HIV voluntary counseling and testing (VCT) programs are usually delivered by government health agencies in China. This study examined the feasibility of using a Chinese non-government organization (NGO) to deliver a VCT program to injection drug users (IDUs) in a southern Chinese city. The process data indicated the program successfully recruited and served 226 male and female IDUs in 4 months. The HIV prevalence rate of the study population was 57.5% by rapid HIV testing with a secondary rapid test to confirm. Quantitative and qualitative evaluations indicated that the VCT program was implemented appropriately and participants' HIV knowledge and safe drug and sex practices were significantly improved after participation in the VCT program. This study demonstrates the feasibility of a Chinese NGO to provide VCT for IDUs and documents the processes and outcomes of the program. There remains a great need to find additional sources to provide VCT and other HIV prevention services to IDUs and other high-risk populations in China. Chinese NGOs have the potential to fill this need.

BackgroundEmerging studies have investigated the contribution of food environment to obesity in the USA. However, the findings were inconsistent. Methodological explanations for the inconsistent findings included: (1) using individual store/restaurant exposure as food environment indicator, and (2) not accounting for non-stationarity assumption. This study aimed to describe the spatial distribution of obesity and examine the association between community food environment and obesity, and the variation of magnitude and direction of this association across the USA.MethodsData from 20 897 adults who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment between January 2003 and October 2007 were eligible in analysis. Hot Spot analysis was used to assess the spatial distribution of obesity. The association between community food environment and obesity and the variation of this association across the USA were examined using global ordinary least squares regression and local geographically weighted regression.ResultsHigher body mass index (BMI) clusters were more likely to locate in socioeconomically disadvantaged, rural, minority neighbourhoods with a smaller population size, while lower BMI clusters were more likely to appear in more affluent, urban neighbourhoods with a higher percentage of non-Hispanic white residences. There was an overall significant, inverse association between community food environment and obesity (β=−0.0210; p<0.0001). Moreover, the magnitude and direction of this association varied significantly across the US regions.ConclusionsThe findings underscored the need for geographically tailored public health interventions and policies to address unique local food environment issues to achieve maximum effects on obesity prevention.

Purpose: This study aims to test the hypothesis that in addition to a direct effect of food environment on obesity, food environment is indirectly associated with obesity through consuming Mediterranean diet (MD). Design: Cross-sectional secondary data analysis. Setting: Nationwide community-dwelling residency. Sample: A total of 20 897 non-Hispanic black and white adults aged ≥45 years who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment during January 2003 and October 2007. Measures: The Modified Retail Food Environment Index (mRFEI; 0-100) was used as food environment indicator. The MD score (0-9) was calculated to indicate the dietary pattern adherence. Body mass index (BMI; kg/m2) was used to estimate obesity. Analysis: Path analysis was used to quantify the pathways between food environment, MD adherence, and obesity. Proper data transformation was made using Box–Cox power transformation to meet certain analysis assumptions. Results: The participants were from 49 states of the United States, with the majority (64.42%) residing in the South. Most of the participants were retired, female, white, married, having less than college graduate education, having annual household income ≤75 000, and having health insurance. The means of mRFEI was 10.92 (standard deviation [SD] = 10.19), MD score was 4.36 (SD = 1.70), and the BMI was 28.96 kg/m2 (SD = 5.90). Access to healthy food outlets (β = .04, P < .0001) and MD adherence (β = .08, P < .0001) had significant and inverse relationships with BMI, respectively. Mediterranean diet adherence mediated the relationship between food environment and obesity among a subpopulation who had an annual household income of <$75 000 (β = −.02, P = .0391). Conclusion: Population-tailored interventions/policies to modify food environment and promote MD consumption are needed in order to combat the obesity crisis in the United States.

Objective: The current study aims to describe the Mediterranean diet (MD) adherence across the US regions, and explore the predictive factors of MD adherence among US adults. Design: Cross-sectional secondary data analysis. MD adherence score (0–9) was calculated using the Block 98 FFQ. Hot spot analysis was conducted to describe the geospatial distribution of MD adherence across the US regions. Logistic regression explored predictors of MD adherence. Setting: Nationwide community-dwelling residency in the USA. Participants: Adults aged ≥45 years (n 20 897) who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment during January 2003 and October 2007. Results: The mean of MD adherence score was 4·36 (sd 1·70), and 46·5 % of the sample had high MD adherence (score 5–9). Higher MD adherence clusters were primarily located in the western and northeastern coastal areas of the USA, whereas lower MD adherence clusters were majorly observed in south and east-north-central regions. Being older, black, not a current smoker, having a college degree or above, an annual household income ≥ $US 75K, exercising ≥4 times/week and watching TV/video <4 h/d were each associated with higher odds of high MD adherence. Conclusions: There were significant geospatial and population disparities in MD adherence across the US regions. Future studies are needed to explore the causes of MD adherence disparities and develop effective interventions for MD promotion in the USA.

Background The United States (US) healthcare system has experienced enormous economic impact due to the COVID-19 pandemic, driven by both loss of revenue related to shutdowns and increased strain on resources. These factors have impacted the workload and finances of physicians. Methods A 31-item anonymous survey evaluating the psychological impact of the COVID-19 pandemic on physicians was developed at the University of Alabama at Birmingham using QualtricsXM software and included questions on adverse economic impact (defined as selecting job loss, furlough or reduced income as a stressor), workload, and compensation. It was distributed via physician professional and social networks including email, Facebook groups, and #MedicalTwitter May 14-July 31, 2020. Results Among 597 respondents, 295 (49%) reported adverse economic impact, with the highest proportions among emergency medicine (71%), anesthesiologists (63%), and surgeons (60%) and lowest among infectious diseases (ID) (25%). In multivariable analysis (Table), physicians practicing in the Northeastern US saw the lowest economic impact versus the South (OR 3.44, 95% CI: 2.03–5.84), Midwest (2.62, 1.36–5.05) or West (1.98, 1.06–3.71). Physicians practicing in federal or academic settings experienced less economic impact than those in community settings (0.09, 0.03–0.30 and 0.61, 0.41–0.93 respectively). Increased work hours were identified by 185 (31%) of respondents as a stressor, with 169 (92%) reporting additional hours were partially or completely uncompensated. Among 584 respondents, 212 (36%) had new roles and responsibilities (Figure), with the highest proportion among ID physicians (75%). Table 1: Characteristics and factors associated with reporting adverse economic impact of the COVID-19 pandemic among 597 physicians in the United States Figure: New roles and responsbilities assumed by 212 physicians during the COVID-19 pandemic Conclusion The COVID-19 pandemic has increased physician workload, with approximately one-third of physicians taking on new responsibilities and a similar proportion reporting increased work hours. Much of this additional work is uncompensated due to the economic impact of the pandemic on the healthcare system. Simultaneously, many physicians across the US have suffered adverse economic consequences, especially in the South. ID physicians have experienced higher workload but less economic impact, related to increased need for their expertise and new roles and responsibilities. Disclosures Dustin Long, PhD, Nothing to disclose