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1.
Dialogues Health ; 4: 100179, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38813579

ABSTRACT

Background: During the COVID-19 pandemic there was a plethora of dynamical forecasting models created, but their ability to effectively describe future trajectories of disease was mixed. A major challenge in evaluating future case trends was forecasting the behavior of individuals. When behavior was incorporated into models, it was primarily incorporated exogenously (e.g., fitting to cellphone mobility data). Fewer models incorporated behavior endogenously (e.g., dynamically changing a model parameter throughout the simulation). Methods: This review aimed to qualitatively characterize models that included an adaptive (endogenous) behavioral element in the context of COVID-19 transmission. We categorized studies into three approaches: 1) feedback loops, 2) game theory/utility theory, and 3) information/opinion spread. Findings: Of the 92 included studies, 72% employed a feedback loop, 27% used game/utility theory, and 9% used a model if information/opinion spread. Among all studies, 89% used a compartmental model alone or in combination with other model types. Similarly, 15% used a network model, 11% used an agent-based model, 7% used a system dynamics model, and 1% used a Markov chain model. Descriptors of behavior change included mask-wearing, social distancing, vaccination, and others. Sixty-eight percent of studies calibrated their model to observed data and 25% compared simulated forecasts to observed data. Forty-one percent of studies compared versions of their model with and without endogenous behavior. Models with endogenous behavior tended to show a smaller and delayed initial peak with subsequent periodic waves. Interpretation: While many COVID-19 models incorporated behavior exogenously, these approaches may fail to capture future adaptations in human behavior, resulting in under- or overestimates of disease burden. By incorporating behavior endogenously, the next generation of infectious disease models could more effectively predict outcomes so that decision makers can better prepare for and respond to epidemics. Funding: This study was funded in-part by Centers for Disease Control and Prevention (CDC) MInD-Healthcare Program (1U01CK000536), the National Science Foundation (NSF) Modeling Dynamic Disease-Behavior Feedbacks for Improved Epidemic Prediction and Response grant (2229996), and the NSF PIPP Phase I: Evaluating the Effectiveness of Messaging and Modeling during Pandemics grant (2200256).

2.
Ann Emerg Med ; 2024 Jan 23.
Article in English | MEDLINE | ID: mdl-38260931

ABSTRACT

STUDY OBJECTIVE: Inappropriate antibiotic prescribing for acute respiratory tract infections is a common source of low-value care in the emergency department (ED). Racial and socioeconomic disparities have been noted in episodes of low-value care, particularly in children. We evaluated whether prescribing rates for acute respiratory tract infections when antibiotics would be inappropriate by guidelines differed by race and socioeconomics. METHODS: A retrospective cross-sectional analysis of adult and pediatric patient encounters in the emergency department (ED) between 2015 and 2023 at 5 hospitals for acute respiratory tract infections that did not require antibiotics by guidelines. Multivariable regression was used to calculate the risk ratio between race, ethnicity, and area deprivation index and inappropriate antibiotic prescribing, controlling for patient age, sex, and relevant comorbidities. RESULTS: A total of 147,401 ED encounters (55% pediatric, 45% adult) were included. At arrival, 4% patients identified as Asian, 50% as Black, 5% as Hispanic, and 23% as White. Inappropriate prescribing was noted in 7.6% of overall encounters, 8% for Asian patients, 6% for Black patients, 5% for Hispanic patients, and 12% for White patients. After adjusting for age, sex, comorbidities, and area deprivation index, White patients had a 1.32 (95% confidence interval, 1.26 to 1.38) higher likelihood of receiving a prescription compared with Black patients. Patients residing in areas of greater socioeconomic deprivation, regardless of race and ethnicity, had a 0.74 (95% confidence interval, 0.70 to 0.78) lower likelihood of receiving a prescription. CONCLUSION: Our results suggest that although overall inappropriate prescribing was relatively low, White patients and patients from wealthier areas were more likely to receive an inappropriate antibiotic prescription.

3.
Open Forum Infect Dis ; 10(3): ofad096, 2023 Mar.
Article in English | MEDLINE | ID: mdl-36949878

ABSTRACT

Background: Declines in outpatient antibiotic prescribing were reported during the beginning of the coronavirus disease 2019 (COVID-19) pandemic in the United States; however, the overall impact of COVID-19 cases on antibiotic prescribing remains unclear. Methods: This was an ecological study using random-effects panel regression of monthly reported COVID-19 county case and antibiotic prescription data, controlling for seasonality, urbanicity, health care access, nonpharmaceutical interventions (NPIs), and sociodemographic factors. Results: Antibiotic prescribing fell 26.8% in 2020 compared with prior years. Each 1% increase in county-level monthly COVID-19 cases was associated with a 0.009% (95% CI, 0.007% to 0.012%; P < .01) increase in prescriptions per 100 000 population dispensed to all ages and a 0.012% (95% CI, -0.017% to -0.008%; P < .01) decrease in prescriptions per 100 000 children. Counties with schools open for in-person instruction were associated with a 0.044% (95% CI, 0.024% to 0.065%; P < .01) increase in prescriptions per 100 000 children compared with counties that closed schools. Internal movement restrictions and requiring facemasks were also associated with lower prescribing among children. Conclusions: The positive association of COVID-19 cases with prescribing for all ages and the negative association for children indicate that increases in prescribing occurred primarily among adults. The rarity of bacterial coinfection in COVID-19 patients suggests that a fraction of these prescriptions may have been inappropriate. Facemasks and school closures were correlated with reductions in prescribing among children, possibly due to the prevention of other upper respiratory infections. The strongest predictors of prescribing were prior years' prescribing trends, suggesting the possibility that behavioral norms are an important driver of prescribing practices.

4.
J Womens Health (Larchmt) ; 31(5): 733-740, 2022 05.
Article in English | MEDLINE | ID: mdl-35005999

ABSTRACT

Background: Long-acting reversible contraceptives (LARCs) are highly effective forms of contraception, which can reduce the risk of unintended pregnancy. Despite LARC effectiveness, women may desire to discontinue this method. This study will examine reasons for intent to discontinue and remove LARCs among U.S. women 15-49 years of age from 2017 to 2019. Methods: The National Survey of Family Growth 2017-2019 was utilized with a sample of 6141 female respondents. Descriptive statistics for intention to discontinue LARCs, difficulty removing LARCs, and reasons for LARC discontinuation and removal were examined. Rao-Scott chi-square tests were conducted in SAS. Results: Overall, 22.9% of women reported ever using LARCs. Among LARC users, most women (81.2%) reported using LARC in the past 10 years. Among these women, 63.9% intended to discontinue LARCs, and 11.5% had difficulty removing LARCs. Reasons for wanting to discontinue LARCs include side effects (29.6%), LARC expiration (26.8%), LARC complications (19.3%), and decided to get pregnant (15.9%). Primary reasons reported for difficulty removing LARCs included: complications (68.3%), other reasons (13.4%), discouragement by provider (5.8%), and provider's inability to remove (4.9%). Conclusions: Given that women who use a LARC method rely on providers to remove this contraceptive method, understanding the reasons for discontinuation and difficulties encountered is needed. Findings from this nationally representative sample identified provider-level and system-level barriers for LARC removal. To respect the reproductive autonomy of LARC users' method for pregnancy prevention, these barriers must be overcome.


Subject(s)
Contraceptive Agents , Intention , Contraception/methods , Contraception Behavior , Female , Humans , Pregnancy , Pregnancy, Unplanned
5.
Wound Manag Prev ; 66(11): 31-42, 2020 11.
Article in English | MEDLINE | ID: mdl-33206627

ABSTRACT

Biofilms are believed to be a source of chronic inflammation in non-healing wounds. PURPOSE: In this study, the pre-clinical anti-biofilm efficacy of several wound cleansers was examined using the Calgary minimum biofilm eradication concentration (MBEC) and ex vivo porcine dermal explant (PDE) models on Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), and Candida albicans biofilms. METHODS: A surfactant-based cleanser and antimicrobial-based cleansers containing ionic silver, hypochlorous acid (HOCl), sodium hypochlorite (NaOCl), and polyhexamethylene biguanide (PHMB) were tested on the MBEC model biofilms with a 10-minute application time. Select cleansers were then tested on the mature PDE biofilms with 10-minute applications followed by the application of cleanser-soaked gauze. The PDE model was further expanded to include single and daily applications of the cleansers to mimic daily and 72-hour dressing changes. RESULTS: In the MBEC model, PHMB- and HOCl-based cleansers reduced immature MRSA, C albicans, and P aeruginosa biofilm regrowth by > 3× when compared with silver, surfactant, and saline cleansers. The major differences could be elucidated in the PDE model in which, after daily application, 1 PHMB-based cleanser showed a statistically significant reduction (3-8 CFU/mL log reduction) in all mature biofilms tested, while a NaOCl-based cleanser showed significant reduction in 2 microorganisms (3-5 CFU/mL log reduction, P aeruginosa and MRSA).The other PHMB-based cleanser showed a statistically significant 3 log CFU/mL reduction in P aeruginosa. The remaining cleansers showed no statistically significant difference from the saline control. CONCLUSION: Results confirm that there are model-dependent differences in the outcomes of these studies, suggesting the importance of model selection for product screening. The results indicate that 1 PHMB-based cleanser was effective in reducing mature P aeruginosa, MRSA, and C albicans biofilms and that sustained antimicrobial presence was necessary to reduce or eliminate these mature biofilms.


Subject(s)
Biofilms , Detergents/therapeutic use , Methicillin-Resistant Staphylococcus aureus/drug effects , Wound Healing/drug effects , Animals , Biguanides/standards , Biguanides/therapeutic use , Detergents/standards , Disease Models, Animal , Silver/standards , Silver/therapeutic use , Sodium Hypochlorite/standards , Sodium Hypochlorite/therapeutic use , Swine/microbiology
6.
Wounds ; 32(8): 208-216, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32804659

ABSTRACT

INTRODUCTION: Biofilm in chronic wounds impedes the wound healing process. Each biofilm has differing characteristics requiring a multifaceted approach for removal while maintaining a surrounding environment conducive to wound healing. OBJECTIVE: In this study, 3 of the components in a wound cleanser are tested to determine synergy in eradicating biofilms of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa in vitro. MATERIALS AND METHODS: The 3 components assessed for synergy were ethylenediamine tetraacetic acid sodium salts (EDTA), vicinal diols (VD; ethylhexylglycerin and octane-1,2-diol), and polyhexamethylene biguanide (PHMB). Each component was assessed individually and in combination while dissolved in a base solution. The Calgary assay method was used for biofilm growth and treatment. Kull Equation analysis for synergy was conducted using viable count results. RESULTS: Synergy is defined as the interaction of components to produce a combined effect greater than the sum of their separate effects. The base solution containing all 3 components (EDTA, VD, and PHMB) reduced biofilm viability by more than 5 logs, demonstrating statistically significant synergy. The 3 components tested individually in the base solution resulted in the following: EDTA did not reduce bacteria viability; VD reduced viability by about 1 log; and PHMB reduced P aeruginosa viability by about 2.5 logs and MRSA viability by about 4 logs. Of importance, the MRSA biofilm failed to regrow in the recovery plates after combined treatment, indicating complete elimination of the biofilm bacteria. CONCLUSIONS: The experimental and calculated results indicate the 3 components (VD, EDTA, and PHMB) when used together act synergistically to eradicate MRSA and P aeruginosa biofilms in vitro.


Subject(s)
Biguanides/therapeutic use , Biofilms/drug effects , Detergents/therapeutic use , Edetic Acid/therapeutic use , Glyceryl Ethers/therapeutic use , Octanols/therapeutic use , Skin/drug effects , Wounds and Injuries/drug therapy , Biguanides/administration & dosage , Detergents/administration & dosage , Drug Synergism , Edetic Acid/administration & dosage , Glyceryl Ethers/administration & dosage , Humans , Methicillin-Resistant Staphylococcus aureus/drug effects , Octanols/administration & dosage , Pseudomonas aeruginosa/drug effects , Skin/microbiology , Wounds and Injuries/microbiology
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