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Mancilla-Martinez J, Oh MH, Luk G, Rollins A. Special Education Representation Trends Vary by Language Status: Evidence of Underrepresentation in Tennessee. J Learn Disabil 2024; 57:153-167. [PMID: 37309592 PMCID: PMC11044507 DOI: 10.1177/00222194231178285] [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] [Indexed: 06/14/2023]
Abstract
Using U.S. state-level data, we report unadjusted and adjusted odds ratio of special education (SPED) trends in Tennessee from 2009 to 2019 for students in Grades 3 to 8 by three language groups: native English speakers (NES), English-proficient bilinguals (EPB), and Current English learners (Current EL). We report trends across all SPED disability categories and across five prevalent disability categories (specific learning disability, specific language impairment, intellectual disability, other health impairments, and autism). The cross-sectional analytic sample included 812,783 students from 28 districts that met the SPED risk ratio threshold set by the state. Results revealed that, compared with NES students, both EPB and Current EL students were generally less likely to receive SPED services, suggesting evidence of language status disparities in SPED representation. Furthermore, findings varied depending on whether adjustments were made to generate odds ratios, especially for higher-incidence disabilities (specific learning disability, specific language impairment, and intellectual disability). Finally, the most severe evidence of underrepresentation was in lower-incidence disabilities (other health impairments and autism). Our results underscore the need for further examination into low rates of SPED identification among learners whose first language is not English (EPB and Current EL). We discuss the contextualized research, practice, and policy implications of our findings.
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Affiliation(s)
| | - Min Hyun Oh
- University of Virginia, Charlottesville, USA
| | - Gigi Luk
- McGill University, Montreal, Quebec, Canada
| | - Adam Rollins
- Tennessee Department of Education, Nashville, USA
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Horn A, Adgent MA, Osmundson SS, Wiese AD, Phillips SE, Patrick SW, Griffin MR, Grijalva CG. Risk of Death at 1 Year Following Postpartum Opioid Exposure. Am J Perinatol 2024; 41:949-960. [PMID: 35640619 PMCID: PMC9708936 DOI: 10.1055/s-0042-1745848] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Opioids are commonly prescribed to women for acute pain following childbirth. Postpartum prescription opioid exposure is associated with adverse opioid-related morbidities but the association with all-cause mortality is not well studied. This study aimed to examine the association between postpartum opioid prescription fills and the 1-year risk of all-cause mortality among women with live births. METHODS In a retrospective cohort study of live births among women enrolled in Tennessee Medicaid (TennCare) between 2007 and 2015, we compared women who filled two or more postpartum outpatient opioid prescriptions (up to 41 days of postdelivery discharge) to women who filled one or fewer opioid prescription. Women were followed from day 42 postdelivery discharge through 365 days of follow-up or date of death. Deaths were identified using linked death certificates (2007-2016). We used Cox's proportional hazard regression and inverse probability of treatment weights to compare time to death between exposure groups while adjusting for relevant confounders. We also examined effect modification by delivery route, race, opioid use disorder, use of benzodiazepines, and mental health condition diagnosis. RESULTS Among 264,135 eligible births, 216,762 (82.1%) had one or fewer maternal postpartum opioid fills and 47,373 (17.9%) had two or more fills. There were 182 deaths during follow-up. The mortality rate was higher in women with two or more fills (120.5 per 100,000 person-years) than in those with one or fewer (57.7 per 100,000 person-years). The risk of maternal death remained higher in participants exposed to two or more opioid fills after accounting for relevant covariates using inverse probability of treatment weighting (adjusted hazard ratio: 1.46 [95% confidence interval: 1.01, 2.09]). Findings from stratified analyses were consistent with main findings. CONCLUSION Filling two or more opioid prescriptions during the postpartum period was associated with a significant increase in 1-year risk of death among new mothers. KEY POINTS · Opioid prescribing in the postpartum period is common.. · Prior studies show that >1 postnatal opioid fill is associated with adverse opioid-related events.. · > 1 opioid fill within 42 days of delivery was associated with an increase in 1-year risk of death..
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Affiliation(s)
- Arlyn Horn
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Margaret A. Adgent
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah S. Osmundson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew D. Wiese
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Sharon E. Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Stephen W. Patrick
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Marie R. Griffin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Veterans’ Health Administration Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Nashville, TN
| | - Carlos G. Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Veterans’ Health Administration Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Nashville, TN
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Steppe S, Stokes DC, Underhill C, Winders TA, Gardner DD, Michael CF. Changing high-risk asthma in Memphis through partnership: Results from the CHAMP program. Ann Allergy Asthma Immunol 2024; 132:485-490.e2. [PMID: 38081410 DOI: 10.1016/j.anai.2023.12.002] [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: 06/12/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Children in metro Shelby County, Tennessee, have disproportionally high asthma-related health care resource use (HRU) compared with those in other regions in Tennessee. OBJECTIVE To describe the goals, logistics, and outcomes of the Changing High-Risk Asthma in Memphis through Partnership (CHAMP) program implemented to improve pediatric asthma care in Shelby County. METHODS CHAMP established a multidisciplinary team with dedicated medical staff and community health workers, implemented a 24/7 call line to improve access to care, established a patient data registry to address fragmented care, assigned community health educators to improve asthma education and social needs, and partnered with services to address environmental triggers and social determinants of health. Patients eligible for CHAMP are Shelby County residents aged 2 to 18 years with high-risk asthma enrolled in Tennessee's Medicaid managed care program. Health care resource use outcomes 1-year pre- and post-CHAMP enrollment were analyzed for patients who had completed 1 year of CHAMP between January 2013 and December 2022. The 24/7 call line data between November 2013 and December 2022 were analyzed. RESULTS CHAMP has enrolled 1348 children; 945 have completed 1 year (63% male; 90% identified as Black). At 1-year post-CHAMP enrollment, patients had 58%, 68%, 42%, and 53% reductions in emergency department visits, inpatient and observation visits, urgent care visits, and total asthma exacerbations, respectively. The number of asthma exacerbations per patient significantly decreased from 2.97 to 1.40 at 1-year post-CHAMP enrollment. Of the calls made to the 24/7 call line, 58% occurred after hours and 52% led to issue resolution without a medical facility visit. CONCLUSION CHAMP successfully decreased asthma HRU in children with high-risk asthma in Shelby County by implementing initiatives that targeted barriers to asthma care.
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Affiliation(s)
- Susan Steppe
- Methodist Le Bonheur Community Outreach, Memphis, Tennessee
| | - Dennis C Stokes
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | | | - Tonya A Winders
- Allergy & Asthma Network, Fairfax, Virginia; Global Allergy & Airways Patient Platform, Vienna, Austria
| | | | - Christie F Michael
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee.
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Thomas CM, Hartley A, Schmitz A, Reid HD, Sullivan S, Huebner E, Robinson M, Mathis A, Fill MMA, Levinson KJ, Jones TF, Schaffner W, Newhouse CN, Dunn JR. Implications of Measles Inclusion by Commercial Syndromic Polymerase Chain Reaction Panels - United States, May 2022-April 2023. MMWR Morb Mortal Wkly Rep 2024; 73:260-264. [PMID: 38547036 PMCID: PMC10986817 DOI: 10.15585/mmwr.mm7312a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Syndromic polymerase chain reaction (PCR) panels are used to test for pathogens that can cause rash illnesses, including measles. Rash illnesses have infectious and noninfectious causes, and approximately 5% of persons experience a rash 7-10 days after receipt of a measles, mumps, and rubella (MMR) vaccine. MMR vaccine includes live attenuated measles virus, which is detectable by PCR tests. No evidence exists of person-to-person transmission of measles vaccine virus, and illness does not typically result among immunocompetent persons. During September 2022-January 2023, the Tennessee Department of Health received two reports of measles detected by syndromic PCR panels. Both reports involved children (aged 1 and 6 years) without known risk factors for measles, who were evaluated for rash that occurred 11-13 days after routine MMR vaccination. After public health responses in Tennessee determined that both PCR panels had detected measles vaccine virus, six state health departments collaborated to assess the frequency and characteristics of persons receiving a positive measles PCR panel test result in the United States. Information was retrospectively collected from a commercial laboratory testing for measles in syndromic multiplex PCR panels. During May 2022-April 2023, among 1,548 syndromic PCR panels, 17 (1.1%) returned positive test results for measles virus. Among 14 persons who received a positive test result and for whom vaccination and case investigation information were available, all had received MMR vaccine a median of 12 days before specimen collection, and none had known risk factors for acquiring measles. All positive PCR results were attributed to detection of measles vaccine virus. Increased awareness among health care providers about potential measles detection by PCR after vaccination is needed. Any detection of measles virus by syndromic PCR testing should be immediately reported to public health agencies, which can use measles vaccination history and assessment of risk factors to determine the appropriate public health response. If a person recently received MMR vaccine and has no risk factors for acquiring measles, additional public health response is likely unnecessary.
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Cunningham-Erves J, George W, Sanderson M, Stewart E, Jin SW, Davis J, Brandt HM. Predictors of seasonal influenza and COVID-19 vaccination coverage among adults in Tennessee during the COVID-19 pandemic. Front Public Health 2024; 12:1321173. [PMID: 38500722 PMCID: PMC10945017 DOI: 10.3389/fpubh.2024.1321173] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/06/2024] [Indexed: 03/20/2024] Open
Abstract
Background The COVID-19 pandemic has convoluted hesitancy toward vaccines, including the seasonal influenza (flu) vaccine. Because of COVID-19, the flu season has become more complicated; therefore, it is important to understand all the factors influencing the uptake of these vaccines to inform intervention targets. This article assesses factors related to the uptake of influenza and COVID-19 vaccines among adults in Tennessee. Methods A cross-sectional, secondary data analysis of 1,400 adults was conducted in Tennessee. The adult sample came from two data sources: Data source 1 completed a baseline survey from January to March 2022, and data source 2 was completed from May to August 2022. Data on vaccine attitudes, facilitators and barriers, and communication needs were collected via random digit dial by Scientific Telephone Samples (STS). Two multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to predict sociodemographic and overall vaccine-related factors associated with receipt or non-receipt (referent) of COVID-19 and influenza vaccines. Results Approximately 78% of the adult sample had received the COVID-19 vaccination. A significant positive association for COVID-19 vaccine uptake was seen among those who were older (aged 50-65) (aOR = 1.9; 95% CI: 1.2-3.2), Black (aOR = 2.0; 95% CI:1.3-2.8), and had a college education and higher (aOR = 2.3; 95% CI: 1.5-3.6). However, there was a significant negative association for persons reporting they were extremely religious (aOR = 0.5; 95% CI:0.3-0.9). Over 56% of the adult sample had received the influenza vaccination this season. Those who had a higher annual household income ($80,000+) (aOR = 1.9; 95% CI: 1.3-2.6) and had health insurance (aOR = 2.6; 95% CI: 1.4-4.8) had a significant positive association with influenza vaccine receipt. However, those who were employed part-time or were unemployed had a significant negative association for influenza vaccine receipt (aOR = 0.7; 95% CI: 0.5-0.9). Both COVID-19 and influenza vaccine receipt had strongly significant positive trends with increasing belief in effectiveness and trust (p < 0.0001) and strongly significant negative trends with higher levels of overall vaccine hesitancy (p < 0.0001). Conclusion Strategies to increase COVID-19 and influenza vaccination should be age-specific, focus on increasing geographical and financial access, and offer tailored messages to address concerns about these vaccines.
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Affiliation(s)
- J. Cunningham-Erves
- Department of Internal Medicine, School of Medicine, Meharry Medical College, Nashville, TN, United States
| | - W. George
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States
| | - M. Sanderson
- Department of Family and Community Medicine, School of Medicine, Meharry Medical College, Nashville, TN, United States
| | - E. Stewart
- Department of Internal Medicine, School of Medicine, Meharry Medical College, Nashville, TN, United States
| | - S. W. Jin
- School of Social Work, The University of Memphis, Memphis, TN, United States
| | - J. Davis
- Department of Biochemistry and Cancer Biology, School of Medicine, Meharry Medical College, Nashville, TN, United States
| | - H. M. Brandt
- St. Jude Children’s Research Hospital, Department of Epidemiology and Cancer Control, Memphis, TN, United States
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Dzikowicz DJ, Saoji SB, Tam WC, Brunner WM, Carey MG. The Effect of Mandatory Fitness Requirements on Cardiovascular Events: A State-by-State Analysis Using a National Database. Workplace Health Saf 2024; 72:101-107. [PMID: 38217417 DOI: 10.1177/21650799231221575] [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: 01/15/2024]
Abstract
BACKGROUND Cardiovascular events are known to be the leading cause of death among on-duty firefighters. Implementing fitness standards may help reduce the incidence of cardiovascular deaths; however, standards vary between firefighter type and states. We aimed to investigate the rate of cardiovascular events among firefighters across states. METHODS Using publicly available data from the United States Fire Administration, we explored the rates of cardiovascular deaths between firefighter type (e.g., career, volunteer, and wildland) and state. Specifically, we examined rates of cardiovascular deaths between California and Tennessee, which have fitness standards for all firefighters, and New York, which does not have fitness standards for volunteer firefighters. We used descriptive statistics and trend analysis to examine the data. FINDINGS Most cardiovascular events occur among volunteer firefighters (60.6%, n = 877). Volunteer firefighters had 7.5 (95% CI = [4.8, 11.7], p < .001) greater odds of cardiovascular events compared to wildland firefighters, who had the lowest incidence of cardiovascular events (1.7%, n = 24). New York reported the most cardiovascular events (n = 161), primarily among volunteer firefighters (73.9%, n = 119). After the passage of legislation mandating fitness standards in California, a downtrend in the number of volunteer firefighter fatalities is observed. However, a null effect was observed in Tennessee after the passage of similar fitness standards as in California. CONCLUSIONS/APPLICATIONS TO PRACTICE Volunteer firefighters are significantly more likely to die of a cardiovascular event than career and wildland firefighters, both of which have stricter fitness standards. However, the effect of legislation mandating stricter fitness standards among volunteers did not produce a clear benefit for preventing fatalities. Nurses need to promote cardiovascular health among volunteer firefighters.
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Affiliation(s)
- Dillon J Dzikowicz
- School of Nursing, University of Rochester
- University of Rochester Medical Center
- Clinical Cardiovascular Research Center
| | | | - Wai Cheong Tam
- Fire Research Division, National Institute of Standards and Technology
| | | | - Mary G Carey
- School of Nursing, University of Rochester
- University of Rochester Medical Center
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AHONKHAI AA, BIAN A, ROBBINS NN, MAURER LA, CLOUSE K, PIERCE LJ, PERKINS JM, WERNKE SA, SHEPHERD BE, BRANTLEY M. Characterizing residential mobility among people with HIV in Tennessee and its impact on HIV care outcomes. AIDS 2024; 38:397-405. [PMID: 37916463 PMCID: PMC10872643 DOI: 10.1097/qad.0000000000003778] [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: 11/03/2023]
Abstract
OBJECTIVE Our objective was to assess the prevalence and patterns of mobility among people with HIV (PWH) in Tennessee and its impact on HIV care outcomes. DESIGN Retrospective cohort study. METHODS We combined residential address and HIV surveillance data from PWH in Tennessee from 2016 to 2018. Using Poisson regression, we estimated associations between in-state mobility (change in address or total miles moved) in 1 year and outcomes in the subsequent year; retention: having two CD4 + /HIV RNA values (labs) in a calendar year at least 3 months apart, loss to follow-up (LTFU): having labs at baseline but not the subsequent year, and viral suppression: HIV RNA less than 200 copies/ml. We applied a kernel density estimator to origin-destination address lines to visualize mobility patterns across demographic subgroups. RESULTS Among 17 428 PWH [median age 45 years (interquartile range; IQR 34-53)], 6564 (38%) had at least one move. Median miles moved was 8.9 (IQR 2.6-143.4)). We observed in-state movement between major cities (Chattanooga, Knoxville, Memphis and Nashville) and out-of-state movement to and from Georgia and Florida. Having at least one in-state move was associated with a decreased likelihood of retention [adjusted relative risk (aRR) = 0.91; 95% confidence interval (CI) 0.88-0.95], and an increased risk of LTFU (aRR = 1.17; 95% CI 1.04-1.31, two to three moves vs. none). Greater distance moved in-state was associated with decreased retention and increased LTFU (aRR = 0.53; 95% CI 0.49-0.58, aRR = 2.52; 95% CI 2.25-2.83, respectively for 1000 vs. 0 miles). There was no association between mobility and viral suppression. CONCLUSION Mobility is common among PWH in Tennessee and is associated with initial poor engagement in HIV care.
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Affiliation(s)
- Aima A. AHONKHAI
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Aihua BIAN
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Kate CLOUSE
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt University School of Nursing, Nashville, TN
| | - Leslie J. PIERCE
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jessica M. PERKINS
- Department of Human & Organizational Development, Peabody College, Vanderbilt University, Nashville, TN
| | - Steven A. WERNKE
- Department of Anthropology, Vanderbilt University, Nashville, TN
| | - Bryan E. SHEPHERD
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
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Hazlehurst MF, Hajat A, Tandon PS, Szpiro AA, Kaufman JD, Tylavsky FA, Hare ME, Sathyanarayana S, Loftus CT, LeWinn KZ, Bush NR, Karr CJ. Associations of residential green space with internalizing and externalizing behavior in early childhood. Environ Health 2024; 23:17. [PMID: 38331928 PMCID: PMC10851463 DOI: 10.1186/s12940-024-01051-9] [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: 02/19/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Green space exposures may promote child mental health and well-being across multiple domains and stages of development. The aim of this study was to investigate associations between residential green space exposures and child mental and behavioral health at age 4-6 years. METHODS Children's internalizing and externalizing behaviors in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) cohort in Shelby County, Tennessee, were parent-reported on the Child Behavior Checklist (CBCL). We examined three exposures-residential surrounding greenness calculated as the Normalized Difference Vegetation Index (NDVI), tree cover, and park proximity-averaged across the residential history for the year prior to outcome assessment. Linear regression models were adjusted for individual, household, and neighborhood-level confounders across multiple domains. Effect modification by neighborhood socioeconomic conditions was explored using multiplicative interaction terms. RESULTS Children were on average 4.2 years (range 3.8-6.0) at outcome assessment. Among CANDLE mothers, 65% self-identified as Black, 29% as White, and 6% as another or multiple races; 41% had at least a college degree. Higher residential surrounding greenness was associated with lower internalizing behavior scores (-0.66 per 0.1 unit higher NDVI; 95% CI: -1.26, -0.07) in fully-adjusted models. The association between tree cover and internalizing behavior was in the hypothesized direction but confidence intervals included the null (-0.29 per 10% higher tree cover; 95% CI: -0.62, 0.04). No associations were observed between park proximity and internalizing behavior. We did not find any associations with externalizing behaviors or the attention problems subscale. Estimates were larger in neighborhoods with lower socioeconomic opportunity, but interaction terms were not statistically significant. CONCLUSIONS Our findings add to the accumulating evidence of the importance of residential green space for the prevention of internalizing problems among young children. This research suggests the prioritization of urban green spaces as a resource for child mental health.
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Affiliation(s)
- Marnie F Hazlehurst
- Department of Epidemiology, Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA.
| | - Anjum Hajat
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Pooja S Tandon
- Seattle Children's Research Institute, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Joel D Kaufman
- Department of Environmental & Occupational Health Sciences, Department of Epidemiology, Division of General Internal Medicine, Department of Medicine, University of Washington School of Public Health, University of Washington School of Medicine, Seattle, WA, USA
| | - Frances A Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sheela Sathyanarayana
- Seattle Children's Research Institute; Department of Pediatrics, University of Washington School of Medicine; Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
| | - Christine T Loftus
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nicole R Bush
- Department of Psychiatry, Department of Pediatrics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Catherine J Karr
- Department of Pediatrics, Department of Environmental & Occupational Health Sciences, University of Washington School of Medicine, University of Washington School of Public Health, Seattle, WA, USA
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Saint SR, Onyango E, Korona-Bailey J, Jayasundara J, Hall K, Mukhopadhyay S. Diphenhydramine-involved Fatal and Nonfatal Drug Overdoses in Tennessee, 2019-2022. Subst Use Misuse 2024; 59:638-642. [PMID: 38189325 DOI: 10.1080/10826084.2023.2280542] [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] [Indexed: 01/09/2024]
Abstract
BACKGROUND Diphenhydramine (DPH), known as the brand name Benadryl, is an over-the-counter medication associated with accidental ingestion leading to nonfatal overdoses. Additionally, DPH has been used in tandem with illicit substances leading to fatal drug overdoses. OBJECTIVE In response to DPH being seized with illicit drugs as an adulterant, as well as its growing intentional misuse, we sought to explore its recent involvement in fatal and nonfatal drug overdoses in the state of Tennessee. METHODS We conducted a statewide cross-sectional study to determine the characteristics of DPH-involved fatal and nonfatal overdoses in Tennessee during 2019-2022 using data from the State Unintentional Drug Overdose Reporting System, the Electronic Surveillance System for the Early Notification of Community-based Epidemics, and the National Forensic Laboratory Information System Public Data Query System. Frequencies were generated to compare demographic characteristics, circumstances, and toxicology between fatal and nonfatal DPH-involved overdoses. RESULTS We identified 143 suspected nonfatal DPH and 409 fatal DPH-involved overdoses in Tennessee from 2019 to 2022. Nonfatal overdoses remained consistent while fatal overdoses peaked in 2021. Most nonfatal overdoses were under 18 (63.4%), while most fatal overdoses were between 18 and 64 years of age (95.7%). For fatal overdoses, fentanyl was the most prevalent substance on toxicology followed by prescription opioids. CONCLUSION Nonfatal overdoses remained consistent while fatal overdoses peaked in 2021 in Tennessee. Use of DPH among other illicit substances lends to evidence suggesting its use as an adulterant. Monitoring of DPH-involved fatal and nonfatal overdoses is critical to inform harm reduction initiatives.
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Affiliation(s)
- Sarah Riley Saint
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee, USA
| | - Edward Onyango
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee, USA
| | - Jessica Korona-Bailey
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee, USA
| | - Joshua Jayasundara
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee, USA
| | - Kristi Hall
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee, USA
| | - Sutapa Mukhopadhyay
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, Tennessee, USA
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von Hippel PT. The effect of smaller classes on infection-related school absence: evidence from the Project STAR randomized controlled trial. BMC Public Health 2024; 24:83. [PMID: 38172812 PMCID: PMC10765901 DOI: 10.1186/s12889-023-17503-9] [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: 07/09/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In an effort to reduce viral transmission, many schools reduced class sizes during the recent pandemic. Yet the effect of class size on transmission is unknown. METHODS We used data from Project STAR, a randomized controlled trial in which 10,816 Tennessee elementary students were assigned at random to smaller classes (13 to 17 students) or larger classes (22 to 26 students) in 1985-89. We merged Project STAR schools with data on local deaths from pneumonia and influenza in the 122 Cities Mortality Report System. Using mixed effects linear, Poisson, and negative binomial regression, we estimated the main effect of smaller classes on absence. We used an interaction to test whether the effect of small classes on absence was larger when and where community pneumonia and influenza prevalence was high. RESULTS Small classes reduced absence by 0.43 days/year (95% CI -0.06 to -0.80, p < 0.05), but small classes had no significant interaction with community pneumonia and influenza mortality (95% CI -0.27 to + 0.30, p > 0.90), indicating that the reduction in absence due to small classes was not larger when community disease prevalence was high. CONCLUSION Small classes reduced absence, but the reduction was not larger when disease prevalence was high, so the reduction in absence was not necessarily achieved by reducing infection. Small classes, by themselves, may not suffice to reduce the spread of respiratory viruses.
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Affiliation(s)
- Paul T von Hippel
- Center for Health and Social Policy, LBJ School of Public Affairs, University of Texas, Austin, USA.
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Tran PM, Zhu C, Harris WT, Raghavan SKK, Odoi A, Tran L. An examination of geographic access to outpatient stroke rehabilitation services in Tennessee, a stroke belt state. J Stroke Cerebrovasc Dis 2024; 33:107472. [PMID: 37944281 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107472] [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: 08/25/2023] [Revised: 10/24/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND While over half of US stroke patients were discharged to home, estimates of geographic access to outpatient stroke rehab facilities are unavailable. The objective of our study was to assess distance and travel time to the nearest outpatient stroke rehab facility in Tennessee, a high stroke prevalence state. METHODS We systematically scraped Google Maps with the terms "stroke", "rehabilitation", and "outpatient" to identify Tennessee stroke rehab facilities. We then averaged/aggregated Census block-level travel distance and travel time to determine the mean travel distance/time to a facility for each of the 95 Tennessee counties and the overall state. Comparisons of mean travel time/distance were made between rural and urban counties and between low, medium, and high stroke prevalence counties. RESULTS We found that 79% of facilities were in urban areas. Significantly higher median of mean travel times and distances (p values both <0.001) were observed in rural (22.0 miles, 31.6 min) versus urban counties (10.5 miles, 18.4 min). High (21.5 miles, 32.5 min) and medium (18.7 miles, 28.3 minutes) stroke prevalence counties, which often overlap with rural counties, had significantly higher median of mean travel times and distance than low stroke prevalence counties (7.3 miles, 14.5 min). CONCLUSIONS Rural Tennessee counties were faced with high stroke prevalence, inadequate facilities, and significantly greater travel distance and time to access care. Additional efforts to address transportation barriers and accelerate telerehabilitation implementation are crucial for improving equal access to stroke aftercare in these areas.
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Affiliation(s)
- Phoebe M Tran
- Department of Public Health, University of Tennessee, Knoxville, TN, USA.
| | - Cenjing Zhu
- Department of Chronic Disease Epidemiology, Yale University, New Haven, CT, USA
| | | | - Sajeesh K Kamala Raghavan
- Department of Diagnostic and Health Sciences, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, USA
| | - Liem Tran
- Deparment of Geography and Sustainability, University of Tennessee, Knoxville, TN, USA
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12
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Hung YC, Evans AG, Ruiz DP, Lee MS, Jackson KR, Thayer WP, Hill JB. Reduced Access to Acute Hand Care and Potential Role of Telemedicine in Tennessee During the COVID Pandemic. Ann Plast Surg 2024; 92:50-54. [PMID: 37856233 DOI: 10.1097/sap.0000000000003717] [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: 10/21/2023]
Abstract
INTRODUCTION Previous studies have identified that there is limited, although expanding, access to acute hand care in Tennessee. Because of the rapid changes that occurred in health delivery and access during the coronavirus disease pandemic, we reassessed access to acute hand care, with particular interest in the utilization of telemedicine to assess if this increased access. METHOD We surveyed Tennessee hospitals listed by the Tennessee Hospital Association on their management of hand trauma and availability of telemedicine programs. Census data including population demographics such as race, age, income, and county size were merged with the survey data. Descriptive analysis was performed comparing the 2021 cohort with the historic 2018 cohort and between counties that had hand care versus counties that had no hand care. RESULT Survey response rate was 71.4% (n = 80 of 112). Telemedicine was used in 80% of the hospitals for other specialties but was not used for hand care. Overall, counties that offered hand trauma care reduced from 60% to 26% from 2018 to 2021 ( P < 0.001). This change was associated with a significant reduction of acute hand care among counties that were classified micropolitan (from 56.3% to 6.7%, P < 0.01). Percentage of hand specialists on staff and 24/7 specialists availability remained low and were similar to the availability in 2018. CONCLUSIONS There was a decrease of acute hand care access in Tennessee during the coronavirus disease pandemic despite widespread utilization of telemedicine for other specialty consults. Expansion of telemedicine in acute hand care, targeted to micropolitan areas, may help to reduce variability in access to care.
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Affiliation(s)
- Ya-Ching Hung
- From the Department of Plastic Surgery, Vanderbilt University Medical Center
| | - Adam G Evans
- From the Department of Plastic Surgery, Vanderbilt University Medical Center
| | - Darren P Ruiz
- School of Medicine, Meharry Medical College, Nashville TN
| | - Mykia S Lee
- School of Medicine, Meharry Medical College, Nashville TN
| | - Kianna R Jackson
- From the Department of Plastic Surgery, Vanderbilt University Medical Center
| | - Wesley P Thayer
- From the Department of Plastic Surgery, Vanderbilt University Medical Center
| | - J Bradford Hill
- From the Department of Plastic Surgery, Vanderbilt University Medical Center
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13
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Singh N, Khare R, Mazumder S. Mycobacterium senegalense Infection in Kidney Transplant Patient with Diabetes, Memphis, Tennessee, USA. Emerg Infect Dis 2024; 30:192-194. [PMID: 38147514 PMCID: PMC10756380 DOI: 10.3201/eid3001.231013] [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: 12/28/2023] Open
Abstract
Fewer than 30 cases of Mycobacterium senegalense infection have been reported. We report a complicated case of M. senegalense infection in Memphis, Tennessee, in the southeastern United States. The patient's comorbidities of past organ transplant and insulin-dependent diabetes required delicate consideration of those health conditions to guide treatment.
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14
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Moses J, Korona-Bailey J, Mukhopadhyay S. Exploring trends in benzodiazepine-positive fatal drug overdoses in Tennessee, 2019-2021. Ann Med 2023; 55:2287194. [PMID: 38039554 PMCID: PMC10836290 DOI: 10.1080/07853890.2023.2287194] [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: 08/18/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Benzodiazepine-positive overdoses increased between 2019 and 2021 in Tennessee. We sought to determine the changes in the number and characteristics of prescription and illicit benzodiazepine-positive fatal drug overdoses during this period. MATERIALS AND METHODS A statewide study was conducted to determine changes in the number and characteristics of benzodiazepine-positive drug overdose decedents using 2019-2021 data from the Tennessee State Unintentional Drug Overdose Reporting System. The analyses were limited to Tennessee residents aged ≥ 18 years. A benzodiazepine-positive overdose was defined as any benzodiazepine on toxicology, regardless of the presence of other substances. Frequencies were generated to compare demographics, circumstances, prescription history, and toxicology between 2019 and 2021 for illicit and prescription benzodiazepine-positive fatal overdoses. RESULTS Between 2019 and 2021, 1666 benzodiazepine-positive unintentional or undetermined fatal drug overdoses out of 5916 total overdoses that occurred among adult Tennessee residents with available toxicological information. Prescription benzodiazepines were identified in 80.7% of deaths, whereas illicit benzodiazepines were identified in 12.0% of deaths. Many decedents had an anxiety disorder (45.5%), while over half of all decedents had a history of substance use disorder (52.3%). Most benzodiazepine-positive overdoses involved fentanyl (71.3%). CONCLUSIONS This analysis can inform local and regional public health workers to implement focused prevention and intervention efforts for people with co-occurring mental health conditions and substance use disorders to curb overdose epidemics among persons using benzodiazepines in Tennessee. Public health campaigns should focus on educating people on appropriate prescription medication use and the dangers of obtaining substances illicitly. Given the high proportion of opioids in this population, further education also is needed on the dangers of polysubstance drug use. The differences between prescription and illicit benzodiazepine-positive fatal overdoses indicate the need to develop substance-specific prevention and treatment strategies.
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Affiliation(s)
| | | | - Sutapa Mukhopadhyay
- TN Department of Health, Office of Informatics and Analytics, Nashville, TN, USA
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15
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Massion SP, Howa AC, Zhu Y, Kim A, Halasa N, Chappell J, McGonigle T, Mellis AM, Deyoe JE, Reed C, Rolfes MA, Talbot HK, Grijalva CG. Sex differences in COVID-19 symptom severity and trajectories among ambulatory adults. Influenza Other Respir Viruses 2023; 17:e13235. [PMID: 38125808 PMCID: PMC10730332 DOI: 10.1111/irv.13235] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background The ongoing COVID-19 pandemic has led to hundreds of millions of infections worldwide. Although differences in COVID-19 hospitalization rates between males and females have been described, many infections in the general population have been mild, and the severity of symptoms during the course of COVID-19 in non-hospitalized males and females is not well understood. Methods We conducted a case-ascertained study to examine household transmission of SARS-CoV-2 infections in Nashville, Tennessee, between April 2020 and April 2021. Among enrolled ambulatory adult participants with laboratory-confirmed SARS-CoV-2 infections, we assessed the presence and severity of symptoms (total, systemic, and respiratory) daily using a symptoms severity questionnaire, from illness onset and throughout the 2-week follow-up period. We compared the mean daily symptom severity scores (0-3: none, mild, moderate, and severe) and change in symptoms between males and females using a multivariable linear mixed effects regression model. Results The analysis included 223 enrolled adults with SARS-CoV-2 infection (58% females, mostly white, non-Hispanic) from 146 households with 2917 total daily symptom reports. The overall mean severity of total symptoms reported over the illness period was 1.04 and 0.90 for females and males, respectively. Mean systemic and respiratory scores were higher for females than for males (p < 0.001). In multivariable analyses, females reported more severe total and systemic symptoms during the illness period compared with males. However, no significant differences in reported respiratory symptoms were observed. Conclusions Our findings indicate that among ambulatory adults with SARS-CoV-2 infections, females reported slightly higher symptom severity during their illness compared with males.
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Affiliation(s)
- Samuel P. Massion
- Department of Health PolicyVanderbilt University Medical CenterNashvilleTennesseeUSA
- School of MedicineVanderbilt UniversityNashvilleTennesseeUSA
| | - Amanda C. Howa
- Department of Health PolicyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Yuwei Zhu
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Ahra Kim
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Natasha Halasa
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - James Chappell
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Trey McGonigle
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Alexandra M. Mellis
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Jessica E. Deyoe
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Carrie Reed
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Melissa A. Rolfes
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - H. Keipp Talbot
- Department of Health PolicyVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Carlos G. Grijalva
- Department of Health PolicyVanderbilt University Medical CenterNashvilleTennesseeUSA
- School of MedicineVanderbilt UniversityNashvilleTennesseeUSA
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTennesseeUSA
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16
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Ketel C, Clouse K, Jordan H, Uroza S, Kirby J, Adams K, Davis T, Janbakhsh D, Green M, Hopkins P, James B, Rahman N, Thomas A, Plummer C. Bringing COVID-19 vaccine to medically underserved populations utilizing a community-guided mobile vaccine program. Public Health Nurs 2023; 40:925-930. [PMID: 37622842 DOI: 10.1111/phn.13249] [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: 04/11/2023] [Revised: 07/08/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
Between March 23, 2021, and December 31, 2022, the Mobile Vaccine Program (MVP) vaccinated 5044 individuals from medically-underserved communities in Middle Tennessee identified through and guided by a collaboration of local community agencies. The primary objective of the MVP was to vaccinate individuals for COVID-19 who had barriers to traditional mass vaccine strategies through community-guided strategies and partnerships. Three strategies were developed and implemented with community partners and their affiliated community health workers (CHWs). The strategies included pop-up vaccination clinics at community partner events, CHW-guided door-to-door in-home vaccination, and community partner-initiated homebound referrals for vaccination.
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Affiliation(s)
- Christian Ketel
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Kate Clouse
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Heather Jordan
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah Uroza
- Lipscomb University College of Pharmacy, Nashville, Tennessee
| | - Justin Kirby
- Lipscomb University College of Pharmacy, Nashville, Tennessee
| | - Keri Adams
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Michael Green
- Metropolitan Development and Housing Agency, Nashville, Tennessee
| | - Paige Hopkins
- Metropolitan Development and Housing Agency, Nashville, Tennessee
| | | | - Nadia Rahman
- Nashville International Center for Empowerment, Nashville, Tennessee
| | - Ally Thomas
- Nashville International Center for Empowerment, Nashville, Tennessee
| | - Carrie Plummer
- Vanderbilt University School of Nursing, Nashville, Tennessee
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17
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Koethe JR, Eeds A, Stewart LV, Haas DW, Hildreth JEK, Mallal S, Wanjalla C, Perkins J, Ahonkhai A, Dong X, Berhanu R, Dash C. The Tennessee Center for AIDS Research HIV Research Training Program for Minority High School and Undergraduate Students: Development, Implementation, and Early Outcomes. J Acquir Immune Defic Syndr 2023; 94:S42-S46. [PMID: 37707847 PMCID: PMC10503046 DOI: 10.1097/qai.0000000000003261] [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: 09/15/2023]
Abstract
BACKGROUND The Southern region of the United States has the highest HIV incidence, and new infections disproportionately affect Black Americans. The Tennessee Center for AIDS Research (CFAR) Diversity, Equity, and Inclusion Pathway Initiative (CDEIPI) program supports the training of individuals from groups underrepresented in medicine and science in multiple areas of research to increase the pool of HIV-focused investigators at early educational and career stages. SETTING The Tennessee CFAR is a partnership between Vanderbilt University Medical Center, Meharry Medical College (one of the oldest historically Black medical colleges), Tennessee Department of Health, and Nashville Community AIDS Resources, Education and Services (a sophisticated community service organization, which emphasizes research training responsive to regional and national priorities). METHODS The Tennessee CFAR CDEIPI program leverages existing Vanderbilt University Medical Center and Meharry Medical College structured biomedical training programs for high school and undergraduate students to provide an intensive, mentored, HIV research experience augmented by CFAR resources situating this training within the broader history, scientific breadth, and societal and political aspects of the HIV epidemic. RESULTS The first year of the Tennessee CFAR CDEIPI program trained 3 high school and 3 undergraduate students from underrepresented in medicine and science backgrounds in basic, clinical/translational, and community-focused research projects with a diverse group of 9 mentors. All students completed the program, and evaluations yielded positive feedback regarding mentoring quality and effectiveness, and continued interest in HIV-related research. CONCLUSIONS The Tennessee CFAR CDEIPI program will continue to build upon experience from the first year to further contribute to national efforts to increase diversity in HIV-related research.
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Affiliation(s)
| | | | | | - David W. Haas
- Vanderbilt University Medical Center, Nashville, TN
- Meharry Medical College, Nashville TN
| | | | - Simon Mallal
- Vanderbilt University Medical Center, Nashville, TN
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18
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Thomas Tobin CS, Huynh J, Farmer HR, Israel Cross R, Barve A, Robinson M, Leslie EP, Thorpe RJ. Perceived Neighborhood Racial Composition and Depressive Symptoms Among Black Americans Across Adulthood: Evaluating the Role of Psychosocial Risks and Resources. J Aging Health 2023; 35:660-676. [PMID: 35657773 PMCID: PMC10478356 DOI: 10.1177/08982643221100789] [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: 11/16/2022]
Abstract
Objectives: To evaluate the relationships between perceived neighborhood racial composition (PNRC), psychosocial risks and resources, and depressive symptoms among young (ages 22-35), middle-aged (ages 36-49), and older (ages 50+) Black Americans. Methods: Full sample and age-stratified linear regression models estimated the PNRC-depressive symptoms association and the extent to which it persisted after accounting for psychosocial risks (i.e., neighborhood disorder, other social stressors) and resources (i.e., mastery, social support, racial identity) among 627 Black Americans in the Nashville Stress and Health Study. Results: Living in racially integrated and predominately White neighborhoods was associated with elevated depressive symptoms. While psychosocial risks and resources explained a substantial portion of these associations, patterns varied across age groups. Discussion: PNRC impacts depressive symptoms among Black Americans by shaping psychosocial risks and resources. Findings underscore interconnections between contextual and psychosocial factors, as well as the distinct mental health significance of these processes across stages of adulthood.
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Affiliation(s)
| | - James Huynh
- Department of Community Health Sciences, University of California, Los Angeles, CA, USA
| | - Heather R. Farmer
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Rebekah Israel Cross
- Department of Health Behavior/ Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Apurva Barve
- Department of Community Health Sciences, University of California, Los Angeles, CA, USA
| | - Millicent Robinson
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Roland J. Thorpe
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Baltimore, MD, USA
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Hall KF, Korona-Bailey J, Mukhopadhyay S. Phentermine involvement in fatal drug overdoses in Tennessee, 2019-2022. Int J Drug Policy 2023; 119:104151. [PMID: 37549596 DOI: 10.1016/j.drugpo.2023.104151] [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: 02/09/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Phentermine, one of the most-commonly prescribed pharmaceuticals for weight-loss in the United States (US), has appeared on toxicology and listed as a cause of death in fatal drug overdoses in the state of Tennessee. This study aims to evaluate phentermine's involvement in fatal drug overdoses in the state of Tennessee. METHODS We used Tennessee State Unintentional Drug Overdose Reporting System (SUDORS) data and controlled substances monitoring program data (CSMD) to evaluate demographics, prescription history and co-occurring substances on toxicology in phentermine-positive cases compared with all other SUDORS cases from January 1, 2019 to June 30, 2022. A subset of these cases which listed phentermine as a cause of death was also assessed. RESULTS We identified 51 phentermine-positive cases, with a subset of 20 that listed phentermine as a cause of death. When compared to all SUDORS cases, a higher proportion of cases that listed phentermine as a cause of death were White race, females, and aged 35-44. Additionally, in all phentermine-positive cases, 41% (21) of decedents had not had a phentermine prescription dating back to 2012 and 20% (Lee et al., 1998) did not have one within the last 30 days. While there was a slight decline each year in the number of phentermine-positive cases, the number of cases that listed phentermine as a cause of death remained relatively consistent, with 95% (19) of cases having different prescriptions and/or illicit drugs listed as a cause of death along with phentermine. CONCLUSION Phentermine was listed as a cause of death in 20 fatal drug overdoses in TN. Our findings suggest there may be differences in the characteristics of these decedents when compared to all SUDORS decedents, including distribution of age, gender, and race. We also found a large presence of other prescription and illicit drugs in toxicology and cause of death along with phentermine, as well as evidence of use of the drug without a prescription. Given the lack of currently available data about non-prescribed phentermine use and its involvement in fatal drug overdoses elsewhere, a need exists to both expand surveillance capabilities and broaden research to better inform policies governing this drug in the US and internationally.
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Affiliation(s)
- Kristi F Hall
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7th Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States
| | - Jessica Korona-Bailey
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7th Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States
| | - Sutapa Mukhopadhyay
- Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower 7th Floor, 710 James Robertson Parkway, Nashville, TN 37243, United States
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20
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McKay T, Gastineau K, Wrenn JO, Han JH, Storrow AB. Trends in paediatric firearm-related encounters during the COVID-19 pandemic by age group, race/ethnicity and schooling mode in Tennessee. Inj Prev 2023; 29:327-333. [PMID: 37137687 DOI: 10.1136/ip-2023-044852] [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: 01/17/2023] [Accepted: 03/26/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Increases in paediatric firearm-related injuries during the COVID-19 pandemic may be due to changes in where children and adolescents spent their time. This study examines changes in the frequency of paediatric firearm-related encounters as a function of schooling mode overall and by race/ethnicity and age group at a large trauma centre through 2021. METHODS We use data from a large paediatric and adult trauma centre in Tennessee from January 2018 to December 2021 (N=211 encounters) and geographically linked schooling mode data. We use Poisson regressions to estimate smoothed monthly paediatric firearm-related encounters as a function of schooling mode overall and stratified by race and age. RESULTS Compared with pre pandemic, we find a 42% increase in paediatric encounters per month during March 2020 to August 2020, when schools were closed, no significant increase during virtual/hybrid instruction, and a 23% increase in encounters after schools returned to in-person instruction. The effects of schooling mode are heterogeneous by patient race/ethnicity and age. Encounters increased among non-Hispanic black children across all periods relative to pre pandemic. Among non-Hispanic white children, encounters increased during the closure period and decreased on return to in-person instruction. Compared with pre pandemic, paediatric firearm-related encounters increased 205% for children aged 5-11 and 69% for adolescents aged 12-15 during the school closure period. CONCLUSION COVID-19-related changes to school instruction mode in 2020 and 2021 are associated with changes in the frequency and composition of paediatric firearm-related encounters at a major trauma centre in Tennessee.
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Affiliation(s)
- Tara McKay
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee, USA
| | - Kelsey Gastineau
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jesse O Wrenn
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jin H Han
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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21
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Hardman RH, Ammar S, Gerhold R, Sutton W, Carter ED, Snyder S, Neto JDS, Tarkington M, Gray MJ, Miller DL. Coccidiosis in Wild Eastern Newts (Notophthalmus viridescens): An Unexpected Finding in Consecutive Mortality Events in Tennessee, USA. J Wildl Dis 2023; 59:479-486. [PMID: 37179488 DOI: 10.7589/jwd-d-22-00107] [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: 08/08/2022] [Accepted: 02/13/2023] [Indexed: 05/15/2023]
Abstract
Wildlife diseases are a major threat for species conservation, and there is a growing need to implement more comprehensive disease response programs to better identify these diseases of concern. During March 2017, we observed moribund and dead eastern newts, Notophthalmus viridescens, in a single pond in middle Tennessee. All moribund individuals were emaciated. We euthanized and processed all individuals immediately on-site and later performed histopathology and quantitative PCR for ranavirus, the protist Perkinsea, and chytrid fungi Batrachochytrium dendrobatidis and Batrachochytrium salamandrivorans. One newt was positive for ranavirus. Histopathology showed no evidence of ranavirosis but did reveal overwhelming coccidiosis. Overlapping partial sequences of coccidian 18S subunit DNA showed a 96.4% match with Eimeria steinhausi, suggesting that lesions were due to a previously undescribed Eimeria sp. In 2019, two more moribund newts were encountered at the same pond. Histopathology revealed the same suspicious parasitic organisms, and one individual was positive for B. dendrobatidis. Further research on how seasonal and other environmental parameters may influence coccidia-associated morbidity and mortality is warranted. These events highlight the importance of histopathologic evaluation of mortality events and provide guidance for investigation of future outbreaks.
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Affiliation(s)
- Rebecca H Hardman
- University of Tennessee, Center for Wildlife Health, Department of Forestry, Wildlife, and Fisheries, 427 Plant Biotechnology Building 2505 E. J. Chapman Dr., Knoxville, Tennessee 37996, USA
- University of Tennessee, College of Veterinary Medicine, Department of Biomedical and Diagnostic Sciences, 2407 River Dr., Knoxville, Tennessee 37996, USA
- Florida Fish and Wildlife Conservation Commission, Fish and Wildlife Research Institute, 100 8th Ave. SE, St. Petersburg, Florida 33701, USA
| | - Sawsan Ammar
- University of Tennessee, College of Veterinary Medicine, Department of Biomedical and Diagnostic Sciences, 2407 River Dr., Knoxville, Tennessee 37996, USA
- The University of Sadat City, College of Veterinary Medicine, Sadat City, Menofia 32511 Egypt
| | - Richard Gerhold
- University of Tennessee, Center for Wildlife Health, Department of Forestry, Wildlife, and Fisheries, 427 Plant Biotechnology Building 2505 E. J. Chapman Dr., Knoxville, Tennessee 37996, USA
- University of Tennessee, College of Veterinary Medicine, Department of Biomedical and Diagnostic Sciences, 2407 River Dr., Knoxville, Tennessee 37996, USA
| | - William Sutton
- Wildlife Ecology Laboratory, Tennessee State University, Department of Agricultural and Environmental Sciences, 3500 John A. Merritt Blvd., Farrell-Westbrook Building, Nashville, Tennessee 37209, USA
| | - E Davis Carter
- University of Tennessee, Center for Wildlife Health, Department of Forestry, Wildlife, and Fisheries, 427 Plant Biotechnology Building 2505 E. J. Chapman Dr., Knoxville, Tennessee 37996, USA
| | - Shawn Snyder
- Wildlife Ecology Laboratory, Tennessee State University, Department of Agricultural and Environmental Sciences, 3500 John A. Merritt Blvd., Farrell-Westbrook Building, Nashville, Tennessee 37209, USA
| | - Jeronimo da Silva Neto
- Wildlife Ecology Laboratory, Tennessee State University, Department of Agricultural and Environmental Sciences, 3500 John A. Merritt Blvd., Farrell-Westbrook Building, Nashville, Tennessee 37209, USA
| | - Meredith Tarkington
- University of Tennessee, Center for Wildlife Health, Department of Forestry, Wildlife, and Fisheries, 427 Plant Biotechnology Building 2505 E. J. Chapman Dr., Knoxville, Tennessee 37996, USA
| | - Matthew J Gray
- University of Tennessee, Center for Wildlife Health, Department of Forestry, Wildlife, and Fisheries, 427 Plant Biotechnology Building 2505 E. J. Chapman Dr., Knoxville, Tennessee 37996, USA
| | - Debra L Miller
- University of Tennessee, Center for Wildlife Health, Department of Forestry, Wildlife, and Fisheries, 427 Plant Biotechnology Building 2505 E. J. Chapman Dr., Knoxville, Tennessee 37996, USA
- University of Tennessee, College of Veterinary Medicine, Department of Biomedical and Diagnostic Sciences, 2407 River Dr., Knoxville, Tennessee 37996, USA
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22
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Kurth KA, Watson EM, Gerhold RW, Metts DL, Miller BF, Morin DJ, Eda S, Yang SI, Muller LI. MORTALITY, SURVIVAL, AND SEROLOGIC RESULTS FOR ELK (CERVUS CANADENSIS) IN THE CUMBERLAND MOUNTAINS OF TENNESSEE, USA. J Wildl Dis 2023; 59:420-431. [PMID: 37269302 DOI: 10.7589/jwd-d-22-00099] [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: 07/21/2022] [Accepted: 12/14/2022] [Indexed: 06/05/2023]
Abstract
Comprehensive disease surveillance has not been conducted in elk (Cervus canadensis) in Tennessee, US, since their reintroduction to the state 20 yr ago. We identified causes of death, estimated annual survival, and identified pathogens of concern in elk at the North Cumberland Wildlife Management Area (NCWMA), Tennessee, US. In 2019 and 2020, we captured 29 elk (21 females, eight males) using chemical immobilization and fitted individuals with GPS collars with mortality sensors. Elk that died between February 2019 and February 2022 were necropsied to identify causes of death; these included disease associated with meningeal worm (Parelaphostrongylus tenuis; n=3), poaching (n=1), vehicular collision (n=1), legal hunter harvest (n=1), and unknown due to carcass degradation (n=3). Using data from GPS collars and known-fate survival models, we estimated an average yearly survival rate of 80.2%, indicating that survival had not significantly increased from soon after elk reintroduction (79.9%). We collected blood, tissue, feces, and ectoparasites opportunistically from anesthetized elk for health surveillance. We identified lone star ticks (Amblyomma americanum; n=53, 85.5%; 95% confidence interval [CI], 73.72-92.75), American dog ticks (Dermacentor variabilis; n=8, 12.9%; 95% CI, 6.13-24.40), and black-legged ticks (Ixodes scapularis; n=1, 1.6%; 95% CI, 0.08-9.83). We detected evidence of exposure to Anaplasma marginale (100%; 95% CI, 84.50-100.00), Leptospira interrogans (70.4%; 95% CI, 49.66-85.50), Toxoplasma gondii (55.6%; 95% CI, 35.64-73.96), epizootic hemorrhagic disease virus (51.9%; 95% CI, 32.35-70.84), and Theileria cervi (25.9%; 95% CI, 11.78-46.59). Johne's disease (Mycobacterium avium subsp. paratuberculosis) is potentially established within the population, but has not been previously documented in eastern elk populations. Disease associated with P. tenuis was a primary cause of death, and more research is needed to understand its ecology and epidemiology. Research to determine population implications of other detected pathogens at the NCWMA is warranted.
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Affiliation(s)
- Katherine A Kurth
- School of Natural Resources, University of Tennessee, 427 Plant Biotechnology, 2505 E. J. Chapman Drive, Knoxville, Tennessee 37996, USA
| | - Eryn M Watson
- School of Natural Resources, University of Tennessee, 427 Plant Biotechnology, 2505 E. J. Chapman Drive, Knoxville, Tennessee 37996, USA
| | - Richard W Gerhold
- Biomedical and Diagnostic Sciences, University of Tennessee College of Veterinary Medicine, A201 Veterinary Medical Center, 2407 River Drive, Knoxville, Tennessee 37996, USA
| | - Dailee L Metts
- School of Natural Resources, University of Tennessee, 427 Plant Biotechnology, 2505 E. J. Chapman Drive, Knoxville, Tennessee 37996, USA
| | - Brad F Miller
- Tennessee Wildlife Resources Agency, 609 Titus Hollow Road, Pioneer, Tennessee 37847, USA
| | - Dana J Morin
- Department of Wildlife and Fisheries, College of Forest Resources, Mississippi State University, Thompson Hall, Starkville, Mississippi 39762, USA
| | - Shigetoshi Eda
- School of Natural Resources, University of Tennessee, 427 Plant Biotechnology, 2505 E. J. Chapman Drive, Knoxville, Tennessee 37996, USA
| | - Sheng-I Yang
- School of Natural Resources, University of Tennessee, 427 Plant Biotechnology, 2505 E. J. Chapman Drive, Knoxville, Tennessee 37996, USA
| | - Lisa I Muller
- School of Natural Resources, University of Tennessee, 427 Plant Biotechnology, 2505 E. J. Chapman Drive, Knoxville, Tennessee 37996, USA
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23
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Deyoe JE, Kelly JD, Grijalva CG, Bonenfant G, Lu S, Anglin K, Garcia-Knight M, Pineda-Ramirez J, Hagen MB, Saydah S, Abedi GR, Goldberg SA, Tassetto M, Zhang A, Donohue KC, Davidson MC, Sanchez RD, Djomaleu M, Mathur S, Shak JR, Deeks SG, Peluso MJ, Chiu CY, Zhu Y, Halasa NB, Chappell JD, Mellis A, Reed C, Andino R, Martin JN, Zhou B, Talbot HK, Midgley CM, Rolfes MA. Association of Culturable-Virus Detection and Household Transmission of SARS-CoV-2, California and Tennessee, 2020-2022. J Infect Dis 2023; 227:1343-1347. [PMID: 36705269 PMCID: PMC10266938 DOI: 10.1093/infdis/jiad018] [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: 09/28/2022] [Revised: 12/27/2022] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
From 2 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) household transmission studies (enrolling April 2020 to January 2022) with rapid enrollment and specimen collection for 14 days, 61% (43/70) of primary cases had culturable virus detected ≥6 days post-onset. Risk of secondary infection among household contacts tended to be greater when primary cases had culturable virus detected after onset. Regardless of duration of culturable virus, most secondary infections (70%, 28/40) had serial intervals <6 days, suggesting early transmission. These data examine viral culture as a proxy for infectiousness, reaffirm the need for rapid control measures after infection, and highlight the potential for prolonged infectiousness (≥6 days) in many individuals.
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Affiliation(s)
- Jessica E Deyoe
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- San Francisco VA Medical Center, San Francisco, California, USA
- F.I. Proctor Foundation, University of California, San Francisco, California, USA
| | | | - Gaston Bonenfant
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Khamal Anglin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Miguel Garcia-Knight
- Department of Microbiology and Immunology, University of California, San Francisco, California, USA
| | - Jesus Pineda-Ramirez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | | | - Sharon Saydah
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Glen R Abedi
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah A Goldberg
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Michel Tassetto
- Department of Microbiology and Immunology, University of California, San Francisco, California, USA
| | - Amethyst Zhang
- Department of Microbiology and Immunology, University of California, San Francisco, California, USA
| | - Kevin C Donohue
- School of Medicine, University of California, San Francisco, California, USA
| | - Michelle C Davidson
- School of Medicine, University of California, San Francisco, California, USA
| | - Ruth Diaz Sanchez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Manuella Djomaleu
- Department of Microbiology and Immunology, University of California, San Francisco, California, USA
| | - Sujata Mathur
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Joshua R Shak
- San Francisco VA Medical Center, San Francisco, California, USA
- School of Medicine, University of California, San Francisco, California, USA
| | - Steven G Deeks
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, California, USA
| | - Michael J Peluso
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, California, USA
| | - Charles Y Chiu
- Division of Infectious Diseases, University of California, San Francisco, California, USA
| | - Yuwei Zhu
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Alexandra Mellis
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carrie Reed
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Raul Andino
- Department of Microbiology and Immunology, University of California, San Francisco, California, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Bin Zhou
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Claire M Midgley
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa A Rolfes
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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24
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Robinson MN, Erving CL, Thomas Tobin CS. Are Distressed Black Women Also Depressed? Implications for a Mental Health Paradox. J Racial Ethn Health Disparities 2023; 10:1280-1292. [PMID: 35556224 PMCID: PMC9652478 DOI: 10.1007/s40615-022-01313-7] [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: 01/27/2022] [Revised: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Recent research suggests the determinants of and links between psychological distress and psychiatric disorder are distinct among Black Americans. Yet, these associations have not been explored among Black women, despite the unique social experiences, risks, and mental health patterns they face. The present study assessed the sociodemographic and psychosocial determinants of distress and disorder and evaluated the distress-disorder association, including whether it was conditional on sociodemographic and psychosocial characteristics among Black women. METHODS Data were from 328 Black women in the Nashville Stress and Health Study, a cross-sectional community epidemiologic survey of Blacks and Whites in Nashville, Tennessee, and was used to assess the correlates of distress (CES-D depressive symptoms scale) and major depressive disorder (MDD; based on the CIDI). Multinomial logistic regression models estimated the extent to which greater distress was associated with higher risk of "chronic" or "resolved MDD". RESULTS Stress exposure and marital status were associated with greater distress, while stress exposure and childhood SES were associated with elevated disorder risk. Although increased distress was associated with greater disorder risk, significant interactions indicated these associations depend on differences in age and adult socioeconomic status within this population. CONCLUSIONS This study identifies distinct correlates of distress and disorder and shows that the distress-disorder association varies among subgroups of Black women. Results have important implications for public health research and practice, as they highlight the factors that matter most for the mental health outcomes of Black women.
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Affiliation(s)
- Millicent N Robinson
- Department of Community Health Sciences (Office 21-245), Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA.
| | - Christy L Erving
- Department of Sociology, College of Arts and Science, Vanderbilt University, Nashville, TN, USA
| | - Courtney S Thomas Tobin
- Department of Community Health Sciences (Office 21-245), Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA
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25
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Thomas CM, Marr JH, Durso LM, Golwalkar M, Irving DJ, Orejuela K, Rasnic R, Ripley D, Rue B, Thomas LS, Viruez J, Fill MMA, Garman KN, Dunn JR. Notes from the Field: Shiga Toxin-Producing Escherichia coli O157:H7 Linked to Raw Milk Consumption Associated with a Cow-Share Arrangement - Tennessee, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:469-470. [PMID: 37104169 DOI: 10.15585/mmwr.mm7217a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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26
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Patwary AL, Khattak AJ. Crash harm before and during the COVID-19 pandemic: Evidence for spatial heterogeneity in Tennessee. Accid Anal Prev 2023; 183:106988. [PMID: 36724654 PMCID: PMC9874053 DOI: 10.1016/j.aap.2023.106988] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/19/2022] [Accepted: 01/23/2023] [Indexed: 05/05/2023]
Abstract
Major concerns have been raised about road safety during the COVID-19 pandemic in the US, as the crash fatalities have increased, despite the substantial reduction in traffic. However, a comprehensive analysis of safety-critical events on roadways based on a broader set of traffic safety metrics and their correlates is needed. In addition to fatalities, this study uses changes in total crashes and total monetary harm as additional measures of safety. A comprehensive and unique time-series database of crashes and socio-economic variables is created at the county level in Tennessee. Statistics show that while fatal crashes increase by 8.2%, total crashes decrease by 15.3%, and the total harm cost is lower by about $1.76 billion during COVID-19 (2020) compared with pre-COVID-19 conditions (2019). Several models, including generalized least squares linear, Poisson, and geographically weighted regression models using the differences between 2020 and 2019 values, are estimated to rigorously quantify the correlates of fatalities, crashes, and crash harm. The results indicate that compared to the pre-pandemic periods, fatal crashes that occurred during the pandemic are associated with more speeding & reckless behaviors and varied across jurisdictions. Fatal crashes are more likely to happen on interstates and dark-not-lighted roads and involve commercial trucks. These same factors largely contribute to crash harm. In addition, a greater number of long trips per person not staying home during COVID-19 is found to be associated with more crashes and crash harm. These results can inform policymaking to strengthen traffic law enforcement through appropriate countermeasures, such as the placement of warning signs and the reduction of the speed limit in hotspots.
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Affiliation(s)
- A Latif Patwary
- Department of Civil and Environmental Engineering, University of Tennessee, Knoxville, TN 37996, USA
| | - Asad J Khattak
- Department of Civil and Environmental Engineering, University of Tennessee, Knoxville, TN 37996, USA.
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27
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Bellamy M, Eckerman K, Dauer L. Reconstructed lung doses for the million person study cohort of 26,650 Tennessee Eastman corporation workers employed between 1942 and 1947. J Radiol Prot 2023; 43:013503. [PMID: 36626823 PMCID: PMC9930615 DOI: 10.1088/1361-6498/acb1be] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Tennessee Eastman Corporation workers were exposed to uranium dust resulting in high-linear energy transfer (LET) irradiation to lung tissue. In this work, radiation lung doses were reconstructed for 26 650 men and women working at the plant between 1942 and 1947. Site air monitoring data of uranium concentrations and payroll records were used to determine the daily inhaled activities and annualized lung doses. Variations in the activity median aerodynamic diameter of the uranium dust, the solubility of particulate matter in the lungs and the sex-specific breathing rate were investigated as part of a sensitivity analysis. Male and female mean lung doses of 18.9 and 32.7 mGy, respectively, from high-LET alpha irradiation, and there was general agreement with evaluations from previously published epidemiological studies. Annual lung dose estimates and sensitivity analysis for the 26 650 workers in the TEC cohort have been archived on the United States Department of Energy Comprehensive Epidemiologic Data Resource.
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Affiliation(s)
- Michael Bellamy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Keith Eckerman
- Oak Ridge National Laboratory (Retired), Oak Ridge, TN, United States of America
| | - Lawrence Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
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28
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Hudson LK, Andershock WE, Qian X, Gibbs PL, Orejuela K, Garman KN, Dunn JR, Denes TG. Phylogeny and Genomic Characterization of Clinical Salmonella enterica Serovar Newport Collected in Tennessee. Microbiol Spectr 2023; 11:e0387622. [PMID: 36602313 PMCID: PMC9927352 DOI: 10.1128/spectrum.03876-22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/21/2022] [Indexed: 01/06/2023] Open
Abstract
Salmonella enterica subsp. enterica serovar Newport (S. Newport) is a clinically and epidemiologically significant serovar in the United States. It is the second most prevalent clinically isolated Salmonella serovar in the United States, and it can contaminate a wide variety of food products. In this study, we evaluated the population structure of S. Newport clinical isolates obtained by the Tennessee Department of Health during routine surveillance (n = 346), along with a diverse set of other global clinical isolates obtained from EnteroBase (n = 271). Most of these clinical isolates belonged to established lineages II and III. Additionally, we performed lineage-specific phylogenetic analyses and were able to identify 18 potential epidemiological clusters among the isolates from Tennessee, which represented a greater proportion of Tennessee isolates belonging to putative epidemiological clusters than the proportion of isolates of this serovar that are outbreak related. IMPORTANCE This study provides insight on the genomic diversity of one of the Salmonella serovars that most frequently cause human illness. Specifically, we explored the diversity of human clinical isolates from a localized region (Tennessee) and compared this level of diversity with the global context. Additionally, we showed that a greater proportion of isolates were associated with potential epidemiological clusters (based on genomic relatedness) than historical estimates. We also identified that one potential cluster was predicted to be multidrug resistant. Taken together, these findings provide insight on Salmonella enterica serovar Newport that can impact public health surveillance and responses and serve as a foundational context for the Salmonella research community.
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Affiliation(s)
- Lauren K. Hudson
- Department of Food Science, University of Tennessee, Knoxville, Tennessee, USA
| | | | - Xiaorong Qian
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Paula L. Gibbs
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Kelly Orejuela
- Tennessee Department of Health, Nashville, Tennessee, USA
| | | | - John R. Dunn
- Tennessee Department of Health, Nashville, Tennessee, USA
| | - Thomas G. Denes
- Department of Food Science, University of Tennessee, Knoxville, Tennessee, USA
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29
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Thomas CM, White EB, Kojima N, Fill MMA, Hanna S, Jones TF, Newhouse CN, Orejuela K, Roth E, Winders S, Chandler DR, Grijalva CG, Schaffner W, Schmitz JE, DaSilva J, Kirby MK, Mellis AM, Rolfes MA, Sumner KM, Flannery B, Talbot HK, Dunn JR. Early and Increased Influenza Activity Among Children - Tennessee, 2022-23 Influenza Season. MMWR Morb Mortal Wkly Rep 2023; 72:49-54. [PMID: 36656786 PMCID: PMC9869745 DOI: 10.15585/mmwr.mm7203a1] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Influenza seasons typically begin in October and peak between December and February (1); however, the 2022-23 influenza season in Tennessee began in late September and was characterized by high pediatric hospitalization rates during November. This report describes a field investigation conducted in Tennessee during November 2022, following reports of increasing influenza hospitalizations. Data from surveillance networks, patient surveys, and whole genome sequencing of influenza virus specimens were analyzed to assess influenza activity and secondary illness risk. Influenza activity increased earlier than usual among all age groups, and rates of influenza-associated hospitalization among children were high in November, reaching 12.6 per 100,000 in children aged <5 years, comparable to peak levels typically seen in high-severity seasons. Circulating influenza viruses were genetically similar to vaccine components. Among persons who received testing for influenza at outpatient clinics, children were twice as likely to receive a positive influenza test result as were adults. Among household contacts exposed to someone with influenza, children were more than twice as likely to become ill compared with adults. As the influenza season continues, it is important for all persons, especially those at higher risk for severe disease, to protect themselves from influenza. To prevent influenza and severe influenza complications, all persons aged ≥6 months should get vaccinated, avoid contact with ill persons, and take influenza antivirals if recommended and prescribed.
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30
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Belcher RH, Patel SA, Kynes M, Carlucci JG, Hodson E, Zhao S, Lipscomb B, Heimburger DC. Demographics and trends of cleft lip and palate patients born in Tennessee from 2000 to 2017. Int J Pediatr Otorhinolaryngol 2022; 163:111312. [PMID: 36257171 DOI: 10.1016/j.ijporl.2022.111312] [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: 05/31/2022] [Revised: 07/26/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the prevalence of orofacial clefts (OFCs) in Tennessee over the span of 2000-2017, and evaluate the effects of race/ethnicity, sex, maternal/paternal age and socioeconomic status on the prevalence. METHODS Records of all live births and demographics of newborns in Tennessee from 2000 to 2017 were requested from the Tennessee Department of Health to calculate the prevalence of OFCs. Data from United States Census was also obtained. Data provided were deidentified. RESULTS Tennessee showed a significant decrease in prevalence rates of cleft lip, with and without cleft palate (CL ± P), when comparing the time periods of 2000-2007 to 2008-2017. A significant positive correlation was found with CL ± P prevalence rates in regions with higher Caucasian populations and a negative correlation in regions with higher African American populations. The CP prevalence rates showed a negative correlation with increased median household income. CONCLUSION To our knowledge, this is the first study to show a significant negative correlation with median household income and CP prevalence rates. Our study showing an increase in prevalence rates of OFCs with decreased socioeconomic status indicates that the areas of Tennessee with the lowest median household income averages would likely benefit from understanding other possible modifiable factors that are driving this correlation.
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Affiliation(s)
- Ryan H Belcher
- Vanderbilt Department of Otolaryngology - Head and Neck Surgery, Pediatric Otolaryngology Division, USA; Vanderbilt Pediatric Cleft and Craniofacial Program, USA.
| | | | - Matthew Kynes
- Department of Anesthesia, Vanderbilt University Medical Center, USA
| | - James G Carlucci
- Department of Pediatrics, Indiana University School of Medicine, USA
| | | | - Shilin Zhao
- Vanderbilt Ingram Cancer Center, Department of Biostatistics, Vanderbilt University Medical Center, USA
| | - Brittany Lipscomb
- Vanderbilt Department of Otolaryngology - Head and Neck Surgery, Pediatric Otolaryngology Division, USA; Surgical Outcomes Center for Kids at Monroe Carell Jr. Children's Hospital at Vanderbilt, USA
| | - Douglas C Heimburger
- Department of Medicine, Vanderbilt University Medical Center, USA; Vanderbilt Institute of Global Health, USA
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31
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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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32
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Rankin DA, Yanis A, Talj R, Howe HL, Bloos SM, Fernandez KN, Amarin JZ, Bruce M, Salib S, Hargrave S, Chappell JD, Spieker AJ, Halasa NB, Howard LM. Clinical presentations of adult and pediatric SARS-CoV-2-positive cases in a community cohort, Nashville, Tennessee. J Med Virol 2022; 94:5560-5566. [PMID: 35815457 PMCID: PMC9350274 DOI: 10.1002/jmv.27988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
Compared to adults, the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness in children has been lower and less severe. However, reports comparing SARS-CoV-2 infection among children and adults are limited. As part of our longitudinal cohort study of adults and children with SARS-CoV-2 infection and their household contacts in Nashville, Tennessee, we compared the clinical characteristics and outcomes of SARS-CoV-2 infections between children and adults. Children were more likely to be asymptomatically infected and had a shorter illness duration compared to adults. The differences observed in clinical presentation across ages may inform symptom-specific testing, screening, and management algorithms.
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Affiliation(s)
- Danielle A. Rankin
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt Epidemiology PhD ProgramVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Ahmad Yanis
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Rana Talj
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Harrison L. Howe
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Sean M. Bloos
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
- Tulane University School of MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Kailee N. Fernandez
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Justin Z. Amarin
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Mercedes Bruce
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Seifein Salib
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Samarian Hargrave
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - James D. Chappell
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Andrew J. Spieker
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Natasha B. Halasa
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Leigh M. Howard
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
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Wingate H, Sizemore L, Black J, Heth Z, Talley P, Patrick SW, Wester C. Using Public Health Surveillance Data to Determine Hepatitis C Virus Exposure Among Live-Born Infants in Tennessee, 2013-2017. Public Health Rep 2022; 137:860-866. [PMID: 34404285 PMCID: PMC9379847 DOI: 10.1177/00333549211035854] [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: 07/12/2021] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE Maternal hepatitis C virus (HCV) infection reported on birth certificates has been shown to underestimate HCV infection. We sought to determine the usefulness of HCV surveillance data for (1) quantifying the number of HCV-positive reproductive-aged women with a live birth, (2) comparing maternal HCV surveillance data with reported HCV infection status on birth certificates, and (3) delineating past versus current maternal infection to identify true perinatal exposures. METHODS We extracted data from January 1, 2013, through December 31, 2017, on birth certificate indication of HCV exposure from the Tennessee Birth Statistical File, and we ascertained indication of HCV exposure by using laboratory data from the Tennessee National Electronic Disease Surveillance System (NEDSS) Base System (NBS). We conducted a sensitivity analysis comparing birth certificate indication of HCV exposure with HCV laboratory data to determine whether true perinatal exposure had occurred. RESULTS During the study period, 6731 mothers with live births in Tennessee reported having HCV infection during pregnancy: 3295 (49.0%) had both laboratory and birth certificate indication of HCV infection, 2130 (31.6%) had indication of HCV infection on the laboratory report only, and 1306 (19.4%) had indication of HCV infection on the birth certificate only. CONCLUSIONS Using data from a public health HCV surveillance system with birth certificate data may improve the identification of HCV-infected pregnant women and perinatally exposed infants. Surveillance systems that include complete reporting of all HCV RNA results can be used to distinguish past from present maternal HCV infection to focus limited public health resources on currently infected mothers and their exposed infants.
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Affiliation(s)
- Heather Wingate
- HIV/STD/Viral Hepatitis Section, Division of Communicable and
Environmental Disease and Emergency Preparedness, Tennessee Department of Health,
Nashville, TN, USA
| | - Lindsey Sizemore
- HIV/STD/Viral Hepatitis Section, Division of Communicable and
Environmental Disease and Emergency Preparedness, Tennessee Department of Health,
Nashville, TN, USA
| | - Jennifer Black
- HIV/STD/Viral Hepatitis Section, Division of Communicable and
Environmental Disease and Emergency Preparedness, Tennessee Department of Health,
Nashville, TN, USA
| | - Zachary Heth
- HIV/STD/Viral Hepatitis Section, Division of Communicable and
Environmental Disease and Emergency Preparedness, Tennessee Department of Health,
Nashville, TN, USA
| | - Pamela Talley
- HIV/STD/Viral Hepatitis Section, Division of Communicable and
Environmental Disease and Emergency Preparedness, Tennessee Department of Health,
Nashville, TN, USA
| | - Stephen W. Patrick
- Vanderbilt Center for Child Health Policy, Departments of
Pediatrics and Health Policy, Vanderbilt University Medical Center, Nashville, TN,
USA
| | - Carolyn Wester
- HIV/STD/Viral Hepatitis Section, Division of Communicable and
Environmental Disease and Emergency Preparedness, Tennessee Department of Health,
Nashville, TN, USA
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Vakili J, Sizemore L, Rebeiro PF, Tyndall B, Talley P, Whaley K, Brantley M. Assessment of Tennessee's county-level vulnerability to hepatitis C virus and HIV outbreaks using socioeconomic, healthcare, and substance use indicators. PLoS One 2022; 17:e0270891. [PMID: 35925969 PMCID: PMC9352017 DOI: 10.1371/journal.pone.0270891] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV), hepatitis C virus (HCV), and injection drug use are syndemic in the central Appalachian states. In Tennessee (TN), declines in HIV among persons who inject drugs (PWID) stalled, and HCV infection rates increased significantly from 2013-2017. To better target strategies to address the syndemic, county-level socioeconomic, opioid use, access to healthcare, and health factors were modeled to identify indicators predictive of vulnerability to an HIV/HCV outbreak among PWID in TN. METHODS Newly reported chronic HCV cases among persons aged 13-39 years in 2016-2017 were used as a proxy for county-level HIV/HCV vulnerability among TN's 95 counties. Seventy-five publicly available county-level measures from 2016-2017 were collected and reduced through multiple dimension reduction techniques. Negative binomial regression identified indicators associated with HCV which were used to calculate county-level vulnerability to a local HIV/HCV outbreak. RESULTS Thirteen county-level indicators were identified as strongly predictive of HIV/HCV vulnerability with the statistically significant indicators being percentage of the population aged 20-44 years, per capita income, teen birth rate, percentage of clients in TDMHSAS-funded opioid treatment and recovery, syphilis case rate, and percentage of homes with at least one vehicle. Based on the 13 indicators, we identified the distribution of vulnerability to an HIV/HCV outbreak among TN's counties. Eleven high vulnerability counties were identified, with the preponderance located in east and middle TN. CONCLUSION This analysis identified the county-level factors most associated with vulnerability to an HIV/HCV outbreak among PWID in TN. These results, alongside routine surveillance, will guide targeted prevention and linkage to care efforts for the most vulnerable communities.
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Affiliation(s)
- Jessica Vakili
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Lindsey Sizemore
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Peter F. Rebeiro
- Vanderbilt University School of Medicine, Departments of Medicine and Biostatistics, Nashville, TN, United States of America
| | - Ben Tyndall
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Pamela Talley
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Kristyn Whaley
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Meredith Brantley
- Tennessee Department of Health, Nashville, TN, United States of America
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Haddadin Z, Spieker AJ, Rahman H, Rankin DA, Talj R, Yanis A, Amarin JZ, Schmitz J, Chappell J, Halasa NB. Respiratory pathogens during the COVID-19 pandemic: Alterations in detection and seasonality in Nashville, Tennessee. PLoS One 2022; 17:e0270469. [PMID: 35921608 PMCID: PMC9348857 DOI: 10.1371/journal.pone.0270469] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/12/2022] [Indexed: 11/30/2022] Open
Abstract
Shortly after the implementation of community mitigation measures in response to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), sharp declines in respiratory syncytial virus and influenza circulation were noted; post-mitigation circulation of other respiratory pathogens has gone unexplored. We retrospectively analyzed all records of a provider-ordered multiplex test between April 1, 2018, and July 31, 2021, in Nashville, Tennessee, and we noted disrupted historical seasonal patterns for common respiratory pathogens during the SARS-CoV-2 pandemic.
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Affiliation(s)
- Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Herdi Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Rana Talj
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Justin Z. Amarin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Jonathan Schmitz
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - James Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States of America
- * E-mail:
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Tao L, Fill MMA, Banerjee R, Humphries RM. Notes from the Field: Cluster of Parechovirus Central Nervous System Infections in Young Infants — Tennessee, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:977-978. [PMID: 35900934 PMCID: PMC9345175 DOI: 10.15585/mmwr.mm7130a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Grome HN, Yackley J, Goonewardene D, Cushing A, Souza M, Carlson A, Craig L, Cranmore B, Wallace R, Orciari L, Niezgoda M, Panayampalli S, Gigante C, Fill MM, Jones T, Schaffner W, Dunn J. Translocation of an Anteater ( Tamandua tetradactyla) Infected with Rabies from Virginia to Tennessee Resulting in Multiple Human Exposures, 2021. MMWR Morb Mortal Wkly Rep 2022; 71:533-537. [PMID: 35421075 PMCID: PMC9020858 DOI: 10.15585/mmwr.mm7115a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Grome HN, Meyer B, Read E, Buchanan M, Cushing A, Sawatzki K, Levinson KJ, Thomas LS, Perry Z, Uehara A, Tao Y, Queen K, Tong S, Ghai R, Fill MM, Jones TF, Schaffner W, Dunn J. SARS-CoV-2 Outbreak among Malayan Tigers and Humans, Tennessee, USA, 2020. Emerg Infect Dis 2022; 28:833-836. [PMID: 35318922 PMCID: PMC8962897 DOI: 10.3201/eid2804.212219] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We report an outbreak of severe acute respiratory syndrome coronavirus 2 involving 3 Malayan tigers (Panthera tigris jacksoni) at a zoo in Tennessee, USA. Investigation identified naturally occurring tiger-to-tiger transmission; genetic sequence change occurred with viral passage. We provide epidemiologic, environmental, and genomic sequencing data for animal and human infections.
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Sackey ENS, Pemmaraju M, Griffin MR, Castilho JL. Impact of prior underinsurance on cervical cancer screening among Davidson County, Tennessee, women diagnosed with invasive cervical cancer, 2008-2018. BMC Womens Health 2022; 22:68. [PMID: 35279162 PMCID: PMC8918308 DOI: 10.1186/s12905-022-01638-9] [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: 09/10/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We sought to investigate the association between insurance coverage history and cervical cancer screening among Davidson County, Tennessee, women diagnosed with incident cervical cancer. METHODS We reviewed medical records of women diagnosed with invasive cervical cancer from 2008 through 2018 identified via the state's cancer registry and by active surveillance of diagnostic pathology reports for the HPV-IMPACT project. Per 2012 United States Preventive Services Task Force recommended cervical cancer screening guidelines, women were characterized into three screening history categories: "no screening", "no follow-up" and "test/screening failure". Multivariable logistic regression measured the association of prior inadequate insurance (underinsurance) and screening history ("no screening/no follow-up" compared to "test/screening failure"). RESULTS Of 212 women, most (77%) had not undergone recommended cervical cancer screening or follow-up prior to cancer diagnosis. Overall, 28% of women had history of underinsurance in 5 years prior to diagnosis. In adjusted analyses, underinsured women were more likely to have a "no screening/no follow-up" prior to cancer diagnosis (aOR 4.26; 95% CI 1.15-15.80) compared to "test/screening failure" history. Non-white race (aOR 2.73; 95% CI 0.98-7.61), older age (aOR 1.03 per year; 95% CI 1.00-1.07), and history of smoking (aOR 4.07; 95% CI 1.54-10.74) were also associated with increased likelihood of "no screening/no follow-up". CONCLUSIONS Previous underinsurance was independently associated with non-adherence to cervical cancer screening and follow-up guidelines among women with incident cervical cancer. Further study of factors contributing to inadequate cervical cancer screening and interventions to increase cervical cancer screening in high-risk populations is needed.
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Affiliation(s)
- Emmanuel N S Sackey
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Manideepthi Pemmaraju
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marie R Griffin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica L Castilho
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Ahonkhai AA, Rebeiro PF, Jenkins CA, Rickles M, Cook M, Conserve DF, Pierce LJ, Shepherd BE, Brantley M, Wester C. Individual, community, and structural factors associated with linkage to HIV care among people diagnosed with HIV in Tennessee. PLoS One 2022; 17:e0264508. [PMID: 35239705 PMCID: PMC8893655 DOI: 10.1371/journal.pone.0264508] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We assessed trends and identified individual- and county-level factors associated with individual linkage to HIV care in Tennessee (TN). METHODS TN residents diagnosed with HIV from 2012-2016 were included in the analysis (n = 3,751). Individuals were assigned county-level factors based on county of residence at the time of diagnosis. Linkage was defined by the first CD4 or HIV RNA test date after HIV diagnosis. We used modified Poisson regression to estimate probability of 30-day linkage to care at the individual-level and the contribution of individual and county-level factors to this outcome. RESULTS Both MSM (aRR 1.23, 95%CI 0.98-1.55) and women who reported heterosexual sex risk factors (aRR 1.39, 95%CI 1.18-1.65) were more likely to link to care within 30-days than heterosexual males. Non-Hispanic Black individuals had poorer linkage than White individuals (aRR 0.77, 95%CI 0.71-0.83). County-level mentally unhealthy days were negatively associated with linkage (aRR 0.63, 95%CI: 0.40-0.99). CONCLUSIONS Racial disparities in linkage to care persist at both individual and county levels, even when adjusting for county-level social determinants of health. These findings suggest a need for structural interventions to address both structural racism and mental health needs to improve linkage to care and minimize racial disparities in HIV outcomes.
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Affiliation(s)
- Aima A. Ahonkhai
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Peter F. Rebeiro
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
- Department of Medicine, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Cathy A. Jenkins
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Michael Rickles
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Mekeila Cook
- Division of Public Health Practice, Meharry Medical College, Nashville, TN, United States of America
| | - Donaldson F. Conserve
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, United States of America
| | - Leslie J. Pierce
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Meredith Brantley
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Carolyn Wester
- Tennessee Department of Health, Nashville, TN, United States of America
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Cerreta AJ, Yang TS, Ramsay EC, Birkenheuer AJ, Rahoi D, Qurollo B, Wilson J, Cushing AC. DETECTION OF VECTOR-BORNE INFECTIONS IN LIONS AND TIGERS AT TWO ZOOS IN TENNESSEE AND OKLAHOMA, USA. J Zoo Wildl Med 2022; 53:50-59. [PMID: 35339149 PMCID: PMC10685398 DOI: 10.1638/2020-0199] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/21/2022] Open
Abstract
Protozoal and bacterial vector-borne infections are frequently diagnosed in domestic felids. However, with the exception of Mycoplasma haemofelis and Cytauxzoon felis, their occurrence in managed nondomestic felids housed in the United States is largely unknown. Following a case in February 2020 of fulminant cytauxzoonosis in an African lion (Panthera leo), EDTA-whole blood samples were collected opportunistically from February 2020 through June 2020 from 34 adult tigers (Panthera tigris) and eight adult African lions from the same sanctuary in eastern Tennessee as well as 14 adult tigers from a zoo in southern Oklahoma. Samples were analyzed for Cytauxzoon felis, Bartonella spp., hemotropic Mycoplasma, Rickettsia spp., Anaplasma spp., Ehrlichia spp., Babesia spp., and Hepatozoon spp. DNA by PCR amplification. All animals were asymptomatic at the time of collection. None of the Oklahoma animals were positive for vector-borne organisms, but these pathogens were detected in tigers at the Tennessee facility, including Cytauxzoon felis (11.8%), "Candidatus Mycoplasma haemominutum" (5.9%), and Ehrlichia ewingii (2.9%). During the study period, two animals developed clinical signs of cytauxzoonosis and were assessed for vector-borne infections as part of their diagnostic evaluation. This study documents the presence of tick-borne diseases in managed nondomestic felids in the southeastern United States and underscores that ectoparasite control measures should be practiced to minimize exposure of carnivores in managed care.
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Affiliation(s)
- Anthony J Cerreta
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
| | - Tzushan S Yang
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Edward C Ramsay
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
| | - Adam J Birkenheuer
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Dane Rahoi
- Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA
| | - Barbara Qurollo
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - James Wilson
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Andrew C Cushing
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA,
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Montiel Ishino FA, Odame EA, Villalobos K, Whiteside M, Mamudu H, Williams F. Applying Latent Class Analysis on Cancer Registry Data to Identify and Compare Health Disparity Profiles in Colorectal Cancer Surgical Treatment Delay. J Public Health Manag Pract 2022; 28:E487-E496. [PMID: 33729186 PMCID: PMC8435045 DOI: 10.1097/phh.0000000000001341] [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: 11/26/2022]
Abstract
CONTEXT Colorectal cancer (CRC) surgical treatment delay (TD) has been associated with mortality and morbidity; however, disparities by TD profiles are unknown. OBJECTIVES This study aimed to identify CRC patient profiles of surgical TD while accounting for differences in sociodemographic, health insurance, and geographic characteristics. DESIGN We used latent class analysis (LCA) on 2005-2015 Tennessee Cancer Registry data of CRC patients and observed indicators that included sex/gender, age at diagnosis, marital status (single/married/divorced/widowed), race (White/Black/other), health insurance type, and geographic residence (non-Appalachian/Appalachian). SETTING The state of Tennessee in the United States that included both Appalachian and non-Appalachian counties. PARTICIPANTS Adult (18 years or older) CRC patients (N = 35 412) who were diagnosed and surgically treated for in situ (n = 1286) and malignant CRC (n = 34 126). MAIN OUTCOME MEASURE The distal outcome of TD was categorized as 30 days or less and more than 30 days from diagnosis to surgical treatment. RESULTS Our LCA identified a 4-class solution and a 3-class solution for in situ and malignant profiles, respectively. The highest in situ CRC patient risk profile was female, White, aged 75 to 84 years, widowed, and used public health insurance when compared with respective profiles. The highest malignant CRC patient risk profile was male, Black, both single/never married and divorced/separated, resided in non-Appalachian county, and used public health insurance when compared with respective profiles. The highest risk profiles of in situ and malignant patients had a TD likelihood of 19.3% and 29.4%, respectively. CONCLUSIONS While our findings are not meant for diagnostic purposes, we found that Blacks had lower TD with in situ CRC. The opposite was found in the malignant profiles where Blacks had the highest TD. Although TD is not a definitive marker of survival, we observed that non-Appalachian underserved/underrepresented groups were overrepresented in the highest TD profiles. The observed disparities could be indicative of intervenable risk.
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Affiliation(s)
- Francisco A. Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Emmanuel A. Odame
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Kevin Villalobos
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Martin Whiteside
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Hadii Mamudu
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
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Stevens MN, Patro A, Rahman B, Gao Y, Liu D, Cmelak A, Wiggleton J, Kim YJ, Langerman A, Mannion K, Sinard RJ, Netterville JL, Rohde SL, Topf MC. Impact of COVID-19 on presentation, staging, and treatment of head and neck mucosal squamous cell carcinoma. Am J Otolaryngol 2022; 43:103263. [PMID: 34653954 PMCID: PMC8500684 DOI: 10.1016/j.amjoto.2021.103263] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES During the COVID-19 pandemic, maintenance of safe and timely oncologic care has been challenging. The goal of this study is to compare presenting symptoms, staging, and treatment of head and neck mucosal squamous cell carcinoma during the pandemic with an analogous timeframe one year prior. MATERIALS AND METHODS Retrospective cohort study at a single tertiary academic center of new adult patients evaluated in a head and neck surgical oncology clinic from March -July 2019 (pre-pandemic control) and March - July 2020 (COVID-19 pandemic). RESULTS During the pandemic, the proportion of patients with newly diagnosed malignancies increased by 5%, while the overall number of new patients decreased (n = 575) compared to the control year (n = 776). For patients with mucosal squamous cell carcinoma (SCC), median time from referral to initial clinic visit decreased from 11 days (2019) to 8 days (2020) (p = 0.0031). There was no significant difference in total number (p = 0.914) or duration (p = 0.872) of symptoms. During the pandemic, patients were more likely to present with regional nodal metastases (adjusted odds ratio (OR) 2.846, 95% CI 1.072-3.219, p = 0.028) and more advanced clinical nodal (N) staging (p = 0.011). No significant difference was seen for clinical tumor (T) (p = 0.502) or metastasis (M) staging (p = 0.278). No significant difference in pathologic T (p = 0.665), or N staging (p = 0.907) was found between the two periods. CONCLUSION Head and neck mucosal SCC patients presented with more advanced clinical nodal disease during the early months of the COVID-19 pandemic despite no change in presenting symptoms.
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Affiliation(s)
- Madelyn N Stevens
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Ankita Patro
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Bushra Rahman
- Vanderbilt University School of Medicine, 1161 21st Ave S, Nashville, TN 37232, USA
| | - Yue Gao
- Department of Biostatistics, Vanderbilt University, 2525 West End Ave Ste 1100, Nashville, TN 37203, USA
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University, 2525 West End Ave Ste 1100, Nashville, TN 37203, USA
| | - Anthony Cmelak
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Ave, Nashville, TN 37232, USA
| | - Jamie Wiggleton
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Young J Kim
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Alexander Langerman
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Kyle Mannion
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Robert J Sinard
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - James L Netterville
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Sarah L Rohde
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Michael C Topf
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
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Schmidt AL, Tucker MD, Bakouny Z, Labaki C, Hsu CY, Shyr Y, Armstrong AJ, Beer TM, Bijjula RR, Bilen MA, Connell CF, Dawsey SJ, Faller B, Gao X, Gartrell BA, Gill D, Gulati S, Halabi S, Hwang C, Joshi M, Khaki AR, Menon H, Morris MJ, Puc M, Russell KB, Shah NJ, Sharifi N, Shaya J, Schweizer MT, Steinharter J, Wulff-Burchfield EM, Xu W, Zhu J, Mishra S, Grivas P, Rini BI, Warner JL, Zhang T, Choueiri TK, Gupta S, McKay RR. Association Between Androgen Deprivation Therapy and Mortality Among Patients With Prostate Cancer and COVID-19. JAMA Netw Open 2021; 4:e2134330. [PMID: 34767021 PMCID: PMC8590166 DOI: 10.1001/jamanetworkopen.2021.34330] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Androgen deprivation therapy (ADT) has been theorized to decrease the severity of SARS-CoV-2 infection in patients with prostate cancer owing to a potential decrease in the tissue-based expression of the SARS-CoV-2 coreceptor transmembrane protease, serine 2 (TMPRSS2). OBJECTIVE To examine whether ADT is associated with a decreased rate of 30-day mortality from SARS-CoV-2 infection among patients with prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed patient data recorded in the COVID-19 and Cancer Consortium registry between March 17, 2020, and February 11, 2021. The consortium maintains a centralized multi-institution registry of patients with a current or past diagnosis of cancer who developed COVID-19. Data were collected and managed using REDCap software hosted at Vanderbilt University Medical Center in Nashville, Tennessee. Initially, 1228 patients aged 18 years or older with prostate cancer listed as their primary malignant neoplasm were included; 122 patients with a second malignant neoplasm, insufficient follow-up, or low-quality data were excluded. Propensity matching was performed using the nearest-neighbor method with a 1:3 ratio of treated units to control units, adjusted for age, body mass index, race and ethnicity, Eastern Cooperative Oncology Group performance status score, smoking status, comorbidities (cardiovascular, pulmonary, kidney disease, and diabetes), cancer status, baseline steroid use, COVID-19 treatment, and presence of metastatic disease. EXPOSURES Androgen deprivation therapy use was defined as prior bilateral orchiectomy or pharmacologic ADT administered within the prior 3 months of presentation with COVID-19. MAIN OUTCOMES AND MEASURES The primary outcome was the rate of all-cause 30-day mortality after COVID-19 diagnosis for patients receiving ADT compared with patients not receiving ADT after propensity matching. RESULTS After exclusions, 1106 patients with prostate cancer (before propensity score matching: median age, 73 years [IQR, 65-79 years]; 561 (51%) self-identified as non-Hispanic White) were included for analysis. Of these patients, 477 were included for propensity score matching (169 who received ADT and 308 who did not receive ADT). After propensity matching, there was no significant difference in the primary end point of the rate of all-cause 30-day mortality (OR, 0.77; 95% CI, 0.42-1.42). CONCLUSIONS AND RELEVANCE Findings from this cohort study suggest that ADT use was not associated with decreased mortality from SARS-CoV-2 infection. However, large ongoing clinical trials will provide further evidence on the role of ADT or other androgen-targeted therapies in reducing COVID-19 infection severity.
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Affiliation(s)
- Andrew L. Schmidt
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Ziad Bakouny
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chris Labaki
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chih-Yuan Hsu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yu Shyr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, North Carolina
| | - Tomasz M. Beer
- Oregon Health and Science University Knight Cancer Institute, Portland
| | | | - Mehmet A. Bilen
- Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | | | | | - Xin Gao
- Massachusetts General Hospital, Boston
| | | | - David Gill
- Intermountain Healthcare, Salt Lake City, Utah
| | - Shuchi Gulati
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Susan Halabi
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, North Carolina
| | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan
| | - Monika Joshi
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Ali Raza Khaki
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle
- Stanford University, Stanford, California
| | - Harry Menon
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | | | | | | | - Neil J. Shah
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nima Sharifi
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Justin Shaya
- Moores Cancer Center, University of California, San Diego
| | - Michael T. Schweizer
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle
| | - John Steinharter
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Wenxin Xu
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jay Zhu
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Petros Grivas
- University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle
| | - Brian I. Rini
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Tian Zhang
- Duke Cancer Institute Center for Prostate and Urologic Cancer, Duke University, Durham, North Carolina
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Shilpa Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Rana R. McKay
- Moores Cancer Center, University of California, San Diego
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Haddadin Z, Batarseh E, Hamdan L, Stewart LS, Piya B, Rahman H, Spieker AJ, Chappell J, Wikswo ME, Dunn JR, Payne DC, Vinjé J, Hall AJ, Halasa N. Characteristics of GII.4 Norovirus Versus Other Genotypes in Sporadic Pediatric Infections in Davidson County, Tennessee, USA. Clin Infect Dis 2021; 73:e1525-e1531. [PMID: 32667045 PMCID: PMC8492161 DOI: 10.1093/cid/ciaa1001] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 04/07/2020] [Accepted: 07/10/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Norovirus is a leading cause of epidemic acute gastroenteritis (AGE), with most outbreaks occurring during winter. The majority of outbreaks are caused by GII.4 noroviruses; however, data to support whether this is true for sporadic medically attended AGE are limited. Therefore, we sought to compare the clinical characteristics and seasonality of GII.4 vs non-GII.4 viruses. METHODS Children aged 15 days -17 years with AGE symptoms were recruited from the outpatient, emergency department, and inpatient settings at Vanderbilt Children's Hospital, Davidson County, Nashville, Tennessee, from December 2012 -November 2015. Stool specimens were tested using qRT-PCR for GI and GII noroviruses and subsequently genotyped by sequencing a partial region of the capsid gene. RESULTS A total of 3705 patients were enrolled, and stool specimens were collected and tested from 2885 (78%) enrollees. Overall, 636 (22%) samples were norovirus-positive, of which 567 (89%) were GII. Of the 460 (81%) genotyped GII-positive samples, 233 (51%) were typed as GII.4 and 227 (49%) as non-GII.4. Compared with children with non-GII.4 infections, children with GII.4 infections were younger, more likely to have diarrhea, and more likely to receive oral rehydration fluids. Norovirus was detected year-round and peaked during winter. CONCLUSIONS Approximately 40% of sporadic pediatric norovirus AGE cases were caused by GII.4 norovirus. Children infected with GII.4 had more severe symptoms that required more medical care. Seasonal variations were noticed among different genotypes. These data highlight the importance of continuous norovirus surveillance and provide important information on which strains pediatric norovirus vaccines should protect against.
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Affiliation(s)
- Zaid Haddadin
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Einas Batarseh
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lubna Hamdan
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura S Stewart
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bhinnata Piya
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Herdi Rahman
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Chappell
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mary E Wikswo
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John R Dunn
- Tennessee Department of Health, Nashville, Tennessee, USA
| | - Daniel C Payne
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jan Vinjé
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron J Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natasha Halasa
- Department of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Mathias JG, Nolan VG, Klesges LM, Badawy SM, Cooper WO, Hankins JS, Smeltzer MP. Hydroxyurea Use After Transitions of Care Among Young Adults With Sickle Cell Disease and Tennessee Medicaid Insurance. JAMA Netw Open 2021; 4:e2128971. [PMID: 34643722 PMCID: PMC8515209 DOI: 10.1001/jamanetworkopen.2021.28971] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This cohort study examines whether hydroxyurea use changes in young adults with sickle cell disease who are transitioning from pediatric to adult health care.
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Affiliation(s)
- Joacy G. Mathias
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Vikki G. Nolan
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Lisa M. Klesges
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Sherif M. Badawy
- Division of Hematology, Oncology, Neuro-Oncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - William O. Cooper
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee
| | - Jane S. Hankins
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, Tennessee
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Parker JJ, Octaria R, Smith MD, Chao SJ, Davis MB, Goodson C, Warkentin J, Werner D, Fill MMA. Characteristics, Comorbidities, and Data Gaps for Coronavirus Disease Deaths, Tennessee, USA. Emerg Infect Dis 2021; 27:2521-2528. [PMID: 34545796 PMCID: PMC8462317 DOI: 10.3201/eid2710.211070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
As of March 2021, coronavirus disease (COVID-19) had led to >500,000 deaths in the United States, and the state of Tennessee had the fifth highest number of cases per capita. We reviewed the Tennessee Department of Health COVID-19 surveillance and chart-abstraction data during March 15‒August 15, 2020. Patients who died from COVID-19 were more likely to be older, male, and Black and to have underlying conditions (hereafter comorbidities) than case-patients who survived. We found 30.4% of surviving case-patients and 20.3% of deceased patients had no comorbidity information recorded. Chart-abstraction captured a higher proportion of deceased case-patients with >1 comorbidity (96.3%) compared with standard surveillance deaths (79.0%). Chart-abstraction detected higher rates of each comorbidity except for diabetes, which had similar rates among standard surveillance and chart-abstraction. Investing in public health data collection infrastructure will be beneficial for the COVID-19 pandemic and future disease outbreaks.
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Gray JD, Harris CR, Wylezinski LS, Spurlock Iii CF. Predictive modeling of COVID-19 case growth highlights evolving racial and ethnic risk factors in Tennessee and Georgia. BMJ Health Care Inform 2021; 28:e100349. [PMID: 34385289 PMCID: PMC8361702 DOI: 10.1136/bmjhci-2021-100349] [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: 02/25/2021] [Accepted: 07/19/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The SARS-CoV-2 (COVID-19) pandemic has exposed the need to understand the risk drivers that contribute to uneven morbidity and mortality in US communities. Addressing the community-specific social determinants of health (SDOH) that correlate with spread of SARS-CoV-2 provides an opportunity for targeted public health intervention to promote greater resilience to viral respiratory infections. METHODS Our work combined publicly available COVID-19 statistics with county-level SDOH information. Machine learning models were trained to predict COVID-19 case growth and understand the social, physical and environmental risk factors associated with higher rates of SARS-CoV-2 infection in Tennessee and Georgia counties. Model accuracy was assessed comparing predicted case counts to actual positive case counts in each county. RESULTS The predictive models achieved a mean R2 of 0.998 in both states with accuracy above 90% for all time points examined. Using these models, we tracked the importance of SDOH data features over time to uncover the specific racial demographic characteristics strongly associated with COVID-19 incidence in Tennessee and Georgia counties. Our results point to dynamic racial trends in both states over time and varying, localized patterns of risk among counties within the same state. For example, we find that African American and Asian racial demographics present comparable, and contrasting, patterns of risk depending on locality. CONCLUSION The dichotomy of demographic trends presented here emphasizes the importance of understanding the unique factors that influence COVID-19 incidence. Identifying these specific risk factors tied to COVID-19 case growth can help stakeholders target regional interventions to mitigate the burden of future outbreaks.
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Affiliation(s)
- Jamieson D Gray
- Decode Health, Inc. and IQuity Labs, Inc, Nashville, Tennessee, USA
| | - Coleman R Harris
- Decode Health, Inc. and IQuity Labs, Inc, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lukasz S Wylezinski
- Decode Health, Inc. and IQuity Labs, Inc, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Charles F Spurlock Iii
- Decode Health, Inc. and IQuity Labs, Inc, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Pereira DE, Naguib MM, Siktberg J. Public Health Engagement With Immigrant Communities During COVID-19. Acad Med 2021; 96:785. [PMID: 33538472 PMCID: PMC8140625 DOI: 10.1097/acm.0000000000003951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Daniel E Pereira
- Medical student, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Mark M Naguib
- Medical student, Vanderbilt University School of Medicine, Nashville, Tennessee; ; Twitter: @m_guib
| | - Jonathan Siktberg
- Medical student, Vanderbilt University School of Medicine, Nashville, Tennessee
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50
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Butler RA, Kennedy ML, Houston AE, Bowers EK, Coons LB, Paulsen D, Trout Fryxell RT. No Evidence of Competition Between the Blacklegged Tick (Acari: Ixodidae) and American Dog Tick on the Rodent Host White-Footed Deermouse (Rodentia: Cricetidae) in Southwestern Tennessee. J Med Entomol 2021; 58:1470-1475. [PMID: 33629730 DOI: 10.1093/jme/tjab012] [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: 08/31/2020] [Indexed: 06/12/2023]
Abstract
Investigations that analyze interspecific associations of vectors on their hosts are important for understanding community structure and implementing ways to comprehend mechanisms of pathogen transmission. We assessed the interspecific association of two tick species (Ixodes scapularis Say (Ixodida: Ixodidae) and Dermacentor variabilis Say (Ixodida: Ixodidae)) on the rodent host Peromyscus leucopus Rafinesque (Rodentia: Cricetidae) at the Hobart Ames Research and Education Center in southwestern Tennessee. Of the rodents captured, 95 (63%) had neither species of tick, 6 (4%) had both tick species, 25 (16%) had I. scapularis only, and 26 (17%) had D. variabilis only. A coefficient of association (C7 = -0.08) was calculated, which suggested there was competition between the two species of ectoparasites, but this value was not significant, indicating that there was a neutral relationship between the tick species on P. leucopus. The co-occurrence of both tick species on their host at the same time suggested that the two tick species can occupy the same host and use the same resources without competing.
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Affiliation(s)
- R A Butler
- Department of Biological Sciences, The University of Memphis, Memphis, TN, USA
- Department of Entomology and Plant Pathology, The University of Tennessee, Knoxville, TN, USA
| | - M L Kennedy
- Department of Biological Sciences, The University of Memphis, Memphis, TN, USA
| | - A E Houston
- Department of Forestry, Wildlife and Fisheries, The University of Tennessee, Knoxville, TN, USA
| | - E K Bowers
- Department of Biological Sciences, The University of Memphis, Memphis, TN, USA
| | - L B Coons
- Department of Biological Sciences, The University of Memphis, Memphis, TN, USA
| | - D Paulsen
- Department of Entomology and Plant Pathology, The University of Tennessee, Knoxville, TN, USA
| | - R T Trout Fryxell
- Department of Entomology and Plant Pathology, The University of Tennessee, Knoxville, TN, USA
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