Prevalence of and Risk Factors for Hepatitis C Virus Infection in World Trade Center Responders.

BACKGROUND: The risk of hepatitis C virus (HCV) infection among emergency responders exposed to human remains, blood/bodily fluids, and/or sewage is unknown. Methods: A cross-sectional study of 3871 World Trade Center General Responder Cohort (WTCGRC) members followed at the Icahn School of Medicine at Mount Sinai, born from 1945-1965, and recruited from 2016-2018 were tested for HCV infection, and prevalence was compared to National Health and Nutrition Examination Survey data from 2003 to 2012. A nested case-control study compared 61 HCV antibody positive cases to 2571 controls. Multivariable logistic regression models adjusting for time of birth, traditional HCV risk factors, and type of work at the World Trade Center (WTC) site, determined if contact with human remains, blood/bodily fluids, and/or sewage at the WTC site was associated with HCV infection. Results: The age-standardized point prevalence of HCV infection among WTCGRC members was 2.98% [95% CI (2.39, 3.56)] and in the US population was 3.33% [95% CI (2.54, 4.11)] [% difference = 0.35%, 95% CI (- 0.31%, 1.01%), P=0.47]. In separate multivariable models, adjusting for possible confounders, contact with human remains was not associated with HCV infection [OR = 1.10, 95%CI(0.63, 1.91), P = 0.74)], contact with blood and/or bodily fluids was not associated with HCV infection [OR = 1.45, 95%CI(0.82, 2.56), P = 0.20], and contact with sewage was significantly associated with HCV infection [OR = 1.72, 95%CI(1.00, 2.98), P = 0.05]. Conclusion: Contact with sewage may increase the risk of HCV infection.

Anorectal Testing for Mpox Virus Infection in Men Who Have Sex With Men With and Without Proctitis.

We performed anorectal testing in 18 cis-gender men who have sex with men with symptoms consistent with mpox virus (MPXV) infection. We found rectal MPXV DNA in 9/9 with and 7/9 without proctitis. Future study of anorectal testing is needed and may inform the diagnosis and pathogenesis of MPXV disease.

Telehealth treatment for nonspecific low back pain: A review of the current state in mobile health.

INTRODUCTION: Nonspecific low back pain (LBP) is an idiopathic musculoskeletal condition that affects four of five individuals in their lifetime and is the leading cause of job-related disability in the United States. The interest in interactive and dynamic telehealth treatments for LBP continues to grow, and it is important for the medical community to remain up-to-date on the state of the science. LITERATURE SURVEY: Relevant studies published from March 2016 until March 2021 were identified through a systematic search of EMBASE, MedLine, and Web of Science. The search strategy combined the concepts of back pain, telehealth, and mobile applications. METHODOLOGY: Titles and abstracts were screened to select full-text randomized controlled trials or protocols, and methodological quality and risk of bias was assessed using the Cochrane risk-of-bias tool. Data were synthesized narratively. SYNTHESIS: We included seven concluded randomized-controlled trials and two study protocols reporting mobile health (mHealth) solutions for LBP. Six of the seven concluded trials found a significant improvement in self-reported numerical pain rating scale compared to the control group. A single trial compared a mHealth solution to physical therapy, with the majority of studies comparing interventions to "usual care." Substantial heterogeneity in reporting of sample characteristics was found, indicating a lack of standardization through the field. CONCLUSIONS: mHealth solutions may positively impact people with LBP. Larger trials should be encouraged and the field should coalesce around a set of baseline variables for collection and reporting. Because many interventions involve patient engagement, future trials should aim to further quantify adherence levels and begin to define telehealth "doses" associated with better outcomes.

Exposure to permethrin and cancer risk: a systematic review.

No systematic reviews are available on data from humans on cancer risk from exposure to permethrin, a widely used insecticide for which some animal studies have reported positive findings based on mechanisms that may not be relevant to humans. We identified potentially relevant articles through a search of electronic databases which included all studies of pesticide exposure and human cancer. A total of 18 articles were selected, including six identified from the list of references of other articles. Most articles were based on analyzes of the Agriculture Health Study (AHS); they provided no evidence of an increased risk of cancers of colon, rectum, pancreas, lung, melanoma, female breast, prostate, urinary bladder, as well as non-Hodgkin lymphoma (including its main subtypes), and leukemia. An increased risk of multiple myeloma was reported among AHS members with the highest tertile of estimated permethrin exposure (odds ratio 5.01; 95% confidence interval 2.41-10.42; p for trend <0.01). A subsequent analysis with a larger number of cases found a less pronounced association between permethrin exposure and risk of multiple myeloma; no exposed cases were reported in a separate study. Two case-control studies of childhood leukemia reported an association with biological markers of permethrin metabolites; in another study self-reported exposure to permethrin was associated with risk in children below 1 year of age, but not in older children. In conclusion, permethrin exposure does not seem to entail a risk of cancer in humans. Results on multiple myeloma and childhood leukemia are weak and inconsistent, and require replication in independent populations.