Trichomonas vaginalis (TV) and bacterial vaginosis (BV) are highly prevalent vaginal infections. Both are associated with pelvic inflammatory disease and HIV acquisition and transmission, though the underlying mechanisms are incompletely understood. We characterized the effect of TV and BV infection on inflammatory markers in the vagina among reproductive-aged women in Atlanta, Georgia. Cervicovaginal lavage specimens were collected from HIV seronegative women at a baseline visit and again three months later. Eighteen individual cytokines, 17 T cell subsets, BV, and TV were measured at both timepoints. After natural log transformation, the median cytokine concentration and number of T cells were compared by infection status statistically using the Kruskal-Wallis test. A cytokine inflammation score and a T cell score were created using principal components analysis. The scores were then used as outcomes in separate linear mixed regression models with a random intercept. Sixty women had baseline data and 43 were seen for follow-up. The median age was 30 years, 78% self-reported Black race. TV and BV prevalence at the baseline visit was 15% and 37%, respectively. The concentration of 16 out of 18 cytokines differed by infection status. In multivariable modeling, neither TV nor BV were associated with cytokine score. Most CD4+ T cell subsets (7 out of 9) differed by infection status. In a multivariable model, TV infection was associated with a higher T cell score (1.54; 95%CI 0.00, 3.08). BV was not associated with a higher T cell score. Increased concentration of vaginal mucosal T cells may explain the observed association between TV infection and HIV risk.

BACKGROUND: Monitoring temporal trends in firearm injury-related emergency department (ED) visits is challenging because traditional surveillance systems lack detailed temporal information. OBJECTIVE: To describe temporal patterns of ED visits for firearm injury using data from the Centers for Disease Control and Prevention's (CDC) Firearm Injury Surveillance Through Emergency Rooms (FASTER) program. DESIGN: Cross-sectional analysis of firearm injury-related ED visits. SETTING: 9 states (Florida, Georgia, New Mexico, North Carolina, Oregon, Utah, Virginia, Washington, and West Virginia) and the District of Columbia from 1 January 2018 to 31 August 2023. PATIENTS: ED visits for firearm injury (n = 93 022) from CDC's FASTER program. MEASUREMENTS: ED visits for firearm injury per 100 000 ED visits, analyzed by time of day (in 30-minute intervals), day of the week, day of the year, and holidays. RESULTS: From January 2018 through August 2023, there were 93 022 firearm injury ED visits (73.9 per 100 000 ED visits), or approximately 1 firearm injury every 30 minutes overall. Rates of firearm injury ED visits were highest between 2:30 and 3:00 a.m. and lowest between 10:00 and 10:30 a.m. Nighttime peaks and daily rates were highest on Friday and Saturday. Monthly rates were highest in July and lowest in February; daily rates were disproportionately high on most holidays, especially Independence Day and New Year's Eve. LIMITATIONS: Data are limited to 9 states and the District of Columbia and are not nationally representative. The analysis of ED visits for firearm injury does not distinguish injury intent and is based on arrival time rather than actual injury time. CONCLUSION: Distinct temporal patterns in firearm injury ED visits highlight resource allocation considerations for prevention and response efforts. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.

INTRODUCTION: Intimate partner violence accounts for up to one half of all homicides of women in the United States. Rates of intimate partner homicide are associated with both race/ethnicity and social determinants of health, but their relative contribution is incompletely understood. METHODS: We used negative binomial regression to model the relationship between counties' racial/ethnic composition and their rates of intimate partner homicide of women, controlling for urbanicity, median income, gender pay gap, unemployment, school funding, and violent crime rate. We used data from 49 states and the District of Columbia between 2016 and 2021. Analyses were conducted in 2024. RESULTS: In unadjusted analysis, counties with a lower proportion of White residents experienced higher rates of intimate partner homicide (IRR = 1.11; 95% CI: 1.08 - 1.13). When controlling for social determinants of health, this association was not observed (IRR = 1.01; 95% CI: 0.97 - 1.04). Median income, school funding, and violent crime rate were independent predictors of intimate partner homicide in the multivariate model. CONCLUSIONS: Racial/ethnic composition of a population does not independently predict its rate of intimate partner homicide when controlling for social determinants of health. Racial/ethnic inequities in intimate partner homicide are largely attributable to structural factors, which may be modifiable through policy changes.

INTRODUCTION: Disease and non-battle injuries (DNBIs) cause substantial losses among military personnel. NATO has monitored DNBIs among its personnel since 1996 using multiple versions of a tool now called EpiNATO-2, but the surveillance system has never been systematically evaluated. Following a request from NATO to the CDC, the objective of this study was to assess surveillance system attributes of EpiNATO-2 using CDC's updated guidelines for evaluating public health surveillance systems. MATERIALS AND METHODS: Between June and October 2022, a literature review and key informant interviews were conducted to assess the following attributes: usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness, timeliness, stability, informatics system quality, informatics service quality, and informatics interoperability. Key informant interviews were conducted in Kosovo, Germany, and remotely with EpiNATO-2 users spanning three levels: clinical and data entry personnel (tactical level); regional medical and public health officers (operational level); and senior commanders and other governmental entities (strategic level). RESULTS: Fourteen EpiNATO-2 users participated in interviews, representing 3 of the 5 major NATO missions, 3 partner entities, and 7 nationalities. All users (100%) reported that the system did not meet their needs, with most users noting the following challenges: lack of clearly defined system objectives; poor data quality due to ambiguous case definitions and frequently unsubmitted reports (37% missing during January to June 2022); long delay between the occurrence of health events and the availability of corresponding data (≥2 weeks); and an antiquated and inflexible data management system. Overall, performance was deemed unsatisfactory on 11 of the 13 attributes. CONCLUSIONS: This multinational sample of EpiNATO-2 users at all military levels reported that the system is currently not useful with respect to its stated objectives. Opportunities exist to improve the performance and usefulness of EpiNATO-2: improve case definitions, modernize data infrastructure, and regularly evaluate the surveillance system.

Firearm-related deaths and injuries have increased in recent years. Comprehensive and timely information on firearm injuries and the communities and geographic locations most affected by firearm violence is crucial for guiding prevention activities. However, traditional surveillance systems for firearm injury, which are mostly based on hospital encounters and mortality-related data, often lack information on the location where the shooting occurred. This study examined annual and monthly rates of emergency medical services (EMS) encounters for firearm injury per 100,000 total EMS encounters during January 2019-September 2023 in 858 counties in 27 states, by patient characteristics and characteristics of the counties where the injuries occurred. Overall, annual rates of firearm injury EMS encounters per 100,000 total EMS encounters ranged from 222.7 in 2019 to 294.9 in 2020; rates remained above prepandemic levels through 2023. Rates were consistently higher among males than females. Rates stratified by race and ethnicity were highest among non-Hispanic Black or African American persons; rates stratified by age group were highest among persons aged 15-24 years. The greatest percentage increases in annual rates occurred in urban counties and in counties with higher prevalence of severe housing problems, higher income inequality ratios, and higher rates of unemployment. States and communities can use the timely and location-specific data in EMS records to develop and implement comprehensive firearm injury prevention strategies to address the economic, social, and physical conditions that contribute to the risk for violence, including improvements to physical environments, secure firearm storage, and strengthened social and economic supports.