Local Health Centers Research Articles

Icahn School of Medicine at Mount Sinai.

Icahn School of Medicine at Mount Sinai.

Physical Activity, Step Counts, and Grip Strength in the Chinese Children and Families Cohort Study.

Objectives: This paper describes the development of a physical activity questionnaire (PAQ) designed for Chinese adolescents and their mothers in urban and rural settings, and reports on results of the PAQ, pedometry, and hand grip dynamometry from the Chinese Children and Families Cohort Study pilot investigation (CFCS). Methods: As part of a pilot investigation to evaluate the feasibility to follow-up and obtain detailed nutrition, dietary, physical activity, and ultraviolet radiation (UVR) data from CFCS participants, data were collected in 2013 for 93 adolescent/mother pairs from a rural (n = 41) and an urban site (n = 52) in two provinces. Respondents were asked to wear a pedometer for seven days (Omron HJ-151), use a Takei Digital Grip Strength Dynamometer on (each hand; three trials; two separate days), and complete a 39 item, eight domain PAQ covering the past year. Self-reported physical activity (PA) was linked to metabolic equivalent of task (MET) scores in kcal/kg/hr and used to calculate METs for different domains of PA and intensity categories. Results: Compliance was high (95%) in this measurement protocol administered by health staff during a series of data collection efforts at home and local clinics or health centers. Step counts were highly variable, averaging between 5000 and 10000 per day with somewhat higher step counts in rural adolescent boys. Maximum grip strength (Kgs) was greater in children (Mean = 36.5, SE = 0.8) than mothers (Mean = 28.8, SE = 0.8) and similar in the urban (Mean = 29.6, SE = 0.6) compared to the rural (Mean = 29.6, SE = 0.5) communities overall. Grip strength, step counts, and measures of time spent in different activities or activity intensities were uncorrelated. Conclusion: Device and question-based measurement of PA and strength were readily accepted in these Chinese urban and rural populations. The PAQ on physical activity in the past year produced some plausible population averages, but individual responses suggested recall challenges. If data about specific activities are required, future studies should explore use of standardized survey questions concerning such fewer specific activities or instruments examining shorter time periods such as one, three, or seven day recalls.

Mosquito Behavior of Mansonia and Anopheles and Its Relationship With the Filariasis Disease in Taniwel Timur District and Taniwel, Seram barat regency

Mansonia mosquitoes are in endemic forest and swamp areas, dirty environments and unused fish farming areas, Mansonia mosquitoes are aggressive and suck blood when humans are at night, outside the home. Anopheles actively seeks blood during illness and at night. This research uses survey and cross sectional research, it discusses to study mosquitoes, the density of mosquitoes mansonia and anopheles, as well as looking at the development of disease (prevalence) of filariasis. The population in this study is the population and population of mosquito mansonia and anopheles in East Taniwel and Taniwel Districts. Filariasis in Taniwel and East Taniwel Sub-districts, West Seram District was reported in local health centers of around 15 people. The outbreak of filariasis in Taniwel District around 2010-2019. Mansonia bleeds people at home when sick at 18: 00-18: 45. While outside the house at night 20: 00-20: 45. While Anopheles mosquitoes bite humans, at dusk and at night at 16.00-24.00, The peak is 02.00-03.00. The density of mansonia mosquitoes in Sohuwe Village, 4.00 - 5.85, Lumalatal 5.00 - 6.60 and Maloang 4.00-5.50 (moderate), Anopheles in Sohuwe 7.00-9.85, Lumalatal 5.89- 6.82, Maloang 5.00-6.50 (high). The prevalence of filariasis in Sohuwe 0.66, Lumlat 0.88. and Maloang 1.54. There is a relationship between attitudes and community relations with filariasis

COVID-19 Emergency and Post-Emergency in Italian Cancer Patients: How Can Patients Be Assisted?

Italy and worldwide are experiencing an outbreak of a new coronavirus-related disease, named COVID-19, declared by the WHO COVID-19 a pandemic. The fragility of cancer patients is well-known, with many cases affecting aged patients or those with several comorbidities that frequently result in a loss of independency and functionality. Therefore, cancer patients have been greatly affected by this health emergency and, due to their vulnerability to COVID-19, oncologic patient visits have been often delayed or canceled leading to possible under-treatment. Different solutions can be adopted for reducing travels to cancer screening centers and the overall impact of cancer screening visits. As a consequence, it has been recommended that, when possible, the follow-up visits for cancer patients treated with oral anticancer drugs could be performed telematically. Furthermore, many patients refuse hospital visits, even if necessary, because of fear of contagion. Moreover, in some regions in Italy even the very first non-urgent visits have been postponed with the consequent delay in diagnosis, which may negatively affect disease prognosis. For these reasons, new approaches are needed such as the telemedicine tool. Throughout organized and appropriate tools, it would be possible to manage patients’ visits and treatments, to avoid the dangerous extension of waiting lists when the standard activities will resume. In this context, a number of hospital visits can be substituted with visits at small local health centers, and general practitioners’office, taking in turn, advantage of well-defined telemedicine path which will be developed in the post-emergency phase.

Quality of Diabetes and Hypertension Management at the DAWN (Dedicated to Aurora's Wellness and Needs) Student-Run Free Clinic.

IntroductionStudent-Run Free Clinics (SRFCs) are part of the safety-net healthcare system. Given variable settings and models, relatively little is known about the quality of care in these settings.MethodsA mixed-methods evaluation of diabetes and hypertension management was conducted for patients initiating care from March 1, 2015, to September 31, 2016, at the DAWN (Dedicated to Aurora’s Wellness and Needs) SRFC. Retrospective chart review assessed whether patients received recommended screening tests (process outcomes) and achieved disease control (short-term outcomes). These outcomes were compared to a local community health center (CHC), a local federally qualified health center (FQHC) network, and Colorado Medicaid (CoM) using one proportion t-tests. In-depth case studies of randomly selected individuals with good and poor disease control identified targets for quality improvement through nominal group technique.ResultsDiabetic patients (n=30) were recommended screening, including HbA1c (93.3%) (vs. 77.8% with CoM, p=0.04), nephropathy care (70%) (vs. 85.4% with CoM, p=0.02), retinopathy examination (30%) (vs. 40.47% with CoM, p=0.24). Diabetic short-term outcomes showed 46.6% with poor control (vs. 61.1% at the CHC, p=0.10; vs. 30.62% at the FQHC, p=0.06; vs. 55% with CoM, p=0.10). Patients with hypertension (n=75) 33.3% had controlled (<140/90) blood pressure (vs. 49.2% at the CHC, p<0.01; vs. 61.1% at the FQHC, p<0.01; vs. 58.9% with CoM, p<0.01). Themes for quality improvement included improving follow-up, documentation and data collection, clinic processes, and addressing barriers to care.DiscussionDAWN outcomes were comparable to other safety-net providers for diabetes, similar to findings in evaluations conducted by other SRFCs. However, DAWN did not have equivalent outcomes for hypertension in contrast to other published findings from SRFCs. Poor access to care and baseline chronic disease control among DAWN patients may have contributed to these findings.ConclusionsWhile this study is not directly generalizable to all SRFC models and communities, these results contribute to the growing body of data around SRFCs and chronic disease management and indicate that SRFCs may have a role in the safety-net healthcare system. However, more study is needed to ensure that SRFCs can provide high-quality care because otherwise efforts should focus on other strategies to expand access within the safety-net system.

Correlation Between Knowledge of Health Information About Picky Eating, Supplementary Feeding, Management Ability of Appetite Herbs

Picky eaters continue to pose challenges in providing additional food, hindering efforts to address child stunting. Thus, understanding the causes of picky eating in relation to maternal knowledge of health information about picky eaters, supplementary feeding management, and appetite herbs is crucial. This study aims to explore the correlation between knowledge of health information about picky eater, supplementary feeding, and the ability to manage food and herbal appetite in mothers of stunted children in Srimartani Village, Piyungan, Yogyakarta. Employing a cross-sectional survey design, the study involved 27 mothers (aged 23-42) of stunted children in October 2022. A research instrument comprising 21 questions was developed based on the concept of picky eating, adapted to the research context. Data analysis employed Kendall's tau_b statistical test to assess correlations. Stunting data were obtained from documented diagnoses at the local community health center, including malnourished toddlers and undernourished children. Findings revealed no correlation between knowledge of health information about picky eater and supplementary feeding, as well as between supplementary feeding and the ability to manage supplementary feeding and appetite herbs. However, a significant correlation was observed knowledge of health information about between picky eater and the ability to manage additional food and appetite herbs. In conclusion, higher picky eater knowledge was associated with better ability to manage additional food and appetite herbs, while knowledge of supplementary feeding did not show such a correlation. Further research with a more representative sample is recommended to provide a comprehensive understanding of the picky eater phenomenon

Epidemiological situation and spatial distribution of visceral leishmaniasis in the Republic of Azerbaijan.

Rising risk factors have made leishmaniasis a growing public health problem in many countries around the world. While some risk factors are associated with a specific eco-epidemiological unit, others affect all forms of leishmaniasis. The purpose of this study was to analyze the epidemiological situation of visceral leishmaniasis (VL), to determine the distribution of VL areas and to improve the epidemiological surveillance system against VL. In this cross-sectional study, the data on VL cases were collected from local health centers in the Republic of Azerbaijan in 2014-2018 to establish a geodatabase using ArcGIS10.4. Data analysis was conducted using SPSS25 and ArcMap Spatial Analyst. The prevalence of the disease was calculated as 1.7 per 100,000 populations in this period. Two hotspots were found in Berde and Terter regions of the Republic of Azerbaijan with 14.70% and 14.12% of total cases, respectively. There was an increase in the incidence rate of VL in the Republic of Azerbaijan from 0.63 in 2014 to 4.31/1,000,000 per populations in 2018. There was no spatial autocorrelation between the county and the total number of cases (P > 0.05). According to the derived distribution maps, the disease is spreading to new locations in central and northwest parts of the country. The number of cases increased from 2014 to 2018 fivefold. Therefore, due to the endemic nature of the disease in some parts the Republic of Azerbaijan, increasing physicians' awareness, especially pediatric specialists of the disease, and conducting control measurements in these regions are recommended.

Disclosure of HIV status among patients new to HIV care in Southern Ethiopia: role of perceived social support and other factors

ABSTRACT Reports from Sub-Saharan Africa, with a large HIV-infected population, vary widely in how often HIV status is disclosed to others, including spouses and other partners. We surveyed 1799 Ethiopian HIV patients newly enrolled in care within the previous 3 months at one of 32 local hospitals and health centers about disclosure of HIV status and two perceived social support domains: emotional/informational (EI) and tangible assistance (TA) support. Disclosure to another person was reported by 1389 (77%) persons. Disclosure rates to specific persons were: spouses or other partners = 74%; mothers = 24%; fathers = 16%; children = 26%; other family members = 37%; friends = 19%, and neighbors/other community members = 13%. Disclosure to another person was associated with higher social support scores on both EI and TA domains, marriage, and a longer time knowing HIV status. In multivariate adjusted models, disclosure to any person, as well as disclosure specifically to a spouse or partner, were associated with higher EI and higher TA social support scores. Provision of knowledgeable and emotionally supportive assistance can be an important factor in facilitating HIV disclosure. Helping persons with HIV decide who to disclose to and how to do so in the most positive manner is an essential component of HIV care and support.

Effects Of Jump Training On Postural Balance And Leg Muscle Function In Healthy Older Adults

Age-associated loss of skeletal muscle strength and postural balance are critical determinants of independent daily living activities in later life. PURPOSE: This study aimed to investigate the effects of different jumping exercise tempos on static balance and leg muscle function in healthy older adults. METHODS: Twenty-six community-living older adults were randomly assigned to a quick 108 per minute tempo (QJ; n = 14; 6 men) or slow 60 per minute tempo [AS1] (SJ; n = 12; 5 men) jumping exercise group. Both groups performed one set of jumps until they reached a level of exertion they perceived as difficult (Borg-RPE Scale of 15). Both groups trained three times a week for 12 weeks and participated in 60-min supervised group exercise sessions at a local health center. Outcome measures included center of foot pressure (CoP) sway parameters during quiet standing with eyes open (EO) and eyes closed (EC), four-square step (FSS), two-step stride length (TSL), and rate of force development (RFD) for vertical ground reaction force in sit-to-stand movement. RESULTS: Repeated-measures analysis of variance showed a significant main effect for FSS (P = 0.009) and TSL (P = 0.002). After the training period, QJ demonstrated a significantly decreased FSS time (5.17 ± 1.00 vs. 4.87 ± 1.00 s, P < 0.05) and SJ demonstrated a significantly increased TSL (210.8 ± 21.1 vs. 227.3 ± 27.2 cm, P < 0.05). Both groups showed no changes in CoP sway parameters with EO or EC in quiet standing. CONCLUSIONS: Jumps at a quick tempo improved dynamic standing balance evaluated by the FSS, while jumps at a slow tempo improved leg muscle strength. Thus, 12 weeks of jump training at different tempos appeared to have no effects on quiet standing balance, but different effects on dynamic standing balance and leg muscle strength in healthy older adults. [AS1]The phrase 'per minute' was included for one group only, but the meaning was not clear. Please check my suggested alterations.

In Memoriam: Kirk R. Smith.

In Memoriam: Kirk R. Smith.

Hookworm Infection among Pregnant Women at First Antenatal Visit in Lira, Uganda: A Cross-Sectional Study.

Background Hookworm infection in expectant mothers has adverse health effects on both the mothers and their unborn babies. Foetal effects are known to include intrauterine growth retardation and physical and mental growth retardation, while the mothers may develop anemia which could potentially result in death. Unfortunately, little is known about factors that may predispose a pregnant woman to infection by hookworm. In this study, we strived to determine not only the prevalence of hookworm infection among pregnant women attending their first antenatal visit during the current pregnancy in a local health center in northern Uganda but also factors that might predispose them to hookworm infection. Method This cross-sectional study was conducted among 346 pregnant women from Ogur Health Center IV located in Lira district, northern Uganda. Stool samples were collected from each study participant and analyzed for hookworms. The independent variables listed in this study (participant's sociodemographic characteristics, preconception care, and sanitation factors) were obtained using a structured questionnaire. Data analysis, including calculation of adjusted ratios, was performed using STATA software (version 14). Results Prevalence of hookworm infection among pregnant women who attended their first antenatal visit at Ogur Health Center IV was 11% (n = 38). After controlling for confounders, factors found to be significantly associated with this infection among pregnant women here were gardening barefooted (adjusted odds ratio (AOR), 3.4; 95% confidence interval (CI), 1.6 to 7.5; P < 0.001) and fetching unsafe water shared with animals for domestic uses (AOR, 2.8; 95% CI, 1.3 to 6.2; P value of 0.002). Conclusion Hookworm infection among pregnant women at Ogur Health Center IV in Lira district, at 11%, is a public health concern and significantly associated with barefoot gardening and fetching water from unsafe sources shared with animals. We, therefore, recommend that special emphasis during routine prenatal health education be placed on the use of protective footwear during farming and fetching water for domestic use from protected safe sources. Author Summary. Hookworm infection is a parasitic condition that more often goes unnoticed, yet it presents immense detrimental effects, especially to pregnant women and their unborn children. It is a chronic disease with accruing effects of blood depletion resulting in anemia. Anemia is, by far, one of the major causes of maternal morbidity and mortality in Uganda. Pregnant women are more prone to hookworm infection by virtue of their compromised immunity, secondary to the physiological process of pregnancy. We demonstrated here that hookworm infection still exists among pregnant women in Uganda. We also showed that gardening barefooted and fetching water for domestic uses from unsafe sources shared with animals were major factors associated with this helminthic infection. This study provides evidence necessary to influence decision making on prevention of hookworm infection in the study area.

Intestinal helminth infection and malnutrition among public primary school children in Ibadan, Nigeria

Intestinal helminthiasis associated with malnutrition in children remains endemic in developing countries despite considerable efforts at control. This study was carried out to determine the current prevalence status and the risk factors associated with intestinal helminth infections among primary school children in Ibadan. A cross-sectional study was undertaken among 5-16 year old pupils, from 7 primary schools in Ibadan, Oyo State. Microscopic examination of stool for ova was carried out using a formol-ether concentration technique. Predisposing risk factors were determined from questionnaire data while anthropometric indices consisting of weight, height and age were the measured indicators of the nutritional status. Of the 485 pupils examined, 187(38.6%) had helminth infections and the parasites identified were Ascaris lumbricoides (35.9%), Strongyloides stercoralis (12.4%), hookworm (8.5%), Enterobius vermicularis (4.9%), Schistosoma mansoni (3.5%) and Trichuris trichiura (0.4%). More male pupils (52.9%, p = 0.05) than females (47.1%) had infections. Pupils aged between 9-12 years (p = 0.02) had highest (49.2%) infection rates. Infections were recorded in 13(18.57%) of 70 pupils treated with levamisole by the local health centres 2 weeks prior to this study. Wearing of footwear, parent’s occupation, drinking water sources, family size and toilet type were risk factors significantly associated (p&lt;0.05) with infection in this study. The overall prevalence of wasting, stunting and underweight were 24.4%, 28.8% and 7.8% respectively, there was however, no statistical relationship (p&gt;0.05) between the prevalence of infection and malnutrition. Intestinal helminthiasis is still prevalent in schoolchildren despite targeted chemotherapy. It is therefore suggested that chemotherapy should include all children in the communities along with continuous enlightenment to ensure the disruption of parasite transmission.&#x0D; Keywords: Intestinal helminths; school children; malnutrition; Ibadan; chemotherapy.

Promoting Caries-Free Program by having Regular 6-Month Dental Check-up in Ketabang Area, Surabaya

Background: An epidemiological study conducted in two kindergartens located in Ketabang and Embong Kaliasinreported that 63% of kindergarteners were affected by dental caries. The study also found that only 8% of them receiveddental treatment. The remaining 92% of kindergarteners never had dental treatment due to uncovered health insurance,unavailability of parents during working days and hours, mother’s education level, mother’s medical history, paternalsupport in dental and oral health care. Promotive, preventive, and referral efforts for dental and oral health can be doneby empowering UKGS teachers in the kindergarten concerned and in collaboration with local public health center routine6-month dental check-up. Purpose: To promote dental health education for children and forming the habit of visitingdentist for dental check-up. Methods: This program was intended to support UKGS teachers’ roles and encourage themother to admit their children for a dental check-up. The dental check-up results of Dharma Putra kindergarteners werethen recorded to the report. The report consisted of the prioritized tooth to treat, treated tooth, and treatment fee. Results:The dentists have recorded the examination results on the report sheet and informed the parents about their children’sdental and oral health status. The UKGS teacher then scheduled follow-up appointment per group per week for dentaltreatment. 3 out of 3 kindergarteners attended the follow-up appointment. Conclusion: This program is effective topromote children to come to dentist.

Preventing Dental Cavities with Mouth Rinsing Song for Elementary School Students, Sawahan District, Surabaya City

Background: Dental and oral health is one of the public health indicators. Dental and oral health problems decreaseindividual health function. A lack of mouth rinsing causes dental and oral health problems in children after consumingsweet food. Dental health promotion can help the children learn about mouth rinsing and encourage them to have itregularly. MisDent is an educational program about dental health designed for children. We demonstrated and promotedmouth rinsing to the students, especially after they confused sweet food. Purpose: To promote correct tooth brushingto children and help monitoring student’s dental health partnering with the local public health center. Methods: Theprogram used dental health promotion strategies Patemon 2 Elementary School. We evaluated the program as well.Results: About 60% of students at Petemon 2 Elementary School were able to answer the questions correctly, have mouthrinsing correctly, memorize the “REK KUMUR REK” song. Conclusion: “MisDent” involved the first and second-gradestudents of Patemon 2 Elementary School. The program was expected to help to educate the students about dental andoral health.

Maternal Factors on Stunting in Pekanbaru Local Health Center, Indonesia

Stunting is a health problem by multiple factors (Mother factor, socio-economic factor). The growth retardation (stunting ) was measure by height for age scale which primarily indicates chronic undernutrition. In 2018, the prevalence of stunting in Riau province was 35%, which was higher than the national prevalence of 30.8%. This was an quanitative with cross sectional analytic deign. The study was conducted in Puskesmas Harapan Raya Pekanbaru, Riau, Indonesia. The population was all children (4000), sampel was 187 children by systematic random sampling. Research was to analyze independents variable (risk of stunting) to the dependent’s variable (mother’s age, Prity, Mother Parity, Mother’s Height, (Lila) / MUAC (Mid Upper Arm Circumference), Maternal Characteristics (hemoglobin), Tension Mother’s, ANC Visit, Dietary habit, Mother’s child care, Completed immunization, Weight child and Drink for child.) Research results is maternal hemoglobin ​​in pregnancy with a risk category of having a stunting 53.4%, exlusive breastfeeding with a risk category of having a stunting 54.1%, dietary habit with a risk category of having a stunting 51.3%. Independents variable (Maternal Characteristics (hemoglobin), Exclusive Breastfeeding, Dietary Habis), is a significant association to stunting. The findings from this study will be helpful for programmatic intervention to reduce the stunting.

Malaria patterns across altitudinal zones of Mount Elgon following intensified control and prevention programs in Uganda

BackgroundMalaria remains a major tropical vector-borne disease of immense public health concern owing to its debilitating effects in sub-Saharan Africa. Over the past 30 years, the high altitude areas in Eastern Africa have been reported to experience increased cases of malaria. Governments including that of the Republic of Uganda have responded through intensifying programs that can potentially minimize malaria transmission while reducing associated fatalities. However, malaria patterns following these intensified control and prevention interventions in the changing climate remains widely unexplored in East African highland regions. This study thus analyzed malaria patterns across altitudinal zones of Mount Elgon, Uganda.MethodsTimes-series data on malaria cases (2011–2017) from five level III local health centers occurring across three altitudinal zones; low, mid and high altitude was utilized. Inverse Distance Weighted (IDW) interpolation regression and Mann Kendall trend test were used to analyze malaria patterns. Vegetation attributes from the three altitudinal zones were analyzed using Normalized Difference Vegetation Index (NDVI) was used to determine the Autoregressive Integrated Moving Average (ARIMA) model was used to project malaria patterns for a 7 year period.ResultsMalaria across the three zones declined over the study period. The hotspots for malaria were highly variable over time in all the three zones. Rainfall played a significant role in influencing malaria burdens across the three zones. Vegetation had a significant influence on malaria in the higher altitudes. Meanwhile, in the lower altitude, human population had a significant positive correlation with malaria cases.ConclusionsDespite observed decline in malaria cases across the three altitudinal zones, the high altitude zone became a malaria hotspot as cases variably occurred in the zone. Rainfall played the biggest role in malaria trends. Human population appeared to influence malaria incidences in the low altitude areas partly due to population concentration in this zone. Malaria control interventions ought to be strengthened and strategically designed to achieve no malaria cases across all the altitudinal zones. Integration of climate information within malaria interventions can also strengthen eradication strategies of malaria in such differentiated altitudinal zones.

Respiratory health and eruptions of the Nyiragongo and Nyamulagira volcanoes in the Democratic Republic of Congo: a time-series analysis

BackgroundNyamulagira and Nyiragongo are active volcanoes situated close to Goma (North Kivu, Democratic Republic of Congo). These volcanoes are among the most prolific sources of volcanic SO2 pollution on earth.ObjectiveWe investigated the possible spatiotemporal relationships between volcanic degassing represented by eruptive emissions of SO2 that occurred between 2000 and 2010, and the incidence of acute respiratory symptoms (ARS) in populations living in areas up to more than 100 km from the volcanoes.MethodologyThe total flux of SO2 emitted during eruptions since 2000 and the average spatial distribution of the volcanic plume (2004–2008) were based on publicly available remote sensing data. The monthly numbers of adults and children reporting acute respiratory symptoms were extracted from health data collected routinely by selected local health centres and hospitals between 2000 and 2010. The monthly numbers of persons with ARS recorded during or after eruptions were compared with those recorded before eruptions, using negative binomial regression models allowing the calculation of incidence rate ratios (IRR) and their 95% confidence intervals. We first compared years with and without eruptions and then considered shorter time-windows (months).ResultsIn the investigated area, ARS were the second most frequent cause of medical visits (12.2%, n = 3.2 million cases), after malaria (32.3%, n = 8.4 million cases). SO2 emissions gradually increased 30 to 50 times in 2010 compared to 2002. Taking 1999 as a reference, the IRR for ARS increased three-fold between 2000 [0.9 (0.8, 1.1)] and 2009 [2.8 (2.2, 3.7)]. Although the incidence of ARS appeared to increase after some eruptions, especially in areas close (< 26 km) to the volcanoes, we did not find a consistent temporal association between the yearly incidence of ARS and volcanic eruptions when considering the entire observation period. When we analysed shorter time-windows (6 months in the year preceding an eruption), we observed increased ARS incidences in eruptive months, except in 2010. IRRs were increased for centres situated close to volcanoes (< 26 km) in 2001 and 2002.ConclusionARS incident cases increased over the years in populations living around the Nyamulagira and Nyiragongo volcanoes, but we found no consistent evidence for an association between the yearly incidence of ARS and volcanic eruptions or the intensity of SO2 emissions, possibly because of interference with man-made events, including massive population displacements caused by insecurity in the area. Nevertheless, some evidence was found for increased incidence of ARS following eruptions, especially in areas close to volcanoes. Assessing personal, ground level exposure to SO2 and particulates with adequate controlling for confounding, such as viral and other infections, could clarify the contribution, if any, of volcanic emissions of SO2 to the high burden of respiratory diseases in this region.

Effects of Patient-Centered Communication on Influenza Vaccination and Self-Reported General Health Status among Asian Americans: A Comparison Model for Young/Middle-Aged and Older Adults.

Objectives: Asian American subgroups' influenza vaccination is still below the US standards. This study examined the effects of patient-centered communication (PCC) on influenza vaccination and the general health (GH) of Chinese, Vietnamese, and Korean Americans. A group difference between younger and older adults was investigated. Methods: The 2014-2016 California Health Interview Surveys were merged (Chinese [N = 1,680], Korean [N = 514], and Vietnamese [N = 644]; age 18+; younger = 1,629 and older = 1,209). Two path models (PCC [measured by physicians' careful listening], vaccination, and GH; PCC [measured by physicians' clear explanation], vaccination, and GH) were evaluated. Regression maximum likelihood was applied for missing values. Results: Both the first and second models showed good model fit scores (comparative fit index [CFI] = .95, root mean square error of approximation [RMSEA] = .04, and standardized root mean residual [SRMR] = .03; CFI = .93, RMSEA = .04, and SRMR = .03). There were direct effects of PCC on vaccination among younger adults. PCC directly influenced GH for both age-groups. Discussion: A PCC manual for physicians in local or community health centers could enhance both younger and older adults' influenza vaccination.

Abstract IA23: Engaging refugees and immigrants in breast health education

Abstract Refugees and immigrants often come from countries where preventative medicine and cancer screening opportunities are neither attainable nor a priority. Often, preventative services like mammography are new concepts for immigrant and refugee women. Language barriers can decrease patients' access to services, especially for screening tests. Barriers to health screenings include cultural belief factors along with limited knowledge, racial discrimination, embarrassment, fear of the test and/or diagnosis, and lack of culturally appropriate health resources. While barriers make it difficult for refugee and immigrant women to gain access to health services, the need to provide culturally sensitive health educational programs that address these issues in a culturally sensitive way is essential to ensure a healthy life style for this population. The International Institute has over 100 years of experience in serving refugees and immigrants in many capacities and is considered a reliable resource within the local immigrant and refugee community. The Institute worked closely with Roswell Park Comprehensive Cancer Center, local community health centers, and resettlement agencies to provide culturally tailored health education programming to over 1500 refugee and immigrant women and men, and screened approximately 400 women for mammography and clinical breast exams. Additionally, the institute has educated over 1,000 local health care providers working with the immigrant and refugee population on the importance of cultural competency in order to impact their cultural sensitivity in their current medical practices. Educational programs that train health care providers in cultural competency have been shown to improve patient-provider interaction. Successful methods used in working with the immigrant and refugee population include utilizing cultural and linguistic diverse staff, proficient interpreters and translators, and partnering with community-based agencies that also serve this population. Building trust and creating personal relationships with female attendees are crucial in working with the immigrant and refugee population. Fear of the cancer test and/or diagnosis is a major barrier for most immigrant/refugee women, and to freely discuss breast health and the importance of cancer screening is a novel concern, as the word “cancer” is taboo in most cultures and is not openly discussed. This presentation will discuss strategies used to engage this diverse population and discuss lessons learned from multiple community-based educational programs on breast health among immigrant and refugee females. Citation Format: May Shogan, Frances Saad-Harfouche. Engaging refugees and immigrants in breast health education [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA23.

4185 Assessing Barriers to Retention in Care Continuum Among HCV Positive Homeless Adults of New Orleans

OBJECTIVES/GOALS: This study has two primary aims: 1) evaluate points of success and failure in connecting hepatitis C virus (HCV) positive homeless patients to care following a preliminary positive rapid HCV test result, and 2) describe the barriers cited by patients who drop out at each step in the care continuum. METHODS/STUDY POPULATION: A retrospective longitudinal analysis of adult (18 years or older) homeless individuals accessing shelter at six homeless shelters in New Orleans, LA was conducted. Every patient who came through a testing site received a survey collecting information on demographics, barriers to healthcare, and recent utilization of health services. A retrospective chart review of hospital and homeless clinic medical records was used to track patient linkage to care and their progress through the HCV care continuum. We defined successful linkage to care as attendance at the first scheduled follow-up appointment for treatment with a primary care physician. RESULTS/ANTICIPATED RESULTS: A total of 1719 unique patients were identified from August 2016 through August 2019 which included 36% self-identified as African American/Black, 55% identified as White and 8% identified as mixed-race or other. A total of 24% of individuals reported no insurance coverage while 66% of patients reported having insurance. Overall, 85 patients reported they experienced no barriers to healthcare. Of those who reported barriers, 44% reported trouble with finances or insurance, 22% transportation, 18% personal drug use, 9% personal alcohol use, and 7% reported a distrust of healthcare providers or the system. Other barriers included long wait times, distance, and recent incarceration. DISCUSSION/SIGNIFICANCE OF IMPACT: Although screening for HCV is readily available, barriers exist which prevent diagnosis and treatment. We implemented a HCV testing and linkage-to-care program between local homeless shelters and health centers in New Orleans in an effort to reduce HCV-related morbidity and mortality.