Diagnosis of hepatitis C virus infection in pregnancy increased nearly 10-fold from 2000 to 2019; this increase was associated with increasing prevalence of common hepatitis C virus infection risk factors.

Abstract. The association between heavy rainfall and an increased risk of diarrhea has been well established but less is known about the effect of drought on diarrhea transmission. In 2011, the Pacific island nation of Tuvalu experienced a concurrent severe La Niña-associated drought and large diarrhea outbreak. We conducted a field investigation in Tuvalu to identify factors that contributed to epidemic transmission in the context of a drought emergency. Peak case numbers coincided with the nadir of recorded monthly rainfall, the lowest recorded since 1930. Independent factors associated with increased risk of diarrhea were households with water tank levels below 20% (odds ratio [OR] = 2.31; 95% confidence interval = 1.16-4.60) and decreased handwashing frequency (OR = 3.00 [1. .08]). The resolution of the outbreak occurred after implementation of a hygiene promotion campaign, despite persistent drought and limited water access. These findings are potentially important given projections that future climate change will cause more frequent and severe droughts.

Objective: To assess the baseline types of HPV infection among HIV-positive and HIVnegative women in western Kenya undergoing cryotherapy or loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia. Methods: A prospective observational study was conducted of baseline HPV characteristics of women undergoing visual inspection with acetic acid (VIA) and cryotherapy or LEEP. After a positive VIA in HIV-positive and HIV-negative women, data on demographics, CD4 count, and use of antiretroviral therapy and a cervical swab were collected. HPV typing was performed using the Roche Linear Array. Results: Of 175 participants, 86 (49.1%) were HIV-positive and had a higher prevalence of low-risk HPV types (odds ratio [OR] 5.28, P=0.005) compared with HIV-negative women. The most common high-risk (HR)-HPV types in HIV-positive women were HPV 16 (13.9%) and HPV 18 (11.1%). HIV-positive women requiring LEEP were more likely to have HR-HPV types (OR 6.67, P=0.012) and to be infected with multiple HR-HPV types (OR 7.79, P=0.024) compared to those undergoing cryotherapy. Conclusion: HIV-positive women requiring LEEP versus cryotherapy had a higher prevalence of any HR-HPV type and multiple HR-HPV types. There were no such differences in HPV types identified among HIV-negative women.

OBJECTIVE: To compare nationwide trends in the rate of inpatient and outpatient hysterectomy between 2019 and 2020 during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Using weighted data from the National Inpatient Sample and the National Ambulatory Surgery Sample, we examined the number of hysterectomies performed by month from 2019 through 2020. Monthly trends were compared between years overall, stratified by the route of surgery (abdominal, laparoscopic, and vaginal) and by indication for surgery (benign, preinvasive, cancer). Trends analyses were conducted using Joinpoint regression and reported as average monthly percentage change (AMPC). Differences in demographic characteristics between the years were compared using χ2 tests. RESULTS: From January 2019 through December 2020, after weighting, 1,029,792 hysterectomies were performed, including 548,802 (53.2%) in 2019 and 480,990 (46.7%) in 2020. Starting in January 2020, monthly cases declined significantly, from 40,240 to a nadir of 10,566 hysterectomies in April 2020 (AMPC −29.2%, 95% CI −39.8% to −16.8%) (P<.001). The subsequent months saw a significant increase in cases, from the nadir in April 2020 to 40,023 cases in July 2020 (AMPC 39.4%, 95% CI 18.6–63.9%) (P=.001), which then stabilized to the end of the year (AMPC −1.3%, 95% CI −4.8% to 2.4%) (P=.46). In March 2020 there was a 24.0% decrease, in April 2020 a 74.2% decrease, and in May 2020 a 35.1% decrease compared with the respective months in 2019. The rates of vaginal hysterectomy declined more than the rates of other routes of surgery, and procedures performed for benign and preinvasive disease decreased more than those for cancer. CONCLUSION: The rate of hysterectomy in the United States decreased in 2020 compared with 2019, with the greatest decrease from March to May of 2020, corresponding with the initial wave of COVID-19.

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Purpose It is predicted that increasing numbers of citizens of the Pacific Island nation of Tuvalu will migrate to New Zealand in the coming decades due to the threat of climate change. Tuvaluans currently living in New Zealand face disparities in income, education and health. This study aims to understand the views of recent Tuvaluan immigrants to Auckland, New Zealand on health behaviors, health care and immigration. Design/methodology/approach The authors conducted semi-structured interviews, key informant interviews and participant observation using a focused ethnography methodology. Findings Participants explained that Tuvaluans in New Zealand do not fully use primary care services, have a poorer diet and physical activity compared to those living in Tuvalu, and struggle to maintain well-paying, full-time employment. Practical implications As Tuvaluan immigration to New Zealand continues, it will be important to educate the Tuvaluan community about the role of primary health-care services and healthy behaviors, facilitate the current process of immigration and provide job training to recent immigrants to improve their opportunities for full-time employment and ensure cultural survival in the face of the threat of climate change. Originality/value This paper contributes to a greater understanding of the challenges to be faced by Tuvaluan environmental migrants in the future and features a high proportion of study participants who migrated due to climate change.

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