Born Persons Research Articles

Tuberculosis and Chronic Hepatitis B Virus Infection Screening Among Non-US-Born Persons in an Integrated Health System in California.

Tuberculosis infection (TBI) and chronic hepatitis B virus (HBV) infection disproportionately affect non-US-born persons. Early identification and treatment are critical to reduce transmission, morbidity, and mortality, but little is known about screening in the United States. We conducted a cross-sectional study in a large integrated California health system in September 2022 assessing TBI and HBV screening among persons aged ≥18 years who were born in countries with high TB burden (TB disease incidence rates ≥20/100 000 population) and/or HBV burden (hepatitis B surface antigen seroprevalence >2%). Of 510 361 non-US-born persons born in countries with high TB burden, 322 027 (63.1%) were born in countries with high HBV burden and 188 334 (36.9%) in countries with only high TB burden. Among persons born in countries with high TB and HBV burden, 29.6% were screened for TBI, 64.5% for HBV, and 23.4% for TBI and HBV; 9.9% had TBI and 3.1% had HBV infection. Among persons born in countries with high TB burden only, 27.9% were screened for TBI and 7.5% had TBI. Among non-US-born persons from countries with high TB and HBV burden, we found low screening rates and elevated prevalence of TBI and chronic HBV infection. Cotesting for TBI and HBV infection in non-US-born persons from countries with high TB and HBV burden might improve outcomes by identifying persons who warrant TBI treatment, HBV treatment, or HBV vaccination. Increased screening is the first step in reducing health inequities and overall disease burden.

2511. Screening for Hepatitis B Virus (HBV) and Tuberculosis (TB) Infection among Non-U.S.-Born Adults from High HBV and TB Burden Countries

Abstract Background Hepatitis B virus (HBV) infection and tuberculosis (TB) infection both disproportionately affect non-U.S.–born persons from countries with hepatitis B surface antigen (HBsAg) seroprevalence ≥2% or TB incidence rates ≥20/100,000 population. Early identification and treatment of chronic HBV and TB infection are critical to reduce morbidity and mortality, but little is known about HBV and TB screening among non-U.S.–born persons in the United States. Methods In a cross-sectional study using electronic health record data, we assessed HBV and TB infection screening practices among Kaiser Permanente Northern California eligible members aged ≥18 years born in countries with intermediate to high burdens of both HBV and TB infection. HBV screening was defined as testing for HBV surface antigen and HBV core antibody. TB infection screening was defined as testing with interferon gamma release assay or tuberculin skin test. We calculated the proportion of individuals from intermediate and high HBV-TB burden countries who had HBV or TB infection screening and the proportion of patients positive for HBV or TB infection. Results Of 498,339 non-U.S.–born adults, 275,708 (55.3%) were born in intermediate or high HBV-TB burden countries. Most patients were aged ≥50 years (65.3%) and 23.5% had diabetes. Among persons born in intermediate or high HBV-TB burden countries, 67.1% were screened for HBV infection, 29.4% were screened for TB infection, and only 23.7% were screened for both HBV and TB infection. Among all persons born in intermediate or high HBV-TB burden countries (both screened and unscreened), 3.7% had HBV infection and 10.1% had TB infection. Among 231,431 persons born in intermediate or high HBV-TB burden countries without current or prior HBV infection, 72.9% had received at least one HBV vaccine dose. Conclusion Among non-U.S.–born adults from intermediate or high HBV-TB burden countries, we found low screening proportions, intermediate prevalence of chronic HBV infection and high prevalence of TB infection. Given the large population of persons from intermediate or high HBV-TB burden countries in Kaiser Permanente Northern California, screening for both infections at the same time could improve early diagnosis and treatment for both conditions. Disclosures Jacek Skarbinski, MD, Genentech: Grant/Research Support|Gilead Sciences: Grant/Research Support Robert J. Wong, MD, MS, Gilead Sciences: Grant/Research Support

Geographic Variation in Late-Stage Cervical Cancer Diagnosis

There are stark disparities in cervical cancer burden in the United States, notably by race and ethnicity and geography. Late-stage diagnosis is an indicator of inadequate access to and utilization of screening. To identify geospatial clusters of late-stage cervical cancer at time of diagnosis in Texas. This population-based cross-sectional study used incident cervical cancer data from the Texas Cancer Registry from 2014 to 2018 of female patients aged 18 years or older. Late-stage cervical cancer cases were geocoded at the census tract level (n = 5265) using their residential coordinates (latitude and longitude) at the time of diagnosis. Statistical analysis was performed from April to September 2023. Census tract of residence at diagnosis. Late-stage cervical cancer diagnosis (ie, cases classified by the National Cancer Institute Surveillance, Epidemiology and End Results summary stages 2 to 4 [regional spread] or 7 [distant metastasis]). A Poisson probability-based model of the SaTScan purely spatial scan statistics was applied at the census tract-level to identify geographic clusters of higher (hot spots) or lower (cold spots) proportions than expected of late-stage cervical cancer diagnosis and adjusted for age. Among a total of 6484 female patients with incident cervical cancer cases (mean [SD] age, 48.7 [14.7] years), 2300 (35.5%) were Hispanic, 798 (12.3%) were non-Hispanic Black, 3090 (47.6%) were non-Hispanic White, and 296 (4.6%) were other race or ethnicity. Of the 6484 patients, 2892 with late-stage diagnosis (mean [SD] age, 51.8 [14.4] years were analyzed. Among patients with late-stage diagnosis, 1069 (37.0%) were Hispanic, 417 (14.4%) were non-Hispanic Black, 1307 (45.2%) were non-Hispanic White, and 99 (3.4%) were other race or ethnicity. SaTScan spatial analysis identified 7 statistically significant clusters of late-stage cervical cancer diagnosis in Texas, of which 4 were hot spots and 3 were cold spots. Hot spots included 1128 census tracts, predominantly in the South Texas Plains, Gulf Coast, and Prairies and Lakes (North Texas) regions. Of the 2892 patients with late-stage cervical cancer, 880 (30.4%) were observed within hot spots. Census tract-level comparison of characteristics of clusters suggested that hot spots differed significantly from cold spots and the rest of Texas by proportions of racial and ethnic groups, non-US born persons, and socioeconomic status. In this cross-sectional study examining geospatial clusters of late-stage cervical cancer diagnosis, place-based disparities were found in late-stage cervical cancer diagnosis in Texas. These findings suggest that these communities may benefit from aggressive cervical cancer interventions.

Tabby2: a user-friendly web tool for forecasting state-level TB outcomes in the United States

BackgroundIn the United States, the tuberculosis (TB) disease burden and associated factors vary substantially across states. While public health agencies must choose how to deploy resources to combat TB and latent tuberculosis infection (LTBI), state-level modeling analyses to inform policy decisions have not been widely available.MethodsWe developed a mathematical model of TB epidemiology linked to a web-based user interface — Tabby2. The model is calibrated to epidemiological and demographic data for the United States, each U.S. state, and the District of Columbia. Users can simulate pre-defined scenarios describing approaches to TB prevention and treatment or create their own intervention scenarios. Location-specific results for epidemiological outcomes, service utilization, costs, and cost-effectiveness are reported as downloadable tables and customizable visualizations. To demonstrate the tool’s functionality, we projected trends in TB outcomes without additional intervention for all 50 states and the District of Columbia. We further undertook a case study of expanded treatment of LTBI among non-U.S.–born individuals in Massachusetts, covering 10% of the target population annually over 2025-2029.ResultsBetween 2022 and 2050, TB incidence rates were projected to decline in all states and the District of Columbia. Incidence projections for the year 2050 ranged from 0.03 to 3.8 cases (median 0.95) per 100,000 persons. By 2050, we project that majority (> 50%) of TB will be diagnosed among non-U.S.–born persons in 46 states and the District of Columbia; per state percentages range from 17.4% to 96.7% (median 83.0%). In Massachusetts, expanded testing and treatment for LTBI in this population was projected to reduce cumulative TB cases between 2025 and 2050 by 6.3% and TB-related deaths by 8.4%, relative to base case projections. This intervention had an incremental cost-effectiveness ratio of $180,951 (2020 USD) per quality-adjusted life year gained from the societal perspective.ConclusionsTabby2 allows users to estimate the costs, impact, and cost-effectiveness of different TB prevention approaches for multiple geographic areas in the United States. Expanded testing and treatment for LTBI could accelerate declines in TB incidence in the United States, as demonstrated in the Massachusetts case study.

Adherence to chronic hepatitis B screening guidelines for persons from intermediate to high prevalence Countries.

The adherence to the CDC guideline on screening non-U.S. born persons for hepatitis B virus infection was assessed. A retrospective cohort study was conducted at University of Washington primary care clinics using the electronic medical records. Persons from hepatitis B virus prevalent countries were identified using country of origin and language. Of 2329 eligible for screening, only 617 (26.5%) were screened. The prevalence of HBsAg was 35 (5.7%). Among women of reproductive age (18-44years, n = 906), 238 (26.3%) were screened, and 7 (2.9%) were HBsAg positive. Low screening practice for chronic hepatitis B infection, and high infection prevalence among those screened was noted. The findings indicate that potentially three out of every one detected case may be missed. Urgent efforts are needed to scale up and consistently implement HBV screening at primary care clinics.

Latent tuberculosis infection: Misperceptions among non-U.S.–born-populations from countries where tuberculosis is common

ABSTRACT The Centers for Disease Control and Prevention works to eliminate tuberculosis (TB) disease by finding and treating cases of TB disease and expanding latent tuberculosis infection (LTBI) testing and treatment to prevent TB disease. Approximately 70% of reported TB cases in the United States occur among non-U.S.–born persons. We conducted 15 focus groups with U.S. residents born in the six most common countries of birth among non-U.S.–born TB patients: Mexico, the Philippines, India, Vietnam, China and Guatemala. Participants reacted to 39 messages on LTBI and TB disease risk factors, the Bacille Calmette-Guérin (BCG) vaccine, and LTBI testing and treatment. There was low awareness of LTBI, the TB blood test, and how the TB blood test is not affected by prior BCG vaccination. Several participants thought TB disease is contracted by sharing kitchenware. Some felt negatively targeted when presented with information about countries where TB disease is more common than the U.S. Findings highlight the need for communication aimed at increasing LTBI testing and treatment to include messages framed in ways that will be resonant and actionable to populations at risk. Focus groups revealed LTBI misconceptions which highlight areas for targeted education to decrease TB stigma and increase LTBI testing and treatment.

Aberrant Claustrum Microstructure in Humans after Premature Birth.

Several observations suggest an impact of prematurity on the claustrum. First, the claustrum's development appears to depend on transient subplate neurons of intra-uterine brain development, which are affected by prematurity. Second, the claustrum is the most densely connected region of the mammalian forebrain relative to its volume; due to its effect on pre-oligodendrocytes, prematurity impacts white matter connections and thereby the development of sources and targets of such connections, potentially including the claustrum. Third, due to its high connection degree, the claustrum contributes to general cognitive functioning (e.g., selective attention and task switching/maintaining); general cognitive functioning, however, is at risk in prematurity. Thus, we hypothesized altered claustrum structure after premature birth, with these alterations being associated with impaired general cognitive performance in premature born persons. Using T1-weighted and diffusion-weighted magnetic resonance imaging in 70 very preterm/very low-birth-weight (VP/VLBW) born adults and 87 term-born adults, we found specifically increased mean diffusivity in the claustrum of VP/VLBW adults, associated both with low birth weight and at-trend with reduced IQ. This result demonstrates altered claustrum microstructure after premature birth. Data suggest aberrant claustrum development, which is potentially related with aberrant subplate neuron and forebrain connection development of prematurity.

The inconsistency argument: why apparent pro-life inconsistency undermines opposition to induced abortion

Most opposition to induced abortion turns on the belief that human fetuses are persons from conception. On this view, the moral status of the fetus alone requires those in a...

Bartholomew Abominations

Reviewed by: Bartholomew Abominations Rob Conkie Bartholomew Abominations Presented by Graeae Theatre Company and Naked Productions on BBC Radio 4 from 7 November 2020. Written by Paul Sirett. Directed by Jenny Sealey and Polly Thomas. Sound Recording by Louis Blatherwick. Sound design and production by Eloise Whitmore. Original music by Oliver Vibrans. British Sign Language Interpretation by Caroline Richardson, Jeni Draper, Vikki Gee-Dare, and Chandrika Gopalakrishnan. Executive Production by Jeremy Mortimer. With Liz Carr (Mrs. Purecraft), Jack Hunter (John), Chloe Ewart (Ursula), Stacey Ghent (Alice), Stephen Collins (Tom), Michael Golab (Ned), Garry Robson (Best), and Mina Anwar (Hobbs). When was the last time you experienced theater that turned you inside out? For me, this one did. When was the last time a theatrical production changed not just the way you view the world, but how you operate within it? For me, this one did. Bartholomew Abominations, a radio play co-production between the Deaf and disabled theater company Graeae and audio production company Naked Productions, uses Ben Jonson’s riotous Bartholomew Fair as a launchpad for a much darker, anti-carnivalesque tale. In brief, the abominations are the political energies that facilitate two hundred wedding fairs spread across England in the year 2032. The action of the radio play is set at the “St. Bartholomew Exhibition and Conference Centre in London,” where one such wedding fair takes place. The flesh that is traded at the fairs is that of marriage hopefuls, individuals prepared to undergo speed dating and arbitrary matrimony in order to secure an English-born partner and therefore escape the punishment promised to those who do not march to the New Puritan Party’s ideological drum. Thus, the Home Secretary Sir Michael Best, beautifully and skin-crawlingly played by Garry Robson, broadcasts to those at the fair a rhetoric both horrifically dystopian and yet all-too-familiar: At midnight tonight all non-English born persons and deaf, blind, disabled, and neurodiverse persons without proof of intended marriage to an English-born, able-bodied English person are to be rounded up [. . .]. Those of foreign blood will be deported to the country of their birth. Those with disabilities will be re-located to one of the government’s new facilities where they will be held until our proud country is free from the taint of disability forever [. . .]. People of England, the New Puritan Party is ready. Are you ready? Because together we will be free. We will make England English again! [End Page 310] Opposed to this abhorrent viciousness are a number of covert activists, chief among them the so-called Voice. The Voice—reader, you must expect SPOILERS from here on, and I recommend you listen to the recording before continuing with this review—is the first voice that we hear. It is a distorted voice, audio scrambled to preserve dissident anonymity. The Voice tests this distortion by anticipating the first phrase of Sir Michael’s speech, but with an additional clarification: “At midnight tonight, mass deportations begin.” The only hints that the person changing their voice might not be sinister are the ironic responses to the initial attempts: “I sound like Satan” and then “that’ll do.” But in the experience of listening to the play for the first time, and without reading along with the script, this is a disconcerting opening, a promise of danger and violence. The next sounds are harmonious, if anodyne: chamber music designed to establish a wedding fair atmosphere. Here, two women—Ursula and Alice—attempt to set up their marriage booth. They are interrupted by a police officer and their authorization to be there is questioned. Just as the police officer threatens to expose them, “The sound of several text, WhastApp, Facebook, Instagram alerts go[es] off at the same time” and the Voice hack broadcasts the message tested earlier to mobile devices and through the wedding fair public address system. The police officer, realizing this is serious but not sure why, excuses himself. As the play progresses, the audience soon learns that Ursula and Alice, who regularly and tenderly express their love for one another, are in league with the Voice, and have infiltrated the marriage-selling operation in order...

Optimal Testing Choice and Diagnostic Strategies for Latent Tuberculosis Infection Among US-Born People Living with Human Immunodeficiency Virus (HIV).

Increased risk of progression from latent tuberculosis infection (LTBI) to tuberculosis (TB) disease among people living with human immunodeficiency virus (HIV; PLWH) prioritizes them for LTBI testing and treatment. Studies comparing the performance of interferon gamma release assays (IGRAs) and the tuberculin skin test (TST) among PLWH are lacking. We used Bayesian latent class analysis to estimate the prevalence of LTBI and diagnostic characteristics of the TST, QuantiFERON Gold In-Tube (QFT), and T.SPOT-TB (TSPOT) among a prospective, multicenter cohort of US-born PLWH ≥5 years old with valid results for all 3 LTBI tests using standard US cutoffs (≥5 mm TST, ≥0.35 IU/mL QFT, ≥8 spots TSPOT). We also explored the performance of varying LTBI test cutoffs. Among 1510 PLWH (median CD4+ count 532 cells/mm3), estimated LTBI prevalence was 4.7%. TSPOT was significantly more specific (99.7%) and had a significantly higher positive predictive value (90.0%, PPV) than QFT (96.5% specificity, 50.7% PPV) and TST (96.8% specificity, 45.4% PPV). QFT was significantly more sensitive (72.2%) than TST (54.2%) and TSPOT (51.9%); negative predictive value of all tests was high (TST 97.7%, QFT 98.6%, TSPOT 97.6%). Even at the highest cutoffs evaluated (15 mm TST, ≥1.00 IU/mL QFT, ≥8 spots TSPOT), TST and QFT specificity was significantly lower than TSPOT. LTBI prevalence among this cohort of US-born PLWH was low compared to non-US born persons. TSPOT's higher PPV may make it preferable for testing US-born PLWH at low risk for TB exposure and with high CD4+ counts.

Disparate Outcomes in Non-Small Cell Lung Cancer By Race and Immigrant Status

Prior studies demonstrated the impact of race on overall survival (OS) for non-small cell lung cancer (NSCLC). However, there is limited data evaluating the effects of both race and nation of origin on OS. The purpose of this study was to evaluate OS outcomes by race, stratified by country of origin in patients diagnosed with NSCLC. We performed a retrospective analysis of NSCLC patients diagnosed between 2000 and 2012 recorded in the California Cancer Registry. Race/ethnicity was defined as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic (H), and Asian (A) and further stratified by country of origin (US vs. non-US [NUS]) creating the following patient cohorts: NHW-US, NHW-NUS, NHB-US, NHB-NUS, H-US, H-NUS, A-US, A-NUS. Kaplan-Meier analysis was performed for univariate survival. Cox proportional hazards models estimated hazard of mortality by race and immigration status adjusting for age, sex, marital status, neighborhood socioeconomic status (nSES), health insurance, year of diagnosis, overall stage and histology. A separate model included all previous factors and treatment received (surgery, radiation, chemotherapy). Multivariate logistic regression was performed to predict differences in treatment. A total of 140,366 patients with NSCLC were included. Median OS presented from highest to lowest are: A-NUS (33.4 mos), A-US (33.1 mos), NHW-NUS (31.2 mos), NHW-US (30.2 mos), H-NUS (29.6 mos), H-US (28.0 mos), NHB-US (26.5 mos), NHB-NUS (24.4 mos) (log rank p<0.001). On multivariate analysis including patient and disease characteristics only, NHB-US, A-US, A-NUS, and H-NUS had longer OS when compared to NHW-US (hazard ratios [HRs] 0.85-0.96, p ≤ 0.006 for all). NHW-NUS (HR 1.02, p=0.010) and NHB-NUS (HR 1.05, p=0.004) had worse OS, with no significant difference seen for H-US (HR 0.97, p=0.174). When accounting for treatment received, NHB-US, A-US, NHW-NUS (HR 0.97, p<0.001), H-NUS, and A-NUS had improved OS compared to NHW-US (HRs 0.79-0.93, p≤0.004 for all). There was no significant difference in OS for H-US (0.97, p=0.062) and NHB-NUS (HR 0.97, p=0.056). When compared to NHB-US, NHB-NUS were less likely to undergo treatment including chemotherapy (odds ratio [OR] 0.75, p<0.001) and surgery (OR 0.78, p<0.001); no difference was seen with radiation. This novel study showed that disparities in both OS and treatment are influenced by both race and immigrant status. Foreign born persons of African Ancestry/Blacks with NSCLC appear to have the highest risk of mortality when not accounting for receipt of treatment. When treatment is accounted for, there appears to be no significant difference in survival between Blacks and NHWs. In comparison to US born African-Americans, foreign born persons of African ancestry appear to less commonly undergo treatment including surgery or chemotherapy.

The Law and Ethics of Fetal Burial Requirements for Reproductive Health Care

In Box v. Planned Parenthood (May 28, 2019), the U.S. Supreme Court upheld an Indiana provision which mandates any clinician or facility providing abortion to bury or cremate fetal remains, no different than the requirements for cadavers. Indiana is one of eight states that requires fetal remains be interred or cremated, rather than disposed of as medical material under the rules set forth by the state’s environment and health departments. Individual practitioners or medical facilities must absorb the substantial financial costs required to dispose of fetal remains like deceased persons, or pass them along to their patients, who are in turn forced into making unwanted funerary arrangements for their aborted fetuses – without any countervailing medical benefit. The Supreme Court upheld the Indiana law for serving the state's legitimate interest in expressing respect for unborn life. What the Court missed is how it restricts the right to abortion in ways that demand more rigorous constitutional scrutiny in order to avoid violating a fundamental right. Beyond the burdens that fetal disposition laws place on women, they bear broader cultural consequences by implying that aborted fetuses should be treated no different than born persons who are buried or created after they die.

Narrative experiences of interactions with pharmacists among African-born persons living with HIV: "It's mostly business."

African-born persons constitute 1% of the total Minnesota population, yet 24% of new HIV infections occurred in this population in 2016. Furthermore, 32% of the African born persons living with HIV [PLWH] did not check their CD4 counts or viral load in 2018. Little is known of the role of pharmacists in antiretroviral (ARV) management in the PLWH of African origin. This study aimed to describe the experiences of African-born PLWH in their interactions with pharmacists and perceptions of pharmacists' roles in fostering adherence to ARV therapy. A qualitative approach was used for this study. Recruitment via fliers for in-person interviews with African-born PLWH in Minnesota continued until saturation was achieved. Narrative Interviews with 14 participants lasting up to 2 h were conducted over five months. All interviews were audio recorded and transcribed verbatim by a professional transcription service. Conventional Content Analysis was used to analyze the data. Three themes emerged from analyzed data "Interaction with the pharmacists," "Revealing the diagnosis to a pharmacist," and "Lack of disclosure of HIV status to a pharmacist." The participants referred to the interaction with pharmacists as a "business" or "transactional interaction." To better understand the interaction between pharmacists and PLWH of African-born, future studies could benefit from interviewing pharmacists from different practice settings.

752. Geographic Analysis of Latent Tuberculosis Screening: A Health System Approach

BackgroundTargeted testing and treatment of latent tuberculosis infection is a key element of tuberculosis (TB) elimination in the United States. In particular, foreign-born persons from TB-endemic countries are high priority for latent TB screening.MethodsWe used the DEDUCE interface to query the electronic medical records of all patients presenting to Duke University Health System from January 1, 2010 to November 1, 2017. Latent tuberculosis screening was identified using CPT codes for the tuberculin skin test (TST) and/or interferon gamma release assays (IGRA). Patients’ home addresses were mapped to census tracts; demographic data for these tracts were obtained from the American Community Survey. Higher-risk foreign born persons were defined as persons born in Africa, Asia, or Latin America.ResultsThirty-six thousand eight hundred and twenty-five patients received 48,419 TSTs and 5,366 received 5,746 IGRAs during the study period. Excluding census tracts with fewer than 20 Health System patients (to reduce referral bias), census tracts with a higher proportion of higher risk residents had a greater proportion of Health System patients screened for latent TB (P < 0.001, figure). Health system patients residing in census tracts with greater proportions of higher risk foreign born residents were more likely to be screened with TST than with an IGRA (P < 0.001).ConclusionLatent TB screening was significantly but weakly associated with a greater proportion of higher risk foreign born persons in a given census tract, and persons residing in such tracts were more likely to be screened with TST, which is not preferred due to cross-reaction with the BCG vaccine. Focusing latent TB screening on higher risk areas and using more IGRAs will be necessary to optimize TB prevention efforts. Disclosures All authors: No reported disclosures.

Toxoplasma gondii Infection in the United States, 2011-2014.

Toxoplasma gondii can cause severe neurologic and ocular disease when transmitted congenitally and in immunosuppressed persons. Sera collected in the National Health and Nutrition Examination Survey 2011 through 2014 in 13,507 persons ≥ 6 years old were tested for T. gondii immunoglobulin (Ig) G and IgM antibodies, and in those both IgG and IgM antibody positive, for IgG avidity. Overall, 11.14% (95% confidence limits [CL] 9.88%, 12.51%) were seropositive for T. gondii IgG antibody (age-adjusted seroprevalence 10.42% [95% CL 9.19%, 11.76%]); in women aged 15-44 years, the age-adjusted T. gondii IgG seroprevalence was 7.50% (95% CL 6.00%, 9.25%). In multivariable analysis, risk for IgG seropositivity increased with age and was higher in males; persons living below the poverty level; persons with ≤ a high school education compared with those with > a high school education; and non-Hispanic black, Mexican American, and foreign born non-Hispanic white persons compared with U.S.-born non-Hispanic white persons. Overall, 1.16% (95% CL 0.94%, 1.42%) were T. gondii IgM antibody positive and 0.71%, (95% CL 0.54%, 0.92%) were both IgM and IgG antibody positive. In multivariable analysis, the significant risk factors for being both IgM and IgG positive were older age, crowding, and non-U.S. birth origin compared with U.S.-born persons. Among those positive for both IgM and IgG antibody, almost all had high avidity (all women aged 15-44 years had high avidity). Toxoplasma gondii antibody prevalence remains relatively low in the United States, although it is higher in non-U.S.-born persons, males, and some minority and socioeconomically disadvantaged groups.

Immigration trends’ impacts on state vocational rehabilitation agency minority application rates: An empirical forecast model demonstration study

BACKGROUND: Incessant migration trends of persons of color to the United States warrant the identification of promising forecast models to help state vocational rehabilitation agencies (SVRAs), policy makers, researchers, and advocates inform strategic plans, policy formulation, and research agenda development. OBJECTIVE: This study demonstrated and assessed the efficacy of two different multivariate empirical forecast models’ (i.e., Vector Autoregressive [VAR] model and Multivariable Grey Model [MGM]) ability to accurately predict immigration (Blacks [e.g., Kenya, Nigeria, South Africa, Cameroon], American Indians or Alaskan Natives [e.g., Canada, Mexico], Asians [e.g., China, India, Vietnam, Korea, Japan], Native Hawaiian or other Pacific Islanders [e.g., the Philippines], and Latinos [e.g., Mexico, El Salvador, Guatemala, Cuba, Dominican Republic] trends’ impact on new unduplicated application rates among minorities. METHOD: Nine years of Rehabilitation Services Administration (RSA)-911 case record data (fiscal year [FY] 2006 thru 2014) on SVRA applications and U.S. Census Bureau American Community Survey 1-year estimates (calendar year 2006 thru 2014) on foreign born persons were entered into the VAR model and MGM to test their predictive performance. RESULTS: The MGM was demonstrated to be superior to the VAR model in predictive accuracy. The MGM three-year forecast projected an upward curve trend trajectory in the percentage of new Black or African American, American Indian or Alaskan Natives, Asians, and Latino SVRA applicants for FYs 2015 thru 2017. CONCLUSION: The MGM can be considered for use by SVRAs as a promising tool to help them respond appropriately to the needs of new immigrants and other minority group members.

Enacting Blind Spaces and Spatialities: A Sociological Study of Blindness Related to Space, Environment and Interaction

Lack of eyesight generates blind spaces. Blind spaces often enacted together with sighted are different from visual spaces in important ways. Sharing physical and social space with sighted may imply special challenges for blind persons with regard to interaction order and social identities. The article is based on ethnographic data with the purpose to describe enactment and management of physical and social spaces for blind born persons in different settings. It focuses on the physical and social plasticity of blind spaces and the mediated, practiced and often toolic relationship between body, self and physical and social environments.

Prevalence of latent tuberculosis infection and associated risk factors among 3,374 healthcare students in Italy.

IntroductionThe risk of tuberculosis (TB) in healthcare personnel (HCP) is related to its incidence in the general population. Healthcare students involved in clinical training could be exposed to occupational risks similar to those that HCP face. The prevalence of latent tuberculosis infection (LTBI) among undergraduate healthcare students with different working seniority in Italy was analysed.MethodsA cross-sectional study under a screening programme for LTBI among undergraduate and postgraduate students attending Medical School at the Second University of Naples was conducted between January 2012 and December 2013 with clinical evaluations, tuberculin skin testing (TST) and, in positive TST students, Interferon-γ release assays (IGRA). Putative risk factors for LTBI were assessed by means of a standardised questionnaire.Results3,374 students attending the Medical School of the Second University of Naples were submitted to a screening programme for TBC. 3,331 performed TST as a first-level test and 43 performed a Quantiferon test (QFT). 128 students were TST-positive and continued the diagnostic work with QFT, which was positive in 34 students. Of the 43 subjects who took the QFT as a first-level test only 1 was positive. In 35 students positive to the QFT test we formulated the diagnosis of LTBI by clinical and radiographic results. A correlation was found between age, non-Italian born persons, studying age, post-medical school status and LTBI.ConclusionsThe prevalence of LTBI among healthcare students in our study was very low. In countries with a low incidence of TB, the screening programmes of healthcare students can be useful for early identification and treatment of sporadic cases of LTBI.Electronic supplementary materialThe online version of this article (doi:10.1186/s12995-014-0034-5) contains supplementary material, which is available to authorized users.

The changing epidemiology of hepatitis C virus infection in the United States: National health and nutrition examination survey 2001 through 2010

In light of the dramatically changing hepatitis C therapeutic landscape, knowledge of the current burden of HCV infection in the general population of the United States is critical. The National Health and Nutrition Examination survey collects nationally representative data on HCV infection in the civilian population of the United States. Data from 2001 to 2010 were combined for this study. HCV testing was completed in 38,025 participants. The prevalence of anti-HCV in the United Sates decreased from 1.9% (95% CI 1.5%-2.5%) in 2001-2002 to 1.3% (95% CI 0.9%-1.8%) in 2005-2006, and remained stable up to 2010. About 67% of all infected persons were positive for HCV RNA, indicating 2.3 million people with chronic HCV infection, of whom 68% have genotype 1. Seventy percent of infected persons were born between 1945 and 1965, with prevalence of 3.5% (95% CI 2.2%-4.8%). The stable rate since 2006 is mostly related to prevalent cases and foreign born persons migrating into US. Other important risk factors include less education and low economic status. Race, HIV status, number of sexual partners, and blood transfusions are no longer associated with HCV infection. As of 2010, approximately 2.3 million persons were chronically infected with Hepatitis C in the US. Most of those infected are prevalent, rather than incident cases. The prevalence of HCV was on the decline, but has stabilized since 2006. Future studies should explore reasons for no decline in HCV prevalence since 2006.

Comparison of Stroke Mortality in Finnish-Born Migrants Living in Sweden 1970–1999 and in Swedish-Born Individuals

A limited number of studies have been found on stroke mortality in migrants showing higher mortality for some groups. Influence of time of residence has been studied by one research group. An earlier study showed a significantly higher number of deaths in Diseases of the circulatory system in Finnish migrants compared with native Swedes. To test the hypothesis of a higher mortality in and a decrease in mortality over time in stroke among Finnish migrants in Sweden. The study was based on National Population data, the study population included 321,407 Swedish and 307,174 foreign born persons living in Sweden 1987-1999. Mean age was lower at time for death for Finnish migrants than native Swedes, men 5.1 years difference and women 2.3 years. The difference decreased over time. The risk of death by stroke was higher for migrants with short time of residence than with long time (≤10 years, OR 1.61-1.36 vs ≥11 year, OR 1.18). Migrants with short time of residence died 9.8-5.3 years earlier than native Swedes. The hypothesis was confirmed and an indication of adjustment to life in the new country was found. International studies show similar results for other migrant groups but further studies are needed to verify if the same pattern can be found in other migrants groups in Sweden and to generalise the findings.