Prevalence of Positive Childhood Experiences Among Adults - Behavioral Risk Factor Surveillance System, Four States, 2015-2021.

Positive childhood experiences (PCEs) promote optimal health and mitigate the effects of adverse childhood experiences, but PCE prevalence in the United States is not well-known. Using Behavioral Risk Factor Surveillance System data, this study describes the prevalence of individual and cumulative PCEs among adults residing in four states: Kansas (2020), Montana (2019), South Carolina (2020), and Wisconsin (2015). Cumulative PCE scores were calculated by summing affirmative responses to seven questions. Subscores were created for family-related (three questions) and community-related (four questions) PCEs. The prevalence of individual PCEs varied from 59.5% (enjoyed participating in community traditions) to 90.5% (adult in respondents' household made them feel safe), and differed significantly by race and ethnicity, age, and sexual orientation. Fewer non-Hispanic Black or African American (49.2%), non-Hispanic Alaska Native or American Indian (37.7%), and Hispanic or Latino respondents (38.9%) reported 6-7 PCEs than did non-Hispanic White respondents (55.2%). Gay or lesbian, and bisexual respondents were less likely than were straight respondents to report 6-7 PCEs (38.1% and 27.4% versus 54.7%, respectively). A PCE score of 6-7 was more frequent among persons with higher income and education. Improved understanding of the relationship of PCEs to adult health and well-being and variation among population subgroups might help reduce health inequities.

Which Features of Telehealth in HIV Care Are Most Important? A Mixed-Methods Study With HIV Care Providers and People Living With HIV in South Carolina.

ABSTRACT: Telehealth was rapidly implemented in HIV care during COVID-19 yet remains understudied. To assess the importance of telehealth features, we conducted a mixed-methods study with HIV care providers and people living with HIV. Qualitative interviews and ranking exercises revealed heterogeneity in preference-relevant features of telehealth in HIV care.

Exponential growth of private coastal infrastructure influenced by geography and race in South Carolina, USA.

Homeowners in coastal environments often augment their access to estuarine ecosystems by building private docks on their personal property. Despite the commonality of docks, particularly in the Southeastern United States, few works have investigated their historical development, their distribution across the landscape, or the environmental justice dimensions of this distribution. In this study, we used historic aerial photography to track the abundance and size of docks across six South Carolina counties from the 1950s to 2016. Across our roughly 60-year study period, dock abundance grew by two orders of magnitude, mean length of newly constructed docks doubled, and the cumulative length of docks ballooned from 34 to 560 km. Additionally, we drew on census data interpolated into consistent 2010 tract boundaries to analyze the racial and economic distribution of docks in 1994, 1999, 2011, and 2016. Racial composition, measured as the percentage of a tract's population that was White, positively correlated with dock abundance in each year. Median household income and dock abundance were only correlated in 2011. Taken together, these metrics indicate the growing desire for direct estuary access, however, that access does not appear to be equally spread across racial groups. Because docks enhance estuarine access and demarcate private property, our study provides longitudinal insights into environmental justice concerns related to disparate private property ownership. We found a persistent correlation between the racial characteristics of an area and dock abundance, strongly indicating that White South Carolinians have had disproportionately greater private water access for the past two decades.

Antenatal depressive symptoms and adverse birth outcomes in healthy start participants: The modifying role of utilization of mental health services.

OBJECTIVE: We examined the association between antenatal depressive symptoms and adverse birth outcomes in Midland Healthy Start (MHS) participants and determined whether receiving mental health services reduced the odds of adverse outcomes among those with elevated antenatal depressive symptoms. METHOD: Data from a retrospective cohort of participants (N = 1,733) served by the MHS in South Carolina (2010-2019) were linked with their birth certificates. A score of ≥16 on the Center for Epidemiologic Studies Depression Scale was defined as elevated antenatal depressive symptoms. Services provided by MHS were categorized into: (1) receiving mental health services, (2) receiving other services, and (3) not receiving any services. Adverse birth outcomes included preterm birth, low birth weight, and small for gestational age. RESULTS: Around 31 % had elevated antenatal depressive symptoms. The prevalences of preterm birth, low birthweight, and small for gestational age were 9.5 %, 9.1 %, and 14.6 %, respectively. No significant associations were observed between elevated depressive symptoms and adverse outcomes. Among women with elevated antenatal depressive symptoms, the odds for small for gestational age were lower in those who received mental health services (AOR 0.33, 95 % CI 0.15-0.72) or other services (AOR 0.34, 95 % CI 0.16-0.74) compared to those who did not receive any services. The odds for low birth weight (AOR 0.34, 95 % CI 0.13-0.93) were also lower in those who received mental health services. CONCLUSIONS: Receiving screening and referral services for antenatal depression reduced the risks of having small for gestational age or low birth weight babies among MHS participants.

The dynamic risk factors of cardiovascular disease among people living with HIV: a real-world data study.

BACKGROUND: This study aims to investigate the incidence and dynamic risk factors for cardiovascular diseases (CVD) among people living with HIV (PLWH). METHODS: In this population-based statewide cohort study, we utilized integrated electronic health records data to identify adult (age ≥ 18) who were diagnosed with HIV between 2006 and 2019 and were CVD event-free at the HIV diagnosis in South Carolina. The associations of HIV-related factors and traditional risk factors with the CVD incidence were investigated during the overall study period, and by different follow-up periods (i.e., 0-5yrs, 6-10yrs 11-15yrs) using multivariable logistic regression models. RESULTS: Among 9,082 eligible participants, the incidence of CVD was 18.64 cases per 1000 person-years. Overall, conventional risk factors, such as tobacco use, hypertension, obesity, chronic kidney disease (CKD), were persistently associated with the outcome across all three groups. While HIV-related factors, such as recent CD4 count (e.g., > 350 vs. <200 cells/mm3: adjusted odds ratio [aOR] range: 0.18-0.25), and percent of years in retention (e.g., 31-75% vs. 0-30%: aOR range: 0.24-0.57) were associated with lower odds of CVD incidence regardless of different follow up periods. The impact of the percent of days with viral suppression gradually diminished as the follow-up period increased. CONCLUSIONS: Maintaining an optimal viral suppression might prevent CVD incidence in the short term, whereas restoring immune recovery may be beneficial for reducing CVD risk regardless of the duration of HIV diagnosis. Our findings suggest the necessity of conducting more targeted interventions during different periods of HIV infection.

Increasing Preterm Delivery and Small for Gestational Age Trends in South Carolina during the COVID-19 Pandemic.

Preterm delivery (PTD) complications are a major cause of childhood morbidity and mortality. We aimed to assess trends in PTD and small for gestational age (SGA) and whether trends varied between race-ethnic groups in South Carolina (SC). We utilized 2015-2021 SC vital records linked to hospitalization and emergency department records. PTD was defined as clinically estimated gestation less than (<) 37 weeks (wks.) with subgroup analyses of PTD < 34 wks. and < 28 wks. SGA was defined as infants weighing below the 10th percentile for gestational age. This retrospective study included 338,532 (243,010 before the COVID-19 pandemic and 95,522 during the pandemic) live singleton births of gestational age ≥ 20 wks. born to 260,276 mothers in SC. Generalized estimating equations and a change-point during the first quarter of 2020 helped to assess trends. In unadjusted analyses, pre-pandemic PTD showed an increasing trend that continued during the pandemic (relative risk (RR) = 1.04, 95% CI: 1.02-1.06). PTD < 34 wks. rose during the pandemic (RR = 1.07, 95% CI: 1.02-1.12) with a significant change in the slope. Trends in SGA varied by race and ethnicity, increasing only in Hispanics (RR = 1.02, 95% CI: 1.00-1.04) before the pandemic. Our study reveals an increasing prevalence of PTD and a rise in PTD < 34 wks. during the pandemic, as well as an increasing prevalence of SGA in Hispanics during the study period.

Maternal care utilization and provision during the COVID-19 pandemic: Voices from minoritized pregnant and postpartum women and maternal care providers in Deep South.

BACKGROUND: The COVID-19 pandemic has significantly affected maternal care services especially for minoritized individuals, creating challenges for both service users (i.e., African American and Hispanic pregnant/postpartum women) and maternal care providers (MCPs). Guided by a socioecological framework, this study aims to investigate the experiences of African American and Hispanic pregnant and postpartum women, as well as MCPs, in accessing and providing maternal care services during the COVID-19 pandemic in the Deep South. METHODS: We conducted semi-structured interviews with 19 African American women, 20 Hispanic women, and 9 MCPs between January and August 2022. Participants were recruited from Obstetrics and Gynecology clinics, pediatric clinics, and community health organizations in South Carolina, and all births took place in 2021. Interview transcripts were analyzed thematically. RESULTS: Maternal care utilization and provision were influenced by various factors at different socioecological levels. At the intrapersonal level, women's personal beliefs, fears, concerns, and stress related to COVID-19 had negative impacts on their experiences. Some women resorted to substance use as a coping strategy or home remedy for pregnancy-induced symptoms. At the interpersonal level, family and social networks played a crucial role in accessing care, and the discontinuation of group-based prenatal care had negative consequences. Participants reported a desire for support groups to alleviate the pressures of pregnancy and provide a platform for shared experiences. Language barriers were identified as an obstacle for Hispanic participants. Community-level impacts, such as availability and access to doulas and community health workers, provided essential information and support, but limitations in accessing doula support and implicit bias were also identified. At the institutional level, mandatory pre-admission COVID-19 testing, visitation restrictions, and reduced patient-MCP interactions were women's common concerns. Short staffing and inadequate care due to the impact of COVID-19 on the health care workforce were reported, along with anxiety among MCPs about personal protective equipment availability. MCPs emphasized the quality of care was maintained, with changes primarily attributed to safety protocols rather than a decline in care quality. CONCLUSION: The pandemic has disrupted maternal care services. To overcome these issues, health facilities should integrate community resources, adopt telehealth, and develop culturally tailored education programs for pregnant and postpartum women. Supporting MCPs with resources will enhance the quality of care and address health disparities in African American and Hispanic women.

Examining incidence of diabetes in people with HIV: tracking the shift in traditional and HIV-related risk factors.

BACKGROUND AND OBJECTIVE: The risk factors of diabetes mellitus (DM) in people with HIV (PWH) may be dynamic in a life course manner. This study aimed to describe incidence of DM and investigate the trajectory of changes in risk factor associated with DM incidence over around 15 years among a statewide cohort of PWH in South Carolina (SC). DESIGN: This is a population-based cohort study. METHODS: Data were retrieved from the integrated statewide electronic health records between 2006 and 2020 in SC. Separate subgroup analysis was conducted according to the patients' different follow up duration (i.e., 5, 10, and 15 years) to observe the evolving risk factors of DM development, using multivariable logistic regressions. RESULTS: The DM incidence among a total of 9115 PWH was 8.9 per 1000 person-years. In the overall model, being >60 years old, hypertension, and obesity were positively associated with DM while alcohol consumption, years of HIV diagnosis and high percentage days of viral suppression were negatively associated with the outcome. In the subgroup analyses, similar risk factors were observed. The odds of DM increased in a graded fashion with age. Hypertension was positively associated with DM in all groups and retention to care was negatively associated with the outcome in groups 1 and 3. CONCLUSION: This large-scale population-based study has revealed a relatively lower incidence of DM among PWH than some other US States. The evolving risk factors over time underline the need for maintaining retention to care to prevent the occurrence of DM.

Association of COVID-19 pandemic societal closures with gestational weight gain among women in South Carolina, 2018-2021.

PURPOSE: During the early COVID-19 pandemic, an increase in weight gain among the general population was observed; however, gestational weight gain (GWG) was not thoroughly evaluated. We evaluated changes in GWG during the pandemic closures in South Carolina. METHODS: We used live, singleton birth records to compare GWG outcomes among three pregnancy groups occurring before (January 2018-February 2020), during (March-May 2020), and after (June 2020-December 2021) pandemic closures. GWG categories were defined by the Institute of Medicine (IOM) recommendations. We used multinomial logistic regression models to calculate prevalence ratios (PRs) of GWG categories stratified by prepregnancy body mass index (BMI) category. RESULTS: We analyzed 177,571 birth records. Women with normal weight (n = 64,491, 36%) had a slightly lower prevalence of excessive GWG during and after the pandemic closures (PR 0.94; 95% CI: 0.91-0.98 and PR 0.95; 95% CI: 0.93-0.98, respectively). We observed no changes in GWG patterns for women with overweight and obesity. CONCLUSIONS: We found limited changes in GWG patterns for a subset of pregnant women during and after pandemic closures, compared with prepandemic period in South Carolina, countering findings of weight changes among the general population.

The role of public policy in reducing moped and scooter injuries in South Carolina.

INTRODUCTION: Mopeds and electric scooters have grown in popularity in recent years. A South Carolina (SC) law was passed on November 19, 2018, aimed to regulate mopeds and scooters. This study aims to evaluate whether this SC law was associated with a decrease in the moped injury rate in a Level 1 Trauma Center. METHODS: A retrospective review of trauma registry data was used to identify a cohort of patients 14 years and older who came to a Level 1 trauma center for a moped/scooter accident between January 2014 - December 2022. The proportion of moped injuries before and after the passing of the law was calculated. The chi-square test and Wilcoxon Rank Sum test were used to compare differences in proportions for categorical factors and continuous factors, respectively. RESULTS: A total of 350 moped injury cases were identified. There was a significant decrease in the moped injury rate after the passing of the 2018 SC law (0.9 % vs 1.8 %, p<0.001). Additionally, those treated post-law implementation were significantly older (47.4 vs 43.2 years, p = 0.013) and more likely to be male (95.5 % vs 87.9 %, p = 0.025) than those treated pre-law. Patients treated post-law were significantly more likely to be uninsured (45.1 % vs 42.7 %, p = 0.009) and less likely to have commercial (16.2 % vs 20.1 %, p = 0.009), or government (29.7 % vs 35.6 %, p = 0.009) health insurance compared to those treated pre-law. There was no significant difference between the two groups in Glascow Coma Scale, Injury severity score, Trauma Injury Severity Score, or rate of fatalities. CONCLUSION: After the implementation of a SC law, we found that the local proportion of injuries due to moped and scooter accidents was significantly lower than pre-law proportions. These findings suggest that public policies aimed at increasing regulations for mopeds may decrease the rate of injury, but not severity, from moped use.

Features of the Physical and Social Neighborhood Environment and Neighborhood-Level Alzheimer's Disease and Related Dementia in South Carolina.

BACKGROUND: Studies are increasingly examining the relationship between the neighborhood environment and cognitive decline; yet, few have investigated associations between multiple neighborhood features and Alzheimer's disease and related dementias (ADRD). OBJECTIVE: We investigated the relationship between neighborhood features and ADRD cumulative incidence from 2010 to 2014 in the South Carolina Alzheimer's Disease Registry (SCADR). METHODS: Diagnosed ADRD cases ≥50 years of age were ascertained from the SCADR by ZIP code and census tract. Neighborhood features from multiple secondary sources included poverty, air pollution [particulate matter with a diameter of 2.5 micrometers or less (PM2.5)], and rurality at the census-tract level and access to healthy food, recreation facilities, and diabetes screening at the county level. In addition to using Poisson generalized linear regression to estimate ADRD incident rate ratios (IRR) with 95% confidence intervals (CIs), we applied integrated nested Laplace approximations and stochastic partial differential equations (INLA-SPDE) to address disparate spatial scales. We estimated associations between neighborhood features and ADRD cumulative incidence. RESULTS: The average annual ADRD cumulative incidence was 690 per 100,000 people per census tract (95% CI: 660, 710). The analysis was limited to 98% of census tracts with a population ≥50 years old (i.e., 1,081 of 1,103). The average percent of families living below the federal poverty line per census tract was 18.8%, and ∼20% of census tracts were considered rural. The average percent of households with limited access to healthy food was 6.4%. In adjusted models, every 5µg/m3) increase of PM2.5 was associated with 65% higher ADRD cumulative incidence (IRR=1.65; 95% CI: 1.30, 2.09), where PM2.5 at or below 12 µg/m3 is considered healthy. Compared to large urban census tracts, rural and small urban tracts had 10% (IRR=1.10; 95% CI: 1.00, 1.23) and 5% (IRR=1.05; 95% CI: 0.96, 1.16) higher ADRD, respectively. For every percent increase of the county population with limited access to healthy food, ADRD was 2% higher (IRR=1.02; 95% CI: 1.01, 1.04). CONCLUSIONS: Neighborhood environment features, such as higher air pollution levels, were associated with higher neighborhood ADRD incidence. The INLA-SPDE method could have broad applicability to data collected across disparate spatial scales. https://doi.org/10.1289/EHP13183.

Eco-epidemiology of Rickettsia amblyommatis and Rickettsia parkeri in naturally infected ticks (Acari: Ixodida) from South Carolina.

BACKGROUND: Spotted fever group Rickettsia (SFGR) is the largest group of Rickettsia species of clinical and veterinary importance emerging worldwide. Historically, SFGR cases were linked to Rickettsia rickettsii, the causal agent of Rocky Mountain spotted fever; however, recently discovered species Rickettsia parkeri and Rickettsia amblyommatis have been shown to cause a wide range of clinical symptoms. The role of R. amblyommatis in SFGR eco-epidemiology and the possible public health implications remain unknown. METHODS: This study evaluated statewide tick surveillance and land-use classification data to define the eco-epidemiological relationships between R. amblyommatis and R. parkeri among questing and feeding ticks collected across South Carolina between 2021 and 2022. Questing ticks from state parks and feeding ticks from animal shelters were evaluated for R. parkeri and R. amblyommatis using reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) on pooled samples. A Bayesian multivariable logistic regression model for pool testing data was used to assess associations between R. parkeri or R. amblyommatis infection and land-use classification variables among questing ticks. The Spearman correlation was used to evaluate the relationship between the two tested pathogens. RESULTS: The infection prevalence for R. amblyommatis was 24.8% (23.4-26.3%) among questing ticks, and 39.5% (37.4-42.0%) among feeding ticks; conversely, for R. parkeri it was 19.0% (17.6-20.5%) among questing ticks and 22.4% (20.3-24.5%) among feeding ticks. A negative, refractory correlation was found between the species, with ticks significantly more likely to contain one or the other pathogen, but not both simultaneously. The Bayesian analysis revealed that R. amblyommatis infection was positively associated with deciduous, evergreen, and mixed forests, and negatively associated with hay and pasture fields, and emergent herbaceous wetlands. Rickettsia parkeri infection was positively associated with deciduous, mixed, and evergreen forests, herbaceous vegetation, cultivated cropland, woody wetlands, and emergent herbaceous wetlands, and negatively associated with hay and pasture fields. CONCLUSIONS: This is the first study to evaluate the eco-epidemiological factors driving tick pathogenicity in South Carolina. The negative interactions between SFGR species suggest the possible inhibition between the two pathogens tested, which could have important public health implications. Moreover, land-use classification factors revealed environments associated with tick pathogenicity, highlighting the need for tick vector control in these areas.

Identification of Large Adenovirus Infection Outbreak at University by Multipathogen Testing, South Carolina, USA, 2022.

Using multipathogen PCR testing, we identified 195 students with adenovirus type 4 infections on a university campus in South Carolina, USA, during January-May 2022. We co-detected other respiratory viruses in 43 (22%) students. Continued surveillance of circulating viruses is needed to prevent virus infection outbreaks in congregate communities.

Health disparities in mortality among individuals with HIV-associated dementia in South Carolina.

HIV disproportionately affects the South compared to other regions of the US. Some people living with HIV (PLWH) may acquire HIV-associated neurocognitive disorders (HAND), of which HIV-associated dementia (HAD) is the most severe form. This study aimed to examine the disparities in mortality among individuals with HAD. Data were obtained from the South Carolina Alzheimer's Disease and Related Dementias Registry from 2010 to 2016 (HAD: n = 505; N = 164,982). Logistic regression and Cox proportional hazards models were used to determine mortality related to HIV-associated dementia and potential sociodemographic differences. Adjusted models controlled for age, gender, race, rurality, and place of diagnosis. Individuals diagnosed in a nursing facility were three times more likely to die with HAD compared to those diagnosed in the community (OR: 3.25; 95% CI: 2.08-5.08). Black populations were more likely to die with HAD compared to White populations (OR: 1.52; 95% CI: 0.953-2.42). Disparities in mortality among patients with HAD were found in place of diagnosis and by race. Future research should determine if mortality among individuals with HAD were as a result of HAD or non-HIV related decline.

Stories of childhood sexual abuse (CSA) among older adults living with HIV (OALH) in South Carolina: a qualitative study.

Childhood sexual abuse (CSA) devastatingly impacts an individual's behavioral, psychological, and social health. Childhood, a developmental stage directly influenced by the home or school environment, leaves a life-long imprint. Compared with the general population, CSA prevalence is doubled among people living with HIV. Thus, the study aimed to explore CSA circumstances among older adults living with HIV (OALH) in South Carolina (SC). We included 24 OALH aged 50 and above who reported CSA. The data were collected at an immunology center in SC. In-depth semi-structured interviews were conducted, audio-recorded, transcribed, and analyzed using a thematic analysis approach. The iterative analytic process included a discussion of initial thoughts and key concepts, identification, and reconciliation of codes, and naming of emergent themes. Six themes emerged: known perpetrators, re-victimization, "nobody believed me", "cannot live like others", lack of CSA disclosure, and interconnections with other adverse childhood experiences (ACEs). CSA experiences and non-disclosure were found to be linked with shame, embarrassment, fear, and trust issues. Hence, trauma-focused interventions are required to resolve these issues and improve the quality of life of OALH with past trauma. Counseling or therapy programs should incorporate psychological and behavioral theoretical models to best target OALH who are CSA survivors.

Do Aedes triseriatus Respect State Boundaries?: A Paucity of La Crosse Virus in the South Carolina Appalachian Mountains.

Background: La Crosse virus is an important endemic public health concern in the North Carolina Appalachian Mountains; however, human incidence is not commonly noted in this region on the South Carolina side of the mountain range border. No relevant studies have been performed in South Carolina evaluating mosquito vector populations for La Crosse virus (LACV) infection; thus, a pilot mosquito surveillance study was executed in summer 2020. Material and Methods: Vector surveillance occurred at five South Carolina state parks bordering neighboring state endemic counties from May to August 2020. Collections were approved by the state park authority, as noted in Permit No. N-8-20. Results: All three competent mosquito vectors were collected during the study duration; however, these vectors were collected in low abundance: Aedes triseriatus (4.5% of all collected mosquitos); Aedes albopictus (2.0%); Aedes japonicus (1.4%). Principal mosquito vector specimens, Ae. triseriatus, were sent to Centers for Disease Control and Prevention for testing of LACV by real-time reverse transcription PCR-all were negative. Discussion: While entomologic evidence suggests low transmission risk for this arbovirus in the South Carolina Appalachian Mountain region, further eco-epidemiologic investigations are warranted to understand this endemicity variance within a relatively small geographic area.

Understanding social risk factors of county-level disparities in COVID-19 tests per confirmed case in South Carolina using statewide electronic health records data.

BACKGROUND: COVID-19 testing is essential for pandemic control, and insufficient testing in areas with high disease burdens could magnify the risk of poor health outcomes. However, few area-based studies on COVID-19 testing disparities have considered the disease burden (e.g., confirmed cases). The current study aims to investigate socioeconomic drivers of geospatial disparities in COVID-19 testing relative to disease burden across 46 counties in South Carolina (SC) in the early (from April 1, 2020, to June 30, 2020) and later (from July 1, 2020, to September 30, 2021) phases of the pandemic. METHODS: Using SC statewide COVID-19 testing data, the COVID-19 testing coverage was measured by monthly COVID-19 tests per confirmed case (hereafter CTPC) in each county. We used modified Lorenz curves to describe the unequal geographic distribution of CTPC and generalized linear mixed-effects regression models to assess the association of county-level social risk factors with CTPC in two phases of the pandemic in SC. RESULTS: As of September 30, 2021, a total of 641,201 out of 2,941,227 tests were positive in SC. The Lorenz curve showed that county-level disparities in CTPC were less apparent in the later phase of the pandemic. Counties with a larger percentage of Black had lower CTPC during the early phase (ß = -0.94, 95%CI: -1.80, -0.08), while such associations reversed in the later phase (ß = 0.28, 95%CI: 0.01, 0.55). The association of some other social risk factors diminished as the pandemic evolved, such as food insecurity (ß: -1.19 and -0.42; p-value is < 0.05 for both). CONCLUSIONS: County-level disparities in CTPC and their predictors are dynamic across the pandemic. These results highlight the systematic inequalities in COVID-19 testing resources and accessibility, especially in the early stage of the pandemic. Counties with greater social vulnerability and those with fewer health care resources should be paid extra attention in the early and later phases, respectively. The current study provided empirical evidence for public health agencies to conduct more targeted community-based testing campaigns to enhance access to testing in future public health crises.

RACCOONS (PROCYON LOTOR) SHOW HIGHER TRYPANOSOMA CRUZI DETECTION RATES THAN VIRGINIA OPOSSUMS (DIDELPHIS VIRGINIANA) IN SOUTH CAROLINA, USA.

Chagas disease, a significant public health concern in the Americas, is caused by a protozoan parasite, Trypanosoma cruzi. The life cycle of T. cruzi involves kissing bugs (Triatoma spp.) functioning as vectors and mammalian species serving as hosts. Raccoons (Procyon lotor) and opossums (Didelphis virginiana) have been identified as important reservoir species in the life cycle of T. cruzi, but prevalence in both species in the southeastern US is currently understudied. We quantified T. cruzi prevalence in these two key reservoir species across our study area in South Carolina, US, and identified factors that may influence parasite detection. We collected whole blood from 183 raccoons and 126 opossums and used PCR to detect the presence of T. cruzi. We then used generalized linear models with parasite detection status as a binary response variable and predictor variables of land cover, distance to water, sex, season, and species. Our analysis indicated that raccoons experienced significantly higher parasite detection rates than Virginia opossums, with T. cruzi prevalence found to be 26.5% (95% confidence interval [CI], 20.0-33.8) in raccoons and 10.5% (95% CI, 5.51-17.5) in opossums. Overall, our results concur with previous studies, in that T. cruzi is established in reservoir host populations in natural areas of the southeastern US.

Sociodemographic Characteristics of HIV-Associated Dementia in the South Carolina Alzheimer's Disease Registry.

OBJECTIVES: Studies examining the sociodemographic characteristics associated with human immunodeficiency virus (HIV)-associated dementia (HAD) are lacking, especially in the southern United States. The aim of this study was to describe the characteristics of HAD using South Carolina Alzheimer's Disease Registry data, and examine these characteristics across two time periods. METHODS: Data were obtained from the population-based, South Carolina Alzheimer's Disease Registry from 2000-2006 and 2010-2016 (N = 165,487). Crude and multivariable logistic regression models were applied to determine sociodemographic characteristics associated with HAD by time period. RESULTS: Younger, Black, Other, men, and urban populations had greater odds of being diagnosed as having HAD in both time periods. For example, compared with individuals aged 85 years and older, individuals aged 18 to 34 had 97 times the odds (adjusted odds ratio 97.0; 95% confidence interval 31.6-297.8) of being diagnosed as having HAD. In 2010-2016, however, nursing facility populations had a greater odds of being diagnosed as having HAD. CONCLUSIONS: We found that younger populations (younger than 74 years), communities of color, men, urban populations, and nursing facility populations were more likely to have HAD. Future research should focus on the association between HAD and risk for Alzheimer's disease.

Trends in Self-Reported Fentanyl and Other Illicit Substance Use in South Carolina Emergency Department Patients, 2020-2022.

BACKGROUND: Opioid-involved deaths are continuing to increase across the United States, exceeding 100,000 for the first time in 2021. Contamination with, and intentional use of, synthetic opioids such as fentanyl are a major driver of this increase. Utilizing self-report substance use data of patients being treated in the emergency department (ED) can be useful to determine which substances patients are intentionally seeking. OBJECTIVES: 1) Examine changes in self-reported illicit substance use (including fentanyl) over time; 2) Examine changes in the co-occurrence of self-reported fentanyl with other illicit substance use over time. METHODS: All patients presenting to the study EDs that answered anything other than "never" on the National Institute on Drug Abuse Quick Screen and were seen by a peer recovery specialist in the ED between July 1, 2020 and December 31, 2022 were included for analysis. The substance of use as reported by each patient was recorded by the peer recovery specialist. Differences in substance use by type over time were examined using chi-squared tests of proportions. RESULTS: There were 7568 patients that met inclusion criteria. Self-reported fentanyl (1760%; p < 0.0001) and cocaine (82%; p = 0.034) use increased, whereas heroin use (16%; p < 0.0001) decreased. CONCLUSIONS: Self-reported fentanyl and cocaine use has increased significantly in South Carolina ED patients between 2020 and 2022. Given the high morbidity and mortality associated with fentanyl and fentanyl analog use, further measures to identify these patients and provide harm reduction and treatment from the ED setting are warranted.