Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome among neonates born to mothers with drug dependence disorders. NAS poses a significant public health challenge nationally, with a six-fold increase in incidence (1.2 to 6.7 per 1000 hospital births/year) from 2000–2016. Besides national data, it is critical to quantify NAS at the state-level to identify target areas for prevention. The objectives of this study were to ascertain statewide burden, including county and regional distribution of NAS in Nevada during 2016–2018, and to investigate potential factors associated with NAS. This study utilized hospital administrative data, and a total of 100,845 inpatient pediatric discharges were examined to identify NAS cases. Statistical analyses included estimation of crude incidence rates per 1000 hospital births and multilevel logistic regression modeling. NAS incidence in Nevada decreased slightly from 8.6 to 7.7 per 1000 hospital births between 2016 and 2018, but the overall incidence of 8 was substantially higher than earlier estimates (4.8/1000 hospital births) reported for 2013. Incidence was disproportionately higher among white newborns (12, 95% CI 11.0,13.0) and Medicaid enrollees (13.2, 95% CI 11.0,15.0). Southern Nevada had the highest incidence rate of 8.2 per 1000 hospital births. Nearly 75% of NAS cases were residents of Clark County. Incidence rates of NAS parallel the growing opioid prescription rates in Nevada and highlight the need for adopting opioid control prescribing practices to combat this drug epidemic. These findings might help in designing and evaluating state- and system-level interventions introduced to combat the opioid epidemic.
Dengue Fever (DF) is an important arthropod-borne viral infection that has repeatedly occurred as outbreaks in eastern and northeastern Ethiopia since 2013. A cross-sectional epidemiological outbreak investigation was carried out from September to November 2019 on febrile patients (confirmed malaria negative) who presented with suspected and confirmed DF at both public and private health facilities in Gewane District, Afar Region, northeastern Ethiopia. Entomological investigation of containers found in randomly selected houses belonging to DF-positive patients was undertaken to survey for the presence of Aedes larvae/pupae. A total of 1185 DF cases were recorded from six health facilities during the 3-month study period. The mean age of DF cases was 27.2 years, and 42.7% of cases were female. The most affected age group was 15–49 years old (78.98%). The total case proportions differed significantly across age groups when compared to the population distribution; there were approximately 15% and 5% higher case proportions among those aged 15–49 years and 49+ years, respectively. A total of 162 artificial containers were inspected from 62 houses, with 49.4% found positive for Aedes aegypti larva/pupae. Aedes mosquitoes were most commonly observed breeding in plastic tanks, tires, and plastic or metal buckets/bowls. World Health Organization entomological indices classified the study site as high risk for dengue virus outbreaks (House Index = 45.2%, Container Index = 49.4%, and Breteau Index = 129). Time series climate data, specifically rainfall, were found to be significantly predictive of AR (p = 0.035). Study findings highlight the importance of vector control to prevent future DF outbreaks in the region. The scarcity of drinking water and microclimatic conditions may have also contributed to the occurrence of this outbreak.
Background and Objectives:Limbic predominant age related TDP-43 (LATE) impacts similar neuroanatomical networks as Alzheimer’s disease (AD) and is often comorbid with AD, though frequently missed in clinical diagnosis. The primary aim of this study was to elucidate the clinical and cognitive differences at baseline between patients with autopsy confirmed LATE, compared to patients with AD and comorbid LATE+AD.Methods:Clinical and neuropathological datasets were requested from the National Alzheimer’s Coordination Center (NACC). Baseline data from individuals 75+ years at time of death without neuropathological indication of frontotemporal lobar degeneration were included in analyses. Pathologically defined groups reflecting LATE, AD, and comorbid LATE+AD were identified. Group differences in clinical characteristics and cognition were explored through analysis of variance and chi-square using measures from the Uniform Data Set measures.Results:Pathology groups included 31 individuals with LATE (Mage: 80.6±5.4), 393 with AD (Mage: 77.8±6.4), and 262 with LATE+AD (Mage: 77.8±6.6) without significant differences in sex, education, or race. Compared to participants with AD and LATE+AD pathology, participants with LATE pathology lived significantly longer (Mvisits: LATE=7.3±3.7; AD=5.8±3.0; LATE+AD=5.8±3.0; F(2,683)=3.7, p<.05), reported later onset of cognitive decline (Monset: LATE=78.8±5.7; AD=72.5±7.0; LATE+AD=72.9±7.0; F(2,516)=6.2, p<.01), and were more likely to be diagnosed as cognitively normal at baseline (LATE=41.9%; AD=25.4%; LATE+AD=12%; χ2=38.7, p<.001). Individuals with LATE (45.2%) also reported fewer memory complaints than those with AD (74.4%) or LATE+AD (66.4%; χ2=13.3, p=.001) and were less likely to be classified as Impaired on the Mini Mental State Exam (LATE=6.5%; AD=24.2%; LATE+AD=40.1%; χ2=29.20, p<.001). Across all neuropsychological measures, participants with LATE+AD pathology performed significantly worse than the AD and LATE groups.Conclusions:Those with LATE pathology were older when cognitive symptoms began and lived longer than participants with AD or LATE+AD pathology. Participants with LATE pathology were also more likely to be classified as “cognitively normal” based on objective screening and self-report measures, and they had higher scores on neuropsychological testing. Consistent with prior literature, comorbid pathologies led to more significant cognitive and functional impairment. Early disease characteristics based on clinical presentation alone were insufficient for differentiating LATE from AD, reiterating the need for a validated biomarker.
Background Pacifier use can interfere with nurturing care practices such as breastfeeding, soothing, and sleeping. Due to contradicting beliefs, recommendations, and the high frequency of pacifier use, understanding its associations may support shaping equitable public health recommendations. This study explored the socio-demographic, maternal, and infant characteristics associated with pacifier use among six-months old infants in Clark County, Nevada. Method Cross-sectional survey was conducted in 2021 with a sample of mothers (n = 276) of infants under six months old in Clark County, Nevada. Participants were recruited through advertisements in birth, lactation, pediatric care centers, and social media. We used binomial and multinomial logistic models to assess the association between pacifier use and the age of pacifier introduction, respectively, with household, maternal, infant, healthcare characteristics, and feeding and sleeping practices. Results More than half of the participants offered pacifiers (60.5%). Pacifier use was higher among low-income households (OR (95% CI) 2.06 (0.99–4.27)), mothers who identified as non-Hispanic (OR (95% CI) 2.09 (1.22–3.59)), non-first-time mothers (OR (95% CI) 2.09 (1.11–3.05)), and bottle-feeding infants (OR (95% CI) 2.76 (1.35–5.65)). Compared to those who did not introduce a pacifier, non-Hispanic mothers (RRR (95% CI) 2.34 (1.30–4.21)) and bottle-fed infants (RRR (95% CI) 2.71 (1.29–5.69)) had a higher risk of introducing pacifier within two weeks. Likewise, infants living in food insecure households (RRR (95% CI) 2.53 (0.97–6.58)) and mothers who have more than one child (RRR (95% CI) 2.44 (1.11–5.34)) had a higher risk of introducing a pacifier after two weeks. Conclusion Pacifier use is independently associated with maternal income, ethnicity, parity, and bottle feeding among six-month-old infants living in Clark County, Nevada. Household food insecurity increased the relative risk of introducing a pacifier after two weeks. Qualitative research on pacifier use among families with diverse ethnic/racial backgrounds is needed to improve equitable interventions.
Pulex irritans Linnaeus is commonly known as the human flea owing to its general association with humans, with human dwellings, and with pets and other animals in close association with humans. In fact, this species has been found associated with human archaeological sediments in Europe and Greenland, underscoring the long-term correlation between humans and this flea (Buckland and Sadler 1989). The human flea is cosmopolitan (Mullen and Durden 2019, Gage 2005, Marquardt et al. 2000), but is found in highest abundance in areas where it can readily find mammalian hosts. Though its relative abundance and overall medical importance is disputed, this flea has been implicated as a potentially important vector of the human pathogens causing plague and murine typhus as well as serving as a potential vector of a tapeworm known to parasitize humans (Eldridge and Edman 2004). This review is intended for a general audience interested in understanding the biology, ecology, and medical importance of the human flea.
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