Characteristics of Persons Who Died with COVID-19 - United States, February 12-May 18, 2020.

During January 1, 2020-May 18, 2020, approximately 1.3 million cases of coronavirus disease 2019 (COVID-19) and 83,000 COVID-19-associated deaths were reported in the United States (1). Understanding the demographic and clinical characteristics of decedents could inform medical and public health interventions focused on preventing COVID-19-associated mortality. This report describes decedents with laboratory-confirmed infection with SARS-CoV-2, the virus that causes COVID-19, using data from 1) the standardized CDC case-report form (case-based surveillance) (https://www.cdc.gov/coronavirus/2019-ncov/php/reporting-pui.html) and 2) supplementary data (supplemental surveillance), such as underlying medical conditions and location of death, obtained through collaboration between CDC and 16 public health jurisdictions (15 states and New York City).

Health Advantages and Disparities in Preterm Birth Among Immigrants Despite Disparate Sociodemographic, Behavioral, and Maternal Risk Factors in San Diego, California.

INTRODUCTION: Reproductive health advantages have been reported among selected immigrants, but few studies have included new immigrants and refugees, nor simultaneously adjusted for socioeconomic, behavioral, and medical disparities. METHODS: We examined the risk of preterm birth (PTB, < 37 weeks' gestation) among singleton live births in San Diego County from 2007 to 2012. Multivariable regression was used to compare PTB (1) by nativity within racial/ethnic groups and (2) among immigrants compared to United States (US) born Whites, while adjusting for sociodemographic, behavioral, reproductive and medical variables. RESULTS: Among 230,878 singleton live births, overall PTB prevalence was highest among parturient women who were US-born Blacks (10.9%), Philippine (10.8%) and US-born Filipinas (10.7%), and US-born Asians (8.6%) despite differences in socioeconomic and maternal risk factors, and lowest among Somali (5.5%) migrants. Blacks born in Somalia or outside of the US, had significantly lower overall PTB prevalence compared to US-born Blacks (5.5% vs 7.6% vs 10.9%). Compared to US-born Whites, spontaneous PTB risk was significantly lower among Somali migrants (4.8% vs 3.7%, adjusted relative risk, aRR 0.7 [95% Confidence Intervals 0.5-0.9]), but higher among Philippine migrants (4.8% vs 7.7%, aRR 1.4 [1.3-1.6]). The strongest risk factor for overall PTB among nulliparous US-born Blacks was preexisting diabetes (aRR 3.81 [2.05-7.08]), and preexisting hypertension among Filipinas (aRR: 3.27 [2.36-4.54] and US-born Asians (aRR: 3.64 [1.61-8.24]). CONCLUSION: Black migrants had lower PTB prevalence compared to US-born Blacks, but this immigrant advantage was not observed in other racial/ethnic groups. Compared to US-born Whites, Somali migrants had significantly lower risk of spontaneous PTB while Filipinas had elevated risk.

Designing and implementing a regional active transportation monitoring program through a county-MPO-university collaboration.

PURPOSE: This article describes a unique effort underway in San Diego County to establish a regional nonmotorized data collection system in support of long-range planning for bicycle and pedestrian systems, and physical activity promotion and monitoring. DESIGN: Case study of a novel approach to sitting a regional active travel data collection program. SETTING: San Diego County, California. SUBJECTS: None. INTERVENTION: Installation of 54 automated bicycle and pedestrian counting units at 35 sites across San Diego County. MEASURES: Equipment sitting criteria including population density, employment density, median household income, planned bicycle network, and planned land uses. ANALYSIS: Mapping, stakeholder input, site visits. RESULTS: A comprehensive network of 76 sites identified and proposed for long-range implementation. CONCLUSION: This research establishes a sitting methodology that holds promise for replication in other regions. San Diego's counting program is one of the most comprehensive automated data collection systems of any region in the United States.

Ethnic differences and treatment trajectories in chronic kidney disease.

Little is known about barriers to care experienced by Latino children with chronic kidney disease (CKD). We conducted a qualitative study with children with CKD and their families to elucidate conceptions about disease process, expression, and treatment; perceived access to care barriers; and potential for treatment non-adherence. Semi-structured interviews were conducted with 42 individuals from 28 family units treated for CKD in San Diego, California. Transcripts were analyzed by coding consensus, co-occurrence, and comparison. Latino patients cited pre-diagnosis barriers in accessing primary and subspecialty care not mentioned by non-Latino Whites. Whites described a pro-active style of interacting with the health care system not mentioned by Latinos. There were no differences apparent in reports of medication adherence, but both groups emphasized the importance of extended social networks in adhering to treatment regimens. Families' perspectives provide valuable information that can serve future studies and interventions for improving care for children with CKD.

Evaluation of residency training in the delivery of culturally effective care.

OBJECTIVE: To augment resident training in the delivery of culturally effective care in order to improve clinician capacity to effectively care for patients from diverse backgrounds. METHODS: Residents from the Naval Medical Center San Diego and the University of California San Diego participated in experiential learning and service activities. Programme evaluation assessed aspects of the delivery of culturally effective care in community settings. A community-based participatory approach to engaging residents in the delivery of culturally effective care and evaluation of the effectiveness of this approach are described. RESULTS: A significant pre-post rotation increase was noted in residents' self-perceived ability to identify culture-related issues that may impact on the patient's view of illness (P<0.001) and ability to address a culture-related issue (P<0.001). Community evaluations rated residents positively on behaviours that reflected communication skills and professionalism, but less positively on knowledge about communities. CONCLUSIONS: The authors conclude that resident exposure to the block rotation curriculum contributes to improved knowledge of the skills necessary to provide culturally effective care in diverse community settings.

Training healthcare professionals in youth violence prevention: an overview.

Youth violence prevention (YVP) is a top priority for all healthcare providers. Violence ranks among the leading causes of death for children and adolescents. The Centers for Disease Control and Prevention established the Academic Centers of Excellence on Youth Violence Prevention (ACE YVP) to address this important national problem. One of the tasks of each ACE YVP is to develop YVP curricula for healthcare professionals. This article describes the experience of three ACE YVPs in developing curricula for nurses, allied health professionals, and physicians, including the identification of national resources, incorporation with local community resources, and areas of commonality and difference for incorporation at other sites. Each of the ACE YVP curricula described uses a multidisciplinary approach to teach learners. Two of the sites developed separate courses for students (University of California, San Diego and University of Puerto Rico) whereas the third integrated teaching through the medical school (University of Hawaii).

Communities as teachers: learning to deliver culturally effective care in pediatrics.

A patient's culture has an effect on her or his view of illness, decision to seek care, and adherence to treatment plans and follow-up visits. In this article, we describe community-academic partnerships designed to teach improved delivery of culturally effective care conducted in pediatric residency training programs in New York, New York, and San Diego, California. Columbia University-Children's Hospital of New York-Presbyterian focuses most of residents' cultural-training experiences within 1 community program, a home-visitation program (Best Beginnings) with which residents work in various capacities throughout residency. The University of California, San Diego and Naval Medical Center San Diego use a series of cultural "immersion experiences" as a primary method. The creation of community-academic partnerships for the purpose of service and training can be a critical asset in the development of culturally effective care training: community partners become teachers and local communities serve as classrooms.