Family Health Center of Worcester

The primary care clinician can play a substantial role in the management and prevention of viral hepatitis infections, which cause a substantial burden of hepatocellular carcinoma and cirrhosis worldwide and in the US. One-time hepatitis B and C virus testing is now recommended as part of universal adult screening measures, and more frequently based on risk factors. Immunization strategies for hepatitis A and B have also been updated, with a new adjuvanted, conjugated hepatitis B vaccine (HepB-CpG) that provides greater efficacy than older vaccines. Management of hepatitis B and C has been streamlined based on current tolerable, effective oral regimens that can reduce the individual's risks of liver fibrosis and cancer and interrupt the cycles of community transmission. The epidemiology and natural history of these viral infections are summarized and concise updates of screening, diagnosis, treatment, and prevention strategies are provided.

Abstract Intergenerational learning is thought to be an effective strategy for disrupting ageist stereotypes youth may hold and addressing the social isolation of participants. For the past 5 years, “The Humanity Restoration Project” has studied the benefits of intergenerational learning between college-aged students and nursing home residents and staff using Anne Basting’s improvisational storytelling method TimeSlips™ (TS) and the related “beautiful questions”. The central goals of the study include exposing students to intergenerational conversations, countering ageist and ableist social assumptions, and supporting community members living and working in institutional care settings. Both residents’ quality of life and staff work satisfaction have been demonstrated to improve during arts-based interventions and intergenerational programming. We collected data through observations, written student reflections, student oral presentations, pre- and post-test surveys and semi-structured individual interviews and focus groups. Students report improved ability to imagine themselves as future old people, a reduction of negativity/stigma about aging, and genuine respect for and identification with older adult participants. Residents were more engaged and felt valued through helping “teach” young people about aging. Like students, the project allowed staff to see residents in a new, more positive and personal light. Intergenerational learning has the dual benefit of disrupting negative views of aging and older people while simultaneously providing meaningful connection and social interactions. It also has the emancipatory potential - for students and staff alike - of restoring the humanity to some of the most disenfranchised among us: older adults living in nursing homes.

This study aims to quantitatively assess the baseline level of self-perceived cultural competency preparedness and skillfulness among medical and health professions students from 21 universities around the world utilizing a previously validated and standardized testing tool. Cross-sectional study. The International Collaboration and Exchange Program (ICEP), a global exchange initiative for junior medical and health professions students spanning 21 universities across four continents. A total of 753 students from the 2021 and 2022 ICEP cohorts. Students self-evaluated their cultural competency skills on a 5-point Likert-type scale encompassing different areas of competency. Multiple linear regression was performed to identify contributors to cultural competency levels. Upon rating how skillful they are at interacting with culturally diverse patients, North American students reported the highest scores with a mean of 3.22, while Australian students showed the lowest score of 2.82. When analyzing students' stages of study, those in clinical years of medical schools scored the highest at 3.29. Significant variations were observed in the cultural competency self-rating scores among students based on their respective regions (p < .005) and program types/stages (p < .05). Notably, students in their clinical years of school consistently rated themselves higher compared to their preclinical counterparts (p < .05). Furthermore, students from Europe displayed elevated self-ratings compared to the other regions (p < .005). Though these participants represent a highly motivated subgroup of students, potentially limiting result generalizability, the findings emphasize that regional differences exist. Given the multifaceted nature of cultural competency, the results suggest that factors such as educational stage, age, and region may influence students' perceived competency levels.

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Supporting gender equity for women working in geriatrics is important to the growth of geriatrics across disciplines and is critical in achieving our vision for a future in which we are all able to contribute to our communities and maintain our health, safety, and independence as we age. Discrimination can have a negative impact on public health, particularly with regard to those who care for the health of older Americans and other vulnerable older people. Women working in the field of geriatrics have experienced implicit and explicit discriminatory practices that mirror available data on the entire workforce. In this position article, we outline strategic objectives and accompanying practical recommendations for how geriatrics, as a field, can work together to achieve a future in which the rights of women are guaranteed and women in geriatrics have the opportunity to achieve their full potential. This article represents the official positions of the American Geriatrics Society. J Am Geriatr Soc 67:2447-2454, 2019.

BackgroundDecades of persecution culminated in a statewide campaign of organized, systematic, and violent eviction of the Rohingya people by the Myanmar government beginning in August 2017. These attacks included the burning of homes and farms, beatings, shootings, sexual violence, summary executions, burying the dead in mass graves, and other atrocities. The Myanmar government has denied any responsibility. To document evidence of reported atrocities and identify patterns, we interviewed survivors, documented physical injuries, and assessed for consistency in their reports.MethodsWe use purposive and snowball sampling to identify survivors residing in refugee camps in Bangladesh. Interviews and examinations were conducted by trained investigators with the assistance of interpreters based on the Istanbul Protocol – the international standard to investigate and document instances of torture and other cruel, inhuman, and degrading treatment. The goal was to assess whether the clinical findings corroborate survivors’ narratives and to identify emblematic patterns.ResultsDuring four separate field visits between December 2017 and July 2018, we interviewed and where relevant, conducted physical examinations on a total of 114 refugees. The participants came from 36 villages in Northern Rakhine state; 36 (32%) were female, 26 (23%) were children. Testimonies described several patterns in the violence prior to their flight, including the organization of the attacks, the involvement of non-Rohingya civilians, the targeted and purposeful destruction of homes and eviction of Rohingya residents, and the denial of medical care. Physical findings included injuries from gunshots, blunt trauma, penetrating trauma such as slashings and mutilations, burns, and explosives and from sexual and gender-based violence.ConclusionsWhile each survivor’s experience was unique, similarities in the types and organization of attacks support allegations of a systematic, widespread, and premeditated campaign of forced displacement and violence. Physical findings were consistent with survivors’ narratives of violence and brutality. These findings warrant accountability for the Myanmar military per the Rome Statute of the International Criminal Court (ICC), which has jurisdiction to try individuals for serious international crimes, including crimes against humanity and genocide. Legal accountability for these crimes should be pursued along with medical and psychological care and rehabilitation to address the ongoing effects of violence, discrimination, and displacement.

Care of patients with HIV infection starts with diagnosis as soon as possible, preferably at or near the time of acute infection. Opportunistic infections, malignancies, and other conditions develop progressively over time, particularly in untreated patients. The AIDS-defining opportunistic infections most common in the United States include Pneumocystis jirovecii pneumonia, Candida esophagitis, toxoplasmic encephalitis, tuberculosis, disseminated Mycobacterium avium complex, cryptococcal meningitis, and cytomegalovirus retinitis. Specific prophylaxis regimens exist for several opportunistic infections, and effective antiretroviral therapy reduces the risk of most others. Other AIDS-defining conditions include wasting syndrome and HIV encephalopathy. AIDS-defining malignancies include Kaposi sarcoma, systemic non-Hodgkin lymphoma, primary central nervous system lymphoma, and invasive cervical cancer. Although not an AIDS-defining condition, anal cancer is common in patients with HIV infection. Other HIV-related conditions include thrombocytopenia, recurrent bacterial respiratory infections, HIV-associated nephropathy, and HIV-associated neurocognitive disorder.

Developing effective primary prevention initiatives may help recently arrived refugees retain some of their own healthy cultural habits and reduce the tendency to adopt detrimental ones. This research explores recent arrivals' knowledge regarding eating behaviors, physical activity and sleep habits. Working collaboratively with community members, a healthy living curriculum was adapted and pilot tested in focus groups. A community-engaged approach to revising and implementing a health promotion tool was effective in beginning dialogue about primary prevention among a group of recently arrived refugees from Burma. Seven themes were identified as particularly relevant: food choices, living environment, health information, financial stress, mobility/transportation, social interaction and recreation, and hopes and dreams. Refugees desire more specific information about nutrition and exercise, and they find community health workers an effective medium for delivering this information. The outcomes of this study may inform future targeted interventions for health promotion with refugees from Burma.

OBJECTIVETo test whether a theory-based, literacy, and culturally tailored self-management intervention, Latinos en Control, improves glycemic control among low-income Latinos with type 2 diabetes.RESEARCH DESIGN AND METHODSA total of 252 patients recruited from community health centers were randomized to the Latinos en Control intervention or to usual care. The primarily group-based intervention consisted of 12 weekly and 8 monthly sessions and targeted knowledge, attitudes, and self-management behaviors. The primary outcome was HbA1c. Secondary outcomes included diet, physical activity, blood glucose self-monitoring, diabetes knowledge and self-efficacy, and other physiological factors (e.g., lipids, blood pressure, and weight). Measures were collected at baseline and at 4- and 12-month follow-up. Change in outcomes over time between the groups and the association between HbA1c and possible mediators were estimated using mixed-effects models and an intention-to-treat approach.RESULTSA significant difference in HbA1c change between the groups was observed at 4 months (intervention −0.88 [−1.15 to −0.60] versus control −0.35 [−0.62 to 0.07], P < 0.01), although this difference decreased and lost statistical significance at 12 months (intervention −0.46 [−0.77 to −0.13] versus control −0.20 [−0.53 to 0.13], P = 0.293). The intervention resulted in significant change differences in diabetes knowledge at 12 months (P = 0.001), self-efficacy (P = 0.001), blood glucose self-monitoring (P = 0.02), and diet, including dietary quality (P = 0.01), kilocalories consumed (P < 0.001), percentage of fat (P = 0.003), and percentage of saturated fat (P = 0.04). These changes were in turn significantly associated with HbA1c change at 12 months.CONCLUSIONSLiteracy-sensitive, culturally tailored interventions can improve diabetes control among low-income Latinos; however, strategies to sustain improvements are needed.