Intervention to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers a systematic review of provider reminders.
Baron RC , Melillo S , Rimer BK , Coates RJ , Kerner J , Habarta N , Chattopadhyay S , Sabatino SA , Elder R , Leeks KJ . Am J Prev Med 2010 38 (1) 110-117 Most major medical organizations recommend routine screening for breast, cervical, and colorectal cancers. Screening can lead to early detection of these cancers, resulting in reduced mortality. Yet, not all people who should be screened are screened regularly or, in some cases, ever. This report presents results of systematic reviews of effectiveness, applicability, economic efficiency, barriers to implementation, and other harms or benefits of provider reminder/recall interventions to increase screening for breast, cervical, and colorectal cancers. These interventions involve using systems to inform healthcare providers when individual clients are due (reminder) or overdue (recall) for specific cancer screening tests. Evidence in this review of studies published from 1986 through 2004 indicates that reminder/recall systems can effectively increase screening with mammography, Pap, fecal occult blood tests, and flexible sigmoidoscopy. Additional research is needed to determine if provider reminder/recall systems are effective in increasing colorectal cancer screening by colonoscopy. Specific areas for further research are also suggested. copyright 2010. |
Human prion diseases in the United States
Holman RC , Belay ED , Christensen KY , Maddox RA , Minino AM , Folkema AM , Haberling DL , Hammett TA , Kochanek KD , Sejvar JJ , Schonberger LB . PLoS One 2010 5 (1) e8521 BACKGROUND: Prion diseases are a family of rare, progressive, neurodegenerative disorders that affect humans and animals. The most common form of human prion disease, Creutzfeldt-Jakob disease (CJD), occurs worldwide. Variant CJD (vCJD), a recently emerged human prion disease, is a zoonotic foodborne disorder that occurs almost exclusively in countries with outbreaks of bovine spongiform encephalopathy. This study describes the occurrence and epidemiology of CJD and vCJD in the United States. METHODOLOGY/PRINCIPAL FINDINGS: Analysis of CJD and vCJD deaths using death certificates of US residents for 1979-2006, and those identified through other surveillance mechanisms during 1996-2008. Since CJD is invariably fatal and illness duration is usually less than one year, the CJD incidence is estimated as the death rate. During 1979 through 2006, an estimated 6,917 deaths with CJD as a cause of death were reported in the United States, an annual average of approximately 247 deaths (range 172-304 deaths). The average annual age-adjusted incidence for CJD was 0.97 per 1,000,000 persons. Most (61.8%) of the CJD deaths occurred among persons >or=65 years of age for an average annual incidence of 4.8 per 1,000,000 persons in this population. Most deaths were among whites (94.6%); the age-adjusted incidence for whites was 2.7 times higher than that for blacks (1.04 and 0.40, respectively). Three patients who died since 2004 were reported with vCJD; epidemiologic evidence indicated that their infection was acquired outside of the United States. CONCLUSION/SIGNIFICANCE: Surveillance continues to show an annual CJD incidence rate of about 1 case per 1,000,000 persons and marked differences in CJD rates by age and race in the United States. Ongoing surveillance remains important for monitoring the stability of the CJD incidence rates, and detecting occurrences of vCJD and possibly other novel prion diseases in the United States. |
Public health interventions for arthritis: expanding the toolbox of evidence-based interventions
Brady TJ , Jernick SL , Hootman JM , Sniezek JE . J Womens Health (Larchmt) 2009 18 (12) 1905-17 BACKGROUND: Since 1999, the Centers for Disease Control and Prevention's (CDC) Arthritis Program has worked to improve the quality of life for people with arthritis, in part by funding state health departments to disseminate physical activity (PA) and self-management education (SME) interventions. Initially, only one SME and two PA interventions were considered evidence-based and appropriate for people with arthritis. The purposes of this article are to describe the processes and criteria used to screen new or existing intervention programs and report the results of that screening, including an updated list of recommended intervention programs. METHODS: A series of three sets of screening criteria was created in consultation with subject matter experts: arthritis appropriateness, adequacy of the evidence base, and implementability as a public health intervention. Screening interventions were categorized as Recommended, Promising Practices, Watch List, Future Possibility, or Unlikely to Meet criteria based on how well the intervention met the screening criteria. RESULTS: A total of 15 packaged PA interventions and six SME interventions were screened. Three PA and three SME interventions met all three sets of criteria and were added to the list of recommended public health interventions for use by CDC-funded state arthritis programs. An additional two SME interventions are developing the infrastructure for public health dissemination and were categorized as Promising Practices, and six PA interventions have evaluations underway and are on the Watch List. CONCLUSIONS: The CDC Arthritis Program identified arthritis-appropriate interventions that can be used effectively and efficiently in public health settings to improve the quality of life of people with arthritis. The screening criteria used offer a guide to intervention developers on necessary characteristics of interventions for use in public health settings. The expanded menu of interventions is beneficial to clinical care and public health professionals and, ultimately, to people with arthritis. |
Serum concentrations of vitamin D and parathyroid hormone and prevalent metabolic syndrome among adults in the United States
Ford ES , Zhao GX , Li CY , Pearson WS . J Diabetes 2009 1 (4) 296-303 BACKGROUND: Some reports suggest that concentrations of vitamin D are inversely, whereas concentrations of parathyroid hormone (PTH) are directly, associated with prevalent metabolic syndrome. Because of lingering uncertainty about these associations, we examined the cross-sectional associations between serum concentrations of 25-hydroxyvitamin D3 and PTH with metabolic syndrome in a representative sample of adults in the US. METHODS: We used data from 1705 participants in the 2005-2006 National Health and Nutrition Examination Survey. Vitamin D was measured by radioimmunoassay, whereas PTH was measured using an electrochemiluminescent process. RESULTS: The mean concentration of vitamin D for participants with and without metabolic syndrome was 20.3 and 22.9 ng/mL, respectively (P=0.001). The mean concentration of PTH for participants with and without metabolic syndrome was 44.5 and 41.0 pg/mL, respectively (P=0.002). The age-adjusted mean concentrations of vitamin D (P for linear trend <0.001) decreased linearly, whereas PTH (P for linear trend=0.002) increased linearly, as the number of components of metabolic syndrome increased. After adjusting for age, gender, physical activity, urinary albumin creatinine ratio, and concentrations of C-reactive protein and calcium, concentrations in the highest quintile of vitamin D [prevalence ratio (PR)=0.59; 95% confidence interval (CI) 0.44-0.79], but not PTH (PR=1.18; 95% CI 0.97-1.43), was significantly associated with prevalent metabolic syndrome. CONCLUSION: Concentrations of vitamin D, but not PTH, were significantly associated with prevalent metabolic syndrome among US adults. |
Disease and economic burden of rotavirus diarrhoea in India
Tate JE , Chitambar S , Esposito DH , Sarkar R , Gladstone B , Ramani S , Raghava MV , Sowmyanarayanan TV , Gandhe S , Arora R , Parashar UD , Kang G . Vaccine 2009 27 Suppl 5 F18-24 We used published and unpublished studies and national statistics to estimate the number of deaths, hospitalizations, and outpatient visits due to rotavirus diarrhoea and the associated national economic burden of disease in India. Annually in India, rotavirus diarrhoea causes an estimated 122,000-153,000 deaths, 457,000-884,000 hospitalizations, and 2 million outpatient visits in children <5 years of age. India spends Rs 2.0-3.4 billion (US$ 41-72 million) annually in medical costs to treat rotavirus diarrhoea. The use of specific interventions against rotavirus, such as newly available vaccines, would help prevent much of this large disease and economic burden. |
Influenza: prevention and treatment
Dawood FS , Finelli L , Fiore A . Minerva Pneumol 2009 48 (2) 177-194 Influenza viruses cause annual epidemics of respiratory illness, and have caused three influenza pandemics since 1900. Although young children <2 years of age, adults >65 years of age and persons with underlying chronic medical conditions are at greatest risk for influenza complications, severe complications, including death, can occur in any age group. Influenza also results in a substantial amount of work and school absenteeism and losses in productivity. The diagnosis of influenza should be considered in persons presenting with respiratory symptoms or fever during periods when influenza virus is known to circulate locally, and influenza diagnostic testing is the only reliable way to differentiate influenza from other respiratory viral illnesses, which can present with the same constellation of symptoms. Annual influenza vaccination is the most effective way to prevent influenza and can provide protection against influenza even during seasons, where there is a suboptimal match between circulating influenza strains and the strains found in the influenza vaccine. Influenza vaccines are available in two forms: inactivated influenza vaccine and live attenuated influenza vaccine. Antiviral medications are an important adjunct to influenza prevention and control. However, the increasing prevalence of influenza viruses, that are resistant to currently licensed antiviral medications, highlights the need for the development of new antiviral medications. Some influenza viruses can infect many species of animals in addition to humans. Human infection with avian and swine influenza viruses is now well-documented, but modes of animal-human transmission and the burden of human infection with animal influenza viruses is still not well understood. In addition, an outbreak of novel swine-origin influenza A (H1N1) virus (S-OIV) was recently identified in many countries. The burden of disease resulting from S-OIV and its spread are still being characterized. |
Climate change, its impact on human health in the Arctic and the public health response to threats of emerging infectious diseases
Parkinson AJ , Evengard B . Glob Health Action 2009 2 The Arctic has warmed substantially over the last few decades. A recent study shows that temperatures over the last century increased almost three times faster in the Arctic than elsewhere in the Northern Hemisphere, reversing a 2000-year cooling trend, and outpacing current climate model predictions (1). This rapid warming trend is anticipated to continue into the next century with temperature increases exceeding those predicted in the rest of the Northern Hemisphere and will result in accelerated loss of land and sea ice, and an increased rate of sea level rise, with global consequences. These changes are already impacting local communities, which have observed profound changes in their local environments, and are leading to significant economic and cultural upheaval particularly for the indigenous peoples of the Arctic (2). Because climate change is more advanced in the Arctic than other regions of the world, the Arctic can play a vital role in preparing the world for what is to come. | Resident indigenous populations of the Arctic are uniquely vulnerable to climate change because of their close relationship with, and dependence on, the land, sea and natural resources for their well-being (3). Direct health threats from climate change include morbidity and mortality resulting from increasing extreme events (storms, floods, increased heat and cold) and an increased incidence of injury and mortality associated with unpredictable ice and storm conditions. Indirect effects include increased mental and social stress related to changes in environment and loss of traditional lifestyle; potential changes in bacterial and viral diseases; and decreased access to quality water sources (4, 5). Some regions are at risk for increasing illness due to failing sanitation infrastructure resulting from changes in permafrost and storm surges. Some regions will also experience changes in diet resulting from changes in subsistence species distribution and accessibility (6). This may result in a shift away from a traditional subsistence diet to a more Western diet. While this shift may be beneficial, providing a more varied and reliable diet, the increased accessibility to processed foods, high in saturated fats and sugar, may result in an increase in the incidence of obesity, diabetes, cardiovascular disease and cancer (7, 8). Projected warming will affect the transport, distribution and behaviour of contaminants, further threatening the safety of the traditional food supply and potentially increasing human exposure (9). Higher temperatures at lower latitudes will increase volatisation of contaminants resulting in increased delivery of contaminants to the Arctic. As precipitation increases over land, river flow will increase resulting in greater delivery of contaminants to the coasts and oceans. |
Pelvic inflammatory disease among privately insured women, United States, 2001-2005
Bohm MK , Newman L , Satterwhite CL , Tao G , Weinstock HS . Sex Transm Dis 2009 37 (3) 131-6 BACKGROUND: We explored the utility of using insurance claims data for surveillance of pelvic inflammatory disease (PID). PID rates are an important indicator of population level trends in reproductive morbidity; however, data available to monitor PID trends are limited. National survey data are currently used to estimate PID rates in the United States, but a declining number of cases threaten their future usefulness. METHODS: We performed a retrospective analysis of PID diagnosis rates using administrative claims data from 2001 to 2005. Diagnostic codes were used to identify women aged 15 to 44 in the study population that were diagnosed with acute PID as inpatients, in emergency departments, and in outpatient ambulatory settings. RESULTS: Rates of PID diagnoses among privately insured women declined significantly from 2001 to 2005 among all age groups examined and within all geographic regions. Annual PID diagnosis rates decreased from 317.0 to 236.0 per 100,000 enrollees, representing a 25.5% decline over the study period. The highest rates of PID were among 25- to 29-year-olds (352.8 per 100,000 in 2005) and among those residing in the South (314.3 per 100,000 in 2005). Most women (70.1%) received PID care through physician offices and other outpatient facilities; of these women, approximately 40% were treated by an obstetrician/gynecologist. CONCLUSIONS: The decline in PID diagnoses corresponds with previous reports from national surveys. Claims data offer a much needed new data source that will allow for continued monitoring of PID among a broad population in both inpatient and outpatient clinical settings. |
The impact of obesity on time spent with the provider and number of medications managed during office-based physician visits using a cross-sectional, national health survey
Pearson WS , Bhat-Schelbert K , Ford ES , Mokdad AH . BMC Public Health 2009 9 436 BACKGROUND: Obesity is associated with morbidity, mortality, and increased health care costs. Few studies have examined the impact of obesity on outpatient office visits. The purpose of this study was to determine if outpatient visits by obese persons required more time with the provider and more prescription medication management compared to visits made by non-obese persons. METHODS: Obesity status was determined for 9,280 patient visits made by persons aged 18 years or older in the 2006 National Ambulatory Medical Care Survey. Multivariate analyses compared obese and non-obese visits, stratified by sex, for duration of the visit and the number of medications mentioned at the visit. RESULTS: Average duration of visit was higher among visits with patients determined to be obese. However, these differences were not considered significant after statistical testing. Visits made by obese female patients were significantly more likely to involve more than two prescription medications (OR 1.26, 95% CI 1.05 - 1.51) and visits made by obese male patients were significantly more likely to involve more than two prescription medications (OR 1.46, 95% CI 1.16 - 1.83) as compared to visits made by non-obese patients. CONCLUSION: Time spent with the provider was found to be greater among visits with obese patients, but not significantly different from visits with non-obese patients. The number of medications for each visit was found to be significantly greater for visits where the patient was considered to be obese. Increased time for the visit and increased numbers of medication for each visit translate into increased costs. These findings document the impact of obesity on our health care system and have great implications on medical care cost and planning. |
Importance and challenges of accurately counting rotavirus deaths in China, 2002
Yee EL , Fang ZY , Liu N , Hadler SC , Liang X , Wang H , Zhu X , Jiang B , Parashar U , Widdowson MA , Glass RI . Vaccine 2009 27 Suppl 5 F46-9 Rotavirus mortality is an important component of the total burden of rotavirus disease for children under 5 years old, but accurate estimation is difficult for many developing countries. Here we applied a more direct method to improve estimates of rotavirus mortality in China using 2002 Chinese-specific data. Results indicate that in 2002, approximately 13,400 children under 5 years old in China died from rotavirus and 70% of these deaths occur in rural areas. Thus, a national rotavirus immunization program targeting rural areas with high mortality from diarrhoea could dramatically reduce these deaths and urban areas could reduce childhood hospitalizations attributed to rotavirus by 43%. |
Attribution of hepatitis C virus seroconversion risk in young injection drug users in 5 US cities
Hagan H , Pouget ER , Williams IT , Garfein RL , Strathdee SA , Hudson SM , Latka MH , Ouellet LJ . J Infect Dis 2010 201 (3) 378-85 BACKGROUND: In studies of hepatitis C virus (HCV) seroconversion in injection drug users (IDUs), some have questioned whether underreporting of syringe sharing, a stigmatized behavior, has led to misattribution of HCV risk to other injection-related behaviors. METHODS: IDUs aged 15-30 years who were seronegative for human immunodeficiency virus and HCV antibodies were recruited into a prospective study in 5 US cities. Behavioral data were collected via computer-assisted self-interviewing to reduce socially desirable reporting. Hazard ratios (HRs) were estimated to assess associations between behavior and HCV seroconversion. Because the shared use of cookers, cottons, and rinse water was highly correlated, a summary variable was created to represent drug preparation equipment sharing. RESULTS: Among 483 IDUs who injected during the period covered by the follow-up assessments, the incidence of HCV infection was 17.2 cases per 100 person years; no HIV seroconversions occurred. Adjusting for confounders, the shared use of drug preparation equipment was significantly associated with HCV seroconversion (adjusted HR, 2.66; 95% confidence interval, 1.03-23.92), but syringe sharing was not (adjusted HR, 0.91). We estimated that 37% of HCV seroconversions in IDUs were due to the sharing of drug preparation equipment. CONCLUSIONS: Associations between sharing drug preparation equipment and HCV seroconversion are not attributable to underascertainment of syringe sharing. Avoiding HCV infection will require substantial reductions in exposure to all sources of contaminated blood. |
Use of dual protection in Botswana
Kraft JM , Galavotti C , Carter M , Jamieson DJ , Busang L , Fleming D , Kilmarx PH . Stud Fam Plann 2009 40 (4) 319-328 High rates of unintended pregnancy and of HIV and other sexually transmitted infections prompt calls for use of "dual-protection" strategies, including consistent condom use or dual-method use. This study examines the use of dual-protection strategies in a sample of 15-49-year-old men and women in Botswana in 2003. Half of sexually active respondents reported consistent condom use in the past year; 2.5 percent reported dual-method use. Multiple logistic regression analyses showed that urban residence, less than a ten-year age difference between partners, discussing HIV and contraception with one's partner, not intending to have a child in the next year, having no children, being in a relationship where one or both partners have additional concurrent partners, and supportive condom norms were associated with dual protection - that is, with consistent condom or dual-method use. In the context of high HIV prevalence, concerns about disease prevention likely influence contraception, and interventions should address childbearing desires and sexual risk simultaneously. |
Provider-initiated HIV testing in health care settings: should it include client-centered counselling?
Kiene SM , Bateganya M , Wanyenze R , Lule H , Mayer K , Stein M . SAHARA J 2009 6 (3) 115-119 To increase access to HIV testing, the WHO and CDC have recommended implementing provider-initiated HIV testing (PITC). To address the resource limitations of the PITC setting, WHO and CDC suggest that patient-provider interactions during PITC may need to focus on providing information and referrals, instead of engaging patients in client-centered counselling, as is recommended during client-initiated HIV testing. Providing HIV prevention information has been shown to be less effective than client-centered counselling in reducing HIV-risk behaviour and STI incidence. Therefore, concerns exist about the efficacy of PITC as an HIV prevention approach. However, reductions in HIV incidence may be greater if more people know their HIV status through expanded availability of PITC, even if PITC is a less effective prevention intervention than is client-initiated HIV testing for individual patients. In the absence of an answer to this public health question, adaptation of effective brief client-centered counselling approaches to PITC should be explored along with research assessing the efficacy of PITC. |
Recommended adult immunization schedule: United States, 2010
Advisory Committee on Immunization Practices , Baker CJ , Pickering LK , Chilton L , Cieslak P , Ehresmann KR , Englund J , Friedman C , Judson FN , Keitel WA , Lett SM , Plain J , Marcy MS , Meissner CH , Neuzil K , Sawyer MH , Sumaya CV , Temte J . Ann Intern Med 2010 152 (1) 36-9 The Advisory Committee on Immunization Practices (ACIP) annually reviews the Recommended Adult Immunization Schedule (Figure) to ensure that the schedule reflects current recommendations for the licensed vaccines. In October 2009, ACIP approved the Adult Immunization Schedule for 2010, which includes several changes. A bivalent human papillomavirus vaccine (HPV2) was licensed for use in females in October 2009. The ACIP recommends vaccination of females with either HPV2 or the quadrivalent human papillomavirus vaccine (HPV4). HPV4 was licensed for use in males, and the ACIP used a permissive recommendation for use of this vaccine in males. Introductory sentences were added to the footnotes for measles, mumps, rubella, influenza, pneumococcal, hepatitis A, hepatitis B, and meningococcal vaccines. Clarifications were made to the footnotes for measles, mumps, rubella, influenza, hepatitis A, meningococcal, and Haemophilus influenzae type B (Hib) vaccines, and schedule information was added to the hepatitis B vaccine footnote. |
Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine
Pilishvili T , Lexau C , Farley MM , Hadler J , Harrison LH , Bennett NM , Reingold A , Thomas A , Schaffner W , Craig AS , Smith PJ , Beall BW , Whitney CG , Moore MR , Active Bacterial Core Surveillance/Emerging Infections Program Network . J Infect Dis 2010 201 (1) 32-41 BACKGROUND: Changes in invasive pneumococcal disease (IPD) incidence were evaluated after 7 years of 7-valent pneumococcal conjugate vaccine (PCV7) use in US children. METHODS: Laboratory-confirmed IPD cases were identified during 1998-2007 by 8 active population-based surveillance sites. We compared overall, age group-specific, syndrome-specific, and serotype group-specific IPD incidence in 2007 with that in 1998-1999 (before PCV7) and assessed potential serotype coverage of new conjugate vaccine formulations. RESULTS: Overall and PCV7-type IPD incidence declined by 45% (from 24.4 to 13.5 cases per 100,000 population) and 94% (from 15.5 to 1.0 cases per 100,000 population), respectively (P< .01 all age groups). The incidence of IPD caused by serotype 19A and other non-PCV7 types increased from 0.8 to 2.7 cases per 100,000 population and from 6.1 to 7.9 cases per 100,000 population, respectively (P< .01 for all age groups). The rates of meningitis and invasive pneumonia caused by non-PCV7 types increased for all age groups (P< .05), whereas the rates of primary bacteremia caused by these serotypes did not change. In 2006-2007, PCV7 types caused 2% of IPD cases, and the 6 additional serotypes included in an investigational 13-valent conjugate vaccine caused 63% of IPD cases among children <5 years-old. CONCLUSIONS: Dramatic reductions in IPD after PCV7 introduction in the United States remain evident 7 years later. IPD rates caused by serotype 19A and other non-PCV7 types have increased but remain low relative to decreases in PCV7-type IPD. |
Meningococcal conjugate vaccination among adolescents aged 13-17 years, United States, 2007
Lu PJ , Jain N , Cohn AC . Vaccine 2009 28 (11) 2350-5 BACKGROUND: An estimated 1000-2000 cases of invasive meningococcal diseases occur annually in the United States. In 2005, a new quadrivalent meningococcal conjugate vaccine (MCV4) was approved and, because of supply constraints, was recommended for routine vaccination of some groups of adolescents. In August 2007, vaccination recommendations were expanded for all adolescents 11-18 years. METHODS: We analyzed data from the 2007 National Immunization Survey-Teen (NIS-Teen), a nationally representative random digit dialed telephone survey. Estimates of MCV4 coverage were assessed from provider-reported vaccination histories. A multivariable logistic regression analysis and predictive marginal model were performed to identify factors independently associated with MCV4 vaccination. RESULTS: Provider-reported vaccination histories were available for 2947 adolescents aged 13-17 years with a response rate of 55.9%. Overall, MCV4 coverage was 32.4% (95% confidence interval (CI)=30.2-34.7%) in 2007. Vaccination coverage was similar among adolescents aged 13-14 years compared to those aged 15-17 years (32.1% vs. 32.6%, respectively). Coverage was 30.6% for non-Hispanic whites, 35.9% for non-Hispanic blacks, and 36.1% for Hispanics; however, these variations were not statistically significant. Characteristics independently associated with a higher likelihood of MCV4 vaccination included having ≥2 physician contacts in the past year, having a well child visit at age 11-12 years, and ever having a doctor recommendation for meningitis vaccination of the adolescent. CONCLUSIONS: In 2007, MCV4 coverage among 13-17 year olds increased 20.7 percentage points from 2006. Achieving high vaccination coverage among adolescents will be challenging. Targeting adolescents with no health insurance and no recent healthcare provider visits may be important to increase coverage. |
Rapid identification and discrimination of Brucella isolates using real-time PCR and high resolution melt analysis
Winchell JM , Wolff BJ , Tiller R , Bowen M , Hoffmaster A . J Clin Microbiol 2010 48 (3) 697-702 Definitive identification of Brucella species remains a challenge due to the high degree of genetic homology shared within the genus. We report the development of a molecular technique which utilizes real-time PCR followed by high resolution melt (HRM) curve analysis to reliably type members of this genus. Using a panel of seven primer sets, we have tested 153 Brucella spp. isolates with >99% accuracy when compared to traditional techniques. This assay provides a useful diagnostic tool that can rapidly type Brucella spp. isolates and has the potential to detect novel species. This approach may also prove helpful for clinical, epidemiological and veterinary investigations. |
Evaluation of local MCP-1 and IL-12 nanocoatings for infection prevention in open fractures
Li B , Jiang B , Dietz MJ , Smith ES , Clovis NB , Rao KM . J Orthop Res 2010 28 (1) 48-54 The increasing incidence of bacterial infection and the appearance of Staphylococcus aureus (S. aureus) strains that are resistant to commonly used antibiotics has made it important to develop non-antibiotic approaches for infection prevention. The aim of this study was to develop local monocyte chemoattractant protein-1 (MCP-1) and interleukin-12 p70 (IL-12 p70) therapies to prevent S. aureus infection by enhancing the recruitment and activation of macrophages, which are believed to play an important role in infection prevention as the first line of defense against invading pathogens. Nanocoating systems for MCP-1 and IL-12 p70 deliveries were prepared, and their release characteristics desirable for infection prevention in open fractures were explored. Local MCP-1 therapy reduced S. aureus infection and influenced white blood cell populations, and local IL-12 p70 treatment had a more profound effect on preventing S. aureus infection. No synergistic relationship in decreasing S. aureus infection was observed when MCP-1 and IL-12 p70 treatments were combined. This reported new approach may reduce antibiotic use and antibiotic resistance. |
Genetic relationships among reptile and mammalian Campylobacter fetus by multilocus sequence typing
Dingle KE , Blaser MJ , Tu ZC , Pruckler J , Fitzgerald C , van Bergen MA , Lawson AJ , Owen RJ , Wagenaar JA . J Clin Microbiol 2010 48 (3) 977-80 Reptile Campylobacter fetus isolates and closely related strains causing human disease were characterized by multilocus sequence typing. They shared approximately 90% nucleotide sequence identity with classical mammalian C. fetus and there was evidence of recombination amongst these two groups. The reptile group represents a possible separate genomospecies capable of infecting humans. |
Identification of a potential molecular link between the glucocorticoid and serotonergic signaling systems
Falkenberg VR , Rajeevan MS . J Mol Neurosci 2010 41 (2) 322-7 Glucocorticoid receptor (GR) and serotonin (5-hydroxytryptamine (5-HT)) signaling systems play a pivotal role in the regulation of the hypothalamic-pituitary-adrenal (HPA) axis, but the molecular nature of interactions between these two systems remain largely unidentified. We used computational and experimental approaches to evaluate if DNA-protein interactions would provide a molecular link for the interaction between 5-HT and GR systems. Bioinformatic analysis identified nine binding sites in various serotonin receptors (HTR1D, HTR1F, HTR2A, HTR3A, and HTR6) for transcription factors in the GR family. Electrophoretic mobility shift assays (EMSA) using HeLa nuclear extract and purified full-length GR verified most of the predicted DNA-protein interactions. Six binding sites verified by EMSA results were evolutionarily conserved in multiple species. Multiple lines of evidence from computational and experimental analyses in this study support the potential of a molecular link between 5-HT and GR signaling systems. This finding provides new approaches to studies directed at mechanisms for glucocorticoid negative feedback regulation of the HPA axis involving 5-HT and interventional studies directed to neuropsychiatric diseases. |
Assessing the validity of the Omron HEM-907XL oscillometric blood pressure measurement device in a National Survey environment
Ostchega Y , Nwankwo T , Sorlie PD , Wolz M , Zipf G . J Clin Hypertens (Greenwich) 2010 12 (1) 22-8 Blood pressure (BP) readings taken by Omron HEM-907XL were compared with the results obtained using sphygmomanometer (HgS) in 509 individuals using 2002 Association for the Advancement of Medical Instrumentation (AAMI) criteria. With the exception of diastolic BP in youth ages 13 to 19 years (mean difference, -1.77 mm Hg; standard deviation, 8.65), the Omron device met the criteria. Agreement for hypertension (BP >or=140/90 mm Hg) was above chance (kappa=0.68) and, compared with HgS, Omron underestimated the prevalence of hypertension by 2.65%. The Omron and HgS measurements were highly correlated (r=0.94 for systolic BP and r=0.83 for diastolic BP). Both increased systolic and diastolic BP decreased device agreement (beta-coefficient=-0.10872, P<.0001; beta-coefficient=-0.25981, P<.0001, respectively). The Omron device meets AAMI criteria with the exception of diastolic BP in youth ages 13 to 19 years. However, Omron underestimated the prevalence of hypertension and device agreement decreases with increased systolic and diastolic BP. |
Critical cysteine residues of Kelch-like ECH-associated protein 1 in arsenic sensing and suppression of nuclear factor erythroid 2-related factor 2
He X , Ma Q . J Pharmacol Exp Ther 2010 332 (1) 66-75 Arsenic activates nuclear factor erythroid 2-related factor 2 (Nrf2) to induce phase II and antioxidative genes. Here we analyzed arsenic-Kelch-like ECH-associated protein 1 (Keap1) cysteine thiol interaction in Nrf2 activation. Arsenic-based Nrf2 activators, fluorescent biarsenical labeling reagent (FlAsH) and phenylarsine oxide (PAO), were used to probe binding of arsenic to Keap1. Strong fluorescence was observed on binding of FlAsH to purified Keap1. Pretreatment with arsenic, tert-butylhydroquinone (tBHQ), or 2,3-dimercaptopropanol significantly reduced the fluorescent signal. PAO affinity beads effectively pulled down Keap1 in vitro and from hepa1c1c7 cells. Arsenic, tBHQ, free PAO, or cadmium blocked Keap1 pulldown. Furthermore, arsenic and free PAO significantly reduced the free thiol contents of purified or endogenous Keap1. Thus, arsenic, FlAsH, and PAO, as well as tBHQ and cadmium, bind to Keap1 cysteine thiols in a similar fashion. All the domains of Keap1 bound PAO, and the linker region exhibited the highest binding activity. The function of arsenic-Keap1 interaction was evaluated in a reconstituted system that mimics endogenous Nrf2 regulation. Mutation of Cys273 or Cys288 in the linker region resulted in high level basal expression of Nrf2 protein. Mutation of Cys151 abolished Nrf2 activation by arsenic. Overexpression of C273A, C288A, or C151A altered the basal and arsenic-induced expression of Nrf2 target genes. The study shows an important role of Cys273 and Cys288 in the suppression of Nrf2 by Keap1 and a critical function of Cys151 in arsenic responsiveness. Our findings support a model in which arsenic binds to different sets of Keap1 cysteine residues to regulate divergent functions in Nrf2 signal transduction. |
Protracted exposure to supraphysiological levels of corticosterone does not cause neuronal loss or damage and protects against kainic acid-induced neurotoxicity in the hippocampus of C57BL/6J mice
Benkovic SA , O'Callaghan JP , Miller DB . Neurotoxicology 2009 30 (6) 965-76 High levels of stress or stress hormones have been reported to exacerbate a variety of human disorders of the cardiovascular, gastrointestinal, immune, reproductive, and nervous systems. In rats, high glucocorticoid levels have been reported to cause neuronal death and injury as well as enhance susceptibility to neurotoxic agents and attenuate repair mechanisms; however, the impact of high dosages of CORT in mice has not been fully evaluated. We investigated the ability of supraphysiological levels of CORT to cause hippocampal neuronal death, and to modulate the neurotoxicity of kainic acid (KA) in male C57BL/6J mice. Timed-release CORT pellets (10, 35, 100 mg/21 d) were implanted subcutaneously in the back of mice, and the sustained release of glucocorticoid caused involution of the thymus and decreased the weight of the spleen. Kainic acid caused stage 1 seizures that were unaffected by CORT; however, steroid treatment decreased KA-associated mortality. Little neuronal damage was detected by the cupric-silver neurodegeneration stain. Neurotoxicity caused by an intraperitoneal injection of 25mg/kg KA was attenuated by seven days of CORT pre-treatment. The KA-induced increase in cupric-silver staining, reactive gliosis, microglial activation, and blood-brain barrier disruption was attenuated indicating neuroprotection. Our data indicate supraphysiological levels of CORT do not cause neuronal death or injury in hippocampus of C57BL/6J mice and provide neuroprotection against KA-induced neural damage. |
Accuracy of serological assays for detection of recent infection with HIV and estimation of population incidence: a systematic review
Guy R , Gold J , Calleja JM , Kim AA , Parekh B , Busch M , Rehle T , Hargrove J , Remis RS , Kaldor JM , WHOWorking Group on HIV Incidence Assays . Lancet Infect Dis 2009 9 (12) 747-59 We systematically reviewed the accuracy of serological tests for recent infections with HIV that have become widely used for measuring population patterns incidence of HIV. Across 13 different assays, sensitivity to detect recent infections ranged from 42-100% (median 89%). Specificity for detecting established infections was between 49.5% and 100% (median 86.8%) and was higher for infections of durations longer than 1 year (median 98%, range 31.5-100.0). For four different assays, comparisons were made between assay-derived population incidence estimates and a reference incidence estimate. The median percentage difference between the assay-derived incidence and reference incidence was 26.0%. Serological assays have reasonable sensitivity for the detection of recent infection with HIV, but are vulnerable to misclassifying established infections as recent-potentially leading to biases in incidence estimates. This conclusion is highly qualified by the apparent absence of a standardised approach to assay evaluation. There is an urgent need for an internationally agreed framework for evaluating and comparing these tests. |
Does frank diabetes in first-degree relatives of a pregnant woman affect the likelihood of her developing gestational diabetes mellitus or nongestational diabetes?
Kim C , Liu T , Valdez R , Beckles GL . Am J Obstet Gynecol 2009 201 (6) 576 e1-6 OBJECTIVE: We sought to examine the associations between patterns of family histories of diabetes and a history of gestational diabetes mellitus (hGDM). STUDY DESIGN: Parous women participating in the National Health and Nutrition Examination Survey III (n=4566) were classified as having hGDM only, diagnosed diabetes, or neither. Family history of diabetes was categorized as: maternal only, paternal only, biparental, and sibling only. The covariate-adjusted prevalence and odds of having hGDM were estimated. RESULTS: Compared to women without a family history of diabetes, women with a maternal (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.2-7.3), paternal (OR, 3.3; 95% CI, 1.1-10.2), or sibling (OR, 7.1; 95% CI, 1.6-30.9) history of diabetes had greater odds of hGDM, after adjustment for age and race/ethnicity. CONCLUSION: Women with a sibling history of diabetes were more likely to have hGDM than women with other family history patterns. |
Neonatal mortality risk for repeat cesarean compared to vaginal birth after cesarean (VBAC) deliveries in the United States, 1998-2002 birth cohorts
Menacker F , Macdorman MF , Declercq E . Matern Child Health J 2010 14 (2) 147-54 To examine trends in repeat cesarean delivery, the characteristics of women who have repeat cesareans, and the risk of neonatal mortality for repeat cesarean birth compared to vaginal birth after cesarean (VBAC). Trends and characteristics of repeat cesareans were examined for: the period 1998-2002 for [1] all births, [2] low-risk births (singleton, term, vertex births) and [3] "no indicated risk" (NIR) births (singleton, term, vertex presentation births with no reported medical risks or complications). For low-risk and NIR births, neonatal mortality rates for repeat cesareans and VBACs were compared. Multivariate logistic regression was used to examine the risk of neonatal mortality for repeat cesareans and VBACs, after controlling for demographic and health factors. In 2002 the repeat cesarean rate was 87.4%, and varied little by maternal risk status or by demographic and health characteristics. From 1998-2002 rates increased by 20% for low risk and by 21% for NIR births, respectively. For low-risk women for the 1998-2002 birth cohorts, the adjusted odds ratio for neonatal mortality associated with repeat cesarean delivery (compared with VBAC) was 1.36 (95% C.I. 1.20-1.55). For NIR women, the adjusted odds ratio was 1.24 (0.99-1.55). The experience of a prior cesarean has apparently become a major indication for a repeat cesarean. Regardless of maternal risk status, almost 90% of women with a prior cesarean have a subsequent (i.e., repeat) cesarean delivery. This is the case even if there was no other reported medical indication. Our findings do not support the widely-held belief that neonatal mortality risk is significantly lower for repeat cesarean compared to VBAC delivery. |
Infant deaths associated with human parechovirus infection in Wisconsin
Sedmak G , Nix WA , Jentzen J , Haupt TE , Davis JP , Bhattacharyya S , Pallansch MA , Oberste MS . Clin Infect Dis 2010 50 (3) 357-61 BACKGROUND: From December 1987 through August 2004, lung tissue, nasopharyngeal swabs, and colon swab specimens obtained during 1263 autopsies of infants and young children were examined to assess the role of viruses in deaths of children aged <2 years. METHODS:. Multiple cell cultures were used to isolate viruses. With 4 exceptions, virus isolates were identified by neutralization, immunofluorescence assay, or enzyme immunoassay. RNA extracted from these 4 isolates and associated autopsy specimens was tested using parechovirus-specific real-time polymerase chain reaction (RT-PCR) and sequencing assays. RESULTS: Specimens from 426 (34%) autopsies were positive for at least 1 virus; enteroviruses and adenoviruses were the most commonly identified. Human parechoviruses (HPeVs) were identified antigenically in isolates from 18 decedents (all HPeV type 1) and by RT-PCR in isolates and multiple autopsy specimens from 4 decedents with untypeable virus isolates. Sequencing of the VP1 region identified these 4 HPeVs as HPeV type 3 ([Formula: see text]) and HPeV type 6 ([Formula: see text]). Despite the detection of HPeV, the deaths of decedents 3 and 4 were determined to have been from noninfectious causes. CONCLUSIONS: These are the first confirmed HPeV type 3 and HPeV type 6 detections in the United States. This is also the initial report of fatal cases with associated HPeV type 3 infection. These results support prior findings associating HPeVs with serious disease in young children. Clinical testing for HPeVs and routine HPeV surveillance by public health laboratories will help determine the burden of disease caused by HPeVs. |
Chlorhexidine maternal-vaginal and neonate body wipes in sepsis and vertical transmission of pathogenic bacteria in South Africa: a randomised, controlled trial
Cutland CL , Madhi SA , Zell ER , Kuwanda L , Laque M , Groome M , Gorwitz R , Thigpen MC , Patel R , Velaphi SC , Adrian P , Klugman K , Schuchat A , Schrag SJ , PoPS Trial Team . Lancet 2009 374 (9705) 1909-16 BACKGROUND: About 500,000 sepsis-related deaths per year arise in the first 3 days of life. On the basis of results from non-randomised studies, use of vaginal chlorhexidine wipes during labour has been proposed as an intervention for the prevention of early-onset neonatal sepsis in developing countries. We therefore assessed the efficacy of chlorhexidine in early-onset neonatal sepsis and vertical transmission of group B streptococcus. METHODS: In a trial in Soweto, South Africa, 8011 women (aged 12-51 years) were randomly assigned in a 1:1 ratio to chlorhexidine vaginal wipes or external genitalia water wipes during active labour, and their 8129 newborn babies were assigned to full-body (intervention group) or foot (control group) washes with chlorhexidine at birth, respectively. In a subset of mothers (n=5144), we gathered maternal lower vaginal swabs and neonatal skin swabs after delivery to assess colonisation with potentially pathogenic bacteria. Primary outcomes were neonatal sepsis in the first 3 days of life and vertical transmission of group B streptococcus. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00136370. FINDINGS: Rates of neonatal sepsis did not differ between the groups (chlorhexidine 141 [3%] of 4072 vs control 148 [4%] of 4057; p=0.6518). Rates of colonisation with group B streptococcus in newborn babies born to mothers in the chlorhexidine (217 [54%] of 401) and control groups (234 [55%] of 429] did not differ (efficacy -0.05%, 95% CI -9.5 to 7.9). INTERPRETATION: Because chlorhexidine intravaginal and neonatal wipes did not prevent neonatal sepsis or the vertical acquisition of potentially pathogenic bacteria among neonates, we need other interventions to reduce childhood mortality. FUNDING: US Agency for International Development, National Vaccine Program Office and Centers for Disease Control's Antimicrobial Resistance Working Group, and Bill & Melinda Gates Foundation. |
Occupational hazards experienced by cleaning workers and janitors: a review of the epidemiologic literature
Charles LE , Loomis D , Demissie Z . Work 2009 34 (1) 105-16 Building cleaners are an important group of workers who experience diverse occupational hazards resulting in health problems. A review of epidemiologic studies conducted between 1981 and 2005 was performed using PubMed and PsychLit, to identify health outcomes and the associated hazards in the work environment of cleaners. Among 35 studies, respiratory diseases (n = 17) and dermatologic diseases (n = 9) were the most common and were associated with exposure to cleaning agents, wet work, and rubber latex. The potential for infectious diseases (n = 3) was identified among cleaners in medical laboratories and was associated with exposure to broken glass and uncapped needles in the trash. Musculoskeletal disorders (n = 5) were associated with several physical stressors (e.g., awkward postures, prolonged standing) and psychosocial stressors (e.g., monotonous job, low potential for promotion). Mental disorders (n = 1) were also associated with psychosocial stressors and societal stigma. Future studies may be enhanced by better assessment of the specific job exposures of cleaners and implementation of a prospective design. |
Controlling dust exposures in longwall mining utilizing a simple barrier
Sweeney DD , Slagley JM , Smith DA , Rider JP . Min Eng 2009 61 (12) 58-61 The United States coal mining industry has traditionally experienced difficulty in controlling dust levels below the occupational exposure limit. While improvements in face ventilation and water spray nozzles have decreased dust exposures, approximately eight percent of experienced coal miners are still developing Coal Worker's Pneumoconiosis. This investigation tested the feasibility of enhancing existing engineering dust controls by mounting a simple barrier on a longwall shearer that separated the operators from the cutting drums. The barrier was constructed and tested above ground at the National Institute for Occupational Safety and Health Pittsburgh Research Laboratory longwall gallery test facility. A 96-percent reduction of respirable dust occurred at the headgate sampling position when tested at 2.4 m/sec (480 ft/min). The average dust level decreased from 39 mg/m3 to 1.5 mg/m3 by utilizing the barrier. |
Doing the math: the effectiveness of enclosed-cab air-cleaning methods can be spelled out in mathematical equations
Organiscak JA , Cecala AB . Rock Prod 2009 112 (10) 20-22 Enclosed cabs are a primary means of reducing equipment operators' silica dust exposure at surface mines. The National Institute of Occupational Safety and Health recently performed a laboratory study to evaluate which factors on an enclosed-cab filtration system are most significant. The various factors evaluated were intake filter efficiency, intake air leakage, intake filter loading, wind infiltration, use of a recirculation filter, and the use of an intake pressurization fan. The result of this laboratory testing has shown that the two most important factors for an effective filtration system on an enclosed cab were the efficiency of the intake filter and the use of a recirculation filter. A higher-efficiency intake filter considerably increased the quality of the intake air that was delivered into the enclosed cab. It also was determined that air leakage around the intake filter noticeably reduced its air cleaning effectiveness. The second key factor is the use of a recirculation filter, which was shown to improve the air quality in the enclosed cab by six to 12.7 times more than the intake filter alone. The reason for the significant improvement was that the cab air was constantly drawn through the recirculation filter, thus continually filtering the dust out of the air. These cab protection factor calculations represent operating conditions at steady-state conditions within a sealed, pressurized cab (doors and windows closed). Actual cab protection factors over a working shift will vary below this calculated value, depending on the frequency and time that the operator opens the cab door and windows. Therefore, keeping the cab tightly sealed and pressurized is a key aspect in achieving the highest protection factor for an operator. The higher the protection factor achieved on a cab reduces the operator's exposure to the outside dust. Finally, an effective cab filtration system reduces the dust and dirt that infiltrates the HVAC system, increasing its thermal effectiveness and reducing wear on its internal components. |
Quality of malaria case management at outpatient health facilities in Angola
Rowe AK , de Leon GF , Mihigo J , Santelli AC , Miller NP , Van-Dunem P . Malar J 2009 8 (1) 275 BACKGROUND: Angola's malaria case-management policy recommends treatment with artemether-lumefantrine (AL). In 2006, AL implementation began in Huambo Province, which involved training health workers (HWs), supervision, delivering AL to health facilities, and improving malaria testing with microscopy and rapid diagnostic tests (RDTs). Implementation was complicated by a policy that was sometimes ambiguous. METHODS: Fourteen months after implementation began, a cross-sectional survey was conducted in 33 outpatient facilities in Huambo Province to assess their readiness to manage malaria and the quality of malaria case-management for patients of all ages. Consultations were observed, patients were interviewed and re-examined, and HWs were interviewed. RESULTS: Ninety-three HWs and 177 consultations were evaluated, although many sampled consultations were missed. All facilities had AL in-stock and at least one HW trained to use AL and RDTs. However, anti-malarial stock-outs in the previous three months were common, clinical supervision was infrequent, and HWs had important knowledge gaps. Except for fever history, clinical assessments were often incomplete. Although testing was recommended for all patients with suspected malaria, only 30.7% of such patients were tested. Correct testing was significantly associated with caseloads < 25 patients/day (odds ratio: 18.4; p < 0.0001) and elevated patient temperature (odds ratio: 2.5 per 1 degrees C increase; p = 0.007). Testing was more common among AL-trained HWs, but the association was borderline significant (p = 0.072). When the malaria test was negative, HWs often diagnosed patients with malaria (57.8%) and prescribed anti-malarials (60.0%). Sixty-six percent of malaria-related diagnoses were correct, 20.1% were minor errors, and 13.9% were major (potentially life-threatening) errors. Only 49.0% of malaria treatments were correct, 5.4% were minor errors, and 45.6% were major errors. HWs almost always dosed AL correctly and gave accurate dosing instructions to patients; however, other aspects of counseling needed improvement. CONCLUSION: By late-2007, substantial progress had been made to implement the malaria case-management policy in a setting with weak infrastructure. However, policy ambiguities, under-use of malaria testing, and distrust of negative test results led to many incorrect malaria diagnoses and treatments. In 2009, Angola published a policy that clarified many issues. As problems identified in this survey are not unique to Angola, better strategies for improving HW performance are urgently needed. |
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