Assessing Community Health Needs in a Rural Area: Determining Best Practices to Meet New Affordable Care Act Requirements

We conducted a review of the peer-reviewed literature focused on conducting community health needs assessments and highlighted the necessary steps to conduct a community health needs assessment in a rural community. From the literature review, we identified three steps necessary— establishing partnerships, using a mixed methods approach, and disseminating results—to successfully conduct a needs assessment that fitted the definition of the Affordable Care Act. These three steps have been used as a guide for developing a protocol for conducting a community health needs assessment in Meadville, PA. We detail our preliminary project protocol here.

The health and economic benefits of the global programme to eliminate lymphatic filariasis (2000–2014)

Background:Lymphatic filariasis(LF),also known as elephantiasis,is a neglected tropical disease(NTD)targeted for elimination through a Global Programme to Eliminate LF(GPELF).Between 2000 and 2014,the GPELF has delivered 5.6 billion treatments to over 763 million people.Updating the estimated health and economic benefits of this significant achievement is important in justifying the resources and investment needed for eliminating LF.Method:We combined previously established models to estimate the number of clinical manifestations and disability-adjusted life years(DALYs)averted from three benefit cohorts(those protected from acquiring infection,those with subclinical morbidity prevented from progressing and those with clinical disease alleviated).The economic savings associated with this disease prevention was then analysed in the context of prevented medical expenses incurred by LF clinical patients,potential income loss through lost-labour,and prevented costs to the health system to care for affected individuals.The indirect cost estimates were calculated using the human capital approach.A combination of four wage sources was used to estimate the fair market value of time for an agricultural worker with LF infection(to ensure a conservative estimate,the lowest wage value was used).Results:We projected that due to the first 15 years of the GPELF 36 million clinical cases and 175(116–250)million DALYs will potentially be averted.It was estimated that due to this notable health impact,US$100.5 billion will potentially be saved over the lifetimes of the benefit cohorts.This total amount results from summing the medical expenses incurred by LF patients(US$3 billion),potential income loss(US$94 billion),and costs to the health system(US$3.5 billion)that were projected to be prevented.The results were subjected to sensitivity analysis and were most sensitive to the assumed percentage of work hours lost for those suffering from chronic disease(changing the total economic benefit between US$69.30–150.7 billion).Conclusions:Despite the limitations of any such analysis,this study identifies substantial health and economic benefits that have resulted from the first 15 years of the GPELF,and it highlights the value and importance of continued investment in the GPELF.

Delivery of public health services by community health workers(CHWs)in primary health care settings in China:a systematic review(1996–2016)

Background:Community Health Workers(CHWs)have been widely used in response to the shortage of skilled health workers especially in resource limited areas.China has a long history of involving CHWs in public health intervention project.CHWs in China called village doctors who have both treatment and public health responsibilities.This systematic review aimed to identify the types of public health services provided by CHWs and summarized potential barriers and facilitating factors in the delivery of these services.Methods:We searched studies published in Chinese or English,on Medline,PubMed,Cochrane,Google Scholar,and CNKI for public health services delivered by CHWs in China,during 1996-2016.The role of CHWs,training for CHWs,challenges,and facilitating factors were extracted from reviewed studies.Results:Guided by National Basic Public Health Service Standards,services provided by CHW covered five major areas of noncommunicable diseases(NCDs)including diabetes and/or hypertension,cancer,mental health,cardiovascular diseases,and common NCD risk factors,as well as general services including reproductive health,tuberculosis,child health,vaccination,and other services.Not many studies investigated the barriers and facilitating factors of their programs,and none reported cost-effectiveness of the intervention.Barriers challenging the sustainability of the CHWs led projects were transportation,nature of official support,quantity and quality of CHWs,training of CHWs,incentives for CHWs,and maintaining a good rapport between CHWs and target population.Facilitating factors included positive official support,integration with the existing health system,financial support,considering CHW’s perspectives,and technology support.Conclusion:CHWs appear to frequently engage in implementing diverse public health intervention programs in China.Facilitators and barriers identified are comparable to those identified in high income countries.Future CHWs-led programs should consider incorporating the common barriers and facilitators identified in the current study to maximize the benefits of these programs.

Utilization of HIV and Sexually Transmitted Infections Prevention Services, and Associated Factors among the Long-Distance Truck Drivers along the Northern Corridor Highway, Kenya

Background: Often, long-distance truck drivers’ (LDTDs’) work predisposes them to sexually transmitted infections (STIs) whose outcomes are influenced by access and behavior of seeking sexual health care. Methodology: In this study, we assessed the utilization of HIV/STI preventive services and associated factors among 296 LDTDs operating along the northern corridor highway using an interviewer-administered questionnaire for data collection at Mlolongo stopover in Machakos, Kenya. Responses for the investigated variables, including condom use, history of HIV testing, frequency of HIV testing, antiretroviral therapy (ART) use and follow-up for the HIV positive and STI treatment, were assigned a score of either 1 or 0 depending on the question’s dimension. Following summing up for each participant, we computed a weighted score ranging between 0 and 1 by dividing the summed responses by the number of eligible variables. We arbitrarily multiplied these scores by 8 to generate endpoint scores ranging from one to eight for each participant to help create a dichotomized outcome variable for utilization levels: limited utilization (1 to 4) and good utilization (5 to 8). Association between certain independent variables and the outcome variable (level of utilization of H.I.V./STIs preventive services) was analyzed using binomial logistic regression analysis in R statistical software. Results: The mean age of the LDTDs was 38.4 years, ranging from 24 - 57 years. The majority (n = 287, 97%) of the LDTDs had been tested on HIV at least once since the beginning of their career. Only 4.9% of the LDTDs had been tested on HIV within the previous three months. Of the 175 LDTDs who reported a history of STI, most (n = 173, 98.9%) of them had sought treatment. Condom use rates were higher (97.1%) among the LDTDs who had sexual interactions with casual sexual partners compared to 47.2% among regular sexual partners. Analyses classed most of the respondents (n = 231, 78.0%) as having good utilization, while the rest (22%) had limited utilization. History of STI was independently associated with utilizing HIV/STI preventive services (OR 8.4;95% CI;4.5, 16.7;P < 0.001). Conclusion: Although most of the LDTDs were classed to have good utilization of HIV/STI preventive services, the uptake of subsequent HIV testing services among them was low at only 4.9%. The association of STI history with utilization levels that we determined supports policies of integrating HIV and STI services in the delivery of sexual healthcare provision among LDTDs.

Characterization of sugar diversity in floral and extra-floral nectar from the Coastal Coral Tree(Erythrina caffra Thunb.)in Southern California

The Coastal Coral Tree (Erythrina caffra Thunb.) produces floral nectar (FN) that serves to attract pollinating insects, but also secretes nectar from extra-floral (EFN) glands that serves to attract predatory insects, such as ants. While studies on myrmecophytes (i.e. specialized plants that attract and interact with ants) have primarily focused on interspecific evaluations of EFN chemistry, the Coastal Coral tree offers an opportunity to contrast intraspecific nectar chemistry with differing evolutionary and ecological functions. We hypothesized that the richness of (molecular) sugar species, relative concentrations, and diversity of sugars in FN and foliar EFN would diverge due to differences in the ecological role of the two types of nectar. High performance liquid chromatography with refractive index detection was used to identify the richness of sugar species (based on retention time), measure the relative concentrations, and evaluate the diversity of sugars in FN and foliar EFN secretions. We detected sugar species unique to each gland type and reported significant differences in the relative concentration of one sugar species common to both gland types. While the mean diversity index of sugars was similar for both gland types, the diversity of foliar EFN sugars was significantly more variable than that of FN sugars. The composition of FN showed little variation, and was reflective of its fundamental role in plant reproduction. Foliar EFN, however, demonstrated the variability expected of a context-dependent myrmecophyte that interacts with a facultative ant species assemblage across a mosaic of abiotic and biotic conditions.

Anti-PD-L1 antibody ASC22 in combination with a histone deacetylase inhibitor chidamide as a “shock and kill” strategy for ART-free virological control: a phase Ⅱ single-arm study

The combination of ASC22, an anti-PD-L1 antibody potentially enhancing HIV-specific immunity and chidamide, a HIV latency reversal agent, may serve as a strategy for antiretroviral therapy-free virological control for HIV. People living with HIV, having achieved virological suppression, were enrolled to receive ASC22 and chidamide treatment in addition to their antiretroviral therapy. Participants were monitored over 24 weeks to measure changes in viral dynamics and the function of HIV-specific CD8^(+) T cells (NCT05129189). 15 participants completed the study. At week 8, CA HIV RNA levels showed a significant increase from baseline, and the values returned to baseline after discontinuing ASC22 and chidamide. The total HIV DNA was only transiently increased at week 4 (P = 0.014). In contrast, integrated HIV DNA did not significantly differ from baseline. Increases in the proportions of effector memory CD4^(+) and CD8^(+) T cells (TEM) were observed from baseline to week 24 (P = 0.034 and P = 0.002, respectively). The combination treatment did not succeed in enhancing the function of HIV Gag/Pol- specific CD8^(+) T cells. Nevertheless, at week 8, a negative correlation was identified between the proportions of HIV Gag-specific TEM cells and alterations in integrated DNA in the T cell function improved group (P = 0.042 and P = 0.034, respectively). Nine adverse events were solicited, all of which were graded 1 and resolved spontaneously. The combined treatment of ASC22 and chidamide was demonstrated to be well-tolerated and effective in activating latent HIV reservoirs. Further investigations are warranted in the context of analytic treatment interruption.

Sodium lauryl sulfate and its potential impacts on organisms and the environment:A thematic analysis

Due to its ubiquitous presence in the environment and the lack of a scientific consensus regarding the environmental safety of the widely used anionic surfactant Sodium Lauryl Sulfate(CAS No:151-21-3),a systematic literature review and thematic analysis was conducted.All studies about sodium lauryl sulfate(SLS)in the environment in key databases were reviewed,with coding methods used to identify impact categories from SLS exposure without potential narration bias.Based on the limited number of studies on SLS,there is empirical evidence of this surfactant contributing to environmental toxicity at various concentrations(0.004-3509 mg L^(-1)),with aquatic organisms at a higher risk from exposure.Furthermore,exposure to SLS can elicit changes to various organismic processes and environmental equilibrium.Hence,further study on SLS in various environmental compartments is recommended to monitor the level of SLS pollution,understand its behavior upon contact with various environmental media,and understand its impacts on flora and fauna.Lastly,SLS quantification should be done on commonly used consumer products to potentially regulate its use and to consequently curb SLS pollution from its source.

南宁市社区老年人轻度认知障碍患病现况及影响因素研究

目的调查南宁市社区老年人轻度认知障碍患病率及影响因素,为制定轻度认知功能障碍(mild cognitive impairment, MCI)早期干预措施提供科学依据。方法采用整群随机抽样的方法,分别抽取南宁市3个社区60岁及以上的老年人3 000人,使用蒙特利尔量表北京版(the Beijing version of the Montreal cognitive assessment, MOCA-BJ)进行认知功能评估。结果检测到833例MCI患者,以南宁市2010年人口年龄构成进行标准化,MCI标准化患病率为27.27%;单因素分析显示,不同年龄、文化程度、职业、睡眠时间、运动时间、阅读次数、参加社区活动次数、家务次数的老年人MCI患病率差异均有统计学意义(均有P<0.05);多因素分析显示:高龄、小学文化程度、职业为农民/农民工和企业人员/工人是MCI的危险因素(均有P<0.05),充足的睡眠时间、适量的运动时间和阅读次数是MCI的保护因素(均有P<0.05)。结论南宁市老年人MCI患病率较高,高龄、小学文化程度、职业为农民/农民工和企业人员/工人的老年人可能是MCI的高危人群,应尽早采取有效措施阻止MCI的发生发展。

Potential therapeutic options for coronavirus disease 2019:using knowledge of past outbreaks to guide future treatment

In December 2019,initial cases of the novel coronavirus(2019-nCoV)infection,termed coronavirus disease 2019(COVID-19),were first reported in Wuhan,China.[1]In humans,infections with the human coronavirus 229E,OC43,NL63,and HKU1 usually result in mild,selflimiting upper respiratory tract infections.However,other variants have rapid transmission rates and can cause severe respiratory syndrome and death.These variants include severe acute respiratory syndrome coronavirus(SARSCoV),Middle East respiratory syndrome coronavirus(MERS-CoV),and the current 2019-nCoV.

Fungal Translocation Marker in People Living with HIV Needing Treatment for Onychomycosis: A Protocol for the Prospective Pilot Study

Increased microbial translocation and chronic immune activation are two critical problems for people living with HIV(PLWH)in the antiretroviral therapy(ART)era.Compared with numerous studies on bacterial microbiomic communities,there are only a limited number of studies focusing on fungal microbiomic composition and products in PLWH.This study protocol is used to evaluate the changes in bacterial and fungal microbiome populations induced by terbinafine treatment,which is an antifungal agent widely used amongst PLWH.Twenty-two PLWH on a stable ART regimen for more than six months,who require treatment for onychomycosis,will be recruited.The participants will be followed-up for a 12-week treatment period(oral terbinafine 250mg daily)and another 12-weeks of terbinafine discontinuation.Plasma and fecal samples will be collected before and after terbinafine treatment,and for 12weeks after the discontinuation of terbinafine.Plasma gut injury and microbial translocation biomarker assays,in addition to testing for gut microbiome composition,will be undertaken.With this pilot study,we will perform formal sample size calculations and test study feasibility for a possible full-scale study.

HIV Compartmentalization in Male Genital Tract:Relevance for Viral Eradication

Human immunodeficiency virus(HIV)has been shown to evolve independently in different anatomical compartments.Characterizing HIV genetic evolution in different tissues and cells provides insights into the mechanisms that maintain the viral reservoir.HIV compartmentalization has been well documented in the semen but rarely in male genital tract(MGT)organs.The precise mechanisms that result in the development of HIV compartmentalization in multiple genitourinary sites have been poorly explored due to the difficulty in accessing these tissues.Based on evidence from lymph nodes and gut tissues,mechanisms that may influence compartmentalization include immune pressures,local concentrations of antiviral drugs,clonal expansion of different cell types and inflammation that alters the cellular microenvironment.We reviewed phylogenetic evidences supporting viral compartmentalization between the blood and multiple genitourinary sites in HIV-infected people.Characterizing distinct viral subpopulations enhances our overall understanding of the HIV reservoir inMGTand could ultimately lead to the development of novel therapies to eradicate the virus in tissues.