Tourette syndrome, parenting aggravation, and the contribution of co-occurring conditions among a nationally representative sample
Robinson LR , Bitsko RH , Schieve LA , Visser SN . Disabil Health J 2013 6 (1) 26-35 BACKGROUND: Previous research suggests that parents of a child with Tourette Syndrome (TS) have lower self-concepts, higher caregiver burden, and more difficulties with home activities. However, the contributions of TS and mental, emotional, or behavioral (MEB) conditions to family functioning are difficult to identify from previous research due to relatively small TS sample sizes and high rates of co-occurring conditions within samples of children with TS. OBJECTIVE: The current study hypothesized that families of children with TS would report significantly more family functioning difficulties (more parenting aggravation, more difficulty with coping with the child's care, less parent-child communication, and less consistent family routines). Specifically, co-occurring conditions would contribute substantially to reported parenting aggravation. METHOD: Parent-reported data from the 2007 National Survey of Children's Health were analyzed, including whether the child had been diagnosed with TS or an MEB. Weighted analyses were restricted to US children 6-17 years of age (n = 64,034) and adjusted for child age, sex, race and ethnicity. RESULTS: Parents of children with TS were more likely to fall into the high parenting aggravation index category compared with parents of children without TS (aPR = 3.8, 95% CI: 2.2-6.6). Controlling for the co-occurring MEB conditions attenuated the relations between TS and parenting aggravation; however, a significant effect for TS remained in some cases. CONCLUSION: Parents of children with TS may face significant challenges in raising their children, leading to increased parenting aggravation; these challenges appear to be primarily associated with the presence of co-occurring MEB conditions. |
Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis
Flegal KM , Kit BK , Orpana H , Graubard BI . JAMA 2013 309 (1) 71-82 IMPORTANCE: Estimates of the relative mortality risks associated with normal weight, overweight, and obesity may help to inform decision making in the clinical setting. OBJECTIVE: To perform a systematic review of reported hazard ratios (HRs) of all-cause mortality for overweight and obesity relative to normal weight in the general population. DATA SOURCES: PubMed and EMBASE electronic databases were searched through September 30, 2012, without language restrictions. STUDY SELECTION: Articles that reported HRs for all-cause mortality using standard body mass index (BMI) categories from prospective studies of general populations of adults were selected by consensus among multiple reviewers. Studies were excluded that used nonstandard categories or that were limited to adolescents or to those with specific medical conditions or to those undergoing specific procedures. PubMed searches yielded 7034 articles, of which 141 (2.0%) were eligible. An EMBASE search yielded 2 additional articles. After eliminating overlap, 97 studies were retained for analysis, providing a combined sample size of more than 2.88 million individuals and more than 270,000 deaths. DATA EXTRACTION: Data were extracted by 1 reviewer and then reviewed by 3 independent reviewers. We selected the most complex model available for the full sample and used a variety of sensitivity analyses to address issues of possible overadjustment (adjusted for factors in causal pathway) or underadjustment (not adjusted for at least age, sex, and smoking). RESULTS: Random-effects summary all-cause mortality HRs for overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5-<25). The summary HRs were 0.94 (95% CI, 0.91-0.96) for overweight, 1.18 (95% CI, 1.12-1.25) for obesity (all grades combined), 0.95 (95% CI, 0.88-1.01) for grade 1 obesity, and 1.29 (95% CI, 1.18-1.41) for grades 2 and 3 obesity. These findings persisted when limited to studies with measured weight and height that were considered to be adequately adjusted. The HRs tended to be higher when weight and height were self-reported rather than measured. CONCLUSIONS AND RELEVANCE: Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons. |
The association of obesity and school absenteeism attributed to illness or injury among adolescents in the United States, 2009
Pan L , Sherry B , Park S , Blanck HM . J Adolesc Health 2013 52 (1) 64-9 PURPOSE: School attendance can impact academic performance. Childhood obesity-related physical and psychosocial consequences are potentially associated with school absenteeism. Thus, we examined the association between school absenteeism attributed to illness or injury and obesity among adolescents aged 12-17 years. METHODS: We used a weighted sample of 3,470 U.S. adolescents from the 2009 National Health Interview Survey. School absenteeism was measured from the parent-reported number of sick days taken in the preceding 12 months. Body mass index was calculated from parent-reported weight and height. Weight status was classified based on the sex-specific body mass index-for-age percentile defined by the CDC growth charts. Poisson regression was conducted to examine the association between school absenteeism and weight status, controlling for selected sociodemographic characteristics and disease status. RESULTS: The mean number of annual sick days was 3.9 days overall; 3.4 days among normal-weight, 4.4 days among overweight, and 4.5 days among obese adolescents. Obese adolescents had a higher proportion of missing ≥4 days of school per year than adolescents of normal weight. Our multivariate analyses found that compared with adolescents of normal weight, overweight and obese adolescents had greater than one-third more sick days annually (rate ratio = 1.36 for overweight and 1.37 for obese adolescents). CONCLUSIONS: Overweight and obese adolescents had 36% and 37% more sick days, respectively, than adolescents of normal weight. The results suggest another potential aspect of obesity prevention and reduction efforts among children and families is to improve children's school attendance. |
Recent trends in prostate cancer incidence by age, cancer stage, and grade, the United States, 2001-2007
Li J , Djenaba JA , Soman A , Rim SH , Master VA . Prostate Cancer 2012 2012 691380 OBJECTIVE: To examine prostate cancer trends by demographic and tumor characteristics because a comprehensive examination of recent prostate cancer incidence rates is lacking. PATIENTS AND METHODS: We described prostate cancer incidence rates and trends using the 2001-2007 National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program data (representing over 93% of US population). Because of coding changes in cancer grade, we restricted analysis to 2004-2007. We conducted descriptive and trend analyses using SEER *Stat. RESULTS: The overall prostate cancer incidence rate was stable from 2001 to 2007; however, rates significantly increased among men aged 40-49 years (APC = 3.0) and decreased among men aged 70-79 years (APC = 2.3), and 80 years or older (APC = -4.4). About 42% of localized prostate cancers diagnosed from 2004 to 2007 were poorly differentiated. The incidence of poorly differentiated cancer significantly increased among localized (APC = 8.0) and regional stage (APC = 6.1) prostate cancers during 2004-2007. CONCLUSIONS: The recent trend in prostate cancer incidence was stable but varied dramatically by age. Given the large proportion of poorly differentiated disease among localized prostate cancers and its increasing trend in more recent years, continued monitoring of prostate cancer incidence and trends by demographic and tumor characteristics is warranted. |
Status of cardiovascular health among adult Americans in the 50 states and the District of Columbia, 2009
Fang J , Yang Q , Hong Y , Loustalot F . J Am Heart Assoc 2012 BACKGROUND: With ideal cardiovascular health metrics, the American Heart Association established a goal of improving cardiovascular health for all Americans by 20% by 2020. Determining how the metrics vary by state is important to the individual states as well as to researchers and policy makers nationwide. METHODS AND RESULTS: Using 2009 data from Behavioral Risk Factor Surveillance System, a state-based telephone survey with 356 441 eligible participants, we examined the 7 metrics defined by the American Heart Association: hypertension, high cholesterol, smoking, body mass index, diabetes, physical activity, and consumption of fruits and vegetables. The 3 primary outcomes of this study were (1) the percentage of the population achieving ideal health status on all 7 factors, (2) the percentage of the population with only 0 to 2 of the 7 metrics (poor cardiovascular health); and (3) the mean overall score (number of ideal metrics). Overall, 3.3% of population was in ideal cardiovascular health, and 9.9% was in poor cardiovascular health. The mean overall score was 4.42. The percentage with ideal cardiovascular health varied from 1.2% (Oklahoma) to 6.9% (District of Columbia ). The adjusted prevalence ratio of ideal cardiovascular health ranged from 0.38, 95% confidence interval 0.29 to 0.52 (Oklahoma), to 1.91, 95% confidence interval 1.51 to 2.42 (District of Columbia), with Illinois as the referent. CONCLUSIONS: In the United States, the cardiovascular health status of the population varies substantially by state. The estimates here could help state programs charged with preventing heart disease and stroke to set their goals for reducing risk and improving cardiovascular health in their jurisdictions. |
Trends in the prevalence of extreme obesity among US preschool-aged children living in low-income families, 1998-2010
Pan L , Blanck HM , Sherry B , Dalenius K , Grummer-Strawn LM . JAMA 2012 308 (24) 2563-5 Obesity and extreme obesity in childhood, which are more prevalent among minority and low-income families, have been associated with other cardiovascular risk factors, increased health care costs, and premature death.1,2 Obesity and extreme obesity during early childhood are likely to continue into adulthood.3 Understanding trends in extreme obesity is important because the prevalence of cardiovascular risk factors increases with severity of childhood obesity.2 However, national trends in extreme obesity among young children living in low-income families are unknown. |
VZV ischemic optic neuropathy and subclinical temporal artery infection without rash
Nagel MA , Russman AN , Feit H , Traktinskiy I , Khmeleva N , Schmid DS , Skarf B , Gilden D . Neurology 2012 80 (2) 220-2 A 75-year-old woman developed periorbital pain and blurred vision OS. Visual acuity (VA) was 20/40 OD, 20/400 OS with mild left relative afferent pupillary defect (APD). Left optic nerve was swollen and hyperemic with peripapillary flame hemorrhages (figure, A). Erythrocyte sedimentation rate (ESR) was 124 mm/h. She was treated with IV methylprednisolone, 250 mg every 6 h. On day 3, headache and vision improved. ESR was 98 mm/h and C-reactive protein was 1.40 mg/L. Rheumatoid factor, antinuclear antibodies, and antineutrophil cytoplasmic antibodies titers were negative. On day 4, left temporal artery biopsy revealed thickened intima and intact internal elastic lamina (figure, B) but no medial necrosis characteristic of giant cell arteritis (GCA). Sections of the temporal artery were deparaffinized and incubated with 10% normal sheep serum (NSS) in phosphate-buffered saline (PBS) for 1 hour at room temperature, rinsed 3 times in PBS, and incubated overnight at 4 degrees C with polyclonal antibodies raised against the varicella-zoster virus (VZV) open reading frame 63 protein (1:1,000 dilution) or with normal rabbit serum (1:1,000 dilution). The next day, sections were washed 3 times in PBS, incubated with a 1:300 dilution of biotinylated goat antirabbit immunoglobulin G (IgG) in PBS containing 5% NSS, washed 3 times in PBS, incubated for 1 hour at room temperature with alkaline phosphatase-conjugated streptavidin (1:100 dilution), and washed 3 times with PBS. The color reaction was developed for 5-30 minutes with fresh fuchsin substrate system. Levamisole was added to the color reaction to block endogenous phosphatase. Uninfected and VZV-infected human fibroblast lung cells were used as controls (not shown). Steroids were changed to oral prednisone 60 mg daily. On day 7, brain MRI with gadolinium was negative. On day 9, pain and vision worsened. On day 11, orbital CT and head CT angiography were negative. On day 15, VA was 20/400 OS with relative left APD. On day 17, OS became blind without direct pupillary light reaction; fundus was obscured by vitreous hemorrhage. CSF contained 8 leukocytes/mm(3), protein 72 mg/L, and glucose 54 mg/L. CSF cultures for bacteria, fungi, acid-fast bacilli, and cytology were negative. Because asymptomatic temporal artery biopsy was GCA-negative, VZV ischemic optic neuropathy (ION) was considered, and she was treated with IV acyclovir, 10 mg/kg every 8 hours for 7 days. On day 31, CSF contained anti-VZV IgG but not anti-herpes simplex virus IgG antibody, and serum-to-CSF ratio of anti-VZV IgG was reduced (14) compared to ratios for total IgG (121) and albumin (81). Immunohistochemistry and pathology revealed VZV antigen and neutrophils in the original left temporal artery specimen (figure, C). On day 31, she was treated with oral valacyclovir, 1 gram TID for 6 weeks; prednisone was reduced to 20 mg daily and tapered 5 mg/week. Six weeks later, pain resolved, and VA improved to finger counting. Left optic nerve was pale with clear margins and resolution of hemorrhage. |
Estimating disability prevalence among adults by body mass index: 2003-2009 National Health Interview Survey
Armour BS , Courtney-Long E , Campbell VA , Wethington HR . Prev Chronic Dis 2012 9 E178 INTRODUCTION: Obesity is associated with adverse health outcomes in people with and without disabilities; however, little is known about disability prevalence among people who are obese. The purpose of this study was to determine the prevalence and type of disability among obese adults in the United States. METHODS: We analyzed pooled data from sample adult modules of the 2003-2009 National Health Interview Survey (NHIS) to obtain national prevalence estimates of disability, disability type, and obesity by using 30 questions that screened for activity limitations, vision and hearing impairment, and cognitive, movement, and emotional difficulties. We stratified disability prevalence by category of body mass index (BMI, measured as kg/m(2)): underweight, less than 18.5; normal weight, 18.5 to 24.9; overweight, 25.0 to 29.9; and obese, 30.0 or higher. RESULTS: Among the 25.3% of adult men and 24.6% of women in our pooled sample who were obese, 35.2% and 46.9%, respectively, reported a disability. In contrast, 26.7% of men and 26.8% women of normal weight reported a disability. Disability was much higher among obese women than among obese men (46.9% vs 35.2%, P < .001). Movement difficulties were the most common disabilities among obese men and women, affecting 25.3% of men and 37.9% of women. CONCLUSION: This research contributes to the literature on obesity by including disability as a demographic in characterizing people by body mass index. Because of the high prevalence of disability among those who are obese, public health programs should consider the needs of those with disabilities when designing obesity prevention and treatment programs. |
Heart disease and stroke statistics--2013 update. A report from the American Heart Association
Go AS , Mozaffarian D , Roger VL , Benjamin EJ , Berry JD , Borden WB , Bravata DM , Dai S , Ford ES , Fox CS , Franco S , Fullerton HJ , Gillespie C , Hailpern SM , Heit JA , Howard VJ , Huffman MD , Kissela BM , Kittner SJ , Lackland DT , Lichtman JH , Lisabeth LD , Magid D , Marcus GM , Marelli A , Matchar DB , McGuire DK , Mohler ER , Moy CS , Mussolino ME , Nichol G , Paynter NP , Schreiner PJ , Sorlie PD , Stein J , Turan TN , Virani SS , Wong ND , Woo D , Turner MB . Circulation 2012 127 (1) e6-e245 Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best national data available on heart disease, stroke, and other cardiovascular disease–related morbidity and mortality and the risks, quality of care, medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited >10 500 times in the literature, based on citations of all annual versions. In 2011 alone, the various Statistical Updates were cited ≈1500 times (data from ISI Web of Science). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas, as well as increasing the number of ways to access and use the information assembled. | For this year’s edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year. This year’s edition also implements a new chapter organization to reflect the spectrum of cardiovascular health behaviors and health factors and risks, as well as subsequent complicating conditions, disease states, and outcomes. Also, the 2013 Statistical Update contains new data on the monitoring and benefits of cardiovascular health in the population, with additional new focus on evidence-based approaches to changing behaviors, implementation strategies, and implications of the AHA’s 2020 Impact Goals. Below are a few highlights from this year’s Update. |
Invasive cervical cancer risk among HIV-infected women: a North American multi-cohort collaboration prospective study
Abraham AG , Strickler HD , Jing Y , Gange SJ , Sterling TR , Silverberg M , Saag M , Rourke S , Rachlis A , Napravnik S , Moore RD , Klein M , Kitahata M , Kirk G , Hogg R , Hessol NA , Goedert JJ , Gill MJ , Gebo K , Eron JJ , Engels EA , Dubrow R , Crane HM , Brooks JT , Bosch R , D'Souza G . J Acquir Immune Defic Syndr 2012 62 (4) 405-13 OBJECTIVE: HIV infection and low CD4+ T-cell count are associated with an increased risk of persistent oncogenic HPV infection - the major risk factor for cervical cancer. Few reported prospective cohort studies have characterized the incidence of invasive cervical cancer (ICC) in HIV-infected women. METHODS: Data were obtained from HIV-infected and -uninfected female participants in the NA-ACCORD with no history of ICC at enrollment. Participants were followed from study entry or January, 1996 through ICC, loss-to follow-up or December, 2010. The relationship of HIV infection and CD4+ T-cell count with risk of ICC was assessed using age-adjusted Poisson regression models and standardized incidence ratios (SIR). All cases were confirmed by cancer registry records and/or pathology reports. Cervical cytology screening history was assessed through medical record abstraction. RESULTS: A total of 13,690 HIV-infected and 12,021 HIV-uninfected women contributed 66,249 and 70,815 person-years (pys) of observation, respectively. Incident ICC was diagnosed in 17 HIV-infected and 4 HIV-uninfected women (incidence rate of 26 and 6 per 100,000 pys, respectively). HIV-infected women with baseline CD4+ T-cells of ≥350, 200-349 and <200 cells/uL had a 2.3-times, 3.0-times and 7.7-times increase in ICC incidence, respectively, compared with HIV-uninfected women (P(trend) =0.001). Of the 17 HIV-infected cases, medical records for the 5 years prior to diagnosis showed that 6 had no documented screening, 5 had screening with low grade or normal results, and 6 had high-grade results. CONCLUSIONS: This study found elevated incidence of ICC in HIV-infected compared to -uninfected women, and these rates increased with immunosuppression. |
Combined effect of lung function level and decline increases morbidity and mortality risks
Baughman P , Marott JL , Lange P , Martin CJ , Shankar A , Petsonk EL , Hnizdo E . Eur J Epidemiol 2012 27 (12) 933-43 Lung function level and decline are each predictive of morbidity and mortality. Evaluation of the combined effect of these measurements may help further identify high-risk groups. Using Copenhagen City Heart Study longitudinal spirometry data (n = 10,457), 16-21 year risks of chronic obstructive pulmonary disease (COPD) morbidity, COPD or coronary heart disease mortality, and all-cause mortality were estimated from combined effects of level and decline in forced expiratory volume in one second (FEV(1)). Risks were evaluated using Cox proportional hazards models for individuals grouped by combinations of baseline predicted FEV(1) and quartiles of slope. Hazard ratios (HR) and 95 % confidence intervals (CI) were estimated using stratified analysis by gender, smoking status, and baseline age (≤45 and >45). For COPD morbidity, quartiles of increasing FEV(1) decline increased HRs (95 % CI) for individuals with FEV(1) at or above the lower limit of normal (LLN) but below 100 % predicted, reaching 5.11 (2.58-10.13) for males, 11.63 (4.75-28.46) for females, and 3.09 (0.88-10.86) for never smokers in the quartile of steepest decline. Significant increasing trends were also observed for mortality and in individuals with a baseline age ≤45. Groups with 'normal' lung function (FEV(1) at or above the LLN) but excessive declines (fourth quartile of FEV(1) slope) had significantly increased mortality risks, including never smokers and individuals with a baseline age ≤45. |
Commentary on the State-of-the-Science Conference on the Role of Active Surveillance in the Management of Men With Localized Prostate Cancer
Hall IJ , Richardson LC . J Natl Cancer Inst Monogr 2012 2012 (45) 135-9 The Centers for Disease Control and Prevention, in collaboration with the partners and experts within the cancer community, is pleased to support this monograph, which summarizes the state of the scientific evidence and current research from experts on issues surrounding active surveillance and document opportunities for future research to optimize its use as a treatment strategy for men with localized prostate cancer. | The American Cancer Society estimates that greater than 240000 cases will be diagnosed this year (1). Prostate-specific antigen (PSA) testing has changed the presentation of prostate cancer diagnoses over time; contemporary PSA testing practices have led to more men being diagnosed with early-stage prostate cancer (2). An estimated 90% of all prostate cancers are discovered in the local or regional stages and have a 5-year relative survival rate approaching 100% (1). Despite the high probability of survival, about 90% of men diagnosed with prostate cancer undergo definitive therapy with curative intent (3,4), unnecessarily risking side effects and complications of treatment (5), including death. A large proportion of these men could possibly benefit from observational strategies and delayed treatment. |
"Testing-only" visits: an assessment of missed diagnoses in clients attending sexually transmitted disease clinics
Xu F , Stoner BP , Taylor SN , Mena L , Martin DH , Powell S , Markowitz LE . Sex Transm Dis 2013 40 (1) 64-9 BACKGROUND: At sexually transmitted disease (STD) clinics, advances in testing technology coupled with increasing demands and diminishing resources have promoted the use of testing-only visits (clinic visits with testing for STDs but no full examination) to meet increasing demands for STD services. OBJECTIVES: The aims of the present study were to estimate the prevalence of STD diagnoses that could become "missed diagnoses" if patients would use testing-only visits and to examine patient characteristics associated with these potential missed diagnoses. METHODS: We conducted a self-administered survey of STD-related symptoms and sexual risk behaviors in patients seeking routine clinical care at 3 STD clinics. Medical charts were abstracted to estimate the prevalence of viral STDs, trichomoniasis, and other diagnoses from standard clinical services that could become missed diagnoses. RESULTS: Of 2582 patients included, the median age was 24 years and 50% were women. In women, overall, 3.2% were diagnosed as having a viral STD; 9.6%, trichomoniasis; and 41.0%, vulvovaginal candidiasis or symptomatic bacterial vaginosis. The prevalence of these potential missed diagnoses varied by patient characteristics, but in women who reported no symptoms, the prevalence of trichomoniasis was still 6.3%. In men, 19.3% received a diagnosis of urethritis but tested negative for both gonorrhea and chlamydia; this prevalence varied from 15.7% in those who reported no symptoms to 32.6% in those who reported malodor. CONCLUSIONS: A high proportion of STD clients received diagnoses from standard care visits that would be missed by testing-only visits. When patients, even those asymptomatic, use testing-only visits, missed diagnoses of STDs or related genital tract conditions can be substantial. The potential disadvantages of testing-only visits should be weighed against the advantages of such visits. |
Lower respiratory tract hemorrhage associated with 2009 pandemic influenza A (H1N1) virus infection
Kennedy ED , Roy M , Norris J , Fry AM , Kanzaria M , Blau DM , Shieh WJ , Zaki SR , Waller K , Kamimoto L , Finelli L , Jhung MA . Influenza Other Respir Viruses 2013 7 (5) 761-5 BACKGROUND: Influenza-associated lower respiratory tract hemorrhage (LRTH) has been reported in previous pandemics and is a rare complication of seasonal influenza virus infection. We describe patients with LRTH associated with 2009 pandemic influenza A (H1N1) (pH1N1) virus infection identified from April 2009 to April 2010 in the United States. METHODS: We ascertained patients with pH1N1-associated LRTH through state and local surveillance, the Emerging Infections Program, and CDCs Infectious Diseases Pathology Branch. All patients had influenza A, evidence of pneumonia, and evidence of LRTH. Results We identified 44 cases; the median number of days from illness onset to clinical signs of LRTH was one. Hemoptysis or respiratory tract bleeding was documented in 40% of pH1N1-associated LRTH cases, often present early during the course of illness. Twenty-one (48%) patients with LRTH had no other hemorrhagic diatheses. Seven (23%) patients with LRTH received antiviral treatment within two days of illness onset. CONCLUSIONS: During influenza season, clinicians should consider influenza infection in the differential diagnosis for patients presenting with hemoptysis or other signs or symptoms of LRTH. While the impact of timing of antiviral therapy on this complication has not been studied, the rapid progression of LRTH may support use of early empiric therapy. Continued investigation is necessary to better define the clinical spectrum of both seasonal influenza- and pH1N1-associated LRTH. |
New in the Journal: "The Real World of STD Prevention"
Rietmeijer CA , Aral SO , Blanchard JF , Schachter J . Sex Transm Dis 2013 40 (1) 1-2 A traditional view holds that the medical and public health work environment changes as a result of the adoption of best practices that, in turn, are based on scientific research. However, this linear and one-way paradigm of translating science into practice is far too limited. As we increasingly appreciate, sexually transmitted disease (STD) clinical and prevention practice is shaped by a number of forces other than science alone: feasibility, acceptability, yield, cost, available resources, and the interest and enthusiasm of the work force to continuously improve quality and innovate in the face of reduced funding. All determine the ultimate translation and effectiveness of scientific evidence and best-practice guidelines into the real world of STD prevention and thus their impact on public health. | “The Real World of STD Prevention,” therefore, seems an appropriate title for a new section in Sexually Transmitted Diseases that provides an editorial framework for articles focusing on STD clinical and prevention practice and the science-to-program interface. This section, a collaborative effort between the journal and STD Prevention Online, aims to address this 2-way exchange by publishing “downstream” evaluations and reports of the translation and implementation of guidelines and research findings into the practice setting, as well as the “upstream” description and evaluation of innovations developed at the individual practice site. The primary audience for these publications comprises STD clinical and prevention practitioners including clinicians, disease intervention specialists, prevention workers, program administrators, and those involved with training the STD prevention workforce. |
A proposed framework to monitor daily oral antiretroviral pre-exposure prophylaxis in the U.S.
Smith DK , Beltrami J . Am J Prev Med 2013 44 S141-6 Safety and substantial efficacy have now been proven for daily antiretroviral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF) in combination with emtricitabine (FTC) for HIV-uninfected men who have sex with men (MSM)1 as well as heterosexual men and women.2, 3 MSM and heterosexuals (who do not inject drugs) comprised 88% of the estimated new HIV infections in the U.S. in 2009 and have evident need for additional prevention methods to substantially lower the incidence of HIV infections.4 | A comprehensive national surveillance system exists for monitoring the diagnosis, treatment, and health effects of HIV infection.5, 6 Periodic multi-city surveys monitor HIV risk and protective behaviors in key transmission risk groups.7 An additional national program-monitoring and evaluation system assesses elements of HIV testing,8 behavioral,9 and structural prevention programs as delivered by community-based organizations and health departments funded by the CDC. |
Introducing wicked issues for HIV pre-exposure prophylaxis implementation in the U.S
Smith DK , Dearing JW , Sanchez T , Goldschmidt RH . Am J Prev Med 2013 44 S59-62 Following U.S. Food and Drug Administration approval and the issuance of interim guidance documents for oral antiretroviral pre-exposure prophylaxis (PrEP) use in the U.S., there is urgent need to begin addressing the complex, multi-stakeholder, and rapidly evolving (i.e., “wicked”) issues posed for the safe, effective, and appropriately targeted use of PrEP for prevention of the sexual acquisition of HIV infection. In this supplement1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 to the American Journal of Preventive Medicine, a series of articles is presented from diverse research and implementation disciplines to explore key issues and identify conceptual frameworks, practice models, resources, and experiences to advance the discussion of how best to introduce, disseminate, and evaluate PrEP as a new component of HIV prevention services in the U.S. | Recent clinical trials of daily oral antiretroviral PrEP have offered evidence of safety and the potential for substantial efficacy of this clinical approach to HIV prevention. Yet even before trial results were available, important questions were being raised about how, if PrEP were to be made available and implemented domestically19 and globally,20 that would best be done. Answers to dissemination and implementation questions are increasingly important as a range of partners with a stake in HIV prevention services consider how best to deliver and evaluate the impact of PrEP for individuals and populations at highest risk of HIV infection in the U.S. |
Reframing the context of preventive health care services and prevention of HIV and other sexually transmitted infections for young men: new opportunities to reduce racial/ethnic sexual health disparities
Lanier Y , Sutton MY . Am J Public Health 2012 103 (2) 262-9 Young Black males, aged 13 to 29 years, have the highest annual rates of HIV infections in the United States. Young Black men who have sex with men (MSM) are the only subgroup with significant increases in HIV incident infections in recent years. Black men, particularly MSM, are also disproportionately affected by other sexually transmitted infections (STIs). Therefore, we must strengthen HIV and STI prevention opportunities during routine, preventive health care visits and at other, nontraditional venues accessed by young men of color, with inclusive, nonjudgmental approaches. The Affordable Care Act and National HIV/AIDS Strategy present new opportunities to reframe and strengthen sexual health promotion and HIV and STI prevention efforts with young men of color. (Am J Public Health. Published online ahead of print December 13, 2012: e1-e8. doi:10.2105/AJPH.2012.300921). |
Retention among North American HIV-infected persons in clinical care, 2000-2008
Rebeiro P , Althoff KN , Buchacz K , Gill MJ , Horberg M , Krentz H , Brooks JT , Gebo KA , Sterling TR , Moore R , Mugavero M , Martin J , Klein M , Hogg R , Silverberg MJ , Rourke S , Thorne J , Gange SJ . J Acquir Immune Defic Syndr 2012 62 (3) 356-62 BACKGROUND: Retention in care is key to improving HIV outcomes. Our goal was to describe "churn" in patterns of entry, exit, and retention in HIV care in the US and Canada. METHODS: Adults contributing ≥1 CD4 count or HIV-1 RNA (HIV-lab) from 2000-2008 in North American Cohort Collaboration on Research and Design (NA-ACCORD) clinical cohorts were included. Incomplete retention was defined as lack of 2 HIV-labs (≥90 days apart) within 12 months, summarized by calendar year. We used beta-binomial regression models to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) of factors associated with incomplete retention. RESULTS: Among 61,438 participants, 15,360 (25%) with incomplete retention significantly differed in univariate analyses (p<0.001) from 46,078 (75%) consistently retained by age, race/ethnicity, HIV risk, CD4, ART use, and country of care (US vs. Canada). From 2000-2004, females (OR=0.82, CI:0.70-0.95), older individuals (OR=0.78, CI:0.74-0.83 per 10 years), and ART users (OR= 0.61, CI:0.54-0.68 vs all others) were less likely to have incomplete retention, while black individuals (OR=1.31, CI:1.16-1.49, vs. white), those with injection drug use (IDU) HIV risk (OR=1.68, CI:1.49-1.89, vs. non-IDU) and those in care longer (OR=1.09, CI:1.07-1.11 per year) were more likely to have incomplete retention. Results from 2005-2008 were similar. DISCUSSION: From 2000 to 2008, 75% of the NA-ACCORD population was consistently retained in care with 25% experiencing some change in status, or churn. In addition to the programmatic and policy implications, our findings identify patient groups who may benefit from focused retention efforts. |
Outbreak of infections caused by Shigella sonnei with reduced susceptibility to azithromycin, United States
Sjolund Karlsson M , Bowen A , Reporter R , Folster JP , Grass JE , Howie RL , Taylor J , Whichard JM . Antimicrob Agents Chemother 2012 57 (3) 1559-60 Shigellosis is the third most common enteric bacterial infection in the United States (9).... |
Baseline findings of an HIV incidence cohort study to prepare for future HIV prevention clinical trials in Kisumu, Kenya
Chege W , Pals SL , McLellan-Lemal E , Shinde S , Nyambura M , Otieno FO , Gust DA , Chen RT , Thomas T . J Infect Dev Ctries 2012 6 (12) 870-80 INTRODUCTION: In an analysis of baseline findings of an HIV incidence cohort study, an assessment was made of HIV prevalence among persons presenting for enrollment and any differences in demographic characteristics between persons not enrolled compared to those enrolled. We also described and compared HIV risk behaviors in males and females enrolled in the study. METHODOLOGY: A computer-assisted survey was administered to collect baseline demographic and HIV risk data from 1,277 men and women aged 18-34 years. Testing for HIV and other sexually transmitted infections (STI) was conducted. Out of 1,277 persons prescreened for eligibility, 625 were enrolled. RESULTS: HIV prevalence of all persons who completed screening was 14.8% (females: 21.1%; males: 8.1%). The odds of being enrolled in the study were higher for persons 18-24 years compared to those 30-34 years of age [adjusted odds ratio (AOR)=2.18, CI=1.13, 4.21] and males compared to females [AOR=2.07, CI=1.43, 2.99]. Among those enrolled in the study, the most prevalent HIV risk behaviors were unprotected sex (49%), alcohol use (45%), and transactional sex (30%) in the last three months. Compared to females, a significantly greater proportion of males reported using any alcohol or recreational drug in the last three months, a history of oral sex, sex with partner other than a spouse or main partner, ever having a blood transfusion, ever being treated for an STI, and having knowledge of their last HIV test result. CONCLUSION: The Kisumu Field Station successfully recruited individuals with HIV risk characteristics for the HIV incidence cohort study. |
Clinical characteristics of norovirus-associated deaths: a systematic literature review
Trivedi TK , Desai R , Hall AJ , Patel M , Parashar UD , Lopman BA . Am J Infect Control 2012 41 (7) 654-7 Although deaths are often reported in the context of norovirus outbreaks, clinical and epidemiologic characteristics of the decedents prior to death are not well established. Through a literature review of published reports of deaths associated with norovirus infection, we identified and summarized 158 norovirus-associated deaths in 12 countries from 1988 to 2011. |
A cluster of patients infected with I221V influenza B virus variants with reduced oseltamivir susceptibility--North Carolina and South Carolina, 2010-2011
Garg S , Moore Z , Lee N , McKenna J , Bishop A , Fleischauer A , Springs CB , Nguyen HT , Sheu TG , Sleeman K , Finelli L , Gubareva L , Fry AM . J Infect Dis 2012 207 (6) 966-73 BACKGROUND: During 2010-2011, influenza B viruses with a novel neuraminidase substitution, denoted I221V, (B/I221V) associated with reduced in vitro oseltamivir susceptibility were detected in North Carolina (NC). METHODS: We determined the prevalence of I221V among B viruses submitted to CDC for antiviral resistance surveillance, including all B viruses submitted to NC and South Carolina (SC) state laboratories, during October 2010-September 2011.We conducted chart reviews and phone interviews to characterize NC and SC patients with B/I221V versus wild-type B virus infection (B/WT). RESULTS: We detected I221V in 45 (22%) of 209 B viruses from NC and 8 (10%) of 82 B viruses from SC. We detected I221V in three (0.3%) of 881 B viruses tested from 45 other states. B/I221V infection was not associated with differences in underlying conditions or illness severity compared with B/WT infection. No patients with B/I221V infection received oseltamivir prior to specimen collection. Among patients who completed oseltamivir, those with B/I221V infection reported a longer duration until illness resolution (5 versus 3 days); P=0.02. CONCLUSIONS: B/I221V co-circulated with B/WT in NC and SC during 2010-2011. I221V did not alter illness severity but may have reduced oseltamivir effectiveness. Thus, global surveillance for I221V is important. |
Control of communicable diseases: foreign; scope and definitions. Direct final rule and request for comments
Centers for Disease Control and Prevention , Marrone AA . Fed Regist 2012 77 (247) 75885-91 Through this Direct Final Rule, the Centers for Disease Control and Prevention (CDC), located within the Department of Health and Human Services (HHS) is updating and reorganizing the Scope and Definitions for foreign quarantine regulations and add a new section to contain definitions for Importations. This Direct Final Rule (DFR) will update the scope and definitions to reflect modern terminology and plain language used globally by industry and public health partners. As part of the update, we are updating five existing definitions; adding thirteen new definitions to help clarify existing provisions; creating a new scope and definitions section for Importations under a new section by reorganizing existing definitions into this new section; and updating regulations to reflect the language used by the most recent Executive Order regarding quarantinable communicable diseases. |
Control of communicable diseases: interstate; scope and definitions. Direct final rule and request for comments
Centers for Disease Control and Prevention , Marrone AA . Fed Regist 2012 77 (247) 75880-4 In this Direct Final Rule, the Centers for Disease Control and Prevention (CDC), located within the Department of Health and Human Services (HHS) is proposing to update the definitions for interstate quarantine regulations to reflect modern terminology and plain language used by private industry and public health partners. These updates will not affect current practices. As part of the update, we are updating two existing definitions and adding eight new definitions to clarify existing provisions, as well as updating regulations to reflect the most recent Executive Order addressing quarantinable communicable diseases. |
Coverage, context and targeted prevention: optimising our impact
Aral SO , Cates W Jr . Sex Transm Infect 2012 89 (4) 336-40 Development of efficacious interventions is only the first step in achieving population level impact. Efficacious interventions impact infection levels in the population only if they are implemented at the right scale. Coverage must be prioritised across subpopulations based on the diversity and clustering of infections and risk in society, and expanded rapidly without delay. It is important to prioritise those who are most likely to transmit infection first. |
Combining real-time polymerase chain reaction using SYBR Green I detection and sequencing to identify vertebrate bloodmeals in fleas.
Graham CB , Black WC , Boegler KA , Montenieri JA , Holmes JL , Gage KL , Eisen RJ . J Med Entomol 2012 49 (6) 1442-52 Programs that aim to control vector-borne zoonotic diseases require information on zoonotic hosts and on the feeding behavior of bridging vectors that are capable of transmitting pathogens from those hosts to humans. Here we describe an assay developed to identify bloodmeals in field-collected cat fleas (Ctenocephalides felis Bouche) to assess this species' potential role as a Yersinia pestis bridging vector in a plague-endemic region of Uganda. Our assay uses a single primer set and SYBR Green I-based real-time polymerase chain reaction to amplify a segment of the 12S mitochondrial ribosomal RNA gene for identification by sequencing. The assay capitalizes on the sensitivity of real-time polymerase chain reaction and the specificity of sequencing and can be used to differentiate vertebrate bloodmeals to the genus or species level without a priori knowledge of the host community. Because real-time assays that detect vertebrate DNA are highly sensitive to human DNA contamination, we analyzed detection in artificially fed and unfed fleas to establish a Ct cutoff that optimized specificity without completely sacrificing sensitivity. Using the established cutoff, our assay detected human, rat, and goat DNA in artificially fed C. felis up to 72 h postfeeding. |
Two pathogens and one disease: detection and identification of flea-borne Rickettsiae in areas endemic for murine typhus in California
Eremeeva ME , Karpathy SE , Krueger L , Hayes EK , Williams AM , Zaldivar Y , Bennett S , Cummings R , Tilzer A , Velten RK , Kerr N , Dasch GA , Hu R . J Med Entomol 2012 49 (6) 1485-94 Results of an environmental assessment conducted in a newly emergent focus of murine typhus in southern California are described. Opossums, Didelphis virginiana Kerr, infested with cat fleas, Ctenocephalides felis Buche, in the suburban area were abundant. Animal and flea specimens were tested for the DNA of two flea-borne rickettsiae, Rickettsia typhi and Rickettsia felis. R. felis was commonly detected in fleas collected throughout this area while R. typhi was found at a much lower prevalence in the vicinity of just 7 of 14 case-patient homes identified. DNA of R. felis, but not R. typhi, was detected in renal, hepatic, and pulmonary tissues of opossums. In contrast, there were no hematologic polymerase chain reaction findings of R. felis or R. typhi in opossums, rats, and cats within the endemic area studied. Our data suggest a significant probability of human exposure to R. felis in the area studied; however, disease caused by this agent is not recognized by the medical community and may be misdiagnosed as murine typhus using nondiscriminatory serologic methods. |
Fungal infections associated with contaminated methylprednisolone injections - preliminary report
Smith RM , Schaefer MK , Kainer MA , Wise M , Finks J , Duwve J , Fontaine E , Chu A , Carothers B , Reilly A , Fiedler J , Wiese AD , Feaster C , Gibson L , Griese S , Purfield A , Cleveland AA , Benedict K , Harris JR , Brandt ME , Blau D , Jernigan J , Weber JT , Park BJ . N Engl J Med 2012 369 (17) 1598-609 BACKGROUND: Fungal infections are rare complications of injections for treatment of chronic pain. In September 2012, we initiated an investigation into fungal infections associated with injections of preservative-free methylprednisolone acetate that was purchased from a single compounding pharmacy. METHODS: Three lots of methylprednisolone acetate were recalled by the pharmacy; examination of unopened vials later revealed fungus. Notification of all persons potentially exposed to implicated methylprednisolone acetate was conducted by federal, state, and local public health officials and by staff at clinical facilities that administered the drug. We collected clinical data on standardized case-report forms, and we tested for the presence of fungi in isolates and specimens by examining cultures and performing polymerase-chain-reaction assays and histopathological and immunohistochemical testing. RESULTS: As of October 19, 2012, more than 99% of 13,534 potentially exposed persons had been contacted. As of December 10, there were 590 reported cases of infection in 19 states, with 37 deaths (6%). As of November 26, laboratory evidence of Exserohilum rostratum was present in specimens from 100 case patients (17%). Additional data were available for 386 case patients (65%); 300 of these patients (78%) had meningitis. Case patients had received a median of 1 injection (range, 1 to 6) of implicated methylprednisolone acetate. The median age of the patients was 64 years (range, 16 to 92), and the median incubation period was 20 days (range, 0 to 120); 33 patients (9%) had a stroke. CONCLUSIONS: Analysis of preliminary data from a large multistate outbreak of fungal infections showed substantial morbidity and mortality. The infections were associated with injection of a contaminated glucocorticoid medication from a single compounding pharmacy. Rapid public health actions included prompt recall of the implicated product, notification of exposed persons, and early outreach to clinicians. |
Mosquitoes of western Uganda
Mutebi JP , Crabtree MB , Kading RC , Powers AM , Lutwama JJ , Miller BR . J Med Entomol 2012 49 (6) 1289-306 The mosquito fauna in many areas of western Uganda has never been studied and is currently unknown. One area, Bwamba County, has been previously studied and documented but the species lists have not been updated for >40 yr. This paucity of data makes it difficult to determine which arthropod-borne viruses pose a risk to human or animal populations. Using CO2 baited-light traps, from 2008 through 2010, 67,731 mosquitoes were captured at five locations in western Uganda including Mweya, Sempaya, Maramagambo, Bwindi (BINP), and Kibale (KNP). Overall, 88 mosquito species, 7 subspecies, and 7 species groups in 10 genera were collected. The largest number of species was collected at Sempaya (65 species), followed by Maramagambo (45), Mweya (34), BINP (33), and KNP (22). However, species diversity was highest in BINP (Simpson's Diversity Index 1-D = 0.85), followed by KNP (0.80), Maramagambo (0.79), Sempaya (0.67), and Mweya (0.56). Only six species Aedes (Aedimorphus) cumminsii (Theobald), Aedes (Neomelaniconion) circumluteolus (Theobald), Culex (Culex) antennatus (Becker), Culex (Culex) decens group, Culex (Lutzia) tigripes De Grandpre and De Charmoy, and Culex (Oculeomyia) annulioris (Theobald), were collected from all five sites suggesting large differences in species composition among sites. Four species (Aedes (Stegomyia) metallicus (Edwards), Anopheles (Cellia) rivulorum Leeson, Uranotaenia (Uranotaenia) chorleyi (Edwards), and Uranotaenia (Uranotaenia) pallidocephala (Theobald) and one subspecies (Aedes (Stegomyia) aegypti formosus (Walker)) were collected in Bwamba County for the first time. This study represents the first description of the mosquito species composition of Mweya, Maramagambo, BINP, and KNP. A number of morphological variations were noted regarding the postspiracular scales, hind tibia, and sternites that make Culex (Culex) neavei (Theobald) challenging to identify. At least 50 species collected in this study have previously been implicated in the transmission of arboviruses of public health importance suggesting a high potential for maintenance and transmission of a wide variety of arboviruses in western Uganda. |
National and state estimates of secondhand smoke infiltration among U.S. multiunit housing residents
King BA , Babb SD , Tynan MA , Gerzoff RB . Nicotine Tob Res 2012 15 (7) 1316-21 INTRODUCTION: Multiunit housing (MUH) residents are susceptible to secondhand smoke (SHS), which can infiltrate smoke-free living units from nearby units and shared areas where smoking is permitted. This study assessed the prevalence and characteristics of MUH residency in the United States, and the extent of SHS infiltration in this environment at both the national and state levels. METHODS: National and state estimates of MUH residency were obtained from the 2009 American Community Survey. Assessed MUH residency characteristics included sex, age, race/ethnicity, and poverty status. Estimates of smoke-free home rule prevalence were obtained from the 2006-2007 Tobacco Use Supplement to the Current Population Survey. The number of MUH residents who have experienced SHS infiltration was determined by multiplying the estimated number of MUH residents with smoke-free homes by the range of self-reported SHS infiltration (44%-46.2%) from peer-reviewed studies of MUH residents. RESULTS: One-quarter of U.S. residents (25.8%, 79.2 million) live in MUH (state range: 10.1% in West Virginia to 51.7% in New York). Nationally, 47.6% of MUH residents are male, 53.3% are aged 25-64 years, 48.0% are non-Hispanic White, and 24.4% live below the poverty level. Among MUH residents with smoke-free home rules (62.7 million), an estimated 27.6-28.9 million have experienced SHS infiltration (state range: 26,000-27,000 in Wyoming to 4.6-4.9 million in California). CONCLUSIONS: A considerable number of Americans reside in MUH and many of these individuals experience SHS infiltration in their homes. Prohibiting smoking in MUH would help protect MUH residents from involuntary SHS exposure. |
Pentachlorophenol contamination of private drinking water from treated utility poles
Karlsson L , Cragin L , Center G , Giguere C , Comstock J , Boccuzzo L , Sumner A . Am J Public Health 2012 103 (2) 276-7 In 2009, after resident calls regarding an odor, the Vermont Department of Health and state partners responded to 2 scenarios of private drinking water contamination from utility poles treated with pentachlorophenol (PCP), an organochlorine wood preservative used in the United States. Public health professionals should consider PCP contamination of private water if they receive calls about a chemical or gasoline-like odor with concurrent history of nearby utility pole replacement. (Am J Public Health. Published online ahead of print December 13, 2012: e1-e2. doi:10.2105/AJPH.2012.300910). |
Impact of locally-produced, ceramic cookstoves on respiratory disease in children in rural western Kenya
Foote EM , Gieraltowski L , Ayers T , Sadumah I , Faith SH , Silk BJ , Cohen AL , Were V , Hughes JM , Quick RE . Am J Trop Med Hyg 2012 88 (1) 132-7 Household air pollution is a risk factor for pneumonia, the leading cause of death among children < 5 years of age. From 2008 to 2010, a Kenyan organization sold approximately 2,500 ceramic cookstoves (upesi jiko) that produce less visible household smoke than 3-stone firepits. During a year-long observational study, we made 25 biweekly visits to 200 homes to determine stove use and observe signs of acute respiratory infection in children < 3 years of age. Reported stove use included 3-stone firepit only (81.8%), upesi jiko only (15.7%), and both (2.3%). Lower, but not statistically significant, percentages of children in upesi jiko-using households than 3-stone firepit-using households had observed cough (1.3% versus 2.9%, rate ratio [RR] 0.48, 95% confidence interval [CI]: 0.22-1.03), pneumonia (0.9% versus 1.7%, RR 0.60, 95% CI: 0.24-1.48), and severe pneumonia (0.3% versus 0.6%, RR 0.66, 95% CI: 0.17-2.62). Upesi jiko use did not result in significantly lower pneumonia rates. Further research on the health impact of improved cookstoves is warranted. |
Agency for Toxic Substances and Disease Registry Brownfields/Land-Reuse Site Tool
Perlman GD , Berman L , Bing KLL . J Environ Health 2012 75 (5) 30-34 As part of our continuing effort to highlight innovative approaches to improving the health and environment of communities, the Journal is pleased to bring back the bimonthly column from the U.S. Agency for Toxic Substances and Disease Registry (ATSDR). The ATSDR, based in Atlanta, Georgia, is a federal public health agency of the U.S. Department of Health and Human Services and shares a common office of the Director with the National Center for Environmental Health at the Centers for Disease Control and Prevention (CDC). ATSDR serves the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and diseases related to toxic substances. The purpose of this column is to inform readers of ATSDR's activities and initiatives to better understand the relationship between exposure to hazardous substances in the environment and their impact on human health and how to protect public health. We believe that the column will provide a valuable resource to our readership by helping to make known the considerable resources and expertise that ATSDR has available to assist communities, states, and others to assure good environmental health practice for all is served. The conclusions of this article are those of the author(s) and do not necessarily represent the views of ATSDR, CDC, or the U.S. Department of Health and Human Services. Gary D. Perlman is an environmental health scientist for ATSDR. He is a commissioned officer with the U.S. Public Health Service and has been deployed in support of numerous environmental disasters including hurricanes Katrina, Rita, Isabelle, and Irene, as well as the Deepwater Horizon oil spill. Laurel Berman is the national brownfields coordinator with ATSDR. She coordinates the ATSDR Brownfields/Land-Reuse Health Initiative. Kathryn Leann Lemley Bing is an environmental health scientist and an ATSDR regional representative in Atlanta. She has specialized expertise working in brownfield/land-reuse communities. |
Epidemiology of pneumococcal serotype 6A and 6C among invasive and carriage isolates from Alaska, 1986-2009.
Rudolph K , Bruce M , Bruden D , Zulz T , Wenger J , Reasonover A , Harker-Jones M , Hurlburt D , Hennessy T . Diagn Microbiol Infect Dis 2012 75 (3) 271-6 We investigated serotype 6A/6C invasive pneumococcal disease (IPD) incidence, genetic diversity, and carriage before and after 7-valent pneumococcal conjugate vaccine (PCV7) introduction in Alaska. IPD cases (1986-2009) were identified through population-based laboratory surveillance. Isolates were initially serotyped by conventional methods, and 6C isolates were differentiated from 6A by polymerase chain reaction. Among invasive and carriage isolates initially typed as 6A, 35% and 50% were identified as 6C, respectively. IPD rates caused by serotype 6A or 6C among children <5 years did not change from the pre- to post-PCV7 period (P = 0.71 and P = 0.09, respectively). Multilocus sequence typing of IPD isolates revealed 28 sequence types. The proportion of serotype 6A carriage isolates decreased from 7.4% pre-PCV7 to 1.8% (P < 0.001) during 2008-2009; the proportion of serotype 6C carriage isolates increased from 3.0% to 8.4% (P = 0.004) among children <5 years. Continued surveillance is warranted to monitor changes in serotype distribution and prevalence. |
Seasonal influenza morbidity estimates obtained from telephone surveys, 2007
Kamimoto L , Euler GL , Lu PJ , Reingold A , Hadler J , Gershman K , Farley M , Terebuh P , Ryan P , Lynfield R , Albanese B , Thomas A , Craig AS , Schaffner W , Finelli L , Bresee J , Singleton JA . Am J Public Health 2012 103 (4) 755-63 OBJECTIVES: We assessed telephone surveys as a novel surveillance method, comparing data obtained by telephone with existing national influenza surveillance systems, and evaluated the utility of telephone surveys. METHODS: We used the 2007 Behavioral Risk Factor Surveillance System (BRFSS) and the 2007 National Immunization Survey-Adult (NIS-Adult) to estimate the incidence of influenza-like illness (ILI), medically attended ILI, provider-diagnosed influenza, influenza testing, and treatment of influenza with antiviral medications during the 2006-2007 influenza season. RESULTS: With the January-May BRFSS, among persons aged 18 years and older, the cumulative incidence of seasonal ILI and provider-diagnosed influenza was 37.9 and 5.7 adults per 100 persons, respectively. Monthly medically attended ILI and provider-diagnosed influenza among adults were temporally associated with influenza activity, as documented by national surveillance. With the NIS-Adult survey data, estimated provider-diagnosed influenza, influenza testing, and antiviral treatment were 2.8%, 1.4%, and 0.6%, respectively. CONCLUSIONS: Our telephone interview-based estimates of influenza morbidity were consistent with those from national influenza surveillance systems. Telephone surveys may provide an alternative method by which population-based influenza morbidity information can be gathered. (Am J Public Health. Published online ahead of print December 13, 2012: e1-e9. doi:10.2105/AJPH.2012.300799). |
Estimates of illnesses, hospitalizations, and deaths caused by major bacterial enteric pathogens in young children in the United States
Scallan E , Mahon BE , Hoekstra RM , Griffin PM . Pediatr Infect Dis J 2012 32 (3) 217-21 BACKGROUND: Many enteric pathogens disproportionately affect young children. However, higher incidences of laboratory-confirmed illness may be explained, at least in part, by higher rates of medical care-seeking and stool sample submission in this age group. We estimated the overall number of bacterial enteric illnesses among children <5 years old in the United States caused by Campylobacter, Escherichia coli O157, nontyphoidal Salmonella, Shigella, and Yersinia enterocolitica. MATERIALS AND METHODS: We used a statistical model that scaled counts of laboratory-confirmed illnesses from the Foodborne Diseases Active Surveillance Network up to an estimated number of illnesses in the United States, adjusting for the surveillance steps needed for an illness to be laboratory-diagnosed (medical care sought, stool sample submitted, bacterial culture performed, laboratory tested for pathogen, laboratory test sensitivity). RESULTS: We estimated that 5 bacterial enteric pathogens caused 291,162 illnesses each year among children <5 years old, resulting in 102,746 physician visits, 7,830 hospitalizations, and 64 deaths. Nontyphoidal Salmonella caused most illnesses (42%), followed by Campylobacter (28%), Shigella (21%), Y. enterocolitica (5%) and E. coli O157 (3%). The estimated annual number of physician visits ranged from 3,763 for E. coli O157 to 44,369 for nontyphoidal Salmonella. Nontyphoidal Salmonella was estimated to cause most hospitalizations (4,670) and deaths (38). CONCLUSIONS: Bacterial enteric infections cause many illnesses in US children. Compared with the general population, enteric illnesses among children <5 years old are more likely to be diagnosed. However, overall rates of illness remain higher in children after adjusting for under-diagnosis in both groups. |
The CDC Hemophilia A Mutation Project (CHAMP) mutation list: a new online resource.
Payne AB , Miller CH , Kelly FM , Soucie JM , Hooper WC . Hum Mutat 2012 34 (2) E2382-91 Genotyping efforts in hemophilia A (HA) populations in many countries have identified large numbers of unique mutations in the Factor VIII gene (F8). To assist HA researchers conducting genotyping analyses, we have developed a listing of F8 mutations including those listed in existing locus-specific databases as well as those identified in patient populations and reported in the literature. Each mutation was reviewed and uniquely identified using Human Genome Variation Society (HGVS) nomenclature standards for coding DNA and predicted protein changes as well as traditional nomenclature based on the mature, processed protein. Listings also include the associated hemophilia severity classified by International Society of Thrombosis and Haemostasis (ISTH) criteria, associations of the mutations with inhibitors, and reference information. The mutation list currently contains 2,537 unique mutations known to cause HA. HA severity caused by the mutation is available for 2,022 mutations (80%) and information on inhibitors is available for 1,816 mutations (72%). The CDC Hemophilia A Mutation Project (CHAMP) Mutation List is available at http://www.cdc.gov/hemophiliamutations for download and search and will be updated quarterly based on periodic literature reviews and submitted reports. |
Adherence to antiretroviral medications for HIV pre-exposure prophylaxis: lessons learned from trials and treatment studies
Koenig LJ , Lyles C , Smith DK . Am J Prev Med 2013 44 S91-8 Several recent clinical trials have shown that daily oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine (TDF–FTC) can reduce the risk for sexually acquired HIV infection in men and women. However, the efficacy of PrEP has varied widely across trials,1 and it is affected heavily by adherence to daily doses of TDF–FTC. To better understand the importance of medication adherence to achieving the PrEP efficacy required for public health impact, and to provide the best guidance for supporting optimal adherence in real-world contexts when PrEP is implemented more broadly, the current paper reviews and summarizes findings from (1) adherence analyses from PrEP clinical trials and (2) the antiretroviral treatment adherence literature. |
Long-term impact of integration of household water treatment and hygiene promotion with antenatal services on maternal water treatment and hygiene practices in Malawi
Loharikar A , Russo E , Sheth A , Menon M , Kudzala A , Tauzie B , Masuku HD , Ayers T , Hoekstra RM , Quick R . Am J Trop Med Hyg 2012 88 (2) 267-74 A clinic-based program to integrate antenatal services with distribution of hygiene kits including safe water storage containers, water treatment solution (brand name WaterGuard), soap, and hygiene education, was implemented in Malawi in 2007 and evaluated in 2010. We surveyed 389 participants at baseline in 2007, and found and surveyed 232 (60%) participants to assess water treatment, test stored drinking water for residual chlorine (an objective measure of treatment), and observe handwashing technique at follow-up in 2010. Program participants were more likely to know correct water treatment procedures (67% versus 36%; P < 0.0001), treat drinking water with WaterGuard (24% versus.2%; P < 0.0001), purchase and use WaterGuard (21% versus 1%; P < 0.001), and demonstrate correct handwashing technique (50% versus 21%; P < 0.001) at the three-year follow-up survey than at baseline. This antenatal-clinic-based program may have contributed to sustained water treatment and proper handwashing technique among program participants. |
Examining self and partners for syphilis among men who have sex with men: five US cities, 2009-2011
Surie D , Furness BW , Hernandez-Kline P , Turner A , Perkins RC , Taylor MM , Brewer T , Workowski K , Gamerdinger K , Markowitz LE , Koumans EH . Int J STD AIDS 2012 23 (12) 859-61 To increase self-examination for syphilis among men who have sex with men (MSM), we developed educational materials to increase knowledge of primary and secondary syphilis manifestations. Materials were piloted in five cities' infectious disease or MSM clinics. Self- and partner-examination behaviour was assessed with an anonymous questionnaire. Of 1459 participants, 914 men had had sex with a man in the previous three months; the 171 MSM who reported having read the materials were significantly more likely to examine themselves (anus, adjusted prevalence ratio [aPR] 1.3, 95% confidence interval [CI] 1.15-1.52), mouth, penis and skin, and their partners' anus (aPR 1.3, 95% CI 1.03-1.73) and mouth (aPR 1.6, 95% CI 1.1-2.26). Further research is needed to determine whether educational materials affect early detection and treatment of primary and secondary syphilis and reduce transmission. |
Colorectal cancer knowledge, attitudes, screening, and intergenerational communication among Japanese American families: an exploratory, community-based participatory study
Lau DT , Machizawa S , Demonte W , Cameron KA , Muramatsu N , Henker RD , Chikahisa F , Tanimura M . J Cross Cult Gerontol 2012 28 (1) 89-101 Adults of Japanese descent (Nikkei) in the United States have higher risk for colorectal cancer (CRC) than their white counterparts. Family norms toward CRC screening may influence screening behaviors of Nikkei adults. This community-based participatory research study explores if mailing educational pamphlets to Nikkei families can influence CRC knowledge, attitudes, and screening adherence; and trigger intergenerational communication about CRC. Among 56 parent-offspring dyads contacted, 24 were eligible (e.g., no prior CRC screening/diagnosis) and were randomized into 3 cohorts defined by the "target recipient(s)" of study pamphlets about CRC screening: parent only, offspring only, and both parent and offspring. Among the 19 completed dyads (79.2 % = 19/24), results showed that CRC knowledge of most pamphlet recipients increased in all cohorts; however, some misinformation and attitudinal barriers persisted. Although some parent-offspring communication about CRC increased after mailing pamphlets to offspring, only spousal communication occurred after mailing pamphlets to parents. Additional benefits were not observed in increasing parental screening intent/behavior after mailing pamphlets to both parent and offspring. At the end, among the 10 parents who reported developing CRC screening intent or having scheduled a CRC screening, 8 attributed to study pamphlets and 2 to communication with their offspring. Self-reported barriers preventing screening and parent-offspring communication about CRC were identified. This exploratory study describes preliminary findings that will inform future research aimed to promote CRC screening and reduce racial/ethnic disparities at the community level by enhancing intergenerational communication among Nikkei families. |
Trivalent inactivated influenza vaccine and spontaneous abortion
Irving SA , Kieke BA , Donahue JG , Mascola MA , Baggs J , Destefano F , Cheetham TC , Jackson LA , Naleway AL , Glanz JM , Nordin JD , Belongia EA . Obstet Gynecol 2013 121 (1) 159-165 OBJECTIVE: To estimate the association between spontaneous abortion and influenza vaccine receipt with a case-control study utilizing data from six health care organizations in the Vaccine Safety Datalink. METHODS: Women aged 18-44 years with spontaneous abortion during the autumn of 2005 or 2006 were identified using International Classification of Diseases, 9th Revision, Clinical Modification codes. Cases of spontaneous abortion at 5-16 weeks of gestation were confirmed by medical record review; date of fetal demise was based on ultrasound information when available. Control group individuals with a live birth were individually matched to case group individuals by health care organization and date of last menstrual period (LMP). The primary exposure of interest was influenza vaccination during the 28 days preceding the date of spontaneous abortion of the matched pair. Conditional logistic regression models adjusted for maternal age, health care utilization, maternal diabetes, and parity. RESULTS: Our final analysis included 243 women with spontaneous abortion and 243 matched control group women; 82% of women with spontaneous abortion had ultrasound confirmation of fetal demise. Using clinical diagnosis and ultrasound data, the mean gestational age at fetal demise was 7.8 weeks. Mean ages at LMP of case group women and control group women were 31.7 and 29.3 years, respectively (P<.001). Sixteen women with spontaneous abortion (7%) and 15 (6%) matched control group women received influenza vaccine within the 28-day exposure window. There was no association between spontaneous abortion and influenza vaccination in the 28-day exposure window (adjusted matched odds ratio 1.23, 95% confidence interval 0.53-2.89; P=.63). CONCLUSION: There was no statistically significant increase in the risk of pregnancy loss in the 4 weeks after seasonal inactivated influenza vaccination. LEVEL OF EVIDENCE: II. |
The rotavirus experience in Mexico: discovery to control
Patel MM , Parashar UD , Santosham M , Richardson V . Clin Infect Dis 2012 56 (4) 548-51 The recent introduction of a rotavirus vaccine program in Mexico to control rotavirus disease, a common killer of children worldwide, has dramatically reduced the number of Mexican children dying and being hospitalized because of diarrhea. The successful introduction of a rotavirus vaccine program was preceded by several decades of focused research efforts to document the burden of disease and to generate the knowledge base to develop and deploy a vaccine. The postlicensure experience from Mexico demonstrates that evaluating the impact and safety of the vaccination program is vitally necessary for sustaining it. All in all, the immensely successful Mexico experience with control of rotavirus disease, if copied, could yield tremendously favorable results for children and parents worldwide. |
Seroprotection after recombinant hepatitis B vaccination among newborn infants: a review
Schillie SF , Murphy TV . Vaccine 2012 31 (21) 2506-16 INTRODUCTION: Hepatitis B vaccination starting at birth provides a safety net for infants exposed to hepatitis B virus (HBV) during delivery or in early life. Hepatitis B vaccine is recommended in the United States for infants prior to birthing facility discharge, and within the first 12h of life for infants born to hepatitis B surface antigen (HBsAg)-positive mothers. We performed a literature review and summarized the response to recombinant hepatitis B vaccine among infants. METHODS: Studies published between 1987 and 2011 assessing seroprotection from recombinant hepatitis B vaccine starting within the first 30 days of life were eligible. Seroprotection was defined using an antibody to hepatitis B surface antigen (anti-HBs) threshold of 10mIU/mL at series completion. Infant seroprotection was compared in trial arms varying by maternal hepatitis B antigen status (e antigen [HBeAg], HBsAg), hepatitis B immune globulin (HBIG) administration, birth weight, vaccine dosage, schedule, and age at first dose. RESULTS: Forty-three studies were included. The median seroprotection proportion overall was 98% (range 52%, 100%). The final median seroprotection proportions did not vary appreciably by maternal HBsAg status, HBIG administration, or schedule. Higher compared to lower dosage resulted in earlier increases in anti-HBs but not in final seroprotection proportions. Infants with birth weights <2000g compared to ≥2000g had lower median seroprotection proportions (93% and 98%, respectively). Median seroprotection proportions were also lower when infants with birth weights <2000g were vaccinated at 0 through 3 days of age compared to 1 month of age or older (68% versus 95%, respectively). CONCLUSION: High levels of protection from recombinant hepatitis B vaccine are achieved in term infants vaccinated at birth, effectively preventing transmission of HBV and resultant morbidity and mortality. Implications, if any, for long-term protection are unknown for differences in responses among infants vaccinated at birth compared to ages older than 1 month. |
The feasibility of using mobile-phone based SMS reminders and conditional cash transfers to improve timely immunization in rural Kenya
Wakadha H , Chandir S , Were EV , Rubin A , Obor D , Levine OS , Gibson DG , Odhiambo F , Laserson KF , Feikin DR . Vaccine 2012 31 (6) 987-93 BACKGROUND: Demand-side strategies could contribute to achieving high and timely vaccine coverage in rural Africa, but require platforms to deliver either messages or conditional cash transfers (CCTs). We studied the feasibility of using short message services (SMS) reminders and mobile phone-based conditional cash transfers (CCTs) to reach parents in rural Western Kenya. METHODS: In a Health and Demographic Surveillance System (HDSS), mothers with children aged 0-3 weeks old were approached to determine who had access to a mobile phone. SMS reminders were sent three days prior to and on the scheduled day of immunization for 1st (age 6 weeks) and 2nd doses (age 10 weeks) of DTP-HepB-Hib (Pentavalent) vaccine, using open-source Rapid SMS software. Approximately $2.00 USD was sent as cash using mPESA, a mobile money transfer platform (2/3 of mothers), or airtime (1/3 of mothers) via phone if the child was vaccinated within 4 weeks of the scheduled date. Follow-up surveys were done when children reached 14 weeks of age. RESULTS: We approached 77 mothers; 72 were enrolled into the study (26% owned a phone and 74% used someone else's). Of the 63 children with known vaccination status at 14 weeks of age, 57 (90%) received pentavalent1 and 54 (86%) received pentavalent2 within 4 weeks of their scheduled date. Of the 61 mothers with follow-up surveys administered at 14 weeks of age, 55 (90%) reported having received SMS reminders. Of the 54 women who reported having received SMS reminders and answered the CCT questions on the survey, 45 (83%) reported receiving their CCT. Most (89%) of mothers in the mPESA group obtained their cash within 3 days of being sent their credit via mobile phone. All mothers stated they preferred CCTs as cash via mobile phone rather than airtime. Of the 9 participants who did not vaccinate their children at the designated clinic 2(22%) cited refusals by husbands to participate in the study. CONCLUSION: The data show that in rural Western Kenya mobile phone-based strategies are a potentially useful platform to deliver reminders and cash transfers. Follow-up studies are needed that provide evidence for the effectiveness of these strategies in improving vaccine coverage and timeliness. |
Influenza vaccination guidelines and vaccine sales in southeast Asia: 2008-2011
Gupta V , Dawood FS , Muangchana C , Lan PT , Xeuatvongsa A , Sovann L , Olveda R , Cutter J , Oo KY , Ratih TS , Kheong CC , Kapella BK , Kitsutani P , Corwin A , Olsen SJ . PLoS One 2012 7 (12) e52842 BACKGROUND: Southeast Asia is a region with great potential for the emergence of a pandemic influenza virus. Global efforts to improve influenza surveillance in this region have documented the burden and seasonality of influenza viruses and have informed influenza prevention strategies, but little information exists about influenza vaccination guidelines and vaccine sales. METHODS: To ascertain the existence of influenza vaccine guidelines and define the scope of vaccine sales, we sent a standard three-page questionnaire to the ten member nations of the Association of Southeast Asian Nations. We also surveyed three multinational manufacturers who supply influenza vaccines in the region. RESULTS: Vaccine sales in the private sector were <1000 per 100,000 population in the 10 countries. Five countries reported purchasing vaccine for use in the public sector. In 2011, Thailand had the highest combined reported rate of vaccine sales (10,333 per 100,000). In the 10 countries combined, the rate of private sector sales during 2010-2011 (after the A(H1N1)2009pdm pandemic) exceeded 2008 pre-pandemic levels. Five countries (Indonesia, Malaysia, Singapore, Thailand and Vietnam) had guidelines for influenza vaccination but only two were consistent with global guidelines. Four recommended vaccination for health care workers, four for elderly persons, three for young children, three for persons with underlying disease, and two for pregnant women. CONCLUSIONS: The rate of vaccine sales in Southeast Asia remains low, but there was a positive impact in sales after the A(H1N1)2009pdm pandemic. Low adherence to global vaccine guidelines suggests that more work is needed in the policy arena. |
Contribution of dendritic cells to measles virus induced immunosuppression
Coughlin MM , Bellini WJ , Rota PA . Rev Med Virol 2012 23 (2) 126-38 Measles virus (MV) remains an important pathogen in children worldwide. The morbidity and mortality of MV is associated with severe immune suppression. Dendritic cells (DCs) were identified as initial target cells in vivo, and DCs were efficiently infected by MV in vitro. MV infection of DCs likely contributes to functional deficiency in these cells; therefore playing a role in MV-induced immunosuppression. DCs appeared to mature phenotypically; however, the ability of infected cells to stimulate T cells was compromised. Phenotypic maturation of infected immature DCs was partially controlled by IFN production; however, infected DCs also maintained markers of an immature phenotype such as the continued uptake of antigen and lack of expression of chemokine receptor CCR7. Furthermore, mature DCs did not appear to maintain phenotypic maturation following infection demonstrated by decreased MHC and co-stimulatory molecule expression. Several mechanisms of MV-induced DC dysfunction have been suggested, each likely contributing to the immunosuppressive effect of MV-infected DCs. Infected DCs responded aberrantly to secondary maturation stimuli such as CD40L or TLR4 stimulation. MV infection resulted in apoptosis in DC/T-cell cocultures, which may contribute to a reduced T-cell response. Additionally, the immunological synapse between infected DCs and T cells was compromised resulting in reduced T-cell interaction times and activation signaling. The mechanisms of MV contribution to DC dysfunction appear multifaceted and central to MV-induced immunosuppression. Copyright (c) 2012 John Wiley & Sons, Ltd. |
Localization of pandemic 2009 H1N1 influenza A virus RNA in lung and lymph nodes of fatal influenza cases by in situ hybridization: new insights on virus replication and pathogenesis.
Bhatnagar J , Jones T , Blau DM , Shieh WJ , Paddock CD , Drew C , Denison AM , Rollin DC , Patel M , Zaki SR . J Clin Virol 2012 56 (3) 232-7 BACKGROUND: Pandemic 2009 H1N1 influenza A (pH1N1) virus has caused substantial morbidity and mortality globally and continues to circulate. Although pH1N1 viral antigens have been demonstrated in various human tissues by immunohistochemistry (IHC), cellular localization of pH1N1 RNA in these tissues has largely remained uninvestigated. OBJECTIVES: To examine the distribution of pH1N1 RNA in tissues of fatal cases in order to understand the virus tissue tropism, replication and disease pathogenesis. STUDY DESIGN: Formalin-fixed, paraffin embedded autopsy tissues from 21 patients with confirmed pH1N1 infection were analyzed by influenza A IHC and by in situ hybridization (ISH) using DIG-labeled sense (detects viral RNA) and antisense probes (detects positive-stranded mRNA and cRNA) targeting the nucleoprotein gene of pH1N1 virus. RESULTS: pH1N1 RNA was localized by ISH in 57% of cases while viral antigens were detected by IHC in 76%. However, in cases with a short duration of illness (1-3 days), more cases (69%) were positive by ISH than IHC (62%). Strong ISH staining was detected by antisense probes in the alveolar pneumocytes of the lungs, mucous glands and in lymph nodes. IHC staining of viral antigens was demonstrated in the lung pneumocytes and mucous glands, but no immunostaining was detected in any of the lymph nodes examined. CONCLUSIONS: This study demonstrates cellular localization of positive-stranded pH1N1 RNA in the lungs, mucous glands and lymph nodes that suggests viral replication in these tissues. The novel ISH assay can be a useful adjunct for the detection of pH1N1 virus in tissues and for pathogenesis studies. |
Adjuvant effect of zymosan after pulmonary treatment in a mouse ovalbumin allergy model
Young SH , Wolfarth MG , Roberts JR , Kashon ML , Antonini JM . Exp Lung Res 2013 39 (1) 48-57 An association has been observed between indoor mold contamination and lung allergy and asthma. This relationship is not fully understood. 1-->3-beta-Glucan is the major cell wall component of fungi and a good marker of fungi exposure. The objective was to evaluate the adjuvant effect of zymosan, a crude yeast cell wall preparation of 1-->3-beta-glucan, during ovalbumin (OVA) sensitization in an allergy model. BALB/c mice were sensitized by pharyngeal aspiration with saline, 50 mcg of OVA, or OVA with 1, 10, 50, or 75 mcg of zymosan on days 0, 7, and 14. One week after sensitization, each sensitized animal group was challenged with an aspiration dose of 50 mcg of OVA once a week for 2 weeks. At 1 day after the last aspiration, bronchoalveolar lavage fluid and blood was collected, and markers of lung allergy and inflammation were assessed. An adjuvant effect of zymosan on OVA allergy during sensitization was observed as indicated by significant elevations in lung eosinophils, serum OVA-specific IgE, and lung IL-5 in the groups sensitized with zymosan and OVA. Pulmonary treatment with zymosan also amplified lung inflammation. Elevations were observed in lung neutrophils, TNF-alpha, and parameters of lung injury in the groups primed with both zymosan and OVA. In nearly all parameters, a non-linear dose-response relationship was observed in the groups primed with OVA and zymosan. The optimum adjuvant dose of zymosan was 10 mcg. This study demonstrated an adjuvant effect of zymosan when exposures occurred during the sensitization phase in an OVA-induced allergy model in BALB/c mice. |
Assays for monitoring susceptibility of influenza viruses to neuraminidase inhibitors
Okomo-Adhiambo M , Sheu TG , Gubareva LV . Influenza Other Respir Viruses 2013 7 Suppl 1 44-9 Close monitoring of drug susceptibility among human influenza viruses was necessitated by widespread resistance to M2 inhibitors in influenza H1N1 (pre-pandemic and 2009 pandemic) and H3N2 viruses, and of oseltamivir resistance in pre-pandemic H1N1 viruses. The FDA-approved neuraminidase (NA) inhibitors (NAIs), oseltamivir and zanamivir, as well as investigational NAIs, peramivir and laninamivir, are currently the principal treatment options for managing influenza infection. However, there are challenges associated with assessing virus susceptibility to this class of drugs. Traditional cell culture-based assays are not reliable for phenotypic testing of NAI susceptibility due to complexity in interpretation. Two types of laboratory assays are currently available for monitoring NAI susceptibility, phenotypic such as the neuraminidase inhibition (NI) assay and genotypic. The NI assay's requirement for propagated virus lengthens testing turnaround; therefore, the need for timely detection of molecular markers associated with NAI resistance (e.g., H275Y in H1N1) has spurred the development of rapid, high-throughput assays, such as real-time RT-PCR and pyrosequencing. The high sensitivity of genotypic assays allows testing of clinical specimens thus eliminating the need for virus propagation in cell culture. The NI assays are especially valuable when a novel virus emerges or a new NAI becomes available. Modifications continue to be introduced into NI assays, including optimization and data analysis criteria. The optimal assay of choice for monitoring influenza drug susceptibility varies widely depending on the needs of laboratories (e.g., surveillance purposes, clinical settings). Optimally, it is desirable to combine functional and genetic analyses of virus isolates and, when possible, the respective clinical specimens. |
Development of a novel rapid HIV test for simultaneous detection of recent or long-term HIV type 1 infection using a single testing device
Granade TC , Nguyen S , Kuehl DS , Parekh BS . AIDS Res Hum Retroviruses 2013 29 (1) 61-7 Laboratory assays for the detection of recent HIV infection for HIV incidence surveillance are essential to HIV prevention efforts worldwide because they can identify populations with a high incidence and allow targeting of resources and monitoring of incidence trends over time. This study describes the development of a novel rapid HIV-1 incidence-prevalence (I-P) test that can be used for the simultaneous detection and discrimination of prevalent (long-term) or incident (recent) HIV infections using a single device. A lateral flow assay was developed that uses a multisubtype recombinant gp41 protein applied at two concentrations of antigen (high and low). Prevalent and incident HIV-1 infections can be distinguished based on differential antibody binding at the two antigen concentrations. High level/high avidity antibodies present in prevalent infections bind to and are detected at both antigen concentrations while low level/low avidity antibodies present in recent HIV infections are detected only at the higher antigen concentration line. A total of 205 HIV-positive specimens with known status (recent=105, long-term=100), including 57 specimens from seroconversion panels, were tested by the rapid I-P assay and the results were compared to the HIV-1 BED capture enzyme immunoassay (CEIA). There was a 95.1% agreement of final classification (recent or long-term) with the BED assay (kappa=0.910) (mean recency period=162 days) and a high correlation between the intensity score of the low antigen line with the BED OD-n (Pearson correlation=0.89). The new rapid I-P test has great potential to simplify HIV surveillance efforts by simultaneously providing information on both HIV prevalence and incidence using a single, rapid test device. |
Recovery and detection of botulinum neurotoxins from a nonporous surface
Lautenschlager M , Maslanka SE , Paul PA , Kalb SR , Barr JR , Raphael BH . J Microbiol Methods 2012 92 (3) 278-80 We describe the adaptation of a sample recovery method for botulinum neurotoxins from stainless steel. Botulinum toxin was recovered from surfaces left to dry for up to 16 hrs and detected by either ELISA or EndoPep mass spectrometry methods. In addition, we demonstrate that this method can be used to evaluate the efficacy of surface decontamination procedures. |
Quantitative assessment of anthrax vaccine immunogenicity using the dried blood spot matrix
Schiffer JM , Maniatis P , Garza I , Steward-Clark E , Korman LT , Pittman PR , Mei JV , Quinn CP . Biologicals 2012 41 (2) 98-103 The collection, processing and transportation to a testing laboratory of large numbers of clinical samples during an emergency response situation present significant cost and logistical issues. Blood and serum are common clinical samples for diagnosis of disease. Serum preparation requires significant on-site equipment and facilities for immediate processing and cold storage, and significant costs for cold-chain transport to testing facilities. The dried blood spot (DBS) matrix offers an alternative to serum for rapid and efficient sample collection with fewer on-site equipment requirements and considerably lower storage and transport costs. We have developed and validated assay methods for using DBS in the quantitative anti-protective antigen IgG enzyme-linked immunosorbent assay (ELISA), one of the primary assays for assessing immunogenicity of anthrax vaccine and for confirmatory diagnosis of Bacillus anthracis infection in humans. We have also developed and validated high-throughput data analysis software to facilitate data handling for large clinical trials and emergency response. |
Neonatal encephalopathy or hypoxic-ischemic encephalopathy?
Schendel D , Nelson KB , Blair E . Ann Neurol 2012 72 (6) 984-5 We agree with Dr Volpe1 that a diagnosis of hypoxic–ischemic encephalopathy (HIE) is appropriate for neonates who have experienced asphyxial birth events such as uterine rupture or cord prolapse, followed by marked acidosis and neonatal neurologic depression, if other known causes of neonatal encephalopathy (NE) have been excluded. However, population-based studies of human infants with NE/HIE, and the few studies in clinical samples that have examined a range of antecedents, have observed that many infants with NE/HIE have not had recognized asphyxial birth events. Unless clinical details are carefully examined in NE, and criteria for HIE have been carefully applied, the probability of overidentifying etiology as hypoxic–ischemic may be high. | Volpe acknowledges that in NE, “…in the typical clinical situation, …the underlying mechanisms are not entirely known,” and cautions that “the clinician must exert great vigilance not to miss the great mimickers of neonatal HIE.” He considers a combination of signs such as abnormal fetal heart rate patterns, meconium in the amniotic fluid, low Apgar scores, and acidosis together with neuroimaging abnormalities, such as basal ganglia–thalamic injuries, to warrant a diagnosis of HIE. However, none of these signs is etiologically specific, even the neuroimaging abnormalities having been identified in infants with placental inflammation and no asphyxial birth events.2, 3 |
Association between reported venlafaxine use in early pregnancy and birth defects, National Birth Defects Prevention Study, 1997-2007
Polen KN , Rasmussen SA , Riehle-Colarusso T , Reefhuis J . Birth Defects Res A Clin Mol Teratol 2012 97 (1) 28-35 BACKGROUND: Few epidemiologic studies have investigated the use of venlafaxine (Effexor XR capsules, Product Monograph, Wyeth, Montreal, Canada), an antidepressant used to treat major depression and anxiety disorders in adults, during pregnancy. Our objective was to determine whether use of venlafaxine during pregnancy is associated with specific birth defects. METHODS: We used data from the National Birth Defects Prevention Study (NBDPS), a population-based, case-control study in the United States. Our analysis included mothers with pregnancies affected by one of 30 selected birth defects (cases) and babies without birth defects (controls) with estimated dates of delivery between 1997 and 2007. Exposure was any reported use of venlafaxine from 1 month preconception through the third month of pregnancy. We calculated adjusted odds ratios (aORs) and 95% Fisher Exact confidence intervals (CIs) for 24 birth defect groups for which at least 400 case mothers were interviewed. Our adjusted analyses controlled for maternal age and race/ethnicity. RESULTS: Among the 27,045 NBDPS participants who met inclusion criteria, 0.17% (14/8002) of control mothers and 0.40% (77/19,043) of case mothers reported any use of venlafaxine from 1 month preconception through the third month of pregnancy. Statistically significant associations were found for anencephaly, atrial septal defect (ASD) secundum, or ASD not otherwise specified, coarctation of the aorta, cleft palate, and gastroschisis. CONCLUSIONS: Our data suggest associations between periconceptional use of venlafaxine and some birth defects. However, sample sizes were small, CIs were wide, and additional studies are needed to confirm these results. Birth Defects Research (Part A), 2012. (c) 2012 Wiley Periodicals, Inc. |
Risk factors, health behaviors, and injury among adults employed in the transportation, warehousing, and utilities super sector
Helmkamp JC , Lincoln JE , Sestito J , Wood E , Birdsey J , Kiefer M . Am J Ind Med 2012 56 (5) 556-68 BACKGROUND: The TWU super sector is engaged in the movement of passengers and cargo, warehousing of goods, and the delivery of services. The purpose of this study is to describe employee self-reported personal risk factors, health behaviors and habits, disease and chronic conditions, and employer-reported nonfatal injury experiences of workers in the TWU super sector. METHODS: National Health Interview Survey (NHIS) data for 1997-2007, grouped into six morbidity and disability categories and three age groups, were reviewed. Demographic characteristics and prevalence estimates are reported for workers in the TWU super sector and the entire U.S. workforce, and compared with national adult population data from the NHIS. Bureau of Labor Statistics employer-reported TWU injury data from 2003 to 2007 was also reviewed. RESULTS: An average of 8.3 million workers were employed annually in the TWU super sector. TWU workers 65 or older reported the highest prevalence of hypertension (49%) across all industry sectors, but the 20% prevalence is notable among middle age workers (25-64). TWU workers had the highest prevalence of obesity (28%), compared to workers in all other industry sectors. Female TWU workers experienced the highest number of lost workdays (6.5) in the past year across all TWU demographic groups. CONCLUSIONS: Self-reported high proportions of chronic conditions including hypertension and heart disease combined with elevated levels of being overweight and obese, and lack of physical activity-particularly among TWUs oldest workers-can meaningfully inform wellness strategies and interventions focused on this demographic group. (Am. J. Ind. Med. (c) 2012 Wiley Periodicals, Inc.) |
Motor vehicle fatalities among oil and gas extraction workers
Retzer KD , Hill RD , Pratt SG . Accid Anal Prev 2012 51C 168-174 Motor vehicle crashes are the leading cause of work-related fatality in the U.S. as well as in the oil and gas extraction industry. This study describes the characteristics of motor vehicle-related fatalities in the oil and gas extraction industry using data from the U.S. Bureau of Labor Statistics' Census of Fatal Occupational Injuries. It compares the risk of dying in a motor vehicle crash in this industry to other major industries and among different types and sizes of oil and gas extraction companies. There were 202 oil and gas extraction workers who died in a work-related motor vehicle crash from 2003 to 2009. The motor vehicle fatality rate for workers in this industry was 8.5 times that of all private wage and salary workers (7.6 vs. 0.9, p<.0001). Workers from small oil and gas establishments (<20 workers) and workers from well-servicing companies were at greatest risk of dying in a motor vehicle crash. Pick-up trucks were the most frequent type of vehicle occupied by the fatally injured worker (n=104, 51.5%). Safety belt non-use was identified in 38.1% (n=77) of the cases. Increased focus on motor vehicle safety in this industry is needed, in particular among small establishments. Extraction workers who drive light duty vehicles need to be a specific focus. |
Occupational exposure to body fluids among health care workers in Georgia
Butsashvili M , Kamkamidze G , Kajaia M , Morse DL , Triner W , Dehovitz J , McNutt LA . Occup Med (Lond) 2012 62 (8) 620-6 BACKGROUND: Health care workers (HCWs) are at increased risk of being infected with blood-borne pathogens. AIMS: To evaluate risk of occupational exposure to blood-borne viruses and determine the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among HCWs in Georgia. METHODS: The sample included HCWs from seven medical institutions in five cities in Georgia. A self-administered questionnaire was used to collect information on demographic, occupational and personal risk factors for blood-borne viruses. After obtaining informed consent, blood was drawn from the study participants for a seroprevalence study of HBV, HCV and HIV infections. RESULTS: There were 1386 participating HCWs from a number of departments, including surgery (29%), internal medicine (19%) and intensive care (19%). Nosocomial risk events were reported by the majority of HCWs, including accidental needlestick injury (45%), cuts with contaminated instruments (38%) and blood splashes (46%). The most frequent risk for receiving a cut was related to a false move during a procedure, reassembling devices and handing devices to a colleague. The highest proportion of needlestick injuries among physicians (22%) and nurses (39%) was related to recapping of used needles. No HIV-infected HCW was identified. Prevalence of HCV infection was 5%, anti-HBc was present among 29% with 2% being HBsAg carriers. CONCLUSIONS: Data from this study can be utilized in educational programs and implementation of universal safety precautions for HCWs in Georgia to help achieve similar reductions in blood-borne infection transmission to those achieved in developed countries. |
Evaluation of sampling probes for fit testing N95 filtering facepiece respirators
Bergman MS , Viscusi DJ , Zhuang Z , Newcomb WE . Ann Occup Hyg 2012 57 (4) 507-18 Previous studies have shown a sampling probe bias for measuring fit factors (FFs) in respirator facepieces. This study was conducted to evaluate three sampling probes for fit testing NIOSH-certified N95 filtering facepiece respirators (FFRs). Two phases of fit test experiments were conducted incorporating 'side-by-side' probe mounting: (i) flush probe versus deep probe and (ii) flush probe versus disc probe. Seven test subjects in Phase 1 and six subjects in Phase 2 were fit tested with one to three N95 FFR models for a total of 10 subject/FFR model combinations for each phase. For each experimental condition, induced faceseal leakage (IFSL) through an induced leak was measured using a PORTACOUNT(R) Plus model 8020A Respirator Fit Tester with a model 8095 N95-Companion accessory. For Phase 1, the mean IFSL of all flush probe measurements (3.6%) was significantly greater than (P < 0.05) the mean IFSL of all deep probe measurements (3.3%). For Phase 2, the mean IFSL of all flush probe measurements (8.5%) was not significantly greater than (P > 0.05) the mean IFSL of all disc probe measurements (8.3%). Results indicate that some leak site and subject/FFR model/leak site combination comparisons (flush probe versus deep probe or flush probe versus disc probe) were statistically different (P < 0.05). The overall mean IFSL for subject/FFR model/leak site combinations differed by 14 and 4% for the flush probe versus deep probe and the flush probe versus disc probe, respectively; however, from a practical standpoint, there is little difference between the flush probe tests compared with the deep probe or disc probe tests. Overall, IFSL measured using the flush probe is higher (resulting in a more conservative measure of faceseal leakage) compared with either the deep probe or disc probe. The more conservative results obtained using the flush probe provide support for its common usage for fit testing cup-shaped FFRs in the USA and potential use for fit testing FFRs in Europe. |
Incidence of malaria among mosquito collectors conducting human landing catches in western Kenya
Gimnig JE , Walker ED , Otieno P , Kosgei J , Olang G , Ombok M , Williamson J , Marwanga D , Abong'o D , Desai M , Kariuki S , Hamel MJ , Lobo NF , Vulule J , Bayoh MN . Am J Trop Med Hyg 2012 88 (2) 301-8 The human landing catch (HLC) has long been the gold standard for estimating malaria transmission by mosquitoes, but has come under scrutiny because of ethical concerns of exposing collectors to infectious bites. We estimated the incidence of Plasmodium falciparum malaria infection in a cohort of 152 persons conducting HLCs and compared it with that of 147 non-collectors in western Kenya. Participants were presumptively cleared of malaria with Coartem (artemether-lumefantrine) and tested for malaria every 2 weeks for 12 weeks. The HLC collections were conducted four nights per week for six weeks. Collectors were provided chemoprophylaxis with Malarone (atovaquone-proguanil) during the six weeks of HLC activities and one week after HLC activities were completed. The incidence of malaria was 96.6% and was lower in collectors than in non-collectors (hazard ratio = 0.034, P < 0.0001). Therefore, with proper prophylaxis, concern about increased risk of malaria among collectors should not be an impediment to conducting HLC studies. |
International guidelines for the in vivo assessment of skin properties in non-clinical settings: part 1. pH
Stefaniak AB , Plessis JD , John SM , Eloff F , Agner T , Chou TC , Nixon R , Steiner MF , Kudla I , Linn Holness D . Skin Res Technol 2012 19 (2) 59-68 BACKGROUND: Skin surface pH is known to influence the dissolution and partitioning of chemicals and may influence exposures that lead to skin diseases. Non-clinical environments (e.g. workplaces) are highly variable, thereby presenting unique measurement challenges that are not typically encountered in clinical settings. Hence, guidelines are needed for consistent measurement of skin surface pH in environments that are difficult to control. METHODS: An expert workshop was convened at the 5th International Conference on Occupational and Environmental Exposure of Skin to Chemicals to review available data on factors that could influence the determination of skin surface pH in non-clinical settings with emphasis on the workplace as a worst case scenario. RESULTS: The key elements of the guidelines are: (i) minimize, to the extent feasible, the influences of relevant endogenous (anatomical position, skin health, time of day), exogenous (hand washing, barrier creams, soaps and detergents, occlusion), environmental (seasonality), and measurement (atmospheric conditions) factors; (ii) report pH measurements results as a difference or percent change (not absolute values) using a measure of central tendency and variability; and (iii) report notable deviations from these guidelines and other relevant factors that may influence measurements. CONCLUSION: Guidelines on the measurement and reporting of skin surface pH in non-clinical settings should promote consistency in data reporting, facilitate inter-comparison of study results, and aid in understanding and preventing occupational skin diseases. |
Visual feedback system to reduce errors while operating roof bolting machines
Steiner LJ , Burgess-Limerick R , Eiter B , Porter W , Matty T . J Safety Res 2012 44 37-44 Operators of roof bolting machines in underground coal mines do so in confined spaces, and in very close proximity to the moving equipment. Errors in the operation of these machines can have serious consequences, and the design of the equipment interface has a critical role in reducing the probability of such errors. Shape coding or length controls may reduce selection errors, and ensuring directional control-response compatibility may reduce direction errors. These issues have previously been examined using a virtual analogy of roof bolting. Another potential control measure is to provide advance visual feedback to the operator regarding the response selected, before the response is activated, with the aim of improving the rate of learning, and the speed with which error correction can occur. An experiment was conducted to explore coding and directional compatibility on actual roof bolting equipment, and to determine the feasibility of a visual feedback system to alert operators of critical movements and to also alert other workers in close proximity to the equipment to the pending movement of the machine. The quantitative results of the study confirmed the potential for both selection errors and direction errors to be made, particularly during training. Subjective data confirmed a potential benefit of providing visual feedback of the intended operations and movements of the equipment. Applications beyond mining can extend to any control design where feedback is critical to the health and safety of the operator and there is a need to improve situational awareness. |
Malaria diagnosed by autopsy in a young traveler returning from Uganda: limitations of surveillance
Taylor CA , Blau DM , Diangelo CR , Shieh WJ , Zaki SR , Arguin PM . J Travel Med 2013 20 (1) 47-9 Fatal infectious disease acquired during international travel is less likely to be captured through existing surveillance when diagnosis is delayed or missed, especially as autopsy rates decline. Death of a young girl owing to malaria demonstrates needs for increased examination of travel-related deaths through postmortem investigation, autopsy, and expanded surveillance. |
Reducing barriers to breast cancer care through Avon patient navigation programs
Stanley S , Arriola KJ , Smith S , Hurlbert M , Ricci C , Escoffery C . J Public Health Manag Pract 2012 19 (5) 461-7 CONTEXT: Avon Foundation for Women grantees provide breast cancer services through patient navigation (PN) in an effort to alleviate barriers to care among underserved women. OBJECTIVE: To gain a better understanding of how PN programs function, this study explores variations in the use of navigators, types of services offered, description of clients they serve, tracking of treatment completion, and evaluation mechanisms. PARTICIPANTS: Fifty-six Avon PN programs funded since 2008 throughout the United States were contacted. DESIGN: An online survey was distributed to the grantees of which 44 (81%) complete responses were collected and analyzed. RESULTS: Clients were racially and ethnically diverse, mostly in the 40- to 64-year old age range (64%) and 91.6% with an average income of less than $30,000. Women were either uninsured (50.7%) or receiving Medicaid (32.4%). PN programs were both community and hospital-based (22.5%); many hospitals (35.2%) were described as safety nets (eg, provide a significant level of care to low-income, uninsured, vulnerable populations). On-site services included breast screening (eg, mammography and breast ultrasound) and treatment (eg, breast surgery and radiation therapy). Some barriers to care identified by the programs included transportation, access to appointments, language, and financial issues (eg, cost of screening and treatment specifically for those uninsured). More than 39% of programs provided care across the cancer continuum. CONCLUSIONS: Many Avon PN programs incorporated navigation services that span the cancer care continuum. They addressed disparities by offering navigation and on-site medical services to reduce multiple systems barriers and social issues related to breast care. |
State adolescent consent laws and implications for HIV pre-exposure prophylaxis
Culp L , Caucci L . Am J Prev Med 2013 44 S119-24 BACKGROUND: Recent large clinical trials have found that pre-exposure prophylaxis (PrEP) reduced HIV infection among men who have sex with men (MSM), but efforts to provide clinical care to minors, including young MSM, may be complicated by a lack of clarity regarding parental consent requirements with respect to medical services. PURPOSE: The goal of this paper was to analyze law related to a minor's ability to consent to medical care, including HIV diagnostic testing and treatment, and its implications for PrEP. METHODS: Analysis was performed in 2012 on laws current as of December 31, 2011. Public Health Law Program staff collected all statutes and regulations pertaining to an adolescent's ability to consent to HIV diagnostic testing and treatment and sexually transmitted infection (STI) diagnostic testing, treatment, and prevention. RESULTS: No state expressly prohibits minors' access to PrEP or other HIV prevention methods. All jurisdictions expressly allow some minors to consent to medical care for the diagnosis or treatment of STIs, but only eight jurisdictions allow consent to preventive or prophylactic services. Thirty-four states either expressly allow minors to consent to HIV services or allow consent to STI or communicable disease services and classify HIV as an STI or communicable disease. Seventeen jurisdictions allow minors to consent to STI testing and treatment, but they do not have an express HIV provision nor classify HIV as an STI or communicable disease. CONCLUSIONS: Minors' access to PrEP without parental consent is unclear, and further analysis is needed to evaluate how state law may relate to the provision of clinical interventions for the prevention of HIV infection. |
An evaluation of situation reports and incident notices: the DBPR/ESRB experience
Fajardo GC , Rosenberg P , Hayashi K . J Public Health Manag Pract 2012 22 (3) E29-38 OBJECTIVE: The main objective of this study is to review information within the situation reports (SITREPs) and incident notices (INs) prepared by the Division of Bioterrorism Preparedness and Response/Epidemiology Surveillance and Response Branch, (DBPR/ESRB), Centers for Disease Control and Prevention (CDC). The secondary objective is to evaluate accuracy and completeness of the information provided in these documents. METHODS: The authors reviewed all SITREPs/INs prepared by DBPR/ESRB from January 2007 to June 2009. Data were abstracted for variables related to the type of incidents, the type of CDC assistance requested, the geographic origin of the calls, and the organization reporting the event or requesting CDC assistance or both. In addition, variables were also created to assess the accuracy and completeness of reports for quality improvement analysis. RESULTS: The DBPR/ESRB prepared 77 SITREPs and 22 INs. Most of them were related to unknown white powders/suspicious packages or BioWatch Actionable Reports (78%). Most calls (79%), requesting CDC assistance or not, were domestic. Almost all calls requesting CDC assistance were for clinical and/or laboratory consultation and/or request for analysis of samples. Most of the calls requesting CDC assistance came from city, county, state, or federal government agencies and military organizations (82%). However, 14 of the analyzed documents (14.4%) were misclassified, that is, a SITREP was written when it should have been an IN or vice versa. The authors also noted the absence of some relevant information among some of the documents, for example, date/time of update. CONCLUSIONS: All of the issues/incidents reported in this article to which DBPR/ESRB responded were cause for legitimate concern. However, significant improvement can be made in the preparation of these reports by CDC staff to ensure efficient and effective response from CDC and its partners. Finally, local entities may wish to develop a similar documentation and reporting process to help manage significant incidents. |
Knowledge, attitudes, and practices regarding Rocky Mountain spotted fever among healthcare providers, Tennessee, 2009
Mosites E , Carpenter LR , McElroy K , Lancaster MJ , Ngo TH , McQuiston J , Wiedeman C , Dunn JR . Am J Trop Med Hyg 2012 88 (1) 162-6 Tennessee has a high incidence of Rocky Mountain spotted fever (RMSF), the most severe tick-borne rickettsial illness in the United States. Some regions in Tennessee have reported increased illness severity and death. Healthcare providers in all regions of Tennessee were surveyed to assess knowledge, attitudes, and perceptions regarding RMSF. Providers were sent a questionnaire regarding knowledge of treatment, diagnosis, and public health reporting awareness. Responses were compared by region of practice within the state, specialty, and degree. A high proportion of respondents were unaware that doxycycline is the treatment of choice in children ≤ 8 years of age. Physicians practicing in emergency medicine, internal medicine, and family medicine; and nurse practitioners, physician assistants, and providers practicing for < 20 years demonstrated less knowledge regarding RMSF. The gaps in knowledge identified between specialties, designations, and years of experience can help target education regarding RMSF. |
Promoting hearing loss prevention in audiology practice
Byrne DC , Themann CL , Meinke DK , Morata TC , Stephenson MR . Perspect Pub Health Iss Rel Hear Bal 2012 13 (1) 3-19 An audiologist should be the principal provider and advocate for all hearing loss prevention activities. Many audiologists equate hearing loss prevention with industrial audiology and occupational hearing conservation programs. However, an audiologist's involvement in hearing loss prevention should not be confined to that one particular practice setting. In addition to supervising occupational programs, audiologists are uniquely qualified to raise awareness of hearing risks, organize public health campaigns, promote healthy hearing, implement intervention programs, and monitor outcomes. For example, clinical audiologists can show clients how to use inexpensive sound level meters, noise dosimeters, or phone apps to measure noise levels, and recommend appropriate hearing protection. Audiologists should identify community events that may involve hazardous exposures and propose strategies to minimize risks to hearing. Audiologists can help shape the knowledge, beliefs, motivations, attitudes, and behaviors of individuals toward self-protection. An audiologist has the education, tools, opportunity, and strategic position to facilitate or promote hearing loss surveillance and prevention services and activities. This article highlights real-world examples of the various roles and substantial contributions audiologists can make toward hearing loss prevention goals. |
Variation in prevalence of gestational diabetes among hospital discharges for obstetric delivery across 23 states in the United States
Bardenheier BH , Elixhauser A , Imperatore G , Devlin HM , Kuklina EV , Geiss LS , Correa A . Diabetes Care 2012 36 (5) 1209-14 OBJECTIVE: To examine variability in diagnosed gestational diabetes mellitus (GDM) prevalence at delivery by race/ethnicity and state. RESEARCH DESIGN AND METHODS: We used data from the Healthcare Cost and Utilization Project State Inpatient Databases for 23 states of the United States with available race/ethnicity data for 2008 to examine age-adjusted and race-adjusted rates of GDM by state. We used multilevel analysis to examine factors that explain the variability in GDM between states. RESULTS: Age-adjusted and race-adjusted GDM rates (per 100 deliveries) varied widely between states, ranging from 3.47 in Utah to 7.15 in Rhode Island. Eighty-six percent of the variability in GDM between states was explained as follows: 14.7% by age; 11.8% by race/ethnicity; 5.9% by insurance; and 2.9% by interaction between race/ethnicity and insurance at the individual level; 17.6% by hospital level factors; 27.4% by the proportion of obese women in the state; 4.3% by the proportion of Hispanic women aged 15-44 years in the state; and 1.5% by the proportion of white non-Hispanic women aged 15-44 years in the state. CONCLUSIONS: Our results suggest that GDM rates differ by state, with this variation attributable to differences in obesity at the population level (or "at the state level"), age, race/ethnicity, hospital, and insurance. |
Preconception health among women with frequent mental distress: a population-based study
Farr SL , Bish CL . J Womens Health (Larchmt) 2012 22 (2) 153-8 PURPOSE: We examined the extent to which mental distress may be associated with a woman's preconception health. METHODS: We analyzed population-based, self-reported data from the 2005, 2007, and 2009 Behavioral Risk Factor Surveillance System (BRFSS) and limited analyses to 213,137 women aged 18-44 years. Women whose mental health was not good for ≥14 days during the past month were categorized as having frequent mental distress. For 15 preconception health indicators, we used chi-square tests to measure differences in prevalence by mental distress and the average marginal predictions approach to logistic regression to assess associations between mental distress and each preconception health indicator in separate models, adjusted for demographic characteristics. We conducted analyses using SUDAAN software to account for the complex sampling design and used weights to produce unbiased estimates. RESULTS: The prevalence of good preconception health for each indicator was higher for women reporting infrequent mental distress (chi-square p value<0.001 for all). The greatest disparities in preconception health between women with infrequent and frequent mental distress, respectively, were adequate social and emotional support (adjusted prevalence ratio [aPR]=1.4, prevalence=83.7% and 54.8%), not smoking (aPR=1.2, 82.3% and 62.4%), adequate fruit and vegetable consumption (aPR=1.2, 26.1% and 21.5%), normal weight (aPR=1.2, 50.4% and 39.0%), and good general health (aPR=1.2, 91.7% and 71.5%). CONCLUSIONS: Interventions tailored for women with poor mental health may be needed to target specific preconception health indicators, such as social support, smoking, weight, and nutrition. |
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