Investigation of hospital discharge cases and SARS-CoV-2 introduction into Lothian care homes

Background The first epidemic wave of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Scotland resulted in high case numbers and mortality in care homes. In Lothian, over one-third of care homes reported an outbreak, while there was limited testing of hospital patients discharged to care homes. Aim To investigate patients discharged from hospitals as a source of SARS-CoV-2 introduction into care homes during the first epidemic wave. Methods A clinical review was performed for all patients discharges from hospitals to care homes from 1st March 2020 to 31st May 2020. Episodes were ruled out based on coronavirus disease 2019 (COVID-19) test history, clinical assessment at discharge, whole-genome sequencing (WGS) data and an infectious period of 14 days. Clinical samples were processed for WGS, and consensus genomes generated were used for analysis using Cluster Investigation and Virus Epidemiological Tool software. Patient timelines were obtained using electronic hospital records. Findings In total, 787 patients discharged from hospitals to care homes were identified. Of these, 776 (99%) were ruled out for subsequent introduction of SARS-CoV-2 into care homes. However, for 10 episodes, the results were inconclusive as there was low genomic diversity in consensus genomes or no sequencing data were available. Only one discharge episode had a genomic, time and location link to positive cases during hospital admission, leading to 10 positive cases in their care home. Conclusion The majority of patients discharged from hospitals were ruled out for introduction of SARS-CoV-2 into care homes, highlighting the importance of screening all new admissions when faced with a novel emerging virus and no available vaccine

SARS-CoV-2 Omicron is an immune escape variant with an altered cell entry pathway

Vaccines based on the spike protein of SARS-CoV-2 are a cornerstone of the public health response to COVID-19. The emergence of hypermutated, increasingly transmissible variants of concern (VOCs) threaten this strategy. Omicron (B.1.1.529), the fifth VOC to be described, harbours multiple amino acid mutations in spike, half of which lie within the receptor-binding domain. Here we demonstrate substantial evasion of neutralization by Omicron BA.1 and BA.2 variants in vitro using sera from individuals vaccinated with ChAdOx1, BNT162b2 and mRNA-1273. These data were mirrored by a substantial reduction in real-world vaccine effectiveness that was partially restored by booster vaccination. The Omicron variants BA.1 and BA.2 did not induce cell syncytia in vitro and favoured a TMPRSS2-independent endosomal entry pathway, these phenotypes mapping to distinct regions of the spike protein. Impaired cell fusion was determined by the receptor-binding domain, while endosomal entry mapped to the S2 domain. Such marked changes in antigenicity and replicative biology may underlie the rapid global spread and altered pathogenicity of the Omicron variant

Examining the Title X Family Planning Program’s (Public Law 91-572) Legislative History through a Feminist Lens: A Thematic Analysis and Oral Histories with Key Stakeholders in Florida

The Title X Family Planning Program (Public Law 91-572), enacted by President Richard Nixon in 1970, provides federal funds for voluntary, confidential family planning services to all women, regardless of their age or economic status. This federal legislation aspired to prevent unintended pregnancies and poor birth outcomes to those in most need. However, over the past three decades, Title X has faced political, financial and social challenges. Despite its enormous success in improving the health and well-being of women and children by decreasing unintended pregnancies, the need for abortions and providing key comprehensive preventive services, without a newfound political will similar to that during which it was conceived, the future of Title X may be in jeopardy. This study grounded theoretically and methodologically in a feminist policy analysis approach, critically examined the maturation of Title X by employing a mixed methodology design that consisted of a thematic analysis on Title X\u27s legislative history and the conduction and analysis of oral histories. In Phase I, themes were extracted from the federal bills included in Title X\u27s legislative history, which assisted in the identification of the issues that this policy has endured. In Phase II, a semi-structured interview guide was developed based upon the themes and findings from the thematic analysis as well as from pre-determined constructs from McPhail\u27s Feminist Policy Analysis Framework, to explore key informants\u27 perceptions, recollections and experiences regarding the Title X program. By examining Title X through a feminist lens, various issues were exposed and critically examined, including issues that are typically ignored by traditional policy analyses. Moreover, understanding the historical underpinnings and evolutions of a policy and recognizing past failures and achievements are necessary in order to make informed future decisions. Implications for research, practice and policy are discussed

Does health literacy affect fruit and vegetable consumption? An assessment of the relationship between health literacy and dietary practices among college students.

Objective: To explore the association between health literacy and fruit and vegetable (F&V) consumption among college students. Participants: In 2018, undergraduate students from a large, southeastern university were recruited to participate in this study. Methods: Participants (n = 436) completed an online survey assessing health literacy, F&V intake, and personal, situational, and societal and environmental determinants of health literacy. Results: There was a significant association between general health literacy, F(2, 161.54) = 6.52, p \u3c.001; disease prevention health literacy, F(2, 214.22) = 4.788, p \u3c.01; and health promotion health literacy, F(2, 138.35) = 5.53, p \u3c.01 with F&V consumption. Students with excellent health literacy consumed significantly more fruits and vegetables than students with limited health literacy. Conclusions: Health literacy may play an important role in F&V consumption among college students. Future research should explore the relationship between the health literacy and dietary practice decision-making to inform intervention development among college students

The Knowledge and Perceptions of Florida Pharmacists in Administering Inactivated Influenza Vaccines to Pregnant Women

Background: Influenza vaccine rates in pregnant women remain suboptimal despite the recommendations from healthcare organizations. Though pharmacists can provide immunization services as a result of the standing order, few studies have examined the role of the pharmacist in providing immunization to pregnant women or explored their perspective on their role in providing influenza vaccines among pregnant women. Purpose: This study explored the perceptions and knowledge of Florida pharmacists in administering inactivated influenza vaccines (IIV) to pregnant women. Methods: Semi-structured in-depth interviews guided by the theory of planned behavior were conducted with 18 licensed Florida pharmacists, including clinical and retail pharmacists. A thematic analysis was conducted. Results: The majority of pharmacists (94%) were knowledgeable about the IIV in pregnant women. Participants expressed mixed attitudes, identified barriers and facilitators, and subjective norms influencing vaccine administration in pregnant women. Participants expressed the importance of trust and how that influenced vaccine uptake. Participants also expressed their position not to only provide immunization services but also to counsel and educate patients. Conclusion: There is a need to strengthen immunization services, provided by pharmacists to more individuals, including high-risk groups such as pregnant women

Transforming Women\u27s Oral–systemic Health Through Discovery, Development and Delivery

Due to the complexity of women\u27s health issues that involve the interplay between oral and systemic health, a multidisciplinary approach to research and practice is critical to ensure health and quality of life among women across the lifespan. The 2nd Annual Conference entitled ‘Transforming Women\u27s Health: Discovery, Development and Delivery of the Oral–Systemic Connection’, was held in Tampa (FL, USA) on 26–27 January 2013. The conference addressed complex oral–systemic women\u27s health issues structured by three organizational pillars: discovery, development and delivery, with overarching topic areas of oral human papillomavirus infection, autoimmune conditions and the Affordable Care Act. This conference served as an effective method for bringing together multiple disciplines to discuss emerging women\u27s health issues

Correlates of long-term physical activity adherence in women

Background: Little is known about the factors that may influence women's adherence to moderate-to-vigorous physical activity (MVPA) using longitudinal data. The purpose of this study was to examine the correlates of long-term physical activity (PA) participation among women. Methods: Female data from Waves I, III, and IV (n = 5381) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were used for the analysis. The outcome of PA adherence was operationalized as (1) consistently physically active (at least 5 instances during the week) in both Waves III and IV (during adulthood), and (2) consistently not physically active or only physically active in either Wave III or IV. Predictor variables from Wave I (during adolescence) included race/ethnicity, PA level, self-perception of being physically fit, general health status, attempt to change weight, parents' income level, parents' education, well-being, depression, access to PA resources, days of physical education (PE), and grade level. Crude and adjusted logistic regression models were utilized to estimate the adjusted odds ratio (aOR) and 95% confidence interval (95%CI) for the outcome variable. Results: PA levels during adolescence significantly predicted PA adherence (aOR = 1.67, 95%CI: 1.35–2.05). Additionally, wanting to lose weight (aOR = 1.49, 95%CI: 1.20–1.85), using fitness center in the neighborhood (aOR = 1.29, 95%CI: 1.05–1.58), and having 5 days of PE a week (aOR = 1.48, 95%CI: 1.09–2.02) were significant predictors. Women who did not perceive being physically fit (aOR = 0.65, 95%CI: 0.44–0.95) and Black, non-Hispanics (aOR = 0.60, 95%CI: 0.44–0.82) were less likely to adhere to PA. Conclusion: The findings suggested that physically active adolescents were more likely to become active adults. Future research should address interventions (e.g., PE program, community resources) that may promote lifetime PA in women, with the goal of decreasing morbidity and mortality

The feminization of HPV: How science, politics, economics and gender norms shaped U.S. HPV vaccine implementation

Human papillomavirus (HPV) can cause a number of anogenital cancers (i.e., cervical, penile, anal, vaginal, vulvar) and genital warts. A decade ago, the HPV vaccine was approved, and has been shown to be a public health achievement that can reduce the morbidity and mortality for HPV-associated diseases. Yet, the mistaken over-identification of HPV as a female-specific disease has resulted in the feminization of HPV and HPV vaccines. In this critical review, we trace the evolution of the intersection of science, politics, economics and gender norms during the original HPV vaccine approval, marketing era, and implementation. Given the focus on cervical cancer screening, women were identified as bearing the burden of HPV infection and its related illnesses, and the group responsible for prevention. We also describe the consequences of the feminization of HPV, which has resulted primarily in reduced protection from HPV-related illnesses for males. We propose a multilevel approach to normalizing HPV vaccines as an important aspect of overall health for both genders. This process must engage multiple stakeholders, including providers, parents, patients, professional organizations, public health agencies, policymakers, researchers, and community-based organizations. Keywords: HPV vaccination, Feminization, Critical revie

Oral health during pregnancy: an analysis of interprofessional guideline awareness and practice behaviors among prenatal and oral health providers

Abstract Background Poor oral health during pregnancy has significant implications across the life course, including increased risk for adverse pregnancy, birth outcomes, and the development of early childhood caries. In efforts to improve perinatal oral health in the United States, a set of national interprofessional guidelines were developed that include recommended practice behaviors for both oral health providers and prenatal providers. The purpose of this study was to examine guideline awareness, familiarity, beliefs, and practice behaviors among both provider types. Methods Prenatal providers and oral health providers in Florida were recruited via random and convenience sampling to complete an online survey guided by the Consolidated Framework for Implementation Research (CFIR) and the Cabana Framework. The present analysis focused on the Individuals Involved domain (CFIR), awareness and familiarity with the guidelines (Cabana Framework), confidence, and practice behaviors as recommended by prenatal oral health guidelines (assess, advise, refer, share/coordinate). Data were analyzed using chi-square tests, independent samples t-tests, Pearson correlation coefficients, and one-way analysis of variance (ANOVA) and analyses were conducted in SPSS. Results Prenatal and oral health providers did not differ significantly in their awareness of the guidelines, but awareness was significantly associated with three of the four practice behaviors for prenatal providers. Familiarity with the guidelines was significantly higher among oral health providers and was associated with all four practice behaviors for both provider types. Five out of ten oral health belief items were significantly associated with practicing the guidelines among prenatal providers, but only two among oral health providers. Confidence in performing the practice behaviors was significantly associated with guideline implementation among both groups. Years in practice was significantly associated with performing practice behaviors for prenatal providers, but not for oral health providers. Conclusions Our findings highlight the importance of professional organizations and the role of clinical guidelines on practice behaviors. Although provider education is a key implementation strategy, organizational and policy-level system changes could also be critical in supporting practice behaviors

Are dental providers the next line of HPV-related prevention? Providers’ perceived role and needs

The rise in HPV-related oropharyngeal cancer incidence necessitates novel prevention efforts including multiple provider types. Although dental providers screen for HPV-related oropharyngeal cancers, little is known about their needs to advance “primordial prevention,” or interventions at the earliest possible stage, to prevent HPV-related cancers. This study assessed dentists' and dental hygienists’ perceived roles and needs regarding HPV-related primordial prevention.We conducted a mixed-method study with data from focus groups with dentists (n= 33) and dental hygienists (n= 48) and surveys from both provider types (n= 203) among providers from a diverse set of practice settings and geographic communities. Data were analyzed using qualitative thematic analysis and chi square tests.Participants affirmed dental professionals’ roles in preventing HPV-related cancers and identified needs to overcome barriers to fulfilling prevention objectives. Barriers included: (1) practice environment and patient characteristics, and (2) the sensitive topic of HPV. Further, participants identified needs to improve HPV-related cancer prevention.Findings from this study suggest that dental providers may become the next line of prevention for HPV-related cancers. Dental providers’ professional associations have provided guidance on HPV and oropharyngeal cancers, but our study reveals dental providers’ needs for following professional organizations’ guidance to advance prevention efforts and reduce HPV-related cancer incidence. Keywords: Oropharyngeal cancer, Human papillomavirus, Dental providers, Preventio