Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
Records 1-21 (of 21 Records) |
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Promising practices observed in high-throughput COVID-19 vaccination sites in the United States, February-May 2021
McColloch CE , Samson ME , Parris K , Stewart A , Robinson JA , Cooper B , Galloway E , Garcia R , Gilani Z , Jayapaul-Philip B , Lucas P , Nguyen KH , Noe RS , Trudeau AT , Kennedy ED . Am J Public Health 2023 113 (8) 909-918 Objectives. To identify promising practices for implementing COVID-19 vaccination sites. Methods. The Centers for Disease Control and Prevention (CDC) and Federal Emergency Management Agency (FEMA) assessed high-throughput COVID-19 vaccination sites across the United States, including Puerto Rico, after COVID-19 vaccinations began. Site assessors conducted site observations and interviews with site staff. Qualitative data were compiled and thematically analyzed. Results. CDC and FEMA conducted 134 assessments of high-throughput vaccination sites in 25 states and Puerto Rico from February 12 to May 28, 2021. Promising practices were identified across facility, clinical, and cross-cutting operational areas and related to 6 main themes: addressing health equity, leveraging partnerships, optimizing site design and flow, communicating through visual cues, using quick response codes, and prioritizing risk management and quality control. Conclusions. These practices might help planning and implementation of future vaccination operations for COVID-19, influenza, and other vaccine-preventable diseases. Public Health Implications. These practices can be considered by vaccination planners and providers to strengthen their vaccination site plans and implementation of future high-throughput vaccination sites. (Am J Public Health. 2023;113(8):909-918. https://doi.org/10.2105/AJPH.2023.307331). |
Inconsistencies in Overdose Suicide Death Investigation Practice and Potential Remedies Using Technology: A Centers for Disease Control and Prevention Consultation Meeting Summary
Mercado MC , Stone DM , Kokubun CW , Trudeau AT , Gaylor E , Holland KM , Bartholow BN . Acad Forensic Pathol 2021 11 (2) 83-93 INTRODUCTION: It is widely accepted that suicides-which account for more than 47 500 deaths per year in the United States-are undercounted by 10% to 30%, partially due to incomplete death scene investigations (DSI) and varying burden-of-proof standards across jurisdictions. This may result in the misclassification of overdose-related suicides as accidents or undetermined intent. METHODS: Virtual and in-person meetings were held with suicidologists and DSI experts from five states (Spring-Summer 2017) to explore how features of a hypothetical electronic DSI tool may help address these challenges. RESULTS: Participants envisioned a mobile DSI application for cell phones, tablets, or laptop computers. Features for systematic information collection, scene description, and guiding key informant interviews were perceived as useful for less-experienced investigators. DISCUSSION: Wide adoption may be challenging due to differences in DSI standards, practices, costs, data privacy and security, and system integration needs. However, technological tools that support consistent and complete DSIs could strengthen the information needed to accurately identify overdose suicides. |
Ebola Virus Disease Outbreak - Democratic Republic of the Congo, August 2018-November 2019.
Aruna A , Mbala P , Minikulu L , Mukadi D , Bulemfu D , Edidi F , Bulabula J , Tshapenda G , Nsio J , Kitenge R , Mbuyi G , Mwanzembe C , Kombe J , Lubula L , Shako JC , Mossoko M , Mulangu F , Mutombo A , Sana E , Tutu Y , Kabange L , Makengo J , Tshibinkufua F , Ahuka-Mundeke S , Muyembe JJ , Ebola Response CDC , Alarcon Walter , Bonwitt Jesse , Bugli Dante , Bustamante Nirma D , Choi Mary , Dahl Benjamin A , DeCock Kevin , Dismer Amber , Doshi Reena , Dubray Christine , Fitter David , Ghiselli Margherita , Hall Noemi , Hamida Amen Ben , McCollum Andrea M , Neatherlin John , Raghunathan Pratima L , Ravat Fatima , Reynolds Mary G , Rico Adriana , Smith Nailah , Soke Gnakub Norbert , Trudeau Aimee T , Victory Kerton R , Worrell Mary Claire . MMWR Morb Mortal Wkly Rep 2019 68 (50) 1162-1165 On August 1, 2018, the Democratic Republic of the Congo Ministry of Health (DRC MoH) declared the tenth outbreak of Ebola virus disease (Ebola) in DRC, in the North Kivu province in eastern DRC on the border with Uganda, 8 days after another Ebola outbreak was declared over in northwest Équateur province. During mid- to late-July 2018, a cluster of 26 cases of acute hemorrhagic fever, including 20 deaths, was reported in North Kivu province.* Blood specimens from six patients hospitalized in the Mabalako health zone and sent to the Institut National de Recherche Biomédicale (National Biomedical Research Institute) in Kinshasa tested positive for Ebola virus. Genetic sequencing confirmed that the outbreaks in North Kivu and Équateur provinces were unrelated. From North Kivu province, the outbreak spread north to Ituri province, and south to South Kivu province (1). On July 17, 2019, the World Health Organization designated the North Kivu and Ituri outbreak a public health emergency of international concern, based on the geographic spread of the disease to Goma, the capital of North Kivu province, and to Uganda and the challenges to implementing prevention and control measures specific to this region (2). This report describes the outbreak in the North Kivu and Ituri provinces. As of November 17, 2019, a total of 3,296 Ebola cases and 2,196 (67%) deaths were reported, making this the second largest documented outbreak after the 2014-2016 epidemic in West Africa, which resulted in 28,600 cases and 11,325 deaths.(†) Since August 2018, DRC MoH has been collaborating with partners, including the World Health Organization, the United Nations Children's Fund, the United Nations Office for the Coordination of Humanitarian Affairs, the International Organization of Migration, The Alliance for International Medical Action (ALIMA), Médecins Sans Frontières, DRC Red Cross National Society, and CDC, to control the outbreak. Enhanced communication and effective community engagement, timing of interventions during periods of relative stability, and intensive training of local residents to manage response activities with periodic supervision by national and international personnel are needed to end the outbreak. |
Trends in cirrhosis and mortality by age, sex, race, and antiviral treatment status among US chronic hepatitis B patients (2006-2016)
Lu M , Li J , Zhou Y , Rupp LB , Moorman AC , Spradling PR , Teshale EH , Boscarino JA , Daida YG , Schmidt MA , Trudeau S , Gordon SC . J Clin Gastroenterol 2022 56 (3) 273-279 BACKGROUND: Changing US demographics and evolving chronic hepatitis B (CHB) treatments may affect longitudinal trends in CHB-related complications. We studied trends in the prevalence of cirrhosis (past or present) and incidence of all-cause mortality, stratified by patient age, sex, race, and antiviral treatment status, in a sample from US health care systems. METHODS: Joinpoint and Poisson regression (univariate and multivariable) were used to estimate the annual percent change in each outcome from 2006 to 2016. RESULTS: Among 5528 CHB patients, cirrhosis prevalence (including decompensated cirrhosis) rose from 6.7% in 2006 to 13.7% in 2016; overall mortality was unchanged. Overall rates of cirrhosis and mortality were higher among treated patients, but adjusted annual percent changes (aAPC) were significantly lower among treated than untreated patients (cirrhosis: aAPC +2.4% vs. +6.2%, mortality: aAPC -3.9% vs. +4.0%). Likewise, among treated patients, the aAPC for mortality declined -3.9% per year whereas among untreated patients, mortality increased +4.0% per year. CONCLUSIONS: From 2006 to 2016, the prevalence of cirrhosis among CHB patients doubled. Notably, all-cause mortality increased among untreated patients but decreased among treated patients. These results suggest that antiviral treatment attenuates the progression of cirrhosis and the risk of death among patients with CHB. |
Lower rates of emergency visits and hospitalizations among chronic hepatitis C patients with sustained virological response to interferon-free direct-acting antiviral therapy (2014-2018)
Gordon SC , Teshale EH , Spradling PR , Moorman AC , Boscarino JA , Schmidt MA , Daida YG , Rupp LB , Trudeau S , Zhang J , Lu M . Clin Infect Dis 2022 75 (8) 1453-1456 We compared rates of emergency department (ED) visits and hospitalizations between HCV patients who achieved sustained virological response (SVR) after direct-acting antiviral (DAA) therapy (cases) to matched controls. Among 3049 pairs, cases demonstrated lower rates of liver-related ED visits (P=.01) than controls; all-cause and liver-related hospitalization rates and hospitalized days were also lower in cases (P<.0001). |
Developing and Implementing Community-Level Strategies for Preventing Youth Violence in the United States
Kingston BE , Zimmerman MA , Wendel ML , Gorman-Smith D , Wright-Kelly E , Mattson SA , Trudeau AT . Am J Public Health 2021 111 S20-s24 Public health researchers recognize that determinants of youth violence exist across multiple contexts and social-ecological levels, which necessitates using a comprehensive approach to prevent youth violence (https://bit.ly/3hFqWCi). A large body of research has focused on developing and evaluating community-based interventions that address individual and family risk factors for youth violence.1 Despite the success of these interventions, youth violence remains a major public health issue. Community-level prevention strategies focus on the characteristics of settings (e.g., schools, workplaces, and neighborhoods) that increase the risk of or protect people from violence, particularly social, economic, and environmental characteristics. These strategies are distinct from community-based strategies, which are implemented in community settings but target individual, peer, or other proximal relationship or family factors.2 Community-level prevention strategies have the potential to impact a greater number of people, yet the current evidence base for youth violence prevention approaches at the outer social-ecological levels (i.e., community, societal) is thin.3 |
Youths and Violence: Changing the Narrative
Metzler M , Jackson T , Trudeau A . Am J Public Health 2021 111 S35-s37 The care and protection of children and youths is widely understood to be the responsibility of adults, communities, and society. The importance of safe, stable, nurturing relationships and environments to support children as they grow into healthy adults enjoying meaningful lives has been well documented.1 Yet, this is not the world that exists for all children, especially those at increased risk of experiencing violence.2 Why is this? If children deserve better, why do inequities in risk for violence persist? What accounts for the limited progress on their behalf?3 | | Story telling is a strategy used in public health to communicate about the lives of people and communities. The term “narrative” is often used interchangeably with “storytelling,” but although these terms are related, “narrative” refers more precisely to connected stories that are articulated and refined over time to advance a central idea or belief. Public narratives are meta-stories that provide an understanding or interpretation of people and situations; dominant public narratives are those that eclipse others and have the most power to shape public consciousness, including society’s collective senses of both responsibility and possibility.4 Words matter, but narrative is about more than words. Narrative is about the ideas that get communicated through language, images, culture, and media. Understanding how narratives operate is critical to violence prevention efforts.5 |
Social and Structural Determinants of Health and Youth Violence: Shifting the Paradigm of Youth Violence Prevention
Nation M , Chapman DA , Edmonds T , Cosey-Gay FN , Jackson T , Marshall KJ , Gorman-Smith D , Sullivan T , Trudeau AT . Am J Public Health 2021 111 S28-s31 Violence against non-Hispanic Black youths continues to be a significant public health issue for many communities in the United States. For more than two decades, homicide has been the leading cause of death among non-Hispanic Black youths aged 10 to 24 years (http://bit.ly/2N3lXko). Also, the burden of exposure to community violence is disproportionately carried by people of color and people living in economically disadvantaged neighborhoods.1 Public health and allied disciplines have played a key role in raising awareness about the system of individual, interpersonal, and social factors that contribute to the development of youth violence and have conducted several decades of research seeking to understand youth violence and develop youth violence–prevention strategies. These efforts have resulted in an array of evidence-based interventions designed to promote a variety of positive outcomes, including promoting positive relationships, developing problem solving, and diffusing interpersonal conflict. However, these interventions have focused heavily on the individual and interpersonal factors while failing to address broader social and structural factors associated with violence. |
Trends in diagnosed chronic hepatitis B in a US health system population, 2006-2015
Lu M , Zhou Y , Holmberg SD , Moorman AC , Spradling PR , Teshale EH , Boscarino JA , Daida YG , Schmidt MA , Li J , Rupp LB , Trudeau S , Gordon SC . Open Forum Infect Dis 2019 6 (7) ofz286 Background: Trends in the epidemiology of chronic hepatitis B (CHB) among routine clinical care patients in the United States are not well documented. We used data from the Chronic Hepatitis Cohort Study to investigate changes in prevalence and newly recorded cases of CHB from 2006 to 2015. Methods: Annual percentage changes (APCs) were estimated using join point Poisson regression. Analyses were adjusted by study site; when an interaction with the trend was observed, APCs were estimated by subgroups. Differences in rates based on race, age, and sex were calculated with rate ratios. Results: We identified 5492 patients with CHB within select health systems with total populations that ranged from 1.9 to 2.4 million persons. From 2006 to 2014, the prevalence of diagnosed CHB increased from 181.3 to 253.0 per 100 000 persons in the health system population; from 2014 to 2015, it declined to 237.0 per 100 000 persons. APC was +3.7%/y through 131 December 2014 (P < .001) and -15.0%/y (P < .001) thereafter. The rate of newly reported cases of CHB did not change significantly across the study period (APC, -1.1%/y; P = .07). The rates of newly reported cases were 20.5 times higher among patients in the Asian American/American Indian/Pacific Islander (ASINPI) category, compared with white patients, and 2.8 times higher among African American patients. The ratio of male to female patients was roughly 3:2. Conclusions: The prevalence of diagnosed CHB in this US patient population increased from 2006 to 2014, after which it decreased significantly. Rates declined most rapidly among patients </=40 or 61-70 years old, as well as among ASINPI patients. The rate of newly reported cases remained steady over the study period. |
Adjuvant ribavirin and longer direct-acting antiviral treatment duration improve sustained virological response among hepatitis C patients at risk of treatment failure
Lu M , Wu KH , Li J , Moorman AC , Spradling PR , Teshale EH , Boscarino JA , Daida YG , Schmidt MA , Rupp LB , Zhang T , Trudeau S , Gordon SC . J Viral Hepat 2019 26 (10) 1210-1217 The role of ribavirin (RBV) in the era of direct-acting antivirals (DAA) is not clear, and DAA studies have been largely genotype- and regimen-specific. Using data from the Chronic Hepatitis Cohort Study, we evaluated the role of RBV and increased DAA treatment duration among patients with chronic hepatitis C (HCV) in routine clinical care. Multivariable analysis of data from 4133 patients receiving any of the following: sofosbuvir (SOF); daclatasvir +SOF; grazoprevir +elbasvir; paritaprevir/ ritonavir +ombitasvir; simeprevir +SOF; and SOF +ledipasvir; SOF +velpatasvir +/-voxilaprevir; and glecaprevir+pibrentasvir-all with/ without RBV. Inverse probability treatment weighting was used to adjust for treatment-selection bias. Sustained virological response (SVR) was defined by undetectable HCV RNA 12 weeks after end of therapy. The overall SVR rate was 95%. Mean treatment duration was 12+/-4.5 weeks. The final model included treatment duration and diabetes, as well as the interaction of RBV with previous treatment status (treatment naive, interferon treatment failure [TF], or previous DAA TF), cirrhosis status, and HCV genotype (GT). Each one month increment of treatment duration increased odds of SVR by 99% (aOR=1.99). Diabetes, previous DAA TF, and decompensated cirrhosis significantly reduced odds of SVR. RBV significantly increased the likelihood of SVR among patients with decompensated cirrhosis (aOR=5.05), previous DAA treatment failure (aOR=5.43), and GT3 (aOR=13.28). Among RBV-free regimens, patients with GT3 were less likely to achieve SVR than those with GT1 or 2 (aOR 0.07). Diabetes, decompensated cirrhosis, and prior DAA TF independently reduced the likelihood of SVR. Longer treatment duration increased likelihood of SVR. RBV increased likelihood of SVR among patients with GT3, previous DAA TF, or decompensated cirrhosis. This article is protected by copyright. All rights reserved. |
Sustained virological response to hepatitis C treatment decreases the incidence of complications associated with type 2 diabetes
Li J , Gordon SC , Rupp LB , Zhang T , Trudeau S , Holmberg SD , Moorman AC , Spradling PR , Teshale EH , Boscarino JA , Schmidt MA , Daida YG , Lu M . Aliment Pharmacol Ther 2019 49 (5) 599-608 BACKGROUND: The role of hepatitis C (HCV) eradication on the long-term complications of type 2 diabetes mellitus remains incompletely studied. AIM: We investigated whether antiviral treatment impacted risk of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy among diabetic patients from the four US health systems comprising the Chronic Hepatitis Cohort Study (CHeCS). METHODS: We included CHeCS HCV patients with diagnosis codes for type 2 diabetes who were on antidiabetic medications. Patients were followed until an outcome of interest, death, or last health system encounter. The effect of treatment on outcomes was estimated using the competing risk analysis (Fine-Gray subdistribution hazard ratio [sHR]), with death as a competing event. RESULTS: Among 1395 HCV-infected patients with type 2 diabetes, 723 (52%) were treated with either interferon-based or direct-acting antivirals (DAAs); 539 (75% of treated) achieved sustained virological response (SVR). After propensity score adjustment to address treatment selection bias, patients with SVR demonstrated significantly decreased risk of acute coronary syndrome (sHR = 0.36; P < 0.001), end-stage renal disease (sHR = 0.46; P < 0.001), stroke (sHR = 0.34; P < 0.001), and retinopathy (sHR = 0.24; P < 0.001) compared to untreated patients. Results were consistent in subgroup analyses of DAA-treated patients and interferon-treated patients, an analysis of cirrhotic patients, as well as in sensitivity analyses considering cause-specific hazards, exclusion of patients with on-treatment retinopathy, and treatment status as a time-varying covariate. CONCLUSION: Successful HCV treatment among patients with type 2 diabetes significantly reduces incidence of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy, regardless of cirrhosis. Our findings support the importance of HCV antiviral therapy among patients with type 2 diabetes to reduce the risk of these extrahepatic outcomes. |
Sustained virological response does not improve long-term glycemic control in patients with type 2 diabetes and chronic hepatitis C
Li J , Gordon SC , Rupp LB , Zhang T , Trudeau S , Holmberg SD , Moorman AC , Spradling PR , Teshale EH , Boscarino JA , Schmidt MA , Daida YG , Lu M . Liver Int 2018 39 (6) 1027-1032 BACKGROUND: Sustained virological response (SVR) to treatment for chronic hepatitis C (HCV) may improve short-term glucose control among patients with type 2 diabetes (T2D), but the long-term impact remains largely unknown. We used data from the Chronic Hepatitis Cohort Study to investigate the impact of SVR on long-term trends in HbA1c in patients with T2D. METHODS: "Index date" was defined as the date of treatment initiation (treated patients) or HCV diagnosis (untreated patients). To address treatment selection bias, we used a propensity score approach. We used a piecewise, linear-spline, mixed-effects model to evaluate changes in HbA1c over a five-year period. RESULTS: Our sample included 384 HCV patients with T2D (192 untreated, 192 treated, with SVR or treatment failure [TF]). After adjusting for BMI, HbA1c was stable among untreated and TF patients. In SVR patients, Hb1Ac trajectories evolved in three phases: 1) index through 6 months post-index, average HbA1c decreased significantly from 7.7-5.4% per 90 days (p<0.001); 2) 6-30 months post-index, HbA1c rebounded at a rate of 1.5% every 90 days (p=0.003); and 3) from 30 months onward, HbA1c stabilized at an average level of 7.9 (p-value =0.34). Results from an analysis restricted to patients receiving direct-acting antivirals were consistent with the main findings. CONCLUSION: Successful HCV treatment among patients with T2D significantly reduces HbA1 shortly after treatment, but these decreases are not sustained long-term. Less than three years after SVR, HbA1c rebounds to levels similar to untreated/TF patients, and higher than recommended for type 2 diabetic maintenance. This article is protected by copyright. All rights reserved. |
Suicide rates by major occupational group - 17 states, 2012 and 2015
Peterson C , Stone DM , Marsh SM , Schumacher PK , Tiesman HM , McIntosh WL , Lokey CN , Trudeau AT , Bartholow B , Luo F . MMWR Morb Mortal Wkly Rep 2018 67 (45) 1253-1260 During 2000-2016, the suicide rate among the U.S. working age population (persons aged 16-64 years) increased 34%, from 12.9 per 100,000 population to 17.3 (https://www.cdc.gov/injury/wisqars). To better understand suicide among different occupational groups and inform suicide prevention efforts, CDC analyzed suicide deaths by Standard Occupational Classification (SOC) major groups for decedents aged 16-64 years from the 17 states participating in both the 2012 and 2015 National Violent Death Reporting System (NVDRS) (https://www.cdc.gov/violenceprevention/nvdrs). The occupational group with the highest male suicide rate in 2012 and 2015 was Construction and Extraction (43.6 and 53.2 per 100,000 civilian noninstitutionalized working persons, respectively), whereas the group with the highest female suicide rate was Arts, Design, Entertainment, Sports, and Media (11.7 [2012] and 15.6 [2015]). The largest suicide rate increase among males from 2012 to 2015 (47%) occurred in the Arts, Design, Entertainment, Sports, and Media occupational group (26.9 to 39.7) and among females, in the Food Preparation and Serving Related group, from 6.1 to 9.4 (54%). CDC's technical package of strategies to prevent suicide is a resource for communities, including workplace settings (1). |
Impact of sustained virological response on risk of type 2 diabetes among hepatitis C patients in the US
Li J , Zhang T , Gordon SC , Rupp LB , Trudeau S , Holmberg SD , Moorman AC , Spradling PR , Teshale EH , Boscarino JA , Schmidt MA , Daida YG , Lu M . J Viral Hepat 2018 25 (8) 952-958 Data regarding the impact of hepatitis C (HCV) therapy on incidence of type 2 diabetes mellitus are limited. We used data from the longitudinal Chronic Hepatitis Cohort Study-drawn from four large US health systems-to investigate how response to HCV treatment impacts risk of subsequent type 2 diabetes mellitus. Among HCV patients without a history of type 2 diabetes mellitus or hepatitis B, we investigated incidence of type 2 diabetes mellitus from 12 weeks post-HCV treatment through December 2015. Cox proportional hazards models were used to test the effect of treatment status (sustained virological response [SVR] or treatment failure) and baseline risk factors on development of type 2 diabetes mellitus, considering any possible risk factor-by-SVR interactions and death as a competing risk. Among 5,127 patients with an average follow-up of 3.7 years, type 2 diabetes mellitus incidence was significantly lower among patients who achieved SVR (231/3748; 6.2%) than among patients with treatment failure (299/1379; 21.7%; adjusted hazard ratio [aHR]= 0.79; 95%CI 0.65-0.96). Risk of type 2 diabetes mellitus was higher among African American and Asian American patients than white patients (aHR=1.82 and 1.75, respectively; p<0.05), and among Hispanic patients than non-Hispanics (aHR=1.86). Patients with BMI >/=30 and 25-30 (aHR=3.62 and 1.72, respectively; p<0.05) demonstrated higher risk than those with BMI <25; patients with cirrhosis at baseline had higher risk than those without cirrhosis (aHR=1.47). Among a large US cohort of patients treated for HCV, patients who achieved SVR demonstrated a substantially lower risk for development of type 2 diabetes mellitus than patients with treatment failure. This article is protected by copyright. All rights reserved. |
Race, Age, and Geography Impact Hepatitis C Genotype Distribution in the United States.
Gordon SC , Trudeau S , Li J , Zhou Y , Rupp LB , Holmberg SD , Moorman AC , Spradling PR , Teshale E , Boscarino JA , Daida YG , Schmidt MA , Lu M . J Clin Gastroenterol 2017 53 (1) 40-50 GOALS: To determine the impact of geography and patient characteristics on hepatitis C virus (HCV) genotype and subtype distribution in a large sample of patients under routine clinical care BACKGROUND:: HCV genotype impacts disease course and response to treatment. Although several studies have reported genotype distribution within specific US populations, there are no comprehensive descriptions in large, geographically diverse cohorts. STUDY: Using data from the Chronic Hepatitis Cohort Study, we present the distribution of HCV genotypes (GT) and subtypes (ST) among a racially diverse cohort of over 8000 HCV-infected patients from four large US health systems. RESULTS: Genotype distribution varied significantly by geographic and demographic factors. In age-adjusted analyses, African American patients had significantly higher prevalence of GT1 (85%) than other racial categories, largely driven by a markedly higher proportion of GT1 subtype b ( approximately 34%) than in Asian/other (24%) and white (21%) patients. GT3 represented an increasing proportion of infections as birth decade progressed, from 4% in patients born before 1946 to 18% of those born after 1976. Within the cohort of "living/uncured" patients, highly elevated alanine aminotransferase (>2 times the upper limit of normal) was significantly more common in GT3 patients, whereas Fibrosis-4 Index scores indicative of cirrhosis were most common in the combined group of GT4&6 patients. CONCLUSION: Distribution of HCV genotypes and subtypes in the United States is more variable than suggested by previous national-level estimates and single-center studies. "Real-world" prevalence data may improve targeting of prevention, screening, and treatment efforts for hepatitis C. |
Deciphering suicide and other manners of death associated with drug intoxication: A Centers for Disease Control and Prevention Consultation Meeting Summary
Stone DM , Holland KM , Bartholow B , Logan J , LiKamWa McIntosh W , Trudeau A , Rockett IRH . Am J Public Health 2017 107 (8) e1-e7 Manner of death (MOD) classification (i.e., natural, accident, suicide, homicide, or undetermined cause) affects mortality surveillance and public health research, policy, and practice. Determination of MOD in deaths caused by drug intoxication is challenging, with marked variability across states. The Centers for Disease Control and Prevention hosted a multidisciplinary meeting to discuss drug intoxication deaths as they relate to suicide and other MOD. The meeting objectives were to identify individual-level, system-level, and place-based factors affecting MOD classification and identify potential solutions to classification barriers. Suggested strategies included improved standardization in death scene investigation, toxicology, and autopsy practice; greater accountability; and creation of job aids for investigators. Continued collaboration and coordination of activities are needed among stakeholders to affect prevention efforts. (Am J Public Health. Published online ahead of print June 22, 2017: e1-e7. doi:10.2105/AJPH.2017.303863). |
Changing trends in complications of chronic hepatitis C
Lu M , Li J , Rupp LB , Zhou Y , Holmberg SD , Moorman AC , Spradling PR , Teshale EH , Boscarino JA , Daida YG , Schmidt MA , Trudeau S , Gordon SC . Liver Int 2017 38 (2) 239-247 BACKGROUND AND AIMS: Chronic hepatitis C virus (HCV)-related complications have increased over the past decade. METHODS: We used join-point regression modeling to investigate trends in these complications from 2006-2015, and the impact of demographics on these trends. Using data from the Chronic Hepatitis Cohort Study (CHeCS), we identified points at which the trend significantly changed, and estimated the annual percent change (APC) in rates of cirrhosis, decompensated cirrhosis, and all-cause mortality, adjusted by race, sex, and age. RESULTS: Among 11,167 adults with chronic HCV infection, prevalence of cirrhosis increased from 20.8% to 27.6% from 2006 to 2015 with adjusted annual percentage change (aAPC) of 1.2 (p<0.01). Although incidence of all-cause mortality increased from 1.8% in 2006 to 2.9% in 2015, a join-point was identified at 2010, with aAPCs of 9.6 before (2006<2010; p<0.01) and -5.2 after (2010≤2015; p<0.01), indicating a decrease in mortality from 2010 and onward. Likewise, although overall prevalence of decompensated cirrhosis increased from 9.3% in 2006 to 10.4% in 2015, this increase was confined to patients 60 or older (aAPC=1.5; p=0.023). Asian American and Black/ African American patients demonstrated significantly higher rates of cirrhosis than White patients, while older patients and men demonstrated higher rates of cirrhosis and mortality. CONCLUSIONS: Although cirrhosis and mortality among HCV-infected patients in the US have increased in the past decade, the mortality has decreased in recent years. |
Long-term progression of viral load and serum markers of fibrosis among treated and untreated patients with chronic hepatitis B
Li J , Gordon SC , Rupp LB , Zhang T , Trudeau S , Holmberg SD , Moorman AC , Spradling PR , Teshale EH , Boscarino JA , Daida YG , Schmidt MA , Lu M . J Gastroenterol Hepatol 2016 32 (6) 1250-1257 BACKGROUND AND AIMS: Antiviral therapy for patients with hepatitis B (HBV) infection is generally deferred for "immune inactive" patients, although longitudinal changes in viral load and liver fibrosis remain understudied in this population. Likewise, in treated patients, the temporal relationship between changes in viral load and liver fibrosis is not well-characterized. Using data from the Chronic Hepatitis Cohort Study, we investigated viral load and the Fibrosis-4 index (FIB4, a serum-based marker of liver fibrosis) trajectories in both untreated and treated HBV patients. MATERIALS AND METHODS: We applied a bivariate, piecewise, linear spline, mixed-effects modeling approach to data from 766 HBV patients (342 untreated, 424 treated). Treatment selection bias was adjusted using propensity scores. Multiple sensitivity analyses were used to confirm results in untreated patients. RESULTS: Among all untreated patients, FIB4 began to increase by 0.9% per month (11% per year) (p < 0.05) at 28 months post-index date, suggesting fibrosis progression. Significant FIB4 progression was also observed within a subgroup analysis of "immune inactive" untreated patients. In treated patients, viral load declined 31.8% per month (p < 0.05) for the first 5 months after treatment initiation, and 1.4-1.7% per month (p < 0.05) thereafter. At 5 months after treatment initiation, FIB4 began to decline 0.5% per month (p < 0.05), stabilizing at 28 months. CONCLUSION: Among untreated HBV patients, FIB4 gradually increases over time, suggesting fibrosis progression, even in those patients designated as immune inactive. In treated patients, antiviral therapy results in a rapid decline in viral load followed by a delayed decline in markers of liver fibrosis. |
Suicide rates by occupational group - 17 states, 2012
McIntosh WL , Spies E , Stone DM , Lokey CN , Trudeau AR , Bartholow B . MMWR Morb Mortal Wkly Rep 2016 65 (25) 641-5 In 2012, approximately 40,000 suicides were reported in the United States, making suicide the 10th leading reported cause of death for persons aged ≥16 years (1). From 2000 to 2012, rates of suicide among persons in this age group increased 21.1%, from 13.3 per 100,000 to 16.1 (1). To inform suicide prevention efforts, CDC analyzed suicide by occupational group, by ascribing occupational codes to 12,312 suicides in 17 states in 2012 from the National Violent Death Reporting System (NVDRS) (2). The frequency of suicide in different occupational groups was examined, and rates of suicide were calculated by sex and age group for these categories. Persons working in the farming, fishing, and forestry group had the highest rate of suicide overall (84.5 per 100,000 population) and among males (90.5); the highest rates of suicide among females occurred among those working in protective service occupations (14.1). Overall, the lowest rate of suicide (7.5) was found in the education, training, and library occupational group. Suicide prevention approaches directed toward persons aged ≥16 years that enhance social support, community connectedness, access to preventive services, and the reduction of stigma and barriers to help-seeking are needed. |
Hepatitis C treatment failure is associated with increased risk of hepatocellular carcinoma
Lu M , Li J , Rupp LB , Holmberg SD , Moorman AC , Spradling PR , Teshale EH , Zhou Y , Boscarino JA , Schmidt MA , Lamerato LE , Trinacty C , Trudeau S , Gordon SC . J Viral Hepat 2016 23 (9) 718-29 Sustained virological response (SVR) to antiviral therapy for hepatitis C (HCV) reduces risk of hepatocellular carcinoma (HCC), but there is little information regarding how treatment failure (TF) compares to lack of treatment. We evaluated the impact of treatment status on risk of HCC using data from the Chronic Hepatitis Cohort Study (CHeCS-an observational study based in four large US health systems, with up to 7 years of follow-up on patients). Multivariable analyses were used to adjust for bias in treatment selection, as well as other covariates, followed by sensitivity analyses. Among 10 091 HCV patients, 3681 (36%) received treatment, 2099 (57%) experienced treatment failure (TF), and 1582 (43%) of these achieved sustained virological response (SVR). TF patients demonstrated almost twice the risk of HCC than untreated patients [adjusted hazard ratio (aHR) = 1.95, 95% confidence interval (CI) 1.50-2.53]; this risk persisted across all stages of fibrosis. Several sensitivity analyses validated these results. Although African Americans were at increased risk of treatment failure, they were at lower risk for HCC and all-cause mortality compared to White patients. SVR patients had lower risk of HCC than TF patients (aHR = 0.48, CI 0.31-0.73), whereas treatment - regardless of outcome - reduced all-cause mortality (aHR = 0.45, CI 0.34-0.60 for SVR patients; aHR = 0.78, CI 0.65-0.93 for TF patients). |
Serum Biomarkers Indicate Long-term Reduction in Liver Fibrosis in Patients With Sustained Virological Response to Treatment for HCV Infection
Lu M , Li J , Zhang T , Rupp LB , Trudeau S , Holmberg SD , Moorman AC , Spradling PR , Teshale EH , Xu F , Boscarino JA , Schmidt MA , Vijayadeva V , Gordon SC . Clin Gastroenterol Hepatol 2016 14 (7) 1044-1055 e3 BACKGROUND & AIMS: Sustained viral response (SVR) to antiviral therapy for hepatitis C virus (HCV) correlates with changes in biochemical measures of liver function. However, little is known about the long-term effects of SVR on liver fibrosis. We investigated the effects of HCV therapy on fibrosis, based on fibrosis-4 (FIB4) score, over a 10 year period. METHODS: We collected data from participants in the chronic hepatitis C cohort-part of an observational multicenter study of patients with hepatitis C at 4 large US health systems-from January 1, 2006 through December 31, 2013. We calculated patients' FIB4 and aminotransferase-to-platelet ratio index (APRI) scores over a 10 year period. Of 4731 patients with HCV infection, 1657 (35%) were treated and 755 (46%) of these patients achieved an SVR. RESULTS: In propensity score-adjusted analyses, we observed significant longitudinal changes in FIB4 score that varied with treatment and response to treatment. In patients with an SVR, FIB4 scores were initially higher than in patients without SVRs, but then decreased sharply, remaining significantly lower over the 10 year period than in untreated patients or patients with treatment failure (P<.001). In independent analyses, men and patients with HCV genotype 1 or 3 infections had higher FIB4 scores than women or patients with HCV genotype 2 infections (P<.01 for both). Findings were similar in a sensitivity analysis that substituted the APRI as the marker of fibrosis instead of FIB4 score. CONCLUSIONS: An SVR to HCV treatment appears to induce long-term regression of fibrosis, based on FIB4 or APRI scores collected over 10 years patients in a large study. Patients receiving no treatment or with treatment failure had progressive increases in FIB4 scores. |
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