Oral human papillomavirus infection among drug users in Puerto Rico.

OBJECTIVE: The prevalence of human papillomavirus (HPV) in the oral cavity has not been as well studied as genital infection and its prevalence among drug users is uncertain. This study describes the prevalence and correlates of oral HPV infection among a sample of drug users in Puerto Rico (PR). METHODS: Cross-sectional study of 271 drug users aged 18-35 years, not undergoing substance abuse treatment, living in the San Juan metropolitan area. Oral samples were collected through an oral rinse and HPV infection status was detected through PCR and HPV typing. Information on covariates was obtained through face-to-face interviews and serum analyses. RESULTS: A total of 34 participants were positive for any HPV type (12.5%), whereas 13 individuals (4.8%) were positive for one of the 38 type-specific HPV probes evaluated. Among those HPV positive, the most common HPV type detected was non-oncogenic HPV 72 (11.8%, n = 4). Oncogenic HPV types detected were 35 (5.9%) and 56 (2.9%). Factors associated with oral HPV infection included binge drinking (OR = 3.85, 95% CI = 1.40, 10.58), HIV positivity (OR = 4.67, 95% CI = 1.58, 13.74) and ever having engaged in commercial sex (OR = 3.55, 95% CI = 1.46, 8.67); infection did not differ by age or gender. CONCLUSION: Consistent with previous studies in the genital and oral tract, HIV infection, alcohol abuse and commercial sex practices were strongly associated with oral HPV infection. Future studies should assess the implications of oral HPV infection on oral cancer risk in this population.

Social determinants of health predict readmission following COVID-19 hospitalization: a health information exchange-based retrospective cohort study.

Introduction: Since February 2020, over 104 million people in the United States have been diagnosed with SARS-CoV-2 infection, or COVID-19, with over 8.5 million reported in the state of Texas. This study analyzed social determinants of health as predictors for readmission among COVID-19 patients in Southeast Texas, United States. Methods: A retrospective cohort study was conducted investigating demographic and clinical risk factors for 30, 60, and 90-day readmission outcomes among adult patients with a COVID-19-associated inpatient hospitalization encounter within a regional health information exchange between February 1, 2020, to December 1, 2022. Results and discussion: In this cohort of 91,007 adult patients with a COVID-19-associated hospitalization, over 21% were readmitted to the hospital within 90 days (n = 19,679), and 13% were readmitted within 30 days (n = 11,912). In logistic regression analyses, Hispanic and non-Hispanic Asian patients were less likely to be readmitted within 90 days (adjusted odds ratio [aOR]: 0.8, 95% confidence interval [CI]: 0.7-0.9, and aOR: 0.8, 95% CI: 0.8-0.8), while non-Hispanic Black patients were more likely to be readmitted (aOR: 1.1, 95% CI: 1.0-1.1, p = 0.002), compared to non-Hispanic White patients. Area deprivation index displayed a clear dose-response relationship to readmission: patients living in the most disadvantaged neighborhoods were more likely to be readmitted within 30 (aOR: 1.1, 95% CI: 1.0-1.2), 60 (aOR: 1.1, 95% CI: 1.2-1.2), and 90 days (aOR: 1.2, 95% CI: 1.1-1.2), compared to patients from the least disadvantaged neighborhoods. Our findings demonstrate the lasting impact of COVID-19, especially among members of marginalized communities, and the increasing burden of COVID-19 morbidity on the healthcare system.

Behavioral correlates of fruit and vegetable intake in Puerto Rico: results from the Health Information National Trends Survey.

OBJECTIVE: A diet high in fruit and vegetables (FV) is associated with a decreased risk for chronic diseases, such as cancer. Limited information exists regarding the factors associated with FV intake in persons living in Puerto Rico. The objective of this study was to examine sociodemographic, behavioral, and health-belief factors associated with dietary habits in Puerto Rico. METHODS: Secondary data analysis of adults aged 18 years and older from the Puerto Rico Health Information National Trends Survey (HINTS-PR) conducted in 2009. Multivariate logistic regression models were used to identify factors associated with meeting the established recommendations for FV consumption. RESULTS: Only 14.5% of the adults in Puerto Rico met the recommendations for daily FV intake, and the vast majority (90.9%) were unaware of current recommendations. Bivariate analyses demonstrated that being obese, having lower than a high school education, and not knowing the recommendations were significantly associated with not meeting these recommendations. In the multivariate logistic regression analysis, being obese (OR = 3.77; 95% CI = 1.41-10.08) and not being aware of the current dietary recommendations (OR = 9.26; 95% CI = 3.77-22.73) continued to be significantly associated with not meeting the FV intake recommendations. CONCLUSION: The Puerto Rican population is far from meeting FV consumption recommendations, with prevalence estimates of consumption that are below the US median. Low FV intake might put the population in Puerto Rico at increased risk of developing cancer as well as a number of other chronic diseases that are secondary both to improper nutrition and to obesity.

Spatial Patterns of COVID-19 Vaccination Coverage by Social Vulnerability Index and Designated COVID-19 Vaccine Sites in Texas.

Equitable access to the COVID-19 vaccine remains a public health priority. This study explores the association between ZIP Code−Tabulation Area level Social Vulnerability Indices (SVI) and COVID-19 vaccine coverage in Texas. A mixed-effects, multivariable, random-intercept negative binomial model was used to explore the association between ZIP Code−Tabulation Area level SVI and COVID-19 vaccination coverage stratified by the availability of a designated vaccine access site. Lower COVID-19 vaccine coverage was observed in ZIP codes with the highest overall SVIs (adjusted mean difference (aMD) = −13, 95% CI, −23.8 to −2.1, p < 0.01), socioeconomic characteristics theme (aMD = −16.6, 95% CI, −27.3 to −5.7, p = 0.01) and housing and transportation theme (aMD = −18.3, 95% CI, −29.6 to −7.1, p < 0.01) compared with the ZIP codes with the lowest SVI scores. The vaccine coverage was lower in ZIP Code−Tabulation Areas with higher median percentages of Hispanics (aMD = −3.3, 95% CI, −6.5 to −0.1, p = 0.04) and Blacks (aMD = −3.7, 95% CI, −6.4 to −1, p = 0.01). SVI negatively impacted COVID-19 vaccine coverage in Texas. Access to vaccine sites did not address disparities related to vaccine coverage among minority populations. These findings are relevant to guide the distribution of COVID-19 vaccines in regions with similar demographic and geospatial characteristics.

Examining Social Vulnerability and the Association With COVID-19 Incidence in Harris County, Texas.

Studies have investigated the association between social vulnerability and SARS-CoV-2 incidence. However, few studies have examined small geographic units such as census tracts, examined geographic regions with large numbers of Hispanic and Black populations, controlled for testing rates, and incorporated stay-at-home measures into their analyses. Understanding the relationship between social vulnerability and SARS-CoV-2 incidence is critical to understanding the interplay between social determinants and implementing risk mitigation guidelines to curtail the spread of infectious diseases. The objective of this study was to examine the relationship between CDC's Social Vulnerability Index (SVI) and SARS-CoV-2 incidence while controlling for testing rates and the proportion of those who stayed completely at home among 783 Harris County, Texas census tracts. SARS-CoV-2 incidence data were collected between May 15 and October 1, 2020. The SVI and its themes were the primary exposures. Median percent time at home was used as a covariate to measure the effect of staying at home on the association between social vulnerability and SARS-CoV-2 incidence. Data were analyzed using Kruskal Wallis and negative binomial regressions (NBR) controlling for testing rates and staying at home. Results showed that a unit increase in the SVI score and the SVI themes were associated with significant increases in SARS-CoV-2 incidence. The incidence risk ratio (IRR) was 1.090 (95% CI, 1.082, 1.098) for the overall SVI; 1.107 (95% CI, 1.098, 1.115) for minority status/language; 1.090 (95% CI, 1.083, 1.098) for socioeconomic; 1.060 (95% CI, 1.050, 1.071) for household composition/disability, and 1.057 (95% CI, 1.047, 1.066) for housing type/transportation. When controlling for stay-at-home, the association between SVI themes and SARS-CoV-2 incidence remained significant. In the NBR model that included all four SVI themes, only the socioeconomic and minority status/language themes remained significantly associated with SARS-CoV-2 incidence. Community-level infections were not explained by a communities' inability to stay at home. These findings suggest that community-level social vulnerability, such as socioeconomic status, language barriers, use of public transportation, and housing density may play a role in the risk of SARS-CoV-2 infection regardless of the ability of some communities to stay at home because of the need to work or other reasons.

Leveraging a health information exchange for analyses of COVID-19 outcomes including an example application using smoking history and mortality.

Understanding sociodemographic, behavioral, clinical, and laboratory risk factors in patients diagnosed with COVID-19 is critically important, and requires building large and diverse COVID-19 cohorts with both retrospective information and prospective follow-up. A large Health Information Exchange (HIE) in Southeast Texas, which assembles and shares electronic health information among providers to facilitate patient care, was leveraged to identify COVID-19 patients, create a cohort, and identify risk factors for both favorable and unfavorable outcomes. The initial sample consists of 8,874 COVID-19 patients ascertained from the pandemic's onset to June 12th, 2020 and was created for the analyses shown here. We gathered demographic, lifestyle, laboratory, and clinical data from patient's encounters across the healthcare system. Tobacco use history was examined as a potential risk factor for COVID-19 fatality along with age, gender, race/ethnicity, body mass index (BMI), and number of comorbidities. Of the 8,874 patients included in the cohort, 475 died from COVID-19. Of the 5,356 patients who had information on history of tobacco use, over 26% were current or former tobacco users. Multivariable logistic regression showed that the odds of COVID-19 fatality increased among those who were older (odds ratio = 1.07, 95% CI 1.06, 1.08), male (1.91, 95% CI 1.58, 2.31), and had a history of tobacco use (2.45, 95% CI 1.93, 3.11). History of tobacco use remained significantly associated (1.65, 95% CI 1.27, 2.13) with COVID-19 fatality after adjusting for age, gender, and race/ethnicity. This effort demonstrates the impact of having an HIE to rapidly identify a cohort, aggregate sociodemographic, behavioral, clinical and laboratory data across disparate healthcare providers electronic health record (HER) systems, and follow the cohort over time. These HIE capabilities enable clinical specialists and epidemiologists to conduct outcomes analyses during the current COVID-19 pandemic and beyond. Tobacco use appears to be an important risk factor for COVID-19 related death.

Geographic proximity to buprenorphine treatment providers in the U.S.

OBJECTIVE: To combat the growing opioid epidemic, people who use drugs need access to medications for opioid use disorder (MOUD) as part of comprehensive treatment. Despite progress, treatment gaps remain. Our objective was to use a geospatial buffering model to estimate treatment access for buprenorphine providers nationally. METHODS: Using buprenorphine provider location data from the Substance Abuse and Mental Health Services Administration (SAMHSA) and population estimates from the U.S. Census, we use geospatial distance buffering analyses to estimate the percent of the population who are within reasonable (10, 30, 50 mile) driving distances from a buprenorphine provider across the contiguous states. Pearson correlation coefficients were used to analyze relationships between variables. RESULTS: There were 47,000 buprenorphine practitioners across the contiguous states, or 14.3 per every 100,000 persons. Approximately 28 million citizens, or 9.2 % of the population, were outside of a 10-mile distance from the nearest buprenorphine provider and 2.65 million outside of a 30-mile range. There was a positive correlation between state's percentage rurality and percentage outside distance buffers (r = .491, p < .000) and access is lower in areas of higher need Texas had the absolute highest number of people outside the 10-mile distance buffer (3.7 million), although South Dakota had 46 % of its overall population outside that access point. CONCLUSIONS: Wide variability in treatment access to buprenorphine providers exists across all states. Improving geospatial proximity to buprenorphine providers is an important goal, but more work needs to be done to improve treatment access especially in certain states.

An Updated Report on the Prevalence of Prior Cancer Among Persons Newly Diagnosed With Cancer in the Surveillance, Epidemiology, and End Results Program.

This cohort study uses population-based data from the National Cancer Institute Surveillance, Epidemiology, and End Results program of cancer registries to estimate prevalence of prior cancer among adults diagnosed with an incident cancer in 2019.

Características epidemiológicas del pterigión en una comunidad rural de Tlaxcala / Epidemiological characteristics of pteryguim in a rural community of Tlaxcala

Resumen El pterigión es un proceso degenerativo crónico de los tejidos subconjuntivales cuya etiología, diagnóstico y tratamiento, continúan siendo motivo de discusión. El desconocimiento de las característícas epidemiológicas del pterigión en México, y la falta de investigaciones en la última década acerca de esta entidad patológica motivaron el desarrollo del presente trabajo en la comunidad rural de San José Teacalco,Tlaxcala. La recolección de datos se realizó mediante entrevista y exploración cliniea a todos los habitantes de 15 a 75 años, durante un periodo de 9 semanas. Se estudiaron 1075 individuos (83.5% de la población de ese grupo de edad); el promedio de edad fue de 34.9 años. En 535 pacientes (49.8) se diagnosticó alguna variedad de la enfermedad; 49% fueron del sexo masculino y el resto del femenino. La frecuencia de la enfermedad fue mayor entre los trabajadores del campo y del hogar. La prevalencia minima fue de 415.7 por 1,000 y se observó un aumento de la misma en relación directa con la edad. En este estudio la edad representó un factor de importancia para el desarrollo de la enfermedad. Las variedades de ptcrigión más frecuente fueron el nasal no invasor y el nasal invasor. detectados en 44.2 y 33.2% de los ojos estudiados, respectivamente. Se observó un alto porcentaje de afección bilateral. 94.6 de los individuos estudiados y de éstos, 82% presentaron pterigión biocular. La variedad invasora de la enfermedad se diagnosticó en 22.7% de los ojos estudiados con una prevalencia de 189.6 por 1,000 ojos. La alta prevalencia observada en este estudio es comparable con la detectada en la Isla de Cheju en Corea del Sur. Nuestros resultados coinciden con los anotados por otros autores, Se sugiere el desarrollo de futuras investigaciones que proporcionen un mejor conocimiento de la distribución del pterigión en nuestro país y de la frecuencia y grado de alteración de la agudeza visual ocasionada por la enfermedad