Publications by authors named "Eyal Oren"

69 Publications

Community Boosts Immunity? Exploring the Relationship Between Social Capital and COVID-19 Social Distancing.

Spat Demogr 2021 Oct 4:1-31. Epub 2021 Oct 4.

San Diego State University, 5500 Campanile Dr, San Diego, CA 92182 USA.

The early stages of the COVID-19 pandemic required a dramatic change in social practices, including distancing from social settings, to limit its spread. While social capital has considerable potential in facilitating the adoption of these norms, it also comes with considerable limitations that potentially undermine its effectiveness. We draw upon recently released mobility data from Google, network data from Facebook, and demographic data from the 2018 American Community Survey to determine how both organizational and networked measures of social capital relate to different forms of distancing. In addition, we employ geographically weighted regression to identify how these relationships vary across the nation. Findings indicate that while both forms of social capital can positively relate to distancing, the impacts are spatially inconsistent and, in some locations, social capital can discourage distancing. In sum, more policy efforts are needed to address not only low-social capital, but also unhelpful social capital.
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http://dx.doi.org/10.1007/s40980-021-00096-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8489173PMC
October 2021

Biomarkers of kidney function and cognitive ability: A Mendelian randomization study.

J Neurol Sci 2021 Sep 14;430:118071. Epub 2021 Sep 14.

Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA.

Background: Estimated glomerular filtration rate (eGFR), albuminuria and serum uric acid (SUA) are markers of kidney function that have been associated with cognitive ability. However, whether these associations are causal is unclear.

Methods: We performed one-sample Mendelian randomization (MR) to estimate the effects of kidney function markers on cognitive performance using data from the UK Biobank. Polygenic scores for SUA, urine albumin to creatinine ratio (ACR), estimated glomerular filtration rate based on serum creatinine (eGFRcre) and serum cystatin C (eGFRcys) were used as instrumental variables, and cognitive function outcomes included tests of verbal-numeric reasoning, reaction time, visual memory, and numeric memory.

Results: We found no evidence of a causal effect of genetically determined SUA, eGFRcre or eGFRcys on cognitive function outcomes. There was no association between a polygenic score for ACR and verbal-numeric reasoning or numeric memory. However, there was suggestive evidence of a relationship between genetically increased ACR and slower reaction time and worse visual memory. ACR was no longer significantly associated with visual memory in analyses using an unweighted polygenic score and in analyses stratified by sex and age category. Pleiotropy adjusted estimates were directionally consistent with those of the principal analysis but overlapped with the null.

Conclusions: This MR study does not support causal effects of SUA, eGFRcre or eGFRcys on cognitive performance. Genetically increased ACR was associated with slower processing speed and visual memory, but results need confirmation in independent samples.
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http://dx.doi.org/10.1016/j.jns.2021.118071DOI Listing
September 2021

Markers of Kidney Function and Longitudinal Cognitive Ability Among Older Community-Dwelling Adults: The Rancho Bernardo Study.

J Alzheimers Dis 2021 ;83(1):319-331

Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA.

Background: Reduced kidney function has been associated with cognitive decline. Most studies have examined a single marker of kidney function and have limited duration of follow-up.

Objective: This study evaluated associations between markers of kidney function (urine albumin, estimated glomerular filtration rate [eGFR], and hyperuricemia) with cognitive performance over time.

Methods: This is a longitudinal study of 1,634 community-dwelling adults (mean age = 71.7 years), with kidney function markers and cognitive ability measured at baseline (1992-1996) and at up to five additional time points with a maximum of 23.4 years (mean = 8.1 years) of follow-up. Associations between kidney function and cognitive performance were assessed using linear mixed effects models. Testing for interaction by sex was conducted.

Results: Albuminuria (urine albumin-to-creatinine ratio [ACR]≥30 mg/g) was associated with steeper annual declines in global cognitive function (MMSE, β= -0.12, p = 0.003), executive function (Trails B, β= 4.50, p < 0.0001) and episodic memory (Buschke total recall, β= -0.62, p = 0.02) scores in men. Results were similar when cognitive test scores were regressed on latent trajectory classes of ACR. In men, hyperuricemia (serum uric acid [SUA]≥6.8 mg/dl for men and SUA≥6.0 mg/dl for women) was associated with lower baseline MMSE (β= -0.70, p = 0.009) scores but not with MMSE change over time. No such associations were detected in women. There were no significant associations between eGFR and cognitive performance for either sex.

Conclusion: In older men, albuminuria is an independent predictor of subsequent cognitive decline. More investigations are needed to explain the observed sex differences and the potential relationship between hyperuricemia and poorer global cognition.
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http://dx.doi.org/10.3233/JAD-201605DOI Listing
January 2021

Municipal police support for harm reduction services in officer-led referrals of people who inject drugs in Tijuana, Mexico.

Harm Reduct J 2021 07 26;18(1):76. Epub 2021 Jul 26.

Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA.

Background: Police constitute a structural determinant of health and HIV risk of people who inject drugs (PWID), and negative encounters with law enforcement present significant barriers to PWID access to harm reduction services. Conversely, police may facilitate access via officer-led referrals, potentiating prevention of HIV, overdose, and drug-related harms. We aimed to identify police characteristics associated with support for officer-led referrals to addiction treatment services and syringe service programs (SSP). We hypothesized that officers who believe harm reduction services are contradictory to policing priorities in terms of safety and crime reduction will be less likely to support police referrals.

Methods: Between January and June 2018, police officers (n = 305) in Tijuana, Mexico, completed self-administered surveys about referrals to harm reduction services during the 24-month follow-up visit as part of the SHIELD police training and longitudinal cohort study. Log-binomial regression was used to estimate adjusted prevalence ratios and model policing characteristics and attitudes related to officers' support for including addiction treatment and SSP in referrals.

Results: Respondents were primarily male (89%), patrol officers (86%) with a median age of 38 years (IQR 33-43). Overall, 89% endorsed referral to addiction services, whereas 53% endorsed SSP as acceptable targets of referrals. Officers endorsing addiction services were less likely to be assigned to high drug use districts (adjusted prevalence ratio [APR] = 0.50, 95% CI 0.24, 1.08) and more likely to agree that methadone programs reduce crime (APR = 4.66, 95% CI 2.05, 9.18) than officers who did not support addiction services. Officers endorsing SSPs were younger (adjusted prevalence ratio [APR] = 0.96 95% CI 0.93, 0.98), less likely to be assigned to high drug use districts (APR = 0.50, 95% CI 0.29, 0.87), more likely to believe that methadone programs reduce crime (APR = 2.43, 95% CI 1.30, 4.55), and less likely to believe that SSPs increase risk of needlestick injury for police (APR = 0.44, 0.27, 0.71).

Conclusions: Beliefs related to the occupational impact of harm reduction services in terms of officer safety and crime reduction are associated with support for referral to related harm reduction services. Efforts to deflect PWID from carceral systems toward harm reduction by frontline police should include measures to improve officer knowledge and attitudes about harm reduction services as they relate to occupational safety and law enforcement priorities.

Trial Registration: NCT02444403.
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http://dx.doi.org/10.1186/s12954-021-00513-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313001PMC
July 2021

Nucleic Acid-based Testing for Noninfluenza Viral Pathogens in Adults with Suspected Community-acquired Pneumonia. An Official American Thoracic Society Clinical Practice Guideline.

Am J Respir Crit Care Med 2021 05;203(9):1070-1087

This document provides evidence-based clinical practice guidelines on the diagnostic utility of nucleic acid-based testing of respiratory samples for viral pathogens other than influenza in adults with suspected community-acquired pneumonia (CAP). A multidisciplinary panel developed a Population-Intervention-Comparison-Outcome question, conducted a pragmatic systematic review, and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. The panel evaluated the literature to develop recommendations regarding whether routine diagnostics should include nucleic acid-based testing of respiratory samples for viral pathogens other than influenza in suspected CAP. The evidence addressing this topic was generally adjudicated to be of very low quality because of risk of bias and imprecision. Furthermore, there was little direct evidence supporting a role for routine nucleic acid-based testing of respiratory samples in improving critical outcomes such as overall survival or antibiotic use patterns. However, on the basis of direct and indirect evidence, recommendations were made for both outpatient and hospitalized patients with suspected CAP. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was not addressed in the literature at the time of the evidence review. The panel formulated and provided their rationale for recommendations on nucleic acid-based diagnostics for viral pathogens other than influenza for patients with suspected CAP.
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http://dx.doi.org/10.1164/rccm.202102-0498STDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8314899PMC
May 2021

Community transmission of multidrug-resistant tuberculosis is associated with activity space overlap in Lima, Peru.

BMC Infect Dis 2021 Mar 18;21(1):275. Epub 2021 Mar 18.

Universidad Peruana Cayetano Heredia, Lima, Peru.

Background: Transmission of multidrug-resistant tuberculosis (MDRTB) requires spatial proximity between infectious cases and susceptible persons. We assess activity space overlap among MDRTB cases and community controls to identify potential areas of transmission.

Methods: We enrolled 35 MDRTB cases and 64 TB-free community controls in Lima, Peru. Cases were whole genome sequenced and strain clustering was used as a proxy for transmission. GPS data were gathered from participants over seven days. Kernel density estimation methods were used to construct activity spaces from GPS locations and the utilization distribution overlap index (UDOI) was used to quantify activity space overlap.

Results: Activity spaces of controls (median = 35.6 km, IQR = 25.1-54) were larger than cases (median = 21.3 km, IQR = 17.9-48.6) (P = 0.02). Activity space overlap was greatest among genetically clustered cases (mean UDOI = 0.63, sd = 0.67) and lowest between cases and controls (mean UDOI = 0.13, sd = 0.28). UDOI was positively associated with genetic similarity of MDRTB strains between case pairs (P < 0.001). The odds of two cases being genetically clustered increased by 22% per 0.10 increase in UDOI (OR = 1.22, CI = 1.09-1.36, P < 0.001).

Conclusions: Activity space overlap is associated with MDRTB clustering. MDRTB transmission may be occurring in small, overlapping activity spaces in community settings. GPS studies may be useful in identifying new areas of MDRTB transmission.
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http://dx.doi.org/10.1186/s12879-021-05953-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977184PMC
March 2021

Informing Healthcare Decisions with Observational Research Assessing Causal Effect. An Official American Thoracic Society Research Statement.

Am J Respir Crit Care Med 2021 01;203(1):14-23

Decisions in medicine are made on the basis of knowledge and reasoning, often in shared conversations with patients and families in consideration of clinical practice guideline recommendations, individual preferences, and individual goals. Observational studies can provide valuable knowledge to inform guidelines, decisions, and policy. The American Thoracic Society (ATS) created a multidisciplinary committee to develop a research statement to clarify the role of observational studies-alongside randomized controlled trials (RCTs)-in informing clinical decisions in pulmonary, critical care, and sleep medicine. The committee examined the strengths of observational studies assessing causal effects, how they complement RCTs, factors that impact observational study quality, perceptions of observational research, and, finally, the practicalities of incorporating observational research into ATS clinical practice guidelines. There are strengths and weakness of observational studies as well as RCTs. Observational studies can provide evidence in representative and diverse patient populations. Quality observational studies should be sought in the development of ATS clinical practice guidelines, and medical decision-making in general, when ) no RCTs are identified or RCTs are appraised as being of low- or very low-quality (); ) RCTs are of moderate quality because of indirectness, imprecision, or inconsistency, and observational studies mitigate the reason that RCT evidence was downgraded (); or ) RCTs do not provide evidence for outcomes that a guideline committee considers essential for decision-making (e.g., rare or long-term outcomes; "). Observational studies should be considered in developing clinical practice guidelines and in making clinical decisions.
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http://dx.doi.org/10.1164/rccm.202010-3943STDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781125PMC
January 2021

Effects of Unfiltered Cigarettes on Smoking Behavior and Toxicant Exposure: Protocol for a Randomized Crossover Clinical Trial.

JMIR Res Protoc 2020 Dec 8;9(12):e19603. Epub 2020 Dec 8.

Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, United States.

Background: Plastic filters on cigarette butts are a widespread source of nonbiodegradable, toxic environmental waste. State and local legislation to ban the sale of single-use cigarettes may be considered to prevent this waste, but scientific evidence on the impact of switching smokers to unfiltered cigarettes on smoking behavior and toxicant exposures is needed to inform this policy. We have designed an open-label, randomized, 9-week, crossover clinical trial of adult filtered-cigarette smokers who switch to unfiltered cigarettes.

Objective: Our objective is to understand the impact of switching smokers of filtered cigarettes to unfiltered cigarettes on smoking behavior and toxic exposures.

Methods: This trial involves a 1-week baseline period; a 2-week period of smoking filtered or unfiltered cigarettes, where groups are randomly assigned; a 3-week washout period; another 1-week baseline period; and a 2-week crossover period of smoking the opposite condition (ie, filtered or unfiltered cigarettes) for a sufficient sample size of 40 participants. We will determine changes in (1) observed topography (ie, puff count, interpuff interval, and puff volume) and cigarettes smoked per day, via butt counts and self-report, (2) expired carbon monoxide and excretion of urinary cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, and volatile organic compounds, and (3) participants' knowledge and attitudes toward unfiltered cigarettes, satisfaction with smoking, and intention to quit if they were not able to smoke filtered cigarettes.

Results: This study was funded in June 2018 and approved by the relevant Institutional Review Boards in July 2018. This study has enrolled 37 participants as of October 2020. Data analysis is currently underway, and trial results are expected to be published in spring 2021.

Conclusions: This pilot proof-of-principle study will inform the design of a larger, future research project that can provide robust scientific evidence on our research question. Such a large study could inform possible state or local legislation to ban the sale of single-use filtered cigarettes in order to mitigate the environmental impact of discarded single-use plastic filters.

Trial Registration: ClinicalTrials.gov NCT03749876; https://clinicaltrials.gov/ct2/show/NCT03749876.

International Registered Report Identifier (irrid): DERR1-10.2196/19603.
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http://dx.doi.org/10.2196/19603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755531PMC
December 2020

Twitter Communication During an Outbreak of Hepatitis A in San Diego, 2016-2018.

Am J Public Health 2020 10;110(S3):S348-S355

Eyal Oren, Purva Jain, Taufa Ahmed, and Intan Purnajo are with the Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA. Lourdes Martinez and R. Eliza Hensley are with the School of Communication, San Diego State University. Atsushi Nara and Ming-Hsiang Tsou are with the Department of Geography, San Diego State University.

To examine how and what information is communicated via social media during an infectious disease outbreak. In the context of the 2016 through 2018 hepatitis A outbreak in San Diego County, California, we used a grounded theory-based thematic analysis that employed qualitative and quantitative approaches to uncover themes in a sample of public tweets (n = 744) from Twitter, a primary platform used by key stakeholders to communicate to the public during the outbreak. Tweets contained both general and hepatitis A-specific information related to the outbreak, restatements of policy and comments critical of government responses to the outbreak, information with the potential to shape risk perceptions, and expressions of concern regarding individuals experiencing homelessness and their role in spreading hepatitis A. We also identified misinformation and common channels of content driving themes that emerged in our sample. Public health professionals may identify real-time public risk perceptions and concerns via social media during an outbreak and target responses that fulfill the informational needs of those who seek direction and reassurance during times of uncertainty.
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http://dx.doi.org/10.2105/AJPH.2020.305900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532315PMC
October 2020

Stress and asthma: Physiological manifestations and clinical implications.

Ann Allergy Asthma Immunol 2020 10 24;125(4):372-373.e1. Epub 2020 Jul 24.

Asthma and Airway Disease Research Center, College of Medicine, University of Arizona Health Sciences, Tucson, Arizona.

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http://dx.doi.org/10.1016/j.anai.2020.07.022DOI Listing
October 2020

"Nobody Is Talking About It": Diné (Navajo) Communities Speak About Stomach Cancer and Helicobacter pylori Infections.

J Cancer Educ 2020 Jul 22. Epub 2020 Jul 22.

Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA.

Stomach cancer is the third leading cause of cancer death globally. Helicobacter pylori plays a role in the healthy human gut, but is also associated with multiple chronic diseases, including stomach cancer. Though H. pylori prevalence is declining in parts of the world, it remains high among certain populations. In Arizona, stomach cancer rates are 3-4 times higher among the Navajo Nation population as compared with the non-Hispanic white population. This pilot project assessed adult Diné (Navajo) individuals' understanding and awareness regarding H. pylori infection and stomach cancer. Focus groups were held in three Diné communities. Data were analyzed thematically using a multi-investigator consensus approach. Participants had limited knowledge of H. pylori infection and stomach cancer and perceived local medical providers as also having limited knowledge on these conditions. Participants described poor health care experiences, structural inequalities, and environmental concerns and associated these with H. pylori infection and stomach cancer. This study highlights the need for additional research and education on current knowledge and perceptions of stomach cancer and H. pylori infections in Navajo Nation.
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http://dx.doi.org/10.1007/s13187-020-01831-0DOI Listing
July 2020

Prevalence and correlates of obstructive lung disease among people who inject drugs, San Diego, California.

Drug Alcohol Depend 2020 09 2;214:108158. Epub 2020 Jul 2.

University of California San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, United States. Electronic address:

Background: Pulmonary tissue damage leading to obstructive lung disease (OLD) could result from intravenous administration of insoluble particles found in illicit drugs. This study described the prevalence and identified correlates of OLD among people who inject drugs (PWID).

Methods: In 2012-2016, a community-based cohort of PWID who had injected within the past month were enrolled in a study to assess HIV, hepatitis C virus (HCV) andMycobacterium tuberculosis (Mtb) infections and their related risk factors. Data were obtained through face-to-face interviews, serological testing and spirometry. Baseline data were used for a cross-sectional analysis of the prevalence and correlates of OLD, defined as FEV1/FVC < 0.7. Univariate and multivariable logistic regression were used to identify factors associated with OLD.

Results: Among 516 participants who had complete spirometry and interview results, the mean age was 43.3 years, 73.6 % were male, 9.5 % were Black, 91.1 % smoked cigarettes and 18.2 % had OLD. Few (9.6 %) PWID with OLD reported a previous diagnosis of COPD although many (44.7 %) reported related symptoms. Black race (AOR = 2.66, 95 %CI: 1.37, 5.17), pack-years smoked (AOR = 1.06/5 years, 95 %CI: 1.01, 1.12), and duration of injection drug use (AOR = 1.13, 95 %CI: 1.01, 1.27) were independently associated with OLD after controlling for age.

Conclusions: The prevalence of OLD was high in this cohort and associated with Black race and cigarette smoking-known risk factors. In addition, OLD prevalence increased with greater duration of injection drug use, suggesting a link between cumulative exposure to injected insoluble particles and OLD. Further examination of these adulterants and lung pathology are needed.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7331511PMC
September 2020

Comparison of three anti-coccidioides antibody enzyme immunoassay kits for the diagnosis of coccidioidomycosis.

Med Mycol 2020 Aug;58(6):774-778

Department of Medicine, The University of Arizona College of Medicine, Tucson, Arizona USA.

Coccidioidomycosis is a common cause of community-acquired pneumonia in endemic areas of the southwestern United States. Clinical presentations range from self-limited disease to severe, disseminated disease. As such, early and accurate diagnosis is essential to ensure appropriate treatment and monitoring. Currently available diagnostic testing has variable accuracy, particularly in certain patient populations, and new tests may offer improved accuracy for the diagnosis of coccidioidomycosis. Serum samples from patients with coccidioidomycosis and controls were tested for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies using the MVista Coccidioides antibody detection EIA and two commonly used commercial enzyme immunoassay (EIA) kits: the IMMY Omega EIA and the Meridian Premier EIA. The sensitivity of the IgG antibody detection was 87.4% using the MVista test compared to 46.6% for IMMY and 70.9% for Meridian. The sensitivity for IgM antibody detection was 61.2% for the MVista test, 22.3% for IMMY and 29.1% for Meridian. For IgG antibody detection, specificity was 90% for the MVista EIA, 94.6% for IMMY, 96.4% for Meridian. For IgM antibody detection, specificity was 95.3% for the MVista test 98.2% for IMMY and 99.1% for Meridian. The MVista Coccidioides antibody EIA offers improved sensitivity, including among high-risk patient populations, for the detection of IgG and IgM antibodies in comparison to other currently available EIAs.
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http://dx.doi.org/10.1093/mmy/myz125DOI Listing
August 2020

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Nature 2019 10 16;574(7778):353-358. Epub 2019 Oct 16.

School of Health Sciences, Madda Walabu University, Bale Goba, Ethiopia.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
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http://dx.doi.org/10.1038/s41586-019-1545-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800389PMC
October 2019

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study.

JAMA Oncol 2019 12;5(12):1749-1768

Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.

Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning.

Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence.

Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs).

Conclusions And Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.
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http://dx.doi.org/10.1001/jamaoncol.2019.2996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777271PMC
December 2019

Ethnic Disparities in Gastric Cancer Presentation and Screening Practice in the United States: Analysis of 1997-2010 Surveillance, Epidemiology, and End Results-Medicare Data.

Cancer Epidemiol Biomarkers Prev 2019 04 26;28(4):659-665. Epub 2019 Mar 26.

Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona.

Background: Chronic infection with () is the strongest risk factor for distal gastric cancer. Although gastric cancer incidence has decreased, variation by race and ethnicity is observed. This study describes gastric cancer presentation and screening services among Medicare patients by race/ethnicity, place of birth, and history of gastric cancer-related conditions.

Methods: Using demographic, location, and disease staging information, extracted from the Surveillance, Epidemiology and End Results-Medicare gastric cancer database (1997-2010), we compared frequencies of gastric cancer-related conditions (e.g., peptic ulcer, gastric ulcer, gastritis) and screening ( testing and endoscopy) from inpatient and outpatient services claims by selected race/ethnicity and place of birth.

Results: Data included 47,994 incident gastric cancer cases with Medicare claims. The majority (48.0%) of Asian/Pacific Islanders (API) were foreign-born, compared with non-Hispanic whites (NHW), Hispanics, and blacks (with 64.4%, 33.9%, and 72.9% U.S.-born, respectively). For NHWs, the most frequently diagnosed gastric cancer site was the cardia (35.6%) compared with <15% ( < 0.001) for APIs, Hispanics, and blacks. Although more than 57% of all cases had a history of gastric cancer-related conditions, testing was reported in only 11.6% of those cases. testing was highest for APIs (22.8%) and lowest for blacks (6.5%).

Conclusions: Noncardia gastric cancer, associated with infection, was diagnosed more frequently among APIs, blacks, and Hispanics than NHWs. Testing for was low among all gastric cancer cases despite evidence of risk factors for which screening is recommended. Studies are needed to increase appropriate testing for among higher risk populations.

Impact: This study sheds light on poor screening practices despite presence of gastric cancer-related conditions.
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http://dx.doi.org/10.1158/1055-9965.EPI-18-0471DOI Listing
April 2019

Understanding Social and Cultural Contexts of Alcohol Misuse in Mexican-Origin Hispanic Men.

Health Educ Behav 2019 08 12;46(4):648-655. Epub 2019 Feb 12.

1 University of Arizona, Tucson, AZ, USA.

Evidence suggests that Hispanic and non-Hispanic White men (NHW) have comparable prevalence rates of alcohol use. However, Hispanic men consistently have higher prevalence rates of alcohol misuse compared with NHW men. Consequently, Hispanic men experience disproportionate levels of adverse health consequences of alcohol misuse when compared with NHW men. The aim of this study was to explore Hispanic male perspectives and opinions regarding alcohol use patterns that may lead to disparate rates of alcohol misuse in Hispanic males. Demographic data were collected with questionnaires. Twenty semistructured one-on-one interviews were completed in English and Spanish with Mexican-origin Hispanic men (age: 44.6 ± 11.3 years). A thematic analysis was conducted using a hybrid deductive-inductive strategy with an a priori codebook supplemented with iterative analysis of transcripts. Results suggest that alcohol misuse patterns in Hispanic males are influenced by an interaction between alcohol-related social norms and learned expressions of masculinity; a lack of knowledge of the alcohol-related health risks that further perpetuate the normalization of alcohol misuse; and expressions of masculinity and adaptive coping that lead to alcohol misuse as an escape from life stressors. Given the rapid expansion of the Hispanic population in the United States, and the disparate consequences of alcohol misuse in this population, it is imperative to consider the complex and often compounded impact of sociocultural norms and the social context on misuse-related behaviors. Viable prevention and treatment strategies should be addressed thought multicomponent, community-level strategies that more comprehensively address the complexities of alcohol misuse in this population.
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http://dx.doi.org/10.1177/1090198119826212DOI Listing
August 2019

Home Oxygen Therapy for Children. An Official American Thoracic Society Clinical Practice Guideline.

Am J Respir Crit Care Med 2019 02;199(3):e5-e23

Background: Home oxygen therapy is often required in children with chronic respiratory conditions. This document provides an evidence-based clinical practice guideline on the implementation, monitoring, and discontinuation of home oxygen therapy for the pediatric population.

Methods: A multidisciplinary panel identified pertinent questions regarding home oxygen therapy in children, conducted systematic reviews of the relevant literature, and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach to rate the quality of evidence and strength of clinical recommendations.

Results: After considering the panel's confidence in the estimated effects, the balance of desirable (benefits) and undesirable (harms and burdens) consequences of treatment, patient values and preferences, cost, and feasibility, recommendations were developed for or against home oxygen therapy specific to pediatric lung and pulmonary vascular diseases.

Conclusions: Although home oxygen therapy is commonly required in the care of children, there is a striking lack of empirical evidence regarding implementation, monitoring, and discontinuation of supplemental oxygen therapy. The panel formulated and provided the rationale for clinical recommendations for home oxygen therapy based on scant empirical evidence, expert opinion, and clinical experience to aid clinicians in the management of these complex pediatric patients and identified important areas for future research.
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http://dx.doi.org/10.1164/rccm.201812-2276STDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802853PMC
February 2019

Emerging Evidence for Infectious Causes of Cancer in the United States.

Epidemiol Rev 2019 01;41(1):82-96

Department of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California.

Worldwide, infectious agents currently contribute to an estimated 15% of new cancer cases. Most of these (92%, or 2 million new cancer cases) are attributable to 4 infectious agents: Helicobacter pylori, human papillomavirus, and hepatitis B and C viruses. A better understanding of how infectious agents relate to the US cancer burden may assist new diagnostic and treatment efforts. We review US-specific crude mortality rates from infection-associated cancers and describe temporal and spatial trends since 1999. We review the US-specific evidence for infection-cancer associations by reporting available estimates for attributable fractions for the infection-cancer associations. Death due to cancers with established infectious associations varies geographically, but estimates for the US attributable fraction are limited to a few observational studies. To describe the burden of infection-associated cancer in the United States, additional observational studies are necessary to estimate the prevalence of infection nationally and within subpopulations. As infectious associations emerge to explain cancer etiologies, new opportunities and challenges to reducing the burden arise. Improved estimates for the United States would help target interventions to higher-risk subpopulations.
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http://dx.doi.org/10.1093/epirev/mxz003DOI Listing
January 2019

Race/Ethnicity-, Socioeconomic Status-, and Anatomic Subsite-Specific Risks for Gastric Cancer.

Gastroenterology 2019 01 26;156(1):59-62.e4. Epub 2018 Sep 26.

Moores Cancer Center, UC San Diego, La Jolla, California; Department of Family Medicine and Public Health, UC San Diego, La Jolla, California.

Anatomic subsite risk factors for gastric cancer differ substantially, and subsite-specific distribution of risk factors (such as Helicobacter pylori) can vary by race and ethnicity and neighborhood socioeconomic status (nSES). We examined differences in gastric cancer incidence by subsite, stratified by race and ethnicity and nSES, using Surveillance Epidemiology and End Results Program 2000-2014 data for 77,881 incident gastric cancer cases (cardia, n = 23,651; non-cardia, n = 35,825; overlapping or unspecified, n = 18,405). Compared with non-Hispanic whites, cardia cancer multivariable-adjusted incidence rate ratios were 35%-47% lower for blacks, Hispanics, Asian or Pacific Islanders, and American Indian or Alaska Natives; conversely, non-cardia incidence rate ratios were 1.7- to 3.9-fold higher for blacks, Hispanics, Asian or Pacific Islanders, and American Indian or Alaska Natives. Higher adjusted incidence rate ratios with decreasing nSES (lowest vs highest nSES quintile) were observed for all gastric (1.3-fold) and non-cardia (1.3-fold) cancers but were borderline significant for cardia cancers (1.1-fold). In conclusion, non-cardia cancer incidence is higher in minorities and varies by nSES, but cardia cancer incidence is higher in non-Hispanic whites and does not vary substantially by nSES. Clarifying reasons for higher cardia risk in non-Hispanic whites and targeted interventions to address non-cardia cancer risk in minorities could lessen the burden of gastric cancer.
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http://dx.doi.org/10.1053/j.gastro.2018.09.045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309455PMC
January 2019

A Case-Control Study to Identify Community Venues Associated with Genetically-clustered, Multidrug-resistant Tuberculosis Disease in Lima, Peru.

Clin Infect Dis 2019 04;68(9):1547-1555

London School of Hygiene and Tropical Medicine, United Kingdom.

Background: The majority of tuberculosis transmission occurs in community settings. Our primary aim in this study was to assess the association between exposure to community venues and multidrug-resistant (MDR) tuberculosis. Our secondary aim was to describe the social networks of MDR tuberculosis cases and controls.

Methods: We recruited laboratory-confirmed MDR tuberculosis cases and community controls that were matched on age and sex. Whole-genome sequencing was used to identify genetically clustered cases. Venue tracing interviews (nonblinded) were conducted to enumerate community venues frequented by participants. Logistic regression was used to assess the association between MDR tuberculosis and person-time spent in community venues. A location-based social network was constructed, with respondents connected if they reported frequenting the same venue, and an exponential random graph model (ERGM) was fitted to model the network.

Results: We enrolled 59 cases and 65 controls. Participants reported 729 unique venues. The mean number of venues reported was similar in both groups (P = .92). Person-time in healthcare venues (adjusted odds ratio [aOR] = 1.67, P = .01), schools (aOR = 1.53, P < .01), and transportation venues (aOR = 1.25, P = .03) was associated with MDR tuberculosis. Healthcare venues, markets, cinemas, and transportation venues were commonly shared among clustered cases. The ERGM indicated significant community segregation between cases and controls. Case networks were more densely connected.

Conclusions: Exposure to healthcare venues, schools, and transportation venues was associated with MDR tuberculosis. Intervention across the segregated network of case venues may be necessary to effectively stem transmission.
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http://dx.doi.org/10.1093/cid/ciy746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181380PMC
April 2019

Adherence to Nutrition and Physical Activity Cancer Prevention Guidelines and Development of Colorectal Adenoma.

Nutrients 2018 Aug 16;10(8). Epub 2018 Aug 16.

Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA.

Adherence to the American Cancer Society's (ACS) Nutrition and Physical Activity Cancer Prevention Guidelines is associated with reductions in overall cancer incidence and mortality, including site-specific cancers such as colorectal cancer. We examined the relationship between baseline adherence to the ACS guidelines and (1) baseline adenoma characteristics and (2) odds of recurrent colorectal adenomas over 3 years of follow-up. Cross-sectional and prospective analyses with a pooled sample of participants from the Wheat Bran Fiber ( = 503) and Ursodeoxycholic Acid ( = 854) trials were performed. A cumulative adherence score was constructed using baseline self-reported data regarding body size, diet, physical activity and alcohol consumption. Multivariable logistic regression demonstrated significantly reduced odds of having three or more adenomas at baseline for moderately adherent (odds ratio [OR] = 0.67, 95% confidence intervals [CI]: 0.46⁻0.99) and highly adherent (OR = 0.50, 95% CI: 0.31⁻0.81) participants compared to low adherers (-trend = 0.005). Conversely, guideline adherence was not associated with development of recurrent colorectal adenoma (moderate adherence OR = 1.16, 95% CI: 0.85⁻1.59, high adherence OR = 1.23, 95% CI: 0.85⁻1.79).
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http://dx.doi.org/10.3390/nu10081098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6115749PMC
August 2018

Exploring Structural, Sociocultural, and Individual Barriers to Alcohol Abuse Treatment Among Hispanic Men.

Am J Mens Health 2018 11 27;12(6):1948-1957. Epub 2018 Jul 27.

1 Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, USA.

Hispanic men have poor access to alcohol abuse treatment, low treatment engagement, and low treatment completion rates despite the contrasting burden of alcohol-related consequences they face. The purpose of this study was to examine Hispanic male perspectives regarding alcohol abuse treatment-seeking behaviors and the structural, sociocultural, and individual factors that may influence initiation and continued engagement in treatment in this population. Individual interviews were conducted with a sample of 20 Hispanic men (age: 44.6 ± 11.3 years). Thematic analysis was completed using a hybrid deductive-inductive approach centered in an a priori codebook that was further supplemented with iterative exploration of transcripts. Results suggested treatment-seeking behaviors were highly influenced by (a) structural factors related to poor treatment access, as well as lack of linguistic- and cultural-responsiveness of available treatment; (b) sociocultural factors related to difficulties problematizing alcohol abuse due to lack of community awareness, societal normalization of consumption, and stigmatization of alcohol abuse treatment; and (c) individual factors related to lack of individual knowledge. This work highlights the perceived lack of congruency between available treatment and the linguistic, cultural, and gender norms of Hispanic men. There is need for responsive treatment strategies that comprehensively consider the gendered- and sociocultural-factors that govern treatment seeking and engagement behaviors. Findings also suggest a need for targeted alcohol abuse awareness building efforts in the Hispanic community. Specifically, the detrimental effects of alcohol-related problems and potential benefits of treatment should be addressed in order to diminish social stigma of abuse and of treatment.
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http://dx.doi.org/10.1177/1557988318790882DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199428PMC
November 2018

Symptom screening for active tuberculosis in pregnant women living with HIV.

Cochrane Database Syst Rev 2018 24;2018(1). Epub 2018 Jan 24.

Department of Medicine, Division of Infectious Diseases, Center for Global Health, Weill Cornell Medical College, New York, USA.

This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To assess the accuracy of the four-symptom screen (cough, fever, night sweats, or weight loss) for identifying active TB in pregnant PLHIV who are screened in an outpatient or community setting. To investigate potential sources of heterogeneity of the accuracy of the four-symptom screen between studies including: ART status, CD4 cell count, gestational age, pregnancy stage (pregnancy vs. postpartum), screening test definition of cough (any cough vs. cough greater than 2 weeks).To describe the accuracy of single symptoms included within the four-symptom screen, additioal symptoms or symptom combinations, for identifying active TB in pregnant PLHIV. For example, additional symptoms may include failure to gain weight or fatigue.
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http://dx.doi.org/10.1002/14651858.CD012934DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5997280PMC
July 2019

Scalable and accurate deep learning with electronic health records.

NPJ Digit Med 2018 8;1:18. Epub 2018 May 8.

4Stanford University, Stanford, CA USA.

Predictive modeling with electronic health record (EHR) data is anticipated to drive personalized medicine and improve healthcare quality. Constructing predictive statistical models typically requires extraction of curated predictor variables from normalized EHR data, a labor-intensive process that discards the vast majority of information in each patient's record. We propose a representation of patients' entire raw EHR records based on the Fast Healthcare Interoperability Resources (FHIR) format. We demonstrate that deep learning methods using this representation are capable of accurately predicting multiple medical events from multiple centers without site-specific data harmonization. We validated our approach using de-identified EHR data from two US academic medical centers with 216,221 adult patients hospitalized for at least 24 h. In the sequential format we propose, this volume of EHR data unrolled into a total of 46,864,534,945 data points, including clinical notes. Deep learning models achieved high accuracy for tasks such as predicting: in-hospital mortality (area under the receiver operator curve [AUROC] across sites 0.93-0.94), 30-day unplanned readmission (AUROC 0.75-0.76), prolonged length of stay (AUROC 0.85-0.86), and all of a patient's final discharge diagnoses (frequency-weighted AUROC 0.90). These models outperformed traditional, clinically-used predictive models in all cases. We believe that this approach can be used to create accurate and scalable predictions for a variety of clinical scenarios. In a case study of a particular prediction, we demonstrate that neural networks can be used to identify relevant information from the patient's chart.
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http://dx.doi.org/10.1038/s41746-018-0029-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6550175PMC
May 2018

The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States.

JAMA 2018 04;319(14):1444-1472

Division of Epidemiology & Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, California.

Introduction: Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state.

Objective: To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016.

Design And Setting: A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year.

Main Outcomes And Measures: Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed.

Results: Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95% UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95% UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% (95% UI, 42.8% to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5% of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states).

Conclusions And Relevance: There are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.
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http://dx.doi.org/10.1001/jama.2018.0158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933332PMC
April 2018

Respiratory syncytial virus tracking using internet search engine data.

BMC Public Health 2018 04 3;18(1):445. Epub 2018 Apr 3.

Microsoft Research, Herzeliya, Israel.

Background: Respiratory Syncytial Virus (RSV) is the leading cause of hospitalization in children less than 1 year of age in the United States. Internet search engine queries may provide high resolution temporal and spatial data to estimate and predict disease activity.

Methods: After filtering an initial list of 613 symptoms using high-resolution Bing search logs, we used Google Trends data between 2004 and 2016 for a smaller list of 50 terms to build predictive models of RSV incidence for five states where long-term surveillance data was available. We then used domain adaptation to model RSV incidence for the 45 remaining US states.

Results: Surveillance data sources (hospitalization and laboratory reports) were highly correlated, as were laboratory reports with search engine data. The four terms which were most often statistically significantly correlated as time series with the surveillance data in the five state models were RSV, flu, pneumonia, and bronchiolitis. Using our models, we tracked the spread of RSV by observing the time of peak use of the search term in different states. In general, the RSV peak moved from south-east (Florida) to the north-west US.

Conclusions: Our study represents the first time that RSV has been tracked using Internet data results and highlights successful use of search filters and domain adaptation techniques, using data at multiple resolutions. Our approach may assist in identifying spread of both local and more widespread RSV transmission and may be applicable to other seasonal conditions where comprehensive epidemiological data is difficult to collect or obtain.
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http://dx.doi.org/10.1186/s12889-018-5367-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883276PMC
April 2018

Mortality estimates among adult patients with severe acute respiratory infections from two sentinel hospitals in southern Arizona, United States, 2010-2014.

BMC Infect Dis 2018 02 12;18(1):78. Epub 2018 Feb 12.

Arizona Department of Health Services, Border Infectious Disease Surveillance Program, 400 West Congress, Suite 116, Tucson, AZ, 85701, USA.

Background: From October 2010 through February 2016, Arizona conducted surveillance for severe acute respiratory infections (SARI) among adults hospitalized in the Arizona-Mexico border region. There are few accurate mortality estimates in SARI patients, particularly in adults ≥ 65 years old. The purpose of this study was to generate mortality estimates among SARI patients that include deaths occurring shortly after hospital discharge and identify risk factors for mortality.

Methods: Patients admitted to two sentinel hospitals between 2010 and 2014 who met the SARI case definition were enrolled. Demographic data were used to link SARI patients to Arizona death certificates. Mortality within 30 days after the date of admission was calculated and risk factors were identified using logistic regression models.

Results: Among 258 SARI patients, 47% were females, 51% were white, non-Hispanic and 39% were Hispanic. The median age was 63 years (range, 19 to 97 years) and 80% had one or more pre-existing health condition; 9% died in hospital. Mortality increased to 12% (30/258, 30% increase) when electronic vital records and a 30-day post-hospitalization time frame were used. Being age ≥ 65 years (OR = 4.0; 95% CI: 1.6-9.9) and having an intensive care unit admission (OR = 7.4; 95% CI: 3.0-17.9) were independently associated with mortality.

Conclusion: The use of electronic vital records increased SARI-associated mortality estimates by 30%. These findings may help guide prevention and treatment measures, particularly in high-risk persons in this highly fluid border population.
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http://dx.doi.org/10.1186/s12879-018-2984-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809880PMC
February 2018

Gender and Cultural Adaptations for Diversity: A Systematic Review of Alcohol and Substance Abuse Interventions for Latino Males.

Subst Use Misuse 2018 08 24;53(10):1608-1623. Epub 2018 Jan 24.

a University of Arizona, Mel and Enid Zuckerman College of Public Health , Department of Health Promotion Sciences , Tucson , Arizona , USA.

Background: Latino men are disproportionately affected by the consequences of alcohol and substance abuse when compared to non-Latino white men. Latino men also face greater barriers to accessing, engaging, and completing alcohol and substance abuse treatment services. Culturally adapted interventions are promoted to overcome these barriers. However, the effectiveness of these efforts is unclear.

Objectives: The purpose of this review was to summarize the published evidence regarding gender-adapted and culturally adapted alcohol and substance abuse treatment that aims to improve physical, behavioral, and social outcomes in Latino men.

Methods: A systematic literature search was conducted for articles reporting on culturally and/or gender-adapted alcohol and/or substance abuse interventions designed exclusively for Latino adults, including a Latino population sample of at least 10% and any proportion of Latino male participants. A thematic analysis based on predetermined themes was used to evaluate the nature of adaptations.

Results: Searches yielded 2685 titles, resulting in 12 articles that fit review parameters. The most scientifically rigorous findings suggest culturally adapted interventions may outperform standard treatment. Nevertheless, a fraction of the interventions did not improve outcomes compared to standard treatment. Considering the scarce number of publications, it is difficult to discern if null findings reflect ineffective interventions or methodological limitations.

Conclusions: While studies are limited and findings are mixed, culturally tailored work shows promise. The growth rate of the Latino population and the current epidemic nature of substance abuse in the United States generate urgency to identify methods to diminish the disparate burden of alcohol and substance abuse in Latinos.
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http://dx.doi.org/10.1080/10826084.2017.1417999DOI Listing
August 2018

Population Knowledge, Attitude, and Practice Regarding Transmission and Outcomes: A Literature Review.

Front Public Health 2017 23;5:144. Epub 2017 Jun 23.

Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States.

Background: infection is associated with the development of chronic gastritis, peptic ulcer disease, and gastric cancer. Current clinical recommendations are that test-and-treat should be individualized based on comorbidities and patient preferences among populations at increased risk for certain morbidities. However, knowledge, attitudes and practices regarding among potential patient populations are largely unknown.

Materials: We conducted a literature review to assess knowledge, attitudes, and practices of patients or community populations around transmission, prevention, and associated morbidity.

Results: Nine studies met the inclusion criteria, all published between 1997 and 2014. Eight studies evaluated perception of among at-risk populations, while one study evaluated perception among a general population. The studies suggest inconsistencies between the perceptions of these populations and the established understanding of knowledge, attitude, and preventive practices for among even at-risk populations.

Conclusion: To adequately respond to current test-and-treat recommendations for treatment of , general population education must be implemented, especially among at-risk populations. Further work is needed within at-risk populations in the United States to determine prevalence of and their current knowledge if adequate prevention strategies are to be designed.
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http://dx.doi.org/10.3389/fpubh.2017.00144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481303PMC
June 2017
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