This paper presents Native Hawaiian cultural practices of prevention and mitigation of leptospirosis. Indigenous cultural practices are described. Relatively high prevalence of leptospirosis is found in Hawai'i. Standard diagnosis and treatment are outlined. Theories are offered of how it was introduced to the Hawaiian Islands.We used data from the Surveillance, Epidemiology, and End Results Program to examine trends in breast cancer treatment and survival among a large sample of American Indian and Alaska Native women diagnosed from 2000-2015. Kaplan-Meier and Cox proportional hazard models were used to estimate survival. Alaska Natives were more likely to undergo mastectomy (48% compared with 39% of American Indians and 36% of non-Hispanic Whites) and were less likely to receive breast reconstruction following mastectomy (9% compared with 17% of American Indians and 28% of non-Hispanic Whites). Alaska Natives had both lower overall (HR 1.40 95% CI 1.19-1.65) and breast-cancer specific (HR 1.29, 95% CI 1.03, 1.63) survival compared with non-Hispanic Whites. Survival differences across the three racial groups varied significantly by age. Efforts to improve survival among American Indian and Alaska Native populations will need to address barriers to access among these vulnerable populations.Overdose-death rates continue to rise, necessitating accessible medication-assisted treatment (MAT). However, national data demonstrate rural shortages. The purpose of the study was to investigate rural/urban comparisons in the Midwest and simultaneously examine the influence of rural and low-income status. We extracted 2018 public data for Michigan's 83 counties on two MAT forms 1) methadone clinics and 2) waivered buprenorphine practitioners. Urbanicity was operationalized using Rural Urban Continuum Codes. Income was categorized with U.S. Census data. Bivariate analyses demonstrated MAT shortages among rural (ps < .001) and low-income counties (ps < .01).  https://www.selleckchem.com/products/blebbistatin.html  In multivariable analyses, urban counties were 35.6 and 12.2 times more likely than rural counties to have any clinic(s) (p < .001) or practitioner(s) (p < .05), respectively. High-income counties were 5.9 times more likely than low-income counties to have any practitioner(s) (p < .01). These state-level findings identify targeted Michigan counties currently underserved for available MAT. Expanding treatment access to underserved communities using economic approaches is urgently needed.
  Describe the characteristics and pharmacological management of hypertensive patients in a Nicaraguan ambulatory care clinic.
 
  The study analyzed a random sample of 349 charts of patients aged older than 18 years from an ambulatory care clinic in Nicaragua and analyzed those who were diagnosed or had a known history of hypertension.
 
  Out of 349 patients, 19.77% (n=69) had a history of hypertension. Hypertensive patients were 66.2% female (n=45) with mean age of 56.1 years (SD=13.7). The most common comorbid condition was type 2 diabetes mellitus, which was present in 18.8% (n=13) of hypertensive patients. Other comorbid conditions included 10% (n=7) with chronic kidney disease and 75.8% (n=50) who were either overweight or obese. The most commonly prescribed antihypertensive medications were losartan, captopril, and enalapril.
 
  Hypertension is common in this clinic population and most commonly treated with angiotension-receptor blockers or angiotensin converting enzyme inhibitors.
 Hypertension is common in this clinic population and most commonly treated with angiotension-receptor blockers or angiotensin converting enzyme inhibitors.Adverse childhood experiences (ACEs) are associated with persistent physical and psychological impairments over time and intergenerational transmission of trauma. Few studies have examined contexts of acute adversity with an eye toward understanding intergenerational transmission of ACEs. Homelessness and residential mobility are strongly associated with increased deficits across key developmental domains throughout the lifespan. This study (N = 86 parent-child dyads living in emergency housing) examined the effect of parent ACEs under the age of 18 years on parent and child lifetime adverse experiences. Results demonstrated significant relationships between parent ACEs and parent adversity over 18 years of age, child lifetime adversity, and current child trauma symptomatology. These findings highlight the impact of parent early experiences on off spring and underscore the importance of understanding the impact of and intervening to end the intergenerational transmission of trauma in acute adversity. Implications of these findings, including intervention, policy, and practice, are discussed.
  To examine the association between school-level poverty status and students' persistent feelings of sadness or hopelessness, suicidality, and experiences with violence victimization among U.S. high school students.
 
  Public schools captured in the 2015 and 2017 national Youth Risk Behavior Surveys were categorized as high-, mid-, or low-poverty based on the percentage of students eligible for free or reduced-price meals (N=29,448).
 
  Students in high-poverty schools were significantly more likely than students in low-poverty schools to experience persistent feelings of sadness or hopelessness, experience suicidal thoughts and attempts, not go to school because of safety concerns, be threatened or injured with a weapon on school property, be bullied on school property, be physically forced to have sexual intercourse, and be victims of sexual and physical dating violence.
 
  School and community approaches to address suicide and violence victimization may be especially important for students living in poverty.
 School and community approaches to address suicide and violence victimization may be especially important for students living in poverty.Although Asian Americans and Pacific Islanders represent less than 5% of the U.S. population, they represent approximately half of all people living with chronic hepatitis B virus (HBV). Harrison, Hancock, and Jackson counties are home to the largest portion of Vietnamese individuals in Mississippi, and have high prevalence rates of HBV. Most people living with HBV do not know they are infected. In 2015, Mississippi State Department of Health began a five-year initiative to implement system-level, evidence-based, community-informed strategies to address HBV in the Vietnamese population of Harrison, Hancock, and Jackson Counties of Mississippi's Gulf Coast region. Presented are results from focus groups conducted with the Vietnamese population that define health issues affecting the Vietnamese community, health care services availability, and knowledge, beliefs, and attitudes regarding HBV and screening. Findings from the focus groups were used to develop a culturally and linguistically tailored HBV screening and care-linkage initiative for the prioritized population.