Body image dissatisfaction in patients with inflammatory bowel disease
Saha S , Zhao Y , Shah SA , Esposti SD , Lidofsky S , Bright R , Law M , Moniz H , Samad Z , Merrick M , Sands BE . Inflamm Bowel Dis 2015 21 (2) 345-52 BACKGROUND: Despite the fact that the inflammatory bowel diseases (IBD) and their treatments may affect physical appearance, the effect of IBD on body image is poorly understood. The aims of this study were to determine whether body image dissatisfaction (BID) changes over time in patients with IBD and to examine the demographic and disease-related variables associated with decreased body image. METHODS: Adults aged 18 and above in the Ocean State Crohn's and Colitis Area Registry with at least 2 years of follow-up were eligible for this study. All patients were enrolled within 6 months of IBD diagnosis and followed prospectively. BID was assessed using a modified version of the Adapted Satisfaction With Appearance questionnaire. Total Adapted Satisfaction With Appearance scores and 2 subscores were calculated. To assess for changes over time, general linear models for correlated data were used for continuous outcomes, and generalized estimating equations were used for discrete outcomes. RESULTS: Two hundred seventy-four patients were studied. BID was found to be stable over time among men and women with IBD despite overall improvements in disease activity. No differences were found in BID according to IBD subtype. Female gender, greater disease activity, higher symptom burden, longer duration of steroid use, dermatologic and musculoskeletal manifestations of IBD, and ileocolonic disease location among patients with Crohn's disease were associated with greater BID. Greater BID was associated with lower health-related quality of life. CONCLUSIONS: BID remains stable in an incident cohort of IBD despite improved disease activity and is associated with lower health-related quality of life. |
The role of lifestyle change for prevention of cardiovascular disease in diabetes
Staimez LR , Weber MB , Gregg EW . Curr Atheroscler Rep 2014 16 (12) 460 The burden of cardiovascular disease (CVD) is disproportionately greater in those with diabetes than in the general population, including higher rates of hospitalization, stroke, myocardial infarction, and mortality. Health-promoting lifestyle factors reduce both diabetes and CVD in healthy individuals; however, the efficacy of these strategies for CVD reduction in people with preexisting diabetes is unclear. In this review, we describe the most recent evidence (2013-2014) surrounding the effects of lifestyle changes on CVD outcomes in those with diabetes, and we contextualize the evidence against a backdrop of earlier key findings. Two major randomized controlled trials were identified, providing opposing conclusions about the role of lifestyle factors on CVD events in those with diabetes. Other recent prospective observational analyses support associations of physical activity and reduced CVD risk in diabetes. Limitations across studies include the use of self-report for measurement of lifestyle or lifestyle change, the length of follow-up needed to measure CVD outcomes, and the role of participants' medications on associations of lifestyle factors and CVD outcomes. Equivocal findings from the two randomized controlled trials support the need for additional research to identify the specific lifestyle factors that reduce CVD mortality and macrovascular complications in populations with diabetes. |
Environmental drivers of the spatiotemporal dynamics of respiratory syncytial virus in the United States
Pitzer VE , Viboud C , Alonso WJ , Wilcox T , Metcalf CJ , Steiner CA , Haynes AK , Grenfell BT . PLoS Pathog 2015 11 (1) e1004591 Epidemics of respiratory syncytial virus (RSV) are known to occur in wintertime in temperate countries including the United States, but there is a limited understanding of the importance of climatic drivers in determining the seasonality of RSV. In the United States, RSV activity is highly spatially structured, with seasonal peaks beginning in Florida in November through December and ending in the upper Midwest in February-March, and prolonged disease activity in the southeastern US. Using data on both age-specific hospitalizations and laboratory reports of RSV in the US, and employing a combination of statistical and mechanistic epidemic modeling, we examined the association between environmental variables and state-specific measures of RSV seasonality. Temperature, vapor pressure, precipitation, and potential evapotranspiration (PET) were significantly associated with the timing of RSV activity across states in univariate exploratory analyses. The amplitude and timing of seasonality in the transmission rate was significantly correlated with seasonal fluctuations in PET, and negatively correlated with mean vapor pressure, minimum temperature, and precipitation. States with low mean vapor pressure and the largest seasonal variation in PET tended to experience biennial patterns of RSV activity, with alternating years of "early-big" and "late-small" epidemics. Our model for the transmission dynamics of RSV was able to replicate these biennial transitions at higher amplitudes of seasonality in the transmission rate. This successfully connects environmental drivers to the epidemic dynamics of RSV; however, it does not fully explain why RSV activity begins in Florida, one of the warmest states, when RSV is a winter-seasonal pathogen. Understanding and predicting the seasonality of RSV is essential in determining the optimal timing of immunoprophylaxis. |
Immune memory to Sudan virus: comparison between two separate disease outbreaks
Sobarzo A , Eskira Y , Herbert AS , Kuehne AI , Stonier SW , Ochayon DE , Fedida-Metula S , Balinandi S , Kislev Y , Tali N , Lewis EC , Lutwama JJ , Dye JM , Yavelsky V , Lobel L . Viruses 2015 7 (1) 37-51 Recovery from ebolavirus infection in humans is associated with the development of both cell-mediated and humoral immune responses. According to recent studies, individuals that did not survive infection with ebolaviruses appear to have lacked a robust adaptive immune response and the expression of several early innate response markers. However, a comprehensive protective immune profile has yet to be described. Here, we examine cellular memory immune responses among survivors of two separate Ebolavirus outbreaks (EVDs) due to Sudan virus (SUDV) infection in Uganda-Gulu 2000-2001 and Kibaale 2012. Freshly collected blood samples were stimulated with inactivated SUDV, as well as with recombinant SUDV or Ebola virus (EBOV) GP (GP1-649). In addition, ELISA and plaque reduction neutralization assays were performed to determine anti-SUDV IgG titers and neutralization capacity. Cytokine expression was measured in whole blood cultures in response to SUDV and SUDV GP stimulation in both survivor pools, demonstrating recall responses that indicate immune memory. Cytokine responses between groups were similar but had distinct differences. Neutralizing, SUDV-specific IgG activity against irradiated SUDV and SUDV recombinant proteins were detected in both survivor cohorts. Furthermore, humoral and cell-mediated crossreactivity to EBOV and EBOV recombinant GP1-649 was observed in both cohorts. In conclusion, immune responses in both groups of survivors demonstrate persistent recognition of relevant antigens, albeit larger cohorts are required in order to reach greater statistical significance. The differing cytokine responses between Gulu and Kibaale outbreak survivors suggests that each outbreak may not yield identical memory responses and promotes the merits of studying the immune responses among outbreaks of the same virus. Finally, our demonstration of cross-reactive immune recognition suggests that there is potential for developing cross-protective vaccines for ebolaviruses. |
The role of social support among people living with HIV in rural Mozambique
Cummings B , Gutin SA , Jaiantilal P , Correia D , Malimane I , Rose CD . AIDS Patient Care STDS 2014 28 (11) 602-12 A Positive Health, Dignity, and Prevention framework is being implemented in Mozambique to maintain the health of persons living with HIV (PLHIV) and prevent onward HIV transmission. An important intervention component is psycho-social support. However, coordinating support services has been challenging. Seventy in-depth individual interviews were conducted with PLHIV between January and June 2010 in three rural provinces to clarify the receipt and provision of support by PLHIV. Thematic coding and analysis were conducted to identify salient responses. PLHIV reported that the majority of social support received was instrumental, followed by emotional and informational support. Instrumental support included material, medical, and financial assistance. Emotional support was mentioned less frequently and was supplied most by family and friends. PLHIV also received informational support from a variety of sources, the most common being family members. Informational support from health providers was rarely mentioned, but this advice was valued and used to educate others. Although most participants described receiving social support from many sources, there were consistently identified needs. This study revealed that social support is central in the lives of PLHIV and identified areas where social support can be improved to better respond to the needs of PLHIV in the Mozambican context. |
HIV testing among adults with mental illness in the United States
Yehia BR , Cui W , Thompson WW , Zack MM , McKnight-Eily L , DiNenno E , Rose CE , Blank MB . AIDS Patient Care STDS 2014 28 (12) 628-34 Nationally representative data from the 2007 National Health Interview Survey (NHIS) were used to compare HIV testing prevalence among US adults with mental illness (schizophrenia spectrum disorder, bipolar disorder, depression, and/or anxiety) to those without, providing an update of prior work using 1999 and 2002 NHIS data. Logistic regression modeling was used to estimate the probability of ever being tested for HIV by mental illness status, adjusting for age, sex, race/ethnicity, marital status, substance abuse, excessive alcohol or tobacco use, and HIV risk factors. Based on data from 21,785 respondents, 15% of adults had a psychiatric disorder and 37% ever had an HIV test. Persons with schizophrenia (64%), bipolar disorder (63%), and depression and/or anxiety (47%) were more likely to report ever being tested for HIV than those without mental illness (35%). In multivariable models, individuals reporting schizophrenia (adjusted prevalence ratio=1.68, 95% confidence interval=1.33-2.13), bipolar disease (1.58, 1.39-1.81), and depression and/or anxiety (1.31, 1.25-1.38) were more likely to be tested for HIV than persons without these diagnoses. Similar to previous analyses, persons with mental illness were more likely to have been tested than those without mental illness. However, the elevated prevalence of HIV in populations with mental illness suggests that high levels of testing along with other prevention efforts are needed. |
Daily insufficient sleep and active duty status
Chapman DP , Liu Y , McKnight-Eily LR , Croft JB , Holt JB , Balkin TJ , Giles WH . Mil Med 2015 180 (1) 68-76 OBJECTIVE: We assessed the relationship between active duty status and daily insufficient sleep in a telephone survey. METHODS: U.S. military service status (recent defined as past 12 months and past defined as >12 months ago) and daily insufficient sleep in the past 30 days were assessed among 566,861 adults aged 18 to 64 years and 271,202 adults aged ≥65 years in the 2009 to 2010 Behavioral Risk Factor Surveillance System surveys. RESULTS: Among ages 18 to 64 years, 1.1% reported recent active duty and 7.1% had past service; among ages ≥65 years, 0.6% reported recent and 24.6% had past service. Among ages 18 to 64 years, prevalence of daily insufficient sleep was 13.7% among those reporting recent duty, 12.6% for those with past service, and 11.2% for those with no service. Insufficient sleep did not vary significantly with active duty status among ages ≥65 years. After adjustment for sociodemographic characteristics, health behaviors, and frequent mental distress in multivariate logistic regression models, respondents aged 18 to 64 years with recent active duty were 34% more likely and those with past service were 23% more likely to report daily insufficient sleep than those with no service (p < 0.05, both). CONCLUSIONS: Adults with either recent or past active duty have a greater risk for daily insufficient sleep. |
Changes in the Population Structure of Invasive Neisseria meningitidis in the United States After Quadrivalent Meningococcal Conjugate Vaccine Licensure.
Wang X , Shutt KA , Vuong JT , Cohn A , MacNeil J , Schmink S , Plikaytis B , Messonnier NE , Harrison LH , Clark TA , Mayer LW . J Infect Dis 2015 211 (12) 1887-94 BACKGROUND: Meningococcal conjugate vaccines (MenACWY) against serogroups A, C, W and Y are recommended for routine use in adolescents aged 11-18 years. Impact of these vaccines on meningococcal population structure in the US remained to be evaluated. METHODS: Meningococcal isolates from 2006-10 (post-MenACWY) collected through Active Bacterial Core surveillance (ABCs) were characterized; serogroup distribution and molecular features of these isolates were compared to previously published data on ABCs isolates from 2000-05 (pre-MenACWY). p values were generated using chi-squared statistics and exact methods. RESULTS: There was a significant change (p<0.05) in serogroup distribution among all age groups between the two periods. A small proportion of isolates has shown evidence of capsular switching in both periods. Between the two periods, significant changes were observed in the distribution of PorA, FetA, and strain genotypes among vaccine and non-vaccine serogroups. CONCLUSIONS: The population structure of U.S. meningococcal isolates is dynamic; some changes occurred over time but the basic structure remained. Vaccine-induced serogroup replacement was not observed, although a small proportion of isolates had undergone capsule switching possibly driven by non-vaccine mediated selection. Changes in the distribution of molecular features are likely due to horizontal gene transfer and changes in serogroup distribution. |
Development and evaluation of multiplexed immunoassay for detection of antibodies to HPV vaccine types
Panicker G , Rajbhandari I , Gurbaxani BM , Querec TD , Unger ER . J Immunol Methods 2014 417 107-114 Reliable antibody based-assays are needed to evaluate the immunogenicity of current vaccines, impact of altered dosing schemes or of new vaccine formulations. An ideal assay platform would allow multiplex type-specific detection with minimal sample requirement. We used the Meso Scale Discovery (MSD) electrochemiluminescence based detection platform to develop a multiplex direct virus-like particles (VLP) ELISA to detect antibodies to HPV 6, 11, 16, and 18 with a protocol developed for detection using the SI 6000 imager (M4ELISA). MSD prepared the plates in the 7-spot/well format, using the purified VLPs (4 spots) and PBS+BSA pH7.4 (3 blank spots). Three-point titrations and the parallel line method were used to calculate antibody levels. Dynamic range, precision, and stability of pre-printed plates were determined using a panel of previously characterized sera. Cut-off values using children's sera were established using 99% RLU limits based on 4-parameter Johnson Su best fit curve. Results of the M4ELISA were compared to competitive Luminex Immunoassay (cLIA) on n=4454 sera from a predominantly unvaccinated cohort. Using a VLP coating concentration of 80mug/ml with BSA provided the most robust RLU signal for all types. The dynamic range of the assay was about 1000 fold, with assay variability under 25% for each of the four vaccine types. Long-term stability of the plates extended to about 7months from the time plates were received in the laboratory after printing. There was moderate agreement (kappa=0.38-0.54) between M4ELISA and cLIA, with antibody detection for each of the 4 types more frequent with M4ELISA. Quantitative analysis however showed a good correlation between concordant samples by both assays (rho ≥0.6). The MSD platform shows promise for simultaneous quantitation of the antibody responses to four HPV vaccine types in a high-throughput manner. |
Suicide prevention: state of the art review
Stone DM , Crosby AE . Am J Lifestyle Med 2014 8 (6) 404-420 Suicide is a public health problem affecting people across the lifespan. It is currently the 10th leading cause of death, with rates having remained relatively flat for the past century. This article summarizes the problem of suicide and suicidal behavior along with suicide prevention efforts in the United States. Part 1 provides an overview of the epidemiology of suicide, including groups most at risk of suicide and suicidal behavior. Part 2 provides a review of common risk factors, organized by developmental life stage. A brief discussion of the lesser well-researched area of protective factors follows. Part 3 provides an overview of suicide prevention today, including the major types of prevention strategies, their successes, including means restriction, quality improvement in behavioral services, and comprehensive programs; and limitations to date, such as a lack of evidence for impact on actual deaths or behavior, small sample sizes, and low base rates. Finally, part 4 discusses challenges and future directions with an eye toward the great many opportunities that exist for prevention. |
Evaluation of the Cepheid Xpert MTB/RIF assay
Shinnick TM , Starks AM , Alexander HL , Castro KG . Expert Rev Mol Diagn 2015 15 (1) 9-22 The lack of capacity to provide laboratory confirmation of a diagnosis of tuberculosis disease (TB) is contributing to enormous gaps in the ability to find, treat and follow TB patients. WHO estimates that globally only about 57% of the notified new cases of pulmonary TB in 2012 and about 19% of rifampicin-resistant TB cases were laboratory confirmed. The Cepheid Xpert((R)) MTB/RIF assay has been credited with revolutionizing laboratory testing to aid in the diagnosis of TB and rifampicin-resistant TB. This semi-automated test can detect both the causative agent of TB and mutations that confer rifampicin resistance from clinical specimens within 2 h after starting the test. In this article, we review the performance of the test, its pathway to regulatory approval and endorsement, guidelines for its use and lessons learned from the implementation of the test in low-burden, high-resource countries and in high-burden, low-resource countries. |
Current and emerging Legionella diagnostics for laboratory and outbreak investigations
Mercante JW , Winchell JM . Clin Microbiol Rev 2015 28 (1) 95-133 Legionnaires' disease (LD) is an often severe and potentially fatal form of bacterial pneumonia caused by an extensive list of Legionella species. These ubiquitous freshwater and soil inhabitants cause human respiratory disease when amplified in man-made water or cooling systems and their aerosols expose a susceptible population. Treatment of sporadic cases and rapid control of LD outbreaks benefit from swift diagnosis in concert with discriminatory bacterial typing for immediate epidemiological responses. Traditional culture and serology were instrumental in describing disease incidence early in its history; currently, diagnosis of LD relies almost solely on the urinary antigen test, which captures only the dominant species and serogroup, Legionella pneumophila serogroup 1 (Lp1). This has created a diagnostic "blind spot" for LD caused by non-Lp1 strains. This review focuses on historic, current, and emerging technologies that hold promise for increasing LD diagnostic efficiency and detection rates as part of a coherent testing regimen. The importance of cooperation between epidemiologists and laboratorians for a rapid outbreak response is also illustrated in field investigations conducted by the CDC with state and local authorities. Finally, challenges facing health care professionals, building managers, and the public health community in combating LD are highlighted, and potential solutions are discussed. |
Laboratory system strengthening and quality improvement in Ethiopia
Hiwotu TM , Ayana G , Mulugeta A , Kassa GB , Kebede Y , Fonjungo PF , Tibesso G , Desale A , Kassa W , Mekonnen T , Yao K , Luman ET , Kebede A , Linde MK . Afr J Lab Med 2014 3 (2) 228 BACKGROUND: In 2010, a National Laboratory Strategic Plan was set forth in Ethiopia to strengthen laboratory quality systems and set the stage for laboratory accreditation. As a result, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme was initiated in 45 Ethiopian laboratories. OBJECTIVES: This article discusses the implementation of the programme, the findings from the evaluation process and key challenges. METHODS: The 45 laboratories were divided into two consecutive cohorts and staff from each laboratory participated in SLMTA training and improvement projects. The average amount of supportive supervision conducted in the laboratories was 68 hours for cohort I and two hours for cohort II. Baseline and exit audits were conducted in 44 of the laboratories and percent compliance was determined using a checklist with scores divided into zero- to five-star rating levels. RESULTS: Improvements, ranging from < 1 to 51 percentage points, were noted in 42 laboratories, whilst decreases were recorded in two. The average scores at the baseline and exit audits were 40% and 58% for cohort I (p < 0.01); and 42% and 53% for cohort II (p < 0.01), respectively. The p-value for difference between cohorts was 0.07. At the exit audit, 61% of the first and 48% of the second cohort laboratories achieved an increase in star rating. Poor awareness, lack of harmonisation with other facility activities and the absence of a quality manual were challenges identified. CONCLUSION: Improvements resulting from SLMTA implementation are encouraging. Continuous advocacy at all levels of the health system is needed to ensure involvement of stakeholders and integration with other improvement initiatives and routine activities. |
The feasibility of rabies virus-vectored immunocontraception in a mouse model
Wu XF , Smith TG , Franka R , Wang M , Carson WC , Rupprecht CE . Trials Vaccinol 2014 3 11-18 Immunocontraceptive vaccines may be an alternative to surgical sterilization. Dual rabies vaccination and dog population management is a helpful tool for rabies prevention. A synthetic gonadotropin-releasing hormone (GnRH) peptide coupled to a carrier protein or T cell epitope is efficacious in inducing immunocontraception in a variety of mammals. However, virus-vectored GnRH recombinant vaccines have advantages over the conjugation method. In a previous in vitro study, we were able to insert a GnRH-coding sequence into the rabies virus (RABV) glycoprotein (G) gene, and the recombinant viruses grew to high titers in cells. Here, we further focused on the RABV G in accepting various copy numbers of GnRH. We demonstrated although RABV G protein with up to 4 copies of GnRH was well expressed, the recombinant virus was recovered only when 2 copies of GnRH (20 amino acids) were incorporated into the G, indicating a possible insertion limit in making a full infectious clone. The investigation provides insight into the utility of RABV G as a carrier for small peptides and its suitability for vaccine studies. Following our previous study, we selected ERAg3p/2 GnRH and tested the construct in mice. The vaccine induced >=80% infertility after three doses without any adjuvant, in live (8 of 10 mice infertility) or inactivated (13 of 14 mice infertility) formulations; while the pregnancy rate was 100% (10 of 10 mice) in the controls. This initial success of immunocontraception in mice is promising, and we are now optimizing the vaccine formulation by using adjuvants and exploring novel delivery methods to minimize the dosage. |
Innovative strategies for a successful SLMTA country programme: the Rwanda story
Nzabahimana I , Sebasirimu S , Gatabazi JB , Ruzindana E , Kayobotsi C , Linde MK , Mazarati JB , Ntagwabira E , Serumondo J , Dahourou GA , Gatei W , Muvunyi CM . Afr J Lab Med 2014 3 (2) 217 BACKGROUND: In 2009, to improve the performance of laboratories and strengthen healthcare systems, the World Health Organization Regional Office for Africa (WHO AFRO) and partners launched two initiatives: a laboratory quality improvement programme called Strengthening Laboratory Management Toward Accreditation (SLMTA), and what is now called the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA). OBJECTIVES: This study describes the achievements of Rwandan laboratories four years after the introduction of SLMTA in the country, using the SLIPTA scoring system to measure laboratory progress. METHODS: Three cohorts of five laboratories each were enrolled in the SLMTA programme in 2010, 2011 and 2013. The cohorts used SLMTA workshops, improvement projects, mentorship and quarterly performance-based financing incentives to accelerate laboratory quality improvement. Baseline, exit and follow-up audits were conducted over a two-year period from the time of enrolment. Audit scores were used to categorise laboratory quality on a scale of zero (< 55%) to five (95% - 100%) stars. RESULTS: At baseline, 14 of the 15 laboratories received zero stars with the remaining laboratory receiving a two-star rating. At exit, five laboratories received one star, six received two stars and four received three stars. At the follow-up audit conducted in the first two cohorts approximately one year after exit, one laboratory scored two stars, five laboratories earned three stars and four laboratories, including the National Reference Laboratory, achieved four stars. CONCLUSION: Rwandan laboratories enrolled in SLMTA showed improvement in quality management systems. Sustaining the gains and further expansion of the SLMTA programme to meet country targets will require continued programme strengthening. |
Detection of influenza virus infection using two PCR methods
Zimmerman RK , Rinaldo CR , Nowalk MP , Balasubramani GK , Thompson MG , Bullotta A , Susick M , Wisniewski S . Adv Virol 2014 2014 274679 Rapid, accurate, and cost-effective methods to identify the cause of respiratory tract infections are needed to maximize clinical benefit. Outpatients with acute respiratory illness were tested for influenza using a singleplex reverse transcriptase polymerase chain reaction (SRT-PCR) method. A multiplex RT-PCR (MRT-PCR) method tested for influenza and 17 other viruses and was compared with SRT-PCR using chi-square tests. Among 935 patients, 335 (36%) tested positive for influenza A and influenza B using SRT-PCR. Using MRT-PCR, 320 (34.2%) tested positive for influenza A and influenza B. This study supports MRT-PCR as a comparable method for detecting influenza among patients seeking outpatient care for acute respiratory illnesses. |
Hazardous drugs: the silent stalker of healthcare workers?
Lucas M , Connor TH . Synergist (Akron) 2015 26 (1) 22-26 NIOSH estimates that approximately 8 million healthcare workers may be exposed to hazardous drugs (HDs). Healthcare workers might not be aware that they may be harming their health when they handle HDs, which are known to cause serious side effects in patients and are capable of causing cancer, organ toxicity, fertility problems, genetic damage, and birth defects in healthcare workers. |
Effects of varying case definition on carpal tunnel syndrome prevalence estimates in a pooled cohort
Thiese MS , Gerr F , Hegmann KT , Harris-Adamson C , Dale AM , Evanoff B , Eisen EA , Kapellusch J , Garg A , Burt S , Bao S , Silverstein B , Merlino L , Rempel D . Arch Phys Med Rehabil 2014 95 (12) 2320-6 OBJECTIVE: To analyze differences in carpal tunnel syndrome (CTS) prevalence using a combination of electrodiagnostic studies (EDSs) and symptoms using EDS criteria varied across a range of cutpoints and compared with symptoms in both ≥1 and ≥2 median nerve-served digits. DESIGN: Pooled data from 5 prospective cohorts. SETTING: Hand-intensive industrial settings, including manufacturing, assembly, production, service, construction, and health care. PARTICIPANTS: Employed, working-age participants who are able to provide consent and undergo EDS testing (N=3130). INTERVENTIONS: None. MAIN OUTCOME MEASURES: CTS prevalence was estimated while varying the thresholds for median sensory latency, median motor latency, and transcarpal delta latency difference. EDS criteria examined included the following: median sensory latency of 3.3 to 4.1 milliseconds, median motor latency of 4.1 to 4.9 milliseconds, and median-ulnar sensory difference of 0.4 to 1.2 milliseconds. EDS criteria were combined with symptoms in ≥1 or ≥2 median nerve-served digits. EDS criteria from other published studies were applied to allow for comparison. RESULTS: CTS prevalence ranged from 6.3% to 11.7%. CTS prevalence estimates changed most per millisecond of sensory latency compared with motor latency or transcarpal delta. CTS prevalence decreased by 0.9% to 2.0% if the criteria required symptoms in 2 digits instead of 1. CONCLUSIONS: There are meaningful differences in CTS prevalence when different EDS criteria are applied. The digital sensory latency criteria result in the largest variance in prevalence. |
Debilitating lung disease among surface coal miners with no underground mining tenure
Halldin CN , Reed WR , Joy GJ , Colinet JF , Rider JP , Petsonk EL , Abraham JL , Wolfe AL , Storey E , Laney AS . J Occup Environ Med 2015 57 (1) 62-7 OBJECTIVE: To characterize exposure histories and respiratory disease among surface coal miners identified with progressive massive fibrosis from a 2010 to 2011 pneumoconiosis survey. METHODS: Job history, tenure, and radiograph interpretations were verified. Previous radiographs were reviewed when available. Telephone follow-up sought additional work and medical history information. RESULTS: Among eight miners who worked as drill operators or blasters for most of their tenure (median, 35.5 years), two reported poor dust control practices, working in visible dust clouds as recently as 2012. Chest radiographs progressed to progressive massive fibrosis in as few as 11 years. One miner's lung biopsy demonstrated fibrosis and interstitial accumulation of macrophages containing abundant silica, aluminum silicate, and titanium dust particles. CONCLUSIONS: Overexposure to respirable silica resulted in progressive massive fibrosis among current surface coal miners with no underground mining tenure. Inadequate dust control during drilling/blasting is likely an important etiologic factor. |
The A581G Mutation in the Gene Encoding Plasmodium falciparum Dihydropteroate Synthetase Reduces the Effectiveness of Sulfadoxine-Pyrimethamine Preventive Therapy in Malawian Pregnant Women.
Gutman J , Kalilani L , Taylor S , Zhou Z , Wiegand RE , Thwai KL , Mwandama D , Khairallah C , Madanitsa M , Chaluluka E , Dzinjalamala F , Ali D , Mathanga DP , Skarbinski J , Shi YP , Meshnick S , Ter Kuile FO . J Infect Dis 2015 211 (12) 1997-2005 BACKGROUND: The Plasmodium falciparum dihydropteroate synthase (Pfdhps) A581 G: mutation in combination with the dhfr/dhps quintuple mutant (the "sextuple" mutant) has been associated with increased placental inflammation and decreased birthweight among women receiving intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP). METHODS: Between 2009-2011, HIV-uninfected delivering women were enrolled in an observational study of IPTp-SP effectiveness in Malawi. Parasites were detected by polymerase chain reaction (PCR); positive samples were sequenced to genotype at dhfr and dhps loci. Presence of Pfdhps-K540 E: was used as a marker for the quintuple mutant. RESULTS: Samples from 1809 women were analysed by PCR; 220 (12%) were positive for P.falciparum. A total of 202 specimens were genotyped at codon Pfdhps-581; 17 (8.4%) harbored the sextuple mutant. The sextuple mutant was associated with higher risks of patent infection in peripheral (adjusted prevalence ratio [aPR] 2.76; 95% confidence interval 1.82-4.18) and placental blood (aPR 3.28 [1.88-5.78]), and higher parasite densities. Recent SP was not associated with increased parasite densities or placental pathology, overall and among women with dhps-A581 G: mutant parasites. CONCLUSIONS: IPTp-SP failed to inhibit parasite growth but did not exacerbate pathology among women infected with sextuple mutant parasites. New interventions to prevent malaria in pregnancy are needed urgently. |
Training public health advisors
Meyer PA , Brusuelas KM , Baden DJ , Duncan HL . J Public Health Manag Pract 2015 21 (6) E19-22 Federal public health advisors provide guidance and assistance to health departments to improve public health program work. The Centers for Disease Control and Prevention (CDC) prepares them with specialized training in administering public health programs. This article describes the evolving training and is based on internal CDC documents and interviews. The first federal public health advisors worked in health departments to assist with controlling syphilis after World War II. Over time, more CDC prevention programs hired them. To meet emerging needs, 3 major changes occurred: the Public Health Prevention Service, a fellowship program, in 1999; the Public Health Associate Program in 2007; and integration of those programs. Key components of the updated training are competency-based training, field experience, supervision, recruitment and retention, and stakeholder support. The enduring strength of the training has been the experience in a public health agency developing practical skills for program implementation and management. |
Smoke-free multiunit housing: a review of the scientific literature
Snyder K , Vick JH , King BA . Tob Control 2015 25 (1) 9-20 OBJECTIVE: Multiunit housing (MUH) residents are susceptible to secondhand smoke (SHS) exposure, which can transfer between living units. This review summarises existing scientific literature relevant to smoke-free MUH, discusses knowledge gaps and provides recommendations for future research to inform public health action. DATA SOURCES: We conducted a systematic search of peer-reviewed articles using three databases: EBSCOhost CINAHL, PubMed and Web of Science. STUDY SELECTION: Article titles, abstracts and text were reviewed to ascertain three inclusion criteria: (1) English language; (2) conducted in the USA; (3) reported on baseline data, development, implementation or evaluation of smoke-free MUH. DATA EXTRACTION: We used a multistep process to identify eligible articles: (1) two reviewers separately evaluated article titles; (2) two reviewers separately evaluated abstracts and (3) one reviewer read each article and determined inclusion eligibility. DATA SYNTHESIS: We identified and included 35 articles published during 2001-2014, grouped based on broad themes: MUH resident (n=16); MUH operator (n=6); environmental monitoring and biomarkers (n=9); economic (n=2); legal (n=3); and implementation process and policy impact (n=8). Studies with multiple themes were included in all relevant groups. CONCLUSIONS: Existing literature has focused on self-reported, cross-sectional studies of MUH residents and operators; some studies of environmental markers, biomarkers and economic indicators have also been conducted. Future research on smoke-free MUH policy compliance and enforcement, and on the impact of these policies on smoking behaviours and health outcomes, could further inform public health planning, policy and practice. Despite these gaps, the current literature provides sufficient evidence for action to eliminate SHS exposure in MUH. |
Changes in quitline caller characteristics during a national tobacco education campaign
Zhang L , Vickerman K , Malarcher A , Carpenter K . Nicotine Tob Res 2015 17 (9) 1161-6 INTRODUCTION: The Centers for Disease Control and Prevention launched the first federally-funded national tobacco education campaign, "Tips From Former Smokers" (Tips), in 2012. This study examined changes in quitline caller characteristics, including demographics and smoking-related behaviors before and during the Tips campaign. METHODS: Using quitline data from 20U.S. states and the District of Columbia, we examined characteristics of 76,933 callers during the Tips campaign (March 19, 2012 to June 10, 2012) compared to 44,710 callers from a similar time period in 2011 (March 21, 2011 to June 12, 2011). We also examined whether characteristics differed by self-reported awareness of Tips during the campaign in 13 quitlines that added a Tips awareness question. Group differences were assessed using chi-square and t tests, adjusted for clustering by state. RESULTS: Overall, few meaningful differences in caller characteristic existed, indicating broad reach of the Tips campaign across demographic groups. Compared with 2011, the number of callers during Tips increased by 72% and callers were twice as likely to hear about the quitline through television media. The proportion of uninsured callers was slightly higher during the Tips campaign than in 2011. Persons aware of the campaign were slightly more likely to be non-Hispanic Blacks, younger than age 55 years, and uninsured than those unaware of the campaign. CONCLUSIONS: The Tips campaign increased the reach of quitline services to the general population of smokers, with increases across all demographic and tobacco use groups, but particularly among those who were uninsured. Such campaigns have the potential to increase access to cessation services for the uninsured. |
Content Index (Achived Edition)
- Chronic Diseases and Conditions
- Communicable Diseases
- Epidemiology and Surveillance
- Immunity and Immunization
- Injury and Violence
- Laboratory Sciences
- Occupational Safety and Health
- Occupational Safety and Health - Mining
- Parasitic Diseases
- Public Health Leadership and Management
- Substance Use and Abuse
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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
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