Publication: "HIV Transmission Through Premastication"
Pediatrics (Sept 2022)
HIV Transmission Through Premastication
Premastication is a potential route of transmission of HIV from caregiver to child. We report the case of a 13-month-old Alaska Native child from rural Alaska who presented with failure to thrive, recurrent pneumonias, severe dental decay, and dysphagia. The mother was HIV-uninfected. Respiratory failure prompted transfer to a children's hospital outside of Alaska where the child received a diagnosis of HIV infection. A grandparent who had been acting as primary caregiver was discovered to be HIV-infected with detectable viral load resulting from intermittent nonadherence to her medication regimen. This grandparent reported feeding the child premasticated food. Sequencing of the hypervariable C2V5 region of the HIV envelope gene in both patients demonstrated less than 0.05% variation, consistent with transmission from grandparent to child. Health care providers should be aware that transmission of HIV can occur via premastication, educate parents and caregivers regarding this risk, and rigorously pursue HIV testing when indicated even in children with HIV-uninfected mothers.
Publication: "Cancer Screening Test Use–U.S., 2019"
AJPM (Sep 2022) | Volume 63, Issue 3
Cancer Screening Test Use–U.S., 2019
INTRODUCTION: The U.S. Preventive Services Task Force recommends breast, cervical, and colorectal cancer screening to reduce mortality from these cancers, but screening use has been below national targets. The purpose of this study is to examine the proportion of screening-eligible adults who are up to date with these screenings and how screening use compares with Healthy People 2020 targets.
METHODS: Data from the 2019 National Health Interview Survey were used to examine the percentages of adults up to date with breast cancer screening among women aged 50‒74 years without previous breast cancer, cervical cancer screening among women aged 21‒65 years without previous cervical cancer or hysterectomy, and colorectal cancer screening among adults aged 50‒75 years without previous colorectal cancer. Estimates are presented by sociodemographic characteristics and healthcare access factors. Analyses were conducted in 2021.
RESULTS: Percentages of adults up to date were 76.2% (95% CI= 75.0, 77.5) for breast cancer screening, 76.4% (95% CI= 75.2, 77.6) for cervical cancer screening, and 68.3% (95% CI= 67.3, 69.3) for colorectal cancer screening. Although some population subgroups met breast and colorectal cancer screening targets (81.1% and 70.5%, respectively), many did not, and cervical cancer screening was below the target for all examined subgroups. Lower education and income, nonmetropolitan county of residence (which included rural counties), no usual source of care or health insurance coverage, and Medicaid coverage were associated with lower screening test use.
CONCLUSIONS: Estimated use of breast, cervical, and colorectal cancer screening tests based on the 2019 National Health Interview Survey were below national targets. Continued monitoring may allow for examination of screening trends, inform interventions, and track progress in eliminating disparities.
Publication: "Using Implementation Mapping to Develop Protocols Supporting the Implementation of a State Policy on Screening Children for Adverse Childhood Experiences in a System of Health Centers in Inland Southern California"
Frontiers in Public Health (Aug 2022)
Using Implementation Mapping to Develop Protocols Supporting the Implementation of a State Policy on Screening Children for Adverse Childhood Experiences in a System of Health Centers in Inland Southern California
Jolles, M. P., Fernández, M. E.*, Jacobs, G., De Leon, J., Myrick, L., & Aarons, G. A. (2022). Using implementation mapping to develop protocols supporting the implementation of a state policy on screening children for adverse childhood experiences in a system of health centers in inland Southern California. Front Public Health. doi: 10.3389/fpubh.2022.876769.
Adverse Childhood Experiences (ACEs) are defined as traumatic events occurring before age 18, such as maltreatment, life-threatening accidents, harsh migration experiences, or violence. Screening for ACEs includes asking questions about an individual's early exposure to these types of events. ACEs screenings have potential value in identifying children exposed to chronic and significant stress that produces elevated cortisol levels (i.e., toxic stress), and its associated physical and mental health conditions, such as heart disease, diabetes, depression, asthma, ADHD, anxiety, and substance dependence. However, ACEs screenings are seldom used in primary care settings. The Surgeon General of California has addressed this care gap by introducing ACEs Aware, an ACEs screening fee-for-service healthcare policy signed into law by Gov. Gavin Newsom. Since January 2020, Medi-Cal, California's Medicaid health care program, has reimbursed primary care providers for using the Pediatric ACEs and Related Life-events Screener (PEARLS) tool to screen children and adults for ACEs during wellness visits. To achieve the goals set by the ACEs Aware state policy, it is essential to develop and test implementation strategies that are informed by the values, priorities, and resources of clinical settings, healthcare professionals, and end-users. To address this need, we partnered with a system of federally qualified health centers in Southern California on a pilot study to facilitate the implementation of ACEs screenings in five community-based clinics. The health centers had broad ideas for an implementation strategy, as well as best practices to improve adoption of screenings, such as focusing on staff training to improve clinic workflow. This knowledge was incorporated into the development of an implementation strategy template, used at the outset of this study. We used the Exploration, Preparation, Implementation and Sustainment (EPIS) framework to guide the study and inform a participatory planning process called Implementation Mapping. In this paper, we describe how Implementation Mapping was used to engage diverse stakeholders and guide them through a systematic process that resulted in the development of the implementation strategy. We also detail how the EPIS framework informed each Implementation Mapping Task and provide recommendations for developing implementation strategies using EPIS and Implementation Mapping in health-care settings.
CDC and NCI Co-Host Webinar in Celebration of CPCRN 20th Anniversary (2002-2022)
In 2002, the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NC collaborated to launch the Cancer Prevention and Control Research Network (CPCRN), a thematic research network within CDC’s Prevention Research Center (PRC) Program. A subset of funded PRCs and select affiliate investigators work with public health practitioners and community partners to translate research into practice to reduce cancer disparities and promote health equity.
Twenty years later, the Network is excited to celebrate "20 Years of the Cancer Prevention and Control Research Network (CPCRN): Past Present and Future." Join us for this special webinar event, during which Network members (pictured below) will share about tools and programs collaboratively developed and implemented, discuss current works in progress, and explore areas for research and practice growth in implementation science.