Health Services Center

IntroductionMany women in the perinatal period present to their women’s health providers with mental health concerns, which may impact the well-being of both the mother and baby. In this study, behavioral health consultants (BHCs) specially trained in the Infant Mental Health (IMH) approach, hereafter referred to as IMH-BHCs, were integrated into prenatal clinics whose patient populations include a significant proportion of Black, Indigenous, and People of Color (BIPOC) women. BIPOC women experience unique challenges in receiving culturally responsive perinatal and general healthcare. The aim of this study was to elucidate healthcare providers’ perceptions of IMH-BHC clinic integration on patient and provider outcomes, assess barriers to integrating behavioral health care into obstetric care environments, and understand the impact on quality of care delivery resulting from adding behavioral health support to perinatal populations.MethodsThis was a mixed-methods study conducted in Midwestern United States (Michigan); we collected survey responses from healthcare providers (n=52) on model knowledge and satisfaction; we also conducted a qualitative analysis of in-depth interviews with a subset (n=9). One-on-one interviews were guided by an ethnographic approach and focused on gathering thoughts, attitudes, and perceptions of health providers on integrating IMH-BHCs into their practice. Analysis included individual review, open coding, and thematic analysis of transcribed interviews using a grounded theory approach.ResultsQuantitative survey results reflected high knowledge about and engagement with the model. Survey respondents also endorsed the presence of the IMH-BHC improving scope focus and time management. Two main themes emerged with five sub-themes from our qualitative interviews. The main themes were: 1) initiation and engagement with the IMH-BHC model, and 2) evaluated effectiveness of the IMH-BHC. The sub-themes were: 1) IMH-BHC strategies to engage patients, 2) barriers to care facilitation, 3) continuity of care with IMH-BHC, 4) presence of the IMH-BHC may help aid in timely care, and 5) potential for reduction in provider workload and stress.ConclusionsOverall, the integration of IMH-BHCs into clinical settings was regarded as beneficial due to decreasing provider workload, increasing accessibility to mental health services for socially marginalized populations, and enhancing patient engagement. Further research is needed to mitigate barriers to IMH-BHC integration.

Abstract Disclosure: E.L. Ferrell: None. S. Schon: None. L. Jiang: None. F. Valbuena: None. M. Castillo-Mackenzie: None. E. Manuel: None. L. Neff: Employee; Self; Eli Lilly & Company. Stock Owner; Self; Eli Lilly & Company. M. Carnethon: None. D.D. Baird: None. E.E. Marsh: Consulting Fee; Self; Pfizer, Inc., Myovant Sciences. Objective: Previous studies have found the prevalence of metabolic syndrome (MetS) is approximately 33% in the United States overall, with highest prevalence among Hispanics at closer to 35%. Data further indicate that this prevalence is increasing significantly among Hispanics, the younger population (age 20-39) and women. Causes of these trends are unknown and likely multivariable. One hypothesized factor is level of food security - a known social determinant of health. Few studies have examined this relationship in reproductive age Latina females - a group at increased risk for both MetS and low food security. The objective of this study was to assess the relationship between MetS and food security in a large cohort of reproductive aged Latina females. Materials & Methods: This is a cross-sectional analysis of data collected as part of a prospective longitudinal cohort study. The Environment, Leiomyomas, Latinas, and Adiposity Study (ELLAS) is a community based participatory study following a cohort of 707 Latina females over a 4-year period. Participants in this study were between the ages of 21-50 at the time of enrollment. Demographic and baseline data were collected by trained bilingual study staff. Anthropometric measurements were performed, and fasting blood samples were collected. MetS diagnosis was based on the AHA/NHLBI (2005) criteria. Food security scores were based on responses to the validated U.S. Household Food Security Survey with possible scores ranging from 0-6 with higher scores indicating lower food security status. Based on survey responses, participants were grouped as high, low, or very low food security. MetS and food security were assessed as categorical variables. Statistical associations were determined using chi-squared tests. Results: Of the 707 participants enrolled in ELLAS, 621 completed the first study visit. Data from the five criteria for diagnosis of MetS were available from 584 participants. The mean age was 37.6±6.97 years and the mean BMI was 30.1±6.76 kg/m2. A total of 143 participants were noted to have MetS (24.2%). Prevalence of MetS was positively correlated with age. Average food security score was 0.83±1.34, with 3.08% having very low food security. Food security was found to be significantly associated with metabolic syndrome (P<0.05). Among participants with high food security, 20.7% had the diagnosis of MetS versus those with low and very low food security at 36.3% and 33.3% respectively. Conclusion: Among a large cohort of reproductive age Latina females, food security status is significantly associated with MetS. This social determinant of health needs to be better studied in this population known to be at increased risk for diabetes and cardiovascular disease. Focusing efforts to improve food security among this population has the potential to reduce cardiovascular, metabolic, and reproductive adverse health outcomes. Presentation: Friday, June 16, 2023

BackgroundDiabetes self-management education and support (DSMES) programs have struggled to deliver sustainable, effective support for adults with diabetes (AWDs) to improve self-management behaviors, achieve glycemic goals, and reduce risk for complications. One largely untapped resource for this support is AWDs’ social networks. Fifty to 75% of AWDs have an unpaid family member or friend (“support person”) who provides ongoing help with diabetes management. However, DSMES interventions to date lack structured and effective approaches to directly engage support persons in AWDs’ diabetes management.MethodsThis parallel arm randomized trial is designed to determine the effectiveness of Family Support for Health Action (FAM-ACT), a novel community health worker (CHW)-delivered program focused on educating and supporting patients with type 2 diabetes (T2D) and their support persons (SPs), relative to an established, CHW-delivered, individual patient-focused DSMES and care management (I-DSMES) intervention. Both interventions were developed using a community-based participatory research (CBPR) approach.The study will be conducted in partnership with an urban Federally Qualified Health Center (FQHC) serving a low-income, Latino/a community, with target enrollment of 268 dyads consisting of an FQHC patient with T2D with high HbA1c and an SP. Patient-SP dyads will be randomized to receive FAM-ACT or I-DSMES over 6 months.The primary outcome is change in patient HbA1c from baseline to 6 months. Secondary patient outcomes include 12-month change in HbA1c, changes in patient blood pressure, diabetes self-management behaviors, diabetes distress, patient activation, diabetes self-efficacy, and perceptions of and satisfaction with SP support for diabetes. Secondary SP outcomes include self-efficacy for helping the patient with diabetes management and SP distress about the patient’s diabetes. We also will assess the effect of the COVID-19 pandemic on patient’s ability to manage diabetes.DiscussionThis study will inform scalable, evidence-based approaches that leverage family support to help AWDs improve and sustain self-management strategies that underpin optimal management of multiple diabetes complication risk factors. The protocol is designed for and evaluated with a low-income and predominantly Latino/a community, which may increase applicability to other similar communities. The COVID-19 pandemic presented several challenges to study protocol and intervention delivery; modifications made to address these challenges are described.Trial registrationClinicalTrials.gov NCT03812614. Registered on 18 January 2019.

BACKGROUNDVancomycin and teicoplanin are both antibiotics that have significant antimicrobial effects on Gram-positive cocci.AIMTo explore the value of teicoplanin combined with conventional (vancomycin only) anti-infective therapy for the treatment of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis pulmonary infections.METHODSA total of 86 patients with methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis pulmonary infections, treated in our hospital between January 2018 and February 2020, were assigned to the study and control groups using a random number table method, with 43 patients in each group. The control group received conventional treatment (vancomycin), and the study group received both teicoplanin and conventional treatment. The following indicators were assessed in both groups: the time required for symptom relief, treatment effectiveness, serum levels of inflammatory factors (procalcitonin, interleukin-1β, tumor necrosis factor-α, C-reactive protein), clinical pulmonary infection scores before and after treatment, and the incidence of adverse reactions.RESULTSPatients in the study group were observed to have faster cough and expectoration resolution, white blood cell count normalization, body temperature normalization, and rales disappearance than patients in the control group (all P < 0.05); the total rate of effectiveness was 93.02% in the study group, higher than the 76.74% in the control group (P < 0.05). The pre-treatment serum levels of procalcitonin, interleukin-1β, tumor necrosis factor-α, and C-reactive protein as well as the clinical pulmonary infection scores were similar among the patients in both groups. However, the post-treatment serum levels of procalcitonin, interleukin-1β, tumor necrosis factor-α, and C-reactive protein as well as the clinical pulmonary infection scores were significantly lower in the study group than in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the groups.CONCLUSIONCompared with conventional (vancomycin only) therapy, teicoplanin and vancomycin combination therapy for patients with pulmonary methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis infections can improve patient clinical symptoms, modulate serum inflammatory factor levels, and improve treatment efficacy, without increasing the risk of adverse reactions.

Eating a healthy diet is important for managing diabetes. Although there are high rates of diabetes in low-income urban areas, these patients often have limited access to fruits and vegetables. The 15-week Fresh Prescription (Fresh Rx) program was designed to improve access and consumption of fruits and vegetables among low-income patients with diabetes in Detroit, MI. The purpose of this study was to evaluate the effects of a fruit and vegetable prescription program on changes in hemoglobin A1C (HbA1C), blood pressure (BP), and body mass index (BMI) in patients with diabetes in a randomized controlled trial at a federally qualified health center (FQHC). Patients randomized to the Fresh Rx group (n=56) were allotted up to $80 ($10 for up to eight weeks) for purchase of produce from a farmers market based at the FQHC. The control group (n=56) received standard treatment plus information on community resources to improve health. Outcomes were compared at baseline and within three months of program completion. There were no significant between-group differences for any of the outcomes at program completion (p>.05); however, there was a small effect size for HbA1c (partialη2=0.02). Within the Fresh Rx group, HbA1c significantly decreased from 9.64% to 9.14% (p=0.006). However, no changes were noted within the control group (9.38 to 9.41%,p=0.89). BMI and BP did not change from pre- to post-study in either group (p>.05). Results from this study offer preliminary evidence that produce prescription programs may reduce HbA1C in low-income patients with diabetes.

Gastric antral vascular ectasia (GAVE) and portal hypertensive gastropathy (PHG) can cause gastrointestinal bleeding in cirrhotic patients. Distinguishing diffuse-type GAVE and severe PHG is important but difficult by conventional endoscopy and endoscopic biopsy. The aim of this study is to evaluate the value of magnifying endoscopy with narrow-band image for diagnosing diffuse-type GAVE in cirrhotic patients. From January 2010 to December 2013, cirrhotic patients with diffuse red spots of stomach in suspicion of diffuse-type GAVE on conventional endoscopy in a tertiary medical center were included. The detection of diffuse red spots on magnifying endoscopy with narrow-band image (NBI) was classified into ring-pattern which suggested GAVE and mosaic-pattern which suggested non-GAVE. The golden diagnosis of GAVE was based on histological criteria of GAVE score ≥3 by any one of two endoscopic sessions. Total 27 cirrhotic patients were included. Twenty-two patients reached the diagnosis of GAVE and five patients were diagnosed of non-GAVE by histology. The diagnostic rate of conventional endoscopy was 81.5% (22/27). The positive rate of initial endoscopic biopsy was 77.2%. On magnifying endoscopy with NBI, the sensitivity, specificity, positive, negative predicted rate and accuracy of ring-pattern for the diagnosis of GAVE were 100, 90, 96.4, 100 and 97.3%. Kappa coefficient of inter-observer agreement for differentiating the ring and mosaic-pattern was 0.92. The efficacy and accuracy of magnifying endoscopy with NBI for diagnosing diffuse-type GAVE in cirrhotic patients have been demonstrated. It can avoid repeated endoscopy to confirm diagnosis and obviate the invasive biopsy in cirrhotic patients.

We read with interest the paper by Rugge et al which reported that Operative Link on Gastritis Assessment (OLGA) staging reliably predicted the risk for development of gastric epithelial neoplasia.1 No neoplastic lesions were found in low-risk OLGA stages (ie, stages 0–II) where they developed exclusively in high-risk stages (ie, stages III–IV) when followed for 55 months. This study also showed that Helicobacter pylori eradication in subjects with high-risk OLGA stages did not abolish the risk for neoplastic progression. These results are quite convincing. However, two concerns would be raised. First, whether endoscopy surveillance …

The Federal Emergency Management Agency (FEMA) Center for Domestic Preparedness (CDP) was established in 1998 and is now 20 years old. In its short history, the CDP has significantly evolved the relevance and responsiveness of its courses and its capability to provide high-fidelity, hands-on training, and exercises to meet the demanding needs of today's responders. This article discusses the basis of need for a competent, responder training program; the genesis of the CDP as a no-cost provider of responder training for state, local, tribal, and territorial responders; describes the current training opportunities available to responders; previews emerging training opportunities that are under development or envisioned in the very near future; and provides insight to the future progression of the CDP as it continues to expand and evolve its role as FEMA's premiere, responder focused, hands-on training provider.