Conceptions of Contraception: Awareness and Access to Emergency Contraception Among Young Adults in Albuquerque

Background: Family planning has enormous societal, economic, and interpersonal implications. The United States, NM is no exception, has a much higher rate of unintended pregnancies (50%) than other developed countries. This is associated with poor health outcomes for the mother and the child. Emergency contraception (EC) provides a safe back up method. NM had tried to increase access to EC by licensing pharmacists to dispense it without a prescription. In addition, the FDA agreed to make it OTC for people \u3e18 years old. Objective: To assess young adults knowledge and access to EC in the Albuquerque area. Our goal is that this information will provide a better understanding of EC use in this population and thereby make EC more available. Methods: Anonymous, self-report, survey administered in university classrooms to individuals who were 18-25 years old and willing to participate. Results: Total 339 participants (female 199, male 140). The majority knew about EC and that it was available (95% and 96% respectively). However where it could be obtained and what exactly it was seemed unclear for the majority of participants. These results did not change based on age. Participants who discussed EC with their HCP were more likely to have used EC (p\u3c0.0001) and know that it was different from \u27the abortion pill\u27 (p=0.005). In total 33% of female participants had used EC. Women who had used EC were only slightly more likely to know that EC was available directly from a pharmacist (Fisher\u27s Exact Test p=0.01). Otherwise, their responses were statistically similar to the other participants. Summary: Emergency contraception is a valuable tool in the arsenal of socially, economically, and individually important campaign of family planning. Young adults\u27 knowledge about EC has improved in some areas (availability from pharmacist, OCT, and the distinction between it and RU 486). Despite the change in status to OTC, public health and Planned Parenthood clinics are still the most common access point. Further study to assess the access of individuals \u3c18 years old, actual use when women have EC on hand, and its correlation with conception is recommended. Lastly, HCP should to continue to inform patients about EC to be used as it was intended —as Plan B for when Plan A —a consistent, reliable, birth control method fails.\u2

DETECTION OF HEALTHCARE-ASSOCIATED INFECTIOUS DISEASE OUTBREAKS WITH A SPECIAL LOOK AT CLOSTRIDIUM DIFFICILE INFECTION IN LONG-TERM CARE FACILITIES

Healthcare-associated infections (HAI) are a major cause of morbidity and mortality and a public health priority. However, standard procedures and comprehensive guidelines for HAI outbreak detection and response are still needed. This hybrid thesis describes what is known about HAI outbreaks in the introduction, reviews the HAI outbreaks reported to New Mexico Department of Health (NMDOH), in the first paper, and then in the second paper examines how established methods for detecting infectious disease outbreaks perform in identifying Clostridium difficile infection (CDI) outbreaks in long-term care facilities (LTCF) in Bernalillo County, New Mexico, and finally, it closes with our overall conclusions at this time from this work. Our main findings are that gastrointestinal illness, most commonly norovirus, in LTCFs is most likely to be reported and that in LTCFs the least complex threshold method performs with the highest sensitivity and specificity in detecting possible CDI outbreaks

Conceptions of Contraception: Awareness and Access to Emergency Contraception Among Young Adults in Albuquerque

Background: Family planning has enormous societal, economic, and interpersonal implications. The United States, NM is no exception, has a much higher rate of unintended pregnancies (50%) than other developed countries. This is associated with poor health outcomes for the mother and the child. Emergency contraception (EC) provides a safe back up method. NM had tried to increase access to EC by licensing pharmacists to dispense it without a prescription. In addition, the FDA agreed to make it OTC for people >18 years old. Objective: To assess young adults’ knowledge and access to EC in the Albuquerque area. Our goal is that this information will provide a better understanding of EC use in this population and thereby make EC more available. Methods: Anonymous, self-report, survey administered in university classrooms to individuals who were 18-25 years old and willing to participate. Results: Total 339 participants (female 199, male 140). The majority knew about EC and that it was available (95% and 96% respectively). However where it could be obtained and what exactly it was seemed unclear for the majority of participants. These results did not change based on age. Participants who discussed EC with their HCP were more likely to have used EC (p<0.0001) and know that it was different from “the abortion pill” (p=0.005). In total 33% of female participants had used EC. Women who had used EC were only slightly more likely to know that EC was available directly from a pharmacist (Fisher’s Exact Test p=0.01). Otherwise, their responses were statistically similar to the other participants. Summary: Emergency contraception is a valuable tool in the arsenal of socially, economically, and individually important campaign of family planning. Young adults’ knowledge about EC has improved in some areas (availability from pharmacist, OCT, and the distinction between it and RU 486). Despite the change in status to OTC, public health and Planned Parenthood clinics are still the most common access point. Further study to assess the access of individuals <18 years old, actual use when women have EC on hand, and its correlation with conception is recommended. Lastly, HCP should to continue to inform patients about EC to be used as it was intended –as Plan B for when Plan A –a consistent, reliable, birth control method fails

Estimation of Undiagnosed Naegleria fowleri Primary Amebic Meningoencephalitis, United States

Primary amebic meningoencephalitis is an acute, rare, typically fatal disease. We used epidemiologic risk factors and multiple cause-of-death mortality data to estimate the number of deaths that fit the typical pattern for primary amebic meningoencephalitis; we estimated an annual average of 16 deaths (8 male, 8 female) in the United States

Integrating Water Treatment into Antenatal Care: Impact on Use of Maternal Health Services and Household Water Treatment by Mothers—Rural Uganda, 2013

To increase maternal health service use and household water treatment (HWT), free water treatment kits were provided at first antenatal care (ANC) visits and free water treatment sachet refills were provided at follow-up ANC visits, delivery, and postnatal visits in 46 health facilities in rural Uganda. We evaluated the impact by surveying 226 women in the initiative (intervention group) and 207 women who received ANC before the initiative began (comparison group). There was no differences in the percentages of intervention and comparison group women with ≥ 4 ANC visits; however, a higher percentage of intervention group women reported treating their drinking water (31.7% versus 19.7%, P = 0.01), and had free chlorine residual in stored water (13.5% versus 3.4%, P = 0.02) than comparison group women. The intervention did not appear to motivate increased maternal health service use, but demonstrated improvements in HWT

Disseminated Acanthamoeba infection in a heart transplant recipient treated successfully with a miltefosine-containing regimen: Case report and review of the literature.

Disseminated acanthamoebiasis is a rare, often fatal, infection most commonly affecting immunocompromised patients. We report a case involving sinuses, skin, and bone in a 60-year-old woman 5&nbsp;months after heart transplantation. She improved with a combination of flucytosine, fluconazole, miltefosine, and decreased immunosuppression. To our knowledge, this is the first case of successfully treated disseminated acanthamoebiasis in a heart transplant recipient and only the second successful use of miltefosine for this infection among solid organ transplant recipients. Acanthamoeba infection should be considered in transplant recipients with evidence of skin, central nervous system, and sinus infections that are unresponsive to antibiotics. Miltefosine may represent an effective component of a multidrug therapeutic regimen for the treatment of this amoebic infection

Impact of 13-Valent Pneumococcal Conjugate Vaccine on Invasive Pneumococcal Disease Among Adults With HIV—United States, 2008–2018

BackgroundPeople with HIV (PWH) are at increased risk for invasive pneumococcal disease (IPD). Thirteen-valent pneumococcal conjugate vaccine (PCV13) was recommended for use in US children in 2010 and for PWH aged 19 years or older in 2012. We evaluated the population-level impact of PCV13 on IPD among PWH and non-PWH aged 19 years or older.MethodsWe identified IPD cases from 2008 to 2018 through the Active Bacterial Core surveillance platform. We estimated IPD incidence using the National HIV Surveillance System and US Census Bureau data. We measured percent changes in IPD incidence from 2008 to 2009 to 2017-2018 by HIV status, age group, and vaccine serotype group, including serotypes in recently licensed 15-valent (PCV15) and 20-valent (PCV20) PCVs.ResultsIn 2008-2009 and 2017-2018, 8.4% (552/6548) and 8.0% (416/5169) of adult IPD cases were among PWH, respectively. Compared with non-PWH, a larger proportion of IPD cases among PWH were in adults aged 19-64 years (94.7%-97.4% vs. 56.0%-60.1%) and non-Hispanic Black people (62.5%-73.0% vs. 16.7%-19.2%). Overall and PCV13-type IPD incidence in PWH declined by 40.3% (95% confidence interval: -47.7 to -32.3) and 72.5% (95% confidence interval: -78.8 to -65.6), respectively. In 2017-2018, IPD incidence was 16.8 (overall) and 12.6 (PCV13 type) times higher in PWH compared with non-PWH; PCV13, PCV15/non-PCV13, and PCV20/non-PCV15 serotypes comprised 21.5%, 11.2%, and 16.5% of IPD in PWH, respectively.ConclusionsDespite reductions post-PCV13 introduction, IPD incidence among PWH remained substantially higher than among non-PWH. Higher-valent PCVs provide opportunities to reduce remaining IPD burden in PWH

Pneumococcal Disease Outbreak at a State Prison, Alabama, USA, September 1–October 10, 2018

A pneumococcal disease outbreak caused by Streptococcus pneumoniae serotype 12F occurred in a state prison in Alabama, USA. Among 1,276 inmates, 40 cases were identified (3 confirmed, 2 probable, 35 suspected). Close living quarters, substance use, and underlying conditions likely contributed to disease risk. Prophylaxis for close contacts included azithromycin and 23-valent pneumococcal polysaccharide vaccine