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COVID-19 vaccine as well as the to take a risk.
9%/y (observation). Other revenue centers with large increases in spending included emergency services (164.7%), clinics (on-site 114.5%, satellite 129.7%), anesthesia (119.6%), echocardiography (114.4%), and computed tomography (100.8%). Most services had volume growths within ±2%/y, although there were exceptions (eg, observation hours increased 10.0%/y). Prices grew fastest for echocardiograms (10.5%/y), cardiac catheterization (9.7%/y), therapeutic radiology (8.0%/y), and emergency visits (7.5%/y). In general, median prices for services in 2016 were larger than Medicare allowed amounts. CONCLUSIONS Overall hospital-based spending increased 66.6% between 2007 and 2016 in California, but there was wide variation in spending growth across revenue centers. Understanding this variation-including the relative contributions of volumes and prices-can guide efforts to curb excessive health care spending and optimize resource dedication to current and future patient care needs.BACKGROUND Up to 30% of women with vaginal symptoms are not assigned a diagnosis after standard diagnostic assessment. METHODS We compared premenopausal women with idiopathic vaginitis (IV) or vulvodynia (VVD) to healthy controls. Microbiota were characterized using rRNA sequencing. Cytokines/chemokines (IL-10, IL-1α, IL-1β, IL-6, IL-8, IL-2, IL-18, IL-4, IL-9, and IL-13) were measured in vaginal lavage fluid using the Meso Scale Discovery platform or ELISA (IL-1ra). Immunoglobulins were measured in vaginal lavage fluid using a bead-based immunoassay (Millipore). Cases and controls were compared using Kruskal-Wallis, analysis of variance, and linear regression or (for microbiome composition) the Bray-Curtis dissimilarity statistic. RESULTS We compared 20 women with IV, 30 with VVD, and 52 controls. Most (80%) had greater than 90% 16S rRNA gene sequences from Lactobacillus crispatus, L. jensenii, L. gasseri, or L. iners. In analyses adjusted for age and hormonal contraception (HC), Gardnerella vaginalis was less prevalent and abundant in women with VVD (2/30, 7%) versus controls (16/52, 31%) or IV (5/20, 25%) (P = 0.030). Bray-Curtis dissimilarity was not significantly different between IV and controls or VVD. Fungal sequences were only detected in 5 participants 2 control, 1 IV, 2 VVD. In univariate analysis, cytokines were not associated with diagnosis. Median vaginal concentration of IgE (but not other immunoglobulins) was lower in women with VVD (P = 0.006). CONCLUSIONS Minimal differences in vaginal microbiota and inflammatory markers between women with IV, VVD or controls suggest no striking association between vaginal bacteria, fungi or inflammation and diagnosis in these women.BACKGROUND Although preventable through timely screening and treatment, congenital syphilis (CS) rates are increasing in the United States (US), occurring in 5% of counties in 2015. Although individual-level factors are important predictors of CS, given the geographic focus of CS, it is also imperative to understand what county-level factors are associated with CS. METHODS This is a secondary analysis of reported county CS cases to the National Notifiable Disease Surveillance System (NNDSS) during 2014-15 and 2016-17. We developed a predictive model to identify county-level factors associated with CS and use these to predict counties at elevated risk for future CS. RESULTS Our final model identified 973 (31.0% of all US counties) counties at elevated risk for CS (sensitivity 88.1%; specificity 74.0%). County factors that were predictive of CS included metropolitan area, income inequality, P&S syphilis rates among women and MSM, and population proportions of those who are non-Hispanic Black, Hispanic, living in urban areas, and uninsured. The predictive model using 2014-2015 CS outcome data was predictive of 2016-2017 CS cases (area under the curve value = 89.2%) CONCLUSIONS Given the dire consequences of CS, increasing prevention efforts remains important. Selleckchem ALK inhibitor The ability to predict counties at most elevated risk for CS based on county factors may help target CS resources where they are needed most.BACKGROUND US guidelines recommend routine HIV screening of all adults and adolescents at least once. The population-level impact of this strategy is unclear and will vary across the country. METHODS We constructed a static linear model to estimate the optimal ages and incremental impact of adding one-time routine HIV screening to risk-based, prenatal, symptom-based, and partner notification testing. Using surveillance data and published studies, we parameterized the model at the national level and for two settings representing subnational variability in the rates and distribution of infection King County, WA and Philadelphia County, PA. Screening strategies were evaluated in terms of the percent of tests that result in new diagnoses (test positivity), cumulative person-years of undiagnosed infection, and the number of symptomatic HIV/AIDS cases. RESULTS Depending on the frequency of risk-based screening, routine screening test positivity was maximized at ages 30-34 years in the national model. The optimal age for routine screening was higher in a setting with a lower proportion of cases among men who have sex with men. Across settings, routine screening resulted in incremental reductions of 3-8% in years of undiagnosed infection and 3-11% in symptomatic cases, compared to reductions of 36-69% and 41-76% attributable to risk-based screening. CONCLUSIONS While routine HIV screening may contribute meaningfully to increased case detection in persons not captured by targeted testing programs in some settings, this strategy will have a limited impact on population-level outcomes. Our findings highlight the importance of a multipronged testing strategy with continued investment in risk-based screening programs.BACKGROUND Persons with sexually transmitted infections (STIs) or hepatitis C virus (HCV) infection often have indicators of HIV risk. We used weighted data from six cycles of the National Health and Nutrition Examination Survey (NHANES) to assess the proportion of persons who reported ever being diagnosed with a selected STI or HCV infection and who reported that they were ever tested for HIV. METHODS Persons aged 20-59 years with prior knowledge of HCV infection before receiving NHANES HCV RNA positive results (2005-2012) or reporting ever being told by a doctor that they had HCV infection (2013-2016), or ever had genital herpes, or had chlamydia or gonorrhea in the past 12 months, were categorized as having had a selected STI or HCV infection. Weighted proportions and 95% confidence intervals were estimated for reporting ever being tested for HIV for those who did and did not report a selected STI or HCV infection. RESULTS A total of 19,102 respondents had non-missing data for STI and HCV diagnoses and HIV testing history; 44.
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