Last data update: May 06, 2024. (Total: 46732 publications since 2009)
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Quickstats: Rate* of emergency department visits,(†) by homeless status(§) - National Hospital Ambulatory Medical Care Survey, United States, 2010-2021
Schappert SM , Santo L . MMWR Morb Mortal Wkly Rep 2023 72 (42) 1153 The rate of visits to hospital emergency departments by persons experiencing homelessness increased from an estimated 141 visits per 100 persons per year during 2010–2011 to 310 during 2020–2021. Rates increased during 2016–2017 compared with 2014–2015, and again during 2020–2021 compared with 2018–2019. Visit rates for persons not experiencing homelessness did not vary significantly across years, ranging from 42 visits per 100 persons per year during 2010–2011 to 40 during 2020–2021. Visit rates for persons experiencing homelessness were higher than rates for persons not experiencing homelessness in all years. |
QuickStats: Percentage of emergency department visits* with Medicaid as the primary expected source of payment among persons aged <65 years, by race and ethnicity(†) - National Hospital Ambulatory Medical Care Survey, United States, 2011-2021
Santo L , Schappert SM , Ashman JJ . MMWR Morb Mortal Wkly Rep 2023 72 (31) 853 During 2011–2021, the percentage of ED visits among persons aged <65 years with Medicaid as the primary expected source of payment increased from 34.0% to 45.3%. This pattern was consistent irrespective of race and Hispanic or Latino (Hispanic) origin. ED visits among Hispanic persons increased the most, from 46.3% in 2011 to 62.7% in 2021. The percentage of ED visits among persons with Medicaid as their primary expected source of payment increased from 40.9% in 2011 to 53.4% in 2021 among Black or African American (Black) persons, and from 27.8% to 35.5% among White persons. During the study period, the percentages of ED visits by Black and Hispanic persons with Medicaid as the primary expected source of payment were higher than the percentages of visits by White persons. |
NHAMCS has been a trusted source of data for healthcare disparities research since 1992
Schappert SM , Santo L , Ward BW , Ashman JJ , DeFrances CJ . Public Health Nurs 2023 40 (6) 811-812 The National Center for Health Statistics (NCHS) conducts the National Hospital Ambulatory Medical Care Survey (NHAMCS), a national probability sample survey of visits to U.S. hospital emergency departments (EDs). NCHS staff recently became aware of a Brief Report published in the July 2022 issue of Public Health Nursing (Marye, 2022) which claimed that healthcare disparities research was limited with NHAMCS data; however, the report included inaccuracies about the survey and its data that should be clarified. NHAMCS has been conducted annually since 1992 and has been used for decades to understand the provision of ambulatory medical care at hospitals, as well as disparities in this care. A brief search in the PubMed® database returns hundreds of peer-reviewed research manuscripts using NHAMCS data, with at least 40 focusing on healthcare disparities. Furthermore, NHAMCS continues to be used in various U.S. government reports that focus on health care and health disparities (Agency for Healthcare Research and Quality, 2022; National Center for Health Statistics, 2023). |
Variant APOL1 protein in plasma associates with larger particles in humans and mouse models of kidney injury.
Andrews M , Yoshida T , Henderson CM , Pflaum H , McGregor A , Lieberman JA , de Boer IH , Vaisar T , Himmelfarb J , Kestenbaum B , Chung JY , Hewitt SM , Santo BA , Ginley B , Sarder P , Rosenberg AZ , Murakami T , Kopp JB , Kuklenyik Z , Hoofnagle AN . PLoS One 2022 17 (10) e0276649 BACKGROUND: Genetic variants in apolipoprotein L1 (APOL1), a protein that protects humans from infection with African trypanosomes, explain a substantial proportion of the excess risk of chronic kidney disease affecting individuals with sub-Saharan ancestry. The mechanisms by which risk variants damage kidney cells remain incompletely understood. In preclinical models, APOL1 expressed in podocytes can lead to significant kidney injury. In humans, studies in kidney transplant suggest that the effects of APOL1 variants are predominantly driven by donor genotype. Less attention has been paid to a possible role for circulating APOL1 in kidney injury. METHODS: Using liquid chromatography-tandem mass spectrometry, the concentrations of APOL1 were measured in plasma and urine from participants in the Seattle Kidney Study. Asymmetric flow field-flow fractionation was used to evaluate the size of APOL1-containing lipoprotein particles in plasma. Transgenic mice that express wild-type or risk variant APOL1 from an albumin promoter were treated to cause kidney injury and evaluated for renal disease and pathology. RESULTS: In human participants, urine concentrations of APOL1 were correlated with plasma concentrations and reduced kidney function. Risk variant APOL1 was enriched in larger particles. In mice, circulating risk variant APOL1-G1 promoted kidney damage and reduced podocyte density without renal expression of APOL1. CONCLUSIONS: These results suggest that plasma APOL1 is dynamic and contributes to the progression of kidney disease in humans, which may have implications for treatment of APOL1-associated kidney disease and for kidney transplantation. |
The National Hospital Care Survey is a unique source of data on rare diseases
Strashny A , Alford J , Rappole C , Santo L . Value Health 2022 OBJECTIVES: This study aims to demonstrate the usefulness of the National Hospital Care Survey (NHCS) for studying rare diseases. METHODS: NHCS contains data on millions of hospital patients from participating US hospitals, including diagnoses coded using 10th revision of International Classification of Diseases, Clinical Modification, making it likely that some of the patients have a diagnosed rare disease. The data for 2016 are unweighted and are not nationally representative. The Orphanet Nomenclature Pack lists 877 10th revision of the International Classification of Diseases codes that correspond to 536 rare diseases. Using Orphanet Nomenclature Pack, we identified NHCS patients with diagnosed rare diseases. We demonstrate the usefulness of NHCS for studying rare diseases by reporting, for each rare disease, the number of patients in NHCS with the disease, the average number of hospital encounters per patient, the average length of hospital stay, and the percent of patients who died either in-hospital or within 90 days after discharge. RESULTS: In just 1 year of NHCS, we identified hundreds of rare diseases with ≥30 patients each (313 rare diseases in the inpatient setting and 273 in the emergency department setting). Although 10th revision of the International Classification of Diseases, Clinical Modification codes identify a small percent of known rare diseases, 12.9% of inpatient patients and 3.4% of emergency department patients had a diagnosed rare disease. CONCLUSIONS: NHCS is a rich source of administrative and electronic health record data on hospital patients with rare diseases, providing unique variables and observations on many patients. Although the percent of patients with each rare disease is low, a large percent of hospital patients has a rare disease. |
Insights into the evolution and dispersion of pyrethroid resistance among sylvatic Andean Triatoma infestans from Bolivia.
MarcetPL , Pablo SO , Messenger LA , Vassena CV . Infect Genet Evol 2021 90 104759 Sylvatic populations of Triatoma infestans represent a challenge to Chagas disease control as they are not targeted by vector control activities and may play a key role in post-spraying house re-infestation. Understanding sylvatic foci distribution and gene flow between sylvatic and domestic populations is crucial to optimize vector control interventions and elucidate the development and spread of insecticide resistance. Herein, the genetic profiles of five Andean T. infestans populations from Bolivia with distinct insecticide susceptibility profiles were compared. Multilocus genotypes based on eight microsatellites and the DNA sequence of a fragment of the cytochrome B (cytB) gene were obtained for 92 individuals. CytB haplotypes were analyzed with previously reported Bolivian T. infestans haplotypes to evaluate putative historical gene flow among populations. Each specimen was also screened for two nucleotide mutations in the sodium channel gene (kdr), related to pyrethroid resistance (L1014 and L9251). Significant genetic differentiation was observed among all populations, although individuals of admixed origin were detected in four of them. Notably, the genetic profiles of adjacent domestic and sylvatic populations of Mataral, characterized by higher levels of insecticide resistance, support their common ancestry. Only one sylvatic individual from Mataral carried the kdr mutation L1014, suggesting that this mechanism is unlikely to cause the altered insecticide susceptibility observed in these populations. However, as the resistance mutation is present in the area, it has the potential to be selected under insecticidal pressure. Genetic comparisons of these populations suggest that insecticide resistance is likely conferred by ancient trait(s) in T. infestans sylvatic populations, which are capable of invading domiciles. These results emphasize the need for stronger entomological surveillance in the region, including early detection of house invasion, particularly post-spraying, monitoring for resistance to pyrethroids and the design of integrative control actions that consider sylvatic foci around domestic settings and their dispersion dynamics. |
Trends in office visits during which opioids were prescribed for adults with arthritis: United States, 2006-2015
Santo L , Schappert SM , Hootman JM , Helmick CG . Arthritis Care Res (Hoboken) 2020 73 (10) 1430-1435 OBJECTIVE: To analyze trends in opioid prescriptions during visits to office-based physicians made by adults with arthritis in the US from 2006 to 2015. METHODS: We analyzed nationally representative data on patient visits to office-based physicians from the National Ambulatory Medical Care Survey (NAMCS) 2006-2015. Visit percentages for first- and any-listed diagnosis of arthritis by age groups and sex are reported. Time points were grouped into 2-year intervals to increase the reliability of estimates. Annual percentage point change and 95% CI were reported from linear regression models. RESULTS: During 2006-2015, the percentage of visits to office-based physicians by adults with a first-listed diagnosis of arthritis increased from 4.1% (95%CI: 3.5%-4.7%) in 2006-2007 to 5.1% (95% CI: 3.9%-6.6%) in 2014-2015 (p=.033). Among these visits, the percentage of visits with opioids prescribed increased from 16.5% (95%CI: 13.1%-20.5%) in 2006-2007 to 25.6% (95%CI: 17.9%-34.6%) in 2014-2015 (p=.017). The percentage of visits with any-listed diagnosis of arthritis increased from 6.6% (95%CI: 5.9%-7.4%) in 2006-2007 to 8.4% (95%CI: 7.0%-10.0%) in 2014-2015 (p=.001). Among these visits the percentage of visits with opioids prescribed increased from 17.4% (95%CI: 14.6%-20.4%) in 2006-2007 to 25.0% (95%CI: 19.7%-30.8%) in 2014-2015 (p=.004). CONCLUSION: During 2006-2015, the percentage of arthritis visits by adults to office-based physicians increased and the percentage of opioids prescribed at these visits increased as well. NAMCS data will allow continued monitoring of these trends after guidelines were implemented. |
Antineoplastic drugs prescription during visits by adult cancer patients with comorbidities: findings from the 2010-2016 National Ambulatory Medical Care Survey
Santo L , Ward BW , Rui P , Ashman JJ . Cancer Causes Control 2020 31 (4) 353-363 PURPOSE: Cancer treatment may be affected by comorbidities; however, studies are limited. The purpose of this study is to examine the frequency of comorbidities at visits by patients with breast, prostate, colorectal, and lung cancer and to estimate frequency of a prescription for antineoplastic drugs being included in the treatment received at visits by patients with cancer and concomitant comorbidities. METHODS: We used nationally representative data on visits to office-based physicians from the 2010-2016 National Ambulatory Medical Care Survey and selected visits by adults with breast, prostate, colorectal, or lung cancer (n = 4,672). Nineteen comorbid conditions were examined. Descriptive statistics were calculated for visits by cancer patients with 0, 1, and >/= 2 comorbidities. RESULTS: From 2010-2016, a total of 10.2 million physician office visits were made annually by adult patients with breast, prostate, colorectal, or lung cancer. Among US visits by adult patients with breast, prostate, colorectal, or lung cancer, 56.3% were by patients with >/= 1 comorbidity. Hypertension was the most frequently observed comorbidity (37.7%), followed by hyperlipidemia (19.0%) and diabetes (12.3%). Antineoplastic drugs were prescribed in 33.5% of the visits and prescribed at a lower percentage among visits by cancer patients with COPD (21.3% versus 34.3% of visits by cancer patients without COPD) and heart disease (22.7% versus 34.2% of visits by cancer patients without heart disease). CONCLUSION: Our study provides information about comorbidities in cancer patients being treated by office-based physicians in an ambulatory setting. |
Risk of yellow fever virus importation into the United States from Brazil, outbreak years 2016-2017 and 2017-2018
Dorigatti I , Morrison S , Donnelly CA , Garske T , Bowden S , Grills A . Sci Rep 2019 9 (1) 20420 Southeast Brazil has experienced two large yellow fever (YF) outbreaks since 2016. While the 2016-2017 outbreak mainly affected the states of Espirito Santo and Minas Gerais, the 2017-2018 YF outbreak primarily involved the states of Minas Gerais, Sao Paulo, and Rio de Janeiro, the latter two of which are highly populated and popular destinations for international travelers. This analysis quantifies the risk of YF virus (YFV) infected travelers arriving in the United States via air travel from Brazil, including both incoming Brazilian travelers and returning US travelers. We assumed that US travelers were subject to the same daily risk of YF infection as Brazilian residents. During both YF outbreaks in Southeast Brazil, three international airports-Miami, New York-John F. Kennedy, and Orlando-had the highest risk of receiving a traveler infected with YFV. Most of the risk was observed among incoming Brazilian travelers. Overall, we found low risk of YFV introduction into the United States during the 2016-2017 and 2017-2018 outbreaks. Decision makers can use these results to employ the most efficient and least restrictive actions and interventions. |
Trends in preventive visits among U.S. youth where weight and height were recorded: 2005-2016
Santo L , Rui P , Hales CM , Arem H , Ogden CL . Am J Prev Med 2019 57 (5) 716-717 In the U.S., 18.5% of U.S. youth aged 2–19 years have obesity.1 Since 2003, the American Academy of Pediatrics has recommended measurement of weight and height at each preventive visit for all children and adolescents to screen for obesity; current guidelines apply to those aged ≥2 years.2–4 | | This study analyzed trends and differences by age in preventive visits of U.S. youth aged 2–19 years to pediatricians and family medicine physicians in which weight and height were recorded between 2005 and 2016. |
In vitro antiviral activity of new oxazoline derivatives as potent poliovirus inhibitors
Madia VN , Messore A , Pescatori L , Saccoliti F , Tudino V , De Leo A , Scipione L , Fiore L , Rhoden E , Manetti F , Oberste MS , Di Santo R , Costi R . J Med Chem 2018 62 (2) 798-810 The final stages of polio eradication are proving more difficult than the early phases, and the development of effective drugs and treatments is considered a priority; thus, the research is ongoing. A screening of our in-house chemical library against poliovirus Sabin strains led to the identification of compounds 5 and 6 as hits active at submicromolar concentrations. Derivatives of these compounds were synthesized as a preliminary structure-activity-relationship study. Among them, 7 and 11 were highly active against poliovirus Sabin 1-3. Compound 11 was also very potent against a large panel of wild and vaccine-derived polioviruses. Time-of-addition experiments suggest that 5 and 7 could be active at an early stage of viral replication, whereas 11 was active at same concentration at all stages of viral replication. A ligand-based approach was applied to find the common structural features shared by the new compounds and already-known poliovirus inhibitors. |
Fatal yellow fever in travelers to Brazil, 2018
Hamer DH , Angelo K , Caumes E , van Genderen PJJ , Florescu SA , Popescu CP , Perret C , McBride A , Checkley A , Ryan J , Cetron M , Schlagenhauf P . MMWR Morb Mortal Wkly Rep 2018 67 (11) 340-341 Yellow fever virus is a mosquito-borne flavivirus that causes yellow fever, an acute infectious disease that occurs in South America and sub-Saharan Africa. Most patients with yellow fever are asymptomatic, but among the 15% who develop severe illness, the case fatality rate is 20%-60%. Effective live-attenuated virus vaccines are available that protect against yellow fever (1). An outbreak of yellow fever began in Brazil in December 2016; since July 2017, cases in both humans and nonhuman primates have been reported from the states of Sao Paulo, Minas Gerais, and Rio de Janeiro, including cases occurring near large urban centers in these states (2). On January 16, 2018, the World Health Organization updated yellow fever vaccination recommendations for Brazil to include all persons traveling to or living in Espirito Santo, Sao Paulo, and Rio de Janeiro states, and certain cities in Bahia state, in addition to areas where vaccination had been recommended before the recent outbreak (3). Since January 2018, 10 travel-related cases of yellow fever, including four deaths, have been reported in international travelers returning from Brazil. None of the 10 travelers had received yellow fever vaccination. |
Coxiella burnetii antibody seropositivity is not a risk factor for AIDS-related non-Hodgkin lymphoma
Miller HK , Santo L , Camargo MC , Winkler CA , Goedert JJ , Kersh GJ , Rabkin CS . Blood 2017 129 (24) 3262-3264 Coxiella burnetii is an important human pathogen and the causative agent of Q fever, a disease that can lead to life-threatening endocarditis and other serious conditions. About 3% of the US population has antibody evidence of exposure to this agent, which can persist for months to years after infection. Recently, chronic C burnetii infection has been linked to the development of non-Hodgkin B-cell lymphoma (NHL).1 This study of 1468 patients from the French National Referral Center for Q Fever database found a 25-fold increase in the risk of NHL development among Q fever patients relative to the general population. The link between Q fever and NHL development is believed to be related to plasmacytoid dendritic cell infection within lymphoid tumors and interleukin-10 (IL-10) overproduction. | HIV is also linked to NHL as progression to AIDS puts patients at increased risk for development of NHL subtypes.2,3 A link between HIV and increased C burnetii seroprevalence has been suggested. Two independent studies in France and Brazil found increased C burnetii seroprevalence in HIV-positive individuals relative to the general population.4-6 Conversely, a study in Spain found seroprevalence among HIV-infected IV drug users similar to that of HIV-negative IV drug users.7 This same study and work in Tanzania found the percentage of HIV-positive individuals within cohorts of acute Q fever patients to be comparable to the general population.7,8 Whether HIV infection alters antibody responses to C burnetii infection or plays a role in increased susceptibility or disease severity is not known. |
Toxicological, enzymatic, and molecular assessment of the insecticide susceptibility profile of Triatoma infestans (Hemiptera: Reduviidae, Triatominae) populations from rural communities of Santa Cruz, Bolivia
Santo-Orihuela PL , Vassena CV , Carvajal G , Clark E , Menacho S , Bozo R , Gilman RH , Bern C , Marcet PL . J Med Entomol 2016 54 (1) 187-195 A wide range of insecticide resistance profiles has been reported across Bolivian domestic and sylvatic populations of Triatoma infestans (Klug, 1834) (Hemiptera, Reduviidae), including some with levels proven to be a threat for vector control. In this work, the insecticide profile of domestic T. infestans was studied with standardized toxicological bioassays, in an area that has not undergone consistent vector control. F1 first-instar nymphs hatched in laboratory from bugs captured in three communities from the Santa Cruz Department were evaluated with different insecticides. Moreover, the enzymatic activity of esterases and cytochrome P450 monooxygenases was measured in individual insects to evaluate the possible mechanism of metabolic resistance to pyrethroids. In addition, the DNA sequence of sodium channel gene (kdr) was screened for two point mutations associated with pyrethroid resistance previously reported in T. infestansAll populations showed reduced susceptibility to deltamethrin and alpha-cypermethrin, albeit the RR50 values varied significantly among them. Increased P450 monooxygenases and permethrate esterases suggest the contribution, as detoxifying mechanisms, to the observed resistance to deltamethrin in all studied populations. No individuals presented either mutation associated to resistance in the kdr gene. The level of susceptibility to alpha-cypermethrin, the insecticide used by the local vector control program, falls within an acceptable range to continue its use in these populations. However, the observed RR50 values evidence the possibility of selection for resistance to pyrethroids, especially to deltamethrin. Consequently, the use of pyrethroid insecticides should be closely monitored in these communities, which should be kept under entomological surveillance and sustained interventions. |
Bacterial composition in a metropolitan drinking water distribution system utilizing different source waters
Gomez-Alvarez V , Humrighouse BW , Revetta RP , Santo Domingo JW . J Water Health 2015 13 (1) 140-151 We investigated the bacterial composition of water samples from two service areas within a drinking water distribution system (DWDS), each associated with a different primary source of water (groundwater, GW; surface water, SW) and different treatment process. Community analysis based on 16S rRNA gene clone libraries indicated that Actinobacteria (Mycobacterium spp.) and alpha-Proteobacteria represented nearly 43 and 38% of the total sequences, respectively. Sequences closely related to Legionella, Pseudomonas, and Vibrio spp. were also identified. In spite of the high number of sequences (71%) shared in both areas, multivariable analysis revealed significant differences between the GW and SW areas. While the dominant phylotypes where not significantly contributing in the ordination of samples, the populations associated with the core of phylotypes (1-10% in each sample) significantly contributed to the differences between both service areas. Diversity indices indicate that the microbial community inhabiting the SW area is more diverse and contains more distantly related species coexisting with local assemblages as compared with the GW area. The bacterial community structure of SW and GW service areas were dissimilar, suggesting that their respective source water and/or water quality parameters shaped by the treatment processes may contribute to the differences in community structure observed. |
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