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Merkle SL, Ingels J, Jung D, Welton M, Tanner A, Buchanan S, Lee S. Reported Impact of COVID-19 Workload and Stressors on School Nurses' Provision of Care During the 2021-2022 School Year: A Secondary Analysis of U.S. School Nurse Survey Data. J Sch Nurs 2024:10598405241248429. [PMID: 38706172 DOI: 10.1177/10598405241248429] [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: 05/07/2024] Open
Abstract
Many school nurses experienced increased work burden and stress during the COVID-19 pandemic. This analysis examined data from a Centers for Disease Control and Prevention cross-sectional, nationwide survey of school nurses in March 2022 to examine associations between school nurses' ability to conduct their core responsibilities and selected nurse and school factors among school nurses during the 2021-2022 school year and COVID-19 pandemic. Perceived adequate staffing and financial compensation reduced the odds of reported difficulties across all core school nursing tasks. Nurses without a registered nurse license and with higher caseloads were more likely to report difficulty in implementing specific tasks. The impact of these factors varied, with inadequate financial compensation having the largest association with school nurses' difficulty implementing all the core responsibilities. The study results improve our understanding of school nurses' challenges in implementing core school nursing responsibilities during the COVID-19 pandemic in the 2021-2022 school year.
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Affiliation(s)
- Sarah L Merkle
- National Center for Environmental Health, CDC, Atlanta, GA, USA
- College of Public Health, University of Georgia, Athens, GA, USA
| | - Justin Ingels
- College of Public Health, University of Georgia, Athens, GA, USA
| | - Daniel Jung
- College of Public Health, University of Georgia, Athens, GA, USA
| | | | - Andrea Tanner
- National Association of School Nurses, Silver Spring, MD, USA
| | | | - Sarah Lee
- National Center for Chronic Disease Prevention and Health Promotion/Division of Adolescent and School Health, CDC, Atlanta, GA, USA
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Garcia CR, Norfolk WA, Howard AK, Glatter AL, Beaudry MS, Mallis NA, Welton M, Glenn TC, Lipp EK, Ottesen EA. Long-term gut colonization with ESBL-producing Escherichia coli in participants without known risk factors from the southeastern United States. medRxiv 2024:2024.02.03.24302254. [PMID: 38370669 PMCID: PMC10871458 DOI: 10.1101/2024.02.03.24302254] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
We evaluated gut carriage of extended spectrum beta lactamase producing Enterobacteriaceae (ESBL-E) in southeastern U.S. residents without recent in-patient healthcare exposure. Study enrollment was January 2021-February 2022 in Athens, Georgia, U.S. and included a diverse population of 505 adults plus 50 child participants (age 0-5). Based on culture-based screening of stool samples, 4.5% of 555 participants carried ESBL-Es. This is slightly higher than reported in studies conducted 2012-2015, which found carriage rates of 2.5-3.9% in healthy U.S. residents. All ESBL-E confirmed isolates (n=25) were identified as Escherichia coli. Isolates belonged to 11 sequence types, with 48% classified as ST131. Ninety six percent of ESBL-E isolates carried a blaCTX-M gene. Isolated ESBL-Es frequently carried virulence genes as well as multiple classes of antibiotic resistance genes. Long-term colonization was common, with 64% of ESBL-E positive participants testing positive when rescreened three months later. One participant yielded isolates belonging to two different E. coli sequence types that carried blaCTX-M-1 genes on near-identical plasmids, suggesting intra-gut plasmid transfer. Isolation of E. coli on media without antibiotics revealed that ESBL-E. coli typically made up a minor fraction of the overall gut E. coli population, although in some cases they were the dominant strain. ESBL-E carriage was not associated with a significantly different stool microbiome composition. However, some microbial taxa were differentially abundant in ESBL-E carriers. Together, these results suggest that a small subpopulation of US residents are long-term, asymptomatic carriers of ESBL-Es, and may serve as an important reservoir for community spread of these ESBL genes.
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Affiliation(s)
| | - William A. Norfolk
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
- Center for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amanda K. Howard
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
- Institute of Bioinformatics, University of Georgia, Athens, GA, USA
| | - Amanda L. Glatter
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Megan S. Beaudry
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
- Daicel Arbor Biosciences, Ann Arbor, MI, USA
| | - Nicholas A. Mallis
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Michael Welton
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Travis C. Glenn
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
| | - Erin K. Lipp
- Department of Environmental Health Sciences, University of Georgia, Athens, GA, USA
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Mallis N, Dailey C, Drewry S, Howard N, Cordero JF, Welton M. SARS-CoV-2 infection and e-cigarette use, binge drinking, and other associated risk factors in a college population. J Am Coll Health 2024; 72:366-370. [PMID: 35324389 DOI: 10.1080/07448481.2022.2053133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
In the summer of 2020, SARS-CoV-2 infection rates among the U.S. population aged 20-39 years exceeded other age groups, with the largest increases occurring in the southern US. As many colleges reopened for in-person instruction in August and September, these trends continued among campuses across the country. Our study aimed to identify risk factors (demographic and behavioral) associated with SARS-CoV-2 infection among college students. We used data from a survey administered to students at a southern university in the US. The survey had a total of 765 respondents and this study included the 679 (88.8%) who responded about their SARS-CoV-2 infection status. We examined associations between population characteristics and reported SARS-CoV-2 infection and calculated prevalence ratios along with 95% confidence intervals. SARS-CoV-2 infection was 2.5 times more likely among current users of electronic nicotine delivery systems (ENDS) compared to those who do not use ENDS (95% confidence interval [CI]: (1.76-3.4)) and 2.8 times more likely among those who reported a high frequency of binge drinking compared to those who did not report binge drinking (95% CI: (1.81-4.36)). Current high frequency ENDS users were 2.76 (1.79-4.25) more likely to report SARS-CoV-2 infection than non-users. Current low frequency users of ENDS were 2.27 (1.53-3.37) times more likely to report SARS-CoV-2 infection than nonusers. A trend analysis among ENDS use frequency and SARS-CoV-2 infection was statistically significant, showing a significant dose response with increasing ENDS use. The results of this analysis may assist in providing guidance on policies as well as may serve as a steppingstone for future research concerning SAR-CoV-2 infection among university populations.
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Affiliation(s)
- Nicholas Mallis
- College of Public Health, Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia, USA
| | - Cody Dailey
- College of Public Health, Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia, USA
| | - Sophia Drewry
- College of Public Health, Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia, USA
| | - Nina Howard
- College of Public Health, Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia, USA
| | - José F Cordero
- College of Public Health, Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia, USA
| | - Michael Welton
- College of Public Health, Department of Epidemiology & Biostatistics, University of Georgia, Athens, Georgia, USA
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4
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Mark-Carew M, van Zyl A, Tatti KM, Chong M, Rose C, Sifre K, Jarris D, Still W, Aynalem G, Welton M, Thomas ES, Hall L, Samson ME. Understanding COVID-19 Vaccine Hesitancy Among K-12 Staff, Parents, and Students: District of Columbia, February to April, 2022. J Sch Health 2023; 93:1079-1090. [PMID: 37602945 PMCID: PMC10833106 DOI: 10.1111/josh.13382] [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] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE Despite widespread availability of COVID-19 vaccines, millions of Americans have not received the recommended vaccine doses. In the District of Columbia (DC), COVID-19 vaccination rates are lowest among residents who are Non-Hispanic (NH) Black and among school-aged children. We assessed COVID-19 vaccine hesitancy among staff and parents of students in DC K-12 public and public charter schools. METHODS We conducted a telephone-based survey from February 6 to April 16, 2022 to staff, students, and parents of students who participated in school-based COVID-19 screening testing. COVID-19-related survey items included: vaccination status, reasons for not getting vaccinated, perceived vaccine access, and trusted COVID-19 information sources. Utilizing time-to-event analyses, we evaluated differences across demographic groups. RESULTS The interview response rate was 25.8% (308/1193). Most unvaccinated participants were NH Black and ages 5 to 11 years. Median time from vaccine eligibility to uptake was 236 days for NH Black participants vs. 10 days for NH White participants. Vaccine safety was the top concern among unvaccinated participants. Government and healthcare providers were the most trusted COVID-19 information sources. CONCLUSIONS Differences in timing of vaccine uptake among respondents and greater vaccine hesitancy among NH Black participants compared to other racial/ethnic groups highlight a need for continued tailored outreach and communication using trusted sources to convey the importance, benefits, and safety of COVID-19 vaccination.
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Affiliation(s)
- Miguella Mark-Carew
- Global Government Solutions (G2S) Corporation, 12500 San Pedro Ave, Suite 403 San Antonio, TX 78216
- US Centers for Disease Control and Prevention COVID-19 Emergency Response Team, 1600 Clifton Road, Atlanta, GA 30329
| | - André van Zyl
- US Centers for Disease Control and Prevention COVID-19 Emergency Response Team, 1600 Clifton Road, Atlanta, GA 30329
| | - Kathleen M. Tatti
- Global Government Solutions (G2S) Corporation, 12500 San Pedro Ave, Suite 403 San Antonio, TX 78216
- US Centers for Disease Control and Prevention COVID-19 Emergency Response Team, 1600 Clifton Road, Atlanta, GA 30329
| | - Muhling Chong
- Global Government Solutions (G2S) Corporation, 12500 San Pedro Ave, Suite 403 San Antonio, TX 78216
- US Centers for Disease Control and Prevention COVID-19 Emergency Response Team, 1600 Clifton Road, Atlanta, GA 30329
| | - Charles Rose
- US Centers for Disease Control and Prevention COVID-19 Emergency Response Team, 1600 Clifton Road, Atlanta, GA 30329
| | - Katlynn Sifre
- Global Government Solutions (G2S) Corporation, 12500 San Pedro Ave, Suite 403 San Antonio, TX 78216
- US Centers for Disease Control and Prevention COVID-19 Emergency Response Team, 1600 Clifton Road, Atlanta, GA 30329
| | - Daniel Jarris
- District of Columbia Department of Health, Washington, District of Columbia, USA
| | - Will Still
- District of Columbia Department of Health, Washington, District of Columbia, USA
| | - Getahun Aynalem
- Global Government Solutions (G2S) Corporation, 12500 San Pedro Ave, Suite 403 San Antonio, TX 78216
- US Centers for Disease Control and Prevention COVID-19 Emergency Response Team, 1600 Clifton Road, Atlanta, GA 30329
| | - Michael Welton
- Global Government Solutions (G2S) Corporation, 12500 San Pedro Ave, Suite 403 San Antonio, TX 78216
- US Centers for Disease Control and Prevention COVID-19 Emergency Response Team, 1600 Clifton Road, Atlanta, GA 30329
| | - Ebony S. Thomas
- US Centers for Disease Control and Prevention COVID-19 Emergency Response Team, 1600 Clifton Road, Atlanta, GA 30329
| | - LaShonda Hall
- US Centers for Disease Control and Prevention COVID-19 Emergency Response Team, 1600 Clifton Road, Atlanta, GA 30329
| | - Marsha E. Samson
- District of Columbia Department of Health, Washington, District of Columbia, USA
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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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6
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Kittleson M, Patel J, Moriguchi J, Cole R, Singer-Englar T, Patel N, Runyan C, Welton M, Czer L, Catarino P, Kobashigawa J. Do Older LVAD Patients Have Compromised Outcome after Heart Transplantation: Should They Stay as Destination Therapy? J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.190] [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: 04/05/2023] Open
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7
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Kittleson M, Patel J, Singer-Englar T, Kim S, Patel N, Wakefield Z, Welton M, Czer L, Esmailian F, Kobashigawa J. Are Redo Heart Transplant Patients Appropriately Listed as Status 4 on the Waitlist. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.525] [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: 04/05/2023] Open
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8
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Merkle SL, Welton M, van Zyl A, Chong M, Tanner A, Rose CE, Hertz M, Hill L, Leroy ZC, Sifre K, Thomas ES. Symptoms of Depression, Anxiety, and Post-Traumatic Stress Disorder, and Suicidal Ideation Among School Nurses in Prekindergarten through Grade 12 Schools - United States, March 2022. J Sch Nurs 2023; 39:114-124. [PMID: 36315836 PMCID: PMC9988285 DOI: 10.1177/10598405221131048] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 11/06/2022] Open
Abstract
School nurses are integral to creating safe environments in U.S. schools. Many experienced increased work burden and stress during the COVID-19 pandemic. CDC collaborated with the National Association of School Nurses and the National Association of State School Nurse Consultants to distribute a 121-item online, anonymous survey to school nurses nationwide during March 7-30, 2022. Among the 7,971 respondents, symptoms of depression, anxiety and PTSD, and suicidal ideation were measured, and prevalence ratios were used to identify associations with demographics, workplace characteristics, and support. Results found high levels of work-related stressors and indicated that employment characteristics, COVID-19-related job duties, and other workplace stressors and supports affected school nurse mental health. The survey findings underscore the mental health challenges many school nurses experienced during the 2021/2022 school year. The findings can inform supportive policies and practices to reduce workplace stressors and increase workplace supports for school nurses.
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Affiliation(s)
- Sarah L Merkle
- COVID-19 Response, 1242CDC, Atlanta, GA, USA.,National Center for Environmental Health, CDC, Atlanta, GA, USA
| | - Michael Welton
- COVID-19 Response, 1242CDC, Atlanta, GA, USA.,G2S Corporation, San Antonio, TX, USA
| | - André van Zyl
- COVID-19 Response, 1242CDC, Atlanta, GA, USA.,4ES Corporation, San Antonio, TX, USA
| | - Muhling Chong
- COVID-19 Response, 1242CDC, Atlanta, GA, USA.,G2S Corporation, San Antonio, TX, USA
| | - Andrea Tanner
- 233071National Association of School Nurses, Silver Spring, MA, USA
| | - Charles E Rose
- COVID-19 Response, 1242CDC, Atlanta, GA, USA.,National Center for Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Marci Hertz
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, GA, USA
| | - Laura Hill
- COVID-19 Response, 1242CDC, Atlanta, GA, USA.,Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Zanie C Leroy
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA,USA
| | - Katlynn Sifre
- COVID-19 Response, 1242CDC, Atlanta, GA, USA.,G2S Corporation, San Antonio, TX, USA
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9
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Bennett CC, Welton M, Bos J, Moon G, Berkley A, Kavlak L, Pearson J, Turabelidze G, Frazier J, Fehrenbach N, Brown CK. Assessment of COVID-19 outbreaks in long-term care facilities. J Hosp Infect 2023; 134:7-10. [PMID: 36696942 PMCID: PMC9867838 DOI: 10.1016/j.jhin.2022.12.022] [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] [Received: 09/08/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND The B.1.167.2 (Delta) variant quickly became the predominant circulating SARS-CoV-2 strain in the USA during summer 2021. Missouri identified a high number of outbreaks in long-term care facilities (LTCFs) across the state with low vaccination rates among LTCF staff members and poor adherence to mitigation measures within local communities. AIM To describe COVID-19 outbreaks that occurred in Missouri LTCFs impacting staff and residents during the surge of the Delta variant. METHODS Outbreaks of COVID-19 in 178 LTCFs were identified by the Missouri Department of Health and Senior Services. Case data from LTCFs with the highest burden of disease were analysed to assess disease transmission, vaccination status, and outcomes among residents and staff. Additional investigational measures included onsite visits to facilities with recent COVID-19 outbreaks in communities with substantial transmission to assess mitigation measures. FINDINGS During April 22nd to July 29th, 2021, 159 COVID-19 cases among 72 staff members and 87 residents were identified in 10 LTCFs. More than 74.7% of resident cases were vaccinated compared to 23.6% of staff cases. Vaccinated residents had a lower proportion of hospitalizations and deaths reported compared to unvaccinated residents. Data analysis and contact-tracing efforts from a sample of the facilities suggest that staff members were likely a major factor in introducing SARS-CoV-2 virus into the facilities. Adherence to COVID-19 mitigation measures varied at the visited facilities. CONCLUSION Data showed that vaccination rates varied between staff cases and resident cases in facilities with high-burden outbreaks. Differences were identified in mitigation practices in at least two facilities.
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Affiliation(s)
- C C Bennett
- State, Tribal, Local, and Territorial Support Task Force, COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - M Welton
- G2S Corporation, San Antonio, TX, USA
| | - J Bos
- Missouri Department of Health and Senior Services, Jefferson City and St Louis, MO, USA
| | - G Moon
- Missouri Department of Health and Senior Services, Jefferson City and St Louis, MO, USA
| | - A Berkley
- Missouri Department of Health and Senior Services, Jefferson City and St Louis, MO, USA
| | - L Kavlak
- Missouri Department of Health and Senior Services, Jefferson City and St Louis, MO, USA
| | - J Pearson
- Missouri Department of Health and Senior Services, Jefferson City and St Louis, MO, USA
| | - G Turabelidze
- Missouri Department of Health and Senior Services, Jefferson City and St Louis, MO, USA
| | - J Frazier
- State, Tribal, Local, and Territorial Support Task Force, COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - N Fehrenbach
- State, Tribal, Local, and Territorial Support Task Force, COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - C K Brown
- State, Tribal, Local, and Territorial Support Task Force, COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Lammie SL, Ford L, Swanson M, Guinn AS, Kamitani E, van Zyl A, Rose CE, Marynak K, Shields J, Donovan CV, Holman EJ, Mark-Carew M, Welton M, Thomas ES, Neatherlin JC. Test-to-Stay Implementation in 4 Pre-K-12 School Districts. Pediatrics 2022; 150:e2022057362. [PMID: 35922896 PMCID: PMC10043738 DOI: 10.1542/peds.2022-057362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Globally, coronavirus disease 2019 (COVID-19) has affected how children learn. We evaluated the impact of Test to Stay (TTS) on secondary and tertiary transmission of severe acute respiratory syndrome coronavirus 2 and potential impact on in-person learning in 4 school districts in the United States from September 13 to November 19, 2021. METHODS Implementation of TTS varied across school districts. Data on index cases, school-based close contacts, TTS participation, and testing results were obtained from 4 school districts in diverse geographic regions. Descriptive statistics, secondary and tertiary attack risk, and a theoretical estimate of impact on in-person learning were calculated. RESULTS Fifty-one schools in 4 school districts reported 374 coronavirus disease COVID-19 index cases and 2520 school-based close contacts eligible for TTS. The proportion participating in TTS ranged from 22% to 79%. By district, the secondary attack risk and tertiary attack risk among TTS participants ranged between 2.2% to 11.1% and 0% to 17.6%, respectively. Nine clusters were identified among secondary cases and 2 among tertiary cases. The theoretical maximum number of days of in-person learning saved by using TTS was 976 to 4650 days across jurisdictions. CONCLUSIONS TTS preserves in-person learning. Decisions to participate in TTS may have been influenced by ease of access to testing, communication between schools and families, testing logistics, and school resources. Tertiary attack risk determination became more complicated when numbers of close contacts increased. Minimizing exposure through continued layered prevention strategies is imperative. To ensure adequate resources for TTS, community transmission levels should be considered.
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Affiliation(s)
- Samantha L Lammie
- Epidemic Intelligence Service
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Contributed equally as co-first authors
| | - Laura Ford
- Epidemic Intelligence Service
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Contributed equally as co-first authors
| | - Megan Swanson
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angie S Guinn
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emiko Kamitani
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - André van Zyl
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- 4ES Corporation, San Antonio Texas
| | - Charles E Rose
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristy Marynak
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jamila Shields
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Catherine V Donovan
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily J Holman
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Miguella Mark-Carew
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- G2S Corporation, San Antonio, Texas
| | - Michael Welton
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- G2S Corporation, San Antonio, Texas
| | - Ebony S Thomas
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John C Neatherlin
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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11
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Jamero G, De Leon F, Ackerman M, Welton M, Kissling N, Velleca A, White M, Czer L, Nikolova A, Kransdorf E, Chang D, Kittleson M, Patel J, Kobashigawa J. NP Telehealth Blood Pressure Management in Heart Transplant Patients - A Single Center Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1572] [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: 11/30/2022] Open
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12
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Kim S, Chang D, Patel J, Kittleson M, Singer-Englar T, Patel N, Welton M, Megna D, Czer L, Kobashigawa J. ACEi Use in Select Patients Awaiting Heart Transplant May Be a Risk Factor for the Development of Primary Graft Dysfunction and Vasoplegia. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1692] [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: 11/30/2022] Open
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13
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Eick SM, Welton M, Claridy MD, Velasquez SG, Mallis N, Cordero JF. Associations between gestational weight gain and preterm birth in Puerto Rico. BMC Pregnancy Childbirth 2020; 20:599. [PMID: 33028249 PMCID: PMC7539475 DOI: 10.1186/s12884-020-03292-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/28/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Preterm birth (PTB; gestational age < 37 weeks) is the leading cause of infant morbidity and mortality worldwide. Low and excessive gestational weight gain (GWG) have been previously cited as risk factors for PTB, however the magnitude of association varies across populations. No studies have examined low and excessive GWG as modifiable risk factors for PTB in Puerto Rico, an area with inexplicably high PTB rates. METHODS To examine the relationship between GWG and PTB, we conducted a retrospective analysis using birth certificate data files from the Puerto Rico Department of Health from 2005 to 2012. GWG was standardized to a 40-week gestational duration and was categorized into low, adequate, or excessive for each category of pre-pregnancy body mass index using American College of Obstetricians and Gynecologists guidelines. Logistic regression was used to determine the crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between GWG and PTB. RESULTS There were 320,695 births included in this analysis; 40.6% with high GWG and 27.3% with low GWG. A greater percentage of women with low GWG were less than 20 years of age, had less than a high school education, and were underweight compared to women with adequate and excessive GWG. Women with low compared to adequate GWG had increased odds of PTB (OR = 1.34, 95% CI = 1.30-1.37). However, excessive compared to adequate GWG was not associated with PTB (OR = 0.99, 95% CI = 0.97-1.02). CONCLUSIONS Among women in Puerto Rico, low GWG was associated with increased odds of PTB. With the exception of obesity, these associations persisted within all strata of pre-pregnancy body mass index, highlighting the importance of maintaining a healthy weight during pregnancy. Future research should examine other factors that may contribute to GWG, such as dietary nutrients, and explore pathways through which GWG may be contributing to PTB.
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Affiliation(s)
- Stephanie M Eick
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Road, GA, Athens, United States.
| | - Michael Welton
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Road, GA, Athens, United States
| | - Mechelle D Claridy
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Road, GA, Athens, United States
| | - Skarlet G Velasquez
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Road, GA, Athens, United States
| | - Nicholas Mallis
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Road, GA, Athens, United States
| | - José F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Road, GA, Athens, United States
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14
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Watkins DJ, Torres Zayas HR, Vélez Vega CM, Rosario Z, Welton M, Agosto Arroyo LD, Cardona N, Díaz Reguero ZJ, Santos Rivera A, Huerta-Montañez G, Brown P, Alshawabkeh A, Cordero JF, Meeker JD. Investigating the impact of Hurricane Maria on an ongoing birth cohort in Puerto Rico. Popul Environ 2020; 42:95-111. [PMID: 33746324 PMCID: PMC7967016 DOI: 10.1007/s11111-020-00345-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Prior to Hurricane Maria, Puerto Rico already had 200+ hazardous waste sites, significant contamination of water resources, and among the highest rates of preterm birth in the US. To address these issues, the Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) Center was formed in 2010 to investigate prenatal environmental exposures, particularly phthalates, and adverse birth outcomes. Recent work from the PROTECT study confirms that in utero exposure to certain phthalates is associated with shorter gestation and increased risk of preterm birth. However, previous research also suggests that pregnant women who experience a natural disaster such as Hurricane Maria are at higher risk of adverse birth outcomes, but it is unknown whether this is due to stress, hazardous exposures, or a combination of factors. Thus, the aim of this analysis was to characterize hurricane-related changes in phthalate exposures and experiences within the PROTECT cohort. Among 176 participants who were pregnant during or within 5 months after Maria, 122 completed a questionnaire on hurricane-related experiences. Questionnaire results and biomarkers of exposure suggest that participants did not have regular access to fresh foods and water during hurricane recovery, and almost half reported structural damage to their home. In addition, biomarker concentrations of phthalates commonly used in food packaging were higher among participants post-hurricane, while phthalates commonly used in personal care products were lower compared to pre-hurricane levels. Hurricane-related increases in phthalate exposure, as well as widespread structural damage, food and water shortages, and long-term absence of electricity and cell phone service, likely increased the risk of adverse birth outcomes among this already vulnerable population.
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Affiliation(s)
- Deborah J. Watkins
- University of Michigan, Department of Environmental Health Sciences - Ann Arbor, Michigan
| | | | - Carmen M. Vélez Vega
- University of Puerto Rico - Medical Sciences Campus, School of Public Health – San Juan, PR
| | - Zaira Rosario
- University of Puerto Rico - Medical Sciences Campus, School of Public Health – San Juan, PR
| | - Michael Welton
- University of Georgia, College of Public Health, University of Georgia, Department of Epidemiology and Biostatistics – Athens, GA
| | - Luis D. Agosto Arroyo
- University of Puerto Rico - Medical Sciences Campus, School of Public Health – San Juan, PR
| | - Nancy Cardona
- University of Puerto Rico - Medical Sciences Campus, School of Public Health – San Juan, PR
| | | | - Amailie Santos Rivera
- University of Puerto Rico - Medical Sciences Campus, School of Public Health – San Juan, PR
| | - Gredia Huerta-Montañez
- University of Puerto Rico - Medical Sciences Campus, School of Public Health – San Juan, PR
| | - Phil Brown
- Northeastern University, Social Science Environmental Health Research Institute – Boston, MA
| | - Akram Alshawabkeh
- Northeastern University, Department of Civil and Environmental Engineering – Boston, MA
| | - José F. Cordero
- University of Georgia, College of Public Health, University of Georgia, Department of Epidemiology and Biostatistics – Athens, GA
| | - John D. Meeker
- University of Michigan, Department of Environmental Health Sciences - Ann Arbor, Michigan
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15
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Thompson JM, Eick SM, Dailey C, Dale AP, Mehta M, Nair A, Cordero JF, Welton M. Relationship Between Pregnancy-Associated Malaria and Adverse Pregnancy Outcomes: a Systematic Review and Meta-Analysis. J Trop Pediatr 2020; 66:327-338. [PMID: 31598714 DOI: 10.1093/tropej/fmz068] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 11/12/2022]
Abstract
BACKGROUND Pregnancy-associated malaria (PAM) has been associated with adverse pregnancy outcomes like preterm birth (PTB) and low birthweight (LBW), which are among the leading causes of infant mortality globally. Rates of PTB and LBW are high in countries with a high burden of malaria. PAM may be a contributing factor to PTB and LBW, but is not well understood. METHODS We conducted a systematic review and meta-analysis of studies examining the relationship between PAM and PTB or LBW using PubMed. The title and abstract of all studies were screened by two reviewers, and the full text of selected studies was reviewed to ensure they met inclusion criteria. Information regarding study characteristics and of PTB and LBW births among women with and without PAM was abstracted for included studies. RESULTS Our search terms yielded 2237 articles, of which 18 met our final inclusion criteria. Eight studies examined associations between PAM and PTB, and 10 examined associations between PAM and LBW (population size ranging from 35 to 9956 women). The overall risk of LBW was 63% higher among women with PAM compared with women without PAM (95% CI = 1.48-1.80) and the risk of PTB was 23% higher among women with PAM compared with women without PAM (95% CI = 1.07-1.41). CONCLUSIONS These results indicate that infection with PAM is associated with PTB and LBW. Further understanding of the pathogenesis of disease and the immunologic changes that occur during pregnancy is essential for reducing the disproportional effects this disease has on this vulnerable population.
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Affiliation(s)
- Julie M Thompson
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA.,College of Veterinary Medicine, University of Georgia, 30602 Athens, GA, USA
| | - Stephanie M Eick
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Services, University of California, San Francisco, 94158 San Francisco, CA, USA
| | - Cody Dailey
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA.,Odum School of Ecology, University of Georgia, 30602 Athens, GA, USA
| | - Ariella P Dale
- Colorado Department of Public Health & Environment, 80246 Denver, CO, USA
| | - Mansi Mehta
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA
| | - Anjali Nair
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA
| | - José F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA
| | - Michael Welton
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA
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16
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Welton M, Vélez Vega CM, Murphy CB, Rosario Z, Torres H, Russell E, Brown P, Huerta-Montanez G, Watkins D, Meeker JD, Alshawabkeh A, Cordero JF. Impact of Hurricanes Irma and Maria on Puerto Rico Maternal and Child Health Research Programs. Matern Child Health J 2020; 24:22-29. [PMID: 31728717 PMCID: PMC7059554 DOI: 10.1007/s10995-019-02824-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/03/2023]
Abstract
Puerto Rico was hit by two major hurricanes in September 2017 causing great devastation, losing over 90% of the power grid, wireless communication and access to potable water, and destroying many homes. Our research programs: Puerto Rico Testsite for Exploring Contamination Threats (PROTECT), Center for Research on Early Childhood Exposure and Development in Puerto Rico (CRECE), Zika in Infants and Pregnancy (ZIP), and Environmental Influences on Child Health Outcomes (ECHO) are ongoing observational cohort studies that have been investigating environmental risk factors for perinatal health outcomes among Puerto Rican mothers and infants. Our projects paused operations for about two weeks, to begin recovery process and become a source of assistance, retaining 95% of study participants across all research programs. We joined with various groups to ensure the safety and welfare of team members, study participants, community health center partners, and members of the surrounding communities. We learned important lessons about the impact of these hurricanes and the difficulties of the recovery. Major challenges post-hurricanes were access to care and nutrition, maternal stress, and environmental damage. We understood the need to integrate disaster preparedness into our programs' operating procedures and future applications, recognizing that these events will recur. We will grow resilience among our staff, maternal and child health partners, and participants by building on the experience of these two storms.
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Affiliation(s)
- Michael Welton
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Health Science Campus, 101 Buck Road, Athens, GA, 30602, USA.
| | - Carmen M Vélez Vega
- School of Public Health, University of Puerto Rico - Medical Sciences Campus, San Juan, PR, USA
| | - Colleen B Murphy
- School of Public Health, University of Puerto Rico - Medical Sciences Campus, San Juan, PR, USA
| | - Zaira Rosario
- School of Public Health, University of Puerto Rico - Medical Sciences Campus, San Juan, PR, USA
| | - Hector Torres
- School of Public Health, University of Puerto Rico - Medical Sciences Campus, San Juan, PR, USA
| | - Elle Russell
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, USA
| | - Phil Brown
- Social Science Environmental Health Research Institute, Northeastern University, Boston, MA, USA
| | - Gredia Huerta-Montanez
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, USA
| | - Deborah Watkins
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, USA
| | - José F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Health Science Campus, 101 Buck Road, Athens, GA, 30602, USA
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17
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Lebov JF, Arias JF, Balmaseda A, Britt W, Cordero JF, Galvão LA, Garces AL, Hambidge KM, Harris E, Ko A, Krebs N, Marques ETA, Martinez AM, McClure E, Miranda-Filho DB, Moreira MEL, Mussi-Pinhata MM, Ochoa TJ, Osorio JE, Scalabrin DMF, Schultz-Cherry S, Seage GR, Stolka K, Ugarte-Gil CA, Vega CMV, Welton M, Ximenes R, Zorrilla C. Correction to: International prospective observational cohort study of Zika in infants and pregnancy (ZIP study): study protocol. BMC Pregnancy Childbirth 2019; 19:423. [PMID: 31744466 PMCID: PMC6862798 DOI: 10.1186/s12884-019-2589-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Following publication of the original article [1], the author mentioned that two additional NIH staff were involved in the development of the protocol who did not receive recognition in the Acknowledgments section in their published article.
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Affiliation(s)
- Jill F Lebov
- Social, Statistical and Environmental Sciences, RTI International, Durham, NC, USA.
| | - Juan F Arias
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Angel Balmaseda
- Centro Nacional de Diagnostico y Referencia, Complejo Nacional de Salud, Managua, Nicaragua
| | - William Britt
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - José F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | | | - Ana Lucía Garces
- Fundación para la Alimentación y Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | - K Michael Hambidge
- Section of Nutrition, Pediatrics, University of Colorado, Aurora, CO, USA
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - Albert Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Brazil
| | - Nancy Krebs
- Section of Nutrition, Pediatrics, University of Colorado, Aurora, CO, USA
| | - Ernesto T A Marques
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Instituto Aggeu Magalhães, Department of Virology and Experimental Therapeutics, FIOCRUZ, Pernambuco, Brazil
| | | | - Elizabeth McClure
- Social, Statistical and Environmental Sciences, RTI International, Durham, NC, USA
| | - Democrito B Miranda-Filho
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS) da Universidade de Pernambuco, Microcephaly Epidemic Research Group, Recife, Brazil
| | | | | | - Theresa J Ochoa
- Instituto de Medicina Tropical Alexander von Humboldt and Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jorge E Osorio
- Department of Pathobiological Sciences, University of Wisconsin, Madison, WI, USA
| | - Deolinda M F Scalabrin
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Brazil
| | - Stacey Schultz-Cherry
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - George R Seage
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, MA, USA
| | - Kristen Stolka
- Social, Statistical and Environmental Sciences, RTI International, Durham, NC, USA
| | - César Augusto Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt and Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Michael Welton
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Ricardo Ximenes
- Departamento de Medicina Tropical da Universidade Federal de Pernambuco, Microcephaly Epidemic Research Group, Recife, Brazil
| | - Carmen Zorrilla
- Maternal-Infant Studies Center (CEMI), San Juan, Puerto Rico
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18
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Abstract
Objectives We examined the association between prepregnancy body mass index (PP-BMI) and preterm birth (PTB) among women in Puerto Rico (PR) as a potentially modifiable risk factor. Methods We conducted a retrospective study using the birth certificate data files from 2005 to 2012 developed by the PR Department of Health to examine the relationship between PP-BMI and PTB. Logistic regression was used to determine crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) for the categories of PP-BMI of overweight (25-29.9 kg/m2), obesity (≥ 30 kg/m2), and overweight and obesity together (≥ 25 kg/m2) and PTB. Stratified analysis explored the associations between PP-BMI and PTB by region within PR and year. Results Following exclusions of birth records with missing data, 343,508 births were included in our analysis. The percentage of PTB decreased from 18.6 to 15.2 during our study period. Statistically significant differences were observed between preterm and full term births across all covariates. Overweight (OR 1.08, 95% CI 1.06, 1.11), obesity (OR 1.17, 95% CI 1.14, 1.20), and overweight and obesity together (OR 1.11, 95% CI 1.09, 1.14) were significantly associated with increased odds of PTB after adjusting for confounders. The associations between PP-BMI and PTB persisted across all regions and years. Conclusions for Practice PP-BMI is associated with increased odds of PTB among women in PR and the associations were consistent in exploratory analyses. Future research should examine the relationship between PP-BMI and PTB among other Hispanic subgroups and among Puerto Ricans in the mainland United States.
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Affiliation(s)
- Stephanie M Eick
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Health Sciences Campus 101 Buck Road, Athens, GA, 30605, USA.
| | - Michael Welton
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Health Sciences Campus 101 Buck Road, Athens, GA, 30605, USA
| | - José F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Health Sciences Campus 101 Buck Road, Athens, GA, 30605, USA
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19
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Lebov JF, Arias JF, Balmaseda A, Britt W, Cordero JF, Galvão LA, Garces AL, Hambidge KM, Harris E, Ko A, Krebs N, Marques ETA, Martinez AM, McClure E, Miranda-Filho DB, Moreira MEL, Mussi-Pinhata MM, Ochoa TJ, Osorio JE, Scalabrin DMF, Schultz-Cherry S, Seage GR, Stolka K, Ugarte-Gil CA, Vega CMV, Welton M, Ximenes R, Zorrilla C. International prospective observational cohort study of Zika in infants and pregnancy (ZIP study): study protocol. BMC Pregnancy Childbirth 2019; 19:282. [PMID: 31391005 PMCID: PMC6686399 DOI: 10.1186/s12884-019-2430-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/26/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Until recently, Zika virus (ZIKV) infections were considered mild and self-limiting. Since 2015, they have been associated with an increase in microcephaly and other birth defects in newborns. While this association has been observed in case reports and epidemiological studies, the nature and extent of the relationship between ZIKV and adverse pregnancy and pediatric health outcomes is not well understood. With the unique opportunity to prospectively explore the full spectrum of issues related to ZIKV exposure during pregnancy, we undertook a multi-country, prospective cohort study to evaluate the association between ZIKV and pregnancy, neonatal, and infant outcomes. METHODS At research sites in ZIKV endemic regions of Brazil (4 sites), Colombia, Guatemala, Nicaragua, Puerto Rico (2 sites), and Peru, up to 10,000 pregnant women will be recruited and consented in the first and early second trimesters of pregnancy and then followed through delivery up to 6 weeks post-partum; their infants will be followed until at least 1 year of age. Pregnant women with symptomatic ZIKV infection confirmed by presence of ZIKV RNA and/or IgM for ZIKV will also be enrolled, regardless of gestational age. Participants will be tested monthly for ZIKV infection; additional demographic, physical, laboratory and environmental data will be collected to assess the potential interaction of these variables with ZIKV infection. Delivery outcomes and detailed infant assessments, including physical and neurological outcomes, will be obtained. DISCUSSION With the emergence of ZIKV in the Americas and its association with adverse pregnancy outcomes in this region, a much better understanding of the spectrum of clinical outcomes associated with exposure to ZIKV during pregnancy is needed. This cohort study will provide information about maternal, fetal, and infant outcomes related to ZIKV infection, including congenital ZIKV syndrome, and manifestations that are not detectable at birth but may appear during the first year of life. In addition, the flexibility of the study design has provided an opportunity to modify study parameters in real time to provide rigorous research data to answer the most critical questions about the impact of congenital ZIKV exposure. TRIAL REGISTRATION NCT02856984 . Registered August 5, 2016. Retrospectively registered.
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Affiliation(s)
- Jill F. Lebov
- Social, Statistical and Environmental Sciences, RTI International, Durham, NC USA
| | - Juan F. Arias
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, TN 38105 USA
| | - Angel Balmaseda
- Centro Nacional de Diagnostico y Referencia, Complejo Nacional de Salud, Managua, Nicaragua
| | - William Britt
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL USA
| | - José F. Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA USA
| | | | - Ana Lucía Garces
- Fundación para la Alimentación y Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | | | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA USA
| | - Albert Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT USA
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Brazil
| | - Nancy Krebs
- Section of Nutrition, Pediatrics, University of Colorado, Aurora, CO USA
| | - Ernesto T. A. Marques
- School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
- Instituto Aggeu Magalhães, Department of Virology and Experimental Therapeutics, FIOCRUZ, Pernambuco, Brazil
| | | | - Elizabeth McClure
- Social, Statistical and Environmental Sciences, RTI International, Durham, NC USA
| | - Democrito B. Miranda-Filho
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS) da Universidade de Pernambuco, Microcephaly Epidemic Research Group, Recife, Brazil
| | | | | | - Theresa J. Ochoa
- Instituto de Medicina Tropical Alexander von Humboldt and Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jorge E. Osorio
- Department of Pathobiological Sciences, University of Wisconsin, Madison, WI USA
| | - Deolinda M. F. Scalabrin
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT USA
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Brazil
| | - Stacey Schultz-Cherry
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, TN 38105 USA
| | - George R. Seage
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, MA USA
| | - Kristen Stolka
- Social, Statistical and Environmental Sciences, RTI International, Durham, NC USA
| | - César Augusto Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt and Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Michael Welton
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA USA
| | - Ricardo Ximenes
- Departamento de Medicina Tropical da Universidade Federal de Pernambuco, Microcephaly Epidemic Research Group, Recife, Brazil
| | - Carmen Zorrilla
- Maternal-Infant Studies Center (CEMI), San Juan, Puerto Rico
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20
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Eick SM, Dale AP, McKay B, Lawrence C, Ebell MH, Cordero JF, Welton M. Seroprevalence of Dengue and Zika Virus in Blood Donations: A Systematic Review. Transfus Med Rev 2018; 33:35-42. [PMID: 30471867 DOI: 10.1016/j.tmrv.2018.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/25/2018] [Accepted: 10/18/2018] [Indexed: 11/15/2022]
Abstract
The presence of antibodies to Zika virus (ZIKV) and dengue virus (DENV) can be detected in blood donations. Donation-based surveillance provides an alternative strategy to estimate population prevalence by detecting antibodies that are circulating. To estimate population prevalence, we conducted a systematic review of literature on the seroprevalence of ZIKV and DENV antibodies in blood donations. We searched PubMed and Web of Science for studies that reported the seroprevalence of ZIKV and DENV in blood donations. The title and abstract of each study were screened by 2 reviewers simultaneously for possible inclusion, and the full text of selected studies was reviewed to ensure that they met inclusion criteria (used primary data collection, reported evidence of immunoglobulin M (IgM) or immunoglobulin G (IgG) antibodies in the blood supply, and included a representative sample of the total population). Immunoglobin test measuring levels of antibodies to IgM and IgG and number of positive cases were extracted from each study. No exclusions were made based on language or country. Our initial search identified 1890 studies after excluding duplicates, of which 76 were assessed for full text eligibility to ensure that they met our final inclusion criteria. There were 14 studies included in our review; 11 examined the seroprevalence of DENV, and 3 examined ZIKV. The highest seroprevalence by IgM was 2.82% for DENV and 0.53% for ZIKV. Our results indicate that the seroprevalence of ZIKV and DENV antibody presence in countries with active transmission is higher than reports by traditional surveillance in some countries. This finding is expected due to the large percentage of asymptomatic cases. The highest seroprevalence was observed for IgG, which can persist over long periods of time compared to IgM. Screening of blood donations may help supplement traditional surveillance measures, especially during outbreak settings.
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Affiliation(s)
- Stephanie M Eick
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, University of Georgia Health Sciences Campus, Athens, GA.
| | - Ariella Perry Dale
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, University of Georgia Health Sciences Campus, Athens, GA.
| | - Brian McKay
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, University of Georgia Health Sciences Campus, Athens, GA.
| | - Casey Lawrence
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, University of Georgia Health Sciences Campus, Athens, GA.
| | - Mark H Ebell
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, University of Georgia Health Sciences Campus, Athens, GA.
| | - José F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, University of Georgia Health Sciences Campus, Athens, GA.
| | - Michael Welton
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, University of Georgia Health Sciences Campus, Athens, GA.
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21
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Brown P, Vélez Vega CM, Murphy CB, Welton M, Torres H, Rosario Z, Alshawabkeh A, Cordero JF, Padilla IY, Meeker JD. Hurricanes and the Environmental Justice Island: Irma and Maria in Puerto Rico. Environ Justice 2018; 11:148-153. [PMID: 31131071 PMCID: PMC6114726 DOI: 10.1089/env.2018.0003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This article presents an overview of our research team's disaster response to the massive destruction of Hurricanes, Irma and Maria, in September 2017, in light of the 120-year colonial legacy and long-term, widespread environmental contamination in Puerto Rico. Both local and federal governmental responses have been extremely inadequate, especially in light of the long-standing issues of environmental contamination throughout the island. Community organizations in Puerto Rico have been fighting for environmental justice for decades, often succeeding, and always confronting government unwillingness to address environmental protection. Hurricanes Irma and Maria afforded attention to Puerto Rico through international news coverage and awareness of its colonial status, rundown infrastructures (especially the electric grid), indebtedness, and environmental hazards. Since the hurricanes, the research teams of the Puerto Rico Test Site to Explore Contamination Threats (PROTECT), the Center for Research on Early Childhood Exposure and Development (CRECE), and Zika in Infants and Pregnancy (ZIP) have worked tirelessly to address the needs of our research participants, partnering clinics, as well as the local team to ensure safety and wellness. We have been able to continue our environmental public health work with pregnant women and children. In response to the historical problems and current crisis, we offer a "visionary rebuilding" approach for remediation of the hurricanes' effects, and for a deeper solution to the environmental and other social injustices Puerto Rico has long faced.
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Affiliation(s)
- Phil Brown
- Address correspondence to:Phil BrownSocial Science Environmental Health Research InstituteNortheastern UniversityINV 318360 Huntington AvenueBoston, MA 02115
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22
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Welton M, DeJoy D, Castellanos ME, Ebell M, Shen Y, Robb S. Ethnic Disparities of Perceived Safety Climate Among Construction Workers in Georgia, 2015. J Racial Ethn Health Disparities 2017. [PMID: 28643270 DOI: 10.1007/s40615-017-0394-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/19/2022]
Abstract
BACKGROUND Safety climate involves worker perception about the relative importance where they work and safety climate and has been shown to be a reliable predictor of safety-related outcomes. METHODS The primary objective of this study is to investigate ethnic differences in perceived safety climate among construction workers. Surveys (n = 179) that included a 10-item safety climate scale were administered in Athens, Georgia (GA), at local construction sites and home improvement stores during June-August, 2015. RESULTS The majority of respondents were carpenters or roofers (39%), followed by laborers (22%), painters and dry wall workers (14%), other skilled trades (14%), and supervisors (11%); 32% were Hispanic. Hispanic ethnicity (p < 0.0001), drinking two or more alcoholic beverages per day (p < 0.0001), working for a company that does not provide health insurance (p = 0.0022), and working for a company with fewer than ten employees (p < 0.0001) were significantly associated with lower perceived safety climate scores. CONCLUSION The lower perceived safety climate scores among Hispanic workers indicate that the perception of the importance of safety on the job site is lower among Hispanics construction workers than non-Hispanics construction workers.
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Affiliation(s)
- Michael Welton
- University of Georgia, College of Public Health, 101 Buck Road, Athens, 30606, GA, USA.
| | - David DeJoy
- University of Georgia, College of Public Health, 101 Buck Road, Athens, 30606, GA, USA
| | | | - Mark Ebell
- University of Georgia, College of Public Health, 101 Buck Road, Athens, 30606, GA, USA
| | - Ye Shen
- University of Georgia, College of Public Health, 101 Buck Road, Athens, 30606, GA, USA
| | - Sara Robb
- University of Georgia, College of Public Health, 101 Buck Road, Athens, 30606, GA, USA
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Welton M, Rodriguez-Lainz A, Loza O, Brodine S, Fraga M. Use of lead-glazed ceramic ware and lead-based folk remedies in a rural community of Baja California, Mexico. Glob Health Promot 2016; 25:6-14. [DOI: 10.1177/1757975916639861] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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]
Abstract
Background: Lead exposure from lead-glazed ceramics (LGCs) and traditional folk remedies have been identified as significant sources of elevated blood lead levels in Mexico and the United States. This study took place from 2005 to 2012 in a rural community in Baja California, Mexico. Objectives: 1) Investigate the knowledge, attitudes, and practices related to lead and lead exposures from LGCs and two lead-based folk remedies ( azarcon and greta); and 2) evaluate a pilot intervention to provide alternative lead-safe cookware. Methods: A baseline household survey was conducted in 2005, followed by the pilot intervention in 2006, and follow-up surveys in 2007 and 2012. For the pilot intervention, families who reported using LGCs were given lead-safe alternative cookware to try and its acceptance was evaluated in the following year. Results: The community was mostly of indigenous background from Oaxaca and a high proportion of households had young children. In 2006, all participants using traditional ceramic ware at the time ( n = 48) accepted lead-safe alternative cookware to try, and 97% reported that they were willing to exchange traditional ceramic ware for lead-safe alternatives. The use of ceramic cookware decreased from over 90% during respondents’ childhood household use in Oaxaca to 47% in 2006 among households in Baja California, and further reduced to 16.8% in 2012. While empacho, a folk illness, was widely recognized as an intestinal disorder, there was almost universal unfamiliarity with the use and knowledge of azarcon and greta for its treatment. Conclusion: This pilot evaluation provides evidence 1) for an effective and innovative strategy to reduce lead exposure from LGCs and 2) of the feasibility of substituting lead-free alternative cookware for traditional ceramic ware in a rural indigenous community, when delivered in a culturally appropriate manner with health education. This strategy could complement other approaches to reduce exposure to lead from LGCs.
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Affiliation(s)
| | | | - Oralia Loza
- The University of Texas at El Paso, El Paso, USA
| | | | - Miguel Fraga
- Universidad Autónoma de Baja California, Tijuana, Mexico
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Brotherton L, Welton M, Robb SW. Racial disparities of pancreatic cancer in Georgia: a county-wide comparison of incidence and mortality across the state, 2000-2011. Cancer Med 2015; 5:100-10. [PMID: 26590010 PMCID: PMC4708903 DOI: 10.1002/cam4.552] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/31/2015] [Accepted: 09/02/2015] [Indexed: 12/20/2022] Open
Abstract
Understanding the geographic distribution of pancreatic cancer is important in assessing disease burden and identifying high‐risk populations. This study examined the geographic trends of pancreatic cancer incidence, mortality, and mortality‐to‐incidence ratios (MIRs) in Georgia, with a special focus on racial disparities of disease. Directly age‐adjusted pancreatic cancer incidence and mortality rates for Georgia counties (N = 159) were obtained for 2000–2011. Maps of county age‐adjusted disease rates and MIRs were generated separately for African Americans and Caucasians. Cluster analyses were conducted to identify unusual geographic aggregations of cancer cases or deaths. Pearson correlation coefficients were calculated to examine associations between county health factors (e.g., health behaviors, clinical care, and physical environment) and pancreatic cancer incidence or mortality rates. African Americans displayed a significantly higher age‐adjusted incidence (14.6/100,000) and mortality rate (13.3/100,000), compared to Caucasians. Cluster analyses identified five significant incidence clusters and four significant mortality clusters among Caucasians; one significant incidence cluster and two significant mortality clusters were identified among African Americans. Weak but significant correlations were noted between physical environment and pancreatic cancer incidence (ρ = 0.16, P = 0.04) and mortality (ρ = 0.18, P = 0.02) among African Americans. A disproportion burden of pancreatic cancer incidence and mortality was exhibited among African Americans in Georgia. Disease intervention efforts should be implemented in high‐risk areas, such as the southwest and central region of the state. Future studies should assess health behaviors and physical environment in relationship with the spatial distribution of pancreatic cancer.
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Affiliation(s)
- Lindsay Brotherton
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - Michael Welton
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - Sara W Robb
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
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Welton M, Robb SW, Shen Y, Guillebeau P, Vena J. Prostate cancer incidence and agriculture practices in Georgia, 2000-2010. Int J Occup Environ Health 2015; 21:251-7. [PMID: 25785490 DOI: 10.1179/2049396714y.0000000106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Georgia has prostate cancer incidence rates consistently above the national average. A notable portion of Georgia's economy is rooted in agricultural production, and agricultural practices have been associated with an increased risk of prostate cancer. METHODS Statistical analyses considered county age-adjusted prostate cancer incidence rates as the outcome of interest and three agricultural variables (farmland as percent of county land, dollars spent per county acre on agriculture chemicals, and dollars spent per county acre on commercial fertilizers) as exposures of interest. Multivariate linear regression models analyzed for each separately. Data were obtained from National Cancer Institute Surveillance, Epidemiology and End Results (SEER) 2000-2010, United States Department of Agriculture (USDA) 1987 Agriculture Survey, and 2010 US Census. RESULTS In counties with equal to or greater than Georgia counties' median percent African-American population (27%), dollars per acre spent on agriculture chemicals was significantly associated (P = 0.04) and dollars spent of commercial fertilizers was moderately associated (P = 0.07) with elevated prostate cancer incidence rates. There was no association between percent of county farmland and prostate cancer rates. CONCLUSION This study identified associations between prostate cancer incidence rates, agriculture chemical expenditure, and commercial fertilizer expenditure in Georgia counties with a population comprised of more than 27% of African Americans.
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Cabebe EC, Kuo T, Koong A, Welton M, Shelton A, Kunz PL, Ford JM, Sikic BI, Kaiser HL, Rogers J, Fisher GA. Phase I trial of preoperative cetuximab in combination with oxaliplatin, capecitabine, and radiation therapy for locally advanced rectal cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tillman G, Fisher G, Cho C, Ford J, Mehta V, Welton M, Shelton A, Bastidas J, Young H, Koong A. The stanford experience with preoperative chemoradiation using CPT-11 and 5-FU in locally advanced rectal cancer: Toxicities and outcomes. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.304] [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: 11/29/2022]
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Compton CC, Fielding LP, Burgart LJ, Conley B, Cooper HS, Hamilton SR, Hammond ME, Henson DE, Hutter RV, Nagle RB, Nielsen ML, Sargent DJ, Taylor CR, Welton M, Willett C. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 2000. [PMID: 10888773 DOI: 10.1043/0003-9985(2000)124<0979:pficc>2.0.co;2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Under the auspices of the College of American Pathologists, the current state of knowledge regarding pathologic prognostic factors (factors linked to outcome) and predictive factors (factors predicting response to therapy) in colorectal carcinoma was evaluated. A multidisciplinary group of clinical (including the disciplines of medical oncology, surgical oncology, and radiation oncology), pathologic, and statistical experts in colorectal cancer reviewed all relevant medical literature and stratified the reported prognostic factors into categories that reflected the strength of the published evidence demonstrating their prognostic value. Accordingly, the following categories of prognostic factors were defined. Category I includes factors definitively proven to be of prognostic import based on evidence from multiple statistically robust published trials and generally used in patient management. Category IIA includes factors extensively studied biologically and/or clinically and repeatedly shown to have prognostic value for outcome and/or predictive value for therapy that is of sufficient import to be included in the pathology report but that remains to be validated in statistically robust studies. Category IIB includes factors shown to be promising in multiple studies but lacking sufficient data for inclusion in category I or IIA. Category III includes factors not yet sufficiently studied to determine their prognostic value. Category IV includes factors well studied and shown to have no prognostic significance. MATERIALS AND METHODS The medical literature was critically reviewed, and the analysis revealed specific points of variability in approach that prevented direct comparisons among published studies and compromised the quality of the collective data. Categories of variability recognized included the following: (1) methods of analysis, (2) interpretation of findings, (3) reporting of data, and (4) statistical evaluation. Additional points of variability within these categories were defined from the collective experience of the group. Reasons for the assignment of an individual prognostic factor to category I, II, III, or IV (categories defined by the level of scientific validation) were outlined with reference to the specific types of variability associated with the supportive data. For each factor and category of variability related to that factor, detailed recommendations for improvement were made. The recommendations were based on the following aims: (1) to increase the uniformity and completeness of pathologic evaluation of tumor specimens, (2) to enhance the quality of the data needed for definitive evaluation of the prognostic value of individual prognostic factors, and (3) ultimately, to improve patient care. RESULTS AND CONCLUSIONS Factors that were determined to merit inclusion in category I were as follows: the local extent of tumor assessed pathologically (the pT category of the TNM staging system of the American Joint Committee on Cancer and the Union Internationale Contre le Cancer [AJCC/UICC]); regional lymph node metastasis (the pN category of the TNM staging system); blood or lymphatic vessel invasion; residual tumor following surgery with curative intent (the R classification of the AJCC/UICC staging system), especially as it relates to positive surgical margins; and preoperative elevation of carcinoembryonic antigen elevation (a factor established by laboratory medicine methods rather than anatomic pathology). Factors in category IIA included the following: tumor grade, radial margin status (for resection specimens with nonperitonealized surfaces), and residual tumor in the resection specimen following neoadjuvant therapy (the ypTNM category of the TNM staging system of the AJCC/UICC). (ABSTRACT TRUNCATED)
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29
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Compton CC, Fielding LP, Burgart LJ, Conley B, Cooper HS, Hamilton SR, Hammond ME, Henson DE, Hutter RV, Nagle RB, Nielsen ML, Sargent DJ, Taylor CR, Welton M, Willett C. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 2000; 124:979-94. [PMID: 10888773 DOI: 10.5858/2000-124-0979-pficc] [Citation(s) in RCA: 846] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Under the auspices of the College of American Pathologists, the current state of knowledge regarding pathologic prognostic factors (factors linked to outcome) and predictive factors (factors predicting response to therapy) in colorectal carcinoma was evaluated. A multidisciplinary group of clinical (including the disciplines of medical oncology, surgical oncology, and radiation oncology), pathologic, and statistical experts in colorectal cancer reviewed all relevant medical literature and stratified the reported prognostic factors into categories that reflected the strength of the published evidence demonstrating their prognostic value. Accordingly, the following categories of prognostic factors were defined. Category I includes factors definitively proven to be of prognostic import based on evidence from multiple statistically robust published trials and generally used in patient management. Category IIA includes factors extensively studied biologically and/or clinically and repeatedly shown to have prognostic value for outcome and/or predictive value for therapy that is of sufficient import to be included in the pathology report but that remains to be validated in statistically robust studies. Category IIB includes factors shown to be promising in multiple studies but lacking sufficient data for inclusion in category I or IIA. Category III includes factors not yet sufficiently studied to determine their prognostic value. Category IV includes factors well studied and shown to have no prognostic significance. MATERIALS AND METHODS The medical literature was critically reviewed, and the analysis revealed specific points of variability in approach that prevented direct comparisons among published studies and compromised the quality of the collective data. Categories of variability recognized included the following: (1) methods of analysis, (2) interpretation of findings, (3) reporting of data, and (4) statistical evaluation. Additional points of variability within these categories were defined from the collective experience of the group. Reasons for the assignment of an individual prognostic factor to category I, II, III, or IV (categories defined by the level of scientific validation) were outlined with reference to the specific types of variability associated with the supportive data. For each factor and category of variability related to that factor, detailed recommendations for improvement were made. The recommendations were based on the following aims: (1) to increase the uniformity and completeness of pathologic evaluation of tumor specimens, (2) to enhance the quality of the data needed for definitive evaluation of the prognostic value of individual prognostic factors, and (3) ultimately, to improve patient care. RESULTS AND CONCLUSIONS Factors that were determined to merit inclusion in category I were as follows: the local extent of tumor assessed pathologically (the pT category of the TNM staging system of the American Joint Committee on Cancer and the Union Internationale Contre le Cancer [AJCC/UICC]); regional lymph node metastasis (the pN category of the TNM staging system); blood or lymphatic vessel invasion; residual tumor following surgery with curative intent (the R classification of the AJCC/UICC staging system), especially as it relates to positive surgical margins; and preoperative elevation of carcinoembryonic antigen elevation (a factor established by laboratory medicine methods rather than anatomic pathology). Factors in category IIA included the following: tumor grade, radial margin status (for resection specimens with nonperitonealized surfaces), and residual tumor in the resection specimen following neoadjuvant therapy (the ypTNM category of the TNM staging system of the AJCC/UICC). (ABSTRACT TRUNCATED)
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Milne R, Wright T, Welton M, Budau C, Gringorten L, Tyrrell D. Identification and partial purification of a cell-lytic factor from Entomophaga aulicae. J Invertebr Pathol 1994. [DOI: 10.1016/s0022-2011(94)90375-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
A 31 year old man from Gambia, resident in the United Kingdom for two years, presented with a two month history of unproductive cough, malaise, weight loss, non-specific abdominal pain, and episodic diarrhoea. Acid alcohol fast bacilli were identified in his sputum, together with Strongyloides stercoralis larvae and Giardia lamblia cysts in his stools. This case illustrates that latent strongyloidiasis can become overt in the presence of tuberculosis, and the diagnosis of strongyloidiasis must be borne in mind in patients who have previously resided in endemic regions.
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Abstract
The effects of corticotropin-releasing factor (CRF) on gastric emptying of a saline solution was further investigated in six dogs prepared with gastric fistulas and chronic cerebroventricular guides and in four other dogs with chronic gastric fistulas and pancreatic (Herrera) cannulas. Intravenous infusion of CRF significantly inhibited gastric emptying whereas intracerebroventricular injection of CRF had no effect. Pharmacologic blockade of beta-adrenergic system by propranolol did not modify intravenous CRF induced delay in gastric emptying. Intravenous CRF did not influence basal pancreatic secretion whereas secretin infused stimulated bicarbonate secretion. These results indicate that intravenous but not intracerebroventricular administration of CRF inhibited gastric emptying of a saline solution in dogs. The inhibitory effect of intravenous CRF on gastric emptying is not mediated by the beta-adrenergic nervous system, and not secondary to the release of other peptides that affect both pancreatic secretion and gastric emptying such as cholecystokinin and peptide YY.
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Affiliation(s)
- T N Pappas
- Center for Ulcer Research and Education, VA Wadsworth Medical Center, Los Angeles, CA 90073
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Abstract
We reviewed 334 patients with cryptorchidism treated at our institution during a 13-year period. Other congenital anomalies were apparent on physical examination in 102 cases and these were more common in patients with bilateral cryptorchidism. Of the 205 excretory urograms done 25 showed abnormalities and, again, these abnormalities were noted more commonly in patients with bilateral cryptorchidism. Of 232 patients with asymptomatic cryptorchidism, that is with no other congenital findings on physical examination, 141 had an excretory urogram and 4 revealed some abnormality, 2 of these warranting surgical intervention. Of the 334 patients 16 had hypospadias and 50 were mentally retarded. The literature is reviewed. It is concluded that an excretory urogram is not justified on a routine basis in patients with asymptomatic cryptorchidism.
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