Last data update: Jul 11, 2025. (Total: 49561 publications since 2009)
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Pre-exposure prophylaxis (PrEP) awareness, use, and discontinuation among Lake Victoria fisherfolk in Uganda: A cross-sectional population-based study
Ntabadde K , Kagaayi J , Ssempijja V , Feng X , Kairania R , Lubwama J , Ssekubugu R , Yeh PT , Ssekasanvu J , Tobian AAR , Kennedy CE , Mills LA , Alamo S , Kreniske P , Santelli J , Nelson LJ , Reynolds SJ , Chang LW , Nakigozi G , Grabowski MK . PLOS Glob Public Health 2025 5 (5) e0003994 There is limited population-level data on the pre-exposure prophylaxis (PrEP) care continuum in eastern Africa. Here, we assessed the PrEP care continuum following PrEP rollout in a Ugandan community with ~40% HIV seroprevalence. We used cross-sectional population-based data collected between September 3 and December 19, 2018 from a Lake Victoria fishing community in southern Uganda to measure levels of self-reported PrEP awareness, ever-use, and discontinuation following 2017 PrEP rollout via a U.S. President's Emergency Plan for AIDS Relief (PEPFAR)-supported phased implementation program. Our analysis included HIV-seronegative persons reporting having ever received an HIV test result. We examined associations between demographic, behavioral, and health utilization factors with each outcome using age-adjusted modified Poisson regression. There were 1,401 HIV-seronegative participants, of whom 1,363 (97.3%) reported ever receiving an HIV test result. Median age was 29 years (IQR: 23-36), and 42.3% (n = 577) were women. Most (85.5%; n = 1,166/1363) participants reported PrEP awareness, but few (14.5%; n = 197/1363) reported ever using PrEP. Among 47.7% (375/786) of men and 29.3% (169/577) of women PrEP-eligible at time of survey, 18.9% (n = 71/375) and 27.8% (n = 47/169) reported ever using PrEP, respectively. Over half (52.3%, n = 103/197) of those who had ever used PrEP, self-reported current use. In this Lake Victoria fishing community, there were low levels of PrEP use despite high levels of PrEP awareness and eligibility, particularly among men. Efforts that enhance awareness of HIV risk and increase PrEP accessibility may help increase PrEP use among HIV-seronegative persons in African settings with high HIV burden. |
Thrombosis risk with use of hormonal contraception among women with thrombophilia: an updated systematic review
Tepper NK , Nguyen AT , Curtis KM , Baumhart C , Schieve L , Whiteman MK . Contraception 2025 110943 ![]() OBJECTIVES: Thrombophilia is associated with an elevated risk of thrombosis, which may be further elevated with use of hormonal contraception. Our objective was to update a previously published systematic review on thrombosis risk with use of hormonal contraception among women with thrombophilia. STUDY DESIGN: We conducted a systematic review of five databases from database inception through December 8, 2022. We searched for articles that examined risk of venous thromboembolism (VTE) or arterial thromboembolism (ATE) in women with thrombophilia using hormonal contraception compared with women using non-hormonal or no contraception. We assessed risk of bias for each study and certainty of evidence for all outcomes. RESULTS: Eighteen articles met inclusion criteria; four had moderate risk of bias and 14 had high risk of bias. Odds of VTE in women with factor V Leiden (FVL) mutation or prothrombin (PT) gene mutation were elevated in combined oral contraception (COC) users vs non-users. Odds of VTE were elevated in COC users with FVL mutation, PT gene mutation, both FVL and PT mutations, antithrombin (AT) deficiency, or protein C deficiency compared with non-users without the mutation. Odds of stroke were elevated in COC users with FVL mutation compared with non-users without the mutation. Evidence was mixed on whether risk was elevated in women with protein S deficiency using COC compared with non-use. One study found elevated odds of VTE in women with FVL mutation but not women with PT gene mutation using progestin-only contraception (POC), compared with non-users without the mutation. CONCLUSIONS: Overall, studies found elevated odds of VTE and ATE in women with thrombophilia using COC compared with non-users without thrombophilia. The certainty of evidence for all outcomes is low. Evidence is also limited by small numbers of women and minimal evidence on use of patch, ring, or POC, and is insufficient to assess differential risk by all thrombophilia types. IMPLICATIONS: Use of estrogen-containing hormonal contraception might further elevate risk of thrombosis among women with thrombophilia. Further study is needed on safety of POC use in women with thrombophilia. |
Disproportionate increase in BMI of ≥60 kg/m(2) in the USA
Kachmar M , Albaugh VL , Yang S , Corpodean F , Heymsfield SB , Katzmarzyk PT , Freedman DS , Schauer PR . Lancet Diabetes Endocrinol 2025 |
Prevalence of Olfactory Dysfunction among Postpartum Women and Impact of SARS-CoV-2 Infection During Pregnancy
Jacobson PT , Arduin E , Hussain M , Kyle MH , Bruno A , Powers E , Varner M , Mourad M , Tita AT , Battarbee AN , Morrill T , Reichle L , Newes-Adeyi G , Mennella JA , Wielgosz K , Gilboa SM , Stockwell MS , Dawood FS , Dumitriu D , Overdevest JB . Chem Senses 2025 ![]() Olfactory dysfunction resulting from COVID-19 has imparted a lasting impact on olfaction among the general public, including pregnant women contracting SARS-CoV-2 infection. While olfactory dysfunction can impact physical, mental, and psychosocial well-being, there has been little research on olfaction during pregnancy and postpartum, nor the impact of SARS-CoV-2 infection on olfaction while pregnant. Therefore, the primary study aims are to evaluate olfaction in the postpartum period and determine the impact of antecedent SARS-CoV-2 infection. We recruited two cohorts of postpartum women, those with a history of SARS-CoV-2 infection before or during pregnancy (COVID cohort; n = 109) and those without (non-COVID cohort; n = 226), and evaluated their olfaction during the postpartum period by administering the University of Pennsylvania Smell Identification Test. Participants were queried about demographics, past SARS-CoV-2 infections, self-reported sense of smell (both in overall ability to smell and for the presence of qualitative smell issues such as parosmia and phantosmia), and perceived cause of smell loss, if any. We found significantly fewer postpartum women with normosmia capabilities in both COVID (27%) and non-COVID (46%) cohorts compared to normative data for aged-matched (30-39 years) women (83%). Women in the non-COVID cohort had significantly higher UPSIT scores and mean subjective olfaction ratings than those in the COVID cohort (95% CI [0.77,2.41] and 95% CI [-0.83,7.34], respectively). This study reflects the largest published cohort of postpartum women evaluated for olfactory function with standardized psychophysical testing. Our findings suggest both postpartum and SARS-CoV-2 infection are associated with diminished smell function. |
Epidemiology of Group B Streptococcus: Maternal Colonization and Infant Disease in Kampala, Uganda
Kyohere M , Davies HG , Karampatsas K , Cantrell L , Musoke P , Nakimuli A , Tusubira V , Nsimire JS , Jamrozy D , Khan UB , Bentley SD , Spiller OB , Farley C , Hall T , Daniel O , Beach S , Andrews N , Schrag SJ , Cutland CL , Gorringe A , Leung S , Taylor S , Heath PT , Cose S , Baker C , Voysey M , Le Doare K , Sekikubo M . Open Forum Infect Dis 2025 12 (4) ofaf167 ![]() ![]() BACKGROUND: Child survival rates have improved globally, but neonatal mortality due to infections, such as group B Streptococcus (GBS), remains a significant concern. The global burden of GBS-related morbidity and mortality is substantial. However, data from low and middle-income countries are lacking. Vaccination during pregnancy could be a feasible strategy to address GBS-related disease burden. METHODS: We assessed maternal rectovaginal GBS colonization and neonatal disease rates in a prospective cohort of 6062 women-infant pairs. Surveillance for invasive infant disease occurred in parallel at 2 Kampala hospital sites. In a nested case-control study, we identified infants <90 days of age with invasive GBS disease (iGBS) (n = 24) and healthy infants born to mothers colonized with GBS (n = 72). We measured serotype-specific anticapsular immunoglobulin G (IgG) in cord blood/infant sera using a validated multiplex Luminex assay. RESULTS: We found a high incidence of iGBS (1.0 per 1000 live births) within the first 90 days of life across the surveillance sites, associated with a high case fatality rate (18.2%). Maternal GBS colonization prevalence was consistent with other studies in the region (14.7% [95% confidence interval, 13.7%-15.6%]). IgG geometric mean concentrations were lower in cases than controls for serotypes Ia (0.005 vs 0.12 µg/mL; P = .05) and III (0.011 vs 0.036 µg/mL; P = .07) and in an aggregate analysis of all serotypes (0.014 vs 0.05 µg/mL; P = .02). CONCLUSIONS: We found that GBS is an important cause of neonatal and young infant disease in Uganda and confirmed that maternally derived antibodies were lower in early-onset GBS cases than in healthy exposed controls. |
A multifaceted intervention to improve diagnosis and early management of hospitalised patients with suspected acute brain infections in Brazil, India, and Malawi: an international multicentre intervention study
Singh B , Lipunga GD , Thangavelu P , Dhar S , Ferreira Cronemberger L , Abhilash KPP , Abraham AM , de Brito CAA , Brito Ferreira ML , Chandrashekar N , Duarte R , Fajardo Modol A , Ghale BC , Kang G , Gowda VK , Kuriakose K , Lant S , Mallewa M , Mbale E , Moore SC , Mwangalika G , Kamath PBT , Navvuga P , Nyondo-Mipando AL , Phiri TJ , Pimentel Lopes de Melo C , Pradeep BS , Rawlinson R , Sheha I , Thomas PT , Newton CR , de Sequeira PC , Sejvar JJ , Dua T , Turtle L , Verghese VP , Arraes Lwms , Desmond N , Easton A , Jones JA , Lilford RJ , Netravathi M , McGill F , Michael BD , Mwapasa V , Griffiths MJ , Parry CM , Ravi V , Burnside G , Cornick J , França RFO , Desai AS , Rupali P , Solomon T . Lancet 2025 BACKGROUND: Brain infections pose substantial challenges in diagnosis and management and carry high mortality and morbidity, especially in low-income and middle-income countries. We aimed to improve the diagnosis and early management of patients admitted to hospital (adults aged 16 years and older and children aged >28 days) with suspected acute brain infections at 13 hospitals in Brazil, India, and Malawi. METHODS: With hospital stakeholders, policy makers, and patient and public representatives, we co-designed a multifaceted clinical and laboratory intervention, informed by an evaluation of routine practice. The intervention, tailored for each setting, included a diagnostic and management algorithm, a lumbar puncture pack, a testing panel, and staff training. We used multivariable logistic regression and interrupted time series analysis to compare the coprimary outcomes-the percentage of patients achieving a syndromic diagnosis and the percentage achieving a microbiological diagnosis before and after the intervention. The study was registered at ClinicalTrials.gov (NCT04190303) and is complete. FINDINGS: Between Jan 5, 2021, and Nov 30, 2022, we screened 10 462 patients and enrolled a total of 2233 patients at 13 hospital sites connected to the four study centres in Brazil, India, and Malawi. 1376 (62%) were recruited before the intervention and 857 (38%) were recruited after the intervention. 2154 patients (96%) had assessment of the primary outcome (1330 [62%] patients recruited pre-intervention and 824 [38%] recruited post-intervention). The median age across centres was 23 years (IQR 6-44), with 1276 (59%) being adults aged 16 years or older and 888 (41%) children aged between 29 days and 15 years; 1264 (59%) patients were male and 890 (41%) were female. Data on race and ethnicity were not recorded. 1020 (77%) of 1320 patients received a syndromic diagnosis before the intervention, rising to 701 (86%) of 813 after the intervention (adjusted odds ratio [aOR] 1·81 [95% CI 1·40-2·34]; p<0·0001). A microbiological diagnosis was made in 294 (22%) of 1330 patients pre-intervention, increasing to 250 (30%) of 824 patients post-intervention (aOR 1·46 [95% CI 1·18-1·79]; p=0·00040). Interrupted time series analysis confirmed that these increases exceeded a modest underlying trend of improvement over time. The percentage receiving a lumbar puncture, time to appropriate therapy, and functional outcome also improved. INTERPRETATION: Diagnosis and management of patients with suspected acute brain infections improved following introduction of a simple intervention package across a diverse range of hospitals on three continents. The intervention is now being implemented in other settings as part of the WHO Meningitis Roadmap and encephalitis control initiatives. FUNDING: UK National Institute for Health and Care Research. |
Anticipated facilitators and barriers for long-acting injectable antiretrovirals as HIV treatment and prevention in Vietnam: a qualitative study among healthcare workers
Dang MT , Le YN , Naz-McLean S , Vo NTT , Do PT , Doan LTT , Do NT , Nguyen MT , Phan AH , Dziuban EJ , Bhatia R , Cosimi L , Phan HTT , Pollack TM . BMC Infect Dis 2024 24 (1) 1462 BACKGROUND: Long-acting injectable antiretrovirals (LAI-ARVs) for HIV prevention and treatment have been demonstrated in clinical trials to be non-inferior to daily oral medications, providing an additional option to help users overcome the challenges of daily adherence. Approval and implementation of these regimens in low- and middle-income settings have been limited. METHOD: This study describes the anticipated barriers and facilitators to implementing LAI-ARVs in Vietnam to inform future roll-out. From July to August 2022, we conducted 27 in-depth interviews with healthcare workers and public health stakeholders involved in HIV programs at national, provincial, and clinic levels across four provinces in Vietnam. The interviews followed a semi-structured questionnaire and were audio recorded. Data were analyzed using a rapid thematic analysis approach to identify facilitators and barriers to the adoption of LAI-ARVs. RESULTS: In total, 27 participants from 4 provinces were interviewed including 14 (52%) men and 13 (48%) women. Participants median age was 48 years and they had 11.5 years of experience with HIV services and programs. Perceived user-level facilitators included the greater convenience of injectables in comparison to oral regimens, while barriers included the increased frequency of visits, fear of pain and side effects, and cost. Clinic-level facilitators included existing technical capacity to administer injections and physical storage availability in district health centers, while barriers included lack of space and equipment for administering injections for HIV-related services, concerns about cold chain maintenance for LAI-ART, and workload for healthcare workers. Health system-level facilitators included existing mechanisms for medication distribution, while barriers included regulatory approval processes and concerns about supply chain continuity. CONCLUSION: Overall, participants were optimistic about the potential impact of LAI-ARVs but highlighted important considerations at multiple levels needed to ensure successful implementation in Vietnam. CLINICAL TRIAL NUMBER: Not applicable. |
Evaluating the effectiveness of external molecular proficiency testing in the Global Polio Laboratory Network, 2021-2022
Gerloff N , Burns CC . Pathogens 2024 13 (11) ![]() ![]() In the Global Poliovirus Laboratory Network (GPLN), participation and successful completion in annual proficiency test (PT) panels has been a part of the WHO accreditation process for decades. The PT panel is a molecular external quality assessment (mEQA) that evaluates laboratory preparedness, technical proficiency, the accuracy of data interpretation, and result reporting. Using the Intratypic Differentiation (ITD) real-time RT-PCR kits from CDC, laboratories run screening assays and report results in accordance with the ITD algorithm to identify and type polioviruses. The mEQA panels consisted of 10 blinded, non-infectious lyophilized RNA transcripts, including programmatically relevant viruses and targets contained in the real-time PCR assays. Sample identities included wildtype, vaccine-derived (VDPV), Sabin-like polioviruses, enterovirus, and negatives, as well as categories of invalid and indeterminate. The performance of individual laboratories was assessed based on the laboratory's ability to correctly detect and characterize the serotype/genotype identities of each sample. The scoring scheme assessed the laboratory readiness following GPLN guidelines. Laboratories receiving mEQA scores of 90 or higher passed the assessment, scores of less than 90 failed and required remedial actions and re-evaluation. In 2021 and 2022, 123 and 129 GPLN laboratories were invited to request the annual PT panel, and 118 and 127 laboratories submitted results, respectively. The overall results were good, with 86% and 91.5% of laboratories passing the PT panel on their first attempt in 2021 and 2022, respectively. Most labs scored the highest score of 100, and less than one quarter scored between 90 and 95. Less than 10% of submitting laboratories failed the PT, resulting in in-depth troubleshooting to identify root causes and remediations. Most of these laboratories were issued a second PT panel for repeat testing, and almost all laboratories passed the repeat PT panel. The results of the 2021 and 2022 annual mEQA PTs showed that, despite the COVID-19 pandemic, the performance remained high in the GPLN, with most labs achieving the highest score. For these labs, the real-time PCR assay updates that were implemented during 2021-2022 were carried out with full adherence to procedures and algorithms. Even initially failing labs achieved passing scores after remediation. |
Evaluating injury and illness trends in federal and Postal Service employees using workers' compensation claims data 2007-2022
Wurzelbacher SJ , Krieg EF , Meyers AR , Bushnell PT , Van Nguyen N , Tseng CY . J Occup Environ Med 2025 [Epub ahead of print] Objective: The purpose of this study was to understand federal workplace injury/illness trends. Methods: Over 1.5 million federal and Postal Service employee workers' compensation (WC) claims from 2007 to 2022 were linked to employment data and analyzed. Results: From 2007 to 2019, Falls, Slips, Trips represented the highest proportion of claims (30.7%), followed by Overexertion and Bodily Reaction (24.4%), Unclassified (16.4%), Contact with Objects and Equipment (13.1%), Violence and Other Injuries by Persons or Animals (8.8%), Transportation Incidents (4.0%), Exposure to Harmful Substances or Environments (2.5%), and Fires and Explosions (0.24%). From 2020 to 2022, COVID-19 drove a major shift to Exposure to Harmful Substances or Environments representing the highest proportion of claims (44.3%). Conclusions: Claims data represent a potentially rich data source that employing agencies can use to focus prevention and treatment of injury/illness. |
Epidemiologic and genomic characterization of an outbreak of Rift Valley fever among humans and dairy cattle in northern Tanzania
Madut DB , Rubach MP , Allan KJ , Thomas KM , de Glanville WA , Halliday JEB , Costales C , Carugati M , Rolfe RJ , Bonnewell JP , Maze MJ , Mremi AR , Amsi PT , Kalengo NH , Lyamuya F , Kinabo GD , Mbwasi R , Kilonzo KG , Maro VP , Mmbaga BT , Lwezaula B , Mosha C , Marandu A , Kibona TJ , Zhu F , Chawla T , Chia WN , Anderson DE , Wang LF , Liu J , Houpt ER , Martines RB , Zaki SR , Leach A , Gibbons A , Chiang CF , Patel K , Klena JD , Cleaveland S , Crump JA . J Infect Dis 2024 ![]() ![]() BACKGROUND: A peri-urban outbreak of Rift Valley fever virus (RVFV) among dairy cattle from May through August 2018 in northern Tanzania was detected through testing samples from prospective livestock abortion surveillance. We sought to identify concurrent human infections, their phylogeny, and epidemiologic characteristics in a cohort of febrile patients enrolled from 2016-2019 at hospitals serving the epizootic area. METHODS: From September 2016 through May 2019, we conducted a prospective cohort study that enrolled febrile patients hospitalized at two hospitals in Moshi, Tanzania. Archived serum, plasma, or whole blood samples were retrospectively tested for RVFV by PCR. Human samples positive for RVFV were sequenced and compared to RVFV sequences obtained from cattle through a prospective livestock abortion study. Phylogenetic analysis was performed on complete RVFV genomes. RESULTS: Among 656 human participants, we detected RVFV RNA in four (0.6%), including one death with hepatic necrosis and other end-organ damage at autopsy. Humans infected with RVFV were enrolled from June through August 2018, and all resided in or near urban areas. Phylogenetic analysis of human and cattle RVFV sequences demonstrated that most clustered to lineage B, a lineage previously described in East Africa. A lineage E strain clustering with lineages in Angola was also identified in cattle. CONCLUSION: We provide evidence that an apparently small RVFV outbreak among dairy cattle in northern Tanzania was associated with concurrent severe and fatal infections among humans. Our findings highlight the unidentified scale and diversity of inter-epizootic RVFV transmission, including near and within an urban area. |
Cutaneous myiasis by Calliphoridae dipterans in dogs from Chad
Ramos RAN , Hakimi H , Metinou SK , Danzabe W , Overcast M , Cox J , Garabed R , Ouakou PT , Nare RNB , Torres-Velez F , Tritten L , Saleh MN , Verocai GG . Acta Trop 2024 107454 ![]() Cutaneous myiasis caused by various Calliphoridae dipteran species is prevalent worldwide and is of particular veterinary and public health concern. Recently, in a scientific exploration of the Guinea Worm Eradication Program to Chad, Africa, we observed that dogs with mutilated ears, based on local awareness, were caused by cutaneous myiasis. In this study, we analyzed epidemiological, morphological, and molecular data on cutaneous myiasis in dogs from Chad. From September to October 2022, dogs (n = 1,562) from 56 villages situated along the Chari River were physically inspected for cutaneous myiasis. All larvae were collected and identified morphologically and by molecular analysis of the partial cytochrome oxidase c subunit I (COI) mitochondrial gene. The prevalence of myiasis infestation along with 95% confidence intervals (95% CI) was determined using the modified Wilson method. Myiasis was detected in dogs from 21 villages (37.5%; 95% CI 26 - 50%), predominating in the southernmost region. Of 1,562 dogs, 66 (4.22%; 95% CI 3.34 - 5.34%) were infested by calliphorid larvae, with a mean infestation of 2.28 larvae per animal (range = 1 to 24). Specimens were morphologically identified as Cordylobia anthropophaga (n = 94), Chrysomya bezziana (n = 54), and Chrysomya sp. (n = 3), which were detected in 57, eight and one dog, respectively. No co-infestations were observed. The molecular analyses confirmed the morphological identification and revealed the presence of 17 haplotypes for C. anthropophaga, 2 for C. bezziana, and one for Chrysomya sp. Our study emphasizes the veterinary importance of myiasis in dogs in Africa and proposes measures to assure their health and well-being. |
Identifying factors associated with physical therapy use versus non-use among injured workers with back pain in Washington State
Chin B , Rundell SD , Sears JM , Fulton-Kehoe D , Spector JT , Franklin GM . Am J Ind Med 2024 BACKGROUND: There is little information about predictors of physical therapy (PT) use among injured workers with back pain. The primary objective of this study is to investigate the associations between PT use and baseline factors not routinely captured in workers' compensation (WC) data. METHODS: We conducted a secondary analysis using the Washington State Workers' Compensation Disability Risk Identification Study Cohort, which combines self-reported surveys with claims data from the Washington State Department of Labor and Industries State Fund. Workers with an accepted or provisional WC claim for back injury between June 2002 and April 2004 were eligible. Baseline factors for PT use were selected from six domains (socio-demographic, pain and function, psychosocial, clinical, health behaviors, and employment-related). The outcome was a binary measure for PT use within 1 year of injury. Bivariate and multivariable logistic regression models were conducted to evaluate the associations between PT use and baseline factors. RESULTS: Among the 1370 eligible study participants, we identified 673 (49%) who received at least one PT service. Baseline factors from five of the six domains (all but health behaviors) were associated with PT use, including gender, income, pain and function measures, injury severity rating, catastrophizing, recovery expectations, fear avoidance, mental health score, body mass index, first provider seen for injury, previous injury, and several work-related factors. CONCLUSION: We identify baseline factors that are associated with PT use, which may be useful in addressing disparities in access to care for injured workers with back pain in a WC system. |
Coronavirus disease 2019 infections among emergency health care personnel: Impact on delivery of United States emergency medical care, 2020
Weber KD , Mower W , Krishnadasan A , Mohr NM , Montoy JC , Rodriguez RM , Giordano PA , Eyck PT , Harland KK , Wallace K , McDonald LC , Kutty PK , Hesse EM , Talan DA . Ann Emerg Med 2024 STUDY OBJECTIVE: In the early months of the coronavirus disease 2019 (COVID-19) pandemic and before vaccine availability, there were concerns that infected emergency department (ED) health care personnel could present a threat to the delivery of emergency medical care. We examined how the pandemic affected staffing levels and whether COVID-19 positive staff were potentially infectious at work in a cohort of US ED health care personnel in 2020. METHODS: The COVID-19 Evaluation of Risks in Emergency Departments (Project COVERED) project was a multicenter prospective cohort study of US ED health care personnel conducted from May to December 2020. During surveillance, health care personnel completed weekly electronic surveys and underwent periodic serology and nasal reverse transcription polymerase chain reaction testing for SARS-CoV-2, and investigators captured weekly data on health care facility COVID-19 prevalence and health care personnel staffing. Surveys asked about symptoms, potential exposures, work attendance, personal protective equipment use, and behaviors. RESULTS: We enrolled 1,673 health care personnel who completed 29,825 person weeks of surveillance. Eighty-nine (5.3%) health care personnel documented 90 (0.3%; 95% confidence interval [CI] 0.2% to 0.4%) person weeks of missed work related to documented or concerns for COVID-19 infection. Health care personnel experienced symptoms of COVID-19 during 1,256 (4.2%) person weeks and worked at least one shift whereas symptomatic during 1,042 (83.0%) of these periods. Seventy-five (4.5%) participants tested positive for SARS-CoV-2 during the surveillance period, including 43 (57.3%) who indicated they never experienced symptoms; 74 (98.7%; 95% CI 90.7% to 99.9%) infected health care personnel worked at least one shift during the initial period of infection, and 71 (94.7%) continued working until laboratory confirmation of their infection. Physician staffing was not associated with the facility or community COVID-19 levels within any time frame studied (Kendall tau's 0.02, 0.056, and 0.081 for no shift, one-week time shift, and 2-week time shift, respectively). CONCLUSIONS: During the first wave of the pandemic, COVID-19 infections in ED health care personnel were infrequent, and the time lost from the workforce was minimal. Health care personnel frequently reported for work while infected with SARS-CoV-2 before laboratory confirmation. The ED staffing levels were poorly correlated with facility and community COVID-19 burden. |
Genetics and genomics for the prevention and treatment of cardiovascular disease: update: a scientific statement from the American Heart Association.
Ganesh SK , Arnett DK , Assimes TL , Basson CT , Chakravarti A , Ellinor PT , Engler MB , Goldmuntz E , Herrington DM , Hershberger RE , Hong Y , Johnson JA , Kittner SJ , McDermott DA , Meschia JF , Mestroni L , O'Donnell CJ , Psaty BM , Vasan RS , Ruel M , Shen WK , Terzic A , Waldman SA . Circulation 2013 128 (25) 2813-51 ![]() Cardiovascular diseases (CVDs) are a major source of morbidity and mortality worldwide. Despite a decline of ≈30% over the past decade, heart disease remains the leading killer of Americans.1 For rare and familial forms of CVD, we are increasingly recognizing single-gene mutations that impart relatively large effects on individual phenotype. Examples include inherited forms of cardiomyopathy, arrhythmias, and aortic diseases. However, the prevalence of monogenic disorders typically accounts for a small proportion of the total CVD observed in the population. CVDs in the general population are complex diseases, with several contributing genetic and environmental factors. Although recent progress in monogenic disorders has occurred, we have seen a period of intense investigation to identify the genetic architecture of more common forms of CVD and related traits. | | Genomics serves several roles in cardiovascular health and disease, including disease prediction, discovery of genetic loci influencing CVD, functional evaluation of these genetic loci to understand mechanisms, and identification of therapeutic targets. For single-gene CVDs, progress has led to several clinically useful diagnostic tests, extending our ability to inform the management of afflicted patients and their family members. However, there has been little progress in developing genetic testing for complex CVD because individual common variants have only a modest impact on risk. The study of the genomics of complex CVDs is further challenged by the influence of environmental variables, phenotypic heterogeneity, and pathogenic complexity. Characterization of the clinical phenotype requires consideration of the clinical details of the diseases and traits under study. |
Differentiation of hypervirulent and classical Klebsiella pneumoniae with acquired drug resistance
Russo TA , Alvarado CL , Davies CJ , Drayer ZJ , Carlino-MacDonald U , Hutson A , Luo TL , Martin MJ , Corey BW , Moser KA , Rasheed JK , Halpin AL , McGann PT , Lebreton F . mBio 2024 e0286723 ![]() ![]() ![]() Hypervirulent Klebsiella pneumoniae (hvKp) is a concerning pathogen that can cause life-threatening infections in otherwise healthy individuals. Importantly, although strains of hvKp have been acquiring antimicrobial resistance, the effect on virulence is unclear. Therefore, it is of critical importance to determine whether a given antimicrobial resistant K. pneumoniae isolate is hypervirulent. This report determined which combination of genotypic and phenotypic markers could most accurately identify hvKp strains with acquired resistance. Both logistic regression and a machine-learning prediction model demonstrated that biomarker count alone was the strongest predictor. The presence of all five of the biomarkers iucA, iroB, peg-344, rmpA, and rmpA2 was most accurate (94%); the presence of ≥4 of these biomarkers was most sensitive (100%). Accurately identifying hvKp is vital for surveillance and research, and the availability of biomarker data could alert the clinician that hvKp is a consideration, which, in turn, would assist in optimizing patient care. |
Avian influenza A(H5) virus circulation in live bird markets in Vietnam, 2017-2022
Nguyen DT , Sumner KM , Nguyen TTM , Phan MQ , Hoang TM , Vo CD , Nguyen TD , Nguyen PT , Yang G , Jang Y , Jones J , Olsen SJ , Gould PL , Nguyen LV , Davis CT . Influenza Other Respir Viruses 2023 17 (12) e13245 ![]() BACKGROUND: Highly pathogenic avian influenza A(H5) human infections are a global concern, with many A(H5) human cases detected in Vietnam, including a case in October 2022. Using avian influenza virus surveillance from March 2017-September 2022, we described the percent of pooled samples that were positive for avian influenza A, A(H5), A(H5N1), A(H5N6), and A(H5N8) viruses in live bird markets (LBMs) in Vietnam. METHODS: Monthly at each LBM, 30 poultry oropharyngeal swab specimens and five environmental samples were collected. Samples were pooled in groups of five and tested for influenza A, A(H5), A(H5N1), A(H5N6), and A(H5N8) viruses by real-time reverse-transcription polymerase chain reaction. Trends in the percent of pooled samples that were positive for avian influenza were summarized by LBM characteristics and time and compared with the number of passively detected avian influenza outbreaks using Spearman's rank correlation. RESULTS: A total of 25,774 pooled samples were collected through active surveillance at 167 LBMs in 24 provinces; 36.9% of pooled samples were positive for influenza A, 3.6% A(H5), 1.9% A(H5N1), 1.1% A(H5N6), and 0.2% A(H5N8). Influenza A(H5) viruses were identified January-December and at least once in 91.7% of sampled provinces. In 246 A(H5) outbreaks in poultry; 20.3% were influenza A(H5N1), 60.2% A(H5N6), and 19.5% A(H5N8); outbreaks did not correlate with active surveillance. CONCLUSIONS: In Vietnam, influenza A(H5) viruses were detected by active surveillance in LBMs year-round and in most provinces sampled. In addition to outbreak reporting, active surveillance for A(H5) viruses in settings with high potential for animal-to-human spillover can provide situational awareness. |
Accuracy-based proficiency testing for estradiol measurements
Tim Cao Z , Rej R , Vesper H , Rex Astles J . Clin Biochem 2023 110700 OBJECTIVES: Accuracy of estradiol measurements is important but conventional proficiency testing (PT) cannot assess accuracy when possibly non-commutable samples are used and method peer-group means are the targets. Accuracy-based assessment of estradiol measurements is needed. Design and Methods Five serum samples were prepared from single donors, frozen, and distributed overnight to 76 New York State Department of Health (NYSDOH)-certified laboratories. Participants analyzed samples for estradiol. The biases of group means were assessed against the Centers for Disease Control and Prevention (CDC)-defined targets, evaluated using the Hormones Standardization Program (HoSt) E2 performance criterion of ±12.5%. Each laboratory's performance was evaluated using total allowable error (acceptance limits) of target ±25% or ±15 pg/mL (55.1 pmol/L) (whichever was greater, NYSDOH), target ±30% (Clinical Laboratory Improvement Amendments [CLIA]), and target ±26% (minimal limit based on biological variation [BV]). RESULTS: The biases (range) were 34% (-17% to 175%), 40% (-33% to 386%), 16% (-45% to 193%), 5% (-27% to 117%), and -4% (-31% to 21%), for samples at estradiol of 24.1, 28.4, 61.7, 94.1 and 127 pg/mL, or 88.5, 104.3, 226.5, 245.4 and 466.2 pmol/L, respectively. Large positive method/analytical systematic biases were revealed for 9 commonly used method/analytical systems in the United States at low estradiol concentrations. Of the 9 analytical systems, 0, 0, 3, 7 and 6 met the HoSt criterion for the samples with estradiol at the five respective concentrations. PT evaluation showed that 59%, 69% and 87% of laboratories would receive a PT event pass score when the CDC-defined target and a criterion of NYSDOH, CLIA or BV was used, respectively. However, >95% laboratories would obtain PT pass score if method peer-group means were used as targets regardless of the criterion used. CONCLUSIONS: Improvement in accuracy of estradiol measurements is needed, particularly at low estradiol concentrations. Accuracy-based PT provides unambiguous information about the accuracy of methods/analytical systems. |
Using regional sero-epidemiology SARS-CoV-2 Anti-S antibodies in the Dominican Republic to inform targeted public health response
Mario Martin B , Cadavid Restrepo A , Mayfield HJ , Then Paulino C , De St Aubin M , Duke W , Jarolim P , Zielinski Gutiérrez E , Skewes Ramm R , Dumas D , Garnier S , Etienne MC , Peña F , Abdalla G , Lopez B , de la Cruz L , Henríquez B , Baldwin M , Sartorius B , Kucharski A , Nilles EJ , Lau CL . Trop Med Infect Dis 2023 8 (11) Incidence of COVID-19 has been associated with sociodemographic factors. We investigated variations in SARS-CoV-2 seroprevalence at sub-national levels in the Dominican Republic and assessed potential factors influencing variation in regional-level seroprevalence. Data were collected in a three-stage cross-sectional national serosurvey from June to October 2021. Seroprevalence of antibodies against the SARS-CoV-2 spike protein (anti-S) was estimated and adjusted for selection probability, age, and sex. Multilevel logistic regression was used to estimate the effect of covariates on seropositivity for anti-S and correlates of 80% protection (PT(80)) against symptomatic infection for the ancestral and Delta strains. A total of 6683 participants from 134 clusters in all 10 regions were enrolled. Anti-S, PT80 for the ancestral and Delta strains odds ratio varied across regions, Enriquillo presented significant higher odds for all outcomes compared with Yuma. Compared to being unvaccinated, receiving ≥2 doses of COVID-19 vaccine was associated with a significantly higher odds of anti-S positivity (OR 85.94, [10.95-674.33]) and PT(80) for the ancestral (OR 4.78, [2.15-10.62]) and Delta strains (OR 3.08, [1.57-9.65]) nationally and also for each region. Our results can help inform regional-level public health response, such as strategies to increase vaccination coverage in areas with low population immunity against currently circulating strains. |
Prevalence of pharmacologic and nonpharmacologic pain management therapies among adults with chronic pain-United States, 2020
Rikard SM , Strahan AE , Schmit KM , Guy GP Jr . Ann Intern Med 2023 176 (11) 1571-1575 Background: In 2021, approximately 1 in 5 adults in the United States experienced chronic pain (1). The Centers for Disease Control and Prevention’s “CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022” (2) recommends maximizing nonpharmacologic and nonopioid therapies for pain as appropriate for the specific condition and patient. Whereas previous research reported the prevalence of use of nonpharmacologic and opioid therapies for pain (3), this study adds information about prescription nonopioids, over-the-counter pain relievers, and exercise. | | Objective: To estimate the prevalence of use of pharmacologic and nonpharmacologic therapies among adults with chronic pain in the United States. | | Methods and Findings: We used the 2020 National Health Interview Survey (NHIS) (31 568 total respondents) to identify adults who self-reported pain on most days or every day in the past 3 months (unweighted n = 7422) (4). Respondents reported use of pharmacologic (prescription opioids, prescription nonopioids, over-the-counter pain relievers) and nonpharmacologic (physical or occupational therapy [PT/OT], cognitive behavioral therapy [CBT], exercise, complementary therapies) pain management therapies in the past 3 months. We report therapy prevalence overall and by demographic characteristics. Adjusted prevalence was estimated using predictive margins from multivariable logistic regression models. All analyses account for the complex NHIS survey design. This study was exempt from institutional review board review. | | In 2020, approximately 54 million adults self-reported chronic pain. Among pharmacologic therapies, use of over-the-counter pain relievers in the past 3 months was most prevalent (75.5%), followed by prescription nonopioids (31.3%) and prescription opioids (13.5%) (Table 1). Among nonpharmacologic therapies, exercise was most prevalent (55.0%), followed by complementary therapies (36.7%), PT/OT (17.2%), and CBT (2.6%). Pharmacologic therapy use alone was reported by 26.6% of adults, with most (22.4%) reporting nonopioid use only and 1.0% reporting opioid use only. Most adults (60.2%) reported using both pharmacologic and nonpharmacologic therapies, with 50.9% reporting nonopioid and nonpharmacologic therapy use and 7.7% reporting combined use of opioids, nonopioids, and nonpharmacologic therapy. |
Occupational injuries among construction workers by age and related economic loss: findings from Ohio workers' compensation, USA: 2007-2017
Kaur H , Wurzelbacher SJ , Bushnell PT , Bertke S , Meyers AR , Grosch JW , Naber S , Lampl M . Saf Health Work 2023 14 (4) [Epub ahead of print] Background: This study examined age-group differences in the rate, severity, and cost of injuries among construction workers to support evidence-based worker safety and health interventions in the construction industry. Methods: Ohio workers' compensation claims for construction workers were used to estimate claim rates and costs by age group. We analyzed claims data auto-coded into five event/exposure categories: transportation incidents; slips, trips, and falls (STFs); exposure to harmful substances and environments (EHS); contact with objects and equipment (COB); and overexertion and bodily reaction. American Community Survey data were used to determine the proportion of workers by age group. Results: From 2007-2017, among 72,416 accepted injury claims for 166,000 construction full-time equivalent (FTE) per year, nearly half were caused by COB, followed by STFs (20%) and overexertion (20%). Claim rates related to COB and EHS were highest among those 18-24 years old, with claim rates of 313.5 and 25.9 per 10,000 FTE, respectively. STFs increased with age, with the highest claim rates for those 55-64 years old (94.2 claims per 10,000 FTE). Overexertion claim rates increased and then declined with age, with the highest claim rate for those 35-44 years old (87.3 per 10,000 FTE). While younger workers had higher injury rates, older workers had higher proportions of lost-time claims and costs per claim. The total cost per FTE was highest for those 45-54 years old ($1,122 per FTE). Conclusion: The variation in rates of injury types by age suggests age-specific prevention strategies may be useful. |
Workers' Compensation costs for occupational hearing loss claims in the United States, 2009-2013
Masterson EA , Wurzelbacher SJ , Bushnell PT , Tseng CY . Semin Hear 2023 44 (4) 412-436 This study estimated the average annual number of U.S. workers' compensation (WC) claims for occupational hearing loss (OHL) and their associated cost and identified the industry/occupation classifications with the highest numbers of OHL claims. The most recent U.S. cost estimate ($242 million) was based on data from one state in 1 year (1991). WC data from the National Council on Compensation Insurance, Inc. (35 states) and two additional individual states were examined, incorporating data from 37 states and the District of Columbia. Costs and numbers of claims were estimated for the 13 missing states to develop estimates for the United States. Sensitivity analyses were also performed to develop ranges for the point estimates. The estimated U.S. average annual OHL claim cost fell within the range of $49 to $67 million during 2009-2013, with a point estimate of $60 million (2013 dollars). The estimated average annual number of OHL claims ranged from 4,114 to 5,986, with a point estimate of 4,965 claims. Based on data available from 36 states and DC, 18 of the 40 industry/occupation classifications with ≥50 OHL claims were in the manufacturing sector. WC data underestimate the true burden of OHL. Most OHL cases are not compensated. WC laws, industry composition and other factors vary widely by state, so estimates must employ data for many states. This study incorporated data from most states and utilized sensitivity and comparative analyses to obtain estimates. Workers in a wide range of industry/occupation classifications need special attention to prevent OHL. © 2023. Thieme. All rights reserved. Thieme Medical Publishers, Inc. |
High post-exposure prophylaxis (PEP) uptake among household contacts of pertussis patients enrolled in a PEP effectiveness evaluation - United States, 2015-2017
McNamara LA , Rubis AB , Pawloski L , Briere E , Misegades L , Brusseau AA , Peña S , Edge K , Wester R , Burzlaff K , Cruz V , Tondella L , Skoff TH . PLoS One 2023 18 (5) e0285953 BACKGROUND: Post-exposure prophylaxis (PEP) for pertussis is recommended for household contacts of pertussis cases in the United States within 21 days of exposure, but data on PEP effectiveness for prevention of secondary cases in the setting of widespread pertussis vaccination are limited. We implemented a multi-state evaluation of azithromycin PEP use and effectiveness among household contacts. METHODS: Culture- or PCR-confirmed pertussis cases were identified through surveillance. Household contacts were interviewed within 7 days of case report and again 14-21 days later. Interviewers collected information on exposure, demographics, vaccine history, prior pertussis diagnosis, underlying conditions, PEP receipt, pertussis symptoms, and pertussis testing. A subset of household contacts provided nasopharyngeal and blood specimens during interviews. RESULTS: Of 299 household contacts who completed both interviews, 12 (4%) reported not receiving PEP. There was no evidence of higher prevalence of cough or pertussis symptoms among contacts who did not receive PEP. Of 168 household contacts who provided at least one nasopharyngeal specimen, four (2.4%) were culture or PCR positive for B. pertussis; three of these received PEP prior to their positive test result. Of 156 contacts with serologic results, 14 (9%) had blood specimens that were positive for IgG anti-pertussis toxin (PT) antibodies; all had received PEP. CONCLUSIONS: Very high PEP uptake was observed among household contacts of pertussis patients. Although the number of contacts who did not receive PEP was small, there was no difference in prevalence of pertussis symptoms or positive laboratory results among these contacts compared with those who did receive PEP. |
The COVID-19 Pandemic and the Five Essential Elements in Mass Trauma Intervention: Perspectives from World Trade Center Health Program Mental Health Clinicians
Lowe SM , Haugen PT , Marrone K , Rosen R , Reissman DB . Psychiatry 2021 84 (4) 386-392 In 2007, Hobfoll and coauthors described “Five Essential Elements of Immediate and Mid–Term Mass Trauma Intervention: Empirical Evidence,” a framework to guide intervention and prevention efforts in the aftermath of mass trauma. Briefly, these include promoting safety, calm, self- and community efficacy, connectedness, and hope for the future. These evidence-informed elements have been used in early disaster interventions, such as Psychological First Aid (Brymer et al., 2006), and have widely influenced international public health policy. This commentary will address whether these elements have provided guidance when applied to the setting of the COVID-19 pandemic. | | As of this writing (July 11, 2021), there have been more than 185 million confirmed cases of COVID-19 world-wide, resulting in over 4 million reported deaths (Johns Hopkins Coronavirus Resource Center). This international public health disaster, tremendous in scope and scale, has unfolded in unyielding and uneven waves, affecting different regions of the world with varied intensity over the past 18 months. Global mortality, societal and economic disruption, and the protracted nature of the crisis have overwhelmed medical facilities, health care systems, and communities. Inconsistent messaging about the transmissibility of the virus and seriousness of COVID-19 magnified uncertainty and fear. Early efforts focused on containing the spread of infection and managing serious respiratory illness. This quickly grew to include concern about the psychological trauma surrounding both the seriousness of the disease and the psychosocial and economic effect of its containment efforts. A large body of evidence reveals that during the initial phase of the pandemic, there was an increase in levels of anxiety, depression, substance misuse, and suicidal ideation in the U.S. (e.g., Czeisler et al., 2020; Ettman et al., 2020). Notably, youth, women, and those caring for young children –groups not previously identified as high risk for psychiatric disorders – experienced disproportionate psychological distress and possible increases in self-harm (Aknin et al., 2021). |
Evaluative Thinking in Practice: The National Asthma Control Program
Fierro LA , Codd H , Gill S , Pham PK , Grandjean Targos PT , Wilce M . New Dir Eval 2018 2018 (158) 49-72 Although evaluative thinking lies at the heart of what we do as evaluators and what we hope to promote in others through our efforts to build evaluation capacity, researchers have given limited attention to measuring this concept. We undertook a research study to better understand how instances of evaluative thinking may present in practice-based settings-specifically within four state asthma control programs funded by the Centers for Disease Control and Prevention's National Asthma Control Program. Through content analyses of documents as well as interviews and a subsequent focus group with four state asthma control programs' evaluators and program managers we identified and defined twenty-two indicators of evaluative thinking. Findings provide insights about what practitioners may wish to look for when they intend to build evaluative thinking and the types of data sources that may be more or less helpful in such efforts. |
A pilot PT scheme for external assessment of laboratory performance in testing synthetic opioid compounds in urine, plasma, and whole blood
Hart ED , Bynum ND , Evans A , Swanson KD , Blake TA . Forensic Sci Int 2023 347 111679 A proficiency testing (PT) scheme was prepared for laboratories engaged in bioanalytical testing for synthetic opioid compounds in urine, plasma, and whole blood. Samples were prepared using compounds included in the Opioid Certified Reference Material Kit (Opioid CRM Kit) developed by the U.S. Centers for Disease Control and Prevention. Laboratories received samples during a 2-year project with each year consisting of two PT events 6 months apart. In the first year (pilot test), participants included 10 public health laboratories throughout the United States. In the second year, the group of laboratories expanded to include clinical and forensic drug testing laboratories, and 12 additional participating labs joined the program. In Year 1, overall detection percentages for the compounds present in the PT samples were 95.5% in Event 1% and 97.2% in Event 2. There were 31 apparent false positives reported in Event 1 and four apparent false positives reported in Event 2. Carryover or contamination in laboratory analytical systems were found to be the most significant causes of the false positive results, and none of the laboratories that reported false positives in Event 1 did so in Event 2. In Year 2, overall detection percentages for the compounds present in the PT samples were 89.5% in Event 3% and 94.8% in Event 4. There was one apparent false positive reported in Event 3 and three apparent false positives reported in Event 4. Improvements in drug detection between the two PT events in each year demonstrated the benefit of PT schemes in identifying and addressing potential deficiencies in laboratory systems. |
Neuroinvasive Onchocerca lupi infection in a ten-year-old girl
Bowers Wu D , Ko B , Lopez Hernandez G , Botros J , Spader H , Sapp S , Qvarnstrom Y , Paddock CD , Cantey PT , Dehority W . Case Rep Infect Dis 2022 2022 9773058 The nematode Onchocerca lupi is an emerging human pathogen. Though its life cycle is not well studied, it likely infects humans after a bite from a black fly vector, which in turn acquires infective microfilariae from an infected canid. These microfilariae mature into an infective larval stage within the fly. Among six reported cases in the United States, five involved children, and all occurred in the southwest. In this report, we present a case of O. lupi infection with cervical spine invasion in a healthy 10-year-old girl. She presented with five months of neurological symptoms from a rural and medically underserved area, highlighting a need for clinical vigilance in such settings for this emerging infectious threat in the American southwest. |
The World Trade Center Health Program: an introduction to best practices
Calvert GM , Anderson K , Cochran J , Cone JE , Harrison DJ , Haugen PT , Lilly G , Lowe SM , Luft BJ , Moline JM , Reibman J , Rosen R , Udasin IG , Werth AS . Arch Environ Occup Health 2022 78 (4) 1-7 More than 20 years have elapsed since the September 11, 2001 (9/11) terrorist attacks on the World Trade Center (WTC), Pentagon and at Shanksville, PA. Many persons continue to suffer a variety of physical and mental health conditions following their exposures to a mixture of incompletely characterized toxicants and psychological stressors at the terrorist attack sites. Primary care and specialized clinicians should ask patients who may have been present at any of the 9/11 sites about their 9/11 exposures, especially patients with cancer, respiratory symptoms, chronic rhinosinusitis, gastroesophageal reflux disease, psychiatric symptoms, and substance use disorders. Clinicians, especially those in the NY metropolitan area, should know how to evaluate, diagnose, and treat patients with conditions that could be associated with exposure to the 9/11 attacks and its aftermath. As such, this issue of Archives contains a series of updates to clinical best practices relevant to medical conditions whose treatment is covered by the WTC Health Program. This first paper in the 14-part series describes the purpose of this series, defines the WTC Health Program and its beneficiaries, and explains how relevant Clinical Practice Guidelines were identified. This paper also reminds readers that because physical and mental health conditions are often intertwined, a coordinated approach to care usually works best and referral to health centers affiliated with the WTC Health Program may be necessary, since all such Centers offer multidisciplinary care. |
Intensity of physical therapy services: Association with work and health outcomes in injured workers with back pain in Washington State
Chin B , Rundell SD , Sears JM , Fulton-Kehoe D , Spector JT , Franklin GM . Am J Ind Med 2022 66 (1) 94-106 BACKGROUND: Associations between the intensity of physical therapy (PT) treatments and health outcomes among individuals with back pain have been examined in the general population; however, few studies have explored these associations in injured workers. Our study objective was to examine whether intensity of PT treatments is positively associated with work and health outcomes in injured workers with back pain. METHODS: We conducted a secondary analysis of prospective data collected from the Washington State Workers' Compensation (WC) Disability Risk Identification Study Cohort (D-RISC). D-RISC combined survey results with WC data from the Washington State Department of Labor and Industries. Workers with a State Fund WC claim for back injuries between June 2002 and April 2004 and who received PT services within the first year of injury were eligible. Intensity of PT treatment was measured as the type and amount of PT services within 28 days from the first PT visit. Outcome measures included work disability and self-reported measures for working for pay, pain intensity, and functional status at 1-year follow-up. We conducted linear and logistic regression models to test associations. RESULTS: We identified 662 eligible workers. In adjusted models, although the intensity of PT treatment was not significantly associated with work disability at 1-year follow-up, it was associated with lower odds of working for pay, decreased pain intensity, and improved functional status. CONCLUSIONS: Our findings suggest that there may be small benefits from receiving active PT, manual therapy, and frequent PT treatments within 28 days of initiating PT care. |
Improving the quality of HIV rapid testing in Ghana using the dried tube specimen-based proficiency testing program
Nkrumah B , Iriemenam NC , Frimpong F , Kalou MB , Botchway B , Adukpo R , Jackson KG , Angra P , Whistler T , Adhikari AP , Ayisi-Addo S , Melchior MA . PLoS One 2022 17 (10) e0264105 BACKGROUND: The introduction of human immunodeficiency virus (HIV) antibody rapid testing (RT) in resource-limited settings has proven to be a successful intervention to increase access to prevention measures and improve timely linkage to care. However, the quality of testing has not always kept pace with the scale-up of this testing strategy. To monitor the accuracy of HIV RT test results, a national proficiency testing (PT) program was rolled out at selected testing sites in Ghana using the dried tube specimen (DTS) approach. METHODS: Between 2015 and 2018, 635 HIV testing sites, located in five regions and supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), were enrolled in the HIV PT program of the Ghana Health Service National AIDS/STI Control Programme. These sites offered various services: HIV Testing and Counselling (HTC), prevention of mother-to-child transmission (PMTCT) and Antiretroviral Treatment (ART). The PT panels, composed of six DTS, were prepared by two regional laboratories, using fully characterized plasma obtained from the regional blood banks and distributed to the testing sites. The results were scored by the PT providers according to the predefined acceptable performance criteria which was set at ≥ 95%. RESULTS: Seven rounds of PT panels were completed successfully over three years. The number of sites enrolled increased from 205 in round 1 (June 2015) to 635 in round 7 (December 2018), with a noticeable increase in Greater Accra and Eastern regions. The average participation rates of enrolled sites ranged from 88.0% to 98.0% across the PT rounds. By round 7, HTC (257/635 (40.5%)) and PMTCT (237/635 (37.3%)) had a larger number of sites that participated in the PT program than laboratory (106/635 (16.7%)) and ART (12/635 (1.9%)) sites. The average testing performance rate improved significantly from 27% in round 1 to 80% in round 7 (p < 0.001). The highest performance rate was observed for ART (100%), HTC (92%), ANC/PMTCT (90%) and Laboratory (89%) in round 5. CONCLUSION: The DTS PT program showed a significant increase in the participation and performance rates during this period. Sub-optimal performances observed was attributed to non-compliance to the national testing algorithm and testing technique. However, the implementation of review meetings, peer-initiated corrective action, supportive supervisory training, and mentorship proved impactful. The decentralized approach to preparing the PT panels ensured ownership by the region and districts. |
Identification of small molecules with improved potency against orthopoxviruses from vaccinia to smallpox
Brown LE , Seitz S , Kondas AV , Marcyk PT , Filone CM , Hossain MM , Schaus SE , Olson VA , Connor JH . Antimicrob Agents Chemother 2022 66 (11) e0084122 The genus Orthopoxvirus contains several human pathogens, including vaccinia, monkeypox, cowpox, and variola virus, the causative agent of smallpox. Although there are a few effective vaccines, widespread prophylactic vaccination has ceased and is unlikely to resume, making therapeutics increasingly important to treat poxvirus disease. Here, we described efforts to improve the potency of the anti-poxvirus small molecule CMLDBU6128. This class of small molecules, referred to as pyridopyrimidinones (PDPMs), showed a wide range of biological activities. Through the synthesis and testing of several exploratory chemical libraries based on this molecule, we identified several compounds that had increased potency from the micromolar into the nanomolar range. Two compounds, designated (12) and (16), showed inhibitory concentrations of 326 nM and 101 nM, respectively, which was more than a 10-fold increase in potency to CMLDBU6128 with an inhibitory concentration of around 6 μM. We also expanded our investigation of the breadth of action of these molecules and showed that they can inhibit the replication of variola virus, a related orthopoxvirus. Together, these findings highlighted the promise of this new class of antipoxviral agents as broad-spectrum small molecules with significant potential to be developed as antiviral therapy. This would add a small molecule option for therapy of spreading diseases, including monkeypox and cowpox viruses, that would also be expected to have efficacy against smallpox. |
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