Introduction: This study evaluates the impact of the COVID-19 pandemic on testing for common sexually transmitted infections. Specifically, changes are measured in chlamydia and gonorrhea testing and case detection among patients aged 14−49 years during the COVID-19 pandemic.Methods: U.S. chlamydia and gonorrhea testing and positivity were analyzed on the basis of >18.6 million tests (13.6 million tests for female patients and 4.7 million tests for male patients) performed by a national reference clinical laboratory from January 2019 through June 2020.Results: Chlamydia and gonorrhea testing reached a nadir in early April 2020, with decreases (relative to the baseline level) of 59% for female patients and 63% for male patients. Declines in testing were strongly associated with increases in weekly positivity rates for chlamydia (R 2 =0.96) and gonorrhea (R 2 =0.85). From March 2020 through June 2020, an expected 27,659 (26.4%) chlamydia and 5,577 (16.5%) gonorrhea cases were potentially missed. Conclusions:The COVID-19 pandemic impacted routine sexually transmitted infection services, suggesting an increase in syndromic sexually transmitted infection testing and missed asymptomatic cases. Follow-up analyses will be needed to assess the long-term implications of missed screening opportunities. These findings should serve as a warning for the potential sexual and reproductive health implications that can be expected from the overall decline in testing and potential missed cases.

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Background: Cancer mortality is higher in counties with high levels of (current) poverty, but less is known about associations with persistent poverty. Persistent poverty counties (with ≥20% of residents in poverty since 1980) face social, structural, and behavioral challenges that may make their residents more vulnerable to cancer. Methods: We calculated 2007 to 2011 county-level, age-adjusted, and overall and type-specific cancer mortality rates (deaths/100,000 people/year) by persistent poverty classifications, which we contrasted with mortality in counties experiencing current poverty (≥20% of residents in poverty according to 2007–2011 American Community Survey). We used two-sample t tests and multivariate linear regression to assess mortality by persistent poverty, and compared mortality rates across current and persistent poverty levels. Results: Overall cancer mortality was 179.3 [standard error (SE) = 0.55] deaths/100,000 people/year in nonpersistent poverty counties and 201.3 (SE = 1.80) in persistent poverty counties (12.3% higher, P < 0.0001). In multivariate analysis, cancer mortality was higher in persistent poverty versus nonpersistent poverty counties for overall cancer mortality as well as for several type-specific mortality rates: lung and bronchus, colorectal, stomach, and liver and intrahepatic bile duct (all P < 0.05). Among counties experiencing current poverty, those counties that were also experiencing persistent poverty had elevated mortality rates for all cancer types as well as lung and bronchus, colorectal, breast, stomach, and liver and intrahepatic bile duct (all P < 0.05). Conclusions: Cancer mortality was higher in persistent poverty counties than other counties, including those experiencing current poverty. Impact: Etiologic research and interventions, including policies, are needed to address multilevel determinants of cancer disparities in persistent poverty counties.

The important role of caregivers in heart failure (HF) management is well documented, but few studies have explored HF patient–caregiver dyads when dyadic incongruence is evident. The purpose of this study was to determine the prevalence of incongruence between HF patient–caregiver dyads, areas of incongruence, and the impact on individuals in the dyadic relationship. Data were collected as part of a longitudinal qualitative study examining the palliative care needs of HF dyads. Interviews with dyads determined to be incongruent were further analyzed. Of the 100 dyads, 47 were identified as being incongruent. Dyads were found to be incongruent in illness management, health care issues, and end-of-life decisions. Dyads that were incongruent reported more psychosocial issues and distress within the dyad and individually. Further research is needed to determine the impact of incongruence and whether interventions to modify incongruence will lead to improved HF patient and caregiver outcomes and experiences.

On behalf of the American Sexually Transmitted Diseases Association, we discuss benefits and challenges of direct-to-consumer test services for sexually transmitted infections and offer recommendations for future directions.

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Introduction: Integration of interprofessional education (IPE) activities into health professions curricula aims to promote collaborative practice with a goal of improving patient care. Methods: Through intercollegiate collaborations involving four different educational organizations and an academic health center, an interprofessional stroke simulation involving standardized patients was developed and instituted for IPE-naive student learners from medicine, nursing, physician assistant, occupational therapy, and physical therapy programs with additional involvement from pharmacy and social work learners. Herein, we describe the design of the IPE simulation and examine its impact on students' interprofessional development as assessed by students' completion of a validated IPE competency self-assessment tool and written reflective comments after the simulation. Results: Self-assessed interprofessional interaction and values domains were evaluated before and after the activity using the shortened 16-question Interprofessional Education Collaborative Competency Self-Assessment tool; data revealed significant changes in both the values and interaction domains of the tool from pre-to postsimulation experience (p < .0001). The qualitative student reflections revealed new student realizations around the concepts of collaboration, leadership, roles of different professions, and the importance of communication after participating in the simulation. Discussion: Quantitative data coupled with qualitative reflections from learners support the effectiveness of this activity for facilitating development of interprofessional competencies among health professions students.

Background Most persistent poverty counties are rural and contain high concentrations of racial minorities. Cancer mortality across persistent poverty, rurality, and race is understudied. Methods We gathered data on race and cancer deaths (all sites; lung and bronchus; colorectal; liver and intrahepatic bile duct; oropharyngeal; breast and cervical [females]; and prostate [males]) from National Death Index (1990–1992; 2014–2018). We linked these data to county characteristics: a) persistent poverty or not and b) rural or urban. We calculated absolute (range difference) and relative (range ratio) disparities for each cancer mortality outcome across persistent poverty, rurality, race, and time. Results The 1990–1992 range difference for all sites combined indicated persistent poverty counties had 12.73 (95% confidence interval [CI]=11.37-14.09) excess deaths per 100,000 people/year compared to non-persistent poverty counties; the 2014–2018 range difference was 10.99 (95% CI = 10.22-11.77). Similarly, the 1990–1992 range ratio for all sites indicated mortality rates in persistent poverty counties were 1.06 (95% CI = 1.05-1.07) times as high as non-persistent poverty counties; the 2014-2018 range ratio was 1.07 (95% CI = 1.07-1.08). Between 1990-1992 and 2014-2018, absolute and relative disparities by persistent poverty widened for colorectal and breast cancers; however, for remaining outcomes, trends in disparities were stable or mixed. The highest mortality rates were observed among African American/Black residents of rural, persistent poverty counties for all sites, colorectal, oropharyngeal, breast, cervical, and prostate cancers. Conclusions Mortality disparities by persistent poverty endured over time for most cancer outcomes, particularly for racial minorities in rural, persistent poverty counties. Multisector interventions are needed to improve cancer outcomes.