Forecasting the morbidity and mortality associated with prevalent cases of pre-cirrhotic chronic hepatitis C in the United States
Rein DB , Wittenborn JS , Weinbaum CM , Sabin M , Smith BD , Lesesne SB . Dig Liver Dis 2011 43 (1) 66-72 BACKGROUND: Without diagnosis and antiviral therapy, many patients with chronic hepatitis C infections will develop end-stage liver disease and die from complications. AIMS: To evaluate the future impacts of preventive interventions and treatment advances, this paper forecasts a baseline estimate of the future morbidity and mortality of prevalent hepatitis C when left untreated. METHODS: We simulated the future disease progression and death for all Americans with prevalent hepatitis C in 2005. To validate the model, we used past seroprevalence to forecast contemporary outcomes. We used the validated model to forecast future cases of end-stage liver disease, transplants, and deaths from 2010 to 2060, and we estimated credible intervals using Monte Carlo simulation. RESULTS: When programmed with past data, our model predicted current levels of hepatitis C outcomes with accuracy between +/-1% and 13%. Morbidity and mortality from hepatitis C will rise from 2010 to a peak between the years 2030 and 2035. We forecasted a peak of 38,600 incident cases of end-stage liver disease; 3200 referrals for transplant; and 36,100 deaths. CONCLUSIONS: Because current rates of screening and treatment are low, future morbidity and mortality from hepatitis C are likely to increase substantially without public health interventions to increase treatment. |
Identifying adults at high risk for diabetes and cardiovascular disease using hemoglobin A1c National Health and Nutrition Examination Survey 2005-2006
Ackermann RT , Cheng YJ , Williamson DF , Gregg EW . Am J Prev Med 2011 40 (1) 11-7 BACKGROUND: The American Diabetes Association (ADA) recently proposed the use of hemoglobin A1c as a practical and valid strategy to identify high-risk people for whom delivery of an intensive lifestyle intervention to prevent type 2 diabetes is likely to be cost effective. PURPOSE: To estimate composite risks of developing diabetes and cardiovascular disease (CVD) for adults with different hemoglobin A1c test results and to compare those risks with those of adults who met the 2003 ADA definition for prediabetes. METHODS: Cross-sectional data from the 2005-2006 National Health and Nutrition Examination Survey were analyzed in 2009. The method of Stern and colleagues was used to estimate the 7.5-year probability of type 2 diabetes, and the Framingham General CVD Risk Engine was used to estimate the 10-year probability of CVD for adults with different A1c results. Sample weights were used to account for sampling probability and to adjust for noncoverage and nonresponse. RESULTS: Among adults meeting the 2003 ADA definition for prediabetes, the probabilities for incident type 2 diabetes (over 7.5 years) and CVD (over 10 years) were 33.5% and 10.7%, respectively. Use of A1c alone, in the range of 5.5% to <6.5%, would identify a population with comparable risks for diabetes (32.4% [SE=1.2%]) and CVD (11.4% [SE=0.6%]). A slightly higher cutoff (≥5.7%) would identify adults with risks of 41.3% (SE=1.5%) for diabetes and 13.3% (SE=0.8%) for CVD-risks that are comparable to people enrolled in the Diabetes Prevention Program. CONCLUSIONS: A1c-based testing in clinical settings should be considered as a means to identify greater numbers of adults at high risk of developing type 2 diabetes and CVD. |
Clostridium difficile infection among children with cancer
Tai E , Richardson LC , Townsend J , Howard E , McDonald LC . Pediatr Infect Dis J 2011 30 (7) 610-2 We used data from the Kids' Inpatient Database to examine Clostridium difficile infection (CDI) among children with cancer. The CDI rate was 15 times greater among children with cancer compared with those without cancer. Children with cancer accounted for 21% of all pediatric CDI cases. Increased adherence to infection control recommendations is needed to address CDI in children with cancer. |
Patient preference for patient-delivered partner therapy: exploratory findings from three sexually transmitted disease clinics
Howard EJ , Xu F , Taylor SN , Stoner BP , Mena L , Nsuami MJ , Powell S , Lillis R , Martin DH . Sex Transm Dis 2011 38 (2) 148-9 Chlamydia trachomatis (CT) is the most common sexually transmitted bacterial infection reported in the United States.1 Most recurrent CT infections in women in the first few months after treatment are due to reinfection by an untreated male partner.2 The Centers for Disease Control and Prevention (CDC) recommend that all persons with a diagnosis of CT infection be candidates for partner services. Patient-delivered partner therapy (PDPT), where patients are given medication to deliver to each sex partner, is an important strategy for partner services when resources are limited.3 PDPT has been shown to reduce the risk for reinfection with CT.4,5 This study aimed to describe the partner treatment preference of patients visiting urban sexually transmitted disease (STD) clinics. | Men and women who visited STD clinics in 3 US cities—New Orleans, LA; Jackson, MS; and St. Louis, MO—between June and September 2008 were invited to complete a short survey before being seen at the clinic. The survey was piloted at each study clinic before its implementation. The study was approved by institution review boards at each institution and the CDC and was exempt from informed consent. A total of 2887 individuals completed the survey. Over 90% of participants were blacks, 49.7% were female, and the mean age was 27.1 year (men: 28.4, women: 25.9). |
A comparison of the epidemiology and clinical presentation of seasonal influenza A and 2009 pandemic influenza A (H1N1) in Guatemala
Lindblade KA , Arvelo W , Gray J , Estevez A , Frenkel G , Reyes L , Moscoso F , Moir JC , Fry AM , Olsen SJ . PLoS One 2010 5 (12) e15826 BACKGROUND: A new influenza A (H1N1) virus was first found in April 2009 and proceeded to cause a global pandemic. We compare the epidemiology and clinical presentation of seasonal influenza A (H1N1 and H3N2) and 2009 pandemic influenza A (H1N1) (pH1N1) using a prospective surveillance system for acute respiratory disease in Guatemala. METHODOLOGY/FINDINGS: Patients admitted to two public hospitals in Guatemala in 2008-2009 who met a pneumonia case definition, and ambulatory patients with influenza-like illness (ILI) at 10 ambulatory clinics were invited to participate. Data were collected through patient interview, chart abstraction and standardized physical and radiological exams. Nasopharyngeal swabs were taken from all enrolled patients for laboratory diagnosis of influenza A virus infection with real-time reverse transcription polymerase chain reaction. We identified 1,744 eligible, hospitalized pneumonia patients, enrolled 1,666 (96%) and tested samples from 1,601 (96%); 138 (9%) had influenza A virus infection. Surveillance for ILI found 899 eligible patients, enrolled 801 (89%) and tested samples from 793 (99%); influenza A virus infection was identified in 246 (31%). The age distribution of hospitalized pneumonia patients was similar between seasonal H1N1 and pH1N1 (P = 0.21); the proportion of pneumonia patients <1 year old with seasonal H1N1 (39%) and pH1N1 (37%) were similar (P = 0.42). The clinical presentation of pH1N1 and seasonal influenza A was similar for both hospitalized pneumonia and ILI patients. Although signs of severity (admission to an intensive care unit, mechanical ventilation and death) were higher among cases of pH1N1 than seasonal H1N1, none of the differences was statistically significant. CONCLUSIONS/SIGNIFICANCE: Small sample sizes may limit the power of this study to find significant differences between seasonal influenza A and pH1N1. In Guatemala, influenza, whether seasonal or pH1N1, appears to cause severe disease mainly in infants; targeted vaccination of children should be considered. |
Using community-based participatory approaches to mobilize communities for policy change
Wynn TA , Taylor-Jones MM , Johnson RE , Bostick PB , Fouad M . Fam Community Health 2011 34 Suppl 1 S102-14 The Racial and Ethnic Approaches to Community Health (REACH) Alabama Breast and Cervical Cancer Coalition used community-based participatory research principles to address breast and cervical cancer disparities among Alabama's most vulnerable African American communities. With funding from the Centers for Disease Control and Prevention, the Alabama Breast and Cervical Cancer Coalition implemented a multilevel action plan, which entailed disseminating evidence-based strategies to community organizations interested in addressing cancer and other health disparities. Based on the Alabama Breast and Cervical Cancer Coalition's technical assistance on advocacy, an independent, community-led coalition was formed. This article uses a case study approach to document the steps taken by this empowered coalition to mobilize their community to impact cancer disparities using community-based participatory research principles as a tool to change tobacco and breast and cervical cancer legislation. |
Efforts to decrease diabetes-related amputations in African Americans by the Racial and Ethnic Approaches to Community Health Charleston and Georgetown Diabetes Coalition
Jenkins C , Myers P , Heidari K , Kelechi TJ , Buckner-Brown J . Fam Community Health 2011 34 Suppl 1 S63-78 Diabetes is the leading cause of amputation of the lower limbs. Yet, half of these amputations might be prevented through simple but effective foot care practices. This article describes the progress made in the reduction of lower extremity amputations in people with diabetes by the Racial and Ethnic Approaches to Community Health (REACH) Charleston and Georgetown Diabetes Coalition. The coalition's community action plan and interventions were based on an expanded Chronic Care Model that spawned changes in policies, health and education systems, and other community systems for people with diabetes and their support systems. |
Foreword. REACH U.S. in action: inspiring hope, rewarding courage
Liburd LC . Fam Community Health 2011 34 Suppl 1 S2-6 I am writing this foreword just days after returning from the 20th International Union for Health Promotion and Education World Conference on Health Promotion in Geneva, Switzerland (July 11-15, 2010). The primary goals of the conference were to “build bridges between sustainable development and health promotion, the outreach of health in all policies, and the transfer of knowledge with long-term impact” (http://www.iuhpe.org). More than 2200 health promoters from 123 countries and all continents contemplated how we might achieve health equity and sustainable development in a global environment of overtaxed natural resources, struggling political economies, and competing ideologies about the way forward. Notable speakers from around the world described the interconnectedness between how we use the finite resources of the planet; policies governing globalization; social, political, and economic inequality within and between nation-states; and the people's health. Promising strategies were showcased, and provocative conversations reframing more traditional approaches to protecting the public's health were presented. Translate this broad thinking to the community level, and we see a snapshot of the day-to-day realities, experience, leadership, and community-based participatory approaches of Racial and Ethnic Approaches to Community Health Across the United States (REACH U.S.) in eliminating racial and ethnic health disparities. | This special issue of the Journal of Family and Community Health provides a much needed collection of community voices describing how they are working to transform their social environments—one victory at a time—to improve health outcomes in communities that are disproportionately affected by preventable premature death and treatable disability. In preparing the reader for this special issue, I first of all situate the work of REACH U.S. in the global movement to reduce health inequalities through attention to the social determinants of health. I describe how the REACH experience in addressing the social determinants of health reflects a familiar clash of interests of people at the nexus of industry (including art), politics, and science. In these articles, we discover through detailed case studies how local communities resolved some of these competing interests. At the end, I briefly broach the issue of culture as a social determinant of health, and how community health workers have been vital resources in eliminating health disparities as both cultural translators and frontline advocates for health equity. |
Reducing asthma disparities by addressing environmental inequities: a case study of Regional Asthma Management and Prevention's advocacy efforts
Lamb AK , Ervice J , Lorenzen K , Prentice B , White S . Fam Community Health 2011 34 Suppl 1 S54-62 Regional Asthma Management and Prevention describes its collaborative approach to address a social determinant of health--air quality--and the associated inequities that have led to asthma disparities impacting African American and Latino communities in the San Francisco Bay Area. The strategies, aimed at decreasing diesel pollution in disproportionately impacted communities, span the levels of the socioecological model, with an emphasis on policy outcomes. Regional Asthma Management and Prevention describes how this work fits within a larger comprehensive approach to address asthma disparities encompassing several components, ranging from clinical management to environmental protection. |
Mold exposure and respiratory health in damp indoor environments
Park JH , Cox-Ganser JM . Front Biosci (Elite Ed) 2011 3 (2) 757-71 Almost all modern buildings experience at least minor, and sometimes serious, water damage during their life span. Excess moisture in buildings becomes a critical factor for mold (fungal) proliferation in nutrient-rich environments. As a result, building occupants may be exposed to increased levels of microbial agents such as fungal spores, cell fragments, cell wall components, or toxins. Such exposures may result in various diseases and symptoms, both respiratory and non-respiratory. Respiratory health complaints are common in damp buildings and have been more thoroughly studied than non-respiratory complaints. Respiratory diseases and symptoms which may be produced by exposure to indoor fungi include asthma development, exacerbation of asthma, hypersensitivity pneumonitis, cough, wheeze, dyspnea (shortness of breath), nasal and throat symptoms, and respiratory infections. In addition to these illnesses, rhinosinusitis and sarcoidosis in water-damaged building occupants are also drawing more scientific attention. In this article, we explore the evidence for adverse effects of fungal exposure on respiratory health in damp indoor environments and potential disease mechanisms related to the exposure. |
Reaction rates of ozone and terpenes adsorbed to model indoor surfaces
Springs M , Wells JR , Morrison G . Indoor Air 2010 21 (4) 319-27 Reaction rates and reaction probabilities have been quantified on model indoor surfaces for the reaction of ozone with two monoterpenes (Delta(3) -carene and d-limonene). Molar surface loadings were obtained by performing breakthrough experiments in a plug-flow reactor (PFR) packed with beads of glass, polyvinylchloride or zirconium silicate. Reaction rates and probabilities were determined by equilibrating the PFR with both the terpene and ozone and measuring the ozone consumption rate. To mimic typical indoor conditions, temperatures of 20 degrees C, 25 degrees C, and 30 degrees C were used in both types of experiments along with a relative humidity ranging from 10% to 80%. The molar surface loading decreased with increased relative humidity, especially on glass, suggesting that water competed with the terpenes for adsorption sites. The ozone reactivity experiments indicate that higher surface loadings correspond with higher ozone uptake. The reaction probability for Delta(3) -carene with ozone ranged from 2.9x10(-6) to 3.0x10(-5) while probabilities for d-limonene ranged from 2.8x10(-5) to 3.0x10(-4) . These surface reaction probabilities are roughly 10 to 100 times greater than the corresponding gas-phase values. Extrapolation of these results to typical indoor conditions suggests that surface conversion rates may be substantial relative to gas-phase rates, especially for lower volatility terpenoids. |
Foodborne illness acquired in the United States-major pathogens
Scallan E , Hoekstra RM , Angulo FJ , Tauxe RV , Widdowson MA , Roy SL , Jones JL , Griffin PM . Emerg Infect Dis 2011 17 (1) 7-15 Estimates of foodborne illness can be used to direct food safety policy and interventions. We used data from active and passive surveillance and other sources to estimate that each year 31 major pathogens acquired in the United States caused 9.4 million episodes of foodborne illness (90% credible interval [CrI] 6.6-12.7 million), 55,961 hospitalizations (90% CrI 39,534-75,741), and 1,351 deaths (90% CrI 712-2,268). Most (58%) illnesses were caused by norovirus, followed by nontyphoidal Salmonella spp. (11%), Clostridium perfringens (10%), and Campylobacter spp. (9%). Leading causes of hospitalization were nontyphoidal Salmonella spp. (35%), norovirus (26%), Campylobacter spp. (15%), and Toxoplasma gondii (8%). Leading causes of death were nontyphoidal Salmonella spp. (28%), T. gondii (24%), Listeria monocytogenes (19%), and norovirus (11%). These estimates cannot be compared with prior (1999) estimates to assess trends because different methods were used. Additional data and more refined methods can improve future estimates. |
Foodborne illness acquired in the United States-unspecified agents
Scallan E , Griffin PM , Angulo FJ , Tauxe RV , Hoekstra RM . Emerg Infect Dis 2011 17 (1) 16-22 Each year, 31 major known pathogens acquired in the United States caused an estimated 9.4 million episodes of foodborne illness. Additional episodes of illness were caused by unspecified agents, including known agents with insufficient data to estimate agent-specific illness, known agents not yet recognized as causing foodborne illness, substances known to be in food but of unproven pathogenicity, and unknown agents. To estimate these additional illnesses, we used data from surveys, hospital records, and death certificates to estimate illnesses, hospitalizations, and deaths from acute gastroenteritis and subtracted illnesses caused by known gastroenteritis pathogens. If the proportions acquired by domestic foodborne transmission were similar to those for known gastroenteritis pathogens, then an estimated 38.4 million (90% credible interval [CrI] 19.8-61.2 million) episodes of domestically acquired foodborne illness were caused by unspecified agents, resulting in 71,878 hospitalizations (90% CrI 9,924-157,340) and 1,686 deaths (90% CrI 369-3,338). |
Synopsis of preterm birth genetic association studies: the preterm birth genetics knowledge base (PTBGene).
Dolan SM , Hollegaard MV , Merialdi M , Betran AP , Allen T , Abelow C , Nace J , Lin BK , Khoury MJ , Ioannidis JP , Bagade S , Zheng X , Dubin RA , Bertram L , Velez Edwards DR , Menon R . Public Health Genomics 2010 13 514-23 AIM: Our goal was to produce a field synopsis of genetic associations with preterm birth and to set up a publicly available online database summarizing the data. METHODS: We performed a systematic review and meta-analyses to identify genetic associations with preterm birth. We have set up a publicly available online database of genetic association data on preterm birth called PTBGene (http://ric.einstein.yu.edu/ptbgene/index.html) and report on a structured synopsis thereof as of December 1, 2008. RESULTS: Data on 189 polymorphisms in 84 genes have been included and 36 meta-analyses have been performed. Five gene variants (4 in maternal DNA, one in newborn DNA) have shown nominally significant associations, but all have weak epidemiological credibility. CONCLUSION: After publishing this field synopsis, the PTBGene database will be regularly updated to keep track of the evolving evidence base of genetic factors in preterm birth with the goal of promoting knowledge sharing and multicenter collaboration among preterm birth research groups. |
Endurance, refuge, and reemergence of dengue virus type 2, Puerto Rico, 1986-2007
McElroy KL , Santiago GA , Lennon NJ , Birren BW , Henn MR , Munoz-Jordan JL . Emerg Infect Dis 2011 17 (1) 64-71 To study the evolution of dengue virus (DENV) serotype 2 in Puerto Rico, we examined the genetic composition and diversity of 160 DENV-2 genomes obtained through 22 consecutive years of sampling. A clade replacement took place in 1994-1997 during a period of high incidence of autochthonous DENV-2 and frequent, short-lived reintroductions of foreign DENV-2. This unique clade replacement was complete just before DENV-3 emerged. By temporally and geographically defining DENV-2 lineages, we describe a refuge of this virus through 4 years of low genome diversity. Our analyses may explain the long-term endurance of DENV-2 despite great epidemiologic changes in disease incidence and serotype distribution. |
Evolutionary history and population dynamics of hepatitis E virus
Purdy MA , Khudyakov YE . PLoS One 2010 5 (12) e14376 BACKGROUND: Hepatitis E virus (HEV) is an enterically transmitted hepatropic virus. It segregates as four genotypes. All genotypes infect humans while only genotypes 3 and 4 also infect several animal species. It has been suggested that hepatitis E is zoonotic, but no study has analyzed the evolutionary history of HEV. We present here an analysis of the evolutionary history of HEV. METHODS AND FINDINGS: The times to the most recent common ancestors for all four genotypes of HEV were calculated using BEAST to conduct a Bayesian analysis of HEV. The population dynamics for genotypes 1, 3 and 4 were analyzed using skyline plots. Bayesian analysis showed that the most recent common ancestor for modern HEV existed between 536 and 1344 years ago. The progenitor of HEV appears to have given rise to anthropotropic and enzootic forms of HEV, which evolved into genotypes 1 and 2 and genotypes 3 and 4, respectively. Population dynamics suggest that genotypes 1, 3 and 4 experienced a population expansion during the 20(th) century. Genotype 1 has increased in infected population size approximately 30-35 years ago. Genotype 3 and 4 have experienced an increase in population size starting late in the 19(th) century until ca.1940-45, with genotype 3 having undergone additional rapid expansion until ca.1960. The effective population size for both genotype 3 and 4 rapidly declined to pre-expansion levels starting in ca.1990. Genotype 4 was further examined as Chinese and Japanese sequences, which exhibited different population dynamics, suggesting that this genotype experienced different evolutionary history in these two countries. CONCLUSIONS: HEV appears to have evolved through a series of steps, in which the ancestors of HEV may have adapted to a succession of animal hosts leading to humans. Analysis of the population dynamics of HEV suggests a substantial temporal variation in the rate of transmission among HEV genotypes in different geographic regions late in the 20(th) Century. |
Influence of family history of cardiovascular disease on clinicians' preventive recommendations and subsequent adherence of patients without cardiovascular disease.
Zlot AI , Valdez R , Han Y , Silvey K , Leman RF . Public Health Genomics 2010 13 457-66 BACKGROUND: Family history of cardiovascular disease (CVD) is an independent risk factor for CVD. Therefore, efforts to prevent CVD among asymptomatic persons with a family history are warranted. Little is known about preventive recommendations clinicians offer their patients with a family history of CVD, and adherence to preventive recommendations by patients at risk for CVD has not been well described. METHODS: We used the 2007 Oregon Behavioral Risk Factor Surveillance System to evaluate among 2,566 adults without CVD associations between family history of CVD and (a) clinician recommendations; (b) perceived risk of developing CVD; (c) adoption of preventive and screening behaviors; and (d) risk factors of CVD. RESULTS: Compared with adults with no family history of CVD, those with a family history reported that their clinician was more likely to ask about their family history information (OR = 2.6; 95% CI, 1.9-3.4), discuss the risk of developing CVD (OR = 2.0; 95% CI, 1.6-2.5), and make recommendations to prevent CVD (OR = 2.1; 95% CI, 1.7-2.7). Family history and clinician recommendations were associated with a higher likelihood of reported changes in diet or physical activity to prevent CVD (OR = 2.7; 95% CI, 2.3-3.2). Persons with a family history of CVD were more likely to report having high cholesterol, having high blood pressure, taking aspirin, and having had their cholesterol checked. CONCLUSION: The presence of a family history of CVD appears to prompt clinicians to recommend preventive changes and may motivate patients without CVD to adopt these recommendations. |
The Treatment Advocacy Program: a randomized controlled trial of a peer-led safer sex intervention for HIV-infected men who have sex with men
McKirnan DJ , Tolou-Shams M , Courtenay-Quirk C . J Consult Clin Psychol 2010 78 (6) 952-63 OBJECTIVE: Primary care may be an effective venue for delivering behavioral interventions for sexual safety among HIV-positive men who have sex with men (MSM); however, few studies show efficacy for such an approach. We tested the efficacy of the Treatment Advocacy Program (TAP), a 4-session, primary-care-based, individual counseling intervention led by HIV-positive MSM "peer advocates" in reducing unprotected sex with HIV-negative or unknown partners (HIV transmission risk). METHOD: We randomized 313 HIV-positive MSM to TAP or standard care. HIV transmission risk was assessed at baseline, 6 months, and 12 months (251 participants completed all study waves). We conducted intent-to-treat analyses using general estimating equations to test the interaction of group (TAP vs. standard care) by follow-up period. RESULTS: At study completion, TAP participants reported greater transmission risk reduction than did those receiving standard care, chi2(2, N = 249) = 6.6, p = .04. Transmission risk among TAP participants decreased from 34% at baseline to about 20% at both 6 and 12 months: Transmission risk ranged from 23% to 25% among comparison participants. CONCLUSIONS: TAP reduced transmission risk among HIV-positive MSM, although results are modest. Many participants and peer advocates commented favorably on the computer structure of the program. We feel that the key elements of TAP-computer-based and individually tailored session content, delivered by peers, in the primary care setting-warrant further exploration. |
Varicella-related hospitalizations in the United States, 2000-2006: the 1-dose varicella vaccination era
Lopez AS , Zhang J , Brown C , Bialek S . Pediatrics 2011 127 (2) 238-45 OBJECTIVE: To describe the effect of the mature 1-dose varicella vaccination program on varicella morbidity, we analyzed 2 national databases for varicella-related hospitalizations in the United States since implementation of the varicella vaccination program in 1995. PATIENTS AND METHODS: Data from the National Hospital Discharge Survey and Nationwide Inpatient Sample were analyzed to describe trends in varicella-related hospitalizations during the 1-dose vaccination era (2000-2006) compared with those in the prevaccination era (1988-1995). Varicella-related hospitalizations were defined by using International Classification of Diseases, Ninth Revision codes. Results were extrapolated to represent national estimates. RESULTS: Using National Hospital Discharge Survey data, 24,488 varicella-related hospitalizations were estimated to occur in the United States during the 1-dose vaccination era. The varicella-related hospitalization rate was 0.12 per 10 000 population during the 1-dose vaccination era versus 0.42 per 10,000 population in the prevaccination era (P < .01). During the 1-dose vaccination era, the estimated annual average number of varicella-related hospitalizations was significantly lower and decreased by ≥65% in all age groups compared with those in the prevaccination era (P < .001 in all age groups). The varicella-related hospitalization rate during the 1-dose vaccination era estimated from the Nationwide Inpatient Sample was 0.09 per 10,000 population. CONCLUSIONS: Varicella-related hospitalization numbers and rates declined significantly during the 1-dose varicella vaccination era. Assuming declines in varicella-related hospitalizations are due, mainly, to the routine childhood varicella vaccination program, these data suggest that varicella vaccination prevented approximately 50,000 varicella-related hospitalizations in the United States from 2000 to 2006. |
Early estimate of the effectiveness of quadrivalent meningococcal conjugate vaccine
MacNeil JR , Cohn AC , Zell ER , Schmink S , Miller E , Clark T , Messonnier NE . Pediatr Infect Dis J 2011 30 (6) 451-5 BACKGROUND: In January 2005, a quadrivalent meningococcal conjugate vaccine (MenACWYD) was licensed for use in the United States. The Advisory Committee on Immunization Practices recommends MenACWYD for all adolescents aged 11 to 18 years and others at increased risk for meningococcal disease. METHODS: Reports of breakthrough meningococcal disease after vaccination with MenACWYD were collected. A simulation approach was used to estimate the expected number of cases in vaccinated persons. RESULTS: Between 2005 and 2008, 14 breakthrough cases, including 3 deaths occurred. At a vaccine effectiveness (VE) of 90%, 7 breakthrough cases would be expected (range, 1-17); at VE of 85%, 11 cases (range, 2-30); at VE of 80%, 15 cases (range, 5-28); and at VE of 75%, 18 cases (range, 7-32) would be expected. The probability of the ≥14 observed cases occurring was 2.9% at VE of 90%, 29.3% at VE of 85%, 66.1% at VE of 80%, and 83.0% at VE of 75%. CONCLUSIONS: This report provides an early estimate of MenACWYD effectiveness within 3 to 4 years after vaccination, and suggests that MenACWYD effectiveness is 80% to 85%, similar to the VE reported for meningococcal polysaccharide vaccine. |
Impact of 2-dose vaccination on varicella epidemiology: Connecticut--2005-2008
Kattan JA , Sosa LE , Bohnwagner HD , Hadler JL . J Infect Dis 2011 203 (4) 509-12 In 2006, the Advisory Committee on Immunization Practices recommended that children routinely receive 2 varicella vaccine doses in place of the 1 dose previously recommended. This recommendation's initial impact on varicella epidemiology in Connecticut was assessed. Reported incidence and case-specific data were compared for 2005 and 2008. Varicella incidence decreased from 48.7 cases/100,000 persons in 2005 to 24.5 in 2008. Age-specific incidence decreased significantly (P < .05) among children aged 1-14 years. Reported varicella incidence has declined in Connecticut after implementation of routine 2-dose varicella vaccination for children. Continued surveillance is needed to determine the recommendation's full impact. |
Detection of pneumonia using free-text radiology reports in the BioSense system
Asatryan A , Benoit S , Ma H , English R , Elkin P , Tokars J . Int J Med Inform 2011 80 (1) 67-73 OBJECTIVE: Near real-time disease detection using electronic data sources is a public health priority. Detecting pneumonia is particularly important because it is the manifesting disease of several bioterrorism agents as well as a complication of influenza, including avian and novel H1N1 strains. Text radiology reports are available earlier than physician diagnoses and so could be integral to rapid detection of pneumonia. We performed a pilot study to determine which keywords present in text radiology reports are most highly associated with pneumonia diagnosis. DESIGN: Electronic radiology text reports from 11 hospitals from February 1, 2006 through December 31, 2007 were used. We created a computerized algorithm that searched for selected keywords ("airspace disease", "consolidation", "density", "infiltrate", "opacity", and "pneumonia"), differentiated between clinical history and radiographic findings, and accounted for negations and double negations; this algorithm was tested on a sample of 350 radiology reports. We used the algorithm to study 189,246 chest radiographs, searching for the keywords and determining their association with a final International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis of pneumonia. MEASUREMENTS: Performance of the search algorithm in finding keywords, and association of the keywords with a pneumonia diagnosis. RESULTS: In the sample of 350 radiographs, the search algorithm was highly successful in identifying the selected keywords (sensitivity 98.5%, specificity 100%). Analysis of the 189,246 radiographs showed that the keyword "pneumonia" was the strongest predictor of an ICD-9-CM diagnosis of pneumonia (adjusted odds ratio 11.8) while "density" was the weakest (adjusted odds ratio 1.5). In general, the most highly associated keyword present in the report, regardless of whether a less highly associated keyword was also present, was the best predictor of a diagnosis of pneumonia. CONCLUSION: Empirical methods may assist in finding radiology report keywords that are most highly predictive of a pneumonia diagnosis. |
Antimicrobial resistance among invasive nontyphoidal Salmonella enterica in the United States, National Antimicrobial Resistance Monitoring System, 1996-2007
Crump JA , Medalla FM , Joyce KW , Krueger AL , Hoekstra RM , Whichard JM , Barzilay EJ . Antimicrob Agents Chemother 2011 55 (3) 1148-54 Nontyphoidal salmonellae (NTS) are important causes of community-acquired bloodstream infection. We describe patterns of antimicrobial resistance among invasive NTS in the United States. We compared bloodstream NTS isolates with those from stool submitted to the National Antimicrobial Resistance Monitoring System (NARMS) from 1996-2007. We described antimicrobial resistance among invasive strains by serogroup and serotype. Of the 19,302 NTS, 17,804 (92.2%) were from stool or blood. Of these, 1,050 (5.9%) were bloodstream isolates. The median age (range) of patients with and without bacteremia was 36 (0, 97) years and 20 (0, 105) years, respectively (p<0.001). Males (OR 1.21, 95% CI 1.06, 1.38) and those aged ≥65 years were at greater risk for invasive disease. Enteritidis, Typhimurium, and Heidelberg were the most common serotypes isolated from blood; Dublin, Sandiego, and Schwarzengrund were associated with the greatest risk for bloodstream isolation. Of invasive isolates 208 (19.8%) were resistant to ampicillin, 117 (11.1%) to chloramphenicol, and 26 (2.5%) to trimethoprim-sulfamethoxazole; 28 (2.7%) isolates were resistant to nalidixic acid and 26 (2.5%) to ceftriaxone. Antimicrobial resistance to traditional agents is common. However, the occurrence of nalidixic acid and ceftriaxone resistance among invasive NTS is cause for clinical and public health vigilance. |
CTX-M-producing non-Typhi Salmonella spp. isolated from humans, United States
Sjolund-Karlsson M , Howie R , Krueger A , Rickert R , Pecic G , Lupoli K , Folster JP , Whichard JM . Emerg Infect Dis 2011 17 (1) 97-9 CTX-M-type Beta-lactamases are increasing among US Enterobacteriaceae isolates. Of 2,165 non-Typhi Salmonella isolates submitted in 2007 to the National Antimicrobial Resistance Monitoring System, 100 (4.6%) displayed elevated MICs (≥2 mg/L) of ceftriaxone or ceftiofur. Three isolates (serotypes Typhimurium, Concord, and I 4,5,12:i:-) contained blaCTX-M-5, blaCTX-M-15, and blaCTX-M-55/57, respectively. |
Studies on botulinum neurotoxins type/C1 and mosaic/DC using endopep-MS and proteomics
Moura H , Terilli RR , Woolfitt AR , Gallegos-Candela M , McWilliams LG , Solano MI , Pirkle JL , Barr JR . FEMS Immunol Med Microbiol 2010 61 (3) 288-300 Botulinum neurotoxins (BoNTs) are very potent toxins and category A biological threat agents. BoNT serotypes/C1 and/D affect birds and mammals and can be potentially lethal to humans. We have previously described the usefulness of the Endopep-MS method to detect the activity of BoNT A through G. This report was followed by the application of the method to clinical samples. The activity of the BoNT serotypes associated with human disease (/A,/B,/E, and/F) was successfully detected. However, BoNT/C and/D require different conditions for fast substrate cleavage and a comprehensive description of a method to study BoNT/C and/D has not yet been reported. This work describes a new, optimized version of the Endopep-MS method to detect BoNTs/C1 and/DC either spiked directly in 20 muL of reaction buffer or spiked in a larger volume of buffer and further extracted using antibody-coated magnetic beads. It was found that the incubation temperature at 42 degrees C was more effective for both toxin serotypes, but each toxin serotype has an optimum cleavage pH. Additionally, we describe for the first time a proteomics study using a fast trypsin digestion method and label-free quantification of these toxin serotypes. |
Vitamin E and C supplementation reduces oxidative stress, improves antioxidant enzymes and positive muscle work in chronically loaded muscles of aged rats
Ryan MJ , Dudash HJ , Docherty M , Geronilla KB , Baker BA , Haff GG , Cutlip RG , Alway SE . Exp Gerontol 2010 45 (11) 882-95 Aging is associated with increased oxidative stress. Muscle levels of oxidative stress are further elevated with exercise. The purpose of this study was to determine if dietary antioxidant supplementation would improve muscle function and cellular markers of oxidative stress in response to chronic repetitive loading in aging. The dorsiflexors of the left limb of aged and young adult Fischer 344 BrownxNorway rats were loaded 3 times weekly for 4.5 weeks using 80 maximal stretch-shortening contractions per session. The contra-lateral limb served as the intra-animal control. The rats were randomly assigned to a diet supplemented with Vitamin E and Vitamin C or normal non-supplemented rat chow. Biomarkers of oxidative stress were measured in the tibialis anterior muscle. Repetitive loading exercise increased maximal isometric force, negative work and positive work in the dorsiflexors of young adult rats. Only positive work increased in the aged animals that were supplemented with Vitamin E and C. Markers of oxidative stress (H(2)O(2), total GSH, GSH/GSSG ratio, malondialdehyde and 8-OHdG) increased in the tibialis anterior muscles from aged and young adult animals with repetitive loading, but Vitamin E and C supplements attenuated this increase. MnSOD activity increased with supplementation in the young adult animals. CuZnSOD and catalase activity increased with supplementation in young adult and aged animals and GPx activity increased with exercise in the non-supplemented young adult and aged animals. The increased levels of endogenous antioxidant enzymes after Vitamin E and C supplementation appear to be regulated by post-transcriptional modifications that are affected differently by age, exercise, and supplementation. These data suggest that antioxidant supplementation improves indices of oxidative stress associated with repetitive loading exercise and aging and improves the positive work output of muscles in aged rodents. |
Evaluation of time to detection of Mycobacterium tuberculosis in broth culture as a determinant for end points in treatment trials
Weiner M , Prihoda TJ , Burman W , Johnson JL , Goldberg S , Padayatchi N , Duran P , Engle M , Muzanye G , Mugerwa RD , Sturm AW . J Clin Microbiol 2010 48 (12) 4370-6 Time to detection of Mycobacterium tuberculosis in broth culture was examined for utility as a treatment efficacy end point. Of 146 patients in a phase IIB trial, a decreased mean time to detection was found in 5 with treatment failure. Time to detection in an analysis-of-covariance model was associated with lung cavities, less intensive treatment, and differences in the bactericidal effects of treatment regimens. |
In vivo ribavirin activity against severe pandemic H1N1 influenza A/Mexico/4108/2009
Rowe T , Banner D , Farooqui A , Ng DC , Kelvin AA , Rubino S , Huang SS , Fang Y , Kelvin DJ . J Gen Virol 2010 91 2898-906 The use of ribavirin in influenza treatment is a matter of debate. Due to adamantine- and oseltamivir-resistant strains of the current pandemic H1N1 (pdmH1N1) influenza viruses, the demand for alternative antiviral treatments has increased. This study demonstrated the potent antiviral effects of ribavirin in a mouse model of pdmH1N1 influenza infection (A/Mexico/4108/2009). It was found that treatment with 40 mg ribavirin kg(1) day(1) partially protected the animals if initiated immediately upon infection. Administration of similar concentrations on subsequent days or immediate therapy with lower doses efficiently delayed disease progression. Correlation studies showed a direct relationship between low viral titres in the lung during the early stages of infection with animal survival in ribavirin-treated animals. Reduced lung pathology in animals treated with ribavirin following infection also indicated the importance of immediate treatment. This study revealed the antiviral properties of ribavirin and these results justify comprehensive clinical studies for the use of ribavirin against influenza virus in future outbreaks. |
Evaluation of multiple (3-Cycle) decontamination processing for filtering facepiece respirators
Bergman MS , Viscusi DJ , Heimbuch BK , Wander JD , Sambol AR , Shaffer RE . J Eng Fiber Fabr 2010 5 (4) 33-41 Disposable N95 filtering facepiece respirators (FFRs) certified by the National Institute for Occupational Safety and Health (NIOSH) are widely used by healthcare workers to reduce exposures to infectious biological aerosols. There is currently major concern among public health officials about a possible shortage of N95 FFRs during an influenza pandemic. Decontamination and reuse of FFRs is a possible strategy for extending FFR supplies in an emergency; however, the NIOSH respirator certification process does not currently include provisions for decontamination and reuse. Recent studies have investigated the laboratory performance (filter aerosol penetration and filter airflow resistance) and physical integrity of FFRs following one-cycle (1X) processing of various decontamination treatments. The studies found that a single application of some methods did not adversely affect laboratory performance. In the event that healthcare facilities experience dramatic shortages of FFR supplies, multiple decontamination processing may become necessary. This study investigates three-cycle (3X) processing of eight different methods: ultraviolet germicidal irradiation, ethylene oxide, hydrogen peroxide gas plasma, hydrogen peroxide vapor, microwave-oven-generated steam, bleach, liquid hydrogen peroxide, and moist heat incubation (pasteurization). A four-hour 3X submersion of FFR in deionized water was performed for comparison (control). Following 3X treatment by each decontamination and control method, FFRs were evaluated for changes in physical appearance, odor, and laboratory filtration performance. Only the hydrogen peroxide gas plasma treatment resulted in mean penetration levels 5% for four of the six FFR models; FFRs treated by the seven other methods and the control samples had expected levels of filter aerosol penetration ( 5%) and filter airflow resistance. Physical damage varied by treatment method. Further research is still needed before any specific decontamination methods can be recommended. |
The 2010 update to the NIOSH list of hazardous drugs
Connor TH . Pharm Purch Prod 2010 7 (11) 28-30 When NIOSH first published the alert Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings in September 2004, the driving motivator was to provide health care workers, and their employers, with information on the risks of working with hazardous drugs, as well as measures they could take to protect their health. In the 2004 alert, it was proposed that the list be revised on an annual basis in order to continually provide the most up-to-date information to those workers who may come in contact with hazardous drugs throughout the process of receiving, handling, administration, and disposal. Although annually revising the list has proven untenable, an update to the original listing of NIOSH-designated hazardous drugs was released this past September. |
Association between workaholism and sleep problems among hospital nurses
Kubota K , Shimazu A , Kawakami N , Takahashi M , Nakata A , Schaufeli WB . Ind Health 2010 48 (6) 864-71 The present study examined the association between workaholism, the tendency to work excessively hard in a compulsive fashion, and sleep problems among Japanese nurses. A cross-sectional survey was conducted among 600 nurses from 2 university hospitals in Japan using a self-reported questionnaire on workaholism, sleep, job-related variables (i.e., job demands, job control, and worksite support), and demographic variables. A total of 394 nurses returned the questionnaire (response rate=65.7%) and complete data from 312 female nurses were used for analyses (final coverage rate=52.0%). Workaholics, as measured using the Japanese version of the Dutch Workaholism Scale, were defined as those having high scores on both the "work excessively" and "work compulsively" subscales. Logistic regression analyses revealed that workaholics had higher risks for sleep problems in terms of subjective sleep insufficiency, excessive daytime sleepiness at work, difficulty awakening in the morning, and feeling tired when waking up in the morning (odds ratios [OR] of 4.40, 3.18, 3.48, and 4.61, respectively, p<0.05). These remained significant even after adjusting for demographic and job-related variables (OR 3.41, 5.36, 2.56, and 2.77, respectively). However, no significant associations were found between workaholism and insomnia symptoms. These results suggest that workaholic nurses had higher risks for impaired awakening, insufficient sleep, and workplace sleepiness. |
Public health implications of cysticercosis acquired in the United States
Sorvillo F , Wilkins P , Shafir S , Eberhard M . Emerg Infect Dis 2011 17 (1) 1-6 Cysticercosis has emerged as a cause of severe neurologic disease in the United States that primarily affects immigrants from Latin America. Moreover, the relevance of cysticercosis as a public health problem has been highlighted by local transmission. We searched the biomedical literature for reports documenting cases of cysticercosis acquired in the United States. A total of 78 cases, principally neurocysticercosis, were reported from 12 states during 1954-2005. A confirmed or presumptive source of infection was identified among household members or close personal contacts of 16 (21%) case-patients. Several factors, including the severe, potentially fatal, nature of cysticercosis; its fecal-oral route of transmission; the considerable economic effect; the availability of a sensitive and specific serologic test for infection by adult Taenia solium tapeworms; and the demonstrated ability to find a probable source of infection among contacts, all provide a compelling rationale for implementation of public health control efforts. |
A survey of knowledge, attitudes, and beliefs of medical students concerning antimicrobial use and resistance
Minen MT , Duquaine D , Marx MA , Weiss D . Microb Drug Resist 2010 16 (4) 285-9 Physicians who are insufficiently prepared to make choices on antibiotic selection may use antibiotics inappropriately. We surveyed medical students' perceptions and attitudes about their training on antimicrobial use to identify gaps in medical education. Medical students at an urban medical school in the northeast were e-mailed a link to an online survey. The survey was online for 1 week, after which time the survey responses were downloaded and analyzed. Thirty percent of medical students responded to the survey (n = 304). The majority of third- and fourth-year medical students believe that antibiotics are overused in the hospital and in outpatient areas. Over three quarters of the students would like more education on antibiotic selection, and 83% wanted this education to be during the third year of medical school. The resources they used the most for antibiotic selection included other physicians and handheld programs such as Epocrates, but no clear resource emerged as the dominant preference. Medical students recognized the importance of judicious antibiotic use and would like greater instruction on how to choose antibiotics appropriately. Medical school curricula should be expanded in the third year of medical school to provide students with additional training timed with their clinical rotations. |
Menthol cigarette use among racial and ethnic groups in the United States, 2004-2008
Rock VJ , Davis SP , Thorne SL , Asman KJ , Caraballo RS . Nicotine Tob Res 2010 12 Suppl 2 S117-24 INTRODUCTION: Understanding the patterns of menthol cigarette use can be useful in developing and justifying policies designed to prevent and reduce cigarette use and exposure to tobacco smoke. This report provides an update and summary of the demographic distribution and trends of menthol cigarette use in the United States. METHODS: Data from the 2004-2008 National Survey on Drug Use and Health were analyzed to estimate menthol cigarette use among current smokers by race/ethnicity, sex, and age (12 years and older). A t-test was used to compare estimates for menthol and nonmenthol use by demographic group. Trend analyses were conducted to examine differences in menthol cigarette use by race/ethnicity and age from 2004 to 2008. RESULTS: Over half of menthol cigarette smokers were female (52.2%), and approximately 29.4% of all menthol smokers were Black, which was almost 10 times the percentage of nonmenthol smokers who were Black (3.0%, p < .01). Prevalence of past month menthol cigarette use was highest among current smokers aged 12-17 years (44.7%) and decreased as age group increased. From 2004 to 2008, menthol cigarette use increased significantly among White smokers aged 12-17 years (from 40.3% in 2004 to 46.0% in 2008, p < .01). Menthol cigarette use among young adult smokers aged 18-25 years increased for Hispanics (from 33.9% in 2004 to 42.4% in 2008, p < .01) and Whites (from 26.7% to 32.5%, p < .01). CONCLUSIONS: Demographic disparities in menthol cigarette use persist in the United States. Continued monitoring and improvement of existing surveillance systems to identify patterns and trends in menthol cigarette use are needed. |
Perceptions of menthol cigarette use among U.S. adults and adult smokers: findings from the 2009 HealthStyles survey
Davis SP , McClave-Regan AK , Rock VJ , Kruger J , Garrett BE . Nicotine Tob Res 2010 12 Suppl 2 S125-35 INTRODUCTION: Perceptions of menthol cigarette use may have implications for smoking initiation and cessation. This study explores harm and health perceptions of menthol cigarette use among a national sample of U.S. adults and current smokers. METHODS: We examined data from the 2009 HealthStyles survey (n = 4,556), an annual mail survey of adults ≥18 years of age that collects information on attitudes and behaviors, including smoking. Frequencies and weighted percentages were calculated by sex, race/ethnicity, age, education level, household income, and smoking status. Unadjusted odds ratios (OR) were used to compare perceptions of menthol cigarette use between demographic groups. RESULTS: Close to half of adults (45.8%) believed that menthol cigarettes are just as harmful as nonmenthol cigarettes, and 40.9% of adults did not know whether menthol cigarettes are more or less harmful than nonmenthol cigarettes. Few adults (0.6%), including smokers, perceived menthol cigarettes to be less harmful than nonmenthol cigarettes. Blacks (OR = 3.22, 95% CI = 1.80-5.76) were more likely to believe that menthol cigarettes have health benefits when compared with Whites. Almost half of current smokers believed menthol cigarettes are equally addictive as nonmenthol cigarettes and 74.9% believed menthol and nonmenthol cigarettes are equally hard to quit. CONCLUSIONS: Findings suggest directions for targeted public health messages for menthol cigarette use. Future research is needed among a nationally representative sample to capture more subtle differences in perceptions among menthol and nonmenthol smokers. |
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