BACKGROUND: The relationship between asthma and coccidioidomycosis has not been fully described. We have hypothesised that Coccidioides could trigger inflammatory airway responses, similar to other fungi. OBJECTIVES: To estimate the frequency of new-onset asthma-related symptoms after coccidioidomycosis and identify potentially associated factors. PATIENTS/METHODS: We used a large health insurance claims database to identify patients with coccidiomycosis with and without an asthma diagnosis code or a short-acting β(2) agonist prescription in the year after diagnosis. RESULTS: Thirteen per cent of 1657 patients with an asthma diagnosis code or a short-acting β(2) agonist prescription (median 2.5 months later). CONCLUSIONS: Increased healthcare provider awareness of asthma as a potential coccidioidomycosis complication could benefit patients, especially female patients and patients with severe pulmonary infection.

INTRODUCTION: Metabolic and bariatric surgery (MBS) is an effective intervention to manage diabetes and obesity. The population-based incidence of MBS is unknown. OBJECTIVE: To estimate the incidence of MBS among US adults with obesity by diabetes status and selected sociodemographic characteristics. RESEARCH DESIGN AND METHODS: This cross-sectional study used data from the 2016-2020 Nationwide Inpatient Sample and Nationwide Ambulatory Surgery Sample to capture MBS procedures. The National Health Interview Survey was used to establish the denominator for incidence calculations. Participants included US non-pregnant adults aged ≥18 years with obesity. The main outcome was incident MBS without previous MBS, defined by International Classification of Diseases, Tenth Revision Procedure Codes, Diagnosis Related Group system codes, and Current Procedural Terminology codes. Adjusted incidence and annual percentage change (2016-2019) were estimated using logistic regression. RESULTS: Among US adults with obesity, over 900 000 MBS procedures were performed in inpatient and hospital-owned ambulatory surgical centers in the USA during 2016-2020. The age- and sex-adjusted incidence of MBS per 1000 adults was 5.9 (95% CI 5.4 to 6.4) for adults with diabetes and 2.0 (95% CI 1.9 to 2.1) for adults without diabetes. MBS incidence was significantly higher for women and adults with class III obesity regardless of diabetes status. The highest incidence of MBS occurred in the Northeast region. Sleeve gastrectomy was the most common MBS surgical approach. CONCLUSIONS: Incident MBS procedures were nearly threefold higher among adults with obesity and diabetes than those with obesity but without diabetes. Continued monitoring of the trends of MBS and other treatment modalities can inform our understanding of treatment accessibility to guide prevention efforts aimed at reducing obesity and diabetes.

This study examines trends in the prevalence of obesity-related measures in the US overall and by sex and age group, including weight-for-length, body mass index, and waist circumference. | eng

Candida species are the predominant cause of fungal infections in patients treated in hospital, contributing substantially to morbidity and mortality. Candidaemia and other forms of invasive candidiasis primarily affect patients who are immunocompromised or critically ill. In contrast, mucocutaneous forms of candidiasis, such as oral thrush and vulvovaginal candidiasis, can occur in otherwise healthy individuals. Although mucocutaneous candidiasis is generally not life-threatening, it can cause considerable discomfort, recurrent infections, and complications, particularly in patients with underlying conditions such as diabetes or in those taking immunosuppressive therapies. The rise of difficult-to-treat Candida infections is driven by new host factors and antifungal resistance. Pathogens, such as Candida auris (Candidozyma auris) and fluconazole-resistant Candida parapsilosis, pose serious global health risks. Recent taxonomic revisions have reclassified several Candida spp, potentially causing confusion in clinical practice. Current management guidelines are limited in scope, with poor coverage of emerging pathogens and new treatment options. In this Review, we provide updated recommendations for managing Candida infections, with detailed evidence summaries available in the appendix.

To understand how coronavirus disease 2019 vaccines impact infection risk in children <5 years, we assessed risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from September 2022 to April 2023 in 3 cohort studies. There was no difference in risk by vaccination status. While vaccines reduce severe disease, they may not reduce SARS-CoV-2 infections in naïve young children.

BACKGROUND: Daily oral pre-exposure prophylaxis (PrEP) use among gay, bisexual, and other men who have sex with men (GBMSM) remains suboptimal. Assessing behavioral readiness for PrEP use among GBMSM who can benefit and offering PrEP may increase uptake among GBMSM. We measured 4-item readiness for taking PrEP among GBMSM who have not been offered PrEP by a provider. METHODS: GBMSM in Atlanta, Chicago, and Raleigh-Durham reporting recent condomless anal sex were assessed for "readiness" to discuss PrEP with a provider, test for HIV, take a daily pill, attend provider appointments, and a 4-component composite score for PrEP readiness. Chi-square tests and multivariable logistic regression were applied to examine factors associated with readiness to use PrEP. RESULTS: Study sample (n=187) was 51% Black, 15% Hispanic, 30% identified as bisexual or straight or other, and 29% had no health insurance. 55% said they were ready to discuss PrEP with a provider, 88% were ready to get an HIV test, 45% were ready to take a daily pill, 48% were ready to attend appointments, and 37% reported overall PrEP readiness. Having no health insurance was associated with readiness for a daily pill (AOR=2.78, CI=1.34-5.78) and 4-item PrEP readiness (AOR=2.34, CI=1.13-4.85). Self-identification as gay (vs bisexual/straight) was associated with readiness to discuss PrEP (AOR=2.14, CI=1.05-4.36). CONCLUSION: Only 37% of GBMSM with recent condomless anal sex were ready for PrEP based on the 4-item readiness. Readiness may differ based on sexual identity, insurance status, and other characteristics. Efforts are needed to increase readiness across behavioral components of PrEP use.

BACKGROUND: Respiratory syncytial virus (RSV) is the leading cause of hospitalization among infants in the United States (US). RSV immunization, in the form of a monoclonal antibody (mAb) for infants and vaccines for pregnant people, may reduce infant RSV risk. METHODS: In April and May 2023, we surveyed adults with children in Oregon and Washington about the likelihood to accept infant mAb and maternal RSV vaccine and RSV awareness. We used multivariable logistic regression to identify predictors of self-reported likelihood of accepting RSV immunization. RESULTS: Among 1082 respondents, 68% and 70% responded they would very likely accept infant mAb or maternal RSV vaccine, respectively. Respondents had lower odds of accepting infant mAb (OR: 0.10, 95% CI: 0.07-0.15) and maternal RSV vaccine (OR: 0.16, 95% CI: 0.12-0.23) if they were somewhat or very concerned about side effects. Respondents had higher odds of accepting infant mAb if they received an influenza vaccination (OR: 3.79, 95% CI: 1.88-7.63). Respondents had higher odds of accepting maternal vaccine if they had an advanced degree (OR: 1.70, 95% CI: 1.06-2.73), had received an influenza vaccination (OR: 3.62, 95% CI: 1.80-7.25), or were aware of RSV before our survey (OR: 2.03, 95% CI: 1.03-4.01). CONCLUSION: Most respondents reported that they would likely accept RSV mAb for their infant or an RSV vaccine during pregnancy. Concerns about side effects lowered the odds of accepting immunization, however, nearly one-half of those concerned about side effects still expressed a high likelihood of accepting either immunization.

OBJECTIVE: Resilience of the healthcare system has been described as the ability to absorb, adapt, and respond to stress while maintaining the provision of safe patient care. We quantified the impact that stressors associated with the COVID-19 pandemic had on patient safety, as measured by central line-associated bloodstream infections (CLABSIs) reported to the Centers for Disease Control and Prevention's National Healthcare Safety Network. DESIGN: Acute care hospitals were mandated to report markers of resource availability (staffing and hospital occupancy with COVID-19 inpatients) to the federal government between July 2020 and June 2021. These data were used with community levels of COVID-19 to develop a statistical model to assess factors influencing rates of CLABSIs among inpatients during the pandemic. RESULTS: After risk adjustment for hospital characteristics, measured stressors were associated with increased CLABSIs. Staff shortages for more than 10% of days per month were associated with a statistically significant increase of 2 CLABSIs per 10,000 central line days versus hospitals reporting staff shortages of less than 10% of days per month. CLABSIs increased with a higher inpatient COVID-19 occupancy rate; when COVID-19 occupancy was 20% or more, there were 5 more CLABSIs per 10,000 central line days versus the referent (less than 5%). CONCLUSIONS: Reporting of data pertaining to hospital operations during the COVID-19 pandemic afforded an opportunity to evaluate resilience of US hospitals. We demonstrate how the stressors of staffing shortages and high numbers of patients with COVID-19 negatively impacted patient safety, demonstrating poor resilience. Understanding stress in hospitals may allow for the development of policies that support resilience and drive safe care.

Local alcohol-based hand rub (ABHR) production systems in low-resource settings, such as in health care facilities (HCFs) in low- and middle-income countries, frequently reuse containers for storing and dispensing ABHR. Cleaning/disinfection (C/D) of ABHR containers is necessary to safely reuse them and is an integral part of the WHO's guidelines on local ABHR production. However, HCFs may not be aware of the need for C/D; combined with suboptimal implementation, this poses a risk of contamination of ABHR. As part of district-led ABHR production in HCFs in five rural districts in Uganda, we developed a standard operating procedure (SOP) for C/D of reused ABHR containers and provided on-site training for infection prevention and control personnel. Using in-person surveys, we assessed the availability of C/D supplies and equipment and the self-reported C/D practices before and after the training. At baseline, almost all (n = 90/91) HCFs reported reusing ABHR containers; 8% and 12% of HCFs routinely had all of the key C/D materials needed for adequately cleaning and disinfecting containers using chlorine and thermal disinfection methods, respectively. HCFs that reported adequately cleaning containers per the SOP increased from 3% (n = 2) at baseline to 18% (n = 16) after the training, whereas adequate disinfection increased from 0% (n = 0) to 5% (n = 5). All HCFs that performed disinfection reported using chlorine, and none reported using thermal disinfection. Improving access to C/D supplies, providing routine mentorship, and monitoring ABHR container C/D are needed to further improve C/D practices.

BACKGROUND: The One Health approach aims to balance and optimize the health of humans, animals, and ecosystems, recognizing that shared health outcomes are interdependent. A One Health approach to disease surveillance, control, and prevention requires infrastructure for coordinating, collecting, integrating, and analyzing data across sectors, incorporating human, animal, and environmental surveillance data, as well as pathogen genomic data. However, unlike data interoperability problems faced within a single organization or sector, data coordination and integration across One Health sectors requires engagement among partners to develop shared goals and capacity at the response level. Successful examples are rare; as such, we sought to develop a framework for local One Health practitioners to utilize in support of such efforts. METHODS: We conducted a systematic scientific and gray literature review to inform development of a One Health data integration framework. We discussed a draft framework with 17 One Health and informatics experts during semi-structured interviews. Approaches to genomic data integration were identified. RESULTS: In total, 57 records were included in the final study, representing 13 pre-defined frameworks for health systems, One Health, or data integration. These frameworks, included articles, and expert feedback were incorporated into a novel framework for One Health data integration. Two scenarios for genomic data integration were identified in the literature and outlined. CONCLUSIONS: Frameworks currently exist for One Health data integration and separately for general informatics processes; however, their integration and application to real-time disease surveillance raises unique considerations. The framework developed herein considers common challenges of limited resource settings, including lack of informatics support during planning, and the need to move beyond scoping and planning to system development, production, and joint analyses. Several important considerations separate this One Health framework from more generalized informatics frameworks; these include complex partner identification, requirements for engagement and co-development of system scope, complex data governance, and a requirement for joint data analysis, reporting, and interpretation across sectors for success. This framework will support operationalization of data integration at the response level, providing early warning for impending One Health events, promoting identification of novel hypotheses and insights, and allowing for integrated One Health solutions.

BACKGROUND: Tuberculosis (TB) disease during pregnancy results in adverse maternal and infant outcomes. The development of a TB vaccine with potential for administration during pregnancy or lactation is a priority identified by the World Health Organization. We assessed the acceptability of vaccines currently administered during pregnancy [tetanus, diphtheria and COVID-19] and willingness to receive a new TB vaccine during pregnancy and/or lactation among Ethiopian women. METHODS: From January to February 2022, we conducted surveys among pregnant women receiving antenatal care at 20 hospitals in Amhara, Ethiopia. We evaluated uptake of available vaccines (diphtheria), acceptance of new and future vaccines (COVID-19 and TB) during pregnancy and lactation, and knowledge, attitudes and beliefs associated with vaccine-specific acceptance. RESULTS: Among 200 participants, we found high intention to receive a TB vaccine during pregnancy (90%) and lactation (92%) and low COVID-19 vaccine acceptance during pregnancy (40%) and lactation (47%). Most participants believed TB vaccination would protect their child from disease (82.5%) and have societal benefits (81.5%), while few women perceived the COVID-19 vaccine to offer protection (35.5%) or have societal benefits (42.5%). Intention to receive TB vaccination during pregnancy was associated with the belief that a future maternal TB vaccine would prevent TB among infants (adjusted prevalence ratio 1.37, 95% CI: 1.10-1.70). Most participants reported high acceptability of educational interventions to increase uptake of maternal immunization. CONCLUSIONS: We found high intention to receive a new TB vaccine during pregnancy and lactation among Ethiopian women. Our findings support vaccine-specific educational interventions to strengthen maternal immunization programs in Ethiopia.

OBJECTIVES: This project aimed to understand the experiences and preferences for social risk factor screening among racially, ethnically, and linguistically diverse cancer survivors in the Washington, DC, region. METHODS: Semi-structured interviews were conducted with English, Spanish, and Amharic-speaking breast and prostate cancer survivors. Data were inductively coded to identify themes, and differences by race and preferred language were evaluated. FINDINGS: Twenty-two interviews in English (n = 14), Spanish (n = 7), and Amharic (n = 1) among participants who identified as Black (n = 8), White (n = 5), Asian (n = 1), Other (n = 6), and multiracial (n = 2) were completed. Participants reported unresolved needs during treatment including transportation, healthful food, mental health care, financial help, and employment assistance. COVID-19 exacerbated many needs. Most participants did not recall discussing needs with oncology teams, but all participants were open to having these conversations. CONCLUSION(S): This research reveals that cancer survivors might benefit from culturally appropriate strategies that address social needs.

INTRODUCTION: There is limited information about vaccine-preventable disease (VPD) surveillance cost. To address this gap, retrospective micro-costing studies of pre-COVID-19 pandemic VPD surveillance were conducted in Nepal and Ethiopia. Based on these evaluations-the sole cost evaluations on comprehensive VPD surveillance-this article provides methodological considerations and recommendations for other countries planning to conduct VPD surveillance costing studies to inform planning and budgeting. METHODS: The methods used for each study were systematically compared by key themes: costing perspective, cost categories, costing approach, allocation of shared costs, sampling criteria, extrapolation strategies, data collection, and analytic adjustments. For each theme, investigators identified methodologic challenges and potential strategies to address them, compared study methodologies to surveillance costing guidelines, and recommended practices for future such studies. RESULTS: The studies used similar perspectives and VPD inclusion criteria. Costs in Nepal were collected and analyzed by a subset of surveillance core and support functions, whereas the Ethiopia study categorized costs using surveillance support functions from the Global Strategy on Comprehensive VPD Surveillance. A mix of random and purposive sampling of surveillance sites was used in both studies. Surveillance sites were selected considering the strata of interest at each administrative level. Results from both studies were extrapolated country-wide using sampling weights and assumptions about the representativeness of purposively sampled units. DISCUSSION: The review highlighted potential methodologic tradeoffs in utility and precision of results based on the lessons learned from two country VPD surveillance cost studies. The advantages of collecting and using cost estimates by VPD surveillance core versus support function for program budgeting for varied audiences should be explored in future studies. Sampling strategies should be developed with consideration for the precision needed for the intended use of costing results. The resulting recommendations can improve and standardize the conduct and interpretation of future such studies.

BACKGROUND: Mozambique introduced 10-valent-pneumococcal conjugate vaccine (PCV10) in 2013. We aimed to evaluate the indirect effect of PCV10 on invasive pneumococcal disease (IPD) and clinical severe pneumonia (CSP) in infants aged less than 10 weeks. METHODS: Routine surveillance data for IPD and CSP among admitted infants less than 10 weeks of age were analyzed to compare IPD and CSP incidence using demographic surveillance data from pre- and post-PCV10 periods. IPD was defined as isolation of pneumococcus from blood or cerebrospinal fluid, and CSP according to World Health Organization criteria. RESULTS: The incidence of IPD and CSP among infants less than 10 weeks decreased by 87% [incidence rate ratio (IRR): 0.13; 95% confidence interval (CI): 0.02-0.95] from 283/100,000 in the pre-PCV to 36/100,000 children year at risk (CYAR) post-PCV, and by 62% (IRR: 0.38; 95% CI: 0.27-0.52) from 4100/100,000 pre-PCV to 1550/100,000 CYAR post-PCV periods, respectively. Vaccine-type IPD incidence declined by 92% (IRR: 0.18; 95% CI: 0.02-1.34) from 205/100,000 pre-PCV to 36/100,000 CYAR post-PCV, though the reduction was not statistically significant. The mortality rate due to IPD among infants less than 10 weeks declined from 47/100,000 CYAR in the pre-PCV to 0 in the post-PCV period. Mortality due to CSP declined by 29% (IRR: 0.71; 95% CI: 0.34-1.50), from 457/100,000 CYAR in the pre-PCV to 324/100,000 in the post-PCV periods. CONCLUSIONS: PCV10 introduction led to substantial declines in the incidence of IPD, CSP and associated mortality in infants too young to be vaccinated (less than 10 weeks) in Mozambique, suggesting indirect protection.

Background: Annual estimates of seasonal influenza vaccine effectiveness can guide global risk communication and vaccination strategies to mitigate influenza-associated illness. We aimed to evaluate vaccine effectiveness in countries using the 2023 southern hemisphere influenza vaccine formulation.

BACKGROUND: Pneumococcal conjugate vaccines (PCVs) introduced in childhood national immunization programs lowered vaccine-type invasive pneumococcal disease (IPD), but replacement with non-vaccine-types persisted throughout the PCV10/13 follow-up period. We assessed PCV10/13 impact on pneumococcal meningitis incidence globally. METHODS: The number of cases with serotyped pneumococci detected in cerebrospinal fluid and population denominators were obtained from surveillance sites globally. Site-specific meningitis incidence rate ratios (IRRs) comparing pre-PCV incidence to each year post-PCV10/13 were estimated by age (<5, 5-17 and ≥18 years) using Bayesian multi-level mixed effects Poisson regression, accounting for pre-PCV trends. All-site weighted average IRRs were estimated using linear mixed-effects regression stratified by age, product (PCV10 or PCV13) and prior PCV7 impact (none, moderate, or substantial). Changes in pneumococcal meningitis incidence were estimated overall and for product-specific vaccine-types and non-PCV13-types. RESULTS: Analyses included 10,168 cases <5 y from PCV13 sites and 2849 from PCV10 sites, 3711 and 1549 for 5-17 y and 29,187 and 5653 for ≥18 y from 42 surveillance sites (30 PCV13, 12 PCV10, 2 PCV10/13) in 30 countries, primarily high-income (84%). Six years after PCV10/PCV13 introduction, pneumococcal meningitis declined 48-74% across products and PCV7 impact strata for children <5 y, 35-62% for 5-17 y and 0-36% for ≥18 y. Impact against PCV10-types at PCV10 sites, and PCV13-types at PCV13 sites was high for all age groups (<5 y: 96-100%; 5-17 y: 77-85%; ≥18 y: 73-85%). After switching from PCV7 to PCV10/13, increases in non-PCV13-types were generally low to none for all age groups. CONCLUSION: Pneumococcal meningitis declined in all age groups following PCV10/PCV13 introduction. Plateaus in non-PCV13-type meningitis suggest less replacement than for all IPD. Data from meningitis belt and high-burden settings were limited.

Smart Paper Technology, an innovative paper-to-digital system implemented at Bundung Maternal and Child Health Hospital in The Gambia links maternal and newborn health information with immunization records. In 9 months, Smart Paper Technology facilitated over 3500 mother-child connections, replacing traditional paper-based registers and ensuring DHIS2 interoperability. This pilot enhances reporting and data availability, advancing maternal vaccine safety surveillance in resource-limited settings.

Objectives. To estimate the association of state policies that define prenatal substance use as child abuse and mandate that health care professionals report prenatal substance use to child protective services with congenital syphilis case rates. Methods. We used 2018 to 2022 US data on congenital syphilis case notifications to the National Notifiable Diseases Surveillance System. We conducted linear regression with a generalized estimating equation approach to compare congenital syphilis case rates in states with a child abuse policy only, a mandated reporting policy only, and both polices to rates in states with neither policy. Results. After adjustment for confounders, the rate of congenital syphilis cases was, on average, 23.5 (95% confidence interval = 2.2, 44.8) cases per 100 000 live births higher in states with both a child abuse policy and a mandated reporting policy for prenatal substance use than in states with neither policy. Rates were similar in states with a child abuse policy only and a mandated reporting policy only compared to states with neither policy. Conclusions. The combination of state child abuse policies and mandated reporting policies for prenatal substance use potentially contributes to higher congenital syphilis case rates. (Am J Public Health. Published online ahead of print February 13, 2025:e1-e9. https://doi.org/10.2105/AJPH.2024.307951).

PURPOSE: Surveillance of traumatic brain injury (TBI) in the United States has historically relied on healthcare administrative datasets, but these sources likely underestimate the true burden of TBI. Surveys that ask individuals to self- or proxy-report their experiences with their injuries are an alternative source for surveillance. This paper provides results from a large national survey that ascertained TBI among sampled adults and children. METHODS: Data from the 2023 National Health Interview Survey, a nationally representative household survey of the civilian non-institutionalized US population, were examined. Descriptive and bivariate statistics of demographic and injury characteristics of children and adults who sustained a TBI in the past 12 months were calculated. RESULTS: Analyses reveal that 3.0% (n=9,757,000) of Americans (3.3% of adults and 2.2% of children (aged ≤17 years)) reported a TBI in the past year. Among children who sustained a TBI in the past year, over half (55.5%) sustained their TBI during a sport or recreational activity, and 62.4% were evaluated by a medical professional. The prevalence of TBI and injury characteristics varied by select demographics. CONCLUSION: These findings demonstrate that TBI affects a large number of Americans and highlight the value of TBI surveillance through nationally representative surveys, providing a broad picture of prevalence, healthcare utilization, and setting of injury.

Purpose: To investigate the prevalence, patterns, and predictors of SARS-CoV-2 RNA and culturable virus in tears of a case-ascertained household cohort. Design: Prospective, longitudinal case-ascertained household cohort identified through convenience sampling. MethodsThis analysis was restricted to individuals who were non-hospitalized, symptomatic, and tested positive for SARS-CoV-2 by nasal RT-PCR. Tears and anterior nasal biospecimens were serially collected throughout the acute period. Tears specimens were collected by the study staff using Schirmer test strips, and nasal specimens were self-collected. For both, SARS-CoV-2 RNA was quantified using qRT-PCR, and culturable virus was detected using presence of cytopathic effect (CPE) in tissue culture; positive CPE was confirmed by a qRT-PCR step. A series of cross-sectional unadjusted analyses were performed investigating the relationship between different sociodemographic determinants and biological factors associated with tears RNA positivity.

OBJECTIVES: To evaluate how postmortem anthropometric malnutrition (PAM) measures align with expert panel attribution of malnutrition as a causal or significant condition in under-5 mortality (U5M). DESIGN: Cohort study using data from the Child Health and Mortality Prevention Surveillance network, incorporating clinical records, postmortem anthropometrics, minimally invasive tissue sampling, clinical abstraction and verbal autopsy to determine multiple causes of death. SETTING/PARTICIPANTS: 1405 deaths of children aged 1-59 months from six African countries between 2016 and 2023. PRIMARY AND SECONDARY OUTCOME MEASURES: PAM was determined using z-scores from the WHO Child Growth Standards: underweight (weight-for-age<(-2)), wasting (arm circumference-for-age or weight-for-length<(-2)) and stunting (length-for-age <(-2)). Performance metrics (sensitivity (SE), specificity (SP) and positive predictive values (PPV)) were calculated to determine the alignment between PAM and expert panel attribution of malnutrition as a causal or significant condition to death. RESULTS: Nearly 75% of cases demonstrated moderate-to-severe malnutrition by PAM, while expert panels attributed malnutrition in 41% of cases. Performance metrics varied across anthropometric indices: underweight exhibited the highest SE (89.7%), while wasting based on arm circumference had the highest SP (81.9%) and PPV (76.8%). Discrepancies between PAM classification and expert panel attribution differed significantly by site, age, location of death and preventability of death (p<0.05). Adjusted multivariate regression showed that expert panel attribution was more likely with increasing severity of PAM. CONCLUSIONS: The proportion of U5M attributable to malnutrition ranged between 41% (expert panel attribution) and 74% (PAM). Variability in classification underscores the need for monitoring and quality improvement measures to address discrepancies. Improved alignment between PAM and panel assessments is essential for accurately identifying malnutrition-related deaths and designing effective interventions to reduce U5M.

BACKGROUND: Although many factors are associated with gastroschisis risk, studies have not systematically explored whether they account for its increasing frequency over the past decades or its inverse association with maternal age. We examined whether previously reported risk factors for gastroschisis from the National Birth Defects Prevention Study (NBDPS) explain the association with increasing temporal prevalence or young maternal age. METHODS: Using data from the NBDPS (1997-2011), crude odds ratios (ORs) were calculated for birth years 2005-2011 versus 1997-2004 and maternal age < 25 versus 25+ years. We then adjusted for 16 factors separately with logistic regression (paternal age, interpregnancy interval, parity, alcohol, cigarettes, illicit drugs, oral contraceptives, cold/flu with fever, genitourinary infection, polycyclic aromatic hydrocarbons, diet quality, prepregnancy body mass index, parental race and ethnicity, language spoken at home, years lived in the United States, and household income). RESULTS: The birth year OR (1.28; 95% CI: 1.14, 1.44) was attenuated by 16% after adjustment for polycyclic aromatic hydrocarbon exposure (OR 1.08; 95 CI: 0.92, 1.26). The young maternal age OR (7.76; 95% CI: 6.71, 8.97) was attenuated by 30% after adjustment for paternal age (OR 5.43; 95% CI: 4.55, 6.48) and separately for interpregnancy interval (OR 5.45; 95% CI: 4.43, 6.69). CONCLUSION: Some evidence suggests that risk factors for gastroschisis account for small amounts of the time trend and maternal age associations. However, it remains unclear what factors underlie the complete calendar time or maternal age associations.

Anemia is an important cause of child morbidity and mortality. Postmortem point-of-care hemoglobin testing is a potential method for assessing anemia at death, but its reliability has not been extensively studied. We aimed to assess the feasibility and validity of postmortem point-of-care hemoglobin assessment using HemoCue in the setting of a child mortality surveillance program in South Africa.In a pilot cohort study, 44 children under five years of age who died in an academic hospital in South Africa were enrolled. Hemoglobin levels were measured from venous blood antemortem using standard hematology analyzers and postmortem using the HemoCue 201 from blood collected within 72 hours of death (either by needle aspiration or from whole blood collected in an EDTA tube). Updated World Health Organization hemoglobin cutoffs to define anemia were used. Wilcoxon signed-rank tests, equivalence tests, and regression models assessed the concordance between antemortem and postmortem hemoglobin concentrations. Postmortem testing showed a significant decrease in hemoglobin concentrations compared to antemortem levels. However, no significant differences were found between hemoglobin measurements from needle aspiration and those from EDTA tubes postmortem. The prevalence of anemia increased from 52% antemortem to 73-77% postmortem, with the most notable rises in moderate and severe anemia. Bland-Altman analysis confirmed a systematic, not random, decrease in postmortem hemoglobin measurements. Upon applying a fixed adjustment of 2.5 g/dL, the sensitivity and specificity of postmortem hemoglobin testing to diagnose anemia were 69.6% and 61.9%, respectively. Postmortem point-of-care hemoglobin testing using HemoCue is feasible and offers a potentially valid reflection of antemortem anemia status in deceased children, despite consistently lower measured values postmortem. These findings support the utility of postmortem hemoglobin assessments in determining the presence and severity of anemia at the time of death.

Wildland-urban interface (WUI) firefighting involves exposure to burning vegetation, structures, and other human-made hazards, often without respiratory protection. Response activities can last for long periods of time, spanning multiple days or weeks. Epigenetic modifications, including microRNA (miRNA) expression and DNA methylation, are responsive to toxicant exposures and are part of the development of cancers and other diseases. Epigenetic modifications have not been studied in relation to WUI fires. Firefighters (n = 99) from southern California, including 79 firefighters who responded to at least one WUI fire, provided blood samples at baseline and approximately 10 months later. We quantified the relative abundance of 800 miRNAs in blood samples using the nCounter Human v3 miRNA expression panel and blood leukocyte DNA methylation throughout the genome via the Infinium EPIC array. We used linear mixed models to compare the expression of each miRNA across time and DNA methylation at each locus, adjusting for potential confounders. In the miRNA analysis among all firefighters, 65 miRNAs were significantly different at follow-up compared to baseline at a false discovery rate of 5%. Results were similar when restricted to firefighters with a recorded WUI fire exposure during the interim period, although only 50 were significant. Expression of miRNA hsa-miR-518c-3p, a tumor suppressor, was significantly associated with WUI fire response (fold change 0.77, 95% CI = [0.69, 0.87]). In the DNA methylation analysis, no statistically significant changes over time were identified. In summary, WUI fire exposures over a wildfire season altered miRNA expression but did not substantially impact DNA methylation.

Our understanding of how exposure to school microbiota affects the respiratory health of staff and students in schools is limited. We examined the associations between exposure to school microbiota and respiratory and gastrointestinal infections. We performed an epidemiologic analysis of 1,529 school employees in the U.S. A questionnaire was administered to school staff to collect health information, and floor dust was vacuumed from 500 classrooms in 50 schools. Fungal internal transcribed spacer region and bacterial 16S amplicon sequencing were performed with extracted genomic DNA using Illumina Mi-Seq platform. The resulting DNA sequences were clustered into operational taxonomic units (OTUs). Staff were assigned the school-building-specific floor average number of bacterial or fungal OTUs from the same floor as their exposure. We used logistic regression models to estimate adjusted odds ratios of reported respiratory and gastrointestinal infections in the last 12 months. Exposure to the highest quartile in number of OTUs (Q4, highest richness) of the bacterial phyla Firmicutes or Actinobacteria was associated with 28–61 % lower odds of upper or lower respiratory infections compared to the lower three quartiles (Q123). Higher Firmicutes diversity was more strongly associated with upper respiratory infections, while greater Actinobacteria diversity showed a stronger association with lower respiratory infections. Fungal diversity was not associated with any type of infection, and neither bacterial nor fungal diversity was associated with gastrointestinal infections. Our study suggests that exposure to a highly diverse bacterial microbiota in school environments may play an important role in protecting school staff against respiratory infections. © 2025

This study demonstrated that workers' compensation claims data can provide insights into federal employees' workplace injuries and illnesses. Employing agencies, safety staff, and occupational clinicians can use these data to direct efforts to improve conditions to prevent injuries/illnesses, optimize programs for injured worker treatment, rehabilitation, accommodation, and stay-at-work or return-to-work programs. Objective: The purpose of this study was to understand federal workplace injury/illness trends. Methods: Over 1.5 million federal and Postal Service employee workers' compensation (WC) claims from 2007 to 2022 were linked to employment data and analyzed. Results: From 2007 to 2019, falls, slips, trips represented the highest proportion of claims (30.7%), followed by overexertion and bodily reaction (24.4%), unclassified (16.4%), contact with objects and equipment (13.1%), violence and other injuries by persons or animals (8.8%), transportation incidents (4.0%), exposure to harmful substances or environments (2.5%), and fires and explosions (0.24%). From 2020 to 2022, COVID-19 drove a major shift to exposure to harmful substances or environments representing the highest proportion of claims (44.3%). Conclusions: Claims data represent a potentially rich data source that employing agencies can use to focus prevention and treatment of injury/illness.

BACKGROUND: While evidence suggests Medicaid expansion can reduce overdose, some expressed concern expansion fueled the US opioid overdose crisis by increasing access to low-cost prescription opioids diverted for non-prescribed use. Ecologic studies find a protective relationship or no relationship between expansion and area-level opioid prescribing. Little is known about the relationship between expansion and opioid use among people experiencing poverty who inject drugs (PWID), a population at heightened risk of overdose likely to benefit from Medicaid expansion. We examined whether expansion was associated with prescription opioid and benzodiazepine misuse among PWID experiencing poverty and whether associations varied by race/ethnicity and HIV status. METHODS: This serial cross-sectional observational study used generalized difference-in-differences models to analyze data (2012, 2015, 2018) from 19,728 PWID aged 18-64 with income ≤138 % of federal poverty line from 13 states in the CDC's National HIV Behavioral Surveillance. Outcomes included past 12-month non-injection and injection prescription opioid misuse and benzodiazepine misuse. RESULTS: The sample (N = 19,728) was 40 % non-Latinx Black persons and 22 % Latinx persons. Past 12-month non-injection prescription opioid misuse was 33 %, injection prescription opioid misuse was 16 %, and benzodiazepine use was 40 %. Across all models, there was no association between expansion and prescription opioid misuse (confidence intervals included 0) or prescription benzodiazepine misuse (confidence intervals included 0). Associations did not vary by race/ethnicity or HIV status. CONCLUSIONS: We found no association between Medicaid expansion and opioid or benzodiazepine misuse overall, by race/ethnicity, or HIV status among a large, geographically diverse sample of PWID. These findings provide empirical evidence that expansion is not associated with prescription opioid or benzodiazepine misuse in a population likely to benefit from expansion.

Introduction: There is substantial evidence that mass media campaigns increase calls to quitlines as well as smoking cessation. In 2012, the Centers for Disease Control and Prevention launched the first federally funded national tobacco education campaign, Tips From Former Smokers (ie, Tips). From 2012 through 2023, Tips aired advertisements on television. To date, no studies have examined the long-term effect of a national smoking cessation campaign on quitline calls. This study examined the long-term impact of Tips television ads on calls to 1-800-QUIT-NOW from 2012 through 2023. Method(s): Exposure to the Tips campaign was measured using weekly gross rating points (GRPs) for television ads in each U.S. designated market area. We obtained data on calls to 1-800-QUIT-NOW from the National Cancer Institute and used linear regression to model calls to 1-800-QUIT-NOW, from 2012 through 2023, as a function of weekly media market-level GRPs for Tips television ads. Using the regression model results, we calculated predicted values of calls to 1-800-QUIT-NOW across observed GRP values to determine the total calls to 1-800-QUIT-NOW that were attributable to the Tips campaign during 2012-2023. Results.Tips GRPs were positively and significantly associated with calls to 1-800-QUIT-NOW across all years (b = 39.94, p < .001). Based on this association, we estimate the Tips campaign generated nearly 2.1 million additional calls to 1-800-QUIT-NOW during 2012-2023. Conclusion(s): Exposure to the Tips campaign has consistently and significantly increased calls to tobacco quitlines. Implications: Quitlines provide evidence-based support to help people quit smoking. They have been shown to increase the likelihood of successfully quitting. Mass media campaigns have promoted quitlines, and quitline calls have increased significantly with media promotion. The long-term effect of campaigns-like the Centers for Disease Control and Prevention's Tips From Former Smokers (ie, Tips)-on quitline calls has not been determined. From 2012 through 2023, exposure to the Tips campaign is estimated to have generated nearly 2.1 million additional calls to 1-800-QUIT-NOW. This study supports the continued use of mass media to promote quitlines. Copyright © The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.

OBJECTIVE: This pilot study explores the feasibility and acceptability of using telephonic verbal autopsies (teleVAs) in South Africa to collect information on causes of death. DESIGN: Quantitative and qualitative data collection methods were used to evaluate the feasibility and acceptability of these telephonic interviews. SETTING: The teleVA pilot was conducted in South Africa's Western Cape province. The qualitative component also included two rural South African Population Research Infrastructure Network nodes (Africa Health Research Institute in KwaZulu-Natal and Agincourt in Mpumalanga), which had transitioned to teleVAs during COVID-19, allowing exploration of teleVA's feasibility in both urban and rural settings. PARTICIPANTS: We recruited 229 respondents to participate in a pilot teleVA. After each VA, VA interviewers filled in a survey to assess their perceptions and discern if they experienced any technical challenges. We also conducted 18 in-depth interviews with both interviewers (n=6) and respondents (n=12) to explore their views on the acceptability of the teleVA. We conducted a thematic analysis of these interviews. INTERVENTIONS: VA was piloted over the phone, instead of face-to-face. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes focused on the feasibility and acceptability of phone VAs among both interviewers and respondents. Secondary outcomes evaluated the quality of teleVAs. RESULTS: Participants expressed willingness to participate in teleVAs, considering them valuable for public health planning and decision-making. The feasibility of collecting next-of-kin information proved challenging, with incomplete or incorrect contact details posing future logistic issues. Only one question out of 76, showed a statistically significant difference in the proportions of non-informative teleVA compared with face-to-face VA. CONCLUSIONS: The study offers valuable insights into using teleVAs to gather cause of death information in resource-limited settings. It highlights the feasibility and acceptability of teleVAs while emphasising the need for comprehensive planning, integration with the civil registration and vital statistics system and community participation enhancement.

A Rocky Mountain spotted fever (RMSF) epidemic has spread through the state of Baja California, Mexico over the last decade and a half, beginning in Mexicali, and subsequently to Tijuana and to Ensenada by 2018. In October of 2022, we surveyed dogs and homes in randomly selected Áreas Geoestadisticas Básicas (AGEBs) with and without reported human cases. Brown dog ticks (Rhipicephalus sanguineus sensu lato) were found on 33.9% of dogs and in the yards of 23.6% of homes. Homes from AGEBs with cases had over a 6-fold increased odds of ticks being present in the yard than AGEBs without reported cases. Both dogs that were permitted to roam and the presence of roaming dogs in the neighborhood were strongly associated with tick infestation of dogs and homes. No ticks or blood samples were polymerase chain reaction-positive for Rickettsia (R.) rickettsii, the causative agent of RMSF, although 54.6% of dogs were seropositive for spotted fever group rickettsiae, and 17.4% were seropositive for typhus group rickettsiae. R. massiliae and R. felis were detected in eight (1.3%) and 29 (4.8%) ticks, respectively; and R. felis was also detected in eight (4.6%) dog blood samples. Although the pathogenic potential of these other rickettsial species and their role in RMSF transmission remains unclear, our data on tick burdens in dogs and homes as risk factors for RMSF exposure provide further support to the pivotal need to reduce tick burdens and the numbers of roaming dogs to successfully manage the RMSF epidemic in northern Mexico.