Disease Prevention Guidelines Research Articles

Centers for Disease Control and Prevention Guideline for Prescribing Opioids, 2022—Need for Integrating Dosing Benchmarks With Shared Decision-Making

This viewpoint evaluates the CDC’s 2022 clinical practice guideline for prescribing opioids and suggests a model for supplemented shared decision-making between patients and clinicians about long-term opioid therapy.

Impact of Novel Coronavirus Pandemic on Emergency and Elective Surgical Practice: A Retrospective Study in a Tertiary Care Center

Coronavirus disease 2019 (COVID-19) pandemic has led to a significant worldwide impact on general surgical practice. Since the beginning of this pandemic, hospitals have become a hot zone for the transmission of coronavirus. Routine and emergency surgical services have been severely disrupted worldwide due to this pandemic and may continue to be so for some time if more mutations take place in the virus. As of February 27, 2022, at 9 a.m., 43.5 crore positive cases were confirmed worldwide with over 6 million deaths. In India, 42,916,117 positive cases were confirmed to this date with 513,756 deaths. The impact of the COVID-19 pandemic on surgery daily practice and surgical patients was very high. There was a high impact on elective, semi-elective, cancer surgery, transplant programs, and education programs in our institution during the COVID-19 era. The most common reasons were being reduced number of availabilities of non-COVID-19 beds in the general surgical ward, difficulty in separating COVID-19 and non-COVID-19 patients, high transmission, and infection rate of COVID-19, reduced number of surgical intensive care unit beds and operation theatre due to allotment of these exclusively for COVID-19 patients. The reduced number of staff and health-care workers due to posting in the COVID-19 ward was also a major factor in the reduced number of electives and other surgeries in our institution. We need to find ways to continue providing essential medical services to patients while fighting this pandemic since it might take longer than expected to end. The present report summarizes the impact of the COVID-19 pandemic on our surgical services and the changes that we have adopted for better care of surgical patients and safe surgical practice to provide valuable information worldwide. This article also summarizes current evidence and recommendations for changes to surgical practice in our hospital according to the World Health Organization, Ministry of Health and Family Welfare, Indian Council of Medical Research, and Centers for Disease Control and Prevention guidelines to minimize the effect of the COVID-19 pandemic on surgical services.

Benefits and limitations of clinical assessment of abnormal vaginal discharge etiology

Abnormal vaginal discharge (AVD) is a common syndrome. Its management is addressed in many evidence-based guidelines: International Union of Sexually Transmitted Infections (IUSTI) and WHO Guidelines for management of vaginal discharge (2018); American College of Obstetrics and Gynecology (ACOG) Practice Bulletin No. 215 «Vaginitis in non-pregnant patients» (2020); U.S. Centers for Disease Control and Prevention (CDC) Guidelines for the treatment of sexually transmitted diseases (2021) etc. In December 2022, the Ministry of Health of Ukraine approved an adapted Clinical Guidelines and Standards of Medical Care “Abnormal vaginal discharge”.A special aspect of AVD management is frequent recurrence. Among the many hypotheses of the etiology of the recurrent course of vaginal infections the clinical aspect of difficulties of identifying all pathogens in case of mixed forms deserves special attention. Thus, there is need to presume the possibility of a mixed etiology of AVD or an atypical course of mono-infection at the stage of clinical examination.This review focuses on the role of vaginal discharge pH measuring both in the clinical stage of diagnosing the causes of AVD and in the interpreting laboratory results. Vaginal pH testing is an important component of the clinical stage in diagnostics of the AVD causes. This feasible and quick study allows objectifying the vaginal dysbiosis with a decrease in lactoflora and lactic acid value, which requires further laboratory diagnostics during the examination. Also it is an integral part of the Amsel criteria in the diagnostics of bacterial vaginosis, and vaginal health index to assess the degree of vaginal atrophy in menopause. Vaginal pH testing improves the diagnosis of difficult-to-detect infections and rare causes of AVD. Also, this method is useful for telemedicineto prevent unnecessary medical examinations, laboratory tests and self-treatment, or vice versa, to confirm the need for a specialist consultation.

Case Report: Concomitant presence of two STIs in a male patient

Background: The spirochaete Treponema pallidum subsp. pallidum, which causes the infectious disease syphilis, can be spread through sexual contact or perinatal transmission. In recent years, cases of syphilis have increased, especially among individuals engaging in behaviour that makes them more vulnerable (condomless sex and multiple sexual partners) and in men who have sex with men. Condylomata acuminata (external genital warts) is one of the most common viral sexually transmitted infections (STIs). Individuals who are behaviourally vulnerable are also highly prone to be exposed to one or more STIs. Our case exemplifies the occurrence of two STIs in a young man who was behaviourally vulnerable to acquiring STIs. Case: We report a case of a 21-year-old year old heterosexual man presenting with concomitant primary syphilis and genital warts. He presented with a painless genital ulcer and warty growths on his glans penis. Examination showed a painless indurated ulcer and multiple genital warts. Serology was positive for quantitative serological disease research laboratory test (1:16 titre). The patient was diagnosed with two concomitant STIs. He was treated as per the latest Centers for Disease Control and Prevention (CDC) guidelines for primary syphilis and podophyllin resin for genital warts. After four weeks, the genital ulcer showed complete healing and there was a significant reduction of genital warts. Conclusions: Individuals with multiple sexual partners engaging in sexual activity without the use of prevention tools are at a greater chance of acquiring two or more STIs. To reduce concomitant transmission, preventive measures against genital ulcer diseases caused by human papilloma virus, syphilis, herpes, and chancroid, such as early identification and treatment, and condom distribution, must be strengthened as part of national STI prevention. Patients with two or more STIs should be followed regularly to assess the progress of infection and should be offered timely medical treatment.

Prevention of surgical site infections: a personal odyssey

Prevention of surgical site infections: a personal odyssey

Postpartum contraception: A matter of guidelines.

The postpartum period is the perfect time to access family planning services. WHO guidelines contraindicate combined hormonal contraceptives postpartum in breastfeeding patients between 6 weeks and 6 months after delivery (Medical Eligibility Criteria category 3). On the contrary, the Faculty of Sexual and Reproductive Healthcare and the Centers for Disease Control and Prevention guidelines do not contraindicate their use in women who breastfeed from 6 weeks to 6 months postpartum. New combined hormonal contraceptives with natural estrogens have never been studied in this setting. Guidelines agree on the prescription of the progestin-only pill postpartum in non-breastfeeding women (category 1). Differences are found in women who breastfeed. In non-breastfeeding women, an implant is considered safe (category 1) by all guidelines, without any distinction in time. Regarding postpartum breastfeeding women, the guidelines for implants give quite different indications but are still permissive. Intrauterine devices are viable options for postpartum contraception but guidelines give different indications about the timing of insertion. Postplacental intrauterine device placement can reduce the subsequent unintended pregnancy rate, particularly in settings at greatest risk of not having recommended postpartum controls. However, it has yet to be understood whether this approach can really have an advantage in high-income countries. Postpartum contraception is not a 'matter of guidelines': it is the best customization for each woman, as early as possible but at the ideal timing.

Prevalence and Characterization of Legionella pneumophila and Related Species from Water-Based Recreational Sites

Abstract Background and Objectives Legionella is a genus of gram-negative bacteria common in soil and aquatic systems and is associated with protists. They have emerged as a pathogenic group due to the increased use and poor maintenance of artificial water environments. This study aims at phenotypic and molecular identification of Legionella in water and swab samples collected from water-based recreational sites. The biofilm-forming ability of Legionella on exposure to various temperatures and iron concentrations was also studied. Methods A total of 60 samples including 30 swab samples and 30 water samples (decorative fountain ponds, swimming pools, garden sprinklers, drip irrigation system) were collected from in and around Mangalore, Karnataka, India. From each source, swab and water samples were collected as per the Indian standard IS: 1622. The collected samples were processed within 4 hours of collection. The samples were subjected to microbiological and chemical estimation followed by filtration through a 0.2 µm membrane filter. Isolation of Legionella from collected samples was performed as per US Centers for Disease Control and Prevention guidelines 2005. The positive isolates were then checked for biofilm-forming ability at various temperatures (25°C, 35°C, and 45°C) and iron concentration (3 mg/L, 30 mg/L, and 300 mg/L) using crystal violet assay. Results Out of 30, water and swab samples tested, one water sample from a garden sprinkler, swimming pool, and one from both water and swab samples from a decorative fountain showed the presence of Legionella. A biofilm study of Legionella at various temperatures and iron concentrations categorized the bacteria as a moderate biofilm former. Conclusion This study revealed that most of the water and swab samples were found to be negative for Legionella that is quite encouraging and the contamination of water systems in recreational facilities can be reduced by decontamination techniques and proper hygienic practices.

Naloxone-Prescribing Practices in a Freestanding Rehabilitation Hospital.

The study aims to determine whether Physical Medicine & Rehabilitation physicians offer naloxone per the Centers for Disease Control and Prevention Guidelines to patients at the highest risk of complications from opioid treatment and whether there is a difference between inpatient and outpatient naloxone prescribing. A retrospective chart review on 389 adults (outpatient n = 166; inpatient n = 223) from May 4 to May 31, 2022, at an academic rehabilitation hospital. Prescribed medications and comorbidities were evaluated to determine whether Centers for Disease Control and Prevention criteria for offering naloxone were met and whether naloxone was offered. One hundred twenty-nine opioid prescriptions were written for 102 outpatients; 61 qualified for naloxone (morphine milliequivalent range = 10-1080, mean = 158.08). On inpatient, 68 patients received 86 opioid prescriptions; 35 qualified for naloxone (morphine milliequivalent range = 3.75-246, mean = 62.36). Overall, there was a significantly lower rate of opioid prescriptions for inpatients (30.49%) than outpatients (61.45%) ( P < 0.0001), a nonsignificant lower rate of inpatient (51.47%) than outpatient (59.80%) "at-risk" prescriptions ( P = 0.351), and a weakly significant lower rate of naloxone prescribing for inpatient (2.86%) than outpatient visits (8.20%) ( P < 0.0519). At this rehabilitation hospital, there was a low rate of naloxone prescribing by inpatient and outpatient providers, with a higher rate occurring in the outpatient than inpatient setting. More research is needed to understand this prescribing trend to determine potential interventions.

#3349 METICULOUS CATHETER CARE CAN REDUCE CATHETER-RELATED BLOODSTREAM INFECTIONS SIGNIFICANTLY IN HAEMODIALYSIS PATIENTS – A 5-YEAR SINGLE CENTRE STUDY

Abstract Background and Aims The use of central venous catheters as hemodialysis (HD) vascular access is a leading contributor to a high rate of bloodstream infection. Our dialysis unit in China has followed the China National Infection Control Policy for HD unit as well as developed its own specific dialysis catheter care protocol using the Centre for Disease Control and Prevention (CDC) guidelines as a template. By doing so, our HD unit has achieved a tunneled dialysis catheter (TDC)- related bloodstream infection rate of 0.0229 per 1000 catheter days in the past 5 years. This report, aims to share our experience with the other units. Method We have undertaken a retrospective analysis to determine our catheter-related bloodstream infection (CRBSI) rate. The local Ethics and Research Committee has approved the conduct of the retrospective study. In this study, the definition of a CRBSI is taken from Kidney Disease Outcomes Quality Initiative (KDOQI) Vascular Access-2019 update as 1) clinical manifestations (fever &amp;gt; 37.5°C or rigors or presence of clinical signs of infection); 2) confirmation of bacteremia (blood cultures growing the same organism from the dialysis catheter and a peripheral vein), with either positive semiquantitative (&amp;gt;15CFU/catheter segment), or quantitative (&amp;gt;102 CFU/catheter segment), differential period of catheter culture versus peripheral blood culture (BC) positivity of 2 hours; 3) exclusion of another source of infection. Information including patient demographics, causes of kidney failure, and duration of TDC was obtained. Results The Covidien Palindrome chronic catheters have been used in the majority of our patients during the study period. All tunneled dialysis catheters were placed by the nephrologists under radiological guidance in the Hospital's sterile Digital Subtraction Angiography (DSA) Suite. In the study period (2017-2021), an average of 235 prevalent patients were receiving dialysis in the HD unit. A total of 212 tunneled dialysis catheters have been inserted and managed according to our local dialysis access pathway and catheter care protocol. The TDC days have been calculated by adding all the catheter days until the catheters have been removed or the patients have been transferred out of our HD unit. There was a total of 43,585 catheter days. The average waiting time for arteriovenous fistula (AVF) surgery was two weeks. The mean duration of TDC use was 107.8±14.8 days, range 1-1827 days. The incidence of confirmed tunneled CRBSI was 0.0229/ 1000 catheter days. Conclusion Our local catheter care protocol is similar to the CDC's “scrub-the-hub” protocol. 2% chlorhexidine with 70% alcohol has been used for the scrubbing and disinfection but we have a few additional steps. In our practice, great attention is given to the cleansing of the clamps. 1) Prior to removal of the caps, the clamps are opened and the surroundings are cleaned and disinfected thoroughly. 2) Two nurses are assigned to connect the bloodlines to the hubs, hence the risk of hub contamination is reduced. 3) The point of connection between the hubs and the bloodlines is protected with a gauze dressing in 3 layers during the entire duration of the dialysis. We believe our success with a very low rate of CRBSI has been the result of strict adherence to 1) good and general hygiene, 2) a well-designed dialysis catheter care protocol, 3) good use of a vascular access nurse, 4) short-duration of TDC days, and 5) short waiting time for AVF. Limitations: We may have underestimated the true rate of CRBSI because of the inherent nature of the diagnostic criteria as mentioned above. Although it is unlikely that a blood culture would have been missed before intravenous antibiotics under our hospital's stringent antibiotics stewardship and continuous audit, it is still possible in theory. Finally, a small number of patients has been transferred out to other HD units due to their change of residence, hence the follow up data might be incomplete. However, such patients are very few in number and the long follow up of this study strengthens our findings and conclusion.

Social Determinants of Health and Health Equity in the Diagnosis and Management of Pediatric Mild Traumatic Brain Injury: A Content Analysis of Research Underlying Clinical Guidelines.

We conducted a content analysis of the literature underlying the Centers for Disease Control and Prevention (CDC) Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children (i.e., the "Guideline") to determine the extent to which social determinants of health (SDoH) were examined or addressed. The systematic review forming the basis for the Guideline included 37 studies addressing diagnosis, prognosis, and treatment/rehabilitation. We examined those studies to identify SDoH domains derived from the U.S. Department of Health and Human Services' Healthy People 2020 and 2030 websites. No study explicitly mentioned "social determinants of health," by name, and few studies addressed SDoH domains as a primary focus (ranging from 0% to 27% of studies across SDoH domains). The most frequently represented SDoH domains, described in an inferential or a descriptive manner, were Education Access and Quality (29.7% of studies), Social and Community Context (27.0% of studies), and Economic Stability (21.6% of studies). Health Care Access (13.5% of studies) was less well represented and no studies (0%) examined Neighborhood and Built Environment. In terms of the CDC clinical questions, SDoH were only examined as predictors of outcome (prognosis) and no studies examined SDoH in relation to diagnosis or treatment/rehabilitation. The Guideline includes some commentary on health literacy and socioeconomic status. Overall, social determinants of health are largely unrepresented as important or meaningful variables influencing the Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children, or in the studies that informed the Guideline.

Improving Chronic Pain Management in a Family Medicine Residency.

Although the opioid epidemic continues to affect millions of Americans, many family physicians feel underprepared to perform chronic pain management (CPM) and treat opioid use disorder (OUD). To address this gap, we created organizational policy changes and implemented a didactic curriculum to help improve patient care, including medication-assisted treatment (MAT) into our residency. We investigated whether the educational program improved the comfort and ability of family physicians to prescribe opioids and utilize MAT. Clinic policies and protocols were updated to align with the 2016 Centers for Disease Control and Prevention Guidelines for Prescribing Opioids. A didactic curriculum was created to improve resident and faculty comfort with CPM and introduce MAT. An online survey was completed pre- and postintervention between December 2019 and February 2020, utilizing paired sample t test and percentage effective (z test) to assess for change in provider comfort with opioid prescribing. Assessments were made using clinical metrics to monitor compliance with the new policy. Following the interventions, providers reported improved comfort with CPM (P=.001) and perception of MAT (P&lt;.0001). Within the clinical setting there was significant improvement in the number of CPM patients who had a pain management agreement on file (P&lt;.001) and completed a urine drug screen within the past year (P&lt;.001). Provider comfort with CPM and OUD increased over the course of the intervention. We were also able to introduce MAT, adding a tool to the toolbox to help our residents and graduates treat OUD.

Early SARS-CoV-2 Reinfections Involving the Same or Different Genomic Lineages, Spain.

Centers for Disease Control and Prevention guidelines consider SARS-CoV-2 reinfection when sequential COVID-19 episodes occur >90 days apart. However, genomic diversity acquired over recent COVID-19 waves could mean previous infection provides insufficient cross-protection. We used genomic analysis to assess the percentage of early reinfections in a sample of 26 patients with 2 COVID-19 episodes separated by 20-45 days. Among sampled patients, 11 (42%) had reinfections involving different SARS-CoV-2 variants or subvariants. Another 4 cases were probable reinfections; 3 involved different strains from the same lineage or sublineage. Host genomic analysis confirmed the 2 sequential specimens belonged to the same patient. Among reinfections, 36.4% involved non-Omicron, then Omicron lineages. Early reinfections showed no specific clinical patterns; 45% were among unvaccinated or incompletely vaccinated persons, 27% were among persons <18 years of age, and 64% of patients had no risk factors. Time between sequential positive SARS-CoV-2 PCRs to consider reinfection should be re-evaluated.

College students’ knowledge, attitude, and practices on COVID-19 prevention post e-health education program

This study explored if significant improvements in knowledge, attitude, and practices among college students will be observed post E-health education program on COVID-19 prevention. The study reports a pre-post quantitative research on 178 college students. The participants received nine sessions of e-health education developed using the Communicable Disease Control Health Education Curriculum Analysis Tool (HECAT) through Zoom. The adapted and modified questionnaire was developed from previously published literature regarding viral epidemics related to MERS-CoV disease, infection prevention, and control measures for COVID-19 by World Health Organization and the Communicable Disease Control and Prevention guidelines. The first phase gathers the relevant profile and background of the participants, and the last phase comprises post-evaluation. The data were analyzed using SPSS version 27. The results indicate above-average means for knowledge on COVID-19 prevention in the pretest (17.75±2.27) and the posttest (17.60±2.95). Moreover, the participants were aware of the importance of vaccination, social distancing measures, following health protocols, and the essentiality of compliance with government agencies' guidelines. However, the participants were not practicing some of these health measures, as evidenced by the low means in the pretest (1.75±0.97) and posttest (1.66±1.08). All tests for significant differences of pretest and posttest means of knowledge (p=0.46), attitude (p=0.12), and practices (p=0.41) on COVID-19 prevention were all insignificant. Our study provides evidence that the online health education program improved college students' knowledge and attitude toward COVID-19 prevention. Still, they did not adhere to or practice some of the health measures to prevent its transmission.

Evaluation of readability of patient education materials on lateral epicondylitis (tennis elbow) from the top 25 orthopedic institutions

Lateral epicondylitis (LE), also known as "tennis elbow," is a common orthopedic tendinosis of the elbow that affects between 1% and 3% of the overall population. LE occurs due to overuse of the extensor mechanism or muscles of supination in the forearm. The National Institute of Health and the Center for Disease Control suggest that patient education materials (PEMs) be written at a 6th or 8th grade reading level, respectively; however, PEMs are often written far beyond these recommended reading levels. The goal of this study was to assess the readability level of PEMs published by some of the top orthopedic institutions throughout the United States. A list of the top 25 ranking orthopedic hospitals in the country was compiled using the 2022 U.S. News and World Report Best Hospitals Specialty Ranking. PEMs related to LE were cataloged from each institution's website, and readability levels for each PEM were measured using the http://www.readabilityformulas.com website. This software analyzes readability using the formulas listed in Table1. While the Flesch-Kincaid (FK) Reading Ease Score formula outputs a number from 0 to 100, in which larger numbers indicate easier reading, the remaining formulas demonstrate a text's readability through assigning a grade-appropriate reading level. A Spearman regression was used to evaluate correlation between institutional ranking and FK Reading Ease Scores. Of the 25 PEM texts analyzed during this study, none were written at or below the sixth grade reading level, as recommended by the National Institutes of Health. These results suggest that the most prestigious orthopedic hospitals provide online informational resources that are unable to be read or understood by a large portion of the institution's intended audience. Additionally, there was no correlation found between institutional ranking and FK Reading Ease Score. Internet-based health information has conveniently allowed patients to educate themselves on their health care. In accordance with National Institutes of Health and Centers for Disease Control and Prevention guidelines, orthopedic institutions should strive to publish PEMs at or below an eighth grade reading level.

Emergence of Erythromycin-Resistant Invasive Group A Streptococcus, West Virginia, USA, 2020-2021.

Clindamycin and β-lactam antibiotics have been mainstays for treating invasive group A Streptococcus (iGAS) infection, yet such regimens might be limited for strains displaying MLSB phenotypes. We investigated 76 iGAS isolates from 66 patients in West Virginia, USA, during 2020-2021. We performed emm typing using Centers for Disease Control and Prevention guidelines and assessed resistance both genotypically and phenotypically. Median patient age was 42 (range 23-86) years. We found 76% of isolates were simultaneously resistant to erythromycin and clindamycin, including all emm92 and emm11 isolates. Macrolide resistance was conferred by the plasmid-borne ermT gene in all emm92 isolates and by chromosomally encoded ermA, ermB, and a single mefA in other emm types. Macrolide-resistant iGAS isolates were typically resistant to tetracycline and aminoglycosides. Vulnerability to infection was associated with socioeconomic status. Our results show a predominance of macrolide-resistant isolates and a shift in emm type distribution compared with historical reports.

Macromastia and Reduction Mammaplasty: Analysis of Outpatient Cost of Care and Opioid Consumption at 5 Years Postoperatively.

Macromastia is associated with increased opioid consumption, which could potentially be the initial exposure for patients with an opioid use disorder amid an escalating opioid crisis in the United States. The purpose of this study was to evaluate outpatient cost of care and opioid consumption in patients with macromastia and compare those who underwent reduction mammaplasty vs those who did not have surgery. PearlDiver, a database encompassing a national cohort of private payers with 153 million unique patients, was queried. The study cohort included patients diagnosed with macromastia who did or did not undergo reduction mammaplasty utilizing both ICD-9 and ICD-10 and CPT codes. Outpatient cost of care and morphine milligram equivalents (MME) were calculated up to 5 years postoperatively for both cohorts. At 1 to 3 years postoperatively, there was no statistically significant difference in outpatient cost of care between cohorts. At every follow-up thereafter, outpatient cost of care was higher among macromastia patients who did not undergo reduction mammaplasty, with cohort differences of US$240.68 and US$349.90 at 4 years and 5 years, respectively (P < .05). MME consumption was greater in patients who underwent reduction mammaplasty up to 30 days postoperatively (P < .01). Beyond that, there was no significant difference in MME consumption between cohorts. However, patients who did not undergo surgery had opioid consumption levels above 50 MME/day until 3 years after diagnosis of macromastia. Patients with macromastia who undergo reduction mammaplasty have lower outpatient care costs than patients who do not undergo reduction mammaplasty, with safer long-term opioid consumption in alignment with current Centers for Disease Control and Prevention guidelines.

Comparative Performance Evaluation of the Public Health Surveillance Systems in 6 Gulf Cooperation Countries: Cross-sectional Study.

Evaluating public health surveillance systems is important to ensure that events of public health importance are appropriately monitored. Evaluation studies based on the Centers for Disease Control and Prevention (CDC) guidelines have been used to appraise surveillance systems globally. Previous evaluation studies undertaken in member countries of the Gulf Cooperation Council (GCC) were limited to specific illnesses within a single nation. We aimed to evaluate public health surveillance systems in GCC countries using CDC guidelines and recommend necessary improvements to enhance these systems. The CDC guidelines were used for evaluating the surveillance systems in GCC countries. A total of 6 representatives from GCC countries were asked to rate 43 indicators across the systems' level of usefulness, simplicity, flexibility, acceptability, sensitivity, predictive value positive, representativeness, data quality, stability, and timeliness. Descriptive data analysis and univariate linear regression analysis were performed. All surveillance systems in the GCC covered communicable diseases, and approximately two-thirds (4/6, 67%, 95% CI 29.9%-90.3%) of them covered health care-associated infections. The mean global score was 147 (SD 13.27). The United Arab Emirates scored the highest in the global score with a rating of 167 (83.5%, 95% CI 77.7%-88.0%), and Oman obtained the highest scores for usefulness, simplicity, and flexibility. Strong correlations were observed between the global score and the level of usefulness, flexibility, acceptability, representativeness, and timeliness, and a negative correlation was observed between stability and timeliness score. Disease coverage was the most substantial predictor of the GCC surveillance global score. GCC surveillance systems are performing optimally and have shown beneficial outcomes. GCC countries must use the lessons learned from the success of the systems of the United Arab Emirates and Oman. To maintain GCC surveillance systems so that they are viable and adaptable to future potential health risks, measures including centralized information exchange, deployment of emerging technologies, and system architecture reform are necessary.

Are We Undertreating Pain—A Review of the CDC 2022 Opioid Prescription Guidelines in the Context of Otolaryngology

This Viewpoint discusses the 2022 Centers for Disease Control and Prevention guidelines for opioid prescription in the context of otolaryngology.

Sexual and Reproductive Healthcare Visits as a Venue for PrEP Service Delivery among Women in the United States: Results from a Nationally-Representative Survey.

Pre-Exposure Prophylaxis (PrEP) for HIV is disproportionately under prescribed to women. Centers for Disease Control and Prevention (CDC) guidelines identify a group of women at risk of HIV acquisition who should be offered PrEP, but opportunities remain to improve patient awareness of and provider counseling about PrEP, and to expand service delivery of PrEP. Using nationally representative data from the 2017-2019 National Survey of Family Growth, we compared women with (n = 689) and without (n = 5,452) CDC indications for PrEP on measures of PrEP awareness, counseling by a provider, and interaction with the health care system. Women with PrEP indications were no more likely to report awareness of PrEP (OR 1.03, 95% CI 0.82-1.29) or PrEP counseling by a provider (OR 1.32, 95% CI 0.77-2.27), compared to those without PrEP indications. However, women with PrEP indications were more likely than those without to report a birth control visit (OR 1.82, 95% CI 1.39-2.38) or an abortion within the last 12 months (OR 5.93, 95% CI 1.48-23.73), and to currently use prescription contraception (OR 1.45, 95% CI 1.19-1.78). A majority of both groups reported accessing prenatal care within the last 12 months. There remains a gap in PrEP awareness and counseling among women at highest risk for HIV acquisition. Sexual and reproductive health visits represent a logical and feasible venue for PrEP provision. Obstetrician-gynecologists and other family planning providers may be able to aid in service delivery innovations by providing PrEP alongside other sexual and reproductive health care.

Optimal dietary patterns for prevention of chronic disease.

Multiple dietary patterns have been associated with different diseases; however, their comparability to improve overall health has yet to be determined. Here, in 205,852 healthcare professionals from three US cohorts followed for up to 32 years, we prospectively assessed two mechanism-based diets and six diets based on dietary recommendations in relation to major chronic disease, defined as a composite outcome of incident major cardiovascular disease (CVD), type 2 diabetes and cancer. We demonstrated that adherence to a healthy diet was generally associated with a lower risk of major chronic disease (hazard ratio (HR) comparing the 90th with the 10th percentile of dietary pattern scores = 0.58-0.80). Participants with low insulinemic (HR = 0.58, 95% confidence interval (CI) = 0.57, 0.60), low inflammatory (HR = 0.61, 95% CI = 0.60, 0.63) or diabetes risk-reducing (HR = 0.70, 95% CI = 0.69, 0.72) diet had the largest risk reduction for incident major CVD, type 2 diabetes and cancer as a composite and individually. Similar findings were observed across gender and diverse ethnic groups. Our results suggest that dietary patterns associated with markers of hyperinsulinemia and inflammation and diabetes development may inform on future dietary guidelines for chronic disease prevention.