Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-30 (of 73 Records) |
Query Trace: Heath B[original query] |
---|
Vital Signs: Mammography use and association with social determinants of health and health-related social needs among women - United States, 2022
Miller JW , King JA , Trivers KF , Town M , Sabatino SA , Puckett M , Richardson LC . MMWR Morb Mortal Wkly Rep 2024 73 (15) 351-357 INTRODUCTION: Approximately 40,000 U.S. women die from breast cancer each year. Mammography is recommended to screen for breast cancer and reduce breast cancer mortality. Adverse social determinants of heath (SDOH) and health-related social needs (HRSNs) (e.g., lack of transportation and social isolation) can be barriers to getting mammograms. METHODS: Data from the 2022 Behavioral Risk Factor Surveillance System were analyzed to estimate the prevalence of mammography use within the previous 2 years among women aged 40-74 years by jurisdiction, age group, and sociodemographic factors. The association between mammography use and measures of SDOH and HRSNs was assessed for jurisdictions that administered the Social Determinants and Health Equity module. RESULTS: Among women aged 50-74 years, state-level mammography use ranged from 64.0% to 85.5%. Having health insurance and a personal health care provider were associated with having had a mammogram within the previous 2 years. Among women aged 50-74 years, mammography prevalence was 83.2% for those with no adverse SDOH and HRSNs and 65.7% for those with three or more adverse SDOH and HRSNs. Life dissatisfaction, feeling socially isolated, experiencing lost or reduced hours of employment, receiving food stamps, lacking reliable transportation, and reporting cost as a barrier for access to care were all strongly associated with not having had a mammogram within the previous 2 years. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Identifying specific adverse SDOH and HRSNs that women experience and coordinating activities among health care providers, social services, community organizations, and public health programs to provide services that help address these needs might increase mammography use and ultimately decrease breast cancer deaths. |
Assessment of weight gain in adult patients living with HIV receiving first-line dolutegravir-based or efavirenz-based ART regimens in routine care clinics in Tshwane district, South Africa: An observational study
Sawry S , Ayalew K , Maimela G , Briggs-Hagen M , van Wyk-Heath M , Mthethwa S , Shai S , Mngomezulu NN , Tlhowe L , Achere-Darko J , Bedford J , Martin CE , Fairlie L , Imrie J . HIV Med 2024 INTRODUCTION: Although dolutegravir (DTG) is deemed stable, safe, cost-effective, and clinically beneficial, it also carries the risk of side effects, including observed weight gain among patients on DTG-based antiretroviral therapy (ART) regimens. We compared weight changes among adults (≥18 years) initiating tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD) or tenofovir disoproxil fumarate, emtricitabine, and efavirenz (TEE) regimens and those switching from TEE to TLD (TEE-to-TLD switchers) in three large primary care facilities in South Africa METHODS: We conducted a retrospective longitudinal record review using patient medical records, extracting relevant demographic and clinical data from October 2018 to June 2021 from randomly selected adults who initiated TLD or TEE (initiators) and adult TEE-to-TLD switchers. We assessed weight, body mass index (BMI), and percentage weight changes for both groups and fitted linear regression and generalized linear models to determine factors associated with weight and BMI change and percentage weight change ≥10%, respectively, among treatment initiators. We fitted linear mixed-effect models among TEE-to-TLD switchers to consider repeated measures. RESULTS: Of 860 initiators, 450 (52.3%) initiated on TEE and 410 (47.7%) on TLD, with median follow-up of 1.4 years and 1.0 year, respectively. At initiation, 43.3% on TEE and 40.8% on TLD were overweight or obese. TLD initiators had an adjusted higher mean weight gain of 1.6 kg (p < 0.001) and mean BMI gain of 0.51 kg/m(2) (p < 0.001) than TEE initiators. Independent risk factors for higher mean weight and BMI included age ≥50 years, male, on ART for >12 months, initial BMI of <18.5 kg/m(2), and CD4 counts <200 cells/μL. Of 298 TEE-to-TLD switchers, 36.6% were overweight or obese at TEE initiation. Comparing before and after TLD switch, TEE-to-TLD switchers had an adjusted mean weight of 1.2 kg less while on TLD (p = 0.026). Being overweight and CD4 counts >350 cells/μL were independent risk factors for lower weight gain after TLD switch. CONCLUSIONS: We report more weight gain among TLD than among TEE initiators, although to a lesser extent than previously reported. TEE-to-TLD switchers experienced less weight gain after TLD switch; return to health before receiving TLD may be a contributory factor. The current findings are reassuring for those switching to a DTG-based regimen. |
Parks, trails, and greenways for physical activity: A Community Guide systematic economic review
Jacob V , Reynolds JA , Chattopadhyay SK , Hopkins DP , Brown DR , Devlin HM , Barrett A , Berrigan D , Crespo CJ , Heath GW , Brownson RC , Cuellar AE , Clymer JM , Chriqui JF . Am J Prev Med 2024 INTRODUCTION: This systematic economic review examined the cost-benefit and cost-effectiveness of park, trail, and greenway infrastructure interventions to increase physical activity or infrastructure use. METHODS: The search period covered the date of inception of publications databases through February 2022. Inclusion was limited to studies that reported cost-benefit or cost-effectiveness outcomes and were based in the United States and other high-income countries. Analyses were conducted during March 2022 through December 2022. All monetary values reported are in 2021 U.S. dollars. RESULTS: The search yielded 1 study based in the United States and 7 based on other high-income countries, with 1 reporting cost-effectiveness and 7 reporting cost-benefit outcomes. The cost-effectiveness study based in the United Kingdom reported $23,254 per disability-adjusted life year averted. The median benefit to cost ratio was 3.1 (Interquartile Interval: 2.9 to 3.9) based on 7 studies. DISCUSSION: The evidence shows that economic benefits exceed the intervention cost of park, trail, and greenway infrastructure. Given large differences in the size of infrastructure, intervention cost and economic benefits varied substantially across studies. There was insufficient number of studies to determine cost-effectiveness of these interventions. |
Tracing the evolutionary history and global expansion of Candida auris using population genomic analyses (preprint)
Chow NA , Munoz JF , Gade L , Berkow EL , Li X , Welsh RM , Forsberg K , Lockhart SR , Adam R , Alanio A , Alastruey-Izquierdo A , Althawadi S , Arauz AB , Ben-Ami R , Bharat A , Calvo B , Desnos-Ollivier M , Escandon P , Gardam D , Gunturu R , Heath CH , Kurzai O , Martin R , Litvintseva AP , Cuomo CA . bioRxiv 2020 2020.01.06.896548 Candida auris has emerged globally as a multidrug-resistant yeast that can spread via nosocomial transmission. An initial phylogenetic study of isolates from Japan, India, Pakistan, South Africa, and Venezuela revealed four populations (Clades I, II, III, and IV) corresponding to these geographic regions. Since this description, C. auris has been reported in over 30 additional countries. To trace this global emergence, we compared the genomes of 304 C. auris isolates from 19 countries on six continents. We found that four predominant clades persist across wide geographic locations. We observed phylogeographic mixing in most clades; Clade IV, with isolates mainly from South America, demonstrated the strongest phylogeographic substructure. C. auris isolates from two clades with opposite mating types were detected contemporaneously in a single healthcare facility in Kenya. We estimated a Bayesian molecular clock phylogeny and dated the origin of each clade within the last 339 years; outbreak-causing clusters from Clades I, III, and IV originated 34-35 years ago. We observed high rates of antifungal resistance in Clade I, including four isolates resistant to all three major classes of antifungals. Mutations that contribute to resistance varied between the clades, with Y132F in ERG11 as the most widespread mutation associated with azole resistance and S639P in FKS1 for echinocandin resistance. Copy number variants in ERG11 predominantly appeared in Clade III and were associated with fluconazole resistance. These results provide a global context for the phylogeography, population structure, and mechanisms associated with antifungal resistance in C. auris.Importance In less than a decade, C. auris has emerged in healthcare settings worldwide; this species is capable of colonizing skin and causing outbreaks of invasive candidiasis. In contrast to other Candida species, C. auris is unique in its ability to spread via nosocomial transmission and its high rates of drug resistance. As part of the public health response, whole-genome sequencing has played a major role in characterizing transmission dynamics and detecting new C. auris introductions. Through a global collaboration, we assessed genome evolution of isolates of C. auris from 19 countries. Here, we described estimated timing of the expansion of each C. auris clade and of fluconazole resistance, characterized discrete phylogeographic population structure of each clade, and compared genome data to sensitivity measurements to describe how antifungal resistance mechanisms vary across the population. These efforts are critical for a sustained, robust public health response that effectively utilizes molecular epidemiology. |
Treated, hospital-onset Clostridiodes difficile infection: An evaluation of predictors and feasibility of benchmarking comparing 2 risk-adjusted models among 265 hospitals
Yu KC , Ye G , Edwards JR , Dantes R , Gupta V , Ai C , Betz K , Benin AL . Infect Control Hosp Epidemiol 2023 1-9 OBJECTIVES: To evaluate the incidence of a candidate definition of healthcare facility-onset, treated Clostridioides difficile (CD) infection (cHT-CDI) and to identify variables and best model fit of a risk-adjusted cHT-CDI metric using extractable electronic heath data. METHODS: We analyzed 9,134,276 admissions from 265 hospitals during 2015-2020. The cHT-CDI events were defined based on the first positive laboratory final identification of CD after day 3 of hospitalization, accompanied by use of a CD drug. The generalized linear model method via negative binomial regression was used to identify predictors. Standardized infection ratios (SIRs) were calculated based on 2 risk-adjusted models: a simple model using descriptive variables and a complex model using descriptive variables and CD testing practices. The performance of each model was compared against cHT-CDI unadjusted rates. RESULTS: The median rate of cHT-CDI events per 100 admissions was 0.134 (interquartile range, 0.023-0.243). Hospital variables associated with cHT-CDI included the following: higher community-onset CDI (CO-CDI) prevalence; highest-quartile length of stay; bed size; percentage of male patients; teaching hospitals; increased CD testing intensity; and CD testing prevalence. The complex model demonstrated better model performance and identified the most influential predictors: hospital-onset testing intensity and prevalence, CO-CDI rate, and community-onset testing intensity (negative correlation). Moreover, 78% of the hospitals ranked in the highest quartile based on raw rate shifted to lower percentiles when we applied the SIR from the complex model. CONCLUSIONS: Hospital descriptors, aggregate patient characteristics, CO-CDI burden, and clinical testing practices significantly influence incidence of cHT-CDI. Benchmarking a cHT-CDI metric is feasible and should include facility and clinical variables. |
Prevalence and determinants of hepatitis delta virus infection among HIV/hepatitis B-coinfected adults in care in the United States
Ferrante ND , Kallan MJ , Sukkestad S , Kodani M , Kitahata MM , Cachay ER , Bhattacharya D , Heath S , Napravnik S , Moore RD , Yendewa G , Mayer KH , Reddy KR , Hayden T , Kamili S , Martin JN , Kim HN , Lo Re V 3rd . J Viral Hepat 2023 30 (11) 879-888 Hepatitis delta virus (HDV) infection increases the risk of liver complications compared to hepatitis B virus (HBV) alone, particularly among persons with human immunodeficiency virus (HIV). However, no studies have evaluated the prevalence or determinants of HDV infection among people with HIV/HBV in the US. We performed a cross-sectional study among adults with HIV/HBV coinfection receiving care at eight sites within the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) between 1996 and 2019. Among patients with available serum/plasma specimens, we selected the first specimen on or after their initial HBV qualifying test. All samples were tested for HDV IgG antibody and HDV RNA. Multivariable log-binomial generalized linear models were used to estimate prevalence ratios (PRs) with 95% CIs of HDV IgG antibody-positivity associated with determinants of interest (age, injection drug use [IDU], high-risk sexual behaviour). Among 597 adults with HIV/HBV coinfection in CNICS and available serum/plasma samples (median age, 43 years; 89.9% male; 52.8% Black; 42.4% White), 24/597 (4.0%; 95% CI, 2.4%-5.6%) were HDV IgG antibody-positive, and 10/596 (1.7%; 95% CI, 0.6%-2.7%) had detectable HDV RNA. In multivariable analysis, IDU was associated with exposure to HDV infection (adjusted PR = 2.50; 95% CI, 1.09-5.74). In conclusion, among a sample of adults with HIV/HBV coinfection in care in the US, 4.0% were HDV IgG antibody-positive, among whom 41.7% had detectable HDV RNA. History of IDU was associated with exposure to HDV infection. These findings emphasize the importance of HDV testing among persons with HIV/HBV coinfection, especially those with a history of IDU. |
A qualitative evaluation and conceptual framework on the use of the Birth weight and Age-at-death Boxes for Intervention and Evaluation System (BABIES) matrix for perinatal health in Uganda
Dynes MM , Daniel GA , Mac V , Picho B , Asiimwe A , Nalutaaya A , Opio G , Kamara V , Kaharuza F , Serbanescu F . BMC Pregnancy Childbirth 2023 23 (1) 86 BACKGROUND: Perinatal mortality (newborn deaths in the first week of life and stillbirths) continues to be a significant global health threat, particularly in resource-constrained settings. Low-tech, innovative solutions that close the quality-of-care gap may contribute to progress toward the Sustainable Development Goals for health by 2030. From 2012 to 2018, the Saving Mothers, Giving Life Initiative (SMGL) implemented the Birth weight and Age-at-Death Boxes for Intervention and Evaluation System (BABIES) matrix in Western Uganda. The BABIES matrix provides a simple, standardized way to track perinatal health outcomes to inform evidence-based quality improvement strategies. METHODS: In November 2017, a facility-based qualitative evaluation was conducted using in-depth interviews with 29 health workers in 16 health facilities implementing BABIES in Uganda. Data were analyzed using directed content analysis across five domains: 1) perceived ease of use, 2) how the matrix was used, 3) changes in behavior or standard operating procedures after introduction, 4) perceived value of the matrix, and 5) program sustainability. RESULTS: Values in the matrix were easy to calculate, but training was required to ensure correct data placement and interpretation. Displaying the matrix on a highly visible board in the maternity ward fostered a sense of accountability for health outcomes. BABIES matrix reports were compiled, reviewed, and responded to monthly by interprofessional teams, prompting collaboration across units to fill data gaps and support perinatal death reviews. Respondents reported improved staff communication and performance appraisal, community engagement, and ability to track and link clinical outcomes with actions. Midwives felt empowered to participate in the problem-solving process. Respondents were motivated to continue using BABIES, although sustainability concerns were raised due to funding and staff shortages. CONCLUSIONS: District-level health systems can use data compiled from the BABIES matrix to inform policy and guide implementation of community-centered health practices to improve perinatal heath. Future work may consider using the Conceptual Framework on Use of the BABIES Matrix for Perinatal Health as a model to operationalize concepts and test the impact of the tool over time. |
Methodology for a correlate of protection for group B Streptococcus: Report from the Bill & Melinda Gates Foundation workshop held on 10 and 11 February 2021
Gilbert PB , Isbrucker R , Andrews N , Goldblatt D , Heath PT , Izu A , Madhi SA , Moulton L , Schrag SJ , Shang N , Siber G , Sobanjo-Ter Meulen A . Vaccine 2022 40 (32) 4283-4291 Worldwide, childhood mortality has declined significantly, with improvements in hygiene and vaccinations against common childhood illnesses, yet newborn mortality remains high. Group B Streptococcus (GBS) disease significantly contributes to newborn mortality and is the leading cause of meningitis in infants. Many years of research have demonstrated the potential for maternal vaccination against GBS to confer protection to the infant, and at least three vaccine candidates are currently undergoing clinical trials. Given the relatively low disease incidence, any clinical vaccine efficacy study would need to include at least 40,000 to 60,000 participants. Therefore, a path to vaccine licensure based on a correlate of protection (CoP) would be the preferred route, with post-approval effectiveness studies demonstrating vaccine impact on reduction of disease burden likely to be required as part of conditional marketing approval. This workshop, hosted by the Bill & Melinda Gates Foundation on 10 and 11 February 2021, discussed considerations and potential statistical methodologies for establishing a CoP for GBS disease. Consensus was reached that an antibody marker with global threshold predictive of a high level of vaccine protection would be most beneficial for licensure assessments. IgG binding antibody in cord blood would likely serve as the CoP, with additional studies needed to confirm a high correlation with functional antibody and to demonstrate comparable kinetics of natural versus vaccine-induced antibody. Common analyses of ongoing seroepidemiological studies include estimation of absolute and relative disease risk as a function of infant antibody concentration, with adjustment for confounders of the impact of antibody concentration on infant GBS disease including gestational age and maternal age. Estimation of an antibody concentration threshold indicative of high protection should build in margin for uncertainties from sources including unmeasured confounders, imperfect causal mediation, and variability in point and confidence interval estimates across regions and/or serotypes. |
WHO method for estimating congenital syphilis to inform surveillance and service provision, Paraguay
Heath K , Alonso M , Aguilar G , Samudio T , Korenromp E , Rowley J , Suleiman A , Shwe YY , Htin KCW , Ishikawa N , Owiredu MN , Taylor M . Bull World Health Organ 2022 100 (3) 231-236 PROBLEM: In Paraguay, incomplete surveillance data resulted in the burden of congenital syphilis being underestimated, which, in turn, led to missed opportunities for infant diagnosis and treatment. APPROACH: The prevalence of congenital syphilis, as defined by the World Health Organization (WHO), was estimated for Paraguay using the WHO congenital syphilis estimation tool. This tool was also used to monitor progress towards the elimination of mother-to-child transmission of syphilis. LOCAL SETTING: The burden of syphilis in Paraguay has historically been high: its prevalence in pregnant women was estimated to be 3% in 2018. RELEVANT CHANGES: The incidence rate of congenital syphilis estimated using the WHO tool was around nine times the reported prevalence. Subsequently, Paraguay: (i) provided training to improve diagnosis and case reporting; (ii) strengthened information systems for case monitoring and reporting; and (iii) procured additional rapid dual HIV-syphilis and rapid plasma reagin tests to increase syphilis testing capacity. In addition, the Ministry of Health prepared a new national plan for eliminating mother-to-child transmission of syphilis, with clear monitoring milestones. LESSONS LEARNT: Health-care providers' reporting and surveillance procedures for congenital syphilis may not adequately reflect national and international case definitions. Use of the WHO congenital syphilis estimation tool in Paraguay drew attention to congenital syphilis as a national public health problem and highlighted the importance of comprehensive national surveillance systems and accurate data. Ongoing use of the WHO tool can track progress towards the elimination of mother-to-child transmission of syphilis by helping improve syphilis service coverage and national surveillance. |
A Strategy for Field Evaluations of Exposures and Respiratory Health of Workers at Small- to Medium-Sized Coffee Facilities
Virji MA , Cummings KJ , Cox-Ganser JM . Front Public Health 2021 9 705225 Coffee production is a global industry with roasteries throughout the world. Workers in this industry are exposed to complex mixtures of gases, dusts, and vapors including carbon monoxide, carbon dioxide, coffee dust, allergens, alpha-diketones, and other volatile organic compounds (VOCs). Adverse respiratory health outcomes such as respiratory symptoms, reduced pulmonary function, asthma, and obliterative bronchiolitis can occur among exposed workers. In response to health hazard evaluations requests received from 17 small- to medium-sized coffee facilities across the United States, the National Institute for Occupational Safety and Health conducted investigations during 2016-2017 to understand the burden of respiratory abnormalities, exposure characteristics, relationships between exposures and respiratory effects, and opportunities for exposure mitigation. Full-shift, task-based, and instantaneous personal and area air samples for diacetyl, 2,3-pentanedione and other VOCs were collected, and engineering controls were evaluated. Medical evaluations included questionnaire, spirometry, impulse oscillometry, and fractional exhaled nitric oxide. Exposure and health assessments were conducted using standardized tools and approaches, which enabled pooling data for aggregate analysis. The pooled data provided a larger population to better address the requestors' concern of the effect of exposure to alpha-diketones on the respiratory heath of coffee workers. This paper describes the rationale for the exposure and health assessment strategy, the approach used to achieve the study objectives, and its advantages and limitations. |
Estimation of benzathine penicillin G demand for congenital syphilis elimination with adoption of dual HIV/syphilis rapid diagnostic tests in eleven high burden countries
Shah S , Garg S , Heath K , Ofili O , Bansal Y , Seghers F , Storey A , Taylor M . PLoS One 2021 16 (8) e0256400 BACKGROUND: WHO recommends use of rapid dual HIV/syphilis tests for screening pregnant women (PW) during antenatal care to prevent mother-to-child transmission. Scale-up of testing implies a need to accurately forecast and procure benzathine penicillin (BPG) to treat the additionally identified PW with syphilis. METHODS: Country-reported ANC coverage, PW syphilis screening and treatment coverage values in 2019 were scaled linearly to EMTCT targets by 2030 (constant increasing slope from 2019 figures to 95% in 2030) for 11 focus countries. Antenatal syphilis screening coverage was substituted with HIV screening coverage to estimate potential contribution of rapid dual HIV/syphilis tests in identifying additional PW with syphilis. BPG demand was calculated for 2019-2030 accordingly. RESULTS: The estimated demand for BPG (in 2.4 million unit vials) using current maternal syphilis prevalence and treatment coverage will increase from a baseline of 414,459 doses in 2019 to 683,067 doses (+65%) in 2021 assuming immediate replacement of single HIV test kits with rapid dual HIV/syphilis tests for these 11 countries. Continued scale up of syphilis screening and treatment coverage to reach elimination coverage of 95% will result in an estimated demand increase of 160%, (663,969 doses) from 2019 baseline for a total demand of 1,078,428 BPG doses by 2030. CONCLUSIONS: Demand for BPG will increase following adoption of rapid dual HIV/syphilis test kits due to increases in maternal diagnoses of syphilis. To eliminate congenital syphilis, MNCH clinical programs will need to synergize with disease surveillance programs to accurately forecast BPG demand with scale up of antenatal syphilis screening to ensure adequate treatment is available for pregnant women diagnosed with syphilis. |
Health Status and Health Care Use Among Adolescents Identified With and Without Autism in Early Childhood - Four U.S. Sites, 2018-2020
Powell PS , Pazol K , Wiggins LD , Daniels JL , Dichter GS , Bradley CB , Pretzel R , Kloetzer J , McKenzie C , Scott A , Robinson B , Sims AS , Kasten EP , Fallin MD , Levy SE , Dietz PM , Cogswell ME . MMWR Morb Mortal Wkly Rep 2021 70 (17) 605-611 Persons identified in early childhood as having autism spectrum disorder (autism) often have co-occurring health problems that extend into adolescence (1-3). Although only limited data exist on their health and use of health care services as they transition to adolescence, emerging data suggest that a minority of these persons receive recommended guidance* from their primary care providers (PCPs) starting at age 12 years to ensure a planned transition from pediatric to adult health care (4,5). To address this gap in data, researchers analyzed preliminary data from a follow-up survey of parents and guardians of adolescents aged 12-16 years who previously participated in the Study to Explore Early Development (https://www.cdc.gov/ncbddd/autism/seed.html). The adolescents were originally studied at ages 2-5 years and identified at that age as having autism (autism group) or as general population controls (control group). Adjusted prevalence ratios (aPRs) that accounted for differences in demographic characteristics were used to compare outcomes between groups. Adolescents in the autism group were more likely than were those in the control group to have physical difficulties (21.2% versus 1.6%; aPR = 11.6; 95% confidence interval [CI] = 4.2-31.9), and to have additional mental health or other conditions(†) (one or more condition: 63.0% versus 28.9%; aPR = 1.9; 95% CI = 1.5-2.5). Adolescents in the autism group were more likely to receive mental health services (41.8% versus 22.1%; aPR = 1.8, 95% CI = 1.3-2.6) but were also more likely to have an unmet medical or mental health service need(§) (11.0% versus 3.2%; aPR = 3.1; 95% CI = 1.1-8.8). In both groups, a small percentage of adolescents (autism, 7.5%; control, 14.1%) received recommended health care transition (transition) guidance. These findings are consistent with previous research (4,5) indicating that few adolescents receive the recommended transition guidance and suggest that adolescents identified with autism in early childhood are more likely than adolescents in the general population to have unmet health care service needs. Improved provider training on the heath care needs of adolescents with autism and coordination of comprehensive programs(¶) to meet their needs can improve delivery of services and adherence to recommended guidance for transitioning from pediatric to adult health care. |
Population heath informatics can advance interoperability: National Program of Cancer Registries Electronic Pathology Reporting Project
Pollack LA , Jones SF , Blumenthal W , Alimi TO , Jones DE , Rogers JD , Benard VB , Richardson LC . JCO Clin Cancer Inform 2020 4 985-992 PURPOSE: Given the reach, breadth, and volume of data collected from multiple clinical settings and systems, US central cancer registries (CCRs) are uniquely positioned to test and advance cancer health information exchange. This article describes a current Centers for Disease Control and Prevention (CDC) National Program of Cancer Registries (NPCR) cancer informatics data exchange initiative. METHODS: CDC is using an established cloud-based platform developed by the Association of Public Health Laboratories (APHL) for national notifiable disease reporting to enable direct transmission of standardized electronic pathology (ePath) data from laboratories to CCRs in multiple states. RESULTS: The APHL Informatics Messaging Services (AIMS) Platform provides an infrastructure to enable a large national laboratory to submit data to a single platform. State health departments receive data from the AIMS Platform through a secure portal, eliminating separate data exchange routes with each CCR. CONCLUSION: Key factors enabling ePath data exchange from laboratories to CCRs are having established cancer registry data standards and using a single platform/portal to reduce data streams. NPCR plans to expand this approach in alignment with ongoing cancer informatics efforts in clinical settings. The 50 CCRs supported by NPCR provide a variety of scenarios to develop and disseminate cancer data informatics initiatives and have tremendous potential to increase the implementation of cancer data exchange. |
Human immunodeficiency virus prevention for people who use drugs: Overview of reviews and the ICOS of PICOS
Johnson WD , Rivadeneira N , Adegbite AH , Neumann MS , Mullins MM , Rooks-Peck C , Wichser ME , McDonald CM , Higa DH , Sipe TA . J Infect Dis 2020 222 S278-s300 BACKGROUND: This article summarizes the results from systematic reviews of human immunodeficiency virus (HIV) prevention interventions for people who use drugs (PWUD). We performed an overview of reviews, meta-analysis, meta-epidemiology, and PROSPERO Registration CRD42017070117. METHODS: We conducted a comprehensive systematic literature search using the Centers for Disease Control and Prevention HIV/AIDS Prevention Research Synthesis Project database to identify quantitative systematic reviews of HIV public heath interventions with PWUD published during 2002-2017. We recombined results of US studies across reviews to quantify effects on HIV infections, continuum of HIV care, sexual risk, and 5 drug-related outcomes (sharing injection equipment, injection frequency, opioid use, general drug use, and participation in drug treatment). We conducted summary meta-analyses separately for reviews of randomized controlled trials (RCTs) and quasi-experiments. We stratified effects by 5 intervention types: behavioral-psychosocial (BPS), syringe service programs (SSP), opioid agonist therapy (OAT), financial and scheduling incentives (FSI), and case management (CM). RESULTS: We identified 16 eligible reviews including >140 US studies with >55 000 participants. Summary effects among US studies were significant and favorable for 4 of 5 outcomes measured under RCT (eg, reduced opioid use; odds ratio [OR] = 0.70, confidence interval [CI] = 0.56-0.89) and all 6 outcomes under quasi-experiments (eg, reduced HIV infection [OR = 0.42, CI = 0.27-0.63]; favorable continuum of HIV care [OR = 0.68, CI = 0.53-0.88]). Each intervention type showed effectiveness on 1-6 outcomes. Heterogeneity was moderate to none for RCT but moderate to high for quasi-experiments. CONCLUSIONS: Behavioral-psychosocial, SSP, OAT, FSI, and CM interventions are effective in reducing risk of HIV and sequelae of injection and other drug use, and they have a continuing role in addressing the opioid crisis and Ending the HIV Epidemic. |
Association between the Tips From Former Smokers Campaign and smoking cessation among adults, United States, 2012-2018
Murphy-Hoefer R , Davis KC , King BA , Beistle D , Rodes R , Graffunder C . Prev Chronic Dis 2020 17 E97 In 2012, the Centers for Disease Control and Prevention (CDC) launched the national Tips From Former Smokers (Tips) campaign to encourage people who smoke to quit by showing real-life heath consequences of tobacco use and promoting evidence-based resources for quitting. To assess the campaign's impact on quit attempts and sustained-quit estimates (ie, quits lasting ≥6 mos), CDC analyzed data from a nationally representative longitudinal survey of US adults who smoke cigarettes, aged 18 years or older in 2012-2018. The Tips campaign was associated with an estimated 16.4 million quit attempts and 1,005,419 sustained quits. Continued implementation of cessation campaigns, including the Tips campaign, could accelerate progress toward reducing rates of smoking-related diseases and death. |
Assessment of VaxTrac electronic immunization registry in an urban district in Sierra Leone: Implications for data quality, defaulter tracking, and policy
Jalloh MF , Namageyo-Funa A , Gleason B , Wallace AS , Friedman M , Sesay T , Ocansey D , Jalloh MS , Feldstein LR , Conklin L , Hersey S , Singh T , Kaiser R . Vaccine 2020 38 (39) 6103-6111 BACKGROUND: In 2016, the Sierra Leone Ministry of Health and Sanitation (MoHS) piloted VaxTrac, an electronic immunization registry (EIR), in an urban district to improve management of vaccination records and tracking of children who missed scheduled doses. We aimed to document lessons learned to inform decision-making on VaxTrac and similar EIRs' future use. METHODS: Ten out of 50 urban health facilities that implemented VaxTrac were purposively selected for inclusion in a rapid mixed-method assessment from November to December 2017. For a one-month period, records of six scheduled vaccine doses among children < 2 years old in VaxTrac were abstracted and compared to three paper-based records (register of under-two children, daily tally sheet, and monthly summary form). We used the under-two register as the reference gold standard for comparison purposes. We interviewed and observed 10 heath workers, one from each selected facility, who were using VaxTrac. RESULTS: Overall, VaxTrac captured < 65% of the vaccine doses reported in the paper-based sources, but in the largest health facility VaxTrac captured the highest number of doses. Two additional notable patterns emerged: 1) the aggregated data sources reported higher doses administered compared to the under-two register and VaxTrac; 2) data sources that need real-time data capture during the vaccination session reported fewer doses administered compared to the monthly HF2 summary form. Health workers expressed that the EIR helped them to shorten the time to manage, summarize, and report vaccination records. Workflows for data entry in VaxTrac were inconsistent among facilities and rarely integrated into existing processes. Data sharing restrictions contributed to duplicate records. CONCLUSION: Although VaxTrac helped to shorten the time to manage, summarize, and report vaccination records, data sharing restrictions coupled with inconsistent and inefficient workflows were major implementation challenges. Readiness-to-introduce and sustainability should be carefully considered before implementing an EIR. |
Using real-time respirable dust monitors to address the silica health hazard in mining
Patts J . Rock Prod 2020 123 (7) 101-103 Mining operations, by their very nature, create a lot of dust, with varying percentages of silica content. Modern mining operators are well aware of the hazard created by respirable crystalline silica dust (RCS). Operators also need to recognize that silicosis is an irreversible occupational disease with terrible consequences including lung cancer, respiratory failure and tuberculosis. And there is no cure for silicosis - the only fix is to prevent the disease by limiting worker exposure. Based on the latest work-related lung disease surveillance report by the CDC, between 1990 and 1999, just over 20% of all total silica deaths occurred in the M/NM industry. And between 2000 and 2017, 12% of MSHA personal heath samples were greater than the MSHA PEL of 100 ug/m3 and 34% of those were greater than the OSHA PEL of 50 ug/m3. The benefit of real-time dust sensing lies in the ability to help the operator understand when certain exposures occurred. Pairing real-time sensing with Helmet-CAM technology, mine operators can also understand the specific tasks that led to those exposures. Further adding the use of an FTIR instrument and end-of-shift analysis can effectively yield silica estimation. All three of these approaches can be combined to estimate real-time silica concentrations. Importantly, to quantify worker exposure, there is no substitute for personal sampling. Complementary to personal sampling is area sampling, and when area sampling is conducted in real time then the dust levels present at mines in key areas can be quantified on a continuous, long-term basis. NIOSH has conducted many years of engineering control research and has published extensively on the topic. While the commonly used hierarchy of controls puts substitution as the best method for reducing worker exposures, often in mining the best controls are engineering-based, such as exhaust ventilation, dust capture systems, and total structure ventilation. Fueled by a growing global desire to understand indoor and outdoor air quality (most commonly combustion aerosols in the atmosphere), numerous "low-cost" particulate sensors have been developed and marketed to those interested in quantifying their local air quality. Further, studies have compared these sensors to research-grade federal environmental monitoring devices and, after some appropriate scaling factor is applied, the agreement can be quite good. NIOSH recently began a new research effort in the fall of 2019 which aims to evaluate the applicability of these sensors not to ambient aerosols, but to the perhaps more challenging role of measuring real-time mining dust levels. This work poses many challenges - larger and more varied dusts, higher dust concentrations, and harsh environments - but the potential to inexpensively quantify mining dust levels in real time is intriguing. If low-cost area dust sensing for mining becomes a reality, it's possible that plant operators could apply engineering controls more widely by justifying installations that would most efficiently reduce both area exposures and individual worker exposures, providing a significant health benefit. |
Tracing the Evolutionary History and Global Expansion of Candida auris Using Population Genomic Analyses.
Chow NA , Munoz JF , Gade L , Berkow EL , Li X , Welsh RM , Forsberg K , Lockhart SR , Adam R , Alanio A , Alastruey-Izquierdo A , Althawadi S , Arauz AB , Ben-Ami R , Bharat A , Calvo B , Desnos-Ollivier M , Escandon P , Gardam D , Gunturu R , Heath CH , Kurzai O , Martin R , Litvintseva AP , Cuomo CA . mBio 2020 11 (2) Candida auris has emerged globally as a multidrug-resistant yeast that can spread via nosocomial transmission. An initial phylogenetic study of isolates from Japan, India, Pakistan, South Africa, and Venezuela revealed four populations (clades I, II, III, and IV) corresponding to these geographic regions. Since this description, C. auris has been reported in more than 30 additional countries. To trace this global emergence, we compared the genomes of 304 C. auris isolates from 19 countries on six continents. We found that four predominant clades persist across wide geographic locations. We observed phylogeographic mixing in most clades; clade IV, with isolates mainly from South America, demonstrated the strongest phylogeographic substructure. C. auris isolates from two clades with opposite mating types were detected contemporaneously in a single health care facility in Kenya. We estimated a Bayesian molecular clock phylogeny and dated the origin of each clade within the last 360 years; outbreak-causing clusters from clades I, III, and IV originated 36 to 38 years ago. We observed high rates of antifungal resistance in clade I, including four isolates resistant to all three major classes of antifungals. Mutations that contribute to resistance varied between the clades, with Y132F in ERG11 as the most widespread mutation associated with azole resistance and S639P in FKS1 for echinocandin resistance. Copy number variants in ERG11 predominantly appeared in clade III and were associated with fluconazole resistance. These results provide a global context for the phylogeography, population structure, and mechanisms associated with antifungal resistance in C. auris IMPORTANCE In less than a decade, C. auris has emerged in health care settings worldwide; this species is capable of colonizing skin and causing outbreaks of invasive candidiasis. In contrast to other Candida species, C. auris is unique in its ability to spread via nosocomial transmission and its high rates of drug resistance. As part of the public health response, whole-genome sequencing has played a major role in characterizing transmission dynamics and detecting new C. auris introductions. Through a global collaboration, we assessed genome evolution of isolates of C. auris from 19 countries. Here, we described estimated timing of the expansion of each C. auris clade and of fluconazole resistance, characterized discrete phylogeographic population structure of each clade, and compared genome data to sensitivity measurements to describe how antifungal resistance mechanisms vary across the population. These efforts are critical for a sustained, robust public health response that effectively utilizes molecular epidemiology. |
Shaping meeting to explore the value of a coordinated work plan for epidemic and pandemic influenza vaccine preparedness
Ruscio B , Bolster A , Bresee J . Vaccine 2020 38 (16) 3179-3183 In March 2019, a group of global health leaders with expertise in influenza, vaccinology and pandemic preparedness was convened for a meeting titled "Shaping Meeting to explore the value of a coordinated work plan for epidemic and pandemic influenza vaccine preparedness." Influenza epidemics occur annually in every country in the world, resulting in significant global burden of illness and deaths. While every country is effected, most deaths and severe disease occur in low- and lower middle-income countries (LIC and LMIC). Influenza immunization programs that limit the burden of disease, deaths, and reduce economic impact are a fundamental public health intervention for seasonal epidemics. In addition, they provide the experience, systems and infrastructure for the timely and efficient use of vaccines and other medical countermeasures critical for effective pandemic responses. Pandemic influenza response activities, including vaccination efforts, will be most effective if used and practiced regularly. Consequently, countries with seasonal influenza prevention and control programs should be better prepared for, and have more effective pandemic responses than countries without such programs. A decade after the 2009 pandemic, despite ongoing prevention efforts, most LICs and LMICs still lack access to robust seasonal influenza immunization programs. Given this current state, meeting participants concluded that there is critical need to advance the expansion and strengthening of seasonal influenza immunization programs in LICs and LMICs not only to reduce the economic and public health effects of annual influenza epidemics, but also to increase preparedness to mitigate the threat of future pandemics and improve global heath security. Many government and private sectors, in a whole of government approach, need to be working together to support and advance countries' epidemic and pandemic influenza capacities preparedness objectives. Accomplishment of these objectives can be achieved with a coordinated work plan developed and guided by an alliance of international stakeholders, to include, among others, government, and nongovernment organization representation, civil society representatives, vaccine manufacturers, international organizations, and health security and influenza experts. |
Tracking of obesity among 2- to 9-year-olds in an electronic heath record database from 2006 to 2018
Freedman DS , Goodman AB , King RJ , Blanck HM . Obes Sci Pract 2020 6 (3) 300-306 Background and Objective: As obesity among children and adolescents is associated with major health risks, including the persistence of obesity into adulthood, there has been interest in targeting prevention efforts at children and adolescent. The longitudinal tracking of BMI and obesity, as well as the effects of initial age and duration of follow-up on this tracking, were examined in a large electronic health record (EHR) database. Method(s): The data consisted of 2.04 million children who were examined from 2006 through 2018. These children were initially examined between ages 2 and 9 years and had a final examination, on average, 4 years later. Result(s): Overall, children with obesity at one examination were 7.7 times more likely to have obesity at a subsequent examination than children with a BMI <= 95th percentile. Further, 71% of children with obesity at one examination continued to have obesity at re-examination. Although 2-year-olds had a relative risk of 5.5 and a positive predictive value of 54%, then sensitivity of obesity at younger ages was low. Of the children who were re-examined after age 10 y and found to have obesity, only 22% had a BMI >= 95th percentile at age 2 years. Conclusion(s): Despite the tracking of obesity at all ages, these results agree with previous reports that have found that an elevated BMI at a very young age will identify only a small proportion of older children with obesity. Copyright Published 2020. This article is a U.S. Government work and is in the public domain in the USA. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd |
Design of an enhanced public health surveillance system for hepatitis C virus elimination in King County, Washington
Baer A , Fagalde MS , Drake CD , Sohlberg EH , Barash E , Glick S , Millman AJ , Duchin JS . Public Health Rep 2020 135 (1) 33-39 INTRODUCTION: With the goal of eliminating hepatitis C virus (HCV) as a public health problem in Washington State, Public Health-Seattle & King County (PHSKC) designed a Hepatitis C Virus Test and Cure (HCV-TAC) data system to integrate surveillance, clinical, and laboratory data into a comprehensive database. The intent of the system was to promote identification, treatment, and cure of HCV-infected persons (ie, HCV care cascade) using a population health approach. MATERIALS AND METHODS: The data system automatically integrated case reports received via telephone and fax from health care providers and laboratories, hepatitis test results reported via electronic laboratory reporting, and data on laboratory and clinic visits reported by 6 regional health care systems. PHSKC examined patient-level laboratory test results and established HCV case classification using Council of State and Territorial Epidemiologists criteria, classifying patients as confirmed if they had detectable HCV RNA. RESULTS: The data enabled PHSKC to report the number of patients at various stages along the HCV care cascade. Of 7747 HCV RNA-positive patients seen by a partner site, 5377 (69%) were assessed for severity of liver fibrosis, 3932 (51%) were treated, and 2592 (33%) were cured. PRACTICE IMPLICATIONS: Data supported local public heath surveillance and HCV program activities. The data system could serve as a foundation for monitoring future HCV prevention and control programs. |
Neonatal seizures: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data
Pellegrin S , Munoz FM , Padula M , Heath PT , Meller L , Top K , Wilmshurst J , Wiznitzer M , Das MK , Hahn CD , Kucuku M , Oleske J , Vinayan KP , Yozawitz E , Aneja S , Bhat N , Boylan G , Sesay S , Shrestha A , Soul JS , Tagbo B , Joshi J , Soe A , Maltezou HC , Gidudu J , Kochhar S , Pressler RM . Vaccine 2019 37 (52) 7596-7609 Seizures are the most common neurological emergency in newborns and can be associated with significant mortality and neuro-developmental disability. Neonatal seizures are a major challenge for clinicians because of inconspicuous clinical presentation, variable electro-clinical correlation, and poor response to antiseizure drugs. It is well recognized that fever and infection can trigger seizures in young children and that this risk is enhanced in children with epilepsy. As immunization may cause a fever, vaccination can be a non-specific trigger for seizures in children [1]. On the other hand, children with epilepsy do not appear to be at increased risk of seizures following immunization [2]. It is unclear whether vaccination in newborns or maternal vaccination, is associated with a higher risk of neonatal seizures. However, as maternal immunization with established vaccines becomes more prevalent across multiple geographies, and new maternal vaccine candidates enter late-stage development, it is becoming increasingly important to create easily adopted standard definitions for adverse events potentially associated with these interventions. The Brighton Collaboration has previously published a case definition for seizures in children [3] but not for seizures in neonates. |
The burden of non-communicable diseases and their related risk factors in the country of Georgia, 2015
Russell S , Sturua L , Li C , Morgan J , Topuridze M , Blanton C , Hagan L , Salyer SJ . BMC Public Health 2019 19 479 Background: Non-communicable diseases (NCDs), mainly cardiovascular diseases, are a substantial cause of mortality in the country of Georgia, accounting for approximately 93% of all deaths (standardized mortality rate 630.7 deaths per 100,000 persons per year) and an important threat to health security. We conducted a nationally representative survey examining the prevalence of NCDs and their risk factors as part of a 2015 Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) serosurvey. Methods: We conducted a cross-sectional serosurvey among adults aged ≥18 years using a stratified, multi-stage cluster design (n = 7000). We asked participants standardized questions from the Global Adult Tobacco Survey and the WHO STEPwise approach to Surveillance (STEPS) Survey. We also measured blood pressure and Body Mass Index for each participant. Weighted frequencies were computed for NCD and risk factor prevalence and compared to 2010 STEPS results. Results: Georgians reported high rates of smoking, alcohol use, elevated blood pressure, obesity, diabetes and cardiovascular disease. An estimated 27.1% (95% confidence interval [CI]: 25.3, 28.8%) of adults (51.5% of men and 6.0% of women) reported daily use of tobacco products and 27.5% (95% CI: 25.7, 29.2%) of adults (52.1% of men and 7.0% of women) reported binge drinking within the last 30 days. Physical measurements revealed that 37.5% (95% CI: 35.8, 39.3%) of adults had elevated blood pressure and 33.4% (95% CI: 31.8, 35.0%) had obesity. 5.4% (95% CI: 4.6, 6.2%) of adults had self-reported diagnosed diabetes and 15.3% (95% CI: 14.1, 16.6%) had self-reported diagnosed cardiovascular disease. From 2010 to 2015, the prevalence of obesity increased by 8.3 percentage points (95% CI: 5.9, 10.7%; p < 0.01) and the prevalence of elevated blood pressure increased by 4.1 percentage points (95% CI: 1.4, 6.8%; p < 0.01). Conclusions: Georgia has a high NCD burden, and results from the survey showed an increase in obesity and elevated blood pressure since 2010. The prevalence of other major NCDs have remained near levels reported in the 2010 STEPs survey. Comprehensive public health interventions are needed to control the heath security threats of major NCDs and their risk factors in the future. |
The role of immune correlates of protection on the pathway to licensure, policy decision and use of group B Streptococcus vaccines for maternal immunization: considerations from World Health Organization consultations
Vekemans J , Crofts J , Baker CJ , Goldblatt D , Heath PT , Madhi SA , Le Doare K , Andrews N , Pollard AJ , Saha SK , Schrag SJ , Smith PG , Kaslow DC . Vaccine 2019 37 (24) 3190-3198 The development of a group B Streptococcus (GBS) vaccine for maternal immunization constitutes a global public health priority, to prevent GBS-associated early life invasive disease, stillbirth, premature birth, maternal sepsis, adverse neurodevelopmental consequences, and to reduce perinatal antibiotic use. Sample size requirements for the conduct of a randomized placebo-controlled trial to assess vaccine efficacy against the most relevant clinical endpoints, under conditions of appropriate ethical standards of care, constitute a significant obstacle on the pathway to vaccine availability. Alternatively, indirect evidence of protection based on immunologic data from vaccine and sero-epidemiological studies, complemented by data from opsonophagocytic in vitro assays and animal models, could be considered as pivotal data for licensure, with subsequent confirmation of effectiveness against disease outcomes in post-licensure evaluations. Based on discussions initiated by the World Health Organization we present key considerations about the potential role of correlates of protection towards an accelerated pathway for GBS vaccine licensure and wide scale use. Priority activities to support progress to regulatory and policy decision are outlined. |
Engaging communities to reach immigrant and minority populations: The Minnesota Immunization Networking Initiative (MINI), 2006-2017
Peterson P , McNabb P , Maddali SR , Heath J , Santibanez S . Public Health Rep 2019 134 (3) 241-248 In Minneapolis-St Paul, Minnesota, factors such as cultural and linguistic diversity make it difficult for public health agencies to reach immigrant and racial/ethnic minority populations with health initiatives. Founded in 2006, the Minnesota Immunization Networking Initiative (MINI) is a community project that has provided more than 80 000 free influenza vaccinations to vulnerable populations, including immigrants and racial/ethnic minority groups. MINI administered 5910 vaccinations through 99 community-based vaccination clinics during the 2017-2018 influenza season and surveyed the clients in their own language about influenza vaccination knowledge and practices. Among those surveyed, 2545 (43.1%) were uninsured and 408 (6.9%) received a first-time influenza vaccination at the MINI clinic. A total of 2893 (49.0%) respondents heard about the clinic through their faith community. Lessons learned included the importance of building relationships with community leaders and involving them as full partners, holding clinics in community-based settings to bring vaccinations to clients, and reporting outcomes to partners. |
Public Health Workforce 3.0: Recent progress and what's on the horizon to achieve the 21st-century workforce
Glynn MK , Jenkins ML Jr , Ramsey C , Simone PM . J Public Health Manag Pract 2019 25 Suppl 2 S6-s9 Twenty-five years ago, the 10 essential public health services were defined and disseminated1 and public health was charged with ensuring that our workforce had mastery of the competencies to deliver these services.2,3 Although these essential services remain a useful framework for the practice of public health, the concept of an effective public health worker has evolved in the intervening decades. The necessary skills and aptitudes now extend beyond the traditional competencies (eg, epidemiology) to focus on strategic and systems thinking, communication, and translating science to policy, along with the public health practitioner's role as chief health strategist.4–8 A subcommittee of the Public Health Functions Project Steering Committee laid out an agenda in 1994 to realize the vision of “Healthy People in Healthy Communities” and recommended actions in 5 main areas (national leadership, state and local leadership, workforce composition, curriculum development, and distance learning).1 Progress in each of these 5 areas has been documented,9–11 with particularly substantial advances observed in the last 5 years.12–16 From a federal perspective, we believe that the recent, increasing rate of these advances can be attributed to a few main factors. Collaboration among federal and other partners working at the national level has provided the necessary leadership. Partners have built upon each other's work rather than working in isolation. Accreditation of health departments has provided a consistent approach for strengthening state and local health agencies. Researchers have taken action and are building evidence that informs practice at the federal, state, tribal, local, and territorial levels. Nonetheless, gaps remain. Using the areas for action as a framework and a federal perspective, we highlight recent accomplishments and important areas for future attention to continue the path toward the public health workforce of the 21st century—a public heath workforce 3.0. |
Alcohol, prescription drug misuse, sexual violence, and dating violence among high school youth
Espelage DL , Davis JP , Basile KC , Rostad WL , Leemis RW . J Adolesc Health 2018 63 (5) 601-607 PURPOSE: Sexual violence (SV), teen dating violence (TDV), and substance use are significant public health concerns among U.S. adolescents. This study examined whether latent classes of baseline alcohol and prescription drug misuse longitudinally predict SV and TDV victimization and perpetration (i.e., verbal, relational, physical/threatening, and sexual) 1 year later. METHODS: Students from six Midwestern high schools (n=1,875; grades 9-11) completed surveys across two consecutive spring semesters. Latent class analysis was used to identify classes of individuals according to four substance use variables. A latent class regression and a manual three-step auxiliary approach were used to assess concurrent and distal relationships between identified classes and SV and TDV victimization and perpetration. RESULTS: Three classes of substance use were identified: low/no use (41% of sample), alcohol only use (45%), and alcohol and prescription drug misuse (APD) (14%). Youth in the APD class experienced greater SV and TDV victimization and perpetration than the alcohol only class at baseline. At Time 2 (one year later), youth in the baseline APD class experienced significantly higher SV and TDV victimization and perpetration outcomes than youth in the alcohol only class with the exception of sexual and physical TDV perpetration. CONCLUSIONS: The misuse of both alcohol and prescription drugs emerged as a significant risk factor for later SV and TDV among adolescents. As such, it would be beneficial if future research continued to assess the nature of these associations and incorporate prescription drug use and misuse into heath education, substance use, and violence prevention programs. |
Maternal immunization against Group B streptococcus: World Health Organization research and development technological roadmap and preferred product characteristics
Vekemans J , Moorthy V , Friede M , Alderson MR , Sobanjo-Ter Meulen A , Baker CJ , Heath PT , Madhi SA , Mehring-Le Doare K , Saha SK , Schrag S , Kaslow DC . Vaccine 2018 37 (50) 7391-7393 Group B streptococcus, found in the vagina or lower gastrointestinal tract of about 10-40% of women of reproductive age, is a leading cause of early life invasive bacterial disease, potentially amenable to prevention through maternal immunization during pregnancy. Following a consultation process with global stakeholders, the World Health Organization is herein proposing priority research and development pathways and preferred product characteristics for GBS vaccines, with the aim to facilitate and accelerate vaccine licensure, policy recommendation for wide scale use and implementation. |
Neonatal encephalopathy with group B streptococcal disease worldwide: Systematic review, investigator group datasets, and meta-analysis
Tann CJ , Martinello KA , Sadoo S , Lawn JE , Seale AC , Vega-Poblete M , Russell NJ , Baker CJ , Bartlett L , Cutland C , Gravett MG , Ip M , Le Doare K , Madhi SA , Rubens CE , Saha SK , Schrag S , Sobanjo-Ter Meulen A , Vekemans J , Heath PT . Clin Infect Dis 2017 65 S173-s189 Background: Neonatal encephalopathy (NE) is a leading cause of child mortality and longer-term impairment. Infection can sensitize the newborn brain to injury; however, the role of group B streptococcal (GBS) disease has not been reviewed. This paper is the ninth in an 11-article series estimating the burden of GBS disease; here we aim to assess the proportion of GBS in NE cases. Methods: We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups reporting GBS-associated NE. Meta-analyses estimated the proportion of GBS disease in NE and mortality risk. UK population-level data estimated the incidence of GBS-associated NE. Results: Four published and 25 unpublished datasets were identified from 13 countries (N = 10436). The proportion of NE associated with GBS was 0.58% (95% confidence interval [CI], 0.18%-.98%). Mortality was significantly increased in GBS-associated NE vs NE alone (risk ratio, 2.07 [95% CI, 1.47-2.91]). This equates to a UK incidence of GBS-associated NE of 0.019 per 1000 live births. Conclusions: The consistent increased proportion of GBS disease in NE and significant increased risk of mortality provides evidence that GBS infection contributes to NE. Increased information regarding this and other organisms is important to inform interventions, especially in low- and middle-resource contexts. |
Neurodevelopmental impairment in children after group B streptococcal disease worldwide: Systematic review and meta-analyses
Kohli-Lynch M , Russell NJ , Seale AC , Dangor Z , Tann CJ , Baker CJ , Bartlett L , Cutland C , Gravett MG , Heath PT , Ip M , Le Doare K , Madhi SA , Rubens CE , Saha SK , Schrag S , Sobanjo-Ter Meulen A , Vekemans J , O'Sullivan C , Nakwa F , Ben Hamouda H , Soua H , Giorgakoudi K , Ladhani S , Lamagni T , Rattue H , Trotter C , Lawn JE . Clin Infect Dis 2017 65 S190-s199 Background: Survivors of infant group B streptococcal (GBS) disease are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified. This is the 10th of 11 articles estimating the burden of GBS disease. Here we aimed to estimate NDI in survivors of infant GBS disease. Methods: We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on the risk of NDI after invasive GBS disease in infants <90 days of age. We did meta-analyses to derive pooled estimates of the percentage of infants with NDI following GBS meningitis. Results: We identified 6127 studies, of which 18 met eligibility criteria, all from middle- or high-income contexts. All 18 studies followed up survivors of GBS meningitis; only 5 of these studies also followed up survivors of GBS sepsis and were too few to pool in a meta-analysis. Of meningitis survivors, 32% (95% CI, 25%-38%) had NDI at 18 months of follow-up, including 18% (95% CI, 13%-22%) with moderate to severe NDI. Conclusions: GBS meningitis is an important risk factor for moderate to severe NDI, affecting around 1 in 5 survivors. However, data are limited, and we were unable to estimate NDI after GBS sepsis. Comparability of studies is difficult due to methodological differences including variability in timing of clinical reviews and assessment tools. Follow-up of clinical cases and standardization of methods are essential to fully quantify the total burden of NDI associated with GBS disease, and inform program priorities. |
- Page last reviewed:Feb 1, 2024
- Page last updated:May 06, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure