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1.
Mymensingh Med J ; 31(4): 983-991, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36189542

RESUMO

Growth assessment is an essential component of child health surveillance. The most influential tool in the growth assessment is the growth chart. Growth parameters of children are usually interpreted in relation to international standards like the NCHS/1977, CDC/2000 and WHO/2007 growth charts. This comparative study was carried out in the Department of Paediatrics, Mymensingh Medical College, Mymensingh, Bangladesh from November 2014 to October 2015 to compare the growth parameters of children using 2000 CDC standards and 2007 WHO standards. A total of five hundred healthy school children, aged 6 to 10 years were randomly selected proportionately from each class of five government primary schools from Mymensingh city area. Children with physical deformities and acutely ill and those with chronic debilitating diseases were excluded from the study. The mean and median weight, height and BMI were calculated for each age and sex. The median weight, height and BMI were then standardized by converting them to Z-scores (SD) for comparing against known reference values of 2000 CDC and 2007 WHO charts. Among 500 children, 252(50.4%) were boys and 248(49.6%) were girls. The mean age was found 8.0±1.42 years in boys and 8.04±1.42 years in girls. The mean weight was found 24.4±6.36kg in boys and 24.08±6.35kg in girls. The mean height was 125.90±10.16cm in boys and 125.38±10.74cm in girls. The mean weight, height and BMI of boys and girls were found to be lower in all age groups with compared to 2000 CDC standard and 2007 WHO standard but were closer to the WHO standards compared to the CDC standards. According to CDC and WHO in the study it was observed that underweight was found 16.3% and 14.7%, stunting 7.1% and 6.7%, overweight 6.7% and 8.7%, and obese 2.8% and 4.0% respectively in male subjects. On the other hand, in female subjects it was observed that according to CDC chart and WHO chart underweight was found 19.4% and 13.3%, stunting 6.0% and 4.8%, overweight 7.3% and 8.1% and obese 2.0% and 2.0% respectively. The findings in this study imply that growth pattern of Bangladeshi school children is closer with WHO standards and wider from CDC standards.


Assuntos
Sobrepeso , Magreza , Bangladesh/epidemiologia , Estatura , Índice de Massa Corporal , Peso Corporal , Centers for Disease Control and Prevention, U.S. , Criança , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Masculino , Obesidade/epidemiologia , Magreza/epidemiologia , Estados Unidos , Organização Mundial da Saúde
5.
BMJ Open ; 12(9): e061286, 2022 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109025

RESUMO

INTRODUCTION: Antimicrobial stewardship (AMS) is an important strategy to control antimicrobial resistance. Resources are available to provide guidance for design and implementation of AMS programmes, however these may have limited applicability in resource-limited settings including those in Asia. This scoping review aims to identify context-specific domains and items for the development of a healthcare facility (HCF)-level tool to guide AMS implementation in Asia. METHODS AND ANALYSIS: This review is the first step in a larger project to assess AMS implementation, needs and gaps in Asia. We will employ a deductive qualitative approach to identify locally appropriate domains and items of AMS implementation guided by Nilsen and Bernhardsson's contextual dimensions. This process is also informed by discussions from a technical advisory group coordinated by the US Centers for Disease Control and Prevention to develop an AMS HCF-level assessment tool for low-income and middle-income countries. We will review English-language documents that discuss HCF-level implementation, including those describing frameworks, components/elements or recommendations for design, implementation or assessment globally and specific to Asia. We have performed the search in August-September 2021 including general electronic databases (MEDLINE, Embase, Web of Science and Google Scholar), region-specific databases, national action plans, grey literature sources and reference lists to identify eligible documents. Country-specific documents will be restricted to countries in three subregions: South Asia, East Asia and Southeast Asia. Codes and themes will be derived through a content analysis, classified following the predefined context dimensions and used for developing domains and items of the assessment tool. ETHICS AND DISSEMINATION: Results from this review will feed into our stepwise process for developing a context-specific HCF-level assessment tool for AMS programmes to assess the implementation status, identify intervention opportunities and monitor progress over time. The process will be done in consultation with local stakeholders, the end-users of the generated knowledge.


Assuntos
Anti-Infecciosos , Gestão de Antimicrobianos , Anti-Infecciosos/uso terapêutico , Gestão de Antimicrobianos/métodos , Ásia , Centers for Disease Control and Prevention, U.S. , Humanos , Pobreza , Literatura de Revisão como Assunto , Estados Unidos
6.
J Am Heart Assoc ; 11(18): e025903, 2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-36073626

RESUMO

Background Despite improvements in the management and prevention of stroke, increasing hospitalizations for stroke and stagnant mortality rates have been described in young adults. However, there is a paucity of contemporary national mortality estimates in young adults. Methods and Results Trends in mortality related to stroke in young adults (aged 25-64 years) were assessed using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Age-adjusted mortality rates per 100 000 people with associated annual percentage change were calculated. Joinpoint regression was used to assess the trends in the overall sample and different demographic (sex, race and ethnicity, and age) and geographical (state, urban-rural, and regional) subgroups. Between 1999 and 2019, a total of 566 916 stroke-related deaths occurred among young adults. After the initial decline in mortality in the overall population, age-adjusted mortality rate increased from 2013 to 2019 with an associated annual percentage change of 1.5 (95% CI, 1.1-2.0). Mortality rates were higher in men versus women and in non-Hispanic Black people versus individuals of other races and ethnicities. Non-Hispanic American Indian or Alaskan Native people had a marked increase in stroke-related mortality (annual percentage change 2010-2019: 3.3). Furthermore, rural (nonmetropolitan) counties experienced the greatest increase in mortality (annual percentage change 2012-2019: 3.1) compared with urban (metropolitan) counties. Conclusions Following the initial decline in stroke-related mortality, young adults have experienced increasing mortality rates from 2013 to 2019, with considerable differences across demographic groups and regions.


Assuntos
Etnicidade , Acidente Vascular Cerebral , Centers for Disease Control and Prevention, U.S. , Feminino , Humanos , Masculino , Mortalidade , População Rural , Estados Unidos/epidemiologia , Adulto Jovem
7.
Am J Public Health ; 112(S7): S647-S650, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36179291

RESUMO

Opportunities for lead exposure are common in the United States. The American Academy of Pediatrics, in collaboration with the Centers for Disease Control and Prevention, launched the Increasing Capacity for Blood Lead Testing Extension for Community Healthcare Outcomes (ECHO) project to educate pediatricians on the importance of testing children for lead exposure and to assess practice behavior change. We found that two weeks to one month after receiving training, more than 80% of participants reported increased lead testing and practice changes. Our results support use of the ECHO model as a mechanism for practice change. (Am J Public Health. 2022;112(S7):S647-S650. https://doi.org/10.2105/AJPH.2022.307084).


Assuntos
Chumbo , Pediatras , Centers for Disease Control and Prevention, U.S. , Criança , Humanos , Estados Unidos
8.
Am J Public Health ; 112(S7): S706-S714, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36179293

RESUMO

Objectives. To (1) determine the prevalence of elevated blood lead levels (EBLLs; ≥ 5 µg/dL) among newly arrived refugee children, (2) understand the demographic characteristics of refugee children with EBLLs, and (3) assess health care providers' compliance with Centers for Disease Control and Prevention (CDC) recommendations for retesting. Methods. We matched refugee demographic data (2015-2019) from the CDC's Electronic Disease Notification (EDN) system with lead-testing laboratory report data from the Pennsylvania National Electronic Disease Surveillance System using Match*Pro software. Results. Of 3833 refugee children 16 years or younger in the EDN system, matching identified 3142 children with blood lead level data. Among children with blood lead level data, 578 (18.4%) had EBLLs. Among children with EBLLs, 341 (59.0%) were male. Of the 1370 children aged 6 years or younger with blood level test results, 335 (24.5%) had initial EBLLs, and only 78 (5.7%) were retested within 3 to 6 months. Of the 335 children 6 years or younger with an initial EBLL, only 44 (13.1%) were retested within 3 to 6 months. Conclusions. Following up on refugee children with EBLLs is necessary to ensure that they do not have continued lead exposure. (Am J Public Health. 2022;112(S7):S706-S714. https://doi.org/10.2105/AJPH.2022.306856).


Assuntos
Intoxicação por Chumbo , Refugiados , Centers for Disease Control and Prevention, U.S. , Criança , Feminino , Humanos , Lactente , Chumbo , Intoxicação por Chumbo/diagnóstico , Intoxicação por Chumbo/epidemiologia , Masculino , Pennsylvania , Estados Unidos
10.
J Acquir Immune Defic Syndr ; 91(2): 117-121, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36094476

RESUMO

BACKGROUND: Organizations offering HIV prevention services have reported interruptions during the COVID-19 pandemic. The national extent of these interruptions and their public health impact remain largely unexplored. METHODS: Using data from 60 state and local health departments, we compared HIV testing services outcomes in calendar years 2019 and 2020, including the number of Centers for Disease Control and Prevention (CDC)-funded HIV tests conducted, the percentage of persons with newly diagnosed HIV infection (ie, HIV positivity), and the percentage linked to HIV medical care within 30 days after new diagnoses (ie, linkage to care) using χ2 and robust Poisson models. We also assessed the independent associations between the pandemic period (ie, March-December 2020) and the number of COVID-19 cases with monthly HIV testing services outcomes using multivariable robust Poisson models. RESULTS: There was a 46.0% (P < 0.001) reduction in the number of CDC-funded HIV tests conducted in 2020 (n = 1,255,895) compared with 2019 (n = 2,324,421). Although there were fewer persons with newly diagnosed HIV in 2020 (n = 5581 vs. n = 7739 in 2019), HIV positivity was greater in 2020 (0.4% vs. 0.3% in 2019; adjusted prevalence ratio [aPR] = 1.33, 95% confidence interval [CI]: 1.05 to 1.69). When adjusting for the monthly number of COVID-19 cases, the pandemic period was associated with a 56% reduction in the number of monthly CDC-funded HIV tests (adjusted rate ratio = 0.44, 95% CI: 0.37 to 0.52) but 28% higher monthly HIV positivity (aPR = 1.28 95% CI: 1.16 to 1.41) and 10% higher linkage to care (aPR = 1.10, 95% CI: 1.02 to 1.18). DISCUSSION: Despite increased HIV positivity, a drastic reduction in the number of CDC-funded HIV tests was observed in 2020, affecting the ability to identify persons with newly diagnosed HIV. CDC and health departments will need to expand testing strategies to cover tests not conducted in 2020 while adapting to the continuing pandemic.A visual abstract is available for this article at: http://links.lww.com/QAI/B941.


Assuntos
COVID-19 , Infecções por HIV , COVID-19/diagnóstico , COVID-19/epidemiologia , Centers for Disease Control and Prevention, U.S. , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Teste de HIV , Humanos , Programas de Rastreamento , Pandemias , Estados Unidos/epidemiologia
11.
Antimicrob Agents Chemother ; 66(9): e0049622, 2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-36066241

RESUMO

The CDC's Emerging Infections Program (EIP) conducted population- and laboratory-based surveillance of US carbapenem-resistant Pseudomonas aeruginosa (CRPA) from 2016 through 2018. To characterize the pathotype, 1,019 isolates collected through this project underwent antimicrobial susceptibility testing and whole-genome sequencing. Sequenced genomes were classified using the seven-gene multilocus sequence typing (MLST) scheme and a core genome (cg)MLST scheme was used to determine phylogeny. Both chromosomal and horizontally transmitted mechanisms of carbapenem resistance were assessed. There were 336 sequence types (STs) among the 1,019 sequenced genomes, and the genomes varied by an average of 84.7% of the cgMLST alleles used. Mutations associated with dysfunction of the porin OprD were found in 888 (87.1%) of the genomes and were correlated with carbapenem resistance, and a machine learning model incorporating hundreds of genetic variations among the chromosomal mechanisms of resistance was able to classify resistant genomes. While only 7 (0.1%) isolates harbored carbapenemase genes, 66 (6.5%) had acquired non-carbapenemase ß-lactamase genes, and these were more likely to have OprD dysfunction and be resistant to all carbapenems tested. The genetic diversity demonstrates that the pathotype includes a variety of strains, and clones previously identified as high-risk make up only a minority of CRPA strains in the United States. The increased carbapenem resistance in isolates with acquired non-carbapenemase ß-lactamase genes suggests that horizontally transmitted mechanisms aside from carbapenemases themselves may be important drivers of the spread of carbapenem resistance in P. aeruginosa.


Assuntos
Infecções por Pseudomonas , Pseudomonas aeruginosa , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Centers for Disease Control and Prevention, U.S. , Humanos , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Porinas/genética , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/epidemiologia , Estados Unidos/epidemiologia , beta-Lactamases/genética , beta-Lactamases/metabolismo
13.
Front Public Health ; 10: 927318, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36033752

RESUMO

The pathogen laboratory (p-lab) is the core and primary department of centers for disease control and prevention (CDCs) in China to respond to infectious disease outbreaks such as COVID-19. To understand the current status and capacity of p-labs in Chinese CDCs during the COVID-19 pandemic, we conducted a nationwide cross-sectional survey among 399 respondents from 239 CDCs. Differences in the current status of p-labs in CDCs of provinces, cities, and counties mainly comprised laboratory equipment, IEIs, mastery of personal occupational skills, and maximum detection capacity. Most CDCs reported a lack of staff and funds for personnel, which should be a priority in China's upcoming public health reform. The development of sequencing technologies has received considerable attention in CDCs. These are mainly used to study respiratory viruses such as influenza and SARS-CoV-2. The COVID-19 pandemic has driven development of the CDCs in China, and personnel and funds are considered key factors in improving the detection capacity of CDC p-labs.


Assuntos
COVID-19 , Centers for Disease Control and Prevention, U.S. , China , Estudos Transversais , Reforma dos Serviços de Saúde , Humanos , Laboratórios , Pandemias , SARS-CoV-2 , Estados Unidos
14.
Prev Med ; 163: 107183, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35964778

RESUMO

The number of nonfatal firearm injuries in the US by intent (e.g., due to assault) is not reliably known: First, although the largest surveillance system for hospital-treated events, the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (HCUP-NEDS), provides accurate data for the number of nonfatal firearm injuries, injury intent is not coded reliably. Second, the system that reliably codes intent, the CDC's National Electronic Injury Surveillance System - Firearm Injury Surveillance Study (NEISS-FISS), while large enough to produce stable estimates of the distribution of intent, is too small to produce stable estimates of the number of these events. Third, a large proportion of cases in NEISS-FISS, notably in early years of the system, are coded as of "undetermined intent." Trends in the proportion of nonfatal firearm injuries by intent in NEISS-FISS thus depend on whether these cases are treated as a distinct category, or, instead, can be re-classified through imputation. We contrast the distributions of nonfatal firearm injury by intent generated using multiple imputation with those generated using complete-case analyses and analyses that consider "undetermined intent" as a distinct category. We produce estimates of the annual number of firearm injuries by intent in a two-step process. First, we impute intent for cases coded as "undetermined" using Multiple Imputation by Super Learning (MISL). Second, we apply MISL-derived distributions to aggregate count data from HCUP-NEDS. The proportion of non-fatal firearm assaults appears to increase over time when injuries coded as undetermined are included as a category. By contrast, the proportion of assaults remains relatively constant over time in complete-case and multiply imputed analyses. Differences between complete-case and multiple imputation approaches become apparent in subgroup analyses. Trends in the number of nonfatal firearm injuries by intent, 2006-2016, derived in our two-step process, are relatively flat. Multiple imputation strategies recovered intent distribution trends that differed from trends derived using methods that are not designed to account for the multiple complex relationships of missingness present in NEISS - FISS data. When applied to NEISS - FISS, MISL imputation produces plausible distributional estimates of firearm injury by intent.


Assuntos
Vítimas de Crime , Armas de Fogo , Ferimentos por Arma de Fogo , Centers for Disease Control and Prevention, U.S. , Serviço Hospitalar de Emergência , Humanos , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/epidemiologia
16.
MMWR Morb Mortal Wkly Rep ; 71(34): 1081-1084, 2022 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-36006831

RESUMO

Dog-maintained rabies virus variant (DMRVV) was eliminated in the United States in 2007. During 2015­2019, three dogs with rabies were imported into the United States from Egypt, where DMRVV is endemic. CDC developed a risk mitigation strategy, in consultation with a diverse group of subject matter experts, that permitted 296 dogs to be imported from Egypt during May 10, 2019­December 31, 2020, minimizing the risk for future rabid dog importations. The broadly vetted risk mitigation strategy, which included serologic testing for rabies antibody titer, improved CDC's ability to ensure that imported dogs from Egypt posed no public health risk in the United States. This strategy could be used to guide future policy decisions regarding dog importations.


Assuntos
Doenças do Cão , Vacinas Antirrábicas , Vírus da Raiva , Raiva , Animais , Centers for Disease Control and Prevention, U.S. , Doenças do Cão/epidemiologia , Cães , Egito , Humanos , Saúde Pública , Raiva/epidemiologia , Raiva/prevenção & controle , Raiva/veterinária , Estados Unidos/epidemiologia
18.
Curr Probl Cardiol ; 47(11): 101344, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35918011

RESUMO

The population of adults with congenital heart disease (ACHD) is rapidly increasing. There is limited understanding of location of death and associated disparities in these patients. From 2005-2018, a trend-level analysis was performed using death certificate data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Database, with individual-level mortality data obtained from National Center for Health Statistics. Places of death were classified as hospital, home, hospice facility, nursing home/long-term care and other. A total of 15,507 total deaths were identified in ACHD from 2005-2018 (54% Male, 84% White). ACHD patients were more likely to die in the hospital (64%) compared to general population (41%). Younger decedents (20-34) with ACHD were more likely to die in the hospital, while older decedents (≥65) were more likely to die at Hospice/Nursing facilities. Black and Hispanic patients with ACHD were more likely to die in the hospital compared to White and non-Hispanic patients. A significantly large proportion of ACHD deaths are observed in younger patients and occur in inpatient facilities. End-of-life planning among socially vulnerable populations should be prioritized.


Assuntos
Cardiopatias Congênitas , Hospitais para Doentes Terminais , Adulto , Centers for Disease Control and Prevention, U.S. , Feminino , Cardiopatias Congênitas/epidemiologia , Humanos , Masculino , Casas de Saúde , Estados Unidos/epidemiologia
19.
Brain Inj ; 36(9): 1133-1139, 2022 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-35980309

RESUMO

BACKGROUND: Concussion education for parents/guardians (hereafter referred to as parents) has the potential to play an important role in youth athlete concussion safety. The goal of this study was to evaluate the impact of the Centers for Disease Control and Prevention's (CDC) HEADS UP handout on parent-child communication about concussion. METHODS: YMCA branches from 15 associations from across the United States were randomized to CDC HEADS UP intervention condition or education as usual control condition using a cluster randomization strategy. In the intervention condition, coaches shared parent- and athlete-specific handouts with parents and asked parents to share and discuss the athlete-specific handouts with their child. Generalized estimating equations, with repeated measures to account for the correlation among matched participants and YMCA associations, were employed. RESULTS: Multivariable analyses exploring the relationship between time (pre- and post-intervention) and communication showed that the percent of parents who talked to their child about concussion increased in the intervention group (aRR=1.33, 95% CI=1.22, 1.44), but not in the control group. CONCLUSION: CDC HEADS UP handouts help families talk about concussion safety. Sports organizations seeking to educate parents of athletes about concussion should consider using CDC HEADS UP handouts and following a similar dissemination strategy.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Esportes Juvenis , Adolescente , Atletas , Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/prevenção & controle , Centers for Disease Control and Prevention, U.S. , Comunicação , Humanos , Relações Pais-Filho , Pais , Estados Unidos
20.
Ann Intern Med ; 175(9): 1240-1249, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35914253

RESUMO

BACKGROUND: Centers for Disease Control and Prevention (CDC) defines low, medium, and high "COVID-19 community levels" to guide interventions, but associated mortality rates have not been reported. OBJECTIVE: To evaluate the diagnostic performance of CDC COVID-19 community level metrics as predictors of elevated community mortality risk. DESIGN: Time series analysis over the period of 30 May 2021 through 4 June 2022. SETTING: U.S. states and counties. PARTICIPANTS: U.S. population. MEASUREMENTS: CDC "COVID-19 community level" metrics based on hospital admissions, bed occupancy, and reported cases; reported COVID-19 deaths; and sensitivity, specificity, and predictive values for CDC and alternative metrics. RESULTS: Mean and median weekly mortality rates per 100 000 population after onset of high COVID-19 community level 3 weeks prior were, respectively, 2.6 and 2.4 (interquartile range [IQR], 1.7 to 3.1) across 90 high episodes in states and 4.3 and 2.1 (IQR, 0 to 5.4) across 7987 high episodes in counties. In 85 of 90 (94%) episodes in states and 4801 of 7987 (60%) episodes in counties, lagged weekly mortality after onset exceeded 0.9 per 100 000 population, and in 57 of 90 (63%) episodes in states and 4018 of 7987 (50%) episodes in counties, lagged weekly mortality after onset exceeded 2.1 per 100 000, which is equivalent to approximately 1000 daily deaths in the national population. Alternative metrics based on lower hospital admissions or case thresholds were associated with lower mortality and had higher sensitivity and negative predictive value for elevated mortality, but the CDC metrics had higher specificity and positive predictive value. Ratios between cases, hospitalizations, and deaths have varied substantially over time. LIMITATIONS: Aggregate mortality does not account for nonfatal outcomes or disparities. Continuing evolution of viral variants, immunity, clinical interventions, and public health mitigation strategies complicate prediction for future waves. CONCLUSION: Designing metrics for public health decision making involves tradeoffs between identifying early signals for action and avoiding undue restrictions when risks are modest. Explicit frameworks for evaluating surveillance metrics can improve transparency and decision support. PRIMARY FUNDING SOURCE: Council of State and Territorial Epidemiologists.


Assuntos
COVID-19 , Centers for Disease Control and Prevention, U.S. , Hospitalização , Humanos , Saúde Pública , Estados Unidos/epidemiologia
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