Acute Kidney Injury Among Children Likely Associated with Diethylene Glycol-Contaminated Medications - The Gambia, June-September 2022.

On July 26, 2022, a pediatric nephrologist alerted The Gambia's Ministry of Health (MoH) to a cluster of cases of acute kidney injury (AKI) among young children at the country's sole teaching hospital, and on August 23, 2022, MoH requested assistance from CDC. CDC epidemiologists arrived in The Gambia, a West African country, on September 16 to assist MoH in characterizing the illness, describing the epidemiology, and identifying potential causal factors and their sources. Investigators reviewed medical records and interviewed caregivers to characterize patients' symptoms and identify exposures. The preliminary investigation suggested that various contaminated syrup-based children's medications contributed to the AKI outbreak. During the investigation, MoH recalled implicated medications from a single international manufacturer. Continued efforts to strengthen pharmaceutical quality control and event-based public health surveillance are needed to help prevent future medication-related outbreaks.

Community health impacts after a jet fuel leak contaminated a drinking water system: Oahu, Hawaii, November 2021.

BACKGROUND: In 2021, a large petroleum leak contaminated a water source that supplied drinking water to military and civilians in Oahu, Hawaii. METHODS: We conducted an Assessment of Chemical Exposures (ACE) survey and supplemented that information with complementary data sources: (1) poison center caller records; (2) emergency department visit data; and (3) a key informant questionnaire. RESULTS: Among 2,289 survey participants, 86% reported ≥1 new or worsening symptom, 75% of which lasted ≥30 days, and 37% sought medical care. Most (n = 1,653, 72%) reported new mental health symptoms. Among equally observable symptoms across age groups, proportions of children ≤2 years experiencing vomiting, runny nose, skin rashes, and coughing (33, 46, 56, and 35%, respectively) were higher than other age groups. Poison center calls increased the first 2 weeks after the contamination, while emergency department visits increased in early December 2021. Key informant interviews revealed themes of lack of support, mental health symptoms, and long-term health impact concerns. DISCUSSION: This event led to widespread exposure to petroleum products and negatively affected thousands of people. Follow-up health surveys or interventions should give special consideration to longer-term physical and mental health, especially children due to their unique sensitivity to environmental exposures.

Association of Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination or a Prior Positive Test Result in Adolescents during the Delta Variant Surge in Kentucky.

In a cross-sectional study of 89 736 adolescents in Kentucky, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination provided an estimated protection against infection of 81% when the highly transmissible Delta variant was predominant. Vaccination provided added benefit to those with a history of prior infection. These findings support the recommendation that all adolescents receive SARS-CoV-2 vaccination.

Evaluating risk factors associated with COVID-19 infections among vaccinated people early in the U.S. vaccination campaign: an observational study of five states, January-March 2021.

BACKGROUND: COVID-19 vaccines are an effective tool to prevent illness due to SARS-CoV-2 infection. However, infection after vaccination still occurs. We evaluated all infections identified among recipients of either the Pfizer-BioNTech or Moderna COVID-19 vaccine in five U.S. states during January-March 2021. METHODS: Using observational data reported to CDC, we compared the incidence of SARS-CoV-2 infection among vaccinated and unvaccinated persons, and the sex, age, and vaccine product received for individuals with vaccine breakthrough infections to those of the vaccinated population using Poisson regression models. We also compared the proportion of vaccine breakthrough cases due to a SARS-CoV-2 variant of concern to data reported to CDC's national genomic surveillance program. RESULTS: The age-adjusted incidence of reported SARS-CoV-2 infection was 97% lower among vaccinated as compared to unvaccinated persons aged ≥ 16 years (68 vs 2252 cases per 100,000 people). Vaccinated adults aged ≥ 85 years were 1.6 times (95% CI 1.3-1.9) as likely to become infected with SARS-CoV-2 than vaccinated adults aged < 65 years. Pfizer-BioNTech COVID-19 vaccine recipients were 1.4 times (95% CI 1.3-1.6) as likely to experience infection compared to Moderna COVID-19 recipients. The proportion of infections among vaccinated persons caused by SARS-CoV-2 variants of concern was similar to the proportion of circulating viruses identified as variants of concern in the five states during the same time. CONCLUSIONS: Vaccinated persons had a substantially lower incidence of SARS-CoV-2 infection compared to unvaccinated persons. Adults aged ≥ 85 years and Pfizer-BioNTech vaccine recipients had a higher risk of infection following vaccination. We provide an analytic framework for ongoing evaluation of patterns associated with SARS-CoV-2 infection among vaccinated persons using observational surveillance and immunization data. Our findings reinforce the effectiveness of COVID-19 vaccines in preventing infection in real-world settings.

Reduced Risk of Reinfection with SARS-CoV-2 After COVID-19 Vaccination - Kentucky, May-June 2021.

Although laboratory evidence suggests that antibody responses following COVID-19 vaccination provide better neutralization of some circulating variants than does natural infection (1,2), few real-world epidemiologic studies exist to support the benefit of vaccination for previously infected persons. This report details the findings of a case-control evaluation of the association between vaccination and SARS-CoV-2 reinfection in Kentucky during May-June 2021 among persons previously infected with SARS-CoV-2 in 2020. Kentucky residents who were not vaccinated had 2.34 times the odds of reinfection compared with those who were fully vaccinated (odds ratio [OR] = 2.34; 95% confidence interval [CI] = 1.58-3.47). These findings suggest that among persons with previous SARS-CoV-2 infection, full vaccination provides additional protection against reinfection. To reduce their risk of infection, all eligible persons should be offered vaccination, even if they have been previously infected with SARS-CoV-2.

Suspected Recurrent SARS-CoV-2 Infections Among Residents of a Skilled Nursing Facility During a Second COVID-19 Outbreak - Kentucky, July-November 2020.

Reinfection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is believed to be rare (1). Some level of immunity after SARS-CoV-2 infection is expected; however, the evidence regarding duration and level of protection is still emerging (2). The Kentucky Department for Public Health (KDPH) and a local health department conducted an investigation at a skilled nursing facility (SNF) that experienced a second COVID-19 outbreak in October 2020, 3 months after a first outbreak in July. Five residents received positive SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test results during both outbreaks. During the first outbreak, three of the five patients were asymptomatic and two had mild symptoms that resolved before the second outbreak. Disease severity in the five residents during the second outbreak was worse than that during the first outbreak and included one death. Because test samples were not retained, phylogenetic strain comparison was not possible. However, interim period symptom resolution in the two symptomatic patients, at least four consecutive negative RT-PCR tests for all five patients before receiving a positive test result during the second outbreak, and the 3-month interval between the first and the second outbreaks, suggest the possibility that reinfection occurred. Maintaining physical distance, wearing face coverings or masks, and frequent hand hygiene are critical mitigation strategies necessary to prevent transmission of SARS-CoV-2 to SNF residents, a particularly vulnerable population at risk for poor COVID-19-associated outcomes.* Testing, containment strategies (isolation and quarantine), and vaccination of residents and health care personnel (HCP) are also essential components to protecting vulnerable residents. The findings of this study highlight the importance of maintaining public health mitigation and protection strategies that reduce transmission risk, even among persons with a history of COVID-19 infection.

COVID-19 Outbreak Associated with a SARS-CoV-2 R.1 Lineage Variant in a Skilled Nursing Facility After Vaccination Program - Kentucky, March 2021.

Although COVID-19 mRNA vaccines demonstrated high efficacy in clinical trials (1), they were not 100% efficacious. Thus, some infections postvaccination are expected. Limited data are available on effectiveness in skilled nursing facilities (SNFs) and against emerging variants. The Kentucky Department for Public Health (KDPH) and a local health department investigated a COVID-19 outbreak in a SNF that occurred after all residents and health care personnel (HCP) had been offered vaccination. Among 83 residents and 116 HCP, 75 (90.4%) and 61 (52.6%), respectively, received 2 vaccine doses. Twenty-six residents and 20 HCP received positive test results for SARS-CoV-2, the virus that causes COVID-19, including 18 residents and four HCP who had received their second vaccine dose >14 days before the outbreak began. An R.1 lineage variant was detected with whole genome sequencing (WGS). Although the R.1 variant has multiple spike protein mutations, vaccinated residents and HCP were 87% less likely to have symptomatic COVID-19 compared with those who were unvaccinated. Vaccination of SNF populations, including HCP, is critical to reduce the risk for SARS-CoV-2 introduction, transmission, and severe outcomes in SNFs. An ongoing focus on infection prevention and control practices is also essential.

Rehabilitation After Total Knee Arthroplasty: Do Racial Disparities Exist?

BACKGROUND: Racial disparities in functional outcomes after total knee arthroplasty (TKA) exist. Whether differences in rehabilitation utilization contribute to these disparities remains to be investigated. METHODS: Among 8349 women enrolled in the prospective Women's Health Initiative cohort who underwent primary TKA between 2006 and 2013, rehabilitation utilization was determined through linked Medicare claims data. Postacute discharge destination (home, skilled nursing facility, and inpatient rehabilitation facility), facility length of stay, and number of home health physical therapy (HHPT) and outpatient physical therapy (OPPT) sessions were compared between racial groups. RESULTS: Non-Hispanic black women had worse physical function (median score, 65 vs 70) and higher likelihood of disability (13.2% vs 6.9%) than non-Hispanic white women before surgery. After TKA, black women were more likely to be discharged postacutely to an institutional facility (64.3% vs 54.5%) than white women, were more likely to receive HHPT services (52.6% vs 47.8%), and received more HHPT and OPPT sessions. After stratification by postacute discharge setting, the likelihood of receipt of HHPT or OPPT services was similar between racial groups. No significant difference in receipt of HHPT or OPPT services was found after use of propensity score weighting to balance health and medical characteristics indicating severity of need for physical therapy services. CONCLUSION: Rehabilitation utilization was generally comparable between black and white women who received TKA when accounting for need. There was no evidence of underutilization of post-TKA rehabilitation services, and thus disparities in post-TKA functional outcomes do not appear to be a result of inequitable receipt of rehabilitation care.

Occupational health risks and intervention strategies for US taxi drivers.

Research has shown that taxi drivers are at risk for numerous health concerns, such as low back and leg pain, linked to their highly sedentary occupation, long work hours and stressors related to the job (e.g. low income, safety threats). The goal of this study was to explore occupational health risks and opportunities for health interventions with taxi drivers using community-based participatory research (CBPR) methods. A mixed methods approach included first a convenience sample of 19 East African taxi drivers participating in focus group discussions. Second, a convenience sample of 75 current taxi drivers (M age = 45.7 years) and 25 non-driver comparison participants (M age = 40.3 years) were recruited to complete a structured self-reported questionnaire and objective measures of health. Health education was provided alongside the research to address common health concerns and to ensure mutual benefit and an action orientation. The focus groups described numerous health concerns that drivers attributed to their occupation, including chronic pain, sleep deprivation, cardiovascular disease, diabetes, kidney disease and eye problems, as the most common. Participants offered ideas for health interventions that include workplace reform and driver education. Quantitative data indicate that 44% of drivers reported their health as 'fair' or 'poor'. Drivers were more likely to report musculoskeletal pain, less sleep, more fatigue and less physical activity as compared to non-drivers. The majority of drivers reported financial and job dissatisfaction. The research provides data to inform targeted health interventions that support the health and safety of taxi drivers.

Making my family proud: The unique contribution of familism pride to the psychological adjustment of Latinx emerging adults.

OBJECTIVES: Familism values serve to provide key cultural scripts in Latinx families, and these values have been associated with positive psychosocial outcomes for Latinx youth (Stein et al., 2014). Yet, how familism values intersect with the experience of positive emotions remains relatively unknown. In particular, familism pride may be an important positive emotion that links familism values to positive psychosocial outcomes. To fill this gap in the literature, the current study developed a measure of familism pride and examined its unique prediction to psychosocial outcomes. METHOD: Self-report survey data were collected from 2 samples of Latinx emerging adults who were part of a psychology subject pool at a comprehensive university in Los Angeles designated as an Hispanic-serving institution. Sample 1 (n = 352) was 72.2% women with a mean age of 18.9 years, whereas Sample 2 was 68.6% women with a mean age of 19.3 years. RESULTS: Factor analyses supported that familism pride was distinct from familism values (familial support, obligation, reference, respeto). Familism pride was associated with fewer depressive symptoms and greater experience of joy when controlling for familism values in both samples. CONCLUSIONS: Our study underscores the importance of examining emotional processes in the study of familism and suggests a new dimension of familism that has not received research attention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Ethnic-racial socialization in Latino families: The influence of mothers' socialization practices on adolescent private regard, familism, and perceived ethnic-racial discrimination.

OBJECTIVES: Cultural value endorsement and ethnic-racial identity promote Latino/a adolescent positive adaptation and mitigate the negative impacts of perceived ethnic-racial discrimination. This study explored the intergenerational process of how adolescents develop these cultural characteristics in concert with their experiences of discrimination, focusing on the role of youth-reported maternal ethnic-racial socialization processes. METHOD: Participants included 175 Latino/a adolescent-mother dyads recruited from the 7th and 8th grades in an understudied emerging immigrant destination. We tested the effects of maternal cultural characteristics (i.e., familism, private regard, and perceived discrimination) on the same adolescent outcomes through youth-reported maternal ethnic-racial socialization practices (i.e., cultural socialization, preparation for bias, promotion of mistrust, and familism socialization, a novel construct introduced in this study). RESULTS: Three significant indirect pathways were identified. Higher maternal private regard was associated with both higher youth familism and higher youth private regard through greater youth-reported familism socialization, and higher maternal private regard was associated with more perceived youth discrimination through greater youth-reported preparation for bias. CONCLUSION: Our results highlight maternal private regard as particularly important for understanding how youth perceptions of socialization processes encourage the development of adolescent cultural characteristics and the benefit of using specific assessment tools, such as a familism socialization measure, to identify how ethnic-racial socialization processes serve as intergenerational links. Directions for future research and implications for intervention are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Depressive symptoms in Latina mothers in an emerging immigrant community.

OBJECTIVES: Latina mothers in emerging immigrant communities experience heightened risk for depressive symptoms because of the convergence of multiple risk factors rooted in economic, cultural, and familial experiences. Previous research with Latina/o adolescents has found that discrimination, and not acculturative stress, predicts depressive symptoms; however, no research to our knowledge has examined the relative impact of both discrimination and acculturative stress in Latina mothers. METHOD: The present study expands this literature by examining how both universal (i.e., economic hardship and parent-child conflict) and cultural stressors (i.e., discrimination and acculturative-based family conflict) predict maternal depressive symptoms in a sample of 169 Latina mothers in an emerging immigrant context. RESULTS: Results found that the presence of universal stressors for Latina mothers does indeed significantly predict depressive symptoms, and that uniquely, 1 type of cultural stressor (i.e., acculturative-based family conflict) predicts depressive symptoms above and beyond the universal stressors. CONCLUSIONS: These findings indicate that it is important to examine how cultural stressors may have differential impact for youth and their parents; thus, more work should examine the impact of acculturative-based family conflict for Latina mothers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

When Discrimination Hurts: The Longitudinal Impact of Increases in Peer Discrimination on Anxiety and Depressive Symptoms in Mexican-origin Youth.

Life course models of the impact of discrimination on health and mental health outcomes posit that the pernicious effects of discrimination may not be immediate, but instead may become apparent at later stages in development. This study tests whether peer discrimination changes at particular transition points (i.e., transition to middle and high school) predict subsequent internalizing symptoms in Mexican-origin youth. In a sample of 674 Mexican-origin youth (50% female), this study used a latent change score framework to model changes in peer discrimination across time and to test whether changes in peer discrimination at 7th and 9th grades predicted greater depressive and anxiety symptoms in 12th grade controlling for 5th grade symptoms. Irrespective of longitudinal changes, greater peer discrimination in 5th grade predicted greater depressive and anxiety symptoms in 12th grade. Further, significant increases in peer discrimination from 7th to 8th grade and in 9th to 10th grade uniquely predicted greater anxiety symptoms in 12th grade. These findings suggest that longitudinal research on peer discrimination needs to take into account unique periods of risk. Future research implications are discussed.

Protective and Promotive Effects of Latino Early Adolescents' Cultural Assets Against Multiple Types of Discrimination.

Given adversity associated with discrimination, it is important to identify culturally relevant factors that may protect against its harmful effects. Using latent variable interactions, this study examined the moderating effects of cultural assets on the association between multiple types of discrimination and adolescents' adjustment. Participants included 174 seventh- and eighth-grade Latino adolescents (51% girls); majority were of Mexican origin. Peer discrimination was associated with higher internalizing symptoms, whereas cultural assets predicted higher academic motivation above and beyond racial-ethnic discrimination, demonstrating a promotive effect. Adolescents' Latino cultural assets also protected against higher levels of externalizing symptoms in the context of high peer discrimination and foreigner objectification. The discussion focuses on the conceptual and applied implications of these findings.

African American parents' racial and emotion socialization profiles and young adults' emotional adaptation.

The current study aimed to identify parents' profiles of racial and emotion socialization practices, to determine if these profiles vary as a function of family income and young adult child gender, and to examine their links with young adults' emotional adaptation. Participants included 192 African American young adults (70% women) who ranged in age from 18 to 24 years (M = 19.44 years). Four maternal profiles emerged: cultural-supportive (high cultural socialization and supportive responses to children's negative emotions), moderate bias preparation (moderate preparation for bias, promotion of mistrust, and nonsupportive responses to negative emotions), high bias preparation (high preparation for bias, promotion of mistrust, and nonsupportive responses), and low engaged (low across racial and socialization constructs). Three paternal profiles emerged: multifaceted (moderate across racial and emotion socialization constructs), high bias preparation, and low engaged. Men were more likely to have mothers in the high bias preparation and to have fathers in the multifaceted or high bias preparation profiles. Individuals with higher income were more likely to have mothers in the cultural-supportive profile and to have fathers in the multifaceted profile. Young adults whose mothers fit the cultural-supportive profile or the moderate bias preparation profile had lower levels of depressive symptoms than young adults whose mothers fit the high bias preparation profile.

Links Between Remembered Childhood Emotion Socialization and Adult Adjustment: Similarities and Differences Between European American and African American Women.

The purpose of this paper was to examine whether recollections of mothers' emotion socialization practices during childhood are linked to adult emotional well-being as indexed by depression, trait anger, and cardiac vagal tone, and whether these effects vary for African American and European American women. Participants included 251 women (128 European American; 123 African American) who ranged in age from 18 to 44 years (M = 25 years). Multigroup confirmatory factor analyses indicated strong measurement and factor invariance across African American and European American participants. Remembered non-supportive emotion socialization was linked with elevated depressive symptoms for European American women, but not African American women and with elevated trait anger for both groups. Remembered supportive emotion socialization was linked with higher resting vagal tone for both groups. The results provide some support for the view that non-supportive emotion socialization may be more detrimental for European Americans than African Americans.

Characteristics of Decedents With COVID-19-Related Mortality in Kentucky, July 1-August 13, 2021.

OBJECTIVE: Although vaccination reduces the risk of severe COVID-19, fatal COVID-19 cases after vaccination can occur. We examined the characteristics of decedents with COVID-19-related mortality to help inform discussions about vaccination, boosters, and mitigation strategies. METHODS: We examined COVID-19-related deaths in Kentucky resulting from infections occurring from July 1 through August 13, 2021. We used records from case investigations, medical records, the Kentucky Health Information Exchange, and the Kentucky Immunization Registry to determine demographic information, vaccination status, and underlying health conditions, including calculation of the Charlson Comorbidity Index (CCI). We calculated mortality incidence rates by vaccination status by using data for unvaccinated and fully vaccinated populations in Kentucky as of July 1, 2021. RESULTS: In total, 777 COVID-19-related deaths occurred in Kentucky during the study period; 592 (76.2%) occurred among unvaccinated people. Compared with unvaccinated decedents, fully vaccinated decedents were older (median age, 77 vs 65 years; P < .001), had higher comorbidity levels (median CCI, 3 vs 1; P < .001), and were more likely to have immunocompromised health status (26.4% vs 16.0%; P = .003). Diabetes, hypertension, heart disease, and chronic lung disease were more common among vaccinated decedents than among unvaccinated decedents. Unvaccinated adults had a significantly higher risk of death than fully vaccinated adults (incidence rate ratio for age 20-49 years: 20.5 [95% CI, 6.5-64.8]; 50-64 years: 14.6 [95% CI, 9.4-22.7]; ≥65 years: 10.2 [95% CI, 8.3-12.4]). CONCLUSIONS: Immunocompromised health status, older age, and higher comorbidity were prevalent among fully vaccinated decedents, suggesting adults with these characteristics may benefit from additional protection strategies. Further understanding of the protection of additional and booster doses is needed.

Protective Immunity after Natural Infection with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) - Kentucky, USA, 2020.

BACKGROUND: As vaccine supply and access remain limited in many parts of the world, understanding the duration of protection from reinfection after natural infection is important. METHODS: Distinct individuals testing positive and negative for SARS-CoV-2 between March 6, 2020, and August 31, 2020, in Kentucky, USA, were identified using the Kentucky National Electronic Disease Surveillance System. Individuals were followed for occurrence of a positive test for SARS-CoV-2 from 91 days after their initial test result through December 31, 2020. Protection from reinfection provided by a prior infection was calculated and additional analyses evaluated impact of age, sex, symptom status, long-term care facility connection, testing occurrence and frequency, and time from initial infection. RESULTS: The protective effect from prior infection was 80.3% (95% CI, 78.2%-82.2%) for those aged 20-59 years and 67.4% (95% CI, 62.8%-71.4%) for those aged ≥60 years. At 30-day time periods through 270 days (with limited exceptions), protection was estimated to be >75% for those aged 20-59 years and >65% for those aged ≥60 years. Factors associated with repeat positive testing included a connection to a long-term care facility, duration of potential exposure, and absence of symptoms during initial infection. CONCLUSIONS: Natural infection provides substantial and persistent immunologic protection for a period of several months for most individuals, although subpopulations may be at greater risk of repeat positive testing and potential poor outcomes associated with reinfection. These subgroups include individuals aged ≥60 years, residents and staff of long-term care facilities, and those who have mild or asymptomatic illness with initial infection. Continued emphasis on vaccination and infection prevention and control strategies remains critically important in reducing the risk of reinfection and associated severe outcomes for these groups.

Incorporating callous-unemotional behaviors into school-based research.

This study investigated the utility of including teacher-reported callous-unemotional (CU) behaviors in the assessment of disruptive behaviors in school-based research. Participants included 138 first- and second-grade children (68% male; 76% eligible for free or reduced-price lunch; 61% Black, 9% Latinx, 23% White, and 7% multiracial) who completed assessments during the baseline assessment of an intervention study. Results indicated that teachers could distinguish CU from traditional indicators of disruptive behavior, including attention deficit hyperactivity disorder (ADHD) behaviors and conduct problems (CP). When considered alone, there was mixed evidence for the utility of CU behaviors. Although higher levels of CU behaviors explained unique variation in teacher-reported social competence and global impairment, CU behaviors did not explain unique variation in disciplinary infractions, classroom behavior, or academic functioning after accounting for ADHD and CP behaviors. A different pattern of results was evident when CU was considered in conjunction with ADHD and CP behaviors. Latent profile analyses identified three subgroups of participants (i.e., a nondisruptive group, an ADHD group, and a comorbid group, who exhibited elevated levels of ADHD, CP, and CU). Compared to the nondisruptive group, the ADHD group exhibited higher rates of off-task classroom behavior and worse academic functioning. The comorbid group exhibited moderate-to-large differences from both groups on teacher-reported and objective outcomes. The implications of these results are discussed with respect to the potential value of incorporating CU behaviors, which are becoming prominent in clinical psychology and psychiatry, into school-based research and for school psychology practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).