Complicated Lives: A Look Into the Experience of Individuals Living with HIV, Legal Impediments, and Other Social Determinants of Health

Those living with HIV continue to have challenges that extend well beyond their medical needs Public misconceptions surrounding HIV transmission and treatment have resulted in systemic and pervasive discrimination against those living with the disease. Common misconceptions include overly optimistic perceptions of the modern state of medical treatment, leading the uninformed to conclude that people living with HIV are minimally impacted by the disease, and misunderstandings regarding how the disease is transmitted from person-to-person, leading to stigma and social prejudice. Because of these misconceptions, three professors from the University of Massachusetts Dartmouth formed a community partnership to determine the unmet needs of individuals living with HIV in the Southcoast region of Massachusetts. The team used the social determinants of health as its framework for conducting a community assessment. The goal of the study was to uncover factors preventing individuals living with HIV from attaining optimal health outcomes. The study addressed the concerns of those living with HIV in Southcoast, Massachusetts. However, the barriers faced by those living with HIV in Southcoast mirror difficulties faced by those in other areas of the country in fundamental ways. This study and others reveal that the social determinants of health influence the quality of life experienced by those living with HIV as much as the condition itself. Out of this study developed the University of Massachusetts School of Law Human Rights at Home Clinic which provides services to low income residents of Southcoast Massachusetts with an interest in serving people living with HIV or AIDS and others experiencing stigma. The implementation of the clinic and its work is not the subject of this article, but its ongoing community activism informs the article’s discussion. Part I describes the study partnerships as well as the study processes. Part II addresses legal and other stressors on those living with HIV that impact many HIV positive individuals locally and across the country. Part III includes a discussion of the study results and the ongoing needs of those living with HIV with a focus on transportation

Services and Resources for People Living with HIV/AIDS in the Southcoast of Massachusetts: “Can’t Get There From Here!”

Fall River and New Bedford, two diverse and economically challenged cities in the Southcoast region of Massachusetts, are areas of substantial concern in the effort to reduce HIV incidence and to provide effective services for people living with HIV/AIDS in the Commonwealth. In these two communities, HIV disparately impacts marginalized populations, with particularly high infection and prevalence rates among men who have sex with men and injection drug users in comparison to other Massachusetts localities. This project used community engaged research principles to conduct a community assessment guided by the social determinants of health. The primary goal of this study was to identify the gaps in resources and services and highlight challenges and barriers to treatment for people living with HIV/AIDS in Fall River and New Bedford, Massachusetts. Transportation was a major barrier in not accessing available community services and resources

Examining How Dog ‘Acquisition’ Affects Physical Activity and Psychosocial Well-Being: Findings from the BuddyStudy Pilot Trial

Dog owners are more physically active than non-dog owners, but evidence of a causal relationship between dog acquisition and increased physical activity is lacking. Such evidence could inform programs and policies that encourage responsible dog ownership. Randomized controlled trials are the ‘gold standard’ for determining causation, but they are prohibited in this area due to ethical concerns. In the BuddyStudy, we tested the feasibility of using dog fostering as a proxy for dog acquisition, which would allow ethical random assignment. In this single-arm trial, 11 participants fostered a rescue dog for six weeks. Physical activity and psychosocial data were collected at baseline, 6, and 12 weeks. At 6 weeks, mean change in steps/day was 1192.1 ± 2457.8. Mean changes on the Center for Epidemiologic Studies Depression Scale and the Perceived Stress Scale were −4.9 ± 8.7 and −0.8 ± 5.5, respectively. More than half of participants (55%) reported meeting someone new in their neighborhood because of their foster dog. Eight participants (73%) adopted their foster dog after the 6-week foster period; some maintained improvements in physical activity and well-being at 12 weeks. Given the demonstrated feasibility and preliminary findings of the BuddyStudy, a randomized trial of immediate versus delayed dog fostering is warranted

Genotypic and phenotypic characterization of antimicrobial resistance in Neisseria gonorrhoeae: A cross-sectional study of isolates recovered from routine urine cultures in a high-incidence setting

ABSTRACT The objectives of this study were to perform genomic and phenotypic characterization of antimicrobial resistance in Neisseria gonorrhoeae isolates recovered from urine samples from patients in St. Louis, MO, USA. Sixty-four clinical isolates were banked over a 2-year period and subjected to antimicrobial susceptibility testing (AST) by Kirby-Bauer disk diffusion (penicillin, tetracycline, cefuroxime, and ciprofloxacin) and gradient diffusion (tetracycline, doxycycline, azithromycin, ceftriaxone, cefixime, ciprofloxacin, gemifloxacin, and delafloxacin). The medical records for the patients were evaluated to determine the demographics, location, and prescribed treatment regimen. Isolate draft genomes were assembled from Illumina shotgun sequencing data, and resistance determinants were identified by ResFinder and PointFinder. Of the 64 isolates, 97% were nonsusceptible to penicillin, with resistant isolates all containing the blaTEM-1b gene; 78 and 81% of isolates were nonsusceptible to tetracycline and doxycycline, respectively, with resistant isolates all containing the tet(M) gene. One isolate was classified as non-wild-type to azithromycin, and all isolates were susceptible to ceftriaxone; 89% of patients received this combination of drugs as first-line therapy. Six percent of isolates were resistant to ciprofloxacin, with most resistant isolates containing multiple gyrA and parC mutations. Correlation between disk and gradient diffusion AST devices was high for tetracycline and ciprofloxacin (R2 > 99% for both). The rates of N. gonorrhoeae antibiotic resistance in St. Louis are comparable to current rates reported nationally, except ciprofloxacin resistance was less common in our cohort. Strong associations between specific genetic markers and phenotypic susceptibility testing hold promise for the utility of genotype-based diagnostic assays to guide directed antibiotic therapy. IMPORTANCE Neisseria gonorrhoeae causes the sexually transmitted infection gonorrhea, which is most commonly diagnosed using a DNA-based detection method that does not require growth and isolation of N. gonorrhoeae in the laboratory. This is problematic because the rates of antibiotic resistance in N. gonorrhoeae are increasing, but without isolating the organism in the clinical laboratory, antibiotic susceptibility testing cannot be performed on strains recovered from clinical specimens. We observed an increase in the frequency of urine cultures growing N. gonorrhoeae after we implemented a total laboratory automation system for culture in our clinical laboratory. Here, we report on the rates of resistance to multiple historically used, first-line, and potential future-use antibiotics for 64 N. gonorrhoeae isolates. We found that the rates of antibiotic resistance in our isolates were comparable to national rates. Additionally, resistance to specific antibiotics correlated closely with the presence of genetic resistance genes, suggesting that DNA-based tests could also be designed to guide antibiotic therapy for treating gonorrhea

Pollen metabarcoding reveals broad and species-specific resource use by urban bees

Bee populations are currently undergoing severe global declines driven by the interactive effects of a number of factors. Ongoing urbanisation has the potential to exacerbate bee declines, unless steps are taken to ensure appropriate floral resources are available. Sown wildflower strips are one way in which floral resources can be provided to urban bees. However, the use of these strips by pollinators in urban environments remains little studied. Here, we employ pollen metabarcoding of the rbcL gene to compare the foraging patterns of different bee species observed using urban sown wildflower strips in July 2016, with a goal of identifying which plant species are most important for bees. We also demonstrate the use of a non-destructive method of pollen collection. Bees were found to forage on a wide variety of plant genera and families, including a diverse range of plants from outside the wildflower plots, suggesting that foragers visiting sown wildflower strips also utilize other urban habitats. Particular plants within the wildflower strips dominated metabarcoding data, particularly Papaver rhoeas and Phacelia tanacetifolia. Overall, we demonstrate that pollinators observed in sown wildflower strips use certain sown foodplants as part of a larger urban matrix

Subtle shifts in microbial communities occur alongside the release of carbon induced by drought and rewetting in contrasting peatland ecosystems

Abstract Peat represents a globally significant pool of sequestered carbon. However, peatland carbon stocks are highly threatened by anthropogenic climate change, including drought, which leads to a large release of carbon dioxide. Although the enzymatic mechanisms underlying drought-driven carbon release are well documented, the effect of drought on peatland microbial communities has been little studied. Here, we carried out a replicated and controlled drought manipulation using intact peat ‘mesocosm cores’ taken from bog and fen habitats, and used a combination of community fingerprinting and sequencing of marker genes to identify community changes associated with drought. Community composition varied with habitat and depth. Moreover, community differences between mesocosm cores were stronger than the effect of the drought treatment, emphasising the importance of replication in microbial marker gene studies. While the effect of drought on the overall composition of prokaryotic and eukaryotic communities was weak, a subset of the microbial community did change in relative abundance, especially in the fen habitat at 5 cm depth. ‘Drought-responsive’ OTUs were disproportionately drawn from the phyla Bacteroidetes and Proteobacteria. Collectively, the data provide insights into the microbial community changes occurring alongside drought-driven carbon release from peatlands, and suggest a number of novel avenues for future research

Overview of Australian Indigenous health status, 2013

The main purpose of the Overview is to provide a comprehensive summary of the most recent indicators of the health and current health status of Australia’s Indigenous people. It has been prepared by the Australian Indigenous HealthInfoNet as a part of our contributions to ‘closing the gap’ in health between Indigenous people and other Australians by making relevant, high quality knowledge and information easily accessible to policy makers, health service providers, program managers, clinicians, researchers, students and the general community. The initial sections of this Overview provide information about the context of Indigenous health, Indigenous population, and various measures of population health status. Most of the subsequent sections about specific health conditions comprise an introduction about the condition and evidence of the current burden of the condition among Indigenous people. Where available and appropriate; information is provided for each state and territory and for demographics such as gender and age. While it provides a comprehensive review of key indicators across a range of health topics, it is beyond the scope of the Overview to provide detailed information on other aspects, such as the availability and use of services (including barriers to their use) and strategies and policies related to specific health topics. Interested readers should refer to the topic-specific reviews that are available on the HealthInfoNet’s website. Additional, more in depth, information about the topics summarised in this Overview is included in the corresponding sections of the HealthInfoNet’s website (www.healthinfonet.ecu.edu.au)

Overview of Australian Indigenous health status, 2014

The main purpose of the Overview is to provide a comprehensive summary of the most recent indicators of the health and current health status of Australia’s Aboriginal and Torres Strait Islander peoples. It has been prepared by the Australian Indigenous HealthInfoNet as a part of our contribution to ‘closing the gap’ in health between Aboriginal and Torres Strait Islander people and other Australians by making relevant, high quality knowledge and information easily accessible to policy makers, health service providers, other health professionals including Health workers, program managers, clinicians, researchers, students and the general community. The initial sections of this Overview provide information about the context of Aboriginal and Torres Strait Islander health, Aboriginal and Torres Strait Islander population, and various measures of population health status. Most of the subsequent sections about specific health conditions comprise an introduction about the condition and evidence of the current burden of the condition among Aboriginal and Torres Strait Islander people. Information is provided for state and territories and for demographics such as gender and age when it is available and appropriate. While the Overview provides a comprehensive review of key indicators across a range of health topics, it is beyond the scope to provide detailed information on other aspects, such as the availability and use of services (including barriers to their use) and strategies and policies related to specific health topics. Interested readers should refer to the topic-specific reviews that are available on the HealthInfoNet’s website. Additional, more in depth, information about the topics summarised in this Overview is included in the corresponding sections of the HealthInfoNet’s website (www.healthinfonet.ecu.edu.au). There are a number of additions to this Overview. We have included a recognition statement, a note on the use of appropriate terminology that introduces our guidelines on the matter, and a statement of commitment to enhancing our strengths based approach to reporting

Overview of Aboriginal and Torres Strait Islander health status, 2017

The Overview of Aboriginal and Torres Strait Islander health status (Overview) aims to provide a comprehensive summary of the most recent indicators of the health and current health status of Australia’s Aboriginal and Torres Strait Islander people. The initial sections of the Overview provide information about the context of Aboriginal and Torres Strait Islander health, population, and various measures of population health status. The remaining sections are about selected health conditions and risk and protective factors that contribute to the overall health of Aboriginal and Torres Strait Islander people. These sections comprise an introduction and evidence of the extent of the condition or risk/protective factor. The annual Overview is a resource relevant for workers, students and others who need to access up-to-date information about Aboriginal and Torres Strait Islander health