Are Direct Primary Care Practices Located in Health Professional Shortage Areas?

Direct primary care (DPC) is a model of health care delivery that relies on membership fees for service; however, it has been criticized as potentially worsening the shortage of primary care physicians. We sought to compare the distribution of DPC practices in the United States to that of non-DPC primary care and assess the overlap with Health Resources and Services Administration designated health professional shortage areas (HPSAs). We mined data from publicly available sources on DPC practices, HPSAs, and other primary care physicians.

Contrasting methods to operationalize antibiotic exposure in clinical research: a real-world application on healthcare-associated Clostridioides difficile infection.

The goal of this article is to summarize common methods of antibiotic operationalization used in clinical research and demonstrate methods for exposure variable selection. We demonstrate three methods for modeling exposure, using data from a case-control study on Clostridioides difficile infection in hospitalized patients: 1) factor analysis, 2) logistic regression models, and 3) Least Absolute Shrinkage and Selection Operator (LASSO) regression. The factor analysis identified 8 variables contributing the most variation in the dataset: any antibiotic exposure; number of antibiotic classes; number of antibiotic courses; dose; and specific classes monobactam, 𝛽-lactam 𝛽-lactamase inhibitors, rifamycin, and cephalosporin.

Self-Reported PrEP Use and Risk of Bacterial STIs Among Ontarian Men Who Are Gay or Bisexual or Have Sex With Men.

Purpose: HIV pre-exposure prophylaxis (PrEP) may increase rates of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM) through risk compensation (eg, an increase in condomless sex or number of partners); however, longitudinal studies exploring the time-dependent nature of PrEP uptake and bacterial STIs are limited. We used marginal structural models to estimate the effect of PrEP uptake on STI incidence.

Methods: We analyzed data from the iCruise study, an online longitudinal study of 535 Ontarian GBM from July 2017 to April 2018, to estimate the effects of PrEP uptake on incidence of self-reported bacterial STIs (chlamydia, gonorrhea, and syphilis) collected with 12 weekly diaries.

Inferring Population HIV Viral Load From a Single HIV Clinic's Electronic Health Record: Simulation Study With a Real-World Example.

Background: Population viral load (VL), the most comprehensive measure of the HIV transmission potential, cannot be directly measured due to lack of complete sampling of all people with HIV.

Objective: A given HIV clinic's electronic health record (EHR), a biased sample of this population, may be used to attempt to impute this measure.

Methods: We simulated a population of 10,000 individuals with VL calibrated to surveillance data with a geometric mean of 4449 copies/mL.

A Qualitative Study of Physicians' Views on the Reuse of Electronic Health Record Data for Secondary Analysis.

Electronic health records (EHRs) have become ubiquitous in clinical practice. Given the rich biomedical data captured for a large panel of patients, secondary analysis of these data for health research is also commonplace. Yet, there are many caveats to EHR data that the researchers must be aware of, such as the accuracy of and motive for documentation, and the reason for patients' visits to the clinic.

Geospatial Disparities in Youth Sexually Transmitted Infections During COVID-19.

Introduction: Early in the COVID-19 pandemic, routine sexually transmitted infection (STI) screenings decreased, and test positivity rates increased due to limited screening appointments, national-level STI testing supply shortages, and social distancing mandates. It is unclear if adolescent preventive STI screening has returned to pre-pandemic levels and if pre-existing disparities worsened in late-pandemic.

Methods: This cross-sectional study examined 22,974 primary care visits by 13-19-year-olds in the Philadelphia metropolitan area undergoing screening for gonorrhea and chlamydia in a 31-clinic pediatric primary care network during 2018-2022.

Measuring variation in infant mortality and deaths of despair by US congressional district in Pennsylvania: a methodological case study.

Many ecological studies examine health outcomes and disparities using administrative boundaries such as census tracts, counties, or states. These boundaries help us to understand the patterning of health by place, along with impacts of policies implemented at these levels. However, additional geopolitical units (units with both geographic and political meaning), such as congressional districts (CDs), present further opportunities to connect research with public policy.

Alignment of Ending the HIV Epidemic Priority Jurisdictions With Availability of HIV Service Organizations: An Ecological Study.

We sought to describe and quantify the association between HIV service organization availability, HIV burden, and HIV awareness and prevention in the 57 priority jurisdictions selected as part of the U.S. Ending the HIV Epidemic initiative.

Geolocation to Identify Online Study-Eligible Gay, Bisexual, and Men who have Sex with Men in Philadelphia, Pennsylvania.

Background: Data collection and cleaning procedures to exclude bot-generated responses are used to maintain the data integrity of samples from online surveys. However, these procedures may be time-consuming and difficult to implement. Thus, we aim to evaluate the validity of a single-step geolocation algorithm for recruiting eligible gay, bisexual, and men who have sex with men in Philadelphia for an online study.

Modeling the impact of xenointoxication in dogs to halt Trypanosoma cruzi transmission.

Background: Chagas disease, a vector-borne parasitic disease caused by Trypanosoma cruzi, affects millions in the Americas. Dogs are important reservoirs of the parasite. Under laboratory conditions, canine treatment with the systemic insecticide fluralaner demonstrated efficacy in killing Triatoma infestans and T.

A Catchment and Location-Allocation Analysis of Mammography Access in Delaware, US: Implications for disparities in geographic access to breast cancer screening.

Background: Despite a 40% reduction in breast cancer mortality over the last 30 years, not all groups have benefited equally from these gains. A consistent link between later stage of diagnosis and disparities in breast cancer mortality has been observed by race, socioeconomic status, and rurality. Therefore, ensuring equitable geographic access to screening mammography represents an important priority for reducing breast cancer disparities.

Modeling the impact of xenointoxication in dogs to halt transmission.

Background: Chagas disease, a vector-borne parasitic disease caused by , affects millions in the Americas. Dogs are important reservoirs of the parasite. Under laboratory conditions, canine treatment with the systemic insecticide fluralaner demonstrated efficacy in killing and vectors, when they feed on dogs.

Data Quality in Electronic Health Record Research: An Approach for Validation and Quantitative Bias Analysis for Imperfectly Ascertained Health Outcomes Via Diagnostic Codes.

It is incumbent upon all researchers who use the electronic health record (EHR), including data scientists, to understand the quality of such data. EHR data may be subject to measurement error or misclassification that have the potential to bias results, unless one applies the available computational techniques specifically created for this problem. In this article, we begin with a discussion of data-quality issues in the EHR focusing on health outcomes.

Perceived Barriers to and Facilitators of Long-Acting Injectable HIV PrEP Use Among Black, Hispanic/Latino, and White Gay, Bisexual, and Other Men Who Have Sex With Men.

Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) was recently approved for HIV prevention as an alternative to daily oral PrEP. We explored preferences and attitudes toward LAI-PrEP among Black, Hispanic/Latino, and White gay, bisexual, and other men who have sex with men (GBM) using focus groups ( = 13) and in-depth interviews ( = 17). Participants expressed differing levels of interest in LAI-PrEP.

Accessibility of HIV Services in Philadelphia: Location-Allocation Analysis.

Introduction: As the first step in the HIV care continuum, timely diagnosis is central to reducing transmission of the virus and ending the HIV epidemic. Studies have shown that distance from a testing site is essential for ease of access to services and educational material. This study shows how location-allocation analysis can be used to improve allocation of HIV testing services utilizing existing publicly available data from 2015 to 2019 on HIV prevalence, testing site location, and factors related to HIV in Philadelphia, Pennsylvania.

Partisan Polarization of Childhood Vaccination Policies, 1995‒2020.

To examine trends in partisan polarization of childhood vaccine bills and the impact of polarization on bill passage in the United States. We performed content analysis on 1497 US state bills (1995-2020) and obtained voting returns for 228 legislative votes (2011‒2020). We performed descriptive and statistical analyses using 2 measures of polarization.

Practical data considerations for the modern epidemiology student.

As an inherent part of epidemiologic research, practical decisions made during data collection and analysis have the potential to impact the measurement of disease occurrence as well as statistical and causal inference from the results. However, the computational skills needed to collect, manipulate, and evaluate data have not always been a focus of educational programs, and the increasing interest in "data science" suggest that data literacy has become paramount to ensure valid estimation. In this article, we first motivate such practical concerns for the modern epidemiology student, particularly as it relates to challenges in causal inference; second, we discuss how such concerns may be manifested in typical epidemiological analyses and identify the potential for bias; third, we present a case study that exemplifies the entire process; and finally, we draw attention to resources that can help epidemiology students connect the theoretical underpinning of the science to the practical considerations as described herein.

Towards Eliminating Nonmedical Vaccination Exemptions Among School-Age Children.

The increase in childhood vaccine hesitancy and corresponding use of nonmedical exemptions to abstain from vaccination has deleteriously impacted the public's health. This has many in the field calling for widespread elimination of nonmedical school-entry exemptions, as has been done in six states to date: West Virginia, Mississippi, California, New York, Maine, and Connecticut. By eliminating nonmedical exemptions, vaccination rates can be improved, with the corresponding decline in vaccine-preventable disease incidence.

State-Level Social and Economic Policies and Their Association With Perinatal and Infant Outcomes.

Unlabelled: Policy Points State-level social and economic policies that expand tax credits, increase paid parental leave, raise the minimum wage, and increase tobacco taxes have been demonstrated to reduce adverse perinatal and infant health outcomes. These findings can help prioritize evidence-based legislated policies to improve perinatal and infant outcomes in the United States.

Context: Rates of preterm birth and infant mortality are alarmingly high in the United States.

A narrative review on the validity of electronic health record-based research in epidemiology.

Electronic health records (EHRs) are widely used in epidemiological research, but the validity of the results is dependent upon the assumptions made about the healthcare system, the patient, and the provider. In this review, we identify four overarching challenges in using EHR-based data for epidemiological analysis, with a particular emphasis on threats to validity. These challenges include representativeness of the EHR to a target population, the availability and interpretability of clinical and non-clinical data, and missing data at both the variable and observation levels.