Medical and Research Library News
DSHS Medical and Research Library publishes MRL News, a monthly newsletter that highlights training opportunities, trending topics, and journal articles for public health professionals.
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HHS employees may email the Medical and Research Library to receive research assistance, learn how to access electronic resources featured in the newsletter, or obtain the full text of articles mentioned in this month’s news.
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Medical and Research Library News By Month
Medical and Research Library News
December 2024
Training opportunities
Websites and reports on trending topics
Journal articles of note
Training opportunities
The webinars and online classes listed here are shared solely as opportunities to learn more information of interest to public health personnel. All times listed are in Central Time.
December 4, 2024; 11 a.m.–2 p.m. Maternal Health - The Rising Incidence of Maternal Syphilis and What We Need to Do About It.
This webinar hosted by Renaye James Healthcare Advisors will discuss how to evaluate individuals at higher risk for becoming infected with syphilis and reviews the screening tests, diagnosis, and treatment for pregnant individuals to minimize the risk of the fetus acquiring congenital syphilis. This webinar aligns with the Health Center Performance Improvement domain of Quality, Patient Care, and Safety as it discusses direct patient care strategies to mitigate complications in the postpartum period.
December 5, 2024; 12.–2:30 p.m. Effective Models to Address Mental Health and Substance Use Disorders.
Join this webinar from the National Academies of Sciences, Engineering, and Medicine (NASEM) to learn about effective models to address mental health and substance use disorders. Discussion topics may include policy implications of selected abatement interventions, effective care models for opioid use disorder and substance use disorder, and addressing issues in access to effective, affordable, and appropriate treatments.
December 10, 2024; 12–1 p.m. Empowering Tobacco Cessation: How Motivational Interviewing Supports Every Stage of Change.The National Center for Farmworker Health (NCFH) is hosting an interactive webinar focusing on the importance of tobacco use screening and self-help education tools. The webinar will cover the stages of change in patients and how motivational interviewing (MI) can empower individuals in their journey to quit tobacco. Attendees will see scenario-based examples of MI in action and receive resources to improve tobacco cessation initiatives for their patient populations.
December 17, 2024; 11 a.m.–12 p.m. Supporting CHWs with Technology to Achieve Value: Hearing from CHWs on Challenges and Successes of Joining the Team.
Hosted by the Health Information and Technology, Evaluation and Quality (HITEQ), this training will feature a conversation with community health workers (CHWs), sharing their challenges and successes in becoming team members in the current landscape of value-based care.
Websites and reports on trending topics
FDA Adverse Event Reporting System (FAERS) is a database that contains adverse event reports, medication error reports, and product quality complaints resulting in adverse events that were submitted to FDA.
speechBITE is a database of intervention studies across the scope of speech pathology practice. It includes evidence-based practices for speech pathologists, including systematic reviews, trials, clinical practice guidelines and more.
STAT!Ref is a DSHS Medical and Research Library resource that provides full text access to key medical reference sources. It includes Red Book, AMA coding manuals, medical dictionaries, drug guides, and many other medical reference books.
Trip is a clinical search engine of evidence-based content designed to support clinical practice and care. It includes research evidence and other content types including images, videos, patient information leaflets, educational courses, and news.
Journal articles of note
Allred RP, Aguilar-Martinez J, Howell R, et al. Epidemiology of macrocephaly in the Texas Birth Defects Registry, 1999-2019. Birth Defects Res. 2024;116(11):e2415. doi:10.1002/bdr2.2415
Abstract
Background: Macrocephaly is a clinical observation denoted as an occipitofrontal head circumference exceeding two standard deviations above same age and sex norms. By its definition, macrocephaly occurs in approximately 3% of the population. Descriptive epidemiologic evaluations of macrocephaly are lacking in the literature. The primary objective of this study was to describe the prevalence of macrocephaly captured by the Texas Birth Defects Registry (TBDR) by infant sex, rural/urban residence, and select maternal characteristics.
Methods: Cases of TBDR between 1999 and 2019 with a six-digit Centers for Disease Control modified-British Pediatric Association (BPA) code of 742.400 (enlarged brain/head, large head, macrocephaly, megalencephaly) were identified. All pregnancy outcomes and diagnostic certainties were included. Prevalence (per 10,000 live births) and 95% confidence intervals (CIs) were calculated using a Poisson table by rural/urban residence, infant sex, maternal age, education, race/ethnicity, history of diabetes, and body mass index (BMI). Prevalence calculations were repeated across multiple sensitivity analyses including (1) definite, isolated cases excluding those with indication of being either "benign" or "familial", (2) definite, non-isolated cases, (3) definite non-isolated cases excluding chromosomal and syndromic cases, and (4) definite, proportionate (at birth) cases. A secondary objective was to describe the most common co-occurring congenital defects among definite, non-isolated cases.
Results: Overall, between 1999 and 2019, 14,637 cases of macrocephaly were identified in the TBDR resulting in a prevalence of 18.12/10,000 live births (95% CI: 17.83-18.42). Most cases were live born (99%), had a definite diagnosis (87%), and were non-isolated (57%). Prevalence was significantly higher among males, among those with an urban residence, and among mothers who were older, Non-Hispanic White, who had greater than high school education, who had a history of diabetes, and who were obese. Prevalence patterns remained consistent across all sensitivity analyses. The most common co-occurring congenital defects among definite, non-isolated cases were minor and primarily included skull and facial bone anomalies (e.g., plagiocephaly [18%]).
Conclusions: To our knowledge, this is the first epidemiologic evaluation of macrocephaly in a birth defects registry. The long-term clinical impact of isolated macrocephaly is not well understood and should be the focus of future investigations.
Luo Q, Horner MJ, Haas CB, et al. Differences in trends in cancer incidence rates among people with HIV during 2001-2019 by race and ethnicity and by risk group in the United States. Clin Infect Dis. Published online November 7, 2024. doi:10.1093/cid/ciae555
Abstract
Background: Cancer risk among people with HIV (PWH) has declined over time as a result of antiretroviral therapy, but it is unclear whether all racial/ethnic groups and transmission risk groups have experienced equal declines.
Methods: We used data on PWH aged ≥20 years old from the HIV/AIDS Cancer Match Study during 2001-2019. We used Poisson regression to assess time trends in incidence rates for each cancer site by racial/ethnicity and risk group, adjusting for age, registry, and sex. We also estimated adjusted rate ratios across racial and ethnic and risk groups in 2001-2004 and 2015-2019.
Results: Trends in age-standardized rates differed across Black, White, and Hispanic PWH, and across risk groups for some cancers. For example, liver cancer rates declined 23% per 5-year period among White PWH, 11% in Black PWH, and 18% in Hispanic PWH. Anal cancer rates declined among men who have sex with men, were stable among people who inject drugs, and increased among other risk groups. Between 2001-2004 and 2015-2019, relative difference in cancer incidence rates by race/ethnicity increased for HL and liver cancer, but decreased for NHL; by risk group, relative differences increased for NHL and liver cancer, and decreased for HL, lung and anal cancers.Conclusions: Among PWH in the US, during 2001-2019, HL, lung, liver, and cervical cancer rate trends were different across racial/ethnic groups. HL, lung, anal, and liver cancer rates trends were different across risk groups. Future work should examine underlying causes of the differences in trends.
Mitchell DL, Chambers TM, Agopian AJ, et al. Epidemiology of coloboma: prevalence and patterns in Texas, 1999-2014. Birth Defects Res. 2024;116(11):e2413. doi:10.1002/bdr2.2413
Abstract
Background: Coloboma is a rare congenital malformation in which part of the tissue that makes up the eye is missing and may cause visual impairment or blindness. Little is known about the epidemiology of this condition. Therefore, we obtained data from the Texas Birth Defects Registry on children identified with coloboma for the period 1999-2014.
Methods: Using information on all live births from the same period, prevalence ratios (PRs) for selected demographic and clinical factors were used to estimate associations using Poisson regression among cases with coloboma. Coloboma cases were divided into subgroups to explore patterns of co-occurring defects and syndromes. All variables significant in unadjusted models (p < 0.05) were included in multivariable models to evaluate adjusted PRs (aPRs).
Results: We identified 1587 cases with coloboma, of whom 934 (58.8%) were nonsyndromic, and 474 (29.9%) were isolated. When considering all identified cases, factors associated with significant differences in prevalence included plurality (multiple vs. singleton aPR = 1.4, 95% CI: 1.1-1.8); maternal education (college or greater vs. less than high school aPR = 0.7, 95% CI: 0.6-0.9); maternal race/ethnicity (Hispanic vs. non-Hispanic White aPR = 0.9, 95% CI: 0.8-1.0); and maternal diabetes (yes vs. no aPR = 1.3, 95% CI: 1.0-1.6). There was a notable increase in the birth prevalence of coloboma during the study period (p-for-trend < 0.001). Effect estimates were similar across the different subgroups.
Conclusion: In our large population, we identified several factors associated with the prevalence of coloboma. These findings may help define subgroups of women more likely to have children affected by coloboma, which could inform improved screening efforts.
Zhong L, Smith ML, Lyu N, et al. The opioid public health crisis in Texas: characterizing real-world healthcare resource utilization and economic burden in different clinical settings. J Opioid Manag. 2024;20(5):393-409.
Abstract
Background and aims: Given the national opioid public health crisis, this study aimed to characterize the real-world healthcare resource utilization pattern and to quantify the economic burden associated with opioid misuse in Texas.
Methods: A retrospective cross-sectional study was conducted using Texas state-wide Inpatient, Outpatient, and Emergency Department (ED) administrative data. International Classification of Diseases, 10th Revision (ICD-10-CM) codes related to opioid abuse, adverse effects, dependence, and poisoning identified opioid-related clinical encounters. High-sensitivity and high-specificity definition criteria were used to capture the range of opioid-related clinical encounters. Descriptive statistics were applied to evaluate the resource utilization and economic burden in different clinical settings and by different types of opioid misuse. Multivariable logistic regression models were applied to identify the association with patients' characteristics.
Results: The high-sensitivity definition identified three to six times more opioid-related clinical encounters related as compared to the high-specificity definition (31,901 vs 10,423 outpatient visits and 47,021 vs 7,444 inpatient visits). A greater proportion of these patients were aged 18-44, White, non-Hispanic, living in metro areas, and uninsured as compared to all-cause visits. EDs were heavily utilized with the outpatient visits predominantly through the ED (>90 percent) and between 49 and 78 percent of inpatient hospitalizations admitted through ED. The multivariable association between patient characteristics and opioid-related clinical encounters varied with clinical settings and the two definitions. High-sensitivity opioid-related clinical encounters were generally associated with higher charges as compared to high-specificity encounters. The total healthcare charge related to opioid misuse in 2016 was estimated to be USD 0.27 billion using the high-specificity definition and USD 2.6 billion using the high-sensitivity definition.
Conclusions: Findings indicate opioid-related clinical encounters impose significant clinical and economic burdens in Texas. Study findings can help healthcare policymakers, professionals, and clinicians better classify opioid use disorder as a major but underreported condition in Texas.
For more information, employees may email the Medical and Research Library at library@dshs.texas.gov to receive research assistance, learn how to access electronic materials, or to obtain the full text of articles mentioned in this month’s news.
The Medical and Research Library News is sent out once a month or when important library news or events occur. Recent issues of the MRL News are online. If any of the links do not open for you, please email library@dshs.texas.gov and we will send you what you need. Thank you!
If you would like to subscribe, please send an email to library@dshs.texas.gov with Subscribe in the subject line.
Medical and Research Library News
November 2024
Training opportunities
Websites and reports on trending topics
Journal articles of note
Training opportunities
The webinars and online classes listed here are shared solely as opportunities to learn more information of interest to public health personnel. All times listed are in Central Time.
November 7, 2024; 1–2 p.m. In the Pursuit of Mental Well-being: Robert
H. Felix and His Role in the Establishment of Mental Health in America.
This talk from the National Library of Medicine’s History Talks series will address mental well-being in mid-20th century America. Realizing the necessity of a comprehensive plan for mental health in the U.S. after World War II, the discipline of psychiatry found themselves unprepared for the
new blueprint. To overcome the long-existing limits, psychiatry needed to transform its old look which had seemingly been esoteric, institution-based, and even unscientific. The National Mental Health Act of 1946 was a striking signal to break away from its unpopular image of discipline. Robert H. Felix, the first director of the National Institute of Mental Health (NIMH), was one of the significant players in determining the trajectory of the future mental health plan. This talk focuses on Dr. Felix’s role in the installation and formation of the country’s mental well-being and his philosophy on mental health itself based on the Robert H. Felix papers from the National Library
of Medicine.
November 13, 2024; 11 a.m.–12:30 p.m. Diabetes and Your Eyes: Understanding the Connection.
This webinar is offered by the DSHS Office of Practice and Learning
Grand Rounds program. This informative session will delve into the relationship between diabetes and eye health. Diabetes, a widespread microvascular disorder, is the leading cause of blindness in adults aged 20 - 74. Through this lecture, we explore the various ways diabetes impacts vision and eye health. We'll discuss the underlying mechanisms, risk factors, and preventive measures to safeguard eye health in individuals with diabetes. By understanding the link between diabetes and eye health, we can be better equipped to support ourselves, family members, friends and/or patients managing this chronic condition. Visit the Grand Rounds calendar to see information on upcoming sessions. Held monthly on the fourth Wednesday, sessions last 90 minutes with the final 20 minutes reserved for Q&A.
November 13, 2024; 10–11 a.m. A Guide to Getting Started in Research
and Publishing.
This webinar from the Network of the National Library of Medicine (NNLM)
is designed to give new professionals a look at how to approach publishing and research. Starting with idea formation and running through finding collaborators, submitting to the IRB, submitting the first manuscript, rewrites and more. Dr. Blake will break down the writing, research and publication processes into steps designed to help new or accomplished professionals to move through each area more easily.
November 21, 2024; 12–1 p.m. Non-Medical Drivers of Health: Policy Options to Improve Health Care Quality.
This webinar from the Michael & Susan Dell Center for Healthy Living
will explore innovative strategies to enhance the value of healthcare spending. By focusing on the conditions that most impact Texans, we’re driving meaningful improvements in health outcomes. The conversation will highlight policy options from the recent report published through
Rice University’s Baker Institute for Public Policy to build on and initiate programming addressing the non-medical needs of priority populations and health conditions.
Websites and reports on trending topics
medRxiv – This resource is a free online archive and distribution server for complete but unpublished manuscripts (preprints) in the medical, clinical, and related health sciences.
Our World in Data - Our World in Data’s mission is to publish the research and data to make progress against the world’s largest problems. It includes more than 12,800 interactive charts and interactive visualization tools to explore a wide range of related indicators.
PolicyMap - This mapping tool provided by the Public Health Digital Library (PHDL) allows users to dig deeper into place-based data and gain insights
to help find solutions to the most tractable issues. It combines extensive data indicators with a contemporary, state of the art mapping platform and expanded analytics. As a PHDL consortium member, the DSHS Medical and Research Library provides this tool and many other public health information resources. Access is available through the PHDL portal. First time users will need to register with their DSHS email.
ProQuest Ebook Central – ProQuest Ebook Central is a science and technology ebook collection. It offers more than 28,000 ebooks spanning coverage in all science and technology topics with a focus on computers
and IT, engineering, life and physical sciences, and math. Register here
to create an account for access.
Journal articles of note
Cole KA, Jupiter DC. Charcot neuroarthropathy in diabetic patients in Texas. Prim Care Diabetes. 2024;18(5):533-538. doi:10.1016/j.pcd.2024.06.012
Abstract
Aims: Charcot neuroarthropathy (CN) is a complex disease of the bone and joints that can lead to serious and life-threatening complications. This study investigates epidemiologic trends in diabetic CN in Texas and the impact of age on these values.
Methods: A retrospective analysis was conducted using the Texas Department of State Health Services Hospital Discharge Data Public Use Data File. Using International Classification of Diseases, Ninth (ICD-9) and Tenth (ICD-10) Revision codes, we identified patients with diabetes and Charcot ankle or foot. Data extracted included diagnoses, race, and gender. Population rates were estimated using census data, calculated per 1000 population and standardized by age.
Results: Overall and age-standardized rates of CN increased each year from 2006 to 2016, except for a downward trend from 2014 to 2016. Poisson regression revealed significant increases in the incidence rate ratio compared to 2006 for each year from 2008 to 2016. When age group is included, all years except 2007 show a significant increase relative to 2006, and all age groups have increased rates relative to ages 18-44. Major and minor amputations in patients with CN have increased.
Conclusions: The increasing rates of CN and amputations highlight the need for further research and standardized strategies for diagnosis and management.
Hajdu G, Hughes T, Ouedraogo GL, et al. Safety of a 4-dose 20-valent pneumococcal conjugate vaccine series in infants: a randomized trial. Pediatrics. Published online October 4, 2024. doi:10.1542/peds.2023-065218
Abstract
Background and objectives: The 20-valent pneumococcal conjugate vaccine (PCV20) was developed to expand protection for pneumococcal disease. It contains all 13-valent pneumococcal conjugate vaccine (PCV13) components plus conjugates for 7 additional serotypes. Our primary objective with this study was to evaluate PCV20 tolerability and safety.
Methods: In this phase 3, multi-country, double-blind study, healthy infants born at ≥34 weeks' gestation were randomly assigned 2:1 to receive PCV20 or PCV13 at 2, 4, 6, and 12 to 15 months of age. Safety assessments included local reactions and systemic events within 7 days after each vaccination, adverse events (AEs) from dose 1 to 1 month after dose 3 and from dose 4 to 1 month after dose 4, and serious AEs and newly diagnosed chronic medical conditions from dose 1 through 6 months after the last dose.
Results: Participants received PCV20 (N = 1000) or PCV13 (N = 504); 91.7% received all 4 doses. The frequencies of local reactions and systemic events were generally similar in PCV20 and PCV13 groups, with most reported as mild or moderate. The most common local reaction was injection site pain (PCV20, 24.7% to 40.5%; PCV13, 26.8% to 42.0%); irritability was the most common systemic event (PCV20, 54.8% to 68.2%; PCV13, 54.7% to 68.5%). AE frequencies were similar in both groups. No serious AEs were related to study vaccines. Few newly diagnosed chronic medical conditions were reported (2.8% in both groups). PCV20 was safe across multiple countries, in late preterm infants, and when administered with other vaccines.
Conclusions: A 4-dose series of PCV20 had a tolerability and safety profile similar to that of PCV13.
Rocha ES, Peñate SB, Van Ramshorst RD. Leveraging quality improvement and shared learning to improve infant well-child visit rates in Texas. Healthcare. 2024;12(19):1965. Published 2024 Oct 2. doi:10.3390/healthcare12191965
Abstract
Texas Medicaid improved infant well-child visit rates by participating in a national learning collaborative. The two-year program encouraged creativity and innovation in care for Medicaid recipients through partnerships with managed care organizations (MCOs). The MCO projects discovered valuable practices in member outreach and were disseminated in shared learning experiences. At the completion of the learning collaborative, Texas Medicaid surveyed the MCO participants to assess the impact of their projects on Medicaid beneficiaries in Texas as well as the quality improvement project format. Collectively, the MCOs raised the infant well-child visit rate year-over-year. All of the partner MCOs stated they plan to continue focused work on improving infant well-child visit rates after the learning collaborative.
Weyant C, Lin A, Newgard CD, et al. Cost-effectiveness and health impact of increasing emergency department pediatric readiness in the US. Health Aff. 2024;43(10):1370-1378. doi:10.1377/hlthaff.2023.01489
Abstract
The quality of emergency department (ED) care for children in the US is highly variable. The National Pediatric Readiness Project aims to improve survival for children receiving emergency services. We conducted a cost-effectiveness analysis of increasing ED pediatric readiness, using a decision-analytic simulation model. Previously published primary analyses of a nationally representative, population-based cohort of children receiving emergency services at 747 EDs in eleven states provided clinical and cost parameters. From a health care sector perspective, we used a 3 percent annual discount rate and quantified lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). We performed probabilistic, one-way, and subgroup sensitivity analyses. Increasing ED pediatric readiness yields 69,100 QALYs for the eleven-state cohort, costing $9,300 per QALY gained. Achieving high readiness nationally yields 179,000 QALYs at the same ICER (with implementation costs of approximately $260 million). Implementing high ED pediatric readiness for all EDs in the US is highly cost-effective.
For more information, employees may email the Medical and Research Library at library@dshs.texas.gov to receive research assistance, learn how to access electronic materials, or to obtain the full text of articles mentioned in this month’s news.
The Medical and Research Library News is sent out once a month or when important library news or events occur. Recent issues of the MRL News are online. If any of the links do not open for you, please email library@dshs.texas.gov and we will send you what you need. Thank you!
If you would like to subscribe to the MRL News, please send an email to library@dshs.texas.gov with Subscribe in the subject line.
Medical and Research Library News
October 2024
Training opportunities
Websites and reports on trending topics
Journal articles of note
Training opportunities
The webinars and online classes listed here are shared solely as opportunities to learn more information of interest to public health personnel. All times listed are in Central Time.
October 3, 2024; 12–1 p.m. Food as Medicine in Pediatrics: A Necessary Responsibility.
This lecture from the Michael & Susan Dell Center for Healthy Living will explore the pivotal role of "food as medicine" in promoting community health and well-being. Keynote speaker Dr. Kofi Essel will emphasize the importance of a holistic, family-centered approach that extends beyond adults to include the individual child and the entire household. He will highlight how food-based interventions, such as medically-tailored meals and produce prescriptions, hold immense potential to prevent and manage chronic conditions, particularly when leveraging the reach of large healthcare organizations.
October 17, 2024; 1-2 p.m. Visionary Technology: Exploring Eyeglasses and Impairment in the NLM’s Collections.
Join Dr. Rachael Gillibrand as she explores the connections between eye impairments and the creation of eyeglasses, using the collections of the National Library of Medicine (NLM). The talk will highlight items from her 'ocular impairment' resource collection, accessible through the Medical Heritage Library, as well as materials used in her forthcoming book on premodern disability. Together, we will dive into the pages of historical texts, including Guy de Chauliac's Chyrurgia, Bartholomeus Anglicus' De proprietatibus rerum and the writings of Ambroise Paré, to explore how ocular health has influenced the design of eyeglasses throughout history.
October 30, 2024; 11 a.m.–12:30 p.m. Zoonotic Tuberculosis.
This webinar is offered by the DSHS Office of Practice and Learning
Grand Rounds program. DSHS Grand Rounds explores the science
and practice of population health and awards continuing education credits/contact hours for various disciplines. Visit the Grand Rounds calendar to see information on upcoming sessions. Held monthly on the fourth Wednesday, sessions last 90 minutes with the final 20 minutes reserved for Q&A.
October 31, 2024; 12–1 p.m. From Problem to Prevention: Evidence-Based Public Health.
Curious about evidence-based public health (EBPH) but not sure where to start? This class from the Network of the National Library of Medicine (NNLM) will explain the basics of EBPH and highlight essentials of the EBPH process such as identifying the problem, forming a question, searching the literature, and evaluating the intervention. The purpose of this class is to introduce the world of evidence based public health and to give those already familiar with EBPH useful information that can be applied in their practices.
Websites and reports on trending topics
Gale Academic OneFile – This TexShare resource lets you access millions of articles from thousands of scholarly and authoritative sources in the humanities, science, social science, business, and more. The Topic Finder feature is an easy visual to help explore sub-topics of your initial search. Please email the library for remote access to this resource.
MedlinePlus - Produced by the National Library of Medicine, this resource has extensive information from the National Institutes of Health and other trusted sources on over 975 diseases and conditions. There are directories, a medical encyclopedia and a medical dictionary, health information in Spanish, extensive information on prescription and nonprescription drugs, health information from the media, and links to thousands of clinical trials.
Launching Lifelong Health by Improving Health Care for Children, Youth, and Families – This report from the National Academies examines how the health care system can be better positioned to address the needs of all children and families and leverage community supports. This requires transforming key components, such as health care financing, public health investment, community partnerships, and accountability strategies, to encourage team-based care delivery models and attention to and health promotion, prevention, and root causes of health disparities.
October is Breast Cancer Awareness Month - Each year in the United States, more than 240,000 women are diagnosed with breast cancer and 42,000 women die from the disease. This website from the CDC will help you recognize symptoms, identify risk factors, and lower your risk.
Toxic Substances Portal from the Agency for Toxic Substances and Disease Registry’s (ASTDR) makes it easy for researchers and individuals to find information about toxic chemicals, understand how these chemicals can affect health, and learn how to prevent exposure. It features a search engine that facilitates finding substances by substance name, Chemical Abstract Service (CAS) registry number, synonym, or trade name.
Journal articles of note
Adekanmbi V, Sokale I, Guo F, et al. Human papillomavirus vaccination and human papillomavirus-related cancer rates. JAMA Netw Open. 2024;7(9):e2431807. Published 2024 Sep 3. doi:10.1001/jamanetworkopen.2024.31807
Abstract
Importance: To inform the design and implementation of targeted interventions to reduce the future burden of human papillomavirus (HPV)-related cancers in Texas, it is necessary to examine the county and health service region (HSR) levels of (1) the proportion of children and teenagers aged 9 to 17 years who initiated and were up to date for HPV vaccination series and (2) HPV-related cancer incidence rates (IRs).
Objective: To evaluate temporal trends and geospatial patterns of HPV vaccination initiation and up-to-date status as well as HPV-related cancer rates at county and HSR levels in Texas.
Design, setting, and participants: This population-based cross-sectional study used data from the Texas Immunization Registry, the National Cancer Institute's Surveillance, Epidemiology, and End Results Program database, and Texas Department of State Health Services annual population counts from 2006 to 2022. The analysis of HPV vaccination rates was conducted among children and teenagers aged 9 to 17 years; the analysis of HPV-related cancer rates was conducted among adults aged 20 years and older. Data were extracted between June and July 2023 and statistical analysis was performed from February to April 2024.
Main outcomes and measures: HPV vaccination initiation and up-to-date status rates and HPV-related cancer IR at county and HSR levels.
Results: A total of 32,270,243 children and teenagers (65.8% female individuals and 34.2% male individuals) and 22,490,105 individuals aged 20 years and older (50.7% female individuals and 49.3% male individuals) were included. The mean 2021 to 2022 county-level HPV vaccination series initiation estimates ranged from 6.3% to 69.1% for female and from 7.0% to 77.6% for male children and teenagers aged 9 to 17 years. County-level vaccination up-to-date estimates were generally lower compared with those of initiation estimates and ranged from 1.6% to 30.4% for female and from 2.1% to 34.8% for male children and teenagers. The pattern of HPV vaccination rates stratified by sex were similar across counties and HSRs. The age-adjusted annual HPV-related cancer IR by county for years 2016 to 2020 ranged from 0 to 154.2 per 100,000 for female individuals and from 0 to 60.1 per 100 000 for male individuals. The counties located in North Texas, HSRs 2/3 and 4/5N, had lower HPV vaccination rates and higher IRs of HPV-related cancers for both female and male individuals compared with other regions.
Conclusions and relevance: In this study, the incidence of HPV-related cancers varied widely across the counties and HSRs of Texas. More counties in North Texas, HSRs 2/3 and 4/5N, had higher IRs of HPV-related cancers and a lower proportion of HPV vaccination rates than counties in other regions. Designing and implementing targeted interventions to increase uptake and completion of HPV vaccination series across counties with low HPV vaccination rates may help to reduce future the burden of HPV-related cancers.
Forestieri NE, Olshan AF, Oster ME, et al. Survival of children with critical congenital heart defects in the National Birth Defects Prevention Study. Birth Defects Res. 2024;116(9):e2394. doi:10.1002/bdr2.2394
Abstract
Background: Critical congenital heart defects (CCHDs) are associated with considerable morbidity and mortality. This study estimated survival of children with nonsyndromic CCHDs and evaluated relationships between exposures of interest and survival by CCHD severity (univentricular or biventricular function).
Methods: This analysis included 4380 infants with CCHDs (cases) born during 1999-2011 and enrolled in the National Birth Defects Prevention Study, a multisite, population-based case-control study of major birth defects. Cases were linked to state death files. Nonparametric Kaplan-Meier survival functions were used to estimate 1- and 5-year survival probabilities overall and by severity group (univentricular/biventricular) stratified by demographic and clinical exposure variables of interest. The log-rank test was used to determine whether stratified survival curves were equivalent. Survival and 95% confidence intervals (CIs) were also estimated using Cox proportional hazards modeling adjusted for maternal age, education, race/ethnicity, study site, and birth year.
Results: One- and five-year survival rates were 85.8% (CI 84.7-86.8) and 83.7% (CI 82.5-84.9), respectively. Univentricular 5-year survival was lower than biventricular case survival [65.3% (CI 61.7-68.5) vs. 89.0% (CI 87.8-90.1; p < 0.001)]. Clinical factors (e.g. preterm birth, low birthweight, and complex/multiple defects) were associated with lower survival in each severity group. Sociodemographic factors (non-Hispanic Black race/ethnicity, <high school education, smoking, and lower household income) were only associated with survival among biventricular cases.
Conclusions: Mortality among children with CCHDs occurred primarily in the first year of life. Survival was lower for those with univentricular defects, and social determinants of health were most important in predicting survival for those with biventricular defects.
Messiah SE, Abbas R, Bergqvist E, et al. Factors associated with elevated SARS-CoV-2 immune response in children and adolescents. Front Pediatr. 2024;12:1393321. Published 2024 Aug 15. doi:10.3389/fped.2024.1393321
Abstract
Background: Understanding the distinct immunologic responses to SARS-CoV-2 infection among pediatric populations is pivotal in navigating the COVID-19 pandemic and informing future public health strategies. This study aimed to identify factors associated with heightened antibody responses in children and adolescents to identify potential unique immune dynamics in this population.
Methods: Data collected between July and December 2023 from the Texas Coronavirus Antibody REsponse Survey (Texas CARES), a statewide prospective population-based antibody survey among 1-to-19-year-old participants, were analyzed. Each participant had the following data available for analysis: (1) Roche Elecsys® Anti-SARS-CoV-2 Immunoassay for Nucleocapsid protein antibodies (Roche N-test), (2) qualitative and semi-quantitative detection of antibodies to the SARS CoV-2 spike protein receptor binding domain (Roche S-test), and (3) self-reported antigen/PCR COVID-19 test results, vaccination, and health status. Statistical analysis identified associations between participant characteristics and spike antibody quartile group.
Results: The analytical sample consisted of 411 participants (mean age 12.2 years, 50.6% female). Spike antibody values ranged from a low of 6.3 U/ml in the lowest quartile to a maximum of 203,132.0 U/ml in the highest quartile in the aggregate sample. Older age at test date (OR = 1.22, 95% CI: 1.12, 1.35, p < .001) and vaccination status (primary series/partially vaccinated, one or multiple boosters) showed significantly higher odds of being in the highest spike antibody quartile compared to younger age and unvaccinated status. Conversely, fewer days since the last immunity challenge showed decreased odds (OR = 0.98, 95% CI: 0.96, 0.99, p = 0.002) of being in the highest spike antibody quartile vs. more days since last immunity challenge. Additionally, one out of every three COVID-19 infections were asymptomatic
Conclusions: Older age, duration since the last immunity challenge (vaccine or infection), and vaccination status were associated with heightened spike antibody responses, highlighting the nuanced immune dynamics in the pediatric population. A significant proportion of children/adolescents continue to have asymptomatic infection, which has important public health implications.
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