Reprint of: Assessment of a naloxone distribution plan in a veteran population who experienced an opioid-related overdose event.

Background: The Veteran Health Administration prioritizes the distribution of naloxone to veterans diagnosed with opioid use disorder (OUD) to prevent deaths due to opioid-related overdose. The Overdose Education and Naloxone Distribution (OEND) program was created with tools to supplement efforts in identifying veterans at risk of opioid-related adverse events secondary to OUD or other comorbidities and increase access, education, and distribution of naloxone. Utilizing the OEND tool, Veteran Health Indiana (VHI) employed two different distribution initiatives to increase access to naloxone.

Assessment of a naloxone distribution plan in a veteran population who experienced an opioid-related overdose event.

Background: The Veteran Health Administration prioritizes the distribution of naloxone to veterans diagnosed with opioid use disorder (OUD) to prevent deaths due to opioid-related overdose. The Overdose Education and Naloxone Distribution (OEND) program was created with tools to supplement efforts in identifying veterans at risk of opioid-related adverse events secondary to OUD or other comorbidities and increase access, education, and distribution of naloxone. Utilizing the OEND tool, Veteran Health Indiana (VHI) employed two different distribution initiatives to increase access to naloxone.

Assessment of an education tool to improve knowledge and reduce stigma of a syringe service program (SSP) at a VA Medical Center.

Background: Drug overdose deaths are a growing epidemic in the United States owing in part to inadequate support from health care systems. In response, the Veterans Health Administration (VHA) plans to implement syringe service programs (SSPs) across VHA medical centers. This SSP education project aims to positively affect health care staff perceptions regarding SSPs and reduce the stigma surrounding substance use.

Assessment of hepatitis C monitoring adherence after viral eradication in veterans with substance use to improve care and surveil reinfection.

Introduction: Hepatitis C virus (HCV) incidence rates are rising for patients with substance use and/or SUDs. Guidelines provide monitoring recommendations to ensure remission after successful treatment. The study's objective was to identify gaps in follow-up for patients with documented substance use and/or SUD through assessment of adherence to guideline-recommended HCV RNA lab 12 months post-treatment.

HCV eradication in veterans with underlying mental health disorders and substance use.

Objective: Hepatitis C virus (HCV) disproportionately affects those with mental health disorders and those with substance use, and the increasing HCV transmission in the United States is driven by the opioid epidemic. However, patients with a mental health disorder, substance use, or combination of both historically have had limited access to HCV treatment. The goal of our study was to compare sustained virologic response (SVR) rates of HCV treatment with direct-acting antivirals (DAAs) between subjects with and without a mental health disorder, substance use, or combination of both.

Drinking water improvements and rates of urinary and gastrointestinal infections in Galápagos, Ecuador: Assessing household and community factors.

Objectives: The Galápagos provides an important setting to investigate the health impacts of a new drinking water treatment plant (DWTP) in a limited resource environment. We examine how household perceptions and practices affect the relationship between water quality and infections before and after DWTP.

Methods: Ethnographic data and self-reported infections were collected from 121 mothers and 168 children ages 2 to 10 from Isla San Cristóbal.

Pharmacist-driven multidisciplinary pretreatment workup process for hepatitis C care: A novel model for same-day pretreatment workup.

Objectives: The objective is to describe and quantify the impact of a novel practice model for pharmacist involvement in care coordination and patient education in hepatitis C virus (HCV) care.

Setting: This practice model was implemented in the gastroenterology clinic at the Richard L. Roudebush Veterans Affairs Medical Center in Indianapolis, Indiana.

Rising rates of cesarean delivery in Ecuador: Socioeconomic and institutional determinants over two decades.

Background: Ecuador's cesarean delivery rate far exceeds that recommended by the Pan American Health Organization (PAHO) and the World Health Organization (WHO). Using data from three iterations of Ecuador's nationally representative, population-based survey Encuesta Nacional de Salud y Nutrición (ENSANUT/ENDEMAIN), spanning 23 years, this study examines women's mode of delivery outcomes by sociodemographic characteristics and hospital type (private, public, social security) in light of Ecuador's major health care reform over the past two decades.

Methods: Using data from the 1994, 2004, and 2012 iterations of the data set, we analyzed trends in cesarean delivery based on province, year, and institution of care.

Pathways linking caesarean delivery to early health in a dual burden context: Immune development and the gut microbiome in infants and children from Galápagos, Ecuador.

Objectives: Global increases in caesarean deliveries are exposing more infants to perinatal environments that are evolutionarily novel and potentially increasing their risks for inflammatory conditions. Yet, the pathways linking caesareans to later health outcomes are not well understood, particularly in dual burden contexts. We test two of the hypothesized pathways, altered immune function and gut microbiota, which may link delivery mode to later health outcomes and test whether these associations persist when controlling for postnatal nutritional and pathogenic exposures.

Water quality at points-of-use in the Galapagos Islands.

Piped drinking water is often considered a gold standard for protecting public health but research is needed to explicitly evaluate the effect of centralized treatment systems on water quality in developing world settings. This study examined the effect of a new drinking water treatment plant (DWTP) on microbial drinking water quality at the point-of-use on San Cristobal Island, Galapagos using fecal indicator bacteria total coliforms and Escherichia coli. Samples were collected during six collection periods before and after operation of the DWTP began from the freshwater sources (n=4), the finished water (n=6), and 50 sites throughout the distribution system (n=287).

Multilevel examination of the association of urbanization with inflammation in Chinese adults.

We examine the associations between overall urbanicity and specific physical and social components of community-level urbanization with C-reactive protein (CRP) in adults participating in the China Health and Nutrition Study. Higher overall urbanicity and environment-related urbanicity component scores, including education, housing quality, and access to markets, were associated with elevated CRP in multilevel models controlling for clustering by community. These associations differed by age and gender and persisted after controlling for individual-level anthropometric, diet, and pathogenic risk factors.

Pathogenic and obesogenic factors associated with inflammation in Chinese children, adolescents and adults.

Objectives: Influenced by pathogen exposure and obesity, inflammation provides a critical biological pathway linking changing environments to the development of cardiometabolic disease. This study tests the relative contribution of obesogenic and pathogenic factors to moderate and acute CRP elevations in Chinese children, adolescents and adults.

Methods: Data come from 8795 participants in the China Health and Nutrition Study.

The effects of market integration on childhood growth and nutritional status: the dual burden of under- and over-nutrition in the Northern Ecuadorian Amazon.

Objectives: Market integration is an important source of cultural change exposing indigenous populations to epidemiologic and nutrition transitions. As children and adolescents are biologically sensitive to the health effects of market integration, we examine community variation of anthropometric indicators of nutritional status and growth among a cross-cultural sample of Kichwa, Shuar, Huaorani, and Cofán indigenous groups in the northern Ecuadorian Amazon.

Methods: We measured height, weight, body mass index (BMI), upper arm circumference, and triceps skinfolds of 186 children and adolescents aged 2 to 18 years from seven communities.