Provider and partner interactions in the treatment decision-making process for newly diagnosed localized prostate cancer
Zeliadt SB , Penson DF , Moinpour CM , Blough DK , Fedorenko CR , Hall IJ , Smith JL , Ekwueme DU , Thompson IM , Keane TE , Ramsey SD . BJU Int 2011 108 (6) 851-6; discussion 856-7 OBJECTIVE: To evaluate the degree to which the partners of prostate cancer patients participate in the shared decision-making process with the patients' providers during the time between diagnosis and initiating treatment. PATIENTS AND METHODS: We recruited patients with newly diagnosed local-stage prostate cancer and their partners to complete take-home surveys after biopsy but before initiating treatment at urology practices in three states. We asked partners to describe their roles in the decision-making process, including participation in clinic visits, and perceptions of encouragement from providers to participate in the treatment decision-making process. We also asked partners to rate their satisfaction with the patients' providers. RESULTS: Family members of 80% of newly diagnosed patients agreed to participate; most (93%) were partners (i.e. spouses or significant others). Most partners (93%) had direct contact with the patients' physicians. Among the partners who had contact with providers, most (67%) were very satisfied with the patients' providers and 80% indicated that the doctor encouraged them to participate in the treatment decision. Overall, 91% of partners reported very frequent discussions with their loved one about the pending treatment decision, and 69% reported that their role was to help the patient make a decision. In multivariate models, provider encouragement of partner participation was associated with higher partner satisfaction (odds ratio 3.4, 95% CI 1.4-8.4) and an increased likelihood of partners reporting very frequent discussions with their loved one (odds ratio 6.1, 95% CI 1.3-27.7). CONCLUSIONS: Partners often attended clinic visits and were very involved in discussions about treatment options with both loved ones and providers. Provider encouragement of participation by partners greatly facilitates shared decision-making between patients and partners. |
Diabetes and prediabetes screening and prevalence among adults with coronary heart disease
Kilmer G , Hughes E , Zhang X , Elam-Evans L . Am J Prev Med 2011 40 (2) 159-65 BACKGROUND: Clinical performance measures recommend that nondiabetic patients with coronary heart disease (CHD) be screened for diabetes every 3 years. PURPOSE: The purpose of this study is to report the prevalence of diabetes and prediabetes among U.S. adults aged ≥35 years with CHD and to determine factors associated with not receiving recommended diabetes screenings. METHODS: The Behavioral Risk Factor Surveillance System (BRFSS) is an annual state-based telephone survey of non-institutionalized U.S. adults. Information on prediabetes prevalence was collected for 33 states in 2008; data analysis was conducted in 2009. The prevalence of diabetes and prediabetes among adults aged ≥35 years with CHD (n=20,618) and prevalence of diabetes screening among nondiabetic adults with CHD (n=14,335) were assessed. Multivariate logistic regression was used to calculate the odds of not being screened for diabetes in the past 3 years while controlling for other factors. RESULTS: Among adults with CHD, 30.7% (95% CI=29.4%, 32.1%) reported being diagnosed with diabetes and 10.0% (95% CI=9.2%, 10.8%) reported prediabetes. Among nondiabetic adults with CHD, 25.4% (95% CI=23.9%, 26.9%) reported not being screened for diabetes in the past 3 years. Those with no recent routine checkup and those with no health insurance had the highest odds of no recent diabetes screening. CONCLUSIONS: The prevalence of diabetes and prediabetes is substantial among adults with CHD and likely underestimated because of suboptimal screening. One of four nondiabetic adults with CHD reported not being screened for diabetes in the past 3 years. |
Leptin Is inversely associated with lung function in African Americans, independent of adiposity: The Jackson Heart Study
Hickson DA , Burchfiel CM , Petrini MF , Liu J , Campbell-Jenkins BW , Bhagat R , Marshall GD . Obesity (Silver Spring) 2010 19 (5) 1054-61 Leptin, a 16-kDa protein, has proinflammatory properties and has been linked to respiratory physiological responses in majority white populations. Little is known, however, about the relationship of leptin with lung function in nonwhites. Cross-sectional associations of circulating serum leptin concentrations with forced expiratory volume in 1 s (FEV(1)), FEV in 6 s (FEV(6)), and vital capacity (FVC), assessed by spirometry, were examined in 4,679 African-American men and women participants (54.3 +/- 12.4 years; 62.7% women) in the Jackson Heart Study (JHS). The independent association of leptin was examined in relation to FEV(1), FEV(6), and FVC% predicted after adjustment for age, education, smoking status, pack-years of cigarette smoking, respiratory medication use, and menopausal status in women; additional adjustment included total body weight, waist circumference, and BMI. Serum leptin was inversely related to FEV(1), FEV(6), and FVC% predicted values in men. A dose-response relationship was observed with men in the highest leptin quartile having a significantly lower lung function compared to men in the lower leptin quartile. BMI significantly modified this relationship in women: leptin was most consistently associated with lung function in obese women, less consistent in overweight women, and absent in normal-weight women. Serum leptin concentration was strongly, inversely, and independently associated with lung function in African Americans, especially African-American men and obese women. |
HIV tropism and decreased risk of breast cancer
Hessol NA , Napolitano LA , Smith D , Lie Y , Levine A , Young M , Cohen M , Minkoff H , Anastos K , D'Souza G , Greenblatt RM , Goedert JJ . PLoS One 2010 5 (12) e14349 BACKGROUND: During the first two decades of the U.S. AIDS epidemic, and unlike some malignancies, breast cancer risk was significantly lower for women with human immunodeficiency virus (HIV) infection compared to the general population. This deficit in HIV-associated breast cancer could not be attributed to differences in survival, immune deficiency, childbearing or other breast cancer risk factors. HIV infects mononuclear immune cells by binding to the CD4 molecule and to CCR5 or CXCR4 chemokine coreceptors. Neoplastic breast cells commonly express CXCR4 but not CCR5. In vitro, binding HIV envelope protein to CXCR4 has been shown to induce apoptosis of neoplastic breast cells. Based on these observations, we hypothesized that breast cancer risk would be lower among women with CXCR4-tropic HIV infection. METHODS AND FINDINGS: We conducted a breast cancer nested case-control study among women who participated in the WIHS and HERS HIV cohort studies with longitudinally collected risk factor data and plasma. Cases were HIV-infected women (mean age 46 years) who had stored plasma collected within 24 months of breast cancer diagnosis and an HIV viral load≥500 copies/mL. Three HIV-infected control women, without breast cancer, were matched to each case based on age and plasma collection date. CXCR4-tropism was determined by a phenotypic tropism assay. Odds ratios (OR) and 95% confidence intervals (CI) for breast cancer were estimated by exact conditional logistic regression. Two (9%) of 23 breast cancer cases had CXCR4-tropic HIV, compared to 19 (28%) of 69 matched controls. Breast cancer risk was significantly and independently reduced with CXCR4 tropism (adjusted odds ratio, 0.10, 95% CI 0.002-0.84) and with menopause (adjusted odds ratio, 0.08, 95% CI 0.001-0.83). Adjustment for CD4+ cell count, HIV viral load, and use of antiretroviral therapy did not attenuate the association between infection with CXCR4-tropic HIV and breast cancer. CONCLUSIONS: Low breast cancer risk with HIV is specifically linked to CXCR4-using variants of HIV. These variants are thought to exclusively bind to and signal through a receptor that is commonly expressed on hyperplastic and neoplastic breast duct cells. Additional studies are needed to confirm these observations and to understand how CXCR4 might reduce breast cancer risk. |
Herpes zoster vaccine in older adults and the risk of subsequent herpes zoster disease
Tseng HF , Smith N , Harpaz R , Bialek SR , Sy LS , Jacobsen SJ . JAMA 2011 305 (2) 160-6 CONTEXT: Approximately 1 million episodes of herpes zoster occur annually in the United States. Although prelicensure data provided evidence that herpes zoster vaccine works in a select study population under idealized circumstances, the vaccine needs to be evaluated in field conditions. OBJECTIVE: To evaluate risk of herpes zoster after receipt of herpes zoster vaccine among individuals in general practice settings. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study from January 1, 2007, through December 31, 2009, of individuals enrolled in the Kaiser Permanente Southern California health plan. Participants were immunocompetent community-dwelling adults aged 60 years or older. The 75,761 members in the vaccinated cohort were age matched (1:3) to 227,283 unvaccinated members. MAIN OUTCOME MEASURE: Incidence of herpes zoster. RESULTS: Herpes zoster vaccine recipients were more likely to be white, women, with more outpatient visits, and fewer chronic diseases. The number of herpes zoster cases among vaccinated individuals was 828 in 130,415 person-years (6.4 per 1000 person-years; 95% confidence interval [CI], 5.9-6.8), and for unvaccinated individuals it was 4606 in 355,659 person-years (13.0 per 1000 person-years; 95% CI, 12.6-13.3). In adjusted analysis, vaccination was associated with a reduced risk of herpes zoster (hazard ratio [HR], 0.45; 95% CI, 0.42-0.48); this reduction occurred in all age strata and among individuals with chronic diseases. Risk of herpes zoster differed by vaccination status to a greater magnitude than the risk of unrelated acute medical conditions, suggesting results for herpes zoster were not due to bias. Ophthalmic herpes zoster (HR, 0.37; 95% CI, 0.23-0.61) and hospitalizations coded as herpes zoster (HR, 0.35; 95% CI, 0.24-0.51) were less likely among vaccine recipients. CONCLUSIONS: Among immunocompetent community-dwelling adults aged 60 years or older, receipt of the herpes zoster vaccine was associated with a lower incidence of herpes zoster. The risk was reduced among all age strata and among individuals with chronic diseases. |
High prevalence of pulmonary tuberculosis and inadequate case finding in rural western Kenya
Van't Hoog AH , Laserson KF , Githui WA , Meme HK , Agaya JA , Odeny LO , Muchiri BG , Marston BJ , Decock KM , Borgdorff MW . Am J Respir Crit Care Med 2011 183 (9) 1245-53 RATIONALE: Limited information exists on the prevalence of tuberculosis and adequacy of case finding in African populations with high HIV-prevalence. OBJECTIVE: To estimate the prevalence of bacteriologically confirmed pulmonary tuberculosis (PTB), the fraction attributable to HIV, and evaluate case detection. METHODS: Residents ≥15 years old, from 40 randomly sampled clusters, provided two sputum samples for microscopy; those with chest radiograph abnormalities or symptoms suggestive of PTB provided one additional sputum for culture. MEASUREMENTS: PTB was defined by a culture positive for M.tuberculosis or 2 positive smears. Persons with PTB were offered HIV-testing, and interviewed on care seeking behavior. We estimated the population attributable fraction of HIV on prevalent and notified PTB, the patient diagnostic rate (PDR), and case detection rate (CDR), using provincial TB notification data. MAIN RESULTS: Among 20,566 participants, 123 had PTB. TB prevalence was 6.0/1000 (95% CI 4.6-7.4) for all PTB and 2.5/1000 (1.6-3.4) for smear-positive PTB. Of 101 prevalent TB cases tested, 52 (51%) were HIV-infected, and 58 (64%) of 91 cases who were not on treatment and were interviewed had not sought care. Forty-eight percent of prevalent and 65% of notified PTB cases were attributable to HIV. For smear-positive and smear-negative PTB combined, the PDR was 1.4 cases detected per person-year among HIV-infected persons having PTB and 0.6 for HIV-uninfected, corresponding to CDRs of 56% and 65%, respectively. CONCLUSIONS: Undiagnosed PTB is common in this community. TB case finding needs improvement, through intensified case finding, rigorous HIV-testing, and improved diagnosis of smear-negative TB. |
Afriflu--international conference on influenza disease burden in Africa, 1-2 June 2010, Marrakech, Morocco
Steffen C , Diop OM , Gessner BD , Hacen MM , Hassar M , Katz MA , Miller MA , Paget WJ , Schoub BD , Vernet G , Ndumbe PM . Vaccine 2011 29 (3) 363-9 The burden of influenza disease is to a large extent unknown for the African continent. Moreover, the interaction of influenza with common infectious diseases in Africa remains poorly described. Solid scientific evidence on the influenza disease burden in Africa is critical for the development of effective influenza vaccine policies. On 1st and 2nd June 2010 in Marrakech, Morocco, over eighty surveillance and influenza experts from 22 African countries as well as Europe and America met at the 'Afriflu' conference to discuss influenza challenges and solutions for the continent. During the meeting, participants exchanged their experiences and discussed a wide variety of topics related to influenza in Africa, including diagnosis, surveillance, epidemiology, and interventions. The meeting concluded with a pledge to improve influenza knowledge and awareness in Africa, with an emphasis on accurate determination of disease burden to help orient public health policies. |
Chikungunya fever in the United States: a fifteen year review of cases
Gibney KB , Fischer M , Prince HE , Kramer LD , St George K , Kosoy OL , Laven JJ , Staples JE . Clin Infect Dis 2011 52 (5) e121-6 BACKGROUND: Chikungunya virus (CHIKV) represents a threat to the United States, because humans amplify CHIKV and vectors that transmit CHIKV are present. METHODS: We described the epidemiology of laboratory-confirmed chikungunya fever (CHIK) cases in the United States in 1995-2009 and compared states with CHIKV vectors with states with returning viremic CHIK cases. For 2006-2009, we evaluated reporting of CHIK cases to ArboNET, the arboviral surveillance system. RESULTS: In 1995-2009, 109 CHIK cases were identified in the United States; all adult travelers. Sixty-two subjects (57%) had recently visited India, and 13 (12%) had CHIKV viremia. Of the 26 jurisdictions with CHIK cases, 22 (85%) reported the presence of CHIKV vectors. Twelve viremic travelers returned to 6 states with CHIKV vectors. Of the 106 cases identified in 2006-2009, only 27 (25%) were reported to ArboNET, with a median of 122 days (range, 44-273 days) between illness onset and reporting. CONCLUSIONS: No locally acquired CHIK cases were identified. However, several viremic travelers returned to states with CHIKV vectors and presented a risk for local transmission. Incomplete and delayed reporting made ArboNET less useful. To minimize the risk of CHIKV spread in the United States, healthcare providers and public health officials should be educated about recognition, diagnosis, and reporting of CHIK cases. |
Coccidioidomycosis: knowledge, attitudes, and practices among healthcare providers - Arizona, 2007
Chen S , Erhart LM , Anderson S , Komatsu K , Park B , Chiller T , Sunenshine R . Med Mycol 2011 49 (6) 649-56 Coccidioidomycosis presumably causes ≤ 33% of community-acquired pneumonias cases, although < 15% of the patients are tested for coccidioidomycosis. We assessed healthcare providers' knowledge, attitudes, and practices regarding coccidioidomycosis diagnosis and treatment in Arizona. A survey was mailed to 7,608 eligible healthcare providers licensed by the Arizona medical, osteopathic, and nursing boards in October and December 2007. We used weights to adjust for non-response and multivariate logistic regression models to identify predictors of ≥ 70% correct regarding knowledge and treatment practices. Of 1,823 (24%) respondents, 53% were physicians, 52% were male, and the mean age was 51 years. Approximately 50% reported confidence in their ability to treat coccidioidomycosis, and 21% correctly answered all four treatment questions. Predictors of ≥ 70% correct concerning knowledge and treatment practices included always counseling patients after diagnosis (adjusted odds ratio [AOR] = 4.4; 95% confidence interval [CI]: 2.8-7.1); specializing in infectious diseases (AOR = 2.4; 95% CI: 1.0-5.7); and having received coccidioidomycosis continuing medical education (CME) in the last year (AOR = 1.8; 95% CI: 1.2-2.6). These findings demonstrate that coccidioidomycosis CME improves knowledge of disease diagnosis and management, underscoring the need for a comprehensive coccidioidomycosis education campaign for healthcare providers in Arizona. |
Use of serology and urine antigen detection to estimate the proportion of adult community-acquired pneumonia attributable to Streptococcus pneumoniae
Watt JP , Moisi JC , Donaldson RL , Reid R , Ferro S , Whitney CG , Santosham M , O'Brien KL . Epidemiol Infect 2010 138 (12) 1796-803 Streptococcus pneumoniae is a common cause of community-acquired pneumonia (CAP) but existing diagnostic tools have limited sensitivity and specificity. We enrolled adults undergoing chest radiography at three Indian Health Service clinics in the Southwestern United States and collected acute and convalescent serum for measurement of PsaA and PspA titres and urine for pneumococcal antigen detection. Blood and sputum cultures were obtained at the discretion of treating physicians. We compared findings in clinical and radiographic CAP patients to those in controls without CAP. Urine antigen testing showed the largest differential between CAP patients and controls (clinical CAP 13%, radiographic CAP 17%, control groups 2%). Serological results were mixed, with significant differences between CAP patients and controls for some, but not all changes in titre. Based on urine antigen and blood culture results, we estimated that 11% of clinical and 15% of radiographic CAP cases were due to pneumococcus in this population. |
Interferon-gamma release assays for the diagnosis of latent tuberculosis infection in HIV-infected individuals - a systematic review and meta-analysis
Cattamanchi A , Smith R , Steingart KR , Metcalfe JZ , Date A , Coleman C , Marston BJ , Huang L , Hopewell PC , Pai M . J Acquir Immune Defic Syndr 2010 56 (3) 230-8 OBJECTIVE: To determine whether interferon-gamma release assays (IGRAs) improve the identification of HIV-infected individuals who could benefit from LTBI therapy. DESIGN: Systematic review and meta-analysis. METHODS: We searched multiple databases through May 2010 for studies evaluating the performance of the newest commercial IGRAs (QuantiFERON-Gold In-tube [QFT-GIT] and T-SPOT.TB [TSPOT]) in HIV-infected individuals. We assessed the quality of all studies included in the review, summarized results in pre-specified sub-groups using forest plots, and where appropriate, calculated pooled estimates using random effects models. RESULTS: The search identified 37 studies that included 5736 HIV-infected individuals. In 3 longitudinal studies, the risk of active TB was higher in HIV-infected individuals with positive versus negative IGRA results. However, the risk difference was not statistically significant in the 2 studies that reported IGRA results according to manufacturer-recommended criteria. In persons with active TB (a surrogate reference standard for LTBI), pooled sensitivity estimates were heterogeneous, but higher for TSPOT (72%, 95% CI 62-81%) than for QFT-GIT (61%, 95% CI 41-75%). However, neither IGRA was consistently more sensitive than the tuberculin skin test (TST) in head-to-head comparisons. While TSPOT appeared to be less affected by immunosuppression than QFT-GIT and TST, overall, differences between the three tests were small or inconclusive. CONCLUSIONS: Current evidence suggests that IGRAs perform similarly to the TST at identifying HIV-infected individuals with LTBI. Given that both tests have modest predictive value and sub-optimal sensitivity, the decision to use either test should be based on country guidelines and resource and logistical considerations. |
Persistent infection or successive re-infection of deer mice with Bartonella vinsonii subsp. arupensis
Bai Y , Calisher CH , Kosoy MY , Root JJ , Doty JB . Appl Environ Microbiol 2011 77 (5) 1728-31 Bartonella infections are common in rodents. From 1994-2006, longitudinal studies of a rodent community, mainly consisting of deer mice (Peromyscus maniculatus), were conducted in southwestern Colorado to study hantaviruses. Blood samples from deer mice captured one or more times during the period 2003-2006 (n=737) were selected to study bartonellae in deer mice. Bartonellae were found to be widely distributed in that population, with an overall prevalence of 82.4% (607/737). No correlation was found between bartonella prevalence and deer mouse weight or sex. Persistent or successive infections with bartonellae were observed in deer mice captured repeatedly, with a prevalence of 83.9% (297/354), and the infection appeared to last for more than one year in some of them. Persistent infection with bartonellae could explain the high prevalence of these bacteria in deer mice at this site and, perhaps, elsewhere. Genetic analysis demonstrated that deer mouse-borne bartonella isolates at this site belong to the same species, B. vinsonii subsp. arupensis, demonstrating a specific relationship between B. vinsonii subsp. arupensis and deer mice. |
20 µg versus >20 µg estrogen combined oral contraceptives for contraception
Gallo MF , Nanda K , Grimes DA , Lopez LM , Schulz KF . Cochrane Database Syst Rev 2011 1 (1) CD003989 BACKGROUND: Concern about estrogen-related adverse effects has led to progressive reductions in the estrogen dose in combination oral contraceptives (COCs). However, reducing the amount of estrogen to improve safety could result in decreased contraceptive effectiveness and unacceptable changes in bleeding patterns. OBJECTIVES: To test the hypothesis that COCs containing ≤ 20 mug ethinyl estradiol (EE) perform similarly as those containing > 20 mug in terms of contraceptive effectiveness, bleeding patterns, discontinuation, and side effects. SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE, POPLINE, ClinicalTrials.gov, and ICTRP, and examined references of eligible trials. Initially, we wrote to oral contraceptive manufacturers to identify trials. SELECTION CRITERIA: English-language reports of randomized controlled trials were eligible that compare a COC containing ≤ 20 mug EE with a COC containing > 20 mug EE. We excluded studies where the interventions were designed to be administered for less than three consecutive cycles or to be used primarily as treatment for non-contraceptive conditions. Trials had to report on contraceptive effectiveness, bleeding patterns, trial discontinuation due to bleeding-related reasons or other side effects, or side effects to be included in the review. DATA COLLECTION AND ANALYSIS: One author evaluated all titles and abstracts from literature searches to determine whether they met the inclusion criteria. Two authors independently extracted data from studies identified for inclusion. We wrote to the researchers when additional information was needed. Data were entered and analyzed with RevMan. MAIN RESULTS: No differences were found in contraceptive effectiveness for the 13 COC pairs for which this outcome was reported. Compared to the higher-estrogen pills, several COCs containing 20 mug EE resulted in higher rates of early trial discontinuation (overall and due to adverse events such as irregular bleeding) as well as increased risk of bleeding disturbances (both amenorrhea or infrequent bleeding and irregular, prolonged, frequent bleeding, or breakthrough bleeding or spotting). AUTHORS' CONCLUSIONS: While COCs containing 20 mug EE may be theoretically safer, this review did not focus on the rare events required to assess this hypothesis. Data from existing randomized controlled trials are inadequate to detect possible differences in contraceptive effectiveness. Low-dose estrogen COCs resulted in higher rates of bleeding pattern disruptions. However, most trials compared COCs containing different progestin types, and changes in bleeding patterns could be related to progestin type as well as estrogen dose. Higher follow-up rates are essential for meaningful interpretation of results. |
Serum dioxins and polychlorinated biphenyls are associated with growth among Russian boys
Burns JS , Williams PL , Sergeyev O , Korrick S , Lee MM , Revich B , Altshul L , Del Prato JT , Humblet O , Patterson DG Jr , Turner WE , Needham LL , Starovoytov M , Hauser R . Pediatrics 2011 127 (1) e59-68 OBJECTIVE: We evaluated the associations of serum dioxins and polychlorinated biphenyls (PCBs) with longitudinally assessed growth measurements among peripubertal Russian boys. METHODS: A total of 499 boys from Chapaevsk, Russia, aged 8 to 9 years were enrolled in the study from 2003 to 2005 and were followed prospectively for 3 years. Blood samples were collected and physical examinations were conducted at entry and repeated at annual study visits. Multivariate mixed-effects regression models for repeated measures were used to examine the associations of serum dioxins and PCBs with longitudinal measurements of BMI, height, and height velocity. RESULTS: Serum dioxin (total 2005 toxic equivalency [TEQ] median: 21.1 pg/g lipid) and PCBs (median sum of PCBs: 250 ng/g lipid) were measured in 468 boys. At study entry and during 3 years of follow-up, >50% of the boys had age-adjusted BMI and height z scores within 1 SD of World Health Organization-standardized mean values for age. Boys in the highest exposure quintile of the sum of dioxin and PCB concentrations and total TEQs had a significant decrease in mean BMI z scores of 0.67 for dioxins and TEQs and 1.04 for PCBs, compared with boys in the lowest exposure quintile. Comparison of the highest versus the lowest quintile revealed that higher serum PCB concentrations were associated with significantly lower height z scores (mean z-score decrease: 0.41) and height velocity (mean decrease: 0.19 cm/year) after 3 years of follow-up. CONCLUSIONS: Our findings suggest that exposures to dioxins and PCBs are associated with reduced growth during the peripubertal period and may compromise adult body mass, stature, and health. |
Surface chemistry of a pine-oil cleaner and other terpene mixtures with ozone on vinyl flooring tiles
Ham JE , Wells JR . Chemosphere 2011 83 (3) 327-33 Indoor environments are dynamic reactors where consumer products (such as cleaning agents, deodorants, and air fresheners) emit volatile organic compounds (VOCs) that can subsequently interact with indoor oxidants such as ozone (O(3)), hydroxyl radicals, and nitrate radicals. Typically, consumer products consist of mixtures of VOCs and semi-VOCs which can react in the gas-phase or on surfaces with these oxidants to generate a variety of oxygenated products. In this study, the reaction of a pine-oil cleaner (POC) with O(3) (100ppb) on a urethane-coated vinyl flooring tile was investigated at 5% and 50% relative humidity. These results were compared to previous alpha-terpineol+O(3) reactions on glass and vinyl surfaces. Additionally, other terpene and terpene alcohol mixtures were formulated to understand the emission profiles as seen in the POC data. Results showed that the alpha-terpineol+O(3) reaction products were the prominent species that were also observed in the POC/O(3) surface experiments. Furthermore, alpha-terpineol+O(3) reactions generate the largest fraction of oxygenated products even in equal mixtures of other terpene alcohols. This finding suggests that the judicial choice of terpene alcohols for inclusion in product formulations may be useful in reducing oxidation product emissions. |
Net survival of perinatally and postnatally HIV-infected children: a pooled analysis of individual data from sub-Saharan Africa
Marston M , Becquet R , Zaba B , Moulton LH , Gray G , Coovadia H , Essex M , Ekouevi DK , Jackson D , Coutsoudis A , Kilewo C , Leroy V , Wiktor S , Nduati R , Msellati P , Dabis F , Newell ML , Ghys PD . Int J Epidemiol 2011 40 (2) 385-96 BACKGROUND: Previously, HIV epidemic models have used a double Weibull curve to represent high initial and late mortality of HIV-infected children, without distinguishing timing of infection (peri- or post-natally). With more data on timing of infection, which may be associated with disease progression, a separate representation of children infected early and late was proposed. METHODS: Paediatric survival post-HIV infection without anti-retroviral treatment was calculated using pooled data from 12 studies with known timing of HIV infection. Children were grouped into perinatally or post-natally infected. Net mortality was calculated using cause-deleted life tables to give survival as if HIV was the only competing cause of death. To extend the curve beyond the available data, children surviving beyond 2.5 years post infection were assumed to have the same survival as young adults. Double Weibull curves were fitted to both extended survival curves to represent survival of children infected perinatally or through breastfeeding. RESULTS: Those children infected perinatally had a much higher risk of dying than those infected through breastfeeding, even allowing for background mortality. The final-fitted double Weibull curves gave 75% survival at 5 months after infection for perinatally infected, and 1.1 years for post-natally infected children. An estimated 25% of the early infected children would still be alive at 10.6 years compared with 16.9 years for those infected through breastfeeding. CONCLUSIONS: The increase in available data has enabled separation of child mortality patterns by timing of infection allowing improvement and more flexibility in modelling of paediatric HIV infection and survival. |
The effect of age on transmission of 2009 pandemic influenza A (H1N1) in a camp and associated households
Sugimoto JD , Borse NN , Ta ML , Stockman LJ , Fischer GE , Yang Y , Halloran ME , Longini IM Jr , Duchin JS . Epidemiology 2011 22 (2) 180-7 BACKGROUND: A major portion of influenza disease burden during the 2009 pandemic was observed among young people. METHODS: We examined the effect of age on the transmission of influenza-like illness associated with the 2009 pandemic influenza A (H1N1) virus (pH1N1) for an April-May 2009 outbreak among youth-camp participants and household contacts in Washington State. RESULTS: An influenza-like illness attack rate of 51% was found among 96 camp participants. We observed a cabin secondary attack rate of 42% (95% confidence interval = 21%-66%) and a camp local reproductive number of 2.7 (1.7-4.1) for influenza-like illness among children (less than 18 years old). Among the 136 contacts in the 41 households with an influenza-like illness index case who attended the camp, the influenza-like illness secondary attack rate was 11% for children (5%-21%) and 4% for adults (2%-8%). The odds ratio for influenza-like illness among children versus adults was 3.1 (1.3-7.3). CONCLUSIONS: The strong age effect, combined with the low number of susceptible children per household (1.2), plausibly explains the lower-than-expected household secondary attack rate for influenza-like illness, illustrating the importance of other venues where children congregate for sustaining community transmission. Quantifying the effects of age on pH1N1 transmission is important for informing effective intervention strategies. |
Application of the time-series approach to assess the temporal trend of racial disparity in chlamydia prevalence in the US National Job Training Program
Tian LH , Satterwhite CL , Braxton JR , Groseclose SL . Am J Epidemiol 2011 173 (2) 217-24 The authors applied a time-series approach to assess the temporal trend of racial disparity in chlamydia prevalence between young, socioeconomically disadvantaged blacks and whites entering the US National Job Training Program. Racial disparity was defined as the arithmetic difference between age group-, specimen type-, and region of residence-standardized chlamydia prevalences in blacks and whites. A regression with autoregressive moving average errors model was employed to adjust for serial correlation. Data from 46,849 women (2006-2008) and 136,892 men (2004-2008) were analyzed. Racial disparity significantly decreased among women (by an average of 0.122% per 2-month interval; P < 0.05) but not among men (-0.010%, P = 0.57). Chlamydia prevalence significantly declined for black women (-0.139% per 2-month interval; P = 0.004), black men (-0.045%, P < 0.001), and white men (-0.035%, P = 0.002) but not for white women (-0.028%, P = 0.413). Despite the decreases among black women and black men, the black-white disparities remained high for both sexes; in 2008, the racial disparity was 8.1% (95% confidence interval: 6.8, 9.3) for women and 9.0% (95% confidence interval: 8.4, 9.6) for men. These findings suggest that current chlamydia control efforts may be reaching young black men and women but need to be scaled up or modified to address the excess risk among blacks. |
Estimating the rotavirus hospitalization disease burden and trends, using capture-recapture methods
Staat MA , Rice MA , Donauer S , Payne DC , Bresee JS , Mast TC , Curns AT , Cortese MM , Connelly B , McNeal M , Ward RL , Bernstein DI , Parashar UD , Salisbury S . Pediatr Infect Dis J 2010 29 (12) 1083-6 BACKGROUND: Rotavirus surveillance is needed to provide estimates of disease burden and to evaluate the effect of vaccination programs. Our objective was to use capture-recapture methods to estimate rotavirus hospitalization rates and to examine trends over time. METHODS: Children <3 years of age residing in Hamilton County, Ohio hospitalized with acute gastroenteritis, and laboratory-confirmed rotavirus between 1997 and 2008 were identified through 2 independent surveillance systems: an active system with prospective enrollment of children admitted with acute gastroenteritis and a passive system of children identified by rotavirus testing as part of their usual medical care. Capture-recapture methods compared cases from both systems to estimate the number of missed cases from either system. Using census data for Hamilton County, rates per 10,000 with 95% confidence intervals (CI) for rotavirus hospitalizations were estimated. RESULTS: Overall, 486 cases were identified using active surveillance and 244 using passive surveillance, with 127 cases captured by both. Using capture-recapture methods, the overall rate in children <3 years old was 26.9/10,000; CI: 24.1, 30.6. Rates varied by year: highest in 1998 (48.1/10,000; CI: 32.4, 92.2) and lowest in 2008 (3.2/10,000; CI: 2.1, 6.1) after rotavirus vaccine introduction. Among children <5 years old, rates were highest in <3-month-old children (51.8/10,000; CI: 39.4, 75.1) and lowest in older age groups: 24 to 35 months (20.5/10,000; CI: 14.7, 30.3) and 36 to 59 months (4.1/10,000; CI: 2.9, 7.2). Rates from capture-recapture methods and adjusted active system were comparable. CONCLUSIONS: Capture-recapture methods were a useful tool to estimate rotavirus disease burden and to monitor trends, especially in the era of rotavirus immunization. |
Horizon scanning for new genomic tests.
Gwinn M , Grossniklaus DA , Yu W , Melillo S , Wulf A , Flome J , Dotson WD , Khoury MJ . Genet Med 2011 13 (2) 161-5 PURPOSE: The development of health-related genomic tests is decentralized and dynamic, involving government, academic, and commercial entities. Consequently, it is not easy to determine which tests are in development, currently available, or discontinued. We developed and assessed the usefulness of a systematic approach to identifying new genomic tests on the Internet. METHODS: We devised targeted queries of Web pages, newspaper articles, and blogs (Google Alerts) to identify new genomic tests. We finalized search and review procedures during a pilot phase that ended in March 2010. Queries continue to run daily and are compiled weekly; selected data are indexed in an online database, the Genomic Applications in Practice and Prevention Finder. RESULTS: After the pilot phase, our scan detected approximately two to three new genomic tests per week. Nearly two thirds of all tests (122/188, 65%) were related to cancer; only 6% were related to hereditary disorders. Although 88 (47%) of the tests, including 2 marketed directly to consumers, were commercially available, only 12 (6%) claimed United States Food and Drug Administration licensure. CONCLUSION: Systematic surveillance of the Internet provides information about genomic tests that can be used in combination with other resources to evaluate genomic tests. The Genomic Applications in Practice and Prevention Finder makes this information accessible to a wide group of stakeholders. |
Genome-based knowledge and public health: the vision of tomorrow and the challenge of today.
Schulte In den Bauman T , Khoury MJ . Eur J Public Health 2011 21 (1) 4-5 Several years after the first human genome has been decoded, the various ‘omics’ technologies struggle to translate basic science discoveries into clinical and public health applications. While several success stories are available, the promise of genomic medicine for 2010 remains largely unfulfilled. Most genomic publications are in basic sciences and little translational research is carried out to feed the pipeline of applications. We need to take a closer look at the way we translate discoveries from the bench to the population and how we process and integrate evidence. This also implies that more realistic expectations are needed to fulfil the promise of genomics to improve health. |
New gene variants associated with venous thrombosis - a replication study in United States Whites and Blacks
Austin H , De Staercke C , Lally C , Bezemer ID , Rosendaal FR , Hooper WC . J Thromb Haemost 2011 9 (3) 489-95 BACKGROUND: We evaluated 10 SNPs identified in 3 European case-control studies as risk factors for venous thrombosis. OBJECTIVES: We sought to replicate the positive findings from this report among Whites and to evaluate the association of these SNPs with venous thrombosis for the first time among Blacks. PATIENTS/METHODS: These SNPs were evaluated in a case-control study of deep vein thrombosis and pulmonary embolism that included 1,076 cases and 1,239 controls. About 50% of subjects were African Americans. We measured plasma FXI on a subset of subjects. RESULTS: Among Whites, positive findings for rs13146272 in the CYP4V2 gene, for rs3087505 in the KLKB1 gene, and for rs3756008 and rs2036914 in the F11 gene were found. We did not find significant associations for rs2227589 in the SERPINC1 gene and for rs1613662 in the GP6 gene. Among Blacks rs2036914 in F11 and rs670659 in RGS7 were related to venous thrombosis, but the study had limited statistical power for many SNPs. Among Blacks plasma FXI was related to two SNPs and the OR relating to the 90(th) percentile of the control distribution of plasma FXI was 2.6 (95% CI: 1.4, 5.0). CONCLUSIONS: Our study supports the finding that genetic variants in the F11 gene are risk factors for venous thrombosis both among Whites and Blacks, although the findings in Blacks require confirmation. A meta-analysis of 5 case-control studies indicates that rs2227589 in the SERPINC1 gene, rs13146272 in the CYP4V2 gene, and rs1613662 in the GP6 gene are risk factors for venous thrombosis among Whites. |
Using the Extended Health Belief Model to understand siblings' perceptions of risk for hereditary hemochromatosis
Bylund CL , Galvin KM , Dunet DO , Reyes M . Patient Educ Couns 2011 82 (1) 36-41 OBJECTIVE: This research focuses on individuals' reactions to news that a sibling has been diagnosed with hereditary hemochromatosis (HH). We used the Extended Health Belief Model (EHBM) to frame our analysis of siblings' perceptions of risk for HH and decision of whether to obtain diagnostic testing. METHOD: 60 patient and 25 sibling interviews were transcribed and thematically analyzed for the six components of the EHBM. RESULTS: Patient and sibling reports of siblings' perceptions were categorized into the six components of the EHBM: susceptibility, severity, benefits, barriers, cue to action, and self-efficacy. CONCLUSION: In the case of HH, siblings' perceptions of HH are varied and include a range of motivators and barriers that may impact family-based detection. Family-based detection can often play an important part of effective public health strategies to address inherited risk of disease. Further research should examine the EHBM with other genetic conditions. PRACTICE IMPLICATIONS: This analysis using the EHBM suggests areas of importance for message development for both medical personnel and HH patients to promote diagnostic testing of at-risk siblings. |
Does social media improve communication? Evaluating the NIOSH science blog
Sublet V , Spring C , Howard J . Am J Ind Med 2011 54 (5) 384-94 BACKGROUND: In 2007, NIOSH created the Science Blog as its first social media channel. The blog has more than 22,000 subscribers. The purpose of the evaluation was to identify the blog community of readers, its use as a two-way conversation channel and its effectiveness as an information resource. METHODS: Seventy-five readers randomly participated in an online survey from July 2009 to September 2009 to evaluate the Science Blog. RESULTS: Responses indicated that the NIOSH Science Blog was a valued social media resource. Sixty percent of participants planned to continue using the blog in the next 6 months. A significant proportion of readers reported that they would make changes in the workplace based on information obtained from the Science Blog. CONCLUSIONS: The NIOSH Science Blog provides is a useful communication channel to provide workplace safety and health information and expand the Institute's reach to new consumers. Am. J. Ind. Med. (c) 2011 Wiley-Liss, Inc. |
Projected health benefits and costs of pneumococcal and rotavirus vaccination in Uganda
Tate JE , Kisakye A , Mugyenyi P , Kizza D , Odiit A , Braka F . Vaccine 2011 29 (17) 3329-34 We determined impact and cost-effectiveness of pneumococcal and rotavirus vaccination programs among children<5 years of age in Uganda from the public health system perspective. Disease-specific models compared the disease burden and cost with and without a vaccination program. If introduced, pneumococcal and rotavirus vaccine programs will save 10,796 and 5265 lives, respectively, prevent 94,071 Streptococcus pneumoniae and 94,729 rotavirus cases in children<5 years, and save 3886 and 996 million Ugandan shillings ($2.3 and $0.6 million US dollars), respectively, in direct medical costs annually. At the GAVI price ($0.15/dose), pneumococcal vaccine will be cost-saving and rotavirus vaccine highly cost-effective. |
Genetic characterization of bulgarian rotavirus isolates and detection of rotavirus variants: challenges for the rotavirus vaccine program?
Mladenova Z , Iturriza-Gomara M , Esona MD , Gray J , Korsun N . J Med Virol 2011 83 (2) 348-56 Annually 20-70% of all hospital admissions and 20% of fatal diarrhea cases among children less than 5 years of age occur due to severe rotavirus diarrhea. Universal immunization is the major strategy aimed at controlling rotavirus infection. The main objective of the present study was to elucidate the evolutionary relationships of the most common rotavirus strains co-circulating in Bulgaria. The sequence and phylogenetic analysis revealed strain diversity and circulation of different rotavirus variants belonging to a single genotype. A mutated G4P[8] strain with the insertion of an asparagine residue in position 76; G2, G9, and G1 variants with amino acid substitutions in the antigenic regions A, B, and/or C were all identified in this study in the absence of an immunization program. Rotavirus strain surveillance in both the pre- and post-vaccine eras is of increasing importance in order to assess the effectiveness of the rotavirus vaccines for protection against disease associated with a diverse population of rotavirus strains. |
Herpes zoster vaccination among adults aged 60 years and older, in the U.S., 2008
Lu PJ , Euler GL , Harpaz R . Am J Prev Med 2011 40 (2) e1-6 BACKGROUND: Shingles (herpes zoster [HZ]) is a localized, generally painful and debilitating disease that occurs most frequently among older adults. It is caused by reactivation of varicella-zoster virus. HZ causes substantial morbidity, especially among older adults. The vaccine to prevent HZ was approved by Food and Drug Administration and recommended by the Advisory Committee for Immunization Practices for people aged ≥60 years in 2006 (these recommendations were published in 2008). PURPOSE: To examine HZ vaccination among people aged ≥60 years in the U.S. in 2008. METHODS: Data from the 2008 National Health Interview Survey among people aged ≥60 years were analyzed in 2010. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with HZ vaccination. Potential missed opportunities also were assessed. RESULTS: By 2008, only 6.7% (95% CI=5.9%, 7.6%) of adults aged ≥60 years reported having had HZ vaccination. The level of HZ vaccination coverage was lower (4.7%) among people aged 60-64 years compared to people aged 65-74 years (7.4%); 75-84 years (7.6%); and ≥85 years (8.2%). Coverage was statistically higher for non-Hispanic whites (7.6%) compared with non-Hispanic blacks (2.5%) and Hispanics (2.1%). Among people aged ≥60 years who reported never receiving HZ vaccination, 95.1% reported at least one missed opportunity to be vaccinated. People more likely to report ever having been vaccinated were older, female, non-Hispanic white, married, more educated, and reporting received influenza vaccination in the past year. CONCLUSIONS: By 2008, HZ vaccination coverage was 6.7%. The coverage level was low among all groups, but it was lowest among minority groups. Increased efforts are needed to remove barriers and to enable HZ vaccination among all adults aged ≥60 years. |
Increased potency of an inactivated trivalent polio vaccine with oil-in-water emulsions
Baldwin SL , Fox CB , Pallansch MA , Coler RN , Reed SG , Friede M . Vaccine 2011 29 (4) 644-9 The use of inactivated poliovirus vaccines (IPV) will be required to achieve, world-wide eradication of polio. The current expense of IPV is however prohibitive for, some countries, and therefore efforts to decrease the costs of the vaccine are a high, priority. Our results show that the addition of oil-in-water emulsion adjuvants to an, inactivated trivalent poliovirus vaccine are dose-sparing and are capable of enhancing, neutralizing antibody titers in the rat potency model. |
Diarrhea-associated hospitalizations among US children over 2 rotavirus seasons after vaccine introduction
Yen C , Tate JE , Wenk JD , Harris JM 2nd , Parashar UD . Pediatrics 2011 127 (1) e9-e15 OBJECTIVE: After implementation of rotavirus vaccination in 2006, large decreases in rates of severe diarrhea among US children occurred in 2007-2008. We ascertained whether these decreases were sustained in 2008-2009. METHODS: We examined hospital discharge data from a national network of pediatric hospitals and compared all-cause diarrhea-related and rotavirus-specific hospitalizations in 3 prevaccine rotavirus seasons (2003-2006) with those in 2 postvaccine seasons (2007-2008 and 2008-2009) among children <5 years of age. We defined rotavirus seasons using data from a national laboratory surveillance network. RESULTS: At 62 consistently reporting hospitals, a median of 15,645 diarrhea-related hospitalizations (range: 14,881-16,884 hospitalizations) occurred each rotavirus season among children <5 years of age in 2003-2006. Compared with this median, all-cause diarrhea-related hospitalizations decreased by 50% (n = 7760) in 2007-2008 and by 29% (n = 11 039) in 2008-2009. In 2007-2008, reductions of 47% to 55% were seen for all age groups, including vaccine-ineligible children ≥2 years of age (48%). In 2008-2009, these reductions decreased in magnitude, especially among children ≥2 years of age (17%). Decreases in 2007-2008 and 2008-2009 were similar in the Northeast and West, but decreases were smaller in 2008-2009, compared with 2007-2008, in the Midwest and South. CONCLUSIONS: Compared with prevaccine seasons, decreases in diarrhea- and rotavirus-associated hospitalizations seen in 2007-2008 were sustained in 2008-2009 but were somewhat smaller. Given the variability in diarrhea-related hospitalization trends over the 2 postvaccine seasons according to age group and region, continued surveillance is required for full assessment of the impact of rotavirus vaccination. |
Full impact of laboratory information system requires direct use by clinical staff: cluster randomized controlled trial
Blaya JA , Shin S , Contreras C , Yale G , Suarez C , Asencios L , Kim J , Rodriguez P , Cegielski P , Fraser HS . J Am Med Inform Assoc 2011 18 (1) 11-6 OBJECTIVE: To evaluate the time to communicate laboratory results to health centers (HCs) between the e-Chasqui web-based information system and the pre-existing paper-based system. METHODS: Cluster randomized controlled trial in 78 HCs in Peru. In the intervention group, 12 HCs had web access to results via e-Chasqui (point-of-care HCs) and forwarded results to 17 peripheral HCs. In the control group, 22 point-of-care HCs received paper results directly and forwarded them to 27 peripheral HCs. Baseline data were collected for 15 months. Post-randomization data were collected for at least 2 years. Comparisons were made between intervention and control groups, stratified by point-of-care versus peripheral HCs. RESULTS: For point-of-care HCs, the intervention group took less time to receive drug susceptibility tests (DSTs) (median 9 vs 16 days, p<0.001) and culture results (4 vs 8 days, p<0.001) and had a lower proportion of 'late' DSTs taking >60 days to arrive (p<0.001) than the control. For peripheral HCs, the intervention group had similar communication times for DST (median 22 vs 19 days, p=0.30) and culture (10 vs 9 days, p=0.10) results, as well as proportion of 'late' DSTs (p=0.57) compared with the control. CONCLUSIONS: Only point-of-care HCs with direct access to the e-Chasqui information system had reduced communication times and fewer results with delays of >2 months. Peripheral HCs had no benefits from the system. This suggests that health establishments should have point-of-care access to reap the benefits of electronic laboratory reporting. |
Size-selective sampling of particulates using a physiologic sampling pump
Lee LA , Lee EG , Lee T , Kim SW , Slaven JE , Harper M . J Environ Monit 2011 13 (3) 527-35 Recent laboratory research indicates physiologic sampling of gas and vapor may provide more representative estimates of personal exposures than traditional methods. Modifications to the physiologic sampling pump (PSP) used in that research are described which extend its usefulness to size-selective sampling of particulates. PSPs used in previous research varied motor speed to keep sampling proportional to the subject's inhalation. This caused airflow and particle velocities through the collection device to continually change making those pumps unsuitable for sampling particulates. The modified implementation of the PSP pulls a constant airflow into and through a cyclone, then uses valves to either direct the airflow through, or divert the airflow around, the sampling filter. By using physiologic inputs to regulate the fraction of each second that air flows through the sampling filter, samples may be collected in proportion to inhalation rate. To evaluate the performance of a functional prototype 5 different sizes of monodisperse aerosols of ammonium fluorescein were generated by a vibrating orifice aerosol generator and introduced into a calm air chamber. To simulate different inhalation rates the valves of the PSP were energized using 9 different duty cycles. Efficiency curves are presented and compared to a standard respirable convention by bias mapping. The performance of the modified cyclone used in the PSP sampling head compared favorably with a commercially available cyclone of the same model, operating at a constant airflow (+/-10% over almost all the size distributions of concern). The new method makes physiologic sampling of the respirable fraction of particulates feasible. |
Hormonal synchronization of the menstrual cycles of pigtail macaques to facilitate biomedical research including modeling HIV susceptibility
Livingston L , Sweeney E , Mitchell J , Luo W , Paul K , Powell N , Hendry RM , McNicholl J , Kersh E . J Med Primatol 2011 40 (3) 164-70 BACKGROUND: Menstrual cycle synchronization of female pigtail macaques could prove an invaluable resource in studies of the reproductive tract, associated infections, and other potential research fields. We tested whether use of an oral progesterone and estradiol combination tablet could synchronize menstrual cycles following treatment discontinuation. METHODS: Daily desogestrel 0.075 mg and ethinyl estradiol 0.01 mg were administered orally to three pigtail macaques at visual onset of perineal sex swelling and were continued until all animals had received it for at least 45 days. The hormones were discontinued, and these three macaques and three controls were observed for menstruation and had blood progesterone and estrogen measured over an additional 2-month period. RESULTS: All treatment animals showed spontaneous menstrual cycle synchronization for 2 months after menstrual cycling resumed. CONCLUSION: Progesterone and estradiol combination therapy can be used in pigtail macaques to induce synchronized cycling that persists in the absence of on-going hormone treatments. |
Coevolution of the hepatitis C virus polyprotein sites in patients on combined pegylated interferon and ribavirin therapy
Lara J , Xia G , Purdy M , Khudyakov Y . J Virol 2011 85 (7) 3649-63 Genotype-specific sensitivity of the hepatitis C virus (HCV) to interferon/ribavirin (IFN/RBV) combination therapy and reduced HCV response to IFN/RBV as infection progresses from acute to chronic infection suggest that HCV genetic factors and intra-host HCV evolution play important roles in therapy outcomes. HCV polyprotein sequences (n=40) from 10 patients with unsustainable response (UR, breakthrough and relapse) and 10 patients with no response (NR) following therapy were identified through the Virahep-C study. Bayesian Networks (BN) were constructed to relate interrelationships among HCV polymorphic sites to UR/NR outcomes. All models showed an extensive interdependence of HCV sites and strong connections (p≤0.003) to therapy response. Although all HCV proteins contributed to the networks, the topological properties of sites differed among proteins. E2 and NS5A together contributed approximately 40% of all sites and approximately 62% of all links to the polyprotein-BN. The NS5A-BN and E2-BN predicted UR/NR outcomes with 85% and 97.5% accuracy, respectively, in ten-fold cross-validation experiments. The NS5A model constructed using physicochemical properties of only 5 sites was shown to predict the UR/NR outcomes with 83.3% accuracy for 6 UR and 12 NR cases of the HALT-C study. Thus, HCV adaptation to IFN/RBV is a complex trait encoded in the interrelationships among many sites along the entire HCV polyprotein. E2 and NS5A generate broad epistatic connectivity across the HCV polyprotein and essentially shape intra-host HCV evolution toward the IFN/RBV resistance. Both proteins can be used to accurately predict the outcomes of IFN/RBV therapy. |
Comparison of influenza vaccine effectiveness using different methods of case detection: clinician-ordered rapid antigen tests vs. active surveillance and testing with real-time reverse-transcriptase polymerase chain reaction (rRT-PCR)
Coleman LA , Kieke B , Irving S , Shay DK , Vandermause M , Lindstrom S , Belongia EA . Vaccine 2011 29 (3) 387-90 Annual evaluation of influenza vaccine effectiveness (VE) is needed to assess ongoing impact of immunization efforts in the setting of antigenic drift and periodic vaccine reformulation. Optimal methodology for determining VE remains unclear. We compared influenza VE generated from prospective enrollment and rRT-PCR testing (active surveillance group) with VE based on clinician-ordered diagnostic tests (clinical testing group) in a defined population over four seasons. VE was calculated as (1 - adjusted OR) for vaccination in cases vs. test-negative controls. VE based on clinical testing underestimated VE based on active surveillance and testing with rRT-PCR by 5-33% depending on season. |
Determining when enhanced pause (Penh) is sensitive to changes in specific airway resistance
Frazer DG , Reynolds JS , Jackson MC . J Toxicol Environ Health A 2011 74 (5) 287-95 Penh is a dimensionless index normally used to evaluate changes in the shape of the airflow pattern entering and leaving a whole-body flow plethysmograph as an animal breathes. The index is sensitive to changes in the distribution of area under the waveform during exhalation and increases in a nonlinear fashion as the normalized area increases near the beginning of the curve. Enhanced pause (Penh) has been used to evaluate changes in pulmonary function and as a method to evaluate airway reactivity. However, the use of Penh to assess pulmonary function has been challenged (Bates et al., 2004; Lundblad et al., 2002; Mitzner et al., 2003; Mitzner & Tankersley, 1998; Petak et al., 2001; Sly et al., 2005). The objective of this study was to show how Penh of the thorax and plethysmograph flow patterns are related. That relationship is used to describe the conditions under which whole-body plethysmograph Penh measurements can be used to detect changes in sR(aw). |
Detection of GI and GII noroviruses in ground water using ultrafiltration and TaqMan real-time RT-PCR
Hill VR , Mull B , Jothikumar N , Ferdinand K , Vinje J . Food Environ Virol 2010 2 (4) 218-224 Noroviruses (NoVs) are a leading cause of epidemic and sporadic acute gastrointestinal illness globally. These viruses can potentially contaminate rural private wells and non-community drinking water systems, and cause waterborne disease outbreaks related to consumption of contaminated ground water. Detection of NoVs in water samples can be challenging because they are genetically and antigenically diverse, and noncultivable. In the present study, the detection limits of a novel broadly reactive GI assay and an existing GII NoV real-time TaqMan reverse transcriptase-polymerase chain reaction (RT-qPCR) assay in ground water concentrates was determined. Ground water samples (50 l) from two sources (Lawrenceville, GA and Gainesville, FL, USA) were seeded with electron microscopy-enumerated and RT-qPCR quantified NoV and concentrated using hollow-fiber ultrafiltration (UF) followed by either polyethylene glycol (PEG) precipitation or microconcentrators. Detection limits for GI NoV ranged from 1 x 10^4 (GA source) to 2 x 10^5 (FL source) virus particles in 50 l water samples (corresponding to 200-3,000 particles/l) and 5 x 10^4 (GA source) to 5 x 10^5 (FL source) virus particles (corresponding to 1,000-10,000 particles/l) for GII NoV. The reported UF method, sample processing procedures, and RT-qPCR assays should be effective tools for sensitive detection of NoVs in large-volume water samples. 2010 Springer Science+Business Media, LLC (outside the USA). |
Prevention of intellectual disability through screening for congenital hypothyroidism: how much and at what level?
Grosse SD , Vliet GV . Arch Dis Child 2011 96 (4) 374-9 OBJECTIVE: Congenital hypothyroidism (CHT) is a common cause of preventable mental retardation, and the quantification of intellectual disability due to CHT is needed to assess the public health benefit of newborn screening. DESIGN: Review of published studies conducted among children born prior to the introduction of newborn screening for CHT and reporting cognitive test scores. SETTING: Population-based studies. PATIENTS: Children with clinically diagnosed CHT. INTERVENTIONS: Thyroid hormone substitution. MAIN OUTCOME MEASURES: Intelligence quotient (IQ) (mean and distribution). RESULTS: The prevalence of recognised CHT rose from one in 6500 prior to screening to approximately one in 3000 with screening. In four population-based studies in high-income countries, among children with clinically diagnosed CHT 8-28% were classified as having intellectual disability (defined as an IQ <70) and the mean IQ was 85 (a leftward shift of 1 SD). Among children with subclinical CHT, the risk of overt intellectual disability was lower (zero in one study), but decreased intellectual potential and increased behavioural abnormalities were documented. CONCLUSIONS: Although the prevalence of overt disability among children with CHT in the absence of screening may be less than previously estimated, the preventable burden of intellectual disability due to CHT is substantial and justifies newborn screening. However, changes in existing newborn screening protocols to capture more cases are unlikely to prevent overt cases of disability and should therefore be justified instead by the documentation of other benefits of early detection. |
Statement on national worklife priorities
Cherniack M , Henning R , Merchant JA , Punnett L , Sorensen GR , Wagner G . Am J Ind Med 2011 54 (1) 10-20 The National Institute for Occupational Safety and Health (NIOSH) WorkLife Initiative (WLI) [http://www.cdc.gov/niosh/worklife] seeks to promote workplace programs, policies, and practices that result in healthier, more productive employees through a focus simultaneously on disease prevention, health promotion, and accommodations to age, family, and life stage. The Initiative incorporates the Institute's foundational commitment to workplaces free of recognized hazards into broader consideration of the factors that affect worker health and wellbeing. Workplace hazards, such as physical demands, chemical exposures, and work organization, often interact with non-work factors such as family demands and health behaviors to increase health and safety risks. New workplace interventions being tested by the first three NIOSH WLI Centers of WorkLife Excellence are exploring innovative models for employee health programs to reduce the human, social, and economic costs of compromised health and quality of life. Many parties in industry, labor, and government share the goals of improving employee health while controlling health care costs. NIOSH convened a workshop in 2008 with representatives of the three Centers of Excellence to develop a comprehensive, long-range strategy for advancing the WorkLife Initiative. The recommendations below fall into three areas: practice, research, and policy. Responding to these recommendations would permit the WorkLife Center system to establish a new infrastructure for workplace prevention programs by compiling and disseminating the innovative practices being developed and tested at the Centers, and elsewhere. The WLI would also extend the customary scope of NIOSH by engaging with multiple NIH Institutes that are already generating research-to-practice programs involving the working-age population, in areas such as chronic disease prevention and management. Research to Practice (r2p) is a concept focused on the translation of research findings, technologies, and information into evidence-based prevention practices and products that are adopted in the workplace or other "real-world" settings. NIOSH's goal is to overcome the translational issues that now prevent state-of-the-art occupational health, health promotion, and chronic disease research findings from benefiting working age populations immediately, regardless of workplace size, work sector, or region of the country. |
Long work hours is associated with suboptimal glycemic control among US workers with diabetes
Davila EP , Florez H , Trepka MJ , Fleming LE , Niyonsenga T , Lee DJ , Parkash J . Am J Ind Med 2011 54 (5) 375-83 BACKGROUND: Increasing numbers of US workers are diabetic. We assessed the relationship between glycemic control and work hours and type of occupation among employed US adults with type 2 diabetes. METHODS: Data were obtained from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). A representative sample of employed US adults ≥20 years with self-reported type 2 diabetes (n = 369) was used. Two dichotomous glycemic control indicators, based on various HbA1c level cut-points, were used as dependent variables in weighted logistic regression analyses with adjustment for confounders. RESULTS: Adults working over 40 hr/week were more likely to have suboptimal glycemic control (HbA1c ≥ 7%) compared to those working 20 hr or less (odds ratio = 5.09; 95% confidence interval: [1.38-18.76]). CONCLUSIONS: Work-related factors, such as number of hours worked, may affect the ability of adults with type 2 diabetes to reach and maintain glycemic control goals. These factors should be considered in the development of workplace policies and accommodations for the increasing number of workers with type 2 diabetes. Am. J. Ind. Med. (c) 2011 Wiley-Liss, Inc. |
Characterization of lead in US workplaces using data from OSHA's Integrated Management Information System
Henn SA , Sussell AL , Li J , Shire JD , Alarcon WA , Tak S . Am J Ind Med 2011 54 (5) 356-65 BACKGROUND: Lead hazards continue to be encountered in the workplace. OSHA's Integrated Management Information System (IMIS) is the largest available database containing sampling results in US workplaces. METHODS: Personal airborne lead sampling results in IMIS were extracted for years 1979-2008. Descriptive analyses, geographical mapping, and regression modeling of results were performed. RESULTS: Seventy-nine percent of lead samples were in the manufacturing sector. Lead sample results were highest in the construction sector (median = 0.03 mg/m(3) ). NORA sector, year, OSHA region, number of employees at the worksite, federal/state OSHA plan, unionization, advance notification, and presence of an employee representative were statistically associated with having a lead sample result exceed the PEL. CONCLUSIONS: Lead concentrations within construction have been higher than any other industry. Lead hazards have been most prevalent in the north and northeastern US. IMIS data can be useful as a surveillance tool and for targeting prevention efforts toward hazardous industries. Am. J. Ind. Med. (c) 2011 Wiley-Liss, Inc. |
Persistence of tungsten oxide particle/fiber mixtures in artificial human lung fluids
Stefaniak AB . Part Fibre Toxicol 2010 7 (1) 38 BACKGROUND: During the manufacture of tungsten metal for non-sag wire, tungsten oxide powders are produced as intermediates and can be in the form of tungsten trioxide (WO3) or tungsten blue oxides (TBOs). TBOs contain fiber-shaped tungsten sub-oxide particles of respirable or thoracic size. The aim of this research was to investigate whether fiber-containing TBOs had prolonged biodurability in artificial lung fluids compared to tungsten metal or WO3 and therefore potentially could pose a greater inhalation hazard. METHODS: Dissolution of tungsten metal, WO3, one fiber-free TBO (WO2.98), and three fiber-containing TBO (WO2.81, WO2.66, and WO2.51) powders were measured for the material as-received, dispersed, and mixed with metallic cobalt. Solubility was evaluated using artificial airway epithelial lining fluid (SUF) and macrophage phagolysosomal simulant fluid (PSF). RESULTS: Dissolution rates of tungsten compounds were one to four orders of magnitude slower in PSF compared to SUF. The state of the fiber-containing TBOs did not influence their dissolution in either SUF or PSF. In SUF, fiber-containing WO2.66 and WO2.51 dissolved more slowly than tungsten metal or WO3. In PSF, all three fiber-containing TBOs dissolved more slowly than tungsten metal. CONCLUSIONS: Fiber-containing TBO powders dissolved more slowly than tungsten metal and WO3 powders in SUF and more slowly than tungsten metal in PSF. Existing pulmonary toxicological information on tungsten compounds indicates potential for pulmonary irritation and possibly fibrosis. Additional research is needed to fully understand the hazard potential of TBOs. |
Treatment coverage survey after a school-based mass distribution of mebendazole: Kampot Province; Cambodia
Chesnaye N , Sinuon M , Socheat D , Koporc K , Mathieu E . Acta Trop 2011 118 (1) 21-6 In efforts to reduce the global burden of soil transmitted helminth (STH) infections in school age children (SAC, 6-14 years old), Children Without Worms donates mebendazole to 8 countries with high prevalence of STH infections. Cambodia's national deworming program currently targets SAC through bi-annual school-based distributions of a single dose of mebendazole. A 30-cluster household survey was conducted in the rural province Kampot, to validate mebendazole treatment coverage in SAC and to assess the level of improved water supply and sanitation. Bi-annual primary school-based distributions proved to be an effective strategy in reaching school attending SAC, with treatment coverage rates between the 84.1% and 88.8%. However, significantly lower rates (23.3% - 48.8%) were seen among SAC not enrolled in primary schools. Often members of the most marginalized families of the community, they are particularly at risk of STH infection. Methods to reach these children need to be explored to avoid treatment inequities. |
Effects of nurse navigators on health outcomes of cancer patients
Lee T , Ko I , Lee I , Kim E , Shin M , Roh S , Yoon D , Choi S , Chang H . Cancer Nurs 2011 34 (5) 376-84 BACKGROUND: Care coordination has received increased attention in recent years because it critically affects patient safety and care quality across services and settings. OBJECTIVE: The effectiveness of systematically developed nurse navigator interventions for newly diagnosed cancer patients was evaluated. METHODS: Seventy-eight patients participated in a nonequivalent control group pretest-posttest design study. The study design spanned a 3-month period for all participants. Patient outcome measures included quality of life, satisfaction with care, and length of hospital stay. RESULTS: Participants in the experimental program reported significant increases in several components of quality of life and with satisfaction with care and experienced fewer hospital stay days compared with the control group. CONCLUSION: This study provides evidence that standardized nurse navigator programs can improve patient outcomes in cancer care. IMPLICATIONS FOR PRACTICE: Positive outcomes of the reduced length of stay and improved quality of life and patient satisfaction may help transform the cancer care delivery model toward more nurse-initiated cost-effective model. |
Evaluating bias from birth-cohort effects in the age-based Cox proportional hazards model
Hein MJ , Schubauer-Berigan MK , Deddens JA . Epidemiology 2011 22 (2) 249-56 The nested case-control design is frequently used to evaluate exposures and health outcomes within the confines of a cohort study. When incidence-density sampling is used to identify controls, the resulting data can be analyzed using conditional logistic regression (equivalent to stratified Cox proportional hazards regression). In these studies, exposure lagging is often used to account for disease latency. In light of recent criticism of incidence-density sampling, we used simulated occupational cohorts to evaluate age-based incidence-density sampling for lagged exposures in the presence of birth-cohort effects and associations among time-related variables. Effect estimates were unbiased when adjusted for birth cohort; however, unadjusted effect estimates were biased, particularly when age at hire and year of hire were correlated. When the analysis included an adjustment for birth cohort, the inclusion of lagged-out cases and controls (assigned a lagged exposure of zero) did not introduce bias. |
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