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Cogordan C, Fressard L, Brosset E, Bocquier A, Velter A, Annequin M, Bourrelly M, Constance J, Michels D, Mora M, Morel S, Oliveri C, Maradan G, Berenger C, Spire B, Verger P. Sexual and preventive behaviors associated with HAV, HBV, and HPV vaccine hesitancy among men who have sex with men in France. Hum Vaccin Immunother 2024; 20:2348845. [PMID: 38783608 PMCID: PMC11135958 DOI: 10.1080/21645515.2024.2348845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Vaccination coverage against hepatitis A virus (HAV), hepatitis B virus (HBV), and human papillomaviruses (HPV) is insufficient among men who have sex with men (MSM), partly because of their high prevalence of vaccine hesitancy (VH) specific to these vaccines. This study aimed to investigate determinants of specific VH in MSM, focusing on characteristics of their sexual activity, propensity to use prevention tools and medical care, disclosure of sexual orientation to health care professionals (HCPs), and perceived stigmatization. A cross-sectional electronic survey (February - August 2022) collected perceptions of HBV, HAV, and HPV, and of their respective vaccines among 3,730 French MSM and enabled the construction of a specific VH variable. Using agglomerative hierarchical cluster analysis, we constructed a typology of MSM sexual and prevention practices. We identified three MSM clusters (low- (C1, 24%), moderate- (C2, 41%), and high- (C3, 35%) "sexual activity/medical engagement") that showed an increasing gradient in the use of medical prevention with regular medical care and exposure to high-risk sexual practices. A multiple ordinal logistic regression showed that overall specific VH was higher in the C1 cluster and in men who had not informed their physician of their sexual orientation. This typology could usefully help to adapt vaccination communication strategies for MSM prevention program according to patients' profiles. HCPs should be encouraged and trained to ask men about their sexual practices and to provide appropriate vaccination recommendations nonjudgmentally.
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Affiliation(s)
- Chloé Cogordan
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Lisa Fressard
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Emeline Brosset
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Aurélie Bocquier
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Inserm, INSPIIRE, Université de Lorraine, Nancy, France
| | - Annie Velter
- Santé publique France (The French Public Health Agency), Saint-Maurice, France
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Margot Annequin
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Jean Constance
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - David Michels
- AIDES, Pantin, France
- Laboratoire de recherche communautaire, Coalition PLUS, Pantin, France
| | - Marion Mora
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | | | - Camilla Oliveri
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Gwenaëlle Maradan
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Cyril Berenger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Bruno Spire
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Unité des Virus Émergents, UVE: Aix-Marseille Univ Università di Corsica, Marseille, France
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Owens C, Hubach RD. Rural-urban differences in monkeypox behaviors and attitudes among men who have sex with men in the United States. J Rural Health 2023; 39:508-515. [PMID: 36394371 DOI: 10.1111/jrh.12726] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE An outbreak of the monkeypox virus has been documented in the United States with most cases occurring among gay, bisexual, and other men who have sex with men (MSM). As monkeypox cases increase among relatively rural states, current public health messaging may not resonate with rural at-risk populations. Given this, there is a need to assess potential rural-urban differences in monkeypox behaviors and attitudes among MSM. METHODS A total of 582 eligible MSM completed an online cross-sectional survey between August 6 and 15, 2022. Participants answered questions about their demographics, sexual behaviors, monkeypox testing and vaccination behaviors, monkeypox media consumption and attitudes, and their intention and attitudes found in the Health Belief Model of getting the monkeypox vaccine. Rural-urban differences in behaviors and attitudes were assessed with a chi-square test of independence. Differences in intention to get vaccinated and Health Belief Model factors were assessed with a Mann-Whitney U test. FINDINGS Rural MSM, in comparison to their urban counterparts, were found to be less likely to report modifying their behaviors to decrease monkeypox exposure, being susceptible to monkeypox, or perceiving severe consequences acquiring monkeypox. Similarly, rural MSM had a lower intention to get vaccinated for monkeypox. CONCLUSIONS As vaccination uptake among rural populations for vaccine-preventable diseases remains suboptimal, results from this novel study can inform the development of monkeypox prevention, testing, and vaccination messaging campaigns geared toward rural MSM and other at-risk populations. It will be important to ensure that monkeypox prevention, testing, and vaccination interventions are available and accessible in rural areas.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
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Townes A, Gaul Z, Henny KD. Sexual health discussion practices and HIV clinical care provided by primary care providers in the Southeast United States, K-BAP Study (2017-2018). Fam Pract 2023; 40:39-46. [PMID: 35899789 DOI: 10.1093/fampra/cmac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Research underscores the importance of providers having routine discussions with patients about their sexual health. We examined the occurrences and association of routine sexual health discussion practices and human immunodeficiency virus (HIV) clinical care among primary care providers (PCPs) in areas with high HIV prevalence. METHODS We analysed data collected between April and August 2017 from an online survey that assessed PCPs knowledge, behaviours, attitudes, and practices of HIV-related care in 6 Southeast US jurisdictions (Atlanta, Baltimore, Baton Rouge, District of Columbia, Miami, and New Orleans). RESULTS Among PCPs, we found that 39.2% routinely obtained sexual health histories, 78.5% offered HIV testing, and 16.0% ever prescribed preexposure prophylaxis (PrEP). Based on adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs), the proportion of PCPs who routinely obtained sexual histories was higher among female PCPs (aPR = 1.47, 95% CI 1.04, 2.08), PCPs who had a patient population that was >50% men who have sex with men (MSM) (aPR = 1.94, 95% CI 1.72, 2.18), offered HIV testing (aPR = 3.60, 95% CI 2.23, 5.79), and ever prescribed PrEP (aPR = 1.43, 95% CI 1.06, 1.93). CONCLUSION Improving patient-provider discussions are needed to reduce HIV-related service barriers for disproportionately affected populations. PRACTICE IMPLICATIONS Routine discussions can reduce barriers to important HIV prevention and care services and help reduce disparities among patients living in highly prevalent HIV locations.
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Affiliation(s)
- Ashley Townes
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States.,Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Zaneta Gaul
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Social & Scientific Systems, Silver Spring, MD, United States
| | - Kirk D Henny
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Jaiswal J, LoSchiavo C, Meanley S, Hascher K, Cox AB, Dunlap KB, Singer SN, Halkitis PN. Correlates of PrEP Uptake Among Young Sexual Minority Men and Transgender Women in New York City: The Need to Reframe "Risk" Messaging and Normalize Preventative Health. AIDS Behav 2021; 25:3057-3073. [PMID: 33830327 PMCID: PMC8419019 DOI: 10.1007/s10461-021-03254-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective form of HIV prevention, but young sexual minority men face myriad barriers to PrEP uptake. Participants (n = 202) completed a survey on healthcare experiences and beliefs about HIV and PrEP. While 98% of the sample knew about PrEP, only 23.2% reported currently taking PrEP. Participants were more likely to be taking PrEP if they received PrEP information from a healthcare provider and endorsed STI-related risk compensation. Conversely, PrEP uptake was less likely among those with concerns about medication use and adherence. While there were no racial/ethnic differences in PrEP uptake, there were differences in correlates of PrEP use for White participants and participants of color. To facilitate PrEP uptake, clinicians should provide PrEP education and screen all patients for PrEP candidacy. Additionally, public health messaging must reframe HIV "risk", highlight benefits of STI testing, and emphasize the importance of preventive healthcare for SMM.
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Affiliation(s)
- J Jaiswal
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA.
- Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, New Haven, CT, 06510, USA.
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA.
| | - C LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- School of Public Health, Rutgers University, Piscataway, NJ, 08854, USA
| | - S Meanley
- Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, New Haven, CT, 06510, USA
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, 19104, USA
| | - K Hascher
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA
| | - A B Cox
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA
| | - K B Dunlap
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA
| | - S N Singer
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ, 08854, USA
| | - P N Halkitis
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- School of Public Health, Rutgers University, Piscataway, NJ, 08854, USA
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Turner MJ, Chu M, Cotler K, Yingling C. Application of a Sexual Risk Assessment Tool in a Primary Care Clinic. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shihabuddin CD, Leasure AR, Agudelo Higuita NI, Overcash J. A Quality Improvement Project Using Microlearning to Increase Provider Adherence to Extragenital Sexually Transmitted Infection Screening Guidelines in Men Who Have Sex With Men. J Assoc Nurses AIDS Care 2021; 32:629-635. [PMID: 35137721 DOI: 10.1097/jnc.0000000000000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The Centers for Disease Control and Prevention (CDC) recommend screening men who have sex with men who are living with HIV for sexually transmitted infections at appropriate extragenital contact sites for bacterial sexually transmitted infections. In an effort to increase provider adherence to CDC recommended guidelines at a Ryan White Clinic, microlearning educational sessions were used. A quality improvement project was designed to determine the rate of provider adherence to CDC guidelines pre/post microlearning sessions. Student t-test was used to compare the number of patients who received urine and extragenital screening to those who received urine-only screening, to before and after the microlearning sessions. The rate of extragenital screening significantly increased after the microlearning sessions (4/460 vs. 70/507, p < .0001). The rate of urine screening remained unchanged (p = 1). Although extragenital screening significantly increased, it remained low. A decision tree in the electronic medical record to prompt providers to screen was developed.
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Affiliation(s)
- Courtney DuBois Shihabuddin
- Courtney DuBois Shihabuddin, DNP, APRN-CNP, is an Assistant Professor of Clinical Practice at The Ohio State University's College of Nursing, Columbus, Ohio, USA . A. Renee Leasure, PhD, RN, CNS, CCRN, is an Associate Professor at the University of Oklahoma Health Sciences Center College of Nursing, Oklahoma City, Oklahoma, USA. Nelson Iván Agudelo Higuita, MD, is an Assistant Professor at the University of Oklahoma Health Sciences Center College of Medicine, Oklahoma City, Oklahoma, USA. Janine Overcash, PhD, APRN-CNP, GNP, FAANP, FAAN, is the Co-Director of the Academy for Teaching Innovation, Excellence and Scholarship and a Professor of Clinical Nursing at The Ohio State University's College of Nursing, Columbus, Ohio, USA
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Pregnall AM, Churchwell AL, Ehrenfeld JM. A Call for LGBTQ Content in Graduate Medical Education Program Requirements. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:828-835. [PMID: 34031304 DOI: 10.1097/acm.0000000000003581] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A well-developed body of literature demonstrates that lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals experience poorer health outcomes and report worse health care experiences than straight/cisgender individuals. Many reforms since 2010 have addressed the LGBTQ-related education of future health care professionals at the undergraduate medical education (UME) level; however, reforms at the graduate medical education (GME) level are lagging, and new literature suggests that didactic education at the UME level is not enough to prepare future physicians to properly and compassionately care for LGBTQ patients. Recently, the Accreditation Council for Graduate Medical Education (ACGME) implemented a major revision of its Common Program Requirements that requires residents to demonstrate, as a competence, respect and responsiveness to diverse populations. Given these revisions and the ongoing failure of many GME training programs to adequately prepare future physicians to care for LGBTQ patients, the authors argue that now is the time for the ACGME to develop and implement LGBTQ health-related residency requirements. In addition, the authors outline a path by which the academic medical community may develop and implement these requirements.
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Affiliation(s)
- Andrew M Pregnall
- A.M. Pregnall is LGBTQ health intern, Vanderbilt Program for LGBTQ Health, Vanderbilt University Medical Center, Nashville, Tennessee; ORCID: https://orcid.org/0000-0001-9629-0636
| | - André L Churchwell
- A.L. Churchwell is professor of medicine (cardiology), professor of radiology and radiological sciences, professor of biomedical engineering, and senior associate dean, Diversity Affairs, Vanderbilt University School of Medicine, and chief diversity officer, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jesse M Ehrenfeld
- J.M. Ehrenfeld is senior associate dean and director, Advancing a Healthier Wisconsin Endowment, the Medical College of Wisconsin, Milwaukee, Wisconsin
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Assessment for sexually transmitted infections in men who have sex with men attending a nurse-run HIV preexposure prophylaxis clinic. J Am Assoc Nurse Pract 2021; 33:1290-1294. [PMID: 33625163 DOI: 10.1097/jxx.0000000000000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Male-to-male sexual contact remains the primary mode of transmission for HIV and other sexually transmitted infections (STIs) in the United States. Reported STI rates in men who have sex with men (MSM) taking HIV preexposure prophylaxis (PrEP) are higher than expected, possibly due to decreased condom use while on PrEP or more frequent STI screening with routine PrEP care. LOCAL PROBLEM Hamilton County, located in southwestern Ohio, consistently has the highest rates of gonorrhea and syphilis and second highest rate of chlamydia in the state. The purpose of this project was to incorporate Centers for Disease Control and Prevention (CDC)-recommended comprehensive STI evaluations for MSM attending a nurse-run PrEP clinic in southwestern Ohio. METHODS Seventy-five MSM seen for PrEP between January 1, 2017, and May 15, 2019, were included in the STI testing program. Of these, 59 were included in outcome evaluation. INTERVENTION Sexually transmitted infection testing was performed every three months, including HIV and syphilis, with chlamydia/gonorrhea testing performed at all potentially exposed sites. RESULTS During the evaluation period, 43 STIs occurred in 18 patients (30.5%). Affected sites for gonorrhea included 10 oropharynx, eight anorectal, and two genitourinary; for chlamydia, it included one oropharynx, 12 anorectal, and one genitourinary. All extragenital infections were asymptomatic. CONCLUSIONS Sexually transmitted infection results in this population are consistent with those reported in other PrEP centers and reinforce importance of three-point chlamydia/gonorrhea testing as part of comprehensive STI evaluation. Implementing CDC screening recommendations in PrEP programs has been effective in identifying and treating STIs. Incorporating sexual history and comprehensive testing may help providers in other settings identify patients who need more frequent HIV/STI screening and prevention services.
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Hoover KW, Khalil GM, Cadwell BL, Rose CE, Peters PJ. Benchmarks for HIV Testing: What Is Needed to Achieve Universal Testing Coverage at U.S. Ambulatory Healthcare Facilities. J Acquir Immune Defic Syndr 2021; 86:e48-e53. [PMID: 33136820 DOI: 10.1097/qai.0000000000002553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/18/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Black and Hispanic men have the highest rates of HIV diagnoses. To decrease the number of U.S. men who are unaware of their HIV status, they should be tested at least once. Our objective was to estimate the increases needed in HIV testing rates at ambulatory health care visits to achieve universal coverage. METHODS We analyzed nationally representative medical record abstraction data to estimate the number of visits per person to physician offices, emergency departments, and outpatient clinics among men aged 18-39 years during 2009-2016, and the percentage of visits with an HIV test. We calculated the increase in the percentage of visits with an HIV test needed to achieve universal testing coverage of men by age 39 years. RESULTS Men had a mean of 75.3 million ambulatory visits per year and 1.67 visits per person. An HIV test was performed at 0.9% of the ambulatory visits made by white men, 2.5% by black men, and 2.4% by Hispanic men. A 3-fold increase in the percentage of visits with an HIV test would result in coverage of 46.2% of white, 100% of black, and 100% of Hispanic men; an 11-fold increase would be needed to result in coverage of 100% of white men. CONCLUSIONS HIV testing rates of men at ambulatory health care visits were too low to provide HIV testing coverage of all men by aged 39 years. A 3-fold increase in the percentage of visits with an HIV test would result in universal testing coverage of black and Hispanic men by age 39 years.
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Affiliation(s)
- Karen W Hoover
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Cottrell DB. Fostering sexual and gender minority status disclosure in patients. Nurse Pract 2019; 44:43-49. [PMID: 31180978 DOI: 10.1097/01.npr.0000559846.83872.da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Members of the sexual and gender minority (SGM) community face complex barriers to accessing quality healthcare. NPs have a responsibility to create welcoming care settings where patients can share a trusting provider-patient relationship to disclose their SGM status, an event shown to improve patient outcomes.
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Affiliation(s)
- Damon B Cottrell
- Damon B. Cottrell is an assistant dean and clinical professor at Texas Woman's University, Denton, Tex., and an NP at Denton Regional Urgent Care, Denton, Tex
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