Since 1991, the Centers for Disease Control and Prevention has administered the Youth Risk Behavior Survey (YRBS) biennially to representative samples of high school students. YRBS results indicate that health-risk behaviors often developed during middle school years. To date, few state and local education agencies have administered the YRBS-Middle School. This study measured prevalence of health-risk behaviors among middle school students in a large, majority-minority school district (n = 1,783). Results indicated that young adolescents (ages 11-14) are engaging in multiple health-risk behaviors. For example, 24.4% seriously considered committing suicide in the previous year, 53.3% had been in a physical fight, 50.2% ever drank alcohol, 17.9% ever used marijuana, and 13.4% had already had sex. Such behaviors potentially could lead to serious consequences related to their educational achievement and overall health status. Health-related policy and program applications are discussed.
Importance New guidelines recommend that molecular testing replace sputum-smear microscopy to guide discontinuation of respiratory isolation in patients undergoing evaluation for active tuberculosis(TB) in health-care settings. Objective To evaluate the implementation and impact of a molecular-testing strategy to guide discontinuation of isolation. Design Prospective cohort study with a pragmatic, before-and-after-implementation design. Setting Zuckerberg San Francisco General Hospital and Trauma Center. Participants 621 consecutive hospitalized patients undergoing sputum examination for evaluation for active pulmonary TB from January 2014—January 2016. Intervention Implementation of a sputum molecular-testing algorithm using GeneXpert MTB/RIF(Xpert) to guide discontinuation of isolation. Main Outcomes and Measures We measured the proportion of patients with molecular testing ordered and completed; the accuracy of the molecular-testing algorithm in reference to mycobacterial culture; the duration of each component of the testing and isolation processes; length of stay; mean days in isolation and in hospital; and mean cost. We extracted data from hospital records and compared measures before and after implementation. Results Among 320 patients evaluated in the post-implementation period, clinicians ordered molecular testing for 234(73%) patients and received results for 295/302(98%) tests ordered. Median age was 54(interquartile range 44–63), and 161(26%) were women. The molecular-testing algorithm accurately diagnosed all seven patients with culture-confirmed TB and excluded TB in all 251 Mtb-culture-negative patients. Compared to the pre-implementation period, there were significant decreases in median times to final rapid-test result(39.1 vs. 22.4 hours, p<0.001), discontinuation of isolation(2.9 vs. 2.5 days, p=0.001), and hospital discharge(6.0 vs 4.9 days, p=0.003), on average saving $13,347 per isolated non-TB patient. Conclusions and Relevance A sputum molecular-testing algorithm to guide discontinuation of respiratory isolation for patients undergoing evaluation for active TB was safe, feasible, widely and sustainably adopted, and provided substantial clinical and economic benefits. Molecular testing may facilitate more efficient, patient-centered evaluation for possible TB in U.S. hospitals.
Background Our medical center laboratory recently adapted its 24/7, two-hourly testing program to use an ARCHITECT-Multispot-viral load (AR-MS-VL) algorithm in place of a previous rapid test-immunofluorescence (RT-IF) algorithm. Objectives We evaluated screening test performance, acute case detection, turnaround time and ability to resolve HIV status under the new algorithm. Study Design We considered consecutive HIV tests from January-November 2015. AR-MS-VL results at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG) were compared with RT-IF results at ZSFG and also with AR-MS-VL results in the recently completed CDC Screening Targeted Populations to Interrupt On-going Chains of HIV Transmission with Enhanced Partner Notification (STOP) Study for targeted testing of MSM at publicly funded testing sites in San Francisco. Results Among 21,985 HIV tests performed at ZSFG, 16,467 were tested by RT-IF and 5,518 by AR-MS-VL. There were 321 HIV infections detected, of which 274 (84%) were known HIV+ cases, and 47 were newly identified HIV infections (prevalence 0.22%). Under the AR-MS-VL algorithm, turnaround times for screening and full algorithm results were 3 and 21 hours; status-unresolved cases were reduced (from 47% to 22%) compared with the RT-IF algorithm. The positive predictive value (PPV) of a new-positive AR screening test was low (0.44) at ZSFG, where no acute infections were detected. At STOP Study sites where acute infection was more common, the AR PPV was higher (0.93). All 24 false-positive AR screening tests at ZSFG had a signal/cutoff (S/CO) ratio of <15 and all 88 true-positive tests had S/CO ratio >15. Of 62 acute infections in the STOP Study, 23 (37%) had an S/CO<15. Discussion An AR-MS-VL algorithm is feasible and can return rapid results in a large medical center. In this setting, reactive 4th generation assay tests that are negative for HIV antibodies are typically false-positive with low S/CO ratios.
Public health interventions to decrease the spread of SARS-CoV-2 were largely implemented in the United States during spring 2020. This study evaluates the additional effects of these interventions on non-SARS-CoV-2 respiratory viral infections from a single healthcare system in the San Francisco Bay Area. The results of a respiratory pathogen multiplex polymerase chain reaction panel intended for inpatient admissions were analyzed by month between 2019 and 2020. We found major decreases in the proportion and diversity of non-SARS-CoV-2 respiratory viral illnesses in all months following masking and shelter-in-place ordinances. These findings suggest real-world effectiveness of nonpharmaceutical interventions on droplet-transmitted respiratory infections.
Background Most diagnostic tests for SARS-CoV-2, the causative agent of COVID-19, are RT-PCR based. This method is sensitive but cannot distinguish replicating from non-replicating virus. RT-PCR cycle threshold (Ct) values are inversely correlated with viral load, and higher Ct values have been correlated with lower in vitro viral infectivity. However, relatively few data exist on the association between Ct values and patients’ duration of symptoms remains unclear. We thus evaluated Ct values and symptom duration in a cohort of patients hospitalized with COVID-19. Methods We assessed all patients admitted to San Francisco General Hospital between April 1 and May 18, 2020 with confirmed COVID-19 infection based on RT-PCR testing (Abbott m2000 platform). We included patients having diagnostic testing for suspected COVID-19 and patients having asymptomatic testing per hospital policy. For symptomatic patients, date of symptom onset was abstracted from hospital records, and time from symptom onset to test date was calculated. RT-PCR Ct values were manually extracted. Median Ct and IQR were calculated for patients with < 10 days of symptoms, ≥10 days of symptoms, and asymptomatic disease. Between-group comparisons were performed using the Kruskal-Wallis test. Results Among 61 patients with positive RT-PCR tests, 40 patients reported < 10 days of symptoms at the time of testing, 15 reported ≥10 days of symptoms, and 6 were asymptomatic. The median Ct value was 14.2 cycles (IQR, 10.2, 18.3) among patients reporting < 10 days of symptoms, 19.7 cycles (IQR, 15.3, 23.9) among patients reporting ≥10 days of symptoms, and 26.3 (IQR, 25.0, 29.1) among asymptomatic patients. Ct values were significantly lower among patients with < 10 days of symptoms compared to patients with >=10 days of symptoms (p=0.01) and when compared to asymptomatic patients (p=0.0002) [Figure]. Cycle threshold (Ct) by days of symptoms at time of testing Conclusion SARS-CoV-2 RT-PCR cycle threshold values were higher (indicating lower viral load) in patients with longer symptom duration and were highest in asymptomatic patients. These results add to emerging data suggesting that strategies for optimal isolation of patients in both community and hospital settings could be informed by a combination of symptom duration and RT-PCR Ct values. Disclosures All Authors: No reported disclosures
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.