Prevalence of diagnosed cancer according to duration of diagnosed diabetes and current insulin use among U.S. adults with diagnosed diabetes: findings from the 2009 Behavioral Risk Factor Surveillance System
Li C , Zhao G , Okoro CA , Wen XJ , Ford ES , Balluz LS . Diabetes Care 2013 36 (6) 1569-76 OBJECTIVE: To estimate the prevalence of diagnosed cancer according to duration of diagnosed diabetes and current insulin use among U.S. adults with diagnosed diabetes. RESEARCH DESIGN AND METHODS: We analyzed data from 25,964 adults aged ≥18 years with diagnosed diabetes who participated in the 2009 Behavioral Risk Factor Surveillance System. RESULTS: After adjustment for potential confounders, we found that the greater the duration of diagnosed diabetes, the higher the prevalence of diagnosed cancers (P < 0.0001 for linear trend). Among adults with diagnosed type 2 diabetes, the prevalence estimate for cancers of all sites was significantly higher among men (adjusted prevalence ratio 1.6 [95% CI 1.3-1.9]) and women (1.8 [1.5-2.1]) who reported being diagnosed with diabetes ≥15 years ago than among those reporting diabetes diagnosis <15 years ago. The prevalence estimate for cancers of all sites was ~1.3 times higher among type 2 diabetic adults who currently used insulin than among those who did not use insulin among both men (1.3 [1.1-1.6]) and women (1.3 [1.1-1.5]). CONCLUSION: Our results suggest that there is an increased burden of diagnosed cancer among adults with a longer duration of diagnosed diabetes and among type 2 diabetic adults who currently used insulin. |
Advances at Preventing Chronic Disease: public health research, practice, and policy
Posner SF . Prev Chronic Dis 2013 10 120304 In 2003, Drs James Marks and Lynne Wilcox began developing a plan to realize their vision of creating a scholarly journal that would strengthen the links connecting public health research, practice, and policy with regard to chronic diseases. Their vision resulted in the publication the following year of Preventing Chronic Disease: Public Health Research, Practice, and Policy (PCD). As we start our 10th year of publication, we can reflect on what has been accomplished and what might be on the horizon. In the accompanying editorial, Dr Wilcox describes the importance of the journal’s focus on chronic disease in 2004 and highlights some of the early milestones in the journal’s development (1). One of the core drivers for starting PCD was the recognition that the field of public health would benefit from an open access forum for sharing successes and lessons learned in order to increase the quality, relevance, and effectiveness of our efforts and to improve their efficiency. The journal’s focus on chronic conditions and its commitment to providing a forum for sharing best practices and innovations is just as important today as it was a decade ago, and will increasingly be so in the future. | PCD has grown and changed with advances in technology and public health science to meet the changing demands of the field. In 2004, the journal was among the first to be published only in electronic format. The landscape of e-publishing has dramatically changed since then. In a world of increasing demand and constricting resources, there is an increasing push to use these resources effectively and efficiently. Since its inception, the journal has evolved to meet these challenges. PCD will continue to build on its solid foundation and expand its efforts by increasing its quality, relevance, impact, and efficiency. |
Annual report to the nation on the status of cancer, 1975-2009, featuring the burden and trends in human papillomavirus (HPV)-associated cancers and HPV vaccination coverage levels
Jemal A , Simard EP , Dorell C , Noone AM , Markowitz LE , Kohler B , Eheman C , Saraiya M , Bandi P , Saslow D , Cronin KA , Watson M , Schiffman M , Henley SJ , Schymura MJ , Anderson RN , Yankey D , Edwards BK . J Natl Cancer Inst 2013 105 (3) 175-201 BACKGROUND: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updates on cancer incidence and death rates and trends in these outcomes for the United States. This year's report includes incidence trends for human papillomavirus (HPV)-associated cancers and HPV vaccination (recommended for adolescents aged 11-12 years). METHODS: Data on cancer incidence were obtained from the CDC, NCI, and NAACCR, and data on mortality were obtained from the CDC. Long- (1975/1992-2009) and short-term (2000-2009) trends in age-standardized incidence and death rates for all cancers combined and for the leading cancers among men and among women were examined by joinpoint analysis. Prevalence of HPV vaccination coverage during 2008 and 2010 and of Papanicolaou (Pap) testing during 2010 were obtained from national surveys. RESULTS: Death rates continued to decline for all cancers combined for men and women of all major racial and ethnic groups and for most major cancer sites; rates for both sexes combined decreased by 1.5% per year from 2000 to 2009. Overall incidence rates decreased in men but stabilized in women. Incidence rates increased for two HPV-associated cancers (oropharynx, anus) and some cancers not associated with HPV (eg, liver, kidney, thyroid). Nationally, 32.0% (95% confidence interval [CI] = 30.3% to 33.6%) of girls aged 13 to 17 years in 2010 had received three doses of the HPV vaccine, and coverage was statistically significantly lower among the uninsured (14.1%, 95% CI = 9.4% to 20.6%) and in some Southern states (eg, 20.0% in Alabama [95% CI = 13.9% to 27.9%] and Mississippi [95% CI = 13.8% to 28.2%]), where cervical cancer rates were highest and recent Pap testing prevalence was the lowest. CONCLUSIONS: The overall trends in declining cancer death rates continue. However, increases in incidence rates for some HPV-associated cancers and low vaccination coverage among adolescents underscore the need for additional prevention efforts for HPV-associated cancers, including efforts to increase vaccination coverage. |
Association of an intensive lifestyle intervention with remission of type 2 diabetes
Gregg EW , Chen H , Wagenknecht LE , Clark JM , Delahanty LM , Bantle J , Pownall HJ , Johnson KC , Safford MM , Kitabchi AE , Pi-Sunyer FX , Wing RR , Bertoni AG . JAMA 2012 308 (23) 2489-2496 CONTEXT: The frequency of remission of type 2 diabetes achievable with lifestyle intervention is unclear. OBJECTIVE: To examine the association of a long-term intensive weight-loss intervention with the frequency of remission from type 2 diabetes to prediabetes or normoglycemia. DESIGN, SETTING, AND PARTICIPANTS: Ancillary observational analysis of a 4-year randomized controlled trial (baseline visit, August 2001-April 2004; last follow-up, April 2008) comparing an intensive lifestyle intervention (ILI) with a diabetes support and education control condition (DSE) among 4503 US adults with body mass index of 25 or higher and type 2 diabetes. INTERVENTIONS: Participants were randomly assigned to receive the ILI, which included weekly group and individual counseling in the first 6 months followed by 3 sessions per month for the second 6 months and twice-monthly contact and regular refresher group series and campaigns in years 2 to 4 (n=2241) or the DSE, which was an offer of 3 group sessions per year on diet, physical activity, and social support (n=2262). MAIN OUTCOME MEASURES: Partial or complete remission of diabetes, defined as transition from meeting diabetes criteria to a prediabetes or nondiabetic level of glycemia (fasting plasma glucose <126 mg/dL and hemoglobin A(1c) <6.5% with no antihyperglycemic medication). RESULTS Intensive lifestyle intervention participants lost significantly more weight than DSE participants at year 1 (net difference, -7.9%; 95% CI, -8.3% to -7.6%) and at year 4 (-3.9%; 95% CI, -4.4% to -3.5%) and had greater fitness increases at year 1 (net difference, 15.4%; 95% CI, 13.7%-17.0%) and at year 4 (6.4%; 95% CI, 4.7%-8.1%) (P <.001 for each). The ILI group was significantly more likely to experience any remission (partial or complete), with prevalences of 11.5% (95% CI, 10.1%-12.8%) during the first year and 7.3% (95% CI, 6.2%-8.4%) at year 4, compared with 2.0% for the DSE group at both time points (95% CIs, 1.4%-2.6% at year 1 and 1.5%-2.7% at year 4) (P <.001 for each). Among ILI participants, 9.2% (95% CI, 7.9%-10.4%), 6.4% (95% CI, 5.3%-7.4%), and 3.5% (95% CI, 2.7%-4.3%) had continuous, sustained remission for at least 2, at least 3, and 4 years, respectively, compared with less than 2% of DSE participants (1.7% [95% CI, 1.2%-2.3%] for at least 2 years; 1.3% [95% CI, 0.8%-1.7%] for at least 3 years; and 0.5% [95% CI, 0.2%-0.8%] for 4 years). CONCLUSIONS: In these exploratory analyses of overweight adults, an intensive lifestyle intervention was associated with a greater likelihood of partial remission of type 2 diabetes compared with diabetes support and education. However, the absolute remission rates were modest. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00017953. |
Recurrent epidemic cholera with high mortality in Cameroon: persistent challenges 40 years into the seventh pandemic
Cartwright EJ , Patel MK , Mbopi-Keou FX , Ayers T , Haenke B , Wagenaar BH , Mintz E , Quick R . Epidemiol Infect 2013 141 (10) 1-11 SUMMARY: Cameroon has experienced recurrent cholera epidemics with high mortality rates. In September 2009, epidemic cholera was detected in the Far North region of Cameroon and the reported case-fatality rate was 12%. We conducted village-, healthcare facility- and community-level surveys to investigate reasons for excess cholera mortality. Results of this investigation suggest that cholera patients who died were less likely to seek care, receive rehydration therapy and antibiotics at a healthcare facility, and tended to live further from healthcare facilities. Furthermore, use of oral rehydration salts at home was very low in both decedents and survivors. Despite the many challenges inherent to delivering care in Cameroon, practical measures could be taken to reduce cholera mortality in this region, including the timely provision of treatment supplies, training of healthcare workers, establishment of rehydration centres, and promotion of household water treatment and enhanced handwashing with soap. |
Sapovirus gastroenteritis in preschool center, Puerto Rico, 2011
Hassan-Rios E , Torres P , Munoz E , Matos C , Hall AJ , Gregoricus N , Vinje J . Emerg Infect Dis 2013 19 (1) 174-5 TO THE EDITOR: Human sapoviruses belong to a group of viruses within the family Caliciviridae, which also includes noroviruses, that cause acute gastroenteritis (1). Evidence of worldwide distribution of sapovirus has been documented on the basis of detection of virus and antibody prevalence against sapovirus in different populations (2). However, no evidence of sapovirus infection or outbreaks in Latin America and the Caribbean Islands has been reported. |
Seropositivity for influenza A(H1N1)pdm09 virus among frontline health care personnel
Alagappan K , Silverman RA , Hancock K , Ward MF , Akerman M , Dawood FS , Branch A , De Cicco S , Steward-Clark E , McCullough M , Tenner K , Katz JM . Emerg Infect Dis 2013 19 (1) 140-3 Seroprevalence of antibodies to influenza A(H1N1)pdm09 virus among 193 emergency department health care personnel was similar among 147 non-health care personnel (odds ratio 1.4, 95% CI 0.8-2.4). Working in an acute care setting did not substantially increase risk for virus infection above risk conferred by community-based exposures. |
Pooled individual data analysis of 5 randomized trials of infant nevirapine prophylaxis to prevent breast-milk HIV-1 transmission
Hudgens MG , Taha TE , Omer SB , Jamieson DJ , Lee H , Mofenson LM , Chasela C , Kourtis AP , Kumwenda N , Ruff A , Bedri A , Jackson JB , Musoke P , Bollinger RC , Gupte N , Thigpen MC , Taylor A , van der Horst C . Clin Infect Dis 2013 56 (1) 131-9 BACKGROUND: In resource-limited settings, mothers infected with human immunodeficiency virus type 1 (HIV-1) face a difficult choice: breastfeed their infants but risk transmitting HIV-1 or not breastfeed their infants and risk the infants dying of other infectious diseases or malnutrition. Recent results from observational studies and randomized clinical trials indicate daily administration of nevirapine to the infant can prevent breast-milk HIV-1 transmission. METODS: Data from 5396 mother-infant pairs who participated in 5 randomized trials where the infant was HIV-1 negative at birth were pooled to estimate the efficacy of infant nevirapine prophylaxis to prevent breast-milk HIV-1 transmission. Four daily regimens were compared: nevirapine for 6 weeks, 14 weeks, or 28 weeks, or nevirapine plus zidovudine for 14 weeks. RESULTS: The estimated 28-week risk of HIV-1 transmission was 5.8% (95% confidence interval [CI], 4.3%-7.9%) for the 6-week nevirapine regimen, 3.7% (95% CI, 2.5%-5.4%) for the 14-week nevirapine regimen, 4.8% (95% CI, 3.5%-6.7%) for the 14-week nevirapine plus zidovudine regimen, and 1.8% (95% CI, 1.0%-3.1%) for the 28-week nevirapine regimen (log-rank test for trend, P < .001). Cox regression models with nevirapine as a time-varying covariate, stratified by trial site and adjusted for maternal CD4 cell count and infant birth weight, indicated that nevirapine reduces the rate of HIV-1 infection by 71% (95% CI, 58%-80%; P < .001) and reduces the rate of HIV infection or death by 58% (95% CI, 45%-69%; P < .001). CONCLUSIONS: Extended prophylaxis with nevirapine or with nevirapine and zidovudine significantly reduces postnatal HIV-1 infection. Longer duration of prophylaxis results in a greater reduction in the risk of infection. |
Effect of the 2009 influenza A(H1N1) pandemic on invasive pneumococcal pneumonia
Fleming-Dutra KE , Taylor T , Link-Gelles R , Garg S , Jhung MA , Finelli L , Jain S , Shay D , Chaves SS , Baumbach J , Hancock EB , Beall B , Bennett N , Zansky S , Petit S , Yousey-Hindes K , Farley MM , Gershman K , Harrison LH , Ryan P , Lexau C , Lynfield R , Reingold A , Schaffner W , Thomas A , Moore MR . J Infect Dis 2013 207 (7) 1135-43 BACKGROUND: Because pneumococcal pneumonia was prevalent during previous influenza pandemics, we evaluated invasive pneumococcal pneumonia (IPP) rates during the 2009 influenza A(H1N1) pandemic. METHODS: We identified laboratory-confirmed, influenza-associated hospitalizations and IPP cases (pneumococcus isolated from normally sterile sites with discharge diagnoses of pneumonia) using active, population-based surveillance in the U.S. We compared IPP rates during peak pandemic months (April 2009-March 2010) to mean IPP rates in non-pandemic years (April 2004-March 2009) and, using Poisson models, to 2006-8 influenza seasons. RESULTS: Higher IPP rates occurred during the peak pandemic month compared to non-pandemic periods in 5-24 (IPP rate per 10 million: 48 v. 9 (95% confidence interval (CI) 5-13), 25-49 (74 v. 53 (CI 41-65)), 50-64 (188 v. 114 (CI 85-143)), and ≥65 year-olds (229 v. 187 (CI 159-216)). In the models with seasonal influenza rates included, observed IPP rates during the pandemic peak were within the predicted 95% CIs, suggesting this increase was not greater than observed with seasonal influenza. CONCLUSIONS: The recent influenza pandemic likely resulted in an out-of-season IPP peak among persons ≥5 years. The IPP peak's magnitude was similar to that seen during seasonal influenza epidemics. |
Fecal shedding of Shiga toxin-producing Escherichia coli: what should be done to prevent secondary cases?
Mody RK , Griffin PM . Clin Infect Dis 2013 56 (8) 1141-4 Much of what is known about the shedding and person-to-person transmission of Shiga toxin–producing Escherichia coli (STEC) infection is specific to a single serogroup, O157 (H7 and nonmotile). In many countries, it accounts for the greatest number of severe STEC infections, including those associated with life-threatening postdiarrheal hemolytic uremic syndrome (HUS) [1–6]. Secondary cases, transmitted person-to-person through fecal shedding, are estimated to account for 11% of infections [7]. In certain settings, such as childcare centers, outbreaks result nearly entirely from person-to-person spread [8]. | Ever since the association was first made between STEC and HUS in 1983, it has been known that some non-O157 STEC can also cause HUS [9]. However, non-O157 STEC strains are diverse; some are just as virulent as STEC O157, others tend to cause only mild diarrheal illness, and others are not human pathogens. This spectrum of virulence is governed in part by the type of Shiga toxin expressed [10–12] and the presence of genomic pathogenicity islands that contain virulence genes, including those for intestinal adherence [13, 14]. STEC strains that produce specific Shiga toxin (Stx) 2 subtypes, especially Stx2a, Stx2c, and Stx2d, tend to be more virulent [15–18]. Person-to-person transmission is an important mode of spread for at least some of the common non-O157 serotypes [19–27]. |
HIV counseling and testing and access-to-care needs of populations most-at-risk for HIV in Nigeria
Ahmed S , Delaney K , Villalba-Diebold P , Aliyu G , Constantine N , Ememabelem M , Vertefeuille J , Blattner W , Nasidi A , Charurat M . AIDS Care 2013 25 (1) 85-94 Mobile HIV counseling and testing (mHCT) is an effective tool to access hard-to-reach most-at-risk populations (MARPs), but identifying which populations are not accessing services is often a challenge. We compared correlates of human immunodeficiency virus (HIV) infection and awareness of HIV care services among populations tested through mHCT and at testing facilities in Nigeria. Participants in a cross-sectional study completed a questionnaire and HCT between May 2005 and March 2010. Of 27,586 total participants, 26.7% had been previously tested for HIV; among mHCT clients, 14.7% had previously been tested. HIV prevalence ranged from 6.6% among those tested through a facility to 50.4% among brothel-based sex workers tested by mHCT. Among mHCT participants aged 18-24, women were nine times more likely to be infected than men. Women aged 18-24 were also less likely than their male counterparts to know that there were medicines available to treat HIV (63.2 vs. 68.1%; p=0.03). After controlling for gender, age, and other risk factors, those with current genital ulcer disease were more likely to be HIV-infected (OR(mHCT)=1.65, 1.31-2.09; OR(facility)=1.71, 1.37-2.14), while those previously tested were less likely to be HIV-infected (OR(mHCT)=0.75, 0.64-0.88; OR(facility)=0.27, 0.24-0.31). There is an urgent need to promote strategies to identify those who are HIV-infected within MARPs, particularly young women, and to educate and inform them about availability of HIV testing and care services. mHCT, ideally coupled with sexually transmitted infection management, may help to ensure that MARPs access HIV prevention support, and if infected, access care, and treatment. |
Impact of the fall 2009 influenza A(H1N1)pdm09 pandemic on US hospitals
Rubinson L , Mutter R , Viboud C , Hupert N , Uyeki T , Creanga A , Finelli L , Iwashyna TJ , Carr B , Merchant R , Katikineni D , Vaughn F , Clancy C , Lurie N . Med Care 2013 51 (3) 259-65 BACKGROUND: Understanding how hospitals functioned during the 2009 influenza A(H1N1)pdm09 pandemic may improve future public health emergency response, but information about its impact on US hospitals remains largely unknown. RESEARCH DESIGN: We matched hospital and emergency department (ED) discharge data from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project with community-level influenza-like illness activity during each hospital's pandemic period in fall 2009 compared with a corresponding calendar baseline period. We compared inpatient mortality for sentinel conditions at high-surge versus nonsurge hospitals. RESULTS: US hospitals experienced a doubling of pneumonia and influenza ED visits during fall 2009 compared with prior years, along with an 18% increase in overall ED visits. Although no significant increase in total inpatient admissions occurred overall, approximately 10% of all study hospitals experienced high surge, associated with higher acute myocardial infarction and stroke case fatality rates. These hospitals had similar characteristics to other US hospitals except that they had higher mortality for acute cardiac illnesses before the pandemic. After adjusting for 2008 case fatality rates, the association between high-surge hospitals and increased mortality for acute myocardial infarction and stroke patients persisted. CONCLUSIONS: The fall 2009 pandemic period substantially impacted US hospitals, mostly through increased ED visits. For a small proportion of hospitals that experienced a high surge in inpatient admissions, increased mortality from selected clinical conditions was associated with both prepandemic outcomes and surge, highlighting the linkage between daily hospital operations and disaster preparedness. |
Burden of norovirus gastroenteritis in the ambulatory setting--United States, 2001-2009
Gastanaduy PA , Hall AJ , Curns AT , Parashar UD , Lopman BA . J Infect Dis 2013 207 (7) 1058-65 BACKGROUND: Gastroenteritis remains an important cause of morbidity in the U.S. The burden of norovirus gastroenteritis in ambulatory U.S. patients is not well understood. METHODS: Cause-specified and cause-unspecified gastroenteritis emergency department (ED) and outpatient visits during July 2001 to June 2009 were extracted from MarketScan insurance claim databases. Using cause-specified encounters, time-series regression models were fitted to predict the number of unspecified gastroenteritis visits due to specific pathogens other than norovirus. Model residuals were used to estimate norovirus visits. MarketScan rates were extrapolated to the U.S. population to estimate national ambulatory visits. RESULTS: From 2001-2009, the estimated annual mean rate of norovirus-associated ED and outpatient visits was 14 and 57 cases per 10,000 persons, respectively, across all ages. Rates for age-groups 0-4, 5-17, 18-64, and ≥65 years, were 38, 10, 12, and 15 ED, and 233, 85, 35, and 54 outpatient visits per 10,000 persons, respectively. Norovirus was estimated to cause 13% of all ambulatory gastroenteritis and 50% of visits occurred during November to February. Nationally, norovirus contributed to approximately 400,000 ED and 1.7 million office visits annually, resulting in $284 million healthcare charges. CONCLUSIONS: Norovirus is a substantial cause of gastroenteritis in the ambulatory setting. |
Cholera surveillance during the Haiti epidemic - the first 2 years
Barzilay EJ , Schaad N , Magloire R , Mung KS , Boncy J , Dahourou GA , Mintz ED , Steenland MW , Vertefeuille JF , Tappero JW . N Engl J Med 2013 368 (7) 599-609 BACKGROUND: In October 2010, nearly 10 months after a devastating earthquake, Haiti was stricken by epidemic cholera. Within days after detection, the Ministry of Public Health and Population established a National Cholera Surveillance System (NCSS). METHODS: The NCSS used a modified World Health Organization case definition for cholera that included acute watery diarrhea, with or without vomiting, in persons of all ages residing in an area in which at least one case of Vibrio cholerae O1 infection had been confirmed by culture. RESULTS: Within 29 days after the first report, cases of V. cholerae O1 (serotype Ogawa, biotype El Tor) were confirmed in all 10 administrative departments (similar to states or provinces) in Haiti. Through October 20, 2012, the public health ministry reported 604,634 cases of infection, 329,697 hospitalizations, and 7436 deaths from cholera and isolated V. cholerae O1 from 1675 of 2703 stool specimens tested (62.0%). The cumulative attack rate was 5.1% at the end of the first year and 6.1% at the end of the second year. The cumulative case fatality rate consistently trended downward, reaching 1.2% at the close of year 2, with departmental cumulative rates ranging from 0.6% to 4.6% (median, 1.4%). Within 3 months after the start of the epidemic, the rolling 14-day case fatality rate was 1.0% and remained at or below this level with few, brief exceptions. Overall, the cholera epidemic in Haiti accounted for 57% of all cholera cases and 53% of all cholera deaths reported to the World Health Organization in 2010 and 58% of all cholera cases and 37% of all cholera deaths in 2011. CONCLUSIONS: A review of NCSS data shows that during the first 2 years of the cholera epidemic in Haiti, the cumulative attack rate was 6.1%, with cases reported in all 10 departments. Within 3 months after the first case was reported, there was a downward trend in mortality, with a 14-day case fatality rate of 1.0% or less in most areas. |
The cure for cholera - improving access to safe water and sanitation
Waldman RJ , Mintz ED , Papowitz HE . N Engl J Med 2013 368 (7) 592-4 Whenever epidemics of cholera occur, the global public health community is energized. Experts meet, guidelines for control are reviewed and reissued, and new and modified interventions are proposed and promoted. In the past two decades, these things happened after cholera appeared in Latin America in 1991, in the wake of the Rwandan genocide and the ensuing refugee crisis in Zaire (now Democratic Republic of Congo) in 1994, in Zimbabwe in 2008, and in October 2010, at the onset of the ongoing epidemic in Haiti (see article by Barzilay et al.). But even when it is not covered in the news . . . |
Historic aspects of human susceptibility to leprosy and the risk of conjugal transmission
Joyce MP . Mem Inst Oswaldo Cruz 2012 107 Suppl 1 17-21 Estimates of genetic susceptibility to leprosy were made in the past from observational reports in familial settings using descriptive epidemiologic data. Risk of conjugal transmission of leprosy (from one spouse to another) has been estimated between 1-10% and is thought to occur in 3-5% of spouses exposed to untreated lepromatous disease in the partner. Risk of secondary transmission is presumed higher in other family members than for the conjugal partner. This belief has become dogma to many leprologists who may no longer know the basis for this estimation. This article reviews the historic epidemiologic descriptions of risk for leprosy transmission in married couples compared to other family members. Although uncommon, conjugal leprosy occurs and at higher rates in populations with traditional familial intermarriage and consanguinity. |
Increase in rates of hospitalization due to laboratory-confirmed influenza among children and adults during the 2009-10 influenza pandemic
Cox CM , D'Mello T , Perez A , Reingold A , Gershman K , Yousey-Hindes K , Arnold KE , Farley MM , Ryan P , Lynfield R , Morin C , Baumbach J , Hancock EB , Zansky S , Bennett NM , Thomas A , Schaffner W , Finelli L . J Infect Dis 2012 206 (9) 1350-8 BACKGROUND: The Emerging Infections Programs (EIP) network has conducted population-based surveillance for hospitalizations due to laboratory-confirmed influenza among children since 2003, with the network expanding in 2005 to include adults. METHODS: From 15 April 2009 through 30 April 2010, the EIP conducted surveillance among 22.1 million people residing in 10 states. Incidence rates per 100,000 population were calculated using US Census Bureau data. Mean historic rates were calculated on the basis of previously published and unpublished EIP data. RESULTS: During the 2009 pandemic of influenza A virus subtype H1N1 infection, rates of hospitalizations due to laboratory-confirmed influenza were 202, 88, 49, 31, 27, 36, 28, and 27 episodes per 100,000 among persons aged <6 months, 6-23 months, 2-4 years, 5-17 years, 18-49 years, 50-64 years, 65-74 years, and ≥75 years, respectively. Comparative mean rates from previous influenza seasons during which EIP conducted surveillance were 153, 53, 20, 6, 4, 8, 20, and 56 episodes per 100,000 among persons aged <6 months, 6-23 months, 2-4 years, 5-17 years, 18-49 years, 50-64 years, 65-74 years, and ≥75 years, respectively. CONCLUSIONS: During the pandemic, rates of hospitalization due to laboratory-confirmed influenza among individuals aged 5-17 years and 18-49 years increased 5-fold and 6-fold, respectively, compared with mean rates from previous influenza seasons. Hospitalization rates for other pediatric and adult age groups increased, compared with mean rates from previous influenza seasons, whereas the rate among individuals aged ≥75 years decreased. |
If not now, when? Seizing the moment for antibiotic stewardship
Pollack LA , Gould CV , Srinivasan A . Infect Control Hosp Epidemiol 2013 34 (2) 117-8 Efforts to improve antibiotic use in hospitals are consistently hampered by the complexity of medical decision making surrounding antibiotic administration. In addition to the myriad factors that influence a decision to start ntibiotics in the first place, there are a variety of issues that might change frequently during a course of therapy that can impact the decision to continue, change, or stop antibiotics. | There is certainly a great need to improve the way clinicians make decisions to start antibiotics. Better education and availability of information at the point of care on optimal diagnosis and treatment of infectious syndromes and on antibiotic spectra and dosing will lead to more effective decisions on the initiation of antibiotics. Interventions at the time of antibiotic prescribing using decision support or prior approval programs have proven highly effective in improving the way we start antibiotics.1,2 | Just as important as the decision to start antibiotics is the decision to continue them. Antibiotics are often started in settings where their utility is unclear. Hence, the need for continued antibiotic therapy needs to be regularly reassessed in light of ever-changing clinical information. At least it should. Too often, antibiotics are started and simply continued without critical reappraisal. |
The relationships between pesticide metabolites and neurobehavioral test performance in the third National Health and Nutrition Examination Survey
Krieg EF Jr . Arch Environ Occup Health 2013 68 (1) 39-46 Regression analysis was used to estimate and test for relationships between urinary pesticide metabolites and neurobehavioral test performance in adults, 20 to 59 years old, participating in the third National Health and Nutrition Examination Survey. The 12 pesticide metabolites included 2 naphthols, 8 phenols, a phenoxyacetic acid, and a pyridinol. The 3 neurobehavioral tests included in the survey were simple reaction time, symbol-digit substitution, and serial digit learning. As the 2,4-dichlorophenol, 2,5-dichlorophenol, and the pentachlorophenol concentrations increased, performance on the serial digit learning test improved. As the 2,5-dichlorophenol concentration increased, performance on the symbol-digit substitution test improved. At low concentrations, the parent compounds of these metabolites may act at acetylcholine and gamma-aminobutyric acid synapses in the central nervous system to improve neurobehavioral test performance. |
Vocal cord dysfunction related to water-damaged buildings
Cummings KJ , Fink JN , Vasudev M , Piacitelli C , Kreiss K . J Allergy Clin Immunol Pract 2013 1 (1) 46-50 Vocal cord dysfunction (VCD) is the intermittent paradoxical adduction of the vocal cords during respiration, resulting in variable upper airway obstruction. Exposure to damp indoor environments is associated with adverse respiratory health outcomes, including asthma, but its role in the development of VCD is not well described. We describe the spectrum of respiratory illness in occupants of 2 water-damaged office buildings. The National Institute for Occupational Safety and Health conducted a health hazard evaluation that included interviews with managers, a maintenance officer, a remediation specialist who had evaluated the 2 buildings, employees, and consulting physicians. In addition, medical records and reports of building evaluations were reviewed. Diagnostic evaluations for VCD had been conducted at the Asthma and Allergy Center of the Medical College of Wisconsin. Two cases of VCD were temporally related to occupancy of water-damaged buildings. The patients experienced cough, chest tightness, dyspnea, wheezing, and hoarseness when in the buildings. Spirometry was normal. Methacholine challenge did not show bronchial hyperreactivity but did elicit symptoms of VCD and inspiratory flow-volume loop truncation. Direct laryngoscopy revealed vocal cord adduction during inspiration. Coworkers developed upper and lower respiratory symptoms; their diagnoses included sinusitis and asthma, consistent with recognized effects of exposure to indoor dampness. Building evaluations provided evidence of water damage and mold growth. VCD can occur with exposure to water-damaged buildings and should be considered in exposed patients with asthma-like symptoms. |
Novel framework for assessing epidemiologic effects of influenza epidemics and pandemics
Reed C , Biggerstaff M , Finelli L , Koonin LM , Beauvais D , Uzicanin A , Plummer A , Bresee J , Redd SC , Jernigan DB . Emerg Infect Dis 2013 19 (1) 85-91 The effects of influenza on a population are attributable to the clinical severity of illness and the number of persons infected, which can vary greatly between seasons or pandemics. To create a systematic framework for assessing the public health effects of an emerging pandemic, we reviewed data from past influenza seasons and pandemics to characterize severity and transmissibility (based on ranges of these measures in the United States) and outlined a formal assessment of the potential effects of a novel virus. The assessment was divided into 2 periods. Because early in a pandemic, measurement of severity and transmissibility is uncertain, we used a broad dichotomous scale in the initial assessment to divide the range of historic values. In the refined assessment, as more data became available, we categorized those values more precisely. By organizing and prioritizing data collection, this approach may inform an evidence-based assessment of pandemic effects and guide decision making. |
Prevalence of HPV types in cervical specimens from an integrated healthcare delivery system: baseline assessment to measure HPV vaccine impact
Dunne EF , Klein NP , Naleway AL , Baxter R , Weinmann S , Riedlinger K , Fetterman B , Steinau M , Scarbrough MZ , Gee J , Markowitz LE , Unger ER . Cancer Causes Control 2013 24 (2) 403-7 PURPOSE: Two human papillomavirus (HPV) vaccines are available to prevent cervical cancer. One early measure of HPV vaccine impact would be a reduction in vaccine-related HPV types (HPV 6, 11, 16, or 18, or HPV 16, 18) in cervical samples from young women. We aimed to assess feasibility of specimen collection and baseline HPV prevalence in an integrated healthcare delivery system. METHODS: Residual cervical specimens collected during routine cervical cancer screening (2006-2008) were retained consecutively from eligible females aged 11-29 years, stratified by age group. Specimens were evaluated for 37 HPV genotypes using the Roche Linear Array assay. RESULTS: Of 10,124 specimens submitted, 10,103 (99 %) were adequate for HPV testing. Prevalence of HPV 6, 11, 16, or 18 genotype was 11.4 % overall and was the highest in the youngest age group (18.1 % in the 11-19-year-olds, 12.5 % in the 20-24-year-olds, and 7.0 % in the 25-29-year-olds). CONCLUSIONS: HPV types 6, 11, 16, or 18 prevalence could be measured over time to assess early HPV vaccine impact using residual specimens from an integrated healthcare delivery system, particularly if sampling focused on young women. |
Results from the first 30 months of national sentinel surveillance for influenza in Tanzania, 2008-2010
Mmbaga VM , Mwasekaga MJ , Mmbuji P , Matonya M , Mwafulango A , Moshi S , Emukule G , Katz MA . J Infect Dis 2012 206 Suppl 1 S80-6 Limited data exist on the burden of influenza in developing countries. In 2008, in order to better understand the epidemiology of influenza virus infection in Tanzania, the Tanzanian Ministry of Health and Social Welfare created a sentinel surveillance system for influenza. At 5 hospitals across the country, patients with influenza-like illness (ILI) and severe acute respiratory illness (SARI) had oropharyngeal and nasopharyngeal samples collected. At the National Influenza Center in Dar es Salaam, specimens were tested for influenza using real-time polymerase chain reaction tests. From May 2008 through November 2010, a total of 1794 samples were collected from 5 sentinel sites, of which 61% were from patients with ILI and 39% were from patients with SARI. Of all ILI and SARI samples, 8.0% were positive for influenza; 6.9% yielded influenza A virus, and 1.1% yielded influenza B virus. Most influenza A virus was subtype H3, which circulated in nearly every month of 2010. The proportion of influenza-positive cases was similar among ILI (8.5%) and SARI (7.3%) patients (P = .39). In multivariate logistic regression, influenza-positive SARI cases were more likely than influenza-negative SARI cases to have had rhonchi (adjusted OR [aOR], 2.31; 95% confidence interval [CI], 1.14-4.67), nasal discharge (aOR, 4.57; 95% CI, 1.30-16.10), and stridor (aOR, 2.63; 95% CI, 1.17-5.90). Influenza-positive ILI patients had a longer duration of fever on presentation, compared with influenza-negative ILI patients (median, 4 vs 3 days; P = .004). Otherwise, there was no difference in signs or symptoms among influenza-positive and influenza-negative ILI patients. During 2.5 years of surveillance for influenza at 5 geographically disbursed sites in Tanzania, we found that influenza circulated year-round. Surveillance should continue in order to fully understand the seasonality and epidemiology of influenza in Tanzania. |
Evaluation of ICD-9-CM codes for craniofacial microsomia
Luquetti DV , Saltzman BS , Vivaldi D , Pimenta LA , Hing AV , Cassell CH , Starr JR , Heike CL . Birth Defects Res A Clin Mol Teratol 2012 94 (12) 990-5 BACKGROUND: Craniofacial microsomia (CFM) is a congenital condition characterized by microtia and mandibular underdevelopment. Healthcare databases and birth defects surveillance programs could be used to improve knowledge of CFM. However, no specific International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code exists for this condition, which makes standardized data collection challenging. Our aim was to evaluate the validity of existing ICD-9-CM codes to identify individuals with CFM. METHODS: Study sample eligibility criteria were developed by an expert panel and matched to 11 ICD-9-CM codes. We queried hospital discharge data from two craniofacial centers and identified a total of 12,254 individuals who had ≥1 potentially CFM-related code(s). We reviewed all (n = 799) medical records identified at the University of North Carolina (UNC) and 500 randomly selected records at Seattle Children's Hospital (SCH). Individuals were classified as a CFM case or non-case. RESULTS: Thirty-two individuals (6%) at SCH and 93 (12%) at UNC met the CFM eligibility criteria. At both centers, 59% of cases and 95% of non-cases had only one code assigned. At both centers, the most frequent codes were 744.23 (microtia), 754.0 and 756.0 (nonspecific codes), and the code 744.23 had a positive predictive value (PPV) >80% and sensitivity >70%. The code 754.0 had a sensitivity of 3% (PPV <1%) at SCH and 36% (PPV = 5%) at UNC, whereas 756.0 had a sensitivity of 38% (PPV = 5%) at SCH and 18% (PPV = 26%) at UNC. CONCLUSIONS: These findings suggest the need for a specific CFM code to facilitate CFM surveillance and research. (Birth Defects Research (Part A), 2012. (c) 2012 Wiley Periodicals, Inc.) |
Influenza sentinel surveillance in Rwanda, 2008-2010
Nyatanyi T , Nkunda R , Rukelibuga J , Palekar R , Muhimpundu MA , Kabeja A , Kabanda A , Lowrance D , Tempia S , Koama JB , McAlister D , Mukabayire O , Wane J , Raghunathan P , Katz M , Karema C . J Infect Dis 2012 206 Suppl 1 S74-9 BACKGROUND: In 2008, Rwanda established an influenza sentinel surveillance (ISS) system to describe the epidemiology of influenza and monitor for the emergence of novel influenza A viruses. We report surveillance results from August 2008 to July 2010. METHODS: We conducted ISS by monitoring patients with influenza-like illness (ILI) and severe acute respiratory infection (SARI) at 6 hospitals. For each case, demographic and clinical data, 1 nasopharyngeal specimen, and 1 oropharyngeal specimen were collected. Specimens were tested by real-time reverse-transcription polymerase chain reaction for influenza A and B viruses at the National Reference Laboratory in Rwanda. RESULTS: A total of 1916 cases (945 ILI and 971 SARI) were identified. Of these, 29.2% (n = 276) of ILI and 10.4% (n = 101) of SARI cases tested positive for influenza. Of the total influenza-positive cases (n = 377), 71.8% (n = 271) were A(H1N1) pdm09, 5.6% (n = 21) influenza A(H1), 7.7% (n = 29) influenza A(H3), 1.6% (n = 6) influenza A (unsubtyped), and 13.3% (n = 50) influenza B. The percentage of positivity for influenza viruses was highest in October-November and February-March, during peaks in rainfall. CONCLUSIONS: The implementation of ISS enabled characterization of the epidemiology and seasonality of influenza in Rwanda for the first time. Future efforts should determine the population-based influenza burden to inform interventions such as targeted vaccination. |
Challenges of establishing routine influenza sentinel surveillance in Ethiopia, 2008-2010
Ayele W , Demissie G , Kassa W , Zemelak E , Afework A , Amare B , Cox CM , Jima D . J Infect Dis 2012 206 Suppl 1 S41-5 Ethiopia launched influenza surveillance in November 2008. By October 2010, 176 patients evaluated at 5 sentinel health facilities in Addis Ababa met case definitions for influenza-like illness or severe acute respiratory illness (SARI). Most patients (131 [74%]) were children aged 0-4 years. Twelve patients (7%) were positive for influenza virus. Most patients (109 [93%]) were aged <5 years, of whom only 3 (2.8%) had laboratory-confirmed influenza. Low awareness of influenza by healthcare workers, misperceptions regarding case definitions, and insufficient human resources at sites could have potentially led to many missed cases, resulting in suboptimal surveillance. |
Listeriosis outbreaks and associated food vehicles, United States, 1998-2008
Cartwright EJ , Jackson KA , Johnson SD , Graves LM , Silk BJ , Mahon BE . Emerg Infect Dis 2013 19 (1) 1-9 Listeria monocytogenes, a bacterial foodborne pathogen, can cause meningitis, bacteremia, and complications during pregnancy. This report summarizes listeriosis outbreaks reported to the Foodborne Disease Outbreak Surveillance System of the Centers for Disease Control and Prevention during 1998-2008. The study period includes the advent of PulseNet (a national molecular subtyping network for outbreak detection) in 1998 and the Listeria Initiative (enhanced surveillance for outbreak investigation) in 2004. Twenty-four confirmed listeriosis outbreaks were reported during 1998-2008, resulting in 359 illnesses, 215 hospitalizations, and 38 deaths. Outbreaks earlier in the study period were generally larger and longer. Serotype 4b caused the largest number of outbreaks and outbreak-associated cases. Ready-to-eat meats caused more early outbreaks, and novel vehicles (i.e., sprouts, taco/nacho salad) were associated with outbreaks later in the study period. These changes may reflect the effect of PulseNet and the Listeria Initiative and regulatory initiatives designed to prevent contamination in ready-to-eat meat and poultry products. |
Novel epidemic clones of Listeria monocytogenes, United States, 2011
Lomonaco S , Verghese B , Gerner-Smidt P , Tarr C , Gladney L , Joseph L , Katz L , Turnsek M , Frace M , Chen Y , Brown E , Meinersmann R , Berrang M , Knabel S . Emerg Infect Dis 2013 19 (1) 147-50 We identified a novel serotype 1/2a outbreak strain and 2 novel epidemic clones of Listeria monocytogenes while investigating a foodborne outbreak of listeriosis associated with consumption of cantaloupe during 2011 in the United States. Comparative analyses of strains worldwide are essential to identification of novel outbreak strains and epidemic clones. |
Hospital-acquired listeriosis outbreak caused by contaminated diced celery--Texas, 2010
Gaul LK , Farag NH , Shim T , Kingsley MA , Silk BJ , Hyytia-Trees E . Clin Infect Dis 2013 56 (1) 20-6 BACKGROUND: Listeria monocytogenes causes often-fatal infections affecting mainly immunocompromised persons. Sources of hospital-acquired listeriosis outbreaks can be difficult to identify. We investigated a listeriosis outbreak spanning 7 months and involving 5 hospitals. METHODS: Outbreak-related cases were identified by pulsed-field gel electrophoresis (PFGE) and confirmed by multiple-locus variable-number tandem-repeat analysis (MLVA). We conducted patient interviews, medical records reviews, and hospital food source evaluations. Food and environmental specimens were collected at a hospital (hospital A) where 6 patients had been admitted before listeriosis onset; these specimens were tested by culture, polymerase chain reaction (PCR), and PFGE. We collected and tested food and environmental samples at the implicated processing facility. RESULTS: Ten outbreak-related patients were immunocompromised by ≥1 underlying conditions or treatments; 5 died. All patients had been admitted to or visited an acute-care hospital during their possible incubation periods. The outbreak strain of L. monocytogenes was isolated from chicken salad and its diced celery ingredient at hospital A, and in 19 of >200 swabs of multiple surfaces and in 8 of 11 diced celery products at the processing plant. PCR testing detected Listeria in only 3 of 10 environmental and food samples from which it was isolated by culturing. The facility was closed, products were recalled, and the outbreak ended. CONCLUSIONS: Contaminated diced celery caused a baffling, lengthy outbreak of hospital-acquired listeriosis. PCR testing often failed to detect the pathogen, suggesting its reliability should be further evaluated. Listeriosis risk should be considered in fresh produce selections for immunocompromised patients. |
Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Vos Theo , Flaxman Abraham D , Naghavi Mohsen , Lozano Rafael , Michaud Catherine , Ezzati Majid , Shibuya Kenji , Salomon Joshua A , Abdalla Safa , Aboyans Victor , Abraham Jerry , Ackerman Ilana , Aggarwal Rakesh , Ahn Stephanie Y , Ali Mohammed K , Alvarado Miriam , Anderson H Ross , Anderson Laurie M , Andrews Kathryn G , Atkinson Charles , Baddour Larry M , Bahalim Adil N , Barker-Collo Suzanne , Barrero Lope H , Bartels David H , Basanez Maria-Gloria , Baxter Amanda , Bell Michelle L , Benjamin Emelia J , Bennett Derrick , Bernabe Eduardo , Bhalla Kavi , Bhandari Bishal , Bikbov Boris , Bin Abdulhak Aref , Birbeck Gretchen , Black James A , Blencowe Hannah , Blore Jed D , Blyth Fiona , Bolliger Ian , Bonaventure Audrey , Boufous Soufiane , Bourne Rupert , Boussinesq Michel , Braithwaite Tasanee , Brayne Carol , Bridgett Lisa , Brooker Simon , Brooks Peter , Brugha Traolach S , Bryan-Hancock Claire , Bucello Chiara , Buchbinder Rachelle , Buckle Geoffrey , Budke Christine M , Burch Michael , Burney Peter , Burstein Roy , Calabria Bianca , Campbell Benjamin , Canter Charles E , Carabin Helene , Carapetis Jonathan , Carmona Loreto , Cella Claudia , Charlson Fiona , Chen Honglei , Cheng Andrew Tai-Ann , Chou David , Chugh Sumeet S , Coffeng Luc E , Colan Steven D , Colquhoun Samantha , Colson K Ellicott , Condon John , Connor Myles D , Cooper Leslie T , Corriere Matthew , Cortinovis Monica , de Vaccaro Karen Courville , Couser William , Cowie Benjamin C , Criqui Michael H , Cross Marita , Dabhadkar Kaustubh C , Dahiya Manu , Dahodwala Nabila , Damsere-Derry James , Danaei Goodarz , Davis Adrian , De Leo Diego , Degenhardt Louisa , Dellavalle Robert , Delossantos Allyne , Denenberg Julie , Derrett Sarah , Des Jarlais Don C , Dharmaratne Samath D , Dherani Mukesh , Diaz-Torne Cesar , Dolk Helen , Dorsey E Ray , Driscoll Tim , Duber Herbert , Ebel Beth , Edmond Karen , Elbaz Alexis , Ali Suad Eltahir , Erskine Holly , Erwin Patricia J , Espindola Patricia , Ewoigbokhan Stalin E , Farzadfar Farshad , Feigin Valery , Felson David T , Ferrari Alize , Ferri Cleusa P , Fevre Eric M , Finucane Mariel M , Flaxman Seth , Flood Louise , Foreman Kyle , Forouzanfar Mohammad H , Fowkes Francis Gerry R , Franklin Richard , Fransen Marlene , Freeman Michael K , Gabbe Belinda J , Gabriel Sherine E , Gakidou Emmanuela , Ganatra Hammad A , Garcia Bianca , Gaspari Flavio , Gillum Richard F , Gmel Gerhard , Gosselin Richard , Grainger Rebecca , Groeger Justina , Guillemin Francis , Gunnell David , Gupta Ramyani , Haagsma Juanita , Hagan Holly , Halasa Yara A , Hall Wayne , Haring Diana , Haro Josep Maria , Harrison James E , Havmoeller Rasmus , Hay Roderick J , Higashi Hideki , Hill Catherine , Hoen Bruno , Hoffman Howard , Hotez Peter J , Hoy Damian , Huang John J , Ibeanusi Sydney E , Jacobsen Kathryn H , James Spencer L , Jarvis Deborah , Jasrasaria Rashmi , Jayaraman Sudha , Johns Nicole , Jonas Jost B , Karthikeyan Ganesan , Kassebaum Nicholas , Kawakami Norito , Keren Andre , Khoo Jon-Paul , King Charles H , Knowlton Lisa Marie , Kobusingye Olive , Koranteng Adofo , Krishnamurthi Rita , Lalloo Ratilal , Laslett Laura L , Lathlean Tim , Leasher Janet L , Lee Yong Yi , Leigh James , Lim Stephen S , Limb Elizabeth , Lin John Kent , Lipnick Michael , Lipshultz Steven E , Liu Wei , Loane Maria , Ohno Summer Lockett , Lyons Ronan , Ma Jixiang , Mabweijano Jacqueline , MacIntyre Michael F , Malekzadeh Reza , Mallinger Leslie , Manivannan Sivabalan , Marcenes Wagner , March Lyn , Margolis David J , Marks Guy B , Marks Robin , Matsumori Akira , Matzopoulos Richard , Mayosi Bongani M , McAnulty John H , McDermott Mary M , McGill Neil , McGrath John , Medina-Mora Maria Elena , Meltzer Michele , Mensah George A , Merriman Tony R , Meyer Ana-Claire , Miglioli Valeria , Miller Matthew , Miller Ted R , Mitchell Philip B , Mocumbi Ana Olga , Moffitt Terrie E , Mokdad Ali A , Monasta Lorenzo , Montico Marcella , Moradi-Lakeh Maziar , Moran Andrew , Morawska Lidia , Mori Rintaro , Murdoch Michele E , Mwaniki Michael K , Naidoo Kovin , Nair M Nathan , Naldi Luigi , Narayan K M Venkat , Nelson Paul K , Nelson Robert G , Nevitt Michael C , Newton Charles R , Nolte Sandra , Norman Paul , Norman Rosana , O'Donnell Martin , O'Hanlon Simon , Olives Casey , Omer Saad B , Ortblad Katrina , Osborne Richard , Ozgediz Doruk , Page Andrew , Pahari Bishnu , Pandian Jeyaraj Durai , Rivero Andrea Panozo , Patten Scott B , Pearce Neil , Padilla Rogelio Perez , Perez-Ruiz Fernando , Perico Norberto , Pesudovs Konrad , Phillips David , Phillips Michael R , Pierce Kelsey , Pion Sebastien , Polanczyk Guilherme V , Polinder Suzanne , Pope C Arden 3rd , Popova Svetlana , Porrini Esteban , Pourmalek Farshad , Prince Martin , Pullan Rachel L , Ramaiah Kapa D , Ranganathan Dharani , Razavi Homie , Regan Mathilda , Rehm Jurgen T , Rein David B , Remuzzi Guiseppe , Richardson Kathryn , Rivara Frederick P , Roberts Thomas , Robinson Carolyn , De Leon Felipe Rodriguez , Ronfani Luca , Room Robin , Rosenfeld Lisa C , Rushton Lesley , Sacco Ralph L , Saha Sukanta , Sampson Uchechukwu , Sanchez-Riera Lidia , Sanman Ella , Schwebel David C , Scott James Graham , Segui-Gomez Maria , Shahraz Saeid , Shepard Donald S , Shin Hwashin , Shivakoti Rupak , Singh David , Singh Gitanjali M , Singh Jasvinder A , Singleton Jessica , Sleet David A , Sliwa Karen , Smith Emma , Smith Jennifer L , Stapelberg Nicolas J C , Steer Andrew , Steiner Timothy , Stolk Wilma A , Stovner Lars Jacob , Sudfeld Christopher , Syed Sana , Tamburlini Giorgio , Tavakkoli Mohammad , Taylor Hugh R , Taylor Jennifer A , Taylor William J , Thomas Bernadette , Thomson W Murray , Thurston George D , Tleyjeh Imad M , Tonelli Marcello , Towbin Jeffrey A , Truelsen Thomas , Tsilimbaris Miltiadis K , Ubeda Clotilde , Undurraga Eduardo A , van der Werf Marieke J , van Os Jim , Vavilala Monica S , Venketasubramanian N , Wang Mengru , Wang Wenzhi , Watt Kerrianne , Weatherall David J , Weinstock Martin A , Weintraub Robert , Weisskopf Marc G , Weissman Myrna M , White Richard A , Whiteford Harvey , Wiersma Steven T , Wilkinson James D , Williams Hywel C , Williams Sean R M , Witt Emma , Wolfe Frederick , Woolf Anthony D , Wulf Sarah , Yeh Pon-Hsiu , Zaidi Anita K M , Zheng Zhi-Jie , Zonies David , Lopez Alan D , Murray Christopher J L , Global Burden of Disease Study 2010 . Lancet 2013 380 (9859) 2163-96 BACKGROUND: Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs). METHODS: Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. FINDINGS: Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350,000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0.37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. INTERPRETATION: Rates of YLDs per 100,000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world. FUNDING: Bill & Melinda Gates Foundation. |
A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Lim Stephen S , Vos Theo , Flaxman Abraham D , Danaei Goodarz , Shibuya Kenji , Adair-Rohani Heather , Amann Markus , Anderson H Ross , Andrews Kathryn G , Aryee Martin , Atkinson Charles , Bacchus Loraine J , Bahalim Adil N , Balakrishnan Kalpana , Balmes John , Barker-Collo Suzanne , Baxter Amanda , Bell Michelle L , Blore Jed D , Blyth Fiona , Bonner Carissa , Borges Guilherme , Bourne Rupert , Boussinesq Michel , Brauer Michael , Brooks Peter , Bruce Nigel G , Brunekreef Bert , Bryan-Hancock Claire , Bucello Chiara , Buchbinder Rachelle , Bull Fiona , Burnett Richard T , Byers Tim E , Calabria Bianca , Carapetis Jonathan , Carnahan Emily , Chafe Zoe , Charlson Fiona , Chen Honglei , Chen Jian Shen , Cheng Andrew Tai-Ann , Child Jennifer Christine , Cohen Aaron , Colson K Ellicott , Cowie Benjamin C , Darby Sarah , Darling Susan , Davis Adrian , Degenhardt Louisa , Dentener Frank , Des Jarlais Don C , Devries Karen , Dherani Mukesh , Ding Eric L , Dorsey E Ray , Driscoll Tim , Edmond Karen , Ali Suad Eltahir , Engell Rebecca E , Erwin Patricia J , Fahimi Saman , Falder Gail , Farzadfar Farshad , Ferrari Alize , Finucane Mariel M , Flaxman Seth , Fowkes Francis Gerry R , Freedman Greg , Freeman Michael K , Gakidou Emmanuela , Ghosh Santu , Giovannucci Edward , Gmel Gerhard , Graham Kathryn , Grainger Rebecca , Grant Bridget , Gunnell David , Gutierrez Hialy R , Hall Wayne , Hoek Hans W , Hogan Anthony , Hosgood H Dean 3rd , Hoy Damian , Hu Howard , Hubbell Bryan J , Hutchings Sally J , Ibeanusi Sydney E , Jacklyn Gemma L , Jasrasaria Rashmi , Jonas Jost B , Kan Haidong , Kanis John A , Kassebaum Nicholas , Kawakami Norito , Khang Young-Ho , Khatibzadeh Shahab , Khoo Jon-Paul , Kok Cindy , Laden Francine , Lalloo Ratilal , Lan Qing , Lathlean Tim , Leasher Janet L , Leigh James , Li Yang , Lin John Kent , Lipshultz Steven E , London Stephanie , Lozano Rafael , Lu Yuan , Mak Joelle , Malekzadeh Reza , Mallinger Leslie , Marcenes Wagner , March Lyn , Marks Robin , Martin Randall , McGale Paul , McGrath John , Mehta Sumi , Mensah George A , Merriman Tony R , Micha Renata , Michaud Catherine , Mishra Vinod , Hanafiah Khayriyyah Mohd , Mokdad Ali A , Morawska Lidia , Mozaffarian Dariush , Murphy Tasha , Naghavi Mohsen , Neal Bruce , Nelson Paul K , Nolla Joan Miquel , Norman Rosana , Olives Casey , Omer Saad B , Orchard Jessica , Osborne Richard , Ostro Bart , Page Andrew , Pandey Kiran D , Parry Charles D H , Passmore Erin , Patra Jayadeep , Pearce Neil , Pelizzari Pamela M , Petzold Max , Phillips Michael R , Pope Dan , Pope C Arden 3rd , Powles John , Rao Mayuree , Razavi Homie , Rehfuess Eva A , Rehm Jurgen T , Ritz Beate , Rivara Frederick P , Roberts Thomas , Robinson Carolyn , Rodriguez-Portales Jose A , Romieu Isabelle , Room Robin , Rosenfeld Lisa C , Roy Ananya , Rushton Lesley , Salomon Joshua A , Sampson Uchechukwu , Sanchez-Riera Lidia , Sanman Ella , Sapkota Amir , Seedat Soraya , Shi Peilin , Shield Kevin , Shivakoti Rupak , Singh Gitanjali M , Sleet David A , Smith Emma , Smith Kirk R , Stapelberg Nicolas J C , Steenland Kyle , Stockl Heidi , Stovner Lars Jacob , Straif Kurt , Straney Lahn , Thurston George D , Tran Jimmy H , Van Dingenen Rita , van Donkelaar Aaron , Veerman J Lennert , Vijayakumar Lakshmi , Weintraub Robert , Weissman Myrna M , White Richard A , Whiteford Harvey , Wiersma Steven T , Wilkinson James D , Williams Hywel C , Williams Warwick , Wilson Nicholas , Woolf Anthony D , Yip Paul , Zielinski Jan M , Lopez Alan D , Murray Christopher J L , Ezzati Majid , Global Burden of Disease Study 2010 . Lancet 2013 380 (9859) 2224-60 BACKGROUND: Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS: We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS: In 2010, the three leading risk factors for global disease burden were high blood pressure (7.0% [95% uncertainty interval 6.2-7.7] of global DALYs), tobacco smoking including second-hand smoke (6.3% [5.5-7.0]), and alcohol use (5.5% [5.0-5.9]). In 1990, the leading risks were childhood underweight (7.9% [6.8-9.4]), household air pollution from solid fuels (HAP; 7.0% [5.6-8.3]), and tobacco smoking including second-hand smoke (6.1% [5.4-6.8]). Dietary risk factors and physical inactivity collectively accounted for 10.0% (95% UI 9.2-10.8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0.9% (0.4-1.6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION: Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children. FUNDING: Bill & Melinda Gates Foundation. |
Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010
Murray Christopher J L , Vos Theo , Lozano Rafael , Naghavi Mohsen , Flaxman Abraham D , Michaud Catherine , Ezzati Majid , Shibuya Kenji , Salomon Joshua A , Abdalla Safa , Aboyans Victor , Abraham Jerry , Ackerman Ilana , Aggarwal Rakesh , Ahn Stephanie Y , Ali Mohammed K , Alvarado Miriam , Anderson H Ross , Anderson Laurie M , Andrews Kathryn G , Atkinson Charles , Baddour Larry M , Bahalim Adil N , Barker-Collo Suzanne , Barrero Lope H , Bartels David H , Basanez Maria-Gloria , Baxter Amanda , Bell Michelle L , Benjamin Emelia J , Bennett Derrick , Bernabe Eduardo , Bhalla Kavi , Bhandari Bishal , Bikbov Boris , Bin Abdulhak Aref , Birbeck Gretchen , Black James A , Blencowe Hannah , Blore Jed D , Blyth Fiona , Bolliger Ian , Bonaventure Audrey , Boufous Soufiane , Bourne Rupert , Boussinesq Michel , Braithwaite Tasanee , Brayne Carol , Bridgett Lisa , Brooker Simon , Brooks Peter , Brugha Traolach S , Bryan-Hancock Claire , Bucello Chiara , Buchbinder Rachelle , Buckle Geoffrey , Budke Christine M , Burch Michael , Burney Peter , Burstein Roy , Calabria Bianca , Campbell Benjamin , Canter Charles E , Carabin Helene , Carapetis Jonathan , Carmona Loreto , Cella Claudia , Charlson Fiona , Chen Honglei , Cheng Andrew Tai-Ann , Chou David , Chugh Sumeet S , Coffeng Luc E , Colan Steven D , Colquhoun Samantha , Colson K Ellicott , Condon John , Connor Myles D , Cooper Leslie T , Corriere Matthew , Cortinovis Monica , de Vaccaro Karen Courville , Couser William , Cowie Benjamin C , Criqui Michael H , Cross Marita , Dabhadkar Kaustubh C , Dahiya Manu , Dahodwala Nabila , Damsere-Derry James , Danaei Goodarz , Davis Adrian , De Leo Diego , Degenhardt Louisa , Dellavalle Robert , Delossantos Allyne , Denenberg Julie , Derrett Sarah , Des Jarlais Don C , Dharmaratne Samath D , Dherani Mukesh , Diaz-Torne Cesar , Dolk Helen , Dorsey E Ray , Driscoll Tim , Duber Herbert , Ebel Beth , Edmond Karen , Elbaz Alexis , Ali Suad Eltahir , Erskine Holly , Erwin Patricia J , Espindola Patricia , Ewoigbokhan Stalin E , Farzadfar Farshad , Feigin Valery , Felson David T , Ferrari Alize , Ferri Cleusa P , Fevre Eric M , Finucane Mariel M , Flaxman Seth , Flood Louise , Foreman Kyle , Forouzanfar Mohammad H , Fowkes Francis Gerry R , Fransen Marlene , Freeman Michael K , Gabbe Belinda J , Gabriel Sherine E , Gakidou Emmanuela , Ganatra Hammad A , Garcia Bianca , Gaspari Flavio , Gillum Richard F , Gmel Gerhard , Gonzalez-Medina Diego , Gosselin Richard , Grainger Rebecca , Grant Bridget , Groeger Justina , Guillemin Francis , Gunnell David , Gupta Ramyani , Haagsma Juanita , Hagan Holly , Halasa Yara A , Hall Wayne , Haring Diana , Haro Josep Maria , Harrison James E , Havmoeller Rasmus , Hay Roderick J , Higashi Hideki , Hill Catherine , Hoen Bruno , Hoffman Howard , Hotez Peter J , Hoy Damian , Huang John J , Ibeanusi Sydney E , Jacobsen Kathryn H , James Spencer L , Jarvis Deborah , Jasrasaria Rashmi , Jayaraman Sudha , Johns Nicole , Jonas Jost B , Karthikeyan Ganesan , Kassebaum Nicholas , Kawakami Norito , Keren Andre , Khoo Jon-Paul , King Charles H , Knowlton Lisa Marie , Kobusingye Olive , Koranteng Adofo , Krishnamurthi Rita , Laden Francine , Lalloo Ratilal , Laslett Laura L , Lathlean Tim , Leasher Janet L , Lee Yong Yi , Leigh James , Levinson Daphna , Lim Stephen S , Limb Elizabeth , Lin John Kent , Lipnick Michael , Lipshultz Steven E , Liu Wei , Loane Maria , Ohno Summer Lockett , Lyons Ronan , Mabweijano Jacqueline , MacIntyre Michael F , Malekzadeh Reza , Mallinger Leslie , Manivannan Sivabalan , Marcenes Wagner , March Lyn , Margolis David J , Marks Guy B , Marks Robin , Matsumori Akira , Matzopoulos Richard , Mayosi Bongani M , McAnulty John H , McDermott Mary M , McGill Neil , McGrath John , Medina-Mora Maria Elena , Meltzer Michele , Mensah George A , Merriman Tony R , Meyer Ana-Claire , Miglioli Valeria , Miller Matthew , Miller Ted R , Mitchell Philip B , Mock Charles , Mocumbi Ana Olga , Moffitt Terrie E , Mokdad Ali A , Monasta Lorenzo , Montico Marcella , Moradi-Lakeh Maziar , Moran Andrew , Morawska Lidia , Mori Rintaro , Murdoch Michele E , Mwaniki Michael K , Naidoo Kovin , Nair M Nathan , Naldi Luigi , Narayan K M Venkat , Nelson Paul K , Nelson Robert G , Nevitt Michael C , Newton Charles R , Nolte Sandra , Norman Paul , Norman Rosana , O'Donnell Martin , O'Hanlon Simon , Olives Casey , Omer Saad B , Ortblad Katrina , Osborne Richard , Ozgediz Doruk , Page Andrew , Pahari Bishnu , Pandian Jeyaraj Durai , Rivero Andrea Panozo , Patten Scott B , Pearce Neil , Padilla Rogelio Perez , Perez-Ruiz Fernando , Perico Norberto , Pesudovs Konrad , Phillips David , Phillips Michael R , Pierce Kelsey , Pion Sebastien , Polanczyk Guilherme V , Polinder Suzanne , Pope C Arden 3rd , Popova Svetlana , Porrini Esteban , Pourmalek Farshad , Prince Martin , Pullan Rachel L , Ramaiah Kapa D , Ranganathan Dharani , Razavi Homie , Regan Mathilda , Rehm Jurgen T , Rein David B , Remuzzi Guiseppe , Richardson Kathryn , Rivara Frederick P , Roberts Thomas , Robinson Carolyn , De Leon Felipe Rodriguez , Ronfani Luca , Room Robin , Rosenfeld Lisa C , Rushton Lesley , Sacco Ralph L , Saha Sukanta , Sampson Uchechukwu , Sanchez-Riera Lidia , Sanman Ella , Schwebel David C , Scott James Graham , Segui-Gomez Maria , Shahraz Saeid , Shepard Donald S , Shin Hwashin , Shivakoti Rupak , Singh David , Singh Gitanjali M , Singh Jasvinder A , Singleton Jessica , Sleet David A , Sliwa Karen , Smith Emma , Smith Jennifer L , Stapelberg Nicolas J C , Steer Andrew , Steiner Timothy , Stolk Wilma A , Stovner Lars Jacob , Sudfeld Christopher , Syed Sana , Tamburlini Giorgio , Tavakkoli Mohammad , Taylor Hugh R , Taylor Jennifer A , Taylor William J , Thomas Bernadette , Thomson W Murray , Thurston George D , Tleyjeh Imad M , Tonelli Marcello , Towbin Jeffrey A , Truelsen Thomas , Tsilimbaris Miltiadis K , Ubeda Clotilde , Undurraga Eduardo A , van der Werf Marieke J , van Os Jim , Vavilala Monica S , Venketasubramanian N , Wang Mengru , Wang Wenzhi , Watt Kerrianne , Weatherall David J , Weinstock Martin A , Weintraub Robert , Weisskopf Marc G , Weissman Myrna M , White Richard A , Whiteford Harvey , Wiebe Natasha , Wiersma Steven T , Wilkinson James D , Williams Hywel C , Williams Sean R M , Witt Emma , Wolfe Frederick , Woolf Anthony D , Wulf Sarah , Yeh Pon-Hsiu , Zaidi Anita K M , Zheng Zhi-Jie , Zonies David , Lopez Alan D , Global Burden of Disease Study 2010 . Lancet 2013 380 (9859) 2197-223 BACKGROUND: Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time. METHODS: We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights. FINDINGS: Global DALYs remained stable from 1990 (2.503 billion) to 2010 (2.490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions. INTERPRETATION: Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results. FUNDING: Bill & Melinda Gates Foundation. |
Patterns of condom use among students at historically black colleges and universities: implications for HIV prevention efforts among college-age young adults
El Bcheraoui C , Sutton MY , Hardnett FP , Jones SB . AIDS Care 2013 25 (2) 186-93 Over 1.1 million Americans are living with human immunodeficiency virus (HIV), and African-American youth and young adults are disproportionately affected. Condoms are the most effective prevention tool, yet data regarding condom use patterns for African-American college youth are lacking. To inform and strengthen HIV prevention strategies with African-American college-age youth, we surveyed students attending 24 historically Black colleges and universities regarding condom use patterns. Students were administered anonymous questionnaires online to explore knowledge, attitudes, and practices related to condom use during last sexual intercourse (LSI). Among 824 sexually active respondents (51.8% female, median age 20 years, 90.6% heterosexuals), 526 (63.8%) reported condom use during LSI. Students who used condoms for disease prevention, whose mothers completed high school or had some college education or completed college were more likely to have used a condom during LSI. Spontaneity of sexual encounters, not feeling at risk of HIV, and partner-related perceptions were associated with condom non-use during LSI (p<0.05). Over a third of our college youth sample did not use a condom during LSI and may benefit from increased condom education efforts. These efforts should highlight condoms' effectiveness in protection from HIV. Future HIV education and prevention strategies with similar groups of young adults should explore the implications of maternal education, clarify perceptions of HIV risk, and consider strategies that increase consistent condom use to interrupt sexual transmission of HIV. |
Problem behavior, victimization, and soda intake in high school students
Park S , Blanck HM , Sherry B , Foti K . Am J Health Behav 2013 37 (3) 414-421 OBJECTIVE: To examine associations of problem behaviors and victimization with nondiet soda intake among a national sample of 16,188 US high school students. METHODS: We used the 2009 national Youth Risk Behavior Survey. The outcome measure was daily nondiet soda intake. RESULTS: Smoking, having any sex partners, not always wearing a seat belt, being bullied/threatened/ injured on school property, and being physically hurt by their boyfriend/girlfriend were significantly associated with daily nondiet soda intake after adjustment for age, sex, race/ethnicity, and weight status. CONCLUSIONS: Our findings suggest a need to examine why nondiet soda intake is associated with these behaviors to understand potential mechanisms. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract). |
What girls won't do for love: human immunodeficiency virus/sexually transmitted infections risk among young African-American women driven by a relationship imperative
Raiford JL , Seth P , Diclemente RJ . J Adolesc Health 2012 52 (5) 566-71 PURPOSE: Rates of Human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) continue to increase among African-American youth. Adolescents who have a stronger identity in relation to others (relational identity) rather than to themselves (self-identity) may view intimate relationships as imperative to a positive self-concept, which may lead to risky sexual behavior and abuse. Therefore, the present study assessed the associations among a relationship imperative and HIV/STI-related risk factors and behaviors. METHODS: Participants were 715 African-American adolescent females, aged 15 to 21 years. They completed measures that assessed how important a relationship was to them and HIV-related risk factors and behaviors. Participants also provided vaginal swab specimens for STI testing. RESULTS: Multivariate logistic regression analyses, controlling for covariates, were conducted. Females who endorsed a relationship imperative (29%), compared to those who did not, were more likely to report: unprotected sex, less power in their relationships, perceived inability to refuse sex, anal sex, sex while their partner was high on alcohol/drugs, and partner abuse. Furthermore, participants with less power, recent partner abuse, and a perceived ability to refuse sex were more likely to test STI positive. CONCLUSION: These results indicate that if African-American adolescent females believe a relationship is imperative, they are more likely to engage in riskier sexual behaviors. Additionally, less perceived power and partner abuse increases their risk for STIs. HIV/STI prevention programs should target males and females and address healthy relationships, sense of self-worth, self-esteem and the gender power imbalance that may persist in the community along with HIV/STI risk. |
Outbreak of hepatitis B virus infections associated with assisted monitoring of blood glucose in an assisted living facility - Virginia, 2010
Bender TJ , Wise ME , Utah O , Moorman AC , Sharapov U , Drobeniuc J , Khudyakov Y , Fricchione M , White-Comstock MB , Thompson ND , Patel PR . PLoS One 2012 7 (12) e50012 INTRODUCTION: In January 2010, the Virginia Department of Health received reports of 2 hepatitis B virus (HBV) infections (1 acute, 1 chronic) among residents of a single assisted living facility (ALF). Both infected residents had diabetes and received assisted monitoring of blood glucose (AMBG) at the facility. An investigation was initiated in response. OBJECTIVE: To determine the extent and mechanism of HBV transmission among ALF residents. DESIGN: Retrospective cohort study. SETTING: An ALF that primarily housed residents with neuropsychiatric disorders in 2 adjacent buildings in Virginia. PARTICIPANTS: Residents of the facility as of March 2010. MEASUREMENTS: HBV serologic testing, relevant medical history, and HBV genome sequences. Risk ratios (RR) and 95% confidence intervals (CIs) were used to identify risk factors for HBV infection. RESULTS: HBV serologic status was determined for 126 (91%) of 139 residents. Among 88 susceptible residents, 14 became acutely infected (attack rate, 16%), and 74 remained uninfected. Acute HBV infection developed among 12 (92%) of 13 residents who received AMBG, compared with 2 (3%) of 75 residents who did not (RR = 35; 95% CI, 8.7, 137). Identified infection control breaches during AMBG included shared use of fingerstick devices for multiple residents. HBV genome sequencing demonstrated 2 building-specific phylogenetic infection clusters, each having 99.8-100% sequence identity. LIMITATIONS: Transfer of residents out of the facility prior to our investigation might have contributed to an underestimate of cases. Resident interviews provided insufficient information to fully assess behavioral risk factors for HBV infection. CONCLUSIONS: Failure to adhere to safe practices during AMBG resulted in a large HBV outbreak. Protection of a growing and vulnerable ALF population requires improved training of staff and routine facility licensing inspections that scrutinize infection control practices. |
The first National Adult Immunization Summit 2012: implementing change through action
Shen AK , Bridges CB , Tan L . Vaccine 2013 31 (2) 279-84 To address lagging vaccine coverage among adults in the United States, over 150 organizations representing a wide range of immunization partners convened in Atlanta, GA from May 15-16, 2012 for the inaugural National Adult Immunization Summit. The meeting called for solution-oriented discussion toward improving current immunization levels, implementing the 2011 National Vaccine Advisory Committee adult immunization recommendations, and capitalizing on new opportunities to improve coverage. Provisions in the federal health reform law that increase access to preventive services, including immunizations, and the increasing numbers of complementary vaccine providers such as pharmacists, create new opportunities to increase access for immunization services and improve coverage for adults. The Summit organized around five focal areas: empowering providers, quality and performance measures, increasing access and collaboration, educating patients, and informing decision-makers. These focal areas formed the basis of working groups, charged to coordinate efforts by the participating organizations to address gaps in the current immunization system. Summit participants identified priority themes to address as tasks during the coming year, including better communicating the value of immunizations to increase demand for immunizations, creating a central repository of resources for providers, patients, and others interested in improving adult immunization levels, examining performance and quality measures and evaluating means to use such measures to motivate vaccine providers, increasing engagement with employer and employee groups to increase awareness and demand for vaccinations, improving the use of immunization information systems and electronic health reports, decreasing barriers to all vaccine providers including pharmacists and community vaccinators, decreasing the complexity of the adult vaccine schedule where possible, engaging adult immunization champions and leaders in key sectors, including adult healthcare provider groups, and encouraging more integration of immunization services with other preventive services. |
A phase 3 trial of RTS,S/AS01 malaria vaccine in African infants
Agnandji ST , Lell B , Fernandes JF , Abossolo BP , Methogo BG , Kabwende AL , Adegnika AA , Mordmüller B , Issifou S , Kremsner PG , Sacarlal J , Aide P , Lanaspa M , Aponte JJ , Machevo S , Acacio S , Bulo H , Sigauque B , Macete E , Alonso P , Abdulla S , Salim N , Minja R , Mpina M , Ahmed S , Ali AM , Mtoro AT , Hamad AS , Mutani P , Tanner M , Tinto H , D'Alessandro U , Sorgho H , Valea I , Bihoun B , Guiraud I , Kaboré B , Sombié O , Guiguemdé RT , Ouédraogo JB , Hamel MJ , Kariuki S , Oneko M , Odero C , Otieno K , Awino N , McMorrow M , Muturi-Kioi V , Laserson KF , Slutsker L , Otieno W , Otieno L , Otsyula N , Gondi S , Otieno A , Owira V , Oguk E , Odongo G , Woods JB , Ogutu B , Njuguna P , Chilengi R , Akoo P , Kerubo C , Maingi C , Lang T , Olotu A , Bejon P , Marsh K , Mwambingu G , Owusu-Agyei S , Asante KP , Osei-Kwakye K , Boahen O , Dosoo D , Asante I , Adjei G , Kwara E , Chandramohan D , Greenwood B , Lusingu J , Gesase S , Malabeja A , Abdul O , Mahende C , Liheluka E , Malle L , Lemnge M , Theander TG , Drakeley C , Ansong D , Agbenyega T , Adjei S , Boateng HO , Rettig T , Bawa J , Sylverken J , Sambian D , Sarfo A , Agyekum A , Martinson F , Hoffman I , Mvalo T , Kamthunzi P , Nkomo R , Tembo T , Tegha G , Tsidya M , Kilembe J , Chawinga C , Ballou WR , Cohen J , Guerra Y , Jongert E , Lapierre D , Leach A , Lievens M , Ofori-Anyinam O , Olivier A , Vekemans J , Carter T , Kaslow D , Leboulleux D , Loucq C , Radford A , Savarese B , Schellenberg D , Sillman M , Vansadia P . N Engl J Med 2012 367 (24) 2284-95 BACKGROUND: The candidate malaria vaccine RTS,S/AS01 reduced episodes of both clinical and severe malaria in children 5 to 17 months of age by approximately 50% in an ongoing phase 3 trial. We studied infants 6 to 12 weeks of age recruited for the same trial. METHODS: We administered RTS,S/AS01 or a comparator vaccine to 6537 infants who were 6 to 12 weeks of age at the time of the first vaccination in conjunction with Expanded Program on Immunization (EPI) vaccines in a three-dose monthly schedule. Vaccine efficacy against the first or only episode of clinical malaria during the 12 months after vaccination, a coprimary end point, was analyzed with the use of Cox regression. Vaccine efficacy against all malaria episodes, vaccine efficacy against severe malaria, safety, and immunogenicity were also assessed. RESULTS: The incidence of the first or only episode of clinical malaria in the intention-to-treat population during the 14 months after the first dose of vaccine was 0.31 per person-year in the RTS,S/AS01 group and 0.40 per person-year in the control group, for a vaccine efficacy of 30.1% (95% confidence interval [CI], 23.6 to 36.1). Vaccine efficacy in the per-protocol population was 31.3% (97.5% CI, 23.6 to 38.3). Vaccine efficacy against severe malaria was 26.0% (95% CI, -7.4 to 48.6) in the intention-to-treat population and 36.6% (95% CI, 4.6 to 57.7) in the per-protocol population. Serious adverse events occurred with a similar frequency in the two study groups. One month after administration of the third dose of RTS,S/AS01, 99.7% of children were positive for anti-circumsporozoite antibodies, with a geometric mean titer of 209 EU per milliliter (95% CI, 197 to 222). CONCLUSIONS: The RTS,S/AS01 vaccine coadministered with EPI vaccines provided modest protection against both clinical and severe malaria in young infants. (Funded by GlaxoSmithKline Biologicals and the PATH Malaria Vaccine Initiative; RTS,S ClinicalTrials.gov number: NCT00866619.). |
Orphaned and abused youth are vulnerable to pregnancy and suicide risk
Zapata LB , Kissin DM , Bogoliubova O , Yorick RV , Kraft JM , Jamieson DJ , Marchbanks PA , Hillis SD . Child Abuse Negl 2013 37 (5) 310-9 OBJECTIVE: Little is known about the magnitude and consequences of violence against children for those living outside family care. We sought to estimate the frequency of childhood abuse and examine its association with lifetime pregnancy involvement (LPI) and past year suicide ideation among orphaned youth. METHODS: We analyzed data collected via cross-sectional interviewer-administered surveys completed by 293 orphaned youth aged 16-23 years living outside of family care in St. Petersburg, Russia. We used multivariable logistic regression to estimate adjusted odds ratios (AORs) of LPI and past year suicide ideation associated with childhood physical and sexual abuse. Other risk factors were also examined (e.g., social vulnerability, sexual and substance use behaviors), and characteristics of orphaned youth with LPI and past year suicide ideation were described. RESULTS: The prevalence of childhood abuse was higher among females than among males (23.3% versus 15.6% for physical abuse, and 20.3% versus 5.6% for sexual abuse), as was the prevalence of LPI and past year suicide ideation among those with histories of abuse. Experiences of childhood abuse were strong risk factors for both LPI and past year suicide ideation, with significant variation by gender. While both types of abuse were significantly associated with LPI and past year suicide ideation among females, physical abuse was significantly associated with LPI and sexual abuse was associated with suicide ideation for males. Of the other characteristics examined, strong modifiable risk factors included having no one to turn to for help and no involvement in activities outside of class. Among those with LPI (n=36), nearly 20% had been pregnant or gotten someone pregnant ≥2 times, most (61.8%) reported at least one induced abortion, and current use of effective contraception was nearly non-existent. Among those with past year suicide ideation (n=30), nearly half (44.8%) reported attempting suicide. CONCLUSIONS: There is an urgent need for interventions to prevent and mitigate the negative influence of childhood abuse experiences. Programs providing services to orphaned youth should increase access to sexual education, effective contraceptives, and mental health counseling. |
Detection of hepatitis C virus transmission by use of DNA mass spectrometry.
Ganova-Raeva LM , Dimitrova ZE , Campo DS , Yulin L , Ramachandran S , Xia GL , Honisch C , Cantor CR , Khudyakov YE . J Infect Dis 2013 207 (6) 999-1006 The molecular detection of transmission of rapidly mutating pathogens such as hepatitis C virus (HCV) is commonly achieved by assessing the genetic relatedness of strains among infected patients. We describe the development of a novel mass spectrometry (MS)-based approach to identification of HCV transmissions. MS was used to detect products of base-specific cleavage of RNA molecules obtained from HCV PCR fragments. The MS-peak profiles (MSPs) were found to reflect variation in the HCV genomic sequence and the intra-host composition of the HCV population. Serum specimens (n=60) originating from case-patients of 14 epidemiologically confirmed outbreaks and unrelated controls (n=25) were tested. Neighbor-joining trees constructed using MSP-based Hamming distances showed 100% accuracy, and linkage networks constructed using a threshold established from the Hamming distances between epidemiologically unrelated cases showed 100% sensitivity and 99.93% specificity in transmission detection. The MS approach is rapid, robust, reproducible and cost-effective, and applicable to investigating transmissions of other pathogens. |
Occurrence of ß-lactamase genes among non-Typhi Salmonella enterica isolated from humans, food animals, and retail meats in the United States and Canada.
Sjolund-Karlsson M , Howie RL , Blickenstaff K , Boerlin P , Ball T , Chalmers G , Duval B , Haro J , Rickert R , Zhao S , Fedorka-Cray PJ , Whichard JM . Microb Drug Resist 2013 19 (3) 191-7 Non-Typhi Salmonella cause over 1.7 million cases of gastroenteritis in North America each year, and food-animal products are commonly implicated in human infections. For invasive infections, antimicrobial therapy is indicated. In North America, the antimicrobial susceptibility of Salmonella is monitored by the U.S. National Antimicrobial Resistance Monitoring System (NARMS) and The Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS). In this study, we determined the susceptibility to cephalosporins by broth microdilution among 5,041 non-Typhi Salmonella enterica isolated from food animals, retail meats, and humans. In the United States, 109 (4.6%) of isolates collected from humans, 77 (15.7%) from retail meat, and 140 (10.6%) from food animals displayed decreased susceptibility to cephalosporins (DSC). Among the Canadian retail meat and food animal isolates, 52 (13.0%) and 42 (9.4%) displayed DSC. All isolates displaying DSC were screened for beta-lactamase genes (bla(TEM), bla(SHV), bla(CMY), bla(CTX-M), and bla(OXA-1)) by polymerase chain reaction. At least one beta-lactamase gene was detected in 74/109 (67.9%) isolates collected from humans, and the bla(CMY) genes were most prevalent (69/109; 63.3%). Similarly, the bla(CMY) genes predominated among the beta-lactamase-producing isolates collected from retail meats and food animals. Three isolates from humans harbored a bla(CTX-M-15) gene. No animal or retail meat isolates harbored a bla(CTX-M) or bla(OXA-1) gene. A bla(TEM) gene was found in 5 human, 9 retail meat, and 17 animal isolates. Although serotype distributions varied among human, retail meat, and animal sources, overlap in bla(CMY)-positive serotypes across sample sources supports meat and food-animal sources as reservoirs for human infection. |
Role of Nrf2 in oxidative stress and toxicity
Ma Q . Annu Rev Pharmacol Toxicol 2013 53 401-26 Organismal life encounters reactive oxidants from internal metabolism and environmental toxicant exposure. Reactive oxygen and nitrogen species cause oxidative stress and are traditionally viewed as being harmful. On the other hand, controlled production of oxidants in normal cells serves useful purposes to regulate signaling pathways. Reactive oxidants are counterbalanced by complex antioxidant defense systems regulated by a web of pathways to ensure that the response to oxidants is adequate for the body's needs. A recurrent theme in oxidant signaling and antioxidant defense is reactive cysteine thiol-based redox signaling. The nuclear factor erythroid 2-related factor 2 (Nrf2) is an emerging regulator of cellular resistance to oxidants. Nrf2 controls the basal and induced expression of an array of antioxidant response element-dependent genes to regulate the physiological and pathophysiological outcomes of oxidant exposure. This review discusses the impact of Nrf2 on oxidative stress and toxicity and how Nrf2 senses oxidants and regulates antioxidant defense. |
Single-tier testing with the C6 peptide ELISA kit compared with two-tier testing for Lyme disease
Wormser GP , Schriefer M , Aguero-Rosenfeld ME , Levin A , Steere AC , Nadelman RB , Nowakowski J , Marques A , Johnson BJ , Dumler JS . Diagn Microbiol Infect Dis 2013 75 (1) 9-15 For the diagnosis of Lyme disease, the 2-tier serologic testing protocol for Lyme disease has a number of shortcomings including low sensitivity in early disease; increased cost, time, and labor; and subjectivity in the interpretation of immunoblots. In this study, the diagnostic accuracy of a single-tier commercial C6 ELISA kit was compared with 2-tier testing. The results showed that the C6 ELISA was significantly more sensitive than 2-tier testing with sensitivities of 66.5% (95% confidence interval [CI] 61.7-71.1) and 35.2% (95% CI 30.6-40.1), respectively (P < 0.001) in 403 sera from patients with erythema migrans. The C6 ELISA had sensitivity statistically comparable to 2-tier testing in sera from Lyme disease patients with early neurologic manifestations (88.6% versus 77.3%, P = 0.13) or arthritis (98.3% versus 95.6%, P = 0.38). The specificities of C6 ELISA and 2-tier testing in over 2200 blood donors, patients with other conditions, and Lyme disease vaccine recipients were found to be 98.9% and 99.5%, respectively (P < 0.05, 95% CI surrounding the 0.6 percentage point difference of 0.04 to 1.15). In conclusion, using a reference standard of 2-tier testing, the C6 ELISA as a single-step serodiagnostic test provided increased sensitivity in early Lyme disease with comparable sensitivity in later manifestations of Lyme disease. The C6 ELISA had slightly decreased specificity. Future studies should evaluate the performance of the C6 ELISA compared with 2-tier testing in routine clinical practice. |
Macrophage-derived Hedgehog ligands promotes fibrogenic and angiogenic responses in human schistosomiasis mansoni
Pereira TA , Xie G , Choi SS , Syn WK , Voieta I , Lu J , Chan IS , Swiderska M , Amaral KB , Antunes CM , Secor WE , Witek RP , Lambertucci JR , Pereira FL , Diehl AM . Liver Int 2013 33 (1) 149-61 BACKGROUND: Schistosomiasis mansoni is a major cause of portal fibrosis and portal hypertension. The Hedgehog pathway regulates fibrogenic repair in some types of liver injury. AIMS: Determine if Hedgehog pathway activation occurs during fibrosis progression in schistosomiasis and to determine if macrophage-related mechanisms are involved. METHODS: Immunohistochemistry was used to characterize the cells that generate and respond to Hedgehog ligands in 28 liver biopsies from patients with different grades of schistosomiasis fibrosis staged by ultrasound. Cultured macrophages (RAW264.7 and primary rat Kupffer cells) and primary rat liver sinusoidal endothelial cells (LSEC) were treated with schistosome egg antigen (SEA) and evaluated using qRT-PCR. Inhibition of the Hedgehog pathway was used to investigate its role in alternative activation of macrophages (M2) and vascular tube formation. RESULTS: Patients with schistosomiasis expressed more ligands (Shh and Ihh) and target genes (Patched and Gli2) than healthy individuals. Activated LSEC and myofibroblasts were Hedgehog responsive [Gli2(+)] and accumulated in parallel with fibrosis stage (P < 0.05). Double IHC for Ihh/CD68 showed that Ihh(+) cells were macrophages. In vitro studies demonstrated that SEA-stimulated macrophages to express Ihh and Shh mRNA (P < 0.05). Conditioned media from such macrophages induced luciferase production by Shh-LightII cells (P < 0.001) and Hedgehog inhibitors blocked this effect (P < 0.001). SEA-treated macrophages also up-regulated their own expression of M2 markers, and Hh pathway inhibitors abrogated this response (P < 0.01). Inhibition of the Hedgehog pathway in LSEC blocked SEA-induced migration and tube formation. CONCLUSION: SEA stimulates liver macrophages to produce Hh ligands, which promote alternative activation of macrophages, fibrogenesis and vascular remodelling in schistosomiasis. |
Optimization of the cut-off value for a commercial anti-dengue virus IgG immunoassay
Marrero-Santos KM , Beltran M , Carrion-Lebron J , Sanchez-Vegas C , Hamer DH , Barnett ED , Santiago LM , Hunsperger EA . Clin Vaccine Immunol 2013 20 (3) 358-62 A commercial anti-dengue virus (DENV) indirect IgG enzyme-linked immunosorbent assay (ELISA) for serological diagnosis was evaluated for its utility in determining previous DENV exposure in US travelers. The Boston Area Travel Medicine Network clinics used Focus Diagnostics anti-DENV IgG ELISA to measure anti-DENV IgG antibodies in 591 pre-travel specimens from US residents who had traveled to dengue endemic countries. When using the manufacturer's index cut-off value for this ELISA, false-positive results were observed that overestimated the perceived past DENV exposure in US travelers. Validation of 121 of these anti-DENV IgG results by plaque reduction neutralization test (PRNT) was used for receiver operator characteristics (ROC) curve optimization of the index cut-off value from 1 to 3.0, improving the specificity of the anti-DENV IgG ELISA from 24% to 95.7%. Additionally, previous vaccination with yellow fever virus contributed to 52.8% of the false positive rate in the anti-DENV IgG ELISA results. Optimization of the cut-off value of the anti-DENV IgG ELISA provided better interpretation and confidence in the results and eliminated the need for confirmation by PRNT. The travel history of US travelers was also useful for categorizing these travelers in groups for analysis of previous DENV exposure. |
Comparison of the performance of IFA, CFA, and ELISA assays for the serodiagnosis of acute Q fever by quality assessment
Herremans T , Hogema BM , Nabuurs M , Peeters M , Wegdam-Blans M , Schneeberger P , Nijhuis C , Notermans DW , Galama J , Horrevorts A , van Loo IH , Vlaminckx B , Zaaijer HL , Koopmans MP , Berkhout H , Socolovschi C , Raoult D , Stenos J , Nicholson W , Bijlmer H . Diagn Microbiol Infect Dis 2013 75 (1) 16-21 The indirect immunofluorescence assay (IFA) is considered the reference method for diagnosing Q fever, but serology is also performed by complement fixation assay (CFA) or enzyme-linked immunosorbent assay (ELISA). However, comparability between these assays is not clear, and therefore a quality assessment was performed. A total of 25 serum samples from negative controls, Q fever patients, and a serial diluted high-positive sample were analyzed in 10 Dutch laboratories. Six laboratories performed CFA, 5 performed IFA, and 5 performed ELISAs. Three international reference laboratories from Australia, France, and the USA also participated in this study. Qualitative values between laboratories using the same methods were within close range, and all 3 methods correctly identified acute Q fever patients. The IFA, ELISA, and CFA are all suitable serodiagnostic assays to diagnose acute Q fever, but the IFA remains an important tool in the follow-up of patients and in identifying patients at risk for developing chronic Q fever. |
Hexamethylene diisocyanate (HDI) vapor reactivity with glutathione and subsequent transfer to human albumin
Wisnewski AV , Mhike M , Hettick JM , Liu J , Siegel PD . Toxicol In Vitro 2012 27 (2) 662-71 INTRODUCTION: Airway fluid glutathione (GSH) reactivity with inhaled vapors of diisocyanate, a common occupational allergen, is postulated to be a key step in exposure-induced asthma pathogenesis. METHODS: A mixed (vapor/liquid) phase exposure system was used to model the in vivo reactivity of inhaled HDI vapor with GSH in the airway fluid. HDI-GSH reaction products, and their capacity to transfer HDI to human albumin, were characterized through mass spectrometry and serologic assays, using HDI-specific polyclonal rabbit serum. RESULTS: HDI vapor exposure of 10mM GSH solutions resulted in primarily S-linked, bis(GSH)-HDI reaction products. In contrast, lower GSH concentrations (100muM) resulted in mainly mono(GSH)-HDI conjugates, with varying degrees of HDI hydrolysis, dimerization and/or intra-molecular cyclization, depending upon the presence/absence of H(2)PO(4)(-)/HPO(4)(2-) and Na(+)/Cl(-) ions. The ion composition and GSH concentration of the fluid phase, during HDI vapor exposure, strongly influenced the transfer of HDI from GSH to albumin, as did the pH and duration of the carbamoylating reaction. When carbamoylation was performed overnight at pH 7, 25 of albumin's lysines were identified as potential sites of conjugation with partially hydrolyzed HDI. When carbamoylation was performed at pH 9, more rapid (within 3h) and extensive modification was observed, including additional lysine sites, intra-molecular cross-linkage with HDI, and novel HDI-GSH conjugation. CONCLUSIONS: The data define potential mechanisms by which the levels of GSH, H(2)PO(4)(-)/HPO(4)(2-), and/or other ions (e.g. H(+)/OH(-), Na(+), Cl(-)) affect the reactivity of HDI vapor with self-molecules in solution (e.g. airway fluid), and thus, might influence the clinical response to HDI respiratory tract exposure. |
Application of an updated physiologically-based pharmacokinetic model for chloroform to evaluate CYP2E1-mediated renal toxicity in rats and mice
Sasso AF , Schlosser PM , Kedderis GL , Genter MB , Snawder J , Li Z , Rieth S , Lipscomb JC . Toxicol Sci 2012 131 (2) 360-74 Physiologically-based pharmacokinetic (PBPK) models are tools for interpreting toxicological data, and extrapolating observations across species and route of exposure. Chloroform (CHCl(3)) is a chemical for which there are PBPK models available in different species, and multiple sites of toxicity. Since chloroform induces toxic effects in the liver and kidneys via production of reactive metabolites, proper characterization of metabolism in these tissues is essential for risk assessment. While hepatic metabolism of chloroform is adequately described by these models, there is higher uncertainty for renal metabolism due to a lack of species-specific data and direct measurements of renal metabolism. Furthermore, models typically fail to account for regional differences in metabolic capacity within the kidney. Mischaracterization of renal metabolism may have a negligible effect on systemic chloroform levels, but it is anticipated to have a significant impact on the estimated site-specific production of reactive metabolites. In this paper, rate parameters for chloroform metabolism in the kidney are revised for rats, mice, and humans. New in vitro data were collected in mice and humans for this purpose and are presented here. The revised PBPK model is used to interpret data of chloroform-induced kidney toxicity in rats and mice exposed via inhalation and drinking water. Benchmark dose (BMD) modeling is used to characterize the dose-response relationship of kidney toxicity markers as a function of PBPK-derived internal kidney dose. Applying the PBPK model, it was also possible to characterize the dose-response for a recent dataset of rats exposed via multiple routes simultaneously. Consistent BMD modeling results were observed regardless of species or route of exposure. |
Combination therapy using monoclonal antibodies against respiratory syncytial virus (RSV) G glycoprotein protects from RSV disease in BALB/c Mice
Caidi H , Harcourt JL , Tripp RA , Anderson LJ , Haynes LM . PLoS One 2012 7 (12) e51485 Therapeutic options to control respiratory syncytial virus (RSV) are limited, thus development of new therapeutics is high priority. Previous studies with a monoclonal antibody (mAb) reactive to an epitope proximal to the central conserved region (CCR) of RSV G protein (mAb 131-2G) showed therapeutic efficacy for reducing pulmonary inflammation RSV infection in BALB/c mice. Here, we show a protective effect in RSV-infected mice therapeutically treated with a mAb (130-6D) reactive to an epitope within the CCR of G protein, while treatment with a mAb specific for a carboxyl G protein epitope had no effect. Combined treatment with mAbs 130-6D and 131-2G significantly decreased RSV-associated pulmonary inflammation compared to either antibody alone. The results suggest that anti-RSV G protein mAbs that react at or near the CCR and can block RSV G protein-mediated activities are effective at preventing RSV disease and may be an effective strategy for RSV therapeutic treatment. |
Blood lead level analysis among refugee children resettled in New Hampshire and Rhode Island
Raymond JS , Kennedy C , Brown MJ . Public Health Nurs 2013 30 (1) 70-9 OBJECTIVE: To examine the association between refugee status and elevated blood lead levels (EBLLs) among children living in two U.S. cities and to assess the effect of the Centers for Disease Control and Prevention recommendations for BLL testing of newly emigrated refugee children for EBLLs. DESIGN AND SAMPLE: A longitudinal study was conducted of 1,007 refugee children and 953 nonrefugee children living, when blood testing occurred, in the same buildings in Manchester, New Hampshire and Providence, Rhode Island. MEASURES: Surveillance and blood lead data were collected from both sites, including demographic information, BLLs, sample type, refugee status, and age of housing. RESULTS: Refugee children living in Manchester were statistically significantly more likely to have an EBLL compared with nonrefugee children even after controlling for potential confounders. We did not find this association in Providence. Compared with before enactment, the mean time of refugee children to fall below 10 mcg/dL was significantly shorter after the recommendations to test newly emigrated children were enacted. CONCLUSIONS: Refugee children living in Manchester were significantly more likely to have an EBLL compared with nonrefugee children. And among refugee children, we found a statistically significant difference in the mean days to BLL decline <10 mcg/dL before and after recommendations to test newly emigrated children. |
Selected birth defects data from population-based birth defects surveillance programs in the United States, 2005-2009: featuring critical congenital heart defects targeted for pulse oximetry screening
Mai CT , Riehle-Colarusso T , O'Halloran A , Cragan JD , Olney RS , Lin A , Feldkamp M , Botto LD , Rickard R , Anderka M , Ethen M , Stanton C , Ehrhardt J , Canfield M . Birth Defects Res A Clin Mol Teratol 2012 94 (12) 970-983 Since 1997, the National Birth Defects Prevention Network (NBDPN), in collaboration with the Centers for Disease Control and Prevention (CDC), has published data on major birth defects affecting the central nervous, eye, ear, cardiovascular, orofacial, gastrointestinal, genitourinary, and musculoskeletal systems, as well as trisomies, amniotic bands, and fetal alcohol syndrome, from population-based birth defects surveillance programs in the United States. Annually, the NBDPN Data Committee issues a data request to population-based birth defects programs for data on 47 major birth defects; the specific defects with accompanying diagnostic codes are detailed in Appendix 1 on page 10. This year’s report containing data from 41 population-based birth defects surveillance programs for births occurring from January 1, 2005, through December 31, 2009, is available as a supplement on pages. The data are presented by racial/ethnic groups for all defects and additionally by maternal age for triso-mies 13, 18, and 21. | To calculate prevalence, programs were also asked to provide the number of total live births and male live births for each calendar year submitted. The standard method for calculating birth defects prevalence is to divide the number of cases (birth defect for any pregnancy outcome) by total live births for the catchment area and then multiply by 10,000 to obtain the prevalence per 10,000 live births; Mason et al. (2005) provide further detail and rationale for this approach. This methodology is used for all defects except hypospadias, which is calculated using a denominator of total male live births. An attempt was made to standardize both the submitted data and presentation of state surveillance data, however, differences in the way programs collect and report birth defects data are listed in the footnotes of the accompanying tables and may be referenced in the program directories on pages S121-S169 (online). Some programs were able to only provide data for selected years, were unable to report counts and prevalence by race/ethnicity, or were unable to provide data for each specific defect requested due to differences in the coding systems (i.e., International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] vs CDC/British Pediat-ric Association [BPA]) Classification of Diseases used to classify birth defects. |
Maternal caffeine consumption and risk of congenital limb deficiencies
Chen L , Bell EM , Browne ML , Druschel CM , Romitti PA , Schmidt RJ , Burns TL , Moslehi R , Olney RS . Birth Defects Res A Clin Mol Teratol 2012 94 (12) 1033-43 BACKGROUND: Animal studies have shown that high doses of caffeine might cause congenital limb deficiencies (LDs); however, no epidemiologic studies have explored this relation. METHODS: This case-control study assessed associations between maternal dietary caffeine and congenital LDs using data from the National Birth Defects Prevention Study (NBDPS), with 844 LD cases and 8069 controls from 1997 to 2007. Caffeine intakes from beverages (coffee, tea, and soda) and chocolate combined and by beverage type were examined. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated for subtypes of isolated LDs (no additional major anomalies) and LDs with other major anomalies separately, comparing the odds of 10 to <100, 100 to <200, 200 to <300, and 300+ mg/day total caffeine intake to 0 to <10 mg/day. RESULTS: All total dietary caffeine intake categories of 10 mg/day and above were marginally associated with odds of all isolated LDs combined (aOR, 1.4-1.7), isolated longitudinal LDs (aOR, 1.2-1.6), and isolated transverse LDs (aOR, 1.3-1.8) compared to the lowest intake category. A dose-response pattern for total dietary caffeine intake was not observed. CONCLUSIONS: A weak increased risk of congenital LDs associated with maternal dietary caffeine consumption was observed in this study; however, risk did not vary by amount of caffeine consumed. (Birth Defects Research (Part A), 2012. (c) 2012 Wiley Periodicals, Inc.) |
Association between weight gain during pregnancy and neural tube defects and gastroschisis in offspring
Yang W , Carmichael SL , Tinker SC , Shaw GM . Birth Defects Res A Clin Mol Teratol 2012 94 (12) 1019-1025 BACKGROUND: Limited information is available about the association of maternal weight gain during pregnancy and birth defects. The objective of this study was to investigate the association of maternal weight gain with neural tube defects (NTDs) and gastroschisis among offspring. METHODS: We used data from the National Birth Defects Prevention Study, an ongoing multicenter, population-based, case-control study. Mothers of cases and controls were interviewed by telephone. Analyses included 255 anencephaly, 577 spina bifida, 648 gastroschisis cases, and 5587 controls with deliveries from 1999 to 2005. After subtracting birth weight, the associations of total and average weekly weight gain (kg) with each phenotype were estimated, stratified by gestational age (<37 vs. ≥37 weeks) and adjusted for relevant covariates. RESULTS: Among deliveries <37 weeks gestation, mothers of infants with anencephaly and spina bifida had lower weight gains compared to control mothers; no association between weight gains and gastroschisis was observed. Among deliveries ≥37 weeks, mothers of infants with anencephaly had lower weight gains during pregnancy; a similar association was not observed for spina bifida; mothers of infants with gastroschisis were twice as likely to have weight gains in the highest quartile. Stratification by maternal age (gastroschisis) or body mass index (BMI) or race/ethnicity (all phenotypes) did not alter odds ratio estimates. CONCLUSION: Altered weight gain during pregnancy may be a consequence of carrying an NTD/gastroschisis affected fetus or a marker for underlying factors common to the etiology of these birth defects. It is possible that whatever mechanisms influence weight gain may also influence the development of NTDs and gastroschisis, but in opposite directions. |
Sequential Gaussian co-simulation of rate decline parameters of longwall gob gas ventholes
Karacan CO , Olea RA . Int J Rock Mech Min Sci 2013 59 1-14 Gob gas ventholes (GGVs) are used to control methane inflows into a longwall mining operation by capturing the gas within the overlying fractured strata before it enters the work environment. Using geostatistical co-simulation techniques, this paper maps the parameters of their rate decline behaviors across the study area, a longwall mine in the Northern Appalachian basin. Geostatistical gas-in-place (GIP) simulations were performed, using data from 64 exploration boreholes, and GIP data were mapped within the fractured zone of the study area. In addition, methane flowrates monitored from 10 GGVs were analyzed using decline curve analyses (DCA) techniques to determine parameters of decline rates. Surface elevation showed the most influence on methane production from GGVs and thus was used to investigate its relation with DCA parameters using correlation techniques on normal-scored data. Geostatistical analysis was pursued using sequential Gaussian co-simulation with surface elevation as the secondary variable and with DCA parameters as the primary variables. The primary DCA variables were effective percentage decline rate, rate at production start, rate at the beginning of forecast period, and production end duration. Co-simulation results were presented to visualize decline parameters at an area-wide scale. Wells located at lower elevations, i.e., at the bottom of valleys, tend to perform better in terms of their rate declines compared to those at higher elevations. These results were used to calculate drainage radii of GGVs using GIP realizations. The calculated drainage radii are close to ones predicted by pressure transient tests. |
Growing the field: current approaches to data collection at farmers' markets
Karpyn A , Kim SA , DaCosta RV , Gasinu S , Law YM . J Hunger Environ Nutr 2013 7 (4) 436-448 There is limited published research about the dietary impacts of farmers' markets. We sought to understand whether market managers collect data about markets and to examine the instruments and strategies used. Of the 359 market managers contacted across the United States, representing 543 markets, 185 managers participated in a telephone survey. A subset supplied copies of data collection tools for further analysis. Ninety-three percent of market managers collect data such as customer surveys, vendor applications, customer counts, or demographics. The potential utility of the data collected by mangers and suggestions for study of the dietary impacts of farmers markets are discussed. (2013 Copyright Taylor & Francis Group, LLC.) |
Respirator use among US farm operators: evidence from the 2006 Farm and Ranch Safety Survey
Syamlal G , Schleiff PL , Mazurek JM , Doney B , Greskevitch M . J Agromedicine 2013 18 (1) 27-38 The objective of this study was to estimate the national prevalence of respirator use among primary farm operators in the United States. The authors analyzed the 2006 Farm and Ranch Safety Survey data collected for 12,278 actively farming primary farm operators. Weighted prevalence and adjusted prevalence ratios (PRs) of respirator use were calculated by farm operator characteristics, farm characteristics, and selected exposures/hazards. Of the estimated 2.1 million farm operators, 37.2% used a respirator on their farm. Respirator use prevalence was significantly higher among operators aged 16-34 years than those aged ≥65 years (46.9% vs. 30.0%; PR = 1.6); male than female operators (39.0% vs. 24.4%; PR = 1.6); operators managing crop farms than operators managing livestock farms (40.9% vs. 33.7%; PR = 1.2); and operators managing farms with value of sales ≥$100,000 than operators managing farms with value of sales ≤$9999 (57.4% vs. 31.4%; PR = 1.8). Of the operators who used a respirator, 69.9% used while working in a dusty environment, 22.6% used while applying/handling pesticides, and 30.4% used while doing other farm-related activities. These results show that an estimated one third of operators used respirators in 2006, and respirator use is most frequent among operators working in a dusty environment. Additional research identifying specific exposures for which respirators or dust masks are used, barriers to respirator or dust mask use, motivators for wearing respirators, and opportunities to increase the use of respiratory protection among farm operators, particularly on smaller farms, is needed. |
Personal carbon monoxide exposures among firefighters at prescribed forest burns in the southeastern United States
Dunn KH , Shulman S , Stock AL , Naeher LP . Arch Environ Occup Health 2013 68 (1) 55-9 Exposure to combustion products from wildland fires causes respiratory irritation and decreased lung function among firefighters. The authors evaluated carbon monoxide (CO) exposures of a group of wildland firefighters who conducted prescribed burns in the southeastern United States of America. A total of 149 person-days of samples were collected using data logging CO monitors. A questionnaire was administered to collect data on job tasks and self-reported smoke exposure. Overall, the highest exposures were seen amongst firefighters assigned to holding and mop-up tasks (geometric mean [GM]: 2.6 ppm), whereas the lowest were associated with lighting and jobs such as burn boss (GM: 1.6 and 0.3 ppm, respectively). The self-reported smoke exposure showed a significant linear trend with increasing CO exposure. The numbers of acres burned or burn duration, however, were not good predictors of exposure. |
Application of thermoregulatory modeling to predict core and skin temperatures in firefighters
Kim J-H , Williams WJ , Coca A , Yokota M . Int J Ind Ergon 2013 43 (1) 115-120 The purpose of the study was to compare body temperature responses from subjects who exercised while wearing firefighter clothing to predictive data from a real-time thermoregulatory model that had been initially developed and validated for use in the military. Data from two firefighter studies, firefighter study 1 (FFS1: 7 males and 3 females, continuous treadmill exercise at 50% VO2max, 25 °C, 50% RH) and firefighter study 2 (FFS2: 6 males, intermittent treadmill exercise at 75% VO2max, 35 °C, 50% RH), were utilized for the thermoregulatory modeling and comparison. The results showed that prediction error (RMSD) of the model for core and skin temperatures was 0.33 and 0.65 °C in FFS1 and 0.39 and 0.86 °C in FFS2, respectively. While the real-time thermoregulatory model tested in the present study showed the potential for providing a means for reasonably accurate prediction of body temperature responses in firefighters, further development on the model's metabolism algorithms to include adjustments for protective clothing, options to facilitate external work, inclusions of cooling effects are suggested. Relevance to industry Firefighters exposed to thermal extremes experience physiological strain, but direct monitoring of physiological variables is not always practical. Thermoregulatory models can simulate the thermal responses reasonably accurately by applying known thermo-physiological mechanisms together with heat loss mechanisms related to clothing and environment in an effort to improve firefighter safety. |
Noise impacts from professional dog grooming forced-air dryers
Scheifele PM , Johnson MT , Byrne DC , Clark JG , Vandlik A , Kretschmer LW , Sonstrom KE . Noise Health 2012 14 (60) 224-6 This study was designed to measure the sound output of four commonly used brands of forced-air dryers used by dog groomers in the United States. Many dog groomers have questions about the effect of this exposure on their hearing, as well as on the hearing of the dogs that are being groomed. Readings taken from each dryer at 1 meter (the likely distance of the dryer from the groomer and the dog) showed average levels ranging from 105.5 to 108.3 dB SPL or 94.8 to 108.0 dBA. Using the 90 dBA criterion required by the US Occupational Safety and Health Administration, dog groomers/bathers are at risk if exposure to the lowest intensity dryer (94.8 dBA) exceeds 4 hours per day. If the more stringent 85 dBA criterion and 3 dB tradeoff is applied, less than one hour of exposure is permissible in an 8 hour day. Cautions are recommended for any persons exposed to noise from forced-air dryers. |
Occupational fatalities in Alaska: two decades of progress, 1990-1999 and 2000-2009
Lincoln JM , O'Connor MB , Retzer KD , Hill RD , Teske TD , Woodward CC , Lucas DL , Somervell PD , Burton JT , Mode NA , Husberg BJ , Conway GA . J Safety Res 2012 44 105-10 INTRODUCTION: Alaska had the highest work-related fatality rate of any state during 1980-1989. The National Institute for Occupational Safety and Health established the Alaska Field Station (AFS) to address this problem. METHODS: AFS established surveillance systems to provide scientific assessments of occupational hazards. Interventions were developed in collaboration with partners and evaluated. RESULTS: During 2000-2009, Alaska experienced a 42.5% decline in work-related fatalities over the previous decade of 1990-1999. In 2009, the workplace fatality rate for Alaska was 5.6/100,000 workers. Commercial pilot deaths were reduced by 50% and Bering Sea crab fishing death rates were reduced by 60%. Building on this success, AFS established national programs to improve safety in the commercial fishing and oil and gas extraction industries. IMPACT ON INDUSTRY: A focused, epidemiological approach to reducing fatalities in high-risk occupations is effective. Ongoing commitment to this type of approach will assist in continued success in Alaska and elsewhere. |
Anthropometric procedures for protective equipment sizing and design
Hsiao H . Hum Factors 2012 55 (1) 6-35 OBJECTIVES: This article presented four anthropometric theories (univariate, bivariate/probability distribution, multivariate, and shape-based methods) for protective equipment design decisions. BACKGROUND: While the significance of anthropometric information for product design is well recognized, designers continue to face challenges in selecting efficient anthropometric data processing methods and translating the acquired information into effective product designs. METHODS: For this study, 100 farm tractor operators, 3,718 respirator users, 951 firefighters, and 816 civilian workers participated in four studies on the design of tractor roll-over protective structures (ROPS), respirator test panels, fire truck cabs, and fall-arrest harnesses, respectively. Their anthropometry and participant-equipment interfaces were evaluated. RESULTS: Study 1 showed a need to extend the 90-cm vertical clearance for tractor ROPS in the current industrial standards to 98.3 to 101.3 cm. Study 2 indicated that current respirator test panel would have excluded 10% of the male firefighter population; a systematic adjustment to the boundaries of test panel cells was suggested. Study 3 provided 24 principal component analysis-based firefighter body models to facilitate fire truck cab design. Study 4 developed an improved gender-based fall-arrest harness sizing scheme to supplant the current unisex system. CONCLUSIONS: This article presented four anthropometric approaches and a six-step design paradigm for ROPS, respirator test panel, fire truck cab, and fall-arrest harness applications, which demonstrated anthropometric theories and practices for defining protective equipment fit and sizing schemes. APPLICATIONS: The study provided a basis for equipment designers, standards writers, and industry manufacturers to advance anthropometric applications for product design and improve product efficacy. |
Silica and respirable content in rock dust samples
Colinet JF , Listak JM . Coal Age 2012 117 (12) 48-52 The Code of Federal Regulations defines specific size and silica limitations for rock dust that is used in the underground coal mining industry. MSHA collected 444 grab samples of rock dust from mines located in Districts 2 through 11 and made these samples available to NIOSH for analysis. XRF and XRD analyses were completed on 261 rock dust samples, representing 23 producers and seven distributors. Results from the XRF analysis show that 93.5% of the analyzed samples meet the CFR requirement of containing 4% or less of FCS. Another 5.7% of the samples contained between 4.1 and 5% FCS, which can be approved for use by the Secretary of Labor. Consequently, only 0.8% of the samples analyzed contained FCS above the maximum allowable limit. Fifteen or more samples of rock dust were analyzed for six different producers. These samples were delivered to the mines in 40- or 50-lb bags or in bulk quantities. Comparison of the percentage of FCS and quartz content for the bagged and bulk products showed that these percentages were within 0.1% of each other for eight of 12 comparisons, with a maximum difference of 0.5% for FCS and 0.4% for quartz in the four remaining samples. Although not specified in the CFR, NIOSH was interested in quantifying the quartz content in the rock dust samples and had XRD analysis completed on these grab samples. Even though this analysis was not specifically conducted on the respirable fraction of the grab samples, the presence of rock dust continued quartz and a high respirable content would provide the potential for quartz inhalation by mine workers when exposed to airborne rock dust. A summary of these results showed that 97.3% of the samples contained less than 2% quartz. This quartz content is relatively low when compared to the 5% quartz level that must be exceeded in airborne respirable coal mine dust samples to result in a reduced respirable dust standard. However, size analysis of the rock dust samples showed that 87.7% of the samples contained over 20% respirable-sized dust, while 29.6% of the samples contained over 30% respirable dust. Not all of the respirable-sized dust in these samples will be present as airborne respirable dust when the rock dust is applied in mine entries. Nonetheless, mine operators should be aware of the potential exposure to respirable rock dust containing quartz and take steps to minimize or eliminate the time that mine workers are exposed to airborne rock dust. For workers required to apply the rock dust, it may also be appropriate for them to wear respiratory protection while completing this task. |
Malaria prevention knowledge, attitudes, and practices (KAP) among international flying pilots and flight attendants of a US commercial airline
Selent M , de Rochars VMB , Stanek D , Bensyl D , Martin B , Cohen NJ , Kozarsky P , Blackmore C , Bell TR , Marano N , Arguin PM . J Travel Med 2012 19 (6) 366-372 BACKGROUND: In 2010, malaria caused approximately 216 million infections in people and 655,000 deaths. In the United States, imported malaria cases occur every year, primarily in returning travelers and immigrants from endemic countries. In 2010, five Plasmodium falciparum malaria cases occurred among crew members of one US commercial airline company (Airline A). This investigation aimed to assess the malaria prevention knowledge, attitudes, and practices (KAP) of Airline A crew members to provide information for potential interventions. METHODS: The web link to a self-administered on-line survey was distributed by internal company communications to Airline A pilots and flight attendants (FA) eligible for international travel. The survey collected demographic information as well as occupation, work history, and malaria prevention education. RESULTS: Of approximately 7,000 nonrandomly selected crew members, 220 FA and 217 pilots completed the survey (6%). Respondents correctly identified antimalarial medication (91% FA, 95% pilots) and insect repellents (96% FA, 96% pilots) as effective preventive measures. While in malaria-intense destinations, few FA and less than half of pilots always took antimalarial medication (4% FA, 40% pilots) yet many often spent greater than 30 minutes outdoors after sundown (71% FA, 66% pilots). Less than half in both groups always used insect repellents (46% FA, 47% pilots). Many respondents were unaware of how to get antimalarial medications (52% FA, 30% pilots) and were concerned about their side effects (61% FA, 31% pilots). CONCLUSION: Overall, FA and pilots demonstrated good knowledge of malaria prevention, but many performed risky activities while practicing only some recommended malaria preventive measures. Malaria prevention education should focus on advance notification if traveling to a malaria-endemic area, how to easily obtain antimalarial medications, and the importance of practicing all recommended preventive measures. (2012 International Society of Travel Medicine, 1195-1982.) |
High prevalence of schistosomiasis in Mbita and its adjacent islands of Lake Victoria, western Kenya
Odiere MR , Rawago FO , Ombok M , Secor WE , Karanja DM , Mwinzi PN , Lammie PJ , Won K . Parasit Vectors 2012 5 278 BACKGROUND: Intestinal schistosomiasis continues to be a significant cause of morbidity among communities located around Lake Victoria and on its islands. Although epidemiological surveys have been conducted in other areas bordering the lake in western Kenya, Mbita district and its adjacent islands have never been surveyed, largely due to logistical challenges in accessing these areas. Consequently, there is a paucity of data on prevalence of schistosomiasis and soil-transmitted helminth (STH) infections that are endemic in this region. METHODS: This cross-sectional study determined the prevalence, intensity of infection and geographical distribution of schistosome and STH infections among 4,065 children aged 5-19 years in 84 primary schools in Mbita and nearby islands of Lake Victoria (Mfangano, Ringiti, Rusinga and Takawiri), in western Kenya. Single stool samples were collected and examined for eggs of Schistosoma mansoni and STHs (Hookworms, Ascaris lumbricoides and Trichuris trichiura) using the Kato-Katz technique. Primary schools were mapped using geographical information system data on PDAs and prevalence maps generated using ArcView GIS software. RESULTS: Overall, 65.6% (95% CI = 64.2-67.1%) of children were infected with one or more helminth species; 12.4% (95% CI = 11.4-13.4%) of children were infected with one or more STH species. Mean school prevalence of S. mansoni infection was 60.5% (95% CI = 59.0-62.0%), hookworms 8.4% (95% CI = 7.6-9.3%), A. lumbricoides 3.3% (95% CI = 2.7-3.8%), and T. trichiura 1.6% (95% CI = 1.2-2.0%). Interestingly, the mean S. mansoni prevalence was 2-fold higher on the islands (82%) compared to the mainland (41%) (z = 5.8755, P < 0.0001). Similarly, intensity of infection was 54% higher on the islands (217.2 +/- 99.3) compared to the mainland (141.3 +/- 123.7) (z = 3.9374, P < 0.0001). Schools in closest proximity to Lake Victoria had the highest S. mansoni prevalence while prevalence of STHs was more homogenously distributed. CONCLUSIONS: The very high prevalence of schistosomiasis in Mbita and the 4 islands is quite alarming, and indicates an urgent and critical need for control interventions. Findings from this survey indicate the need to implement treatment in remote areas not previously covered by mass drug administration programs. |
Sustained improvements in handwashing indicators more than 5 years after a cluster-randomised, community-based trial of handwashing promotion in Karachi, Pakistan
Bowen A , Agboatwalla M , Ayers T , Tobery T , Tariq M , Luby SP . Trop Med Int Health 2013 18 (3) 259-67 OBJECTIVE: To evaluate handwashing behaviour 5 years after a handwashing intervention in Karachi, Pakistan. METHODS: In 2003, we randomised neighbourhoods to control, handwashing promotion, or handwashing promotion and water treatment. Intervention households were given soap +/- water treatment product and weekly handwashing education for 9 months. In 2009, we re-enrolled 461 households from the three study groups: control (160), handwashing (141), and handwashing + water treatment (160) and assessed hygiene-related outcomes, accounting for clustering. RESULTS: Intervention households were 3.4 times more likely than controls to have soap at their handwashing stations during the study visit [293/301 (97%) vs. 45/159 (28%), P < 0.0001]. While nearly all households reported handwashing after toileting, intervention households more commonly reported handwashing before cooking [relative risk (RR) 1.2 (95% confidence interval (CI) 1.0-1.4)] and before meals [RR 1.7 (95% CI, 1.3-2.1)]. Control households cited a mean of 3.87 occasions for washing hands; handwashing households, 4.74 occasions; and handwashing + water treatment households, 4.78 occasions (P < 0.0001). Households reported purchasing a mean of 0.65 (control), 0.91 (handwashing) and 1.1 (handwashing + water treatment) bars of soap/person/month (P < 0.0001). CONCLUSIONS: Five years after receiving handwashing promotion, intervention households were more likely to have soap at the household handwashing station, know key times to wash hands and report purchasing more soap than controls, suggesting habituation of improved handwashing practices in this population. Intensive handwashing promotion may be an effective strategy for habituating hygiene behaviours and improving health. |
Handling worker and third-party exposures to nanotherapeutics during clinical trials
Ramachandran G , Howard J , Maynard A , Philbert M . J Law Med Ethics 2012 40 (4) 856-864 The article focuses on issues relating to occupational exposures of researchers and lab workers, and exposures of bystanders such as health care workers and family members during HSR using nanomaterials. Such third-party exposures give rise to unique challenges relating to oversight as well as exposures to worker groups not previously studied. Given the current state of knowledge regarding health risks from such exposures, a more precautionary approach to oversight seems advisable. |
Using evaluability assessment to support the development of practice-based evidence in public health
Dunet DO , Losby JL , Tucker-Brown A . J Public Health Manag Pract 2013 19 (5) 479-82 Practice-based evidence arises from programs implemented in real-world settings. Program success may be judged on the basis of experience; however, formal evaluation studies of methodological rigor can provide a high level of credible evidence to inform public health practice. Such studies can be lengthy and expensive. Furthermore, even well-designed studies may not reach conclusive findings, for example, when a program lacks full implementation, when data systems do not have capacity to collect evaluation data, or when program implementation has not attained stability. An evaluability assessment is used to determine the capacity and readiness of a program for full-scale effectiveness evaluation. Evaluators at the Centers for Disease Control and Prevention use evaluability assessment as a preevaluation consisting of brief, focused, criteria-based assessments, document review, and a site visit. Evaluability assessment is used to guide investments in subsequent rigorously designed evaluations that yield conclusive findings to build strong and credible practice-based evidence. |
Prevention of Chlamydia-induced infertility by inhibition of local caspase activity
Igietseme JU , Omosun Y , Partin J , Goldstein J , He Q , Joseph K , Ellerson D , Ansari U , Eko FO , Bandea C , Zhong G , Black CM . J Infect Dis 2013 207 (7) 1095-104 Tubal factor infertility (TFI) represents 36% of female infertility and genital infection by Chlamydia trachomatis (Ct) as a major cause. While TFI is associated with host inflammatory responses to bacterial components, the molecular pathogenesis of Chlamydia-induced infertility remains poorly understood. We investigated the hypothesis that activation of specific cysteine proteases, the caspases, during Ct genital infection causes the disruption of key fertility-promoting molecules required for embryo development and implantation. We analyzed the effect of caspase inhibition on infertility and the integrity of Dicer, a caspase-sensitive, fertility-promoting ribonuclease III enzyme, and key micro-RNAs in the reproductive system. Genital infection with the inflammation- and caspase-inducing, wild-type Ct serovar L2 led to infertility, but the non-inflammation-inducing, plasmid-free strain did not. We confirmed that caspase-mediated apoptotic tissue destruction may contribute to chlamydial pathogenesis. Caspase-1 or -3-deficiency, or local administration of the pan caspase inhibitor, Z-VAD-FMK into normal mice protected against Chlamydia-induced infertility. Finally, the oviducts of infected infertile mice showed evidence of caspase-mediated cleavage inactivation of Dicer and alteration in critical miRNAs that regulate growth, differentiation and development, including mir-21. These results provide new insight into the molecular pathogenesis of TFI with significant implications for new strategies for treatment and prevention of chlamydial complications. |
Depressive and conduct disorder symptoms in youth living with HIV: the independent and interactive roles of coping and neuropsychological functioning
Salama C , Morris M , Armistead L , Koenig LJ , Demas P , Ferdon C , Bachanas P . AIDS Care 2013 25 (2) 160-8 Emerging research suggests the importance of psychosocial characteristics (e.g., coping and social support) for positive adaptation among youth with behaviorally acquired HIV. However, little is known about how these traits interact with cognitive abilities to impact emotional and behavioral adjustment. This study examined whether coping skills and executive functioning interact in their association with psychological adjustment in HIV-positive youth. Data from Project Adolescents Living with HIV/AIDS (ALPHA), a study to examine psychosocial, behavioral and neuropsychological functioning of youth with behaviorally acquired HIV, were used. Fifty-nine participants, aged 14-23, diagnosed with HIV prior to age 20 and receiving care in one of two HIV clinics in Atlanta or New York City, were recruited, consented and enrolled. Participants completed measures of depressive symptoms (Beck Depression Inventory), conduct disorder (Adolescent Symptom Index), and use of positive and negative coping strategies (Kidcope). The Wisconsin Card Sorting Test (WCST) assessed abstract reasoning (categories completed) and cognitive inflexibility (perseverative errors). In this sample of HIV-positive youth, depressive symptoms were best predicted by an interactive combination of negative coping skills and poor neuropsychological functioning. Neuropsychological functioning (cognitive inflexibility) and negative coping skills were directly associated with conduct disorder symptoms. Results highlight the importance of including neuropsychological assessment in the evaluation of HIV-positive youth, particularly those with emotional or behavioral problems. |
Depressive symptoms among immigrant Latino sexual minorities
Rhodes SD , Martinez O , Song E-Y , Daniel J , Alonzo J , Eng E , Duck S , Downs M , Bloom FR , Allen AB , Miller C , Reboussin B . Am J Health Behav 2013 37 (3) 404-413 OBJECTIVE: To estimate the prevalence and identify correlates of depressive symptoms among immigrant Latino sexual minorities. METHODS: Respondent-driven sampling (RDS) was used to estimate the prevalence of depressive symptoms, and univariate and multivariable analyses were conducted to identify correlates of depressive symptoms. RESULTS: Unweighted and RDS-weighted prevalence estimates of depressive symptoms were 69.2% and 74.8%, respectively. In the multivariable analysis, low social support, sexual compulsivity, and high self-esteem were significantly associated with increased depressive symptoms. CONCLUSIONS: A need exists for culturally congruent mental health services for immigrant Latino sexual minorities in the southern United States. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract). |
Attitudes toward smoke-free workplaces, restaurants, and bars, casinos, and clubs among U.S. adults: findings from the 2009-2010 National Adult Tobacco Survey
King BA , Dube SR , Tynan MA . Nicotine Tob Res 2013 15 (8) 1464-70 INTRODUCTION: An increasing number of U.S. states and communities have implemented smoke-free policies prohibiting smoking in all indoor workplaces and public areas. Public attitudes toward smoke-free environments are an evidenced-based, key indicator for the successful implementation and enforcement of smoke-free policies. METHODS: Data were obtained from the 2009-2010 National Adult Tobacco Survey, a landline and cell phone survey of adults aged ≥18 years old residing in the 50 U.S. states and the District of Columbia. The overall proportion of respondents who reported that smoking should "never be allowed" in workplaces, restaurants, and bars/casinos/clubs was calculated, both nationally and by state. National estimates were also calculated by sex, age, race/ethnicity, education, annual household income, sexual orientation, and smoking status. RESULTS: Nationally, 81.6% of U.S. adults think workplaces should be smoke-free (state range: 68.6% [Kentucky] to 89.1% [California]); 74.9% think restaurants should be smoke-free (state range: 59.5% [Missouri] to 84.6% [California]); 50.0% think bars/casinos/clubs should be smoke-free (state range: 32.3% [Nevada] to 61.3% [Maine]); and 47.5% think workplaces, restaurants, and bars/casinos/clubs should be smoke-free (state range: 30.3% [Nevada] to 58.8% [Maine]). Regardless of venue type, women, older individuals, non-Hispanic Asians, individuals with higher education and income, and nonsmokers were the most likely to think these environments should be smoke-free. CONCLUSIONS: A majority of U.S. adults think workplaces and restaurants should be smoke-free, while half think bars, casinos, and clubs should be smoke-free. Continued efforts are needed to educate the public about the dangers of secondhand smoke and the benefits of smoke-free indoor environments. |
Chemical analysis of Alaskan iq'mik smokeless tobacco
Hearn BA , Renner CC , Ding YS , Vaughan-Watson C , Stanfill SB , Zhang L , Polzin GM , Ashley DL , Watson CH . Nicotine Tob Res 2013 15 (7) 1283-8 INTRODUCTION: Iq'mik, a form of smokeless tobacco (ST), is traditionally used by Cup'ik and Yup'ik Eskimo people of western Alaska. Iq'mik is sometimes incorrectly considered to be a healthier alternative to smoking because its ingredients are perceived as "natural." Our chemical characterization of iq'mik shows that iq'mik is not a safe alternative to smoking or other ST use. METHODS: We measured nicotine and pH levels of tobacco and ash used to prepare iq'mik. We also characterized levels of toxins which are known to be present in ST including tobacco-specific nitrosamines (TSNAs) and polycyclic aromatic hydrocarbons (PAHs) using chromatographic separations coupled with isotope dilution mass spectrometry. RESULTS: Nicotine content in the iq'mik tobacco was very high, ranging from 35 to 43mg/g, with a mean of 39mg/g. The pH of the iq'mik tobacco-ash mixture was 11, an extremely high level compared with most ST products. High levels of PAHs were seen in the fire-cured tobacco samples with a benzo[a]pyrene level of 87ng/g. Average TSNA levels in the tobacco were 34, 2,700, and 340ng/g for 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), N'-nitrosonornicotine (NNN), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), respectively. CONCLUSIONS: Iq'mik contains high levels of the more easily absorbed unionized nicotine as well as known carcinogenic TSNAs and PAHs. The perception that iq'mik is less hazardous than other tobacco products due to the use of "natural" ingredients is not warranted. This chemical characterization of iq'mik gives a better understanding of the risk of possible adverse health effects of its use. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Drug Safety
- Environmental Health
- Epidemiology and Surveillance
- Food Safety
- Global Health
- Health Behavior and Risk
- Healthcare Associated Infections
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Mining
- Nutritional Sciences
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Parasitic Diseases
- Program Evaluation
- Public Health Ethics
- Public Health Leadership and Management
- Reproductive Health
- Social and Behavioral Sciences
- Substance Use and Abuse
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 29, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure