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Growing Concern About Unsheltered Homelessness Among Veterans: Clinical Characteristics and Engagement in Health Care Services. 退伍军人无家可归问题日益受到关注:退伍军人的临床特征和参与医疗保健服务的情况。
IF 3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 Epub Date: 2024-02-07 DOI: 10.1177/00333549241227155
Rebecca L Kinney, Dorota Szymkowiak, Jack Tsai

Objectives: Veteran homelessness has declined in the past decade, but the proportion of unsheltered homeless veterans has increased. We identified characteristics of unsheltered homelessness in a large contemporary veteran cohort and examined outpatient and inpatient encounters before and after intake to US Department of Veterans Affairs (VA) homeless programs.

Methods: National data from the Homeless Operations Management Evaluation System (HOMES) database and the Corporate Data Warehouse were analyzed on 191 204 veterans experiencing housing instability from January 2018 through December 2021. We used hierarchical multivariate logistic regressions to model associations between sheltered status and veteran correlates. Repeated-measures analysis of variance assessed changes in care utilization after intake in homeless programs.

Results: Age <50 years (odds ratio [OR] = 1.3; 95% CI, 1.2-1.4), Hispanic ethnicity (OR = 1.2; 95% CI, 1.1-1.3), some college education (OR = 1.1; 95% CI, 1.0-1.1), and a bachelor's degree (OR = 1.2; 95% CI, 1.1-1.2) were associated with veteran unsheltered homelessness. Unsheltered veterans were more likely to have a VA service-connected disability (OR = 1.4; 95% CI, 1.4-1.5), military sexual trauma (OR = 1.1; 95% CI, 1.0-1.1), and/or combat exposure (OR = 1.1; 95% CI, 1.0-1.1). Unsheltered and sheltered homeless veterans had an increase in outpatient encounters and a decrease in inpatient care after intake to the VA homeless program.

Conclusions: Contemporary unsheltered homeless veterans are younger and Hispanic with some college education. Innovative public health approaches that better engage and reduce barriers to entry need to be tested for a diverse unsheltered homeless population.

目标:在过去十年中,退伍军人无家可归的现象有所减少,但无家可归的退伍军人比例却在增加。我们确定了大量当代退伍军人无家可归的特征,并研究了美国退伍军人事务部(VA)无家可归者项目接收前后的门诊和住院情况:我们分析了无家可归者运营管理评估系统(HOMES)数据库和企业数据仓库中的全国数据,这些数据来自 2018 年 1 月至 2021 年 12 月期间经历住房不稳定的 191 204 名退伍军人。我们使用分层多元逻辑回归来模拟庇护状态与退伍军人相关因素之间的关联。重复措施方差分析评估了无家可归者项目接收后护理利用率的变化:年龄结论:当代无家可归的退伍军人更年轻,是受过一定大学教育的西班牙裔。需要针对不同的无家可归者人群测试创新的公共卫生方法,以更好地吸引他们参与并减少进入项目的障碍。
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引用次数: 0
Disparities in Rates of Death From HIV or Tuberculosis Before Age 65 Years, by Race, Ethnicity, and Sex, United States, 2011-2020. 美国 2011-2020 年按种族、族裔和性别分列的 65 岁前死于艾滋病毒或结核病比率的差异。
IF 3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 Epub Date: 2023-12-18 DOI: 10.1177/00333549231213328
Nelson Adekoya, Man-Huei Chang, Jonathan Wortham, Benedict I Truman

Objective: Death from tuberculosis or HIV among people from racial and ethnic minority groups who are aged <65 years is a public health concern. We describe age-adjusted, absolute, and relative death rates from HIV or tuberculosis from 2011 through 2020 by sex, race, and ethnicity among US residents.

Methods: We used mortality data from the Centers for Disease Control and Prevention online data system on deaths from multiple causes from 2011 through 2020 to calculate age-adjusted death rates and absolute and relative disparities in rates of death by sex, race, and ethnicity. We calculated corresponding 95% CIs for all rates and determined significance at P < .05 by using z tests.

Results: For tuberculosis, when compared with non-Hispanic White residents, non-Hispanic American Indian or Alaska Native residents had the highest level of disparity in rate of death (666.7%). Similarly, as compared with non-Hispanic White female residents, American Indian or Alaska Native female residents had a high relative disparity in death from tuberculosis (620.0%). For HIV, the age-adjusted death rate was more than 8 times higher among non-Hispanic Black residents than among non-Hispanic White residents, and the relative disparity was 735.1%. When compared with non-Hispanic White female residents, Black female residents had a high relative disparity in death from HIV (1529.2%).

Conclusion: Large disparities in rates of death from tuberculosis or HIV among US residents aged <65 years based on sex, race, and ethnicity indicate an ongoing unmet need for effective interventions. Intervention strategies are needed to address disparities in rates of death and infection among racial and ethnic minority populations.

目标少数种族和少数族裔群体中的老年人死于结核病或 HIV 的情况 方法:我们使用了美国疾病控制与预防中心在线数据系统中 2011 年至 2020 年多种原因导致的死亡数据,计算了年龄调整后的死亡率,以及不同性别、种族和民族的绝对和相对死亡率差异。我们计算了所有死亡率的相应 95% CI,并通过 z 检验确定 P < .05 时的显著性:就肺结核而言,与非西班牙裔白人居民相比,非西班牙裔美国印第安人或阿拉斯加原住民居民的死亡率差异最大(666.7%)。同样,与非西班牙裔白人女性居民相比,美国印第安人或阿拉斯加原住民女性居民死于肺结核的相对差距也很大(620.0%)。就艾滋病毒而言,非西班牙裔黑人居民的年龄调整后死亡率是非西班牙裔白人居民的 8 倍多,相对差距为 735.1%。与非西班牙裔白人女性居民相比,黑人女性居民死于艾滋病毒的相对差距较大(1529.2%):结论:在年龄介于 15 岁到 18 岁之间的美国居民中,死于肺结核或 HIV 的比例存在巨大差异。
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引用次数: 0
Lessons Learned From Implementation of Mpox Surveillance During an Outbreak Response in Tennessee, 2022. 2022 年田纳西州疫情应对期间实施麻疹腮腺炎监测的经验教训。
IF 3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 Epub Date: 2024-01-24 DOI: 10.1177/00333549231223710
Christine M Thomas, Julie Shaffner, Renee Johnson, Caleb Wiedeman, Mary-Margaret A Fill, Timothy F Jones, William Schaffner, John R Dunn

Objectives: Mpox surveillance was integral during the 2022 outbreak response. We evaluated implementation of mpox surveillance in Tennessee during an outbreak response and made recommendations for surveillance during emerging infectious disease outbreaks.

Methods: To understand surveillance implementation, system processes, and areas for improvement, we conducted 8 semistructured focus groups and 7 interviews with 36 health care, laboratory, and health department representatives during September 9-20, 2022. We categorized and analyzed session transcription and notes. We analyzed completeness and timeliness of surveillance data, including 349 orthopoxvirus-positive laboratory reports from commercial, public health, and health system laboratories during July 1-August 31, 2022.

Results: Participants described an evolving system and noted that existing informatics platforms inefficiently supported iterations of reporting requirements. Clear communication, standardization of terminology, and shared, adaptable, and user-friendly informatics platforms were prioritized for future emerging infectious disease surveillance systems. Laboratory-reported epidemiologic information was often incomplete; only 55% (191 of 349) of reports included patient address and telephone number. The median time from symptom onset to specimen collection was 5 days (IQR, 3-6 d), from specimen collection to laboratory reporting was 3 days (IQR, 1-4 d), from laboratory reporting to patient interview was 1 day (IQR, 1-3 d), and from symptom onset to patient interview was 9 days (IQR, 7-12 d).

Conclusions: Future emerging infectious disease responses would benefit from standardized surveillance approaches that facilitate rapid implementation. Closer collaboration among informatics, laboratory, and clinical partners across jurisdictions and agencies in determining system priorities and designing workflow processes could improve flexibility of the surveillance platform and completeness and timeliness of laboratory reporting. Improved timeliness will facilitate public health response and intervention, thereby mitigating morbidity.

目标:在 2022 年疫情应对期间,水痘监测是不可或缺的。我们评估了田纳西州在疫情应对期间对天花病毒监测的实施情况,并对新发传染病疫情期间的监测工作提出了建议:为了了解监控的实施情况、系统流程和需要改进的地方,我们在 2022 年 9 月 9 日至 20 日期间对 36 名医疗保健、实验室和卫生部门的代表进行了 8 次半结构化焦点小组讨论和 7 次访谈。我们对会议记录和笔记进行了分类和分析。我们分析了监控数据的完整性和及时性,包括 2022 年 7 月 1 日至 8 月 31 日期间来自商业、公共卫生和卫生系统实验室的 349 份矫形病毒阳性实验室报告:结果:与会者描述了一个不断发展的系统,并指出现有的信息学平台无法有效支持报告要求的迭代。清晰的沟通、术语的标准化以及共享、适应性强且用户友好的信息平台被列为未来新兴传染病监测系统的优先事项。实验室报告的流行病学信息往往不完整;只有 55% 的报告(349 份中的 191 份)包含患者地址和电话号码。从症状出现到标本采集的中位时间为 5 天(IQR,3-6 天),从标本采集到实验室报告的中位时间为 3 天(IQR,1-4 天),从实验室报告到患者访谈的中位时间为 1 天(IQR,1-3 天),从症状出现到患者访谈的中位时间为 9 天(IQR,7-12 天):结论:未来的新发传染病应对措施将受益于便于快速实施的标准化监测方法。各辖区和机构的信息学、实验室和临床合作伙伴在确定系统优先级和设计工作流程时加强合作,可提高监测平台的灵活性以及实验室报告的完整性和及时性。提高及时性将有助于公共卫生响应和干预,从而降低发病率。
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引用次数: 0
Analysis of the Federal Section 317 Immunization Program and Routine Adult Immunization Activities, United States, 2022-2023. 2022-2023 年美国联邦第 317 款免疫计划和常规成人免疫活动分析。
IF 3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 Epub Date: 2024-03-19 DOI: 10.1177/00333549241236085
Charleigh J Granade, Nathan E Crawford, Michelle Banks, Sam Graitcer

Objectives: The federal Section 317 Immunization Program, administered by the Centers for Disease Control and Prevention (CDC), provides funding to support adult immunization efforts; however, current information on program implementation at the jurisdictional level is limited. We assessed the use of Section 317 and other funding sources to support routine adult immunization activities among the 64 immunization programs ("awardees").

Methods: We conducted a survey and key informant interviews with awardees in October to December 2022 to collect quantitative and qualitative data on current adult vaccine purchase and program operation activities funded by Section 317 and other funding sources. We assessed total vaccine cost and data on vaccine purchase projections for each awardee with CDC's Cost and Affordability Tool for 2023.

Results: Immunization program managers or their designees from 62 of 64 awardees (97%) completed the survey; 12 awardees participated in key informant interviews. Of 62 awardees, 32 (52%) used a single funding source to support adult vaccine purchases, of which 29 (91%) used only Section 317 funds, 21 (34%) reported not planning to purchase ≥1 age-based recommended vaccine for adults in 2023, and 33 (53%) reported using Section 317 funds only to support adult immunization program operations. Key informant interviews showed varied operational activities among awardees, but 8 awardees stated the need for additional staff to expand adult immunization program services in health care provider education (n = 5), program administration (n = 5), and site visits (n = 6).

Conclusions: Additional efforts are needed to understand how to better support routine adult immunization activities implemented at the jurisdictional level.

目标:由美国疾病控制与预防中心(CDC)管理的联邦第 317 款免疫计划为成人免疫工作提供资金支持;然而,目前有关该计划在辖区层面实施情况的信息非常有限。我们对 64 个免疫计划("获奖者")利用第 317 款和其他资金来源支持常规成人免疫活动的情况进行了评估:方法:我们于 2022 年 10 月至 12 月对获奖者进行了调查和关键信息员访谈,以收集有关当前由第 317 款和其他资金来源资助的成人疫苗采购和计划运营活动的定量和定性数据。我们使用疾病预防控制中心的 2023 年成本和承受能力工具评估了每个获奖者的疫苗总成本和疫苗采购预测数据:64 位获奖者中有 62 位(97%)的免疫项目经理或其指定人员完成了调查;12 位获奖者参加了关键信息员访谈。在 62 位获奖者中,32 位(52%)使用单一资金来源支持成人疫苗采购,其中 29 位(91%)仅使用第 317 款资金,21 位(34%)报告称未计划在 2023 年采购≥1 种基于年龄的成人推荐疫苗,33 位(53%)报告称仅使用第 317 款资金支持成人免疫项目的运营。关键信息提供者访谈显示,获奖者开展的业务活动各不相同,但有 8 位获奖者表示需要额外的工作人员来扩大成人免疫接种项目服务,包括医疗保健提供者教育(5 位)、项目管理(5 位)和现场访问(6 位):需要进一步努力了解如何更好地支持在辖区一级实施的常规成人免疫接种活动。
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引用次数: 0
Health Equity Requires Working Toward Antiracist Local Public Health Departments. 健康平等要求地方公共卫生部门努力实现反种族主义。
IF 3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 Epub Date: 2024-03-22 DOI: 10.1177/00333549241237382
Melissa S Creary, Whitney Peoples, Paul J Fleming
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引用次数: 0
Rapid Identification of Suspected Drug Overdose Deaths by Death Investigators, New Jersey, 2020. 2020 年新泽西州死亡调查员对疑似吸毒过量死亡的快速识别。
IF 3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 Epub Date: 2024-03-17 DOI: 10.1177/00333549241230921
Karli R Hochstatter, Marlon Williams, Shanna Latham, David Fenton, Andrew L Falzon

Objective: While the number of overdoses in the United States continues to increase, lags in data availability have undermined efforts to monitor, respond to, and prevent drug overdose deaths. We examined the performance of a single-item mandatory radio button implemented into a statewide medical examiner database to identify suspected drug overdose deaths in near-real time.

Materials and methods: The New Jersey Office of the Chief State Medical Examiner operates a statewide mandated case management data system to document deaths that fall under the jurisdiction of a medical examiner office. In 2018, the New Jersey Office of the Chief State Medical Examiner implemented a radio button into the case management data system that requires investigators to report whether a death is a suspected drug overdose death. We examined the performance of this tool by comparing confirmed drug overdose deaths in New Jersey during 2020 with suspected drug overdose deaths identified by investigators using the radio button. To measure performance, we calculated sensitivity, specificity, positive predictive value, negative predictive value, and false-positive and false-negative error rates.

Results: During 2020, New Jersey medical examiners investigated 26 527 deaths: 2952 were confirmed by the state medical examiner as a drug overdose death and 3050 were identified by investigators using the radio button as a suspected drug overdose death. Sensitivity was calculated as 96.1% (2837/2952), specificity as 99.1% (23 362/23 575), positive predictive value as 93.0% (2837/3050), negative predictive value as 99.5% (23 362/23 477), false-positive error rate as 7.0% (213/3050), and false-negative error rate as 3.9% (115/2952).

Practice implications: Implementation of a radio button into death investigation databases provides a simple and accurate method for identifying and tracking drug overdose deaths in near-real time.

目标:虽然美国吸毒过量的人数在持续增加,但数据可用性的滞后却影响了监测、应对和预防吸毒过量死亡的工作。我们研究了在全州法医数据库中实施的单项强制性单选按钮的性能,该按钮可在近乎实时的时间内识别疑似吸毒过量死亡:新泽西州首席法医办公室运营着一个全州范围的强制病例管理数据系统,用于记录法医办公室管辖范围内的死亡病例。2018 年,新泽西州首席法医办公室在病例管理数据系统中设置了一个单选按钮,要求调查人员报告死亡是否为疑似药物过量死亡。我们通过比较 2020 年期间新泽西州确认的吸毒过量死亡病例和调查人员使用单选按钮确定的疑似吸毒过量死亡病例,检查了这一工具的性能。为了衡量性能,我们计算了灵敏度、特异性、阳性预测值、阴性预测值以及假阳性和假阴性错误率:2020 年期间,新泽西州法医调查了 26 527 例死亡:其中 2952 例经州法医确认为药物过量死亡,3050 例由调查人员使用单选按钮确定为疑似药物过量死亡。灵敏度为 96.1%(2837/2952),特异性为 99.1%(23 362/23 575),阳性预测值为 93.0%(2837/3050),阴性预测值为 99.5%(23 362/23 477),假阳性错误率为 7.0%(213/3050),假阴性错误率为 3.9%(115/2952):实践意义:在死亡调查数据库中加入单选按钮为近乎实时地识别和追踪吸毒过量死亡提供了一种简单而准确的方法。
{"title":"Rapid Identification of Suspected Drug Overdose Deaths by Death Investigators, New Jersey, 2020.","authors":"Karli R Hochstatter, Marlon Williams, Shanna Latham, David Fenton, Andrew L Falzon","doi":"10.1177/00333549241230921","DOIUrl":"10.1177/00333549241230921","url":null,"abstract":"<p><strong>Objective: </strong>While the number of overdoses in the United States continues to increase, lags in data availability have undermined efforts to monitor, respond to, and prevent drug overdose deaths. We examined the performance of a single-item mandatory radio button implemented into a statewide medical examiner database to identify suspected drug overdose deaths in near-real time.</p><p><strong>Materials and methods: </strong>The New Jersey Office of the Chief State Medical Examiner operates a statewide mandated case management data system to document deaths that fall under the jurisdiction of a medical examiner office. In 2018, the New Jersey Office of the Chief State Medical Examiner implemented a radio button into the case management data system that requires investigators to report whether a death is a suspected drug overdose death. We examined the performance of this tool by comparing confirmed drug overdose deaths in New Jersey during 2020 with suspected drug overdose deaths identified by investigators using the radio button. To measure performance, we calculated sensitivity, specificity, positive predictive value, negative predictive value, and false-positive and false-negative error rates.</p><p><strong>Results: </strong>During 2020, New Jersey medical examiners investigated 26 527 deaths: 2952 were confirmed by the state medical examiner as a drug overdose death and 3050 were identified by investigators using the radio button as a suspected drug overdose death. Sensitivity was calculated as 96.1% (2837/2952), specificity as 99.1% (23 362/23 575), positive predictive value as 93.0% (2837/3050), negative predictive value as 99.5% (23 362/23 477), false-positive error rate as 7.0% (213/3050), and false-negative error rate as 3.9% (115/2952).</p><p><strong>Practice implications: </strong>Implementation of a radio button into death investigation databases provides a simple and accurate method for identifying and tracking drug overdose deaths in near-real time.</p>","PeriodicalId":20793,"journal":{"name":"Public Health Reports","volume":" ","pages":"549-556"},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluating the Screening and Enrollment of People at Risk of HIV in Mexico's Preexposure Prophylaxis Demonstration Project, 2018-2020. 评估 2018-2020 年墨西哥三暴露预防示范项目中艾滋病毒高危人群的筛查和注册情况。
IF 3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 Epub Date: 2024-03-15 DOI: 10.1177/00333549241230479
Heleen Vermandere, Gisela Martínez-Silva, Santiago Aguilera-Mijares, Araczy Martínez-Dávalos, Sergio Bautista-Arredondo

Objectives: Screening tools in which participants self-report sexual behaviors can identify people at risk of HIV acquisition for enrollment in preexposure prophylaxis (PrEP). We compared enrollment outcomes (ie, receiving PrEP vs being excluded by a counselor or declining PrEP) in Mexico's PrEP demonstration project and evaluated the validity of a 4-criteria PrEP eligibility tool in which participants self-reported risk behavior-having condomless anal sex, transactional sex, a partner living with HIV, or a sexually transmitted infection-as compared with PrEP eligibility assessed by a counselor.

Methods: We recruited men who have sex with men and transwomen who were offered PrEP services in Mexico. We characterized participants according to enrollment outcome and identified underlying factors through logistic regression analyses. We calculated the sensitivity and specificity of the self-reported risk criteria, using the counselor's risk assessment as the point of reference.

Results: Of 2460 participants, 2323 (94%) had risk criteria of HIV acquisition according to the 4-criteria tool; 1701 (73%) received PrEP, 247 (11%) were excluded by a counselor, and 351 (15%) declined PrEP despite being considered eligible by the counselor. Participants who were excluded or who declined PrEP were less likely to report HIV risk behaviors than those who received PrEP, and participants who declined PrEP were more likely to be transwomen (vs men who have sex with men) and aged ≤25 years (vs >25 y). The 4-criteria risk tool had high sensitivity (98.6%) and low specificity (29.8%).

Conclusion: The screening tool identified most participants at risk of HIV acquisition, but counselors' assessment helped refine the decision for enrollment in PrEP by excluding those with low risk. Public health strategies are needed to enhance enrollment in PrEP among some groups.

目的:通过参与者自我报告性行为的筛查工具,可以确定哪些人有感染 HIV 的风险,并将其纳入暴露前预防疗法 (PrEP)。我们比较了墨西哥 PrEP 示范项目的入组结果(即接受 PrEP 与被咨询师排除在外或拒绝接受 PrEP),并评估了 4 项 PrEP 资格标准工具的有效性,该工具由参与者自我报告风险行为--无套肛交、性交易、伴侣感染 HIV 或性传播感染--与咨询师评估的 PrEP 资格进行比较:我们在墨西哥招募了获得 PrEP 服务的男男性行为者和变性女性。我们根据注册结果对参与者进行了特征描述,并通过逻辑回归分析确定了潜在因素。我们以咨询师的风险评估为参考点,计算了自我报告风险标准的敏感性和特异性:在 2460 名参与者中,有 2323 人(94%)根据 4 项标准工具确定了感染 HIV 的风险标准;1701 人(73%)接受了 PrEP,247 人(11%)被咨询师排除在外,351 人(15%)拒绝接受 PrEP,尽管咨询师认为他们符合条件。与接受 PrEP 的参与者相比,被排除在外或拒绝接受 PrEP 的参与者报告 HIV 风险行为的可能性较低,拒绝接受 PrEP 的参与者更有可能是变性女性(与男男性行为者相比)和年龄小于 25 岁(与大于 25 岁相比)。4项标准风险工具的灵敏度高(98.6%),特异性低(29.8%):结论:筛查工具识别出了大多数有感染 HIV 风险的参与者,但咨询师的评估排除了低风险者,有助于完善加入 PrEP 的决定。需要采取公共卫生策略来提高某些群体的 PrEP 注册率。
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引用次数: 0
Differences in Cesarean Rates for Nulliparous, Term, Singleton, Vertex Births Among Racial and Ethnic Groups and States Before and After Stay-at-Home Orders During the COVID-19 Pandemic, United States, 2017-2021. 2017-2021年美国COVID-19大流行期间,各种族和族裔群体以及各州在下达居家分娩令前后无痛分娩、足月分娩、单胎分娩、顶点分娩的剖宫产率差异。
IF 3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-01 Epub Date: 2024-03-19 DOI: 10.1177/00333549241236629
Khaleel S Hussaini, Romeo Galang, Rui Li

Objectives: Evidence is limited on differences in cesarean rates for nulliparous, term, singleton, vertex (NTSV) births across racial and ethnic groups at the national and state level during the COVID-19 pandemic. We assessed changes in levels and trends of NTSV cesarean rates before and after stay-at-home orders (SAHOs) were implemented in the United States (1) overall, (2) by racial and ethnic groups, and (3) by 50 US states from January 2017 through December 2021.

Methods: We used birth certificate data from 2017 through 2021, restricted to hospital births, to calculate monthly NTSV cesarean rates for the United States and for racial and ethnic groups and to calculate quarterly NTSV cesarean rates for the 50 states. We used interrupted time-series analysis to measure changes in NTSV cesarean rates before and after implementation of SAHOs (March 1 through May 31, 2020).

Results: Of 6 022 552 NTSV hospital births, 1 579 645 (26.2%) were cesarean births. Before implementation of SAHOs, NTSV cesarean rates were declining in the United States overall; were declining among births to non-Hispanic Asian, non-Hispanic Black, Hispanic, and non-Hispanic White women; and were declining in 6 states. During the first month of implementation of SAHOs in May 2020, monthly NTSV rates increased in the United States by 0.55%. Monthly NTSV rates increased by 1.20% among non-Hispanic Black women, 0.90% among Hispanic women, and 0.28% among non-Hispanic White women; quarterly NTSV rates increased in 6 states.

Conclusion: In addition to emergency preparedness planning, hospital monitoring, and reporting of NTSV cesarean rates to increase provider awareness, reallocation and prioritization of resources may help to identify potential strains on health care systems during public health emergencies such as the COVID-19 pandemic.

目标:在 COVID-19 大流行期间,关于全国和各州不同种族和民族的无产钳、足月、单胎、顶点(NTSV)分娩剖宫产率差异的证据很有限。我们评估了美国从 2017 年 1 月到 2021 年 12 月实施居家分娩令(SAHOs)前后 NTSV 剖宫产率水平和趋势的变化:(1)总体变化;(2)按种族和民族群体划分;(3)按美国 50 个州划分:我们使用 2017 年至 2021 年的出生证明数据(仅限于医院分娩),计算了美国以及种族和民族群体的每月 NTSV 剖宫产率,并计算了 50 个州的季度 NTSV 剖宫产率。我们使用间断时间序列分析法来衡量 SAHOs 实施前后(2020 年 3 月 1 日至 5 月 31 日)NTSV 剖宫产率的变化:在 6 022 552 例 NTSV 住院分娩中,1 579 645 例(26.2%)为剖宫产。在实施SAHOs之前,美国的NTSV剖宫产率总体呈下降趋势;非西班牙裔亚裔、非西班牙裔黑人、西班牙裔和非西班牙裔白人产妇的NTSV剖宫产率呈下降趋势;6个州的NTSV剖宫产率呈下降趋势。在2020年5月实施SAHOs的第一个月,美国的月NTSV率上升了0.55%。非西班牙裔黑人妇女的月 NTSV 发生率上升了 1.20%,西班牙裔妇女上升了 0.90%,非西班牙裔白人妇女上升了 0.28%;6 个州的季度 NTSV 发生率有所上升:除了应急准备计划、医院监测和报告 NTSV 剖宫产率以提高医疗服务提供者的意识外,资源的重新分配和优先排序可能有助于在 COVID-19 大流行等公共卫生突发事件期间识别医疗系统的潜在压力。
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引用次数: 0
Characteristics of People Who Do Not Complete a Public Health Interview: An Assessment of Colorado Enteric Disease Surveillance Data. 未完成公共卫生访谈者的特征:科罗拉多州肠道疾病监测数据评估。
IF 3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-31 DOI: 10.1177/00333549241269483
Amanda D Tran, Alice E White, Rachel H Jervis, Ingrid Hewitson, Elaine J Scallan Walter

Objectives: Although enteric disease case interviews are critical for control measures and education, not all case-patients are interviewed. We evaluated systematic differences between people with an enteric disease in Colorado who were and were not interviewed to identify ways to increase response rates and reduce biases in the surveillance data used to guide public health interventions.

Methods: We obtained data from the Colorado Electronic Disease Reporting System from March 1, 2017, through December 31, 2019. Among case-patients not interviewed and interviewed, we used univariate analyses to describe sociodemographic characteristics, timing of contact attempts, and effect of additional funding.

Results: As compared with case-patients who were interviewed, case-patients who were not interviewed were significantly more likely to be aged 18 to 39 years (35.7% vs 31.7%; P < .001); identify as male, Hispanic, or Black; be experiencing homelessness or hospitalization; reside in rural/frontier areas or an institution; or live in areas with lower levels of education, life expectancy, and income. Time to first contact attempt was longer for case-patients who were not interviewed than for those who were (mean days from specimen collection to first contact attempt, 9.8 vs 6.8; P < .001). Residing in a jurisdiction with additional funding for interviewing was associated with increased interview rates (87.7% vs 68.8%) and timeliness of public health report and first contact attempt (2.3 vs 4.4 days; P < .001).

Conclusion: Findings can guide efforts to improve response rates in groups least likely to be interviewed, resulting in reduced biases in surveillance data, better disease mitigation, and increased efficiency in case investigations. Timeliness of case interviews and additional funding to conduct case investigations were factors in increasing response rates.

目标:尽管肠道疾病病例访谈对于控制措施和教育至关重要,但并非所有病例患者都接受了访谈。我们评估了科罗拉多州接受和未接受访谈的肠道疾病患者之间的系统性差异,以确定提高响应率和减少用于指导公共卫生干预的监测数据偏差的方法:我们从科罗拉多州电子疾病报告系统中获取了 2017 年 3 月 1 日至 2019 年 12 月 31 日期间的数据。在未接受访谈和接受访谈的病例患者中,我们使用单变量分析来描述社会人口学特征、尝试联系的时间以及额外资金的影响:结果:与接受访谈的病例患者相比,未接受访谈的病例患者年龄在 18 岁至 39 岁之间的比例明显更高(35.7% 对 31.7%;P P P P 结论:研究结果可以指导我们提高响应率的工作:研究结果可以指导我们努力提高最不可能接受访谈的群体的回复率,从而减少监测数据的偏差,更好地缓解疾病,并提高病例调查的效率。病例访谈的及时性和开展病例调查的额外资金是提高应答率的因素。
{"title":"Characteristics of People Who Do Not Complete a Public Health Interview: An Assessment of Colorado Enteric Disease Surveillance Data.","authors":"Amanda D Tran, Alice E White, Rachel H Jervis, Ingrid Hewitson, Elaine J Scallan Walter","doi":"10.1177/00333549241269483","DOIUrl":"10.1177/00333549241269483","url":null,"abstract":"<p><strong>Objectives: </strong>Although enteric disease case interviews are critical for control measures and education, not all case-patients are interviewed. We evaluated systematic differences between people with an enteric disease in Colorado who were and were not interviewed to identify ways to increase response rates and reduce biases in the surveillance data used to guide public health interventions.</p><p><strong>Methods: </strong>We obtained data from the Colorado Electronic Disease Reporting System from March 1, 2017, through December 31, 2019. Among case-patients not interviewed and interviewed, we used univariate analyses to describe sociodemographic characteristics, timing of contact attempts, and effect of additional funding.</p><p><strong>Results: </strong>As compared with case-patients who were interviewed, case-patients who were not interviewed were significantly more likely to be aged 18 to 39 years (35.7% vs 31.7%; <i>P</i> < .001); identify as male, Hispanic, or Black; be experiencing homelessness or hospitalization; reside in rural/frontier areas or an institution; or live in areas with lower levels of education, life expectancy, and income. Time to first contact attempt was longer for case-patients who were not interviewed than for those who were (mean days from specimen collection to first contact attempt, 9.8 vs 6.8; <i>P</i> < .001). Residing in a jurisdiction with additional funding for interviewing was associated with increased interview rates (87.7% vs 68.8%) and timeliness of public health report and first contact attempt (2.3 vs 4.4 days; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>Findings can guide efforts to improve response rates in groups least likely to be interviewed, resulting in reduced biases in surveillance data, better disease mitigation, and increased efficiency in case investigations. Timeliness of case interviews and additional funding to conduct case investigations were factors in increasing response rates.</p>","PeriodicalId":20793,"journal":{"name":"Public Health Reports","volume":" ","pages":"333549241269483"},"PeriodicalIF":3.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142111367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Developing and Implementing a Diversity, Equity, and Inclusion Curriculum Self-reflection Process at a School of Public Health. 在公共卫生学院开发和实施多样性、公平和包容课程的自我反思过程。
IF 3 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-27 DOI: 10.1177/00333549241271728
Stacy Davis, Devin English, Stephanie Shiau, Rajita Bhavaraju, Shauna Downs, Gwyneth M Eliasson, Kristen D Krause, Emily V Merchant, Tess Olsson, Michelle M Ruidíaz-Santiago, Nimit N Shah, Laura E Liang, Teri Lassiter

We critically reviewed the motivations, processes, and implementation methods underlying a faculty-driven diversity, equity, and inclusion (DEI) curriculum self-reflection project in the Rutgers School of Public Health. This case study offers guidance on a curriculum self-reflection tool that was developed through the school's Curriculum Committee to promote DEI throughout the school's curricula. We review the key steps in this process and the unique aspects of developing and implementing such evaluations within higher education. The study draws on faculty experience, was informed by students and staff within the Curriculum Committee, and builds on existing knowledge and tools. A flexible 6-step framework-including guiding principles and strategic approaches to planning, developing, and implementing a DEI curriculum self-assessment-is provided to assist instructors, curriculum committees, DEI groups, and academic leaders at schools of public health interested in refining their courses and curricula. Academic units experience contextual challenges, and while each is at a different stage in curriculum reform, our findings provide lessons about integrating the assessment of DEI in school curriculum in a systematic and iterative way. Our approach can be applied to diverse academic settings, including those experiencing similar implementation challenges.

我们对罗格斯大学公共卫生学院由教师推动的多样性、公平性和包容性(DEI)课程自我反思项目的动机、过程和实施方法进行了严格审查。本案例研究为课程自我反思工具提供了指导,该工具是通过学校的课程委员会开发的,目的是在学校的整个课程中促进多元化、公平和包容(DEI)。我们回顾了这一过程中的关键步骤,以及在高等教育中开发和实施此类评估的独特之处。这项研究借鉴了教师的经验,听取了课程委员会学生和教职员工的意见,并以现有的知识和工具为基础。本研究提供了一个灵活的 6 步框架,包括规划、开发和实施发展与教育课程自我评估的指导原则和战略方法,以帮助公共卫生学院的教师、课程委员会、发展与教育小组以及有兴趣完善其课程和教学大纲的学术带头人。各学术单位都面临着不同的挑战,虽然每个单位在课程改革中都处于不同的阶段,但我们的研究结果为以系统和迭代的方式在学校课程中整合 DEI 评估提供了经验。我们的方法可以应用于不同的学术环境,包括那些遇到类似实施挑战的学术环境。
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Public Health Reports
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