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We compared the rates of hospital-onset secondary bacterial infections in patients with coronavirus disease 2019 (COVID-19) with rates in patients with influenza and controls, and we investigated reports of increased incidence of Enterococcus infections in patients with COVID-19.
Retrospective cohort study.
An academic quaternary-care hospital in San Francisco, California.
Patients admitted between October 1, 2019, and October 1, 2020, with a positive SARS-CoV-2 PCR (N = 314) or influenza PCR (N = 82) within 2 weeks of admission were compared with inpatients without positive SARS-CoV-2 or influenza tests during the study period (N = 14,332).
National Healthcare Safety Network definitions were used to identify infection-related ventilator-associated complications (IVACs), probable ventilator-associated pneumonia (PVAP), bloodstream infections (BSIs), and catheter-associated urinary tract infections (CAUTIs). A multiple logistic regression model was used to control for likely confounders.
COVID-19 patients had significantly higher rates of IVAC and PVAP compared to controls, with adjusted odds ratios of 4.7 (95% confidence interval [CI], 1.7–13.9) and 10.4 (95 % CI, 2.1–52.1), respectively. COVID-19 patients had higher incidence of BSI due to Enterococcus but not BSI generally, and whole-genome sequencing of Enterococcus isolates demonstrated that nosocomial transmission did not explain the increased rate. Subanalyses of patients admitted to the intensive care unit and patients who required mechanical ventilation revealed similar findings.
COVID-19 is associated with an increased risk of IVAC, PVAP, and Enterococcus BSI compared with hospitalized controls, which is not fully explained by factors such as immunosuppressive treatments and duration of mechanical ventilation. The mechanism underlying increased rates of Enterococcus BSI in COVID-19 patients requires further investigation.
To evaluate the relationships between maternal fish consumption and pregnancy outcomes in a large, population-based sample of women in the USA.
We collected average fish consumption prior to pregnancy using a modified version of the semi-quantitative Willett FFQ. We estimated adjusted OR (aOR) and 95 % CI for associations between different levels of fish consumption and preterm birth (<37 weeks), early preterm birth (<32 and <35 weeks) and small-for-gestational-age infants (SGA; <10th percentile).
The National Birth Defects Prevention Study (NBDPS).
Control mother–infant pairs with estimated delivery dates between 1997 and 2011 (n 10 919).
No significant associations were observed between fish consumption and preterm birth or early preterm birth (aOR = 0·7–1·0 and 0·7–0·9, respectively). The odds of having an SGA infant were elevated (aOR = 2·1; 95 % CI 1·2, 3·4) among women with daily fish consumption compared with women consuming fish less than once per month. No associations were observed between other levels of fish consumption and SGA (aOR = 0·8–1·0).
High intake of fish was associated with twofold higher odds of having an SGA infant, while moderate fish consumption prior to pregnancy was not associated with preterm or SGA. Our study, like many other studies in this area, lacked information regarding preparation methods and the specific types of fish consumed. Future studies should incorporate information on nutrient and contaminant contents, preparation methods and biomarkers to assess these relationships.
The Blueprint for Transparency at the FDA recommends that the FDA proactively release more clinical trial data. We show that the FDA possesses the legal authority to act on this recommendation, and describe several reasons that the agency should do so. In particular, the primary existing route for researchers to obtain access to this data, the Freedom of Information Act (FOIA), has important limits, as our own recent experience shows.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
We characterized evacuations related to Hurricane Sandy, which made landfall in New Jersey on October 29, 2012.
We analyzed data from the 2014 New Jersey Behavioral Risk Factor Survey. The proportion of respondents reporting evacuation was used to estimate the number of New Jersey adults who evacuated. We determined evacuation rates in heavily impacted and less-impacted municipalities, as well as evacuation rates for municipalities under and not under mandatory evacuation orders. We tested associations between demographic and health factors, such as certain chronic health conditions, and evacuation.
Among respondents, 12.7% (95% CI: 11.8%-13.6%) reported evacuating, corresponding to approximately 880,000 adults. In heavily impacted municipalities, 17.0% (95% CI: 15.2%-18.7%) evacuated, compared with 10.1% (95% CI: 9.0%-11.2%) in less-impacted municipalities. In municipalities under mandatory evacuation orders, 42.5% (95% CI: 35.1%-49.8%) evacuated, compared with 11.8% (95% CI: 10.9%-12.9%) in municipalities not under mandatory orders. Female gender (odds ratio [OR]: 1.36; 95% CI: 1.14-1.64), unmarried status (OR: 1.22; 95% CI: 1.02-1.46), shorter length of residence (OR: 1.28; 95% CI: 1.03-1.60), and living in a heavily impacted municipality (OR: 1.84; 95% CI: 1.54-2.20) were significantly associated with evacuation. History of stroke (OR: 1.61; 95% CI: 1.02-2.53) was the only chronic condition associated with evacuation.
Approximately 880,000 New Jersey adults evacuated because of Hurricane Sandy. Those in heavily impacted municipalities and municipalities under mandatory evacuation orders had higher evacuation rates; however, still fewer than half evacuated. These findings can be used for future disaster planning. (Disaster Med Public Health Preparedness. 2017;11:720–728).
Evacuation and damage following a widespread natural disaster may affect short-term access to medical care. We estimated medical care needs in New Jersey following Hurricane Sandy in 2012.
Hurricane Sandy-related questions regarding medical needs included in the Behavioral Risk Factor Surveillance System survey were administered to survey respondents living in New Jersey when Sandy occurred.
Recently arrived foreign-born residents were more likely than US-born residents to need medical care following Sandy. Others with greater medical needs included the uninsured and evacuees. Persons who evacuated or lived in areas that experienced the greatest hurricane impact were less likely to be able to fill a prescription. Only 15% of New Jerseyans were aware of the Emergency Pharmaceutical Assistance Program (EPAP), a federal program which allows prescription refills for the uninsured following a disaster. Recently arrived foreign-born residents and the uninsured were less frequently aware of EPAP: 8.7% and 10.9%.
Populations with impaired access to care in normal times—such as the recently arrived foreign-born and the uninsured—were also at risk of compromised access in the hurricane’s aftermath. Measures to address prescription refills during a disaster need better promotion among at-risk populations. (Disaster Med Public Health Preparedness. 2016;10:485–491)
Studies with members of the armed forces have found a gap between reports
of mental health symptoms and treatment-seeking.
To assess the impact of attitudes on treatment-seeking behaviours in
soldiers returning from a combat deployment.
A sample of 529 US soldiers were surveyed 4 months (time 1) and 12 months
(time 2) post-deployment. Mental health symptoms and treatment-seeking
attitudes were assessed at time 1; reported mental healthcare visits were
assessed at time 2.
Factor analysis of the total time 1 sample revealed four attitude
factors: professional concerns, practical barriers, preference for
self-management and positive attitudes about treatment. For the subset of
160 soldiers reporting a mental health problem at time 1, and controlling
for mental health symptom severity, self-management inversely predicted
treatment-seeking; positive attitudes were positively related.
Results demonstrate the importance of broadening the conceptualisation of
barriers and facilitators of mental healthcare beyond stigma. Techniques
and delivery models emphasising self-care may help increase soldiers'
interest in using mental health services.
A trend toward greater body size in dizygotic (DZ) than in monozygotic (MZ) twins has been suggested by some but not all studies, and this difference may also vary by age. We analyzed zygosity differences in mean values and variances of height and body mass index (BMI) among male and female twins from infancy to old age. Data were derived from an international database of 54 twin cohorts participating in the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins), and included 842,951 height and BMI measurements from twins aged 1 to 102 years. The results showed that DZ twins were consistently taller than MZ twins, with differences of up to 2.0 cm in childhood and adolescence and up to 0.9 cm in adulthood. Similarly, a greater mean BMI of up to 0.3 kg/m2 in childhood and adolescence and up to 0.2 kg/m2 in adulthood was observed in DZ twins, although the pattern was less consistent. DZ twins presented up to 1.7% greater height and 1.9% greater BMI than MZ twins; these percentage differences were largest in middle and late childhood and decreased with age in both sexes. The variance of height was similar in MZ and DZ twins at most ages. In contrast, the variance of BMI was significantly higher in DZ than in MZ twins, particularly in childhood. In conclusion, DZ twins were generally taller and had greater BMI than MZ twins, but the differences decreased with age in both sexes.
Lithium was associated with significantly reduced non-suicide mortality in the intent-to-treat cohort over 0–90 days (hazard ratio (HR) = 0.67, 95% CI 0.51–0.87) but not longer. In secondary analyses, a sizeable reduction in mortality was observed during active treatment with lithium across all time periods studied (for example 365-day HR = 0.62, 95% CI 0.45–0.84), but significantly increased risks were observed among patients discontinuing lithium by 180 days (HR = 1.54, 95% CI 1.01–2.37).
Patients initiating lithium had lower non-suicide mortality over 0–90 days than patients initiating valproate and consistently lower non-suicide mortality among patients maintaining treatment, but elevated risk among patients discontinuing treatment by 180 days. Although residual confounding or selection effects cannot be excluded, this study suggests potential benefits to enhancing lithium treatment persistence and the monitoring of patients discontinuing lithium. There is a need for further research.
A new measurement technique using a cantilever probe with an integrated thermal sensor is investigated for measuring thermal conductivity at the nanometer scale. The probe is used in a configuration wherein the laser from an atomic force microscope (AFM) heats the tip of the probe above ambient temperature. Heat is transferred from the probe to a sample based on the thermal conductivity of the sample. The heat flow creates a temperature change, as small as 0.01 °C, which is detected by the thermal sensor. The measurement technique presented offers a simple and effective method for mapping the thermal conductivity of a number of materials. We explore the ability of the technique to map silicon oxide on silicon, carbon fibers and gold nanoparticles. Analysis shows that the technique can be used to produce images with a thermal resolution surpassing 25 nm.
On May 7-9, 2012, obesity prevention leaders, including public health professionals across federal, state and local levels, policymakers and decision makers, community leaders as well as researchers engaged in policy, systems and environmental (PSE) efforts related to obesity prevention, convened at the Weight of the Nation (WON) conference in Washington, D.C. In recognition of the growing interest in the relationship between the food system and public health, and obesity in particular, organizers of the WON invited leading experts from multiple disciplines to work as a committee to plan five sessions related to these topics. These experts decided to expand the focus of the sessions to include public drinking water systems and to organize sessions with the goal of identifying solutions to create a healthy, sustainable, and equitable food and water system. This paper presents the key themes, challenges, and potential solutions and discussed within the Food and Water System: Agriculture, Access and Sustainability track (hereinafter referred to as the “Food and Water System Track”).