BackgroundPartner notification services (PNS) are recommended by the Centers for Disease Control and Prevention as a public health intervention for addressing the spread of HIV and other sexually transmitted diseases (STDs). Barriers and facilitators to the partner notification process from a public health perspective have not been well described.MethodsIn 2015, a coalition of New England public health STD directors and investigators formed to address the increasing STD prevalence across the region (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) and to promote communication between state STD programs. To evaluate barriers and facilitators of PNS programs, a survey was administered to representatives from each state to describe PNS processes and approaches.ResultsOf the six PNS programs, Connecticut, Maine, Massachusetts, Vermont, and New Hampshire had combined HIV and STD PNS programs; Rhode Island’s programs were integrated but employed separate disease intervention specialists (DIS). All states performed PNS for HIV and syphilis. Maine, New Hampshire and Vermont performed services for all gonorrhea cases. Rhode Island, Connecticut, and Massachusetts performed limited partner notification for gonorrhea due to lack of resources. None of the six states routinely provided services for chlamydia, though Maine and Vermont did so for high-priority populations such as HIV co-infected or pregnant individuals. Across all programs, clients received risk reduction counseling and general STD education as a component of PNS, in addition to referrals for HIV/STD care at locations ranging from Planned Parenthood to community- or hospital-based clinics. Notable barriers to successful partner notification across all states included anonymous partners and index cases who did not feel comfortable sharing partners’ names with DIS. Other common barriers included insufficient staff, inability of DIS to identify and contact partners, and index cases declining to speak with DIS staff.ConclusionsIn New England, state health departments use different strategies to implement PNS programs and referral to STD care. Despite this, similar challenges exist across settings, including difficulty with anonymous partners and limited state resources.
Background: In the United States, syphilis cases have increased dramatically over the last decade. Recognition and timely diagnosis by medical providers are essential to treating syphilis and preventing further transmission. Methods: From 2016 to 2017, a cross-sectional survey was performed among medical students, residents, fellows, and attending physicians in Rhode Island. Topics included demographics, level of medical training, experience diagnosing and treating syphilis, and familiarity with the reverse testing algorithm. Participants were asked 25 true/false questions to assess basic knowledge of syphilis, which covered five domains: epidemiology, transmission, clinical signs and symptoms, diagnosis, and treatment. Univariate and bivariate analyses were performed to determine knowledge levels across provider characteristics. Significance was defined as p < 0.05. Results: Of the 231 participants, 45% were medical students, 34% were residents or fellows, 11% were medicine attendings (non-infectious diseases), and 10% were infectious diseases attendings. The overall mean score was 9.79 (out of 25; range = 0–23, p ⩽ 0.001). Mean scores differed significantly ( p < 0.001) across groups, including 7.68 for students (range = 0–16), 10.61 for residents/fellows (range = 3–17), 10.41 for non-infectious diseases attendings (range = 4–18), and 16.38 for infectious diseases attendings (range = 6–23). Familiarity with the reverse sequence algorithm was low with only 22% having heard of it. Infectious diseases attendings were significantly more knowledgeable compared to other groups. Overall and across domains, infectious diseases attendings had significantly higher scores except when compared to non-infectious diseases attendings in the epidemiology domain and residents/fellows in the transmission domain. Conclusion: Overall syphilis knowledge among non-infectious diseases medical providers was low. Improved education and clinical training are needed to promote early diagnosis, treatment, and prevention efforts.
As the shortage of mental health care providers comes into focus against a growing need for mental health care worldwide, and the community of individuals pursuing careers in global health broadens, the question emerges: What are the ethics of practicing internationally in a field like psychiatry, which seems inextricably linked with cultural norms, language, sociopolitical events, and the ability to cultivate long‐term therapeutic relationships? I took the opportunity to attend the 18th annual World Psychiatric Association's (WPA's) World Congress of Psychiatry (WCP) in Mexico City in an attempt to learn more.
The consumption of adequate nutrition in adolescence can have long‐term positive effects on physical and emotional development, contributing to the prevention of several chronic diseases, including obesity, coronary heart disease, stroke, and Type 2 diabetes. While many of these diseases are not detected until adulthood, childhood obesity has emerged as a significant public health issue. The prevalence of obesity has doubled among American youth in the past three decades, with the most recent data confirming that one in three children in the United States are clinically overweight or obese.
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