Centers For Prevention Research Articles

STRATEGI PEMERINTAH DAERAH KABUPATEN BANYUMAS DALAM MENCEGAH KORUPSI ANGGARAN PENDAPATAN DAN BELANJA DAERAH (APBD) DI KABUPATEN BANYUMAS

Abstrak . Banyumas Regency is one of the regencies that received the highest ranking for corruption prevention. According to the Corruption Eradication Commission's Monitoring Center for Prevention (MCP) corruption prevention instrument, Banyumas Regency is ranked sixth at the national level with an index of 95.79. This research was conducted to find out the strategies of the Banyumas Regency Regional Government in preventing corruption of the Regional Budget (APBD) in Banyumas Regency and the obstacles of the Banyumas Regency Regional Government in implementing strategies to prevent corruption of the Regional Budget (APBD) in Banyumas Regency. The research method used is normative juridical using secondary data sources and primary data sources in the form of data from interviews with the Banyumas Regency local government consisting of the Regional Secretariat of the Legal Section and the Banyumas Regency Regional Inspectorate. Based on the results of the study, that the strategies and effective efforts of the Banyumas Regency local government in preventing corruption of the Regional Budget (APBD) in Banyumas Regency can be done through the establishment of regulations, handling conflicts of interest, fostering the State Civil Apparatus (ASN), using the Monitoring Center for Prevention (MCP), using the Whistleblowing System (WBS), using complaint stalls, conducting investigative audits, implementing the Government Internal Control System (SPIP), and carry out the duties and functions of local government on the regional revenue and expenditure budget (APBD). The obstacles of The Banyumas Regency Regional Government in preventing Corruption in the Regional Budget (APBD) in Banyumas Regency include delays in the implementation of activity schedules, the effectiveness of regulations, and the incompatibility of public complaints. Keyword: Corruption, APBD, Banyumas Regency.

The impact of climate variation on the spread of Shiga toxin-producing E. coli.

Shiga toxin-producing Escherichia coli (STEC) is influenced by seasonality, but there is limited understanding of how specific climatic variables contribute to disease spread. This information aids in understanding disease transmission dynamics and could potentially inform public health modeling. This retrospective cohort study analyzed public health data from Ontario, Canada, between 2012 and 2021, along with historical climate data from Environment Canada. We employed Seasonal Autoregressive Integrated Moving Average (S-ARIMA) models to assess how temperature and precipitation impact the incidence of STEC infections, measured per 10,000,000 population. The study included 1658 confirmed STEC cases. A significant correlation was found between STEC incidence and climatic variables. Each degree Celsius increase in maximum temperature was associated with a rise of 3 STEC cases per 10,000,000 population (Centers for Disease Control and Prevention (2024)). Additionally, each millimeter of increased precipitation correlated with an increase of 1.1 cases per 10,000,000 population. The findings demonstrate a significant impact of temperature and precipitation on STEC transmission, highlighting the importance of integrating meteorological data into public health surveillance. This integration may help inform public health responses and support healthcare systems in planning for future outbreaks. Further studies are needed to refine predictive models and develop effective early warning systems for clinical settings.

Time interval distribution of hepatitis B vaccine immunization among infants in China from 2017 to 2021

ABSTRACT Infant hepatitis B vaccine coverage in China is high, with over 95% of infants immunized; however, high vaccine coverage can often mask low timeliness. The vaccination interval between the second and third doses is not clearly defined by immunization guidelines in China. This retrospective cohort study assessed the time interval distribution of hepatitis B vaccination among a cohort of randomly selected live births from the Centers for Disease Control and Prevention across four provinces or municipalities in China between January 2017 and December 2021. Among the infants analyzed, 163,224 received the first dose of hepatitis B vaccine with 146,905 (90.0%) and 135,757 (83.2%) infants receiving the second and third doses, respectively. A total of 132,577 (90.2%) infants received the second dose between 28 and 61 days after the first dose. Of the 119,437 (88.0%) infants that completed the hepatitis B series between 61 and 214 days after the second dose 87,067 (64.1%) infants were vaccinated with the third dose between 151 and 180 days after the second dose. The time interval distribution varied across the four provinces or municipalities (p < .001). Of the 58,077 infants who completed the hepatitis B vaccine series, 36,377 (62.6%) infants used the same type of hepatitis B vaccine for all three doses. Overall, the timeliness of hepatitis B vaccination for infants was lower than expected, with regional disparities observed. This highlights the need for improved timeliness through the introduction of a defined timeframe for the last two doses of vaccine and training for obstetricians and related personnel.

Assessment of Public Health Agency and Utility Training Needs for CDC National Wastewater Surveillance System Jurisdictions in the United States.

Since the start of the COVID-19 pandemic, wastewater surveillance hasemerged as a critical tool for tracking the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and other pathogens in communities throughout the United States. In 2020, the Centers for Disease Control and Prevention (CDC) launched the National Wastewater Surveillance System (NWSS), which partners with state, local, tribal, and territorial health departments to develop and implement wastewater collection and analysis systems and to share data. In 2022, the CDC established the first two NWSS Centers of Excellence to lead its implementation and coordination efforts-one in Colorado (Colorado CoE) and one in Houston (Houston CoE). As the NWSS expands, it is becoming more important to support the training needs of jurisdictions at different stages of developing their wastewater surveillance infrastructure. To evaluate these needs, the Colorado CoE and Houston CoE conducted a needs assessment study of NWSS-funded public health agencies and public utilities departments located in the United States using surveys developed by the Colorado CoE. The results of the surveys showed that although some training needs were universal, it will be most beneficial to develop training modules tailored to the needs of entities that operate wastewater surveillance programs of various sizes, workforce experience levels, and at different stages in the infrastructure development process.

Predicting superagers: a machine learning approach utilizing gut microbiome features.

Cognitive decline is often considered an inevitable aspect of aging; however, recent research has identified a subset of older adults known as "superagers" who maintain cognitive abilities comparable to those of younger individuals. Investigating the neurobiological characteristics associated with superior cognitive function in superagers is essential for understanding "successful aging." Evidence suggests that the gut microbiome plays a key role in brain function, forming a bidirectional communication network known as the microbiome-gut-brain axis. Alterations in the gut microbiome have been linked to cognitive aging markers such as oxidative stress and inflammation. This study aims to investigate the unique patterns of the gut microbiome in superagers and to develop machine learning-based predictive models to differentiate superagers from typical agers. We recruited 161 cognitively unimpaired, community-dwelling volunteers aged 60 years or from dementia prevention centers in Seoul, South Korea. After applying inclusion and exclusion criteria, 115 participants were included in the study. Following the removal of microbiome data outliers, 102 participants, comprising 57 superagers and 45 typical agers, were finally analyzed. Superagers were defined based on memory performance at or above average normative values of middle-aged adults. Gut microbiome data were collected from stool samples, and microbial DNA was extracted and sequenced. Relative abundances of bacterial genera were used as features for model development. We employed the LightGBM algorithm to build predictive models and utilized SHAP analysis for feature importance and interpretability. The predictive model achieved an AUC of 0.832 and accuracy of 0.764 in the training dataset, and an AUC of 0.861 and accuracy of 0.762 in the test dataset. Significant microbiome features for distinguishing superagers included Alistipes, PAC001137_g, PAC001138_g, Leuconostoc, and PAC001115_g. SHAP analysis revealed that higher abundances of certain genera, such as PAC001138_g and PAC001115_g, positively influenced the likelihood of being classified as superagers. Our findings demonstrate the machine learning-based predictive models using gut-microbiome features can differentiate superagers from typical agers with a reasonable performance.

HPV vaccination strategy for 14-year-old females and economic returns for cervical cancer prevention in Wuxi City, China: a cost effectiveness analysis

BackgroundSince December 2021, Wuxi, China has offered a two-dose human papillomavirus (HPV) vaccination to 14-year-old females for free. This study evaluated the costs and benefits of this vaccination scheduled in the Expanded Program on Immunization in Wuxi from the perspective of the cities’ demographic characteristics, economic development, and policy support.MethodsThe model-based economic evaluation used TreeAge Pro software to construct a decision tree-Markov model for the vaccination strategy in which 100,000 14-year-old females received two doses of bivalent HPV vaccine or no vaccination. Costs and effects of the strategy were assessed from a societal perspective through literature research and data obtained from the Wuxi Centre for Disease Control and Prevention. Univariate, multivariate, and probabilistic sensitivity analyses assessed the stability of the findings.ResultsThe cost of the bivalent HPV vaccine in Wuxi is 711.3 CNY. The two-dose of bivalent HPV vaccine for 100,000 14-year-old females would cost an additional 658,016 CNY compared to no vaccination, but would result in 1,960 Quality Adjustment Years of Life (QALYs). Using the per capita gross domestic product of 187,415 CNY in 2021 in Wuxi as the willingness-to-pay threshold, the vaccination strategy costs 3,357.37 CNY per QALY gained, which is much lower than the threshold, suggesting that it is a very cost-effective strategy. In addition, the vaccine strategy reduced the incidence of cervical cancer by 300 cases and cervical cancer deaths by 181 cases, representing a benefit-cost ratio of 2.86 (> 1) when health output outcomes were measured in monetary terms. These results suggested that the vaccination strategy was advantageous. Sensitivity analyses showed that changes in the parameters did not affect the conclusions and that the findings were robust.ConclusionsCompared to no vaccination, the delivery of two doses of bivalent HPV vaccine for 14-year-old females was a more highly cost-effective and optimal strategy.

Identifying Effective Strategies for Improving Engagement in HIV Prevention and Care Among Transgender Persons in the United States: A Systematic Review.

This systematic review synthesized published literature (2000 - 2023) to identify HIV interventions specifically designed for transgender persons in the United States (PROSPERO registration number: CRD42021256460). The review also summarized strategies for improving outcomes related to the four pillars of the Ending the HIV Epidemic (EHE) initiative in the United States: Diagnose, Treat, Prevent, and Respond. A comprehensive search was conducted using the Centers for Disease Control and Prevention's HIV Prevention Research Synthesis Project database, which included over 120,000 citations from routine systematic searches in CINAHL, EMBASE, Global Health, MEDLINE, PsycInfo, and Sociological Abstracts. Of 23 interventions that met inclusion criteria, 94% focused on transgender women of color and 22% focused on young transgender persons aged 15-29 years old. Most interventions focused on Treat or Prevent, few focused on Diagnosis, and none focused on Respond. Twenty interventions (87%) showed improvement in at least one EHE related outcome and a quarter of these effective interventions were tested with randomized controlled trials. Common strategies observed in effective interventions include the following: engaging the community in intervention development; pilot-testing with the focus population to ensure appropriateness and acceptability; addressing social determinants of health (e.g. stigma, discrimination, violence) through empowerment and gender-affirming approaches; increasing access to care, prevention, and services through co-location and one-stop shop models; and utilizing peer-led counseling, education, support, and navigation. Continuous effort is needed in addressing gaps, including more research for transgender men and rural settings and for how best to adopt and adapt best practices for subgroups of transgender population.

A case report of human infection with avian influenza H10N3 with a complex respiratory disease history

BackgroundOn March 16th 2024, the first case of Human infection with avian influenza H10N3 since the end of the global COVID-19 Pandemic was reported in Kunming, China. To enhance comprehension of the source of infection and risk factors of the H10N3 virus infection, this case report summarizes the clinical features, epidemiological investigation, and laboratory test results. Provides recommendations for the prevention and control of Human infection with avian influenza H10N3.Case presentationA 51-year-old male with a history of COVID-19 infection and a smoking habit of 30 years, worked in livestock breeding and was exposed to sick and dead poultry before falling ill with fever and chills on 28th February 2024. A week later, he was diagnosed with severe pneumonia, influenza, and respiratory failure by the Third People's Hospital of Kunming(KM-TPH). He was discharged on 17th April and none of his 6 close contacts showed any symptoms of illness. Environmental samples taken from the epidemic spot revealed that peacock feces tested positive for avian influenza sub-type H9 and waterfowl specimens showed positive results for avian influenza sub-type H5. Gene sequencing conducted on positive specimens from the patient's respiratory tract by the Chinese Centre for Disease Control and Prevention (CCDC) showed a high degree of similarity (98.6–99.5%) with the strain responsible for the second global case of human infected with H10N3 (reported from Zhejiang, China 2022).ConclusionsAccording to the available epidemiological information, there is limited evidence to suggest that H10N3 viruses are excessively lethal. However, adaptive site mutations have been observed in the H10N3 isoform of mammals. While it is unlikely that the H10N3 virus will spread among humans, the possibility of additional cases cannot be entirely ruled out. Symptoms of human infection with H10N3 avian influenza are similar to those of common respiratory infections, which may result in them being overlooked during initial clinical consultations. Therefore, it is essential to improve surveillance of the H10 sub-type of avian influenza and to increase the awareness of hospital-related workers of cases of pneumonia of unknown origin.

Evaluation of Etest and MICRONAUT-AM Assay for Antifungal Susceptibility Testing of Candida auris: Underestimation of Fluconazole Resistance by MICRONAUT-AM and Overestimation of Amphotericin B Resistance by Etest.

Multidrug-resistant Candida auris has recently caused major outbreaks in healthcare facilities. Rapid and accurate antifungal susceptibility testing (AST) of C. auris is crucial for proper management of invasive infections. The Commercial Sensititre Yeast One and Vitek 2 methods underestimate or overestimate the resistance of C. auris to fluconazole and amphotericin B (AMB). This study evaluated the AST results of C. auris against fluconazole and AMB by gradient-MIC-strip (Etest) and broth microdilution-based MICRONAUT-AM-EUCAST (MCN-AM) assays. Clinical C. auris isolates (n = 121) identified by phenotypic and molecular methods were tested. Essential agreement (EA, ±1 two-fold dilution) between the two methods and categorical agreement (CA) based on the Centers for Disease Control and Prevention's (CDC's) tentative resistance breakpoints were determined. Fluconazole resistance-associated mutations were detected by PCR-sequencing of ERG11. All isolates identified as C. auris belonged to South Asian clade I and contained the ERG11 Y132F or K143R mutation. The Etest-MCN-AM EA was poor (33%) for fluconazole and moderate (76%) for AMB. The CA for fluconazole was higher (94.2%, 7 discrepancies) than for AMB (91.7%, 10 discrepancies). Discrepancies were reduced when an MCN-AM upper-limit value of 4 µg/mL for fluconazole-susceptible C. auris and an Etest upper-limit value of 8 µg/mL for the wild type for AMB were used. Our data show that resistance to fluconazole was underestimated by MCN-AM, while resistance to AMB was overestimated by Etest when using the CDC's tentative resistance breakpoints of ≥32 µg/mL for fluconazole and ≥2 µg/mL for AMB. Method-specific resistance breakpoints should be devised for accurate AST of clinical C. auris isolates for proper patient management.

Spatial-temporal distribution of neglected tropical diseases burdens in China from 2005 to 2020

BackgroundOut of the 21 neglected tropical diseases (NTDs) listed by the World Health Organization, 15 affect the People’s Republic of China. Despite significant achievements in controlling NTDs, comprehensive assessments of the disease burden based on actual case data and detailed information on spatial and temporal dynamics are still lacking. This study aims to assess the disease burden and spatial–temporal distribution of NTDs in China from 2005 to 2020, to provide a reference for the formulation of national health agendas in line with the global health agenda, and guide resource allocation.MethodsThe number of cases and deaths of major NTDs in China from 2005 to 2020 were downloaded from the China Public Health Science Data Center (https://www.phsciencedata.cn/Share/index.jsp) of the Chinese Center for Disease Control and Prevention and relevant literatures. Simplified formulas for disability-adjusted life years (DALYs) helped estimate the years of life lost (YLLs), years lived with disability (YLDs), and total DALYs. Spatial autocorrelation analysis of the average NTDs burden data for the years 2005 to 2020 was evaluated using Moran's I statistic.ResultsChina's overall NTDs burden decreased significantly, from 245,444.53 DALYs in 2005 to 18,984.34 DALYs in 2020, marking a reduction of 92.27%. In 2005, the DALYs caused by schistosomiasis and rabies represent a substantial proportion of the total disease burden, accounting for 65.37% and 34.43% respectively. In 2015, Hunan and Sichuan provinces had the highest diversity of NTDs, with 9 and 8 number of different NTDs reported respectively. And the highest disease burden was observed in Sichuan (242,683.46 DALYs), Xizang Zizhiqu (178,318.99 DALYs) and Guangdong (154,228.31 DALYs). The “high-high” clustering areas of NTDs were mainly in China's central and southern regions, as identified by spatial autocorrelation analysis.ConclusionsChina has made unremitting efforts in the prevention and control of NTDs, and the disease burden of major NTDs in China has decreased significantly. Using the One Health concept to guide disease prevention and control in the field to effectively save medical resources and achieve precise intervention.Graphical abstract

Rates of Sudden Unexpected Infant Death Before and During the COVID-19 Pandemic

Infection has been postulated as a driver in the sudden infant death syndrome (SIDS) cascade. Epidemiologic patterns of infection, including respiratory syncytial virus and influenza, were altered during the COVID-19 pandemic. Comparing month-to-month variation in both sudden unexpected infant death (SUID) and SIDS rates before and during the pandemic offers an opportunity to generate and expand existing hypotheses regarding seasonal infections and SUID and SIDS. To compare prepandemic and intrapandemic rates of SUID and SIDS, assessing for monthly variation. This cross-sectional study assessed US mortality data provided by the Centers for Disease Control and Prevention for January 1, 2018, through December 31, 2021. Events with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for SIDS (R95), unknown (R99), and accidental suffocation and strangulation in bed (W75) causes of death were examined. The data analysis was performed between November 2, 2023, and June 2, 2024. COVID-19 pandemic. The primary and secondary outcomes were the monthly rates of SUID and SIDS during the COVID-19 pandemic (March 1, 2020, to December 31, 2021) compared with the prepandemic period (March 1, 2018, to December 31, 2019) as measured using generalized linear mixed-effects models. Seasonal trends in RSV and influenza rates were also examined. There were 14 308 SUID cases from January 1, 2018, to December 31, 2021 (42% female infants). Compared with the prepandemic period, the risk of SUID increased during the intrapandemic period (intensity ratio [IR], 1.06; 95% CI, 1.05-1.07). Monthly assessments revealed an increased risk of SUID beyond the prepandemic baseline starting in July 2020, with a pronounced epidemiologic shift from June to December 2021 (ranging from 10% to 14%). Rates of SIDS were elevated throughout the intrapandemic period compared with the prepandemic baseline, with the greatest increase in July 2021 (IR, 1.18; 95% CI, 1.13-1.22) and August 2021 (IR, 1.17; 95% CI, 1.13-1.22). Seasonal shifts in RSV hospitalizations correlated with monthly changes in SUID observed during 2021. This cross-sectional study found increased rates of both SUID and SIDS during the COVID-19 pandemic, with a significant shift in epidemiology from the prepandemic period noted in June to December 2021. These findings support the hypothesis that off-season resurgences in endemic infectious pathogens may be associated with SUID rates, with RSV rates in the US closely approximating this shift. Further investigation into the role of infection in SUID and SIDS is needed.

Opioid Prescriptions for US Patients Undergoing Long-Term Dialysis or with Kidney Transplant from 2011 to 2020.

Pain is important for patients with kidney failure, but opioid medication prescriptions are associated with morbidity and mortality. The Centers for Disease Control and Prevention issued opioid prescription guidelines in 2016 and 2022, associated with dramatically decreased prescription rates in the United States. It is critical to know if nationwide opioid prescription rates for patients with kidney failure have decreased. We analyzed the USRDS database from 2011 to 2020 to describe trends in the proportion of ESKD patients who received one or more, or long-term opioid prescriptions, examined factors associated with long-term opioid prescriptions, and evaluated associations of all-cause death with short-term or long-term opioid prescriptions. From 2011-2022, the percentage of patients with kidney failure (dialysis and kidney transplant) who received at least one or more, or who had received long-term opioid medication prescriptions decreased steadily, from 60% to 42%, and from 23% to 13%, respectively (both P for trend <0.001). The largest reductions in prescription rates were for hydrocodone and oxycodone. Similar trends existed for dialysis and kidney transplant patients. Women, the poor and those in rural settings were more likely to receive long-term opioid prescriptions. Prescription rates were highest in White patients and those 45 to 64 years old. Short-term and long-term opioid medication prescriptions were associated with higher mortality in both dialysis and kidney transplant patients. ESKD patients' opioid prescription rates decreased between 2011 and 2020. Higher mortality risk was associated with both short-term and long-term opioid prescriptions. Mortality risk was monotonically associated with morphine milligram equivalents in patients with kidney failure who received long-term opioid prescriptions.

Salivary immune responses after COVID-19 vaccination.

mRNA-based COVID-19 vaccines have played a critical role in reducing severe outcomes of COVID-19. Humoral immune responses against SARS-CoV-2 after vaccination have been extensively studied in blood; however, limited information is available on the presence and duration of SARS-CoV-2 specific antibodies in saliva and other mucosal fluids. Saliva offers a non-invasive sampling method that may also provide a better understanding of mucosal immunity at sites where the virus enters the body. Our objective was to evaluate the salivary immune response after vaccination with the COVID-19 Moderna mRNA-1273 vaccine. Two hundred three staff members of the U.S. Centers for Disease Control and Prevention were enrolled prior to receiving their first dose of the mRNA-1273 vaccine. Participants were asked to self-collect 6 saliva specimens at days 0 (prior to first dose), 14, 28 (prior to second dose), 42, and 56 using a SalivaBio saliva collection device. Saliva specimens were tested for anti-spike protein SARS-CoV-2 specific IgA and IgG enzyme immunoassays. Overall, SARS-CoV-2-specific salivary IgA titers peaked 2 weeks after each vaccine dose, followed by a sharp decrease during the following weeks. In contrast to IgA titers, IgG antibody titers increased substantially 2 weeks after the first vaccine dose, peaked 2 weeks after the second dose and persisted at an elevated level until at least 8 weeks after the first vaccine dose. Additionally, no significant differences in IgA/IgG titers were observed based on age, sex, or race/ethnicity. All participants mounted salivary IgA and IgG immune responses against SARS-CoV-2 after receiving the mRNA-1273 COVID-19 vaccine. Because of the limited follow-up time for this study, more data are needed to assess the antibody levels beyond 2 months after the first dose. Our results confirm the potential utility of saliva in assessing immune responses elicited by immunization and possibly by infection.

Effect of Wound Irrigation with Povidone Iodine Versus Normal Saline on Superficial Incisional Surgical Site Infection Following Laparotomy for Peritonitis

Abstract Background: Peritonitis is a surgical emergency arising mostly from the perforation or rupture of an abdominal hollow viscus. Surgical operations for peritonitis are often attended by high morbidity and sometimes mortality in severe cases. Surgical site infection (SSI) is perhaps the most common post-operative morbidity following laparotomy for peritonitis. Objective: To compare the rate of SSI in abdominal operations for peritonitis following wound irrigation with povidone iodine versus normal saline at a tertiary health institution in Nigeria. Materials and Methods: This was a prospective, comparative hospital-based study over a year. Consecutive consenting adult patients were randomised into two groups in this study. The first group (A) used 500 mL of 1% povidone iodine for subcutaneous wound irrigation, while the second group (B) used 500 mL of normal saline for subcutaneous wound irrigation. Wound irrigation was done after an appropriate surgical procedure had been carried out based on the pathology. Wounds were assessed for SSI for up to 30 days after operation using the definition criteria by the Centre for Disease Control and Prevention (CDC). SSI rates were compared between the two groups. Result: Fifty-eight consecutive patients with generalised peritonitis over a one-year period were enrolled in this study, but 53 patients who completed the study were analysed. Thirty patients were males and 23 were females, and their mean age was 40.83 ± 17.96 years. Overall, 15 (28.3%) patients had incisional SSI. There were nine (34.6%) cases in the povidone group, while there were six (22.2%) in the saline group. This difference was not statistically significant (P = 0.32). Klebsiella species were the dominant organisms isolated from the infected wounds. Conclusion: Wound irrigation with povidone iodine after laparotomy for peritonitis did not reduce the rate and severity of surgical site infection more when compared to normal saline. We suggest further studies with a large number of patients in a multi-centre study to explore further the effect of povidone iodine versus normal saline wound irrigation on SSI following laparotomy for peritonitis.

Mediterranean diet adherence in 9-years old children: a cross-sectional study in the part of the Split-Dalmatia County, Croatia.

Childhood obesity is a growing global problem that can be prevented by improving diet quality. Mediterranean diet (MedDiet), historically present in Mediterranean countries, is considered one of the healthiest dietary patterns. This cross-sectional study aimed to determine the MedDiet adherence and anthropometric parameters in 9-year-old children from the central geographic locations of Split-Dalmatia County, Croatia. The study analysed data obtained from 158 children aged nine years from central parts of Dalmatia: Split and Hvar. To assess the MedDiet adherence, the parents of the children filled out the Mediterranean Diet Index (KIDMED) questionnaire. Appointed school medicine specialists collected anthropometric data of the children and categorized them into body mass index (BMI) categories according to the Center for Disease Control and Prevention (CDC) criteria. Additionally, we assessed the influence of parents' education degree on children's MedDiet adherence and anthropometric measures. Results showed that more than a quarter of nine-year-olds included in this study were overweight or obese (BMI ≥ 85th percentile for age and sex). One of the main findings was that 72% of children had suboptimal (poor or average) MedDiet adherence. Moreover, children with suboptimal KIDMED results (KI < 8) had significantly higher body weight, waist circumference, hip circumference, and waist-to-height ratio. Also, results showed that mothers' education notably influences children's anthropometry. Our study found that childhood obesity is a significant concern among 9-year-olds, with a high prevalence of overweight and obesity. Additionally, our results showed that MedDiet adherence is suboptimal among this age group. These results indicate that children of the Mediterranean are not spared of modern life challenges. This problem should be prioritized in the future to prevent the development of a metabolically compromised adult population.

Severe Maternal Morbidity by Disability Status and Type in the United States

OBJECTIVE: To estimate the risk of severe maternal morbidity (SMM) among women with disabilities compared with those without disabilities in a nationally representative sample of U.S. delivery hospitalizations. METHODS: We conducted a retrospective cohort analysis using the 2016–2021 Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. We identified delivery hospitalizations and disability status using International Classification of Diseases, Tenth Revision diagnosis codes. The primary outcome was SMM, which was determined using 21 indicators specified by the Centers for Disease Control and Prevention. We used Poisson regression to estimate unadjusted and adjusted relative risks (aRRs) and 95% CIs for the association between disability status and type with SMM outcomes. RESULTS: Among 4,331,457 delivery hospitalizations, 128,413 (3.0%) were to women with disabilities. Women with disabilities had significantly higher rates of SMM compared with those without disabilities (396/10,000 deliveries vs 177/10,000 deliveries). In fully adjusted models, women with disabilities had an aRR of 1.86 (95% CI, 1.80–1.91) for one or more SMM indicators. The risk of SMM varied by disability type, with the highest risks observed for women who had vision disabilities (aRR 3.02, 95% CI, 2.70–3.38) or had physical disabilities (aRR 2.44, 95% CI, 2.34–2.55). Women with disabilities had the highest risk for other medical complications (puerperal cerebrovascular disorders and sickle cell disease with crisis), followed by other obstetric complications, respiratory complications, cardiovascular complications, acute renal failure, sepsis, and bleeding complications compared with women without disabilities. CONCLUSION: Women with disabilities have a significantly higher risk of SMM during delivery compared with those without disabilities, with the magnitude of risk varying by disability type. Efforts to reduce SMM and maternal mortality in the United States must prioritize the unique needs of this population and ensure equitable, disability-competent care for all women.

Excess Death Rates by State During the COVID-19 Pandemic: United States, 2020‒2023.

Objectives. To estimate state-level excess death rates during 2020 to 2023 and examine differences by region and partisan orientation. Methods. We modeled death and population counts from the Centers for Disease Control and Prevention to estimate excess death rates for the United States, 9 census divisions, and 50 states. We compared excess death rates for states with different partisan orientations, measured by the party of the seated governor and the level of partisan representation in state legislatures. Results. The United States experienced 1 277 697 excess deaths between March 2020 and July 2023. Almost 90% of these deaths were attributed to COVID-19, and 51.5% occurred after vaccines were available. The highest excess death rates first occurred in the Northeast and then shifted to the South and Mountain states. Between weeks ending June 20, 2020, through March 19, 2022, excess death rates were higher in states with Republican governors and greater Republican representation in state legislatures. Conclusions. Excess death rates during the COVID-19 pandemic varied considerably across the US states and were associated with partisan representation in state government, although the influence of confounding variables cannot be excluded. (Am J Public Health. 2024;114(9):882-891. https://doi.org/10.2105/AJPH.2024.307731).

Microbiology testing capacity and antimicrobial drug resistance in surgical-site infections: a post-hoc, prospective, secondary analysis of the FALCON randomised trial in seven low-income and middle-income countries

Surgical-site infection (SSI) is one of the most common health-care-associated infections, substantially contributing to antibiotic use. Targeted antibiotic prophylaxis to prevent SSIs and effective treatment are crucial to controlling antimicrobial resistance (AMR). This study aimed to describe the testing capacity and multidrug resistance (MDR) of SSI microorganisms in low-income and middle-income countries (LMICs). This analysis included patients undergoing abdominal surgery in seven LMICs (Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa) as part of the FALCON randomised controlled trial. Wound swabs were collected from patients diagnosed with SSI, as per US Centers for Disease Control and Prevention (CDC) definition. Data on microorganism species and MDR, as per CDC and European Centre for Disease Prevention and Control definitions, were analysed alongside hospital-level data on local microbiological practices. An adjusted analysis was performed to identify perioperative factors associated with MDR. Testing capacity was assessed by the completion of swab testing in positively diagnosed SSIs. Between Dec 10, 2018, and Sept 7, 2020, 5788 patients were recruited to the FALCON trial. 1163 patients were diagnosed with an SSI, of whom 905 (77·8%) received prophylactic antibiotics before surgery. In patients with SSIs, 935 of 1163 (80·4%) did not have a wound swab; 195 were from hospitals not performing swabs (15 hospitals) and 740 were from hospitals with capacity but no swab performed (35 hospitals). Of 228 patients swabbed, 200 (88·5%) had microorganisms detected. Escherichia coli (89 of 200, 37·9%) was the most common microorganism and 116 of 200 (58·0%) patients were not covered by the perioperative prophylactic antibiotic. MDR was found in 102 of 147 (69·4%) patients for whom data were available to determine MDR status. Adjusted analysis found that appropriate prophylactic antibiotic coverage (adjusted odds ratio 0·43, 95% CI 0·19-0·96) and regular availability of infection control teams (0·32, 0·11-0·93) were associated with a significant reduction in MDR. Targeted perioperative antibiotic prophylaxis during contaminated abdominal surgery is insufficient in LMICs, with very few SSI organisms undergoing formal diagnosis. Expansion of testing capacity, development of local guidelines, and implementation of infection control teams could support the prevention of SSI through directed antibiotic prophylaxis, subsequently reducing the burden of MDR. National Institute for Health and Care Research. For the French and Spanish translations of the abstract see Supplementary Materials section.

The need for rural–urban county type in Centers for Disease Control and Prevention’s Social Vulnerability Index concerning human immunodeficiency virus reporting data.

The need for rural–urban county type in Centers for Disease Control and Prevention’s Social Vulnerability Index concerning human immunodeficiency virus reporting data.

Immunoglobulins as Tools for Passive Immunization in Preventive Healthcare

Immunoglobulins have emerged as an important tool in passive immunization for the prevention and treatment of infectious diseases. Immunoglobulins are the proteins produced by B cells that bind to specific pathogens, neutralize them, and facilitate their removal by the immune system. In preventive healthcare, immunoglobulins are used for primordial, primary, secondary, tertiary, and quaternary prevention of infectious diseases. This work was designed to carry out an extensive literature search to provide useful information on immunoglobulins as the tools of passive immunization in preventive healthcare. Relevant and accurate literatures were sourced from the World Health Organization. Centers for Disease Control and Prevention, National Center for Disease Control, PubMed, Scopus, PLoS One, and NATURE journals: Primordial prevention aims to prevent the emergence and spread of risk factors for infectious diseases. Immunoglobulins can be used to prevent the spread of infectious diseases by targeting the pathogens that cause them. The primary prevention aims to prevent the initial infection of individuals at risk of acquiring infectious diseases. Immunoglobulins can be used as prophylaxis to prevent the onset of infection in high-risk individuals. The secondary prevention aims to reduce the severity and duration of infectious diseases. Immunoglobulins can be used to treat infectious diseases and prevent complications. The tertiary prevention aims to prevent the recurrence and complications of infectious diseases. Immunoglobulins can be used to prevent the recurrence of infections in individuals who have already been infected. Quaternary prevention aims to prevent the overuse, misuse, and abuse of medical interventions. Immunoglobulins can be used to prevent the development of antibiotic resistance by reducing the use of antibiotics. However, the use of immunoglobulins in preventive healthcare is not without challenges. The cost-effectiveness of immunoglobulin therapy, long-term safety, and the potential for cross-infection are some of the challenges that need to be addressed. Further research is needed to optimize the use of immunoglobulins in preventive health-care delivery. Immunoglobulins are valuable tools in passive immunization for the prevention and treatment of infectious diseases in preventive healthcare. Their use can help reduce the burden of infectious diseases and improve public health outcomes. Keywords: Immunoglobulins, passive immunization, preventive healthcare.