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DSHS Authors: 2022 Research Articles by DSHS Staff

The following list includes peer-reviewed research articles that have been written by staff of the Texas Department of State Health Services. For more information about these articles or for a full-text copy, please contact the Medical and Research Library by email at library@dshs.texas.gov by calling 512-776-7559.

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2022 Articles (in date order with most recent first)

Pont SJ, Shuford JA, et al. Antibody duration after infection from SARS-CoV-2 in the Texas Coronavirus Antibody Response Survey [published online ahead of print, 2022 May 6]. J Infect Dis. 2022;jiac167. doi:10.1093/infdis/jiac167 
Understanding the duration of antibodies to the SARS-CoV-2 virus that causes COVID-19 is important to controlling the current pandemic. Participants from the Texas Coronavirus Antibody REsponse Survey (Texas CARES) with at least one nucleocapsid protein antibody test were selected for a longitudinal analysis of antibody duration. A linear mixed model was fit to data from participants (n= 4,553) with one to three antibody tests over 11 months (10/1/2020-9/16/2021), and models fit showed that expected antibody response after COVID-19 infection robustly increases for 100 days post-infection, and predicts individuals may remain antibody positive from natural infection beyond 500 days, depending on age, body mass index, smoking or vaping use, and disease severity (hospitalized or not; symptomatic or not).

Singh S, Caggana M, Johnson C, et al. COVID-19 pandemic-related impacts on newborn screening public health surveillance. Int J Neonatal Screen. 2022;8(2):28. Published 2022 Apr 15. doi:10.3390/ijns8020028
Newborn screening (NBS) is an essential public health service that performs screening to identify those newborns at increased risk for a panel of disorders, most of which are genetic. The goal of screening is to link those newborns at the highest risk to timely intervention and potentially life-saving treatment. The global COVID-19 pandemic led to disruptions within the United States public health system, revealing implications for the continuity of newborn screening laboratories and follow-up operations. The impacts of COVID-19 across different states at various time points meant that NBS programs impacted by the pandemic later could benefit from the immediate experiences of the earlier impacted programs. This article will review the collection, analysis, and dissemination of information during the COVID-19 pandemic facilitated by a national, centralized technical assistance and resource center for NBS programs.

Golden MR, AugsJoost B, Bender M, et al. The organization, content, and case-finding effectiveness of HIV assisted partner services in high HIV morbidity areas of the United States. J Acquir Immune Defic Syndr. 2022;89(5):498-504. doi:10.1097/QAI.0000000000002904
Background: The contemporary effectiveness of assisted partner notification services (APS) in the United States is uncertain.
Setting: State and local jurisdictions in the United States that reported ≥300 new HIV diagnoses in 2018 and were participating in the Ending the Epidemic Initiative.
Methods: The study surveyed health departments to collect data on the content and organization of APS and aggregate data on APS outcomes for 2019. Analyses defined contact and case-finding indices (i.e., sex partners named and newly diagnosed per index case receiving APS) and estimated staff case-finding productivity.
Results: Sixteen (84%) of 19 jurisdictions responded to the survey, providing APS outcome data for 14 areas (74%). Most health departments routinely integrated APS with linkage of cases and partners to HIV care (88%) and pre-exposure prophylaxis (88%). A total of 19,164 persons were newly diagnosed with HIV in the 14 areas. Staff initiated APS investigations on 14,203 cases (74%) and provided APS to 9937 cases (52%). Cases named 6799 partners (contact index = 0.68), of whom 1841 (27%) had previously diagnosed HIV, 2202 (32%) tested HIV negative, 541 (8% of named and 20% of tested partners) were newly diagnosed with HIV, and 2215 (33%) were not known to have tested. Across jurisdictions, the case-finding index was 0.054 (median = 0.05, range 0.015-0.12). Health departments employed 292 full-time equivalent staff to provide APS. These staff identified a median of 2.0 new HIV infections per staff per year. APS accounted for 2.8% of new diagnoses in 2019.
Conclusions: HIV case-finding resulting from APS in the United States is low.

Deka MA, Marston CK, Garcia-Diaz J, Drumgoole R, Traxler RM. Ecological niche model of Bacillus cereus group isolates containing a homologue of the pXO1 anthrax toxin genes infecting metalworkers in the United States. Pathogens. 2022;11(4):470. Published 2022 Apr 14. doi:10.3390/pathogens11040470
While Bacillus cereus typically causes opportunistic infections in humans, within the last three decades, severe and fatal infections caused by isolates of the B. cereus group harboring anthrax toxin genes have been reported in the United States. From 1994 to 2020, seven cases of anthrax-like illness resulting from these isolates have been identified. With one exception, the cases have occurred in the Gulf States region of the United States among metalworkers. We aimed to develop an ecological niche model (ENM) to estimate a spatial area conducive to the survival of these organisms based on the presence of known human infections and environmental variables. The estimated ecological niche for B. cereus was modeled with the maximum entropy algorithm (Maxent). Environmental variables contributing most to the model were soil characteristics (cation exchange capacity, carbon content, soil pH), temperature, enhanced vegetation index (EVI), and land surface temperature (LST). Much of the suitable environments were located throughout the Gulf Coast Plain, Texas Backland Prairies, East Central Texas Plains, Edwards Plateau, Cross Timbers, Mississippi Alluvial Plain, and Central Great Plains. These findings may provide additional guidance to narrow potential risk areas to efficiently communicate messages to metalworkers and potentially identify individuals who may benefit from the anthrax vaccine.

Rao AK, Schulte J, Chen TH, et al. Monkeypox in a traveler returning from Nigeria - Dallas, Texas, July 2021. MMWR Morb Mortal Wkly Rep. 2022;71(14):509-516. Published 2022 Apr 8. doi:10.15585/mmwr.mm7114a1
Monkeypox is a rare, sometimes life-threatening zoonotic infection that occurs in west and central Africa. It is caused by Monkeypox virus, an orthopoxvirus similar to Variola virus (the causative agent of smallpox) and Vaccinia virus (the live virus component of orthopoxvirus vaccines) and can spread to humans. After 39 years without detection of human disease in Nigeria, an outbreak involving 118 confirmed cases was identified during 2017-2018 (1); sporadic cases continue to occur. During September 2018-May 2021, six unrelated persons traveling from Nigeria received diagnoses of monkeypox in non-African countries: four in the United Kingdom and one each in Israel and Singapore. In July 2021, a man who traveled from Lagos, Nigeria, to Dallas, Texas, became the seventh traveler to a non-African country with diagnosed monkeypox. Among 194 monitored contacts, 144 (74%) were flight contacts. The patient received tecovirimat, an antiviral for treatment of orthopoxvirus infections, and his home required large-scale decontamination. Whole genome sequencing showed that the virus was consistent with a strain of Monkeypox virus known to circulate in Nigeria, but the specific source of the patient's infection was not identified. No epidemiologically linked cases were reported in Nigeria; no contact received postexposure prophylaxis (PEP) with the orthopoxvirus vaccine ACAM2000.

Langlois PH, Canfield MA, et al. Association between maternal smoking and survival among infants with trisomy 21. Birth Defects Res. 2022;114(7):249-258. doi:10.1002/bdr2.1993
Background: Trisomy 21 (T21) is common, with affected infants having an increased risk of infant mortality (5.9-7.1%). Maternal smoking is associated with infant mortality in the general population, and we evaluated if similar associations were present among infants with T21.
Methods: We identified infants with T21 from the Texas Birth Defects Registry, and maternal smoking and infant vital status were obtained from linked birth and death certificate data, respectively. Cox proportional hazards regression models were used to calculate hazard ratios between maternal smoking and death between 0 to ≤ 364 days, 28-364 days, and 0-27 days.
Results: We found a significant association between maternal smoking and death between 0 to ≤ 364 (unadjusted HR 1.72, 95% CI 1.07, 2.77), which was no longer statistically significant after adjustment for covariates (adjusted HR 1.55, 95% CI 0.94, 2.56). A similar pattern was observed for death between 28-364 days (adjusted HR: 1.68, 95% CI 0.93, 3.03), whereas the association for 0-27 days (adjusted HR: 1.30, 95% CI 0.51, 3.29) was not statistically significant before and after adjustment.
Conclusions: The observed magnitudes of associations were similar to previous estimates among the general population. Further work considering the role of other maternal and infant risk factors and social determinants of health is necessary to better understand the observed results.

Langlois PH, Canfield MA, et al. Birth defect co-occurrence patterns among infants with cleft lip and/or palate. Cleft Palate Craniofac J. 2022;59(4):417-426. doi:10.1177/10556656211010060
Objective: To investigate 2- to 5-way patterns of defects co-occurring with orofacial clefts using data from a population-based registry.
Design: We used data from the Texas Birth Defects Registry for deliveries between 1999 and 2014 to Texas residents, including 1884 cases with cleft palate (CP) and 5289 cases with cleft lip with or without cleft palate (CL±P) without a known syndrome. We identified patterns of defects co-occurring with CP and with CL±P observed more frequently than would be expected if these defects occurred independently. We calculated adjusted observed-to-expected (O/E) ratios to account for the known tendency of birth defects to cluster nonspecifically.
Results: Among infants without a syndrome, 23% with CP and 21% with CL±P had at least 1 additional congenital anomaly. Several combinations of defects were observed much more often than expected. For example, the combination of CL±P, congenital hydrocephaly, anophthalmia, and other nose anomalies had an O/E ratio of 605. For both CP and CL±P, co-occurrence patterns with the highest O/E ratios involved craniofacial and brain abnormalities, and many included the skeletal, cardiovascular, and renal systems.
Conclusions: The patterns of defects we observed co-occurring with clefts more often than expected may help improve our understanding of the relationships between multiple defects. Further work to better understand some of the top defect combinations could reveal new phenotypic subgroups and increase our knowledge of the developmental mechanisms that underlie the respective defects.

Langlois PH, Canfield MA, et al. The epidemiology of biliary atresia: Exploring the role of developmental factors on birth prevalence [published online ahead of print, 2022 Mar 29]. J Pediatr. 2022;S0022-3476(22)00288-8. doi:10.1016/j.jpeds.2022.03.038
Objectives: To identify key epidemiological factors relevant to fetal development that are associated with biliary atresia STUDY DESIGN: This population-based registry study examined infants born in Texas between 1999 and 2014. Epidemiological data relevant to fetal development was compared between cases of biliary atresia identified in the Texas Birth Defects Registry (n=305) versus all live births (n=4,689,920), and Poisson regression was used to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs).
Results: The prevalence of BA was 0.65 per 10,000 live births over the study period. BA was positively associated with female sex (adjusted PR 1.68, 95% CI: 1.33-2.12), delivery before 32-37 weeks gestation (adjusted PR 1.64, 95%CI 1.18-2.29), delivery before 32 weeks gestation (adjusted PR 3.85, 95%CI 2.38-6.22), and non-Hispanic Black versus non-Hispanic White maternal race/ethnicity (adjusted PR 1.54, 95%CI 1.06-2.24), and BA was inversely associated with season of conception in the fall relative to spring (adjusted PR 0.62, 95%CI 0.45-0.86). In addition, BA was associated with maternal diabetes (adjusted PR 2.34, 95%CI 1.57-3.48), with a stronger association with pre-gestational compared with gestational diabetes. In sub-group analyses, these associations were present in isolated BA cases which do not have any additional birth defects.
Conclusions: BA is associated with multiple factors related to fetal development, including pre-gestational maternal diabetes, female sex, and preterm birth. These associations were also observed in isolated cases of biliary atresia without other malformations or laterality defects. Our results are consistent with early life events influencing the pathogenesis of biliary atresia, and support further studies investigating in utero events to better understand the etiology and time of onset.

Butler AM, Hilliard ME, Fegan-Bohm K, Minard C, Anderson BJ. Peer-support intervention for African American and Latino parents to improve the glycemic control trajectory among school-aged children with type 1 diabetes: A pilot and feasibility protocol [published online ahead of print, 2022 Mar 25]. Contemp Clin Trials. 2022;116:106739. doi:10.1016/j.cct.2022.106739
Background Type 1 diabetes (T1D) is a common, chronic pediatric health condition with complicated management demands. African American and Latino children with T1D have troubling disparities in glycemic outcomes and acute complications. While there are empirically supported behavioral interventions to support disease management in youth with T1D, there are few that specifically aim to reduce health disparities in this population. While collaborative parent involvement with the child with T1D management tasks is important to promote optimal glycemic outcomes during childhood, our formative research identified multiple individual, family, and broader system factors that impede or facilitate collaborative parental involvement among African American and Latino parents of children with T1D. Methods This paper describes the development, design, and study protocol for the Type 1 Diabetes Empowerment And Management (TEAM) pilot trial. The TEAM intervention is a novel, group-based behavioral intervention designed to enhance collaborative involvement in T1D management for African American and Latino parents of children aged 5-10. This randomized pilot trial's primary aim is to evaluate the TEAM intervention's feasibility and acceptability. The secondary aim is to examine preliminary intervention outcomes (i.e., children's HbA1c, treatment adherence, collaborative parent involvement in T1D management, parent/child quality of life, and parent's diabetes-related distress, depressive symptoms, and self-efficacy) compared to usual T1D care. Discussion The trial will provide preliminary information about whether optimizing appropriate parent involvement during the school-age years may increase T1D treatment adherence and stabilize or improve glycemic control in African American and Latino school-aged children.

Hills SL, Broussard KR, Broyhill JC, et al. Tick-borne encephalitis among US travellers, 2010-20. J Travel Med. 2022;29(2):taab167. doi:10.1093/jtm/taab167
Background: Tick-borne encephalitis (TBE) is an arboviral disease that is focally endemic in parts of Europe and Asia. TBE cases among US travellers are rare, with previous reports of only six cases among civilian travellers through 2009 and nine military-related cases through 2020. A TBE vaccine was licenced in the USA in August 2021. Understanding TBE epidemiology and risks among US travellers can help with the counselling of travellers going to TBE-endemic areas.
Methods: Diagnostic testing for TBE in the USA is typically performed at the Centers for Disease Control and Prevention (CDC) because no commercial testing is available. Diagnostic testing for TBE at CDC since 2010 was reviewed. For individuals with evidence of TBE virus infection, information was gathered on demographics, clinical presentations and risk factors for infection.
Results: From 2010-20, six patients with TBE were identified. Cases occurred among both paediatric and adult travellers and all were male. Patients were diagnosed with meningitis (n = 2) or encephalitis (n = 4); none died. Cases had travelled to various countries in Europe or Russia. Three cases reported visiting friends or relatives. Activities reported included hiking, camping, trail running, or working outdoors, and two cases had a recognized tick bite.
Conclusions: TBE cases among US travellers are uncommon, with these six cases being the only known TBE cases among civilian travellers during this 11-year period. Nonetheless, given potential disease severity, pre-travel counselling for travellers to TBE-endemic areas should include information on measures to reduce the risk for TBE and other tick-borne diseases, including possible TBE vaccine use if a traveller's itinerary puts them at higher risk for infection. Clinicians should consider the diagnosis of TBE in a patient with a neurologic or febrile illness recently returned from a TBE-endemic country, particularly if a tick bite or possible tick exposure is reported.

Shuford JA, Pont SJ, et al. Durability of SARS-CoV-2 antibodies from natural infection in children and adolescents [published online ahead of print, 2022 Mar 18]. Pediatrics. 2022;10.1542/peds.2021-055505. doi:10.1542/peds.2021-055505
As of January 27, 2022 over 11.4 million children in the United States (US) have tested positive for COVID-19.1 COVID-19 cases among US children have seen an exponential increase in December 2021 and January 2022, a very short time period that far exceeds previous peaks of infection.1 These recent data suggest the omicron (B.1.1.529) variant is more transmissible compared to the delta (B.1.617.2) and alpha (B.1.1.7) variants.1 These data are particularly troubling as they coincide with school re-openings after the 2021-22 holiday break across the country. Information about the durability of SARS-CoV-2-specific natural immune responses in children is important to inform community-based transmission mitigation and pediatric vaccination strategies, for both current and potential future variants. However, the true incidence and longitudinal presence of natural (not-vaccine induced) antibody response to SARS-CoV-2 infection is not known in the pediatric population due to the high proportion of asymptomatic infection2 and prioritization of testing for adults and those with severe illness early in the pandemic. This is important information for the field as not all parents can or will choose to vaccinate their child.

Rositch AF, Levinson K, Suneja G, et al. Epidemiology of cervical adenocarcinoma and squamous cell carcinoma among women living with human immunodeficiency virus compared with the general population in the United States. Clin Infect Dis. 2022;74(5):814-820. doi:10.1093/cid/ciab561
Background: Although cervical cancer risk overall is elevated among women living with human immunodeficiency virus (HIV; WLH), it is unclear whether risks are similarly elevated across histologic subtypes.
Methods: Data from the HIV/AIDS Cancer Match Study, a linkage of 12 US HIV and cancer registries during 1996 -2016, were used. Cervical cancers were categorized as adenocarcinoma (AC), squamous cell carcinoma (SCC), or other histologic subtype. Standardized incidence ratios compared rates of AC and SCC in WLH to those in general population. For WLH, risk factors for AC and SCC were evaluated using Poisson regression. Five-year survival was estimated by HIV status and histology.
Results: Overall, 62 615 cervical cancers were identified, including 609 in WLH. Compared with the general population, incidence of AC was 1.47 times higher (95% confidence interval [CI]: 1.03-2.05) and SCC was 3.62 times higher among WLH (95% CI: 3.31-3.94). Among WLH, there was no difference in AC rates by race/ethnicity or HIV transmission group, although SCC rates were lower among White women (vs Black) and higher among women who inject drugs (vs heterosexual transmission). Among WLH, 5-year overall survival was similar for AC (46.2%) and SCC (43.8%) but notably lower than for women not living with HIV.
Conclusions: Among WLH, AC rates were modestly elevated, whereas SCC rates were greatly elevated compared with the general population. These findings suggest there may be differences in the impact of immunosuppression and HIV in the development of AC versus SCC, given their common etiology in human papillomavirus infection.

Gee JE, Bower WA, Kunkel A, et al. Multistate outbreak of melioidosis associated with imported aromatherapy spray. N Engl J Med. 2022;386(9):861-868. doi:10.1056/NEJMoa2116130
Melioidosis, caused by the bacterium Burkholderia pseudomallei, is an uncommon infection that is typically associated with exposure to soil and water in tropical and subtropical environments. It is rarely diagnosed in the continental United States. Patients with melioidosis in the United States commonly report travel to regions where melioidosis is endemic. We report a cluster of four non-travel-associated cases of melioidosis in Georgia, Kansas, Minnesota, and Texas. These cases were caused by the same strain of B. pseudomallei that was linked to an aromatherapy spray product imported from a melioidosis-endemic area.

Saxton DL, Archer NP. The effect of postpartum depressive symptoms (PDS) on maternal health practices after childbirth, Texas pregnancy risk assessment monitoring system, 2012-2015. Matern Child Health J. 2022;26(3):537-544. doi:10.1007/s10995-021-03304-2
Objectives: This study examined the contribution of postpartum depressive symptoms (PDS) on select maternal health practices among Texas women, using 2012-2015 survey data from the Pregnancy Risk Assessment Monitoring System.
Methods: Multiple logistic regression was used to assess the effect of PDS on postpartum checkups, postpartum dental visits, and use of postpartum birth control. Covariates included maternal age, race/ethnicity, marital status, education, and depression before birth.
Results: Data from 4679 respondents were used in analyses, and the prevalence of women reporting PDS was 13.8 percent. Women without PDS were more likely to attend a postpartum checkup (adjusted OR = 1.5; 95% CI 1.1-2.1) or have a postpartum dental visit (adjusted OR = 1.4, 95% CI 1.0-1.8) than women with PDS. There was insufficient evidence to conclude any association between PDS and use of postpartum birth control.
Conclusions: These findings highlight adverse effects of PDS on maternal health practices not previously studied. Results stress the importance of healthcare professionals monitoring the moods and actions of women of childbearing age to provide early interventions for women experiencing PDS, and of emphasizing positive maternal health practices after childbirth.

Langlois PH, Marengo L, Lupo PJ, et al. Evaluating the proportion of isolated cases among a spectrum of birth defects in a population-based registry [published online ahead of print, 2022 Feb 26]. Birth Defects Res. 2022;10.1002/bdr2.1990. doi:10.1002/bdr2.1990
Introduction: Because the etiology and outcomes of birth defects may differ by the presence vs. absence of co-occurring anomalies, epidemiologic studies often attempt to classify cases into isolated versus non-isolated groupings. This report describes a computer algorithm for such classification and presents results using data from the Texas Birth Defects Registry (TBDR).
Methods: Each of the 1,041 birth defects coded by the TBDR was classified as chromosomal, syndromic, minor, or "needs review" by a group of three clinical geneticists. A SAS program applied those classifications to each birth defect in a case (child/fetus), and then hierarchically combined them to obtain one summary classification for each case, adding isolated and multiple defect categories. The program was applied to 136,121 cases delivered in 2012-2017.
Results: Of total cases, 49% were classified by the platform as isolated (having only one major birth defect). This varied widely by birth defect; of those examined, the highest proportion classified as isolated was found in pyloric stenosis (87.6%), whereas several cardiovascular malformations had low proportions, including tricuspid valve atresia/stenosis (2.3%).
Discussion: This is one of the first and largest attempts to identify the proportion of isolated cases across a broad spectrum of birth defects, which can inform future epidemiologic and genomic studies of these phenotypes. Our approach is designed for easy modification for use with any birth defects coding system and category definitions, allowing scalability for different studies or birth defects registries, which often do not have resources for individual clinical review of all case records.

Cantu C, Surita K, Buendia J. Factors that increase risk of an HIV diagnosis following a diagnosis of syphilis: A population-based analysis of Texas men. [published online ahead of print, 2022 Feb 2]. AIDS Behav. 2022;10.1007/s10461-022-03593-w. doi:10.1007/s10461-022-03593-w
Studies have consistently shown that diagnosis of a syphilis infection increases the risk of human immunodeficiency virus (HIV) infection. This study examines patterns in HIV incidence among men following a Primary and Secondary (P&S) syphilis diagnosis. P&S syphilis cases among men reported to the Texas Department of State Health Services between January 2010 and June 2018 were linked to the Enhanced HIV/AIDS Reporting System. Risk factors for HIV diagnosis were identified using univariate and multivariate extended Cox proportional hazards models. The 9113 men with syphilis without a concurrent or prior HIV diagnosis contributed a cumulative 35,674 person-years with a mean follow-up time of 3.9 years. The multivariate model showed that among men with a P&S syphilis diagnosis, age, race/ethnicity, transmission risk, comorbid STDs, subsequent STDs, and syphilis diagnosing facility were independently associated with a new HIV diagnosis. The results highlight disparities in HIV diagnoses, despite current prevention recommendations. Reducing these disparities will require multi-level, comprehensive interventions that are appropriate for the diverse populations around the state.

Royse SK, Costacou T, Nunley KA, Orchard TJ, Rosano C. Neural correlates of slower gait in middle-aged persons with childhood-onset type 1 diabetes mellitus: The impact of accelerated brain aging. J Diabetes Complications. 2022;36(2):108084. doi:10.1016/j.jdiacomp.2021.108084
Aims: We aimed to determine if neuroimaging characteristics of gray and white matter are associated with gait speed in middle-aged individuals with childhood-onset type 1 diabetes (T1D), and whether associations are independent of diabetic peripheral neuropathy (DPN) status.
Methods: In a cohort of 100 middle-aged adults with childhood-onset T1D (aged 49.2 ± 7.0 years, 50F/50M), we assessed cross-sectional associations of DPN, severity of white matter hyperintensities (WMH; Fazekas score), and regional gray matter volume (GMV) with gait speed. Associations were tested separately and combined in linear regression models adjusted for diabetes duration and locomotor risk factors.
Results: Average gait speed was 1.3 m/s, with 52% of participants walking below the age-appropriate range of 1.3-1.5 m/s. In separate models, higher WMH severity (β = -0.27, p = 0.01) and smaller caudate GMV (β = -0.21, p = 0.04), but not DPN (β = -0.20, p = 0.08) were associated with slower gait speed. When combined, only WMH severity remained significant (β = -0.22, p = 0.04).
Conclusions: More than half of participants walked more slowly than expected based on age. Gait speed was slower among those with more severe WMH independent of locomotor risk factors. Gait slowing in middle-aged persons with T1D may reflect brain changes, and thus, deserve further attention.

Franco G, Herrera IMR, Castro KVH, Chattu VK, Sunil T. Knowledge, attitudes, behavior, and practices of self breast examination in Nicaragua. Cureus. 2022;14(1):e21317. Published 2022 Jan 17. doi:10.7759/cureus.21317
Self breast examination (SBE) has been recommended as an important preventative practice for the early identification of breast cancer in women. However, our understanding of women's knowledge, attitudes, and practices of self breast examination in Nicaragua is limited. In the present study, we conducted a cross-sectional study of women aged 18 years and over (n=500) living in selected urban and rural areas of Nicaragua. Measures included the survey reflected knowledge, attitudes, behaviors, and practices related to self breast examination. We compared these measures between women living in urban and rural areas and women aged 18-39 years and 40+ years. Using a t-test, we tested the significance of these differentials. Results indicate widespread and significant differentials in basic knowledge and behaviors on self-breast examination practices among women living in rural and urban locations in Nicaragua. Further, while younger women reported significant and lower overall knowledge about breast cancer (BC), purpose and reasons for SBE, characteristics of women who tend to be at higher risk for BC, and strategies and steps women take performing SBE compared to women who were in the 40+ age group. Study results call for location and population-specific programs and policies addressing disparities in breast cancer prevention efforts in the country.

Stallings EB, Isenburg JL, Aggarwal D, et al. Prevalence of critical congenital heart defects and selected co-occurring congenital anomalies, 2014-2018: A U.S. population-based study. Birth Defects Res. 2022;114(2):45-56. doi:10.1002/bdr2.1980
Background: Critical congenital heart defects (CCHDs) are one of the most common types of birth defects and can lead to significant morbidity and mortality along with surgical or catheter interventions within the first year of life. This report updates previously published estimates of CCHD prevalence with the latest population-based surveillance data from 19 birth defect surveillance programs.
Methods: The U.S. population-based surveillance programs submitted data on identified cases of 12 CCHDs and co-occurring cardiovascular and chromosomal birth defects from 2014 to 2018. We estimated prevalence by program type and maternal and infant characteristics. Among nine programs with active case ascertainment that collect more than live births, we estimated the percentage of co-occurring cardiovascular and chromosomal birth defects for the 12 CCHDs.
Results: We identified 18,587 cases of CCHD among all participating programs. Overall CCHD prevalence was 19.6 per 10,000 live births among all 19 programs and 20.2 per 10,000 live births among active programs. Among maternal racial/ethnic groups, infants/fetuses born to American Indian/Alaska Native mothers showed the highest overall prevalence for all CCHDs (28.3 per 10,000) along with eight of the 12 individual CCHDs. Among 7,726 infants/fetuses with CCHD from active case ascertainment programs, 15.8% had at least one co-occurring chromosomal birth defect.
Conclusion: Our study provides prevalence estimates for CCHDs by maternal and infant characteristics along with co-occurrence with cardiovascular and chromosomal birth defects among infants/fetuses with CCHD using one of the largest and most recent cohorts since the implementation of widespread CCHD screening. These data can provide a basis for future research to better understand risk factors for these defects.

Ethen MK, et al. Interpregnancy interval and prevalence of selected birth defects: A multistate study. Birth Defects Res. 2022;114(2):69-79. doi.org/10.1002/bdr2.1960
Background: Both short and long interpregnancy intervals (IPIs) have been associated with adverse birth outcomes. We undertook a multistate study to escribe the prevalence of selected birth defects by IPI. 
Methods: We obtained data from nine population-based state birth defects registries for singleton live births in 2000-2009 among mothers with a previous live birth identified through birth certificates. IPI was calculated as the difference between prior birthdate and start of the current pregnancy (conception date). We estimated prevalence of selected defects per 10,000 live births and prevalence ratios (PRs) with 95% confidence intervals (CIs) overall and stratified by maternal age at previous birth and race/ethnicity. Primary analyses focused on short IPI < 6 months and long IPI ≥ 60 months compared to 18-23 months (referent). Sensitivity analyses limited to active-surveillance states and those with<10% missing IPI.
Results: Among 5,147,962 eligible births, 6.3% had short IPI while 19.8% had long IPI. Compared to referent, prevalence with short IPI was elevated for gastroschisis (3.7, CI: 3.0-4.5 vs. 2.0, CI: 1.6-2.4) and with both short and long IPI for tetralogy of Fallot (short: 3.4, 2.8-4.2 long: 3.8, 3.4-4.3 vs. 2.7, 2.3-3.2) and cleft lip ± palate (short: 9.9, 8.8-11.2 long: 9.2, 8.5-9.8 vs. 8.4, 7.6-9.2). Stratified analyses identified additional associations, including elevated prevalence of anencephaly with short IPI in younger mothers and limb defects with long IPI in those ages 25-34 at prior birth. Sensitivity
analyses showed similar results.
Conclusion: In this population-based study, we observed increased prevalence of several birth defects with short and long IPI

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Last updated May 17, 2022