Diagnoses, prevalence, and state-based federal spending for HIV prevention and treatment in the United States, 2006-2009.

BACKGROUND: In response to an article published in 2012 by officials at the US Department of Health and Human Services (DHHS), an independent analysis of state-based federal resource allocation for HIV was conducted to determine if the funding accurately reflected diagnosis and prevalence rates. METHODS: Total state-based federal funding for HIV, state-based funding for HIV prevention, and state-based funding for HIV treatment were compared to state-based HIV diagnosis and prevalence rates from 2006-2009. RESULTS: Total state-based federal funding for HIV and funding for HIV prevention and treatment were highly correlated with HIV diagnosis and prevalence rates during the time horizon of the study; however, correlations between state-based HIV prevention funding and state-based HIV diagnosis rates were lower than the correlations between state-based HIV treatment funding and HIV prevalence. CONCLUSIONS: Our findings suggest that state-based federal resource allocation for HIV prevention and treatment may be better aligned with HIV diagnosis and prevalence rates than previously reported; however resource allocation for HIV prevention is less aligned than funding for HIV treatment signaling the need to reexamine state-based federal funding for HIV prevention.

Review of MPH practicum requirements in accredited schools of public health.

Accreditation criteria by the Council on Education for Public Health (CEPH) state that prior to graduation, Masters of Public Health (MPH) students must demonstrate the application of knowledge and skills through a practice experience, commonly called the "Practicum." The purpose of this research was to review those MPH Practicum requirements. Practicum guidelines from US-based schools of public health that were accredited as of October 2011 were reviewed. Data on each Practicum's level of coordination, timing, and credit and contact hours as well as information about written agreements, preceptors, and how the Practicum was graded were collected. Seventy-four Practicums in 46 accredited schools of public health were reviewed. The majority (85 %) of accredited schools controlled the Practicum at the school-level. Among the Practicums reviewed, most did not require completion of any credit hours or the MPH core courses (57 and 74 %, respectively) prior to starting the Practicum; 82 % required written agreements; 60 % had stated criteria for the approval of preceptors; and 76 % required students to submit a product for grading at the conclusion of the Practicum. The results of this research demonstrate that the majority of accredited schools of public health designed Practicum requirements that reflect some of the criteria established by CEPH; however, issues related to timing, credit and contact hours, and preceptor qualifications vary considerably. We propose that a national dialogue begin among public health faculty and administrators to address these and other findings to standardize the Practicum experience for MPH students.

Psychometric properties of an HIV knowledge scale administered with populations at high risk for HIV infection.

HIV prevention programs targeting men who have sex with men, Blacks, and young adults commonly use measures of HIV knowledge as an important component of demonstrating overall program effectiveness. These scales, however, are rarely subjected to repeated analysis to confirm reliability and validity and the results of psychometric analysis rarely include subpopulation variations. In this study, we administered an adapted version of a previously validated HIV knowledge scale to participants of a large, city-wide HIV prevention program (n = 5,027) and performed psychometric analysis to determine if differences existed across populations. Analysis showed that the HIV knowledge scale performed poorly for men who have sex with men, but very well for transgenders. Results were similar for Blacks, Hispanics, and Whites, very poor for 30- to 39-year-olds, but very well for 60+ year olds. Findings underscore the need for further research on the measurement of HIV knowledge among high-risk populations and the importance of culturally appropriate survey items tailored to each population.

From the Defense Health Board: Military Accessions and the Continuum of Mental Health Research.

The Defense Health Board conducted a year-long examination of mental health accession screening and related issues. In its August 2020 report, Examination of Mental Health Accession Screening: Predictive Value of Current Measures and Processes, the Board recommends a paradigm shift in how mental health impacts on readiness are understood and addressed. This shift can only occur with the development and implementation of a research plan that follows cohorts of military personnel from recruitment through their military career. The following article describes this research plan as an excerpt of the larger report.

Online learning to improve hand hygiene knowledge and compliance among health care workers.

BACKGROUND: The Centers for Disease Control and Prevention published a hand hygiene guideline for health care workers. The emergence of online learning approaches has introduced new opportunities for providing continuing education regarding hand hygiene. METHODS: This study assessed the effectiveness of an online continuing education program in increasing health care workers' knowledge of hand hygiene practices and guidelines and promoting behavioral change as measured by self-assessment of adherence to guidelines. A total of 256 health care workers at two hospitals completed all three sessions of the online continuing education program. RESULTS: Health care workers reported a significant improvement in hand hygiene knowledge and self-assessed compliance with hand hygiene behaviors. Most (97%) of the participating health care workers reported that the program was effective in improving clinical compliance behaviors. CONCLUSION: The results of this study indicated that individual health care workers can and will use self-assessment to prompt improvement in hand hygiene.

Medical education goes to prison: why?

The authors describe a pilot medical education program that developed a new and ongoing correctional medicine curriculum for third- and fourth-year medical students at Nova Southeastern University College of Osteopathic Medicine. During the first two years of the pilot program (2000-02), a total of 53 students were placed in one-month rotations in prison health care settings. Students received orientations, directed readings, and prison clinic experience under the director of board-certified physician preceptors. An evaluation of the pilot experience was conducted by student survey. The findings indicate that students had positive experiences related to continuity of care, access to pathology, access to procedures, and exposure to a unique managed care model. Students requested more structured curriculum and more opportunities to develop content understanding of the unique clinical aspects of prison health care. The authors conclude that given the increasing U.S. prison population, the constitutional requirement to provide medical care to inmates, and demand for career-oriented correctional physicians, the favorable outcome of this pilot educational program provides support for implementing such programs in medical schools throughout the country. They also speculate that the program may encourage some students to practice in correctional institutions as a career.

Suicidal behaviors among adolescents in juvenile detention: role of adverse life experiences.

PURPOSE: The purpose of this study was to assess the influence of multiple adverse life experiences (sexual abuse, homelessness, running away, and substance abuse in the family) on suicide ideation and suicide attempt among adolescents at an urban juvenile detention facility in the United States. MATERIALS AND METHODS: The study sample included a total of 3,156 adolescents processed at a juvenile detention facility in an urban area in Ohio between 2003 and 2007. The participants, interacting anonymously with a voice enabled computer, self-administered a questionnaire with 100 items related to health risk behaviors. RESULTS: Overall 19.0% reported ever having thought about suicide (suicide ideation) and 11.9% reported ever having attempted suicide (suicide attempt). In the multivariable logistic regression analysis those reporting sexual abuse (Odds Ratio = 2.75; 95% confidence interval  = 2.08-3.63) and homelessness (1.51; 1.17-1.94) were associated with increased odds of suicide ideation, while sexual abuse (3.01; 2.22-4.08), homelessness (1.49; 1.12-1.98), and running away from home (1.38; 1.06-1.81) were associated with increased odds of a suicide attempt. Those experiencing all four adverse events were 7.81 times more likely (2.41-25.37) to report having ever attempted suicide than those who experienced none of the adverse events. CONCLUSIONS: Considering the high prevalence of adverse life experiences and their association with suicidal behaviors in detained adolescents, these factors should not only be included in the suicide screening tools at the intake and during detention, but should also be used for the intervention programming for suicide prevention.

Prescription drug abuse among adolescent arrestees: correlates and implications.

This preliminary study examines the correlates of prescription drug abuse in a sample of adolescents in an urban juvenile detention center in Ohio. The study measures risk in 359 incarcerated females (20.1%) and 1,425 males (79.9%) by asking questions related to problems with alcohol, drug use, treatment history, mental and physical health problems, sexual behavior, anger management, physical violence, and family support. The results of the study suggest that incarcerated adolescents may benefit from interventions targeting prescription drug misuse. Female adolescent detainees abuse prescription drugs at a higher level than male adolescent detainees (17% vs. 10%). The correlates of prescription drug abuse are complex and multidimensional and offer opportunities for further study.

Brief motivational intervention to reduce HIV risk and to increase HIV testing among offenders under community supervision.

Risky drug- and sex-related behaviors put criminal offenders at high risk for HIV. Intervening with this population under supervision can potentially reduce risk. This study reports a randomized trial that examines the efficacy of brief negotiation interviewing (BNI) compared to usual education activities. BNI is a computerized, self-directed intervention that combines a short structured interview with a brief counseling session. The study examined whether BNI could decrease HIV risks and increase testing for HIV in a cohort of criminal-justice-involved clients. The trial randomly assigned 212 participants to experimental (108) and control (104) conditions. Interview data were collected at baseline and at 2-month follow-up. Results indicate that the BNI intervention group had a significantly higher rate of HIV testing and was more likely to consider behavioral changes.

Using computers to reduce medication misuse of community-based seniors: results of a pilot intervention program.

Persons over the age of 65 are at high risk for conditions related to medication misuse. Addressing this issue is important to prevent serious outcomes such as falls, drug interactions, rehospitalization, and addiction. The role of community-based organizations, such as senior centers, in preventing medication misuse can be enhanced by the use of standardized interventions. This article reports a pilot project implementing laptop computer interventions for medication misuse by seniors. The study was conducted in Cleveland, Ohio, with 412 seniors participating in Area Agency on Aging programs. Seniors completed a computerized simple screening for medication misuse and watched short video clips related to their own potential misuse. Seniors also received a medication reminder checklist and a 7-day pill-dispensing box. Results of a 2-month follow-up interview revealed promising results, with 55% of participants using the medication reminder checklist. One-third of participants visited their doctor to discuss the medication misuse feedback. Almost all of the participants found the computerized administration of the intervention to be easy and helpful. The study supports the further development of community-based interventions for seniors using computerized administration.