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Talal AH, Dharia A, Kapadia SN, Tyson GL, Birch S, Zerzan-Thul J, Sullivan D, Britton E, Wethington E, Gonzalez CJ, Fliss M, Mizroch B, McCall F, Lloyd AR, Shapiro MF, Franco R. Hepatitis C Virus Elimination Programs in Louisiana and Washington: Importance of Screening and Surveillance Systems. J Public Health Manag Pract 2024; 30:208-212. [PMID: 37594263 PMCID: PMC10833194 DOI: 10.1097/phh.0000000000001808] [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: 08/19/2023]
Abstract
The US government has established a national goal of hepatitis C virus (HCV) elimination by 2030. To date, most HCV elimination planning and activity have been at the state level. Fifteen states presently have publicly available HCV elimination plans. In 2019, Louisiana and Washington were the first states to initiate 5-year funded HCV elimination programs. These states differ on motivation for pursuing HCV elimination and ranking on several indicators. Simultaneously, however, they have emphasized several similar elimination components including HCV screening promotion through public awareness, screening expansion, surveillance enhancement (including electronic reporting and task force development), and harm reduction. The 13 other states with published elimination plans have proposed the majority of the elements identified by Louisiana and Washington, but several have notable gaps. Louisiana's and Washington's comprehensive plans, funding approaches, and programs provide a useful framework that can move states and the nation toward HCV elimination.
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Affiliation(s)
- Andrew H. Talal
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Arpan Dharia
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Shashi N. Kapadia
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Gia L. Tyson
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Susan Birch
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Judy Zerzan-Thul
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Donna Sullivan
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Elizabeth Britton
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Elaine Wethington
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Christopher J. Gonzalez
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Mary Fliss
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Brandon Mizroch
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Frederic McCall
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Audrey R. Lloyd
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Martin F. Shapiro
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
| | - Ricardo Franco
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York (Drs Talal and Dharia); Divisions of Infectious Diseases (Dr Kapadia) and General Internal Medicine (Drs Gonzalez and Shapiro), Weill Cornell Medicine, New York, New York; Louisiana Department of Health, New Orleans, Louisiana (Drs Tyson, Mizroch, and McCall and Ms Britton); Washington State Healthcare Authority, Olympia, Washington (Drs Sullivan and Zerzan-Thul and Mss Birch and Fliss); Cornell University, Ithaca, New York (Dr Wethington); and Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama (Drs Lloyd and Franco)
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Shu B, Wilson MM, Keller MW, Tran H, Sokol T, Lee G, Rambo‐Martin BL, Kirby MK, Hassell N, Haydel D, Hand J, Wentworth DE, Barnes JR. In-field detection and characterization of B/Victoria lineage deletion variant viruses causing early influenza activity and an outbreak in Louisiana, 2019. Influenza Other Respir Viruses 2024; 18:e13246. [PMID: 38188372 PMCID: PMC10767671 DOI: 10.1111/irv.13246] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 01/09/2024] Open
Abstract
Background In 2019, the Louisiana Department of Health reported an early influenza B/Victoria (B/VIC) virus outbreak. Method As it was an atypically large outbreak, we deployed to Louisiana to investigate it using genomics and a triplex real-time RT-PCR assay to detect three antigenically distinct B/VIC lineage variant viruses. Results The investigation indicated that B/VIC V1A.3 subclade, containing a three amino acid deletion in the hemagglutinin and known to be antigenically distinct to the B/Colorado/06/2017 vaccine virus, was the most prevalent circulating virus within the specimens evaluated (86/88 in real-time RT-PCR). Conclusion This work underscores the value of portable platforms for rapid, onsite pathogen characterization.
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Affiliation(s)
- Bo Shu
- Virology, Surveillance and Diagnosis Branch, Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Malania M. Wilson
- Virology, Surveillance and Diagnosis Branch, Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Matthew W. Keller
- Virology, Surveillance and Diagnosis Branch, Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Ha Tran
- Louisiana Department of HealthOffice of Public Health LaboratoryBaton RougeLouisianaUSA
| | - Theresa Sokol
- Louisiana Department of HealthOffice of Public Health, Infectious Disease EpidemiologyNew OrleansLouisianaUSA
| | - Grace Lee
- Louisiana Department of HealthOffice of Public Health, Infectious Disease EpidemiologyNew OrleansLouisianaUSA
| | - Benjamin L. Rambo‐Martin
- Virology, Surveillance and Diagnosis Branch, Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Marie K. Kirby
- Virology, Surveillance and Diagnosis Branch, Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Norman Hassell
- Virology, Surveillance and Diagnosis Branch, Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Danielle Haydel
- Louisiana Department of HealthOffice of Public Health LaboratoryBaton RougeLouisianaUSA
| | - Julie Hand
- Louisiana Department of HealthOffice of Public Health, Infectious Disease EpidemiologyNew OrleansLouisianaUSA
| | - David E. Wentworth
- Virology, Surveillance and Diagnosis Branch, Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - John R. Barnes
- Virology, Surveillance and Diagnosis Branch, Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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Essajee NM, Oddo-Moise H, Hagensee ME, Lillis RA, Maffei J, Butler I, Lovett A, Sokol T, Clement ME. Characteristics of Mpox Infections in Louisiana in the 2022 Outbreak. AIDS Res Hum Retroviruses 2023; 39:587-592. [PMID: 37424520 PMCID: PMC10621655 DOI: 10.1089/aid.2023.0011] [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: 07/11/2023] Open
Abstract
The 2022 outbreak of mpox in Louisiana was limited to just >300 cases, perhaps an unexpected outcome given the state's high rates of HIV and other sexually transmitted infections (STIs). We aimed to describe the local outbreak within two health centers in the New Orleans region, partnering with the Louisiana Department of Health to offer additional statewide data. We reviewed charts of persons testing positive for mpox in New Orleans from July to November 2022 at two local health centers that together accounted for half of local cases. We abstracted data on HIV status, immune function [CD4 count, viral load (VL)], antiretroviral therapy regimen, symptoms and severity of infection, vaccination status, and whether tecovirimat was administered. We present local data relative to statewide data (July 2022-January 2023). Of 103 individuals in our network for whom charts were reviewed, 96 (93%) identified as male, 52 (50%) were Black, and 69 (67%) had HIV, including 12 (17%) with uncontrolled HIV (CD4 < 200 cells/mm3 or VL >200 copies/mL). The most common presenting symptoms were rash (n = 71, 69%), fever (n = 36, 35%), and rectal pain (n = 33, 32%). Of six (6%) patients hospitalized, four (67%) were persons with HIV (PWH). Two were hospitalized for severe mpox infection with >100 lesions at presentation; both were PWH, and one had uncontrolled infection. Across the state, 307 cases have been identified and 24 have been hospitalized. Of those hospitalized, 18 (75%) were PWH, including 9 (50%) with uncontrolled HIV. The demographic data from Louisiana, a state with high prevalence of STIs and HIV/AIDS, are consistent with prior reports describing the 2022 mpox outbreak. Our results contribute to accumulating data on the severity of infection in individuals with HIV-related immunocompromise.
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Affiliation(s)
- Nabil M. Essajee
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Hope Oddo-Moise
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Michael E. Hagensee
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Rebecca A. Lillis
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Joanne Maffei
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Isolde Butler
- CrescentCare Federally Qualified Health Center, New Orleans, Louisiana, USA
| | - Aish Lovett
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Theresa Sokol
- Office of Public Health, Louisiana Department of Health, New Orleans, Louisiana, USA
| | - Meredith E. Clement
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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Cooper D, Harmon D, Alemayehu C, Levy J, Gastañaduy M, Birdsall Fort L, McCoin N. Survey of Vaccine Hesitancy in Patients Visiting Three Tertiary-care Emergency Departments in Southeast Louisiana. West J Emerg Med 2023; 24:1073-1084. [PMID: 38165190 PMCID: PMC10754190 DOI: 10.5811/westjem.57449] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives Vaccine hesitancy has been a barrier to achieving herd immunity during the coronavirus 2019 (COVID-19) pandemic. Having low socioeconomic status and education levels, and being a person of color, are associated with higher COVID-19 infection risk and worse outcomes. These same groups are associated with higher vaccine hesitancy. The state of Louisiana has one of the lowest vaccination rates in the country. In this study we aimed to identify demographic, perspective, and health behavior factors associated with vaccine hesitancy in emergency departments (ED) in Southeast Louisiana. Methods A cross-sectional survey was distributed at three tertiary-care hospital EDs. Patients >18 years old and not in acute distress were recruited between April-July 2021. The 37-item questionnaire addressed socioeconomic demographics, social determinants of health, COVID-19 safety practices, thoughts and perceptions on COVID-19 and vaccines, sources of COVID-19 and vaccine information, and trust in the healthcare system. Results Overall, 247 patients completed our survey. Of those, 29.6% reported they were vaccine hesitant. These respondents were significantly more likely, when compared to vaccine-acceptant respondents, to never have married, to have some college education, make less than <$25,000 in household earnings yearly, be unsure whether vaccines prevent disease, not have discussed the COVID-19 vaccine with their primary care doctor, and to prefer to do their own research for COVID-19 vaccine information. We observed no statistically significant differences based on gender, race/ethnicity, parental status, area of living, or their perceived risk of needing hospitalization for treatment or dying from the virus. Conclusion Vaccine hesitancy was associated with multiple socioeconomic factors, perspectives, and beliefs. Vaccine-hesitant individuals were more uncertain about the safety of the COVID-19 vaccine, the feasibility of obtaining the vaccine, and its efficacy. Public health interventions aimed at these findings and improving public trust in healthcare systems are needed to increase vaccine acceptance.
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Affiliation(s)
- Denrick Cooper
- Ochsner Health, Department of Emergency Medicine, New Orleans, Louisiana
| | - David Harmon
- Ochsner Health, Department of Emergency Medicine, New Orleans, Louisiana
- Ochsner Health, Department of Clinical Research, New Orleans, Louisiana
| | - Carmel Alemayehu
- Ochsner Health, Department of Clinical Research, New Orleans, Louisiana
- Georgetown University, School of Medicine, Washington D.C
| | - Julia Levy
- Oregon Health & Sciences University, Department of Internal Medicine, Portland, Oregon
| | - Mariella Gastañaduy
- Ochsner Health, Department of Clinical Research, New Orleans, Louisiana
- Ochsner Health, Office of Epidemiology and Biostatistics, New Orleans, Louisiana
| | - Lisa Birdsall Fort
- Ochsner Health, Department of Emergency Medicine, New Orleans, Louisiana
| | - Nicole McCoin
- Ochsner Health, Department of Emergency Medicine, New Orleans, Louisiana
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Harville EW, Kracht CL, Cohen NL, Sutton EF, Kebbe M, Redman LM. Trends in Gestational Weight Gain in Louisiana, March 2019 to March 2022. JAMA Netw Open 2023; 6:e2331277. [PMID: 37642960 PMCID: PMC10466167 DOI: 10.1001/jamanetworkopen.2023.31277] [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] [Received: 04/03/2023] [Accepted: 07/22/2023] [Indexed: 08/31/2023] Open
Abstract
Importance Average gestational weight gain (GWG) increased during the COVID-19 pandemic, but it is not known whether this trend has continued. Objective To examine patterns of GWG during the COVID-19 pandemic by delivery and conception timing through the second year of the pandemic. Design, Setting, and Participants This cohort study is a retrospective review of birth certificate and delivery records from 2019 to 2022. Electronic health records were from the largest delivery hospital in Louisiana. Participants included all individuals giving birth from March 2019 to March 2022. Data analysis was performed from October 2022 to July 2023. Exposure Delivery date (cross-sectionally) and conception before the pandemic (March 2019 to March 2020) and during the peak pandemic (March 2020 to March 2021) and late pandemic (March 2021 to March 2022). Main Outcomes and Measures The primary outcome was GWG (total GWG and adherence to the 2009 Institute of Medicine recommendations) analyzed using linear and log-linear regression with control for covariates. Results Among 23 012 total deliveries (8763 Black individuals [38.1%]; 11 774 White individuals [51.2%]; mean [SD] maternal age, 28.9 [5.6] years), 3182 individuals (42.0%) exceeded the recommended weight gain in the year proceeding the pandemic, 3400 (45.4%) exceeded recommendations during the peak pandemic, and 3273 (44.0%) exceeded recommendations in the late pandemic. Compared with those who delivered before the pandemic (reference), participants had higher total GWG if they delivered peak or late pandemic (adjusted β [SE], 0.38 [0.12] kg vs 0.19 [0.12] kg; P = .007). When cohorts were defined by conception date, participants who conceived before the pandemic but delivered after the pandemic started had higher GWG compared with those whose entire pregnancy occurred before the pandemic (adjusted β [SE], 0.51 [0.16] kg). GWG was lower in the pregnancies conceived after the pandemic started and the late pandemic (adjusted β [SE], 0.29 [0.12] kg vs 0.003 [0.14] kg; P = .003) but these participants began pregnancy at a slightly higher weight. Examining mean GWG month by month suggested a small decrease for March 2020, followed by increased mean GWG for the following year. Individuals with 2 pregnancies (1289 individuals) were less likely to gain weight above the recommended guidelines compared with their prepandemic pregnancy, but this association was attenuated after adjustment. Conclusions and Relevance In this cohort, individuals with critical time points of their pregnancy during the COVID-19 pandemic gained more weight compared with the previous year. The increased GWG leveled off as the pandemic progressed but individuals were slightly heavier beginning pregnancy.
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Affiliation(s)
- Emily W. Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Nicole L. Cohen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Maryam Kebbe
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
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Pathak S, Wang H, Seals K, Adusumilli NC, Holston D. Self-assessed health status and obesity vulnerability in rural Louisiana: A cross-sectional analysis. PLoS One 2023; 18:e0287181. [PMID: 37327219 PMCID: PMC10275442 DOI: 10.1371/journal.pone.0287181] [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] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 05/14/2023] [Indexed: 06/18/2023] Open
Abstract
Rural communities are resource-constrained and at higher risk of obesity and obesity-related conditions. Thus, studying self-assessed health status and underlying vulnerabilities is critical to provide insights to the program planners for effective and efficient planning of obesity prevention programs. This study aims to investigate the correlates of self-assessed health status and subsequently determine the obesity vulnerability level of residents in rural communities. Randomly sampled data were obtained from in-person community surveys in three rural Louisiana counties-East Carroll, Saint Helena, and Tensas-in June 2021. The association of social-demographic factors, grocery store choice, and exercise frequency with self-assessed health was investigated using the ordered logit model. An obesity vulnerability index was constructed using the weights obtained from the principal component analysis. The results show that gender, race, education, possession of children, exercise frequency, and grocery store choice significantly influence self-assessed health status. Around 20% of respondents fall into the most-vulnerable segment and 65% of respondents are vulnerable to obesity. The obesity vulnerability index ranged from -4.036 to 4.565, indicating a wide heterogeneity in the vulnerability level of rural residents. The findings show that the self-assessed health status of rural residents is not promising along with a high level of vulnerability to obesity. The findings from this study could serve as a reference in the policy discussion regarding an effective and efficient suite of interventions in rural communities to address obesity and promote well-being.
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Affiliation(s)
- Santosh Pathak
- Department of Agricultural Economics and Agribusiness, Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, Louisiana, United States of America
| | - Hua Wang
- Department of Agricultural Economics and Agribusiness, Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, Louisiana, United States of America
| | - Katherine Seals
- School of Nutrition and Food Sciences, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Naveen C. Adusumilli
- Department of Agricultural Economics and Agribusiness, Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, Louisiana, United States of America
| | - Denise Holston
- School of Nutrition and Food Sciences, Louisiana State University, Baton Rouge, Louisiana, United States of America
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Rahman MM, Johnson C, Taylor SN, Peterman TA, Bennett TS, Haydel D, Newman DR, Furness BW. Extragenital Sexually Transmitted Infection Testing Among Louisiana Parish Health Units, 2016-2019. Sex Transm Dis 2023; 50:274-279. [PMID: 36630331 PMCID: PMC10190115 DOI: 10.1097/olq.0000000000001764] [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: 01/12/2023]
Abstract
BACKGROUND The Centers for Disease Control and Prevention recommends that men who have sex with men (MSM) get tested annually for urethral and rectal chlamydia (CT) and gonorrhea (NG), and pharyngeal NG. There are no national recommendations to screen women and heterosexual men at extragenital sites. We assessed extragenital CT/NG screening among men and women at Louisiana's Parish Health Units (PHU). METHODS The Louisiana STD/HIV/Hepatitis Program piloted extragenital screening at 4 PHUs in February 2016 and expanded to 11 PHUs in 2017. Sexual histories were used to identify gender of sex partners and exposed sites. Because of billing restrictions, up to 2 anatomical sites were tested for CT/NG. RESULTS From February 2016 to June 2019, 70,895 urogenital and extragenital specimens (56,086 urogenital, 13,797 pharyngeal, and 1,012 rectal) were collected from 56,086 patients. Pharyngeal CT positivity was 160 of 7,868 (2.0%) among women, 54 of 4,838 (1.1%) among men who have sex with women (MSW) and 33 of 1,091 (3.0%) among MSM. Rectal CT positivity was 51 of 439 (11.6%) among women and 95 of 573 (16.6%) among MSM. Pharyngeal NG positivity was 299 of 7,868 (3.8%) among women, 222 of 4,838 (4.6%) among MSW, and 97 of 1,091 (8.9%) among MSM. Rectal NG positivity was 20 of 439 (4.6%) among women and 134 of 573 (23.4%) among MSM.Urogenital-only screening would have missed: among women, 173 of 3,923 (4.4%) CT and 227 of 1,480 (15.3%) NG infections; among MSW, 26 of 2,667 (1%) CT and 149 of 1,709 (8.7%) NG infections; and among MSM, 116 of 336 (34.5%) CT and 127 of 413 (42.1%) NG infections. CONCLUSIONS Many CT/NG infections would have been missed with urogenital-only screening. Men who have sex with men had much higher extragenital infection rates than women and MSW.
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Affiliation(s)
- Mohammad M. Rahman
- Louisiana Department of Health-STD/HIV/Hepatitis Program, New Orleans, LA
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Chaquetta Johnson
- Louisiana Department of Health-Office of Public Health, New Orleans, LA
| | - Stephanie N. Taylor
- Louisiana Department of Health-Office of Public Health, New Orleans, LA
- LSU School of Medicine-Section of Infectious Diseases, New Orleans, LA
| | - Thomas A. Peterman
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tammy S. Bennett
- Louisiana Department of Health-Bureau of Family Health, New Orleans, LA
| | - Danielle Haydel
- Louisiana Department of Health-Office of Public Health Laboratory, Baton Rouge, LA
| | - Daniel R. Newman
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bruce W. Furness
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Scott JL, Lee-Johnson NM, Danos D. Place, Race, and Case: Examining Racialized Economic Segregation and COVID-19 in Louisiana. J Racial Ethn Health Disparities 2023; 10:775-787. [PMID: 35239176 PMCID: PMC8893059 DOI: 10.1007/s40615-022-01265-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/19/2022]
Abstract
Early COVID-19 pandemic data suggested racial/ethnic minority and low-income earning people bore the greatest burden of infection. Structural racism, the reinforcement of racial and ethnic discrimination via policy, provides a framework for understanding disparities in health outcomes like COVID-19 infection. Residential racial and economic segregation is one indicator of structural racism. Little attention has been paid to the relationship of infection to relative overall concentrations of risk (i.e., segregation of the most privileged from the most disadvantaged). We used ordinary least squares and geographically weighted regression models to evaluate the relationship between racial and economic segregation, measured by the Index of Concentration at the Extremes, and COVID-19 cases in Louisiana. We found a significant global association between racial segregation and cumulative COVID-19 case rate in Louisiana and variation across the state during the study period. The northwest and central regions exhibited a strong negative relationship indicating greater risk in areas with high concentrations of Black residents. On the other hand, the southeastern part of the state exhibited more neutral or positive relationships indicating greater risk in areas with high concentrations of White residents. Our findings that the relationship between racial segregation and COVID-19 cases varied within a state further support evidence that social and political determinants, not biological, drive racial disparities. Small area measures and measures of polarization provide localized information better suited to tailoring public health policy according to the dynamics of communities at the census tract level, which may lead to better health outcomes.
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Affiliation(s)
- Jennifer L Scott
- School of Social Work, Louisiana State University, 2167 Pleasant Hall, Baton Rouge, LA, 70803, USA.
| | - Natasha M Lee-Johnson
- School of Social Work, Louisiana State University, 2167 Pleasant Hall, Baton Rouge, LA, 70803, USA
| | - Denise Danos
- School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, USA
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9
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Abstract
BACKGROUND At the onset of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services broadened access to telehealth. This provided an opportunity to test whether diabetes, a risk factor for COVID-19 severity, can be managed with telehealth services. OBJECTIVE The objective of this study was to examine the impacts of telehealth on diabetes control. RESEARCH DESIGN A doubly robust estimator combined a propensity score-weighting strategy with regression controls for baseline characteristics using electronic medical records data to compare outcomes in patients with and without telehealth care. Matching on preperiod trajectories in outpatient visits and weighting by odds were used to ensure comparability between comparators. SUBJECTS Medicare patients with type 2 diabetes in Louisiana between March 2018 and February 2021 (9530 patients with a COVID-19 era telehealth visit and 20,666 patients without one). MEASURES Primary outcomes were glycemic levels and control [ie, hemoglobin A1c (HbA1c) under 7%]. Secondary outcomes included alternative HbA1c measures, emergency department visits, and inpatient admissions. RESULTS Telehealth was associated with lower pandemic era mean A1c values [estimate=-0.080%, 95% confidence interval (CI): -0.111% to -0.048%], which translated to an increased likelihood of having HbA1c in control (estimate=0.013; 95% CI: 0.002-0.024; P<0.023). Hispanic telehealth users had relatively higher COVID-19 era HbA1c levels (estimate=0.125; 95% CI: 0.044-0.205; P<0.003). Telehealth was not associated with differences in the likelihood of having an emergency department visits (estimate=-0.003; 95% CI: -0.011 to 0.004; P<0.351) but was associated with more the likelihood of having an inpatient admission (estimate=0.024; 95% CI: 0.018-0.031; P<0.001). CONCLUSION Telehealth use among Medicare patients with type 2 diabetes in Louisiana stemming from the COVID-19 pandemic was associated with relatively improved glycemic control.
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Affiliation(s)
- Brigham Walker
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
- ConcertAI, Cambridge, MA
| | - Charles Stoecker
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Yixue Shao
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | | | | | - Lizheng Shi
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
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Callison K, Anderson A, Shao Y, LaVeist TA, Walker B. Disparities in Telemedicine Use Among Louisiana Medicaid Beneficiaries During the COVID-19 Pandemic. Med Care 2023; 61:S70-S76. [PMID: 36893421 PMCID: PMC9994576 DOI: 10.1097/mlr.0000000000001795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND The COVID-19 pandemic led to an increased reliance on telemedicine. Whether this exacerbated existing disparities within vulnerable populations is not yet known. OBJECTIVES Characterize changes in outpatient telemedicine evaluation and management (E&M) services for Louisiana Medicaid beneficiaries by race, ethnicity, and rurality during the COVID-19 pandemic. RESEARCH DESIGN Interrupted time series regression models estimated pre-COVID-19 trends and changes in E&M service use at the April and July 2020 peaks in COVID-19 infections in Louisiana and in December 2020 after those peaks had subsided. SUBJECTS Louisiana Medicaid beneficiaries continuously enrolled between January 2018 and December 2020 who were not also enrolled in Medicare. MEASURES Monthly outpatient E&M claims per 1000 beneficiaries. RESULTS Prepandemic differences in service use between non-Hispanic White and non-Hispanic Black beneficiaries narrowed by 34% through December 2020 (95% CI: 17.6%-50.6%), while differences between non-Hispanic White and Hispanic beneficiaries increased by 10.5% (95% CI: 0.1%-20.7%). Non-Hispanic White beneficiaries used telemedicine at higher rates than non-Hispanic Black (difference=24.9 claims per 1000 beneficiaries, 95% CI: 22.3-27.4) and Hispanic beneficiaries (difference=42.3 claims per 1000 beneficiaries, 95% CI: 39.1-45.5) during the first wave of COVID-19 infections in Louisiana. Telemedicine use increased slightly for rural beneficiaries compared with urban beneficiaries (difference=5.3 claims per 1000 beneficiaries, 95% CI: 4.0-6.6). CONCLUSIONS The COVID-19 pandemic narrowed gaps in outpatient E&M service use between non-Hispanic White and non-Hispanic Black Louisiana Medicaid beneficiaries, though gaps in telemedicine use emerged. Hispanic beneficiaries experienced large reductions in service use and relatively small increases in telemedicine use.
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Yu Q, Cao W, Hamer D, Urbanek N, Straif-Bourgeois S, Cormier SA, Ferguson T, Richmond-Bryant J. Associations of COVID-19 Hospitalizations, ICU Admissions, and Mortality with Black and White Race and Their Mediation by Air Pollution and Other Risk Factors in the Louisiana Industrial Corridor, March 2020-August 2021. Int J Environ Res Public Health 2023; 20:4611. [PMID: 36901619 PMCID: PMC10001987 DOI: 10.3390/ijerph20054611] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Louisiana ranks among the bottom five states for air pollution and mortality. Our objective was to investigate associations between race and Coronavirus Disease 2019 (COVID-19) hospitalizations, intensive care unit (ICU) admissions, and mortality over time and determine which air pollutants and other characteristics may mediate COVID-19-associated outcomes. In our cross-sectional study, we analyzed hospitalizations, ICU admissions, and mortality among positive SARS-CoV-2 cases within a healthcare system around the Louisiana Industrial Corridor over four waves of the pandemic from 1 March 2020 to 31 August 2021. Associations between race and each outcome were tested, and multiple mediation analysis was performed to test if other demographic, socioeconomic, or air pollution variables mediate the race-outcome relationships after adjusting for all available confounders. Race was associated with each outcome over the study duration and during most waves. Early in the pandemic, hospitalization, ICU admission, and mortality rates were greater among Black patients, but as the pandemic progressed, these rates became greater in White patients. However, Black patients were disproportionately represented in these measures. Our findings imply that air pollution might contribute to the disproportionate share of COVID-19 hospitalizations and mortality among Black residents in Louisiana.
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Affiliation(s)
- Qingzhao Yu
- Biostatistics Program, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Wentao Cao
- Biostatistics Program, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Diana Hamer
- Division of Academic Affairs, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA 70808, USA
| | - Norman Urbanek
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC 27695, USA
| | - Susanne Straif-Bourgeois
- Epidemiology Program, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Stephania A. Cormier
- Department of Biological Sciences, Louisiana State University, Baton Rouge, LA 70803, USA
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Tekeda Ferguson
- Epidemiology Program, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Jennifer Richmond-Bryant
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC 27695, USA
- Center for Geospatial Analytics, North Carolina State University, Raleigh, NC 27695, USA
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12
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Stroope S, Slack T, Kroeger RA, Keating KS, Beedasy J, Sury JJ, Brooks J, Chandler T. Deepwater Horizon Oil Spill Exposures and Long-term Self-rated Health Effects Among Parents in Coastal Louisiana. Disaster Med Public Health Prep 2023; 17:e329. [PMID: 36815367 DOI: 10.1017/dmp.2022.223] [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] [Indexed: 02/24/2023]
Abstract
PURPOSE To assess whether exposure to the 2010 Deepwater Horizon oil spill (DHOS) was related to parents' self-rated health over time. DESIGN 3 waves of panel data were drawn from the Gulf Coast Population Impact study (2014) and Resilient Children, Youth, and Communities study (2016, 2018). SETTING Coastal Louisiana communities in high-impact DHOS areas. PARTICIPANTS Respondents were parents or guardians aged 18 - 84, culled from a probability sample of households with a child aged 4 to 18 (N = 526) at the time of the 2010 DHOS. MEASURES Self-rated health was measured at each wave. Self-reported physical exposure to the DHOS, economic exposure to the DHOS, and control variables were measured in 2014. ANALYSIS We used econometric random effects regression for panel data to assess relationships between DHOS exposures and self-rated health over time, controlling for potentially confounding covariates. RESULTS Both physical exposure (b = -0.39; P < 0.001) and economic exposure (b = -0.34; P < 0.001) to the DHOS had negative associations with self-rated health over the study period. Physical exposure had a larger effect size. CONCLUSION Parents' physical contact with, and economic disruption from, the 2010 DHOS were tied to long-term diminished health.
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Affiliation(s)
- Samuel Stroope
- Department of Sociology, Louisiana State University, Stubbs Hall, Baton Rouge, LA, USA
| | - Tim Slack
- Department of Sociology, Louisiana State University, Stubbs Hall, Baton Rouge, LA, USA
| | - Rhiannon A Kroeger
- Department of Sociology, Louisiana State University, Stubbs Hall, Baton Rouge, LA, USA
| | | | - Jaishree Beedasy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jeremy Brooks
- Columbia Climate School, Columbia University, New York, USA
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13
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Stefanescu A, Jespersen M. American Indian/Alaska Native Birth and Maternal Health Outcomes in Louisiana: Investigating Regional Disparities. Matern Child Health J 2023; 27:318-327. [PMID: 36622538 DOI: 10.1007/s10995-022-03571-7] [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] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To report regional maternal and infant health characteristics in the Louisiana American Indian/Alaska Native (AIAN) population. METHODS This was a cross-sectional descriptive analysis using 2016-2019 Louisiana birth certificate data (N = 242,359; 3205 AIAN births). Prevalence of health characteristics and disparities from population averages were calculated. Health characteristics included low birth weight, preterm birth, very low birth weight, very preterm birth, high birth weight, NICU admission, breastfeeding at discharge, rurality, cesarean section, inadequate prenatal care, and maternal smoking. RESULTS Low birth weight prevalence ranged from 5.7% in central Louisiana to 20.7% in northeast Louisiana. Most other infant outcomes followed a similar pattern. Disparities from regional averages also varied. AIAN infants had 8% higher risk of LBW than the northeast Louisiana average and 4% lower risk in central Louisiana. Maternal smoking was most prevalent in northern and western Louisiana. Across Louisiana, maternal smoking was as or more prevalent in mothers of AIAN infants compared to regional averages. CONCLUSIONS FOR PRACTICE There is substantial regional variability in maternal and infant health characteristics in Louisiana AIAN populations, motivating emphasis on locally focused epidemiology to better serve Indigenous communities.
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Affiliation(s)
- Andrei Stefanescu
- Louisiana Department of Health, Office of Public Health, Bureau of Family Health, New Orleans, USA.
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.
| | - Megan Jespersen
- Louisiana Department of Health, Infectious Disease Epidemiology, Baton Rouge, USA
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14
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Park S, Walker B, Anderson A, Shao Y, Callison K. COVID-19 and Telemedicine Use by Age in Louisiana Medicaid (Preprint). J Med Internet Res 2023; 25:e46123. [PMID: 37099371 PMCID: PMC10173045 DOI: 10.2196/46123] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Limited availability of in-person health care services and fear of contracting COVID-19 during the pandemic promoted an increased reliance on telemedicine. However, long-standing inequities in telemedicine due to unequal levels of digital literacy and internet connectivity among different age groups raise concerns about whether the uptake of telemedicine has exacerbated or alleviated those inequities. OBJECTIVE The aim of this study is to examine changes in telemedicine and in-person health service use during the COVID-19 pandemic across age groups for Medicaid beneficiaries in the state of Louisiana. METHODS Interrupted time series models were used on Louisiana Medicaid claims data to estimate trends in total, in-person, and telemedicine monthly office visit claims per 1000 Medicaid beneficiaries between January 2018 and December 2020. Changes in care pattern trends and levels were estimated around the infection peaks (April 2020 and July 2020) and for an end-of-year infection leveling off period (December 2020). Four mutually exclusive age categories (0 to 17, 18 to 34, 35 to 49, and 50 to 64 years) were used to compare the differences. RESULTS Prior to the COVID-19 pandemic, telemedicine services accounted for less than 1% of total office visit claim volume across the age groups. Each age group followed similar patterns of sharp increases in April 2020, downward trends until sharp increases again in July 2020, followed by flat trends thereafter until December 2020. These sharp increases were most pronounced for older patients, with those aged 50 to 64 years seeing increases of 184.09 telemedicine claims per 1000 Medicaid beneficiaries in April 2020 (95% CI 172.19 to 195.99) and 120.81 in July 2020 (95% CI 101.32 to 140.31) compared with those aged 18 to 34 years, seeing increases of 84.47 (95% CI 78.64 to 90.31) and 57.00 (95% CI 48.21 to 65.79), respectively. This resulted in overall changes from baseline to December 2020 levels of 123.65 (95% CI 112.79 to 134.51) for those aged 50 to 64 years compared with 59.07 (95% CI 53.89 to 64.24) for those aged 18 to 34 years. CONCLUSIONS Older Medicaid beneficiaries in Louisiana had higher rates of telemedicine claim volume during the COVID-19 pandemic compared with younger beneficiaries.
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Affiliation(s)
- Sooyeol Park
- Department of Health Policy and Management, Tulane University, New Orleans, LA, United States
| | - Brigham Walker
- Department of Health Policy and Management, Tulane University, New Orleans, LA, United States
| | - Andrew Anderson
- Department of Health Policy and Management, Tulane University, New Orleans, LA, United States
| | - Yixue Shao
- Department of Health Policy and Management, Tulane University, New Orleans, LA, United States
| | - Kevin Callison
- Department of Health Policy and Management, Tulane University, New Orleans, LA, United States
- Murphy Institute for Political Economy, Tulane University, New Orleans, LA, United States
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15
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Al-Dahir S, Earls M, Gillard C, Singleton B, Hall E. Assessing the Impact of COVID-19 Phased Vaccine Eligibility on COVID-19 Vaccine Intent among African Americans in Southeastern Louisiana: A Community-Based, Cohort Study. Int J Environ Res Public Health 2022; 19:16737. [PMID: 36554617 PMCID: PMC9779262 DOI: 10.3390/ijerph192416737] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
The purpose of this study was to explore the impact of eligibility for the coronavirus 2019 (COVID-19) vaccine at the time of the vaccine rollout as a predictor of vaccine intent within the African American community. METHODS Four hundred eighty-seven African American participants in southeastern Louisiana were surveyed from January-April of 2021, with follow-up surveys occurring in Fall 2021. Survey domains included demographics, vaccine hesitancy, discrimination in the healthcare setting, and knowledge and experiences with COVID-19. Descriptive statistics, Chi-square tests, and binary logistic regression were performed. RESULTS Participants eligible for the vaccine were 1.61 times as likely to express positive vaccine intent versus ineligible participants. Additional predictors of vaccine intent were age, insurance status and coverage, and female sex at birth. In the multivariable logistic analysis, eligible individuals were 2.07 times as likely to receive the vaccine versus ineligible individuals. CONCLUSIONS Vaccine eligibility for the COVID-19 vaccine was a significant predictor of intent to vaccinate in the African American community. Younger individuals were less likely to have a positive intent, correlating with the eligibility of ages 16+ occurring 5 months post-vaccine approval.
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Soelaeman RH, Mendoza L, McDonald R, Hand J, Sokol TM. Characteristics of JYNNEOS Vaccine Recipients Before and During a Large Multiday LGBTQIA+ Festival - Louisiana, August 9-September 5, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1379-1381. [PMID: 36301814 PMCID: PMC9620571 DOI: 10.15585/mmwr.mm7143e3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Since May 2022, 27,558 monkeypox cases have been identified in the United States (1). Gay, bisexual, and other men who have sex with men (MSM) represent the most affected demographic group in the current multinational outbreak (2). As of October 18, 2022, Louisiana had reported 273 monkeypox cases with 187 (68.5%) among residents of the Louisiana Department of Health (LDH) Southeast Region, which includes the city of New Orleans (3).
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MALONEY PATRICK, RUNG ARIANE, BROYLES STEPHANIE, COUK JOHN, PETERS EDWARD, STRAIF-BOURGEOIS SUSANNE. Assessing influenza vaccination coverage and predictors in persons living with HIV/AIDS in Louisiana, June 2002-June 2013. J Prev Med Hyg 2022; 63:E115-E124. [PMID: 35647374 PMCID: PMC9121668 DOI: 10.15167/2421-4248/jpmh2022.63.1.2258] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/02/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite the burden of disease and increased risk of influenza-associated morbidity and mortality among PLWHA, influenza vaccination has been understudied in this population. METHODS We built an 11-year cohort of HIV-infected adults from medical records of PLWHA seeking care within the Louisiana State University medical system from June 2002-June 2013. Influenza vaccination uptake among PLWHA was calculated overall and for each medical facility for each influenza season. Linear regression was used to assess influenza vaccination uptake over time, both overall and by facility. Data were restricted to the final influenza season (2012-13) to assess predictors of PLWHA vaccination. Individuals were nested within medical facilities in order to assess the amount of variability in influenza vaccination rates across medical facilities. RESULTS Influenza vaccination uptake among PLWHA increased over the study period (p < 0.01). The overall proportion of PLWHA vaccinated during the 2012-13 influenza season was 33.7%. 37.9% of the variability in the model occurred at the facility-level. CONCLUSIONS Although there was an increase in influenza vaccination within the PLWHA cohort over the course of the study, vaccination rates remained low overall. Special efforts must be made to increase vaccination uptake among PLWHA, with particular focus on those within the population who are likely to be at highest risk. The substantial variability at the facility-level indicates that there are unmeasured facility-level factors that contribute significantly to PLWHA vaccination.
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Affiliation(s)
- PATRICK MALONEY
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA
- Correspondence: Patrick Maloney, Centers for Disease Control and Prevention, Dominican Republic Field Office, US Embassy, Dominican Republic – E-mail: - Tel.: (404) 718 8191
| | - ARIANE RUNG
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA
| | - STEPHANIE BROYLES
- Louisiana State University Pennington Biomedical Research Center, Baton Rouge, LA
| | - JOHN COUK
- Louisiana State University Health Care Services Division, New Orleans, LA
| | - EDWARD PETERS
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA
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Rizor J, Yanez RA, Thaiwong T, Kiupel M. Angiostrongylus cantonensis in a Red Ruffed Lemur at a Zoo, Louisiana, USA. Emerg Infect Dis 2022; 28:1058-1060. [PMID: 35447053 PMCID: PMC9045436 DOI: 10.3201/eid2805.212287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A red ruffed lemur (Varecia rubra) from a zoo in Louisiana, USA, was euthanized for worsening paresis. Brain and spinal cord histology identified eosinophilic meningoencephalomyelitis with intralesional adult Angiostrongylus sp. nematodes. PCR and sequencing confirmed A. cantonensis infection, indicating this parasite constitutes an emerging zoonosis in the southeastern United States.
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Cummings CO, Mitchell MA, Nevarez JG. Morbidity and Mortality of Mississippi Kites (Ictinia mississippiensis) Presenting to the Wildlife Hospital of Louisiana, USA. J Wildl Dis 2022; 58:436-439. [PMID: 35029674 PMCID: PMC10752443 DOI: 10.7589/jwd-d-21-00075] [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] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/07/2021] [Indexed: 11/20/2022]
Abstract
A review of hospital admissions for Mississippi Kites (Ictinia mississippiensis) 2014-20 found that most admissions were due to trauma, including ballistic trauma. Overall, 118/ 282 (42%) survived, including releases and transfers. This baseline data may enable earlier detection of epidemics and of human-animal conflict escalation in other kite populations.
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Affiliation(s)
- Charles O. Cummings
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, 1909 Skip Bertman Dr., Baton Rouge, LA 70803, USA
- Current: Tufts Clinical and Translational Science Institute, Tufts Medical Center, Tufts University, 35 Kneeland St. #8, Boston, MA 02111, USA
| | - Mark. A Mitchell
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, 1909 Skip Bertman Dr., Baton Rouge, LA 70803, USA
| | - Javier G. Nevarez
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, 1909 Skip Bertman Dr., Baton Rouge, LA 70803, USA
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Dyer L, Chambers BD, Crear-Perry J, Theall KP, Wallace M. The Index of Concentration at the Extremes (ICE) and Pregnancy-Associated Mortality in Louisiana, 2016-2017. Matern Child Health J 2022; 26:814-822. [PMID: 34148221 PMCID: PMC8684557 DOI: 10.1007/s10995-021-03189-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Social and contextual factors underlying the continually disproportionate and burdensome risk of adverse health outcomes experienced by Black women in the US are underexplored in the literature. The aim of this study was to use an index based on area-level population distributions of race and income to predict risk of death during pregnancy and up to 1 year postpartum among women in Louisiana. METHODS Using vital records data provided by the Louisiana Department of Health 2016-2017 (n = 125,537), a modified Poisson model was fit with generalized estimating equations to examine the risk of pregnancy-associated death associated with census tract-level values of the Index of Concentration at the Extremes (ICE)-grouped by tertile-while adjusting for both individual and tract-level confounders. RESULTS Analyses resulted in an estimated 1.73 (95% CI 1.02-2.93) times increased risk for pregnancy-associated death for those in areas which were characterized by concentrated deprivation (high proportions of Black and low-income residents) relative to those in areas of concentrated privilege (high proportions of white and high-income residents), independent of other factors. CONCLUSIONS FOR PRACTICE In addition to continuing to consider the deeply entrenched racism and economic inequality that shape the experience of pregnancy-associated death, we must also consider their synergistic effect on access to resources, maternal population health, and health inequities.
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Affiliation(s)
- Lauren Dyer
- Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA.
| | - Brittany D Chambers
- School of Medicine, Epidemiology and Biostatistics, University of San Francisco, 550 16th St., San Francisco, CA, 94158, USA
| | - Joia Crear-Perry
- National Birth Equity Collaborative, 4747 Earhart Blvd, New Orleans, LA, USA
| | - Katherine P Theall
- Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA
| | - Maeve Wallace
- Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA
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21
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Bakshi A, Van Doren A, Maser C, Aubin K, Stewart C, Soileau S, Friedman K, Williams A. Identifying Louisiana communities at the crossroads of environmental and social vulnerability, COVID-19, and asthma. PLoS One 2022; 17:e0264336. [PMID: 35196332 PMCID: PMC8865632 DOI: 10.1371/journal.pone.0264336] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/08/2022] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has disproportionately affected the socially and environmentally vulnerable, including through indirect effects on other health conditions. Asthma is one such condition, which may be exacerbated by both prolonged adverse in-home exposures if quarantining in unhealthy homes and prolonged outdoor exposures if the ambient air quality is unhealthy or hazardous. As both are often the case in Environmental Justice (EJ) communities, here we have analyzed data at the census tract (CT) level for Louisiana to assess any correlation between social and environmental vulnerability, and health issues like COVID-19 and asthma. Higher Social Vulnerability Index (SVI), Particulate Matter less than 2.5 μm in diameter (PM2.5) and Ozone levels were associated with higher rates of cumulative COVID-19 incidence at various time points during the pandemic, as well as higher average annual asthma hospitalization rates and estimated asthma prevalence. Further, cumulative COVID-19 incidence during the first three months of the pandemic was moderately correlated with both asthma hospitalizations and estimated prevalence, suggesting similar underlying factors may be affecting both conditions. Additionally, 137 CTs were identified where social and environmental vulnerabilities co-existed, of which 75 (55%) had high estimated prevalence of asthma. These areas are likely to benefit from asthma outreach that considers both social and environmental risk factors. Fifteen out of the 137 CTs (11%) not only had higher estimated prevalence of asthma but also a high burden of COVID-19. Further research in these areas may help to elucidate any common social determinants of health that underlie both asthma and COVID-19 burdens, as well as better clarify the possible role of the environment as related to the COVID-19 burden in Louisiana.
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Affiliation(s)
- Arundhati Bakshi
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Alicia Van Doren
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Colette Maser
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Kathleen Aubin
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Collette Stewart
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Shannon Soileau
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Kate Friedman
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Alexis Williams
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
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22
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Abstract
Purpose Currently, rural residents in the United States (US) experience a greater cancer burden for tobacco-related cancers and cancers that can be prevented by screening. We aim to characterize geographic determinants of colorectal cancer (CRC) incidence in Louisiana due to rural residence and other known geographic risk factors, area socioeconomic status (SES), and cultural region (Acadian or French-speaking). Methods Primary colorectal cancer diagnosed among adults 30 years and older in 2008–2017 were obtained from the Louisiana Tumor Registry. Population and social and economic data were obtained from US Census American Community Survey. Rural areas were defined using US Department of Agriculture 2010 rural–urban commuting area codes. Estimates of relative risk (RR) were obtained from multilevel binomial regression models of incidence. Results The study population was 16.1% rural, 18.4% low SES, and 17.9% Acadian. Risk of CRC was greater among rural white residents (RR Women: 1.09(1.02–1.16), RR Men: 1.11(1.04–1.18)). Low SES was associated with increased CRC for all demographic groups, with excess risk ranging from 8% in Black men (RR: 1.08(1.01–1.16)) to 16% in white men (RR: 1.16(1.08–1.24)). Increased risk in the Acadian region was greatest for Black men (RR: 1.21(1.10–1.33)) and women (RR: 1.21(1.09–1.33)). Rural–urban disparities in CRC were no longer significant after controlling for SES and Acadian region. Conclusion SES remains a significant determinant of CRC disparities in Louisiana and may contribute to observed rural–urban disparities in the state. While the intersectionality of CRC risk factors is complex, we have confirmed a robust regional disparity for the Acadian region of Louisiana. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-021-01546-7.
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Affiliation(s)
- Denise Danos
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
| | - Claudia Leonardi
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Xiao-Cheng Wu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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23
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Stoecker C, Shao Y, Schmidt N, Martin DH, Kissinger PJ. Impact of Check It: A Novel Community-Based Chlamydia Screening and Expedited Treatment Program for Young Black Men. Sex Transm Dis 2022; 49:1-4. [PMID: 34407010 PMCID: PMC8665060 DOI: 10.1097/olq.0000000000001526] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study aimed to estimate the impact of the Check It program, a novel community-based chlamydia seek, test, and treat program for young Black men who have sex with women, on test positivity rates for chlamydia in young Black women. METHODS We used a synthetic control model to compare chlamydia test positivity rates in Orleans Parish (intervention site) with other similar parishes (control sites) in Louisiana. We estimated a model that used all other parishes as potential contributors to a synthetic control for Louisiana as well as a sample limited to the 40 parishes in Louisiana with the largest Black populations. RESULTS The Check It program was associated with a 1.69-percentage-point decline in chlamydia positivity in the first full year of operation and a 2.44-percentage-point decline in chlamydia positivity in the second full year of operation compared with control sites with the largest Black populations (P = 0.05). Results were similar when the treatment site was compared with all other sites in Louisiana. CONCLUSIONS The Check It program was associated with a significant decline in chlamydia testing positivity rates among women in Orleans Parish compared with control sites. Screening of young Black men who have sex with women can decrease rates in women living in the same community. Future recommendations for chlamydia screening of young men should be considered.
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Affiliation(s)
- Charles Stoecker
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Yixue Shao
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Norine Schmidt
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine
| | - David H. Martin
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine
- Louisiana State University School of Medicine – Department of Internal Medicine, Section of Infectious Diseases
| | - Patricia J. Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine
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24
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Gupta A, Kachur SM, Tafur JD, Patel HK, Timme DO, Shariati F, Rogers KD, Morin DP, Lavie CJ. Development and Validation of a Multivariable Risk Prediction Model for COVID-19 Mortality in the Southern United States. Mayo Clin Proc 2021; 96:3030-3041. [PMID: 34863394 PMCID: PMC8445799 DOI: 10.1016/j.mayocp.2021.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate clinical characteristics of patients admitted to the hospital with coronavirus disease 2019 (COVID-19) in Southern United States and development as well as validation of a mortality risk prediction model. PATIENTS AND METHODS Southern Louisiana was an early hotspot during the pandemic, which provided a large collection of clinical data on inpatients with COVID-19. We designed a risk stratification model to assess the mortality risk for patients admitted to the hospital with COVID-19. Data from 1673 consecutive patients diagnosed with COVID-19 infection and hospitalized between March 1, 2020, and April 30, 2020, was used to create an 11-factor mortality risk model based on baseline comorbidity, organ injury, and laboratory results. The risk model was validated using a subsequent cohort of 2067 consecutive hospitalized patients admitted between June 1, 2020, and December 31, 2020. RESULTS The resultant model has an area under the curve of 0.783 (95% CI, 0.76 to 0.81), with an optimal sensitivity of 0.74 and specificity of 0.69 for predicting mortality. Validation of this model in a subsequent cohort of 2067 consecutively hospitalized patients yielded comparable prognostic performance. CONCLUSION We have developed an easy-to-use, robust model for systematically evaluating patients presenting to acute care settings with COVID-19 infection.
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Affiliation(s)
- Aashish Gupta
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; University of Queensland School of Medicine, Brisbane, Australia.
| | - Sergey M Kachur
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; University of Queensland School of Medicine, Brisbane, Australia; Department of Medicine, University of Central Florida School of Medicine, Orlando, FL
| | - Jose D Tafur
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; University of Queensland School of Medicine, Brisbane, Australia
| | - Harsh K Patel
- Department of Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Divina O Timme
- Department of Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | | | - Kristen D Rogers
- Department of Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Daniel P Morin
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; University of Queensland School of Medicine, Brisbane, Australia
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; University of Queensland School of Medicine, Brisbane, Australia
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25
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Levitt DE, Ferguson TF, Primeaux SD, Zavala JA, Ahmed J, Marshall RH, Simon L, Molina PE. Skeletal muscle bioenergetic health and function in people living with HIV: association with glucose tolerance and alcohol use. Am J Physiol Regul Integr Comp Physiol 2021; 321:R781-R790. [PMID: 34585616 PMCID: PMC8616628 DOI: 10.1152/ajpregu.00197.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 08/03/2021] [Accepted: 09/20/2021] [Indexed: 11/22/2022]
Abstract
At-risk alcohol use is prevalent and increases dysglycemia among people living with human immunodeficiency virus (PLWH). Skeletal muscle (SKM) bioenergetic dysregulation is implicated in dysglycemia and type 2 diabetes. The objective of this study was to determine the relationship between at-risk alcohol, glucose tolerance, and SKM bioenergetic function in PLWH. Thirty-five PLWH (11 females, 24 males, age: 53 ± 9 yr, body mass index: 29.0 ± 6.6 kg/m2) with elevated fasting glucose enrolled in the ALIVE-Ex study provided medical history and alcohol use information [Alcohol Use Disorders Identification Test (AUDIT)], then underwent an oral glucose tolerance test (OGTT) and SKM biopsy. Bioenergetic health and function and mitochondrial volume were measured in isolated myoblasts. Mitochondrial gene expression was measured in SKM. Linear regression adjusting for age, sex, and smoking was performed to examine the relationship between glucose tolerance (2-h glucose post-OGTT), AUDIT, and their interaction with each outcome measure. Negative indicators of bioenergetic health were significantly (P < 0.05) greater with higher 2-h glucose (proton leak) and AUDIT (proton leak, nonmitochondrial oxygen consumption, and bioenergetic health index). Mitochondrial volume was increased with the interaction of higher 2-h glucose and AUDIT. Mitochondrial gene expression decreased with higher 2-h glucose (TFAM, PGC1B, PPARG, MFN1), AUDIT (MFN1, DRP1, MFF), and their interaction (PPARG, PPARD, MFF). Decreased expression of mitochondrial genes were coupled with increased mitochondrial volume and decreased bioenergetic health in SKM of PLWH with higher AUDIT and 2-h glucose. We hypothesize these mechanisms reflect poorer mitochondrial health and may precede overt SKM bioenergetic dysregulation observed in type 2 diabetes.
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Affiliation(s)
- Danielle E Levitt
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Tekeda F Ferguson
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Stefany D Primeaux
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Joint Diabetes, Endocrinology & Metabolism Center, Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Jeanette A Zavala
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jameel Ahmed
- Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Richard H Marshall
- Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Liz Simon
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Patricia E Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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26
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Dawson P, Schrodt CA, Feldmann K, Traxler RM, Gee JE, Kolton CB, Marston CK, Gulvik CA, Antonini JM, Negrón ME, McQuiston JR, Hendricks K, Weiner Z, Balsamo GA, Sokol T, Byers P, Taylor K, Zaheer S, Long S, O’Sullivan B, de Perio MA, Hoffmaster AR, Salzer JS, Bower WA. Notes from the Field: Fatal Anthrax Pneumonia in Welders and Other Metalworkers Caused by Bacillus cereus Group Bacteria Containing Anthrax Toxin Genes - U.S. Gulf Coast States, 1994-2020. MMWR Morb Mortal Wkly Rep 2021; 70:1453-1454. [PMID: 34648482 PMCID: PMC8631286 DOI: 10.15585/mmwr.mm7041a4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Christofferson RC, O’Neal HR, Jagneaux T, O’Neal C, Walsh CS, Mayton EH, Vu LD, Fish AI, Phan A, Stoufflet TE, Schroeder JR, Walker M, Turner EA, Pierce C, Wester KS, DeLeo C, Tenreiro E, Ogden B, Cormier SA. Reduced turnaround times through multi-sectoral community collaboration during the first surge of SARS-CoV-2 and associated effect on patient care and hospital operations. PLoS One 2021; 16:e0257302. [PMID: 34618831 PMCID: PMC8496830 DOI: 10.1371/journal.pone.0257302] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In March 2020, an influx of admissions in COVID-19 positive patients threatened to overwhelm healthcare facilities in East Baton Rouge Parish, Louisiana. Exacerbating this problem was an overall shortage of diagnostic testing capability at that time, resulting in a delay in time-to-result return. An improvement in diagnostic testing availability and timeliness was necessary to improve the allocation of resources and ultimate throughput of patients. The management of a COVID-19 positive patient or patient under investigation requires infection control measures that can quickly consume personal protective equipment (PPE) stores and personnel available to treat these patients. Critical shortages of both PPE and personnel also negatively impact care in patients admitted with non-COVID-19 illnesses. METHODS A multisectoral partnership of healthcare providers, facilities and academicians created a molecular diagnostic lab within an academic research facility dedicated to testing inpatients and healthcare personnel for SARS-CoV-2. The purpose of the laboratory was to provide a temporary solution to the East Baton Rouge Parish healthcare community until individual facilities were self-sustaining in testing capabilities. We describe the partnership and the impacts of this endeavor by developing a model derived from a combination of data sources, including electronic health records, hospital operations, and state and local resources. FINDINGS Our model demonstrates two important principles: the impact of reduced turnaround times (TAT) on potential differences in inpatient population numbers for COVID-19 and savings in PPE attributed to the more rapid TAT.
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Affiliation(s)
- Rebecca C. Christofferson
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States of America
- Center for Computation and Technology, Louisiana State University, Baton Rouge, LA, United States of America
- * E-mail:
| | - Hollis R. O’Neal
- Louisiana State University Health Sciences Center, Baton Rouge, LA, United States of America
| | - Tonya Jagneaux
- Louisiana State University Health Sciences Center, Baton Rouge, LA, United States of America
| | - Catherine O’Neal
- Louisiana State University Health Sciences Center, Baton Rouge, LA, United States of America
| | - Christine S. Walsh
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States of America
| | - E. Handly Mayton
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States of America
| | - Luan D. Vu
- Pennington Biomedical Research Center, Baton Rouge, LA, United States of America
| | - Abigail I. Fish
- Environmental Health and Safety, Louisiana State University, Baton Rouge, LA, United States of America
| | - Anh Phan
- Pennington Biomedical Research Center, Baton Rouge, LA, United States of America
| | - Thaya E. Stoufflet
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States of America
| | - Jonathan R. Schroeder
- Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, United States of America
| | - Morgan Walker
- Louisiana State University Health Sciences Center, Baton Rouge, LA, United States of America
| | - Erik A. Turner
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States of America
| | - Christi Pierce
- Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, United States of America
| | - K. Scott Wester
- Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, United States of America
| | - Connie DeLeo
- Baton Rouge General Hospital, Baton Rouge, LA, United States of America
| | - Edgardo Tenreiro
- Baton Rouge General Hospital, Baton Rouge, LA, United States of America
| | - Beverly Ogden
- Woman’s Hospital, Baton Rouge, LA, United States of America
| | - Stephania A. Cormier
- Pennington Biomedical Research Center, Baton Rouge, LA, United States of America
- College of Science, Louisiana State University, Baton Rouge, LA, United States of America
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Afaneh H, Straif-Bourgeois S, Oral E, Wennerstrom A, Sugarman O, Robinson WT, Whittington A, Trapido E. Louisiana Medicaid access for treatment and care for hepatitis C virus (LA-MATCH) project: A cross-sectional study protocol. PLoS One 2021; 16:e0257437. [PMID: 34613969 PMCID: PMC8494345 DOI: 10.1371/journal.pone.0257437] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction This article presents the Louisiana Hepatitis C Elimination Program’s evaluation protocol underway at the Louisiana State University Health Sciences Center–New Orleans. With the availability of direct-acting antiviral (DAA) agents, the elimination of Hepatitis C (HCV) has become a possibility. The HCV Elimination Program was initiated by the Louisiana Department of Health (LDH) Office of Public Health (OPH), LDH Bureau of Health Services Financing (Medicaid), and the Louisiana Department of Public Safety and Corrections (DPSC) to provide HCV treatment through an innovative pricing arrangement with Asegua Therapeutics, whereby a fixed cost is set for a supply of treatment over five years. Materials and methods A cross-sectional study design will be used. Data will be gathered from two sources: 1) an online survey administered via REDCap to a sample of Medicaid members who are receiving HCV treatment, and 2) a de-identified data set that includes both Medicaid claims data and OPH surveillance data procured via a Data Use Agreement between LSUHSC-NO and Louisiana Medicaid. Discussion The evaluation will contribute to an understanding of the scope and reach of this innovative treatment model, and as a result, an understanding of areas for improvement. Further, this evaluation may provide insight for other states considering similar contracting mechanisms and programs.
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Affiliation(s)
- Hasheemah Afaneh
- Department of Epidemiology, New Orleans School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
- * E-mail:
| | - Susanne Straif-Bourgeois
- Department of Epidemiology, New Orleans School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Evrim Oral
- Department of Biostatistics, New Orleans School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Ashley Wennerstrom
- Department of Behavioral and Community Health Sciences and Center for Healthcare Value & Equity, New Orleans School of Public Health, LSU Health Sciences Center–New Orleans, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Olivia Sugarman
- Department of Behavioral and Community Health Sciences and Center for Healthcare Value & Equity, New Orleans School of Public Health, LSU Health Sciences Center–New Orleans, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - William T. Robinson
- Department of Behavioral and Community Health Sciences and Center for Healthcare Value & Equity, New Orleans School of Public Health, LSU Health Sciences Center–New Orleans, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Angel Whittington
- University of Louisiana at Monroe, Medicaid, Monroe, Lousiana, United States of America
| | - Edward Trapido
- Department of Epidemiology, New Orleans School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
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29
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Zeller M, Gangavarapu K, Anderson C, Smither AR, Vanchiere JA, Rose R, Snyder DJ, Dudas G, Watts A, Matteson NL, Robles-Sikisaka R, Marshall M, Feehan AK, Sabino-Santos G, Bell-Kareem AR, Hughes LD, Alkuzweny M, Snarski P, Garcia-Diaz J, Scott RS, Melnik LI, Klitting R, McGraw M, Belda-Ferre P, DeHoff P, Sathe S, Marotz C, Grubaugh ND, Nolan DJ, Drouin AC, Genemaras KJ, Chao K, Topol S, Spencer E, Nicholson L, Aigner S, Yeo GW, Farnaes L, Hobbs CA, Laurent LC, Knight R, Hodcroft EB, Khan K, Fusco DN, Cooper VS, Lemey P, Gardner L, Lamers SL, Kamil JP, Garry RF, Suchard MA, Andersen KG. Emergence of an early SARS-CoV-2 epidemic in the United States. Cell 2021; 184:4939-4952.e15. [PMID: 34508652 PMCID: PMC8313480 DOI: 10.1016/j.cell.2021.07.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/07/2021] [Accepted: 07/22/2021] [Indexed: 12/12/2022]
Abstract
The emergence of the COVID-19 epidemic in the United States (U.S.) went largely undetected due to inadequate testing. New Orleans experienced one of the earliest and fastest accelerating outbreaks, coinciding with Mardi Gras. To gain insight into the emergence of SARS-CoV-2 in the U.S. and how large-scale events accelerate transmission, we sequenced SARS-CoV-2 genomes during the first wave of the COVID-19 epidemic in Louisiana. We show that SARS-CoV-2 in Louisiana had limited diversity compared to other U.S. states and that one introduction of SARS-CoV-2 led to almost all of the early transmission in Louisiana. By analyzing mobility and genomic data, we show that SARS-CoV-2 was already present in New Orleans before Mardi Gras, and the festival dramatically accelerated transmission. Our study provides an understanding of how superspreading during large-scale events played a key role during the early outbreak in the U.S. and can greatly accelerate epidemics.
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Affiliation(s)
- Mark Zeller
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA.
| | - Karthik Gangavarapu
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA.
| | - Catelyn Anderson
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Allison R Smither
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - John A Vanchiere
- Department of Pediatrics, Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA 71130, USA
| | | | - Daniel J Snyder
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15219, USA; Center for Evolutionary Biology and Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Gytis Dudas
- Gothenburg Global Biodiversity Centre (GGBC), Gothenburg, Sweden
| | - Alexander Watts
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Bluedot, Toronto, Canada
| | - Nathaniel L Matteson
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Refugio Robles-Sikisaka
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Maximilian Marshall
- Department of Civil and Systems Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Amy K Feehan
- Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Gilberto Sabino-Santos
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA; Centre for Virology Research, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP 14049900, Brazil
| | - Antoinette R Bell-Kareem
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Laura D Hughes
- Department of Integrative, Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Manar Alkuzweny
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Patricia Snarski
- Heart and Vascular Institute, John W. Deming Department of Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA; Department of Physiology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | | | - Rona S Scott
- Department of Microbiology and Immunology, Louisiana State University Health Science Center Shreveport, Shreveport, LA 71103, USA
| | - Lilia I Melnik
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Raphaëlle Klitting
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Michelle McGraw
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Pedro Belda-Ferre
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California, USA; Center for Microbiome Innovation, Jacobs School of Engineering, University of California San Diego, La Jolla, California, USA
| | - Peter DeHoff
- Department of Obstetrics, Gynecology, and Reproductive Science, University of California, San Diego, La Jolla, CA 92037, USA
| | - Shashank Sathe
- Department of Cellular and Molecular Medicine, University of California at San Diego, La Jolla, California 92093, USA; Stem Cell Program, University of California San Diego, La Jolla, CA 92093, USA
| | - Clarisse Marotz
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California, USA; Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, USA
| | - Nathan D Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | | | - Arnaud C Drouin
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; Department of Physiology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Kaylynn J Genemaras
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; Bioinnovation Program, Tulane University, New Orleans, LA 70118, USA
| | - Karissa Chao
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; Bioinnovation Program, Tulane University, New Orleans, LA 70118, USA
| | - Sarah Topol
- Scripps Research Translational Institute, La Jolla, CA 92037, USA
| | - Emily Spencer
- Scripps Research Translational Institute, La Jolla, CA 92037, USA
| | - Laura Nicholson
- Scripps Research Translational Institute, La Jolla, CA 92037, USA
| | - Stefan Aigner
- Department of Cellular and Molecular Medicine, University of California at San Diego, La Jolla, California 92093, USA; Stem Cell Program, University of California San Diego, La Jolla, CA 92093, USA; Institute for Genomic Medicine, University of California, San Diego, La Jolla, California, USA
| | - Gene W Yeo
- Department of Cellular and Molecular Medicine, University of California at San Diego, La Jolla, California 92093, USA; Stem Cell Program, University of California San Diego, La Jolla, CA 92093, USA; Institute for Genomic Medicine, University of California, San Diego, La Jolla, California, USA
| | - Lauge Farnaes
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA; Rady Children's Hospital, San Diego, CA 92123, USA
| | - Charlotte A Hobbs
- Rady Children's Institute for Genomic Medicine, San Diego, CA 92123, USA; Rady Children's Hospital, San Diego, CA 92123, USA
| | - Louise C Laurent
- Department of Obstetrics, Gynecology, and Reproductive Science, University of California, San Diego, La Jolla, CA 92037, USA
| | - Rob Knight
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, California, USA; Center for Microbiome Innovation, Jacobs School of Engineering, University of California San Diego, La Jolla, California, USA; Department of Computer Science and Engineering, Jacobs School of Engineering, University of California San Diego, La Jolla, California, USA; Department of Bioengineering, University of California San Diego, La Jolla, California, USA
| | | | - Kamran Khan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Bluedot, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Dahlene N Fusco
- Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA; Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70114, USA
| | - Vaughn S Cooper
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15219, USA; Center for Evolutionary Biology and Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Phillipe Lemey
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Belgium; Global Virology Network
| | - Lauren Gardner
- Department of Civil and Systems Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Jeremy P Kamil
- Department of Microbiology and Immunology, Louisiana State University Health Science Center Shreveport, Shreveport, LA 71103, USA
| | - Robert F Garry
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA 70112, USA; Zalgen Labs LLC, Germantown, MD, USA
| | - Marc A Suchard
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Kristian G Andersen
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA; Scripps Research Translational Institute, La Jolla, CA 92037, USA.
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Anderson CE, Broyles ST, Wallace ME, Bazzano LA, Gustat J. Association of the Neighborhood Built Environment With Incident and Prevalent Depression in the Rural South. Prev Chronic Dis 2021; 18:E67. [PMID: 34237245 PMCID: PMC8269752 DOI: 10.5888/pcd18.200605] [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] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION A neighborhood's built environment is associated with physical activity among its residents, and physical activity is associated with depression. Our study aimed to determine whether the built environment was associated with depression among residents of the rural South and whether observed associations were mediated by physical activity. METHODS We selected 2,000 participants from the Bogalusa Heart Study who had a valid residential address, self-reported physical activity (minutes/week), and a complete Center for Epidemiologic Study-Depression (CES-D) scale assessment from 1 or more study visits between 1998 and 2013. We assessed the built environment with the Rural Active Living Assessment street segment audit tool and developed built environment scores. The association between built environment scores and depression (CES-D ≥16) in geographic buffers of various radii were evaluated by using modified Poisson regression, and mediation by physical activity was evaluated with mixed-effects models. RESULTS Depression was observed in 37% of study participants at the first study visit. One-point higher physical security and aesthetic scores for the street segment of residence were associated with 1.07 times higher (95% CI, 1.02-1.11) and 0.96 times lower (95% CI, 0.92-1.00) baseline depression prevalence. One-point higher destination scores (ie, more commercial and civic facilities) in radius buffers of 0.25 miles or more were associated with 1.06 times (95% CI, 1.00-1.13) the risk of depression during follow-up. Neighborhood poverty (defined as percentage of residents with incomes below the federal poverty level and dichotomized at 28.3%) modified cross-sectional and longitudinal associations. Associations were not mediated by physical activity. CONCLUSION The built environment was associated with prevalence and risk of depression, and associations were stronger in high-poverty neighborhoods. Built environment improvements to promote physical activity should take neighborhood context into consideration to minimize negative side effects on mental health in high-poverty communities.
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Affiliation(s)
- Christopher E Anderson
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste 2000, New Orleans, LA 70112.
| | - Stephanie T Broyles
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Maeve E Wallace
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Lydia A Bazzano
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Jeanette Gustat
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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Fearnbach SN, Flanagan EW, Höchsmann C, Beyl RA, Altazan AD, Martin CK, Redman LM. Factors Protecting against a Decline in Physical Activity during the COVID-19 Pandemic. Med Sci Sports Exerc 2021; 53:1391-1399. [PMID: 33449607 PMCID: PMC8205931 DOI: 10.1249/mss.0000000000002602] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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: 02/06/2023]
Abstract
PURPOSE The spread of COVID-19 and the associated stay-at-home orders and shutdowns of gyms and fitness centers have drastically influenced health behaviors leading to widespread reductions in physical activity (PA). The recent Call to Action from the American College of Sports Medicine has promoted "innovative strategies to promote PA during the COVID-19 pandemic." We aimed to identify individual-level factors that protected against declines in PA levels amid the COVID-19 restrictions. METHODS We used the Pennington Biomedical COVID-19 Health Behaviors Survey for our analyses and used mixed-effect linear and generalized linear models to estimate the effects of individual-level factors on changes in PA levels during the COVID-19 restrictions. RESULTS Participants (n = 4376) provided information on PA behaviors before and during the COVID-19 shutdown. Overall, PA levels declined by a mean ± SD of 112 ± 1460 MET·min·wk-1 during the COVID-19 shutdown; however, changes in PA were heterogeneous, with 55% of the participants reporting increases in or maintenance of PA during that time. Several social and demographic factors were significantly related to declines in PA, including high prepandemic PA levels, living alone (difference = 118 MET·min·wk-1), low household income (difference between the highest and the lowest income group = 363 MET·min·wk-1), COVID-19-related changes in income (difference = 110 MET·min·wk-1), and loss of employment (difference = 168 MET·min·wk-1). The substitution of prepandemic gym attendance with the purchase and use of home exercise equipment or exercise through virtual fitness platforms promoted increases in PA during the COVID-19 shutdown. CONCLUSIONS While promoting PA through the COVID-19 pandemic, it is important to consider demographic factors, which greatly influence health behaviors and implementation of, and access to, replacement behaviors. The promotion of such strategies could help maintain PA levels during potential future stay-at-home orders.
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Feehan AK, Fort D, Velasco C, Burton JH, Garcia-Diaz J, Price-Haywood EG, Sapp E, Pevey D, Seoane L. The importance of anosmia, ageusia and age in community presentation of symptomatic and asymptomatic SARS-CoV-2 infection in Louisiana, USA; a cross-sectional prevalence study. Clin Microbiol Infect 2021; 27:633.e9-633.e16. [PMID: 33421576 PMCID: PMC7787079 DOI: 10.1016/j.cmi.2020.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE While many seroprevalence studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been performed, few are demographically representative. This investigation focused on defining the nature and frequency of symptomatic and asymptomatic SARS-CoV-2 infection in a representative, cross-sectional sample of communities in Louisiana, USA. METHODS A sample of 4778 adults from New Orleans and Baton Rouge, Louisiana were given a survey of symptoms and co-morbidities, nasopharyngeal swab to test for active infection (PCR), and blood draw to test for past infection (IgG). Odds ratios, cluster analysis, quantification of virus and antibody, and linear modelling were used to understand whether certain symptoms were associated with a positive test, how symptoms grouped together, whether virus or antibody varied by symptom status, and whether being symptomatic was different across the age span. RESULTS Reported anosmia/ageusia was strongly associated with a positive test; 40.6% (93/229) tested positive versus 4.8% (218/4549) positivity in those who did not report anosmia/ageusia (OR 13.6, 95% CI 10.1-18.3). Of the people who tested positive, 47.3% (147/311) were completely asymptomatic. Symptom presentation clustered into three groups; low/no symptoms (0.4 ± 0.9, mean ± SD), highly symptomatic (7.5 ± 1.9) or moderately symptomatic (4.0 ± 1.5). Quantity of virus was lower in the asymptomatic versus symptomatic group (cycle number 23.3 ± 8.3 versus 17.3 ± 9.0; p < 0.001). Modelling the probability of symptoms showed changes with age; the highest probability of reporting symptoms was 64.6% (95% CI 50.4-76.5) at age 29 years, which decreased to a probability of 49.3% (95% CI 36.6-62.0) at age 60 years and only 25.1% (95% CI 5.0-68.1) at age 80 years. CONCLUSION Anosmia/ageusia can be used to differentiate SARS-CoV-2 infection from other illnesses, and, given the high ratio of asymptomatic individuals, contact tracing should include those without symptoms. Regular testing in congregant settings of those over age 60 years may help mitigate asymptomatic spread.
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Affiliation(s)
- Amy K Feehan
- Ochsner Clinic Foundation, New Orleans, LA, USA; University of Queensland, Ochsner Clinical School, New Orleans, LA, USA.
| | - Daniel Fort
- Ochsner Clinic Foundation, New Orleans, LA, USA
| | | | | | - Julia Garcia-Diaz
- Ochsner Clinic Foundation, New Orleans, LA, USA; University of Queensland, Ochsner Clinical School, New Orleans, LA, USA
| | - Eboni G Price-Haywood
- Ochsner Clinic Foundation, New Orleans, LA, USA; University of Queensland, Ochsner Clinical School, New Orleans, LA, USA
| | - Eric Sapp
- Public Democracy, Arlington, VA, USA
| | - Dawn Pevey
- Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Leonardo Seoane
- Ochsner Clinic Foundation, New Orleans, LA, USA; University of Queensland, Ochsner Clinical School, New Orleans, LA, USA; Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, USA
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Mills KT, Peacock E, Chen J, Zimmerman A, He H, Cyprian A, Davis G, Fuqua SR, Gilliam DS, Greer A, Gray‐Winfrey L, Williams S, Wiltz GM, Winfrey KL, Whelton PK, Krousel‐Wood M, He J. Experiences and Beliefs of Low-Income Patients With Hypertension in Louisiana and Mississippi During the COVID-19 Pandemic. J Am Heart Assoc 2021; 10:e018510. [PMID: 33267723 PMCID: PMC7955429 DOI: 10.1161/jaha.120.018510] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/20/2020] [Indexed: 12/21/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic disproportionately affects individuals with hypertension and health disparities. Methods and Results We assessed the experiences and beliefs of low-income and minority patients with hypertension during the COVID-19 pandemic. Participants (N=587) from the IMPACTS-BP (Implementation of Multifaceted Patient-Centered Treatment Strategies for Intensive Blood Pressure Control) study completed a telephone survey in May and June of 2020. Participants were 65.1% Black and 59.7% female, and 57.7% reported an income below the federal poverty level. Overall, 2.7% tested positive and 15.3% had lost a family member or friend to COVID-19. These experiences were significantly more common in Black (3.9% and 19.4%, respectively) than in non-Black participants (0.5% and 7.8%, respectively). In addition, 14.5% lost a job and 15.9% reported food shortages during the pandemic. Most participants complied with stay-at-home orders (98.3%), social distancing (97.8%), and always wearing a mask outside their home (74.6%). Participants also reported high access to needed health care (94.7%) and prescription medications (97.6%). Furthermore, 95.7% of respondents reported that they continued to take their regular dosage of antihypertensive medications. Among the 44.5% of participants receiving a healthcare appointment by telehealth, 96.6% got the help they needed, and 80.8% reported that the appointment quality was as good as or better than in-person visits. Finally, 88.9% were willing to return to their primary care clinic. Conclusions These data suggest that low-income patients, especially Black patients, were negatively impacted by COVID-19. However, most patients were able to access needed healthcare services and were willing to return to their primary care clinic for hypertension management. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03483662.
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Affiliation(s)
- Katherine T. Mills
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
- Tulane University Translational Sciences InstituteNew OrleansLA
| | - Erin Peacock
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - Jing Chen
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
- Tulane University Translational Sciences InstituteNew OrleansLA
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - Amanda Zimmerman
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
| | - Hua He
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
- Tulane University Translational Sciences InstituteNew OrleansLA
| | | | | | - Sonja R. Fuqua
- Community Health Center Association of MississippiJacksonMS
| | | | | | | | | | | | | | - Paul K. Whelton
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
- Tulane University Translational Sciences InstituteNew OrleansLA
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - Marie Krousel‐Wood
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
- Tulane University Translational Sciences InstituteNew OrleansLA
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - Jiang He
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
- Tulane University Translational Sciences InstituteNew OrleansLA
- Department of MedicineTulane University School of MedicineNew OrleansLA
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Biggs EN, Maloney PM, Rung AL, Peters ES, Robinson WT. The Relationship Between Social Vulnerability and COVID-19 Incidence Among Louisiana Census Tracts. Front Public Health 2021; 8:617976. [PMID: 33553098 PMCID: PMC7856141 DOI: 10.3389/fpubh.2020.617976] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 10/15/2020] [Accepted: 12/18/2020] [Indexed: 11/17/2022] Open
Abstract
Objective: To examine the association between the Centers for Disease Control and Prevention (CDC)'s Social Vulnerability Index (SVI) and COVID-19 incidence among Louisiana census tracts. Methods: An ecological study comparing the CDC SVI and census tract-level COVID-19 case counts was conducted. Choropleth maps were used to identify census tracts with high levels of both social vulnerability and COVID-19 incidence. Negative binomial regression with random intercepts was used to compare the relationship between overall CDC SVI percentile and its four sub-themes and COVID-19 incidence, adjusting for population density. Results: In a crude stratified analysis, all four CDC SVI sub-themes were significantly associated with COVID-19 incidence. Census tracts with higher levels of social vulnerability were associated with higher COVID-19 incidence after adjusting for population density (adjusted RR: 1.52, 95% CI: 1.41-1.65). Conclusions: The results of this study indicate that increased social vulnerability is linked with COVID-19 incidence. Additional resources should be allocated to areas of increased social disadvantage to reduce the incidence of COVID-19 in vulnerable populations.
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Affiliation(s)
- Erin N. Biggs
- Epidemiology Program, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, United States
| | - Patrick M. Maloney
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Epidemiology and Surveillance Branch, Atlanta, GA, United States
| | - Ariane L. Rung
- Epidemiology Program, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, United States
| | - Edward S. Peters
- Epidemiology Program, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, United States
| | - William T. Robinson
- Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, United States
- STD/HIV Program, Louisiana Office of Public Health, New Orleans, LA, United Sates
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Wallace M, James AE, Silver R, Koh M, Tobolowsky FA, Simonson S, Gold JAW, Fukunaga R, Njuguna H, Bordelon K, Wortham J, Coughlin M, Harcourt JL, Tamin A, Whitaker B, Thornburg NJ, Tao Y, Queen K, Uehara A, Paden CR, Zhang J, Tong S, Haydel D, Tran H, Kim K, Fisher KA, Marlow M, Tate JE, Doshi RH, Sokol T, Curran KG. Rapid Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in Detention Facility, Louisiana, USA, May-June, 2020. Emerg Infect Dis 2021; 27:421-429. [PMID: 33395380 PMCID: PMC7853536 DOI: 10.3201/eid2702.204158] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
To assess transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a detention facility experiencing a coronavirus disease outbreak and evaluate testing strategies, we conducted a prospective cohort investigation in a facility in Louisiana, USA. We conducted SARS-CoV-2 testing for detained persons in 6 quarantined dormitories at various time points. Of 143 persons, 53 were positive at the initial test, and an additional 58 persons were positive at later time points (cumulative incidence 78%). In 1 dormitory, all 45 detained persons initially were negative; 18 days later, 40 (89%) were positive. Among persons who were SARS-CoV-2 positive, 47% (52/111) were asymptomatic at the time of specimen collection; 14 had replication-competent virus isolated. Serial SARS-CoV-2 testing might help interrupt transmission through medical isolation and quarantine. Testing in correctional and detention facilities will be most effective when initiated early in an outbreak, inclusive of all exposed persons, and paired with infection prevention and control.
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Abstract
BACKGROUND Louisiana in the summer of 2020 had the highest per capita case count for COVID-19 in the United States and COVID-19 deaths disproportionately affects the African American population. Neighborhood deprivation has been observed to be associated with poorer health outcomes. The purpose of this study was to examine the relationship between neighborhood deprivation and COVID-19 in Louisiana. METHODS The Area Deprivation Index (ADI) was calculated and used to classify neighborhood deprivation at the census tract level. A total of 17 US census variables were used to calculate the ADI for each of the 1148 census tracts in Louisiana. The data were extracted from the American Community Survey (ACS) 2018. The neighborhoods were categorized into quintiles as well as low and high deprivation. The publicly available COVID-19 cumulative case counts by census tract were obtained from the Louisiana Department of Health website on July 31, 2020. Descriptive and Poisson regression analyses were performed. RESULTS Neighborhoods in Louisiana were substantially different with respect to deprivation. The ADI ranged from 136.00 for the most deprived neighborhood and -33.87 in the least deprived neighborhood. We observed that individuals residing in the most deprived neighborhoods had almost a 40% higher risk of COVID-19 compared to those residing in the least deprived neighborhoods. CONCLUSION While the majority of previous studies were focused on very limited socio-environmental factors such as crowding and income, this study used a composite area-based deprivation index to examine the role of neighborhood environment on COVID-19. We observed a positive relationship between neighborhood deprivation and COVID-19 risk in Louisiana. The study findings can be utilized to promote public health preventions measures besides social distancing, wearing a mask while in public and frequent handwashing in vulnerable neighborhoods with greater deprivation.
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Affiliation(s)
- Madhav K. C.
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States of America
| | - Evrim Oral
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States of America
| | - Susanne Straif-Bourgeois
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States of America
| | - Ariane L. Rung
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States of America
| | - Edward S. Peters
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States of America
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Feehan AK, Velasco C, Fort D, Burton JH, Price-Haywood EG, Katzmarzyk PT, Garcia-Diaz J, Seoane L. Racial and Workplace Disparities in Seroprevalence of SARS-CoV-2, Baton Rouge, Louisiana, USA. Emerg Infect Dis 2020; 27. [PMID: 33171096 PMCID: PMC7774581 DOI: 10.3201/eid2701.203808] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
By using paired molecular and antibody testing for severe acute respiratory syndrome coronavirus 2 infection, we determined point prevalence and seroprevalence in Louisiana, USA, during the second phase of reopening. Infections were highly variable by race and ethnicity, work environment, and ZIP code. Census-weighted seroprevalence was 3.6%, and point prevalence was 3.0%.
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Kale NN, Patel AH, Leddy MJ, Savoie FH, Sherman WF. The Effect of COVID-19 on Orthopedic Practices and Surgeons in Louisiana. Orthopedics 2020; 43:351-355. [PMID: 33211903 DOI: 10.3928/01477447-20201023-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/06/2020] [Indexed: 02/03/2023]
Abstract
This study was performed to analyze the effect that coronavirus 2019 (COVID-19) has had on orthopedic surgeons' practices, their patients, and orthopedic surgeons themselves through a survey distributed to members of the Louisiana Orthopaedic Association (LOA). An anonymous 22-question online survey was created and distributed to 323 LOA members. Of the 323 recipients of the survey, 99 (30.7%) responded. As a part of a multiple response set, in which respondents could choose more than one answer, the majority reported delayed care for routine orthopedic injuries (81 of 97, 83.5%). Almost every surgeon (n=95, 96.0%) reported stopping or delaying elective surgery because of COVID-19 and an increase in pain/disability/deformity in patients due to delay in elective procedures (73 of 97, 75.3%) and delay in seeking care (66 of 97, 68.0%). The majority reported an increased use of telehealth visits (68 of 97, 70.1%), a decrease in patient volume (88 of 97, 90.7%), and a reduction in income (79 of 98, 80.6%) during the past 6 months. A majority of surgeons (58 of 98, 59.2%) reported that they had applied for government assistance or took out loans. Via a multiple response set, respondents indicated that as a result of the pandemic, telehealth will become more widespread (64 of 98, 65.3%) and hospitals will exert a stronger influence over health care (64 of 98, 65.3%). The COVID-19 pandemic has had lasting effects on orthopedic surgeons in Louisiana and their practices, with a substantial decrease in the number of patients treated (90.5%), surgical volume, and revenue (80.6%). Orthopedic surgeons affected by the pandemic could use these data to further understand future challenges with patient care and changing orthopedic practice dynamics during this unique time. [Orthopedics. 2020;43(6):351-355.].
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Harville EW, Bazzano L, Qi L, He J, Dorans K, Perng W, Kelly T. Branched-chain amino acids, history of gestational diabetes, and breastfeeding: The Bogalusa Heart Study. Nutr Metab Cardiovasc Dis 2020; 30:2077-2084. [PMID: 32819784 PMCID: PMC7606618 DOI: 10.1016/j.numecd.2020.06.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS To examine the associations between history of gestational diabetes mellitus (GDM) and breastfeeding with branched-chain amino acids (BCAA) and their metabolites in later life. METHODS AND RESULTS 638 women (mean age 48.0 y) who had participated in the Bogalusa Heart Study and substudies of pregnancy history had untargeted, ultrahigh performance liquid chromatography-tandem mass spectroscopy conducted by Metabolon© on serum samples. Metabolites were identified that were BCAA or associated with BCAA metabolic pathways. History of GDM at any pregnancy (self-reported, confirmed with medical records when possible) as well as breastfeeding were examined as predictors of BCAA using linear models, controlling for age, race, BMI, waist circumference, and menopausal status. None of the BCAA differed statistically by history of either GDM or breastfeeding, although absolute levels of each of the BCAA were higher with GDM and lower with breastfeeding. Of the 27 metabolites on the leucine, isoleucine and valine metabolism subpathway, 1-carboxyethylleucine, 1-carboxyethyvaline, and 3-hydroxy-2-ethylpropionate were higher in women with a history of GDM, but lower in women in women with a history of breastfeeding. Similar results were found for alpha-hydroxyisocaproate, 1-carboxyethylisoleucine, and N-acetylleucine. CONCLUSIONS GDM and breastfeeding are associated in opposite directions with several metabolites on the BCAA metabolic pathway.
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Affiliation(s)
- Emily W Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States.
| | - Lydia Bazzano
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Lu Qi
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Jiang He
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Kirsten Dorans
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Wei Perng
- Department of Epidemiology, Colorado School of Public Health, Denver, CO, United States
| | - Tanika Kelly
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, United States
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Cornelius B, Ferrell E, Kilgore P, Cox R, Golden R, Cvek U, Trutschl M, Dubose A, Cornelius A. Incidence of Hypocalcemia and Role of Calcium Replacement in Major Trauma Patients Requiring Operative Intervention. AANA J 2020; 88:383-389. [PMID: 32990208] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Traumatic injury is a major cause of morbidity and mortality, and hemorrhage is a primary factor. Evidence exists that major trauma patients are at high risk of hypocalcemia. The purpose of this study was to determine the incidence and rate of calcium replacement in major trauma patients requiring operative intervention, and to investigate the impact of hypocalcemia on rate of transfusion and mortality. A retrospective analysis was conducted of all top-tier trauma activations presenting to our institution during a 12-month period. A total of 638 activations were identified; 441 were excluded, primarily because of lack of operative intervention. Patients were predominantly male following blunt trauma. The mean initial calcium level was 8.11 mg/dL and 8.64 mg/dL, correcting for albumin levels. An acute decline was noted when initial serum calcium levels and intraoperative calcium levels were compared (7.51 mg/dL). Intraoperative ionized calcium levels were on the low end of the normal range, and 28.42% received supplemental calcium. Patients in our cohort arrived hypocalcemic, which has been previously associated with increased mortality. Patients requiring operative intervention are at increased risk of hypocalcemia. Recognition of this potential is key for improved outcomes.
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Affiliation(s)
- Brian Cornelius
- is a nurse anesthetist, Department of Anesthesia, Ochsner LSU Health, Shreveport, Louisiana, and an assistant professor, Doctor of Nurse Anesthesia Practice, Midwestern University, Glendale, Arizona
| | - Eric Ferrell
- is a nurse anesthetist, Department of Anesthesia, Ochsner LSU Health, Shreveport, Louisiana
| | - Phillip Kilgore
- is employed by the Laboratory for Advanced Biomedical Informatics, Department of Computer Science, Louisiana State University Shreveport, Shreveport, Louisiana
| | - Rachel Cox
- is a postgraduate year (PGY) 5 resident employed by the Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Reid Golden
- is a PGY 3 resident in the Department of Emergency Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Urska Cvek
- is employed by the Laboratory for Advanced Biomedical Informatics, Department of Computer Science, Louisiana State University Shreveport
| | - Marjan Trutschl
- is employed by the Laboratory for Advanced Biomedical Informatics, Department of Computer Science, Louisiana State University Shreveport
| | - Arielle Dubose
- is an assistant professor, Department of Surgery, Louisiana State University Health Sciences Center, Shreveport
| | - Angela Cornelius
- is an associate professor, Department of Emergency Medicine, Louisiana State University Health Sciences Center, Shreveport
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Razavi AC, Fernandez C, He J, Kelly TN, Krousel-Wood M, Whelton SP, Carmichael OT, Bazzano LA. Left Ventricular Mass Index Is Associated With Cognitive Function in Middle-Age: Bogalusa Heart Study. Circ Cardiovasc Imaging 2020; 13:e010335. [PMID: 32772573 PMCID: PMC7428065 DOI: 10.1161/circimaging.119.010335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Elevated cardiovascular disease risk factor burden is a recognized contributor to poorer cognitive function; however, the physiological mechanisms underlying this association are not well understood. We sought to assess the potential mediation effect of left ventricular (LV) remodeling on the association between lifetime systolic blood pressure and cognitive function in a community-based cohort of middle-aged adults. METHODS Nine hundred sixty participants of the Bogalusa Heart Study (59.2% women, 33.8% black, aged 48.4±5.1 years) received 2-dimensional echocardiography to quantify relative wall thickness, LV mass, and diastolic and systolic LV function; and a standardized neurocognitive battery to assess memory, executive functioning, and language processing. Multivariable linear regression assessed the association of cardiac structure and function with a global composite cognitive function score, adjusting for traditional cardiovascular disease risk factors. Mediation analysis assessed the effect of LV mass index on the association between lifetime systolic blood pressure burden and cognitive function. RESULTS There were 233 (24.3%) and 136 (14.2%) individuals with concentric LV remodeling and concentric LV hypertrophy, respectively. Each g/m2.7 increment in LV mass index was associated with a 0.03 standardized unit decrement in global cognitive function (P=0.03). Individuals with concentric LV remodeling and isolated diastolic dysfunction had the poorest cognitive function, and a greater ratio between early mitral inflow velocity and early diastolic mitral annular velocity (E/e') was associated with poorer cognitive function, even after adjustment for LV mass index (B=-0.12; P=0.03). A total of 18.8% of the association between lifetime systolic blood pressure burden and midlife cognitive function was accounted for by LV mass index. CONCLUSIONS Cardiac remodeling partially mediates the association between lifespan systolic blood pressure burden and adult cognition in individuals without dementia or clinical cardiovascular disease. Slowing or reversing the progression of cardiac remodeling in middle-age may be a novel therapeutic approach to prevent cognitive decline.
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Affiliation(s)
- Alexander C. Razavi
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Camilo Fernandez
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Tanika N. Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Marie Krousel-Wood
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Seamus P. Whelton
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Owen T. Carmichael
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Lydia A. Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
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Feehan AK, Fort D, Garcia-Diaz J, Price-Haywood EG, Velasco C, Sapp E, Pevey D, Seoane L. Seroprevalence of SARS-CoV-2 and Infection Fatality Ratio, Orleans and Jefferson Parishes, Louisiana, USA, May 2020. Emerg Infect Dis 2020; 26:2766-2769. [PMID: 32731911 PMCID: PMC7588526 DOI: 10.3201/eid2611.203029] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Using a novel recruitment method and paired molecular and antibody testing for severe acute respiratory syndrome coronavirus 2 infection, we determined seroprevalence in a racially diverse municipality in Louisiana, USA. Infections were highly variable by ZIP code and differed by race/ethnicity. Overall census-weighted seroprevalence was 6.9%, and the calculated infection fatality ratio was 1.63%.
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Njuguna H, Wallace M, Simonson S, Tobolowsky FA, James AE, Bordelon K, Fukunaga R, Gold JAW, Wortham J, Sokol T, Haydel D, Tran H, Kim K, Fisher KA, Marlow M, Tate JE, Doshi RH, Curran KG. Serial Laboratory Testing for SARS-CoV-2 Infection Among Incarcerated and Detained Persons in a Correctional and Detention Facility - Louisiana, April-May 2020. MMWR Morb Mortal Wkly Rep 2020; 69:836-840. [PMID: 32614816 PMCID: PMC7332096 DOI: 10.15585/mmwr.mm6926e2] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brewer R, Hood KB, Moore M, Spieldenner A, Daunis C, Mukherjee S, Smith-Davis M, Brown G, Bowen B, Schneider JA. An Exploratory Study of Resilience, HIV-Related Stigma, and HIV Care Outcomes Among Men who have Sex with Men (MSM) Living with HIV in Louisiana. AIDS Behav 2020; 24:2119-2129. [PMID: 31916097 DOI: 10.1007/s10461-020-02778-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 12/31/2022]
Abstract
The various forms of HIV-related stigma continue to serve as major barriers to HIV care and treatment among men who have sex with men (MSM). The study of resilience within the context of HIV-related stigma among MSM living with HIV represents a promising area of research to inform the development of future HIV interventions for this population. We examined resilience within the context of HIV related stigma among MSM living with HIV in Louisiana with a particular interest in how resilience may be more relevant for Black MSM. We utilized Pearson's correlations and layered chi-square non-parametric tests to examine associations and racial differences in resilience, four HIV-related stigma measures/consequences (i.e., anticipated, internalized, enacted, and consequences of enacted HIV stigma), and HIV care outcomes (i.e., length of time since last HIV care visit, time since last HIV lab result, most recent HIV viral load result) among 110 MSM living with HIV in Louisiana who participated in the Louisiana HIV Stigma Index Project. The majority of MSM participants were Black (75%), lived in New Orleans (52%), and reported limited education (52%) and income (76%). MSM who reported higher levels of enacted HIV stigma, consequences of enacted HIV stigma, and internalized HIV stigma reported poorer HIV care outcomes. Both internalized and anticipated HIV stigma significantly negatively impacted Black MSM perceptions of their overall health compared with White MSM. Compared with White MSM, Black MSM who reported greater consequences of enacted HIV stigma had poorer HIV care outcomes. Resilience was associated with positive HIV care outcomes for both Black and White MSM. However, having higher levels of resilience may have been more protective for Black MSM such that higher levels of resilience were associated with less time since last HIV care visit for Black MSM than for White MSM. The current study provides preliminary information on the potential positive relationship between resilience and HIV care outcomes among MSM, particularly Black MSM. However, these findings need to be confirmed among a more representative sample of Black and White MSM in Louisiana.
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Affiliation(s)
- Russell Brewer
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.
- Chicago Center for HIV Elimination, Chicago, IL, USA.
| | | | - Mary Moore
- Dillard University, New Orleans, LA, USA
| | | | | | - Snigdha Mukherjee
- Educational Commission for Foreign Medical Graduates, Philadelphia, PA, USA
| | | | - Gina Brown
- Southern AIDS Coalition, New Orleans, LA, USA
| | - Brandi Bowen
- New Orleans Regional AIDS Planning Council, New Orleans, LA, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA
- Chicago Center for HIV Elimination, Chicago, IL, USA
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Wallace M, Marlow M, Simonson S, Walker M, Christophe N, Dominguez O, Kleamenakis L, Orellana A, Pagan-Pena D, Singh C, Pogue M, Saucier L, Lo T, Benson K, Sokol T. Public Health Response to COVID-19 Cases in Correctional and Detention Facilities - Louisiana, March-April 2020. MMWR Morb Mortal Wkly Rep 2020; 69:594-598. [PMID: 32407301 DOI: 10.15585/mmwr.mm6919e3] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Correctional and detention facilities face unique challenges in the control of infectious diseases, including coronavirus disease 2019 (COVID-19) (1-3). Among >10 million annual admissions to U.S. jails, approximately 55% of detainees are released back into their communities each week (4); in addition, staff members at correctional and detention facilities are members of their local communities. Thus, high rates of COVID-19 in correctional and detention facilities also have the potential to influence broader community transmission. In March 2020, the Louisiana Department of Health (LDH) began implementing surveillance for COVID-19 among correctional and detention facilities in Louisiana and identified cases and outbreaks in many facilities. In response, LDH and CDC developed and deployed the COVID-19 Management Assessment and Response (CMAR) tool to guide technical assistance focused on infection prevention and control policies and case management with correctional and detention facilities. This report describes COVID-19 prevalence in correctional and detention facilities detected through surveillance and findings of the CMAR assessment. During March 25-April 22, 489 laboratory-confirmed COVID-19 cases, including 37 (7.6%) hospitalizations and 10 (2.0%) deaths among incarcerated or detained persons, and 253 cases, including 19 (7.5%) hospitalizations and four (1.6%) deaths among staff members were reported. During April 8-22, CMAR telephone-based assessments were conducted with 13 of 31 (42%) facilities with laboratory-confirmed cases and 11 of 113 (10%) facilities without known cases. Administrators had awareness and overall understanding of CDC guidance for prevention of transmission in these facilities but reported challenges in implementation, related to limited space to quarantine close contacts of COVID-19 patients and inability of incarcerated and detained persons to engage in social distancing, particularly in dormitory-style housing. CMAR was a useful tool that helped state and federal public health officials assist multiple correctional and detention facilities to better manage COVID-19 patients and guide control activities to prevent or mitigate transmission.
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Gu X, Li C, He J, Li S, Bazzano LA, Kinchen JM, Chen W, He H, Gu D, Kelly TN. Serum metabolites associate with lipid phenotypes among Bogalusa Heart Study participants. Nutr Metab Cardiovasc Dis 2020; 30:777-787. [PMID: 32131987 PMCID: PMC7524581 DOI: 10.1016/j.numecd.2020.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/06/2019] [Accepted: 01/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Dyslipidemia has been identified as a major risk factor for cardiovascular disease. We aimed to identify metabolites and metabolite modules showing novel association with lipids among Bogalusa Heart Study (BHS) participants using untargeted metabolomics. METHODS AND RESULTS Untargeted ultrahigh performance liquid chromatography-tandem mass spectroscopy was used to quantify serum metabolites of 1 243 BHS participants (816 whites and 427 African-Americans). The association of single metabolites with lipids was assessed using multiple linear regression models to adjust for covariables. Weighted correlation network analysis was utilized to identify modules of co-abundant metabolites and examine their covariable adjusted correlations with lipids. All analyses were conducted according to race and using Bonferroni-corrected α-thresholds to determine statistical significance. Thirteen metabolites with known biochemical identities showing novel association achieved Bonferroni-significance, p < 1.04 × 10-5, and showed consistent effect directions in both whites and African-Americans. Twelve were from lipid sub-pathways including fatty acid metabolism (arachidonoylcholine, dihomo-linolenoyl-choline, docosahexaenoylcholine, linoleoylcholine, oleoylcholine, palmitoylcholine, and stearoylcholine), monohydroxy fatty acids (2-hydroxybehenate, 2-hydroxypalmitate, and 2-hydroxystearate), and lysoplasmalogens [1-(1-enyl-oleoyl)-GPE (P-18:1) and 1-(1-enyl-stearoyl)-GPE (P-18:0)]. The gamma-glutamylglutamine, peptide from the gamma-glutamyl amino acid sub-pathway, were also identified. In addition, four metabolite modules achieved Bonferroni-significance, p < 1.39 × 10-3, in both whites and African-Americans. These four modules were largely comprised of metabolites from lipid sub-pathways, with one module comprised of metabolites which were not identified in the single metabolite analyses. CONCLUSION The current study identified 13 metabolites and 4 metabolite modules showing novel association with lipids, providing new insights into the physiological mechanisms regulating lipid levels.
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Affiliation(s)
- Xiaoying Gu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Changwei Li
- Department of Epidemiology & Biostatistics, College of Public Health, University of Georgia, Athens, GE, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Shengxu Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Wei Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Hua He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Dongfeng Gu
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tanika N Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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Owusu D, Hand J, Tenforde MW, Feldstein LR, DaSilva J, Barnes J, Lee G, Tran J, Sokol T, Fry AM, Brammer L, Rolfes MA. Early Season Pediatric Influenza B/Victoria Virus Infections Associated with a Recently Emerged Virus Subclade - Louisiana, 2019. MMWR Morb Mortal Wkly Rep 2020; 69:40-43. [PMID: 31945035 PMCID: PMC6973347 DOI: 10.15585/mmwr.mm6902e1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dyer L, Hardeman R, Vilda D, Theall K, Wallace M. Mass incarceration and public health: the association between black jail incarceration and adverse birth outcomes among black women in Louisiana. BMC Pregnancy Childbirth 2019; 19:525. [PMID: 31881857 PMCID: PMC6935062 DOI: 10.1186/s12884-019-2690-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/19/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A growing body of evidence is beginning to highlight how mass incarceration shapes inequalities in population health. Non-Hispanic blacks are disproportionately affected by incarceration and criminal law enforcement, an enduring legacy of a racially-biased criminal justice system with broad health implications for black families and communities. Louisiana has consistently maintained one of the highest rates of black incarceration in the nation. Concurrently, large racial disparities in population health persist. METHODS We conducted a cross-sectional analysis of all births among non-Hispanic black women in Louisiana in 2014 to identify associations between parish-level (county equivalent) prevalence of jail incarceration within the black population and adverse birth outcomes (N = 23,954). We fit a log-Poisson model with generalized estimating equations to approximate the relative risk of preterm birth and low birth weight associated with an interquartile range increase in incarceration, controlling for confounders. In sensitivity analyses, we additionally adjusted for the parish-level index crime prevalence and analyzed regression models wherein white incarceration was used to predict the risk of adverse birth outcomes in order to quantify the degree to which mass incarceration may harm health above and beyond living in a high crime area. RESULTS There was a significant 3% higher risk of preterm birth among black women associated with an interquartile range increase in the parish-level incarceration prevalence of black individuals, independent of other factors. Adjusting for the prevalence of index crimes did not substantively change the results of the models. CONCLUSION Due to the positive significant associations between the prevalence of black individuals incarcerated in Louisiana jails and estimated risk of preterm birth, mass incarceration may be an underlying cause of the persistent inequities in reproductive health outcomes experienced by black women in Louisiana. Not only are there economic and social impacts stemming from mass incarceration, but there may also be implications for population health and health inequities, including the persistence of racial disparities in preterm birth and low birth weight.
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Affiliation(s)
- Lauren Dyer
- Mary Amelia Douglas-Whited Community Women’s Health Education Center, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA 70112 USA
| | - Rachel Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN 55455 USA
| | - Dovile Vilda
- Mary Amelia Douglas-Whited Community Women’s Health Education Center, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA 70112 USA
| | - Katherine Theall
- Mary Amelia Douglas-Whited Community Women’s Health Education Center, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA 70112 USA
| | - Maeve Wallace
- Mary Amelia Douglas-Whited Community Women’s Health Education Center, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA 70112 USA
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Gollub EL, Green J, Richardson L, Kaplan I, Shervington D. Indirect violence exposure and mental health symptoms among an urban public-school population: Prevalence and correlates. PLoS One 2019; 14:e0224499. [PMID: 31774835 PMCID: PMC6881142 DOI: 10.1371/journal.pone.0224499] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022] Open
Abstract
Available literature identifies the need for a deeper understanding of the role of gender, age and socioeconomic status in children's exposure to violence and associations with mental health (MH) outcomes. The 1548 participants for this study were enrolled from 28 public charter schools and 9 community-based settings; youth were administered a screener that assessed exposure to traumatic events and symptoms of post-traumatic stress disorder (PTSD) and depression. Respondents reported extremely high levels of exposure to indirect violence: 41.7% witnessed shooting/stabbing/beating; 18.3% witnessed murder; and 53.8% experienced the murder of someone close. Frequency of adverse MH outcomes was high: 21.2% screened positive for depression; 45.7% for lifetime PTSD; and 26.9% for current PTSD. More males than females reported witnessing shooting/stabbing/beating (p = .04); females more often reported experiencing the murder of someone close (p = .001). Indirect violence exposure generally increased with age. Youth attending schools with ≥90% free/reduced lunch participation (FRLP) showed significantly higher levels of violence exposure compared to youth in schools with <90% FRLP. Females endorsed significantly higher levels of depression (21.4% vs. 9.7%), and lifetime (53.9% vs. 34.9%) and current (32.5% vs. 19.6%) PTSD, compared with males (p < .0001, all comparisons). Female sex (aOR = 2.6), FRLP (aOR = 1.4 for ≥90% vs. <90%) and the number of different indirect violence exposures (aORs from 1.3 to 10.4), were significantly associated with a positive screen for any adverse MH outcome. Our data add important insights into gender heterogeneity of viewed violence, mental health symptoms, and their association-all of which are critical to guiding effective intervention efforts.
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Affiliation(s)
- Erica L. Gollub
- Health Science Program, College of Health Professions, Pace University, Pleasantville, NY, United States of America
| | - Jakevia Green
- Institute of Women & Ethnic Studies, New Orleans, LA, United States of America
| | - Lisa Richardson
- Institute of Women & Ethnic Studies, New Orleans, LA, United States of America
| | - Ilyssa Kaplan
- Department of Psychology, Pace University, New York, NY, United States of America
| | - Denese Shervington
- Institute of Women & Ethnic Studies, New Orleans, LA, United States of America
- Charles R. Drew School of Medicine and Science, Psychiatry and Behavioral Sciences, Los Angeles, CA, United States of America
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Heath M, Buckley R, Gerber Z, Davis P, Linneman L, Gong Q, Barkemeyer B, Fang Z, Good M, Penn D, Kim S. Association of Intestinal Alkaline Phosphatase With Necrotizing Enterocolitis Among Premature Infants. JAMA Netw Open 2019; 2:e1914996. [PMID: 31702803 PMCID: PMC6902776 DOI: 10.1001/jamanetworkopen.2019.14996] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Necrotizing enterocolitis (NEC) in preterm infants is an often-fatal gastrointestinal tract emergency. A robust NEC biomarker that is not confounded by sepsis could improve bedside management, lead to lower morbidity and mortality, and permit patient selection in randomized clinical trials of possible therapeutic approaches. OBJECTIVE To evaluate whether aberrant intestinal alkaline phosphatase (IAP) biochemistry in infant stool is a molecular biomarker for NEC and not associated with sepsis. DESIGN, SETTING, AND PARTICIPANTS This multicenter diagnostic study enrolled 136 premature infants (gestational age, <37 weeks) in 2 hospitals in Louisiana and 1 hospital in Missouri. Data were collected and analyzed from May 2015 to November 2018. EXPOSURES Infant stool samples were collected between 24 and 40 or more weeks postconceptual age. Enrolled infants underwent abdominal radiography at physician and hospital site discretion. MAIN OUTCOMES AND MEASURES Enzyme activity and relative abundance of IAP were measured using fluorometric detection and immunoassays, respectively. After measurements were performed, biochemical data were evaluated against clinical entries from infants' hospital stay. RESULTS Of 136 infants, 68 (50.0%) were male infants, median (interquartile range [IQR]) birth weight was 1050 (790-1350) g, and median (IQR) gestational age was 28.4 (26.0-30.9) weeks. A total of 25 infants (18.4%) were diagnosed with severe NEC, 19 (14.0%) were suspected of having NEC, and 92 (66.9%) did not have NEC; 26 patients (19.1%) were diagnosed with late-onset sepsis, and 14 (10.3%) had other non-gastrointestinal tract infections. For severe NEC, suspected NEC, and no NEC samples, median (IQR) fecal IAP content, relative to the amount of IAP in human small intestinal lysate, was 99.0% (51.0%-187.8%) (95% CI, 54.0%-163.0%), 123.0% (31.0%-224.0%) (95% CI, 31.0%-224.0%), and 4.8% (2.4%-9.8%) (95% CI, 3.4%-5.9%), respectively. For severe NEC, suspected NEC, and no NEC samples, median (IQR) enzyme activity was 183 (56-507) μmol/min/g (95% CI, 63-478 μmol/min/g) of stool protein, 355 (172-608) μmol/min/g (95% CI, 172-608 μmol/min/g) of stool protein, and 613 (210-1465) μmol/min/g (95% CI, 386-723 μmol/min/g) of stool protein, respectively. Mean (SE) area under the receiver operating characteristic curve values for IAP content measurements were 0.97 (0.02) (95% CI, 0.93-1.00; P < .001) at time of severe NEC, 0.97 (0.02) (95% CI, 0.93-1.00; P < .001) at time of suspected NEC, 0.52 (0.07) (95% CI, 0.38-0.66; P = .75) at time of sepsis, and 0.58 (0.08) (95% CI, 0.42-0.75; P = .06) at time of other non-gastrointestinal tract infections. Mean (SE) area under the receiver operating characteristic curve values for IAP activity were 0.76 (0.06) (95% CI, 0.64-0.86; P < .001), 0.62 (0.07) (95% CI, 0.48-0.77; P = .13), 0.52 (0.07) (95% CI, 0.39-0.67; P = .68), and 0.57 (0.08) (95% CI, 0.39-0.69; P = .66), respectively. CONCLUSIONS AND RELEVANCE In this diagnostic study, high amounts of IAP protein in stool and low IAP enzyme activity were associated with diagnosis of NEC and may serve as useful biomarkers for NEC. Our findings indicated that IAP biochemistry was uniquely able to distinguish NEC from sepsis.
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Affiliation(s)
- Maya Heath
- Department of Pediatrics and Neonatology, Louisiana State University School of Medicine, Children’s Hospital of New Orleans, New Orleans
| | - Rebecca Buckley
- Department of Biochemistry and Molecular Biology, Louisiana State University School of Medicine and Health Sciences Center, New Orleans
| | - Zeromeh Gerber
- Department of Pediatrics and Neonatology, Louisiana State University School of Medicine, Children’s Hospital of New Orleans, New Orleans
| | - Porcha Davis
- Department of Biochemistry and Molecular Biology, Louisiana State University School of Medicine and Health Sciences Center, New Orleans
| | - Laura Linneman
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis Children’s Hospital, St Louis, Missouri
| | - Qingqing Gong
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis Children’s Hospital, St Louis, Missouri
| | - Brian Barkemeyer
- Department of Pediatrics and Neonatology, Louisiana State University School of Medicine, Children’s Hospital of New Orleans, New Orleans
| | - Zhide Fang
- Department of Biostatistics, Louisiana State University School of Public Health, New Orleans
| | - Misty Good
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis Children’s Hospital, St Louis, Missouri
| | - Duna Penn
- Department of Pediatrics and Neonatology, Louisiana State University School of Medicine, Children’s Hospital of New Orleans, New Orleans
| | - Sunyoung Kim
- Department of Biochemistry and Molecular Biology, Louisiana State University School of Medicine and Health Sciences Center, New Orleans
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