The Utah Department of Health is the Government of Utah's body responsible for public health.It is headquartered in the Cannon Health Building in Salt Lake City.
BACKGROUND:Many studies have attempted to define which injured children should undergo computed tomography (CT) imaging. Specifically, the Pediatric Emergency Care Applied Research Network (PECARN), a conglomerate of pediatric trauma centers, prospectively collected data on a large population of patients and have published multiple studies with recommendations on when to image based on the likelihood of a clinically important injury. Using these data and others, the Utah Pediatric Trauma Network (UPTN) created guidelines to help determine when imaging of injured children should be performed at our participating non-pediatric hospitals (non-PED1). The purpose of this study was to evaluate compliance to these guidelines. METHODS:The UPTN REDCap® database was retrospectively reviewed between 1/2019-12/2022. An analysis of injured Utah children who underwent CT imaging based on UPTN guidelines was performed. RESULTS:Of the 5224 cases reviewed, 4162 (80 %) underwent CT scan for evaluation, of which 3275 (79 %) received CT imaging at a non-PED1 center. Those treated at a non-PED1 hospital tended to be older (mean 10.2 v. 9.1 years, p = 0.002) and more likely to be ≥ 14 years (33 %v.28 %,p = 0.003). They were also less likely to have a traumatic brain injury (81 %v.91 %,p < 0.0001) or an orthopedic injury (14 %v.21 %,p < 0.0001). Children treated at non-PED1 hospitals were less likely to undergo a CT of the head (59 % v. 88 %,p < 0.0001) and abdomen (18 % v. 32 %,p < 0.0001), but more likely of the chest (17 %v.11 %,p = 0.01) or a pan scan (13 %v.8 %,p = 0.001). Compliance to guidelines was lower compared to the PED1 center for CT of the head (67 %v.87 %,p < 0.0001). Overall, compliance increased in the later years of the study for cervical spine and abdomen/pelvis (p = 0.0002,p < 0.0001 respectively), and decreased for head (p = 0.001). CONCLUSIONS:Across Utah, CT imaging is highly utilized in the evaluation of injured children. Non-compliance to imaging guidelines was found to be highest for imaging of the cervical-spine, chest, and abdomen. STUDY TYPE/LEVEL OF EVIDENCE:Level III, Prognostic/epidemiological.
To examine the relationship between socioeconomic deprivation and complex needs, defined as mental and physical comorbidities, we conducted a cross-sectional retrospective cohort analysis of adult Utah Medicaid beneficiaries. Our analysis included Medicaid beneficiaries with geocoded addresses aged ≥18 years in Utah (N = 157,739). We geocoded beneficiary addresses and assigned them to census block groups. We compared the socioeconomic status of block groups (Singh’s area deprivation index) with the proportion of complex needs, defined based on cluster analysis as 1 physical condition with depression or ≥ 2 physical with ≥1 mental health condition. Spatial mapping was performed of prevalence quantiles grouped by count overlaid with Medicaid-covered mental health facilities. Prevalence of complex needs was 18.9% (n = 29,742); beneficiaries with >3 emergency department visits had 12.8 odds of having complex needs; 39.7% of beneficiaries with >$5,000 in annual costs had complex needs. Common comorbid conditions among beneficiaries with complex needs were hypertension (56.0%), hyperlipidemia (35.5%), depression (68.8%), anxiety (56.2%), drug use (16.0%), and alcohol use disorders (15.2%). Census block groups with higher deprivation had a higher proportion of complex needs (ρ = 0.21, p < 0.001). There was a statistically significant spatial autocorrelation of the prevalence of complex needs (Moran’s I index: 0.65; p < 0.001). Six high-count census blocks had no mental health facilities. Areas with increased socioeconomic deprivation had a greater proportion of complex needs and fewer mental health facilities. Integrated programs addressing both physical and mental health conditions with a focus on socioeconomically deprived areas might benefit Medicaid recipients in populations such as those in Utah.
Chronic granulomatous disease (CGD) is an inborn error of immunity caused by defects in NADPH oxidase, which causes phagocyte dysfunction. CGD is characterized by recurrent infections and autoimmunity. Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative therapy. However, data regarding patient satisfaction with post-HSCT state of health and quality of life are lacking. A Primary Immune Deficiency Treatment Consortium (PIDTC) working group designed online surveys to assess post-HSCT quality of life and satisfaction with transplantation. Surveys were distributed from November 2023 to March 2024 to all members of the CGD Association of America (CGDAA). Adults who personally underwent or parents of children who underwent HSCT for CGD were asked to participate. Two surveys were offered: one for participants who were 18 years or older and one for parents of patients. Complete surveys representing 54 unique patients were included for analysis. Forty-four were from parents whose children were a median of 12 years old and a median of 6 years post-transplant. Nine were returned from patients who were a median of 30 years old and a median of 4 years post-transplant (Table 1). Table 1. Seventy-eight percent of patient and parent respondents reported that quality of life was better after transplant and 89% felt that the transplant improved their physical health (Figure 1). Figure 1. (A) Do you feel quality of life is better now post-transplant than it was pre-transplant? (B) Do you feel that the transplant has been beneficial from a medical perspective? PROMIS Global Health scoring tool revealed 84% of patients had mental health scores within 1 SE of the mean. Only a few mental health diagnoses were self-reported (Figure 2). Figure 2. (A) PROMIS Mental Health Report Scores. (B) Mental health condition diagnosed by a physician. After transplant, there were no self-reported cases of autoimmune disease or malignancy. Three participants were able to conceive children. One respondent used sperm banking; two did not use fertility preservation or treatments. Our data demonstrate that the majority of patients who undergo allogeneic HSCT for definitive treatment of CGD experience improvements in physical and/or mental health and enjoy an improved quality of life after transplant. Overall, this study supports positive outcomes for patients treated with allogeneic HSCT.
Background: Commercially available CTLA-4 antibodies are associated with a high incidence of immune mediated adverse events. Evalstotug (BA3071) is a conditionally active biologic (CAB) anti–CTLA-4 monoclonal antibody that blocks the interaction of CTLA-4 with its ligands in the low-pH conditions of the tumor microenvironment. CABs are not masked or caged and do not require enzymatic cleavage for activation. They are reversibly bound in the acidic tumor microenvironment, which is expected to reduce off-tumor immune-related adverse events, enhance host immunity, avoid tissue-mediated drug disposition, and improve pharmacokinetics. This study evaluated the safety and antitumor activity of evalstotug ± anti-PD-1 therapy in patients (pts) with advanced solid tumors. Methods: In an ongoing cohort for adult 1st line pts, treatment naïve unresectable/metastatic melanoma with measurable disease per RECIST v1.1 received evalstotug (350 – 1000 mg) every 3 weeks (Q3W) + pembrolizumab 200 mg Q3W. Safety was assessed using the NCI CTCAE v5, and efficacy was assessed using RECIST v1.1, with response assessment performed Q6W for 24 weeks, then Q12W. Results: An initial eight pts were treated with evalstotug (350-1000 mg) + anti-PD-1. Seven patients received prior neoadjuvant/adjuvant immunotherapy. Pts received a median of 9 doses. Most related treatment-emergent adverse events (TEAEs) were low grade. Two pts experienced grade 3 related TEAEs (1. colitis and 2. pneumonitis and pancreatitis) that led to discontinuation of treatment, but which quickly resolved. No grade 4/5 related TEAEs were observed to date. All patients experienced tumor volume reduction and those who were dose escalated were able to regain tumor control. Four of 8 pts responded - 3 PRs, 1 CR and 4 pts experienced stable disease. Conclusions: All (8/8) metastatic and unresectable melanoma pts safely achieved tumor reduction with evalstotug + anti-PD-1, including patients with only 1 scan, which will be further updated. It was notable that intrapatient evalstotug dose escalation safely re-attained tumor control, suggesting increasing evalstotug exposure can drive improved antitumor activity, even after months on anti-CTLA4 therapy. No new safety signals were identified, and the incidence and severity of imAEs was in line with previous reports, consistent with evalstotug’s tumor selectivity. Dose optimization is actively underway, and pivotal trial initiation is anticipated in 2025. Citation Format: Inderjit Mehmi, Jennifer E Selfridge, Ankit Mangla, Matthew H Taylor, Constantine Albany, Vineet Kwatra, Jacob Thomas, Siwen Hu-Lieskovan, Kyechin Chen, Judith Llorin-Sangalang, Kartik Aysola, Omid Hamid. Updated results from a study of evalstotug (BA3071), an anti–CTLA-4 conditionally active biologic, in melanoma [abstract]. In: Proceedings of the AACR IO Conference: Discovery and Innovation in Cancer Immunology: Revolutionizing Treatment through Immunotherapy; 2025 Feb 23-26; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Immunol Res 2025;13(2 Suppl):Abstract nr A107.
During July-September 2023, an outbreak of Shiga toxin-producing Escherichia coli O157:H7 illness among children in city A, Utah, caused 13 confirmed illnesses; seven patients were hospitalized, including two with hemolytic uremic syndrome. Local, state, and federal public health partners investigating the outbreak linked the illnesses to untreated, pressurized, municipal irrigation water (UPMIW) exposure in city A; 12 of 13 ill children reported playing in or drinking UPMIW. Clinical isolates were genetically highly related to one another and to environmental isolates from multiple locations within city A's UPMIW system. Microbial source tracking, a method to indicate possible contamination sources, identified birds and ruminants as potential sources of fecal contamination of UPMIW. Public health and city A officials issued multiple press releases regarding the outbreak reminding residents that UPMIW is not intended for drinking or recreation. Public education and UPMIW management and operations interventions, including assessing and mitigating potential contamination sources, covering UPMIW sources and reservoirs, indicating UPMIW lines and spigots with a designated color, and providing conspicuous signage to communicate risk and intended use might help prevent future UPMIW-associated illnesses.
