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Valencia D, Yu AT, Wheeler A, Hopkins L, Pray I, Horter L, Vugia DJ, Matzinger S, Stadler L, Kloczko N, Welton M, Bertsch-Merbach S, Domakonda K, Antkiewicz D, Turner H, Crain C, Mulenga A, Shafer M, Owiti J, Schneider R, Janssen KH, Wolfe MK, McClellan SL, Boehm AB, Roguet A, White B, Schussman MK, Rane MS, Hemming J, Collins C, Abram A, Burnor E, Westergaard R, Ricaldi JN, Person J, Fehrenbach N. Notes from the Field: The National Wastewater Surveillance System's Centers of Excellence Contributions to Public Health Action During the Respiratory Virus Season - Four U.S. Jurisdictions, 2022-23. MMWR Morb Mortal Wkly Rep 2023; 72:1309-1312. [PMID: 38032883 DOI: 10.15585/mmwr.mm7248a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
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Taylor MM, Deb A, Frazier B, Lueken JR, Das M, Molke J, Fitzgerald E, Ullian T, Nair R, Couch M, Turbyfill C, Horter L, Joshi C, DeLuca N. Evaluation of the impact of guideline communication from the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services among US healthcare providers: COVID-19 prevention counselling guidance. Nurs Open 2023; 10:7437-7445. [PMID: 37254439 PMCID: PMC10563432 DOI: 10.1002/nop2.1862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/05/2022] [Accepted: 05/09/2023] [Indexed: 06/01/2023] Open
Abstract
AIM To evaluate healthcare provider awareness and uptake of the Centers for Medicare & Medicaid Services (CMS) billing for coronavirus disease 2019 (COVID-19) prevention counselling and the delivery of prevention counselling to patients awaiting severe acute respiratory syndrome coronavirus 2 test results. DESIGN Cross sectional survey of US-based healthcare providers in February 2021. METHODS Analysis of associations with healthcare provider-reported awareness of CMS prevention counselling guidance and billing with provider type, specialty, and work setting. RESULTS A total of 1919 healthcare providers responded to the survey. Overall, 38% (726/1919) of providers reported awareness of available CMS reimbursement for COVID-19 patient counselling and 29% (465/1614) of CMS billing-eligible providers reported billing for this counselling. Among physicians, those aware of CMS guidance were significantly more likely to bill (58%) versus those unaware (10%). Among RNSights respondents eligible for CMS billing (n = 114), 31% of those aware of the guidance reported billing as compared to 0% of those not aware.
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Affiliation(s)
- Melanie M. Taylor
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Arkaprava Deb
- Hospital and Ambulatory Policy GroupCenters for Medicare and Medicaid ServicesWoodlawnMarylandUSA
| | - Bernita Frazier
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - James Reiss Lueken
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Mansi Das
- Office of the Assistant Director of CommunicationsCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | | | | | | | - Caitlin Turbyfill
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Libby Horter
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Cecilia Joshi
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Nickolas DeLuca
- COVID‐19 Response, State, Tribal, Local, and Territorial Support Task Force, Contact Tracing and Innovation SectionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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Cox H, Gebru Y, Horter L, Palomeque FS, Myers K, Stowell D, Easterling T, de Noguera NS, Medina-Forrester A, Bravo J, Pérez S, Chaparro J, Ekpo LLP, Cranford H, Santibañez S, Valencia D. New York State, New York City, New Jersey, Puerto Rico, and the US Virgin Islands' Health Department Experiences Promoting Health Equity During the Initial COVID-19 Omicron Variant Period, 2021-2022. Health Secur 2023; 21:S25-S34. [PMID: 37590481 PMCID: PMC10818041 DOI: 10.1089/hs.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/23/2023] [Accepted: 06/03/2023] [Indexed: 08/19/2023] Open
Abstract
In this case study, we aim to understand how health departments in 5 US jurisdictions addressed health inequities and implemented strategies to reach populations disproportionately affected by COVID-19 during the initial Omicron variant period. We used qualitative methods to examine health department experiences during the initial Omicron surge, from November 2021 to April 2022, assessing successful interventions, barriers, and lessons learned from efforts to promote health equity. Our findings indicate that government leadership supported prioritizing health equity from the beginning of the pandemic, seeing it as a need and vital part of the response framework. All jurisdictions acknowledged the historical trauma and distrust of the government. Health departments found that collaborating and communicating with trusted community leaders helped mitigate public distrust. Having partnerships, resources, and infrastructure in place before the pandemic facilitated the establishment of equity-focused COVID-19 response activities. Finally, misinformation about COVID-19 was a challenge for all jurisdictions. Addressing the needs of diverse populations involves community-informed decisionmaking, diversity of thought, and delivery measures that are tailored to the community. It is imperative to expand efforts to reduce and eliminate health inequities to ensure that individuals and communities recover equitably from the effects of COVID-19.
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Affiliation(s)
- Heidi Cox
- Heidi Cox, MPH, is a Public Health Analyst; in the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Yonathan Gebru
- Yonathan Gebru, MPH, is a Public Health Advisor; in the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Libby Horter
- Libby Horter, MPH, is a Data Manager; in the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Francisco S. Palomeque
- Francisco S. Palomeque, MPH, is a Health Scientist, Division of State and Local Readiness, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA
| | - Kristopher Myers
- Kristopher Myers, PhD, was a Consultant Data Manager, State, Tribal, Local, and Territorial Support Task Force, CDC, Atlanta, GA. He is currently a Data Manager, Goldbelt, C6, LLC, Chesapeake, VA
| | - Daniel Stowell
- Daniel Stowell, MPH, is a Public Health Analyst, Center for Global Health, CDC, Atlanta, GA
| | - Torian Easterling
- Torian Easterling, MD, PhD, is First Deputy Commissioner and Chief Equity Officer, New York City Department of Health and Mental Hygiene, New York, NY
| | - Nayeli Salazar de Noguera
- Nayeli Salazar de Noguera, PhD, is a Program Management Officer, the New Jersey Department of Health, Trenton, NJ
| | - Amanda Medina-Forrester
- Amanda Medina-Forrester, MPH, is Executive Director of Office of Minority and Multicultural Health; the New Jersey Department of Health, Trenton, NJ
| | - Josely Bravo
- Josely Bravo, MPH, is a COVID-19 Vaccine Equity Official; the Puerto Rico Department of Health, San Juan, PR
| | - Siomara Pérez
- Siomara Pérez, DrPH, is a Project Manager; the Puerto Rico Department of Health, San Juan, PR
| | - Jaikiz Chaparro
- Jaikis Chaparro, MSW, is Director of Health Equity Program; the Puerto Rico Department of Health, San Juan, PR
| | - Lisa La Place Ekpo
- Lisa La Place Ekpo, DrPH, is Epidemiologists, US Virgin Islands Department of Health, Saint Thomas, USVI
| | - Hannah Cranford
- Hannah Cranford, MPH, is Epidemiologists, US Virgin Islands Department of Health, Saint Thomas, USVI
| | - Scott Santibañez
- Scott Santibañez, MD, MPHTM, is Chief Medical Officer and Associate Director for Science; in the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Diana Valencia
- Diana Valencia, MS, is a Health Scientist; in the Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention (CDC), Atlanta, GA
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Lane-Barlow C, Thomas I, Horter L, Green J, Byrkit R, Juluru K, Weitz A, Ricaldi JN, Fleurence R, Valencia D. Experiences of Health Departments on Community Engagement and Implementation of a COVID-19 Self-testing Program. J Public Health Manag Pract 2023; 29:539-546. [PMID: 36729971 PMCID: PMC10198798 DOI: 10.1097/phh.0000000000001688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CONTEXT Health departments (HDs) work on the front lines to ensure the health of their communities, providing a unique perspective to public health response activities. Say Yes! COVID Test (SYCT) is a US federally funded program providing free COVID-19 self-tests to communities with high COVID-19 transmission, low vaccination rates, and high social vulnerability. The collaboration with 9 HDs was key for the program distribution of 5.8 million COVID-19 self-tests between March 31 and November 30, 2021. OBJECTIVE The objective of this study was to gather qualitative in-depth information on the experiences of HDs with the SYCT program to better understand the successes and barriers to implementing community-focused self-testing programs. DESIGN Key informant (KI) interviews. SETTING Online interviews conducted between November and December 2021. PARTICIPANTS Sixteen program leads representing 9 HDs were purposefully sampled as KIs. KIs completed 60-minute structured interviews conducted by one trained facilitator and recorded. MAIN OUTCOME MEASURES Key themes and lessons learned were identified using grounded theory. RESULTS Based on perceptions of KIs, HDs that maximized community partnerships for test distribution were more certain that populations at a higher risk for COVID-19 were reached. Where the HD relied predominantly on direct-to-consumer distribution, KIs were less certain that communities at higher risk were served. Privacy and anonymity in testing were themes linked to higher perceived community acceptance. KIs reported that self-test demand and distribution levels increased during higher COVID-19 transmission levels. CONCLUSION HDs that build bridges and engage with community partners and trusted leaders are better prepared to identify and link high-risk populations with health services and resources. When collaborating with trusted community organizations, KIs perceived that the SYCT program overcame barriers such as mistrust of government intervention and desire for privacy and motivated community members to utilize this resource to protect themselves against COVID-19.
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Affiliation(s)
| | - Isabel Thomas
- CDC COVID-19 Response Team
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Libby Horter
- CDC COVID-19 Response Team
- Goldbelt C6, LTD, Chesapeake, Virginia
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Moore JT, Wigington C, Green J, Horter L, Kone A, Lopes-Cardozo B, Byrkit R, Rao CY. Understanding Low Utilization of Employee Assistance Programs and Time Off by US Public Health Workers During the COVID-19 Pandemic. Public Health Rep 2023:333549231165287. [PMID: 37052332 PMCID: PMC10102824 DOI: 10.1177/00333549231165287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE Despite high rates of reported mental health symptoms among public health workers (PHWs) during the COVID-19 pandemic, utilization of employer-offered resources was low. Our objective was to understand what barriers and deterrents exist for PHWs accessing employer-offered resources. METHODS Four national public health organizations disseminated a national online survey of public health department employees during March-April 2021; 26 174 PHWs completed the survey. We examined 5164 write-in survey responses using thematic analysis to identify key reasons why PHWs were not accessing time off and employee assistance programs (EAPs) and to understand what resources PHWs would like to see their employers offer. RESULTS The top reasons that PHWs reported for not taking time off during the COVID-19 pandemic were financial concerns (24.4%), fear of judgment or retaliation (20.8%), and limitations in the amount of time off offered or available (11.0%). The top reasons that PHWs reported for not using EAPs during the COVID-19 pandemic were difficulty accessing EAPs (53.1%), use of external services (21.5%), and a lack of awareness about EAPs or motivation to initiate their use (11.3%). While desired employer-offered resources varied widely, PHWs most frequently listed financial incentives, paid time off, flexible scheduling, and organizational change. CONCLUSION Organizations can best help their employees by organizing the workforce in a way that allows PHWs to take time off, creating a positive and supportive organizational climate, regularly assessing the needs of PHWs, clearly communicating the availability of employer-offered benefits, and emphasizing the acceptability of using those benefits.
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Affiliation(s)
- Jazmyn T Moore
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claire Wigington
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Jamilla Green
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Libby Horter
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Goldbelt C6, LLC, Chesapeake, VA, USA
| | - Ahoua Kone
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Barbara Lopes-Cardozo
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ramona Byrkit
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carol Y Rao
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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6
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Tiesman HM, Hendricks SA, Wiegand DM, Lopes-Cardozo B, Rao CY, Horter L, Rose CE, Byrkit R. Workplace Violence and the Mental Health of Public Health Workers During COVID-19. Am J Prev Med 2023; 64:315-325. [PMID: 36464557 PMCID: PMC9659550 DOI: 10.1016/j.amepre.2022.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION During the COVID-19 pandemic, public health workers were at an increased risk for violence and harassment due to their public health work and experienced adverse mental health conditions. This article quantifies the prevalence of job-related threats, harassment, and discrimination against public health workers and measures the association of these incidents with mental health symptoms during the COVID-19 pandemic. METHODS A nonprobability convenience sample of state, local, and tribal public health workers completed a self-administered, online survey in April 2021. The survey link was emailed to members of national public health associations and included questions on workplace violence, demographics, workplace factors, and mental health symptoms. Mental health symptoms were measured using standardized, validated tools to assess depression, anxiety, post-traumatic stress disorder, and suicidal ideation. Multivariable Poisson models calculated adjusted prevalence ratios of mental health symptoms, with workplace violence as the primary risk factor. Analyses were conducted in 2021-2022. RESULTS Experiencing any type or combination of workplace violence was significantly associated with an increased likelihood of reporting depression symptoms (prevalence ratio=1.21, 95% CI=1.15, 1.27), anxiety (prevalence ratio=1.21, 95% CI=1.15, 1.27), post-traumatic stress disorder (prevalence ratio=1.31, 95% CI=1.25, 1.37), and suicidal ideation (prevalence ratio=1.26, 95% CI=1.14, 1.38), after adjusting for confounders. A dose‒response relationship was found between the number of workplace violence events experienced by a public health worker and the likelihood of reporting mental health symptoms. CONCLUSIONS Violence targeted at the public health workforce is detrimental to workers and their communities. Ongoing training, workplace support, and increased communication after a workplace violence incident may be helpful. Efforts to strengthen public health capacities and support the public health workforce are also needed.
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Affiliation(s)
- Hope M Tiesman
- Analysis and Field Evaluations Branch, Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, West Virginia.
| | - Scott A Hendricks
- Analysis and Field Evaluations Branch, Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, West Virginia
| | - Douglas M Wiegand
- Hazard Evaluations & Technical Assistance Branch, Division of Field Studies & Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - Barbara Lopes-Cardozo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carol Y Rao
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Libby Horter
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia; Goldbelt C6, Chesapeake, Virginia
| | - Charles E Rose
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ramona Byrkit
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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Luckhaupt SE, Horter L, Groenewold MR, de Perio MA, Robbins CL, Sweeney MH, Thomas I, Valencia D, Ingram A, Heinzerling A, Nguyen A, Townsend EB, Weber RC, Reichbind D, Dishman H, Kerins JL, Lendacki FR, Austin C, Dixon L, Spillman B, Simonson S, Tonzel J, Krueger A, Duwell M, Bachaus B, Rust B, Barrett C, Morrison B, Owers Bonner KA, Karlsson ND, Angelon-Gaetz K, McClure ES, Kline KE, Dangar D, Reed C, Karpowicz J, Anderson SM, Cantor S, Chaudhary I, Ellis EM, Taylor ML, Sedon A, Kocharian A, Morris C, Samson ME, Mangla AT. COVID-19 Outbreaks Linked to Workplaces, 23 US Jurisdictions, August-October 2021. Public Health Rep 2023; 138:333-340. [PMID: 36482712 PMCID: PMC9742731 DOI: 10.1177/00333549221138294] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Early in the COVID-19 pandemic, several outbreaks were linked with facilities employing essential workers, such as long-term care facilities and meat and poultry processing facilities. However, timely national data on which workplace settings were experiencing COVID-19 outbreaks were unavailable through routine surveillance systems. We estimated the number of US workplace outbreaks of COVID-19 and identified the types of workplace settings in which they occurred during August-October 2021. METHODS The Centers for Disease Control and Prevention collected data from health departments on workplace COVID-19 outbreaks from August through October 2021: the number of workplace outbreaks, by workplace setting, and the total number of cases among workers linked to these outbreaks. Health departments also reported the number of workplaces they assisted for outbreak response, COVID-19 testing, vaccine distribution, or consultation on mitigation strategies. RESULTS Twenty-three health departments reported a total of 12 660 workplace COVID-19 outbreaks. Among the 12 470 workplace types that were documented, 35.9% (n = 4474) of outbreaks occurred in health care settings, 33.4% (n = 4170) in educational settings, and 30.7% (n = 3826) in other work settings, including non-food manufacturing, correctional facilities, social services, retail trade, and food and beverage stores. Eleven health departments that reported 3859 workplace outbreaks provided information about workplace assistance: 3090 (80.1%) instances of assistance involved consultation on COVID-19 mitigation strategies, 1912 (49.5%) involved outbreak response, 436 (11.3%) involved COVID-19 testing, and 185 (4.8%) involved COVID-19 vaccine distribution. CONCLUSIONS These findings underscore the continued impact of COVID-19 among workers, the potential for work-related transmission, and the need to apply layered prevention strategies recommended by public health officials.
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Affiliation(s)
- Sara E. Luckhaupt
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
- Sara E. Luckhaupt, MD, Centers for Disease
Control and Prevention, COVID-19 Response Team, 1090 Tusculum Ave, MS R-12,
Cincinnati, OH 45226, USA.
| | - Libby Horter
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
- Goldbelt C6, LLC, Chesapeake, VA,
USA
| | - Matthew R. Groenewold
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Marie A. de Perio
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Cheryl L. Robbins
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Marie Haring Sweeney
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Isabel Thomas
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
- ORISE Fellowship, Oak Ridge Associated
Universities, Oak Ridge, TN, USA
| | - Diana Valencia
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Amanda Ingram
- Alabama Department of Public Health,
Montgomery, AL, USA
| | | | - Alyssa Nguyen
- California Department of Public Health,
Sacramento, CA, USA
| | - Emily B. Townsend
- Colorado Department of Public Health
and Environment, Denver, CO, USA
| | - Rachel C. Weber
- Colorado Department of Public Health
and Environment, Denver, CO, USA
| | | | - Hope Dishman
- Georgia Department of Public Health,
Atlanta, GA, USA
| | | | | | - Connie Austin
- Illinois Department of Public Health,
Springfield, IL, USA
| | - Liana Dixon
- Kentucky Department for Public
Health, Frankfort, KY, USA
| | | | - Sean Simonson
- Louisiana Department of Health, Baton
Rouge, LA, USA
| | - Julius Tonzel
- Louisiana Department of Health, Baton
Rouge, LA, USA
| | - Anna Krueger
- Maine Center for Disease Control and
Prevention, Augusta, ME, USA
| | | | | | - Britney Rust
- Mississippi Department of Health,
Jackson, MS, USA
| | | | | | - Katharine A. Owers Bonner
- New Hampshire Division of Public
Health Services, Department of Health and Human Services, Concord, NH, USA
| | - Nicole D. Karlsson
- New Hampshire Division of Public
Health Services, Department of Health and Human Services, Concord, NH, USA
| | - Kim Angelon-Gaetz
- North Carolina Department of Health
and Human Services, Raleigh, NC, USA
| | | | | | - Dhara Dangar
- Pennsylvania Department of Health,
Harrisburg, PA, USA
| | - Chasey Reed
- Rhode Island Department of Health,
Providence, RI, USA
| | | | | | - Sophia Cantor
- Texas Department of State Health
Services, Austin, TX, USA
| | | | - Esther M. Ellis
- US Virgin Islands Department of
Health, Christiansted, VI, USA
| | | | | | | | | | | | - Anil T. Mangla
- District of Columbia Department of
Health, Washington, DC, USA
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Meehan AA, Thomas I, Horter L, Schoonveld M, Carmichael AE, Kashani M, Valencia D, Mosites E. Incidence of COVID-19 Among Persons Experiencing Homelessness in the US From January 2020 to November 2021. JAMA Netw Open 2022; 5:e2227248. [PMID: 35980638 PMCID: PMC9389352 DOI: 10.1001/jamanetworkopen.2022.27248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
IMPORTANCE A lack of timely and high-quality data is an ongoing challenge for public health responses to COVID-19 among people experiencing homelessness (PEH). Little is known about the total number of cases of COVID-19 among PEH. OBJECTIVE To estimate the number of COVID-19 cases among PEH and compare the incidence rate among PEH with that in the general population. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from a survey distributed by the Centers for Disease Control and Prevention to all US state, district, and territorial health departments that requested aggregated COVID-19 data among PEH from January 1, 2020, to September 30, 2021. Jurisdictions were encouraged to share the survey with local health departments. MAIN OUTCOMES AND MEASURES The primary study outcome was the number of cases of COVID-19 identified among PEH. COVID-19 cases and incidence rates among PEH were compared with those in the general population in the same geographic areas. RESULTS Participants included a population-based sample of all 64 US jurisdictional health departments. Overall, 25 states, districts, and territories completed the survey, among which 18 states (72.0%) and 27 localities reported COVID-19 data among PEH. A total of 26 349 cases of COVID-19 among PEH were reported at the state level and 20 487 at the local level. The annual incidence rate of COVID-19 among PEH at the state level was 567.9 per 10 000 person-years (95% CI, 560.5-575.4 per 10 000 person-years) compared with 715.0 per 10 000 person-years (95% CI, 714.5-715.5 per 10 000 person-years) in the general population. At the local level, the incidence rate of COVID-19 among PEH was 799.2 per 10 000 person-years (95% CI, 765.5-834.0 per 10 000 person-years) vs 812.5 per 10 000 person-years (95% CI, 810.7-814.3 per 10 000 person-years) in the general population. CONCLUSIONS AND RELEVANCE These results provide an estimate of COVID-19 incidence rates among PEH in multiple US jurisdictions; however, a national estimate and the extent of under- or overestimation remain unknown. The findings suggest that opportunities exist for incorporating housing and homelessness status in infectious disease reporting to inform public health decision-making.
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Affiliation(s)
- Ashley A. Meehan
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
| | - Isabel Thomas
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
- Oak Ridge Institute for Science and Education Fellowship, Oak Ridge Associated Universities, Oak Ridge, Tennessee
| | - Libby Horter
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
- Goldbelt C6, LLC, Chesapeake, Virginia
| | - Megan Schoonveld
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
- Oak Ridge Institute for Science and Education Fellowship, Oak Ridge Associated Universities, Oak Ridge, Tennessee
| | - Andrea E. Carmichael
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
- Oak Ridge Institute for Science and Education Fellowship, Oak Ridge Associated Universities, Oak Ridge, Tennessee
| | - Mitra Kashani
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
- Oak Ridge Institute for Science and Education Fellowship, Oak Ridge Associated Universities, Oak Ridge, Tennessee
| | - Diana Valencia
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
| | - Emily Mosites
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
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Koné A, Horter L, Thomas I, Byrkit R, Lopes-Cardozo B, Rao CY, Rose C. Symptoms of Mental Health Conditions and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers — United States, March 14–25, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:925-930. [PMID: 35862276 PMCID: PMC9310631 DOI: 10.15585/mmwr.mm7129a4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Kone A, Horter L, Rose C, Rao CY, Orquiola D, Thomas I, Byrkit R, Bryant-Genevier J, Lopes-Cardozo B. The impact of traumatic experiences, coping mechanisms, and workplace benefits on the mental health of U.S. public health workers during the COVID-19 pandemic. Ann Epidemiol 2022; 74:66-74. [PMID: 35850418 PMCID: PMC9287576 DOI: 10.1016/j.annepidem.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 12/01/2022]
Abstract
Purpose To evaluate the association between risk factors, mitigating factors, and adverse mental health outcomes among United States public health workers. Methods Cross-sectional online survey data were collected March to April 2021. The survey was distributed to public health workers who worked in a state, tribal, local, or territorial public health department since March 2020. Results In total, 26,174 United States state and local public health workers completed the survey. Feeling isolated was a risk factor for anxiety (PR, 1.84; 95% CI, 1.74–1.95), depression (PR, 1.84; 95% CI, 1.75–1.94), post-traumatic stress disorder (PR, 1.50; 95% CI, 1.43–1.57), and suicidal ideation (PR, 3.23; 95% CI, 2.82–3.69). The ability to take time off was linked to fewer reported symptoms of anxiety (PR, 0.87; 95% CI, 0.83–0.90), depression (PR, 0.86; 95% CI, 0.83–0.89), post-traumatic stress disorder (PR, 0.84; 95% CI, 0.81–0.88), and suicidal ideation (PR, 0.84; 95% CI, 0.77–0.92). Conclusions Since COVID-19 was declared a pandemic, respondents who felt isolated and alone were at an increased risk for adverse mental health outcomes. Findings from this study call for public health organizations to provide their workforce with services and resources to mitigate adverse mental health outcomes.
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Affiliation(s)
- Ahoua Kone
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Libby Horter
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charles Rose
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carol Y Rao
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diana Orquiola
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Isabel Thomas
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ramona Byrkit
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Barbara Lopes-Cardozo
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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11
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Tang S, Horter L, Bosh K, Kassem AM, Kahn EB, Ricaldi JN, Pao LZ, Kang GJ, Singleton CM, Liu T, Thomas I, Rao CY. Change in unemployment by social vulnerability among United States counties with rapid increases in COVID-19 incidence—July 1–October 31, 2020. PLoS One 2022; 17:e0265888. [PMID: 35442951 PMCID: PMC9020703 DOI: 10.1371/journal.pone.0265888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
Objective During the COVID-19 pandemic, the unemployment rate in the United States peaked at 14.8% in April 2020. We examined patterns in unemployment following this peak in counties with rapid increases in COVID-19 incidence. Method We used CDC aggregate county data to identify counties with rapid increases in COVID-19 incidence (rapid riser counties) during July 1–October 31, 2020. We used a linear regression model with fixed effect to calculate the change of unemployment rate difference in these counties, stratified by the county’s social vulnerability (an indicator compiled by CDC) in the two months before the rapid riser index month compared to the index month plus one month after the index month. Results Among the 585 (19% of U.S. counties) rapid riser counties identified, the unemployment rate gap between the most and least socially vulnerable counties widened by 0.40 percentage point (p<0.01) after experiencing a rapid rise in COVID-19 incidence. Driving the gap were counties with lower socioeconomic status, with a higher percentage of people in racial and ethnic minority groups, and with limited English proficiency. Conclusion The widened unemployment gap after COVID-19 incidence rapid rise between the most and least socially vulnerable counties suggests that it may take longer for socially and economically disadvantaged communities to recover. Loss of income and benefits due to unemployment could hinder behaviors that prevent spread of COVID-19 (e.g., seeking healthcare) and could impede response efforts including testing and vaccination. Addressing the social needs within these vulnerable communities could help support public health response measures.
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Affiliation(s)
- Shichao Tang
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Libby Horter
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Karin Bosh
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ahmed M. Kassem
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Emily B. Kahn
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica N. Ricaldi
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Leah Zilversmit Pao
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gloria J. Kang
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christa-Marie Singleton
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tiebin Liu
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Isabel Thomas
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Carol Y. Rao
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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12
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Sami S, Horter L, Valencia D, Thomas I, Pomeroy M, Walker B, Smith-Jeffcoat SE, Tate JE, Kirking HL, Kyaw NTT, Burns R, Blaney K, Dorabawila V, Hoen R, Zirnhelt Z, Schardin C, Uehara A, Retchless AC, Brown VR, Gebru Y, Powell C, Bart SM, Vostok J, Lund H, Kaess J, Gumke M, Propper R, Thomas D, Ojo M, Green A, Wieck M, Wilson E, Hollingshead RJ, Nunez SV, Saady DM, Porse CC, Gardner K, Drociuk D, Scott J, Perez T, Collins J, Shaffner J, Pray I, Rust LT, Brady S, Kerins JL, Teran RA, Hughes V, Sepcic V, Low EW, Kemble SK, Berkley A, Cleavinger K, Safi H, Webb LM, Hutton S, Dewart C, Dickerson K, Hawkins E, Zafar J, Krueger A, Bushman D, Ethridge B, Hansen K, Tant J, Reed C, Boutwell C, Hanson J, Gillespie M, Donahue M, Lane P, Serrano R, Hernandez L, Dethloff MA, Lynfield R, Como-Sabetti K, Lutterloh E, Ackelsberg J, Ricaldi JN. Investigation of SARS-CoV-2 Transmission Associated With a Large Indoor Convention - New York City, November-December 2021. MMWR Morb Mortal Wkly Rep 2022; 71:243-248. [PMID: 35176005 PMCID: PMC8853477 DOI: 10.15585/mmwr.mm7107a4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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13
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Hoffman V, Hallas J, Linder M, Margulis AV, Suehs BT, Arana A, Phiri K, Enger C, Horter L, Odsbu I, Olesen M, Perez-Gutthann S, Xu Y, Kristiansen NS, Appenteng K, de Vogel S, Seeger JD. Cardiovascular Risk in Users of Mirabegron Compared with Users of Antimuscarinic Treatments for Overactive Bladder: Findings from a Non-Interventional, Multinational, Cohort Study. Drug Saf 2021; 44:899-915. [PMID: 34236595 PMCID: PMC8280006 DOI: 10.1007/s40264-021-01095-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION During clinical trials, mirabegron, a β3-adrenoreceptor agonist, was associated with increased vital signs vs placebo in patients with overactive bladder. OBJECTIVE The purpose of this study was to compare incidence rates of adverse cardiovascular (CV) outcomes following mirabegron or antimuscarinic use. METHODS We conducted an observational post-marketing safety study utilising real-world data. The study population was identified within five sources: Danish and Swedish National Registers, Clinical Practice Research Datalink (UK), Optum (USA) and Humana (USA). Episodes of time when patients were new users of mirabegron or antimuscarinics (October 2012-December 2018) were sourced from prescriptions and matched on propensity scores. Occurrences of major adverse cardiovascular events (MACE), acute myocardial infarction (AMI), stroke, CV mortality and all-cause mortality were identified. Outcome incidence rates and hazard ratios from Cox models were estimated. RESULTS Overall, 152,026 mirabegron and 152,026 antimuscarinic episodes were matched. The population consisted of 63.1% women and 72.6% were ≥ 65 years old. There were no appreciable differences in the incidence rates of MACE, AMI or stroke between users of mirabegron and antimuscarinics. Incidence rates of CV mortality (hazard ratio 0.83, 95% confidence interval 0.73-0.95) and all-cause mortality (hazard ratio 0.80, 95% confidence interval 0.76-0.84) were no higher with mirabegron vs antimuscarinics. Results restricted to episodes at high risk for CV events or stratified by age (< 65 years, ≥ 65 years) or prior overactive bladder medication use were consistent with overall findings. CONCLUSIONS This large, multinational study found no higher risk of MACE, AMI, stroke, CV mortality or all-cause mortality among users of mirabegron relative to users of antimuscarinics.
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Affiliation(s)
| | | | - Marie Linder
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Cheryl Enger
- Optum, 1325 Boylston Street, Boston, MA, 02215, USA
| | | | - Ingvild Odsbu
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Yihua Xu
- Humana Healthcare Research, Louisville, KY, USA
| | | | | | | | - John D Seeger
- Optum, 1325 Boylston Street, Boston, MA, 02215, USA.
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14
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Phiri K, Hallas J, Linder M, Margulis A, Suehs B, Arana A, Bahmanyar S, Hoffman V, Enger C, Horter L, Odsbu I, Olesen M, Perez-Gutthann S, Kristiansen NS, Appenteng K, de Vogel S, Seeger J. A study of cancer occurrence in users of mirabegron and antimuscarinic treatments for overactive bladder. Curr Med Res Opin 2021; 37:867-877. [PMID: 33591859 DOI: 10.1080/03007995.2021.1891035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This post-authorization safety study (EU PAS Register Number: EUPAS16088) was designed to compare the incidence of cancer outcomes in patients treated with mirabegron versus antimuscarinic medications. METHODS Cohorts of mirabegron initiators during 2012-2018 were propensity-score matched to antimuscarinic medication initiators within real-world data sources (Danish National Registers, Swedish National Registers, Clinical Practice Research Datalink [UK], Optum [US], and Humana [US]). Incident cancer cases were identified during follow-up from direct linkage to cancer registers or validated through medical record review or through physician questionnaires. Comparisons of sex-specific composite cancer outcomes (cancer of the lung/bronchus, colon/rectum, melanoma of skin, urinary bladder, non-Hodgkin lymphoma, kidney/renal pelvis, pancreas, prostate in men and breast and uterus in women) were made overall and for person-time in the first year and after the first year following start of treatment, for all ages and for the subgroup ≥65 years. RESULTS Among the 80,637 mirabegron initiators matched to 169,885 antimuscarinic medication initiators, 68% were at least 65 years of age and 66% were women. Over 5000 incident cancer cases were observed overall. Incidence rates were higher for men than women for composite and individual cancer outcomes. The pooled fixed effects hazard ratios for composite cancer outcomes (all ages) were 1.05 (95% confidence interval [CI]: 0.98-1.14) for women and 1.06 (95% CI: 0.98-1.14) for men. Results were similar in persons ≥65 years. CONCLUSIONS The results suggest no association between mirabegron use and risk of cancer, compared with antimuscarinic medications, in either men or women. Registration: EU PAS Register Number: EUPAS16088.
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Affiliation(s)
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Marie Linder
- Centre for Pharmacoepidemiology, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Brandon Suehs
- Humana Healthcare Research, Humana, Louisville, KY, USA
| | | | - Shahram Bahmanyar
- Centre for Pharmacoepidemiology, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Libby Horter
- Humana Healthcare Research, Humana, Louisville, KY, USA
| | - Ingvild Odsbu
- Centre for Pharmacoepidemiology, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Morten Olesen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Nina Sahlertz Kristiansen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Stefan de Vogel
- Pharmacovigilance, Astellas Pharma Europe B.V, Leiden, The Netherlands
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15
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Casebeer A, Horter L, Hayden J, Simmons J, Evers T. Phenotypic clustering of heart failure with preserved ejection fraction reveals different rates of hospitalization. J Cardiovasc Med (Hagerstown) 2020; 22:45-52. [PMID: 32941326 DOI: 10.2459/jcm.0000000000001116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Approximately 50% of patients with heart failure have preserved (≥50%) ejection fraction (HFpEF). Improved understanding of the phenotypic heterogeneity of HFpEF might facilitate development of targeted therapies and interventions. METHODS This retrospective study characterized a cohort of patients with HFpEF based on similar clinical profiles and evaluated 1-year heart failure related hospitalization. Enrolment, medical and pharmacy data were used to identify patients newly diagnosed with heart failure enrolled in a Medicare Advantage Prescription Drug or commercial healthcare plan. To identify only those patients with HFpEF, we used natural language processing techniques of ejection fraction values abstracted from a linked free-text clinical notes data source. The study population comprised 1515 patients newly identified with HFpEF between 1 January 2011 and 31 December 2015. RESULTS Using unsupervised machine learning, we identified three distinguishable patient clusters representing different phenotypes: cluster-1 patients had the lowest prevalence of heart failure comorbidities and highest mean age; cluster-2 patients had higher prevalence of metabolic syndrome and pulmonary disease, despite younger mean age; and cluster-3 patients had higher prevalence of cardiac arrhythmia and renal disease. Cluster-3 had the highest 1-year heart failure related hospitalization rates. Within-cluster analysis, prior use of diuretics (cluster-1 and cluster-2) and age (cluster-2 and cluster-3) was associated with 1-year heart failure related hospitalization. Combination therapy was associated with decreased 1-year heart failure related hospitalization in cluster-1. CONCLUSION This study demonstrated that clustering can be used to characterize subgroups of patients with newly identified HFpEF, assess differences in heart failure related hospitalization rates at 1 year and suggest patient subtypes may respond differently to treatments or interventions.
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Affiliation(s)
| | | | | | - Jeff Simmons
- Healthcare Services, Humana Inc, Louisville, Kentucky, USA
| | - Thomas Evers
- Digital & Commercial Innovation, Bayer AG, Wuppertal, Germany
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16
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Barnes-Marrero I, Horter L, Hayden JD, Patel NC, Mendoza L, Castillo L. Diagnostic accuracy of the repeatable battery of the assessment of neuropsychological status update, Spanish version, in predicting Alzheimer's disease among Hispanic older adults in the United States reporting memory problems. Appl Neuropsychol Adult 2020; 29:509-519. [PMID: 32584154 DOI: 10.1080/23279095.2020.1777554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: There are few standardized, Spanish-language diagnostic tools to help identify Hispanic persons at early stages of Alzheimer's disease (AD). This study evaluated the accuracy of the Spanish version of the Repeatable Battery for the Assessment of Neuropsychological Status-Update (RBANS) in predicting AD in older Hispanic adults in the United States reporting memory problems.Methods: We analyzed data from age, sex, and education level propensity score-matched Hispanic memory clinic patients with (n = 38) and without (n = 38) a clinical diagnosis of AD. Estimates of diagnostic accuracy included sensitivity, specificity, predictive value, and receiver operating characteristic analysis.Results: After controlling for sex and matched pairs, the Total Scale score [area under curve (AUC) = 0.7417] and the Immediate (AUC = 0.7258) and Delayed (AUC = 0.7735) Memory index scores provided better estimates of diagnostic accuracy than Language, Attention, and Visuospatial/Constructional index scores. A minus 2-standard deviation (SD) cut point enhanced the predictive probability of the Delayed Memory index score. A cut point of -1.5 SD optimized the predictive probability of the Total Scale score.Conclusions: These results suggest that optimal cutoff values for the RBANS Delayed Memory index and Total Scale scores that may help identify Hispanic patients with AD as part of a comprehensive diagnostic AD assessment.
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Affiliation(s)
| | - Libby Horter
- Humana Healthcare Research, Inc, Louisville, KY, USA
| | | | - Nick C Patel
- Humana Healthcare Research, Inc, Louisville, KY, USA
| | - Lisandra Mendoza
- Department of Clinical Psychology, Albizu University, Miami, FL, USA
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17
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Hayden JD, Horter L, Parsons T, Ruble M, Townsend S, Klein CC, Duran RP, Welge JA, Crystal S, Patel NC, Correll CU, DelBello MP. Metabolic Monitoring Rates of Youth Treated with Second-Generation Antipsychotics in Usual Care: Results of a Large US National Commercial Health Plan. J Child Adolesc Psychopharmacol 2020; 30:119-122. [PMID: 31851522 DOI: 10.1089/cap.2019.0087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives: To examine metabolic monitoring rates in commercially insured children and adolescents treated with a second-generation antipsychotic (SGA) during calendar years (CYs) 2016 and 2017. Methods: In this retrospective study, data were collected from a large national commercial health plan for the period covering January 1, 2016 to December 31, 2017. Commercially insured children and adolescents, aged 8-19 years with ≥2 SGA prescription claims during the CY, were identified for the CY2016 and CY2017 cohorts. The primary outcome of interest was the percentage of subjects with any glucose or lipid metabolism parameter monitoring. Other calculated metabolic testing rates included glucose, hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), other cholesterol (including triglycerides), and combined glucose and lipid metabolism testing (≥1 test for blood glucose or HbA1c and ≥1 test for LDL-C or other cholesterol). Results: In CY2016 and CY2017, 1502 and 1239 subjects, respectively, were identified for this study. The most common psychiatric diagnoses in CY2016 and CY2017 were major depressive disorder (57.1%, 56.5%, respectively), anxiety disorders (42.9%, 47.5%), attention-deficit/hyperactivity disorder (41.6%, 45.8%), and bipolar disorder (24.1%, 25.9%). The rate of any metabolic testing was 53.5% in CY2016 and 51.3% in CY2017. Glucose testing (50.3%, 46.9%, respectively) was most common in both CYs, followed by LDL-C testing (31.2%, 28.5%). Rates of combined glucose and lipid metabolism testing were 30.7% in CY2016 and 26.9% in CY2017. Conclusions: Given the known potential for adverse cardiometabolic effects, rates of metabolic monitoring associated with SGA use in children and adolescents urgently need to be improved. There is a critical need for understanding barriers to routine monitoring, particularly of lipids, and developing interventions to enhance metabolic monitoring.
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Affiliation(s)
| | - Libby Horter
- Humana Healthcare Research, Inc., Louisville, Kentucky
| | | | | | | | - Christina C Klein
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Rodrigo Patino Duran
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jeffrey A Welge
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, New Brunswick, New Jersey
| | - Nick C Patel
- Humana Healthcare Research, Inc., Louisville, Kentucky
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York.,Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,The Feinstein Institute for Medical Research, Manhasset, New York.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Dang-Tan T, Kamble PS, Meah Y, Gamble C, Ganguly R, Horter L. Real-world Effectiveness of Liraglutide vs. Sitagliptin Among Older Patients with Type 2 Diabetes Enrolled in a Medicare Advantage Prescription Drug Plan: A Retrospective Observational Study. Diabetes Ther 2020; 11:213-228. [PMID: 31820328 PMCID: PMC6965544 DOI: 10.1007/s13300-019-00739-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Liraglutide and sitagliptin were compared on glycemic control and all-cause healthcare costs over a 1-year period among older adults with type 2 diabetes (65-89 years) enrolled in a national Medicare Advantage Prescription Drug health plan. METHODS This was a retrospective study in which the index date was the first prescription fill for liraglutide or sitagliptin between 25 January 2010 and 31 December 2014. Post-index treatment persistence and glycosylated hemoglobin (HbA1c) at baseline and 1 year (± 90 days) post-index date were required. Patients were excluded if their record included use of insulin during the baseline period. Inverse probability of treatment weighting using stabilized weights was employed with final covariate adjusted regression modeling to estimate the primary outcome (mean change in HbA1c) and secondary outcomes (achieving glycemic goal and costs), each at 1-year post-index date. RESULTS Overall, 3056 patients met the selection criteria, of whom 218 filled prescriptions for liraglutide and 2838 for sitagliptin. Adjusted mean change in HbA1c at 1 year post-index was - 0.42 with liraglutide versus - 0.12 with sitagliptin (P = 0.0012). Adjusted odds of achieving the treatment goals of HbA1c < 7% and achieving an HbA1c reduction of ≥ 1% were higher for those on liraglutide than for those on sitagliptin (1.68, 95% confidence interval [CI] 1.25-2.24 and 1.76, 95% CI 1.31-2.36), respectively. Total healthcare costs in those achieving an HbA1c of < 7% were not significantly different between treatment groups but were higher within the liraglutide group for those achieving an HbA1c < 8%. CONCLUSIONS When compared to sitagliptin, liraglutide was associated with greater achievement of an HbA1c < 7% over a 1-year period in an older population. This finding was not associated with a statistically significant increase in all-cause total healthcare costs, although costs were slightly higher in the liraglutide group than in the sitagliptin group.
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Affiliation(s)
| | | | | | | | | | - Libby Horter
- Humana Healthcare Research, Inc., Louisville, KY, USA
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19
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Dacus KC, Horter L, Hayden J, Harvey RA, Thompson S, Gervasio J. Abstract 9: Alirocumab Prior Authorization Approval and Prescription Fill Rates Among Medicare Advantage Patients in a Large US Managed Care Plan. Circ Cardiovasc Qual Outcomes 2018. [DOI: 10.1161/circoutcomes.11.suppl_1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Alirocumab is a proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitor approved as an adjunct to diet and maximally tolerated statin therapy for treatment of adults with heterozygous familial hypercholesterolemia (HeFH) or clinical atherosclerotic cardiovascular disease who require additional lowering of LDL-cholesterol. Barriers to possession, including therapy cost and cost-sharing implications, may contribute to low utilization of this therapy.
Objective:
To explore differences in demographic and clinical characteristics between patients with prior authorization (PA) approvals or denials for alirocumab as evidenced through filled alirocumab prescription claims.
Methods:
A retrospective claims-based database analysis of patients with a Medicare Advantage Prescription Drug (MAPD) plan was conducted to identify patients with evidence of a PA approval for alirocumab. Among the group of patients with a PA for alirocumab, the pharmacy claims database was searched for evidence of a corresponding prescription claim within 30 days following the first PA request (index date). The analysis was stratified by evidence of Federal low income subsidy (LIS) support, a program that provides extra assistance with prescription drug costs for eligible individuals whose income and resources are limited, and/ or dual eligibility (DE) status, eligible for Medicare and Medicaid, (LIS/DE) at index.
Results:
A total of 2,098 MAPD patients meeting study inclusion/exclusion criteria and with a PA for alirocumab were identified between March 1, 2016 and February 28, 2017. Non-LIS/DE patients comprised approximately 82% of the eligible population (n=1,730). There were several notable differences in baseline demographics between the non-LIS/DE vs. the LIS/DE cohorts with an approved PA claim, including Deyo-Charlson Comorbidity Index (2.2 vs. 3.0), prevalence of diabetes mellitus (39.2% vs. 54.7%), and prevalence of HeFH (11.8% vs. 15.6%). While the percentage of patients with an approved PA was similar between the LIS/DE and non-LIS/DE cohorts, 88.9% and 91.2%, respectively, substantially more patients in the LIS/DE cohort had evidence of alirocumab possession based on a paid claim (60.6%) vs. those in the non-LIS/DE cohort (17.3%).
Conclusion:
Although a high percentage of MAPD patients had evidence of an approved PA, there were notable differences in clinical and demographic characteristics between those with and without LIS/ DE status. Further, the proportion of patients with an approved PA and a paid prescription claim differed markedly amongst MAPD patients with and without LIS/DE status, suggesting further research is needed to understand potential barriers to obtaining PCSK9i therapy.
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Affiliation(s)
| | - Libby Horter
- Comprehensive Health Insights, Humana, Inc., Louisville, KY
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20
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Johnson JL, Hadad DJ, Dietze R, Maciel ELN, Sewali B, Gitta P, Okwera A, Mugerwa RD, Alcaneses MR, Quelapio MI, Tupasi TE, Horter L, Debanne SM, Eisenach KD, Boom WH. Shortening treatment in adults with noncavitary tuberculosis and 2-month culture conversion. Am J Respir Crit Care Med 2009; 180:558-63. [PMID: 19542476 DOI: 10.1164/rccm.200904-0536oc] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Cavitary disease and delayed culture conversion have been associated with relapse. Combining patient characteristics and measures of bacteriologic response might allow treatment shortening with current drugs in some patients. OBJECTIVES To assess whether treatment could be shortened from 6 to 4 months in patients with noncavitary tuberculosis whose sputum cultures converted to negative after 2 months. METHODS This study was a randomized, open-label equivalence trial. HIV-uninfected adults with noncavitary tuberculosis were treated daily with isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months, followed by 2 months of isoniazid and rifampin. After 4 months, patients with drug-susceptible TB whose sputum cultures on solid media were negative after 8 weeks of treatment were randomly assigned to continue treatment for 2 more months or to stop treatment. Patients were followed for relapse for 30 months after beginning treatment. MEASUREMENTS AND MAIN RESULTS Enrollment was stopped by the safety monitoring committee after 394 patients were enrolled due to apparent increased risk for relapse in the 4-month arm. A total of 370 patients were eligible for per protocol analysis. Thirteen patients in the 4-month arm relapsed, compared with three subjects in the 6-month arm (7.0 vs. 1.6%; risk difference, 0.054; 95% confidence interval with Hauck-Anderson correction, 0.01-0.10). CONCLUSION Shortening treatment from 6 to 4 months in adults with noncavitary disease and culture conversion after 2 months using current drugs resulted in a greater relapse rate. The combination of noncavitary disease and 2-month culture conversion was insufficient to identify patients with decreased risk for relapse.
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Affiliation(s)
- John L Johnson
- Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio 44106-5083, USA.
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Kizza HM, Rodriguez B, Quinones-Mateu M, Mirza M, Aung H, Yen-Lieberman B, Starkey C, Horter L, Peters P, Baseke J, Johnson JL, Toossi Z. Persistent replication of human immunodeficiency virus type 1 despite treatment of pulmonary tuberculosis in dually infected subjects. Clin Diagn Lab Immunol 2006; 12:1298-304. [PMID: 16275944 PMCID: PMC1287765 DOI: 10.1128/cdli.12.11.1298-1304.2005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Tuberculosis (TB) is the most common life-threatening infection in human immunodeficiency virus (HIV)-infected persons and frequently occurs before the onset of severe immunodeficiency. Development of TB is associated with increased HIV type 1 (HIV-1) viral load, a fall in CD4 lymphocyte counts, and increased mortality. The aim of this study was to examine how treatment of pulmonary TB affected HIV-1 activity in HIV-1/TB-coinfected subjects with CD4 cell counts of >100 cells/mul. HIV-1/TB-coinfected subjects were recruited in Kampala, Uganda, and were monitored over time. Based upon a significant (0.5 log10 copies/ml) decrease in viral load by the end of treatment, two patient groups could be distinguished. Responders (n = 17) had more rapid resolution of anemia and pulmonary lesions on chest radiography during TB treatment. This group had a significant increase in viral load to levels not different from those at baseline 6 months after completion of TB treatment. HIV-1 viral load in nonresponders (n = 10) with TB treatment increased and at the 6 month follow-up was significantly higher than that at the time of diagnosis of TB. Compared to baseline levels, serum markers of macrophage activation including soluble CD14 decreased significantly by the end of TB treatment in responders but not in nonresponders. These data further define the impact of pulmonary TB on HIV-1 disease. HIV-1 replication during dual HIV-1/TB infection is not amenable to virologic control by treatment of TB alone. Concurrent institution of highly active antiretroviral treatment needs to be evaluated in patients dually infected with pulmonary TB and HIV-1.
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Affiliation(s)
- Harriet Mayanja Kizza
- Case Western Reserve University, Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH 44106-4984, USA
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Johnson JL, Okwera A, Horter L, Whalen CC, Mugerwa RD. Rifampicin-containing regimens for the treatment of latent tuberculosis infection also prevented diarrheal illnesses in HIV-infected Ugandan adults. AIDS 2004; 18:706-8. [PMID: 15090784 DOI: 10.1097/00002030-200403050-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wallis RS, Kyambadde P, Johnson J, Horter L. Adjunctive treatment with etanercept in HIV-1-associated tuberculosis. J Am Acad Dermatol 2004. [DOI: 10.1016/j.jaad.2003.10.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wallis RS, Kyambadde P, Johnson JL, Horter L, Kittle R, Pohle M, Ducar C, Millard M, Mayanja-Kizza H, Whalen C, Okwera A. A study of the safety, immunology, virology, and microbiology of adjunctive etanercept in HIV-1-associated tuberculosis. AIDS 2004; 18:257-64. [PMID: 15075543 DOI: 10.1097/00002030-200401230-00015] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Tumor necrosis factor (TNF), an important inflammatory mediator in tuberculosis, has been implicated in causing accelerated HIV disease progression in HIV-associated tuberculosis. However, TNF blockade, particularly by monoclonal antibody, has been associated with the reactivation of latent Mycobacterium tuberculosis infection by the impairment of mycobacterial immunity. This phase 1 study examined the safety, microbiology, immunology, and virology of TNF blockade using etanercept (soluble TNF receptor, Enbrel) during the initial treatment of HIV-associated tuberculosis. DESIGN A single-arm trial, with key endpoints compared with historical controls, conducted in Mulago Hospital, Kampala, Uganda. SUBJECTS : Sixteen HIV-1-infected patients and 42 CD4-frequency-matched controls with sputum smear-positive tuberculosis and CD4 cell counts > 200 cells/microl. INTERVENTION Etanercept 25 mg, eight doses administered subcutaneously twice weekly beginning on day 4 of tuberculosis therapy. MAIN OUTCOME MEASURES Serial examination, radiography, sputum culture, CD4 T-cell counts, plasma log10 HIV-RNA copy numbers. RESULTS Trends towards superior responses to tuberculosis treatment were evident in etanercept-treated subjects in body mass, performance score, number of involved lung zones, cavitary closure, and time to sputum culture conversion. Etanercept treatment resulted in a 25% increase in CD4 cells by week 4 (P = 0.1 compared with controls). The change in CD4 cell count was inversely related to the change in serum neopterin, a marker of macrophage activation. There was no effect on plasma HIV RNA. CONCLUSION Etanercept can be safely administered during the initial treatment of pulmonary tuberculosis. Further studies are warranted to examine the effects of etanercept on T-cell numbers, activation and apoptosis in AIDS and tuberculosis.
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Affiliation(s)
- Robert S Wallis
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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