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Maglaque D, Master M, von Esenwein S, Gazmararian J, Clark CJ, Blake SC. Addressing the Community Resource and Social Service Needs of Families During the COVID-19 Pandemic: Perspectives of Home Visiting Staff and Clients in Georgia. Matern Child Health J 2024; 28:804-811. [PMID: 38261275 DOI: 10.1007/s10995-023-03866-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Home visiting programs provide support services to families and their children to promote positive health outcomes. This study sought to describe strategies employed by home visiting programs during the early phase of the COVID-19 pandemic to address the community resource and social service needs of home visiting clients in Georgia. METHODS We conducted a mixed methods study between December 2020 and April 2021 using online surveys and key informant interviews of home visiting staff and clients from 21 program sites. Structured content analysis was conducted of the triangulated data to elicit thematic findings. RESULTS Due to the pandemic-induced economic conditions, clients expressed increased demand for housing, employment, and childcare support services. Staff experienced challenges with client referrals to these services because of interruptions in social service availability and transitions to virtual services. In response to these challenges, home visiting programs strengthened existing community partnerships and created new collaborations with local agencies to fill any gaps in services. DISCUSSION Home visiting programs in Georgia provided critical linkages to community resources for families during the early phase of the pandemic. Preserving this essential home visiting service in future national emergencies will require improved coordination of community resources and social services.
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Affiliation(s)
- Dianne Maglaque
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA.
| | - Margaret Master
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Silke von Esenwein
- Center for Public Partnerships and Research, University of Kansas, 1617 St. Andrews Drive, Lawrence, KS, 66047, USA
| | - Julie Gazmararian
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Cari Jo Clark
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Sarah C Blake
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
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Ross-Driscoll K, Ayuk-Arrey AT, Lynch R, McCullough LE, Roccaro G, Nephew L, Hundley J, Rubin RA, Patzer R. Disparities in Access to Liver Transplant Referral and Evaluation among Patients with Hepatocellular Carcinoma in Georgia. Cancer Res Commun 2024; 4:1111-1119. [PMID: 38517133 PMCID: PMC11034460 DOI: 10.1158/2767-9764.crc-23-0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/16/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024]
Abstract
Liver transplantation offers the best survival for patients with early-stage hepatocellular carcinoma (HCC). Prior studies have demonstrated disparities in transplant access; none have examined the early steps of the transplant process. We identified determinants of access to transplant referral and evaluation among patients with HCC with a single tumor either within Milan or meeting downstaging criteria in Georgia.Population-based cancer registry data from 2010 to 2019 were linked to liver transplant centers in Georgia. Primary cohort: adult patients with HCC with a single tumor ≤8 cm in diameter, no extrahepatic involvement, and no vascular involvement. Secondary cohort: primary cohort plus patients with multiple tumors confined to one lobe. We estimated time to transplant referral, evaluation initiation, and evaluation completion, accounting for the competing risk of death. In sensitivity analyses, we also accounted for non-transplant cancer treatment.Among 1,379 patients with early-stage HCC in Georgia, 26% were referred to liver transplant. Private insurance and younger age were associated with increased likelihood of referral, while requiring downstaging was associated with lower likelihood of referral. Patients living in census tracts with ≥20% of residents in poverty were less likely to initiate evaluation among those referred [cause-specific hazard ratio (csHR): 0.62, 95% confidence interval (CI): 0.42-0.94]. Medicaid patients were less likely to complete the evaluation once initiated (csHR: 0.53, 95% CI: 0.32-0.89).Different sociodemographic factors were associated with each stage of the transplant process among patients with early-stage HCC in Georgia, emphasizing unique barriers to access and the need for targeted interventions at each step. SIGNIFICANCE Among patients with early-stage HCC in Georgia, age and insurance type were associated with referral to liver transplant, race, and poverty with evaluation initiation, and insurance type with evaluation completion. Opportunities to improve transplant access include informing referring providers about insurance requirements, addressing barriers to evaluation initiation, and streamlining the evaluation process.
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Affiliation(s)
- Katherine Ross-Driscoll
- Division of Transplantation, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
- Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia
| | | | - Raymond Lynch
- Division of Transplantation, Department of Surgery, Pennsylvania State University School of Medicine, Hershey, Pennsylvania
| | - Lauren E. McCullough
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Giorgio Roccaro
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Lauren Nephew
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Jonathan Hundley
- Piedmont Transplant Institute, Piedmont Healthcare, Atlanta, Georgia
| | - Raymond A. Rubin
- Piedmont Transplant Institute, Piedmont Healthcare, Atlanta, Georgia
| | - Rachel Patzer
- Division of Transplantation, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
- Regenstrief Institute, Indianapolis, Indiana
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Kaur Singh H, Prakash-Asrani R, Pall A, Ray SM, Tobin-D’Angelo M, Fridkin SK. Quantifying racial disparities in risk of invasive Staphylococcus aureus infection in Metropolitan Atlanta, Georgia, during the 2020-2021 coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2024; 45:534-536. [PMID: 38149355 PMCID: PMC11007357 DOI: 10.1017/ice.2023.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 12/28/2023]
Abstract
We estimated the racial disparity in rates of invasive S. aureus infections based on community coronavirus disease 2019 (COVID-19) rates at the county level. Our data suggest that COVID-19 infection burden (1) affects not only hospital-onset MRSA invasive infection risk but also community-onset S. aureus invasive infection risk and (2) affects Black residents ∼60% more than White residents.
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Affiliation(s)
- Herveen Kaur Singh
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Allison Pall
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta, Georgia
- Atlanta Veterans’ Affairs Health System, Atlanta, Georgia
| | - Susan M. Ray
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta, Georgia
| | | | - Scott K. Fridkin
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
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Anderson AT, Mack WJ, Horiuchi SS, Paulukonis S, Zhou M, Snyder AB, Doctor JN, Kipke M, Coates T, Freed G. National Quality Indicators in Pediatric Sickle Cell Anemia. Pediatrics 2024; 153:e2022060804. [PMID: 38444343 PMCID: PMC10982541 DOI: 10.1542/peds.2022-060804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE To assess nationally endorsed claims-based quality measures in pediatric sickle cell anemia (SCA). METHODS Using data from the Sickle Cell Data Collection programs in California and Georgia from 2010 to 2019, we evaluated 2 quality measures in individuals with hemoglobin S/S or S/β-zero thalassemia: (1) the proportion of patients aged 3 months to 5 years who were dispensed antibiotic prophylaxis for at least 300 days within each measurement year and (2) the proportion of patients aged 2 to 15 years who received at least 1 transcranial Doppler ultrasound (TCD) within each measurement year. We then evaluated differences by year and tested whether performance on quality measures differed according to demographic and clinical factors. RESULTS Only 22.2% of those in California and 15.5% in Georgia met or exceeded the quality measure for antibiotic prophylaxis, with increased odds associated with rural residence in Georgia (odds ratio 1.61; 95% confidence interval 1.21-2.14) compared with urban residence and a trend toward increased odds associated with a pediatric hematologist prescriber (odds ratio 1.28; 95% confidence interval 0.97, 1.69) compared with a general pediatrician. Approximately one-half of the sample received an annual assessment of stroke risk using TCD (47.4% in California and 52.7% in Georgia), with increased odds each additional year in both states and among younger children. CONCLUSIONS The rates of receipt of recommended antibiotic prophylaxis and annual TCD were low in this sample of children with SCA. These evidence-based quality measures can be tracked over time to help identify policies and practices that maximize survival in SCA.
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Affiliation(s)
- Ashaunta T. Anderson
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Wendy J. Mack
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | | | - Mei Zhou
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | - Angela B. Snyder
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | - Jason N. Doctor
- Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, Los Angeles, California
| | - Michele Kipke
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Thomas Coates
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Gary Freed
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
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Saber LB, Kennedy SS, Yang Y, Moore KN, Wang Y, Hilton SP, Chang TY, Liu P, Phillips VL, Akiyama MJ, Moe CL, Spaulding AC. Correlation of SARS-CoV-2 in Wastewater and Individual Testing Results in a Jail, Atlanta, Georgia, USA. Emerg Infect Dis 2024; 30:S21-S27. [PMID: 38561638 PMCID: PMC10986836 DOI: 10.3201/eid3013.230775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Institution-level wastewater-based surveillance was implemented during the COVID-19 pandemic, including in carceral facilities. We examined the relationship between COVID-19 diagnostic test results of residents in a jail in Atlanta, Georgia, USA (average population ≈2,700), and quantitative reverse transcription PCR signal for SARS-CoV-2 in weekly wastewater samples collected during October 2021‒May 2022. The jail offered residents rapid antigen testing at entry and periodic mass screenings by reverse transcription PCR of self-collected nasal swab specimens. We aggregated individual test data, calculated the Spearman correlation coefficient, and performed logistic regression to examine the relationship between strength of SARS-CoV-2 PCR signal (cycle threshold value) in wastewater and percentage of jail population that tested positive for COVID-19. Of 13,745 nasal specimens collected, 3.9% were COVID-positive (range 0%-29.5% per week). We observed a strong inverse correlation between diagnostic test positivity and cycle threshold value (r = -0.67; p<0.01). Wastewater-based surveillance represents an effective strategy for jailwide surveillance of COVID-19.
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Tsai MH, Cabral DN, Grunert C, Moore JX. Colorectal cancer survival disparities in the five regions of Georgia. PLoS One 2024; 19:e0301027. [PMID: 38547204 PMCID: PMC10977806 DOI: 10.1371/journal.pone.0301027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND/OBJECTIVE The objective of this study was to examine 5-year colorectal cancer survival rates. We also determined whether demographics, tumor characteristics, and treatment modality were associated with 5-year CRC survival in the Clayton, West Central, East Central, Southeast, and Northeast Georgia regions because the significant higher CRC mortality rates in these regions in comparison to the overall rates in the State of Georgia. METHODS We conducted a retrospective cohort analysis using data from the 1975-2016 Surveillance, Epidemiology, and End Results program aggregated CRC patients to these five regions. Five-year CRC survival was calculated and stratified by the five regions of Georgia, using the Kaplan-Meier method with log-rank test. Cox proportional hazard regression was used to examine the mentioned association in these five regions. RESULTS Among 11,023 CRC patients, 5-year CRC survival was lowest in Clayton (65.9%) compared to the West Central (69.0%), East Central (68.2%), Southeast (70.5%), and Northeast regions (69.5%) (p-value = 0.02). In multivariable analysis, greater risk of CRC death was found in the Clayton region compared to the West Central (HR, 1.12; 95%, 1.00-1.25) region when adjusting for demographics, tumor characteristics, and treatment modality. Among Clayton Georgians, age of 75+ years (HR, 2.13; 95%, 1.56-2.89), grade 3 & 4 tumors (HR, 2.22; 95%, 1.64-3.00), and distant stage (HR, 20.95; 95%, 15.99-27.45) were negatively associated with CRC survival. CONCLUSION We observed place-based differences in CRC survival with significantly lower survival rates in the Clayton region. Factors associated with higher risk of CRC death include older age at diagnosis, high-grade tumors, and distant stage CRC among Clayton Georgians. Our study provides important evidence to all relevant stakeholders in furthering the development of culturally tailored CRC screening interventions aimed at CRC early detection and improved outcomes.
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Affiliation(s)
- Meng-Han Tsai
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, Georgia, United States of America
- Georgia Prevention Institute, Augusta University, Augusta, Georgia, United States of America
| | - Daramola N. Cabral
- Department of Health, Human Services, and Public Policy, College of Health Sciences and Human Services, California State University, Monterey Bay, Seaside, California, United States of America
- African Caribbean Cancer Consortium, Philadelphia, Pennsylvania, United States of America
| | - Caitlyn Grunert
- Department of Health Management and Policy, University of Kentucky, Lexington, Kentucky, United States of America
| | - Justin X. Moore
- Center for Health Equity Transformation, Department of Behavioral Science, Department of Internal Medicine, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
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Philpott DC, Bonacci RA, Weidle PJ, Curran KG, Brooks JT, Khalil G, Feldpausch A, Pavlick J, Wortley P, O'Shea JG. Low CD4 Count or Being Out of Care Increases the Risk for Mpox Hospitalization Among People With Human Immunodeficiency Virus and Mpox. Clin Infect Dis 2024; 78:651-654. [PMID: 37590957 PMCID: PMC10873466 DOI: 10.1093/cid/ciad482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/27/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023] Open
Abstract
Human immunodeficiency virus (HIV)-associated immunosuppression may increase the risk of hospitalization with mpox. Among persons diagnosed with mpox in the state of Georgia, we characterized the association between hospitalization with mpox and HIV status. People with HIV and a CD4 count <350 cells/mm3 or who were not engaged in HIV care had an increased risk of hospitalization.
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Affiliation(s)
- David C Philpott
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert A Bonacci
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul J Weidle
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn G Curran
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John T Brooks
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - George Khalil
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Jesse G O'Shea
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Warren JL, Mariotto AB, Stevens J, Davidoff AJ, Shankaran V, Ward KC, Wu XC, Schwartz SM, Penberthy L, Yabroff KR. Association of Major Adverse Financial Events and Later-Stage Cancer Diagnosis in the United States. J Clin Oncol 2024; 42:1001-1010. [PMID: 38320222 PMCID: PMC10950180 DOI: 10.1200/jco.23.01067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 02/08/2024] Open
Abstract
PURPOSE This study assessed the prevalence of specific major adverse financial events (AFEs)-bankruptcies, liens, and evictions-before a cancer diagnosis and their association with later-stage cancer at diagnosis. METHODS Patients age 20-69 years diagnosed with cancer during 2014-2015 were identified from the Seattle, Louisiana, and Georgia SEER population-based cancer registries. Registry data were linked with LexisNexis consumer data to identify patients with a history of court-documented AFEs before cancer diagnosis. The association of AFEs and later-stage cancer diagnoses (stages III/IV) was assessed using separate sex-specific multivariable logistic regression. RESULTS Among 101,649 patients with cancer linked to LexisNexis data, 36,791 (36.2%) had a major AFE reported before diagnosis. The mean and median timing of the AFE closest to diagnosis were 93 and 77 months, respectively. AFEs were most common among non-Hispanic Black, unmarried, and low-income patients. Individuals with previous AFEs were more likely to be diagnosed with later-stage cancer than individuals with no AFE (males-odds ratio [OR], 1.09 [95% CI, 1.03 to 1.14]; P < .001; females-OR, 1.18 [95% CI, 1.13 to 1.24]; P < .0001) after adjusting for age, race, marital status, income, registry, and cancer type. Associations between AFEs prediagnosis and later-stage disease did not vary by AFE timing. CONCLUSION One third of newly diagnosed patients with cancer had a major AFE before their diagnosis. Patients with AFEs were more likely to have later-stage diagnosis, even accounting for traditional measures of socioeconomic status that influence the stage at diagnosis. The prevalence of prediagnosis AFEs underscores financial vulnerability of patients with cancer before their diagnosis, before any subsequent financial burden associated with cancer treatment.
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Affiliation(s)
- Joan L. Warren
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD
| | - Angela B. Mariotto
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD
| | | | - Amy J. Davidoff
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD
| | - Veena Shankaran
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Kevin C. Ward
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Xiao-Cheng Wu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Stephen M. Schwartz
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Lynne Penberthy
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD
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Reeves SL, Horiuchi S, Zhou M, Paulukonis S, Snyder A, Wilson-Frederick S, Hulihan M. Case Ascertainment of Sickle Cell Disease Using Surveillance or Single Administrative Database Case Definitions. Public Health Rep 2024; 139:187-194. [PMID: 37204194 PMCID: PMC10851905 DOI: 10.1177/00333549231166465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE In the absence of access to surveillance system data, single-source administrative databases are often used to study health care utilization and health outcomes among people with sickle cell disease (SCD). We compared the case definitions from single-source administrative databases with a surveillance case definition to identify people with SCD. MATERIALS AND METHODS We used data from Sickle Cell Data Collection programs in California and Georgia (2016-2018). The surveillance case definition for SCD developed for the Sickle Cell Data Collection programs uses multiple databases, including newborn screening, discharge databases, state Medicaid programs, vital records, and clinic data. Case definitions for SCD in single-source administrative databases varied by database (Medicaid and discharge) and years of data (1, 2, and 3 years). We calculated the proportion of people meeting the surveillance case definition for SCD that was captured by each single administrative database case definition for SCD, by birth cohort, sex, and Medicaid enrollment. RESULTS In California, 7117 people met the surveillance case definition of SCD from 2016 through 2018; 48% of this group was captured by the Medicaid case definition and 41% by the discharge case definition. In Georgia, 10 448 people met the surveillance case definition of SCD from 2016 through 2018; 45% of this group was captured by the Medicaid case definition and 51% by the discharge case definition. These proportions differed by years of data, birth cohort, and length of Medicaid enrollment. PRACTICE IMPLICATIONS The surveillance case definition identified twice as many people with SCD as the single-source administrative database definitions during the same period, but trade-offs exist in using single administrative databases for decisions on policy and program expansion for SCD.
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Affiliation(s)
- Sarah L. Reeves
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics and Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sophia Horiuchi
- Tracking California, Public Health Institute, Oakland, CA, USA
| | - Mei Zhou
- Andrew Young School of Policy Studies, Georgia Health Policy Center, Georgia State University, Atlanta, GA, USA
| | | | - Angela Snyder
- Andrew Young School of Policy Studies, Georgia Health Policy Center, Georgia State University, Atlanta, GA, USA
| | | | - Mary Hulihan
- Epidemiology and Surveillance Branch, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Coffman E, Rappold AG, Nethery RC, Anderton J, Amend M, Jackson MA, Roman H, Fann N, Baker KR, Sacks JD. Quantifying Multipollutant Health Impacts Using the Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE): A Case Study in Atlanta, Georgia. Environ Health Perspect 2024; 132:37003. [PMID: 38445893 PMCID: PMC10916644 DOI: 10.1289/ehp12969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 11/28/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Air pollution risk assessments do not generally quantify health impacts using multipollutant risk estimates, but instead use results from single-pollutant or copollutant models. Multipollutant epidemiological models account for pollutant interactions and joint effects but can be computationally complex and data intensive. Risk estimates from multipollutant studies are therefore challenging to implement in the quantification of health impacts. OBJECTIVES Our objective was to conduct a case study using a developmental multipollutant version of the Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE) to estimate the health impact associated with changes in multiple air pollutants using both a single and multipollutant approach. METHODS BenMAP-CE was used to estimate the change in the number of pediatric asthma emergency department (ED) visits attributable to simulated changes in air pollution between 2011 and 2025 in Atlanta, Georgia, applying risk estimates from an epidemiological study that examined short-term single-pollutant and multipollutant (with and without first-order interactions) exposures. Analyses examined individual pollutants (i.e., ozone, fine particulate matter, carbon monoxide, nitrogen dioxide (NO 2 ), sulfur dioxide, and particulate matter components) and combinations of these pollutants meant to represent shared properties or predefined sources (i.e., oxidant gases, secondary pollutants, traffic, power plant, and criteria pollutants). Comparisons were made between multipollutant health impact functions (HIF) and the sum of single-pollutant HIFs for the individual pollutants that constitute the respective pollutant groups. RESULTS Photochemical modeling predicted large decreases in most of the examined pollutant concentrations between 2011 and 2025 based on sector specific (i.e., source-based) estimates of growth and anticipated controls. Estimated number of avoided asthma ED visits attributable to any given multipollutant group were generally higher when using results from models that included interaction terms in comparison with those that did not. We estimated the greatest number of avoided pediatric asthma ED visits for pollutant groups that include NO 2 (i. e., criteria pollutants, oxidants, and traffic pollutants). In models that accounted for interaction, year-round estimates for pollutant groups that included NO 2 ranged from 27.1 [95% confidence interval (CI): 1.6, 52.7; traffic pollutants] to 55.4 (95% CI: 41.8, 69.0; oxidants) avoided pediatric asthma ED visits. Year-round results using multipollutant risk estimates with interaction were comparable to the sum of the single-pollutant results corresponding to most multipollutant groups [e.g., 52.9 (95% CI: 43.6, 62.2) for oxidants] but were notably lower than the sum of the single-pollutant results for some pollutant groups [e.g., 77.5 (95% CI: 66.0, 89.0) for traffic pollutants]. DISCUSSION Performing a multipollutant health impact assessment is technically feasible but computationally complex. It requires time, resources, and detailed input parameters not commonly reported in air pollution epidemiological studies. Results estimated using the sum of single-pollutant models are comparable to those quantified using a multipollutant model. Although limited to a single study and location, assessing the trade-offs between a multipollutant and single-pollutant approach is warranted. https://doi.org/10.1289/EHP12969.
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Affiliation(s)
- Evan Coffman
- Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency (US EPA), Research Triangle Park, North Carolina, USA
| | - Ana G. Rappold
- Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency (US EPA), Research Triangle Park, North Carolina, USA
| | - Rachel C. Nethery
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jim Anderton
- Industrial Economics, Inc., Cambridge, Massachusetts, USA
| | - Meredith Amend
- Industrial Economics, Inc., Cambridge, Massachusetts, USA
| | | | - Henry Roman
- Industrial Economics, Inc., Cambridge, Massachusetts, USA
| | - Neal Fann
- Office of Air Quality Planning and Standards, Office of Air and Radiation, US EPA, Research Triangle Park, North Carolina, USA
| | - Kirk R. Baker
- Office of Air Quality Planning and Standards, Office of Air and Radiation, US EPA, Research Triangle Park, North Carolina, USA
| | - Jason D. Sacks
- Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency (US EPA), Research Triangle Park, North Carolina, USA
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Barber LE, Maliniak ML, Nash R, Moubadder L, Haynes D, Ward KC, McCullough LE. A Comparison of Three Area-Level Indices of Neighborhood Deprivation and Socioeconomic Status and their Applicability to Breast Cancer Mortality. J Urban Health 2024; 101:75-79. [PMID: 38158547 PMCID: PMC10897108 DOI: 10.1007/s11524-023-00811-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
Neighborhood deprivation indices are widely used in research, but the performance of these indices has rarely been directly compared in the same analysis. We examined the Area Deprivation Index, Neighborhood Deprivation Index, and Yost index, and compared their associations with breast cancer mortality. Indices were constructed for Georgia census block groups using 2011-2015 American Community Survey data. Pearson correlation coefficients and percent agreement were calculated. Associations between each index and breast cancer mortality were estimated among 36,795 women diagnosed with breast cancer using Cox proportional hazards regression. The indices were strongly correlated (absolute value of correlation coefficients > 0.77), exhibited moderate (41.4%) agreement, and were similarly associated with a 36% increase in breast cancer mortality. The similar associations with breast cancer mortality suggest the indices measure the same underlying construct, despite only moderate agreement. By understanding their correlations, agreement, and associations with health outcomes, researchers can choose the most appropriate index for analysis.
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Affiliation(s)
- Lauren E Barber
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA.
| | - Maret L Maliniak
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Rebecca Nash
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Leah Moubadder
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - David Haynes
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Kevin C Ward
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Lauren E McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
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12
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Tsai M, Vernon M, Su S, Coughlin SS, Dong Y. Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia. Cancer Med 2024; 13:e6954. [PMID: 38348574 PMCID: PMC10904969 DOI: 10.1002/cam4.6954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/15/2023] [Accepted: 01/10/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The study's purpose was to examine 5-year colorectal cancer (CRC) survival rates between White and Black patients. We also determined whether regional socioeconomic status (SES) is associated with CRC survival between White and Black patients in the Clayton, West Central, East Central, Southeast, and Northeast Georgia public health districts. METHODS We performed a retrospective cohort analysis using data from the 1975 to 2016 Surveillance, Epidemiology, and End Results program. The 2015 United States Department of Agriculture Economic Research Services county typology codes were used to identify region-level SES with persistent poverty, low employment, and low education. Kaplan-Meier method and Cox proportional hazard regression were performed. RESULTS Among 10,876 CRC patients (31.1% Black patients), 5-year CRC survival rates were lower among Black patients compared to White patients (65.4% vs. 69.9%; p < 0.001). In multivariable analysis, White patients living in regions with persistent poverty had a 1.1-fold increased risk of CRC death (HR, 1.12; 95% CI, 1.00-1.25) compared to those living in non-persistent poverty regions. Among Black patients, those living in regions with low education were at a 1.2-fold increased risk of CRC death (HR, 1.19; 95% CI, 1.01-1.40) compared to those living in non-low education regions. DISCUSSION AND CONCLUSIONS Black patients demonstrated lower CRC survival rates in Georgia compared to their White counterparts. White patients living in regions with persistent poverty, and Black patients living in regions with low education had an increased risk of CRC death. Our findings provide important evidence to all relevant stakeholders in allocating health resources aimed at CRC early detection and prevention and timely referral for CRC treatment by considering the patient's regional SES in Georgia.
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Affiliation(s)
- Meng‐Han Tsai
- Cancer Prevention, Control & Population Health Program, Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
| | - Marlo Vernon
- Cancer Prevention, Control & Population Health Program, Georgia Cancer CenterAugusta UniversityAugustaGeorgiaUSA
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
| | - Shaoyong Su
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
| | - Steven S. Coughlin
- Department of Biostatistics, Data Science and EpidemiologyAugusta UniversityAugustaGeorgiaUSA
| | - Yanbin Dong
- Georgia Prevention Institute, Augusta UniversityAugustaGeorgiaUSA
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13
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Montgomery A, Basey S, Baucom L, Scoggins C. Stress and suicidal ideation among first-generation farmers: A cross-sectional study with 1,288 farmers in Georgia. J Rural Health 2024; 40:75-86. [PMID: 37095593 DOI: 10.1111/jrh.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/14/2023] [Accepted: 04/13/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The suicide rate among farmers is higher than that of the overall working population. Literature on farmer mental health in Georgia (GA) has been scarce and mostly focused on suicide as a result. Literature on stressors or coping are mostly qualitative studies. This study looks at the influence of being a first-generation farmer on farm-related stressors and coping mechanisms. METHODS This cross-sectional study inventories mental well-being, stressors, and coping mechanisms for different types of farmers in GA, USA. The online survey ran from January 2022 through April 2022. Participants (N = 1,288) were asked about demographics, work descriptors, health care access, specific stressors, stress levels, and coping mechanisms. FINDINGS Two-thirds of our sample were first-generation farmers. First-generation farmers had a higher stress score on average, as well as being more likely to feel depressed, and feel hopeless. They also showed less diverse coping mechanisms than generational farmers, with alcohol in their top 3 coping mechanisms. First-generation farmers were also much more likely to experience suicidal ideation: 9% daily and 61% at least once in the past year (vs generational: 1% daily; 20% once in the past year). Binary logistic regression indicated that having more diverse coping mechanisms is a protective factor against suicidal ideation within the previous year. The same model indicated that being a farm owner or farm manager, being first-generation, being unhappy with one's role, feeling sad or depressed, and feeling hopeless were all risk factors. CONCLUSIONS First-generation farmers experience more stress and exhibit more risk factors for suicidal ideation than generational farmers.
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Affiliation(s)
- Anne Montgomery
- Georgia Rural Health Innovation Center at Mercer University, Macon, Georgia, USA
- School of Medicine, Mercer University, Macon, Georgia, USA
| | - Stephanie Basey
- Georgia Rural Health Innovation Center at Mercer University, Macon, Georgia, USA
- School of Medicine, Mercer University, Macon, Georgia, USA
| | - Lily Baucom
- Georgia Foundation for Agriculture, Macon, Georgia, USA
| | - Chris Scoggins
- Georgia Rural Health Innovation Center at Mercer University, Macon, Georgia, USA
- School of Medicine, Mercer University, Macon, Georgia, USA
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14
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Haskins DL, Brown MK, Meichner K, Coleman AL, Allender MC, Tuberville TD. Factors Predicting Apparent Ophidiomycosis in Wild Brown Watersnakes (Nerodia taxispilota). J Wildl Dis 2024; 60:64-76. [PMID: 37823517 DOI: 10.7589/jwd-d-23-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/21/2023] [Indexed: 10/13/2023]
Abstract
Ophidiomycosis, also known as snake fungal disease, is caused by Ophidiomyces ophidiicola and is a threat to snake conservation worldwide. Ophidiomycosis has been reported throughout much of the eastern US, and outbreaks have been associated with local population declines of already strained populations. Previous studies report significant variability in ophidiomycosis among species sampled, with higher prevalence typically observed in Nerodia spp. Although ophidiomycosis can lead to morbidity and mortality in affected individuals, little is known about disease dynamics in free-ranging populations. Herein, we examine how individual-specific factors (e.g., life stage [immature, mature], contaminant status, sex, hemograms) may be associated with ophidiomycosis status in the brown watersnake (Nerodia taxispilota). During 2018-19, we sampled 97 N. taxispilota from five locations along the Savannah River in South Carolina and Georgia, US. Ophidiomyces ophidiicola DNA was detected in 66 snakes for a prevalence of 68% (95% confidence interval, 59-77). Mature snakes had a significantly higher risk of apparent ophidiomycosis (skin lesions present and quantitative PCR [qPCR], positive) relative to immature snakes. Snakes classified as having possible (skin lesions present, but qPCR negative) or apparent ophidiomycosis exhibited a relative azurophilia and heterophilia compared with individuals classified as negative (P≤0.037). Nerodia taxispilota in this region appear to have a high prevalence of apparent ophidiomycosis (22%; 95% CI, 14-31), similar to previous reports from the southeastern US. Additional epidemiologic investigations are warranted to further elucidate other individual-specific and environmental factors that may dictate disease risk and outcomes in affected populations.
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Affiliation(s)
- David L Haskins
- University of Georgia's Savannah River Ecology Laboratory, Aiken, South Carolina 29802, USA
- Warnell School of Forestry and Natural Resources, University of Georgia, Athens, Georgia 30602, USA
| | - M Kyle Brown
- University of Georgia's Savannah River Ecology Laboratory, Aiken, South Carolina 29802, USA
- Warnell School of Forestry and Natural Resources, University of Georgia, Athens, Georgia 30602, USA
| | - Kristina Meichner
- Department of Pathology, University of Georgia's College of Veterinary Medicine, Athens, Georgia 30602, USA
| | - Austin L Coleman
- University of Georgia's Savannah River Ecology Laboratory, Aiken, South Carolina 29802, USA
| | - Matthew C Allender
- Wildlife Epidemiology Laboratory, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois 61802, USA
- Brookfield Zoo, Chicago Zoological Society, Brookfield, Illinois 60513, USA
| | - Tracey D Tuberville
- University of Georgia's Savannah River Ecology Laboratory, Aiken, South Carolina 29802, USA
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Pantha B, Mohammed-Awel J, Vaidya NK. Effects of vaccination on the two-strain transmission dynamics of COVID-19: Dougherty County, Georgia, USA, as a case study. Math Med Biol 2023; 40:308-326. [PMID: 37963602 DOI: 10.1093/imammb/dqad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 08/16/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023]
Abstract
The emergence of multiple strains of SARS-COV-2 has made it complicated to predict and control the COVID-19 pandemic. Although some vaccines have been effective in reducing the severity of the disease, these vaccines are designed for a specific strain of the virus and are usually less effective for other strains. In addition, the waning of vaccine-induced immunity, reinfection of recovered people, and incomplete vaccination are challenging to the vaccination program. In this study, we developed a detailed model to describe the multi-strain transmission dynamics of COVID-19 under vaccination. We implemented our model to examine the impact of inter-strain transmission competition under vaccination on the critical outbreak indicators: hospitalized cases, undiagnosed cases, basic reproduction numbers, and the overtake-time by a new strain to the existing strain. In particular, our results on the dependence of the overtake-time on vaccination rates, progression-to-infectious rate, and relative transmission rates provide helpful information for managing a pandemic with circulating two strains. Furthermore, our results suggest that a reduction in the relative transmission rates and a decrease in vaccination dropout rates or an increase in vaccination rates help keep the reproduction number of both strains below unity and keep the number of hospitalized cases and undiagnosed cases at their lowest levels. Moreover, our analysis shows that the second and booster-dose vaccinations are useful for further reducing the reproduction number.
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Affiliation(s)
- Buddhi Pantha
- Abraham Baldwin Agricultural College, Tifton, GA, USA
| | | | - Naveen K Vaidya
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA, USA
- Computational Science Research Center, San Diego State University, San Diego, CA, USA
- Viral Information Institute, San Diego State University, San Diego, CA, USA
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16
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Roth KB, Gaveras E, Ghiathi F, Shaw EK, Shoemaker MS, Howard NA, Dhir M, Caiza GR, Szlyk HS. A Community-Engaged Approach to Understanding Suicide in a Small Rural County in Georgia: A Two-Phase Content Analysis of Individual and Focus Group Interviews. Int J Environ Res Public Health 2023; 20:7145. [PMID: 38131697 PMCID: PMC10743163 DOI: 10.3390/ijerph20247145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
Suicide is a significant public health problem, with disproportionate rates in rural areas. Rural communities face substantial structural and cultural barriers to suicide prevention. This study aimed to gain a deeper understanding of the need for suicide prevention and gauge the appropriateness of prevention efforts in the context of a rural Georgia county by leveraging existing community resources and knowledge. Twenty one-on-one, semi-structured interviews and two focus groups were conducted, with participants recruited via purposive snowball sampling. Data analysis included qualitative deductive and inductive content analysis from individual interviews and focus groups with community stakeholders. The findings highlight how rural contexts exacerbate drivers of death by suicide and how the substantial loss of community members to suicide contributes to the ongoing crisis and reduces available support. Access to mental health care often depended on a connection to an established public system such as schools, a military base, or Veterans Administration. There were perceived gaps in crisis and post-crisis services, with participants actively trying to address these gaps and build community support through coalition building. This study contributes knowledge to contextual drivers of suicide in rural areas beyond individual-level risk factors. Community-engaged suicide prevention research in rural areas is promising, but there is a need to develop interventions to best support coalition building and capacity development.
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Affiliation(s)
- Kimberly Beth Roth
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Eleni Gaveras
- Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA;
| | - Fatima Ghiathi
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Eric Kendall Shaw
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Melanie Shanlin Shoemaker
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Nicholas Adam Howard
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Meena Dhir
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Genesis Rebeca Caiza
- Department of Community Medicine, School of Medicine, Mercer University, 1250 E 66th Street, Savannah, GA 31404, USA; (F.G.); (E.K.S.); (M.S.S.); (N.A.H.); (M.D.); (G.R.C.)
| | - Hannah Selene Szlyk
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA;
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17
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Kachikis A, Schiff MA, Moore K, Chapple-McGruder T, Arluck J, Hitti J. Risk Factors Associated with Congenital Syphilis, Georgia, 2008-2015. Infect Dis Obstet Gynecol 2023; 2023:3958406. [PMID: 38026087 PMCID: PMC10651339 DOI: 10.1155/2023/3958406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Congenital syphilis (CS) is associated with significant perinatal morbidity and mortality. The study objectives were to compare risk factors among women with syphilis infection whose pregnancies did and did not result in CS cases and to evaluate other geographic and socioeconomic characteristics of county of residence as a measure of healthcare inequity. Methods This study linked maternal and congenital syphilis data from the Georgia Department of Public Health (DPH), 2008-2015. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline was followed. Demographic, behavioral, and case characteristics were compared among women with syphilis infection who did and did not have an infant with CS. Chi-square, Fisher's exact, and multivariate regression analyses were performed using STATA 14.2 (College Station, TX). Results Of 505 women with syphilis infection, 23% had an infant with CS, while 77% did not. After adjusting for race/ethnicity, factors associated with CS outcome were age greater than 35 years (adjusted odds ratio (aOR) 3.88; 95% confidence interval (CI) 1.01-14.89), hospital/emergency department diagnosis of syphilis (aOR 3.43; 95% CI 1.54-7.62), and high-risk behaviors such as exchanging sex for money or drugs (aOR 3.25; 95% CI 1.18-8.98). There were no associations between characteristics of county of residence and CS outcome. Conclusions This study highlights risk factors that may be associated with CS incidence and the adverse pregnancy outcomes associated with CS. Further work is needed to study improved data collection systems, contributing factors related to CS as well as prevention measures in the United States.
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Affiliation(s)
- Alisa Kachikis
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Melissa A. Schiff
- Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | | | | | - Jessica Arluck
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Jane Hitti
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
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Wehrle CJ, Quinones PM, Smith HT, Fox ED, Holsten SB, Lawson A. Assessing the Impact of Hands-Free Georgia on Serious Motor Vehicle Accidents. Am Surg 2023; 89:4789-4792. [PMID: 36284492 DOI: 10.1177/00031348221136575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Hands-Free Georgia Law (HB673) was designed to prevent motor vehicle collisions (MVCs) by banning drivers from using their hands for non-driving-related activities, including cell phone use. We investigate HB673 effect on trauma activations secondary to MVCs in Georgia. METHODS The Georgia Trauma Registry (GTR) was queried for MVCs from 2017 to 2019, representing the 18 months prior and following implementation of HB673. The number of MVCs for each period and severity of MVC designated by the average injury severity score (ISS) for each trauma activation were collected. RESULTS Prior to implementation, a total of 43 080 traumas were recorded in GTR, 11 111 (25.8%) were attributed to an MVC. Following implementation, 12 130 (23.6%) occurred secondary to MVCs. Statewide MVC-related traumas per 1000 residents increased from 1.07 to 1.14 with increased mortality rate and unchanged median ISS per MVC. CONCLUSIONS The Hands-Free Georgia Law seems to have not had a major reduction in mortality in its early implementation.
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Affiliation(s)
- Chase J Wehrle
- Medical College of Georgiaat Augusta University, Augusta, GA, USA
| | | | - Hallie T Smith
- Medical College of Georgiaat Augusta University, Augusta, GA, USA
| | - Elizabeth D Fox
- Department of Surgery, Medical College of Georgiaat Augusta University, Augusta, GA, USA
| | - Steven B Holsten
- Department of Surgery, Medical College of Georgiaat Augusta University, Augusta, GA, USA
| | - Andrew Lawson
- Department of Surgery, Medical College of Georgiaat Augusta University, Augusta, GA, USA
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Stanhope KK, Kapila P, Umerani A, Hossain A, Abu-Salah M, Singisetti V, Carter S, Boulet SL. Political representation and perinatal outcomes to Black, White, and Hispanic people in Georgia: a cross-sectional study. Ann Epidemiol 2023; 87:S1047-2797(23)00167-9. [PMID: 37689094 PMCID: PMC10842944 DOI: 10.1016/j.annepidem.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/24/2023] [Accepted: 09/05/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE Our goal was to estimate differences in perinatal outcomes by racial differences in political representation, a measure of structural racism. METHODS We gathered data on the racial composition of county-level elected officials for all counties in Georgia (n = 159) in 2022. We subtracted the percent of non-White elected officials from the percent of non-White residents to calculate the "representation difference," with greater positive values indicating a larger disparity. We linked this to data from 2020-2021 birth certificates (n = 238,795) on outcomes (preterm birth, <37 weeks, low birthweight birth <2500 g, birthweight, hypertensive disorders of pregnancy, cesarean delivery). We fit log binomial and linear models with generalized estimating equations, stratified by individual race/ethnicity and including individual and county covariates. RESULTS Median representation difference was 17.5% points (interquartile range: 17.2). A 25-percentile point increase in representation difference was associated with a greater risk of hypertensive disorders of pregnancy [White: adjusted risk ratio (RR): 1.12, 95% confidence interval (CI): (1.05, 1.2), Black: 1.06, 95% CI: (0.95, 1.17), other: 1.14, 95% CI: (1.0, 1.3), Hispanic: 1.19, 95% CI: (1.07, 1.32)] and lower mean birthweight for Black birthing people [adjusted beta -15.3, 95% CI: (-25.5, -7.4)]. CONCLUSIONS Parity in political representation may be associated with healthier environments.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.
| | - Pari Kapila
- Emory College of Arts and Sciences, Atlanta, GA
| | | | | | | | | | - Sierra Carter
- Department of Psychology, Georgia State University, Atlanta
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA
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Fang D, Guo L, Hughes MC, Tan J. Dynamic Patterns and Modeling of Early COVID-19 Transmission by Dynamic Mode Decomposition. Prev Chronic Dis 2023; 20:E95. [PMID: 37884317 PMCID: PMC10625432 DOI: 10.5888/pcd20.230089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Understanding the transmission patterns and dynamics of COVID-19 is critical to effective monitoring, intervention, and control for future pandemics. The aim of this study was to investigate the spatial and temporal characteristics of COVID-19 transmission during the early stage of the outbreak in the US, with the goal of informing future responses to similar outbreaks. METHODS We used dynamic mode decomposition (DMD) and national data on COVID-19 cases (April 6, 2020-October 9, 2020) to model the spread of COVID-19 in the US as a dynamic system. DMD can decompose the complex evolution of disease cases into linear combinations of simple spatial patterns or structures (modes) with time-dependent mode amplitudes (coefficients). The modes reveal the hidden dynamic behaviors of the data. We identified geographic patterns of COVID-19 spread and quantified time-dependent changes in COVID-19 cases during the study period. RESULTS The magnitude analysis from the dominant mode in DMD showed that California, Louisiana, Kansas, Georgia, and Texas had higher numbers of COVID-19 cases than other areas during the study period. States such as Arizona, Florida, Georgia, Massachusetts, New York, and Texas showed simultaneous increases in the number of COVID-19 cases, consistent with data from the Centers for Disease Control and Prevention. CONCLUSION Results from DMD analysis indicate that certain areas in the US shared similar trends and similar spatiotemporal transmission patterns of COVID-19. These results provide valuable insights into the spread of COVID-19 and can inform policy makers and public health authorities in designing and implementing mitigation interventions.
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Affiliation(s)
- Dehong Fang
- Department of Mechanical Engineering, Northern Illinois University, 1425 W Lincoln Hwy, DeKalb, IL 60115
| | - Lei Guo
- School of Interdisciplinary Health Professions, Northern Illinois University, DeKalb, Illinois
| | - M Courtney Hughes
- School of Health Studies, Northern Illinois University, DeKalb, Illinois
| | - Jifu Tan
- Department of Mechanical Engineering, Northern Illinois University, DeKalb, Illinois
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Sakhelashvili I, Spruyt K. The interaction between stress and sleep disorders among foreign medical students in Georgia. Sleep Med 2023; 110:225-230. [PMID: 37647713 DOI: 10.1016/j.sleep.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES This study aimed to: a. Investigate daytime sleepiness, stress, and pre-sleep arousal prevalence among foreign medical students in Georgia. b. Explore gender-based associations between sleep and stress parameters. METHODS Mental health was assessed in 207 foreign medical students in Georgia using the Epworth Sleepiness Scale (ESS), Pre-Sleep Arousal Scale (PSAS), and Student-Life Stress Inventory (SLSI). RESULTS Most participants reported elevated stress levels and excessive daytime sleepiness (EDS). EDS affected 25.1% of students, with slightly higher prevalence in males. PSAS was prevalent in 97.1% of students. Stress was widely reported, with 78% experiencing it, with a higher prevalence in females. Significant correlations were observed between sleepiness and arousal, including somatic (r = 0.41) and total scores (r = 0.28). Sleepiness was also linked to stressors like pressure, changes, self-imposed stress, and overall self-evaluation stress (r = 0.45). Strong correlations existed between ESS, Total PSAS, and overall self-evaluation SLSI scores for both genders. Gender differences were observed in the associations with Cohen's d within the small to moderate size. Men showed significant associations between ESS and stressors: conflict, pressure, chances, all stress reaction categories, and total SLSI scores (p < 0.001). In women, ESS correlated significantly only with overall self-evaluation (p < 0.001). Excessive daytime sleepiness, especially with somatic and total PSAS, predicted total SLSI scores for the entire sample and both genders, with stronger predictive values for total PSAS. CONCLUSION The study reveals a high prevalence of clinical sleepiness and its significant correlation with pre-sleep arousal and stress among foreign medical students, with females experiencing more difficulties than males.
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Affiliation(s)
- Irine Sakhelashvili
- Georgian -American University, Medical School, M. Aleksidze Str, Tbilisi, 0160, Georgia.
| | - Karen Spruyt
- INSERM UMR 1141 NeuroDiderot, Hôpital Robert Debré, Bâtiment Bingen, Point Jaune-3ème et 4ème Etages, 48, boulevard Sérurier, 75019, Paris, France.
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22
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Gottdenker NL, Nascimento Ramos RA, Hakimi H, McHale B, Rivera S, Miller BM, Howerth EW, Burrell CE, Stilwell JM, McManamon R, Verocai GG. Angiostrongylus cantonensis Infection in Brown Rats (Rattus norvegicus), Atlanta, Georgia, USA, 2019-2022. Emerg Infect Dis 2023; 29:2167-2170. [PMID: 37735783 PMCID: PMC10521602 DOI: 10.3201/eid2910.230706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
Rat lungworm (Angiostrongylus cantonensis), a zoonotic parasite invasive to the United States, causes eosinophilic meningoencephalitis. A. cantonensis harbors in rat reservoir hosts and is transmitted through gastropods and other paratenic hosts. We discuss the public health relevance of autochthonous A. cantonensis cases in brown rats (Rattus norvegicus) in Atlanta, Georgia, USA.
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23
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Gamkrelidze A, Shadaker S, Tsereteli M, Alkhazashvili M, Chitadze N, Tskhomelidze I, Gvinjilia L, Khetsuriani N, Handanagic S, Averhoff F, Cloherty G, Chakhunashvili G, Drobeniuc J, Imnadze P, Zakhashvili K, Armstrong PA. Nationwide Hepatitis C Serosurvey and Progress Towards Hepatitis C Virus Elimination in the Country of Georgia, 2021. J Infect Dis 2023; 228:684-693. [PMID: 36932731 PMCID: PMC10506179 DOI: 10.1093/infdis/jiad064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The country of Georgia initiated its hepatitis C virus (HCV) elimination program in 2015, at which point a serosurvey showed the adult prevalence of HCV antibody (anti-HCV) and HCV RNA to be 7.7% and 5.4%, respectively. This analysis reports hepatitis C results of a follow-up serosurvey conducted in 2021, and progress towards elimination. METHODS The serosurvey used a stratified, multistage cluster design with systematic sampling to include adults and children (aged 5-17 years) providing consent (or assent with parental consent). Blood samples were tested for anti-HCV and if positive, HCV RNA. Weighted proportions and 95% confidence intervals (CI) were compared with 2015 age-adjusted estimates. RESULTS Overall, 7237 adults and 1473 children were surveyed. Among adults, the prevalence of anti-HCV was 6.8% (95% CI, 5.9-7.7). The HCV RNA prevalence was 1.8% (95% CI, 1.3-2.4), representing a 67% reduction since 2015. HCV RNA prevalence decreased among those reporting risk factors of ever injecting drugs (51.1% to 17.8%), and ever receiving a blood transfusion (13.1% to 3.8%; both P < .001). No children tested positive for anti-HCV or HCV RNA. CONCLUSIONS These results demonstrate substantial progress made in Georgia since 2015. These findings can inform strategies to meet HCV elimination targets.
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Affiliation(s)
| | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maia Tsereteli
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | | | - Lia Gvinjilia
- Eastern Europe and Central Asia Regional Office, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | - Nino Khetsuriani
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Senad Handanagic
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Francisco Averhoff
- Abbott Diagnostics, Abbott Park, IL, USA
- Abbott Pandemic Defense Coalition, Abbott Park, IL, USA
| | - Gavin Cloherty
- Abbott Diagnostics, Abbott Park, IL, USA
- Abbott Pandemic Defense Coalition, Abbott Park, IL, USA
| | | | - Jan Drobeniuc
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paata Imnadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Paige A. Armstrong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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24
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Mehrotra A, Munakata N, Maal-Bared R, Gerrity D, Sabater J, Bessler S. Wastewater-Based Surveillance Does Not Belong in a Regulatory Framework Designed to Protect Waters That Receive Treated Wastewater. Comment on Wright, T.; Adhikari, A. Utilizing a National Wastewater Monitoring Program to Address the U.S. Opioid Epidemic: A Focus on Metro Atlanta, Georgia. Int. J. Environ. Res. Public Health 2023, 20, 5282. Int J Environ Res Public Health 2023; 20:6636. [PMID: 37681776 PMCID: PMC10487102 DOI: 10.3390/ijerph20176636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
We read with great interest the work by Wright and Adhikari on "Utilizing a National Wastewater Monitoring Program to Address the U.S. Opioid Epidemic: A Focus on Metro Atlanta, Georgia" [...].
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Affiliation(s)
- Anna Mehrotra
- Water Environment Federation, Alexandra, VA 22314, USA;
| | - Naoko Munakata
- Los Angeles County Sanitation Districts, Whittier, CA 90601, USA;
| | | | - Daniel Gerrity
- Southern Nevada Water Authority, Las Vegas, NV 89193, USA;
| | | | - Scott Bessler
- Metropolitan Sewer District of Greater Cincinnati, Cincinnati, OH 45204, USA;
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25
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Gvinjilia L, Baliashvili D, Shadaker S, Averhoff F, Kandelaki L, Kereselidze M, Tsertsvadze T, Chkhartishvili N, Butsashvili M, Metreveli D, Gamkrelidze A, Armstrong PA. Impact of Hepatitis C Virus Infection and Treatment on Mortality in the Country of Georgia, 2015-2020. Clin Infect Dis 2023; 77:405-413. [PMID: 37099136 PMCID: PMC10527899 DOI: 10.1093/cid/ciad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Mortality related to hepatitis C virus (HCV) infection is a key indicator for elimination. We assessed the impact of HCV infection and treatment on mortality in the country of Georgia during 2015-2020. METHODS We conducted a population-based cohort study using data from Georgia's national HCV Elimination Program and death registry. We calculated all-cause mortality rates in 6 cohorts: (1) Negative for anti-HCV; (2) anti-HCV positive, unknown viremia status; (3) current HCV infection and untreated; (4) discontinued treatment; (5) completed treatment, no sustained virologic response (SVR) assessment; (6) completed treatment and achieved SVR. Cox proportional hazards models were used to calculate adjusted hazards ratios and confidence intervals. We calculated the cause-specific mortality rates attributable to liver-related causes. RESULTS After a median follow-up of 743 days, 100 371 (5.7%) of 1 764 324 study participants died. The highest mortality rate was observed among HCV infected patients who discontinued treatment (10.62 deaths per 100 PY, 95% confidence interval [CI]: 9.65, 11.68), and untreated group (10.33 deaths per 100 PY, 95% CI: 9.96, 10.71). In adjusted Cox proportional hazards model, the untreated group had almost 6-times higher hazard of death compared to treated groups with or without documented SVR (adjusted hazard ratio [aHR] = 5.56, 95% CI: 4.89, 6.31). Those who achieved SVR had consistently lower liver-related mortality compared to cohorts with current or past exposure to HCV. CONCLUSIONS This large population-based cohort study demonstrated the marked beneficial association between hepatitis C treatment and mortality. The high mortality rates observed among HCV infected and untreated persons highlights the need to prioritize linkage to care and treatment to achieve elimination goals.
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Affiliation(s)
- Lia Gvinjilia
- Eastern Europe and Central Asia Regional Office, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | | | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Francisco Averhoff
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Levan Kandelaki
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Maia Kereselidze
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Clinic "Hepa," Tbilisi, Georgia
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | | | | | - Amiran Gamkrelidze
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Paige A Armstrong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Goldstein MH, Moore S, Mohamed M, Byrd R, Curtis MG, Rice WS, Camacho-Gonzalez A, Zanoni BC, Hussen SA. A qualitative analysis examining intersectional stigma among young adults living with HIV in Atlanta, Georgia. PLoS One 2023; 18:e0289821. [PMID: 37561729 PMCID: PMC10414665 DOI: 10.1371/journal.pone.0289821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
HIV-related stigma is a barrier to engagement in care for young adults living with HIV. Other intersecting forms of stigma (e.g., racism, sexism, homophobia), may worsen HIV-related stigma and impact engagement in care. From November 2020 to February 2021, we conducted 20 in-depth qualitative interviews among young adults living with HIV attending a large, comprehensive HIV care center in Atlanta, Georgia. Semi-structured interview guides based on Earnshaw and Chaudoir's HIV Stigma Framework and the theory of intersectionality facilitated discussion around experiences with various forms of stigma and its possible influence on healthcare engagement. Using the social-ecological model, we used thematic analysis to contextualize how young adults living with HIV experienced intersectional stigma and enacted, anticipated, and internalized HIV stigma in both healthcare and non-healthcare settings. Most participants identified as male, Black/African American, and gay. Participants described stigma at intrapersonal, interpersonal, clinic, and community levels. Intrapersonal stigma was associated with delayed care seeking, isolation, and fear of disclosure. Interpersonal stigma included discrimination from family and friends and avoidance of close relationships to elude disclosure. At the clinic level, stigma included negative experiences with staff in HIV and non-HIV healthcare settings, which contributed to decreased engagement in care. Stigma in the community included differential treatment from employers, community leaders, and religious community and was associated with feelings of helplessness related to current societal inequalities. Coping/motivating mechanisms for stigma included prioritizing health, eliciting support from the medical care team and peers. Our findings show different intersecting stigmas are barriers to healthcare at multiple levels for young adults living with HIV, potentially exacerbating existing health and social disparities. To improve engagement in care among young adults living with HIV, future interventions should address the different mechanisms of stigma at community, clinic, interpersonal and intrapersonal levels by enhancing social support and improving healthcare structural competency.
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Affiliation(s)
- Madeleine H. Goldstein
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Shamia Moore
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Munira Mohamed
- College of Arts and Sciences, Emory University, Atlanta, GA, United States of America
| | - Rosalind Byrd
- School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Michael G. Curtis
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Whitney S. Rice
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Andres Camacho-Gonzalez
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Brian C. Zanoni
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Sophia A. Hussen
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
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Meyer CH, Noorbakhsh S, Jackson K, Holstein R, Sola R, Koganti D, Bliton J, Smith A, Doh KF, Chaudhary S, Sciarretta JD, Smith RN. Trends in Adolescent Firearm-Related Injury: A Time Series Analysis. Am Surg 2023; 89:3429-3432. [PMID: 36916309 PMCID: PMC10696842 DOI: 10.1177/00031348231157905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Firearm-related injury (FRI) became the leading cause of death among children/adolescents in 2019. PURPOSE This study sought to determine changes over time in the population of adolescents affected by FRI in Atlanta, Georgia, such that high risk cohorts could be identified. RESEARCH DESIGN City-wide retrospective cohort review. STUDY SAMPLE Adolescent victims (age 11-21 years of age) of FRI, defined by ICD9/10 codes, in Atlanta, Georgia. DATA ANALYSIS Descriptive, multivariate and time series analysis. RESULTS There were 1,453 adolescent FRI victims in this time period, predominantly Black (86%) and male (86.6%). Unintentional injury was higher among ages 11-14 years (43.1%) compared to 15-17 years (10.2%) and 18-21 years (9.3%) (P < .01). FRI affecting females increased at a rate of 8.1 injuries/year (P < .01), and unintentional injuries increased at by 7.6/year (P < .01). Mortality declined from 16% in 2016 to 7.7% in 2021. CONCLUSION Our data provides evidence for firearm policy reform. Interventions should target prevention of intentional injury among AQ4 females and seek to reverse the trend in unintentional injuries.
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Affiliation(s)
- Courtney H. Meyer
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Soroosh Noorbakhsh
- Emory University School of Medicine, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Katie Jackson
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Richard Sola
- Grady Health System, Atlanta, GA, USA
- Morehouse University School of Medicine, Atlanta, GA, USA
| | - Deepika Koganti
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - John Bliton
- Jamaica Hospital Medical Center, Queens, NY, USA
| | - Alexis Smith
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Kiesha Fraser Doh
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Sofia Chaudhary
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Jason D. Sciarretta
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | - Randi N. Smith
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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28
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Wien S, Guest JL, Luisi N, Taussig J, Kramer MR, Stephenson R, Millett G, del Rio C, Sullivan PS. Racial differences in the association of undetectable HIV viral load and transportation to an HIV provider among men who have sex with men in Atlanta, Georgia: a health equity perspective. AIDS Care 2023; 35:1154-1163. [PMID: 36878481 PMCID: PMC10426396 DOI: 10.1080/09540121.2023.2182871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
There are inequities in HIV outcomes among Black gay, bisexual, and other sexual minority men who have sex with men (GBMSM) compared to GBMSM overall, including access to transportation to HIV care. It is unclear if the relationship between transportation and clinical outcomes extends to viral load. We assessed the relationship between transportation dependence to an HIV provider and undetectable viral load among Black and White GBMSM in Atlanta. We collected transportation and viral load information from GBMSM with HIV from 2016-2017 (n = 345). More Black than White GBMSM had a detectable viral load (25% vs. 15%) and took dependent (e.g. public) transportation (37% vs. 18%). Independent (e.g. car) transportation was associated with undetectable viral load for White GBMSM (cOR 3.61, 95% CI 1.45, 8.97) but was attenuated by income (aOR. 2.29, 95% CI 0.78, 6.71), and not associated for Black GBMSM (cOR 1.18, 95% CI 0.58, 2.24). One possible explanation for no association for Black GBMSM is that there are more competing barriers to HIV care for Black GBMSM than White GBMSM. Further investigation is needed to confirm whether 1) transportation is unimportant for Black GBMSM or 2) transportation interacts with additional factors not considered in this analysis.
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Affiliation(s)
- Simone Wien
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jodie L. Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer Taussig
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael R. Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Populations, and Leadership, School of Nursing, and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Greg Millett
- American Foundation for AIDS Research, Washington DC, USA
| | - Carlos del Rio
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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29
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Awan S, Saini G, Gogineni K, Luningham JM, Collin LJ, Bhattarai S, Aneja R, Williams CP. Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia. Cancer Med 2023; 12:17331-17339. [PMID: 37439033 PMCID: PMC10501236 DOI: 10.1002/cam4.6341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Little is known regarding the association between insurance status and treatment delays in women with breast cancer and whether this association varies by neighborhood socioeconomic deprivation status. METHODS In this cohort study, we used medical record data of women diagnosed with breast cancer between 2004 and 2022 at two Georgia-based healthcare systems. Treatment delay was defined as >90 days to surgery or >120 days to systemic treatment. Insurance coverage was categorized as private, Medicaid, Medicare, other public, or uninsured. Area deprivation index (ADI) was used as a proxy for neighborhood-level socioeconomic status. Associations between delayed treatment and insurance status were analyzed using logistic regression, with an interaction term assessing effect modification by ADI. RESULTS Of the 14,195 women with breast cancer, 54% were non-Hispanic Black and 52% were privately insured. Compared with privately insured patients, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 79%, 75%, and 27% higher odds of delayed treatment, respectively (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.32-2.43; OR: 1.75, 95% CI: 1.43-2.13; OR: 1.27, 95% CI: 1.06-1.51). Among patients living in low-deprivation areas, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 100%, 84%, and 26% higher odds of delayed treatment than privately insured patients (OR: 2.00, 95% CI: 1.44-2.78; OR: 1.84, 95% CI: 1.48-2.30; OR: 1.26, 95% CI: 1.05-1.53). No differences in the odds of delayed treatment by insurance status were observed in patients living in high-deprivation areas. DISCUSSION/CONCLUSION Insurance status was associated with treatment delays for women living in low-deprivation neighborhoods. However, for women living in neighborhoods with high deprivation, treatment delays were observed regardless of insurance status.
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Affiliation(s)
- Sofia Awan
- School of Public Health, Georgia State UniversityAtlantaGeorgiaUSA
| | - Geetanjali Saini
- Department of Clinical and Diagnostic Sciences, School of Health ProfessionsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Keerthi Gogineni
- Department of Hematology–Medical OncologyWinship Cancer Institute, Emory University School of MedicineAtlantaGeorgiaUSA
- Department of SurgeryWinship Cancer Institute, Emory University School of MedicineAtlantaGeorgiaUSA
- Georgia Cancer Center for Excellence, Grady Health SystemAtlantaGeorgiaUSA
| | - Justin M. Luningham
- Department of Biostatistics and Epidemiology, School of Public HealthUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Lindsay J. Collin
- Department of Population Health SciencesHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Shristi Bhattarai
- Department of Clinical and Diagnostic Sciences, School of Health ProfessionsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Ritu Aneja
- Department of Clinical and Diagnostic Sciences, School of Health ProfessionsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Courtney P. Williams
- Department of Medicine, Division of Preventive MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Fridkin SK, Onwubiko UN, Dube W, Robichaux C, Traenkner J, Goodenough D, Angulo FJ, Zamparo JM, Gonzalez E, Khanna S, Myers C, Dumyati G. Determinates of Clostridioides difficile infection (CDI) testing practices among inpatients with diarrhea at selected acute-care hospitals in Rochester, New York, and Atlanta, Georgia, 2020-2021. Infect Control Hosp Epidemiol 2023; 44:1085-1092. [PMID: 36102331 PMCID: PMC10369210 DOI: 10.1017/ice.2022.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We evaluated the impact of test-order frequency per diarrheal episodes on Clostridioides difficile infection (CDI) incidence estimates in a sample of hospitals at 2 CDC Emerging Infections Program (EIP) sites. DESIGN Observational survey. SETTING Inpatients at 5 acute-care hospitals in Rochester, New York, and Atlanta, Georgia, during two 10-workday periods in 2020 and 2021. OUTCOMES We calculated diarrhea incidence, testing frequency, and CDI positivity (defined as any positive NAAT test) across strata. Predictors of CDI testing and positivity were assessed using modified Poisson regression. Population estimates of incidence using modified Emerging Infections Program methodology were compared between sites using the Mantel-Hanzel summary rate ratio. RESULTS Surveillance of 38,365 patient days identified 860 diarrhea cases from 107 patient-care units mapped to 26 unique NHSN defined location types. Incidence of diarrhea was 22.4 of 1,000 patient days (medians, 25.8 for Rochester and 16.2 for Atlanta; P < .01). Similar proportions of diarrhea cases were hospital onset (66%) at both sites. Overall, 35% of patients with diarrhea were tested for CDI, but this differed by site: 21% in Rochester and 49% in Atlanta (P < .01). Regression models identified location type (ie, oncology or critical care) and laxative use predictive of CDI test ordering. Adjusting for these factors, CDI testing was 49% less likely in Rochester than Atlanta (adjusted rate ratio, 0.51; 95% confidence interval [CI], 0.40-0.63). Population estimates in Rochester had a 38% lower incidence of CDI than Atlanta (summary rate ratio, 0.62; 95% CI, 0.54-0.71). CONCLUSION Accounting for patient-specific factors that influence CDI test ordering, differences in testing practices between sites remain and likely contribute to regional differences in surveillance estimates.
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Affiliation(s)
- Scott K. Fridkin
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia
- Rollins School of Public Health, Emory University, AtlantaGeorgia
| | | | - William Dube
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia
| | - Chad Robichaux
- Division of Biomedical Informatics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Jessica Traenkner
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia
| | - Dana Goodenough
- Foundation for Atlanta Veterans’ Education and Research, Decatur, Georgia
- Atlanta Veterans’ Affairs Medical Center, Decatur, Georgia
- Georgia Emerging Infections Program, Atlanta, Georgia
| | - Frederick J. Angulo
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, Pennsylvania
| | - Joann M. Zamparo
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, Pennsylvania
| | - Elisa Gonzalez
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, Pennsylvania
| | - Sahil Khanna
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Christopher Myers
- Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York
- Infectious Diseases Division, University of Rochester Medical Center, Rochester, New York
| | - Ghinwa Dumyati
- Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York
- Infectious Diseases Division, University of Rochester Medical Center, Rochester, New York
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Lin X, Ali F, Leong T, Edelson M, Hampton S, Zuo Z, Li C, Rice C, Yan F, Baltrus PT, Randolph S, Immergluck LC. Influence of Mask Wearing during COVID-19 Surge and Non-Surge Time Periods in Two K-12 Public School Districts in Georgia, USA. IJERPH 2023; 20:5715. [PMID: 37174233 PMCID: PMC10177845 DOI: 10.3390/ijerph20095715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Into the third year of the COVID-19 pandemic and the second year of in-person learning for many K-12 schools in the United States, the benefits of mitigation strategies in this setting are still unclear. We compare COVID-19 cases in school-aged children and adolescents between a school district with a mandatory mask-wearing policy to one with an optional mask-wearing policy, during and after the peak period of the Delta variant wave of infection. METHODS COVID-19 cases during the Delta variant wave (August 2021) and post the wave (October 2021) were obtained from public health records. Cases of K-12 students, stratified by grade level (elementary, middle, and high school) and school districts across two counties, were included in the statistical and spatial analyses. COVID-19 case rates were determined and spatially mapped. Regression was performed adjusting for specific covariates. RESULTS Mask-wearing was associated with lower COVID-19 cases during the peak Delta variant period; overall, regardless of the Delta variant period, higher COVID-19 rates were seen in older aged students. CONCLUSION This study highlights the need for more layered prevention strategies and policies that take into consideration local community transmission levels, age of students, and vaccination coverage to ensure that students remain safe at school while optimizing their learning environment.
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Affiliation(s)
- Xiting Lin
- Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Fatima Ali
- Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Traci Leong
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | | | | | - Zoey Zuo
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Chaohua Li
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | | | - Fengxia Yan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Peter T Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Sonya Randolph
- Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Lilly Cheng Immergluck
- Department of Microbiology/Biochemistry/Immunology and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA 30310, USA
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Kramer MR, Labgold K, Zertuche AD, Runkle JD, Bryan M, Freymann GR, Austin D, Adams EK, Dunlop AL. Severe Maternal Morbidity in Georgia, 2009-2020. Med Care 2023; 61:258-267. [PMID: 36638324 PMCID: PMC10079300 DOI: 10.1097/mlr.0000000000001819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The increasing focus of population surveillance and research on maternal-and not only fetal and infant-health outcomes is long overdue. The United States maternal mortality rate is higher than any other high-income country, and Georgia is among the highest rates in the country. Severe maternal morbidity (SMM) is conceived of as a "near miss" for maternal mortality, is 50 times more common than maternal death, and efforts to systematically monitor SMM rates in populations have increased in recent years. Much of the current population-based research on SMM has occurred in coastal states or large cities, despite substantial geographical variation with higher maternal and infant health burdens in the Southeast and rural regions. METHODS This population-based study uses hospital discharge records linked to vital statistics to describe the epidemiology of SMM in Georgia between 2009 and 2020. RESULTS Georgia had a higher SMM rate than the United States overall (189.2 vs. 144 per 10,000 deliveries in Georgia in 2014, the most recent year with US estimates). SMM was higher among racially minoritized pregnant persons and those at the extremes of age, of lower socioeconomic status, and with comorbid chronic conditions. SMM rates were 5 to 6 times greater for pregnant people delivering infants <1500 grams or <32 weeks' gestation as compared with those delivering normal weight or term infants. Since 2015, SMM has increased in Georgia. CONCLUSION SMM represents a collection of life-threatening emergencies that are unevenly distributed in the population and require increased attention. This descriptive analysis provides initial guidance for programmatic interventions intending to reduce the burden of SMM and, subsequently, maternal mortality in the US South.
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Affiliation(s)
| | | | | | - Jennifer D. Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, NC
| | - Michael Bryan
- Division of Epidemiology, Maternal and Child Health Epidemiology Unit, Georgia Department of Public Health
| | - Gordon R. Freymann
- Georgia Department of Public Health, Office of Health Indicators for Planning
| | - David Austin
- Georgia Department of Public Health, Office of Health Indicators for Planning
| | - E. Kathleen Adams
- Department of Health Policy and Management, Rollins School of Public Health
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA
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Baliashvili D, Blumberg HM, Gandhi NR, Averhoff F, Benkeser D, Shadaker S, Gvinjilia L, Turdziladze A, Tukvadze N, Chincharauli M, Butsashvili M, Sharvadze L, Tsertsvadze T, Zarkua J, Kempker RR. Hepatitis C care cascade among patients with and without tuberculosis: Nationwide observational cohort study in the country of Georgia, 2015-2020. PLoS Med 2023; 20:e1004121. [PMID: 37141386 PMCID: PMC10194957 DOI: 10.1371/journal.pmed.1004121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 05/18/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The Eastern European country of Georgia initiated a nationwide hepatitis C virus (HCV) elimination program in 2015 to address a high burden of infection. Screening for HCV infection through antibody testing was integrated into multiple existing programs, including the National Tuberculosis Program (NTP). We sought to compare the hepatitis C care cascade among patients with and without tuberculosis (TB) diagnosis in Georgia between 2015 and 2019 and to identify factors associated with loss to follow-up (LTFU) in hepatitis C care among patients with TB. METHODS AND FINDINGS Using national ID numbers, we merged databases of the HCV elimination program, NTP, and national death registry from January 1, 2015 to September 30, 2020. The study population included 11,985 adults (aged ≥18 years) diagnosed with active TB from January 1, 2015 through December 31, 2019, and 1,849,820 adults tested for HCV antibodies between January 1, 2015 and September 30, 2020, who were not diagnosed with TB during that time. We estimated the proportion of patients with and without TB who were LTFU at each step of the HCV care cascade and explored temporal changes. Among 11,985 patients with active TB, 9,065 (76%) patients without prior hepatitis C treatment were tested for HCV antibodies, of which 1,665 (18%) had a positive result; LTFU from hepatitis C care was common, with 316 of 1,557 (20%) patients with a positive antibody test not undergoing viremia testing and 443 of 1,025 (43%) patients with viremia not starting treatment for hepatitis C. Overall, among persons with confirmed viremic HCV infection, due to LTFU at various stages of the care cascade only 28% of patients with TB had a documented cure from HCV infection, compared to 55% among patients without TB. LTFU after positive antibody testing substantially decreased in the last 3 years, from 32% among patients diagnosed with TB in 2017 to 12% among those diagnosed in 2019. After a positive HCV antibody test, patients without TB had viremia testing sooner than patients with TB (hazards ratio [HR] = 1.46, 95% confidence intervals [CI] [1.39, 1.54], p < 0.001). After a positive viremia test, patients without TB started hepatitis C treatment sooner than patients with TB (HR = 2.05, 95% CI [1.87, 2.25], p < 0.001). In the risk factor analysis adjusted for age, sex, and case definition (new versus previously treated), multidrug-resistant (MDR) TB was associated with an increased risk of LTFU after a positive HCV antibody test (adjusted risk ratio [aRR] = 1.41, 95% CI [1.12, 1.76], p = 0.003). The main limitation of this study was that due to the reliance on existing electronic databases, we were unable to account for the impact of all confounding factors in some of the analyses. CONCLUSIONS LTFU from hepatitis C care after a positive antibody or viremia test was high and more common among patients with TB than in those without TB. Better integration of TB and hepatitis C care systems can potentially reduce LTFU and improve patient outcomes both in Georgia and other countries that are initiating or scaling up their nationwide hepatitis C control efforts and striving to provide personalized TB treatment.
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Affiliation(s)
- Davit Baliashvili
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Henry M. Blumberg
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Neel R. Gandhi
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Francisco Averhoff
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - David Benkeser
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lia Gvinjilia
- Eastern Europe and Central Asia Regional Office, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | | | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | | | | | - Lali Sharvadze
- Clinic “Hepa”, Tbilisi, Georgia
- The University of Georgia, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | - Russell R. Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
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Paulukonis ST, Snyder A, Smeltzer MP, Sutaria AN, Hurden I, Latta K, Chennuri S, Vichinsky E, Reeves SL. COVID-19 Infection and Outcomes in Newborn Screening Cohorts of Sickle Cell Trait and Sickle Cell Disease in Michigan and Georgia. J Pediatr Hematol Oncol 2023; 45:174-180. [PMID: 37083273 PMCID: PMC10249598 DOI: 10.1097/mph.0000000000002671] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/01/2023] [Indexed: 04/22/2023]
Abstract
The sickle cell mutation increases morbidity in those with sickle cell disease (SCD) and potentially sickle cell trait, impacting pulmonary, coagulation, renal, and other systems that are implicated in COVID-19 severity. There are no population-based registries for hemoglobinopathies, and they are not tracked in COVID-19 testing. We used COVID-19 test data from 2 states linked to newborn screening data to estimate COVID outcomes in people with SCD or trait compared with normal hemoglobin. We linked historical newborn screening data to COVID-19 tests, hospitalization, and mortality data and modeled the odds of hospitalization and mortality. Georgia's cohort aged 0 to 12 years; Michigan's, 0 to 33 years. Over 8% of those in Michigan were linked to positive COVID-19 results, and 4% in Georgia. Those with SCD showed significantly higher rates of COVID-19 hospitalization than the normal hemoglobin Black cohort, and Michigan had higher rates of mortality as well. Outcomes among those with the trait did not differ significantly from the normal hemoglobin Black group. People with SCD are at increased risk of COVID-19-related hospitalization and mortality and are encouraged to be vaccinated and avoid infection. Persons with the trait were not at higher risk of COVID-related severe outcomes.
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Affiliation(s)
| | - Angela Snyder
- Georgia Health Policy Center, Georgia State University, Atlanta, GA
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
| | - Ankit N. Sutaria
- Division of Health Protection, Georgia Department of Public Health, Maternal and Child Health Epidemiology, Atlanta, GA
| | - Isabel Hurden
- Michigan Department of Health & Human Services, Detroit
| | - Krista Latta
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center
| | | | - Elliott Vichinsky
- University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, CA
| | - Sarah L. Reeves
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
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Hussen SA, Doraivelu K, Goldstein MH, Shenvi N, Easley KA, Zanoni BC, Camacho-González A, del Río C. Human Immunodeficiency Virus (HIV) Care Continuum Outcomes After Transition to Adult Care Among a Prospective Cohort of Youth With HIV in Atlanta, Georgia. Clin Infect Dis 2023; 76:1218-1224. [PMID: 36409586 PMCID: PMC10319754 DOI: 10.1093/cid/ciac904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Healthcare transition from pediatric to adult-oriented clinical settings is often viewed as a high-risk time for care disengagement. However, there is a paucity of prospective, longitudinal research documenting human immunodeficiency virus (HIV) care outcomes after healthcare transition. METHODS We conducted a prospective, observational cohort study of healthcare transition among youth enrolled at an HIV care center in Atlanta, Georgia. Pediatric clinic patients (average age, 24 years) were enrolled up to 3 months before the expected transition and were followed up to determine linkage, retention, and viral suppression in adult care through electronic medical record abstractions at the baseline and at 6, 12, 18, and 24 months. RESULTS The majority of our cohort (n = 70) was male (88.6%) and black (92.9%) and acquired HIV horizontally (80%). Most of our cohort was linked to adult care by 12 months (84%) after enrollment. Of those who linked to adult care by 12 months, retention rates were 86% (95% confidence interval, 78%-94%) at 6 months, 76% (66%-86%) at 12 months, and 66% (55%-78%) at 18 and 24 months. Once in adult care, the proportion with viral suppression was stable (73% at baseline and 74%, 77%, 67%, and 78% at 6, 12, 18, and 24 months, respectively). CONCLUSIONS Although most youth successfully linked to adult care, retention rates decreased over the 24-month follow-up period. Rates of viral suppression were stable for those who remained in care. Strategies to support retention in adult care will be critical to optimizing this transition for youth with HIV.
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Affiliation(s)
- Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kamini Doraivelu
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Madeleine H Goldstein
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neeta Shenvi
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Kirk A Easley
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Brian C Zanoni
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrés Camacho-González
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carlos del Río
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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Wright T, Adhikari A. Utilizing a National Wastewater Monitoring Program to Address the U.S. Opioid Epidemic: A Focus on Metro Atlanta, Georgia. Int J Environ Res Public Health 2023; 20:5282. [PMID: 37047898 PMCID: PMC10093898 DOI: 10.3390/ijerph20075282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
The opioid epidemic has continued to be an ongoing public health crisis within Metro Atlanta for the last three decades. However, estimating opioid use and exposure in a large population is almost impossible, and alternative methods are being explored, including wastewater-based epidemiology. Wastewater contains various contaminants that can be monitored to track pathogens, infectious diseases, viruses, opioids, and more. This commentary is focusing on two issues: use of opioid residue data in wastewater as an alternative method for opioid exposure assessment in the community, and the adoption of a streamlined approach that can be utilized by public health officials. Opioid metabolites travel through the sanitary sewer through urine, fecal matter, and improper disposal of opioids to local wastewater treatment plants. Public health officials and researchers within various entities have utilized numerous approaches to reduce the impacts associated with opioid use. National wastewater monitoring programs and wastewater-based epidemiology are approaches that have been utilized globally by researchers and public health officials to combat the opioid epidemic. Currently, public health officials and policy makers within Metro Atlanta are exploring different solutions to reduce opioid use and opioid-related deaths throughout the community. In this commentary, we are proposing a new innovative approach for monitoring opioid use and analyzing trends by utilizing wastewater-based epidemiologic methods, which may help public health officials worldwide manage the opioid epidemic in a large metro area in the future.
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Affiliation(s)
- Tamara Wright
- University College, University of Denver, 2211 South Josephine Street, Denver, CO 80208, USA
| | - Atin Adhikari
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, 501 Forest Drive, Statesboro, GA 30460, USA;
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Saldana C, Philpott DC, Mauck DE, Hershow RB, Garlow E, Gettings J, Freeman D, France AM, Johnson EN, Ajmal A, Elimam D, Reed K, Sulka A, Adame JF, Andía JF, Gutierrez M, Padilla M, Jimenez NG, Hayes C, McClung RP, Cantos VD, Holland DP, Scott JY, Oster AM, Curran KG, Hassan R, Wortley P. Public Health Response to Clusters of Rapid HIV Transmission Among Hispanic or Latino Gay, Bisexual, and Other Men Who Have Sex with Men - Metropolitan Atlanta, Georgia, 2021-2022. MMWR Morb Mortal Wkly Rep 2023; 72:261-264. [PMID: 36893048 PMCID: PMC10010755 DOI: 10.15585/mmwr.mm7210a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
During February 2021-June 2022, the Georgia Department of Public Health (GDPH) detected five clusters of rapid HIV transmission concentrated among Hispanic or Latino (Hispanic) gay, bisexual, and other men who have sex with men (MSM) in metropolitan Atlanta. The clusters were detected through routine analysis of HIV-1 nucleotide sequence data obtained through public health surveillance (1,2). Beginning in spring 2021, GDPH partnered with health districts with jurisdiction in four metropolitan Atlanta counties (Cobb, DeKalb, Fulton, and Gwinnett) and CDC to investigate factors contributing to HIV spread, epidemiologic characteristics, and transmission patterns. Activities included review of surveillance and partner services interview data,† medical chart reviews, and qualitative interviews with service providers and Hispanic MSM community members. By June 2022, these clusters included 75 persons, including 56% who identified as Hispanic, 96% who reported male sex at birth, 81% who reported male-to-male sexual contact, and 84% of whom resided in the four metropolitan Atlanta counties. Qualitative interviews identified barriers to accessing HIV prevention and care services, including language barriers, immigration- and deportation-related concerns, and cultural norms regarding sexuality-related stigma. GDPH and the health districts expanded coordination, initiated culturally concordant HIV prevention marketing and educational activities, developed partnerships with organizations serving Hispanic communities to enhance outreach and services, and obtained funding for a bilingual patient navigation program with academic partners to provide staff members to help persons overcome barriers and understand the health care system. HIV molecular cluster detection can identify rapid HIV transmission among sexual networks involving ethnic and sexual minority groups, draw attention to the needs of affected populations, and advance health equity through tailored responses that address those needs.
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Redd SK, Mosley EA, Narasimhan S, Newton-Levinson A, AbiSamra R, Cwiak C, Hall KS, Hartwig SA, Pringle J, Rice WS. Estimation of Multiyear Consequences for Abortion Access in Georgia Under a Law Limiting Abortion to Early Pregnancy. JAMA Netw Open 2023; 6:e231598. [PMID: 36877521 PMCID: PMC9989903 DOI: 10.1001/jamanetworkopen.2023.1598] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/18/2023] [Indexed: 03/07/2023] Open
Abstract
Importance Following the US Supreme Court ruling in Dobbs v Jackson Women's Health Organization, Georgia's law limiting abortion to early pregnancy, House Bill 481 (HB481), was allowed to go into effect in July 2022. Objectives To estimate anticipated multiyear effects of HB481, which prohibits abortions after detection of embryonic cardiac activity, on abortion incidence in Georgia, and to examine inequities by race, age, and socioeconomic status. Design, Setting, and Participants This repeated cross-sectional analysis used abortion surveillance data from January 1, 2007, to December 31, 2017, to estimate future effects of HB481 on abortion care in Georgia, with a focus on the 2 most recent years of data (2016 and 2017). Abortion surveillance data were obtained from the 2007-2017 Georgia Department of Public Health's Induced Termination of Pregnancy files. Linear regression was used to estimate trends in abortions provided at less than 6 weeks' gestation and at 6 weeks' gestation or later in Georgia, and χ2 analyses were used to compare group differences by race, age, and educational attainment. Data were analyzed from July 26 to September 22, 2022. Exposures HB481, Georgia's law limiting abortion to early pregnancy. Main Outcome and Measures Weeks' gestation at abortion (<6 vs ≥6 weeks). Results From January 1, 2007, to December 31, 2017, there were 360 972 reported abortions in Georgia, with an annual mean (SD) of 32 816 (1812) abortions. Estimates from 2016 to 2017 suggest that 3854 abortions in Georgia (11.6%) would likely meet eligibility requirements for abortion care under HB481. Fewer abortions obtained by Black patients (1943 [9.6%] vs 1280 [16.2%] for White patients), patients younger than 20 years (261 [9.1%] vs 168 [15.0%] for those 40 years and older), and patients with fewer years of education (392 [9.2%] with less than a high school diploma and 1065 [9.6%] with a high school diploma vs 2395 [13.5%] for those with some college) would likely meet eligibility requirements under HB481. Conclusions and Relevance These findings suggest that Georgia's law limiting abortion to early pregnancy (HB481) would eliminate access to abortion for nearly 90% of patients in Georgia, and disproportionately harm patients who are Black, younger, and in lower socioeconomic status groups.
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Affiliation(s)
- Sara K. Redd
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Elizabeth A. Mosley
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Suba Narasimhan
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Anna Newton-Levinson
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | | | - Carrie Cwiak
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kelli Stidham Hall
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Sophie A. Hartwig
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Johanna Pringle
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Whitney S. Rice
- Center for Reproductive Health Research in the Southeast, Emory University Rollins School of Public Health, Atlanta, Georgia
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Wiginton JM, Eaton LA, Kalinowski J, Watson RJ, Kalichman SC. Lifetime prevalence of syphilis infection among predominantly Black sexual and gender minorities living with HIV in Atlanta, Georgia: a cross-sectional analysis. Ethn Health 2023; 28:159-169. [PMID: 34818951 PMCID: PMC9126996 DOI: 10.1080/13557858.2021.2007225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Syphilis infection disproportionately impacts Black sexual and gender minorities (SGM) in the United States. The extent of this impact among those living with HIV has been minimally examined. This study sought to examine lifetime syphilis prevalence and associated factors in a community sample of predominantly Black SGM living with HIV in the Southeastern US. DESIGN Participants (N = 174) enrolled in a stigma-mitigation trial for people living with HIV in Atlanta, Georgia, completed a sub-study involving testing for Treponema pallidum antibodies, indicative of lifetime syphilis infection. We performed chi-square and Fisher's exact tests to assess sociodemographic and healthcare differences by presence/absence of lifetime syphilis infection. RESULTS Most participants identified as non-Hispanic Black (n = 142/174; 81.6%) and cisgender male (n = 146/174; 83.9%). More than two thirds (n = 120/174) identified as gay/homosexual. We documented a 55.7% (n = 97/174) lifetime prevalence of syphilis infection and observed differences by sexual identity, with 77.3% (n = 75/97) of those screening positive reporting gay/homosexual identity relative to 58.4% (n = 45/77) of those screening negative (chi-square[1] = 7.8, p < 0.010). CONCLUSION Findings underscore how syphilis prevention efforts have missed the most marginalized, warranting a renewed, comprehensive strategy for improving the sexual health of Black SGM. Embedding targeted, respectful community engagement, expanded testing access, and healthcare provider training into broader sexual health and psychosocial wellness efforts is needed.
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Affiliation(s)
- John Mark Wiginton
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Jolaade Kalinowski
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Seth C. Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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Carlson JM, Tannis A, Woodworth KR, Reynolds MR, Shinde N, Anderson B, Hobeheidar K, Praag A, Campbell K, Carpentieri C, Willabus T, Burkhardt E, Torrone E, O’Callaghan KP, Miele K, Meaney-Delman D, Gilboa SM, Olsen EO, Tong VT. Substance Use Among Persons with Syphilis During Pregnancy - Arizona and Georgia, 2018-2021. MMWR Morb Mortal Wkly Rep 2023; 72:63-67. [PMID: 36656787 PMCID: PMC9869742 DOI: 10.15585/mmwr.mm7203a3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Despite universal prenatal syphilis screening recommendations and availability of effective antibiotic treatment, syphilis prevalence during pregnancy and the incidence of congenital syphilis have continued to increase in the United States (1,2). Concurrent increases in methamphetamine, injection drug, and heroin use have been described in women with syphilis (3). CDC used data on births that occurred during January 1, 2018-December 31, 2021, from two states (Arizona and Georgia) that participate in the Surveillance for Emerging Threats to Pregnant People and Infants Network (SET-NET) to describe the prevalence of substance use among pregnant persons with syphilis by congenital syphilis pregnancy outcome (defined as delivery of a stillborn or live-born infant meeting the surveillance case definition for probable or confirmed congenital syphilis). The prevalence of substance use (e.g., tobacco, alcohol, cannabis, illicit use of opioids, and other illicit, nonprescription substances) in persons with a congenital syphilis pregnancy outcome (48.1%) was nearly double that among those with a noncongenital syphilis pregnancy outcome (24.6%). Persons with a congenital syphilis pregnancy outcome were six times as likely to report illicit use of opioids and four times as likely to report using other illicit, nonprescription substances during pregnancy than were persons with a noncongenital syphilis pregnancy outcome. Approximately one half of persons who used substances during pregnancy and had a congenital syphilis pregnancy outcome had late or no prenatal care. Tailored interventions should address barriers and facilitators to accessing screening and treatment for syphilis among persons who use substances. The need for syphilis screening and treatment should be addressed at any health care encounter during pregnancy, especially among persons who use substances.
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Gibbs DC, Ng S, Baranowski MLH, Reddy S, Bederman A, Bean MB, Eisenstadt R, Chen SC. Skin cancer surveillance practices and attitudes among hairdressers: A cross-sectional study in Atlanta, Georgia. J Am Acad Dermatol 2023; 88:155-158. [PMID: 31325550 PMCID: PMC7374908 DOI: 10.1016/j.jaad.2019.07.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 01/03/2023]
Affiliation(s)
- David C Gibbs
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Emory University School of Medicine, Emory University, Atlanta, Georgia
| | - Spencer Ng
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Marissa L H Baranowski
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Emory University School of Medicine, Emory University, Atlanta, Georgia
| | | | - Annelise Bederman
- Emory University School of Medicine, Emory University, Atlanta, Georgia
| | - Marta B Bean
- Emory University School of Medicine, Emory University, Atlanta, Georgia
| | - Rachel Eisenstadt
- Emory University School of Medicine, Emory University, Atlanta, Georgia
| | - Suephy C Chen
- Emory University School of Medicine, Emory University, Atlanta, Georgia; Department of Dermatology, Emory University, Atlanta, Georgia; Division of Dermatology, Atlanta VA Medical Center, Atlanta, Georgia.
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Lipscomb J, Switchenko JM, Flowers CR, Gillespie TW, Wortley PM, Bayakly AR, Almon L, Ward KC. Impact of multi-agent systemic therapy on all-cause and disease-specific survival for people living with HIV who are diagnosed with non-Hodgkin lymphoma: population-based analyses from the state of Georgia. Leuk Lymphoma 2023; 64:151-160. [PMID: 36308021 PMCID: PMC9905298 DOI: 10.1080/10428194.2022.2133539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 01/12/2023]
Abstract
For people living with HIV (PLWH) who are subsequently diagnosed with non-Hodgkin lymphoma (NHL), we investigate the impact of standard-of-care (SoC) cancer treatment on all-cause, NHL-specific, and HIV-specific survival outcomes. The focus is on a registry-derived, population-based sample of HIV + adults diagnosed with NHL within 2004-2012 in the state of Georgia. SoC treatment is defined as receipt of multi-agent systemic therapy (MAST). In multivariable survival analyses, SoC cancer treatment is significantly associated with better all-cause and NHL-specific survival, but not better HIV-specific survival across 2004-2017. Having a CD4 count <200 near the time of cancer diagnosis and Ann Arbor stage III/IV disease are associated with worse all-cause and HIV-specific survival; the effects on NHL survival trend negative but are not significant. Future work should expand the geographic base and cancers examined, deepen the level of clinical detail brought to bear, and incorporate the perspectives and recommendations of patients and providers.
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Affiliation(s)
- Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Christopher R Flowers
- Division of Cancer Medicine, Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Theresa W Gillespie
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Lyn Almon
- Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin C Ward
- Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Liu CY, Smith S, Chamberlain AT, Gandhi NR, Khan F, Williams S, Shah S. Use of surveillance data to elucidate household clustering of SARS-CoV-2 in Fulton County, Georgia a major metropolitan area. Ann Epidemiol 2022; 76:121-127. [PMID: 36210009 PMCID: PMC9536872 DOI: 10.1016/j.annepidem.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Households are important for SARS-CoV-2 transmission due to high intensity exposure in enclosed spaces over prolonged durations. We quantified and characterized household clustering of COVID-19 cases in Fulton County, Georgia. METHODS We used surveillance data to identify all confirmed COVID-19 cases in Fulton County. Household clustered cases were defined as cases with matching residential address. We described the proportion of COVID-19 cases that were clustered, stratified by age over time and explore trends in age of first diagnosed case within households and subsequent household cases. RESULTS Between June 1, 2020 and October 31, 2021, 31,449(37%) of 106,233 cases were clustered in households. Children were the most likely to be in household clusters than any other age group. Initially, children were rarely (∼ 10%) the first cases diagnosed in the household but increased to almost 1 of 3 in later periods. DISCUSSION One-third of COVID-19 cases in Fulton County were part of a household cluster. Increasingly children were the first diagnosed case, coinciding with temporal trends in vaccine roll-out among the elderly and the return to in-person schooling in Fall 2021. Limitations include restrictions to cases with a valid address and unit number and that the first diagnosed case may not be the infection source for the household.
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Affiliation(s)
- Carol Y Liu
- Emory University Rollins School of Public Health, Atlanta, GA.
| | | | | | - Neel R Gandhi
- Emory University Rollins School of Public Health, Atlanta, GA; Emory School of Medicine, Atlanta, GA
| | - Fazle Khan
- Fulton County Board of Health, Atlanta, GA
| | | | - Sarita Shah
- Emory University Rollins School of Public Health, Atlanta, GA; Emory School of Medicine, Atlanta, GA
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Olusanya OA, White B, Malik F, Hester KA, Davis RL, Bednarczyk RA, Shaban-Nejad A. Healthcare professionals' perceptions and recommendations regarding adolescent vaccinations in Georgia and Tennessee during the COVID-19 pandemic: A qualitative research. PLoS One 2022; 17:e0277748. [PMID: 36399477 PMCID: PMC9674128 DOI: 10.1371/journal.pone.0277748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite its benefits, HPV vaccine uptake has been historically lower than other recommended adolescent vaccines in the United States (US). While hesitancy and misinformation have threatened vaccinations for many years, the adverse impacts from COVID-19 pandemic on preventive services have been far-reaching. OBJECTIVES To explore the perceptions and experiences of adolescent healthcare providers regarding routine vaccination services during the COVID-19 pandemic. METHODOLOGY Between December 2020 and May 2021, in-depth qualitative interviews were conducted via Zoom video conferencing among a purposively selected, diverse group of adolescent healthcare providers (n = 16) within 5 healthcare practices in the US southeastern states of Georgia and Tennessee. Audio recordings were transcribed verbatim and analyzed using a rapid qualitative analysis framework. Our analysis was guided by the grounded theory and inductive approach. RESULTS Participants reported that patient-provider communications; effective use of presumptive languaging; provider's continuing education/training; periodic reminders/recall messages; provider's personal conviction on vaccine safety/efficacy; early initiation of HPV vaccination series at 9 years; community partnerships with community health navigators/vaccine champions/vaccine advocates; use of standardized forms/prewritten scripts/standard operating protocols for patient-provider interactions; and vaccine promotion through social media, brochures/posters/pamphlets as well as outreaches to schools and churches served as facilitators to adolescent HPV vaccine uptake. Preventive adolescent services were adversely impacted by the COVID-19 pandemic at all practices. Participants highlighted an initial decrease in patients due to the pandemic, while some practices avoided the distribution of vaccine informational materials due to sanitary concerns. CONCLUSION As part of a larger study, we provided contextual information to refine an intervention package currently being developed to improve adolescent preventive care provision in healthcare practices. Our results could inform the implementation of comprehensive intervention strategies that improve HPV vaccination rates. Additionally, lessons learned (e.g. optimizing patient- provider interactions) could be adopted to expand COVID-19 vaccine acceptance on a sizable scale.
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Affiliation(s)
- Olufunto A. Olusanya
- Department of Pediatrics, Center for Biomedical Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- * E-mail: (OAO); (AS-N)
| | - Brianna White
- Department of Pediatrics, Center for Biomedical Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Fauzia Malik
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Kyra A. Hester
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Robert L. Davis
- Department of Pediatrics, Center for Biomedical Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Robert A. Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Arash Shaban-Nejad
- Department of Pediatrics, Center for Biomedical Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- * E-mail: (OAO); (AS-N)
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Adam CM, Borroto R, Thomas E, Tuttle J, Pavlick J, Drenzek CL. Syndromic Surveillance as a Tool for Case-Based Varicella Reporting in Georgia, 2016-2019. Public Health Rep 2022; 137:1070-1078. [PMID: 34644188 PMCID: PMC9574311 DOI: 10.1177/00333549211050897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Syndromic surveillance can be used to enhance notifiable disease case-based surveillance. We analyzed features of varicella reported in Georgia to evaluate case detection through syndromic surveillance and to compare varicella reported through syndromic surveillance with varicella reported from all other sources. METHODS Syndromic surveillance was incorporated into case-based varicella surveillance by the Georgia Department of Public Health (GDPH) in May 2016. A cross-sectional study design evaluated syndromic and nonsyndromic varicella reported to GDPH from May 1, 2016, through December 31, 2019. Varicella was reported by nonsyndromic sources including health care providers, schools, and laboratories. We identified syndromic varicella cases from urgent care and emergency department visit data with discharge diagnoses containing the terms "varicella" or "chickenpox." RESULTS Syndromic notifications accounted for 589 of 2665 (22.1%) suspected varicella reports investigated by GDPH. The positive predictive value was 33.1% for syndromic notifications and 31.3% for nonsyndromic notifications. Mean days from rash onset to GDPH notification was 3.2 days fewer (P < .001) among patients identified through syndromic notification than among patients identified through nonsyndromic notification. The odds of varicella identified by syndromic notification being outbreak-associated were 0.18 (95% CI, 0.09-0.36) times those of varicella identified through nonsyndromic notification. PRACTICE IMPLICATIONS Syndromic notifications were an effective, timely means for varicella case detection. Syndromic patients were significantly less likely than nonsyndromic patients to be outbreak-associated, possibly because of early detection. Syndromic surveillance enhanced case-based reporting for varicella in Georgia and was a useful tool to improve notifiable disease surveillance.
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Affiliation(s)
- Carolyn M. Adam
- Epidemiology Section, Georgia Department of Public Health, Atlanta, GA, USA
| | - René Borroto
- Epidemiology Section, Georgia Department of Public Health, Atlanta, GA, USA
| | - Ebony Thomas
- Epidemiology Section, Georgia Department of Public Health, Atlanta, GA, USA
| | - Jessica Tuttle
- Epidemiology Section, Georgia Department of Public Health, Atlanta, GA, USA
| | - Jessica Pavlick
- Epidemiology Section, Georgia Department of Public Health, Atlanta, GA, USA
| | - Cherie L. Drenzek
- Epidemiology Section, Georgia Department of Public Health, Atlanta, GA, USA
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Millman AJ, Denson DJ, Allen ML, Malone JA, Daskalakis DC, Durrence D, Rustin RC, Toomey KE. A Health Equity Approach for Implementation of JYNNEOS Vaccination at Large, Community-Based LGBTQIA+ Events - Georgia, August 27-September 5, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1382-1883. [PMID: 36301799 PMCID: PMC9620574 DOI: 10.15585/mmwr.mm7143e4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Gay, bisexual, and other men who have sex with men (MSM) have been disproportionately affected during the 2022 U.S. monkeypox outbreak, with Black or African American (Black) MSM being the most affected demographic group (1). As of September 28, 2022, Georgia had reported 1,784 monkeypox cases; 98% of which occurred in males and 77% among Black persons (2). As of September 13, 2022, 60% of reported cases were among persons with HIV infection, and 50% of persons with monkeypox had a sexually transmitted infection within the past year (3). Because of racial disparities in the incidence of monkeypox cases and a large proportion of cases among MSM in Georgia, early vaccination beginning in July focused on improving equitable access by establishing new and leveraging existing partnerships with community-based organizations that serve affected populations, including persons with HIV infection. Despite these efforts, disparities persisted because of high demand and limited vaccine supply. The Georgia Department of Public Health (DPH) requested CDC support for a vaccine pilot and received an additional allocation of 5,500 doses of JYNNEOS vaccine for administration at events leading up to and throughout a Black gay Pride festival in Atlanta, a multiday event held Labor Day weekend (September 2-5, 2022). The event celebrates lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other (LGBTQIA+) communities of color and hosts more than 125,000 attendees each year. Before the festival (as of August 24), 17,546 persons had been vaccinated in Georgia, of whom 96% were male, 34% aged 25-36 years, 44% Black, and 8% Hispanic or Latino (Hispanic) (4).
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Luningham JM, Seth G, Saini G, Bhattarai S, Awan S, Collin LJ, Swahn MH, Dai D, Gogineni K, Subhedar P, Mishra P, Aneja R. Association of Race and Area Deprivation With Breast Cancer Survival Among Black and White Women in the State of Georgia. JAMA Netw Open 2022; 5:e2238183. [PMID: 36306134 PMCID: PMC9617173 DOI: 10.1001/jamanetworkopen.2022.38183] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE Increasing evidence suggests that low socioeconomic status and geographic residence in disadvantaged neighborhoods contribute to disparities in breast cancer outcomes. However, little epidemiological research has sought to better understand these disparities within the context of location. OBJECTIVE To examine the association between neighborhood deprivation and racial disparities in mortality among Black and White patients with breast cancer in the state of Georgia. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study collected demographic and geographic data from patients diagnosed with breast cancer between January 1, 2004, and February 11, 2020, in 3 large health care systems in Georgia. A total of 19 580 patients with breast cancer were included: 12 976 from Piedmont Healthcare, 2285 from Grady Health System, and 4319 from Emory Healthcare. Data were analyzed from October 2, 2020, to August 11, 2022. EXPOSURES Area deprivation index (ADI) scores were assigned to each patient based on their residential census block group. The ADI was categorized into quartile groups, and associations between ADI and race and ADI × race interaction were examined. MAIN OUTCOMES AND MEASURES Cox proportional hazards regression models were used to compute hazard ratios (HRs) and 95% CIs associating ADI with overall mortality by race. Kaplan-Meier curves were used to visualize mortality stratified across racial and ADI groups. RESULTS Of the 19 580 patients included in the analysis (mean [SD] age at diagnosis, 58.8 [13.2] years), 3777 (19.3%) died during the course of the study. Area deprivation index contributed differently to breast cancer outcomes for Black and White women. In multivariable-adjusted models, living in a neighborhood with a greater ADI (more deprivation) was associated with increased mortality for White patients with breast cancer; compared with the ADI quartile of less than 25 (least deprived), increased mortality HRs were found in quartiles of 25 to 49 (1.22 [95% CI, 1.07-1.39]), 50 to 74 (1.32 [95% CI, 1.13-1.53]), and 75 or greater (1.33 [95% CI, 1.07-1.65]). However, an increase in the ADI quartile group was not associated with changes in mortality for Black patients with breast cancer (quartile 25 to 49: HR, 0.81 [95% CI, 0.61-1.07]; quartile 50 to 74: HR, 0.91 [95% CI, 0.70-1.18]; and quartile ≥75: HR, 1.05 [95% CI, 0.70-1.36]). In neighborhoods with an ADI of 75 or greater, no racial disparity was observed in mortality (HR, 1.11 [95% CI, 0.92-1.36]). CONCLUSIONS AND RELEVANCE Black women with breast cancer had higher mortality than White women in Georgia, but this disparity was not explained by ADI: among Black patients, low ADI was not associated with lower mortality. This lack of association warrants further investigation to inform community-level approaches that may mitigate the existing disparities in breast cancer outcomes in Georgia.
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Affiliation(s)
- Justin M. Luningham
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Ft Worth
| | - Gaurav Seth
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta
| | - Geetanjali Saini
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta
| | - Shristi Bhattarai
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta
| | - Sofia Awan
- School of Public Health, Georgia State University, Atlanta
| | - Lindsay J. Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Monica H. Swahn
- Department of Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, Georgia
| | - Dajun Dai
- Department of Geosciences, Georgia State University, Atlanta
| | - Keerthi Gogineni
- Department of Hematology–Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
- Georgia Cancer Center for Excellence, Grady Health System, Atlanta
| | - Preeti Subhedar
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Pooja Mishra
- Georgia Cancer Center for Excellence, Grady Health System, Atlanta
| | - Ritu Aneja
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta
- Department of Clinical and Diagnostic Sciences, School of Health Professions, University of Alabama at Birmingham
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Adams C, Wortley P, Chamberlain A, Lopman BA. Declining COVID-19 case-fatality in Georgia, USA, March 2020 to March 2021: a sign of real improvement or a broadening epidemic? Ann Epidemiol 2022; 72:57-64. [PMID: 35649472 PMCID: PMC9148435 DOI: 10.1016/j.annepidem.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To examine whether declines in the crude U.S. COVID-19 case fatality ratio is due to improved clinical care and/or other factors. METHODS We used multivariable logistic regression, adjusted for age and other individual-level characteristics, to examine associations between report month and mortality among confirmed and probable COVID-19 cases and hospitalized cases in Georgia reported March 2, 2020 to March 31, 2021. RESULTS Compared to August 2020, mortality risk among cases was lowest in November 2020 (OR = 0.84; 95% CI: 0.78-0.91) and remained lower until March 2021 (OR = 0.86; 95% CI: 0.77-0.95). Among hospitalized cases, mortality risk increased in December 2020 (OR = 1.16, 95% CI: 1.07-1.27) and January 2021 (OR = 1.25; 95% CI: 1.14-1.36), before declining until March 2021 (OR = 0.90, 95% CI: 0.78-1.04). CONCLUSIONS After adjusting for other factors, including the shift to a younger age distribution of cases, we observed lower mortality risk from November 2020 to March 2021 compared to August 2020 among cases. This suggests that improved clinical management may have contributed to lower mortality risk. Among hospitalized cases, mortality risk increased again in December 2020 and January 2021, but then decreased to a risk similar to that among all cases by March 2021.
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Affiliation(s)
- Carly Adams
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Pascale Wortley
- HIV Epidemiology Section, Georgia Department of Public Health, State of Georgia Building, Atlanta, GA
| | - Allison Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Brown LD, Maness R, Greer K. Detection of Bartonella spp. and Rickettsia spp. in cat fleas (Ctenocephalides felis) collected from free-roaming domestic cats in southeastern Georgia, USA. Vet Parasitol Reg Stud Reports 2022; 32:100743. [PMID: 35725106 DOI: 10.1016/j.vprsr.2022.100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
The cat flea (Ctenocephalides felis) is a competent vector of numerous bacterial pathogens in the genera Bartonella and Rickettsia. In the United States, free-roaming domestic cats (Felis catus) increase the risk of exposure to C. felis for humans and their companion animals. In collaboration with a trap-neuter-return program, we collected fleas from 283 feral/stray cats in southeastern Georgia between May and July of 2020. A total of 3,643 flea specimens were collected, and C. felis was the only flea species recovered from all cats sampled. The mean number of fleas per cat host was highest in the month of June when compared to May and July, and higher in juvenile cats (< 1 year) than the adults (≥ 1 year). Real-time PCR assays were used to test a subset of the collected fleas (n = 468) for the presence of Bartonella spp. and Rickettsia spp. DNA. Among those flea pools tested, 35.2% were positive for genus-specific citrate synthase gene of Bartonella, 16.5% were positive for the genus-specific 17-kDa protein antigen gene of Rickettsia, and none were positive for the species-specific outer membrane protein B gene of Rickettsia typhi. The identification of potential flea-borne pathogens was more frequent from the subset of C. felis collected in May, and female cats had more Bartonella-positive fleas and less Rickettsia-positive fleas than male cats. Overall, the present study provides valuable insights into the frequency of C. felis from outdoor community cats in southeastern Georgia, and highlights the possible risk for human exposure to potential flea-borne pathogens.
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Affiliation(s)
- Lisa D Brown
- Department of Biology, Georgia Southern University, 4324 Old Register Rd., Statesboro, GA 30460, USA.
| | - Ryne Maness
- Department of Biology, Texas A&M University, College Station, TX 77843, USA
| | - Kania Greer
- The Center for STEM Education, Georgia Southern University, Statesboro, GA 30460, USA
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Klosky JV, Gazmararian JA, Casimir O, Blake SC. Effects of Remote Education During the COVID-19 Pandemic on Young Children's Learning and Academic Behavior in Georgia: Perceptions of Parents and School Administrators. J Sch Health 2022; 92:656-664. [PMID: 35411613 PMCID: PMC9115169 DOI: 10.1111/josh.13185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/20/2022] [Accepted: 03/08/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND In Spring 2020, Georgia public schools implemented remote learning to manage the spread of COVID-19. This study explores the effects of remote schooling on the learning of young children in Georgia during the early COVID-19 pandemic from the perspectives of school administrators and essential working parents. METHODS A qualitative exploratory study was conducted with eight school administrators and 26 essential working parents of children in kindergarten through third grades of two rural and two urban schools in Georgia. Data collection included online surveys, virtual interviews and focus groups. Descriptive analyses of the demographics provided context to emerging themes from qualitative data. RESULTS Most school administrators and parents reported declines in student learning and academic behavior related to remote learning. Lack of Wi-Fi, technology, and digital literacy were often cited as barriers to learning. Challenges with remote learning were amplified for students and parents of vulnerable groups. CONCLUSIONS The findings of this study illustrate the need to institute policies, procedures, and supports to maximize schools' ability to safely offer in-person learning during the COVID-19 pandemic. Considerations should be made of the needs of essential working parents, vulnerable populations, and the digital divide.
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Affiliation(s)
- Jill V. Klosky
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public HealthEmory University1518 Clifton RoadAtlantaGA30322USA
| | - Julie A. Gazmararian
- Department of Epidemiology, Rollins School of Public HealthEmory University1518 Clifton RoadAtlantaGA30322USA
| | - Olivia Casimir
- Department of Global Health, Rollins School of Public HealthEmory University1518 Clifton RoadAtlantaGA30322USA
| | - Sarah C. Blake
- Department of Health Policy & Management, Rollins School of Public HealthEmory University1518 Clifton RoadAtlantaGA30322USA
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