Striking Differences in Physical and Mental/Behavioral Health Status Between Homeless Bisexual and Gay Young Men in New York City, United States

Although many studies have been conducted on Human Immunodeficiency Virus (HIV) infection and treatment among homeless bisexual and gay young men, few have focussed on their overall health status. This study was conducted as a comparative assessment of self-reported physical and mental health status between homeless bisexual and gay young adult men in NewYork City, United States. Face-to-face interviews were conducted with a purposive sample of 30 subjects in a homeless drop-in program. Bisexual men reported more physical and mental/behavioral health concerns than gay men. More large-scale research is needed to understand reasons how bisexual men accessed healthcare as compared to gay men. Key words: • Health • Homeless • Bisexual • Gay • Mental health • Physical health Copyright © 2020 Gunness. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Monitoring for Local Transmission of Zika Virus using Emergency Department Data

ObjectiveCase and cluster identification of emergency department visitsrelated to local transmission of Zika virus.IntroductionThe first travel-associated cases of Zika virus infection in NewYork City (NYC) were identified in January 2016. Local transmissionof Zika virus from imported cases is possible due to presence ofAedes albopictus mosquitos. Timely detection of local Zika virustransmission could inform public health interventions and mitigateadditional spread of illness. Daily emergency department (ED) visitsurveillance to detect individual cases and spatio-temporal clusters oflocally-acquired Zika virus disease was initiated in June 2016.MethodsED visits were classified into two Zika syndromes based onchief complaint text and the International Classification of Diseasesversion 9 and 10 diagnosis codes for patients≥6 years old: 1) feverand 2) Zika-like illness. Zika-like illness was defined as visits withmention of Zika; symptoms of rash, fever, and either joint pain orconjunctivitis; diagnosis of Guillain-Barré syndrome; or diagnosis ofrare and non-endemic arboviral infection.We applied the prospective space-time permutation scan statistic1in SaTScan daily since June 2016 to the fever syndrome, selectedas a single representative symptom, to detect clusters by hospital orzip code of patient residence. The maximum spatial cluster size is20% of observed visits, and the maximum temporal cluster size is 14days – reflecting the incubation period.2The study period is 90 days.Statistical significance is determined using Monte Carlo simulations(N=999). Any cluster with a recurrence interval≥365 days issummarized in a map and line-list of contributing visits. The mapdepicts the zip codes of the cluster with an overlay of census tracts athighest risk for human importation of Zika virus, as estimated by azero-inflated Poisson regression model developed at NYC DOHMHthat is updated regularly to reflect the most recent available data onconfirmed cases.Zika-like illness syndrome visits are output in a daily line-list.DOHMH staff contact the EDs that patients visited to determinetravel to Zika-affected country, clinical suspicion of Zika infection,and laboratory testing.ResultsDuring June 1–August 16, 2016, we observed a mean of 253(range: 202-299) ED visits for the fever syndrome per day. Sixteenspatio-temporal fever syndrome clusters have been detected. Of these,2 clusters were during testing and optimization of scan parameters,13 were due to data quality issues, and 1 was dismissed due to thelarge geographic range of the cluster, spanning 3 boroughs.During June 1–August 16, 2016, we observed a mean of 2.7(range: 0-7) ED visits for the Zika-like illness syndrome. Daily countsranged from 0-3 visits from June 1-June 16 and 1-7 visits since June16. Nineteen visits that occurred from July 31-August 4 were furtherinvestigated to establish a protocol for follow-up. Of those, elevenpatients reported recent travel to countries with local transmission,one had travel over 3 months ago and an alternate diagnosis, six hadunknown travel history due to incomplete follow-up, and one reportedno travel. The one without travel had a diagnosis inconsistent withZika virus disease. Subsequently, analysts contacted EDs only for thesubset of Zika-like illness syndrome visits with no indication of travelor without an alternate discharge diagnosis. Findings from this effortwill be presented.ConclusionsThe fever syndrome provides a means to monitor for clusters usingED data. Prospective cluster detection signal volume was manageableand has not identified clusters requiring additional investigation.The Zika-like illness syndrome can be used for case finding.Contacting EDs helps to supplement information missing in thesyndromic system, such as travel history as well as Zika testing anddiagnosis. As Zika-like illness syndrome counts are low and diseaseis emergent, contacting EDs is feasible and helpful in ruling out localZika virus transmission. No visits or clusters to-date have indicatedlocal transmission.

Posttraumatic Stress Disorder in Posttransplant Children: Creating a Clinical Program to Address Their Needs

Posttraumatic stress symptoms have been shown to occur in pediatric and adult solid-organ transplant recipients. The presence of these symptoms is associated with non-adherence to medications, increased distress, and poor outcome. Because posttraumatic stress disorder is treatable and because a transplant operation usually is an “anticipated trauma,” it is possible to address posttraumatic stress disorder symptoms in transplant recipients and attempt to prevent their development. Under my direction, the pediatric liver transplant program at Mount Sinai Medical Center in NewYork City created research and clinical programs to address posttraumatic stress symptoms and their consequences. Specifically, the focus on non-adherence to immunosuppressive medications in transplant recipients who are distressed and their parents. This article begins with a review of the data that led to the decision to start these programs. I then present the basic elements that are in place, in this particular program, to address patients' needs. I end this review with preliminary outcome data that illustrate the potential impact of such an integrated approach to patient care on medical outcomes.