Suchergebnisse

ABSTRACTObjectivesTo examine the oral health knowledge and practices of pediatric nurses who coordinate healthcare services for special needs children and to identify those factors that influenced their perceived effectiveness in managing their patients' oral health needs.MethodsSelf‐reported data were collected from 376 nurses employed at Children's Medical Services who responded to an online survey. Likert scale scores were used to specifically assess the nurses' perceived effectiveness in addressing the oral health needs of special needs children.ResultsCharacteristics significantly associated with special needs pediatric nurses who described themselves as "effective or very effective" included: the self‐perception of being very knowledgeable about basic oral health, receiving four or more hours of continuing education training, and securing dental appointments for the majority of their pediatric special needs patients with minimal waiting times.ConclusionFindings reveal that oral health knowledge significantly influenced nurses' perceived effectiveness in addressing the oral health needs of special needs children, as well as their ability to secure timely dental appointments. These results support the need to incorporate oral health education into nursing curricula and expand upon the dental workforce available and willing to treat disabled patients.

This article compares the health care need and health care use of injection drug users, other chronic drug users, and nondrug users. Data from 1,330 non-Hispanic White, African American, and Hispanic/Latino men and women were analyzed to determine independent risk factors for two outcome variables: (a) need for health care treatment and (b) use of health care treatment. Ten independent demographic, health, and drug use variables were assessed in logistic regression models. Drug use (injection drug use or other chronic drug use), being female, having insurance, and perceived health status of very good/good or fair/poor were independently associated with increased need for health care. Injection drug use and other chronic drug use decreased the likelihood of receiving health care treatment, whereas being female, having insurance, and a perceived health status of fair/poor increased the likelihood of receiving health care.

The Yunnan Province in China may be experiencing the highest incidence of heroin use in China, in part because of its proximity to the Golden Triangle. This high incidence, as elsewhere, threatens to increase associated problems in China, including the spread of HIV. Furthermore, the high purity of heroin used in this Province leads to rapid addiction and increased difficulties in treating the symptoms of withdrawal. One response to this epidemic is the development and implementation of the Kunming Drug Rehabilitation Center. The Center, with a capacity for 620 addicts, is grounded in a recovery-oriented perspective that is based on the Therapeutic Community model and modified for the Yunnan Province and China. It is referred to as the Kunming Model and is known for the development of its own medicine for detoxification and its individualized psychological, psychiatric, medical, and biosocial program. Similarities and differences between the Kunming Center and treatment programs in the United States are discussed and implications for universal approaches to drug treatment are addressed.

The advent of antiretroviral therapy and biomedical prevention has transformed HIV from a fatal disease to a chronic condition where people with HIV (PWH) can live long, healthy lives. Yet, there remains a subset of PWH left behind from receiving timely HIV diagnosis and care. Striking inequalities in access to resources, socioeconomic disparities, and social forces have prevented certain PWH from achieving significant health and quality of life (QOL) improvements experienced by those who secure life-saving treatment. For decades, our multidisciplinary team developed a collaborative scientific portfolio focused on helping those left behind advance along the HIV continuum of care. In this manuscript, we highlight some of our U.S.-based social interventions that have addressed the disparities and sub-optimal QOL encountered by overlooked populations with the goal of achieving timely HIV diagnosis, care, and sustained viral suppression. We then outline our many lessons learned and vision for the next crucial steps ahead.

In the South, people living with HIV experience worse health outcomes than in other geographic regions, likely due to regional political, structural, and socioeconomic factors. We describe the neighborhoods of women (n=1,800) living with and without HIV in the Women's Interagency HIV Study (WIHS), a cohort with Southern sites in Chapel Hill, NC; Atlanta, GA; Birmingham, AL; Jackson, MS; and Miami, FL; and non-Southern sites in Brooklyn, NY; Bronx, NY; Washington, DC; San Francisco, CA; and Chicago, IL. In 2014, participants' addresses were geocoded and matched to several administrative data sources. There were a number of differences between the neighborhood contexts of Southern and non-Southern WIHS participants. Southern states had the lowest income eligibility thresholds for family Medicaid, and consequently higher proportions of uninsured individuals. Modeled proportions of income devoted to transportation were much higher in Southern neighborhoods (Location Affordability Index of 28–39% compared to 16–23% in non-Southern sites), and fewer participants lived in counties where hospitals reported providing HIV care (55% of GA, 63% of NC, and 76% of AL participants lived in a county with a hospital that provided HIV care, compared to >90% at all other sites). Finally, the states with the highest adult incarceration rates were all in the South (per 100,000 residents: AL 820, MS 788, GA 686, FL 644). Many Southern states opted not to expand Medicaid, invest little in transportation infrastructure, and have staggering rates of incarceration. Resolution of racial and geographic disparities in HIV health outcomes will require addressing these structural barriers.