Evaluation of Screening Practices for Alcohol Use in Primary Care

Purpose: The purpose of this practice inquiry project was to examine current screening practices for alcohol misuse within a primary care clinic. The United States Preventive Services Task Force (USPSTF) guidelines state that alcohol misuse screening should be performed on adults aged 18 years or older using one of three standardized screening tools: Alcohol Use Disorders Identification Test (AUDIT), the abbreviated AUDIT-Consumption (AUDIT-C), or a single-question screening. If indicated, providers should provide a brief intervention and/or referral to treatment through the process known as SBIRT (screening, brief intervention, referral to treatment). Methods: A retrospective chart review was conducted to examine current screening practices within Norton Healthcare and to determine the percentage of patients being seen for a new patient visit or an annual wellness exam who were being screened for alcohol misuse. Demographic data, comorbidities, and who performed the screening were assessed. The charts were also examined to determine if a standardized screening tool was used to assess for alcohol misuse. Results: While 97% of patients in the examined population were asked about whether or not they used alcohol using a yes or no question, there was no evidence of a standardized screening tool being used to evaluate alcohol misuse. There was no evidence of a screening bias with regard to patient characteristics such as age, gender or health problems. Conclusion: No standardized tool for screening for alcohol misuse is currently in use within Norton Healthcare. Though 97% of patients were asked about their alcohol use, current practice does not adhere to the recommendations of the USPSTF. A toolkit has been developed to provide the foundation for provider education in the Norton Healthcare System. Provider education regarding the SBIRT process and using standardized tools may help to increase adherence to national guidelines and to facilitate practice change

Zika virus: New clinical syndromes and its emergence in the western hemisphere

Zika virus (ZIKV) had remained a relatively obscure flavivirus until a recent series of outbreaks accompanied by unexpectedly severe clinical complications brought this virus into the spotlight as causing an infection of global public health concern. In this review, we discuss the history and epidemiology of ZIKV infection, recent outbreaks in Oceania and the emergence of ZIKV in the Western Hemisphere, newly ascribed complications of ZIKV infection, including Guillain-Barré syndrome and microcephaly, potential interactions between ZIKV and dengue virus, and the prospects for the development of antiviral agents and vaccines

Visual Analytics of Surveillance Data on Foodborne Vibriosis, United States, 1973–2010

Foodborne illnesses caused by microbial and chemical contaminants in food are a substantial health burden worldwide. In 2007, human vibriosis (non-cholera Vibrio infections) became a notifiable disease in the United States. In addition, Vibrio species are among the 31 major known pathogens transmitted through food in the United States. Diverse surveillance systems for foodborne pathogens also track outbreaks, illnesses, hospitalization and deaths due to non-cholera vibrios. Considering the recognition of vibriosis as a notifiable disease in the United States and the availability of diverse surveillance systems, there is a need for the development of easily deployed visualization and analysis approaches that can combine diverse data sources in an interactive manner. Current efforts to address this need are still limited. Visual analytics is an iterative process conducted via visual interfaces that involves collecting information, data preprocessing, knowledge representation, interaction, and decision making. We have utilized public domain outbreak and surveillance data sources covering 1973 to 2010, as well as visual analytics software to demonstrate integrated and interactive visualizations of data on foodborne outbreaks and surveillance of Vibrio species. Through the data visualization, we were able to identify unique patterns and/or novel relationships within and across datasets regarding (i) causative agent; (ii) foodborne outbreaks and illness per state; (iii) location of infection; (iv) vehicle (food) of infection; (v) anatomical site of isolation of Vibrio species; (vi) patients and complications of vibriosis; (vii) incidence of laboratory-confirmed vibriosis and V. parahaemolyticus outbreaks. The additional use of emerging visual analytics approaches for interaction with data on vibriosis, including non-foodborne related disease, can guide disease control and prevention as well as ongoing outbreak investigations

Utilizing Interprofessional Collaboration in an Opioid Addiction Treatment Center

This paper examines the practicum placement I\u27ve held for the duration of this semester. This paper discusses Behavioral Health Group\u27s Level 1 outpatient substance abuse clinic. Behavioral Health Group is located in Richmond, Kentucky\u27s rural Madison County. BHG Richmond offers Methadone, Suboxone, and Vivitrol Medication-Assisted Treatment. This paper explores the function of the social worker as a counselor and member of an interdisciplinary team. This paper examines the ethical models and skills that social workers can use to promote an effective treatment experience for patients who present to BHG Richmond, as well as the close monitoring from the beginning to the end of their treatment experience and the follow-up procedures to provide aftercare support for this complex and vulnerable population

An Exploration of the Relationships Between Sense of Community, Park Benefits, and Neighborhood Park Use

The purpose of this study was to explore the relationship between park use by residents that live within a ¼ to ½ mile radius of their neighborhood park, perceived benefits from neighborhood parks, and neighborhood sense of community (SOC) in three Norfolk, Virginia neighborhoods. The neighborhoods included Titustown, Colonial Place, and Edgewater. There is a lack of research regarding the relationship between neighborhood parks, perceived recreation benefits from neighborhood parks, and their relationship to neighborhood SOC (Gómez, Baur, Hill, & Georgiev, 2015). Participants completed a questionnaire that included the Sense of Community Index-2 (SCI-2), demographic questions, park usage questions, and park benefit questions. The SCI-2, which is a measurement tool based on the theoretical framework of SOC by McMillan and Chavis (1986), was used to rate their level of SOC in their neighborhoods. A second scale, the Perceived Benefits of Municipal Parks (PBMP) Scale (after Gómez, 1999) was used to measure benefits. Questionnaires were administered in person in the neighborhoods. Descriptive statistics examined demographic characteristics and park use questions. Confirmatory factor analysis (CFA)/structural equation modeling (SEM) was used to confirm the two scales used in the study. Pearson correlations (r) were used to assess if there was a direct relationship between park use and SOC. Additional correlations explored the relationship between (a) access to the park, (b) perception of the park, (c) park use, (d) SOC, (e) benefits, and (f) length of stay at the park. Independent samples t-tests were performed to see if there are differences with respect to users and non-users of the parks. Independent samples t-tests and ANOVAs were used to explore demographic differences. All analyses were performed at p \u3c .05. Results indicate there is a significant but weak relationship between park use and SOC; however, park use was not a significant predictor of SOC. Results show a significant relationship between perceived park benefits and SOC, and benefits was a significant predictor of SOC. Practitioners can use findings to provide support for parks as catalysts to increase SOC in neighborhoods. Academics can use the scales for future research in parks and recreation management

Modeling the long term dynamics of pre-vaccination pertussis

The dynamics of strongly immunizing childhood infections is still not well understood. Although reports of successful modeling of several incidence data records can be found in the literature, the key determinants of the observed temporal patterns have not been clearly identified. In particular, different models of immunity waning and degree of protection applied to disease and vaccine induced immunity have been debated in the literature on pertussis. Here we study the effect of disease acquired immunity on the long term patterns of pertussis prevalence. We compare five minimal models, all of which are stochastic, seasonally forced, well-mixed models of infection based on susceptible-infective-recovered dynamics in a closed population. These models reflect different assumptions about the immune response of naive hosts, namely total permanent immunity, immunity waning, immunity waning together with immunity boosting, reinfection of recovered, and repeat infection after partial immunity waning. The power spectra of the output prevalence time series characterize the long term dynamics of the models. For epidemiological parameters consistent with published data for pertussis, the power spectra show quantitative and even qualitative differences that can be used to test their assumptions by comparison with ensembles of several decades long pre-vaccination data records. We illustrate this strategy on two publicly available historical data sets.Comment: paper (31 pages, 11 figures, 1 table) and supplementary material (19 pages, 5 figures, 2 tables

Risk for rabies transmission from encounters with bats, Colorado, 1977-1996.

To assess the risk for rabies transmission to humans by bats, we analyzed the prevalence of rabies in bats that encountered humans from 1977 to 1996 and characterized the bat-human encounters. Rabies was diagnosed in 685 (15%) of 4,470 bats tested. The prevalence of rabies in bats that bit humans was 2.1 times higher than in bats that did not bite humans. At least a third of the encounters were preventable

Item Response Modeling of Multivariate Count Data With Zero Inflation, Maximum Inflation, and Heaping

Questionnaires that include items eliciting count responses are becoming increasingly common in psychology. This study proposes methodological techniques to overcome some of the challenges associated with analyzing multivariate item response data that exhibit zero inflation, maximum inflation, and heaping at preferred digits. The modeling framework combines approaches from three literatures: item response theory (IRT) models for multivariate count data, latent variable models for heaping and extreme responding, and mixture IRT models. Data from the Behavioral Risk Factor Surveillance System are used as a motivating example. Practical implications are discussed, and recommendations are provided for researchers who may wish to use count items on questionnaires

Assisted reproductive technology in the USA: is more regulation needed?

The regulation of assisted reproductive technologies is a contested area. Some jurisdictions, such as the UK and a number of Australian states, have comprehensive regulation of most aspects of assisted reproductive technologies; others, such as the USA, have taken a more piecemeal approach and rely on professional guidelines and the general regulation of medical practice to govern this area. It will be argued that such a laissez-faire approach is inadequate for regulating the complex area of assisted reproductive technologies. Two key examples, reducing multiple births and registers of donors and offspring, will be considered to illustrate the effects of the regulatory structure of assisted reproductive technologies in the USA on practice. It will be concluded that the regulatory structure in the USA fails to provide an adequate mechanism for ensuring the ethical and safe conduct of ART services, and that more comprehensive regulation is required