Centers For Disease Control Research Articles

Abstract C044: Social vulnerability is an important predictor of cardiovascular disease risk after allogeneic hematopoietic cell transplantation

Abstract Introduction: Allogeneic hematopoietic cell transplantation (HCT) is a curative treatment for malignant and non-malignant hematologic diseases. However, long-term HCT survivors have a >4-fold risk of developing cardiovascular disease (CVD) compared to the general population, and CVD is a leading cause of excess mortality after HCT. Comorbidities that emerge after HCT such as hypertension (HTN), diabetes mellitus (DM), and dyslipidemia (DL) are important modifiers of CVD risk, but the impact of social determinants of health (SDOH) on the development of these risk factors and resultant CVD has not been well-characterized. Methods: This retrospective cohort study included 889 patients who underwent an allogenic HCT between 2013 and 2019 at City of Hope and survived ≥1y after HCT. Demographic, disease, treatment, comorbidity, and health outcomes data were abstracted from medical records. The social vulnerability index (SVI), obtained from the Center for Disease Control, represented overall social vulnerability and included 4 themes: socioeconomic status, household composition & disability, minority status & language, and housing & transportation. SVI scores were derived using patients’ addresses at time of HCT. SVI scores ranged from 0 (least vulnerable) to 100 (most vulnerable). Fine-Gray regression analysis evaluated the association between SVI and risk of HTN, DM, and DL, adjusted for age at HCT and treating death as competing risk. We also evaluated the association between having 0, 1, ≥2 cardiovascular risk factors on incidence of clinically significant CVD (heart failure, coronary artery disease, pericarditis, stroke, intracranial hemorrhage, arrhythmia, and/or valvular disease) after HCT. Results: Mean age at HCT was 44.2y (standard deviation 19.8y); 56.7% were male, 43.8% were non-Hispanic White, 35.4% were Hispanic, and 12.9% were Asian. The most common diagnosis was acute myeloid leukemia (39.6%); 48.6% received reduced intensity conditioning. Higher overall SVI was associated with increased risk of HTN (adjusted Hazard Ratio per 10 unit increase in SVI [aHR] 1.10, 95%CI 1.02-1.19) and DM (aHR 1.13, 95%CI 1.03-1.25). There was also an increased risk for DL for the highest SVI tertile for the housing & transportation theme (aHR 1.61, 95%CI 1.10-2.37). Accumulation of de novo risk factors after HCT was associated with an incremental 5y incidence of CVD (None: 6.1%, 95% CI 3.4%-9.9%; 1 risk factor: 15.7%, 95% CI 7.1%-27.3%; >2 risk factors: 31.6%, 95%CI 12.8%-52.4%; p<0.001). In the adjusted multivariable model, survivors with >2 risk factors had 7.0-fold (aHR 6.99, 95%CI 2.86-17.05) risk of CVD compared to those without (ref). Conclusion: Among allogeneic HCT recipients, higher SVI was associated with increased risk of HTN, DM, and DL after HCT, which in turn were associated with incrementally higher 5y incidence of CVD. These findings underscore the importance of SDOH on clinically important outcomes after allogeneic HCT, and may ultimately inform tailored approaches for risk-based screening and resource allocation in long-term survivors. Citation Format: Osariemen V Ogiamien, Sitong Chen, Lizel Atencio, Alysia Bosworth, Meagan Echevarria, Caitlyn Estrada, Mareen Kassabian, Lanie Lindenfeld, F. Lennie Wong, Saro H Armenian, Rusha Bhandari. Social vulnerability is an important predictor of cardiovascular disease risk after allogeneic hematopoietic cell transplantation [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C044.

CDC data show some relief in overdose deaths

The most recent data from the federal Centers for Disease Control and Prevention indicate that the death rate from overdoses took a dip, for the first time in years. It's still bad news. But possibly, if the trend continues, good news.

Organisational models for managing Public Health Emergencies of International Concern (PHEICs) in the South-East Asia Region (SEAR) nations: protocol for a systematic review

IntroductionThe current literature suggests that the frequency and complexity of public health emergencies are rising and this trend will likely continue. From 2000 to 2023, seven events have been declared...

The coming microbial crisis: Our antibiotic bubble is about to burst

This month, the United Nations (UN) General Assembly will convene its second High-Level Meeting on antimicrobial resistance , urging UN member states to take decisive action against this growing threat. The US Centers for Disease Control and Prevention (CDC) has released a list of the drug-resistant bacterial and fungal infections that pose the greatest concern to public health. Yet, despite increasing warnings from infectious disease experts, the public remains largely unaware of the true scale of the problem. In a world where antibiotics still protect us from bacterial infections, we are shielded from experiencing antimicrobial resistance as an immediate threat to our daily lives.

Vaping: The Key to Quitting Cigarettes or a Gateway to Addiction?

Background and Objectives: In 2022, the Centers for Disease Control and Prevention (CDC) discovered that 2.55 million middle and high school students were using electronic cigarettes (e-cigarettes) in the US alone. E-cigarettes allow people to inhale a nicotine solution (e-liquid) into their bodies. While e-cigarettes are often advertised as a way to help people quit traditional tobacco products, the World Health Organization (WHO) has stated that there is no proof of e-cigarettes being effective at reducing an individual's tobacco use. The objective of this study is to determine why adolescents start smoking e-cigarettes. Materials and Methods: For the following study, the National Youth Tobacco Survey (NYTS) 2021 was used. This is a nationally representative cross-sectional survey that includes middle and high school students. The data were analyzed using SAS v.9.4. The odds ratio for smoking e-cigarettes was evaluated for both sex and race via a logistic regression. Results: It was discovered that the percentage of only e-cigarette smokers (12.10%) was 5.5 times the percentage of only traditional smokers (2.19%). Additionally, the median age at which adolescents started smoking e-cigarettes was fifteen years with an IQR (Inter Quartile Range) of two. We used a logistic regression to show that biological sex and race were significant predictors of e-cigarette usage. Conclusions: In general, we saw that adolescents were mostly starting to smoke e-cigarettes because their friends were doing it, out of curiosity, they were depressed or anxious, and/or to get a "high", implying that adolescents mostly started smoking in order to fit in and/or to numb themselves. Interestingly, reasons like cost, using them to quit smoking, seeing them in the media, and ease of attainment were ranked the lowest when it came to smoking e-cigarettes. However, their lower costs naturally lead to increased accessibility compared to traditional cigarettes, making them easier to reach the hands of teenagers. Overall, in this paper, we aim to identify if adolescents are choosing e-cigarettes as their first foray into tobacco products and why.

Breaking Down Silos in the Workplace: A Framework to Foster Collaboration.

Employees are often placed within an organization based on their respective roles or duties, which can lead to vertical and horizontal organizational silos. Organizational silos may restrict information, resources, and stymie progress and innovation. This analysis presents a framework to mitigate silos and overcome communication barriers within an organization by increasing collaboration. The project team examined results from the Centers for Disease Control and Prevention (CDC), the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) 2020 Employee Viewpoint Survey Results and conducted 19 key informant discussions with NCCDPHP employees. Participants were asked to provide feedback on (1) understanding silos in the workplace and (2) best practices for reducing silos and fostering collaboration. A thematic analysis was conducted to understand organizational silos, the motivation to reduce silos, and identify best practices and strategies. Respondents felt that siloing exists at the division and branch levels; however, 95% of respondents were motivated to reduce silos. Fifty-eight percent of respondents identified that institutional factors such as the organizational structure (n=8) and red tape/bureaucracy (n=3) contribute to siloing. Additional behaviors and actions that perpetuate silos were identified, and efforts to reduce silos were categorized to propose a model: Framework to Foster Collaboration for improving organizational collaborative efforts. Key themes included inclusion, shared goals and vision, bi-directional communication, and relationship building and developing trust as critical elements for improving collaboration and creating synergy across teams in efforts to reduce silos in the workplace.

Automating COVID-19 epidemiological situation reports based on multiple data sources, the Netherlands, 2020 to 2023

BackgroundDuring the COVID-19 pandemic, the National Institute for Public Health and the Environment in the Netherlands developed a pipeline of scripts to automate and streamline the production of epidemiological situation reports (epi‑sitrep). The pipeline was developed for the Automation of Data Import, Summarization, and Communication (hereafter called the A-DISC pipeline). ObjectiveThis paper describes the A-DISC pipeline and provides a customizable scripts template that may be useful for other countries wanting to automate their infectious disease surveillance processes. MethodsThe A-DISC pipeline was developed using the open-source statistical software R. It is organized in four modules: Prepare, Process data, Produce report, and Communicate. The Prepare scripts set the working environment (e.g., load packages). The (data-specific) Process data scripts import, validate, verify, transform, save, analyze, and summarize data as tables and figures and store these data summaries. The Produce report scripts gather summaries from multiple data sources and integrate them into a RMarkdown document – the epi‑sitrep. The Communicate scripts send e-mails to stakeholders with the epi‑sitrep. ResultsAs of March 2023, up to ten data sources were automatically summarized into tables and figures by A-DISC. These data summaries were featured in routine extensive COVID-19 epi‑sitreps, shared as open data, plotted on RIVM's website, sent to stakeholders and submitted to European Centre for Disease Prevention and Control via the European Surveillance System -TESSy [38]. DiscussionIn the face of an unprecedented high number of cases being reported during the COVID-19 pandemic, the A-DISC pipeline was essential to produce frequent and comprehensive epi‑sitreps. A-DISC's modular and intuitive structure allowed for the integration of data sources of varying complexities, encouraged collaboration among people with various R-scripting capabilities, and improved data lineage. The A-DISC pipeline remains under active development and is currently being used in modified form for the automatization and professionalization of various other disease surveillance processes at the RIVM, with high acceptance from the participant epidemiologists. ConclusionThe A-DISC pipeline is an open-source, robust, and customizable tool for automating epi‑sitreps based on multiple data sources.

Investigation on the current situation of occupational disease hazards in stone processing enterprises in Weihai City

Objective: To analyze the occupational disease hazards in stone processing enterprises in Weihai City to provide scientific basis for occupational disease prevention. Methods: From January 2021 to December 2022, 107 stone processing enterprises in Weihai City were selected to collect the detection status of occupational hazard factors in the workplace through on-site investigation and on-site monitoring of occupational hazard factors. The diagnostic reports on occupational diseases and suspected occupational diseases of 780 workers were collected through the Occupational Diseases and Hazard Factors Monitoring Information System of the Chinese Center for Disease Control and Prevention, the occupational health monitoring files of the occupational health examination institutions and the information data of the occupational disease diagnosis institutions. The differences between the measurement data were analyzed by Chi-square test or Fisher exact probability method. Results: 107 stone processing enterprises were mainly focused on granite processing, and the average free silica content in granite was 32.92% (12.78%-47.84%). The over-standard rate of silica dust was 0.31% (6/1920), and the over-standard rate of noise was 86.20% (1324/1536). Among them, the noise intensity of cutting position was the highest[120.5 dB (A) ]. The over-standard rates of noise in cutting, water grinding, dry grinding (polishing) and material preparation (forklift transportation) were 98.05%, 89.55%, 70.00% and 42.62%, respectively, and the differences were statistically significant (P<0.05). Among 780 workers, 31 cases (3.97%) of suspected silicosis were detected, and 13 cases (1.67%) were diagnosed with silicosis. 51 cases (6.54%) of suspected occupational noise deafness were detected, and 11 cases (1.41%) were diagnosed with occupational noise deafness. Conclusion: Silicon dust and noise in some positions of stone processing enterprises in Weihai City exceed the standard, and supervision should be strengthened, prevention and control measures should be implemented to protect the occupational health of workers.

Cognitive, emotional, communicative, and motor development in children born from couple’s gametes cryopreserved oocytes. A 20 years single-center experience

ObjectiveTo study if social and emotional, communicative, cognitive, motor development of children born from cryopreserved oocytes are comparable to general population. DesignSurvey study. ExposureThis is a single-center population study, focusing on all children born from cycles of in vitro fertilization of cryopreserved oocytes at Humanitas Fertility Center from January 1st,2003, until December 31st, 2021. Main outcome measuresGeneral information about birth history were collected from all parents. Then, screening for developmental delay was performed by administration of a questionnaire, edited according to milestones set for age by the Center for Disease Control and Prevention.Primary outcomes included the percentage of children, for each age range, that reached related milestones. In children younger than 6 years of age, milestones were considered to be reached by each age-based population subgroup studied when ≥ 75 % of included children expressed the tested competences. ResultsA total of 355 live births fulfilled the inclusion and exclusion criteria and were included in the study. Results showed that each age-based population subgroup, younger than 6 years of age, scored ≥ 75 % in all the milestones included in the questionnaire.In preadolescents and adolescents, it was noted a decrease in unstructured in-person socializing. Indeed, milestones that scored the lowest values, based on parents’ judgement, included tasks concerning peer-to-peer interaction (72.31%) and sexuality and sentimental relationships (63.08%). ConclusionsResults indicated that the achievement of emotional, communicative, cognitive, and motor milestones in infants, toddlers, and preschoolers was comparable to the general pediatric population. Similarly, emotional wellbeing and social engagement in school-aged children, preadolescents, and adolescents were in line with their peers.

Bionomics and distribution of malaria vectors in Kisumu city, Western Kenya: Implications for urban malaria transmission.

Increasing urbanization in tropical Africa may create new niches for malaria vectors, potentially leading to higher disease transmission rates. Vector control efforts remain largely targeted at ecologically rural bio-complexities with multiple hosts. Understanding mosquito species composition, ecology, host diversity and biting behavior in urban areas is crucial for planning effective control. This study assessed mosquito species diversity, abundance, behavioral patterns, and Plasmodium sporozoite infection rates of Anopheles vectors along an urban-rural transect in Kisumu city, western Kenya. Indoor and outdoor host-seeking and resting adult mosquitoes were collected using Centers for Disease Control and Prevention miniature light traps (CDC-LT) and mechanical aspirators (Prokopack) along an urban-rural transect. Females Anopheles mosquitoes collected were identified using morphological taxonomic keys to species level. Specimens belonging to the Anopheles gambiae complex and Anopheles funestus group were further processed using polymerase chain reaction (PCR) to identify members of each complex/group. Subsequently, sporozoite infection rates of the anopheline mosquitoes were determined using a multiplexed real-time quantitative PCR (qPCR) assay. A total of 3,394 female Anopheles mosquitoes were collected and identified. These comprised of An. gambiae s.l. (68%), An. funestus group (19.8%), An. coustani (7.8%), An. pharoensis (2.6%), An. maculipalipis (1.6%), and An. leesoni(0.2%). All six species were found in urban zone, but only three were found in peri-urban and rural sites. Overall, urban collections accounted for the majority of these collections (55.5%) of mosquitoes collected, followed by those from peri-urban (30%) and rural sites (14.5%). Species distribution across the three ecotypes showed Anopheles arabiensis was the dominant species in urban (84.3%) and peri-urban (89%) sites, while An. gambiae s.s. was predominantly found in the rural zone (60.2%) alongside An. arabiensis (39.7%). Anopheles funestus was the predominant species in peri-urban (98.4%) and rural (85.7%) areas, with An. leesoni accounted for 1.6% and 14.3%, respectively. In urban areas, all samples from the An. funestus group were identified as An. funestus s.s.. Majority (55.5%) of Anopheles mosquitoes were collected indoors, while secondary vectors were primarily caught outdoors. Overall, sporozoite rates were higher outdoors 3.5% compared to indoors 1.45% in rural areas. Specifically, sporozoite infectivity rates for An. funestus, An. gambiae s.s and An. arabiensis collected indoors in the rural zone was 2.5%, 1.4% and 1% respectively. Outdoors in rural areas, An. gambiae had a sporozoite rate of 5.3%, while An. arabiensis had a rate of 2.1%. In peri-urban areas An. gambiae had a sporozoite rate of 2.3%. No sporozoites were detected in samples from urban sites. The study highlights a shift of diversity of Anopheles species towards urban areas with increased outdoor activity, and significant outdoor malaria transmission in rural and peri-urban areas, emphasizing the need for tools targeting outdoor-biting mosquitoes. The presence of An. funestus in urban settings is of interest and highlights the critical importance of sustained entomological surveillance to inform integrated vector control and prevent future transmission risks.

Laboratory maintenance and care of Rhodnius prolixus (Hemiptera: Reduviidae) and other Triatominae

Abstract Triatomines (Hemiptera: Reduviidae) are hematophagous insects that transmit Trypanosoma cruzi, the etiological agent for Chagas disease, to humans and other mammals. As medically important vectors, species such as Rhodnius prolixus (Hemiptera: Reduviidae) have long been used as a model organism for physiological studies. Laboratory rearing of triatomines is needed to support vector and parasite research. Many environmental conditions, such as suitable housing containers, light source and duration, temperature, humidity, and density, must be addressed when adapting triatomines from a natural habitat for artificial rearing to create conditions for optimal growth and survival. Food source is also an important factor, as triatomines are considered the obligate blood feeders. Parasites and pathogens present risks not only for triatomines but also for the laboratorians handling them. Equipping an insectary space should apply best practices to ensure community, personnel, and insect health. Various triatomine colonies have been maintained in the Centers for Disease Control and Prevention (CDC) Entomology Branch insectary for over 25 years and have more recently been made available to the research community through the Biodefense and Emerging Infections Research Resources Repository (BEI Resources). The CDC Rhodnius prolixus genome has been characterized and thus represents an opportunity for continued model organism research. In addition to fulfilling requests for live triatomines, inquiries are received for support in establishing new and troubleshooting existing laboratory colonies. To accompany the extensive MR4 manual, Methods in Anopheles Research, procedures for triatomine husbandry have been developed and are shared here to address the aforementioned topics.

Safety of the Seasonal Influenza Vaccine in 2 Successive Pregnancies

ImportanceAlthough influenza vaccination has been found to be safe in pregnancy, few studies have assessed repeated influenza vaccination over successive pregnancies, including 2 vaccinations in a year, in terms of adverse perinatal outcomes.ObjectiveTo examine the association of seasonal influenza vaccination across successive pregnancies with adverse perinatal outcomes and whether the association varies by interpregnancy interval (IPI) and vaccine type (quadrivalent or trivalent).Design, Setting, and ParticipantsThis retrospective cohort study included individuals with at least 2 successive singleton live-birth pregnancies between January 1, 2004, and December 31, 2018. Data were collected from the Vaccine Safety Datalink, a collaboration between the Centers for Disease Control and Prevention and integrated health care organizations. Data analysis was performed between January 8, 2021, and July 17, 2024.ExposuresInfluenza vaccination was identified using vaccine administration codes. The vaccinated cohort consisted of people who received influenza vaccines during the influenza season (August 1 through April 30) in 2 successive pregnancies. The comparator cohort consisted of people identified as unvaccinated during both pregnancies.Main Outcomes and MeasuresMain outcomes were risk of preeclampsia or eclampsia, placental abruption, fever, preterm birth, preterm premature rupture of membranes, chorioamnionitis, and small for gestational age among individuals with and without vaccination in both pregnancies. Adjusted relative risks (RRs) from Poisson regression were used to assess the magnitude of associations. The associations with adverse outcomes by IPI and vaccine type were evaluated.ResultsOf 82 055 people with 2 singleton pregnancies between 2004 and 2018, 44 879 (54.7%) had influenza vaccination in successive pregnancies. Mean (SD) age at the start of the second pregnancy was 32.2 (4.6) years for vaccinated individuals and 31.2 (5.0) years for unvaccinated individuals. Compared with individuals not vaccinated in both pregnancies, vaccination in successive pregnancies was not associated with increased risk of preeclampsia or eclampsia (adjusted RR, 1.10; 95% CI, 0.99-1.21), placental abruption (adjusted RR, 1.01; 95% CI, 0.84-1.21), fever (adjusted RR, 0.87; 95% CI, 0.47-1.59), preterm birth (adjusted RR, 0.83; 95% CI, 0.78-0.89), preterm premature rupture of membranes (RR, 1.00; 95% CI, 0.94-1.06), chorioamnionitis (adjusted RR, 1.03; 95% CI, 0.90-1.18), or small for gestational age birth (adjusted RR, 0.99; 95% CI, 0.93-1.05). IPI and vaccine type did not modify the observed associations.Conclusions and RelevanceIn this large cohort study of successive pregnancies, influenza vaccination was not associated with increased risk of adverse perinatal outcomes, irrespective of IPI and vaccine type. Findings support recommendations to vaccinate pregnant people or those who might be pregnant during the influenza season.

Factors associated with fall risk increasing drug use in older black and white men and women: the Health ABC Study

BackgroundMost older adults use medications that may increase falls, often defined as fall risk increasing drugs or “FRIDs”. Two definitions for FRIDs, the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI-Rx) and Swedish National Board of Health and Welfare (SNBHW) definitions, are widely accepted, though include different FRIDs in their definitions. Whether factors associated with FRID use in older adults differ by definition is unknown.MethodsWe hypothesized that factors for FRID use will vary by FRID definition in 1,352 community-dwelling older Black and White adults with medication information in the Health, Aging and Body Composition Study (Health ABC; 2007–08 clinic visit; 83.4 ± 2.8 years; 54.1% women; 65.1% White). Multivariable logistic regression and multivariable negative binomial regression, progressively entering groups of covariates (demographics, lifestyle/behavior factors, and multimorbidity), modeled FRID use (yes/no) and count.ResultsOf 87.0% participants using SNBHW FRIDs, 82.9% used cardiac medications, with lower use of all other FRIDs (range:1.1-12.4%). Of 86.6% participants using STEADI-Rx FRIDs, 80.5% used cardiac medications, with lower use of all other FRIDs (range:1.1-16.1%). Participants with FRID use by either definition were more likely to have chronic health conditions, a hospitalization in the prior year, higher non-FRIDs medication counts, higher Center for Epidemiologic Studies Depression Scale (CES-D) scores, and less physical activity (all p < 0.05). Participants with STEADI-Rx FRID use had poorer vision and higher Modified Mini-Mental State (3MS) scores. In multivariable logistic regression for SNBHW use, hypertension, body mass index (BMI), 3MS scores, and non-FRID count were positively associated with FRID use and poorer vision and Digit Symbol Substitution Test (DSST) scores were negatively associated. In addition to SNBHW factors, higher CES-D scores were associated with STEADI-Rx FRID use. In multivariable negative binomial regression, hypertension, higher BMI, CES-D scores, and non-FRID count were associated with higher FRID count and sleep problems with lower FRID count for both definitions. Higher 3MS and lower DSST scores were associated with higher STEADI-Rx FRID count. Women had lower SNBHW FRID count after adjustments.ConclusionsRisk factors for FRID use in older adults differ slightly by STEADI-Rx and SNBHW FRIDs definition, but are largely similar.

Social Vulnerability and Receipt of Guideline-Concordant Care among Patients with Colorectal Cancer.

Cancer outcome disparities have been reported in highly vulnerable communities. The objective of this study was to evaluate the association of social vulnerability with receipt of guideline-concordant care (GCC) and mortality risk for patients with colorectal cancer. This retrospective observational study identified patients with stage I-III colon or stage II-III rectal cancer between 2018 and 2020 from the National Program of Cancer Registries Database. Data were merged with the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) at the county level. GCC was defined as stage-appropriate lymphadenectomy, radiation therapy, or systemic therapy. Multivariable logistic regression and Cox proportional hazards regression investigated associations of SVI, as a continuous and categorical variable stratified into quartiles, with GCC and 3-year cancer-specific mortality risk, respectively. Among 124,950 patients (colon, n=102,399; rectal, n=22,551), median SVI was 60.9 (IQR 35.0 to 79.5). Patients in the highest SVI quartile had 21% decreased odds of receiving GCC (95% CI 0.76 - 0.83). Treatment at Commission on Cancer (CoC) accredited hospitals was associated with increased GCC (OR 1.79; 95% CI 1.72 - 1.85). Although there was an inverse, decreasing association between SVI and probability of GCC, probability at non-CoC-accredited hospitals declined faster than at CoC-accredited hospitals (p<0.05). After adjusting for receipt of GCC, highly vulnerable patients treated at CoC-accredited hospitals had decreased mortality risk (HR 0.91; 95% CI 0.83 - 0.98). For highly vulnerable patients, treatment at CoC-accredited hospitals was associated with increased receipt of GCC and decreased mortality risk, which may reflect CoC-accreditation requirements for treatment guideline adherence, community engagement, and addressing barriers to care.

Epidemiology and SARIMA model of deaths in a tertiary comprehensive hospital in Hangzhou from 2015 to 2022

BackgroundBy analysing the deaths of inpatients in a tertiary hospital in Hangzhou, this study aimed to understand the epidemiological distribution characteristics and the composition of the causes of death. Additionally, this study aimed to predict the changing trend in the number of deaths, providing valuable insights for hospitals to formulate relevant strategies and measures aimed at reducing mortality rates.MethodsIn this study, data on inpatient mortality at a tertiary hospital in Hangzhou from 2015 to 2022 were obtained via the population information registration system of the Chinese Center for Disease Control and Prevention. The death data of inpatients were described and analysed through a retrospective study. Excel 2016 was utilized for data sorting, and SPSS 22.0 software was employed for data analysis. The statistical inference of single factor differences was conducted via χ2 tests. The SARIMA model was established via the forecast, aTSA, and tseries software packages (version 4.3.0) to forecast future changes in the number of deaths.ResultsA total of 1938 inpatients died at the tertiary hospital in Hangzhou, with the greatest number of deaths occurring in 2022 (262, 13.52%). The sex ratio was 2.22:1, and there were significant differences between sexes in terms of age, marital status, educational level, and place of residence (P < 0.05). The percentage of males in the groups aged of 20 to 29 and 30 to 39 years was significantly greater than that of females (χ2 = 46.905, P < 0.001). More females than males died in the widowed group, and divorced and married males experienced a greater number of deaths than divorced and married females did (χ2 = 61.130, P < 0.001). The proportions of male students with a junior college and senior high school education were significantly greater than that of female students (χ2 = 12.310, P < 0.05). The primary causes of mortality within the hospital setting included circulatory system diseases, injury, poisoning, tumours, and respiratory system diseases. These leading factors accounted for 86.12% of all recorded deaths. Finally, the SARIMA (2, 1, 1) (1, 1, 1)12 model was determined to be the optimal model, with an AIC of 380.23, a BIC of 392.79, and an AICc of 381.81. The MAPE was 14.99%, indicating a satisfactory overall fit of this model. The relative error between the predicted and actual number of deaths in 2022 was 8.02%. Therefore, the SARIMA (2, 1, 1) (1, 1, 1)12 model demonstrates good predictive performance.ConclusionsHospitals should enhance the management of sudden cardiac death, acute myocardial infarction, severe craniocerebral injury, lung cancer, and lung infection to reduce the mortality rate. The SARIMA model can be employed for predicting the number of deaths.

Estimated Airline Compliance With Predeparture SARS-CoV-2 Testing for Passengers on Flights to the United States, January 2021 to June 2022.

In the early years of the COVID-19 pandemic, unprecedented public health measures were designed and implemented to mitigate the spread of SARS-CoV-2. On January 26, 2021, US Centers for Disease Control and Prevention (CDC) staff began daily audits of documents of arriving passengers at 18 US international ports of entry to ensure documentation of either a negative predeparture antigen or nucleic acid amplification test result for SARS-CoV-2 or recent recovery from COVID-19. This case study briefly describes the results of those audits. The CDC found a very low rate of issues overall. Of the 483,251 passengers selected for audit, 2,142 (0.44%) had issues with their COVID-19 test documentation and 1,182 (0.24%) provided documentation of recovery from COVID-19 rather than a negative test result. The low rate of issues noted during traveler audits indicated airlines were largely compliant with the order. However, the burden of SARS-CoV-2 infections within the United States was high during much of this period, which suggests that implementing a predeparture testing requirement earlier in the pandemic might have had more impact on spread. Digital solutions could reduce the burden of similar interventions in the future on airlines, public health authorities, and other partners.

Multidimensional data visualization and synchronization for revealing hidden pandemic information

Visualization is integral to uncovering hidden information in data and providing users with intuitive feedback for decision-making. Data visualization is crucial for transforming complex data into actionable insights across various domains. In recent years, coronavirus disease vaccines have become increasingly available to much of the population. However, the CDC (Centers for Disease Control and Prevention) often fails to consider multidimensional coronavirus pandemic data from a side-by-side perspective, limiting the ability of medical professionals and individuals to compare and interact with comprehensive data visualizations. Effectively displaying coronavirus and vaccination data collected from multiple sources is essential for interpreting pandemic transmission patterns and vaccine efficiency. This paper presents a new platform for innovative data visualizations that offers users intuitive feedback and a complete data story. We designed algorithms to seamlessly combine multiple parameters, synchronize attributes, and dynamically visualize data over time on a single webpage. Instead of integrating all attributes into a single plot, which can be overwhelming due to space limitations and make it difficult to extract crucial information from overcrowded display components, we developed algorithms to classify, enhance, and group all parameters based on their relationships and similarities. Furthermore, a side-by-side visualization method was created to dynamically link all parameters in multiple images for data exploration, trend comparison, hidden information detection, and correspondence analysis. Our platform provides real-time performance, enabling healthcare professionals to make informed decisions, communicate findings effectively, and uncover patterns that might not be apparent in raw data. The proposed multidimensional data visualization algorithms have broad applications in general data exploration and revealing hidden information.

Evaluation of a Standardized Obstetrics Insulin Drip Protocol and Order Set

Objective The prevalence of pregnancies affected by diabetes is increasing, with the Centers for Disease Control and Prevention reporting that 1–2% of pregnant women have type 1 or type 2 diabetes and up to 10% of pregnancies are affected by gestational diabetes as of 2018. Maternal glycemic management is directly related to fetal and neonatal outcomes, and aberrant maternal hyperglycemia has known negative outcomes. Although most of glycemic management centers on outpatient treatment, evidence exists to support the use of intravenous insulin drips during inpatient admissions. This study aimed to evaluate an intravenous insulin protocol specific to the obstetric (OB) population. Research Design and Methods This was a single-center retrospective pre-/post- cohort study of OB patients with diabetes admitted to an academic medical center. Groups were differentiated based on admission date and protocol implementation with a 6-month washout period. Included patients received an intravenous insulin drip around either antenatal corticosteroid administration or during labor and delivery. Those who were within 7 days of receiving a diabetic ketoacidosis diagnosis or who were admitted to an intensive care unit were excluded. Results Fifty-nine patients received 69 distinct insulin drip orders. Twelve drips were included in the group admitted before initiation of the insulin drop protocol (pre-group) and 57 in the group admitted after the protocol went into effect (post-group). Time spent within the goal glucose range while on an insulin drip in the pre-group was 1.63% compared with 39.30% in the post-group (P &amp;lt;0.001). Glucose levels &amp;lt;70 mg/dL was 0.00% in the pre-group compared with 3.23% in the post-group (P = 0.045). There were no differences in severe hypoglycemia (glucose &amp;lt;50 mg/dL), hyperglycemia (glucose &amp;gt;110 mg/dL), or neonatal outcomes. Conclusion Implementation of a nursing-driven, obstetrics-specific intravenous insulin drip protocol significantly improved maternal glycemic management within a goal glucose range of 70–110 mg/dL during antenatal corticosteroid administration and labor and delivery.

Tracking temporal variations of fatality and symptomology correlated with COVID-19 dominant variants and vaccine effectiveness in the United States.

We described how COVID-19 fatality and symptoms varied by dominant variant and vaccination in the US. Using the Restricted Access Dataset from the US CDC (1/1/2020-10/20/2022), we conducted a cross-sectional study assessing differences in COVID-19 deaths, severity indicators (hospitalization, ICU, pneumonia, abnormal X-ray, acute respiratory distress syndrome, mechanical ventilation) and 12 mild symptoms by dominant variant/vaccination periods using logistic regression after controlling for confounders. We found the highest fatality during the dominant periods of Wild (4.6%) and Delta (3.4%). Most severe symptoms appeared when Delta was dominant (Rate range: 2.0-9.4%). Omicron was associated with higher mild symptoms than other variants. Vaccination showed consistent protection against death and severe symptoms for most variants (Risk Ratio range: 0.41-0.93). Boosters, especially the second, provided additional protection, reducing severe symptoms by over 50%. This dataset may serve as a useful tool to monitor temporospatial changes of fatality and symptom for case management and surveillance.

A relaxation‐based Voronoi diagram approach for equitable resource distribution

AbstractThis paper introduces a methodology designed to reduce cost, improve demand coverage, and ensure equitable vaccine distribution during the initial stages of the vaccination campaign when demand significantly exceeds supply. We formulate an enhanced maximum covering problem as a mixed integer linear program, aiming to minimize the total vaccine distribution cost while maximizing the allocation of vaccines to population blocks under equity constraints. Block‐level census data are employed to define demand locations, identifying gender, age, and racial groups within each block using population data. A Lagrangian relaxation technique integrated with a modified Voronoi diagram is proposed to solve the location–allocation problem efficiently. Empirical case studies in Pennsylvania, using real‐world data from the Centers for Disease Control and Prevention and health department websites, were conducted for the first 4 months of the COVID‐19 vaccination campaign. Preliminary results show that the proposed solution algorithm effectively solves the problem, achieving a 5.92% reduction in total transportation cost and a 28.15% increase in demand coverage. Moreover, our model can reduce the deviation from equity to 0.07 (∼50% improvement).