Childhood chronic health conditions and educational attainment: a social ecological approach
Champaloux SW , Young DR . J Adolesc Health 2015 56 (1) 98-105 PURPOSE: This study examined the association between types of chronic health conditions reported during childhood and adolescence and their impact on educational attainment. School and neighborhood environments and potential mediating factors from academic and psychosocial variables were investigated. METHODS: Using the National Longitudinal Survey of Youth-Cohort 1997, multivariate logistic regression models were fit to estimate the association between chronic health conditions and educational attainment, adjusting for confounders. Chronic health conditions were defined as a parental (1997) or participant (2002) report of a chronic health condition and classified into (1) asthma; (2) cancer, diabetes, and epilepsy; (3) heart conditions; and (4) other. Educational attainment was defined as receiving a high school diploma or Graduate Equivalency Degree by age 21, determined from self-report. RESULTS: Youth who reported having a chronic health condition had higher odds of low educational attainment compared with youth who did not report a condition (n = 6,795; odds ratio [OR], 1.47; 95% confidence interval [CI], 1.22-1.76). Specifically, youth with asthma (OR, 1.63; 95% CI, 1.31-2.02) and those with cancer, diabetes, or epilepsy (OR, 1.96; 95% CI, 1.13-3.37) had higher odds of low attainment. For youth who reported cancer, diabetes, or epilepsy, the variables "school absences," "repeated a grade," and "depressive symptoms" attenuated the association and were considered mediators. CONCLUSIONS: Youth with chronic health conditions had lower educational attainment. Students with cancer, diabetes, or epilepsy who had a high number of absences, had repeated a grade, or had a high-depressive symptoms score were particularly impacted. |
Diabetes and fracture risk in older U.S. adults
Looker AC , Eberhardt MS , Saydah SH . Bone 2015 82 9-15 OBJECTIVE: We examined the diabetes-fracture relationship by race/ethnicity, including the link between pre-diabetes and fracture. RESEARCH DESIGN AND METHODS: We used Medicare- and mortality-linked data for respondents aged 65years and older from the third National Health and Nutrition Examination Survey (NHANES III) and NHANES 1999-2004 for three race/ethnic groups: non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Mexican Americans (MA). Diabetes was defined as diagnosed diabetes (self-reported) and diabetes status: diagnosed and undiagnosed diabetes (positive diagnosis or hemoglobin A1c (A1C)≥6.5%); pre-diabetes (no diagnosis and A1C between 5.7% and 6.4%); and no diabetes (no diagnosis and A1C<5.7%). Non-skull fractures (n=750) were defined using published algorithms. Hazards ratios (HRs) were calculated using Cox proportional hazards models. RESULTS: The diabetes-fracture relationship differed significantly by race/ethnicity (pinteraction<0.05). Compared to those without diagnosed diabetes, the HRs for those with diagnosed diabetes were 2.37 (95% CI 1.49-3.75), 1.87 (95% CI 1.02-3.40), and 1.22 (95% CI 0.93-1.61) for MA, NHB, and NHW, respectively, after adjusting for significant confounders. HRs for diagnosed and undiagnosed diabetes were similar to those for diagnosed diabetes alone. Pre-diabetes was not significantly related to fracture risk, however. Compared to those without diabetes, adjusted HRs for those with pre-diabetes were 1.42 (95% CI 0.72-2.81), and 1.20 (95% CI 0.96-1.51) for MA and NHW, respectively. There were insufficient fracture cases to examine detailed diabetes status in NHB. CONCLUSIONS: The diabetes-fracture relationship was stronger in MA and NHB. Pre-diabetes was not significantly associated with higher fracture risk, however. |
Cardio-metabolic risk screening among adolescents: understanding the utility of body mass index, waist circumference and waist to height ratio
Bauer KW , Marcus MD , El Ghormli L , Ogden CL , Foster GD . Pediatr Obes 2014 10 (5) 329-37 BACKGROUND: Few studies have assessed how well body mass index (BMI), waist circumference (WC), or waist to height ratio (WtHR) perform in identifying cardio-metabolic risk among youth. OBJECTIVE: The objective of this study was to evaluate the utility of BMI and WC percentiles and WtHR to distinguish adolescents with and without cardio-metabolic risk. METHODS: A cross-sectional analysis of data from 6097 adolescents aged 10-13 years who participated in the HEALTHY study was conducted. Receiver operating characteristic curves determined the discriminatory ability of BMI and WC percentiles and WtHR. RESULTS: The discriminatory ability of BMI percentile was good (area under the curve [AUC] ≥ 0.80) for elevated insulin and clustering of ≥3 risk factors, with optimal cut-points of 96 and 95, respectively. BMI percentile performed poor to fair (AUC = 0.57-0.75) in identifying youth with the majority of individual risk factors examined (elevated glucose, total cholesterol, low-density lipoprotein, blood pressure, triglycerides and high-density lipoprotein). WC percentile and WtHR performed similarly to BMI percentile. CONCLUSIONS: The current definition of obesity among US children performs well at identifying adolescents with elevated insulin and a clustering of ≥3 cardio-metabolic risk factors. Evidence does not support WC percentile or WtHR as superior screening tools compared with BMI percentile for identifying cardio-metabolic risk. |
Treatment for preventing tuberculosis in children and adolescents: a randomized clinical trial of a 3-month, 12-dose regimen of a combination of rifapentine and isoniazid
Villarino ME , Scott NA , Weis SE , Weiner M , Conde MB , Jones B , Nachman S , Oliveira R , Moro RN , Shang N , Goldberg SV , Sterling TR . JAMA Pediatr 2015 169 (3) 247-55 IMPORTANCE: Three months of a once-weekly combination of rifapentine and isoniazid for treatment of latent tuberculosis infection is safe and effective for persons 12 years or older. Published data for children are limited. OBJECTIVES: To compare treatment safety and assess noninferiority treatment effectiveness of combination therapy with rifapentine and isoniazid vs 9 months of isoniazid treatment for latent tuberculosis infection in children. DESIGN, SETTING, AND PARTICIPANTS: A pediatric cohort nested within a randomized, open-label clinical trial conducted from June 11, 2001, through December 17, 2010, with follow-up through September 5, 2013, in 29 study sites in the United States, Canada, Brazil, Hong Kong (China), and Spain. Participants were children (aged 2-17 years) who were eligible for treatment of latent tuberculosis infection. INTERVENTIONS: Twelve once-weekly doses of the combination drugs, given with supervision by a health care professional, for 3 months vs 270 daily doses of isoniazid, without supervision by a health care professional, for 9 months. MAIN OUTCOMES AND MEASURES: We compared rates of treatment discontinuation because of adverse events (AEs), toxicity grades 1 to 4, and deaths from any cause. The equivalence margin for the comparison of AE-related discontinuation rates was 5%. Tuberculosis disease diagnosed within 33 months of enrollment was the main end point for testing effectiveness. The noninferiority margin was 0.75%. RESULTS: Of 1058 children enrolled, 905 were eligible for evaluation of effectiveness. Of 471 in the combination-therapy group, 415 (88.1%) completed treatment vs 351 of 434 (80.9%) in the isoniazid-only group (P = .003). The 95% CI for the difference in rates of discontinuation attributed to an AE was -2.6 to 0.1, which was within the equivalence range. In the safety population, 3 of 539 participants (0.6%) who took the combination drugs had a grade 3 AE vs 1 of 493 (0.2%) who received isoniazid only. Neither arm had any hepatotoxicity, grade 4 AEs, or treatment-attributed death. None of the 471 in the combination-therapy group developed tuberculosis vs 3 of 434 (cumulative rate, 0.74%) in the isoniazid-only group, for a difference of -0.74% and an upper bound of the 95% CI of the difference of +0.32%, which met the noninferiority criterion. CONCLUSIONS AND RELEVANCE: Treatment with the combination of rifapentine and isoniazid was as effective as isoniazid-only treatment for the prevention of tuberculosis in children aged 2 to 17 years. The combination-therapy group had a higher treatment completion rate than did the isoniazid-only group and was safe. TRIAL REGISTRATION: clinicaltrials.gov IDENTIFIER: NCT00023452. |
Use of a nationwide call center for Ebola response and monitoring during a 3-day house-to-house campaign - Sierra Leone, September 2014
Miller LA , Stanger E , Senesi RG , DeLuca N , Dietz P , Hausman L , Kilmarx PH , Mermin J . MMWR Morb Mortal Wkly Rep 2015 64 (1) 28-29 During May 23, 2014-January 10, 2015, Sierra Leone reported 7,777 confirmed cases of Ebola virus disease (Ebola). In response to the epidemic, on August 5, Sierra Leone's Emergency Operations Center established a toll-free, nationwide Ebola call center. The purpose of the call center is to encourage public reporting of possible Ebola cases and deaths to public health officials and to provide health education about Ebola to callers. This information also functions as an "alert" system for public health officials and supports surveillance efforts for the response. National call center dispatchers call district-level response teams composed of surveillance officers and burial teams to inform them of reported deaths and possible Ebola cases. Members of these response teams investigate cases and conduct follow-up actions such as transporting ill persons to Ebola treatment units or providing safe, dignified medical burials as resources permit. The call center continues to operate. This report describes calls received during a 3-day national campaign and reports the results of an assessment of the call center operation during the campaign. |
Loperamide therapy for voluminous diarrhea in Ebola virus disease
Chertow DS , Uyeki TM , DuPont HL . J Infect Dis 2015 211 (7) 1036-7 The number of cases of Ebola virus disease (EVD) in West Africa has surpassed 19 000 [1]. Efforts to identify, isolate, and provide medical care to patients with EVD are ongoing, and efforts to improve clinical care must focus on improved management of massive gastrointestinal fluid loss. Gastrointestinal fluid losses, largely through diarrhea, are a hallmark manifestation of EVD that contribute to hypovolemic shock, severe electrolyte abnormalities, and high mortality [2, 3]. In contrast to cholera toxin–mediated diarrheal losses, in which oral rehydration solution alone dramatically reduces mortality [4], oral rehydration for patients with EVD is often insufficient to accomplish resuscitation or repletion of ongoing fluid losses. However, EVD is a systemic viral illness with profound and debilitating manifestations, including high fever, asthenia, myalgia, and delirium, that limit self-directed oral rehydration. New strategies are needed to limit mortality related to cholera-like gastrointestinal fluid losses in EVD. | Massive gastrointestinal fluid and electrolyte losses may be successfully managed in resource-rich settings through careful estimation of volume losses, close laboratory monitoring of electrolytes and organ function, and replacement of fluid losses through balanced intravenous infusions over the course of illness [3]. This same level of intensive monitoring and care cannot be achieved in most EVD treatment units in West Africa, where high case loads, staffing shortages, and limited time in personal protective equipment because of the risk of heat exposure prohibit extended patient care interactions. In this setting, administration of antidiarrheal agents to limit gastrointestinal fluid and electrolyte losses may provide “a solution that prevents the problem at its source”. However, use of antidiarrheal agents for the management of EVD-mediated diarrhea is infrequently reported, and no safety and efficacy data to guide use in EVD exist. |
Neuraminidase inhibitors, superinfection and corticosteroids affect survival of influenza patients
Lee N , Leo YS , Cao B , Chan PK , Kyaw WM , Uyeki TM , Tam WW , Cheung CS , Yung IM , Li H , Gu L , Liu Y , Liu Z , Qu J , Hui DS . Eur Respir J 2015 45 (6) 1642-52 We aimed to study factors influencing outcomes of adults hospitalised for seasonal and pandemic influenza. Individual-patient data from three Asian cohorts (Hong Kong, Singapore and Beijing; N=2649) were analysed. Adults hospitalised for laboratory-confirmed influenza (prospectively diagnosed) during 2008-2011 were studied. The primary outcome measure was 30-day survival. Multivariate Cox regression models (time-fixed and time-dependent) were used. Patients had high morbidity (respiratory/nonrespiratory complications in 68.4%, respiratory-failure in 48.6%, pneumonia in 40.8% and bacterial superinfections in 10.8%) and mortality (5.9% at 30 days and 6.9% at 60 days). 75.2% received neuraminidase inhibitors (NAI) (73.8% received oseltamivir and 1.4% received peramivir/zanamivir; 44.5% of patients received NAI 2 days and 65.5% 5 days after onset of illness); 23.1% received systemic corticosteroids. There were fewer deaths among NAI-treated patients (5.3% versus 7.6%; p=0.032). NAI treatment was independently associated with survival (adjusted hazard ratio (HR) 0.28, 95% CI 0.19-0.43), adjusted for treatment-propensity score and patient characteristics. Superinfections increased (adjusted HR 2.18, 95% CI 1.52-3.11) and chronic statin use decreased (adjusted HR 0.44, 95% CI 0.23-0.84) death risks. Best survival was shown when treatment started within 2 days (adjusted HR 0.20, 95% CI 0.12-0.32), but there was benefit with treatment within 3-5 days (adjusted HR 0.35, 95% CI 0.21-0.58). Time-dependent analysis showed consistent results of NAI treatment (adjusted HR 0.39, 95% CI 0.27-0.57). Corticosteroids increased superinfection (9.7% versus 2.7%) and deaths when controlled for indications (adjusted HR 1.73, 95% CI 1.14-2.62). Early NAI treatment was associated with shorter length of stay in a subanalysis. NAI treatment may improve survival of hospitalised influenza patients; benefit is greatest from, but not limited to, treatment started within 2 days of illness. Superinfections and corticosteroids increase mortality. Antiviral and non-antiviral management strategies should be considered. |
Notes from the field: acute flaccid myelitis among persons aged ≤21 years - United States, August 1-November 13, 2014
CDC NCIRD Division of Viral Diseases , CDC NCEZID Division of Vector-Borne Diseases , CDC NCEZID Division of High-Consequence Pathogens and Pathology , Children's Hospital Colorado , Council of State and Territorial Epidemiologists , Leshem E . MMWR Morb Mortal Wkly Rep 2015 63 (53) 1243-4 In August 2014, physicians at Children's Hospital Colorado in Aurora, Colorado, noted a cluster of cases of acute limb weakness among children. Most patients were found to have distinctive abnormalities of the central spinal cord (i.e., gray matter) on magnetic resonance imaging, and most reported a respiratory or febrile illness preceding the onset of neurologic symptoms. On September 12, the Colorado Department of Public Health and Environment alerted CDC about this cluster. These cases coincided with a national outbreak of severe respiratory disease among children caused by enterovirus D68 (EV-D68). |
Notes from the field: outbreak of diarrheal illness caused by Shigella flexneri - American Samoa, May-June 2014
Painter JE , Walker AT , Pytell J , Nua MT , Soliai-Lemusu S , Mintz E , Ali I , Parsons M , Martin H , Beach M , Bowen A , Cope J . MMWR Morb Mortal Wkly Rep 2015 64 (1) 30 On May 9, 2014, a physician at hospital A in American Samoa noticed an abnormally high number of children presenting to the emergency department with bloody diarrhea. Based on preliminary testing of stool specimens, Entamoeba histolytica infection was suspected as a possible cause. Shigella was also suspected in a subset of samples. On May 22, the American Samoa Department of Health requested assistance from CDC with the outbreak investigation. The goals of the investigation were to establish the presence of an outbreak, characterize its epidemiology and etiology, and recommend control measures. The CDC field team reviewed the emergency department log book for cases of diarrheal illness during April 15-June 13, 2014. During this period, 280 cases of diarrheal illness were recorded, with a peak occurring on May 10. Twice as many cases occurred during this period in 2014 compared with the same period in 2011, the most recent year for which comparable surveillance data were available. Cases were widely distributed across the island. The highest number of cases occurred in children aged 0-9 years. Across age groups, cases were similarly distributed among males and females. These patterns are not consistent with the epidemiology of disease caused by E. histolytica, which tends to cause more cases in males of all ages. |
Prevention of mother-to-child transmission of HIV Type 1: the role of neonatal and infant prophylaxis
Hurst SA , Appelgren KE , Kourtis AP . Expert Rev Anti Infect Ther 2015 13 (2) 169-81 The prevention of mother-to-child transmission (PMTCT) of HIV is one of the great public health successes of the past 20 years. Much concerted research efforts and dedicated work have led to the achievement of very low rates of PMTCT of HIV in settings that can implement optimal prophylaxis. Though several implementation challenges remain, global elimination of pediatric HIV infection seems now more than ever to be an attainable goal. Often overlooked, the role of prophylaxis of the newborn is nevertheless a very important component of PMTCT. In this paper, we focus on the role of neonatal and infant prophylaxis, discuss mechanisms of protection, and present the clinical trial-generated evidence that led to the current recommendations for preventing infections in breastfed and non-breastfed infants. PMTCT of HIV should not end at birth; a continuum of care extending postpartum and postnatally is required to minimize the risk of new pediatric HIV infections. |
Epidemiology of infant meningococcal disease in the United States, 2006-2012
MacNeil JR , Bennett N , Farley MM , Harrison LH , Lynfield R , Nichols M , Petit S , Reingold A , Schaffner W , Thomas A , Pondo T , Mayer LW , Clark TA , Cohn AC . Pediatrics 2015 135 (2) e305-11 BACKGROUND: The incidence of meningococcal disease is currently at historic lows in the United States; however, incidence remains highest among infants aged <1 year. With routine use of Haemophilus influenzae type b and pneumococcal vaccines in infants and children in the United States, Neisseria meningitidis remains an important cause of bacterial meningitis in young children. METHODS: Data were collected from active, population- and laboratory-based surveillance for N meningitidis conducted through Active Bacterial Core surveillance during 2006 through 2012. Expanded data collection forms were completed for infant cases identified in the surveillance area during 2006 through 2010. RESULTS: An estimated 113 cases of culture-confirmed meningococcal disease occurred annually among infants aged <1 year in the United States from 2006 through 2012, for an overall incidence of 2.74 per 100 000 infants. Among these cases, an estimated 6 deaths occurred. Serogroup B was responsible for 64%, serogroup C for 12%, and serogroup Y for 16% of infant cases. Based on the expanded data collection forms, a high proportion of infant cases (36/58, 62%) had a smoker in the household and the socioeconomic status of the census tracts where infant meningococcal cases resided was lower compared with the other Active Bacterial Core surveillance areas and the United States as a whole. CONCLUSIONS: The burden of meningococcal disease remains highest in young infants and serogroup B predominates. Vaccines that provide long-term protection early in life have the potential to reduce the burden of meningococcal disease, especially if they provide protection against serogroup B meningococcal disease. |
Estimates on HCV disease burden worldwide - filling the gaps
Wedemeyer H , Dore GJ , Ward JW . J Viral Hepat 2015 22 Suppl 1 1-5 Hepatitis C is caused by infection with the hepatitis C virus (HCV) and represents a major global health burden. Persistent HCV infection can lead to progressive liver disease with the development of liver cirrhosis and hepatocellular carcinoma, possibly accounting for up to 0.5 million deaths every year. Treatment of HCV infection is undergoing a profound and radical change. As new treatments are extremely safe and effective, there are virtually no medical reasons to withhold therapy. Yet, the new therapies are expensive. As resources are limited, solid data to estimate the disease burden caused by HCV are urgently needed. Epidemiology data and disease burden analyses for 16 countries are presented. For almost all countries, the peak of HCV-related cirrhosis, hepatocellular carcinoma and liver-related death is a decade or more away. However, a surprising heterogeneity in country-specific HCV-associated disease burden exists. Also, HCV diagnosis and treatment uptake varied markedly between countries. A consistent finding was that a reduction of HCV liver-related mortality is dependent on access to therapy. Increasing efficacy of therapy alone with a constant numbers of treatments will not have a major impact on the HCV-related disease burden. The data presented here should inform public health policy and help drive advocacy for enhanced strategic investment and action. HCV kills patients, and the disease burden will continue to rise in most countries unless action is taken soon. Chronic HCV is a curable infection and a reversible liver disease. Fortunately, the tools to eliminate HCV are now available. |
Estimating HIV protective effects of method adherence with combinations of preexposure prophylaxis and condom use among African American men who have sex with men
Smith DK , Herbst JH , Rose CE . Sex Transm Dis 2015 42 (2) 88-92 BACKGROUND: Prevention of sexually acquired HIV infection now includes both consistent condom use and daily use of oral antiretroviral preexposure prophylaxis (PrEP). Persons at substantial HIV risk can now use one or both prevention methods, but a combined HIV protective effect has not been assessed. METHODS: We use deterministic models to examine the impact of method adherence and rates of PrEP and male condom use on number of anticipated HIV infections. Analyses were based on hypothetical cohorts of 10,000 African American men who have sex with men (AAMSM), a population with the highest HIV incidence in the United States. Parameters used in the model (condom effectiveness, PrEP effectiveness, HIV incidence) were based on published findings. RESULTS: Among AAMSM who never use PrEP, an estimated 323 annual HIV infections would occur among those who always use condoms, 1007 among sometimes condom users, and 1094 among never condoms users. Among AAMSM who never (or inconsistently) use condoms, 295 (272) infections would occur among those who report at least 90% PrEP adherence and 744 (684) infection occur with less than 50% adherence. Among AAMSM who are consistently (or sometimes) taking PrEP, the highest protection is seen with consistent condom use, 87 (220) HIV infections and 92.0% (79.9%) prevention effectiveness. DISCUSSION: Among AAMSM with inconsistent or never condom use, the addition of PrEP at either modest or high adherence can increase HIV protection. For consistent condom users, any PrEP use can increase HIV protection. These analyses provide an approach for rethinking HIV risk management by calculating combined HIV protective effects of using one or more effective prevention methods. |
Improving burial practices and cemetery management during an Ebola virus disease epidemic - Sierra Leone, 2014
Nielsen CF , Kidd S , Sillah AR , Davis E , Mermin J , Kilmarx PH . MMWR Morb Mortal Wkly Rep 2015 64 (1) 20-27 As of January 3, 2015, Ebola virus disease (Ebola) has killed more than 2,500 persons in Sierra Leone since the epidemic began there in May 2014. Ebola virus is transmitted principally by direct physical contact with an infected person or their body fluids during the later stages of illness or after death. Contact with the bodies and fluids of persons who have died of Ebola is especially common in West Africa, where family and community members often touch and wash the body of the deceased in preparation for funerals. These cultural practices have been a route of Ebola transmission. In September 2014, CDC, in collaboration with the Sierra Leone Ministry of Health and Sanitation (MOH), assessed burial practices, cemetery management, and adherence to practices recommended to reduce the risk for Ebola virus transmission. The assessment was conducted by directly observing burials and cemetery operations in three high-incidence districts. In addition, a community assessment was conducted to assess the acceptability to the population of safe, nontraditional burial practices and cemetery management intended to reduce the risk for Ebola virus transmission. This report summarizes the results of these assessments, which found that 1) there were not enough burial teams to manage the number of reported deaths, 2) Ebola surveillance, swab collection, and burial team responses to a dead body alert were not coordinated, 3) systematic procedures for testing and reporting of Ebola laboratory results for dead bodies were lacking, 4) cemetery space and management were inadequate, and 5) safe burial practices, as initially implemented, were not well accepted by communities. These findings were used to inform the development of a national standard operating procedure (SOP) for safe, dignified medical burials, released on October 1. A second, national-level, assessment was conducted during October 10-15 to assess burial team practices and training and resource needs for SOP implementation across all 14 districts in Sierra Leone. The national-level assessment confirmed that burial practices, challenges, and needs at the national level were similar to those found during the assessment conducted in the three districts. Recommendations based on the assessments included 1) district-level trainings on the components of the SOP and 2) rapid deployment across the 14 districts of additional trained burial teams supplied with adequate personal protective equipment (PPE), other equipment (e.g., chlorine, chlorine sprayers, body bags, and shovels), and vehicles. Although these assessments were conducted very early on in the response, during October-December national implementation of the SOP and recommendations might have made dignified burial safer and increased community support for these practices; an evaluation of this observation is planned. |
Additional benefits of GeneXpert MTB/RIF assay for the evaluation of pulmonary tuberculosis among inpatients
Baker BJ , Holtom PD . Clin Infect Dis 2015 60 (8) 1287-8 In the 4 August 2014 issue of Clinical Infectious Diseases, Chaisson et al [1] demonstrated that a single GeneXpert MTB/RIF assay (Xpert) could assist in discontinuing isolation for patients with suspected tuberculosis. These results are tremendously helpful in further establishing the clinical utility of nucleic acid amplification tests (such as Xpert), which are already considered “standard practice in the United States to aid in the initial diagnosis of patients with suspected [tuberculosis]” [2]. However, because of the small sample size and low prevalence of paucibacillary (eg, smear-negative, culture-positive) disease in the study population, we believe that the results may have underestimated some of the important clinical benefits of Xpert implementation. |
Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa
Loveday M , Wallengren K , Brust J , Roberts J , Voce A , Margot B , Ngozo J , Master I , Cassell G , Padayatchi N . Int J Tuberc Lung Dis 2015 19 (2) 163-71 SETTING: KwaZulu-Natal, South Africa, a predominantly rural province with a high burden of tuberculosis (TB), multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection. OBJECTIVE: To determine the most effective care model by comparing MDR-TB treatment outcomes at community-based sites with traditional care at a central, specialised hospital. DESIGN: A non-randomised observational prospective cohort study comparing community-based and centralised care. Patients at community-based sites were closer to home and had easier access to care, and home-based care was available from treatment initiation. RESULTS: Four community-based sites treated 736 patients, while 813 were treated at the centralised hospital (total = 1549 patients). Overall, 75% were HIV co-infected (community: 76% vs. hospitalised: 73%, P = 0.45) and 86% received antiretroviral therapy (community: 91% vs. hospitalised: 82%, P = 0.22). On multivariate analysis, MDR-TB patients were more likely to have a successful treatment outcome if they were treated at a community-based site (adjusted OR 1.43, P = 0.01). However, outcomes at the four community-based sites were heterogeneous, with Site 1 demonstrating that home-based care was associated with an increased treatment success of 72% compared with success rates of 52-60% at the other three sites. CONCLUSION: Community-based care for MDR-TB patients was more effective than care in a central, specialised hospital. Home-based care further increased treatment success. |
Sexually transmitted disease partner notification among African-American, adolescent women
Buchsbaum A , Gallo MF , Whiteman MK , Cwiak C , Goedken P , Kraft JM , Jamieson DJ , Kottke M . Infect Dis Obstet Gynecol 2014 2014 619632 OBJECTIVE: To better understand preferences and practices regarding partner notification of sexually transmitted infection (STI) among female, African-American adolescents. METHODS: Participants completed a questionnaire and STI testing at baseline. Those diagnosed with Chlamydia or gonorrhea were recruited for a follow-up study, involving another questionnaire and repeat STI testing after three months. RESULTS: At baseline, most participants (85.1%) preferred to tell their partner about an STI diagnosis themselves instead of having a health care provider inform him, and 71.0% preferred to bring their partner for clinic treatment instead of giving him pills or a prescription. Two-thirds of participants were classified as having high self-efficacy for partner notification of a positive STI diagnosis. In the multivariable analysis, older participants and those with fewer lifetime sexual partners were more likely to have high self-efficacy. Ninety-three participants (26.6%) had Chlamydia or gonorrhea and, of this subset, 55 participated in the follow-up study. Most adolescents in the follow-up study (76.4%) notified their partner about their infection. CONCLUSION: Although participants were willing to use most methods of partner notification, most preferred to tell partners themselves and few preferred expedited partner therapy. Traditional methods for partner notification and treatment may not be adequate for all adolescents in this population. |
A systematic review of intervention studies to prevent hospitalizations of community-dwelling older adults with dementia
Phelan EA , Debnam KJ , Anderson LA , Owens SB . Med Care 2015 53 (2) 207-13 OBJECTIVES: To conduct a systematic literature review to determine if there were any intervention strategies that had any measurable effect on acute-care hospitalizations among community-dwelling adults with dementia. DESIGN: Studies were identified by a professional research librarian and content experts. SETTING: Community dwelling. PARTICIPANTS: Participants were diagnosed with dementia, severity ranging from mild to severe, and were recruited from health care and community agencies. MEASUREMENTS: A study met the inclusion criteria if it: (a) was published in English; (b) included a control or comparison group; (c) published outcome data from the intervention under study; (d) reported hospitalization as one of the outcomes; (e) included community-dwelling older adults; and (f) enrolled participants with dementia. Ten studies met all inclusion criteria. RESULTS: Of the 10 studies included, most assessed health services use (ie, hospitalizations) as a secondary outcome. Participants were recruited from a range of health care and community agencies, and most were diagnosed with dementia with severity ratings ranging from mild to severe. Most intervention strategies consisted of face-to-face assessments of the persons living with dementia, their caregivers, and the development and implementation of a care plan. A significant reduction in hospital admissions was not found in any of the included studies, although 1 study did observe a reduction in hospital days. CONCLUSIONS: The majority of studies included hospitalizations as a secondary outcome. Only 1 intervention was found to have an effect on hospitalizations. Future work would benefit from strategies specifically designed to reduce and prevent acute hospitalizations in persons with dementia. |
Emergency department visits by children and adolescents for antipsychotic drug adverse events
Hampton LM , Daubresse M , Chang HY , Alexander GC , Budnitz DS . JAMA Psychiatry 2015 72 (3) 292-4 The per capita number of outpatient visits in which an antipsychotic drug was supplied or prescribed increased approximately 660% among children and 380% among adolescents between the mid-1990s and the mid-2000s in the United States,1 prompting concerns about possible inappropriate prescribing. The most recent revisions to the DSM-5 were intended in part to decrease inappropriate child and adolescent antipsychotic drug use,2 and the American Psychiatric Association has warned against using antipsychotics as first-line therapy in children and adolescents for conditions other than psychotic disorders.3 To quantify acute harms from child and adolescent antipsychotic drug use, we estimated the numbers and rates of US emergency department (ED) visits and hospitalizations for adverse drug events (ADEs) from therapeutic use of antipsychotics and comparator psychotropic medications among children 10 years or younger and adolescents 11 to 18 years. |
Need for certification of household water treatment products: examples from Haiti
Murray A , Pierre-Louis J , Joseph F , Sylvain G , Patrick M , Lantagne D . Trop Med Int Health 2014 20 (4) 462-70 OBJECTIVE: To evaluate four household water treatment (HWT) products currently seeking approval for distribution in Haiti, through the application of a recently-developed national HWT product certification process. METHODS: Four chemical treatment products were evaluated against the certification process validation stage by verifying international product certifications confirming treatment efficacy and reviewing laboratory efficacy data against WHO HWT microbiological performance targets; and against the approval stage by confirming product composition, evaluating treated water chemical content against national and international drinking water quality guidelines and reviewing packaging for dosing ability and usage directions in Creole. RESULTS: None of the four evaluated products fulfilled validation or approval stage requirements. None was certified by an international agency as efficacious for drinking water treatment, and none had data demonstrating its ability to meet WHO HWT performance targets. All product sample compositions differed from labelled composition by >20%, and no packaging included complete usage directions in Creole. CONCLUSIONS: Product manufacturers provided information that was inapplicable, did not demonstrate product efficacy, and was insufficient to ensure safe product use. Capacity building is needed with country regulatory agencies to objectively evaluate HWT products. Products should be internationally assessed against WHO performance targets and also locally approved, considering language, culture and usability, to ensure effective HWT. |
The Cancer Genomics and Epidemiology Navigator: An NCI online tool to enhance cancer epidemiology research.
Schully SD , Rogers SD , Lam TK , Chang CQ , Clyne M , Cyr J , Watson D , Khoury MJ . Cancer Epidemiol Biomarkers Prev 2014 23 (11) 2610-1 The Epidemiology and Genomics Research Program (EGRP) at the National Cancer Institute (NCI) has undergone strategic planning in an effort to transform the practice of cancer epidemiology in the 21st century [1]. Through these efforts, the program has focused on the need for knowledge integration across the various disciplines that comprise cancer epidemiology [2]. To this end, EGRP has released an online tool for the cancer epidemiology community; the Cancer Genomics and Epidemiology Navigator (CGEN, http://epi.grants.cancer.gov/cgen/) which is an integrated, searchable, and regularly updated knowledge base intended to facilitate cancer epidemiologic research. | CGEN collates linked data on EGRP-funded grants, peer-reviewed publications on cancer epidemiology, publications on human genome epidemiology, and genomic evidence-based guidelines and recommendations into a centralized search engine to assess the impact of genomic, environmental and clinical factors on cancer occurrence and outcomes. CGEN has full text searching and filtering capabilities that make it possible to search data fields across all data sources within the database. Additionally, filtering options equipped with graphs and real-time counts permit users to fine-tune searches, or export faceted (filtered) data for further processing. An advanced search is available to perform phrase matching or matching on any/all/none of the provided terms, or when field-level search granularity is necessary. CGEN also identifies links between publications and grants, and between publications and other sources of data. |
Incidence of notifiable diseases among American Indians/Alaska Natives - United States, 2007-2011
Adekoya N , Truman B , Landen M . MMWR Morb Mortal Wkly Rep 2015 64 (1) 16-19 American Indian/Alaska Native (AI/AN) populations experience substantial disparities in the incidence of multiple diseases compared with other racial/ethnic groups in the United States. A major goal of Healthy People 2020 is to eliminate health disparities, monitor disease trends, and identify population groups and diseases for targeted interventions. High rates of certain infectious diseases continue to be a major problem facing AI/AN populations. During 1990-2011, incidence rates for some infectious diseases declined among AI/AN populations, but disparities remain and AI/AN populations are still disproportionately affected. To describe disparities in selected notifiable diseases among AI/ANs, CDC analyzed data from the National Notifiable Diseases Surveillance System (NNDSS) for 2007-2011, the most recent 5 years for which data are available. The results of this analysis of 26 infectious diseases indicate that incidence rates of 14 diseases were higher for AI/ANs than for whites. Interventions are needed to address and reduce disparities in chlamydia, gonorrhea, West Nile virus, spotted fever rickettsiosis, and other infections among AI/ANs. |
Indicators for chronic disease surveillance - United States, 2013
Holt JB , Huston SL , Heidari K , Schwartz R , Gollmar CW , Tran A , Bryan L , Liu Y , Croft JB . MMWR Recomm Rep 2015 64 1-246 Chronic diseases are an important public health problem, which can result in morbidity, mortality, disability, and decreased quality of life. Chronic diseases represented seven of the top 10 causes of death in the United States in 2010 (Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. Natl Vital Stat Rep 2013;6. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf Adobe PDF file). Chronic diseases and risk factors vary by geographic area such as state and county, where essential public health interventions are implemented. The chronic disease indicators (CDIs) were established in the late 1990s through collaboration among CDC, the Council of State and Territorial Epidemiologists, and the Association of State and Territorial Chronic Disease Program Directors (now the National Association of Chronic Disease Directors) to enable public health professionals and policymakers to retrieve data for chronic diseases and risk factors that have a substantial impact on public health. This report describes the latest revisions to the CDIs, which were developed on the basis of a comprehensive review during 2011-2013. The number of indicators is increasing from 97 to 124, with major additions in systems and environmental indicators and additional emphasis on high-impact diseases and conditions as well as emerging topics. |
A systems analysis of irrigation water quality in an environmental assessment of an E. coli O157: H7 outbreak in the United States linked to iceberg lettuce
Gelting RJ , Baloch MA , Zarate-Bermudez M , Hajmeer MN , Yee JC , Brown T , Yee BJ . Agric Water Manag 2015 150 (3) 111-118 A foodborne Escherichia coli O157:H7 outbreak in December 2006 included 77 illnesses reported in Iowa and Minnesota. Epidemiologic investigations by health departments in those states and the U.S. Centers for Disease Control and Prevention (CDC) identified shredded iceberg lettuce (Lactuca sativa L.) as the vehicle of transmission. The U.S. Food and Drug Administration (FDA) and Minnesota and California public health agencies traced the lettuce to several growing regions in California based on information from a lettuce processor in Minnesota.Samples from an environmental investigation initiated by the California Food Emergency Response Team (CalFERT) revealed a genetic match between the outbreak strain and environmental samples from a single farm, leading to an in-depth systems-based analysis of the irrigation water system on that farm. This paper presents findings from that systems-based analysis, which assessed conditions on the farm potentially contributing to contamination of the lettuce. The farm had three sources of irrigation water: groundwater from onsite wells, surface water delivered by a water management agency and effluent from wastewater lagoons on nearby dairy farms. Wastewater effluent was blended with the other sources and used only to irrigate animal feed crops. However, water management on the farm, including control of wastewater blending, appeared to create potential for cross-contamination. Pressure gradients and lack of backflow measures in the irrigation system might have created conditions for cross-contamination of water used to irrigate lettuce. The irrigation network on the farm had evolved over time to meet various needs, without an overall analysis of how that evolution potentially created vulnerabilities to contamination of irrigation water. The type of systems analysis described here is one method for helping to ensure that such vulnerabilities are identified and addressed. A preventive, risk-based management approach, such as the Water Safety Plan process for drinking water, may also be useful in managing irrigation water quality. |
Trichinellosis surveillance - United States, 2008-2012
Wilson NO , Hall RL , Montgomery SP , Jones JL . MMWR Surveill Summ 2015 64 1-8 PROBLEM/CONDITION: Trichinellosis is a parasitic disease caused by nematodes in the genus Trichinella, which are among the most widespread zoonotic pathogens globally. Infection occurs following consumption of raw or undercooked meat infected with Trichinella larvae. Clinical manifestations of the disease range from asymptomatic infection to fatal disease; the common signs and symptoms include eosinophilia, fever, periorbital edema, and myalgia. Trichinellosis surveillance has documented a steady decline in the reported incidence of the disease in the United States. In recent years, proportionally fewer cases have been associated with consumption of commercial pork products, and more are associated with meat from wild game such as bear. Period Covered: 2008-2012. DESCRIPTION OF SYSTEM: Trichinellosis has been a nationally notifiable disease in the United States since 1966 and is reportable in 48 states, New York City, and the District of Columbia. The purpose of national surveillance is to estimate incidence of infection, detect outbreaks, and guide prevention efforts. Cases are defined by clinical characteristics and the results of laboratory testing for evidence of Trichinella infection. Food exposure histories are obtained at the local level either at the point of care or through health department interview. States notify CDC of cases electronically through the National Notifiable Disease Surveillance System (available at http://wwwn.cdc.gov/nndss). In addition, states are asked to submit a standardized supplementary case report form that captures the clinical and epidemiologic information needed to meet the surveillance case definition. Reported cases are summarized weekly and annually in MMWR. RESULTS: During 2008-2012, a total of 90 cases of trichinellosis were reported to CDC from 24 states and the District of Columbia. Six (7%) cases were excluded from analysis because a supplementary case report form was not submitted or the case did not meet the case definition. A total of 84 confirmed trichinellosis cases, including five outbreaks that comprised 40 cases, were analyzed and included in this report. During 2008-2012, the mean annual incidence of trichinellosis in the United States was 0.1 cases per 1 million population, with a median of 15 cases per year. Pork products were associated with 22 (26%) cases, including 10 (45%) that were linked with commercial pork products, six (27%) that were linked with wild boar, and one (5%) that was linked with home-raised swine; five (23%) were unspecified. Meats other than pork were associated with 45 (54%) cases, including 41 (91%) that were linked with bear meat, two (4%) that were linked with deer meat, and two (4%) that were linked with ground beef. The source for 17 (20%) cases was unknown. Of the 51 patients for whom information was reported on the manner in which the meat product was cooked, 24 (47%) reported eating raw or undercooked meat. INTERPRETATION: The risk for Trichinella infection associated with commercial pork has decreased substantially in the United States since the 1940s, when data collection on trichinellosis cases first began. However, the continued identification of cases related to both pork and nonpork sources indicates that public education about trichinellosis and the dangers of consuming raw or undercooked meat still is needed. PUBLIC HEALTH ACTIONS: Changes in domestic pork production and public health education regarding the safe preparation of pork have contributed to the reduction in the incidence of trichinellosis in the United States; however, consumption of wild game meat such as bear continues to be an important source of infection. Hunters and consumers of wild game meat should be educated about the risk associated with consumption of raw or undercooked meat. |
Managerial practices regarding workers working while ill
Norton DM , Brown LG , Frick R , Carpenter LR , Green AL , Tobin-D'Angelo M , Reimann DW , Blade H , Nicholas DC , Egan JS , Everstine K . J Food Prot 2015 78 (1) 187-95 Surveillance data indicate that handling of food by an ill worker is a cause of almost half of all restaurant-related outbreaks. The U.S. Food and Drug Administration (FDA) Food Code contains recommendations for food service establishments, including restaurants, aimed at reducing the frequency with which food workers work while ill. However, few data exist on the extent to which restaurants have implemented FDA recommendations. The Centers for Disease Control and Prevention's Environmental Health Specialists Network (EHS-Net) conducted a study on the topic of ill food workers in restaurants. We interviewed restaurant managers (n = 426) in nine EHS-Net sites. We found that many restaurant policies concerning ill food workers do not follow FDA recommendations. For example, one-third of the restaurants' policies did not specifically address the circumstances under which ill food workers should be excluded from work (i.e., not be allowed to work). We also found that, in many restaurants, managers are not actively involved in decisions about whether ill food workers should work. Additionally, almost 70% of managers said they had worked while ill; 10% said they had worked while having nausea or "stomach flu," possible symptoms of foodborne illness. When asked why they had worked when ill, a third of the managers said they felt obligated to work or their strong work ethic compelled them to work. Other reasons cited were that the restaurant was understaffed or no one was available to replace them (26%), they felt that their symptoms were mild or not contagious (19%), they had special managerial responsibilities that no one else could fulfill (11%), there was non-food handling work they could do (7%), and they would not get paid if they did not work or the restaurant had no sick leave policy (5%). Data from this study can inform future research and help policy makers target interventions designed to reduce the frequency with which food workers work while ill. |
Viral Genetic Diversity and Polymorphisms in a Cohort of HIV-1-Infected Patients Eligible for Initiation of Antiretroviral Therapy in Abuja, Nigeria.
Yang C , Diallo K , Zheng DP , Rottinghaus EK , Bassey OO . AIDS Res Hum Retroviruses 2015 31 (5) 564-75 Studying the genetic diversity and natural polymorphisms of HIV-1 would benefit our understanding of HIV drug resistance (HIVDR) development and predict treatment outcomes. In this study, we have characterized the HIV-1 genetic diversity and natural polymorphisms at the 5' region of pol gene encompassing the protease (PR) and reverse transcriptase (RT) from 271 plasma specimens collected in 2008 from HIV-1-infected patients who were eligible for initiating antiretroviral therapy in Abuja (Nigeria). The analysis indicated that the predominant subtype was subtype G (31.0%), followed by CRF02-AG (19.2 %), CRF43-02G (18.5%), A/CRF36-cpx (11.4%) and the remaining (19.9%) were other subtypes and circulating (CRF) and unique (URF) recombinant forms. Recombinant viruses (68.6%) were the major viral strains in the region. Eighty-four subtype G sequences were further classified into two major and two minor clusters; sequences in the two major clusters were closely related to the HIV-1 strains in two of the three major subtype G clusters detected worldwide. Those in the two minor clusters appear to be new subtype G strains circulating only in Abuja. The pre-treatment DR prevalence was < 3%, however, numerous natural polymorphisms were present. Eleven polymorphic mutations (G16E, K20I, L23P, E35D, M36I, N37D/S/T, R57K, L63P, and V82I) were detected in the PR that were subtype or CRF specific while only 3 mutations (D123N, I135T and I135V) were identified in the RT. Overall, this study indicates an evolving HIV-1 epidemic in Abuja with recombinant viruses becoming the dominant strains and emergence of new subtype G strains; pre-treatment HIVDR was low and natural polymorphism occurrence in PR region was subtype or CRF dependent. |
Draft Genome Sequence of Legionella pneumophila D-5864, a Serogroup 6 Strain.
Morrison SS , Kozak-Muiznieks NA , Sammons S , Rowe LA , Frace M , Winchell JM . Genome Announc 2015 3 (1) Legionella pneumophila is the leading etiology of legionellosis infections in North America and Europe. Here we report the draft genome sequence of L. pneumophila D-5864, a serogroup 6 strain, which was isolated from a bronchial alveolar lavage specimen of a male patient from Arizona in 2009. Genes within the lipopolysaccharide (LPS)-biosynthesis region could potentially be determinants of serogroup specificity. |
Defining the phylogenomics of Shigella species: a pathway to diagnostics.
Sahl JW , Morris CR , Emberger J , Fraser CM , Ochieng JB , Juma J , Fields B , Breiman RF , Gilmour M , Nataro JP , Rasko DA . J Clin Microbiol 2015 53 (3) 951-60 Shigellae cause significant diarrheal disease and mortality in humans, as there are approximately 163 million episodes of shigellosis and 1.1 million deaths annually. While significant strides have been made in the understanding of the pathogenesis, few studies on the genomic content of the Shigella species have been completed. The goal of this study was to characterize the genomic diversity of Shigella species through sequencing of 55 isolates representing members of each of the four Shigella species: S. flexneri, S. sonnei, S. boydii, and S. dysenteriae. Phylogeny inferred from 336 available Shigella and E. coli genomes defined exclusive clades of Shigella; conserved genomic markers were then identified that can identify each clade. Polymerase chain reaction (PCR) assays were developed for each clade-specific marker, which was combined with an amplicon for the conserved Shigella invasion antigen, IpaH3, into a multiplex PCR assay. This assay demonstrated high specificity, correctly identifying 218 of 221 presumptive Shigella isolates, and sensitivity, by not identifying any of 151 diverse E. coli isolates incorrectly as Shigella. This new phylogenomic-based PCR assay represents a valuable tool for rapid typing of uncharacterized Shigella isolates and provides a framework that can be utilized for the identification of novel genomic markers from genomic data. |
Phenotypic and genetic characterization of vibrio cholerae O1 isolated from various regions of Kenya between 2007 and 2010
Mercy N , Mohamed AA , Zipporah N , Chowdhury G , Pazhani GP , Ramamurthy T , Boga HI , Kariuki SM , Joseph O . Pan Afr Med J 2014 19 8 INTRODUCTION: Cholera, a disease caused by Vibrio cholerae O1 and O139 remains an important public health problem globally. In the last decade, Kenya has experienced a steady increase of cholera cases. In 2009 alone, 11,769 cases were reported to the Ministry of Public Health and Sanitation. This study sought to describe the phenotypic characteristics of the isolated V. cholerae isolates. METHODS: This was a laboratory based cross-sectional study that involved isolates from different cholera outbreaks. Seventy six Vibrio cholerae O1 strains from different geographical areas were used to represent 2007 to 2010 cholera epidemics in Kenya, and were characterized by serotyping, biotyping, polymerase chain r(PCR), pulsed-field gel electrophoresis (PFGE) and ribotyping along with antimicrobial susceptibility testing. RESULTS: Seventy six Vibrio cholerae O1 strains from different geographical areas were used to represent 2007 to 2010 cholera epidemics in Kenya. Serotype Inaba was dominant (88.2%) compared to Ogawa. The isolates showed varying levels of antibiotic resistance ranging from 100% susceptible to tetracycline, doxycycline, ofloxacin, azithromycin, norfloxacin and ceftriaxone to 100% resistant to furazolidone, trimethoprim-sulfamethoxazole, polymyxin-B and streptomycin. The isolates were positive for ctxA, tcpA (El Tor), rtxC genes and were biotype El Tor variant harboring classical ctxB gene. All the isolates were classified as cholera toxin (CT) genotype 1 as they had mutation in the ctxB at positions 39 and 68. All the isolates had genetically similar NotI PFGE and BglI ribotype patterns. The absence of any observed variation is consistent with a clonal origin for all of the isolates. CONCLUSION: Kenya experienced cholera numerous outbreak from 2007-2010. The clinical Vibrio cholerae O1 isolates from the recent cholera epidemic were serotypes Inaba and Ogawa, Inaba being the predominant serotype. The Vibrio cholerae O1 strains were biotype El Tor variants that produce cholera toxin B (ctx B) of the classical type and were positive for ctxA, tcpA El Tor and rtxC genes. |
Bundling of STDs and HIV in prevention messages
Poehlman J , Uhrig JD , Friedman A , Scales M , Forsythe A , Robinson SJ . J Soc Mark 2015 5 (1) 2-20 PURPOSE: This study aims to explore peoples cognitive perceptions of HIV and other sexually transmitted diseases (STDs) to inform decisions on message development with regard to message bundling, with limited research on the concept of bundling-related prevention messages and no studies that consider the bundling of HIV and other STD prevention messages. DESIGN/METHODOLOGY/APPROACH: Individual and small-group interviews were conducted with 158 African American men and women to explore perceptions of STDs and communication preferences. Open-ended questions and a pile-sort exercise were used to elicit individuals’ judgments on similarities of 12 STDs, including HIV. Interview data were coded and analyzed for themes and patterns; pile sort data were analyzed using multidimensional scaling (MDS) and cluster analysis to visualize the set of relations identified from the piles. FINDINGS: STDs and HIV are associated with stigma, risk behaviors and personal responsibility. The card sorting activity revealed two primary dimensions by which people organized STDs: seriousness and curability. Potential clusters of STDs that correspond to participants described sorting strategies were identified and they may have implications for message bundling. Disaggregation of the data by sex and age revealed slight variations in the relationships of HIV and human papillomavirus (HPV) to other STDs. ORIGINALITY/VALUE: By identifying a set of cognitive attributes people use in organizing the overall semantic domain of STDs, ideas can be generated for how best to combine STD and HIV messages to meet public health communication goals. |
National Healthcare Safety Network report, data summary for 2013, device-associated Module
Dudeck MA , Edwards JR , Allen-Bridson K , Gross C , Malpiedi PJ , Peterson KD , Pollock DA , Weiner LM , Sievert DM . Am J Infect Control 2015 43 (3) 206-21 This report is a summary of Device-associated (DA) Module data collected by hospitals participating in the National Healthcare Safety Network (NHSN) for events occurring from January through December 2013 and reported to the Centers for Disease Control and Prevention (CDC) by June 1, 2014. This report updates previously published DA Module data from NHSN and provides contemporary comparative rates.1 Figure 1 provides a brief summary of highlights from this report. This report complements other NHSN reports, including national and state-specific progress reports for select healthcare-associated infections (HAIs).2 |
Notes from the field: occupationally acquired HIV infection among health care workers - United States, 1985-2013
Joyce MP , Kuhar D , Brooks JT . MMWR Morb Mortal Wkly Rep 2015 63 (53) 1245-6 Case investigations of human immunodeficiency virus (HIV) infection in health care workers (HCWs) possibly acquired by exposure to HIV in the workplace are conducted by state health department HIV surveillance staff members with assistance from CDC. Since 1991, reports of occupationally acquired HIV in HCWs have been recorded by the National HIV Surveillance System following a standardized case investigation protocol. HCWs are defined as all paid and unpaid persons working in health care settings with the potential for exposure to infectious materials (e.g., blood, tissue, and specific body fluids) or contaminated medical supplies, equipment, or environmental surfaces. HCWs can include but are not limited to physicians, nurses, dental personnel, laboratory personnel, students and trainees, and persons not directly involved in patient care (e.g., housekeeping, security, and volunteer personnel). In 1987, CDC recommended the use of "universal precautions," which became a part of "standard precautions" in 1995, to prevent occupational HIV exposures. Since 1996, occupational postexposure prophylaxis with antiretrovirals to prevent infection has been recommended. |
The epidemiology of Clostridium difficile infection inside and outside health care institutions
Gerding DN , Lessa FC . Infect Dis Clin North Am 2015 29 (1) 37-50 This article describes the global changes in Clostridium difficile epidemiology since the late twentieth century and into the twenty-first century when the new epidemic strain BI/NAP1/027 emerged. The article provides an overview of how understanding of C difficile epidemiology has rapidly evolved since its initial association with colitis in 1974. It also discusses how C difficile has spread across the globe, the role of asymptomatic carriers in disease transmission, the increased recognition of C difficile outside health care settings, the changes in epidemiology of C difficile infection in children, and the risk factors for disease. |
Contribution of the BacT/ALERT MB mycobacteria bottle to bloodstream infection surveillance in Thailand: added yield for Burkholderia pseudomallei
Jorakate P , Higdon M , Kaewpan A , Makprasert S , Yuenprakhon S , Tawisaid K , Dejsirilert S , Whistler T , Baggett HC . J Clin Microbiol 2015 53 (3) 910-4 Community-acquired bloodstream infections cause substantial morbidity and mortality worldwide but microbiology capacity and surveillance limitations have challenged good descriptions of pathogen distribution in many regions, including Southeast Asia. Active surveillance for bloodstream infections has been conducted in two rural Thailand provinces for >7 years. Blood specimens were divided into two culture bottles: one optimized for aerobic growth (F bottle) and a second for enhanced growth of mycobacteria (MB bottle), and processed used the BactT/ALERT 3D(R) system. Because routine use of MB culture bottles is resource intensive (expensive and prolonged incubation), we assessed the added yield of MB bottles by comparing the proportion of pathogens detected by MB vs. F bottles from 2005 - 2012. Of 63,066 blood cultures, 7,296(12%) were positive for at least one pathogen, the most common pathogens were Escherichia coli (28%), Burkholderia pseudomallei (11%), Klebsiella pneumoniae (9%) and Staphylococcus aureus (6%). Two bottles improved yield overall, but added yield attributable to the MB bottles was limited to a few pathogens. In addition to mycobacteria and some fungi, MB bottles improved B. pseudomallei detection (MB 27% vs. F 8%; p-value < 0.0001) with added benefit if therapy was initiated prior to the blood draw culture. Targeted use of MB bottles is warranted for patients at risk for mycobacterial and fungal infections, as well as B. pseudomallei, a common cause of septicemia in Thailand. |
Rubella.
Lambert N , Strebel P , Orenstein W , Icenogle J , Poland GA . Lancet 2015 385 (9984) 2297-307 Rubella remains an important pathogen worldwide, with roughly 100 000 cases of congenital rubella syndrome estimated to occur every year. Rubella-containing vaccine is highly effective and safe and, as a result, endemic rubella transmission has been interrupted in the Americas since 2009. Incomplete rubella vaccination programmes result in continued disease transmission, as evidenced by recent large outbreaks in Japan and elsewhere. In this Seminar, we provide present results regarding rubella control, elimination, and eradication policies, and a brief review of new laboratory diagnostics. Additionally, we provide novel information about rubella-containing vaccine immunogenetics and review the emerging evidence of interindividual variability in humoral and cell-mediated innate and adaptive immune responses to rubella-containing vaccine and their association with haplotypes and single-nucleotide polymorphisms across the human genome. |
Variation in rotavirus vaccine coverage by provider location and subsequent disease burden
Sahni LC , Tate JE , Payne DC , Parashar UD , Boom JA . Pediatrics 2015 135 (2) e432-9 BACKGROUND: Rotavirus vaccines were introduced in the United States in 2006. Full-series coverage is lower than for other vaccines, and disease continues to occur. We examined variation in vaccine coverage among provider locations and correlated coverage with the detection of rotavirus in children who sought treatment of severe acute gastroenteritis (AGE). METHODS: Vaccine records of children enrolled in an AGE surveillance program were obtained and children were grouped by the location that administered each child's 2-month vaccines. Cases were children with laboratory-confirmed rotavirus AGE; controls were children with rotavirus-negative AGE or acute respiratory infection. Location-level coverage was calculated using ≥1 dose rotavirus vaccine coverage among controls and classified as low (<40%), medium (≥40% to <80%), or high (≥80%). Rotavirus detection rates among patients with AGE were calculated by vaccine coverage category. RESULTS: Of controls, 80.4% (n = 1123 of 1396) received ≥1 dose of rotavirus vaccine from 68 locations. Four (5.9%) locations, including a NICU, were low coverage, 22 (32.3%) were medium coverage, and 42 (61.8%) were high coverage. In low-coverage locations, 31.4% of patients with AGE were rotavirus-positive compared with 13.1% and 9.6% in medium- and high-coverage locations, respectively. Patients with AGE from low-coverage locations had 3.3 (95% confidence interval 2.4-4.4) times the detection rate of rotavirus than patients with AGE from high vaccine coverage locations. CONCLUSIONS: We observed the highest detection of rotavirus disease among locations with low rotavirus vaccine coverage, suggesting that ongoing disease transmission is related to failure to vaccinate. Educational efforts focusing on timely rotavirus vaccine administration to age-eligible infants are needed. |
Live virus vaccines based on a yellow fever vaccine backbone: standardized template with key considerations for a risk/benefit assessment
Monath TP , Seligman SJ , Robertson JS , Guy B , Hayes EB , Condit RC , Excler JL , Mac LM , Carbery B , Chen RT . Vaccine 2015 33 (1) 62-72 The Brighton Collaboration Viral Vector Vaccines Safety Working Group (V3SWG) was formed to evaluate the safety of live, recombinant viral vaccines incorporating genes from heterologous viruses inserted into the backbone of another virus (so-called "chimeric virus vaccines"). Many viral vector vaccines are in advanced clinical trials. The first such vaccine to be approved for marketing (to date in Australia, Thailand, Malaysia, and the Philippines) is a vaccine against the flavivirus, Japanese encephalitis (JE), which employs a licensed vaccine (yellow fever 17D) as a vector. In this vaccine, two envelope proteins (prM-E) of YF 17D virus were exchanged for the corresponding genes of JE virus, with additional attenuating mutations incorporated into the JE gene inserts. Similar vaccines have been constructed by inserting prM-E genes of dengue and West Nile into YF 17D virus and are in late stage clinical studies. The dengue vaccine is, however, more complex in that it requires a mixture of four live vectors each expressing one of the four dengue serotypes. This vaccine has been evaluated in multiple clinical trials. No significant safety concerns have been found. The Phase 3 trials met their endpoints in terms of overall reduction of confirmed dengue fever, and, most importantly a significant reduction in severe dengue and hospitalization due to dengue. However, based on results that have been published so far, efficacy in preventing serotype 2 infection is less than that for the other three serotypes. In the development of these chimeric vaccines, an important series of comparative studies of safety and efficacy were made using the parental YF 17D vaccine virus as a benchmark. In this paper, we use a standardized template describing the key characteristics of the novel flavivirus vaccine vectors, in comparison to the parental YF 17D vaccine. The template facilitates scientific discourse among key stakeholders by increasing the transparency and comparability of information. The Brighton Collaboration V3SWG template may also be useful as a guide to the evaluation of other recombinant viral vector vaccines. |
Monitoring the impact of human papillomavirus vaccines on high-grade pre-invasive cervical lesions: designing a framework of linked immunization information system and cancer registry data in Michigan
Potter RC , Flagg EW , Datta SD , Saraiya M , Copeland G . Vaccine 2015 33 (11) 1400-5 State immunization and cancer registries contain data that, if linked, could be used to monitor the impact of human papillomavirus (HPV) vaccine on cervical cancer and precancer. Michigan is uniquely positioned to examine these outcomes using two population-based resources: the state-wide cancer registry and immunization information system (IIS). We assessed the feasibility of identifying females in the IIS who had continuous Michigan residence and linking them to the cancer registry. We considered continuous residence necessary for future studies of vaccine impact to avoid misclassifying those who may have been immunized while residing out-of-state and whose immunization therefore may not have been reported in Michigan. We identified females with 1976-1996 birthdates in the IIS and used probabilistic linkage software to match them with Michigan birth records. A stratified random sample of IIS-birth matches was provided to a commercial locator service to identify females with continuous Michigan residence. Cervical carcinoma in situ cases diagnosed in 2006 among females aged 10 through 30 years were also matched with the birth records; cancer registry-birth matches were merged with the IIS-birth matches using the birth record identifier. Overall, 68% of the 1274,282 IIS and 61% of the 1358 cancer registry records could be matched with birth records. Among the sample of IIS-birth matches, most (86%) were continuous residents. Seventy percent or more of cancer registry-birth matches merged with IIS-birth matches for cases born after 1984. This is the first effort in the U.S. to show that linking records across IIS and cancer registries is practical and reasonably efficient. The increasing proportion of matches between the registries and live birth file with birth year, and the use of population-based data, strengthen the utility of this approach. Future steps include use of this method to examine incidence of cervical cancer precursors in HPV immunization-eligible females. |
Early estimates of seasonal influenza vaccine effectiveness - United States, January 2015
Flannery B , Clippard J , Zimmerman RK , Nowalk MP , Jackson ML , Jackson LA , Monto AS , Petrie JG , McLean HQ , Belongia EA , Gaglani M , Berman L , Foust A , Sessions W , Thaker SN , Spencer S , Fry AM . MMWR Morb Mortal Wkly Rep 2015 64 (1) 10-15 In the United States, annual vaccination against seasonal influenza is recommended for all persons aged ≥6 months. Each season since 2004-05, CDC has estimated the effectiveness of seasonal influenza vaccine in preventing medically attended acute respiratory illness (ARI) associated with laboratory-confirmed influenza. This season, early estimates of influenza vaccine effectiveness are possible because of widespread, early circulation of influenza viruses. By January 3, 2015, 46 states were experiencing widespread flu activity, with predominance of influenza A (H3N2) viruses. This report presents an initial estimate of seasonal influenza vaccine effectiveness at preventing laboratory-confirmed influenza virus infection associated with medically attended ARI based on data from 2,321 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness Network (Flu VE) during November 10, 2014-January 2, 2015. During this period, overall vaccine effectiveness (VE) (adjusted for study site, age, sex, race/ethnicity, self-rated health, and days from illness onset to enrollment) against laboratory-confirmed influenza associated with medically attended ARI was 23% (95% confidence interval [CI] = 8%-36%). Most influenza infections were due to A (H3N2) viruses. This interim VE estimate is relatively low compared with previous seasons when circulating viruses and vaccine viruses were well-matched and likely reflects the fact that more than two-thirds of circulating A (H3N2) viruses are antigenically and genetically different (drifted) from the A (H3N2) vaccine component of 2014-15 Northern Hemisphere seasonal influenza vaccines. These early, low VE estimates underscore the need for ongoing influenza prevention and treatment measures. CDC continues to recommend influenza vaccination because the vaccine can still prevent some infections with the currently circulating A (H3N2) viruses as well as other viruses that might circulate later in the season, including influenza B viruses. Even when VE is reduced, vaccination still prevents some illness and serious influenza-related complications, including thousands of hospitalizations and deaths. Persons aged ≥6 months who have not yet been vaccinated this season should be vaccinated, including persons who might already have been ill with influenza this season. |
Hepatitis B surface antigen seroprevalence among children in Papua New Guinea, 2012-2013
Kitau R , Sankar Datta S , Patel MK , Hennessey K , Wannemuehler K , Sui G , Lagani W . Am J Trop Med Hyg 2015 92 (3) 501-6 Approximately 8% of the population in Papua New Guinea (PNG) has chronic hepatitis B virus (HBV) infection. To decrease the burden of chronic HBV infection, a national 3-dose infant hepatitis B vaccination program was implemented starting in 1989, with a birth dose (BD) added to the schedule in 1992. To assess the impact of the hepatitis B vaccination program, we conducted a serosurvey among children born after vaccine introduction. During 2012-2013, a cross-sectional stratified four-stage cluster survey was conducted to estimate hepatitis B surface antigen (HBsAg) prevalence among children 4-6 years of age. We collected demographic data, vaccination history, and tested children for HBsAg. Of 2,133 participants, 2,130 children had vaccination data by either card or recall: 28% received a BD; 81% received ≥ 3 vaccine doses. Of 2,109 children providing a blood sample, 60 (2.3%) tested positive for HBsAg. This is the largest, most geographically diverse survey of hepatitis B vaccination and HBsAg seroprevalence done in PNG. Progress has been made in PNG toward the Western Pacific Regional goal to reduce the prevalence of chronic HBV infection to < 1% by 2017 among 5-year-old children. Vaccination efforts should be strengthened, including increasing BD coverage and completing the 3-dose series. |
Increasing uptake of live attenuated influenza vaccine among children in the United States, 2008-2014
Rodgers L , Pabst LJ , Chaves SS . Vaccine 2015 33 (1) 22-4 The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for all persons in the United States aged ≥6 months. On June 25, 2014, ACIP preferentially recommended live attenuated influenza vaccine (LAIV) for healthy children aged 2-8 years [1]. Little is known about national LAIV uptake. To determine uptake of LAIV relative to inactivated influenza vaccine, we analyzed vaccination records from six immunization information system sentinel sites (approximately 10% of US population). LAIV usage increased over time in all sites. Among children 2-8 years of age vaccinated for influenza, exclusive LAIV usage in the collective sentinel site area increased from 20.1% (2008-09 season) to 38.0% (2013-14). During 2013-14, at least half of vaccinated children received LAIV in Minnesota (50.0%) and North Dakota (55.5%). Increasing LAIV usage suggests formulation acceptability, and this preexisting trend offers a favorable context for implementation of ACIP's preferential recommendation. |
The long-acting integrase inhibitor GSK744 protects macaques from repeated intravaginal SHIV challenge
Radzio J , Spreen W , Yueh YL , Mitchell J , Jenkins L , Garcia-Lerma JG , Heneine W . Sci Transl Med 2015 7 (270) 270ra5 Daily preexposure prophylaxis (PrEP) with Truvada is a proven HIV prevention strategy; however, its effectiveness is limited by low adherence. Antiretroviral drug formulations that require infrequent dosing may increase adherence and thus PrEP effectiveness. We investigated whether monthly injections of a long-acting formulation of the HIV integrase inhibitor GSK1265744 (GSK744 LA) prevented simian/human immunodeficiency virus (SHIV) infection by vaginal challenge in macaques. Female pigtail macaques (n = 12) were exposed to intravaginal inoculations of SHIV twice a week for up to 11 weeks. Half of the animals received a GSK744 LA injection every 4 weeks, and half received placebo. GSK744 LA, at plasma concentrations achievable with quarterly injections in humans, protected all six macaques from infection. Placebo controls were all infected after a median of 4 (range, 2 to 20) vaginal challenges with SHIV. Efficacy was related to high and sustained vaginal and plasma drug concentrations that remained above the protein-adjusted 90% inhibitory concentration during the dosing cycles. These data support advancement of GSK744 LA as a potential PrEP candidate for women. |
Potential in vitro model for testing the effect of exposure to nanoparticles on the lung alveolar epithelial barrier
Derk R , Davidson DC , Manke A , Stueckle TA , Rojanasakul Y , Wang L . Sens Biosensing Res 2015 3 38-45 Pulmonary barrier function plays a pivotal role in protection from inhaled particles. However, some nano-scaled particles, such as carbon nanotubes (CNT), have demonstrated the ability to penetrate this barrier in animal models, resulting in an unusual, rapid interstitial fibrosis. To delineate the underlying mechanism and specific bio-effect of inhaled nanoparticles in respiratory toxicity, models of lung epithelial barriers are required that allow accurate representation of in vivo systems; however, there is currently a lack of consistent methods to do so. Thus, this work demonstrates a well-characterized in vitro model of pulmonary barrier function using Calu-3 cells, and provides the experimental conditions required for achieving tight junction complexes in cell culture, with trans-epithelial electrical resistance measurement used as a biosensor for proper barrier formation and integrity. The effects of cell number and serum constituents have been examined and we found that changes in each of these parameters can greatly affect barrier formation. Our data demonstrate that use of 5.0 × 104 Calu-3 cells/well in the Transwell cell culture system, with 10% serum concentrations in culture media is optimal for assessing epithelial barrier function. In addition, we have utilized CNT exposure to analyze the dose-, time-, and nanoparticle property-dependent alterations of epithelial barrier permeability as a means to validate this model. Such high throughput in vitro cell models of the epithelium could be used to predict the interaction of other nanoparticles with lung epithelial barriers to mimic respiratory behavior in vivo, thus providing essential tools and bio-sensing techniques that can be uniformly employed. |
Quantification of ricin, RCA and comparison of enzymatic activity in 18 Ricinus communis cultivars by isotope dilution mass spectrometry
Schieltz DM , McWilliams LG , Kuklenyik Z , Prezioso SM , Carter AJ , Williamson YM , McGrath SC , Morse SA , Barr JR . Toxicon 2015 95 72-83 The seeds of the Ricinus communis (Castor bean) plant are the source of the economically important commodity castor oil. Castor seeds also contain the proteins ricin and R. communis agglutinin (RCA), two toxic lectins that are hazardous to human health. Radial immunodiffusion (RID) and the enzyme linked immunosorbent assay (ELISA) are two antibody-based methods commonly used to quantify ricin and RCA; however, antibodies currently used in these methods cannot distinguish between ricin and RCA due to the high sequence homology of the respective proteins. In this study, a technique combining antibody-based affinity capture with liquid chromatography and multiple reaction monitoring (MRM) mass spectrometry (MS) was used to quantify the amounts of ricin and RCA independently in extracts prepared from the seeds of eighteen representative cultivars of R. communis which were propagated under identical conditions. Additionally, liquid chromatography and MRM-MS was used to determine rRNA N-glycosidase activity for each cultivar and the overall activity in these cultivars was compared to a purified ricin standard. Of the cultivars studied, the average ricin content was 9.3 mg/g, the average RCA content was 9.9 mg/g, and the enzymatic activity agreed with the activity of a purified ricin reference within 35% relative activity. |
KSHV reactivation and novel implications of protein isomerization on lytic switch control
Guito J , Lukac DM . Viruses 2015 7 (1) 72-109 In Kaposi's sarcoma-associated herpesvirus (KSHV) oncogenesis, both latency and reactivation are hypothesized to potentiate tumor growth. The KSHV Rta protein is the lytic switch for reactivation. Rta transactivates essential genes via interactions with cofactors such as the cellular RBP-Jk and Oct-1 proteins, and the viral Mta protein. Given that robust viral reactivation would facilitate antiviral responses and culminate in host cell lysis, regulation of Rta's expression and function is a major determinant of the latent-lytic balance and the fate of infected cells. Our lab recently showed that Rta transactivation requires the cellular peptidyl-prolyl cis/trans isomerase Pin1. Our data suggest that prolinedirected phosphorylation regulates Rta by licensing binding to Pin1. Despite Pin1's ability to stimulate Rta transactivation, unchecked Pin1 activity inhibited virus production. Dysregulation of Pin1 is implicated in human cancers, and KSHV is the latest virus known to co-opt Pin1 function. We propose that Pin1 is a molecular timer that can regulate the balance between viral lytic gene expression and host cell lysis. Intriguing scenarios for Pin1's underlying activities, and the potential broader significance for isomerization of Rta and reactivation, are highlighted. |
Methane emissions and airflow patterns along longwall faces and through bleeder ventilation systems
Krog RB , Schatzel SJ , Dougherty HN . Int J Min Miner Eng 2014 5 (4) 328-349 The National Institute for Occupational Safety and Health (NIOSH) conducted an investigation of longwall face and bleeder ventilation systems using tracer gas experiments and computer network ventilation. The condition of gateroad entries, along with the caved material's permeability and porosity changes as the longwall face advances, determine the resistance of the airflow pathways within the longwall's worked-out area of the bleeder system. A series of field evaluations were conducted on a four-panel longwall district. Tracer gas was released at the mouth of the longwall section or on the longwall face and sampled at various locations in the gateroads inby the shield line. Measurements of arrival times and concentrations defined airflow/gas movements for the active/completed panels and the bleeder system, providing real field data to delineate these pathways. Results showed a sustained ability of the bleeder system to ventilate the longwall tailgate corner as the panels retreated. |
Quantitation of 4,4′-methylene diphenyl diisocyanate human serum albumin adducts
Luna LG , Green BJ , Zhang F , Arnold SM , Siegel PD , Bartels MJ . Toxicol Rep 2014 1 743-751 4,4′-Methylene diphenyl diisocyanate (herein 4,4′-MDI) is used in the production of polyurethane foams, elastomers, coatings, adhesives and the like for a wide range of commercial products. Occupational exposure to MDI levels above current airborne exposure limits can elicit immune mediated hypersensitivity reactions such as occupational asthma in sensitive individuals. To accurately determine exposure, there has been increasing interest in developing analytical methods to measure internal biomarkers of exposure to MDI. Previous investigators have reported methodologies for measuring MDI diamine metabolites and MDI-Lysine (4,4′-MDI-Lys) adducts. The purpose of this study was to develop and validate an ultra performance liquid chromatography isotope dilution tandem mass spectrometry (UPLC-ID/MS/MS) quantitation method via a signature peptide approach to enable biomonitoring of 4,4′-MDI adducted to human serum albumin (HSA) in plasma. A murine, anti-4,4′-MDI monoclonal IgM antibody was bound to magnetic beads and utilized for enrichment of the MDI adducted HSA. Following enrichment, trypsin digestion was performed to generate the expected 414 site (primary site of adduction) 4,4′-MDI-adducted HSA signature peptide that was quantified by UPLC-ID/MS/MS. An Agilent 6530 UPLC/quadrupole time of flight MS (QTOF) system was utilized for intact adducted protein analysis and an Agilent 6490 UPLC/MS/MS system operated in multiple reaction monitoring (MRM) mode was utilized for quantification of the adducted signature peptide biomarker both for in chemico and worker serum samples. Worker serum samples were initially screened utilizing the previously developed 4,4′-MDI-Lys amino acid method and results showed that 12 samples were identified as quantifiable for 4,4′-MDI-Lys adducts. The signature peptide adduct approach was applied to the 12 worker samples identified as quantifiable for 4,4′-MDI-Lys adducts. Results indicated no positive results were obtained above the quantification limit by the signature peptide approach. If the 414 site of lysine adduction accounted for 100% of the 4,4′-MDI adductions in the signature peptide adduct approach, the three highest quantifiable samples by the 4,4′-MDI-Lys method should have at least been detectable by the signature peptide method. Results show that although the 4,4′-MDI signature peptide approach is more selective, it is 18 times less sensitive than the 4,4′-MDI-Lys method, thus limiting the ability to detect adduct levels relative to the 4,4′-MDI-Lys amino acid method. |
Evaluation of commercially available diagnostic tests for the detection of dengue virus NS1 antigen and anti-dengue virus IgM antibody
Hunsperger EA , Yoksan S , Buchy P , Nguyen VC , Sekaran SD , Enria DA , Vazquez S , Cartozian E , Pelegrino JL , Artsob H , Guzman MG , Olliaro P , Zwang J , Guillerm M , Kliks S , Halstead S , Peeling RW , Margolis HS . PLoS Negl Trop Dis 2014 8 (10) e3171 Commercially available diagnostic test kits for detection of dengue virus (DENV) non-structural protein 1 (NS1) and anti-DENV IgM were evaluated for their sensitivity and specificity and other performance characteristics by a diagnostic laboratory network developed by World Health Organization (WHO), the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and the Pediatric Dengue Vaccine Initiative (PDVI). Each network laboratory contributed characterized serum specimens for the panels used in the evaluation. Microplate enzyme-linked immunosorbent assay (ELISA) and rapid diagnostic test (RDT formats) were represented by the kits. Each ELISA was evaluated by 2 laboratories and RDTs were evaluated by at least 3 laboratories. The reference tests for IgM anti-DENV were laboratory developed assays produced by the Armed Forces Research Institute for Medical Science (AFRIMS) and the Centers for Disease Control and Prevention (CDC), and the NS1 reference test was reverse transcriptase polymerase chain reaction (RT-PCR). Results were analyzed to determine sensitivity, specificity, inter-laboratory and inter-reader agreement, lot-to-lot variation and ease-of-use. NS1 ELISA sensitivity was 60-75% and specificity 71-80%; NS1 RDT sensitivity was 38-71% and specificity 76-80%; the IgM anti-DENV RDTs sensitivity was 30-96%, with a specificity of 86-92%, and IgM anti-DENV ELISA sensitivity was 96-98% and specificity 78-91%. NS1 tests were generally more sensitive in specimens from the acute phase of dengue and in primary DENV infection, whereas IgM anti-DENV tests were less sensitive in secondary DENV infections. The reproducibility of the NS1 RDTs ranged from 92-99% and the IgM anti-DENV RDTs from 88-94%. |
An evaluation of welding processes to reduce hexavalent chromium exposures and reduce costs by using better welding techniques
Keane MJ . Environ Health Insights 2014 8 47-50 A group of stainless steel arc welding processes was compared for emission rates of fume and hexavalent chromium, and costs per meter length of weld. The objective was to identify those with minimal emissions and also compare relative labor and consumables costs. The selection included flux-cored arc welding (FCAW), shielded-metal arc welding (SMAW), and multiple gas metal arc welding (GMAW) processes. Using a conical chamber, fumes were collected, and fume generation rates and hexavalent chromium (Cr(6+)) were measured. GMAW processes used were short-circuit (SC) and pulsed-spray modes. Flux-cored welding used gas shielding. Costs were estimated per meter of a 6.3-mm thick horizontal butt weld. Emission rates of Cr(6+) were lowest for GMAW processes and highest for SMAW; several GMAW processes had less than 2% of the SMAW generation rate. Labor and consumable costs for the processes studied were again highest for SMAW, with those of several GMAW types about half that cost. The results show that use of any of the GMAW processes (and flux-cored welding) could substantially reduce fume and Cr(6+) emissions, and greatly reduce costs relative to SMAW. |
Improving quality in national reference laboratories: the role of SLMTA and mentorship
Audu RA , Onubogu CC , Nwokoye NN , Ofuche E , Baboolal S , Oke O , Luman ET , Idigbe EO . Afr J Lab Med 2014 3 (2) 200 BACKGROUND: The Nigerian Institute of Medical Research houses two reference laboratories: The virology and tuberculosis laboratories. Both were enrolled in the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. OBJECTIVE: To describe the impact of SLMTA and discuss factors affecting the results, with an emphasis on mentorship. METHODS: The SLMTA programme was implemented from April 2010 through November 2012. Participants attended three workshops and executed quality improvement projects; laboratory auditors evaluated performance using a standard checklist. The virology laboratory did not receive mentorship; however, the tuberculosis laboratory had an international mentor who visited the laboratory four times during the programme, spending two to four weeks embedded within the laboratory during each visit. RESULTS: There was an overall improvement in the performance of both laboratories, with the virology laboratory increasing 13% (from 80% at baseline to 93% at exit audit) and the tuberculosis laboratory increasing 29% (from 66% to 95%). These scores were maintained nine months later at the surveillance audit. CONCLUSION: The SLMTA programme resulted in improved and sustained quality management performance for both laboratories. Mentoring was a possible factor in the substantial improvement made by the tuberculosis laboratory and should be considered in order to augment the training received from the SLMTA workshops. |
Back to the real world: connecting models with data
Mitchell RM , Whitlock RH , Grohn YT , Schukken YH . Prev Vet Med 2014 118 215-25 Mathematical models for infectious disease are often used to improve our understanding of infection biology or to evaluate the potential efficacy of intervention programs. Here, we develop a mathematical model that aims to describe infection dynamics of Mycobacterium avium subspecies paratuberculosis (MAP). The model was developed using current knowledge of infection biology and also includes some components of MAP infection dynamics that are currently still hypothetical. The objective was to show methods for parameter estimation of state transition models and to connect simulation models with detailed real life data. Thereby making model predictions and results of simulations more reflective and predictive of real world situations. Longitudinal field data from a large observational study are used to estimate parameter values. It is shown that precise data, including molecular diagnostics on the obtained MAP strains, results in more precise and realistic parameter estimates. It is argued that modeling of infection disease dynamics is of great value to understand the patho-biology, epidemiology and control of infectious diseases. The quality of conclusions drawn from model studies depend on two key issues; first, the quality of biology that has gone in the process of developing the model structure; second the quality of the data that go into the estimation of the parameters and the quality and quantity of the data that go into model validation. The more real world data that are used in the model building process, the more likely that modeling studies will provide novel, innovative and valid results. |
Supplement use and other characteristics among pregnant women with a previous pregnancy affected by a neural tube defect - United States, 1997-2009
Arth A , Tinker S , Moore C , Canfield M , Agopian A , Reefhuis J . MMWR Morb Mortal Wkly Rep 2015 64 (1) 6-9 Neural tube defects (NTDs) include anomalies of the brain (anencephaly and encephalocele) and spine (spina bifida). Even with ongoing mandatory folic acid fortification of enriched cereal grain products, the U.S. Preventive Services Task Force recommends that women of childbearing potential consume a daily supplement containing 400 microg-800 microg of folic acid. Women with a prior NTD-affected pregnancy have an increased risk for having another NTD-affected pregnancy, and if they are planning another pregnancy, the recommendation is that they consume high-dosage folic acid supplements (4.0 mg/day) beginning ≥4 weeks before conception and continuing through the first 12 weeks of pregnancy. To learn whether folic acid supplementation (from multivitamins or single- ingredient supplements) was commonly used during pregnancy by women with a previous NTD-affected pregnancy, supplement use was assessed among a convenience sample of women with a previous NTD-affected pregnancy who participated in the National Birth Defects Prevention Study (NBDPS), a case-control study of major birth defects in the United States. Characteristics of women who previously had an NTD-affected pregnancy and whose index pregnancy (pregnancy included in NBDPS) was either affected by an NTD (N = 17) (i.e., recurrence-cases) or resulted in a live-born infant without a major birth defect (N = 10) (i.e., recurrence-controls) were assessed. Taking a supplement that included folic acid was more common among recurrence-control mothers (80%) than recurrence-case mothers (35%). The recommendation that women should take folic acid supplements just before and during early pregnancy is not being followed by many women and offers an opportunity for NTD prevention, especially among women who are at a higher risk because they have had a previous pregnancy affected by an NTD. |
Updated estimates of neural tube defects prevented by mandatory folic acid fortification - United States, 1995-2011
Williams J , Mai CT , Mulinare J , Isenburg J , Flood TJ , Ethen M , Frohnert B , Kirby RS . MMWR Morb Mortal Wkly Rep 2015 64 (1) 1-5 In 1992, the U.S. Public Health Service recommended that all women capable of becoming pregnant consume 400 microg of folic acid daily to prevent neural tube defects (NTDs). NTDs are major birth defects of the brain and spine that occur early in pregnancy as a result of improper closure of the embryonic neural tube, which can lead to death or varying degrees of disability. The two most common NTDs are anencephaly and spina bifida. Beginning in 1998, the United States mandated fortification of enriched cereal grain products with 140 microg of folic acid per 100 g. Immediately after mandatory fortification, the birth prevalence of NTD cases declined. Fortification was estimated to avert approximately 1,000 NTD-affected pregnancies annually. To provide updated estimates of the birth prevalence of NTDs in the period after introduction of mandatory folic acid fortification (i.e., the post-fortification period), data from 19 population-based birth defects surveillance programs in the United States, covering the years 1999-2011, were examined. After the initial decrease, NTD birth prevalence during the post-fortification period has remained relatively stable. The number of births occurring annually without NTDs that would otherwise have been affected is approximately 1,326 (95% confidence interval = 1,122-1,531). Mandatory folic acid fortification remains an effective public health intervention. There remain opportunities for prevention among women with lower folic acid intakes, especially among Hispanic women, to further reduce the prevalence of NTDs in the United States. |
Provider communication on perinatal depression: a population-based study
Farr SL , Ko JY , Burley K , Gupta S . Arch Womens Ment Health 2015 19 (1) 35-40 Women's lack of knowledge on symptoms of perinatal depression and treatment resources is a barrier to receiving care. We sought to estimate the prevalence and predictors of discussing depression with a prenatal care provider. We used the 2011 population-based data from 24 sites participating in the Pregnancy Risk Assessment Monitoring System (n = 32,827 women with recent live births) to examine associations between maternal characteristics and report that a prenatal care provider discussed with her what to do if feeling depressed during or after pregnancy. Overall, 71.9 % of women reported discussing perinatal depression with their prenatal care provider (range 60.7 % in New York City to 85.6 % in Maine). Women were more likely to report a discussion on perinatal depression with their provider if they they were 18-29years of age than over 35 years of age compared to older (adjusted prevalence ratio [aPR] 18 to 19 y = 1.08, 20 to 24 y = 1.10, 25 to 29 y = 1.09), unmarried (aPR = 1.07) compared to married, had <12 years of education (aPR = 1.05) compared to >12 years, and had no previous live births (aPR = 1.03) compared to ≥1 live births. Research is needed on effective ways to educate women about perinatal depression and whether increased knowledge on perinatal depression results in higher rates of treatment and shorter duration of symptoms. |
Development of a tool to describe overall health, social independence and activity limitation of adolescents and young adults with disability
Deroche CB , Holland MM , McDermott S , Royer JA , Hardin JW , Mann JR , Salzberg D , Ozturk O , Ouyang L . Res Dev Disabil 2015 38c 288-300 There is a need for research that focuses on the correlation between self-perceived quality of life (QoL) and the health outcomes of adolescents with disability transitioning to adulthood. To better understand the transition experience of adolescents and young adults with disability, we developed a questionnaire to assess the impact of disability on QoL. We recruited 174 participants who were 15-24 years old and diagnosed with Fragile X syndrome (FXS), spina bifida (SB) or muscular dystrophy (MD) and conducted an exploratory factor analysis to identify factors that characterize QoL. Five factors emerged: emotional health, physical health, independence, activity limitation, and community participation. To validate the tool, we linked medical claims and other administrative data records and examined the association of the factor scores with health care utilization and found the questionnaire can be utilized among diverse groups of young people with disability. |
Blood component use in a sub-Saharan African country: results of a 4-year evaluation of diagnoses associated with transfusion orders in Namibia
Pitman JP , Wilkinson R , Liu Y , von Finckenstein B , Smit Sibinga CT , Lowrance DW , Marfin AA , Postma MJ , Mataranyika M , Basavaraju SV . Transfus Med Rev 2014 29 (1) 45-51 National blood use patterns in sub-Saharan Africa are poorly described. Although malaria and maternal hemorrhage remain important drivers of blood demand across Africa, economic growth and changes in malaria, HIV/AIDS, and noncommunicable disease epidemiology may contribute to changes in blood demand. We evaluated indications for blood use in Namibia, a country in southern Africa, using a nationally representative sample and discuss implications for the region. Clinical and demographic data related to the issuance of blood component units in Namibia were reviewed for a 4-year period (August 1, 2007-July 31, 2011). Variables included blood component type, recipient age and sex, and diagnosis. Diagnoses reported by clinicians were reclassified into International Statistical Classification of Diseases, 10th Revision categories. Multiple imputation methods were used to complete a data set missing age, sex or diagnosis data. Descriptive analyses were conducted to describe indications for transfusions and use of red blood cells (RBCs), platelets, and plasma. A total of 39 313 records accounting for 91 207 blood component units were analyzed. The median age of Namibian transfusion recipients was 45 years (SD, +/-19). A total of 78 660 RBC units were issued in Namibia during the study period. Red blood cells transfused for "unspecified anemia" accounted for the single largest category of blood issued (24 798 units). Of the overall total, 38.9% were for diseases of the blood and blood-forming organs (D50-D89). Infectious disease (A00-B99), pregnancy (O00-O99), and gastrointestinal (K20-K93) accounted for 14.8%, 11.1%, and 6.1% of RBC units issued, respectively. Although a specific diagnosis of malaria accounted for only 2.7% of pediatric transfusions, an unknown number of additional transfusions for malaria may have been categorized by requesting physicians as unspecified anemia and counted under diseases of blood forming organs. During the study period, 9751 units of fresh-frozen plasma were issued. Nearly one-quarter of these units (23.1%) were issued for gastrointestinal (K20-K93) diagnoses. Malignant neoplasms (C00-C97) accounted for 38.1% of 2978 platelet units issued. Blood use in Namibia reflects changes in the health care system due to economic development, improvement in HIV/AIDS and malaria epidemiology, high rates of health care facility-based childbirth, and access to noncommunicable disease treatment. However, better documentation of the indications for transfusion is needed to confirm these observations. Changing patterns of health care will result in changing demands for blood components. Improved methods to evaluate blood use patterns in sub-Saharan Africa may help set realistic national blood collection goals. |
Large-scale experiments and absolute detonability of methane/air mixtures
Oran ES , Gamezo VN , Zipf RK Jr . Combust Sci Technol 2015 187 324-341 The Gas Explosions Research Facility at Lake Lynn Experimental Mines was used to determine the detonability limit of methane for a 1-meter diameter tube as a function of the percent of methane in air. The measurements showed detonation limits of 5.3% (lean) and 15.6% (rich). A method for extrapolating these limits to larger systems, more relevant to coal mine tunnels, was proposed based on a simple scaling law and some empirical information on the number of cells required for a detonation to propagate in closed, open, and partially open geometries. The scaling law reproduces the measured detonation-cell sizes measured in the 1-m tube. Applying this to a tunnel the size of a coal mine produces a detonability limit less than the currently measured flammability limit for methane/air at atmospheric conditions, which raises interesting questions for detonation and combustion theory and suggests measurements in larger tubes. |
A review of underground coal mine emergency communications and tracking system installations
Damiano N , Homce G , Jacksha R . Coal Age 2014 119 (11) 34-35 The 2006 Mine Improvement and New Emergency Response Act of 2006 (MINER Act) required all underground coal mines in the U.S. to have a plan to provide post-accident communication and electronic tracking for any mine workers trapped underground. | In response, post-accident communications and electronic tracking (emergency CT) technologies designed to meet MINER Act requirements have been developed by various manufacturers and approved for permissibility by the Mine Safety and Health Administration (MSHA), meaning they may be used safely in coal mines that may have gassy or dust-laden atmospheres. As a result, more than a dozen different emergency CT systems have become available for U.S. underground coal mining. | The National Institute for Occupational Safety and Health (NIOSH) recently conducted a review of the latest MSHA-approved Emergency Response Plans (ERPs) for each active underground coal mine on file as of February 2014 to identify and characterize the types of emergency CT systems installed. This review pertains only to CT systems installed underground for emergency purposes, and does not include any CT systems installed or used for non-emergency situations, such as communications for everyday operations. |
Incorporating decision-making into quarterly escape training
Brnich MJ Jr , Hall EE . Coal Age 2014 119 (11) 44-47 The 19 fatalities in two explosions and a mine fire in underground coal mines in 2006 raised a number of issues about mine emergency preparedness and response. Reviews of federal investigation reports for these incidents indicated that investigators had concerns about miners’ ability to don and use self-contained self-rescuers (SCSRs); miners’ judgment and decision making abilities; miners’ familiarity with escape procedures; and emergency communications (Murray et al. 2007; Light et al. 2007; Gates et al. 2007). | Following the three major mine incidents in 2006, the National Mining Association’s (NMA) Mine Safety Technology and Training Commission (MSTTC) reviewed National Institute of Occupational Safety and Health’s (NIOSH) prior research on mine emergency decision-making. In addition, the commission conducted a survey to seek the opinion of industry and Mine Safety and Health Administration (MSHA) safety professionals on issues related to “training for preparedness.” Of the 79 participants in the survey, 76% felt there was a need to improve training on how to make decisions during mine emergencies, including those involving self-escape and aided rescue (Mine Safety Technology and Training Commission, 2006). | NIOSH has conducted research focusing on judgment and decision-making in mine emergencies. A study by Vaught et al. (2000) looked at judgment and decision-making in the context of escaping a mine fire. In 2010, researchers conducted interviews with personnel from six coal mining operations to understand how they approach judgment and decision-making when developing quarterly mine escape training (Brnich and Hall 2013). |
Work-related asthma in Korea - findings from the Korea Work-Related Asthma Surveillance (KOWAS) program, 2004-2009
Kwon SC , Song J , Kim YK , Calvert GM . Allergy Asthma Immunol Res 2015 7 (1) 51-9 PURPOSE: To determine the incidence and epidemiological characteristics of work-related asthma in Korea. METHODS: During 2004-2009, the Korea Work-Related Asthma Surveillance (KOWAS) program collected data on new cases of work-related asthma from occupational physicians, allergy and chest physicians, regional surveillance systems, and workers' compensation schemes. The incidence was calculated on the basis of industry, occupation, sex, age, and region. In addition, the distribution of causal agents was determined. RESULTS: During the study period, 236 cases of work-related asthma were reported, with 77 cases from more than 1 source. A total of 22.0% (n=52) were reported by occupational physicians, 52.5% (n=124) by allergy and chest physicians, 24.2% (n=57) by regional surveillance systems, and 43.2% (n=102) by workers' compensation schemes. The overall average annual incidence was 3.31 cases/million workers, with a rate of 3.78/million among men and 2.58/million among women. The highest incidence was observed in the 50-59-year age group (7.74/million), in the Gyeonggi/Incheon suburb of Seoul (8.50/million), in the furniture and other instrument manufacturing industries (67.62/million), and among craft and related trades workers (17.75/million). The most common causal agents were isocyanates (46.6%), flour/grain (8.5%), metal (5.9%), reactive dyes (5.1%), and solvents (4.2%). CONCLUSIONS: The incidence of work-related asthma in Korea was relatively low, and varied according to industry, occupation, gender, age, and region. Data provided by workers' compensation schemes and physician reports have been useful for determining the incidence and causes of work-related asthma. |
Workplace safety and health for the veterinary health care team
Gibbins JD , MacMahon K . Vet Clin North Am Small Anim Pract 2015 45 (2) 409-26, vii-viii Veterinary clinic employers have a legal and ethical responsibility to provide a safe and healthy workplace. Clinic members are responsible for consistently using safe practices and procedures set up by their employer. Development and implementation of a customized comprehensive workplace safety and health program is emphasized, including an infection control plan. Occupational safety and health regulations are reviewed. The hazards of sharps, animal bites and scratches, and drugs are discussed. Strategies to prevent or minimize adverse health effects and resources for training and education are provided. |
Occupational exposures associated with severe exacerbation of asthma
Henneberger PK , Liang X , Lillienberg L , Dahlman-Hoglund A , Toren K , Andersson E . Int J Tuberc Lung Dis 2015 19 (2) 244-50 BACKGROUND: The exacerbation of asthma by workplace conditions is common, but little is known about which agents pose a risk. OBJECTIVE: We used data from an existing survey of adults with asthma to identify occupational exposures associated with severe exacerbation of asthma. DESIGN: Questionnaires were completed by 557 working adults with asthma. Severe exacerbation of asthma in the past 12 months was defined as asthma-related hospitalization, or reports of both unplanned asthma care and treatment with a short course of oral corticosteroids. Occupational exposures for the same time period were assessed using an asthma-specific job exposure matrix. We modeled severe exacerbation to yield prevalence ratios (PRs) for exposures while controlling for potential confounders. RESULTS: A total of 164 participants (29%) were positive for severe exacerbation, and 227 (40.8%) were assessed as being exposed to asthma agents at work. Elevated PRs were observed for several specific agents, notably the irritant subcategories of environmental tobacco smoke (PR 1.84, 95%CI 1.34-2.51) among all participants, inorganic dusts (PR 2.53, 95%CI 1.37-4.67) among men, and the low molecular weight subcategory of other highly reactive agents (PR 1.97, 95%CI 1.08-3.60) among women. CONCLUSION: Among working adults with asthma, severe exacerbation was associated with several occupational agents. |
An examination of the vibration transmissibility of the hand-arm system in three orthogonal directions
Welcome DE , Dong RG , Xu XS , Warren C , McDowell TG , Wu JZ . Int J Ind Ergon 2015 45 (1) 21-34 The objective of this study is to enhance the understanding of the vibration transmission in the hand-arm system in three orthogonal directions (X, Y, and Z). For the first time, the transmitted vibrations distributed on the entire hand-arm system exposed in the three orthogonal directions via a 3-D vibration test system were measured using a 3-D laser vibrometer. Seven adult male subjects participated in the experiment. This study confirms that the vibration transmissibility generally decreased with the increase in distance from the hand and it varied with the vibration direction. Specifically, to the upper arm and shoulder, only moderate vibration transmission was measured in the test frequency range (16 to 500Hz), and virtually no transmission was measured in the frequency range higher than 50Hz. The resonance vibration on the forearm was primarily in the range of 16-30Hz with the peak amplitude of approximately 1.5 times of the input vibration amplitude. The major resonance on the dorsal surfaces of the hand and wrist occurred at around 30-40Hz and, in the Y direction, with peak amplitude of more than 2.5 times of the input amplitude. At higher than 50Hz, vibration transmission was effectively limited to the hand and fingers. A major finger resonance was observed at around 100Hz in the X and Y directions and around 200Hz in the Z direction. In the fingers, the resonance magnitude in the Z direction was generally the lowest, and the resonance magnitude in the Y direction was generally the highest with the resonance amplitude of 3 times the input vibration, which was similar to the transmissibility at the wrist and hand dorsum. The implications of the results are discussed. RELEVANCE TO INDUSTRY: Prolonged, intensive exposure to hand-transmitted vibration could result in hand-arm vibration syndrome. While the syndrome's precise mechanisms remain unclear, the characterization of the vibration transmissibility of the system in the three orthogonal dimensions performed in this study can help understand the syndrome and help develop improved frequency weightings for assessing the risk of the exposure for developing various components of the syndrome. |
Potential health effects associated with dermal exposure to occupational chemicals
Anderson SE , Meade BJ . Environ Health Insights 2014 8 51-62 There are a large number of workers in the United States, spanning a variety of occupational industries and sectors, who are potentially exposed to chemicals that can be absorbed through the skin. Occupational skin exposures can result in numerous diseases that can adversely affect an individual's health and capacity to perform at work. In general, there are three types of chemical-skin interactions of concern: direct skin effects, immune-mediated skin effects, and systemic effects. While hundreds of chemicals (metals, epoxy and acrylic resins, rubber additives, and chemical intermediates) present in virtually every industry have been identified to cause direct and immune-mediated effects such as contact dermatitis or urticaria, less is known about the number and types of chemicals contributing to systemic effects. In an attempt to raise awareness, skin notation assignments communicate the potential for dermal absorption; however, there is a need for standardization among agencies to communicate an accurate description of occupational hazards. Studies have suggested that exposure to complex mixtures, excessive hand washing, use of hand sanitizers, high frequency of wet work, and environmental or other factors may enhance penetration and stimulate other biological responses altering the outcomes of dermal chemical exposure. Understanding the hazards of dermal exposure is essential for the proper implementation of protective measures to ensure worker safety and health. |
Federal public health workforce development: an evidence-based approach for defining competencies
Mumford K , Young AC , Nawaz S . J Public Health Manag Pract 2015 22 (3) 290-7 OBJECTIVE: This study reports the use of exploratory factor analysis to describe essential skills and knowledge for an important segment of the domestic public health workforce-Centers for Disease Control and Prevention (CDC) project officers-using an evidence-based approach to competency development and validation. DESIGN:: A multicomponent survey was conducted. Exploratory factor analysis was used to examine the underlying domains and relationships between competency domains and key behaviors. The Cronbach alpha coefficient determined the reliability of the overall scale and identified factors. SETTING AND PARTICIPANTS: All domestic (US state, tribe, local, and territorial) grantees who received funding from the CDC during fiscal year 2011 to implement nonresearch prevention or intervention programs were invited to participate in a Web-based questionnaire. MAIN OUTCOME MEASURE(S): A total of 34 key behaviors representing knowledge, skills, and abilities, grouped in 7 domains-communication, grant administration and management, public health applied science and knowledge, program planning and development, program management, program monitoring and improvement, and organizational consultation-were examined. RESULTS: There were 795 responses (58% response rate). A total of 6 factors were identified with loadings of 0.40 or more for all 34 behavioral items. The Cronbach alpha coefficient was 0.95 overall and ranged between 0.73 and 0.91 for the factors. CONCLUSIONS: This study provides empirical evidence for the construct validity of 6 competencies and 34 key behaviors important for CDC project officers and serves as an important first step to evidence-driven workforce development efforts in public health. |
Safety of assisted reproductive technology in the United States, 2000-2011
Kawwass JF , Kissin DM , Kulkarni AD , Creanga AA , Session DR , Callaghan WM , Jamieson DJ . JAMA 2015 313 (1) 88-90 Use of assisted reproductive technology (ART) continues to increase in the United States and globally. In an effort to improve patient safety, stimulation protocols have become less aggressive, oocyte retrieval has transitioned from laparoscopic to transvaginal, and pregnancy rates have improved.1 However, limited data exist regarding the incidence of maternal complications.2 We explored incidence and trends in reported patient and donor complications in fresh ART cycles using the US Centers for Disease Control and Prevention National ART Surveillance System (NASS). |
Vital signs: alcohol poisoning deaths - United States, 2010-2012
Kanny D , Brewer RD , Mesnick JB , Paulozzi LJ , Naimi TS , Lu H . MMWR Morb Mortal Wkly Rep 2015 63 (53) 1238-42 Excessive alcohol use accounted for an average of one in 10 deaths among working-age adults (aged 20-64 years) in the United States each year during 2006-2010, and cost the United States $223.5 billion in 2006. Binge drinking, defined as consuming four or more drinks for women or five or more drinks for men on an occasion, was responsible for more than half of these deaths and three fourths of the economic costs. Binge drinking also is responsible for many health and social problems, including alcohol poisoning. Yet, approximately 38 million U.S. adults report binge drinking an average of four times per month, and consume an average of eight drinks per binge episode. Most binge drinkers (90%) are not alcohol dependent. |
Comment on Farsalinos et al., "Evaluation of electronic cigarette liquids and vapour for the presence of selected inhalation toxins"
Hubbs AF , Cummings KJ , McKernan LT , Dankovic DA , Park RM , Kreiss K . Nicotine Tob Res 2015 17 (10) 1288-9 We read with great interest the recent publication, Evaluation of electronic cigarette liquids and aerosol for the presence of selected inhalation toxins.1 We are particularly grateful to the authors for recognizing the high rate of chronic obstructive pulmonary disease and of bronchiolitis, specifically, in smokers and for measuring the concentrations of diacetyl (DA) and acetyl propionyl (AP, also known as 2,3-pentanedione) in electronic cigarette (e-cigarette) liquids and aerosols. However, we would like to clarify two issues: | The National Institute for Occupational Safety and Health (NIOSH) draft document, Criteria for a Recommended Standard: Occupational Exposure to Diacetyl and 2,3-Pentanedione, proposes recommended exposure limits (RELs) to reduce the risk of respiratory impairment (decreased lung function) and the severe irreversible lung disease, constrictive bronchiolitis obliterans, associated with occupational exposure to these chemicals. As noted by Farsalinos and co-workers in their limitations section, it is not intended to establish “safe” exposure concentrations for consumers or the general public.1 | The exposure comparisons between e-cigarette users and traditional cigarette smokers and workers use values that are not widely accepted. |
Smokeless tobacco use: a meta-analysis of risk and attributable mortality estimates for India
Sinha DN , Palipudi KM , Gupta PC , Singhal S , Ramasundarahettige C , Jha P , Indrayan A , Asma S , Vendhan G . Indian J Cancer 2014 51 Suppl S73-7 BACKGROUND: Use of smokeless tobacco (SLT) is widely prevalent in India and Indian subcontinent. Cohort and case-control studies in India and elsewhere report excess mortality due to its use. OBJECTIVE: The aim was to estimate the SLT use-attributable deaths in males and females, aged 35 years and older, in India. MATERIALS AND METHODS: Prevalence of SLT use in persons aged 35 years and older was obtained from the Global Adult Tobacco Survey in India and population size and deaths in the relevant age-sex groups were obtained from UN estimates (2010 revision) for 2008. A meta-relative risk (RR) based population attributable fraction was used to estimate attributable deaths in persons aged 35 years and older. A random effects model was used in the meta-analysis on all-cause mortality from SLT use in India including four cohort and one case-control study. The studies included in the meta-analysis were adjusted for smoking, age and education. RESULTS: The prevalence of SLT use in India was 25.2% for men and 24.5% for women aged 35 years and older. RRs for females and males were 1.34 (1.27-1.42) and 1.17 (1.05-1.42), respectively. The number of deaths attributable to SLT use in India is estimated to be 368127 (217,076 women and 151,051 men), with nearly three-fifth (60%) of these deaths occurring among women. CONCLUSION: SLT use caused over 350,000 deaths in India in 2010, and nearly three-fifth of SLT use-attributable deaths were among women in India. This calls for targeted public health intervention focusing on SLT products especially among women. |
Levels and trends of smokeless tobacco use among youth in countries of the World Health Organization South-East Asia Region
Sinha DN , Palipudi KM , Jones CK , Khadka BB , Silva PD , Mumthaz M , Shein N , Gyeltshen T , Nahar K , Asma S , Kyaing NN . Indian J Cancer 2014 51 Suppl S50-3 BACKGROUND: At least two rounds of the Global Youth Tobacco Survey (GYTS) have been completed in most of the countries in the World Health Organization South-East Asia region. Comparing findings from these two rounds provides trend data on smokeless tobacco (SLT) use for the first time. METHODS: This study uses GYTS data from Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste during 2006-2013. GYTS is a nationally representative survey of 13-15-year-old students using a consistent and standard protocol. Current SLT use is defined as using any kind of SLT products, such as chewing betel quid or nonbetel quid or snuffing any other products orally or through the nasal route, during the 30 days preceding the survey. Prevalence and 95% confidence intervals were computed using SAS/SUDAAN software. RESULTS: According to most recent GYTS data available in each country, the prevalence of current use of SLT among youth varied from 5.7% in Thailand to 23.2% in Bhutan; among boys, from 7.1% in Bangladesh to 27.2% in Bhutan; and among girls, from 3.7% in Bangladesh to 19.8% in Bhutan. Prevalence of SLT was reported significantly higher among boys than girls in Bhutan (boys 27.2%; girls 19.8%), India (boys 11.1%; girls 6.0%), Maldives (boys 9.2%; girls 2.9%), Myanmar (boys 15.2%; girls 4.0%), and Sri Lanka (boys 13.0%; girls 4.1%). Prevalence of current SLT use increased in Bhutan from 9.4% in 2009 to 23.2% in 2013, and in Nepal from 6.1% in 2007 to 16.2% in 2011. CONCLUSION: The findings call for countries to implement corrective measures through strengthened policy and enforcement. |
Influence of tobacco industry advertisements and promotions on tobacco use in India: findings from the Global Adult Tobacco Survey 2009-2010
Sinha DN , Palipudi KM , Oswal K , Gupta PC , Andes LJ , Asma S . Indian J Cancer 2014 51 Suppl S13-8 INTRODUCTION: The developing world, including countries like India, has become a major target for the tobacco industry to market its products. This study examines the influence of the marketing (advertising and promotion) of tobacco products on the use of tobacco by adults (ages 15 and over) in India. METHOD: Data from Global Adult Tobacco Survey 2009-2010 was analyzed using methods for complex (clustered) sample designs. Multivariate logistic regression was employed to predict the use of different tobacco products by level of exposure to tobacco marketing using adults who have never used tobacco as the reference category. Odds ratios (ORs) were adjusted for education, gender, age, state of residence, wealth index, and place of residence (urban/rural). RESULTS: Adults in India were almost twice as likely to be current smokers (versus never users) when they were exposed to a moderate level of bidi or cigarette marketing. For bidis, among adults with high exposure, the OR for current use was 4.57 (95% confidence interval [CI]: 1.6, 13.0). Adults were more likely to be current users of smokeless tobacco (SLT) with even a low level of exposure to SLT marketing (OR = 1.24 [95% CI: 1.1, 1.4]). For SLT, the ORs showed an increasing trend (P for trend < 0.001) with greater level of exposure (moderate, OR = 1.55 [95% CI: 1.1, 2.2]; high, OR = 2.05 [95% CI: 0.8, 5.1]). The risk of any current tobacco use rose with increasing level of exposure to any marketing (minimum, OR = 1.25 [1.1-1.4]; moderate, OR = 1.38 [1.1-1.8]; and high, OR = 2.73 [1.8-4.2]), with the trend highly significant (P < 0.001). CONCLUSION: Exposure to the marketing of tobacco products, which may take the form of advertising at the point of sale, sales or a discounted price, free coupons, free samples, surrogate advertisements, or any of several other modalities, increased prevalence of tobacco use among adults. An increasing level of exposure to direct and indirect advertisement and promotion is associated with an increased likelihood of tobacco use. |
Comparison of anamnestic responses to rabies vaccination in dogs and cats with current and out-of-date vaccination status
Moore MC , Davis RD , Kang Q , Vahl CI , Wallace RM , Hanlon CA , Mosier DA . J Am Vet Med Assoc 2015 246 (2) 205-11 OBJECTIVE: To compare anamnestic antibody responses of dogs and cats with current versus out-of-date vaccination status. DESIGN: Cross-sectional study. ANIMALS: 74 dogs and 33 cats. PROCEDURES: Serum samples were obtained from dogs and cats that had been exposed to rabies and brought to a veterinarian for proactive serologic monitoring or that had been brought to a veterinarian for booster rabies vaccination. Blood samples were collected on the day of initial evaluation (day 0) and then again 5 to 15 days later. On day 0, a rabies vaccine was administered according to label recommendations. Paired serum samples were analyzed for antirabies antibodies by means of a rapid fluorescent focus inhibition test. RESULTS: All animals had an antirabies antibody titer ≥ 0.5 IU/mL 5 to 15 days after booster vaccination. Dogs with an out-of-date vaccination status had a higher median increase in titer, higher median fold increase in titer, and higher median titer following booster vaccination, compared with dogs with current vaccination status. Most (26/33) cats, regardless of rabies vaccination status, had a titer ≥ 12 IU/mL 5 to 15 days after booster vaccination. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that dogs with out-of-date vaccination status were not inferior in their antibody response following booster rabies vaccination, compared with dogs with current vaccination status. Findings supported immediate booster vaccination followed by observation for 45 days of dogs and cats with an out-of-date vaccination status that are exposed to rabies, as is the current practice for dogs and cats with current vaccination status. |
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