Impact of the COVID-19 pandemic on inpatient antibiotic use in the United States, January 2019 through July 2022
O'Leary EN , Neuhauser MM , Srinivasan A , Dubendris H , Webb AK , Soe MM , Hicks LA , Wu H , Kabbani S , Edwards JR . Clin Infect Dis 2023 Antimicrobial use (AU) data reported to the National Healthcare Safety Network's Antimicrobial Use and Resistance Module between January 2019 and July 2022 were analyzed to assess the impact of the COVID-19 pandemic on inpatient antimicrobial use. |
Comparison of antibiotic prescribing between physicians and advanced practice clinicians
Hersh AL , Shapiro DJ , Sanchez GV , Hicks LA . Infect Control Hosp Epidemiol 2023 1-3 We compared antibiotic prescribing rates for respiratory conditions in a national sample of outpatient visits from 2010 to 2018 between physicians and advanced practice clinicians (APCs). APCs prescribed antibiotics more frequently than physicians (58% vs 52%), but there were no differences in selection of guideline recommended first-line agents between specialties. |
Antibiotic stewardship: A decade of progress
Cosgrove SE , Srinivasan A . Infect Dis Clin North Am 2023 37 (4) 659-667 Antibiotic stewardship has seen transformative change over the past decade. Antibiotic stewardship infrastructure has grown significantly across the spectrum of health care in hospitals, nursing homes, and ambulatory settings, and issues related to improving antibiotic use have become central to high-level policy discussions, regulations, and legislation. Herein we review important events and developments in stewardship across the spectrum of care with a focus on (1) infrastructure and implementation, (2) requirement and regulation, and (3) measurement of antibiotic use and other outcomes. |
Cluster of carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa among patients in an adult intensive care unit - Idaho, 2021-2022
Cahill ME , Jaworski M , Harcy V , Young E , Ham DC , Gable P , Carter KK . MMWR Morb Mortal Wkly Rep 2023 72 (31) 844-846 Treatment of carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) infections is challenging because of antibiotic resistance. CP-CRPA infections are highly transmissible in health care settings because they can spread from person to person and from environmental sources such as sink drains and toilets. During September 2021-January 2022, an Idaho hospital (hospital A) isolated CP-CRPA from sputum of two patients who stayed in the same intensive care unit (ICU) room (room X), 4 months apart. Both isolates had active-on-imipenem metallo-beta-lactamase (IMP) carbapenemase gene type 84 (bla(IMP-84)) and were characterized as multilocus sequence type 235 (ST235). A health care-associated infections team from the Idaho Division of Public Health visited hospital A during March 21-22, 2022, to discuss the cluster investigation with hospital A staff members and to collect environmental samples. CP-CRPA ST235 with bla(IMP-84) was isolated from swab samples of one sink in room X, suggesting it was the likely environmental source of transmission. Recommended prevention and control measures included application of drain biofilm disinfectant, screening of future patients who stay in room X (e.g., the next 10 occupants) upon reopening, and continuing submission of carbapenem-resistant P. aeruginosa (CRPA) isolates to public health laboratories. Repeat environmental sampling did not detect any CRPA. As of December 2022, no additional CP-CRPA isolates had been reported by hospital A. Collaboration between health care facilities and public health agencies, including testing of CRPA isolates for carbapenemase genes and implementation of sink hygiene interventions, was critical in the identification of and response to this CP-CRPA cluster in a health care setting. |
Low rates of antifungal therapeutic drug monitoring among inpatients who received itraconazole, posaconazole, or voriconazole, United States, 2019-2021
Benedict K , Gold JAW , Toda M , Thompson GR 3rd , Wiederhold NP , Smith DJ . Open Forum Infect Dis 2023 10 (8) ofad389 Antifungal therapeutic drug monitoring (TDM) is recommended for hospitalized patients receiving itraconazole, posaconazole, or voriconazole for treatment or prophylaxis. In this analysis of hospital-based data, TDM was uncommonly performed (15.8%) in a large cohort of eligible patients, suggesting missed opportunities to avoid subtherapeutic drug levels and minimize toxicity. |
Epidemiology and antimicrobial resistance of Campylobacter infections in the United States, 2005-2018
Ford L , Healy JM , Cui Z , Ahart L , Medalla F , Ray LC , Reynolds J , Laughlin ME , Vugia DJ , Hanna S , Bennett C , Chen J , Rose EB , Bruce BB , Payne DC , Francois Watkins LK . Open Forum Infect Dis 2023 10 (8) ofad378 BACKGROUND: Campylobacter is the most common cause of bacterial diarrhea in the United States; resistance to macrolides and fluoroquinolones limits treatment options. We examined the epidemiology of US Campylobacter infections and changes in resistance over time. METHODS: The Foodborne Diseases Active Surveillance Network receives information on laboratory-confirmed Campylobacter cases from 10 US sites, and the National Antimicrobial Resistance Monitoring System receives a subset of isolates from these cases for antimicrobial susceptibility testing. We estimated trends in incidence of Campylobacter infection, adjusting for sex, age, and surveillance changes attributable to culture-independent diagnostic tests. We compared percentages of isolates resistant to erythromycin or ciprofloxacin during 2005-2016 with 2017-2018 and used multivariable logistic regression to examine the association of international travel with resistance. RESULTS: Adjusted Campylobacter incidence remained stable or decreased for all groups analyzed since 2012. Among 2449 linked records in 2017-2018, the median patient age was 40.2 years (interquartile range, 21.6-57.8 years), 54.8% of patients were male, 17.2% were hospitalized, and 0.2% died. The percentage of resistant infections increased from 24.5% in 2005-2016 to 29.7% in 2017-2018 for ciprofloxacin (P < .001) and from 2.6% to 3.3% for erythromycin (P = .04). Persons with recent international travel had higher odds than nontravelers of having isolates resistant to ciprofloxacin (adjusted odds ratio [aOR] varied from 1.7 to 10.6 by race/ethnicity) and erythromycin (aOR = 1.7; 95% confidence interval, 1.3-2.1). CONCLUSIONS: Campylobacter incidence has remained stable or decreased, whereas resistance to antimicrobials recommended for treatment has increased. Recent international travel increased the risk of resistance. |
The HEARTS partner forum-supporting implementation of HEARTS to treat and control hypertension
Khan T , Moran AE , Perel P , Whelton PK , Brainin M , Feigin V , Kostova D , Richter P , Ordunez P , Hennis A , Lackland DT , Slama S , Pineiro D , Martins S , Williams B , Hofstra L , Garg R , Mikkelsen B . Front Public Health 2023 11 1146441 Cardiovascular diseases (CVD), principally ischemic heart disease (IHD) and stroke, are the leading causes of death (18. 6 million deaths annually) and disability (393 million disability-adjusted life-years lost annually), worldwide. High blood pressure is the most important preventable risk factor for CVD and deaths, worldwide (10.8 million deaths annually). In 2016, the World Health Organization (WHO) and the United States Centers for Disease Control (CDC) launched the Global Hearts initiative to support governments in their quest to prevent and control CVD. HEARTS is the core technical package of the initiative and takes a public health approach to treating hypertension and other CVD risk factors at the primary health care level. The HEARTS Partner Forum, led by WHO, brings together the following 11 partner organizations: American Heart Association (AHA), Center for Chronic Disease Control (CCDC), International Society of Hypertension (ISH), International Society of Nephrology (ISN), Pan American Health Organization (PAHO), Resolve to Save Lives (RTSL), US CDC, World Hypertension League (WHL), World Heart Federation (WHF) and World Stroke Organization (WSO). The partners support countries in their implementation of the HEARTS technical package in various ways, including providing technical expertise, catalytic funding, capacity building and evidence generation and dissemination. HEARTS has demonstrated the feasibility and acceptability of a public health approach, with more than seven million people already on treatment for hypertension using a simple, algorithmic HEARTS approach. Additionally, HEARTS has demonstrated the feasibility of using hypertension as a pathfinder to universal health coverage and should be a key intervention of all basic benefit packages. The partner forum continues to find ways to expand support and reinvigorate enthusiasm and attention on preventing CVD. Proposed future HEARTS Partner Forum activities are related to more concrete information sharing between partners and among countries, expanded areas of partner synergy, support for implementation, capacity building, and advocacy with country ministries of health, professional societies, academy and civil societies organizations. Advancing toward the shared goals of the HEARTS partners will require a more formal, structured approach to the forum and include goals, targets and published reports. In this way, the HEARTS Partner Forum will mirror successful global partnerships on communicable diseases and assist countries in reducing CVD mortality and achieving global sustainable development goals (SDGs). |
Probability of 5% or greater weight loss or BMI reduction to healthy weight among adults with overweight or obesity
Kompaniyets L , Freedman DS , Belay B , Pierce SL , Kraus EM , Blanck HM , Goodman AB . JAMA Netw Open 2023 6 (8) e2327358 IMPORTANCE: Information on the probability of weight loss among US adults with overweight or obesity is limited. OBJECTIVE: To assess the probability of 5% or greater weight loss, 10% or greater weight loss, body mass index (BMI) reduction to a lower BMI category, and BMI reduction to the healthy weight category among US adults with initial overweight or obesity overall and by sex and race. DESIGN, SETTING, AND PARTICIPANTS: This cohort study obtained data from the IQVIA ambulatory electronic medical records database. The sample consists of US ambulatory patients 17 years or older with at least 3 years of BMI information from January 1, 2009, to February 28, 2022. Minimum age was set at 17 years to allow for the change in BMI or weight starting at 18 years. Maximum age was censored at 70 years. EXPOSURES: Initial BMI (calculated as weight in kilograms divided by height in meters squared) category was the independent variable of interest, and the categories were as follows: lower than 18.5 (underweight), 18.5 to 24.9 (healthy weight), 25.0 to 29.9 (overweight), 30.0 to 34.9 (class 1 obesity), 35.0 to 39.9 (class 2 obesity), and 40.0 to 44.9 and 45.0 or higher (class 3 or severe obesity). MAIN OUTCOMES AND MEASURES: The 2 main outcomes were 5% or greater weight loss (ie, a ≥5% reduction in initial weight) and BMI reduction to the healthy weight category (ie, BMI of 18.5-24.9). RESULTS: The 18 461 623 individuals in the sample had a median (IQR) age of 54 (40-66) years and included 10 464 598 females (56.7%) as well as 7.7% Black and 72.3% White patients. Overall, 72.5% of patients had overweight or obesity at the initial visit. Among adults with overweight and obesity, the annual probability of 5% or greater weight loss was low (1 in 10) but increased with higher initial BMI (from 1 in 12 individuals with initial overweight to 1 in 6 individuals with initial BMI of 45 or higher). Annual probability of BMI reduction to the healthy weight category ranged from 1 in 19 individuals with initial overweight to 1 in 1667 individuals with initial BMI of 45 or higher. Both outcomes were generally more likely among females than males and were highest among White females. Over the 3 to 14 years of follow-up, 33.4% of persons with overweight and 41.8% of persons with obesity lost 5% or greater of their initial weight. At the same time, 23.2% of persons with overweight and 2.0% of persons with obesity reduced BMI to the healthy weight category. CONCLUSIONS AND RELEVANCE: Results of this cohort study indicate that the annual probability of 5% or greater weight loss was low (1 in 10) despite the known benefits of clinically meaningful weight loss, but 5% or greater weight loss was more likely than BMI reduction to the healthy weight category, especially for patients with the highest initial BMIs. Clinicians and public health efforts can focus on messaging and referrals to interventions that are aimed at clinically meaningful weight loss (ie, ≥5%) for adults at any level of excess weight. |
2020 cancer incidence data in the USA reveal effects of the COVID-19 pandemic
Townsend JS . Lancet Oncol 2023 24 (8) 825-826 Routine screening for breast, cervical, and colorectal cancers decreased substantially after the COVID-19 public health emergency was declared in early 2020.1, 2 This decrease was largely due to facility closures, local policies to limit viral spread, and cancelation of non-emergency procedures.1, 2 Screening generally rebounded later in 2020, but not uniformly across all areas of the USA or segments of the population.1, 2 Some people might have also delayed seeking medical care during the height of the pandemic for symptoms suggestive of cancer because of concerns regarding contact with SARS-CoV-2.3 | | 3 years after the start of the pandemic, US nationwide cancer incidence data are starting to reveal its impact on cancer diagnoses. In The Lancet Oncology, a study by Xuesong Han and colleagues assessed data from the US Commission on Cancer's National Cancer Database, including the recently released 2020 dataset.4 The authors found a 17·2% reduction in stage I cancers diagnosed in 2020 compared with 2019 (278 400 cases in 2020 vs 336 136 in 2019). Diagnoses of stage IV cancers decreased by 9·8% (148 339 in 2020 vs 164 545 in 2019). However, the odds of having a cancer diagnosed as stage IV in 2020 increased by about 7% compared with 2019 (adjusted odds ratio [aOR] 1·074 [1·066–1·083] for stage IV vs stage I–III). |
Extragenital gonorrhoea, chlamydia, and HIV co-infection in people with mpox
Herrera K , Lyang J , Holly T , Faherty EA , Luc C , Korban C , Kern D , Tabidze I . Lancet Infect Dis 2023 23 (9) e334-e336 High prevalence of sexually transmitted infections, including gonorrhoea (28%), chlamydia (25%), syphilis (8%), and HIV (38%) co-infections have been reported in the 2022 mpox outbreak,1 which has disproportionately affected men who have sex with men and minoritised racial and ethnic groups.2 Although the outbreak has receded, a modelling analysis predicts that most jurisdictions in the USA could be at risk of resurgence without continued vaccination efforts.3 In previous mpox outbreaks, co-infection with HIV has been associated with poor mpox health outcomes.1, 4 Furthermore, among people with mpox in eight jurisdictions in the USA in 2022, those with HIV co-infection were more likely to report severe symptoms compared with those without HIV co-infection.1 Unprotected anal intercourse confers a significant risk for HIV acquisition as the rectal membrane is susceptible to infection due to its thin and friable nature.5 Previous gonorrhoea and chlamydia diagnoses are also established risk factors for HIV acquisition.6 These findings, along with clinical manifestations of mpox at rectal, genital, and oral sites warrant further investigation. This Correspondence aims to explore predictors, including gonorrhoea and chlamydia sites of infection in the previous 12 months of mpox diagnosis, and HIV co-infection among people with mpox in Chicago, USA. It is hypothesised that a previous or current rectal site of gonorrhoea or chlamydia infection will be associated with an increased prevalence of HIV and mpox co-infection. |
Notes from the field: Measles outbreak - central Ohio, 2022-2023
Tiller EC , Masters NB , Raines KL , Mathis AD , Crooke SN , Zwickl RC , French GK , Alexy ER , Koch EM , Tucker NE , Wilson EM , Krauss TS , Leasure E , Budd J , Billing LM , Dewart C , Tarter K , Dickerson K , Iyer R , Jones AN , Halabi KC , Washam MC , Sugerman DE , Roberts MW . MMWR Morb Mortal Wkly Rep 2023 72 (31) 847-849 On November 5, 2022, Columbus Public Health, Ohio and the Ohio Department of Health were notified of two children aged 2 years who were admitted to a central Ohio hospital with rash, fever, cough, and congestion, suggestive of measles. Both children were undergoing medical evaluation and treatment for other etiologies before measles was considered in the differential diagnosis. Neither child had received measles, mumps, and rubella (MMR) vaccine, and neither had known contact with a person with measles. Each patient subsequently received a positive measles real-time reverse transcription–polymerase chain reaction (RT-PCR) test result. Neither child had traveled internationally, but during June 12–October 8, 2022, four internationally imported measles cases had been confirmed among unvaccinated Franklin County, Ohio residents who had traveled to areas in East Africa where measles outbreaks were ongoing (1). Investigation of the U.S.-acquired measles cases identified additional measles cases, and local and state health departments confirmed a community outbreak on November 9, 2022. During this community measles outbreak in central Ohio, 85 locally acquired measles cases were confirmed with rash onsets during October 22–December 24, 2022; however, no definitive link to the previous international importations was established. The outbreak was declared over on February 4, 2023, 42 days (two measles incubation periods) after the last reported case. |
Community-based integrated tick management programs: cost and feasibility scenarios
Schulze TL , Eisen L , Russell K , Jordan RA . J Med Entomol 2023 60 (5) 1048-1060 Numerous studies have assessed the efficacy of environmentally based control methods to suppress populations of the blacklegged tick (Ixodes scapularis Say), but few of these estimated the cost of control. We estimated costs for a range of tick control methods (including habitat management, deer exclusion or population reduction, broadcast of acaricides, and use of host-targeted acaricides) implemented singly or in combination and applied to a model community comprising 320 residential properties and parklands. Using the high end for cost ranges, tick control based on a single method was estimated to have mean annual costs per household in the model community ranging from $132 for treating only forest ecotone with a broadcast synthetic acaricide to kill host-seeking ticks (or $404 for treating all residential forested habitat) to >$2,000 for deployment of bait boxes (SELECT TCS) across all residential tick habitat to treat rodents topically with acaricide to kill infesting ticks. Combining different sets of multiple methods in an integrated tick management program placed the annual cost between $508 and 3,192 annually per household in the model community, underscoring the disconnect between what people in Lyme disease endemic areas say they are willing to pay for tick control (not more than $100-150 annually) and the actual costs for tick control. Additional barriers to implementing community-based tick management programs within residential communities are discussed. |
Potential pharmacokinetic interactions with concurrent use of herbal medicines and a ritonavir-boosted COVID-19 protease inhibitor in low and middle-income countries
Smith DJ , Bi H , Hamman J , Ma X , Mitchell C , Nyirenda K , Monera-Penduka T , Oketch-Rabah H , Paine MF , Pettit S , Pheiffer W , Van Breemen RB , Embry M . Front Pharmacol 2023 14 1210579 The COVID-19 pandemic sparked the development of novel anti-viral drugs that have shown to be effective in reducing both fatality and hospitalization rates in patients with elevated risk for COVID-19 related morbidity or mortality. Currently, nirmatrelvir/ritonavir (Paxlovid™) fixed-dose combination is recommended by the World Health Organization for treatment of COVID-19. The ritonavir component is an inhibitor of cytochrome P450 (CYP) 3A, which is used in this combination to achieve needed therapeutic concentrations of nirmatrelvir. Because of the critical pharmacokinetic effect of this mechanism of action for Paxlovid™, co-administration with needed medications that inhibit or induce CYP3A is contraindicated, reflecting concern for interactions with the potential to alter the efficacy or safety of co-administered drugs that are also metabolized by CYP3A. Some herbal medicines are known to interact with drug metabolizing enzymes and transporters, including but not limited to inhibition or induction of CYP3A and P-glycoprotein. As access to these COVID-19 medications has increased in low- and middle-income countries (LMICs), understanding the potential for herb-drug interactions within these regions is important. Many studies have evaluated the utility of herbal medicines for COVID-19 treatments, yet information on potential herb-drug interactions involving Paxlovid™, specifically with herbal medicines commonly used in LMICs, is lacking. This review presents data on regionally-relevant herbal medicine use (particularly those promoted as treatments for COVID-19) and mechanism of action data on herbal medicines to highlight the potential for herbal medicine interaction Herb-drug interaction mediated by ritonavir-boosted antiviral protease inhibitors This work highlights potential areas for future experimental studies and data collection, identifies herbal medicines for inclusion in future listings of regionally diverse potential HDIs and underscores areas for LMIC-focused provider-patient communication. This overview is presented to support governments and health protection entities as they prepare for an increase of availability and use of Paxlovid™. |
Per- and polyfluoroalkyl substances (PFAS) and lipid trajectories in women 45-56 years of age: The study of women's health across the nation
Kang H , Ding N , Karvonen-Gutierrez CA , Mukherjee B , Calafat AM , Park SK . Environ Health Perspect 2023 131 (8) 87004 BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) are associated with less favorable blood lipid profiles in epidemiological studies. However, little is known about the potential role of PFAS in longitudinal changes in lipids among midlife women even though women become more susceptible to metabolic alterations during the menopausal transition. OBJECTIVES: To examine associations of serum PFAS concentrations with longitudinal trajectories of blood total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides in midlife women undergoing menopausal transition. METHODS: The sample included 1,130 women from the Study of Women's Health Across the Nation 45-56 y of age at baseline (1999-2000). We measured serum PFAS concentrations including linear perfluorooctanoic acid (n-PFOA), perfluorononanoic acid (PFNA), linear and branched perfluorooctanesulfonic acid (n-PFOS and Sm-PFOS, respectively), and perfluorohexanesulfonic acid (PFHxS) at baseline. We used k-means clustering to identify subgroups with different patterns of PFAS mixture. Blood lipids were measured annually or biannually through 2016 with an average follow-up of 14.8 y. We identified longitudinal trajectories of each lipid using latent class growth models. We used multinomial log-linear models adjusted for covariates to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of lipid trajectory classes by PFAS and their mixtures. RESULTS: Three distinct trajectories (low, middle, high) of total, LDL, and HDL cholesterol and two distinct trajectories (low and high) of triglycerides were identified. n-PFOS, Sm-PFOS, and PFHxS were positively associated with total and LDL cholesterol trajectories. n-PFOS was inversely associated with triglycerides trajectories. PFAS mixtures (high vs. low) showed positive associations with total and LDL cholesterol trajectories (high vs. low), showing ORs (95% CIs) of 1.69 (95% CI: 1.36, 2.12) and 1.79 (95% CI: 1.44, 2.22), respectively. DISCUSSION: Concentrations of serum PFAS were positively associated with trajectories of total and LDL cholesterol, providing a line of evidence supporting adverse effects of PFAS on lipid homeostasis. https://doi.org/10.1289/EHP12351. |
A methodology for calculating inhalation dose to public health personnel exposed to material resuspended from evacuees following the detonation of a fission device
Anspaugh LR , Mauro J , Briggs N , Porrovecchio J , Amann W , Salame-Alfie A , Ansari A . Health Phys 2023 125 (4) 289-304 Following a nuclear fission event, there likely would be a large number of contaminated persons who would seek assistance at community reception centers to be established outside the affected area. This paper provides a methodology for calculating inhalation doses to public health and other response personnel at such facilities who would be receiving and assisting potentially contaminated persons from whom particles can be resuspended. Three hypothetical facilities were considered: the Base Case is a rather small room with no forced air ventilation. The Preferred Case, which is more realistic, is a mid-sized room with an operating HVAC system with air being recirculated through a filter. The Gymnasium Case has only fresh air intake. Initial bounding calculations for the Base Case indicated the need for pre-screening of arrivals to avoid unacceptable doses to staff. The screening criterion selected was 1.67 × 106 Bq m-2. Calculations are presented for radionuclide concentrations in air, dose to staff from inhalation, and how exposures and the resulting doses can be altered by air-turnover rates and the use of filters with varying efficiency. Doses are presented for various arrival times and for both plutonium- and uranium-fueled detonations. The highest calculated dose via inhalation with no respiratory protection was 0.23 mSv for the Base Case. The more important radionuclides contributing to dose with exposure starting at day D + 1 were 239Np and 133I. At day D + 30, 131I and 140Ba were the more important dosimetrically. The variable creating the highest uncertainty was the slough-off factor for resuspension of contamination from people arriving at the reception center. |
Peri-operative exposure to volatile organic compounds in neonates undergoing cardiac surgery
Gaynor JW , Graham EM , Bhandari D , Fenchel M , Bradman A , Klepczynski B , Collier H , Ittenbach RF , Reese CM , Blount BC . J Thorac Cardiovasc Surg 2023 OBJECTIVE: Volatile organic compounds (VOCs) are used in the sterilization and manufacture of medical equipment. These compounds have high vapor pressures with low water solubility and are emitted as gases from solids or liquids. They can be mutagenic, neurotoxic, genotoxic, and/or carcinogenic. Safe limits of exposure are not known for neonates. This study examined determinants of exposure in newborns undergoing cardiac surgery. METHODS: Twenty metabolites of 16 VOCs (e.g., xylene, cyanide, acrolein, acrylonitrile, N, N-dimethylformamide, 1,3-butadiene, styrene, and benzene) were measured as metabolites in daily urine samples collected from 10 neonates undergoing cardiac operations (n = 150 samples). Metabolites were quantified using reversed-phase ultra-high performance liquid chromatography and electrospray ionization tandem mass spectrometry. Repeated measures ANOVA was performed for each metabolite to examine associations with use of medical devices. RESULTS: At least 3 metabolites were detected in every sample. The median number of metabolites detected in each sample was 14 (range: 3-15). In a model controlling for other factors, the use of extracorporeal membrane oxygenation was associated with significantly (p ≤ 0.05) higher metabolite levels of acrolein, acrylonitrile, ethylene oxide, propylene oxide, styrene, and ethylbenzene. Patients breathing ambient air had higher levels of metabolites of acrolein, xylene, N,N-dimethylformamide, methyl isocyanate, cyanide, 1,3-butadiene (all p≤ 0.05). CONCLUSIONS: Exposure to volatile organic compounds is pervasive in newborns undergoing cardiac surgery. Sources of exposure likely include medical devices and inhalation from the air in the intensive care unit. The contribution of VOC exposure during cardiac surgery in newborns to adverse outcomes warrants further evaluation. |
The enhanced gonococcal surveillance programme, Cambodia
Ouk V , Pham CD , Wi T , van Hal SJ , Lahra MM . Lancet Infect Dis 2023 23 (9) e332-e333 Antimicrobial resistance in Neisseria gonorrhoeae is a global public health threat, exemplified by increasing reports of isolates with high minimum inhibitory concentrations (MICs) to cephalosporin antibiotics, the last remaining first-line agent.1 Since 2015, there have been sporadic reports of N gonorrhoeae isolates with elevated ceftriaxone MIC values from several countries. The overwhelming majority of these isolates harbour the penA-60.001 allele (a gene encoding the gonococcal penicillin binding protein 2, associated with ceftriaxone resistance) and are closely related to the original described resistant strain, FC428.2, 3 An increase in the detection of such isolates from returned travellers was reported in the UK and Austria.3, 4 | | The Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) uses standardised methods for antimicrobial resistance surveillance5 and was established in Cambodia in 2020. In 2021–22, N gonorrhoeae was isolated from 93 urethral specimens collected from symptomatic males in Cambodia where the clinical guidelines recommend a single oral 400 mg dose of cefixime. The N gonorrhoeae isolates were referred to the partnering WHO collaborating centre in Australia for confirmation and genomic analysis (see appendix pp 7–8). |
Better data for decision-making through Bayesian imputation of suppressed provisional COVID-19 death counts
Kao SZ , Tutwiler MS , Ekwueme DU , Truman BI . PLoS One 2023 18 (8) e0288961 PURPOSE: To facilitate use of timely, granular, and publicly available data on COVID-19 mortality, we provide a method for imputing suppressed COVID-19 death counts in the National Center for Health Statistic's 2020 provisional mortality data by quarter, county, and age. METHODS: We used a Bayesian approach to impute suppressed COVID-19 death counts by quarter, county, and age in provisional data for 3,138 US counties. Our model accounts for multilevel data structures; numerous zero death counts among persons aged <50 years, rural counties, early quarters in 2020; highly right-skewed distributions; and different levels of data granularity (county, state or locality, and national levels). We compared three models with different prior assumptions of suppressed COVID-19 deaths, including noninformative priors (M1), the same weakly informative priors for all age groups (M2), and weakly informative priors that differ by age (M3) to impute the suppressed death counts. After the imputed suppressed counts were available, we assessed three prior assumptions at the national, state/locality, and county level, respectively. Finally, we compared US counties by two types of COVID-19 death rates, crude (CDR) and age-standardized death rates (ASDR), which can be estimated only through imputing suppressed death counts. RESULTS: Without imputation, the total COVID-19 death counts estimated from the raw data underestimated the reported national COVID-19 deaths by 18.60%. Using imputed data, we overestimated the national COVID-19 deaths by 3.57% (95% CI: 3.37%-3.80%) in model M1, 2.23% (95% CI: 2.04%-2.43%) in model M2, and 2.96% (95% CI: 2.76%-3.16%) in model M3 compared with the national report. The top 20 counties that were most affected by COVID-19 mortality were different between CDR and ASDR. CONCLUSIONS: Bayesian imputation of suppressed county-level, age-specific COVID-19 deaths in US provisional data can improve county ASDR estimates and aid public health officials in identifying disparities in deaths from COVID-19. |
Vaccine safety surveillance in Kenya using GAIA standards: A feasibility assessment of existing national and subnational research and program systems
Izulla P , Wagai JN , Akelo V , Ombeva A , Okeri E , Onyango D , Omore R , Fuller S , Khagayi S , Were J , Anderson SA , Wong HL , Tippett Barr BA . Vaccine 2023 41 (39) 5722-5729 BACKGROUND: Active surveillance systems for monitoring vaccine safety among pregnant women address some of the limitations of a current passive surveillance approach utilized in low- and middle-income countries (LMIC). However, few active surveillance systems in LMIC exist. Our study assessed the feasibility of utilizing three existing data collection systems in Kenya for active surveillance of maternal immunization and to assess the applicability of Global Alignment of Immunization Safety Assessment in pregnancy (GAIA) case definitions that were initially developed for clinical trials within these systems. METHODS: We assessed applicability of GAIA case definition for maternal Tetanus Toxoid exposure, stillbirth, low birth weight, small for gestational age, Neonatal Invasive Blood Stream Infection (NIBSI), prematurity and neonatal death in two routine web-based health information systems (Kenya EMR and DHIS-2), and a web-based population-based pregnancy research platform (ANCOV(1)) in Kenya. RESULTS: All three HIS were capable of reporting selected outcomes to varying degrees of GAIA certainty. The ANCOV platform was the most robust in collecting and collating clinical data for effective maternal pharmacovigilance. The utilization of facility- and district-aggregated data limits the usefulness of DHIS-2 in pharmacovigilance as currently operationalized. While the Kenya EMR contained individual level data and meets the key considerations for effective pharmacovigilance, it was used primarily for HIV care and treatment records in a small proportion of health facilities and would require additional resources to expand to all antenatal care facilities and to link maternal and infant records. DISCUSSION: Population-based research studies may offer a responsive short-term option for implementing maternal vaccine pharmacovigilance in LMICs. However, the foundation exists for long-term capacity building within the national health electronic data systems to provide this critical service as well as ensure participation of the country in international studies on maternal vaccine safety. |
Retrospective evaluation of an integrated molecular-epidemiological approach to cyclosporiasis outbreak investigations - United States, 2021
Ahart L , Jacobson D , Rice M , Richins T , Peterson A , Zheng Y , Barratt J , Cama V , Qvarnstrom Y , Montgomery S , Straily A . Epidemiol Infect 2023 151 e131 Cyclosporiasis results from an infection of the small intestine by Cyclospora parasites after ingestion of contaminated food or water, often leading to gastrointestinal distress. Recent developments in temporally linking genetically related Cyclospora isolates demonstrated effectiveness in supporting epidemiological investigations. We used 'temporal-genetic clusters' (TGCs) to investigate reported cyclosporiasis cases in the United States during the 2021 peak-period (1 May - 31 August 2021). Our approach split 655 genotyped isolates into 55 genetic clusters and 31 TGCs. We linked two large multi-state epidemiological clusters (Epidemiologic Cluster 1 [n = 136 cases, 54 genotyped] and Epidemiologic Cluster 2 [n = 42 cases, 15 genotyped]) to consumption of lettuce varieties; however, product traceback did not identify a specific product for either cluster due to the lack of detailed product information. To evaluate the utility of TGCs, we performed a retrospective case study comparing investigation outcomes of outbreaks first detected using epidemiological methods with those of the same outbreaks had TGCs been used to first detect them. Our study results indicate that adjustments to routine epidemiological approaches could link additional cases to epidemiological clusters of cyclosporiasis. Overall, we show that CDC's integrated genotyping and epidemiological investigations provide valuable insights into cyclosporiasis outbreaks in the United States. |
MicroRNA-based discovery of biomarkers, therapeutic targets, and repositioning drugs for breast cancer
Ye Q , Raese RA , Luo D , Feng J , Xin W , Dong C , Qian Y , Guo NL . Cells 2023 12 (14) Breast cancer treatment can be improved with biomarkers for early detection and individualized therapy. A set of 86 microRNAs (miRNAs) were identified to separate breast cancer tumors from normal breast tissues (n = 52) with an overall accuracy of 90.4%. Six miRNAs had concordant expression in both tumors and breast cancer patient blood samples compared with the normal control samples. Twelve miRNAs showed concordant expression in tumors vs. normal breast tissues and patient survival (n = 1093), with seven as potential tumor suppressors and five as potential oncomiRs. From experimentally validated target genes of these 86 miRNAs, pan-sensitive and pan-resistant genes with concordant mRNA and protein expression associated with in-vitro drug response to 19 NCCN-recommended breast cancer drugs were selected. Combined with in-vitro proliferation assays using CRISPR-Cas9/RNAi and patient survival analysis, MEK inhibitors PD19830 and BRD-K12244279, pilocarpine, and tremorine were discovered as potential new drug options for treating breast cancer. Multi-omics biomarkers of response to the discovered drugs were identified using human breast cancer cell lines. This study presented an artificial intelligence pipeline of miRNA-based discovery of biomarkers, therapeutic targets, and repositioning drugs that can be applied to many cancer types. |
Out-of-pocket costs and payer types for buprenorphine among US youth aged 12 to 19 years
Terranella A , Guy G Jr , Strahan A , Mikosz C . JAMA Pediatr 2023 This cross-sectional study examines out-of-pocket costs and payer types for buprenorphine prescriptions filled for youth aged 12 to 19 years at US retail pharmacies. | eng |
QuickStats: Percentage of emergency department visits* with Medicaid as the primary expected source of payment among persons aged <65 years, by race and ethnicity(†) - National Hospital Ambulatory Medical Care Survey, United States, 2011-2021
Santo L , Schappert SM , Ashman JJ . MMWR Morb Mortal Wkly Rep 2023 72 (31) 853 During 2011–2021, the percentage of ED visits among persons aged <65 years with Medicaid as the primary expected source of payment increased from 34.0% to 45.3%. This pattern was consistent irrespective of race and Hispanic or Latino (Hispanic) origin. ED visits among Hispanic persons increased the most, from 46.3% in 2011 to 62.7% in 2021. The percentage of ED visits among persons with Medicaid as their primary expected source of payment increased from 40.9% in 2011 to 53.4% in 2021 among Black or African American (Black) persons, and from 27.8% to 35.5% among White persons. During the study period, the percentages of ED visits by Black and Hispanic persons with Medicaid as the primary expected source of payment were higher than the percentages of visits by White persons. |
Inequities in COVID-19 vaccination coverage for adolescents with and without disability, National Immunization Survey-Child COVID module, July 22, 2021-February 26, 2022
Hollis ND , Zhou T , Rice CE , Yeargin-Allsopp M , Cree RA , Singleton JA , Santibanez TA , Ryerson AB . Disabil Health J 2023 16 (4) 101509 BACKGROUND: Some people with disabilities are likely at increased risk of health impacts from coronavirus disease 2019 (COVID-19). OBJECTIVE: To describe parent-reported COVID-19 vaccination status of adolescents (aged 13-17 years) and parental intent to get their child vaccinated, among adolescents with versus without disability. METHODS: National Immunization Survey-Child COVID Module data from interviews conducted July 22, 2021-February 26, 2022, were analyzed to assess disability status and type and COVID-19 vaccination status for adolescents (n = 12,445). Prevalence estimates with 95% confidence intervals were calculated; T-tests were conducted. RESULTS: A lower percentage of adolescents with disability received ≥1 dose of COVID-19 vaccine compared to adolescents without disability (52.5% vs. 58.6%), [those with cognition (50.8%) or not performing errands independently (49.5%) disabilities were significantly lower]; and a higher percentage of parents reported intent to definitely vaccinate (9.9% vs. 6.5%) and definitely not vaccinate (14.9% vs. 11.8%) their adolescent. Among the unvaccinated adolescents, parents of those with disability were more likely to report difficulty getting their child vaccinated (19.1% vs. 12.9%), inconvenient vaccination-site operating hours (7.6% vs. 3.9%), difficulty knowing where to get their child vaccinated (7.2% vs. 2.7%), and difficulty getting to vaccination sites (6.0% vs. 3.0%), than parents of those without disability. CONCLUSIONS: Adolescents with disability had lower vaccination coverage compared to adolescents without disability. Parents of adolescents with disability reported higher intent to get their adolescents vaccinated, but among unvaccinated adolescents with disability, parents reported greater difficulty in accessing COVID-19 vaccines. Findings highlight the need for prioritized outreach to increase COVID-19 vaccination for this population. |
Racial disparities, risk factors, and clinical management practices for tinea capitis: An observational cohort study among U.S. children with Medicaid
Hennessee IP , Benedict K , Dulski TM , Lipner SR , Gold JAW . J Am Acad Dermatol 2023 89 (6) 1261-1264 Tinea capitis (TC), a common childhood scalp and hair dermatophytosis, is associated with lower socioeconomic status,1 54 but national data on TC incidence and risk factors among children from lower income | 55 households are lacking to guide public health efforts and clinical care. We estimated incidence, assessed | 56 risk factors, and described clinical practices for TC among a large U.S. cohort of Medicaid-insured | 57 children. | In the MerativeTM MarketScan® Multi-State Medicaid Database* 58 , we identified TC cases among children | <18 years, underlying conditions, and TC-related diagnostic testing† 59 (Supplemental Table, available via | 60 Mendeley at https://data.mendeley.com/datasets/7wz5p6bxk3/1). We calculated one-year TC incidence | 61 overall and by race/ethnicity, age, and underlying health conditions. We used Poisson regression to | 62 assess associations between risk factors and TC incidence and compared TC diagnostic and treatment | 63 patterns by race/ethnicity using chi-square tests (α=0.05). |
Transmission of yellow fever vaccine virus through blood transfusion and organ transplantation in the USA in 2021: Report of an investigation
Gould CV , Free RJ , Bhatnagar J , Soto RA , Royer TL , Maley WR , Moss S , Berk MA , Craig-Shapiro R , Kodiyanplakkal RPL , Westblade LF , Muthukumar T , Puius YA , Raina A , Hadi A , Gyure KA , Trief D , Pereira M , Kuehnert MJ , Ballen V , Kessler DA , Dailey K , Omura C , Doan T , Miller S , Wilson MR , Lehman JA , Ritter JM , Lee E , Silva-Flannery L , Reagan-Steiner S , Velez JO , Laven JJ , Fitzpatrick KA , Panella A , Davis EH , Hughes HR , Brault AC , St George K , Dean AB , Ackelsberg J , Basavaraju SV , Chiu CY , Staples JE . Lancet Microbe 2023 4 (9) e711-e721 BACKGROUND: In 2021, four patients who had received solid organ transplants in the USA developed encephalitis beginning 2-6 weeks after transplantation from a common organ donor. We describe an investigation into the cause of encephalitis in these patients. METHODS: From Nov 7, 2021, to Feb 24, 2022, we conducted a public health investigation involving 15 agencies and medical centres in the USA. We tested various specimens (blood, cerebrospinal fluid, intraocular fluid, serum, and tissues) from the organ donor and recipients by serology, RT-PCR, immunohistochemistry, metagenomic next-generation sequencing, and host gene expression, and conducted a traceback of blood transfusions received by the organ donor. FINDINGS: We identified one read from yellow fever virus in cerebrospinal fluid from the recipient of a kidney using metagenomic next-generation sequencing. Recent infection with yellow fever virus was confirmed in all four organ recipients by identification of yellow fever virus RNA consistent with the 17D vaccine strain in brain tissue from one recipient and seroconversion after transplantation in three recipients. Two patients recovered and two patients had no neurological recovery and died. 3 days before organ procurement, the organ donor received a blood transfusion from a donor who had received a yellow fever vaccine 6 days before blood donation. INTERPRETATION: This investigation substantiates the use of metagenomic next-generation sequencing for the broad-based detection of rare or unexpected pathogens. Health-care workers providing vaccinations should inform patients of the need to defer blood donation for at least 2 weeks after receiving a yellow fever vaccine. Despite mitigation strategies and safety interventions, a low risk of transfusion-transmitted infections remains. FUNDING: US Centers for Disease Control and Prevention (CDC), the Biomedical Advanced Research and Development Authority, and the CDC Epidemiology and Laboratory Capacity Cooperative Agreement for Infectious Diseases. |
Retrospective review of blood culture-confirmed cases of enteric fever in Navi Mumbai, India: 2014-2018
Jayaprasad N , Borhade P , LeBoa C , Date K , Joshi S , Shimpi R , Andrews JR , Luby SP , Hoffman SA . Am J Trop Med Hyg 2023 109 (3) 571-574 India has one of the highest estimated burdens of enteric fever globally. Prior to the implementation of Typbar-TCV typhoid conjugate vaccine (TCV) in a public sector pediatric immunization campaign in Navi Mumbai, India, we conducted a retrospective review of blood culture-confirmed cases of typhoid and paratyphoid fevers to estimate the local burden of disease. This review included all blood cultures processed at a central microbiology laboratory, serving multiple hospitals, in Navi Mumbai (January 2014-May 2018) that tested positive for either Salmonella Typhi or Salmonella Paratyphi A. Of 40,670 blood cultures analyzed, 1,309 (3.2%) were positive for S. Typhi (1,201 [92%]) or S. Paratyphi A (108 [8%]). Culture positivity was highest in the last months of the dry season (April-June). Our findings indicate a substantial burden of enteric fever in Navi Mumbai and support the importance of TCV immunization campaigns and improved water, sanitation, and hygiene. |
Ebola vaccine uptake and attitudes among healthcare workers in North Kivu, Democratic Republic of the Congo, 2021
Doshi RH , Garbern SC , Kulkarni S , Perera SM , Fleming MK , Muhayangabo RF , Ombeni AB , Tchoualeu DD , Kallay R , Song E , Powell J , Gainey M , Glenn B , Mutumwa RM , Hans Bateyi Mustafa S , Earle-Richardson G , Gao H , Abad N , Soke GN , Fitter DL , Hyde TB , Prybylski D , Levine AC , Jalloh MF , Mbong EN . Front Public Health 2023 11 1080700 INTRODUCTION: During the 2018-2020 Ebola virus disease (EVD) outbreak in the eastern part of the Democratic Republic of the Congo (DRC), prevention and control measures, such as Ebola vaccination were challenging by community mistrust. We aimed to understand perceptions regarding Ebola vaccination and identify determinants of Ebola vaccine uptake among HCWs. METHODS: In March 2021, we conducted a cross-sectional survey among 438 HCWs from 100 randomly selected health facilities in three health zones (Butembo, Beni, Mabalako) affected by the 10th EVD outbreak in North Kivu, DRC. HCWs were eligible if they were ≥ 18 years and were working in a health facility during the outbreak. We used survey logistic regression to assess correlates of first-offer uptake (i.e., having received the vaccine the first time it was offered vs. after subsequent offers). RESULTS: Of the 438 HCWs enrolled in the study, 420 (95.8%) reported that they were eligible and offered an Ebola vaccine. Among those offered vaccination, self-reported uptake of the Ebola vaccine was 99.0% (95% confidence interval (CI) [98.5-99.4]), but first-offer uptake was 70.2% (95% CI [67.1, 73.5]). Nearly all HCWs (94.3%; 95% CI [92.7-95.5]) perceived themselves to be at risk of contracting EVD. The most common concern was that the vaccine would cause side effects (65.7%; 95% CI [61.4-69.7]). In the multivariable analysis, mistrust of the vaccine source or how the vaccine was produced decreased the odds of first-time uptake. DISCUSSION: Overall uptake of the Ebola vaccine was high among HCWs, but uptake at the first offer was substantially lower, which was associated with mistrust of the vaccine source. Future Ebola vaccination efforts should plan to make repeated vaccination offers to HCWs and address their underlying mistrust in the vaccines, which can, in turn, improve community uptake. |
Complexity of options related to restarting oral poliovirus vaccine (OPV) in national immunization programs after OPV cessation
Kalkowska DA , Wassilak SG , Wiesen E , FEstivariz C , Burns CC , Badizadegan K , Thompson KM . Gates Open Res 2023 7 55 Background: The polio eradication endgame continues to increase in complexity. With polio cases caused by wild poliovirus type 1 and circulating vaccine-derived polioviruses of all three types (1, 2 and 3) reported in 2022, the number, formulation, and use of poliovirus vaccines poses challenges for national immunization programs and vaccine suppliers. Prior poliovirus transmission modeling of globally-coordinated type-specific cessation of oral poliovirus vaccine (OPV) assumed creation of Sabin monovalent OPV (mOPV) stockpiles for emergencies and explored the potential need to restart OPV if the world reached a specified cumulative threshold number of cases after OPV cessation. Methods: We document the actual experience of type 2 OPV (OPV2) cessation and reconsider prior modeling assumptions related to OPV restart. We develop updated decision trees of national immunization options for poliovirus vaccines considering different possibilities for OPV restart. Results: While OPV restart represented a hypothetical situation for risk management and contingency planning to support the 2013-2018 Global Polio Eradication Initiative (GPEI) Strategic Plan, the actual epidemiological experience since OPV2 cessation raises questions about what, if any, trigger(s) could lead to restarting the use of OPV2 in routine immunization and/or plans for potential future restart of type 1 and 3 OPV after their respective cessation. The emergency use listing of a genetically stabilized novel type 2 OPV (nOPV2) and continued evaluation of nOPV for types 1 and/or 3 add further complexity by increasing the combinations of possible OPV formulations for OPV restart. Conclusions: Expanding on a 2019 discussion of the logistical challenges and implications of restarting OPV, we find a complex structure of the many options and many issues related to OPV restart decisions and policies as of early 2023. We anticipate many challenges for forecasting prospective vaccine supply needs during the polio endgame due to increasing potential combinations of poliovirus vaccine choices. |
Notes from the field: Safety monitoring of Novavax COVID-19 vaccine among persons aged 12 years - United States, July 13, 2022-March 13, 2023
Romanson B , Moro PL , Su JR , Marquez P , Nair N , Day B , DeSantis A , Shimabukuro TT . MMWR Morb Mortal Wkly Rep 2023 72 (31) 850-851 The NVX-CoV2373 (Novavax) COVID-19 vaccine is a recombinant spike protein nanoparticle vaccine with Matrix-M adjuvant. Novavax is authorized and recommended as a primary 2-dose monovalent vaccination series in persons aged ≥12 years to prevent COVID-19 and as a monovalent booster dose in persons aged ≥18 years who are unable to or unwilling to receive an mRNA COVID-19 bivalent vaccine (1). | | Top | | Investigation and Outcomes | During July 13, 2022–March 13, 2023, a total of 69,227 Novavax doses were administered to persons aged ≥12 years in the United States, and 230 reports of adverse events (AEs) after Novavax vaccination were received by the Vaccine Adverse Event Reporting System (VAERS) (2). The median age of patients in the reports was 45 years (IQR = 31–61 years); 152 (66.1%) reports concerned females, and 104 (45.2%) concerned non-Hispanic White persons (Table). Within the study period, VAERS received no reports concerning pregnant women. Most VAERS reports (211; 91.7%) were classified as nonserious.* The most commonly reported AEs included dizziness (33; 14.3%), fatigue (26; 11.3%), and headache (25; 10.9%). |
Comparing Amyotrophic lateral sclerosis (ALS) patient characteristics from the National ALS Registry and the Massachusetts ALS Registry, data through 2015
Raymond J , Punjani R , Larson T , Berry JD , Horton DK , Mehta P . Amyotroph Lateral Scler Frontotemporal Degener 2023 1-8 OBJECTIVE: To compare, for completeness, ALS patients identified in the National ALS Registry (National Registry) from MA to those in the Massachusetts ALS Registry (MA Registry) through 2015. METHODS: Sensitivity analyses were conducted to determine the completeness among patients reported in both registries. Patients were matched on first and last name, month and year of birth, sex, as well as Soundex name matching. Demographics for matching and nonmatching ALS patients were also examined using bivariate analyses and logistic regression. RESULTS: There were 1,042 ALS patients in the MA Registry, and 642 patients matched (61.6%) in the National Registry. Sensitivity analyses found the National Registry had a sensitivity of 87.7% and specificity of 60%. For these matched patients, 522 (81.2%) came from Medicare. Of the 400 patients in the MA Registry not matched to the National Registry, 11.1% were nonwhite, compared to 6.0% in the matched group) (p = 0.0091) and 59.2% were diagnosed before age 60, compared to 28.6% in the matched group (p < 0.0001). Multivariate logistic regression analysis showed being an ALS case (p < 0.0001) and having an ALS diagnosis at age 60 or later (p < 0.0001) were associated with being more likely to match between the two registries. CONCLUSIONS: These findings show that ALS's non-notifiable condition status at the national level continues to pose a challenge in identifying all ALS patients. This analysis also showed missing cases at the state level even with a reporting statute. Additional strategies are needed for better patient-ascertainment to quantify all ALS patients in the U.S. |
Positive predictive value of International Classification of Diseases, Ninth Revision, Clinical Modification, and International Classification of Diseases, Tenth Revision, Clinical Modification, codes for identification of congenital heart defects
Ivey LC , Rodriguez FH 3rd , Shi H , Chong C , Chen J , Raskind-Hood CL , Downing KF , Farr SL , Book WM . J Am Heart Assoc 2023 12 (16) e030821 Background Administrative data permit analysis of large cohorts but rely on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes that may not reflect true congenital heart defects (CHDs). Methods and Results CHDs in 1497 cases with at least 1 encounter between January 1, 2010 and December 31, 2019 in 2 health care systems, identified by at least 1 of 87 ICD-9-CM/ICD-10-CM CHD codes were validated through medical record review for the presence of CHD and CHD native anatomy. Interobserver and intraobserver reliability averaged >95%. Positive predictive value (PPV) of ICD-9-CM/ICD-10-CM codes for CHD was 68.1% (1020/1497) overall, 94.6% (123/130) for cases identified in both health care systems, 95.8% (249/260) for severe codes, 52.6% (370/703) for shunt codes, 75.9% (243/320) for valve codes, 73.5% (119/162) for shunt and valve codes, and 75.0% (39/52) for "other CHD" (7 ICD-9-CM/ICD-10-CM codes). PPV for cases with >1 unique CHD code was 85.4% (503/589) versus 56.3% (498/884) for 1 CHD code. Of cases with secundum atrial septal defect ICD-9-CM/ICD-10-CM codes 745.5/Q21.1 in isolation, PPV was 30.9% (123/398). Patent foramen ovale was present in 66.2% (316/477) of false positives. True positives had younger mean age at first encounter with a CHD code than false positives (22.4 versus 26.3 years; P=0.0017). Conclusions CHD ICD-9-CM/ICD-10-CM codes have modest PPV and may not represent true CHD cases. PPV was improved by selecting certain features, but most true cases did not have these characteristics. The development of algorithms to improve accuracy may improve accuracy of electronic health records for CHD surveillance. |
Simulation models for suicide prevention: A survey of the state-of-the-art
Schuerkamp R , Liang L , Rice KL , Giabbanelli PJ . Computers 2023 12 (7) Suicide is a leading cause of death and a global public health problem, representing more than one in every 100 deaths in 2019. Modeling and Simulation (M&S) is widely used to address public health problems, and numerous simulation models have investigated the complex, dependent, and dynamic risk factors contributing to suicide. However, no review has been dedicated to these models, which prevents modelers from effectively learning from each other and raises the risk of redundant efforts. To guide the development of future models, in this paper we perform the first scoping review of simulation models for suicide prevention. Examining ten articles, we focus on three practical questions. First, which interventions are supported by previous models? We found that four groups of models collectively support 53 interventions. We examined these interventions through the lens of global recommendations for suicide prevention, highlighting future areas for model development. Second, what are the obstacles preventing model application? We noted the absence of cost effectiveness in all models reviewed, meaning that certain simulated interventions may be infeasible. Moreover, we found that most models do not account for different effects of suicide prevention interventions across demographic groups. Third, how much confidence can we place in the models? We evaluated models according to four best practices for simulation, leading to nuanced findings that, despite their current limitations, the current simulation models are powerful tools for understanding the complexity of suicide and evaluating suicide prevention interventions. © 2023 by the authors. |
Special report from the CDC: Provider knowledge and practices around driving safety and fall prevention screening and recommendations for their older adult patients, DocStyles 2019
Ortmann N , Haddad YK , Beck L . J Safety Res 2023 86 401-408 Introduction: Falls and motor-vehicle crashes (MVCs) are leading causes of unintentional injury deaths among older adults (65+) in the United States. Injury prevention resources exist to help healthcare providers reduce fall and MVC risk among older adult patients. However, awareness of these resources among healthcare providers is unclear. Methods: Questions were included in the 2019 DocStyles survey that assessed healthcare provider awareness of three injury prevention resources: (1) the American Geriatrics Society's (AGS's) Clinician's Guide to Assessing and Counseling Older Drivers, (2) the Clinical Assessment of Driving Related Skills (CADReS), and (3) the Centers for Disease Control and Prevention's (CDC) Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. We also explored the circumstances and current practices for counseling older adult patients on fall prevention and driving safety. Results: Only 20% of providers reported awareness of any of the injury prevention resources. Providers were more likely to report either screening for fall risk or unsafe driving when an older adult presented with a fall concern (74.5%) or driving concern or recent crash (85.1%), compared to annual screening for fall risk (67.7%) or driving safety (47.7%). More providers reported discussing the increased fall or MVC risk associated with patient medications, referring patient for driving fitness evaluations, or discussing alternative transportation options with the patient after adverse events or patient-initiated concerns compared to routine annual discussions. Conclusion: Healthcare gaps persist in the screening and assessment of older adult risk factors for falls and unsafe driving. Limited provider awareness of clinical resources related to preventing older adult falls and unsafe driving may be contributing to these healthcare gaps. Practical Applications: Improving healthcare provider awareness of these resources could help them identify older adults at risk of a fall or MVC and promote injury prevention efforts in their clinical practices. © 2023 National Safety Council and Elsevier Ltd |
Characterization of a multi-stage focusing nozzle for collection of spot samples for aerosol chemical analysis
Zervaki O , Dionysiou DD , Kulkarni P . J Aerosol Sci 2023 174 Concentrated collection of aerosol particles on a substrate is essential for their chemical analysis using various microscopy and laser spectroscopic techniques. An impaction-based aerosol concentration system was developed for focused collection of particles using a multi-stage nozzle that consists of a succession of multiple smooth converging stages. Converging sections of the nozzle were designed to focus and concentrate a particle diameter range of 900–2500 nm into a relatively narrower particle beam to obtain particulate deposits with spot diameters of 0.5–1.56 mm. A slightly diverging section before the last contractions was included to allow for better focusing of particles at the lower end of the collectable diameter range. The characterization of this multi-stage nozzle and the impaction-based aerosol concentration system was accomplished both numerically and experimentally. The numerical and experimental trends in collection efficiency and spot diameters agreed well qualitatively; however, the quantitative agreement between numerical and experimental results for wall losses was poor, particularly for larger particle diameters. The resulting concentrated particulate deposit, a spot sample, was analysed using Raman spectroscopy to probe the effect of spot size on analytical sensitivity of measurement. The method's sensitivity was compared against other conventional techniques, such as filtration and aerosol focused impaction, implementing condensational growth. Impaction encompassing the multi-stage focusing nozzle is the only method that can ensure high sensitivity at Reynolds numbers greater than 2000, that can be supported by small pumps which renders such method suitable for portable instrumentation. © 2023 |
Single-dose mucosal replicon-particle vaccine protects against lethal Nipah virus infection up to 3 days after vaccination
Welch SR , Spengler JR , Genzer SC , Coleman-McCray JD , Harmon JR , Sorvillo TE , Scholte FEM , Rodriguez SE , O'Neal TJ , Ritter JM , Ficarra G , Davies KA , Kainulainen MH , Karaaslan E , Bergeron É , Goldsmith CS , Lo MK , Nichol ST , Montgomery JM , Spiropoulou CF . Sci Adv 2023 9 (31) eadh4057 Nipah virus (NiV) causes a highly lethal disease in humans who present with acute respiratory or neurological signs. No vaccines against NiV have been approved to date. Here, we report on the clinical impact of a novel NiV-derived nonspreading replicon particle lacking the fusion (F) protein gene (NiVΔF) as a vaccine in three small animal models of disease. A broad antibody response was detected that included immunoglobulin G (IgG) and IgA subtypes with demonstrable Fc-mediated effector function targeting multiple viral antigens. Single-dose intranasal vaccination up to 3 days before challenge prevented clinical signs and reduced virus levels in hamsters and immunocompromised mice; decreases were seen in tissues and mucosal secretions, critically decreasing potential for virus transmission. This virus replicon particle system provides a vital tool to the field and demonstrates utility as a highly efficacious and safe vaccine candidate that can be administered parenterally or mucosally to protect against lethal Nipah disease. |
The modified clinical progression scale for pediatric patients: Evaluation as a severity metric and outcome measure in severe acute viral respiratory illness
Leland SB , Staffa SJ , Newhams MM , Khemani RG , Marshall JC , Young CC , Maddux AB , Hall MW , Weiss SL , Schwarz AJ , Coates BM , Sanders RC Jr , Kong M , Thomas NJ , Nofziger RA , Cullimore ML , Halasa NB , Loftis LL , Cvijanovich NZ , Schuster JE , Flori H , Gertz SJ , Hume JR , Olson SM , Patel MM , Zurakowski D , Randolph AG . Pediatr Crit Care Med 2023 24 (12) 998-1009 OBJECTIVES: To develop, evaluate, and explore the use of a pediatric ordinal score as a potential clinical trial outcome metric in children hospitalized with acute hypoxic respiratory failure caused by viral respiratory infections. DESIGN: We modified the World Health Organization Clinical Progression Scale for pediatric patients (CPS-Ped) and assigned CPS-Ped at admission, days 2-4, 7, and 14. We identified predictors of clinical improvement (day 14 CPS-Ped ≤ 2 or a three-point decrease) using competing risks regression and compared clinical improvement to hospital length of stay (LOS) and ventilator-free days. We estimated sample sizes (80% power) to detect a 15% clinical improvement. SETTING: North American pediatric hospitals. PATIENTS: Three cohorts of pediatric patients with acute hypoxic respiratory failure receiving intensive care: two influenza (pediatric intensive care influenza [PICFLU], n = 263, 31 sites; PICFLU vaccine effectiveness [PICFLU-VE], n = 143, 17 sites) and one COVID-19 (n = 237, 47 sites). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Invasive mechanical ventilation rates were 71.4%, 32.9%, and 37.1% for PICFLU, PICFLU-VE, and COVID-19 with less than 5% mortality for all three cohorts. Maximum CPS-Ped (0 = home at respiratory baseline to 8 = death) was positively associated with hospital LOS (p < 0.001, all cohorts). Across the three cohorts, many patients' CPS-Ped worsened after admission (39%, 18%, and 49%), with some patients progressing to invasive mechanical ventilation or death (19%, 11%, and 17%). Despite this, greater than 76% of patients across cohorts clinically improved by day 14. Estimated sample sizes per group using CPS-Ped to detect a percentage increase in clinical improvement were feasible (influenza 15%, n = 142; 10%, n = 225; COVID-19, 15% n = 208) compared with mortality (n > 21,000, all), and ventilator-free days (influenza 15%, n = 167). CONCLUSIONS: The CPS-Ped can be used to describe the time course of illness and threshold for clinical improvement in hospitalized children and adolescents with acute respiratory failure from viral infections. This outcome measure could feasibly be used in clinical trials to evaluate in-hospital recovery. |
Maternal physical activity, sitting, and risk of non-cardiac birth defects
Evenson KR , Mowla S , Olshan AF , Shaw GM , Ailes EC , Reefhuis J , Joshi N , Desrosiers TA . Pediatr Res 2023 BACKGROUND: The relationship between maternal physical activity (PA)/sitting and birth defects is largely unexplored. We examined whether pre-pregnancy PA/sitting were associated with having a pregnancy affected by a birth defect. METHODS: We used data from two United States population-based case-control studies: 2008-2011 deliveries from the National Birth Defects Prevention Study (NBDPS; 9 states) and 2014-2018 deliveries from the Birth Defects Study To Evaluate Pregnancy exposureS (BD-STEPS; 7 states). Cases with one of 12 non-cardiac birth defects (n = 3798) were identified through population-based registries. Controls (n = 2682) were live-born infants without major birth defects randomly sampled using vital/hospital records. Mothers self-reported pre-pregnancy PA/sitting. Unconditional logistic regression models estimated associations between PA/sitting categories and the 12 birth defects. RESULTS: Mothers engaging in pre-pregnancy PA was associated with a reduced odds of five (spina bifida, cleft palate, anorectal atresia, hypospadias, transverse limb deficiency) and a higher odds of two (anencephaly, gastroschisis) birth defects. Mothers spending less time sitting in pre-pregnancy was associated with a reduced odds of two (anorectal atresia, hypospadias) and a higher odds of one (cleft lip with or without cleft palate) birth defect. CONCLUSIONS: Reasonable next steps include replication of these findings, improved exposure assessment, and elucidation of biologic mechanisms. IMPACT: Using data from two population-based case-control studies, we found that mothers engaging in different types of physical activity in the 3 months before pregnancy had an infant with a reduced odds of five and a higher odds of two birth defects. Mothers spending less time sitting in the 3 months before pregnancy had an infant with a reduced odds of two and a higher odds of one birth defect. Clarification and confirmation from additional studies are needed using more precise exposure measures, distinguishing occupational from leisure-time physical activity, and elucidation of mechanisms supporting these associations. |
Post-discharge risk of mortality in children under 5 years of age in western Kenya: A retrospective cohort study
Kwambai TK , Kariuki S , Smit MR , Nevitt S , Onyango E , Oneko M , Khagayi S , Samuels AM , Hamel MJ , Laserson K , Desai M , Ter Kuile FO . Am J Trop Med Hyg 2023 109 (3) 704-712 Limited evidence suggests that children in sub-Saharan Africa hospitalized with all-cause severe anemia or severe acute malnutrition (SAM) are at high risk of dying in the first few months after discharge. We aimed to compare the risks of post-discharge mortality by health condition among hospitalized children in an area with high malaria transmission in western Kenya. We conducted a retrospective cohort study among recently discharged children aged < 5 years using mortality data from a health and demographic surveillance system that included household and pediatric in-hospital surveillance. Cox regression was used to compare post-discharge mortality. Between 2008 and 2013, overall in-hospital mortality was 2.8% (101/3,639). The mortality by 6 months after discharge (primary outcome) was 6.2% (159/2,556) and was highest in children with SAM (21.6%), followed by severe anemia (15.5%), severe pneumonia (5.6%), "other conditions" (5.6%), and severe malaria (0.7%). Overall, the 6-month post-discharge mortality in children hospitalized with SAM (hazard ratio [HR] = 3.95, 2.60-6.00, P < 0.001) or severe anemia (HR = 2.55, 1.74-3.71, P < 0.001) was significantly higher than that in children without these conditions. Severe malaria was associated with lower 6-month post-discharge mortality than children without severe malaria (HR = 0.33, 0.21-0.53, P < 0.001). The odds of dying by 6 months after discharge tended to be higher than during the in-hospital period for all children, except for those admitted with severe malaria. The first 6 months after discharge is a high-risk period for mortality among children admitted with severe anemia and SAM in western Kenya. Strategies to address this risk period are urgently needed. |
Associations between comfort eating and weight change during the COVID-19 pandemic among U.S. adults
Ederer DJ , Lee SH , Belay B , Boutelle K , Park S . Human Nutrition and Metabolism 2023 33 (no pagination) Objective: To examine associations between comfort eating in response to loneliness or stress and weight change during the COVID-19 pandemic among U.S. adults. Design(s): Quantitative, cross-sectional study. Setting(s): The 2021 SummerStyles survey data. Subjects: U.S. adults (>=18 years; N = 4068). Measures: The outcome was reported weight changes since the start of the COVID-19 pandemic with four responses: lost weight, weight remained the same, gained weight, and don't know. The exposure variable was frequency of comfort eating in response to loneliness or stress during the past year with three responses: never/rarely, sometimes, or often/always. Analysis: We used chi-square analysis to examine the independence of survey variables related to weight changes, and comfort eating in response to loneliness or stress during the COVID-19 pandemic. Next, we used a multinomial logistic regression to estimate adjusted odds ratios for weight changes by comfort eating in response to loneliness or stress frequency. Result(s): Overall, 20.1% of adults reported losing weight, 39.9% remained about the same weight, 30.4% gained weight, and 9.4% did not know about their weight change during the COVID-19 pandemic. Taking comfort by eating in response to loneliness or stress was reported by over 33% of participants (often/always = 8.3%; sometimes = 25.3%). Weight change and comfort eating during the COVID-19 pandemic significantly varied by sociodemographic factors. Respondents that sometimes or often/always reported taking comfort by eating in response to loneliness or stress were more likely to report losing weight (Adjusted Odds Ratio ranges: 1.62-2.99) or gaining weight (Adjusted Odds Ratio ranges: 3.10-4.61) than those who never/rarely took comfort by eating in response to loneliness or stress. Conclusion(s): Taking comfort by eating when stressed/lonely was significantly associated with reported weight changes during the COVID-19 pandemic. Weight changes may lead to additional health complications. Implementing evidence-based strategies to reduce loneliness or stress and support healthy eating during the COVID-19 pandemic may benefit weight management and future well-being. Copyright © 2023 |
The challenge of defining the global burden of iron deficiency anaemia
Young MF , Luo H , Suchdev PS . Lancet Haematol 2023 10 (9) e702-e704 Despite decades of research and programmatic focus, | anaemia is a persistent global health problem and | can have negative health implications across the | lifecycle, including impaired child development and | work productivity and increased risk of adverse birth | outcomes, morbidity and mortality.1,2 | In The Lancet Haematology, the GBD 2021 Anaemia | Collaborators use 2021 data from the Global Burden | of Disease, Injuries and Risk Factors Study (GBD 2021) | to report that nearly one in four individuals worldwide | have anaemia, with notable differences by age, sex, | and geography.3 | The most common estimated causes | of anaemia were dietary iron deficiency, haemoglobinopathies and haemolytic anaemias, and other | neglected tropical diseases; iron deficiency alone | contributed up to 66% of the total anaemia burden. | These findings highlight the crucial role of nutrition in | reducing anaemia. Although iron deficiency has long been | considered a leading cause of anaemia, estimates vary | widely across reports and settings. GBD 2021 presents | the most comprehensive and current analysis of anaemia | burden and causes globally; however, some researchers | have questioned how micronutrient deficiencies, | including iron deficiency, are estimated in the GBD | analyses.4 | Rather than estimating iron deficiency using | valid inflammation-adjusted micronutrient biomarker | data from representative surveys, GBD 2021 used | complex statistical modelling.3 | In brief, spatiotemporal | Gaussian process regression models were used to estimate | the prevalence of anaemia and predictive covariates | were modelled using separate mixed-effects linear | regression to create an ensemble model. Iron deficiency | was modelled as a residual cause, which assumes that | the causal attribution not explained by other causes of | anaemia was due to iron deficiency. The comparability of | the GBD modelling approach to a biomarker approach for | estimating iron deficiency is unclear. |
The Diesel Exhaust in Miners Study (DEMS) II: Temporal factors related to diesel exhaust exposure and lung cancer mortality in the Nested Case-Control Study
Silverman DT , Bassig BA , Lubin J , Graubard B , Blair A , Vermeulen R , Attfield M , Appel N , Rothman N , Stewart P , Koutros S . Environ Health Perspect 2023 131 (8) 87002 BACKGROUND: The Diesel Exhaust in Miners Study (DEMS) was an important contributor to the International Agency for Research on Cancer reclassification of diesel exhaust as a Group I carcinogen and subsequent risk assessment. We extended the DEMS cohort follow-up by 18 y and the nested case-control study to include all newly identified lung cancer deaths and matched controls (DEMS II), nearly doubling the number of lung cancer deaths. OBJECTIVE: Our purpose was to characterize the exposure-response relationship with a focus on the effects of timing of exposure and exposure cessation. METHODS: We conducted a case-control study of lung cancer nested in a cohort of 12,315 workers in eight nonmetal mines (376 lung cancer deaths, 718 controls). Controls were selected from workers who were alive when the case died, individually matched on mine, sex, race/ethnicity, and birth year (within 5 y). Based on an extensive historical exposure assessment, we estimated respirable elemental carbon (REC), an index of diesel exposure, for each cohort member. Odds ratios (ORs) were estimated by conditional regression analyses controlling for smoking and other confounders. To evaluate time windows of exposure, we evaluated the joint OR patterns for cumulative REC within each of four preselected exposure time windows, < 5, 5-9, 10-19, and ≥ 20 y prior to death/reference date, and we evaluated the interaction of cumulative exposure across time windows under additive and multiplicative forms for the joint association. RESULTS: ORs increased with increasing 15-y lagged cumulative exposure, peaking with a tripling of risk for exposures of ∼ 950 to < 1,700 μg/m3-y [OR = 3.23; 95% confidence interval (CI): 1.47, 7.10], followed by a plateau/decline among the heavily exposed (OR = 1.85; 95% CI: 0.85, 4.04). Patterns of risk by cumulative REC exposure varied across four exposure time windows (phomogeneity < 0.001), with ORs increasing for exposures accrued primarily 10-19 y prior to death (ptrend < 0.001). Results provided little support for a waning of risk among workers whose exposures ceased for ≥ 20 y. CONCLUSION: DEMS II findings provide insight into the exposure-response relationship between diesel exhaust and lung cancer mortality. The pronounced effect of exposures occurring in the window 10-19 y prior to death, the sustained risk 20 or more years after exposure ceases, and the plateau/decline in risk among the most heavily exposed provide direction for future research on the mechanism of diesel-induced carcinogenesis in addition to having important implications for the assessment of risk from diesel exhaust by regulatory agencies. https://doi.org/10.1289/EHP11980. |
Exposure risks and potential control measures for a fire behavior lab training structure: part b-chemical gas concentrations
Horn GP , Stakes K , Neumann D , Madrzykowski D , Fent KW . Fire Technol 2023 [Epub ahead of print] Firefighters' or instructors' exposure to airborne chemicals during live-fire training may depend on fuels being burned, fuel orientation and participants' location within the structure. This study was designed to evaluate the impact of different control measures on exposure risk to combustion byproducts during fire dynamics training where fuel packages are mounted at or near the ceiling. These measures included substitution of training fuels (low density wood fiberboard, oriented strand board (OSB), pallets, particle board, plywood) and adoption of engineering controls such as changing the location of the instructor and students using the structure. Experiments were conducted for two different training durations: the typical six ventilation cycle (six-cycle) and a shorter three ventilation cycle (three-cycle) with a subset of training fuels. In Part A of this series, we characterized the fire dynamics within the structure, including the ability of each fuel to provide an environment that achieves the training objectives. Here, in Part B, airborne chemical concentrations are reported at the location where fire instructors would typically be operating. We hypothesized that utilizing a training fuel package with solid wood pallets would result in lower concentrations of airborne contaminants at the rear instructor location than wood-based sheet products containing additional resins and/or waxes. In the six-cycle experiments (at the rear instructor location), OSB-fueled fires produced the highest median concentrations of benzene and 1,3 butadiene, plywood-fueled fires produced the highest total polycyclic aromatic hydrocarbon (PAH) concentrations, particle board-fueled fires produced the highest methyl isocyanate concentrations, and pallet-fueled fires produced the highest hydrogen chloride concentrations. All fuels other than particle board produced similarly high levels of formaldehyde at the rear instructor location. The OSB fuel package created the most consistent fire dynamics over six-cycles, while fiberboard resulted in consistent fire dynamics only for the first three cycles. In the follow-on three-cycle experiment, PAH, benzene, and aldehyde concentrations were similar for the OSB and fiberboard-fueled fires. Air sampling did not identify any clear differences between training fires from burning solid wood pallets and those that incorporate wood-based sheet products for this commonly employed fuel arrangement with fuels mounted high in the compartment. However, it was found that exposure can be reduced by moving firefighters and instructors lower in the compartment and/or by moving the instructor in charge of ventilation from the rear of the structure (where highest concentrations were consistently measured) to an outside position. |
Construction industry workers compensation injury claims due to slips, trips, and falls Ohio, 20102017
Socias-Morales C , Konda S , Bell JL , Wurzelbacher SJ , Naber SJ , Scott Earnest G , Garza EP , Meyers AR , Scharf T . J Saf Res 2023 Problem: Compared to other industries, construction workers have higher risks for serious fall injuries. This study describes the burden and circumstances surrounding injuries related to compensable slip, trip, and fall (STF) claims from private construction industries covered by the Ohio Bureau of Workers Compensation. Methods: STF injury claims in the Ohio construction industry from 20102017 were manually reviewed. Claims were classified as: slips or trips without a fall (STWOF), falls on the same level (FSL), falls to a lower level (FLL), and other. Claim narratives were categorized by work-related risk and contributing factors. Demographic, employer, and injury characteristics were examined by fall type and claim type (medical-only (MO, 07 days away from work, DAFW) or lost-time (LT, 8 DAFW)). Claim rates per 10,000 estimated full-time equivalent employees (FTEs) were calculated. Results: 9,517 Ohio construction industry STF claims occurred during the 8-year period, with an average annual rate of 75 claims per 10,000 FTEs. The rate of STFs decreased by 37% from 2010 to 2017. About half of the claims were FLL (51%), 29% were FSL, 17% were STWOF, and 3% were other. Nearly 40% of all STF claims were LT; mostly among males (96%). The top three contributing factors for STWOF and FSL were: slip/trip hazards, floor irregularities, and ice/snow; and ladders, vehicles, and stairs/steps for FLL. FLL injury rates per 10,000 FTE were highest in these industries: Foundation, Structure, and Building Exterior Contractors (52); Building Finishing Contractors (45); and Residential Building Construction (45). The highest rate of FLL LT claims occurred in the smallest firms, and the FLL rate decreased as construction firm size increased. Discussion and Practical Applications: STF rates declined over time, yet remain common, requiring prevention activities. Safety professionals should focus on contributing factors when developing prevention strategies, especially high-risk subsectors and small firms. 2023 |
Malaria elimination in Zanzibar: where next
Ali MH , Kitau J , Ali AS , Al-Mafazy AW , Tegegne SG , Ussi O , Musanhu C , Shija SJ , Khatib BO , Mkali H , Mkude S , Makenga G , Kasagama E , Molteni F , Kisoka N , Kitojo C , Serbantez N , Reaves E , Yoti Z . Pan Afr Med J 2023 45 7 In 2018, Zanzibar developed a national malaria strategic plan IV (2018-2023) to guide elimination of malaria by 2023. We assessed progress in the implementation of malaria activities as part of the end-term review of the strategic plan. The review was done between August and October 2022 following the WHO guideline to assess progress made towards malaria elimination, effectiveness of the health systems in delivering malaria case management; and malaria financing. A desk review examined available malaria data, annual work plans and implementation reports for evidence of implemented malaria activities. This was complemented by field visits to selected health facilities and communities by external experts, and interviews with health management teams and inhabitants to authenticate desk review findings. A steady increase in the annual parasite incidence (API) was observed in Zanzibar, from 2.7 (2017) to 3.6 (2021) cases per 1,000 population with marked heterogeneity between areas. However, about 68% of the detected malaria cases were imported into Zanzibar. Malaria case follow-up and investigation increased from <70% in 2017 to 94% and 96% respectively, in 2021. The review noted a 3.7-fold increase of the health allocation in the country's budget, from 31.7 million USD (2017/18) to 117.3 million USD (2022/23) but malaria allocation remained low (<1%). The varying transmission levels in the islands suggest a need for strategic re-orientation of the elimination attempts from a national-wide to a sub-national agenda. We recommend increasing malaria allocation from the health budget to ensure sustainability of malaria elimination interventions. |
Next generation 3D-printed intravaginal ring for prevention of HIV and unintended pregnancy
Young IC , Srinivasan P , Shrivastava R , Janusziewicz R , Thorson A , Cottrell ML , Sellers RS , Sykes C , Schauer A , Little D , Kelley K , Kashuba ADM , Katz D , Pyles RB , García-Lerma JG , Vincent KL , Smith J , Benhabbour SR . Biomaterials 2023 301 122260 Globally, there are 20 million adolescent girls and young women living with HIV who have limited access to long-acting, effective, women-controlled preventative methods. Additionally, although there are many contraceptive methods available, globally, half of all pregnancies remain unintended. Here we report the first 3D-printed multipurpose prevention technology (MPT) intravaginal ring (IVR) for HIV prevention and contraception. We utilized continuous liquid interface production (CLIP™) to fabricate MPT IVRs in a biocompatible silicone-based resin. Etonogestrel (ENG), ethinyl estradiol (EE), and islatravir (ISL) were loaded into the silicone poly(urethane) IVR in a controlled single step drug loading process driven by absorption. ENG/EE/ISL IVR promoted sustained release of drugs for 150 days in vitro and 14 days in sheep. There were no adverse MPT IVR-related findings of cervicovaginal toxicity or changes in vaginal biopsies or microbiome community profiles evaluated in sheep. Furthermore, ISL IVR in macaques promoted sustained release for 28 days with ISL-triphosphate levels above the established pharmacokinetic benchmark of 50-100 fmol/10(6) PBMCs. The ISL IVR was found to be safe and well tolerated in the macaques with no observed mucosal cytokine changes or alterations in peripheral CD4 T-cell populations. Collectively, the proposed MPT IVR has potential to expand preventative choices for young women and girls. |
WHO Framework Convention on Tobacco Control learnings
Cohen JE , Myers ML , Ahluwalia IB . Health Secur 2023 21 (5) 428-429 We are pleased that the World Health Organization (WHO) is developing a pandemic treaty to improve the global response to future pandemics. In their article, De Luca and Ramirez1 rightly argue that a pandemic treaty should be informed by experiences with WHO's existing treaty, the WHO Framework Convention on Tobacco Control (WHO FCTC), which came into force in 2005. However, the authors have mischaracterized the WHO FCTC and made criticisms that could hinder a productive discussion about a treaty for pandemics. | | The authors identify a limited emphasis on “harm reduction” as a key limitation of the WHO FCTC. However, the treaty itself includes “harm reduction strategies” in its definition of tobacco control.2 As the authors indicate, harm reduction encompasses actions “aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely or permanently.”1,3 The WHO FCTC and its guidelines for implementation—which include requiring smoke-free public places; banning tobacco advertising, promotion, and sponsorship; and reducing the attractiveness of tobacco products by limiting flavoring agents—allow the continuation of product use, while reducing t |
Polysubstance use in pregnancy: Surveillance, interventions, and next steps
Park Y , Dang EP , Board A , Gilboa SM , Ondersma SJ , Smid MC , Shakib JH , Mitchell KT , England LJ , Broussard CS , Meaney-Delman D , Iskander J , Kim SY . J Womens Health (Larchmt) 2023 32 (9) 899-904 Substance use during pregnancy increases risk for a wide range of adverse maternal and neonatal health outcomes. Polysubstance use is common among people who use substances during pregnancy; however, the risks of combined substance exposures during pregnancy are poorly understood. In this report, we provide an overview of the activities of the Centers for Disease Control and Prevention (CDC) and partners and identified gaps related to (1) surveillance, (2) routine screening, and (3) prevention of polysubstance use during pregnancy. Efforts by CDC and other partners to reduce polysubstance use during pregnancy can improve the health of pregnant people and their infants and children. |
Use of medication for opioid use disorder among adults with past-year opioid use disorder in the US, 2021
Jones CM , Han B , Baldwin GT , Einstein EB , Compton WM . JAMA Netw Open 2023 6 (8) e2327488 This cross-sectional study uses data from the 2021 National Survey on Drug Use and Health to estimate the receipt of medication for opioid use disorder among US adults with past-year opioid use disorder. | eng |
Changes in tobacco product use among students aged 13 to 15 years in 34 countries, Global Youth Tobacco Survey, 2012-2020
Njie GJ , Kirksey Jones C , Jacques N , Adetokun A , Ross J , Owens A , Anton L , Johns M , Pan L . Prev Chronic Dis 2023 20 E68 INTRODUCTION: Most adults who currently use tobacco start before age 21. Comprehensive, cost-effective strategies and interventions to prevent initiation and encourage tobacco use cessation among youth are critical aspects of protecting youth from the harms of commercial tobacco. We describe changes in current tobacco product use among youth in 34 sites using data from the Global Youth Tobacco Survey (GYTS). METHODS: GYTS is a nationally representative school-based survey of students aged 13 to 15 years. The analysis included 34 sites that completed 2 survey waves during 2012-2020. Prevalence of current tobacco use was assessed for each country. Marginal effects in multivariable logistic regression models were used to estimate adjusted prevalence difference (aPD) between waves. RESULTS: The adjusted prevalence of current tobacco product use remained unchanged in more than 60% of the included sites. For any tobacco use, significant decreases were reported for Bhutan (aPD = -8.1; 95% CI, -12.9 to -3.4), Micronesia (aPD = -7.2; 95% CI, -9.7 to -4.7), San Marino (aPD = -7.0; 95% CI, -11.2 to -2.7), Togo (aPD = -2.7; 95% CI, -4.6 to -0.7), and Panama (aPD = -2.2; 95% CI, -4.1 to -0.4); significant increases were reported for Moldova, Albania, and Paraguay. Current e-cigarette use increased significantly in 7 of 10 sites. CONCLUSION: Data show that progress toward reducing tobacco use among youth stalled during 2012-2020, while e-cigarette use increased in a few sites with available data. |
Contamination control during sample preparation for trace element analysis of electronic cigarette aerosol with inductively coupled plasma-mass spectrometry, Part 2
Pappas RS , Gray N . Spectroscopy (Santa Monica) 2023 38 (7) 6-13 Part 1 of this tutorial addressed how environmental contamination may be minimized by using proper personal analytical practices, sample preparation environmental suggestions, avoidance of glass and low purity quartz contact with samples and standards during sample collection and preparation, and appropriate choices of high purity solvents during sample collection and preparation. Part 2 continues the discussion in terms of minimizing sample contamination issues by using high purity polymer materials for sample collection and preparation, as well as discuss the differences between instrument and method limits of detection (LODs). Accepted and appropriate procedures for calculating method LODs are related to variability in instrument response and unavoidable environmental contamination during even the cleanest sample preparation. Adherence to such practices will help analysts avoid false positives and report results with a high level of confidence. © 2023 Advanstar Communications Inc.. All rights reserved. |
Research Alliance For Veterinary Science and Biodefense BSL-3 Network (RAV3N): Report on network origin and phase i activities
Hunt CL , Landers RSM , Spengler JR , Motroni R , Clavijo A , Zuelke K . Antiviral Res 2023 217 105693 Recent disease events have heightened awareness for the need for collaboration between the nation's public health and veterinary infectious disease communities to improve preparedness for current and future biological threats. To address this need, the U.S. Department of Agriculture's National Bio- and Agro-Defense Facility (USDA NBAF) has partnered with Texas A&M University through its Global Health Research Complex (TAMGHRC) to establish the Research Alliance for Veterinary Science and Biodefense BSL-3 Network (RAV3N). As a collaborative network of U.S. university and federal BSL-3Ag/BSL-3/BSL-4 laboratory research facilities, the objective of RAV3N is to establish strategic and coordinated approaches for harnessing collective large-animal biocontainment infrastructure and research capacity to improve bio-surveillance, diagnostics, and countermeasure development against high-consequence pathogens of veterinary and zoonotic importance. Here, we describe the origin and development of RAV3N, detail phase I activities, and summarize the proceedings of its first membership meeting held in August 2022. |
Fleaborne typhus-associated deaths - Los Angeles County, California, 2022
Alarcón J , Sanosyan A , Contreras ZA , Ngo VP , Carpenter A , Hacker JK , Probert WS , Terashita D , Balter S , Halai UA . MMWR Morb Mortal Wkly Rep 2023 72 (31) 838-843 Fleaborne typhus (also known as murine typhus), a widely distributed vectorborne zoonosis caused by Rickettsia typhi, is a moderately severe, but infrequently fatal illness; among patients who receive doxycycline, the case-fatality rate is <1%. Fleaborne typhus is a mandated reportable condition in California. Reported fleaborne typhus cases in Los Angeles County have been increasing since 2010, with the highest number (171) reported during 2022. During June-October 2022, Los Angeles County Department of Public Health learned of three fleaborne typhus-associated deaths. This report describes the clinical presentation, illness course, and methods used to diagnose fleaborne typhus in these three cases. Severe fleaborne typhus manifestations among these cases included hemophagocytic lymphohistiocytosis, a rare immune hyperactivation syndrome that can occur in the infection setting; myocarditis; and septic shock with disseminated intravascular coagulation. Increased health care provider and public health awareness of the prevalence and severity of fleaborne typhus and of the importance of early doxycycline therapy is essential for prevention and treatment efforts. |
Development of a neutralization assay using a vesicular stomatitis virus expressing Nipah virus glycoprotein and a fluorescent protein
Jain S , Lo MK , Kainulainen MH , Welch SR , Spengler JR , Satter SM , Rahman MZ , Hossain ME , Chiang CF , Klena JD , Bergeron É , Montgomery JM , Spiropoulou CF , Albariño CG . Virology 2023 587 109858 Nipah virus (NiV) is a highly pathogenic paramyxovirus with a high case fatality rate. Due to its high pathogenicity, pandemic potential, and lack of therapeutics or approved vaccines, its study requires biosafety level 4 (BSL4) containment. In this report, we developed a novel neutralization assay for use in biosafety level 2 laboratories. The assay uses a recombinant vesicular stomatitis virus expressing NiV glycoprotein and a fluorescent protein. The recombinant virus propagates as a replication-competent virus in a cell line constitutively expressing NiV fusion protein, but it is restricted to a single round of replication in wild-type cells. We used this system to evaluate the neutralization activity of monoclonal and polyclonal antibodies, plasma from NiV-infected hamsters, and serum from human patients. Therefore, this recombinant virus could be used as a surrogate for using pathogenic NiV and may constitute a powerful tool to develop therapeutics in low containment laboratories. |
Content Index (Achived Edition)
- Antimicrobial Resistance and Antibiotic Stewardship
- Chronic Diseases and Conditions
- Communicable Diseases
- Disease Reservoirs and Vectors
- Drug Safety
- Environmental Health
- Epidemiology and Surveillance
- Food Safety
- Genetics and Genomics
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- Healthcare Associated Infections
- Immunity and Immunization
- Informatics
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Nutritional Sciences
- Occupational Safety and Health
- Parasitic Diseases
- Reproductive Health
- Substance Use and Abuse
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