scholarly journals Tuberculosis in the United States: Medical Consultation Services Provided by 5 Tuberculosis Regional Training and Medical Consultation Centers, 2013–2017

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
Neela D Goswami ◽  
Sundari Mase ◽  
David Griffith ◽  
Rajita Bhavaraju ◽  
Alfred Lardizabal ◽  
...  

Abstract With only 9105 new US tuberculosis (TB) cases reported in 2017, expert consultation is essential for TB care. Data were captured 2013–2017 from consultations by 5 CDC-funded centers, now the TB Centers of Excellence (COEs). 14 586 consultations were provided to TB providers, most related to TB disease and treatment regimens.

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S819-S820
Author(s):  
Jonathan Todd ◽  
Jon Puro ◽  
Matthew Jones ◽  
Jee Oakley ◽  
Laura A Vonnahme ◽  
...  

Abstract Background Over 80% of tuberculosis (TB) cases in the United States are attributed to reactivation of latent TB infection (LTBI). Eliminating TB in the United States requires expanding identification and treatment of LTBI. Centralized electronic health records (EHRs) are an unexplored data source to identify persons with LTBI. We explored EHR data to evaluate TB and LTBI screening and diagnoses within OCHIN, Inc., a U.S. practice-based research network with a high proportion of Federally Qualified Health Centers. Methods From the EHRs of patients who had an encounter at an OCHIN member clinic between January 1, 2012 and December 31, 2016, we extracted demographic variables, TB risk factors, TB screening tests, International Classification of Diseases (ICD) 9 and 10 codes, and treatment regimens. Based on test results, ICD codes, and treatment regimens, we developed a novel algorithm to classify patient records into LTBI categories: definite, probable or possible. We used multivariable logistic regression, with a referent group of all cohort patients not classified as having LTBI or TB, to identify associations between TB risk factors and LTBI. Results Among 2,190,686 patients, 6.9% (n=151,195) had a TB screening test; among those, 8% tested positive. Non-U.S. –born or non-English–speaking persons comprised 24% of our cohort; 11% were tested for TB infection, and 14% had a positive test. Risk factors in the multivariable model significantly associated with being classified as having LTBI included preferring non-English language (adjusted odds ratio [aOR] 4.20, 95% confidence interval [CI] 4.09–4.32); non-Hispanic Asian (aOR 5.17, 95% CI 4.94–5.40), non-Hispanic black (aOR 3.02, 95% CI 2.91–3.13), or Native Hawaiian/other Pacific Islander (aOR 3.35, 95% CI 2.92–3.84) race; and HIV infection (aOR 3.09, 95% CI 2.84–3.35). Conclusion This study demonstrates the utility of EHR data for understanding TB screening practices and as an important data source that can be used to enhance public health surveillance of LTBI prevalence. Increasing screening among high-risk populations remains an important step toward eliminating TB in the United States. These results underscore the importance of offering TB screening in non-U.S.–born populations. Disclosures All Authors: No reported disclosures


PEDIATRICS ◽  
1991 ◽  
Vol 88 (2) ◽  
pp. 332-334
Author(s):  
ARTHUR LAVIN ◽  
ALAN H. NAUSS

Atherosclerosis is the leading cause of death in the United States. Studies in adults have shown that intervention with combined diet and medication can reduce atherosclerotic plaque formation and, as a result, the incidence of symptomatic coronary artery disease.1-4 With a strong tradition of preventive medicine, the pediatric community has begun exploring the prevention of adult atherosclerosis through intervention in childhood. Although issues such as universal vs selective high-risk screening, ideal age for screening and intervention, and treatment regimens remain unresolved and controversial, many preventive cardiology clinics, as well as individual pediatricians, have been screening and treating children.5,6 As part of an initial evaluation of hypercholesterolemic children and prior to any intervention, it is important to determine whether other disease processes are contributing to the child's dyslipoproteinemia.


Insects ◽  
2019 ◽  
Vol 10 (10) ◽  
pp. 361 ◽  
Author(s):  
Samantha Wisely ◽  
Gregory Glass

Globally, vector-borne diseases are an increasing public health burden; in the United States, tick-borne diseases have tripled in the last three years. The United States Centers for Disease Control and Prevention (CDC) recognizes the need for resilience to the increasing vector-borne disease burden and has called for increased partnerships and sustained networks to identify and respond to the most pressing challenges that face vector-borne disease management, including increased surveillance. To increase applied research, develop communities of practice, and enhance workforce development, the CDC has created five regional Centers of Excellence in Vector-borne Disease. These Centers are a partnership of public health agencies, vector control groups, academic institutions, and industries. This special issue on tick and tick-borne disease surveillance is a collection of research articles on multiple aspects of surveillance from authors that are affiliated with or funded by the CDC Centers of Excellence. This body of work illustrates a community-based system of research by which participants share common problems and use integrated methodologies to produce outputs and effect outcomes that benefit human, animal and environmental health.


Viruses ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 1318
Author(s):  
Scott D. Haller ◽  
Michael L. Monaco ◽  
Karim Essani

Pancreatic ductal adenocarcinoma (PDAC) is the fifth leading cause of cancer-related death in Western countries. The incidence of PDAC has increased over the last 40 years and is projected to be the second leading cause of cancer death by 2030. Despite aggressive treatment regimens, prognosis for patients diagnosed with PDAC is very poor; PDAC has the lowest 5-year survival rate for any form of cancer in the United States (US). PDAC is very rarely detected in early stages when surgical resection can be performed. Only 20% of cases are suitable for surgical resection; this remains the only curative treatment when combined with adjuvant chemotherapy. Treatment regimens excluding surgical intervention such as chemotherapeutic treatments are associated with adverse effects and genetherapy strategies also struggle with lack of specificity and/or efficacy. The lack of effective treatments for this disease highlights the necessity for innovation in treatment options for patients diagnosed with early- to late-phase PDAC and immuno-oncolytic viruses (OVs) have been of particular interest since 2006 when the first oncolytic virus was approved as a therapy for nasopharyngeal cancers in China. Interest resurged in 2015 when T-Vec, an oncolytic herpes simplex virus, was approved in the United States for treatment of advanced melanoma. While many vectors have been explored, few show promise as treatment for pancreatic cancer, and fewer still have progressed to clinical trial evaluation. This review outlines recent strategies in the development of OVs targeting treatment of PDAC, current state of preclinical and clinical investigation and application.


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Caroline Sobotyk ◽  
Kaitlyn E. Upton ◽  
Manigandan Lejeune ◽  
Thomas J. Nolan ◽  
Antoinette E. Marsh ◽  
...  

Abstract Background Companion animal endoparasites play a substantial role in both veterinary medicine and public health. Updated epidemiological studies are necessary to identify trends in occurrence and distribution of these parasites, and their associated risk factors. This study aimed to assess the occurrence of canine endoparasites  retrospectively, using fecal flotation  test data available through participating academic veterinary parasitology diagnostic laboratories across the United States of America (USA). Methods Canine fecal flotation records from ten veterinary diagnostic laboratories located in nine states in the USA acquired from January 1, 2018, to December 31, 2018, were included. Results A total of 4692 fecal flotation test results were obtained, with a majority comprised of client-owned dogs (3262; 69.52%), followed by research dogs (375; 8.00%), and shelter dogs (122; 2.60%). Samples from 976 (20.80%) dogs were positive for at least one parasite, and co-infections of two or more parasites were found in 3.82% (179/4692) of the samples. The five most commonly detected parasites were: Giardia sp., (8.33%; 391/4692), Ancylostomatidae (5.63%; 264/4692), Cystoisospora spp. (4.35%; 204/4692), Toxocara canis (2.49%;117/4692), and Trichuris vulpis (2.43%; 114/4692). Various other internal parasites, including gastrointestinal and respiratory nematodes, cestodes, trematodes, and protozoans were detected in less than 1% of samples. Conclusions These data illustrate the importance of parasite prevention, routine fecal screening, and treatment of pet dogs. Additionally, pet owners should be educated about general parasite prevalence, prevention, and anthelmintic treatment regimens to reduce the risks of environmental contamination and zoonotic transmission. Graphical Abstract


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1360-1360
Author(s):  
Dong Dai ◽  
Ji Haeng Heo ◽  
Andrew Rava ◽  
Etienne Jousseaume ◽  
Roberto Ramos ◽  
...  

Abstract Objective: To determine treatment regimens used in clinical practice and the associated clinical outcomes among third line (3L) follicular lymphoma (FL) patients in the United States (US). Methods: This non-interventional, retrospective study used Optum electronic health records (EHR) database for FL patients in the US between 1 Jan 2007 and 31 Dec 2020. The start of this period was selected to align with the Morrison et al. 2019, with 5 years of additional data. The identification period was 1 Jan 2008 to 31 Dec 2019, to ensure at least 1 year of baseline before and 60 days of follow-up (unless death happens before) after the index date, defined as start date of 3L treatment. Adult patients (≥18 years) treated in integrated delivery networks with at least one of the 3L treatments of interest (rituximab, bendamustine and rituximab, phosphatidylinositol 3-kinase [PI3K] inhibitors [copanlisib, duvelisib, idelalisib], lenalidomide and rituximab [R2], tazemetostat, and stem cell transplant) were included. Patients with Diffuse Large B-cell Lymphoma (DLBCL) diagnosis or clinical trial enrollment on or before the index date or any other cancer diagnosis before the first FL diagnosis were excluded. All agents initiated within 90 days after the index diagnosis constituted the 1L treatment. A subsequent line of therapy (LOT) was defined as treatment initiated after ≥180 days following the runout date of all agents, or addition or substitution of a new agent in the prior LOT after 90 days. The primary endpoints were time to progression (DLBCL transformation, new LOT initiation, or supportive care), overall survival (OS) and progression-free survival (PFS), while time to next treatment (TTNT) and treatment patterns were the key secondary endpoints. The analyses were conducted for the overall cohort, patients with early progression within 24 months (POD24) after 1L treatment, patients with index date after and including year 2014, as well as for different 3L treatment regimens. The sub-group with 2014 as index date was selected based on idelalisib approval in 2014. Results: The final cohort of patients (used one of the 3L treatments of interest and met inclusion/exclusion criteria) consisted of 687 patients: mean age 62.9 years (range 18 - 86), female (46.9%), Caucasians (87.3%), non-Hispanics (92.1%), and median Charlson Comorbidity Index (CCI) 3 (range 1 - 18). Rituximab-based regimens (73.7%) were the most common 3L treatments (mono 38.4%, combo 35.2%). Obinutuzumab was used as combination 3L therapy by 6 (0.87%) patients. Bendamustine, PI3K and lenalidomide monotherapies were administered to 3.1%, 2.2% and 1.9% patients, respectively (Figure 1). Rituximab-based regimens were also the most frequently used 1L, 2L, and 4L treatment options (50.8% moved to 4L and 33.6% had rituximab-based regimens). The median time to progression, PFS, and TTNT for 3L in the overall cohort were 16.6 (95% CI 14.4, 18.1), 12.5 (95% CI 11.3, 14.4), and 18 (95% CI 15.8, 19.9) months, respectively. The 1-, 2-and 5-year OS were 83.1%, 74.8% and 61.4%, respectively. The outcomes of 3L among POD24 , non-POD24, as well as patients with index date after and including year 2014 were similar to that of the overall cohort. The median time to progression, PFS, and TTNT with rituximab treatment were 19.1 (95% CI 16.7, 21.7), 15.7 (95% CI 14.2, 17.5), and 18.8 (95% CI 17, 21.7) months respectively. The median OS with rituximab therapy was not reached while the 5-year OS was 67% (Table 1). Moreover, we did not observe statistically significant differences in time to progression, OS, PFS, and TTNT for the 3L treatment between POD24 and non-POD24 patients using a Cox regression model with adjustment for baseline characteristics (age, gender, region, and CCI). The median time to progression, PFS, and TTNT among POD24 vs. non-POD24 were 15.7 vs. 17.9, 11.6 vs. 15.2, and 18 vs. 17.9 months, respectively. Conclusion: Rituximab-based regimens were the most common 3L treatment options for FL patients. Bendamustine, PI3K, and lenalidomide monotherapies were used by a smaller proportion of patients. R2 was used by a small number of patients for 3L treatment, but it is becoming an important option for FL treatment since its approval in 2019. The majority of outcomes observed could be considered poor, newer agents undergoing clinical trials could provide additional treatment choices to physicians to balance treatment effectiveness with safety and patients' quality of life. Figure 1 Figure 1. Disclosures Dai: Novartis: Current Employment, Current equity holder in publicly-traded company. Heo: Genesis Research: Current Employment, Current equity holder in publicly-traded company. Rava: Genesis Research: Current Employment, Current equity holder in publicly-traded company. Jousseaume: Novartis: Current Employment, Current equity holder in publicly-traded company. Ramos: Novartis: Current Employment, Current equity holder in publicly-traded company. Bollu: Novartis: Current Employment, Current equity holder in publicly-traded company.


1997 ◽  
Vol 15 (1) ◽  
pp. 153-184 ◽  
Author(s):  
FELISSA L. COHEN

Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide. In the United States, TB has undergone a resurgence and the appearance of multidrugresistant TB has caused new concerns. A critical part of TB treatment is adherence to the prescribed therapy for a considerable time period. Treatment “failure” is often due to nonadherence. Many factors influence adherence to therapy in TB. This chapter reviews research in the area of adherence to the TB treatment plan in the United States and worldwide. It discusses adherence as an outcome related to treatment regimens such as directly observed therapy, patient characteristics, life and family circumstances, motivation, education, incentives, and combination strategies. Themes across studies are compared and suggestions for successful future studies are identified.


2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 143s-143s
Author(s):  
A. Criswell ◽  
A. Ciupek ◽  
A. Copeland ◽  
J. King

Background and context: In 2010, the National Lung Screening Trial was halted in the United States after showing a 20% reduction in mortality for high risk individuals when three years of annual lung cancer screening was performed by low dose computed tomography (LDCT). Many questions remained about whether this type of screening could be properly implemented in nonacademic, community settings. Aim: Our aim was to promote high-quality, responsible lung cancer screening throughout the United States, including in community settings where most lung cancer is diagnosed. Strategy/Tactics: Lung Cancer Alliance developed a National Framework for Excellence in Lung Cancer Screening and Continuum of Care in 2012 and began a nationwide network dedicated to responsible lung cancer screening. The Screening Center of Excellence designation requires a center to ensure shared decision-making, comply with best practice standards, work with a multidisciplinary care team, refer for smoking cessation, provide results in a timely manner, and meet standards set by the American College of Radiology. Program/Policy process: From 2012 through 2016, over 500 centers were designated as Screening Centers of Excellence. These centers represented 42 states and more than 60% were from community/nonacademic community centers. High-risk individuals who come to the Lung Cancer Alliance Web site or contact the organization by phone to find a screening center are directed to a Center of Excellence. A data collection effort in 2017 collected comprehensive information about the state of lung cancer screening and care at their institution. Nearly 70% of centers responded to the survey. Outcomes: This program has helped promoted high quality lung cancer screening throughout the United States. Our program data shows that screening is being performed widely across the United States, including in nonacademic centers. For centers who were able to provide numbers of screenings performed and diagnoses, we identified a clear trend in diagnosis of Stage 1 lung cancer, indicating these screenings are able to find lung cancer early. We also identified a number of implementation challenges around referral patterns, insurance and billing, and determining appropriate risk criteria. What was learned: We have shown that a patient advocacy group working with medical professionals can help deliver high quality care to a broad population. Data collection from the Screening Centers of Excellence provides a snapshot of the state of lung cancer screening in the United States that underscores the success of LDCT and the importance of early detection but also identifies barriers in implementation that still need to be addressed.


1995 ◽  
Vol 3 (4) ◽  
pp. 149-157 ◽  
Author(s):  
MerriKay A. Oleen-Burkey ◽  
Sharon L. Hillier

Objective: This study was undertaken to estimate the annual direct costs of complications associated with bacterial vaginosis (BV) in pregnant women in the United States.Methods: An economic model was developed from evidence in the published literature linking perinatal complications to BV. The estimates of attributable risks were applied to the estimated population of pregnant women in the United States in 1993. The charge data from a database of hospital utilization information were then used to estimate the direct costs of each pregnancy complication and the total direct costs associated with BV.Results: Under the assumptions of our model, the direct costs of preterm labor, preterm delivery, the attendant low birth weight (LBW), and other perinatal complications associated with BV were estimated at nearly $1.0 billion in 1993. Over 40% of the total cost was associated with preterm delivery and intensive care of LBW infants, while another 24.5% of the cost was related to preterm labor.Conclusions: If the current frequency of BV among pregnant women persists and BV is not detected and treated during pregnancy, the projected annual costs will reach $1.4 billion by the year 2000. Reducing the heavy economic burden associated with BV in pregnant women will require the establishment of effective screening and treatment regimens.


Sign in / Sign up

Export Citation Format

Share Document