (315, 23.2%), Dermacentor albipictus (97, 7.1%), and Amblyomma maculatum (6, 0.4%) were taken from 151 deer heads harvested from 21 deer processing centers (n = 4-17 heads/processor). A total of 87.7% (prevalence) of deer heads had one or more ticks. We used two standard numerical descriptors of tick numbers, abundance, and relative abundance. No significant stepwise regressions (p > 0.05) were found between tick abundance (all ticks, I. scapularis, A. americanum) and the predictor variables of latitude, deer density, season, and year. In addition, the correlation between the abundance of I. scapularis and A. americanum was not significant (p > 0.5). In contrast, the relative abundance of both I. scapularis and A. americanum showed a significant (P < 0.05) relationship with latitude, with the relative abundance of I. scapularis increasing on deer with increased latitude and A. americanum showing the opposite pattern.


Assuntos
Cervos , Ixodes , Infestações por Carrapato , Animais , Infestações por Carrapato/epidemiologia , Infestações por Carrapato/veterinária , Alabama/epidemiologia
5.
Vaccine ; 40(48): 6908-6916, 2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36280559

RESUMO

Interactive stories are a relatively newer form of storytelling with great potential to correct misinformation while increasing self-efficacy, which is crucial to vaccine acceptance. To address COVID-19 vaccine hesitancy and medical mistrust in young Black adults (BYA), we sought to adapt a pre-existing application ("app"; Tough Talks) designed to address HIV disclosure decision-making through choose-your-own adventure (CYOA) narratives and other activities. The adapted app (Tough Talks - COVID) uses a similar approach to situate COVID-19 vaccination decision-making within social contexts and to encourage greater deliberation about decisions. To inform content for the CYOA narratives, we conducted an online survey that was used to elicit the behavioral, cognitive, and environmental determinants influencing COVID-19 vaccine hesitancy among 150 BYA (ages 18-29) in Georgia, Alabama, and North Carolina. The survey included scenario questions that were developed with input from a youth advisory board to understand responses to peer and family influences. In two scenarios that involved discussions with family and friends about vaccination status, most respondents chose to be honest about their vaccination status. However, vaccinated individuals perceived more social pressure and stigma about not being vaccinated than unvaccinated respondents who were not as motivated by social pressure. Personal choice/agency in the face of perceived vaccine risks was a more common theme for unvaccinated respondents. Results suggest that relying on changing social norms alone may not impact barriers to vaccination in unvaccinated young adults without also addressing other barriers to vaccination such as concerns about autonomy and vaccine safety. Based on these findings, CYOA narratives in the app were adapted to include discussions with family and friends but also to touch on themes of personal choice as well as other topics that influence behaviors besides norms such as safety, side effects, and risk of COVID-19 in an evolving pandemic.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Adolescente , Adulto Jovem , Humanos , Adulto , COVID-19/prevenção & controle , Alabama , Georgia , North Carolina , Confiança , Vacinação/métodos
6.
J Med Entomol ; 59(6): 2053-2065, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36256531

RESUMO

In the southeastern United States, biting midges transmit agents of hemorrhagic diseases that are enzootic among white-tailed deer (Odocoileus virginianus (Zimmermann), Artiodactyla: Cervidae). Culicoides sonorensis Wirth and Jones (Diptera: Ceratopogonidae), the only confirmed vector of epizootic hemorrhagic disease virus (EHDV) and bluetongue virus (BTV) in the United States, is rarely collected in the Southeast, implying that other Culicoides Latreille species act as vectors. Despite multiple surveillance studies, the influence of trapping habitat and light wavelength on Culicoides sampling has yet to be investigated in Alabama. This study sampled Culicoides species at a deer research facility using CO2-baited CDC light traps with three distinct wavelengths. Traps were rotated within three habitats to examine impacts of habitat type and light wavelength on Culicoides abundance and parity status. For most species, midges were more abundant in a pine forest compared to a hardwood-forest riparian zone or a lightly wooded area adjacent to a seasonal pond. The pine forest generally had negative effects on parity status, suggesting that most females in this habitat were foraging for their first bloodmeal. Ultraviolet (UV) black-light (350 nm-360 nm) attracted more midges than incandescent light or UV LED light (385 nm-395 nm), but wavelength had less of an effect on parity than habitat. This study indicates that light wavelength and habitat significantly influence Culicoides sampling outcomes, and that when collecting parous females is desired (e.g., EHDV/BTV surveillance), targeting areas around oviposition sites may be a better strategy than trapping where midges are most abundant.


Assuntos
Vírus Bluetongue , Ceratopogonidae , Cervos , Vírus da Doença Hemorrágica Epizoótica , Feminino , Animais , Alabama , Ecossistema
7.
Zootaxa ; 5133(1): 53-82, 2022 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-36101111

RESUMO

We describe a new, narrowly endemic species of swamp-dwelling dusky salamander (Plethodontidae: Desmognathus pascagoula sp. nov.) from the Gulf Coastal Plain of southeastern Mississippi and southwestern Alabama based on linear morphometrics, mitochondrial DNA, and single nucleotide polymorphisms from 881 loci produced using genotype-by-sequencing. Some populations of the new species were historically referred to as D. auriculatus, a polyphyletic assemblage of at least three species in the Atlantic and Gulf Coastal Plain from Texas to North Carolina. Populations of D. auriculatus from the Gulf Coastal Plain in Louisiana and Mississippi were recently described as D. valentinei. The new species includes populations that were tentatively referred to D. valentinei, but we find it is morphologically, genetically, and geographically distinct. It is smaller, has a more defined dorsal color pattern, more irregular whitish portholes in up to three rows on the lateral surfaces of the body and tail, and a brighter orange or yellowish orange postocular stripe. At present, the new species is known from only six extant populations in the lower Pascagoula, Escatawpa, and Mobile drainages. The latter represents a distinct phylogeographic lineage. We also refer a historical collection from the northeastern side of the Mobile-Tensaw River Delta to this species, suggesting a much broader range in the past. We suspect that more populations remain to be discovered in the area, and their potential species-level distinctiveness should be tested further. This discovery increases knowledge of the biodiversity in the southeastern United States Coastal Plain, a candidate region meeting the global criteria for a biodiversity hotspot, and underscores the amount of cryptic diversity likely remaining to be discovered and described in Nearctic salamanders.


Assuntos
Urodelos , Áreas Alagadas , Alabama , Animais , Mississippi , Filogenia , Urodelos/genética
8.
J Int Assoc Provid AIDS Care ; 21: 23259582221127936, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36147031

RESUMO

Black adolescent girls and young women (AGYW) are disproportionately affected by HIV in the United States. HIV pre-exposure prophylaxis (PrEP) is effective for HIV prevention, but prescription rates remain low. We conducted a survey of medical providers caring for Black AGYW in Alabama to explore PrEP prescription practices. While over half of the N = 36 providers reported minimal HIV testing of AGYW in clinic, most (N = 29, 81%) reported feeling confident discussing HIV prevention. Most reported willingness to prescribe PrEP to Black AGYW (58%-72%), but only 11 (31%) had prescribed PrEP to any female client. Low familiarity with CDC guidelines (N = 20, 56%) and PrEP options (N = 19, 53%) were barriers to prescription. Prescribing PrEP to AGYW was associated with provider training, with internal medicine providers being least likely to prescribe. These findings support the need to develop training tools to directly address unique training needs of providers who care for this population.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Adolescente , Alabama , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Pessoal de Saúde , Humanos , Prescrições , Estados Unidos
9.
J Public Health Manag Pract ; 28(6): 631-638, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36037510

RESUMO

OBJECTIVE: To examine knowledge, attitudes, and practices about COVID-19 in Alabama, with a primary focus on vaccination perception and utilization. DESIGN: We used a COVID-19 Knowledge, Attitudes, and Practices survey and recruited adult Alabama residents in April-May 2021. PARTICIPANTS: Initial surveys from 1324 Alabamian participants were considered for analysis; after careful review of incomplete responses, 953 were ultimately included for analysis. MAIN OUTCOME MEASURE: Vaccine behavior and hesitancy comprise a self-reported response contained in the survey instrument. Three primary vaccine groups were used to assess differences in demographic characteristics, health status, perception of susceptibility and severity of COVID-19, sources of information, and trust about COVID-19. RESULTS: Of the 953 survey participants included for analysis, 951 had self-identified vaccine status in which 153 (16.1%) reported to have received the vaccine at the time of the survey, 375 (39.4%) were very likely or somewhat likely to get an approved COVID-19 vaccine if it was offered, and 423 (44.5%) were somewhat unlikely or very unlikely to get an approved COVID-19 vaccine. Health care providers were the most trusted sources of information, regardless of vaccine status. For participants unlikely to receive a vaccine, social media and local news sources were consistently more trusted and utilized than those who were vaccinated or were likely to be. CONCLUSIONS: The perceptions among unvaccinated participants are actionable and provide teachable opportunities to decrease vaccine apprehension.


Assuntos
COVID-19 , Vacinas , Adulto , Alabama/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Vacinação
10.
Am J Nurs ; 122(9): 39-47, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36005794

RESUMO

ABSTRACT: The high prevalence of diabetes in Alabama and the limited diabetes education available to patients in that state suggest that new interventions are needed. To that end, the authors developed a project to assess whether the use of telehealth technology to deliver diabetes self-management education and support (DSMES) in a small group setting is an effective and acceptable way to increase access to such education by underserved individuals. Certified diabetes educators, RNs, and telehealth services at three rural county health departments in Alabama implemented a DSMES program. Data were collected from participant registration forms, pre- and postintervention surveys, and telehealth surveys to assess participants' baseline and postintervention diabetes knowledge, self-care, and sense of self-efficacy. Blood pressure, glycated hemoglobin (HbA1c) levels, and weight were also measured before and after the intervention. Forty-two people attended the DSMES program and participated in its evaluation. The findings demonstrated that for this sample, telehealth was an effective and acceptable way to conduct DSMES. The substantial improvements in health status, coupled with the fact that most participants had never participated in a DSMES program before, highlight the untapped potential of such programs to increase access to diabetes education in underserved areas.


Assuntos
Diabetes Mellitus , Telemedicina , Alabama/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Hemoglobina A Glicada , Humanos , Autocuidado
11.
Am J Public Health ; 112(10): 1399-1403, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35952331

RESUMO

Rural communities are often underserved by public health testing initiatives in Alabama. As part of the National Institutes of Health's Rapid Acceleration of Diagnostics‒Underserved Populations initiative, the University of Alabama at Birmingham, along with community partners, sought to address this inequity in COVID-19 testing. We describe the participatory assessment, selection, and implementation phases of this project, which administered more than 23 000 COVID-19 tests throughout the state, including nearly 4000 tests among incarcerated populations. (Am J Public Health. 2022;112(10):1399-1403. https://doi.org/10.2105/AJPH.2022.306985).


Assuntos
COVID-19 , População Rural , Alabama , COVID-19/diagnóstico , COVID-19/epidemiologia , Teste para COVID-19 , Humanos , Populações Vulneráveis
12.
PLoS One ; 17(8): e0272370, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35925951

RESUMO

Hospitals acquire and maintain long-term operating assets such as land, buildings, and equipment. In this study, we analyzed hospitals' long-term assets acquisitions data extracted from the Medicare Cost Report, a mandatory annual filing for all Medicare-certified hospitals. The first objective of this study is to examine the time trend of land, buildings, and equipment acquisitions of all general acute care hospitals in the U.S. from 2005 to 2019 to understand the relative magnitude and temporal changes for the operating assets. The second objective is to examine the 15-year accumulated acquisitions of land, buildings, and equipment per capita in each state to understand the variations of potential access to hospital operating resources across states. To understand the longitudinal changes in acquisitions of operating assets for each year from 2005 to 2019, we calculated the total acquisition amounts across all hospitals for land, buildings, and equipment, respectively, and adjusted the amounts to 2019 dollars based on the consumer price index (CPI). For each state (including Washington D.C.) and the whole nation, the 15-year accumulated CPI-adjusted acquisition amounts per capita for land, buildings, and equipment were also calculated, respectively. The nationwide acquisitions of those operating assets grew rapidly from 2005 to 2008 followed by a negative overall growth from 2008 to 2014 and since 2015, started increasing steadily again. In 2019, U.S. general acute care hospitals acquired $3.0 billion of land, $44.6 billion of buildings, and $33.9 billion of equipment. Huge geographical variation in per capita cumulative total asset investment were also found with the first place North Dakota having a per capita investment that is almost four times higher than that in the lowest ranked state of Alabama.


Assuntos
Investimentos em Saúde , Medicare , Alabama , Hospitais , North Dakota , Estados Unidos
13.
Public Health Rep ; 137(5): 832-840, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35861310

RESUMO

Engaging communities is a key strategy to increase COVID-19 vaccination. The Centers for Disease Control and Prevention (CDC) COVID-19 Vaccine Confidence Rapid Community Assessment Guide was developed for community partners to obtain insights about barriers to COVID-19 vaccine uptake and to engage community partners in designing interventions to build vaccine confidence. In spring 2021, 3 CDC teams were deployed to Alabama and Georgia to conduct a rapid community assessment in selected jurisdictions. Data collection included interviews, listening sessions, observations, and street intercept surveys. We identified 3 facilitators and barriers to vaccine uptake: (1) planning and coordination, (2) capacity and implementation, and (3) attitudes and beliefs. We found that the use of the rapid community assessment in Alabama and Georgia was feasible to implement, useful in eliciting unique community concerns and dispelling assumptions, and useful in informing intervention strategies. Our results underscore the importance of community engagement in COVID-19 mitigation strategies.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Alabama/epidemiologia , Atitude Frente a Saúde , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Participação da Comunidade , Georgia/epidemiologia , Humanos
14.
Antimicrob Resist Infect Control ; 11(1): 95, 2022 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-35836272

RESUMO

BACKGROUND: Microbial etiology for community-acquired pneumonia (CAP) is evolving with pathogens known for high CAP mortality e.g., Pseudomonas species. Chronic obstructive pulmonary disease (COPD) patients are at risk for hospitalization for CAP. Understanding regional patterns and risk factors for multidrug-resistant (MDR) Pseudomonas acquisition has implications for antimicrobial stewardship. OBJECTIVES: To evaluate the regional epidemiology of MDR Pseudomonas CAP and its association with COPD. METHODS: We queried the electronic medical records of the University of Alabama at Birmingham Healthcare System to identify patients hospitalized for CAP with Pseudomonas positive respiratory samples between 01/01/2013-12/31/2019. Log binomial regression models were used to examine associations between COPD diagnosis and risk of Pseudomonas/MDR Pseudomonas CAP. RESULTS: Cohort consisted of 913 culture positive CAP cases aged 59-year (IQR:48-68), 61% (560) male, 60% (547) white, 65% (580) current/past smokers, and 42% (384) COPD. Prevalence of Pseudomonas CAP in culture positive CAP was 18% (167), MDR Pseudomonas CAP in Pseudomonas CAP was 22% (36), and yearly incidence of MDR Pseudomonas CAP was stable (p = 0.169). COPD was associated with Pseudomonas CAP (RR 1.39; 95% CI 1.01, 1.91; p = 0.041) but not with MDR Pseudomonas CAP (0.71; 95% CI 0.35, 1.45; p = 0.349). Stroke (RR 2.64; 95% CI 1.51, 4.61; p = 0.0006) and use of supplemental oxygen (RR 2.31; 95% CI 1.30, 4.12; p = 0.005) were associated with MDR Pseudomonas CAP. CONCLUSION: Incidence of MDR Pseudomonas CAP was stable over time. COPD was associated with Pseudomonas CAP but not with MDR Pseudomonas CAP. Larger cohort studies are needed to confirm findings.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Pneumonia , Infecções por Pseudomonas/epidemiologia , Pseudomonas/efeitos dos fármacos , Doença Pulmonar Obstrutiva Crônica/complicações , Idoso , Alabama/epidemiologia , Estudos de Coortes , Infecções Comunitárias Adquiridas/etiologia , Resistência a Múltiplos Medicamentos , Feminino , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Pseudomonas/patogenicidade , Infecções por Pseudomonas/microbiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fatores de Risco
15.
BMC Health Serv Res ; 22(1): 919, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35841096

RESUMO

BACKGROUND: Alabama is one of seven priority states for the National Ending the HIV Epidemic Initiative due to a large rural burden of disease. Mental health (MH) and substance use disorders (SUD) represent obstacles to HIV care in rural areas lacking Medicaid expansion and infrastructure. Evidence-informed technologies, such as telehealth, may enhance SUD and MH services but remain understudied in rural regions. METHODS: We conducted a readiness assessment using a mixed methods approach to explore opportunities for enhanced SUD and MH screening using electronic patient reported outcomes (ePROs) and telehealth at five Ryan White HIV/AIDS Program-funded clinics in AL. Clinic providers and staff from each site (N = 16) completed the Organizational Readiness to Implement Change (ORIC) assessment and interviews regarding existing services and readiness to change. People with HIV from each site (PLH, N = 18) completed surveys on the acceptability and accessibility of technology for healthcare. RESULTS: Surveys and interviews revealed that all clinics screen for depression annually by use of the Patient Health Questionnaire-9 (PHQ9). SUD screening is less frequent and unstandardized. Telehealth is available at all sites, with three of the five sites beginning services due to the COVID-19 pandemic; however, telehealth for MH and SUD services is not standardized across sites. Results demonstrate an overall readiness to adopt standardized screenings and expand telehealth services beyond HIV services at clinics. There were several concerns including Wi-Fi access, staff capacity, and patients' technological literacy. A sample of 18 people with HIV (PWH), ages 18 to 65 years, participated in surveys; all demonstrated adequate technology literacy. A majority had accessed telehealth and were not concerned about it being too complicated or limiting communication. There were some concerns around lack of in-person interaction and lack of a physical exam and high-quality care with telehealth. CONCLUSION: This study of PWH and the clinics that serve them reveals opportunities to expand SUD and MH services in rural regions using technology. Areas for improvement include implementing routine SUD screening, expanding telehealth while maintaining opportunities for in-person interaction, and using standardized ePROs that are completed by patients, in order to minimize stigma and bias.


Assuntos
COVID-19 , Infecções por HIV , Transtornos Relacionados ao Uso de Substâncias , Telemedicina , Adolescente , Adulto , Idoso , Alabama/epidemiologia , COVID-19/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Humanos , Saúde Mental , Pessoa de Meia-Idade , Pandemias , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Tecnologia , Estados Unidos , Adulto Jovem
16.
Public Health Rep ; 137(5): 826-831, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35861562

RESUMO

OBJECTIVE: Community of Hope Health Clinic (CHHC), a free and charitable clinic in Shelby County, Alabama, developed a screening protocol to identify patients with asymptomatic COVID-19 with the goal of minimizing infection risk for other patients, health care providers, and staff. We sought to determine whether the use of the CHHC screening protocol identified asymptomatic carriers of SARS-CoV-2 before their scheduled clinic visits. METHODS: The CHHC screening protocol included the use of an adapted Centers for Disease Control and Prevention questionnaire via telephone 48-72 hours before a scheduled clinic appointment, coupled with a second administration of the questionnaire and a temperature check immediately before the patient's scheduled visit. Patients with positive responses to any questions or whose temperatures were greater than 100.4 °F were refused entry to the clinic, their appointments were rescheduled, and a SARS-CoV-2 test was recommended. SARS-CoV-2 laboratory testing was conducted on all patients with an appointment from October 26, 2020, through February 18, 2021, to verify whether the screening protocol was effective. RESULTS: Of 298 patient encounters, 20 patients screened positive on the SARS-CoV-2 patient screen. Another 278 patients screened negative, were seen for patient care, and received a SARS-CoV-2 test via nasal swab; 274 (98.6%) patients received a negative test result, and 4 (1.4%) patients received a positive test result. CONCLUSIONS: The CHHC SARS-CoV-2 screening protocol, as validated by SARS-CoV-2 assay, was effective in screening out asymptomatic patients infected with SARS-CoV-2 before they were seen in clinic. As clinics and office practices return to prepandemic volumes, the use of such a screening protocol can help mitigate the risk of serious COVID-19 infection, especially for unvaccinated patients, health care providers, and staff.


Assuntos
COVID-19 , Alabama/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Pessoal de Saúde , Humanos , Saúde Pública , SARS-CoV-2
17.
J Med Entomol ; 59(5): 1678-1686, 2022 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-35851609

RESUMO

The insecticide sensitivity and resistance status of both adults and larvae from six Aedes albopictus samples collected in Tuskegee, Tuscaloosa, Birmingham, Dothan, Mobile, and Montgomery, Alabama, were evaluated for the levels of sensitivity and resistance to eight insecticides: ß-cyfluthrin, chlorpyrifos, deltamethrin, etofenprox, fenitrothion, permethrin, resmethrin, and malathion. Adult Ae. albopictus from all locations showed similar results for the difference between the time to 100% mortality and the diagnostic time in the CDC bottle bioassay, although Ae. albopictus survive longer than the diagnostic time to permethrin, fenitrothion, and resmethrin treatments. The larval bioassay indicated that malathion was the least toxic to Ae. albopictus from all locations (LC50: ranging from 0.1 ppm to 1.2 ppm), followed by resmethrin and etofenprox (LC50: 0.05 ppm-0.4 ppm), and deltamethrin and fenitrothion (LC50: 0.01 ppm-0.06 ppm). Chlorpyrifos exhibited the highest larval toxicity (LC50: 0.003 ppm-0.05 ppm). The resistance status of Ae. albopictus from all six locations was similar to the resistance levels found in a previous survey in 2004, indicating that in Alabama the development of resistance is slow in this strain, although comparing the resistance of Ae. albopictus from Tuskegee to that of a susceptible strain showed that it is resistant to chlorpyrifos. The slopes of the dose-response curves to most of the insecticides tested for these field populations of Ae. albopictus were generally similar to or slightly higher than those measured eighteen years previously, indicating that these populations are relatively homozygous in response to all the insecticides tested.


Assuntos
Aedes , Clorpirifos , Inseticidas , Alabama , Animais , Fenitrotion , Resistência a Inseticidas , Inseticidas/farmacologia , Larva , Malation , Mosquitos Vetores , Nitrilas , Permetrina , Piretrinas
18.
Complement Ther Clin Pract ; 49: 101639, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35841719

RESUMO

BACKGROUND: Mindfulness interventions can improve psychological distress and quality of life (QoL) in cancer survivors. Few mindfulness programs for cancer recovery exist in Southeastern U.S. The primary objective of this study was to assess the feasibility of a modified mindfulness-based stress reduction (MBSR) program for breast cancer patients in Birmingham, Alabama. The secondary objective was to explore potential program effects on mindfulness skills and QoL. METHODS: This study was a prospective, quasi-experimental feasibility study conducted over 10 months at a university hospital. Feasibility was achieved if 80% of eligible patients screened enrolled in the study and 70% of enrolled patients attended all 8 program sessions. Effectiveness was estimated by changes in mindfulness and QoL indicators measured with validated scales administered at 3 time points and assessed with a non-parametric Friedman test. Sessions included meditation, yoga, and an attention practice called body scan. There were 3 groups of 2-5 patients. RESULTS: The sample totaled 12 patients. Forty-four percent (12/27) of eligible patients enrolled in the study, and two out of 12 enrolled patients completed 8 program sessions, resulting in 16.7% (2/12) retention. However, more than half (66.7%) of participants completed at least 7 sessions. Between baseline and 8-week follow-up, patients demonstrated statistically significant improvements in distress, general wellbeing, and fatigue-related QoL. CONCLUSIONS: Feasibility objectives were not achieved. However, a majority of participants (66.7%) completed 7 of 8 program sessions. Program effects were promising for distress, fatigue, and wellbeing. Results warrant further research on MBSR-like programs for breast cancer patients in Alabama.


Assuntos
Neoplasias da Mama , Meditação , Atenção Plena , Feminino , Humanos , Neoplasias da Mama/terapia , Neoplasias da Mama/psicologia , Fadiga/terapia , Estudos de Viabilidade , Atenção Plena/métodos , Estudos Prospectivos , Qualidade de Vida/psicologia , Estresse Psicológico/terapia , Resultado do Tratamento , Alabama
19.
South Med J ; 115(7): 414-419, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35777746

RESUMO

OBJECTIVES: Increasing healthcare access is a Healthy People 2030 priority. This study examined healthcare access from the residents' perspective in the two most rural counties in the United States and compared the findings with data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) in rural and urban counties in Alabama. METHODS: We conducted an in-person population-based survey using cluster sampling within census tracts assessing health insurance coverage, having a usual primary care provider, having had a routine healthcare visit within the past year, and barriers to care. RESULTS: Among the 395 participants, 81.4% indicated having health insurance coverage, which was slightly lower than the BRFSS data for rural (87.6%) and urban counties in Alabama (87%); 89.6% of respondents indicated having a usual primary care provider compared with 84.3% of rural and 77.2% of urban residents; and 83.2% of participants indicated having had a routine healthcare visit in the last year compared with 77.3% of rural and 77.6% of urban residents. These indicators varied significantly across age, sex, and educational attainment and were consistent with BRFSS findings. CONCLUSIONS: Healthcare access, as indicated by health insurance coverage and healthcare utilization, among residents in the two most rural US counties is comparable to access among rural and urban Alabamians. Primary care is a highly used resource in rural areas, and further research should characterize other social/behavioral factors that may explain the poor health outcomes seen in rural areas. In addition, BRFSS data continue to offer a reliable picture of healthcare access in rural areas.


Assuntos
Acesso aos Serviços de Saúde , População Rural , Alabama/epidemiologia , Sistema de Vigilância de Fator de Risco Comportamental , Humanos , Estados Unidos
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