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Chlamydia trachomatis (CT) is a sexually transmitted infection that can lead to adverse reproductive health outcomes. CT prevalence estimates are primarily derived from screening using nucleic acid amplification tests (NAATs). However, screening guidelines in the United States only include particular subpopulations, and NAATs only detect current infections. In contrast, seroassays identify past CT infections, which is important for understanding the public health impacts of CT, including pelvic inflammatory disease and tubal factor infertility. Older seroassays have been plagued by low sensitivity and specificity and have not been validated using a consistent reference measure, making it challenging to compare studies, define the epidemiology of CT, and determine the effectiveness of control programs. Newer seroassays have better performance characteristics. This narrative review summarizes the "state of the science" for CT seroassays that have been applied in epidemiologic studies and provides practical considerations for interpreting the literature and employing seroassays in future research.

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Many chemicals associated with unconventional oil and natural gas (UOG) are known toxicants, leading to health concerns about the effects of UOG. Our objective was to conduct a scoping review of the toxicological literature to assess the effects of UOG chemical exposures in models relevant to human health. We searched databases for primary research studies published in English or French between January 2000 and June 2023 on UOG-related toxicology studies. Two reviewers independently screened abstracts and full texts to determine inclusion. Seventeen studies met our study inclusion criteria. Nine studies used solely in vitro models, while six conducted their investigation solely in animal models. Two studies incorporated both types of models. Most studies used real water samples impacted by UOG or lab-made mixtures of UOG chemicals to expose their models. Most in vitro models used human cells in monocultures, while all animal studies were conducted in rodents. All studies detected significant deleterious effects associated with exposure to UOG chemicals or samples, including endocrine disruption, carcinogenicity, behavioral changes and metabolic alterations. Given the plausibility of causal relationships between UOG chemicals and adverse health outcomes highlighted in this review, future risk assessment studies should focus on measuring exposure to UOG chemicals in human populations.

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The mental health impact of disasters is substantial, with 30-40% of direct disaster victims developing post-traumatic stress disorder (PTSD). It is not yet clear why some people cope well with disaster-related trauma while others experience chronic dysfunction. Prior research on non-disaster trauma suggests that an individual's history of traumatic experiences earlier in the life course, prior to the disaster, may be a key factor in explaining variability in psychological responses to disasters. This study evaluated the extent to which pre-disaster trauma predicts PTSD trajectories in a sample of Hurricane Katrina survivors followed for 12 years after the storm. Four PTSD trajectories were identified using latent class growth analysis: Resistant (49.0%), Recovery (29.3%), Delayed-Onset (8.0%), and Chronic-High (13.7%). After adjusting for covariates, pre-Katrina trauma had only a small, positive impact on the probability of long-term, chronic Katrina-specific PTSD, and little effect on the probability of the Resistant and Delayed-Onset trajectories. Higher pre-Katrina trauma exposure moderately decreased the probability of being in the Recovery trajectory, in which Katrina-specific PTSD symptoms are initially high before declining over time. When covariates were added to the model one at a time, the association between pre-Katrina trauma and Chronic-High PTSD was attenuated most by the addition of Katrina-related trauma. Our findings suggest that while pre-disaster trauma exposure does not have a strong direct effect on chronic Katrina-specific PTSD, pre-Katrina trauma may impact PTSD through other factors that affect Katrina-related PTSD, such as by increasing the severity of Katrina-related trauma. These findings have important implications for the development of disaster preparedness strategies to diminish the long-term burden of disaster-related PTSD.

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BACKGROUND: Substance use-related emergency department (ED) visits have increased substantially in North America. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthesizes evidence on diagnostic accuracy of ED screening tools to detect harmful substance use. METHODS: We included derivation or validation studies, with or without comparator, that included adult (≥ 18 years) ED patients and evaluated screening tools to identify general or specific substance use disorders or harmful use. Our search strategy combined concepts Emergency Department AND Screening AND Substance Use. Trained reviewers assessed title/abstracts and full-text articles for inclusion, extracted data, and assessed risk of bias (QUADAS-2) independently and in duplicate. Reviewers resolved disagreements by discussion. Primary investigators adjudicated if necessary. Heterogeneity precluded meta-analysis. We descriptively summarized results. RESULTS: Our search strategy yielded 2696 studies; we included 33. Twenty-one (64%) evaluated a North American population. Fourteen (42%) applied screening among general ED patients. Screening tools were administered by research staff (n = 21), self-administered by patients (n = 10), or non-research healthcare providers (n = 1). Most studies evaluated alcohol use screens (n = 26), most commonly the Alcohol Use Disorders Identification Test (AUDIT; n = 14), Cut down/Annoyed/Guilty/Eye-opener (CAGE; n = 13), and Rapid Alcohol Problems Screen (RAPS/RAPS4/RAPS4-QF; n = 12). Four studies assessing six tools and screening thresholds for alcohol abuse/dependence in North American patients (AUDIT ≥ 8; CAGE ≥ 2; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-2] ≥ 1; RAPS ≥ 1; National Institute on Alcohol Abuse and Alcoholism [NIAAA]; Tolerance/Worry/Eye-opener/Amnesia/K-Cut down [TWEAK] ≥ 3) reported both sensitivities and specificities ≥ 83%. Two studies evaluating a single alcohol screening question (SASQ) (When was the last time you had more than X drinks in 1 day?, X = 4 for women; X = 5 for men) reported sensitivities 82-85% and specificities 70-77%. Five evaluated screening tools for general substance abuse/dependence (Relax/Alone/Friends/Family/Trouble [RAFFT] ≥ 3, Drug Abuse Screening Test [DAST] ≥ 4, single drug screening question, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST] ≥ 42/18), reporting sensitivities 64%-90% and specificities 61%-100%. Studies' risk of bias were mostly high or uncertain. CONCLUSIONS: Six screening tools demonstrated both sensitivities and specificities ≥ 83% for detecting alcohol abuse/dependence in EDs. Tools with the highest sensitivities (AUDIT ≥ 8; RAPS ≥ 1) and that prioritize simplicity and efficiency (SASQ) should be prioritized.

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OBJECTIVE: Unconventional oil and gas development (UOGD, sometimes termed "fracking" or "hydraulic fracturing") is an industrial process to extract methane gas and/or oil deposits. Many chemicals used in UOGD have known adverse human health effects. Canada is a major producer of UOGD-derived gas with wells frequently located in and around rural and Indigenous communities. Our objective was to conduct a scoping review to identify the extent of research evidence assessing UOGD exposure-related health impacts, with an additional focus on Canadian studies. METHODS: We included English- or French-language peer-reviewed epidemiologic studies (January 2000-December 2022) which measured exposure to UOGD chemicals directly or by proxy, and where health outcomes were plausibly caused by UOGD-related chemical exposure. Results synthesis was descriptive with results ordered by outcome and hierarchy of methodological approach. SYNTHESIS: We identified 52 studies from nine jurisdictions. Only two were set in Canada. A majority (n = 27) used retrospective cohort and case-control designs. Almost half (n = 24) focused on birth outcomes, with a majority (n = 22) reporting one or more significant adverse associations of UOGD exposure with: low birthweight; small for gestational age; preterm birth; and one or more birth defects. Other studies identified adverse impacts including asthma (n = 7), respiratory (n = 13), cardiovascular (n = 6), childhood acute lymphocytic leukemia (n = 2), and all-cause mortality (n = 4). CONCLUSION: There is a growing body of research, across different jurisdictions, reporting associations of UOGD with adverse health outcomes. Despite the rapid growth of UOGD, which is often located in remote, rural, and Indigenous communities, Canadian research on its effects on human health is remarkably sparse. There is a pressing need for additional evidence.

RéSUMé: OBJECTIF: L'exploitation pétrolière et gazière non conventionnelle (EPGNC, parfois appelée « fracturation ¼ ou « fracturation hydraulique ¼) est un processus industriel d'extraction du méthane et/ou de gisements de pétrole. De nombreux produits chimiques utilisés dans l'EPGNC ont des effets indésirables connus sur la santé humaine. Le Canada est un grand producteur de gaz dérivé de l'EPGNC, dont les puits sont souvent situés à l'intérieur et autour de communautés rurales et autochtones. Nous avons mené une étude de champ pour déterminer l'étendue des données de recherche évaluant les effets sur la santé de l'exposition à l'EPGNC, en nous concentrant plus particulièrement sur les études canadiennes. MéTHODE: Nous avons inclus des études épidémiologiques en anglais ou en français évaluées par les pairs (janvier 2000 à décembre 2022) qui mesuraient l'exposition directe ou indirecte aux produits chimiques de l'EPGNC et dans lesquelles les résultats cliniques étaient plausiblement causés par l'exposition aux produits chimiques liés à l'EPGNC. La synthèse des résultats est descriptive, et les résultats sont ordonnés selon les résultats cliniques et l'approche méthodologique. SYNTHèSE: Nous avons identifié 52 études menées dans neuf juridictions. Deux seulement étaient canadiennes. La majorité (n = 27) faisaient appel à des cohortes rétrospectives ou étaient des études cas-témoins. Près de la moitié (n = 24) portaient sur les issues de la grossesse, et la majorité (n = 22) déclaraient une ou plusieurs associations indésirables significatives entre l'exposition à l'EPGNC et : l'insuffisance de poids à la naissance; la petite taille du bébé pour son âge gestationnel; la naissance avant terme; et une ou plusieurs anomalies congénitales. D'autres études faisaient état d'effets indésirables, dont l'asthme (n = 7), les troubles respiratoires (n = 13), les troubles cardiovasculaires (n = 6), la leucémie aiguë lymphoblastique infantile (n = 2) et la mortalité toutes causes confondues (n = 4). CONCLUSION: Il existe dans différents pays un corpus croissant d'études qui font état d'associations entre l'EPGNC et des résultats sanitaires indésirables. Malgré la croissance rapide de l'EPGNC, souvent présente dans des communautés éloignées, rurales et autochtones, la recherche canadienne sur ses effets sur la santé humaine est remarquablement clairsemée. Il y a un besoin urgent de recueillir d'autres données probantes à ce sujet.

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Background: Weather-related disasters, including hurricanes, are becoming more frequent and severe due to climate change. Vulnerable populations, such as people with low income and racial and ethnic minorities, are particularly prone to increased levels of physical harm and psychiatric adversity from weather-related events.Objectives: We aimed to explore psychosocial resources and coping of survivors with three different posttraumatic stress symptom (PTSS) trajectories (High-Decreasing, Moderate-Decreasing, and High-Stable), after Hurricane Katrina across two different time points: F1 (1-year post-disaster) and F3 (12 years post-disaster).Method: Participants in this multi-method study were part of a larger cohort of the Resilience in Survivors of Katrina (RISK) project. Transcripts of interviews completed at the two time points were analysed using two qualitative methods, combining thematic analysis and narrative analysis, and providing both breadth of perspectives with the depth of specific case studies.Results: Sixteen survivors completed interviews at both F1 and F3. From our in-depth analysis of the data, we derived five inductive themes: 'Hope,' 'Adaptive vs maladaptive avoidance,' 'Emotional delay,' 'Acceptance, Finding Meaning and Being in the Moment,' and 'Coping strategies.' Survivors with High-Decreasing and Moderate-Decreasing PTSS trajectories experienced hope for future, accepted the hurricane and its results, and found efficient ways to cope with their situation. Survivors with High-Stable PTSS trajectories tended to express a lack of hope for future and struggled to be mindful and accept the hurricane and its harm. Unlike survivors with High-Decreasing and Moderate-Decreasing PTSS trajectories, survivors with High-Stable PTSS trajectories also reported less social and family support and faced more discrimination and racism.Conclusion: There are factors beyond individual-level psychosocial resources that may shape post-disaster resilience. When supporting survivors after a weather-related disaster, it is essential to provide ongoing psychological, financial, and physical assistance to bolster these resources.

After Hurricane Katrina, survivors with different posttraumatic stress symptom trajectories reported different levels of hope, mindfulness, and willingness to talk about the hurricane, emotional processing, and coping strategies.These experiences varied over time for survivors in all three trajectories.Survivors who report ongoing high levels of symptoms should be offered additional support to bolster these psychosocial resources.

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Pharmacogenomic (PGx) testing may increase the probability of remission and response in patients with major depressive disorder (MDD) undergoing pharmacotherapy. Given the potential implications of these outcomes and recent proliferation of PGx studies, we conducted a systematic review to evaluate the effectiveness of PGx testing on clinical outcomes in patients with MDD as compared to treatment as usual (TAU). MEDLINE, Embase, PsycInfo, and CENTRAL were searched for English-language articles from 2000 to 2021 for randomized controlled trials (RCTs) comparing PGx-guided treatment vs. TAU in patients with MDD. Meta-analyses were conducted in R. Ten RCTs were included: eight reported remission and seven reported response. The best available evidence suggests that PGx-guided care for moderate-to-severe adult depression is more likely to result in remission and response than TAU (both risk ratios significant). However, there are limitations in the evidence base, including high risk of bias and inconsistency between trials. Despite the consequent very low certainty in the magnitude of effect, there is confidence in the direction. Though modest, the beneficial effects of PGx for adults with moderate-severe MDD could - as a result of the scope and scale of the condition and its impacts - have important ramifications for patients and the health system.

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BACKGROUND: Genome-based precision medicine strategies promise to minimize premature graft loss after renal transplantation, through precision approaches to immune compatibility matching between kidney donors and recipients. The potential adoption of this technology calls for important changes to clinical management processes and allocation policy. Such potential policy change decisions may be supported by decision models from health economics, comparative effectiveness research and operations management. OBJECTIVE: We used a systematic approach to identify and extract information about models published in the kidney transplantation literature and provide an overview of the status of our collective model-based knowledge about the kidney transplant process. METHODS: Database searches were conducted in MEDLINE, Embase, Web of Science and other sources, for reviews and primary studies. We reviewed all English-language papers that presented a model that could be a tool to support decision making in kidney transplantation. Data were extracted on the clinical context and modelling methods used. RESULTS: A total of 144 studies were included, most of which focused on a single component of the transplantation process, such as immunosuppressive therapy or donor-recipient matching and organ allocation policies. Pre- and post-transplant processes have rarely been modelled together. CONCLUSION: A whole-disease modelling approach is preferred to inform precision medicine policy, given its potential upstream implementation in the treatment pathway. This requires consideration of pre- and post-transplant natural history, risk factors for allograft dysfunction and failure, and other post-transplant outcomes. Our call is for greater collaboration across disciplines and whole-disease modelling approaches to more accurately simulate complex policy decisions about the integration of precision medicine tools in kidney transplantation.

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BACKGROUND: Patients who experience harms from alcohol and other substance use often seek care in the emergency department (ED). ED visits related to alcohol withdrawal have increased across the world during the COVID-19 pandemic. ED clinicians are responsible for risk-stratifying patients under time and resource constraints and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care. Published guidelines for alcohol withdrawal are largely limited to the primary care and outpatient settings, and do not provide specific guidance for ED use. The purpose of this review was to synthesize published evidence on the treatment of alcohol withdrawal syndrome in the ED. METHODS: We conducted a rapid review by searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (1980 to 2020). We searched for grey literature on Google and hand-searched the conference abstracts of relevant addiction medicine and emergency medicine professional associations (2015 to 2020). We included interventional and observational studies that reported outcomes of clinical interventions aimed at treating alcohol withdrawal syndrome in adults in the ED. RESULTS: We identified 13 studies that met inclusion criteria for our review (7 randomized controlled trials and 6 observational studies). Most studies were at high/serious risk of bias. We divided studies based on intervention and summarized evidence narratively. Benzodiazepines decrease alcohol withdrawal seizure recurrence and treat other alcohol withdrawal symptoms, but no clear evidence supports the use of one benzodiazepine over another. It is unclear if symptom-triggered benzodiazepine protocols are effective for use in the ED. More evidence is needed to determine if phenobarbital, with or without benzodiazepines, can be used safely and effectively to treat alcohol withdrawal in the ED. Phenytoin does not have evidence of effectiveness at preventing withdrawal seizures in the ED. CONCLUSIONS: Few studies have evaluated the safety and efficacy of pharmacotherapies for alcohol withdrawal specifically in the ED setting. Benzodiazepines are the most evidence-based treatment for alcohol withdrawal in the ED. Pharmacotherapies that have demonstrated benefit for treatment of alcohol withdrawal in other inpatient and outpatient settings should be evaluated in the ED setting before routine use.

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We present a case of severe hyponatraemia due to syndrome of inappropriate antidiuretic hormone (SIADH) in a patient with respiratory syncytial virus (RSV) infection. A retrospective analysis of all patients admitted to our hospital with RSV in the preceding 3-year period revealed hyponatraemia in 41 (28%) cases, of which 13 (8.9%) were moderate or severe. SIADH was explored and confirmed in five (3.4%) patients, raising this as an important, previously unrecognised, complication of RSV infection in adults. Physician awareness of SIADH as a potential complication of RSV will facilitate early diagnosis and treatment of this potentially fatal disorder.

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PURPOSE OF REVIEW: To explain the role of African American survivor advocates in addressing breast cancer disparities. RECENT FINDINGS: The Sisters Network, Inc. is a national African American survivor advocates organization, founded in Houston Texas in 1994 and active today via affiliate chapters throughout the United States as well as its national headquarters. The Sisters Network provides essential outreach, educational, and research support to the breast oncology community. SUMMARY: The breast oncology community should partner with the Sisters Network and support their activities in efforts to achieve breast health equity.

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BACKGROUND: Multiresistant organisms (MROs) pose a critical threat to public health. Population-based programs for control of MROs such as carbapenemase-producing Enterobacterales (CPE) have emerged and evaluation is needed. We assessed the feasibility and impact of a statewide CPE surveillance and response program deployed across Victoria, Australia (population 6.5 million). METHODS: A prospective multimodal intervention including active screening, carrier isolation, centralized case investigation, and comparative pathogen genomics was implemented. We analyzed trends in CPE incidence and clinical presentation, risk factors, and local transmission over the program's first 3 years (2016-2018). RESULTS: CPE case ascertainment increased over the study period to 1.42 cases/100 000 population, linked to increased screening without a concomitant rise in active clinical infections (0.45-0.60 infections/100 000 population, P = .640). KPC-2 infection decreased from 0.29 infections/100 000 population prior to intervention to 0.03 infections/100 000 population in 2018 (P = .003). Comprehensive case investigation identified instances of overseas community acquisition. Median time between isolate referral and genomic and epidemiological assessment for local transmission was 11 days (IQR, 9-14). Prospective surveillance identified numerous small transmission networks (median, 2; range, 1-19 cases), predominantly IMP and KPC, with median pairwise distance of 8 (IQR, 4-13) single nucleotide polymorphisms; low diversity between clusters of the same sequence type suggested genomic cluster definitions alone are insufficient for targeted response. CONCLUSIONS: We demonstrate the value of centralized CPE control programs to increase case ascertainment, resolve risk factors, and identify local transmission through prospective genomic and epidemiological surveillance; methodologies are transferable to low-prevalence settings and MROs globally.

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BACKGROUND/OBJECTIVES: Micro-induction is a novel buprenorphine induction approach that seeks to avoid withdrawal and minimize precipitated withdrawal, both barriers to standard inductions. We aimed to synthesize evidence on micro-induction effectiveness, and regimens described. METHODS: We searched scientific databases and grey literature for studies including adolescents or adults with opioid use disorder who received buprenorphine micro-induction. Study selection, data extraction and quality assessments occurred in duplicate. We narratively synthesized results. RESULTS: We screened 4,752 citations and included 19 case studies/series and one feasibility study (n = 57 patients; mean age 38 years [SD 12.0]; 57.9% male [33/57]). Studies described 26 regimens; starting and maintenance doses ranged from 0.03 to 1.0 mg, and 8 to 32 mg, respectively. We calculated rate of increase to 8 mg. All patients achieved the desired maintenance dose. Among 54 patients in whom precipitated withdrawal was not reported, mean increases were 1.36 mg/day (SD 0.41). For three patients in whom precipitated withdrawal was specifically reported, mean increase was 1.17 mg/day (SD 0.11). All studies were low quality. DISCUSSION: Described regimens are highly variable. Inconsistent reporting, selection bias, and poor quality evidence limit conclusions regarding optimal dosing, and patient characteristics and clinical settings in which micro-induction is likely beneficial. CONCLUSIONS: This systematic review provides the most up-to-date synthesis on buprenorphine micro-induction regimens. Rigorous studies evaluating effectiveness and safety of micro-induction, and patient and clinical factors influencing its success, are needed.

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Objectives. To examine how physical health symptoms developed and resolved in response to Hurricane Katrina.Methods. We used data from a 2003 to 2018 study of young, low-income mothers who were living in New Orleans, Louisiana, when Hurricane Katrina struck in 2005 (n = 276). We fit logistic regressions to model the odds of first reporting or "developing" headaches or migraines, back problems, and digestive problems, and of experiencing remission or "recovery" from previously reported symptoms, across surveys.Results. The prevalence of each symptom increased after Hurricane Katrina, but the odds of developing symptoms shortly before versus after the storm were comparable. The number of traumatic experiences endured during Hurricane Katrina increased the odds of developing back and digestive problems just after the hurricane. Headaches or migraines and back problems that developed shortly after Hurricane Katrina were more likely to resolve than those that developed just before the storm.Conclusions. While traumatic experiences endured in disasters such as Hurricane Katrina appear to prompt the development of new physical symptoms, disaster-induced symptoms may be less likely to persist or become chronic than those emerging for other reasons.

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Climate change exacerbates the severity of natural disasters, which disproportionately affect vulnerable populations. Mitigating disasters' health consequences is critical to promoting health equity, but few studies have isolated the short- and long-term effects of disasters on vulnerable groups. We filled this gap by conducting a fifteen-year (2003-2018) prospective study of low-income, predominantly Black parents who experienced Hurricane Katrina: the Resilience in Survivors of Katrina (RISK) Project. Here we describe this project and synthesize lessons from work that has resulted from it. Our findings can guide policy makers, service providers, and health officials in disaster planning and response. We synthesize them into an organizational schema of five priorities: Primary efforts should be aimed at preventing exposure to trauma through investments in climate resilience and by eliminating impediments to evacuation, health care policies should promote uninterrupted and expanded access to care, social services should integrate and strive to reduce the administrative burden on survivors, programs should aid survivors in forging or strengthening connections to their communities, and policy makers should fund targeted long-term services for highly affected survivors.

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Exposure to disasters is associated with a range of posttraumatic stress symptom (PTSS) trajectories. However, few studies have tracked PTSS for more than a decade postdisaster, and none to our knowledge has explored the role of predisaster resources and vulnerabilities in shaping the likelihood of trajectory membership. The current study included participants from the Resilience in Survivors of Katrina Study (N = 885). Participants were originally part of a community college intervention study and were assessed prior to the hurricane (6-21 months predisaster), and approximately 1 year, 4 years, and 12 years postdisaster. Latent class growth analysis identified PTSS trajectories. Perceived social support, probable mental illness, and physical health conditions or problems-all assessed predisaster-were examined as predictors of trajectory membership at the univariate level and in multivariable models without and with adjustment for disaster exposure. Three PTSS trajectories were detected: Moderate-Decreasing (69.3%), High-Decreasing (23.1%), and High-Stable (7.6%). In the multivariable predictive model without adjustment for disaster exposure, probable predisaster mental illness was significantly associated with greater odds of the High-Decreasing and High-Stable trajectories, and physical health conditions or problems with greater odds of the High-Decreasing trajectory, relative to the Moderate-Decreasing trajectory. However, when disaster exposure was adjusted, only the association between predisaster mental illness and the odds of the High-Stable trajectory remained statistically significant. Lower predisaster perceived social support was significantly associated with membership in the High-Decreasing trajectory, relative to the Moderate-Decreasing, at the univariate level, but not in either multivariable model. Whereas predisaster mental illness confers risk for chronic postdisaster PTSS, other impacts of predisaster resources and vulnerabilities on elevated PTSS trajectories do not go beyond those of disaster exposure. The results support disaster preparedness efforts targeting those with mental and physical health conditions, and postdisaster mental health services addressing preexisting vulnerabilities in addition to disaster-related PTSS.

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