Centers For Disease Control Research Articles

The Evolution of a Pediatric Public Health Crisis: E-cigarette or Vaping-Associated Lung Injury.

E-cigarettes and vaping products were first introduced in the United States around 2007, and quickly grew in popularity. By 2014, e-cigarettes had become the most commonly used tobacco product among youth in the United States. An e-cigarette, or vaping, product use-associated lung injury (EVALI) outbreak was identified by the Centers for Disease Control and Prevention (CDC) in 2019, with many cases in the adolescent population. The CDC opened a national database of cases and launched a multistate investigation; reported cases reached a peak in September 2019. The CDC investigation found that a vaping liquid additive, vitamin E acetate, was strongly linked to the EVALI outbreak but determined that the decline in cases was likely multifactorial. Due to decreased cases and the identification of a potential cause of the outbreak, the CDC stopped collecting data on EVALI cases as of February 2020. However, e-cigarettes and vaping products have continued to be the most popular tobacco product among youth, though state and national regulations on these products have increased since 2016. While pediatric case series and studies have shown differences in clinical presentation and medical histories between pediatric and adult EVALI cases, the fact that cases are no longer tracked at a national level limits necessary information for pediatric clinicians and researchers. We describe the available literature on the diagnosis, pathophysiology, treatment, and outcomes of EVALI in the pediatric population, and provide clinical and public health recommendations to facilitate prevention and management of EVALI specific to pediatrics.

Draft genome sequences from 127 Legionella spp. strains isolated in water systems linked to legionellosis outbreaks.

Legionnaires' disease is a severe form of pneumonia caused by Legionella spp. bacteria. According to the European Centre for Disease Prevention and Control, problems related to this pathogen showed a significant surge in recent years, making its monitoring critical.

Wash your hands: CDC, WHO, and NHS Tweets in the #COVID19 pandemic

This work tracks public health messaging and evidence of stability and change in corpora of the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and National Health Service (NHS) official account tweets throughout 2020. Using corpus-based methods, including keyword analysis, major similarities and differences are identified across tweets by each organization over time. Larger macro-level and micro-level discourses and linguistic patterns are revealed, with specific applications relevant to public health and governmental messaging, especially regarding risk and health communication. Findings include the NHS providing the most comprehensive and varied messaging out of each organization, including references to recommended actions, communities and individuals, and information. The WHO focuses predominantly on cases and region-specific information, while the CDC includes a variety of information, with a US-internal focus. Applications include further recommendations for public health communication, including the necessity of diverse linguistic patterns and interactive messaging tactics for governmental organizations.

Ipsilateral and contralateral coadministration of influenza and COVID-19 vaccines produce similar antibody responses

BackgroundWorld Health Organisation (WHO) and USA Centers for Disease Control and Prevention (U.S. CDC) recommendations now allow simultaneous administration of COVID-19 and other vaccines. We compared antibody responses after coadministration of influenza and bivalent COVID-19 vaccines in the same (ipsilateral) arm vs. different (contralateral) arms. MethodsPre- and post-vaccination serum samples from individuals in the Prospective Assessment of COVID-19 in a Community (PACC) cohort were used to conduct haemaglutination inhibition (HI) assays with the viruses in the 2022-23 seasonal influenza vaccine and focus reduction neutralisation tests (FRNT) using a BA.5 SARS-CoV-2 virus. The effect of ipsilateral vs. contralateral vaccination on immune responses was inferred in a model that accounted for higher variance in vaccine responses at lower pre-vaccination titers. FindingsIpsilateral vaccination did not cause higher influenza vaccine responses compared to contralateral vaccination. The response to SARS-CoV-2 was slightly increased in the ipsilateral group, but equivalence was not excluded. InterpretationCoadministration of influenza and bivalent COVID-19 vaccines in the same arm or different arms did not strongly influence the antibody response to either vaccine. FundingThis work was supported by the U.S. CDC (grant number: 75D30120C09259).

Real-time investigation of an influenza A(H3N2) virus outbreak in a refugee community, November 2022

ObjectivesTo report epidemiological and virological results of an outbreak investigation of influenza-like illness (ILI) among refugees in Northern Italy. Study designOutbreak investigation of ILI cases observed among nearly 100 refugees in Northern Italy unvaccinated for influenza. MethodsAn epidemiological investigation matched with a differential diagnosis was carried out for each sample collected from ILI cases to identify 10 viral pathogens (SARS-CoV-2, influenza virus type A and B, respiratory syncytial virus, metapneumovirus, parainfluenza viruses, rhinovirus, enterovirus, parechovirus, and adenovirus) by using specific real-time PCR assays according to the Centers for Disease Control and Prevention (CDC) protocols. In cases where the influenza virus type was identified, complete hemagglutinin (HA) gene sequencing and the related phylogenetic analysis were conducted. ResultsThe outbreak was caused by influenza A(H3N2): the attack rate was 83.3% in children aged 9–14 years, 84.6% in those aged 15–24 years, and 28.6% in adults ≥25 years. Phylogenetic analyses uncovered that A(H3N2) strains were closely related since they segregated in the same cluster, showing both a high mean nucleotide identity (100%), all belonging to the genetic sub-group 3C.2a1b.2a.2, as those mainly circulating into the general population in the same period. ConclusionsThe fact that influenza outbreak strains as well as the community strains were genetically related to the seasonal vaccine strain suggests that if an influenza prevention by vaccination strategy had been implemented, a lower attack rate of A(H3N2) and ILI cases might have been achieved.

Strategies to strengthen COVID-19 vaccine uptake and improve vaccine equity in U.S. Territories and Freely Associated States during the first six months of vaccine rollout

The eight U.S. territories and freely associated states (TFAS) have historically faced unique social and structural barriers in the implementation of vaccination programs due to geographic remoteness, a high prevalence of socioeconomic disparities, increasing prevalence of natural disasters, limited vaccine providers and clinics, difficulties with procurement and shipping, and difficulty tracking highly mobile populations. In the months leading up to emergency authorizations for the use of COVID-19 vaccines, the TFAS developed tailored vaccination strategies to ensure that key at-risk populations received timely vaccination, and successfully implemented these strategies during the first six months of the vaccine rollout. Subject matter experts supporting the Centers for Disease Control and Prevention’s COVID-19 Response recognized the unique historical, geographic, social, and cultural dynamics for residents in the TFAS and worked with partners to prevent, detect, and respond to the pandemic in these jurisdictions. As a result of innovative partnerships and vaccine distribution strategies, vaccine equity was improved in the TFAS during the COVID-19 vaccine rollout.

Heart Failure-Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020.

Population-based data on heart failure (HF)-related death in patients with atrial fibrillation (AF) are lacking. We assessed HF-related death in people with AF in the United States over the past 21 years and examined differences by age, sex, race, ethnicity, urbanization, and census region. Data were extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to determine trends in age-adjusted mortality rates per 100 000 people, due to HF-related death among subjects with AF aged ≥15 years. To calculate nationwide annual trends, we assessed the average annual percent change (AAPC) and annual percent change with relative 95% CIs using joinpoint regression. Between 1999 and 2020, 916 685 HF-related deaths (396 205 men and 520 480 women) occurred among US adults having a concomitant AF. The overall age-adjusted mortality rates increased (AAPC: +4.1% [95% CI, 3.8-4.4]; P<0.001), especially after 2011 (annual percent change, +6.8% [95% CI, 6.2-7.4]; P<0.001) in men (AAPC, +4.8% [95% CI, 4.4-5.1]; P<0.001), in White subjects (AAPC: +4.2% [95% CI, 3.9 to 4.6]; P<0.001) and in subjects aged <65 years (AAPC: +7.5% [95% CI, 6.7-8.4]; P<0.001). The higher percentage of deaths were registered in the South (32.8%). During the first year of the COVID-19 pandemic, a significant excess in HF-related deaths among patients with AF aged >65 years was observed. A worrying increase in the HF-related mortality rate among patients with AF has been observed in the United States over the past 2 decades.

Impact of Social Vulnerability on Cardiac Arrest Mortality in the United States, 2016 to 2020.

Cardiac arrest is 1 of the leading causes of morbidity and mortality, with an estimated 340 000 out-of-hospital and 292 000 in-hospital cardiac arrest events per year in the United States. Survival rates are lower in certain racial and socioeconomic groups. We performed a county-level cross-sectional longitudinal study using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research multiple causes of death data set between 2016 and 2020 among individuals of all ages whose death was attributed to cardiac arrest. The Social Vulnerability Index is a composite measure that includes socioeconomic vulnerability, household composition, disability, individuals from racial and ethnic minority groups status and language, and housing and transportation domains. We examined the impact of social determinants on cardiac arrest mortality stratified by age, race, ethnicity, and sex in the United States. All age-adjusted mortality rate (cardiac arrest AAMRs) are reported as per 100 000. Overall cardiac arrest AAMR during the study period was 95.6. The cardiac arrest AAMR was higher for men compared with women (119.6 versus 89.9) and for the Black population compared with the White population (150.4 versus 92.3). The cardiac arrest AAMR increased from 64.8 in counties in quintile 1 of Social Vulnerability Index to 141 in quintile 5, with an average increase of 13% (95% CI, 9.8%-16.9%) in AAMR per quintile increase. Mortality from cardiac arrest varies widely, with a >2-fold difference between the counties with the highest and lowest social vulnerability, highlighting the differential burden of cardiac arrest deaths throughout the United States based on social determinants of health.

Profitability and cost-effectiveness analysis of brucellosis control in Armenia: A One Health approach

Abstract Brucellosis is endemic in the Republic of Armenia and constitutes a financial and public health burden on the nation. Control of the disease is currently using the test-and-slaughter strategy, reportedly at a coverage level deemed insufficient to interrupt transmission by the authorities responsible for disease control. A key aspect of this control strategy is the shared costs between the agricultural and public health sectors. An earlier study conducted by the Advanced One Health Class at the Swiss Tropical and Public Health Institute developed a mathematical-compartmental transmission model to represent the transmission of Brucella between cattle, sheep, and humans. The study simulated the performance of the existing control strategy and three other upgraded scenarios over a decade, giving the cumulative incidence of human and livestock prevalence (2022–2031). Based on the cumulative incidence of human and livestock prevalence from 10-year simulations, this study evaluates Armenia’s current brucellosis control program’s profitability, cost-effectiveness, and cost distribution for the existing test-and-slaughter level and three proposed upgraded scenarios in cattle and sheep. In these scenarios, the percentages represent the proportion of animals that were culled when they tested positive for brucellosis: Scenario 1 – 86% of cattle and 65% of sheep; Scenario 2 – 88% of cattle and 70% of sheep; Scenario 3 – 90% of cattle and 75% of sheep. Further estimations were made on public and private health costs, and income loss of human brucellosis patients averted through the different livestock-level interventions. The incremental livestock production and the averted human health cost were summed up as societal benefits of brucellosis interventions. From a societal perspective, the most profitable scenario is estimated to have a net present value of US$ 41.82 million, from an overall cost of US$ 48.27 million and a benefit of US$ 6.45 million, resulting in a benefit-cost ratio of 0.133 at 80% compensation for farmers’ losses and discounted at 5%. From a public health perspective, the cost-effectiveness ratio for the same intervention scenario is US$ 1587 per DALY averted (95% CI: US$ 1268–US$ 2009). When private costs, which are the private income loss and out-of-pocket costs of patients, are added to the public health costs, the cost-effectiveness decreases to US$ 6727 per DALY averted at a 5% discount rate (95% CI: US$ 5371–US$ 8504). These cost-effectiveness and benefit-cost ratios highlight the remarkable disparity in the cost of the test-and-slaughter strategy across the agriculture and public health sectors. Our study highlights the need to reassess the cost-effectiveness of the test-and-slaughter strategy for brucellosis control in Armenia and consider an equitable distribution of the cost of the test-and-slaughter strategy among the sectors as this could facilitate better disease control and cost-effectiveness of the strategy. Armenia should view brucellosis elimination as a public good, justifying public spending for compensation. As seen in other countries, its elimination could boost the economy by lowering trade barriers, making brucellosis-free status a societal benefit. One Health impact statement Our study focuses on controlling brucellosis in Armenia using an integrated approach called One Health, which seeks to demonstrate the incremental benefit of closer cooperation between human and animal health and other sectors. We evaluate how profitable and cost-effective test-and-slaughter interventions are in improving the health of both humans and animals while also considering the costs for farmers and the state. Using a One Health approach, we can better understand the cross-sector expenses related to the disease and develop more efficient strategies to interrupt transmission and eventually eliminate the disease. The result is improved animal and human health outcomes, enhanced livelihoods, and a positive contribution to the economy’s overall growth (Narrod et al ., 2012 ). To carry out this study, we collaborated closely with non-academic partners from the Food Safety and Inspectorate Body (FSIB) and the National Centre for Disease Control in Armenia (NCDC). This collaboration resulted in the creation of valuable knowledge and practical solutions, underscoring the importance of working together across different sectors, including indigenous communities, academia, and non-academic organizations.

The relationship between acrochordons, obesity, and metabolic syndrome in the pediatric population: A retrospective cohort study.

Acrochordons or skin tags are common benign skin growths. Several studies explored the relationship between obesity and metabolic syndrome in adults but remains unexplored in children. This was a single-center retrospective cohort study of outpatient dermatology patients between 1 January 2000 to 1 January 2021. Children under 18 years old diagnosed with acrochordons using diagnostic codes International Classification of Diseases, 10th Revision (ICD-10) L91.8 and 9th Revision (ICD-9) 701.8 were included. We collected patient demographics, past medical history, laboratory values, vital signs, and physical exam. Body mass index (BMI) was calculated and stratified into categories based on the Center for Disease Control's BMI-for-Age Growth Charts. Metabolic syndrome was diagnosed when three of the five criteria were met. Data were propensity-matched and compared with NHANES (National Health and Nutrition Examination Survey), which offered a generalizable sample to the US population. Fifty-five patients under 18 years old with a diagnosis of acrochordons were mostly Caucasian (76%) and female (64%). The mean BMI was 27.3, with 49.5% categorized as obese and 20% as overweight. The mean age of diagnosis was 10.1 years. Acrochordon predominantly appeared in the axilla. In our cohort, three patients (5.5%) met the criteria for metabolic syndrome. The prevalence of obesity (42% vs. 21%), type 2 diabetes mellitus (4.8% vs. 0.6%), hyperlipidemia (8.1% vs. 0%), and hypertension (1.6% vs. 0%) was greater in our cohort compared with NHANES. Like the adult population, acrochordons may serve as marker for metabolic disease in the pediatric population.

Prevalence of Overweight and Obesity in School Children in Bosnia and Herzegovina: A Cross-Sectional Study

Purpose: To identify the characteristics of age groups of children from 10 to 14 years old in terms of the ratio of body weight and length, in particular, the relative number of children with overweight and obesity, and to develop recommendations for reducing body weight for children 10-14 years old. Material and Methods: An observational cross-sectional survey of the health status (overweight and obesity) of school children was conducted on sample 500 school children from Bosnia and Herzegovina (Republic Srpska entity), which included 246 boys and 254 girls, aged 10 to 14 years. Anthropometric data including Body height (BH), Body weight (BW) and age were collected from all elementary school children. Body mass index (BMI) is an anthropometric index of weight and height that is calculated by dividing a person's weight (kg) by the square of their height (m^2). BMI participants was estimated with the Percentile BMI calculator for children and teens aged 2-19 years. The studied children were defined as underweight, normal (healthy)-weight, overweight and obese according to the Center for Disease Control and Prevention (CDC) child growth characteristics for age, sex, and BMI. Basic central and dispersion parameters (Mean, Min., Max., Range, SD, CI 95%, CV%, Skew., Kurt.) were calculated for each variable. To confirm normality, the Kolmogorov-Smirnov test was applied (p&gt;0.05). The homogeneity of variance was tested with Levene's test. The nutritional status of the subjects was assessed using percentile values on the basis of which the percentile categories are calculated. Statistical procedures and analyzes were performed using the statistical package STATISTICA 10.0 for Windows. Results: The dynamics of changes in the relative number of children with overweight and obesity from 10 to 14 years old was revealed. The lowest number of overweight and obese students was recorded at the age of 14 (1% &lt;). The results of malnutrition in boys point to the conclusion that it is present in a smaller percentage, from 1.96% (age 14) to 6.12% (age 12). The largest number of girls at the age of 13 were overweight, 10 (19.23%) and obese (2%&lt;), and then at the age of 10 and 11 (overweight 15.68% vs. 13.72%, and obesity 1.96% vs 3.92%). Malnutrition as a category is in a slightly higher percentage than for boys, ranging from 3.92% (11 and 12 years) to 7.84% (10 years). Conclusions: If a child is overweight at any age, this should be an alarming signal, as it can provoke weight gain in adulthood or with the slightest decrease in self-control. Therefore, the best strategy would be to create conditions for a child's development in which he will receive joy from other sources, and not just from food and activities that do not require physical activity. Finding even a relatively small number of overweight and obese children is not a benign problem. It requires its own solution, helping such children understand their problem and overcome it.

When Antimicrobial Treatment and Surgical Prophylaxis Collide: A Stewardship Opportunity

Background: In 2002, the Centers for Medicare and Medicaid Services (CMS) in collaboration with the Centers for Disease Control and Prevention (CDC) established the Surgical Infection Prevention (SIP) project for the purposes of developing and standardizing quality improvement measures known to reduce the rates of post-operative surgical site infections (SSIs). Four years later the Surgical Care Improvement Project (SCIP), an expansion of SIP, was published in governmental Specifications Manual for National Inpatient Quality Measures and provided several additional initiatives applicable to the perioperative period. Central to both projects are the assurance of the timeliness, selection, and duration of peri-operative surgical prophylactic antibiotics. In support of this objective, various medical associations, such as the American Society of Health-System Pharmacists (ASHP) and the Infectious Diseases Society of America (IDSA), have developed the Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery. To ensure compliance with quality measures, hospitals are required to report data to the Physicians Quality Reporting System, which is then reviewed by CMS for reimbursement purposes and to measure hospital performance. To maintain optimal standards of care and satisfy all core measures, it is expected that patients undergoing most categories of surgical procedures receive prophylactic antibiotics. We recognized that patients already being administered antimicrobial therapy as treatment for the condition requiring the surgery not uncommonly also were prescribed unwarranted and redundant pre-operative antibiotics. Our study was meant to quantify such antibiotic redundancy, which only risks the development of antimicrobial resistance and adverse events, to bolster our and other hospitals antimicrobial stewardship programs. Methods: A retrospective analysis of computerized hospital records over a one-month period of time (November 2022) was conducted focusing on hospital admissions that involved surgical operative procedures. Only those patients who had received a pre-operative surgical prophylactic antibiotic were included in the analysis. Results: Of the 92 surgeries that fulfilled the inclusion criteria, 38 (41.3%) were performed on patients who were already receiving therapeutic antibiotics for more than 24 hours targeted to treat the infection for which they were undergoing surgery. These included laparoscopic cholecystectomy (24), appendectomy (12), wound debridement (12), and soft tissue incision and drainage procedures (9), comprising nearly 50% of each type of these operations performed during the study time period. Conclusion: These findings demonstrate a clear opportunity to strengthen both our, and presumably other, hospitals antimicrobial stewardship programs. Together with physician education, granting the pharmacy the ability to cancel unnecessary and redundant surgical prophylactic antibiotics would conceivably be of great benefit.

Implementation of a COVID-19 Closed/Open POD Partnership: A Creative Professional Practice Exemplar for Occupational and Environmental Health Nurses.

For more than 15 years, the U.S. Centers for Disease Control and Prevention has recommended that all community agencies and workplace environments create structured communication and collaborative plans for emergency or disaster events (2008). This recommendation is aligned with the U.S. Department of Homeland Security's (2022) National Infrastructure Protection Plan. The Coronavirus Disease 2019 (COVID-19) pandemic ultimately demonstrated the importance of having organized plans and processes in place for the effective and rapid dispensing of medical countermeasures (MCMs) to the general populace. Occupational and environmental health nurses (OHNs) can utilize examples of successful MCM dispensing programs and adjust details to fit individual organizational needs. This report examines a closed point of dispensing (Closed POD) mass vaccination program as a guide for designing successful workplace partnerships. Closed PODs are public or private sites that have set up a memorandum of understanding (MOU) with local health authorities to dispense MCMs to their populations during a public health emergency. The desired outcome of a closed POD agreement is the facilitation of employee health and safety, as well as enabling workplace continuity of operations. OHNs will play a pivotal role in any future disaster or emergency event. Because OHNs understand the critical need for anticipatory planning, they are in a prime position to drive the creation and implementation of a closed POD partnership between their workplace and their local health department.

Screening Strategies to Reduce COVID-19 Mortality in Nursing Homes

Nursing home residents continue to bear a disproportionate share of COVID-19 morbidity and mortality, accounting for 9% of all US COVID-19 deaths in 2023, despite comprising only 0.4% of the population. To evaluate the cost-effectiveness of screening strategies in reducing COVID-19 mortality in nursing homes. An agent-based model was developed to simulate SARS-CoV-2 transmission in the nursing home setting. Parameters were determined using SARS-CoV-2 virus data and COVID-19 data from the Centers for Medicare & Medicaid Services and US Centers for Disease Control and Prevention that were published between 2020 and 2023, as well as data on nursing homes published between 2010 and 2023. The model used in this study simulated interactions and SARS-CoV-2 transmission between residents, staff, and visitors in a nursing home setting. The population used in the simulation model was based on the size of the average US nursing home and recommended staffing levels, with 90 residents, 90 visitors (1 per resident), and 83 nursing staff members. Screening frequency (none, weekly, and twice weekly) was varied over 30 days against varying levels of COVID-19 community incidence, booster uptake, and antiviral use. The main outcomes were SARS-CoV-2 infections, detected cases per 1000 tests, and incremental cost of screening per life-year gained. Nursing home interactions were modeled between 90 residents, 90 visitors, and 83 nursing staff over 30 days, completing 4000 to 8000 simulations per parameter combination. The incremental cost-effectiveness ratios of weekly and twice-weekly screening were less than $150 000 per resident life-year with moderate (50 cases per 100 000) and high (100 cases per 100 000) COVID-19 community incidence across low-booster uptake and high-booster uptake levels. When COVID-19 antiviral use reached 100%, screening incremental cost-effectiveness ratios increased to more than $150 000 per life-year when booster uptake was low and community incidence was high. The results of this cost-effectiveness analysis suggest that screening may be effective for reducing COVID-19 mortality in nursing homes when COVID-19 community incidence is high and/or booster uptake is low. Nursing home administrators can use these findings to guide planning in the context of widely varying levels of SARS-CoV-2 transmission and intervention measures across the US.

Genetic basis of clarithromycin resistance in Bacillus anthracis.

The high-consequence pathogen Bacillus anthracis causes human anthrax and often results in lethal infections without the rapid administration of effective antimicrobial treatment. Antimicrobial resistance profiling is therefore critical to inform post-exposure prophylaxis and treatment decisions, especially during emergencies such as outbreaks or where intentional release is suspected. Whole-genome sequencing using a rapid long-read sequencer can uncover antimicrobial resistance patterns if genetic markers of resistance are known. To identify genomic markers associated with antimicrobial resistance, we isolated B. anthracis derived from the avirulent Sterne strain with elevated minimal inhibitory concentrations to clarithromycin. Mutants were characterized both phenotypically through broth microdilution susceptibility testing and observations during culturing, as well as genotypically with whole-genome sequencing. We identified two different in-frame insertions in the L22 ribosomal protein-encoding gene rplV, which were subsequently confirmed to be involved in clarithromycin resistance through the reversion of the mutant gene to the parent (drug-susceptible) sequence. Detection of the rplV insertions was possible with rapid long-read sequencing, with a time-to-answer within 3 h. The mutations associated with clarithromycin resistance described here will be used in conjunction with known genetic markers of resistance for other antimicrobials to strengthen the prediction of antimicrobial resistance in B. anthracis.IMPORTANCEThe disease anthrax, caused by the pathogen Bacillus anthracis, is extremely deadly if not treated quickly and appropriately. Clarithromycin is an antibiotic recommended for the treatment and post-exposure prophylaxis of anthrax by the Centers for Disease Control and Prevention; however, little is known about the ability of B. anthracis to develop resistance to clarithromycin or the mechanism of that resistance. The characterization of clarithromycin-resistant isolates presented here provides valuable information for researchers and clinicians in the event of a release of the resistant strain. Additionally, knowledge of the genetic basis of resistance provides a foundation for susceptibility prediction through rapid genome sequencing to inform timely treatment decisions.

Representativeness of a national, probability-based panel survey of COVID-19 isolation practices-United States, 2020-2022.

The U.S. Centers for Disease Control and Prevention (CDC) received surveillance data on how many people tested positive for SARS-CoV-2, but there was little information about what individuals did to mitigate transmission. To fill the information gap, we conducted an online, probability-based survey among a nationally representative panel of adults living in the United States to better understand the behaviors of individuals following a positive SARS-CoV-2 test result. Given the low response rates commonly associated with panel surveys, we assessed how well the survey data aligned with CDC surveillance data from March, 2020 to March, 2022. We used CDC surveillance data to calculate monthly aggregated COVID-19 case counts and compared these to monthly COVID-19 case counts captured by our survey during the same period. We found high correlation between our overall survey data estimates and monthly case counts reported to the CDC during the analytic period (r: +0.94; p < 0.05). When stratified according to demographic characteristics, correlations remained high. These correlations strengthened our confidence that the panel survey participants were reflective of the cases reported to CDC and demonstrated the potential value of panel surveys to inform decision making.

Analysis of the Role of Positive Romantic Relationship Plays on Reducing Depression

It is very interesting to notice when we compare the data collected by the Centers for Disease Control and Prevention the main age of getting depression which is from aged 18 to 24 years old is coincidence with the age of getting into a first love from 15 to 21 years old. So there could be a very high chance for youth with depression to face the situation of making decisions about romantic relationships. The problem has formed those people with depression symptoms might be worried about whether there will be an interaction of symptoms and romantic relationships to cause a bad effect on each side. Those worrying about these problems can lead to anxiety for themselves and their partners who fall in love with them. To prove that a healthy relationship can help reduce depression levels, this study anonymously interviews depressed adolescents in romantic relationships and conducts secondary surveys to draw conclusions. Currently there are not too many studies on the effect of love relationships on depression reduction. It hopes that through the results of this study can reduce the anxiety of depressed patients about entering a romantic relationship, and at the same time, they hope to prove that healthy romantic relationship as a caring method to reduce depression can make patients healthier.

Randomised controlled trial of preoperative antibiotic prophylaxis in the prevention of surgical site infections in tertiary care hospital of central India

Background Surgical site infections (SSI) remain a significant concern in the realm of surgical interventions, posing a threat to both patient well-being and healthcare systems. This study protocol outlines a rigorous investigation aimed at assessing the effectiveness of pre-operative antibiotic prophylaxis in the prevention of SSIs in clean and clean-contaminated surgical cases within the tertiary care setting of central India. The primary aim is to determine the best suitable antibiotic regimen, optimal timing for administration, and the associated economic burden of SSIs. Method The study utilizes a Randomized Controlled Trial (RCT) design with four intervention groups, each receiving distinct antibiotic prophylaxis protocols. Comprehensive post-operative monitoring, adhering to the Centers for Disease Control and Prevention (CDC) guidelines, will be employed to identify SSI occurrences. Key data collection points include clinical evaluations, temperature monitoring, wound inspection, pain assessments, and culture and sensitivity testing. Expected outcome The study also emphasizes post-operative follow-up assessments, incorporating outpatient visits at 15-, 30-, and 90-days post-surgery. These evaluations will be instrumental in assessing the time duration for effective prophylactic antibiotic administration and determining the economic burden associated with SSI. The findings of this research endeavor hold the potential to enhance patient outcomes, minimize SSI incidences, and reduce the economic impact of SSIs on healthcare systems. By optimizing pre-operative antibiotic prophylaxis practices, this study aims to advance evidence-based guidelines for SSI prevention in clean and clean-contaminated surgical cases. CTRI REF/2023/07/070549

Black Americans' Drug Mortality Increases and Local Employment Opportunities, 2010‒2021.

Objectives. To test the associations between local employment opportunities for the Black workforce and drug mortality among Black Americans, while examining the potential moderating effects of fentanyl seizure rates. Methods. We derived data from the National Center for Health Statistics' restricted-access Multiple Cause of Death file, linked with county-level job counts, drug supply, and other characteristics from the US Census Bureau and the Centers for Disease Control and Prevention. After examining the characteristics of counties by the magnitudes of increases in drug mortality from 2010‒2013 to 2018-2021, we conducted a first-differenced regression analysis to test the associations between the job-to-Black workforce ratio and age-adjusted drug mortality rates among Black Americans in US counties and test the moderating effects of state-level fentanyl seizure rates. Results. One more job per 100 Black workers was associated with 0.29 fewer drug overdose deaths per 100 000 Black Americans in the county. This negative association was stronger in the counties of the states with higher increases in fentanyl seizure rates. Conclusions. Increasing employment opportunities can be an important strategy for preventing Black Americans' drug mortality, especially among those living in areas with higher increases in fentanyl seizure rates. (Am J Public Health. Published online ahead of print April 25, 2024:e1-e4. https://doi.org/10.2105/AJPH.2024.307646).

Emergency department documentation of legal intervention injuries at a Washington, DC, hospital.

The U.S. Centers for Disease Control and Prevention (CDC) defines legal intervention injuries as injuries caused by law enforcement agents in the course of official duties. Public health databases utilize International Classification of Diseases, 10th Revision (ICD-10), coding to collect these data through the "Y35" family ICD-10 code. Prior studies report deficiencies in public health recording of fatal legal intervention injuries. Few studies have characterized nonfatal injuries. This study investigates emergency department (ED) capture of legal intervention injury diagnostic coding. A retrospective chart review was performed on ED encounter data from January 1, 2017, to June 30, 2019, at an academic hospital in Washington, DC. Charts were identified using a keyword search program for "police." Chart abstracters reviewed the flagged charts and abstracted those that met injury definition. Primary outcomes included injury severity, patient demographics, and documented ICD-10 codes. One sample proportion testing was performed comparing sample census ED data. A total of 340 encounters had sufficient descriptions of legal intervention injuries. A total of 259 had descriptions consistent with the patient specifier of "suspect." Hospital coders recorded 74 charts (28.6%) with the Y35 family legal intervention injury code. A total of 212 involved a Black patient. A total of 122 patients had Medicaid and 94 were uninsured. Black patients made up a higher proportion of individuals in the "suspect identified legal intervention injury" group than the total population (0.819 vs. 0.609, p < 0.01, 95% CI 0.772-0.866). Patients with Medicaid or who were uninsured made up substantial proportions as well (0.471 vs. 0.175, p < 0.01, 95% CI 0.410-0.532 for Medicaid patients and 0.363 vs. 0.155, p < 0.01, 95% CI 0.304-0.424 for the uninsured patients). A large proportion of nonfatal legal intervention injuries remain unreported. Black and low-income patients are disproportionately affected. More research is needed but benefits from interprofessional data sharing, injury pattern awareness, and diagnostic coding guidance may improve reporting.