Trends in Health Care Access Disparities Among Asian and Pacific Islander Health Fair Participants in Los Angeles, 2011-2019.

OBJECTIVES: Given several efforts to improve health care access in California and nationally, we studied whether linguistic and socioeconomic disparities in health care access changed from 2011 to 2019 among Asian and Pacific Islander American (APIA) people in Los Angeles, California. METHODS: We analyzed survey responses from APIA health fair participants (n = 5032) in the Greater Los Angeles area from May 15, 2011, through October 20, 2019. To assess the effect of socioeconomic factors on and shifts in health care access (ie, health insurance status/regular doctor), we used a logistic regression model. Covariates included English proficiency, year, age, sex, ethnicity, income, employment, and education. We also ran an interaction analysis between English proficiency and year. RESULTS: Health insurance access increased and doctor access remained stable throughout the study period; however, disparities in health insurance status widened by a factor of 1.08 per year between participants with high English proficiency (HEP) and participants with low English proficiency (LEP) (P = .01). People with HEP were 2.02 times more likely to have a regular doctor than people with LEP (P < .001), and this disparity persisted from 2011 to 2019 (P = .58). Participants who were young (P < .001) and male (P = .005) were significantly less likely to have health insurance and a regular doctor (P < .001) than participants who were older and female. Chinese participants were significantly more likely than Thai (P = .002) and Korean (P < .001) participants to be insured but not more likely to have a regular doctor, when controlling for health insurance. CONCLUSIONS: Policy changes targeting language and cultural barriers to care for APIA people with LEP may address the disparities observed.

Development of an Effective Electronic Medical Record for Student-Run Free Health Fairs Using Research Electronic Data Capture (REDCap) Software.

BACKGROUND: The University of Miami Mitchell Wolfson Sr. Department of Community Service (DOCS) is a student-run organization providing free health care to the medically underserved in South Florida. For a large organization providing care to thousands of people per year, an effective electronic medical record (EMR) is necessary to keep track of patient records. METHODS: A REDCap project was configured in a way that allows it to mimic a basic EMR. This was done by assigning patients medical record numbers, creating repeating events allowing patient results to be seen over time, and incorporating extensive logic to facilitate clinical decision-making. RESULTS: DOCS was able to create a basic EMR using REDCap and has seen success with this approach. DISCUSSION: REDCap is capable of functioning as a robust, basic EMR which can be suitable for any purpose. It is HIPAA-compliant, comprehensive and low-cost, making it suitable for serving underserved populations.

Exploring the utility of nursing student-led health fairs: Educating the college population.

OBJECTIVE: The purpose of this study is to examine public health nursing (PHN) students' experiences delivering peer-to-peer health education to college students during a health fair. DESIGN: A qualitative, descriptive research design was used. SAMPLE: Senior-level nursing students (n = 13) completing the clinical portion of a PHN course. MEASUREMENTS: A semi-structured focus group guide consisting of 10 questions and follow-up probes was used to elicit PHN student experiences. Focus groups were recorded, transcribed, and analyzed using a thematic analysis technique. RESULTS: Five main themes were identified: (1) benefits of health fairs in general, (2) benefits of nursing-student-led health fairs, (3) negatives of nursing-student-let health fairs, (4) importance of interaction, and (5) suggestions for maximizing the potential of nursing student-led health fairs. CONCLUSIONS: Although challenges exist, PHN students experienced several benefits from the provision of peer-to-peer health education. College campuses represent a unique clinical site that allows nursing students to utilize their insider status to better assess, understand, and provide tailored health education to the college community. This clinical site has shown to provide positive experiences for nursing students and is critical in developing essential nursing skills and building confidence for future clinical rotations.

The Agreement Between an iPad Visual Field App and Humphrey Frequency Doubling Technology in Visual Field Screening at Health Fairs.

PRECIS: This is the first exploratory study demonstrating the promising potential of app-based visual fields testing in a low-resource health fair setting for community screening of high-risk Latino adults. PURPOSE: To compare the "Visual Fields Easy" (VFE) iPad application against the Humphrey Frequency Doubling Technology (FDT) N-30-5 in detecting abnormal visual fields in a low-resource health fair setting. METHODS: Latinos aged 40 to 80 years were recruited at a health fair in Los Angeles, California, in November 2017. Both eyes were tested using VFE and FDT. To account for possible nested correlations between participants and eyes, linear mixed effects models were used to estimate the difference in test time and the association in percent of missed points. A Bland-Altman plot and receiver operator characteristic curve were constructed for further comparisons. RESULTS: Forty-five participants with a mean age of 58.5 years (SD=9.5 y) were recruited and both eyes were tested (90 eyes). VFE testing took on average 141 seconds longer per eye than FDT (95% confidence interval: 137-145 s), and FDT resulted in having 7.50% more missed points than VFE (95% confidence interval: 2.56%-12.43%, P=0.002). The Bland-Altman plot depicted reduced agreement with increasing average of percent of points missed. The sensitivity and specificity of VFE were 67% and 77%, respectively, with an area under the receiver operator characteristic curve of 0.71. CONCLUSIONS: In this exploratory study, VFE exhibited moderate discrimination for identifying Latino adults with abnormal visual fields compared with FDT. Agreement between FDT and VFE was greater for patients with mild-to-moderate visual field loss. Further software enhancements of app-based fields testing, in concert with other portable testing, represents promising screening methods for high-risk groups in resource-limited environments.

Early childhood oral health promotion for First Nations and Métis communities and caregivers in Manitoba. / Promotion de la santé buccodentaire des jeunes enfants auprès des collectivités et des fournisseurs de soins des Premières Nations et des Métis du Manitoba.

INTRODUCTION: Early childhood caries is a public health concern, and the considerable burden exhibited by Indigenous children highlights the oral health inequities across populations in Canada. Barriers include lack of access to oral health care and lack of culturally appropriate oral health promotion. The purpose of this study was to determine where and how First Nations and Métis parents, caregivers and community members learn about caring for young children's oral health, and what ideas and suggestions they have on how to disseminate information and promote early childhood oral health (ECOH) in Indigenous communities. METHODS: Sharing circles and focus groups engaged eight groups of purposively sampled participants (n = 59) in four communities in Manitoba. A grounded theory approach guided thematic analysis of audiorecorded and transcribed data. RESULTS: Participants said that they learned about oral health from parents, caregivers and friends, primary care providers, prenatal programs, schools and online. Some used traditional medicines. Participants recommended sharing culturally appropriate information through community and prenatal programs and workshops; schools and day care centres; posters, mailed pamphlets and phone communication (calls and text messages) to parents and caregivers, and via social media. Distributing enticing and interactive oral hygiene products that appeal to children was recommended as a way to encourage good oral hygiene. CONCLUSION: Evidence-based oral health information and resources tailored to First Nations and Métis communities could, if strategically provided, reach more families and shift the current trajectory for ECOH.

Prevalence of Hypertension in Homeless Adults: An Interprofessional Education Community-Based Health Fairs Cross-Sectional Study in Urban Long Beach, California.

INTRODUCTION: Hypertension (SBP/DBP > 130/80 mmHg) is a leading risk factor for cardiovascular disease worldwide. AIM: To determine the prevalence of hypertension in a homeless community during an interprofessional education (IPE)-based health fair. METHODS: Homeless participants were recruited between August 2019-September 2019. Faculty, nursing, and pharmacist students, educated 477 participants, aged 18-80 years, on the risk factors associated with untreated hypertension. Then, participants self-completed the consented demographic survey questionnaire. Finally, the sitting blood pressure (BP) was recorded three times based on a standardized procedure, using Omron BPN monitor with cuff. RESULTS: Seven pharmacy students, nine nursing students, two registered nurses, five registered pharmacists, and two medical doctors collaboratively provided health education to the homeless community and screened their sitting BP. 390/477 (81.8%) of participants satisfied the inclusion criteria. Participants (54.7%) of the reported education level was at the high School level or less. More than the half of the participants (average age of 51 ± 13 years) had hypertension (median SBP/DBP ≥ 130/82.7 mmHg), respectively. The prevalence of hypertension for the overall cohort was 61.52% (95% CI, 56.59-66.35). Age (p value = 0.000) was significantly associated with hypertension based on the binary logistic analysis. CONCLUSION: This study demonstrated a high prevalence of hypertension in the homeless community in Long Beach, California with high risk of cardio-vascular events or strokes. This works sheds new light on an issue of major public health significance and points to the need for fostering IPE community-based health fairs intervention program for the US homeless population.

Lead Health Fairs: A Community-Based Approach to Addressing Lead Exposure in Chicago.

Lead exposure has been linked to neurological, reproductive, and developmental effects, and approximately 3.5% of Chicago children under the age of 3 years have elevated blood lead levels. The aim of this research was to provide outreach opportunities to address the issue of lead exposure in water and soil. A series of seven community-based health fairs were held with a combined approach of screening and education accomplished through partnerships with organizations established within underserved communities that leveraged resources. Community members attending the fairs brought in samples of soil from their yards and tap water for lead testing. Lead concentrations in the soil samples had a mean value of 305.7 parts per million, and 30% of the samples were above the Environmental Protection Agency's action level for children's play lots. The mean lead concentration in tap water was 8.3 parts per billion, with 6% of sample testing above the Environmental Protection Agency's action level. There was no significant correlation between the lead levels in water and soil (p = .21), and there was no significant difference between the average lead concentrations in different areas of the city. A multifaceted approach was utilized to educate and engage and ultimately empower the communities affected by exposure to lead in urban settings.

Cross-Sectional Survey of Two Community-Based Health Fairs: Demographics, Healthcare Attitudes, and Hepatitis B.

Asian Americans Pacific Islanders (AAPI) share a disproportionate burden of chronic hepatitis B (CHB) in both the United States and New York State. Current hepatitis B virus (HBV) screening and research efforts have focused on urban communities. We administered a cross-sectional survey to 64 attendants at two free health fairs hosted by AAPI organizations on suburban Long Island, New York. We report the demographic make-up, healthcare attitudes, and HBV-related health histories of event attendees in Nassau and Suffolk Counties. Participants in Nassau County generally had more access to healthcare (97.1% vs 74.1% insured, 91.4% vs. 63.0% annual physician visit) and more familiarity with HBV screening (57.1% vs 17.2% history of HBV screening, 42.9% vs 3.9% physician recommendation for HBV screening). AAPI are a heterogenous population. Communities in close proximity may be demographically distinct and efforts to screen for HBV should be tailored to individual communities.

A public health approach to cervical cancer screening in Africa through community-based self-administered HPV testing and mobile treatment provision.

The World Health Organization (WHO) refers to cervical cancer as a public health problem, and sub-Saharan Africa bears the world's highest incidence. In the realm of screening, simplified WHO recommendations for low-resource countries now present an opportunity for a public health approach to this public health problem. We evaluated the feasibility of such a public health approach to cervical cancer screening that features community-based self-administered HPV testing and mobile treatment provision. In two rural districts of western-central Uganda, Village Health Team members led community mobilization for cervical cancer screening fairs in their communities, which offered self-collection of vaginal samples for high-risk human papillomavirus (hrHPV) testing. High-risk human papillomavirus-positive women were re-contacted and referred for treatment with cryotherapy by a mobile treatment unit in their community. We also determined penetrance of the mobilization campaign message by interviewing a probability sample of adult women in study communities about the fair and their attendance. In 16 communities, 2142 women attended the health fairs; 1902 were eligible for cervical cancer screening of which 1892 (99.5%) provided a self-collected vaginal sample. Among the 393 (21%) women with detectable hrHPV, 89% were successfully contacted about their results, of which 86% returned for treatment by a mobile treatment team. Most of the women in the community (93%) reported hearing about the fair, and among those who had heard of the fair, 68% attended. This public health approach to cervical cancer screening was feasible, effectively penetrated the communities, and was readily accepted by community women. The findings support further optimization and evaluation of this approach as a means of scaling up cervical cancer control in low-resource settings.

Construcción de una red colectiva: la feria en el cotidiano de un asentamiento rural / Construction of a collective network: the fair in the daily living of a rural settlement

La fotografía en cuestión trae una reflexión sobre las relaciones colectivas que impregnan la vida cotidiana en un asentamiento rural, ubicado en Brasil. Aspecto que marca así los modos de vida que se establecen en este territorio. La feria es un ejemplo que demuestra estas relaciones, es entonces una estrategia de ayuda mutua que promueve y mejora las redes de cooperación comunitaria y lazos de interdependencia para superar los desafíos que suceden en la vida de todos los días

The photograph in question brings a reflection about the collective relations that permeate the everyday of a rural settlement, located in Brazil. This aspect marks the ways of life established in this territory. The fair is a mutual aid strategy that promotes the community cooperation networks and interdependence bonds, necessary to overcome the challenges that happen on the daily living

Population screening for atrial fibrillation by student pharmacists at health fairs.

BACKGROUND: Individuals with unrecognized atrial fibrillation (AF) may be at an increased risk of stroke. There is a need to develop a sustainable and reproducible population-based screening model to identify unrecognized AF. OBJECTIVE: The objective of this study is to evaluate AF screening and education at student pharmacist-driven health fairs. METHODS: Screening for AF was performed by student members of the American Pharmacist Association Academy of Student Pharmacists with preceptor oversight. Participants were screened using the KardiaMobile device (AliveCor, Mountain View, CA), a Food and Drug Administration-cleared device that interprets a medical-grade electrocardiogram in 30 seconds. Student pharmacists also calculated a CHA2DS2-VASc score. Participant education was provided using an American Heart Association AF patient information sheet. Learning assessment was evaluated with 3 multiple choice questions. RESULTS: Students screened a total of 697 participants over a 6-month period at 13 health fairs. Overall, 71% of the participants were women aged 56 ± 15 years (mean ± SD). Sixteen of the participants (2.3%) who were screened received results indicating possible AF. None of the participants with a possible positive finding had symptoms suggestive of AF. Of these 16 participants, 11 (69%) had a CHA2DS2-VASc score greater than or equal to 2 (2.7 ± 0.7). Most participants answered each learning assessment question correctly. More than 95% of participants believed that screening for AF at health fairs was important or very important. CONCLUSION: Student pharmacist-driven health fairs were shown to be feasible models to screen for AF and were effective in providing AF education to the public. Student pharmacists also cultivated a clinical skill that is transferable to their future practice setting, including the community pharmacy setting. Additional studies are needed to assess whether population-based real-time assessment and detection of AF can reduce the risk of stroke in individuals with previously undetected AF.

Construção de cartilha educativa sobre cuidados com crianças frente à pandemia covid-19: relato de experiência / Construcción de un folleto educativo sobre el cuidado infantil frente a la pandemia covid-19: informe de experiencia / Construction of an educational booklet on child care before the covid-19 pandemic: experience report

Objetivo relatar a experiência da produção e divulgação de tecnologia, em forma de cartilha educativa, para informar e orientar sobre os cuidados com as crianças frente à pandemia da COVID-19. Metodologia trata-se de relato de experiência sobre a construção de uma cartilha on-line e gratuita, tendo como público-alvo crianças a partir de dois anos de idade, os pais ou responsáveis e a comunidade. A construção foi realizada por estudantes de enfermagem, em maio de 2020. Resultados a construção da cartilha possibilitou a integração entre pesquisadoras, educadores e comunidade. O produto foi amplamente divulgado e houve retorno positivo das orientações passadas de forma lúdica, fidedignas e acessíveis. Conclusão a experiência oportunizou a disseminação de informações seguras, com fontes confiáveis e embasamento científico, além da integração das pesquisadoras à comunidade. Ampliou o vínculo extramuros da Universidade, fator imprescindível para atuação junto à população.

Objetivo informar la experiencia de la producción y difusión de tecnología, en forma de folleto educativo, para informar y orientar sobre el cuidado de los niños frente a la pandemia de COVID-19. Metodología este es un informe de experiencia sobre la construcción de un folleto en línea y gratuito, dirigido a niños a partir de dos años de edad, padres o tutores y la comunidad. La construcción fue llevada a cabo por estudiantes de enfermería en mayo de 2020. Resultados la construcción del folleto permitió la integración entre investigadores, educadores y la comunidad. El producto fue ampliamente difundido y hubo un retorno positivo de las orientaciones anteriores de una manera lúdica, fiable y accesible. Conclusión la experiencia permitió la difusión de información segura, con fuentes fiables y base científica, además de la integración de los investigadores en la comunidad. Amplió el vínculo extramuros de la Universidad, un factor indispensable para trabajar con la población.

Objective to report the experience of producing and disseminating technology as an educational booklet, to inform and guide about the childcare before the COVID-19 pandemic. Methodology this is an experience report on the construction of an online and free booklet, targeting children from two years of age, parents or guardians and the community. The construction was carried out by nursing students in May 2020. Results the construction of the booklet allowed integrating researchers, educators and the community. The product was widely disseminated and there was a positive return of the provided guidelines in a playful, reliable and accessible way. Conclusion the experience allowed for the dissemination of safe information, with reliable sources and scientific basis, in addition to integrating researchers into the community. It expanded the extramural bond of the University, an indispensable factor for working with the population.

Public survey reactions to an arts-based educational menopausal hot flash exhibit.

OBJECTIVE: The aim of this study was to obtain public survey reactions to concept art for an exhibit about menopausal hot flashes designed to stimulate learning, dispel myths, spur dialogue, and increase empathy. METHODS: Immediately before viewing the art, participants provided demographic information and answered one open-ended question. Immediately after viewing the art, participants answered the same open-ended question, one additional open-ended question, and completed quantitative survey questions. RESULTS: Overall, public reactions to the concept art were positive. Qualitative and quantitative data indicated that the public thought the exhibit was appealing, stimulated learning, dispelled myths, spurred desire to have conversations about hot flashes, and increased empathy for women with menopausal hot flashes. CONCLUSIONS: The exhibit concept art was appealing and was reported to have a positive impact on the public. Study findings provide support for building the exhibit full-scale as a traveling educational resource that might change public discourse around menopausal hot flashes.

An arts-based educational exhibit on menopausal hot flashes.

OBJECTIVE: The aim of this study was to describe the development process, science, and symbolism of an arts-based educational exhibit designed to address myths, misinformation, negative imagery, and use of unproven treatments related to menopausal hot flashes. METHODS: The development process included iterative and informal feedback from a variety of individuals, a partnership with an experienced exhibit designer, and collaborations between artists and scientists. RESULTS: The resulting exhibit creates an environment where the public is immersed in accurate information about hot flashes. Although based on an iterative process, the resulting exhibit content reflects an estimated 500+ scientific studies, including those referenced in The North American Menopause Society position statements on hormone and nonhormone management of hot flashes. The seven main exhibit pieces convey scientific information and symbolize various aspects of women's experiences. CONCLUSIONS: This innovative exhibit has high potential to be a disruptive innovation to address the preponderance of myths, misinformation, and negative imagery surrounding menopausal hot flashes and potentially decrease the use of unproven therapies.

Screening children for type 1 diabetes-associated antibodies at community health fairs.

OBJECTIVE: The incidence of type 1 diabetes (T1D) is increasing, most notably in young children and in racial and ethnic minorities. Historically, screening for risk with T1D-associated antibodies has been limited to those with a family history, while up to 90% of newly diagnosed patients lack such a family history. To address the needs to screen diverse ethnic groups in the general population, we screened children for T1D-associated antibodies in the Denver, Colorado metro area at community health fairs. METHODS: Children attending health fairs from 2015 to 2018 were offered free T1D screening by measuring the four prototypical T1D-associated antibodies. A finger stick capillary puncture was performed to collect blood spots on filter paper. Dried blood spots (DBSs) were eluted and antibodies were measured using fluid-phase radio-binding assays. RESULTS: At 39 health fairs, children were educated on the signs and symptoms of diabetes, and screened for T1D-associated antibodies (n = 478), which represented 90% of those that attended. Median age was 9.0 years (range of 1-18) with diverse ethnic backgrounds: 37% Hispanic, 31% Caucasian, 20% African American, and 12% other. Nine children screened positive for antibodies, single n = 8 and multiple n = 1, and confirmation with serum samples showed excellent correlation to the measurements from DBSs for antibodies directed against GAD, IA-2, and ZnT8 (P < .01 for each). CONCLUSIONS: Screening for T1D risk at community health fairs using DBSs on filter paper is feasible and provides an avenue to screen children from ethnically diverse backgrounds.

At-Risk Stakeholder Behavior Change with Community-Based Health Events.

Community-based interventions such as health fairs feature diagnostic and preventive services that are useful to address health disparities in underserved stakeholders. Quantitative evaluation of these events presents challenges. This study applied the contemplation stage of the Trans-Theoretical Model of Behavioral Change (TTM-C) to evaluate health disparity-focused community interventions. Most of the 412 event participants self-identified as lower socioeconomic status (54%), overweight (74%), female (74%), and African American (83%). After event participation, stakeholders demonstrated significant improvement in overall TTM-C scores based on a standard t-test, where pre-event scores (M=30.8, SD=7.0) and post-event scores (M=32.3, SD=6.9) conditions t(346)=5.167, p=.001. For health disparity-related community events, underserved African American women are most likely to recognize a specific health issue and seek ideas about how to address it during these events. This study validates TTM-C behavioral change as a novel means to evaluate community health events.

A Multilevel Intervention With African American Churches to Enhance Adoption of Point-of-Care HIV and Diabetes Testing, 2014-2018.

We describe a multilevel intervention to enhance adoption of point-of-care HIV and diabetes testing at church health fairs in Atlanta, Georgia. Church leaders viewed a leadership video and subsequently conducted social activities that support testing. After the multilevel intervention, a third of churches hosted HIV and diabetes health fairs, and church leaders engaged in more social activities. Of 193 attendees receiving health services, 56.6% received HIV testing and 92.7% received diabetes testing. This implementation science approach could reduce HIV and diabetes disparities among African Americans.

Hearing Screening in the Community.

BACKGROUND: Adults typically wait 7-10 yr after noticing hearing problems before seeking help, possibly because they are unaware of the extent of their impairment. Hearing screenings, frequently conducted at health fairs, community events, and retirement centers can increase this awareness. To our knowledge, there are no published studies in which testing conditions and outcomes have been examined for multiple "typical screening events." PURPOSE: The purpose of this article is to report hearing screening outcomes for pure tones and self-report screening tests and to examine their relationship with ambient noise levels in various screening environments. STUDY SAMPLE: One thousand nine hundred fifty-four individuals who completed a hearing screening at one of 191 community-based screening events that took place in the Portland, OR, and Tampa, FL, metro areas. DATA COLLECTION AND ANALYSIS: The data were collected during the recruitment phase of a large multisite study. All participants received a hearing screening that consisted of otoscopy, pure-tone screening, and completion of the Hearing Handicap Inventory-Screening Version (HHI-S). In addition, ambient sound pressure levels were measured just before pure-tone testing. RESULTS: Many more individuals failed the pure-tone screening (n = 1,238) and then failed the HHI-S (n = 796). The percentage of individuals who failed the pure-tone screening increased linearly with age from <20% for ages <45 yr to almost 100% for individuals aged ≥85 yr. On the other hand, the percentage of individuals who failed the HHI-S remained unchanged at approximately 40% for individuals aged ≥55 yr. Ambient noise levels varied considerably across the hearing screening locations. They impacted the pure-tone screen failure rate but not the HHI-S failure rate. CONCLUSIONS: It is important to select screening locations with a quiet space for pure-tone screening, use headphones with good passive attenuation, measure sound levels regularly during hearing screening events, halt testing if ambient noise levels are high, and/or alert individuals to the possibility of a false-positive screening failure. The data substantiate prior findings that the relationship between pure-tone sensitivity and reported hearing loss changes with age. Although it might be possible to develop age-specific HHI-S failure criteria to adjust for this, such an endeavor is not recommended because perceived difficulties are the best predictor of hearing health behaviors. Instead, it is proposed that a public health focus on education about hearing and hearing loss would be more effective.