Fair Haven Community Health Center

This Viewpoint proposes 5 concrete steps to prevent neurological disorders.

Real-time or synchronous telemedicine can be a valuable adjunctive strategy for chronic disease management, but few studies have assessed its impact on hypertension control among safety-net populations. To evaluate whether telemedicine is associated with blood pressure (BP) control. Retrospective cohort study. Mixed-effects logistic regression models clustered by the patient estimated associations between telemedicine and BP control after adjusting for patient factors and neighborhood context. Patients seeking care at an urban, multisite community health center with hypertension and ≥1 BP measurement between 2020 and 2022 (3663 patient-year observations across 2086 unique patients). The primary outcome was BP control defined as a binary variable. We used the Centers for Medicare & Medicaid Services' Controlling High Blood Pressure quality measure criteria of systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg in the most recent recording in the measurement year. Among the 2086 patients with hypertension in our sample, there were 1257 (60.3%) Latinx and 425 (20.4%) Black patients. Over 90% lived in a neighborhood of high deprivation as categorized by the social deprivation index. Telemedicine visits, compared to none, were not associated with blood pressure control (1-2 telemedicine visits aOR, 1.05 [95% CI, 0.86-1.28]; ≥3 telemedicine visits aOR, 0.86 [95% CI, 0.68-1.09]). One in-person visit per year, compared to 2-3, was associated with lower odds of BP control (aOR, 0.72 [95% CI, 0.55-0.94]). Black patients, compared to Latinx patients, were less likely of having BP control (aOR, 0.64 [95% CI, 0.48-0.87]). In this community health center cohort of patients with hypertension, telemedicine did not compromise blood pressure control. Persistent racial disparities in blood pressure control underscore the need for equity-centered strategies for hypertension management in safety-net primary care settings.

This Arts and Medicine feature uses the A Star is Born movie series to chart trends in popular cultural representations of addiction and to argue for more authentic Hollywood depictions of substance use disorder.

Program Goals: During the COVID-19 pandemic, anticipatory guidance, developmental surveillance andimmunizations may be postponed At Fair Haven Community Health Care (FHCHC), a multi-site communityhealth center (CHC) in New Haven, CT, serving approximately 18,000 patients (9,000 children), weimplemented cohorting during the period of greatest local impact of the pandemic Our goals were to (1)prioritize well-child care for children due for immunizations, (2) increase the capacity for telemedicine forpatients with chronic illness or acute complaints, and (3) implement on-site COVID-19 testing with socialdeterminants screening Evaluation: We implemented cohorting for pediatric patients at FHCHC on March 12,2020 (for reference, Connecticut's stay-at-home order was signed March 23) Previously scheduled well childcare (WCC) for key age groups - birth to 24 months and 4 to 5 years - were moved to a “clean” site where onlyWCC and prenatal care were offered All other children received telemedicine visits, which could be converted to same-day in-person visits at the discretion of the clinician School-based health center providers were re-purposed to call patients with asthma in need of follow-up using a chronic care model On April 22, 2020,shortly after the neighborhood surrounding FHCHC's main site was identied as a COVID-19 “hot-spot,” weimplemented on-site testing regardless of symptoms, exposure, or prior use of FHCHC services Patientstested on-site were seen prior to their test via telemedicine for symptom assessment and to be screened forsocial determinants using the Accountable Health Communities instrument They were given locally-specicinformation to meet social needs generated by the NowPow platform From March 12 through April 30, wecompleted 3,302 visits for children 0 through 22 years;1,595 (48%) were via telemedicine Younger childrenages 0-5 years had a greater proportion of visits in-person (634, 60%) than children 6-12 years (438, 46%) oradolescents 12-22 years (635, 49%) Visit counts by time, stratied by visit-type, are shown in the Figure FromApril 22 through 30, 2020, we have scheduled 317 visits for on-site testing, 243 (77%) of which werecompleted, 36 of whom were children, all of whom were screened for social determinants of health Discussion: CHCs can cohort children to ensure that preventive care and vaccinations happen in a timelyfashion in the context of an epidemic Responding to local epidemiologic data, CHCs can provide trustingenvironments for surveillance testing Testing for COVID-19 represents a feasible opportunity to screen forsocial determinants of health and facilitate community linkages to meet social needs using electronicplatforms After the COVID-19 pandemic has subsided, CHCs can offer episodic telemedicine visits for children,and can screen for social determinants at various points of contact with families

Purpose The purpose of the study was to explore preventive behaviors and attitudes among mostly low-income, young Hispanic women with and without prediabetes. Methods In 2017, a convenience sample of women without diabetes aged 18 to 49 years (n = 214, 77.8% Hispanic) was recruited from the waiting room of a community health center to complete a 77-item questionnaire. Attitudes, risk perception, and recent lifestyle change were measured using a validated instrument, the Risk Perceptions Survey: Developing Diabetes. Chi-squared tests and multivariable binary logistic regression were conducted to assess the relationship between prediabetes diagnosis and attitude or lifestyle variables. Results Women diagnosed with prediabetes were more likely to report worry about diabetes and to perceive themselves at higher risk for developing diabetes in the next 10 years than women without a prior prediabetes diagnosis. There was no significant association between prediabetes diagnosis and recent adoption of lifestyle changes compared with those without prediabetes. After controlling for demographic characteristics and risk factors for type 2 diabetes, prediabetes diagnosis was significantly associated with elevated risk perception for developing diabetes if no lifestyle change is made but not with worry or risk perception for developing diabetes generally. Conclusions Prediabetes diagnosis is associated with heightened perception of diabetes risk but not lifestyle change compared to women without prediabetes in this low-income, predominantly Hispanic population. Prediabetes counseling efforts must emphasize evidence-based approaches for motivating preventive behaviors.

This Arts and Medicine essay discusses the relevance of hip-hop musician Kendrick Lamar’s music and lyrics to the health challenges of urban youth and argues for physician literacy that incorporates the arts that are important to patients.

The Diabetes Prevention Program (DPP) demonstrated that weight loss from intensive lifestyle intervention (ILI) in adults with prediabetes could decrease progression to type 2 diabetes. Inner-city, low-income Hispanic women are at high risk for developing type 2 diabetes; however, this type of intervention is not well established in this group. We hypothesized that a DPP intervention modified for a community health center (CHC) setting would decrease weight and improve metabolic measures in Hispanic women with prediabetes. Women diagnosed with prediabetes on a screening oral glucose tolerance test were recruited from a CHC. Participants (90% of whom were Hispanic) were randomized to either usual care (age 43 ± 9.7 years, BMI 35.2 ± 7.3 kg/m(2)) or ILI (age 43.8 ± 10.8 years, BMI 35.4 ± 8.5 kg/m(2)), structured as 14 weeks of group sessions focused on food choices, behavior change, physical activity, and weight loss. One year after enrollment, 122 women repeated baseline measures. Groups had similar baseline weight, BMI, and fasting and 2-h glucose. One year later, the ILI group had lost 3.8 kg (4.4%), while the usual care group had gained 1.4 kg (1.6%, P < 0.0001). Two-hour glucose excursion decreased 15 mg/dL (0.85 mmol/L) in the ILI and 1 mg/dL (0.07 mmol/L) in the usual care group (P = 0.03). Significant decreases favoring the ILI group were noted in BMI, percent body fat, waist circumference, and fasting insulin. A 14-week ILI program based on the DPP can effectively be translated into a predominantly Hispanic CHC setting, resulting in decreased weight, improved fasting insulin, and smaller glucose excursions 1 year after enrolling in the program.

This reminiscence group helped disoriented old people find intimacy with others in the present time. Telling of loss, group members resolved grief by seeking meaning in their experience. Folktales allowed the group to reminisce even when memories failed. The group's time limited structure helped the worker empathize with old people's life tasks. But time limits were not useful to a group whose members had little awareness of calendar time.