In 2022, San Joaquin County had approximately 2,319 unhoused/unsheltered individuals, with 66% residing in Stockton. Studies have found that approximately 75% of unhoused individuals reported drug use of any kind and 12% reported opioid use. Additionally, drug overdosedeaths increased in the United States by more than 30% from 2019 to 2020. Transmission rates of infections associated with injection drug use have also been increasing. Harm reduction services, including syringe exchange and naloxone distribution, have been shown toreduce the rates of disease transmission and drug overdose death within communities.
In 2016, the rate of drug-induced deaths was 56% higher in San Joaquin County than the California state average. Developed in July 2020, The Stockton Harm ReductionProgram (SHRP) provides sterile syringes and injection equipment, condoms, naloxone, hygiene products, and referrals for health and housing services to people in San Joaquin County. The purpose of this study is to determine the impact of a mobile harm reduction program on usage of sterilesyringes and naloxone by program participants.
The primary aim was to examining abortion-trained physician perspectives on barriers toabortion access and their views on physicians'roles in the legislative regulation of abortion.
The secondary aim was to elicit theperspectives and experiences of abortion-trained physicians to understand the effectsof legislation on their ability to providepatients with comprehensive reproductivecare.
To evaluate the consistency of contraceptionplan identified at delivery hospitalization withreported contraception use over 6 monthspostpartum.
Neurofibromatosis type 1 (NF1) is an inherited tumor syndrome caused by heterozygous germline mutations in the NF1 gene, occurring in approximately 1/2600 individuals. A subset of patients with neurofibromatosis type 1 (NF1) develop juvenile xanthogranulomas (JXGs), a non-Langerhans cell histiocytosis, and some of these patients also develop juvenile myelomonocytic leukemia (JMML).Yet, these associations are poorly delineated.JXG is a benign proliferation of non-Langerhans cells histiocytes characterized by small yellow/brown papulonodules ranging from 1-20 mm in size. JMML is a mixed myeloproliferative-myelodysplastic disorder that affects children, most often before age 6.4. The first and only systematic review on this described therisk of developing JMML 20 to 30 times higher in patients with NF1 with JXG lesions compared to those without JXG. Since then, mostly isolated case reports have either refuted or confirmed this triple association.
Determine which elements of a lactating patient’s clinical presentation, including breast pump use and symptoms, are associated with a diagnosis of nipple thrush.
Racial inequities in medicine have impacted health outcomes in various communities. These inequities have been documented in journals to highlight racial inequities in health status, racial inequities in clinical algorithms, and racial identity and health. We conducted a review of literature and selected 95 articles to analyze and summarize in an annotated bibliography. The annotated bibliography was sorted into four categories: racial inequality in health status, racial inequality in clinical algorithms, racial identity and health (ex. mental health, development, schooling, etc.) including biracial and multiracial individuals, and the impact of racism on health. These articles highlight a theme of racial inequities in policy making, racial perceptions which influence clinical decision making, and the use of race as a sole indicator for diagnosis and treatment options in clinical algorithms. Racist perceptions against non-white patients were found to negatively influence clinical decision making in emergency settings.
Rural communities can be particularly susceptible to devastating effects of a global pandemic given factors such as decreased access to care, isolation, and insufficient broadband internet infrastructure. It is important to assess the needs of rural communities amidst the pandemic caused by COVID-19 to have appropriate resource allocation. To this end, 129 community college students from the Tahoe Truckee Campus of Sierra College were surveyed in April 2020, which was two weeks after the first stay-at-home orders were initiated by the state of California. Furthermore, community partners were contacted to help design the survey along with report on increased resource demand over the course of Summer 2020. Results indicated that students were anxious and depressed for a greater number of days after the stay-at-home orders compared to before (anxiety: Z = 5.41, p < .01; depression: Z = 5.70, p < .01). Thirty-seven students (32%) identified that food insecurity was a problem, with this affecting more Latino than White students, U = 738, p = .006. Fourteen percent of students, all of whom were White, reported that their non-prescribed drug and alcohol intake increased after the stay-at-home orders. The Sierra Community House reported double the calls to their 24-hour emergency hotline, a steep increase in food distribution, and higher levels of housing and utility assistance applications between April and September 2020. This exploratory needs assessment identified mental health along with food and housing security as areas of ongoing demand. It is important to further assess how the pandemic is affecting the low income and Latino populations in these rural communities and if there is disproportionate access to tele-health and tele-education.
The passage of the Patient Protection and Affordable Care Act (ACA) in 2010 has expanded health care access in the United States by subsidizing insurance premiums, establishing marketplaces for private insurance plans, and expanding Medicaid eligibility. 1 Since the passage of the ACA, more than 20 million previously uninsured people have been able to enroll in health insurance programs. Despite these gains, more than 32 million Americans remain uninsured. 2 Uninsured patients rely heavily on safety-net services such as free clinics for medical care. There are over 1,000 student-run clinics (SRCs) and other free clinics in in the United States, serving over 1.8 million patients annually. 3 These clinics primarily provide primary care services, although some clinics offer a broader scope of care. Nevertheless, these clinics do not offer the full range of services available in other care settings to patients with insurance. 3,4 Despite the increased availability of health insurance, there are still barriers that prevent uninsured patients of free clinics from enrolling in health insurance. Several studies have examined these barriers and a few studies have examined the protocols used by clinics to enroll patients in health insurance and effectiveness of these protocols. The purpose of this review is to synthesize the findings of studies that have assessed these topics.
In the beginning of 2020, the United States experienced a shortage of personal protective equipment (PPE) for healthcare workers fighting the COVID-19 pandemic. This shortage of PPE partially contributed to healthcare providers contracting COVID-19. In response to the PPE crisis, UC Davis medical students organized the UC Davis COVID-19 Response Team and collaborated with MedSupplyDrive, a 501(c)(3) non-profit organization created in March 2020 to address PPE shortages. MedSupplyDrive regional coordinators worked with medical student volunteers to address the PPE shortage by collecting PPE from the community and distributing it to hospitals and clinics in need.
As of February 8th , 2021, there were a total of 26,761,047 cases of Coronavirus Disease 2019 (COVID-19) in the United States, with over 460,582 deaths. One population with increased susceptibility and high risk for serious illness is that of people experiencing homelessness. In order to effectively implement pandemic responses to COVID-19 within this community, lessons can be derived from the prior H1N1 pandemic (influenza A virus subtype H1N1). A necessary mode of healthcare delivery frequently described during the H1N1 pandemic was outreach medicine. Recommendations extrapolated from the homeless sector’s response during H1N1 include the need for an integrated approach, equitable distribution of resources, mitigation of the decreased use of drop-in services, the voice of the unhoused contributing to planning, and vaccination.
