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Introduction: Using National HIV surveillance system data, we estimated life expectancy and average years of life lost (AYLL) among persons diagnosed with HIV infection during 2008-2011. Methods: Population-based surveillance data, restricted to persons with diagnosed HIV infection aged 13 years or older, from all 50 states and Washington, D.C. were used to estimate life expectancy after HIV diagnosis using the life table method. Generated estimates were compared with life expectancy in the general population in the same calendar year to calculate AYLL. Life expectancy and AYLL were also estimated for subgroups by age, sex, and race/ethnicity. Results: The overall life expectancy after HIV diagnosis in the United States increased by 3.43 years from 25.43 (95% CI: 25.37 to 25.49) in 2008 to 28.86 (95% CI: 28.80 to 28.92) in 2011. Improvements were observed irrespective of sex, race/ethnicity, transmission category, and stage of disease at diagnosis, though the extent of improvement varied by different characteristics. Based on the life expectancy in the general population, in 2010, the AYLL were 12.8 years for males and 16.5 years for females. By race/ ethnicity, on average, blacks (13.3 years) and whites (13.4 years) had fewer AYLL than Hispanics/Latinos (14.7). Conclusions: Despite improvements in life expectancy among people diagnosed with an HIV infection during 2008-2011, disparities by sex and by race/ethnicity persist. Targeted efforts should continue to further reduce disparities and improve life expectancy after HIV diagnosis. [ABSTRACT FROM AUTHOR]

The article reports on the initiative to reduce African Americans with HIV infection through the National HIV/AIDS Strategy from 2008 through 2012. Topics discussed include the mortality rate among African Americans based on the National HIV Surveillance System for 2008-2012 data, racial and ethnic disparities in U.S. states and the effect of the disease on persons living with HIV. The prevention approach adopted by the Centers for Disease Control and Prevention (CDC) is mentioned.

This study prospectively compared the effect of secondary prophylaxis to episodic treatment on target joint ( TJ) range of motion ( ROM), number of joint haemorrhages and new TJ development in patients with moderate or severe haemophilia. Two-hundred and eighty-six males, 17% in prophylaxis, 83% in episodic treatment group, participating in the Centers for Disease Control and Prevention's Universal Data Collection project, fulfilled inclusion criteria: age >2 years at enrolment, free of TJs at enrolment, developed at least one TJ after enrolment, and received either prophylaxis or episodic treatment continuously for two follow-up visits after TJ development. The outcomes of interest - percentage change in TJ ROM, number of joint haemorrhages and new TJ development, were modelled using multivariate linear, Poisson and logistic regression techniques respectively. Individuals who received secondary prophylaxis in comparison to episodic treatment were younger at TJ development ( P < 0·01); there was no difference in the decrease in TJ ROM between the two groups ( P = 0·9). Factors significantly associated with a higher rate of haemarthroses included episodic treatment, severe haemophilia, age >5 years at TJ development, obesity and inhibitor negative status. Secondary prophylaxis significantly decreased haemarthroses but was not associated with a significant improvement in TJ ROM or with new TJ development. [ABSTRACT FROM AUTHOR]

HIV infection is monitored through the National HIV Surveillance System (NHSS) to help improve the health of people with HIV and reduce transmission. NHSS data are routinely used at federal, state, and local levels to monitor the distribution and transmission of HIV, plan and evaluate prevention and care programs, allocate resources, inform policy development, and identify and respond to rapid transmission in the United States. We describe the expanded use of HIV surveillance data since the 2013 NHSS status update, during which time the Centers for Disease Control and Prevention (CDC) coordinated to revise the HIV surveillance case definition to support the detection of early infection and reporting of laboratory data, expanded data collection to include information on sexual orientation and gender identity, enhanced data deduplication processes to improve quality, and expanded reporting to include social determinants of health and health equity measures. CDC maximized the effects of federal funding by integrating funding for HIV prevention and surveillance into a single program; the integration of program funding has expanded the use of HIV surveillance data and strengthened surveillance, resulting in enhanced cluster response capacity and intensified data-to-care activities to ensure sustained viral suppression. NHSS data serve as the primary source for monitoring HIV trends and progress toward achieving national initiatives, including the US Department of Health and Human Services' Ending the HIV Epidemic in the United States initiative, the White House's National HIV/AIDS Strategy (2022-2025), and Healthy People 2030. The NHSS will continue to modernize, adapt, and broaden its scope as the need for high-quality HIV surveillance data remains. [ABSTRACT FROM AUTHOR]

Background: Hemophilia is a hereditary bleeding disorder. Its complications can result in substantial morbidity, but few efforts have been made to quantify the disease burden. Purpose: The objective of this analysis was to estimate the burden of disease due to hemophilia (A and B) in the U.S., using disability-adjusted life years (DALY). Methods: The approach taken by the WHO in its Global Burden of Disease study was followed. Assumptions were drawn from published literature, and population estimates from the U.S. Census Bureau for the Year 2007 were used. Estimations of years of life lost resulting from mortality (YLL) and years of life lost resulting from morbidity (YLD) were done separately by gender, 5-year age intervals, and severity of disease (morbidity only) with their sum representing DALYs. Disability weights were derived from the quality-of-life tool EuroQol (EQ-5D). The stability of burden estimates was tested by performing sensitivity analyses, changing one assumption at a time. Results: In the U.S. in 2007, hemophilia resulted in 110,095 DALYs, composed of 13,418 YLLs and 96,677 YLDs. Large differences between men/boys (107,346) and women/girls (2749) were observed, given that females are genetic carriers of the disorder and rarely present with disease. Sensitivity analyses revealed a relatively robust estimate with a maximum variation of 4.49%. Conclusions: This first estimate of hemophilia-related DALYs in the U.S. indicates that control of hemophilia can potentially result in a gain of 1 healthy year of life for every 2700 people in the population. [Copyright &y& Elsevier]

Objective The purpose of this study was to test for moderating effects of patient characteristics on self-management interventions developed to address symptoms during cancer treatment. Patient's age, education, and depressive symptomatology were considered as potential moderators. Methods A secondary analysis of data of 782 patients from two randomized clinical trials was performed. Both trials enrolled patients with solid tumors undergoing chemotherapy. After completing baseline interviews, patients were randomized to a nurse-delivered intervention versus intervention delivered by a 'coach' in trial I and to a nurse-delivered intervention versus an intervention delivered by an automated voice response system in trial II. In each of the two trials, following a six-contact 8-week intervention, patients were interviewed at week 10 to assess the primary outcome of symptom severity. Results Although nurse-delivered intervention proved no better than the coach or automated system in lowering symptom severity, important differences in the intervention by age were found in both trials. Patients aged ≤45 years responded better to the coach or automated system, whereas those aged ≥75 years favored the nurse. Education and depressive symptomatology did not modify the intervention effects in either of the two trials. Depressive symptomatology had a significant main effect on symptom severity at week 10 in both trials ( p = 0.03 and p < 0.01, respectively). Education was not associated with symptom severity over and above age and depressive symptomatology. Conclusions Clinicians need to carefully consider the age of the population when using or testing interventions to manage symptoms among cancer patients. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In its decades-long history, the Division of Blood Disorders (DBD) at CDC has evolved from a patient-focused, services-supporting entity at inception, to one of the world leaders in the practice of public health to improve the lives of people at risk for or affected by nonmalignant blood disorders. The DBD’s earliest public health activities consisted of working with care providers in a network of hemophilia treatment centers to provide AIDS risk reduction services to people with hemophilia. Because this infectious disease threat has been reduced over time as a result of the development of safer treatment products, the DBD—under the auspices of congressional appropriations guidance—has expanded its core activities to encompass blood disorders other than hemophilia, including hemoglobinopathies such as thalassemia and sickle cell disease, and Diamond Blackfan anemia. Simultaneously, in transitioning to a greater public health role, the DBD has expanded its network of partners to new consumer and professional organizations, as well as state and other federal health agencies. The DBD has also developed and maintains many surveillance and registry activities beyond the Universal Data Collection system aimed at providing a better understanding of the health status, health needs, and health-related quality of life of people with nonmalignant blood disorders. The DBD has integrated applicable components of the Essential Services of Public Health successfully to promote and advance the agenda of blood disorders in public health. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To evaluate patient characteristics to predict selection and maintenance of a complementary therapy and the feasibility of a randomized clinical trial (RCT) of complementary therapies. Design: Quasi-experimental, exploratory study, unblinded and nonrandomized. Setting: A comprehensive cancer center in Michigan. Sample: 96 patients undergoing chemotherapy, predominantly Caucasian women. Methods: Consenting patients with caregivers could choose a reflexology, guided imagery, guided imagery plus reflexology, or interview-only group. Patients without caregivers were restricted to guided imagery or interview-only groups. Data on demographics, depression, anxiety, and functional status were collected using established instruments. Main Research Variables: Quality of life (QOL) and patient characteristics in relation to complementary therapy choice. Findings: Patients who chose a complementary therapy rather than an interview only tended to be older and in worse health and had higher percentages of lung cancer, late-stage cancers, higher anxiety, depressive symptoms, and physical limitations at baseline. Patients lost from the guided imagery and guided imagery plus reflexology groups had greater symptom severity, depressive symptoms and anxiety, and worse physical and emotional well-being than those lost from the reflexology group. Conclusions: Patient characteristics influence choice of complementary therapies, highlighting the need for RCTs to evaluate the true effect of complementary therapies on the QOL of patients with cancer. Further research on complementary therapies can help healthcare providers identify patients who are likely to benefit most by addressing nursing-sensitive outcomes. Implications for Nursing: An RCT of reflexology as a single therapy for females with breast cancer is most feasible compared to other complementary therapies. [ABSTRACT FROM AUTHOR]

Background: The majority of U.S. disease surveillance systems contain incomplete information regarding socioeconomic status (SES) indicators like household or family income and educational attainment in case reports, which reduces the usefulness of surveillance data for these parameters. We investigated the association between select SES attributes at the neighborhood level and Salmonella infections in the three most populated counties in Michigan using a geographic information system. Methods: We obtained data on income, education, and race from the 2000 U.S. Census, and the aggregate number of laboratory-confirmed cases of salmonellosis (1997-2006) at the block group level from the Michigan Department of Community Health. We used ArcGIS to visualize the distribution, and Poisson regression analysis to study associations between potential predictor variables and Salmonella infections. Results: Based on data from 3,419 block groups, our final multivariate model revealed that block groups with lower educational attainment were less commonly represented among cases than their counterparts with higher education levels (< high school degree vs. ≥ college degree: rate ratio (RR) = 0.79, 95% confidence interval (CI):0.63, 0.99; ≥ and high school degree, but no college degree vs. ≥ college degree: RR = 0.84, 95% CI: 0.76, 0.92). Levels of education also showed a dose-response relation with the outcome variable, i.e., decreasing years of education was associated with a decrease in Salmonella infections incidence at the block group level. Conclusion: Education plays a significant role in health-seeking behavior at the population level. It is conceivable that a reporting bias may exist due to a greater detection of Salmonella infections among high education block groups compared to low education block groups resulting from differential access to healthcare. In addition, individuals of higher education block groups who also have greater discretionary income may eat outside the home frequently and be more likely to own pets considered reservoirs of Salmonella, which increase the likelihood of contracting Salmonella infections compared to their counterparts with lower levels of education. Public health authorities should focus on improving the level of disease detection and reporting among communities with lower income and education and further evaluate the role of higher educational attainment in the predisposition for salmonellosis. [ABSTRACT FROM AUTHOR]

Objective: To examine changes in the rate of beta-blocker (BB) use at admission, in hospital, and at discharge between 1994 and 1995 (MICH I) and 1997 (MICH II) in patients with acute myocardial infarction (AMI).Design: Comparison of two prospectively enrolled cohorts.Setting: Five mid-Michigan community hospitals.Patients: We studied 287 MICH I patients and 121 MICH II patients with AMI who had no contraindications to BB use from cohorts of consecutively admitted cases of AMI (814 in MICH I; 500 in MICH II).Results: Prescription of BBs to ideal patients with AMI increased in patients with previous history of myocardial infarction on arrival at the hospital (12.5% vs 36.0%; P= .01), in hospital (47.0% vs 76%; P < .01), and at discharge (34.0% vs 61.9%; P < .01). Neither race nor gender was a predictor of BB use. Younger age predicted BB prescription at discharge (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.32 to 3.23). Later study cohort was the most important predictor of BB use in hospital (OR, 3.4; 95% CI, 2.09 to 5.25).Conclusion: BB use improved dramatically over the study period, but additional work is needed to improve use of BB after discharge and among elderly patients with AMI. [ABSTRACT FROM AUTHOR]

Background Annual human immunodeficiency virus (HIV) diagnoses in the United States (US) have plateaued since 2013. We assessed whether there is an association between uptake of pre-exposure prophylaxis (PrEP) and decreases in HIV diagnoses. Methods We used 2012–2016 data from the US National HIV Surveillance System to estimate viral suppression (VS) and annual percentage change in diagnosis rate (EAPC) in 33 jurisdictions, and data from a national pharmacy database to estimate PrEP uptake. We used Poisson regression with random effects for state and year to estimate the association between PrEP coverage and EAPC: within jurisdictional quintiles grouped by changes in PrEP coverage, regressing EAPC on time; and among all jurisdictions, regressing EAPC on both time and jurisdictional changes in PrEP coverage with and without accounting for changes in VS. Results From 2012 to 2016, across the 10 states with the greatest increases in PrEP coverage, the EAPC decreased 4.0% (95% confidence interval [CI], −5.2% to −2.9%). On average, across the states and District of Columbia, EAPC for a given year decreased by 1.1% (95% CI, −1.77% to −.49%) for an increase in PrEP coverage of 1 per 100 persons with indications. When controlling for VS, the state-specific EAPC for a given year decreased by 1.3% (95% CI, −2.12% to −.57%) for an increase in PrEP coverage of 1 per 100 persons with indications. Conclusions We found statistically significant associations between jurisdictional increases in PrEP coverage and decreases in EAPC independent of changes in VS, which supports bringing PrEP use to scale in the US to accelerate reductions in HIV infections. [ABSTRACT FROM AUTHOR]

Background: The suppression of viremia among persons with HIV (PWH) using antiretroviral therapy has been hypothesized to reduce HIV incidence at the population level. We investigated the impact of state level viral suppression among PWH in the United States on estimated HIV incidence between 2010 and 2015. Methods: Viral suppression data and HIV incidence estimates from the National HIV Surveillance System were available from 29 states and the District of Columbia. We assumed a one year delay for viral suppression to impact incidence. Poisson regression models were used to calculate the estimated annual percent change (EAPC) in incidence rate. We employed a multivariable mixed-effects Poisson regression model to assess the effects of state level race/ethnicity, socioeconomic status, percent men who have sex with men (MSM) and hepatitis C virus prevalence as a proxy for injection drug use on HIV incidence. Findings: Fitted HIV incidence for 30 jurisdictions declined from 11.5 in 2010 to 10.0 per 100,000 population by 2015 corresponding with an EAPC of -2.67 (95% confidence interval [95%CI] -2.95, -2.38). Southern states experienced the highest estimated incidence by far throughout this period but upon adjustment for viral suppression and demographics there was a 36% lower incidence rate than Northeast states (adjusted rate ratio [aRR] 0.64; 95%CI 0.42, 0.99). For every 10 percentage point (pp) increase in viral suppression there was an adjusted 4% decline in HIV incidence rate in the subsequent year (aRR 0.96; 95%CI 0.93, 0.99). While controlling for viral suppression, HIV incidence rate increased by 42% (aRR 1.42 95%CI 1.31, 1.54) for every 5 pp increase in percent Black race and by 27% (aRR 1.27 95%CI 1.10, 1.48) for every 1 pp increase in percent MSM in states. Interpretation: A decline in estimated HIV incidence from 2010 to 2015 was associated with increasing viral suppression in the United States. Race and sexual orientation were important HIV acquisition risk factors. [ABSTRACT FROM AUTHOR]

Background: In 2017, 19% of new HIV diagnoses in the United States were in women. HIV acquisition can be prevented with pre-exposure prophylaxis, and HIV transmission with viral suppression. HIV viral suppression is achieved by linking women to care and supporting adherence to antiretroviral medications. The national HIV prevention goal for viral suppression is 80%. Setting: United States. Methods: We analyzed data reported by 40 US jurisdictions to the Centers for Disease Control and Prevention's National HIV Surveillance System to determine the number and rate of HIV diagnoses per 100,000 women in 2016. We also determined the percentages of women with diagnosed HIV who were linked to care within 1 and 3 months, received HIV care, were retained in HIV care, and were virally suppressed in 2015. Findings were stratified by demographic characteristics and HIV transmission category. Results: In 2016, 6407 women were diagnosed with HIV. Black women had a rate of 783.7 per 100,000, Hispanic/Latino women 182.7, and white women 43.6. In 2015, 190,735 women were living with diagnosed HIV. Viral suppression increased with age, ranging from 46.5% among women aged 13–24 years to 62.3% among women aged ≥45 years. Black women had the lowest rate of viral suppression (55.5%). No age group of women achieved 80% viral suppression. Conclusions: Pre-exposure prophylaxis implementation for women at high risk for HIV infection can help to decrease new infections. Women living with HIV would benefit from interventions that support linkage to HIV care and antiretroviral medication adherence to increase viral suppression. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to use Indian Health Service (IHS) data from electronic health records to analyze human immunodeficiency virus (HIV) diagnoses among American Indian/Alaska Natives (AI/ANs) and to identify current rates and trends that can support data-driven policy implementation and resource allocation for this population. Methods: We analyzed provider visit data from IHS to capture all AI/AN patients who met a definition of a new HIV diagnosis from 2005 through 2014 by using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We calculated rates and trends of new HIV diagnoses by age, sex, region, and year per 100 000 AI/ANs in the IHS user population. Results: A total of 2273 AI/ANs met the definition of newly diagnosed with HIV from 2005 through 2014, an average annual rate of 15.1 per 100 000 AI/ANs. Most (356/391) IHS health facilities recorded at least 1 new HIV diagnosis. The rate of new HIV diagnoses among males (21.3 per 100 000 AI/ANs) was twice as high as that among females (9.5 per 100 000 AI/ANs; rate ratio = 2.2; 95% confidence interval, 2.1-2.4); by age, rates were highest among those aged 20-54 for males and females. By region, the Southwest region had the highest number (n = 1016) and rate (19.9 per 100 000 AI/ANs) of new HIV diagnoses. Overall annual rates of new HIV diagnoses were stable from 2010 through 2014, although diagnosis rates increased among males (P < .001) and those aged 15-19 (P < .001), 45-59 (P < .001), and 50-54 (P = .01). Conclusions: New HIV diagnoses, derived from provider visit data, among AI/ANs were stable from 2010 through 2014. AI/ANs aged 20-54, particularly men, may benefit from increased HIV prevention and screening efforts. Additional services may benefit patients in regions with higher rates of new diagnoses and in remote settings in which reported HIV numbers are low. [ABSTRACT FROM AUTHOR]

The transformation of HIV from a fatal disease to lifelong disease has resulted in an HIV-infected population that is growing and aging, placing new and increasing demands on public programs and health services. We used National HIV Surveillance System and US census data to project the demographic composition of the population of people living with diagnosed HIV (PLWDH) in the United States through 2045. The input parameters for the projections include: (1) census projections, (2) number of people with an existing HIV diagnosis in 2013, (3) number of new HIV diagnoses in 2013, and (4) death rate within the PLWDH population in 2013. Sex-, risk group-, and race-specific projections were estimated through an adapted Leslie Matrix Model for age-structured populations. Projections for 2013–2045 suggest that the number of PLWDH in the U.S. will consistently grow, from 917,294 to 1,232,054, though the annual growth rate will slow from 1.8% to 0.8%. The number of PLWDH aged 55 years and older will increase from 232,113 to 470,221. The number of non-Hispanic (NH) African Americans/Blacks and Hispanics is projected to consistently grow, shifting the racial/ethnic composition of the US PLWDH population from 32 to 23% NH-White, 42 to 38% NH-Black, and 20–32% Hispanic between 2013 and 2045. Given current trends, the composition of the PLWDH population is projected to change considerably. Public health practitioners should anticipate large shifts in the age and racial/ethnic structure of the PLWDH population in the United States. [ABSTRACT FROM PUBLISHER]

Objective: A recent HIV outbreak in a rural network of persons who inject drugs (PWID) underscored the intersection of the expanding epidemics of opioid abuse, unsterile injection drug use (IDU), and associated increases in hepatitis C virus (HCV) infections. We sought to identify US communities potentially vulnerable to rapid spread of HIV, if introduced, and new or continuing high rates of HCV infections among PWID. Design: We conducted a multistep analysis to identify indicator variables highly associated with IDU. We then used these indicator values to calculate vulnerability scores for each county to identify which were most vulnerable. Methods: We used confirmed cases of acute HCV infection reported to the National Notifiable Disease Surveillance System, 2012-2013, as a proxy outcome for IDU, and 15 county-level indicators available nationally in Poisson regression models to identify indicators associated with higher county acute HCV infection rates. Using these indicators, we calculated composite index scores to rank each county's vulnerability. Results: A parsimonious set of 6 indicators were associated with acute HCV infection rates (proxy for IDU): drug-overdose deaths, prescription opioid sales, per capita income, white, non-Hispanic race/ethnicity, unemployment, and buprenorphine prescribing potential by waiver. Based on these indicators, we identified 220 counties in 26 states within the 95th percentile of most vulnerable. Conclusions: Our analysis highlights US counties potentially vulnerable to HIV and HCV infections among PWID in the context of the national opioid epidemic. State and local health departments will need to further explore vulnerability and target interventions to prevent transmission. [ABSTRACT FROM AUTHOR]

Hispanics or Latinos represent about 17% of the total U.S. population and are disproportionately affected by human immunodeficiency virus (HIV) infection in the United States. In 2013, the rate of HIV diagnosis among Hispanics or Latinos (18.7) was nearly three times that of non-Hispanic whites (6.6). To better characterize HIV infection among Hispanics or Latinos aged ≥13 years in the United States, CDC analyzed data from the National HIV Surveillance System (NHSS). During 2008-2013, the rate of diagnoses of HIV infection among adult and adolescent Hispanics or Latinos decreased from 28.3 per 100,000 population in 2008 to 24.3 in 2013 (estimated annual percentage change [EAPC] = -3.6); however, the number of diagnoses among males with infection attributed to male-to-male sexual contact increased 16%, from 6,141 in 2008 to 7,098 in 2013 (EAPC = 3.0). In 2013, the rate of diagnosis of HIV infection among males (41.3) was six times the rate among females (6.8). During 2008-2013, behavioral risk factors for HIV infection among Hispanics or Latino differed among males and females and by place of birth. Among Hispanic or Latino males born in Puerto Rico, the proportion of HIV infections attributed to injection drug use (24.9%) was greater than among those born elsewhere. Among HIV-infected Hispanic or Latino females, those born in the United States (21.2%) and Puerto Rico (20.5%) had a greater proportion of HIV infections attributed to injection drug use than those born elsewhere. Additional interventions and public health strategies to further decrease the rates of HIV among the Hispanic or Latino population are needed. [ABSTRACT FROM AUTHOR]

Background: Infections with Salmonella serotypes continue to be a significant global public health problem. In addition to contaminated foods, several other sources contribute to infections with Salmonella serotypes. We have assessed the role of socioeconomic factors, exposure to food, and environmental sources in the etiology of nontyphoidal Salmonella infections in Michigan children. Findings: A case-control study among Michigan children aged ≤ 10 years was conducted. A total of 123 cases of children with laboratory-confirmed Salmonella infections and 139 control children, who had not experienced symptoms of gastrointestinal illness during the month prior to the interviews, were enrolled. The cases and controls were matched on age-category (<1 year, 2-<6 years and 6-10 years). Data on socioeconomic status, food intake, and environmental exposures, were collected on the queried case and control subjects. After adjusting for race and household-income the final regression multivariable model revealed that Salmonella infections were significantly associated with attendance of a daycare center (adjusted matched odds ratio = 5.00, 95% CI: 1.51 - 16.58), contact with cats (MOR = 2.53, 95% CI: 1.14 - 5.88), and contact with reptiles (MOR = 7.90, 95% CI: 1.52 - 41.01), during the 3 days prior to the onset of child's illness. Conclusions: Study results suggest that exposure to environmental sources may play an important role in sporadic infections with Salmonella serotypes in children. Additional efforts are needed to educate parents and caretakers about the risk of Salmonella transmission to children from these sources. [ABSTRACT FROM AUTHOR]

Epidemiologic studies conducted in the 1990s identified several independent healthcare associated risk factors for HBV and HCV infections in Pakistan. In 2002, we re-examined healthcare associated HBV and/or HCV infection risk factors in volunteer blood donors. In this case-control study, we collected data using a structured questionnaire on socioeconomic attributes, putative healthcare related risk factors, and other known factors for HBV and HCV infections in Karachi, Pakistan. The multivariable logistic-regression model (166 cases, 394 controls) after adjusting for socio-demographic attributes and other known HBV and HCV risk factors revealed that more cases than controls had multiple lifetime hospitalization, adjusted odds ratio (AOR) = 2.48; 95% confidence interval (CI) 1.04, 5.94, and had received dental treatment from an unqualified provider (AOR = 5.90, CI, 1.66, 21.02). More cases than controls had received a large number of therapeutic injections during the last 5 years (1-5 injections vs. 0, AOR = 2.64, 95% CI 1.06, 6.60; 6-19 injections vs. 0, AOR = 4.09, 95% CI 1.59, 10.51; > or = 20 injections vs. 0, AOR = 4.34, 95% CI 1.70,11.07), and had their last injection given using a re-usable glass syringe (AOR = 3.41 CI 1.13, 10.29). Our data suggest that risk factors for HBV and HCV infections identified in the last decade have remained unchanged in healthcare facilities in Karachi. Additional multi-disciplinary efforts are needed to control healthcare associated HBV and HCV transmission in Pakistan. [ABSTRACT FROM AUTHOR]

Background: Telephone counseling in chronic disease self-management is increasing, but has not been tested in studies that control for quality of medical care.Objective: To test the effectiveness of a six-session outpatient telephone-based counseling intervention to improve secondary prevention (behaviors, medication) in patients with acute coronary syndrome (ACS) following discharge from hospital, and impact on physical functioning and quality of life at 8 months post-discharge.Design: Patient-level randomized trial of hospital quality improvement (QI-only) versus quality improvement plus brief telephone coaching in three months post-hospitalization (QI-plus).Data: medical record, state vital records, patient surveys (baseline, three and eight months post-hospitalization).Analysis: pooled-time series generalized estimating equations to analyze repeated measures; intention-to-treat analysis.Participants: Seven hundred and nineteen patients admitted to one of five hospitals in two contiguous mid-Michigan communities enrolled; 525 completed baseline surveys.Measurements: We measured secondary prevention behaviors, physical functioning, and quality of life.Results: QI-plus patients showed higher self-reported physical activity (OR = 1.53; p = .01) during the first three months, with decline after active intervention was withdrawn. Smoking cessation and medication use were not different at 3 or 8 months; functional status and quality of life were not different at 8 months.Conclusions: Telephone coaching post-hospitalization for ACS was modestly effective in accomplishing short-term, but not long-term life-style behavior change. Previous positive results shown in primary care did not transfer to free-standing telephone counseling as an adjunct to care following hospitalization. [ABSTRACT FROM AUTHOR]