Sexually Transmitted Infections Among California Youth: Estimated Incidence and Direct Medical Cost, 2005

Purpose: The purpose of this study was to estimate the incidence and the direct medical cost of sexually transmitted infections (STIs) among young persons in California and each of its 58 counties, and to better inform discussions about statewide policies and local resources needed for STI prevention and control efforts. Methods: On the basis of the methods developed at the Centers for Disease Control and Prevention we estimated the statewide number of new cases of eight major STIs among young persons aged 15 to 24 years in California in 2005: chlamydia, gonorrhea, syphilis, genital herpes, human papillomavirus (HPV), hepatitis B, trichomoniasis, and HIV. We also calculated the direct medical cost of these STIs using national cost-per-case estimates. To inform local policy discussions about STI control efforts, the statewide estimates were allocated by county. Results: An estimated 1.1 million new cases of STIs occurred among young persons in California in 2005, with a direct medical cost of $1.1 billion. The estimated number of new cases within counties ranged from a low of 82 in Alpine and Sierra counties, at a cost of$38,000, to a high of about 360,000 in Los Angeles County, at a cost of $390 million. Conclusions: These estimates illustrate the widespread and frequently underreported incidence and costs of youth STIs in California and its counties, and provide the foundation for a comprehensive assessment of youth STI prevention needs

Statewide Policy Advocacy Intervention in California: The No Time for Complacency Initiative

California has made substantial progress since 1991 in reducing its teen birth rate, and its rate reduction now leads the nation. Yet more than 50,000 Californian teens continue to give birth each year, and many more became pregnant. And due to changing demographics and the recent reversal in the last decade’s poverty rate declines, California’s improvements are at risk. The No Time for Complacency (NTFC) initiative is a policy advocacy intervention designed to promote effective statewide teen pregnancy prevention policy and funding in California. This initiative employs legislative-district data analysis to provide a politically compelling organization of teen birth data, cost analyses to heighten the societal relevance of teen births, policy analysis to identify promising and effective state policies, and media advocacy to focus attention on these issues in all regions of the state. The process and results described show how it was possible to achieve impacts on state-level health policy and program funding

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

A Statewide Policy Advocacy Intervention in California: The No Time for Complacency Initiative

Abstract California has made substantial progress since 1991 in reducing its teen birth rate, and its rate reduction now leads the nation. Yet more than 50,000 Californian teens continue to give birth each year, and many more became pregnant. And due to changing demographics and the recent reversal in the last decade&apos;s poverty rate declines, California&apos;s improvements are at risk. The No Time for Complacency (NTFC) initiative is a policy advocacy intervention designed to promote effective statewide teen pregnancy prevention policy and funding in California. This initiative employs legislative-district data analysis to provide a politically compelling organization of teen birth data, cost analyses to heighten the societal relevance of teen births, policy analysis to identify promising and effective state policies, and media advocacy to focus attention on these issues in all regions of the state. The process and results described show how it was possible to achieve impacts on state-level health policy and program funding

Risk of COVID-19 after natural infection or vaccinationResearch in context

Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health

Risk of COVID-19 after natural infection or vaccinationResearch in context

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health