scholarly journals 1272. A Routine, HIV and HCV Testing and Treatment Program in a Large, Multi-Campus Emergency Department Finds High Prevalence of Acute HIV and Chronic Hepatitis C

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S387-S388
Author(s):  
Ryan Anson ◽  
Christopher Hall ◽  
Erica Ivans ◽  
Kara Vassily ◽  
Annette Shaieb ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
People Living With Hiv ◽  
Younger Patients ◽  
Healthcare Needs ◽  
High Prevalence ◽  
Grant Recipient ◽  
Acute Hiv ◽  
Chronic Hcv ◽  
Hcv Testing

Abstract Background One in seven people living with HIV in the United States are unaware of their serostatus. Approximately 11,280 annual HIV infections (30.2%) are caused by this subset of individuals (CDC, 2017). In addition, acute HCV infections have nearly tripled since 2011, with many states seeing a dramatic increase in incidence among younger people outside the birth cohort (CDC, 2017). Because many individuals still use emergency departments (EDs) for their healthcare needs, these institutions play an increasingly important role in screening patients for HIV and HCV and linking them to medical services. Routine, opt-out testing initiatives are particularly effective at identifying new cases of HIV and HCV that could have otherwise been missed by a risk-based approach to screening. Methods In early May 2017, physicians and advanced practice nurses from Sutter Health’s Alta Bates Summit Medical Center (ABSMC) and a nearby outpatient HIV clinic implemented a routine HIV and HCV screening program at the hospital’s large, two-campus ED system in Oakland, CA. ED medical directors created a Nursing Standardized Procedure (NSP) to allow registered nurses (RNs) to independently order both blood tests using an automated, best practice authority (BPA) screen in the electronic health record (EHR) of any patient who met CDC-defined age criteria for testing. Results Of the 6,315 people screened for HIV between May 1, 2017 and March 31, 2018, 43 (0.7%) patients tested positive. Twelve (57%) of the 21 patients found to have a new HIV diagnosis also had symptomatic, acute HIV infection (AHI). All 12 patients with AHI initiated anti-retroviral therapy (ART) within five to 96 hours of their preliminary positive test result. Of the 5,820 patients screened for HCV, 424 (7.3%) were anti-HCV positive, while 185 (3.2%) patients had chronic infection. Thirty-nine percent of chronic HCV cases were among younger patients born before 1965. All patients with HIV or chronic HCV were referred to medical care at East Bay Advanced Care (EBAC). Conclusion An automated, routine HIV-HCV testing program integrated into standard nursing workflow at a community ED resulted in the timely screening, diagnosis, and treatment of many patients with acute HIV, and identified a high prevalence of chronic HCV infections among younger patients. Disclosures R. Anson, Frontline of Communities in the United States (Gilead, Inc.): Grant Investigator, Grant recipient. C. Hall, Frontline of Communities in the United States (Gilead, Inc.): Grant Investigator, Grant recipient.

scholarly journals 354. The Epidemiology and Clinical Features of Acanthamoeba Disease in the United States, 1956–2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S246-S246
Author(s):  
Kevin O’Laughlin ◽  
Jennifer R Cope ◽  
Zachary A Marsh
Keyword(s):  
United States ◽  
Case Reports ◽  
The United States ◽  
Severe Illness ◽  
People Living With Hiv ◽  
Cutaneous Lesions ◽  
Free Living ◽  
Organ Systems ◽  
Free Living Ameba ◽  
Soil And Water

Abstract Background Acanthamoeba is a free-living ameba found worldwide in soil and water that can cause severe illness. Transmission is thought to be through the skin, eyes, or lungs; Acanthamoeba can cause disseminated infection (Acanthamoeba disease) in addition to the more widely recognized Acanthamoeba keratitis. Infections however are rare, and only case reports or small case series have been published. We review Acanthamoeba disease cases from the Centers for Disease Control and Prevention (CDC) free-living ameba registry to characterize the disease in the United States. Methods CDC maintains a free-living ameba (FLA) registry of laboratory-confirmed Acanthamoeba cases (excluding keratitis) sourced from published case reports, CDC case report forms, and CDC laboratory results. SAS© version 9.4 software was used to calculate descriptive statistics and frequencies. Results We identified 163 cases of Acanthamoeba disease between 1956 and 2018. Of cases with documented outcome, 85% were fatal (105/124). Most (88%) cases were in patients who were immunocompromised (136/155): 66 people living with HIV (of whom 49 were classified as having AIDS); 33 recipients of organ transplantation; 30 people diagnosed with malignancy. The most common manifestation of disease was encephalitis (49%). Other clinical presentations included cutaneous lesions (20%) and rhinosinusitis (6%); 40 cases involved multiple organ systems. Median patient age was 42 years (range 0–83 years). Males accounted for 71% (114/160) of cases. California (29) and Texas (14) had the most case reports; 30 other states reported cases. The source of exposure was unknown in most cases (75%); soil and water were documented in 14 and 17 cases, respectively. Conclusion Acanthamoeba disease in the United States is primarily characterized by encephalitis and cutaneous lesions that affect predominately immunocompromised individuals. Acanthamoeba as a cause of encephalitis in immunocompromised patients should be considered by clinicians, which may lead to earlier diagnosis and treatment. Disclosures All Authors: No reported disclosures

Testing for Hepatitis C Virus Infection Among Adults Aged ≥18 in the United States, 2013-2017

2021 ◽  
pp. 003335492110472
Author(s):  
Hope King ◽  
J. E. Soh ◽  
William W. Thompson ◽  
Jessica Rogers Brown ◽  
Karina Rapposelli ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Hepatitis C Virus ◽  
Liver Disease ◽  
Hepatitis C ◽  
The United States ◽  
Hcv Infection ◽  
High School Education ◽  
Related Risk ◽  
Hcv Testing

Objective Approximately 2.4 million people in the United States are living with hepatitis C virus (HCV) infection. The objective of our study was to describe demographic and socioeconomic characteristics, liver disease–related risk factors, and modifiable health behaviors associated with self-reported testing for HCV infection among adults. Methods Using data on adult respondents aged ≥18 from the 2013-2017 National Health Interview Survey, we summarized descriptive data on sociodemographic characteristics and liver disease–related risk factors and stratified data by educational attainment. We used weighted logistic regression to examine predictors of HCV testing. Results During the study period, 11.7% (95% CI, 11.5%-12.0%) of adults reported ever being tested for HCV infection. Testing was higher in 2017 than in 2013 (adjusted odds ratio [aOR] = 1.27; 95% CI, 1.18-1.36). Adults with ≥some college were significantly more likely to report being tested (aOR = 1.60; 95% CI, 1.52-1.69) than adults with ≤high school education. Among adults with ≤high school education (but not adults with ≥some college), those who did not have health insurance were less likely than those with private health insurance (aOR = 0.78; 95% CI, 0.68-0.89) to get tested, and non–US-born adults were less likely than US-born adults to get tested (aOR = 0.77; 95% CI, 0.68-0.87). Conclusions Rates of self-reported HCV testing increased from 2013 to 2017, but testing rates remained low. Demographic characteristics, health behaviors, and liver disease–related risk factors may affect HCV testing rates among adults. HCV testing must increase to achieve hepatitis C elimination targets.

scholarly journals A Comparison of Mental Health Outcomes in the United States and Italy at Different Levels of Cumulative COVID-19 Prevalence

2021 ◽  
Author(s):  
Anthony D Mancini ◽  
Gabriele Prati
Keyword(s):  
Mental Health ◽  
United States ◽  
New York ◽  
San Francisco ◽  
The United States ◽  
Ptsd Symptoms ◽  
General Distress ◽  
High Prevalence ◽  
Low Prevalence ◽  
Different Levels

How does the prevalence of COVID-19 impact people’s mental health? In a preregistered study (N = 857), we sought to answer this question by comparing demographically matched samples in four regions in the United States and Italy with different levels of cumulative COVID-19 prevalence. No main effect of prevalence emerged. Rather, prevalence region had opposite effects, depending on the country. New York City participants (high prevalence) reported more general distress, PTSD symptoms, and COVID-19 worry than San Francisco (low prevalence). Conversely, Campania participants (low prevalence) reported more general distress, PTSD symptoms, and COVID-19 worry than Lombardy (high prevalence). Consistent with these patterns, COVID-19 worry was more strongly linked with general distress and PTSD symptoms in New York than San Francisco, whereas COVID-19 worry was more strongly linked with PTSD in Campania than Lombardy. In exploratory analyses, media exposure predicted and mapped on to geographic variation in mental health outcomes.

scholarly journals Aetiological Factors of Osteoarthritis: A Review Update

2015 ◽  
Vol 2 (1) ◽  
pp. 18-23
Author(s):  
M. Jahidul Islam ◽  
M. Shahadat Hossain ◽  
M. Ruhul Amin ◽  
Monzur Ahmed
Keyword(s):  
United States ◽  
Joint Damage ◽  
The Elderly ◽  
The United States ◽  
Common Type ◽  
High Rate ◽  
Lumbosacral Spine ◽  
First Metatarsal ◽  
High Prevalence ◽  
Wear And Tear

Osteoarthritis (OA) is no longer considered ‘degenerative’ or ‘wear and tear’ arthritis; rather involves dynamic biomechanical, biochemical and cellular process. Indeed, the joint damage that occurs in OA is the result of active remodeling involving all the joint structures. Although articular cartilage is at the center of change, OA is viewed as a disease of the entire joint. Traditionally, OA has been viewed as an inevitable degenerative condition of the cartilage. It is currently viewed as a biomechanical and biochemical inflammatory disease of the entire joints. Osteoarthritis (OA) is the most common type of arthritis. Its high prevalence, especially in the elderly, and the high rate of disability related to disease make it a leading cause of disability in the elderly. Because of the aging of Western populations and because obesity, a major risk factor, are increasing in prevalence, the occurrence of osteoarthritis is on the rise. In the United States, osteoarthritis prevalence will increase from 66–100% by the year 2020. OA affects certain joints, yet spares others. Commonly affected joints include the cervical and lumbosacral spine, hip, knee, and first metatarsal phalangeal joint (MTP). In the hands, the distal and proximal inter-phalangeal joints and the base of the thumb are often affected. Usually spared are the wrist, elbow, and ankle.Journal of Current and Advance Medical Research 2015;2(1):18-23DOI: http://dx.doi.org/10.3329/jcamr.v2i1.22584

scholarly journals Satisfaction with health care system: A comparative study between market-based insurance model of the United States and “out-of-pocket” model in developing and low-income countries

2020 ◽  
Vol 6 (1) ◽  
pp. 41
Author(s):  
Ram Lakhan ◽  
Sean Y. Gillette ◽  
Sean Lee ◽  
Manoj Sharma
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care System ◽  
Undergraduate Students ◽  
Low Income ◽  
Access To Health Care ◽  
The United States ◽  
Low Income Countries ◽  
Healthcare Needs ◽  
Care System

Background and purpose: Access to healthcare services is an essential component for ensuring the quality of life. Globally, there is inequity and disparities regarding access to health care. To meet the global healthcare needs, different models of healthcare have been adopted around the world. However, all healthcare models have some strengths and weaknesses. The purpose of this study was to examine the satisfaction among a group of undergraduate students from different countries with their health care models namely, insurance-based model in the United States and “out-of-pocket” model prevalent in low-income countries.Methods and materials: The study utilized a cross-sectional research design. Undergraduate students, representing different nationalities from a private Southeastern College, were administered a researcher-designed 14-item self-reported electronic questionnaire. Independent t-test and χ2 statistics were used to examine the differences between two health care systems and the qualitative responses were analyzed thematically.Results: Satisfaction towards health care system between the United States and low-income countries was found significantly different (p < .05). However, students in both settings experienced an inability toward affording quality healthcare due to economic factors and disparities.Conclusions: There is dissatisfaction with health care both in the United States and low-income developing countries among a sample of undergraduate students representing these countries. Efforts to ensure low-cost affordable health care should be a global goal.

scholarly journals Implications for Europe of high prevalence of HIV drug resistance in the United States

2002 ◽  
Vol 6 (2) ◽  
Author(s):  
D Pillay
Keyword(s):  
United States ◽  
Drug Resistance ◽  
Disease Progression ◽  
Successful Treatment ◽  
Virological Failure ◽  
The United States ◽  
Viral Rna ◽  
Viral Rebound ◽  
Drug Compliance ◽  
High Prevalence

Over 16 drugs are now available for use against HIV, broadly comprising three classes of agent. Their use, in combination, has had a dramatic impact in reducing disease progression. Successful treatment is increasingly defined as the maintenance of plasma viral RNA load at undetectable levels. Reasons for ‘virological failure’ (viral rebound) on treatment are many, but perhaps the single most important factor is suboptimal drug compliance.

Handguns: Risks versus Benefits

PEDIATRICS ◽  
1986 ◽  
Vol 77 (5) ◽  
pp. 781-782
Author(s):  
KATHERINE K. CHRISTOFFEL ◽  
TOM CHRISTOFFEL
Keyword(s):  
United States ◽  
New York ◽  
New York Times ◽  
The United States ◽  
Gun Control ◽  
Second Amendment ◽  
High Prevalence ◽  
The Us ◽  
Us Supreme Court ◽  
P 16

THE ISSUE There are an estimated 40 to 50 million handguns in the United States, with approximately 2 million more being manufactured annually1 (The New York Times, July 9, 1985, p 16). The high prevalence of handgun injury in the United States is unique in all the world and is increasing. Children are among the growing legions of US citizens harmed by the handgun epidemic.2 The effort to control handguns is focussed on developing laws to control their manufacture, importation, purchase, possession, and use. Opponents of these legal approaches claim that gun control endangers constitutional freedoms. When asked, the US Supreme court has consistently rejected that position in favor of the view that the Second Amendment protects a collective, not a personal, right to bear arms.3,4

Variation in pediatric stereoelectroencephalography practice among pediatric neurosurgeons in the United States: survey results

2021 ◽  
pp. 1-9
Author(s):  
Benjamin C. Kennedy ◽  
Joshua Katz ◽  
Jacob Lepard ◽  
Jeffrey P. Blount
Keyword(s):  
United States ◽  
The United States ◽  
Median Number ◽  
Pediatric Epilepsy ◽  
Case Volume ◽  
Median Response ◽  
Younger Patients ◽  
Electronic Survey ◽  
Survey Results ◽  
Survey Responses

OBJECTIVE Stereoelectroencephalography (SEEG) has become widespread in the United States during the past decade. Many pediatric neurosurgeons practicing SEEG may not have had experience with this technique during their formal training, and the literature is mostly limited to single-center series. As a result, implementation of this relatively new technique may vary at different institutions. The authors hypothesized that aspects of SEEG experience, techniques, and outcomes would vary widely among programs across the country. METHODS An electronic survey with 35 questions addressing the categories of training and experience, technique, electrode locations, and outcomes was sent to 128 pediatric epilepsy surgeons who were potential SEEG users. RESULTS Sixty-one pediatric fellowship-trained epilepsy surgeons in the United States responded to the survey. Eighty-nine percent were actively using SEEG in their practice. Seventy-two percent of SEEG programs were in existence for less than 5 years, and 68% were using SEEG for > 70% of their invasive monitoring. Surgeons at higher-volume centers operated on younger patients (p < 0.001). Most surgeons (70%) spent 1–3 hours per case planning electrode trajectories. Two-thirds of respondents reported a median implant duration of 5–7 days, but 16% reported never having an implant duration > 5 days, and 16% reported having had implants stay in place for > 4 weeks. The median response for the median number of electrodes initially implanted was 12 electrodes, although 19% of respondents reported median implants of 5–8 electrodes and 17% reported median implants of 15–18 electrodes. Having a higher volume of SEEG cases per year was associated with a higher median number of electrodes implanted (p < 0.001). Most surgeons found SEEG helpful in defining an epileptic network and reported that most of their SEEG patients undergo focal surgical treatment. CONCLUSIONS SEEG has been embraced by the pediatric epilepsy surgery community. Higher case volume is correlated with a tendency to place more electrodes and operate on younger patients. For most parameters addressed in the survey, responses from surgeons clustered around a norm, though additional findings of substantial variations highlight differences in implementation and philosophy among pediatric epilepsy programs.

Salmonella enterica Serovar Diversity, Distribution, and Prevalence in Public Access Waters from a Central California Coastal Leafy Green Growing Region during 2011 - 2016

2021 ◽  
Author(s):  
Lisa Gorski ◽  
Anita S. Liang ◽  
Samarpita Walker ◽  
Diana Carychao ◽  
Ashley Aviles Noriega ◽  
...  
Keyword(s):  
United States ◽  
Salmonella Enterica ◽  
The United States ◽  
Public Access ◽  
Bias Analysis ◽  
Central California ◽  
High Prevalence ◽  
Human Salmonellosis ◽  
Rain Events ◽  
Growing Region

Prevalence and serovar diversity of Salmonella enterica was measured during a five-year survey of surface waters in a 500 mi^2 agricultural region of the Central California Coast. Rivers, streams, lakes, and ponds were sampled bimonthly resulting in 2,979 samples. Overall prevalence was 56.4% with higher levels detected in Spring than in Fall. Small, but significant, differences in prevalence were detected based on sample locations. Detection of Salmonella was correlated positively with both significant rain events and, in some environments, levels of generic Escherichia coli . Analysis of 1,936 isolates revealed significant serovar diversity, with 91 different serovars detected. The most common isolated serovars were S. enterica subsp. enterica serovars I 6,8:d:- (406 isolates, 21.0%, and potentially monophasic Salmonella Muenchen), Give (334 isolates, 17.3%), Muenchen (158 isolates, 8.2%), Typhimurium (227 isolates, 11.7%), Oranienburg (106 isolates, 5.5%), and Montevideo (78 isolates, 4%). Sixteen of the 24 most common serovars detected in the region are among the serovars reported to cause the most human salmonellosis in the United States. Some of the serovars were associated with location and seasonal bias. Analysis of Xba I Pulsed Field Gel Electrophoresis (PFGE) patterns of strains of serovars Typhimurium, Oranienburg, and Montevideo showed significant intra-serovar diversity. PFGE pulsotypes were identified in the region for multiple years of the survey, indicating persistence or regular re-introduction to the region. Importance Non-typhoidal Salmonella is the among the leading causes of bacterial foodborne illness and increasing numbers of outbreaks and recalls are due to contaminated produce. High prevalence and 91 different serovars were detected in this leafy green growing region. Seventeen serovars that cause most of the human salmonellosis in the United States were detected, with 16 of those serovars detected in multiple locations and multiple years of the 5-year survey. Understanding the widespread prevalence and diversity of Salmonella in the region will assist in promoting food safety practices and intervention methods for growers and regulators.

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