with all other racial/ethnic groups included in the total). The gastroschisis case definition was based on the British Pediatric Association Classification of Diseases code (756.71) or the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for gastroschisis (756.73, or before 10/1/2009, 756.79, with verification to confirm cases of gastroschisis, because the previous code was shared with omphalocele). Gastroschisis cases included live births, fetal deaths, † and elective terminations. § Data were pooled at CDC, and gastroschisis prevalence was calculated for each year, maternal age group, and race/ethnicity. Prevalence was calculated as number of gastroschisis cases among all birth outcomes divided by the total number of live births. The denominators of total number of live births in the same catchment area as the birth defects surveillance program were reported by states or obtained from public use data files. Poisson exact methods were used to calculate 95% CIs for each prevalence estimate. Prevalence ratios were calculated by dividing the prevalence during 2006-2012 by the prevalence during 1995-2005, and CIs for the prevalence ratios were calculated using Poisson regression.Because the comparison of prevalence between the two study periods involved an artificial breakpoint during the 18-year data span and only examined pooled prevalence within those periods, joinpoint regression analysis was used to identify statistically significant changes in the annual prevalence of gastroschisis over the course of the entire study period (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). Joinpoint regression initially models annual trend data by fitting a straight line (i.e., zero joinpoints). Then, joinpoints are added, one at a time, and a Monte Carlo permutation test is used to determine the optimal number of joinpoints. Each joinpoint in the final model corresponds to a significant change in the trend, and an AAPC and its 95% CI are calculated to describe how the rate changes within each time interval (3). The estimated overall percent change was calculated by first converting the AAPC to the projected single year change in prevalence and then exponentiating to the number of years studied minus one to estimate the total increase throughout the 18 years. This gives the magnitude of the increase, which

BackgroundExtended-spectrum beta-lactamase (ESBL)-producing Escherichia coli cause up to 10% of catheter-associated urinary tract infections (CAUTI). We report changes in ESBL prevalence among CAUTIs in an adult acute care hospital from 2006-2012 and describe factors associated ESBL-production among E. coli CAUTI.FindingsData on patients ≥18 years discharged from a 647-bed tertiary/quaternary care hospital (2006-2012), a 221-bed community hospital (2007-2012), and a 914-bed tertiary/quaternary care hospital (2008) were obtained retrospectively from an electronic database (N = 415,430 discharges). Infections were identified using a previously validated electronic algorithm. Information on medical conditions and treatments were collected from electronic health records and discharge billing codes. A case-control design was used to determine factors associated with having a CAUTI caused by an ESBL-producing E. coli versus a non-ESBL-producing E. coli. Changes in yearly proportion of ESBL E. coli CAUTI at the 647-bed tertiary/quaternary care hospital were evaluated. ESBL increased from 4% in 2006 to 14% in 2012, peaking at 18% in 2009. Prior antibiotic treatment and urinary tract disease significantly increased odds of ESBL.ConclusionsThis study provides evidence that treatment with beta-lactam and non-beta-lactam antibiotics is a risk factor for acquiring ESBL-producing E. coli CAUTI, and the prevalence of this organism may be increasing in acute care hospitals.

Alcohol consumption is a significant public health concern among Latino men and Latina transgender women who have sex with men. However, characteristics and behaviors associated with alcohol consumption in this population, particularly in regard to the complex influence of syndemic factors, remain understudied. The purpose of this study was to examine predictors of high-risk alcohol consumption (i.e. binge or heavy drinking). Between January and March of 2014, 176 Latino men and Latina transgender women in New York City completed an interviewer-administered questionnaire. We developed a syndemics scale to reflect the total number of syndemic factors – clinically significant depression, childhood sexual abuse, intimate partner violence, and discrimination – reported by each participant. We also carried out a multinomial logistic regression model predicting binge and heavy drinking. Forty-seven percent of participants reported high-risk alcohol consumption in the past 30 days (21% binge and 26% heavy). Approximately 16% of participants reported no syndemic factors, 27% reported one factor, 39% reported two factors, and 18% reported three or four. In the multinomial logistic regression model, our syndemic factors scale was not significantly associated with binge drinking. However, participants who reported three or four factors were significantly more likely to report heavy drinking. In addition, having multiple sexual partners was associated with an increased risk of binge and heavy drinking; involvement in a same-sex relationship was associated with binge drinking. Further work is needed to develop effective prevention intervention approaches for high-risk alcohol consumption within this population.

We assessed the extent to which sociodemographic, personal, and behavioral factors are associated with human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing among a diverse group of Latino men who have sex with men (MSM) in New York City. The triangulation approach was used to synthesize data from 176 MSM who completed an in-person or phone questionnaire about substance use, alcohol consumption, sexual behaviors and HIV/STI testing history and 40 participants who participated in focus groups. Correlates of testing significant in univariable analyses (p< 0.05) were entered into multivariable logistic regression models. Over half (57.9%) of study subjects tested for HIV in the previous 12 months and 60.2% tested for STIs in the previous 12 months. Age and education were positively correlated with HIV testing in multivariable analysis. No significant correlates of STI testing were identified. Spanish-speaking only subjects were less likely to get tested for HIV and STI, however this association was not significant. Our study demonstrates the need for further study of predictors of STI testing as well as the potential role of language barriers and education in routine testing for HIV. Social and behavioral factors may intensify these obstacles. Future research and interventions should address the role of language barriers and perceived issues of immigration status in the decision to get tested.

In this paper, we describe a population of mothers who are opioid dependent at the time of giving birth and neonates exposed to opioids in utero who experience withdrawal following birth. While there have been studies of national trends in this population, there remains a gap in studies of regional trends. Using data from the Arizona Department of Health Services Hospital Discharge Database, this study aimed to characterize the population of neonates with neonatal opioid withdrawal syndrome (NOWS) and mothers who were opioid dependent at the time of giving birth, in Arizona. We analyzed approximately 1.2 million electronic medical records from the Arizona Department of Health Services Hospital Discharge Database to identify patterns and disparities across socioeconomic, ethnic, racial, and/or geographic groupings. In addition, we identified comorbid conditions that are differentially associated with NOWS in neonates or opioid dependence in mothers. Our analysis was designed to assess whether indicators such as race/ethnicity, insurance payer, marital status, and comorbidities are related to the use of opioids while pregnant. Our findings suggest that women and neonates who are non-Hispanic White and economically disadvantaged, tend be part of our populations of interest more frequently than expected. Additionally, women who are opioid dependent at the time of giving birth are unmarried more often than expected, and we suggest that marital status could be a proxy for support. Finally, we identified comorbidities associated with neonates who have NOWS and mothers who are opioid dependent not previously reported.