The Marie Skłodowska-Curie Symposia on Cancer Research and Care (MSCS-CRC) promote collaborations between cancer researchers and care providers in the United States, Canada and Central and Eastern European Countries (CEEC) to accelerate the development of new cancer therapies, new strategies for early detection and prevention, and improve cancer care and the quality of life for patients and their families. The 4th MSCS-CRC (September 25-27, 2024, Buffalo, New York) brought together 147 participants from the US, Canada, Croatia, Czechia, Lithuania, Poland, Romania and Ukraine, and involved representatives of the US Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI) and their counterparts from Poland, Ukraine Lithuania and other CEECs. They were accompanied by New York State (NYS) and local representatives of the NYS Empire State Development, and of the Translational Research Consortium of Cancer Centers (TRCCC), involving 13 cancer centers from the Northeastern US and Canada, as well as several Pharma and Biotech companies. The 4th Meeting focused on prevention and early detection of smoking- and HPV-related cancers, reducing disparities in cancer detection-, care and outcomes, and increasing the feasibility and reducing costs of high-end treatments, such as cell therapies for patients with advanced cancers. The second focus area were the available sources of funding of regional and international collaborations in these areas. The relevance of the successful model TRCC to promoting the oncology training and research collaborations in the CEE Countries was discussed. The 5th MSCR-CRC meeting will take place September 3-5, 2025, in Warsaw, Poland.

PROBLEM/CONDITION: Autism spectrum disorder (ASD). PERIOD COVERED: 2022. DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates prevalence and characteristics of ASD and monitors timing of ASD identification among children aged 4 and 8 years. In 2022, a total of 16 sites (located in Arizona, Arkansas, California, Georgia, Indiana, Maryland, Minnesota, Missouri, New Jersey, Pennsylvania, Puerto Rico, Tennessee, Texas [two sites: Austin and Laredo], Utah, and Wisconsin) conducted surveillance for ASD among children aged 4 and 8 years and suspected ASD among children aged 4 years. Surveillance included children who lived in the surveillance area at any time during 2022. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement in a comprehensive developmental evaluation, 2) autism special education eligibility, or 3) an ASD International Classification of Diseases, Ninth Revision (ICD-9) code in the 299 range or International Classification of Diseases, Tenth Revision (ICD-10) code of F84.0, F84.3, F84.5, F84.8, or F84.9. Children aged 4 years were classified as having suspected ASD if they did not meet the case definition for ASD but had an evaluator's suspicion of ASD documented in a comprehensive developmental evaluation. RESULTS: Among children aged 8 years in 2022, ASD prevalence was 32.2 per 1,000 children (one in 31) across the 16 sites, ranging from 9.7 in Texas (Laredo) to 53.1 in California. The overall observed prevalence estimate was similar to estimates calculated using Bayesian hierarchical and random effects models. ASD was 3.4 times as prevalent among boys (49.2) than girls (14.3). Overall, ASD prevalence was lower among non-Hispanic White (White) children (27.7) than among Asian or Pacific Islander (A/PI) (38.2), American Indian or Alaska Native (AI/AN) (37.5), non-Hispanic Black or African American (Black) (36.6), Hispanic or Latino (Hispanic) (33.0), and multiracial children (31.9). No association was observed between ASD prevalence and neighborhood median household income (MHI) at 11 sites; higher ASD prevalence was associated with lower neighborhood MHI at five sites.Record abstraction was completed for 15 of the 16 sites for 8,613 children aged 8 years who met the ASD case definition. Of these 8,613 children, 68.4% had a documented diagnostic statement of ASD, 67.3% had a documented autism special education eligibility, and 68.9% had a documented ASD ICD-9 or ICD-10 code. All three elements of the ASD case definition were present for 34.6% of children aged 8 years with ASD.Among 5,292 (61.4% of 8,613) children aged 8 years with ASD with information on cognitive ability, 39.6% were classified as having an intellectual disability. Intellectual disability was present among 52.8% of Black, 50.0% of AI/AN, 43.9% of A/PI, 38.8% of Hispanic, 32.7% of White, and 31.2% of multiracial children with ASD. The median age of earliest known ASD diagnosis was 47 months and ranged from 36 months in California to 69.5 months in Texas (Laredo).Cumulative incidence of ASD diagnosis or eligibility by age 48 months was higher among children born in 2018 (aged 4 years in 2022) than children born in 2014 (aged 8 years in 2022) at 13 of the 15 sites that were able to abstract records. Overall cumulative incidence of ASD diagnosis or eligibility by age 48 months was 1.7 times as high among those born in 2018 compared with those born in 2014 and ranged from 1.4 times as high in Arizona and Georgia to 3.1 times as high in Puerto Rico. Among children aged 4 years, for every 10 children meeting the case definition of ASD, one child met the definition of suspected ASD.Children with ASD who were born in 2018 had more evaluations and identification during ages 0-4 years than children with ASD who were born in 2014 during the 0-4 years age window, with an interruption in the pattern in early 2020 coinciding with onset of the COVID-19 pandemic.Overall, 66.5% of children aged 8 years with ASD had a documented autism test. Use of autism tests varied widely across sites: 24.7% (New Jersey) to 93.5% (Puerto Rico) of children aged 8 years with ASD had a documented autism test in their records. The most common tests documented for children aged 8 years were the Autism Diagnostic Observation Schedule, Autism Spectrum Rating Scales, Childhood Autism Rating Scale, Gilliam Autism Rating Scale, and Social Responsiveness Scale. INTERPRETATION: Prevalence of ASD among children aged 8 years was higher in 2022 than previous years. ASD prevalence was higher among A/PI, Black, and Hispanic children aged 8 years than White children aged 8 years, continuing a pattern first observed in 2020. A/PI, Black, and Hispanic children aged 8 years with ASD were also more likely than White or multiracial children with ASD to have a co-occurring intellectual disability. Identification by age 48 months was higher among children born in 2018 compared with children born in 2014, suggesting increased early identification consistent with historical patterns. PUBLIC HEALTH ACTION: Increased identification of autism, particularly among very young children and previously underidentified groups, underscores the increased demand and ongoing need for enhanced planning to provide equitable diagnostic, treatment, and support services for all children with ASD. The substantial variability in ASD identification across sites suggests opportunities to identify and implement successful strategies and practices in communities to ensure all children with ASD reach their potential.

Despite the success in scaling-up antiretroviral therapy (ART) services in Ethiopia, suboptimal adherence to ART has been an existing challenge. There is a dearth of evidence on the status of adherence to ART following the adoption of test and treat strategy in Ethiopia. This study aimed to investigate on the magnitude of suboptimal adherence and its predictors among patients taking ART. A multicenter prospective cohort study was conducted among adults aged 15 years and above who started ART between March and June 2019 in 39 health facilities (HFs) in Ethiopia. Measurements on sociodemographic, behavioral, and clinical characteristics were taken at baseline and 6- and 12-months following ART initiation. Multivariable logistic regression model using generalized estimating equations was used to identify factors associated with suboptimal adherence. In total, 1229 individuals who started ART were included in the study. The proportion of suboptimal adherence was 8.0% and 7.9% at 6- and 12-months, respectively. Younger age (adjusted odds ratio (AOR) = 2.28 (95% confidence interval (CI) 1.10, 4.74)), being single (AOR = 2.08 (95% CI 1.25, 3.48)), and being a farmer (AOR = 3.21 (95% CI 1.84, 5.61)) were associated with increased risk for suboptimal adherence. Similarly, alcohol intake (AOR = 3.31 (95% CI 2.14, 5.11)), missing clinic appointment (AOR = 5.73 (95% CI 3.76, 8.75)), having opportunistic infections (AOR = 2.86 (95% CI 1.67, 4.88)) and presence of comorbidities (AOR = 3.51 (95% CI 1.89, 6.53)) were associated with higher risk for suboptimal adherence. We observed lower rate of suboptimal adherence to ART following the implementation of test and treat strategy in Ethiopia. Various sociodemographic, clinical, and behavioral factors were found to be independent predictors of suboptimal adherence. The findings highlight the importance of person-centered adherence support based on individual characteristics.

The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) vaccination at 11-12 years; the series can begin at age 9. U.S. HPV vaccination coverage is lower than other adolescent vaccinations. One proposed strategy to increase coverage is initiation at 9-10 years. We systematically reviewed studies addressing vaccination at age 9 to identify and evaluate evidence regarding potential programmatic advantages. Among 30 publications from 2014 to 2024 there were retrospective cohort studies (N = 11), intervention studies with a component focused on vaccination at 9-10 (N = 12), and studies of feasibility or acceptability by providers or caregivers (N = 7). While retrospective analyses found earlier initiation associated with completion, limitations in methodology preclude a cause-and-effect interpretation. Impact of age 9 vaccination is difficult to isolate in intervention studies that had multiple components. While initiating vaccination at age 9 is feasible, questions remain regarding the benefit of this approach to increase coverage.

BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection in children less than 5 years of age worldwide. In the United States, RSV commonly causes hospitalization in young children and is the leading cause of hospitalizations in infants. As new RSV immunizations become available, burden estimates are critical to guide the implementation of recommendations and quantify impact. METHODS: We estimated RSV-associated hospitalization rates at a large US pediatric medical center during an 8-year period using five approaches, namely, estimation directly from active and passive surveillance systems, both a crude and stratified capture-recapture analysis of data from both systems, and estimation based on discharge diagnosis codes. The stratified analysis was performed to ensure adherence with the capture-recapture methodology assumption that samples are independent and participants have an equal probability of being observed within each system. RESULTS: Overall, estimated RSV-associated hospitalization rates per 1000 children were 4.0 (2.5, 6.1) based on adjusted estimates from active surveillance, 1.7 (2.1, 4.4) from passive surveillance, 7.9 (5.7, 13.0) from crude capture-recapture analysis, 5.0 (3.8, 7.2) from the stratified capture-recapture, and 4.4 (4.0, 4.9) from discharge diagnosis codes. CONCLUSIONS: Each method has limitations and inherent biases that may impact the estimation of the burden of RSV. Capture-recapture analysis may be a useful tool to estimate the burden of RSV, but needs to be adjusted to account for possible violation of the assumptions of independence and equal probability of capture to ensure accurate approximation of disease burden and avoid over estimation.

We conducted formative interviews and design workshops to tailor evidence-based tools addressing informational needs around pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM) of color. Clients (n = 18) and providers (n = 19) were interviewed to explore needs and preferences for PrEP-related decision-making tools. Next, we developed an analysis matrix to design personas to tailor materials to real-world contexts. Existing PrEP educational materials were then revised using participant feedback elicited through the personas. We presented personas, findings, and revised materials to clients (n = 9) and providers (n = 9) in iterative design workshops and solicited further feedback. Revisions to materials for providers included tips for destigmatizing PrEP counseling and routine care, sexual practices, and structural barriers that YMSM of color often navigate. Our evidence-based approach has the potential to enhance shared decision-making and destigmatize HIV prevention counseling in our larger trial, thus promoting both PrEP uptake and persistence among YMSM of color. © 2025 National Communication Association.

Same-day pre-exposure prophylaxis for HIV (PrEP) is recommended to improve access to this important HIV prevention tool. A PrEP program at a community-based LGBTQ+ clinic in Seattle, Washington provided PrEP via telemedicine with a focus on converting testing-only visits to same-day 'Insta-PrEP' visits. We identified three key barriers to same-day PrEP for clients who present to clinic for testing-only visits: delays related to health insurance; longer counseling times; and disruption of clinic flow following Insta-PrEP visits. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

BACKGROUND: Seasonal influenza causes an estimated 120 000 to 710 000 hospitalizations annually in the United States. Treatment with antiviral medications, such as oseltamivir, can reduce risks of hospitalization among people with influenza-associated illness. The US Centers for Disease Control and Prevention recommends initiating antiviral treatment as soon as possible for outpatients with suspected or confirmed influenza who have severe or progressive illness or are at higher risk of influenza complications. METHODS: We developed a probabilistic model to estimate the impact of antiviral treatment in reducing hospitalizations among US outpatients with influenza. Parameters were informed by seasonal influenza surveillance platforms and stratified by age group and whether individuals had a condition associated with higher risk of influenza complications. We modeled different scenarios for influenza antiviral effectiveness and outpatient testing and prescribing practices, then compared our results with a baseline scenario in which antivirals were not used. RESULTS: Across the modeled scenarios, antiviral treatment resulted in 1215 to 14 184 fewer influenza-associated hospitalizations on average when compared with the baseline scenario (0.2%-2.7% reduction). The greatest effects occurred among adults aged ≥65 years and individuals with conditions associated with higher risk of influenza complications. Modeling 50% improvements in access to care, testing, prescribing, and treatment resulted in greater potential impacts, with over 71 000 (13.3%) influenza-associated hospitalizations averted on average compared to baseline. CONCLUSIONS: Our results support recommendations to prioritize outpatient antiviral treatment among older adults and others at higher risk of influenza complications. Improving access to prompt testing and treatment among outpatients with suspected influenza could reduce hospitalizations substantially.

Nirsevimab is a long-acting monoclonal antibody that protects infants and young children against severe respiratory syncytial virus (RSV) disease. Children are eligible for one 50 mg dose, one 100 mg dose, or two 100 mg doses of nirsevimab based on age, weight, time of year, maternal vaccination, and risk of severe disease. In winter 2023/2024, we developed a model to project the number of nirsevimab doses needed to immunize all eligible U.S. children during the 2024/2025 season. We grouped all births from March 2023 through March 2025 into weekly cohorts, partitioned those cohorts based on eligibility criteria, and computed eligibility for each partition. In the absence of maternal RSV vaccination, we estimated U.S. children would be eligible to receive 4.3 million nirsevimab doses in 2024/2025, of which 48% would be 100 mg doses. Projections of total eligibility can be used to inform production goals and avoid shortages of nirsevimab.

OBJECTIVE: The objective of this study was to generate updated estimates for the incidence rate, cost burden, and case fatality rate (CFR) of neonatal herpes simplex virus (nHSV) infections in the US in 2019. METHODS: A nationally representative sample of US pediatric discharges was assessed using data from the Healthcare Cost and Utilization Project Kids' Inpatient Database to estimate the incidence, costs, and fatality of nHSV in 2019. Cases were estimated using herpes simplex virus International Classification of Diseases, Tenth Revision, Clinical Modification codes (B00.xx, A60.xx, or P35.2) among infants aged 28 days or younger admitted to the hospital and with hospital stays more than 5 days or resulting in death. A matching algorithm was developed to deduplicate records of readmissions or transfers from another hospital. Estimates were generated overall and by sociodemographic factors including race, US region, primary payer, and median household income. RESULTS: In total, 561 nHSV cases were estimated in the US in 2019, resulting in an incidence rate of 15.7 per 100 000 hospital births. The highest incidence rate was in the South (21.3; 95% confidence interval [CI], 19.0-23.9) and in infants born to Black birth parents (27.3; 95% CI, 22.8-32.4). The total cost to the US health care system was estimated at $28.9 million. The CFR among infants with nHSV was estimated to be 4.6%. CONCLUSION: This study updates the incidence rate, cost burden, and CFR of nHSV in 2019, an increase compared with past estimates, and highlights the racial and geographic disparities across the US. Public health interventions for early detection and prevention are critical to mitigate these disparities.

OBJECTIVES: To evaluate the cost-effectiveness of testing and treatment for Mycobacterium tuberculosis (Mtb) infection among Asian and Hispanic persons with diagnosed diabetes in the United States. METHODS: We estimated population size and Mtb infection prevalence for Asian and Hispanic persons aged ≥15 years with diagnosed, non-gestational diabetes, by age and US-born-status. We assumed a one-time test for Mtb infection intervention, with positive-testing persons offered treatment. Using a deterministic, transmission-dynamic model of TB in the United States, we estimated costs, TB cases and deaths averted, and quality-adjusted life-years (QALY) gained under the intervention compared to no-intervention. We estimated incremental cost-effectiveness ratios (ICERs), calculated as costs per QALY-gained, from a TB health services perspective, including diagnosis and treatment for TB infection and disease. We also assessed health services and societal perspectives. We estimated 95% uncertainty intervals via probabilistic sensitivity analysis. RESULTS: TB cases averted per 100,000 persons tested ranged from 7.5 (95% uncertainty interval: 6.9-8.1) among US-born Hispanic persons to 238.9 (225.2-254.3) among non-US-born Asian persons. TB deaths averted per 100,000 persons tested ranged from 1.3 (1.2-1.4) among US-born Hispanic persons to 53.7 (51.4-56.1) among non-US-born Asian persons. ICERs for US-born Asian and Hispanic populations were $856,671 ($533,506-$1,234,032) and $1,081,646 ($673,142-$1,551,264), respectively. ICERs for non-US-born Asian and Hispanic populations were lower: $66,664 ($41,456-$93,625) and $68,749 ($43,136-$97,044), respectively. ICERs were 2-19% higher under a societal perspective. CONCLUSIONS: While the intervention produced health benefits for all populations assessed, health benefits were greater-and ICERs more favorable-for non-US-born Asian and Hispanic populations with diagnosed-diabetes.

INTRODUCTION: Although preventable, dental caries remains highly prevalent. Many children do not receive preventive dental services routinely in clinical settings. This review examined the effectiveness of school (preschool through high school) fluoride varnish delivery programs (SFVDP) in preventing caries. METHODS: Community Guide systematic review methods were followed. In 2024, databases were searched for studies published through December 2023 on SFVDP effectiveness in increasing fluoride varnish (FV) receipt and decreasing caries. Included studies had to be written in English, published in peer-reviewed journals, and conducted in upper-middle or high-income countries. Data synthesis conducted in 2024 used median RR and interquartile interval (IQI) to summarize findings across studies. RESULTS: Of 31 included studies with 60,780 students, 25 were randomized controlled trials-20 with good quality of execution. Most studies were conducted in low socioeconomic status (SES) areas among students at elevated caries risk. SFVDP reduced caries initiation by 32% (IQI: 21%, 37%) in permanent teeth (19 studies, 25,826 students) and by 25% (IQI: 4%, 37%) in primary teeth (12 studies, 4,304 students). Stratified assessments indicated findings were largely applicable to different settings, populations, and intervention characteristics. Two studies found SFVDP significantly increased the number of annual FV applications and two found that SFVDP effectiveness was inversely related to SES. DISCUSSION: About 30% of states report having no SFVDPs. Possible barriers to implementation include that Medicaid in some states only reimburses dental and medical professionals and does not reimburse non-dental providers for FV delivered to children older than 6 years.

BACKGROUND: Public health threats (PHTs) influence how and in what ways managers communicate with employees. Employee resources and information during uncertain times has been noted as a reoccurring gap, especially as it relates to personal protective equipment (PPE). This study explored general and PPE-specific communication practices with 22 healthcare and emergency medical service (EMS) managers to support workers, particularly in the context of preparedness and response. METHODS: Data collection occurred in two phases that involved interviews and small group discussions to identify, examine, and better frame and execute communication practices. Qualitative analysis was informed by the 4i FACT framework and the social ecological model (SEM) to identify relevant communication practices and intervention points within health delivery settings. RESULTS: Results elucidated perceived, effective leadership practices and interpersonal influences in the workplace. Tangible leadership communication practices were identified as important intervention points within the SEM, with a focus on proactive behaviors to procure necessary PPE and disseminate information. Participants emphasized one-on-one interactions with employees, and the use of trusted messengers to share health-related messages. They also highlighted the challenges of PPE shortages and the importance of access to resources across different job roles, organizations, and work settings. CONCLUSIONS/APPLICATION TO PRACTICE: This study contributes insights into communication practices during a public health emergency, offering a nuanced understanding of managerial approaches, PPE-related communication, and the broader contextual factors influencing information dissemination. Further, the integration of frameworks like 4i FACT and SEM provides a structured perspective for future communication strategies, supporting tailored approaches across organizations.

Leptospirosis (caused by pathogenic bacteria in the genus Leptospira) is prevalent worldwide but more common in tropical and subtropical regions. Transmission can occur following direct exposure to infected urine from reservoir hosts, or a urine-contaminated environment, which then can serve as an infection source for additional rats and other mammals, including humans. The brown rat, Rattus norvegicus, is an important reservoir of Leptospira spp. in urban settings. We investigated the presence of Leptospira spp. among brown rats in Boston, Massachusetts and hypothesized that rat population dynamics in this urban setting influence the transportation, persistence, and diversity of Leptospira spp. We analyzed DNA from 328 rat kidney samples collected from 17 sites in Boston over a seven-year period (2016-2022); 59 rats representing 12 of 17 sites were positive for Leptospira spp. We used 21 neutral microsatellite loci to genotype 311 rats and utilized the resulting data to investigate genetic connectivity among sampling sites. We generated whole genome sequences for 28 Leptospira spp. isolates obtained from frozen and fresh tissue from some of the 59 positive rat kidneys. When isolates were not obtained, we attempted genomic DNA capture and enrichment, which yielded 14 additional Leptospira spp. genomes from rats. We also generated an enriched Leptospira spp. genome from a 2018 human case in Boston. We found evidence of high genetic structure among rat populations that is likely influenced by major roads and/or other dispersal barriers, resulting in distinct rat population groups within the city; at certain sites these groups persisted for multiple years. We identified multiple distinct phylogenetic clades of L. interrogans among rats that were tightly linked to distinct rat populations. This pattern suggests L. interrogans persists in local rat populations and its transportation is influenced by rat population dynamics. Finally, our genomic analyses of the Leptospira spp. detected in the 2018 human leptospirosis case in Boston suggests a link to rats as the source. These findings will be useful for guiding rat control and human leptospirosis mitigation efforts in this and other similar urban settings.

Survey research relies on cooperation and coordination between researchers and respondents. Survey-literate respondents possess a level of understanding of the survey process that facilitates their participation. Non-survey-literate respondents, on the other hand, are less equipped to provide accurate responses, which can lead to increased survey error. In this article, we present findings from a cognitive interview project conducted in Brazil to illustrate potential barriers to respondent participation and demonstrate how these barriers contribute to response error. To test questions on inclusive education, researchers from the Collaborating Center for Questionnaire Design and Evaluation Research at the National Center for Health Statistics facilitated the collection of data through 80 cognitive interviews conducted in various neighborhoods in Rio de Janeiro, Brazil. Recruitment targeted caregivers of children with and without disabilities, and respondents were predominantly female with low literacy levels. The results indicated that respondents with limited familiarity with the survey process (non-survey-literate) struggled to orient themselves to the survey task. They faced challenges in choosing response options, understanding scale relationships, and interpreting vocabulary. Additionally, many respondents expressed a need to share salient details of their lives, which the survey was not designed to capture. Understanding these barriers to participation and identifying ways to mitigate them can help reduce survey error, particularly in vulnerable populations.

In 2017, Uganda implemented an electronic Integrated Disease Surveillance and Response System (eIDSR) to improve data completeness and reporting timelines. However, the eIDSR system had limited functionality and was implemented on a small scale. The Ministry of Health, with support from the Infectious Disease Institute, Makerere University, and Health Information Systems Program Uganda, upgraded the system functionality and scaled up its implementation. This study describes the process and impact of upgrading eIDSR functionality and expanding its implementation across additional districts. The Ministry of Health, through its Integrated Epidemiology, Surveillance & Public Health Emergency Department, coordinated the implementation of the eIDSR. User requirements were identified through consultations with national surveillance stakeholders. The feedback informed the design and development of the upgraded eIDSR functionalities. The eIDSR rollout followed a consultative workshop to create awareness of the system among stakeholders. A curriculum was developed, and a national training of trainers was conducted. These trainers cascaded the training to the district health teams, who later cascaded the training to health workers. The training adopted an on-site training approach, where a group of national or district trainers would train new users at their desks. The eIDSR system was upgraded to the District Health Information Software 2 (DHIS2) 2.35 platform featuring faster reading and writing tracker data, handling over 100 concurrent users and enhanced case-based surveillance features on Android and web platforms. From October 2020 to September 2022, the eIDSR was rolled out in 68% (100/146) of districts. Additionally, the system permitted prompt reporting of signals of epidemic-prone diseases. Improving the functionality and the expanded geographical scope of the eIDSR system enhanced disease surveillance. Stakeholder commitment and leveraging existing structures will be needed to scale up eIDSR.

The use of mobile phone surveys (MPS) for regionally or nationally representative data allows for quick, efficient and affordable data collection for monitoring trends and generating results to guide action. By digitizing this process, data flows can be expanded to include metadata and paradata that allow survey administrators to evaluate and improve survey processes and parameters. Between 2017 and early 2022, the Centers for Disease Control and Prevention provided technical support to country partners to implement MPS gathering indicators on noncommunicable diseases within adult populations in seven countries. These surveys resulted in 37 591 completed interviews containing no personal identifiable information. When combined, these surveys result in over 25 million rows of paradata representing timestamped interactions between the data collection platform and each survey respondent. Using exploratory data analysis, five key metrics were identified which had implications on MPS process optimization: timing of engagement, question randomization, contacts to complete, errors and mode effect. The use of survey paradata allows for real-time process evaluations and identifies factors that can improve efficiency and effectiveness of MPS methods.

We report the genome of a case of mpox detected in Kenya involving a truck driver with travel history to Uganda. Whole genome sequencing and phylogenetic analysis of the mpox virus (MPXV) showed that the genome clustered with clade Ib, which was recently identified in the Democratic Republic of Congo.

Purpose: Research suggests that sexual minority women (SMW) face elevated HIV risk compared with their heterosexual counterparts. This study examined the association between sexual minority status-defined by identity and behavior-and HIV-related vulnerabilities among heterosexually active low-income women. Methods: This analysis used National HIV Behavioral Surveillance data (n = 5542) collected in 2019 from heterosexually active low-income women in 23 U.S. urban areas. We examined sexual minority identity and behavior and a set of substance use, sexual behavior, health and health care, and social determinants of health indicators commonly associated with heightened HIV transmission risk. Log-linked Poisson regression models generated adjusted prevalence ratios and 95% confidence intervals. Results: Among women who reported sexual minority identity (22.2%; n = 1231), 34.6% (n = 426) reported past-year sex with only men. Of women who reported past-year sex with both women and men (17.8%; n = 985), 18.3% (n = 180) identified as heterosexual. In adjusted models, SMW had significantly higher prevalence of nearly every HIV risk-associated factor examined than their heterosexual counterparts. Risk profiles by identity and behavior were similar. Notably, SMW defined by behavior had similar or higher prevalence of nearly every risk factor than those defined by identity. Conclusions: This study demonstrates disproportionate HIV-related vulnerabilities among SMW compared with their heterosexual counterparts. The findings underscore the importance of measuring multiple dimensions of sexual orientation (identity and behavior), as SMW and their associated risks show important nuances. Implications include tailoring HIV prevention and health promotion interventions to meet the needs of low-income SMW.

Critical appraisal of the quality of randomised trials is possible only if their design, conduct, analysis, and results are completely and accurately reported. Without transparent reporting of the methods and results, readers will not be able to fully evaluate the reliability and validity of trial findings. The CONSORT (Consolidated Standards of Reporting Trials) statement aims to improve the quality of reporting and provides a minimum set of items to be included in a report of a randomised trial. CONSORT was first published in 1996 and was updated in 2001 and 2010. CONSORT comprises a checklist of essential items that should be included in reports of randomised trials and a diagram for documenting the flow of participants through a trial. The CONSORT statement has been updated (CONSORT 2025) to reflect recent methodological advancements and feedback from end users, ensuring that it remains fit for purpose. Here, we present the updated CONSORT explanation and elaboration document, which has been extensively revised and describes the rationale and scientific background for each CONSORT 2025 checklist item and provides published examples of good reporting. The objective is to enhance the use, understanding, and dissemination of CONSORT 2025 and provide guidance to authors about how to improve the reporting of their trials and ensure trial reports are complete, and transparent.

IMPORTANCE: Well-designed and properly executed randomized trials are considered the most reliable evidence on the benefits of health care interventions. However, there is overwhelming evidence that the quality of reporting is not optimal. The CONSORT (Consolidated Standards of Reporting Trials) statement was designed to improve the quality of reporting and provides a minimum set of items to be included in a report of a randomized trial. CONSORT was first published in 1996, then updated in 2001 and 2010. Herein, we present the updated CONSORT 2025 statement, which aims to account for recent methodological advancements and feedback from end users. OBSERVATIONS: We conducted a scoping review of the literature and developed a project-specific database of empirical and theoretical evidence related to CONSORT to generate a list of potential changes to the checklist. The list was enriched with recommendations provided by the lead authors of existing CONSORT extensions (harms, outcomes, nonpharmacological treatment), other related reporting guidelines (Template for Intervention Description and Replication [TIDieR]), and recommendations from other sources (eg, personal communications). The list of potential changes to the checklist was assessed in a large, international, online, 3-round Delphi survey involving 317 participants and discussed at a 2-day online expert consensus meeting of 30 invited international experts. We have made substantive changes to the CONSORT checklist. We added 7 new checklist items, revised 3 items, deleted 1 item, and integrated several items from key CONSORT extensions. We also restructured the CONSORT checklist, with a new section on open science. The CONSORT 2025 statement consists of a 30-item checklist of essential items that should be included when reporting the results of a randomized trial and a diagram for documenting the flow of participants through the trial. To facilitate implementation of CONSORT 2025, we have also developed an expanded version of the CONSORT 2025 checklist, with bullet points eliciting critical elements of each item. CONCLUSIONS AND RELEVANCE: Authors, editors, reviewers, and other potential users should use CONSORT 2025 when writing and evaluating manuscripts of randomized trials to ensure that trial reports are clear and transparent.

In Lesotho, the Ministry of Health and key donors have made significant advancements to develop digital health solutions specific to HIV services including an eRegister which is interoperable with the health management information system, pharmacy services and the laboratory information system. New investments from the Millennium Challenge Corporation will expand digital health services to all reported communicable and non-communicable disease areas at health facilities throughout the country. This paper explores how digital health interventions designed to support comprehensive HIV care can be leveraged to provide universal digital health coverage. Specifically, three priority areas will be addressed: (i) governance, security, and system architecture (ii) power, connectivity, and equipment (iii) human resources and change management.

Introduction: Emergency 9-1-1 incident data are recorded voluntarily within fire-department-specific computer-aided dispatch systems. The National Fire Incident Reporting System serves as a repository for these data, but inconsistency and variability in reporting practices across departments often lead to challenges in data quality and utility. This study aims to enhance emergency incident categorization and explore the feasibility of an automated system using free-text incident data from the National Fire Operations Reporting System (NFORS). Method: Researchers extracted and standardized 3,564 unique 9–1-1 incident descriptions from six fire departments using NFORS data, including narrative fields from emergency reports. The data were preprocessed using natural language processing (NLP) techniques, such as tokenization, stop word removal, and feature extraction (e.g., TF-IDF and n-grams). These features were used to train and evaluate Machine Learning (ML) models, including Naïve Bayes, Random Forest, and Support Vector Machine, to classify incidents into nine categories. The NLP techniques prepared the text data for the ML models, which performed the classification and assessed the automated system's performance. Results: The study demonstrated significant improvements in incident categorization accuracy using the NLP and ML approach. Unigram models achieved 93% accuracy when applied to 3,564 unique incident descriptions. This performance was evaluated by comparing the automated classifications to manually assigned categories, which served as the reference. Mis-categorizations primarily occurred with “Emergency Medical Services (EMS).” Conclusions: Standardized and consistent incident categorization is vital for informed decision-making, efficient resource allocation, and effective emergency response. Our findings suggest that adopting a robust categorization system, such as the nine-category model using NLP and ML, can improve categorization accuracy and enhance data quality and utility for decision-making. Practical Applications: Public safety agencies can leverage these insights to modernize data systems, strengthen occupational surveillance, and create more resilient and sustainable public safety data systems. © 2025

OBJECTIVE: Promoting health during adolescence can support long-term well-being, especially for teens diagnosed with attention-deficit/hyperactivity disorder (ADHD), who face increased risks due to the disorder's impact on development and health behaviors. ADHD is often associated with difficulties in social interactions, a higher likelihood of bullying involvement, and co-occurring mental health conditions. These factors may also be influenced by health factors such as physical activity, sleep quality, and screen time usage. Nationally representative teen self-reports provide a novel perspective on ADHD-related health outcomes compared with relying on parent reports. METHOD: We used nationally representative data from the National Health Interview Survey (NHIS) and NHIS-Teen from July 2021 to December 2022, to examine teen-reported health and well-being factors, stratified by parent-reported ADHD diagnoses among teens aged 12 to 17 years. Weighted prevalence estimates and adjusted prevalence ratios (aPR) adjusting for teen age, sex, and family income, all with 95% confidence intervals (CIs), were calculated. RESULTS: Just over 10% of teens had ADHD and they reported higher prevalence of bullying victimization (aPR = 1.64, CI = 1.27-2.11), difficulties making friends (aPR = 1.83, CI = 1.15-2.90), difficulty getting out of bed (aPR = 1.29, CI = 1.02-1.64), irregular wake times (aPR = 2.17, CI = 1.45-3.25), and >4 hours daily screen time (aPR = 1.26, CI = 1.05-1.52) than teens without ADHD; teens with ADHD reported a lower prevalence of lacking peer support (aPR = 0.70, CI = 0.51-0.96). CONCLUSION: Teens with ADHD face distinct challenges related to social-emotional well-being and health behaviors that support overall wellness. Findings may inform opportunities for health promotion among teens with ADHD.

BACKGROUND: Monitoring temporal trends in firearm injury-related emergency department (ED) visits is challenging because traditional surveillance systems lack detailed temporal information. OBJECTIVE: To describe temporal patterns of ED visits for firearm injury using data from the Centers for Disease Control and Prevention's (CDC) Firearm Injury Surveillance Through Emergency Rooms (FASTER) program. DESIGN: Cross-sectional analysis of firearm injury-related ED visits. SETTING: 9 states (Florida, Georgia, New Mexico, North Carolina, Oregon, Utah, Virginia, Washington, and West Virginia) and the District of Columbia from 1 January 2018 to 31 August 2023. PATIENTS: ED visits for firearm injury (n = 93 022) from CDC's FASTER program. MEASUREMENTS: ED visits for firearm injury per 100 000 ED visits, analyzed by time of day (in 30-minute intervals), day of the week, day of the year, and holidays. RESULTS: From January 2018 through August 2023, there were 93 022 firearm injury ED visits (73.9 per 100 000 ED visits), or approximately 1 firearm injury every 30 minutes overall. Rates of firearm injury ED visits were highest between 2:30 and 3:00 a.m. and lowest between 10:00 and 10:30 a.m. Nighttime peaks and daily rates were highest on Friday and Saturday. Monthly rates were highest in July and lowest in February; daily rates were disproportionately high on most holidays, especially Independence Day and New Year's Eve. LIMITATIONS: Data are limited to 9 states and the District of Columbia and are not nationally representative. The analysis of ED visits for firearm injury does not distinguish injury intent and is based on arrival time rather than actual injury time. CONCLUSION: Distinct temporal patterns in firearm injury ED visits highlight resource allocation considerations for prevention and response efforts. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.

INTRODUCTION: A complex and ongoing issue in firearm violence prevention research is correctly classifying injury intent (e.g., homicide, suicide, or unintentional). Emerging rule-based approaches to improve classification use the number of bullet wounds to infer intent of the injury when additional information is not available. Using the Centers for Disease Control and Prevention's National Violent Death Reporting System (NVDRS), which captures detailed information on intent of firearm injuries from coroner/medical examiner reports, law enforcement reports, and death certificates, this study examined potential evidence to support intent determination based on the number of bullet wounds. METHODS: 2003-2021 NVDRS data on fatal firearm injuries was analyzed in 2023. ANOVA was used to test statistical significance of differences in average number of bullet wounds by intent, and Tukey's Honest Significant Difference Test was used to determine specific differences by intent. RESULTS: A total of 299,362 fatal firearm injury decedents were identified. The average number of bullet wounds significantly differed by intent: suicide, 1.02; homicide, 2.72; and unintentional injury, 1.01 (P<.001). Homicide decedents had a significantly higher average number of wounds than unintentional injury decedents and suicide decedents (ΔM homicide-unintentional injury [1.71; 95% CI: 1.62 - 1.79; P<.001] and ΔM homicide-suicide [1.70; 95% CI: 1.68 - 1.72; P<.001]). CONCLUSIONS: The number of bullet wounds may be a useful indicator for classifying intent of firearm injuries, particularly for interpersonal assault, and when other supporting information is not available for medical coding. Accurate counts of firearm injuries by intent are critical for public health surveillance and prevention planning.

BACKGROUND: Job loss among both adults and adolescents increased markedly early in the COVID-19 pandemic. While parental job loss has been associated with the adverse effects, including adolescent substance use, no research is available on the effects of adolescent job loss on substance use. METHODS: Analyses of Adolescent Behaviors and Experiences Survey (ABES) data from January to June 2021 were conducted to assess associations between parent and student pre-pandemic employment status and pandemic-era job loss and adolescent substance use behaviors. Cigarette, electronic vapor product (EVP), alcohol, and drug use were examined in a nationally representative sample of 7,705 U.S. high-school students. RESULTS: Compared to students who did not lose their job during the pandemic, students reporting job loss had significantly elevated prevalences of current EVP use (29.9% vs. 19.7%), drinking more alcohol during the pandemic (25.3% vs. 16.7%), and current marijuana use (25.8% vs. 15.6%). Additionally, parental job loss was significantly associated with all substance use behaviors. CONCLUSIONS: Higher levels of substance use associated with student and parental job loss, as well as parental unemployment, indicate that care may be needed for those students experiencing these losses. School-based intervention and prevention programs, including job loss supports for students, could be useful.

BACKGROUND: Powered equipment for patient handling was designed to alleviate Emergency Medical Service (EMS) clinician injuries while lifting patients. This project evaluated the organizational rationale for purchasing powered equipment and the outcomes from equipment use. METHODS: This project analyzed secondary data obtained via an insurance Safety Intervention Grant (SIG) program in Ohio USA. These data were primarily in reports from EMS organizations. Investigators applied a mixed-methods approach, analyzing quantitative data from 297 grants and qualitative data from a sample of 64 grants. Analysts abstracted data related to: work-related injuries or risk of musculoskeletal-disorders (MSD), employee feedback regarding acceptance or rejection, and impact on quality, productivity, staffing, and cost. RESULTS: A total of $16.67 million (2018 adjusted USD) was spent from 2005 through 2018 for powered cots, powered loading systems, powered stair chairs, and non-patient handling equipment (eg, chest compression system, powered roller). Organizations purchased equipment to accommodate staff demographics (height, age, sex) and patient characteristics (weight, impairments). Grantees were fire departments (n = 254) and public (n = 19) and private (n = 24) EMS organizations consisting of career (45%), volunteer (20%), and a combination of career and volunteer (35%) staff. Powered equipment reduced reported musculoskeletal injuries, and organizations reported it improved EMS clinicians' safety. Organization feedback was mostly positive, and no organization indicated outright rejection of the purchased equipment. Analyst-identified design advantages for powered cots included increased patient weight capacity and hydraulic features, but the greater weight of the powered cot was a disadvantage. The locking mechanism to hold the cot during transportation was reported as an advantage, but it was a disadvantage for older cots without a compatibility conversion kit. Around one-half of organizations described a positive impact on quality of care and patient safety resulting from the new equipment. CONCLUSION: Overall, organizations reported improved EMS clinicians' safety but noted that not all safety concerns were addressed by the new equipment.

OBJECTIVES: This study examines the prevalence of health conditions for which miners enrolled in a state-funded insurance program sought care. METHODS: We conducted a retrospective analysis of claims data submitted to the Wyoming Miner's Hospital during 2014-2023. Using International Classification of Diseases codes and identifiers unique to each miner, we calculated the number of unique miners with claims submitted for major disease categories and common diagnoses within each category. RESULTS: Musculoskeletal disorders (MSDs) and diseases of the endocrine and cardiovascular systems were the most prevalent conditions, affecting 72.7%, 34.2%, and 31.1% of enrolled miners, respectively. CONCLUSIONS: This population of miners has a substantial burden of health conditions that can adversely impact health and well-being. Mine safety and health professionals can use analyses of claims data to identify priorities for improving miner health and well-being.

Inflammation and infections such as malaria affect concentrations of many micronutrient biomarkers, and hence estimates of nutritional status. We aimed to assess the relationship between malaria infection and micronutrient biomarker concentrations in pre-school children (PSC), school-age children (SAC) and women of reproductive age (WRA) in Malawi, and to examine the potential role of malaria immunity on the relationship between malaria and micronutrient biomarkers. Data from the 2015/2016 Malawi micronutrient survey were used. The associations between current or recent malaria infection, detected by rapid diagnostic test, and concentration of serum ferritin, soluble transferrin receptor (sTfR), zinc, serum folate, red blood cell (RBC) folate and vitamin B12, were estimated using multivariable linear regression. Factors related to malaria immunity including age, altitude and presence of hemoglobinopathies were examined as effect modifiers. Serum ferritin, sTfR and zinc were adjusted for inflammation using the BRINDA method. Malaria infection was associated with 68% (95% CI 51, 86), 28% (18,40) and 34% (13,45) greater inflammation-adjusted ferritin in PSC, SAC and WRA respectively (p<0.001 for each). In PSC, the positive association was stronger in younger children, in high altitude, and in children who were not carriers of the sickle cell trait. In PSC and SAC, sTfR was elevated (+ 25% (16, 29) and + 15% (9,22) respectively, p<0.001). Serum folate and RBC folate were elevated in WRA with malaria (+ 18% (3,35) and + 11% (1,23), p=0.01 and p=0.003 respectively). Malaria affects the interpretation of micronutrient biomarker concentrations and examining factors related to malaria immunity may be informative.

Access to and use of cannabis in the United States has increased as new product types emerge in the marketplace, and as additional states legalize its use for medical and nonmedical purposes. To tailor education messages for preventing adverse health effects of cannabis use, understanding the routes of use of these products in the general population is important. The 2022 Behavioral Risk Factor Surveillance System included a newly revised optional marijuana module comprising questions on marijuana routes of use among adults aged ≥18 years who used marijuana during the past 30 days (current use). Twenty-two states and two territories administered the optional marijuana module in 2022. Weighted prevalences (with 95% CIs) of current and daily or near-daily marijuana use, as well as prevalence of each route of use, were reported overall and by demographic characteristics and, among women aged ≤49 years, by pregnancy status. Among the 15.3% of respondents who reported current marijuana use, smoking was the most frequent route (79.4%), followed by eating (41.6%), vaping (30.3%), and dabbing (inhaling heated concentrated cannabis) (14.6%). Vaping and dabbing were most prevalent among persons aged 18-24 years. Intervention measures intended for persons who smoke cannabis are important; however, understanding health outcomes associated with other routes of use might have substantial public benefit.

OBJECTIVE: To establish baseline seroprevalence of soil-borne, waterborne, and foodborne diseases and to monitor diseases that are eliminated or on the path to elimination in the Paraguayan Chaco. METHODS: A total of 1 100 school-age children (6-15 years) were tested in urban and rural schools selected for a cross-cutting population-based survey using a two-stage probabilistic sample design in the three departments of the Paraguayan Chaco. Blood samples were taken on filter paper to measure IgG antibodies using a multiplex bead assay. Data collection was carried out through interviews with parents and caregivers. Access to basic sanitation and improved water was assessed. Differences in pathogen seropositivity and seroprotection were estimated by urban and rural areas. RESULTS: Seroprotection against measles was 62.9% and against rubella was 78.2%. Minimal diphtheria and tetanus seroprotection (≥0.01 IU/ml) was 92.9% and 98.3%, respectively. Seroprotective levels against these four vaccine-preventable diseases significantly decreased with increasing age (p < 0.05). The following pathogens and respective antigens showed significantly higher seroprevalence (p < 0.05) in rural areas compared with urban areas: Cryptosporidium parvum Cp17: 80.4% vs 64.6%, and Cp23: 60.6% vs 44.8%; Giardia lamblia VSP3: 26.9% vs 16.6%; Strongyloides stercoralis NIE: 11.5% vs 4.1%; and Taenia solium T24H: 7.1% vs 1.6%. Seroprevalence for these pathogens was also higher in Indigenous population when compared to non-Indigenous. Basic sanitation conditions showed significant differences (p < 0.05) between rural and urban areas: adobe and soil dwelling floor (65.3% vs 30.2%), use of pit latrine (90.3% vs 44.2%), availability of drainage or septic tank (8.7% vs 55.2%), access to safe water (19.7% vs 44.9%), and water treatment (6.8% vs 32.3%). CONCLUSIONS: We identified high exposure to soil-borne, waterborne, and foodborne diseases in rural areas and Indigenous population in the Paraguayan Chaco. Low seroprotection against measles and rubella alerts about the risk of immunity gaps to maintain elimination targets.

Nipah virus (NiV) is a deadly zoonotic pathogen in Southeast Asia causing severe respiratory and encephalitis symptoms with a high fatality rate. Whole-genome sequencing (WGS) is crucial for tracking transmission, conducting epidemiological analyses, and understanding NiV's adaptive evolution. WGS is essential for analyzing genomes, particularly in understanding pathogen nature, and pathogenesis and aiding in the development of therapeutics. However, sequencing this highly contagious virus directly from samples is challenging in low- and middle-income countries lacking BSL-4 facilities. This study developed and optimized a culture-independent, high-throughput multiplex PCR-based third-generation sequencing protocol for NiV using the Oxford Nanopore Technology platform and a proposed bioinformatics pipeline to generate consensus genome sequences directly from environmental and clinical specimens. We amplified 12 NiV RT-PCR-positive specimens (11 clinical, one environmental) to produce 60 amplicons, each approximately 400 bp, covering the entire ~18.2 kb genome. Using a two-step reverse transcriptase PCR approach, libraries were prepared with a ligation sequencing kit. Raw sequence data were then analyzed using bioinformatics tools. A minimum of 10,000 total reads per sample provided a nearly complete coverage (>95%) of the NiV genome, even with low virus concentrations (Ct ≤ 32), with an average quality score of 10.2. The WGS of 12 NiV-positive samples achieved coverage between 95.71% (Ct 29.54) and 99.3% (Ct 22.34). The entire process, from RNA extraction to finished sequences, took only 24 h. We developed a portable, culture-independent, high-throughput sequencing workflow suitable for resource-limited settings, aiding in real-time monitoring, outbreak investigation, and detection of new NiV strains and genetic evolution. IMPORTANCE: The development of a culture-independent, high-throughput whole-genome sequencing (WGS) protocol for Nipah virus (NiV) using the Oxford Nanopore MinION technology marks a significant advancement in outbreak response, surveillance, and genomic analysis of NiV. NiV is an RG4 category C pathogen; working with the NiV virus is a deep concern of biosafety and biosecurity. It demands the development of biologically safe procedures to get genetic information. This protocol utilizes biologically safe samples that were collected into recommended lysis solution, multiplex PCR, and third-generation sequencing, effectively addressing challenges in sequencing NiV. This optimized workflow achieved over 95% genome coverage without the need for virus culture. It is a cost-effective, rapid, and efficient approach to the WGS of NiV, making it suitable for resource-limited settings like Bangladesh. The method enhances the capacity for outbreak investigations, epidemiological analyses, and monitoring virus, aiding in detecting emerging strains. This work contributes significantly to global pandemic preparedness and response efforts.