HIV and Sexually Transmitted Infection Testing Among High-Risk Youths: Supporting Positive Opportunities With Teens (SPOT) Youth Center

Objectives. We investigated the development of and service utilization at Supporting Positive Opportunities with Teens (SPOT)—a community-based health and social service facility in St. Louis, Missouri, for youths that focuses on increasing HIV and sexually transmitted infection (STI) testing.Methods. We identified the US-based, co-located youth health and social service models that guided the establishment of the SPOT. We analyzed the first 5 years (2008–2013) of service delivery and utilization data.Results. During the study period, the SPOT provided services for 8233 youths in 37 480 visits. The 5 most utilized services included HIV and STI screening, food, transportation, contraception, and case management. A total of 9812 gonorrhea and chlamydia screenings revealed 1379 (14.1%) cases of chlamydia and 437 (4.5%) cases of gonorrhea, and 5703 HIV tests revealed 59 HIV infections (1.0%); 93.0% of patients found to have an STI were treated within a 5-day window.Conclusions. Co-locating health and social services in informal community settings attracts high-risk youths to utilize services and can prove instrumental in reducing STI burden in this population.Sexual behaviors that contribute to unintended pregnancy and sexually transmitted infections (STIs), including HIV, are considered a priority health-risk behavior among youths in the United States.1 In 2008, St. Louis, Missouri, had some of the highest rates of Neisseria gonorrheae and Chlamydia trachomatis infections of all US cities.2 The majority of STIs in youths aged 15 to 24 years in Missouri are seen disproportionately among African American youths. HIV infection rates among youths continue to rise.3 From 2008 to 2010 new cases of HIV/AIDS among male youths in St. Louis increased by 33%, compared with a 2% increase among adult males.3,4These high rates of STIs and HIV highlight gaps in services for youths in our region. Evidence suggests that it is best to co-locate health and social services when providing care to a very needy population of youths.5–7 There are programs that do this in multiple sites across the country. Studies found that peer-to-peer information sharing and outreach, peer advisory groups, tightly linked medical and social services, and active case management to assess need and link youths to services were critical for keeping youths engaged.6,7 Despite the obvious needs of youths in St. Louis, no social service agency or health facility has ever combined these services for youths aged 13 to 24 years.We describe the development of our youth center, the SPOT (Supporting Positive Opportunities with Teens), and report screening outcomes and service utilization measures for the first 5 years of the center. We focus on identifying STI and HIV infections in youths and ensuring access to timely treatment.     

Assessing the Biodiversity of Wood Decay Fungi in Northern Forests of Iran

Fungal diversity in the Hyrcanian forests can greatly vary due to diverse ecological conditions. The scope of the present research was to investigate the diversity of wood decay fungi at three sites in the northern forests of Iran. Fruiting bodies of fungi were collected in three plots dominated by Quercus castaneifolia C.A.M. (oak) and Carpinus betulus L. (hornbeam) in the Hyrcanian Forest. As many as 19 and 13 taxa were found on hornbeam and oak, respectively. The identification of these fungi revealed Fomes fomentarius (L.) Fr. and Ganoderma lucidum (Curtis) P. Karst. as highly abundant on hornbeam and oak, respectively. Highest fungal abundance was observed at an altitude range of 1150-1200 meters above sea level. Diversity of macro-fungi was determined and the mean Shannon diversity index was found to be 2.52 and 1.94 for hornbeam and oak, respectively, and mean equitability was calculated as 0.84 and 0.73 for hornbeam and oak, respectively. There were no significant differences in the Shannon Diversity Index or equitability. Overall, current work showed that most of the identified fungi were classified as white rot fungi.     

The changing role of residential intervention

ABSTRACT

The role of therapeutic residential care (TRC) is changing. In fact, this article reframes the terminology of TRC and uses “residential interventions” to more accurately reflect that residential programs provide time-limited “intervention” and treatment efforts must connect and extend to families and communities. Such changes are being compelled by necessity and innovation. Necessity is demanding evidence, data, and durable positive outcomes for this expensive intervention. Innovation is transforming basic service delivery through meaningful inclusion of youth and families and effective collaboration with community-based organizations. Service elements that confound this changing role are being reconsidered, including reductions in length of stay, a focus on long-term permanency, and the location of the actual intervention from program-centric practice to interventions in the home and community.     

Lean Body Mass Associated with Upper Body Strength in Healthy Older Adults While Higher Body Fat Limits Lower Extremity Performance and Endurance

Impaired strength adversely influences an older person’s ability to perform activities of daily living. A cross-sectional study of 117 independently living men and women (age = 73.4 ± 9.4 year; body mass index (BMI) = 27.6 ± 4.8 kg/m²) aimed to assess the association between body composition and: (1) upper body strength (handgrip strength, HGS); (2) lower extremity performance (timed up and go (TUG) and sit to stand test (STS)); and (3) endurance (6-minute walk (SMWT). Body composition (% fat; lean body mass (LBM)) was assessed using bioelectrical impedance. Habitual physical activity was measured using the Minnesota Leisure Time Physical Activity Questionnaire (MLTPA) and dietary macronutrient intake, assessed using 24 h recalls and 3-day food records. Regression analyses included the covariates, protein intake (g/kg), MLTPA, age and sex. For natural logarithm (Ln) of right HGS, LBM (p < 0.001) and % body fat (p < 0.005) were significant (r² = 46.5%; p < 0.000). For left LnHGS, LBM (p < 0.000), age (p = 0.036), protein intake (p = 0.015) and LnMLTPA (p = 0.015) were significant (r² = 0.535; p < 0.000). For SMW, % body fat, age and LnMLTPA were significant (r² = 0.346; p < 0.000). For STS, % body fat and age were significant (r² = 0.251; p < 0.000). LBM is a strong predictor of upper body strength while higher % body fat and lower physical activity are associated with poorer outcomes on tests of lower extremity performance.     

Contextualizing the findings of a systematic review on patient and carer experiences of dementia diagnosis and treatment: a qualitative study

Background

Involving service users in the systematic review process is seen as increasingly important. As systematic reviews often include studies from diverse settings and covering a time span of several decades, involving service users in consideration of applicability to specific populations or settings might make reviews more useful to practitioners and policymakers.

Objectives

To test and contextualize the findings of a systematic review of qualitative studies looking at patient and carer experiences of diagnosis and treatment of dementia.

Methods

Results from the systematic review were discussed in focus groups and semi‐structured interviews with patient, public and professional participants in the South East of England. Analysis was guided by coding frameworks developed from the results of the systematic review.

Participants

We recruited 27 participants, including three people with dementia, 12 carers, six service providers and five older people without dementia.

Results

Findings from the focus groups and interviews were consistent with those from the systematic review and suggest that our review findings were applicable to the local setting. We found some evidence that access to information and diagnostic services had improved but, as in the systematic review, post‐diagnosis support was still often experienced as inadequate.

Conclusions

Focus groups and interviews with service users and their representatives can provide useful contextual information. However, such strategies can require considerable investment of the part of the researcher in terms of time and resources, and more work is needed to refine strategies and establish the benefits for patients and the organization of services.