Non-healthcare Settings Research Articles

User-resistance behaviours toward electronic health records: uncovering the determinants of perceived threats

ABSTRACT This study uncovers the determinants of perceived threats that have long been associated with resistance to healthcare information technology in general, and electronic health records in particular. Conceptualised as perceived dissatisfaction with outcomes and perceived helplessness over process, these threats are discussed from the perspective of the Psychological Reactance Theory. Study participants consisting of a diverse group of healthcare professionals were drawn from sample frame of health practices. Data from a sample of 217 participants were used to test the model. Using structural equation modeling, the model relationships were analyzed, and hypotheses were tested. The study results show that perceived threats to electronic health records are triggered by two types of factors: namely, intrinsic stimuli like self-efficacy and performance expectancy; and extrinsic causes such as social enabling effect and social influence. The implications of these findings are particularly useful to both research and practice. Managers and informaticians in both healthcare and non-healthcare settings will find the results both instructive and helpful in mitigating resistance. Theorists will be enriched by the insights from the antecedents of perceived threats to advance research.

Asian People Reached by the Centers for Disease Control and Prevention HIV Testing Program in the United States: HIV Testing, Linkage to HIV Medical Care, and Interview for Partner Services 2014-2020.

The purpose of this analysis is to describe HIV tests and associated outcomes for Asian people reached by the Centers for Disease Control and Prevention (CDC) HIV testing program. We analyzed CDC-funded HIV tests among Asian individuals in the United States, Puerto Rico, and the U.S. Virgin Islands (2014-2020). Of the 415,560 tests, the positivity of new diagnoses was higher among males (0.49%, aPR = 7.64) than females (0.06%), and in the West (0.42%, aPR = 1.15) than in the South (0.25%). In non-health care settings, positivity was highest among men who have sex with men (MSM; 0.87%) and transgender people (0.46%). Linkage to HIV medical care among Asian people was 87.5%, and 70.7% were interviewed for partner services. Our findings suggest that improvements are crucial, particularly for Asian MSM, in linkage to care and interview for partner services.

Human Papillomavirus Vaccine Awareness and Acceptability for Primary Prevention of Cervical Cancer in Pakistan: A Cross-Sectional Study.

Human papillomavirus (HPV) vaccine is the most effective option for primary prevention HPV, a well-known cause of cervical cancer. The objective of the study was to assess awareness of HPV, the acceptability of its vaccine and factors associated with the acceptability among the adult population in Pakistan. A cross-sectional survey was conducted among adult population of Pakistan from January 2022 and March 2022. Due to the ongoing COVID-19 pandemic, instead of face-to-face interviews, a self-administered questionnaire was developed and distributed through Google Forms. The questionnaire was available in both English and Urdu languages to cater to a diverse population. Overall, 313 (65.2 %) study participants had heard about HPV infection, while 297 (61.9%) knew HPV as the cause of genital warts and 256 (53.3 %) knew that HPV can cause any type of cancer, with a higher percentage of awareness among those who were in any health care setting compared to those who were in a non-healthcare setting. Regarding the acceptability to get HPV vaccine, 320 (66.7%) of the study participants were willing to get vaccinated, while only 15(3.1%) of the study population had previously received HPV vaccine. The most important factors associated with HPV vaccine acceptability were younger age of 18-25 years (Prevalence Ratio (PR) =1.60, 95% Confidence Interval (CI) =1.11, 2.32), and 26-35 years (PR= 1.65, 95% CI=1.09, 2.50). HPV vaccine acceptability was also associated with working in a healthcare setting due to better awareness of HPV vaccine (PR= 1.29, 95% CI=1.03, 1.62). It is important to address the knowledge gaps existing in the community about HPV vaccine acceptability and barriers against it for the successful rollout of the HPV vaccination program in Pakistan. Mass awareness campaigns about HPV, HPV vaccine, and cervical cancer are needed to increase the acceptability of HPV vaccine among public at the time of reintroducing HPV vaccine.

Supermarket/hypermarket opportunistic screening for atrial fibrillation (SHOPS-AF) using sensors embedded in the handles of supermarket trolleys: A feasibility study

BackgroundAtrial fibrillation (AF) increases the risk of death, stroke, heart failure, cognitive decline, and healthcare costs but is often asymptomatic and undiagnosed. There is currently no national screening programme for AF. The advent of validated hand-held devices allows AF to be detected in non-healthcare settings, enabling screening to be undertaken within the community. Method and ResultsIn this novel observational study, we embedded a MyDiagnostick single lead ECG sensor into the handles of shopping trolleys in four supermarkets in the Northwest of England: 2155 participants were recruited. Of these, 231 participants either activated the sensor or had an irregular pulse, suggesting AF. Some participants agreed to use the sensor but refused to provide their contact details, or consent to pulse assessment. In addition, some data were missing, resulting in 203 participants being included in the final analyses. Fifty-nine participants (mean age 73.6 years, 43% female) were confirmed or suspected of having AF; 20 were known to have AF and 39 were previously undiagnosed. There was no evidence of AF in 115 participants and the remaining 46 recordings were non-diagnostic, mainly due to artefact. Men and older participants were significantly more likely to have newly diagnosed AF. Due to the number of non-diagnostic ECGs (n=46), we completed three levels of analyses, excluding all non-diagnostic ECGs, assuming all non-diagnostic ECGs were masking AF, and assuming all non-diagnostic ECGs were not AF. Based on the results of the three analyses, the sensor's sensitivity (95% CI) ranged from 0.70 - 0.93; specificity from 0.15 - 0.97; positive predictive values (PPV) and negative predictive values (NPV) ranged from 0.24 - 0.56 and 0.55-1.00, respectively. These values should be interpreted with caution, as the ideal reference standard on 1934 participants was imperfect. ConclusionThe study demonstrates that the public will engage with AF screening undertaken as part of their daily routines using hand-held devices. Sensors can play a key role in identifying asymptomatic patients in this way, but the technology must be further developed to reduce the quantity of non-diagnostic ECGs.

Rationale and design of the NODE-303 study: evaluating the safety of symptom-prompted, self-administered etripamil for paroxysmal supraventricular tachycardia episodes in real-world settings

Paroxysmal supraventricular tachycardia (PSVT) is a common episodic arrhythmia characterized by unpredictable onset and burdensome symptoms including palpitations, dizziness, chest pain, distress, and shortness of breath. Treatment of acute episodes of PSVT in the clinical setting consists of intravenous adenosine, beta-blockers, and calcium channel blockers (CCBs). Etripamil is an intranasally self-administered L-type CCB in development for acute treatment of AV-nodal dependent PSVT in a non-medical supervised setting. This paper summarizes the rationale and study design of NODE-303 that will assess the efficacy and safety of etripamil. In the randomized, double-blinded, placebo-controlled, Phase 3 RAPID trial, etripamil was superior to placebo in the conversion of single PSVT episodes by 30 minutes post initial dose when administered in the non-healthcare setting; this study required a mandatory and observed test dosing prior to randomization. The primary objective of NODE-303 is to evaluate the safety of symptom-prompted, self-administered etripamil for multiple PSVT episodes in real-world settings, without the need for test dosing prior to first use during PSVT. Secondary endpoints include efficacy and disease burden. Upon perceiving a PSVT episode, the patient applies an electrocardiographic monitor, performs a vagal maneuver, and, if the vagal maneuver is unsuccessful, self-administers etripamil 70 mg, with an optional repeat dose if symptoms do not resolve within 10 minutes after the first dose. A patient may treat up to four PSVT episodes during the study. Adverse events are recorded as treatment-emergent if they occur within 24 hours after the administration of etripamil. Efficacy endpoints include time to conversion to sinus rhythm within 30 and 60 mins after etripamil administration, and the proportion of patients who convert at 3, 5, 10, 20, 30, and 60 min. Patient-reported outcomes are captured by the Brief Illness Perception Questionnaire, the Cardiac Anxiety Questionnaire, the Short Form Health Survey 36, the Treatment Satisfaction Questionnaire for Medication and a PSVT survey. Overall, these data will support the development of a potentially paradigm-changing long-term management strategy for recurrent PSVT.

Fuzzy adaptive resonance theory failure mode effect analysis non-healthcare setting for infectious disease: review

<span>Fuzzy adaptive resonance theory (ART) is an ART network that is developed as one of the alternative methods to evaluate risk priority number (RPN) in failure mode and effect analysis (FMEA). Not only is FMEA are common technique as an analysis tool in industrial sectors, but also, especially during the global emergency COVID-19 pandemic hits, FMEA is used in prevention and mitigation measures. Many alternative methods have been proposed. However, not many investigations use clustering models such as Fuzzy ART in FMEA. This paper aims to provide a comprehensive review and then propose a model for systematic risk analysis which implement the fuzzy ART model, named clustering- transmission causes and effects analysis (c-TCEA), for the prevention and mitigation of infectious diseases.</span>

Risk exposure to SARS-CoV-2 and workers’ risk perception in non-healthcare setting in Hong Kong, Nanjing and Wuhan: A qualitative multi-site study

Introducción: Understanding risk perception that hinges on health-protective behaviors is central to strategies for prevention. Aim: To classify the pattern of potential risk of worker exposure to SARS-CoV-2, and to assess association with risk perception among non-healthcare workers Methods: In a multi-site, qualitative study, we conducted individual in-depth interviews and mini focus group discussions with employees, managerial staff and self-employees from Hong Kong (n=87), Nanjing (n=60), and Wuhan (n=60) between June 2020 and March 2021. Audios were transcribed and categorized by themes following Grounded Theory approach. Results: We identified seven major types of potential risk exposure pattern by category of parameters. The risk perceptions decreased among Type A workers, working at fixed location in office, and no/little contacts with clients/customers, and increased among workers having the concern of asymptomatic characteristics of SAR-CoV-2, daily contact with large size of the unfamiliar crowds, unhygienic behaviors of clients/customers, and use of public transportation to commute to work. The notion that the sense of safety deriving from the implementation and adherence with safety measures despite stringency, and trust with the government was most frequently reported in Nanjing and Wuhan. Conclusion: Study examines COVID-19 risks and risk perceptions among non-healthcare workers in three cities. Variations in risk perceptions were found, influenced by factors such as work patterns and safety measures. Trust in government and concerns about international contacts were common themes. The findings emphasize the need for targeted interventions, mental health support, and inclusive policies to address occupational health disparities and promote workplace safety.

Validation of the brain injury associated visual impairment - impact questionnaire (BIVI-IQ)

PurposeThe Brain Injury associated Visual Impairment - Impact Questionnaire (BIVI-IQ) was developed to assess the impact of post-stroke visual impairment. The development of the questionnaire used robust methods involving stroke survivors and clinicians. The aim of this study was to assess the validity of the BIVI-IQ in a stroke population.MethodsStroke survivors with visual impairment were recruited from stroke units, outpatient clinics and non-healthcare settings. Participants were asked to complete questionnaire sets on three separate occasions; the BIVI-IQ at each visit with additional questionnaires at baseline and visit 2. Vision assessment and anchor questions from participants and clinicians were collected. The analysis included assessment of missing data, acceptability, Rasch model analysis, test–retest reliability, construct validity (NEI VFQ-25, EQ-5D-5L) and responsiveness to change.Results316 stroke survivors completed at least one questionnaire of the 326 recruited. Mean age was 67 years and 64% were male. Adequate fit statistics to the Rasch model were reached (χ2 = 73.12, p = 0.02) with two items removed and thresholds of two adjusted, indicating validity and unidimensionality. Excellent test–retest reliability was demonstrated (ICC = 0.905) with a 3-month interval. Construct validity was demonstrated with a strong significant correlation to the NEI VFQ-25 (r = 0.837, p < 0.01). The BIVI-IQ also demonstrated responsiveness to change with significant differences identified between groups based on participant and clinician anchor questions (X2 = 23.29, p < 0.001; X2 = 24.56, p < 0.001).ConclusionThe BIVI-IQ has been shown to be valid and practical for ‘everyday’ use by clinicians and researchers to monitor vision-related quality of life in stroke survivors with visual impairment.

Agreement and Reliability of Patient-measured Postvoid Residual Bladder Volumes

BackgroundPost-void residual bladder volume (PVR) measurement in the non-healthcare setting is a valuable opportunity for remote monitoring of voiding dysfunction patients. We hypothesized that PVR self-measurement using a smart-device portable ultrasound system with artificial intelligence would demonstrate high reliability, strong agreement with provider measurement, and be preferred over provider measurements. MethodsPatients were enrolled during outpatient Urology visits. PVRs were measured in triplicate by providers using each of the following: an FDA-cleared (standard) bladder scanner, the portable ultrasound probe using ultrasound images (ButterflyTM US image mode), and the portable ultrasound probe using abstract images (ButterflyTM abstract mode). Subjects self-measured PVRs in triplicate using both imaging modes and reported their experiences via questionnaire. Reliability was assessed via intraclass correlation (ICC). Agreement between methods was assessed via Bland-Altman analyses using a clinically acceptable difference threshold of 50 mL. Results50 patients were enrolled. ICCs ranged from 0.95-0.98 for each method. 95% limits of agreement between standard bladder scanner and patient self-measurement were -71.73 mL and 86.73 mL using ButterflyTM US image mode and -93.84 mL and 112.52 mL using ButterflyTM abstract mode, respectively. Most patients preferred self-measurement over provider measurement (74% vs 26%, respectively). ConclusionsPatient self-measurement of PVR using smart-device integrated portable ultrasound probes is feasible, reliable, and preferred by patients. Limits of agreement between patient self-measurement and standard bladder scanner measurements exceeded our clinically acceptable difference threshold, though the inherent error of ultrasound-based bladder volume measurements should be considered. Longitudinal PVR assessments in non-healthcare settings may facilitate remote monitoring of voiding dysfunction patients.

1767. Ventilation in Non-Healthcare Congregate Settings: Capacity-Building Assessments to Reduce COVID-19 Exposure Risks, California 2022 – 2023

Abstract Background Optimizing indoor air quality has been increasingly recognized as a cornerstone strategy to minimize aerosol transmission of SARS-CoV-2, particularly in non-healthcare congregate settings. Expertise often is lacking within local health departments (LHDs), to provide ventilation guidance to such facilities. Methods We offered non-regulatory ventilation assessments by state industrial hygienists (IHs) to 58 LHDs. Interested LHDs selected 1-2 non-healthcare congregate facilities, prioritized by: administrator interest, whether they were publicly funded, or had past COVID-19 outbreaks. We requested on-site participation of LHD and facility staff. State IHs presented educational material at pre-visit meetings and during the visits. Findings were collected systematically, and recommendations shared in reports and post-visit debriefings. Participants completed post-visit surveys. Results We visited 25 facilities in 19 counties, including 8 homeless shelters, 7 jails, 8 schools, 1 campground, and 1 behavioral health facility. Most (68%) were not operating heating, ventilation, and air conditioning (HVAC) systems continuously and air dampers were closed or obstructed in 4 (16%) facilities. Half of facilities had insufficient HVAC maintenance. Only 7 (28%) facilities used Minimum Efficiency Reporting Value (MERV) 13 filters. Of residential facilities, 3 (19%) had medical isolation spaces equipped with dedicated air handlers. Of non-correctional facilities, 11 (61%) used portable air cleaners. No facilities had implemented staff training on ventilation measures. In post-visit surveys, LHDs reported gaining a better understanding of actions that facilities can take to improve ventilation practices, which could also be generalized to other settings. Conclusion State IHs can have an important impact in bolstering public health workforce knowledge of principles of ventilation assessments. Common inadequacies in ventilation practices may occur in a variety of non-healthcare congregate settings, increasing the risk of SARS-CoV-2 transmission and outbreaks in vulnerable persons. Demonstrative site visits can effectively provide practical training to LHDs and inform the development of tools to build public health capacity to guide under-resourced settings. Disclosures All Authors: No reported disclosures

Pediatric AKI in the real world: changing outcomes through education and advocacy—a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference

BackgroundAcute kidney injury (AKI) is independently associated with increased morbidity and mortality across the life course, yet care for AKI remains mostly supportive. Raising awareness of this life-threatening clinical syndrome through education and advocacy efforts is the key to improving patient outcomes. Here, we describe the unique roles education and advocacy play in the care of children with AKI, discuss the importance of customizing educational outreach efforts to individual groups and contexts, and highlight the opportunities created through innovations and partnerships to optimize lifelong health outcomes.MethodsDuring the 26th Acute Disease Quality Initiative (ADQI) consensus conference, a multidisciplinary group of experts discussed the evidence and used a modified Delphi process to achieve consensus on recommendations on AKI research, education, practice, and advocacy in children.ResultsThe consensus statements developed in response to three critical questions about the role of education and advocacy in pediatric AKI care are presented here along with a summary of available evidence and recommendations for both clinical care and research.ConclusionsThese consensus statements emphasize that high-quality care for patients with AKI begins in the community with education and awareness campaigns to identify those at risk for AKI. Education is the key across all healthcare and non-healthcare settings to enhance early diagnosis and develop mitigation strategies, thereby improving outcomes for children with AKI. Strong advocacy efforts are essential for implementing these programs and building critical collaborations across all stakeholders and settings.

Efficacy of facemasks in preventing transmission of COVID-19 in non-healthcare settings: A scoping review.

During the COVID-19 pandemic, an abundance of literature relating to the efficacy of face masks on reducing transmission of COVID-19 in non-healthcare settings emerged. The aim of this scoping review was to allow the identification of: types of evidence conducted in this area; knowledge gaps and common concepts relating to mask efficacy in non-healthcare settings. A comprehensive literature search was conducted in PubMed, CINAHL, MEDLINE, Embase and the Irish Management Institute bibliographic database on December 15th, 2021. All types of face masks were included. Of 722 records, 16 were included after full text screening. Themes from an adapted model of Howard et al. framework were used to group results and identify common concepts. The grouped thematic results were then applied to the socio-ecological model. This illustrated the multifactorial elements determining the efficacy of masks themselves while also illustrating how other factors such as individual behaviours, social interactions, settings and national policy can influence the degree of the protective effect. The findings from this scoping review indicate that an abundance of experimental literature is available indicating that masks are effective at preventing COVID-19 transmission but their degree of efficacy is impacted by external factors. This review highlights that the quality of the evidence available is low.

Perception of COVID-19 infection risk among students in healthcare professions: a qualitative study.

The aim of this study was to describe how students in healthcare professions perceived the risk of COVID-19 infection during their curricular internships in the post-lockdown period, in order to evaluate possible corrective and/or improvement actions to ensure future safe learning experiences. Is a descriptive qualitative study conducted in March 2021 using Focus Groups, with the participation of students from all the involved study programs, based on a voluntary proactive sampling approach. The study was conducted among students in healthcare professions at the University of Bologna, in collaboration with the Local Health Authority of Imola, who were undertaking curricular internships in various public or private healthcare, social, and non-healthcare settings, as specified in the educational plan. The results showed that the students reported having knowledge about preventive measures to avoid infection, being attentive observers of the organizational aspects within their internship contexts, and considering the internship tutor as a significant guiding figure in their perception of risk and the related measures to be adopted. Despite the challenges, the students evaluated their internship experience as an opportunity to acquire distinctive skills. Students who embarked on their internships without prior experience expressed additional and diverse aspects that warrant further investigation. Therefore, it was deemed necessary to conduct further qualitative research to broaden the perception of SARS-CoV-2 infection risk in this group of students.

Parents' Perceptions of a Serious Game for Educating Families on Prescription Opioid Safety: Qualitative Pilot Study of MedSMARxT: Adventures in PharmaCity.

Opioid misuse is a pervasive, worsening problem that affects the health of people throughout the United States, including adolescents. There are few adolescent-focused interventions designed to educate them about opioid medication safety. The MedSMARxT: Adventures in PharmaCity, is a serious educational video game that teaches parents and their youths about safe opioid practices. This study aimed to elucidate parent's perceptions of MedSMARxT: Adventures in PharmaCity and its potential use by parents and their adolescents. Parents of adolescents aged 12 to 18 years who live in the United States were recruited from April to October 2021 via Qualtrics research panels, social media, email listserves, and snowball sampling. The study participants played MedSMARxT: Adventures in PharmaCity for 30 minutes and then participated in a 30-minute postgame interview via WebEx (Cisco). Questions were developed and piloted to examine adults' perceptions of the game. Participants were asked three sets of open-ended questions: (1) questions about the game and elements of the game, (2) what they learned from the game, and (3) questions about their experience with games. Audio recordings were transcribed verbatim. Interview transcripts were coded using content and thematic analysis by study team members to identify major themes and subthemes from the data. Parent participants (N=67) played MedSMARxT: Adventures in PharmaCity and completed a postgame interview. Analysis extrapolated four primary themes from the data: (1) participant gaming experience, (2) perception of game features, (3) educational purpose of the game, and (4) future use of the game. Most participants (n=56, 84%), had at least some experience with video games. More than half of the participants (n=35, 52%) participants, had positive reactions to the game characters and scenes depicted in MedSMARxT: Adventures in PharmaCity and stated they were realistic for adolescents. Most participants (n=39, 58%), would recommend the game to others. Significant difficulties with gameplay navigation were reported by 38 (57%) participants, as well as a slow game pace. All participants were able to accurately identify the overarching goal of the game: opioid or medication safety. The game reinforced existing knowledge for participants, though many (n=15, 22%), reported a new awareness of the need to store opioid medications in a locked area and the availability of medication disposal drop boxes at pharmacies. Participants stated that they would recommend the game for future use by families and youths in various health care and non-health care settings. The use of a tailored serious game is a novel, engaging tool to educate adolescents on opioid safety. MedSMARxT: Adventures in PharmaCity can be used as a tool for parents and adolescents to facilitate meaningful dialogue about safe and appropriate opioid use.

Impact of COVID-19 on occupational injuries and illnesses among nursing care facility workers: Analysis of California workers' compensation data, 2019-2021.

The coronavirus disease 2019 (COVID-19) pandemic greatly affected healthcare workers, both physically and psychologically, by increasing their workload and stress. This may also have increased their risk of occupational injuries. This study analyzed workers' compensation (WC) claims among California nursing care facility workers during 2019-2021, to assess the impact of the pandemic on occupational injury risk. This study used data from the California Workers' Compensation Information System. WC claims in prepandemic and pandemic periods were described and compared between nursing care facilities and other settings. Nursing facility cases were described by demographic, job, and injury characteristics. In 2019-2021, we identified 41,134 claims as nursing facility cases in California. Annual claims increased by 64.6% from 2019 to 2020 and then decreased in 2021, returning to levels similar to pre-COVID. In contrast, non-healthcare settings had decreases in claims during the pandemic. COVID-related claims accounted for 50.5% of claims in nursing facilities in 2020-2021; this proportion was much higher compared with other healthcare (35.7%) or nonhealthcare settings (14.3%). Non-COVID claims decreased during the pandemic but mental disorder or stress claims increased in nursing facilities, particularly in 2020 (+42.5%). Our findings show that nursing care facilities were more severely affected by the pandemic than other settings. We did not find evidence of an increased risk of occupational injuries during the pandemic, except for increased claims for stress or mental disorders. Our findings indicate a clear need to address psychological stress and mental health among nursing facility workers during a pandemic.

A qualitative analysis examining intersectional stigma among young adults living with HIV in Atlanta, Georgia.

HIV-related stigma is a barrier to engagement in care for young adults living with HIV. Other intersecting forms of stigma (e.g., racism, sexism, homophobia), may worsen HIV-related stigma and impact engagement in care. From November 2020 to February 2021, we conducted 20 in-depth qualitative interviews among young adults living with HIV attending a large, comprehensive HIV care center in Atlanta, Georgia. Semi-structured interview guides based on Earnshaw and Chaudoir's HIV Stigma Framework and the theory of intersectionality facilitated discussion around experiences with various forms of stigma and its possible influence on healthcare engagement. Using the social-ecological model, we used thematic analysis to contextualize how young adults living with HIV experienced intersectional stigma and enacted, anticipated, and internalized HIV stigma in both healthcare and non-healthcare settings. Most participants identified as male, Black/African American, and gay. Participants described stigma at intrapersonal, interpersonal, clinic, and community levels. Intrapersonal stigma was associated with delayed care seeking, isolation, and fear of disclosure. Interpersonal stigma included discrimination from family and friends and avoidance of close relationships to elude disclosure. At the clinic level, stigma included negative experiences with staff in HIV and non-HIV healthcare settings, which contributed to decreased engagement in care. Stigma in the community included differential treatment from employers, community leaders, and religious community and was associated with feelings of helplessness related to current societal inequalities. Coping/motivating mechanisms for stigma included prioritizing health, eliciting support from the medical care team and peers. Our findings show different intersecting stigmas are barriers to healthcare at multiple levels for young adults living with HIV, potentially exacerbating existing health and social disparities. To improve engagement in care among young adults living with HIV, future interventions should address the different mechanisms of stigma at community, clinic, interpersonal and intrapersonal levels by enhancing social support and improving healthcare structural competency.

Microbiome of Clothing Items Worn for a Single Day in a Non-Healthcare Setting

When worn, clothing acquires a microbiome of bacteria and fungi derived from the wearer’s skin and from the environment. The types of bacteria and fungi that may be recovered from clothing in healthcare settings have been well characterized, but less is known regarding the microbiome of clothing worn in non-healthcare settings and the possible roles that such clothing may play in microbial exchange. Culture-based methods and culture-independent genomic sequencing were used to enumerate and identify bacteria and fungi recovered from T-shirts, baby onesies, socks, and underwear worn for a single day after having been purchased new, washed, and dried. The highest bacterial loads were recovered from socks, underwear, and onesies (&gt;106 colony-forming units [cfu]/sample) and the highest fungal loads were obtained from socks and underwear (&gt;5 × 102 cfu/sample). The sequencing method identified opportunistic pathogens present in the samples, including members of genus Staphylococcus and Corynebacterium, as well as anaerobic members of the family Clostridiales. The opportunistic fungal pathogen Candida parapsilosis was identified in a high proportion of worn clothing samples. These results suggest that clothing may represent a pathogen reservoir and a vector for microbial exchange between household occupants or the community outside of the home.

Province-to-province variability in hepatitis C testing, care, and treatment across Canada.

Few countries have implemented the necessary policy changes to reduce the number of steps in the cascade of care to achieve hepatitis C virus (HCV) elimination, including Canada. The aim of this study was to describe and compare legislation, scope of practice, and policy as it relates to the provision of HCV care in each province. We reviewed grey literature and regulatory and legislative documents which affect various aspects of the HCV cascade of care. Findings were verified by content experts. HCV RNA reflex testing ensures those that are antibody positive get an HCV RNA test; however only 80% of provinces have reflex test. Point-of-care antibody testing can be offered in most community non-health care settings, yet many types of health care providers are unable to do this independently. Following a positive test, it may not be feasible to complete venipuncture; however only a single province processes HCV RNA dried blood spot cards. In many provinces, training and verification are required for novice prescribers, and in some provinces prescribing continues to be restricted to specialists. Only a single province has task-shifted treatment to a non-physician non-nurse practitioner model, where pharmacists can prescribe treatment. Finally, 80% of provinces require authorization forms, and 30% require proof of investigations for treatment. No single province is optimizing the use of diagnostic tools and task shifting and decreasing paperwork to expedite treatment initiation. Collaboration between provinces is needed to streamline practice, update policy, and promote equity in HCV diagnosis, care, and treatment.

Occurrence of Human Viruses on Fomites in the Environment: A Systematic Review and Meta-analysis.

Documenting the occurrence of viruses on fomites is crucial in determining the significance of fomite-mediated transmission and the potential use of fomites for environmental disease surveillance. We conducted a systematic review and meta-analysis to compile information on the occurrence of human viruses on fomites in the environment; we identified 134 peer-reviewed papers. We compiled sampling and measurement methods, results, quality control information, and whether virus data were compared with community health data from the papers. We conducted univariate and multivariate analyses to investigate if presence of virus on fomites was associated with virus type (enveloped, nonenveloped), sampling location (healthcare setting, nonhealthcare temporary setting, nonhealthcare nontemporary setting), and area of fomite swabbed (<50, 50-100, >100 cm2). Across 275 data sets from the 134 papers, there was the most data available for Coronaviridae and from fomites at hospitals. Positivity rates, defined as the percent positive fomite samples, were low (median = 6%). Data were available on viruses from 16 different viral families, but data on viruses from 9 families had few (n < 5) data sets. Many human virus families were not identified in this review (11 families). Less than 15% of the data sets reported virus concentrations in externally valid units (viruses per area of surface), and 16% provided a quantitative comparison between virus and health data. Virus type and area swabbed were significant predictors of virus presence on fomites, and the positivity rate of data sets collected from healthcare settings and nonhealthcare nontemporary settings (e.g., individual housing) were significantly higher than those collected in nonhealthcare temporary settings (e.g., restaurants). Data from this review indicates that viruses may be present on fomites, that fomite-mediated virus transmission may occur, and that fomites may provide information on circulation of infectious diseases in the community. However, more quantitative data on diverse viruses are needed, and method reporting needs significant improvements.

CDC-Funded HIV Testing Services Outcomes and Social Determinants of Health in Ending the HIV Epidemic in the U.S. Jurisdictions.

We performed an ecological analysis to examine associations between CDC-funded HIV testing services outcomes and social determinants of health (SDOH) among Ending the HIV Epidemic in the U.S. jurisdictions. Using National HIV Prevention Program Monitoring & Evaluation (2020) and American Community Survey (2016-2020) data, we ran robust Poisson models (adjusted for race/ethnicity). In healthcare settings, a 10% absolute increase in percentage without health insurance was associated with a 40% lower prevalence of newly diagnosed positivity (aPR = 0.60, 95% CI: 0.43-0.83); a $5,000 increase in median household income (aPR = 1.04, 95% CI: 1.03-1.06) and a 10% absolute increase in percentage unemployed (aPR = 1.80, 95% CI: 1.31-2.46) were associated with 4% and 80%, respectively, higher prevalence of percentage linked to HIV medical care within 30 days of diagnosis (i.e., linkage). In non-healthcare settings, a 10% absolute increase in percentage with less than high school diploma (aPR = 0.53, 95% CI: 0.29-0.96) was associated with a 47% lower prevalence of newly diagnosed positivity, whereas a 10% absolute increase in percentage without health insurance (aPR = 1.92, 95% CI: 1.29-2.88) was associated with a 92% higher prevalence of newly diagnosed positivity; a 10% absolute increase in percentage with less than high school diploma was associated with a 35% lower prevalence of linkage (aPR = 0.65, 95% CI: 0.43-0.97). Addressing SDOH in HIV prevention programs will play an important role in ending the HIV epidemic.