Centers For Prevention Research Articles

Microfluidics for detection of food pathogens: recent trends and opportunities.

Safe and healthy food is the fundamental right of every citizen. Problems caused by foodborne pathogens have always raised a threat to food safety and human health. Centers for Disease Control and Prevention (CDC) estimates that around 48 million people are affected by food intoxication, and 3000 people succumb to death. Hence, it is inevitable that an approach that is efficient, reliable, sensitive, and rapid approach that can replace the conventional analytical methods such as microbiological and biochemical methods, high throughput next-generation sequence (NGS), polymerase chain reaction (PCR), and enzyme-linked immunosorbent assay (ELISA), etc. Even though the accuracy of conventional methods is high, it is tedious; increased consumption of reagents/samples, false positives, and complex operations are the drawbacks of these methods. Microfluidic devices have shown remarkable advances in all branches of science. They serve as an alternative to conventional ways to overcome the abovementioned drawbacks. Furthermore, coupling microfluidics can improve the efficiency and accuracy of conventional methods such as surface plasma resonance, loop-mediated isothermal amplification, ELISA, and PCR. This article reviewed the progress of microfluidic devices in the last ten years in detecting foodborne pathogens. Microfluidic technology has opened the research gateway for developing low-cost, on-site, portable, and rapid assay devices. The article includes the application of microfluidic-based devices to identify critical food pathogens and briefly discusses the necessary research in this area.

EFFECT OF SEX AND AGE ON SURVIVAL OF ADULT CULEX TARSALIS FROM A SUSCEPTIBLE LABORATORY STRAIN EXPOSED TO PERMETHRIN IN THE CDC BOTTLE BIOASSAY

ABSTRACT This study investigates the effect of mosquito sex and age on the survival and resistance determination of adult Culex tarsalis exposed to permethrin, a pyrethroid commonly used for mosquito control, using the Centers for Disease Control and Prevention (CDC) bottle bioassay method. A permethrin-susceptible strain of Cx. tarsalis (Bakersfield strain) was used in this study. Survival was compared for young adult females (2–5 days old) relative to older adult females (7–10 days old) and separately for female and male mosquitoes of the same age (2–5 days old). Mortality was slightly higher for males than females during the first observation period (0–5 min) following permethrin exposure, and higher for older females relative to younger females from 5 to 10 min following permethrin exposure, with no differences in mortality by either sex or age for observation periods during the remainder of the diagnostic period. When evaluated over the full diagnostic period, survival varied with mosquito age but not sex. However, all mosquitoes, regardless of sex or age, died within the 30-min diagnostic period for this species, confirming their permethrin susceptibility per the CDC bottle bioassay. This research contributes valuable insight into the potential impact of sex and age on mosquito susceptibility to insecticides in the context of insecticide resistance determination.

Development and validation of an Arabic tool for assessment of post-vaccination confidence in COVID-19 vaccines (ARAB-VAX-CONF)

Abstract Background Vaccine confidence is described as a belief that vaccines are effective, safe, and part of a trustworthy health system. The objective of this study was to develop and validate an Arabic tool to evaluate confidence in the received coronavirus disease 2019 (COVID-19) vaccines (ARAB-VAX-CONF). Methods The research team developed the ARAB-VAX-CONF based on three areas specified by the Centers for Disease Control and Prevention (CDC): confidence in vaccine effectiveness, confidence in vaccine safety, and confidence in the healthcare system. The analysis includes data from 406 eligible vaccinated persons (≥ 18 years). Cronbach’s alpha was used to measure internal consistency, while convergent, discriminant, exploratory, and confirmatory factor analyses were used to verify construct validity. Results A total of 406 adults were recruited, with a mean age of 33.0 ± 12.2 years. A total of 63.1% were males, 56.7% were married, 21.9% had chronic conditions, 93.3% were nonsmokers, and 39.6% were obligated to obtain vaccines. The three domains of the scale met the criterion of internal consistency (Cronbach’s alpha > 0.7). Convergent validity was identified by the significant inter-item and item-mean score of the domain correlation (P < 0.001). Discriminant validity was reported as the inter-factor correlation matrix (< 0.7). The Kaiser–Meyer–Olkin sampling adequacy measure was 0.80, and Bartlett’s sphericity test was significant (P < 0.001). Exploratory factor analysis indicated that the scale could be summarized into three factors. Confirmatory factor analysis confirmed the adequate psychometric properties and fit with observed data (root-mean-square error of approximation = 0.08, comparative fit index = 0.945, Tucker-Lewis index = 0.924, standardized root-mean-square residual = 0.086, normed fit index = 0.918, and goodness-of-fit index = 0.909). Conclusions The ARAB-VAX-CONF developed in this study is valid and reliable for assessing confidence in vaccine effectiveness, safety, and confidence in the healthcare system. The ARAB-VAX-CONF can support decision-makers in addressing the gap in vaccine confidence among various populations.

The Promotion of Non-Communicable Disease Screening in Gurage Zone, Ethiopia: A Mixed-Method Study

Background: Despite the high non-communicable disease (NCD) mortality in Ethiopia, NCD screening in the country remains suboptimal. This study assessed the health communication process and materials designed to promote NCD screening among adult primary healthcare facility attendants in the Gurage Zone, Ethiopia. Methods: A parallel mixed-methods approach was employed. Seven health communication materials were evaluated using the Modified Clear Communication Index Score by the Center for Disease Control and Prevention (CDC). Seven key informants who were involved in the production were interviewed to explore the process. Users’ satisfaction with the materials was assessed through a cross-sectional survey (N = 412). We used multivariable logistic regression with SPSS version 27 software to determine the factors associated with users’ satisfaction. Thematic analysis was applied for the qualitative data analysis using Opencode 4.03 software. Results: Qualitative interviews indicated that the production process relied on evidence, involved stakeholders, and included pretesting. The CDC index score revealed that five of the seven materials were considered clear and user-friendly, whereas two required improvement. Overall users’ satisfaction with the material was high with a mean score of 22.10 (SD ± 2.34; min: 14, max: 25). Age and educational status had significant positive association with users’ satisfaction. Conclusions: Developing health communication materials on promoting NCD screening based on evidence, stakeholders’ input, and pretesting can lead to good quality material and user satisfaction. We recommend future research works to measure changes in NCD screening service uptake as a result of using the health communication materials considered in this study.

Impact of Expanded HIV Testing and Rapid Antiretroviral Therapy Initiation in Southwest China: An Interrupted Time-Series Analysis.

This study evaluates the impact of an expanded HIV testing initiative, launched in June 2018 in Luzhou, Sichuan, China, on antiretroviral therapy (ART) initiation rates among people living with HIV (PLWH). Using an uncontrolled interrupted time-series design, we analyzed data from 11,040 PLWH between June 2016 and December 2022, extracted from 108 health facilities via the Center for Disease Control and Prevention's ART database. The primary outcome measures were ART initiation rates within 7 and 30 days of HIV diagnosis. Results showed a significant improvement in the 30-day ART initiation rate following expanded testing, increasing from 46.1% to 90.9% by the study's end. The 7-day initiation rate also improved but remained below 30%. The study found that expanded testing enhanced the role of primary health care institutions in ART initiation. However, the COVID-19 pandemic, beginning January 2020, negatively impacted ART initiation rates, with a slight effect on 30-day rates but a persistent negative impact on 7-day rates. Despite these challenges and an increased HIV burden, Luzhou's ART initiation rates surpassed the national average. This study emphasizes the effectiveness of expanded HIV testing in ensuring timely ART access, crucial for HIV epidemic control, and improved patient outcomes. It also reveals challenges in maintaining HIV services during public health crises, offering insights into health care system resilience. Future research should focus on evaluating long-term treatment outcomes and strategies to support ending the AIDS epidemic.

Embracing Controversy: A Second Look at CDC Reform Efforts in the Wake of COVID-19.

Addressing criticism that the agency's Covid-19 response was lacking, the US Centers for Disease Control and Prevention (CDC) has proposed internal agency reforms intended to improve its performance during the next pandemic. They are aimed at improving surveillance and analytic capacity and agency communications. This essay, via a counterfactual analysis of the CDC's proposed reforms, asks how, if completed in advance of Covid-19, they might have changed outcomes in four cases of guidance controversy during the pandemic. CDC planned reforms, though they have merit, are predicated on the ability to come to "scientific closure" in a highly charged political environment. To improve outcomes in a future pandemic, the agency should consider how it plans to communicate with the public when recovering from error and when addressing controversy spurred by criticism from credible experts. However, the ability of future presidents to limit CDC performance and communications in the next pandemic and the lack of political consensus around the value of independent public health expertise threaten the agency's reform goals.

Identifying the geographic leading edge of Lyme disease in the United States with internet searches: A spatiotemporal analysis of Google Health Trends data.

The geographic footprint of Lyme disease is expanding in the United States, which calls for novel methods to identify emerging endemic areas. The ubiquity of internet use coupled with the dominance of Google's search engine makes Google user search data a compelling data source for epidemiological research. We evaluated the potential of Google Health Trends to track spatiotemporal patterns in Lyme disease and identify the leading edge of disease risk in the United States. We analyzed internet search rates for Lyme disease-related queries at the designated market area (DMA) level (n = 206) for the 2011-2019 and 2020-2021 (COVID-19 pandemic) periods. We used maps and other exploratory methods to characterize changes in search behavior. To assess statistical correlation between searches and Lyme disease cases reported to Centers for Disease Control and Prevention (CDC) between 2011 and 2019, we performed a longitudinal ecological analysis with modified Poisson generalized estimating equation regression models. Mapping DMA-level changes in "Lyme disease" search rates revealed an expanding area of higher rates occurring along the edges of the northeastern focus of Lyme disease. Bivariate maps comparing search rates and CDC-reported incidence rates also showed a stronger than expected signal from Google Health Trends in some high-risk adjacent states such as Michigan, North Carolina, and Ohio, which may be further indication of a geographic leading edge of Lyme disease that is not fully apparent from routine surveillance. Searches for "Lyme disease" were a significant predictor of CDC-reported disease incidence. Each 100-unit increase in the search rate was significantly associated with a 10% increase in incidence rates (RR = 1.10, 95% CI: 1.07, 1.12) after adjusting for environmental covariates of Lyme disease identified in the literature. Google Health Trends data may help track the expansion of Lyme disease and inform the public and health care providers about emerging risks in their areas.

Frequency and risk factors of nosocomial infections in atrauma center: acase study from the Beni Suef University Hospital, Egypt.

Hospital-acquired infections (HAI) cause asignificant risk to patient maintenance and wellbeing, particularly within the specialized environment of atrauma center. This study focuses on investigating the frequency of HAI in atrauma center through acomprehensive surveillance and monitoring system. This observational study, conducted between January 2023 and June 2023, focused on the 16-bed trauma center. HAI diagnoses were based on the centers for disease control and prevention (CDC) definitions that typically include specific criteria for different types of infections, for example, urinary tract infections, surgical site infections, bloodstream infections, and others. Among the 160 trauma center-admitted patients, 89were included in the study. 44patients contracted HAI, resulting in afrequency of 49.4%. The incidence rates (IR) were 21/1000 central venous catheter (CVC) days for catheter-related bloodstream infections (CRBSI), 10/100 urinary catheter days for catheter-associated urinary tract infections (CAUTI), and 34/1000 ventilator days for ventilator-associated pneumonia (VAP). The HAI percentages noticed in the trauma center are comparatively lower than those reported in other developing country hospitals. The incidence of VAP aligns with findings from other studies.

Trends in the Mortality and Death of Periviable Preterm Infants in the United States, 2011 to 2020.

This study aimed to examine the trends in the infant mortality rate (IMR) and the trends in the timing of death among periviable preterm infants at 22 to 24 weeks' gestational age (GA) in the United States from 2011 to 2020. Retrospective, serial cross-sectional analysis of periviable preterm infants born in the United States at 22 to 24 weeks' GA using the linked birth/infant death records from the Centers for Disease Control and Prevention. Data were analyzed from 2011 to 2020. The exposure was the year of death, and the outcome was the changes over time in the IMR and the timing of death. Further, we evaluated racial differences in the timing of death. We used nonparametric trend analysis to evaluate changes in mortality rate across the study period. The IMR was inversely related to GA, and for each GA and race/ethnicity, the IMR significantly declined during the study period. The IMR rate was highest in the first 7 days of life for all GAs and races/ethnicities. While Non-Hispanic White infants had a higher infant neonatal mortality rate than non-Hispanic Black infants, non-Hispanic Black infants had a higher postneonatal mortality rate. The IMR among periviable infants born at 22 to 24 weeks' GA improved for all GAs and races in the United States between 2011 and 2020. However, significant racial differences in the timing of death exist. · As expected, the IMR was inversely related to gestational age at 22 to 24 weeks.. · At each gestational age and for each racial/ethnic group, the overall IMR decreased during the study period.. · Non-Hispanic White infants had a higher neonatal mortality rate, whereas non-Hispanic Black infants had a higher postneonatal mortality rate..

Abstract 4117310: Alcohol-Related Cardiomyopathy - Exploration of Recent Mortality Trends in the United States

Introduction: Data is accumulating regarding the contemporary trends of mortality rates in patients with alcohol-related cardiomyopathy across the United States. Hypothesis: We hypothesized that with increased awareness about the adverse effects of alcohol on the cardiovascular system and the advancement of echocardiography in the early diagnosis of alcoholic cardiomyopathy, mortality rates may show a downward trend. Methods: This is a retrospective observational study that retrieved death certificates from the CDC WONDER (Center for Disease Control and Prevention’s Wide-ranging ONline Data for Epidemiological Research) database from 2001-2020. The mortality rate of alcohol-related cardiomyopathy using ICD code I42.6 (Alcoholic cardiomyopathy) was studied from 2001-2020. This study duration was further subdivided into five-year periods. We calculated the crude mortality rate and age-adjusted mortality rate per 100,000 for four U.S census regions (CR-1 Northeast, CR-2 Midwest, CR-3 South, CR-4 West). Results: The overall age-adjusted mortality rate remained at 0.1/100,000 deaths in four U.S census regions until 2015; however, in the last five years of the study period, AAMR(age-related mortality rate) increased from 0.1 to 0.2/100,000 deaths. Conclusions: The mortality trends associated with alcohol-related cardiomyopathy have not changed significantly over the past two decades. This can be explained by the larger number of people developing alcoholic cardiomyopathy due to the increase in global alcohol use in addition to the fact that more diagnosed patients are receiving earlier treatment with goal-directed medical therapy for cardiomyopathy. Limitations of this study include intrinsic weakness of the WONDER dataset (changes with ICD-9 to ICD-10 codes, and potentially miscoding) which needs further research. Discussion: This suggests that while mortality rates associated with alcohol-related cardiomyopathy remained relatively steady for most of the study period, there was a concerning uptick in the latter years. This could prompt further investigation into potential factors contributing to this increase, despite advancements in awareness and diagnostic techniques.

Abstract 4138275: Demographic, Regional, and State-level Trends of Mortality in patients with Atrial fibrillation in the United States, 1999 to 2020

Background: There exists a paucity of data regarding mortality trends among individuals with atrial fibrillation (AF) based on age, gender, race and ethnicity, and geographic regions. Objective: To investigate the trends in mortality in the United States (US) associated with AF among individuals aged ≥45 years. Methods: We reviewed the death certificate data from the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database to examine atrial fibrillation–related mortality trends from 1999 to 2020 in individuals ≥45 years of age. We calculated crude and age adjusted mortality rates (AAMRs) per 100 000 patients and annual percentage change (APC) with 95% CIs. Results: Between 1999 and 2020, 2,576,839 AF-related deaths were identified among US adults over 45 years of age. The age adjusted mortality rate (AAMR) for AF-related deaths rose significantly from 70.6 in 1999 to 149.1 in 2020. Initially, the AAMR remained stable from 1999 to 2009 (APC): 2.31; 95% CI: -0.57 to 5.84), then increased significantly from 2009 to 2018 (APC: 3.60; 95% CI: 2.12 to 4.75), and saw a sharp rise from 2018 to 2020 (APC: 8.46; 95% CI: 4.76 to 10.44). There were notable disparities among demographic groups. Men consistently had higher AAMRs than women from 1999 (men: 79.9, women: 64.4) to 2020 (men: 180.5, women: 125.3). Non-Hispanic (NH) White adults had the highest AAMR (108.6), followed by NH American Indian/Alaska Native (73.4), NH Black (66.7), Hispanic or Latino (55.5), and NH Asian or Pacific Islander adults (51.2). The age group 85+ consistently showed the highest mortality rates throughout the study period. Regional differences were also evident, with the residents of western region (109.5) and nonmetropolitan areas (109.6) having the higher AAMRs when compared to other regions (Midwest: 104.3, Northeast: 95.1, and South: 95.0) and metropolitan areas (98.3), respectively. State-level variations were also significant. Conclusion: Our study found a rise in AF-related mortality in the US from 1999 to 2020, with significant disparities among demographic and geographic subgroups. Higher AAMRs were noted in males, non-Hispanic Whites, adults over 85, and residents of the western and nonmetropolitan US. Addressing disparities in access to quality care, timely diagnosis, insurance maintenance, and implementing targeted health policies can help reduce AF-related mortality.

Geo-classification of drug-resistant travel-associated Plasmodium falciparum using Pfs47 and Pfcpmp gene sequences (USA, 2018-2021).

Travel-related malaria is regularly encountered in the United States, and the U.S. Centers for Disease Control and Prevention (CDC) characterizes Plasmodium falciparum drug-resistance genotypes routinely for travel-related cases. An important aspect of antimalarial drug resistance is understanding its geographic distribution. However, specimens submitted to CDC laboratories may have missing, incomplete, or inaccurate travel data. To complement genotyping for drug-resistance markers Pfcrt, Pfmdr1, Pfk13, Pfdhps, Pfdhfr, and PfcytB at CDC, amplicons of Pfs47 and Pfcpmp are also sequenced as markers of geographic origin. Here, a bi-allele likelihood (BALK) classifier was trained using Pfs47 and Pfcpmp sequences from published P. falciparum genomes of known geographic origin to classify clinical genotypes to a continent. Among P. falciparum-positive blood samples received at CDC for drug-resistance genotyping from 2018 to 2021 (n = 380), 240 included a travel history with the submission materials, though 6 were excluded due to low sequence quality. Classifications obtained for the remaining 234 were compared to their travel histories. Classification results were over 96% congruent with reported travel for clinical samples, and with collection sites for field isolates. Among travel-related samples, only two incongruent results occurred; a specimen submitted citing Costa Rican travel classified to Africa, and a specimen with travel referencing Sierra Leone classified to Asia. Subsequently, the classifier was applied to specimens with unreported travel histories (n = 140; 5 were excluded due to low sequence quality). For the remaining 135 samples, geographic classification data were paired with results generated using CDC's Malaria Resistance Surveillance (MaRS) protocol, which detects single-nucleotide polymorphisms in and generates haplotypes for Pfcrt, Pfmdr1, Pfk13, Pfdhps, Pfdhfr, and PfcytB. Given the importance of understanding the geographic distribution of antimalarial drug resistance, this work will complement domestic surveillance efforts by expanding knowledge on the geographic origin of drug-resistant P. falciparum entering the USA.

Abstract 4112716: The Trend In Racial Differences In Mortality Attributed To Congenital Heart Diseases In Infants In The United States From 2005 To 2019

Background: Deaths from congenital heart disease (CHD) in children have been decreasing in the United States. We examined the differences in mortality trends between Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) infants. Methods: We retrospectively analyzed publicly available data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). The data was obtained from the linked birth/infant deaths from 2005 to 2019. We evaluated all infant deaths up to 1 year of age with the cause of death listed as CHD (International classification of diseases, 10 th revision (ICD-10) codes Q20-Q26 (except atrial septal defect, Q21.1 and patent ductus arteriosus, Q25. CHD infant mortality rate (IMR) was calculated per 100,000 live births. Race was ascertained based on death certificate reporting. Joinpoint regression was used to examine CHD-IMR by year, including stratification by NHB vs NHW, and neonatal vs postneonatal. The difference between NHB and NHW CHD-IMR was ascertained via the Mann-Whitney U test. P<0.05 was considered statistically significant. Results: Out of 60,243,988 live births, there were 19,004 CHD-related infant deaths. The characteristics of the study population are displayed in Table 1. The overall CHD-IMR declined from 36.1 to 27.0 per 100,000 live births (25.2%) with an average annual percentage change (AAPC) of -2.1 [95% CI -2.6, -1.572] (Figure 1). The CHD-IMR was significantly higher in NHB than in NHW (40 vs 29.3; P<0.0001) and this difference remained when the mortality rate was stratified by neonatal and post-neonatal periods. The CHD-IMR decreased significantly in NHW [AAPC: -2%; 95% CI: -2.5, -1.5%], but not in NHB [AAPC of -1.4%, 95% CI, -3.0, 0.3%]. The NHB-to-NHW CHD-IMR ratio, a measure of CHD-IMR disparity averaged 1.4 over the study period [AAPC: 0.8%; 95% CI: -0.2, 1.8%] (Figure 2). Conclusions: The CHD-IMR declined significantly for NHW, but not in NHB in the US from 2005 to 2019. The CHD-IMR was higher in NHB than in NHW. There was no significant change in the NHB-to-NHW CHD-IMR ratio, signifying no change in the disparity that exists between NHB and NHW IMR. These findings may have implications for patient care and public health policymaking. They lay the groundwork for additional studies to determine and understand the drivers behind these findings such as in prenatal diagnosis.

A statewide system for maternal-infant linked longitudinal surveillance: Indiana's model for improving maternal and child health

Indiana, located in the Midwest region of the United States, faces significant challenges with respect to health, especially maternal and child health (MCH). These challenges include high rates of stillbirth, neonatal abstinence syndrome (NAS) and congenital syphilis (CS). Not only are these often-fatal conditions underreported, but it can also be difficult to track them longitudinally, as mothers and infants are not routinely linked through electronic health records (EHRs). This paper describes the process, structure and planned outcomes of a partnership between Indiana University, Regenstrief Institute and public health partners in support of the U.S. Centers for Disease Control and Prevention's Pregnant People-Infant Linked Longitudinal Surveillance (PILLARS) program. Together, academic, clinical and public health organisations are collaboratively developing an infrastructure and deploying novel methods to surveil stillbirth, CS and NAS longitudinally. The infrastructure includes: (a) deploying deterministic and probabilistic algorithms to link mothers and their infants using multiple, linked data sources; (b) creating and maintaining a registry of maternal-infant dyads; (c) using the registry to perform longitudinal surveillance in collaboration with Indiana public health authorities on stillbirth, NAS and CS and (d) translating information from surveillance activities into action by collaborating with public health and community-based organisations to improve and implement prevention activities in vulnerable Indiana communities. Our long-term goal is to improve outcomes for these conditions and other priority MCH outcomes by expanding our work to additional MCH use cases.

The national ambulatory medical care survey (NAMCS) at fifty: Past and future

IntroductionNAMCS, sponsored by the Centers for Disease Control and Prevention, is an annual nationally representative sample survey of visits to non-federal office-based physicians, excluding anesthesiologists, radiologists, and pathologists. NAMCS has collected physician-reported ambulatory care encounter-specific content over five decades. We assessed trends in the use of the data by the health services research community, response rates, and questionnaire changes. MethodsWe extracted all peer-reviewed journal articles using NAMCS data published between 1973 and 2020 and categorized publications into high- and low-impact groups, with high impact considered as the top 25 % of journals. We then examined the annual number of journal publications using NAMCS, data according to the year collected, by impact score groups for 50 years. We compared response rates and the information requested by NAMCS questionnaires from 1973 to the present. ResultsThere has been a significant decline in the overall use of NAMCS data by the non-federal health services research community for publication in both high and lower-impact journals. Data used for high impact publications peaked in 1998, at 87, remained high at 58 in 2008 but then sharply declined. Concurrently, there was a substantial decline in NAMCS survey response rates (highest: 80.5 % in 1975 vs. lowest: 28.8 % in 2015). These changes came in the context of increasing questionnaire complexity. ConclusionOver the last two decades, annual publication rates citing NAMCS data have declined, coincident with lower response rates and more detailed questionnaires. Nationally representative encounter-specific data verified by the clinician of record will likely have renewed value for those who develop, implement, and assess healthcare policy if response rates improve, and questionnaire review and finalization are streamlined. Though multispecialty data offer unique opportunities for comparisons, sampling a subset of clinicians, such as those providing primary care, would complement national efforts to improve access to continuous comprehensive care.

Expanding Naloxone Coprescribing at a Regional VA Medical Center.

Veterans are disproportionately affected by chronic pain and are more likely to be prescribed opioids. As a means of risk mitigation, the Centers for Disease Control and Prevention and Department of Defense recommend naloxone for patients on opioids with risk factors, including use of ≥50 morphine milligram equivalents daily, concurrent benzodiazepine/sedative use, and pulmonary or liver disease. An interprofessional quality improvement team consisting of 6 residents, a pharmacist, a nurse educator, and a faculty mentor was formed to increase naloxone coprescriptions at a regional VA medical center Continuity of Care Clinic. Primary intervention identified eligible patients via the VA Primary Care Almanac's Opioid Therapy Risk Report and alerted providers by email and secure messaging. Naloxone coprescription rates increased from 42% initially in June 2022 to 82% by June 2023 (29/69 to 41/50 patients, P < 0.0001). This project demonstrates that notifying providers of high-risk patients can significantly increase naloxone coprescriptions.

Awareness and Uptake of HIV Preexposure Prophylaxis and Postexposure Prophylaxis Among College Students With Sexual Experiences: Institutional-Based Cross-Sectional Study.

Evidence has shown that HIV prevalence among young people, especially college students, has increased disproportionately. Preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) are two of the most effective ways to prevent HIV, which are vital for college students with sexual experiences who have sexual risks. To provide evidence for effective intervention to reduce the risk of HIV infection among young students, this study aimed to analyze the awareness and uptake of HIV PrEP and PEP among college students with sexual experiences. An institutional-based cross-sectional study design was used to collect data through an electronic questionnaire from college students in 5 colleges located in Zhejiang Province. A total of 21,962 college students were investigated, of which 2605 students with sexual experiences were included in the data analysis with the following information collected: sociodemographic characteristics, awareness and uptake of HIV PrEP and PEP, sexual behaviors, and HIV tests. Binary logistic regression analysis was used to explore the factors on seeking PrEP and PEP. The average age of college students with sexual experiences was 21.25 (SD 2.75) years. Overall, 61.4% (n=1600) of the participants were aware of PrEP, and 53.0% (n=1380) of them were aware of PEP. Moreover, 5.6% (n=146) of them have sought PrEP or/and PEP, and 89.1% (n=2321) have not sought PrEP or PEP. College students who had more than 6 sexual partners, have always had unprotected sex, have subjective perceived risk behavior, and undergo HIV testing were more likely to seek PrEP or/and PEP. The main ways for the participants to learn PrEP and PEP were through school clubs, the internet, and the Centers for Disease Control and Prevention. Moreover, senior students and those who had not undergone an HIV test had a lower likelihood of seeking PrEP and PEP. College students who did not have risky sexual behaviors (odds ratio 0.468, P=.004) and homosexual students (odds ratio 0.318, P=.03) were more likely not to seek PEP. College students with sexual experiences rarely seek PrEP and PEP, with a relatively low awareness of PrEP and PEP. It is very important to increase the knowledge and uptake of PrEP and PEP by educational and behavioral interventions among young students at risk for HIV infection.

The impact of the Centers for Disease Control and Prevention new surveillance definitions of ventilator-associated event on our clinical practice

ABSTRACT Objective Surveillance of ventilator-associated pneumonia is subjective, inaccurate, time-consuming, and does not predict outcomes. The Centers for Disease Control and Prevention (CDC) recommended the use of ventilator-associated event (VAE) definitions instead of ventilator-associated pneumonia (VAP) in 2013. Therefore, we evaluated this novel surveillance algorithm by comparing the results of our VAP and VAE methods. Material Methods We evaluated mechanically ventilated adult medical and surgical patients in our 13-bed intensive care unit (ICU). Nine patients diagnosed with VAP in 2018-2019 and 11 patients diagnosed with VAE in 2022-2024 were retrospectively evaluated. The impact of the new definitions on clinical processes such as days on the mechanical ventilator, duration of antibiotic use, ICU stay in determining infectious status was monitored. Results. Statistical analysis revealed that demographic and numeric data were similar in both VAP and VAE diagnosis groups (p

Beyond CDC-Defined Surgical Site Infection: Factors Associated with Antibiotic Prescription After Breast Operation.

Background: Most studies on surgical site infections (SSIs) use the US Centers for Disease Control and Prevention (CDC) guidelines, which excludes inflammation or cellulitis without fever. The aim of this study was to evaluate antibiotic prescription trends in the post-operative period among patients undergoing breast operation. We explore the outcomes of patients receiving antibiotic agents outside of the CDC-defined SSI. Patients and Methods: A retrospective review of patients undergoing breast operation from January 2021 to May 2021 was conducted. Solely reconstructive and cosmetic cases were excluded. The primary outcome was the prevalence of antibiotic prescription in the absence of CDC-defined SSI, excluding routine prophylactic antibiotic agents, with analysis of associated factors. Results: A total of 754 breast surgical procedures were included. Seventy-seven patients (10.2%) were prescribed outpatient antibiotic agents. CDC-defined SSI occurred in 5.3% (n = 40), mostly involving tissue expander/implant-based reconstruction (47.5%, n = 19). However, 37 (4.9%) did not progress to meet the CDC criteria for SSI. Patients prescribed outpatient antibiotic agents without CDC-defined SSI did not have increased rates of diabetes mellitus, obesity, or current smoking. These patients were more likely to have a surgical drain (48.6% vs. 28.4%, p = 0.02), plastic surgery involvement (32.4% vs. 18.0%, p = 0.048), and a post-operative seroma (32.4% vs. 8.1%, p < 0.001) and or or cellulitis (18.9% vs. 0%, p < 0.001). Conclusion: Patients are prescribed antibiotic agents after breast operation based on clinical judgment for indications other than CDC-defined SSI. Post-operative wound morbidity including seroma and cellulitis could be contributing to these antibiotic prescriptions. Further study is needed to determine whether providers are preemptively treating SSIs appropriately or over-treating non-infectious wound complications.

Clinical Decision Support to Increase Emergency Department Naloxone Coprescribing: Implementation Report.

Coprescribing naloxone with opioid analgesics is a Centers for Disease Control and Prevention (CDC) best practice to mitigate the risk of fatal opioid overdose, yet coprescription by emergency medicine clinicians is rare, occurring less than 5% of the time it is indicated. Clinical decision support (CDS) has been associated with increased naloxone prescribing; however, key CDS design characteristics and pragmatic outcome measures necessary to understand replicability and effectiveness have not been reported. This study aimed to rigorously evaluate and quantify the impact of CDS designed to improve emergency department (ED) naloxone coprescribing. We hypothesized CDS would increase naloxone coprescribing and the number of naloxone prescriptions filled by patients discharged from EDs in a large health care system. Following user-centered design principles, we designed and implemented a fully automated, interruptive, electronic health record-based CDS to nudge clinicians to coprescribe naloxone with high-risk opioid prescriptions. "High-risk" opioid prescriptions were defined as any opioid analgesic prescription ≥90 total morphine milligram equivalents per day or for patients with a prior diagnosis of opioid use disorder or opioid overdose. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate pragmatic CDS outcomes of reach, effectiveness, adoption, implementation, and maintenance. Effectiveness was the primary outcome of interest and was assessed by (1) constructing a Bayesian structural time-series model of the number of ED visits with naloxone coprescriptions before and after CDS implementation and (2) calculating the percentage of naloxone prescriptions associated with CDS that were filled at an outpatient pharmacy. Mann-Kendall tests were used to evaluate longitudinal trends in CDS adoption. All outcomes were analyzed in R (version 4.2.2; R Core Team). Between November 2019 and July 2023, there were 1,994,994 ED visits. CDS reached clinicians in 0.83% (16,566/1,994,994) of all visits and 15.99% (16,566/103,606) of ED visits where an opioid was prescribed at discharge. Clinicians adopted CDS, coprescribing naloxone in 34.36% (6613/19,246) of alerts. CDS was effective, increasing naloxone coprescribing from baseline by 18.1 (95% CI 17.9-18.3) coprescriptions per week or 2,327% (95% CI 3390-3490). Patients filled 43.80% (1989/4541) of naloxone coprescriptions. The CDS was implemented simultaneously at every ED and no adaptations were made to CDS postimplementation. CDS was maintained beyond the study period and maintained its effect, with adoption increasing over time (τ=0.454; P<.001). Our findings advance the evidence that electronic health record-based CDS increases the number of naloxone coprescriptions and improves the distribution of naloxone. Our time series analysis controls for secular trends and strongly suggests that minimally interruptive CDS significantly improves process outcomes.