Incidence of treatment for end-stage renal disease among individuals with diabetes in the U.S. continues to decline
Burrows NR , Li Y , Geiss LS . Diabetes Care 2010 33 (1) 73-7 OBJECTIVE: We examined trends in incidence of treatment for diabetes-related end-stage renal disease (ESRD) in the U.S. RESEARCH DESIGN AND METHODS: Using the U.S. Renal Data System, we obtained the number of individuals having diabetes listed as primary diagnosis who initiated ESRD treatment between 1990 and 2006. Incidence was calculated using the estimated U.S. population with diabetes from the National Health Interview Survey and then was age adjusted based on the 2000 U.S. standard population. Trends were analyzed using joinpoint regression. RESULTS: The number of individuals who began diabetes-related ESRD treatment increased from 17,727 in 1990 to 48,215 in 2006. From 1990 to 1996, the age-adjusted diabetes-related ESRD incidence increased somewhat from 299.0 to 343.2 per 100,000 diabetic population (P = 0.45). However, from 1996 to 2006, the age-adjusted diabetes-related ESRD incidence decreased by 3.9% per year (P < 0.01) from 343.2 to 197.7 per 100,000 diabetic population. Among individuals with diabetes aged <45 years, diabetes-related ESRD incidence decreased by 4.3% per year (P < 0.01) from 1990 to 2006. Among older individuals, incidence increased during the 1990s but decreased in later years, by 3.9% per year (P < 0.01) among individuals aged 45-64, by 3.4% per year (P < 0.01) among individuals aged 65-74 years, and by 2.1% per year (P = 0.02) among individuals aged > or =75 years. CONCLUSIONS: Diabetes-related ESRD incidence in the diabetic population has declined in all age-groups, probably because of a reduction in the prevalence of ESRD risk factors, improved treatment and care, and other factors. |
Timeliness of breast cancer diagnosis and initiation of treatment in the National Breast and Cervical Cancer Early Detection Program, 1996-2005
Richardson LC , Royalty J , Howe W , Helsel W , Kammerer W , Benard VB . Am J Public Health 2009 100 (9) 1769-76 OBJECTIVES: To determine the effects of program policy changes, we examined service delivery benchmarks for breast cancer screening in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS: We analyzed NBCCEDP data for women with abnormal mammogram or clinical breast examination (n=382416) from which 23701 cancers were diagnosed. We examined time to diagnosis and treatment for 2 time periods: 1996 to 2000 and 2001 to 2005. We compared median time for diagnostic, treatment initiation, and total intervals with the Kruskal-Wallis test. We calculated adjusted proportions (predicted marginals) with logistic regression to examine diagnosis and treatment within program benchmarks (≤60 days) and time from screening to treatment (≤120 days). RESULTS: Median diagnostic intervals decreased by 2 days (25 vs 23; P<.001). Median treatment initiation intervals increased by 2 days (12 vs 14; P<.001). Total intervals decreased by 3 days (43 vs 40; P<.001). Women meeting the 60-day benchmark for diagnosis improved the most for women with normal mammograms and abnormal clinical breast examinations from 77% to 82%. CONCLUSIONS: Women screened by the NBCCEDP received diagnostic followup and initiated treatment within preestablished program guidelines. |
Hepatitis E epidemic, Uganda
Teshale EH , Howard CM , Grytdal SP , Handzel TR , Barry V , Kamili S , Drobeniuc J , Okware S , Downing R , Tappero JW , Bakamutumaho B , Teo CG , Ward JW , Holmberg SD , Hu DJ . Emerg Infect Dis 2010 16 (1) 126-9 In October 2007, an epidemic of hepatitis E was suspected in Kitgum District of northern Uganda where no previous epidemics had been documented. This outbreak has progressed to become one of the largest hepatitis E outbreaks in the world. By June 2009, the epidemic had caused illness in >10,196 persons and 160 deaths. |
Cluster of serogroup W135 meningococci, southeastern Florida, 2008-2009
Doyle TJ , Mejia-Echeverry A , Fiorella P , Leguen F , Livengood J , Kay R , Hopkins R . Emerg Infect Dis 2010 16 (1) 113-5 Recently, 14 persons in southeastern Florida were identified with Neisseria meningitidis serogroup W135 invasive infections. All isolates tested had matching or near-matching pulsed-field gel electrophoresis patterns and belonged to the multilocus sequence type 11 clonal complex. The epidemiologic investigation suggested recent endemic transmission of this clonal complex in southeastern Florida. |
Severe 2009 H1N1 influenza in pregnant and postpartum women in California
Louie JK , Acosta M , Jamieson DJ , Honein MA , California Pandemic (H1N1) Working Group . N Engl J Med 2009 362 (1) 27-35 BACKGROUND: Like previous epidemic and pandemic diseases, 2009 pandemic influenza A (H1N1) may pose an increased risk of severe illness in pregnant women. METHODS: Statewide surveillance for patients who were hospitalized with or died from 2009 H1N1 influenza was initiated by the California Department of Public Health. We reviewed demographic and clinical data reported from April 23 through August 11, 2009, for all H1N1-infected, reproductive-age women who were hospitalized or died - nonpregnant women, pregnant women, and postpartum women (those who had delivered ≤2 weeks previously). RESULTS: Data were reported for 94 pregnant women, 8 postpartum women, and 137 nonpregnant women of reproductive age who were hospitalized with 2009 H1N1 influenza. Rapid antigen tests were falsely negative in 38% of the patients tested (58 of 153). Most pregnant patients (89 of 94 [95%]) were in the second or third trimester, and approximately one third (32 of 93 [34%]) had established risk factors for complications from influenza other than pregnancy. As compared with early antiviral treatment (administered ≤2 days after symptom onset) in pregnant women, later treatment was associated with admission to an intensive care unit (ICU) or death (relative risk, 4.3). In all, 18 pregnant women and 4 postpartum women (total, 22 of 102 [22%]) required intensive care, and 8 (8%) died. Six deliveries occurred in the ICU, including four emergency cesarean deliveries. The 2009 H1N1 influenza-specific maternal mortality ratio (the number of maternal deaths per 100,000 live births) was 4.3. CONCLUSIONS: 2009 H1N1 influenza can cause severe illness and death in pregnant and postpartum women; regardless of the results of rapid antigen testing, prompt evaluation and antiviral treatment of influenza-like illness should be considered in such women. The high cause-specific maternal mortality rate suggests that 2009 H1N1 influenza may increase the 2009 maternal mortality ratio in the United States. Copyright 2009 Massachusetts Medical Society. |
2009 H1N1 update: what every nurse needs to know
Sunenshine R . Ariz Nurse 2009 62 (4) 10-11 Q: What is H1N1 influenza? | A: H1N1 influenza is a new strain of influenza virus that causes respiratory illness in people and is causing widespread disease in Arizona and worldwide. Just like seasonal influenza, it causes an unpleasant illness in most people but can lead to serious complications or death in some, especially those with high risk conditions. | Q: What is an influenza pandemic and how does it relate to H1N1? | A: A pandemic is a global disease outbreak. A flu pandemic occurs when a new influenza virus emerges for which people have little or no immunity and for which there is no vaccine (at least in the beginning). The disease spreads easily person-to-person, causes serious illness, and can sweep across the country and around the world in a very short time. | On June 11, 2009 the World Health Organization (WHO) officially declared the 2009 H1N1 influenza outbreak a pandemic. | Q: Why has the H1N1 influenza sometimes been called the "swine flu"? | A: This virus was originally referred to as "swine flu" because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in swine in North America. Further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and avian genes and human genes. Scientists call this a "quadruple reassortant" virus. |
H1N1 flu
Centers for Disease Control and Prevention . Plast Surg Nurs 2009 29 (4) 271-8 Centers for Disease Control and Prevention, U.S. Department of Health & Human Services. |
Hepatitis B and Hepatitis C seroprevalence in children receiving antiretroviral therapy for human immunodeficiency virus-1 infection in China, 2005-2009
Zhou S , Zhao Y , He Y , Li H , Bulterys M , Sun X , Dou Z , Robinson M , Zhang F . J Acquir Immune Defic Syndr 2009 54 (2) 191-6 BACKGROUND: Coinfection of hepatitis B virus (HBV) or hepatitis C virus (HCV) may compromise pediatric antiretroviral therapy (ART) in China. In this study, we evaluated the seroprevalence of HBV and HCV in children receiving ART and associated factors. METHODS: Patients were selected from HIV-1-infected children under age 16 enrolled in China National Pediatric ART Cohort since July 2005. Medical assessments, hepatitis B surface antigen (HBsAg), and anti-HCV antibody serologies, and transaminase levels were obtained for analysis. RESULTS: A total of 53 of 1082 children tested were HBsAg seropositive [4.9%; 95% confidence interval (CI): 3.6% to 6.2%], and 90 of 938 children tested were anti-HCV antibody positive (9.6%; 95% CI: 7.7% to 11.5%). No other serologic assays were performed for HBV detection. Age was associated with HBV coinfection in univariate analysis; older children were more likely to be HBsAg positive. Multivariate analysis revealed that children infected with HIV through transfusion of contaminated blood or blood products were more likely to be anti-HCV antibody positive than those infected with HIV through other routes (adjusted odds ratio = 6.2; 95% CI: 3.3% to 11.7%). CONCLUSIONS: The high prevalence of HBV and HCV coinfection in HIV-infected children in China receiving ART demands routine screening for viral hepatitis coinfection, intensive prevention of childhood HBV and HCV transmission, and modification of the management of pediatric HIV infection. |
Undiagnosed HIV infection among New York City jail entrants, 2006: results of a blinded serosurvey
Begier EM , Bennani Y , Forgione L , Punsalang A , Hanna DB , Herrera J , Torian L , Gbur M , Sepkowitz KA , Parvez F . J Acquir Immune Defic Syndr 2009 54 (1) 93-101 OBJECTIVE: Since 2004, when all New York City jail entrants began being offered rapid testing at medical intake, HIV testing has increased 4-fold. To guide further service improvement, we determined HIV prevalence among jail entrants, including proportion undiagnosed. METHODS: Remnant serum from routine syphilis screening was salvaged for blinded HIV testing in 2006. Using HIV surveillance data and electronic clinical data, we ascertained previously diagnosed HIV infections before permanently removing identifiers. We defined "undiagnosed" as HIV-infected entrants who were unreported to surveillance and denied HIV infection. RESULTS: Among the 6411 jail entrants tested (68.9% of admissions), HIV prevalence was 5.2% overall (males 4.7%; females: 9.8%). Adjusting for those not in the serosurvey, estimated seroprevalence is 8.7% overall (6.5% males, 14% females). Overall, 28.1% of HIV infections identified in the serosurvey were undiagnosed at jail entry; only 11.5% of these were diagnosed during routine jail testing. Few (11.1%) of the undiagnosed inmates reported injection drug use or being men who have sex with men. CONCLUSIONS: About 5%-9% of New York City jail entrants are HIV infected. Of the infected, 28% are undiagnosed; most of whom denied recognized HIV risk factors. To increase inmate's acceptance of routine testing, we are working to eliminate the required separate written consent for HIV testing to allow implementation of the Centers for Disease Control and Prevention-recommended opt out testing model. |
From manganism to manganese-induced parkinsonism: a conceptual model based on the evolution of exposure
Lucchini RG , Martin CJ , Doney BC . Neuromolecular Med 2009 11 (4) 311-21 Manganism is a distinct medical condition from Parkinson's disease. Manganese exposure scenarios in the last century generally have changed from the acute, high-level exposure conditions responsible for the occurrence of manganism to chronic exposure to much lower levels. Such chronic exposures may progressively extend the site of manganese deposition and toxicity from the globus pallidus to the entire area of the basal ganglia, including the substantia nigra pars compacta involved in Parkinson's disease. The mechanisms of manganese neurotoxicity from chronic exposure to very low levels are not well understood, but promising information is based on the concept of susceptibility that may place individuals exposed to manganese at a higher risk for developing Parkinsonian disturbances. These conditions include mutations of genes which play important pathogenetic roles in both Parkinsonism and in the regulation of manganese transport and metabolism. Liver function is also important in manganese-related neurotoxicity and sub-clinical impairment may increase the risk of Parkinsonism. The purpose and scope of this report are to explore the literature concerning manganese exposure and potential subclinical effects and biological pathways, impairment, and development of diseases such as Parkinsonism and manganism. Inhalation and ingestion of manganese will be the focus of this report. |
Inactivation of adenoviruses, enteroviruses, and murine norovirus in water by free chlorine and monochloramine
Cromeans TL , Kahler AM , Hill VR . Appl Environ Microbiol 2009 76 (4) 1028-33 Inactivation of infectious viruses during drinking water treatment is usually achieved with free chlorine. Many drinking water utilities in the United States now use monochloramine as a secondary disinfectant to minimize disinfectant byproduct formation and biofilm growth. The inactivation of adenoviruses 2, 40 and 41 (HAdV2, HAdV40 and HAdV41), coxsackieviruses B3 and B5 (CVB3 and CVB5), echoviruses 1 and 11 (E1 and E11) and murine norovirus (MNV), are compared in this study. Experiments were performed with 0.2 mg/L free chlorine or 1 mg/L monochloramine at pH 7 and pH 8 in buffered reagent grade water (RGW) at 5 degrees C. Ct values for 2-4-log10 (99-99.99%) reductions in viral titers were calculated using the Efficiency Factor Hom (EFH) model. The enteroviruses required the longest times for chlorine inactivation and MNV the least time. CVB5 required the longest exposure time, with Ct values of 7.4 and 10 mg-min/L (pH 7 and 8) for 4-log10 inactivation. Monochloramine disinfections was most effective for E1 (Ct values ranged from 8 to 18 mg-min/L for 2- and 3-log10 reductions, respectively). E11 and HAdV2 were the least susceptible to monochloramine disinfection, (Ct values of 1300 and 1600 mg-min/L for 3-log10 reductions, respectively). Monochloramine inactivation was most successful for the adenoviruses, CVB5, and E1 at pH 7. A greater variation in inactivation rates between viruses was observed during monochloramine disinfection than during chlorine disinfection. This data will be useful in drinking water risk assessment studies and disinfection system planning. |
The prevalence of multiple sclerosis in 3 US communities
Noonan CW , Williamson DM , Henry JP , Indian R , Lynch SG , Neuberger JS , Schiffer R , Trottier J , Wagner L , Marrie RA . Prev Chronic Dis 2010 7 (1) A12 INTRODUCTION: We estimated the prevalence of multiple sclerosis (MS) in 3 large geographic areas in the southern, middle, and northern United States. METHODS: The primary data source was medical records from office visits to private neurologists' practices or to neurology departments in tertiary care facilities during a 3-year period. Additional data sources included patient advocacy groups, nursing homes, and general practitioners. RESULTS: Three-year US age-adjusted prevalence estimates for the study areas varied substantially. The prevalence was lowest (47.2 per 100,000 population) in the Texas study area (33 degrees 30' north latitude), intermediate (86.3 per 100,000 population) in the Missouri study area (39 degrees 07' north latitude), and highest (109.5 per 100,000 population) in the Ohio study area (41 degrees 24' north latitude). The geographic differences remained strong after age-adjustment to the world standard population. The inverse association between UV light exposure and MS prevalence estimates was consistent with this observed latitude gradient. In all 3 areas, MS prevalence was highest among women, people aged 40 to 59 years, and non-Hispanics. CONCLUSION: These results provide necessary prevalence estimates for community cluster investigations and establish baseline estimates for future studies to evaluate temporal trends in disease prevalence. |
National influenza surveillance in Vietnam, 2006-2007
Nguyen HT , Dharan NJ , Le MT , Nguyen NB , Nguyen CT , Hoang DV , Tran HN , Bui CT , Dang DT , Pham DN , Phan TV , Dennis DT , Uyeki TM , Mott J , Nguyen YT , Vietnam National Influenza Surveillance Evaluation Team . Vaccine 2009 28 (2) 398-402 In 2006, national influenza surveillance was implemented in Vietnam. Epidemiologic and demographic data and a throat swab for influenza testing were collected from a subset of outpatients with influenza-like illness (ILI). During January 1, 2006 through December 31, 2007, of 184,521 ILI cases identified at surveillance sites, 11,082 were tested and 2112 (19%) were positive for influenza by reverse transcription polymerase chain reaction. Influenza viruses were detected year-round, and similar peaks in influenza activity were observed in all surveillance regions, coinciding with cooler and rainy periods. Studies are needed to ascertain the disease burden and impact of influenza in Vietnam. |
Accuracy of data on influenza vaccination status at four Vaccine Safety Datalink sites
Greene SK , Shi P , Dutta-Linn MM , Shoup JA , Hinrichsen VL , Ray P , Nordin JD , Kuckler L , Weintraub ES , Yih WK . Am J Prev Med 2009 37 (6) 552-5 BACKGROUND: Studies of influenza vaccination using electronic medical records rely on accurate classification of vaccination status. Vaccinations not entered into electronic records would be unavailable for study. PURPOSE: This study evaluated the sensitivity and negative predictive value (NPV) of electronic records for influenza vaccination and factors associated with failure to capture vaccinations. METHODS: In four diverse medical care organizations in the Vaccine Safety Datalink, those aged 50-79 years with no influenza vaccination record during the 2007-2008 season were surveyed by telephone, and electronic records were analyzed in 2008. The sensitivity and NPV of electronic records were estimated, using survey responses as the gold standard. Logistic regression models determined associations between 1-NPV and demographic factors, risk of influenza complications, and healthcare utilization levels. RESULTS: Data were obtained for 933 survey participants and 1,085,916 medical care organization members. Sites varied significantly in the sensitivity (51%, 68%, 79%, 89%) and NPV (46%, 62%, 66%, 87%) of electronic records. In multivariate analysis, the rate of failure to capture vaccinations was significantly higher for those aged 65-79 years than for those aged 50-64 years at three sites. Of vaccinations not captured by electronic records, 58% were reportedly administered in nontraditional settings, usually workplaces; the rest were given within the sites. CONCLUSIONS: Influenza vaccination studies relying on electronic records may misclassify substantial proportions of vaccinated individuals as unvaccinated, producing biased estimates of vaccine effectiveness. Sites with limited sensitivity to capture vaccinations administered within their organization should seek possible remedies. More complete capture of vaccinations administered to older patients and in nontraditional settings would further reduce misclassification. |
Improving on analyses of self-reported data in a large-scale health survey by using information from an examination-based survey
Schenker N , Raghunathan TE , Bondarenko I . Stat Med 2009 29 (5) 533-45 Common data sources for assessing the health of a population of interest include large-scale surveys based on interviews that often pose questions requiring a self-report, such as, 'Has a doctor or other health professional ever told you that you have health condition of interest ?' or 'What is your height/weight ?' Answers to such questions might not always reflect the true prevalences of health conditions (for example, if a respondent misreports height/weight or does not have access to a doctor or other health professional). Such 'measurement error' in health data could affect inferences about measures of health and health disparities. Drawing on two surveys conducted by the National Center for Health Statistics, this paper describes an imputation-based strategy for using clinical information from an examination-based health survey to improve on analyses of self-reported data in a larger interview-based health survey. Models predicting clinical values from self-reported values and covariates are fitted to data from the National Health and Nutrition Examination Survey (NHANES), which asks self-report questions during an interview component and also obtains clinical measurements during a physical examination component. The fitted models are used to multiply impute clinical values for the National Health Interview Survey (NHIS), a larger survey that obtains data solely via interviews. Illustrations involving hypertension, diabetes, and obesity suggest that estimates of health measures based on the multiply imputed clinical values are different from those based on the NHIS self-reported data alone and have smaller estimated standard errors than those based solely on the NHANES clinical data. The paper discusses the relationship of the methods used in the study to two-phase/two-stage/validation sampling and estimation, along with limitations, practical considerations, and areas for future research. Published in 2009 by John Wiley & Sons, Ltd. |
Sushi in pregnancy, parasitic diseases - obstetrician survey
Jones JL , Anderson B , Schulkin J , Parise ME , Eberhard ML . Zoonoses Public Health 2009 58 (2) 119-25 Parasites from raw fish can lead to a wide range of clinical manifestations and can be challenging to treat in pregnancy as result of medication exposure of the foetus. We surveyed obstetrician-gynecologists (ob-gyns) in the U.S. to determine their knowledge about the consumption of raw fish during pregnancy. In March 2007, a questionnaire was mailed to members of the American College of Obstetricians and Gynecologists (ACOG) randomly selected to represent all members. Non-responding physicians were sent two additional mailings. Of the 606 ACOG members surveyed, 305 (50%) responded. Most (82%) respondents indicated that eating raw fish is not safe during pregnancy. However, few (19%) knew that thorough freezing kills parasites in fish. Nearly all (94%) respondents thought that parasitic infections can be more challenging to treat in pregnancy. U.S. ob-gyns believe that eating raw fish during pregnancy is not safe; most would benefit from information about how to prevent infection and about treatment. |
Does consumption of processed foods explain disparities in the body weight of individuals? The case of Guatemala
Asfaw A . Health Econ 2009 20 (2) 184-95 Overweight/obesity, caused by the 'nutrition transition', is identified as one of the leading risk factors for non-communicable mortality. The nutrition transition in developing countries is associated with a major shift from the consumption of staple crops and whole grains to highly and partially processed foods. This study examines the contribution of processed foods consumption to the prevalence of overweight/obesity in Guatemala using generalized methods of moments (GMM) regression. The results show that all other things remaining constant, a 10% point increase in the share of partially processed foods from the total household food expenditure increases the BMI of family members (aged 10 years and above) by 3.95%. The impact of highly processed foods is much stronger. A 10% point increase in the share of highly processed food items increases the BMI of individuals by 4.25%, ceteris paribus. The results are robust when body weight is measured by overweight/obesity indicators. These findings suggest that increasing shares of partially and highly processed foods from the total consumption expenditure could be one of the major risk factors for the high prevalence of overweight/obesity in the country. Copyright (c) 2009 John Wiley & Sons, Ltd. |
Evidence of selective sweeps in genes conferring resistance to chloroquine and pyrimethamine in Plasmodium falciparum within India
Mixson-Hayden T , Jain V , McCollum AM , Poe A , Nagpal AC , Dash AP , Stiles JK , Udhayakumar V , Singh N . Antimicrob Agents Chemother 2009 54 (3) 997-1006 Treatment of Plasmodium falciparum is complicated by the emergence and spread of parasite resistance to many of the first line drugs used to treat malaria. Anti-malarial drug resistance has been associated with specific point mutations in several genes, suggesting that these single nucleotide polymorphisms can be useful in tracking the emergence of drug resistance. In India, P. falciparum can manifest itself as asymptomatic, mild, or severe malaria, with or without cerebral involvement. We tested whether chloroquine and antifolate drug resistant genotypes would be more commonly associated with cases of cerebral malaria than with cases of mild malaria in the province of Jabalpur, India by genotyping the genes dhps, dhfr, pfmdr-1, and pfcrt using pyrosequencing, direct sequencing, and real time PCR. Further, we used microsatellites surrounding the genes to determine the origins and spread of the drug resistant genotypes in this area. Resistance to chloroquine was essentially fixed with 95% of the isolates harboring the pfcrt K76T mutation. Resistant genotypes of dhfr, dhps, and pfmdr-1 were found in 94%, 17%, and 77% of the isolates, respectively. Drug resistant genotypes were equally likely to be associated with cerebral malaria as they were with cases of mild malaria. We found evidence of a selective sweep in pfcrt and, to a lesser degree, dhfr, indicating high levels of resistance to chloroquine and evolving resistance to pyrimethamine. Microsatellites surrounding pfcrt indicate that the resistant genotypes (SVMNT) were most similar to those found in Papua New Guinea. |
Human leukocyte antigen class I supertypes and HIV-1 control in African Americans
Lazaryan A , Song W , Lobashevsky E , Tang J , Shrestha S , Zhang K , Gardner LI , McNicholl JM , Wilson CM , Klein RS , Rompalo A , Mayer K , Sobel J , Kaslow Richard A , HIV Epidemiology Research Study , Reaching for Excellence in Adolescent Care and Health Study . J Virol 2009 84 (5) 2610-7 The role of human leukocyte antigen (HLA) class I supertypes in controlling human immunodeficiency virus type 1 (HIV-1) infection in African Americans has not been established. We examined the effects of alleles HLA-A and HLA-B and supertypes on the outcomes of HIV-1 clade B infection among 338 African American women and adolescents. HLA-B58 and -B62 supertypes (B58s and B62s) were associated with favorable HIV-1 disease control (proportional odds ratio [POR] 0.33; 95% CI, 0.21-0.52 and POR 0.26; 95% CI, 0.09-0.73), respectively; B7s and B44s were associated with unfavorable disease control (POR 2.39; 95% CI, 1.54-3.73 and POR 1.63; 95% CI, 1.08-2.47). In general, individual alleles within specific B supertypes exerted relatively homogeneous effects. A notable exception was B27s, whose protective influence (POR 0.58; 95% CI, 0.35-0.94) was masked by the opposing effect of it member allele B*1510. The associations of most B supertypes (e.g., B58s, B7s) were largely explained either by well known effects of constituent B alleles or by effects of previously unimplicated B alleles aggregated into a particular supertype (e.g., B44s, B62s). Higher frequency of HLA-B genotypic supertypes correlated with higher mean viral load (VL) and lower mean CD4 count (Pearson's r=0.63 and 0.62, respectively, P=0.03). Among the genotypic supertypes B58s and its member allele B*57 contributed disproportionately to the explainable VL variation. The study demonstrated the dominant role of HLA-B supertypes in HIV-1 clade B-infected African Americans and further dissected the contributions of individual class I alleles and their population frequencies to the supertype effects. |
Determinants of contraceptive choice among women with HIV
Whiteman MK , Kissin DM , Samarina A , Curtis KM , Akatova N , Marchbanks PA , Jamieson DJ , Martirosyan M , Revzina N , Hillis SD . AIDS 2009 23 S47-S54 OBJECTIVE: To examine factors associated with contraceptive choice among HIV-infected women. DESIGN: Data for this cross-sectional analysis were derived from baseline visits of 435 participants in an ongoing prospective study of contraception among HIV-infected women in Russia. Participants enrolled in one of four groups: combined oral contraceptives (COCs) along with condoms, depot medroxyprogesterone acetate (DMPA) along with condoms, copper intrauterine device (IUD) along with condoms, or condoms alone. METHODS: After contraceptive counseling and assessment of medical eligibility to use study methods, participants selected a method. Standardized interviews were used to collect demographic, reproductive and behavioral information. RESULTS: Most women were eligible to use COCs (89%) and DMPA (94%); 87% of nonpostpartum women were eligible to use the IUD. The method chosen by most women was condoms alone (47%), followed by COCs along with condoms (29%), DMPA along with condoms (20%) and IUD along with condoms (4%). In multivariable analyses, independent predictors of choosing a method highly effective during typical use (COCs, DMPA, or IUD) along with condoms included having at least two births (prevalence ratio=1.4), postpartum enrolment (prevalence ratio=1.3), desiring (prevalence ratio=1.4), or uncertainty about desiring (prevalence ratio=1.3) a future pregnancy, prior oral contraceptive use (prevalence ratio=1.3), recent injection drug use (prevalence ratio=1.3) and never (prevalence ratio=2.3) or sometimes (prevalence ratio=1.9) using condoms in the last year. CONCLUSION: Among HIV-infected women, several characteristics that may place women at greater risk for unintended pregnancy and its adverse consequences were associated with choice of highly effective contraceptive methods. These findings may aid in the development of interventions to increase use of effective contraception among HIV-infected women. |
Factors influencing acceptance of influenza vaccination given in an ED
Cassidy W , Marioneaux DM , Windham AF , Manning S , Fishbein D , Horswell RL . Am J Emerg Med 2009 27 (9) 1027-33 Factors correlating with successful administration of flu vaccine in an emergency department (ED) were examined. Patients 18 years and older were screened for indications for flu immunization. Vaccine was offered to those with indications. Of 3425 patients screened, 1311 had indications, 705 of 1311 agreed to immunization, and 513 of 705 were immunized. Factors related to immunization agreement were comorbidity, interviewer, and being 50 to 64 years old with prior immunization. Immunization factors were month, comorbidity, and not being pregnant. Factors associated with suboptimal acceptance and receipt should be addressed in future efforts. |
Health-seeking behavior among HIV-infected patients treated for TB in Thailand
Burapat C , Kittikraisak W , Cain KP , Tasaneeyapan T , Nateniyom S , Akksilp S , Mankatittham W , Sirinak C , Sattayawuthipong W , Varma JK . Southeast Asian J Trop Med Public Health 2009 40 (6) 1335-1346 In Asia, patients increasingly seek tuberculosis (TB) treatment in the private sector; however, few private sector practices follow international TB management guidelines We conducted a study to measure the frequency and predictors of seeking TB diagnosis in the private sector among 756 HIV-infected TB patients in four Thai provinces during 2005-2006. Of enrolled patients, 97 (13%) first sought care at a private. provider and 83 (11%) at a pharmacy. In multivariable analysis, the only factor independently associated with seeking care at a private provider was having a high TB stigma score. Factors independently associated with seeking care at a pharmacy included not knowing that TB call be cured and that TB care call be provided close to home. Patients reported that the Most Influential factor in choosing a provider was confidentiality (468, 62%). Further research is needed to evaluate whether educating the community about the confidentiality, availability, and success of curing TB at government health facilities can promote prompt utilization of public TB treatment services by HIV-infected patients in Thailand. |
Public communication in unplanned biomass burning events
Damon SA , Naylor R , Therriault S . Inhal Toxicol 2009 22 (2) 113-6 Public communication related to emergency, unplanned, or "wildfire" biomass burning is best understood as a function of the audience for that communication. Two enduring communication models, the Health Belief Model and the Stages of Change or Transtheoretical Model, are instructive in analyzing and preparing differing communication response strategies that are indicated for communities with varying degrees of experience in responding to unplanned biomass burning smoke events. |
Tobacco use, exposure to secondhand smoke, and training on cessation counseling among nursing students: Cross-country data from the Global Health Professions Student Survey (GHPSS), 2005-2009
Warren CW , Sinha DN , Lee J , Lea V , Jones NR . Int J Environ Res Public Health 2009 6 (10) 2534-2549 The Nursing Global Health Professions Student Survey (GHPSS) has been conducted in schools in 39 countries and the Gaza Strip/West Bank (identified as "sites" for the remainder of this paper). In half the sites, over 20% of the students currently smoked cigarettes, with males having higher rates than females in 22 sites. Over 60% of students reported having been exposed to secondhand smoke in public places in 23 of 39 sites. The majority of students recognized that they are role models in society, believed they should receive training on counseling patients to quit using tobacco, but few reported receiving any formal training. Tobacco control efforts must discourage tobacco use among health professionals, promote smoke free workplaces, and implement programs that train health professionals in effective cessation-counseling techniques. copyright 2009 by the authors; licensee Molecular Diversity Preservation International. |
Web usage data as a means of evaluating public health messaging and outreach
Tian H , Brimmer DJ , Lin JM , Tumpey AJ , Reeves WC . J Med Internet Res 2009 11 (4) e52 BACKGROUND: The Internet is increasingly utilized by researchers, health care providers, and the public to seek medical information. The Internet also provides a powerful tool for public health messaging. Understanding the needs of the intended audience and how they use websites is critical for website developers to provide better services to the intended users. OBJECTIVE: The aim of the study was to examine the utilization of the chronic fatigue syndrome (CFS) website at the Centers for Disease Control and Prevention (CDC). We evaluated (1) CFS website utilization, (2) outcomes of a CDC CFS public awareness campaign, and (3) user behavior related to public awareness campaign materials and CFS continuing medical education courses. METHODS: To describe and evaluate Web utilization, we collected Web usage data over an 18-month period and extracted page views, visits, referring domains, and geographic locations. We used page views as the primary measure for the CFS awareness outreach effort. We utilized market basket analysis and Markov chain model techniques to describe user behavior related to utilization of campaign materials and continuing medical education courses. RESULTS: The CDC CFS website received 3,647,736 views from more than 50 countries over the 18-month period and was the 33rd most popular CDC website. States with formal CFS programs had higher visiting density, such as Washington, DC; Georgia; and New Jersey. Most visits (71%) were from Web search engines, with 16% from non-search-engine sites and 12% from visitors who had bookmarked the site. The public awareness campaign was associated with a sharp increase and subsequent quick drop in Web traffic. Following the campaign, user interest shifted from information targeting consumer basic knowledge to information for health care professionals. The market basket analysis showed that visitors preferred the 60-second radio clip public service announcement over the 30-second one. Markov chain model results revealed that most visitors took the online continuing education courses in sequential order and were less likely to drop out after they reached the Introduction pages of the courses. CONCLUSIONS: The utilization of the CFS website reflects a high level of interest in the illness by visitors to the site. The high utilization shows the website to be an important online resource for people seeking basic information about CFS and for those looking for professional health care and research information. Public health programs should consider analytic methods to further public health by understanding the characteristics of those seeking information and by evaluating the outcomes of public health campaigns. The website was an effective means to provide health information about CFS and serves as an important public health tool for community outreach. |
Differential maternal responses to a newly developed vaccine information pamphlet
Klein NP , Kissner J , Aguirre A , Sparks R , Campbell S , Edwards KM , Dekker CL , Shui I , Gust DA . Vaccine 2009 28 (2) 323-8 We compared the response to a new vaccine information pamphlet with the current CDC Vaccine Information Statements (VIS) among recently delivered mothers who were screened to identify those with concerns about immunization. Eligible mothers (n=226) were randomly assigned to one of three equal groups; those reviewing only the new pamphlet, those receiving only VIS, or those receiving both. Among those mothers reviewing both, 61% preferred the new pamphlet for its visual appeal (P<0.0001) and ease of understanding (P=0.005). Overall, mothers expressed increased confidence and fewer concerns regarding multiple injections after reviewing the pamphlet. However, older, more-highly educated mothers were less likely to report improved vaccine confidence after reviewing either the pamphlet or the VIS. Mothers in all three groups stated a preference for receiving the vaccine information during pregnancy or prior to the actual immunization visit. These data suggest that early provision of tailored immunization material along with the VIS to new mothers may enhance their overall confidence in vaccines and that additional strategies targeted toward certain mothers may be needed. |
Outbreak of late-onset group B Streptococcus in a neonatal intensive care unit
Macfarquhar JK , Jones TF , Woron AM , Kainer MA , Whitney CG , Beall B , Schrag SJ , Schaffner W . Am J Infect Control 2009 38 (4) 283-8 BACKGROUND: In September 2007, the Tennessee Department of Health was notified of a cluster of late-onset group B streptococcal (GBS) infections in a neonatal intensive care unit (NICU). Outbreaks of late-onset GBS are rare. METHODS: A case was defined as culture-confirmed invasive GBS infection in a neonate aged ≥7 days, identified in hospital A during August 23 to September 6, 2007. We reviewed medical records; examined NICU microbiology reports; and performed serotyping, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST) on invasive isolates. Maternal GBS screening, prophylaxis, and infection control policies were reviewed and staff practices observed. RESULTS: Five cases of late-onset GBS were identified. None of the mothers of the infants received optimal GBS prophylaxis. Patient isolates were of 2 serotypes, 3 PFGE patterns, and 2 MLST patterns. Three isolates were indistinguishable on subtyping. These 3 cases were clustered in time. No common health care providers were identified. Infection control deviations in the NICU were observed. CONCLUSION: We identified a multiclonal cluster of 5 late-onset GBS cases. Multiple factors likely contributed to the outbreak, including nosocomial transmission of GBS. Further efforts to prevent late-onset GBS disease are necessary. |
Influenza vaccination rates among healthcare workers in the Department of Veterans Affairs community living centers
Tsan L , Langberg R , Gibert C , Davis C , Hojlo C , Pierce J , Phillips Y , Gaynes R , Montgomery O , Danko L , Roselle G . Infect Control Hosp Epidemiol 2009 31 (2) 191-2 Vaccination is the primary means to prevent influenza, limit | transmission, and reduce complications from influenza in | long-term care facilities.1 | The Centers for Disease Control | and Prevention recommend annual influenza vaccination for | all residents of long-term care facilities and for all healthcare | workers (HCWs) who have contact with residents and visitors.2 | However, despite the Centers for Disease Control and | Prevention's recommendation, on average, less than 40% of | HCWs receive influenza vaccination each year.3 | The National | Healthy People 2010 goal for annual influenza vaccination | coverage of HCWs in long-term care facilities is 60%." | The Department of Veterans Affairs (VA), with 133 community living centers (formerly called nursing home care | units), is the largest single provider of nursing home care in | the United States. Annual influenza vaccination is provided | free of charge to all residents and HCWs of VA community | living centers. Here, we report the influenza vaccination rates | among HCWs at VA community living centers during the | 2006 and 2007 influenza seasons. |
Naturally occurring human monoclonal antibodies neutralize both 1918 and 2009 A(H1N1) pandemic influenza viruses
Krause JC , Tumpey TM , Huffman CJ , McGraw PA , Pearce MB , Tsibane T , Hai R , Basler CF , Crowe JE Jr . J Virol 2009 84 (6) 3127-30 The 2009 A(H1N1) pandemic influenza virus exhibits hemagglutinin protein sequence homology with the 1918 pandemic influenza virus. We found that human monoclonal antibodies recognized the Sa antigenic site on the head domain of both 1918 and 2009 hemagglutinins, a site that is hypervariable due to immune selection. These antibodies exhibited high potency against the 2009 virus in vitro, and one exerted a marked therapeutic effect in vivo. |
Optimizing tactics for use of the U.S. antiviral strategic national stockpile for pandemic (H1N1) influenza, 2009
Dimitrov N , Goll S , Meyers LA , Pourbohloul B , Hupert N . PLoS Curr 2009 1 RRN1127 Public health agencies across the globe are working to mitigate the impact of the 2009 pandemic caused by swine-origin influenza A (H1N1) virus. Prior to the large-scale distribution of an effective vaccine, the primary modes of control have included careful surveillance, social distancing and hygiene measures, strategic school closures, other community measures, and the prudent use of antiviral medications to prevent infection (prophylaxis) or reduce the severity and duration of symptoms (treatment). Here, we use mathematical models to determine the optimal geo-temporal tactics for distributing the U.S. strategic national stockpile of antivirals for treatment of infected cases during the early stages of a pandemic, prior to the wide availability of vaccines.We present a versatile optimization method for efficiently searching large sets of public health intervention strategies, and apply it to evaluating tactics for distributing antiviral medications from the U.S. Strategic National Stockpile (SNS). We implemented the algorithm on a network model of H1N1 transmission within and among U.S. cities to project the epidemiological impacts of antiviral stockpile distribution schedules and priorities. The resulting optimized strategies critically depend on the rates of antiviral uptake and wastage (through misallocation or loss). And while a surprisingly simple pro rata distribution schedule is competitive with the optimized strategies across a wide range of uptake and wastage, other equally simple policies perform poorly.Even as vaccination campaigns get underway worldwide, antiviral medications continue to play a critical in reducing H1N1-associated morbidity and mortality. If efforts are made to increase the fraction of cases treated promptly with antivirals above current levels, our model suggests that optimal use of the antiviral component of the Strategic National Stockpile may appreciably slow the transmission of H1N1 during fall 2009, thereby improving the impact of targeted vaccination. A more aggressive optimized antiviral strategy of this type may prove critical to mitigating future flu pandemics, but may increase the risk of antiviral resistance. |
2009 influenza A(H1N1) monovalent vaccines for children
Fiore AE , Neuzil KM . JAMA 2009 303 (1) 73-4 The 2009 influenza A(H1N1) virus was first identified 8 months ago,1 but the virus has already had a substantial effect on human health. Influenza activity in the United States has remained higher than normal since May, and measures of severe illness such as hospitalizations and deaths during the summer and fall have been equal to or higher than rates usually observed in a typical winter influenza season in all age groups except older adults.2 Even though influenza activity has decreased in recent weeks in some states, there remains the possibility of continued activity through the traditional winter influenza season and the prospect of normal winter circulation of seasonal influenza viruses. | The 2009 influenza A(H1N1) pandemic highlights the role of children in influenza epidemiology. Serological studies suggested that children had no measurable immunity against H1N1 prior to the outbreak.3 In addition, children have been a primary source of illness in community outbreaks of pandemic influenza, as indicated by the association between outbreaks in schools or summer camps and influenza activity in the community.4 Children also have developed severe influenza A(H1N1)–related complications more frequently than is usually seen for seasonal influenza and reports of pediatric deaths and hospitalizations continue to increase.2 As of December 5, 2009, 224 laboratory-confirmed deaths among children had been reported to the Centers for Disease Control and Prevention, far surpassing any recent influenza season,2 and the actual number of pediatric deaths due to the influenza A(H1N1) virus pandemic is likely to be considerably higher.5 Children have been among the primary groups targeted for the limited amount of vaccine available in most areas.6 |
Antibody-mediated synergy and interference in the neutralization of SARS-CoV at an epitope cluster on the spike protein
Zhong L , Haynes L , Struble EB , Tamin A , Virata-Theimer ML , Zhang P . Biochem Biophys Res Commun 2009 390 (3) 1056-60 Incomplete neutralization of virus, especially when it occurs in the presence of excess neutralizing antibody, represents a biological phenomenon that impacts greatly on antibody-mediated immune prophylaxis of viral infection and on successful vaccine design. To understand the mechanism by which a virus escapes from antibody-mediated neutralization, we have investigated the interactions of non-neutralizing and neutralizing antibodies at an epitope cluster on the spike protein of severe acute respiratory syndrome coronavirus (SARS-CoV). The epitope cluster was mapped at the C-terminus of the spike protein; it consists of structurally intertwined epitopes recognized by two neutralizing monoclonal antibodies (mAbs), 341C and 540C, and a non-neutralizing mAb, 240C. While mAb 341C binds to a mostly linear epitope composed of residues (507)PAT(509) and V(349), mAb 240C binds to an epitope that partially overlaps the former by at least two residues (P(507) and A(508)). The epitope corresponding to mAb 540C is a conformational one, involving residues L(504) and N(505). In neutralization assays, non-neutralizing 240C disrupted virus neutralization by mAb 341C and/or mAb 540C, whereas a combination of mAbs 341C and 540C blocked virus infectivity synergistically. These findings indicate that the epitope cluster on the spike protein may serve as an evolutionarily conserved platform at which a dynamic interplay between neutralizing and non-neutralizing antibodies occurs, thereby determining the outcome of SARS-CoV infection. |
Characterization of the cellular immune response in hepatitis C virus infection
Zhang X , Dou J , Germann MW . Med Res Rev 2009 29 (6) 843-66 Hepatitis C virus (HCV), a hepatotropic RNA virus, is a major causative agent of chronic hepatitis, liver cirrhosis, and hepatocellular carcinomas. The host immune responses, especially cellular immune responses, play an important role in viral clearance, liver injury, and persistent HCV infection. A thorough characterization of the HCV cellular immune responses is important for understanding the interplays between host immune system and viral components, as well as for developing effective therapeutic and prophylactic HCV vaccines. Recent advances that provide better understanding the cell immune responses in HCV infection are summarized in this article. |
Choropleth map design for cancer incidence, part 1
Richards TB , Berkowitz Z , Thomas CC , Foster SL , Gardner A , King JB , Ledford K , Royalty J . Prev Chronic Dis 2010 7 (1) A23 Choropleth maps are commonly used in cancer reports and community discussions about cancer rates. Cancer registries increasingly use geographic information system techniques. The Centers for Disease Control and Prevention's Division of Cancer Prevention and Control convened a Map Work Group to help guide application of geographic information systems mapping techniques and to promote choropleth mapping of data from central cancer registries supported by the National Program of Cancer Registries, especially for planning and evaluation of comprehensive cancer control programs. In this 2-part series in this issue of Preventing Chronic Disease, we answer frequently asked questions about choropleth map design to display cancer incidence data. We recommend that future initiatives consider more advanced mapping, spatial analysis, and spatial statistics techniques, and include usability testing with representatives of state and local programs and other cancer prevention partners. |
Choropleth map design for cancer incidence, part 2
Richards TB , Berkowitz Z , Thomas CC , Foster SL , Gardner A , King JB , Ledford K , Royalty J . Prev Chronic Dis 2010 7 (1) A24 Choropleth maps are commonly used in cancer reports and community discussions about cancer rates. Cancer registries increasingly use geographic information system techniques. The Centers for Disease Control and Prevention's Division of Cancer Prevention and Control convened a Map Work Group to help guide application of geographic information system mapping techniques and to promote choropleth mapping of data from central cancer registries supported by the National Program of Cancer Registries, especially for comprehensive cancer control planning and evaluation purposes. In this 2-part series, we answer frequently asked questions about choropleth map design to display cancer incidence data. We recommend that future initiatives consider more advanced mapping, spatial analysis, and spatial statistics techniques and include usability testing with representatives of state and local programs and other cancer prevention partners. |
The role of nanotoxicology in realizing the 'helping without harm' paradigm of nanomedicine: lessons from studies of pulmonary effects of single-walled carbon nanotubes
Shvedova AA , Kagan VE . J Intern Med 2010 267 (1) 106-118 Nano-sized materials and nano-scaled processes are widely used in many industries. They are being actively introduced as diagnostic and therapeutic in biomedicine and they are found in numerous consumer products. The small size of nanoparticles, comparable with molecular machinery of cells, may affect normal physiological functions of cells and cause cytotoxicity. Their toxic potential cannot be extrapolated from studies of larger particles due to unique physicochemical properties of nanomaterials. Therefore, the use of nanomaterials may pose unknown risks to human health and the environment. This review discusses several important issues relevant to pulmonary toxicity of nanoparticles, especially single-walled carbon nanotubes (SWCNT), their direct cytotoxic effects, their ability to cause an inflammatory response, and induce oxidative stress upon pharyngeal aspiration or inhalation. Further, recognition and engulfment of nanotubes by macrophages as they relate to phagocytosis and bio-distribution of nanotubes in tissues and circulation are discussed. The immunosuppressive effects of CNT and their significance in increased sensitivity of exposed individuals to microbial infections are summarized. Finally, data on biodegradation of SWCNT by oxidative enzymes of inflammatory cells are presented in lieu of their persistence and distribution in the body. |
Laboratory surge capacity and pandemic influenza
Meltzer MI , McNeill KM , Miller JD . Emerg Infect Dis 2010 16 (1) 147-8 In this issue, Crawford et al. describe their experiences running a clinical diagnostic laboratory during the first 3 weeks of the influenza A pandemic (H1N1) 2009 outbreak (1). During the early weeks of the outbreak, their laboratory, which serves 15 hospitals and affiliated physician practices in the greater New York City metropolitan area, experienced an approximately 8x increase in respiratory virus testing, reaching a maximum of about 900 samples processed in 1 day. |
Comparison of five commercial DNA extraction kits for the recovery of Yersinia pestis DNA from bacterial suspensions and spiked environmental samples
Dauphin LA , Stephens KW , Eufinger SC , Bowen MD . J Appl Microbiol 2010 108 (1) 163-72 AIM: To evaluate commercial DNA extraction kits for their ability to isolate DNA from Yersinia pestis suspensions and spiked environmental samples. METHODS AND RESULTS: Five commercially available DNA extraction kits were evaluated: the ChargeSwitch gDNA Mini Bacteria Kit, the IT 1-2-3 Sample DNA Purification Kit, the MasterPure Complete DNA and RNA Purification Kit, the QIAamp DNA Blood Mini Kit and the UltraClean Microbial DNA Isolation Kit. The extraction methods were performed upon six Y. pestis strains and spiked environmental specimens, including three swab types and one powder type. Taqman real-time PCR analysis revealed that the use of the MasterPure kit resulted in DNA with the most consistently positive results and the lowest limit of detection from Y. pestis suspensions and spiked environmental samples. CONCLUSION: Comparative evaluations of the five commercial DNA extraction methods indicated that the MasterPure kit was superior for the isolation of PCR-amplifiable DNA from Y. pestis suspensions and spiked environmental samples. SIGNIFICANCE AND IMPACT OF THE STUDY: The results of this study can assist diagnostic laboratories with selecting the best extraction method for processing environmental specimens for subsequent detection of Y. pestis by real-time PCR. |
Mitochondrial targeting of electron scavenging antioxidants: regulation of selective oxidation vs random chain reactions
Kagan VE , Wipf P , Stoyanovsky D , Greenberger JS , Borisenko G , Belikova NA , Yanamala N , Samhan Arias AK , Tungekar MA , Jiang J , Tyurina YY , Ji J , Klein-Seetharaman J , Pitt BR , Shvedova AA , Bayir H . Adv Drug Deliv Rev 2009 61 (14) 1375-85 Effective regulation of highly compartmentalized production of reactive oxygen species and peroxidation reactions in mitochondria requires targeting of small molecule antioxidants and antioxidant enzymes into the organelles. This review describes recently developed approaches to mitochondrial targeting of small biologically active molecules based on: (i) preferential accumulation in mitochondria because of their hydrophobicity and positive charge (hydrophobic cations), (ii) binding with high affinity to an intra-mitochondrial constituent, and (iii) metabolic conversions by specific mitochondrial enzymes to reveal an active entity. In addition, targeted delivery of antioxidant enzymes via expression of leader sequences directing the proteins into mitochondria is considered. Examples of successful antioxidant and anti-apoptotic protection based on the ability of targeted cargoes to inhibit cytochrome c-catalyzed peroxidation of a mitochondria-specific phospholipid cardiolipin, in vitro and in vivo are presented. Particular emphasis is placed on the employment of triphenylphosphonium- and hemi-gramicidin S-moieties as two effective vehicles for mitochondrial delivery of antioxidants. |
Novel pandemic influenza A(H1N1) viruses are potently inhibited by DAS181, a sialidase fusion protein
Triana-Baltzer GB , Gubareva LV , Nicholls JM , Pearce MB , Mishin VP , Belser JA , Chen LM , Chan RW , Chan MC , Hedlund M , Larson JL , Moss RB , Katz JM , Tumpey TM , Fang F . PLoS One 2009 4 (11) e7788 BACKGROUND: The recent emergence of a novel pandemic influenza A(H1N1) strain in humans exemplifies the rapid and unpredictable nature of influenza virus evolution and the need for effective therapeutics and vaccines to control such outbreaks. However, resistance to antivirals can be a formidable problem as evidenced by the currently widespread oseltamivir- and adamantane-resistant seasonal influenza A viruses (IFV). Additional antiviral approaches with novel mechanisms of action are needed to combat novel and resistant influenza strains. DAS181 (Fludase) is a sialidase fusion protein in early clinical development with in vitro and in vivo preclinical activity against a variety of seasonal influenza strains and highly pathogenic avian influenza strains (A/H5N1). Here, we use in vitro, ex vivo, and in vivo models to evaluate the activity of DAS181 against several pandemic influenza A(H1N1) viruses. METHODS AND FINDINGS: The activity of DAS181 against several pandemic influenza A(H1N1) virus isolates was examined in MDCK cells, differentiated primary human respiratory tract culture, ex-vivo human bronchi tissue and mice. DAS181 efficiently inhibited viral replication in each of these models and against all tested pandemic influenza A(H1N1) strains. DAS181 treatment also protected mice from pandemic influenza A(H1N1)-induced pathogenesis. Furthermore, DAS181 antiviral activity against pandemic influenza A(H1N1) strains was comparable to that observed against seasonal influenza virus including the H274Y oseltamivir-resistant influenza virus. CONCLUSIONS: The sialidase fusion protein DAS181 exhibits potent inhibitory activity against pandemic influenza A(H1N1) viruses. As inhibition was also observed with oseltamivir-resistant IFV (H274Y), DAS181 may be active against the antigenically novel pandemic influenza A(H1N1) virus should it acquire the H274Y mutation. Based on these and previous results demonstrating DAS181 broad-spectrum anti-IFV activity, DAS181 represents a potential therapeutic agent for prevention and treatment of infections by both emerging and seasonal strains of IFV. |
Pulsed-field gel electrophoresis subtypes of shiga toxin-producing Escherichia coli O157 isolated from ground beef and humans, United States, 2001-2006
Lanier WA , Leeper MM , Smith KE , Tillman GE , Holt KG , Gerner-Smidt P . Foodborne Pathog Dis 2009 6 (9) 1075-82 Pulsed-field gel electrophoresis XbaI patterns of Shiga toxin-producing Escherichia coli O157 (STEC O157) isolates (n = 156) found in ground beef sampled from U.S. processing plants and retail stores during 2001 to 2006 were summarized and compared with XbaI patterns from human STEC O157 isolates (n = 14,591) in the national PulseNet E. coli database. Four ground beef samples contained more than one pulsed-field gel electrophoresis subtype of STEC O157. Of the 117 unique patterns found in ground beef, 100 (85%) appeared only once, and 17 (15%) were found in more than one isolate. The six patterns that appeared most frequently in human isolates were also found among the eight most common ground beef patterns. The yearly proportion of human isolates with the two most common patterns changed inversely, such that these patterns traded dominance over the study period. Human isolates with patterns that were first detected in both ground beef and humans contemporaneously were clustered in a 6-month window around the time of the respective ground beef sample. Of the 156 ground beef isolates, 82 (53%) were indistinguishable from at least one human isolate in this 6-month window. The yearly proportions of human STEC O157 isolates that were indistinguishable from ground beef isolates decreased significantly from 2002 to 2003 (12.3-0.8%), and then increased significantly from 2003 to 2006 (overall 0.8-12.6%). This increase in the numbers of human isolates that matched a ground beef isolate occurred during a period of relatively consistent rates of ground beef contamination with STEC O157. Pattern similarity of STEC O157 isolates derived from ground beef and clinical cases may serve as a good predictor of human incidence trends. |
Relation between electrical mobility, mass, and size for nanodrops 1-6.5 nm in diameter in air
Ku BK , de la Mora JF . Aerosol Sci Technol 2009 43 (3) 241-249 A large number of data on mobility and mass have been newly obtained or reanalyzed for clusters of a diversity of materials, with the aim of determining the relation between electrical mobility (Z) and mass diameter d(m) = (6m/pi rho)(1/3) (m is the particle mass and rho the bulk density of the material forming the cluster) for nanoparticles with dm ranging from 1 nm to 6.5 nm. The clusters were generated by electrospraying solutions of ionic liquids, tetra-alkyl ammonium salts, cyclodextrin, bradykinin, etc., in acetonitrile, ethanol, water, or formamide. Their electrical mobilities Z in air were measured directly by a differential mobility analyzer (DMA) of high resolution. Their masses m were determined either directly via mass spectrometry, or assigned indirectly by first distinguishing singly (z = 1) and doubly ( z = 2) charged clusters, and then identifying monomers, dimers, ... n-mers, etc., from their ordering in the mobility spectrum. Provided that d(m) > 1.3 nm, data of the form dm vs. [z(1+ m(g)/m)(1/2)/Z)](1/2) fall in a single curve for nanodrops of ionic liquids (ILs) for which. is known (m(g) is the mass of the molecules of suspending gas). Using an effective particle diameter d(p) = d(m) + d(g) and a gas molecule diameter d(g) = 0.300 nm, this curve is also in excellent agreement with the Stokes-Millikan law for spheres. Particles of solid materials fit similarly well the same Stokes-Millikan law when their ( unknown) bulk density is assigned appropriately. |
An SOA model for toluene oxidation in the presence of inorganic aerosols
Cao G , Jang M . Environ Sci Technol 2009 44 (2) 727-33 A predictive model for secondary organic aerosol (SOA) formation including both partitioning and heterogeneous reactions is explored for the SOA produced from the oxidation of toluene in the presence of inorganic seed aerosols. The predictive SOA model comprises the explicit gas-phase chemistry of toluene, gas-particle partitioning, and heterogeneous chemistry. The resulting products from the explicit gas phase chemistry are lumped into several classes of chemical species based on their vapor pressure and reactivity for heterogeneous reactions. Both the gas-particle partitioning coefficient and the heterogeneous reaction rate constant of each lumped gas-phase product are theoretically determined using group contribution and molecular structure-reactivity. In the SOA model, the predictive SOA mass is decoupled into partitioning (OM(P)) and heterogeneous aerosol production (OM(H)). OM(P) is estimated from the SOA partitioning model developed by Schell et al. ( J. Geophys. Res. 2001, 106, 28275-28293 ) that has been used in a regional air quality model (CMAQ 4.7). OM(H) is predicted from the heterogeneous SOA model developed by Jang et al. ( Environ. Sci. Technol. 2006, 40, 3013-3022 ). The SOA model is evaluated using a number of the experimental SOA data that are generated in a 2 m(3) indoor Teflon film chamber under various experimental conditions (e.g., humidity, inorganic seed compositions, NO(x) concentrations). The SOA model reasonably predicts not only the gas-phase chemistry, such as the ozone formation, the conversion of NO to NO(2), and the toluene decay, but also the SOA production. The model predicted that the OM(H) fraction of the total toluene SOA mass increases as NO(x) concentrations decrease: 0.73-0.83 at low NO(x) levels and 0.17-0.47 at middle and high NO(x) levels for SOA experiments with high initial toluene concentrations. Our study also finds a significant increase in the OM(H) mass fraction in the SOA generated with low initial toluene concentrations, compared to those with high initial toluene concentrations. On average, more than a 1-fold increase in OM(H) fraction is observed when the comparison is made between SOA experiments with 40 ppb toluene to those with 630 ppb toluene. Such an observation implies that heterogeneous reactions of the second-generation products of toluene oxidation can contribute considerably to the total SOA mass under atmospheric relevant conditions. |
Twist: a regulator of epithelial-mesenchymal transition in lung fibrosis
Pozharskaya V , Torres-Gonzalez E , Rojas M , Gal A , Amin M , Dollard S , Roman J , Stecenko AA , Mora AL . PLoS One 2009 4 (10) e7559 BACKGROUND: Several studies have implicated viral infection as an important factor in the pathogenesis of IPF and related fibrotic lung disorders. Viruses are thought to cause epithelial cell injury and promote epithelial-mesenchymal transition (EMT), a process whereby differentiated epithelial cells undergo transition to a mesenchymal phenotype, and considered a source of fibroblasts in the setting of lung injury. We have demonstrated an association between the epithelial injury caused by chronic herpes virus infection with the murine gamma-herpes virus, MHV68, and lung fibrosis. We hypothesize that EMT in this model of virus-induced pulmonary fibrosis is driven by the expression of the transcription factor Twist. METHODS/FINDINGS: In vitro MHV68 infection of murine lung epithelial cells induced expression of Twist, and mesenchymal markers. Stable overexpression of Twist promoted EMT in MLE15 lung epithelial cells. Transient knockdown expression of Twist resulted in preservation of epithelial phenotype after in vitro MHV68 infection. In concordance, high expression of Twist was found in lung epithelial cells of MHV68 infected mice, but not in mock infected mice. Alveolar epithelial cells from lung tissue of idiopathic pulmonary fibrosis (IPF) patients were strongly positive for Twist. These cells demonstrated features of EMT with low expression of E-cadherin and upregulation of the mesenchymal marker N-cadherin. Finally, IPF tissue with high Twist protein levels was also positive for the herpesvirus, EBV. CONCLUSIONS/SIGNIFICANCE: We conclude that Twist contributes to EMT in the model of virus-induced pulmonary fibrosis. We speculate that in some IPF cases, gamma-herpes virus infection with EBV might be a source of injury precipitating EMT through the expression of Twist. |
Usefulness of PCR method for detection of Leishmania in Poland
Myjak P , Szulta J , de Almeida ME , da Silva AJ , Steurer F , Lass A , Pietkiewicz H , Nahorski WL , Goljan J , Knap J , Szostakowska B . Pol J Microbiol 2009 58 (3) 219-22 Leishmania parasites are the etiological agents of leishmaniosis, with severe course and often fatal prognosis, and the global number of cases has increased in recent decades. The gold standards for the diagnosis of leishmaniosis are microscopic examinations and culture in vitro of the different clinical specimens. The sensitivity of these methods is insufficient. Recent development in specific and sensitive molecular methods (PCR) allows for detection as well as identification of the parasite species (subspecies). The aim of the study was to estimate the usefulness of molecular methods (PCR) for detection of Leishmania species and consequently for the implementation of such methods in routine diagnostics of leishmaniosis in Polish patients returning from endemic areas of the disease. In our investigations we used 54 known Leishmania positive DNA templates (from culture and clinical specimens) received from the CDC (Atlanta, GA, USA). Moreover, 25 samples of bone marrow, blood or other tissues obtained from 18 Polish individuals suspected of leishmaniosis were also examined. In PCR we used two pairs of primers specific to the conserved region of Leishmania kinetoplast DNA (kDNA) minicircle (13A/13B and F/R). Using these primers we obtained amplicons in all DNA templates from the CDC and in three Polish patients suspected for Leishmania infection. In one sample from among these cases we also obtained positive results with DNA isolated from a blood specimen which was previously negative in microscopic examinations. |
What additional factors beyond state-of-the-art analytical methods are needed for optimal generation and interpretation of biomonitoring data?
Calafat AM , Needham LL . Environ Health Perspect 2009 117 (10) 1481-5 BACKGROUND: The routine use of biomonitoring (i.e., measurement of environmental chemicals, their metabolites, or specific reaction products in human biological specimens) to assess internal exposure (i.e., body burden) has gained importance in exposure assessment. OBJECTIVES: Selection and validation of biomarkers of exposure are critical factors in interpreting biomonitoring data. Moreover, the strong relation between quality of the analytical methods used for biomonitoring and quality of the resulting data is well understood. However, the relevance of collecting, storing, processing, and transporting the samples to the laboratory to the overall biomonitoring process has received limited attention, especially for organic chemicals. DISCUSSION: We present examples to illustrate potential sources of unintended contamination of the biological specimen during collection or processing procedures. The examples also highlight the importance of ensuring that the biological specimen analyzed both represents the sample collected for biomonitoring purposes and reflects the exposure of interest. CONCLUSIONS: Besides using high-quality analytical methods and good laboratory practices for biomonitoring, evaluation of the collection and handling of biological samples should be emphasized, because these procedures can affect the samples integrity and representativeness. Biomonitoring programs would be strengthened with the inclusion of field blanks. |
Detection of molecular markers of drug resistance in the 2009 pandemic influenza A (H1N1) viruses using pyrosequencing
Deyde VM , Sheu TG , Trujillo AA , Okomo-Adhiambo M , Garten R , Klimov AI , Gubareva LV . Antimicrob Agents Chemother 2009 54 (3) 1102-10 BACKGROUND: M2 blockers, amantadine and rimantadine, and neuraminidase (NA) inhibitors (NAIs), oseltamivir and zanamivir, are FDA-approved for control of influenza A virus infections. The 2009 pandemic viruses (H1N1pdm) are reassortants that acquired M and NA gene segments from a Eurasian adamantane resistant swine virus. NAI-resistance in the H1N1pdm viruses has been rare and is mainly limited to oseltamivir exposed patients. The pyrosequencing assay has been proven a useful tool in surveillance for drug resistance in seasonal influenza A viruses. METHOD: Here we provide a protocol which allows detection of adamantane resistance markers as well as the I43T change- which is unique to the H1N1pdm M2 protein. The protocol also allows detection of changes at residues V116, I117, E119, Q136, K150, D151, D199, I223, H275, and N295 in the NA, known to alter NAI drug susceptibility. RESULTS: We report here detection of the first cases of the oseltamivir resistance mutation H275Y and the change I223V in viruses from the US using the approach described in this study. Moreover, the assay permits a quick identification of the major NA group (V106/N248, I106/D248, or I106/N248) to which a pandemic virus belongs. CONCLUSIONS: pyrosequencing is well suited for detection of drug resistance markers and signature mutations in the M and NA of the pandemic H1N1 influenza viruses. |
Effect of carbon dioxide on broth microdilution susceptibility testing of Brucella spp
Lonsway DR , Jevitt LA , Uhl JR , Cockerill FR 3rd , Anderson ME , Sullivan MM , De BK , Edwards JR , Patel JB . J Clin Microbiol 2009 48 (3) 952-6 Since some strains of Brucella species may require carbon dioxide for growth, a multilaboratory study was conducted to compare broth microdilution susceptibility results using ambient air (AA) and 5% CO2 incubation conditions. Six antimicrobial agents were tested against 39 Brucella isolates. Aminoglycoside MICs tended to be 1 log2 dilution higher in CO2 than in AA; tetracycline-class MICs to be 1 log2 dilution lower in CO2. |
The highly virulent variola and monkeypox viruses express secreted inhibitors of type I interferon
Del Mar Fernandez de Marco M , Alejo A , Hudson P , Damon IK , Alcami A . FASEB J 2009 24 (5) 1479-88 Variola virus (VARV) caused smallpox, one of the most devastating human diseases and the first to be eradicated, but its deliberate release represents a dangerous threat. Virulent orthopoxviruses infecting humans, such as monkeypox virus (MPXV), could fill the niche left by smallpox eradication and the cessation of vaccination. However, immunomodulatory activities and virulence determinants of VARV and MPXV remain largely unexplored. We report the molecular characterization of the VARV- and MPXV-secreted type I interferon-binding proteins, which interact with the cell surface after secretion and prevent type I interferon responses. The proteins expressed in the baculovirus system have been purified, and their interferon-binding properties characterized by surface plasmon resonance. The ability of these proteins to inhibit a broad range of interferons was investigated to identify potential adaptation to the human immune system. Furthermore, we demonstrate by Western blot and activity assays the expression of the type I interferon inhibitor during VARV and MPXV infections. These findings are relevant for the design of new vaccines and therapeutics to smallpox and emergent virulent orthopoxviruses because the type I interferon-binding protein is a major virulence factor in animal models, vaccination with this protein induces protective immunity, and its neutralization prevents disease progression. |
Inhibition of neuraminidase inhibitor-resistant influenza virus by DAS181, a novel sialidase fusion protein
Triana-Baltzer GB , Gubareva LV , Klimov AI , Wurtman DF , Moss RB , Hedlund M , Larson JL , Belshe RB , Fang F . PLoS One 2009 4 (11) e7838 Antiviral drug resistance for influenza therapies remains a concern due to the high prevalence of H1N1 2009 seasonal influenza isolates which display H274Y associated oseltamivir-resistance. Furthermore, the emergence of novel H1N1 raises the potential that additional reassortments can occur, resulting in drug resistant virus. Thus, additional antiviral approaches are urgently needed. DAS181 (Fludase), a sialidase fusion protein, has been shown to have inhibitory activity against a large number of seasonal influenza strains and a highly pathogenic avian influenza (HPAI) strain (H5N1). Here, we examine the in vitro activity of DAS181 against a panel of 2009 oseltamivir-resistant seasonal H1N1 clinical isolates. The activity of DAS181 against nine 2009, two 2007, and two 2004 clinical isolates of seasonal IFV H1N1 was examined using plaque number reduction assay on MDCK cells. DAS181 strongly inhibited all tested isolates. EC50 values remained constant against isolates from 2004, 2007, and 2009, suggesting that there was no change in DAS181 sensitivity over time. As expected, all 2007 and 2009 isolates were resistant to oseltamivir, consistent with the identification of the H274Y mutation in the NA gene of all these isolates. Interestingly, several of the 2007 and 2009 isolates also exhibited reduced sensitivity to zanamivir, and accompanying HA mutations near the sialic acid binding site were observed. DAS181 inhibits IFV that is resistant to NAIs. Thus, DAS181 may offer an alternative therapeutic option for seasonal or pandemic IFVs that become resistant to currently available antiviral drugs. |
Inter-rater reliability of malaria parasite counts and comparison of methods
Bowers KM , Bell D , Chiodini PL , Barnwell J , Incardona S , Yen S , Luchavez J , Watt H . Malar J 2009 8 267 BACKGROUND: The introduction of artemesinin-based treatment for falciparum malaria has led to a shift away from symptom-based diagnosis. Diagnosis may be achieved by using rapid non-microscopic diagnostic tests (RDTs), of which there are many available. Light microscopy, however, has a central role in parasite identification and quantification and remains the main method of parasite-based diagnosis in clinic and hospital settings and is necessary for monitoring the accuracy of RDTs. The World Health Organization has prepared a proficiency testing panel containing a range of malaria-positive blood samples of known parasitaemia, to be used for the assessment of commercially available malaria RDTs. Different blood film and counting methods may be used for this purpose, which raises questions regarding accuracy and reproducibility. A comparison was made of the established methods for parasitaemia estimation to determine which would give the least inter-rater and inter-method variation METHODS: Experienced malaria microscopists counted asexual parasitaemia on different slides using three methods; the thin film method using the total erythrocyte count, the thick film method using the total white cell count and the Earle and Perez method. All the slides were stained using Giemsa pH 7.2. Analysis of variance (ANOVA) models were used to find the inter-rater reliability for the different methods. The paired t-test was used to assess any systematic bias between the two methods, and a regression analysis was used to see if there was a changing bias with parasite count level. RESULTS: The thin blood film gave parasite counts around 30% higher than those obtained by the thick film and Earle and Perez methods, but exhibited a loss of sensitivity with low parasitaemia. The thick film and Earle and Perez methods showed little or no bias in counts between the two methods, however, estimated inter-rater reliability was slightly better for the thick film method. CONCLUSION: The thin film method gave results closer to the true parasite count but is not feasible at a parasitaemia below 500 parasites per microlitre. The thick film method was both reproducible and practical for this project. The determination of malarial parasitaemia must be applied by skilled operators using standardized techniques. |
Cardiomyopathy and other myocardial disorders among hospitalizations for pregnancy in the United States: 2004-2006
Kuklina EV , Callaghan WM . Obstet Gynecol 2010 115 (1) 93-100 OBJECTIVES: To estimate the rate of pregnancy hospitalizations for women with two groups of myocardial disorders, cardiomyopathy and other myocardial disorders, and report the rate of severe obstetric complications among these hospitalizations in delivery and postpartum periods. METHODS: We performed a cross-sectional study using 14,323,731 hospitalizations for pregnancy identified from the 2004-2006 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. We reported rates of pregnancy hospitalizations with cardiomyopathy and other myocardial disorders per 1,000 deliveries and rates of severe complications per 1,000 hospitalizations during delivery and postpartum periods by myocardial disease status. We compared these rates by using chi2 tests with adjustment of P values for multiple comparisons using the Bonferroni method. RESULTS: Among all pregnancy hospitalizations, the overall prevalence of hospitalizations with myocardial disorders was 1.33 per 1,000 deliveries. The rate of pregnancy hospitalizations with cardiomyopathy was 0.46 per 1,000 deliveries (0.18 for apparent peripartum cardiomyopathy and 0.28 for other cardiomyopathies). The rate of pregnancy hospitalizations with other myocardial disorders was 0.87 per 1,000 deliveries. Myocardial disorders were rare during delivery hospitalizations (0.01%) but not uncommon among postpartum hospitalizations (4.2%). Among hospitalizations with myocardial disorders, the rate of severe complications ranged from 13.2 for acute myocardial infarction to 128.6 for adult respiratory distress syndrome and from 10.7 for pulmonary edema to 193.0 for fluid and electrolyte disorders per 1,000 delivery and postpartum hospitalizations, respectively. Among hospitalizations without myocardial disorders, the rate of severe complications ranged from 0.07 to 1.9 and from 0.4 to 65.5 for cardiac arrest and for fluid and electrolyte disorders per 1,000 hospitalizations, in delivery and postpartum periods, respectively. CONCLUSION: Although only a minority of hospitalizations for cardiomyopathy are consistent with peripartum cardiomyopathy, cardiomyopathy and other myocardial disorders are important contributors to severe obstetric complications. LEVEL OF EVIDENCE: III. |
Maternal caffeine intake during pregnancy and orofacial clefts
Collier SA , Browne ML , Rasmussen SA , Honein MA , National Birth Defects Prevention Study . Birth Defects Res A Clin Mol Teratol 2009 85 (10) 842-9 BACKGROUND: Moderate caffeine intake during pregnancy is common, but little is known about its potential association with birth defects. METHODS: The National Birth Defects Prevention Study is a population-based, case-control study of major birth defects, excluding infants with single-gene disorders and chromosomal abnormalities. This analysis includes infants with cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO), excluding infants whose cleft was secondary to holoprosencephaly or amniotic band sequence. Mothers reported dietary caffeine intake from coffee, tea, sodas, and chocolate in the year before pregnancy and reported intake of medications containing caffeine during pregnancy. We assessed the association between dietary caffeine intake, frequency of consuming each type of caffeinated beverage, medications containing caffeine, and CL/P or CPO among infants born from October 1997 through December 2004. RESULTS: This analysis included 1531 infants with CL/P, 813 infants with CPO, and 5711 infants with no major birth defects (controls). Examining dietary sources among control mothers, 11% reported consuming at least 300 mg of caffeine per day and 17% reported consuming less than 10 mg of caffeine per day; high consumption (>or=3 servings per day) was reported by 8% (coffee), 4% (tea), and 15% (sodas); medications containing at least 100 mg caffeine/dose were reported by less than 1%. Although some effect estimates were elevated for moderate caffeine intake from all beverages, estimates were closer to the null for high caffeine levels. Isolated CL/P was associated with use of medications containing at least 100 mg of caffeine per dose. CONCLUSIONS: Our data do not suggest an association between maternal dietary caffeine intake and orofacial clefts, but caffeine-containing medications merit further study. |
Perinatal systemic inflammatory response syndrome and retinopathy of prematurity
Sood BG , Madan A , Saha S , Schendel D , Thorsen P , Skogstrand K , Hougaard D , Shankaran S , Carlo W , NICHD Neonatal Research Network . Pediatr Res 2009 67 (4) 394-400 Fetal and neonatal inflammation is associated with several morbidities of prematurity. Its relationship to retinopathy of prematurity (ROP) has not been investigated. Our objective was to determine the relationship between cytokine levels and ROP in the first three postnatal weeks. Data for this study were derived from the NICHD Cytokine Study. Dried blood spots were obtained from infants <1000g on days 0-1, 3+/-1, 7+/-2, 14+/-3, and 21+/-3. Infants were classified into three groups -- No, Mild, and Severe ROP. Multiplex Luminex assay was used to quantify 20 cytokines. Temporal profiles of cytokines were evaluated using mixed effects models after controlling for covariates. Of 1074 infants enrolled, 890 were examined for ROP and 877 included in the analysis. ROP was associated with several clinical characteristics on unadjusted analyses. Eight cytokines remained significantly different across ROP groups in adjusted analyses. IL-6 and IL-17 showed significant effects in early time periods (D0-3); TGF-beta, brain derived neurotrophic factor (BDNF), and regulated upon activation, normal T cell expressed and secreted (RANTES) in later time periods (D7-21) and IL-18, C-reactive protein (CRP) and neurotrophin-4 (NT-4) in both early and later time periods. We conclude that perinatal inflammation may be involved in the pathogenesis of ROP. |
Herbal use before and during pregnancy
Broussard CS , Louik C , Honein MA , Mitchell AA , National Birth Defects Prevention Study . Am J Obstet Gynecol 2009 202 (5) 443 e1-6 OBJECTIVE: We estimated the prevalence and patterns of herbal use among US women before and during pregnancy. STUDY DESIGN: The National Birth Defects Prevention Study is an ongoing, population-based, case-control study. This analysis included 4239 women from 10 centers in the United States who delivered infants without major birth defects from 1998-2004. RESULTS: The prevalence of reported herbal use 3 months before or during pregnancy was 10.9%. During pregnancy, prevalence was 9.4% and was highest in the first trimester. Higher prevalence was associated with age greater than 30 years and education greater than 12 years. Use varied considerably by state (5-17%). Ginger and ephedra were the most commonly reported products early in pregnancy; teas and chamomile were most commonly reported throughout pregnancy. CONCLUSION: Potentially 395,000 US births annually involve antenatal exposure to herbal products. Health care providers should inquire routinely about herbal use and educate patients about what little is known regarding risks of these products. |
Identifying unreported and undiagnosed cases of congenital syphilis in Arizona using live birth and fetal death registries
Winscott M , Taylor MM , Kenney K . Sex Transm Dis 2009 37 (4) 244-7 To investigate the drop in reported congenital syphilis cases from 28 in 2005 to 16 in 2006, the Arizona infant registries were cross matched with reported syphilis test among women in the state STD database. Six previously unreported cases were identified; four live births and two still births. |
Increased risk of death among children with Lennox-Gastaut syndrome and infantile spasms
Autry AR , Trevathan E , Van Naarden Braun K , Yeargin-Allsopp M . J Child Neurol 2009 25 (4) 441-7 The magnitude and causes of death among a cohort of children with epilepsy were determined. A follow-up study with a population-based cohort of 10-year-old children in the metropolitan Atlanta area with epilepsy was conducted. The National Death Index and linkage to State of Georgia death certificates were used to identify deaths. The authors estimated the expected numbers of deaths by applying mortality rates adjusted by age, race, and sex for the entire state of Georgia to the population for the follow-up period. Among the 688 children who were in the final epilepsy cohort, 64 deaths occurred; 20.6 deaths were expected (mortality ratio adjusted for age, race, and sex = 3.11). The mortality ratios for children with Lennox-Gastaut syndrome and infantile spasms were 13.92 and 11.91, respectively. Children and adolescents with epilepsy, especially those with Lennox-Gastaut syndrome or infantile spasms, have an increased risk of death. |
Case records of the Massachusetts General Hospital. Case 40-2009. A 29-year-old man with fever and respiratory failure
Uyeki TM , Sharma A , Branda JA . N Engl J Med 2009 361 (26) 2558-69 Dr. Wilson Tak-Yu Kwong (Medicine): A 29-year-old man was admitted in July 2009 to the critical care unit of this hospital because of fever and respiratory failure. | The patient had been well until 9 days earlier, when a nonproductive cough and myalgias in his legs developed. One week before admission, he had a temperature of 39.4°C, associated with headache. During the next week, sore throat and nasal congestion developed, the cough became productive of clear sputum, and he noted mild chest pain under his ribs during inspiration. Four days before admission, he was seen at the emergency department of another hospital. He did not have neck pain or photophobia. He reported finding a tick on his scalp 1 month earlier. On examination, he appeared in mild distress. The temperature was 38.2°C and the pulse 106 beats per minute; the remainder of the examination was normal. A rapid test of a specimen from a buccal swab was negative for influenza A and B antigens, and no parasites were seen on a peripheral-blood smear; other test results are shown in Table 1. Acetaminophen, ketorolac, and ceftriaxone were administered, and normal saline was infused. Doxycycline was prescribed, and he was discharged. | The patient returned the next afternoon because of persistent fever, cough, myalgias, low back pain, and new scrotal pain. The temperature was 39.0°C, and the other vital signs were normal. There were rhonchi in the left lower lung field, and the remainder of the examination was normal. A test for Lyme disease, sent the day before, was negative. Other test results are shown in Table 1. A chest radiograph showed incomplete segmental consolidation of the apical posterior segment of the right upper lobe and right hilar prominence, features suggestive of pneumonia and lymphadenopathy, respectively. Levofloxacin was prescribed, and he was sent home. |
Continuing medical education challenges in chronic fatigue syndrome
Brimmer DJ , McCleary KK , Lupton TA , Faryna KM , Reeves WC . BMC Med Educ 2009 9 70 BACKGROUND: Chronic fatigue syndrome (CFS) affects at least 4 million people in the United States, yet only 16% of people with CFS have received a diagnosis or medical care for their illness. Educating health care professionals about the diagnosis and management of CFS may help to reduce population morbidity associated with CFS. METHODS: This report presents findings over a 5-year period from May 2000 to June 2006 during which we developed and implemented a health care professional educational program. The objective of the program was to distribute CFS continuing education materials to providers at professional conferences, offer online continuing education credits in different formats (e.g., print, video, and online), and evaluate the number of accreditation certificates awarded. RESULTS: We found that smaller conference size (OR = 80.17; 95% CI 8.80, 730.25), CFS illness related target audiences (OR = 36.0; 95% CI 2.94, 436.34), and conferences in which CFS research was highlighted (OR = 4.15; 95% CI 1.16, 14.83) significantly contributed to higher dissemination levels, as measured by visit rates to the education booth. While print and online courses were equally requested for continuing education credit opportunities, the online course resulted in 84% of the overall award certificates, compared to 14% for the print course. This remained consistent across all provider occupations: physicians, nurses, physician assistants, and allied health professionals. CONCLUSION: These findings suggest that educational programs promoting materials at conferences may increase dissemination efforts by targeting audiences, examining conference characteristics, and promoting online continuing education forums. |
Whole-body inhalation exposure to 1-bromopropane suppresses the IgM response to sheep red blood cells in female B6C3F1 mice and Fisher 344/N rats
Anderson SE , Munson AE , Butterworth LF , Germolec D , Morgan DL , Roycroft JA , Dill J , Meade BJ . Inhal Toxicol 2009 22 (2) 125-32 1-Bromopropane (1-BP) is categorized as a high-production-volume chemical and is currently used in the manufacture of pharmaceuticals, pesticides, and other chemicals. Its usage is estimated to be around 5 million pounds per year, resulting in the potential for widespread exposure in the workplace. Case reports and animal studies have suggested exposure to this compound may cause adverse reproductive and neurological effects. Using a battery of immunological assays, the immunotoxicity of 1-BP after whole body inhalation exposure in both mice and rats was evaluated. Significant decreases in the spleen immunoglobulin (Ig) M response to sheep red blood cells (SRBC) were observed in both mice (125-500 ppm) and rats (1000 ppm) after exposure to 1-BP for 10 wk. In addition, total spleen cells and T cells were significantly decreased after approximately 4 wk of 1-BP exposure in both mice (125-500 ppm) and rats (1000 ppm). No change in natural killer (NK) cell activity was observed. The observed alterations in spleen cellularity, phenotypic subsets, and impairment of humoral immune function across species raise further concern about human exposure to 1-BP and demonstrate the need for additional investigations into potential adverse health effects. |
A health hazard evaluation of antimony exposure in fire fighters
de Perio MA , Durgam S , Caldwell KL , Eisenberg J . J Occup Environ Med 2009 52 (1) 81-4 OBJECTIVES: Some firefighter station uniforms contain the flame-retardant, antimony trioxide. National Institute for Occupational Safety and Health investigated a possible outbreak of antimony toxicity wherein 30 firefighters reported elevated antimony levels on hair analyses. METHODS: We surveyed and collected urine samples from firefighters not wearing (Fire Department A) and wearing (Fire Department B) antimony-containing pants. Urine antimony concentrations were measured and adjusted for creatinine. RESULTS: All 20 participating firefighters from Fire Department A and 41 (97.6%) of 42 participating firefighters from Fire Department B had urine antimony concentrations below or within the national reference range. No differences in urine antimony levels between departments were detected. CONCLUSIONS: Wearing antimony-containing uniforms does not pose a risk for antimony toxicity. This investigation highlights the importance of using validated methods for toxicity determination and of accurate, timely risk communication. |
Promoting continuous use as a strategy for achieving adherence in a trial of the diaphragm with candidate microbicide
Penman-Aguilar A , Swezey T , Turner AN , Bell AJ , Ramiandrisoa FN , Legardy-Williams J , Randrianasolo B , Van Damme K , Dulyx J , Behets F , Jamieson DJ . AIDS Educ Prev 2009 21 (6) 512-25 Women need more choices for protection from HIV and other sexually transmitted infections (STIs). We conducted a randomized 4-week study in Madagascar in preparation for a Phase III randomized controlled trial (RCT) of the diaphragm with a candidate microbicide for STI prevention. All participants completed quantitative surveys; half participated in a qualitative interview. We advised women to wear the diaphragm at all times except for daily cleaning (rather than inserting it before intercourse). The objective of this analysis was to determine whether women who followed this "continuous use" approach more often used the diaphragm for 100% of sex acts as compared with other women. If so, this would support advising continuous diaphragm use in the upcoming RCT. To meet our objective, we analyzed qualitative data thematically, developed a measure of continuous diaphragm use based on qualitative data, and used multiple regression to evaluate the measure's association with adherence to diaphragm use during 100% of sex acts. Women who wore the diaphragm continuously had 4 times higher odds of reporting diaphragm use during 100% of sex acts (OR: 4.6, 95% CI: 1.2, 24.0). If the diaphragm proves effective against STI, continuous use may help women achieve high levels of protection. |
Safety of hormonal and intrauterine methods of contraception for women with HIV/AIDS: a systematic review
Curtis KM , Nanda K , Kapp N . AIDS 2009 23 S55-S67 OBJECTIVE: To determine from the literature whether HIV-infected women who use hormonal or intrauterine contraception are at increased risk of HIV disease progression, other adverse health outcomes, or HIV transmission to uninfected sexual partners. DESIGN: A systematic review. METHODS: We searched PubMed for articles published in peer-reviewed journals through August 2009 for evidence relevant to all hormonal and intrauterine contraceptive methods and HIV/AIDS. RESULTS: Eight observational studies reported no increased risk of HIV disease progression with hormonal or intrauterine contraceptive use, whereas one randomized controlled trial found increased risks of declining CD4 cell count and death for hormonal contraceptive users compared with intrauterine device users. Women with HIV who used hormonal contraception had increased risks of acquiring sexually transmitted infections compared with women not using hormonal contraception, similar to the risks reported among uninfected women. One study found no association between hormonal or intrauterine contraceptive use and increased risk of HIV transmission to uninfected partners, whereas findings from nine studies examining contraceptive use and viral shedding from the genital tract were inconsistent. CONCLUSIONS: Evidence regarding the safety of hormonal and intrauterine contraceptive use among women with HIV remains limited, but generally reassuring regarding adverse health effects, disease transmission to uninfected partners, and disease progression; however, one randomized trial raised concerns about enhanced disease progression among women using hormonal contraception. Preventing unintended pregnancy among women with HIV remains a high priority in public health, both for the health of the woman as well as for the prevention of mother-to-child transmission of HIV. |
Use of intrauterine devices in women with uterine anatomic abnormalities
Tepper NK , Zapata LB , Jamieson DJ , Curtis KM . Int J Gynaecol Obstet 2009 109 (1) 52-4 OBJECTIVE: To examine the evidence regarding the safety and effectiveness of intrauterine devices (IUDs) in women with uterine abnormalities. METHODS: We searched PubMed for all peer-reviewed articles in any language that had been published on the topic from database inception to September 2009. Primary research articles were included if they addressed the safety or effectiveness of any type of IUD among women with Mullerian anomalies or uterine synechiae. RESULTS: In total, 19 case reports or case series met the inclusion criteria. Reported complications included expulsion, pregnancy, bleeding, perforation, and pain. In several case reports, no complications were reported. CONCLUSION: Evidence concerning the safety and effectiveness of IUD use among women with uterine abnormalities is very limited. |
Estimation of the contribution of non-assisted reproductive technology ovulation stimulation fertility treatments to US singleton and multiple births
Schieve LA , Devine O , Boyle CA , Petrini JR , Warner L . Am J Epidemiol 2009 170 (11) 1396-407 Infertility treatments that include ovulation stimulation, both assisted reproductive technologies (ARTs) and non-ART ovulation stimulation, are associated with increased risks of multiple birth and concomitant sequelae and adverse outcomes, even among singletons. While a US surveillance system for ART-induced births is ongoing, no population-based tracking system exists for births resulting from non-ART treatments. The authors developed a multistage model to estimate the uncertain proportion of US infants born in 2005 who were conceived by using non-ART ovulation treatments. Using published surveillance data, they estimated proportions of US multiple births conceived naturally and by ART and assumed that the remainder were conceived with non-ART treatments. They used Bayesian meta-analyses to summarize published clinical studies on the multiple-gestation risk associated with non-ART ovulation treatments, applied a fetal survival factor, and used this multiple-birth risk estimate and their own estimate of the proportion of US multiple births attributable to non-ART ovulation stimulation to estimate the total (and, through subtraction, singleton) proportion of infants conceived with such treatments. On the basis of the model, the authors estimate that 4.6% of US infants born in 2005 (95% uncertainty range: 2.8%-7.1%) resulted from non-ART ovulation treatments. Notably, this figure is 4 times greater than the ART contribution. |
Health behaviors and quality of life of cancer survivors in Massachusetts, 2006: data use for comprehensive cancer control
Fairley TL , Hawk H , Pierre S . Prev Chronic Dis 2010 7 (1) A09 INTRODUCTION: Nearly 12 million cancer survivors are living in the United States. Few state-based studies have examined the health status and health-related quality of life (HRQOL) of this growing population. The objective of this study was to use Massachusetts Behavioral Risk Factor Surveillance System (BRFSS) data to describe cancer survivors' demographics, health behaviors, quality of life, use of preventive care services, and influenza vaccination rates. METHODS: The demographic characteristics of cancer survivors and respondents without cancer were estimated on the basis of responses to questions in the 2006 Massachusetts BRFSS. We used multivariate logistic regression to compare health behaviors, comorbidities, quality of life, and cancer screening and influenza vaccination rates for cancer survivors compared with respondents who did not have cancer. RESULTS: Cancer survivors and respondents who did not have cancer had similar rates of health behavioral risk factors including smoking, obesity, and physical activity. Rates of chronic disease (eg, heart disease, asthma) and disability were higher among cancer survivors. Cancer survivors reported higher rates of influenza vaccination and breast, colorectal, and cervical cancer screening than did respondents who did not have cancer. Survivors' self-reported health status and HRQOL (physical and mental health) improved as length of survivorship increased. CONCLUSION: This state-based survey allowed Massachusetts to assess health-related issues for resident cancer survivors. These findings will help state-based public health planners develop interventions to address the long-term physical and psychosocial consequences of cancer diagnosis and treatment. |
Trends in hospitalizations with psychiatric diagnoses among HIV-infected women in the USA, 1994-2004
Bansil P , Jamieson DJ , Posner SF , Kourtis AP . AIDS Care 2009 21 (11) 1432-8 Psychiatric illnesses commonly co-occur with HIV infection and such illnesses have been linked to women's poorer medication adherence and suicide. Using hospital discharge data from the 1994-2004 Nationwide Inpatient Sample, we conducted this study to describe hospitalizations with psychiatric diagnoses from 1994 through 2004 and evaluate the association of specific psychiatric disorders among hospitalized HIV-infected women in the USA with their lack of adherence to medical treatment and suicide attempt. Multivariable logistic regression analyses were used to examine trends in hospitalizations with psychiatric diagnoses among nonpregnant HIV-infected women and the association between specific disorders and women's lack of adherence to medical treatment and suicide attempt. Between 1994 and 2004, the estimated number of all hospitalizations among nonpregnant HIV-infected women increased by 8%, while the number of hospitalizations with a psychiatric diagnosis in this population increased by 73%. After adjusting for demographic factors and alcohol/substance abuse, we found that HIV-infected women were more likely to be hospitalized for mood (odds ratio (OR): 2.35; 95% confidence interval (CI): 1.93-2.88), anxiety (OR: 2.24, 95%CI: 1.74-2.88), and psychotic (OR: 1.45, 95%CI: 1.10-1.90) disorders in 2004 than in 1994. There was a significant association of alcohol/substance abuse with mood, adjustment, anxiety, personality, and psychotic disorders. Noncompliance with medical treatment was significantly associated with psychotic disorders, whereas suicide attempt/self-inflicted injury was significantly associated with mood, adjustment, anxiety, personality, and psychotic disorders. The number of hospitalizations with a psychiatric diagnosis among HIV-infected women in the USA has increased substantially. As HIV-infected women live longer, these results highlight the need for targeted public health interventions to address mental health issues in this population. |
Does mental health history explain gender disparities in insomnia symptoms among young adults?
Hale L , Do DP , Basurto-Davila R , Heron M , Finch BK , Dubowitz T , Lurie N , Bird CE . Sleep Med 2009 10 (10) 1118-23 BACKGROUND: Insomnia is the most commonly reported sleep disorder, characterized by trouble falling asleep, staying asleep, or waking up too early. Previous epidemiological data reveal that women are more likely than men to suffer from insomnia symptoms. We investigate the role that mental health history plays in explaining the gender disparity in insomnia symptoms. METHODS: Using logistic regression, we analyze National Health and Nutritional Examination Survey (NHANES) III interview and laboratory data, merged with data on sociodemographic characteristics of the residential census tract of respondents. Our sample includes 5469 young adults (ages 20-39) from 1429 census tracts. RESULTS: Consistent with previous research, we find that women are more likely to report insomnia symptoms compared to men (16.7% vs. 9.2%). However, in contrast to previous work, we show that the difference between women's and men's odds of insomnia becomes statistically insignificant after adjusting for history of mental health conditions (OR=1.08, p>.05). CONCLUSIONS: The gender disparity in insomnia symptoms may be driven by higher prevalence of affective disorders among women. This finding has implications for clinical treatment of both insomnia and depression, especially among women. |
Cognitive attributions for smoking among adolescents in China
Guo Q , Unger JB , Azen SP , Li C , Spruijt-Metz D , Palmer PH , Chou CP , Lee L , Sun P , Johnson CA . Addict Behav 2010 35 (2) 95-101 To design more effective health communication messages for smoking cessation and prevention, it is important to understand people's own perceptions of the factors that influence their decisions to smoke. Studies have examined cognitive attributions for smoking in Western countries but not in the Chinese cultural context. In a study of 14,434 Chinese adolescents, exploratory factor analysis grouped 17 cognitive attributions into 8 factors: curiosity, coping, social image, social belonging, engagement, autonomy, mental enhancement, and weight control. The factors were ranked based on the participants' self-reports of importance and by the strength of their associations with smoking behavior. Among all smokers, curiosity was the most frequently-ranked attribution factor at the early stages of smoking but not for daily smoking. Coping was highly-ranked across smoking stages. Social image and social belonging were more highly-ranked at earlier stages, whereas engagement and mental enhancement were ranked more highly at later stages of smoking. More attributions were associated with smoking among males than among females. This information could be useful for the development of evidence-based anti-smoking programs in China. |
Annual summary of vital statistics: 2007
Heron M , Sutton PD , Xu J , Ventura SJ , Strobino DM , Guyer B . Pediatrics 2009 125 (1) 4-15 The number of births in the United States increased between 2006 and 2007 (preliminary estimate of 4317119) and is the highest ever recorded. Birth rates increased among all age groups (15 to 44 years); the increase among teenagers is contrary to a long-term pattern of decline during 1991-2005. The total fertility rate increased 1% in 2007 to 2122.5 births per 1000 women. This rate was above replacement level for the second consecutive year. The proportion of all births to unmarried women increased to 39.7% in 2007, up from 38.5% in 2006, with increases noted for all race and Hispanic-origin groups and within each age group of 15 years and older. In 2007, 31.8% of all births occurred by cesarean delivery, up 2% from 2006. Increases in cesarean delivery were noted for most age groups and for non-Hispanic white, non-Hispanic black, and Hispanic women. Multiple-birth rates, which rose rapidly over the last several decades, did not increase during 2005-2006. The 2007 preterm birth rate was 12.7%, a decline of 1% from 2006. The low-birth-weight rate also declined in 2007 to 8.2%. The infant mortality rate was 6.77 infant deaths per 1000 live births in 2007, which is not significantly different from the 2006 rate. Non-Hispanic black infants continued to have much higher rates than non-Hispanic white and Hispanic infants. States in the southeastern United States had the highest infant and fetal mortality rates. The United States continues to rank poorly in international comparisons of infant mortality. Life expectancy at birth reached a record high of 77.9 years in 2007. Crude death rates for children aged 1 to 19 years decreased by 2.5% between 2006 and 2007. Unintentional injuries and homicide were the first and second leading causes of death, respectively, accounting for 53.7% of all deaths to children and adolescents in 2007. |
Death in the United States, 2007
Minino AM , Xu J , Kochanek KD , Tejada-Vera B . NCHS Data Brief 2009 (26) 1-8 KEY FINDINGS: Data from the National Vital Statistics System, Mortality In 2007, the age-adjusted death rate for the United States reached a record low of 760.3 per 100,000 population. Life expectancy at birth reached a record high of 77.9 years. States in the southeast region have higher death rates than those in other regions of the country. In 2007, the five leading causes of death were heart disease, cancer, stroke, chronic lower respiratory diseases, and accidents. These accounted for over 64 percent of all deaths in the United States. White females have the longest life expectancy (80.7 years), followed by black females (77.0 years). The gap in life expectancy between white persons and black persons declined by 35 percent between 1989 and 2007. The race differential was 4.6 years in 2007. |
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