Do women with a previous unintended birth subsequently experience missed opportunities for postpartum family planning counseling? A multilevel mixed effects analysis.

Client-provider communication about family planning (FP) remains an important strategy for preventing unintended pregnancy. Yet, the literature lacks empirical studies examining whether and how women's intendedness of a recent pregnancy may impact subsequent receipt of FP counseling. We investigated whether the intendedness of a recent pregnancy is associated with subsequent missed opportunities (MOs) for FP counseling, taking into account compositional and contextual factors. We performed a secondary analysis using pooled data from the 2016, 2017 and 2018 Performance Monitoring and Accountability 2020 cross-sectional surveys conducted in Nigeria, adjusting for complex design effects. Weighted multilevel logistic regression modeling was used to examine the relationships between pregnancy intention and MOs, overall and at the health facility, using two-level random intercept models. In the analytic sample of women within 24 months postpartum (N = 6479), nearly 60% experienced MOs for FP counseling overall and even 45% of those who visited a health facility visit in the past 12 months (N = 4194) experienced MOs. In the multivariable models adjusted for individual-/household- and community-level factors, women whose recent birth was either mistimed or unwanted were just as likely to have MOs for FP counseling as their counterparts whose pregnancy was intended (p > 0.05). Factors independently associated with a MOs include individual/household level factors such as level of education, exposure to FP media, household wealth index and contextual-level variables (geographic region). While evidence that pregnancy intendedness is associated with MOs for FP counseling remains inconclusive, efforts to mitigate these MOs requires prioritizing women's prior pregnancy intentions as well as equipping healthcare providers with the capacity need to provide high-quality client-centered FP counseling, particularly for women whose recent birth was unintended.

Trends in maternal opioid use: Statewide differences by sociodemographic characteristics in Florida from 2000 to 2019.

BACKGROUND: Maternal opioid use (MOU) remains a public health concern. Studies have demonstrated significant increases in MOU, but estimates using ICD-10-CM or stratified by sociodemographic variables are limited. OBJECTIVES: Using a statewide, population-based dataset of Florida resident deliveries from 2000 to 2019, we examined the trend of MOU by age, race/ethnicity, education level, and insurance. METHODS: Florida administrative data was used to conduct a retrospective cohort study. MOU was identified using opioid-related hospital discharge diagnoses documented prenatally or at delivery. Maternal sociodemographic variables were obtained from Florida vital statistics. Joinpoint regression was used to identify statistically significant changes in the trends overall and stratified by sociodemographic variables. Results are presented as annual percentage changes (APC) and 95% confidence intervals. RESULTS: Our sample included over 3.6 million Florida resident mothers; of which, MOU was identified in 1% (n = 22,828) of the sample. From 2000 to 2019, MOU increased over ten-fold from 8.7 to 94.7 per 10,000 live birth deliveries. MOU increased significantly from 2000 to 2011 (APC: 32.8; 95% CI: 29.4, 36.2), remained stable from 2011 to 2016, and decreased significantly from 2016 to 2019 (APC: 3.9; 95% CI: -6.6, -1.0). However, from 2016 to 2019, MOU increased among non-Hispanic Black mothers (APC: 9.2; 95% CI: 7.5, 11.0), and those ages 30-34 (APC: 2.9; 95% CI: 1.2, 4.6) and 35-39 (APC: 6.4; 95% CI: 4.3, 8.4). CONCLUSIONS: Accurate prevalence estimates of MOU by sociodemographic factors are necessary to fully understand prevalence trends, describe the burden among sub-populations, and develop targeted interventions.

Exploring challenges and opportunities in detecting emerging drug trends: A socio-technical analysis of the Canadian context.

OBJECTIVES: This study aimed to apply a systems thinking approach to explore factors influencing the detection of emerging drug trends in Canada's provinces and territories to better understand how the local context can influence the design and performance of a pan-Canadian (i.e., national) substance use early warning system (EWS). This study also presents a set of actionable recommendations arising from the results. METHODOLOGY AND METHODS: Semi-structured interviews were conducted with 13 purposively recruited Medical Officers of Health and epidemiologists from across Canada working in the field of substance use. Thematic and social network analysis guided by the socio-technical systems framework were subsequently employed. RESULTS: Barriers and facilitators for detecting emerging drug trends in provinces and territories are a product of the collective linkages and interactions between social (objectives, people, culture), technical (tools, practices, infrastructure), and external environmental (financial, regulatory frameworks, stakeholders) factors. Shortcomings in several of these areas shaped the system's behaviour and together contributed to fragmented operations that lacked strategic focus, poorly designed cross-sector partnerships, and unactionable information outputs. Participants' experiences shaped perceptions of a national substance use EWS, with some voicing potential opportunities and others expressing doubts about its effectiveness. CONCLUSION: This study highlights interconnected social, technical, and external environmental considerations for the design and implementation of a national substance use EWS in Canada. It also demonstrates the value of using the socio-technical systems framework to understand a complex public health surveillance issue and how it can be used to inform a path forward.

RéSUMé: OBJECTIFS: Cette étude visait à appliquer une approche de pensée systémique pour explorer les facteurs influençant la détection des tendances émergentes en matière de drogues dans les provinces et territoires (P/T) du Canada afin de mieux comprendre comment le contexte local peut influencer la conception et le rendement d'un système pancanadien (c.-à-d. national) d'alerte précoce (SAP) en matière de consommation de substances. Cette étude présente également un ensemble de recommandations réalisables découlant des résultats. MéTHODOLOGIE ET MéTHODES: Des entrevues semi-structurées ont été menées auprès de 13 médecins hygiénistes et épidémiologistes recrutés dans tout le Canada et travaillant dans le domaine de la toxicomanie. L'analyse des réseaux thématiques et sociaux guidée par le cadre des systèmes socio-techniques (STS) a ensuite été utilisée. RéSULTATS: Les obstacles et les facilitateurs à la détection des tendances émergentes en matière de drogues dans les provinces et les territoires sont le produit des liens et des interactions collectifs entre les facteurs sociaux (objectifs, personnes, culture), techniques (outils, pratiques, infrastructure) et environnementaux externes (cadres financiers, réglementaires, intervenants). Les lacunes dans plusieurs de ces domaines ont façonné le comportement du système et, ensemble, ont contribué à des opérations fragmentées qui manquaient d'orientation stratégique, à des partenariats intersectoriels mal conçus et à de l'information inexploitable. Les expériences des participants ont façonné les perceptions d'un SAP national sur la consommation de substances, certains exprimant des opportunités potentielles et d'autres exprimant des doutes quant à son efficacité. CONCLUSION: Cette étude met en évidence les considérations sociales, techniques et environnementales externes interconnectées pour la conception et la mise en œuvre d'un SAP national sur la consommation de substances au Canada. Il démontre également la valeur de l'utilisation du cadre STS pour comprendre un problème complexe de surveillance de la santé publique et comment il peut être utilisé pour éclairer une voie à suivre.

Predicting Antibiotic Susceptibility Among Patients With Recurrent Urinary Tract Infection Using a Prior Culture.

PURPOSE: Recurrent cystitis guidelines recommend relying on a local antibiogram or prior urine culture to guide empirical prescribing, yet little data exist to quantify the predictive value of a prior culture. We constructed a urinary antibiogram and evaluated test metrics (sensitivity, specificity, and Bayes' positive and negative predictive values) of a prior gram-negative organism on predicting subsequent resistance or susceptibility among patients with uncomplicated, recurrent cystitis. MATERIALS AND METHODS: We performed a retrospective database study of adults with recurrent, uncomplicated cystitis (cystitis occurring 2 times in 6 months or 3 times in 12 months) from urology or primary care clinics between November 1, 2016, and December 31, 2018. We excluded pregnant females, patients with complicated cystitis, or pyelonephritis. Test metrics were calculated between sequential, paired cultures using standard formulas. RESULTS: We included 597 visits from 232 unique patients wherein 310 (51.2%) visits had a urine culture and 165 had gram-negative uropathogens isolated. Patients with gram-negative uropathogens were mostly females (97%), with a median age of 58.5 years. Our antibiogram found 38.0%, 27.9%, and 5.5% of Escherichia coli isolates had resistance to trimethoprim-sulfamethoxazole, ciprofloxacin, and nitrofurantoin, respectively. Prior cultures (within 2 years) had good predictive value for detecting future susceptibility to first-line agents nitrofurantoin (0.85) and trimethoprim-sulfamethoxazole (0.78) and excellent predictive values (≥0.90) for cefepime, ceftriaxone, cefuroxime, ciprofloxacin, levofloxacin, gentamicin, tobramycin, piperacillin-tazobactam, and imipenem. CONCLUSIONS: Considerable antibiotic resistance was detected among E coli isolates in patients with recurrent, uncomplicated cystitis. Using a prior culture as a guide can enhance the probability of selecting an effective empirical agent.

Epidemiology of COVID-19 in Infants in the United States: Incidence, Severity, Fatality, and Variants of Concern.

BACKGROUND: The clinical spectrum of infant COVID-19 ranges from asymptomatic infection to life-threatening illness, yet epidemiologic surveillance has been limited for infants. METHODS: Using COVID-19 case data (restricted to reporting states) and national mortality data, we calculated incidence, hospitalization, mortality and case fatality rates through March 2022. RESULTS: Reported incidence of COVID-19 was 64.1 new cases per 1000 infant years (95% CI: 63.3-64.9). We estimated that 594,012 infants tested positive for COVID-19 nationwide by March 31, 2022. Viral variant comparisons revealed that incidence was 7× higher during the Omicron (January-March 2022) versus the pre-Delta period (June 2020-May 2021). The cumulative case hospitalization rate was 4.1% (95% CI: 4.0%-4.3%). For every 74 hospitalized infants, one infant death occurred, but overall COVID-19-related infant case fatality was low, with 7.0 deaths per 10,000 cases (95% CI: 5.6-8.7). Nationwide, 333 COVID-19 infant deaths were reported. Only 13 infant deaths (3.9%) were the result of usually lethal congenital anomalies. The majority of infant decedents were non-White (28.2% Black, 26.1% Hispanic, 8.1% Asian, Indigenous or multiracial). CONCLUSIONS: More than half a million US infants contracted COVID-19 by March 2022. Longitudinal assessment of long-term infant SARS-CoV-2 infection sequelae remains a critical research gap. Extremely low infant vaccination rates (<5%), waning adult immunity and continued viral exposure risks suggest that infant COVID-19 will remain a persistent public health problem. Our study underscores the need to increase vaccination rates for mothers and infants, decrease viral exposure risks and improve health equity.