Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-24 (of 24 Records) |
Query Trace: Learner E [original query] |
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Expanding the evidence-base for improving sexual health among transgender communities: the importance of rigorous epidemiologic studies
Rushmore J , Learner ER , Bernstein KT . J Infect Dis 2024 Though approximately 1.3 million adults identify as transgender in United States (US) [1], | transgender populations remain marginalized and understudied in public health. Epidemiological | studies of health outcomes of transgender populations are infrequent, but available data show | alarming disparities with respect to sexual health between transgender and cisgender populations | [2-4]. Additionally, the few studies examining health, and specifically sexual health, of | transgender populations are often published in specialty journals. This highlights the important | work published by Brown et al. about sexual health of transgender women in this issue of The | Journal of Infectious Diseases. | Brown et al. greatly advance the field of transgender sexual health research by presenting baseline | findings for a multisite prospective cohort study called The Leading Innovation for Transgender | Women’s Health and Empowerment (LITE). Specifically, Brown et al. investigate the prevalence | and factors associated with bacterial sexually transmitted infections (STIs) among a communitybased sample of adult transgender women, stratified by HIV status, in six cities across the eastern | and southern US. The study highlights the high prevalence of bacterial STIs among transgender | women (16%) and differences in STI prevalence by HIV status(32% among transgender with HIV | versus 11% without HIV). These findings suggest unique considerations are needed for | transgender women with and without HIV and may help inform tailored interventions to curtail | sexual health inequities. Given the sparsity of robust epidemiologic data to inform best practices for improving the sexual and reproductive health of transgender persons, Brown et al.’s paper is | impactful. |
Artificial intelligence in the prediction of venous thromboembolism: A systematic review and pooled analysis
Chiasakul T , Lam BD , McNichol M , Robertson W , Rosovsky RP , Lake L , Vlachos IS , Adamski A , Reyes N , Abe K , Zwicker JI , Patell R . Eur J Haematol 2023 111 (6) 951-962 BACKGROUND: Accurate diagnostic and prognostic predictions of venous thromboembolism (VTE) are crucial for VTE management. Artificial intelligence (AI) enables autonomous identification of the most predictive patterns from large complex data. Although evidence regarding its performance in VTE prediction is emerging, a comprehensive analysis of performance is lacking. AIMS: To systematically review the performance of AI in the diagnosis and prediction of VTE and compare it to clinical risk assessment models (RAMs) or logistic regression models. METHODS: A systematic literature search was performed using PubMed, MEDLINE, EMBASE, and Web of Science from inception to April 20, 2021. Search terms included "artificial intelligence" and "venous thromboembolism." Eligible criteria were original studies evaluating AI in the prediction of VTE in adults and reporting one of the following outcomes: sensitivity, specificity, positive predictive value, negative predictive value, or area under receiver operating curve (AUC). Risks of bias were assessed using the PROBAST tool. Unpaired t-test was performed to compare the mean AUC from AI versus conventional methods (RAMs or logistic regression models). RESULTS: A total of 20 studies were included. Number of participants ranged from 31 to 111 888. The AI-based models included artificial neural network (six studies), support vector machines (four studies), Bayesian methods (one study), super learner ensemble (one study), genetic programming (one study), unspecified machine learning models (two studies), and multiple machine learning models (five studies). Twelve studies (60%) had both training and testing cohorts. Among 14 studies (70%) where AUCs were reported, the mean AUC for AI versus conventional methods were 0.79 (95% CI: 0.74-0.85) versus 0.61 (95% CI: 0.54-0.68), respectively (p < .001). However, the good to excellent discriminative performance of AI methods is unlikely to be replicated when used in clinical practice, because most studies had high risk of bias due to missing data handling and outcome determination. CONCLUSION: The use of AI appears to improve the accuracy of diagnostic and prognostic prediction of VTE over conventional risk models; however, there was a high risk of bias observed across studies. Future studies should focus on transparent reporting, external validation, and clinical application of these models. |
Metamodeling for policy simulations with multivariate outcomes
Zhong H , Brandeau ML , Yazdi GE , Wang J , Nolen S , Hagan L , Thompson WW , Assoumou SA , Linas BP , Salomon JA . Med Decis Making 2022 42 (7) 272989x221105079 PURPOSE: Metamodels are simplified approximations of more complex models that can be used as surrogates for the original models. Challenges in using metamodels for policy analysis arise when there are multiple correlated outputs of interest. We develop a framework for metamodeling with policy simulations to accommodate multivariate outcomes. METHODS: We combine 2 algorithm adaptation methods-multitarget stacking and regression chain with maximum correlation-with different base learners including linear regression (LR), elastic net (EE) with second-order terms, Gaussian process regression (GPR), random forests (RFs), and neural networks. We optimize integrated models using variable selection and hyperparameter tuning. We compare the accuracy, efficiency, and interpretability of different approaches. As an example application, we develop metamodels to emulate a microsimulation model of testing and treatment strategies for hepatitis C in correctional settings. RESULTS: Output variables from the simulation model were correlated (average ρ = 0.58). Without multioutput algorithm adaptation methods, in-sample fit (measured by R(2)) ranged from 0.881 for LR to 0.987 for GPR. The multioutput algorithm adaptation method increased R(2) by an average 0.002 across base learners. Variable selection and hyperparameter tuning increased R(2) by 0.009. Simpler models such as LR, EE, and RF required minimal training and prediction time. LR and EE had advantages in model interpretability, and we considered methods for improving the interpretability of other models. CONCLUSIONS: In our example application, the choice of base learner had the largest impact on R(2); multioutput algorithm adaptation and variable selection and hyperparameter tuning had a modest impact. Although advantages and disadvantages of specific learning algorithms may vary across different modeling applications, our framework for metamodeling in policy analyses with multivariate outcomes has broad applicability to decision analysis in health and medicine. |
Primary and secondary syphilis among men who have sex with men and women, 2010-2019
Learner ER , Grey JA , Bernstein K , Kirkcaldy RD , Torrone EA . Sex Transm Dis 2022 49 (11) 794-796 The relative proportion of cases of P&S syphilis among men who have sex with men and women reported through national case report data from 2010 through 2019 appeared stable overall and stratified by race/ethnicity, region, and age group, but case counts increased. |
Predicting Emergence of Primary and Secondary Syphilis Among Women of Reproductive Age in U.S. Counties
Kimball A , Torrone EA , Bernstein KT , Grey JA , Bowen VB , Rickless DS , Learner ER . Sex Transm Dis 2021 49 (3) 177-183 BACKGROUND: Syphilis, a sexually transmitted infection that can cause severe congenital disease when not treated during pregnancy, is on the rise in the United States. Our objective was to identify U.S. counties with elevated risk for emergence of primary and secondary (P&S) syphilis among reproductive-aged women. METHODS: Using syphilis case reports, we identified counties with no cases of P&S syphilis among reproductive-aged women in 2017 and ≥ 1 case in 2018. Using county-level syphilis and sociodemographic data, we developed a model to predict counties with emergence of P&S syphilis among women and a risk score to identify counties at elevated risk. RESULTS: Of 2,451 counties with no cases of P&S syphilis among reproductive-aged women in 2017, 345 counties (14.1%) had documented emergence of syphilis in 2018. Emergence was predicted by the county's P&S syphilis rate among men; violent crime rate; proportions of Black, White, Asian, and Hawaiian/Pacific Islander persons; urbanicity; presence of a metropolitan area; population size; and having a neighboring county with P&S syphilis among women. A risk score of ≥20 identified 75% of counties with emergence. CONCLUSIONS: Jurisdictions can identify counties at elevated risk for emergence of syphilis in women and tailor prevention efforts. Prevention of syphilis requires multidisciplinary collaboration to address underlying social factors. |
Evaluation of the impact of immunization second year of life training interventions on health care workers in Ghana
Tchoualeu DD , Harvey B , Nyaku M , Opare J , Traicoff D , Bonsu G , Quaye P , Sandhu HS . Glob Health Sci Pract 2021 9 (3) 498-507 INTRODUCTION: As part of a suite of training interventions to improve the knowledge and practice of immunization in the second year of life (2YL), training of trainers workshops were conducted with regional and district health management teams (DHMTs) in 15 districts in 3 regions of Ghana. Using adult learning principles, DHMTs implemented several capacity-building activities at the subdistrict and health facility levels, including health facility visits, on-the-job training, and review meetings. The current evaluation investigated whether frontline health care workers (HCWs) reported or demonstrated improvements in knowledge, attitudes, and practices after training interventions. METHODS: Quantitative and qualitative methods with a utilization-focused approach guided the framework for this evaluation. A systematic random sample of 115 HCWs in 3 regions of Ghana was selected to complete a competency survey before and after training, which focused on 3 core competency areas-Expanded Programme on Immunization (EPI) policy; communication with caregivers; and immunization data management, recording, and use. Interviews and direct observations by data collectors were done to assess HCWs' knowledge, self-reported attitude, and behavior changes in practices. RESULTS: Of 115 HCWs, 102 were surveyed before and 4 months after receiving capacity-building interventions. Modest but not statistically significant improvements were found in knowledge on EPI policy, immunization data management, and communication skills with caregivers. HCWs reported that they had improved several attitudes and practices after the 2YL training. The most improved practice reported by HCWs and observed in all 3 regions was the creation of a defaulter list. DISCUSSION: Findings of this evaluation provide encouraging evidence in taking the first step toward improving HCW knowledge, attitudes, and practices for 3 core immunization competency areas. The use of learner-focused teaching methods combined with adult learning principles is helpful in solving specific performance problems (such as lack of knowledge of EPI policy). |
Antimicrobial susceptibility of urogenital and extragenital neisseria gonorrhoeae isolates among men who have sex with men - SURRG and eGISP, 2018-2019
Quilter LAS , St Cyr SB , Hong J , Asbel L , Bautista I , Carter B , Casimir Y , Denny M , Ervin M , Gomez R , Harvey A , Holderman JL , Johnson K , Kohn RP , Learner ER , Mauk K , Menza T , Mettenbrink C , Nettleton WD , Nicosia KR , Pham CD , Ried C , Schlanger K , Schneider A , Soge OO , Tabidze I , Taylor SN , Tilghman W , Toler C , Weinstock H , Torrone EA . Sex Transm Dis 2021 48 S111-S117 BACKGROUND: We investigated differences in gonococcal antimicrobial susceptibility by anatomic site among cisgender men who have sex with men (MSM) using specimens collected through CDC's enhanced Gonococcal Isolate Surveillance Project (eGISP) and Strengthening the U.S. Response to Resistant Gonorrhea (SURRG). METHODS: During January 1, 2018-December 31, 2019, 12 eGISP and 8 SURRG sites collected urogenital, pharyngeal, and rectal isolates from cisgender MSM in STD clinics. Gonococcal isolates were sent to regional laboratories for antimicrobial susceptibility testing by agar dilution. To account for correlated observations, linear mixed-effects models were used to calculate geometric mean minimum inhibitory concentrations (MICs) and mixed-effects logistic regression models were used to calculate the proportion of isolates with elevated or resistant MICs; comparisons were made across anatomic sites. RESULTS: Participating clinics collected 3,974 urethral, 1,553 rectal, and 1,049 pharyngeal isolates from 5,456 unique cisgender MSM. There were no significant differences in the geometric mean MICs for azithromycin, ciprofloxacin, penicillin, and tetracycline by anatomic site. For cefixime and ceftriaxone, geometric mean MICs for pharyngeal isolates were higher compared to anogenital isolates (p < 0.05). The proportion of isolates with elevated ceftriaxone MICs (≥0.125 μg/ml) at the pharynx (0.67%) was higher than at rectal (0.13%) and urethral (0.18%) sites (p < 0.05). CONCLUSIONS: Based on data collected from multi-jurisdictional sentinel surveillance projects, antimicrobial susceptibility patterns of N. gonorrhoeae isolates may differ among MSM at extragenital sites, particularly at the pharynx. Continued investigation into gonococcal susceptibility patterns by anatomic site may be an important strategy to monitor and detect the emergence of antimicrobial resistant gonorrhea over time. |
Strengthening the U.S. Response to Resistant Gonorrhea (SURRG): An overview of a multi-site program to enhance local response capacity for antibiotic-resistant Neisseria gonorrhoeae
Schlanger K , Learner ER , Pham CD , Mauk K , Golden M , Wendel KA , Amsterdam L , McNeil CJ , Johnson K , Nguyen TQ , Holderman JL , Hasty GL , St Cyr SB , Town K , Nash EE , Kirkcaldy RD . Sex Transm Dis 2021 48 S97-S103 BACKGROUND: In 2016, CDC initiated Strengthening the U.S. Response to Resistant Gonorrhea (SURRG) in multiple jurisdictions to enhance antibiotic resistant gonorrhea rapid detection and response infrastructure and evaluate the impact of key strategies. METHODS: Eight jurisdictions were funded to establish or enhance local gonococcal culture specimen collection in STD and community clinics, conduct rapid antimicrobial susceptibility testing (AST) in local laboratories, modify systems for enhanced data collection and rapid communication of results, and initiate enhanced partner services among patients with gonorrhea demonstrating elevated minimum inhibitory concentrations (MICs) to ceftriaxone, cefixime or azithromycin. RESULTS: Grantees incorporated genital, pharyngeal, and rectal gonococcal culture collection from all genders at participating clinics. During 2018-2019, grantees collected 58,441 culture specimens from 46,822 patients and performed AST on 10,814 isolates (representing 6.8% (3,412) and 8.9% (4,883) of local reported cases in 2018 and 2019 respectively). Of isolates that underwent AST, 11% demonstrated elevated azithromycin MICs; fewer than 0.5% demonstrated elevated ceftriaxone or cefixime MICs. Among patients whose infections demonstrated elevated MICs, 81.7% were interviewed for partner elicitation; however, limited new cases were identified among partners and contacts. CONCLUSIONS: As a public health model to build capacity to slow the spread of emerging resistance, SURRG successfully expanded culture collection, implemented rapid AST, and implemented an enhanced partner services investigation approach in participating jurisdictions. Findings from SURRG may enhance preparedness efforts and inform a longer-term, comprehensive, and evidence-based public health response to emerging gonococcal resistance. Continued development of innovative approaches to address emerging resistance is needed. |
The Health Education Teacher Instructional Competency Framework: A conceptual guide for quality instruction in school health
Szucs LE , Andrzejewski JD , Robin L , Telljohann S , Pitt Barnes S , Hunt P . J Sch Health 2021 91 (10) 774-787 BACKGROUND: Teacher instructional competency, the set of essential knowledge and skills needed to guide teaching practice, is critical to the successful implementation of school health education. The purpose of this paper is to introduce the Health Education Teacher Instructional Competency (HETIC) framework, a new conceptualization describing teacher characteristics, essential knowledge, and essential skills, which can influence instructional practice and improve student learning outcomes in health education. METHODS: Data from 17 publicly available guidance documents, professional standards, published reports, and empirical studies relevant to the fields of public education, school health education, and sexual health education were abstracted and analyzed using qualitative thematic content analysis. RESULTS: The framework describes 3 domains: personal characteristics, essential knowledge, and essential skills, which are believed to contribute to teachers' instructional competencies in delivering health education. The knowledge domain asserts 5 key categories, while the essential skills domain includes 3 categories (learning environments, content and delivery, and collaboration and learning) and contains 11 unique skills. Collectively, these domains are influenced by the learner, school/community, and policy-level factors that shape health education curriculum and instruction. CONCLUSIONS: The HETIC framework presents a conceptual roadmap to guide quality health education preparation, job-embedded training, and delivery. Improving teachers' instructional competencies strengthens learning and prosocial environments that are inclusive, responsive, and affirming of students' health and learning needs. Teacher who demonstrate instructional competency can help students to achieve desired education and health outcomes, specifically acquiring the knowledge and skills needed to adapt, practice, and maintain healthy behaviors throughout their lifetime. |
Demographic and epidemiological characteristics associated with reduced antimicrobial susceptibility to Neisseria gonorrhoeae in the United States, Strengthening the U.S. Response to Resistant Gonorrhea (SURRG), 2018-2019
Gieseker K , Learner ER , Mauk K , Barbee LA , McNeil CJ , Hasty GL , Black JM , Johnson K , Quyen Nguyen T , Shrestha D , Pham CD , St Cyr S , Schlanger K , Kirkcaldy RD . Sex Transm Dis 2021 48 S118-S123 BACKGROUND: Jurisdictions participating in Strengthening the United States Response to Resistant Gonorrhea (SURRG) implemented specimen collection for culture and antimicrobial susceptibility testing (AST) from a sample of persons of all genders (at multiple anatomic sites) attending STD clinics and community clinics. We describe the percentage and characteristics of patients whose isolates demonstrated reduced susceptibility (RS) to azithromycin, ceftriaxone, or cefixime. METHODS: We included patients from clinics that participated in SURRG whose isolates underwent AST by Etest. We defined RS as azithromycin minimum inhibitory concentrations (MICs) ≥2 μg/ml (AZM-RS), ceftriaxone MICs ≥0.125 μg/ml (CRO-RS), or cefixime MICs ≥0.25 μg/ml (CFX-RS). Patients with repeated infections appeared >1 time in the data. We calculated the frequency and percentage of patients with an isolate demonstrating RS by epidemiological characteristics. RESULTS: During 2018-2019, 10,013 patients from eight jurisdictions provided 10,735 isolates. Among 10,013 patients, 11.0% (n = 1,099) had ≥1 isolate with AZM-RS (range by jurisdiction 2.5%-18.0%). Approximately 11.3% of 8,771 of patients visiting STD clinics and approximately 8.8% of 1,242 patients visiting community clinics had an AZM-RS isolate. Nearly 6% of 1,013 females had an AZM-RS isolate; among males, the percent of patients with an AZM-RS isolate was 17.7% among 4,177 men who have sex only with men and 6.1% among 3,581 men who have sex only with women. Few (0.4%) patients had isolates with CFX-RS (n = 40) or CRO-RS (n = 43). CONCLUSIONS: Although infections with reduced cephalosporin susceptibility were rare, AZM-RS infections were prevalent in this sample of patients in multiple jurisdictions and across gender and gender of sex partner categories. |
Impact of anatomic site, specimen collection timing, and patient symptom status on Neisseria gonorrhoeae culture recovery
Nash EE , Pham CD , Raphael B , Learner ER , Mauk K , Weiner J , Mettenbrink C , Thibault CS , Fukuda A , Dobre-Buonya O , Black JM , Johnson K , Sellers K , Schlanger K . Sex Transm Dis 2021 48 S151-S156 BACKGROUND: Neisseria gonorrhoeae culture is required for antimicrobial susceptibility testing (AST), but recovering isolates from clinical specimens is challenging. While many variables influence culture recovery, studies evaluating the impact of culture specimen collection timing and patient symptom status are limited. This study analyzed urogenital and extragenital culture recovery data from CDC's Strengthening US Response to Resistant Gonorrhea (SURRG) program, a multi-site project, which enhances local N. gonorrhoeae culture and AST capacity. METHODS: Eight SURRG jurisdictions collected gonococcal cultures from patients with N. gonorrhoeae-positive nucleic acid amplification tests (NAATs) attending STD and community clinics. Matched NAAT and culture specimens from the same anatomic site were collected, and culture recovery was assessed. Time between NAAT and culture specimen collection was categorized as, same day, 1-7 days, 8-14 days, or ≥ 15 days and patient symptoms were matched to the anatomic site where culture specimens were collected. RESULTS: From 2018-2019, among persons with N. gonorrhoeae-positive NAAT, urethral infections resulted in the highest culture recovery (5927/6515 = 91.0%), followed by endocervical, (222/363 = 61.2%), vaginal (63/133 = 47.4%) rectal (1117/2805 = 39.8%), and pharyngeal (1019/3678 = 27.7%) infections. Culture recovery was highest when specimens were collected on the same day as NAAT specimens and significantly decreased after 7 days. Symptoms were significantly associated with culture recovery at urethral (p = <0.0001) and rectal (p = <0.0001) sites of infection but not endocervical, vaginal, or pharyngeal sites. CONCLUSIONS: Culture specimen collection timing and patient symptomatic status can impact culture recovery. These findings can guide decisions about culture collection protocols to maximize culture recovery and strengthen detection of antimicrobial resistant infections. |
Test of cure return rate and test positivity, Strengthening the U.S Response to Resistant Gonorrhea (SURRG), United States, 2018-2019
Schlanger K , Mauk K , Learner ER , Schillinger JA , Nishiyama M , Kohn R , Thibault C , Hermus H , Dewater J , Pabon V , Black J , St Cyr S , Pham CR , Kirkcaldy RD . Sex Transm Dis 2021 48 S167-S173 BACKGROUND: Reduced antibiotic susceptibility (RS) in Neisseria gonorrhoeae (GC) may increase treatment failure. Conducting tests-of-cure (TOC) for patients with RS-GC may facilitate identification of treatment failures. METHODS: We examined 2018-2019 data from eight jurisdictions participating in CDC's Strengthening U.S. Response to Resistant Gonorrhea project. Jurisdictions collected GC isolates and epidemiological data from patients and performed antimicrobial susceptibility testing. Minimum inhibitory concentrations of ceftriaxone ≥0.125 μg/mL, cefixime ≥0.250 μg/mL, or azithromycin ≥2.0 μg/mL were defined as RS. Patients with RS-infections were asked to return for a TOC 8-10 days post-treatment. We calculated a weighted TOC return rate and described time to TOC and suspected reasons for any positive TOC results. RESULTS: Overall, 1,165 patients were diagnosed with RS-infections. Over half returned for TOC (weighted TOC: 61% [95% confidence interval: 50.1%-72.6%], range by jurisdiction: 32%-80%). TOC rates were higher among asymptomatic (68%) than symptomatic patients (53%, p = 0.001), and MSM (62%) compared to MSW (50%; p < 0.001). Median time between treatment and TOC was 12 days (interquartile range: 9-16). Of the 31 (4.5%) TOC patients with positive results, 13 (42%) were suspected due to reinfection and 11 (36%) due to false positive results. There were no treatment failures suspected to be due to RS-GC. CONCLUSIONS: Most patients with a RS-infection returned for a TOC, though return rates varied by jurisdiction and patient characteristics. TOC can identify and facilitate treatment of reinfections, but false positive TOC results may complicate interpretation and clinical management. |
Outcomes of traditional and enhanced gonorrhea partner services in the strengthening the US Response to Resistant Gonorrhea Project, 2017- 2019
Learner ER , Schlanger K , Mauk K , Pham CD , Holderman JL , Kirkcaldy RD . Sex Transm Dis 2021 48 S124-S130 INTRODUCTION: The CDC implemented Strengthening the U.S. Response to Resistant Gonorrhea (SURRG) to build local detection and response capacity and evaluate responses to antibiotic-resistant gonorrhea outbreaks, including partner services for gonorrhea. We evaluated outcomes of traditional partner services conducted under SURRG, which involved (1) counseling index patients and eliciting sexual partners, (2) interviewing, testing and treating partners, and (3) providing partner services to partners newly diagnosed with gonorrhea. We also evaluated outcomes of enhanced partner services, which additionally involved interviewing and testing partners of persons who tested negative, and social contacts of index patients and partners. METHODS: We analyzed partner services investigation data from eight jurisdictions participating in SURRG from 2017 through 2019. We summed total index patients, partners from traditional partner services, and partners and contacts from enhanced partner services, and calculated partner services outcomes among partners and contacts. We also visualized sexual networks from partner services data. RESULTS: Of 1,242 index patients identified, 506 named at least one sexual partner. Traditional partner services yielded 1,088 sexual partners and 105 were newly diagnosed with gonorrhea. Enhanced partner services yielded an additional 59 sexual partners and 52 social contacts. Of those partners and contacts, 3 were newly diagnosed with gonorrhea. Network visualization revealed sparse networks with few complex partnership clusters. CONCLUSIONS: Traditional partner services for gonorrhea may be useful for eliciting, notifying, and diagnosing partners of index patients in an outbreak setting. Enhanced partner services are unlikely to be effective for eliciting, notifying, and diagnosing a substantial number of additional people. |
Exploring and comparing the structure of sexual networks affected by Neisseria gonorrhoeae using sexual partner services investigation and genomic data.
Town K , Learner ER , Chivukula VL , Mauk K , Reimche JL , Schmerer MW , Black J , Pathela P , Bhattacharyya S , Kerani RP , Gieseker KE , Fukuda A , Sankaran M , McNeil CJ , Spicknall IH , Raphael BH , St Cyr SB , Bernstein K , Kersh EN , Kirkcaldy RD , Schlanger K , Gernert KM . Sex Transm Dis 2021 48 S131-S136 BACKGROUND: Sexual networks are difficult to construct due to incomplete sexual partner data. The proximity of people within a network may be inferred from genetically similar infections. We explored genomic data combined with partner services investigation (PSI) data to extend our understanding of sexual networks affected by Neisseria gonorrhoeae (NG). METHODS: We used 2017-2019 PSI and whole-genome sequencing (WGS) data from eight jurisdictions participating in CDC's Strengthening the United States Response to Resistant Gonorrhea (SURRG) project. Clusters were identified from sexual contacts and through genetically similar NG isolates. Sexual mixing patterns were characterized by describing the clusters by the individual's gender and gender of their sex partners. RESULTS: Our study included 4,627 diagnoses of NG infection (81% sequenced), 2,455 people received a PSI, 393 people were negative contacts of cases, and 495 contacts with unknown NG status. We identified 823 distinct clusters using PSI data combined with WGS data. Of cases that were not linked to any other case using PSI data, 37% were linked when using WGS data. Overall, 40% of PSI cases were allocated to a larger cluster when PSI and WGS data were combined compared with PSI data alone. Mixed clusters containing women, men who report sex with women, and men who report sex with men were common when using the WGS data either alone or in combination with the PSI data. CONCLUSIONS: Combining PSI and WGS data improves our understanding of sexual network connectivity. |
Improving laboratory quality and capacity through leadership and management training: Lessons from Zambia 2016-2018
Gopolang F , Zulu-Mwamba F , Nsama D , Kruuner A , Nsofwa D , Kasvosve I , Gomo R , Motlhabane T , Chohan B , Soge O , Osterhage D , Campbell N , Noble M , Downer A , Flandin JF , Nartker A , Koehn C , Nonde LK , Shibemba A , Ndongmo CB , Steinau M , Perrone LA . Afr J Lab Med 2021 10 (1) 1225 BACKGROUND: Competent leadership and management are imperative for delivering quality laboratory services; however, few laboratory managers receive job-specific training in organisational management and leadership. OBJECTIVE: To develop and evaluate participants' competencies in organisational leadership and management as measured through learner and laboratory quality improvement assessments. METHODS: This professional development programme employed a mentored, blended learning approach, utilising in-person didactic and online training, with the practical application of a capstone project in the laboratories. Programme impact was evaluated through a series of pre- and post-laboartory assessments using the Stepwise Laboratory Improvement Process Towards Accreditation checklist, as well as learner-competency assessments through online quizzes and discussions. RESULTS: From 2016 to 2018, 31 managers and quality officers from 16 individual laboratories graduated from the programme having completed capstone projects addressing areas in the entire laboratory testing process. Laboratories increased their compliance with the International Organization for Standardization 15189 standard and all but two laboratories significantly increased their accreditation scores. Two laboratories gained three stars, two laboratories gained two stars, and five laboratories gained one star. Five laboratories subsequently achieved International Organization for Standardization 15189 accreditation in 2019. CONCLUSION: This programme taught leadership theory to laboratory managers and allowed them to implement leadership and management practices in the laboratory setting. Programmes such as this complement existing laboratory quality management training programmes such as Strengthening Laboratory Management Toward Accreditation. |
Why are rates of reported chlamydia changing in the United States: Insights from the National Job Training Program
Diesel J , Kreisel K , Learner E , Torrone E , Peterman T . Sex Transm Dis 2020 48 (3) 152-160 BACKGROUND: During 2010-2017, rates of reported chlamydia decreased among young Black women but increased for White women and all men. Since chlamydia case rates can be influenced by changes in prevalence, screening, and other factors, we compared chlamydia prevalence trends in a sentinel population to national case rate trends to understand potential drivers of case rate trends. METHODS: Chlamydia prevalence was calculated annually among 16-24 year old entrants to the National Job Training Program (NJTP) during 2010-2017. An expectation-maximization-based maximum likelihood approach was used to adjust for misclassification due to imperfect test sensitivity and specificity. Models were stratified by sex, age, and race/ethnicity. A statistically significant trend in prevalence was defined as non-overlapping 95% confidence intervals comparing 2010 and 2017. Trends in chlamydia prevalence were compared to trends in case rates using percentage change over time; relative changes ≥10% were considered meaningful. RESULTS: Among NJTP entrants during 2010-2017, chlamydia prevalence was stable for all Black women, while case rates decreased for adolescents (-12%) and were stable for 20-24 year-olds (-4%). Among adolescent White women, prevalence was stable while case rates increased (+30%). For White women aged 20-24 years, prevalence increased +62% and case rates increased +43%. Trends in prevalence differed from trends in case rates for all subgroups of men. CONCLUSIONS: Prevalence trends in this sentinel population differed from national case rate trends for Black women, White women, and men, suggesting potential decreased screening among Black women 16-19, increased prevalence among White women 20-24, and increased screening among men. |
Transactional sex and incident chlamydia and gonorrhea among black men who have sex with men in Atlanta, Georgia
Rucinski KB , Eaton LA , Learner ER , Watson RJ , Maksut JL , Earnshaw VA . Sex Transm Dis 2020 47 (6) 355-360 BACKGROUND: Black men who have sex with men (BMSM) are disproportionately affected by sexually transmitted infections (STI), including chlamydia and gonorrhea. Transactional sex is an hypothesized risk factor for STI acquisition in BMSM. METHODS: We estimated the association of transactional sex with incident chlamydia/gonococcal infection among BMSM using longitudinal data from a randomized trial in Atlanta (2012-2015). BMSM were eligible for inclusion if they tested human immunodeficiency virus (HIV)-antibody-negative and reported both ≥2 male sex partners and any condomless anal sex in the last year. We defined chlamydia/gonorrhea incidence as the first occurrence of either rectal or urogenital chlamydia or gonococcal infections after a negative result at enrollment. We used Poisson regression to estimate the incidence rate (IR) for chlamydia/gonorrhea over 12 months. Incidence rate ratios (IRR) compared estimates by reported experience of transactional sex. Subgroup analyses assessed potential heterogeneity by age and sexual identity. RESULTS: This analysis included 416 BMSM, of whom 191 (46%) were gay-identified, 146 (42%) reported a history of transactional sex, and 57 (14%) had prevalent chlamydia/gonococcal infection at baseline. Over a median of 1 year of follow-up, an additional 55 men tested laboratory-positive for chlamydia/gonorrhea (IR, 17.3 per 100 person-years). Transactional sex was not associated with chlamydia/gonorrhea incidence overall. However, among gay-identified BMSM, transactional sex was associated with incident chlamydia/gonorrhea (IRR, 2.9; 95% confidence interval, 1.2-6.8). CONCLUSIONS: Economic and social vulnerabilities may motivate engagement in high-risk sexual behaviors through commodified sex, potentially increasing the burden of STIs among BMSM. In this investigation, the relationship between transactional sex and chlamydia/gonorrhea was not homogenous across BMSM with diverse sexual identities in Atlanta, suggesting that within select sexual networks, transactional sex may drive STI risks. Delivering accessible and targeted STI screening for marginalized BMSM should be prioritized for STI and HIV prevention. |
Gonorrhea prevalence among young women and men entering the National Job Training Program, 2000-2017
Learner ER , Kreisel K , Kirkcaldy RD , Schlanger K , Torrone EA . Am J Public Health 2020 110 (5) e1-e8 Objectives. To examine long-term gonorrhea prevalence trends from a sentinel surveillance population of young people at elevated risk for gonorrhea.Methods. We analyzed annual cross-sectional urogenital gonorrhea screening data from 191 991 women (2000-2017) and 224 348 men (2003-2017) 16 to 24 years of age entering the National Job Training Program, a US vocational training program. We estimated prevalence among women using an expectation-maximization algorithm incorporated into a logistic regression to account for increases in screening test sensitivity; log-binomial regression was used to estimate prevalence among men.Results. The adjusted gonorrhea prevalence among women followed a U-shaped curve, falling from 2.9% to 1.6% from 2000 through 2011 before rising to 2.7% in 2017. The prevalence among men declined from 1.4% to 0.8% from 2003 through 2017. In the case of both women and men, the prevalence was highest across all study years among those who were Black or American Indian/Alaska Native and those who resided in the South or Midwest.Conclusions. Trends among National Job Training Program enrollees suggest that gonorrhea prevalence is rising among young women while remaining low and steady among young men. (Am J Public Health. Published online ahead of print March 19, 2020: e1-e8. doi:10.2105/AJPH.2019.305559). |
The influence of screening, misclassification, and reporting biases on reported chlamydia case rates among young women in the US, 2000 through 2017
Learner ER , Powers KA , Torrone EA , Pence BW , Fine JP , Miller WC . Sex Transm Dis 2020 47 (6) 369-375 BACKGROUND: National chlamydia case rate trends are difficult to interpret due to biases from partial screening coverage, imperfect diagnostic tests, and under-reporting. We examined the extent to which these time-varying biases could influence reported annual chlamydia case rates. METHODS: Annual reported case rates among women aged 15 through 24 years from 2000 through 2017 were obtained from the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention AtlasPlus tool. Estimates of reporting completeness, diagnostic test sensitivity and specificity, and screening coverage were derived from literature review and expert opinion. We adjusted annual reported case rates for incomplete reporting, imperfect diagnostic tests, and partial screening coverage through a series of corrections, and calculated annual adjusted case rates of correctly diagnosed chlamydia. RESULTS: Adjusted chlamydia case rates among young women were higher than reported case rates throughout the study period. Reported case rates increased over the study period, but adjusted rates declined from 12,900 to 7,900 cases per 100,000 person-years between 2000 and 2007. After 2007, adjusted case rates declined to 7,500 cases per 100,000 person-years in 2017. Bias from partial screening coverage had a larger impact on case rate magnitude and trend shape than bias from imperfect diagnostic tests or under-reporting. CONCLUSIONS: Reported chlamydia case rates may be substantially lower than true chlamydia case rates due to incomplete reporting, imperfect diagnostic tests, and partial screening coverage. Because the magnitude of these biases has declined over time, the differences between reported and adjusted case rates has narrowed, revealing a sharp decline in adjusted case rates even as reported case rates have risen. The decline in adjusted case rates suggests that the rise in reported case rates should not be interpreted strictly as increasing chlamydia incidence, as the observed rise can be explained by improvements in screening coverage, diagnostic tests, and reporting. |
After the bell rings: Looking beyond the classroom to reduce inequalities in educational achievement and health outcomes
Liburd LC . J Public Health Manag Pract 2019 25 (6) 581-583 The relationship between educational achievement and health outcomes is well documented but not well understood.1,2 Hahn and Truman describe education as “a process and a product,” that is, the process of education occurs in multiple settings within and outside of the classroom, and the product of the educational process is “the array of knowledge, skills, and capacities (ie, intellectual, socio-emotional, physical, productive, and interactive) acquired by a learner through formal and experiential learning.”1(p2) Education is essential to achieving health equity. | According to the Center on Society and Health at Virginia Commonwealth University, | Americans with less education are—now, more than ever—dying earlier than their peers. Between 1990 and 2008, the life expectancy gap between the most and least educated Americans grew from 13 to 14 years among males and from 8 to 10 years among females. The gap has been widening since the 1960s.3 | In addition, adults with only a high school diploma can expect to die 9 years sooner than college graduates, and adults with less education are more likely to report having diabetes and heart disease and to have worse health overall.3 These and other health outcomes are associated with educational attainment. |
Chlamydia prevalence trends among women and men entering the National Job Training Program from 1990 through 2012
Learner ER , Torrone EA , Fine JP , Pence BW , Powers KA , Miller WC . Sex Transm Dis 2018 45 (8) 554-559 BACKGROUND: Evaluating chlamydia prevalence trends from sentinel surveillance is important for understanding population disease burden over time. However, prevalence trend estimates from surveillance data may be misleading if they do not account for changes in risk profiles of individuals who are screened (case mix) and changing performance of the screening tests used. METHODS: We analyzed chlamydia screening data from a sentinel surveillance population of 389,555 young women (1990-2012) and 303,699 young men (2003-2012) entering the US National Job Training Program. This period follows the introduction of national chlamydia screening programs designed to prevent transmission and reduce population disease burden. After ruling out bias due to case mix, we used an expectation-maximization based maximum likelihood approach to account for measurement error from changing screening tests, and generated minimally-biased long-term chlamydia prevalence trend estimates among youth and young adults in this sentinel surveillance population. RESULTS: Adjusted chlamydia prevalence among women was high throughout the study period, but fell from 20% in 1990 to 12% in 2003, and remained between 12% and 14% through 2012. Adjusted prevalence among men was steady throughout the study period at approximately 7%. For both women and men, adjusted prevalence was highest among Black and American Indian youth and young adults, and in the Southern and Midwestern regions of the US throughout the study period. CONCLUSIONS: Our minimally-biased trend estimates provide support for an initial decrease in chlamydia prevalence among women soon after the introduction of national chlamydia screening programs. Constant chlamydia prevalence in more recent years suggests that screening may not be sufficient to further reduce chlamydia prevalence among high-risk youth and young adults. |
Increasing sample size in prospective birth cohorts: back-extrapolating prenatal levels of persistent organic pollutants in newly enrolled children
Verner MA , Gaspar FW , Chevrier J , Gunier RB , Sjodin A , Bradman A , Eskenazi B . Environ Sci Technol 2015 49 (6) 3940-8 Study sample size in prospective birth cohorts of prenatal exposure to persistent organic pollutants (POPs) is limited by costs and logistics of follow-up. Increasing sample size at the time of health assessment would be beneficial if predictive tools could reliably back-extrapolate prenatal levels in newly enrolled children. We evaluated the performance of three approaches to back-extrapolate prenatal levels of p,p'-dichlorodiphenyltrichloroethane (DDT), p,p'-dichlorodiphenyldichloroethylene (DDE) and four polybrominated diphenyl ether (PBDE) congeners from maternal and/or child levels 9 years after delivery: a pharmacokinetic model and predictive models using deletion/substitution/addition or Super Learner algorithms. Model performance was assessed using the root mean squared error (RMSE), R(2), and slope and intercept of the back-extrapolated versus measured levels. Super Learner outperformed the other approaches with RMSEs of 0.10 to 0.31, R(2)s of 0.58 to 0.97, slopes of 0.42 to 0.93 and intercepts of 0.08 to 0.60. Typically, models performed better for p,p'-DDT/E than PBDE congeners. The pharmacokinetic model performed well when back-extrapolating prenatal levels from maternal levels for compounds with longer half-lives like p,p'-DDE and BDE-153. Results demonstrate the ability to reliably back-extrapolate prenatal POP levels from levels 9 years after delivery, with Super Learner performing best based on our fit criteria. |
Knowledge Management and E-Learning
Costarides MV . Health Promot Pract 2014 15 (6) 790-794 The book Knowledge Management and E-Learning, which is intended for both scholars and practitioners, provides a historical perspective on the evolution of online learning and discusses the potential impact of implementing e-learning initiatives. Chapter authors also discuss the importance of technology in propelling learner contributions through a well-designed technologic platform or learning management system. Knowledge management specialists and e-learning advocates can gain insight into the expectations of adult learners and in how to use technology to develop effective training programs through the many illustrations of contemporary learning theories in practice. |
Foreword to "Graduated driver licensing research, 2007-present: a review and commentary"
Shults RA . J Safety Res 2010 41 (2) 75 Since the Journal of Safety Research published its first summary of Graduated Driver Licensing (GDL) research in 2003, tremendous progress has been made in reducing adolescent motor-vehicle crash deaths. During 2003–2008, the rate of crash deaths among 13–19 year-olds fell 31%, from 19.7 to 13.6 per 100,000 population (Insurance Institute for Highway Safety [IIHS], 2010). In contrast, crash deaths among adults aged 20–69 years declined 13%, from 16.4 to 14.3 per 100,000 population. Despite this progress, motor-vehicle crashes remain the leading cause of death for adolescents in the United States, accounting for one third of all deaths in this age group (Centers for Disease Control and Prevention [CDC], 2010). | GDL addresses this principal health threat to adolescents using a classic public health approach—primary prevention. By limiting the novice driver's exposure to challenging driving conditions, GDL seeks to prevent crash-related injuries from occurring during this high-risk period. The protection provided by GDL applies to the entire population of novice teen drivers (and their passengers), whereas law enforcement approaches focus more on individuals who are caught violating traffic laws. By extending the learner stage of the licensure process, GDL encourages teens to gain driving experience under the safest possible, realistic conditions—with an adult supervisor. During the provisional license stage, teens transition from driving under the supervision of an adult to being fully “in charge” of the vehicle. During this transition time, passenger and night driving restrictions provide continued protection by limiting exposure to the most dangerous known conditions. |
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