BACKGROUND:Incidence estimates of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, also known as long COVID, have varied across studies and changed over time. We estimated long COVID incidence among adult and pediatric populations in 3 nationwide research networks of electronic health records (EHRs) participating in the RECOVER (Researching COVID to Enhance Recovery) Initiative using different classification algorithms (computable phenotypes). METHODS:This EHR-based retrospective cohort study included adult and pediatric patients with documented acute SARS-CoV-2 infection and 2 control groups: contemporary coronavirus disease 2019 (COVID-19)-negative and historical patients (2019). We examined the proportion of individuals identified as having symptoms or conditions consistent with probable long COVID within 30-180 days after COVID-19 infection (incidence proportion). Each network (the National COVID Cohort Collaborative [N3C], National Patient-Centered Clinical Research Network [PCORnet], and PEDSnet) implemented its own long COVID definition. We introduced a harmonized definition for adults in a supplementary analysis. RESULTS:Overall, 4% of children and 10%-26% of adults developed long COVID, depending on computable phenotype used. Excess incidence among SARS-CoV-2 patients was 1.5% in children and ranged from 5% to 6% among adults, representing a lower-bound incidence estimation based on our control groups. Temporal patterns were consistent across networks, with peaks associated with introduction of new viral variants. CONCLUSIONS:Our findings indicate that preventing and mitigating long COVID remains a public health priority. Examining temporal patterns and risk factors for long COVID incidence informs our understanding of etiology and can improve prevention and management.

PURPOSE:To assess whether neighborhood-level measures of policing are spatio-temporally associated with psychiatric hospialization among adolescents and young adults in New York City, and whether this association varies by neighborhood racial composition. METHODS:We derived population-based measures of policing from the New York City Police Department (NYPD), psychiatric hospitalization from Statewide Planning and Research Cooperative System (SPARCS) data, and socio-demographic data from the American Community Survey (ACS), aggregated by month and ZIP Code Tabulation Area (ZCTA) from 2006 to 2014. Multi-level negative binomial regression models assessed hospitalization-time of youth aged 10-24 as the dependent variable and the rate of policing events as the primary independent variable, adjusting for neighborhood poverty, unemployment, and educational attainment. Multiplicative interaction was assessed between policing and tertiles of the percentage of Black residents. RESULTS:A total of 11,900,192 policing incidents and 2,118,481 person-days of hospitalization were aggregated to 19,440 ZCTA-months. After adjusting for neighborhood-level sociodemographic characteristics, an increase in one policing incident per 1,000 residents was associated with a 0.3% increase in the rate of youth psychiatric hospitalization time (IRR 1.003 [1.001-1.005]). Neighborhood racial composition modified this effect; not only was the rate of psychiatric hospitalization and policing higher in neighborhoods with a higher proportion of Black residents, but the association between these was also significantly higher in neighorhoods with a larger share of Black residents compared with predominantly non-Black neighborhoods. CONCLUSION:Neighborhoods experiencing higher rates of policing during the study period experienced higher burdens of psychiatric hospitalization among adolescent and young adult residents. This association was larger in neighborhoods of color which have been disproportionately targeted by "hot spot" and order-maintenance policing practices and policies.

Structural racism in the United States has resulted in neighborhoods with higher proportions of non-Hispanic Black (Black) or Hispanic/Latine residents having more features that intensify, and less that cool, the local-heat environment. This study identifies areas of New York City (NYC) where racial/ethnic heat exposure disparities are concentrated. We analyzed data from the 2013-2017 American Community Survey, U.S Landsat-8 Analysis Ready Data on summer surface temperatures, and NYC Land Cover Dataset at the census tract-level (n = 2098). Four cross-sectional regression modeling strategies were used to estimate the overall City-wide association, and associations across smaller intra-city areas, between tract-level percent of Black and percent Hispanic/Latine residents and summer day surface temperature, adjusting for altitude, shoreline, and nature-cover: overall NYC linear, borough-specific linear, Community District-specific linear, and geographically weighted regression models. All three linear regressions identified associations between neighborhood racial and ethnic composition and summer day surface temperatures. The geographically weighted regression models, which address the issue of spatial autocorrelation, identified specific locations (such as northwest Bronx, central Brooklyn, and uptown Manhattan) within which racial and ethnic disparities for heat exposures are concentrated. Through examining the overall effects and geographic effect measure modification across spatial scales, the results of this study identify specific geographic areas for intervention to mitigate heat exposure disparities experienced by Black and Hispanic/Latine NYC residents.

Objectives:To assess the association of Long COVID with housing insecurity in the United States.Methods:To compare the prevalence of 3 binary indicators of housing insecurity between people with Long COVID (symptoms >3 months) and COVID-19 survivors who did not report long-term symptoms, we used survey-weighted regression models on 206,969 responses from the Household Pulse Survey, a representative cross-sectional survey of US households collected September 2022-April 2023. Among people with Long COVID, we additionally assessed whether functional impairment, current COVID-19 related symptoms, and symptom impact on day-to-day life were associated with a higher prevalence of housing insecurity.Results:During the study period, 56,353 respondents with prior COVID-19 experienced symptoms lasting 3 months or longer (27%), representing an estimated 28 million US adults. After adjusting for demographic factors, people with Long COVID were 1.5-2 times as likely to experience significant difficulty with household expenses (Prevalence ratio [PR] 1.48, 95% CI 1.42-1.55), be behind on housing payments (PR 1.48, 95% CI 1.36-1.60), and face likely eviction or foreclosure (PR 1.86, 95% CI 1.58-2.18). The risk of housing insecurity was highest among low-income adults with Long COVID. Among people with Long COVID, functional limitation and current symptoms which impact day-to-day life were associated with higher prevalence of housing insecurity.Conclusions:Compared with COVID-19 survivors who do not experience long-term symptoms, people with Long COVID are more likely to report indicators of housing insecurity, particularly those of lower socio-economic status, and those with functional limitations or long-term COVID-19 related symptoms impacting day-to-day life. Policies are needed to support people living with chronic illnesses following SARS-CoV-2 infection.

Estimates of post-acute sequelae of SARS-CoV-2 infection (PASC) incidence, also known as Long COVID, have varied across studies and changed over time. We estimated PASC incidence among adult and pediatric populations in three nationwide research networks of electronic health records (EHR) participating in the RECOVER Initiative using different classification algorithms (computable phenotypes). Overall, 7% of children and 8.5%-26.4% of adults developed PASC, depending on computable phenotype used. Excess incidence among SARS-CoV-2 patients was 4% in children and ranged from 4-7% among adults, representing a lower-bound incidence estimation based on two control groups - contemporary COVID-19 negative and historical patients (2019). Temporal patterns were consistent across networks, with peaks associated with introduction of new viral variants. Our findings indicate that preventing and mitigating Long COVID remains a public health priority. Examining temporal patterns and risk factors of PASC incidence informs our understanding of etiology and can improve prevention and management.

Introduction Medication automatic dispensing systems (ADS) have been implemented in many settings, including fire-based EMS stations. The aim of this study was to evaluate the impact of in-station ADSs on controlled substance administration rates and EMS response intervals. Methods This study was a retrospective review of data from a single fire-based EMS agency. Medication administration rates and EMS response intervals were compared before ADS implementation (P1; 6/1/15 to 5/31/16) and after ADS implementation (P3; 6/1/17-5/31/19). Cases with missing data and during a one-year implementation period were excluded. Results 4045 cases were identified in P1 and 8168 in P3. The odds of morphine or versed administration increased following ADS implementation: OR = 1.77 (95% CI: 1.53, 2.03) and OR = 1.53 (95%CI: 1.18, 2.00) respectively. There were statistically, but likely not operationally significant increases in median response interval and transport interval from P1 to P3 of 14 seconds, (p < 0.001) and 39 seconds (p < 0.001) respectively. Time at hospital for all calls decreased by more than 11 minutes for all transports, from a median of 34 minutes (IQR; 23.7, 45.5) to 22.7 minutes (IQR:18.5, 27.6) in P3, p < 0.001 and by 27.9 minutes for calls in which a controlled substance was given: P1 = 50.6 minutes (IQR: 34.6, 63.2), P3 = 22.7 minutes (IQR: 18.3, 27.4), p < 0.001. Conclusion In this system, medication ADS implementation was associated with an increase in the rates of controlled substance administration and a decrease in the time units were at hospitals.

Objective:After remaining stable for many years, the prevalence of depression among adolescents increased over the past decade, particularly among girls. In this study, we used longitudinal data from a cohort of high school students to characterize sex-specific trajectories of depressive symptoms during this period of increasing prevalence and widening gender gap in adolescent depression. Method:Using data from the Health and Happiness Cohort, a longitudinal 8-wave study of high school students residing in Los Angeles County from 2013 to 2017 (N = 3,393), we conducted a multiple-group, latent class growth analysis by sex to differentiate developmental trajectories in depressive symptoms scores measured by the Center for Epidemiological Studies- Depression (CES-D) scale (range, 0-60). Results:A 4-class solution provided the best model fit for both girls and boys. Trajectories among girls included low stable (35.1%), mild stable (42.8%), moderate decreasing (16.2%), and high arching (5.9%). Trajectories among boys included low stable (49.2%), mild increasing (34.7%), moderate decreasing (12.2%), and high increasing (3.9%). Average scores consistently exceeded or crossed the threshold for probable depression (≥16). Across comparable sex-specific trajectory groups, the average CES-D scores of girls were higher than those of boys, whose average scores increased over time. Conclusion:In a diverse cohort of students in Los Angeles County, depressive symptom trajectories were comparable to prior time periods but with a higher proportion of students in trajectories characterized by probable depression. Trajectories differed by sex, suggesting that future research should consider differential severity and onset of depression between boys and girls.

Genomic surveillance and wastewater tracking strategies were used to strengthen the public health response to an outbreak of the SARS-CoV-2 Delta AY.25 lineage associated with a university campus in Arizona. Epidemiologic and clinical data routinely gathered through contact tracing were matched to SARS-CoV-2 genomes belonging to an outbreak of AY.25 identified through ongoing phylogenomic analyses. Continued phylogenetic analyses were conducted to further describe the AY.25 outbreak. Wastewater collected twice weekly from sites across campus was tested for SARS-CoV-2 by RT-qPCR, and subsequently sequenced to identify variants. The AY.25 outbreak was defined by a single mutation (C18804T) and comprised 379 genomes from SARS-CoV-2 positive cases associated with the university and community. Several undergraduate student gatherings and congregate living settings on campus likely contributed to the rapid spread of COVID-19 across the university with secondary transmission into the community. The clade defining mutation was also found in wastewater samples collected from around student dormitories a week before the semester began, and 9 days before cases were identified. Genomic, epidemiologic, and wastewater surveillance provided evidence that an AY.25 clone was likely imported into the university setting just prior to the onset of the Fall 2021 semester, rapidly spread through a subset of the student population, and then subsequent spillover occurred in the surrounding community. The university and local public health department worked closely together to facilitate timely reporting of cases, identification of close contacts, and other necessary response and mitigation strategies. The emergence of new SARS-CoV-2 variants and potential threat of other infectious disease outbreaks on university campuses presents an opportunity for future comprehensive One Health genomic data driven, targeted interventions.

Background: There is limited understanding of the prevalence of psychological distress and associated stressors and supports among displaced adults in low- and middle-income first asylum countries. Method: This article reports the findings of a cross-sectional study. We recruited 245 Congolese adults (18-80 years) residing in Nairobi, Kenya using snowball sampling. Data were collected using an interviewer-administered questionnaire consisting of sociodemographic characteristics, the Self-Reporting Questionnaire (SRQ-20), and a locally developed stressors and supports survey. We used multivariable logistic regression to examine associations among sociodemographic, stressor, and support variables and the likelihood of experiencing psychological distress. Results: More than half of the participants (52.8%) reported symptoms indicative of psychological distress. Factors associated with increased psychological distress included perceiving to have a useful role in one's family or community, AOR = 1.85; 95% CI [1.1.17, 3.11], p = .012, feeling confused or not knowing what to do, AOR = 2.13; 95% CI [1.20, 4.6], p = .014, and feeling afraid to leave home for medical/health care to help with an illness, AOR = 1.57; 95% CI [1.17, 2.15], p < .01. Additionally, ethnic Banyamulenge Congolese adults without legal refugee status had an increased likelihood of experiencing psychological distress, AOR = .07; 95% CI [0,.74], p = .035. Conclusion: Future research is warranted to understand how to implement targeted mental health and psychosocial support (MHPSS) to improve urban-displaced adults' sense of safety and belonging. Our findings suggest that legal refugee status is an important structural determinant of mental health, which should be considered in MHPSS practice and policy.

Rationale: Cigarette smoke (CS) inhalation triggers oxidative stress and inflammation, leading to accelerated lung aging, apoptosis, and emphysema, as well as systemic pathologies. Metformin is beneficial for protecting against aging-related diseases. Objectives: We sought to investigate whether metformin may ameliorate CS-induced pathologies of emphysematous chronic obstructive pulmonary disease (COPD). Methods: Mice were exposed chronically to CS and fedmetforminenriched chow for the second half of exposure. Lung, kidney, andmuscle pathologies, lung proteostasis, endoplasmic reticulum(ER) stress, mitochondrial function, andmediators ofmetformin effects in vivo and/ or in vitro were studied. We evaluated the association ofmetformin use with indices of emphysema progression over 5 years of follow-up among the COPDGene (Genetic Epidemiology of COPD) study participants. The association ofmetformin usewith the percentage of emphysema and adjusted lung density was estimated by using a linearmixedmodel. Measurements and Main Results: Metformin protected against CS-induced pulmonary inflammation and airspace enlargement; small airway remodeling, glomerular shrinkage, oxidative stress, apoptosis, telomere damage, aging, dysmetabolism in vivo and in vitro; and ER stress. The AMPK (AMP-activated protein kinase) pathway was central to metformin's protective action. Within COPDGene, participants receiving metformin compared with those not receiving it had a slower progression of emphysema (-0.92%; 95% confidence interval [CI], 21.7% to -0.14%; P= 0.02) and a slower adjusted lung density decrease (2.2 g/L; 95% CI, 0.43 to 4.0 g/L; P= 0.01). Conclusions: Metformin protected against CS-induced lung, renal, and muscle injury; mitochondrial dysfunction; and unfolded protein responses and ER stress in mice. In humans, metformin use was associated with lesser emphysema progression over time. Our results provide a rationale for clinical trials testing the efficacy of metformin in limiting emphysema progression and its systemic consequences.

BackgroundPositive serology for cytomegalovirus (CMV) has been associated with all-cause mortality risk but its role in COPD mortality is unknown. The objective of the present study was to assess the relationship between CMV serology and COPD mortality.MethodsWe analysed data from 806 participants in the Tucson Epidemiological Study of Airway Obstructive Disease who, at enrolment, were aged 28–70 years and had completed lung function tests. We tested CMV serology in sera from enrolment and defined “high CMV serology” as being in the highest tertile. Vital status, date and cause of death were assessed through death certificates and/or linkage with the National Death Index up to January 2017. The association of CMV serology with all-cause and cause-specific mortality risk was tested in Cox models adjusted for age, sex, level of education, body mass index, smoking status and pack-years.ResultsHigh CMV serology was marginally associated with all-cause mortality (p=0.071) but the effect was inversely dependent on age, with the association being much stronger among participants <55 years than among participants ≥55 years at enrolment (p-value for CMV-by-age interaction <0.001). Compared with low CMV serology, high CMV serology was associated with mortality from COPD among all subjects (adjusted hazard ratio (HR) 2.38, 95% CI 1.11–5.08; p=0.025) and particularly in subjects <55 years old at enrolment (HR 5.40, 95% CI 1.73–16.9; p=0.004). Consistent with these results, high CMV serology also predicted mortality risk among subjects who already had airflow limitation at enrolment (HR 2.10, 95% CI 1.20–3.68; p=0.009).ConclusionsWe report a strong relationship between CMV serology and the risk of dying from COPD, and thus identify a novel risk factor for COPD mortality.

Background: An upregulation of the B cell compartment is present in the COPD lungs, together with increases in the number of B cell-rich lymphoid follicles (LFs), and in the levels of B cell products such as B cell Activation Factor (BAFF). We hypothesize that this exaggerated B cell response observed in COPD is associated with the extent of computed tomography (CT)-defined emphysema independently of the airflow limitation and thus GOLD stage. Methods: We performed immunofluorescence stainings for B cells, BAFF, CD138 (plasmacells), CD10 (immature B cells), CD24 (naive B cells), CD27 (memory B cells), IgD and IgG on lung sections from 23 GOLD 1-2 and 18 GOLD 3-4 COPD patients, and 11 smokers without COPD. All these cell types were counted, normalized by alveolar tissue area, and correlated with the degree of emphysema (% low-attenuation areas below − 950 HU threshold [%LAA-950]) and FEV1% pred. Results: %LAA950 and FEV1%pred were both associated with all the B cellular parameters studied when tested separately in multivariate linear regression models. However, when they were mutually adjusted in the same regression models, only %LAA950 and not FEV1%pred (P<0.005 and not significant, respectively, for all parameters studied) remained strongly associated with all these cellular parameters, even within each COPD GOLD stage. Conclusions: The extent of emphysema, and not the severity of airflow limitation, is the strongest predictor of an upregulation of the B cell immune compartment in the lung. A B cell endotype associated with emphysema could define the clinical phenotype (likely emphysema) that could benefit from therapies targeting B cells, leading to earlier and more personalized therapeutic interventions for COPD.

Background: Positive serology for cytomegalovirus (CMV) has been associated with all-cause mortality risk in previous studies. Aims: We sought to determine the relation of CMV serology to COPD mortality. Methods: We analyzed data from 806 participants in the TESAOD cohort who at enrollment in 1972 were aged 28–70 yrs and completed lung function tests. CMV serology in serum samples from enrollment was categorized as low, medium, and high tertiles. Date and cause of death were assessed through death certificates and linkage to the National Death Index up to January 2017. The association of CMV serology to all-cause and cause-specific mortality was tested in Cox models adjusted for age, sex, level of education, BMI, smoking status, and pack-years. Results: CMV serology was associated with subsequent all-cause mortality, but the effect was strongly dependent on age at enrollment. Among subjects <55 years at enrollment, high CMV serology was associated with a 90% increased mortality risk compared to low CMV serology (adjHR: 1.90, 1.38-2.61, p<0.0001), whereas no association was found among participants ≥55 years at enrollment. HighCMV serology was associated with COPD mortality among all subjects (2.38, 1.11-5.08, p=0.025) and particularly in subjects <55 years at enrollment (5.40, 1.73-16.9, p=0.004). This association was confirmed after further adjustment for serology against Chlamydia pneumoniae and Mycoplasma pneumoniae and for serum levels of C-reactive protein. CMV serology predicted mortality risk also among the 113 subjects who had already airflow limitation, the hallmark of COPD, at enrollment (2.10, 1.20-3.68, p=0.009). Conclusions: High CMV serology is a novel and potentially modifiable risk factor for COPD mortality.

ObjectiveUsing a syndromic surveillance system to understand the magnitude and risk factors related to heat-related illness (HRI) in Pinal County, AZ.IntroductionExtreme heat is a major cause of weather-related morbidity and mortality in the United States (US).1 HRI is the most frequent cause of environmental exposure-related injury treated in US emergency departments.2 More than 65,000 emergency room visits occur for acute HRI each summer nationwide.3 In Arizona, HRI accounts for an estimated 2,000 emergency room patients and 118 deaths each year.4 As heat-related illness becomes increasingly recognized as a public health issue, local health departments are tasked with building capacity to conduct enhanced surveillance of HRI in order to inform public health preparedness and response efforts. In Pinal County, understanding the magnitude and risk factors of HRI is important for informing prevention efforts as well as developing strategies to respond to extreme heat.MethodsTo gain a better understanding of the magnitude of HRI in Pinal County, historical cases were reviewed from hospital discharge data (HDD) from 2010-2016. Cases were included if the discharge record included any ICD codes consistent with HRI (ICD-9 codes 992 or ICD-10 codes T67 or X30) and if the patient’s county of residence was Pinal County. Recent HRI cases during the summer of 2017 were identified using the National Syndromic Surveillance Program BioSense Platform. The ESSENCE syndromic surveillance tool within the BioSense Platform includes data reported by local hospitals. This data can be used to detect abnormal activity for public health investigation. HRI cases were identified in ESSENCE based on ICD-10 codes and chief complaint terms according to a standardized algorithm developed by the Council of State and Territorial Epidemiologists.1 Both emergency department and admitted patients with a HRI were abstracted from HDD and ESSENCE. To assess HRI risk factors for the summer of 2017, a survey instrument was developed. Survey questions included the nature and location of the HRI incident, potential risk factors, and knowledge and awareness of HRI. Cases were identified in ESSENSE on a weekly basis from May 1, 2017-September 12, 2017, and follow up phone interviews were conducted with eligible cases. For HRI cases eligible for interview, three attempts were made to contact the patient by phone. Cases were excluded if the patient was incarcerated, deceased, or did not have a HRI upon medical record review. An exploratory analysis was performed for the data from HDD, ESSENCE, and interviews.ResultsPinal County Public Health Services District identified 1,321 HRI cases from 2010-2016, an average of 189 per year. Hospital discharge data suggest HRI cases are more likely to occur in males between the ages of 20-44 years old (27%). It is also notable that a sharp increase in HRI cases is observed each year in mid-to-late June, with an estimated 14% of annual cases occurring during the third week of June. Further analysis of HDD showed 31% of cases received medical treatment in Casa Grande in central Pinal County. Between May 1st and September 12th of 2017, 161 HRI cases were detected using ESSENCE. Of which 149 cases were determined to be HRI; 22 cases did not have contact information, and 4 cases were ineligible due to incarceration or death. A total of 31 HRI cases were interviewed out of the eligible 123 ESSENSE cases (25% response rate). Interview data indicated occupational exposure to extreme heat as a major risk factor for HRI. Additional risk factors reported during interviews included exposure to extreme heat while at home or traveling, although interview results are not representative due to a small sample size (n=31).ConclusionsSyndromic surveillance combined with interviews and a review of HDD provides an informative approach for monitoring and responding to HRI. Data suggest Pinal County should expect an increase in HRI cases by mid-June each year, typically coinciding with the first National Weather Service Extreme Heat Warning of the season. Preliminary results suggest that cases occur more frequently in working males ages 20-44 years old in occupations that expose workers to extreme heat conditions. Additional information is needed to assess risk factors for HRI among vulnerable populations in Pinal County who were not represented in this study, including individuals who are homeless, undocumented, elderly, or in correctional facilities. Future areas for improvement include improving the phone interview script to include English and Spanish language versions and performing medical record abstractions on all HRI cases. Enhanced syndromic surveillance is recommended to provide information on risk factors for HRI to inform prevention efforts in Pinal County.References1. Heat-Related Illness Syndrome Query: A Guidance Document For Implementing Heat-Related Illness Syndromic Surveillance in Public Health Practice. In: Epidemiologists CoSaT, ed. Vol 1.02016:1-12.2. Pillai SK, Noe RS, Murphy MW, et al. Heat illness: predictors of hospital admissions among emergency department visits-Georgia, 2002-2008. J Community Health. 2014;39(1):90-98.3. Centers for Disease Control and Prevention . Climate Change and Extreme Heat: What You Can Do to Prepare. 2016; Available from https://www.cdc.gov/climateandhealth/pubs/extreme-heat-guidebook.pdf4. Trends in Morbidity and Mortality from Exposure to Excessive Natural Heat in Arizona, 2012 report. In: Services ADoH, ed2012.

Latent tuberculosis (TB) infection is routinely diagnosed using the tuberculin skin test (TST). New methods of detection more specific than TST such as QuantiFERON TB Gold In-Tube (QFT-GIT) have been developed but evidence remains limited on their acceptability among migrant farmworkers. This article examined the acceptability of screening tests among migrant farmworkers working on the Arizona-Mexico border. We conducted a cross-sectional survey of migrant farmworkers via questionnaire. Of 83 participants interviewed, 53 (63.9%) believed that TB was a serious disease that could result in death and 59 (71.1%) considered TB a health concern in their community. Sixty-four participants (77.1%) rated QFT-GIT test as performing better than TST. Our study demonstrates preference for QFT-GIT results over TST, and highlights migrant farmworkers' considering themselves at risk of TB and TB as a health concern. Policies that create easy access and culturally appropriate, affordable healthcare for this vulnerable population should be encouraged.