Association of the COVID-19 Pandemic With Women, Infants, and Children (WIC) Receipt Among Pregnant Individuals: United States, 2016-2022

Objectives. To evaluate the effect of COVID-19 on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) receipt among pregnant individuals overall and by race/ethnicity. Methods. We measured changes in WIC receipt among Medicaid-covered births (n = 10 484 697) from the US National Center for Health Statistics Natality Files (2016-2022). Our interrupted time series logistic model included a continuous monthly variable, a binary post-COVID variable, and a continuous slope shift variable. We additionally fit separate models for each race/ethnicity relative to White individuals, using interaction terms between the time series variables and race/ethnicity. Results. We found decreases in WIC receipt (adjusted odds ratio [AOR] = 0.899; P < .001) from before COVID (66.6%) to after COVID (57.9%). There were larger post-COVID decreases for American Indian/Alaska Native (AOR = 0.850; P < .001), Native Hawaiian/Other Pacific Islander (AOR = 0.877; P = .003), Black (AOR = 0.974; P < .001), and Hispanic (AOR = 0.972, P < .001) individuals relative to White individuals. Conclusions. The greater reductions in WIC receipt among minoritized individuals highlights a pathway through which the pandemic may have widened gaps in already disparate maternal and infant health. Public Health Implications. Continued efforts to increase WIC utilization are needed overall and among minoritized populations. (Am J Public Health. 2023;113(S3):S240-S247. https://doi.org/10.2105/AJPH.2023.307525).

Mathematical modeling of the circadian dynamics of the neuroendocrine-immune network in experimentally induced arthritis

The circadian dynamics of important neuroendocrine-immune mediators have been implicated in progression of rheumatoid arthritis pathophysiology, both clinically as well as in animal models. We present a mathematical model that describes the circadian interactions between mediators of the hypothalamic-pituitary-adrenal (HPA) axis and the proinflammatory cytokines. Model predictions demonstrate that chronically elevated cytokine expression results in the development of adrenal insufficiency and circadian variability in paw edema. Notably, our model also predicts that an increase in mean secretion of corticosterone (CST) after the induction of the disease is accompanied by a decrease in the amplitude of the CST oscillation. Furthermore, alterations in the phase of circadian oscillation of both cytokines and HPA axis mediators are observed. Therefore, by incorporating the circadian interactions between the neuroendocrine-immune mediators, our model is able to simulate important features of rheumatoid arthritis pathophysiology.

Usefulness of the stool Wright's stain in the emergency department

A prospective study was conducted to determine if a Wright's stain of stool specimen to detect fecal leukocytes was accurate in predicting the presence of a bacterial pathogen on stool culture. Entry criteria were patient age greater than or equal to 3 months and diarrhea of greater than 1 day. The patient population was drawn from an urban county hospital emergency department on the Texas-Mexican border. A total of 69 patients were evaluated by both routine stool culture and stool Wright's stain. Twenty-three were evaluated for parasitic pathogens. There were seventeen cultures positive for bacterial pathogens and twenty-three positive Wright's stains. Bacterial isolates included Shigella, Salmonella and Campylobacter. Also detected were Giardia, Shistosoma, Blastocytis and Cryptosporidium. The sensitivity of a Wright's stain positive for fecal leukocytes for the presence of a bacterial pathogen by culture was 82%, with a specificity of 83%. These were significantly correlated with a positive culture for a bacterial pathogen (P less than .01). The predictive value of a positive result was 61%, and predictive value of a negative result was 94%, for bacterial pathogens. The Wright's stain is a useful tool for the early presumptive diagnosis of infectious bacterial diarrhea in the emergency department.

Rapid diagnosis of group A strep pharyngitis in the emergency department

Two ten-minute rapid tests for diagnosing Group A streptococcal pharyngitis in 147 emergency department patients with a complaint of sore throat were evaluated using positive throat cultures as the marker for disease. Treatment was initiated solely on the basis of clinical judgment. Sensitivity and specificity were 78% and 93%, respectively, for the rapid test and 69% and 56%, respectively, for clinical judgment. The rapid test was significantly better than clinical judgment alone in determining the presence of disease (P less than .05). The predictive values of the positive and negative and were 78% and 93%, respectively, for the rapid test and 38% and 85%, respectively, for clinical judgment. In the ED setting in which adequate followup is difficult, the rapid test can identify more accurately than can clinical judgment alone those patients who need therapy.

Possible effects of non-HLA antibodies in common typing sera on HLA antigen frequency data in leukemia

Selective adsorption of several common "monospecific" HLA typing sera with HLA typed platelets, purified B lymphocytes, cultured lymphoid cells, or lymphocytes from patients with active chronic lymphocytic leukemia demonstrated that many of these sera contain antibodies to non-HLA antigens. Antibodies were detected to antigens present on peripheral blood B-lymphocytes, cultured lymphoid cells and leukemic cells from patients with both myelocytic and lymphocytic forms of leukemia but absent from T-lymphocytes and platelets. Since these kinds of antibodies appear to be present in a large proportion of common HLA typing sera, caution should be used in interpreting all data related to HLA antigen expression in leukemia.