Public Health Reports最新文献

Objectives: Lyme carditis is a rare, potentially fatal manifestation of Lyme disease. Although Lyme disease is nationally notifiable, data on clinical manifestations are not collected systematically in the United States. We developed a syndromic surveillance definition to identify patients with Lyme carditis in New York State during 2017-2021.

Methods: We developed a definition of Lyme carditis by using diagnostic codes and keywords to identify emergency department visits related to Lyme carditis through the National Syndromic Surveillance Program's BioSense Platform. We systematically abstracted information for each identified patient by reviewing medical records in New York State's regional health information exchange system. Physician reviewers independently assigned a clinical case status to each record. We mapped cases of Lyme carditis by county and described their characteristics.

Results: We identified records for 173 individuals; 32% (n = 55) were classified as confirmed, 16% (n = 27) as probable, and 53% (n = 91) as not a case of Lyme carditis. In total, we identified 82 cases of confirmed or probable Lyme carditis; the positive predictive value of the definition was 47%. Cases occurred in 49% of New York State counties and peaked annually in July and August. Among patients with confirmed and probable Lyme carditis, age distribution was bimodal, with incidence peaking at about ages 32 and 70 years; 71% were male. Eighty-four percent had positive 2-tiered serologic test results for Lyme disease, and second- or third-degree atrioventricular block was present in two-thirds of patients (67%).

Practical implications: This definition may be a useful tool to detect changing patterns of Lyme carditis in areas with a high incidence of Lyme disease.

The Dietary Supplement Health and Education Act of 1994 specified that dietary supplements must be swallowed. In this study, we investigated whether kratom-derived products are being sold to consumers in nonswallowed formulations. Kratom is the fresh or dried leaf powder of the Mitragyna speciosa tree. We identified 49 kratom-derived products being sold in the form of sublingual strips (24%), buccal pouches (8%), and vaping products (67%). Most contained 7-hydroxymitragynine (an alkaloid that the US Food and Drug Administration seeks to make a controlled substance), but we also identified mitragynine extract and mitragynine pseudoindoxyl products. The majority had flavoring or a scent, and some had mascots, pictures of fruit or mint, or formulation colors or packaging that could appeal to children. Most products were not sold in child-resistant packaging. Several kratom vaping products additionally contained intoxicating hemp cannabinoids. With no clinical, safety, or pharmacokinetic data for kratom-derived products that bypass first-pass metabolism (ie, where a chemical absorbed through the stomach or intestines is metabolized in the liver before reaching the general bloodstream), people should be advised to avoid these products, and regulatory action is needed to prevent their sale to consumers.

Despite Alzheimer disease and related dementias/disorders (ADRD) being a substantial public health concern, the Deaf community remains underrepresented in ADRD research. We examined the extent and nature of existing literature on ADRD in the Deaf community. We conducted a scoping review following Arksey and O'Malley's framework, adhering to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. We searched 7 databases for peer-reviewed studies published in English, with no restrictions on publication date or study design. Inclusion studies addressed ADRD within the Deaf community and examined aspects such as diagnosis, care, and communication. Our search identified 435 articles, of which 16 met the inclusion criteria. Studies primarily originated from the United Kingdom and Finland, followed by the United States. Most used qualitative methodologies and explored lived experiences and communication barriers. Common themes included limited access to culturally competent care and caregiving challenges. Few studies highlighted diagnostic interventions but noted a general scarcity of resources tailored to Deaf populations. Notable gaps emerged in geographic focus, the range of studied variables, and the lack of validated sign language-based diagnostic instruments and interventions. We recommend expanding research beyond the Global North (ie, higher-income industrialized countries with greater access to resources), incorporating more longitudinal and intersectional approaches, and tailoring resources for Deaf communities. The review underscores the need for culturally competent care, improved diagnostic tools, and policy reforms to address ADRD-related disparities in the Deaf community. Future research should prioritize inclusive methodologies and community-driven interventions to enhance health outcomes and equity for Deaf individuals affected by ADRD.

Objective: In 2020, the National Institutes of Health (NIH) established the Community Engagement Alliance (CEAL) to ensure that communities experiencing health disparities had a voice in finding effective solutions. This mixed-methods study evaluated processes and outcomes of CEAL.

Methods: We used the National Academy of Medicine's Assessing Meaningful Community Engagement conceptual model to guide our evaluation. Data sources for the evaluation included interviews, programmatic data, community surveys, and partner surveys. We assessed the domains of strengthened partnerships, expanded knowledge, and improved health, health programs, and policies.

Results: CEAL teams built a robust partnership network that reached populations most affected by COVID-19, facilitated knowledge increases among community members and partner organizations, and positively affected COVID-19 vaccination rates.

Conclusions: This evaluation suggests that the infrastructure built by CEAL teams could be leveraged to address additional topics and populations of interest and enhance future National Institutes of Health-funded efforts in community-engaged research.

Objectives: Fetal alcohol syndrome (FAS) is frequently undiagnosed or misdiagnosed, particularly among populations at elevated risk of the condition. We examined the prevalence of FAS among children aged 0 to 5 years enrolled in Medicaid, described characteristics of affected children, and evaluated diagnostic timing between children in foster care and children not in foster care.

Methods: We conducted a retrospective analysis of Medicaid Transformed Analytic Files for children born from 2015 through 2017 with FAS diagnoses (n = 771), following each birth cohort for 5 years. We used descriptive statistics to examine prevalence rates and demographic characteristics. Multivariate linear regression models assessed differences in diagnostic timing between children in foster care and children not in foster care, controlling for demographic factors.

Results: The overall FAS prevalence per 100 000 children aged 0 to 5 years enrolled in Medicaid was 7.7, increasing from 5.1 in 2015 to 11.4 in 2017. Children in foster care represented 60.2% (n = 464) of the FAS cohort. Although behavioral assessments occurred at similar ages for both groups, children in foster care received FAS diagnoses 4.6 to 5.4 months later than children not in foster care (P < .001). The time between the first behavioral assessment and FAS diagnosis was 2.1 to 3.9 months longer for children in foster care than for children not in foster case.

Conclusions: Children in foster care had substantial delays in diagnosis compared with children not in foster care. Initial access to behavioral assessment appears equitable; however, barriers exist in the progression from assessment to diagnosis for children in foster care. Implementing targeted screening protocols, improving cross-system information sharing, and enhancing health care provider training could reduce diagnostic delays and improve outcomes for this population.

Objective: Most people in the United States are unaware that alcohol causes cancer and increases heart disease risk. Warning labels on alcohol containers can increase knowledge about these harms. Yet, it is unclear if Americans support this policy. We assessed attitudes toward cancer and heart disease warning labels on alcohol containers.

Methods: In May 2024, we surveyed 1095 adults (aged ≥18 y) participating in AmeriSpeak, a nationally representative panel of the US noninstitutionalized civilian adult population. We analyzed support for warning labels overall and by sociodemographic characteristics by using descriptive statistics weighted to represent the US population.

Results: Overall, 4 in 10 respondents supported cancer or heart disease warning labels on alcohol containers. Fewer than 10% opposed warning labels; many were neutral. More young adults (aged 18-29 y; 57.9% [95% CI, 44.6%-70.0%]) than older adults (aged ≥60 y; 36.0% [95% CI, 30.3%-42.1%]) supported cancer warning labels (P = .04). More women (50.8%; 95% CI, 45.0%-56.6%) than men (40.5%; 95% CI, 34.1%-47.2%) supported heart disease warning labels (P = .03).

Conclusions: Most people in the United States are neutral about or support cancer and heart disease warning labels on alcohol containers. Leveraging warning labels is a cost-effective way to inform the public about alcohol's link to cancer and heart disease.

Objectives: During the past century, the age of menarche (onset of the first menstrual cycle) has dropped worldwide, with a decline of 2 or 3 months every 10 years in the United States. The adverse health effects of this change are just starting to be understood. Little is known about how the age of menarche affects the future health of African American women. Our objective was to examine the association between early menarche and cardiovascular disease in African American women.

Methods: The study sample included 2397 African American women in the Jackson Heart Study (64% of the total original cohort). We examined the association of early menarche (at age <12 y) with prevalent coronary heart disease, myocardial infarction, stroke, hypertension, diabetes, general obesity, and abdominal obesity.

Results: The mean (SD) baseline age of participants was 55.2 (12.5) years, with a mean (SD) age of menarche of 12.8 (1.8) years; 20.6% of these women experienced early menarche. After adjustment for relevant covariates, early menarche was significantly associated with increased odds of coronary heart disease (odds ratio [OR] = 2.16; 95% CI, 1.44-3.22), myocardial infarction (OR = 1.90; 95% CI, 1.17-3.08), hypertension (prevalence ratio [PR] = 1.15; 95% CI, 1.07-1.24), general obesity (PR = 1.22; 95% CI, 1.14-1.31), and abdominal obesity (PR = 1.14; 95% CI, 1.08-1.20).

Conclusions: Among this cohort, early menarche was a risk factor for the development of cardiovascular disease among African American women. Addressing this risk requires policies and clinical guidelines that recognize early menarche as a marker for early intervention.