Disparities in Referral initiation and Completion at an Urban FQHC Look-alike (FQHC-LA) Clinic

Introduction. The purpose of this study was to determine referral initiation and completion disparities across primary care encounters at the Hope Family Care Center (HFCC) in Kansas City, MO, by payor type (primary insurance): private insurance, Medicaid, Medicare, and self-pay. Methods. Data were collected and analyzed for all encounters (N = 4235) over a 15-month period including payor type, referral initiation and completion, and demographics. Referral initiation and completion were calculated by payor type and differences analyzed using Chi-square tests and t-tests. Logistic regression examined payor type association with referral initiation and completion, accounting for demographic variables. Results. Our analysis showed a meaningful difference in rate of referral to specialists by payor type. The Medicaid encounter referral initiation rate was higher than rates for all other payor types (7.4% vs. 5.0%), and self-pay encounters' referral initiation rate was lower than rates for all other payor types (3.8% vs. 6.4%).of initiating a referral compared to private insurance encounters. There was no difference in referral completion by payor type or demographic category. Conclusions. Equal referral completion rates across payor types suggested HFCC may have had well-established referral resources for patients. Higher referral initiation rates for Medicaid and lower for self-pay may suggest that insurance coverage offered financial confidence when seeking specialist care. Higher odds of Medicaid encounters initiating a referral could imply greater health needs among Medicaid patients.       &nbsp

Investigation of human bocavirus associated with acute respiratory infection in patients treated in health unit in Guarapuava – PR / Investigação de bocavírus humano associado à infecção respiratória aguda em pacientes atendidos em unidade de sáude do Município de Guarapuava - PR

Human Bocavirus (HBoV) is a parvovirus in human respiratory secretions isolates from symptomatic patients. Its prevalence varies from 1.5 to 19% and the most common age for a primary infection is between 6 to 24 months age. HBoV has been associated with infections in the upper and lower children respiratory tract, little is known about HBoV infections among adults and the elderly. The present study objective was to investigate the HBoV occurrence in children and adults with acute respiratory symptoms. One hundred and eighty-theree nasal swab samples from symptomatic patients that are attended in the public health services in Guarapuava city, in Paraná State between 2014 and 2015. The patients´ mean age included in the essay was 35 years old and the 33 years median, varying from less than 1 year and up to 82 years age. The most commonly observed symptoms were coryza, cough and fever. The samples were tested for HBoV DNA presence by standard PCR methodology. No positive samples were detected for HBoV. Thus, we did not demonstrate the HBoV circulation in Guarapuava - PR, but more studies are necessary, taking into account that these new viruses may be important pathogens in respiratory diseases in Brazil

Survival Stories: Relationships of Justice-involved Women with History of Trauma

Title from PDF of title page viewed June 2, 2017Dissertation advisor: Patricia J. KellyVitaIncludes bibliographical references (pages 163-186)Thesis (Ph.D.)--School of Nursing and Health Studies. University of Missouri--Kansas City, 2017Over one million women are incarcerated in local and county jails or placed under community supervision of the criminal justice system in the U.S. each year. Women with history of incarceration have higher rates of many chronic and infectious diseases, and their access to health care is often complicated by mental illness, drug addiction, and significant lifetime history of trauma. Systemic barriers, including cost, restricted availability, and confusing fragmentation of services and care make access difficult for justice-involved women. Little is known about how women navigate support after and between incarcerations to survive. In this study, I explored justice-involved women’s perceptions and management of informal sources of social support through narratives of interpersonal relationship. Minimally structured, story-eliciting interviews were conducted with 10 jailincarcerated and recently released women with history of lifetime trauma. Interviews were analyzed using thematic and structural narrative inquiry techniques, and two explanatory models were derived. The first model described women’s use of opportunizing talk and fatalizing talk in embedded trauma stories as a reflection of their perception of self-and-other in the process of support-seeking. The second model focused on empowerment and entanglement, prominent themes through which women organized perceptions of the outcomes of support-seeking through social bonds, specifically in stories of housing need. For nurses and other care and service providers who work with justice-involved women, the models for understanding women’s perceptions of support provide insight into how effective and ineffective practices take shape and may point to better targeted care planning, program design, and policy advocacy.Introduction -- Review of the literature -- Methods -- Opportunizing and fatalizing: self and other in the trauma narratives of justice-involved women -- Housing for the justice involved: empowerment and entanglement in narratives of shelter support -- Conclusion -- Appendix A. Participant characteristics -- Appendix B. University of Kansas Medical Center IEB approval -- Appendix C. Approved request to rely agreement -- Appendix D. Human subjects (CITI program) training -- Appendix E. Interview protocol --Appendix F. Code lis

Avaliação da compreensão de equipe multiprofissional intensivista sobre necessidade de pausa da nutrição enteral na ocorrência de diarreia: Assessment of the understanding of a multiprofessional intensive care team about the need to pause the enteral nutrition in the event of diarrhea

Objetivo - Avaliar a compreensão, condutas e as práticas da Equipe Multiprofissional da Atenção a Terapia Intensiva na ocorrência de diarreia em pacientes com dieta enteral. Método - Estudo transversal, prospectivo, realizado em um hospital terciário do estado de São Paulo, por meio de coleta de dados aplicado às equipes de enfermagem, nutrição e médica. Utilizou-se formulário impresso com quatorze perguntas, considerando: possíveis condutas em ocorrência de diarreia em pacientes com dieta enteral, compreensão de definição de diarreia, meios de orientações de condutas utilizados e possíveis dificuldades em ocorrência de diarreia.  Resultados – Participaram da pesquisa 85 profissionais, em sua maioria técnicos de enfermagem, nutricionistas e enfermeiros. As alternativas "informo a equipe de enfermagem e aguardo a orientação da conduta" e “informo a equipe médica e aguardo a orientação da conduta” demostraram valores significativos (p=0,003 e p<0.001, respectivamente) e observa-se uma tendência por parte da equipe da enfermagem e da nutrição para “informo a equipe de nutrição e aguardo orientação da conduta” (p=0,056). Sobre o conhecimento do protocolo do hospital sobre ocorrência de diarreia em pacientes com dieta enteral, 73,33% dos nutricionistas relataram seu conhecimento (p=0,0018). A maioria dos profissionais pesquisados relataram não ter participado de dinâmica sobre o tema (p=0,028). Apesar dos dados promissores, evidencia-se a necessidade de dinâmicas e educação continuada sobre esta temática para os profissionais estudados

Collaborating to offer HPV vaccinations in jails: results from a pre-implementation study in four states

BACKGROUND: Correctional facilities are an underutilized venue for reaching young adults who have not vaccinated for human papillomavirus (HPV). The objective of this study was to identify factors that are associated with jail and local health department (LHD) interest in partnering to offer HPV vaccinations to young adults in jail. METHODS: Consolidated framework for implementation research (CFIR)-guided surveys were conducted with jail administrators in Iowa, Kansas, Missouri, and Nebraska, September 2017-October 2018. Jail survey data were analyzed using chi square distribution and relative risk regression. Using data from sister surveys conducted with LHD administrators in the same counties (results previously reported), we identified characteristics of counties in which both the jail and LHD indicated interest in collaborating to offer HPV vaccinations in the jail. RESULTS: Jail survey response was 192/347 (55.3%). Surveys with LHDs yielded 237/344 (68.9%) responses. Eleven communities were identified where both the jail and LHD expressed interest. Only any vaccines provided in jail predicted shared interest (RR: 5.36; CI: 2.52-11.40; p \u3c .01). For jail administrators, offering other vaccines was 3 times (CI:1.49-6.01; p \u3c .01) and employing a nurse 1.65 times more likely (CI: 1.20-2.28; p \u3c .01) to predict interest in collaborating to offer HPV vaccination. Open-ended responses indicated that managing linkages and stakeholder investment were areas of emphasis where collaborations to provide vaccinations in the jails had been previously implemented. CONCLUSIONS: Interest in jail-LHD partnerships to provide HPV vaccinations in jails exists in the Midwest but will require building-out existing programs and linkages and identifying and strengthening shared values, goals, and benefits at all levels

Leucine Rich α-2 Glycoprotein: A Novel Neutrophil Granule Protein and Modulator of Myelopoiesis

Leucine-rich α2 glycoprotein (LRG1), a serum protein produced by hepatocytes, has been implicated in angiogenesis and tumor promotion. Our laboratory previously reported the expression of LRG1 in murine myeloid cell lines undergoing neutrophilic granulocyte differentiation. However, the presence of LRG1 in primary human neutrophils and a role for LRG1 in regulation of hematopoiesis have not been previously described. Here we show that LRG1 is packaged into the granule compartment of human neutrophils and secreted upon neutrophil activation to modulate the microenvironment. Using immunofluorescence microscopy and direct biochemical measurements, we demonstrate that LRG1 is present in the peroxidase-negative granules of human neutrophils. Exocytosis assays indicate that LRG1 is differentially glycosylated in neutrophils, and co-released with the secondary granule protein lactoferrin. Like LRG1 purified from human serum, LRG1 secreted from activated neutrophils also binds cytochrome c. We also show that LRG1 antagonizes the inhibitory effects of TGFβ1 on colony growth of human CD34+ cells and myeloid progenitors. Collectively, these data invoke an additional role for neutrophils in innate immunity that has not previously been reported, and suggest a novel mechanism whereby neutrophils may modulate the microenvironment via extracellular release of LRG1

The Role of the Magnetic Field in the Interstellar Medium of the Post-Starburst Dwarf Irregular Galaxy NGC 1569

(abridged) NGC 1569 is a nearby dwarf irregular galaxy which underwent an intense burst of star formation 10 to 40 Myr ago. We present observations that reach surface brightnesses two to eighty times fainter than previous radio continuum observations and the first radio continuum polarization observations. These observations allow us to probe the relationship of the magnetic field of NGC 1569 to the rest of its interstellar medium. We confirm the presence of an extended radio continuum halo at 20 cm and see for the first time the radio continuum feature associated with the western Halpha arm at wavelengths shorter than 20cm. The spectral index trends in this galaxy support the theory that there is a convective wind at work in this galaxy. We derive a total magnetic field strength of 38 microG in the central regions and 10-15 microG in the halo. The magnetic field is largely random in the center of the galaxy; the uniform field is ~3-9 microG and is strongest in the halo. We find that the magnetic pressure is the same order of magnitude but, in general, a factor of a few less than the other components of the interstellar medium in this galaxy. The uniform magnetic field in NGC 1569 is closely associated with the Halpha bubbles and filaments. We suggest that a supernova-driven dynamo may be operating in this galaxy. The outflow of hot gas from NGC 1569 is clearly shaping the magnetic field, but the magnetic field in turn may be aiding the outflow by channeling gas out of the disk of the galaxy. Dwarf galaxies with extended radio continuum halos like that of NGC 1569 may play an important role in magnetizing the intergalactic medium.Comment: ApJ accepted. 56 pages, 14 figures (low resolution), 8 tables. Version with high resolution figures at http://www.astro.virginia.edu/~aak8t/data/n1569/ms.pd

VULNERABILIDAD PROGRAMÁTICA A LAS IST/AIDS EN LA ATENCIÓN PRIMÁRIA DE SALUD: UN HABITUS PERMEADO DE VIOLENCIA SIMBÓLICA

Objetivo: identificar a vulnerabilidade programática às Infecções Sexualmente Transmissíveis/aids na Atenção Primária à Saúde.Método: estudo descritivo, realizado no ano de 2018, em 52 Unidades Básicas de Saúde de um município do nordeste brasileiro. Aplicou-se um Questionário com o responsável técnico  da unidade, identificando os marcadores de vulnerabilidade, que foram analisados por meio da estatística descritiva e à luz da sociologia do Poder Simbóilco de Bourdieu.Resultados: destacaram-se com média vulnerabilidade programática as unidades com relação à infraestrutura (55,3%), ações de prevenção (67,8%) e tratamento (60,4%). E com baixa vulnerabilidade as unidades com relação às ações de pré-natal e puerpério em relação à atenção às IST/aids (93,2%) e a integração das ações (61,5%).Conclusão: apesar da potencialidade dos marcadores do pré-natal e puerpério e da integração de ações, as fragilidades em maior frequência indicam que a Atenção Primária à Saúde ainda é permeada por violência simbólica na assistência às IST/aids.Objetivo: identificar la vulnerabilidad programática a las Enfermedades de Transmisión Sexual /Aids en la Atención Primaria de Salud. Método: estudio descriptivo realizado en 2018 en 52 Unidades Básicas de Salud de un municipio del Nordeste de Brasil. Se aplicó un cuestionario con el responsable técnico de la unidad, identificando los marcadores de vulnerabilidad, que fueron analizados mediante estadística descriptiva y a la luz de la sociología del Poder Simbólico de Bourdieu. Resultados: se destacaron con una media vulnerabilidad programática las unidades con relación a la infraestructura (55,3%), acciones de prevención (67,8%) y el tratamiento (60,4%). Y con baja vulnerabilidad las unidades con relación a las acciones de prenatal y puerperio en relación a las ETS/SIDA (93,2%) y a la integración de las acciones(61,5%). Conclusión: a pesar de la potencialidad de los marcadores del prenatal y puerperio y de la integración de las acciones, las fragilidades de mayor frecuencia indican que la Atención Primaria de Salud todavía está impregnada de la violencia simbólica en la asistencia a las ETS/SIDA.Objective: to identify programmatic vulnerability to Sexually Transmitted Infections/AIDS in Primary Health Care.Method: descriptive study, conducted in 2018, in 52 Basic Health Units of a municipality in northeastern Brazil. A questionnaire was applied to the unit´s technical manager, identifying the vulnerability markers which were analyzed using descriptive statistics and in the light of Bourdieu`s sociology of Symbolic Power.Results: the units stood out with average programmatic vulnerability to infrastructure (55.3%), prevention actions (67.8%) and treatment (60.4%). And with low vulnerability the units with regard to prenatal and postpartum actions in relation to STI/AIDS (93.2%) and the integration of actions (61.5%).Conclusion: despite the potentiality of prenatal and postpartum markers and the integration of actions, the most frequent weaknesses indicate that Primary Health Care is still permeated by symbolic violence in STI/AIDS care

Arteriovenous malformation associated with trauma : a case report

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ESTABILIDADE DE AGREGADOS EM ÁREA DE CULTIVO ORGÂNICO COM DIFERENTES MANEJOS E CONVENCIONAL

O objetivo desse trabalho foi avaliar as propriedades físicas do solo em áreas com diferentes manejos do sistema de cultivo orgânico e cultivo convencional. O experimento foi conduzido na Estação Experimental Professor Alcibíades Luiz Orlando, localizada no município de Entre Rios do Oeste. O solo da região é classificado como Latossolo Vermelho Eutroférrico, o delineamento experimental foi inteiramente casualizado (DIC), onde em cada área em estudo foram demarcados seis pontos de amostragem, sendo cada ponto representante de uma repetição dentro da área. Os talhões em estudo e seus respectivos manejos foram considerados os tratamentos e o talhão convencional foi considerado a testemunha. Para determinação da estabilidade coletou-se monólitos de solo na camada de 0-0,10 e 0,10 a 0,20 m. Os resultados demonstraram que a melhor estabilidade dos agregados avaliadas pelo diâmetro médio ponderado e geométrico foi no sistema de rotação: Soja/ trigo mourisco/ aveia preta + nabo/ milho/ aveia preita + nabo/ lab-lab + feijão-guandu; onde houve a maior diversidade de plantas de cobertura. O talhão cultivado no sistema plantio direto, mas manejado convencionalmente obteve menor qualidade estrutural