Medicine and Health Sciences Commons^™

Factors Associated With Delaying Medical Care: Cross-Sectional Study Of Nebraska Adults, Kendra Ratnapradipa, Snehal Jadhav, Josiane Kabayundo, Hongmei Wang, Lisa C. Smith

Journal Articles: Epidemiology

BACKGROUND: Delayed medical care may result in adverse health outcomes and increased cost. Our purpose was to identify factors associated with delayed medical care in a primarily rural state.

METHODS: Using a stratified random sample of 5,300 Nebraska households, we conducted a cross-sectional mailed survey with online response option (27 October 2020 to 8 March 2021) in English and Spanish. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals.

RESULTS: The overall response rate was 20.8% (n = 1,101). Approximately 37.8% of Nebraskans ever delayed healthcare (cost-related 29.7%, transportation-related 3.7%), with 22.7% delaying care in the …

How The Commonwealth Of The Northern Mariana Islands Stalled Covid-19 For 22 Months And Managed Its First Significant Community Transmission, Dwayne Davis, Stephanie Kern-Allely, Lily Muldoon, John M. Tudela, Jesse Tudela, Renea Raho, Heather S. Pangelinan, Halina Palacios, John Tabaguel, Alan Hinson, Guillermo Lifoifoi, Warren Villagomez, Joseph R. Fauver, Haley L. Cash, Esther Muña, Sean T. Casey, Ali S. Khan

Journal Articles: Epidemiology

OBJECTIVE: The Commonwealth of the Northern Mariana Islands (CNMI) is a remote Pacific island territory with a population of 47 329 that successfully prevented the significant introduction of coronavirus disease (COVID-19) until late 2021. This study documents how the response to the introduction of COVID-19 in CNMI in 2021 was conducted with limited resources without overwhelming local clinical capacity or compromising health service delivery for the population.

METHODS: Data from COVID-19 case investigations, contact tracing, the Commonwealth's immunization registry and whole genome sequencing were collated and analysed as part of this study.

RESULTS: Between 26 March 2020 and 31 December …

Accelerated Sars-Cov-2 Intrahost Evolution Leading To Distinct Genotypes During Chronic Infection, Chrispin Chaguza, Anne M. Hahn, Mary E. Petrone, Shuntai Zhou, David Ferguson, Mallery I. Breban, Kien Pham, Mario A. Peña-Hernández, Christopher Castaldi, Verity Hill, Yale Sars-Cov-2 Genomic Surveillance Initiative, Wade Schulz, Ronald I. Swanstrom, Scott C. Roberts, Nathan D. Grubaugh, Kendall Billig, Rebecca Earnest, Joseph R. Fauver, Chaney C. Kalinch, Nicholas Kerantzas, Tobias R. Koch, Bony De Kumar, Marie L. Landry, Isabel M. Ott, David Peaper, Irina R. Tikhonova, Chantal B. F. Vogels

Journal Articles: Epidemiology

The chronic infection hypothesis for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant emergence is increasingly gaining credence following the appearance of Omicron. Here, we investigate intrahost evolution and genetic diversity of lineage B.1.517 during a SARS-CoV-2 chronic infection lasting for 471 days (and still ongoing) with consistently recovered infectious virus and high viral genome copies. During the infection, we find an accelerated virus evolutionary rate translating to 35 nucleotide substitutions per year, approximately 2-fold higher than the global SARS-CoV-2 evolutionary rate. This intrahost evolution results in the emergence and persistence of at least three genetically distinct genotypes, suggesting …

Nasal Host Response-Based Screening For Undiagnosed Respiratory Viruses: A Pathogen Surveillance And Detection Study, Nagarjuna R. Cheemarla, Amelia Hanron, Joseph R. Fauver, Jason Bishai, Timothy A. Watkins, Anderson F. Brito, Dejian Zhao, Tara Alpert, Chantal B. F. Vogels, Albert I. Ko, Wade L. Schulz, Marie L. Landry, Nathan D. Grubaugh, David Van Dijk, Ellen F. Foxman

Journal Articles: Epidemiology

BACKGROUND: Symptomatic patients who test negative for common viruses are an important possible source of unrecognised or emerging pathogens, but metagenomic sequencing of all samples is inefficient because of the low likelihood of finding a pathogen in any given sample. We aimed to determine whether nasopharyngeal CXCL10 screening could be used as a strategy to enrich for samples containing undiagnosed viruses.

METHODS: In this pathogen surveillance and detection study, we measured CXCL10 concentrations from nasopharyngeal swabs from patients in the Yale New Haven health-care system, which had been tested at the Yale New Haven Hospital Clinical Virology Laboratory (New Haven, …

Viral Kinetics Of Sequential Sars-Cov-2 Infections, Stephen M. Kissler, James A. Hay, Joseph R. Fauver, Christina Mack, Caroline G. Tai, Deverick J. Anderson, David D. Ho, Nathan D. Grubaugh, Yonatan H. Grad

Journal Articles: Epidemiology

The impact of a prior SARS-CoV-2 infection on the progression of subsequent infections has been unclear. Using a convenience sample of 94,812 longitudinal RT-qPCR measurements from anterior nares and oropharyngeal swabs, we identified 71 individuals with two well-sampled SARS-CoV-2 infections between March 11^th, 2020, and July 28^th, 2022. We compared the SARS-CoV-2 viral kinetics of first vs. second infections in this group, adjusting for viral variant, vaccination status, and age. Relative to first infections, second infections usually featured a faster clearance time. Furthermore, a person's relative (rank-order) viral clearance time, compared to others infected with the …

Nonsystematic Reporting Biases Of The Sars-Cov-2 Variant Mu Could Impact Our Understanding Of The Epidemiological Dynamics Of Emerging Variants, Mary E. Petrone, Carolina Lucas, Bridget Menasche, Mallery I. Breban, Inci Yildirim, Melissa Campbell, Saad B. Omer, Edward C. Holmes, Albert I. Ko, Nathan D. Grubaugh, Akiko Iwasaki, Craig B. Wilen, Chantal B. F. Vogels, Joseph R. Fauver

Journal Articles: Epidemiology

Developing a timely and effective response to emerging SARS-CoV-2 variants of concern (VOCs) is of paramount public health importance. Global health surveillance does not rely on genomic data alone to identify concerning variants when they emerge. Instead, methods that utilize genomic data to estimate the epidemiological dynamics of emerging lineages have the potential to serve as an early warning system. However, these methods assume that genomic data are uniformly reported across circulating lineages. In this study, we analyze differences in reporting delays among SARS-CoV-2 VOCs as a plausible explanation for the timing of the global response to the former VOC …

Exploring Barriers And Promoters Of Crc Screening Use Among Agricultural Operators: A Pilot Study Of An Application Of Concept Mapping, Cheryl Beseler, Jungyoon Kim, Roma Subramanian, Susan Harris, Karen Funkenbusch, Aaron Yoder, Tamara Robinson, Jason M. Foster, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

INTRODUCTION: The purpose of the study was to identify barriers and facilitators of colorectal cancer (CRC) screening use among agricultural operators in Nebraska, US.

METHODS: The concept mapping approach was used to engage participants and enhance the generation of ideas and opinions regarding CRC screening. Two focus groups (seven women and seven men) were conducted.

RESULTS: Among women, the cost domain was most agreed upon as important, followed by experiencing symptoms, awareness, and family. Among men, the important concepts related to CRC screening were family and friend support, feeling too young to get CRC, family or personal history of CRC, …

Biomarkers Of Toxic Exposure And Oxidative Stress Among U.S. Adult Users Of Premium Cigar Versus Other Cigar Subtypes: 2013-2019, Hongying Dai, Neal L. Benowitz, Eleanor Rogan, Abraham Degarege, James Buckley, Ali S. Khan

Journal Articles: Epidemiology

INTRODUCTION: Cigars are currently the second-highest-used combustible tobacco product among U.S. adults, but knowledge about health effects of premium cigars versus other cigar subtype use is limited.

AIMS AND METHODS: This study analyzed the biospecimen data (n = 31 875) from Waves 1-5 of the Population Assessment of Tobacco and Health Study, collected during 2013-2019. Multivariable generalized estimation equations, accounting for within-person clustering, were conducted to examine differences in urine biomarkers of exposure (BOE) from five classes of harmful and potentially harmful constituents along with a biomarker of oxidative stress (urine 8-isoprostane) among exclusive users of premium cigars versus other …

Development And Validation Of A Questionnaire To Assess Awareness And Knowledge Of Nonalcoholic Fatty Liver Disease, A Liver Cancer Etiological Factor, Among Chinese Young Adults, Yi Du, Fedja A. Rochling, Dejun Su, Kendra Ratnapradipa, Jianghu James Dong, Evi A. Farazi

Journal Articles: Epidemiology

PURPOSE: Despite the increasing prevalence of nonalcoholic fatty liver disease (NAFLD), a liver cancer etiological factor, among Chinese young adults (CYA), there is a lack of valid, reliable, ready-to-use survey instruments for assessing awareness and knowledge of NAFLD in this population. The aims of this study were to develop, validate, and assess the reliability of a web-based, self-administered questionnaire evaluating awareness and knowledge of NAFLD among CYA.

METHODS: Based on review of relevant literature, a draft questionnaire was initially developed. Face and content validity of the questionnaire was evaluated by an expert panel of seven gastroenterologists. The construct validity was …

Exploring First Responders' Use And Perceptions On Continuous Health And Environmental Monitoring, Jacob Grothe, Sarah Tucker, Anthony Blake, Chandran Achutan, Sharon J. Medcalf, Troy Suwondo, Ann Fruhling, Aaron Yoder

Journal Articles: Epidemiology

First responders lose their lives in the line of duty each year, and many of these deaths result from strenuous physical exertion and exposure to harmful environmental agents. Continuous health monitoring may detect diseases and alert the first responder when vital signs are reaching critical levels. However, continuous monitoring must be acceptable to first responders. The purpose of this study was to discover first responders' current use of wearable technology, their perceptions of what health and environmental indicators should be monitored, and who should be permitted to monitor them. The survey was sent to 645 first responders employed by 24 …