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Households are a significant source of SARS-CoV-2 transmission, even during periods of low community-level spread. Comparing household transmission rates by SARS-CoV-2 variant may provide relevant information about current risks and prevention strategies. This investigation aimed to estimate differences in household transmission risk comparing the SARS-CoV-2 Delta and Omicron variants using data from contact tracing and interviews conducted from November 2021 through February 2022 in five U.S. public health jurisdictions (City of Chicago, Illinois; State of Connecticut; City of Milwaukee, Wisconsin; State of Maryland; and State of Utah). Generalized estimating equations were used to estimate attack rates and relative risks for index case and household contact characteristics. Data from 848 households, including 2,622 individuals (median household size = 3), were analyzed. Overall transmission risk was similar in households with Omicron (attack rate = 47.0%) compared to Delta variant (attack rate = 48.0%) circulation. In the multivariable model, a pattern of increased transmission risk was observed with increased time since a household contact’s last COVID-19 vaccine dose in Delta households, although confidence intervals overlapped (0–3 months relative risk = 0.8, confidence interval: 0.5–1.2; 4–7 months relative risk = 1.3, 0.9–1.8; ≥8 months relative risk = 1.2, 0.7–1.8); no pattern was observed in Omicron households. Risk for household contacts of symptomatic index cases was twice that of household contacts of asymptomatic index cases (relative risk = 2.0, 95% confidence interval: 1.4–2.9), emphasizing the importance of symptom status, regardless of variant. Uniquely, this study adjusted risk estimates for several index case and household contact characteristics and demonstrates that few characteristics strongly dictate risk, likely reflecting the complexity of the biological and social factors which combine to impact SARS-CoV-2 transmission.

Purpose A comparatively high prevalence of comorbidities among African-American/Blacks (AA/B) has been implicated in disparate survival in breast cancer. There is a scarcity of data, however, if this effect persists when accounting for the adverse triple-negative breast cancer (TNBC) subtype which occurs at threefold the rate in AA/B compared to white breast cancer patients. Methods We reviewed charts of 214 white and 202 AA/B breast cancer patients in the NCI-SEER Connecticut Tumor Registry who were diagnosed in 2000–2007. We employed the Charlson Co-Morbidity Index (CCI), a weighted 17-item tool to predict risk of death in cancer populations. Cox survival analyses estimated hazard ratios (HRs) for all-cause mortality in relation to TNBC and CCI adjusting for clinicopathological factors. Results Among patients with SEER local stage, TNBC increased the risk of death (HR 2.18, 95 % CI 1.14–4.16), which was attenuated when the CCI score was added to the model (Adj. HR 1.50, 95 % CI 0.74–3.01). Conversely, the adverse impact of the CCI score persisted when controlling for TNBC (Adj. HR 1.49, 95 % CI 1.29–1.71; per one point increase). Similar patterns were observed in SEER regional stage, but estimated HRs were lower. AA/B patients with a CCI score of ≥3 had a significantly higher risk of death compared to AA/B patients without comorbidities (Adj. HR 5.65, 95 % CI 2.90–11.02). A lower and nonsignificant effect was observed for whites with a CCI of ≥3 (Adj. HR 1.90, 95 % CI 0.68–5.29). Conclusions comorbidities at diagnosis increase risk of death independent of TNBC, and AA/B patients may be disproportionately at risk.

The B.1.1.529 (Omicron) variant, first detected in November 2021, was responsible for a surge in U.S. infections with SARS-CoV-2, the virus that causes COVID-19, during December 2021-January 2022 (1). To investigate the effectiveness of prevention strategies in household settings, CDC partnered with four U.S. jurisdictions to describe Omicron household transmission during November 2021-February 2022. Persons with sequence-confirmed Omicron infection and their household contacts were interviewed. Omicron transmission occurred in 124 (67.8%) of 183 households. Among 431 household contacts, 227 were classified as having a case of COVID-19 (attack rate [AR] = 52.7%). The ARs among household contacts of index patients who had received a COVID-19 booster dose, of fully vaccinated index patients who completed their COVID-19 primary series within the previous 5 months, and of unvaccinated index patients were 42.7% (47 of 110), 43.6% (17 of 39), and 63.9% (69 of 108), respectively. The AR was lower among household contacts of index patients who isolated (41.2%, 99 of 240) compared with those of index patients who did not isolate (67.5%, 112 of 166) (p-value <0.01). Similarly, the AR was lower among household contacts of index patients who ever wore a mask at home during their potentially infectious period (39.5%, 88 of 223) compared with those of index patients who never wore a mask at home (68.9%, 124 of 180) (p-value <0.01). Multicomponent COVID-19 prevention strategies, including up-to-date vaccination, isolation of infected persons, and mask use at home, are critical to reducing Omicron transmission in household settings.

Background: Women with invasive breast cancer should be tested for human epidermal growth factor receptor-2 (HER2) status at the time of diagnosis. To date, no population-based patterns of use studies have examined demographic and clinicopathologic factors associated with decisions by clinicians to test patients. Methods: We reviewed summary pathology reports submitted to the Connecticut Tumor Registry for all Black/African American (B/AA) women ( n = 644) and a 7% random sample ( n = 720) of White women diagnosed in 2000–2003 with primary invasive breast carcinoma. Receipt of a HER2 test (yes vs. no) was examined in relation to patient race, age, socioeconomic status, year of diagnosis, estrogen receptor (ER) status, tumor grade, lymph node status, size and stage at diagnosis. Results: A greater proportion of tumors from B/AA patients were tested compared to those of White women (69.5% vs. 61.9%, p < 0.05). Tumors of patients under the age of 60 were 1.50-times more likely than older women to have been tested, and B/AA women were 1.40-times more likely than White patients to be tested. HER2 testing was more likely to be observed when information also was reported about ER status (OR = 15.9, p < 0.001), tumor grade (OR = 2.28, p < 0.05), tumor size (OR = 2.16, p < 0.05), and lymph node status (OR = 2.06, p < 0.05). Conclusions: Variation in which breast cancer patients received HER2 testing appears to reflect expectations about a woman's prognosis. Discrepancies in receipt of testing deserve further study as current guidelines call for all tumors to be assessed in order to adequately characterize prognosis and determine eligibility for HER2-targeted therapy.

Correspondence to Dr Margaret L Lind, School of Public Health, Yale University, New Haven, CT 06520, USA; margaret.lind@yale.edu COVID-19 has disproportionally burdened racial and ethnic minority groups within the USA.1–5 However, prior studies relied predominately on aggregated data from populations residing in congregate and non-congregate settings.1–5 This approach may underestimate outcome disparities in the community, especially in states that experienced a large COVID-19 burden in nursing homes.5 Herein, we identified COVID-19-related deaths among Connecticut residents of congregate and non-congregate settings and characterised the evolution of racial and ethnic disparities in COVID-19-related mortality among residents of non-congregate settings. Temporal trends in COVID-19-related deaths and mortality among the Connecticut population residing in congregate and non-congregate settings, according to composite race and ethnic groups, March 2020 to December 2021. Ethics approval This study involves human participants and was not deemed as human research by the Yale University Institutional Review Board (IRB).

Physician-assisted suicide appears to be a solution for patients who no longer want to live with the pain of their illness. Most do not realize, that by legalizing this we are violating the Hippocratic Oath, given to all medical students before they become doctors, that states that as doctors they will promote the health of a patient and care for the sick. By legalizing a procedure in which life is taken away from a patient, we are not doing this. Supporters would argue that the patient could be more harmed by letting them live in pain rather than relieving it through euthanasia.

Introduction Disordered eating behaviors (DEBs), including restrictive eating, binge eating and purging, are associated with mental health problems and an increased risk of eating disorders (EDs), which often occur in adolescence and can have serious health consequences. In addition, the increasing rates of overweight and obesity among children and adolescents raise concerns about their associated physical and mental health risks. Attentional biases (ABs) to food- and body-related cues have been proposed as cognitive mechanisms that contribute to the development and maintenance of EDs and are also discussed in the etiology of overweight and obesity. While theoretical models suggest that ABs may contribute to the maintenance of EDs, DEBs, and obesity, empirical evidence in young populations is still limited. Method This systematic review (PROSPERO: CRD42023399292) examined literature from PsycINFO, PubMed, and Scopus on ABs to food- and body-related stimuli in children and adolescents with overweight, obesity, or ED symptoms, compared to healthy comparisons. A total of 30 peer-reviewed studies published in English since 2003 were included. Results The evidence on AB for food in young people with overweight and obesity remains inconclusive, and studies provide conflicting results. Similarly, studies in adolescents with AN show heightened attention to low-calorie foods and inconsistent attentional patterns toward high-calorie foods, indicating a complex and heterogeneous picture. Evidence on AB for food in young people with BED is scarce, with one study reporting an attentional bias towards food. For LOC eating, findings were mixed and less conclusive. This suggests that body-related AB may serve as a relevant marker for the psychopathology of EDs, particularly in AN. Conclusion This review underscores the role of ABs in EDs and overweight/obesity and highlights methodological inconsistencies as well as research gaps, particularly in samples beyond AN and overweight/obesity. Future studies should therefore employ standardized methods, diverse samples, and developmental perspectives to improve understanding of AB in the etiology of these pathologies and inform targeted interventions for at-risk youth. Plain English summary Eating disorders (EDs) and unhealthy eating behaviors can seriously affect young people’s mental and physical health. In addition, the increasing rates of overweight and obesity among adolescents raise concerns about their associated physical and mental health risks. One possible factor influencing eating behavior and body perception is attentional bias (AB) – the tendency to selectively filter certain information, such as food or body-related cues. This review systematically examines studies on AB in young people with EDs, overweight, or obesity. Findings on food-related ABs were inconsistent, with some studies showing increased attention to food in young people with obesity/overweight or EDs compared to comparison participants, while others found no clear differences or even decreased attention to food. In contrast, research on body-related ABs in anorexia nervosa (AN) was more consistent, showing a stronger focus on thin bodies and self-perceived unattractive body areas in young people with AN compared to comparison participants. These findings suggest body-related ABs may play a role in AN, yet, overall, research remains limited and inconsistent. More studies using reliable methods are needed to clarify similarities and differences in ABs across different eating behaviors and to provide a basis for improving prevention and strategies for at-risk children and adolescents.

Background More than 1 in 7 patients with human immunodeficiency virus (HIV) infection in the United States are unaware of their serostatus despite recommendations of US agencies that all adults through age 65 be screened for HIV at least once. To facilitate universal screening, an electronic medical record (EMR) reminder was created for our primary care practice. Screening rates before and after implementation were assessed to determine the impact of the reminder on screening rates. Methods A retrospective cohort analysis was performed for patients age 18–65 with visits between January 1, 2012-October 30, 2014. EMR databases were examined for HIV testing and selected patient characteristics. We evaluated the probability of HIV screening in unscreened patients before and after the reminder and used a multivariable generalized linear model to test the association between likelihood of HIV testing and specific patient characteristics. Results Prior to the reminder, the probability of receiving an HIV test for previously unscreened patients was 15.3%. This increased to 30.7% after the reminder (RR 2.02, CI 1.95–2.09, p  < 0.0001). The impact was most significant in patients age 45–65. White race, English as primary language, and higher median household income were associated with lower likelihoods of screening both before and after implementation (RR 0.68, CI 0.65–0.72; RR 0.74, CI 0.67–0.82; RR 0.84, CI 0.80–0.88, respectively). Conclusions The EMR reminder increased rates of HIV screening twofold in our practice. It was most effective in increasing screening rates in older patients. Patients who were white, English-speaking, and had higher incomes were less likely to be screened for HIV both before and after the reminder.