East Chatham County, North Carolina : an action-oriented community diagnosis : findings and next steps of action : final document

Action-Oriented Community Diagnosis (AOCD) is a process to learn about the cultural, social, economic, and health experiences of individuals in a community through attending community-wide events, analyzing secondary data, and interviewing both community members and service providers about the strengths, assets and needs of the community. In our description of the study, the word “diagnosis” was changed to “assessment” in order to more accurately reflect the process and intent of the interviews. From this point on, AOCD will be referred to as AOCA. From September 2005 to April 2006, our team of five students from the University of North Carolina at Chapel Hill, School of Public Health completed an AOCA in the eastern region of Chatham County. An additional team of five students completed an assessment in the western part of the county. Both teams worked in conjunction with the Chatham Health Assessment (CHA) Team, a group coordinated by the Chatham County Public Health Department, who are conducting a county-wide health assessment to identify the health priorities of Chatham residents and to inform future services. Using the Chatham County Public Health Department’s established list of 11 health priorities from 2002, the student team inquired about community members’ and service providers’ knowledge of existing programs to address these health priorities, and asked which items should continue to remain priorities for the health department. This document is intended to summarize the identified assets, needs and strengths of the community and serve as a resource to Chatham County community members and service providers so that action steps can be taken. This document begins with a brief background of Chatham County, before delving into seven recurring issues that were identified as important to the fifteen community members and fifteen service providers interviewed. These themes are: water quality, affordable housing, job availability, centralized communication, recreation, growth, and health priorities. Each of the seven prioritized themes contain secondary data, observations (when applicable), the perspectives of service providers and of community members, as well as a comparison of the two perspectives. Additionally, those themes that were discussed at the community forum (water quality, affordable housing, job availability, centralized communication and recreation) include a section outlining action steps that emerged. Next, the methodology of the various components of the AOCA process, such as conducting interviews and forum planning, are discussed. This document concludes with a discussion of the limitations and future considerations.Master of Public Healt

Barriers and Facilitators to Testing, Treatment Entry, and Engagement in Care by HIV-Positive Women of Color

Women of color (WOC) are at increased risk of dying from HIV/AIDS, a disparity that may be partially explained by the care barriers they face. Based in a health care disparity model and the socio-ecological framework, the objective of this study was to identify the barriers and facilitators to HIV care at three points along the HIV continuum: HIV testing, entry/early care, and engagement. Two focus groups (n=11 women) and 19 semi-structured interviews were conducted with HIV-positive WOC in an academic medical setting in North Carolina. Content was analyzed and interpreted. We found barriers and facilitators to be present at multiple levels of the ecological framework, including personal-, provider-, clinic-, and community-levels. The barriers reported by women were aligned with the racial health care disparity model constructs and varied by stage of HIV. Identifying the salient barriers and facilitators at multiple ecological levels along the HIV care continuum may inform intervention development

'He said he was going to kill me'

This article uses a case study design to explore attempted intimate femicide in metropolitan São Paulo, Brazil. We conducted 30 in-depth interviews with adult women on community and personal relationship experiences, health-care services, and national legislation about violence against women. Through a thorough transcript review, we identified two participants, Maria* and Raquel*, whose intimate partners attempted to kill them. We used a modified grounded theory approach to code the entire sample, and further analysed these transcripts to identify missed opportunities for intervention in both the prevention of- and responses to intimate partner violence (IPV), and the antecedents of attempted intimate femicide. Both women had normalized experiences of violence, and experienced psychological abuse prior to the attempted intimate femicide. Social and familial networks were sources of shame for Raquel and support for Maria. Neither woman expressed confidence in law enforcement’s ability to protect women and girls from IPV. These cases illustrate the need for multi-tiered interventions to prevent femicide in Brazil, which boasts one of the highest global female homicide rates. Although anti-femicide laws exist, better mechanisms are needed to integrate health, legal and social services for IPV and femicide prevention. In addition, community- and interpersonal- level interventions that counteract the Brazilian ‘culture of violence’ and machismo may provide support for at-risk women and girls. *pseudonyms have been used to protect the identity of the participant

Inflammasome Proteins in Serum and Serum-Derived Extracellular Vesicles as Biomarkers of Stroke

The inflammasome is a key contributor to the inflammatory innate immune response after stroke. We have previously shown that inflammasome proteins are released in extracellular vesicles (EV) after brain and spinal cord injury. In addition, we have shown that inflammasome proteins offer great promise as biomarkers of central nervous system (CNS) injury following brain trauma. In the present study, we used a Simple Plex Assay (Protein Simple), a novel multi-analyte automated microfluidic immunoassay platform, to analyze serum and serum-derived EV samples from stroke patients and control subjects for inflammasome protein levels of caspase-1, apoptosis-associated speck-like protein containing a caspase-recruitment domain (ASC), Interleukins (IL)-1β, and (IL)-18. Receiver operator characteristic (ROC) curves with associated confidence intervals obtained from the analysis of serum samples revealed that the area under the curve (AUC) for ASC was 0.99 with a confidence interval between 0.9914 and 1.004, whereas the AUC for caspase-1, IL-1β, and IL-18 were 0.75, 0.61, and 0.67, respectively. Thus, these data indicate that ASC is a potential biomarker of stroke and highlight the role of the inflammasome in the inflammatory response after brain ischemia

MSM in HIV-Prevention Trials are Sexual Partners With Each Other: An Ancillary Study to the EXPLORE Intervention

The EXPLORE study evaluated a behavioral intervention to prevent HIV seroconversion among men who have sex with men (MSM). The present ancillary study enrolled 345 EXPLORE participants at one study site (Boston) and assessed high-risk sexual behavior with other EXPLORE participants. It also assessed sexual intentions across other EXPLORE participants, HIV-negative individuals, and unknown HIV serostatus partners. Thirty-one percent reported having sex with another EXPLORE participant: 27% unprotected receptive oral sex with ejaculation (UO), 30% unprotected insertive anal sex (UIA), and 34% reported unprotected receptive anal sex (URA). Significant relationships between intentions to engage in UO, UIA, and URA, and type of partner emerged with intentions to engage in UO, UIA, and URA higher in HIV-negative partners, other EXPLORE participants, and unknown-HIV serostatus partners. Future HIV-prevention studies recruiting MSM at increased sexual risk of HIV infection should address participants potentially becoming sexual partners with each other.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44009/1/10461_2005_Article_9025.pd

Inflammasome Proteins in Serum and Serum-Derived Extracellular Vesicles as Biomarkers of Stroke

The inflammasome is a key contributor to the inflammatory innate immune response after stroke. We have previously shown that inflammasome proteins are released in extracellular vesicles (EV) after brain and spinal cord injury. In addition, we have shown that inflammasome proteins offer great promise as biomarkers of central nervous system (CNS) injury following brain trauma. In the present study, we used a Simple Plex Assay (Protein Simple), a novel multi-analyte automated microfluidic immunoassay platform, to analyze serum and serum-derived EV samples from stroke patients and control subjects for inflammasome protein levels of caspase-1, apoptosis-associated speck-like protein containing a caspase-recruitment domain (ASC), Interleukins (IL)-1β, and (IL)-18. Receiver operator characteristic (ROC) curves with associated confidence intervals obtained from the analysis of serum samples revealed that the area under the curve (AUC) for ASC was 0.99 with a confidence interval between 0.9914 and 1.004, whereas the AUC for caspase-1, IL-1β, and IL-18 were 0.75, 0.61, and 0.67, respectively. Thus, these data indicate that ASC is a potential biomarker of stroke and highlight the role of the inflammasome in the inflammatory response after brain ischemia.</p

A Pilot Study of Youth With Type 1 Diabetes Initiating Use of a Hybrid Closed-Loop System While Receiving a Behavioral Economics Intervention

OBJECTIVE: Many youth do not use the hybrid closed-loop system for type 1 diabetes effectively. This study evaluated the impact of financial incentives for diabetes-related tasks on use of the 670G hybrid closed-loop system and on glycemia. METHODS: At auto mode initiation and for 16 weeks thereafter, participants received a flat rate for wearing and calibrating the sensor ($1/day), administering at least 3 mealtime insulin boluses per day ($1/day), and uploading ($5/week). Weekly bonuses were given for maintaining at least 70$3/week to a maximum of $13/week. If a participant failed to maintain auto mode for a week, the rewards were reset to baseline. Data from 17 participants aged 15.9 years ± 2.5 years (baseline hemoglobin A1c [HbA1c] 8.6% ± 1.1%) were collected at 6, 12, and 16 weeks. The reinforcers were withdrawn at 16 weeks, with a follow-up assessment at 24 weeks. RESULTS: With reinforcers, the participants administered an average of at least 3 mealtime insulin boluses per day and wore the sensor over 70% of the time. However, auto mode use waned. HbA1c levels decreased by 0.5% after 6 weeks, and this improvement was maintained at 12 and 16 weeks (P \u3c .05). Upon withdrawal of reinforcers, HbA1c levels increased back to baseline at 24 weeks. CONCLUSION: Compensation for diabetes-related tasks was associated with lower HbA1c levels, consistent administration of mealtime insulin boluses, and sustained sensor use. These results support the potential of financial rewards for improving outcomes in youth with type 1 diabetes

Barriers and Facilitators to Testing, Treatment Entry, and Engagement in Care by HIV-Positive Women of Color

Women of color (WOC) are at increased risk of dying from HIV/AIDS, a disparity that may be partially explained by the care barriers they face. Based in a health care disparity model and the socio-ecological framework, the objective of this study was to identify the barriers and facilitators to HIV care at three points along the HIV continuum: HIV testing, entry/early care, and engagement. Two focus groups (n=11 women) and 19 semi-structured interviews were conducted with HIV-positive WOC in an academic medical setting in North Carolina. Content was analyzed and interpreted. We found barriers and facilitators to be present at multiple levels of the ecological framework, including personal-, provider-, clinic-, and community-levels. The barriers reported by women were aligned with the racial health care disparity model constructs and varied by stage of HIV. Identifying the salient barriers and facilitators at multiple ecological levels along the HIV care continuum may inform intervention development