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Aníbal A Teherán,1 Luis M Pombo,1 Vanessa Cadavid,1 María C Mejía,1 Jaime F La Rota,2 Juan C Hernández,3 Norma Montoya,4 Thalia S López31Research Center, Juan N. Corpas University, Bogota, Colombia; 2Toxicology Department, Santa Clara Hospital, Bogota, Colombia; 3Emergency Deparment, Clínica de Occidente, Bogota, Colombia; 4Clinical Laboratory, Clínica de Occidente S.A., Bogota, ColombiaCorrespondence: Vanessa CadavidResearch Center, Juan N. Corpas University, Carerra 111 # 159 A – 61 – Fundación, Bogota, ColombiaTel +57 1 662 2222Email cadavid-vanessa@juanncorpas.edu.coIntroduction: Cocaine and ethanol (EtOH) co-consumption is a risk factor for physiologically and clinically negative outcomes. We describe the occurrence of cocaine consumption alone or co-consumption with EtOH and others psychotropics.Patients and methods: The descriptive research used data on medical records of patients positive to cocaine test who attended an emergency room between 2016 and 2017. We determined the frequency of cocaine consumption alone and co-consumption with EtOH, cannabis or benzodiazepines (BZDs).Results: Over one year period, 88 patients (13.3%) were positive to cocaine test, mainly attended on weekends, in holiday months, young adults or men. Among those positive for cocaine, 72% were also positive for EtOH, cannabis or BZD. Cocaine co-consumption with one or two out of three substance was 55.2% (CI95%; 44.7-65.8%) and 16.4% (CI95%;8.58-24.3%), respectively. Co-consumption was more frecuently wih EtOH, followed by cannabis or BZD.&#x00A0Conclusion: Co-consumption of cocaine with EtOH is very common and could be associated with acute or chronic consumption of cannabis or acute exposure to BZDs. It is important that emergency physicians use a systematic approach to diagnose and treat more than one psychotropic substance in cocaine positive patients.Keywords: cocaine, ethanol, emergency room, cannabis, co-consumption, psychotropic substance

Competing Interests: Declarations of interest None.

Background/objectives: Suicide in the United States (US) adolescents is a major clinical and public health problem. In this original investigation, we explored trends in suicidal behaviors (ideation, planning, and attempts) among US adolescents from 2011 to 2021., Methods: The study sample included 90,306 adolescents from the 2011-2021 Youth Risk Behavior Surveillance System. Descriptive statistics and the chi-squared test were used to assess differences in suicidal behaviors across gender, race/ethnicity, and grade between 2011 and 2021., Results: The overall percentage of female adolescents reporting suicidal behaviors increased significantly between 2011 and 2021, and it was higher than males. In 2021, females exhibited significantly higher rates of considering suicide (30.0% vs. 14.3%), planning (23.6% vs. 11.6%), and attempts (13.3% vs. 6.6%) compared to their male counterparts. Whites were more likely to report suicidal ideation (22.7%) while Black non-Hispanic youth had a higher likelihood of making a suicide plan (17.7%), attempting suicide (14.5%), or making a suicide attempt requiring medical treatment (4.4%) relative to other racial/ethnic groups. Overall, ninth graders were more likely to report suicide attempts (11.6%) compared to 12th graders (8.6%)., Conclusions: The results demonstrate significant increases in suicidal behavior among US adolescents, particularly in females. They suggest the need for gender-sensitive approaches in mental health support and prevention strategies. Overall, given the significant increase in suicidal behaviors, healthcare providers as well as public health professionals should prioritize mental health initiatives, promote awareness, and ensure access to mental health resources for adolescents.

Objectives: Cannabis use disorder (CUD) among pregnant women is increasing, yet limited information exists on admissions for treatment in this population. This study examined trends in CUD admissions among pregnant women in publicly funded U.S. treatment facilities from 2000 to 2021., Methods: Using the Treatment Episode Data Set-Admissions, we analyzed 33,729 admissions of pregnant women with CUD. Descriptive statistics were used to assess patterns by race/ethnicity, age, and co-substance use., Results: CUD admissions increased 2.7-fold, from 2.3 % in 2000 to 6.2 % in 2009, followed by a decrease to 4.3 % in 2014, a peak of 6.7 % in 2018, and a decline to 3.0 % in 2021. In 2021, racial/ethnic disparities were noted, with higher proportions of admissions among White (48.8 %) and Black (32.5 %) non-Hispanic women compared to Hispanic women (9.6 %). Admissions decreased for women aged ≤20 years old (y/o), but increased for women aged ≥30 y/o from 2010 to 2021, with the highest prevalence in those aged 21-29 y/o. Co-substance use, particularly narcotics, stimulants, depressants, and hallucinogens, was prevalent from 2017 to 2021., Conclusions: CUD admissions among pregnant women have fluctuated over two decades, with variations by race/ethnicity and age. These findings highlight the need for tailored interventions and ongoing adaptation of treatment services for pregnant women with CUD., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Background: In the United States (US) and worldwide alcohol is a major contributor to premature mortality and morbidity. We explored US trends in alcohol related mortality from 1999 to 2020 overall and by age, gender, race, and region METHODS: Publicly available US Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) and the underlying cause of death file from CDC WONDER using ICD-10 codes., Results: In 1999, there were 19,356 alcohol-related deaths, a mortality rate of 10.7 per 100,000. By 2020, deaths increased to 48,870 or 21.6 per 100,000. Overall, the mortality rate ratio (MRR) was significantly increased by about 2.0-fold. There were significant increases in all 10-year age groups with the largest 3.8-fold in those 25 to 34. Women experienced a 2.5-fold increase; Asians and Pacific Islanders had the largest increase of 2.4-fold; and the Midwest showed the largest regional increase of 2.5-fold., Conclusions: During the last 20 years there have been significant increases of about 2-fold in US alcohol-related mortality. Clinical challenges are increased by interrelationships of risk factors, especially overweight and obesity, and diabetes, alcohol, overweight and obesity all cause liver damage which may be additive and lead to earlier onset of alcohol related mortality. In addition, health providers should also consider demographic shifts and regional differences. Targeted interventions by health care providers may reduce this increasing US epidemic of alcohol related mortality. These data also generate many hypotheses testable in analytic studies designed a priori to do so., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Marijuana is a widely used substance in the United States (US) and worldwide. We explored trends in self-reported marijuana use among US adolescents overall as well as by gender, race/ethnicity, and school grade., Methods: Biennial data from the Youth Risk Behavior Survey from 2011 to 2021 included 88,183 adolescents in grades 9th through 12th. We used percentage change as a measure of effect and the chi-square test for significance. All analyses were conducted at the national level., Results: The percentage of adolescents who reported current marijuana use dropped significantly from 23.1% in 2011 to 15.8% in 2021 ( p < 0.05). The self-report of trying marijuana for the first time before age 13 also decreased significantly from 8.1% in 2011 to 4.9% in 2021 ( p < 0.05). For current use, there were similar significant decreases by race/ethnicity, with Asian, Hispanic, and White adolescents experiencing the steepest declines. In 2021, the percentage of Black adolescents self-reporting marijuana use was significantly higher (20.5%) compared to White (14.8%), Hispanic (16.7%), and Asian (5.1%) adolescents. Although current marijuana use declined significantly for both girls and boys over time, in 2021 girls were more likely (17.8%) to currently use marijuana than boys (13.6%). In 2011, the opposite was true, with boys (25.9%) being more likely to use marijuana than girls (20.1%)., Conclusions: In US adolescents in 2021, there were decreases in self-reports of marijuana use compared to 2011. Behavioral interventions within school and family environments may be critical in mitigating the risk of marijuana use.

Background: Hospitalization of patients with DKA creates a significant burden on the US healthcare system. While previous studies have identified multiple potential contributors, a comprehensive review of the factors leading to DKA readmissions within the US healthcare system has not been done. This scoping review aims to identify how access to care, treatment adherence, socioeconomic status, race, and ethnicity impact DKA readmission-related patient morbidity and mortality and contribute to the socioeconomic burden on the US healthcare system. Additionally, this study aims to integrate current recommendations to address this multifactorial issue, ultimately reducing the burden at both individual and organizational levels., Methods: The PRISMA-SCR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) was used as a reference checklist throughout this study. The Arksey and O'Malley methodology was used as a framework to guide this review. The framework methodology consisted of five steps: (1) Identify research questions; (2) Search for relevant studies; (3) Selection of studies relevant to the research questions; (4) Chart the data; (5) Collate, summarize, and report the results., Results: A total of 15 articles were retained for analysis. Among the various social factors identified, those related to sex/gender (n = 9) and age (n = 9) exhibited the highest frequency. Moreover, race and ethnicity (n = 8) was another recurrent factor that appeared in half of the studies. Economic factors were also identified in this study, with patient insurance type having the highest frequency (n = 11). Patient income had the second highest frequency (n = 6). Multiple studies identified a link between patients of a specific race/ethnicity and decreased access to treatment. Insufficient patient education around DKA treatment was noted to impact treatment accessibility. Certain recommendations for future directions were highlighted as recurrent themes across included studies and encompassed patient education, early identification of DKA risk factors, and the need for a multidisciplinary approach using community partners such as social workers and dieticians to decrease DKA readmission rates in diabetic patients., Conclusion: This study can inform future policy decisions to improve the accessibility, affordability, and quality of healthcare through evidence-based interventions for patients with DM following an episode of DKA., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To identify the out-of-pocket expenses and parent-reported quality of life (QoL) of children with a diagnosis of cow's milk protein allergy between the ages of 0 and 5 using the Food Allergy Quality of Life Questionnaire - Parent Form., Methods: A cross-sectional study was conducted in two tertiary care centers in Bogotá. Demographic, medical information, and QoL scores were collected by parental interview. We carried out a cost-of-illness analysis based on self-reported out-of-pocket expenses attributed to the treatment as a whole and the family's monthly income. Exploratory analyses used the QoL scores and the percentage of out-of-pocket expenses attributable to treatment as outcomes., Results: 122 families were analyzed. Median subject age was 17 months (Q1-Q3: 11-26.75 months) and female subjects made up 71% of the sample. The median QoL score was 3.21 points (Q1-Q3: 2.43-4.34) and only differed by age groups and personal history of other food allergies. The median out-of-pocket treatment related costs was 300,000 Colombian pesos (COP) (Q1-Q3: 280,000-340,000 COP). About 17% of the families had to pay over 15% of their monthly income to purchase food and dietary products. Out-of-pocket treatment related costs differed depending on whether the treatment included formulas (Mann-Whitney test p < 0.001). Out-of-pocket treatment expenses were uncorrelated with the QoL scores., Conclusion: Food allergy related QoL scores were not associated with out-of-pocket expenses as a whole or as a fraction of monthly income but were higher in children with additional food allergies and in older age groups, suggesting a lower QoL., (© 2024 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Background: The COVID-19 pandemic exacerbated disparities in mental healthcare and substance use disorder (SUD) treatment access, especially in under-resourced communities. This study aimed to comprehend the experiences of under-resourced women with SUD during the pandemic, their knowledge and attitudes toward it, and its impact on substance use and treatment access., Methods: A cross-sectional study included 66 under-resourced women receiving medically managed withdrawal treatment at a community residential SUD center. Data collection occurred between November 2021 and August 2022, utilizing a 75-item instrument covering COVID-19 exposure and its impact on health, substance use, treatment access, vaccination status, beliefs, and knowledge. Descriptive analyses summarized the data., Results: Participants faced various challenges during the pandemic. Many reported increased substance use, especially alcohol, opioids, benzodiazepines, and nicotine. Mental health stability was negatively affected, exacerbating existing disorders and limiting mental healthcare access. A majority (56.1%) reported that their chronic mental health disorder was less stable during the pandemic. Twenty (30.3%) participants reported that they had been diagnosed with a new mental health disorder since the pandemic, and 28.8% reported that it was harder for them to access mental healthcare during the pandemic. Job loss, housing instability, and financial strain were prevalent. Half (n=33, 50%) received a COVID-19 vaccine dose, while 27.3% (n=18) declined vaccination due to knowledge gaps and religious beliefs. The majority (n=41, 62.1%) worried about securing basic needs such as groceries and medication, with 64.6% (n=42) expressing a desire to cope using alcohol or drugs., Conclusions: This study expands upon previous research by examining the effect of the COVID-19 pandemic on mental health in the context of substance use disorder treatment. Unlike previous data, which focused solely on substance use behaviors, our study delves into the impact of the pandemic on co-occurring mental health disorders. Findings underscore the need for gender-responsive and culturally appropriate SUD treatment. Vaccine hesitancy, as reflected in the study, necessitates more effective, tailored evidence-based informational campaigns. Efforts must focus on enhancing mental healthcare access, reducing stigma, and supporting individuals with co-occurring conditions amidst this evolving COVID-19 health crisis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Institutional Review Board of Baylor College of Medicine issued approval H-50771. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mejia et al.)

Background: The use of electronic vapor products (EVPs) increases the risks of nicotine addiction, drug-seeking behavior, mood disorders, and avoidable premature morbidities and mortality. We explored temporal trends in EVP use among US adolescents. Methods: We used data from the Youth Risk Behavior Survey for school grades 9 through 12 from 2015 (earliest available data) to 2021 (the most recently available data) from the US Centers for Disease Control and Prevention (n=57,006). Results: Daily use of EVPs increased from 2.0% in 2015 to 7.2% in 2019, a greater than 3.5-fold increase. Although the percentage decreased to 5.0% in 2021, it was still a >2.5-fold increase since 2015. In 2015, the percentage of EVP use was significantly higher in boys (2.8%) than girls (1.1%). By 2021, the percentage of EVP use was higher in girls (5.6%) than boys (4.5%), a 1.24-fold increase. In addition, the percentage of EVP use in 2021 was higher in White youth (6.5%) vs Black (3.1%), Asian (1.2%), and Hispanic/Latino (3.4%) youth compared to 2015, but White and Black adolescents had the highest increases of approximately 3.0-fold between 2015 and 2021. Adolescents in grade 12 had the highest percentages of EVP use at all periods. Conclusion: These data show alarming statistically significant and clinically important increases in EVP use in US adolescents in school grades 9 through 12. The magnitude of the increases may have been blunted by coronavirus disease 2019, a hypothesis that requires direct testing in analytic studies. These trends create clinical and public health challenges that require targeted interventions such as mass media campaigns and peer interventions to combat the influences of social norms that promote the adoption of risky health behaviors during adolescence., (©2024 by the author(s); Creative Commons Attribution License (CC BY).)

Background: Substance use disorder (SUD) presents a range of public health challenges and consequences. Despite the prevention potential of screening and brief intervention (SBI) in the primary care setting, implementation is low. The purpose of this study was to assess associations of primary care clinicians' knowledge of SBI and SUD treatment, subjective norms, and perceived behavioral control with intention to incorporate SBI and SUD treatment into regular clinical practice., Methods: This online survey was administered to primary care clinicians who practice in Texas between March 1, 2021, and February 5, 2023. Survey questions were mapped to factors in the Theory of Planned Behavior and included measures of knowledge, subjective norms, and perceived behavioral controls related to SBI and SUD treatment. Intention to engage in SBI and SUD treatment was assessed as the outcome., Results: Of 645 participants included in this study, 59.5% were physicians. Knowledge was low, with less than half correctly reporting what was considered a standard drink (39.6%) and only 20% knew the correct number of alcoholic beverages considered risky drinking in 21-year-old non-pregnant women. Subjective norms, such as having colleagues within their practice support addressing SUDs, and perceived behavioral control such as having SUD screening routinized within clinic workflows, were positively associated with intention to implement SBI and SUD treatment in primary care settings., Conclusions: Modifying knowledge gaps, subjective norms, and perceived behavioral control requires a multipronged interventional approach that blends accessible clinician training with systemic workplace enhancements and a collective shift in professional norms., (© 2024. The Author(s).)

Objectives: We explored temporal trends in drug-related infant deaths in the United States (U.S.) from 2018 to 2022., Methods: We used data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER). A total of 295 drug-involved infant deaths were identified from 2018 to 2022 (provisional mortality data for year 2022) based on the underlying cause of death., Results: In the U.S. from 2018 to 2022, there was a significant 2.2-fold increase in drug-involved infant mortality. The observed increases were higher in non-Hispanic White and Black infants. The findings show that drug-involved infant deaths were more likely to occur in the postneonatal period, defined as ages 28-364 days (81.4 %) compared to the neonatal period. The most prevalent underlying causes of death included assault (homicide) by drugs, medicaments and biological substances (35.6 %) followed by poisoning due to exposure to narcotics and psychodysleptics (hallucinogens) (15.6 %). The most common multiple causes of drug-involved infant deaths were psychostimulants with abuse potential of synthetic narcotics., Conclusions: Drug-related infant mortality has increased significantly from 2018 to 2022. These increases are particularly evident among White and Black infants and occurred predominantly in the postneonatal period. These findings require more research but also indicate the need to address drug-involved infant deaths as preventable clinical and public health issues. Effective strategies to reduce drug-involved infant deaths will require preventing and treating maternal substance use disorders, enhancing prenatal care access, and addressing broader social and behavioral risk factors among vulnerable maternal and infant populations., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

This study investigated the impact of a specialized program aimed at improving substance use disorder and trauma treatment, recovery, and reentry services for adult female offenders. Trained recovery coaches delivered pretreatment interventions such as prescreening, motivational interviewing, and support-building to facilitate treatment entry and improve outcomes. Of 113 participants, 40% identified as racial/ethnic minorities, and 72% fell within the 25-45 age range. A notable 44.5% reduction in self-reported psychiatric symptoms was observed, alongside significant improvements in abstinence and trauma symptoms. Recovery capital and psychosocial functioning showed marked improvement including significant changes in employment status and housing stability and a decrease in criminal justice involvement. The results suggest that targeted, client-centered approaches can effectively improve recovery and psychosocial functioning among female offenders while reducing re-incarceration rates. These findings underscore the importance of addressing the unique needs of this population in both pre-and post-release settings to ensure equitable access to reentry services., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In this original research we present new emerging data in COVID-19 that create urgent challenges for health providers in prevention and treatment. Health providers should be aware that COVID-19 cases, hospitalizations, and deaths have increased markedly in August 2023. Further, recent data demonstrate a new emerging strain resistant to prior natural and vaccine immunity. The most recent emerging data show that only this updated COVID-19 vaccine produces the same immune response as previous vaccines that reduced mortality by over 95 % and morbidity by over 99 %. This recommendation encompasses all adults and children aged 6 months and older, regardless of whether they have had a prior COVID-19 infection or even if they have never received a prior vaccination. This updated COVID-19 vaccine, approved in September 2023, will be the best means to prevent COVID-19 during this upcoming season of respiratory viruses. In the meanwhile, all members of the US population regardless of previous natural infection, vaccines, or boosters are equally susceptible. At present, health providers should counsel all their patients about masking, social distancing, and avoiding crowds, especially indoors where regions of extreme weather conditions are keeping people indoors in closed quarters. In the treatment of COVID-19 the major clinical challenge to health providers, especially in their Black patients, is to prescribe Paxlovid during the first 5 days after onset of symptoms and a positive test., (Copyright © 2024 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Objective: Our objective was to explore evolving trends in US drug overdose mortality, overall and by age, sex, race, urbanization, and geography from 1999-2020., Methods: This is a descriptive epidemiologic study. We used the US Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research and Multiple Cause of Death files from the National Center for Health Statistics. We used crude and age-adjusted cause of death and mortality rate ratios as measures of effects and 95% confidence limits to test for significance., Results: From 1999-2020, drug overdoses caused 1,013,852 deaths and 4.3-fold increase in mortality rate ratios. Subgroup findings were sex (4.5 men, 4.0 women), race (4.6 White, 3.9 Black or African American, 4.0 Asian or Pacific Islanders, 5.1 Native Americans or Alaskan Natives), age (highest 5.6 in 25-34 years, lowest 1.1 in 75-84, and 0.77 in 85+), geography (highest 6.0 in Midwest, lowest 2.6 in West), and urbanization (highest 6.2 in non-metro, lowest 3.7 in metro)., Conclusions: Drug overdoses in the United States from 1999-2020 increased 4.3-fold, with the highest increase in White and Native American or Alaskan Native populations, and Midwest and non-metro areas. The data create preventive and therapeutic challenges, including restrictions on pharmaceutical industries and enhanced efforts by health care providers in safer prescribing. Addiction care should be integrated into all clinical practices, regardless of specialty, and into undergraduate, graduate, and continuing medical education. Targeted interventions are needed to adequately assess patients and provide care. Analytic studies designed a priori are necessary to test hypotheses formulated from these data., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Cigarette smoking remains the leading avoidable cause of premature death in the United States, accounting for approximately 500,000, or 1 in 5, deaths annually. We explored trends in cigarette smoking among US adolescents. Methods: We used data for adolescents in grades 9 through 12 from 1991 to 2021 from the Youth Risk Behavior Survey provided by the US Centers for Disease Control and Prevention. We explored trends overall as well as by sex, race/ethnicity, and school grade. Results: All cigarette use-assessed as ever, occasional, frequent, or daily-among adolescents declined markedly from 1991 to 2021. Specifically, ever use significantly decreased from 70.1% in 1991 to 17.8% in 2021 ( P <0.05), an almost 4-fold decline. Occasional use significantly decreased from 27.5% in 1991 to 3.8% in 2021 ( P <0.05), a greater than 7-fold decline. Frequent use significantly decreased from 12.7% to 0.7%, a greater than 18-fold decline. Daily use declined from 9.8% in 1991 to 0.6% in 2021, a greater than 16-fold decline. Cigarette smoking significantly decreased from 1999 to 2021 across sex, race/ethnicity, and school grade ( P <0.05). In 2021, daily use was higher in boys vs girls; Hispanic/Latino and White youth vs Black and Asian youth; and 12th graders vs 9th, 10th, and 11th graders. Conclusion: These data show large and significant decreases in cigarette use among US adolescents in high school grades 9 through 12 from 1991 to 2021. Nonetheless, the data also suggest residual clinical and public health challenges that will require targeted interventions., (©2023 by the author(s); Creative Commons Attribution License (CC BY).)

Background: Congenital toxoplasmosis (CT) is a widespread infection in several countries, and it is defined as an infection of a fetus, newborn, or infant under 1 year of age. Moreover, it represents a thread to pregnant women globally. The objective of our study is to evaluate a potential association between prematurity and CT and whether intrauterine transmission impacts gestational length during pregnancy., Methods: PubMed, Cochrane Library and Google Scholar databases were searched from 1950 to 2019. Case-control studies, retrospective, and prospective cohort studies were eligible. Seven studies were included from a total of 314. The Newcastle-Ottawa scale was used to establish the quality of the articles included., Results: Based on our review, an association between CT and preterm labor was not established, which may reflect heterogeneity in screening, treatments administered, and differing reported incidences of CT across continents over 69 years. A multicenter prospective cohort study powered to investigate a potential association is indicated., Conclusion: Further studies are needed including multicenter prospective cohort studies powered to investigate key clinical associations such as vertical transmission and preterm birth., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Implementing evidence-based practice (EBP) in a safety net healthcare system is challenging. This study examined factors associated with feasibility and potential facilitators and barriers which might affect the implementation of a new evidence-based comprehensive primary care and community health-based program aiming to promote efficient and equitable delivery of Lung Cancer Screening and Tobacco Cessation (LCS-TC). Fifty-three key informants were interviewed. Informants discussed their perceptions of adoption of screening and appropriate referral practices across 15 community health centers. They also identified barriers and facilitators to implementing the LCS-TC program. Interview data were analyzed using inductive thematic analysis. Three major themes representing facilitators and barriers were identified: (1) Allocation of resources and services coverage; (2) need for a collaborative process to engage stakeholders and identify champions; and (3) stakeholders need different types of evidence to support implementation. The top three activities identified as essential for success included provision of sufficient resources for radiologic screening (30%); using non-physician staff for screening (30%); and minimizing the time healthcare providers need to contribute (23%). Conversely, the top three barriers were lack of resources for screening and treatment (60%); insufficient time to address complex patient problems (36%); and perceived lack of patient buy-in (30%). Models for EBP implementation provide stepwise guidance; however, particular contextual factors act as facilitators or barriers to the process. Findings inform EBP implementation efforts regarding resources and key barriers to success around organizational-level supports and promotion of suitable EBP programs., (© 2021. American Association for Cancer Education.)

Background: Coronavirus disease 2019 (COVID-19) produces a wide array of deleterious consequences, some of which are unintended. Data are sparse on whether, and if so, how, current cigarette smoking habits are affected by COVID-19. We describe changes to smoking habits and their correlates during the COVID-19 pandemic among participants in a tobacco cessation and lung cancer screening program. Methods: Between June and October 2020, we conducted a cross-sectional survey of a convenience sample of 150 participants in a lung cancer screening and tobacco cessation program. The survey consisted of 3 parts: (1) changes in tobacco use, (2) impact and coping strategies toward COVID-19, and (3) COVID-19 exposure and use of protective measures. Demographic variables included age, sex, race/ethnicity, and marital status. Results: All 150 participants who were contacted agreed to participate in this cross-sectional survey. The statistically significant correlates of increased tobacco use were high uncertainty about the future ( P <0.001), loneliness because of social distancing or self-isolating ( P <0.001), anger or frustration with how the pandemic has disrupted daily life ( P <0.001), boredom resulting from inability to work or engage in regular daily activities/routines ( P <0.001), desire to cope using alcohol or drugs ( P =0.002), sadness or feelings of hopelessness ( P =0.003), and worry or fear about challenges to securing basic needs such as groceries or medication ( P <0.001). In contrast, those who smoked less were more likely to practice social distancing ( P =0.002) and use protective measures ( P =0.005). Conclusion: Among those who decreased or stopped smoking, correlates included greater use of protective measures for COVID-19, including social distancing and testing. These data may aid healthcare providers to identify and provide counsel to cigarette smokers at greater risks for increasing tobacco consumption during stresses such as COVID-19., (©2022 by the author(s); Creative Commons Attribution License (CC BY).)

Public health prevention efforts have led to overall reductions in mortality from screening-preventable cancers. We explored cancer screening behaviors of smokers, former smokers, and nonsmokers among patients of large primary care practices to discover the relationship between smoking status and previous adherence to the United States Preventive Services Task Force breast, cervical, and colorectal cancer screening recommendations. Our descriptive study of electronic medical record data included 6,029 established primary care patients. Multi-predictor log-binomial regression models yielded prevalence ratios (PRs) and 95% confidence intervals (CIs) to determine associations between smoking status and the likelihood of nonadherence. All models were adjusted for race/ethnicity, age, insurance, primary care specialty, number of comorbidities, and sex. Smoking history was obtained from all participants in January 2020. Current smokers accounted for 4.8%, while 22.7% were former smokers, and 72.5% were never smokers. Current smokers (compared to never smokers) were 63% more likely to be mammogram nonadherent (PR: 1.63, 95% CI: 1.31 to 2.02), 26% more likely to be Pap smear nonadherent (PR: 1.26, 95% CI: 1.04 to 1.53), and 39% more likely to be colonoscopy nonadherent (PR: 1.39, 95% CI: 1.16 to 1.66). Current smokers and former Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation smokers had on average 2.9 comorbidities while never smokers had on average 2.1 comorbidities. Our findings showed that current smokers experienced significantly lower rates of cancer screening compared to never smokers. Further research is needed to investigate and identify best practices for increasing cancer screening uptake in this population., (© Society of Behavioral Medicine 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Cancer among infants (<1 year old) has unique epidemiologic, clinical, and genetic characteristics compared with cancer in older children. Nonetheless, data on secular trends in infant cancer incidence and survival in the United States is sparse., Methods: Population-based data from nine areas of the Surveillance Epidemiology and End Results (SEER) were used to estimate the incidence, average annual percentage change (APC) for trends, and survival of malignant neoplasm among infants from 1975 to 2014. Data were stratified by gender, race, registry, and cancer type., Results: There were 3437 new infant cancer cases with an overall incidence of 23.6/100 000. Neuroblastoma was the most common infant malignancy (6.5/100 000), followed by leukemia (3.8/100 000), and brain and central nervous system tumors (3.3/100 000). The incidence rate increased significantly from 1975 to 2014 (APC 0.68; 95% CI 0.30-1.06; P < .05). Variations in overall incidence rates were uneven across SEER registry geographic areas, with the lowest rates among both males and females in New Mexico. Relative to other racial distribution, infant cancer rates were highest among Whites. The relative survival rates improved over time for all tumors except for renal, sarcomas, and germ cells and were not significantly different by gender or race., Conclusions: Cancer incidence among infants increased over time largely driven by leukemia, germ cell, and sarcoma mainly among male infants. The overall survival for infant cancer has improved over the past 40 years, especially since 1990 for hepatic tumors, lymphoma, and leukemia. Further research is needed to explore the potential impacts of genetic, environmental, and perinatal factors for possible explanations for these increased cancer incidence trends., (© 2021 Wiley Periodicals LLC.)

Objectives: There is considerable evidence to support the effectiveness of inpatient tobacco cessation interventions. However, national trends data in tobacco-use disorder among hospitalized patients in the United States is scarce. We compared temporal trends (2002-2017) in diagnoses of tobacco-use disorder among hospitalized patients with estimates of current and former smoking in the general population, based on 2 multiyear national databases., Methods: We used data from the National Inpatient Sample (NIS) and the Behavioral Risk Factor Surveillance Survey (BRFSS) to establish annual estimates of current and former smoking. We assessed temporal trends (Joinpoint regression analysis) overall and within levels of several sociodemographic factors. To describe the burden and risk of tobacco-use disorder in inpatient settings, we used principal codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) that corresponded with the highest volume (burden) and rates (risk) of tobacco-use disorder., Results: There were contrasting trends in the prevalence of current tobacco-use disorder between the NIS population (significantly increasing) and BRFSS (significantly decreasing). Concordance (at 16%) was only recorded in 2017, with approximately 5,022,000 hospitalizations with a recorded diagnosis of tobacco-use disorder. Among all hospitalizations, the highest number of cases of tobaccouse disorder occurred for mood disorders (n = 2,415,985), chronic obstructive pulmonary disease and bronchiectasis (n = 2,406,551), and acute myocardial infarction (n = 1,873,326)., Conclusions: Despite the underestimation of current smoking by NIS, we believe the trends toward improved identification and documentation-which is likely leading to the increasing prevalence we observed among hospitalized patients of all ages-bodes well for future utilization of smoking data in the NIS for epidemiological and health services research.

Competing Interests: Declaration of Competing Interest Ovini D. Rodrigo, Sarah K. Wood, Maria C. Mejia, Jason L. Salemi, Baqar A. Husaini, and Robert S. Levine report no potential conflicts of interest. Professor Hennekens reports that he serves as an independent scientist in an advisory role to investigators and sponsors as: Chair or Member of Data and Safety Monitoring Boards for Amgen, British Heart Foundation, Cadila, Canadian Institutes of Health Research, DalCor, Lilly, Regeneron, and the Wellcome Foundation; to the United States (U.S.) Food and Drug Administration, and UpToDate; receives royalties for authorship or editorship of 3 textbooks and as coinventor on patents for inflammatory markers and CV disease that are held by Brigham and Women's Hospital; has an investment management relationship with the West-Bacon Group within SunTrust Investment Services, which has discretionary investment authority and does not own any common or preferred stock in any pharmaceutical or medical device company.

Background: Since 1979, mortality from hepatocellular cancer (HCC) has doubled in the United States (US). Lifesaving drugs, prohibitively expensive for some, were approved and marketed to treat hepatitis C virus (HCV), a major risk factor for HCC, beginning in 1997. After the prior introduction of other lifesaving innovations, including active retroviral drug therapy for human immunodeficiency virus and surfactant for respiratory distress syndrome of the newborn, racial inequalities in their mortalities increased in the US. In this descriptive study, we explored racial inequalities in mortality from HCC before and after licensure of HCV drugs in the US., Methods: The US Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (WONDER) were used to describe HCC mortality rates from 1979 to 2016 in those 55 years of age and older, because they suffer the largest disease burden. Joinpoint regression was used to analyze trends. To estimate excess deaths, we applied White age-sex-specific rates to corresponding Black populations., Findings: From 1979 to 1998, racial inequalities in mortality from HCC in the US were declining but from 1998 to 2016 racial inequalities steadily increased. From 1998 to 2016, of the 16,770 deaths from HCC among Blacks, the excess relative to Whites increased from 27.8% to 45.4%, and the trends were more prominent in men. Concurrently, racial inequalities in mortality decreased for major risk factors for HCC, including alcohol, obesity and diabetes., Interpretation: These descriptive data, useful to formulate but not test hypotheses, demonstrate decreasing racial inequalities in mortality from HCC which were followed by increases after introduction of lifesaving drugs for HCV in the US. Among many plausible hypotheses generated are social side effects, including unequal accessibility, acceptability and/or utilization. Analytic epidemiological studies designed a priori to do so are necessary to test these and other hypotheses., Competing Interests: RSL, MCM, JLS, SJG, MHA, BAH, RJZ report no conflicts., (© 2020 The Author(s).)

Background: Dengue, chikungunya and Zika are viral infections transmitted by Aedes aegypti mosquitoes, and present major public health challenges in tropical regions. Traditional vector control methods have been ineffective at halting disease transmission. The World Mosquito Program has developed a novel approach to arbovirus control using Ae. aegypti stably transfected with the Wolbachia bacterium, which have significantly reduced ability to transmit dengue, Zika and chikungunya in laboratory experiments. Field releases in eight countries have demonstrated Wolbachia establishment in local Ae. aegypti populations. Methods: We describe a pragmatic approach to measuring the epidemiological impact of city-wide Wolbachia deployments in Bello and Medellín, Colombia. First, an interrupted time-series analysis will compare the incidence of dengue, chikungunya and Zika case notifications before and after Wolbachia releases, across the two municipalities. Second, a prospective case-control study using a test-negative design will be conducted in one quadrant of Medellín. Three of the six contiguous release zones in the case-control area were allocated to receive the first Wolbachia deployments in the city and three to be treated last, approximating a parallel two-arm trial for the >12-month period during which Wolbachia exposure remains discordant. Allocation, although non-random, aimed to maximise balance between arms in historical dengue incidence and demographics. Arboviral disease cases and arbovirus-negative controls will be enrolled concurrently from febrile patients presenting to primary care, with case/control status classified retrospectively following laboratory diagnostic testing. Intervention effect is estimated from an aggregate odds ratio comparing Wolbachia -exposure odds among test-positive cases versus test-negative controls. Discussion: The study findings will add to an accumulating body of evidence from global field sites on the efficacy of the Wolbachia method in reducing arboviral disease incidence, and can inform decisions on wider public health implementation of this intervention in the Americas and beyond. Trial registration: ClinicalTrials.gov: NCT03631719. Registered on 15 August 2018., Competing Interests: No competing interests were disclosed., (Copyright: © 2019 Velez ID et al.)

Background: A guide for the implementation of dental digital imaging reports was developed and validated through the International Standard of Health Informatics-Health Level Seven (HL7), achieving interoperability with an electronic system that keeps dental records., Introduction: Digital imaging benefits patients, who can view previous close-ups of dental examinations; providers, because of greater efficiency in managing information; and insurers, because of improved accessibility, patient monitoring, and more efficient cost management. Finally, imaging is beneficial for the dentist who can be more agile in the diagnosis and treatment of patients using this tool., Materials and Methods: The guide was developed under the parameters of an HL7 standard. It was necessary to create a group of dentists and three experts in information and communication technologies from different institutions., Discussion: Diagnostic images scanned with conventional radiology or from a radiovisiograph can be converted to Digital Imaging and Communications in Medicine (DICOM) format, while also retaining patient information. The guide shows how the information of the health record of the patient and the information of the dental image could be standardized in a Clinical Dental Record document using international informatics standard like HL7-V3-CDA document (dental document Level 2). Since it is an informatics standardized document, it could be sent, stored, or displayed using different devices-personal computers or mobile devices-independent of the platform used., Conclusions: Interoperability using dental images and dental record systems reduces adverse events, increases security for the patient, and makes more efficient use of resources. This article makes a contribution to the field of telemedicine in dental informatics. In addition to that, the results could be a reference for projects of electronic medical records when the dental documents are part of them., Competing Interests: Statement No competing financial interests exist.

A bacterial strain was taxonomically characterised by means of a genomic approach comprising 16S rRNA gene sequence analysis, multilocus sequence analysis (MLSA), the DNA G+C content, whole genome analyses (ANI and GGDC) and phenotypic characterisation. The strain CAIM 1540(T) was isolated from a cultured oyster Crassostrea corteziensis in La Cruz, Sinaloa state, México. The isolate was found to be catalase and oxidase positive, cells were observed to be motile, O/129-sensitive and facultatively anaerobic. The almost-complete 16S rRNA gene sequence placed this strain within the genus Vibrio; the closest related species were found to be Vibrio aestivus, Vibrio marisflavi, Vibrio maritimus and Vibrio variabilis with similarity values of 99.02, 97.05, 96.70, and 96.59 % respectively. MLSA of four housekeeping genes (ftsZ, gapA, recA, and topA) was performed with the closely related species. A draft genome sequence of strain CAIM 1540(T) was obtained. The DNA G+C content of this strain was determined to be 43.7 mol%.The ANI values with V. aestivus were 89.6 % (ANIb), 90.6 % (ANIm) and a GGDC value of 39.5 ± 2.5 % was obtained; with V. marisflavi the genomic similarities were 71.5 % (ANIb), 85.5 % (ANIm) and 20.2 ± 2.3 % (GGDC); with V. maritimus 72.6 % (ANIb), 85.7 % (ANIm) and 22.0 ± 2.0 % (GGDC); and with V. variabilis 72.6 % (ANIb), 85.8 % (ANIm) and 21.6 ± 1.6 % (GGDC). These ANI and GGDC values are below the threshold for the delimitation of prokaryotic species, i.e. 95-96 and 70 %, respectively. Phenotypic characters also showed differences with the closest related species analysed. The results presented here support the description of a novel species, for which the name Vibrio mexicanus sp. nov. is proposed, with strain CAIM 1540(T) (= CECT 8828(T), = DSM 100338(T)) as the type strain. In addition, we found that the recently described species Vibrio thalassae and Vibrio madracius might be a single species because the values of ANIb 95.8 %, ANIm 96.6 % and GGDC 70.2 ± 2.9 % are above the accepted species thresholds.

We examined the relationships between survival after AIDS diagnosis and outpatient mental health service use among men with history of highly active antiretroviral therapy (HAART). Analysis involved 1913 black and 1684 white men with AIDS who received HIV care in 2003 in the Veterans Affairs health care system. Negative binomial regression was used to assess the association between service use and length of AIDS diagnosis. Patients with longer survival after AIDS had higher rates of outpatient visits for stress and adjustment disorders as well as for mood, anxiety, and sexual disorders. Blacks had more visits for stress and adjustment disorders (7.4 versus 5.1; p < 0.05). Multiple regression analysis showed that prolonged survival after AIDS (incident rate ratios [IRR] = 1.87; 95% confidence interval [CI] = 1.25-2.77), having CD4 cell count less than 200 cells/mm(3) (IRR = 1.91; 95% CI = 1.19-3.04), and mortality (IRR = 3.84; 95% CI = 1.29-11.43) were associated with greater number of visits for mood, anxiety, and sexual disorders. Injection drug users (IRR = 3.52; 95% CI = 1.94-6.38), men who have sex with men (IRR = 2.87; 95% CI = 1.62-5.06), and patients with AIDS-defining illness (IRR = 2.48; 95% CI = 1.47-4.17) had greater rates of visits for stress and adjustment disorders. Survival after AIDS is associated with mental health service use. As more HIV-infected persons survive longer, adequate risk assessment of mental health concerns that considers race and HIV risk factors should be undertaken to effectively address the impact of mental health on treatment outcomes and mortality.

Based on the new social security system in Colombia (1993), which establishes equity and mandatory care as the basis for public health care provision, the authors analyze whether the formulation and implementation of pharmaceutical policy promote accessibility, availability, and rational use of medicines, thereby contributing to equity in health. Two approaches were used: a macro approach centered on the legal framework and various actors in the reform process and a micro approach related to the processes and results in the drug supply system. The authors studied the legal instruments backing the country's pharmaceutical policy and evaluated their application, using indicators and a specific disease (diabetes mellitus) as a marker. Although there is a legal framework providing the people's right to access health care services and essential medicines, the country lacks a comprehensive pharmaceuticals policy. Most of the institutions experience problems in distributing the medicines listed under the Mandatory Health Plan, a low percentage of medicines is dispensed at zero cost, and a major portion of patients purchase medicines through associations of diabetics or rely on alternative medicine. The study unveiled several obstacles to equity in health care coverage and access to essential medicines.

Background: Prognosis in neuroblastoma is based upon several clinical factors such as age, tumoral staging and other genetic factors like N-myc oncogene amplification or deletion of the short arm of chromosome 1 (del 1p). Recent reports indicate that bcl-2 protein expression is associated with a poor outcome in patients with neuroblastoma., Materials and Methods: We present a study of 80 cases from the files of the Spanish neuroblastoma study group (N-II-92) analysing bcl-2 protein expression by means of immunohistochemical methods and its relation with other parameters such as histopathology, PCNA expression, N-myc amplification and DNA study of apoptosis., Results: We found a statistical correlation between bcl-2 protein expression and unfavourable histopathology, N-myc amplification and PCNA nuclear staining. An inverse relation between bcl-2 staining and apoptosis was detected., Conclusions: Based on present findings it can be concluded that the determination of bcl-2 protein provides prognostic information when associated with other biological factors involved in neuroblastomas.