Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-10 (of 10 Records) |
Query Trace: Corcoran C[original query] |
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An Update on Pediatric Environmental Health Specialty Units: Activities and impacts, 2015-2019
Woolf AD , Jackson JE , Corcoran P , Fritz MK , Kim SS , Maslak TM , Shah M , Hansen L . Acad Pediatr 2024 INTRODUCTION: Pediatric Environmental Health Specialty Units (PEHSUs) address health concerns impacting children and their families related to environmental hazards by providing consultation and education to families, communities, and healthcare professionals. This analysis evaluated productivity of the national PEHSU program. METHODS: PEHSUs reported data on services provided to U.S. communities between October 1, 2014 and September 30, 2019. Descriptive statistics and qualitative analysis are presented. RESULTS: During this period, 6,102 consultations and 4,644 educational outreach activities were recorded. PEHSU faculty and staff published 462 articles, reviews, book chapters, fact sheets, commentaries, short informational pieces, and other materials between 2014-2019. These included 190 articles in scientific peer-reviewed journals and 29 textbook chapters to increase professional capacity in pediatric and reproductive environmental health. Lead, other metals, substances of abuse, pesticides, mold, and air pollution were frequently reported as agents of concern and educational topics. Requests for an overview of pediatric environmental health and outdoor pollutants were other frequently reported topics. DISCUSSION: PEHSUs work to decrease harmful exposures and improve children's health. They serve as expert resources for families, healthcare professionals, and communities on health effects related to environmental exposures. Data show the breadth and depth of concerns addressed and demonstrate the productivity and impact of this national program. WHATS-NEW: In 2015-2019, Pediatric Environmental Health Specialty Units (PEHSUs) doubled their average annual productivity as measured by numbers of consultations and training activities, compared with the previous ten years. PEHSUs continue to be a critical resource for healthcare professonals and communities. |
Triangulating truth and reaching consensus on population size, prevalence, and more: Modeling study
Fellows IE , Corcoran C , McIntyre AF . JMIR Public Health Surveill 2024 10 e48738 BACKGROUND: Population size, prevalence, and incidence are essential metrics that influence public health programming and policy. However, stakeholders are frequently tasked with setting performance targets, reporting global indicators, and designing policies based on multiple (often incongruous) estimates of these variables, and they often do so in the absence of a formal, transparent framework for reaching a consensus estimate. OBJECTIVE: This study aims to describe a model to synthesize multiple study estimates while incorporating stakeholder knowledge, introduce an R Shiny app to implement the model, and demonstrate the model and app using real data. METHODS: In this study, we developed a Bayesian hierarchical model to synthesize multiple study estimates that allow the user to incorporate the quality of each estimate as a confidence score. The model was implemented as a user-friendly R Shiny app aimed at practitioners of population size estimation. The underlying Bayesian model was programmed in Stan for efficient sampling and computation. RESULTS: The app was demonstrated using biobehavioral survey-based population size estimates (and accompanying confidence scores) of female sex workers and men who have sex with men from 3 survey locations in a country in sub-Saharan Africa. The consensus results incorporating confidence scores are compared with the case where they are absent, and the results with confidence scores are shown to perform better according to an app-supplied metric for unaccounted-for variation. CONCLUSIONS: The utility of the triangulator model, including the incorporation of confidence scores, as a user-friendly app is demonstrated using a use case example. Our results offer empirical evidence of the model's effectiveness in producing an accurate consensus estimate and emphasize the significant impact that the accessible model and app offer for public health. It offers a solution to the long-standing problem of synthesizing multiple estimates, potentially leading to more informed and evidence-based decision-making processes. The Triangulator has broad utility and flexibility to be adapted and used in various other contexts and regions to address similar challenges. |
Modelling the impact of CD4 testing on mortality from TB and cryptococcal meningitis among patients with advanced HIV disease in nine countries
Oboho IK , Paulin H , Corcoran C , Hamilton M , Jordan A , Kirking HL , Agyemang E , Podewils LJ , Pretorius C , Greene G , Chiller T , Desai M , Bhatkoti R , Shiraishi RW , Shah NS . J Int AIDS Soc 2023 26 (3) e26070 INTRODUCTION: Despite antiretroviral therapy (ART) scale-up among people living with HIV (PLHIV), those with advanced HIV disease (AHD) (defined in adults as CD4 count <200 cells/mm(3) or clinical stage 3 or 4), remain at high risk of death from opportunistic infections. The shift from routine baseline CD4 testing towards viral load testing in conjunction with "Test and Treat" has limited AHD identification. METHODS: We used official estimates and existing epidemiological data to project deaths from tuberculosis (TB) and cryptococcal meningitis (CM) among PLHIV-initiating ART with CD4 <200 cells/mm(3) , in the absence of select World Health Organization recommended diagnostic or therapeutic protocols for patients with AHD. We modelled the reduction in deaths, based on the performance of screening/diagnostic testing and the coverage and efficacy of treatment/preventive therapies for TB and CM. We compared projected TB and CM deaths in the first year of ART from 2019 to 2024, with and without CD4 testing. The analysis was performed for nine countries: South Africa, Kenya, Lesotho, Mozambique, Nigeria, Uganda, Zambia, Zimbabwe and the Democratic Republic of Congo. RESULTS: The effect of CD4 testing comes through increased identification of AHD and consequent eligibility for protocols for AHD prevention, diagnosis and management; algorithms for CD4 testing avert between 31% and 38% of deaths from TB and CM in the first year of ART. The number of CD4 tests required per death averted varies widely by country from approximately 101 for South Africa to 917 for Kenya. CONCLUSIONS: This analysis supports retaining baseline CD4 testing to avert deaths from TB and CM, the two most deadly opportunistic infections among patients with AHD. However, national programmes will need to weigh the cost of increasing CD4 access against other HIV-related priorities and allocate resources accordingly. |
Scale-up of HIV antiretroviral therapy and estimation of averted infections and HIV-related deaths - Uganda, 2004-2022
Dirlikov E , Kamoga J , Talisuna SA , Namusobya J , Kasozi DE , Akao J , Birabwa E , Ward JA , Elur B , Shiraishi RW , Corcoran C , Vasireddy V , Nelson R , Nelson LJ , Borgman M , Magongo EN , Kisaakye LN , Katureebe C , Kirungi W , Musinguzi J . MMWR Morb Mortal Wkly Rep 2023 72 (4) 90-94 On January 28, 2003, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the largest commitment by any nation to address a single disease in history, was announced.* In April 2004, the first person in the world to receive PEPFAR-supported antiretroviral therapy (ART) was a man aged 34 years in Uganda. Effective ART reduces morbidity and mortality among persons with HIV infection (1) and prevents both mother-to-child transmission (MTCT) (2) and sexual transmission once viral load is suppressed to undetectable levels (<200 viral copies/mL) (3). By September 2022, more than 1.3 million persons with HIV infection in Uganda were receiving PEPFAR-supported ART, an increase of approximately 5,000% from September 2004. As indicators of the ART program's effectiveness, a proxy MTCT rate decreased 77%, from 6.4% in 2010 to 1.5% in 2022, and the viral load suppression rate (<1,000 viral copies/mL) increased 3%, from 91% in 2016 to 94% in September 2022. During 2004-2022, ART scale-up helped avert nearly 500,000 HIV infections, including more than 230,000 infections among HIV-exposed infants, and approximately 600,000 HIV-related deaths. Going forward, efforts will focus on identifying all persons with HIV infection and rapidly linking them to effective ART. PEPFAR remains committed to continued strong partnership with the Government of Uganda, civil society, and other development partners toward sustainable solutions aligned with the Joint United Nations Programme on HIV/AIDS (UNAIDS) fast-track strategy to ending the global AIDS epidemic by 2030(†) and safeguarding impact achieved in the long term. |
An innovative approach to increase lead testing by pediatricians in children, United States, 2019-2021
Calabrese T , Corcoran P , Limjuco S , Bernardi C , Plattos A , LeBlanc TT , Woolf A . Am J Public Health 2022 112 S647-s650 Opportunities for lead exposure are common in the United States. The American Academy of Pediatrics, in collaboration with the Centers for Disease Control and Prevention, launched the Increasing Capacity for Blood Lead Testing Extension for Community Healthcare Outcomes (ECHO) project to educate pediatricians on the importance of testing children for lead exposure and to assess practice behavior change. We found that two weeks to one month after receiving training, more than 80% of participants reported increased lead testing and practice changes. Our results support use of the ECHO model as a mechanism for practice change. (Am J Public Health. 2022;112(S7):S647-S650. https://doi.org/10.2105/AJPH.2022.307084). |
Using genomics to examine the persistence of streptococcus pneumoniae serotype 19a in Ireland and the emergence of a sub-clade associated with vaccine failures
Corcoran M , Mereckiene J , Cotter S , Murchan S , Lo SW , McGee L , Breiman RF , Cunney R , Humphreys H , Bentley SD , Gladstone RA . Vaccine 2021 39 (35) 5064-5073 BACKGROUND: Streptococcus pneumoniae serotype 19A remains a significant cause of invasive pneumococcal disease (IPD) in Ireland despite the successful introduction of a 13-valent pneumococcal conjugate vaccine (PCV13) in 2010 which reduced the overall incidence of IPD in children. METHODS: Invasive Streptococcus pneumoniae serotype 19A isolates from the Irish reference laboratory between 2007-08 and 2017-18 were analysed using whole genome sequencing (WGS) to investigate the persistence of this vaccine-preventable serotype. We compared the entire national 19A collection to other international collections using a standardised nomenclature of Global Pneumococcal Sequencing Clusters (GPSC). RESULTS: Expansion of GPSCs and clonal complexes (CCs) may have been associated with vaccine introduction and antimicrobial prescribing policies. A sub-clade of GPSC1-CC320 (n = 25) unique to Ireland, included five of the ten vaccine failures/breakthrough cases identified (p = 0.0086). This sub-clade was not observed in a global GPSC1-CC320 collection. All isolates within the sub-clade (n = 25) contained a galE gene variant rarely observed in a global pneumococcal collection (n = 37/13454, p < 0.001) nor within GPSC1-CC320 (n = 19/227) (p < 0.001). The sub-clade was estimated to have emerged at the start of the PCV-vaccine era (ancestral origin 2000, range 1995-2004) and expanded in Ireland, with most isolated after PCV13 introduction (n = 24/25). CONCLUSIONS: The identification of a sub-clade/variant of serotype 19A highlights the benefit of using WGS to analyse genotypes associated with persistence of a preventable serotype of S. pneumoniae. Particularly as this sub-clade identified was more likely to be associated with IPD in vaccinated children than other 19A genotypes. It is possible that changes to the galE gene, which is involved in capsule production but outside of the capsular polysaccharide biosynthesis locus, may affect bacterial persistence within the population. Discrete changes associated with vaccine-serotype persistence should be further investigated and may inform vaccine strategies. |
Global Landscape Review of Serotype-Specific Invasive Pneumococcal Disease Surveillance among Countries Using PCV10/13: The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) Project
Deloria Knoll M , Bennett JC , Garcia Quesada M , Kagucia EW , Peterson ME , Feikin DR , Cohen AL , Hetrich MK , Yang Y , Sinkevitch JN , Ampofo K , Aukes L , Bacci S , Bigogo G , Brandileone MC , Bruce MG , Camilli R , Castilla J , Chan G , Chanto Chacón G , Ciruela P , Cook H , Corcoran M , Dagan R , Danis K , de Miguel S , De Wals P , Desmet S , Galloway Y , Georgakopoulou T , Hammitt LL , Hilty M , Ho PL , Jayasinghe S , Kellner JD , Kleynhans J , Knol MJ , Kozakova J , Kristinsson KG , Ladhani SN , Lara CS , León ME , Lepp T , Mackenzie GA , Mad'arová L , McGeer A , Mungun T , Mwenda JM , Nuorti JP , Nzoyikorera N , Oishi K , De Oliveira LH , Paragi M , Pilishvili T , Puentes R , Rafai E , Saha SK , Savrasova L , Savulescu C , Scott JA , Scott KJ , Serhan F , Setchanova LP , Sinkovec Zorko N , SkoczyĆska A , Swarthout TD , Valentiner-Branth P , van der Linden M , Vestrheim DF , von Gottberg A , Yildirim I , Hayford K , Pserenade Team . Microorganisms 2021 9 (4) Serotype-specific surveillance for invasive pneumococcal disease (IPD) is essential for assessing the impact of 10- and 13-valent pneumococcal conjugate vaccines (PCV10/13). The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project aimed to evaluate the global evidence to estimate the impact of PCV10/13 by age, product, schedule, and syndrome. Here we systematically characterize and summarize the global landscape of routine serotype-specific IPD surveillance in PCV10/13-using countries and describe the subset that are included in PSERENADE. Of 138 countries using PCV10/13 as of 2018, we identified 109 with IPD surveillance systems, 76 of which met PSERENADE data collection eligibility criteria. PSERENADE received data from most (n = 63, 82.9%), yielding 240,639 post-PCV10/13 introduction IPD cases. Pediatric and adult surveillance was represented from all geographic regions but was limited from lower income and high-burden countries. In PSERENADE, 18 sites evaluated PCV10, 42 PCV13, and 17 both; 17 sites used a 3 + 0 schedule, 38 used 2 + 1, 13 used 3 + 1, and 9 used mixed schedules. With such a sizeable and generally representative dataset, PSERENADE will be able to conduct robust analyses to estimate PCV impact and inform policy at national and global levels regarding adult immunization, schedule, and product choice, including for higher valency PCVs on the horizon. |
Serotype distribution of remaining pneumococcal meningitis in the mature PCV10/13 period: Findings from the PSERENADE Project
Garcia Quesada M , Yang Y , Bennett JC , Hayford K , Zeger SL , Feikin DR , Peterson ME , Cohen AL , Almeida SCG , Ampofo K , Ang M , Bar-Zeev N , Bruce MG , Camilli R , Chacón GC , Ciruela P , Cohen C , Corcoran M , Dagan R , De Wals P , Desmet S , Diawara I , Gierke R , Guevara M , Hammitt LL , Hilty M , Ho PL , Jayasinghe S , Kleynhans J , Kristinsson KG , Ladhani SN , McGeer A , Mwenda JM , Pekka Nuorti J , Oishi K , Ricketson LJ , Sanz JC , Savrasova L , Setchanova LP , Smith A , Valentiner-Branth P , Valenzuela MT , van der Linden M , van Sorge NM , Varon E , Winje BA , Yildirim I , Zintgraff J , Knoll MD . Microorganisms 2021 9 (4) Pneumococcal conjugate vaccine (PCV) introduction has reduced pneumococcal meningitis incidence. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project described the serotype distribution of remaining pneumococcal meningitis in countries using PCV10/13 for least 5-7 years with primary series uptake above 70%. The distribution was estimated using a multinomial Dirichlet regression model, stratified by PCV product and age. In PCV10-using sites (N = 8; cases = 1141), PCV10 types caused 5% of cases <5 years of age and 15% among ≥5 years; the top serotypes were 19A, 6C, and 3, together causing 42% of cases <5 years and 37% ≥5 years. In PCV13-using sites (N = 32; cases = 4503), PCV13 types caused 14% in <5 and 26% in ≥5 years; 4% and 13%, respectively, were serotype 3. Among the top serotypes are five (15BC, 8, 12F, 10A, and 22F) included in higher-valency PCVs under evaluation. Other top serotypes (24F, 23B, and 23A) are not in any known investigational product. In countries with mature vaccination programs, the proportion of pneumococcal meningitis caused by vaccine-in-use serotypes is lower (≤26% across all ages) than pre-PCV (≥70% in children). Higher-valency PCVs under evaluation target over half of remaining pneumococcal meningitis cases, but questions remain regarding generalizability to the African meningitis belt where additional data are needed. |
Emergency declarations for public health issues: Expanding our definition of emergency
Sunshine G , Barrera N , Corcoran AJ , Penn M . J Law Med Ethics 2019 47 95-99 Emergency declarations are a vital legal authority that can activate funds, personnel, and material and change the legal landscape to aid in the response to a public health threat. Traditionally, declarations have been used against immediate and unforeseen threats such as hurricanes, tornadoes, wildfires, and pandemic influenza. Recently, however, states have used emergency declarations to address public health issues that have existed in communities for months and years and have risk factors such as poverty and substance misuse. Leaders in these states have chosen to use emergency powers that are normally reserved for sudden catastrophes to address these enduring public health issues. This article will explore emergency declarations as a legal mechanism for response; describe recent declarations to address hepatitis A and the opioid overdose epidemic; and seek to answer the question of whether it is appropriate to use emergency powers to address public health issues that are not traditionally the basis for an emergency declaration. |
Notes from the Field: Acute Intoxications from Consumption of Amanita muscaria Mushrooms - Minnesota, 2018
Taylor J , Holzbauer S , Wanduragala D , Ivaskovic A , Spinosa R , Smith K , Corcoran J , Jensen A . MMWR Morb Mortal Wkly Rep 2019 68 (21) 483-484 In October, 2018, a middle-aged ethnic Karen* man from Burma was evaluated at a hospital emergency department with altered mental status, vomiting, diarrhea, incontinence, sweating, swelling of the lip and tongue, and excessive salivation. Signs and symptoms began approximately 2–3 hours after eating mushrooms at home. The patient was admitted for supportive treatment, including endotracheal intubation for airway protection and mechanical ventilation because of acute respiratory failure and hypoxia for 4 days. His daughter, who also ate the mushrooms, was evaluated for similar, but milder symptoms, including mild sweating and nausea; she was admitted overnight for observation, and was discharged the following day. The father recovered and was discharged 8 days after admission. |
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