Project COALESCE—An Example of Academic Institutions as Conveners of Community-Clinic Partnerships to Improve Cancer Screening Access

In Virginia, 56% of colorectal cancers (CRC) are diagnosed late, making it one of three enduring CRC mortality hotspots in the US. Cervical cancer (CCa) exhibits a similar pattern, with 48% late-stage diagnosis. Mortality for these cancers is worse for non-Latinx/e(nL)-Black people relative to nL-White people in Virginia, but preventable with equitable screening access and timely diagnostic follow-up. However, structural barriers, such as fractured referral systems and extended time between medical visits, remain. Because Federally Qualified Health Centers (FQHCs) care for a large proportion of racial and ethnic minorities, and underserved communities, regardless of ability to pay, they are ideal partners to tackle structural barriers to cancer screenings. We piloted a quality improvement initiative at five FQHCs in southcentral Virginia to identify and address structural, race-related barriers to CRC, as well as CCa screening and diagnostic follow-up using evidence-based approaches. Uniquely, FQHCs were paired with local community organizations in a didactic partnership, to elevate the community’s voice while together, increase support, acceptance, uptake, and intervention sustainability. We report on project development, and share preliminary data within the context of project goals, namely, to increase cancer screenings by 5–10%, improve knowledge and diagnostic follow-up processes, and build longitudinal partnerships.

student-run free clinic project: lessons in compassion, community, and courage

For 25 years, UC San Diego Student-Run Free Clinic Project has provided free high-quality care to underserved communities, while inspiring the next generation of health professionals. Free thorough ongoing care is provided in community settings to people who have nowhere to turn and do not qualify for access to care. The clinic philosophy has four tenets: empowerment - creating environments where patients take charge of their lives and achieve wellbeing, a humanistic approach - embodying Rogerian principles of empathy, respect, and self-awareness, a transdisciplinary model, one where the patient and community are the teacher. This philosophy permeates the life of the clinic. These values are taught, modeled, expected, and observed in curricular components throughout the four years of medical school. 250 medical, 75 pharmacy, and 100 predental students are involved each year as well as students in law, social work, and acupuncture. Students learn to be healers, artists, teachers as they become health professionals. At each clinic session student leaders gather the team in a large circle, and lead a sharing of recent stories and experiences reflecting the core tenets. All work is directly supervised by licensed clinicians, many of whom were once free clinic students. During the era of COVID, care became virtual. Promotors helped patients learn to use Zoom to receive care. Visit attendance increased to 100%. Our Spanish language empowerment group met online. The clinic already provided healthy food bags to patients at medical visits. Students and volunteers organized to deliver food and medication to people’s homes.

Acceptability of Traditional Chinese Medicine in Chinese People Based on 10-Year's Real World Study With Mutiple Big Data Mining

In the past decades, numerous clinical researches have been conducted to illuminate the effects of traditional Chinese medicine for better inheritance and promotion of it, which are mostly clinical trials designed from the doctor's point of view. This large-scale data mining study was conducted from real-world point of view in up to 10 years' big data sets of Traditional Chinese Medicine (TCM) in China, including both medical visits to hospital and cyberspace and contemporaneous social survey data. Finally, some important and interesting findings appear: (1) More Criticisms vs. More Visits. The intensity of criticism increased by 2.33 times over the past 10 years, while the actual number of visits increased by 2.41 times. (2) The people of younger age, highly educated and from economically developed areas have become the primary population for utilizing TCM, which is contrary to common opinions on the characteristics of TCM users. The discovery of this phenomenon indicates that TCM deserves further study on how it treats illness and maintains health.

The Impact of COVID-19 on Routine Medical Care and Cancer Screening

Background COVID-19 restrictions and fear dramatically changed the use of medical care. Understanding the magnitude of cancelled and postponed appointments and associated factors can help identify approaches to mitigate unmet need. Objective To determine the proportion of medical visits cancelled or postponed and for whom. We hypothesized that adults with serious medical conditions and those with higher anxiety, depressive symptoms, and avoidance-oriented coping would have more cancellations/postponements. Design Four nationally representative cross-sectional surveys conducted online in May, July, October, and December 2020. Participants 59,747 US adults who completed 15-min online surveys. 69% cooperation rate. Measures Physical and mental health visits and cancer screening cancelled or postponed over prior 2 months. Plan to cancel or postpone visits over the next 2 months. Relationship with demographics, medical conditions, local COVID-19 death rate, anxiety, depressive symptoms, coping, intolerance of uncertainty, and perceived COVID-19 risk. Key Results Of the 58% (N = 34,868) with a medical appointment during the 2 months before the survey, 64% had an appointment cancelled or postponed in May, decreasing to 37% in December. Of the 41% of respondents with scheduled cancer screening, 20% cancelled/postponed, which was stable May to December. People with more medical conditions were more likely to cancel or postpone medical visits (OR 1.19 per condition, 95% CI 1.16, 1.22) and cancer screening (OR 1.20, 95% CI 1.15, 1.24). Race, ethnicity, and income had weak associations with cancelled/postponed visits, local death rate was unrelated, but anxiety and depressive symptoms were strongly related to cancellations, and this grew between May and December. Conclusions Cancelled medical care and cancer screening were more common among persons with medical conditions, anxiety and depression, even after accounting for COVID-19 deaths. Outreach and support to ensure that patients are not avoiding needed care due to anxiety, depression and inaccurate perceptions of risk will be important.

Combination Vaccines

Combination vaccines have been around since 1945 (trivalent influenza vaccine) and they combine either different serotypes of one microorganism (e.g., influenza or pneumococcal vaccines) or different microorganisms (e.g., DTP combinations). Potential chemical and physical interactions, unpredictable immunological interactions, and in one instance: increased AE, increasing likelihood of production failures, and reduced flexibility of a vaccination program are challenges for developing combination vaccines. With an increasing number of new vaccines for protecting the very young, DTaP- and DTwP-based combinations have become the cornerstone of pediatric vaccination programs around the globe since the mid-1990s. Live vaccine combinations include MR, MMR, and MMRV combinations as well as (trivalent) OPV. Combination vaccines for travelers include HAV-HBV combination and HAV-Ty vaccines. Dozens of diverse combination vaccine products are licensed today around the globe, some of them only in single countries to cover specific local needs. Combination vaccines have been shown to result in increased acceptance, completion and compliance with vaccination programs; in addition, they offer simplified logistics, reduce administration errors, reduce the number of medical visits and cost for the individual as well as for society, among other benefits.

Associations of Medical Visits with Dentist Visits: A Register-Linkage Study of a Working-Age Population in Finland

Studies have usually addressed the utilization of either medical or dental services, and less is known about how medical and dentist visits are associated. As oral health is linked to systemic health, knowledge on care coordination between dental and medical services is important to gain understanding of the overall functioning of health care. Register data on 25–64-year-old residents of the city of Oulu, Finland, were used for the years 2017–2018 (N = 91,060). Logit models were estimated to analyze the probability of dentist visits, according to the number of medical visits in total and by three separate health care sectors. The majority, 61%, had visited both a medical professional and a dentist. All sectors combined, as few as one to two visits increased the odds of dentist visits (OR: 1.43, CI: 1.33, 1.53). When separated by medical professionals’ health care sectors, for one to two visits, the strongest association was found with public (OR: 1.17, CI: 1.12, 1.22) and private sector (OR: 1.35, CI: 1.30, 1.41). For occupational health service visits, the odds increased only after six or more visits. The results support the idea of integrated medical and dental care. However, the result may also arise from individual health behavior where health-conscious persons seek both medical and dental care independently.

Psychosis in Parkinson’s disease in a Southeast Asian cohort: prevalence and clinical correlates

Introduction: Psychosis is a prominent neuropsychiatric symptom of Parkinson’s disease (PD) and is associated with negative outcomes, such as poorer quality of life and greater rate of functional impairment. Early identification of patients with PD at risk of developing psychosis facilitates appropriate management to improve outcomes. However, this phenomenon has not been examined locally. This study aimed to examine the prevalence of PD-associated psychosis in the local setting, identify any associated risk factors, as well as characterise the cognitive trajectory of patients with PD with psychosis. Methods: A retrospective cohort of 336 patients with PD, who presented to the National Neuroscience Institute, Singapore, in 2006 and 2007 and attended follow-up visits through to 2013 was analysed. The data analysed included scores from clinician assessments of cognitive function, disease severity and presence of psychotic symptoms, conducted when clinically appropriate during patients’ medical visits. Survival analysis and logistic and linear regression analysis were performed. Results: Psychosis was diagnosed in 63 patients with PD, indicating a prevalence of 18.8% for PD-associated psychosis. Incidence of psychosis in PD was calculated to be 40 per 1,000 person-years. No significant association was found between demographic variables and the odds of developing psychosis in PD. Regression analyses found that the presence of psychosis significantly predicted greater cognitive decline and disease severity. Conclusion: Psychosis has a significant presence among the PD population in Singapore, possibly serving as an indicator of more rapid cognitive decline and progression of PD severity.

Adapting to Create Innovative Virtual Falls Prevention Programs for at Risk Older Adults During a Global Pandemic

Baystate Health’s Geriatrics Workforce Enhancement Program (GWEP) postponed implementation of Group Medical Visits focused on falls reduction for older adults in Springfield, Massachusetts due to COVID-19 and quickly shifted efforts to participate in Dartmouth’s Falls Prevention Training Program. Long standing GWEP Community Based Organizations (CBOs) were consulted, and all believed that the virtual Tai Ji Quan Moving for Better Balance® (TJQMBB) program would combat social isolation and improve older adults’ comfort with technology in addition to reducing falls during the COVID-19 pandemic. Baystate’s GWEP was able to reallocate grant dollars to support the purchase of equipment for CBOs to deliver TJQMBB virtually. While many challenges continue to arise, the innovative and collaborative approach between the two GWEPs and Baystate’s CBOs leveraging Administration for Community Living falls prevention funding has led to high level engagement and rapid implementation. Dartmouth’s model capitalizes on and strengthens existing GWEP partnerships with its CBOs.

Medical Care at California Wildfire Incident Base Camps

Objective: The California Emergency Medical Services Authority manages and deploys California Medical Assistance Teams (CAL-MAT) to disaster medical incidents in the state. This analysis reviews diagnoses for ambulatory medical visits at multiple wildland fire incident base camp field sites in California during the 2020 fire season. Methods: Clinical data without personal health information were extracted retrospectively from patient care records from all patients seen by a provider. Results were entered into Excel spreadsheets with calculation of summary statistics. Results: During the 2020 fire season, CAL-MAT teams deployed 21 times for a total of 327 days to base camps supporting large fire incidents and cared for 1756 patients. Impacts of heat and environmental smoke are a constant factor near wildfires; however, our most common medical problem was rhus dermatitis (54.5%) due to poison oak. All 2020 medical missions were further complicated by prevention and management of coronavirus disease (COVID-19). Conclusions: There is very little literature regarding the acute medical needs facing responders fighting wildland fires. Ninety-five percent of clinical conditions presenting to a field medical team at the wildfire incident base camp during a severe fire season in California can be managed by small teams operating in field tents.