scholarly journals The distribution and spread of susceptible and resistant Neisseria gonorrhoeae across demographic groups in a major metropolitan center

2020 ◽  
Author(s):  
Tatum D Mortimer ◽  
Preeti Pathela ◽  
Addie Crawley ◽  
Jennifer L Rakeman ◽  
Ying Lin ◽  
...  
Keyword(s):  
The United States ◽  
Empiric Therapy ◽  
Health Clinic ◽  
Convenience Sample ◽  
Demographic Groups ◽  
Genomic Epidemiology ◽  
Main Driver ◽  
Sex With Men ◽  
Epidemiology Studies ◽  
Local Transmission

Abstract Background Genomic epidemiology studies of gonorrhea in the United States have primarily focused on national surveillance for antibiotic resistance, and patterns of local transmission between demographic groups of resistant and susceptible strains are unknown. Methods We analyzed a convenience sample of genome sequences, antibiotic susceptibility, and patient data from 897 gonococcal isolates cultured at the NYC Public Health Laboratory from NYC Department of Health and Mental Hygiene (DOHMH) Sexual Health Clinic (SHC) patients, primarily in 2012-13. We reconstructed the gonococcal phylogeny, defined transmission clusters using a 10 non-recombinant single nucleotide polymorphism threshold, tested for clustering of demographic groups, and placed NYC isolates in a global phylogenetic context. Results The NYC gonococcal phylogeny reflected global diversity with isolates from 22/23 of the prevalent global lineages (96%). Isolates clustered on the phylogeny by patient sexual behavior (p&0.001) and race/ethnicity (p&0.001). Minimum inhibitory concentrations were higher across antibiotics in isolates from men who have sex with men compared to heterosexuals (p&0.001) and white heterosexuals compared to black heterosexuals (p&0.01). In our dataset, all large transmission clusters (≥10 samples) of N. gonorrhoeae were susceptible to ciprofloxacin, ceftriaxone, and azithromycin and comprised isolates from patients across demographic groups. Conclusions All large transmission clusters were susceptible to gonorrhea therapies, suggesting that resistance to empiric therapy was not a main driver of spread, even as risk for resistance varied across demographic groups. Further study of local transmission networks is needed to identify drivers of transmission.

scholarly journals The distribution and spread of susceptible and resistant Neisseria gonorrhoeae across demographic groups in a major metropolitan center

2020 ◽  
Author(s):  
Tatum D. Mortimer ◽  
Preeti Pathela ◽  
Addie Crawley ◽  
Jennifer L. Rakeman ◽  
Ying Lin ◽  
...  
Keyword(s):  
The United States ◽  
Empiric Therapy ◽  
Health Clinic ◽  
Convenience Sample ◽  
Demographic Groups ◽  
Genomic Epidemiology ◽  
Main Driver ◽  
Sex With Men ◽  
Epidemiology Studies ◽  
Local Transmission

AbstractBackgroundGenomic epidemiology studies of gonorrhea in the United States have primarily focused on national surveillance for antibiotic resistance, and patterns of local transmission between demographic groups of resistant and susceptible strains are unknown.MethodsWe analyzed a convenience sample of genome sequences, antibiotic susceptibility, and patient data from 897 gonococcal isolates cultured at the NYC Public Health Laboratory from NYC Department of Health and Mental Hygiene (DOHMH) Sexual Health Clinic (SHC) patients, primarily in 2012-13. We reconstructed the gonococcal phylogeny, defined transmission clusters using a 10 non-recombinant single nucleotide polymorphism threshold, tested for clustering of demographic groups, and placed NYC isolates in a global phylogenetic context.ResultsThe NYC gonococcal phylogeny reflected global diversity with isolates from 22/23 of the prevalent global lineages (96%). Isolates clustered on the phylogeny by patient sexual behavior (p<0.001) and race/ethnicity (p<0.001).Minimum inhibitory concentrations were higher across antibiotics in isolates from men who have sex with men compared to heterosexuals (p<0.001) and white heterosexuals compared to black heterosexuals (p<0.01). In our dataset, all large transmission clusters (≥10 samples) of N. gonorrhoeae were susceptible to ciprofloxacin, ceftriaxone, and azithromycin and comprised isolates from patients across demographic groups.ConclusionsAll large transmission clusters were susceptible to gonorrhea therapies, suggesting that resistance to empiric therapy was not a main driver of spread, even as risk for resistance varied across demographic groups. Further study of local transmission networks is needed to identify drivers of transmission.

scholarly journals Impact of Acculturation on Body Mass Index in Haitians

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Nirva Berthold Lafontant
Keyword(s):  
United States ◽  
Body Mass Index ◽  
Length Of Stay ◽  
Body Mass ◽  
Research Question ◽  
The United States ◽  
Health Clinic ◽  
Health Providers ◽  
Cross Sectional ◽  
Convenience Sample

Longer term immigrants residing in the United States exhibit physical health decline related to higher body mass index (BMI). Theories on immigrant acculturation have been used to examine health patterns by length of stay in the United States. The purpose of this cross-sectional study, guided by the Schwartz model of acculturation, was to examine the effect of acculturation and length of stay in the United States on BMI in a sample of Haitian immigrants living in a northeast metropolitan area. The research question was developed to examine the effects of acculturation and how long immigrants reside in the United States on BMI. The Participants included a convenience sample of 116 Haitian men and women, aged 18 years and older, who had relocated to the United States for 3 years or more. Data were collected using a demographic questionnaire and medical records from a participating health clinic and then analyzed by conducting multiple linear regression statistical analyses. Results revealed that acculturation, length of stay in the United States, age, gender, and physical activity were not significant predictors of BMI change. An ancillary analysis using the subscales of acculturation revealed similar results. This study may provide positive social change by enabling health providers to understand the beliefs, values, and practices of Haitian immigrant groups and the acculturation pattern of individuals when providing care for this population.

scholarly journals Swab-Yourself Trial With Economic Monitoring and Testing for Infections Collectively (SYSTEMATIC): Part 2. A Diagnostic Accuracy and Cost-effectiveness Study Comparing Rectal, Pharyngeal, and Urogenital Samples Analyzed Individually, Versus as a Pooled Specimen, for the Diagnosis of Gonorrhea and Chlamydia

2020 ◽  
Author(s):  
Janet D Wilson ◽  
Harriet E Wallace ◽  
Michelle Loftus-Keeling ◽  
Helen Ward ◽  
Bethan Davies ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Cost Effective ◽  
Nucleic Acid Amplification ◽  
Sexual History ◽  
Health Clinic ◽  
Convenience Sample ◽  
Diagnostic Cost ◽  
Sex With Men ◽  
Pooled Samples ◽  
Cost Effectiveness Study

Abstract Background Sexual history does not accurately identify those with extragenital Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT), so universal extragenital sampling is recommended. Nucleic acid amplification tests (NAATs) are expensive. If urogenital, plus rectal and pharyngeal, samples are analyzed, the diagnostic cost is trebled. Pooling samples into 1 NAAT container would cost the same as urogenital samples alone. We compared clinician triple samples analyzed individually with self-taken pooled samples for diagnostic accuracy, and cost, in men who have sex with men (MSM) and females. Methods This was a prospective, convenience sample in United Kingdom sexual health clinic. Randomized order of clinician and self-samples from pharynx, rectum, plus first-catch urine (FCU) in MSM and vulvovaginal swabs (VVS) in females, for NG and CT detection. Results Of 1793 participants (1284 females, 509 MSM), 116 had NG detected (75 urogenital, 83 rectum, 72 pharynx); 276 had CT detected (217 urogenital, 249 rectum, 63 pharynx). There was no difference in sensitivities between clinician triple samples and self-pooled specimens for NG (99.1% and 98.3%), but clinician samples analyzed individually identified 3% more chlamydia infections than pooled (99.3% and 96.0%; P = .027). However, pooled specimens identified more infections than VVS/FCU alone. Pooled specimens missed 2 NG and 11 CT infections, whereas VVS/FCU missed 41 NG and 58 CT infections. Self-taken pooled specimens were the most cost-effective. Conclusions FCU/VVS testing alone missed many infections. Self-taken pooled samples were as sensitive as clinician triple samples for identifying NG, but clinician samples analyzed individually identified 3% more CT infections than pooled. The extragenital sampling was achievable at no additional diagnostic cost to the FCU/VVS. Clinical Trials Registration NCT02371109.

scholarly journals Genomic Epidemiology of Clostridioides difficile Sequence Types 1 and 2 Across Three US Medical Centers

2020 ◽  
Vol 41 (S1) ◽  
pp. s238-s238
Author(s):  
Arianna Miles-Jay ◽  
Vincent Young ◽  
Eric Pamer ◽  
Tor Savidge ◽  
Mini Kamboj ◽  
...  
Keyword(s):  
Medical Center ◽  
The United States ◽  
Collection Site ◽  
Convenience Sample ◽  
Genomic Epidemiology ◽  
Clostridioides Difficile ◽  
Medical Centers ◽  
Recent Transmission ◽  
Genetic Linkages ◽  
Collection Sites

Background:Clostridioides difficile is a toxin-producing bacterium that is the foremost cause of healthcare-associated diarrhea in the United States. Recent epidemiologic and genomic evidence indicates that divergent C. difficile strains have varying propensities for transmission within healthcare settings. We investigated whether and how these differences are reflected in the genomic epidemiology of 2 common C. difficile strains—sequence type (ST) 1 (analogous to Ribotype 027) and ST2 (associated with Ribotypes 014/020)—across 3 geographically distinct US medical centers. Methods: Between 2011 and 2017, a convenience sample of ST1 and ST2 C. difficile clinical isolates were collected from 3 US sites: The University of Michigan Medical Center, Texas Medical Center Hospitals, and Memorial Sloan Kettering Cancer Center. Isolates underwent whole-genome sequencing and in silico multilocus sequence typing to verify strain types. Sequences were mapped to ST1 and ST2 reference genomes and single nucleotide variants (SNVs) were identified, filtered, and used to construct pairwise SNV distance matrices. A range of pairwise SNV distance thresholds were applied to assess genetic linkages consistent with recent transmission within ST1 compared to within ST2. Proportions of genetically linked isolates were compared using 2 tests. Results: We identified 200 ST1 and 188 ST2 isolates across the 3 collection sites. Overall, ST2 was more genetically diverse than ST1 (pairwise SNV distance range, 0–156 SNVs and 0–78 SNVs, respectively). ST2 isolates displayed significantly less evidence of recent transmission: 10 ST2 isolates (5.3%) were within 2 SNVs of another isolate compared to 88 (44%) ST1 isolates (P .001) (Fig. 1). As the SNV threshold increased to 5 and 10 SNVs, this trend was maintained (all P < .001). ST2 isolates were also more likely to be genetically linked to an isolate from a different collection site than ST1 isolates. Among isolates with genetic links to at least 1 other isolate at the 5 SNV and 10 SNV thresholds, 21 of 37 and 74 of 89 ST2 isolates (57%, 83%) were linked to an isolate from a different collection site, compared to 2 of 88 and 48 of 157 ST1 isolates (2% and 31%, respectively; both P < .001). Conclusions: Compared to C. difficile ST1 isolates, ST2 isolates displayed less evidence of recent healthcare transmission and were more likely to be genetically linked to isolates from divergent collection sites. Interpreting genetic linkages among C. difficile isolates requires an understanding of regional and strain-specific genetic diversity to avoid misattribution of genetic linkages to recent transmission.Funding: NoneDisclosures: None

scholarly journals Swab-yourself Trial With Economic Monitoring and Testing for Infections Collectively (SYSTEMATIC): Part 1. A Diagnostic Accuracy and Cost-effectiveness Study Comparing Clinician-taken vs Self-taken Rectal and Pharyngeal Samples for the Diagnosis of Gonorrhea and Chlamydia

2020 ◽  
Author(s):  
Janet D Wilson ◽  
Harriet E Wallace ◽  
Michelle Loftus-Keeling ◽  
Helen Ward ◽  
Bethan Davies ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Controlled Trial ◽  
Sexual History ◽  
Health Clinic ◽  
Convenience Sample ◽  
Randomized Controlled ◽  
Home Testing ◽  
Sex With Men ◽  
Trial Evidence ◽  
Cost Effectiveness Study

Abstract Background Urogenital testing misses extragenital Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT). Extragenital self-sampling is frequently undertaken despite no robust randomized, controlled trial evidence of efficacy. We compared clinician-taken rectal and pharyngeal samples with self-taken samples for diagnostic accuracy and cost in men who have sex with men (MSM) and in females. Methods This was a prospective convenience sample from a UK sexual health clinic. We randomized the order of clinician- and self-taken samples from the pharynx and rectum, plus first catch urine (MSM) and vulvovaginal swabs (females), for NG/CT detection. Results Of 1793 participants (1284 females, 509 MSM), 116 had NG detected (75 urogenital, 83 rectum, 72 pharynx); 9.4% infected females and 67.3% MSM were urogenital-negative. A total of 276 had CT detected (217 urogenital, 249 rectum, 63 pharynx); 13.1% infected females and 71.8% MSM were urogenital-negative. Sexual history did not identify those with rectal infections. There was no difference in diagnostic accuracy between clinician- and self-taken samples from the rectum or pharynx. Clinicians took swabs more quickly than participants, so costs were lower. However, in asymptomatic people, nonqualified clinicians would oversee self-swabbing making these costs lower. Conclusions There was no difference in the diagnostic accuracy of clinician-taken compared with self-taken extragenital samples. Sexual history did not identify those with rectal infections, so individuals should have extragenital clinician- or self-taken samples. Clinician-taken swabs cost less than self-taken swabs; however, in asymptomatic people or those who perform home testing, the costs would be lower than for clinician-taken swabs. Clinical Trials Registration NCT02371109.

Collaborative Effort to Manage Childhood Obesity: Parental Employer, Health Insurance, and Employee Health Clinic

2018 ◽  
Vol 11 (1) ◽  
pp. 35-42
Author(s):  
Lizy Jimmy Johns ◽  
Sharolyn Dihigo ◽  
Richard E. Gilder
Keyword(s):  
United States ◽  
Childhood Obesity ◽  
Parental Education ◽  
Healthy Lifestyle ◽  
Health Care Expenditures ◽  
The United States ◽  
Employee Health ◽  
Lifestyle Changes ◽  
Health Clinic ◽  
Convenience Sample

Background:Childhood obesity is an epidemic in the United States affecting 12.7 million children (Centers for Disease Control and Prevention, 2015a), and costing the United States $14.1 billion every year (Cawley, 2010). It also costs corporate America about $9 billion in direct costs (Adeagbo, 2015) and $4.3 billion in indirect costs for health-care expenditures (Cawley, 2010). Studies suggest interventions implemented by employers involving the whole family are twice as effective as interventions with employees alone (Adeagbo, 2015).Methods:This quality improvement pilot study used a quasi-experimental pretest and posttest design in an outpatient employee health clinic to evaluate a coaching method for empowering parents to manage childhood obesity. A convenience sample of 10 employed parents who had children between the ages of 2 and 19 years who were overweight or obese and met study criteria, were enrolled. Three coaching sessions lasting 20–30 minutes were provided before administering the posttest questionnaire.Results:The Mann–Whitney U test showed a measurable positive difference after coaching on healthy behaviors and was statistically and clinically significant (Mann–Whitney U = 80, Wilcoxon W = 125, standard error = 12.26 and p = .003).Conclusion:Findings indicate management of childhood obesity through parental education, coaching, and family-based interventions can promote healthy lifestyle changes among children.

Mental, Physical, and Financial Health Concerns of Underrepresented Undergraduate Students During Initial Stages of the COVID-19 Pandemic in the United States

2020 ◽  
Author(s):  
Kristina Nelson ◽  
Matt Honore ◽  
Jen Lindwall ◽  
Arjun Viray ◽  
Lisa Marriott ◽  
...  
Keyword(s):  
Physical Health ◽  
Undergraduate Students ◽  
Research Training ◽  
High Stress ◽  
The United States ◽  
First Generation College Students ◽  
Financial Health ◽  
Demographic Groups ◽  
First Generation College ◽  
Research Training Program

In April 2020, at the onset of COVID-19 in the U.S., we implemented a weekly survey of underrepresented undergraduate students participating in a biomedical research training program. The 10-week survey collected qualitative and quantitative data on mental health, physical health, and financial health. Responses indicated high stress during the pandemic, particularly during the survey’s final weeks which occurred during a period of social unrest. Physical health declined throughout the survey, stabilizing in its final weeks. Financial health declined initially and stayed low throughout. Students from certain demographic groups, such as first generation college students and those with dependents were disproportionately impacted. Qualitative responses highlighted the intersectionality of the three constructs and illustrated the impacts of these events.

scholarly journals Facemasking Behaviors, Preferences, and Attitudes Among Emerging Adults in the United States During the COVID-19 Pandemic: An Exploratory Study

2021 ◽  
pp. 0887302X2110067
Author(s):  
Denise Nicole Green ◽  
Frances Holmes Kozen ◽  
Catherine Kueffer Blumenkamp
Keyword(s):  
Emerging Adults ◽  
The United States ◽  
Living Situation ◽  
Demographic Groups ◽  
Political Beliefs ◽  
Education Status ◽  
Work Education ◽  
Public Opinion Polls ◽  
Opinion Polls ◽  
Distinct Period

Facemasks have become requisite amid the COVID-19 pandemic. We explore facemasking behaviors, preferences, and attitudes among emerging adults, a “distinct period demographically” within the lifespan. Public opinion polls conducted in May 2020 found that emerging adults were the least compliant when compared to other demographic groups. To understand why, we developed a survey instrument that was administered to a demographically representative quota sample of 1,005 participants. Demographic comparisons revealed that behaviors and attitudes differed significantly by political beliefs, gender, living situation, and race. An exploratory factor analysis revealed six underlying variables: (a) facemask avoidance; (b) concerned adherence (c) vexed faultfinding; (d) statement making; (e) fashion enthusiasm; and (f) hygiene adherence. All factors varied significantly by political affiliation, and in some cases by gender, race, living situation, location, and work/education status. Significant correlations were present between all factors except fashion enthusiasm and vexed faultfinding.

scholarly journals Transmission Potential of Zika Virus by Aedes aegypti (Diptera: Culicidae) and Ae. mediovittatus (Diptera: Culicidae) Populations From Puerto Rico

2021 ◽  
Author(s):  
Rebecca A Zimler ◽  
Donald A Yee ◽  
Barry W Alto
Keyword(s):  
Puerto Rico ◽  
Aedes Aegypti ◽  
Zika Virus ◽  
Mosquito Species ◽  
The United States ◽  
Infection Rates ◽  
Transmission Potential ◽  
Transmission Rates ◽  
Higher Doses ◽  
Local Transmission

Abstract Recurrence of local transmission of Zika virus in Puerto Rico is a major public health risk to the United States, where mosquitoes Aedes aegypti (Linnaeus) and Aedes mediovittatus (Coquillett) are abundant. To determine the extent to which Ae. mediovittatus are capable of transmitting Zika virus and the influence of viremia, we evaluated infection and transmission in Ae. mediovittatus and Ae. aegypti from Puerto Rico using serial dilutions of infectious blood. Higher doses of infectious blood resulted in greater infection rates in both mosquitoes. Aedes aegypti females were up to twice as susceptible to infection than Ae. mediovittatus, indicating a more effective midgut infection barrier in the latter mosquito species. Aedes aegypti exhibited higher disseminated infection (40–95%) than Ae. mediovittatus (&lt;5%), suggesting a substantial midgut escape barrier in Ae. mediovittatus. For Ae. aegypti, transmission rates were low over a range of doses of Zika virus ingested, suggesting substantial salivary gland barriers.

scholarly journals Surge of severe acute respiratory syndrome coronavirus 2 infections linked to single introduction of a virus strain in Myanmar, 2020

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Myat Htut Nyunt ◽  
Hnin Ohnmar Soe ◽  
Kay Thi Aye ◽  
Wah Wah Aung ◽  
Yi Yi Kyaw ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Early Phase ◽  
International Travel ◽  
Health Concern ◽  
Whole Genome ◽  
Genome Sequences ◽  
Genomic Epidemiology ◽  
Local Spread ◽  
Control And Prevention ◽  
Local Transmission

AbstractSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a major health concern globally. Genomic epidemiology is an important tool to assess the pandemic of coronavirus disease 2019 (COVID-19). Several mutations have been reported by genome analysis of the SARS-CoV-2. In the present study, we investigated the mutational and phylogenetic analysis of 30 whole-genome sequences for the virus's genomic characteristics in the specimens collected in the early phase of the pandemic (March–June, 2020) and the sudden surge of local transmission (August–September, 2020). The four samples in the early phase of infection were B.6 lineage and located within a clade of the samples collected at the same time in Singapore and Malaysia, while five returnees by rescue flights showed the lineage B. 1.36.1 (three from India), B.1.1 (one from India) and B.1.80 (one from China). However, there was no evidence of local spread from these returnees. Further, all 19 whole-genome sequences collected in the sudden surge of local transmission showed lineage B.1.36. The surge of the second wave on SARS-CoV-2 infection was linked to the single-introduction of a variant (B.1.36) that may result from the strict restriction of international travel and containment efforts. These genomic data provides the useful information to disease control and prevention strategy.

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